Enhanced Recovery after Elective Open Surgical Repair of Abdominal Aortic Aneurysm: A Complementary Overview through a Pooled Analysis of Proportions from Case Series Studies

Objectives: To evaluate the efficacy and safety of enhanced recovery after surgery (ERAS) programs in elective open surgical repair (OSR) of abdominal aortic aneurysm (AAA).Background: Open surgical repair of AAA is associated with high morbidity and mortality, prolonged hospital stay and high costs. ERAS programs contribute to the optimization of treatment by reducing hospital stay and improving clinical outcomes.Methods: A review of PubMed, EMBASE and LILACS databases was conducted. As only one randomized controlled trial was found, a pooled analysis of proportions from case series was conducted, considering it a complementary overview of the topic. Inclusion criteria were case series with more than five cases reported, adult patients who underwent an elective OSR of AAA and use of an ERAS program. ERAS was compared to conventional perioperative care. The pooled proportion and the confidence interval (CI) are shown for each outcome. The overlap of the CI suggests similar effect of the interventions studied.Results: Thirteen case series studies with ERAS involving 1,250 patients were compared to six case series with conventional care with a total of 1,429 patients. The pooled, respective proportions for ERAS and conventional care were: mortality, 1.51% [95% CI: 0.0091, 0.0226] and 3.0% [95% CI 0.0183, 0.0445]; and incidence of complications, 3.82% [95% CI 0.0259, 0.0528] and 4.0% [95% CI 0.03, 0.05].Conclusion: This review shows that ERAS and conventional care therapies have similar mortality and complication rates in OSR of AAA.

Experience with the sandwich technique in endovascular thoracoabdominal aortic aneurysm repair

Background: The sandwich technique is an endovascular off-the-shelf solution for patients with thoracoabdominal aortic aneurysms (TAAAs). In a sandwich configuration, the chimney stent runs in the middle of a space created by two or three aortic endografts.Methods: All patients with TAAAs who were treated with the sandwich technique were included in the study. Self-expanding Viabahn grafts (W. L. Gore and Associates Inc, Flagstaff, Ariz) were used as parallel grafts in the renal arteries and visceral vessels. Caudad-facing chimney grafts were used for the visceral arteries and cephalad-facing periscope grafts for the renal arteries.Results: During the study period, 32 patients with TAAAs were treated with sandwich grafts. Indication for the procedure in 43% was an acute onset of symptoms, including two patients with a rupture and a retroperitoneal hematoma. Three patients required an additional debranching procedure. A total of 104 chimney grafts were implanted. Two patients died postoperatively because of the operation. Major adverse events were recorded in five patients, including one patient with persistent paraplegia and two with permanent renal failure requiring dialysis. The incidence of chimney graft occlusion was higher in patients with three or four parallel grafts than in those with two chimney grafts only. Patients with chronic dissections had a 12-times higher incidence of chimney graft occlusion than aneurysm patients. The number of patients with type I or III endoleaks was higher in the group with three or four parallel grafts.Conclusions: The sandwich technique is an off-the-shelf endovascular alternative to treat patients with TAAAs in an emergent setting. The combination of chimney grafts with a periscope configuration enables a rapid endovascular aneurysm exclusion with acceptable midterm results.

Left ventricular sphericity index predicts systolic dysfunction in rats with experimental aortic regurgitation

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Phenomenological Interpretation of Impedance/Capacitance Measurements on Organic Electronic Devices Under Illumination

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

An Experimental Study on the Effect of Temperature on Piezoelectric Sensors for Impedance-Based Structural Health Monitoring

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Leakage detection in water pipe networks using electromechanical impedance (EMI) based technique

The electromechanical impedance (EMI) technique has been successfully used in structural health monitoring (SHM) systems on a wide variety of structures. The basic concept of this technique is to monitor the structural integrity by exciting and sensing a piezoelectric transducer, usually a lead zirconate titanate (PZT) wafer bonded to the structure to be monitored and excited in a suitable frequency range. Because of the piezoelectric effect, there is a relationship between the mechanical impedance of the host structure, which is directly related to its integrity, and the electrical impedance of the PZT transducer, obtained by a ratio between the excitation and the sensing signals.This work presents a study on damage (leaks) detection using EMI based method. Tests were carried out in a rig water system built in a Hydraulic Laboratory for different leaks conditions in a metallic pipeline. Also, it was evaluated the influence of the PZT position bonded to the pipeline. The results show that leaks can effectively be detected using common metrics for damage detection such as RMSD and CCDM. Further, it was observed that the position of the PZT bonded to the pipes is an important variable and has to be controlled.

Phenomenological model for the interpretation of impedance/admittance spectroscopy results in polymer light-emitting electrochemical cells

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Impedance-derived electrochemical capacitance spectroscopy for the evaluation of lectin-glycoprotein binding affinity

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Lumped element modeling of operational structures by inverting the mobility models

This paper is concerned with what a source precisely sees when it drives a receiver such as a continuous structural object. An equivalent lumped element system consisting of masses, springs and dampers is developed to visually represent the operational structural dynamics of a single-input structure at the driving point. The development is solely based on the mobility model of the driving point response. The mobility model is mathematically inverted to give the impedance model that is suitable for lumped element modeling. The two types of structures studied are unconstrained inertial objects and constrained resilient objects. The lumped element systems presented suggest a new view to dynamics that a single-input flexible structure in operation can be decomposed into the two subsystems: a base system of single degree of freedom (or of a mass for an inertial object) whose mass is in contact with the source and an appendage system consisting of a series of oscillators each of which is attached to the base mass. The driving point response is a result of the coupling between the two subsystems. (C) 2014 Elsevier Ltd. All rights reserved.

Endothelial AT(1) and AT(2) pathways in aortic responses to angiotensin II after stress and ethanol consumption in rats

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

FINITE ELEMENT SIMULATIONS FOR THE COMPREHENSION OF PHYSICAL PHENOMENA INVOLVED IN ELECTRIC IMPEDANCE TOMOGRAPHY OF MASONRY STRUCTURES

The paper describes the preliminary studies of University of Minho on the use of Electric Impedance/Resistance Tomography to assess masonry structures. The study is focused on the analysis of values of current and voltage resulting from the use of an electrical source with voltage and frequency values from a distribution network. The analysis is made from results obtained through computer simulations, using a three-dimensional model of the idealized masonry structures. A finite element program was used for the simulations. Three types of electrodes were used in simulations, and the analysis of the results led to significant conclusions. Later masonry specimens were built and a series of preliminary tests were carried out in the laboratory. The comparative analysis of simulated and experimental results allowed identifying the factors that have influence on the physical results.

Mechanical strain induces the production of spheroid mineralized microparticles in the aortic valve through a RhoA/ROCK-dependent mechanism

Calcific aortic valve disease (CAVD) is a chronic disorder characterized by an abnormal mineralization of the leaflets, which is accelerated in bicuspid aortic valve (BAV). It is suspected that mechanical strain may promote/enhance mineralization of the aortic valve. However, the effect of mechanical strain and the involved pathways during mineralization of the aortic valve remains largely unknown. Valve interstitial cells (VICs) were isolated and studied under strain conditions. Human bicuspid aortic valves were examined as a model relevant to increase mechanical strain. Cyclic strain increased mineralization of VICs by several-fold. Scanning electron microscope (SEM) and energy dispersive X-ray (EDX) analyses revealed that mechanical strain promoted the formation of mineralized spheroid microparticles, which coalesced into larger structure at the surface of apoptotic VICs. Apoptosis and mineralization were closely associated with expression of ENPP1. Inhibition of ENPP1 greatly reduced mineralization of VIC cultures. Through several lines of evidence we showed that mechanical strain promoted the export of ENPP1-containing vesicles to the plasma membrane through a RhoA/ROCK pathway. Studies conducted in human BAV revealed the presence of spheroid mineralized structures along with the expression of ENPP1 in areas of high mechanical strain. Mechanical strain promotes the production and accumulation of spheroid mineralized microparticles by VICs, which may represent one important underlying mechanism involved in aortic valve mineralization. RhoA/ROCK-mediated export of ENPP1 to the plasma membrane promotes strain-induced mineralization of VICs.

The PI3K-Akt-eNOS pathway is involved in aortic hyporeactivity to Phenylephrine associated with late pregnancy in spontaneously hypertensive rats

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Antidepressant treatment decreases daily salt intake and prevents heart dysfunction following subchronic aortic regurgitation in rats

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Design and implementation of wireless sensor networks for impedance-based structural health monitoring using ZigBee and Global System for Mobile Communications

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)