Unlocking the Power of Influenza Vaccines for Pediatric Population: A Narrative Review.

The flu, often known as influenza, is a dangerous public health hazard for the pediatric population. Immunization is essential for decreasing the burden of the disease and avoiding complications related to influenza. However, the immunogenicity, efficacy, and safety of different influenza vaccines in children warrant careful evaluation. The purpose of this narrative review is to give a summary of the existing literature on the immunogenicity, efficacy, and safety of several vaccinations against influenza viruses in children. The review incorporates evidence from a range of studies focusing on the outcomes of interest. Immunogenicity studies have shown that influenza vaccines induce a robust immune response in children, primarily through neutralizing antibodies' formation. However, variations in vaccine composition influence the duration and magnitude of immune responses. Safety is a crucial consideration in pediatric vaccination. In children, influenza vaccinations have generally shown a high safety profile, with mild and temporary side effects being the most common. Vaccinations against influenza have shown a modest level of efficacy in avoiding hospitalizations linked to influenza, laboratory-confirmed influenza infections, and serious consequences in children. Live attenuated vaccines have shown higher effectiveness against matched strains compared to inactivated vaccines. In conclusion, this narrative review highlights that receiving influenza vaccination in children aged six to 47 months is very important. While different vaccines exhibit varying immunogenicity, safety profiles, and effectiveness, they all contribute to reducing the burden of influenza among children. Future research should focus on optimizing vaccine strategies, improving vaccine coverage, and evaluating long-term protection.

Life-Threatening Thrombosis After Large Amounts of Nitrous Oxide Use.

This case report highlights the development of severe, life-threatening thrombotic complications after chronic recreational use of large quantities of nitrous oxide in a 21-year-old patient. In young patients presenting with thromboembolism and nitrous oxide abuse, swift identification of symptoms and management is critical.

Causes of death after first time venous thromboembolism.

BACKGROUND: Causes of death after first time community-acquired venous thromboembolism (VTE) diagnosed in unselected patients at the emergency department (ED) was investigated. MATERIALS AND METHODS: The study consists of all patients > 18 years of age who had a visit for any medical reason to any of 5 different ED in Stockholm County, Sweden from 1st January 2016 to 31st December 2017. We have identified all patients with a first registered incident VTE; deep vein thrombosis (DVT) and/or pulmonary embolism (PE) during the study period. Cox regression models were used to estimate hazards ratios (HR) with 95% confidence intervals (CIs) for all-cause mortality and cause-specific death in patients with DVT or PE using all other patients as the reference group. RESULTS: In total, 359,884 patients had an ED visit during the study period of whom about 2.1% were diagnosed with VTE (DVT = 4,384, PE = 3,212). The patients with VTE were older compared to the control group. During a mean follow up of 2.1 years, 1567 (21%) and 23,741(6.7%) patients died within the VTE and reference group, respectively. The adjusted risk of all-cause mortality was nearly double in patients with DVT (HR 1.7; 95% CI, 1.5-1.8) and more than 3-fold in patients with PE (HR 3.4; 95% CI, 3.1-3.6). While the risk of cancer related death was nearly 3-fold in patient with DVT (HR 2.7; 95% CI, 2.4-3.1), and 5-fold in PE (HR 5.4; 95% CI, 4.9-6.0 respectively). The diagnosis of PE during the ED visit was associated with a significantly higher risk of cardiovascular death (HR 2.2; 95% CI, 1.9-2.6). CONCLUSION: Patients with VTE have an elevated risk of all-cause mortality, including cardiovascular death.

Retraction: Posterior Reversible Encephalopathy Syndrome: A Rare Complication in COVID-19.

[This retracts the article DOI: 10.7759/cureus.18426.].

Association of coronary angiographic lesions and mortality in patients over 80 years with NSTEMI.

OBJECTIVE: Coronary angiography (CA) and percutaneous coronary intervention (PCI) is of great importance during non-ST-segment elevation myocardial infarction (NSTEMI) management. Coronary artery lesions and their association to mortality in elderly patients with NSTEMI was investigated. METHODS: Patients >80 years of age who underwent CA at index NSTEMI during 2011-2014 were included. Data were collected from the Swedish Coronary Angiography and Angioplasty Registry and Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registries. Coronary lesions were categorised into; one vessel disease (1VD), multi-vessel disease (MVD) and left main disease (LMD) and 0%-49% stenosis grade were considered as controls.Cox regression was used to estimate HRs for all-cause mortality associated with coronary lesions. Survival benefit was determined after PCI and in relation to if revascularisation was complete or incomplete and any complications in the Cath lab was assessed. RESULTS: Five thousand seven hundred and seventy patients with history of CA and PCI were included, 10% had normal coronary arteries, 26% had 1VD, 50% MVD and 14% LMD. Mortality was higher in patients with 1VD, MVD and LMD: HR 1.8 (1.3-2.5), HR 2.2 (1.6-3.0) and HR 2.8 (2.1-3.9), respectively. PCI were treated in 84% of 1VD, 73% MVD, and 54% in LMD. Survival was higher with PCI HR 0.85 (0.73-0.99). MVD had lower adjusted mortality HR 0.71 (0.58-0.87) compared with patients with MVD who did not undergo PCI. Complications and mortality were higher in patients with LMD both during CA and PCI, HR 2.9 (1.1-7.6) and HR 4.5 (1.6-12.5). CONCLUSION: Coronary lesions (>50% stenosis) are strong predictors of mortality in elderly patients with NSTEMI. MVD is common and PCI treatment is associated with increased survival.

New application of brown sea algae as an alternative to phosphorous-containing antiscalant.

Over the past decade, green chemistry research has focused on the importance of protecting the environment, especially to align with UN sustainable development goals by avoiding the use of chemicals that are harmful to the environment and society. In this study, an aqueous extract derived from brown sea algae was prepared and its performance as antiscalant was compared to commercial antiscalant (Hydroxy ethylidene, 1-Diphosphonic Acid, HEDP) and evaluated using electrochemical measurements, conductivity and standard NACE test in addition to microscopic examination. It was found that there is a significant inhibition efficiency of brown algae towards the tested scales as HEDP. The obtained extract had the ability to prevent precipitation of calcium sulphate, calcium carbonate, barium sulphate and strontium carbonate with percent inhibition of 100%, 80%, 84% and 75%, respectively. The inhibitory effect of the extract can be attributed to the presence of carboxylate and hydroxyl groups that are adsorbed on the surface sites and disturb the normal crystal growth of the scale. The results of the study will lead to the discovery of further new applications of ecologically, cost-effective, renewable source and benign antiscalant that can be considered as an alternative to non-green technologies particularly those used in the food and pharmaceutical industries as well as in desalination plants.

Posterior Reversible Encephalopathy Syndrome: A Rare Complication in COVID-19.

The coronavirus disease 2019 (COVID-19) has a broad spectrum of manifestations. Neurological complications are not uncommon in patients with COVID-19. We report the case of a middle-aged man who presented with a cough and fever. He had a decreased oxygen saturation and required supplementary oxygen therapy. During his stay, he developed an unexplained seizure. Computed tomography of the brain revealed vasogenic edema located posteriorly. Subsequently, magnetic resonance imaging demonstrated subcortical white-matter hyperdensities, in keeping with the diagnosis of posterior reversible encephalopathy syndrome, an exceedingly rare manifestation in COVID-19. This condition should be kept in mind when encountering unexplained neurological manifestations that developed in patients with COVID-19.

Early Risk of Stroke in Patients Undergoing Acute Versus Elective Cardioversion for Atrial Fibrillation.

Background Electrical cardioversion (ECV) is routinely used to restore sinus rhythm in patients with symptomatic atrial fibrillation. The European guidelines have been updated in recent years. Current information on differences in the risk for stroke after acute versus elective ECV is lacking. Methods And Results All patients with a first-time acute or elective ECV in the Stockholm regional health care data warehouse from 2011 to 2018 were included. Cox regression analyses were performed evaluating ischemic or unspecified stroke within 30 days after ECV with adjustments for the CHA2DS2-VASc score, medical treatment, and year of inclusion. The study included 9139 patients, 3094 after acute and 6045 after elective ECV. The mean age was 65.9±11.3 years, 69.5% were men, and the mean CHA2DS2-VASc score was 2.4±1.7. Before the intervention, 49.6% of patients with an acute ECV and 96.4% of those with an elective ECV had claimed an oral anticoagulant prescription. Ischemic or unspecified stroke occurred in 26 (0.28%) patients within 30 days. The unadjusted risk was higher after acute compared with elective ECV (hazard ratio [HR], 2.29; 95% CI, 1.06-4.96), whereas there was no difference after multivariable adjustments (adjusted HR, 0.99; 95% CI, 0.36-2.72). Both non-vitamin K oral anticoagulants (adjusted HR, 0.28; 95% CI, 0.08-0.98) and warfarin (adjusted HR, 0.17; 95% CI, 0.05-0.53) were associated with a lower risk for stroke compared with no anticoagulation. Conclusions Acute ECV was associated with a higher unadjusted risk for stroke than elective ECV, but the risk was similar after adjustment for anticoagulant treatment. This study indicates the importance of anticoagulation before ECV according to recent European guidelines.

Statin Therapy and Intensity: Prognosis in Patients with Myocardial Injury.

BACKGROUND: No guideline-directed pharmacological therapy has been established for patients with myocardial injury without type 1 myocardial infarction. We investigated the impact of statin treatment in patients with myocardial injury. METHODS: Patients with myocardial injury (nonischemic acute and chronic myocardial injury), type 2 myocardial infarction, and type 1 myocardial infarction with at least 1 emergency department visit for chest pain from 2011 to 2014 were included. Dispensed prescriptions of all types of statins with dosage within 180 days from the index visit were collected. In total, 2054 patients were divided into 3 groups: 1) acute myocardial injury (type 2 myocardial infarction, acute nonischemic myocardial injury), 2) chronic myocardial injury, and 3) type 1 myocardial infarction. We estimated the adjusted hazard ratio with 95% confidence interval for death with low- (reference), moderate-, and high-intensity statin therapy. RESULTS: The mean follow-up was 4.2 ± 1.8 years. Only 13% of patients with acute and chronic myocardial injury and 30% with type 1 myocardial infarction were treated with high-intensity statins. Adjusted mortality rates were higher in patients with acute and chronic myocardial injury than in those with type 1 myocardial infarction across all statin intensity categories. In patients with type 1 myocardial infarction, the adjusted mortality risk was 20% (hazard ratio, 0.80; 95% confidence interval, 0.36-1.77) lower in patients with high-intensity therapy. Point estimates in the adjusted models indicated similar associations between statin intensity and mortality risk in patients with acute and chronic myocardial injury. CONCLUSION: Patients with myocardial injury may benefit from high-intensity statin treatment, but the associations were not statistically significant when adjusting for confounders.

Treatment With Cardiovascular Medications: Prognosis in Patients With Myocardial Injury.

Background There is no clinical guidance on treatment in patients with non-ischemic myocardial injury and type 2 myocardial infarction (T2MI). Methods and Results In a cohort of 22 589 patients in the emergency department at Karolinska University Hospital in Sweden during 2011 to 2014 we identified 3853 patients who were categorized into either type 1 myocardial infarction, T2MI, non-ischemic acute and chronic myocardial injury. Data from all dispensed prescriptions within 180 days of the visit to the emergency department were obtained concerning ß-blockers, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, statins, and platelet inhibitors. We estimated adjusted hazard ratios (HR) with 95% CI for all-cause mortality in relationship to the number of medications (categorized into 0-1 [referent], 2-3 and 4 medications) in the groups of myocardial injury. In patients with T2MI, treatment with 2 to 3 and 4 medications was associated with a 50% and 56% lower mortality, respectively (adjusted HR [95% CI], 0.50 [0.25-1.01], and 0.43 [0.19-0.96]), while corresponding associations in patients with acute myocardial injury were 24% and 29%, respectively (adjusted HR [95% CI], 0.76 [0.59-0.99] and 0.71 [0.5-1.02]), and in patients with chronic myocardial injury 27% and 37%, respectively (adjusted HR [95% CI], 0.73 [0.58-0.92] and 0.63 [0.46-0.87]). Conclusions Patients with T2MI and non-ischemic acute or chronic myocardial injury are infrequently prescribed common cardiovascular medications compared with patients with type 1 myocardial infarction. However, treatment with guideline recommended drugs in patients with T2MI and acute or chronic myocardial injury is associated with a lower risk of death after adjustment for confounders.

Diagnostic Accuracy in Acute Venous Thromboembolism: Comparing D-Dimer, Thrombin Generation, Overall Hemostatic Potential, and Fibrin Monomers.

Introduction For acute venous thromboembolism (VTE), a biomarker with higher specificity than D-dimer would be of great clinical use. Thrombin generation and overall hemostatic potential (OHP) reflect the hemostatic balance by globally assessing multiple coagulation factors and inhibitors. These tests discriminate between healthy controls and patients with a prothrombotic tendency but have yet to be established as clinical biomarkers of VTE. Objective This study compares endogenous thrombin potential (ETP) and OHP to D-dimer and fibrin monomers (FM) in outpatients with suspected VTE. Methods A cross-sectional diagnostic study where 954 patients with suspected pulmonary embolism or deep venous thrombosis were recruited consecutively from the medical emergency department at Karolinska University Hospital. D-dimer, FM, OHP, and ETP were analyzed in a subpopulation of 60 patients with VTE and 98 matched controls without VTE. VTE was verified either by ultrasonography or computed tomography and clinical data were collected from medical records. Results Compared with healthy controls, both VTE and non-VTE patients displayed prothrombotic profiles in OHP and ETP. D-dimer, FM, ETP area under the curve (AUC), and ETP T lag were significantly different between patients with VTE and non-VTE. The largest receiver-operating characteristic AUCs for discrimination between VTE and non-VTE, were found in D-dimer with 0.94, FM 0.77, and ETP AUC 0.65. No useful cutoff could be identified for the ETP or the OHP assay. Conclusion Compared with D-dimer, neither ETP nor OHP were clinically viable biomarkers of acute venous thrombosis. The data indicated that a large portion of the emergency patients with suspected VTE were in a prothrombotic state.

Outcome of Percutaneous Coronary Intervention During Non-ST-Segment-Elevation Myocardial Infarction in Elderly Patients With Chronic Kidney Disease.

Background There is a paucity of data on the benefit of revascularization by percutaneous coronary intervention (PCI) during non-ST-segment-elevation myocardial infarction in patients aged >80 years with concurrent chronic kidney disease. Methods and Results Patients aged >80 years with chronic kidney disease, defined as an estimated glomerular filtration rate (eGFR) <60 mL/min per 1.73 m2 with non-ST-segment-elevation myocardial infarction, during 2011 to 2014 in Sweden retrieved from the SWEDEHEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) Registry. Cox regression was used to estimate adjusted hazard ratios with 95% CIs for all-cause mortality in patients with PCI versus no PCI treatment, stratified for eGFR. Logistic regression was used to evaluate adjusted odds for reinfarction and bleeding during hospitalization. Propensity score weighting analysis was also done as sensitivity analysis. In total, 12 821 patients were included, of whom 47%, 45%, and 8% had an eGFR of >60, 30 to 60, and 15 to <30 mL/min per 1.73 m2, respectively. Patients with eGFR 30 to 60 and 15 to <30 mL/min per 1.73 m2, 22%, and 10%, respectively, underwent PCI, compared with 36% among patients with eGFR >60 mL/min per 1.73 m2. During a mean follow-up of 3.2 years, the absolute risk of death was 42%, 56%, and 76% in patients with eGFR >60, 30 to 60, and 15 to <30 mL/min per 1.73 m2, respectively. Patients who underwent PCI had a lower risk of death in all groups of eGFR (0.47 [95% CI, 0.42-0.53], 0.50 [95% CI, 0.45-0.56], and 0.44 [95% CI, 0.33-0.59], respectively). Patients with eGFR 15 to <30 mL/min per 1.73 m2 had a higher risk of bleeding with PCI. Propensity score weighting showed similar outcomes for mortality risk as the unweighted analysis in all the eGFR groups. Conclusions PCI is rarely used in non-ST-segment-elevation myocardial infarction elderly patients with chronic kidney disease, and it appears to offer a survival benefit.

Causes of Death in Patients With Acute and Chronic Myocardial Injury.

BACKGROUND: Information about causes of death in patients with myocardial injury is limited. The purpose of this study was to explore causes of death in patients with myocardial injury. METHODS: In a cohort of 22,589 patients, 3853 patients with myocardial injury were identified and categorized into: type 1 myocardial infarction, type 2 myocardial infarction, and nonischemic acute and chronic myocardial injury. We included all 1466/3853 (38%) patients who died during follow-up (3.9 ± 2 years). We estimated rates and adjusted odds ratio (OR) with 95% confidence interval (CI) for causes of death in the 4 categories of myocardial injury using patients without myocardial injury 819/17,932 (4.6%) who died as reference. RESULTS: The study cohort included 2285 patients. The proportion of cardiovascular deaths was higher in patients with type 1 myocardial infarction (48%), acute (43%), and chronic (45%) myocardial injury and type 2 myocardial infarction (39%) compared with patients without myocardial injury (25%). Adjusted rates for cardiovascular death were similar in patients with myocardial injury. Type 1 myocardial infarction, acute, and chronic myocardial injury was associated with a 77% (OR: 1.77, 95% CI 1.29-2.41), 40% (OR: 1.40, 95% CI: 1.07-1.84), and 36% (OR: 1.36, 95% CI: 1.05-1.76) higher risk of cardiovascular death. CONCLUSIONS: Patients with type 1 myocardial infarction and acute or chronic myocardial injury have similar proportions and high risks for cardiovascular death. We believe that these findings stress the need for investigating patients without known heart diseases who present with nonischemic myocardial injury, or type 2 myocardial infarction.

Association between reduced left ventricular ejection fraction following non-ST-segment elevation myocardial infarction and long-term mortality in patients of advanced age.

OBJECTIVES: We sought to investigate the association between LVEF and clinical outcomes after NSTEMI, and the benefit of guideline-recommended pharmacotherapy in elderly patients. BACKGROUND: New-onset reduction in LVEF is common after NSTEMI in patients of advanced age. There is little information about outcomes in relation to LVEF, and the benefit of guideline-recommended pharmacotherapy in elderly patients. MATERIALS AND METHODS: The SWEDEHEART registry was used to identify all patients in Sweden >80 years with NSTEMI from 2011 to 2014. A normal LVEF was defined as >50%; mildly reduced, 40%-49%; moderately reduced, 30%-39%; and severely reduced, <30%. Cox regression was used to calculate adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for the association between a reduced LVEF compared with a normal LVEF and all-cause mortality. Similarly, the presence versus absence of treatment with guideline-recommended medications at discharge and mortality was evaluated. RESULTS: 6287 patients were included where 59%, 20%, 13%, and 6% had a normal, mildly reduced, moderately reduced, and severely reduced LVEF, respectively. During a median follow-up of 2.4 years, 2211 (35%) patients died. All three categories of impaired LVEF were associated with higher mortality: mildly reduced (1.44, 1.25-1.65), moderately reduced (1.93, 1.67-2.23), and severely reduced (3.24, 2.74-3.85). Patients who were treated with beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, or statins at discharge had lower mortality. CONCLUSIONS: New-onset reduction of the LVEF is common in advanced-age patients with NSTEMI and is associated with higher mortality. Treatment with guideline-recommended medications is associated with a better prognosis.

Structural characterization of cellulose pulp in aqueous NMMO solution under the process conditions of lyocell slurry.

A systematic structural characterization of dissolving grade cellulose pulp in aqueous NMMO solution is performed under the process conditions of lyocell slurry. Different types of cellulosic pulps such as hard/soft wood and acid sulfite/kraft sulphate pulps are used for the present study. The structural changes of pulp in lyocell slurry at different temperatures are characterized in terms of dimension, interstitial spaces, crystallinity using Optical (weight and thickness gain), SEM and XRD measurement technique, respectively. It was observed that kraft sulphate pulp has higher weight gain and lower thickness gain compared to acid sulphite pulps due to its pulping process chemistry. These results are further supported by SEM and XRD analysis. It is also found that above 50 °C, hardwood kraft sulphate pulp shows homogeneous and consistent swelling compared to other pulp combinations. These findings are commercially useful, because, homogeneous swelling of pulp is one of the essential parameters of slurry preparation.

Effect of ultrasound treatment on swelling behavior of cellulose in aqueous N-methyl-morpholine-N-oxide solution.

The present study deals with the effect of ultrasound on the swelling and dissolution behavior of the cellulose pulp. Hardwood, acid sulfite cellulose pulp sheets were sonicated at different temperatures, operated at a fixed frequency (37 kHz) and power (320 W) to break the intermolecular forces and hydrogen bonds of crystalline region. The obtained samples were evaluated for crystallinity, intrinsic viscosity, molecular weight (MW), molecular weight distribution (MWD) and surface morphology. It was observed that the crystallinity reduced from 61.9 to 18.9% after 20 min of ultrasound treatment at 30 °C, which was equivalent to the swelling at 75 °C for 20 min without the use of ultrasound frequency. It was also found that ultrasound pre-treatment significantly decreased the particle size of the slurry and shortened the dissolution time and temperature requirement without affecting the cellulose solution quality.

Percutaneous coronary intervention versus conservative treatment for non ST-segment elevation myocardial infarction in patients above 80 years of age.

BACKGROUND: There is a paucity of data if there is a benefit for patients above 80 years of age with non-ST-segment elevation myocardial infarction (NSTEMI) to undergo percutaneous coronary intervention (PCI). OBJECTIVES: To investigate the association between PCI or conservative treatment and outcomes in NSTEMI patients above 80 years of age. METHODS: From the SWEDEHEART register were included 13,854 patients above 80 years of age with NSTEMI during 2011-2014 in Sweden. Cox regression was used to calculate hazard ratios (HR) with 95% confidence intervals (CI) for the association between PCI compared with conservative treatment for the outcome all-cause mortality. RESULTS: In total 4158 (30%) patients underwent PCI, and 9696 (70%) were treated conservatively. The mean age was 86 (±4) years. During a mean 2.2 (±1.4) years there were 6458 (47%) deaths, where of 1078 (26%) in PCI treated, and 5380 (56%) in conservatively treated patients. Treatment with PCI compared with conservative treatment was associated with a 40% lower risk of death (adjusted HR 0.60, 95% CI 0.55-0.66). Similarly, patients in the PCI group had a 60% lower 30-day, and 51% lower 1-year all-cause mortality, respectively (adjusted HR 0.40, 95% CI 0.25-0.63, and HR, 0.49 95% CI 0.42-0.57, respectively). There were no differences in risk of bleedings (1.4% versus 1.3%). CONCLUSIONS: PCI compared with conservative treatment was associated with a lower mortality in patients above 80 years of age with NSTEMI without an increased risk of bleedings. PCI may be considered as the treatment of choice for elderly with NSTEMI.

Association of cytochrome P450 1B1 haplotypes with head and neck cancer risk.

Genetic polymorphisms have been reported in several cytochrome P450 (CYP) genes, including CYP1B1 which metabolically activates procarcinogens present in tobacco to carcinogenic intermediates. This study used a case-control approach in North Indian population to determine associations between genetic variants in CYP1B1 and risk of Head and Neck Squamous Cell Carcinoma (HNSCC). We examined the genotype and haplotype frequencies at various single-nucleotide polymorphisms (SNPs), including SNPs previously reported in the promoter region and intron 1 of CYP1B1 in Caucasians. Using cycle sequencing, 9 SNPs were identified in the promoter region, intron 1, and exons 2 and 3. Haplotype analysis revealed that 5 SNPs (those in the promoter region, intron, and Arg48Gly and Ala119Ser in exon 2) were in strong linkage disequilibrium (LD). Cases with the T-A-T-G-T haplotype were significantly associated with increased risk of HNSCC. Interestingly, qRT-PCR studies revealed a significant increase in mRNA expression of CYP1B1 in peripheral blood isolated from cases with the T-A-T-G-T haplotype compared with cases with the C-G-C-C-G haplotype, and in cases compared to controls for both main haplotypes. The data thus provide evidence that CYP1B1 haplotypes could be more effective in predicting HNSCC risk. Environ. Mol. Mutagen. 58:443-450, 2017. © 2017 Wiley Periodicals, Inc.

Human Thiel-Embalmed Cadaveric Aortic Model with Perfusion for Endovascular Intervention Training and Medical Device Evaluation.

PURPOSE: The purpose of this investigation was to evaluate human Thiel-embalmed cadavers with the addition of extracorporeal driven ante-grade pulsatile flow in the aorta as a model for simulation training in interventional techniques and endovascular device testing. MATERIALS AND METHODS: Three human cadavers embalmed according to the method of Thiel were selected. Extracorporeal pulsatile ante-grade flow of 2.5 L per min was delivered directly into the aorta of the cadavers via a surgically placed connection. During perfusion, aortic pressure and temperature were recorded and optimized for physiologically similar parameters. Pre- and post-procedure CT imaging was conducted to plan and follow up thoracic and abdominal endovascular aortic repair as it would be in a clinical scenario. Thoracic endovascular aortic repair (TEVAR) and endovascular abdominal repair (EVAR) procedures were conducted in simulation of a clinical case, under fluoroscopic guidance with a multidisciplinary team present. RESULTS: The Thiel cadaveric aortic perfusion model provided pulsatile ante-grade flow, with pressure and temperature, sufficient to conduct a realistic simulation of TEVAR and EVAR procedures. Fluoroscopic imaging provided guidance during the intervention. Pre- and post-procedure CT imaging facilitated planning and follow-up evaluation of the procedure. CONCLUSION: The human Thiel-embalmed cadavers with the addition of extracorporeal flow within the aorta offer an anatomically appropriate, physiologically similar robust model to simulate aortic endovascular procedures, with potential applications in interventional radiology training and medical device testing as a pre-clinical model.