High-frequency jet ventilation for minimizing breathing-related liver motion during percutaneous radiofrequency ablation of multiple hepatic tumours

Movements of the liver caused by spontaneous breathing (during sedation or local anaesthesia) or by ventilation during anaesthesia are a source of concern in CT-guided procedures because of the limited spatial and contrast resolution of unenhanced imaging, artifacts caused by the probes and the relatively low temporal resolution of the fluoroscopy mode. During CT-guided radiofrequency ablation (RFA), it is essential that the lesion can be visualized optimally and that the ablation probe is positioned accurately to avoid non-target injuries. We therefore used high-frequency jet ventilation and general anaesthesia to minimize ventilation-related liver movement and provide optimal conditions for a patient undergoing RFA of hepatic metastases. The technical and anaesthetic considerations are discussed, and a specific limitation of transcutaneous Pco2 measurement during activation of the ablation is reported for the first tim

The Use of the "Preclosure” Technique for Antegrade Aspiration Thrombectomy with Large Catheters in Acute Limb Ischemia

Purpose: This study was designed to assess retrospectively short- and mid-term outcomes of the use of a suture-mediated closure device to close the antegrade access in patients undergoing percutaneous aspiration thrombectomy with large catheters for acute leg ischemia. Methods: Between November 2005 and February 2010, a suture-mediated active closure system (ProGlide® 6F, Abbott) was placed before arterial sheath (mean 9F, range 6-12F) introduction in 101 patients (74 men, 73%, mean age 70.1±12.6years standard deviation). Data regarding mortality, complications, and factors contributing to vascular complications at the access site was collected for 6month after the intervention to detect device-related problems. As a coincidence, 77 patients had follow-up visits for a duplex ultrasound. Results: There were a total of 19 vascular complications (19%) at the puncture site, all of which were of hemorrhagic nature and none of which consisted of vessel occlusion. Two major outcome complications (2%) occurred. A retroperitoneal hematoma and a serious inguinal bleeding required additive treatment and did not result in permanent sequelae. Nine cases involved death of which eight were not attributable to the closure and one remained unclear. Successful closure was achieved in 95 patients (94%); additional manual compression was sufficient in the majority of the remaining patients. Numerous factors contributing to vascular complications were encountered. Conclusions: With acceptable short- and mid-term outcomes, the "preclose” technique can be a reliable option for the closure of a large antegrade femoral access even for patients at a high risk of vascular complications, such as those undergoing aspiration thrombectom

Mapping quantitative physiological traits in apple ( Malus × domestica Borkh.)

Efficient breeding and selection of high-quality apple cultivars requires knowledge and understanding of the underlying genetics. The availability of genetic linkage maps constructed with molecular markers enables the detection and analysis of major genes and quantitative trait loci contributing to the quality traits of a genotype. A segregating population of the cross between the apple varieties 'sFiesta' (syn. 'sRed Pippin') and 'sDiscovery' has been observed over three years at three different sites in Switzerland and data on growth habit, blooming behaviour, juvenile period and fruit quality has been recorded. QTL analyses were performed, based on a genetic linkage map consisting of 804 molecular markers and covering all 17 apple chromosomes. With the maximum likelihood based interval mapping method, the investigated complex traits could be dissected into a number of QTLs affecting the observed characters. Genomic regions participating in the genetic control of stem diameter, plant height increment, leaf size, blooming time, blooming intensity, juvenile phase length, time of fruit maturity, number of fruit, fruit size and weight, fruit flesh firmness, sugar content and fruit acidity were identified and compared with previously mapped QTLs in apple. Although 'sDiscovery' fruit displayed a higher acid content, both acidity QTLs were attributed to the sweeter parent 'sFiesta'. This indicated homozygosity at the acidity loci in 'sDiscovery' preventing their detection in the progeny due to the lack of segregatio

Bark Beetle (Coleoptera: Curculionidae: Scolytinae) Community Structure in Northeastern and Central Minnesota

Large-scale surveys of forest insects provide two distinct benefits: the detection of invasive and exotic species that cause millions of dollars of damage annually to forest and ornamental industries, and the addition of a wealth of species distribution and diversity information to the scientific community. We intensively surveyed the Northeast and East-central regions of Minnesota from 2006-2008 for invasive/exotic and native Scolytinae using Lindgren funnel traps baited with one of four lures (a/β-pinene, ultra-high-release ethanol [EtOH], EtOH+a-pinene, and Ips 3-part). We captured 16,841 scolytines (representing 25 genera) of which over 40% were Ips pini (Say) and Ips grandicollis (Eichhoff). We found two exotic Scolytinae, Scolytus multistriatus (Marsham) and Scolytus schevyrewi Semenov, both of which had previously been recorded in Minnesota. Two native species, Conophthorus coniperda (Schwarz) and Crypturgus pusillus (Gyllenhal), were reported for the first time in Minnesota. Non-metric multi- dimensional scaling and analysis of similarities indicate that lure types capture different Scolytinae communities, while year, weather pattern and region factors were not significant. We also report the seasonal phenology of the seven most abundantly captured species; Dendroctonus valens LeConte, Hylastes porculus Erichson, Hylurgops rugipennis pinifex (Fitch),I. grandicollis, I. pini, Orthotomicus caelatus (Eichhoff) and Pityophthorus spp. Eichhoff

Simultaneous islet-kidney vs pancreas-kidney transplantation in type 1 diabetes mellitus: a 5year single centre follow-up

Aims/hypothesis: The aim of this study was to compare the long-term outcomes—in terms of glucose control, renal function and procedure-related complications—of simultaneous islet-kidney (SIK) transplantation with those of simultaneous pancreas-kidney (SPK) transplantation in patients with type 1 diabetes mellitus. Methods: HbA1c, need for insulin, GFR and complication rate were compared between 13 recipients of SIK and 25 recipients of SPK transplants at the same institution. The mean follow-up was 41months. Results: Two primary organ non-functions occurred in the SIK group. HbA1c did not differ at any time point during follow-up in the SIK group compared with the SPK group (mean during follow-up 6.3 vs 5.9%). Similarly, kidney function over time was not different between the two groups. A higher rate of insulin independence following SPK transplantation (after 1year 96 vs 31% in the SIK group) was counterbalanced by a higher rate of serious adverse events (40% relaparotomies vs 0% in the SIK group). Conclusions/interpretation: The endogenous insulin production achieved by islet transplantation, combined with optimal insulin therapy, was sufficient for maintaining near-normal glucose levels. In terms of glucose control, islet transplantation provides results comparable to those achieved with pancreas transplantation. However, SPK results in a higher rate of insulin independence, albeit at the cost of more surgical complications. These results have led to a new paradigm in islet transplantation at our institution, where the primary goal is not insulin independence, but good glucose control and avoidance of severe hypoglycaemi

Ablation of an idiopathic left ventricular tachycardia originating from the posterior mitral annulus in a toddler

Ablation of a mitral annulus (MA)-ventricular tachycardia (VT), a rare form of idiopathic left VT, has not yet been described in patients <2 years of age. We describe a case of a toddler with an incessant, poorly tolerated idiopathic VT (190 bpm) refractory to medical therapy, which was successfully ablated in the left ventricle at the infero-posterior part of the MA. Different diagnostic and ablation steps are described. Mitral annulus-ventricular tachycardia, a rare form of idiopathic left VT, can safely and successfully be ablated in very young children

Physical Activity in Fontan Patients Relates to Quality of Life and Sleep Quality

Background and Aim: Fontan patients tend to have reduced physical exercise capacity. This study investigates physical activity (PA) and its relationship to exercise capacity, heart rates, cardiac function, biomarkers, health-related quality of life (HRQoL), and sleep quality. Methods: Cardiovascular magnetic resonance (CMR), exercise testing (CPET), 24 h-ECG, and blood samples were prospectively performed in 38 patients, age 13 (11-16) years. PA was assessed by accelerometer during 7 consecutive days. HRQoL was self-assessed with KIDSCREEN-27 and SF-36 according to patients' age; sleep quality with Pediatric Sleep Questionnaire (PSQ) and Pittsburgh Sleep Quality Index (PSQI). Results: Daily moderate to vigorous physical activity (MVPA) was in median (IQR) 40 (28-57) mins; 7/38 (18%) patients reached the recommended 60 mins/day of MVPA. MVPA did not correlate with gender, age, single ventricle morphology, time from Fontan, heart rate, ventricular volumes, and ejection fraction at CMR, biomarkers, or CPET. Physical wellbeing (r = 0.33, p = 0.04), autonomy (r = 0.39, p = 0.03), and social support (r = 0.43, p = 0.009) assessed using the KIDSCREEN-27, and both physical (r = 0.57, p = 0.03) and mental (r = 0.54, p = 0.04) domains of the SF-36 questionnaire correlated with daily minutes of MVPA. PSQI global sleeping score (r = -0.7, p = 0.007), and PSQ scales for behavior (r = -0.36; p = 0.03) correlated with daily minutes of MVPA. Conclusion: Only 18% of the Fontan patients meet the recommendation for daily MVPA. Measures of exercise capacity, cardiac function or chronotropic competence are not correlated to daily physical activity. In contrast, HRQoL and sleep quality seem to be associated with regular physical activity

Bark Beetle (Coleoptera: Curculionidae: Scolytinae) Community Structure in Northeastern and Central Minnesota

Large-scale surveys of forest insects provide two distinct benefits: the detection of invasive and exotic species that cause millions of dollars of damage annually to forest and ornamental industries, and the addition of a wealth of species distribution and diversity information to the scientific community. We intensively surveyed the Northeast and East-central regions of Minnesota from 2006-2008 for invasive/exotic and native Scolytinae using Lindgren funnel traps baited with one of four lures (a/β-pinene, ultra-high-release ethanol [EtOH], EtOH+a-pinene, and Ips 3-part). We captured 16,841 scolytines (representing 25 genera) of which over 40% were Ips pini (Say) and Ips grandicollis (Eichhoff). We found two exotic Scolytinae, Scolytus multistriatus (Marsham) and Scolytus schevyrewi Semenov, both of which had previously been recorded in Minnesota. Two native species, Conophthorus coniperda (Schwarz) and Crypturgus pusillus (Gyllenhal), were reported for the first time in Minnesota. Non-metric multi- dimensional scaling and analysis of similarities indicate that lure types capture different Scolytinae communities, while year, weather pattern and region factors were not significant. We also report the seasonal phenology of the seven most abundantly captured species; Dendroctonus valens LeConte, Hylastes porculus Erichson, Hylurgops rugipennis pinifex (Fitch),I. grandicollis, I. pini, Orthotomicus caelatus (Eichhoff) and Pityophthorus spp. Eichhoff

Role of lipid apheresis in changing times

During the last decades, LDL-apheresis was established as an extracorporeal treatment option for patients with severe heterozygous or homozygous familial hypercholesterolemia (FH) that is resistant to conventional treatment strategies such as diet, drugs, and changes in lifestyle. Nearly half a century ago, the first LDL-apheresis treatment was performed by plasma exchange in a child with homozygous FH