Cynomorium songaricum Rupr, known as Suo Yang, is most commonly used to treat fatigue, protect the liver, and invigorate kidneys in Northwest China. Given the wide medicinal utilisation and lack of safety evaluation, this work evaluated the acute toxicity, genetic toxicity, and 90-day repeated oral toxicity of Suo Yang. Twenty Kunming mice were orally given Suo Yang once and observed for 14 days in the acute toxicity test. The genetic toxicity of Suo Yang was tested using in vivo and vitro assays . In the 90-day repeated oral toxicity study, 80 SD rats were randomly divided into 4 groups and then orally given Suo Yang at different concentrations , while the control group was given sterile water. In the acute toxicity test, no abnormal behaviour or mortality was found in mice. The results suggest that the maximum tolerable dose of Suo Yang is greater than 15 g/kg. In the genotoxicity studies, no revertant colonies were produced in vitro. In the in vivo assays, no increased frequencies of micronuclei or structural abnormalities of spermatocyte chromosomes were found. In the 90-day repeated oral toxicity study, no significant toxicological manifestations were observed in haematological parameters or clinical and pathological examinations. In summary, these results suggest that Suo Yang at the given doses does not cause adverse effects in animals. Thus, Suo Yang can reasonably be considered a safe herbal medicine. Cynomorium songaricum Rupr, known as Suo Yang, belongs to the genus Cynomorium, the sole genus within the Cynomoriaceae family. Suo Yang plants are holoparasitic and have no leaves  . The liv P<0.05 or 0.01.The data were analysed using SPSS 11 software. All data are expressed as the means ± standard deviations. First, the experimental data were examined for variance homogeneity. When the test results indicated no significant deviations from a homogeneous variance, one-way ANOVA was conducted. When significant deviations were noticed, a multiple comparison test (Dunnett's test) was performed to determine which groups were significantly different from each other. If significant deviations from homogeneous variance were observed, a nonparametric test was performed. The level of significance used wasThe results of the acute toxicity assay are shown in P< 0.01), implying mutagenic effects. For the Suo Yang dose groups, no concentration induced more than double the number of revertant colonies. Furthermore, no significant differences were observed between the Suo Yang dose groups and the untreated control group (P> 0.05). Thus, the bacterial reverse mutation test for Suo Yang was concluded to be negative independently of the effects of the liver microsomal enzyme system.The results of the reverse mutation test are shown in P>0.05). By contrast, the positive control group had a significantly higher ratio than the solvent control group (P< 0.01), indicating that the tested mice are sensitive and provided reliable results. In the prescribed dose ranges, Suo Yang showed negative results in the mouse bone marrow micronucleus assay. These results indicated that Suo Yang did not result in mutagenesis.P > 0.05). However, the positive control group showed significant differences in both the frequency of chromosome abnormalities and abnormal cell rate compared with the solvent group (P<0.05). The results of the test suggested that Suo Yang does not cause spermatocyte chromosomal aberrations in mice.P > 0.05). This finding indicated that Suo Yang did not have any significant harmful effects on body weight and food utilisation.During the oral administration of Suo Yang and the vehicle for 90 days, all rats were in good condition. No significant abnormalities in fur colour, behaviour, food consumption, or drinking were observed between the dose groups and the control group in both male and female rats. The results for body weight and food utilisation rate are shown in Figures P > 0.05). The results of the clinical biochemical biochemistry parameters are shown in P > 0.05).The results of haematological biochemistry analysis are shown in P > 0.05).The organ weights and relative organ weights of rats are shown in The results of pathological examinations are shown in Figures With the increasing use of complementary and alternative medicine, herbal medicine has become increasingly popular . TraditiThe acute toxicity of Suo Yang was investigated using in vivo experiments. No abnormalities or mortality was found in mice treated with Suo Yang at a dose of 18 g/kg, equivalent to 432 times the clinical human dosage. In addition, the approximate lethal doses of Suo Yang for male and female animals were found to be higher than 15 g/kg. Therefore, Suo Yang could be regarded as a nontoxic herbal medicine.P> 0.05). We could conclude that Suo Yang did not exhibit mutagenetic activity in the presence or absence of metabolic activation with S9 mix. The Ames mutagenicity assay is a short-term bacterial reverse mutation assay specifically designed to detect a wide range of chemical substances that can result in genetic damage and lead to gene mutations [P> 0.05). Suo Yang did not damage chromosomes or the mitotic apparatus when orally administered to mice at different doses. This assay is considered a preferable method for evaluating chromosome damage because it allows the determination of both chromosomal loss and breakage [P> 0.05). This result suggested that Suo Yang did not show teratogenicity in the mice. Moreover, this result is consistent with a previous study, which suggested that extracts of Suo Yang can enhance sperm motility [The genotoxicity of the Suo Yang was investigated using in vitro and in vivo assays. In the Ames test , no significant differences were observed between the Suo Yang dose groups and the untreated group . In terms of haematological and clinical biochemical parameters, no significant differences were observed between the control and dose groups in either female or male rats (P > 0.05). For all dose groups, the Eos level was slightly higher than that of the control group. However, because these changes showed no statistically significant difference (P> 0.05) and were within the normal physiological ranges, they were not considered to be related to Suo Yang toxicity [P > 0.05). In the histopathological examinations, slight fatty degeneration of hepatocytes in the liver was observed in the solvent control and high dose groups. However, these lesions were minimal and rare, so they were considered incidental, and this effect can be reasonably considered nontoxicological. Overall, these results revealed that Suo Yang had no toxic effect under our experimental conditions.In the 90-day repeated oral toxicity assay, the food utilisation rate and body weight showed no significant difference between the control group and dose groups in both male and female rats (toxicity . For allSingle-dose acute toxicity, genotoxicity, and 90-day repeated oral toxicity of Suo Yang were examined to identify toxicity and to ensure pharmaceutical safety. As a result, no toxicity or mutagenicity was observed in all studies, including acute toxicity, Ames test, mouse bone marrow micronucleus assay, and 90-day repeated oral toxicity. In conclusion, the toxicity studies indicated that at the tested doses, Suo Yang can be regarded as a safe and nontoxic pharmaceutical material. Therefore, further investigation of the active functions of Suo Yang as a safe herbal medicine is worthwhile.


WM) microstructural abnormalities. We sought to determine whether this association persists into adolescence.In neonates with single ventricle, smaller ascending aorta diameter is associated with cerebral white matter , inferior fronto‐occipital fasciculus (P=0.02), and inferior longitudinal fasciculus (P=0.01); left cingulum–cingulate bundle (P=0.01), superior longitudinal fasciculus (P=0.04), and superior longitudinal fasciculus–temporal component (P=0.01); and right cingulum–hippocampal bundle (P=0.009) and inferior cerebellar peduncle (P=0.01). Lower ascending aorta Z scores were associated with higher radial diffusivity and mean diffusivity in a similar regional pattern but not with axial diffusivity.Ascending aorta WM microstructure in a subset of WM tracts, mostly those located in deeper brain regions. Our findings suggest that despite multiple intervening medical or surgical procedures, prenatal cerebral blood flow may have a lasting influence on WM microstructure in single‐ventricle patients.In adolescents with single ventricle, smaller aorta diameter at birth is associated with abnormalities of  This study is the first to examine the relationship between aortic diameter at birth, a proxy for fetal cerebral blood flow, and adolescent cerebral white matter microstructure.Smaller aortic diameter at birth was associated with abnormal microstructure in a subset of white matter tracts.Abnormal prenatal cerebral blood flow may have a long‐term influence on structural brain development.Further studies should clarify the relationship between prenatal cerebral blood flow and neurodevelopmental outcome.Neurodevelopmental outcomes in children and adolescents with congenital heart disease (CHD) have shown only modest improvement over the past decade despite substantial changes in perioperative management.Infants with CHD, particularly those with single ventricle (SV), are at high risk of cerebral white matter (WM) injury. WM injury is present in 15% to 40% of infants undergoing neonatal surgery, emerging before or after surgery.Reduced cerebral blood flow (CBF) in the fetal period may influence long‐term WM development. WM tracts begin forming as early as the first trimester of pregnancy, with additional tracts emerging and maturing throughout gestation. Transient cerebral compartments that appear during the fetal period—such as the intermediate and subplate zones—are critical for establishing the infrastructure for WM connections and may be specifically vulnerable to hypoxia–ischemia.It is unknown whether the association in the neonate between abnormalities of WM microstructure and smaller ascending aorta diameter persists into later childhood and adolescence. We sought to determine whether reduced antegrade CBF prenatally correlates with long‐term alteration of WM microstructure despite the intervening medical and surgical events in an SV population. We hypothesized that smaller ascending aorta diameter at birth would predict altered WM microstructure in adolescence.The data, analytic methods, and study materials will be made available to other researchers for purposes of reproducing the results or replicating the procedure, upon request.Earlier publications have described recruitment details and data obtained in our cohort of Fontan children and adolescents who underwent brain MRI and neurodevelopmental evaluation.The parent Fontan study collected information on participant characteristics, surgical‐ and catheter‐based interventions, and complications.Z scores (AoZ scores) as ascending aorta diameter adjusted for body surface area.Ascending aorta diameter and body surface area were extracted from a clinical database of the first echocardiogram after birth. From these data, we calculated ascending aorta 3. Twenty‐five diffusion‐weighted gradient directions were acquired at b=1000 s/mm2 and 1 non–diffusion‐weighted image at b=0 s/mm2. DTI data were processed using the FMRIB Software Library v5.0.6 (University of Oxford). Raw diffusion data were corrected for movement and eddy current artifacts, then skull stripped.Methods regarding DTI acquisition and analysis have been reported previously.Fractional anisotropy (FA), axial diffusivity, radial diffusivity (RD), and mean diffusivity (MD) were calculated by fitting a tensor model at every voxel, providing an indirect measure of WM microstructural organization through measurement of water mobility. FA is a weighted average of the eigenvalues of the diffusion tensor.We calculated the mean of each diffusion measure for each participant in 33 regions of interest determined by 2 atlases: the Johns Hopkins University WM tractography atlas and the DTI‐81 atlas.t tests with equal variance or Wilcoxon rank sum tests for normal or nonnormal continuous distributions, respectively. Partial Spearman correlation coefficients and linear regression adjusting for Norwood status were used to examine the relationships of AoZ scores with participant and medical history characteristics. For closed procedures, values of DHCA and total support duration were set to 0. Descriptive statistics for the DTI measures were calculated with values of axial diffusivity, RD, and MD multiplied by 1000 for reporting purposes. Partial Pearson correlation coefficients adjusting for sex, age at MRI, scanner field strength, and Norwood status were used to examine relationships of AoZ scores with DTI measures. Given the exploratory nature of the analysis, we did not adjust for multiple comparisons. SAS 9.4 (SAS Institute) was used for all analyses, and all tests were 2‐sided.Group comparisons were examined by Fisher exact tests for categorical measures and 2‐sample Of 144 Fontan participants who underwent MRI, 102 participants (71%) had available regional DTI measurements. Among those, AoZ scores were available for 42 participants, measured at a median of 0 (range: 0–42) days of age Table . Among tP<0.001); at first operation, were more likely to be a neonate (P=0.049), were more likely to have undergone an open procedure (P<0.001), and to have had more operative complications (P=0.04); and had more total open operations (P<0.001).Table P=0.004). Furthermore, lower AoZ scores were associated with longer DHCA duration at first operation , longer total support duration at first operation , and fewer total catheterization complications . AoZ scores were not significantly associated with participant characteristics, such as birth weight or gestational age at birth, or with other medical history variables, such as age at first operation, total operations, or total operative complications.In regression analyses adjusting for Norwood status, AoZ scores were significantly lower in participants who underwent DHCA during their first operation compared with those who did not  under award number R01 HL096825, the National Institute of Neurological Disorders and Stroke of the NIH under award number K23NS101120, an American Academy of Neurology Clinical Research Training Fellowship, and the Farb Family Foundation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.None.Table S1. Participant, Echocardiogram, and Medical History Characteristics of Fontan Participants With Diffusion‐Tensor Imaging DataTable S2. White Matter Region of Interest Measures (n=42)Click here for additional data file.


What are the types of injuries associated with standing electric scooter use and the characteristics and behaviors of injured patients?In this study of a case series, 249 patients presented to the emergency department with injuries associated with electric scooter use during a 1-year period, with 10.8% of patients younger than 18 years and only 4.4% of riders documented to be wearing a helmet. The most common injuries were fractures (31.7%), head injuries (40.2%), and soft-tissue injuries (27.7%).In this study, injuries associated with electric scooter use were common, ranged in severity, and suggest low rates of adherence to existing regulations around rider age and low rates of helmet use. This study of a case series investigates injuries associated with standing electric scooter use, characteristics and outcomes of injured patients, and common use practices of scooters in a US city. Since September 2017, standing electric scooters have proliferated rapidly as an inexpensive, easy mode of transportation. Although there are regulations for safe riding established by both electric scooter companies and local governments, public common use practices and the incidence and types of injuries associated with these standing electric scooters are unknown.To characterize injuries associated with standing electric scooter use, the clinical outcomes of injured patients, and common use practices in the first US metropolitan area to experience adoption of this technology.This study of a case series used retrospective cohort medical record review of all patients presenting with injuries associated with standing electric scooter use between September 1, 2017, and August 31, 2018, at 2 urban emergency departments associated with an academic medical center in Southern California. All electric scooter riders at selected public intersections in the community surrounding the 2 hospitals were also observed during a 7-hour observation period in September 2018.Incidence and characteristics of injuries and observation of riders’ common use practices.Two hundred forty-nine patients  presented to the emergency department with injuries associated with standing electric scooter use during the study period. Two hundred twenty-eight (91.6%) were injured as riders and 21 (8.4%) as nonriders. Twenty-seven patients were younger than 18 years (10.8%). Ten riders (4.4%) were documented as having worn a helmet, and 12 patients (4.8%) had either a blood alcohol level greater than 0.05% or were perceived to be intoxicated by a physician. Frequent injuries included fractures (79 [31.7%]), head injury (100 [40.2%]), and contusions, sprains, and lacerations without fracture or head injury (69 [27.7%]). The majority of patients (234 [94.0%]) were discharged home from the emergency department; of the 15 admitted patients, 2 had severe injuries and were admitted to the intensive care unit. Among 193 observed electric scooter riders in the local community in September 2018, 182 (94.3%) were not wearing a helmet.Injuries associated with standing electric scooter use are a new phenomenon and vary in severity. In this study, helmet use was low and a significant subset of injuries occurred in patients younger than 18 years, the minimum age permitted by private scooter company regulations. These findings may inform public policy regarding standing electric scooter use. The scooters are located and unlocked using a downloaded smartphone application, rides are paid for by the minute, and the ride can be ended anywhere the rider decides. With a maximum speed of 15 mph,2 these short-range electric vehicles consist of a narrow platform on which the rider stands with 1 foot in front of the other and a waist-high rod with handlebars for steering; after kicking off initially with 1 foot, riders accelerate and brake the scooter using triggers activated with their thumbs.Standing electric scooters first appeared in Santa Monica, California, in September 2017, when the micromobility company Bird Rides, Inc, placed thousands of their scooters all around the city.3 and in April 2018, Bird Rides, Inc, announced more than 1 million completed rides.4 Today, several major companies, including Bird and Lime, offer dockless electric scooter services, and several other companies, including the ride-sharing companies Uber and Lyft, have recently entered the market.5 Availability is projected to grow rapidly, with market analysis showing that Lime was valued at $1.1 billion and its rival Bird was valued at more than $2 billion.6Companies offering standing electric scooters are rapidly expanding in the United States. For example, Lime-S scooters are available in more than 60 US cities and 6 cities internationally,7 In comparison, many thousands of riders are now using standing electric scooters daily on US streets shared with millions of pedestrians and drivers. Therefore, understanding the impact of rising scooter use on public health is more important than ever. Local laws regarding electric scooters are variable, with most locales prohibiting riding on the sidewalk and requiring the use of helmets,8 but no uniform set of policies exists, and differences in enforcement further amplify this variation. The scooter rental smartphone applications require riders to state that they will comply with state and local laws, show proof of a driver’s license, be older than 18 years, and use a helmet as part of their initial user agreements, but it is unclear to what extent these requirements are followed. Debates over the role of greater regulation of electric scooters continue in cities like San Francisco9 and Santa Monica, California.10 Of note, a bill supported by Bird to remove the helmet requirement for riders aged 18 years and older was recently signed into law in California,12 illustrating the timeliness of this issue as well as the importance of garnering evidence to guide policy.The early personal transporters by Segway, introduced in 2001, were few in number, expensive to use, restricted to tourist locations, and associated with a specific set of injuries.Given our institution’s proximity to where these electric scooters were first available in the United States, we have the unique ability to describe injuries associated with electric scooters that were severe enough to trigger an emergency department (ED) visit over the course of 1 year. We report on the patient demographic and clinical characteristics of injuries associated with electric scooter use evaluated in our institution’s 2 EDs. Additionally, we conducted public observations to describe common scooter riding practices in the community near the 2 EDs.STROBE) reporting guideline.13We retrospectively analyzed deidentified data from all patient encounters for standing electric scooter injuries presenting to either of 2 EDs affiliated with the University of California, Los Angeles (UCLA), Ronald Reagan UCLA Medical Center and UCLA Medical Center–Santa Monica. We report summary statistics on the continuous and categorical variables of interest. Additionally, we observed a convenience sample of scooter riders to describe common use practices of standing electric scooters in the community surrounding our hospitals  diagnosis codes.We identified all ED encounters for injuries associated with standing electric scooter use in patients of any age by querying our unified electronic medical record for ED encounters between September 1, 2017, and August 31, 2018, that contained a clinician note with any of the non–case-sensitive terms “scooter,” “bird,” or “lime.” Two of us (T.K.T. and C.L.) reviewed the medical records to verify eligibility and excluded ED encounters that were not due to trauma associated with standing electric scooter use. The eAppendix in the In this descriptive study of a case series, we report proportions, calculate means and standard deviations for normally distributed data, and calculate medians and interquartile ranges for data that were not normally distributed.pm and 11 pm.Two hundred forty-nine patients  presented to the emergency department with injuries associated with standing electric scooter use during the study period . The demAmong scooter riders, the most common mechanisms of injury were fall (183 riders [80.2%]), collision with an object (25 riders [11.0%]), and being hit by a moving vehicle or object (20 riders [8.8%]). Only 10 riders were documented as wearing a helmet, constituting 4.4% of all riders or 11.9% of riders whose helmet use status was documented. Twelve patients (4.8%) had physician-documented intoxication or a blood alcohol level greater than 0.05%.Among the 15 patients (6.0%) who were admitted or transferred, 13 patients were admitted to a floor or observation bed and 2 patients to the intensive care unit . The reasons for hospitalization for the 15 patients admitted were orthopedic injuries (n = 5), intracranial hemorrhage (n = 5), major intra-abdominal or intrathoracic injuries (n = 3), cervical spine fracture (n = 1), and concussion (n = 1).The most common injuries were fracture (79 patients [31.7%]), head injury (100 [40.2%]), and contusions, sprains, and lacerations without fracture or head injury (69 [27.7%]). Common fracture locations included the distal upper extremity (31 [12.5%]), proximal upper extremity (17 [6.8%]), distal lower extremity (11 [4.4%]), and face (14 [5.6%]). There was 1 open fracture. Eight patients (3.2%) received procedural sedation in the ED for reduction of a fracture or dislocation. Ninety-five patients (38.2%) sustained a minor head injury , and 5 patients (2.0%) had an intracranial hemorrhage. Five of 95 patients (5.3%) with a minor head injury were documented as wearing a helmet during the incident, while none of the 5 patients with an intracranial hemorrhage had such documentation. Three patients had injuries to the intrathoracic or intra-abdominal organs, specifically pulmonary contusion, pneumothorax or hemothorax, and splenic injury.A total of 193 scooter riders were observed during 3 public observation sessions, and the following unsafe riding practices were observed: no helmet use (182 riders [94.3%]), tandem riding (15 riders [7.8%]), and failure to comply with traffic laws (18 riders [9.3%]), as shown in eTable 2 in the ICD-10 V10-V19) and 181 visits for pedestrian injuries (ICD-10 V00-V09) during the same time period at the 2 EDs. Scooter injuries documented in this study were mostly minor, but could also be severe and costly, with 6.0% of patients admitted to the hospital, and 0.8% admitted to the intensive care unit.To our knowledge, this is the first study examining the injury patterns and clinical outcomes of patients presenting to the ED after incidents involving standing electric scooters. This rapidly expanding technology is a disruptive force in short-distance transportation, and policy makers seeking to understand associated risks and appropriate regulatory responses should seriously consider its effects on public health. Riders share roads with fast-moving vehicular traffic but appear to underestimate hazards; we found that 94.3% of observed riders in our community were not wearing a helmet. Unsurprisingly, injuries associated with standing electric scooter use are prevalent, with 249 patients presenting to the ED over the course of 1 year in our study of 2 EDs. Comparatively, in a post hoc analysis prompted by the review process, we identified 195 visits for bicyclist injuries (16 Segway-related injuries commonly included upper and lower extremity fractures, but some were severe, including reported cases of intracranial hemorrhage requiring admission to the intensive care unit.16 We noted similar patterns of injury with standing electric scooters. However, unlike Segway transporters, standing electric scooters could have substantial impact on public health given their low cost, popularity, and accessibility.Like standing electric scooters, personal transporters launched by Segway offered a novel and convenient means of short-distance transportation, but came with a serious risk for orthopedic and neurologic trauma.18 we found that 10.8% of electric scooter injuries were in patients younger than 18 years. This suggests that current self-enforced regulations imposed by private electric scooter companies may be inadequate. Although California law required helmet use while operating electric scooters during the entire study period, only 4.4% of injured scooter riders were documented to be wearing a helmet. A newly passed California law will make helmet use optional for electric scooter riders older than 18 years on January 1, 201912; it is unclear how this change in policy will affect rider practices and injury patterns.While riders of electric scooters in California are required to be at least 16 years old by state law and 18 years old by company rental agreements,While this is the first study, to our knowledge, of trauma associated with electric scooter use to provide data on a full year of ED visits, our study is retrospective and therefore necessarily limited to available clinical variables. Future work would benefit from efforts to improve ED clinician documentation of relevant incident characteristics, such as helmet use. We likely underestimated the number of electric scooter–associated injuries for several reasons. We excluded 74 ED encounters where it was suspected, but not clear, that an electric scooter was involved, and we did not include outpatient visits to urgent care or primary care clinics for minor injuries. Additionally, scooter use and availability rapidly increased toward the end of our study period, evidenced by the fact that most associated injuries occurred during the later months of the study (eFigure in the Standing electric scooters are a novel, innovative, and rapidly expanding form of transportation with the potential to alleviate traffic congestion, provide affordable transportation to residents of all incomes, and reshape how commuters travel the “last mile” to home or work. Our findings provide insight into the public health and safety risks associated with this rapidly growing form of transportation and provide a foundation for modernizing public policy to keep pace with this trend.


Escherichia coli. Magnetic immobilization of AiiA was achieved on Fe3O4‐SiO2 iron beads and was confirmed via SDS‐PAGE, zeta potential measurement, FTIR spectrometry, and SEM analysis. The magnetic immobilized AiiA exhibited activity in degrading the quorum sensing signal, C6‐HSL. This study opens a new avenue to actively immobilize enzymes via magnetic interaction and quench quorum sensing.Magnetic immobilization of quorum sensing (QS) signal hydrolases provides a convenient solution for quenching QS process that is essential for bacterial biofilm formation and antimicrobial resistance. In the present study, a QS signal hydrolase, AiiA, was fused with a magnetic protein, MagR, and expressed in  For exaBacterial QS process can be quenched by decreasing QS signal levels with enzymes, antibodies, as well as scavenging or processing by competing organisms  and acquired AiiA‐MagR‐coated IBs (IB@[AiiA‐MagR]), which was characterized by techniques including SEM and FTIR. The enzymatic activity of IB@[AiiA‐MagR] in degrading AHLs was analyzed.In the present study, the magnetic protein MagR was used as a fusion tag for magnetic immobilization of the QS signal hydrolases, AiiA. The recombinant protein AiiA‐MagR was constructed and overexpressed in 22.1The quorum sensing signal hydrolase AiiA was expressed as MagR fusions. The DNA segments encoding MagR (GenBank Accession NP_573062) and AiiA (GenBank Accession AGA83379) were optimized for prokaryotic expression and synthesized by Bio Translation Lab. The coding sequence of AiiA was cloned into the multiple cloning sites of plasmid pET28a containing MagR, resulting in the AiiA protein placing at N‐terminus of MagR. The resultant vector was named as pET28a[AiiA‐MagR] with the sequence was confirmed by DNA sequencing.2.2E. coli BL21 (DE3) harboring plasmid pET28a[AiiA‐MagR] were inoculated into Luria‐Bertani medium containing 50 μg/ml kanamycin and shaken at 37°C overnight. The cell suspension was inoculated into LB medium and followed by shaking at 37°C until the value of OD600 reached 0.5–0.6. Protein expression was initiated by supplying with 0.2 mM of IPTG and was continuously shaken at 20°C for 10–14 hr. Cells were then harvested by centrifugation at 6,000 g for 10 min and stored at −80°C.Expression of AiiA‐MagR fusion protein was based on Jiang et al. . Colonie2.3g for 30 min at 4°C. The supernatant was collected and mixed with 10 mg/ml Fe3O4‐SiO2 iron beads  at a volume ratio of 5:1. The mixture was agitated for 30 min to allow complete interactions between AiiA‐MagR and IBs. The resultant precipitation was harvested by centrifugation and washed three times with TBS buffer to remove unbound proteins. The resultant IBs with coated AiiA‐MagR was labeled as IB@[AiiA‐MagR]. The immobilization efficiency of AiiA‐MagR on IBs was analyzed by heating IB@[AiiA‐MagR] at 90°C for 10 min. The proteins were then analyzed by using SDS‐PAGE. The amount of protein was determined by using BCA Protein Assay Kit with bovine serum albumin (BSA) as the standard.The cell pellet (0.5–1 g) with expressed AiiA‐MagR was resuspended in 5–10 ml of ice‐cold TBS buffer  containing 0.2% (w/v) lysozyme and disrupted two times by continuous flow of high‐pressure freezing cells broken TSO.75 KW . The cell lysate was centrifuged at 10,000 2.4−1, at a resolution of 4 cm−1 with 64 scans by using a Nexus (Thermo Fisher Scientific) Fourier transform infrared (FTIR) spectrometer.The morphology of IB@[AiiA‐MagR] was imaged by using a S4800 (Hitachi Company) scanning electron microscope (SEM), fitted with a field‐emission source operating at 5 kV. The zeta potential was measured using a Zetasizer Nano‐ZS90 . The FTIR spectra of pellets were collected from 4,000 to 400 cm2.5Chromobacterium violaceum CV026  as the reporter bacterial strain. Since CV026 produces purple pigment only in the presence of acylated homoserine lactone (AHL), the degradation of AHL will significantly reduce the color. Briefly, a certain amount of C6‐HSL (0.2–0.8 nmole) in 50 mM phosphate buffer (pH 8.0) was mixed with 1 mg of IB@[AiiA‐MagR]. Degradation of C6‐HSL was initiated by shaking the reaction mixture at 220 rpm for 60 min at 37°C. The reaction mixtures were transferred into one of two wells (5 mm in diameter) on an agar plate that was plated with 400 μl of C. violaceum CV026. The control group (IB‐treated C6‐HSL) was transferred into the other well in the same plate. The plate was then incubated at 28°C. The AHL degradation was exhibited by the reduction or abolishment of purple pigments after 24 hr of incubation  and one piece of sterile catheters (1 × 0.5 cm2) were added into each well. Plates were then incubated at 37°C for 24 hr. The catheter pieces were removed from the plate and washed three times using sterilized PBS to remove cell medium and nonadhered bacteria. The plates were dried at ambient temperature for 20 min and then stained with 0.1% crystal violet for 10 min. Residual solution was then removed, and samples were washed four times using sterilized PBS. Plates were air‐dried before adding 1 ml 30% acetic acid to each well and recording spectrophotometric absorbance at 590 nm.The biofilm formation was quantified using the crystal violet staining method  pond . The binding of AiiA‐MagR to IBs was evidenced with SDS‐PAGE analysis  was observed and confirmed by SDS‐PAGE, zeta potential measurement, FTIR spectrometry, and SEM analysis. The binding capacity of IB to AiiA‐MagR was 5.1 ± 0.3 mg protein per gram IBs. The AiiA‐MagR coating on IBs remained activity in degrading the quorum sensing signal, C6‐HSL. The activity of AiiA‐MagR coating on IBs was detected in inhibiting biofilm formation of P. aeruginosa PA01 on sterile catheters. This study proved that the magnetic protein MagR could be used as a magnetic fusion tag to AiiA and facilitated the active magnetic immobilization of this QS signal hydrolase as well as reduced biofilm formation of bacteria. This magnetic immobilized AiiA‐MagR can be further used for quenching QS and inhibiting biofilm formation in various environments.Enzyme immobilization is important in modern biotechnology and with applications in broad areas such as industrial production of antibiotics and beverages, diagnosis and treatment of diseases, and treatment of sewage and industrial effluents. Enzyme immobilization can be achieved with various techniques such as affinity‐tag binding, adsorption on supports, entrapment, cross‐linkage, and covalent bond. With gene fusion technology, a segment of peptide as a fusion tag can be engineered into a target protein at the genetic level and provide it with biochemical properties of the imported fusion tag. In the present study, a magnetic protein, MagR, as a fusion tag was placed at C‐terminus of a quorum sensing signal hydrolase, AiiA. The resultant recombinant protein AiiA‐MagR was successfully expressed in the The authors declare no financial or commercial conflict of interest.L. Wang and H. Xu conceived and designed experiments. L. Wang and Z. Liu performed experiments and collected data. L. Wang and H. Xie analyzed the data, prepared figures, and wrote the article. C. Yuan, Y. Yang, T. Sun, and J. Guo reviewed and edited the manuscript. All authors read and approved the manuscript.None required.


Purpose: New mothers may question the nature of their motherly love after the birth. Most mothers find that feelings of affection come within a week from birth. However, some mothers are still struggling with this after many months. Many studies place strong emphasis on the importance of maternal affection for the development of the child. Few studies look into mothers’ experiences when maternal affection or love remains a struggle. Method:We present an interpretative synthesis based on a systematic analysis of five qualitative studies that report findings related to mothers’ stated inability to exhibit maternal affection. Result:In answer to our question “what characterizes the experiences of women who struggle with, or are unable to exhibit, maternal affection after birth”, we identified the uncertainty involved in imagining the unborn child, birth and maternal future, birth as a disillusionment, and the ensuing process of decreasing agency and increasing alienation. Especially a traumatic birth may lead to disillusionment. Conclusion: Health care workers and research can support a mother’s positive resolution of her struggle by promoting realistic and more open expectations for maternal affection as well as her sense of agency and ownership during birth and the early mother–child relationship. It is not uncommon that new mothers question the nature of their motherly love after birth. One study revealed that as many as 40% of first-time and 25% of second-time mothers recalled feeling indifference when holding their baby for the first time . They applied “The Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research” .In Nystedt et al.’s  study, sSimilarly, Barrack  reported“I was supposed to do it [giving birth]; me, not the doctors” .These negative birth experiences were often attributed to properties of the self Barrack, . Mothers[Labour and birth] was just nothing like what I’d imagined so I just felt … like just at a disadvantage. Like I’d been thwarted all the way through and … something was taken away from me so I felt like couldn’t really recover, to get back to square one, how I wanted to start out with this new life  Some mAs they spent time with the baby, some mothers felt more at home in the situation and caring for the baby became easier. These mothers described that embodied contact with the baby was important when developing maternal affection; holding, cuddling, talking, carrying, bathing, feeding, and sleeping with their infants promoted feelings of being “bonded” Barrack, . They grI breastfed at day two or three… I was so driven to feed my baby, because of the whole stuff up, I want to succeed at this because I failed him.Women described maternal affection as an intimate, emotional and embodied connectedness to the child. In Coates et al.’s  study, tWomen who had experienced a troubled birth perceived breastfeeding as a form of compensation for the negative experience.While pregnancy is certain, giving birth, motherhood and the child are clouded in uncertainty. The void of uncertainty is filled by imagining how giving birth, motherhood and the child will be. The woman’s imagination is fed by earlier personal experiences, information from her partner, family, friends and health care professionals, and especially by the mother’s awareness and sensations of the child in her womb. Between the mothers in the studies, the futures they imagine range from perfect to natural to terrifying. This range denotes the ambiguity that pregnancy implies, understood as uncertainty filled with imagination of possible future scenarios. Many mothers expect birth and the first encounters with the child to provide the resolution of this ambiguity. However, this resolution may not come as expected, and one of two other unanticipated scenarios may play out. In the first scenario, ambiguity transforms into ambivalence; while birth has passed, the child is born and motherhood has materialized, maternal, loving feelings do not take shape. Shapeless, this ambivalence is about not knowing where to turn for any certainty about how to live life as a mother with an unknown child and a de-owned body. Here, the relationship to the child is one of remoteness. Shame may be the accompanying feeling. In the second scenario, ambiguity is resolved but negatively, making reality clash with any anticipated scenario. When the mother’s body did not perform naturally or perfectly as anticipated, trauma and distress occupy the space where the emotional connection should have formed. The mother seems more occupied with what happened in the recent past and how to repair that in the future than with the here-and-now of being with her child. Guilt may be the accompanying feeling. All in all, especially a traumatic birth may lead to disillusionment when accompanied by a reduced capacity to adapt to difficult, unexpected situations. Yet, as the child’s ability to communicate grows and the mother regains her agency through breastfeeding and other daily caregiving activities, the rhythm of daily life between child and mother may synchronize, gradually strengthening maternal affection.How does maternal love “take hold” as a feeling in the mother? And why do some mothers struggle to develop these feelings? In our synthesis, the first evidence of maternal affection is described in pregnancy, when many mothers experience an increasing emotional connection with the imagined child. Mothers tell about the development of an intimate relationship with the foetus, which they endow with quite complex intentions, thoughts, and feelings. The mother has fantasies about giving birth, how the child is developing, and how she and her partner will act as parents. These fantasies play a major role in preparations for the birth and postpartum period (Raphaell-Leff, The connection between mothers and their foetus increases as it starts to move inside the womb, heightening the mother’s awareness of her child as a separate subject. Similarly, after birth, the mothers often describe an increase in maternal affection parallel to the infant’s growing ability to act and participate as a subject in a common world. Thus, the mother’s affection grows with the increasing separation of herself and her child as individual subjects. Buber  describeThe common cultural conception of maternal love is that of a gendered biological force called maternal instinct, or bonding (Billings, It [feeling of affection] is created by oath, decision, i.e., promised behavior. But we throw ourselves into it, i.e., we end up feeling, and not only by acting, according to the promise. If we did not feel according to the promise, it is because we have not truly decided or promised, a half-decision is a decision to be double. The true decision results in the feeling. (Merleau-Ponty, Merleau-Ponty  observedConsistent with this suggestion, Ruddick  believesA dramatic, medicalized birth or physical illness after birth may delay this process of the mother making an active commitment and investing herself in the child. Having experienced becoming a passive bystander who observes rather than participates creates feelings of helplessness, distance and remoteness. We recognize that sociocultural expectations of instant maternal love clash dramatically with these mothers’ experiences and that this clash often creates feelings of failure, remoteness, shame or guilt. Some mothers with definite expectations for birth, motherhood and the child found the adjustment to reality to be a harsh and difficult process, especially when complications arose. Fantasies about the unborn child, birth and motherhood contributed positively to the development of an emotional connection. When the fantasies were in the form of rigid, detailed plans or expectations, however, they became obstacles to the process of welcoming the actual child and the factual reality as a mother (cf. Besser, Vliegen, Luyten, & Blatt, Merleau-Ponty  can deepThis interpretative synthesis shows that a clash between a woman’s expectations concerning her imagined, unborn child, its birth and early phases of life, on the one hand, and the reality, on the other hand, may initiate a deeply felt struggle or sense of inability to love her child. For some of these women, recovery was gained by taking agency, reclaiming a sense of control by interacting and connecting with the baby. Success in breastfeeding became paramount for many women as it was connected to their image of being a “good mother”, and was a way of making amends for the suffering the baby had endured during the birth. However, if breastfeeding is an expression of mothers’ attempts to regain full control, it may increase the risk of failure as the lack of flexibility makes it difficult to endure the ambiguity of the baby’s signals. The growth of motherly love may involve grieving and letting go of an earlier, inadequate image of the birth, child, or motherhood. An acceptance of the reality of what really happened before, during and after birth may open up for new possibilities and a positive resolution.Health personnel are encouraged to reflect and capitalize on their professional experience of the uncertainties of pregnancy, birth, and early motherhood in order to help women to incorporate realistic expectations for maternal affection during these ambivalent times. The promotion of a realistic sense of agency and ownership during maternity thus deserves greater attention. The compensating effects of bodily contact between mother and child are to be promoted. All the while, however, health personal should be aware that rigid demands concerning breastfeeding or cuddling, from either mother or personnel, can backfire if it is expected to take a perfect shape. Researchers in this field can contribute more extensive qualitative research on women’s experiences of troubled maternal affection. Here, several other important questions should be explored, such as “how do our cultural norms inform our expectations for maternal affection and motherhood in general?”, “do our western cultural expectations increase women’s ambivalence and their feelings of guilt and shame?”, and “how can we best prepare women for motherhood, reducing the gap between expectations and reality, and the sense of detachment from the child?”


N = 37,082) were derived from the 1950 Finnish census, which is linked to later registers. Standard and sibling fixed-effects Poisson and logistic regression models were used. Education and other characteristics were positively associated with the number of children, largely stemming from a higher likelihood of a first birth among the more socioeconomically advantaged men. The educational gradient in the number of children was not explained by early socioeconomic or other characteristics shared by brothers, but occupational position and income in adulthood mediated approximately half of the association. Parity-specific differences existed: education and many other socioeconomic characteristics predicted the likelihood of a first birth more strongly than that of a second birth, and the mediating role of occupational position and income was also strongest for first births. Relatively small differences were found in the likelihood of a third birth. In men, education is positively associated with eventual fertility after controlling for early socioeconomic and other characteristics shared by brothers. Selective entry into fatherhood based on economic provider potential may contribute considerably to educational differentials in the number of children among men.The level of education and other adult socioeconomic characteristics of men are known to associate with their fertility, but early-life socioeconomic characteristics may also be related. We studied how men’s adult and early-life socioeconomic characteristics are associated with their eventual fertility and whether the differences therein by educational level are explained or mediated by other socioeconomic characteristics. The data on men born in 1940–1950 (The online version of this article (doi:10.1007/s10680-017-9430-8) contains supplementary material, which is available to authorized users. Education may influence childbearing among men in various ways over the life course How do the level of education, occupational position, income, and early-life socioeconomic characteristics associate with fertility in men?(ii)Are educational differences in men’s fertility explained by early-life socioeconomic or other characteristics shared by brothers?(iii)Are educational differences in men’s fertility mediated by occupational position and income in adulthood?The role of education and other socioeconomic characteristics in men’s fertility has been addressed in the previous literature, but the mechanisms behind educational differences are still not entirely clear. Economic mechanisms related to income and position in the labour market are often discussed, but alternative mechanisms remain plausible with potentially varying importance depending on parity and the societal context. We conceptualize occupational position as a more proximate indicator of earning potential and attachment to the labour market than education, whereas income measures actual earnings and is a strong indicator of economic resources overall Elo . To gainWe expect to find positive associations between men’s socioeconomic characteristics in adulthood and fertility, but do not hypothesize about the respective associations with early socioeconomic characteristics (i). Regarding educational differences, we expect any explanatory role of early characteristics to be weaker (ii) than any mediating role of adult characteristics (iii). Parity differences, if any, are expected to show as weaker associations of socioeconomic characteristics with higher-order births. We build on the current literature by studying the role of education in men’s childbearing more thoroughly in relation to other socioeconomic characteristics across the life course. The study is based on Finnish population-based register data on birth cohorts 1940–1950 with detailed non-retrospective measurements of early-life characteristics. The data uniquely allow follow-up of the early-life stages up until late reproductive ages, a rich non-retrospective measurement of early-life socioeconomic characteristics, and sibling comparison.The context of this study implied low living standards in the mid-twentieth century, but rising levels thereafter  , lost to follow-up at the ages of 45–49 (n = 2281), or with an unrealistic age at first birth (n = 2). Loss to follow-up was attributable to emigration, mainly to Sweden in the late 1960s and the early 1970s, and to a lesser extent to mortality between 1950 and 1990/1995. The final study sample included 37,082 men. Brothers were identified based on information on place of residence, household, and family collected in 1950. The analysed men came from 27,305 families, of which at least two male siblings were identified in 7671 families. This identification procedure did not distinguish between biological and non-biological siblings. Siblings who had died, moved out of the parental home, or were not yet born at the time of the census were not covered.The data were obtained from a 10% sample of households drawn from the 1950 Finnish census (permission TK-53-704-10)  was close to that of women in a corresponding sample  , categorized as less than primary school, primary school, and more than primary school. The parental occupational position was categorized as manual worker, professional or administrative, farmer with <10 hectares of land, farmer with ≥10 hectares of land, and self-employed/other. The variables measuring overall living conditions included parental home ownership , crowding , and standard of living  in childhood. In this approximate measure, the category The control variables  were also measured at one point in time in the 1950 census when the men were between the ages of zero and 10. Family type was categorized as two parents with children, mother and children, and father and children; sibship size was divided into three categories .Marital history was categorized as never married, intact married (first marriage not dissolved due to divorce or the partner’s death), divorced/widowed (87% divorced), or remarried. This classification was based on longitudinal information on the formation and dissolution of marital unions until 2009. Data on marriages formed and dissolved before 1970 were unavailable. Longitudinal information on cohabitation was not available, but it was still very uncommon in the birth cohort under study, becoming more common in Finland from the 1970s Finnäs .N = 37,082) was used in the analysis of the number of children and the likelihood of a first birth. The likelihood of a second birth was analysed among fathers , and the likelihood of a third birth among fathers with at least two children .Standard Poisson regression was used to assess the associations of education and other socioeconomic characteristics with the number of children. Standard logistic regression was used to study the associations of these explanatory characteristics with the likelihood of a first, second, and third birth. The full sample of men , and the model gave virtually the same results as the Poisson model. We also considered the zero-inflated Poisson model as an alternative to the standard Poisson model, but preferred the latter based on the very few differences in predicted numbers of children between the models and the greater simplicity of the standard Poisson model.An alternative to the standard Poisson model specification for analysing the number of children is the negative binomial model, which would have been preferable had there been overdispersion. However, evidence of overdispersion was not found: in the full  versions of the Poisson and logistic regression models were used to study whether the education–fertility association was confounded by unobserved characteristics shared by brothers Table . This apThroughout the analysis, we accounted for the clustering of brothers within families in the calculation of variance-based measures. We used the bootstrap procedure with cluster resampling in calculating the standard errors (SE) and 95% confidence intervals (with significant findings indicated by asterisks) in Tables The men had on average 1.81 (SD 1.45) children in their lifetime, with 81% having at least one child. The parity distribution by level of education and other descriptive characteristics of the study population are shown in Table Table Including additional control variables (living area and family type in childhood and sibship size) (Model 1) did not change the year-of-birth-adjusted association between education and fertility. Likewise, adjusting for early socioeconomic characteristics (Model 2) had no effect on these estimates. In turn, adjustments to occupational position (Model 3) and income (Model 4) clearly attenuated the differences by education by 41–68%.Results from the parity-specific analysis are shown in Table Education and other socioeconomic characteristics in adulthood also predicted higher chances of a second birth, even if less strongly in comparison with first births, in the year-of-birth-adjusted models (Model 0). Some of the favourable characteristics that predicted higher chances of a first birth had a similar effect on second births. Adjustment for other control variables (Model 1) and socioeconomic characteristics in early life (Model 2) had a negligible effect on the estimates of education on second-birth likelihood, but adjustment for occupational position and income in adulthood (Models 3–4) attenuated the differences between the upper-secondary and tertiary-educated groups and the basic-educated group by 33–41%. The adjustment for marital history had a marginal effect, and the highly educated men were still more likely to experience a second birth (Model 5).Differences by education in the likelihood of a third birth were small: in the year-of-birth-adjusted model the fertility of the lowest and highest educated was at the same level and that of men in the middle categories slightly lower (Model 0). Occupational position had a weak positive association, whereas men in the lowest income quintile were more likely to experience a third birth than two-child fathers with higher incomes. Most of those favourable early-life socioeconomic characteristics that predicted higher chances of a first, and to some extent a second birth, had a null or weak negative association with third-birth likelihood. The adjustment for controls and early-life socioeconomic characteristics had no effect on the education estimates (Models 1–2), and the adjustment for occupational position and income even slightly increased the estimate of the tertiary educated (Models 3–4). The adjustment for marital history had a marginal effect, and after the adjustment, a weak nonlinear association of education with the third-birth likelihood remained (Model 5).Additionally, we note that while staying unmarried was associated with low fertility, remarried men showed the highest numbers of children and the highest chances of a first and especially a third birth Supplementary material 2 (PDF 164 kb)Supplementary material 3 (PDF 164 kb)Below is the link to the electronic supplementary material.


Hydatid cyst is rarely located in soft tissues. This case of a hydatid cyst over the plantar surface of our patient’s foot is one of the rarest presentations.This is a case report of a 22-year-old Somali who presented with a lump over the plantar surface of his foot of 1-year duration. The diagnosis of hydatid cyst was made intraoperatively from the typical appearance of a hydatid cyst. The cyst was completely excised. No local recurrence has been detected to date.The rare location and uncommon incidence made the initial diagnosis of hydatid cyst of the foot difficult. Detection of the typical germinal membrane can guide the diagnosis of hydatid cyst in rare locations that are found incidentally. Echinococcus granulosus in its larval or cyst stage. The tapeworm lives in canids, which are infected by eating the viscera of sheep that contain hydatid cysts. It is a significant public health problem in South and Central America, the Middle East, some sub-Saharan African countries, and China. The dog as a pet is the commonest source of infection transmitted to the intermediate hosts: humans, sheep, and cattle. Of all cases of hydatid cyst, 70% of them are formed in the liver. A few of the ova pass through the liver and are caught in the pulmonary capillary bed; ova that escape the pulmonary capillary bed enter systemic circulation, forming cysts in the lung, spleen, brain, or bones. The natural course of the infection varies. Some cysts spontaneously collapse and may disappear or calcify, while other cysts steadily increase in size, displace or compress healthy tissue and organs, and may become complicated. The annual growth rate of the cyst is usually approximately 1–3 cm in diameter [Hydatid disease is due to infection by the tapeworm This case report presents a rare location of a hydatid cyst: subcutaneously over the foot. Because such a presentation is very unusual, this case report helps diversify the differential diagnosis of soft tissue masses in such a location, particularly in endemic areas. It also describes in depth the presentation of hydatid disease in such locations. As the finding was incidental intraoperatively, it proposes a mode of treatment in such scenarios.A 22-year-old Somali presented to the surgical referral clinic of Djibouti Medical Center  in March 2019 with the main complaint of progressive swelling associated with pain over the left plantar side of his foot. He had no abdominal pain or discomfort, no chest pain or cough. He noticed the swelling 1 year prior to the presentation. There was no history of trauma to the site, no difficulties of walking, no discharge from the swelling, and no lesions noticed on other sites.He is a college student who lives with his parents; he had no prior medical problems. He has two brothers and a sister. There are no medical illnesses that run in the family. There was no history of tobacco smoking or substance abuse. He has never consumed alcohol.At presentation, his blood pressure was 120/70 mmHg, pulse rate was 74 beats per minute (bpm), respiratory rate was 18 per minute, and temperature was 36.0 °C axillary. A physical examination of our patient was normal in the rest of his systems. He also had a normal neurological finding. The pertinent finding was an oval-shaped, 2.5 cm wide in diameter, well-circumscribed lump with no increased vascularity, which was non-pulsatile and located over the mid-plantar area of his left foot. It was minimally tender to touch, fluctuant, and with no color change of the overlying skin.3, creatinine 0.7, blood urea nitrogen (BUN) 17, alanine aminotransferase (ALT) 30, aspartate aminotransferase (AST) 28, alkaline phosphatase (ALP) 58, albumin 4.5, total bilirubin 1.2, and direct bilirubin 0.3.A complete blood count of our patient showed: white blood cells (WBC) 5000 mcL, red blood cells (RBC) 4.7 mcL, hemoglobin (Hgb) 15 gm/dL, hematocrit (Hct) 45%, mean corpuscular volume (MCV) 83, platelets 370 × 10No radiological scan or blood culture was done for our patient. With the initial impression of callus; he was prepared for a minor surgical operation to remove the mass.Following the initial impression and getting informed consent, he was taken to the minor operation theater. His foot and lower leg were cleaned and draped.The area of the lump was infiltrated with local anesthesia: lidocaine without adrenaline was used. A transverse incision was made over the lump, followed by dissection of the subcutaneous tissue. Upon exposing the subcutaneous tissue, a typical endocyst membrane covering the hydatid cyst was encountered Fig. . FurtherIt was injected with hydrogen peroxide and re-aspirated. Later, the whole intact membrane was dissected out; a pericystic cavity lavage was done using hydrogen peroxide too. The subcutaneous tissue layers and the skin were closed in the standard manner. The specimen was sent for pathology. The pathology result reported a germinative layer which consisted of daughter cysts and brood capsules with scolices and clear fluid content.Following surgery, he was sent home with diclofenac 50 mg twice a day for 5 days. Follow-up was done a week later, the wound looked ok. The stitches were removed on the tenth postoperative day. Albendazole 400 mg per day was given for 2 weeks’ duration. Subsequently, an ultrasound of his liver to look for possible primary cysts was done and it did not show any focus of a cyst.He is on follow-up every month at a surgical referral clinic. An abdominal ultrasound was done on the second and fourth month to look for cysts. No local or systemic recurrence of the cysts has been detected so far over the course of 6 months.This case report presents a rare location of a hydatid cyst which was diagnosed intraoperatively and treated surgically. A subcutaneous location of a hydatid cyst is a rare presentation. The unusual presentation of the case makes the diagnosis difficult prior to an operation. This case report tries to describe the management options of an intraoperatively discovered hydatid cyst. An echinococcal cyst can be located almost anywhere in the body and this should be kept in mind in dealing with a cystic lesion in endemic countries ; as thisE. granulosus are canids such as dogs, wolves, and foxes, while intermediate hosts include sheep, goats, and cattle. Humans are a coincidental intermediate host. The disease is more frequent in the Middle East, Central Europe, Australia, and South America, where the intermediate hosts are common. A study conducted to estimate the prevalence of hydatid disease in nomadic pastoralists living in eastern Africa showed that the disease was not common among Somalis [The main hosts for  Somalis . The desExtrahepatic extra pulmonary hydatid cysts were found in 13% of patients with hydatid disease . HydatidPreoperative diagnosis of a hydatid cyst can be challenging and can sometimes be misdiagnosed as an abscess , 6. The A palpable mass is the most constant clinical or exploratory finding of hydatid disease affecting soft tissues . Our patet al. [A hydatid cyst can present as isolated subcutaneously without involving other organs; a rare report of such an incident involving the face was reported by Öztürk et al. . Subcutaet al. .et al. reported that 45% of soft tissue hydatid cysts were located in the lower limb [Isolated subcutaneous involvement of hydatid over the thigh, palms, and calf with no other organ involvement has also been reported , 11. Salwer limb . Also, rwer limb , 14. A cOperative spillage of cyst contents can lead to local regrowth of hydatid cysts after a suitable interval . CompletE. granulosus infection can result in an apparent cure in up to 30% of cases. Duration of therapy and dose are also important, and with albendazole, efficacy seems to increase with exposure up to 3 months in the commoner cyst sites. The issue of cyclical versus continuous treatment still has to be resolved [Treatment with albendazole in resolved . As our The rarity of this case made preoperative diagnosis difficult because our area is not an endemic one and the location of the cyst was very unusual. Intraoperative diagnosis of the typical germinal cyst membrane, with complete excision, was effective for an incidentally discovered subcutaneous hydatid cyst on the plantar side of our patient’s foot.Although hydatid cyst is rare, a high index of suspicion and identification of the typical endomembrane of the cyst could guide intraoperative diagnosis. Chemotherapy with albendazole for a short duration of 15 days could suffice for a subcutaneously located hydatid cyst if the cyst is removed intact with no local spillage. So far, for our patient, no local or systemic recurrence has been detected.


Preterm infants had significantly lower serum irisin levels compared to the term infants. Overall, serum irisin level during the 1st week of life was positively correlated with several anthropometric measurements at birth, as well as during 5th weeks of age. In contrast, serum visfatin levels during 5th week of life were negatively correlated with z-scores of birth weight, weight and head circumference during 5th week of age. We found a strong negative correlation between serum irisin and serum visfatin levels at both analyzed time points. The level of milk visfatin was significantly higher in the mothers of the preterm group during 5th week of life. In conclusion, our results provide further evidence that irisin and visfatin may play physiologic roles in development of both preterm and full-term newborns during their first month after birth. Observed differences in irisin and visfatin serum and breastmilk concentrations during the earliest stages of life may contribute to development of catch up growth, but also, they might eventually lead to a higher risk for metabolic syndrome in prematurely born children in later years.Premature infants represent one of the groups with increased risk for metabolic syndrome. Our study is the first one to evaluate irisin and visfatin levels, associated with the metabolic syndrome, both in blood of preterm and full-term infants, as well as in the breastmilk of their mothers. A total of 72 newborns was enrolled in the study, including 53 very low birth weight preterm infants and a control group of 19 term infants. The levels of irisin and visfatin were determined by a commercial enzyme-linked immunoabsorbent assay both in the baby serum and maternal milk twice, first during the 1 Preterm very low birth weight (VLBW) neonates are at a higher risk of metabolic syndrome later in life. Preterm infants at term equivalent age are lighter, shorter, have higher percentage of total fat mass and lower fat free mass , 2]. At. At2]. AVisfatin, originally identified as pre-B-cell colony-enhancing factor (PBEF), is a 491-amino-acid protein with a molecular weight 52 kDa . It is pIrisin is a newly discovered myokine with anti-obesity properties. Irisin regulates body energy expenditure by turning white adipose tissue into brown-like adipose tissue . It is rVisfatin and irisin are also present in human milk. It is suggested that autonomous production by breast tissue is the source of those hormones in the breast milk. It appears that these bioactive peptides found in the breast milk are important for growth, energy regulation and maturation of the gastrointestinal system in neonates , 18], , . The phyThe prospective observational study included newborns and their lactating mothers admitted to the Neonatal Intensive Care Unit, Department of Paediatrics, Jagiellonian University Medical College, Krakow, Poland, between February 2014 and November 2016. The study protocol was approved by the Jagiellonian University Medical College Ethical Committee (issue No KBET/58/B/2013 from 4.04.2013). Written and informed consents were obtained from the parents. Study was sponsored by NUTRICIA Foundation (RG 7/2013).th day of life, feeding started within first 48 hours of life) were included in the study. Only 2 children were not enrolled due to lack of the parental consent. Full term newborns were admitted to the NICU due to moderate ailments that frequently occurred in the neonatal period , which did not affect proper physical development in researcher’s opinion. A formal sample size calculation was not performed to allow a realization of a hypothesis generating study. The approximate sample size was based on the calculations from the previous publication , b, b24], bterparts , [24], . P. Pst andz et al, , howeverz et al, , 28] an anst andz et al, . In our  studies , 31]..st and 5st as well as 5th week of life. The above hormones present antagonizing actions, since irisin shows anti-obesity properties while visfatin increases in obesity. It is possible that if one of these hormone increases, then the other one is down-regulated, although the exact molecular mechanisms remain to be discovered.We find a strong negative correlation between serum irisin and serum visfatin levels during 1There is a number of reports demonstrating that human milk contains a variety of hormones which regulate body weight and composition , 32], , , 34], , . One of th week postpartum in VLBW group. Since VLBW infants are much more susceptible to severe weight loss after birth, we believe that significantly higher visfatin levels in their mother’s milk may represent some additional, natural protection against it.In the early studies visfatin was identified in the mammalian epithelial cells in the mammary gland and milk, later confirmed in the breast milk in humans, reaching significantly higher concentrations than in the maternal serum 17]. Mor. Mor17].In conclusion, the results of our study suggest that irisin and visfatin may represent a potential link between VLBW status at birth and later metabolic syndrome; however, a direct causal relationship cannot yet be confirmed. Such a hypothesis needs to be addressed in a longitudinal study of irisin levels, postnatal weight gain and their association with obesity and metabolic syndrome in the future.


Newborns are at relatively high risk for developing hypoglycaemia in the first 24 h after birth. Well-known risk factors are prematurity, small for gestational age (SGA) or large for gestational age (LGA), and maternal pre-existent or gestational diabetes mellitus. Prolonged hypoglycaemia is associated with poor neurodevelopmental outcomes; hence, prevention through proper monitoring and treatment is important. Given the ongoing debate concerning frequency and duration of screening for neonatal hypoglycaemia, therefore, we investigated the frequency and duration of glucose monitoring safe to discover neonatal hypoglycaemia in different risk groups. Data of newborns at risk for hypoglycaemia were retrospectively collected and analysed. Blood glucose concentrations were measured 1, 3, 6, 12, and 24 h after birth. Moderate hypoglycaemia was defined as a blood glucose concentration of < 2.2 mM and severe hypoglycaemia as a concentration of < 1.5 mM. Of 1570 newborns, 762 (48.5%) had at least one episode of hypoglycaemia in the first 24 h after birth; 30.6% of them had severe hypoglycaemia . Only three SGA and two LGA newborns had a first moderate asymptomatic hypoglycaemic episode beyond 12 h after birth. The incidence of hypoglycaemia increased with accumulation of multiple risk factors.Conclusion: Safety of limiting the monitoring to 12 h still has to be carefully evaluated in the presence of SGA or LGA newborns; however, our results suggest that 12 h is enough for late preterm newborns (> 34 weeks) and maternal diabetes. To date, there is still little evidence and consensus regarding definition, indication, and frequency of screening for neonatal hypoglycaemia, one of the most frequently encountered problems in neonatology. Newborns are at relatively high risk for developing hypoglycaemia in the first 24 h after birth . The incRisk factors for neonatal hypoglycaemia are prematurity (< 37 weeks of gestation), being small for gestational age (SGA) (birth weight ≤ 10th percentile for GA), large for gestational age (LGA) (birth weight ≥ 90th percentile for GA), and pre-existent maternal diabetes ) or gestational diabetes mellitus (GDM) , 26.In apparently healthy infants, glucose concentrations tend to decrease after birth, reach a nadir 1 h after birth, increase again, and stabilise after one day , 16. TheRecurrent severe hypoglycaemia is associated with poor neurodevelopmental outcomes; however, duration and severity of hypoglycaemia to cause injury are unknown. The management of the asymptomatic infant at risk for low glucose remains controversial. Despite this, prevention of (prolonged) hypoglycaemia by screening and treatment seems rational , 13, 19.Existing guidelines for screening and treatment recommend glucose monitoring in newborns at risk but vary in (1) definition of hypoglycaemia (between 2.2 and 2.6 mM), (2) total monitoring time (12–48 h after birth), and (3) time intervals (between 1 and 8 h). This is illustrating the lack of consensus regarding the frequency and duration of glucose monitoring deemed necessary and safe to discover neonatal hypoglycaemia , 18. FurThis is a retrospective observational cohort study. We enrolled all eligible newborns born and admitted at Radboudumc Amalia Children’s Hospital Nijmegen, the Netherlands, from a four-year period 2010–2013). Inclusion criteria were gestational age (GA) ≥ 34 weeks and screening indication according to our local guideline: prematurity (< 37 weeks of gestation), SGA, LGA, and maternal diabetes of any kind ) [. InclusiBlood glucose samples were taken 1, 3, 6, 12, and 24 h after birth according to local guidelines . In caseFeeding was initiated in the first hour after birth. Breastfeeding was encouraged throughout pregnancy, but the ultimate choice between breastfeeding and formula feeding was made by the parents. In our hospital (as in the Netherlands), approximately 80% of women start with exclusive breastfeeding post-delivery . Feedinghttps://www.perined.nl/producten/geboortegewichtcurven).Birth percentiles, SGA (< 10th percentile) or LGA (> 90th percentile), were calculated using Dutch birth weight curves . Median (range) was used for skewed distributed data. For 2 × 2 tables, chi-square test was performed. Multivariate logistic regression analyses were used to examine the association between (severe) hypoglycaemia and possible risk factors, including screening indications, background information, and other complications. A This study was exempt from Regional Ethics Review Board approval, under the legal requirements for clinical research in the Netherlands.We enrolled 1628 newborns with risk factors for hypoglycaemia of which 1573 met our inclusion and exclusion criteria. Data of three newborns were unavailable. The final analysis was performed on data from 1570 newborns. In 327 cases, data of more than two sample moments were missing. These cases were only used for the overall analysis (hypoglycaemia 125/327). Newborns at risk were premature (33.5%), SGA (32.4%), LGA (27.6%), or born to a diabetic mother (19.1%) (Table p > 0.05)  suffered from at least one episode of hypoglycaemia. One-third of hypoglycaemic episodes were severe (< 1.5 mM), with maternal pre-existing diabetes as the main risk factor (54.5%)  had a hypoglycaemia within 3 h after birth. Hypoglycaemia occurring more than 12 h after birth for the first time was seen in only five newborns (Table p = 0.04).In the group with other complications, e.g. congenital abnormalities, respiratory distress, or (risk for) infection, significantly less newborns developed a hypoglycaemic episode (p = 0.011) and the group with three risk factors ) , comparing to the group with two risk factors , pre-existent DM (T1DM and T2DM combined) , and other complications . Also, in case of severe hypoglycaemia, significant association was found with newborns born to mothers with pre-existent DM  and prematurity .Multivariate logistic regression analysis including all potential risk factors, sex, single/multiple birth, and other complications  infection) showed that hypoglycaemia was significant associated with prematurity  was comparable to the incidence seen in the study of Maayan Metzger et al. (54% GC < 2.6 mM and 83% GC < 2.2 mM)  but rathMore than one risk factor resulted in higher incidence Fig.  which isThe nadir 1–2 h after birth in blood GC is also observed in apparently health newborns and is considered part of normal adaptation to postnatal life by several authors, although it is not consistently described , 16.Our data illustrate that 96.7% (710/734) of all newborns who developed hypoglycaemia had the first hypoglycaemia within 6 h after birth. Since there were only five cases of mild asymptomatic hypoglycaemia beyond 12 h, all treated with additional feeding only, one could argue to stop glucose monitoring after 12 h for all risk groups. Safety of limiting the monitoring to 12 h still has to be carefully evaluated in the presence of SGA or LGA newborns.Some limitations of this study should be addressed. Due to the retrospective design, it was not possible to obtain the exact glucose concentrations in 327 cases. Since the introduction of the electronic patient files, values of blood glucose concentrations are directly stored in these files. Furthermore, not all samples were obtained at the exact prescribed time points, which was mainly due to breastfeeding on demand and sampling just prior to intake . Also, in this time period, several blood glucose meters and analysers were used. It is known that results of POC glucose meters in the critical range may be unreliable . To miniTo our knowledge, this is the largest published study that specifically investigated the length of time that is necessary in neonatal glucose monitoring. The newborns were selected based on strict inclusion criteria for each separate risk factor and GC were measured using a standardised protocol.In conclusion, the onset of first hypoglycaemia did not occur beyond 12 h of glucose monitoring after birth in prematurity and maternal diabetes in the observed time frame. Multiple risk factors and an inappropriate birth weight for gestational age may increase the risk of hypoglycaemic episode.


Improving sow lifetime productivity, herd stability, and maximizing lifetime performance and longevity in the sow herd, represent significant challenges to the swine industry. Routine implementation of efficient gilt development unit (GDU) programs which deliver high quality, breeding-eligible gilts to the sow farm is still needed. Good gilt management starts at birth, because litter of origin, lactation management and the application of early selection strategies are early indicators of future performance and efficiency. A failure to select gilts with the greatest reproductive potential and inappropriate management of their physiological state and metabolic condition at service, are key risk factors for poor sow lifetime productivity (SLP). Management practices that deliver gilts with the greatest potential SLP are crucial to the productivity of conventional production systems. Substantial evidence supports successful management of gilts as an absolutely necessary component of breeding herd management and the pivotal starting point for the future fertility and longevity of the breeding herd. Therefore, gilt management practices from birth have the potential to influence the future reproductive performance of the sow herd. A good gilt management program will address several key components such as birth traits that determine the efficiency of replacement gilt production; effective selection of the most fertile gilts for entry to the breeding herd; effective management programs that provide a consistent supply of service eligible gilts; and appropriate management of weight, physiological maturity, and a positive metabolic state at breeding. Good gilt management can largely resolve the existing gap between excellent genetic potential and the more modest sow lifetime productivity typically achieved in the industry. Investment in good gilt development programs from birth represents a foundational opportunity for improving the efficiency of the pork production industry. Sow lifetime productivity (SLP) is a complex trait that is influenced by both sow productivity  and longevity ,2,3,4. NOur underlying belief is that gilt management practices from birth have the potential to influence the future reproductive performance of the sow herd . A good In recent years, both individual birth weight and litter birth weight phenotype, as well as the sex ratio of the birth litter, have been reported to be predictive factors of future gilt performance.As a consequence of genetic selection for increased litter size, the industry has seen an associated increase in variation in birth weight within the litter and an increase in the proportion of piglets with low birth weight . Within-Post-farrowing management (day one care) is critical to improving the retention and performance of replacement gilts. The main causes of neonatal piglet mortality are chilling, starvation, and crushing by the sow and most preweaning mortality occurs within three days after birth . Low birA reduction in the size of the litter in which replacement females are raised is another management technique that may increase overall growth, enhance early development of reproductive organs, and thus increase longevity and performance. In earlier studies, Nelson and Robinson  showed tA low litter birth weight phenotype (BWP) is hypothesized to carry all the same risks described above for individual low birth weight gilts but as a “litter” trait. This trait is repeatable over consecutive parities and arises from the interactions between a high ovulation rate, the dynamics of early embryonic survival, and limited placental development early in gestation, irrespective of litter size at term ,31,32. CThe ability to predict a sow’s litter BWP is important and has considerable ramifications for the efficiency of replacement gilt production and the lifetime productivity of gilts produced. Identifying sows that repeatedly display the low BWP also allows producers to selectively apply the relevant management interventions discussed earlier. In the most extreme low BWP population (bottom 15%) at production herd level, Smit et al.  reportedThe sex ratio of the litter where the replacement female was born may affect lifetime performance and behavior and could potentially be used as another selection tool at birth ,35. GiltAnogenital distance can be used as an indicator of female masculinization in pigs ,38. DricTaken together, these results confirm that the sex ratio of the litter into which a potential replacement gilt is born, and the anogenital distance at selection, could also be considered when selecting future replacement females. Although more research is needed in the area, future replacement gilts could be non-selected based on sex ratio at birth, or measurements of anogenital distance cold be taken at the time of selection, to further help in improving the productivity of the replacement female.Successful gilt introduction and selection drives lifetime reproductive performance and longevity in the breeding herd. Litter size has been reported to increase until the fourth parity and then slowly declines . The faiAlthough “age at puberty” is a reliable indicator of future sow reproductive performance and longevity , it is iThe characteristics of behavioral estrus at puberty are predictive of future performance: Sows with stronger behavioral symptoms during pubertal estrus (length and strength of the standing reflex) are more likely to farrow , and gilNevertheless, compared to the detailed analysis of sow reproductive performance as a measure of commercial success, objective and critical monitoring of gilt development, and a clear understanding of the link between the quality of the replacement gilt program and overall breeding herd performance, are lacking. Patterson et al.  classifiThe ability to identify early puberty, and to produce a synchronous pubertal response to external stimuli, are both dependent on the age at the start of puberty stimulation and heat detection. When boar exposure commences earlier (140 to 160 d of age), a normal distribution in age at detected first estrus is observed in the majority of the population ,62,63. WAs reviewed by Knox et al. , despiteThe ability to correctly diagnose reproductive failure in the gilt is confounded by the complex interactions involved in the stimulation and detection of pubertal estrus . PubertyKirkwood and Aherne  predicteDeveloping management practices that identify gilts with the greatest potential for lifetime performance is crucial to the productivity of conventional production systems ,55,58. TThe boar is a critical factor influencing puberty attainment in gilts and daily exposures to a rotation of mature, high libido, boars maximizes the response to boar exposure. The boar effect is a combination of tactile, visual, auditory, and olfactory cues . OlfactoTo maximize these components of the “boar effect”, and to efficiently, effectively, and safely stimulate first puberty and identify the most fertile gilts, a purpose-designed puberty stimulation area is invaluable . ImplemePatterson et al.  reportedEven if the proper facilities are available, the success of a GDU program still depends on the observational ability of the staff involved, regular recording and entry of reproductive events into the farm database, and thorough production record monitoring and analysis . The benGilts should be stimulated early enough to permit producers to manage gilts to achieve the appropriate weight, estrus number, and metabolic state prior to service after the first detected HNS event . First aIt is recommended that gilts be bred at a target weight of 135 to 150 kg ,87. FromAlthough information on gilt weight at either the onset of boar stimulation, or at the time of pubertal estrus, is a critical step in meeting target gilt breeding weights , these rPhysiological age at breeding , rather than chronological age, is an important criterion for determining the time of mating in gilts . DelayinAfter the first estrus has been recorded, gilts should be acclimated to stalls or breeding and gestation housing at least 16 d prior to breeding . StudiesThere is substantial evidence supporting successful management of gilts as an absolutely necessary component of herd management and the pivotal starting point for the future fertility and longevity of the breeding herd. Good gilt management starts at birth because litter of origin, lactation management, and the application of early selection strategies are early indicators of future performance and efficiency. Selecting gilts with the greatest potential for lifetime performance is crucial to the productivity of conventional production systems. This can be achieved through the implementation of highly efficient gilt development programs that identify gilts with the greatest reproductive potential, limit entry-to-service intervals, and manage gilts to achieve the appropriate physiological and metabolic state at service. As good gilt management can largely resolve the existing gap between excellent genetic potential and the more modest sow lifetime productivity typically achieved in the industry, an investment in good gilt development programs represents a foundational opportunity for improving the efficiency of the pork production.


Iatrogenic common femoral artery pseudoaneurysm is a well-known complication to vascular access. Many options, both surgical and nonsurgical, have been implemented as means to treat pseudoaneurysms such as thrombin injection, image-guided compression, and percutaneous closure devices. This case report demonstrates a novel technique using a VASCADE closure device to successfully treat an iatrogenic common femoral pseudoaneurysm. Common femoral pseudoaneurysms are a known complication to vascular access with an incidence ranging from 0.2 to 7% , 2. SeveOf the above treatment options, thrombin injection and ultrasound-guided compression have been used more frequently and thus have more available study data. A Cochrane review suggests slight support of the use of thrombin injection over compression, but statistical significance is not present in total . PercutaPrevious case reports have shown success with a vascular closure device called Angio-Seal, which uses an endovascular bioabsorbable anchor and extravascular collagen sponge to seal and thrombose the pseudoaneurysm –9. HowevVASCADE is a vascular closure device made by Cardiva Medical that can be inserted into a 5 French, 6 French, or 7 French procedural sheath. It is a fully integrated system that boasts the ability to close a femoral access site without leaving any permanent components inside or outside the vessel. It uses a bioabsorbable extravascular collagen component to achieve hemostasis with the aid of compression from an expandable endovascular disc . This meThis report shows a single-case success with the VASCADE closure device in treating an iatrogenic right common femoral artery pseudoaneurysm.The patient is a 57-year-old female who underwent cardiac catheterization via the right common femoral artery two weeks prior to developing a large, symptomatic right common femoral artery pseudoaneurysm .The patient began complaining of groin pain two weeks after cardiac catheterization. She has a past medical history of aortic valve replacement secondary to aortic valve infective endocarditis, hyperlipidemia, and hypertension.She underwent two attempts of ultrasound-guided thrombin injection of the pseudoaneurysm. On ultrasound, the size of the pseudoaneurysm was found to be 5 cm × 3 cm × 4.6 cm. The neck of the pseudoaneurysm was measured to be 0.8 cm long. The two attempts involved using a 21 gauge needle to administer 1000 units and 2000 units of thrombin, respectively, into the pseudoaneurysm under ultrasound guidance and with the assistance of compression. Due to the size of the aneurysmal cavity and a relatively large pseudoaneurysm neck, injections were found to be unsuccessful on follow-up ultrasound . This was done without difficulty, and the collagen patch was positioned outside the vessel wall in the area of the pseudoaneurysm neck. Interval angiogram revealed partial occlusion of the pseudoaneurysm neck .It was then decided to place an occlusive 8 mm balloon into the lumen of the right common femoral artery to facilitate pseudoaneurysm thrombosis. The balloon was insufflated up to 8 ATM for 600 seconds. This was done twice in total. Interval angiogram then revealed complete occlusion of the pseudoaneurysm blood flow Figures .All wires and catheters were removed at this point, and a left common femoral artery access sheath was kept in overnight. Postoperatively, the patient had no complications, and formal ultrasound confirmed complete thrombosis of the pseudoaneurysm. The access sheath was then removed without issue. There were no ischemic complications due to balloon occlusion in the immediate postoperative period.There is more data available exploring the efficacy of both manual compression and thrombin injections as means to treat common femoral artery pseudoaneurysms. These options are currently still recommended as earlier options than the use of vascular closure devices. However, this case report allows insight into additional options when first-line treatment fails. It also offers a suggestion for further data collection to explore the efficacy of this alternative.While other case reports have shown successful closure of common femoral artery pseudoaneurysms with the use of Angio-Seal, the success of VASCADE may provide a superior alternative to novel treatments. Particularly, the lack of an endovascular component in VASCADE compared with Angio-Seal's endovascular anchor eliminates the concern for foreign body embolization. This complication has been documented to cause acute distal limb ischemia , 13. EliThis case report highlights a novel treatment for iatrogenic common femoral artery pseudoaneurysm using the VASCADE closure device. This option may be useful when manual compression or thrombin injections fail, and it may be superior to Angio-Seal due to eliminating the need to leave an anchor within the artery. A more comprehensive study needs to be done in order to truly understand the efficacy of this treatment in pseudoaneurysm closure.