Postrivas1104

The adult type of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is characterized by late presentation due to collateral coronary flow. Patients often present with long time recurrent angina or dyspnea. Surgical correction can be a challenge due to the vast collateral coronary circulation.

A previously healthy 41-year-old male presented in the emergency room referring typical angina and dyspnea. Coronary angiography revealed ALCAPA. Surgical correction was indicated. Under cardiopulmonary bypass, the left main coronary artery ostium was isolated and directly reimplanted in the aorta. The patient was discharged from the hospital without complications and asymptomatic. Control coronary angiography showed enlarged left main coronary artery and regression of the collateral circulation.

Even with a well-developed collateral circulation, detachment of the left coronary artery and direct implantation in the aorta is feasible, achieving good long-term results.

Even with a well-developed collateral circulation, detachment of the left coronary artery and direct implantation in the aorta is feasible, achieving good long-term results.

Acute liver failure is a rare and serious disease. Acute liver failuremay be paracetamol-induced or non-paracetamol-induced. Acute liver failurenot caused by paracetamol (acetaminophen) has a poor prognosis with limited treatment options. N-acetylcysteinehas been successful in treating paracetamol-induced acute liver failure and reduces the risk of needing to undergo liver transplantation. Recent randomised clinical trials have explored whether the benefit can be extrapolated to treat non-paracetamol-related acute liver failure. The American Association for the Study of Liver Diseases (AASLD) 2011 guideline suggested that N-acetylcysteine could improve spontaneous survival when given during early encephalopathy stages for patients with non-paracetamol-related acute liver failure.

To assess the benefits and harms of N-acetylcysteine compared with placebo or no N-acetylcysteine, as an adjunct to usual care, in people with non-paracetamol-related acute liver failure.

We searched the Cochrane Hepato-Biliaryliver failure evaluating N-acetylcysteine versus placebo, as well as investigations to identify predictors of response and the optimal N-acetylcysteine dose and duration.

For stereotactic radiosurgery (SRS), accurate evaluation of dose-volume metrics for small structures is necessary. The purpose of this study was to compare the DVH metric capabilities of five commercially available SRS DVH analysis tools (Eclipse, Elements, Raystation, MIM, and Velocity).

DICOM RTdose and RTstructure set files created using MATLAB were imported and evaluated in each of the tools. Each structure set consisted of 50 randomly placed spherical targets. The dose distributions were created on a 1-mm grid using an analytic model such that the dose-volume metrics of the spheres were known. Structure sets were created for 3, 5, 7, 10, 15, and 20mm diameter spheres. The reported structure volume, V100% [cc], and V50% [cc], and the RTOG conformity index and Paddick Gradient Index, were compared with the analytical values.

The average difference and range across all evaluated target sizes for the reported structure volume was-4.73%[-33.2,0.2], 0.11%[-10.9, 9.5], -0.39%[-12.1, 7.0], -2.24%[-21.0, 1. the DVH analysis capabilities of software commonly used for SRS plan evaluation and provides freely available and downloadable analytically derived set of ground truth DICOM dose and structure files for the use of radiotherapy clinics. The differences between systems highlight the need for standardization and/or transparency between systems, especially when evaluating plan quality for multi-institutional clinical trials.Epiphytes, air plants that are structurally dependent on trees, are a keystone group in tropical forests; they support the food and habitat needs of animals and influence water and nutrient cycles. They reach peak diversity in humid montane forests. Climate predictions for Central American mountains include increased temperatures, altered precipitation seasonality, and increased cloud base heights, all of which may challenge epiphytes. Although remaining montane forests are highly fragmented, many tropical agricultural systems include trees that host epiphytes, allowing epiphyte communities to persist even in landscapes with lower forest connectivity. check details I used structural equations models to test the relative effects of climate, land use, tree characteristics, and biotic interactions on vascular epiphyte diversity with data from 31 shade coffee farms and 2 protected forests in northern Nicaragua. I also tested substrate preferences of common species with randomization tests. Tree size, tree diversity, and climate all affected epiphyte richness, but the effect of climate was almost entirely mediated by bryophyte cover. Bryophytes showed strong sensitivity to mean annual temperature and insolation. Many ferns and some orchids were positively associated with bryophyte mats, whereas bromeliads tended to establish among lichen or on bare bark. The tight relationships between bryophytes and climate and between bryophytes and vascular epiphytes indicated that relatively small climate changes could result in rapid, cascading losses of montane epiphyte communities. Currently, shade coffee farms can support high bryophyte cover and diverse vascular epiphyte assemblages when larger, older trees are present. Agroforests serve as valuable reservoirs for epiphyte biodiversity and may be important early-warning systems as the climate changes.Conflict with humans is one of the major threats facing the world's remaining large carnivore populations, and understanding human attitudes is key to improving coexistence. We surveyed people living near Hwange National Park about their attitudes toward coexisting with lions. We used ordinal regression models with the results of the survey to investigate the importance of a range of tangible and intangible factors on attitudes. The variables investigated included the costs and benefits of wildlife presence, emotion, culture, religion, vulnerability, risk perception, notions of responsibility, and personal value orientations. This was for the purpose of effectively tailoring conservation efforts but also for ethical policy making. Intangible factors (e.g., fear and ecocentric values) were as important as, if not more important than, tangible factors (such as livestock losses) for understanding attitudes, based on the effect sizes of these variables. The degree to which participants' fear of lions interfered with their daily activities was the most influential variable.