Evaluation of pollution levels in sediments from Lake Edku, Egypt using laser ablation inductively coupled plasma mass spectrometry.

The concentrations of 11 heavy metals in sediments from Lake Edku, Egypt were determined using LA-ICP-MS. The average concentrations of elements occurred in the order of Fe > V > Cr > Zn > Ni > Cu > Co > Pb > As > Sn > Mo with respective values of 4.67 %, 104.8, 77.9, 76.6, 59.2, 52, 27.8, 19.8, 4.14, 2.24, and 1.45 µg/g. Several pollution indices were used to evaluate individual and cumulative contamination levels. All HMs were found to be in the deficiency to minimal enrichment range based on the enrichment factor. The contamination factor indicated low contamination levels of Cr and As, low to moderate contamination levels of Fe, Ni, Zn, Mo, Sn, and Pb, and moderate contamination levels of Co and Cu. The pollution load index and contamination degree indicated the sediments to be polluted and moderately polluted, respectively.

The effect of augmented reality on preoperative anxiety in children and adolescents: A randomized controlled trial.

BACKGROUND AND AIMS: Virtual reality has been shown to be an effective non-pharmacological intervention for reducing anxiety of pediatric patients. A newer immersive technology, that of augmented reality, offers some practical advantages over virtual reality, and also seems to show beneficial effects on anxiety. The main objective of this study was to determine whether augmented reality could reduce preoperative anxiety in pediatric patients undergoing elective day surgeries. A secondary outcome was to document the level of satisfaction from pediatric patients toward augmented reality intervention. METHODS: Children and adolescents aged between 5 and 17 years old scheduled for elective day surgery under general anesthesia were randomly divided into two groups. Patients in the control group received standard care, whereas patients in the augmented reality group were accompanied by two virtual characters who taught them relaxation techniques and provided emotional and informational support. Anxiety was measured at the time of admission and at the time of induction using the short version of the modified Yale Preoperative Anxiety Scale. RESULTS: The analysis included 37 pediatric patients in the augmented reality group and 64 in the control group. Anxiety scores were statistically significantly lower in the augmented reality group than those in the control group at the time of admission (median difference [95% CI]: 6.3 [0-10.4], p = .01), while no difference was observed between groups at the time of induction (median difference [95% CI]: -4.2 [-5.2-4.2], p = .58). Most patients in the augmented reality group wished to wear the glasses again and reported to be very satisfied with the intervention. CONCLUSION: To our knowledge, this study is the first large randomized controlled trial to provide empirical evidence of reduction in anxiety for children and adolescents using augmented reality prior to induction of general anesthesia.

Evaluation of hydrophilic polymer embolization from endovascular sheath devices in an in vitro perfusion system.

Objective: Case reports, tissue pathology, and autopsies have suggested that the hydrophilic polymer coating designed to improve endovascular deliverability and minimize vessel trauma can embolize and be associated with adverse outcomes such as ischemia, infarction, and death. This study sought to determine whether hydrophilic polymers shed off commercially available sheaths in a controlled in vitro environment, with the hypothesis that significant differences between coated and uncoated (control) sheaths would be found. Methods: Six sheaths from each manufacturer, including Zenith Alpha abdominal endovascular stent grafts (Cook Medical), DrySeal sheaths (W.L. Gore & Associates), and Sentrant Introducer sheaths (Medtronic), were tested in an in vitro environment. Noncoated Check-Flo performer introducer sheaths (Cook Medical) were used as controls. Each test circuit ran for 150 minutes at an output of 3 L/min, the circuit was then drained and the fluid collected. Quantitative analysis included weighing the dried filter paper and using particle size light scattering to quantify the particle size and count. Attenuated total reflectance spectroscopy was also used. Results: Each of the three coated sheaths had significantly greater shedding compared with the control sheaths. The Cook Zenith alpha sheath had significantly more residue weight (2.87 ± 0.52 mg/L) than the Gore DrySeal (1.07 ± 0.06 mg/L) and Medtronic Sentrant introducer (0.98 ± 0.14 mg/L) sheaths. The average particle size was not significantly different between the coated and uncoated (control) sheaths. Attenuated total reflectance spectroscopy identified sheath particulate in the Cook Zenith Alpha and Medtronic Sentrant samples. Conclusions: Polymer embolization was present and significantly greater in all three commercially available hydrophilic sheaths compared with the control group. Further investigation is needed into the clinical significance of these findings.

Comparing a Fitbit Wearable to an Electrocardiogram Gold Standard as a Measure of Heart Rate Under Psychological Stress: A Validation Study.

BACKGROUND: Wearable devices collect physiological and behavioral data that have the potential to identify individuals at risk of declining mental health and well-being. Past research has mainly focused on assessing the accuracy and the agreement of heart rate (HR) measurement of wearables under different physical exercise conditions. However, the capacity of wearables to sense physiological changes, assessed by increasing HR, caused by a stressful event has not been thoroughly studied. OBJECTIVE: This study followed 3 objectives: (1) to test the ability of a wearable device (Fitbit Versa 2) to sense an increase in HR upon induction of psychological stress in the laboratory; (2) to assess the accuracy of the wearable device to capture short-term HR variations caused by psychological stress compared to a gold-standard electrocardiogram (ECG) measure (Biopac); and (3) to quantify the degree of agreement between the wearable device and the gold-standard ECG measure across different experimental conditions. METHODS: Participants underwent the Trier Social Stress Test protocol, which consists of an oral phase, an arithmetic stress phase, an anticipation phase, and 2 relaxation phases (at the beginning and the end). During the stress protocol, the participants wore a Fitbit Versa 2 and were also connected to a Biopac. A mixed-effect modeling approach was used (1) to assess the effect of experimental conditions on HR, (2) to estimate several metrics of accuracy, and (3) to assess the agreement: the Bland-Altman limits of agreement (LoA), the concordance correlation coefficient, the coverage probability, the total deviation index, and the coefficient of an individual agreement. Mean absolute error and mean absolute percent error were calculated as accuracy indices. RESULTS: A total of 34 university students were recruited for this study (64% of participants were female with a mean age of 26.8 years, SD 8.3). Overall, the results showed significant HR variations across experimental phases. Post hoc tests revealed significant pairwise differences for all phases. Accuracy analyses revealed acceptable accuracy according to the analyzed metrics of accuracy for the Fitbit Versa 2 to capture the short-term variations in psychological stress levels. However, poor indices of agreement between the Fitbit Versa 2 and the Biopac were found. CONCLUSIONS: Overall, the results support the use of the Fitbit Versa 2 to capture short-term stress variations. The Fitbit device showed acceptable levels of accuracy but poor agreement with an ECG gold standard. Greater inaccuracy and smaller agreement were found for stressful experimental conditions that induced a higher HR. Fitbit devices can be used in research to measure HR variations caused by stress, although they cannot replace an ECG instrument when precision is of utmost importance.

Body image and health-related behaviors among fitspirit participants.

BACKGROUND: Body image variables such as body size perception (BSP) and body size dissatisfaction (BSD) can influence health-related behaviors. However, few studies have investigated these body image variables in adolescent girls participating in a physical activity intervention. Therefore, the study objectives were to examine the 1) associations between health-related behaviors (physical activity, screen-time, eating habits and sleep duration) and BSP and BSD among girls participating in FitSpirit, a physical activity intervention for girls; and 2) influence of weight control practices on the association between health-related behaviors and BSP and BSD. METHODS: This cross-sectional study assessed a sample of 545 adolescent girls (mean age: 15.0±1.5 years) from 240 schools. Body mass index, health-related behaviors, perceived actual body size and desired body size variables were self-reported and collected via an online questionnaire at the end of the FitSpirit intervention. A negative BSP score [perceived actual body size - calculated BMI z-score] indicates an underestimation of body size. A positive BSD score [perceived actual body size - desired body size] indicates a desire to reduce body size. A multiple linear regression analysis examined the effects of age, zBMI and health behaviors on BSP and BSD. A second multiple linear regression analysis examined the independent associations between BSP and BSD by weight control practice. The linear relationships between BSP and BSD were evaluated with Pearson's correlations. RESULTS: Underestimation and dissatisfaction of body size are more prevalent in participants living with overweight/obesity. Screen-time and sleep duration were independently associated with BSP score (Beta=0.02; P<0.05 and Beta=-0.07; P<0.05, respectively), whereas only screen-time was associated with the BSD score (Beta=0.07; P<0.001). Physical activity was independently associated with the BSP score only in participants trying to control (maintain) their weight (Beta=-0.18; P<0.05). CONCLUSIONS: Body size overestimation and dissatisfaction are associated with health-related behaviors, specifically with more screen-time and less optimal sleeping habits. Physical activity level does not appear to be associated with body image in girls engaged in a physical activity intervention and who want to lose or gain weight. Health promotion interventions could include screen-time and sleep components as they may influence body image.

Percutaneous proximal axillary artery versus femoral artery access for endovascular interventions.

OBJECTIVE: The primary objective of this study is to describe and illustrate the technique of ultrasound-guided percutaneous proximal axillary artery (PAA) access, and secondarily to evaluate the versatility and safety of this approach in peripheral, visceral, and aortic endovascular interventions. METHODS: This is a single-center retrospective review of all peripheral, visceral, and aortic endovascular cases using percutaneous PAA access from February 2019 to March 2021 compared with a sample of an equivalent number of consecutive cases completed via percutaneous common femoral artery (CFA) access during the same time period. Access entry success, minor and major access site complications within 30 days, major adverse events within 30 days, demographics, and procedural details were analyzed using standard statistical analyses. RESULTS: A total of 115 accesses-59 PAA and 56 CFA-were reviewed during the study period. Group demographics were not significantly different. Access entry success was achieved in 58 (98.3%) and 56 (100%) of PAA and CFA accesses, respectively, with no statistically significant difference. There were no significant differences in minor access-site complications (13.6% vs 5.4%; P = .21) major access site complications (3.4% vs 7.1%; P = .43), or major adverse events (6.8% vs 5.4%). between the PAA and CFA groups. With respect to versatility, PAA cases had a significantly greater mean number of vessels intervened on per procedure compared with CFA access (2.59 ± 1.31 vs 1.95 ± 0.98; P < .01). A wide range of target vessels were intervened on in both groups. PAA cases had significantly more bilateral lower leg interventions (28.8% vs 12.5%; P = .04). PAA access had a significantly longer mean procedure time (103.2 minutes vs 58.63 minutes; P < .001) and fluoroscopy time (18.21 minutes vs 12.87 minutes; P = .02). CONCLUSIONS: The PAA is a feasible, versatile, and safe percutaneous access option for endovascular intervention. The in-line trajectory from this site facilitates visceral, renal, aortic, and bilateral lower extremity interventions with ease. Outcomes, complications, and major adverse events are similar to those of conventional CFA access in the short term.

DASS-21: assessment of psychological distress through the Bifactor Model and item analysis / DASS-21: avaliação do distresse psicológico pelo Modelo Bifactor e análise dos itens / DASS-21: evaluación del distrés psicológico mediante el Modelo Bifactor y análisis de ítems

The term distress has been used to refer to a continuous variable operationalized through symptoms of depression, anxiety, and stress. In this study, psychological distress is measured using the Depression, Anxiety, and Stress Scale (DASS-21). Confirmatory Factor Analysis compared the fit of different measurement models for the DASS-21, with the parameters of the items verified through the Andrich rating scale model. A non-clinical sample of 530 participants (mean age=24.35±6.55 years; 71.89% women) responded to the instrument. According to the theoretical hypothesis, the results indicated a better fit for the bifactor model, composed of three specific factors (depression, anxiety, and stress) and a general factor (general psychological distress). The assessment of the item properties allowed for a better understanding of the organization of the continuum represented by the construct psychological distress. It is possible to conclude that the Brazilian version of the DASS-21 is an adequate measure for psychological distress. (AU)

O termo "distresse" psicológico tem sido utilizado na literatura para se referir a uma variável contínua operacionalizada por meio dos sintomas de depressão, ansiedade e estresse. Esta pesquisa propõe a utilização da Escala de Depressão, Ansiedade e Estresse (DASS-21) para avaliação do distresse psicológico. Comparou-se o ajuste de diferentes modelos de medidas propostos a DASS-21 por meio da análise fatorial confirmatória e verificou-se os parâmetros dos itens com o Andrich rating scale model. Uma amostra não clínica de 530 participantes (idade: M = 24,35, DP = 6,55, 71,89% mulheres), respondeu ao instrumento. Os resultados indicaram melhor adequação do modelo bifactor composto por três fatores específicos (depressão, ansiedade e estresse) e um fator geral (distresse psicológico geral), conforme hipótese teórica. A avaliação das propriedades dos itens possibilitou melhor compreensão da organização do contínuo representado pelo construto distresse psicológico (severidade dos sintomas). Conclui-se que a versão brasileira da DASS-21 é uma medida adequada do distresse psicológico geral. (AU)

El término distrés psicológico se ha utilizado en la literatura para referirse una variable continua operada por medio de los síntomas de depresión, ansiedad y el estrés. En esta investigación el distrés psicológico se mide a través de la Escala de Depresión, Ansiedad y Estrés (DASS-21). El Análisis Factorial Confirmatorio comparó el ajuste de diferentes modelos de medición para la DASS-21 y los parámetros de los ítems se verificaron a través de la Andrich rating scale model. Una muestra no clínica de 530 participantes (24,35 ± 6,55, 71,89% mujeres), respondieron al instrumento. Los resultados indicaron una mejor adecuación del modelo bifactor compuesto por tres factores específicos (depresión, ansiedad y estrés) y un factor general (distrés psicológico general), lo que correspondió con la expectativa teórica. La evaluación de las propiedades del ítem permitió una mejor comprensión de la organización del continuo representado por el constructo distrés psicológico. Se concluye que la versión brasileña DASS-21 es una medida adecuada del distrés psicológico general. (AU)

Percutaneous closure of a post-surgical ascending aortic pseudoaneurysm with an amplatzer septal occluder device and steerable guiding sheath.

Thoracic pseudoaneurysm in the ascending aorta is an uncommon condition associated with significant risk of morbidity and mortality. Treatment is recommended in all cases regardless of symptoms as the mortality rate if left untreated has been documented to be as high as 61%. The current standard of care for managing these lesions is open surgical repair. However, this is associated with significant morbidity. In-hospital mortality reported for patients undergoing surgical repair of an ascending aortic pseudoaneurysm ranges from 6.7% to 41%. When anatomically suitable, a less invasive approach using amplatzer vascular plug or septal occluder is an attractive approach. We present a case report of repair of a post-surgical ascending aortic false aneurysm using an amplatzer septal occluder with an Oscor ™ steerable guiding sheath; a novel approach to increase platform stability when engaging an aneurysm neck. Endovascular occluder deployment for closure of aortic false aneurysms remains a relatively novel technique. It is limited by the requirement to develop a stable endovascular platform to deliver the device and avoid system prolapse, particularly when accessing challenging lesions on the inner aortic curvature. We present the first case to utilize a steerable guiding sheath system to improve system stability and facilitate successful device delivery. Given the significant morbidity associated with open repair of these lesions we hope this will further expand the range of lesions viewed as appropriate for endovascular repair.

Ultrasound-guided cyanoacrylate injection for the treatment of incompetent perforator veins.

OBJECTIVE: The use of cyanoacrylate products (CA) in incompetent perforator vein (IPV) treatment has not been thoroughly examined. The primary objective of this study is to describe the technique of ultra sound guided direct injection of IPV with CA, and secondarily to determine early closure rates and safety of this technique. METHODS: A retrospective analysis of patients undergoing IPV injection at two centres between 2015-2018 was conducted. Demographics, CEAP classification and IPV location were collected. Outcomes were assessed at two follow-up appointments. RESULTS: A total of 83 perforator vein injections were completed. CEAP classifications include C2 - C6 classes. Location of perforators were posteromedial (6%), femoral canal (9%), paratibial (14%), and posterior-tibial (71%). IPV closure rates were 96.3% at initial follow-up (16 ± 2 days). Closure rates decreased to 86.5% at second follow-up (72 ± 9 days). There were no deep vein thromboses during follow-up. One patient developed septic thrombophlebitis that was successfully managed with antibiotics. CONCLUSION: Ultrasound-guided CA glue injection is a simple and low risk procedure that effectively closes incompetent perforator veins.

Deformation mechanics of self-expanding venous stents: Modelling and experiments.

Deformation properties of venous stents based on braided design, chevron design, Z design, and diamond design are compared using in vitro experiments coupled with analytical and finite element modelling. Their suitability for deployment in different clinical contexts is assessed based on their deformation characteristics. Self-expanding stainless steel stents possess superior collapse resistance compared to Nitinol stents. Consequently, they may be more reliable to treat diseases like May-Thurner syndrome in which resistance against a concentrated (pinching) force applied on the stent is needed to prevent collapse. Braided design applies a larger radial pressure particularly for vessels of diameter smaller than 75% of its nominal diameter, making it suitable for a long lesion with high recoil. Z design has the least foreshortening, which aids in accurate deployment. Nitinol stents are more compliant than their stainless steel counterparts, which indicates their suitability in veins. The semi-analytical method presented can aid in rapid assessment of topology governed deformation characteristics of stents and their design optimization.

Determination of heavy metal content and pollution indices in the agricultural soils using laser ablation inductively coupled plasma mass spectrometry.

In this study, we determined the concentrations of heavy metals in the agricultural soils of Kafr El-Zayat city using laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS). The LA-ICP-MS performance was firstly evaluated by analyzing appropriate reference materials and comparing the concentration values found to those of the reference values. LA-ICP-MS was then applied to examine the content of 21 elements (Mg, Al, Si, Ca, Ti, V, Cr, Mn, Fe, Co, Ni, Cu, Rb, Sr, Mo, Sn, Ba, Pb, Th, and U) in 16 collected agricultural soil samples from Egypt. The soil quality was assessed by calculating the contamination factor (CF), enrichment factor (EF), and the geo-accumulation index (Igeo) of the measured heavy metals. The average concentrations of V, Cr, Co, Ni, and Cu were higher than the average worldwide background concentrations and exceeded the Canadian soil quality guidelines with values of 162.8, 113.3, 42.2, 88.1, and 70.6 µg/g, respectively. Multivariate analysis was applied to investigate the correlation and sources of heavy metals in agricultural soils. Cluster analysis indicated the clustering of heavy metals into three groups: Cr and Mo; Fe and Mn; and V, Ni, Co, Cu, Zn, and Pb. The results of principal component analysis (PCA) agreed with those of the cluster analysis and yielded three components that explained 81.13% of the total variance. The contamination factor (CF) of soils from all sampling sites showed moderate contamination.

Evaluation of Aortic Zone 2 Proximal Landing Accuracy During Thoracic Endovascular Aortic Repair Following Carotid-Subclavian Revascularization.

BACKGROUND: Adequate seal for thoracic endovascular aortic repair (TEVAR) commonly requires landing in zone 2, but can prove to be challenging due to the tortuous and angulated anatomy of the region. OBJECTIVES: Our objective was to determine the proximal landing accuracy of zone 2-targeted TEVARs following carotid-subclavian revascularization (CSR) and its impact on clinical outcomes. METHODS: Retrospective review of patients that underwent CSR for zone 2 endograft delivery at a tertiary institute between January 2008 and March 2018 was conducted. Technical outcomes were assessed by examining the incidence of intraoperative corrective maneuvers, 1a endoleaks and reinterventions. Distance to target and incidence of LSA stump filling were examined as radiographic markers of landing accuracy. RESULTS: Zone 2-targeted TEVAR with CSR was performed in 53 patients for treatment of dissections (49%), aneurysms (30%) or trauma (21%). Nine (17%) cases required intraoperative corrective procedures: 5 (9%) proximal cuffs due to type 1a endoleak and 4 (8%) left common carotid artery (LCCA) stenting due to inadvertent coverage. Cases performed using higher resolution hybrid fluoroscopy machine compared to mobile C-arm were associated with increased proximal cuff use (OR 8.8; 95% CI 1.2-62.4). Average distance between the proximal edge of the covered graft to LCCA was 8 ± 1 mm and larger distances were not associated with higher rates of 1a endoleak. Twenty-eight (53%) cases of antegrade LSA stump filling were noted on follow-up imaging, but were not associated with higher rates of reinterventions (OR 0.8, 95% CI [0.2-4.6]). Three (6%) patients had a stroke within 30 days and 4 (8%) patients expired within 1 month. Intraoperative corrective maneuvers, post-operative 1a endoleak and reinterventions were not associated with higher rates of stroke or mortality. CONCLUSION: Using current endografts and imaging modalities, zone 2-targeted TEVARs have suboptimal technical accuracy.

Safety and feasibility report on nonimplantable endovenous valve formation for the treatment of deep vein reflux.

OBJECTIVE: Definitive treatment techniques for symptomatic deep venous reflux have been relegated to complex and invasive open surgery which is rarely performed today. The BlueLeaf System provides an endovenous method for the formation of deep venous valves without an implant, avoiding the complications associated with permanent foreign materials. The system has the adaptability to form valves within the femoral and popliteal veins at multiple levels in a single procedure. The aim was to determine the midterm safety and efficacy of this novel device in an early feasibility study. METHODS: Feasibility of endovenous deep venous valve formation was assessed in patients with chronic venous insufficiency (Clinical, Etiologic, Anatomic, Pathophysiologic [CEAP] 4-6). Follow-up was completed through 1 year, assessing vein patency and reflux time (RT) with duplex ultrasound examination. Venous clinical improvement was evaluated using the revised Venous Clinical Severity Scale. RESULTS: Of the 14 patients, 13 (93%) had successful formation of at least one monocuspid valve, with a mean number of 1.4 valves (range, 0-3 valves) per patient. There were no device-related serious adverse events during the index procedure. There were no deep venous thromboses reported at any time point, including 10 patients through the 1-year follow-up. In patients with at least one valve formed, site reported duplex ultrasound examination measured the average RT in the popliteal vein below valve formations, was 3.0 ± 1.0 seconds at baseline, 3.9 ± 3.1 seconds at 30 days, and 3.6 ± 2.1 seconds at 360 days. The revised Venous Clinical Severity Scale improved in all 13 successfully treated patients, decreasing from 15.0 ± 6.0 at baseline to 11.6 ± 5.5 at 30 days, 10.7 ± 5.3 at 210 days, and 9.4 ± 5.0 at 360 days (P = .0002; baseline to 360 days). Among the five patients with an ulcer who reached the 360-day follow-up visit, all (100%) healed at least one ulcer. Two patients (40%) healed all ulcers and three patients (60%) had a decrease in ulcers number but remained at C6 at 360 days. The five patients with a total of nine active ulcers at baseline had four active ulcers at 360 days. CONCLUSIONS: The BlueLeaf System holds promise as a minimally invasive means to safely form fully autogenous deep venous valves. Reconstructed deep veins remained patent, without deep venous thrombosis and symptomatic improvement was consistently observed; however, a decrease in the RT was not. Incremental device design improvements have been undertaken to improve valve function. The results of these iterations await further clinical evaluation.

Influence of artery and vein diameters on autogenous arteriovenous access patency.

OBJECTIVE: Previous investigations have suggested that a minimum venous outflow diameter (MVOD) and perianastomotic arterial diameter are associated with successful autogenous arteriovenous maturation and patency. The goal of this study was to determine anatomic and clinical variables that may influence access patency to guide optimal autogenous access configuration selection. METHODS: Accesses created from 2010 to 2016 were analyzed from data entered into a prospective database. Preprocedure duplex ultrasound mapping data of artery and tourniquet-derived vein diameters and demographic and clinical variables were collected. Survival-based cut point analysis was used to determine anatomic parameters most predictive of access failure. Kaplan-Meier and Cox proportional hazards analyses were used to assess patencies and maturation and to identify independent predictors of access failure. RESULTS: A total of 356 first-time autogenous accesses were created (median follow-up, 20 months; range, 0-73 months). Of these, 202 (56.7%) were radiocephalic and 154 (43.3%) were brachiocephalic. Maturation failure at end of follow-up for arteriovenous accesses was 26% ± 3% for radiocephalic accesses and 15% ± 3% for brachiocephalic accesses (P < .001). For radiocephalic accesses, MVOD <3.0 mm and radial artery diameter <2.1 mm independently predicted access maturation failure (MVOD <3.0 mm: hazard ratio [HR], 2.62 [95% confidence interval (CI), 1.27-5.39; P = .009]; radial artery diameter <2.1 mm: HR, 2.20 [95% CI, 1.20-4.05; P = .011]) and secondary patency loss (MVOD <3.0 mm: HR, 2.21 [95% CI, 1.24-3.96; P = .007]; radial artery diameter <2.1 mm: HR, 2.11 [95% CI, 1.26-3.63; P = .004]). A combination of radial artery diameter <2.1 mm and MVOD <3.0 mm most strongly predicted maturation failure (HR, 4.24; 95% CI, 1.71-10.49; P = .002) and loss of secondary patency (HR, 4.03; 95% CI, 1.88-8.64; P < .001). Only diabetes mellitus (HR, 2.24; P = .012) predicted secondary patency loss. For brachiocephalic accesses, MVOD <3.4 mm (HR, 2.12; 95% CI, 1.02-4.46; P = .043) was found to independently predict secondary patency loss in addition to previous ipsilateral (HR, 2.37; P = .038) and bilateral (HR, 4.00; P = .015) tunneled hemodialysis catheters. Brachial artery diameter was not associated with either access maturation or patency. CONCLUSIONS: Artery and tourniquet-derived vein diameters independently predict radiocephalic access patency and functional outcomes. A combination of a radial artery diameter <2.1 mm and MVOD <3.0 mm best predicts maturation failure and patency loss for radiocephalic access. MVOD <3.4 mm was associated with increased loss of brachiocephalic access secondary patency, but MVOD was not associated with maturation.

Dysphagia aortica secondary to thoracoabdominal aortic aneurysm resolved after endograft placement.

Dysphagia aortica is a rare entity defined as difficulty in swallowing due to external compression by the aorta. Aneurysmal dysphagia aortica successfully treated with thoracic endovascular aortic repair (TEVAR) is exceedingly rare. We report the case of a 74-year-old woman with known thoracoabdominal aneurysm who presented with acute shortness of breath and 3-month history of dysphagia. Computed tomography angiography revealed aneurysmal growth and massive esophageal dilation. She underwent TEVAR and visceral debranching, which led to complete symptom resolution correlated with sac regression. We also present a comprehensive review of the literature with a focus on cases of aneurysmal dysphagia aortica treated with TEVAR.

Hydrophilic polymer embolization after thoracic endovascular aortic repair.

Hydrophilic polymer embolization is a rare complication after endovascular procedures that is currently underappreciated. Present understanding on this phenomenon relies on sparse case reports with histologic evidence of foreign polymers in end-organ tissue. Here, we report two deaths associated with hydrophilic polymer embolization after complex thoracic endovascular aortic repair.

Outcomes of a Spinal Drain and Intraoperative Neurophysiologic Monitoring Protocol in Thoracic Endovascular Aortic Repair.

BACKGROUND: Adjuncts for early detection and treatment of spinal cord ischemia (SCI) in thoracic aortic surgery are supported by robust clinical experience in open repair. The utility of cerebrospinal fluid (CSF) drainage and neurophysiologic monitoring (NPM) in thoracic endovascular aortic repair (TEVAR) is less clear. The purpose of this investigation is to determine the influence of a selective institutional spinal cord protection protocol using prophylactic NPM and CSF on outcomes for standard TEVAR. METHODS: Patients undergoing standard TEVAR entered into a prospectively maintained database from a single institution from 2007 to 2016 were retrospectively reviewed. Preoperative characteristics, aneurysm extent, and etiology were reviewed. Utilization of CSF drains including volume of fluid removed, duration of drainage, and catheter-related complications were collected. NPM data were reviewed to determine the influence on intraoperative management. Exact logistic regression was used to identify independent predictors of SCI. RESULTS: Of 223 patients undergoing TEVAR, 130 met inclusion criteria for the study. CSF drains were used in 71 patients (54.6%), and 56 of 130 (43%) had NPM. SCI occurred in 7 patients (5.4%), of whom 5 had partial or complete recovery. Median time to symptoms of SCI was delayed in all cases (median 52 hr, range 8-312), and none of the 4 of 7 patients with adjunct NPM demonstrated intraoperative changes. Intraoperative changes in NPM occurred in 26 (46%), and represented unilateral leg ischemia in all but 2 cases. In both patients, changes consistent with SCI were associated with intraoperative hypotension and resolved with blood pressure augmentation. Neither patient developed postoperative SCI. Median length of stay (22 vs. 9 days, P = 0.012), operative room time (262 vs. 209, P = 0.040), and perioperative mortality (28.6% vs. 4.1%, P = 0.046) were significantly higher for patients with SCI versus those without. Length of aortic coverage was found to be the sole independent predictor of SCI (odds ratio 8.2, P = 0.026). Complications related to CSF drainage occurred in 4 patients (5.6%) with major complications occurring in 2 patients (2.8%), including 1 with an intrathecal hematoma and permanent bilateral paraparesis. CONCLUSIONS: Selective use of prophylactic CSF drainage in TEVAR was associated with moderate risk and questionable benefit. The use of neurophysiological monitoring allowed for early detection and treatment of spinal ischemia, but its utility is limited by logistical factors and to the minority of patients with intraoperative spinal ischemic events.

Pilot study of a Web-based acceptance and commitment therapy intervention for university students to reduce academic procrastination.

Objective: This pilot study pursued two aims. The first was to investigate the feasibility and acceptability of a Web-based acceptance and commitment therapy (ACT) intervention to reduce academic procrastination among university students. The second aim was to test the effectiveness of the intervention on procrastination and committed actions. Participants: The sample was comprised of Canadian university students (n = 36) that participated in the intervention between September 2016 and April 2017. Methods: The study relied on a prepost research design. Results: The intervention appears feasible, acceptable, and valuable to students. A significant reduction in procrastination and a significant improvement in committed actions were found between pre and postintervention. The effect sizes for these results were medium. Conclusions: Results provide preliminary support for the feasibility and effectiveness of a Web-based ACT intervention for academic procrastination. Results also highlight some aspects that need to be improved for further development.

Comparison of cyanoacrylate embolization and radiofrequency ablation for the treatment of varicose veins.

OBJECTIVE: To review clinical outcomes of varicose vein patients treated with cyanoacrylate embolization and radiofrequency ablation at our institution. METHODS: A retrospective review of patients who underwent cyanoacrylate embolization and radiofrequency ablation during a three-year period. Patient records were reviewed to assess demographics, location and severity of disease, treatment details and outcome at short- and mid-term follow-ups. Outcome parameters included treatment success and complications. RESULTS: Between January 2014 and December 2016, 335 patients with 476 veins were treated with either cyanoacrylate embolization (n = 148) or radiofrequency ablation (n = 328) at the Vancouver General Hospital Vascular Surgery Vein Clinic. The average age of patients were 57 ± 1 years with the majority being female (78%) and an average BMI of 24.8 ± 0.5. CEAP classes were 2 (49%), 3 (26%), 4a (22%) and >4b (3%). Of the veins treated with cyanoacrylate embolization, the vein types were as follows: 76% were great saphenous vein, 16% were small saphenous vein, 5% were anterior accessory great saphenous vein and 1.4% were perforator veins. The vein types for radiofrequency ablation were 88%, 9%, 3% and 0%, respectively. The average amount of cyanoacrylate embolization delivered for great saphenous vein treatment was 1.8 ± 0.1 ml with a treatment length of 43 ± 1 cm. Subgroup comparison was done for great saphenous vein segments. Treatment success was 100% in cyanoacrylate embolization and 99% in radiofrequency ablation. Superficial phlebitis was the most common complication noted at mid-term follow-up in 5% of cyanoacrylate embolization and 16% of radiofrequency ablation treatments (P < 0.05). One patient in each group had asymptomatic proximal thrombus extension treated with anticoagulation for 2-3 weeks. Three superficial infections from glue clumps were noted in the cyanoacrylate embolization group requiring excision and drainage. Five patients in the radiofrequency ablation group had persistent numbness and one wound complications at the access site. CONCLUSION: Cyanoacrylate embolization offers equivalent success rates with lower mid-term complication rates as radiofrequency ablation.

Inventário Reno de Autoperspectiva RISP: adaptação transcultural e evidência de validade / Reno Inventory of Self-Perspective RISP: cross-cultural adaptation and validity evidence / Inventario Reno de Auto-Perspectiva RISP: adaptación transcultural y evidencias de validez

Esta pesquisa teve como objetivos a adaptação transcultural e avaliação das propriedades psicométricas da versão brasileira do Reno Inventory of Self-Perspective - RISP, instrumento que avalia a habilidade de tomada de perspectiva, compreensão de si mesmo enquanto construção contextual, por meio dos fatores enredado, centrado e transcendente. A amostra foi composta por 344 universitários (idade 21,1 ± 4,8; 64,2% mulheres). A estrutura interna foi estimada por meio do Exploratory Structural Equation Modeling (ESEM). Também se avaliou a invariância do modelo fatorial entre participantes do sexo masculino e feminino, indicadores de precisão e associação com variáveis externas: satisfação com a vida, fusão cognitiva, ansiedade, estresse e depressão. Os resultados revelaram a estrutura composta por três fatores, conforme hipótese teórica, com indicadores desejáveis de precisão. Foi demonstrado equivalência do modelo de medida ao avaliar participantes dos diferentes sexos, e associações correspondentes as perspectivas teóricas com as variáveis externas estudadas. Os resultados sugerem adequação da versão brasileira RISP. (AU)

This research aimed to adapt and assess the psychometric properties of the Brazilian version of the Reno Inventory of Self-Perspective (RISP), which aims to measure fusion with self-content, the ability to take a centered self-perspective, and verbal awareness of the transcendent nature of that perspective, using three factors: Entangled, Centered and Transcendent. The sample consisted of 344 Brazilian undergraduate students (age 21.1±4.8; 64.2% women). The dimensionality of the inventory was estimated by the Exploratory Structural Equation Modeling (ESEM). The invariance of the factorial model between men and women, scale reliability and association with other variables: life satisfaction, cognitive fusion, anxiety, stress and depression were estimated as well. The results showed a three-factor structure, confirming the theoretical hypothesis with desirable precision indices. It was also observed the measurement model equivalence to assess participants of both sexes. The results suggest adequacy of the Brazilian version of the RISP. (AU)

Esta investigación tuvo como principal objetivo la adaptación transcultural y la evaluación de las propiedades psicométricas de la versión brasileña del Reno Inventory of Self-Perspective RISP, un instrumento que evalúa la medición de habilidad de capacidad de toma de perspectiva, comprensión de sí mismo como construcción contextual, a través de los factores Enredado, Centrado y Trascendente. La muestra fue compuesta por 344 universitarios (edad 21,1 ± 4,8; 64,2% mujeres). La estructura interna del instrumento fue estimada por la Exploratory Structural Equation Modeling (ESEM). También se evaluó la invariancia del modelo factorial entre participantes de sexo masculino y femenino, indicadores de precisión y asociación con variables externas: satisfacción con la vida, fusión cognitiva, ansiedad, estrés y depresión. Los resultados revelaron la estructura compuesta por tres factores, según hipótesis teórica, con indicadores deseables de precisión. También se demostró la equivalencia del modelo de medida al evaluar participantes de diferente sexo, así como asociaciones correspondientes a perspectivas teóricas con las variables externas estudiadas. Los resultados sugieren adecuación de la versión brasileña RISP. (AU)