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BACKGROUND Continuous compensation of dopamine represents an ideal symptomatic treatment for Parkinson's disease (PD). The feasibility in intracerebroventricular administration (i.c.v.) of dopamine previously failed because of unresolved dopamine oxidation. OBJECTIVES We aim to test the feasibility, safety margins and efficacy of continuous i.c.v. of anaerobic-dopamine (A-dopamine) with a pilot translational study in a non-human primate model of PD. METHODS Continuous and circadian i.c.v. of A-dopamine was administered through a micro-pump connected to a subcutaneous catheter implanted into the right frontal horn of 8 non-human primates treated with 1-methyl-4- phenyl-1,2,3,6-tetrahydropyridine (MPTP). A-dopamine was assessed at acute doses previously reported for dopamine as well as evaluating the long term therapeutic index of A-dopamine in comparison to anaerobically prepared L-dopa or methyl ester L-dopa. RESULTS Over 60 days of a continuous circadian i.c.v. of A-dopamine improved motor symptoms (therapeutic index from 30 to 70 mg/day) without tachyphylaxia. No dyskinesia was observed even with very high doses. Death after 1 to 10 days (without neuronal alteration) was only observed with doses in excess of 160 mg whereas L-dopa i.c.v. was not effective at any dose. The technical feasibility of the administration regimen was confirmed for an anaerobic preparation of dopamine and for administration of a minimal infusion volume by micro-pump at a constant flow that prevented obstruction. CONCLUSION Continuous circadian i.c.v. of A-dopamine appears to be feasible and shows efficacy without dyskinesia with a safe therapeutic index. Neural correlates of decision making under risk are being increasingly utilized as biomarkers of risk for substance abuse and other psychiatric disorders, treatment outcomes, and brain development. This research relies on the basic assumption that fMRI measures of decision making represent stable, trait-like individual differences. However, reliability needs to be established for each individual construct. Here we assessed long-term test-retest reliability (TRR) of regional brain activations related to decision making under risk using the Balloon Analogue Risk Taking task (BART) and identified regions with good TRRs and familial influences, an important prerequisite for the use of fMRI measures in genetic studies. A secondary goal was to examine the factors potentially affecting fMRI TRRs in one particular risk task, including the magnitude of neural activation, data analytical approaches, different methods of defining boundaries of a region, and participant motion. Across regions, reliabilities ranged acrossties. Participant motion had a moderate negative effect on TRR. Regions activated during decision period rather than outcome period of risky decisions showed the greatest TRR and familiality. Regions with reliable activations can be utilized as neural markers of individual differences or endophenotypes in future clinical neuroscience and genetic studies of risk-taking. Understanding the neural implementation of value-based choice has been an important focus of neuroscience for several decades. Although a consensus has emerged regarding the brain regions involved, including ventromedial prefrontal cortex (vmPFC), posterior parietal cortex (PPC), and the ventral striatum (vSTR), the multifaceted nature of decision processes is one cause of persistent debate regarding organization of the value-based choice network. In the current study, we isolate neural activity related to valuation and choice selection using a gambling task where expected gains and losses are dissociated from choice outcomes. We apply multilevel mediation analysis to formally test whether brain regions identified as part of the value-based choice network mediate between perceptions of expected value and choice to accept or decline a gamble. Our approach additionally makes predictions regarding interregional relationships to elucidate the chain of processing events within the value-based decision network. Finally, we use dynamic causal modelling (DCM) to compare plausible models of interregional relationships in value-based choice. We observe that activity in vmPFC does not predict take/pass choices, but rather is highly associated with outcome evaluation. By contrast, both PPC and bilateral vSTR (bilaterally) mediate the relationship between expected value and choice. Interregional mediation analyses reveal that vSTR fully mediates between PPC and choice, and this is supported by DCM. Together these results suggest that vSTR, and not vmPFC nor PPC, functions as an important driver of choice. We developed a new reinforcement technique, the Gorget-Like Cuddling (GOCU) suture, to prevent suture line bleeding during aortic surgery. After continuous aortic anastomosis with thick outer felt, an additional 2-0 Ticron (Medtronic, Minneapolis, MN) suture is placed distal from the first suture line. This GOCU suture directly holds the needle holes. Wall tension on the anastomosis can also be reduced to prevent longitudinal dilatation of the aorta. This technique can contribute to hemostasis for a fragile aortic wall in cases like acute aortic dissection. OBJECTIVES to perform a post-implantation geometrical analysis and to evaluate early and mid-term outcomes of new-generation balloon-expandable covered stents, used in the kissing conformation to treat obstructive lesions involving the aortic bifurcation. METHODS a single-center retrospective review of all patients who underwent endovascular reconstruction of the aorto-iliac bifurcation for obstructive disease, with the use of Viabahn balloon expandable stents (VBX, W. L. Gore & Associates, Flagstaff, AZ-USA) deployed in the kissing conformation, from March 2018 to June 2019 was carried out. Two same-size kissing VBXs were simultaneously deployed from the distal aorta (1.5-2 cm above the aortic bifurcation) to the common iliac arteries; a kissing post-ballooning using compliant balloons was routinely performed to flare the proximal part of the VBX, in order to adapt to the aortic diameter and morphology. A post-operative angio-CT scan was obtained for all patients for the geometrical assessment. "Precision" o-up, no cases of limb occlusion or restenosis occurred. CONCLUSIONS the use of kissing VBX stents may represent a valid option for the treatment of obstructive lesions involving the aortic bifurcation, with excellent early and mid-term outcomes and achievement of optimal stents geometry. A 67 year old male with a history of aortobifemoral bypass graft (ABF) for critical limb ischaemia 10 months prior at a regional hospital was transferred to our centre with one week history of rigors and three months of a chronic discharging left groin sinus. Two months prior he had a right sided ureteric stent inserted for ureteric obstruction. Routine bloods revealed an acute on chronic renal injury and subsequent non-contrast computed tomography (CT) demonstrated left sided hydroureter and hydronephrosis suggestive of extrinsic compression by the left bypass graft limb. A new left sided ureteric stent was inserted and the right exchanged with no gross signs of infection. His impaired renal function precluded intravenous contrast and so a CT with oral contrast showed circumferential oral contrast and gas surrounding the right limb of his ABF. Urgent gastroscopy revealed periprosthetic erosion with the ABF limb traversing the distal third part of the duodenum. He underwent bilateral axillofemoral bypass grafts, laparotomy with explantation of the ABF and primary duodenojejunostomy. Bilateral ureters were compressed by overlying graft limbs. Bilateral groins were infected with frank pus on exploration and were associated with impending anastomotic disruption of his previous ABF distal anastomoses. His postoperative course was complicated by colonic ischaemia with perforation leading to irreversible multi-organ failure. This patient was remarkably well on presentation with life threatening pathology. He had no abdominal symptoms or gastrointestinal bleeding. This case demonstrates the diagnostic and management difficulties of periprosthetic erosions and the consequences of graft tunneling superficial to ureters. PURPOSE To describe a modification technique using the low-profile Cook Zenith Alpha™ thoracic stent graft, and addition of a preloaded wire system, for urgent repair of pararenal (PRA) and thoracoabdominal (TAAA) aortic aneurysms. METHODS We analyzed 20 consecutive patients who underwent urgent physician modified endograft (PMEG) repair of PRA and TAAA at two institutions. The low-profile Cook Zenith Alpha™ Thoracic stent graft was modified in according with each specific patient anatomic characteristics. Endpoints were technical success, 30-day mortality and major adverse events (MAEs). RESULTS Technical success was achieved in all patients (100%). A total of 76 renal-mesenteric arteries were incorporated by fenestrations (70%) or directional branches (30%) with an average of 3.7±0.6 vessels per patient. There were six different types of stent configuration. The most common design consisted of four fenestrations (nine patients, 45%). The average of modification time was 110±27 minutes. Total procedure time (including the time for open component) was 242±75 minutes. There was no death within the first 30-day or hospital stay. MAEs occurred in 10 patients (50%). The most common MAEs were acute kidney injury (by RIFLE criteria) in six patients (30%), EBL >1 L and respiratory failure requiring reintubation in two patients (10%) each, paraplegia and ischemic colitis in one patient (5%) each. One patient (5%) required temporary, new-onset dialysis. 17-AAG ic50 CONCLUSION PMEG using low - profile Zenith Alpha™ thoracic stent graft was safe with no early mortality and acceptable early morbidity. OBJECTIVES To evaluate the feasibility and midterm outcomes of iliac branch devices (IBDs) to preserve the internal iliac artery (IIA) perfusion in emergent endovascular repair of ruptured aorto-iliac aneurysms. METHODS Between December 2012 and July 2017, a total of 8 IBDs were implanted in 6 patients (median age 65 years; all men) in a single tertiary referral center. The indication for IBD implantation was a ruptured abdominal aortic aneurysm with a concomitant common iliac artery (CIA) aneurysm (n=4) or an isolated CIA aneurysms (n=2). The main outcome measures were technical and clinical success. Secondary outcomes were primary and primary assisted patency, occurrence of types I/III endoleaks and re-interventions. RESULTS All patients were hemodynamically stable during the procedures, which were performed under local anesthesia. Technical success was achieved in all cases (median total procedure time 188 min, median IBD procedure time 28 min). Median follow-up was 34 months (IQR 19 -78). There were no deaths during follow up and no major complications unrelated to the IBD. Two (25%) secondary interventions were performed for IBD-occlusion in patients with bilateral IBDs. The other re-intervention was a type II endoleak embolization in one of these 2 patients. The freedom from re-intervention estimate was 75% through 2 year. The overall primary assisted patency was 100% through 3 years. CONCLUSION The use of iliac branched devices in the acute setting is feasible to exclude ruptured aorto-iliac aneurysms while maintaining pelvic circulation. The secondary intervention rate is considerable, however the midterm assisted primary patency rates are promising. Further studies are needed to guide patient selection and to evaluate longer term outcomes.