Wilkersonbanks2346

Predisposing factors for the development of a pre-capillary component in pulmonary hypertension associated with left heart disease remain elusive. We report the case of a patient with persistent combined post-capillary and pre-capillary pulmonary hypertension after cardiac transplantation, in whom a rare BMPR2 variant was found.Pulmonary arterial hypertension is a chronic, progressive, and life-threatening disease in children with diverse causes of pulmonary arterial hypertension. The most severe cases of pulmonary arterial hypertension require aggressive treatments with systemic administration of continuous prostacyclin therapy, including treprostinil and epoprostenol. The successful use of continuous subcutaneous treprostinil therapy eliminates the need for an indwelling central venous catheter and its associated risks. However, pain at the subcutaneous infusion site, an expected side effect of this therapy, is often a deterrent to its widespread use. Effective subcutaneous treprostinil site maintenance and pain management is essential to achieve success with this therapy, but strategies surrounding site maintenance and pain control vary significantly between pediatric pulmonary hypertension treatment centers. In an attempt to standardize practice, a survey on the use of subcutaneous treprostinil and site maintenance and pain management strategies, as well as its perceived effectiveness, was disseminated to 13 pediatric pulmonary hypertension centers of the Pediatric Pulmonary Hypertension Network. Responses to the survey were collected and analyzed and were developed into a set of formalized strategies to facilitate knowledge sharing and standardization of practice.Rupture of the axillary artery in the absence of a fracture of dislocation is a rare traumatic event. An associated injury to the brachial plexus may accompany an axillary artery injury but has rarely been reported in the literature. We present the case of an elderly female, who fell onto an outstretched arm and sustained an axillary artery rupture, combined with a brachial plexus injury. The patient in this case did well post-operatively. The challenge in these cases is early recognition and diagnosis of a vascular injury. A significant mechanism of injury needs to alert the clinician to the possibility of such injuries and if suspected, early investigation and surgical exploration should be initiated to prevent limb ischemia. Subsequently, if the neurological symptoms do not improve, consideration must be given to the possibility of a nerve injury and early recognition and management to prevent long-term functional deficits.Phyllodes tumour (PT) is a rare type of fibroepithelial breast tumour that can present in a wide spectrum of biological behaviours, accounting for less then 1% of breast malignancies. Herein, we present a case of a rare gigantic ulcerating PT in a middle-aged woman from regional Western Australia, who presented with a rapidly growing right breast mass. Core biopsy showed spindle cell lesion with differentials being PT of at least borderline variety or metaplastic carcinoma. The ulcerations over the fungating tumour showed heavy growth of Staphylococcus aureus. The treating team subsequently proceeded to right total mastectomy with level 1 and 2 axillary clearance. This report emphasizes the rare presentation of PT, dilemma in investigations and the difficulties in managing non-compliant patient where treatment protocol needs to be modified.Retention of an intercostal drain segment is an uncommon and infrequently reported complication of underwater seal drain use. We report the case of a 66-year-old New Zealand European male who underwent bilateral lung transplantation for severe chronic obstructive pulmonary disease and bronchiectasis. The patient required a return to the operating room for exploratory surgery after an intercostal drain severed during its attempted removal and became retained within the chest cavity. A deep suture had inadvertently been passed around the chest drain intraoperatively. In the event of such a complication, prompt recognition and removal of the retained segment is required. This novel case is reported to highlight the possibility of an entrapped suture as a cause of resistance when attempting to remove an intercostal drain. Kinking on a chest X-ray may also point to this problem, and senior input should be sought early if radiographic findings are coupled with clinical difficulties.The COVID-19 pandemic has aggravated a preexisting epidemic the opioid crisis. Much literature has shown that the circumstances imposed by COVID-19, such as social distancing regulations, medical and financial instability, and increased mental health issues, have been detrimental to those with opioid use disorder (OUD). In addition, unexpected neurological sequelae in COVID-19 patients suggest that COVID-19 compromises neuroimmunity, induces hypoxia, and causes respiratory depression, provoking similar effects as those caused by opioid exposure. Combined conditions of COVID-19 and OUD could lead to exacerbated complications. With limited human in vivo options to study these complications, we suggest that iPSC-derived brain organoid models may serve as a useful platform to investigate the physiological connection between COVID-19 and OUD. read more This mini-review highlights the advances of brain organoids in other neuropsychiatric and infectious diseases and suggests their potential utility for investigating OUD and COVID-19, respectively.Due to the current lack of innovative and effective therapeutic approaches, tissue engineering (TE) has attracted much attention during the last decades providing new hopes for the treatment of several degenerative disorders. Tissue engineering is a complex procedure, which includes processes of decellularization and recellularization of biological tissues or functionalization of artificial scaffolds by active cells. In this review, we have first discussed those conventional steps, which have led to great advancements during the last several years. Moreover, we have paid special attention to the new methods of post-decellularization that can significantly ameliorate the efficiency of decellularized cartilage extracellular matrix (ECM) for the treatment of osteoarthritis (OA). We propose a series of post-decellularization procedures to overcome the current shortcomings such as low mechanical strength and poor bioactivity to improve decellularized ECM scaffold towards much more efficient and higher integration.