Iatrogenic Subtotal Stenosis of the Right Subclavian Artery Treated With Percutaneous Transluminal Angioplasty

This report describes a rare vascular complication of surgical placement of a marking clip and a possible approach to problem solving. A 55-year-old patient presented with loss of sensation in the fingers and loss of peripheral pulsations in the right arm 4 days after right upper lobectomy for a pT2N1 moderately differentiated adenocarcinoma of the lung. Duplex examination and computed tomography were performed the same day and showed a subtotal stenosis of the right subclavian artery, which was caused by the surgical placement of a metal clip to mark the surgical boundary. Selective angiography was subsequently performed. Percutaneous transluminal angioplasty (PTA) successfully dilated the stenosis and pushed the clip off. Flow in the right subclavian artery (RSA) was completely restored as were neurology and peripheral pulses. In conclusion, arterial stenosis by a surgical (marking) clip may be feasibly treated with PTA

Matrix Protein 2 Vaccination and Protection against Influenza Viruses, Including Subtype H5N1

Vaccination of mice with influenza matrix protein 2 induced cross-reactive antibody responses

Incidence, Risk Factors, and Impact of Severe Neutropenia After Hyperthermic Intraperitoneal Mitomycin C

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are considered the standard of care for patients with peritoneal dissemination of appendiceal cancer and are increasingly being evaluated for use in patients with carcinomatosis from colon cancer. Mitomycin C (MMC) is one of the most frequently used HIPEC agents in the management of peritoneal-based gastrointestinal malignancies. This study analyzes the incidence and risk factors for developing neutropenia following MMC-HIPEC combined with CRS. All patients undergoing CRS and MMC-HIPEC for appendiceal cancer between January 1993 and October 2006 were retrospectively reviewed. Logistic regression was used to identify risk factors for the development of neutropenia, defined as an absolute neutrophil count (ANC) <1,000/mm3. One hundred and twenty MMC-HIPEC were performed in 117 patients with appendiceal cancer. The incidence of neutropenia was 39%. Neutropenia occurred in 57.6% of female and 21.3% of male patients (p < 0.0001). Female gender and MMC dose per body surface area (BSA) were independent risk factors for neutropenia on multivariable logistic regression [odds ratio (OR) of neutropenia in females = 3.58 (95% confidence interval, CI: 1.52, 8.43); OR for 5 unit (mg/m2) increase in MMC dose per BSA = 3.37 (95% CI: 1.72, 6.63)]. Neutropenia did not increase the risk of mortality, postoperative infection or length of hospital stay. Neutropenia is a frequent complication associated with MMC-HIPEC. Female sex and MMC dose per BSA are independent risk factors for neutropenia. These differences must be considered in the management of patients undergoing MMC-HIPEC to minimize the toxicity of the procedure

A picture of medically assisted reproduction activities during the COVID-19 pandemic in Europe

STUDY QUESTION: How did coronavirus disease 2019 (COVID-19) impact on medically assisted reproduction (MAR) services in Europe during the COVID-19 pandemic (March to May 2020)? SUMMARY ANSWER: MAR services, and hence treatments for infertile couples, were stopped in most European countries for a mean of 7 weeks. WHAT IS KNOWN ALREADY: With the outbreak of COVID-19 in Europe, non-urgent medical care was reduced by local authorities to preserve health resources and maintain social distancing. Furthermore, ESHRE and other societies recommended to postpone ART pregnancies as of 14 March 2020. STUDY DESIGN, SIZE, DURATION: A structured questionnaire was distributed in April among the ESHRE Committee of National Representatives, followed by further information collection through email. PARTICIPANTS/MATERIALS, SETTING, METHODS: The information was collected through the questionnaire and afterwards summarised and aligned with data from the European Centre for Disease Control on the number of COVID-19 cases per country. MAIN RESULTS AND THE ROLE OF CHANCE: By aligning the data for each country with respective epidemiological data, we show a large variation in the time and the phase in the epidemic in the curve when MAR/ART treatments were suspended and restarted. Similarly, the duration of interruption varied. Fertility preservation treatments and patient supportive care for patients remained available during the pandemic. LARGE SCALE DATA: N/A. LIMITATIONS, REASONS FOR CAUTION: Data collection was prone to misinterpretation of the questions and replies, and required further follow-up to check the accuracy. Some representatives reported that they, themselves, were not always aware of the situation throughout the country or reported difficulties with providing single generalised replies, for instance when there were regional differences within their country. WIDER IMPLICATIONS OF THE FINDINGS: The current article provides a basis for further research of the different strategies developed in response to the COVID-19 crisis. Such conclusions will be invaluable for health authorities and healthcare professionals with respect to future similar situations.peer-reviewe

Hypothyroidism in an Area of Endemic Goiter and Cretinism in Central Java, Indonesia

In an area of severe endemic goiter in Central Java, Indonesia, clinical overt or mild hypothyroidism appeared to be present in 7 out of 20 cretins and also in 12 out of 94 non-cretinous subjects, all 5–20 years of age, living in the village of Sengi. Hypothyroidism was not found in a control group of 70 subjects of the same age living in Londjong just outside the edemia. In hypothyroid subjects the plasma PBI-concentration was 0.98 ± 0.32 µg/100 ml (mean ± SD) vS 2.72 ± 1.24 µg/100 ml in euthyroid subjects from Sengi and 4.86 ± 0.80 µg/100 ml in controls from Londjong. Values for T3 were 56.3 ± 31.7 ng/100 ml in hypothyroids, 140.5 ± 38.5 ng/100 ml in euthyroids from Sengi and 121.6 ± 27.4 ng/100 ml in controls. The TSH levels (geometric mean and range) in these 3 groups were, respectively, 210.1 (108.0–342), 15.6(3.0– 372) and 4.1 (0.8–7.0) µU/ml. The differences between themean concentration of PBI, T3 and TSH in the hypothyroid and euthyroid groups were highly significant (P < 0.001). These data strengthen the clinical diagnosis of hypothyroidism in cretins as well as in non-cretinous subjects. All hypothyroid subjects had a PBI < 1.8 µg/100 ml and T3 < 120 ng/100 ml and TSH < 100 µU/ml. In 8 hypothyroid subjects, restudied 18 months after iodized oil injection, hypothyroidism was either corrected or markedly improved. It therefore appears that iodine deficiency per se in post natal life may lead to (juvenile) hypothyroidism, which can be corrected by iodine therapy. Our findings have implications for the definition and diagnosis of endemic cretinism. Not all hypothyroid subjects in an area of endemic iodine deficiency should be classified as cretins

Toxicity of copper sulfate and rotenone to Chinese mystery snail (\u3ci\u3eBellamya chinensis\u3c/i\u3e)

The Chinese mystery snail (Bellamya chinensis) is a freshwater snail native to Southeast Asia, Japan, and Russia and is currently classified as an invasive species in at least 27 states in the USA. The species tolerates a wide range of environmental conditions, making management of established populations difficult. We tested the efficacy of two traditional chemical treatments, rotenone and copper sulfate, on the elimination of adult Chinese mystery snails in laboratory experiments. All snails (N=50) survived 72-hour exposure to rotenone-treated lake water, and 96% (N=25) survived 72-hour exposure to pre-determined rotenone concentrations of 0.25, 2.5, and 25.0 mg/L. All snails (N=10) survived exposure to 1.25 mg/L copper sulfate solution, 90% (N=10) survived exposure to 2.50 mg/L copper sulfate solution, and 80% (N=5) survived exposure to 5.0 mg/L copper sulfate solution. Neither rotenone nor copper sulfate effectively killed adult Chinese mystery snails in laboratory experiments, most likely due to their relatively large size, thick shell, and operculum. Therefore, it appears that populations will be very difficult to control once established, and management should focus on preventing additional spread or introductions of this species

Flow profiles in the left anterior descending and the right coronary artery assessed by MR velocity quantification: Effects of through-plane and in-plane motion of the heart

Purpose: The purpose of this work was to compare the temporal profiles of volume flow in the left anterior descending artery (LAD) and the right coronary artery (RCA) and to assess the effect of through-plane and in-plane myocardial motion. Method: In eight healthy volunteers, MR phase-difference velocity quantification was applied with prospective ECG triggering, pixel size of 1.16 x 0.98 mm2 (LAD) or 1.25 x 0.98 mm2 (RCA), velocity sensitivity of 40 cm/s, and data acquisition time window of 64 ms for LAD (3 k(y) lines per heartbeat) and 24 ms for RCA. In-plane motion was measured from the magnitude images. Results: In the LAD, systolic peak and mean flow values were 0.94 ± 0.28 and 0.30 ± 0.22 ml/s, respectively. Diastolic peak and mean flows were 2.42 ± 0.56 and 1.38 ± 0.43 ml/s. The systolic to diastolic ratio was 0.37 ± 0.12 for peak flow and 0.22 ± 0.15 for mean flow. Mean flow through the cardiac cycle was 59.1 ± 15.0 ml/min. In the RCA, systolic peak and mean flow values were 1.96 ± 0.69 and 0.74 ± 0.31 ml/s, respectively. Diastolic peak and mean flows were 1.80 ± 0.53 and 0.83 ± 0.20 ml/s. The systolic to diastolic ratio was 0.97 ± 0.58 for peak flow and 0.85 ± 0.39 for mean flow. Mean flow through the cardiac cycle was 38.4 ± 10.8 ml/min. The in-plane velocity of the coronary artery cross-section was 6.4 ± 1.8 cm/s for the LAD and 14.9 ± 4.0 cm/s for the RCA (given by peak values in diastole). Conclusion: It is confirmed noninvasively with MR that the LAD shows a predominantly diastolic flow, whereas the RCA shows about equal flow values in systole and diastole. Through-plane motion correction is required for assessing the true flow patterns. The in-plane velocities of the coronary artery cross-sections imply a maximum data acquisition time window, estimated at 58 ms for the LAD and at 23 ms for the RCA

Population estimate of Chinese mystery snail (\u3ci\u3eBellamya chinensis\u3c/i\u3e) in a Nebraska reservoir

The Chinese mystery snail (Bellamya chinensis) is an aquatic invasive species in North America. Little is known regarding this species’ impacts on freshwater ecosystems. It is believed that population densities can be high, yet no population estimates have been reported. We utilized a mark-recapture approach to generate a population estimate for Chinese mystery snail in Wild Plum Lake, a 6.47-ha reservoir in southeast Nebraska. We calculated, using bias-adjusted Lincoln-Petersen estimation, that there were approximately 664 adult snails within a 127 m2 transect (5.2 snails/m2). If this density was consistent throughout the littoral zone (depth) of the reservoir, then the total adult population in this impoundment is estimated to be 253,570 snails, and the total Chinese mystery snail wet biomass is estimated to be 3,119 kg (643 kg/ha). If this density is confined to the depth sampled in this study (1.46 m), then the adult population is estimated to be 169,400 snails, and wet biomass is estimated to be 2,084 kg (643 kg/ha). Additional research is warranted to further test the utility of mark-recapture methods for aquatic snails and to better understand Chinese mystery snail distributions within reservoirs