Modern diagnostic approach to patients with abdominal aortic aneurysm.

INTRODUCTION: Abdominal aortic aneurysm (AAA) is a relatively frequent and serious condition in vascular surgery. The diagnostic and indication process and its treatment are driven by the guidelines which dictate an intervention when the maximum AAA diameter is more than 55 mm. Nevertheless, this approach is not fully sufficient in all AAA cases and thus we have been seeking to develop a modern diagnostic tool using computer modeling and vascular wall stress analysis. METHODS: The project has been ongoing in cooperation with engineers from VUT Brno (Brno University of Technology) and VŠB Ostrava (Technical University of Ostrava) for ten years. The design of the analytical tool was created during the first, experimental period of the project; this tool is able to assess vascular wall stress from regular CT scans using the finite element method. This primary model was gradually altered and its precision was increased considerably in the course of the years using data from mechanical and histological tests of AAA wall specimens harvested during open repairs. Additionally, other patient specific data are included in the analysis such as blood pressure, gender and material characteristics. RESULTS: The effectiveness of the method was evaluated in a pseudo-prospective study, showing clear superiority of the vascular wall stress analysis over the maximum diameter approach. The method was used in clinical practice for the first time during restrictions due to the COVID-19 pandemic; based on the analysis we were able to assess which AAA cases can be postponed and which had a high risk of rupture and an intervention was required despite the restrictions. The method achieved 100% sensitivity, and its specificity was also much better compared to the maximum diameter approach. CONCLUSION: The vascular wall stress analysis of AAA seems to be much more precise than the classic indication approach based only on the maximum diameter, and it can be used to determine the therapy based on patient specific parameters.

Records of ocean sunfish Mola mola along the Norwegian coast spanning two centuries, 1801-2015.

Records of the ocean sunfish Mola mola along the Norwegian coast were compiled from all possible sources: literature, media, databases and museums. A total of 216 records were found between 1801 and 2015. They were distributed along the whole coast, except for the most north-eastern part. Nearly all years with more than five records were after 2000, with 1985 as the only exception and with a maximum of 23 records in 2014. Most, 92·4%, were from July to December. Records from before 1979 were more incidental and random and no sunfish were recorded in 54 separate years between 1879 and 2015. The northernmost record was from 70° 44' N in December 1881. No relationship between year and latitude was found. Forty-four per cent of the records were of sunfish caught in fishing gear, 27% were found stranded and 30% were observed alive at sea. A trend of a decrease in numbers of observations of living individuals and an increase in numbers of strandings as dead individuals as autumn progressed was found. Geographical differences in the three categories of observation were also found. Among the specimens whose size was recorded, most were small, <30 kg and 70 cm in total length. Only 10 were heavier than 100 kg, all these were from before 1960. Annual numbers correlated weakly with sea temperatures. This was supported by a weak negative correlation with the North Atlantic Oscillation (NAO) index, because the majority of years since 2000 had a negative NAO.

First confirmed record of Mola sp. A in the western Mediterranean Sea: morphological, molecular and parasitological findings.

Recent molecular and morphological studies suggest the existence of at least three species of Mola (Mola spp. A, B and C). Currently, only Mola mola and Mola ramsayi are formally accepted and species A, B or C have not been assigned to these thus far. In this study, a large ocean sunfish in the western Mediterranean Sea was analysed molecularly and morphologically, identified as Mola sp. A and a detailed account of the specimen's parasite load is reported.

Patient characteristics influencing the variability of distributed parameter-based models in DCE-CT kinetic analysis.

Kinetic parameter variability may be sensitive to kinetic model choice, kinetic model implementation or patient-specific effects. The purpose of this study was to assess their impact on the variability of dynamic contrast-enhanced computed tomography (DCE-CT) kinetic parameters. A total of 11 canine patients with sinonasal tumours received high signal-to-noise ratio, test-double retest DCE-CT scans. The variability for three distributed parameter (DP)-based models was assessed by analysis of variance. Mixed-effects modelling evaluated patient-specific effects. Inter-model variability (CVinter ) was comparable to or lower than intra-model variability (CVintra ) for blood flow (CVinter :[4-28%], CVintra :[28-31%]), fractional vascular volume (CVinter :[3-17%], CVintra :[16-19%]) and permeability-surface area product (CVinter :[5-12%], CVintra :[14-15%]). The kinetic models were significantly (P<0.05) impacted by patient characteristics for patient size, area underneath the curve of the artery and of the tumour. In conclusion, DP-based models demonstrated good agreement with similar differences between models and scans. However, high variability in the kinetic parameters and their sensitivity to patient size may limit certain quantitative applications.

Outcome of definitive fractionated radiation followed by exenteration of the nasal cavity in dogs with sinonasal neoplasia: 16 cases.

Local control is a major challenge in treating canine nasal tumours. Surgical cytoreduction prior to radiation therapy has not been shown to offer a survival advantage. Only one study has previously evaluated the outcome when surgery is performed after radiation, which demonstrated an improved survival time compared with radiation alone. The purpose of this study was to investigate the outcome of surgery after definitive radiation on survival times in dogs with sinonasal tumours. Medical records were retrospectively reviewed for dogs with nasal tumours that received definitive radiation followed by surgery. Information obtained from medical record review included signalment, diagnosis, treatment and outcome. The median survival time was 457 days. No long-term side effects were observed. These findings suggest that exenteration of the nasal cavity following definitive radiation for treatment of dogs with nasal tumours is well-tolerated and provides a similar survival duration to previous reports of radiation alone.

[Our experience with the measurement of transcutaneous oxygen tension for evaluation of blood circulation in peripheral arteries in patients with critical ischemic disease of lower limbs]. / Nase zkusenosti s merením transkutánní tenze kyslíku pro hodnocení prokrvení periferie dolních koncetin u pacientu s chronickou ischemickou chorobou dolních koncetin.

INTRODUCTION: The measurement of transcutaneous oxygen pressure (TcpO2) is a non-invasive method to quantify skin oxygenation at capillary level and their nutritive ability needed to heal the ischemic defect. TcpO2 pressure values below 30 mm Hg are specific for critical limb ischemia and predict complicated healing. The purpose of this study was to verify the cut-off pressure in patient unable to undergo vascular reconstruction, and to verify the possibility of using this method to evaluate the effectiveness of vascular reconstructive surgery. METHODS: The group included 52 patients (35 men and 17 women). The mean age of patients in the group was 66.5 years (max. 85, min. 44). RESULTS: In our group of patients we confirmed that the TcpO2 values of successfully healed ischemic wounds were equal or greater than 30 mm Hg (mean TcpO2 value at the dorsum of the foot was 37.0 mm Hg ± 9.5 mm Hg), compared to the group of unsuccessfully healed patients whose values were lower (mean TcpO2 value at the dorsum of the foot was 9.0 mm Hg ± 5.3 mm Hg). CONCLUSION: TcpO2 is a suitable method in predicting the healing of ischemic defects and any possible need for surgical or endovascular revascularization. Thanks to its non-invasive nature and undemanding measurement, it surely helps to make better decisions in choosing the therapeutic procedure needed to heal the defect.

Stable isotopes challenge the perception of ocean sunfish Mola mola as obligate jellyfish predators.

Evidence is provided from stable isotope analysis that aggregations of small ocean sunfish Mola mola (total length <1 m) feed broadly within coastal food webs and their classification as obligate predators of gelatinous zooplankton requires revision.

Safety evaluation of combination toceranib phosphate (Palladia®) and piroxicam in tumour-bearing dogs (excluding mast cell tumours): a phase I dose-finding study.

Toceranib phosphate and piroxicam have individually demonstrated antineoplastic activity. Additionally, non-steroidal anti-inflammatory therapy is often warranted in aged cancer-bearing dogs for management of osteoarthritis comorbidity. As concurrent use may be warranted for a given individual and the adverse event (AE) profile for each can be overlapping (gastrointestinal), a phase I trial was performed in tumour-bearing (non-mast cell) dogs to establish the safety of the combination using a standard 3+3 cohort design. Five dose-escalating cohorts, up to and including approved label dosage for toceranib and standard dosage for piroxicam, were completed without observing a frequency of dose-limiting AEs necessitating cohort closure. Therefore, the combination of standard dosages of both drugs (toceranib, 3.25 mg kg(-1), every other day; piroxicam, 0.3 mg kg(-1) daily) is generally safe. Several antitumour responses were observed. As with single-agent toceranib, label-indicated treatment holidays and dose reductions (e.g. 2.5-2.75 mg kg(-1)) may occasionally be required owing to gastrointestinal events.

Intravenous administration of docetaxel to cats with cancer.

BACKGROUND: The safety of i.v. administration of docetaxel to cats with cancer has not been reported. OBJECTIVES: Document adverse effects of i.v. administration of docetaxel to cats. ANIMALS: Twenty-one client-owned cats with any confirmed malignancy. METHODS: Cats received up to 5 docetaxel treatments, administered i.v. every 3 weeks. The initial dosage was 1.0 mg/kg, and dosages were increased by increments of 0.25 mg/kg in cohorts of 3 cats. Adverse events were determined by a CBC at days 7 and 21, serum chemistry and urine specific gravity at day 21, and medical histories provided by the owners. RESULTS: Cats received docetaxel dosages ranging from 1.0 to 2.5 mg/kg, for a median of 2 treatments. Dose-limiting toxicoses included fever, neutropenia, and vomiting, seen in 2 of the 4 cats treated at 2.5 mg/kg. Hypersensitivity reactions were infrequent (4 of the 21 cats) and mild. The maximum tolerated dosage was 2.25 mg/kg. CONCLUSIONS AND CLINICAL IMPORTANCE: Docetaxel can be administered i.v. to cats with a low incidence of adverse effects.

Imaginative reality observed during early language development.

The authors argue that our thinking about psychic reality is challenged by research observations of the child during the period of early language development. The toddler, at the beginnings of propositional speech, expresses the capacity for 'two kinds of psychic reality'. A world of imaginative pretence occurs quite early, and supplements the child's everyday experience. The toddler is not confused by these two experiential worlds and, correspondingly, the use of imaginative activity is strongly supported by caregivers. While in some ways there is a rich history of developmental observation and psychoanalytic thinking about such early imaginative activity, its significance is only now being appreciated. Imaginative reality refers to a process in which the child makes use of what is familiar in the remembered past in order to try out a world of new possibilities in the present that, to some extent, are oriented towards the future. Conditional modes of thinking that are affectively meaningful are thereby engaged and practised in play. The authors present vivid observations that illustrate the early imaginative pretence mode of psychic reality. The observations are followed by a developmental discussion integrating recent research with psychoanalytic theory. As would be expected, thinking about early imaginative reality leads to a variety of new questions for research and clinical work.

Effects of solid and liquid guar gum on plasma cholesterol and triglyceride concentrations in moderate hypercholesterolemia.

Guar gum is a dietary fiber reported to decrease plasma cholesterol concentration. This study investigated the effect of guar therapy in 50 men with moderately elevated plasma cholesterol who were randomized to an 8-week study of guar therapy. Three forms of guar gum were used: a medium viscosity solid or liquid form, a high viscosity liquid form or placebo. When the medium viscosity guar therapy groups were combined, 4 weeks of therapy were shown to result in a substantial reduction in total and low density lipoprotein (LDL) cholesterol of 25 mg/dl and 23 mg/dl (p = 0.035 and 0.12), respectively. The high viscosity guar group had a reduction in total cholesterol and LDL cholesterol of 37 and 30 mg/dl, respectively (p less than 0.003 and p less than 0.02). Following 8 weeks of therapy, a return toward baseline values was observed. No significant changes were demonstrated in blood chemistries, triglyceride values, total high density lipoprotein (HDL) cholesterol or the HDL2 fraction of HDL cholesterol. The effect of the solid and liquid forms of guar on plasma cholesterol reduction was similar. This study shows that a nonpharmacologic dietary additive reduces plasma total and LDL cholesterol.