Our results indicate that the two-stage BVT fistula through two skip-arm incisions is superior to the established one-stage procedure in terms of less morbidity but at the cost of a second operation and longer time to access use. Further research comparing these two techniques is necessary. Until this issue is resolved, an individualised approach is suggested.

Open surgical repair of proximal abdominal aortic aneurysms can be performed with low mortality. Acute kidney injury is the most frequent complication, but the need for hemodialysis at discharge is low. Long-term survival is favorable. These data should assist in establishing benchmarks for endovascular repair of complex proximal abdominal aortic aneurysms.

PGS after open AAA repair occurs more frequently than previously reported. Complications requiring intervention can occur in up to 20% of patients with PGS. A variety of treatment modalities can be used to deal with the complications. Earlier CT surveillance is advised after open AAA repair with a PTFE graft if symptoms are suggestive of PGS development.

In the modern era, neck paragangliomas can be managed with a low incidence of long-term sequelae. Smaller, asymptomatic, and incidentally detected tumors are currently the most common presentation pattern.

Purpose of Review Trauma is the principle cause of osteoarthritis in the ankle, which is associated with significant morbidity. This review highlights the current literature for the purpose of bringing the reader up-to-date on the management of posttraumatic ankle arthritis, describing treatment efficacy, indications, contraindications, and complications. Recent Findings Recent studies on osteoarthritis have demonstrated variability among anatomic locations regarding the mechanisms and rates of development for posttraumatic osteoarthritis, which are attributed to newly discovered biological differences intrinsic to each joint. Regarding surgical management of posttraumatic ankle arthritis, osteochondral allograft transplantation of the talus, and supramalleolar osteotomies have demonstrated promising results. Additionally, the outpatient setting was found to be appropriate for managing pain following total ankle arthroplasty, associated with low complication rates and no readmission. Summary Management for posttraumatic ankle arthritis is generally progressive. Initial treatment entails nonpharmacologic options with surgery reserved for posttraumatic ankle arthritis refractory to conservative treatment. Patient demographics and lifestyles should be carefully considered when formulating a management strategy, as outcomes are dependent upon the satisfaction of each set of respective criteria. Ultimately, the management of posttraumatic ankle arthritis should be individualized to satisfy the needs and desires, which are specific to each patient.

phox -gp91 phox interaction (Ad-gp91ds). Common carotid arteries (CCAs) from male Sprague-Dawley rats were transfected with Ad-control, Ad-p67dn, or Ad-gp91ds in pluronic gel. After 2 days, a 2-F (Fogarty) catheter was used to injure CCAs in vivo. After 14 days, CCAs were perfusion-fixed and analyzed. In 13 experiments, digital morphometry suggested a reduction of neointimal hyperplasia with Ad-p67dn compared with Ad-control; however, the reduction did not reach statistical significance (P ϭ 0.058). In contrast, a significant reduction was achieved with Adgp91ds (P ϭ 0.006). No changes in medial area or remodeling were observed with either treatment. Moreover, adventitial fibroblast proliferation in vitro was inhibited by Ad-gp91ds but not by Ad-p67dn, despite confirmation that Ad-p67dn inhibits NADPH oxidase in fibroblasts. These data appear to suggest that a multicomponent vascular NADPH oxidase plays a role in neointimal hyperplasia. However, inhibition of p47 phox may be more effective than inhibition of p67 phox at attenuating neointimal growth.NADPH oxidase; p47 phox ; adventitia; restenosis NEOINTIMAL HYPERPLASIA is a major response to vascular injury (33). Proliferation and migration of vascular smooth muscle cells (VSMCs) and, more recently, fibroblasts have been implicated in narrowing of the arterial lumen in response to injury, mimicking one of the hallmark characteristics of atherosclerosis (6, 32). Smooth muscle cell migration and proliferation are involved in narrowing of the arterial lumen in response to injury and atherosclerosis, a process promoted by protooncogenes (34) and various growth factors (11,19). Recent studies have implicated superoxide anion (O 2 Ϫ ) derived from NADPH oxidase in vascular cell proliferation and neointimal growth (17,37), and processes involving reactive oxygen species (ROS) have been included in a number of growth-related signaling pathways (14).NADPH oxidase is a well-characterized ROS-generating system that catalyzes the one-electron reduction of O 2 to O 2 Ϫ , a precursor of a variety of other ROS. The classical phagocyte NADPH oxidase is known to be a multicomponent enzyme complex that includes the two membrane-spanning polypeptide subunits p22 phox and anchoring component gp91 phox , which are associated with the plasma membrane cytoskeleton (and together comprise flavocytochrome b 558 ), along with three cytoplasmic polypeptide subunits, p40phox , p47 phox , and p67 phox (8,43). The cytosolic guanine nucleotide-binding protein p21 rac , a member of the Ras family of proteins, is required for oxidase activation (20). Exposure of the cell to agonists induces interaction of cytosolic and membrane-associated components and activates the dormant oxidase (8). Numerous studies have suggested a similar process of oxidase activation in the vasculature (16,23,26,29,43).Recently, NADPH oxidases in VSMCs and adventitial fibroblasts have been implicated in the proliferation and migration of cells from the vascular wall to the neointima (13, 18). VSMCs in large arteries exp...

[1] Little is known about the impact of surface transient storage (STS) zones on reach-scale transport and the fate of dissolved nutrients in streams. Exchange with these locations may influence the rates of nutrient cycling often observed in whole-stream tracer experiments, particularly because they are sites of organic matter collection and lower flow velocities than those observed in the thalweg. We performed a conservative stream tracer experiment (slug of dissolved NaCl) in the Ipswich River in northeastern Massachusetts and collected solute tracer data both in the thalweg and adjacent STS zones at three locations in a fifth-order reach. Tracer time series observed in STS zones are an aggregate of residence time distributions (RTDs) of the upstream transport to that point (RTD THAL ) and that of the temporary storage within these zones (RTD STS ). Here we demonstrate the separation of these two RTDs to determine the RTD STS specifically. Total residence times for these individual STS zones range from 4.5 to 7.5 h, suggesting that these zones have the potential to host important biogeochemical transformations in stream systems. All of the RTD STS show substantial deviations from the ideal prescribed by the two-state (mobile/immobile) mass transfer equations. The deviations indicate a model mismatch and that parameter estimation based on the mass transfer equations will yield misleading values.

Patients with a lower SES had reduced short-term and long-term survival after aortic dissection. Patients with type B dissection live in lower socioeconomic neighborhoods than patients with type A dissection.