Background: Medial arterial calcification (MAC) of the tibial and pedal arteries has been associated with an increased risk of amputation among people with diabetes. Endovascular interventions on infrageniculate vessels are frequently performed with the intent of treating peripheral artery disease (PAD) and decreasing the risk of amputation in those with diabetes. This study aimed to investigate how the extent of MAC impacts outcomes of endovascular procedures in people with diabetic foot ulcers (DFU). Methods: We identified all patients who had undergone infrageniculate angioplasty in the setting of DFU at our institution between 2009 and 2019. Subjects were assigned a MAC score based on the severity of MAC in each vessel visualized on plain radiographs of the ankle and foot. We evaluated the relationship between MAC and the primary outcome, major adverse limb event (MALE), using stratified Cox proportional modeling. Results: Among 99 subjects with DFU who had undergone infrageniculate angioplasty, MALE occurred in 50% (95% confidence interval [CI] 38%-61%) of patients within 1 year of intervention. On univariate Cox regression analysis, each 1 point increment in MAC score (hazard ratio [HR], 1.09; 95% CI 1.01-1.18), the third tertile of MAC score (HR, 2.27; 95% CI 1.01-5.11), age (HR 0.96; 95% CI 0.93-0.99), and wound grade (HR, 5.34; 95% CI 2.17-13.14), were significantly associated with increased risk of MALE. On adjusted analysis stratified by wound grade, MAC score was found to be associated with MALE only in patients with a low wound grade. Conclusion: Increased severity of MAC is associated with increased risk of MALE for subjects undergoing infrageniculate angioplasty with a low wound grade. Further research is needed to better understand the complex relationships of MAC, PAD, DFU, and interventions aimed at promoting healing of DFU.

A 40-year-old woman with obesity and hypertension presented to the emergency department with abdominal pain. Physical examination revealed a tender, pulsatile, epigastric abdominal mass. A 6.5 × 6.5-cm fusiform common hepatic artery aneurysm, extending from the celiac bifurcation to the origin of the gastroduodenal artery, was seen on a computed tomography scan (A, B, C/Cover, D). Pulse examination was normal. She denied a smoking history or a family history of aneurysm. The patient was admitted for blood pressure control, and the following day was taken for urgent aneurysm repair. Proximal control of the celiac artery was obtained. The left gastric and splenic arteries were ligated to mobilize celiac artery for adequate exposure and control. Distally, the proper hepatic artery and gastroduodenal artery were controlled. The aneurysm sac was opened and reconstructed using a saphenous vein interposition extending from the celiac artery to the common origin of the proper hepatic and gastroduodenal arteries. The aneurysm sac was closed over the graft. Postoperatively, the patient developed elevations of the hepatic transaminases, which soon normalized. Aspirin was administered for antiplatelet therapy and the patient was discharged home on postoperative day 6 and was advised to return to normal activity. At 6 months, she had no pain and fully resumed her daily activities. Hepatic artery aneurysm has an incidence of 0.002% in the population.1Abbas M.A. Fowl R.J. Stone W.M. Panneton J.M. Oldenburg W.A. Bower T.C. et al.Hepatic artery aneurysm: factors that predict complications.J Vasc Surg. 2003; 38: 41-45Abstract Full Text Full Text PDF PubMed Scopus (229) Google Scholar The causes of hepatic artery aneurysms are unclear, but they are most frequently associated with fibromuscular dysplasia, Takayasu arteritis, vasculitis, Wegner granulomatosis, and connective tissue disorders such as Marfan syndrome and Ehlers-Danlos syndrome.2Chaer R.A. Abularrage C.J. Coleman D.M. Eslami M.H. Kashyap V.S. Rockman C. et al.The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms.J Vasc Surg. 2020; 72S: 3S-39SAbstract Full Text Full Text PDF Scopus (94) Google Scholar Repair is recommended for aneurysms larger than 2 cm in size or if they are symptomatic or ruptured.1Abbas M.A. Fowl R.J. Stone W.M. Panneton J.M. Oldenburg W.A. Bower T.C. et al.Hepatic artery aneurysm: factors that predict complications.J Vasc Surg. 2003; 38: 41-45Abstract Full Text Full Text PDF PubMed Scopus (229) Google Scholar, 2Chaer R.A. Abularrage C.J. Coleman D.M. Eslami M.H. Kashyap V.S. Rockman C. et al.The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms.J Vasc Surg. 2020; 72S: 3S-39SAbstract Full Text Full Text PDF Scopus (94) Google Scholar, 3Berceli S.A. Hepatic and splenic artery aneurysms.Semin Vasc Surg. 2005; 18: 196-201Crossref PubMed Scopus (159) Google Scholar, 4Lumsden A.B. Mattar S.G. Allen R.C. Bacha E.A. Hepatic artery aneurysms: the management of 22 patients.J Surg Res. 1996; 60: 345-350Abstract Full Text PDF PubMed Scopus (82) Google Scholar Endovascular and open repair are viable options. The hepatic circulation should be maintained and ligation is recommended only if adequate collateral circulation is present.2Chaer R.A. Abularrage C.J. Coleman D.M. Eslami M.H. Kashyap V.S. Rockman C. et al.The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms.J Vasc Surg. 2020; 72S: 3S-39SAbstract Full Text Full Text PDF Scopus (94) Google Scholar,3Berceli S.A. Hepatic and splenic artery aneurysms.Semin Vasc Surg. 2005; 18: 196-201Crossref PubMed Scopus (159) Google Scholar Although combined left gastric and splenic ligations can lead to proximal gastric ischemia, if the gastroepiploic artery is preserved, ischemic complications are rare. Open repair was chosen in this case owing to an inadequate distal landing zone for stent placement. Publication was discussed with the patient and consent obtained.

Background: Since December 2019, Coronavirus disease 2019 (COVID-19) has emerged as an international pandemic. COVID-19 patients with cardiac injury might need special attention. However, understanding on this aspect remains unclear.Methods: This retrospective, single-center study included 304 COVID-19 cases hospitalized from January 11 to March 25, 2020. Confirmed by real-time RT-PCR, cases were analyzed for clinical characteristics and complications, specifically with cardiac injury, determined by the serum biomarker hypersensitive troponin I. The primary endpoint was COVID-19 associated mortality.Findings: Of the 304 patients, 96 (31∙6%) patients had cardiac injury and 208 (68∙4%) patients presented without cardiac injury. The median age was 65 (interquartile range, IQR, 54-74) years, and 160 (52∙6%) of COVID-19 patients were men. COVID-19 patients with cardiac injury had more comorbidities (76[79∙2%] vs 122[58∙7%], p<0∙001), and they had lower lymphocyte counts (median[IQR], 0∙6[0∙4-1∙0] vs 1∙0[0∙7-1∙3]/L, P<0∙001), while higher C-reactive protein levels (median[IQR], 84∙9[53∙7-173∙8] vs 28∙5[5∙7-82∙2]mg/L, p<0∙001) and procalcitonin levels (median[IQR], 0∙29[0∙10-1∙09] vs 0∙06[0∙04-0∙14]ng/mL, p<0∙001) and more frequent use of noninvasive ventilation (35[36∙5%] vs 27[13∙0%]), invasive mechanical ventilation (20[20∙8%] vs 11[5∙3%]) and antibiotic treatment (65[67∙7%] vs 53[25∙5%]) compared with patients without cardiac injury. The mortality rate in patients with cardiac injury was much higher than those without (63∙5%, 61/96 vs 13∙0%, 27/208, p<0∙001). The Cox regression showed cardiac injury was the strongest independent predictor to mortality from symptom onset in COVID-19 patients (hazard ratio[HR], 3∙37[95% CI, 1∙90-5∙67], p<0∙001).Interpretation: Cardiac injury is associated with more severe presentation, complex comorbidities and is the strongest independent predictor to mortality in hospitalized patients with COVID-19.Funding Statement: This study received the following funding: Construction Research Project of Key Laboratory (Cultivation) of Chinese Academy of Medical Sciences(No. 2019PT310025); National Natural Science Foundation of China (No. 81971588 and 81771811); Capital Clinically Characteristic Applied Research Fund (No. Z191100006619021); National Foreign Expert Talent Project(No. G20190001630); Education Reform Project of Peking Union Medical College (No. 10023201900204); Clinical and Translational Fund of Chinese Academy of Medical Sciences (No. 2019XK320063); National Natural Science Foundation of China (No. 81970331). Declaration of Interests: The authors declare no competing interests.Ethics Approval Statement: Local ethic approval (Ref: WDRY2020-K094).

BACKGROUND:Infection with the novel severe acute respiratory syndrome coronavirus 2 has been associated with a hypercoagulable state. Emerging data from China and Europe have consistently shown an increased incidence of venous thromboembolism (VTE). We aimed to identify the VTE incidence and early predictors of VTE at our high-volume tertiary care center. METHODS:We performed a retrospective cohort study of 147 patients who had been admitted to Temple University Hospital with coronavirus disease 2019 (COVID-19) from April 1, 2020 to April 27, 2020. We first identified the VTE (pulmonary embolism [PE] and deep vein thrombosis [DVT]) incidence in our cohort. The VTE and no-VTE groups were compared by univariable analysis for demographics, comorbidities, laboratory data, and treatment outcomes. Subsequently, multivariable logistic regression analysis was performed to identify the early predictors of VTE. RESULTS:The 147 patients (20.9% of all admissions) admitted to a designated COVID-19 unit at Temple University Hospital with a high clinical suspicion of acute VTE had undergone testing for VTE using computed tomography pulmonary angiography and/or extremity venous duplex ultrasonography. The overall incidence of VTE was 17% (25 of 147). Of the 25 patients, 16 had had acute PE, 14 had had acute DVT, and 5 had had both PE and DVT. The need for invasive mechanical ventilation (adjusted odds ratio, 3.19; 95% confidence interval, 1.07-9.55) and the admission D-dimer level ≥1500 ng/mL (adjusted odds ratio, 3.55; 95% confidence interval, 1.29-9.78) were independent markers associated with VTE. The all-cause mortality in the VTE group was greater than that in the non-VTE group (48% vs 22%; P = .007). CONCLUSIONS:Our study represents one of the earliest reported from the United States on the incidence rate of VTE in patients with COVID-19. Patients with a high clinical suspicion and the identified risk factors (invasive mechanical ventilation, admission D-dimer level ≥1500 ng/mL) should be considered for early VTE testing. We did not screen all patients admitted for VTE; therefore, the true incidence of VTE could have been underestimated. Our findings require confirmation in future prospective studies.

Conductive composite foams were prepared by exposing iodine-loaded polyurethane (PU) foams to pyrrole vapor. The kinetics, equilibrium, and mechanism of the in situ polymerization of pyrrole by iodine within a PU foam was investigated. The dopant for the polypyrrole (PPy) was primarily I3−, which formed a charge-transfer complex (PPy-I2) with the amine group of the PPy. The conductivity of the composite foams increased with increasing concentration of the PPy-I2 complex and depended on the distribution of the PPy-I2 complex in the PU matrix and the concentration ratio of PPy and iodine. The chemical structure, morphology, mechanical properties, and thermal stability of the composite foams were also characterized.

Liquid amines can be immobilized within the pores of polymeric supports to provide a regenerable CO2 sorbent. This paper describes the capture of CO2 by a range of ethanolamines (primary, secondary, and tertiary) immobilized within the pores of high-surface-area poly(methyl methacrylate) beads. These supported amines were used to remove low concentrations (7.6 mmHg) of CO2 by a pressure swing absorption process, where low-pressure vacuum was used to desorb the CO2 and regenerate the sorbent. The effect on CO2 capture of modification of primary amines to secondary amines by reaction with acrylonitrile was also evaluated. The modified amines provided nearly a factor of 2 increase in CO2 removal capacity compared to the original primary amines. These results suggest that modified amines could potentially be used for CO2 capture in space life support systems as well as for terrestrial flue gas CO2 removal applications.

The structurally novel urea derivatives 4-6 have been synthesized by treating the nucleophilic dipyridoimidazol-2-ylidene 1 with elemental chalcogens Y (Y = S, Se, Te). The oxygen analogue 8 has been obtained indirectly by alkylation of the seleno urea 5, followed by alkaline hydrolysis. All of these urea derivatives share two novel structural features: (1) their nitrogen centers represent the termini of the RED form of a two-step viologen-type redox system, and (ii) they can also be viewed as formally resulting from a cheletropic addition of CY to 2,2'-bipyridine. It has been demonstrated electrochemically that for Y = O, S, Se these ureas can be reversibly oxidized to the corresponding radical cations (SEM forms) at remarkably constant and negative potentials. This also applies to the heaviest congener of the series with Y = Te, except that in this case the oxidation process-exhibits only quasi-reversibility. Electrochemical generation of the corresponding OX forms is observed quasi-reversibly at increasingly positive potentials with increasing mass of the chalcogen Y. However, the bis-oxidation of the telluro species 6 cannot be observed. These experimental results are discussed on the basis of semiempirical calculations for the RED, SEM, and OX forms under consideration. Semiempirical calculations also suggest that fragmentation of the novel urea derivatives into CY and 2,2'-bipyridine should be mildly endothermic for Y = O, but increasingly strongly endothermic with increasing mass of Y. This result is qualitatively in line with expectation considering the increasing reluctance of the heavier chalcogens to take part in multiple bonding to carbon. This phenomenon is also reflected in the mass spectrometric fragmentation patterns of the urea derivatives 4-6 and 8.

This study describes results of fresh-frozen immunohistochemistry applied to two typical Warthin's tumors. Polyclonal follicular center cell staining and an apparent reduction in the number of T-lymphocytes were found. These observations tend to support the concept that the lymphoid infiltrate in Warthin's tumor represents a reactive cellular proliferation.

Background: Infection with the novel severe acute respiratory syndrome coronavirus 2 has been associated with a hypercoagulable state. Emerging data from China and Europe have consistently shown an increased incidence of venous thromboembolism (VTE). We aimed to identify the VTE incidence and early predictors of VTE at our high-volume tertiary