Management of a ruptured epidural catheter, an anesthesiologist's dilemma: a case report

Epidural anesthesia is a widely used anesthetic technique in lower extremity surgeries although it is a relatively safe procedure, it can have complications, such as rupture of the epidural catheter. This is a 69-year-old male patient with a diagnosis of Wagner IV diabetic foot is presented, which was scheduled for left supracondylar amputation in which after epidural block, retention of the catheter tip in the epidural space at level L2-L3 was seen, so hemi laminectomy was performed in a second surgical stage in L2 and removal of the epidural catheter. Ideally a broken needle should be removed as soon as possible

Evaluación geológica - minera del ANAP Jalaoca

El Instituto Geológico Minero y Metalúrgico por medio de la Dirección de Recursos Mineros Energéticos y el Programa de Metalogenia, en el marco del proyecto GE 28: “Prospección de ANAPs” realizó la evaluación Geológico Minero del ANAP Jalaoca. El ANAP Jalaoca está ubicada en la región Apurímac, comprendiendo parte de las provincias de Aymaraes y Antabamba, 30 Km al SE del poblado de Chalhuanca. Tiene un área de 6,400 has y se encuentra a una altura promedio de 4500 msnm. Las propiedades particulares que rodean al ANAP Jalaoca pertenecen a Consorcio Minero Horizonte, Buenaventura, Minera Meridian Peru, Sumitomo Metal Minig, SPCC, Super Strong Mining y Minera Suroeste. Hacia el N y NE del ANAP se encuentran importantes proyectos mineros como Los Chancas, Antilla y Utupara, hacia el S y SE los proyectos de Trapiche y Antabamba (Lahuani). En el ANAP Jalaoca se han reconocido cuatro zonas de interés (targets), que según su importancia económica son: Pucasalla (1048 has), Llamoja (1877 has), Huarajo (100 has) y Mesaorco (369 has). La geología está representada por una secuencia de areniscas, lutitas y calizas de la Formación Socosani del Jurásico medio, cortada por intrusivos del Eoceno – Oligoceno del Batolito Andahuaylas – Yauri formados por la granodiorita pre-mineral, cuarzo-monzonita intermineral tempranas, cuarzo-monzodioritas intermineral tardías, pórfido cuarzo-monzodiorítico tardimineral y pórfidos dacíticos post-mineral. Estas secuencias están cubiertas en discordancia angular por rocas andesíticas del Grupo Tacaza del Oligoceno-Mioceno. El magmatismo, la alteración hidrotermal y la mineralización han sido controladas por tres sistemas estructurales que tienen un azimut de: (1) 120-135°, (2) 070-080°y (3) 010°. Estos sistemas se relacionan con la falla Mollebamba de extensión regional, la cual tiene una orientación NO-SE. Las alteraciones hidrotermales reconocidas son de tipo skarn, potásica, silicificación, fílica, propilítica y argilización. La mineralización se encuentra diseminada y en venillas y consiste de calcopirita en el skarn, y de bornita, calcopirita, pirita, pirrotita, molibdenita y especularita en la areniscas silicificadas; pirita y calcopirita en la zona potásica; molibdenita en vetas de cuarzo. Estas características, sumadas con las anomalías geofísicas muestran un depósito tipo pórfido-skarn Cu-Au en Pucasalla y un depósito tipo pórfido Cu-Mo en Llamoja. A partir de los resultados geoquímicos de sedimentos de quebrada se definieron 13 elementos anómalos: As, Au, Ca, Cd, Cu, Co, Hg, Mo, Na, Pb, Ni, Sb y Zn, los cuales ayudaron a definir los targets en el ANAP Jalaoca. En los trabajos de campo, además del cartografiado geológico y de alteración-mineralización, se recolectaron 455 muestras, de las cuales 49 fueron de sedimentos de quebrada y 333 de esquirlas de roca. A las muestras de campo se agregaron 73 muestras para control de calidad (blancos, estándares, duplicados) y se analizaron por ensayo al fuego de 50g para el Au, vapor en frío para el Hg e ICP-EOS para 32 elementos trazas. Los targets de Pucasalla, Llamoja, Huarajo y Mesaorco presentaron anomalías geoquímicas de rocas en Cu (> 50ppm), Mo (> 10ppm), Au (> 10 ppb), Pb (> 20 ppm) y Zn (> 50 ppm). Las anomalías mayores que las moderadas de Cu-Mo-Au tienen un área efectiva de 0.16 a 1 Km2 y están ubicadas en Pucasalla y Llamoja respectivamente. Estas anomalías permitieron definir las zonas donde se realizaron los trabajos de prospección geofísica. Se realizaron trabajos de prospección geofísica de polarización inducida (IP), resistividad y magnetometría en los cuatro targets, donde se determinaron anomalías de cargabilidad mayores que 28 mV/V, de resistividad menores que 200 Ohmxm y las magnéticas fueron mayores que 24500 nT. Estas anomalías fueron encontradas en Pucasalla, que correspondieron a 3 anomalías de cargabilidad, 2 de resistividad y 2 magnéticas. En Llamoja sólo se encontraron anomalías débiles de cargabilidad ( 50 ppm), Pb (> 20 ppm), Ag (> 10 ppm) y Cu (> 50 ppm) relacionadas con las de cargabilidad, resistividad y magnetometría. Por tal motivo se considera como primera prioridad para perforar. El área prospectiva de Llamoja sería una segunda opción para perforar y confirmar la continuidad de la mineralización en profundidad. Las anomalías de cargabilidad en estos targets muestran una profundidad de la mineralización hasta 500 m. Se puede concluir que el ANAP Jalaoca presenta dos tipos de depósitos tipo pórfido-skarn Cu-Au en Pucasalla y tipo pórfido Cu-Mo en Llamoja. A pesar que las anomalías de molibdeno en el centro de Llamoja puedan mostrar las raíces de un sistema porfirítico, también es probable que las anomalías puedan corresponder a óxidos de molibdeno, ya que en superficie no se ha encontrado mineralización de molibdenita diseminada ni en vetillas

Global and Regional IUCN Red List Assessments: 3

In this contribution, the conservation status assessment of four vascular plants are presented according to IUCN categories and criteria. It includes the assessment at global level of Crepis lacera Ten subsp. titani (Pamp.) Roma-Marzio, G.Astuti & Peruzzi and Anthyllis hermanniae L. subsp. sicula Brullo & Giusso and the regional assessment of Commicarpus plumbagineus (Cav.) Standl. (Spain and Europe) and Ambrosia maritima L. (Italy)

Incidence, Clinical Characteristics and Management of Inflammatory Bowel Disease in Spain : Large-Scale Epidemiological Study

(1) Aims: To assess the incidence of inflammatory bowel disease (IBD) in Spain, to describe the main epidemiological and clinical characteristics at diagnosis and the evolution of the disease, and to explore the use of drug treatments. (2) Methods: Prospective, population-based nationwide registry. Adult patients diagnosed with IBD-Crohn's disease (CD), ulcerative colitis (UC) or IBD unclassified (IBD-U)-during 2017 in Spain were included and were followed-up for 1 year. (3) Results: We identified 3611 incident cases of IBD diagnosed during 2017 in 108 hospitals covering over 22 million inhabitants. The overall incidence (cases/100,000 person-years) was 16 for IBD, 7.5 for CD, 8 for UC, and 0.5 for IBD-U; 53% of patients were male and median age was 43 years (interquartile range = 31-56 years). During a median 12-month follow-up, 34% of patients were treated with systemic steroids, 25% with immunomodulators, 15% with biologics and 5.6% underwent surgery. The percentage of patients under these treatments was significantly higher in CD than UC and IBD-U. Use of systemic steroids and biologics was significantly higher in hospitals with high resources. In total, 28% of patients were hospitalized (35% CD and 22% UC patients, p < 0.01). (4) Conclusion: The incidence of IBD in Spain is rather high and similar to that reported in Northern Europe. IBD patients require substantial therapeutic resources, which are greater in CD and in hospitals with high resources, and much higher than previously reported. One third of patients are hospitalized in the first year after diagnosis and a relevant proportion undergo surgery

Correction : Chaparro et al. Incidence, Clinical Characteristics and Management of Inflammatory Bowel Disease in Spain: Large-Scale Epidemiological Study. J. Clin. Med. 2021, 10, 2885

The authors wish to make the following corrections to this paper [...]

Geographic patterns of tree dispersal modes in Amazonia and their ecological correlates

Aim: To investigate the geographic patterns and ecological correlates in the geographic distribution of the most common tree dispersal modes in Amazonia (endozoochory, synzoochory, anemochory and hydrochory). We examined if the proportional abundance of these dispersal modes could be explained by the availability of dispersal agents (disperser-availability hypothesis) and/or the availability of resources for constructing zoochorous fruits (resource-availability hypothesis). Time period: Tree-inventory plots established between 1934 and 2019. Major taxa studied: Trees with a diameter at breast height (DBH) ≥ 9.55 cm. Location: Amazonia, here defined as the lowland rain forests of the Amazon River basin and the Guiana Shield. Methods: We assigned dispersal modes to a total of 5433 species and morphospecies within 1877 tree-inventory plots across terra-firme, seasonally flooded, and permanently flooded forests. We investigated geographic patterns in the proportional abundance of dispersal modes. We performed an abundance-weighted mean pairwise distance (MPD) test and fit generalized linear models (GLMs) to explain the geographic distribution of dispersal modes. Results: Anemochory was significantly, positively associated with mean annual wind speed, and hydrochory was significantly higher in flooded forests. Dispersal modes did not consistently show significant associations with the availability of resources for constructing zoochorous fruits. A lower dissimilarity in dispersal modes, resulting from a higher dominance of endozoochory, occurred in terra-firme forests (excluding podzols) compared to flooded forests. Main conclusions: The disperser-availability hypothesis was well supported for abiotic dispersal modes (anemochory and hydrochory). The availability of resources for constructing zoochorous fruits seems an unlikely explanation for the distribution of dispersal modes in Amazonia. The association between frugivores and the proportional abundance of zoochory requires further research, as tree recruitment not only depends on dispersal vectors but also on conditions that favour or limit seedling recruitment across forest types

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Geography and ecology shape the phylogenetic composition of Amazonian tree communities

AimAmazonia hosts more tree species from numerous evolutionary lineages, both young and ancient, than any other biogeographic region. Previous studies have shown that tree lineages colonized multiple edaphic environments and dispersed widely across Amazonia, leading to a hypothesis, which we test, that lineages should not be strongly associated with either geographic regions or edaphic forest types.LocationAmazonia.TaxonAngiosperms (Magnoliids; Monocots; Eudicots).MethodsData for the abundance of 5082 tree species in 1989 plots were combined with a mega-phylogeny. We applied evolutionary ordination to assess how phylogenetic composition varies across Amazonia. We used variation partitioning and Moran's eigenvector maps (MEM) to test and quantify the separate and joint contributions of spatial and environmental variables to explain the phylogenetic composition of plots. We tested the indicator value of lineages for geographic regions and edaphic forest types and mapped associations onto the phylogeny.ResultsIn the terra firme and várzea forest types, the phylogenetic composition varies by geographic region, but the igapó and white-sand forest types retain a unique evolutionary signature regardless of region. Overall, we find that soil chemistry, climate and topography explain 24% of the variation in phylogenetic composition, with 79% of that variation being spatially structured (R2 = 19% overall for combined spatial/environmental effects). The phylogenetic composition also shows substantial spatial patterns not related to the environmental variables we quantified (R2 = 28%). A greater number of lineages were significant indicators of geographic regions than forest types.Main ConclusionNumerous tree lineages, including some ancient ones (&gt;66 Ma), show strong associations with geographic regions and edaphic forest types of Amazonia. This shows that specialization in specific edaphic environments has played a long-standing role in the evolutionary assembly of Amazonian forests. Furthermore, many lineages, even those that have dispersed across Amazonia, dominate within a specific region, likely because of phylogenetically conserved niches for environmental conditions that are prevalent within regions

Geography and ecology shape the phylogenetic composition of Amazonian tree communities

Aim: Amazonia hosts more tree species from numerous evolutionary lineages, both young and ancient, than any other biogeographic region. Previous studies have shown that tree lineages colonized multiple edaphic environments and dispersed widely across Amazonia, leading to a hypothesis, which we test, that lineages should not be strongly associated with either geographic regions or edaphic forest types. Location: Amazonia. Taxon: Angiosperms (Magnoliids; Monocots; Eudicots). Methods: Data for the abundance of 5082 tree species in 1989 plots were combined with a mega-phylogeny. We applied evolutionary ordination to assess how phylogenetic composition varies across Amazonia. We used variation partitioning and Moran\u27s eigenvector maps (MEM) to test and quantify the separate and joint contributions of spatial and environmental variables to explain the phylogenetic composition of plots. We tested the indicator value of lineages for geographic regions and edaphic forest types and mapped associations onto the phylogeny. Results: In the terra firme and várzea forest types, the phylogenetic composition varies by geographic region, but the igapó and white-sand forest types retain a unique evolutionary signature regardless of region. Overall, we find that soil chemistry, climate and topography explain 24% of the variation in phylogenetic composition, with 79% of that variation being spatially structured (R$^{2}$ = 19% overall for combined spatial/environmental effects). The phylogenetic composition also shows substantial spatial patterns not related to the environmental variables we quantified (R$^{2}$ = 28%). A greater number of lineages were significant indicators of geographic regions than forest types. Main Conclusion: Numerous tree lineages, including some ancient ones (>66 Ma), show strong associations with geographic regions and edaphic forest types of Amazonia. This shows that specialization in specific edaphic environments has played a long-standing role in the evolutionary assembly of Amazonian forests. Furthermore, many lineages, even those that have dispersed across Amazonia, dominate within a specific region, likely because of phylogenetically conserved niches for environmental conditions that are prevalent within regions

Type 2 Diabetes Variants Disrupt Function of SLC16A11 through Two Distinct Mechanisms

Type 2 diabetes (T2D) affects Latinos at twice the rate seen in populations of European descent. We recently identified a risk haplotype spanning SLC16A11 that explains ∼20% of the increased T2D prevalence in Mexico. Here, through genetic fine-mapping, we define a set of tightly linked variants likely to contain the causal allele(s). We show that variants on the T2D-associated haplotype have two distinct effects: (1) decreasing SLC16A11 expression in liver and (2) disrupting a key interaction with basigin, thereby reducing cell-surface localization. Both independent mechanisms reduce SLC16A11 function and suggest SLC16A11 is the causal gene at this locus. To gain insight into how SLC16A11 disruption impacts T2D risk, we demonstrate that SLC16A11 is a proton-coupled monocarboxylate transporter and that genetic perturbation of SLC16A11 induces changes in fatty acid and lipid metabolism that are associated with increased T2D risk. Our findings suggest that increasing SLC16A11 function could be therapeutically beneficial for T2D. Video Abstract [Figure presented] Keywords: type 2 diabetes (T2D); genetics; disease mechanism; SLC16A11; MCT11; solute carrier (SLC); monocarboxylates; fatty acid metabolism; lipid metabolism; precision medicin