Academic literature on the topic 'Venus Bay (Vic )'

We describe a 9-day-old baby with coarctation of the aorta who required urgent resuscitation including intubation and cardiac compressions. Despite the commencement of prostaglandin E1 (PGE1) to reopen the ductus arteriosus via the intraosseous route, postductal saturations remained unrecordable for a further 45 min. Within 3 min of administration of PGE1 via an umbilical venous catheter (UVC), saturations were recordable at 92%. UVC access was the sentinel intervention that irrevocably altered the clinical prognosis. This baby boy has survived with excellent neurodevelopmental outcome. Clinicians are less familiar with UVCs outside of the newborn period. Our data demonstrate successful placement in neonates up to 28 days of age. We hope this case encourages clinicians to consider the UVC as first-line central venous access in collapsed neonates. In cases of suspected left heart obstruction, we argue that UVCs are the optimal route.

Abstract Background: Platelets are versatile cells and play important roles in hemostasis/thrombosis, inflammation, and atherosclerosis. The pathogenesis of cardiovascular diseases (CVDs) is linked to platelet hyperactivity which is considered an independent risk factor for CVDs. Platelets are critical for promoting the progression of CVDs, and platelet apoptosis have been reported to be involved in platelet activation. Anthocyanins are major phytochemicals abundant in plant food and have been shown to play a protective role against CVDs. Our previous studies demonstrated that anthocyanins from plant food significantly inhibited platelet activation, adhesion, aggregation and granule secretion, as well as attenuated thrombus growth at both arterial and venous shear stresses in vitro and in vivo, however, the effects of anthocyanin on platelet apoptosis and its mechanisms have not been explored. In the present study, we examined whether anthocyanin Cyanidin-3-glucoside (Cy-3-g) affect platelet apoptosis and the BCL-2/BCL-XL intrinsic apoptotic pathway. Methods: Cy-3-g, the predominant bioactive compound of anthocyanin preparations, was obtained from Polyphenol AS Company in Norway.Purified gel-filtered platelets from healthy volunteers were incubated at 37oC for 40 minutes with different concentrations of Cy-3-g (0.5、5、50μM) or PBS buffer as a control. the activated platelets were triggered with 0.5U thrombin for 15min to induce apoptosis. Mitochondria membrane potential (Δψm) and membrane phospholipid phosphatidylserine (PS) exposure in both activated and resting platelets were assessed by flow cytometry. Cytochrome C release, activation of caspase-3, caspase-8, caspase-9, cleavage of gelsolin, the levels of anti-apoptotic BCL-2 family proteins such as BCL-2, BCL-XL and proapoptotic BCL-2 family proteins Bax, Bak, Bad, Bid and tBid in both activated and resting platelets were measured by western blotting. Results: Cy-3-g at 5μM and 50μM directly induced significant ΔΨm dissipation in activated platelets dose dependently. Correspondingly, 50μM Cy-3-g increased cytochrome C release compared to control. The expression of pro-caspase-8 and pro-caspase-9 decreased, activation of caspase-3, caspase-8 and caspase-9 was induced in activated platelets in both 5μM and 50μM Cy-3-g groups. Both PS exposure and the cleavage of gelsolin increased in activated platelets, however these effects were only observed at Cy-3-g doses as high as 50μM. Cy-3-g did not induce the above changes in resting platelets. The intrinsic apoptotic pathway was initiated by Cy-3-g treatment in activated platelets; Cy-3-g significantly inhibited the expression of BCL-2, BCL-XL and increased the levels of Bax, Bak, Bad and Bid in activated platelets dose dependently. No significant difference was observed in resting platelets. Conclusions: Our data demonstrate for the first time that purified anthocyanin Cy-3-g directly accelerated apoptosis in activated platelets via the BCL-2/BCL-XL pathway. Anthocyanins may possess therapeutic potential for patients suffering from thrombotic conditions. Disclosures No relevant conflicts of interest to declare.

In animals, the blockade of acid-sensing ion channels (ASICs), cation pore-forming membrane proteins located in the free nerve endings of group IV afferent fibers, attenuates increases in arterial pressure (AP) and sympathetic nerve activity (SNA) during muscle contraction. Therefore, ASICs play a role in mediating the metabolic component (skeletal muscle metaboreflex) of the exercise pressor reflex in animal models. Here we tested the hypothesis that ASICs also play a role in evoking the skeletal muscle metaboreflex in humans, quantifying beat-by-beat mean AP (MAP; finger photoplethysmography) and muscle SNA (MSNA; microneurography) in 11 men at rest and during static handgrip exercise (SHG; 35% of the maximal voluntary contraction) and postexercise muscle ischemia (PEMI) before (B) and after (A) local venous infusion of either saline or amiloride (AM), an ASIC antagonist, via the Bier block technique. MAP (BAM +30 ± 6 vs. AAM +25 ± 7 mmHg, P = 0.001) and MSNA (BAM +14 ± 9 vs. AAM +10 ± 6 bursts/min, P = 0.004) responses to SHG were attenuated under ASIC blockade. Amiloride also attenuated the PEMI-induced increases in MAP (BAM +25 ± 6 vs. AAM +16 ± 6 mmHg, P = 0.0001) and MSNA (BAM +16 ± 9 vs. AAM +8 ± 8 bursts/min, P = 0.0001). MAP and MSNA responses to SHG and PEMI were similar before and after saline infusion. We conclude that ASICs play a role in evoking pressor and sympathetic responses to SHG and the isolated activation of the skeletal muscle metaboreflex in humans. NEW & NOTEWORTHY We showed that regional blockade of the acid-sensing ion channels (ASICs), induced by venous infusion of the antagonist amiloride via the Bier block anesthetic technique, attenuated increases in arterial pressure and muscle sympathetic nerve activity during both static handgrip exercise and postexercise muscle ischemia. These findings indicate that ASICs contribute to both pressor and sympathetic responses to the activation of the skeletal muscle metaboreflex in humans.

LBA8512 Background: Patients with hepatic metastases from primary melanoma have a median survival between 6 and 9 months. Few treatment strategies provide a meaningful impact on outcome. This report examines the efficacy of a minimally invasive regional therapy with melphalan (MEL) in patients with hepatic metastases from malignant melanoma. Methods: Between February 2006 and October 2009, 93 patients (M:F; 45:48) were accrued to a phase III, random-assignment trial comparing percutaneous hepatic perfusion (PHP-mel) (n=44) to standard of care (BAC) (n=49). This represents 100% of a planned 92 patient accrual. The primary endpoint was hepatic progression-free survival (H-PFS). Crossover to PHP-mel therapy was permitted at hepatic progression. Secondary endpoints included assessment of response rate (RR), duration of response (RES), and overall survival (OS) after PHP. A planned PHP treatment regimen included 4 to 6 PHP procedures at 28 to 35 day intervals. MEL (3.0 mg/kg) was delivered via the hepatic artery in a 30-minute hepatic artery infusion via a percutaneously placed catheter with hepatic venous hemofiltration using a retrohepatic, double balloon catheter (Delcath Systems, Inc.) and paired hemofiltration cartridges. Patients randomized to BAC were offered treatment considered to be the best alternative regimen by the treating physician. Staging evaluations were performed at baseline and then at 6 to 8 week intervals post baseline. All responses represent investigator-based results and were evaluated via standard RECIST criteria. Intent to treat based survival analysis was via the Kaplan-Meier method, with a 2-sided p< 0.05 defining significance. Results: Median H-PFS was 245 days (CI:136, 267) for PHP-mel vs. 49 days (CI:43, 68) for BAC (p<0.001). Overall response rate was 34.1 % (15/44) (CI: 20.5, 49.9) for PHP (15/44) vs. 2.0 % (1/49) (CI: 0.1, 10.9) for BAC (p<0.001). Upon hepatic progression, crossover to PHP occurred in 27 patients (55%) randomized to BAC. Conclusions: For patients with metastatic melanoma to the liver, H-PFS is significantly improved with PHP-mel versus best available care. [Table: see text]

Background. In recent years, Kansas has ranked 40th among all states for worst infant mortality rates. For African American infant mortality, Kansas had the highest rate in the nation. Because of these statistics, initiatives have been implemented to reduce these rates by the KIDS Network, in partnership with the Black Nurses Association and the National Association of Hispanic Nurses. The purpose was to describe participants’ knowledge and intentions regarding safe sleep following a Community Baby Shower. Methods. The Community Baby Shower was targeted to African American women via black churches, physician offices, clinics, black sororities, word of mouth, radio, and print. All Baby Shower participants were asked to complete a brief survey following the shower. Results. The majority were African American (61%) with a high school diploma or less schooling (63%). Nearly all (97%) planned to place their baby supine for sleep. However, less than half (47%) planned to have the baby sleep in the parents’ room in a separate crib. Attendees exhibited high levels of safe sleep knowledge, stated intentions to utilize most safe sleep recommendations, and reported babies would have slept in unsafe environments without the portable crib. Conclusions. Our Baby Showers were attended by the target audience, who exhibited high levels of safe sleep knowledge, and stated intentions to utilize most safe sleep recommendations following the Shower. However, some participants were resistant to following at least some of the recommendations. Additional venues and other educational strategies may be needed to maximize the uptake of these recommendations.

Abstract IL-17 is a recently discovered cytokine that can be released from activated human CD4+ T lymphocytes. This study assessed the proinflammatory effects of human (h) IL-17 in the airways. In vitro, hIL-17 increased the release of IL-8 in human bronchial epithelial and venous endothelial cells, in a time- and concentration-dependent fashion. This effect of hIL-17 was inhibited by cotreatment with an anti-hIL-17 Ab and was potentiated by hTNF-α. In addition, hIL-17 increased the expression of hIL-8 mRNA in bronchial epithelial cells. Conditioned medium from hIL-17-treated bronchial epithelial cells increased human neutrophil migration in vitro. This effect was blocked by an anti-hIL-8 Ab. In vivo, intratracheal instillation of hIL-17 selectively recruited neutrophils into rat airways. This recruitment of neutrophils into the airways was inhibited by an anti-hIL-17 Ab and accompanied by increased levels of rat macrophage inflammatory protein-2 (rMIP-2) in bronchoalveolar lavage (BAL) fluid. The BAL neutrophilia was also blocked by an anti-rMIP-2 Ab. The effect of hIL-17 on the release of hIL-8 and rMIP-2 was also inhibited by glucocorticoids, in vitro and in vivo, respectively. These data demonstrate that hIL-17 can specifically and selectively recruit neutrophils into the airways via the release of C-X-C chemokines from bronchial epithelial cells and suggest a novel mechanism linking the activation of T-lymphocytes to recruitment of neutrophils into the airways.

Introduction Granulocytapheresis from healthy volunteer donors are performed regularly at our institution to treat severely neutropenic leukemia/SCT patients with overwhelming bacterial/fungal infections. 500 to 750 mL of Hespan® (6% hetastarch in 0.9% sodium chloride injection) with citrate anticoagulant is administered by aseptic addition to the input line of the centrifugation apparatus at a ratio of 1:13 to venous whole blood. The traditional method of gravity sedimentation of Granulocyte concentrates (GC) is the addition of 50 cc of 6% Hydroxyethyl starch in ACD anticoagulant which results in RBC volume reduction to &lt; 5ml (range acceptable for transfusion to ABO incompatible recipients according to AABB standards). The method is time consuming, tedious and adds additional HES to the product. We streamlined the process by allowing the sedimented red cells to drain via gravity upon completion of the apheresis procedure without the addition of Hetastarch. Method: GCs are obtained from prescreened eligible (meet AABB/FDA guidelines) family/friends of the patients. G-CSF is administered as a fixed dose of 480 mcg (donors &lt; 250 lbs.) or as 2 doses of 300/480 mcg (donors &gt; 250 lbs) plus 8 mg of dexamethasone (without history of cataracts) 12 hours prior to the collection. 30 ml of TriCitrasol Anticoagulant (46.7% Trisodium citrate) is added to 500 ml of 6% Hetastarch in 0.9% Sodium Chloride Injection for IV use only and not more than 1000 ml is used in a single GC apheresis procedure. Our current practice is to test all O blood group donors for Anti-A Isoagglutinin titers. Cut off titers are set at &lt;128. GCs from group O donors with Anti-A titers &gt; 128 are drained of red cells if the recipient is non-O. For pediatric patients, our practice is to drain all GC products regardless of ABO compatibility between donor and recipient. Process: Upon completion of the Granulocytaheresis, the GC collection bag is left undisturbed hanging on the IV pole leaving all slips clamps attached. Red cells collected during the apheresis procedure settle at the base the collection bag. The collection line of the GC collection bag is clamped distal to the attachment of the sterile barrier filter inclusive of the sample bulb assembly. The clamp proximal to the sample bulb assembly needs to be left clamped. The collection bag is then sterile docked to a transfer bag (the plasma bag from the IDL set can be used) to create a closed sterile system. Two hemostats clamps are placed, one close to the inlet port of the collection bag and the other close to the sterile dock of the transfer bag. The clamps are opened slowly and the sedimented red cells are allowed to slowly drain into the transfer bag. Pressure using two fingers may be used to create a funnel to express the sedimented red cells into the port from the GC unit. When the desired amount of red cells are expressed into the transfer bag the process is stopped. The transfer bag is then removed by clamping and a relatively clean GC product is now available for transfusion. The entire process takes approximately 10-15 minutes. The GC bag is then sampled via the incorporated sample bulbs for the bag count, then labelled ready for release for transfusion. Results: We reviewed the results of six drained GCs by this method; the median Bag RBC was 0.8 x10e6/uL (range 0.06 - 0.23), Bag Hgb 0.8 g/dL (range 0.5-1.0) and Bag Hematocrit 0.7% (range 0.6-2.6). The median Bag WBC count was 10.6 x 10e10 (range 5.8 to 15.1), median bag volume 641 mL (range 462-774) and median volume processed 10526 ml (range 8800-12175 mL). We achieved our goal of reducing the red cells to &lt;2 ml, providing a GC with more than the minimum yield (1.0 x 10e10) required according to AABB standards and also the availability of a GC product within 2 hours of completion for transfusion. Discussion: The use of the newer Apheresis machine allows for efficient removal of the targeted component and monitors/adjusts the depth at which the cells are collected within the Buffy coat layer based on the desired hematocrit of the collected product. Our practice is to collect a relatively clean GC product where there is less than 2 mL of red cell contamination in the GC unit. However, this is not always achieved and the GC units do have to be drained. Approximately 10-25 mL of red cells are drained depending on the collection and the GC units drained in this manner are comparable to the GCs drained after the addition of 50 cc of Hetastarch to the GC product. Disclosures No relevant conflicts of interest to declare.

China Shale-Gas Field Sets Production Record Sinopec recorded China’s highest daily output of shale gas at 20.62 million cubic meters (Mcm) at its Fuling shale-gas field in Chongqing, China, a key gas source for the Sichuan-East gas pipeline. The first major commercial shale-gas project in China, Fuling has continuously broken records for the shortest gasfield drilling cycle while significantly increasing the drilling of high-quality reservoirs covering more than 3 million m, according to Sinopec. Gasfield production construction was also expanded to raise production capacity. The company said the field maintains a daily output of 20 Mcm, producing an estimated 6.7 Bcm per year. Apache and Total Plan Suriname Appraisals Apache filed appraisal plans for its Maka and Sapakara oil discoveries in block 58 offshore Suriname. The company said another submission is expected for Kwaskwasi, the largest find in the block, by the end of the year. Operations continue for Keskesi, the fourth exploration target. There are plans to drill a fifth prospect at Bonboni in the North-Central portion of the concession. Partner company Total is assuming operatorship of the block ahead of next year’s campaigns. BP Emerges as Sole Bid for Offshore Canada Parcels BP was the only operator to place a bid in the Canada-Newfoundland and Labrador Offshore Petroleum Board (C-NLOPB) Call for Bids NL20-CFB01, which offered 17 parcels (4,170,509 hectares) in the eastern Newfoundland region. The successful bid was for Parcel 9 (covering 264,500 hectares) for $27 million in work commitments from BP Canada Energy Group. Subject to BP satisfying specified requirements and receiving government approval, the exploration license will be issued in January 2021. No bids were received for the remaining 16 parcels, which may be reposted in a future Call for Bids. Criteria for selecting a winning bid is the total amount the bidder commits to spend on exploration of the parcel during the first period of a 9-year license, with a minimum acceptable bid of $10 million in work commitments for each parcel. Beach Energy To Drill Otway Basin Well Beach Energy plans to drill at its Artisan-1 well about 32 km offshore Victoria, Australia, in the Otway basin, before the end of 2021. The well, located on Block Vic/P43, was to be spudded in 1H 2020 but was delayed due to COVID-19. The timeframe for drilling was confirmed by the National Offshore Petroleum Safety and Environmental Management Authority, which also said Beach is keeping open the option to suspend the well and develop it, pending reservoir analysis. Anchors, mooring chains, and surface buoys have already been laid for the well, which is in a water depth of approximately 71 m. The well is expected to take approximately 35–55 days to drill, depending on the final work program and potential operational delays. Diamond Offshore’s semisubmersible Ocean Onyx was contracted for the drilling program. Artisan is the first of Beach’s planned multiwell campaigns, which also include development wells at the Geographe and Thylacine fields. Hess Completes Sale of Interest in Gulf of Mexico Field Hess completed the sale of its 28% working interest in the Shenzi Field in the deepwater Gulf of Mexico (GOM) to BHP, the field’s operator, for $505 million. Shenzi is a six-lease development structured as a joint ownership: BHP (operator, 44%), Hess (28%), and Repsol (28%). The acquisition would bring BHP’s working interest to 72%, adding approximately 11,000 BOE/D of production (90% oil). The sale is expected to close by December 2020. Hess CEO John Hess said proceeds from the sale will help fund the company’s investment in Guyana. Greenland Opens New Offshore Areas Greenland opened three new offshore areas for application of oil and gas exploitation licenses off West Greenland. The areas are Baffin Bay, Disko West, and Davis Strait. The country also said it is working on an oil strategy to reduce geological uncertainty by offering an investment package to companies that engage in its Open Door Procedures. The procedures are a first-mover advantage to remove national oil company Nunaoil, as a carried partner, reducing turnover and surplus royalties. It is estimated to reduce the government take by 51.3% to 40.6%. Shell and Impact Oil & Gas Agree to South Africa Farmout Africa Oil announced Impact Oil & Gas entered into two agreements for exploration areas offshore South Africa. The company has a 31.10% share-holding in Impact, a privately owned exploration company. Impact entered into an agreement with BG International, a Shell subsidiary, for the farm-out of a 50% working interest and operatorship in the Transkei and Algoa exploration rights. Shell was also granted the option to acquire an additional 5% working interest should the joint venture (JV) elect to move into the third renewal period, expected in 2024. Algoa is located in the South Outeniqua Basin, east of Block 11B/12B, containing the Brulpadda gas condensate discovery and where Total recently discovered gas condensate. The Transkei block is northeast of Algoa in the Natal Trough Basin where Impact has identified highly material prospectivity associated with several large submarine fan bodies, which the JV will explore with 3D seismic data and then potential exploratory drilling. Impact and Shell plan to acquire over 6,000 km² of 3D seismic data during the first available seismic window following completion of the transaction. This window is expected to be in the Q1 2022. After the closing of the deal, Shell will hold a 50% interest as the operator and Impact will hold 50%. Impact also entered into an agreement with Silver Wave Energy for the farm-in of a 90% working interest and operatorship of Area 2, offshore South Africa. East and adjacent to Impact’s Transkei and Algoa blocks, Area 2 complements Impact’s existing position by extending the entire length of the ultradeepwater part of the Transkei margin. Together, the Transkei and Algoa Blocks and Area 2 cover over 124,000 km2. Area 2 has been opened by the Brulpadda and Luiperd discoveries in the Outeniqua Basin and will be further tested during 2021 by the well on the giant Venus prospect in ultradeepwater Namibia, where Impact is a partner. Impact believes there is good evidence for this Southern African Aptian play to have a common world-class Lower Cretaceous source rock, similar excellent-quality Apto-Albian reservoir sands, and a geological setting suitable for the formation of large stratigraphic traps. Following completion of the farm-in, Impact will hold 90% interest and serve as the operator; Silver Wave will hold 10%. Petronas Awards Sarawak Contract to Seismic Consortium The seismic consortium comprising PGS, TGS, and WesternGeco was awarded a multiyear contract by Petronas to acquire and process up to 105,000 km2 of multisensor, multiclient 3D data in the Sarawak Basin, offshore Malaysia. The contract award follows an ongoing campaign by the consortium in the Sabah offshore region, awarded in 2016, in which over 50,000 km2 of high-quality 3D seismic data have been acquired and licensed to the oil and gas industry to support Malaysia license round and exploration activity. The Sarawak award will allow for a multiphase program to promote exploration efforts in the prolific Sarawak East Natuna Basin (Deepwater North Luconia and West Luconia Province). The consortium is planning the initial phases and is engaging with the oil and gas industry to secure prefunding ahead of planned acquisition, covering both open blocks and areas of existing farm-in opportunities. Total Discovers Second Gas Condensate in South Africa Total made a significant second gas condensate discovery on the Luiperd prospect, located on Block 11B/12B in the Outeniqua Basin, 175 km off the southern coast of South Africa. The discovery follows the adjacent play-opening Brulpadda discovery in 2019. The Luiperd-1X well was drilled to a total depth of about 3,400 m and encountered 73 m of net gas condensate pay in well-developed, good-quality Lower Cretaceous reservoirs. Following a coring and logging program, the well will be tested to assess the dynamic reservoir characteristics and deliverability. The Block 11B/12B covers an area of 19,000 km2, with water depths ranging from 200 to 1800 m. It is operated by Total with a 45% working interest, alongside Qatar Petroleum (25%), CNR International (20%), and Main Street, a South African consortium (10%). The Luiperd prospect is the second to be drilled in a series of five large submarine fan prospects with direct hydrocarbon indicators defined utilizing 2D and 3D seismic data. BP Gas Field Offshore Egypt Begins Production BP started gas production from its Qattameya gasfield development ‎offshore Egypt in the North Damietta offshore concession. Through BP’s joint venture Pharaonic Petroleum Company working with state-owned Egyptian Natural Gas Holding Co., the field, which is ‎expected to produce up to 50 MMcf/D, was developed through a one-well subsea development and tieback to existing infrastructure.‎ Qattameya, whose discovery was announced in 2017, is located approximately 45 km west ‎of the Ha’py platform, in 108 m of water. It is tied back to the Ha’py and Tuart field ‎development via a new 50-km pipeline and connected to existing subsea ‎utilities via a 50-km umbilical. ‎BP holds 100% equity in the North Damietta offshore concession in the East Nile Delta. ‎Gas production from the field is directed to Egypt’s national grid.

The aim of the present study was to investigate whether the dihydropyridine-sensitive L-type Ca2+ channel is operative in adrenal catecholamine (CA) secretion induced by a novel neuropeptide, pituitary adenylate cyclase-activating polypeptide (PACAP), in anesthetized dogs. Plasma CA concentrations in adrenal venous and aortic blood were determined by a high-performance liquid chromatography method. All drugs tested were locally infused into the left adrenal gland via the left adrenolumbar artery. PACAP, with the isoform consisting of 27 (PACAP-27) and 38 (PACAP-38) amino acid residues, significantly increased CA output in a dose-dependent manner, with doses ranging from 5 to 500 ng and 7 to 700 ng, respectively. However, the amplitude of epinephrine response to PACAP-27 was three times greater than that obtained with PACAP-38 at the highest dose tested. In a separate group, a single dose of PACAP-27 (50 ng) induced highly reproducible CA responses when the same dose was repeated with an interval of 35 min. In dogs treated with nifedipine (50 μg), 5 min before the second administration of PACAP-27, the net CA response was significantly inhibited by ∼50% compared with that obtained in the presence of vehicle. A similar CA response to BAY K 8644 (5 μg) was completely abolished by the same dose of nifedipine. The present results indicate that both PACAP-27 and PACAP-38 have the direct local secretagogue effect on the adrenal medulla in vivo and that CA responses to PACAP-27 were greater than those observed with PACAP-38 at equivalent mole doses. The study suggests that the dihydropyridine-sensitive L-type Ca2+ channel is functionally involved in PACAP-induced adrenal CA secretion in the canine adrenal medulla in vivo.

In patients requiring long-term chemotherapy, antibiotics, hemodialysis, or parenteral nutrition, central venous access is usually possible via catheter placement in the jugular, subclavian, or femoral veins. As these routes become complicated by thrombosis, stenosis, infection, or surgical intervention, the options for central venous catheter placement become limited, and direct puncture of the inferior vena cava (IVC) may be required. This chapter reviews the technique for placement of a catheter in the IVC via translumbar approach. Because direct access using anatomic landmarks can be challenging, initial puncture of the hepatic veins can be used to guide placement of an IVC catheter.

Transmesenteric portal access via mini-laparotomy may be used as a salvage technique when standard transjugular intrahepatic portosystemic shunt (TIPS) is unsuccessful due to difficult anatomy or portal vein thrombosis. This technique allows for precise determination of both the portal and the hepatic vein branch involved in the TIPS. This method usually involves the cooperation of a surgeon, who performs a mini-laparotomy and exposes a small bowel loop in the interventional suite. A mesenteric venous branch is then cannulated, providing direct access to the portal venous system. In distinction to standard technique, the hepatic parenchymal tract is created by a puncture from the portal vein into the hepatic vein. A guidewire advanced through the puncture needle is then snared from the hepatic vein, providing through-and-through access. The TIPS can be completed using standard techniques. Upon completion, the mini-laparotomy is closed by the surgeon.

The blood system transports nutrients, oxygen, carbon dioxide and nitrogenous wastes; other functions include defence. Fish have a closed, single circulation in which blood is pumped by a contractile heart via a ventral aorta to the gills, then via the dorsal aorta to vessels supplying the tissues and organs, with a venous return to the heart. Large venous sinuses occur in elasmobranchs. Air-breathing fish have modifications of the circulation. Complex networks of narrow blood vessels can occur as red patches, retia, maximizing transfer of nutrients, oxygen or heat. Most fish have nucleated red blood cells (erythrocytes) with haemoglobin. The types of white blood cells (leucocytes) are similar to those of other vertebrates but there are thrombocytes rather than platelets. Nutrient transport is in the plasma, the fluid component of the blood, which may also carry antifreeze agents and molecules (e.g. urea in elasmobranchs) which counteract deleterious osmotic effects

The diagnosis of intra-abdominal hypertension (IAH)/abdominal compartment syndrome (ACS ) relies on accurate IAP measurement. The current gold standard for measurement is intermittently every 4–6 hours via the bladder. IAP monitoring should be performed in all critically-ill or injured patients exhibiting ≥1 risk factors for the development of IAH, and continued until risk factors are resolved and intra-abdominal pressure (IAP) has remained normal for 24–48 hours. IAH and ACS cause organ dysfunction through direct compression of the heart, compression of both arterial and venous perfusion of the abdominal organs, and abdomino-thoracic pressure transmission. All organ systems are affected by IAH-induced injury. Standard surgical treatment of established ACS not responding to non-invasive management consists of decompressive laparotomy via midline or transverse incision. Promising alternative surgical strategies are being developed to avoid the complications of the open abdomen.

Acute respiratory failure not only impairs gas exchange, but also stresses cardiovascular reserve by increasing the need for increased cardiac output (CO) to sustain O2 delivery in the face of hypoxaemia, increased O2 demand by the increased work of breathing and inefficient gas exchange, and increased right ventricular afterload due to lung collapse via hypoxic pulmonary vasoconstriction. Mechanical ventilation, though often reversing these processes by lung recruitment and improved arterial oxygenation, may also decrease CO by increasing right atrial pressure by either increasing intrathoracic pressure or lung over-distention by excess positive end-expiratory pressure or inadequate expiratory time causing acute cor pulmonale. Finally, spontaneous negative swings in intrathoracic pressure also increase venous return and impede left ventricular ejection thus increasing intrathoracic blood volume and often precipitating or worsening hydrostatic pulmonary oedema. Positive-pressure breathing has the opposite effects.

Although uncommon, a trapped central venous catheter (CVC) can present a significant problem for the interventionalist and pose considerable risk to the patient. The use of chronic long-term CVCs is on the rise, with an average catheter dwell time of 10 months. Although all CVCs are prone to complications, chronic catheters exhibit a higher rate of complications. Chronic catheters are also at risk of becoming trapped, whereby they cannot be removed by standard technique. A simple, elegant technique to remove a trapped CVC via inserting an angioplasty balloon into the lumen of a stuck catheter has been described, as has a modified technique with inclusion of a hemostatic sheath and a stiff guidewire inserted into the cut catheter to ensure hemostasis, prevent air embolism or endoluminal thrombosis, and avoid injury to the central veins and heart. Examples of both applications are provided in this chapter.

Chapter 6 revisits feminist theologies, using body theology commitments to analyze potential issues detected in the works of Carter Heyward and Marcella Althaus-Reid. Inattention to the dynamics of perception fundamental to our bodily experience inadvertently undermines the strength of their respective works. Both theologians explicitly reflect on bodily experience and seek to construct liberative theologies, make reference to the pitfalls of body/mind dualisms, and highlight, in one way or another, knowledge via perception. Bringing body theology commitments to Carter Heyward’s theological project, the chapter discusses ways in which body theology can go beyond naïve appeals to sensory perception as epistemological venue. Marcella Althaus-Reid’s work will serve as an example of body metaphor theology. Exploring and suspending/delaying Althaus-Reid’s theological method will show how body theology can strengthen theological aims, namely by dwelling on and exploring experience more thoroughly, thus avoiding a too quick move from experience to metaphor.

This chapter examines four ideal types of collective financial statecraft of the BRICS (Brazil, Russia, India, China, and South Africa) in four case studies occurring between 2007 and mid-2016. The first type is inside reforms of existing institutions, illustrated by the BRICS’ attempt to gain greater influence within the International Monetary Fund (IMF) and World Bank. A second type is inside reforms of markets, defined as resisting or reallocating the political power accruing to states that possess currency and financial market power. The associated case profiles the BRICS’ opposition to sanctions against Russia over its intervention in Ukraine. A third type of BRICS collective action occurs via the outside option to create new parallel institutions such as the New Development Bank (NDB) and Contingent Reserve Arrangement (CRA). Finally, a fourth type combines the choice of an outside option with a market-based venue. The chapter examines BRICS support of greater internationalization of China’s currency, rivaling the U.S. dollar and thus altering international financial markets. The BRICS have cooperated successfully in most of their attempts.

Vascular access, both arterial and venous, at peripheral and more central sites is relatively new in historical medical terms and has only really developed into mainstream practice in the last 60 years. Other routes of drug and fluid administration via the gut and inhalation preceded it by centuries. It is a core skill for anaesthetists and intensivists, yet is not always well taught or is left out of core training curricula, with the assumption that skills will just be picked up early along the way. Like many procedures, it can be surprisingly easy to learn the basics, but many hazards and difficulties await the less skilled or inexperienced operator. A thorough knowledge of applied anatomy, practical skills, and recognition and management of complications are essential for safe practice. The increasing use of ultrasound, ECG guidance, X-ray screening, and other devices, and improved design of access devices allow much safer and more successful procedures. Many patients will now have long-term devices in situ, which can be used during anaesthesia and critical care. Such devices are increasingly inserted or removed by anaesthetists. Space precludes a detailed description of actual techniques for all routes of access; only general principles will be covered in this chapter.

Higher education in the United States of America, considered by many to set a worldwide standard for broad access and high levels of excellence, has for many decades seen massive changes in its approaches to teaching and learning. Redesigning and transforming the way colleges and universities teach their students has been likened to reconstructing an airplane while it remains aloft. More than 4,000 US colleges and universities have met the challenge by analyzing major changes in student populations and introducing new instructional techniques that recognize the primacy of learning over teaching. This seemingly innocent but powerful transformation, acknowledging that teaching only matters as a means to the real end – learning – is powering a pedagogical revolution. The Learning Revolution in US higher education began when World War II veterans flooded university classrooms, soon to be followed by their children, the American «Baby Boom.» Overwhelming numbers of new students from new kinds of backgrounds flooded colleges and universities, forcing professors to rethink how they went about teaching these new generations. To handle the numbers, many new universities were created, and many established centers for teaching excellence to help professors adapt to new populations with new techniques. In the 1990s, higher education further professionalized the teaching craft via the Scholarship of Teaching and Learning. Research into how students learn and how to help them learn took its place alongside traditional academic research. Aided by a wave of new technologies, teaching centers and the scholarship of teaching and learning are transforming the university classroom as well as many new venues outside the classroom where learning now takes place. The resulting new pedagogical architecture now embraces every dimension of US higher education.

The food services sector has been evolving rapidly over the past decade, accelerated by the Covid-19 pandemic. The traditional linear model of food producers selling through wholesalers to brick and mortar retailers, restaurants and hospitality venues is increasingly being displaced by complex interactive digital ecosystems of online food services providers. Consumers are increasingly able to access food directly at various stages along the traditional value chain via interaction with digital platforms and rapid home-delivery networks, realising greater convenience, more variety in food products and services from a dynamic start-up scene, and overall enhanced value. FSA needs to stay abreast of these changes and develop regulatory responses to ensure these innovations are aligned with the public good and do not compromise food safety and public health.

Aeromagnetic and ground gravity data for the Canadian Superior Province, filtered to extract long wavelength components and converted to pseudo-gravity, highlight deep, N-S trending regional-scale, rectilinear faults and margins to discrete, competent mafic or felsic granulite blocks (i.e. at high angles to most regional mapped structures and sub-province boundaries) with little to no surface expression that are spatially associated with lode ('orogenic') Au and Ni-Cu-PGE-Cr occurrences. Statistical and machine learning analysis of the Red Lake-Stormy Lake region in the W Superior Province confirms visual inspection for a greater correlation between Au deposits and these deep N-S structures than with mapped surface to upper crustal, generally E-W trending, faults and shear zones. Porphyry Au, Ni, Mo and U-Th showings are also located above these deep transverse faults. Several well defined concentric circular to elliptical structures identified in the Oxford Stull and Island Lake domains along the S boundary of the N Superior proto-craton, intersected by N- to NNW striking extensional fractures and/or faults that transect the W Superior Province, again with little to no direct surface or upper crustal expression, are spatially associated with magmatic Ni-Cu-PGE-Cr and related mineralization and Au occurrences. The McFaulds Lake greenstone belt, aka. 'Ring of Fire', constitutes only a small, crescent-shaped belt within one of these concentric features above which 2736-2733 Ma mafic-ultramafic intrusions bodies were intruded. The Big Trout Lake igneous complex that hosts Cr-Pt-Pd-Rh mineralization west of the Ring of Fire lies within a smaller concentrically ringed feature at depth and, near the Ontario-Manitoba border, the Lingman Lake Au deposit, numerous Au occurrences and minor Ni showings, are similarly located on concentric structures. Preliminary magnetotelluric (MT) interpretations suggest that these concentric structures appear to also have an expression in the subcontinental lithospheric mantle (SCLM) and that lithospheric mantle resistivity features trend N-S as well as E-W. With diameters between ca. 90 km to 185 km, elliptical structures are similar in size and internal geometry to coronae on Venus which geomorphological, radar, and gravity interpretations suggest formed above mantle upwellings. Emplacement of mafic-ultramafic bodies hosting Ni-Cr-PGE mineralization along these ringlike structures at their intersection with coeval deep transverse, ca. N-S faults (viz. phi structures), along with their location along the margin to the N Superior proto-craton, are consistent with secondary mantle upwellings portrayed in numerical models of a mantle plume beneath a craton with a deep lithospheric keel within a regional N-S compressional regime. Early, regional ca. N-S faults in the W Superior were reactivated as dilatational antithetic (secondary Riedel/R') sinistral shears during dextral transpression and as extensional fractures and/or normal faults during N-S shortening. The Kapuskasing structural zone or uplift likely represents Proterozoic reactivation of a similar deep transverse structure. Preservation of discrete faults in the deep crust beneath zones of distributed Neoarchean dextral transcurrent to transpressional shear zones in the present-day upper crust suggests a 'millefeuille' lithospheric strength profile, with competent SCLM, mid- to deep, and upper crustal layers. Mechanically strong deep crustal felsic and mafic granulite layers are attributed to dehydration and melt extraction. Intra-crustal decoupling along a ductile décollement in the W Superior led to the preservation of early-formed deep structures that acted as conduits for magma transport into the overlying crust and focussed hydrothermal fluid flow during regional deformation. Increase in the thickness of semi-brittle layers in the lower crust during regional metamorphism would result in an increase in fracturing and faulting in the lower crust, facilitating hydrothermal and carbonic fluid flow in pathways linking SCLM to the upper crust, a factor explaining the late timing for most orogenic Au. Results provide an important new dataset for regional prospectively mapping, especially with machine learning, and exploration targeting for Au and Ni-Cr-Cu-PGE mineralization. Results also furnish evidence for parautochthonous development of the S Superior Province during plume-related rifting and cannot be explained by conventional subduction and arc-accretion models.