Importance of the Adrenal Gland Blood Supply During Laparoscopic Subtotal Adrenalectomy

Introduction: Laparoscopic subtotal adrenalectomy (LSA) has emerged as a treatment option in the management of certain adrenal pathologies. After LSA, a satisfactory blood supply to the adrenal remnant is vital to preserve steroid function. The aim of this study was to review the adrenal blood supply with relevance to LSA. Materials and Methods: The adrenal blood supply was examined in three ways: 1) a review of six previous cadaver studies looking at adrenal blood supply; 2) a review of our 164 consecutive laparoscopic adrenalectomies (LAs) (January 1999-January 2009); the details of the main adrenal veins and variants had been prospectively recorded; and 3) dissection of 4 cadaver specimens (macroscopic and histologic examination was performed). Results: The six cadaver studies showed duplication or triplication of the main adrenal vein with variable frequency. Four of six studies described smaller peripheral veins surrounding the adrenal gland. The arterial supply appeared constant, with each adrenal gland supplied by up to 60 small arteries. In our series of LA, the main adrenal vein was constant. In 6 cases, the main vein was duplicated. Our cadaver dissection showed the large number of small peripheral veins and arteries surrounding the adrenal gland. Histology confirmed that these peripheral veins drained the adrenal gland. Conclusions: After LSA, a nonfunctioning adrenal remnant is unlikely due to an inadequate arterial supply. Division of the main adrenal vein appears safe, but excessive mobilization of the adrenal remnant should be avoided to prevent destruction of the peripheral vein

Using a new local high resolution daily gridded dataset for Attica to statistically downscale climate projections

In this study we present a methodological framework to obtain statistically downscaled high resolution climate projections over the Attica region in Greece. The framework relies on the construction of a local daily gridded dataset for temperature variables (maximum, minimum and mean daily temperatures) and daily precipitation sums. To this aim, a mosaic of data that includes observations derived from ground stations and a high resolution simulation, performed by the Weather Research and Forecasting (WRF) model, for 1 year (1995) are blended using various gridding techniques to produce a 1 km 1 km high resolution daily gridded dataset for the period 1981–2000. The comparison of the gridded dataset against the observations reveals that the produced dataset maintains the observed long term statistical properties over the period 1981–2000 for both temperature and precipitation variables. Consequently, the produced dataset is used to statistically downscale Regional Climate Model simulations from the EURO-CORDEX initiative for the present (1981–2000) and the future climate (2081–2100) under the Representative Concentration Pathway (RCP) 8.5 climate scenario using two different bias adjustment techniques. The results indicate that the selection of the bias adjustment method is important and can affect the simulated climate change signals in a different way. Thus bias adjustment should be performed with caution and examined thoroughly before any such downscaled climate change projection dataset reach decision and policy makers in order to plan climate change related adaptation strategies. © 2022, The Author(s)

Dose-dependent effects of thyroid hormone on post-ischemic cardiac performance: Potential involvement of Akt and ERK signalings

The present study explored the effects of thyroid hormone (TH) treatment on post-ischemic cardiac function and potential implicated mechanisms. Acute myocardial infarction (AMI) was induced in mice by coronary artery ligation while sham-operated animals served as controls. This procedure resulted in a marked depression of cardiac function and significant reduction in TH levels in plasma. TH was given at a dose aiming to normalize T3 levels in plasma [AMI-TH (A)] and also at higher doses. The group of animals treated with the highest dose of TH, which displayed significantly increased mortality rate was included in the study [AMI-TH (B)]. In AMI-TH (A) mice, TH significantly improved left ventricular (LV) ejection fraction (EF%), [27.9% (1.4) in AMI versus 38.0 (3.1) in AMI-TH (A), P < 0.05], and favorably remodeled LV chamber while α-MHC was the dominant isoform expressed. In AMI-TH (B) mice, TH treatment resulted in increased mortality as compared to untreated mice (73% vs 47%, P < 0.05), while the favorable effect of TH was not evident in the survived animals. At the molecular level, TH, at the replacement dose, modestly increased p-Akt levels in the myocardium without any change in p-ERK levels. On the contrary, TH at the higher dose resulted in further increase in p-Akt along with an increase in p-ERK levels. In conclusion, TH appears to have a dose-dependent bimodal effect on post-ischemic cardiac performance and this effect may, at least in part, be mediated by a distinct pattern of activation of Akt and ERK signaling. © 2011 Springer Science+Business Media, LLC