Drainage Site Research Articles

Colloidal metal transport in soils developing on historic coal mine spoil

Chemical weathering of pyrite via oxidative dissolution is well-known for generating Fe(III)-bearing colloids at acid mine drainage (AMD) sites; however, the potential for physical weathering of pyrite-bearing materials and subsequent release and transport of colloidal pyrite and associated trace metals has not been studied. Here, we monitored the colloidal metal transport in soil developing on abandoned coal mine spoil with a history of AMD generation to systematically study the contribution of colloids to base and trace metal transport and determine the elemental and mineralogical composition of colloids. We collected soil pore water using lysimeters with a pore size of approximately 1.3 μm and centrifugation was used to separate the colloids from aqueous fractions. Metal concentrations of Na, Ca, Mg, K, Si, Al, Mn, Fe, Cu, and Zn were analyzed. Our results show only 14% of the total Al and Cu were present in colloidal fractions whereas 23%, 43%, and 54% of Fe, Mn, and Zn were transported in the colloidal phase, respectively. In contrast, all base metals were primarily present in the aqueous concentration with a small fraction (<10%) present in the colloidal phase. The colloidal fractions of the base metals were inferred to be associated with the concentration of clay colloids. The release of colloids exhibited possible sensitivity toward weather conditions such as alternating high temperatures and rainfall during summer (May–July) compared to fall (August–November). The morphology, elemental, and mineral composition of colloids were determined by a scanning electron microscopy equipped with energy dispersive spectroscopy (SEM-EDS) and X-ray diffraction (XRD). Colloids were dominated by phyllosilicates (biotite, muscovite, and kaolinite) with minor quartz and feldspars. Other minerals phases identified in colloidal fractions were hematite, goethite, arsenopyrite, and chalcopyrite. Colloids consisting of Fe, S, and O with structures resembling framboidal pyrite were identified, which is consistent with the non-silicates minerals identified by XRD. Our study suggests that the physical weathering of pyrite in the mine spoil can generate colloidal pyrite, which is mobilized and transported by soil pore water. Our results also indicate that these pyritic colloids are associated with toxic trace metals including Cu, Mn, and Zn. Colloid mobilization is also impacted by changes in temperature and precipitation, where clay mobilization afer rain events is favored. Further, sudden spikes in aqueous and/or colloidal concentrations may be the result of local heterogeneity within soils developing on mine spoil, indicating that further field-based work is necessary to better characterize pore-scale processes that control aqueous and colloid transport at similar sites to have a better understanding of potential contaminant transport from mine spoil systems.

A131 POINT OF CARE ULTRASOUND CHANGES THE NEEDLE INSERTION LOCATION FROM AN ANATOMICALLY LANDMARKED SITE DURING BEDSIDE PARACENTESIS.

Abstract Background Paracentesis is a bedside procedure to obtain ascitic fluid from the peritoneum. It is traditionally performed using anatomic landmarking and percussion to ascertain a safe drainage site. The serious complication rate has been reported as less than 2%. Point-of-care ultrasound (POCUS) has been adopted into education and clinical use and has been shown to improve the safety of certain procedures such as central line insertion and thoracentesis. However, the evidence supporting its use is limited. Aims We aimed to assess if POCUS would yield a user-preferred site for needle insertion compared to conventional landmarking, defined as a &amp;gt;5cm change in location. Methods Adult patients under the care of gastroenterology or general internal medicine at Kingston Health Sciences Centre undergoing paracentesis were consecutively enrolled between January and September of 2020. Physicians performing the procedure were enrolled based on availability. An anatomic site was selected 4cm superiorly and 2-4cm medially to the anterior superior ileac spine and confirmed with dullness to percussion. POCUS was then employed to determine if there was an alternative user-preferred site. Patient and operator demographic data and procedure-related information were collected. Results A total of 30 individual patients and 24 operators were enrolled, comprising 45 unique procedure combinations. Operators were primarily in their PGY 1 and 2 years of training (33% and 31% respectively). Per procedure, patients mean age was 61, and most of the ascites was due to cirrhosis (84%) predominantly due to EtOH (47%) and NAFLD (34%). As per indication, 29% of procedures were for diagnostic purposes alone. In total, users primarily preferred the POCUS site which resulted in a change in needle insertion site &amp;gt;5cm from the anatomic site in 69% of cases. The average depth of fluid was greater at the POCUS site vs. the anatomic site (5.4cm+/-2.8 vs 3.0cm+/-2.5, p&amp;lt;0.005). On average, POCUS deflected the needle insertion site superiorly and laterally to the anatomic site. Operators listed that per procedure the POCUS site was chosen to avoid adjacent organs (38%), optimize fluid pocket (61%) and due to abdominal wall issues (primarily issues with pannus; 11.5%). Importantly 6 cases were aborted due to a lack of an appropriate fluid pocket, despite clinical and/or prior radiographic evidence of ascites. Conclusions Overall, POCUS changes the needle insertion site from the conventional anatomic site for most procedures, due to user-perceived safety concerns. POCUS also prevented an attempt at paracentesis in 6 cases that were deemed unsafe. Therefore, POCUS plays an important role in bedside paracentesis. This research supports the use of POCUS in paracentesis and argues for continued training with POCUS throughout medical school and residency. Funding Agencies None

Lymphatic pathway evaluation in congenital heart disease using 3D whole-heart balanced steady state free precession and T2-weighted cardiovascular magnetic resonance

BackgroundDue to passive blood flow in palliated single ventricle, central venous pressure increases chronically, ultimately impeding lymphatic drainage. Early visualization and treatment of these malformations is essential to reduce morbidity and mortality. Cardiovascular magnetic resonance (CMR) T2-weighted lymphangiography (T2w) is used for lymphatic assessment, but its low signal-to-noise ratio may result in incomplete visualization of thoracic duct pathway. 3D-balanced steady state free precession (3D-bSSFP) is commonly used to assess congenital cardiac disease anatomy. Here, we aimed to improve diagnostic imaging of thoracic duct pathway using 3D-bSSFP.MethodsPatients underwent CMR during single ventricle or central lymphatic system assessment using T2w and 3D-bSSFP. T2w parameters included 3D-turbo spin echo (TSE), TE/TR = 600/2500 ms, resolution = 1 × 1 × 1.8 mm, respiratory triggering with bellows. 3D-bSSFP parameters included electrocardiogram triggering and diaphragm navigator, 1.6 mm isotropic resolution, TE/TR = 1.8/3.6 ms. Thoracic duct was identified independently in T2w and 3D-bSSFP images, tracked completely from cisterna chyli to its drainage site, and classified based on severity of lymphatic abnormalities.ResultsForty-eight patients underwent CMR, 46 of whom were included in the study. Forty-five had congenital heart disease with single ventricle physiology. Median age at CMR was 4.3 year (range 0.9–35.1 year, IQR 2.4 year), and median weight was 14.4 kg (range, 7.9–112.9 kg, IQR 5.2 kg). Single ventricle with right dominant ventricle was noted in 31 patients. Thirty-eight patients (84%) were status post bidirectional Glenn and 7 (16%) were status post Fontan anastomosis. Thoracic duct visualization was achieved in 45 patients by T2w and 3D-bSSFP. Complete tracking to drainage site was attained in 11 patients (24%) by T2w vs 25 (54%) by 3D-bSSFP and in 28 (61%) by both. Classification of lymphatics was performed in 31 patients.ConclusionThoracic duct pathway can be visualized by 3D-bSSFP combined with T2w lymphangiography. Cardiac triggering and respiratory navigation likely help retain lymphatic signal in the retrocardiac area by 3D-bSSFP. Visualizing lymphatic system leaks is challenging on 3D-bSSFP images alone, but 3D-bSSFP offers good visualization of duct anatomy and landmark structures to help plan interventions. Together, these sequences can define abnormal lymphatic pathway following single ventricle palliative surgery, thus guiding lymphatic interventional procedures.

Surgical site infection at chest tube drainage site following pulmonary resection for malignant lesions.

BackgroundWe sometimes experience postoperative surgical site infection (SSI) at the chest tube drainage site (CDS) after thoracotomy. The incidence of and risk factors for SSI at the CDS have remained unclear.MethodsWe conducted a prospective study to determine the incidence and risk factors for SSI at the CDS. We analyzed 99 patients who underwent lobectomy or segmentectomy for pulmonary malignant lesions.ResultsThere were 56 males and 43 females with an average age of 71 years. The postoperative drainage period was 2–15 days. Bacterial species were detected in secretions in 18 of 99 cases (18.2%). Older age was a risk factor for the detection of bacteria at the timing of chest tube removal. Eighteen cases (18.2%) were diagnosed with presence of SSI at the CDS at the timing of staple or suture removal. A pathological diagnosis of squamous cell carcinoma was regarded as a candidate risk factor for SSI. Eleven of 18 SSI patients showed delayed wound healing. A higher level of HbA1c was found in patients with delayed wound healing. Enterococcus faecalis infection may influence the development of complex SSI.ConclusionsWe identified the bacterial profiles, incidence of and risk factors for SSI at the CDS. More intense preoperative glycemic control and an understanding of the bacterial profile and may be useful for reducing the incidence of SSI chest tube drainage sites (CDS).

Changes in Angioarchitecture After Stereotactic Radiosurgery for Dural Arteriovenous Fistula

IntroductionDural arteriovenous fistulae (DAVF) are intracranial vascular abnormalities encountered in neurosurgery practice. Treatment options are microsurgical disconnection, endovascular embolization and/or radiosurgery. Past studies have reported the efficacy, safety, and predictors of success of radiosurgery. In this study, we investigated the angioarchitecture of fistulae at the time of radiosurgery and how the anatomy changed in the time after treatment based on angiogram follow-ups. MethodsA retrospective analysis was performed on patients with angiographic diagnosis of DAVF treated with Gamma Knife radiosurgery (GKRS) between 2013 and 2018. Data collection included demographics, symptoms, grading scores, vascular anatomy, radiation data, treatment strategy, angiographic results, and length of patient follow-up. ResultsOur study reports data on 10 patients with a total of 14 fistulae. On follow-up angiography, 8 (57%) had complete occlusion of the fistula with a median time to follow up of 19.5 months. The remaining 6 (43%) were deemed as near-complete occlusion of fistula with a median time to follow up of 12.0 months. Time from radiosurgery to angiogram revealing incomplete vs. angiogram revealing complete obliteration was significantly different (p=0.045). Nearly all AVFs had decreased feeders over time after treatment with only one AVF developing an additional feeder post-treatment. Arterial feeders, drainage site, sex, Borden type, lesion volume and treatment volume had no predictive value of obliteration outcome. ConclusionsThis study provides data on the angioarchitecture of fistulae treated with GKRS and also serves as an extension of previous studies reporting the safety and efficacy of GKRS treatment for DAVF in a specific patient population.

The role of nanoscale aggregation of ferrihydrite and amorphous silica in the natural attenuation of contaminant metals at mill tailings sites

Ferrihydrite, a hydrous ferric oxide, is ubiquitous in silica-rich mine drainage sites, although some uncertaity remains concerning its nanoscale texture and colloidal properties such as its association with amorphous silica and reactions with contaminant metals. To understand the mechanisms of natural attenuation of contaminants governed by ferrihydrite and amorphous silica aggregations, mine tailings material from the Ningyo-toge uranium deposit, Japan, has been investigated in detail utilizing many traditional solution and mass spectroscopy methods, as well as synchrotron-based methods the latest in FIB- and analytic TEM-based technologies. At this site, the past mining activity results in slightly acidic mine drainage and the contamination of a mill tailings pond with relatively high concentrations of toxic elements, including U, As, and Ra. We have systematically investigated the geochemistry of water, colloids, and sediments from the groundwater draining the former mine site (now remediated), down gradient to the mill tailings pond where the water pH remains ∼6.2. Groundwater with 0.18 mg/L dissolved oxygen (DO) is oxygenated rapidly to levels of 1.65 mg/L DO when exposed to the atmosphere along this flow path. Dissolved Fe2+ is oxidized instantly to form ferrihydrite nanoparticle aggregates > 200 nm in diameter, adsorbing ∼67% of the total As (3.36 µmol/L) in solution. For solutions and particles/aggregates passing through 200-nm filters, ∼17% of the 1.17 µmol/L As is sorbed on these smaller ferrihydrite aggregates. Simultaneously, varying amounts of amorphous silica with particle sizes as small as several nanometers were observed to adsorb onto ferrihydrite aggregates. Arsenic is present predominantly as arsenate, As(V), and preferentially adsorbs to ferrihydrite within these ferrihydrite–amorphous silica aggregates. Arsenate adsorption is not inhibited by silica adsoption on ferrihydrite when the Si/Fe composition is ∼0.25. Uranium is also adsorbed onto aggregates of colloids. After 24 h of static exposure to the ambient atmosphere, the zeta potential of the aggregate that formed in oxygenated water decreases from −16 to −24 mV, near the zeta potential of pure silica, potentially leading to increased colloidal stability. Some large-sized aggregates are deposited at the bottom of the collecting well and slowly adsorb minor amounts of Mn (1.45 wt.%); other aggregates are transported to the mill tailings pond downsteam, where the water is further oxidized (DO = 3.09 mg/L), and deposited onto the sediment together with birnessite, a hydrated Mn-oxide that appears to be biogenic in this case. During sedimentation, associations of amorphous silica within the aggregate play a key role in retaining the ferrihydrite structure that adsorbs toxic elements such as As. Consequently, the mechanism of natural attenuation at the nanoscale constrained by the chemical and physical properties of ferrihydrite–amorphous silica aggregates is of critical importance in the Ningyo-toge mill tailing site. It is shown that it is also important in other mine drainage and mill tailings sites due to the ubiquitous and dominant occurrence of both Si and Fe in these types of settings.

Urban contamination assessment of polycyclic aromatic hydrocarbons released from an oil refinery in Rawalpindi

Polycyclic aromatic hydrocarbons are among persistent organic pollutants and incomplete combustion of hydrocarbons during petroleum processing activities may cause polycyclic aromatic hydrocarbons contamination in the surrounding area. For the first time in Morgah, Rawalpindi, Pakistan, three targeted polycyclic aromatic hydrocarbons i.e. naphthalene, phenanthrene, and pyrene were estimated from surroundings of an oil refinery. Samples were collected simultaneously in soil, water, and leaves of Melia azedarach L., a widely grown tree species in the sampling area, along different selected sites of main drainage coming out of the refinery. Among three polycyclic aromatic hydrocarbons, pyrene was observed in maximum concentration (24.31 mg/kg in soil) among all selected environmental media and studied compounds showed a dynamic behavior in context of accumulation at different sampling points. There was a significant effect of distance, from petroleum refining area on polycyclic aromatic hydrocarbons levels in soil, water and plant leaves. Our findings provide conclusive evidence that location of an oil refinery has attributed to high polycyclic aromatic hydrocarbons contamination in selected study area which can pose significant risk to general environment and to the public.

Pediatric Extracorporeal Cardiopulmonary Resuscitation ELSO Guidelines.

Pediatric Extracorporeal Cardiopulmonary Resuscitation ELSO Guidelines.

Technical Note: Coccygeal vein catheterization for sampling of reproductive tract-derived products from the uterine-ovarian drainage.

Blood sample collection from the caudal vena cava at the site of uterine-ovarian drainage provides a more exact evaluation of the concentration and pattern of secretion of uterine or ovarian secreted products for studies of reproductive processes in cyclic and pregnant cattle compared with samples collected from general circulation. This paper describes a thorough and updated procedure for cannulating the coccygeal vein into the caudal vena cava for the collection of serial blood samples at or near the site of uterine-ovarian drainage. Concentrations of progesterone were quantified in cows of different reproductive tract sizes with an active corpus luteum to assess the distance for proper catheter placement compared with circulating concentrations collected from the jugular vein. This procedure has a low risk for side effects, can be used effectively in pregnant animals with no major consequence to the viability of the pregnancy, and provides means for frequent collections up to 12 d.

Mid-Term Follow-Up of Transcatheter Closure for Coronary Cameral Fistula in Pediatrics.

Coronary cameral fistula (CCF), a rare abnormal coronary communication to cardiac chambers, may lead to coronary steal phenomenon and increase cardiac overload. We investigated the clinical and cardiovascular characteristics in children before and after transcatheter closure. We retrospectively reviewed pediatric patients with CCFs diagnosed by echocardiography in a tertiary medical center between 1998 and 2019. Basic information, echocardiogram, catheterization and interventional procedures were obtained from medical charts. A total of 12 pediatric subjects were included. The median ages at diagnosis and catheterization were 0.2 and 2.8 years, respectively. All CCFs were unilateral and single with varying degrees of coronary artery dilatation and aneurysm formation and diagnosed by echocardiography. The median follow-up periods before and after catheterization were 2.5 and 7.3 years, respectively. Seven of the CCFs originated from the left side. The drainage sites were all right hearts. Before catheterization, the median size of the proximal end of the fistula was 3.1 mm, concomitant with enlargement of conduit coronary arteries. Eleven of the 12 patients underwent transcatheter closure using coils in six and vascular plugs in five. Only one patient had a significant increase in pulmonary-to-systemic flow ratio. The size of conduit coronary artery gradually decreased and the size of ipsilateral coronary branch increased after closure. Transcatheter occlusion for CCFs in children is safe and effective. The morphology of CCFs varies with the degrees of dilation, tortuosity, and aneurysmal formation. After occlusion, alterations in the size of coronary arteries may be a prognostic indicator.

System approach in research of technical efficiency of closed horizontal drainaged

The article presents generalized materials of long – term researches of technical efficiency of the closed horizontal drainage on the irrigated lands of the dry steppe zone of Ukraine. Horizontal drainage is a complex of hydraulic structures, which is a reliable system for preventing unwanted engineering – geological processes – flooding, secondary salinization and salinization of irrigated soils. Drainage provides the project ecological – reclamation condition of irrigated lands in most poorly drained and wasteless areas, where watershed plains and coastal lowlands are composed mainly of aeolian – deluvial loess with filtration coefficients of 0,25-0,50 m / day and depth. 0,0-20,0 from the ground surface are underlain by regional water resistance – red-brown clays with a filtration coefficient of 0,0001 m / day and less. Most of Ukraine’s irrigation systems are located in these natural and climatic conditions: Inguletskaya, Spasskaya, Yavkinskaya, Tatarbunarskaya, Danube-Dniester, Kakhovka, Krasnoznamyanskaya, North-Crimean and others, where irrigation systems and closed horizontal drainage have been built and operate for many decades. The soils on these systems are mainly dark chestnut and southern chernozems. The implementation of the Irrigation and Drainage Strategy in Ukraine for the period up to 2030 requires the restoration, reconstruction, technical modernization and further development of both irrigation and drainage systems, primarily closed horizontal drainage systems. This requires the generalization of all theoretical – methodological and practical experience in design, construction, operation and research aimed at improving the efficiency of closed horizontal drainage: technical, economic, environmental, reclamation. In the restoration of existing closed horizontal drainage systems, which was built in the 60s-80s of the last century and the construction of new drainage systems, the study of the technical condition and efficiency of drainage is a topical issue. On the basis of the materials of the conducted researches the integral, system methodological approach in researches of technical and reclamation efficiency of the closed horizontal drainage is developed, which includes: quantitative estimation of a technical condition of a collector – drainage network; use of regularities of formation of drainage runoff and drainage waters for control of ecological – reclamation condition of irrigated drained lands and efficiency of drainage functioning. It is offered to use the system of estimation of technical and ecological – reclamation efficiency of the closed horizontal drainage for the organization of monitoring of efficiency of functioning of each drainage site on all irrigation massifs.

Valorization of sugarcane bagasse waste for fly ash production and application as an adsorbent

In this study, fly ash (FA) was derived from extracted sugarcane bagasse solid waste (ESBSW) and chemically modified to apply as an adsorbent. Impact of activated FA particles (200 and 250 µm) and adsorbent bed height (4, 6 and 8 mm) on pollutant removal efficiency was evaluated. ESBSW was combusted in laboratory-scale gasifier operated at 1000 °C for 1 h. The black solid residue was sieved to obtain the desired particle size followed by activation with 10% and 15% sulfuric acid. Wastewater samples collected from the drainage site of BUITEMS were analyzed and treated with the prepared adsorbent. ESBSW-FA 250 activated with 15% H 2 SO 4 with 8 mm bed height showed high efficiency. Where, 94.37%, 95.1% and 63.5% removal efficiency of chemical oxygen demand (COD), total solids (TS) and turbidity was attained, respectively. The pH of treated water was neutral. ESBSW has shown great potential to be used as a precursor for valuable byproducts. It's recycling for adsorbent preparation will economically and environmentally benefit the sugar industry.

Valorization of sugarcane bagasse waste for fly ash production and application as an adsorbent

In this study, fly ash (FA) was derived from extracted sugarcane bagasse solid waste (ESBSW) and chemically modified to apply as an adsorbent. Impact of activated FA particles (200 and 250 µm) and adsorbent bed height (4, 6 and 8 mm) on pollutant removal efficiency was evaluated. ESBSW was combusted in laboratory-scale gasifier operated at 1000 °C for 1 h. The black solid residue was sieved to obtain the desired particle size followed by activation with 10% and 15% sulfuric acid. Wastewater samples collected from the drainage site of BUITEMS were analyzed and treated with the prepared adsorbent. ESBSW-FA 250 activated with 15% H2SO4 with 8 mm bed height showed high efficiency. Where, 94.37%, 95.1% and 63.5% removal efficiency of chemical oxygen demand (COD), total solids (TS) and turbidity was attained, respectively. The pH of treated water was neutral. ESBSW has shown great potential to be used as a precursor for valuable byproducts. It's recycling for adsorbent preparation will economically and environmentally benefit the sugar industry.

Valorization of sugarcane bagasse waste for fly ash production and application as an adsorbent

In this study, fly ash (FA) was derived from extracted sugarcane bagasse solid waste (ESBSW) and chemically modified to apply as an adsorbent. Impact of activated FA particles (200 and 250 µm) and adsorbent bed height (4, 6 and 8 mm) on pollutant removal efficiency was evaluated. ESBSW was combusted in laboratory-scale gasifier operated at 1000 °C for 1 h. The black solid residue was sieved to obtain the desired particle size followed by activation with 10% and 15% sulfuric acid. Wastewater samples collected from the drainage site of BUITEMS were analyzed and treated with the prepared adsorbent. ESBSW-FA 250 activated with 15% H 2 SO 4 with 8 mm bed height showed high efficiency. Where, 94.37%, 95.1% and 63.5% removal efficiency of chemical oxygen demand (COD), total solids (TS) and turbidity was attained, respectively. The pH of treated water was neutral. ESBSW has shown great potential to be used as a precursor for valuable byproducts. It's recycling for adsorbent preparation will economically and environmentally benefit the sugar industry.

Coronary artery fistulas morphology in coronary computed tomography angiography.

The aim of the study was to evaluate coronary artery fistulas (CAFs) in coronary computed tomography angiography (coronary CTA) and verify whether there is correlation between the fistula's morphology and other cardiac functional findings and clinical data. A group of 14,308 patients who were diagnosed in coronary CTA was retrospectively analysed. Achieved data were related to referrals. Coronary artery fistula frequency was 0.43% in the examined population. The assessment of coronary artery disease was the most frequent indication for the examination. In 2 out of 3 cases the diagnosis of CAFs was incidental. Fistulas to cardiac chambers were significantly shorter than those to other vascular structures (19.9 vs. 61.8 mm, respectively, p = 0.001). Pulmonary trunk was most often the drainage site. Fistulas with singular supply and drainage constituted the majority. The new morphologic classification of CAFs was introduced with linear, spiral, aneurysmal, grid-like and mixed types. Most numerous was the spiral type group. Patients with aneurysmal fistulas had a tendency for wider diameter of aorta and pulmonary trunk. Smallest left ventricle fraction was observed in gridlike fistulas (48.0%, comparing to 59.2% for all patients with fistulas, p = 0.001). Concomitant abnormalities were found in 13.1% of CAFs patients. Computed tomography angiography has proven to be a useful tool in CAFs detection and morphological assessment. Proposed classification may simplify the predictions whether fistula has a significant influence on cardiac function; however, further studies are needed.

Coronary artery fistulas: a single-center case series

Abstract Introduction Coronary artery fistulas (CAFs) are rare anomalous connections between a coronary artery and a major vessel or cardiac chamber. Currently they are being increasingly encountered due to the more widespread use of various imaging modalities and coronary angiography. Although the vast majority of CAFs are incidentally diagnosed and have no clinical relevance, they can cause significant morbidity such as myocardial infarction, congestive heart failure and endocarditis. Methods A consecutive series of 55867 coronary arteriograms performed in our Cardiology Department from 2007 to 2019 was retrospectively investigated for the presence of coronary artery fistulas. Patients clinical, angiographic and therapeutic data up to november 2019 were analyzed. Data were obtained from medical records of hospital stay and subsequent consultations. Results We identified 50 patients who were diagnosed with one or more CAFs, with ages between 5 and 85 years (mean 59 years). 62% (n=31) were males. The great majority of patients had a single fistula (n=34, 68%), 11 patients had two fistulas (22%), 1 patient had 3 fistulas (2%) and 4 patients had multiple fistulas (8%). CAFs arose more frequently from the left anterior descending artery (n=27), followed by the right coronary (n=18), left circumflex (n=15), left main (n=5) and intermediate artery (n=2). The most frequent drainage site was the pulmonary artery (n=38). The majority of CAFs were incidentally found (n=32; 64%) and thought to have no significance for the patients' clinical status. As for the rest of the patients, CAFs were diagnosed during evaluation of: a heart murmur (n=7); exertional chest pain with no associated significant atherosclerotic coronary artery disease (n=7); exertional dyspnea (n=2); positive exercise stress test (n=1); NSTEMI and cardiac arrest (n=1). Regarding treatment, watchful waiting was the main approach (n=40; 80%). 3 patients had their CAFs closed during surgery for another heart condition (CABG/aortic valve replacement). In 1 patient, heart surgery was specifically conducted for fistula closure. 6 patients (12%) underwent fistula transcatheter closure. Conclusion CAFs are rare coronary anomalies and the majority has no clinical relevance, so watchful waiting is the commonest approach. When they are hemodynamically significant or symptoms/complications arise, surgical or transcatheter closure should be considered. This study describes the angiographic, clinical and therapeutic data of CAFs detected along the last 12 years in a single tertiary care center catheterization laboratory. Funding Acknowledgement Type of funding source: None

Persistent left superior vena cava: clinical importance and differential diagnoses

Persistent left superior vena cava (PLSVC) is the most common thoracic venous anomaly and may be a component of the complex cardiac pathologies. While it is often asymptomatic, it can lead to significant problems such as arrhythmias and cyanosis. Besides, it can cause serious complications during vascular interventional procedures or the surgical treatment of cardiac anomalies (CA). The clinical significance of PLSVC depends on the drainage site and the accompanying CA. In this article, we will describe the epidemiology, embryology, and anatomic variations of PLSVC. Possible accompanying CA and heterotaxy spectrum will be reviewed with the help of multidetector computed tomography (MDCT) images. Radiological pitfalls, differential diagnoses, and the clinical importance of PLSVC will be highlighted.

Effect of arsenite and growth in biofilm conditions on the evolution of Thiomonas sp. CB2.

Thiomonas bacteria are ubiquitous at acid mine drainage sites and play key roles in the remediation of water at these locations by oxidizing arsenite to arsenate, favouring the sorption of arsenic by iron oxides and their coprecipitation. Understanding the adaptive capacities of these bacteria is crucial to revealing how they persist and remain active in such extreme conditions. Interestingly, it was previously observed that after exposure to arsenite, when grown in a biofilm, some strains of Thiomonas bacteria develop variants that are more resistant to arsenic. Here, we identified the mechanisms involved in the emergence of such variants in biofilms. We found that the percentage of variants generated increased in the presence of high concentrations of arsenite (5.33 mM), especially in the detached cells after growth under biofilm-forming conditions. Analysis of gene expression in the parent strain CB2 revealed that genes involved in DNA repair were upregulated in the conditions where variants were observed. Finally, we assessed the phenotypes and genomes of the subsequent variants generated to evaluate the number of mutations compared to the parent strain. We determined that multiple point mutations accumulated after exposure to arsenite when cells were grown under biofilm conditions. Some of these mutations were found in what is referred to as ICE19, a genomic island (GI) carrying arsenic-resistance genes, also harbouring characteristics of an integrative and conjugative element (ICE). The mutations likely favoured the excision and duplication of this GI. This research aids in understanding how Thiomonas bacteria adapt to highly toxic environments, and, more generally, provides a window to bacterial genome evolution in extreme environments.

Distance measurements and origin levels of the coeliac trunk, superior mesenteric artery, and inferior mesenteric artery by multiple-detector computed tomography angiography.

The aim of this study is to determine vertebral levels of the coeliac trunk, the superior mesenteric artery, and the inferior mesenteric artery originated from the abdominal aorta and to calculate the distance measurements between these arteries and between these arteries and the aortic bifurcation by multidetector computed tomography angiography technique. It was determined that the nine different vertebral levels of the coeliac trunk, the nine different vertebral levels of the superior mesenteric artery, and the eleven different vertebral levels of the inferior mesenteric artery. The distance measurements between the coeliac trunk and the superior mesenteric artery, the inferior mesenteric artery, the aortic bifurcation were found significant between female and male. In this study, it was determined more different levels than the levels described in classical anatomy. The preoperative information of these morphological variations can contribute to the reduction of surgical time and perioperative vascular complications especially for anterior lumbar interbody fusion and defining the location of the primary lymphatic drainage site for gastrointestinal malignancies.

Heavy metal contamination in groundwater and surface water due to active Pb-Zn-Cu mine tails and water-rock interactions: A case study from the Küre mine area (Turkey)

This study aimed at elucidating the groundwater and surface water pollution resulting from water-rock interaction, mine tailings, and mining activities at Küre (Kastamonu) sulfidic Pb-Zn-Cu mine area and its vicinity. The study area has a surface area of approximately 2990 km2. The Küre River drainage site covering the study area is approximately 440 km2. The concentrations of SO4, Al, As, Ba, Mn, Ni, Sb, and Pb in some groundwater (K10, K20, K21, K27, K28, K29, K30), and surface water (KR3) exceed the maximum limit values with respect to the Turkish Standards for Water Intended For Human Consumption and World Health Organization Standards. The most polluted waters were K10, K27, and KR3. The K10 well was drilled for observation at the edge of the liquid mine tailing pond of the Küre Pb-Zn-Cu mine area. The K27 well was opened in alluvium outside of the study area and it cuts the clastic units and Mesozoic ophiolites. The KR3 measurement point is located on the Ersizler River, which drains the Küre Pb-Zn-Cu mining site and its dumps. The SO4, Al, As, Pb, and Sb concentrations of the K10, K27, and KR3 waters were 29.3, 0.8, and 15.1 meq/L; 1135, 1112, and 1186 ppb; 284, 255, and 271 ppb; 19.1, 19, and 18.5 ppb; and 18.7, 17.4, and 19.3 ppb, respectively, in the dry period. As revealed by the analysis, the study area had dual pollution source natural pollution caused by water-rock interactions (K27 and others) and anthropogenic pollution (K10 and KR3) caused by the mine tailings. Furthermore, the K10 water had high tritium (3H)-high electrical conductivity (EC) values that likely indicated anthropogenic contamination. The K27 water had low 3H-high EC values, presumably referring to geogenic contamination. The current study also demonstrated that there was leakage from the liquid mine tailing pond into the groundwater (K10), possibly implying discharge of the liquid mine tailings into the river (KR3).