Placement of an aortomonoiliac stent graft without femorofemoral revascularization in endovascular aneurysm repair: a case report

<p>Abstract</p> <p>Introduction</p> <p>Endovascular aortic repair, if technically feasible, is the treatment of choice for patients with a contained ruptured aortic aneurysm who are unfit for open surgery.</p> <p>Case presentation</p> <p>We report the case of an 80-year-old Caucasian man who presented with an unusually configured, symptomatic infrarenal aortic aneurysm. His aneurysm showed an erosion of the fourth lumbar vertebra and a severely arteriosclerotic pelvic axis. A high thigh amputation of his right leg had been performed 15 months previously. On his right side, occlusion of his external iliac artery, common femoral artery, and deep femoral artery had occurred. His aneurysm was treated by a left-sided aortomonoiliac stent graft without femorofemoral revascularization, resulting in occlusions of both internal iliac arteries. No ischemic symptoms appeared, although perfusion of his right side was maintained only over epigastric collaterals.</p> <p>Conclusions</p> <p>The placement of aortomonoiliac stent grafts for endovascular treatment of infrarenal aortic aneurysms without contralateral revascularization is a feasible treatment option in isolated cases. In this report, access problems and revascularization options in endovascular aneurysm repair are discussed.</p

Clinical case of hereditary hemochromatosis

The article presents a clinical case demonstrating the difficulties of timely diagnosis of hereditary hemochromatosis, presents data on modern diagnosis and approaches to the treatment of the disease according to existing clinical guidelines. The described clinical case of hereditary hemochromatosis is associated with a homozygous mutation of C282Y in HFE gene in a 58-year-old patient and his twin brother. Initially, signs of iron deposition in the liver were found on MRI of the abdominal cavity. In laboratory analyses, the patient was found to have an increased level of serum iron - 40 µmol/l and ferritin - 1340 ng/ml. Subsequently, the investigation of HFE gene mutations was carried out and a mutation of C282Y in homozygous form (genotype A/A) was found, which is a molecular genetic confirmation of hereditary hemochromatosis of type 1. At the same time, the patient's twin brother at the targeted examination had the serum iron level of 36 µmol/l, the ferritin level of 600 ng/ml, and also the mutation of HFE gene, the allelic variant of A/A. The results of liver fibroelastometry of the patient correlate with the degree of fibrosis F1 by Metavir scale. Timely started therapeutic phlebotomies led to improved clinical and laboratory parameters of iron metabolism while maintaining normal levels of red blood cells and hemoglobin

Low-Temperature Solution-Grown CsPbBr3_{3} Single Crystals and Their Characterization

Cesium lead bromide (CsPbBr$_{3}$) was recently introduced as a potentially high performance thin-film halide perovskite (HaP) material for optoelectronics, including photovoltaics, significantly more stable than MAPbBr$_{3}$ (MA = CH$_{3}$NH$_{3}$+). Because of the importance of single crystals to study relevant material properties per se, crystals grown under conditions comparable to those used for preparing thin films, i.e., low-temperature solution-based growth, are needed. We show here two simple ways, antisolvent-vapor saturation or heating a solution containing retrograde soluble CsPbBr$_{3}$, to grow single crystals of CsPbBr$_{3}$ from a precursor solution, treated with acetonitrile (MeCN) or methanol (MeOH). The precursor solutions are stable for at least several months. Millimeter-sized crystals are grown without crystal-seeding and can provide a 100% yield of CsPbBr$_{3}$ perovskite crystals, avoiding a CsBr-rich (or PbBr$_{2}$-rich) composition, which is often present alongside the perovskite phase. Further growth is demonstrated to be possible with crystal seeding. The crystals are characterized in several ways, including first results of charge carrier lifetime (30 ns) and an upper-limit of the Urbach energy (19 meV). As the crystals are grown from a polar aprotic solvent (DMSO), which is similar to those used to grow hybrid organic-inorganic HaP crystals, this may allow growing mixed (organic and inorganic) monovalent cation HaP crystals.G.H. and D.C. acknowledge the Israel Ministry of Science and the Israel National Nano-Initiative for partial support and G.H. acknowledges the Leona M. and Harry B. Helmsley Charitable Trust. A.S., M.L.B., and R.H.F. would like acknowledge EPSRC for their support. A.S. would also like to acknowledge support from an India-UK APEX project

Filariasis in Travelers Presenting to the GeoSentinel Surveillance Network

As international travel increases, there is rising exposure to many pathogens not traditionally encountered in the resource-rich countries of the world. The GeoSentinel Surveillance Network, a global network of medicine/travel clinics, was established in 1995 to detect morbidity trends among travelers. Filarial infections (parasitic worm infections that cause, among others, onchocerciasis [river blindness], lymphatic filariasis [e.g. elephantiasis, lymphedema, hydrocele] and loiasis [African eyeworm]) comprised 0.62% (n = 271) of the 43,722 medical conditions reported to the GeoSentinel Network between 1995 and 2004. Immigrants from filarial-endemic regions comprised the group most likely to have acquired a filarial infection; sub-Saharan Africa was the region of the world where the majority of filarial infections were acquired. Long-term travel (greater than 1 month) was more likely to be associated with acquisition of one of the filarial infections than shorter-term travel

Enterococcus faecalis Endocarditis Severity in Rabbits Is Reduced by IgG Fabs Interfering with Aggregation Substance

Background: Enterococcus faecalis is a significant cause of infective endocarditis, an infection of the heart endothelium leading to vegetation formation (microbes, fibrin, platelets, and host cells attached to underlying endothelial tissue). Our previous research determined that enterococcal aggregation substance (AS) is an important virulence factor in causation of endocarditis, although endocarditis may occur in the absence of AS production. Production of AS by E. faecalis causes the organism to form aggregates through AS binding to enterococcal binding substance. In this study, we assessed the ability of IgGs and IgG Fabs against AS to provide protection against AS + E. faecalis endocarditis. Methodology/Principal Findings: When challenged with AS + E. faecalis, 10 rabbits actively immunized against AS + E. faecalis developed more significant vegetations than 9 animals immunized against AS 2 E. faecalis, and 9/10 succumbed compared to 2/9 (p,0.005), suggesting enhanced aggregation by IgG contributes significantly to disease. IgG antibodies against AS also enhanced enterococcal aggregation as tested in vitro. In contrast, Fab fragments of IgG from rabbits immunized against purified AS, when passively administered to rabbits (6/group) immediately before challenge with AS + E. faecalis, reduced total vegetation (endocarditis lesion) microbial counts (7.9610 6 versus 2.0610 5, p = 0.02) and size (40 mg versus 10, p = 0.05). In vitro, the Fabs prevented enterococcal aggregation. Conclusions/Significance: The data confirm the role of AS in infective endocarditis formation and suggest that use of Fab

Редкие виды спонтанных разрывов печени на фоне беременности

This literature review is devoted to the problem of spontaneous liver ruptures in pregnant women. Its goal was to raise awareness among physicians as one of the methods to improve the early diagnosis of the disease, as well as to consider the role of the hepatological surgeon in the surgical treatment of rare obstetric diseases. The main links of the pathogenesis of liver ruptures were considered, the problem of high maternal and perinatal mortality was disclosed. Based on the literature data, the most optimal obstetric and surgical treatment and diagnostic tactics for managing pregnant women with spontaneous liver ruptures were determined.Настоящий литературный обзор посвящен проблеме спонтанных разрывов печени у беременных. Его целью стало повышение информированности врачей как одного из методов улучшения ранней диагностики болезни, а также рассмотрения роли хирурга-гепатолога в рамках хирургического лечения редкого акушерского осложнения. Были рассмотрены основные звенья патогенеза разрывов печени, раскрыта проблема высокой материнской и перинатальной смертности. На основании данных литературы была определена наиболее оптимальная акушерская и хирургическая лечебно-диагностическая тактика ведения беременных со спонтанными разрывами печени

Characterization of Aerosol Deposited Cesium Lead Tribromide Perovskite Films on Interdigited ITO Electrodes

Aerosol deposition (AD) is a promising additive manufacturing method to fabricate low-cost, scalable films at room temperature, but has not been considered for semiconductor processing, so far. The successful preparation of cesium lead tribromide (CsPbBr) perovskite films on interdigitated indium tin oxide (ITO) electrodes by means of AD is reported here. The – µm thick layers are dense and have good adhesion to the substrate. The orthorhombic Pnma crystal structure of the precursor powder was retained during the deposition process with no signs of defect formation. The formation of electronic defects by photoluminescence spectroscopy is investigated and found slightly increased carrier recombination from defect sites for AD films compared to the powder. A nonuniform defect distribution across the layer, presumably induced by the impact of the semiconducting grains on the hard substrate surface, is revealed. The opto-electronic properties of AD processed semiconducting films is further tested by electrical measurements and confirmed good semiconducting properties and high responsivity for the films. These results demonstrate that AD processing of metal halide perovskites is possible for opto-electronic device manufacturing on D surfaces. It is believed that this work paves the way for the fabrication of previously unimaginable opto-electronic devices by additive manufacturing

Study of Healthcare Personnel with Influenza and other Respiratory Viruses in Israel (SHIRI): study protocol

Abstract Background The Study of Healthcare Personnel with Influenza and other Respiratory Viruses in Israel (SHIRI) prospectively follows a cohort of healthcare personnel (HCP) in two hospitals in Israel. SHIRI will describe the frequency of influenza virus infections among HCP, identify predictors of vaccine acceptance, examine how repeated influenza vaccination may modify immunogenicity, and evaluate influenza vaccine effectiveness in preventing influenza illness and missed work. Methods Cohort enrollment began in October, 2016; a second year of the study and a second wave of cohort enrollment began in June 2017. The study will run for at least 3 years and will follow approximately 2000 HCP (who are both employees and members of Clalit Health Services [CHS]) with routine direct patient contact. Eligible HCP are recruited using a stratified sampling strategy. After informed consent, participants complete a brief enrollment survey with questions about occupational responsibilities and knowledge, attitudes, and practices about influenza vaccines. Blood samples are collected at enrollment and at the end of influenza season; HCP who choose to be vaccinated contribute additional blood one month after vaccination. During the influenza season, participants receive twice-weekly short message service (SMS) messages asking them if they have acute respiratory illness or febrile illness (ARFI) symptoms. Ill participants receive follow-up SMS messages to confirm illness symptoms and duration and are asked to self-collect a nasal swab. Information on socio-economic characteristics, current and past medical conditions, medical care utilization and vaccination history is extracted from the CHS database. Information about missed work due to illness is obtained by self-report and from employee records. Respiratory specimens from self-collected nasal swabs are tested for influenza A and B viruses, respiratory syncytial virus, human metapneumovirus, and coronaviruses using validated multiplex quantitative real-time reverse transcription polymerase chain reaction assays. The hemagglutination inhibition assay will be used to detect the presence of neutralizing influenza antibodies in serum. Discussion SHIRI will expand our knowledge of the burden of respiratory viral infections among HCP and the effectiveness of current and repeated annual influenza vaccination in preventing influenza illness, medical utilization, and missed workdays among HCP who are in direct contact with patients. Trial registration NCT03331991 . Registered on November 6, 2017.https://deepblue.lib.umich.edu/bitstream/2027.42/146186/1/12879_2018_Article_3444.pd

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112