Hybrid Repair of Type B Aortic Dissection With Thoracoabdominal Aortic Aneurysmal Degeneration in the Setting of Marfan Syndrome.

Aneurysmal degeneration of the thoracoabdominal aorta after aortic dissection is a well-documented sequela of Marfan syndrome (MFS). Hybrid technique (HT), an emerging treatment modality for complex aortic pathologies, decreases morbidity and mortality relative to open surgery. However, outcome data regarding HT in genetic aortopathies such as MFS is limited. We describe a case of a young male with hypertension and type B aortic dissection (AD) complicated by a symptomatic thoracoabdominal aortic aneurysm (TAAA). He underwent staged HT comprised of carotid-carotid transposition followed by zone 1 thoracic endovascular aortic repair and concurrent retrograde left subclavian stent graft placement. Genetic analysis was consistent with Marfan syndrome. Subsequent growth of his TAAA warranted open extent type IV TAAA repair with individual renovisceral and iliac bypasses. The patient recovered from the second surgery without further progression of disease or late complication.

Ureteral Arterial Fistula - A Role for Open Operation in the 21st Century.

BACKGROUND: Ureteral arterial fistula is a rare and challenging clinical entity. The diagnosis and management of ureteral arterial fistula present a unique disease process that requires a dual specialty approach, involving both vascular and urologic surgeons. There are different options for repair, including both open and endovascular techniques. METHODS AND RESULTS: A 78-year-old male presented to the emergency department (ED) in septic shock secondary to a urinary tract infection and was admitted to the intensive care unit (ICU) for further management and resuscitation. The patient had previously undergone radical cystoprostatectomy with ileal conduit creation in 2011 for recurrent bladder cancer. Following creation of his ileal conduit, he required long-term indwelling ureteral stents bilaterally due to recurrent stricturing at the ureteroneocystostomy with stent exchanges performed 2-3 times per year due to frequent urinary tract infections. During his hospitalization for sepsis, the urology service performed an exchange of his left indwelling ureteral stent. However, pulsatile bleeding was observed from the junction of the ileal conduit and left ureter. The stent was replaced at the bedside, and the bleeding ceased. Vascular surgery consultation and a computed tomography angiogram (CTA) gave support to the diagnosis of a ureteral arterial fistula. A plan was developed to exchange the stent in the operating room with vascular surgery assistance. It was determined that a definitive open repair with excision of the fistula would be the most appropriate course. CONCLUSIONS: In the setting of hemodynamically significant bleeding, we recommend an endovascular approach to obtain hemostasis. However, an open approach provides both reconstruction and infectious resistance in an already soiled field. Open repair may provide a more definitive reconstruction.

Understanding the toxicity of aggregated zero valent copper nanoparticles against Escherichia coli.

Copper nanoparticles are used in wide variety of applications and in the current study we report the antimicrobial activity of these particles. Influence of pH, temperature, aeration rate, concentration of nanoparticles and concentration of bacteria on the toxicity of copper nanoparticles against Escherichia coli have been studied using a centroid mixture design of experiment. The linear and quadratic regression model shows that the toxicity of copper nanoparticles not only depends on the primary effect of the parameters tested (pH, temperature, aeration, concentration of E. coli and concentration of nanoparticles), but also on the interactive effect of these parameters.

Optimization of the fermentation media for sophorolipid production from Candida bombicola ATCC 22214 using a simplex centroid design.

This article describes the use of a simplex centroid mixture experimental design to optimize the fermentation medium in the production of sophorolipids (SLs) using Candida bombicola. In the first stage, 16 media ingredients were screened for the ones that have the most positive influence on the SL production. The sixteen ingredients that were chosen are five different carbohydrates (fructose, glucose, glycerol, lactose, and sucrose), five different nitrogen sources (malt extract, peptone extract, soytone, urea, and yeast extract), two lipid sources (mineral oil and oleic acid), two phosphorus sources (K(2)HPO(4) and KH(2)PO(4)), MgSO(4), and CaCl(2). Multiple regression analysis and centroid effect analysis were carried out to find the sugar, lipid, nitrogen source, phosphorus source, and metals having the most positive influence. Sucrose, malt extract, oleic acid, K(2)HPO(4), and CaCl(2) were selected for the second stage of experiments. An augmented simplex centroid design for five ingredients requiring 16 experiments was used for the optimization stage. This produced a quadratic model developed to help understand the interaction amongst the ingredients and find the optimal media concentrations. In addition, the top three results from the optimization experiments were used to obtain constraints that identify an optimal region. The model together with the optimal region constraints predicts the maximum production of SLs when the fermentation media is composed of sucrose, 125 g/L; malt extract, 25 g/L; oleic acid, 166.67 g/L; K(2)HPO(4), 1.5 g/L; and CaCl(2), 2.5 g/L. The optimal media was validated experimentally and a yield of 177 g/L was obtained.

Dos casos de sarcoma de partes blandas de presentacióninsólita, con dificultades para el diagnóstico (El hombre deEstambul. Una situación bastante habitual: no reconoceruna lesión porque no está en el lugar «adecuado») / Soft tissue sarcoma: 2 cases of unusual presentation and difficult diagnosis. («The man from Istanbul»: a fairly frequent situation in which a lesion is not recognised due to it occurring in an «unexpected»place)

Para un patólogo preparado, reconocer un tumor cuandopresenta la morfología característica y está en su localizaciónhabitual es fácil. Pero cuando se presenta en un lugarinsólito y además la biopsia para diagnóstico es pequeña, esfácil caer en un error de orientación y, aunque a veces lastécnicas auxiliares nos puedan ayudar, en algunas ocasionesno se concreta el diagnóstico hasta que una biopsia completao la extirpación del tumor nos permiten ver la totalidad dela lesión, con la sobrecarga de tiempo, riesgo para el pacientey gasto económico que ello conlleva.El Prof. Rosai describe esta situación con la historia quecontaba Lauren V. Ackerman y que tituló «El hombre deEstambul»: el empecinamiento en no reconocer un tumorporque no está en «su» lugar.Aportamos dos casos de sarcomas de partes blandas quese presentaron en localizaciones que podríamos llamar«invertidas»: un sarcoma sinovial mandibular y un mioepiteliomamaligno yuxtaarticular en un dedo del pie y exponemoslas dificultades que presentaron para su diagnóstico inicial (AU)

A tumour with a characteristic morphological appearanceoccurring in a usual location is easy to diagnose. However,if a tumour is found in an unexpected site and only asmall amount of biopsy material is available, it is more difficultto reach a correct diagnosis.Dr Rosai quotes an expression often used by Lauren V.Ackerman to describe such a situation: «the man from Istanbul», ie. a common lesion occurring in the wrong place.Two cases of common soft tissue tumours located inuncommon places are presented: a synovial sarcoma in themandible and a malignant myoepithelioma (mixed tumour)near the phalangeal joint of the foot. The difficulties of acorrect initial diagnosis are discussed (AU)

Utilization of restaurant waste oil as a precursor for sophorolipid production.

Approximately 100 billion liters of oil is generated per week as waste from restaurants around the country. Because of health, environmental, and economic factors, current methods of disposal are ineffective for disposal of the restaurant oil wastes. In this study we have investigated the ability of Candida bombicola to fermentatively transform the restaurant oil waste into glycolipids called sophorolipids. Batch and fed-batch studies were carried out using oil waste as the lipid feedstock in Erlenmeyer flasks and in a fermentor. Batch fermentation in a fermentor gave the highest yield of sophorolipids of 34 g L-1. Fermentation using oleic acid as control feedstock were also carried out. Batch fermentation in the fermentor using this pure fatty acid gave a highest yield of 42 g L-1. The difference in the sophorolipid yield was attributed to the fatty acid composition of restaurant oil waste.

The structure of phage phi29 transcription regulator p4-DNA complex reveals an N-hook motif for DNA.

Protein p4 affects the transcriptional switch that divides bacteriophage phi29 infection in early and late phases. The synthesis of DNA replication proteins and p4 takes place in the early phase, while structural, morphogenesis, and lysis proteins are synthesized in the late phase. Transcriptional switch by p4 is achieved by activating the late promoter A3 and repressing the early promoters A2b and A2c. The crystal structure of p4 alone and in complex with a 41 bp DNA, including the A3 promoter binding site, helps us to understand how the phage cycle is controlled. Protein p4 has a unique alpha/beta fold that includes a DNA recognition motif consisting of two N-terminal beta turn substructures, or N-hooks, located at the tips of an elongated protein homodimer. The two N-hooks enter the major groove of the double helix, establishing base-specific contacts. A high DNA curvature allows p4 N-hooks to reach two major groove areas three helical turns apart, like a bow and its string.