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Abstract: Background. High-risk pulmonary embolism is associated with a high early mortality rate. We report our experience with percutaneous mechanical thrombectomy in patients with high-risk pulmonary embolism and contraindications for thrombolytic therapy.Patients and methods. This was a retrospective analysis of consecutive patients with high-risk pulmonary embolism and contraindications to thrombolytic therapy. They were treated with percutaneous mechanical thrombectomy which included thrombectomy and additional thrombus aspiration when needed. Clinical parameters and survival to discharge were measured. Results. From November 2005 to September 2015 we treated 25 patients with a mean age of 62.6 +- 12.7 years, 64% were men. Mean simplified Pulmonary Embolism Severity Index was 2.9. Mean maximum lactate levels were 7.8 +- 6.6 mmol/L, vasopressors were used in 77%, and 59% needed mechanical ventilation. Mechanical treatment included thrombus fragmentation complemented with aspiration (56%) and aspiration using Aspirex S catheter (44%). Local (5 patients; 20%) and systemic (3 patients; 12%) thrombolytics were used as a salvage therapy. We observed nonsignifi-cant improvements in systemic blood pressure (100 +- 41 mm Hg vs 119 +- 34; p = 0.100) and heart frequency (99 +- 35 min-1vs 87 +- 31 min-1; p = 0.326) before and after treatment, respectively. Peak systolic tricuspid pressure gradient was significantly lower after treatment (57 +- 14 mm Hg vs 31 +- 3 mm Hg; p = 0.018). Overall the procedure was technically successful in 20 patients (80%) and 17 patients (68%) survived to hospital discharge. Conclusions. In patients with high-risk pulmonary embolism who cannot receive thrombolytic therapy, percutaneous mechanical thrombectomy is a promising alternative to reduce pulmonary artery pressure.
Keywords: high-risk pulmonary embolism, treatment, percutaneous mechanical thrombectomy
Published in DiRROS: 16.07.2024; Views: 17; Downloads: 5
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Abstract: The presence of bacteria and viruses in freshwater represents a global health risk. The substantial spatial and temporal variability of microbes leads to difficulties in quantifying the risks associated with their presence in freshwater. Fine particles, including bacteria and viruses are transported and accumulated into shallow streambed (i.e., benthic) sediment, delaying the downstream transmission during baseflow conditions but contributing to their resuspension and transport downstream during stormflow events. Direct measurements of pathogen accumulation in benthic sediments are rare. Until now, the dynamic role of benthic sediment as both a store and source of microbes, has not been quantified. In this study, we analyze microbial abundance in benthic sediment along a 1 km reach of an intermittent Mediterranean stream receiving inputs from the effluent of a wastewater treatment plant, a known point source of microbes in streams. We sampled benthic sediment during a summer drought when the wastewater effluent constituted 100 % of the stream flow, and thus, large accumulation and persistence of pathogens along the streambed was expected. We measured the abundance of total bacteria, Escherichia coli (as a fecal indicator), and presence of enteric rotavirus (RoV) and norovirus (NoV). The abundance of E. coli, based on qPCR detection, was high (4.99∙102 gc /cm2) along the first 100 m downstream of the wastewater effluent input and in general decreased with distance from the source, with presence of RoV and NoV along the study reach. A particle tracking model was applied, that uses stream water velocity as an input, and accounts for microbial exchange into, immobilization, degradation, and resuspension out of benthic sediment during baseflow and stormflow. Rates of exchange into benthic sediment were 3 orders of magnitude higher during stormflow, but residence times were proportionately lower, resulting in increased longitudinal connectivity from up to downstream during stormflow. Model simulations demonstrated mechanistically how the rates of exchange into and out of the benthic sediment resulted in benthic sediment to act as a store during baseflow and a source during stormflow.
Keywords: E. coli, norovirus, rotavirus, benthic sediment, pathogen transport, microbial risk
Published in DiRROS: 12.07.2024; Views: 56; Downloads: 20
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Abstract: The advances in high-throughput sequencing (HTS) technologies and bioinformatic tools have provided new opportunities for virus and viroid discovery and diagnostics. Hence, new sequences of viral origin are being discovered and published at a previously unseen rate. Therefore, a collective effort was undertaken to write and propose a framework for prioritizing the biological characterization steps needed after discovering a new plant virus to evaluate its impact at different levels. Even though the proposed approach was widely used, a revision of these guidelines was prepared to consider virus discovery and characterization trends and integrate novel approaches and tools recently published or under development. This updated framework is more adapted to the current rate of virus discovery and provides an improved prioritization for filling knowledge and data gaps. It consists of four distinct steps adapted to include a multi-stakeholder feedback loop. Key improvements include better prioritization and organization of the various steps, earlier data sharing among researchers and involved stakeholders, public database screening, and exploitation of genomic information to predict biological properties.
Keywords: plant viruses and viroids, high throughput sequencing (HTS), biological characterization, plant health, regulatory agencies, Pest Risk Analysis (PRA), virus disease
Published in DiRROS: 12.07.2024; Views: 45; Downloads: 20
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Abstract: 1. A large number of non-native trees (NNTs) have been introduced globally andwidely planted, contributing significantly to the world's economy. Although someof these species present a limited risk of spreading beyond their planting sites, agrowing number of NNTs are spreading and becoming invasive leading to diversenegative impacts on biodiversity, ecosystem functions and human well- being. Tohelp minimize the negative impacts and maximize the economic benefits of NNTs,Brundu et al. developed eight guidelines for the sustainable use of NNTs glob-ally—the Global Guidelines for the Use of NNTs (GG-NNTs).2. Here, we used an online survey to assess perceptions of key stakeholders to-wards NNTs, and explore their knowledge of and compliance with the GG-NNTs.3. Our results show that stakeholders are generally aware that NNTs can providebenefits and cause negative impacts, often simultaneously and they consider thattheir organization complies with existing regulations and voluntary agreementsconcerning NNTs. However, they are not aware of or do not apply most of theeight recommendations included in the GG-NNTs.4. We conclude that effectively managing invasions linked to NNTs requires bothmore communication efforts using an array of channels for improving stakeholderawareness and implementation of simple measures to reduce NNT impacts (e.g. via GG-NNTs), and a deeper understanding of the barriers and reluctance ofstakeholders to manage NNT invasions.
Keywords: agroforestry, alien species, forestry, invasion risk, online survey, ornamental trees, perceptions, stakeholder engagement, sustainability, tree invasions
Published in DiRROS: 21.06.2024; Views: 115; Downloads: 58
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Abstract: The paper presents a risk assessment model, developed in the project oVER-FLOw and further implemented in the project CROSScade, for determining the direct and indirect impacts of flooding hazards. As a consequence of flooding, transport infrastructure and flood protection systems can be significantly damaged and cause cascading effects on other infrastructure. To achieve flood resilient infrastructure, it is necessary to assess the vulnerability of critical assets in the affected area. The model uses novel vulnerability assessment methods for embankments and bridges exposed to different flood hazard scenarios allowing the asset owners to understand risk and performance of their infrastructure. Scarce financial resources are allocated on the critical assets allowing significant cost savings and avoiding the waste of non-renewable resources in strengthening large sections which have sufficient resilience. The consequence analysis is based on an improved quantification model for direct and indirect impacts of different flood hazard scenarios used for risk mapping of the affected area.
Keywords: flooding, risk assessment, critical infrastructure, economic loss
Published in DiRROS: 23.05.2024; Views: 201; Downloads: 154
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