Cannulation of the middle cardiac vein during MICS

Coronary sinus cannulation for retrograde cardioplegia administration during cardiac surgery is common practice. Several of the cannulas that are placed by the cardiac surgeon on open procedures are now placed by the cardiac anesthesiologist during minimally invasive cardiac surgery, including the coronary sinus catheter. The understanding of the cardiac venous anatomy is very important during coronary sinus catheter placement. We present a case where a percutaneously placed coronary sinus catheter was inadvertently placed into the middle cardiac vein but detected with the use of fluoroscopy.     

Meta-analysis of the literature on diagnostic accuracy of SPECT in parkinsonian syndromes

Background  

Parkinson's disease (PD) is the second most common neurodegenerative disorder. One of the most widely used techniques to diagnose PD is a Single Photon Emission Computer Tomography (SPECT) scan to visualise the integrity of the dopaminergic pathways in the brain. Despite this there remains some discussion on the value of SPECT in the differential diagnosis of PD. We did a meta-analysis of all the existing literature on the diagnostic accuracy of both pre- and post-synaptic SPECT imaging in the differential diagnosis of PD.     

Molecular evidence places the swallow bug genus Oeciacus Stål within the bat and bed bug genus Cimex Linnaeus (Heteroptera: Cimicidae)

The genera Cimex Linnaeus and Oeciacus Stål (Heteroptera: Cimicidae) are common haematophagous ectoparasites of bats or birds in the Holarctic region. Both their phylogenetic relationship and the systematics of the entire family previously were based on data from morphology and host relationships. Relationships among nine species of the genus Cimex and three species of the genus Oeciacus were analysed here using two mitochondrial and three nuclear genes. Cimex was shown to be paraphyletic with respect to Oeciacus. Oeciacus is thus proposed as a synonym of Cimex. The characteristic phenotype of Oeciacus results from the specific host association with different species of swallows (Hirundinidae). The morphological characters that have been used as diagnostic for the genera were shown to be valid and can be further used for determination at species level. The present analyses recovered the four traditional morphologically defined species groups of the genus Cimex. However, their relationships were poorly resolved – only the C. hemipterus group showed a well‐supported relationship to the C. pipistrelli group. The molecular differentiation within the Palaearctic C. pipistrelli and the Nearctic C. pilosellus species groups correlates with their karyotype differentiation. Furthermore, the analyses suggest poly‐ or paraphyly of the former genus Oeciacus. Either way this indicates there is a large amount of host‐associated phenotypic convergence in either bat‐ or bird‐associated groups of species. The probability of host choice and subsequent switch in Cimicidae are discussed and possible scenarios of the evolution of host association in species of Cimex are suggested.     

Is the ratio of inhaled corticosteroid to bronchodilator a good indicator of the quality of asthma prescribing? Cross sectional study linking prescribing data to data on admissions.

OBJECTIVE: To investigate the ratio of inhaled corticosteroid to bronchodilator as a measure of the quality of asthma prescribing by general practitioners. DESIGN: Ecological cross sectional study linking general practitioner asthma prescribing with hospital admission data and a measure of deprivation. SUBJECTS: 11 family health services authorities in the West Midlands region and 99 general practices in North Staffordshire. MAIN OUTCOME MEASURES: Hospital admission rates for asthma; the ratio of inhaled corticosteroid to bronchodilator; and Townsend deprivation scores. RESULTS: No overall significant correlation was found between admission rates for asthma and corticosteroid:bronchodilator ratios for family health services authorities (Spearman''s rs = -0.109, P = 0.750) or general practices (rs = -0.084, P = 0.407). In deprived family health services authority areas and general practices an inverse non-significant correlation existed between admission rates for asthma and corticosteroid:bronchodilator ratios (rs = -0.300, P = 0.624; rs = -0.218, P = 0.136). In contrast, in more affluent areas and general practices a positive non-significant correlation existed between admission rates and corticosteroid:bronchodilator ratios (rs = 0.371, P = 0.468; rs = 0.038, P = 0.792). CONCLUSION: Although the corticosteroid:bronchodilator ratio may be a valid indicator of the quality of prescribing for individual patients with asthma, caution should be applied in interpreting aggregated ratios. Differences in the severity of asthma or the prevalence of chronic obstructive pulmonary disease may explain inconsistent associations between admission rates for asthma and corticosteroid:bronchodilator ratios in family health services authorities and general practices with different deprivation scores.     

Recent shoreline changes in the Volta River delta,West Africa: the roles of natural processes and human impacts§

The Volta River delta developed as an asymmetric lobe in a tectonic offset on the coast of Ghana. The delta comprises a large curvilinear spit that widens in its central portion due to the adjunction of successive sandy beach ridges. The appearance of a distinct spit, in lieu of a continuous barrier from the present mouth of the Volta River to the Bight of Benin coast, may be an outgrowth of a natural change in the location of the mouth of the Volta. The spit marks a segmentation of the unique sand drift cell that hitherto prevailed on this bight coast. Spit growth has been accompanied by a wave of erosion over the last century of the immediate downdrift sector of the bight coast, endangering the town of Keta. Erosion since the 1960s may have been aggravated by the construction of the Akosombo hydropower dam. The tip of the spit has recently welded to the shoreline, thus assuring resumption of sand supply from the Volta towards the rest of this formerly sand-starved sector of the bight coast. Blocking of sediment by the Akosombo Dam is, in due course, likely to become the overarching factor in delta shoreline stability.     

Sexually dimorphic gall structures correspond to differential phytohormone contents in male and female wasp larvae

Sexually dimorphic galls are rare among gall‐inducing insects and the reason for their occurrence is unknown. The pteromalid wasp Trichilogaster acaciaelongifoliae, which induces galls on Acacia longifolia, is one such species. In the present study, the anatomical and physiological attributes of male and female galls of T. acaciaelongifoliae are examined and compared. Histological preparations are used to characterize anatomical differences between male and female gall chambers. Bioassays, high‐performance liquid chromatography‐mass spectrometry and an enzyme immunoassay are used to measure concentrations of auxin and cytokinin in normal buds, galled tissues, and larvae of both sexes. Female chambers are found to be 3.3‐fold larger, and are associated with 1.5‐fold more storage tissue and 3.5‐fold more vascular tissues than male chambers. Tissues from female chambers induce stronger cytokinin‐like bioactivity than tissues from male chambers. Female larvae have considerably higher concentrations of cytokinin free bases, ribosides, glucosides and monophosphates than male larvae; higher auxin‐like bioactivity than in normal or galled plant tissues; and almost twice the concentration of auxin than male larvae. Both male and female larvae contain much higher auxin concentrations than either galled or normal plant tissues. These findings suggest that differing levels of phytohormones are involved in the development of sexual dimorphism of gall structures in this species.