Inferior vena cava reconstruction to alleviate back pain.

We present the case of a 38-year-old man with end-stage renal disease receiving hemodialysis via a left femoral loop graft who developed debilitating back pain. During a maintenance fistulogram, we found a completely occluded inferior vena cava and engorged lumbar veins. The patient underwent inferior vena cava reconstruction with stenting, which resulted in complete resolution of the engorged lumbar veins on venography and a significant reduction in his back pain. Engorgement of the lumbar veins can cause significant pain, and treatment of the underlying pathology can alleviate these symptoms.

Cutting balloon septotomy for repair of right common iliac artery aneurysm in the setting of type B aortic dissection.

We report a case of using cutting balloon septotomy for a 5-cm right common iliac artery aneurysm repair in a patient with a chronic type B aortic dissection after open repair 10 years before. This technique uses intravenous ultrasound to facilitate deployment of a cutting balloon to shear through the dissection flap, allowing for optimization of the landing zone for endovascular repair of a right common iliac artery aneurysm. Various methods are available for performing septotomy, and the use of a cutting balloon is one that helps with stent placement and position.

Ambient air pollution and consumer spending: Evidence from Spain.

Research on the economic burden of air pollution has focused primarily on its macroeconomic impact. However, as some studies have found that air pollution can lead to avoidance behavior-for example, reducing the time spent outdoors-we hypothesize that it can also influence consumer spending activity. We combine high frequency data on ozone and fine particulate pollution with daily consumer spending in brick-and-mortar retail in 129 postal codes in Spain during 2014 to estimate the association between the two. Using a linear fixed effects model, we find that a 1-standard deviation increase in ozone concentration (20.97 µg/m3) is associated with 3.9 percent decrease in consumer spending (95% CI: -0.066, -0.012; p<0.01). The association of fine particulate matter with consumer spending is, however, not statistically significant (ß: 0.005; 95% CI: -0.009, 0.018; p>0.10). Further, we do not observe a sufficiently strong bounce-back in consumer spending in the day-or even the week-following higher ozone concentration. Also, we find that the relationship between ozone concentration and consumer spending is heterogeneous, with those aged below 25 and those aged 45 or above exhibiting stronger negative association. This research informs policymakers about a plausibly unaccounted cost of ambient air pollution, even at concentrations lower than the WHO air quality guideline for short-term exposure.

Corporate emissions targets and the neglect of future innovators.

Targets can distort competition in favor of incumbent firms.

Ruptured Appendicitis Leading to Development of a Tubo-Ovarian Abscess in a Non-sexually Active Adolescent Patient.

Tubo-ovarian abscesses (TOA) are commonly associated with pelvic inflammatory disease (PID) caused by sexually transmitted infections (STI). There have been several reports of adolescent non-sexually active female patients diagnosed with TOAs. Symptoms of TOAs often mimic appendicitis and have often been diagnosed as such. We present a case of a 12-year-old non-sexually active adolescent who was initially diagnosed with ruptured appendicitis and found to have a TOA engulfing the appendix.

Association of Public Works Disasters with Substance Use Difficulties: Evidence from Flint, Michigan, Five Years after the Water Crisis Onset.

Public works environmental disasters such as the Flint water crisis typically occur in disenfranchised communities with municipal disinvestment and co-occurring risks for poor mental health (poverty, social disconnection). We evaluated the long-term interplay of the crisis and these factors with substance use difficulties five years after the crisis onset. A household probability sample of 1970 adults living in Flint during the crisis was surveyed about their crisis experiences, use of substances since the crisis, and risk/resilience factors, including prior potentially traumatic event exposure and current social support. Analyses were weighted to produce population-representative estimates. Of the survey respondents, 17.0% reported that substance use since the crisis contributed to problems with their home, work, or social lives, including 11.2% who used despite a doctor's warnings that it would harm their health, 12.3% who used while working or going to school, and 10.7% who experienced blackouts after heavy use. A total of 61.6% of respondents reported using alcohol since the crisis, 32.4% using cannabis, and 5.2% using heroin, methamphetamine, or non-prescribed prescription opioids. Respondents who believed that exposure to contaminated water harmed their physical health were more likely to use substances to the detriment of their daily lives (RR = 1.32, 95%CI: 1.03-1.70), as were respondents with prior potentially traumatic exposure (RR = 2.99, 95%CI: 1.90-4.71), low social support (RR = 1.94, 95%CI: 1.41-2.66), and PTSD and depression (RR's of 1.78 and 1.49, respectively, p-values < 0.01). Public works disasters occurring in disenfranchised communities may have complex, long-term associations with substance use difficulties.

Indocyanine Green in Bariatric Surgery: a Systematic Review.

Indocyanine green (ICG) is a fluorescent dye that can be used intraoperatively to assess tissue perfusion, as well as perform leak testing. This study aims to summarize published manuscripts on outcomes of ICG use and reduction of complications compared to traditional leak test and tissue perfusion evaluation. A PubMed search using "ICG and bariatric surgery," "ICG and gastric sleeve," "ICG and gastric bypass," and "ICG and revisional bariatric surgery" was performed. The proportion of patients who underwent an intraoperative decision change due to ICG was 3.8% (95% CI: 2.0 to 7.2%). ICG fluorescent imaging in bariatric surgery is a valuable tool, and further studies are needed to confirm its utility for routine use in both standard or complex cases (PROSPERO #418126).

Process development of a SARS-CoV-2 nanoparticle vaccine.

One of the outcomes from the global COVID-19 pandemic caused by SARS-CoV-2 has been an acceleration of development timelines to provide treatments in a timely manner. For example, it has recently been demonstrated that the development of monoclonal antibody therapeutics from vector construction to IND submission can be achieved in five to six months rather than the traditional ten-to-twelve-month timeline using CHO cells [1], [2]. This timeline is predicated on leveraging existing, robust platforms for upstream and downstream processes, analytical methods, and formulation. These platforms also reduce; the requirement for ancillary studies such as cell line stability, or long-term product stability studies. Timeline duration was further reduced by employing a transient cell line for early material supply and using a stable cell pool to manufacture toxicology study materials. The development of non-antibody biologics utilizing traditional biomanufacturing processes in CHO cells within a similar timeline presents additional challenges, such as the lack of platform processes and additional analytical assay development. In this manuscript, we describe the rapid development of a robust and reproducible process for a two-component self-assembling protein nanoparticle vaccine for SARS-CoV-2. Our work has demonstrated a successful academia-industry partnership model that responded to the COVID-19 global pandemic quickly and efficiently and could improve our preparedness for future pandemic threats.

Predicting European cities' climate mitigation performance using machine learning.

Although cities have risen to prominence as climate actors, emissions' data scarcity has been the primary challenge to evaluating their performance. Here we develop a scalable, replicable machine learning approach for evaluating the mitigation performance for nearly all local administrative areas in Europe from 2001-2018. By combining publicly available, spatially explicit environmental and socio-economic data with self-reported emissions data from European cities, we predict annual carbon dioxide emissions to explore trends in city-scale mitigation performance. We find that European cities participating in transnational climate initiatives have likely decreased emissions since 2001, with slightly more than half likely to have achieved their 2020 emissions reduction target. Cities who report emissions data are more likely to have achieved greater reductions than those who fail to report any data. Despite its limitations, our model provides a replicable, scalable starting point for understanding city-level climate emissions mitigation performance.

Disproportionate exposure to urban heat island intensity across major US cities.

Urban heat stress poses a major risk to public health. Case studies of individual cities suggest that heat exposure, like other environmental stressors, may be unequally distributed across income groups. There is little evidence, however, as to whether such disparities are pervasive. We combine surface urban heat island (SUHI) data, a proxy for isolating the urban contribution to additional heat exposure in built environments, with census tract-level demographic data to answer these questions for summer days, when heat exposure is likely to be at a maximum. We find that the average person of color lives in a census tract with higher SUHI intensity than non-Hispanic whites in all but 6 of the 175 largest urbanized areas in the continental United States. A similar pattern emerges for people living in households below the poverty line relative to those at more than two times the poverty line.

CABG versus PCI in the Treatment of Unprotected Left Main Disease in Diabetics: A Literature Review.

The approach to left main coronary artery disease (CAD) in diabetic patients has been extensively debated. Diabetic patients have an elevated risk of left main disease in addition to multivessel disease. Previous trials have shown increased revascularization rates in percutaneous coronary intervention compared with coronary artery bypass grafting (CABG) but overall comparable outcomes, although many of these studies were not using the latest stent technology or CABG with arterial revascularization. Our aim is to review the most recent trials that have recently published long-term follow-up, as well as other literature pertaining to left main disease in diabetic patients. Furthermore, we will be discussing some future treatment strategies that could likely create a paradigm shift in how left main CAD is managed.

Next-Generation Digital Ecosystem for Climate Data Mining and Knowledge Discovery: A Review of Digital Data Collection Technologies.

Climate change has been called "the defining challenge of our age" and yet the global community lacks adequate information to understand whether actions to address it are succeeding or failing to mitigate it. The emergence of technologies such as earth observation (EO) and Internet-of-Things (IoT) promises to provide new advances in data collection for monitoring climate change mitigation, particularly where traditional means of data exploration and analysis, such as government-led statistical census efforts, are costly and time consuming. In this review article, we examine the extent to which digital data technologies, such as EO (e.g., remote sensing satellites, unmanned aerial vehicles or UAVs, generally from space) and IoT (e.g., smart meters, sensors, and actuators, generally from the ground) can address existing gaps that impede efforts to evaluate progress toward global climate change mitigation. We argue that there is underexplored potential for EO and IoT to advance large-scale data generation that can be translated to improve climate change data collection. Finally, we discuss how a system employing digital data collection technologies could leverage advances in distributed ledger technologies to address concerns of transparency, privacy, and data governance.

ClimActor, harmonized transnational data on climate network participation by city and regional governments.

Cities and regions have become increasingly engaged in global climate change governance. They are pledging their own climate mitigation targets and participating in membership networks that typically are transnational in nature and engage thousands of subnational governments. Researching these growing trends in participation has been difficult due to the disparate and inconsistent nature of this self-reported data. To facilitate future analyses of these actors, we introduce ClimActor, the largest harmonized global dataset of more than 10,000 city and regional governments participating in networks like the Global Covenant of Mayors for Climate and Energy, C40 Cities for Climate Leadership, ICLEI Local Leaders for Sustainability, among others. We include key contextual information on each actor's population, geographic location, and administrative jurisdiction to facilitate disambiguation of potential overlaps in actions or emissions. We also provide a series of cleaning functions based on phonetic and fuzzy string matching algorithms within an open-source R package to make it easy for anyone to immediately use the ClimActor dataset with other relevant data.

Bariatric surgery is associated with reduction in non-alcoholic steatohepatitis and hepatocellular carcinoma: A propensity matched analysis.

INTRODUCTION: Obesity is a risk factor for non-alcoholic steatohepatitis (NASH) and hepatocellular carcinoma (HCC). Bariatric surgery can provide durable weight-loss, but little is known about the later development of NASH and HCC after surgery. METHODS: Bariatric surgery (n = 3,410) and obese controls (n = 46,873) from an institutional data repository were propensity score matched 1:1 by demographics, comorbidities, BMI, and socioeconomic factors. Comparisons were made through paired univariate analysis and conditional logistic regression. RESULTS: Total of 4,112 patients were well matched with no significant baseline differences except initial BMI (49.0 vs 48.2, p = 0.04). Bariatric group demonstrated fewer new-onset NASH (6 0.0% vs 10.3%, p < 0.0001) and HCC (0.05% vs 0.34%, p = 0.03) over a median follow-up of 7.1 years. After risk-adjustment, bariatric surgery was independently associated with reduced development of NASH (OR 0.52, p < 0.0001). CONCLUSIONS: Bariatric surgery is associated with reduced incidence of NASH and HCC in this large propensity matched cohort. This further supports the use of bariatric surgery for morbidly obese patients to ameliorate NASH cirrhosis and development of HCC.

Effect of timing on endovascular therapy and exploratory laparotomy outcome in acute mesenteric ischemia.

BACKGROUND: Abdominal exploration followed by vascular bypass has been the standard of care for acute mesenteric ischemia (AMI), but there is increasing use of endovascular treatment with selective exploratory laparotomy. METHODS: We performed a retrospective review of patients diagnosed with AMI who underwent mesenteric artery angioplasty or stenting at a single institution from 2010-2017. Patients were divided into 3 groups: those who did not undergo exploratory laparotomy; those who received endovascular treatment before laparotomy (post-reperfusion laparotomy group); and those who had endovascular treatment after laparotomy (pre-reperfusion laparotomy group). RESULTS: Patients who did not undergo exploratory laparotomy showed 85.7% (12/14) survival, compared with 63.6% (7/11) in the post-reperfusion group and 25.0% (2/8) in the pre-reperfusion group, P=0.077). Time to reperfusion was significant (P=0.009) in predicting survival for patients who underwent exploratory laparotomy. CONCLUSION: Emergent endovascular treatment prior to laparotomy seems to be associated with a higher survival.