Climbing and Clinging of Urban Lizards are Differentially Affected by Morphology, Temperature, and Substrate.

Urbanization alters the environment along many dimensions, including changes to structural habitat and thermal regimes. These can present challenges, but may also provide suitable habitat for certain species. Importantly, the functional implications of these habitat shifts can be assessed through the morphology-performance-fitness paradigm, though these relationships are complicated by interactions among habitat choice, other abiotic factors, and morphology across scales (i.e., micromorphology and gross anatomy). The common wall lizard (Podarcis muralis) is one example of a cosmopolitan and successful urban colonizer. Quantifying both shifts in morphology over time and morphology-performance relationships under various ecological contexts can provide insight into the success of species in a novel environment. To examine how morphological variation influences performance, we measured seven gross morphological characteristics and utilized scanning electron microscopy to obtain high-resolution images of a claw from individuals living in established populations in Cincinnati, Ohio, USA. We used a geometric morphometric approach to describe variation in claw shape and then compared the claws of contemporary lizards to those of museum specimens collected approximately 40 years ago, finding that claw morphology has not shifted over this time. We then performed laboratory experiments to measure the clinging and climbing performance of lizards on materials that mimic ecologically relevant substrates. Each individual was tested for climbing performance on two substrates (cork and turf) and clinging performance on three substrates (cork, turf, and sandpaper) and at two temperatures (24ºC and 34ºC). Clinging performance was temperature insensitive, but determined by substrate-specific interactions between body dimensions and claw morphology. Conversely, the main determinant of climbing performance was temperature, though lizards with more elongate claws, as described by the primary axis of variation in claw morphology, climbed faster. Additionally, we found strong evidence for within-individual trade-offs between performance measures such that individuals who are better at clinging are worse at climbing and vice versa. These results elucidate the complex interactions shaping organismal performance in different contexts and may provide insight into how certain species are able to colonize novel urban environments.

Impact of endovascular repair for abdominal aortic aneurysms in octogenarians.

A total of 50 consecutive patients (86% male; median age, 82 years) underwent endovascular repair of abdominal aortic aneurysms (AAAs) ranging from 4.0 to 9.0 cm (median, 5.2 cm). Efficacy of aneurysm exclusion was assessed by angiography, duplex scan, and/or contrast-enhanced computed tomography (CT). Acute technical success was 82%. Access failed in one patient, and immediate conversion to open operation was required in two patients. Improper deployment of the endoluminal graft (ELG) across the renal arteries occurred in one patient. The median operation time, estimated blood loss, packed red blood cells received, contrast volume, and length of intensive care and hospital stay were 128 min, 200 mL, 0.1 unit, 297 mL, 0.9 days, and 3 days, respectively. ELG limb thrombosis was seen in one patient. There were 4 (8%) early endoleaks, and 2 endoleaks were discovered in other patients at 3 and 6 months. Local/vascular and remote/systemic postoperative complications were seen in 13 (26%) and 9 (18%) patients, respectively. At a median follow-up of 11 months (range 2 to 36 months), clinical success was 78%. The aneurysm sac diameter (n = 49) decreased from a preoperative median of 5.2 to 4.7 cm (p = 0.0001). Technical success was high, and results at 11 months were satisfactory. Long-term outcomes require further study.

Transrenal fixation of aortic endografts: intermediate follow-up of a single-center experience.

PURPOSE: To examine the fate of the renal ostia following transrenal fixation of endovascular aortic stent-grafts. METHODS: Thirty-five patients (29 men; mean age 75 years) undergoing endovascular repair for abdominal aortic aneurysms (AAAs) had transrenal fixation of the uncovered proximal stent due to a short (< 1.5 cm long) or conical neck or a periprocedural endoleak. Eighteen (51%) patients were hypertensive; 7 (20%) had renal artery stenoses (RAS). Outcome measures included blood pressure, serum creatinine, computed tomography, and renal artery duplex scans. RESULTS: Two patients with > or = 60% RAS had renal stents placed during the endograft procedure; the other 5 RAS patients were normotensive and their renal lesions were not treated. Overall technical success was 82.9% (29/35). One (2.9%) case was converted due to graft twisting. There were 5 (14.2%) early endoleaks. Transient postoperative creatinine elevations were observed in 5 (14.2%) cases. Over a median 11-month period (range 2-24), no secondary endoleaks or silent renal artery occlusions were seen. One normotensive patient with an untreated > or = 60% renal lesion developed hypertension and severe stenosis (99%) at 4 months; stenting through the interstices of the transrenal stent was performed. No disease progression was seen in the other 6 RAS patients. CONCLUSIONS: In the intermediate period, transrenal fixation appears to have no adverse effects on renal blood flow. Moreover, in patients with no evidence of renal disease or preoperative RAS < 60%, it does not precipitate or cause progression of renal stenosis. However, patients with preoperatively documented RAS > or = 60% are a concern and mandate further study.

Intraoperative subclavian artery stenting to salvage a LIMA graft.

The internal mammary artery is the preferred conduit for coronary bypass grafting; however, suboptimal flow through the internal mammary artery is sometimes found during the operation, and the conduit is abandoned. Subclavian artery stenosis, a well-recognized cause of reduced internal mammary artery flow, is easily and effectively treated with endovascular techniques. We describe a case of intraoperative primary stent deployment in a high-grade subclavian artery stenosis compromising internal mammary artery flow.

Tissue response to biomaterials used for staple-line reinforcement in lung resection: a comparison between expanded polytetrafluoroethylene and bovine pericardium.

OBJECTIVE: A study in a canine model of lung-reduction surgery evaluated the tissue response to polytetrafluoroethylene (ePTFE) and bovine pericardium (BP) used for staple-line reinforcement. METHODS: In each of ten dogs, BP was placed in one lung and ePTFE in the other. The implants were retrieved at 30, 95, or 167 days after implantation and studied histologically. The connective tissue covering the implants was measured and analysis of variance was used to compare results with the two materials. RESULTS: At 30 days, the BP specimens showed focal chronic inflammation and thin tissue coverage, whereas the ePTFE specimens had no focal inflammation and thick tissue coverage. At 95 and 167 days, the inflammation in the BP specimens had resolved, but tissue coverage remained minimal, and there was no resorption of the BP. In the ePTFE specimens, tissue coverage had increased. Analysis of variance comparing representative tissue specimens showed that the tissue encapsulating the ePTFE was significantly thicker than that surrounding the BP (P < 0.0001). No air leaks, staple-line disruptions, or infections occurred in the study. CONCLUSIONS: Neither ePTFE nor BP is resorbable. Both materials have been used successfully, without resultant infections, for clinical staple-line reinforcement. The more favorable tissue response to ePTFE observed in this study may have clinical ramifications. Comparative clinical studies of the two materials are needed.

Prevention of air leaks after pulmonary wedge resection.

Prolonged air leak after a lung volume reduction operation for pulmonary emphysema is a major cause of morbidity and prolonged hospital stay. Staple line reinforcement is recognized as an effective adjunctive technique for decreasing the occurrence of air leaks after pulmonary wedge resection. Numerous materials have been used for staple-line reinforcement. We use expanded polytetrafluoroethylene sleeves that fit over the arms of surgical staplers to facilitate staple-line reinforcement in both thoracoscopic and open lung volume reduction procedures. The expanded polytetrafluoroethylene sleeves do not require rinsing or special handling; they are easy to use and effective in preventing air leaks. We had no prolonged air leaks or infections in any of the cases in which we used the sleeves.