Morphological and molecular characterization of fungus isolated from tropical bed bugs in Northern Peninsular Malaysia, Cimex hemipterus (Hemiptera: Cimicidae)

Objective: To investigate some morphological and molecular characteristics of fungal parasites isolated from wild tropical bed bug, Cimex hemipterus. Methods: A series of culture methods were used to obtain fungal isolates from field-collected bed bugs. Characteristics of the isolates such as colony appearance, mycelial texture and pigmen-tation were studied to explore their morphology. Isolates were also subjected to a PCRbased genotyping test. Results: There were noticeable differences in morphological characteristics among the four isolates. Conidial areas of one isolate were dark green, whereas those of the remaining colonies were olive-green, black or dark brown. Conidia of the dark green isolate were globose, while those of olive-green, black and dark brown isolates were globose to subglobose, globose to spherical and globose to subglobose/finely roughened, respectively. These morphological specificities and the molecular analyses showed that the fungal internal transcribed spacer ribosomal region and β-tubulin gene sequences of the isolates shared clade with Trichoderma and Aspergillus sequences. Conclusions: Overall, the new discovery of common pathogens in agricultural field developed in live bed bugs storage tank may initiate the use of biological agents in later years

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy.

Peer reviewe

Various Endoluminal Approaches Available for Treating Pathologies of the Aortic Arch

AbstractOpen surgical repair of the aortic arch for degenerative aortic disease in an unfit patient is associated with significant morbidity and mortality. Endoluminal techniques have advanced over the last decade. Contemporary endovascular options including a hybrid approach (supra-aortic debranching and aortic stent graft), inner branched endograft, chimney stents, and scallop or fenestrated endografts are being used frequently as an alternative to open surgical arch repair. Understanding of the available endoluminal technology along with careful planning and effective teamwork is required to minimise complications associated with the endoluminal techniques, particularly neurological ones. Custom made techniques are superior to chimney or parallel technology in terms of their complications and durability. Integration of the protective devices such as embolic protection filters into stent design may reduce the risk of poor neurological sequelae. Long-term data are needed to assess the durability of these devices.</jats:p

Technical Note: Left Subclavian Artery Scallop Endografts to Facilitate a Proximal Landing Zone and Upper Extremity Access for Branched Endovascular Aortic Repair of Type II Thoracoabdominal Aortic Aneurysms

Abstract Purpose To describe the dual purpose of left subclavian artery (LSA) scallop endografts to create the proximal landing zone (PLZ) and facilitate antegrade left-sided upper extremity access for branched endovascular aortic repair (BEVAR) of Type II thoracoabdominal aneurysms (TAAA) with a short PLZ. Technique Three patients with an inadequate (&lt; 20 mm) PLZ underwent a 2-stage repair of Type II TAAA. Following femoral cut-down, a custom-made LSA scallop endograft was deployed into zone 2 to create the PLZ and maintain perfusion to the LSA. In a second procedure 36–96 days after insertion of the scalloped thoracic stent-graft, a branched abdominal stent-graft was subsequently deployed to dock into the proximal scallop endograft as the second stage. Via a left axillary conduit, a 12Fr sheath was used to cannulate the LSA scallop to facilitate selective catheterisation of antegrade branch cuffs and renovisceral target vessels, and insertion and deployment of bridging stents. The LSA scallop was also used to selectively catheterise and stent the perfusion branches via left-sided brachial puncture that were left open in each of the three cases 8–14 days after the second procedure to minimise the risk of spinal cord ischaemia. There were no neurological or endoleak complications. Conclusion LSA scallop endografts are a feasible and useful adjunct to create the PLZ and to provide antegrade access for visceral stenting of branches and target vessels through the LSA scallop in branched endovascular repair of Type II TAAA with short PLZ. </jats:sec

Initial findings and potential applicability of computational simulation of the aorta in acute type B dissection

ObjectiveType B aortic dissection can be acutely complicated by rapid expansion, rupture, and malperfusion syndromes. Short-term adverse outcomes are associated with failure of the false lumen to thrombose. The reasons behind false lumen patency are poorly understood, and the objective of this pilot study was to use computational fluid dynamics reconstructions of aortic dissection cases to analyze the effect of aortic and primary tear morphology on flow characteristics and clinical outcomes in patients with acute type B dissections.MethodsThree-dimensional patient-specific aortic dissection geometry was reconstructed from computed tomography scans of four patients presenting with acute type B aortic dissection and a further patient with sequential follow-up scans. The cases were selected based on their clinical presentation. Two were complicated by acute malperfusion that required emergency intervention. Three patients were uncomplicated and were managed conservatively. The patient-specific aortic models were used in computational simulations to assess the effect of aortic tear morphology on various parameters including flow, velocity, shear stress, and turbulence.ResultsPulsatile flow simulation results showed that flow rate into the false lumen was dependent on both the size and position of the primary tear. Linear regression analysis demonstrated a significant relationship between percentage flow entering the false lumen and the size of the primary entry tear and an inverse relationship between false lumen flow and the site of the entry tear. Subjects complicated by malperfusion had larger-dimension entry tears than the uncomplicated cases (93% and 82% compared with 32% and 55%, respectively). Blood flow, wall shear stress, and turbulence levels varied significantly between subjects depending on aortic geometry. Highest wall shear stress (>7 Pa) was located at the tear edge, and progression of false lumen thrombosis was associated with prolonged particle residence times.ConclusionsResults obtained from this preliminary work suggest that aortic morphology and primary entry tear size and position exert significant effects on flow and other hemodynamic parameters in the dissected aorta in this preliminary work. Blood flow into the false lumen increases with increasing tear size and proximal location. Morphologic analysis coupled with computational fluid dynamic modeling may be useful in predicting acute type B dissection behavior allowing for selection of proper treatment modalities, and further confirmatory studies are warranted