| 1. |
- Klionsky, Daniel J., et al.
(författare)
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Guidelines for the use and interpretation of assays for monitoring autophagy
- 2012
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Ingår i: Autophagy. - : Informa UK Limited. - 1554-8635 .- 1554-8627. ; 8:4, s. 445-544
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Forskningsöversikt (refereegranskat)abstract
- In 2008 we published the first set of guidelines for standardizing research in autophagy. Since then, research on this topic has continued to accelerate, and many new scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Accordingly, it is important to update these guidelines for monitoring autophagy in different organisms. Various reviews have described the range of assays that have been used for this purpose. Nevertheless, there continues to be confusion regarding acceptable methods to measure autophagy, especially in multicellular eukaryotes. A key point that needs to be emphasized is that there is a difference between measurements that monitor the numbers or volume of autophagic elements (e.g., autophagosomes or autolysosomes) at any stage of the autophagic process vs. those that measure flux through the autophagy pathway (i.e., the complete process); thus, a block in macroautophagy that results in autophagosome accumulation needs to be differentiated from stimuli that result in increased autophagic activity, defined as increased autophagy induction coupled with increased delivery to, and degradation within, lysosomes (in most higher eukaryotes and some protists such as Dictyostelium) or the vacuole (in plants and fungi). In other words, it is especially important that investigators new to the field understand that the appearance of more autophagosomes does not necessarily equate with more autophagy. In fact, in many cases, autophagosomes accumulate because of a block in trafficking to lysosomes without a concomitant change in autophagosome biogenesis, whereas an increase in autolysosomes may reflect a reduction in degradative activity. Here, we present a set of guidelines for the selection and interpretation of methods for use by investigators who aim to examine macroautophagy and related processes, as well as for reviewers who need to provide realistic and reasonable critiques of papers that are focused on these processes. These guidelines are not meant to be a formulaic set of rules, because the appropriate assays depend in part on the question being asked and the system being used. In addition, we emphasize that no individual assay is guaranteed to be the most appropriate one in every situation, and we strongly recommend the use of multiple assays to monitor autophagy. In these guidelines, we consider these various methods of assessing autophagy and what information can, or cannot, be obtained from them. Finally, by discussing the merits and limits of particular autophagy assays, we hope to encourage technical innovation in the field.
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| 2. |
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| 3. |
- Abercrombie, Daniel, et al.
(författare)
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Dark Matter benchmark models for early LHC Run-2 Searches : Report of the ATLAS/CMS Dark Matter Forum
- 2020
-
Ingår i: Physics of the Dark Universe. - : Elsevier BV. - 2212-6864. ; 27
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Tidskriftsartikel (refereegranskat)abstract
- This document is the final report of the ATLAS-CMS Dark Matter Forum, a forum organized by the ATLAS and CMS collaborations with the participation of experts on theories of Dark Matter, to select a minimal basis set of dark matter simplified models that should support the design of the early LHC Run-2 searches. A prioritized, compact set of benchmark models is proposed, accompanied by studies of the parameter space of these models and a repository of generator implementations. This report also addresses how to apply the Effective Field Theory formalism for collider searches and present the results of such interpretations.
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| 4. |
- Aprile, E., et al.
(författare)
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Constraining the Spin-Dependent WIMP-Nucleon Cross Sections with XENON1T
- 2019
-
Ingår i: Physical Review Letters. - 0031-9007 .- 1079-7114. ; 122:14
-
Tidskriftsartikel (refereegranskat)abstract
- We report the first experimental results on spin-dependent elastic weakly interacting massive particle (WIMP) nucleon scattering from the XENON1T dark matter search experiment. The analysis uses the full ton year exposure of XENON1T to constrain the spin-dependent proton-only and neutron-only cases. No significant signal excess is observed, and a profile likelihood ratio analysis is used to set exclusion limits on the WIMP-nucleon interactions. This includes the most stringent constraint to date on the WIMP-neutron cross section, with a minimum of 6.3 x 10(-42) cm(2) at 30 GeV/c(2) and 90% confidence level. The results are compared with those from collider searches and used to exclude new parameter space in an isoscalar theory with an axial-vector mediator.
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| 5. |
- Aprile, E., et al.
(författare)
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Dark Matter Search Results from a One Ton-Year Exposure of XENON1T
- 2018
-
Ingår i: Physical Review Letters. - 0031-9007 .- 1079-7114. ; 121:11
-
Tidskriftsartikel (refereegranskat)abstract
- We report on a search for weakly interacting massive particles (WIMPs) using 278.8 days of data collected with the XENON1T experiment at LNGS. XENON1T utilizes a liquid xenon time projection chamber with a fiducial mass of (1.30 +/- 0.01) ton, resulting in a 1.0 ton yr exposure. The energy region of interest, [1.4; 10.6] keV(ee) ([4.9; 40.9] keV(nr)), exhibits an ultralow electron recoil background rate of [82(-3)(+5) (syst) +/- 3 stat)] events/ton yr keV(ee)). No significant excess over background is found, and a profile likelihood analysis parametrized in spatial and energy dimensions excludes new parameter space for the WIMP-nucleon spin-independent elastic scatter cross section for WIMP masses above 6 GeV/c(2), with a minimum of 4.1 x 10(-47) cm(2) at 30 GeV/c(2) and a 90% confidence level.
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| 6. |
- Aprile, E., et al.
(författare)
-
Effective field theory search for high-energy nuclear recoils using the XENON100 dark matter detector
- 2017
-
Ingår i: Physical Review D. - 2470-0010 .- 2470-0029. ; 96:4
-
Tidskriftsartikel (refereegranskat)abstract
- We report on weakly interacting massive particles (WIMPs) search results in the XENON100 detector using a nonrelativistic effective field theory approach. The data from science run II (34 kg x 224.6 live days) were reanalyzed, with an increased recoil energy interval compared to previous analyses, ranging from (6.6-240) keV(nr). The data are found to be compatible with the background-only hypothesis. We present 90% confidence level exclusion limits on the coupling constants of WIMP-nucleon effective operators using a binned profile likelihood method. We also consider the case of inelastic WIMP scattering, where incident WIMPs may up-scatter to a higher mass state, and set exclusion limits on this model as well.
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| 7. |
- Aprile, E., et al.
(författare)
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First Dark Matter Search Results from the XENON1T Experiment
- 2017
-
Ingår i: Physical Review Letters. - 0031-9007 .- 1079-7114. ; 119:18
-
Tidskriftsartikel (refereegranskat)abstract
- We report the first dark matter search results from XENON1T, a similar to 2000-kg-target-mass dual-phase (liquid-gas) xenon time projection chamber in operation at the Laboratori Nazionali del Gran Sasso in Italy and the first ton-scale detector of this kind. The blinded search used 34.2 live days of data acquired between November 2016 and January 2017. Inside the (1042 +/- 12)-kg fiducial mass and in the [5, 40] keV(nr) energy range of interest for weakly interacting massive particle (WIMP) dark matter searches, the electronic recoil background was (1.93 +/- 0.25) x 10(-4) events/(kg x day x keV(ee)), the lowest ever achieved in such a dark matter detector. A profile likelihood analysis shows that the data are consistent with the background-only hypothesis. We derive the most stringent exclusion limits on the spin-independent WIMP-nucleon interaction cross section for WIMP masses above 10 GeV/c(2), with a minimum of 7.7 x 10(-47) cm(2) for 35-GeV/c(2) WIMPs at 90% C.L.
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| 8. |
- Aprile, E., et al.
(författare)
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First Results on the Scalar WIMP-Pion Coupling, Using the XENON1T Experiment
- 2019
-
Ingår i: Physical Review Letters. - 0031-9007 .- 1079-7114. ; 122:7
-
Tidskriftsartikel (refereegranskat)abstract
- We present first results on the scalar coupling of weakly interacting massive particles (WIMPs) to pions from 1 t yr of exposure with the XENON1T experiment. This interaction is generated when the WIMP couples to a virtual pion exchanged between the nucleons in a nucleus. In contrast to most nonrelativistic operators, these pion-exchange currents can be coherently enhanced by the total number of nucleons and therefore may dominate in scenarios where spin-independent WIMP-nucleon interactions are suppressed. Moreover, for natural values of the couplings, they dominate over the spin-dependent channel due to their coherence in the nucleus. Using the signal model of this new WIMP-pion channel, no significant excess is found, leading to an upper limit cross section of 6.4 x 10(-46) cm(2) (90% confidence level) at 30 GeV/c(2) WIMP mass.
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| 9. |
- Aprile, E., et al.
(författare)
-
Low-mass dark matter search using ionization signals in XENON100
- 2016
-
Ingår i: Physical Review D. - 2470-0010. ; 94:9
-
Tidskriftsartikel (refereegranskat)abstract
- We perform a low-mass dark matter search using an exposure of 30 kg x yr with the XENON100 detector. By dropping the requirement of a scintillation signal and using only the ionization signal to determine the interaction energy, we lowered the energy threshold for detection to 0.7 keV for nuclear recoils. No dark matter detection can be claimed because a complete background model cannot be constructed without a primary scintillation signal. Instead, we compute an upper limit on the WIMP-nucleon scattering cross section under the assumption that every event passing our selection criteria could be a signal event. Using an energy interval from 0.7 keV to 9.1 keV, we derive a limit on the spin-independent WIMP-nucleon cross section that excludes WIMPs with a mass of 6 GeV/c(2) above 1.4 x 10(-41) cm(2) at 90% confidence level.
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| 10. |
- Aprile, E., et al.
(författare)
-
Material radioassay and selection for the XENON1T dark matter experiment
- 2017
-
Ingår i: European Physical Journal C. - : Springer Science and Business Media LLC. - 1434-6044 .- 1434-6052. ; 77:12
-
Tidskriftsartikel (refereegranskat)abstract
- The XENON1T dark matter experiment aims to detect weakly interactingmassive particles (WIMPs) through low-energy interactions with xenon atoms. To detect such a rare event necessitates the use of radiopure materials to minimize the number of background events within the expected WIMP signal region. In this paper we report the results of an extensive material radioassay campaign for the XENON1T experiment. Using gamma-ray spectroscopy and mass spectrometry techniques, systematic measurements of trace radioactive impurities in over one hundred samples within a wide range of materials were performed. The measured activities allowed for stringent selection and placement of materials during the detector construction phase and provided the input for XENON1T detection sensitivity estimates through Monte Carlo simulations.
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| 11. |
- Aprile, E., et al.
(författare)
-
Observation of two-neutrino double electron capture in 124Xe with XENON1T
- 2019
-
Ingår i: Nature. - : Springer Science and Business Media LLC. - 0028-0836 .- 1476-4687. ; 568:7753, s. 532-535
-
Tidskriftsartikel (refereegranskat)abstract
- Two-neutrino double electron capture (2νECEC) is a second-order weak-interaction process with a predicted half-life that surpasses the age of the Universe by many orders of magnitude. Until now, indications of 2νECEC decays have only been seen for two isotopes, 78Kr and 130Ba, and instruments with very low background levels are needed to detect them directly with high statistical significance. The 2νECEC half-life is an important observable for nuclear structure models and its measurement represents a meaningful step in the search for neutrinoless double electron capture—the detection of which would establish the Majorana nature of the neutrino and would give access to the absolute neutrino mass. Here we report the direct observation of 2νECEC in 124Xe with the XENON1T dark-matter detector. The significance of the signal is 4.4 standard deviations and the corresponding half-life of 1.8 × 1022 years (statistical uncertainty, 0.5 × 1022 years; systematic uncertainty, 0.1 × 1022 years) is the longest measured directly so far. This study demonstrates that the low background and large target mass of xenon-based dark-matter detectors make them well suited for measuring rare processes and highlights the broad physics reach of larger next-generation experiments.
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| 12. |
- Aprile, E., et al.
(författare)
-
Online Rn-222 removal by cryogenic distillation in the XENON100 experiment
- 2017
-
Ingår i: European Physical Journal C. - : Springer Science and Business Media LLC. - 1434-6044 .- 1434-6052. ; 77:6
-
Tidskriftsartikel (refereegranskat)abstract
- We describe the purification of xenon from traces of the radioactive noble gas radon using a cryogenic distillation column. The distillation column was integrated into the gas purification loop of the XENON100 detector for online radon removal. This enabled us to significantly reduce the constant Rn-222 background originating from radon emanation. After inserting an auxiliary 222Rn emanation source in the gas loop, we determined a radon reduction factor of R > 27 (95% C.L.) for the distillation column by monitoring the Rn-222 activity concentration inside the XENON100 detector.
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| 13. |
- Aprile, E., et al.
(författare)
-
Physics reach of the XENON1T dark matter experiment
- 2016
-
Ingår i: Journal of Cosmology and Astroparticle Physics. - : IOP Publishing. - 1475-7516. ; :4
-
Tidskriftsartikel (refereegranskat)abstract
- The XENON1T experiment is currently in the commissioning phase at the Laboratori Nazionali del Gran Sasso, Italy. In this article we study the experiment's expected sensitivity to the spin-independent WIMP-nucleon interaction cross section, based on Monte Carlo predictions of the electronic and nuclear recoil backgrounds. The total electronic recoil background in 1 tonne fiducial volume and (1, 12) keV electronic recoil equivalent energy region, before applying any selection to discriminate between electronic and nuclear recoils, is (1.80+/-0.15) . 10(-4) (kg.day.keV)(-1), mainly due to the decay of Rn-222 daughters inside the xenon target. The nuclear recoil background in the corresponding nuclear recoil equivalent energy region (4, 50) keV, is composed of (0.6 +/- 0.1) (t.y)(-1) from radiogenic neutrons, (1.8+/-0.3) . 10(-2) (t.y)(-1) from coherent scattering of neutrinos, and less than 0.01 (t.y)(-1) from muon-induced neutrons. The sensitivity of XENON1T is calculated with the Pro file Likelihood Ratio method, after converting the deposited energy of electronic and nuclear recoils into the scintillation and ionization signals seen in the detector. We take into account the systematic uncertainties on the photon and electron emission model, and on the estimation of the backgrounds, treated as nuisance parameters. The main contribution comes from the relative scintillation efficiency L-eff, which affects both the signal from WIMPs and the nuclear recoil backgrounds. After a 2 y measurement in 1 tonne fiducial volume, the sensitivity reaches a minimum cross section of 1.6 . 10(-47) cm(2) at m(chi) = 50 GeV/c(2).
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| 14. |
- Aprile, E., et al.
(författare)
-
Removing krypton from xenon by cryogenic distillation to the ppq level
- 2017
-
Ingår i: European Physical Journal C. - : Springer Science and Business Media LLC. - 1434-6044 .- 1434-6052. ; 77:5
-
Tidskriftsartikel (refereegranskat)abstract
- The XENON1T experiment aims for the direct detection of dark matter in a detector filled with 3.3 tons of liquid xenon. In order to achieve the desired sensitivity, the background induced by radioactive decays inside the detector has to be sufficiently low. One major contributor is the beta-emitter Kr-85 which is present in the xenon. For XENON1T a concentration of natural krypton in xenon Kr-nat/Xe < 200 ppq (parts per quadrillion, 1 ppq = 10(-15) mol/mol) is required. In this work, the design, construction and test of a novel cryogenic distillation column using the common McCabe-Thiele approach is described. The system demonstrated a krypton reduction factor of 6.4 . 10(5) with thermodynamic stability at process speeds above 3 kg/h. The resulting concentration of natKr/Xe < 26 ppq is the lowest ever achieved, almost one order of magnitude below the requirements for XENON1T and even sufficient for future dark matter experiments using liquid xenon, such as XENONnT and DARWIN.
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| 15. |
- Aprile, E., et al.
(författare)
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Results from a calibration of XENON100 using a source of dissolved radon-220
- 2017
-
Ingår i: Physical Review D. - 2470-0010 .- 2470-0029. ; 95:7
-
Tidskriftsartikel (refereegranskat)abstract
- A Rn-220 source is deployed on the XENON100 dark matter detector in order to address the challenges in calibration of tonne-scale liquid noble element detectors. We show that the Pb-212 beta emission can be used for low-energy electronic recoil calibration in searches for dark matter. The isotope spreads throughout the entire active region of the detector, and its activity naturally decays below background level within a week after the source is closed. We find no increase in the activity of the troublesome Rn-222 background after calibration. Alpha emitters are also distributed throughout the detector and facilitate calibration of its response to Rn-222. Using the delayed coincidence of Rn-220-Po-216, we map for the first time the convective motion of particles in the XENON100 detector. Additionally, we make a competitive measurement of the half-life of Po-212, t(1/2) = (293.9 +/- (1.0)(stat) +/- (0.6)(sys)) ns.
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| 16. |
- Aprile, E., et al.
(författare)
-
Search for bosonic super-WIMP interactions with the XENON100 experiment
- 2017
-
Ingår i: Physical Review D. - 2470-0010 .- 2470-0029. ; 96:12
-
Tidskriftsartikel (refereegranskat)abstract
- We present results of searches for vector and pseudoscalar bosonic super-weakly interacting massive particles (WIMPs), which are dark matter candidates with masses at the keV-scale, with the XENON100 experiment. XENON100 is a dual-phase xenon time projection chamber operated at the Laboratori Nazionali del Gran Sasso. A profile likelihood analysis of data with an exposure of 224.6 live days x34 kg showed no evidence for a signal above the expected background. We thus obtain new and stringent upper limits in the (8-125) keV/c(2) mass range, excluding couplings to electrons with coupling constants of g(ae) > 3 x 10(-13) for pseudo-scalar and alpha'/alpha > 2 x 10(-28) for vector super-WIMPs, respectively. These limits are derived under the assumption that super-WIMPs constitute all of the dark matter in our galaxy.
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| 17. |
- Aprile, E., et al.
(författare)
-
Search for Electronic Recoil Event Rate Modulation with 4 Years of XENON100 Data
- 2017
-
Ingår i: Physical Review Letters. - 0031-9007 .- 1079-7114. ; 118:10
-
Tidskriftsartikel (refereegranskat)abstract
- We report on a search for electronic recoil event rate modulation signatures in the XENON100 data accumulated over a period of 4 yr, from January 2010 to January 2014. A profile likelihood method, which incorporates the stability of the XENON100 detector and the known electronic recoil background model, is used to quantify the significance of periodicity in the time distribution of events. There is a weak modulation signature at a period of 431(-14)(+16) day in the low energy region of (2.0-5.8) keV in the single scatter event sample, with a global significance of 1.9 sigma; however, no other more significant modulation is observed. The significance of an annual modulation signature drops from 2.8 sigma, from a previous analysis of a subset of this data, to 1.8 sigma with all data combined. Single scatter events in the low energy region are thus used to exclude the DAMA/LIBRA annual modulation as being due to dark matter electron interactions via axial vector coupling at 5.7 sigma.
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| 18. |
- Aprile, E., et al.
(författare)
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Search for magnetic inelastic dark matter with XENON100
- 2017
-
Ingår i: Journal of Cosmology and Astroparticle Physics. - : IOP Publishing. - 1475-7516. ; :10
-
Tidskriftsartikel (refereegranskat)abstract
- We present the first search for dark matter-induced delayed coincidence signals in a dual-phase xenon time projection chamber, using the 224.6 live days of the XENON100 science run II. This very distinct signature is predicted in the framework of magnetic inelastic dark matter which has been proposed to reconcile the modulation signal reported by the DAMA/LIBRA collaboration with the null results from other direct detection experiments. No candidate event has been found in the region of interest and upper limits on the WIMP's magnetic dipole moment are derived. The scenarios proposed to explain the DAMA/LIBRA modulation signal by magnetic inelastic dark matter interactions of WIMPs with masses of 58.0 GeV/c(2) and 122.7 GeV/c(2) are excluded at 3.3 sigma and 9.3 sigma, respectively.
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| 19. |
- Aprile, E., et al.
(författare)
-
Search for two-neutrino double electron capture of Xe-124 with XENON100
- 2017
-
Ingår i: Physical Review C. - 2469-9985. ; 95:2
-
Tidskriftsartikel (refereegranskat)abstract
- Two-neutrino double electron capture is a rare nuclear decay where two electrons are simultaneously captured from the atomic shell. For Xe-124 this process has not yet been observed and its detection would provide a new reference for nuclear matrix element calculations. We have conducted a search for two-neutrino double electron capture from the K shell of 124Xe using 7636 kg d of data from the XENON100 dark matter detector. Using a Bayesian analysis we observed no significant excess above background, leading to a lower 90% credibility limit on the half-life T-1/2 > 6.5 x 10(20) yr. We have also evaluated the sensitivity of the XENON1T experiment, which is currently being commissioned, and found a sensitivity of T-1/2 > 6.1 x 10(22) yr after an exposure of 2 t yr.
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| 20. |
- Aprile, E., et al.
(författare)
-
Search for WIMP inelastic scattering off xenon nuclei with XENON100
- 2017
-
Ingår i: Physical Review D. - 2470-0010 .- 2470-0029. ; 96:2
-
Tidskriftsartikel (refereegranskat)abstract
- We present the first constraints on the spin-dependent, inelastic scattering cross section of weakly interacting massive particles (WIMPs) on nucleons from XENON100 data with an exposure of 7.64 x 10(3) kg . days. XENON100 is a dual-phase xenon time projection chamber with 62 kg of active mass, operated at the Laboratori Nazionali del Gran Sasso (LNGS) in Italy and designed to search for nuclear recoils from WIMP-nucleus interactions. Here we explore inelastic scattering, where a transition to a low-lying excited nuclear state of Xe-129 is induced. The experimental signature is a nuclear recoil observed together with the prompt deexcitation photon. We see no evidence for such inelastic WIMP-Xe-129 interactions. A profile likelihood analysis allows us to set a 90% C.L. upper limit on the inelastic, spin-dependent WIMP-nucleon cross section of 3.3 x 10(-38) cm(2) at 100 GeV/c(2). This is the most constraining result to date, and sets the pathway for an analysis of this interaction channel in upcoming, larger dual-phase xenon detectors.
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| 21. |
- Aprile, E., et al.
(författare)
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Signal yields of keV electronic recoils and their discrimination from nuclear recoils in liquid xenon
- 2018
-
Ingår i: Physical Review D. - 2470-0010 .- 2470-0029. ; 97:9
-
Tidskriftsartikel (refereegranskat)abstract
- We report on the response of liquid xenon to low energy electronic recoils below 15 keV from beta decays of tritium at drift fields of 92 V/cm, 154 V/cm and 366 V/cm using the XENON100 detector. A data-to-simulation fitting method based on Markov Chain Monte Carlo is used to extract the photon yields and recombination fluctuations from the experimental data. The photon yields measured at the two lower fields are in agreement with those from literature; additional measurements at a higher field of 366 V/cm are presented. The electronic and nuclear recoil discrimination as well as its dependence on the drift field and photon detection efficiency are investigated at these low energies. The results provide new measurements in the energy region of interest for dark matter searches using liquid xenon.
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| 22. |
- Aprile, E., et al.
(författare)
-
The XENON1T dark matter experiment
- 2017
-
Ingår i: European Physical Journal C. - : Springer Science and Business Media LLC. - 1434-6044 .- 1434-6052. ; 77:12
-
Tidskriftsartikel (refereegranskat)abstract
- The XENON1T experiment at the Laboratori Nazionali del Gran Sasso (LNGS) is the first WIMP dark matter detector operating with a liquid xenon target mass above the ton-scale. Out of its 3.2t liquid xenon inventory, 2.0t constitute the active target of the dual-phase time projection chamber. The scintillation and ionization signals from particle interactions are detected with low-background photomultipliers. This article describes the XENON1T instrument and its subsystems as well as strategies to achieve an unprecedented low background level. First results on the detector response and the performance of the subsystems are also presented.
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| 23. |
- Aprile, E., et al.
(författare)
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XENON100 dark matter results from a combination of 477 live days
- 2016
-
Ingår i: Physical Review D. - 2470-0010 .- 2470-0029. ; 94:12
-
Tidskriftsartikel (refereegranskat)abstract
- We report on WIMP search results of the XENON100 experiment, combining three runs summing up to 477 live days from January 2010 to January 2014. Data from the first two runs were already published. A blind analysis was applied to the last run recorded between April 2013 and January 2014 prior to combining the results. The ultralow electromagnetic background of the experiment, similar to 5 x 10(-3) events/(keV(ee) x kg x day)) before electronic recoil rejection, together with the increased exposure of 48 kg x yr, improves the sensitivity. A profile likelihood analysis using an energy range of (6.6-43.3) keV(nr) sets a limit on the elastic, spin-independent WIMP-nucleon scattering cross section for WIMP masses above 8 GeV/c(2), with a minimum of 1.1 x 10(-45) cm(2) at 50 GeV/c(2) and 90% confidence level. We also report updated constraints on the elastic, spin-dependent WIMP-nucleon cross sections obtained with the same data. We set upper limits on the WIMP-neutron (proton) cross section with a minimum of 2.0 x 10(-40) cm(2) (52 x 10(-40) cm(2)) at a WIMP mass of 50 GeV/c(2), at 90% confidence level.
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| 24. |
- Janko, Matthew, et al.
(författare)
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Contemporary Outcomes After Partial Resection of Infected Aortic Grafts
- 2021
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Ingår i: Annals of Vascular Surgery. - : Elsevier. - 0890-5096 .- 1615-5947. ; 76, s. 202-210
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Aortic graft infection remains a considerable clinical challenge, and it is unclear which variables are associated with adverse outcomes among patients undergoing partial resection.METHODS: A retrospective, multi-institutional study of patients who underwent partial resection of infected aortic grafts from 2002 to 2014 was performed using a standard database. Baseline demographics, comorbidities, operative, and postoperative variables were recorded. The primary outcome was mortality. Descriptive statistics, Kaplan-Meier (KM) survival analysis, and Cox regression analysis were performed.RESULTS: One hundred fourteen patients at 22 medical centers in 6 countries underwent partial resection of an infected aortic graft. Seventy percent were men with median age 70 years. Ninety-seven percent had a history of open aortic bypass graft: 88 (77%) patients had infected aortobifemoral bypass, 18 (16%) had infected aortobiiliac bypass, and 1 (0.8%) had an infected thoracic graft. Infection was diagnosed at a median 4.3 years post-implant. All patients underwent partial resection followed by either extra-anatomic (47%) or in situ (53%) vascular reconstruction. Median follow-up period was 17 months (IQR 1, 50 months). Thirty-day mortality was 17.5%. The KM-estimated median survival from time of partial resection was 3.6 years. There was no significant survival difference between those undergoing in situ reconstruction or extra-anatomic bypass (P = 0.6). During follow up, 72% of repairs remained patent and 11% of patients underwent major amputation. On univariate Cox regression analysis, Candida infection was associated with increased risk of mortality (HR 2.4; P = 0.01) as well as aortoenteric fistula (HR 1.9, P = 0.03). Resection of a single graft limb only to resection of abdominal (graft main body) infection was associated with decreased risk of mortality (HR 0.57, P = 0.04), as well as those with American Society of Anesthesiologists classification less than 3 (HR 0.35, P = 0.04). Multivariate analysis did not reveal any factors significantly associated with mortality. Persistent early infection was noted in 26% of patients within 30 days postoperatively, and 39% of patients were found to have any post-repair infection during the follow-up period. Two patients (1.8%) were found to have a late reinfection without early persistent postoperative infection. Patients with any post-repair infection were older (67 vs. 60 years, P = 0.01) and less likely to have patent repairs during follow up (59% vs. 32%, P = 0.01). Patients with aortoenteric fistula had a higher rate of any post-repair infection (63% vs. 29%, P < 0.01)CONCLUSION: This large multi-center study suggests that patients who have undergone partial resection of infected aortic grafts may be at high risk of death or post-repair infection, especially older patients with abdominal infection not isolated to a single graft limb, or with Candida infection or aortoenteric fistula. Late reinfection correlated strongly with early persistent postoperative infection, raising concern for occult retained infected graft material.
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| 25. |
- Janko, Matthew R., et al.
(författare)
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In situ bypass and extra-anatomic bypass procedures result in similar survival in patients with secondary aortoenteric fistulas
- 2021
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Ingår i: Journal of Vascular Surgery. - : Elsevier. - 0741-5214 .- 1097-6809. ; 73:1, s. 210-221.e1
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The optimal revascularization modality in secondary aortoenteric fistula (SAEF) remains unclear in the literature. The purpose of this investigation was to determine the revascularization approach associated with the lowest morbidity and mortality using real-world data in patients with SAEF. Methods: A retrospective, multi-institutional study of SAEF from 2002 to 2014 was performed using a standardized database. Baseline demographics, comorbidities, and operative and postoperative variables were recorded. The primary outcome was long-term mortality. Descriptive statistics, Kaplan-Meier survival analysis, and univariate and multivariate analyses were performed. Results: During the study period, 182 patients at 34 institutions from 11 countries presented with SAEF (median age, 72 years; 79% male). The initial aortic procedures that resulted in SAEF were 138 surgical grafts (76%) and 42 endografts (23%), with 2 unknown; 102 of the SAEFs (56%) underwent complete excision of infected aortic graft material, followed by in situ (in-line) bypass (ISB), including antibiotic-soaked prosthetic graft (53), autogenous femoral vein (neoaortoiliac surgery; 17), cryopreserved allograft (28), and untreated prosthetic grafts (4). There were 80 patients (44%) who underwent extra-anatomic bypass (EAB) with infected graft excision. Overall median Kaplan-Meier estimated survival was 319 days (interquartile range, 20-2410 days). Stratified by EAB vs ISB, there was no significant difference in Kaplan-Meier estimated survival (P = .82). In comparing EAB vs ISB, EAB patients were older (74 vs 70 years; P = .01), had less operative hemorrhage (1200 mL vs 2000 mL; P = .04), were more likely to initiate dialysis within 30 days postoperatively (15% vs 5%; P = .02), and were less likely to experience aorta-related hemorrhage within 30 days postoperatively (3% aortic stump dehiscence vs 11% anastomotic rupture; P = .03). There were otherwise no significant differences in presentation, comorbidities, and intraoperative or postoperative variables. Multivariable Cox regression showed that the duration of antibiotic use (hazard ratio, 0.92; 95% confidence interval, 0.86-0.98; P = .01) and rifampin use at time of discharge (hazard ratio, 0.20; 95% confidence interval, 0.05-0.86; P = .03) independently decreased mortality. Conclusions: These data suggest that ISB does not offer a survival advantage compared with EAB and does not decrease the risk of postoperative aorta-related hemorrhage. After repair, <50% of SAEF patients survive 10-months. Each week of antibiotic use decreases mortality by 8%. Further study with risk modeling is imperative for this population. (J Vasc Surg 2021;73:210-21.)
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