Objectives In population-based studies performed on multiple continents over the past two decades, diabetes mellitus has been negatively associated with the prevalence and progression of abdominal aortic aneurysm (AAA) disease. We investigated the possibility that metformin, the primary oral hypoglycemic agent in use worldwide, may influence the progression of AAA disease Methods Pre-operative AAA patients with diabetes were identified from an institutional database. After tabulating individual cardiovascular and demographic risk factors and prescription drug regimens, odds ratios for categorical influences on annual AAA enlargement were calculated via nominal logistical regression. Experimental AAA modeling experiments were subsequently performed in normoglycemic mice to validate the database-derived observations, as well as suggest potential mechanisms of metformin-mediated aneurysm suppression. Results Fifty eight patients met criteria for study inclusion. Of 11 distinct classes of medication considered, only metformin usage was negatively associated with AAA enlargement. This association remained significant after controlling for gender, age, cigarette smoking status and obesity. The median enlargement rate in AAA patients not taking oral diabetic medication was 1.5 mm/year; by nominal logistic regression, metformin, hyperlipidemia, and age ≥70 years were associated with below median enlargement, whereas sulfonylurea therapy, initial aortic diameter ≥40 mm and statin usage were associated with above median enlargement. In experimental modeling, metformin dramatically suppressed the formation and progression, with medial elastin and smooth muscle preservation and reduced aortic mural macrophage, CD8 T cell and neovessel density. Conclusions Epidemiologic evidence of AAA suppression in diabetes may be attributable to concurrent therapy with the oral hypoglycemic agent metformin.

Deep neural network is difficult to train and this predicament becomes worse as the depth increases. The essence of this problem exists in the magnitude of backpropagated errors that will result in gradient vanishing or exploding phenomenon. We show that a variant of regularizer which utilizes orthonormality among different filter banks can alleviate this problem. Moreover, we design a backward error modulation mechanism based on the quasiisometry assumption between two consecutive parametric layers. Equipped with these two ingredients, we propose several novel optimization solutions that can be utilized for training a specific-structured (repetitively triple modules of Conv-BN-ReLU) extremely deep convolutional neural network (CNN) WITHOUT any shortcuts/ identity mappings from scratch. Experiments show that our proposed solutions can achieve distinct improvements for a 44-layer and a 110-layer plain networks on both the CIFAR-10 and Im-ageNet datasets. Moreover, we can successfully train plain CNNs to match the performance of the residual counterparts.Besides, we propose new principles for designing network structure from the insights evoked by orthonormality. Combined with residual structure, we achieve comparative performance on the ImageNet dataset.

In repairs for type B ADs, the chimney technique provides a minimally invasive way of preserving flow to the arch branches combined with a favourable mid-term outcome. The bare stents seemed to be related to a higher probability of the immediate type I endoleaks. A balloon-expandable stent should be regarded as the first choice due to its greater radial strength.

This was the first prospective multicenter comparative study on the treatment of type B aortic dissection in China. TEVAR had a significantly lower aorta-related mortality compared with OMT but failed to improve overall survival rate or lower the aorta-related adverse event rate.

Thoracic endovascular aortic repair (TEVAR) is commonly applied in type-B aortic dissection. For patients with dissection affects descending aorta and extends downward to involve abdominal aorta and possibly iliac arteries, false lumen (FL) expansion might occur post-TEVAR. Predictions of dissection development may assist in medical decision on re-intervention or surgery. In this study, two patients are selected with similar morphological features at initial presentation but with different long-term FL development post-TEVAR (stable and enlarged FL). Patient-specific models are established for each of the follow-ups. Flow boundaries and computational validations are obtained from Doppler ultrasound velocimetry. By analyzing the hemodynamic parameters, the false-to-true luminal pressure difference (PDiff) and particle relative residence time (RRT) are found related to FL remodeling. It is found that (i) the position of the first FL flow entry is the watershed of negative-and-positive PDiff and, in long-term follow-ups, and the position of largest PDiff is consistent with that of the greatest increase of FL width; (ii) high RRT occurs at the FL proximal tip and similar magnitude of RRT is found in both stable and enlarged cases; (iii) comparing to the RRT at 7days post-TEVAR, an increase of RRT afterwards in short-term is found in the stable case while a slight decrease of this parameter is found in the enlarged case, indicating that the variation of RRT in short-term post-TEVAR might be potential to predict long-term FL remodeling.