In vitro quantification of stent-graft behaviour during chimney thoracic endovascular aortic repair.

OBJECTIVE: To quantify dynamic gutter phenomena and endograft deformations during double chimney thoracic endovascular aortic repair (ch-TEVAR) in a physiological model of the thoracic aorta subjected to pulsatile haemodynamic conditions. METHODS: Two in vitro procedures revascularizing the brachiocephalic trunk and left common carotid artery were performed representing both balloon-expandable (BE, Ankura-BeGraft) and self-expandable (SE, Ankura-Viabahn) double ch-TEVAR configurations. Retrospectively gated computed tomography (CT) was used to evaluate endograft behaviour. Device interactions were characterised according to gutter volume, gutter surface deviation, and endograft deformation (D-ratio) at end-diastolic and peak-systolic aortic pressure. RESULTS: Use of BE chimney grafts resulted in three times total gutter volume compared to SE chimney grafts. Gutter volumes were observed to vary dynamically between the end-diastolic and peak-systolic phases of the cardiac cycle, with the most substantial change associated with the BE configuration. Chimney graft deformations were dependent on device type, with SE devices exhibiting up to twice the deformation as BE devices. When adjacent, SE chimney grafts were observed to support each other, and thus tended towards a more consistently circular shape. CONCLUSION: Gutter and chimney graft behaviour were dependent on device type, and exhibited both spatial and temporal variability. This study emphasises notable differences between BE and SE double ch-TEVAR configurations which should be considered when evaluating risk of endoleak. The findings reported here also support the use of gated CT to better identify device-related complications with ch-TEVAR, and can be used in the design of next generation devices.

Reconfigurable origami-inspired multistable metamorphous structures.

Origami-inspired metamorphous structures can adjust their shapes and mechanical behaviors according to operational requirements. However, they are typically composed of nonrigid origami, where required facet deformation complicates actuation and makes them highly material dependent. In this study, we present a type of origami metamorphous structure composed of modular bistable units, each of which is a rigid origami. The elasticity within the origami creases and switching of mountain and valley crease lines enable it to have bistability. The resultant metamorphous structure has multistability, allowing it to switch among multifarious configurations with programmable profiles. This concept was validated by potential energy analysis and experiments. Using this concept, we developed a robotic limb capable of both lifting and gripping through configuration changes. Furthermore, we used the origami units to construct a metamaterial whose properties could change with the variation of configurations. These examples demonstrate the concept's remarkable versatility and potential for many applications.

Variable Stiffness Fibers Enabled Universal and Programmable Re-Foldability Strategy for Modular Soft Robotics.

Origami is a rich source of inspiration for creating soft actuators with complex deformations. However, implementing the re-foldability of origami on soft actuators remains a significant challenge. Herein, a universal and programmable re-foldability strategy is reported to integrate multiple origami patterns into a single soft origami actuator, thereby enabling multimode morphing capability. This strategy can selectively activate and deactivate origami creases through variable stiffness fibers. The utilization of these fibers enables the programmability of crease pattern quantity and types within a single actuator, which expands the morphing modes and deformation ranges without increasing their physical size and chamber number. The universality of this approach is demonstrated by developing a series of re-foldable soft origami actuators. Moreover, these soft origami actuators are utilized to construct a bidirectional crawling robot and a multimode soft gripper capable of adapting to object size, grasping orientation, and placing orientation. This work represents a significant step forward in the design of multifunctional soft actuators and holds great potential for the advancement of agile and versatile soft robots.

Effectiveness and safety of REBACIN as a non-invasive intervention for persistent high-risk human papillomavirus infection: A real-world prospective multicenter cohort study.

BACKGROUND: We previously reported that REBACIN effectively eliminates persistent high-risk human papillomavirus (hrHPV) infection. Here, we conducted a prospective multicenter cohort study to evaluate the safety and effectiveness of REBACIN, taking into account factors such as specific hrHPV subtype and patient's age. METHODS: According to inclusion/exclusion criteria and participant willingness, 3252 patients were divided into REBACIN group while 249 patients into control group. Patients in REBACIN group received one course treatment of intravaginal administration of REBACIN while no treatment in control group. After drug withdrawal, participants in both groups were followed up. RESULTS: The clearance rate of persistent hrHPV infection in REBACIN group was 60.64%, compared to 20.08% in control group. Specifically, the clearance rates for single-type infection of HPV16 or HPV18 were 70.62% and 69.23%, respectively, which was higher than that of HPV52 (59.04%) or HPV58 (62.64%). In addition, the single, double, and triple/triple+ infections had a clearance rate of 65.70%, 53.31%, and 38.30%, respectively. Moreover, 1635 patients under 40 years old had a clearance rate of 65.14%, while it was 55.08% for 1447 patients over 40 years old. No serious adverse effects were found. CONCLUSION: This study confirmed that REBACIN can effectively and safely eliminate persistent hrHPV infection, which the clearance rate of HPV16/18 is higher than that of HPV52/58, the clearance rate of single-type infection is higher than that of multiple-type infections, and the clearance rate in young patients is higher than that in elder patients, providing a guidance for REBACIN application in clearing hrHPV persistent infection in real-world settings. CLINICAL TRIAL REGISTRATION: Chinese Clinical Trial Registry Registration Number: ChiCTR1800015617 http://www.chictr.org.cn/showproj.aspx?proj=26529 Date of Registration: 2018-04-11.

Helsmoortel-van der Aa syndrome in a Chinese pediatric patient due to ADNP nonsense mutation: A case report.

Background: Helsmoortel-van der Aa syndrome, also known as ADNP syndrome, is a condition that causes developmental delay, language impairment, autism spectrum, and variable extraneurologic features. It is caused by heterozygous mutations in the ADNP gene on chromosome 20q13. Most of the genetic causes of Helsmoortel-van der Aa syndrome have been reported are as de novo nonsense or frameshift stop mutations in exon 5 of ADNP gene, while fewer truncating variants were discovered in exons 4 and the 5' end of exon 5. Methods: In our study, a 4-year-old female Chinese patient was reported with delayed psychomotor development, language impairment, ataxia, anxiety, aggressive behavior, and congenital heart defect. Trio whole exome sequencing and copy number variation sequencing were performed. Results: A novel de novo heterozygous pathogenic mutation c.568C > T (p.Gln190Ter) was identified in the ADNP gene of the proband. His unaffected parents did not have the variant. According to the American College of Medical Genetics (ACMG) guidelines, c.568C > T was classified as "pathogenic". Conclusion: Our report indicated that c.568C > T (p.Gln190Ter) in ADNP gene is the cause of abnormal development of the nervous system, congenital heart disease and strabismus, broadening the spectrum of ADNP gene mutations associated with Helsmoortel-van der Aa syndrome.

Prognostic factors for patients with hematologic malignancies admitted to the intensive care unit: is allogeneic transplantation still a risk factor?

The rate of intensive care unit (ICU) mortality in patients with hematologic malignancies is high. The risk factors for this were inconsistent across several previous studies, and there is currently no accepted consensus around risk factors for these patients. We aimed to identify which prognostic factors were associated with ICU mortality in critically ill patients with hematologic malignancies, nearly half of which were allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients. In addition, we aimed to compare the characteristics and clinical outcomes of patients with and without allogenic allo-HSCT. In total, 217 patients with hematologic malignancies were enrolled consecutive, 119 (54.8%) of whom underwent HSCT (allo-HSCT: n = 115). All survivors were followed up with until August 1, 2022. The rate of ICU mortality in this cohort was 54.4%: 55.5 and 53.1% for the patients with and without HSCT, respectively (p = 0.724). The probabilities of survival after ICU admission were also comparable between the patients who had allo-HSCT and those who did not. A multivariable analysis revealed that cerebrovascular disease, hyperlactic acidemia on the day of ICU admission, lower platelet count, use of vasoactive drugs, and absence of noninvasive ventilation on the day of ICU admission were independent risk factors for ICU mortality. For patients with three to five of these risk factors, the rate of ICU mortality was as high as 84.6%, which was significantly higher than that of other patients. In this study, the ICU mortality rate in patients with hematologic malignancies was still high, particularly for those with multiple risk factors. However, allo-HSCT was not found to be a risk factor for ICU mortality.

A new class of transformable kirigami metamaterials for reconfigurable electromagnetic systems.

The rapid development of radio frequency (RF) components requires smart multifunctional materials that can adapt their physical shapes and properties according to the environment. While most current reconfigurable systems provide limited flexibility with high manufacturing cost, this research proposes to harness the transformable properties of kirigami-inspired multistable mechanical metasurfaces that can repeatedly deform and lock into different configurations to realize a novel class of low-cost reconfigurable electromagnetic structures with a broad design space. The metasurfaces are formed by designing kinematic-based unit cells with metallised coating that can provide adjustable resonant electromagnetic (EM) properties while rotating with respect to each other. Tailoring the cut length and geometry parameters of the patterns, we demonstrate programming of the topologies and shapes of different configurations. The influence of critical parameters on the structural multistability is illustrated by means of both a simplified energy model and finite element simulations. As examples of the reconfigurable electromagnetic devices that can be realized, we report the development of a tuneable half-wave dipole and two frequency selective surface (FSS) designs featuring isotropic and anisotropic responses. While the kirigami dipole can be tuned by mechanically stretching its arms, the FSSs exhibit distinct transmittance and reflectance spectra in each of the kirigami patterns stable states. The functionality of these kirigami devices is validated both by full-wave EM simulations and experiments. The proposed transformable structures can be mechanically actuated to tune the EM response in frequency or induce anisotropies for wave propagation.

Evaluation of the efficacy and safety of Nocardia rubra cell wall skeleton immunotherapy for cervical high-risk HPV persistent infection / 中华妇产科杂志

Objective: To evaluate the efficacy and safety of Nocardia rubra cell wall skeleton (Nr-CWS) in the treatment of persistent cervical high-risk human papillomavirus (HR-HPV) infection. Methods: A randomized, double blind, multi-center trial was conducted. A total of 688 patients with clinically and pathologically confirmed HR-HPV infection of the cervix diagnosed in 13 hispital nationwide were recruited and divided into: (1) patients with simple HR-HPV infection lasting for 12 months or more; (2) patients with cervical intraepithelial neoplasia (CIN) Ⅰ and HR-HPV infection lasting for 12 months or more; (3) patients with the same HR-HPV subtype with no CINⅡ and more lesions after treatment with CINⅡ or CIN Ⅲ (CINⅡ/CIN Ⅲ). All participants were randomly divided into the test group and the control group at a ratio of 2∶1. The test group was locally treated with Nr-CWS freeze-dried powder and the control group was treated with freeze-dried powder without Nr-CWS. The efficacy and negative conversion rate of various subtypes of HR-HPV were evaluated at 1, 4, 8, and 12 months after treatment. The safety indicators of initial diagnosis and treatment were observed. Results: (1) This study included 555 patients with HR-HPV infection in the cervix (included 368 in the test group and 187 in the control group), with an age of (44.1±10.0) years. The baseline characteristics of the two groups of subjects, including age, proportion of Han people, weight, composition of HR-HPV subtypes, and proportion of each subgroup, were compared with no statistically significant differences (all P>0.05). (2) After 12 months of treatment, the effective rates of the test group and the control group were 91.0% (335/368) and 44.9% (84/187), respectively. The difference between the two groups was statistically significant (χ2=142.520, P<0.001). After 12 months of treatment, the negative conversion rates of HPV 16, 18, 52, and 58 infection in the test group were 79.2% (84/106), 73.3% (22/30), 83.1% (54/65), and 77.4% (48/62), respectively. The control group were 21.6% (11/51), 1/9, 35.1% (13/37), and 20.0% (8/40), respectively. The differences between the two groups were statistically significant (all P<0.001). (3) There were no statistically significant differences in vital signs (body weight, body temperature, respiration, pulse rate, systolic blood pressure, diastolic blood pressure, etc.) and laboratory routine indicators (blood cell analysis, urine routine examination) between the test group and the control group before treatment and at 1, 4, 8, and 12 months after treatment (all P>0.05); there was no statistically significant difference in the incidence of adverse reactions related to the investigational drug between the two groups of subjects [8.7% (32/368) vs 8.0% (15/187), respectively; χ2=0.073, P=0.787]. Conclusion: External use of Nr-CWS has good efficacy and safety in the treatment of high-risk HPV persistent infection in the cervix.

Photonic topological semimetals in bigyrotropic metamaterials.

We investigate the photonic topological phases in bigyrotropic metamaterials characterized by the gyroelectric and gyromagnetic parameters. The underlying medium is considered a photonic analogue of the topological semimetal featured with a pair of Weyl cones separated by a distance in the frequency-wave vector space. As the 'spin'-degenerate condition is satisfied, the photonic system consists of two hybrid modes that are completely decoupled. By introducing the pseudospin states as the basis for the hybrid modes, the photonic system is described by two subsystems in terms of the spin-orbit Hamiltonians with spin 1, which result in nonzero spin Chern numbers that determine the topological properties. Surface modes at the interface between two bigyrotropic metamaterials with opposite sign of the gyrotropic parameters exist in their common gap in the wave vector space, which are analytically formulated by algebraic equations. In particular, two types of surface modes are tangent to or wrapping around the Weyl cones, which form a bent and two twisted surface sheets. At the Weyl frequency, the surface modes contain a typical and two open Fermi arc-like states that concatenate to yield an infinite straight line. Topological features of the bigyrotropic metamaterials are further illustrated with the robust transport of surface modes at an irregular boundary.

Data for "Folding and Deploying Identical Thick Panels with Spring-loaded Hinges".

This article provides supplementary information for the manuscript "Folding and Deploying Identical Thick Panels with Spring-loaded Hinges" (Yang et al. 2022), in which collision-free deployments of a multiple degree-of-freedom (DoF) system are realized by using elastic hinges. This article characterizes two important parameters of such hinges, namely, the spring stiffness and the damping coefficient. The spring stiffness was acquired through quasi-static measurement of torque. A test rig consisting of rotary tables and strain gauges was developed for this purpose. The damping coefficient of the hinge was acquired by analyzing the responses of five free-vibration tests on a rotational mass-spring system. The time history of the response was processed, followed by system identification through the state-space estimation. Apart from the properties of the elastic hinges, the other system properties that were used for the simulations and the physical prototypes in (Yang et al. 2022) were detailed in this article. With these parameters, deployments with and without collisions were demonstrated through videos (, , and ).

Deformation-activated recrystallization twin: New twinning path in pure aluminum enabled by cryogenic and rapid compression.

Bulk aluminum rarely forms deformation or annealing twins owing to its high stacking fault energy. We report a novel twinning mechanism mediated by dynamic recrystallization in 6N pure aluminum under high strain rate (∼1.3 × 104 s-1) impact at a cryogenic temperature (77 K). Discontinuous dynamic recrystallization occurs during rapid severe plastic deformation and generates inhomogeneous microstructures exhibiting low-angle and high-angle grain boundaries. Unexpectedly, Σ3 twin boundaries were able to develop during dynamic recrystallization. Although these recrystallization twins have similar morphology as that of annealing twins, their formation relies on deformation activation instead of thermal activation, which was suppressed by the cryogenic experiment. Besides, strong orientation dependence was observed for formation of these novel twins. Beyond annealing and deformation twin, deformation-activated recrystallization twin is a new path for pure aluminum twinning.

Kirigami-based metastructures with programmable multistability.

SignificanceDifferent from most existing multistable structures whose multiple stable states are achieved through the combinational effect of bistable units, we invent a generic tristable kirigami cuboid. The three stable states have fundamentally distinct geometric configurations and chirality, and the transformation among them can be realized by tension/compression or clockwise/counterclockwise twist. Tessellating the units in series, a family of multistable metamaterials can be constructed, the mechanical behaviors of which are programmable by the unit geometry, the material of the elastic joints, the number of units, and the loading conditions. As a demonstration of the potential applications, a frequency reconfigurable antenna for 5G triple-band communication is developed based on a tristable unit, and the frequency tunability is verified by experiments.

Photonic topological insulators in bianisotropic metamaterials.

We analyze the photonic topological phases in bianisotropic metamaterials characterized by a lossless and reciprocal magnetoelectric tensor. The underlying medium is considered a topological insulator that supports a pair of counterpropagating helical edge states. By introducing the pseudospin basis, the photonic system can be described by the spin-orbit Hamiltonians with spin 1, which result in nonzero spin Chern numbers that determine the topological properties. Surface modes at the interface between two bianisotropic media with opposite chirality exist in their common band gap, which are represented by elliptic or hyperbolic equations. In particular, two branches of hyperbolic surfaces are degenerate at the frequency where the chiral nihility occurs, which depict the helical nature of edge states between two distinct topological phases. Topological features of the bianisotropic metamaterials are further illustrated with the robust transport of surface modes at an irregular boundary.

Observation of synergistic antibacterial properties of prodigiosin from Serratia marcescens jx-1 with metal ions in clinical isolates of Staphylococcus aureus.

Methicillin-resistant Staphylococcus aureus (MRSA) infections are a major global health problem, and novel and effective antimicrobial drugs are urgently required to combat this life-threatening pathogen. Prodigiosin (PG) is a bacterial secondary metabolite with excellent anticancer and antibacterial properties. However, little is known about the antibacterial function of PG against MRSA. Therefore, the antibacterial efficacy of PG alone and PG in combination with different metal ions against clinic isolates of MRSA and methicillin-sensitive S. aureus (MSSA) strain was evaluated in the present study. The minimum inhibitory concentration of PG against both MRSA and MSSA was 0.25 µg/mL. However, 0.1 µg/mL PG showed a stronger inhibitory effect on MSSA cell growth (47.12%) than on MRSA cell growth (35.87%). Surprisingly, we observed a significant difference (p < 0.01) in membrane integrity between PG-treated MRSA and MSSA using the propidium iodide staining assay. Further, we found that in combination with PG, Zn2+, Al3+, and Cu2+ showed synergistic antibacterial effects against MRSA and MSSA. Our results could increase the current knowledge regarding the efficacy of PG in inhibiting the growth of different types of S. aureus clinical isolates and also offer a novel strategy for developing efficient antibacterial agents.

Full-term delivery following spontaneous rupture of a giant fetal sacrococcygeal teratoma: a case report / 中华围产医学杂志

We describe a case of fetal sacrococcygeal teratoma detected by ultrasound at 14 gestational weeks. The tumor was classified as "type Ⅰ" by ultrasonography combined with MRI. The cystic part accounted for over 60% of the mass before 26 weeks and ruptured spontaneously at 28 weeks. The size of the tumor was 12.8 cm×9.7 cm×12.3 cm at 36 +5 gestational weeks. A female newborn was born through cesarean section at 37 weeks of gestation and had the tumor removed surgically on the postnatal day 4. Postoperative follow-up showed that the neonate had a good prognosis without physiological dysfunction.

Analysis of risk factors for atrial fibrillation in elderly Chinese patients with severe valvular heart disease / 中华老年医学杂志

Objective:To explore the risk factors for atrial fibrillation(AF)in elderly Chinese patients with severe valvular heart disease(VHD).Methods:This was a cross-sectional study and consecutively enrolled 978 elderly patients with severe VHD diagnosed in 18 Class A tertiary hospitals across the country from September 2021 to March 2022, including 322(32.9%)patients with concurrent AF.Clinical and echocardiographic data were collected to analyze the risk factors for AF.Results:Among VHD patients, compared with the non-AF group, the AF group was older, had a higher female ratio, higher diastolic blood pressure, higher proportions with cerebrovascular disease and chronic kidney disease, lower serum low density lipoprotein cholesterol and higher serum creatinine, amino-terminal A-type natriuretion peptide and glycosylated hemoglobin.As for echocardiographic parameters, the left atrial diameter was larger, the left ventricular end-diastolic diameter, interventricular septum thickness, and left ventricular posterior wall thickness were smaller in the AF group than in the non-AF group.All of the differences were statistically significant(all P<0.05). The results of multivariate Logistic regression analysis showed that the left atrial anteroposterior diameter increased( OR=1.166, P<0.01), the left ventricular end-diastolic diameter decreased( OR=0.929, P<0.01), and advanced age( OR=1.051, P<0.05)was an independent risk factor for elderly VHD patients with concurrent AF. Conclusions:In elderly patients with severe VHD, advanced age, an increased left atrial anteroposterior diameter, and a decreased left ventricular end-diastolic diameter were independently associated with AF.Therefore, evaluation of cardiac structure and regular follow-up should be performed in elderly patients with severe VHD for early intervention to reduce the incidence of AF.

Synthesis, Characterization and Crystal Structures of Fluoro-Substituted Aroylhydrazones with Antimicrobial Activity.

A series of five new fluoro-substituted aroylhydrazones were prepared and structurally characterized by elemental analysis, IR, UV-Vis and 1H NMR spectroscopy, as well as single crystal X-ray diffraction. The compounds were evaluated for their antibacterial (Bacillus subtilis, Staphylococcus aureus, Escherichia coli, and Pseudomonas fluorescence) and antifungal (Candida albicans and Aspergillus niger) activities by MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide) method. The biological assay indicated that the presence of the electron-withdrawing groups in the aroylhydrazones improved their antimicrobial activities.

A 3D-Printable Robotic Gripper Based on Thick Panel Origami.

Origami has been a source of inspiration for the design of robots because it can be easily produced using 2D materials and its motions can be well quantified. However, most applications to date have utilised origami patterns for thin sheet materials with a negligible thickness. If the thickness of the material cannot be neglected, commonly known as the thick panel origami, the creases need to be redesigned. One approach is to place creases either on top or bottom surfaces of a sheet of finite thickness. As a result, spherical linkages in the zero-thickness origami are replaced by spatial linkages in the thick panel one, leading to a reduction in the overall degrees of freedom (DOFs). For instance, a waterbomb pattern for a zero-thickness sheet shows multiple DOFs while its thick panel counterpart has only one DOF, which significantly reduces the complexity of motion control. In this article, we present a robotic gripper derived from a unit that is based on the thick panel six-crease waterbomb origami. Four such units complete the gripper. Kinematically, each unit is a plane-symmetric Bricard linkage, and the gripper can be modelled as an assembly of Bricard linkages, giving it single mobility. A gripper prototype was made using 3D printing technology, and its motion was controlled by a set of tendons tied to a single motor. Detailed kinematic modelling was done, and experiments were carried out to characterise the gripper's behaviours. The positions of the tips on the gripper, the actuation force on tendons, and the grasping force generated on objects were analysed and measured. The experimental results matched well with the analytical ones, and the repeated tests demonstrate that the concept is viable. Furthermore, we observed that the gripper was also capable of grasping non-symmetrical objects, and such performance is discussed in detail in the paper.

Correlations between alterations of T-helper 17 cells and treatment efficacy after concurrent radiochemotherapy in locally advanced cervical cancer (stage IIB-IIIB): a 3-year prospective study.

BACKGROUND: Recently, T-helper 17 (Th17) cells have been proved to play an important role in promoting cervical cancer. But, till now, few study has been carried out to understand the involvement of these cells in efficacy of anti-tumor treatments. This study aimed to investigate the alterations in the percentage of circulating Th17 cells and related cytokines in locally advanced cervical cancer (LACC) patients before and after concurrent chemoradiotherapy (cCRT) and to analyze the correlations between the alterations in Th17 cells and treatment efficacy. METHODS: A prospective study with 49 LACC (International federation of gynecology and obstetrics [FIGO] stage IIB-IIIB) patients and 23 controls was conducted. Patients received the same cCRT schedule and were followed up for 3 years. Circulating Th17 cells (CD3+CD8- interleukin [IL]-17+ T cells) and related cytokines IL-17, transforming growth factor-ß (TGF-ß), IL-10, IL-23, IL-6, and IL-22 were detected before and after cCRT. Correlations between alterations of circulating Th17 cells and treatment efficacy were analyzed. Kaplan-Meier analysis was used for overall survival (OS) and progression-free survival (PFS). RESULTS: We found that 40 patients finished the entire cCRT schedule and met the endpoint of this study. The percentage of circulating Th17 cells in the LACC patients was higher than that in the controls, and it significantly decreased after cCRT (P < 0.05). After cCRT, patients were divided into two groups based on the average of the Th17 cells declined. The subgroup of patients with a prominent decrease in circulating Th17 cells after cCRT had a higher treatment efficacy and longer PFS and OS times. Compared with the control patients, LACC patients had higher IL-6, IL-10, IL-22, TGF-ß levels and a lower IL-23 level (P < 0.05). After cCRT, IL-6, IL-10, IL-17, IL-23 level significantly increased and TGF-ß level significantly decreased compared with the levels before cCRT (P < 0.05). CONCLUSION: Circulating Th17 cells in the LACC patients (FIGO stage IIB-IIIB) were higher than those in the controls, but they generally decreased after cCRT. A more pronounced decrease in circulating Th17 cells after cCRT was correlated with better therapeutic effect and longer PFS and OS times.

Thoracic aortic parallel stent-graft behaviour when subjected to radial loading.

To manage complex aortic arch disease using minimally invasive techniques, interventionalists have reported the use of multiple stent-graft devices deployed in a parallel configuration. The structural device-device and device-artery interactions arising during aortic arch parallel endografting, also known as chimney thoracic endovascular aortic repair (ch-TEVAR), is not well understood. Through the use of a radial force testing system we sought to characterise both the loading and deformation behaviour of parallel endografts in representative ch-TEVAR configurations. Four commercially available devices (Bentley BeGraft, Gore TAG, Gore Viabahn, and Medtronic Valiant) were subjected to uniform radial load individually, and in six combinations, to quantify loading profiles. Image data collected during testing were analysed to evaluate mechanical deformations in terms of gutters, chimney and main endograft compression, as well as graft infolding. Parallel endografting was found to increase radial loads when compared to standard TEVAR. Chronic outward force during ch-TEVAR was dependent on main endograft manufacturer, with TAG combinations leading to consistently higher loads than Valiant, but independent of chimney graft type. Endograft deformations were dependent on chimney graft type, with Viabahn combinations presenting with lower gutter areas and increased lumen compression than BeGraft. Chimney graft deformations were also influenced by deployment arrangement in the case of double ch-TEVAR. This study emphasizes the significant variability in both radial loads and mechanical deformations between clinically relevant ch-TEVAR configurations.