Surgical treatment of retrograde type A aortic dissection after thoracic endovascular aortic repair for Stanford type B aortic dissection / 中国胸心血管外科临床杂志

@#Objective     To analyze the etiologies, surgical treatment and outcomes of retrograde type A aortic dissection (RTAD) after thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection. Methods     The clinical data of patients with RTAD after TEVAR for Stanford type B aortic dissection receiving operations in Changhai Hospital from March 2014 to August 2018 were analyzed. All patients were followed-up by clinic interview or telephone. Results     A total of 16 patients were enrolled, including 13 males and 3 females with a mean age of 49.1±12.2 years. The main symptoms of RTAD were chest pain in 12 patients, headache in 1 patient, conscious disturbance in 1 patient, and asymptomatic in 2 patients. All the 16 patients received total arch replacement with the frozen elephant trunk technique. Bentall procedure was used in 2 patients, aortic root plasticity in 10 patients and aortic valve replacement in 1 patient. The primary tear in 10 patients was located in the area which were anchored by bare mental stent, and in the other 6 patients it was located in the anterior part of ascending aorta. The mean cardiopulmonary bypass time was 152.2±29.4 min, aortic cross-clamping time was 93.6±27.8 min and selective cerebral perfusion time was 29.8±8.3 min. There was no death in hospital or within postoperative 30 days. The follow-up period was 32-85 (57.4±18.3) months. No death occurred during the follow-up period. One patient underwent TEVAR again 3 years after this operation and had an uneventful survival. Conclusion     Total arch replacement with the frozen elephant trunk technique is a suitable strategy for the management of RTAD after TEVAR for Stanford type B aortic dissection.

Midterm clinical results of Sun's procedure with median resternotomy / 中华胸心血管外科杂志

Objective:To summarize the clinical data of Sun's procedure(total aortic arch replacement with frozen elephant trunk technique) in the treatment of complex aortic arch disease after previous cardiac surgery.Methods:From January 1, 2018 to December 31, 2020, a total of 55 patients underwent resternotomy Sun's procedure in the Aortic Surgery Center of Beijing Anzhen Hospital, including 41 males and 14 females, with a mean age of(45.4±12.7) years old, were retrospectively analyzed. The indications of primary cardiac surgery included type A aortic dissection, aortic root or ascending aortic aneurysm, heart valve surgery, and coronary heart disease. Indications for reoperation included residual aortic dissection larger than 55 mm in diameter, aortic aneurysm dilation, new type A aortic dissection, anastomotic leakage with symptoms, and pseudoaneurysm. All the operations were performed under general anesthesia and median resternotomy, total aortic arch replacement with the stented elephant trunk implantation and were performed by anterograde unilateral or bilateral cerebral perfusion.Results:There was no intraoperative death, and the postoperative mortality was 9.1%(5/55). The causes of death were 2 cases of low cardiac output, 1 case of respiratory failure, 1 case of cerebral complications, and 1 case of gastrointestinal bleeding. Except death, there were 2 cases of postoperative cerebral complications(2/50, 4%), 5 cases of spinal cord injury(transient paraplegia)(5/50, 10%), the median duration of ventilator use was 17 hours(14-42 h). Other postoperative complications included respiratory insufficiency requiring ventilatory support longer than 48 hours(8/50, 16%), renal insufficiency requiring temporary dialysis(2/50, 4%). The follow-up time was(25.9±11.2) months(10-47 months), during which 1 case died due to cerebral complication, 4 cases underwent total thoracoabdominal aorta replacement, and 1 case underwent anastomotic leakage repair.Conclusion:It is safe and effec to perform Sun's procedure(total aortic arch replacement with frozen elephant trunk technique) in the treatment of complex arch disease after previous cardiac surgery.

Gastrointestinal Parasites in Asian and African Elephants: A Systematic Review

@#Gastrointestinal parasites (GIPs) in elephants have been reported in several studies over the last decades. Nonetheless, comprehensive data on clinicopathology of elephant GIPs, parasite burden threshold value, and the effectiveness of conventional anthelmintic drugs are still lacking. Herein, we have systematically reviewed the available knowledge on elephant GIPs identified among different parts of the world based on their prevalence, epidemiology, pathology, diagnosis, treatment, and control. Two electronic databases were searched for publications that met the inclusion criteria. About19 English journal articles published between year of 2011- 2021 were included. The main GIPs reported in elephants were Cyathostomidae (at least 14 species), Ancylostomidae, Haemonchus contortus, Trichostrongylus colubriformis, Oesophagostomum columbianum, Oesophagostomum aceleatum, Ascarids, Trichurids, Strongyloides, Anophlocephalidae, flukes, and Coccidia across different parts of the world, including Malaysia, Indonesia, Thailand, Myanmar, Sri Lanka, India, Kenya, Nigeria, and South Africa. Most elephants show no clinical signs until the equilibrium between parasite and host is disturbed. The common diagnostic methods for GIPs are traditional direct smear, faecal floatation, sedimentation, and McMaster egg counting technique, all involving morphological identification. However, some articles described the use of molecular detection to characterise common GIPs of elephants. Although benzimidazoles and macrocyclic lactones group of anthelmintic are the most conventional GIPs treatment and control for captive and semi-captive elephants, there is limited data on the threshold value of faecal egg count as the baseline for treatment decision. Over the last decades, various studies regarding elephant GIPs have been conducted. However, more focused and systematic studies are required to enhance our knowledge in multiple aspects of elephant parasitology to find effective solutions and improve elephant health.

Evaluation of some effective potentialities of newly formulated rice fermented food using Elephantopus scaber L. rhizome as herbal starter

Traditionally, fermented food and beverages are prepared by adding a mixture of plant residues as a starter or source of microbes. Most of the conventional fermented foods use a local starter which contains a mixture of herbs or old ferment or otherwise cereal dust-coated tablet. In this study, we have made an attempt to prepare a rice-based fermented food with the herbal starter (0.5% w/w) of Elephantopus scaber L. rhizome, and also examined its microbial and nutrient profiles. The food product is fortified with organic acid and titratable acidity of 0.58% and also contained an excellent source of microbes (LAB and Bifidobacterium sp.). The fermented food contains significant amount of fat, protein, minerals, vitamins, oligosaccharide, unsaturated fatty acids (?3, ?6, ?7 and ?9) and a pool of free amino acids. The presence of phytochemical contents in the fermented rice was also exhibited significant effects against commercially available free radicals (DPPH, ABTS, FRAP and OH-radicals). Thus, food-grade microbes containing newly formulated fermented food would provide essential macro-and micro-nutrients to the individuals and convey the sustainability of good health. Therefore, the mentioned plant part would be used as an effective starter for aiding rice-based food products.

Sugarcane bagasse or elephant grass hay in diets for goats: Performance, feeding behavior and carcass characteristics

Background: Novel feeding strategies should be developed to produce high-quality meat in current goat production systems. Objective: To evaluate the effects of castration and the association of spineless cactus with sugarcane bagasse or elephant grass hay on nutrient intake, digestibility, performance, feeding behavior and carcass traits of feedlot kids. Methods: A total of 24 male kids (12 castrated and 12 intact), with an average initial weight of 18.5 ± 3.8 kg were allotted to a completely randomized 2 x 2 factorial design (sugar cane bagasse or elephant grass hay; intact or castrated), and confined for 70 days. Results: Nutrient intake and animal performance were similar between treatments. Sugarcane bagasse increased, when compared to elephant grass hay, the digestibility of dry matter (66.12 vs 62.88; p=0.005), crude protein (74.26 vs 70.95; p=0.029) and non-fibrous carbohydrates (91.94 vs 83.07; p<0.001). The forage source affected the time spent resting, ruminating and total chewing time, but there was no effect of diet on feeding and rumination efficiencies. Elephant grass hay increased, when compared to sugarcane bagasse, hot carcass weight (9.87 vs 10.79; p=0.025) and hot carcass yield (43.81 vs 46.87; p=0.013). Intact kids produced heavier hot carcasses when compared with castrated kids (10.80 vs 9.86; p=0.014). Conclusion: Feeding intact or castrated kids with sugar cane bagasse or elephant grass hay do not affect nutrient intake and performance. Feedlot goats have improved carcass traits if kept intact and fed elephant grass hay.

Antecedentes: Se requiere desarrollar nuevas estrategias de alimentación para producir carne de alta calidad en los sistemas actuales de producción de cabras. Objetivo: Evaluar el efecto de la castración y asociación de palma forrajera con bagazo de caña de azúcar o heno de pasto elefante sobre la ingesta de nutrientes, digestibilidad, rendimiento, comportamiento de alimentación y caracteristicas de la canal de cabritos de engorde. Métodos: Un total de 24 cabritos (12 castrados y 12 intactos) con peso inicial promedio de 18,5 ± 3,8 kg fueron asignados a un diseño factorial 2 x 2 completamente al azar (bagazo de caña de azucar o heno de pasto elefante; castrados o intactos) y confinados durante 70 días. Resultados: La ingesta de nutrientes y el rendimiento animal fueron similares entre tratamientos. El bagazo de caña de azúcar aumentó, en comparación con el heno de pasto elefante, la digestibilidad de la materia seca (66,12 vs 62,88; p=0,005), de la proteína cruda (74,26 vs 70,95; p=0,029) y de los carbohidratos no fibrosos (91,94 vs 83,07; p<0,001). La fuente de forraje afectó el tiempo de descanso, de rumia, y el tiempo total de masticación, pero no hubo efecto de la dieta sobre la eficiencia alimentacia y de la rumia. El heno de pasto elefante aumentó, en comparación con el bagazo, el peso de la canal caliente (9,87 vs 10,79; p=0,025) y el rendimiento de la canal caliente (43,81 vs 46,87; p=0,013). Los animales intactos produjeron canales calientes más pesadas en comparación con los castrados (10,80 vs 9,86; p=0,014). Conclusión: La alimentación de cabritos enteros o castrados con bagazo de caña de azúcar o heno de pasto elefante no afecta la ingesta de nutrientes y el rendimiento. Los cabritos tienen mejores características de canal si se alimentan con heno de pasto elefante y se dejan enteros.

Antecedentes: Novas estratégias de alimentação devem ser desenvolvidas para produção de carne de qualidade nos atuais sistemas de produção de caprinos. Objetivo: Avaliar o efeito da castração e da associação da palma forrageira com o bagaço de cana de açúcar ou feno de capim elefante no consumo de nutrientes, digestibilidade, desempenho, comportamento ingestivo e características de carcaça de cabritos confinados. Métodos: Um total de 24 caprinos (12 castrados e 12 não castrados), com peso inicial médio de 18,5 ± 3,8 kg, distribuídos em um delineamento experimental inteiramente casualizado, em arranjo fatorial 2 x 2 (bagaço de cana de açúcar ou feno de capim elefante; inteiros ou castrados), confinados durante 70 dias. Resultados: O consumo de nutrientes e o desempenho dos animais foram semelhante entre os tratamentos. O bagaço de cana elevou, quando comparado com o feno, a digestibilidade da matéria seca (66,12 vs 62,88; p=0,005), proteína (74,26 vs 70,95; p=0,029) e carboidratos não fibrosos (91,94 vs 83,07; p<0,001). As fontes de fibra afetaram os tempos de ócio, ruminação e mastigação total, mas não houve efeito para as eficiências de alimentação e ruminação. O feno de capim elefante aumentou, quando comparado com o bagaço, o peso de caracaça quente (9,87 vs 10,79; p=0,025) e o rendimento de carcaça quente (43,81 vs 46,87; p=0,013). Os animais inteiros produziram carcaças quentes mais pesadas em comparação aos castrados (10,80 vs 9,86; p=0,014). Conclusão: Alimentar caprinos inteiros ou castrados com bagaço de cana ou feno de capim-elefante não interfere no consumo de nutrientes e desempenho. Caprinos confinados terão as características de carcaça melhoradas se mantidos intactos e alimentados com feno de capim elefante.

Risk factors of spinal cord injury after total aortic arch replacement and frozen elephant trunk / 中华胸心血管外科杂志

Objective:To investigate the risk factors of spinal cord injury after FET for ATAAD.Methods:We analyzed perioperative data of 111 patients with ATAAD who underwent FET in the First Affiliated Hospital of Nanjing Medical University from January 2020 to October 2021.Results:Eleven(9.9%)of 111 patients had postoperative spinal cord injury, which showed varying degrees of paralysis or paraplegia. There was no significant difference in age, sex, medical history, cardiopulmonary bypass time, aortic cross-clamping time, circulatory arrest time and FET length between spinal cord injury group and non-spinal cord injury group( P>0.05). Univariate analysis showed that aortic true lumen away from the spinal side( P<0.001) and the number of segmental arteries originating from the true lumen<3 in T9-L3( P<0.001), left subclavian artery involvement( P<0.05) and stent coverage at T8 or beyond( P<0.05) was associated with postoperative spinal cord injury. Multivariate Logistic analysis showed that aortic true lumen away from the spinal side( P<0.001) and the number of segmental arteries originating from the true lumen<3( P<0.001) in T9-L3 and left subclavian artery involvement( P<0.05) were independent risk factors for postoperative spinal cord injury. Conclusion:The pathogenesis of spinal cord injury is complicated. This study suggests that the occurrence of spinal cord injury is significantly related to aortic true lumen away from the spinal side and the number of segmental arteries originating from the true lumen<3 in T9-L3 and left subclavian artery involvement. It is of great clinical significance to identify the high risk factors of postoperative spinal cord injury as early as possible.

A Case of Paraplegia after Total Arch Replacement with Frozen Elephant Trunk for Acute Type A Aortic Dissection / 日本心臓血管外科学会雑誌

The frozen elephant trunk technique (FET) for the treatment of acute aortic dissection is associated with more favorable remodeling in the descending aorta compared to those patients without FET, but it may also be associated with postoperative spinal cord injury (SCI) and actually,some postoperative SCI cases after FET are reported. Several risk factors for SCI are known and one of them is due to the occlusion of intercostal arteries from false lumen. A 71-year-old woman underwent total arch replacement with FET, but after surgery, she noticed decreased movement in both lower extremities and was suspected of postoperative paraplegia. She went through cerebrospinal fluid drainage but didn't get better at all. According to the preoperative contrast computed tomography images, seven out of ten intercostal arteries were originating from the false lumen and six of them were occluded after surgery. When most of intercostal arteries are originating from the false lumen and there is no entry inside the descending and abdominal aorta, the intercostal arteries may be occluded due to thrombosis of the false lumen and it may cause spinal cord ischemia after surgery.

Association of long frozen elephant trunk and incidence of spinal cord injury in patients with acute type A aortic dissection: A single center retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective    To evaluate whether long frozen elephant trunk (FET) increases the risk of spinal cord injury in patients with acute type A aortic dissection. Methods    From 2018 to 2019, 172 patients with acute type A aortic dissection were treated in Guangdong Provincial People’s Hospital. They were divided into two groups according to the length of FET: patients treated with stents of 100 mm in length were enrolled into a short FET group, and those with stents of 150 mm in length into a long FET group. There were 124 patients in the short FET group, including 108 (87.1%) males and 16 (12.9%) females with a mean age of 51.8±7.9 years. There were 48 patients in the long FET group, including 44 (91.7%) males and 4 (8.3%) females with a mean age of 50.6±9.7 years. The clinical data and prognosis of the patients were analyzed. Results    The mean distal stent graft was at the level of T 8.5±0.7 in the long FET group, and at the level of T 6.8±0.6 in the short FET group (P=0.001). Sixteen patients died after operation in the two groups, including 13 (10.5%) in the short FET group and 3 (6.2%) in the long FET group (P=0.561). There were 7 patients of spinal cord injury in the two groups, including 6 (4.8%) in the short FET group and 1 (2.2%) in the long FET group (P=0.675). There was no statistical difference in other complications between the two groups. The follow-up time was 16.7 (1-30) months. During the follow-up, 2 patients died in the long FET group and 5 died in the short FET group. No new spinal cord injury or distal reintervention occurred during the follow-up. Conclusion    Long FET does not increase the incidence of spinal cord injury in patients with acute type A aortic dissection.

Injuries in survivors of elephant attack: Report of three cases / 中华创伤杂志(英文版)

Human-elephant conflict (HEC) in India is becoming a growing health problem causing many fatalities every year. Elephants produce injuries by trampling, stomping, squeezing, tossing in the air, or crushing/targeting the head and chest commonly. The adult elephants are most aggressive in their mating season, leading to maximum incidences of HECs in this period. These attacks are mostly unprovoked, though most HECs are provoked. In this case series, the authors described the injuries sustained by three survivors in a short span of one month due to the sudden and unprovoked elephant attack. All the injuries were mild to moderate in severity and involved the chest in common. Timely rescue and prompt initiation of treatment were pivotal in their survival. The authors also want to create awareness about the mating season of elephants to minimize these unfortunate events in the future.

Pattern of injuries due to wild animal attack among patients presenting to the emergency department: A retrospective observational study / 中华创伤杂志(英文版)

PURPOSE@#The human-wildlife conflicts (HWCs) causing nuisances and injuries are becoming a growing public health concern over recent years worldwide. We aimed to study the demographic profile, mode of injury, pattern of injury, and outcome of wild animal attack victims presented to the emergency department.@*METHODS@#This retrospective cross-sectional study was conducted in the emergency department of a tertiary-care hospital in Eastern India. Data were retrieved from the medical records from May 2017 to May 2021. Patients of all ages and genders attacked by wild animals and secondary injuries were included in this study. Patients with incomplete data, injuries due to the attack of stray and domestic animals and trauma due to other causes were excluded. Demographic profile, mode of injury, the pattern of injury, injury severity score (ISS), radiological pattern, and outcome were recorded. Statistical analysis with R (version 3.6.1.) was conducted.@*RESULTS@#A total of 411 wild animal attack victims were studied, of which 374 (90.9%) were snakebite injuries and 37 (9.1%) were wild mammalian (WM) attack injuries. The mean age of WM attack victims was 46 years, and the male-to-female ratio was 4:1. Elephant attack injury (40.5%) was the most common WM attack injury reported. Most WM attacks (43.2%) occurred between 4:00 a.m. to 8:00 a.m. The median ISS was 18.5 (13-28), where 54.2% of patients had polytrauma (ISS>15). Elephant attack was associated with a higher ISS, but the difference was not significant compared to other animal types (p = 0.2). Blunt trauma was common pattern of injury in the elephant attack injury cases. Lacerations and soft tissue injuries were common patterns in other animal attacks. Among snakebites, neurotoxic was the most common type (55.4%), and lower extremity was the most common site involved.@*CONCLUSION@#The young male population is the major victim of HWCs; and elephant is the most common animal involved. There is a need to design scientifically sound preventive strategies for HWCs and to strengthen the preparedness in health establishments to manage victims effectively.

A Case of Staged Hybrid Repair for Subacute Type B Aortic Dissection in a Patient with Shaggy Aorta / 日本心臓血管外科学会雑誌

In aortic surgery involving shaggy aorta, surgical strategy to avoid embolism is crucial for each case. We applied the frozen elephant trunk technique to a patient with shaggy aorta. A 79-year-old man was admitted to our hospital for conservative treatment of acute Type B aortic dissection. Dissecting aneurysms of the aortic arch and descending aorta were shown to have rapidly dilated according to CT three weeks later. Preoperative contrast CT showed an ulcerated shaggy aorta from the aortic arch to the mid portion of the descending aorta. To utilize the benefit of the stent compared with the classical elephant trunk technique, we proposed that the frozen elephant trunk technique would be helpful in prevention of embolism. We therefore planned total arch replacement with the frozen elephant trunk technique and performed thoracic endovascular aortic repair. We employed the frozen elephant trunk technique in the first operation and balloon protection of the superior mesenteric artery and the renal artery in the second operation. The patient had an uneventful postoperative course without thromboembolism. The frozen elephant trunk technique may be helpful for patients with shaggy aorta to avoid thromboembolic events.

A Case of a Super-Elderly Patient Who Underwent Total Arch Replacement Using the Frozen Elephant Trunk Technique for a Thoracic Aortic Aneurysm with a Right-Sided Aortic Arch / 日本心臓血管外科学会雑誌

The case is that of a 90-years-old man. A previous doctor performed abdominal graft replacement for an abdominal aortic aneurysm 5 years earlier and continued outpatient CT follow-up. Follow-up CT showed the right aortic arch and dilation of the thoracic aortic aneurysm, and the patient was referred to our hospital. Contrast-enhanced CT showed an aortic arch aneurysm ; the aneurysm diameter was 62 mm in major axis and 60 mm in minor axis, which was judged to be suitable for surgery. It was a rare right-sided aortic arch with no congenital heart malformation and no situs inversus. Endovascular treatment was considered because he was 90 years old and very elderly, but there were concerns about the risk of embolism, irregular manipulation and central landing. For the surgical method, we selected total arch replacement using a frozen elephant trunk technique. We succeeded in avoiding serious complications by selecting an appropriate treatment method through careful evaluation.

Examination of Treatment for Complications of the Downstream Aorta after a Frozen Elephant Trunk Procedure during the Follow-up Period / 日本心臓血管外科学会雑誌

Objective: We examined complications of the downstream aorta after the frozen elephant trunk (FET) procedure. Methods: Complications were diagnosed in eight patients: true aneurysm alone in five patients; type A aortic dissection in two patients; and both true aneurysm and type B aortic dissection in one patient. Results: Elective surgery was performed in seven patients. Five patients received a Matsui-Kitamura stent graft (MKS) and three patients received a J Graft Open Stent Graft (JGOSG). The FET procedure was successfully applied in all cases. Over the long term, dilatation of the descending thoracic aorta (dTA) alone was identified in two patients and dilatation of the dTA and migration was identified in three patients using the MKS. Complications of graft kinking and migration were seen in one patient and distal stent graft-induced new entry in two patients using the JGOSG. Thoracic aortic stent graft repair was successfully performed for complications in seven patients. Conclusion: For the improvement of clinical results, FET devices need to offer flexibility and appropriate radial force.

An elephant trunk stent graft strayed into the false lumen leading to a death during the Sun's operation: A case report / 中南大学学报(医学版)

Type A aortic dissection (AD) is a critical and severe disease with high mortality. The Sun's operation is a standard surgical method for this kind of disease at present. For the procedure, an elephant trunk stent is inserted into the true lumen of the descending aorta and the aortic arch is replaced. A patient was admitted to the First Hospital of Lanzhou University due to sudden chest and back pain for 6 days. Computed tomography angiography (CTA) showed type A AD. Ascending aorta replacement, Sun's operation, and ascending aorta to right femoral artery bypass grafting were performed. After surgery, the patient's condition was worsened. The digital subtraction angiography (DSA) showed the elephant trunk stent was inserted into the false lumen of AD, leading to the occlusion of the large blood vessel at the distal part of the abdominal aorta and below. Although we performed intima puncture and endovascular aortic repair, the patient was still dead.

Importance of sequential herbicide application in the control of Elephantopus mollis / A importância da aplicação sequencial no controle de Elephantopus mollis

RESUMO: Popularmente conhecida como pata de elefante ou sussuaiá, Elephantopus mollis, é uma espécie que recentemente surgiu como uma planta daninha em lavouras de cultivos de grãos. Objetivou-se com este estudo avaliar a sensibilidade diferencial de biótipos de E. mollis oriundos de áreas agrícolas e não agrícolas e determinar as melhores combinações de herbicidas aplicados em diferentes estádios de desenvolvimento para o controle desta espécie. Foram realizados três experimentos. No experimento de sensibilidade diferencial foram utilizados dez herbicidas em dois biótipos em duas fases de desenvolvimento. O experimento de dose resposta foi conduzido com oito doses de sete herbicidas. O experimento a campo foi realizado em uma área que apresenta problemas com a planta daninha para validar os resultados dos experimentos anteriores. O biótipo oriundo de área agrícola apresentou menor sensibilidade aos herbicidas quando comparado ao biótipo oriundo de área não agrícola. Os herbicidas de contato inicialmente apresentam controle superior, mas logo a planta apresenta rebrote em função de gemas presentes no colo da planta. A aplicação isolada de 2,4-D com doses entre 1005 e 1675 g e.a ha-1 possui controle de 25%. Quando o 2,4-D é seguido da aplicação de paraquat (400 g i.a ha-1) o controle passa a ser entre 51 e 68%. O melhor tratamento para o controle de plantas desenvolvidas é a mistura de 2,4-D + glyphosate (1340 + 1080 g e.a ha-1) com aplicação sequencial de paraquat.

ABSTRACT: Elephantopus mollis, popularly known as elephant paw or sussuaiá, is a species that has recently emerged as a weed affecting grain crops. This study aimed to evaluate the differential sensitivity of biotypes of E. mollis obtained from agricultural and nonagricultural areas and to determine the best combinations of herbicides applied at different stages of development for controlling this species. Three experiments were conducted. In the differential sensitivity experiment, 10 herbicides were used in 2 biotypes in 2 stages of development. The dose-response experiment was conducted using 8 doses of 7 herbicides. The field experiment was conducted in an area with weed issues to validate the results of previous experiments. The biotype from the agricultural area showed lower sensitivity to herbicides than the biotype from the nonagricultural area. The contact herbicides initially presented better control; however, the weed shortly showed re-growth due to the presence of buds in the plant crown. Isolated application of 2.4-D amine at doses between 1005 and 1675 g a.e. ha−1 demonstrated 25% control. When 2,4-D amine was followed by paraquat application (400 g a.i. ha−1), the control observed was between 51% and 68%. The best treatment for the control of completely developed weeds is 2,4-D amine + glyphosate mixture (1340 + 1080 g a.e. ha−1), followed by sequential paraquat application.

Murumuru (Astrocaryum murumuru) meal as an additive to elephant grass silage / Torta de murumuru (Astrocaryum murumuru) como aditivo en el ensilado de pasto elefante / Torta de murumuru (Astrocaryum murumuru) como aditivo em silagens de capim elefante

Abstract Background: Tropical grasses, such as elephant grass, have high moisture content during its ideal phenological state for silage. High moisture content hinders proper preservation and reduces the nutritive value of silage due to secondary fermentation and production of effluents. Adding feed materials with high dry matter content, such as murumuru (Astrocaryum murumuru) meal, is a potential alternative to improve silage yield. Objective: To determine the effects of including murumuru meal (0, 7, 14, 21, and 28%) on the fermentative characteristics, microbiological activity, aerobic stability, and chemical composition of elephant grass silages. Methods: A completely randomized design with five treatments and five replicates was used. Elephant grass was collected at 60 d of age, minced, and homogenized with murumuru meal. The mass was placed in experimental 15-L silos. The silos were collected and analyzed 45 d later. Results: Effluent production decreased (p<0.05) as the proportions of murumuru meal in silage increased. A quadratic effect (p<0.05) was observed on dry matter recovery. An increase (p<0.05) was observed in dry matter content, a decrease (p<0.05) in the neutral detergent fiber content, and an increase (p<0.05) in the non-fibrous carbohydrate content with the inclusion of murumuru meal. Conclusions: Addition of murumuru meal improves chemical composition and does not affect the fermentative characteristics of elephant grass silage, while it reduces effluent losses. Nevertheless, the inclusion of murumuru meal in the elephant grass silage decreased the time of aerobic stability.

Resumen Antecedentes: los pastos tropicales, tales como el pasto elefante, tienen alto contenido de humedad cuando están en su estado fenológico ideal para ensilar. Esto dificulta su adecuada preservación en el silo, reduciendo el valor nutritivo del ensilaje debido a fermentaciones secundarias y generación de efluentes. Una posible solución sería incluir materiales con alto contenido de materia seca, tales como la torta de murumuru (Astrocaryum murumuru). Objetivo: determinar el efecto de la inclusión de torta de murumuru (0; 7; 14; 21 y 28%) sobre las características fermentativas, microbiológicas, estabilidad aeróbica y composición química de los ensilajes de pasto elefante. Métodos: se utilizó un diseño completamente al azar, con cinco tratamientos y cinco repeticiones. El pasto elefante fue colectado a los 60 días de edad, luego picado y homogeneizado con la torta de murumuru. La masa fue colocada en silos experimentales con capacidad de 15 L. Luego de 45 días de ensilado, los silos fueron abiertos y las muestras fueron colectadas para su posterior análisis. Resultados: hubo reducción (p<0,05) en la producción de efluentes a medida que se incrementó la proporción de torta de murumuru en el ensilado. Se observó un efecto cuadrático (p<0,05) en la recuperación de materia seca. Hubo aumento (p<0,05) en los contenidos de materia seca con la adición de torta de murumuru. Se observó disminución (p<0,05) en el contenido de fibra detergente neutra y aumento (p<0,05) de carbohidratos no fibrosos. Conclusión: La adición de torta de murumuru mejora la composición química, reduce las perdidas por efluentes y no afecta las características fermentativas de ensilado de pasto elefante. Sin embargo, la inclusión de la torta de murumuru en el ensilado de pasto elefante disminuye el tiempo en estabilidad aeróbica.

Resumo Antecedentes: capins tropicais, como por exemplo o capim-elefante apresentam alto teor de umidade quando possuem produtividade compatível e estão no estádio fenológico adequado para ensilagem. Isso dificulta a adequada preservação no silo, ocasionando a redução do valor nutritivo da silagem devido a fermentações secundárias e a produção de efluentes. Uma possível solução seria o uso de aditivos com alto teor de matéria seca, como bolo de murumuru (Astrocaryum murumuru). Objetivo: determinar o efeito da inclusão da torta de murumuru (0; 7; 14; 21 e 28%) na ensilagem de capim-elefante sobre as características fermentativas, microbiológicas, estabilidade aeróbia e a composição química das silagens. Métodos: utilizou- se um delineamento inteiramente casualizado, com cinco tratamentos e cinco repetições. O capim-elefante foi colhido aos 60 dias de idade, o mesmo foi picado e homogeneizado à torta de murumuru. A massa foi ensilada em silos experimentais com capacidade de 15 L. Após 45 dias de ensilagem, os silos foram abertos e amostras foram coletadas para posteriores análises laboratoriais. Resultados: houve redução (p<0,05) na produção de efluentes à medida que se elevaram as proporções da torta de murumuru na ensilagem. Observou-se efeito quadrático (p<0,05) na recuperação de matéria seca. Houve aumento (p<0,05) nos teores de matéria seca com a adição da torta murumuru. Observou-se diminuição (p<0,05) nos teores de fibra em detergente neutro e aumento (p<0,05) nos teores de carboidratos não fibrosos. Conclusão: torta de murumuru como aditivo melhora a composição química, reduz perdas principalmente por efluente e não afeta as características fermentativas de silagens de capim- elefante. Entretanto, a inclusão da torta de murumuru na ensilagem de capim-elefante diminui o tempo em estabilidade aeróbia.

Frozen elephant trunk implantation for pseudoaneurysms of the distal aortic arch and descending aorta / 中华胸心血管外科杂志

Objective To review the outcomes of the frozen elephant trunk implantation in patients with pseudoaneurysms of the distal aortic arch and descending aorta.Methods From March 2009 to December 2017,patients with pseudoaneurysms of the distal aortic arch and descending aorta who underwent the frozen elephant trunk implantation were enrolled.Patient demographic,preoperative,intraoperative,early morbidity and mortality data were collected from medical and electronic patient records.Clinical follow-up data,including late morbidity and mortality,were obtained by telephone interview with the patient.Results A total of 14 patients were included,13 males and 1 females,aged(41.0 ± 14.7) years.Early mortality rate was 7.14％ (1/14).The cause of death was rupture of the distal descending thoracic aorta.The early complications included reexploration for bleeding in 1 patient and pericardial window for delayed pericardial effusion in 1 patient.The mean follow-up was(32.3 ± 22.3) months.There was 1 late death from severe pulmonary infection.Conclusion The frozen elephant trunk implantation is an appropriate therapeutic strategy for patients with pseudoaneurysms of the distal aortic arch and descending aorta.

Descending Aortic Rupture after Frozen Elephant Trunk Technique for Dissected Aortic Arch Aneurysm / 日本心臓血管外科学会雑誌

We report a 41-year-old man who presented with a ruptured dissecting aneurysm of the descending aorta. He had undergone aortic root replacement for an acute aortic dissection (Stanford type A) ; 8 months later, he had undergone total arch replacement with insertion of a frozen elephant trunk (FET) due to enlargement of the chronic dissecting aneurysm of the arch. FET-induced new entry and incomplete thrombosis occurred postoperatively. Three months after FET insertion, he developed an aortic rupture that required emergency replacement of the descending aorta. The patient tolerated the procedure well and was discharged 16 days after the operation.

Evaluation of the efficacy of restricted bare stent in the treatment of acute stanford A aortic dissection / 中华胸心血管外科杂志

Objective To observe the effect of restrictive bare stent release on the distal end of Stanford type A aortic dissection.Methods From November 2016 to February 2018,20 patients with Stanford type A aortic dissection requiring aortic arch replacement and trunk surgery were selected for restrictive bare stent placement.Among them,there were 17 males and 3 females,aged 34-68 years old with an average age of(50.85 ± 8.49) years.The bare stent was released in the descending thoracic aorta,and the frozen elephant trunk was placed in the bare stent.The CTA of the great vessels was reviewed before discharge and the stent position and complications were observed.And compared with 42 patients with acute aortic arch replacement and stent-like nasal surgery in the acute Stanford type A aortic dissection from December 2013 to June 2015.Of the 42 patients,32 were males and 10 were females,aged 20-78 years,with an average of(49.36 ± 8.02) years.Results One patient in the bare stent group had greater resistance when the bare stent was placed,and the patient was disengaged and abandoned.The remaining 19 patients successfully completed the restrictive bare stent placement.One patient died of a large cerebral infarction during hospitalization.All 18 patients who survived and successfully placed the bare stent were followed up regularly.There was no stroke or death during the follow-up period.The computed tomography angiography of the computed tomography showed good shape and position,no displacement and type lⅢ endoleak,and no new fracture of the distal end of the elephant trunk was observed.In the conventional surgery group,2 patients died,1 patient died of large-scale cerebral infarction,and 1 patient died of perioperative myocardial infarction.No paraplegia cases.In 2 cases,a new rupture of the distal eud of the elephant trunk was performed,and the stent was placed again.Conclusion Compared with the conventional surgery group,the use of the restricted bare stent is safe,can effectively reduce the occurrence of stent-graft induced new entry and can significantly expand the diameter of the distal vessel,and the aortic remodeling effect is good.

Efficacy of restrictive bare stent in the treatment of acute Standford type A aortic dissection / 中国胸心血管外科临床杂志

@#Objective    To observe the efficacy of restrictive bare stent released on the distal end of the trunk of Standford type A aortic dissection. Methods     The clinical data of 22 patients with Standford type A aortic dissection requiring aortic arch replacement and trunk surgery and selected for restrictive bare stent placement from November 2016 to February 2018 in our hospital were retrospectively analyzed. Among them, there were 19 males and 3 females, aged 34-68 (49.72±8.05) years. The bare stent was released in the descending thoracic aorta, and the stented elephant trunk was placed in the bare stent. The aortic computerized tomography angiography was reviewed before discharge and the stent position and complications were observed. Results    One patient failed to be implanted with bare stents due to a greater resistance and prolapse during implantation. Bare stents were successfully implanted in the remaining 21 patients. One patient died of large-area cerebral infarction after surgery and one patient suffered paraplegia. Twenty patients who survived and successfully implanted bare stents were followed up at regular intervals for 4-21 (13.00±6.14) months. No stroke or death occurred during the follow-up. The computerized tomography angiography showed good stent morphology and position, and no displacement or type Ⅲ endoleak. No stent graft-induced new entry was found. Conclusion    As an adjunct to stented elephant trunk, the use of restrictive bare stents can reduce the possibility of recurrence of a distal stent fracture, significantly expand the narrowest segment and true lumen caliber near the endoluminal graft. Aortic remodeling works well.