Endoscopic necrosectomy of infected WON in acute necrotising pancreatitis - Development of an effective therapeutic algorithm based on a single-center consecutive patient cohort.

OBJECTIVE: Development of an effective therapeutic algorithm for interventional (minimally invasive) approach to infected walled-off necrosis (WON) in patients with necrotising pancreatitis reflecting real-word data. MATERIAL/METHODS: All consecutive patients who underwent endoscopic necrosectomy for necrotising pancreatitis through a defined study period were enclosed in this retrospective observational case study. The therapeutic approach was analysed for clinical success rate, complication spectrum and rate as well as mortality and compared with data from the literature. Finally, a therapeutic algorithm was derived. RESULTS: From 2004 to 2019, 126 patients with necrotising pancreatitis (median of APACHE II score, 10.5 points) were treated. In 92.9 % of cases (n=117), an infected WON with microbial pathogen detection was found. After a median of 18 days from symptom onset, first intervention was performed (53.2 % as percutaneous drainage with programmed rinsing, 29.4 % as EUS-guided internal drainage). From 2004 to 2010, double pigtail stents were used. Later, lumen-apposing metal stent (LAMS) such as AXIOSTM stent (Boston Scientific, Ratingen, Germany) was preferred. The combined percutaneous and internal drainage was performed in approximately 50 % of subjects.Endoscopic transluminal necrosectomy was performed in 123 patients (97.6 %) at a median of 33 days from symptom onset. Endoscopic percutaneous necrosectomy was conducted in 11.1 % of the individuals. A median number of two endoscopic necrosectomy sessions per patient was necessary for the therapy. The clinical success rate (discharge without surgical intervention) was 82.5 %. The complication rate (bleeding and perforation) and the need for surgery were both 9.5 %. The overall mortality was 8.7 %. CONCLUSION: Therapy of necrotising pancreatitis with infected WON consists of early calculated antibiotic therapy with adequate drainage. Combined external and internal drainages with programmed rinsing seem to improve prognosis, as well as minimise I) : the need for forced necrosectomies (mainly via a transluminal access site) and II) : complication rate as well as, thus, improve outcome.

Assessing climate change impacts on Pacific salmon and trout using bioenergetics and spatiotemporal explicit river temperature predictions under varying riparian conditions.

Pacific salmon and trout populations are affected by timber harvest, the removal and alteration of riparian vegetation, and the resulting physical changes to water quality, temperature, and associated delivery of high-quality terrestrial prey. Juvenile salmon and trout growth, a key predictor of survival, is poorly understood in the context of current and future (climate-change mediated) conditions, with resource managers needing information on how land use will impact future river conditions for these commercially and culturally important species. We used the Heat Source water temperature modeling framework to develop a spatiotemporal model to assess how riparian canopy and vegetation preservation and addition could influence river temperatures under future climate predictions in a coastal river fed by a moraine-dammed lake: the Quinault River in Washington State. The model predicted higher water temperatures under future carbon emission projections, representative concentration pathway (RCP) 4.5 and 8.5, with varying magnitude based on different riparian vegetation scenarios. We used the daily average temperature output from these scenarios to predict potential juvenile fish growth using the Wisconsin bioenergetics model. A combination of riparian vegetation removal and continued high carbon emissions resulted in a predicted seven-day average daily maximum temperature (7DADM) increase of 1.7°C in the lower river by 2080; increases in riparian shading mitigate this 7DADM increase to only 0.9°C. Under the current thermal regime, bioenergetics modeling predicts juvenile fish lose weight in the lower river; this loss of potential growth worsens by an average of 20-83% in the lower river by 2080, increasing with the loss of riparian shading. This study assess the impact of riparian vegetation management on future thermal habitat for Pacific salmon and trout under warming climates and provide a useful spatially explicit modeling framework that managers can use to make decisions regarding riparian vegetation management and its mechanistic impact to water temperature and rearing juvenile fish.

Beyond Streamflow: Call for a National Data Repository of Streamflow Presence for Streams and Rivers in the United States.

Observations of the presence or absence of surface water in streams are useful for characterizing streamflow permanence, which includes the frequency, duration, and spatial extent of surface flow in streams and rivers. Such data are particularly valuable for headwater streams, which comprise the vast majority of channel length in stream networks, are often non-perennial, and are frequently the most data deficient. Datasets of surface water presence exist across multiple data collection groups in the United States but are not well aligned for easy integration. Given the value of these data, a unified approach for organizing information on surface water presence and absence collected by diverse surveys would facilitate more effective and broad application of these data and address the gap in streamflow data in headwaters. In this paper, we highlight the numerous existing datasets on surface water presence in headwater streams, including recently developed crowdsourcing approaches. We identify the challenges of integrating multiple surface water presence/absence datasets that include differences in the definitions and categories of streamflow status, data collection method, spatial and temporal resolution, and accuracy of geographic location. Finally, we provide a list of critical and useful components that could be used to integrate different streamflow permanence datasets.

A novel polymer-free ciglitazone-coated vascular stent: in vivo and ex vivo analysis of stent endothelialization in a rabbit iliac artery model.

AIM: Peroxisome proliferator-activated receptor-gamma (PPARg) agonists have known pleiotropic cardiovascular effects with favourable properties in vascular remodeling, and specifically in suppression of vascular smooth muscle cell proliferation. A novel vascular stent coating using the PPARg ligand ciglitazone (CCS) was investigated regarding its effects on endothelialization after 7 and 28 days. METHODS: Microporous bare metal stents (BMS) were coated with ciglitazone by ultrasonic flux with a load of 255 µg ciglitazone/stent. SixteenNew Zealand white rabbits, fed a with high cholesterol diet, underwent stent implantation in both iliac arteries. Everolimus-eluting stents (EES) and BMS were comparators. Histology (CD 31 immunostaining, confocal and scanning electron microscopy, morphometry) was performed after 7 and 28 days and by OCT (optical coherence tomography) in vivo after 28 days. RESULTS: Microscopy showed comparable results with near complete endothelialization in CCS and BMS (%CD31 above stent struts after 7 days: 67.92±36.35 vs. 84.48±23.86; p = 0.55; endothel % above stent struts: 77.22±27.9 vs. 83.89±27.91; p = 0.78). EES were less endothelialized with minimal fibrin deposition, not found in BMS and CCS (% CD 31 above struts after 28 days, BMS: 100.0±0.0 vs. EES: 95.9±3.57 vs. CCS: 100.0±0.0; p = 0.0292). OCT revealed no uncovered struts in all stents after 28 days. CONCLUSIONS: Polymer-free coating with ciglitazone, a PPARg agonist is feasible and stable over time. Our data prove unimpaired endothelial coverage of a ciglitazone-coated vascular stent system by histology and OCT. Thus, this PPARg agonist coating deserves further investigation to evaluate its potency on local neointimal suppression.

Climate change poised to threaten hydrologic connectivity and endemic fishes in dryland streams.

Protecting hydrologic connectivity of freshwater ecosystems is fundamental to ensuring species persistence, ecosystem integrity, and human well-being. More frequent and severe droughts associated with climate change are poised to significantly alter flow intermittence patterns and hydrologic connectivity in dryland streams of the American Southwest, with deleterious effects on highly endangered fishes. By integrating local-scale hydrologic modeling with emerging approaches in landscape ecology, we quantify fine-resolution, watershed-scale changes in habitat size, spacing, and connectance under forecasted climate change in the Verde River Basin, United States. Model simulations project annual zero-flow day frequency to increase by 27% by midcentury, with differential seasonal consequences on continuity (temporal continuity at discrete locations) and connectivity (spatial continuity within the network). A 17% increase in the frequency of stream drying events is expected throughout the network with associated increases in the duration of these events. Flowing portions of the river network will diminish between 8% and 20% in spring and early summer and become increasingly isolated by more frequent and longer stretches of dry channel fragments, thus limiting the opportunity for native fishes to access spawning habitats and seasonally available refuges. Model predictions suggest that midcentury and late century climate will reduce network-wide hydrologic connectivity for native fishes by 6-9% over the course of a year and up to 12-18% during spring spawning months. Our work quantifies climate-induced shifts in stream drying and connectivity across a large river network and demonstrates their implications for the persistence of a globally endemic fish fauna.

Psychoactive effects of tasting chocolate and desire for more chocolate.

The purpose of this study was to characterize the psychoactive effects of tasting chocolate and to evaluate the contribution of the main chocolate components to the desire to consume more of it. A total of 280 participants, (F-155; M=125) ranging in age from 18-65, completed the study. Participants were randomly assigned to taste 12.5 g of either white chocolate ("control") or one of four chocolate ("cocoa") samples varying in sugar, fat and percent cocoa content, then answered the question: "Do you want more of this chocolate?" and "If yes, how many more pieces of this chocolate would you like to eat?" They completed pre- and post-consumption surveys, consisting of 30 questions derived from the Addiction Research Center Inventory (ARCI) subscales, Morphine-Benzedrine Group (MBG), Morphine (M) and Excitement (E). Significant decreases in post-pre consumption changes in MBG subscale were observed between the control sample and the 70% cocoa (p=0.046) or the 85% cocoa sample (p=0.0194). Proportionally more men than women wanted more of the tasted chocolate (p=0.035). Participants were more likely to want more of the tasted chocolate if they displayed a greater change in the MBG scale, and if their chocolate sample had high sugar and cocoa content, as assessed by multiple logistic regression. Our results suggest that multiple characteristics of chocolate, including sugar, cocoa and the drug-like effects experienced, play a role in the desire to consume chocolate.

Characterization of cationic amino acid transporters (hCATs) 1 and 2 in human skin.

In the present study, we characterized the distribution of human cationic amino acid transporters 1 (hCAT1) and 2 (hCAT2) in healthy skin and compared it to psoriatic skin lesions by means of immunohistochemistry. Moreover, we tested the hypothesis that L -arginine and L -ornithine influence the expression and synthesis of hCAT1 and hCAT2 in cell culture experiments by means of real-time-PCR and Western blot. Immunohistochemical comparison between healthy and psoriatic skin revealed a decreased amount of hCAT1, especially in the stratum granulosum of psoriatic skin; the distribution pattern of hCAT2 was not significantly affected in psoriatic skin. Cell culture experiments showed that supraphysiological concentrations of 15 mM L -arginine (72 h) lead to a significant increase of the hCAT1-mRNA and protein expression, whereas other concentrations had no significant influence. In contrast, L -arginine concentrations of 2 mM led to a significant increase of the hCAT2B mRNA-expression after 24 h. However, 48 and 72 h revealed no significant changes and high concentrations (15 mM L -arginine) led to a significant downregulation of the hCAT2B transporter over all time points analyzed. L -ornithine had no effect on the hCAT1 expression of mRNA and protein level. On the other hand the expression of hCAT2B was significantly up regulated at a 5-mM concentration of L -ornithine at all analyzed time points. Other concentrations had no effect. For the first time, the findings yield data about hCAT1 and hCAT2 on protein-level and suggest that L -arginine is a worthwhile object of studies, which investigated L -arginine as a possible therapeutic agent to reduce psoriatic symptoms.

Channel and perennial flow initiation in headwater streams: management implications of variability in source-area size.

Despite increasing attention to management of headwater streams as sources of water, sediment, and wood to downstream rivers, the extent of headwater channels and perennial flow remain poorly known and inaccurately depicted on topographic maps and in digital hydrographic data. This study reports field mapping of channel head and perennial flow initiation locations in forested landscapes underlain by sandstone and basalt lithologies in Washington State, USA. Contributing source areas were delineated for each feature using a digital elevation model (DEM) as well as a Global Positioning System device in the field. Systematic source area-slope relationships described in other landscapes were not evident for channel heads in either lithology. In addition, substantial variability in DEM-derived source area sizes relative to field-delineated source areas indicates that in this area, identification of an area-slope relationship, should one even exist, would be difficult. However, channel heads and stream heads, here defined as the start of perennial flow, appear to be co-located within both of the lithologies, which together with lateral expansion and contraction of surface water around channel heads on a seasonal cycle in the basalt lithology, suggest a controlling influence of bedrock springs for that location. While management strategies for determining locations of channel heads and perennial flow initiation in comparable areas could assign standard source area sizes based on limited field data collection within that landscape, field-mapped source areas that support perennial flow are much smaller than recognized by current Washington State regulations.