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Background: A randomized, placebo-controlled phase III study (AB10015) previously demonstrated that orally administered masitinib (4.5 mg/kg/day) slowed rate of functional decline, with acceptable safety, in amyotrophic lateral sclerosis (ALS) patients having an ALS Functional Rating Scale-revised (ALSFRS-R) progression rate from disease onset to baseline of Methods: Survival status of all patients originally randomized in AB10015 was collected from participating investigational sites. Survival analysis (using the multivariate log-rank test and Cox proportional hazards model, with stratification factors as covariates) was performed on the intention-to-treat population and enriched subgroups, which were defined according to initial randomization, baseline ALSFRS-R progression rate and baseline disease severity. Results: A significant survival benefit of 25 months ( p = 0.037) and 47% reduced risk of death ( p = 0.025) was observed for patients receiving 4.5 mg/kg/day masitinib ( n = 45) versus placebo ( n = 62) in an enriched cohort with ⩾2 on each baseline ALSFRS-R individual component score (i.e. prior to any complete loss or severe impairment of functionality) and post-onset ALSFRS-R progression rate Conclusions: Analysis of long-term OS (75 months average follow-up from diagnosis) indicates that oral masitinib (4.5 mg/kg/day) could prolong survival by over 2 years as compared with placebo, provided that treatment starts prior to severe impairment of functionality. This trial was registered at www.ClinicalTrials.gov under identifier NCT02588677 (28 October 2015).

This article deals with the attempt to join HIV and geriatric care management in the 2017 edition of the Italian guidelines for the use of antiretrovirals and the diagnostic-clinical management of HIV-1 infected persons. The outlined recommendations are based on evidence from randomized clinical trials and observational studies published in peer-reviewed journals and/or presented at international scientific conferences in recent years. The principles of starting antiretroviral therapy in elderly patients and the viroimmunological goals are the same as in the general HIV population. However, there are some specificities to consider, related to the host as well as the therapy itself. HIV care in elderly patients must shift from a combined AntiRetroviral Therapy specific approach to a more comprehensive management, and from a disease-based model (list of co-morbidities) to a multi-morbidity and frailty standpoint. The implementation of a geriatric approach, based on the Comprehensive Geriatric Assessment, is essential and consists of a broader evaluation of health status. This multidimensional and multidisciplinary evaluation is focused on the development of a tailored intervention plan. Polypharmacy is a frequent condition in the older population and an independent risk factor for negative health-related outcomes. This can be overcome with a multidisciplinary and cooperative approach involving HIV specialists, geriatricians and primary care physicians. The inclusion of geriatric care becomes necessary due to the novel needs of an evolving patient population. It is important to underline that the HIV specialist will continue to lead multidimensional interventions and optimize quality of care for HIV-positive people.

Cytogenetic studies for systematic and evolutionary purposes are lacking on marine phanerogams. Halophila stipulacea is a tropical seagrass that invaded the Mediterranean from the Red Sea through the Suez Canal. In this study, we report, for the first time, the karyotype features and genome size of H. stipulacea populations from different localities. Also, an attempt to compare our data with those reported in literature on other Halophila species is discussed. To determine the karyological relationships among taxa, we used basic karyotypic features such as chromosome number, size and symmetry, and position of chromosomal landmarks. To estimate karyotype asymmetry, the Coefficient of Variation of Chromosome Length (CVCL) and the Mean Centromeric Asymmetry (MCA) values were calculated. The estimations of DNA amounts were carried out by Image Cytometry (IC) using the interphase-peak method. All the taxa, including those reported in literature, present a uniform and slightly bimodal karyotype, but significant differences are found in nuclear DNA content among species. Each taxa had a karyotype formula 2n = 18 = 10m + 2sm + 6st. Aneuploidy and polyploidy seemed to not be involved in the speciation of this genus. The conserved karyotype in these taxa suggests the presence of mechanisms selecting for constancy, or against changes, in karyotype number and morphology.

Objectives Hepatitis B (HBV) infection, which is prevalent worldwide, is also frequently seen in patients with rheumatoid arthritis (RA). The Italian Society of Rheumatology (SIR) and the Italian Society of Infectious and Tropical Diseases (SIMIT) endorsed a national consensus process to review the available evidence on HBV management in RA patients and to produce practical, hospital-wide recommendations. Methods The consensus panel consisted of infectious disease consultants, rheumatologists and epidemiologists and used the criteria of the Oxford Center for Evidence-based Medicine to assess the quality of the evidence and the strength of their recommendations. Results A core-set of statements has been developed to help clinicians in the management of patients with RA and HBV infection. Vaccination and prophylaxis of RA patients treated with biological drugs have been also discussed. Conclusions HBV infection is not rare in clinical practice; a screening for HBV in all patients with early arthritis is not universally accepted, while it is considered mandatory before starting any immunosuppressive or hepatotoxic treatment. In fact, a specific risk, associated with the use of biologic treatments, exists for patients with HBV infection, although longitudinal studies of viral reactivation are generally reassuring. RA patients with HBV infection should be referred to the hepatologist and correctly classified into active or inactive carriers. Patients with active hepatitis B should undergo antiviral treatment before starting immunosuppressive treatments. Occult HBV carriers should be monitored or receive prophylaxis on the basis of the risk of reactivation associated with the administered treatment.

The dermal sheath (DS) of the hair follicle is comprised by fibroblast-like cells and extends along the follicular epithelium, from the bulb up to the infundibulum. From this structure, cells with stem characteristics were isolated: they have a mesenchymal origin and express CD90 protein, a typical marker of mesenchymal stem cells. It is not yet really clear in which region of hair follicle these cells are located but some experimental evidence suggests that dermal stem cells are localized prevalently in the lower part of the anagen hair follicle. As there are no data available regarding DS stem cells in dog species, we carried out a morphological analysis of the hair follicle DS and performed both an immunohistochemical and an immunocytochemical investigation to identify CD90+ cells. We immunohistochemically evidenced a clear and abundant positivity to CD90 protein in the DS cells located in the lower part of anagen hair follicle. The positive cells showed a typical fibroblast-like morphology. They were flat and elongated and inserted among bundles of collagen fibres. The whole structure formed a close and continuous sleeve around the anagen hair follicle. Our immunocytochemical study allowed us to localize CD90 protein at the cytoplasmic membrane level.

In this paper, a DC/DC power converter devoted to electrical motor drive in motorbike racing application is designed and simulated in MATLAB Simulink environment, along with its control logic strategy. In particular, we conceived, developed and simulated a thermal control strategy, to be implemented as the logic core of the power converter, which dynamically and automatically fits the electric power fed to motor, depending on its actual temperature. As a result, motor burnout during the race is avoided, improving the power train reliability without affecting the racing performance. Simulation results, in which the whole power train system was modeled in Simulink, confirmed the proposed algorithm effectiveness.

Parallel resonant converter (PRC) behaves as a constant current (CC) source when operated at its resonant frequency; however, its output current slightly depends on output load changes. In practical applications - e.g. in LED drivers - a precisely regulated output value should be requested, also over a wide load range. To fix this shortcoming, in this paper we present a PRC-CC with variable switching frequency control implemented on microcontroller (μc), to regulate output current against load variations. Optimal design considerations are introduced to allow the adoption of such kind of control strategy, without losing the CC circuit behavior and zero voltage switching (ZVS) transitions. A 100 W, 2 A PRC-CC prototype was realized. Experimental results demonstrate the CC behavior of the controller, as well as the effective output current regulation.

Recently, DNA phylogenies resulted in the transfer of some species of the halymeniacean genus Aeodes, namely A. orbitosa and A. ulvoidea, to the genus Pachymenia leaving the former supposedly as a monotypic genus based on the type species, A. nitidissima. Nevertheless, that work overlooked the presence of A. marginata, a red foliaceus alga endemic to the Mediterranean Sea with a convoluted nomenclatural history.In the present study, we provided a thorough description of A. marginata based on both anatomical and molecular data and inferred its phylogenetic relationships among halymeniacean genera using both chloroplastic (rbcL) and nuclear genes (LSU). Based on our data, A. marginata allied with Halymenia, Cryptonemia, and associated genera rather than with the generitype A. nitidissima, and presented a unique set of characters deserving the status of genus within the Halymeniaceae. Therefore, we proposed the new genus Felicinia based on Felicinia marginata comb. nov.A description of the multiaxial vegetative of F. marginata construct was provided, highlighting a unique characteristic among red algae: the presence, in the medulla, of peculiar oblique multicellular filaments connecting periclinal filaments. These filaments are produced secondarily as branches from axial filaments and are possibly homologous to the anticlinal filaments observed in the medulla of Halymenia.

The red algal family Halymeniaceae has been recently the subject of taxonomic revisions based strictly on molecular data. As a result, the number of genera ascribed to it has been decreasing and many generic definitions changed profoundly owing to inconsistencies in diacritical vegetative and particularly reproductive characters in standard literature. Reproductive uniformity within this family has been claimed since the late 19th century and is generally supported by recent authors. In this study we report on consistent significant differences in the architecture of carpogonial and auxiliary cell ampullae, as well as in early postfertilization events, among Mediterranean species currently assigned to the genus Grateloupia C. Agardh and provide new interpretations of these features. We recognize several distinct types of ampullae and postfertilization events that distinguish groups of species, these groups proving to be strongly supported by rbcL phylogenies. As a result we conclude that the genu...

In order to maintain the popularity and reputation of a web site, the quality of service perceived by users, especially the service availability, is a success factor. A service that is frequently unavailable may have negative e#ects on the reputation of the service provider, or result in loss of business opportunities. From the user's perspective, a service that exhibits poor quality is virtually equivalent to an unavailable service. In this work, we present the overall architecture and the evaluation of a middleware infrastructure which provides quality-of-service di#erentiation among classes of communication-bound processes. By communication-bound processes we mean processes whose activity is typically dominated by network communication, e.g. a video server. The proposed architecture supports di#erent classes of service, each with di#erent quality attributes concerning the network data delivery performance. In particular, the architecture is able to provide a class of service, namely guaranteed service class, which is suitable for increasing the service availability for a group of premium users, especially in overloaded servers (in absence of external faults).

OBJECTIVES: Mitochondrial dysfunction has been reported in the central nervous system, hepatocytes and peripheral blood lymphocytes from patients with sporadic amyotrophic lateral sclerosis (SALS). However, the status of skin mitochondria has not been reported, in spite of the fact that SALS patients present skin abnormalities. The objective of the present study was to compare mitochondrial ultrastructural parameters in keratinocytes from patients with SALS and healthy controls. METHODS: Our study was based on the analysis of 112 skin mitochondria from 5 SALS patients and 99 organelles from 4 control subjects by electron microscopy. RESULTS: Computerized image analysis showed that mitochondrial major axis length, area and perimeter of the organelle were significantly smaller in SALS respect of healthy control subjects. Morphologically, SALS mitochondria presented cristolysis and breakage of the outer membrane. CONCLUSIONS: Mitochondrial dysfunction in the skin may possibly reflect changes occurring in mitochondria of the central nervous system. The analysis of mitochondrial morphology in this tissue may be of value to follow disease progression and, eventually, the effectiveness of current therapies for SALS.

OBJECTIVES: Mitochondrial dysfunction has been reported in the central nervous system, hepatocytes and peripheral blood lymphocytes from patients with sporadic amyotrophic lateral sclerosis (SALS). However, the status of skin mitochondria has not been reported, in spite of the fact that SALS patients present skin abnormalities. The objective of the present study was to compare mitochondrial ultrastructural parameters in keratinocytes from patients with SALS and healthy controls. METHODS: Our study was based on the analysis of 112 skin mitochondria from 5 SALS patients and 99 organelles from 4 control subjects by electron microscopy. RESULTS: Computerized image analysis showed that mitochondrial major axis length, area and perimeter of the organelle were significantly smaller in SALS respect of healthy control subjects. Morphologically, SALS mitochondria presented cristolysis and breakage of the outer membrane. CONCLUSIONS: Mitochondrial dysfunction in the skin may possibly reflect changes occurring in mitochondria of the central nervous system. The analysis of mitochondrial morphology in this tissue may be of value to follow disease progression and, eventually, the effectiveness of current therapies for SALS. OBJETIVOS: Existen alteraciones en la función mitocondrial en el sistema nervioso central, en hepatocitos y en linfocitos de sangre periférica en SALS. Aunque, no se ha estudiado si existen cambios estructurales en las mitocondrias de la piel. Nuestro objetivo fue comparar la ultraestructura de mitocondrias en queratinocitos de enfermos con SALS con la de controles sanos. MÉTODO: Fueron analizadas en el microscopio electrónico 112 mitocondrias dérmicas de 5 pacientes y 99 provenientes de 4 controles. RESULTADOS: EL análisis computarizado mostró que el eje mayor mitocondrial, el área y el perímetro de las organelas fueran significativamente menor que en controles. Morfológicamente, las mitocondrias de SALS presentaron cristólisis y ruptura de la membrana externa. CONCLUSIÓN: La alteración mitocondrial en la piel posiblemente refleje cambios que también ocurran en las mitocondrias neuronales. Este análisis morfológico de las mitocondrias podría tener valor en el seguimiento de la enfermedad y eventualmente en la evaluación de la efectividad de futuras terapias.

Sporadic amyotrophic lateral sclerosis (sALS) is considered a multifactorial disease with genetic and environmental factors causing motor neuron degeneration. To describe the epidemiological and occupational characteristics of patients with sALS who attended the Ramos Mejía Hospital at Buenos Aires, Argentina. We analyzed the medical records of sALS patients diagnosed between 2001 and 2008. All occupations were coded according to the International Standard Classification of Occupation (ISCO). La esclerosis lateral amiotrófica esporádica (ELAe) es considerada una enfermedad multifactorial. Se describen las características epidemiológicas y laborales de un grupo de pacientes con ELA que fueron evaluados en el Hospital Ramos Mejía de Buenos Aires, Argentina. Se analizaron los registros médicos de pacientes con ELAe diagnosticados entre 2001 y 2008. Las ocupaciones fueron codificadas de acuerdo a la Clasificación Internacional de Ocupaciones (ISCO). Fil: Bettini, Mariela. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; Argentina Fil: Gargiulo Monachelli, Gisella Mariana. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental. Fundación de Instituto de Biología y Medicina Experimental. Instituto de Biología y Medicina Experimental; Argentina Fil: Rodriguez, Gabriel. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; Argentina Fil: Rey, Raúl C.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; Argentina Fil: Martinez Peralta, Liliana A.. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Microbiología; Argentina Fil: Sica, Roberto Ernesto Pedro. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina

This article briefly describes the already known clinical features and pathogenic mechanisms underlying sporadic amyotrophic lateral sclerosis, namely excitoxicity, oxidative stress, protein damage, inflammation, genetic abnormalities and neuronal death. Thereafter, it puts forward the hypothesis that astrocytes may be the cells which serve as targets for the harmful action of a still unknown environmental agent, while neuronal death may be a secondary event following the initial insult to glial cells. The article also suggests that an emergent virus or a misfolded infectious protein might be potential candidates to accomplish this task. El artículo presente describe, brevemente, las características clínicas y los mecanismos patogénicos de la esclerosis lateral amiotrófica esporádica, tales como la excitotoxicidad, el stress oxidativo, el daño proteico, la inflamación, las anormalidades genéticas y la muerte neuronal. Luego de ello, sugiere la posibilidad hipotética de que los astrocitos podrían ser el blanco primario de la acción de una agente ambiental, externo, aún desconocido, y que la muerte neuronal aconteciera secundariamente a ese daño astrocitario inicial. El artículo concluye discutiendo la posibilidad de que un virus ambiental o endógeno o una proteína mal plegada, que adquiriera características de infectividad, puedan ser la causa de la enfermedad.

A straightforward non-invasive method is proposed to accurately evaluate the shunt resistance of an elementary cell of a photovoltaic module connected in an installed string without the need of preliminary knowledge of the intrinsic diode parameters. The approach relies on the measurement of the current-voltage characteristic of the whole string after intentionally shading the selected cell. Calibrated PSPICE simulations are employed to both illustrate and test the method. As a case study, the shunt resistances of several cells belonging to a series array of 10 commercial modules are determined.

A monitoring circuit for individual photovoltaic (PV) panels in grid-connected systems is proposed, which exhibits a number of features devised to simplify and reduce cost of diagnostics and maintenance of the PV plant. In particular, the system is provided with an effective energy harvesting supply stage, which eliminates the requirement for external supply or batteries; furthermore, no cables are needed for data transfer due to the adoption of a rugged wireless connectivity.

CMS is a general purpose experiment, designed to study the physics of pp collisions at 14 TeV at the Large Hadron Collider (LHC). It currently involves more than 2000 physicists from more than 150 institutes and 37 countries. The LHC will provide extraordinary opportunities for particle physics based on its unprecedented collision energy and luminosity when it begins operation in 2007. The principal aim of this report is to present the strategy of CMS to explore the rich physics programme offered by the LHC. This volume demonstrates the physics capability of the CMS experiment. The prime goals of CMS are to explore physics at the TeV scale and to study the mechanism of electroweak symmetry breaking - through the discovery of the Higgs particle or otherwise. To carry out this task, CMS must be prepared to search for new particles, such as the Higgs boson or supersymmetric partners of the Standard Model particles, from the start-up of the LHC since new physics at the TeV scale may manifest itself with modest data samples of the order of a few fb-1 or less. The analysis tools that have been developed are applied to study in great detail and with all the methodology of performing an analysis on CMS data specific benchmark processes upon which to gauge the performance of CMS. These processes cover several Higgs boson decay channels, the production and decay of new particles such as Z′ and supersymmetric particles, Bs production and processes in heavy ion collisions. The simulation of these benchmark processes includes subtle effects such as possible detector miscalibration and misalignment. Besides these benchmark processes, the physics reach of CMS is studied for a large number of signatures arising in the Standard Model and also in theories beyond the Standard Model for integrated luminosities ranging from 1 fb-1 to 30 fb-1. The Standard Model processes include QCD, B-physics, diffraction, detailed studies of the top quark properties, and electroweak physics topics such as the W and Z0 boson properties. The production and decay of the Higgs particle is studied for many observable decays, and the precision with which the Higgs boson properties can be derived is determined. About ten different supersymmetry benchmark points are analysed using full simulation. The CMS discovery reach is evaluated in the SUSY parameter space covering a large variety of decay signatures. Furthermore, the discovery reach for a plethora of alternative models for new physics is explored, notably extra dimensions, new vector boson high mass states, little Higgs models, technicolour and others. Methods to discriminate between models have been investigated. This report is organized as follows. Chapter 1, the Introduction, describes the context of this document. Chapters 2-6 describe examples of full analyses, with photons, electrons, muons, jets, missing E T, B-mesons and τ's, and for quarkonia in heavy ion collisions. Chapters 7-15 describe the physics reach for Standard Model processes, Higgs discovery and searches for new physics beyond the Standard Model. © 2007 IOP Publishing Ltd.

Grateloupia turuturu Yamada is the currently accepted name for the invasive red alga that is present on coasts of the North Atlantic. Previously considered as G. doryphora (Montagne) M.A. Howe, populations of this invasive species were examined and their taxonomic position revised using molecular and morphological techniques. It was also thought that similar invasive populations in the Mediterranean should be identified as G. turuturu. This investigation used rbcL based molecular analyses to clarify the taxonomic position of Grateloupia “doryphora’ from the Straits of Messina. Our results indicate that this population is neither G. doryphora nor G. turuturu. It was placed separately in all analyses and grouped consistently with other Grateloupia species from the Pacific. On the basis of molecular data from this and previous investigations, it is evident that the status of the foliose Atlantic and Mediterranean entities is still unclear and a re-evaluation of the old names connected to them should be undertaken.

SummaryIn the present ultrastructural study, horseradish peroxidase-labelled lectins, in conjunction with antiperoxidase antibody and protein A-gold, were used to characterise and localise the oligosaccharide sequences of zona pellucida glycoproteins at different stages of follicular development in the canine ovary. Deacetylation and sialidase digestion were also performed before lectin cytochemistry. The zona pellucida of oocytes present in unilaminar primary follicles reacts with WGA- and RCA-I-lectins. The zona pellucida of oocytes present in bilaminar and trilaminar secondary follicles displays positivity to WGA, RCA-I, Con-A, UEA-I, and sialidase/SBA. This labelling pattern persists in the zona pellucida of oocytes present in antral tertiary follicles with the exception of WGA and RCA-I reactive sites which are differently distributed throughout the zona pellucida. The topographical distribution of these carbohydrates is not uniform throughout the zona pellucida, indicating the regionalization of oligosaccharide chains within three concentric bands of the zona matrix: an inner surface close to the oocyte plasmamembrane, an intermediate portion and an outer layer in contact with the follicular cells. Our results demonstrated variations in the presence and distribution of the carbohydrate residues in the canine zona pellucida during different stages of follicular growth. We also observed the presence of vesicles in both the ooplasm and granulosa cells, showing a similar lectin binding pattern to that of the zona pellucida.

A user-friendly and fast protocol using PCR was developed to amplify the plastid rbcL gene of Porphyra, the most economically valuable genus of Rhodophyta. The technique involved the use of monospores, providing the advantage of a small and genetically homogeneous set of cells and thus reducing the risk of biological or chemical contamination. An additional factor in the choice of the rbcL gene was the huge amount of sequence data deposited in molecular biology databases and their utility as molecular markers in taxonomic studies.

An ultrastructural localization of lectin receptors on the zona pellucida (ZP) of porcine antral oocytes and on the granulosa cells was performed using a panel of horseradish peroxidase- labelled lectins in conjunction with antiperoxidase antibody and protein A-gold. In some cases, lectin incubation was preceded by sialidase digestion. WGA-, Con-A-, UEA-I-, RCA-I-, PNA- and SBA-reactive sites were distributed differently in the porcine ZP. Sialidase digestion increased the positivity obtained with RCA-I and it was necessary to promote PNA and SBA reactivity. These results indicated that the ZP contained N-acetylglucosamine, a-mannose, a- fucose, b-Gal-(1-4)GlcNAc, b-Gal- (1-3)GalNAc, b-GalNAc and sialic acid residues. We also observed the presence of vesicles in both the ooplasm and granulosa cells, showing a similar lectin binding pattern to that of the ZP, thus suggesting that the oocyte and granulosa cells are the site of synthesis of ZP glucidic determinants.

The life history of Bangia atropurpurea (Bangiales, Rhodophyta) from the Alcantara River (Sicily, Italy) was studied in the field and laboratory. An alternation between a macroscopic phase and a microscopic filamentous conchocelis phase was found, and spermatia and carpogonia are described for the first time in a freshwater population of the species. Endosporangia have also been discovered on gametophytic plants in culture. In addition, the conchocelis phase produced either conchosporangia or monosporangia, and reproduction by fragmentation was common. Sexuality was indicated by chromosome counts of n = 3 and 2n =6 in gametophytes and sporophytes, respectively; resting cells were observed in both.

1. Morphological and histochemical observations were done on the chicken anterior and posterior lingual glands. Histology, ultrastructure and glycoconjugate histochemistry were investigated by means of light and electron microscopy using staining specific for complex carbohydrates. 2. In the anterior lingual glands there are lateral and medial zones showing different morphological and tinctorial features. The secretory cells are typical mucous cells. 3. Histochemical reactions revealed the presence of acidic glycoconjugates with terminal sialic acid residues, and glycoconjugates vicinal diol and sulphate groupings in the secretory granules. 4. It is suggested that the main functions of lingual glands are the lubrication of boli and protection from micro‐organisms.

Background: The best strategy in the treatment for ruptured abdominal aortic aneurysm (RAAA) is an ongoing matter of debate. Differently from several retrospective studies, recent randomized controlled trials (RCTs) failed to demonstrate the superiority of endovascular repair (EVAR) over open repair (OPEN). The aim of the present study was to compare 30-day mortality of EVAR and OPEN in RAAA according to different study designs through a systematic review and meta-analysis. Methods: A systematic literature search of all series comparing the outcome of EVAR and OPEN in RAAA was performed. Studies on symptomatic aneurysms without frank ruptures were excluded. The analyses evaluated the effect of the study design on EVAR versus OPEN 30-day mortality. The pooled mortality risk was expressed as odds ratio (OR) with a 95% confidence interval (CI) by random effect model. Results: Four different study designs were evaluated. 1) Patients allocation in EVAR or OPEN was ‘‘unbiased’’ (3 studies, 2 RCTs): there was no superiority treatment in EVAR versus OPEN (OR, 1.58; 95% CI, 0.82e3.06; P ¼ 0.17). 2) Patients submitted to EVAR were compared with a historical OPEN group (2 studies): no difference between EVAR and OPEN (OR, 3.55; 95% CI, 0.47e26.62; P ¼ 0.22). 3) EVAR was the preferential treatment and OPEN was confined to patients with unsuitable anatomy for endovascular procedures (18 studies): in this type of study OPEN had a higher risk of 30-day mortality (OR, 2.18; 95% CI, 1.61e2.96; P < 0.00001). 4) The 30-day mortality after EVAR introduction in centers using both EVAR and OPEN was compared with the only OPEN treatment (7 studies): the latter had higher mortality compared with the protocol with both EVAR and OPEN options (OR, 2.26; 95% CI, 1.41e3.63; P ¼ 0.0007). Conclusions: Only few studies are available to compare EVAR and OPEN in an ‘‘unbiased’’ cohort, with no significant differences between the 2 treatments. However, after the introduction of EVAR and OPEN protocols, the overall mortality for RAAA was reduced compared with the only OPEN option, suggesting a beneficial effect of EVAR in selected cases.

AIM: Endovascular therapy (ET) is the treatment of choice for critical limb ischemia (CLI) and tibial arteries disease (TAD) in focal lesions with restorable run-off; ankle and foot bypass (BPG) is indicated in patients unfit for ET with foot or ankle arteries suitable for surgery. The aim of this study was to evaluate limb salvage (LS), primary patency (PP) and survival (S) of patients underwent BPG in the era of ET for TAD and to define the correlated prognostic factors. METHODS: Between February 2000 and November 2008, patients with CLI and TAD were collected prospectively in a data-base (demographics, Fontaine's stage, Texas University Wound Classification [TUC]of ulcers, risk-factors, TAD, techniques of foot revascularization and surgical factors). BPG was performed in tibial arteries occlusion longer than 4 cm or focal occlusion without line-flow to pedal arteries. Clinical and Duplex-ultrasound follow-up was performed at discharge, 1, 3, 6 months and every 6 months. LS, PP, and S rates were assessed with Kaplan-Meier method; factors influencing outcomes were sought by multivariate Cox proportional hazards model analysis. RESULTS: A total of 410 revascularizations were performed in patients with CLI and TAD; BPG in 153 patients (mean age:69.3±10.6, male/female=117/36, diabetes mellitus=75.2\% hyperlypidemia=54.9\%, hypertension=87.6\%, renal disease=32.7\%, coronary arteries disease=51.6\%, Fontaine stage IV=96.1\%, TUC grade-III=65.4\%, TUC stage-D=51\%). All autologous grafts in 96.7\% (non-reversed saphenous vein=74.5\%, reversed=7.2\%, composite vein graft=12.4\%, arm's veins=2.6\%). LS and S after 1 month were 88.2\% and 97.1\%, respectively. Mean follow-up was 23 months. At 12 and 36 months: LS 76.7\% and 70.9\%, PP 62.3\% and 52.9\%, S 91.5\% and 74.6\%. LS was negatively associated with age (HR=1.041 [95\%CI=1.005-1.079]), infected ulcers (HR=3.377 [95\%CI=1.571-7.258]), run-off arteries diameter

To evaluate the feasibility and clinical efficacy of endovascular treatment of the infrapopliteal arteries (IPA) in hemodialysis patients with critical limb ischemia (CLI).Between January 2005 and December 2010, patients undergoing hemodialysis who were treated with endovascular treatment of IPA were prospectively collected and evaluated with regard to demographics, clinical risk factors (including duration of hemodialysis), presentation of CLI, lesion type, target arteries, and treatment type. Follow-up was performed on clinical and duplex ultrasonographic evaluation at 1, 3, 6, and 12 months and annually thereafter. End points included technical success, limb salvage, primary and assisted patency, and survival and were calculated using the Kaplan-Meier method. Risk factors were analyzed by Fisher exact test for categorical data and the Mann-Whitney U test for nonparametric quantitative data.Thirty-nine patients (29 men; mean age: 70.6 ± 11 years) with 46 limbs and 91 target tibial arteries were treated. The mean duration of hemodialysis was 5.5 years. A trophic lesion was present in 95.7\% of the limbs. The intent-to-treat was made on 47 (51.6\%) tibial artery stenoses, 21 (23.1\%) obstructions