Amelioration of melittin on adjuvant-induced rheumatoid arthritis: Integrated transcriptome and metabolome.

BACKGROUND: Rheumatoid arthritis (RA) is a chronic autoimmune disease lacking a definitive cure. Although conventional treatments such as dexamethasone and methotrexate are prevalent, their usage is constrained by potential adverse effects. Melittin (MLT) has emerged as a promising natural anti-rheumatic drug; however, studies focusing on the role of MLT in modulating the expression and metabolism of RA-related genes are scarce. METHOD: Arthritis was induced in rats using Complete Freund's Adjuvant (CFA), followed by MLT injections for treatment. Post-treatment, the inflammatory status of each group was assessed, and the mechanistic underpinnings of MLT's ameliorative effects on RA were elucidated through transcriptomic and metabolomic analyses. Additionally, this study conducted qRT-PCR validation of key therapeutic genes and characterized the molecular docking interactions of MLT with key receptor proteins (TNF-α and IL-1ß) using the AutoDock Vina software. RESULT: MLT significantly diminished redness and swelling in affected joints, ameliorated inflammatory cell infiltration, and mitigated joint damage. Integration of transcriptomic and metabolomic data revealed that MLT predominantly regulated the transcription levels of pathways and genes related to cytokines and immune responses, and the metabolic biomarkers of Sphingomyelin, fatty acid, and flavonoid. qRT-PCR confirmed MLT's downregulation of inflammation-related genes such as Il6, Jak2, Stat3, and Ptx3. Molecular docking simulations demonstrated the stable binding of MLT to TNF-α and IL-1ß. CONCLUSION: MLT demonstrated significant efficacy in alleviating RA. This study provides a comprehensive summary of MLT's impact on gene expression and metabolic processes associated with RA.

Melittin promotes dexamethasone in the treatment of adjuvant rheumatoid arthritis in rats.

Background: Rheumatoid arthritis (RA) is an erosive-destructive inflammation of the joints, and the chronic, long-term stiffness and deformation induced by RA are some of the symptoms of arthritis that are difficult to treat. Dexamethasone (DEX) and melittin (MLT) are two interesting anti-inflammatory substances, both of which possess anti-inflammatory effects exerted through the suppression of the immune system. The purpose of this study was to explore the role of MLT in the treatment of RA by DEX as well as to clarify the influence of MLT on the efficacy and side effects of DEX. Method: The rats were injected with Complete Freund's Adjuvant (CFA) to induce arthritis, followed by treatment with different doses of DEX and/or MLT. The relevant indexes of paw inflammation were determined, and the appetite, growth status, arthritis status, cytokine levels, and organ coefficient of the rats were evaluated. In addition, the paraffin sections of the joint tissues were prepared to analyze the pathological changes. Result: DEX exhibited side effects, notably hindering feed intake and growth, and inducing immune organ lesions in the rats. MLT significantly reduced the side effects of DEX and promoted its efficacy. DEX in combination with MLT demonstrated a synergistic efficacy in RA treatment, showing advantages in detumescence reduction, pro-inflammatory cytokine inhibition, and joint internal pathological improvement. Conclusion: Thus, MLT promoted the efficacy of DEX in adjuvant RA treatment in rats, offering an approach to reduce the use dosage and side effects of DEX.

Exosomes From IgE-Stimulated Mast Cells Aggravate Asthma-Mediated Atherosclerosis Through circRNA CDR1as-Mediated Endothelial Cell Dysfunction in Mice.

BACKGROUND: IgE has been known for mediating endothelial cell dysfunction and mast cell (MC) activation to fuel asthma-aggravated high-fat diet-induced atherosclerosis. However, it remains unclear for the mechanism of asthma-mediated atherosclerosis, especially the potential involvement of IgE in the exacerbation of asthma-mediated atherosclerosis with a standard laboratory diet, and the cross talk between endothelial cells and MCs. METHODS: Asthma-mediated atherosclerosis mice models under a standard laboratory diet and FcεR1 knock-out mice were used to determine the role of IgE-FcεR1 signaling in asthma-mediated atherosclerosis, which was assessed by Oil Red O staining and immunohistochemistry. Various in vitro assays including nanoparticle tracking analysis and transmission electron microscopy were used to evaluate exosome characteristics. Immunofluorescence and fluorescent in situ hybridization approaches were used to evaluate the effect and mechanism of MC-secreted exosomes encapsulated circular RNA CDR1as (cerebellar degeneration-related 1 antisense) on endothelial cells in vivo and in vitro. Finally, cohort studies examined the plasma CDR1as levels in patients with atherosclerosis with or without allergies. RESULTS: Asthma mice with a standard laboratory diet showed increased atherosclerotic lesions and inflammatory infiltration depending on IgE-FcεR1 signal. FcεR1 knockout mice and blockage of IgE-FcεR1 signaling with IgE monoclonal antibody, omalizumab, all significantly alleviated asthma-mediated atherosclerosis and vascular inflammatory remodeling. Anti-inflammation with dexamethasone and stabilization of MC with cromolyn partially alleviated atherosclerotic lesions and mitigated the inflammatory infiltration in arteries. Mechanistically, IgE stimulation upregulates MC CDR1as expression in exosomes and upregulates the endothelial cell adhesive factors VCAM-1 (vascular cell adhesion molecule-1) and ICAM-1 (intercellular adhesion molecule-1) via the CDR1as-FUS (fused in sarcoma)-phos-p65 axis. Knockdown of CDR1as in vivo significantly decreased the endothelial adhesion function and mitigated asthma-mediated atherosclerosis. Furthermore, a cohort study indicated higher plasma CDR1as levels in patients with atherosclerosis with allergies than in patients with atherosclerosis and healthy controls. CONCLUSIONS: Exosomes from IgE-stimulated MCs aggravated atherosclerosis through circular RNA CDR1as-mediated endothelial dysfunction, providing a novel insight into asthma-mediated atherosclerosis and potential diagnostic and therapeutic targets.

Rapid diagnosis of cervical cancer based on serum FTIR spectroscopy and support vector machines.

Cervical cancer is one of the most common malignant tumors among female gynecological diseases. This paper aims to explore the feasibility of utilizing serum Fourier Transform Infrared (FTIR) spectroscopy, combined with machine learning and deep learning algorithms, to efficiently differentiate between healthy individuals, hysteromyoma patients, and cervical cancer patients. In this study, serum samples from 30 groups of hysteromyoma, 36 groups of cervical cancer, and 30 healthy groups were collected and FTIR spectra of each group were recorded. In addition, the raw datasets were averaged according to the number of scans to obtain an average dataset, and the raw datasets were spectrally enhanced to obtain an augmentation dataset, resulting in a total of three sets of data with sizes of 258, 96, and 1806, respectively. Then, the hyperparameters in the four kernel functions of the Support Vector Machine (SVM) model were optimized by grid search and leave-one-out (LOO) cross-validation. The resulting SVM models achieved recognition accuracies ranging from 85.0% to 100.0% on the test set. Furthermore, a one-dimensional convolutional neural network (1D-CNN) demonstrated a recognition accuracy of 75.0% to 90.0% on the test set. It can be concluded that the use of serum FTIR spectroscopy combined with the SVM algorithm for the diagnosis of cervical cancer has important medical significance.

Tailoring planar slip to achieve pure metal-like ductility in body-centred-cubic multi-principal element alloys.

Uniform tensile ductility (UTD) is crucial for the forming/machining capabilities of structural materials. Normally, planar-slip induced narrow deformation bands localize the plastic strains and hence hamper UTD, particularly in body-centred-cubic (bcc) multi-principal element high-entropy alloys (HEAs), which generally exhibit early necking (UTD < 5%). Here we demonstrate a strategy to tailor the planar-slip bands in a Ti-Zr-V-Nb-Al bcc HEA, achieving a 25% UTD together with nearly 50% elongation-to-failure (approaching a ductile elemental metal), while offering gigapascal yield strength. The HEA composition is designed not only to enhance the B2-like local chemical order (LCO), seeding sites to disperse planar slip, but also to generate excess lattice distortion upon deformation-induced LCO destruction, which promotes elastic strains and dislocation debris to cause dynamic hardening. This encourages second-generation planar-slip bands to branch out from first-generation bands, effectively spreading the plastic flow to permeate the sample volume. Moreover, the profuse bands frequently intersect to sustain adequate work-hardening rate (WHR) to large strains. Our strategy showcases the tuning of plastic flow dynamics that turns an otherwise-undesirable deformation mode to our advantage, enabling an unusual synergy of yield strength and UTD for bcc HEAs.

A Transfer Learning Approach to Correct the Temporal Performance Drift of Clinical Prediction Models: Retrospective Cohort Study.

BACKGROUND: Clinical prediction models suffer from performance drift as the patient population shifts over time. There is a great need for model updating approaches or modeling frameworks that can effectively use the old and new data. OBJECTIVE: Based on the paradigm of transfer learning, we aimed to develop a novel modeling framework that transfers old knowledge to the new environment for prediction tasks, and contributes to performance drift correction. METHODS: The proposed predictive modeling framework maintains a logistic regression-based stacking ensemble of 2 gradient boosting machine (GBM) models representing old and new knowledge learned from old and new data, respectively (referred to as transfer learning gradient boosting machine [TransferGBM]). The ensemble learning procedure can dynamically balance the old and new knowledge. Using 2010-2017 electronic health record data on a retrospective cohort of 141,696 patients, we validated TransferGBM for hospital-acquired acute kidney injury prediction. RESULTS: The baseline models (ie, transported models) that were trained on 2010 and 2011 data showed significant performance drift in the temporal validation with 2012-2017 data. Refitting these models using updated samples resulted in performance gains in nearly all cases. The proposed TransferGBM model succeeded in achieving uniformly better performance than the refitted models. CONCLUSIONS: Under the scenario of population shift, incorporating new knowledge while preserving old knowledge is essential for maintaining stable performance. Transfer learning combined with stacking ensemble learning can help achieve a balance of old and new knowledge in a flexible and adaptive way, even in the case of insufficient new data.

YB1 dephosphorylation attenuates atherosclerosis by promoting CCL2 mRNA decay.

Chronic inflammation is a key pathological process in atherosclerosis. RNA binding proteins (RBPs) have been reported to play an important role in atherosclerotic plaque formation, and they could regulate the expression of inflammatory factors by phosphorylation modification. Y-box binding protein 1 (YB1) is an RBP that has participated in many inflammatory diseases. Here, we found an increased expression of phosphorylated YB1 (pYB1) in atherosclerotic plaques and demonstrated that YB1 dephosphorylation reduced lipid accumulation and lesion area in the aorta in vivo. Additionally, we found that inflammatory cytokines were downregulated in the presence of YB1 dephosphorylation, particularly CCL2, which participates in the pathogenesis of atherosclerosis. Furthermore, we demonstrated that CCL2 mRNA rapid degradation was mediated by the glucocorticoid receptor-mediated mRNA decay (GMD) process during YB1 dephosphorylation, which resulted in the downregulation of CCL2 expression. In conclusion, YB1 phosphorylation affects the development of atherosclerosis through modulating inflammation, and targeting YB1 phosphorylation could be a potential strategy for the treatment of atherosclerosis by anti-inflammation.

Outcomes of thoracic endovascular aortic repair with chimney technique for aortic arch diseases.

Objective: This study aimed to summarize the long-term experience of using the chimney technique in thoracic endovascular aortic repair (TEVAR) for aortic arch diseases. Methods: From November 2007 to June 2021, a total of 345 consecutive patients (mean age 56 ± 11.3 years, range 28-83, 302 men) with aortic arch pathologies underwent TEVAR combined with chimney technique (cTEVAR). Their medical data and follow-up results were retrospectively reviewed and analyzed. Results: Among the 345 patients, 278 (80.6%) received single chimneys, 53 (15.4%) received double chimneys, 7 (2%) received triple chimneys, and 7 (2%) underwent cTEVAR accompanied by other techniques (two with extra-anatomical bypass, two with in situ fenestration, and three with physician modified fenestration). A total of 412 chimney stents were used, including 27 in the innominate artery (IA), 113 in the left common carotid artery, 270 in the left subclavian artery, and two in the aberrant right subclavian artery. Early type IA endoleaks were found in 38 (11%) patients, including 12 with the double or triple chimney technique. Early type II endoleak was found in nine (2.6%) patients. Early re-intervention occurred in two patients with double chimney technique, one for chimney stent migration and the other for compression of chimney stent. The 30-day mortality was 1.2% (4 in 345). During a mean follow-up of 42 ± 22 months (range 1-108 months), major stroke occurred in nine (2.6%) patients, chimney occlusion or stenosis occurred in six (1.7%), and retrograde type A aortic dissection occurred in four (1.2%). Fourteen (4.1%) patients received the secondary intervention. The all-cause mortality was 6.7% (23 in 345). Additionally, the total adverse event rate after cTEVAR was 13.9% (48 in 345). Conclusion: TEVAR with chimney technique provides a minimally invasive alternative with good chimney graft patency and low postoperative mortality during follow-up. However, the double and triple chimney techniques should be used cautiously as they seem to have a higher risk for type IA endoleak and adverse events after the operation.

A hybrid adaptive approach for instance transfer learning with dynamic and imbalanced data.

Machine learning has demonstrated success in clinical risk prediction modeling with complex electronic health record data. However, the evolving nature of clinical practices can dynamically change the underlying data distribution over time, leading to model performance drift. Adopting an outdated model is potentially risky and may result in unintentional losses. In this paper, we propose a novel Hybrid Adaptive Boosting approach (HA-Boost) for transfer learning. HA-Boost is characterized by the domain similarity-based and class imbalance-based adaptation mechanisms, which simultaneously address two critical limitations of the classical TrAdaBoost algorithm. We validated HA-Boost in predicting hospital-acquired acute kidney injury using real-world longitudinal electronic health records data. The experiment results demonstrate that HA-Boost stably outperforms the competing baselines in terms of both AUROC and AUPRC across a 7-year time span. This study has confirmed the effectiveness of transfer learning as a superior model updating approach in dynamic environment.

Quantitative analysis of renal blood flow during thoracic endovascular aortic repair in type B aortic dissection using syngo iFlow.

BACKGROUND: Currently, the thoracic endovascular aortic repair is the recommended clinical treatment for type B aortic dissections. Unfortunately, malperfusion or ischemia of the kidneys is a major complication of type B aortic dissections. Despite this, few studies have focused on the effects of thoracic endovascular aortic repair on blood flow in renal arteries and parenchyma. This current investigation used novel real-time imaging software to quantitatively analyze the hemodynamic changes in renal artery blood flow and perfusion before and after stent graft placement. METHODS: A total of 51 patients with type B aortic dissection undergoing thoracic endovascular aortic repair between April 2017 and September 2019 were retrospectively recruited. The pre-and post-procedural digital subtraction angiography images were converted into color-coded maps using syngo iFlow for quantitative comparison. Time-intensity curves and related parameters, including the average peak ratio (avg.Pr), average delayed time to peak (avg.dTTP), and average area under the curve ratio (avg.AUCr) of the renal arteries and renal cortex were obtained and analyzed. Wilcoxon signed-rank test was used to compare iFlow parameters before and after endovascular repair. Spearman correlation analyses were performed to study iFlow parameters and renal function parameters and the estimated glomerular filtration rate (eGFR) and blood urea nitrogen (BUN). RESULTS: A total of 102 images including 51 pre-operative and 51 post-operative image datasets were successfully post-processed. Following endovascular repair, syngo iFlow showed a significant 33.0% increase in avg.Pr (P<0.001) and a significant 35.1% increase in avg.AUCr (P<0.001) in the renal artery. Additionally, there was a significant 12.2% decrease in the avg.dTTP (P=0.001), a significant 24.5% increase in avg.Pr (P=0.004), and a significant 38.3% increase in avg.AUCr (P=0.009) in the renal cortex. Spearman correlation analysis showed that after endovascular repair there was a significant correlation between the avg.Pr of the renal artery and eGFR (r=0.30; P=0.0349), the avg.Pr of the renal cortex and eGFR (r=0.30; P=0.0300), and the avg. AUCr of the renal cortex and BUN (r=0.31; P=0.0289). CONCLUSIONS: syngo iFlow provided a novel quantitative method for evaluating renal hemodynamic changes in patients with type B aortic dissection undergoing endovascular treatment. Time-intensity curve parameters may facilitate the intraprocedural evaluation of renal blood flow and perfusion to complement the color-coded map.

Novel deep learning-based transcriptome data analysis for drug-drug interaction prediction with an application in diabetes.

BACKGROUND: Drug-drug interaction (DDI) is a serious public health issue. The L1000 database of the LINCS project has collected millions of genome-wide expressions induced by 20,000 small molecular compounds on 72 cell lines. Whether this unified and comprehensive transcriptome data resource can be used to build a better DDI prediction model is still unclear. Therefore, we developed and validated a novel deep learning model for predicting DDI using 89,970 known DDIs extracted from the DrugBank database (version 5.1.4). RESULTS: The proposed model consists of a graph convolutional autoencoder network (GCAN) for embedding drug-induced transcriptome data from the L1000 database of the LINCS project; and a long short-term memory (LSTM) for DDI prediction. Comparative evaluation of various machine learning methods demonstrated the superior performance of our proposed model for DDI prediction. Many of our predicted DDIs were revealed in the latest DrugBank database (version 5.1.7). In the case study, we predicted drugs interacting with sulfonylureas to cause hypoglycemia and drugs interacting with metformin to cause lactic acidosis, and showed both to induce effects on the proteins involved in the metabolic mechanism in vivo. CONCLUSIONS: The proposed deep learning model can accelerate the discovery of new DDIs. It can support future clinical research for safer and more effective drug co-prescription.

Novel Fe-Based Amorphous Composite Coating with a Unique Interfacial Layer Improving Thermal Barrier Application.

To improve thermal barrier applications in advanced vehicle engines, a novel Fe-based amorphous composite coating was designed by introducing ceramic oxides and was prepared by atmospheric plasma spraying (APS). The microstructure and related properties of the as-deposited coating were investigated in detail. The composite coating comprises a well-formed FeCrNbBSi amorphous metallic matrix and dispersed yttria-stabilized zirconia (YSZ) splats. A unique Si-oxide interfacial layer with a thickness of several nanometers and an amorphous structure forms between the metallic matrix and ceramic phase, which is attributed to a combination of multiple effects. The composite coating displays extremely low thermal conductivity from 2.28 W/mK at 100 °C to 3.36 W/mK at 600 °C and can increase the surface temperature of the piston crown by 18.93 °C, which implies a significant means of enhancing the power efficiency. The improved thermal barrier ability of the composite coating is revealed as the crucial effect of the Si-oxide interfacial layer, which induces an increased interfacial thermal resistance. The fracture toughness of the composite coating remains at 3.40 MPa·m1/2, comparable to that of the monolithic amorphous coating, 3.74 MPa·m1/2, which is closely related to the formation of a Si-oxide layer and its nanoscale thickness. Therefore, the Fe-based amorphous composite coating developed here demonstrates great potential as an innovative metal-based thermal barrier coating for application in vehicle engines and provides specific inspiration for future works exploring the interfacial engineering of coating.

Deformation Mechanisms and Remarkable Strain Hardening in Single-Crystalline High-Entropy-Alloy Micropillars/Nanopillars.

There have been very limited studies on plastic deformation mechanisms in single-crystalline high-entropy alloys (HEAs) with body-centered cubic (BCC) phases. We performed in situ uniaxial compression on single-crystalline BCC AlCrFeCoNi micropillars/nanopillars with three orientations (including [100], [110], and [111]) and diameters of 270-1583 nm, inside a scanning electron microscope. The experimental results showed the significant size effects on yield/flow stress and the remarkable strain hardening in these HEA micropillars/nanopillars. Especially, HEA micropillars/nanopillars with ⟨100⟩ orientation exhibited higher strain hardening exponents than BCC pure metals and Al0.7CrCoFeNi counterparts. A combination of transmission electron microscopy observations and large-scale atomistic simulations revealed that dislocation slip, reaction, tangling and accumulation, and solid solution effects are responsible for the observed size effects on yield/flow stress and remarkable strain hardening, but these dislocation mechanisms are dependent on nanopillar orientation. Our present study sheds light on the underlying deformation mechanisms in BCC HEA single crystals.

Midterm Results of Retrograde In Situ Needle Fenestration During Thoracic Endovascular Aortic Repair of Aortic Arch Pathologies.

PURPOSE: To evaluate the safety and feasibility of the in situ needle fenestration (ISNF) technique for reconstruction of the left subclavian artery (LSA) during thoracic endovascular aortic repair (TEVAR) of complicated aortic arch pathologies. MATERIALS AND METHODS: A retrospective review was conducted from January 2014 to December 2019 of 50 patients (mean age 60.2±11.1; 45 men) who underwent ISNF to revascularize the LSA during TEVAR. Twenty-one of the patients also required revascularization of the left common carotid artery (LCCA; n=19) and innominate artery (IA; n=2) using physician-modified in vitro fenestration. Overall, 73 supra-aortic branches were targeted for revascularization. RESULTS: ISNF was successful in 48 patients (96%); one LSA could not be stented and a tortuous LSA prevented the needle from fenestrating the graft. No perioperative major adverse event occurred. There were no type I and 4 type III endoleaks (8%), 3 of which occurred among the first 20 cases. Types II and IV endoleaks were found in 3 (6%) and 6 (12%) cases, respectively; all disappeared during a median follow-up of 15 months (range 3-66). One death (2%) occurred within 12 months due to cerebral hemorrhage. Two patients (4%) required open reinterventions at 6 and 62 months. CONCLUSION: ISNF for revascularization of the LSA during TEVAR seems to be feasible with acceptable midterm outcomes. The learning curve and evolving patient selection criteria affected technical success, complications, and the need for reinterventions. Long-term durability requires further evaluation.

Electrolysis-assisted UV/sulfite oxidation for water treatment with automatic adjustments of solution pH and dissolved oxygen.

Sulfite as precursor to generate sulfate radical (SO4 •-) for water treatment has gained attention. Here we report a metal-free and highly efficient electro/UV/sulfite process to produce SO4 •- for water treatment. UV/sulfite reaction induces sulfite radical (SO3 •-), which transforms into SO4 •- in the presence of oxygen generated by water electrolysis. Electro/UV/sulfite process generates a steady-state SO4 •- concentration of 0.2 to 1.1 × 10-12 M in our tests. Solution pH affects sulfite species distribution, and higher pH mediates improved yield of steady-state SO4 •- concentration. Effect of sulfite concentration exhibits a bell-shaped pattern toward SO4 •- production due to self-scavenging. The oxidation capability of electro/UV/sulfite process is manifested by removing representative micropollutants (i.e., ibuprofen, salicylic acid, and bisphenol A) and Escherichia coli model pathogen, in both synthetic and natural water matrices. This novel electro/UV/sulfite process has obvious advantages, since it bypasses metal ion catalysts, supplies reaction with electrolytically generated nascent oxygen, and overcomes the acidic pH requirement, that are challenging to traditional metal/sulfite processes. Considering the features of environmental friendliness and low cost, the proposed electro/UV/sulfite process should lead to successful applications in the future.

Endovascular treatment for aortic arch pathologies: chimney, on-the-table fenestration, and in-situ fenestration techniques.

BACKGROUND: Revascularization of the supra-aortic major branches in thoracic endovascular aortic repair (TEVAR) is challenging owing to the complex anatomic configuration of aortic arch pathologies. This study aims to evaluate the feasibility, effectiveness, and safety of three major techniques-chimney, fenestrated, and in-situ fenestration-for patients with aortic arch pathologies. METHODS: A retrospective analysis was performed involving 234 patients with aortic arch lesions, who underwent TEVAR with adaptations in technique (chimney, fenestrated, or in-situ fenestration) between January 2016 and December 2017. RESULTS: One hundred and twenty-six patients underwent the chimney technique (98 single chimneys, 24 double chimneys, and four triple chimneys); one hundred and two patients (102/234) were treated with on-the-table fenestration technique (92 single fenestrations, nine double fenestrations, and one double fenestration plus innominate artery chimney); and the remaining six patients underwent in-situ needle fenestration technique. Overall, indications included aortic dissections (99/234), aortic arch aneurysms (60/234), penetrating aortic ulcers (72/234), and re-interventions (3/234). The technical success rates were 99.6%. There were five cases of early all-cause mortality. The patency rates of overall branches were 99.6%. There were 15 cases with type Ia endoleak-14 in the chimney group (11.1%) and one in the on-the-table fenestration group (1%). Five patients underwent re-interventions. The median follow-up time for all patients was 28 (range, 16-41) months. CONCLUSIONS: Our experience suggests that chimney, on-the-table fenestration, and in-situ needle fenestration techniques are feasible, effective, and safe treatment options for aortic arch pathologies with encouraging mid-term results. Long-term durability concerns require further evaluation.

First-in-Human Implantation of Gutter-Free Design Chimney Stent Graft for Aortic Arch Pathology.

PURPOSE: This report describes first-in-human experiences and early results of gutter-free chimney stent graft implantation for aortic arch pathologies. DESCRIPTION: The gutter-free chimney stent graft consists of an inner stent and an outer skirt fabric to form an integrated structure. The inner and outer layers are nickel-titanium self-expanding skeletal structures with double polytetrafluoroethylene coating. The outer skirt fabric fits the gutter to prevent endoleak, and the proximal inner stent has a larger radial force to ensure the blood flow. All these designs have the advantages to overcome the native defects of current chimney techniques. EVALUATION: We reported 2 patients who were diagnosed as having aortic arch pathologies and received the gutter-free chimney stent graft implantation during thoracic endovascular aortic repair. In all patients, aortic arch lesions were covered, and supraaortic branches were patent without complications after thoracic endovascular aortic repair and during the 17 months of follow-up. CONCLUSIONS: Novel gutter-free chimney stent graft may be safely and effectively utilized for endovascular repair in aortic arch pathologies. Long-term durability should be confirmed by larger studies and ongoing research.

Efficient removal of trichloroethene in oxidative environment by anchoring nano FeS on reduced graphene oxide supported nZVI catalyst: The role of FeS on oxidant decomposition and iron leakage.

The performance of trichloroethene (TCE) removal was initially investigated in sodium persulfate (SPS) or potassium monopersulfate triple salt (PMS) oxidative environment by reduced graphene oxide (rGO) supported nZVI (nZVI-rGO) catalyst and further the role of sulphur by anchoring nano FeS on nZVI-rGO (FeS@nZVI-rGO) was evaluated. The high usage of oxidants and stability of FeS@nZVI-rGO catalyst were significantly improved due to the insoluble nature of this innovative catalyst by involvement of nano FeS which limited the rapid iron loss caused by the corrosion of active sites and mitigated rapid oxidants decomposition in FeS@nZVI-rGO/SPS and FeS@nZVI-rGO/PMS systems. The tests for target contaminant removal showed that over 95 % TCE could be removed at 100 mg L-1 FeS@nZVI-rGO and 1.2 mM SPS or 0.3 mM PMS dosages, in which over 85 % TCE could be dechlorinated. The reactive oxygen radicals (ROSs) generation mechanisms and their contribution to TCE removal were investigated through radical scavenge tests in both systems, indicating that both HO and SO4- were the major ROSs rather than O2-. In conclusion, this study revealed the well function and fundamental mechanism of this innovative catalyst by anchoring nano FeS and worth of further demonstration of this technique in TCE contaminated groundwater remediation application.

Cumulative sum analysis of the learning curve for the preclosure technique using Proglide.

OBJECTIVES: Our study aims to assess the technical quality and the learning curve of the preclosure technique for a vascular surgeon using Proglide using cumulative sum analysis (CUSUM analysis). METHODS: This study was designed retrospectively and enrolled 81 consecutive patients with 88 access sites who underwent endovascular aortic repair or thoracic endovascular aortic repair with the preclosure technique using Proglide between July 2017 and February 2018. The patients were divided into 2 groups chronologically: (A) the first 40 cases and (B) the latter 41 cases. Logistic regression analysis was used to assess the impact of technical risk factors on the success of the preclosure technique, and the χ2 test and 1-way ANOVA were applied to analyse the distribution of individual characteristics and risk factors between the 2 groups. CUSUM analysis was adapted to analyse the learning curve and to monitor the technical quality, with a predetermined target failure rate of 5%, an alternative failure rate of 20% and calculated 80% 'alert', 95% 'alarm' and 80% 'reassurance' lines. RESULTS: Primary technical success was obtained in 81 (92.05%) access sites. There were no significant correlations between primary technical success and risk factors, including, common femoral artery diameter (P = 0.88), common femoral artery depth from the skin (P =0.94), the level of common femoral artery calcification (P =0.86) and size of sheath (P =0.96). Moreover, the distribution of related risk factors was not significantly different between groups A and B. CUSUM analysis showed that the cumulative failure rate never crossed the 80% 'alert' and 95% 'alarm' lines. Additionally, the failure rate began to approach the 80% 'reassurance' line after ∼22 cases and crossed the 80% 'reassurance' line after 36 cases. CONCLUSIONS: The technique of totally percutaneous access using Proglide is safe and effective for an experienced vascular surgeon, even if the operator has no previous experience with any preclosure techniques. CUSUM analysis showed that 36 cases are necessary to achieve the target failure rate of 5%.

Mechanism of carbon tetrachloride reduction in ferrous ion activated calcium peroxide system in the presence of methanol.

This study investigated the reductive initiation for the depletion of highly oxidized/perhalogenated pollutants, specifically the degradation of carbon tetrachloride (CT) was induced by adding methanol (MeOH) into a ferrous ion (Fe(II)) activated calcium peroxide (CaO2) system. The results indicated that CT could be completely degraded within 20 min at CaO2/Fe(II)/MeOH/CT molar ratio of 30/40/10/1 in this system. Scavenging tests suggested that both superoxide radical anion (O2 •-) and carbon dioxide radical anion (CO2 •-) were predominant reactive species responsible for CT destruction. Hydroxymethyl radicals (•CH2OH), an intermediate in the transformation of MeOH, could also initiate CT degradation by reducing C-Cl bond. GC/MS analysis identified CHCl3, C2Cl4, and C2Cl6 as the intermediates accompanied by CT destruction, and a reduction mechanism for CT degradation was proposed accordingly. In addition, the impact of solution matrix and initial solution pH were evaluated, and the results showed that Cl-, NO3 -, and HCO3 - had adverse effects on CT degradation. Moreover, the alkaline condition was unfavorable to CT depletion. In conclusion, the results obtained in the actual groundwater tests encouragingly demonstrated that the CaO2/Fe(II)/MeOH process is a highly promising technique for the remediation of CT-contaminated groundwater.