"Well" off in animals: A taphonomic history of faunal resources and refuse from a well feature at Petsas House, Mycenae (Greece).

At the renowned archaeological site of Mycenae, striking depictions of animals in ancient art and architecture, such as the 'Lion Gate', reflect the great power of elite residents in the Late Bronze Age. To better understand how social complexity relates to human-animal interactions at Mycenae, more research is needed on the animals who actually lived there. In a first for the archaeological site of Mycenae, we utilized a contextual taphonomic approach and statistical analysis to study a faunal assemblage, focusing on a massive deposit recovered from a well feature located in Room Π of Petsas House. Petsas House was an industrial-residential complex at Mycenae used at least in part by ceramic artisans at the time of its destruction in the Late Helladic IIIA2 period. Intra-contextual analysis of the animal remains detected sub-assemblages with variable histories of animal use and deposition. The results revealed multiple disposal events and possible dog interments. Most of the refuse in the well likely originated from rubbish piles in the surrounding rooms and periphery that were cleaned after a destructive earthquake. Together, the faunal evidence yielded a more nuanced, possibly seasonal picture of animal access than previously available at this important political center. The results provide new insights into the diverse and resilient resource provisioning strategies available to extra-palatial residents of Mycenae, especially those who participated in craft production and trade networks at the height of the palatial period.

Ancient DNA reveals admixture history and endogamy in the prehistoric Aegean.

The Neolithic and Bronze Ages were highly transformative periods for the genetic history of Europe but for the Aegean-a region fundamental to Europe's prehistory-the biological dimensions of cultural transitions have been elucidated only to a limited extent so far. We have analysed newly generated genome-wide data from 102 ancient individuals from Crete, the Greek mainland and the Aegean Islands, spanning from the Neolithic to the Iron Age. We found that the early farmers from Crete shared the same ancestry as other contemporaneous Neolithic Aegeans. In contrast, the end of the Neolithic period and the following Early Bronze Age were marked by 'eastern' gene flow, which was predominantly of Anatolian origin in Crete. Confirming previous findings for additional Central/Eastern European ancestry in the Greek mainland by the Middle Bronze Age, we additionally show that such genetic signatures appeared in Crete gradually from the seventeenth to twelfth centuries BC, a period when the influence of the mainland over the island intensified. Biological and cultural connectedness within the Aegean is also supported by the finding of consanguineous endogamy practiced at high frequencies, unprecedented in the global ancient DNA record. Our results highlight the potential of archaeogenomic approaches in the Aegean for unravelling the interplay of genetic admixture, marital and other cultural practices.

Surgical management of Novacor drive-line exit site infections.

Implantable left ventricular assist device (LVAD) drive-line exit site infection, an expected consequence of currently available device use, continues to be a significant limiting factor in long-term support. We theorize that the mechanism behind the establishment of the most chronic exit site infections involves a shearing torsion injury that disrupts the tissue adherence interface with the drive-line. The resulting neo-epithelialized drainage tract prevents permanent clearance of the infection with antibiotics alone. The proposed treatment strategy of established infections involves aggressive surgical excision of the involved exit site.

Late-onset driveline infections: the Achilles' heel of prolonged left ventricular assist device support.

BACKGROUND: A successful left ventricular assist device (LVAD) long-term support in an outpatient setting demands that device-related complications are reduced to a minimum. We hypothesized that late onset driveline infections have serious implications on the anticipated application of LVAD as permanent therapy. METHODS: Between 1996 and 2005, 73 patients were implanted with the Novacor (World Heart Corp, Ottawa, Ontario, Canada; n = 35) or the HeartMate (Thoratec Corp, Pleasanton, CA; n = 38) as either bridge to transplantation (n = 44) or destination therapy (n = 29). Our analysis focused on patients with late-onset infection (> or = 30 days) of the driveline exit site with prior clinical healing of all incisions. RESULTS: Late driveline infections developed in 17 patients (23%) at a median of 158 days (intraquartile range [IQR]: 68 to 213 days) after implantation. The median duration of support in this subgroup was 400 days (IQR, 283 to 849 days). Despite an aggressive treatment algorithm, repeat surgical revision was needed in 12 patients, up to six times in 2 individuals. In 6 patients, the infection progressed to pump pocket infections that led to urgent heart transplantation (n = 4) or explantation (n = 2). The individual risk that a driveline infection would develop dramatically increased with the duration of support, reaching 94% at 1 year. Multivariate analysis identified duration of support (p < 0.001) and documented trauma at the driveline exit site (p < 0.001) as independent predictors of infection. Number and duration of readmissions to the hospital significantly increased (p < 0.001), and long-term follow-up for survival (4.4 +/- 2.2 years, 100% complete) showed a trend towards impaired outcome after driveline infection (5-year survival: 41% versus 70%, p = 0.10). CONCLUSIONS: Long-term LVAD support in the current series was jeopardized by late-onset driveline infections, which occurred in all patients with support duration longer than 1 year. Once driveline infections developed, they were difficult to control and significantly increased morbidity.

Operative strategies to reduce complications in Novacor left ventricular assist device placement.

BACKGROUND: The original Novacor left ventricular assist device (LVAD) implant procedure has been extensively modified since its introduction. Our goal is to describe, in a concise and comprehensive fashion, the status of this evolution as we currently employ it at our institution. We will also investigate the possible impact of the adoption of this current methodology on the incidence of perioperative hemorrhage at our institution. METHODS: The number of units of blood transfused on the day of implant surgery and the incidence of reexploration for postoperative hemorrhage were compared between the early group of consecutive patients implanted before adoption of the described implant strategy (n = 10) and the late group of consecutive patients implanted after uniform implementation of this methodology (n = 20). RESULTS: Operative and immediate postoperative hemorrhage, as demonstrated by the number of blood transfusions on the day of implant surgery, was significantly reduced in the group of consecutive patients implanted after adoption of these techniques when compared to the group of patients implanted prior to technical modification. CONCLUSION: The currently utilized Novacor LVAD implant procedure is described in detail. The amount of blood transfused on the implant day has significantly decreased since the uniform adoption of the current procedure, suggesting that the degree of perioperative hemorrhage has been favorably affected. Although implantation complications can be surgeon, device, institution and patient-specific, the strategies employed in the current implant procedure may be helpful at other heart failure centers.