Computed tomography or necropsy diagnosis of multiple bullae and the treatment of pneumothorax in rhesus macaques (Macaca mulatta)

Pulmonary bullae and pneumothorax have various etiologies in veterinary medicine. We diagnosed multiple pulmonary bullae combined with or without pneumothorax by computed tomography (CT) or necropsy in seven rhesus macaques (Macaca mulatta) imported from China. Two of seven rhesus macaques accompanied by pneumothorax were cured by fixation of ruptured lung through left or right 3rd intercostal thoracotomy. Pneumonyssus simicola, one of the etiologies of pulmonary bullae, was not detected from tracheobronchiolar lavage. To the best of our knowledge, this is the first case report on the CT‐aided diagnosis of pulmonary bullae and the successful treatment of combined pneumothorax by thoracotomy in non‐human primates (NHPs).     

Efficacy and safety of leadless pacemaker: A systematic review,pooled analysis and meta-analysis

BackgroundLeadless pacemakers have been designed as an alternative to transvenous systems which avoid some of the complications associated with transvenous devices. We aim to perform a systematic review of the literature to report the safety and efficacy findings of leadless pacemakers.MethodsWe searched MEDLINE and EMBASE to identify studies reporting the safety, efficacy and outcomes of patients implanted with a leadless pacemaker. The pooled rate of adverse events was determined and random-effects meta-analysis was performed to compare rates of adverse outcomes for leadless compared to transvenous pacemakers.ResultsA total of 18 studies were included with 2496 patients implanted with a leadless pacemaker and success rates range between 95.5 and 100%. The device or procedure related death rate was 0.3% while any complication and pericardial tamponade occurred in 3.1% and 1.4% of patients, respectively. Other complications such as pericardial effusion, device dislodgement, device revision, device malfunction, access site complications and infection occurred in less than 1% of patients. Meta-analysis of four studies suggests that there was no difference in hematoma (RR 0.67 95%CI 0.21–2.18, 3 studies), pericardial effusion (RR 0.59 95%CI 0.15–2.25, 3 studies), device dislocation (RR 0.33 95%CI 0.06–1.74, 3 studies), any complication (RR 0.44 95%CI 0.17–1.09, 4 studies) and death (RR 0.45 95%CI 0.15–1.35, 2 studies) comparing patients who received leadless and transvenous pacemakers.ConclusionLeadless pacemakers are safe and effective for patients who have an indication for single chamber ventricular pacing and the findings appear to be comparable to transvenous pacemakers.     

Fine needle aspiration cytology of lung lesions: a clinicopathological and cytopathological review of 150 cases with emphasis on the relation between the number of passes and the incidence of pneumothorax

Objective: The aim of this study was to review the lung fine needle aspirations (FNA) that were done in our hospital between January 1998 and April 2004. Interobserver agreement, sample adequacy and the relation between the number of passes and the occurrence of pneumothorax are presented. Study design: One hundred fifty cases of lung FNA from the department of pathology files were identified and the available specimens and patient charts were reviewed. The interobserver agreement was calculated. The relation between the number of passes and the subsequent development of pneumothorax was tested using Mann–Whitney U‐test. Results: The material of 132 patients (88%) out of 150 were retrieved and reviewed. There were 85 cases of non‐small cell lung cancer (NSCLC) (64.4%), nine cases of small cell lung cancer (6.8%), five cases of metastatic cancer (3.8%) and 33 cases were reported negative for cancer (25%). The NSCLC included 36 cases of adenocarcinoma (27.3%), 32 cases of squamous cell carcinoma (24.2%), and 17 cases of large cell undifferentiated carcinoma (12.9%). The interobserver agreement k was 0.93, (95% CI 0.87–0.98). The majority of cases (95.5%) were considered adequate for interpretation. The charts of 138 patients (92%) were reviewed for postprocedure radiologically confirmed pneumothorax. Sixteen patients (11.6%) developed pneumothorax only three of whom (2%) required a chest tube for treatment. The number of passes was identified in 118 patients (85.5%). The number of passes did not have a statistically significant association with the development of a pneumothorax (P = 0.747). Conclusion: Fine needle aspirations to diagnose lung lesions is a safe procedure with a low incidence of pneumothorax. Its findings are reproducible with high interobserver agreement. Immediate adequacy evaluation and triage by a pathologist guarantees adequate sample in most instances. The number of passes was not associated with an increased incidence of pneumothorax.     

A cracking complication: Displacement of existing clavicle fracture complicating subcutaneous implantable cardioverter defibrillator implantation

An 18 year old male with an incompletely healed clavicle fracture presented with unexplained syncope. Subsequent investigations were consistent with a diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC). A subcutaneous implantable cardioverter-defibrillator (S-ICD) was successfully implanted and defibrillation threshold (DFT) testing performed as per standard protocol. Shortly following the procedure, the patient complained of pain and swelling over the left clavicle. A radiograph revealed aggravation and displacement of the underlying clavicle fracture. Surgical reduction and internal fixation was performed one week later.     

Effect of intraoperative local application of 3% hydrogen peroxide on pocket infections following cardiac implantable electronic device implantation: An observational study

Aims

The aim of this study was to analyze whether local application of 3% hydrogen peroxide (H2O2) additionally to standard antibiotic prophylaxis following implantation of cardiac implantable electronic devices (CIED) reduces the incidence of pocket infections (PI).

When discrepant events change the plans: An unexpected investigation of physical properties and reactions

Discrepant events are often used by science educators to incite interest and excitement in learners, yet sometimes their results are farther-reaching. The following article describes how one such event—dissolving packing peanuts in acetone—led to a change in the course of a college-level elementary science teaching methods class and to the development of an inquiry-based lesson plan appropriate for use with fifth graders. The lesson is aligned to the NGSS ideas around helping children use observations of properties to describe materials and modeling scientific phenomena that are too small to observe with the naked eye.     

Equilibration of metabolic CO2 with preformed CO2 and bicarbonate: An unexpected finding

Entry of metabolic ¹⁴CO₂ into urea is shown to occur more readily than it equilibrates with the general pool of cellular plus extracellular bicarbonate plus CO₂. Since the sites of CO₂ production (pyruvate dehydrogenase and oxoglutarate dehydrogenase) and of fixation (carbamoylphosphate synthetase) are intramitochondrial, it is likely that the fixation of CO₂ is also more rapid than its equilibration with the cytoplasmic pool of bicarbonate plus CO₂. This observation may point to a more general problem concerning the interpretation of isotope data, when compartmentation or proximity of sites of production and utilisation of metabolites may result in the isotope following a preferred pathway.     

Vasoplegia after implantation of a continuous flow left ventricular assist device: incidence,outcomes and predictors

Background

Vasoplegia after routine cardiac surgery is associated with severe postoperative complications and increased mortality. It is also prevalent in patients undergoing implantation of pulsatile flow left ventricular assist devices (LVAD). However, less is known regarding vasoplegia after implantation of newer generations of continuous flow LVADs (cfLVAD). We aim to report the incidence, impact on outcome and predictors of vasoplegia in these patients.

Methods

Adult patients scheduled for primary cfLVAD implantation were enrolled into a derivation cohort (n?=?118, 2006–2013) and a temporal validation cohort (n?=?73, 2014–2016). Vasoplegia was defined taking into consideration low mean arterial pressure and/or low systemic vascular resistance, preserved cardiac index and high vasopressor support. Vasoplegia was considered after bypass and the first 48?h of ICU stay lasting at least three consecutive hours. This concept of vasoplegia was compared to older definitions reported in the literature in terms of the incidence of postoperative vasoplegia and its association with adverse outcomes. Logistic regression was used to identify independent predictors. Their ability to discriminate patients with vasoplegia was quantified by the area under the receiver operating characteristic curve (AUC).

Results

The incidence of vasoplegia was 33.1% using the unified definition of vasoplegia. Vasoplegia was associated with increased ICU length-of-stay (10.5 [6.9–20.8] vs 6.1 [4.6–10.4] p?=?0.002), increased ICU-mortality (OR 5.8, 95% CI 1.9–18.2) and one-year-mortality (OR 3.9, 95% CI 1.5–10.2), and a higher incidence of renal failure (OR 4.3, 95% CI 1.8–10.4). Multivariable analysis identified previous cardiothoracic surgery, preoperative dopamine administration, preoperative bilirubin levels and preoperative creatinine clearance as independent preoperative predictors of vasoplegia. The resultant prediction model exhibited a good discriminative ability (AUC 0.80, 95% CI 0.71–0.89, p?<? 0.01). Temporal validation resulted in an AUC of 0.74 (95% CI 0.61–0.87, p?<? 0.01).

Conclusions

In the era of the new generation of cfLVADs, vasoplegia remains a prevalent (33%) and critical condition with worse short-term outcomes and survival. We identified previous cardiothoracic surgery, preoperative treatment with dopamine, preoperative bilirubin levels and preoperative creatinine clearance as independent predictors.

     

Pannexin channels in ATP release and beyond: An unexpected rendezvous at the endoplasmic reticulum

The pannexin (Panx) family of proteins, which is co-expressed with connexins (Cxs) in vertebrates, was found to be a new GJ-forming protein family related to invertebrate innexins. During the past ten years, different studies showed that Panxs mainly form hemichannels in the plasma membrane and mediate paracrine signalling by providing a flux pathway for ions such as Ca²⁺, for ATP and perhaps for other compounds, in response to physiological and pathological stimuli. Although the physiological role of Panxs as a hemichannel was questioned, there is increasing evidence that Panx play a role in vasodilatation, initiation of inflammatory responses, ischemic death of neurons, epilepsy and in tumor suppression. Moreover, it is intriguing that Panxs may also function at the endoplasmic reticulum (ER) as intracellular Ca²⁺-leak channel and may be involved in ER-related functions. Although the physiological significance and meaning of such Panx-regulated intracellular Ca²⁺ leak requires further exploration, this functional property places Panx at the centre of many physiological and pathophysiological processes, given the fundamental role of intracellular Ca²⁺ homeostasis and dynamics in a plethora of physiological processes. In this review, we therefore want to focus on Panx as channels at the plasma membrane and at the ER membranes with a particular emphasis on the potential implications of the latter in intracellular Ca²⁺ signalling.     

Incidence of lead dislodgement,malfunction and perforation during the first year following device implantation

Background

The number of cardiac rhythm device implantations has been growing fast due to expanding indications and ageing of the population. Complications of implantation were rare in the trials. However, these involved small numbers and selected patients. Prospective real-life data are necessary to assess cardiac device implantation procedure-related risks.

Objective

To determine the incidence and predictors of lead-related re-intervention in a Dutch high-volume teaching hospital.

Methods

Data from all patients who underwent cardiac rhythm device implantation between January 2010 and December 2011 were collected in a prospective registry. At least 1 year of follow-up regarding re-intervention was available for all patients. Lead-related reasons for re-intervention were categorised into lead dislodgement, malfunctioning or perforation.

Results

One thousand nine hundred twenty-nine devices including 3909 leads were implanted. In 595 patients (30.8 %) a CRT-D/P was implanted. Lead-related re-intervention was necessary in 86 (4.4 %) patients; it was more common in younger and male patients, and due to either lead dislodgement (66 %), malfunctioning (20 %) or perforation (18 %). Coronary sinus lead dislodgement or malfunctioning was 1.4 %. Right atrial dislodgement (1.9 %, p < 0.001) or ICD lead dislodgement (1.8 %, p = 0.002) was more common than right ventricular dislodgement (0.3 %). The incidence of lead malfunctioning was higher (0.8 %) in ICD leads. An apical position of the right ventricular lead and lateral wall position of the right atrial lead were related to cardiac perforation.

Conclusions

The incidence of lead-related re-intervention was comparable with the literature. The majority of re-interventions were due to lead dislodgements, particularly with right atrial and ICD leads. Re-intervention due to coronary sinus lead dislodgement was rare.     

General Surveillance of the soil ecosystem: An approach to monitoring unexpected adverse effects of GMO's

The commercial cultivation of genetically modified (GM) crops in the European Union (EU) necessitates, according to EU legislation, the setting up of a General Surveillance (GS) system that should be able to detect unanticipated effects of GM crops on the environment. Although the applicant is responsible for setting up GS as well as for reporting the results, EU Member States may implement additional supporting surveillance programmes. Devising a GS system to detect unanticipated effects is not straightforward and requires clearly defined protection goals, suitable indicators that are linked to measurable parameters and an objective system for assessing the data. This paper describes a number of recommendations for the development of a General Surveillance system of the soil ecosystem specifically focussed on the situation in the Netherlands. The overarching protection goal of General Surveillance is ‘soil quality’, which is translated into more practical terms of ecosystem services that are relevant for soil quality, and that can be used to select measurable parameters and thus make a link with actual measurements.Ultimately, if and when effects on ecosystem services are detected, decision makers will have to decide whether these effects are acceptable or not. As a support for these decision-making processes, this paper discusses the modalities for the development of a stakeholder participation model. The model involves three groups of persons: the land users, the soil scientists and the decision makers.For reasons of cost effectiveness, a GS system of the soil ecosystem will have to make use of existing networks. The Dutch Soil Quality Network (DSQN) offers an existing infrastructure for soil sampling for GS. Finally, the GS system may be extended to contain data from the Dutch Ecological Monitoring Network, earth observation systems as well as other data resources such as farmers questionnaires or reports form organisations involved in nature conservation. Ideally these data are compiled by a Central Reporting Office (CRO) and maintained in a Geographic Information System (GIS) based database.     

The enzymes of oxalate metabolism: unexpected structures and mechanisms

Oxalate degrading enzymes have a number of potential applications, including medical diagnosis and treatments for hyperoxaluria and other oxalate-related diseases, the production of transgenic plants for human consumption, and bioremediation of the environment. This review seeks to provide a brief overview of current knowledge regarding the major classes of enzymes and related proteins that are employed in plants, fungi, and bacteria to convert oxalate into CO(2) and/or formate. Not only do these enzymes employ intriguing chemical strategies for cleaving the chemically unreactive C-C bond in oxalate, but they also offer the prospect of providing new insights into the molecular processes that underpin the evolution of biological catalysts.     

Angina-like pain: An unexpected side-effect following the simultaneous administration of angiotensin II and prostaglandin E2 in normal adults

Two fit young, non-pregnant adults both experienced marked retrosternal chest pain and chest tightness when receiving 8 ng kg⁻¹ min⁻¹ AII simultaneously with 5 μg min⁻¹ PGE₂. This dose of AII is well within that given experimentally by various workers, and was without such effect when initially given in the absence of PGE₂ infusion. The combination may therefore be a potentially dangerous one.     

An in vitro model of neural trauma: device characterization and calcium response to mechanical stretch

An in vitro model for neural trauma was characterized and validated. The model is based on a novel device that is capable of applying high strain rate, homogeneous, and equibiaxial deformation to neural cells in culture. The deformation waveform is fully arbitrary and controlled via closed-loop feedback. Intracellular calcium ([Ca2+]i) alterations were recorded in real time throughout the imposed strain with an epifluorescent microscopy system. Peak change in [Ca2+]i recovery of [Ca2+]i and percent responding NG108-15 cells were shown to be dependent on strain rate (1(-1) to 10(-1)) and magnitude (0.1 to 0.3 Green's Strain). These measures were also shown to depend significantly on the interaction between strain rate and magnitude. This model for neural trauma is a robust system that can be used to investigate the cellular tolerance and response to traumatic brain injury.     

Epoxidation of C-branched glycals: unexpected stereochemical results and their theoretical rationale

This paper describes the synthesis of C-3 methyl-branched glycosides by epoxidation of partially unblocked L-configured glycals. The stereochemical result depends on the orientation of the allylic hydroxyl group. A theoretical explanation is presented, based on the conformational preferences of the respective glycal half-chair conformations that were estimated by applying the BP density functional and a valence triple-zeta basis set.     

An unexpected cubane-like nickel(II) tetranuclear complex bridged by the anion of 2-hydroxymethylbenzimidazole: Crystal structure and magnetic properties

A novel tetranuclear cubane-like complex [Ni₄(hbzim)₄(N₃)₄(mal)₂(CH₃OH)(H₂O)] (Hhbzim = 2-hydroxymethylbenzimidazole, mal = 4-methoxyaniline) has been synthesized and characterized structurally as well as magnetically. The structure analyses reveal that this complex consists of a Ni₄O₄ cubane core and the different coordinate environments of the nickel(II) ions result in a cubane structure with differing Ni-Ni distances and Ni-O-Ni angles. The magnetic properties of this complex have been interpreted by employing one-J and two-J model. The results show that ferromagnetic interaction dominates in the complex.     

An exceptional irradiance-induced decrease of light trapping in two Tradescantia species: an unexpected relationship with the leaf architecture and zeaxanthin-mediated photoprotection

Leaf anatomy and irradiance-dependent leaf transmittance changes serving as irradiance acclimation mechanisms in leaves were studied in two ecologically contrasting Tradescantia species, a shade plant T. fluminensis Vell. and a sun plant T. sillamontana Matuda, grown at different irradiances. A dramatic increase in leaf thickness (2 to 4-fold) under a high growth irradiance (800 μmol m^?2 s^?1) compared with a low growth irradiance (60 μmol m^?2 s^?1), achieved mainly by expansion of the epidermis, was recorded in both species. The effect took place on the background of modest changes in mesophyll thickness (1.8-fold in T. fluminensis and 1.15-fold in T. sillamontana) and chloroplast size (0.8-fold in T. fluminensis and an insignificant change in T. sillamontana). Mesophyll structure and growth irradiance response did not seem to facilitate significantly light-dependent chloroplast (avoidance) movement in these species. Nevertheless, an exceptionally large (2 to 4-fold) irradiance-induced increase in light transmittance attributable to chloroplast avoidance movement was revealed. This increase by far exceeded that in other higher plants according to available literature. The magnitude of the irradiance-dependent transmittance changes positively correlated both with the rate of photosystem II recovery and with the extent of xanthophyll deepoxidation in the leaves. This was opposite to a negative correlation observed between the same parameters in different plant species. We hypothesize that, at the evolutionary timescale, chloroplast avoidance movement might adjust independently from other photoprotective mechanisms, e.g., non-photochemical quenching, whereas, on the ontogenetic timescale, adjustment of these mechanisms inevitably follows the same trend.