Surgical therapy of celiac axis and superior mesenteric artery syndrome.

INTRODUCTION: Compression syndromes of the celiac artery (CAS) or superior mesenteric artery (SMAS) are rare conditions that are difficult to diagnose; optimal treatment remains complex, and symptoms often persist after surgery. We aim to review the literature on surgical treatment and postoperative outcome in CAS and SMAS syndrome. METHODS: A systematic literature review of medical literature databases on the surgical treatment of CAS and SMAS syndrome was performed from 2000 to 2022. Articles were included according to PROSPERO guidelines. The primary endpoint was the failure-to-treat rate, defined as persistence of symptoms at first follow-up. RESULTS: Twenty-three studies on CAS (n = 548) and 11 on SMAS (n = 168) undergoing surgery were included. Failure-to-treat rate was 28% for CAS and 21% for SMAS. Intraoperative blood loss was 95 ml (0-217) and 31 ml (21-50), respectively, and conversion rate was 4% in CAS patients and 0% for SMAS. Major postoperative morbidity was 2% for each group, and mortality was described in 0% of CAS and 0.4% of SMAS patients. Median length of stay was 3 days (1-12) for CAS and 5 days (1-10) for SMAS patients. Consequently, 47% of CAS and 5% of SMAS patients underwent subsequent interventions for persisting symptoms. CONCLUSION: Failure of surgical treatment was observed in up to every forth patient with a high rate of subsequent interventions. A thorough preoperative work-up with a careful patient selection is of paramount importance. Nevertheless, the surgical procedure was associated with a beneficial risk profile and can be performed minimally invasive.

Perspectives on rapid fentanyl test strips as a harm reduction practice among young adults who use drugs: a qualitative study.

BACKGROUND: In 2016, drug overdose deaths exceeded 64,000 in the United States, driven by a sixfold increase in deaths attributable to illicitly manufactured fentanyl. Rapid fentanyl test strips (FTS), used to detect fentanyl in illicit drugs, may help inform people who use drugs about their risk of fentanyl exposure prior to consumption. This qualitative study assessed perceptions of FTS among young adults. METHODS: From May to September 2017, we recruited a convenience sample of 93 young adults in Rhode Island (age 18-35 years) with self-reported drug use in the past 30 days to participate in a pilot study aimed at better understanding perspectives of using take-home FTS for personal use. Participants completed a baseline quantitative survey, then completed a training to learn how to use the FTS. Participants then received ten FTS for personal use and were asked to return 2-4 weeks later to complete a brief quantitative and structured qualitative interview. Interviews were transcribed, coded, and double coded in NVivo (Version 11). RESULTS: Of the 81 (87%) participants who returned for follow-up, the majority (n = 62, 77%) used at least one FTS, and of those, a majority found them to be useful and straightforward to use. Positive FTS results led some participants to alter their drug use behaviors, including discarding their drug supply, using with someone else, and keeping naloxone nearby. Participants also reported giving FTS to friends who they felt were at high risk for fentanyl exposure. CONCLUSION: These findings provide important perspectives on the use of FTS among young adults who use drugs. Given the high level of acceptability and behavioral changes reported by study participants, FTS may be a useful harm reduction intervention to reduce fentanyl overdose risk among this population. TRIAL REGISTRATION: The study protocol is registered with the US National Library of Medicine, Identifier NCT03373825, 12/24/2017, registered retrospectively. https://clinicaltrials.gov/ct2/show/NCT03373825?id=NCT03373825&rank=1.

[Isolated iliac artery aneurysms : Interventional treatment]. / Isolierte Aneurysmen der Iliakalarterien : Interventionelle Therapie.

CLINICAL ISSUE: Isolated iliac artery aneurysms occur considerably less often than abdominal aortic aneurysms. Mainly older men are affected by this disease. Most of these aneurysms are asymptomatic and are incidentally detected during cross-sectional imaging. Iliac aneurysms with a diameter larger than 3 cm are at risk for rupture, which is associated with high morbidity and mortality. STANDARD TREATMENT: To prevent their rupture as well as for symptomatic or ruptured aneurysms, endovascular treatment has recently been established as the primary approach due to the decreased morbidity and mortality compared to open repair. Endovascular aneurysm exclusion is performed with stent grafts, and depending on the anatomy, by adjunctive internal iliac artery embolization. TREATMENT INNOVATIONS: Up to a quarter of treated patients will require additional endovascular revisions during the long term. Reliable imaging follow-up likely increases the safety of elective or emergent endovascular iliac artery aneurysm repair.

Ordinary injury, big surprise - Traumatic false aneurysm and arteriovenous fistula of the posterior tibial artery after civilian trauma: A case report.

INTRODUCTION: False traumatic aneurysm (FTA) or pseudoaneurysm and traumatic arteriovenous fistulas (TAVF) are rare pathologies in civilian trauma and mainly result from stabs or gunshot wounds. The posterior tibial artery as site of trauma is very rare. PRESENTATION OF CASE: We report on a 39-year old female patient who was suffering from combined FTA and TAVF of the posterior tibial artery after falling into a wine glass. CT-imaging as well as duplex ultrasound and selective arteriography were performed, and two stent-grafts were inserted. DISCUSSION: Based on the presented case, incidence of the described pathology, treatment options and outcomes are discussed. CONCLUSION: Adequate imaging in penetrating wounds to the extremities is crucial in order to provide diagnosis and treatment of concomitant lesions.

Mitral annular disjunction in patients with severe aortic stenosis: Extent and reproducibility of measurements with computed tomography.

OBJECTIVES: To determine with CT the prevalence and extent of mitral annular disjunction (MAD) in patients undergoing transcatheter aortic valve replacement (TAVR) and its association with mitral valve disease and arrhythmia. METHODS: We retrospectively evaluated 408 patients (median age, 82 years; 186 females) with severe aortic stenosis undergoing ECG-gated cardiac CT with end-systolic data acquisition. Baseline and follow-up data were collected in the context of a national registry. Two blinded, independent observers evaluated the presence of MAD on multi-planar reformations. Maximum MAD distance (left atrial wall-mitral leaflet junction to left ventricular myocardium) and circumferential extent of MAD were assessed on CT using dedicated post-processing software. Associated mitral valve disease was determined with echocardiography. RESULTS: 7.8 % (32/408) of patients with severe aortic stenosis had MAD. The maximum MAD was 3.5 mm (interquartile range: 3.0-4.0 mm). The circumferential extent of MAD comprised 34 ±â€¯15 % of the posterior and 26 ±â€¯12 % of the entire mitral annulus. Intra- and interobserver agreement for the detection of MAD on CT were excellent (kappa: 0.90 ±â€¯0.02 and 0.92 ±â€¯0.02). Mitral regurgitation (p = 1.00) and severe mitral annular calcification (p = 0.29) were similarly prevalent in MAD and non-MAD patients. Significantly more patients with MAD (6/32; 19 %) had mitral valve prolapse compared to those without (6/376; 2 %; p < 0.001). MAD was not associated with arrhythmia before and after TAVR (p > 0.05). CONCLUSIONS: Using CT, MAD was found in 7.8 % of patients with severe aortic stenosis, with a higher prevalence in patients with mitral valve prolapse. We found no association of MAD with arrhythmia before or after TAVR.

Converting tissue plasminogen activator to a zymogen: a regulatory triad of Asp-His-Ser.

Unlike most serine proteases of the chymotrypsin family, tissue-type plasminogen activator (tPA) is secreted from cells as an active, single-chain enzyme with a catalytic efficiency only slightly lower than that of the proteolytically cleaved form. A zymogenic mutant of tPA has been engineered that displays a reduction in catalytic efficiency by a factor of 141 in the single-chain form while retaining full activity in the cleaved form. The residues introduced in the mutant, serine 292 and histidine 305, are proposed to form a hydrogen-bonded network with aspartate 477, similar to the aspartate 194-histidine 40-serine 32 network found to stabilize the zymogen chymotrypsinogen.

Comparison of two different meat inspection techniques.

Field studies of meat inspection procedures in three different slaughter houses were performed in Germany, in 1996. In total 22,634 fattening pigs from 63 farms were inspected twice, using a visual and the traditional (mandatory inspection system) procedure. Statistical analysis was performed using the rate of ND+ (Non-Detected Positives) for both visual and traditional inspection. Neither the visual nor the traditional methods detected all lesions which were supposed to be in the lot of animals inspected. Some of the results could be explained by the nature and obviousness of the respective lesion. Conclusions regarding the future performance of inspection should not be drawn before a formal risk analysis procedure for the particular lesion has been done.

[Clinical evaluation of S6472 (prolonged action preparation of cefaclor) in the treatment of skin and soft tissue infections. A double blind comparison of S6472 and cefaclor].

A double-blind comparative study of S6472 and cefaclor (CCL) was conducted to evaluate the therapeutic efficacy, safety and usefulness in the treatment of skin and soft tissue infections. Either 750 mg b.i.d. of S6472 or 750 mg t.i.d. of CCL was administered orally to patients for a period of 7 consecutive days. Of the 250 cases (123 cases of S6472 group and 127 cases of CCL group) recruited in this trial, 228 cases (114 cases of S6472 and 114 cases of CCL) were adopted by the committee members for the evaluation of therapeutic efficacy, 238 cases (118 cases of S6472 group and 120 cases of CCL group) for usefulness, and 245 cases (121 cases of S6472 group and 124 cases of CCL group) were adopted for the evaluation of side effects. The backgrounds of both patients group were almost similar. The results obtained were as follows: Overall clinical effectiveness Of the 114 patients treated with S6472, excellent clinical responses were obtained in 11 patients, good in 79, fair in 19, poor in 5 (efficacy rate 78.9%), and of the 114 patients treated with CCL, excellent were in 16, good in 78, fair in 13, poor in 7 (efficacy rate 82.5%). There was no statistically significant difference between the 2 groups. Clinical effectiveness classified by initial severity and bacteriological efficacy There was no significant difference between the 2 groups in the clinical effectiveness classified by initial severity and in the bacteriological efficacy. Side effects were noticed in 5 patients of 121 treated with S6472 (4.1%) and in 2 patients of 124 treated with CCL (1.6%), and other 13 patients developed some abnormal laboratory findings. But these undesirable reactions were mild, and developed no significant difference between the 2 groups in the incidence of side effects. There was no significant difference between the 2 groups in the usefulness of the drugs. Conclusively, 750 mg b.i.d. of S6472 is anticipative of the same clinical efficacy, safety and usefulness as compared with that of 750 mg t.i.d. of CCL in the treatment of skin and soft tissue infections.

[Fundamental and clinical studies of a sustained release preparation of cefaclor in the surgical field].

Fundamental and clinical studies of S6472 (sustained release preparation of cefaclor (CCL] were conducted in the surgical field and it was confirmed that the preparation is a useful drug. The following is the summary of the results from the fundamental and clinical studies: In vitro antibacterial activity. CCL showed MICs of 0.78 to 6.25 micrograms/ml against almost strains of S. aureus, E. coli and Klebsiella isolated from surgical wound regions, and the antibacterial activities were stronger than those of cephalexin (CEX). Clinical efficacy. S6472 was orally administered to 33 patients with skin and soft tissue infections in 2 divided doses. As a result, excellent clinical response was observed in 13 patients, good response observed in 14 patients, fair in 4 and poor in 1. The clinical efficacy in 1 of the 33 patients was unknown. Overall clinical effective rate was 84.4%. Adverse reaction. In 2 patients, mild gastrointestinal symptoms were observed.

[Flock data reported from a poultry slaughter house (broilers)]. / Herdenbezogene Befunderhebungen im Geflügelschlachtbetrieb (Broiler).

Six broiler flocks have been compared with regard to the occurrence of attributes according to an examination protocol. Approved birds were scrutinized per random sample, condemned birds altogether. Parameters of examination were body weight occurring attributes (computed single and cumulated) count of dead and condemned birds in fattening period, transport and on slaughter line as well. Each flock was conspicuous in one or another respect. The graduation of the flocks was possible using the factors losses in the fattening period count of condemnation losses in the total production line coefficient of variation of weights attributes occurring in the meat inspection cumulated count of all attributes leading to condemnation. Results demonstrate, that graduation of different flocks by means of quantitative measurements is possible.

Microflora of two different types of poultry litter.

1. The microbiological composition of litter (straw and wood shavings) was sampled, prior to placing 1-d-old chicks, during housing of the birds and after depopulation. Two independent trials were conducted. 2. The total aerobic plate count (APC) was determined and the predominant microflora of the samples was identified using flow charts. 3. Before chick placement, the APC of wood shavings (about 4.0 log/g) was lower than the APC of straw (about log 7.5/g). With stocking, in both types of litter the APC increased to about log 9.76/g straw-litter and log 9.89/g wood shavings, respectively. After depopulation, the APC remained high (> log 9 in both types of litter) within the period of observation. 4. From both experiments, 1981 isolates were collected and identified, most of them were Gram-positive. During stocking the birds, the number of Gram-positive isolates (in particular Gram-positive irregular rods and Micrococcaceae) increased; after depopulation it stayed at that high value, whereas the number of Gram-negative isolates remained low. In both types of litter the isolates were obtained in a comparable proportion.

Ratification of broiler carcase condemnations in poultry meat inspection.

1. In the years 1985 to 1989 decisions (approvals and condemnations) made by poultry meat inspectors were examined by the individual reinspection of 26,815 broiler carcases. 2. The extent of agreement between inspection and revision ranged between 83.2 and 86.2%. 3. Agreement between inspectors and revisors was higher for the category of approved birds than for the condemned category. 4. Differences in the criteria used to assess the birds were observed. 5. The conclusion was drawn that findings in meat inspection require further discussion to reach an agreed standard.

Minimum inhibitory concentrations of intestinal Escherichia coli from broiler chickens after oral administration of apramycin.

This study describes the influence of apramycin on minimum inhibitory concentrations (MIC) of intestinal Escherichia coli in young broiler chickens, after oral administration of the antibiotic at a dosage equivalent to a prophylactic course of treatment for 10 d. The bacteria were isolated from cloacal swabs and caecal contents. MICs were determined by agar dilution procedures. MIC of apramycin for the investigated strains ranged from 1 microgram ml-1 to 16 micrograms ml-1. Strains obtained from undosed birds mainly had MIC values of 2 micrograms ml-1. MIC values of 8 micrograms ml-1 or more were recorded only among isolates obtained from chickens which had received apramycin. Administration of apramycin resulted in a slight but statistically significant increase in the average MIC. Statistically higher average MICs were recorded among isolates from cloacal swabs 10 d after withdrawal until the end of the experiment. For strains from caecal contents, this was demonstrated only on one sampling occasion, 15 d after withdrawal.

[Resistance to tetracycline of E. coli of chicken intestines after prophylactic treatment of animal feed with bioptivet GB]. / Tetracyclinresistenz von E. coli aus dem Geflügeldarm nach prophylaktischer Gabe des Fütterungsarzneimittels bioptivet GB.

This study describes the influence of bioptivet GB on minimum inhibitory concentrations (MIC) for oxytetracycline (OTC) of the intestinal E. coli flora of young broiler chickens after oral administration at a dosage equivalent to a prophylactic course of treatment. From day 6 until day 15 one group of 50 birds received a diet containing 124 ppm OTC, another group of 75 birds served as non medicated control. Investigated E. coli had been isolated from cloacal swabs and from caecal contents. MIC of 1581 E. coli strains were determined by agar dilution test procedures. MIC of OTC for the investigated strains were either > or = 128 micrograms/ml (resistant) or < or = 4 micrograms/ml (susceptible). Even from undosed birds resistant strains were isolated frequently, especially from samples of caecal contents. Administration of bioptivet GB resulted in a statistically significant increase in the average MIC. Statistically higher average MIC were recorded among isolates from cloacal swabs only during application of the drug. For strains from caecal contents this could be demonstrated until the end of the experiment.

[Furazolidone resistance of E. coli from chicken intestines after prophylactic treatment with bioptivet GB in animal feed]. / Furazolidonresistenz von E. coli aus dem Geflügeldarm nach prophylaktischer Gabe des Fütterungsarzneimittels bioptivet GB.

This study describes the influence of bioptivet GB on minimum inhibitory concentrations (MIC) for furazolidone of the intestinal E. coli flora of young broiler chickens after prophylactic treatment. From day 6 until day 15 one group of 50 birds received a diet containing 326 ppm furazolidone, another group of 75 birds served as non medicated control. Investigated E. coli had been isolated from cloacal swabs and from caecal contents. MIC of 1581 E. coli strains were determined by agar dilution test. MIC of furazolidone for the investigated strains ranged from 2 micrograms/ml to 64 micrograms/ml. For classification as "resistant" or "susceptible" limits of 16 micrograms/ml and 8 micrograms/ml respectively were used. Strains obtained from undosed birds mainly had MIC values of 4 micrograms/ml or 8 micrograms/ml, i.e. two or three times higher than MIC of E. coli ATCC 25 922, MIC values of 16 micrograms/ml or more were recorded only among isolates obtained from chickens which had received the drug. Administration of bioptivet GB resulted in a statistically significant increase in the average MIC. Statistically higher average MIC were recorded among isolates from cloacal swabs only during application of the drug. For strains from caecal contents, the effect became obvious only at the end of the experiment.

Aspartate aminotransferase isozymes in Panicum miliaceum L., an NAD-malic enzyme-type C4 plant: comparison of enzymatic properties primary structures, and expression patterns.

Panicum miliaceum has at least three isozymes of aspartate aminotransferase (AspAT); the cytosolic and mitochondrial isozymes (cAspAT and mAspAT) are major components and the third is a minor isozyme. Fractionation of leaf subcellular components showed that the minor isozyme was localized in plastids (pAspAT). We purified the three isozymes from green leaves of P. miliaceum. Both cAspAT and pAspAT consisted of triple subforms having the same molecular size but different isoelectric points. No substantial difference in enzymatic properties was observed among these isozymes besides the pH profiles. We isolated a full-length cDNA clone for pAspAT. This clone contains an open reading frame that encodes 457 amino acids. The amino-terminal region of the pAspAT precursor shares common features of plastid transit peptides. The amino acid sequence of P. miliaceum pAspAT shows higher similarity with other plant pAspATs than P. miliaceum cAspAT and mAspAT. The mRNA levels of the three isozymes were high in leaves compared with roots and mesocotyls. The three isozymes showed different expression patterns against environmental stimuli such as light and nitrate. The activities and protein levels of cAspAT and mAspAT increased during greening in accordance with those of phosphoenolpyruvate carboxylase and NAD-malic enzyme involved in the C4 pathway, primarily as a consequence of the increase in the levels of their mRNAs. By contrast, pAspAT was constitutively expressed during greening. The activity and protein levels of cAspAT and mAspAT selectively increased during recovery from an nitrogen deficit, primarily as a consequence of increase in the levels of their mRNAs while those of pAspAT remained unchanged.