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| 2. |
- 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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| 3. |
- Janko, Matthew R., et al.
(författare)
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In-situ bypass is associated with superior infection-free survival compared with extra-anatomic bypass for the management of secondary aortic graft infections without enteric involvement
- 2022
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Ingår i: Journal of Vascular Surgery. - : Elsevier. - 0741-5214 .- 1097-6809. ; 76:2, s. 546-
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The optimal revascularization modality following complete resection of aortic graft infection (AGI) without enteric involvement remains unclear. The purpose of this investigation is to determine the revascularization approach associated with the lowest morbidity and mortality using real-world data in patients undergoing complete excision of AGI. Methods: A retrospective, multi-institutional study of AGI from 2002 to 2014 was performed using a standardized database. Baseline demographics, comorbidities, and perioperative variables were recorded. The primary outcome was infection-free survival. Descriptive statistics, Kaplan-Meier survival analysis, and univariate and multivariable analyses were performed. Results: A total of 241 patients at 34 institutions from seven countries presented with AGI during the study period (median age, 68 years; 75% male). The initial aortic procedures that resulted in AGI were 172 surgical grafts (71%), 66 endografts (27%), and three unknown (2%). Of the patients, 172 (71%) underwent complete excision of infected aortic graft material followed by in situ (in-line) bypass (ISB), including antibiotic-treated prosthetic graft (35%), autogenous femoral vein (neo-aortoiliac surgery) (24%), and cryopreserved allograft (41%). Sixty-nine patients (29%) underwent extra-anatomic bypass (EAB). Overall median Kaplan-Meier estimated survival was 5.8 years. Perioperative mortality was 16%. When stratified by ISB vs EAB, there was a significant difference in Kaplan-Meier estimated infection-free survival (2910 days; interquartile range, 391-3771 days vs 180 days; interquartile range, 27-3750 days; P <.001). There were otherwise no significant differences in presentation, comorbidities, or perioperative variables. Multivariable Cox regression showed lower infection-free survival among patients with EAB (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.6-3.6; P <.001), polymicrobial infection (HR, 2.2; 95% CI, 1.4-3.5; P = .001), methicillin-resistant Staphylococcus aureus infection (HR, 1.7; 95% CI, 1.1-2.7; P = .02), as well as the protective effect of omental/muscle flap coverage (HR, 0.59; 95% CI, 0.37-0.92; P = .02). Conclusions: After complete resection of AGI, perioperative mortality is 16% and median overall survival is 5.8 years. EAB is associated with nearly a two and one-half-fold higher reinfection/mortality compared with ISB. Omental and/or muscle flap coverage of the repair appear protective.
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| 4. |
- 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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| 5. |
- Kahanpää, Henrik, et al.
(författare)
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Convective vortices and dust devils at the MSL landing site : annual variability
- 2016
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Ingår i: Journal of Geophysical Research - Planets. - 2169-9097 .- 2169-9100. ; 121:8, s. 1514-1549
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Tidskriftsartikel (refereegranskat)abstract
- Two hundred fifty-two transient drops in atmospheric pressure, likely caused by passing convective vortices, were detected by the Rover Environmental Monitoring Station instrument during the first Martian year of the Mars Science Laboratory (MSL) landed mission. These events resembled the vortex signatures detected by the previous Mars landers Pathfinder and Phoenix; however, the MSL observations contained fewer pressure drops greater than 1.5 Pa and none greater than 3.0 Pa. Apparently, these vortices were generally not lifting dust as only one probable dust devil has been observed visually by MSL. The obvious explanation for this is the smaller number of strong vortices with large central pressure drops since according to Arvidson et al. [2014] ample dust seems to be present on the surface. The annual variation in the number of detected convective vortices followed approximately the variation in Dust Devil Activity (DDA) predicted by the MarsWRF numerical climate model. This result does not prove, however, that the amount of dust lifted by dust devils would depend linearly on DDA, as is assumed in several numerical models of the Martian atmosphere, since dust devils are only the most intense fraction of all convective vortices on Mars, and the amount of dust that can be lifted by a dust devil depends on its central pressure drop. Sol-to-sol variations in the number of vortices were usually small. However, on 1 Martian solar day a sudden increase in vortex activity, related to a dust storm front, was detected.
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| 6. |
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| 7. |
- Kloos, Jacob L., et al.
(författare)
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The First Martian Year of Cloud Activity from Mars Science Laboratory (Sol 0 - 800)
- 2016
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Ingår i: Advances in Space Research. - : Elsevier BV. - 0273-1177 .- 1879-1948. ; 57:5, s. 1223-1240
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Tidskriftsartikel (refereegranskat)abstract
- Using images from the Navigation Cameras onboard the Mars Science Laboratory rover Curiosity, atmospheric movies were created to monitor the cloud activity over Gale Crater. Over the course of the first 800 sols of the mission, 133 Zenith Movies and 152 Supra-Horizon Movies were acquired which use a mean frame subtraction technique to observe tenuous cloud movement. Moores et al. (2015a) reported on the first 360 sols of observations, representing LS = 150° to 5°, and found that movies up to LS = 184° showed visible cloud features with good contrast while subsequent movies were relatively featureless. With the extension of the observations to a full Martian year, more pronounced seasonal changes were observed. Within the Zenith Movie data set, clouds are observed primarily during LS = 3° - 170°, when the solar flux is diminished and the aphelion cloud belt is present at equatorial latitudes. Clouds observed in the Supra-Horizon Movie data set also exhibit seasonality, with clouds predominantly observed during LS = 72° - 108°. The seasonal occurrence of clouds detected in the atmospheric movies is well correlated with orbital observations of water-ice clouds at similar times from the MCS and MARCI instruments on the MRO spacecraft. The observed clouds are tenuous and on average only make up a few-hundredths of an optical depth, although more opaque clouds are observed in some of the movies. Additionally, estimates of the phase function calculated using water-ice opacity retrievals from MCS are provided to show how Martian clouds scatter sunlight, and thus provide insight into the types of ice crystals that comprise the clouds.
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| 8. |
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| 9. |
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| 10. |
- Moore, Casey A., et al.
(författare)
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A Full Martian Year of Line-of-Sight Extinction within Gale Crater, Mars as Acquired by the MSL Navcam through sol 900
- 2016
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Ingår i: Icarus. - : Elsevier BV. - 0019-1035 .- 1090-2643. ; 264, s. 102-108
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Tidskriftsartikel (refereegranskat)abstract
- We report on line-of-sight extinction in northern Gale Crater, Mars as seen by the Mars Science Laboratory (MSL) rover, Curiosity from sol 100 to sol 900; a little more than an entire martian year. Navcam images oriented due north, which show the distant crater rim, the near ground and the sky allow the extinction due to dust within the crater to be determined. This line-of sight extinction is compared to a complementary dataset of column extinctions derived from Mastcam. The line-of-sight extinction within the crater is less than the column extinction for the majority of the martian year. This implies that the relatively low mixing ratio of dust within the crater as compared to the atmosphere above the crater rim persists through most of the year. This suggests relatively little mixing between the atmosphere above the crater and the atmosphere inside the crater and suggests that northern Gale Crater is a net sink of dust in the current era. The data does however show a yearly convergence of the line-of-sight extinction and the column-averaged extinction around Ls = 270° – 290°. This suggests that air above the crater mixes with air in the crater at this time, as predicted by mesoscale models. Matching line-of-sight and column extinction values are also seen around Ls ≈ 135°, a season that has only been observed once in this dataset, this is particularly interesting as the Rover Environmental Monitoring Station onboard Curiosity reports increased convective boundary layer heights in the same season.
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| 11. |
- Moores, John E., et al.
(författare)
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Atmospheric movies acquired at the Mars Science Laboratory landing site : Cloud Morphology, Frequency and Significance to the Gale Crater Water Cycle and Phoenix Mission Results
- 2015
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Ingår i: Advances in Space Research. - : Elsevier BV. - 0273-1177 .- 1879-1948. ; 55:9, s. 2217-2238
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Tidskriftsartikel (refereegranskat)abstract
- We report on the first 360 sols (LS 150° to 5°), representing just over half a Martian year, of atmospheric monitoring movies acquired using the NavCam imager from the Mars Science Laboratory (MSL) Rover Curiosity. Such movies reveal faint clouds that are difficult to discern in single images. The data set acquired was divided into two different classifications depending upon the orientation and intent of the observation. Up to sol 360, 73 Zenith Movies and 79 Supra-Horizon Movies have been acquired and time-variable features could be discerned in 25 of each. The data set from MSL is compared to similar observations made by the Surface Stereo Imager (SSI) onboard the Phoenix Lander and suggests a much drier environment at Gale Crater (4.6°S) during this season than was observed in Green Valley (68.2°N) as would be expected based on latitude and the global water cycle. The optical depth of the variable component of clouds seen in images with features are up to 0.047 ± 0.009 with a granularity to the features observed which averages 3.8 degrees. MCS also observes clouds during the same period of comparable optical depth at 30 and 50 km that would suggest a cloud spacing of 2.0 to 3.3 km. Multiple motions visible in atmospheric movies support the presence of two distinct layers of clouds. At Gale Crater, these clouds are likely caused by atmospheric waves given the regular spacing of features observed in many Zenith movies and decreased spacing towards the horizon in sunset movies consistent with clouds forming at a constant elevation. Reanalysis of Phoenix data in the light of the NavCam equatorial dataset suggests that clouds may have been more frequent in the earlier portion of the Phoenix mission than was previously thought.
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| 12. |
- Moores, John E., et al.
(författare)
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Observational evidence of a suppressed planetary boundary layer in northern Gale Crater, Mars as seen by the Navcam instrument onboard the Mars Science Laboratory rover
- 2015
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Ingår i: Icarus. - : Elsevier BV. - 0019-1035 .- 1090-2643. ; 249, s. 129-142
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Tidskriftsartikel (refereegranskat)abstract
- The Navigation Cameras (Navcam) of the Mars Science Laboratory rover, Curiosity, have been used to examine two aspects of the planetary boundary layer: vertical dust distribution and dust devil frequency. The vertical distribution of dust may be obtained by using observations of the distant crater rim to derive a line-of-sight optical depth within Gale Crater and comparing this optical depth to column optical depths obtained using Mastcam observations of the solar disc. The line of sight method consistently produces lower extinctions within the crater compared to the bulk atmosphere. This suggests a relatively stable atmosphere in which dust may settle out leaving the air within the crater clearer than air above and explains the correlation in observed column opacity between the floor of Gale Crater and the higher elevation Meridiani Planum. In the case of dust devils, despite an extensive campaign only one optically thick vortex (τ=1.5±0.5×10-3) was observed compared to 149 pressure events > 0.5Pa observed in REMS pressure data. Correcting for temporal coverage by REMS and geographic coverage by Navcam still suggests 104 vortices should have been viewable, suggesting that most vortices are dustless. Additionally, the most intense pressure excursions observed on other landing sites (pressure drop >2.5Pa) are lacking from the observations by the REMS instrument. Taken together, these observations are consistent with pre-landing circulation modeling of the crater showing a suppressed, shallow boundary layer. They are further consistent with geological observations of dust that suggests the northern portion of the crater is a sink for dust in the current era.
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| 13. |
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| 15. |
- Smith, Michael D., et al.
(författare)
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Aerosol optical depth as observed by the Mars Science Laboratory REMS UV photodiodes
- 2016
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Ingår i: Icarus. - : Elsevier BV. - 0019-1035 .- 1090-2643. ; 280, s. 234-248
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Tidskriftsartikel (refereegranskat)abstract
- Systematic observations taken by the REMS UV photodiodes on a daily basis throughout the landed Mars Science Laboratory mission provide a highly useful tool for characterizing aerosols above Gale Crater. Radiative transfer modeling is used to model the approximately 1.75 Mars Years of observations taken to date taking into account multiple scattering from aerosols and the extended field of view of the REMS UV photodiodes. The retrievals show in detail the annual cycle of aerosol optical depth, which is punctuated with numerous short timescale events of increased optical depth. Dust deposition onto the photodiodes is accounted for by comparison with aerosol optical depth derived from direct imaging of the Sun by Mastcam. The effect of dust on the photodiodes is noticeable, but does not dominate the signal. Cleaning of dust from the photodiodes was observed in the season around Ls=270°, but not during other seasons. Systematic deviations in the residuals from the retrieval fit are indicative of changes in aerosol effective particle size, with larger particles present during periods of increased optical depth. This seasonal dependence of aerosol particle size is expected as dust activity injects larger particles into the air, while larger aerosols settle out of the atmosphere more quickly leading to a smaller average particle size over time.
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| 16. |
- Watt, Brenda, et al.
(författare)
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Mutations in or near the Transmembrane Domain Alter PMEL Amyloid Formation from Functional to Pathogenic
- 2011
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Ingår i: PLoS Genetics. - : Public Library of Science (PLoS). - 1553-7390 .- 1553-7404. ; 7:9, s. e1002286-
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Tidskriftsartikel (refereegranskat)abstract
- PMEL is a pigment cell-specific protein that forms physiological amyloid fibrils upon which melanins ultimately deposit in the lumen of the pigment organelle, the melanosome. Whereas hypomorphic PMEL mutations in several species result in a mild pigment dilution that is inherited in a recessive manner, PMEL alleles found in the Dominant white (DW) chicken and Silver horse (HoSi)-which bear mutations that alter the PMEL transmembrane domain (TMD) and that are thus outside the amyloid core-are associated with a striking loss of pigmentation that is inherited in a dominant fashion. Here we show that the DW and HoSi mutations alter PMEL TMD oligomerization and/or association with membranes, with consequent formation of aberrantly packed fibrils. The aberrant fibrils are associated with a loss of pigmentation in cultured melanocytes, suggesting that they inhibit melanin production and/or melanosome integrity. A secondary mutation in the Smoky chicken, which reverts the dominant DW phenotype, prevents the accumulation of PMEL in fibrillogenic compartments and thus averts DW-associated pigment loss; a secondary mutation found in the Dun chicken likely dampens a HoSi-like dominant mutation in a similar manner. We propose that the DW and HoSi mutations alter the normally benign amyloid to a pathogenic form that antagonizes melanosome function, and that the secondary mutations found in the Smoky and Dun chickens revert or dampen pathogenicity by functioning as null alleles, thus preventing the formation of aberrant fibrils. We speculate that PMEL mutations can model the conversion between physiological and pathological amyloid.
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| 17. |
- Webster, Christopher R., et al.
(författare)
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Background levels of methane in Mars' atmosphere show strong seasonal variations
- 2018
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Ingår i: Science. - : American Association for the Advancement of Science. - 0036-8075 .- 1095-9203. ; 360:6393, s. 1093-1096
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Tidskriftsartikel (refereegranskat)abstract
- Variable levels of methane in the martian atmosphere have eluded explanation partly because the measurements are not repeatable in time or location. We report in situ measurements at Gale crater made over a 5-year period by the Tunable Laser Spectrometer on the Curiosity rover. The background levels of methane have a mean value 0.41 ± 0.16 parts per billion by volume (ppbv) (95% confidence interval) and exhibit a strong, repeatable seasonal variation (0.24 to 0.65 ppbv). This variation is greater than that predicted from either ultraviolet degradation of impact-delivered organics on the surface or from the annual surface pressure cycle. The large seasonal variation in the background and occurrences of higher temporary spikes (~7 ppbv) are consistent with small localized sources of methane released from martian surface or subsurface reservoirs.
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| 18. |
- Webster, Christopher R., et al.
(författare)
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Mars methane detection and variability at Gale crater
- 2015
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Ingår i: Science. - : American Association for the Advancement of Science (AAAS). - 0036-8075 .- 1095-9203. ; 347:6220, s. 415-417
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Tidskriftsartikel (refereegranskat)abstract
- Reports of plumes or patches of methane in the Martian atmosphere that vary over monthly timescales have defied explanation to date. From in situ measurements made over a 20-month period by the Tunable Laser Spectrometer (TLS) of the Sample Analysis at Mars (SAM) instrument suite on Curiosity at Gale Crater, we report detection of background levels of atmospheric methane of mean value 0.69 ± 0.25 ppbv at the 95% confidence interval (CI). This abundance is lower than model estimates of ultraviolet (UV) degradation of accreted interplanetary dust particles (IDP’s) or carbonaceous chondrite material. Additionally, in four sequential measurements spanning a 60-sol period, we observed elevated levels of methane of 7.2 ± 2.1 (95% CI) ppbv implying that Mars is episodically producing methane from an additional unknown source.
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