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Surgical management of peritonitis secondary to acute superior mesenteric artery occlusion

World Journal of Gastroenterology 2014年第29期20卷 9936-9941页

作者： stefan acosta Vascular Centre Malm?Sk?ne University Hospital

Diagnosis of acute arterial mesenteric ischemia in the early stages is now possible using modern computed tomography with intravenous contrast enhancement and imaging in the arterial and/or portal *** patients have acute superior mesenteric artery(SMA)occlusion,and a large proportion of these patients will develop peritonitis prior to mesenteric revascularization,and explorative laparotomy will therefore be necessary to evaluate the extent and severity of intestinal ischemia,and to perform bowel *** establishment of a hybrid operating room in vascular units in hospitals is most important to be able to perform successful intestinal *** review outlines current frontline surgical strategies to improve survival and minimize bowel morbidity in patients with peritonitis secondary to acute SMA *** laparotomy needs to be performed *** treatment is based upon intestinal revascularization followed by bowel *** no vascular imaging has been carried out,SMA angiography is *** case of embolic occlusion of the SMA,open embolectomy is performed followed by *** case of thrombotic occlusion,the occlusive lesion can be recanalized retrograde from an exposed SMA,the guidewire snared from either the femoral or brachial artery,and stented with standard devices from these access *** resections and sometimes gall bladder removal due to transmural infarctions are performed at initial laparotomy,leaving definitive bowel reconstructions to a planned second look laparotomy,according to the principles of damage control *** with peritonitis secondary to acute SMA occlusion should be managed by both the general and vascular surgeon,and a hybrid revascularization approach is of utmost importance to improve outcomes.

关键词： Acute mesenteric ischemia Peritonitis Explorative laparotomy Endovascular treatment Hybrid revascularization Superior mesenteric artery occlusion

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Portal vein thrombosis:Prevalence,patient characteristics and lifetime risk:A population study based on 23796 consecutive autopsies

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World Journal of Gastroenterology 2006年第13期12卷 2115-2119页

作者： Mats gren David Bergqvist Martin Bjrck stefan acosta Henry Eriksson Nils H Sternby Department of Vascular Surgery Uppsala University Hospital UppsalaSweden Departments of Vascular Diseases and Pathology Lund University Malm University HospitalMalmSweden Department of Medicine Sahlgrenska University Hospital/stra GteborgSweden Departments of Vascular Diseases and Pathology Lund University MalmUniversity HospitalMalmSweden

AIM： TO assess the lifetime cumulative incidence of portal venous thrombosis （PVT） in the general population. METHODS： Between 1970 and 1982, 23 796 autopsies, representing 84% of all in-hospital deaths in the Malmo city population, were performed, using a standardised protocol including examination of the portal vein. PVT patients were characterised and the PVT prevalence at autopsy, an expression of life-time cumulative incidence, assessed in high-risk disease categories and expressed in terms of odds ratios and 95% CI. RESULTS： The population prevalence of PVT was 1.0%. Of the 254 patients with PVT 28% had cirrhosis, 23% primary and 44% secondary hepatobiliary malignancy, 10% major abdominal infectious or inflammatory disease and 3% had a myeloproliferative disorder. Patients with both cirrhosis and hepatic carcinoma had the highest PVT risk, OR 17.1 （95% CI 11.1-26.4）. In 14% no cause was found; only a minority of them had developed portal-hypertension-related complications. CONCLUSION： In this population-based study, PVT was found to be more common than indicated by previous clinical series. The markedly excess risk in cirrhosis and hepatic carcinoma should warrant an increased awareness in these patients for whom prospective studies of directed intervention might be considered.

关键词： Epidemiology Venous thrombosis Portal hypertension Cirrhosis Gastrointestinal cancer

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Preoperative echocardiographic predictors for 1-year mortality in patients treated with standard endovascular aneurysm repair for abdominal aortic aneurysm

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World Journal of Cardiovascular Diseases 2013年第3期3卷 268-274页

作者： Tomas Ohrlander Magnus Dencker stefan acosta Department of Surgery Eksjo County HospitalEksjoSweden Department of Clinical Physiology and Nuclear Medicine Vascular CenterMalmoSweden Lund and Skane University Hospital MalmoSweden

Background: Abdominal aortic aneurysm (AAA) and cardiovascular disease are intimately associated, the latter representing the most common cause of death in Sweden. Cardiac complications are held responsible for the majority of perioperative morbidity and mortality in patients undergoing repair of AAA. The importance of preoperative thorough cardiac assessment is therefore obvious. The aim of this study was to evaluate the prognostic significance of preoperative echocardiographic findings for 1-year mortality after elective endovascular aneurysm repair (EVAR) of infrarenal AAA. Design: Retrospective analysis. Methods: The 505 patients were identified in a prospective database for endovascular interventions between 1998 and 2011, and data were retrieved from patient records. Preoperative echocardiography reports in 380 patients were reviewed and findings were notified according to a predefined protocol. Results: The 1-year mortality rate was 6.7%. Severe valve disease was present in 8.7% of the patients, aortic valve stenosis being the leading cause of valve pathology. Severe valve disease (OR 3.5, 95% CI [1.2 - 10.7];p = 0.025) and chronic kidney disease grade ≥ 3 (OR 7.5, 95% CI [2.1 - 26.1];p = 0.002) were the only independent risk factors for increased mortality rate at 1-year. Conclusion: Echocardiography should be a part of the preoperative workup in AAA patients. Finding of severe valve disease should be further evaluated by a cardiologist prior to EVAR.

关键词： Echocardiography EVAR Abdominal Aortic Aneurysm Valve Disease Aortic Valve Stenosis

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Incisional Negative Pressure Wound Therapy in the Prevention of Surgical Site Infection after Vascular Surgery with Inguinal Incisions: Rationale and Design of a Randomized Controlled Trial (INVIPS-Trial)

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Surgical Science 2015年第12期6卷 562-571页

作者： Julien Hasselmann Tobias Kühme Jonas Bjork stefan acosta Vascular Center Skane University HospitalMalmoSweden Division of Occupational and Environmental Medicine Lund UniversityLundSweden

Background/Aims: Inguinal incisions are a common route of access in vascular surgery. Due to anatomical challenges and a diverse bacterial flora in this area, surgical site infections (SSI) represent a common, debilitating and sometimes life-threatening complication. The INVIPS-Trial evaluates the role of Negative Pressure Wound Therapy (NPWT) on closed inguinal incisions in elective vascular surgery to prevent SSI and other wound complications. Methods: This randomized controlled trial (RCT) registered at *** (Identifier: NCT01913132) compares the effects of a NPWT dressing (PICO, Smith & Nephew, UK) and the center’s standard wound dressing (Vitri Pad, ViTri Medical, Sweden) on postoperative wound complications, especially SSI. The study includes two distinct vascular procedures with different SSI risk profiles: endovascular aortic repair (EVAR) and open surgical approaches involving the common femoral artery (OPEN). Results: Four hundred ninety-five groin incisions in both treatment arms are anticipated to be included in the EVAR group and 147 inguinal incisions in both treatment arms in the OPEN group. Since a large percentage of inguinal vascular procedures in both groups but especially in the EVAR group are performed bilaterally, many patients can serve as their own control by randomly receiving NPWT on one and the standard dressing on the contralateral inguinal incision. Conclusions: This ongoing RCT attempts to elucidate the potential benefit of NPWT on closed inguinal incisions after different vascular procedures. Outcome and conclusions of this trial could have implications on postoperative wound care of patients in both vascular surgery and other surgical specialties.

关键词： Incisional Negative Pressure Wound Therapy Vascular Surgery Inguinal Incisions Surgical Site Infection Randomized Controlled Trial Research Design

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Modulation of the Nogo signaling pathway to overcome amyloid-β-mediated neurite inhibition in human pluripotent stem cell-derived neurites

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Neural Regeneration Research 2025年第9期20卷 2645-2654页

作者： Kirsty Goncalves stefan Przyborski Department of Biosciences Durham UniversityDurhamUK Reprocell Europe Ltd. GlasgowUK

Neuronal cell death and the loss of connectivity are two of the primary pathological mechanisms underlying Alzheimer's *** accumulation of amyloid-βpeptides,a key hallmark of Alzheimer's disease,is believed to induce neuritic abnormalities,including reduced growth,extension,and abnormal growth cone morphology,all of which contribute to decreased ***,the precise cellular and molecular mechanisms governing this response remain *** this study,we used an innovative approach to demonstrate the effect of amyloid-βon neurite dynamics in both two-dimensional and three-dimensional cultu re systems,in order to provide more physiologically relevant culture *** utilized various methodologies,including the addition of exogenous amyloid-βpeptides to the culture medium,growth substrate coating,and the utilization of human-induced pluripotent stem cell technology,to investigate the effect of endogenous amyloid-βsecretion on neurite outgrowth,thus paving the way for potential future applications in personalized ***,we also explore the involvement of the Nogo signaling cascade in amyloid-β-induced neurite *** demonstrate that inhibition of downstream ROCK and RhoA components of the Nogo signaling pathway,achieved through modulation with Y-27632(a ROCK inhibitor)and Ibuprofen(a Rho A inhibitor),respectively,can restore and even enhance neuronal connectivity in the presence of amyloid-β.In summary,this study not only presents a novel culture approach that offers insights into the biological process of neurite growth and inhibition,but also proposes a specific mechanism for reduced neural connectivity in the presence of amyloid-βpeptides,along with potential intervention points to restore neurite ***,we aim to establish a culture system that has the potential to serve as an assay for measuring preclinical,predictive outcomes of drugs and their ability to promote neurite outgrowth,both generally and in a patie

关键词： Alzheimer's disease induced pluripotent stem cell neurite outgrowth neuron Nogo Rho A ROCK stem cell three-dimensional culture

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Blood pressure-related white matter microstructural disintegrity and associated cognitive function impairment in asymptomatic adults

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Stroke & Vascular Neurology 2023年第5期8卷 358-367页

作者： Julián N acosta stefan P Haider Cyprien Rivier Audrey C Leasure Kevin N Sheth Guido J Falcone Seyedmehdi Payabvash Department of Neurology Yale School of MedicineNew HavenConnecticutUSA Department of Radiology and Biomedical Imaging Yale School of MedicineNew HavenConnecticutUSA Department of Otorhinolaryngology Ludwig Maximilians University MunichMunchenGermany

Background and objectives We aimed to investigate the white matter(WM)microstructural/cytostructural disintegrity patterns related to higher systolic blood pressure(SBP),and whether they mediate SBP effects on cognitive performance in middle-aged *** Using the UK Biobank study of community-dwelling volunteers aged 40-69 years,we included participants without a history of stroke,dementia,demyelinating disease or traumatic brain *** investigated the association of SBP with MRI diffusion metrics:fractional anisotropy(FA),mean diffusivity(MD),intracellular volume fraction(a measure of neurite density),isotropic(free)water volume fraction(ISOVF)and orientation dispersion across WM ***,we determined whether WM diffusion metrics mediated the effects of SBP on cognitive *** We analysed 31363 participants-mean age of 63.8 years(SD:7.7),and 16523(53%)*** SBP was associated with lower FA and neurite density,but higher MD and *** different WM tracts,diffusion metrics of the internal capsule anterior limb,external capsule,superior and posterior corona radiata were most affected by higher *** seven cognitive metrics,SBP levels were only associated with‘fluid intelligence’(adjusted p<0.001).In mediation analysis,the averaged FA of external capsule,internal capsule anterior limb and superior cerebellar peduncle mediated 13%,9%and 13%of SBP effects on fluid intelligence,while the averaged MD of external capsule,internal capsule anterior and posterior limbs,and superior corona radiata mediated 5%,7%,7%and 6%of SBP effects on fluid intelligence,*** Among asymptomatic adults,higher SBP is associated with pervasive WM microstructure disintegrity,partially due to reduced neuronal count,which appears to mediate SBP adverse effects on fluid *** metrics of select WM tracts,which are most reflective of SBP-related parenchymal damage and cognitive impairment,may serve as imaging biomarkers to

关键词： capsule Blood impairment

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Light tuning CO/H_(2)composition on Ag:Unraveling CO_(2)mass transfer and electron-phonon coupling in plasmon-enhanced electrocatalysis

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Nano Research 2025年第1期18卷 173-185页

作者： Rui Lin Dong Fan Luca MBerger Thomas Possmayer Yu Zhou Jiexin Zhu Xingbao Chen Wen Luo Lars Allmendinger Andreas Tittl Leonardo de Souza Menezes Guillaume Maurin Shihe Yang and stefan AMaier Nanoinstitute Munich Faculty of PhysicsLudwig-Maximilians-Universität München80539 MunichGermany Institut Charles Gerhardt Montpellier UMR 5253 CNRS ENSCM UniversitéMontpellierPlace E.Bataillon34090 MontpellierFrance Guangdong Provincial Key Lab of Nano-Micro Material Research School of Advanced MaterialsPeking University Shenzhen Graduate SchoolShenzhen 518055China State Key Laboratory of Advanced Technology for Materials Synthesis and Processing Wuhan University of TechnologyWuhan 430070China Faculty of Chemistry and Pharmacy Ludwig-Maximilians-Universität München81377 MunichGermany Departamento de Física Universidade Federal de Pernambuco50670-901 Recife-PEBrazil School of Physics and Astronomy Monash University Clayton CampusMelbourneVictoria 3800Australia Department of Physics Imperial College LondonSW72AZ LondonUK

Plasmon-enhanced electrocatalysis(PEEC)is an emerging approach to mitigate CO_(2)*** mechanisms behind CO_(2)adsorption and reduction at the catalyst-electrolyte interface in PEEC still need to be further ***,we employ a well-defined Ag nanostructure to elucidate these pivotal *** shining light with wavelengths of 625,525,405 nm on Ag,an adjustable CO/H_(2)ratio from 35 to 1 can be *** reaction pathway changing under plasmonic excitation does not originate from the lowered CO_(2)mass transfer in the vicinity of Ag,as the electrochemical quartz crystal microbalance results unravel that a slightly elevated temperature in bulk electrolyte caused by light irradiation cannot weaken the CO_(2)adsorption at the Ag catalyst-electrolyte *** calculations reveal that optical excitation towards shorter wavelengths leads to a progressive lowered energy barrier for H_(2)formation together with an enhanced energy barrier for^(*)COOH *** thermodynamically suppressed,CO_(2)reduction can still be improved kinetically by optimizing the excitation wavelength and intensity,being accompanied with the enhanced *** absorption spectroscopy results further correlate the higher photocurrent with a prolonged electron-phonon coupling time,verifying that the improvement of CO_(2)reduction kinetics in PEEC can be realized by hot electron harnessing.

关键词： plasmonic catalysis photoelectrochemical CO_(2)reduction CO/H_(2)ratio hot electron generation electronphonon coupling thermal effect

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Generalized Sampling in Shift Invariant Spaces with Frames

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Acta Mathematica Sinica,English Series 2012年第9期28卷 1823-1844页

作者： stefan ERICSSON Department of Engineering Sciences and Mathematics Lule University of Technology

Generalized sampling in a shift invariant subspace V of L2（R） is considered. A function f in V is processed with different filters Lm and then one tries to reconstruct f from the samples L^mf（j＇k）. We develop a theory of how to do this in the case when V possesses a shift invariant frame. Special attention is paid to the question： How to obtain dual frames with compact support？

关键词： Generalized sampling frames Riesz basis reproducing kernel shift invariant spaces

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Constitutive relations for the shear band evolution in granular matter under large strain

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Particuology 2008年第6期6卷 501-505页

作者： stefan Luding Multi Scale Mechanics TS CTW UTwente P.O. Box 217 7500 AE Enschede Netherlands

A so-called ＂split-bottom ring shear cell＂ leads to wide shear bands under slow, quasi-static deformation. Unlike normal cylindrical Couette shear cells or rheometers, the bottom plate is split such that the outer part of it can move with the outer wall, while the other part （inner disk） is immobile. From discrete element simulations （DEM）, several continuum fields like the density, velocity, deformation gradient and stress are computed and evaluated with the goal to formulate objective constitutive relations for the powder flow behavior. From a single simulation, by applying time- and （local） space-averaging, a non-linear yield surface is obtained with peculiar stress dependence. The anisotropy is always smaller than the macroscopic friction coefficient. However, the lower bound of anisotropy increases with the strain rate, approaching the maximum according to a stretched exponential with a specific rate that is consistent with a shear path of about one particle diameter.

关键词： Ring shear cell Shear bands DEM simulation Micro-macro transition Objective constitutive relations Yield stress fluid

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Experimental investigation on slip conditions during thread rolling with flat dies

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Friction 2024年第1期12卷 136-143页

作者： stefan VOLZ Peter GROCHE Institute for Production Engineering and Forming Machines Technical University DarmstadtOtto-Berndt Straße 2Darmstadt 64287Germany

The process design of flat die rolling operations can be a tedious and costly process due to the challenges posed by small process *** this work,an effort is made to closely investigate and understand the process limits caused by excessive slippage of the *** measurements are carried out to capture the characteristics of excessive slippage and the influence of the stroke rate and the tribological system on this process *** differences in slippage were observed,depending on the tribological *** systems with polymer based lubricants showed excessive slippage at low stroke rates,systems using oil or no lubricant endured higher stroke rates before process limits were *** optical measurements revealed three major forms of slippage:successful rolling without slippage,failure due to excessive slippage at process start,and failure due to excessive slippage at around one workpiece rotation.

关键词： rolling incremental forming thread rolling slippage profile rolling

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