To investigate whether pre-procedure Computed Tomography Angiography (CTA) improves radiation exposure, procedure complexity, and symptom recurrence after bronchial embolization for massive ...hemoptysis.
A single-center retrospective review of bronchial artery embolization (BAE) for massive hemoptysis was performed for procedures between 2008 and 2019. Multi-variate analysis was performed to determine the significance of pre-procedure CTA and etiology of hemoptysis on patient radiation exposure (reference point air kerma, RPAK) and rate of recurrent hemoptysis.
There were 61 patients (mean age 52.5 years; SD = 19.2 years, and 57.3% male) and CTA was obtained for 42.6% (26/61). Number of vessels selected was a mean of 7.2 (SD = 3.4) in those without CTA and 7.4 (SD = 3.4) in those with CTA (p = 0.923). Mean procedure duration was 1.8 h (SD = 1.6 h) in those without CTA and 1.3 h (SD = 1.0 h) in those with CTA (p = 0.466). Mean fluoroscopy time and RPAK per procedure were 34.9 min (SD = 21.5 min) and 1091.7 mGy (SD = 1316.6 mGy) for those without a CTA and 30.7 min (SD = 30.7 min) and 771.5 mGy (SD = 590.0 mGy) for those with a CTA (p = 0.523, and p = 0.879, respectively). Mean total iodine given was 49.2 g (SD = 31.9 g) for those without a CTA and 70.6 g (SD = 24.9 g) for those with a CTA (p = 0.001). Ongoing hemoptysis at last clinical follow up was 13/35 (37.1%) in those without CTA and 9/26 (34.6%) in those with CTA (p = 0.794).
Pre-procedure CTA did not improve radiation effective dose and symptom recurrence after BAE and is associated with significant increases in total iodine dose.
•Bronchial artery embolization can be performed without pre-procedure cross-sectional imaging.•Computed tomography angiography does not add significant radiation effective dose.•Cases with an otherwise suspected bleeding site should proceed directly to interventional treatment.
Much has been done to address the challenges of biological invasions, but fundamental questions (e.g., which species invade? Which habitats are invaded? How can invasions be effectively managed?) ...still need to be answered before the spread and impact of alien taxa can be effectively managed. Questions on the role of biogeography (e.g., how does biogeography influence ecosystem susceptibility, resistance and resilience against invasion?) have the greatest potential to address this goal by increasing our capacity to understand and accurately predict invasions at local, continental and global scales. This paper proposes a framework for the development of ‘Global Networks for Invasion Science’ to help generate approaches to address these critical and fundamentally biogeographic questions. We define global networks on the basis of their focus on research questions at the global scale, collection of primary data, use of standardized protocols and metrics, and commitment to long-term global data. Global networks are critical for the future of invasion science because of their potential to extend beyond the capacity of individual partners to identify global priorities for research agendas and coordinate data collection over space and time, assess risks and emerging trends, understand the complex influences of biogeography on mechanisms of invasion, predict the future of invasion dynamics, and use these new insights to improve the efficiency and effectiveness of evidence-based management techniques. While the pace and scale of global change continues to escalate, strategic and collaborative global networks offer a powerful approach to inform responses to the threats posed by biological invasions.
Contrast-induced acute kidney injury (CI-AKI) is a common and serious complication of invasive cardiac procedures. Quality improvement programs have been associated with a lower incidence of CI-AKI ...over time, but there is a lack of high-quality evidence on clinical decision support for prevention of CI-AKI and its impact on processes of care and clinical outcomes.
The Contrast-Reducing Injury Sustained by Kidneys (Contrast RISK) study will implement an evidence-based multifaceted intervention designed to reduce the incidence of CI-AKI, encompassing automated identification of patients at increased risk for CI-AKI, point-of-care information on safe contrast volume targets, personalized recommendations for hemodynamic optimization of intravenous fluids, and follow-up information for patients at risk. Implementation will use cardiologist academic detailing, computerized clinical decision support, and audit and feedback. All 31 physicians practicing in all 3 of Alberta’s cardiac catheterization laboratories will participate using a cluster-randomized stepped-wedge design. The order in which they are introduced to this intervention will be randomized within 8 clusters. The primary outcome is CI-AKI incidence, with secondary outcomes of CI-AKI avoidance strategies and downstream adverse major kidney and cardiovascular events. An economic evaluation will accompany the main trial.
The Contrast RISK study leverages information technology systems to identify patient risk combined with evidence-based protocols, audit, and feedback to reduce CI-AKI in cardiac catheterization laboratories across Alberta. If effective, this intervention can be broadly scaled and sustained to improve the safety of cardiac catheterization.
La néphropathie provoquée par un produit de contraste (NPPC) est une complication grave et fréquente des interventions cardiaques invasives. Les programmes d’amélioration de la qualité ont été associés à une diminution de la fréquence de la NPPC au fil du temps. Cependant, il y a un manque de données probantes de grande qualité au regard de l’aide à la décision clinique pour la prévention de la NPPC et des répercussions de celle-ci sur les processus de soins et les résultats cliniques.
L’étude Contrast RISK (Contrast-Reducing Injury Sustained by Kidneys) permettra de mettre en œuvre une intervention multifacette fondée sur des données probantes et conçue pour réduire la fréquence de la NPPC. Cette intervention comprendra le repérage automatisé des patients exposés à un risque accru de NPPC; l’accès à de l’information sur les volumes cibles sécuritaires de produits de contrastel à où les soins sont dispensés; des recommandations personnalisées pour l’optimisation hémodynamique des fluides administrés par voie intraveineuse; et des renseignements sur le suivi dans le cas des patients à risque. La mise en œuvre de l’intervention fera appel à une présentation faite en milieu d’enseignement par un cardiologue, à un système informatisé d’aide à la décision clinique ainsi qu’à un processus de vérification et de rétroaction. Les 31 médecins qui exercent dans les trois laboratoires de cathétérisme cardiaque de l’Alberta y participeront, suivant un plan d’étude aléatoire par grappes et par étapes. Les médecins seront répartis aléatoirement dans huit grappes, dans l’ordre de présentation de l’intervention. La fréquence de la NPPC est le paramètre d’évaluation principal. Les stratégies d’évitement de la NPPC et les événements rénaux et cardiovasculaires indésirables majeurs en aval constituent les paramètres d’évaluation secondaires. L’essai principal s’accompagnera d’une évaluation économique.
L’étude Contrast RISK met à contribution des systèmes de technologie de l’information pour cerner les risques auxquels les patients sont exposés – parallèlement à des protocoles fondés sur des données probantes et à un processus de vérification et de rétroaction – en vue de réduire la fréquence de la NPPC dans l’ensemble des laboratoires de cathétérisme cardiaque de l’Alberta. Si elle s’avère efficace, cette intervention pourra être déployée et soutenue à grande échelle en vue d’assurer une mise en œuvre plus sécuritaire du cathétérisme cardiaque.
Classical biocontrol constitutes the importation of natural enemies from a native range to control a non-native pest. This is challenging when the target organism is phylogenetically close to a ...sympatric non-target form. Recent papers have proposed and recommended that two European moths (
Archanara
spp.) be introduced to North America to control non-native
Phragmites australis australis
, claiming they would not adversely affect native
P. australis americanus
. We assert that these papers overlooked research contradicting their conclusions and that the authors recommended release of the non-native moths despite results of their own studies indicating that attack on native
Phragmites
is possible after field release. Furthermore, their open-field, host-specificity tests were conducted in non-wetland fields in Switzerland using potted plants, reflecting considerably different conditions than those of North American wetlands. Also, native
Phragmites
in eastern North America has declined, increasing its potential vulnerability to any new stressors. Because all inadvertently introduced, established,
Phragmites
-specialist, herbivorous insects have done more harm to native than non-native
Phragmites
, native
Phragmites
may experience more intense herbivory than non-native
Phragmites
from the introduction of
Archanara
spp. due to demographic mechanisms (e.g., increase in density of the biocontrol agent and spillover onto alternate hosts) or because the herbivores may undergo genetic change. In addition to the risk to native
Phragmites,
significant biomass reduction of non-native
Phragmites
may decrease important ecosystem services, including soil accretion in wetlands affected by sea level rise. We strongly caution against the approval of
Archanara
spp. as biocontrol agents for non-native
Phragmites
in North America.
Streamflow duration information underpins many management decisions. However, hydrologic data are rarely available where needed. Rapid streamflow duration assessment methods (SDAMs) classify reaches ...based on indicators that are measured in a single brief visit. We evaluated a proposed framework for developing SDAMs to develop an SDAM for the Arid West United States that can classify reaches as perennial, intermittent, or ephemeral. We identified 41 candidate biological, geomorphological, and hydrological indicators of streamflow duration in a literature review, evaluated them for a number of desirable criteria (e.g., defensibility and consistency), and measured 21 of them at 89 reaches with known flow durations. We selected metrics for the SDAM based on their ability to discriminate among flow duration classes in analyses of variance, as well as their importance in a random forest model to predict streamflow duration. This approach resulted in a "beta" SDAM that uses five biological indicators. It could discriminate between ephemeral and non-ephemeral reaches with 81% accuracy, but only 56% accuracy when distinguishing 3 classes. A final method will be developed following expanded data collection. This Arid West study demonstrates the effectiveness of our approach and paves the way for more efficient development of scientifically informed SDAMs.
To analyze and provide an overview of the incidence, management, and prevention of conjunctival erosion in Argus II clinical trial subjects and postapproval patients.
This retrospective analysis ...followed the results of 274 patients treated with the Argus II Retinal Prosthesis System between June 2007 and November 2017, including 30 subjects from the US and European clinical trials, and 244 patients in the postapproval phase. Results were gathered for incidence of a serious adverse event, incidence of conjunctival erosion, occurrence sites, rates of erosion, and erosion timing.
Overall, 60% of subjects in the clinical trial subjects versus 83% of patients in the postapproval phase did not experience device- or surgery-related serious adverse events. In the postapproval phase, conjunctival erosion had an incidence rate of 6.2% over 5 years and 11 months. In 55% of conjunctival erosion cases, erosion occurred in the inferotemporal quadrant, 25% in the superotemporal quadrant, and 20% in both. Sixty percent of the erosion events occurred in the first 15 months after implantation, and 85% within the first 2.5 years.
Reducing occurrence of conjunctival erosion in patients with the Argus II Retinal Prosthesis requires identification and minimization of risk factors before and during implantation. Implementing inverted sutures at the implant tabs, use of graft material at these locations as well as Mersilene rather than nylon sutures, and accurate Tenon's and conjunctiva closure are recommended for consideration in all patients.
ABSTRACT Galaxy mergers are important events that can determine the fate of a galaxy by changing its morphology, star formation activity and mass growth. Merger systems have commonly been identified ...from their disturbed morphologies, and we now can employ integral field spectroscopy to detect and analyze the impact of mergers on stellar kinematics as well. We visually classified galaxy morphology using deep images ( ) taken by the Blanco 4 m telescope at the Cerro Tololo Inter-American Observatory. In this paper we investigate 63 bright ( ) spectroscopically selected galaxies in Abell 119, of which 53 are early type and 20 show a disturbed morphology by visual inspection. A misalignment between the major axes in the photometric image and the kinematic map is conspicuous in morphologically disturbed galaxies. Our sample is dominated by early-type galaxies, yet it shows a surprisingly tight Tully-Fisher relation except for the morphologically disturbed galaxies which show large deviations. Three out of the eight slow rotators in our sample are morphologically disturbed. The morphologically disturbed galaxies are generally more asymmetric, visually as well as kinematically. Our findings suggest that galaxy interactions, including mergers and perhaps fly-bys, play an important role in determining the orientation and magnitude of a galaxy's angular momentum.
We present an analysis of the optical spectra of narrow emission-line galaxies, based on mean field independent component analysis (MFICA), a blind source separation technique. Samples of galaxies ...were drawn from the Sloan Digital Sky Survey (SDSS) and used to generate compact sets of 'continuum' and 'emission-line' component spectra. These components can be linearly combined to reconstruct the observed spectra of a wider sample of galaxies. Only 10 components - five continuum and five emission line - are required to produce accurate reconstructions of essentially all narrow emission-line galaxies to a very high degree of accuracy; the median absolute deviations of the reconstructed emission-line fluxes, given the signal-to-noise ratio (S/N) of the observed spectra, are 1.2-1.8σ for the strong lines. After applying the MFICA components to a large sample of SDSS galaxies, we identify the regions of parameter space that correspond to pure star formation and pure active galactic nucleus (AGN) emission-line spectra, and produce high S/N reconstructions of these spectra. The physical properties of the pure star formation and pure AGN spectra are investigated by means of a series of photoionization models, exploiting the faint emission lines that can be measured in the reconstructions. We are able to recreate the emission-line strengths of the most extreme AGN case by assuming that the central engine illuminates a large number of individual clouds with radial distance and density distributions, f(r) ∝ r
γ and g(n) ∝ n
β, respectively. The best fit is obtained with γ = −0.75 and β = −1.4. From the reconstructed star formation spectra, we are able to estimate the starburst ages. These preliminary investigations serve to demonstrate the success of the MFICA-based technique in identifying distinct emission sources, and its potential as a tool for the detailed analysis of the physical properties of galaxies in large-scale surveys.
Epidemiologic data indicate that people who consume low glycemic index (GI) diets are at reduced risk for the onset and progression of age-related macular degeneration (AMD). The authors sought ...corroboration of this observation in an animal model.
Five- and 16-month-old C57BL/6 mice were fed high or low GI diets until they were 17 and 23.5 months of age, respectively. Retinal lesions were evaluated by transmission electron microscopy, and advanced glycation end products (AGEs) were evaluated by immunohistochemistry.
Retinal lesions including basal laminar deposits, loss of basal infoldings, and vacuoles in the retinal pigment epithelium were more prevalent in the 23.5- than in the 17-month-old mice. Within each age group, consumption of a high GI diet increased the risk for lesions and the risk for photoreceptor abnormalities and accumulation of AGEs.
Consuming high GI diets accelerates the appearance of age-related retinal lesions that precede AMD in mice, perhaps by increasing the deposition of toxic AGEs in the retina. The data support the hypothesis that consuming lower GI diets, or simulation of their effects with nutraceuticals or drugs, may protect against AMD. The high GI-fed C57BL/6 mouse is a new model of age-related retinal lesions that precede AMD and mimic the early stages of disease and may be useful for drug discovery.
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