Persistent left superior vena cava: Review of the literature, clinical implications, and relevance of alterations in thoracic central venous anatomy as pertaining to the general principles of central venous access device placement and venography in cancer patients

Persistent left superior vena cava (PLSVC) represents the most common congenital venous anomaly of the thoracic systemic venous return, occurring in 0.3% to 0.5% of individuals in the general population, and in up to 12% of individuals with other documented congential heart abnormalities. In this regard, there is very little in the literature that specifically addresses the potential importance of the incidental finding of PLSVC to surgeons, interventional radiologists, and other physicians actively involved in central venous access device placement in cancer patients. In the current review, we have attempted to comprehensively evaluate the available literature regarding PLSVC. Additionally, we have discussed the clinical implications and relevance of such congenital aberrancies, as well as of treatment-induced or disease-induced alterations in the anatomy of the thoracic central venous system, as they pertain to the general principles of successful placement of central venous access devices in cancer patients. Specifically regarding PLSVC, it is critical to recognize its presence during attempted central venous access device placement and to fully characterize the pattern of cardiac venous return (i.e., to the right atrium or to the left atrium) in any patient suspected of PLSVC prior to initiation of use of their central venous access device

Current Analogues of Future Climate Indicate the Likely Response of a Sensitive Montane Tropical Avifauna to a Warming World

Among birds, tropical montane species are likely to be among the most vulnerable to climate change, yet little is known about how climate drives their distributions, nor how to predict their likely responses to temperature increases. Correlative models of species' environmental niches have been widely used to predict changes in distribution, but direct tests of the relationship between key variables, such as temperature, and species' actual distributions are few. In the absence of historical data with which to compare observations and detect shifts, space-for-time substitutions, where warmer locations are used as analogues of future conditions, offer an opportunity to test for species' responses to climate. We collected density data for rainforest birds across elevational gradients in northern and southern subregions within the Australian Wet Tropics (AWT). Using environmental optima calculated from elevational density profiles, we detected a significant elevational difference between the two regions in ten of 26 species. More species showed a positive (19 spp.) than negative (7 spp.) displacement, with a median difference of ∼80.6 m across the species analysed that is concordant with that expected due to latitudinal temperature differences (∼75.5 m). Models of temperature gradients derived from broad-scale climate surfaces showed comparable performance to those based on in-situ measurements, suggesting the former is sufficient for modeling impacts. These findings not only confirm temperature as an important factor driving elevational distributions of these species, but also suggest species will shift upslope to track their preferred environmental conditions. Our approach uses optima calculated from elevational density profiles, offering a data-efficient alternative to distribution limits for gauging climate constraints, and is sensitive enough to detect distribution shifts in this avifauna in response to temperature changes of as little as 0.4 degrees. We foresee important applications in the urgent task of detecting and monitoring impacts of climate change on montane tropical biodiversity