Fine-root traits in the global spectrum of plant form and function.

Plant traits determine how individual plants cope with heterogeneous environments. Despite large variability in individual traits, trait coordination and trade-offs1,2 result in some trait combinations being much more widespread than others, as revealed in the global spectrum of plant form and function (GSPFF3) and the root economics space (RES4) for aboveground and fine-root traits, respectively. Here we combine the traits that define both functional spaces. Our analysis confirms the major trends of the GSPFF and shows that the RES captures additional information. The four dimensions needed to explain the non-redundant information in the dataset can be summarized in an aboveground and a fine-root plane, corresponding to the GSPFF and the RES, respectively. Both planes display high levels of species aggregation, but the differentiation among growth forms, families and biomes is lower on the fine-root plane, which does not include any size-related trait, than on the aboveground plane. As a result, many species with similar fine-root syndromes display contrasting aboveground traits. This highlights the importance of including belowground organs to the GSPFF when exploring the interplay between different natural selection pressures and whole-plant trait integration.

Changes in the functional diversity of modern bird species over the last million years.

Despite evidence of declining biosphere integrity, we currently lack understanding of how the functional diversity associated with changes in abundance among ecological communities has varied over time and before widespread human disturbances. We combine morphological, ecological, and life-history trait data for >260 extant bird species with genomic-based estimates of changing effective population size (Ne) to quantify demographic-based shifts in avian functional diversity over the past million years and under pre-anthropogenic climate warming. We show that functional diversity was relatively stable over this period, but underwent significant changes in some key areas of trait space due to changing species abundances. Our results suggest that patterns of population decline over the Pleistocene have been concentrated in particular regions of trait space associated with extreme reproductive strategies and low dispersal ability, consistent with an overall erosion of functional diversity. Further, species most sensitive to climate warming occupied a relatively narrow region of functional space, indicating that the largest potential population increases and decreases under climate change will occur among species with relatively similar trait sets. Overall, our results identify fluctuations in functional space of extant species over evolutionary timescales and represent the demographic-based vulnerability of different regions of functional space among these taxa. The integration of paleodemographic dynamics with functional trait data enhances our ability to quantify losses of biosphere integrity before anthropogenic disturbances and attribute contemporary biodiversity loss to different drivers over time.

Contrasting impacts of non-native and threatened species on morphological, life history, and phylogenetic diversity in bird assemblages.

Human activities have altered the species composition of assemblages through introductions and extinctions, but it remains unclear how those changes can affect the different facets of biodiversity. Here we assessed the impact of changes in species composition on taxonomic, functional, and phylogenetic diversity across 281 bird assemblages worldwide. To provide a more nuanced understanding of functional diversity, we distinguished morphological from life-history traits. We showed that shifts in species composition could trigger a global decline in avian biodiversity due to the high number of potential extinctions. Moreover, these extinctions were not random but unique in terms of function and phylogeny at the regional level. Our findings demonstrated that non-native species cannot compensate for these losses, as they are both morphologically and phylogenetically close to the native fauna. In the context of the ongoing biodiversity crisis, such alterations in the functional and phylogenetic structure of bird assemblages could heighten ecosystem vulnerability.

Island biodiversity in peril: Anticipating a loss of mammals' functional diversity with future species extinctions.

Islands are biodiversity hotspots that host unique assemblages. However, a substantial proportion of island species are threatened and their long-term survival is uncertain. Identifying and preserving vulnerable species has become a priority, but it is also essential to combine this information with other facets of biodiversity like functional diversity, to understand how future extinctions might affect ecosystem stability and functioning. Focusing on mammals, we (i) assessed how much functional space would be lost if threatened species go extinct, (ii) determined the minimum number of extinctions that would cause a significant functional loss, (iii) identified the characteristics (e.g., biotic, climatic, geographic, or orographic) of the islands most vulnerable to future changes in the functional space, and (iv) quantified how much of that potential functional loss would be offset by introduced species. Using trait information for 1474 mammal species occurring in 318 islands worldwide, we built trait probability density functions to quantify changes in functional richness and functional redundancy in each island if the mammals categorized by IUCN as threatened disappeared. We found that the extinction of threatened mammals would reduce the functional space in 63% of the assessed islands, although these extinctions in general would cause a reduction of less than 15% of their overall functional space. Also, on most islands, the extinction of just a few species would be sufficient to cause a significant loss of functional diversity. The potential functional loss would be higher on small, isolated, and/or species-rich islands, and, in general, the functional space lost would not be offset by introduced species. Our results show that the preservation of native species and their ecological roles remains crucial for maintaining the current functioning of island ecosystems. Therefore, conservation measures considering functional diversity are imperative to safeguard the unique functional roles of threatened mammal species on islands.

Internal and External Load Profile during Beach Invasion Sports Match-Play by Electronic Performance and Tracking Systems: A Systematic Review.

Beach variants of popular sports like soccer and handball have grown in participation over the last decade. However, the characterization of the workload demands in beach sports remains limited compared to their indoor equivalents. This systematic review aimed to: (1) characterize internal and external loads during beach invasion sports match-play; (2) identify technologies and metrics used for monitoring; (3) compare the demands of indoor sports; and (4) explore differences by competition level, age, sex, and beach sport. Fifteen studies ultimately met the inclusion criteria. The locomotive volumes averaged 929 ± 269 m (average) and 16.5 ± 3.3 km/h (peak) alongside 368 ± 103 accelerations and 8 ± 4 jumps per session. The impacts approached 700 per session. The heart rates reached 166-192 beats per minute (maximal) eliciting 60-95% intensity. The player load was 12.5 ± 2.9 to 125 ± 30 units. Males showed 10-15% higher external but equivalent internal loads versus females. Earlier studies relied solely on a time-motion analysis, while recent works integrate electronic performance and tracking systems, enabling a more holistic quantification. However, substantial metric intensity zone variability persists. Beach sports entail intermittent high-intensity activity with a lower-intensity recovery. Unstable surface likely explains the heightened internal strain despite moderately lower running volumes than indoor sports. The continued integration of technology together with the standardization of workload intensity zones is needed to inform a beach-specific training prescription.

Surfing Time-Motion Characteristics Possible to Gain Using Global Navigation Satellite Systems: A Systematic Review.

The popularity of surfing has increased exponentially, reaching its recent debut in the Olympic Games. However, surfing suffers from a relative immature technological market, while in other sports some technologies such as global navigation satellite systems (GNSSs) have become an essential work material for strength and conditioning and head coaches. This article aims to systematically review surfers' time-motion demands based on GNSSs. A systematic review of relevant articles was carried out using five main databases (PubMed, ProQuest Central, SCOPUS, SPORTDiscus, and FECYT (Web of Sciences, CCC, CIDW, KJD, MEDLINE, RSCI, and SCIELO)) until 23 March 2024. From the 238 studies initially found, 9 were included in the qualitative synthesis. In these, GNSS devices were employed with male (n = 143) and female (n = 28) surfers from different levels during competition and training situations. The studies show that the intermittent nature of the sport is evident, with substantial periods spent paddling and waiting punctuated by relatively brief high-intensity efforts when riding waves at high speeds. Notable differences emerged between competition and training demands, suggesting potential mismatches in how athletes currently prepare compared to event requirements. These novel insights allow quantifying surfing's harsh physiological requirements and could guide conditioning practices to better meet the sport's unique characteristics across populations. Therefore, training should emulate the lengthy aerobic capabilities needed for the paddling volumes observed, while also targeting the anaerobic systems to meet the repeated high-intensity surf riding efforts. However, inconsistencies in methods and reporting practices limit direct comparisons and comprehensive profiling of the sport's physical characteristics.

Examining the Effects of Altitude on Workload Demands in Professional Basketball Players during the Preseason Phase.

Basketball involves frequent high-intensity movements requiring optimal aerobic power. Altitude training can enhance physiological adaptations, but research examining its effects in basketball is limited. This study aimed to characterize the internal/external workload of professional basketball players during preseason and evaluate the effects of altitude and playing position. Twelve top-tier professional male basketball players (Liga Endesa, ACB; guards: n = 3, forwards: n = 5, and centers: n = 4) participated in a crossover study design composed of two training camps with nine sessions over 6 days under two different conditions: high altitude (2320 m) and sea level (10 m). Internal loads (heart rate, %HRMAX) and external loads (total distances covered across speed thresholds, accelerations/decelerations, impacts, and jumps) were quantified via wearable tracking and heart rate telemetry. Repeated-measures MANOVA tested the altitude x playing position effects. Altitude increased the total distance (+10%), lower-speed running distances (+10-39%), accelerations/decelerations (+25-30%), average heart rate (+6%), time in higher-intensity HR zones (+23-63%), and jumps (+13%) across all positions (p < 0.05). Positional differences existed, with guards accruing more high-speed running and centers exhibiting greater cardiovascular demands (p < 0.05). In conclusion, a 6-day altitude block effectively overloads training, providing a stimulus to enhance fitness capacities when structured appropriately. Monitoring workloads and individualizing training by playing position are important when implementing altitude training, given the varied responses.

Intensity Thresholds for External Workload Demands in Basketball: Is Individualization Based on Playing Positions Necessary?

Currently, basketball teams use inertial devices for monitoring external and internal workload demands during training and competitions. However, the intensity thresholds preset by device manufacturers are generic and not adapted for specific sports (e.g., basketball) and players' positions (e.g., guards, forwards, and centers). Using universal intensity thresholds may lead to failure in accurately capturing the true external load faced by players in different positions. Therefore, the present study aimed to identify external load demands based on playing positions and establish different intensity thresholds based on match demands in order to have specific reference values for teams belonging to the highest competitive level of Spanish basketball. Professional male players (n = 68) from the Spanish ACB league were monitored during preseason official games. Three specific positions were used to group the players: guards, forwards, and centers. Speed, accelerations, decelerations, impacts/min, and player load/min were collected via inertial devices. Two-step clustering and k-means clustering categorized load metrics into intensity zones for guards, forwards, and centers. Guards covered more distance at high speeds (12.72-17.50 km/h) than forwards and centers (p < 0.001). Centers experienced the most impacts/min (p < 0.001). Guards exhibited greater accelerations/decelerations, albeit mostly low magnitude (p < 0.001). K-means clustering allowed the setting of five zones revealing additional thresholds. All positions showed differences in threshold values (p < 0.001). The findings provide insights into potential disparities in the external load during competition and help establish position-specific intensity thresholds for optimal monitoring in basketball. These data are highly applicable to the design of training tasks at the highest competitive level.

Observed and dark diversity dynamics over millennial time scales: fast life-history traits linked to expansion lags of plants in northern Europe.

Global change drivers (e.g. climate and land use) affect the species and functional traits observed in a local site but also its dark diversity-the set of species and traits locally suitable but absent. Dark diversity links regional and local scales and, over time, reveals taxa under expansion lags by depicting the potential biodiversity that remains suitable but is absent locally. Since global change effects on biodiversity are both spatially and temporally scale dependent, examining long-term temporal dynamics in observed and dark diversity would be relevant to assessing and foreseeing biodiversity change. Here, we used sedimentary pollen data to examine how both taxonomic and functional observed and dark diversity changed over the past 14 500 years in northern Europe. We found that taxonomic and functional observed and dark diversity increased over time, especially after the Late Glacial and during the Late Holocene. However, dark diversity dynamics revealed expansion lags related to species' functional characteristics (dispersal limitation and stress intolerance) and an extensive functional redundancy when compared to taxa in observed diversity. We highlight that assessing observed and dark diversity dynamics is a promising tool to examine biodiversity change across spatial scales, its possible causes, and functional consequences.

Functional trait trade-offs define plant population stability across different biomes.

Ecological theory posits that temporal stability patterns in plant populations are associated with differences in species' ecological strategies. However, empirical evidence is lacking about which traits, or trade-offs, underlie species stability, especially across different biomes. We compiled a worldwide collection of long-term permanent vegetation records (greater than 7000 plots from 78 datasets) from a large range of habitats which we combined with existing trait databases. We tested whether the observed inter-annual variability in species abundance (coefficient of variation) was related to multiple individual traits. We found that populations with greater leaf dry matter content and seed mass were more stable over time. Despite the variability explained by these traits being low, their effect was consistent across different datasets. Other traits played a significant, albeit weaker, role in species stability, and the inclusion of multi-variate axes or phylogeny did not substantially modify nor improve predictions. These results provide empirical evidence and highlight the relevance of specific ecological trade-offs, i.e. in different resource-use and dispersal strategies, for plant populations stability across multiple biomes. Further research is, however, necessary to integrate and evaluate the role of other specific traits, often not available in databases, and intraspecific trait variability in modulating species stability.

Anticoagulation and hemostasis on extracorporeal membrane oxygenation.

PURPOSE OF REVIEW: The purpose of this review is to describe the hemostatic changes induced by extracorporeal membrane oxygenation (ECMO), the need to balance the risks of bleeding and clotting with anticoagulation and hemostatic transfusions, and the inherent risks to these interventions. RECENT FINDINGS: Both bleeding and clotting are frequent complications of ECMO. To prevent clotting events, virtually, all children are anticoagulated. However, the optimal anticoagulation strategy is unknown. A recent systematic review of observational studies showed that anti-Xa-guided strategies were associated with a two-fold decrease in bleeding and no increase in clotting complications. These results need to be tested in randomized controlled trials. To avoid bleeding events, platelet transfusions are frequently prescribed to children on ECMO. However, platelet transfusions have recently been shown to be independently associated with increased bleeding and clotting. Therefore, the optimal platelet transfusion strategy must be evaluated appropriately. SUMMARY: Most patients on ECMO will develop either a hemorrhagic or thrombotic complication. Balancing these risks involves careful titration of anticoagulation to prevent clotting and hemostatic transfusions to prevent bleeding. As the current level of evidence is low, prospective randomized trials are needed.

Identifying global conservation priorities for terrestrial vertebrates based on multiple dimensions of biodiversity.

The Kunming-Montreal Global Biodiversity Framework of the Convention on Biological Diversity calls for an expansion of the current protected areas (PAs) to cover at least 30% of global land and water areas by 2030 (i.e., the 30×30 target). Efficient spatial planning for PA expansion is an urgent need for global conservation practice. A spatial prioritization framework considering multiple dimensions of biodiversity is critical for improving the efficiency of the spatial planning of PAs, yet it remains a challenge. We developed an index for the identification of priority areas based on functionally rare, evolutionarily distinct, and globally endangered species (FREDGE) and applied it to 21,536 terrestrial vertebrates. We determined species distributions, conservation status (global endangerment), molecular phylogenies (evolutionary distinctiveness), and life-history traits (functional rarity). Madagascar, Central America, and the Andes were of high priority for the conservation of multiple dimensions of terrestrial vertebrate biodiversity. However, 68.8% of grid cells in these priority areas had <17% of their area covered by PAs, and these priority areas were under intense anthropogenic and climate change threats. These results highlight the difficulties of conserving multiple dimensions of biodiversity. Our global analyses of the geographical patterns of multiple dimensions of terrestrial vertebrate biodiversity demonstrate the insufficiency of the conservation of different biodiversity dimensions, and our index, based on multiple dimensions of biodiversity, provides a useful tool for guiding future spatial prioritization of PA expansion to achieve the 30×30 target under serious pressures.

+Identificación de las prioridades mundiales de conservación para los vertebrados terrestres con base en varias dimensiones de la biodiversidad Resumen El Marco Mundial de Biodiversidad de Kunming-Montreal del Convenio sobre Diversidad Biológica demanda la expansión de las áreas protegidas actuales (AP) para que cubran al menos el 30% de las áreas marinas y terrestres para el 2030 (el objetivo 30×30). La conservación mundial necesita con urgencia de la planeación espacial eficiente para que la expansión de las AP. Es importante tener un marco de priorización espacial que considere varias dimensiones de la biodiversidad para mejorar la eficiencia de la planeación espacial de las AP, sin embargo, esto todavía es un reto. Desarrollamos un índice para identificar las áreas prioritarias con base en las especies funcionalmente raras, evolutivamente distintas y en peligro mundial (FREDGE, en inglés). Aplicamos este índice a 21,536 especies de vertebrados terrestres y determinamos su distribución, estado de conservación (peligro mundial), filogenia molecular (singularidad evolutiva) y características de la historia de vida (rareza funcional). Madagascar, América Central y los Andes representaron una gran prioridad para la conservación de varias dimensiones de la biodiversidad de vertebrados terrestres. Sin embargo, el 68.8% de las celdas de la cuadrícula en estas áreas prioritarias tuvieron <17% de su área cubierta por AP, y estas áreas prioritarias estaban sometidas a amenazas intensas de origen antropogénicas y de cambio climático. Estos resultados resaltan las dificultades de conservar las diferentes dimensiones de la biodiversidad. Nuestro análisis mundial de los patrones geográficos de las diferentes dimensiones de la biodiversidad de vertebrados terrestres demuestra la insuficiencia de la conservación de diferentes dimensiones de la biodiversidad y nuestro índice basado en varias dimensiones de la biodiversidad proporciona una herramienta útil para orientar en el futuro la priorización espacial de la expansión de AP para lograr el objetivo 30×30 bajo presión severa.

Synchrony matters more than species richness in plant community stability at a global scale.

The stability of ecological communities is critical for the stable provisioning of ecosystem services, such as food and forage production, carbon sequestration, and soil fertility. Greater biodiversity is expected to enhance stability across years by decreasing synchrony among species, but the drivers of stability in nature remain poorly resolved. Our analysis of time series from 79 datasets across the world showed that stability was associated more strongly with the degree of synchrony among dominant species than with species richness. The relatively weak influence of species richness is consistent with theory predicting that the effect of richness on stability weakens when synchrony is higher than expected under random fluctuations, which was the case in most communities. Land management, nutrient addition, and climate change treatments had relatively weak and varying effects on stability, modifying how species richness, synchrony, and stability interact. Our results demonstrate the prevalence of biotic drivers on ecosystem stability, with the potential for environmental drivers to alter the intricate relationship among richness, synchrony, and stability.

Kidney transplantation reduces the risk of chronic limb threatening ischemia and amputation among patients with end-stage renal disease on hemodialysis.

OBJECTIVE: This study aimed to analyze the risk of chronic limb threatening ischemia (CLTI) or amputation among patients with end-stage renal disease (ESRD) entering a hemodialysis (HD) program and to evaluate the protective effect associated with kidney transplantation (KT). DESIGN, MATERIAL AND METHODS: Retrospective cohort of all consecutive ESRD patients entering into a HD program at our institution between 2000 and 2010. Collected variables included baseline characteristics (pre-entry in hemodialysis), time on HD program, KT and the composite outcome of chronic limb threatening ischemia or need for any amputation (CLTI/AMP). Patients with previous symptomatic peripheral arterial disease or amputation were excluded. RESULTS: The study group included 336 patients (mean age 63 years, 66% male). The mean follow up was 6.7 years with an average time on HD of 4.2 years. Ninety two patients (27.4 %) underwent transplantation. CLTI free survival rates were 90.3 % and 82.6 % at 5 and 10 years, respectively. The episodes of CLT involved 28 revascularization procedures (17 endovascular and 11 open surgeries), 18 minor amputations and 20 major amputations. KT was associated with a protective effect over the development of CLTI (HR: 0.065; CI 95% 0.02-0.21) after adjustment for confounding factors. The long-term survival of non-transplanted patients was 45 % and 15 % at 5 and 10 years, respectively and the long-term survival in transplanted patients was 89% and 80% at 5 and 10 years, respectively; but decreased to 47 % at 1 year and 18.2 % at 5 years once CLTI occurred. CONCLUSION: Patients on HD program show a notorious risk of chronic limb threatening ischemia or amputation over time. Once this complication occurs, patient's survival is markedly reduced. Transplantation confers an independent protective effect over the development of chronic limb threatening ischemia or amputation.

Cardiac manifestations of multisystem inflammatory syndrome of children after SARS-CoV-2 infection: a systematic review and meta-analysis.

This systematic review and meta-analysis were conducted to evaluate the prevalence of cardiac manifestations associated with multisystem inflammatory syndrome in children worldwide. We conducted electronic searches in Ovid MEDLINE, Ovid EMBASE, and the World Health Organization COVID-19 Literature Database from the inception of the SARS-CoV-2 pandemic to 1 January, 2022. Three authors independently screened the abstracts to determine eligibility, assessed methodology in the full texts, and extracted the data.We identified 2848 citations; 94 studies (14,932 patients) were included. The prevalence of vasopressors was 48.2% (95% CI 45.1%, 51.3%), left ventricular systolic dysfunction occurred in 37.2% (95% CI 34.1%, 40.3%), myocarditis in 34.1% (95% CI 30.5%, 37.8%), electrocardiographic dysrhythmias and abnormalities detected in 23.1% (95% CI 18.8%, 27.6%), coronary abnormalities identified in 18% (95% CI 16%, 20%), extracorporeal membrane oxygenation deployed in 2.2% (95% CI 1.7%, 2.8%), and mortality rate of 2.2% (95% CI 1.7%, 2.7%). A sensitivity analysis was performed after removing eleven studies with high bias, and the adjusted prevalence was not different than the original evaluation.In this meta-analysis of the largest cohort of multisystem inflammatory syndrome in children patients to date, we established the most accurate prevalence of the most common cardiac manifestations. Providers will subsequently have more precise data to anticipate patient outcomes and approach discussions concerning the frequency of monitoring outside the acute hospital period.

Crucial workload variables in female-male elite Brazilian Beach Handball: An exploratory factor analysis.

This study aimed to identify the most important variables of male and female beach handball workload demands and compare them by sex. A total of 92 elite Brazilian beach handball players (54 male: age 22.1 ± 2.6 years, height 1.8 ± 0.5 m, weight 77.6 ± 13.4 kg; and 38 female: age 24.4 ± 5.5 years, height 1.7 ± 0.5 m, weight 67.5 ± 6.5 kg) were analyzed in 24 official matches during a four-day congested tournament. From 250 variables measured by the inertial measurement unit, fourteen were extracted for analysis using Principal Component Analysis as selection criteria. Five Principal Components (PC) were extracted that explained 81.2-82.8% of total variance (overview of workload demands during beach handball). Specifically, 36.2-39.3% was explained by PC1 (DistanceExpl, Distance, Distance4-7 km/h, and Acc), 15-18% by PC2 (AccMax, Acc3-4 m/s, Dec4-3 m/s), 10.7-12.9% by PC3 (JumpsAvg Take-Off, JumpsAvg Landing and PLRT), 8-9.4% by PC4 (Distance> 18.1 km/h, SpeedMax), and 6.7-7.7% by PC5 (HRAvg and Step Balance). Sex-related differences were found in the PC distribution of variables, as well as in selected variables (HRAvg, Dec4-3 m/s, Acc3-4 m/s, JumpsAvg Take-Off, JumpsAvg Landing, AccMax, Distance, Distance4-7 km/h, Acc, SpeedMax) with higher values in male players (p < .05). In conclusion, the sex-related PC distribution and workload demands in beach handball should consider for training design and injury prevention programs.

Surgeon and Patient Reports of Fertility Preservation Referral and Uptake in a Prospective, Pan-Canadian Study of Young Women with Breast Cancer.

BACKGROUND: Prompt referral by their surgeon enables fertility preservation (FP) by young women with breast cancer (YWBC) without treatment delay. Following a FP knowledge intervention, we evaluated surgeon and patient reports of fertility discussion, FP referral offer and uptake, and FP choices and reasons for declining FP among patients enrolled in the Reducing Breast Cancer in Young Women, prospective pan-Canadian study. METHODS: Between September 2015 and December 2020, 1271 patients were enrolled at 31 sites. For each patient, surgeons were sent a questionnaire inquiring whether: (1) fertility discussion was initiated by the surgical team; (2) FP referral was offered; (3) referral was accepted; a reason was requested for any "no" response. Patients were surveyed about prediagnosis fertility plans and postdiagnosis oncofertility management. RESULTS: Surgeon questionnaires were completed for 1068 (84%) cases. Fertility was discussed with 828 (84%) and FP consultation offered to 461 (47%) of the 990 YWBC with invasive disease. Among the 906 responding YWBC, referral was offered to 220 (82%) of the 283 (33%) with invasive disease who stated that they had definitely/probably not completed childbearing prediagnosis. Of these, 133 (47%) underwent FP. The two most common reasons for not choosing FP were cost and unwillingness to delay treatment. CONCLUSIONS: Although the rates of surgeon fertility discussion and FP referral was higher than most reports, likely due to our previous intervention, further improvement is desirable. FP should be offered to all YWBC at diagnosis, regardless of perceived childbearing intent. Cost remains an important barrier to FP uptake.

Impact of Target Visceral Vessel Anatomical Configuration on Early Complications Following Endovascular Repair of Thoracoabdominal Aortic Aneurysms.

BACKGROUND: Fenestrated and branched endovascular aortic repair (fEVAR-bEVAR) is a viable treatment option for thoracoabdominal aortic aneurysms but target visceral stent (TVS) endoleak and thrombosis remain a limiting factor. This study aims to evaluate TVS anatomy impact on 1-year risk of thrombosis and endoleak. METHODS: Patients treated with fEVAR-bEVAR for thoracoabdominal aneurysms between 2008 and 2020 in our centre were enrolled. We recorded comorbidities, operative details, 1-month postoperative CT scan (anatomical reference), and TVS behaviour: thrombosis and endoleak at 1-year follow-up. For each TVS, different points were identified using a centre-lumen-line: (A) TVS origin, (B) end of branch/fenestration, (C) visceral vessel entry, (D) end of TVS, (E) 1-cm distally. We analyzed TVS tortuosity ((centre-lumen-line/straight distance)-1, in %), image vector analysis of each segment in 2D (antero-posterior, left-right) and 3D (craneo-caudal displacement), and centre-lumen-line analysis (bending in ABC and CDE). Three independent observers performed a blind analysis, and anatomical differences between bEVAR/fEVAR, and cases with/without 1-year thrombosis and TVS endoleak, were compared using Kaplan-Meier curves (Log-Rank test), and t-test/Wilcoxon signed-ranks test respectively. RESULTS: Fifty-four patients (72 ± 713 years mean age; 182 TVS: 50 branches, 132 fenestrations) met the inclusion criteria. bEVAR cases had longer stents, with more caudal 3D angulation, and greater ABC angulated segment. After excluding bEVAR cases (low case number), 97 fEVAR TVS were analyzed. Five thrombosis and 7 endoleaks were observed. While anatomical configuration showed no association to thrombosis, it was related to endoleak: these cases presented more tortuous stents (5.97% ± 0.10, 21.40% ± 0,22, P = 0.011), with more angulated centre-lumen-line at ABC segment (5.69° ± 15.77°, 7.18° ± 7.77°, P = 0.012), and more upward-pointing stents in the origin of the stent (AB: 89.07° ± 24.46°, 109.09° ± 16.56°, P = 0.012; BC: 87.86° ± 21.10°, 113.11° ± 22.23°, P = 0.026). CONCLUSIONS: Anatomical configuration of the TVS is associated with type III endoleak, but not thrombosis, at 1-year following fEVAR. Cases with endoleak presented more tortuous stents, with a more angulated exit from the endograft, and upward-pointing of the origin of the stent.

Clinical Clues for the Current Diagnosis of Acute Lower Limb Ischemia: A Contemporary Case Series.

BACKGROUND: Acute lower limb ischemia (ALI) is a limb and life-threatening condition whose treatment largely depends on the underlying cause. The clinical distinction between the main causes may have changed over the years because of changes in the epidemiology of this syndrome. The objective of this study was to determine the clinical pattern associated with the main causes of ALI in a contemporary series of cases. METHODS: We retrospectively reviewed all consecutive ALI cases admitted to a tertiary hospital between 2007 and 2019. ALI secondary to other conditions than embolism or NAT were excluded. The association between clinical variables and the ALI cause was assessed with multiple logistic regressions and the discriminative power of the resulting clinical predictive scores with the area under the ROC curve. RESULTS: The study group included 243 patients (mean age 77.2 years; 52.7% male), of which 140 (57.6%) were caused by an arterial embolism and 103 (42.4%) by a NAT. Among these latter, 78 (75.7%) were related to an atherosclerotic NAT and 25 (24.3%) to a complicated popliteal aneurysm. Independent risk factors associated with embolism included atrial fibrillation (OR 10.26, 95% CI 5.1 - 20.67) or female gender (OR 5.44, 95% CI 2.76 - 10.71), but not the severity of the episode or the presence of contralateral pulses. Those related to a NAT included a previous symptomatic peripheral arterial disease (OR 2.68, 95% CI 1.35 - 5.35) and seeking consultation more than 24 hours after the beginning of symptoms (OR 2.57, 95% CI 1.32 - 5), but not a higher rate of other vascular risk factors. Among patients with NAT, previous intermittent claudication (OR 8.34, 95% CI 2.42 - 28.72) and >24 hs delay of arrival of the patient (OR 4.78, 95% CI 1.48 - 15.43) were more frequent among those related to an atherosclerotic NAT, whereas higher hemoglobin levels (OR 1.60, 95% CI 1.21 - 2.11) and non-significantly the history of tobacco smoking (OR 2.95, 95% CI 0.84 - 10.36) among those with a popliteal aneurysm-related NAT. The discriminative power of the two clinical models resulting from these predictive variables for differentiating embolism from NAT and atherosclerosis-related NAT from popliteal aneurysm-related NAT was excellent (0.86 and 0.85, respectively). CONCLUSION: Certain clinical features appear to be no longer useful in the distinction between embolism and NAT, while others may help in the differential diagnosis between atherosclerotic and popliteal aneurysm-related NAT. Surgeons must be aware of possible changes in the presentation of ALI because time constraints are frequent and clinical data remain essential.