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Cerebral small vessel disease (SVD) is a major cause of cognitive impairment in older people. As secondary endpoints in a phase-2 randomised clinical trial, we tested the effects of single administration of a widely-used PDE5 inhibitor, tadalafil, on cognitive performance in older people with SVD. In a double-blinded, placebo-controlled, cross-over trial, participants received tadalafil (20 mg) and placebo on two visits ≥ 7 days apart (randomised to order of treatment). The Montreal Cognitive Assessment (MOCA) was administered at baseline, alongside a measure to estimate optimal intellectual ability (Test of Premorbid Function). Then, before and after treatment, a battery of neuropsychological tests was administered, assessing aspects of attention, information processing speed, working memory and executive function. Sixty-five participants were recruited and 55 completed the protocol (N = 55, age: 66.8 (8.6) years, range 52–87; 15/40 female/male). Median MOCA score was 26 (IQR: 23, 27], range 15–30). No significant treatment effects were seen in any of the neuropsychological tests. There was a trend towards improved performance on Digit Span Forward (treatment effect 0.37, C.I. 0.01, 0.72; P = 0.0521). We did not identify significant treatment effects of single-administration tadalafil on neuropsychological performance in older people with SVD. The trend observed on Digit Span Forward may help to inform future studies. Clinical trial registration: http://www.clinicaltrials.gov. Unique identifier: NCT00123456, https://eudract.ema.europa.eu. Unique identifier: 2015–001,235–20NCT00123456.

A case study was undertaken to assess the long-term effect of sewage irrigation on some soil properties and heavy metals concentrations in the soils of the date palm at Al-Hassa Governorate, Saudi Arabia. Eighty-two surface soil samples were collected from the studying area. Half of it was collected from an area irrigated for more than 13 years with treated sewage effluent. Meanwhile the rest of soil samples were collected from an area irrigated with well water. Furthermore, samples from sewage effluents and well water used for irrigation were collected and analyzed mainly for their chemical composition and their metal contents. The obtained results pertaining irrigation water analysis indicated that sewage effluents were found to contain higher content of Pb, Zn, Cu, Co, Cr, As, Cd, Fe, Mn and Ni compared to well water. On the other hand data emphasized the role of sewage effluent irrigation on increasing heavy metals as well as organic matter contents in the soil samples when comparing with the respective values found in the soil irrigated with well water. The soil salinity ranged from 3.58 to 20.7 dS m−1 with an average of 7.9 dS m−1 due to irrigation with well water. While the respective soil salinity due to irrigation for long period with the treated sewage effluent ranged from 2.5 to 3.69 dS m−1 with an average of 2.8 dS m−1. There was an increase in organic matter content ranging from 17% to 30% in sewage-irrigated soil samples as compared to well water-irrigated ones. On an average, the soil pH dropped by 0.3 U as a result of sewage irrigation. Long term sewage irrigation resulted in significant build-up of total concentration of Zn (130%), Pb (55%), Fe (82%), Ni (84%), Mn (30%), Cu (40%), Cr (75%), Co (78%) and As (67%) in sewage-irrigated soil samples over adjacent well water-irrigated soil samples.

Background: The radial artery is the access of choice in many catheterization labs around the world due to its proven benefits over the femoral artery access. There has been growing interest in the left radial artery. We sought to evaluate the feasibility, safety and complication rates of the left distal radial artery (ldTRA) access for cardiac catheterization., Methods: This is a single arm retrospective study evaluating the feasibility and safety of performing cardiac catheterization through ldTRA. The procedure was completed using standard diagnostic and guiding catheters. Hemostasis was achieved with a radial band. Feasibility was the ability to cannulate the distal left radial artery as well as completing the procedure without requiring an additional arterial access. The safety point included hematoma, bleeding or neuropathy., Results: ldTRA was attempted in 61 patients. 59 patients had successful completion of the procedure through ldTRA. Conversion occurred in 1 patient (1.7%), requiring an additional arterial access to complete the procedure. 34 patients (55.7%) required percutaneous coronary intervention (PCI). There was no access site bleeds post procedure, no hematomas, with 100% successful hemostasis with a radial hemostatic band. There were 2 cases requiring reaccess of the distal left radial artery access for repeat revascularization, with procedure success and good left radial artery patency., Conclusion: ldTRA is a safe and feasible arterial access in a radial experienced catheterization lab. ldTRA provides improved operator ergonomics and patient's comfort, in addition to the advantage of being able to cannulate the bypass grafts and with a very low risk of vascular complications., (Copyright © 2018 Elsevier Inc. All rights reserved.)

A 60-year-old man presented with congestive heart failure and was diagnosed with cor triatriatum after echocardiography. The various imaging modalities used for the definitive diagnosis of this condition are reviewed.