Wisconsin Great Lakes Restoration Projects: Producing Results for People, Communities

This report provides updates on 12 Great Lakes restoration projects occurring in Wisconsin

Exceptional case of aortic atresia associated with atypical double aortic arch

We present the unique case of atretic aortic valve associated with hypoplastic ascending aorta and double aortic arch of unusual configuration supplying retrograde blood flow to the coronary arteries

Dependence of flood peaks and volumes in modeled discharge time series: effect of different uncertainty sources

Flood estimates needed for designing efficient and cost-effective flood protection structures are usually derived using observed peak discharges. This approach neglects, firstly, that floods are characterized not only by peak discharge but also by flood volume, and, secondly, that these characteristics are subject to modifications under climate and land use changes. Bivariate flood frequency analysis based on simulated discharge time series makes it possible to consider both flood peak and flood volume in design flood estimation. Further, this approach considers changes in discharge characteristics by using discharge series generated from climate time series used as an input for a hydrological model. Such series are usually not available at an hourly resolution but at a certain aggregation level (e.g. 24 h) and might not perfectly represent observed precipitation distributions. In this study, we therefore investigate how the aggregation and distribution of precipitation series and discharge distribution affect flood peaks and volumes and their dependence. We propose a framework for assessing the uncertainty in bivariate design flood estimates that is caused by different factors in the modeling chain, which consists of precipitation-discharge modeling, flood event sampling, and bivariate flood frequency analysis. The uncertainty sources addressed are precipitation aggregation and distribution, parameter and model uncertainty, and discharge resolution. Our results show that all of these uncertainty sources are relevant for design flood estimation and that the importance of the individual uncertainty sources is catchment dependent. Our results also demonstrate that substantial uncertainty is introduced already in the first step of the model chain because commonly used calibration procedures do not take into account the reproduction of flood volumes. Researchers should be aware of such deficiencies when performing bivariate flood frequency analysis on modeled discharge time series and should aim to tailor model calibration procedures to the problem at hand

CT measurements of tracheal diameter and length in normocephalic cats.

OBJECTIVES The aim of this study was to measure the tracheal dimensions of normocephalic cats using CT. METHODS CT images of 15 client-owned normocephalic cats were retrospectively evaluated to measure the length of the feline trachea. Transverse and vertical inner diameters were measured in five different tracheal regions, and the cross-sectional area of the tracheal lumen was calculated for each point of measurement. Descriptive statistics were applied using a two-tailed t-test. RESULTS The mean ± SD length of the trachea was 125.13 ± 14.41 mm. Male cats had significantly larger tracheas than female cats. The transverse diameter first increased by 0.94 mm between the most cranial point of measurement and the middle of the trachea. It then decreased by 1.38 mm between the middle of the trachea and the most caudal point of measurement. The vertical diameter decreased by 1.16 mm between the first point of measurement and the penultimate point, and then increased by 0.06 mm between the penultimate point of measurement and the end of the trachea. The two different diameters resulted in an elliptical trachea shape. CONCLUSIONS AND RELEVANCE The feline trachea was circular only at its cranial and caudal ends, and elliptical with a dorsoventral flattening along the rest of its length. Vertical and transverse diameters varied along the entire length. Tracheal shape differences should be considered when performing permanent tracheostomy, tracheal anastomosis or stenting in cats

Comparison of the Trachea in Normocephalic versus Brachycephalic Cats on the Basis of CT-Derived Measurements.

Tracheal hypoplasia is a major concern in brachycephalic dogs, but there is no consensus for the trachea in brachycephalic cats. We aimed to compare tracheal length and diameter between normo- and brachycephalic cats using computed tomography (CT) image measurements and evaluate their usefulness in tracheostomy planning. A total of 15 normocephalic and 14 brachycephalic cats were included in the study. Tracheas of normocephalic cats were significantly longer compared with brachycephalic cats. No difference was detected in tracheal diameter between normocephalic and brachycephalic cats. Both groups had a lateral diameter significantly larger than the dorsoventral diameter at the level of the cranial end of the manubrium sterni and at the level of the second rib. Normocephalic and brachycephalic cats' tracheas have the same dorsoventral flattening at the level of the cranial end of the manubrium sterni and at the level of the second rib. The location between the 4th and 5th cervical vertebrae seems the best place to perform a tracheostomy in cats due to its round shape and easily accessible anatomical location. No sign of tracheal hypoplasia in brachycephalic cats was detected. Finally, 7 mm appears to be an adequate diameter for the tracheal tubes used to perform feline tracheostomies

Pollen allergy and health behavior: patients trivializing their disease

Allergies are increasing in prevalence worldwide, with socioeconomic impacts and effects on quality of life. The aim of this study was to explore the health behavior and the utilization of different treatment options via questionnaires and to investigate for relationships of the above with socioeconomic factors. This cross-sectional survey was carried out among pollen allergic subjects in 2016, using questionnaires. A total of 679 allergics participated in the study (61.2% females). Their average age was 26.8 +/- 8.8years. Their symptom severity was 6.1 +/- 1.9, measured on a 10-step scale and symptoms lasted for 9.0 +/- 6.8weeks during pollen season. Of all allergics, 9.1% were not aware of the causative agent of their allergy and 17.4% had never undergone allergy testing. Symptoms, especially in females, had strong impact on social life, everyday routines and sleep quality. Almost half of the participants treated their allergy without medical supervision, while only 32.3% sought medical support. Nevertheless, three quarters reported self-management of their allergies with oral antihistamines. Compared to males, females sought significantly more medical support, medications and allergen avoidance strategies. Knowledge about allergy increased the likelihood of treatment under supervision of a medical expert than no treatment, as well as symptom severity and interaction between female gender and symptom severity. The attitude of not considering allergy as a serious disease significantly reduced the likelihood of undergoing specific immunotherapy. This survey not only highlights the negative impact of pollen allergies on everyday life of allergics, but also that allergies are often neglected and untreated because of their trivialization by allergic subjects themselves

Antiarrhythmic Medication in Neonates and Infants with Supraventricular Tachycardia

Supraventricular tachycardia (SVT) is the most common arrhythmia in neonates and infants, and pharmacological therapy is recommended to prevent recurrent episodes. This retrospective study aims to describe and analyze the practice patterns, effectiveness, and outcome of drug therapy for SVT in patients within the first year of life. Among the 67 patients analyzed, 48 presented with atrioventricular re-entrant tachycardia, 18 with focal atrial, and one with atrioventricular nodal re-entrant. Fetal tachycardia was reported in 27%. Antiarrhythmic treatment consisted of beta-receptor blocking agents in 42 patients, propafenone in 20, amiodarone in 20, and digoxin in 5. Arrhythmia control was achieved with single drug therapy in 70% of the patients, 21% needed dual therapy, and 6% triple. Propafenone was discontinued in 7 infants due to widening of the QRS complex. After 12 months (6-60), 75% of surviving patients were tachycardia-free and discontinued prophylactic treatment. Patients with fetal tachycardia had a significantly higher risk of persistent tachycardia (p: 0.007). Prophylactic antiarrhythmic medication for SVT in infancy is safe and well tolerated. Arrhythmia control is often achieved with single medication, and after cessation, most patients are free of arrhythmias. Infants with SVT and a history of fetal tachycardia are more prone to suffer from persistent SVT and relapses after cessation of prophylactic antiarrhythmic medication than infants with the first episode of SVT after birth

Kinetics of Plasma Cytokines, Angiopoietin-2, and C-Reactive Protein in Dogs With Gastric Dilatation Volvulus.

Background: The degree of systemic inflammation, reperfusion injury and endothelial activation are potentially important determinants of clinical outcomes in dogs with gastric dilatation volvulus (GDV). Objective: To evaluate plasma concentrations and kinetics of inflammatory markers in dogs with GDV over a time frame of 48 h, and to compare to healthy dogs. Design and Setting: Prospective, observational cohort study in client-owned dogs with GDV. Materials and Methods: Fifteen dogs with GDV and 9 healthy control dogs were enrolled. Plasma concentrations of interleukin (IL)-6, IL-7, IL-8, IL-10, IL-15, IL-18, interferon gamma (IFN-γ), keratinocyte chemotactic-like, monocyte chemotactic protein (MCP)-1, Angiopoietin (Ang)-2, and C-reactive protein (CRP) were measured at admission (prior any therapeutic intervention, (T0), immediately after surgery (T1), 24 ± 4 h (T24), and 48 ± 4 h (T48) post-surgery. Cytokines were measured using multiplex magnetic bead assay. Plasma Ang-2 was measured with a commercial human ELISA test kit validated for dogs. Results: Dogs with GDV had significantly higher plasma concentrations of IFN-γ and IL-10 compared to healthy control dogs at all time points. Concentrations of IL-6 were significantly higher at T1 and T24, concentrations of MCP-1 at T24, and concentrations of CRP at T24 and T48. A significant increase between T0 and T1 was found for IL-6, IL-10, and CRP, between T1 and T24 for IL-8, IFN-γ, MCP-1, and CRP, and between T24 and T48 for IL-15, Ang-2, and CRP. A significant decrease between T0 and T1 was found for IL-7, IL-8, IL-15, IL-18, and Ang-2; between T1 and T24 for IL-6 and KC-like; and between T24 and T48 for IL-6. Conclusion: In GDV dogs, a mild pro-inflammatory reaction was present at admission, which peaked immediately after and up to 24 h post-surgery, mainly represented by IL-6, IFN-γ, MCP-1, and CRP, and which decreased at T48. In addition, the anti-inflammatory IL-10 was increased in GDV dogs at all time points

Paediatric and adult congenital cardiology education and training in Europe

Background:Limited data exist on training of European paediatric and adult congenital cardiologists.Methods:A structured and approved questionnaire was circulated to national delegates of Association for European Paediatric and Congenital Cardiology in 33 European countries.Results:Delegates from 30 countries (91%) responded. Paediatric cardiology was not recognised as a distinct speciality by the respective ministry of Health in seven countries (23%). Twenty countries (67%) have formally accredited paediatric cardiology training programmes, seven (23%) have substantial informal (not accredited or certified) training, and three (10%) have very limited or no programme. Twenty-two countries have a curriculum. Twelve countries have a national training director. There was one paediatric cardiology centre per 2.66 million population (range 0.87–9.64 million), one cardiac surgical centre per 4.73 million population (range 1.63–10.72 million), and one training centre per 4.29 million population (range 1.63–10.72 million population). The median number of paediatric cardiology fellows per training programme was 4 (range 1–17), and duration of training was 3 years (range 2–5 years). An exit examination in paediatric cardiology was conducted in 16 countries (53%) and certification provided by 20 countries (67%). Paediatric cardiologist number is affected by gross domestic product (R$^{2}$ = 0.41).Conclusion:Training varies markedly across European countries. Although formal fellowship programmes exist in many countries, several countries have informal training or no training. Only a minority of countries provide both exit examination and certification. Harmonisation of training and standardisation of exit examination and certification could reduce variation in training thereby promoting high-quality care by European congenital cardiologists

LRH-1/NR5A2 interacts with the glucocorticoid receptor to regulate glucocorticoid resistance

Nuclear receptors are transcription factors with important functions in a variety of physiological and pathological processes. Targeting glucocorticoid receptor (GR) activity using glucocorticoids is a cornerstone in the treatment of patients with T cell acute lymphoblastic leukemia (T-ALL), and resistance to GC-induced cell death is associated with poor outcome and a high risk for relapse. Next to ligand-binding, heterodimerization with other transcription factors presents an important mechanism for the regulation of GR activity. Here, we describe a GC-induced direct association of the Liver Receptor Homolog-1 (LRH-1) with the GR in the nucleus, which results in reciprocal inhibition of transcriptional activity. Pharmacological and molecular interference with LRH-1 impairs proliferation and survival in T-ALL and causes a profound sensitization to GC-induced cell death, even in GC-resistant T-ALL. Our data illustrate that direct interaction between GR and LRH-1 critically regulates glucocorticoid sensitivity in T-ALL opening up new perspectives for developing innovative therapeutic approaches to treat GC-resistant T-ALL