Evolution of concomitant use of veno-arterial extracorporeal membrane oxygenation support with Impella in cardiogenic shock: From percutaneous femoral Impella to axillary Impella 5.5.

BACKGROUND: Little is known about safety and efficacy of the use of Impella 5.5 compared to previous iterations in the setting of Impella with Veno-Arterial Extracorporeal Membrane Oxygenation Support as ECPELLA. METHODS: Consecutive patients who were treated by ECPELLA with surgically implanted axillary Impella 5.5 (N = 13) were compared with patients supported by ECPELLA with percutaneous femoral Impella CP or 2.5 (Control, N = 13). RESULTS: The total ECPELLA flow was higher in ECPELLA 5.5 group (6.9 vs. 5.4 L/min, p = 0.019). Actual hospital survival was higher than predicted and comparable in both groups (ECPELLA 5.5, 61.5% vs. Control, 53.8%, p = 0.691). Both total device complications (ECPELLA 5.5, 7.7% vs. Control, 46.1%, p = 0.021) and Impella-specific complications (ECPELLA 5.5, 0% vs. Control, 30.8%, p = 0.012) were significantly lower in the ECPELLA 5.5 group. CONCLUSIONS: Utilization of Impella 5.5 in the setting of ECPELLA provides greater hemodynamic support with a lower risk of complications compared to Impella CP or 2.5.

Aortic Reoperation After Prior Acute Type A Aortic Dissection Repair: Don't Despair the Repair.

BACKGROUND: There is paucity of data regarding reoperation after acute type A aortic dissection (ATAD) repair. METHODS: From October 2006 to March 2022, 75 patients received 123 reoperations after ATAD (proximal, n = 17; distal, n = 103; and both, n = 3) utilizing redo sternotomy (RS, n = 68), left thoracotomy (LT, n = 44), and endovascular approach (TEVAR, n = 11). The axillary artery cannulation was utilized in 97.1% of the RS cases. A classic elephant trunk technique was used as a 2-staged procedure for distal pathology. Most LT repairs (95.5%) were completed above the celiac axis. RESULTS: Index ATAD repairs were predominantly ascending/hemiarch repair (73.3%). The median duration from the index repair was 2.0 years. Most reoperations were elective procedures (82.1%). Hospital mortality was 2.4% (RS, 1.5%; LT, 4.5%; TEVAR, 0%), and the stroke rate was 1.6%. There was no spinal cord ischemia. The 5-year overall survival and freedom from aortic mortality or procedure were 85.2% ± 5.6% and 80.6% ± 6.1%, respectively. There were 7 distal reinterventions (prior TEVAR, n = 3; prior LT, n = 4). Two patients required LT repair after prior TEVAR and 3 patients received infrarenal aortic repair after prior LT repair. Computed tomography after completion of the distal repair (n = 45) showed an increase of distal aorta at each level as follows: celiac axis 1.2 mm/y; renal artery 1.0 mm/y; and terminal aorta 1.2 mm/y. CONCLUSIONS: Reoperation after ATAD repair can be safely performed as an elective procedure at experienced centers. Staged distal interventions utilizing classic elephant trunk insertion and open repair above the celiac axis showed durable outcomes.

3†Emergency salvage of time expired clinical corneas during the COVID-19 pandemic.

INTRODUCTION: Corneas for clinical use can be stored for a maximum of 28 days in organ culture medium after death. At the beginning of the COVID-19 pandemic in 2020 it became apparent that; a rare situation was arising in that clinical operations were being cancelled and that there would be a surplus of "clinical grade" corneas. Consequently, when the corneas reached the end of the storage period, if the tissue had appropriate consent, they were transferred to the Research Tissue Bank (RTB). However, University research had also stopped due to the pandemic and there was a situation where the RTB had good quality tissue without any users. Rather than discarding the tissue, a decision was made to store the tissue for future use by cryopreservation. MATERIALS AND METHODS: An established protocol for cryopreserving heart valves was adapted. Individual corneas were placed into wax histology cassettes then inside a Hemofreeze heart valve cryopreservation bag with 100 ml cryopreservation medium (10% Dimethyl sulphoxide)). They were frozen in a controlled rate freezer (Planer, UK) to below -150oC and stored in vapour phase over liquid nitrogen (VPLN) below -190oC. To assess morphology, six corneas were cut in half, one half was processed for histology whilst the other half was cryopreserved, stored for 1 week then thawed and processed for histology. The stains used were Haematoxylin and Eosin (H&E) and Miller's with Elastic Van Gieson (EVG). RESULTS: Comparative histological examination indicated that there were no visible, major, detrimental changes in morphology in the cryopreserved group as compared to the controls. Subsequently, a further, 144 corneas were cryopreserved. Samples were assessed for handling properties by eye bank technicians and ophthalmologists. The eye bank technicians felt that the corneas may be suitable for training purposes such a DSAEK or DMEK. The ophthalmologists said that they had no preference between the fresh or cryopreserved corneas, and both would be equally suitable for training purposes. CONCLUSION: Time expired, organ-cultured corneas, can be successfully cryopreserved using an established protocol by adapting the storage container and conditions. These corneas are suitable for training purposes and may prevent discard of corneas in future.

9†Supply of non-clinical ocular tissue from a tissue and eye services research tissue bank.

INTRODUCTION: NHS Blood and Transplant Tissue and Eye Services (TES) is a human multi-tissue, tissue bank supplying tissue for transplant to surgeons throughout the UK. In addition, TES provides a service to scientists, clinicians and tissue bankers by providing a range of non-clinical tissue for research, training and education purposes. A large proportion of the non-clinical tissues supplied is ocular tissue ranging from whole eyes, to corneas, conjunctiva, lens and posterior segments remaining after the cornea is excised. The TES Research Tissue Bank (RTB) is based within the TES Tissue Bank in Speke, Liverpool and is staffed by two full-time staff. Non-clinical tissue is retrieved by Tissue and Organ Donation teams across United Kingdom. The RTB works very closely with two eye banks within TES, the David Lucas Eye Bank in Liverpool and the Filton Eye Bank in Bristol. Non-clinical ocular tissues are primarily consented by TES National Referral Centre Nurses. METHODS AND RESULTS: The RTB receives tissue via two pathways. The first pathway is tissue specifically consented and retrieved for non-clinical use and the second pathway is tissue that becomes available when tissue is found to be unsuitable for clinical use. The majority of the tissue that the RTB receives from the eye banks comes via the second pathway. In 2021, the RTB issued more than 1000 samples of non-clinical ocular tissue. The majority of the tissue, ~64% was issued for research purposes (including research into glaucoma, COVID-19, paediatrics and transplant research), ~31% was issued for clinical training purposes (DMEK and DSAEK preparation, especially after COVID-19 cessation of transplant operations, training for new eye bank staff) and ~5% was issued for in-house and validation purposes. One of the findings was that corneas are still suitable for training purposes up to 6-months after removal from the eye.In 2021, the RTB received 43 applications for ocular projects from new customers and supplied to 36 different projects, meeting 95% of all orders placed this year. DISCUSSION: The RTB works to a partial cost-recovery system and in 2021 became self-sufficient. The supply of non-clinical tissue is crucial for advancement in patient care and has contributed to several peer-reviewed publications.

Androgen Receptor Is Dispensable for X-Zone Regression in the Female Adrenal but Regulates Post-Partum Corticosterone Levels and Protects Cortex Integrity.

Adrenal androgens are fundamental mediators of ovarian folliculogenesis, embryonic implantation, and breast development. Although adrenal androgen function in target tissues are well characterized, there is little research covering the role of androgen-signaling within the adrenal itself. Adrenal glands express AR which is essential for the regression of the X-zone in male mice. Female mice also undergo X-zone regression during their first pregnancy, however whether this is also controlled by AR signaling is unknown. To understand the role of the androgen receptor (AR) in the female adrenal, we utilized a Cyp11a1-Cre to specifically ablate AR from the mouse adrenal cortex. Results show that AR-signaling is dispensable for adrenal gland development in females, and for X-zone regression during pregnancy, but is required to suppress elevation of corticosterone levels post-partum. Additionally, following disruption to adrenal AR, aberrant spindle cell development is observed in young adult females. These results demonstrate sexually dimorphic regulation of the adrenal X-zone by AR and point to dysfunctional adrenal androgen signaling as a possible mechanism in the early development of adrenal spindle cell hyperplasia.

Dissection by genomic and plumage variation of a geographically complex hybrid zone between two Australian non-sister parrot species, Platycercus adscitus and Platycercus eximius.

The study of hybrid zones advances understanding of the speciation process, and approaches incorporating genomic data are increasingly used to draw significant conclusions about the impact of hybridisation. Despite the progress made, the complex interplay of factors that can lead to substantially variable hybridisation outcomes are still not well understood, and many systems and/or groups remain comparatively poorly studied. Our study aims to broaden the literature on avian hybrid zones, investigating a potentially geographically and temporally complex putative hybrid zone between two native Australian non-sister parrot species, the pale-headed and eastern rosellas (Platycercus adscitus and Platycercus eximius, respectively). We analysed six plumage traits and >1400 RADseq loci and detected hybrid individuals and an unexpectedly complex geographic structure. The hybrid zone is larger than previously described due to either observer bias or its movement over recent decades. It comprises different subregions where genetic and plumage signals of admixture vary markedly in their concordance. Evidence of contemporary hybridisation (later generation and backcrossed individuals) both within and beyond the previously defined zone, when coupled with a lack of F1 hybrids and differential patterns of introgression among potentially diagnostic loci, indicates a lack of post-zygotic barriers to gene flow between species. Despite ongoing gene flow, species boundaries are likely maintained largely by strong pre-mating barriers. These findings are discussed in detail and future avenues for research into this system are proposed, which would be of benefit to the speciation and hybrid zone literature.

Delivering sustainable infrastructure that supports the urban built environment.

Sustainable living will require megacity-level infrastructural support designs and paradigms.

A double exponential model for biochemical oxygen demand.

Biochemical oxygen demand (BOD) exertion patterns in anaerobically treated farm dairy wastewater were investigated on a laboratory scale. Oxygen uptake was typically characterised by a period of rapid oxygen exertion, a transitional "shoulder" phase and a period of slower activity. A multi-species model, involving rapidly degradable and slowly degradable material, was developed, leading to a double exponential model of BOD exertion as follows:where t is time, BOD(u1)(') and BOD(u2)(') are apparent ultimate BOD (BOD(u)) values, and k(1) and k(2) are rate constants. The model provided an improved description of BOD exertion patterns in anaerobically treated farm dairy wastewater in comparison to a conventional single exponential model, with rapidly degradable rate constant values (k(1)) ranging from 2.74 to 17.36d(-1), whilst slowly degradable rate constant values (k(2)) averaged 0.25d(-1) (range 0.20-0.29). Rapidly and slowly degradable apparent BOD(u) estimates ranged from 20 to 140g/m(3) and 225 to 500g/m(3), respectively, giving total BOD(u) levels of 265-620g/m(3). The mean square error in the curve fitting procedure ranged between 20 and 60g(2)/m(6), with values on average 70% lower (range 31-91%) than those obtained for the single exponential model. When applied to existing data for a range of other wastewaters, the double exponential model demonstrated a superior fit to the conventional single exponential model and provided a marginally better fit than a mixed order model. It is proposed that the presence of rapidly degradable material may be indicated from the value of the first rate constant (k1) and the time to 95% saturation of the first exponential function. Further model development is required to describe observed transitional and lag phases.

Efficacy of selamectin in the treatment and control of clinical signs of flea allergy dermatitis in dogs and cats experimentally infested with fleas.

OBJECTIVE: To determine whether treatment with selamectin would reduce clinical signs of flea allergy dermatitis (FAD) in dogs and cats housed in flea-infested environments. DESIGN: Randomized controlled trial. ANIMALS: 22 dogs and 17 cats confirmed to have FAD. PROCEDURE: Animals were housed in carpeted pens capable of supporting the flea life cycle and infested with 100 fleas (Ctenocephalides felis) on days -13 and -2 and on alternate weeks with 10 to 20 fleas. On day 0, 11 dogs and 8 cats were treated with selamectin (6 mg/kg [2.7 mg/lb]). Dogs were retreated on day 30; cats were retreated on days 30 and 60. All animals were examined periodically for clinical signs of FAD. Flea counts were conducted at weekly intervals. RESULTS: Throughout the study, geometric mean flea counts exceeded 100 for control animals and were < or = 11 for selamectin-treated animals. Selamectin-treated cats had significant improvements in the severity of miliary lesions and scaling or crusting on days 42 and 84, compared with conditions on day -8, and in severity of excoriation on day 42. In contrast, control cats did not have any significant improvements in any of the clinical signs of FAD. Selamectin-treated dogs had significant improvements in all clinical signs on days 28 and 61, but in control dogs, severity of clinical signs of FAD was not significantly different from baseline severity at any time. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that topical administration of selamectin, even without the use of supplementary environmental control measures and with minimal therapeutic intervention, can reduce the severity of clinical signs of FAD in dogs and cats.

A review of the biology of canine skin with respect to the commensals Staphylococcus intermedins, Demodex canis and Malassezia pachydermatis.

Abstract Skin disease associated with the cutaneous commensal organisms Staphylococcus intermedius, Malassezia pachydermatis and Demodex canis is frequently encountered in veterinary medicine. In treatment the aim is elimination of the commensal, but recurrence of skin disease is not unusual. In this review, these potentially pathogenic commensals and their ecology are discussed with particular reference to skin biology and the surface ecosystem. The strategies employed by the micro-organisms for survival and the defence mechanisms of the host are considered. Disease occurs when the virulence of the commensal overwhelms the resistance of the host. It is hoped that an understanding of the complex nature of the skin and its commensals will lead to a better understanding of those diseases associated with commensals and in consequence more effective treatment. Résumé- Les dermatoses associées aux organismes commensaux cutanés Staphylococcus intermedius, Malassezia pachydermatis et Demodex canis sont fréquentes en médecine vétérinaire. Le traitement vise àéliminer le commensal, mais les récidives sont fréquentes. Dans cet article, les commensaux potentiellement pathogènes et leur écologie sont discutés avec une référence particulière à la biologie cutanée et à l'écosystème de surface. Les stratégies employées par les microorganismes pour survivre et les mécanismes de défense de l'hote sont présentés. La pathologie se développe lorsque la virulence du commensal outrepasse la résistance de l'hote. Il faut espérer que la compréhension de la nature complexe de la peau et de ses commensaux, permettent une meilleure compréhension des pathologies associées à ces commensaux et par conséquent un traitement plus efficace. [Mason, I. S., Mason, K. V., Lloyd, D. H. A review of the biology of canine skin with respect to the commensals Staphylococcus intermedius, Demodex canis and Malassezia pachydermatis (Une revue de la biologie de la peau concernant les commensaux Staphylococcus intermedius, Demodex canis et Malassezia pachydermatis). Veterinary Dermatology 1996; 7: 119-132.] Resumen En medicina veterinaria son frecuentes las dermatopatías asociadas a los microorganismos comensales Staphylococcus intermedius, Demodex canis y Malassezia pachydermatis. El tratamiento busca la eliminatión del comensal, aunque no son raras las recidivas. En esta revisión se discute la ecología de estos comensales potencialmente patógenos, con especial énfasis en la biologia cutánea y el ecosistema superficial. Se tienen en cuenta las estrategias para la supervivencia utilizadas por los microorganismos y los mecanismos de defensa del huésped. La enfernedad se desarrolla cuando la virulencia del comensal supera la resistencia del huésped. Se espera que el mejor conocimiento de la naturaleza compleja de la piel y de sus comensales llevará a un mejor conocimiento de las enfermedades asociadas a los comensales y, consecuentemente, a un tratamiento más efectivo. [Mason, I. S., Mason, K. V., Lloyd, D. H. A review of the biology of canine skin with respect to the commensals Staphylococcus intermedius, Demodex canis and Malassezia pachydermatis (Revision de la biologia cutánea con respecto a los comensales Staphylococcus intermedius, Demodex canis y Malassezia pachydermatis). Veterinary Dermatology 1996; 7: 119-132.] Zusammenfassung- Hauterkrankungen in Verbindung mit den kutanen, kommensalen Organismen Staphylococcu intermedius, Malassezia pachydermatis und Demodex canis werden in der Veterinärmedizin häufig angetroffen. Das Ziel der Behandlung ist die Elimination der Kommensalen, aber die Rezidivierung der Hauterkrankung ist nicht ungewöhnlich. In dieser Übersicht werden diese potentiell pathogenen Kommensalen und ihre Ökologie mit speziellem Bezug zur Biologie der Haut und des Ober-flächenökosystems diskutiert. Die Überlebensstrategien dieser Mikroorganismen und die Abwehrmechanismen des Wirtes werden berücksichtigt. Eine Erkrankung tritt auf, wenn die Virulenz des Kommensal die Widerstandskraft des Wirtes übertrifft. Man hofft, daß das Verstehen der komplexen Natur der Haut und ihrer Kommensalen zum besserem Verständnis dieser mit den Kommensalen verbundenen Krankheiten und damit in der Folge zu wirksamerer Behandlung führt. [Mason, I.S., Mason, K.V., Lloyd, D.H. A review of the biology of canine skin with respect to the commensals Staphylococcus intermedius, Demodex canis and Malassezia pachydermatis (Übersicht über die Biologie der Haut des Hundes mit Berücksichtigung der Kommensalen Staphylococcus intermedius, Demodex canis und Malassezia pachydermatis). Veterinary Dermatology 1996; 7: 119-132.].

Evaluation of compound 48/80 as a model of immediate hypersensitivity in the skin of dogs.

Abstract The macroscopic and histological effects of intradermal injection of compound 48/80 were investigated in dogs. Dose-dependent increases in skin-fold thickness were induced at injection sites and histopathological examination of skin biopsy specimens revealed evidence of mast cell degranulation and cellular infiltration. Intradermal compound 48/80 may form a useful model for studies of canine hypersensitivity disorders including atopic dermatitis. Résumé- Les effets macroscopiques et histologiques de l'injection intradermique du composé 48/80 ont étéétudiés chez le chien. Une augmentation dose-dépendante de l'épaisseur du pli de peau a été induite au niveau des points d'injection et l'examen histopathologique de biopsies cutanées a démontré une dégranulation mastocytaire et une infiltration cellulaire. L'injection du composé 48/80 peut constituer un modèle utile pour l'étude de réactions d'hypersensibilité chez le chien, comme la dermatite atopique. [Mason, I., Lloyd, D. Evaluation of compound 48/80 as a skin model of immediate hypersensitivity in the skin of dogs (Evaluation du compose 48/80 comme modele d'hypersensibilité cutanee immediate chez le chien). Veterinary Dermatology 1996; 7: 81-83.] Resumen Se investigaron los efectos macroscópicos e histológicos de la inyección intradérmica del compuesto 48/80. Estas inyecciones provocaron engrosamiento del grosor cutáneo proporcional a la dosis administrada y el examen histopatológico de biopsias cutáneas reveló degranulación de mastocitos e infiltración celular. El compuesto 48/80 puede constituir un modelo útil para el estudio de las hipersensibilidades caninas, incluyendo la dermatitis atópica. [Mason, I., Lloyd, D. Evaluation of compound 48/80 as a skin model of immediate hypersensitivity in the skin of dogs (Evaluación del compuesto 48/80 como modelo de hipersensibilidad inmediata en la piel del perro). Veterinary Dermatology 1996; 7: 81-83.] Zusammenfassung- Die makroskopischen und histologischen Auswirkungen der intradermalen Injektion von Compound 48/80 wurden bei Hunden untersucht. Dosisabhängige Anstiege in der hautfaltendicke wurden an den Injektionsstellen induziert. Die histopathologische Untersuchung von Hautbioptaten zeigte das Auftreten von Mastzelldegranulation und zellulärer Infiltration. Intradermales Compound 48/80 könnte ein nützliches Modell für Untersuchungen kaniner Hypersensibilitätsprobleme einschließlich der atopischen Dermatitis darstellen. [Mason, I., Lloyd, D. Evaluation of com-pound 48/80 as a skin model of immediate hypersensitivity in the skin of dogs (Die Auswertung von compound 48/80 als Modell für die sofortige hypersensibilität in der haut des hundes). Veterinary Dermatology 1996; 7: 81-83.].

The Macroscopic and Microscopic Effects of Intradermal Injection of Crude and Purified Staphylococcal Extracts on Canine Skin.

Abstract- Intradermal injection of staphylococcal protein A, and crude extracts of Staphylococcus intermedius and Staphylococcus aureus in normal dogs elicited dose-dependent increases in skin fold thickness. The most concentrated doses of S. inlermedius elicited a significantly greater response than the equivalent dose of S. aureus between 30 min and 4 h after injection (p < 0.05). This may be due to prior sensitisation or may indicate that S. intermedius is more virulent. At all other times and doses there was no significant difference between the two crude staphylococcal extracts. Histological examination indicated that while there were differences between the responses to the three extracts, all three elicited similar epidermal lesions (sub-corneal pustules, spongiosis and hyperplasia) and superficial perivascular dermatitis. A similar pattern of changes has been recorded in canine superficial pyoderma supporting the hypothesis that penetration of staphylococcal products into the dermis is involved in the pathogenesis of the lesions of pyoderma. Résumé- Des injections de Protéine A et d'extraits totaux de Staphylococcus intermedius et Staphylococcus aureus sur des chiens normaux entrainent des augmentations dose dépendantes du pli de peau et de l'érythème. La does plus concentrée de Staphycolococcus intermedius entrainent une réponse plus importante statistiquement significative que la réponse obtenue avec une concentration équivalente de Staphylococcus aureus entre 30 minutes et 4 heures après l'injection (p < 0,05). Ceci peut être due à une sensibilisation antérieure ou peut indiquer que Staphylococcus intermedius est plus virulent. Par contre, il n'existe pas de differences significatives entre les deux types d'extraits staphylocoques totaux à d'autres temps et concentrations. Les lesions histopathologiques montrent que tandis qu'il existe des differences entre les réponses aux trois extraits, tous les trois montrent des lesions épidermiques similaires (pustules sous cornées, spongiose et hyperplasie) et de dermatite périvasculaire superficielle. Des lesions semblables sont observées dans les pyodermites superficielles canines. Ceci conforte l'hypothèse que la penetration des produits staphylococciques dans le derme joue en role dans la pathogénie des lesions de pyodermite. [Mason, I. S., LLOyD, D. H. The macroscopic and microscopic effects of intradermal injection of crude and purified staphylococcal extracts on canine skin (Effects macroscopiques et microscopiques de l'injection intradermique d'extraits totaux et purifies staphylococciques sur la peau du chien.