Decreased pH impairs sea urchin resistance to predatory fish: A combined laboratory-field study to understand the fate of top-down processes in future oceans.

Changing oceans represent a serious threat for a wide range of marine organisms, with severe cascading effects on ecosystems and their services. Sea urchins are particularly sensitive to decreased pH expected for the end of the century and their key ecological role in regulating community structure and functioning could be seriously compromised. An integrated approach of laboratory and field experiments has been implemented to investigate the effects of decreased pH on predator-prey interaction involving sea urchins and their predators. Our results suggest that under future Ocean Acidification scenarios adult sea urchins defence strategies, such as spine length, test robustness and oral plate thickness, could be compromised together with their survival chance to natural predators. Sea urchins represent the critical linkage between top-down and bottom-up processes along Mediterranean rocky reefs, and the cumulative impacts of global and local stressors could lead to a decline producing cascading effects on benthic ecosystems.

Appropriateness of metformin prescription for type 2 diabetes mellitus patients with chronic kidney disease (Stages 3-5).

INTRODUCTION: Metformin is the first-line pharmacological therapy for type 2 diabetes mellitus (T2DM). Guidelines recommend metformin to be given at reduced dosages for those with an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m2 and omitted in those with eGFR<30 mL/min/1.73m2. Lactic acidosis is a known complication of those on metformin. This study aimed to determine the appropriateness of metformin prescription in T2DM patients with chronic kidney disease (CKD) stages 3-5 in a tertiary centre in Malaysia. MATERIALS AND METHODS: A cross-sectional design using retrospective secondary data of T2DM patients on metformin attending nephrology and diabetic clinics in the year 2017. eGFR calculated using the CKD-EPI formula identified those in CKD stage 3-5 defined using the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative criteria. Metformin prescription was considered appropriate when the metformin maximum daily dosage does not exceed 1500 mg in CKD stage 3a and 1000 mg in CKD stage 3b and metformin stopped in CKD stages 4 and 5. RESULTS: A total of 143 patients were included. Majority were in the elderly age group (62.9%), male (60.8%) and had concurrent hypertension (85.3%). Median HbA1c was 8.3% (67 mmol/mol) with most patients (88.8%) having HbA1c above 6.5% (48 mmol/ mol). Majority (92.3%) were categorised as stage 3 CKD. Eleven (7.7%) subjects had inappropriate metformin prescription. Seven of nine (78%) subjects in CKD stage 4 were on metformin with a maximum daily dose of 500 mg to1000 mg. Three patients had serum lactate measured. CONCLUSION: The majority of CKD patients had appropriate metformin prescription. However, a considerable number of CKD stage 4 patients continued to be on metformin. The many benefits of metformin may be a reason why it is still continued against recommendations. Only three patients had lactate measured which, although may suggest that lactic acidosis is not a common occurrence, the potential for metformin-associated lactic acidosis especially in those at risk should be considered.

[Coronary artery dissection secondary to selective coronary angiography]. / Dissezione delle arterie coronarie secondaria ad angiografia coronarica selettiva.

Coronary artery dissection during coronary arteriography is a rare complication. We describe three cases occurred in our laboratory (0.18% of all the procedures). All the invasive procedures were performed with a femoral approach with Judkins catheters by three different surgeons with limited experience; all dissections involved the right coronary artery. Two patients were men with coronary artery disease and the third was a woman who underwent catheterization for mitral valve disease. An inferior acute myocardial infarction occurred in both men and one of them was surgically treated. No ischemia was observed in the female patient with mitral disease. According to previous reports, we believe that the patients at risk for such a complication (adults with diffuse coronary artery disease or young women with valvular disease and normal coronary arteries) must be more carefully considered. Moreover, in these patients soft-tip Judkins catheters should be used during femoral procedures in the right coronary artery.

[Hydatid localization in the proximal tract of the right branch of the pulmonary artery. Description of a case]. / Localizzazione idatidea nel tratto prossimale del ramo destro dell'arteria polmonare. Descrizione di un caso.

Hydatid localization in the major branches of the pulmonary circulation have rarely been reported. The AA. describe the case of a young male patient, previously operated for pulmonary and hepatic hydatidosis, who was unresponsive to medical treatment and died of right heart failure. At necropsy a large hydatid cyst occluding the right proximal branch of the artery was found.