Anesthetic Considerations in Combined TAVR and Aortic Endovascular Procedures, a Case Report.

ABSTRACT: We report a case of simultaneous transcatheter aortic valve replacement and endovascular aneurysm repair. Our aim was to advocate the role of local and regional anesthesia as a key contributor in maintaining hemodynamic stability and avoiding abrupt blood pressure change. Endovascular combined procedures are gaining popularity for their numerous advantages. Nevertheless, they carry significant risks for their hemodynamic implications. It is imperative to acknowledge the modifications occurring after each correction and act accordingly. Different anesthesia approaches can dramatically influence hemodynamics; among all, we found local and regional anesthesia would better serve this objective.

Visceral Aorta Electrocautery Septotomy to Allow Branched Endovascular Aortic Repair in Ruptured Chronic Post-Dissection Thoraco-Abdominal Aneurysm.

PURPOSE: Endovascular repair of chronic post-dissection thoraco-abdominal aortic aneurysms (PD-TAAA) presents specific technical challenges due to the presence of chronic septum. Small true lumen diameter and false lumen visceral vessel origin can make branched endograft prohibitive. Septotomy may allow to overcome these challenges in cases of high complex anatomy. TECHNIQUE: We describe the application of electrocautery septotomy to the visceral aorta segment to deploy an off-the-shelf branched endograft in a chronic PD-TAAA rupture with true lumen collapse. CONCLUSIONS: Electrocautery septotomy can be an effective adjunctive technique to facilitate branched endograft, overcoming technical challenges associated with the endovascular treatment of chronic PD-TAAA. CLINICAL IMPACT: Electrocautery septotomy is an adjunctive technique that can facilitate endovascular treatment of post-dissection thoraco-abdominal aneurysm. By creating a common lumen, this technique might reduce the number of re-interventions associated with PD-TAAA endovascular exclusion.

Mid-Term Results of an Italian Multicentric Experience with the RoadsaverTM Dual-Layer Carotid Stent System.

BACKGROUND: Carotid artery stenting (CAS) using first-generation single-layer stents is widely accepted as a good alternative to standard carotid endarterectomy (CEA) but it is associated with worse outcomes in terms of both plaque prolapse and cerebral embolization. AIM: To evaluate the perioperative and midterm outcomes of CAS using the new-generation RoadsaverTM dual-layer micromesh-covered carotid stent. METHODS: Herein, we present the results of an observational, retrospective, multicentric study on non-consecutive patients who underwent the CAS procedure between January 2017 and December 2022 at three Italian, high-volume vascular surgery centers. The inclusion criteria were the patients' eligibility for the CAS procedure in accordance with the current Italian guidelines, and the implantation of a Roadsaver stent. Both symptomatic and asymptomatic patients were included in the study. The patients requiring reintervention for carotid restenosis following CEA were also included. Perioperative data regarding procedural success was defined as the successful implantation of the device in the desired position, less than 30% residual stenosis, and the absence of intraoperative neurological complications. The primary outcome was any adverse cerebrovascular event such as stroke or transient ischemic attack (TIA) during the procedure and/or after discharge. The secondary outcomes were the need for further intervention, and all-cause death following procedure. RESULTS: Three-hundred-fifty-three (353) patients were included in our study; the mean age was 74.3 years. A total of 5.9% of the patients were symptomatic on their operated side, while 7.3% had contralateral carotid occlusion. A cerebral embolic protection device (CPD) was employed in all patients. A total of 13.3% of the patients were operated on for restenosis after CEA Technical success was achieved in 96.9% of the cases with an intraoperative report of six TIAs (1.7%) and six ipsilateral strokes (1.7%). The mean hospital stay was 1.8 days. The thirty-day follow up showed one TIA and one more stroke. At the mean 35-month follow-up time, the primary outcome was present in six patients (1.7%), where four TIAs (1.1%) and two strokes (0.5%) were reported. Restenosis occurred in five patients (1.4%). Death for any cause was reported in 11 patients (3.1%). CONCLUSIONS: As most recent, high-quality studies show, the CAS procedure with second-generation devices such as the Roadsaver stent is safe and effective in preventing carotid-related cerebrovascular events in both symptomatic and asymptomatic patients. The intraoperative and postoperative cerebrovascular complication rate in high volume centers is very low, ensuring confidence in its employment for the CAS procedure along with a CPD as a valid alternative to CEA.

Psychometric properties of the Entrepreneurial Intention Questionnaire (EIQ) in Dominican Republic adolescents

Introduction: This work represents the first attempt to obtain evidence of the validity of an entrepreneurial intention questionnaire in the adolescent population of a Latin American or Caribbean country. The objectives are to study the factor structure, the reliability, the external validity and to test the gender invariance of the Entrepreneurial Intention Questionnaire, in its adaptation for adolescents. Method: The sample consisted of 708 adolescents from the Dominican Republic with a mean age of 15.49, 65.2% of whom were women and 35.8% were men. Analyses included confirmatory factor analysis, Cronbach's Alpha and Omega scores for reliability, correlations, and a gender invariance routine. Finally, latent means of females and males are compared. Results: The confirmatory factor analysis showed a good fit to the data and the reliability results were adequate. In addition, the correlations with the Entrepreneurial Attitudes Scale for Students were positive and statistically significant. Also, strict gender invariance was successfully verified. Although males presented a higher subjective norm, females showed higher entrepreneurial intentions. Conclusions: The Entrepreneurial Intention Questionnaire shows adequate psychometric properties and proves useful in conducting research on the promotion of entrepreneurship in early stages.

Introducción: Este trabajo supone el primer intento de obtener evidencias de validez de un cuestionario de intención emprendedora en adolescentes en un país de Latinoamérica y el Caribe. Tiene como objetivos reportar la estructura interna, fiabilidad, validez externa y probar la invarianza de género del Cuestionario de Intención Emprendedora en su adaptación para adolescentes. Método: La muestra está formada por 708 adolescentes de República Dominicana con una media edad de 15.49, un 65.2% de mujeres y un 35.8% hombres. Los análisis incluyeron análisis factorial confirmatorio, resultados de Alfa de Cronbach y Omega para la fiabilidad, correlaciones y una rutina de invarianza por género. Finalmente se compararon las medias latentes de hombres y mujeres. Resultados: El análisis factorial mostró un buen ajuste a los datos y los resultados de fiabilidad fueron adecuados. Además, las correlaciones con la Escala de Actitudes Emprendedoras para Estudiantes fueron positivas y estadísticamente significativas. También, se comprobó satisfactoriamente la invarianza estricta por género. Aunque los hombres presentaron mayor norma subjetiva, las mujeres mostraron una mayor intención emprendedora. Conclusiones: El Cuestionario de Intención Emprendedora muestra adecuadas propiedades psicométricas para que sea de utilidad en las investigaciones sobre la promoción del emprendimiento en etapas tempranas.

Senior volunteers: addressing loneliness in times of COVID-19.

Volunteering in old age plays an important role in addressing feelings of loneliness, but little research has been conducted on the impact of engaging in volunteering activities during the COVID-19 pandemic. This study investigates the longitudinal impact of volunteering on feelings of loneliness. We analyzed data from 31,667 adults aged 50 years and older in the Survey of Health, Ageing and Retirement in Europe (SHARE), across three consecutive waves (one before the pandemic and two during the COVID-19 pandemic). Binary logistic regression analyses were conducted for loneliness, using volunteering and several control variables as independent variables, and found that even after controlling for previous loneliness, volunteering has a protective effect against experiencing feelings of loneliness. Those who participated in volunteering activities before or during the second pandemic period had a lower risk of loneliness during the second pandemic period. Volunteering during the second pandemic period, before and during the second pandemic period, and during all three periods measured in the study was negatively associated with the odds of feeling lonely. Encouraging volunteering among older adults can be a useful strategy to prevent loneliness during future emergency situations like the COVID-19 outbreak.

Circadian Oscillations of Minimal Erythema Dose (MED) are Also Influenced by Diet in Patients with Psoriasis: A Chronomedical Study.

INTRODUCTION: Minimal erythema dose (MED) remains a parameter of paramount importance to orient narrow-band (NB)-UVB phototherapy in psoriatic (PsO) patients. Recently, circadian rhythm and diet were recognized as potential MED modulators, but their mutual interaction remains understudied. Thus, we aimed to evaluate the potential diet modulation of MED circadian oscillations. METHODS: In the first phase, a cohort study was performed comparing potential MED oscillations (morning, afternoon, and evening) among omnivorous psoriatic patients before and after a phototherapy cycle and omnivorous healthy controls. The two groups were age-, gender-, skin-type-, MED-, and diet-matched. Then, in the second phase, another cohort study was carried out comparing MED oscillations 24 h after the last phototherapeutic session only in psoriatic patients cleared with NB-UVB and undergoing different diets (vegan, vegetarian, paleo , ketogenic, intermittent circadian fasting, and omnivore). Patients with different diets were age-, gender-, and skin-type matched. RESULTS: In the first phase, we enrolled only omnivores, specifically 54 PsO patients and 54 healthy individuals. Their MED before and after NB-UVB therapy changed significantly among the three different time-points (morning, afternoon, and evening) (p < 0.001). The time effect was statistically significant in both groups before and after phototherapy. In the second phase, we enrolled 144 PsO patients (vegan, vegetarian, paleo, ketogenic, intermittent circadian fasting, and omnivore). MED circadian oscillations preserved a significant difference also after clearance and were influenced by diet type and time of day (p < 0.001). In particular, vegans displayed the lowest MED values, whilst Ramadan fasting showed the highest values in morning, afternoon, and evening. CONCLUSIONS: Diet, like other ongoing therapies, should be reported in the medical records of patients with psoriasis undergoing NB-UVB and patients with lower MEDs should be preferentially treated in the morning when the MED is higher.

Adult-specific Reelin expression alters striatal neuronal organization: implications for neuropsychiatric disorders.

In addition to neuronal migration, brain development, and adult plasticity, the extracellular matrix protein Reelin has been extensively implicated in human psychiatric disorders such as schizophrenia, bipolar disorder, and autism spectrum disorder. Moreover, heterozygous reeler mice exhibit features reminiscent of these disorders, while overexpression of Reelin protects against its manifestation. However, how Reelin influences the structure and circuits of the striatal complex, a key region for the above-mentioned disorders, is far from being understood, especially when altered Reelin expression levels are found at adult stages. In the present study, we took advantage of complementary conditional gain- and loss-of-function mouse models to investigate how Reelin levels may modify adult brain striatal structure and neuronal composition. Using immunohistochemical techniques, we determined that Reelin does not seem to influence the striatal patch and matrix organization (studied by µ-opioid receptor immunohistochemistry) nor the density of medium spiny neurons (MSNs, studied with DARPP-32). We show that overexpression of Reelin leads to increased numbers of striatal parvalbumin- and cholinergic-interneurons, and to a slight increase in tyrosine hydroxylase-positive projections. We conclude that increased Reelin levels might modulate the numbers of striatal interneurons and the density of the nigrostriatal dopaminergic projections, suggesting that these changes may be involved in the protection of Reelin against neuropsychiatric disorders.

Does depression mediate the pain-frailty relationship? Latent variables approach.

Frailty is highly prevalent among older adults. This study aims to add evidence to the mediational role of depression in the pain-frailty relationship. Data came from a sample of 2578 Spanish older adults recruited from the Survey of Health, Aging, and Retirement in Europe (SHARE). A set of competing structural equation models were performed: (a) independent prediction, (b) full mediation, and (c) partial mediation. Results showed a better fit for the partial mediation model. This model was extended including covariates. The effects of pain and depression remained relevant in the final model, which explained 91% of the frailty variance. These findings support the relevance of the pain-depression dyad in frailty development. Although the pain shows a direct impact on frailty, this association is partially mediated by depression. The interplay of these conditions could be crucial for treatment effectiveness.

Early Experience of Inner Branch Retrograde Cannulation With E-nside Branch Stent Graft for Thoracoabdominal Aortic Aneurysms.

PURPOSE: The aim of our study is to investigate the feasibility of retrograde cannulation using devices with inner branches (IB) for the endovascular treatment of thoracoabdominal aortic aneurysms (TAAAs). MATERIALS AND METHODS: A retrospective analysis using IB configuration with retrograde cannulation was carried out on TAAAs patients undergoing endovascular treatment. RESULTS: Seven patients underwent IB endovascular treatment with retrograde cannulation between September 2020 and November 2021. The mean age was 80.4 years and 4 patients were male. A total of 26 of 28 target vessels were cannulated by retrograde access with a technical success of 93% (2 of 26 target vessels). Two intra-procedural complications were observed (1 renal artery dissection and 1 collateral renal artery rupture). In total, 26 of 28 treated vessels were retrograde cannulated with a technical success of 93%. A total of 39 stent bridges were used (all Viabahn VBX devices). The mean duration of the procedure was 321±102 minutes, and the mean scan time was 134±62 minutes. Mortality at 30 days was observed in 1 case. During the follow-up, 1 stent bridge occlusion was observed without the need for reintervention. CONCLUSION: Retrograde cannulation can also be successfully performed in the case of inner branches. CLINICAL IMPACT: In inner branched cases, retrograde cannulation should be taken into consideration in particular cases or it could become the option of choice. Dedicated endovascular material available such as steerable catheters and latest generation covered stents is fundamental for the success of the treatment.

A Psychometric Study of the Prosocial Behavior Scale: Differential Item Functioning by Gender.

Some scales co-exist in the literature to measure prosocial behavior in adolescents. Gender differences in prosocial behavior have been a controversial topic of research. To strengthen future research in the area, the psychometric properties of the most used instruments must be guaranteed, especially its gender non-bias. Our study provides psychometric evidence for the Prosocial Behavior Scale in a sample of adolescents, exploring: (a) its factor structure; (b) reliability; (c) gender-related differential item functioning (DIF); (d) nomological validity. A sample of 512 high school students (mean age = 13.62 (SD = 1.34), 51.6% females) participated in the research. Confirmatory Factor Analysis (CFA) was used to test the factor structure of the scale, which adequately fitted the data (χ2 (35) = 152.224, p < 0.001, Comparative Fit Index (CFI) = 0.905, Root Mean Squared Error of Approximation (RMSEA) = 0.085 90%CI [0.072-0.099], Standardized Root Mean Squared Residual (SRMR) = 0.079). Reliability results were good (α = 0.74, ω = 0.74). Regarding the DIF, five items presented some gender-related bias, generally benefiting females. However, the DIF impact could be considered negligible. Correlations with the subdimensions of the psychological capital offered evidence of the nomological validity of the scale. In conclusion, the scale presented adequate psychometric properties that support its ability to effectively assess prosocial behavior and gender differences in the prosocial behavior samples of adolescents. Additionally, the results obtained imply that gender differences in the manifestations of prosocial behavior require measurements that can fairly sample behaviors characteristic of each gender.

Single-center results of the Gore Excluder Conformable Endoprosthesis with active control system in endovascular aneurysm repair.

BACKGROUND: The GORE EXCLUDER Conformable Endoprosthesis with active control (CEXC) was developed to treat challenging aortic neck anatomy. This study investigated the clinical results and changes in endograft (ap)position during follow-up. METHODS: Patients treated with the CEXC between 2018 and 2022 were included in this prospective single-center study. Computed tomography angiography (CTA) follow-up was grouped into three categories: 0 to 6 (FU1), 7 to 18 (FU2), and 19 to 30 (FU3) months. Clinical end points were endograft-associated complications and reinterventions. CTA analysis included the shortest apposition length (SAL) between the endograft fabric and the first slice where circumferential apposition was lost, shortest fabric distance (SFD) between both renal arteries and the endograft fabric, and maximum infrarenal and suprarenal aortic curvature. FU2 and FU3 were compared with FU1 to establish changes. RESULTS: Included were 46 patients, of whom 36 (78%) had at least one hostile neck feature and 13 (28%) were treated outside instructions for use. Technical success was 100%. Median CTA follow-up was 10 months (2-20 months); 39 patients had a CTA available at FU1, 22 at FU2, and 12 at FU3. At FU1, the median SAL was 21.4 mm (13.2-27.4 mm), which did not significantly change during follow-up. No type I endoleaks, and one type III endoleak at an IBD occurred during follow-up. Two cases of endograft migration (SFD increase >10 mm) were seen during follow-up (one treated outside the instructions for use). Maximum infrarenal and suprarenal aortic curvature did not significantly change during follow-up. CONCLUSIONS: The use of the CEXC in challenging aortic necks enables stable apposition without significant changes in aortic morphology at short-term follow-up.

Method Effects Associated to Item Valence: Evidence From the 10-Item Big-Five Inventory in Older Adults.

The objective of this study is to analyze the factor structure of the BFI-10 considering item valence effects when applied to measure older adults. Likewise, this study aims to estimate the factorial structure, internal consistency of the scale, to assess the nomological validity, and the association of the Big Five traits with age. 75,078 participants with mean age of 68.27 from the 7th Wave of the SHARE study were included. Confirmatory Factor Analyses, omega coefficients and Pearson correlations were estimated. The best-fit model identified a five-factor structure with two valence effects, internal consistency ranged from .26 to .64, the nomological network showed that loneliness is negatively associated to neuroticism and positively with the other four traits, and the opposite direction in the associations with the five traits and satisfaction and quality of life. Consciousness, Extraversion and Openness have been found as dimensions that tend to decrease with age.

Learning Strategies and Entrepreneurial Attitudes: A Predictive Model of Entrepreneurship Intention in Peruvian Undergraduate Students / Estrategias de aprendizaje y actitudes emprendedoras: un modelo predictivo de la intención emprendedora en estudiantes universitarios peruanos / Estratégias de aprendizagem e atitudes empreendedoras: um modelo preditivo de intenção empreendedora em estudantes universitários peruanos

This study aims to empirically test how learning strategies would fit into an undergraduate entrepreneur's profile.The design is cross-sectional with a sample of 527 The tested structural model adequately fits the data. It provided helpful information on learning strategies and entrepreneurial attitudes accounting for up to 20 % of variance of entrepreneurship intention. The learning strategies most related to entrepreneurial attitudes are those related to creativity, transference, and assess-ment of one's own performance. This paper provides for the first time evidence about the predictive power of several learning strategies on the entrepreneurial attitudes in connection with entrepreneurship intention (willingness and likelihood). This work increases our understanding of entrepreneurs' learning strategies, so that we can improve the design and implementation of educational resources to promote entrepreneurs' careers in emerging markets.Peruvian undergraduate students. A structural equation model was specified, estimated, and tested in Mplus 8.4. The model hypothesized direct effects of the different learning strategies on a factor of entrepreneurial attitudes (considering proactivity, pro-fessional ethics, empathy, innovation, autonomy, and risktaking dimensions) which, in turn, explained two indicators of entrepreneurship intention as outcomes.

Este estudio busca comprobar empíricamente cómo las estrategias de aprendizaje encajarían en el perfil de un emprendedor de pregrado. El diseño es transversal, con una muestra de 527 estudiantes peruanos de pregrado. Se especificó, estimó y probó un modelo de ecuaciones estructurales en M plus 8.4. El modelo hipotetizó efectos directos de las diferentes estrategias de aprendizaje sobre un factor de actitudes emprendedoras (considerando las dimensiones de proactividad, ética profesional, empatía, innovación, autonomía y asunción de riesgos) que, a su vez, explicaban dos indicadores de intención emprendedora como resultados. El modelo estructural probado se ajusta adecuadamente a los datos. Proporcionó información útil sobre las estrategias de aprendizaje y las actitudes emprendedoras que explican hasta el 20 % de la varianza de la intención emprende-dora. Las estrategias de aprendizaje más relacionadas con las actitudes emprendedoras son las relaciona-das con la creatividad, la transferencia y la evaluación del propio rendimiento. Esta investigación proporciona la primera evidencia acerca del poder predictivo de varias estrategias de aprendizaje sobre las actitudes emprendedoras, en relación con la intención emprendedora (voluntad y probabilidad). Asimismo, aumenta nuestra comprensión de las estrategias de aprendizaje de los emprendedores, de modo que podamos mejorar el diseño y la implementación de recursos educativos para promover las carreras de los emprendedores en los mercados emergentes.

Este estudo teve como objetivo verificar empiricamente como as estratégias de aprendizagem se encaixariam no perfil de um empreendedor de graduação. O desenho é transversal com uma amostra de 527 estudantes de graduação peruanos. Um modelo de equação estrutural foi especificado, estimado e testado no Mplus 8.4. O modelo hipotetizou efeitos diretos das diferentes estratégias de aprendizagem sobre um fator de atitudes empreendedoras (considerando as dimensões de proatividade, ética profissional, empatia, inovação, autonomia e assunção de riscos) que, por sua vez, explicaram como resultados dois indicadores de intenção empreendedora. O modelo estrutural testado ajustase adequadamente aos dados. Forneceu informações úteis sobre estratégias de aprendizagem e atitudes empreendedoras que explicam até 20 % da variância da intenção empreendedora. As estratégias de aprendizagem mais relacionadas com as atitudes em-preendedoras são as relacionadas com a criatividade, a transferência e a avaliação do próprio desempenho. Este trabalho fornece a primeira evidência analisando o poder preditivo de várias estratégias de aprendizagem sobre as atitudes empreendedoras em relação à intenção empreendedora (vontade e probabilidade). Este trabalho aumenta nossa compreensão das estratégias de aprendizagem dos empreendedores para que possamos melhorar o desenho e a implementação de recursos educacionais para fomentar a carreira dos empreendedores em mercados emergentes.

Diet-Related Phototoxic Reactions in Psoriatic Patients Undergoing Phototherapy: Results from a Multicenter Prospective Study.

Vegans and vegetarians often consume foods containing photosensitizers capable of triggering phytophotodermatitis. The potential effect of vegan and vegetarian diets on the response of psoriatic patients undergoing phototherapy is not well characterized. We assessed clinical outcomes of vegan, vegetarian and omnivore adult psoriatic patients undergoing band ultraviolet B phototherapy (NB-UVB). In this multicenter prospective observational study, we enrolled 119 adult, psoriatic patients, of whom 40 were omnivores, 41 were vegetarians and 38 were vegans, with phototherapy indication. After determining the minimum erythemal dose (MED), we performed NB-UVB sessions for 8 weeks. The first irradiation dosage was 70.00% of the MED, then increased by 20.00% (no erythema) or by 10.00% (presence of erythema) until a maximum single dose of 3 J/cm2 was reached and constantly maintained. All the enrolled patients completed the 8 weeks of therapy. Severe erythema was present in 16 (42.11%) vegans, 7 (17.07%) vegetarians and 4 (10.00%) omnivores (p < 0.01). MED was lowest among vegans (21.18 ± 4.85 J/m2), followed by vegetarians (28.90 ± 6.66 J/m2) and omnivores (33.63 ± 4.53 J/m2, p < 0.01). Patients with severe erythema were more likely to have a high furocumarin intake (OR 5.67, 95% CI 3.74-8.61, p < 0.01). Vegans consumed the highest amount of furocumarin-rich foods. A model examining erythema, adjusted for gender, age, skin type, MED, phototherapy type, number of phototherapies and furocumarin intake, confirmed that vegans had a lower number of treatments. Vegans had more frequent severe erythema from NB-UVB, even after adjustment of the phototherapy protocol for their lower MED. Assessing diet information and adapting the protocol for vegan patients may be prudent.

Initial Clinical Experience With a New Conformable Abdominal Aortic Endograft: Aortic Neck Coverage and Curvature Analysis in Challenging Aortic Necks.

OBJECTIVES: Aim of this work was to investigate precision of deployment and conformability of a new generation GORE EXCLUDER Conformable Endoprosthesis with active control system (CEXC Device, W.L. Gore and Associates, Flagstaff, AZ, USA) by analyzing aortic neck coverage and curvature. METHODS: All consecutive elective patients affected by abdominal aortic aneurysm or aortoiliac aneurysm treated at our institution between November 2018 and June 2019 with the new CEXC Device were enrolled. Validated software was adopted to determine the available apposition surface area into the aortic neck, apposition of the endograft to the aortic wall, shortest apposition length (SAL), shortest distance between the endograft fabric and the lowest renal arteries (SFD) and between the endograft fabric and the contralateral renal artery (CFD). Pointwise centerline curvature was also computed. RESULTS: Twelve patients (10 men, median age 78 years (71.75, 81.0)) with available pre- and postoperative computed tomography angiography (CTA) were included. Technical success was obtained in all the cases. Preoperative median length of the proximal aortic neck was 16.1 mm (10.7, 21.7) and suprarenal (α) and infrarenal (ß) neck angulation were, respectively, 28.9° (15.7°, 47.5°) and 75.0° (66.9°, 81.4°). Postoperative median apposition surface coverage was 79% (69.25%, 90.75%) of the available apposition surface. SFD and CFD were 1.5 mm (0.75, 5.25) and 7 mm (4.5, 21.5), respectively. Average curvature over the infrarenal aorta decreased from 25 m-1 (21.75, 29.0) to 22.5 m-1 (18.75, 24.5) postoperatively (p=0.02). Maximum curvature did not decrease significantly from 64.5 m-1 (54.25, 92.0) to 62 m-1 (41.75, 71.5) (p=0.1). CONCLUSIONS: Our early experience showed that deployment of the CEXC Device is safe and effective for patients with challenging proximal aortic necks. Absence of significant changes between pre- and postoperative proximal aortic neck angulations and curvature confirms the high conformability of this endograft.

COVID-19 Impact on Vascular Surgery Practice: Experience From an Italian University Regional Hub Center for Vascular Pathology.

BACKGROUND: The aim of the study is to evaluate the impact of COVID-19 pandemic on vascular surgery practice in a regional hub center for complex vascular disease. METHODS: This is an observational single-center study in which we collected clinical and surgical data during (P1) and after (P2) the COVID-19 outbreak and the lockdown measures implemented in Northern Italy. We compared those data with the two-month period before the pandemic (P0). RESULTS: Compared to P0, ambulatory activities were severely reduced during P1 and limited to hospitalized patients and outpatients with urgent criteria. We performed 61 operations (18 urgent and 43 elective), with a decrease in both aortic (-17.8%), cerebrovascular (-53.3%), and peripheral artery (-42.6%) disease treatments. We also observed a greater drop in open procedures (-53.2%) than in endovascular ones (-22%). All the elective patients were treated for notdeferrable conditions and they were COVID-19 negative at the ward admission screening; despite this one of them developed COVID19 during the hospital stay. Four COVID-19 positive patients were treated in urgent setting for acute limb ischemia. Throughout P2 we gradually rescheduled elective ambulatory (+155.5%) and surgical (+18%) activities, while remaining substantially lower than during P0 (respectively -45.6% and -25.7%). CONCLUSIONS: Despite COVID-19 pandemic, our experience shows that with careful patient's selection, dedicated prehospitalization protocol and proper use of personal protective equipment it is possible to guarantee continuity of care.

Ultrasound-guided fascia closure as bailout technique for large-bore percutaneous femoral access failure: Report of two cases.

Percutaneous endovascular abdominal aortic aneurysm repair is nowadays considered a safe and effective procedure and has gained widespread globally acceptance. However, intraoperative persistent bleeding due to percutaneous access closure device failure can occur. Open conversion is first-line treatment to manage this complication. The fascia suture technique was introduced as an alternative to access closure device or as a solution to manage unsatisfactory hemostasis during percutaneous endovascular abdominal aortic aneurysm repair. In this article, we report a new simple minimally invasive ultrasound-guided fascia suture technique as a bailout method to manage persistent bleeding after percutaneous endovascular abdominal aortic aneurysm repair avoiding open conversion. This technique was successfully used in two cases at our center with satisfactory hemostasis and no further complications. Ultrasound-guided fascia suture technique can be proposed as a minimally invasive bailout technique for access closure device failure.

Phenotypic changes of HER2-positive breast cancer during and after dual HER2 blockade.

The HER2-enriched (HER2-E) subtype within HER2-positive (HER2+) breast cancer is highly addicted to the HER2 pathway. However, ∼20-60% of HER2+/HER2-E tumors do not achieve a complete response following anti-HER2 therapies. Here we evaluate gene expression data before, during and after neoadjuvant treatment with lapatinib and trastuzumab in HER2+/HER2-E tumors of the PAMELA trial and breast cancer cell lines. Our results reveal that dual HER2 blockade in HER2-E disease induces a low-proliferative Luminal A phenotype both in patient's tumors and in vitro models. These biological changes are more evident in hormone receptor-positive (HR+) disease compared to HR-negative disease. Interestingly, increasing the luminal phenotype with anti-HER2 therapy increased sensitivity to CDK4/6 inhibition. Finally, discontinuation of HER2-targeted therapy in vitro, or acquired resistance to anti-HER2 therapy, leads to restoration of the original HER2-E phenotype. Our findings support the use of maintenance anti-HER2 therapy and the therapeutic exploitation of subtype switching with CDK4/6 inhibition.

Publisher Correction: MSK1 regulates luminal cell differentiation and metastatic dormancy in ER+ breast cancer.

In the version of this Article originally published, the boxes framing the two plots in Fig. 1g were misaligned from the axes due to a technical error. This has now been corrected in all versions of the Article.

Regulation of Mammary Luminal Cell Fate and Tumorigenesis by p38α.

Mammary stem and progenitor cells are essential for mammary gland homeostasis and are also candidates for cells of origin of mammary tumors. Here, we have investigated the function of the protein kinase p38α in the mammary gland using mice that delete this protein in the luminal epithelial cells. We show that p38α regulates the fate of luminal progenitor cells through modulation of the transcription factor RUNX1, an important controller of the estrogen receptor-positive cell lineage. We also provide evidence that the regulation of RUNX1 by p38α probably involves the kinase MSK1, which phosphorylates histone H3 at the RUNX1 promoter. Moreover, using a mouse model for breast cancer initiated by luminal cells, we show that p38α downregulation in mammary epithelial cells reduces tumor burden, which correlates with decreased numbers of tumor-initiating cells. Collectively, our results define a key role for p38α in luminal progenitor cell fate that affects mammary tumor formation.