Long-term spatio-temporal dynamics of the mosquito Aedes aegypti in temperate Argentina

Buenos Aires city is located near the southern limit of the distribution of Aedes aegypti (Diptera: Culicidae). This study aimed to assess long-term variations in the abundance of Ae. aegypti in Buenos Aires in relation to changes in climatic conditions. Ae. aegypti weekly oviposition activity was analyzed and compared through nine warm seasons from 1998 to 2014, with 200 ovitraps placed across the whole extension of the city. The temporal and spatial dynamics of abundances were compared among seasons, and their relation with climatic variables were analyzed. Results showed a trend to higher peak abundances, a higher number of infested sites, and longer duration of the oviposition season through subsequent years, consistent with a long-term colonization process. In contrast, thermal favorability and rainfall pattern did not show a consistent trend of changes. The long-term increase in abundance, and the recently documented expansion of Ae. aegypti to colder areas of Buenos Aires province suggest that local populations might be adapting to lower temperature conditions. The steadily increasing abundances may have implications on the risk of dengue transmission.

The Illness Experience of Undocumented Immigrants With End-stage Renal Disease

IMPORTANCE

The exclusion of undocumented immigrants from Medicare coverage for hemodialysis based on a diagnosis of end-stage renal disease (ESRD) requires physicians in some states to manage chronic illness in this population using emergent-only hemodialysis. Emergent-only dialysis is expensive and burdensome for patients.

OBJECTIVE

To understand the illness experience of undocumented immigrants with ESRD who lack access to scheduled hemodialysis.

DESIGN, SETTING, AND PARTICIPANTS

A qualitative, semistructured, interview study was conducted in a Colorado safety-net hospital from July 1 to December 31, 2015, with 20 undocumented immigrants (hereinafter referred to as undocumented patients) with ESRD and no access to scheduled hemodialysis. Demographic information was collected from the participants' medical records. The interviews were audiorecorded, translated, and then transcribed verbatim. The interviews were analyzed using inductive qualitative theme analysis by 4 research team members from March 1 to June 30, 2016.

MAIN OUTCOMES AND MEASURES

Themes and subthemes from semistructured interviews.

RESULTS

All 20 undocumented patients included in the study (10 men and 10 women; mean [SD] age, 51.4 [13.8] years) had been in the United States for at least 5 years preceding their diagnosis with ESRD. They described the following 4 main themes: (1) a distressing symptom burden and unpredictable access to emergent-only hemodialysis, (2) death anxiety associated with weekly episodes of life-threatening illness, (3) family and social consequences of accommodating emergent-only hemodialysis, and (4) perceptions of the health care system.

CONCLUSIONS AND RELEVANCE

Undocumented patients with ESRD experience debilitating, potentially life-threatening physical symptoms and psychosocial distress resulting from emergent-only hemodialysis. States excluding undocumented immigrants with ESRD from scheduled dialysis should reconsider their policies.

Gender Differences in Sexual Interest or Activity among Adults with Symptomatic Heart Failure

CONTEXT

Problems with sexual function can have a detrimental effect on quality of life. Symptomatic heart failure has been associated with problems with sexual function, although the majority of reports are focused on men and erectile dysfunction. Understanding women's perception of and gender differences in problems with sexual function in heart failure could yield new insights.

OBJECTIVES

To determine the gender differences in reporting and bothersomeness of problems with sexual function, defined as sexual interest or activity.

METHODS

Observational, cross-sectional study of adults with symptomatic heart failure from three health systems participating in a clinical trial. Eligible participants completed baseline surveys of symptom prevalence and bothersomeness. Logistic regression modeling was used to identify patient-level factors associated with problems with sexual interest or activity.

RESULTS

Among 314 patients with heart failure, we found large differences in reporting a problem with sexual function or interest in men (62.4%, n = 154/247) compared with women (37.9%, n = 25/66, p = 0.0004). When the symptom was reported, both men and women found it equally bothersome; 73.4% of men and 64.0% of women responded that this problem bothered them quite a bit or very much (p = 0.33). After adjusting for age, marital status, and income, men relative to women were still more likely to report problems with sexual function (OR 3.5, 95% CI 1.8-6.8).

CONCLUSION

While men more commonly reported problems with sexual function, both genders were similarly highly bothered by this problem. These findings support the need for further research to assess and manage this symptom in both men and women with heart failure.

Continuous-flow DNP polarizer for MRI applications at 1.5 T

Here we describe a new hyperpolarization approach for magnetic resonance imaging applications at 1.5 T. Proton signal enhancements of more than 20 were achieved with a newly designed multimode microwave resonator situated inside the bore of the imager and used for Overhauser dynamic nuclear polarization of the water proton signal. Different from other approaches in our setup the hyperpolarization is achieved continuously by liquid water flowing through the polarizer under continuous microwave excitation. With an available flow rate of up to 1.5 ml/min, which should be high enough for DNP MR angiography applications in small animals like mice and rats. The hyperpolarized liquid cooled to physiological temperature can be routed by a mechanical switch to a quartz capillary for injection into the blood vessels of the target object. This new approach allows hyperpolarization of protons without the need of an additional magnet and avoids the losses arising from the transfer of the hyperpolarized solution between magnets. The signal-to-noise improvement of this method is demonstrated on two- and three-dimensional phantoms of blood vessels.

A Step-by-Step Clinical Approach for the Management of Neuroendocrine Tumours

Neuroendocrine tumours (NET) are rare neoplasms, but the incidence is permanently increasing. Most of the NETs are slow proliferating and clinically silent, and for that reason, they are often diagnosed at a stage with advanced disease. The complexity and diversity of the NET-biology require the treatment of patients in specialised centres to guarantee a qualified, multidisciplinary treatment planning. At our institution, we developed an interdisciplinary model for the assessment and treatment of NET. The aim was to adapt the guidelines to the clinical practice, exchange of current knowledge, and a tailored approach to the individual patient. In our team are included medical professionals from pathology, radiology, oncology, gastroenterology, oncological surgery, and nuclear medicine. In this paper, we describe step-by-step a procedural algorithm for the management of patients with neuroendocrine tumours, focusing on midgut-NETs in terms of therapy.

Optical nanoprobes for biomedical applications: shining a light on upconverting and near-infrared emitting nanoparticles for imaging, thermal sensing, and photodynamic therapy

Shining a light on spectrally converting lanthanide (Ln³⁺)-doped nanoparticles: progress, trends, and challenges in Ln³⁺-nanoprobes for near-infrared bioimaging, nanothermometry, and photodynamic therapy.

Treatment of posterior circulation non-saccular aneurysms with flow diverters: a single-center experience and review of 56 patients

BACKGROUND AND PURPOSE

Non-saccular aneurysms of the posterior fossa are an uncommon pathology with no clear treatment strategy. The use of flow-diverting stents (FDS) has had mixed results. We sought to evaluate our experience of FDS for the treatment of this pathology.

METHODS

We retrospectively reviewed our database of prospectively collected information for all patients treated only with flow diversion for an unruptured non-saccular aneurysm of the posterior circulation between February 2009 and April 2016. The aneurysms were classified as dolichoectasia, fusiform or transitional, and imaging characteristics including maximal diameter, disease vessel segment, MRI features (intra-aneurysmal thrombus, T1 hyperintensity in the aneurysmal wall, infarctions in the territory of the posterior circulation, and mass effect) were recorded alongside clinical and follow-up data.

RESULTS

We identified 56 patients (45 men) with 58 aneurysms. The average age of the patients was 63.5 years. Twenty-two patients were symptomatic from the aneurysms at presentation. The majority of the lesions were vertebrobasilar in location (44.8%) with isolated vertebral lesions representing 29.3% of aneurysms. Transitional aneurysms were the most common (48.2%). The mean maximal diameter of the aneurysms was 11 mm. Angiographic exclusion of the aneurysms was seen in 57.4% of aneurysms with follow-up (n=47). During the follow-up period nine patients died.

CONCLUSIONS

Treatment of non-saccular aneurysms of the posterior fossa is technically possible. Early treatment, particularly of the fusiform and transitional subtypes, is recognized, as is treatment prior to the development of symptoms. A 'watch and wait' strategy with regular imaging follow-up could be employed for asymptomatic dolichoectasia.

Treatment of Intra- and Extracranial Aneurysms Using the Flow-Redirection Endoluminal Device: Multicenter Experience and Follow-Up Results

BACKGROUND AND PURPOSE

Flow diversion emerged as a crucial treatment option for intracranial aneurysms. We report a multicenter retrospective analysis of the safety and efficacy in the treatment of intracranial aneurysms with the Flow-Redirection Endoluminal Device (FRED) flow diverter, a dual-layer flow-modulation device.

MATERIALS AND METHODS

All intracranial aneurysms treated with the FRED between March 2013 and February 2016 at 4 neurovascular centers were included. Angiographic and clinical results were retrospectively analyzed, including all follow-up examinations. Aneurysms were unruptured in 44 cases, whereas 8 treatments were due to an acute SAH from the target aneurysm.

RESULTS

Successful implantation of the FRED was possible in 96.2% (50/52) of cases. At 3-month follow-up, complete occlusion was determined in 58.1% (25/43) and near-complete in 25.6% (11/43). At 12-month follow-up, aneurysm occlusion was complete in 75.0% (27/36) and near-complete in 22.2% (8/36). The overall acute and late thromboembolic and hemorrhagic complication rate was 17.3% (9/52), with a permanent treatment-related morbidity and mortality of 4.0% (2/50) and 2.0% (1/50), respectively, to date.

CONCLUSIONS

The FRED device offers an effective tool in the treatment of intracranial aneurysms. The dual-layer design promotes contemporary and stable long-term occlusion rates. Sufficient device expansion should be documented by angiographic CT. Further studies might help to identify a more optimal antiplatelet regimen to avoid thromboembolic complications during the follow-up period.

Experiences and Values of Latinos with End Stage Renal Disease: A Systematic Review of Qualitative Studies

Patients with end stage renal disease (ESRD) experience a high symptom burden and poor quality of life as part of their advanced illness. Latinos experience a higher prevalence of ESRD compared to non-Latino whites; however, they are underrepresented in existing ESRD literature. We conducted a systematic review of qualitative studies that include Latino patients with ESRD and their caregivers in the United States. Of 694 citations published through August 2014, six met inclusion criteria. Four major themes emerged: 1) Losses, 2) Heightened awareness of death, 3) Barriers to quality communication and care, and 4) Mediating Latino traditions and values. A thematic schema was developed.

Coiling of wide-necked carotid artery aneurysms assisted by a temporary bridging device (Comaneci): preliminary experience

Background

Endovascular treatment of wide-necked aneurysms remains challenging without the use of adjunctive devices to preserve the parent artery.

Objective

To present our initial experience with a temporary bridging device, the Comaneci (Rapid Medical, Israel). The compliant remodeling mesh protects the parent artery during coil occlusion without flow arrest in the distal vasculature. Permanent dual antiplatelet therapy is not required since the device is fully removed at the end of the procedure.

Methods

All intracranial aneurysms treated by coil occlusion with the Comaneci device between December 2014 and November 2015 were included. Angiographic and clinical results were retrospectively analysed, including follow-up examinations. All aneurysms were unruptured.

Results

18 aneurysms of the internal carotid artery were included. Successful coil occlusion assisted by the Comaneci device as intended was possible in 14 cases (77.8%). Insufficient coverage of the aneurysmal neck was observed in four cases (22.2%), with modification of the treatment to stent-assisted coiling or remodeling. One clinically relevant complication occurred (5.6%).

Conclusions

Our initial experience shows that use of the Comaneci device is straightforward for the treatment of selected wide-necked aneurysms. Further studies with long-term follow-up data are needed to identify the significance of the presented technique in the neurointerventional armamentarium.