Endovascular stent graft repair for aneurysms on the descending thoracic aorta

BACKGROUND: The traditional treatment of aneurysms of the descending thoracic aorta includes posterolateral thoracotomy and aortic replacement with a prosthetic graft. In this study, we report our experiences and results in endovascular stent graft placement as an alternative to surgical repair. METHODS: Between January 1989 and July 1997, a total of 68 patients (24 women) underwent replacement of the thoracic aorta. Mean age at operation was 51 years. Fifty-eight patients underwent conventional surgical treatment. All of these patients were suitable candidates for endovascular stenting; however, no stent graft material was available at the time of operation. Ten patients (1 chronic dissection, 9 atherosclerotic aneurysm) received in the past 8 months the first commercially manufactured endovascular stent graft. The mean diameter of the aneurysms in this group was 7 cm (range, 6 to 8 cm). Two stent patients were operated on using only spinal cord analgesia. All stent grafts were custom designed for each of the 10 patients. RESULTS: The 30-day mortality in the conventional group was 31% versus 10% in the stent group. Mean length of intervention was 320 minutes in the conventional group versus 150 minutes in the endovascular group. Spinal cord injury occurred in 5 patients (12%) in the surgical group, whereas none of the stented patients developed any neurologic sequelae. Mean intensive care unit stay was 13 days, followed by a mean of 10 days on a ward in the first group compared to 4 days in the intensive care unit and 6 days on the ward in the stent group. One stent was required in 2 patients, two stents were required in 3 patients, and four stents were deployed in 5 patients of our series. Five patients required transposition of the left subclavian artery to achieve a sufficient neck for the proximal placement of the stent. There was complete thrombosis of the thoracic aortic aneurysm surrounding the stent graft in 8 patients (80%). Two patients required restenting as a result of leakage (20%). Stent graft placing was performed through the femoral artery in 8 patients, whereas access was only achieved through the abdominal aorta in 2 patients. CONCLUSIONS: These preliminary results demonstrate that endovascular stent graft replacement might be a promising, cheaper, and safe alternative method in selected patients with descending thoracic aneurysms.     

Hybridization effect of cellulose paper and postcuring conditions on the mechanical properties of flax fiber reinforced epoxy biocomposite

An ever-increasing rise in demand for sustainable materials has received significant attention in developing biocomposites for structural applications. In this regard, natural fibers replacing synthetic fibers as reinforcement in epoxy composite could be a significant gain toward sustainability, especially in automobile and structural applications. Herein, flax fiber/cellulose paper–reinforced epoxy biocomposite (FREC-X) was fabricated via a vacuum infusion process. The influence of postcuring conditions (time and temperature) and cellulose paper density on the mechanical properties of FREC-X was studied. The tensile strength and modulus of FREC-X increased by 37% and 64%, respectively, upon the integration of paper. Postcuring FREC-X further augmented the tensile and flexural properties of the composite, which could be attributed to the increase in cross-linking of the epoxy and yields a strong polymer network. Fractography analysis confirmed that the composites integrated with paper showed fewer defects with improved interfacial adhesion. In addition, the water absorption and thickness swelling results revealed that the presence of cellulose paper marginally increased the water uptake and thickness swelling of FREC-X. Furthermore, there was no significant change in the tensile and flexural properties of FREC-X observed even after immersing in water for >200 h. Such properties of FREC-X seen as a fascinating alternative to synthetic fibers and petroleum-based epoxy and are promising material for sustainable development.     

Endovascular management of "endoleaks" after transluminal infrarenal abdominal aneurysm repair

PURPOSE: To investigate the reasons for endoleaks after transluminal infrarenal abdominal aneurysm management and the potential for transluminal interventions in subsequent management. METHODS: Prospective analysis of 50 consecutive patients undergoing endovascular aneurysm repair at a single institution with Stentor and Vanguard grafts from March 1995 to March 1997. SETTING: Academic teaching hospital. RESULTS: Two procedures were converted for other reasons than leak. In the remaining 48 successful procedures endoleaks were detected in 11 (22.9%): proximal aortic leak (2.1%), distal aortic leak (8.3%), iliac leak (12.5%). Leaks were treated at the initial procedure in five patients, resulting in 87.5% excluded aneurysms. Twelve and a half per cent were discharged with a primary leak. Redo was performed on all iliac leaks within 7 weeks. All aortic leaks showed spontaneous thrombosis within 3 months, but reappeared with local aneurysm expansion. Aortic redo-procedures were performed by proximal tubular extension or converting a tube graft into a bifurcation graft. All rescue procedures were successful. Secondary leaks have been observed twice in this series, both treated by endovascular means. CONCLUSIONS: Endovascular treatment of primary and secondary endoleaks is possible, and may be a safe alternative to a difficult open procedure.     

Efficient Biocatalytic Synthesis of (R)‐Pantolactone

Screening for stereoselective cyanohydrin synthesis in 96‐well plates was employed in the development of an efficient, pH‐stable hydroxynitrile lyase for the conversion of sterically hindered aliphatic aldehydes. Site‐saturation mutagenesis (SSM) resulted in a powerful catalyst for the stereoselective conversion of hydroxypivalaldehyde and pivalaldehyde to their corresponding (R)‐cyanohydrins (ee >97%) which are used as chiral building blocks (e.g., for pantothenic acid production). Furthermore, redesigning the PaHNL5 gene and improving its expression by Pichia pastoris with the help of a new P_AOX1 promoter variant and the helper protein PDI (protein disulfide isomerase) led to elevated amounts of today’s most efficient biocatalyst for vitamin B₅ synthesis.     

Epidemiologic characteristics of conotruncal heart defects in California, 1987-1988

In this population-based case-control study, we explored the association of selected parental and infant characteristics from the birth certificates of children with conotruncal heart defects. We compared 252 cases to a random sample of 5,000 nonmalformed infants from a cohort of 341,839 California live births for 1987-1988. The prevalence of conotruncal defects was 0.732 per 1,000 total births. A decreased risk (OR = 0.55, 95% CI0.33-0.89) for delivering infants with conotruncal defects was found among mothers born in Mexico compared to mothers born in California. An increased risk was observed for Native American mothers compared to non-Hispanic whites (OR = 2.6, 95% CI 1.1-6.0). We also compared risks associated with the individual diagnoses that comprise the group of conotruncal defects. Only minor differences in risk estimates between the anatomic diagnoses were observed, lending support to the methodologic approach of using conotruncal defects as a single category of heart defects in etiologic investigations.     

Factors influencing the processing and technological properties of laminates based on phenolic resin impregnated papers

High quality decorative laminate panels typically consist of two major types of components: the surface layers comprising décor and overlay papers that are impregnated with melamine-based resins, and the core which is made of stacks of kraft papers impregnated with phenolic (PF) resin. The PF-impregnated layers impart superior hydrolytic stability, mechanical strength and fire-resistance to the composite. The manufacturing involves the complex interplay between resin, paper and impregnation/drying processes. Changes in the input variables cause significant alterations in the process characteristics and adaptations of the used materials and specific process conditions may, in turn, be required. This review summarizes the main variables influencing both processability and technological properties of phenolic resin impregnated papers and laminates produced therefrom. It is aimed at presenting the main influences from the involved components (resin and paper), how these may be controlled during the respective process steps (resin preparation and paper production), how they influence the impregnation and lamination conditions, how they affect specific aspects of paper and laminate performance, and how they interact with each other (synergies).     

Thermoplastic polyurethane composites reinforced with renewable and sustainable fillers – a review

ABSTRACT

Thermoplastic polyurethane (TPU) reinforced with natural or renewable fillers gained significant attention in the scientific community and industries. The properties of TPU can be tailored using different reinforcements or blends to enhance its performance and elevate the potential applications of the composite. Besides, composites offer eco-friendliness, recyclability, and biocompatibility thus overcoming the environmental concerns. However, the manufacturing in mass quantity and upholding the quality of these composites has remained one of the principal challenges. Herein, we critically highlighted an overview of the current comprehension of the various eco-friendly and renewable fillers/fibers reinforced in TPU composites for tuning the mechanical and thermal properties of TPU. Some of the important research articles that discuss the influence of interactions, morphology, and modification/treatment of fillers are contained within to understand the behavior and consequence of reinforcements on the physical properties of TPU composites.     

Review on impregnation issues in laminates manufacture: opportunities and risks of phenol substitution by lignins or other natural phenols in resins

The resins used in impregnation of the core layers of Kraft paper-based decorative laminates are basically synthetized from phenol and formaldehyde (PF). The increasing costs of phenol force laminates manufacturers to search for alternatives or partial substitution products to reduce consumption of this chemical. Preferably, such PF alternative substitutes are environmentally friendly bio-based phenolic compounds, such as lignin, tannins, or cashew nut shell liquid. However, substitution raises some technological issues in the impregnation process due to the chemical variability of these natural raw materials and their different properties from phenol. These differences do not only have an influence on the technological behavior of the modified resins during impregnation and laminate pressing, but also require inclusion of new or modified processes such as biomass treatment (down-streaming, modification of natural polyphenols, activation, etc.) or novel synthetic procedures. Moreover, the use of resins containing natural compounds in the laminates manufacture can result in products with minor mechanical properties. This article provides a general overview of the most promising candidates of such bio-based materials and deals with the most important issues when it comes to their incorporation into PF resins. Due to their abundance on Earth, much knowledge of lignin-based materials has already been gained and uses of lignin in PF resins have been studied for many decades. Other natural polyphenols that are less frequently considered for impregnation are covered as well, as they do also possess some potential for PF substitution.