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The Maumee River is the primary source for nutrients fueling seasonal Microcystis-dominated blooms in western Lake Erie’s open waters though such blooms in the river are infrequent. The river also serves as source water for multiple public water systems and a large food services facility in northwest Ohio, USA. On 20 September 2017, an unprecedented bloom was reported in the Maumee River estuary within the Toledo metropolitan area, which triggered a recreational water advisory. Here we (1) explore physical drivers likely contributing to the bloom’s occurrence, and (2) describe the toxin concentration and bacterioplankton taxonomic composition. A historical analysis using ten-years of seasonal river discharge, water level, and local wind data identified two instances when high-retention conditions occurred over ≥10 days in the Maumee River estuary: in 2016 and during the 2017 bloom. Observation by remote sensing imagery supported the advection of cyanobacterial cells into the estuary from the lake during 2017 and the lack of an estuary bloom in 2016 due to a weak cyanobacterial bloom in the lake. A rapid-response survey during the 2017 bloom determined levels of the cyanotoxins, specifically microcystins, in excess of recreational contact limits at sites within the lower 20 km of the river while amplicon sequencing found these sites were dominated by Microcystis. These results highlight the need to broaden our understanding of physical drivers of cyanobacterial blooms within the interface between riverine and lacustrine systems, particularly as such blooms are expected to become more prominent in response to a changing climate.

Liquid chromatography-mass spectrometry (LC-MS) and tandem mass spectrometry (MS/MS) were used to provide qualitative and quantitative information about microcystin (MC) congeners in western Lake Erie. Samples were collected at eight open-water locations on selected days during harmful algal blooms (HABs) in 2016 and 2017. Seven MCs were identified and 20 MCs were tentatively identified using high-resolution mass accuracies and a unique fragment (Adda m/z 135). The most abundant MC was MC-LR, followed by MC-RR, MC-YR, and MC-LA, and these congeners were quantified. Total (extracellular and intracellular) MC concentrations ranged from 0.068 to 14.88 µg/L in 2016, and from 0.050 to 10.15 µg/L in 2017, with averages of 2.71 and 1.86 µg/L, respectively. Near-shore sites in Lake Erie had higher MC concentrations and Microcystis biovolumes than off-shore sites. This implies that nutrient loading from the Maumee River greatly influences Maumee Bay, and this influence decreases with distance from the river. Consequently, six MCs (MC-LR, MC-RR, MC-LA, MC-YR, MC-LW, and MC-LF) were quantified in water samples collected from the Maumee River and the Maumee Bay shore of Lake Erie in 2017, and MC-RR was the most abundant. The total MC concentrations in river samples ranged from 0.17 to 305.03 µg/L. Additionally, an MC degradation product (linear MC-LR) was detected at all open-water locations, and data indicated an increase in its concentration towards the end of the bloom. The trends for 2016 and 2017 HABs are comparable in terms of spatial distribution and MC congeners produced, though the intensity and peak dates change.

Venous thromboembolism (VTE) is a term used collectively for deep vein thrombosis (DVT) and pulmonary embolism. Without prophylaxis, the incidence of documented DVT in the orthopaedic surgery patient is reported in the range of 50%-60%. A multimodal approach to DVT prophylaxis is the standard of care for all patients undergoing total hip arthroplasty and total knee arthroplasty. At our local hospital, low-risk patients are being sent home with aspirin as the medication for VTE prophylaxis. This article will provide an overview of the pathophysiology of VTE and the current prevention guidelines including the use of aspirin.