In this paper the sufficient condition for the existence of optimal solutions for the Lagrange problem with fractional Cauchy problem is formulated and proved. In the proof of the main result, we use the Lower Closure Theorem and the Implicit Function Theorem for a multivalued mapping (Fillipov’s lemma).

Following laser fenestrated endovascular treatment (LEVAR) of abdominal aortic aneurysms (AAAs), we evaluated the impact of stent indentation in LEVAR, long-term patency of target vessels, and the correlation between laser use and target vessel thrombosis in the long term. A retrospective, monocentric, observational study was conducted on patients diagnosed with complex AAAs treated by LEVAR between 2016 and 2017. The procedure consisted of deploying an Endurant (Medtronic) stent graft and antegrade laser fenestrations under image-fusion guidance. Stenting was performed on target vessels after fenestration. All patients underwent a computed tomography (CT) angiography in the days following the operation, and follow-up scans or duplex ultrasound at 1 month, 6 months, and yearly thereafter. The main objective was the patency of target-vessel stents. Endpoints included mortality, follow-up discontinued by the patient, and conversion to surgery. The study population consisted of 15 patients (13 males) with a mean age of 75 years. Ten (66.6%) patients had degenerative juxta-renal AAAs, 3 (20%) patients had thoracoabdominal aortic aneurysms, and one patient had a type 1a endoleak post-EVAR. Two (13.3%) patients had stenting of one renal artery, 2 (13.3%) had stenting of both, 5 (33.3%) also had superior mesenteric artery (SMA) stenting, 2 (13.3%) had stenting of SMA and celiac trunk only, and 5 (33.3%) had stenting of one renal artery and SMA. Mean hospital stay was 9 days, with 30-day mortality for 1 patient, and 2 (13.3%) intrahospital deaths. The mean follow-up was 52 months. One patient had post-operative thrombosis of the SMA stent, and died at Day 5. Another patient had dissection and thrombosis of the left renal artery during the operation. Twelve (80%) patients had preserved target vessel stent permeability until the end of follow-up, and 1 patient (6.6%) had 60–70% stenosis of the left renal artery at 6-month follow-up. LEVAR procedures require well-equipped vascular centers and endovascular experience, but are associated with high rates of long-term patency of target vessels. A cohort study comparing to custom-made fenestrated EVAR may be considered in our center to provide more accurate results.

Several studies reported a >90% technical success rate for the use of laser in situ in aortic stentgraft fenestration (LISF). However, little data are available on the long-term effects of LISF. Between September 2016 and November 2022, 82 patients underwent surgery for a complex aortic pathology with the use of LISF and we looked at the results of patients undergoing surgery in 2016 and 2017 i.e., with more than 5 years of follow-up.

Gastric cancer is one of the five most common types of cancer worldwide. Due to the heterogeneous course and the involvement of many risk factors, its treatment and diagnosis is an important challenge for modern medicine. Recent studies have emphasized the i role of Toll-like receptors (TLRs) expressed on selected cells of the immune system in the pathogenesis of gastric cancer. The aim of this study was to determine the prevalence of TLR2 on T lymphocytes, B lymphocytes, monocytes, and dendritic cells in patients diagnosed with gastric cancer, with particular emphasis on the stage of the disease. Based on the obtained results, we have shown that patients with gastric cancer are characterized by a higher percentage of all tested populations of peripheral blood immune cells expressing TLR2 in relation to patients from the control group. Moreover, a detailed analysis of the collected results showed a significant link between TLR2 and the stage of the disease.

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The relationship between Toll-like receptor 9 (TLR-9) signaling and its involvement with Epstein–Barr virus (EBV) in gastric cancer (GC) is complex and currently under study. This research intended to understand TLR-9’s role in certain T and B lymphocytes and the serum levels of TLR-9 in GC patients versus healthy subjects. The team explored links between these immune markers and various GC traits, such as histological grade, tumor progression stages, cancer types, and survival rates. Additionally, the research sought to find if EBV genetic material influences these immune reactions. Using flow cytometry, TLR-9 levels in different immune cells were analyzed. At the same time, the amount of TLR-9 in the serum was determined. The results showed GC patients had varied TLR-9 levels compared to healthy subjects, with specific cells showing noticeable changes. When grouped by GC attributes, key relationships emerged between TLR-9 amounts, the histological grade, progression stages, and cancer types. A notable finding was the connection between TLR-9 levels and EBV genetic presence, suggesting possible interactions between TLR-9 responses and EBV-related GC processes. Survival data also hinted at TLR-9’s potential as a predictor linked to clinical traits. Overall, this research emphasizes TLR-9’s complex role in GC’s immune responses, pinpointing its interactions with particular cells, clinical features, and EBV. The study unveils a complex web affecting GC and paves the way for new treatment avenues targeting TLR-9 pathways.

This file contains figure legends corresponding to supplementary figures.

This file contains methods which were not included in the main text.

Supplementary Figure S1-9 and Supplementary Tables S1-8

Laser in situ fenestration (LISF) is an expanding technique for supraaortic trunk revascularization (SAR) during endovascular thoracic aortic repair (TEVAR). We present the feasibility and early outcomes of FLIS during TEVAR in a single center.

This file contains supplementary tables 1-7 and the main information was described as follows. Table S1. All primers for real time PCR assay. Table S2. Differentially expressed genes between mesenchymal subtype and other non stem-like. Table S3. microRNA in stem-like/EMT CRC patients. Table S4. Full list of the predicted targets for the four key miRNAs. Table S5. Clinical information of 90 cases CRC patients (Renji cohort 1). Table S6. Clinical information of 100 cases CRC patients (Renji cohort 2). Table S7. Clinical information of 128 cases CRC patients (European cohort).

We present the case of a 55-year-old male patient with acute Stanford type B dissection with anatomy characterized by a large 17-mm intimal tear and a thoracic diameter of 42 mm without proximal sealing zone. This type B aortic dissection was treated using the Chimney technique in the brachiocephalic artery (BCA), laser fenestration in situ of the left common carotid artery (LCCA) and left subclavian artery (LSA), and the STABILISE technique. First, a carotid puncture was performed via carotid access. Next, rapid pacing was performed, and two Valiant stent grafts (Medtronic, Dublin, Ireland) were implanted just below the BCA. Laser fenestration was then performed on the LCCA using a Bentley stent (Bentley InnoMed GmbH, Hechingen, Germany). Unfortunately, the stent graft covering the BCA ostium migrated, which necessitated a bail-out chimney technique using a Bentley stent. In the next phase, via a left humeral puncture, laser fenestration to LSA was performed using a Bentley covered stent. In doing so, a proximal landing zone of 22 mm in length was created. Finally, the true lumen was further expanded using a Zenith Dissection (Cook Medical) large bare stent down the visceral aorta in a STABILISE configuration to promote positive remodeling of the aorta. Control arteriography showed that the procedure was successful, with good patency of the BCA, LCCA and LSA, and the true lumen was expanded. Computed tomography scan showed good permeability of the targeted arteries and true lumen, as well as compression of the false lumen. The patient was discharged on postoperative day 7. In situ laser fenestration has proved to be a versatile procedure. It can be used in emergent situations, contraindications of fenestrated endovascular aneurysm repair, planned stent grafts, endovascular aneurysm repair, and thoracic endovascular aneurysm repair complications, in cases that are symptomatic, in ruptures, or in complex anatomies. It presents several advantages due to its immediate availability, ease of sizing, simplicity and lower cost. The STABILISE technique seems to be a viable option to cure patients with type B aortic dissection and prevent aneurysmal degeneration.

In the paper, the Lagrange problem given by a fractional boundary problem with partial derivatives is considered. The main result is the existence of optimal solutions based on the convexity assumption of a certain set. The proof is based on the lower closure theorem and the appropriate implicit measurable function theorem.

Summary: Background: Gastric cancer (GC) is clinically heterogenous according to location (cardia/non-cardia) and histopathology (diffuse/intestinal). We aimed to characterize the genetic risk architecture of GC according to its subtypes. Another aim was to examine whether cardia GC and oesophageal adenocarcinoma (OAC) and its precursor lesion Barrett’s oesophagus (BO), which are all located at the gastro-oesophageal junction (GOJ), share polygenic risk architecture. Methods: We did a meta-analysis of ten European genome-wide association studies (GWAS) of GC and its subtypes. All patients had a histopathologically confirmed diagnosis of gastric adenocarcinoma. For the identification of risk genes among GWAS loci we did a transcriptome-wide association study (TWAS) and expression quantitative trait locus (eQTL) study from gastric corpus and antrum mucosa. To test whether cardia GC and OAC/BO share genetic aetiology we also used a European GWAS sample with OAC/BO. Findings: Our GWAS consisting of 5816 patients and 10,999 controls highlights the genetic heterogeneity of GC according to its subtypes. We newly identified two and replicated five GC risk loci, all of them with subtype-specific association. The gastric transcriptome data consisting of 361 corpus and 342 antrum mucosa samples revealed that an upregulated expression of MUC1, ANKRD50, PTGER4, and PSCA are plausible GC-pathomechanisms at four GWAS loci. At another risk locus, we found that the blood-group 0 exerts protective effects for non-cardia and diffuse GC, while blood-group A increases risk for both GC subtypes. Furthermore, our GWAS on cardia GC and OAC/BO (10,279 patients, 16,527 controls) showed that both cancer entities share genetic aetiology at the polygenic level and identified two new risk loci on the single-marker level. Interpretation: Our findings show that the pathophysiology of GC is genetically heterogenous according to location and histopathology. Moreover, our findings point to common molecular mechanisms underlying cardia GC and OAC/BO. Funding: German Research Foundation (DFG).

In the endovascular treatment of associated aortoiliac aneurysms, the choice of the technique of distal anchoring faces a lack of standardization and the results of flared distal limbs also called "bell-bottom" remain discussed. The objective was to report the short and mid-term results of the distal endovascular management of aortoiliac aneurisms with the implantation of large diameter flared limbs. The primary outcomes were the rate of reoperation for type 1b endoleak and the appearance of a limb event (composite criterion).

We sought to demonstrate the feasibility of laser techniques in treating type Ia endoleaks (TIaEs) of the left subclavian artery (LSA). The laser procedure to create the stent graft includes seven stages: (1) image fusion, (2) stent graft placement at the level of the target arteries, (3) catheterization through the left brachial artery with the TourGuide steerable sheath (Medtronic, Dublin, Ireland), (4) use of a 0.9-mm laser catheter (Spectranetics, Colorado Springs, Colo) for stent graft perforation, (5) predilatation with a 2.5-mm cutting balloon, (6) a second predilatation with a 4× 20 balloon, and (7) stenting with an Advanta V12 stent (Getinge, Gothenburg, Sweden) and flaring with a 10 × 20 balloon. We performed a laser procedure at the renovisceral artery level in September 2016 and have 63 cases, including 4 for the LSA (20 for TIaEs, including 2 for the LSA). A 68-year-old female patient with a 60-mm diameter proximal thoracic aneurysm diagnosed with a TIaE as a complication morbidity of thoracic endovascular aneurysm repair. The TIaE had been caused by a very short and irregularly shaped upper neck. Precise sizing was prepared for laser fenestration to the LSA procedure. Two Valiant stent grafts (Medtronic) were deployed just below the common brachiocephalic trunk. Catheterization was performed through the left brachial artery. Next, laser perforation of the stent graft was performed, and an Advanta V12 stent was deployed to the LSA. Intraoperative angiography and postoperative computed tomography showed exclusion of the TIaE and patency of the stent to the LSA. We found that the advantages of laser-made vs custom-made stent grafts in the treatment of TIaE after thoracic endovascular aneurysm repair include immediate availability, easier sizing, simpler performance, and less expensive.