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EcoQS assessment of the marine intertidal zone based on its fauna is challenging because the assemblages have a low diversity and consist of stress tolerant species. The new approach we propose is to pool foraminiferal diversity (effective number of species exp(H' bc )) across the whole intertidal zone including the salt marsh and tidal flat. In seven fjordheads studied in northern Fennoscandia, polycyclic aromatic hydrocarbon (PAH) concentrations indicated low levels of pollution (EcoQS PAH Excellent to Moderate). Jadammina or Balticammina dominated the salt marsh, Elphidium albiumbilicatum, Elphidium williamsoni, Elphidium clavatum, and Buccella frigida occurred in the tidal flat. Ovammina opaca thrived in both belts. While foraminiferal test abnormalities are often proposed to measure pollution impacts, we did not detect any correlation with PAHs. EcoQS based on foraminiferal diversity (EcoQS foram Excellent to Good) matched EcoQS based on PAHs suggesting that pooled foraminiferal diversity reliably measures intertidal EcoQS., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

The article presents a microphotograph dataset of 106 taxa of benthic foraminifera (BF) from surface sediments collected at 26 grab station during RV Akademik Ioffe 51st cruise (summer 2016). The selected stations are located along a 59.5°N transect in the North Atlantic. This is the key area of climate control, where the interaction of warm surface and cold deep water masses takes place, which affects the operation of the global oceanic thermohaline circulation. The analysis of the benthic foraminiferal assemblages allows us to describe the properties of bottom water mass, to draw conclusions about the environmental parameters at the bottom. This photo dataset will facilitate the identification of species of BF, and thus will accelerate the routine process of micropaleontological analysis and the subsequent reconstruction of environmental conditions., (© 2019 The Authors.)

Current 'Atlantification' of the Arctic Ocean affects benthic communities leading to the changes in their structure and abundance. Such areas as Svalbard that are seasonally affected by Atlantic and Arctic water masses may give a possibility to preliminary estimate the response of benthic communities to short-term environmental changes and to evaluate their sensitivity. We have sampled Kongsfjorden for modern benthic foraminifera in three different seasons. The record includes data on the abundances of benthic foraminiferal species in the surface sediments (0-2cm). This data gives an insight into the seasonal dynamics of the near-glacial foraminiferal community of Kongsfjorden.

Background: The aim of this study was to evaluate the effectiveness of gracilis muscle transposition (GMT) to treat recurrent anovaginal, rectovaginal, rectourethral, and pouch-vaginal fistulas in patients with inflammatory bowel disease (IBD)., Methods: A retrospective study was conducted in patients with IBD who had GMT performed by a single surgeon between 2000 and 2018. Follow-up data regarding healing rate, complications, additional procedures, and stoma closure rate was collected., Results: A total of 30 women and 2 men had GMT. In all patients fistula was associated with Crohn's disease. In 1 female patient, contralateral gracilis transposition was required after a failed attempt at repair. The primary healing rate was 47% (15/32) and the definitive healing rate (healed by the time of data collection and after secondary procedures) was 71% (23/32). Additional surgical procedures due to fistula persistence or recurrence were performed on 17 patients (53%).At least 7 patients (21%) suffered complications including one wound infection with ischemia of the gracilis muscle. Stoma closure was successful in 18 of 31 cases of patients with stoma (58% of the patients)., Conclusions: GMT for the treatment of recurrent and complex anorectal fistulas in patients with IBD patient is eventually successful in almost 2/3 of patients.

Glaciers in the fjords of Svalbard have been receding over last decades. Tempelfjorden, a typical glaciated fjord in West Spitsbergen (78°24'06″ N, 17°02'30″ E), has been sampled in summer 1995 and 2001-2007 for modern benthic foraminifera. We have normalized the abundances and unified the taxonomy of all these published and unpublished data sets and then compiled the record of foraminiferal assemblages changing over years into a comprehensive database. The record includes data on living and dead abundances of benthic foraminiferal species in the surface sediments (0-2 cm) and downcore abundances of living foraminifera (only for 2004). This database portrays benthic foraminifera, this key group of microfossils, in a gradually changing Arctic environment.

Rectovaginal fistulas (RVF) represent less than 5% of anorectal fistulas. The classification of RVF is based on the localization (low vs. high) and the etiology. The most frequent causes of RVF are birth trauma, Crohn's disease, previous surgery and pelvic irradiation. In most cases a clinical diagnostic assessment is sufficient. Additionally, endosonography is a reliable tool to detect sphincter defects. Computed tomography (CT) and magnetic resonance imaging (MRI) are reserved for special situations (e.g., RVF related to anastomotic leakage, after pelvic irradiation or associated with complex perianal fistulizing Crohn's disease). The surgical treatment is primarily oriented to the localization and etiology. Surgical techniques range from local procedures (e.g., endorectal advancement flap repair, transvaginal or transperineal closure) up to more invasive tissue interposition (e.g., bulbocavernosus muscle fat tissue flap or transposition of the gracilis muscle). In "high" RVF transabdominal approaches such as coloanal anastomosis, pull through procedures or omental interposition are indicated. All surgical procedures show high recurrence rates. Several operations are mostly necessary and a stoma creation is often required., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Foraminifera include diverse shell-building lineages found in a wide array of aquatic habitats from the deep-sea to intertidal zones to brackish and freshwater ecosystems. Recent estimates of morphological and molecular foraminifera diversity have increased the knowledge of foraminiferal diversity, which is critical as these lineages are used as bioindicators of past and present environmental perturbation. However, a comparative analysis of foraminiferal biodiversity between their major habitats (freshwater, brackish, intertidal, and marine) is underexplored, particularly using molecular tools. Here, we present a metabarcoding survey of foraminiferal diversity across different ecosystems using newly designed foraminifera-specific primers that target the hypervariable regions of the foraminifera SSU-rRNA gene (~250-300 bp long). We tested these primer sets on four foraminifera species and then across several environments: the intertidal zone, coastal ecosystems, and freshwater vernal pools. We retrieved 655 operational taxonomic units (OTUs); the majority of which are undetermined taxa that have no closely matching sequences in the reference database. Furthermore, we identified 163 OTUs with distinct habitat preferences. Most of the observed OTUs belonged to lineages of single-chambered foraminifera, including poorly explored freshwater foraminifera which encompass a clade of Reticulomyxa-like forms. Our pilot study provides the community with an additional set of newly designed and taxon-specific primers to elucidate foraminiferal diversity across different habitats., (© 2022 International Society of Protistologists.)

The ecological quality status (EcoQS) of Vellar and Uppanar estuaries (Southeast coast of India) has been monitored monthly, using a combination of foraminiferal (Foram Stress Index: FSI and exp(H' bc ) indices and abiotic (Pollution Load Index: PLI, Dissolved Oxygen: DO, and Total Organic Carbon: TOC) parameters. The Uppanar Estuary shows relatively higher values of PLI and TOC and lower DO values than Vellar Estuary. The highest value of TOC and PLI are recorded during the monsoon season. These variations are well mirrored by the change in exp(H' bc ) and FSI. The lowest values of exp(H' bc ) are observed with the monsoon season and could be ascribed by an overall reduction of salinity, and to the highest level of TOC and PLI in response to enhanced river discharge. The FSI also exhibits great variability with significant higher values in the Vellar Estuary than in the Uppanar Estuary. The EcoQS evaluated by a combination of pollution- (i.e., PLI, TOC and DO) and foraminiferal-based [i.e., FSI and exp(H'bc)] indices are highly consistent (73.4%). The most frequent disagreement among indices is mostly associated to Uppanar Estuary and, particularly, in the inner stations. This difference might be related to a time-lag response of benthic foraminifera in terms of diversity and assemblages' compositions as well as of the pollution indicators in response to enhanced riverine input. This study further supports the application of foraminiferal-based indices in EcoQS assessment in transitional environments including tropical Indian estuaries. It also fills the gap of knowledge by providing a seasonal perspective on the variation of EcoQS based on a monthly-scale sampling., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Glaciers cover about 10% of the Earth's land area but they are retreating rapidly and many will disappear within decades. Glacier retreat is a worldwide phenomenon increasing the threat to water resources, biodiversity and associated ecosystem services for hundreds of millions of people, mostly in developing countries. Our understanding of the ecological consequences of glacier retreat has improved significantly in the past decade, but we still lack a comprehensive framework for predicting biodiversity responses to glacier retreat globally, across diverse habitats and taxa. By conducting a global meta-analysis of 234 published studies, including more than 2,100 biodiversity surveys covering marine, freshwater and terrestrial assemblages, we show here that taxon abundance and richness generally increase at lower levels of glacier influence, suggesting that diversity increases locally as glaciers retreat. However, significant response heterogeneity was observed between study sites and species: 6-11% of the studied populations, particularly in fjords, would lose out from glacier retreat. Most of the losers are specialist species, efficient dispersers, uniquely adapted to glacial conditions, whereas the winners are generalist taxa colonizing from downstream. Our global analyses also identify key geographic variables (glacier cover, isolation and melting rates, but not latitude or altitude) and species traits (body size and trophic position) likely to modulate taxon sensitivity to glacial retreat. Finally, we propose mechanistic diagrams for model development to predict biodiversity change following glacier retreat.

The problem of invasive species is a well-studied one, but knowledge of free-living unicellular eukaryotic invasive species is lacking. A potentially invasive foraminifer (Rhizaria), Nonionella sp. T1, was recently discovered in the Skagerrak and its fjords. Digital polymerase chain reaction (dPCR) was applied to track the spread of this non-indigenous species using a new dPCR assay (T1-1). The use of dPCR appears highly complementary to traditional hand picking of foraminiferal shells from the sediment, and is far less time-consuming. This study indicates that Nonionella sp. T1 has bypassed the outer Skagerrak strait, instead becoming established in Swedish west coast fjords, constituting up to half of the living foraminiferal community in fjord mouth areas. The ecology of Nonionella sp. T1 and its potential invasive impacts are still largely unknown, but it appears to be an opportunist using several energy sources such as nitrate respiration and kleptoplasty along with a possibly more efficient reproductive strategy to gain an advantage over the native foraminiferal species. Future ecological studies of Nonionella sp. T1 could be aided by dPCR and the novel Nonionella sp. T1-specific T1-1 assay., (© 2023 The Authors. Environmental Microbiology published by Applied Microbiology International and John Wiley & Sons Ltd.)

Coastal areas are often intervened by anthropic activities, which increase the contamination of toxic agents such as heavy metals. This causes adverse morphological effects on benthic microorganisms, such as foraminifera. This group is one of the most susceptible to environmental deterioration, so they can be used as pollution biomarkers by identifying shell abnormalities. Therefore, 28 sediment samples from northern Chile were analyzed, calculating the Abnormality Index-FAI and its spatio-temporal distributions in benthic foraminifera, as well as the minimum and maximum abnormality percentages and their relationship with heavy metal concentrations, using a generalized non-linear model and a principal component analysis. The results indicated a proportion of abnormal shells within the ranges described for polluted areas conditions, revealing environmental stress conditions. This reflected a change in the environmental conditions in the most recent sediments of the bay. The highest FAI values were observed to the southwest of the bay, caused by the local current system. The species Bolivina seminuda, Buliminella elegantissima, and Epistominella exigua presented a greater number of deformities, allowing them to be used as contamination biomarkers. A significant correlation was found between Ti, Mn, Ni, Va, and Ba with decreased chamber sizes, wrong coiling, scars, and number of abnormality types. This suggests the effect of the particular geochemical conditions of the area on the heavy metals that cause toxic effects on foraminifera. These analyses are an efficient tool for identifying the effects of environmental stress before they occur in higher organisms, mitigating the environmental impact on marine biodiversity., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The health of coastal marine environments is severely declining with global changes. Proxies, such as those based on microeukaryote communities, can record biodiversity and ecosystem responses. However, conventional studies rely on microscopic observations of limited taxonomic range and size fraction, missing putatively ecologically informative community components. Here, we tested molecular tools to survey foraminiferal biodiversity in a fjord system (Sweden) on spatial and temporal scales: Alpha and beta diversity responses to natural and anthropogenic environmental trends were assessed and variability of foraminiferal environmental DNA (eDNA) compared to morphology-based data. The identification of eDNA-obtained taxonomic units was aided by single-cell barcoding. Our study revealed wide diversity, including typical morphospecies recognized in the fjords, and so-far unrecognized taxa. DNA extraction method impacted community composition outputs significantly. DNA extractions of 10 g sediment more reliably represented present diversity than of 0.5-g samples and, thus, are preferred for environmental assessments in this region. Alpha- and beta diversity of 10-g extracts correlated with bottom-water salinity similar to morpho-assemblage diversity changes. Sub-annual environmental variability resolved only partially, indicating damped sensitivity of foraminiferal communities on short timescales using established metabarcoding techniques. Systematically addressing the current limitations of morphology-based and metabarcoding studies may strongly improve future biodiversity and environmental assessments., (© 2023 The Authors. Journal of Eukaryotic Microbiology published by Wiley Periodicals LLC on behalf of International Society of Protistologists.)

Twenty-nine sediment samples were collected from the Hurghada Bay, a heavily polluted bay on the Red Sea of Egypt, to inspect the environmental quality status and anthropogenic consequences on benthic foraminifera. Some foraminiferal species showed deformations in their apertures and coiling directions as a response to environmental stresses. In addition, the FoRAM index, an index used for evaluating the growth of coral reefs, indicated a hazard in the proximity of nearshore stations. To elucidate the relationships between the biological response and chemistry of sediments, eight heavy metals concentrations (Cu, Cd, Zn, Pb, As, Cr, Ni, and Mn) were analyzed using inductively coupled plasma-atomic emission spectrometers (ICP-AES). Interestingly, two groups of benthic foraminiferal associations were illustrated using multivariate statistical analyses. Group I have extremely high heavy metal concentrations, an enriched total organic matter (TOM)%, high deformation percentages, and mud content. Moreover, it is dominated by Ammonia tepida which is regarded as an opportunistic species. Group II includes low to moderately polluted stations, highly enriched living foraminiferal assemblages, and is dominated by the sensitive rotaliids Neorotalia calcar and Amphistegina lobifera. Alternatively, four geochemical indices, EF, CF, I geo , and PLI, are used to assess the contamination level that shown ominous spots for the nearshore stations of the Hurghada Bay. The pollution indices (HQ and HI) were also conducted to evaluate the risks of carcinogenic heavy metals on human health. Our findings demonstrated that ingestion and dermal exposure have greater carcinogenic hazards for adults and children than inhalation. The lifetime carcinogenic risk (LCR) is significantly higher than the permissible limit and follows this order: Pb > As > Cr > Cd > Ni. To that end, developing strategies to lessen the negative impact of pollution on human health and/or the Red Sea's biodiversity is an inevitable issue in the present day and future., (© 2023. The Author(s).)

The present study investigated the occurrence and distribution of polycyclic aromatic hydrocarbons (PAHs) and phenolic endocrine-disrupting compounds (PEDCs), including bisphenol A (BPA), 4-nonylphenol (4-NP), and its monoethoxylate (NP1EO) and diethoxylate precursors in marine sediments in an Arctic fjord (Svalbard, Norway). The contribution of different local sources of contamination was also evaluated, together with a risk assessment for the marine environment. Samples were collected during two consecutive summer seasons (2018 and 2019), and target contaminants were analyzed with gas chromatography-mass spectrometry (MS) and high-performance liquid chromatography-MS/MS. The results showed no statistical differences between total PAH concentrations measured in 2018 (mean value 53.7 ± 54.3 ng/g) and 2019 (mean value 58.1 ± 63.6 ng/g). Low-ring (three or four rings) PAHs were the most abundant congeners, and single PAH ratios indicated a predominance of petrogenic sources (i.e., coal and liquid fossil fuel combustion). Nonylphenols and BPA showed a significant decrease in 2019 compared to 2018; 4-NP and NP1EO prevailed in both years, particularly in sediments close to the Ny-Ålesund research village. Overall, the results indicate that local anthropic activities are the major source of contamination in the Kongsfjorden ecosystem, but also melting waters from glaciers in the summer season can play an important role as a secondary source of pollutants previously trapped in ice. Comparison between our data and empirical and mechanistic indices derived from sediment quality guidelines suggests that the occurrence of PAHs and PEDCs in sediments does not currently pose a risk for this Arctic ecosystem, but further investigation is needed on the spread of hazardous contaminants and their effects on these fragile environments. Environ Toxicol Chem 2023;42:953-965. SETAC., (© 2022 SETAC.)

Background: A rectovaginal fistula is a debilitating condition that often severely impacts quality of life. Despite many treatment options available, the best surgical treatment is far from being established, and many patients will undergo several procedures before fistula closure is achieved. Gracilis muscle interposition, which is the transposition of the gracilis muscle into the rectovaginal septum, is an option for complex and persistent fistulas, but literature on the subject is scarce, mainly consisting of small case series., Objective: This study aimed to assess the success rate of gracilis muscle interposition for the surgical treatment of rectovaginal fistula., Data Sources: MEDLINE, Embase, Cochrane Library, and Web of Science., Study Selection: Studies comprising at least 5 patients who underwent gracilis muscle interposition for rectovaginal fistula were included. No date or language restrictions was applied., Intervention: Gracilis muscle interposition., Main Outcome Measures: The primary outcome is the fistula closure rate (%). Other domains analyzed are stoma closure rate, postoperative complications, quality of life, fecal continence, and sexual function., Results: Twenty studies were included for a total of 384 patients. The pooled fistula closure rate for gracilis muscle interposition was 64% (95% CI, 53%-74%; range, 33%-100%). Risk factors for failure were smoking, underlying Crohn's disease, and more than 2 previous repairs, whereas stoma formation was associated with improved outcomes. Postoperative complications ranged from 0% to 37%, mostly related to surgical site occurrences at the harvest site and perineal area. No deaths occurred. Gracilis muscle interposition improved quality of life and fecal continence, but impairment of sexual function was common., Limitations: Most of the included studies were small case series., Conclusions: Gracilis muscle interposition is a safe and moderately effective treatment that could be taken into consideration as second- or third-line therapy for recurrent rectovaginal fistula., Registration No: CRD42022319621., (Copyright © The ASCRS 2023.)

Aim: Complex perineal fistulas (CPFs) are among the most challenging problems in colorectal practice. Various procedures have been used to treat CPFs, with none being a panacea. Our study aimed to assess the overall success and complication rates after gracilis muscle interposition in patients with CPF., Method: PubMed, Scopus and Google Scholar databases were systematically searched until January 2022 according to PRISMA 2020 guidelines. Studies including children <18 years or <10 patients were excluded, as well as reviews, duplicate or animal studies, studies with poor documentation (no report of success rate) and non-English text. An open-source, cross-platform software for advanced meta-analysis openMeta [Analyst]™ version 12.11.14 and Cochrane Review Manager 5.4® were used to conduct the meta-analysis of data., Results: Twenty-five studies published between 2002 and 2021 were identified. The studies included 658 patients (409 women). Most patients had rectovaginal (50.7%) or rectourethral fistulas (33.7%). The most common causes of CPF were pelvic surgery (29.4%) and inflammatory bowel disease (25.2%). A history of radiotherapy was reported in approximately 18% of the patients. 498 (75.7%) patients with CPF achieved complete healing after gracilis muscle interposition. The weighted mean rate of success of the gracilis interposition procedure was 79.4% (95% CI 73.8%-85%, I 2  = 75.3%), the weighted mean short-term complication rate was 25.7% (95% CI 18.1-33.2, I 2  = 84.1%) and the weighted mean rate for 30-day reoperation was 3.6% (95% CI 1.6-5.6, I 2  = 42%). The weighted mean rate of fistula recurrence was 16.7% (95% CI 11%-22.3%, I 2  = 61%)., Conclusion: The gracilis muscle interposition technique is a viable treatment option for CPF. Surgeons should be familiar with indications and techniques to offer it as an option for patients. Given the relatively infrequent use of the operation, referral rather than performance of graciloplasty is an acceptable option., (© 2022 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.)

Purpose: Diagnosis and treatment of perianal Crohn's disease is challenging and requires its own domain of therapy. Different types of perianal disease require a spectrum of treatment strategies. Treatment options range from conservative therapy, including immunosuppressives, biologics, or stem cell therapy, to surgical treatment with specific indications depending on the underlying lesion. This is part III of the series "state-of-the-art surgery for Crohn's disease," focusing on the management of perianal disease. We discuss the definition and diagnosis of perianal Crohn's disease, the treatment of perianal lesions, and specific surgical indications and techniques., Results and Conclusion: Pitfalls and complications play a substantial role in the treatment of perianal Crohn's disease, and surgical therapy may fail. Realistic treatment goals and an individual patient-oriented treatment approach are crucial in the treatment of perianal Crohn's disease., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: Complex fistulas often require several attempts at repair and continue to be a challenging task for the surgeon, but above all, a major burden for the affected patient. This study is aimed at evaluating the potential of gracilis muscle transposition (GMT) as a therapeutic option for complex fistulas of diverse etiologies., Methods: A retrospective study was conducted over a period of 16 years with a total of 60 patients (mean age 50 years). All were treated for complex fistula with GMT at St. Josef's Hospital in Regensburg, Germany. Follow-up data were collected and analyzed using a prospective database and telephone interview. Success was defined as the absence of fistula., Results: A total of 60 patients (44 women, 16 men; mean age 50 years, range 24-82 years) were reviewed from January 2005 to June 2021. Primary fistula closure after GMT was achieved in 20 patients (33%) and 19 required further interventions for final healing. Overall healing rate was 65%. Fistula type was heterogeneous, with a dominant subgroup of 35 rectovaginal fistulas. Etiologies of the fistulas were irradiation, abscesses, obstetric injury, and iatrogenic/unknown, and 98% of patients had had previous unsuccessful repair attempts (mean 3.6, range 1-15). In 60% of patients with a stoma (all patients had a stoma, 60/60), stoma closure could be performed after successful fistula closure. Mean follow-up after surgery was 35.9 months (range 1-187 months). No severe intraoperative complications occurred. Postoperative complications were observed in 25%: wound healing disorders (n = 6), gracilis necroses (n = 3), incisional hernia (n = 2), scar tissue pain (n = 2), suture granuloma (n = 1), and osteomyelitis (n = 1). In 3 patients, a second gracilis transposition was performed due to fistula recurrence (n = 2) or fecal incontinence (n = 1)., Conclusion: Based on the authors' experience, GMT is an effective therapeutic option for the treatment of complex fistulas when other therapeutic attempts have failed and should therefore be considered earlier in the treatment process. It should be seen as the main but not the only step, as additional procedures may be required for complete closure in some cases., (© 2023. The Author(s).)

Background: Surgical treatment of recurrent rectovaginal fistulas is notoriously difficult. Placement of the gracilis muscle between the vagina and anus is an advanced technique used to close persistent fistulas. We have utilized this procedure for recalcitrant fistulas and hypothesized that a gracilis interposition would offer a good treatment option for patients with refractory rectovaginal fistulas, regardless of underlying etiology., Objective: The purpose of this study was to investigate healing rates of gracilis interposition in patients with refractory rectovaginal fistulas., Design: Following institutional review board approval, a retrospective review of all adult female patients with a diagnosis of rectovaginal fistula between January 2009 and August 2020 was performed; those who underwent gracilis interposition for definitive fistula closure were included for analysis., Settings: The study was conducted at a colorectal surgery department at a tertiary center in the United States., Patients: All patients were adult females with a diagnosis of a rectovaginal fistula who underwent gracilis interposition for definitive closure., Main Outcome Measures: Patient demographics, etiology of rectovaginal fistula, previous surgical intervention, presence of intestinal diversion, operative details, 30-day morbidity, recurrence of fistula, and time to recurrence. Fistula closure was defined as lack of clinical symptoms following stoma closure, negative fistula detection on gastrograffin enema' and absence of an internal opening at examination under anesthesia., Results: Twenty-two patients were included who had a median age of 43 years (range, 19-64 years) and median body mass index of 31 kg/m 2 (range, 22-51). Median time between prior attempted surgical repair and gracilis surgery was 7 months (range, 3-17). The number of previously attempted repairs were 1-2 (n = 8), 3-4 (n = 9), and > 4 (n = 5). The most recent attempted surgical repair was rectal advancement flap (n = 7), transperineal +/- Martius flap (n = 4), episioproctotomy (n = 3), transvaginal repair (n = 2), and other (n = 6). All patients had fecal diversion at the time of gracilis surgery. Thirty-day postoperative surgical site infection at the graft/donor site was 32% (n = 7). At a median follow-up of 22 months (range 2-62), fistula closure was 59% (n = 13). Gracilis interposition was successful in all inflammatory bowel disease patients., Limitations: The study was limited by its retrospective nature., Conclusions: Gracilis interposition is an effective operative technique for reoperative rectovaginal fistula closure. Patients should be counseled regarding the possibility of graft/donor site infection. See Video Abstract at http://links.lww.com/DCR/B763 ., Reparacin Con Colgajo De Gracilis Para La Fstula Rectovaginal Reoperatoria: ANTECEDENTES:El tratamiento quirúrgico de las fístulas rectovaginales recurrentes es muy difícil. La colocación del músculo gracilis entre la vagina y el ano es una técnica avanzada que se utiliza para cerrar las fístulas persistentes. Hemos utilizado este procedimiento para las fístulas recalcitrantes y planteamos la hipótesis de que una interposición del gracilis ofrecería una buena opción de tratamiento para pacientes con fístulas rectovaginales refractarias, independientemente de la etiología subyacente.OBJETIVO:Investigar las tasas de curación de la interposición del gracilis en pacientes con fístulas rectovaginales refractarias.DISEÑO:Tras la aprobación de la junta de revisión institucional, se realizó una revisión retrospectiva de todas las pacientes adultas con un diagnóstico de fístula rectovaginal entre enero de 2009 y agosto de 2020; los que se sometieron a interposición de gracilis para el cierre definitivo de la fístula se incluyeron para el análisis.AJUSTE:Departamento de cirugía colorrectal de un centro terciario en Estados Unidos.PACIENTES:Todas las pacientes adultas con diagnóstico de fístula rectovaginal que se sometieron a interposición de gracilis para cierre definitivo.PRINCIPALES MEDIDAS DE RESULTADO:datos demográficos del paciente, etiología de la fístula rectovaginal, intervención quirúrgica previa, presencia de derivación intestinal, detalles quirúrgicos, morbilidad a los 30 días, recurrencia de la fístula y tiempo hasta la recurrencia. El cierre de la fístula se definió como la ausencia de síntomas clínicos después del cierre del estoma, la detección negativa de la fístula en el enema de gastrograffin y la ausencia de una abertura interna en el examen bajo anestesia.RESULTADOS:Se incluyeron 22 pacientes que tenían una mediana de edad de 43 años (rango 19-64 años) y una mediana de índice de masa corporal de 31 kg / m2 (rango 22-51). La mediana de tiempo entre el intento previo de reparación quirúrgica y la cirugía del gracilis fue de 7 meses (rango 3-17). El número de reparaciones previamente intentadas fue: 1-2 (n = 8), 3-4 (n = 9), y >4 (n = 5). El intento de reparación quirúrgica más reciente fue el colgajo de avance rectal (n = 7), el colgajo transperineal +/- Martius (n = 4), la episioproctotomía (n = 3), la reparación transvaginal (n = 2) y otros (n = 6). Todos los pacientes tenían derivación fecal en el momento de la cirugía gracilis. La infección del sitio quirúrgico posoperatorio a los 30 días en el sitio del injerto / donante fue del 32% (n = 7). Con una mediana de seguimiento de 22 meses (rango 2-62), el cierre de la fístula fue del 59% (n = 13). La interposición de Gracilis fue exitosa en todos los pacientes con enfermedad inflamatoria intestinal.LIMITACIONES:Carácter retrospectivo de los datos.CONCLUSIONES:La interposición de Gracilis es una técnica quirúrgica eficaz para el cierre reoperatorio de la fístula rectovaginal. Se debe asesorar a los pacientes sobre la posibilidad de infección del sitio del injerto / donante. Consulte Video Resumen en http://links.lww.com/DCR/B763 . (Traducción-Dr. Ingrid Melo )., (Copyright © The ASCRS 2021.)

The ambient environmental parameters have a great bearing on the morphology of living flora and fauna. In this study, we tested this hypothesis on one of the most dominant groups of living unicellular marine microorganism, benthic foraminifera, in the dynamic region of the southeastern Arabian Sea. The living benthic foraminifera from 43 surface samples collected between 25 and 2980 m of water depth were segregated into eight morphogroups (tapered/cylindrical, flattened-ovoid, biconvex, planoconvex, flattened-tapered, spherical, rounded-trochospiral, and rounded-planispiral). We report that the high organic carbon availability is combined with deficiency of oxygen results in benthic foraminifera with low surface area to volume ratio and mostly consists of tapered/cylindrical, flattened-ovoid forms, with a preference for infaunal habitat. However, the tests of the living benthic foraminifera thriving in the oxygen-rich bottom waters have a high surface area to volume ratio, commonly reported as epifaunal, consisting of biconvex and planoconvex forms. Additionally, we also report that the abundance of other morphogroups, namely flattened-tapered, spherical, rounded-trochospiral, and rounded-planispiral, is also controlled by the distinct environmental parameters. We suggest that the living benthic foraminifera are an excellent indicator of the ambient environmental parameters and can be used to reconstruct paleoenvironments., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Little is known about which indicators of performance elite athlete coaches (i.e., professional coaches who coach at the national or international levels) consider to be important for basketball., Objective: Using a Delphi procedure, the aim of this study was to identify the non-game performance indicators elite athlete coaches consider to be important for the recruitment/selection of basketball players., Methods: Ninety elite athlete coaches (basketball coaches (n = 71) and strength/conditioning coaches (n = 19) who coached men (n = 60), women (n = 23), or both (n = 7)), employed in 23 countries across six continents, participated in a three-round online Delphi survey. Round 1 asked coaches to identify the non-game performance indicators (i.e., measures other than game statistics) they currently used (or would like to use) for player recruitment/selection, with common indicators combined into single indicators. Round 2 asked coaches to rate the importance of each performance indicator using a Likert scale (range: 0 = no importance whatsoever to 10 = extremely important). Round 3 asked coaches to identify the single best test measure for each indicator rated ≥ 6 (i.e., important to extremely important) in Round 2. Results were reported descriptively., Results: A total of 608 responses (344 after removal of duplicates) were reported in Round 1, which were collapsed into 35 indicators, all of which were rated as 'important' in Round 2. Psychological and game intelligence indicators were typically rated as very important to extremely important (i.e., median = 9), with physical fitness and movement skills typically rated as very important (i.e., median = 8). For most indicators, coach observation was identified as the best test measure, with unique objective performance/anthropometric tests identified for all physical fitness indicators., Conclusion: This study identified a range of psychological, game intelligence, physical fitness, and movement skill indicators that were considered by elite athlete coaches to be important to extremely important for the recruitment/selection of basketball players. These findings may inform the development of a basketball-specific test battery for recruiting/selecting and monitoring players., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Deep-sea biodiversity, a source of critical ecological functions and ecosystem services, is increasingly subject to the threat of disturbance from existing practices (e.g., fishing, waste disposal, oil and gas extraction) as well as emerging industries such as deep-seabed mining. Current scientific tools may not be adequate for monitoring and assessing subsequent changes to biodiversity. In this paper, we evaluate the scientific and budgetary trade-offs associated with morphology-based taxonomy and metabarcoding approaches to biodiversity surveys in the context of nascent deep-seabed mining for polymetallic nodules in the Clarion-Clipperton Zone, the area of most intense interest. For the dominant taxa of benthic meiofauna, we discuss the types of information produced by these methods and use cost-effectiveness analysis to compare their abilities to yield biological and ecological data for use in environmental assessment and management. On the basis of our evaluation, morphology-based taxonomy is less cost-effective than metabarcoding but offers scientific advantages, such as the generation of density, biomass, and size structure data. Approaches that combine the two methods during the environmental assessment phase of commercial activities may facilitate future biodiversity monitoring and assessment for deep-seabed mining and for other activities in remote deep-sea habitats, for which taxonomic data and expertise are limited. Integr Environ Assess Manag 2022;18:655-663. © 2021 SETAC., (© 2021 SETAC.)

Background: Rectourethral fistula (RUF) is an uncommon serious condition with various etiologies including neoplasm, radiation therapy, and surgery. Treatment for RUF remains problematic with a high recurrence rate. Although studies have suggested the recurrence rate of RUF is lower after surgical repair using a gracilis flap, outcomes have varied and the studies were small and inadequately controlled. Here, we compare outcomes of RUF repair with and without gracilis flap to evaluate its efficacy in preventing fistula recurrence and identify risk factors for recurrence., Methods: We retrospectively reviewed patients who had undergone surgical repair for RUF between 2007 and 2018 at our institution and had at least 30 days of follow-up. Patient demographics, comorbidities, and surgical outcomes were recorded and compared for patients who had gracilis flap repair and those who did not (controls). Single variable logistic regression analysis was used to identify risk factors for recurrence., Results: The gracilis group (n = 24) and control group (n = 12) had similar demographics and comorbidities. Fistula recurrence was far less frequent in the gracilis group (8% vs 50%, P = 0.009). There were no significant differences in other outcomes including length of hospitalization and surgical complications. When recurrent RUF was treated with a muscle flap (gracilis or inferior gluteus), 83% of the group had no additional fistula recurrence. In the control group, history of radiation ( P = 0.04) and urinary incontinence ( P = 0.015) were associated with fistula recurrence., Conclusions: We recommend using a gracilis flap for RUF repair given its association with lower recurrence without increased surgical complications., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Norwegian fjords have been recently recognized as hot spots for carbon burial due to the large amounts of terrestrial organic matter delivered to fjord sediments, as well as the high sediment accumulation rates. Here, we present the first data on the contribution of benthic foraminiferal inorganic carbon to the sediments of three Norwegian fjords. Our study shows that calcareous foraminifera, which are among the most abundant calcifying organisms in the modern global oceans, can constitute between 15% and 33% of inorganic carbon accumulated in the sediments of the two studied southern Norwegian fjords (Raunefjorden and Hjeltefjorden). In a northern Norwegian fjord (Balsfjorden), the contribution of calcareous foraminifera to the inorganic carbon pool is smaller (<1%) than the one observed in southern fjords. We also found that the amount of foraminifera-derived carbon is primarily dependent on the species composition of the foraminifera community. Large calcareous foraminifera species, despite a lower number of individuals, constitute, on average, 13%-29% of the inorganic carbon in the two southern Norwegian fjords, while the contribution of small, highly abundant species does not exceed 4% of the inorganic carbon pools in the sediments. Calcareous foraminifera species that are indicative of dysoxic conditions have been found to have low inorganic carbon contents per specimen compared to other analysed similar-sized calcareous foraminifera species. This relationship most likely exists due to the thin test walls of these foraminifera species, which may facilitate gas exchange. The results of our case study suggest that the climate-driven formation of near-bottom low-oxygen zones may lead to the dominance of foraminifera associated with dysoxic conditions and, in consequence, to the decrease of foraminifera-derived inorganic carbon. However, to properly analyse the contribution of carbon from thin-walled foraminifera to the sedimentary carbon pool, further studies analysing a broader range of these species is needed., (© 2021 John Wiley & Sons Ltd.)

Benthic macrofauna is regularly used in monitoring programmes, however the vast majority of benthic eukaryotic biodiversity lies mostly in microscopic organisms, such as meiofauna (invertebrates < 1 mm) and protists, that rapidly responds to environmental change. These communities have traditionally been hard to sample and handle in the laboratory, but DNA sequencing has made such work less time consuming. While DNA sequencing captures both alive and dead organisms, environmental RNA (eRNA) better targets living organisms or organisms of recent origin in the environment. Here, we assessed the biodiversity of three known bioindicator microeukaryote groups (nematodes, foraminifera, and ciliates) in sediment samples collected at seven coastal sites along an organic carbon (OC) gradient. We aimed to investigate if eRNA shotgun sequencing can be used to simultaneously detect differences in (i) biodiversity of multiple microeukaryotic communities; and (ii) functional feeding traits of nematodes. Results showed that biodiversity was lower for nematodes and foraminifera in high OC (6.2%-6.9%), when compared to low OC sediments (1.2%-2.8%). Dissimilarity in community composition increased for all three groups between Low OC and High OC, as well as the classified feeding type of nematode genera (with more nonselective deposit feeders in high OC sediment). High relative abundant genera included nematode Sabatieria and foraminifera Elphidium in high OC, and Cryptocaryon-like ciliates in low OC sediments. Considering that future sequencing technologies are likely to decrease in cost, the use of eRNA shotgun sequencing to assess biodiversity of benthic microeukaryotes could be a powerful tool in recurring monitoring programmes., (© 2020 The Authors. Molecular Ecology published by John Wiley & Sons Ltd.)

Background: Treatment of complex anal fistula is challenging, often mandating multiple procedures. The gracilis muscle has been used to treat perineal fistulas and to repair perineal defects., Objective: This study aims to report the results of gracilis muscle interposition for complex anal fistula, including prognostic factors for success., Design: This is a retrospective analysis of a prospective database for patients who underwent gracilis muscle interposition for complex anal fistula from 2000 to 2018., Setting: Patient demographics, operative data, and postoperative outcome were obtained from medical records. Office visits were used for follow-up., Patients: All patients who underwent gracilis muscle interposition for complex anal fistula were included. Patients who underwent gracilis muscle interposition for reasons other than complex anal fistula were excluded., Main Outcome Measures: The primary outcome measured was the healing of complex anal fistula following gracilis muscle interposition and following additional procedures, when needed., Results: A total of 119 patients (60 men, 59 women; median age: 56 (21-85) years) were included. The initial success rate of gracilis muscle interposition was 42%; the final success rate if additional procedures were undertaken was 92%. Overall success rate was 32.2% in women and 51.6% in men. Univariate analysis revealed that sex (p = 0.0315) and bed rest >3 days (p = 0.0078) were significant poor prognostic factors for failure, whereas the multivariate logistic regression model showed that length of bed rest >3 days was a significant poor prognostic factor for failure. In the female subgroup, multivariate analysis showed that bed rest ≥3 days was a significant poor prognostic factor, whereas in the male population there was no significant prognostic factor., Limitation: This study was limited by its retrospective nature and the heterogeneity of patients., Conclusion: Although initial success is <50%, the ultimate success after gracilis muscle interposition and other subsequent procedures is >90%. Patients must be preoperatively counseled that additional procedures will probably be required to achieve successful fistula closure. Furthermore, prolonged bed rest should be avoided after gracilis muscle interposition. See Video Abstract at http://links.lww.com/DCR/B551., Interposicin Del Msculo Gracilis Para El Tratamiento De La Fstula Anal Compleja Experiencia Con Pacientes Consecutivos: ANTECEDENTES:El tratamiento de la fístula anal compleja es un desafío que a menudo requiere de múltiples procedimientos quirúrgicos. El músculo gracilis se ha utilizado para tratar fístulas y reparar defectos perineales.OBJETIVO:Informar los resultados de la interposición del músculo gracilis para la fístula anal compleja, incluyendo los factores pronósticos para un tratamiento exitoso.DISEÑO:Se efectuó un análisis retrospectivo obtenido de una base de datos prospectiva para pacientes sometidos a interposición del músculo gracilis por fístula anal compleja del 2000 al 2018.METODO:Los datos demográficos de los pacientes, la información del procedimiento quirúrgico y los resultados postoperatorios se obtuvieron de los expedientes clínicos; el seguimiento se llevó a cabo por medio de visitas al consultorio.PACIENTES:Se incluyeron todos los pacientes sometidos a interposición del músculo gracilis por fístula anal compleja; Se excluyeron los pacientes que se sometieron a interposición del músculo gracilis por motivos distintos a la fístula anal compleja.CRITERIOS DE EVALUACION DE LOS RESULTADOS:Curación de una fístula anal compleja después de la interposición del músculo gracilis y procedimientos adicionales, cuando fueron necesarios.RESULTADOS:Se estudiaron un total de 119 pacientes [60 hombres, 59 mujeres; con media de edad de 56 (21-85) años]. La tasa de éxito inicial de la interposición del músculo gracilis fue del 42%; La tasa de éxito final cuando realizaron procedimientos adicionales fue del 92%. La tasa de éxito global fue del 32,2% en mujeres y del 51,6% en hombres. El análisis univariado reveló que el género (p = 0,0315) y el reposo en cama > 3 días (p = 0,0078) en forma significativa fueron factores de pronóstico bajo para el fracaso, mientras que el modelo de regresión logística multivariable mostró que la duración del reposo en cama> 3 días fue un factor de pronóstico significativamente bajo para fracaso. En el subgrupo de mujeres, el análisis multivariado mostró que el reposo en cama ≥3 días fue un factor de pronóstico significativamente bajo, mientras que en la población masculina no hubo un factor pronóstico significativo.LIMITACIÓN:Carácter retrospectivo y heterogenicidad de los pacientes.CONCLUSIÓN:Aunque el éxito inicial es <50%, el éxito final después de la interposición del músculo gracilis y otros procedimientos posteriores es > 90%. Se debe aconsejar a los pacientes antes de la operación que probablemente se requieran procedimientos adicionales para lograr el cierre exitoso de la fístula. Además, debe evitarse el reposo prolongado en cama después de la interposición del músculo gracilis. Consulte Video Resumen en http://links.lww.com/DCR/B551., (Copyright © The ASCRS 2021.)

Baffin Bay hosts the largest and most productive of the Arctic polynyas: the North Water (NOW). Despite its significance and active role in water mass formation, the history of the NOW beyond the observational era remains poorly known. We reconcile the previously unassessed relationship between long-term NOW dynamics and ocean conditions by applying a multiproxy approach to two marine sediment cores from the region that, together, span the Holocene. Declining influence of Atlantic Water in the NOW is coeval with regional records that indicate the inception of a strong and recurrent polynya from ~ 4400 yrs BP, in line with Neoglacial cooling. During warmer Holocene intervals such as the Roman Warm Period, a weaker NOW is evident, and its reduced capacity to influence bottom ocean conditions facilitated northward penetration of Atlantic Water. Future warming in the Arctic may have negative consequences for this vital biological oasis, with the potential knock-on effect of warm water penetration further north and intensified melt of the marine-terminating glaciers that flank the coast of northwest Greenland.

Purpose: Gracilis muscle transposition (GMT) is an established surgical technique in the treatment of anorectal fistulas and fistulas to the vagina and the urinary system when previous closure options have failed. There is little evidence on the success rate of this procedure in the long term., Methods: This is a follow-up study on all patients undergoing GMT over a 10-year period at a tertiary referral center for complex fistulas. Postoperative function and quality of life were evaluated by standardized questionnaires (Wexner score, Fecal Incontinence Quality of Life Score (FIQL), SF-12 and a brief questionnaire designed for this study). Sexual function was evaluated by the Female Sexual Function Index (FSFI) and the International Index of Erectile Function., Results: Forty-seven gracilis muscle transpositions (GMT) in 46 patients were performed. Most treated patients had (neo-)-rectovaginal fistulas (n = 29). An overall fistula closure was achieved in 34 of 46 patients (74%): in 25 cases primarily by GMT (53%) and in nine patients with persistent or recurrent fistula by additional surgical procedures. A clinically apparent relapse occurred on average 276 days (median: 180 days) after GMT (mean follow-up 73.4 months)., Conclusion: GMT in our hands has a primary closure rate of 53%, and after further procedures, this rises to 74%. Fecal continence is impaired in patients having undergone GMT. The overall quality of life in patients after GMT is only slightly impaired, and sexual function is severely impaired in female patients.

Abstract: Magnetic resonance imaging (MRI) has emerged as the imaging method of choice for evaluation of perianal fistulizing disease. As treatment of Crohn disease and associated perianal fistulas has evolved to include a combination of systemic treatments and surgical interventions, perianal MRI provides critical information to guide treatment selection and timing. Radiologists need to be familiar with the normal regional anatomy to accurately describe perianal fistulas and any associated complications which can then be used to classify fistulas based on several available classification systems. Following treatment, MRI can provide information that suggests treatment success or failure. We propose a perianal fistula reporting template that includes the necessary information to convey fistula complexity, guide treatment, and evaluate treatment response. This review article will also discuss the postoperative appearance of many treatments currently used for management of perianal fistulizing disease and some associated complications., Competing Interests: Santillan should have listed as “Consultant for Alimentiv”. The remaining authors report no conflicts of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Rectovaginal fistulas are notorious for both their morbidity and their difficulty to treat effectively. A variety of methods for repair has been described; however, there is no consensus on the ideal repair. A better understanding of the anatomical relationship of fistulas to the anal sphincter and detrusor muscles is one of the components necessary to develop an effective treatment plan for repair and preservation of sphincter mechanics., Methods: A review of the literature was conducted to determine the types of methods typically used by reconstructive surgeons for repair of rectovaginal fistulas. A critical clinical analysis of our series of 10 patients was performed to determine optimal strategies for and pitfalls of repair in the context of recent reports in hopes of refining surgical techniques., Results: Detailed anatomical understanding of the relationship of fistulas to the surrounding sphincter muscles is described. Etiology of the fistula and its anatomical relationship to the surrounding sphincter complex is used to help develop an algorithm for repair. Suprasphincteric fistulas will necessitate a laparotomy for repair, intersphincteric fistulas will often require muscle interposition with recreation of the vaginal and rectal walls, and low/transphincteric fistulas will require local flaps mostly for coverage and repair of the sphincter muscles., Conclusions: Complex rectovaginal fistulas are both debilitating for the patient and extremely difficult to manage. Plastic surgeons are often involved in such cases only after previous attempts at repair have failed. The success of surgery in treating these patients with rectovaginal fistulas depends on a variety of factors. Unfortunately, the available literature describing these repairs lacks uniform guidance regarding approach to repair. Herein, we attempt to detail the possible anatomical variations of fistulas in relationship to the sphincter muscles to begin the discussion necessary for the development of an algorithm for repair that considers preservation of sphincter mechanism function.

The uncertain response of marine terminating outlet glaciers to climate change at time scales beyond short-term observation limits models of future sea level rise. At temperate tidewater margins, abundant subglacial meltwater forms morainal banks (marine shoals) or ice-contact deltas that reduce water depth, stabilizing grounding lines and slowing or reversing glacial retreat. Here we present a radiocarbon-dated record from Integrated Ocean Drilling Program (IODP) Site U1421 that tracks the terminus of the largest Alaskan Cordilleran Ice Sheet outlet glacier during Last Glacial Maximum climate transitions. Sedimentation rates, ice-rafted debris, and microfossil and biogeochemical proxies, show repeated abrupt collapses and slow advances typical of the tidewater glacier cycle observed in modern systems. When global sea level rise exceeded the local rate of bank building, the cycle of readvances stopped leading to irreversible retreat. These results support theory that suggests sediment dynamics can control tidewater terminus position on an open shelf under temperate conditions delaying climate-driven retreat.

Aim: Successful treatment of complex rectovaginal fistulas (RVFs) continues to be a surgical challenge. Interposition of well-perfused tissue, such as gracilis muscle, is one treatment option. The aim of this study was to investigate the operative results, sexual function and quality of life after gracilis muscle transposition (GMT) in the authors' own group of patients., Method: The study included 19 women with RVF (mean age 48 years). The postoperative outcome was evaluated by a questionnaire and clinical examination., Results: The postoperative follow-up period was 7 months to 3.5 years (mean 23 months). GMT led to primary healing of RVF in 10 (53%) patients. Recurrences were observed in nine (47%) patients with RVF, in four (44%) of whom healing was achieved as a result of further interventions. Following GMT, two complications (abscess formation) requiring revision occurred. Although 42% of the patients reported certain limitations following muscle removal, GMT is a procedure that has a positive influence on the healing rate (74%), quality of life, continence and patient satisfaction., Conclusion: GMT is a procedure that allows healing in the majority of patients with RVFs, and it should be considered especially in patients with recurrent fistulas, in whom a correlation between decreasing healing rates and the number of previous operations has been demonstrated., (Colorectal Disease © 2019 The Association of Coloproctology of Great Britain and Ireland.)