Fracked ecology: Response of aquatic trophic structure and mercury biomagnification dynamics in the Marcellus Shale Formation.

Unconventional natural gas development and hydraulic fracturing practices (fracking) are increasing worldwide due to global energy demands. Research has only recently begun to assess fracking impacts to surrounding environments, and very little research is aimed at determining effects on aquatic biodiversity and contaminant biomagnification. Twenty-seven remotely-located streams in Pennsylvania's Marcellus Shale basin were sampled during June and July of 2012 and 2013. At each stream, stream physiochemical properties, trophic biodiversity, and structure and mercury levels were assessed. We used δ15N, δ13C, and methyl mercury to determine whether changes in methyl mercury biomagnification were related to the fracking occurring within the streams' watersheds. While we observed no difference in rates of biomagnificaion related to within-watershed fracking activities, we did observe elevated methyl mercury concentrations that were influenced by decreased stream pH, elevated dissolved stream water Hg values, decreased macroinvertebrate Index for Biotic Integrity scores, and lower Ephemeroptera, Plecoptera, and Trichoptera macroinvertebrate richness at stream sites where fracking had occurred within their watershed. We documented the loss of scrapers from streams with the highest well densities, and no fish or no fish diversity at streams with documented frackwater fluid spills. Our results suggest fracking has the potential to alter aquatic biodiversity and methyl mercury concentrations at the base of food webs.

Use of dual-energy computed tomography post endovascular treatment of cerebral aneurysm.

BACKGROUND: Along with surgical clipping, endovascular management is one of the mainstay treatment options for cerebral aneurysms. However, immediate post procedural imaging is often hard to interpret due to the presence of contrast material. Dual-energy computed tomography (CT) allows differentiation between contrast extravasation and intracranial hemorrhage and this case illustrates the importance of this following endovascular treatment of an unruptured cerebral aneurysm. CASE DESCRIPTION: A patient presented with acute ophthalmoplegia secondary to mass effect from an intracavernous ICA fusiform aneurysm. The patient underwent an endovascular flow diverting stent to treat this aneurysm. Post procedure, the patient had a reduced level of consciousness and underwent a conventional CT showing diffuse subarachnoid hyperdensity of the left hemisphere. Dual-energy CT allowed accurate differentiation and illustrated diffuse contrast material extravasation, allowing patient to continue on dual antiplatelets and therapeutic anticoagulation to reduce the risk of ischemic injury post endovascular stent. CONCLUSION: Use of dual-energy CT in the setting of endovascular management of intracranial aneurysms allows accurate diagnosis of any postoperative complications. Specifically, differentiating between subarachnoid hemorrhage and contrast extravasation is vital in these patients due to the significant consequences to their ongoing management in regard to continuation or cessation of antiplatelets or anticoagulation. With increasing access to this technology, its use should become standard practice in the post-operative investigation of these patients undergoing endovascular treatment.

Intraoperative MRI in trans-sphenoidal surgery using frameless stereotaxis.

BACKGROUND: Intraoperative magnetic resonance imaging (iMRI) has been used for pituitary surgery for approximately 20 years. The introduction of frameless stereotaxis allows efficient navigation for both the ENT and neurosurgeon. This allows flexibility in placement of the patients head to facilitate resection, efficient use of theater time and improves the safety profile of the operation. This is the first study to describe and investigate the use of frameless stereotaxis in conjunction with iMRI. METHODS: Consecutive patients who underwent iMRI guided trans-sphenoidal debulking using frameless stereotaxis over a 3-year period, from January 2016 to June 2019, were included in this case series and reviewed retrospectively. The use of AxiEM (Medtronic, USA) tracker facilitated frameless stereotaxis in conjunction with iMRI for trans-sphenoidal debulking of sellar lesions based on the "twin-operating" model. RESULTS: The cohort of 47 patients had a mean age of 55 years with a slight female predilection. The average lesion size measured 20 mm (3-46 mm) in maximal diameter with objective evidence of visual deterioration being the most common indication to consider surgery. The use of iMRI identified two patients with suboptimal decompression facilitating further resection in the same anesthetic and one hemorrhagic complication requiring evacuation and hemostasis to reduce postoperative morbidity. CONCLUSION: This study describes the procedural nuances in the use of frameless stereotaxis for iMRI in transsphenoidal surgery to further reduce morbidity and improve outcomes, as well as improving theater utilization and reducing cost.