| 1. |
|
|
| 2. |
|
|
| 3. |
|
|
| 4. |
- Bath, Jonathan, et al.
(författare)
-
Contemporary outcomes after treatment of aberrant subclavian artery and Kommerell's diverticulum
- 2023
-
Ingår i: Journal of Vascular Surgery. - : Elsevier BV. - 0741-5214 .- 1097-6809. ; 77:5, s. 1339-1348.e6
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: Aberrant subclavian artery (ASA) and Kommerell's diverticulum (KD) are rare vascular anomalies that may be associated with lifestyle-limiting and life-threatening complications. The aim of this study is to report contemporary outcomes after invasive treatment of ASA/KD using a large international dataset.Methods: Patients who underwent treatment for ASA/KD (2000-2020) were identified through the Vascular Low Frequency Disease Consortium, a multi-institutional collaboration to investigate uncommon vascular disorders. We report the early and mid-term clinical outcomes including stroke and mortality, technical success, and other operative outcomes including reintervention rates, patency, and endoleak.Results: Overall, 285 patients were identified during the study period. The mean patient age was 57 years; 47% were female and 68% presented with symptoms. A right-sided arch was present in 23%. The mean KD diameter was 47.4 mm (range, 13.0-108.0 mm). The most common indication for treatment was symptoms (59%), followed by aneurysm size (38%). The most common symptom reported was dysphagia (44%). A ruptured KD was treated in 4.2% of cases, with a mean diameter of 43.9 mm (range, 18.0-100.0 mm). An open procedure was performed in 101 cases (36%); the most common approach was ASA ligation with subclavian transposition. An endovascular or hybrid approach was performed in 184 patients (64%); the most common approach was thoracic endograft and carotid-subclavian bypass. A staged operative strategy was employed more often than single setting repair (55% vs 45%). Compared with endovascular or hybrid approach, those in the open procedure group were more likely to be younger (49 years vs 61 years; P < .0001), female (64% vs 36%; P < .0001), and symptomatic (85% vs 59%; P < .0001). Complete or partial symptomatic relief at 1 year after intervention was 82.6%. There was no association between modality of treatment and symptom relief (open 87.2% vs endovascular or hybrid approach 78.9%; P = .13). After the intervention, 11 subclavian occlusions (4.5%) occurred; 3 were successfully thrombectomized resulting in a primary and secondary patency of 95% and 96%, respectively, at a median follow-up of 39 months. Among the 33 reinterventions (12%), the majority were performed for endoleak (36%), and more reinterventions occurred in the endovascular or hybrid approach than open procedure group (15% vs 6%; P = .02). The overall survival rate was 87.3% at a median follow-up of 41 months. The 30-day stroke and death rates were 4.2% and 4.9%, respectively. Urgent or emergent presentation was independently associated with increased risk of 30-day mortality (odds ratio [OR], 19.8; 95% confidence interval [CI], 3.3-116.6), overall mortality (OR, 3.6; 95% CI, 1.2-11.2) and intraoperative complications (OR, 8.3; 95% CI, 2.8-25.1). Females had a higher risk of reintervention (OR, 2.6; 95% CI, 1.0-6.5). At an aneurysm size of 44.4 mm, receiver operator characteristic curve analysis suggested that 60% of patients would have symptoms.Conclusions: Treatment of ASA/KD can be performed safely with low rates of mortality, stroke and reintervention and high rates of symptomatic relief, regardless of the repair strategy. Symptomatic and urgent operations were associated with worse outcomes in general, and female gender was associated with a higher likelihood of reintervention. Given the worse overall outcomes when symptomatic and the inherent risk of rupture, consideration of repair at 40 mm is reasonable in most patients. ASA/KD can be repaired in asymptomatic patients with excellent outcomes and young healthy patients may be considered better candidates for open approaches versus endovascular or hybrid modalities, given the lower likelihood of reintervention and lower early mortality rate.
|
|
| 5. |
- Moffatt, Clare, et al.
(författare)
-
International Multi-Institutional Experience with Presentation and Management of Aortic Arch Laterality in Aberrant Subclavian Artery and Kommerell's Diverticulum
- 2023
-
Ingår i: Annals of Vascular Surgery. - : Elsevier. - 0890-5096 .- 1615-5947. ; 95, s. 23-31
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Aberrant subclavian artery (ASA) with or without Kommerell's diverticulum (KD) is a rare anatomic aortic arch anomaly that can cause dysphagia and/or life-threatening rupture. The objective of this study is to compare outcomes of ASA/KD repair in patients with a left versus right aortic arch.METHODS: Using the Vascular Low Frequency Disease Consortium methodology, a retrospective review was performed of patients ≥18 years old with surgical treatment of ASA/KD from 2000 to 2020 at 20 institutions.RESULTS: 288 patients with ASA with or without KD were identified; 222 left-sided aortic arch (LAA), and 66 right-sided aortic arch (RAA). Mean age at repair was younger in LAA 54 vs. 58 years (P = 0.06). Patients in RAA were more likely to undergo repair due to symptoms (72.7% vs. 55.9%, P = 0.01), and more likely to present with dysphagia (57.6% vs. 39.1%, P < 0.01). The hybrid open/endovascular approach was the most common repair type in both groups. Rates of intraoperative complications, death within 30 days, return to the operating room, symptom relief and endoleaks were not significantly different. For patients with symptom status follow-up data, in LAA, 61.7% had complete relief, 34.0% had partial relief and 4.3% had no change. In RAA, 60.7% had complete relief, 34.4% had partial relief and 4.9% had no change.CONCLUSIONS: In patients with ASA/KD, RAA patients were less common than LAA, presented more frequently with dysphagia, had symptoms as an indication for intervention, and underwent treatment at a younger age. Open, endovascular and hybrid repair approaches appear equally effective, regardless of arch laterality.
|
|
| 6. |
|
|
| 7. |
- Amani, Navid, 1985, et al.
(författare)
-
Array Configuration Effect on the Spatial Correlation of MU-MIMO Channels in NLoS Environments
- 2020
-
Ingår i: 14th European Conference on Antennas and Propagation, EuCAP 2020. ; 2020:March
-
Konferensbidrag (refereegranskat)abstract
- In this paper, three different base-station antenna (BSA) configurations are compared in terms of inter-user spatial correlation in a two dimensional (2D) non-line-of-sight (NLoS) environment. The three configurations are: (i) a regular uniform linear array (ULA); (ii) a periodic sparse array; and (iii) an aperiodic sparse array. Electromagnetic modeling of the NLoS channel is proposed where scatterers are considered as resonant dipoles confined in clusters of scatterers (CoSs). While the probability of facing highly correlated user-equipments (UEs) in a multi-user multiple-input multiple-output (MU-MIMO) system is decreasing as the richness of mutipath increases, the sparsity (increased inter-element spacing) is seen to be capable of reducing this probability as well. This is due to the larger spatial variations experienced by the sparse array. Moreover, the results show that further improvement can be achieved by deploying an aperiodic distribution of antenna elements into the sparse antenna aperture.
|
|
| 8. |
- Cooper, Declan L.M., et al.
(författare)
-
Consistent patterns of common species across tropical tree communities
- 2024
-
Ingår i: Nature. - 0028-0836 .- 1476-4687. ; 625:7996, s. 728-734
-
Tidskriftsartikel (refereegranskat)abstract
- Trees structure the Earth’s most biodiverse ecosystem, tropical forests. The vast number of tree species presents a formidable challenge to understanding these forests, including their response to environmental change, as very little is known about most tropical tree species. A focus on the common species may circumvent this challenge. Here we investigate abundance patterns of common tree species using inventory data on 1,003,805 trees with trunk diameters of at least 10 cm across 1,568 locations 1–6 in closed-canopy, structurally intact old-growth tropical forests in Africa, Amazonia and Southeast Asia. We estimate that 2.2%, 2.2% and 2.3% of species comprise 50% of the tropical trees in these regions, respectively. Extrapolating across all closed-canopy tropical forests, we estimate that just 1,053 species comprise half of Earth’s 800 billion tropical trees with trunk diameters of at least 10 cm. Despite differing biogeographic, climatic and anthropogenic histories 7, we find notably consistent patterns of common species and species abundance distributions across the continents. This suggests that fundamental mechanisms of tree community assembly may apply to all tropical forests. Resampling analyses show that the most common species are likely to belong to a manageable list of known species, enabling targeted efforts to understand their ecology. Although they do not detract from the importance of rare species, our results open new opportunities to understand the world’s most diverse forests, including modelling their response to environmental change, by focusing on the common species that constitute the majority of their trees.
|
|
| 9. |
- Coscieme, Luca, et al.
(författare)
-
Multiple conceptualizations of nature are key to inclusivity and legitimacy in global environmental governance
- 2020
-
Ingår i: Environmental Science and Policy. - : Elsevier BV. - 1462-9011 .- 1873-6416. ; 104, s. 36-42
-
Tidskriftsartikel (refereegranskat)abstract
- Despite increasing scientific understanding of the global environmental crisis, we struggle to adopt the policies science suggests would be effective. One of the reasons for that is the lack of inclusive engagement and dialogue among a wide range of different actors. Furthermore, there is a lack of consideration of differences between languages, worldviews and cultures. In this paper, we propose that engagement across the science-policy interface can be strengthened by being mindful of the breadth and depth of the diverse human-nature relations found around the globe. By examining diverse conceptualizations of nature in more than 60 languages, we identify three clusters: inclusive conceptualizations where humans are viewed as an integral component of nature; non-inclusive conceptualizations where humans are separate from nature; and deifying conceptualizations where nature is understood and experienced within a spiritual dimension. Considering and respecting this rich repertoire of ways of describing, thinking about and relating to nature can help us communicate in ways that resonate across cultures and worldviews. This repertoire also provides a resource we can draw on when defining policies and sustainability scenarios for the future, offering opportunities for finding solutions to global environmental challenges.
|
|
| 10. |
- Farsaei, Amirashkan, et al.
(författare)
-
Uniform Linear Arrays With Optimized Inter-Element Spacing for LOS Massive MIMO
- 2021
-
Ingår i: IEEE Communications Letters. - 1558-2558 .- 1089-7798. ; 25:2, s. 613-616
-
Tidskriftsartikel (refereegranskat)abstract
- In this letter, a uniform linear array (ULA) is proposed for line-of-sight massive multiple-input-multiple-output (MIMO). It is assumed that the number of antennas is fixed. For a given ULA with an arbitrary inter-element spacing, the probability that the correlation among the channel vectors of two users being above a threshold value is derived. The inter-element spacing of the proposed ULA is the one for which the aforementioned probability is minimized. To show the effectiveness of the proposed ULA, simulation results for two scenarios are given for a 64-antenna ULA that serves 6 single-antenna users. By using the proposed ULA instead of conventional half-wavelength ULA, 5th percentile sum-rate for zero-forcing precoder is improved by 9.90 bits/channel use in first scenario without dropping, and by 1.43 bits/channel use in second scenario with dropping 1 user.
|
|
