First Dark Matter Search Results from the LUX-ZEPLIN (LZ) Experiment.

The LUX-ZEPLIN experiment is a dark matter detector centered on a dual-phase xenon time projection chamber operating at the Sanford Underground Research Facility in Lead, South Dakota, USA. This Letter reports results from LUX-ZEPLIN's first search for weakly interacting massive particles (WIMPs) with an exposure of 60 live days using a fiducial mass of 5.5 t. A profile-likelihood ratio analysis shows the data to be consistent with a background-only hypothesis, setting new limits on spin-independent WIMP-nucleon, spin-dependent WIMP-neutron, and spin-dependent WIMP-proton cross sections for WIMP masses above 9 GeV/c^{2}. The most stringent limit is set for spin-independent scattering at 36 GeV/c^{2}, rejecting cross sections above 9.2×10^{-48} cm at the 90% confidence level.

Consensus Document on Intermittent Claudication from the Central European Vascular Forum (C.E.V.F.)-3rd revision (2013) with the sharing of the Mediterranean League of Angiology and Vascular Surgery, and the North Africa and Middle East Chapter of International Union of Angiology.

This paper is the review of the Consensus Document on Intermittent Claudication of the Central European Vascular Forum (CEVF), published in 2008, and and shared with the North Africa and Middle East Chapter of International Union of Angiology and the Mediterranean League of Angiology and Vascular Surgery. The Document presents suggestions for general practitioners and vascular specialists for more precise and appropriate management of PAD, particularly of intermittent claudication, and underlines the investigations that should be required by GPs and what the GP should expect from the vascular specialist (angiologist, vascular surgeon). The idea of the Faculty is to produce a short document, which is an easy reference in daily clinical practice, both for the GPs and vascular specialists.

Prevalence of multifocal atherosclerosis and comorbidity on symptomatic Cypriot inpatients.

AIM: Multifocal atherosclerotic disease or multifocal ischemic pathology (MAD) is an issue gaining a lot of attention by clinicians in recent years, due to its high impact on the morbidity and mortality of vascular patients. The coexistence of coronary artery disease (CAD), peripheral arterial disease (PAD) and carotid disease (CS) is being investigated in this study. METHODS: The study included 556 consecutive inpatients who were admitted to the Nicosia General Hospital in Cyprus for carotid endarterectomy, peripheral arterial reconstruction or coronary artery bypass. All patients were subjected to color duplex examination of the carotid vessels and to lower extremity Doppler study. Cardiac risk screening was performed on patients with PAD and CS. Comorbidity was evaluated by using the Cumulative Illness Rating Scale (CIRS). RESULTS: The prevalence of MAD in atherosclerotic patients was found very high (60.3%). The most frequent comorbidity was the coexistence of PAD and CAD (41.8%). The comorbidity burden of MAD patients, in comparison to that of patients with unifocal atherosclerotic disease, was evaluated to conclude that the burden in the first group (MAD) is significantly higher, not only in relation to the number of clinically relevant diseases that co-exist, but also to the severity of these diseases. Furthermore, functional status is negatively affected by the existence of multifocal ischemic pathology. CONCLUSION: The high prevalence of MAD suggests the necessity of developing a systematic screening approach in the everyday practice. Apart from cardiovascular problems, other diseases affect the clinical situation of these patients. Therefore, it is important to investigate these problems pre- and postoperatively.

Can aortocoronary and peripheral venous bypass graft patency be improved by the administration of pentoxifylline on a long-term basis?

BACKGROUND: Venous bypass grafts to coronary and peripheral arteries have a high rate of occlusion at follow-up. Pentoxifylline, known to reduce blood viscosity, has the potential theoretically to reduce venous graft occlusion. We tested this hypothesis in this study. METHODS: The effect of pentoxifylline (Trental) on the early and late failure of venous bypass grafts was studied on 107 patients who underwent a total of 159 aortocoronary and 55 peripheral venous bypass grafts. Pentoxifylline was initially administered in the prime of the heart-lung machine in coronary patients and intra-arterially in peripheral vascular patients. All patients were treated postoperatively with oral administration of pentoxifylline at a dose of 400 mg daily, during the 2-year follow-up period. The short- and long-term graft patency in this unit was compared to that of an identical placebo unit, composed of 105 patients (141 aortocoronary and 55 peripheral venous bypass grafts). The patients of the placebo unit had the same operative treatment but were not treated with pentoxifylline. These patients were pre- and postoperatively examined by the same methods as the patients of the pentoxifylline unit. RESULTS: The 2-year follow-up demonstrated that in cardiac patients aortocoronary graft patency was 92.5% in the pentoxifylline unit, and 80.6% in the placebo unit. Similar results were observed in peripheral vascular patients, as well as in a small group of patients with multifocal arterial disease. CONCLUSIONS: These results indicate that pentoxifylline affects favorably the patency of both aortocoronary and peripheral bypass grafts.

Effect of pentoxifylline on treatment of lower limb ulcers in patients with thalassemia major.

The possible healing effect of deferoxamine and pentoxifylline on persisting lower limb ulcers was studied in 51 patients with thalassemia major. The results indicated that the regular use of deferoxamine at an intravenous dose of 20 mg/kg did not affect the healing progress and the recurrence rate of these ulcers significantly. On the contrary, the oral administration of pentoxifylline at a dose of 1,200 mg daily during the ulcer's healing time and at a low long-term maintenance dose of 400 mg daily during the ulcer-free intervals improved their healing ability impressively and diminished their recurrence rate significantly.

Comparison of skin and muscle biopsies before and after pentoxifylline treatment in patients with leg ulcers due to deep venous incompetence.

The aim of this study was to understand the possible mechanisms by which deep venous insufficiency and venous hypertension are associated with trophic skin changes and ulceration and to explain the therapeutic effect of Pentoxifylline in patients with leg ulcers due to deep venous incompetence. Twenty patients were included in this pilot study. They were graded into two groups: group 1, included 10 patients (5 F and 5 M) with deep venous incompetence and normal arteries; group 2, included 10 patients (1 F and 9 M) with deep venous incompetence and moderate arterial disease. Skin and muscle biopsies were carried out before and after the oral administration of 1,200 mg of Pentoxifylline daily (400 mg t.d.s). The following parameters were investigated by means of light microscopy and immunofluorescence tests: engorgement of venous stroma; decrease of intimal elastica; hyaline degeneration; floccular degeneration; pericapillary fibrin deposits and fibrin degradation products; inflammation and fat necrosis; myofibril degeneration; fibrous scar; regeneration and reconstitution of muscle fibres. The results indicated that local inflammation at the ulcer's area cause accumulation of white blood cells in the capillaries and the interstitial fluid, where there is also accumulation of fibrinogen. These changes may lead to chronic tissue ischaemia and ulceration. The known favourable effect of Pentoxifylline on red cells and leucocyte function as well as its lowering effect on plasma fibrinogen level, may be responsible for the observed therapeutic effect of Pentoxifylline on venous leg ulcers.

Effect of oral pentoxifylline therapy on venous lower extremity ulcers due to deep venous incompetence.

The effect of oral pentoxifylline, administered 1,200 mg/day (400 mg slow-release tablets tid) through six weeks, was studied in 10 patients with established deep venous incompetence and persisting venous ulcers. The following parameters were used for verification of the therapeutic result: venous patency (VP) and valvular competence (VC) assessed by means of Doppler ultrasound; venous refilling time (VRT) assessed by photoplethysmography; skin blood flow (SBF) at rest and after tiptoeing exercise, as well as skin perfusion pressure (SPP), both assessed by means of 99mtechnetium clearance technique. Finally, photo documentation of the tissue lesion was obtained, using a two-dimensional (max and min diameter = Dmax, Dmin) metered scale photo. There was an overall good response to the treatment, the studied parameters showing the following changes: VP and VC remained unchanged; VRT improved in 8 patients, SBF increased in 10; SPP slightly improved in 5; and Dmax and Dmin in all 10 patients. Removal or substantial diminution of the ulcers was obtained in 8 patients. These findings indicate that oral administration of pentoxifylline over a period of six weeks supports the conservative treatment and improves considerably the condition of patients with persisting venous ulcers.

Continuous infusion treatment with pentoxifylline in patients with severe peripheral vascular occlusive disease.

The effect of continuous i.v. infusion of pentoxifylline, administering 1,200 mg/24 hours through 15 days, was studied in 22 patients (19 m, 3 f) with arteriographically confirmed extensive occlusion in the femoro-popliteal segment, associated with marked intermittent claudication and rest pain of varying severity. The following parameters were used for the verification of the therapeutic response: Flow resistance factor (RF), pressure indices at rest (RPI) and after exercise (PPI) and recovery time (RT) assessed by means of ultrasonic Doppler technique; muscle and skin blood flow at rest and after exercise using 99m Technetium Clearance Technique (TC); toe skin temperature (TST) by electric thermometer; painfree walking distance (WD) assessed on treadmill (horizontal, 4 km/h); rest pain (RP) was assessed by a 4-step-relief-scale. There was an overall good response to treatment, the studied parameters showing the following changes: RF improved in 12/17 patients (= 70%); RT decreased in 14/22 patients (= 63%) RPI and PPI showed no change; TC (muscle) increased after exercise in 17/22 patients (= 77%); TC (skin) increased after exercise in 20/22 patients (= 90%); WD increased on average by 80% (from 115 m to 206 m); TS increased in 16 limbs; RP showed an overall relief. The results of this study indicate that the continuous infusion of pentoxifylline is safe and effective in improving the condition of patients with severe peripheral vascular disease.

Isolated profunda femoris artery occlusion: the mechanism of thigh claudication studied by 99mTc muscle clearance from the thigh and calf.

99mTc muscle clearance from the gastrocnemius and quadriceps and ankle pressure measurements have been studied in 5 limbs of 5 patients with an isolated profunda femoris artery occlusion shown on the aortogram. The changes of flow and pressure which occurred after exercise may explain the hemodynamics of thigh claudication which is the consequence of thigh deprivation in favour of calf flow.

Simultaneous isotope clearance from the muscles of the calf and thigh.

There has been no end to the attempts made to determine the site and severity of arterial lesions in claudicants by the use of non-invasive methods but, so far, their diagnostic value has been limited. A method whose diagnostic accuracy in determining the site and functional severity of the lesions approaches that of arteriography is discussed. The hyperaemic index, which is the ratio of the total excess of blood supply during post-exercise hyperaemia over the maximum hyperaemic flow, has been determined in the thigh and calf simultaneously, by measuring the 99Tcm muscle clearance in 30 limbs of 20 healthy volunteers and 139 limbs of 145 patients with claudication. Lumbar arteriography classified the lesions in all patients as 0-10 per cent, 10-40 per cent, 40-70 per cent and more than 70 per cent stenosis. A bivariate analysis of the hyperamic indices of the thigh and calf determined the site and whether single lesions consisted of a stenosis greater or less than 70 per cent. In limbs with combined aorto-iliac and superficial femoral lesions the values of the hyperaemic indices could determine which of the two lesions was the more severe in addition to whether lesions consisted of a stenosis greater or less than 70 per cent. These findings have been confirmed in a further blind prospective study of 47 limbs in which determination of the site and severity of lesions preceded aortography.

The mechanism of calf claudication: studies of simultaneous clearance of 99Tcm from the calf and thigh.

Simultaneous clearance of 99Tcm from the gastrocnemius and quadriceps muscles has been studied in 74 limbs of 62 patients with claudication and in 20 normal limbs of 15 volunteers. The local decay curve for 10 min at rest and for 20 min after a 3-min treadmill walk at 4.5 km/h was recorded. The changes in blood flow which occurred after exercise were characteristic of the arteriographic lesions and they explain the haemodynamics of claudication.

An objective assessment of common femoral endarterectomy and profundaplasty in patients with superficial femoral occlusion.

Common femoral endarterectomy with profundaplasty has become accepted as a useful operation in the treatment of ischemic arterial disease which is the result of superficial femoral occlusion. However, objective assessment of its long-term postoperative hemodynamic effects has not been reported. This study determines the effect of this operation on the resting pressure index, the walking distance on the treadmill, the fall in postexercise ankle pressure, and the recovery time. Measurements were made just before operation and 1 month later in 20 patients with severe claudication and superficial femoral occlusion. Sixteen patients were available for follow-up at 1 year. These patients were matched according to the resting pressure index to another group of 20 patients with superficial femoral occlusion followed up conservatively. The results indicate that common femoral endarterectomy with profundaplasty improves the distal perfusion pressure and, by inference, flow, which provides strong objective confirmation of the clinical impression that this operation is of value and help in determining its place in the management of severe lower limb ischemia.

Deep venous thrombosis in patients having aorto-iliac reconstruction.

The 125I-labelled fibrinogen test has been used to assess the incidence of deep venous thrombosis in 88 patients who had undergone elective aorto-iliac reconstruction. Deep venous thrombosis was detected in 18 (20.5 per cent). The results suggest that these patients merit prophylaxis.