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Pneumocoelom secondary to primary pulmonary disease was diagnosed via CT (three cases) or radiographs and coelioscopy (one case) in one Kemp's ridley (Lepidochelys kempii) and three loggerhead (Caretta caretta) sea turtles. All cases were suspected to be caused by trauma to the lung, and all exhibited positive buoyancy disorders. Coelomocentesis alone was ineffective at resolving each pneumocoelom, suggesting a large and persistent tear in the pulmonary parenchyma. An autologous (in three cases) or allogenic (in one case) blood patch pleurodesis was performed. The pneumocoelom was resolved in all four cases with no noted postoperative complications. Follow-up diagnostic imaging confirmed resolution of the pneumocoelom in three cases, and all four patients were successfully rehabilitated and had normal buoyancy at the time of release. One rehabilitated loggerhead was satellite tagged, and the tracking data demonstrated that the animal was still alive and moving normally 126 d postrelease, when the tag stopped transmitting. In sea turtles, an autologous or allogenic blood patch pleurodesis can be safely performed in cases of persistent pneumocoelom secondary to traumatic primary pulmonary disease. [ABSTRACT FROM AUTHOR]

Epidermolysis bullosa is a genetic skin disorder characterized by blister formation from mechanical trauma. Dystrophic epidermolysis bullosa (DEB) is caused by mutations in the COL7A1 gene presenting as generalized blisters from birth, which can result in extensive scarring, alopecia, esophageal stenosis, corneal erosions, and nail dystrophy. This disease also often leads to pseudosyndactyly of the digits from the closure of webspaces, progressing to a "mitten hand" deformity. Although traditional and current treatment for DEB is largely supportive with wound care and iterative surgical pseudosyndactyly release, emerging gene therapies and novel skin grafts may offer promising treatment. Studies published in the early 2020s have used HSV-1 vectors expressing missing COL7A1 genes to restore collagen function. One of these treatments, B-VEC, is an HSV-1-based topical gene therapy designed to restore collagen 7 by delivering the COL7A1 gene, leveraging a differentiated HSV-1 vector platform that evades the patient's immune system response. Other work has been performed to retrovirally modify autologous keratinocytes, but limitations of this process include increased labor in harvesting and engineering autologous cells. This article provides an overview of DEB treatment with an emphasis on emerging gene therapies and novel skin grafts, especially as they pertain to pseudosyndactyly treatment. [ABSTRACT FROM AUTHOR]

Objectives: The objective of the European Multicenter Registry to Assess Outcomes in coronary artery bypass grafting (CABG) patients (DuraGraft Registry) was to determine clinical outcomes and quality of life (QoL) after contemporary CABG that included isolated CABG and combined CABG/valve procedures, using an endothelial damage inhibitor (DuraGraft) intraoperatively for conduit preservation. Here, we report outcomes in the patient cohort undergoing isolated CABG. Methods: The primary outcome was the composite of all-cause death, myocardial infarction (MI), or repeat revascularization (RR) [major adverse cardiac events (MACE)] at 1 year. Secondary outcomes included the composite of all-cause death, MI, RR, or stroke [major adverse cardiac and cerebrovascular events (MACCE)], and QoL. QoL was assessed with the EuroQol-5 Dimension questionnaire. Independent risk factors for MACE at 1 year were determined using Cox regression analysis. Results: A total of 2532 patients (mean age, 67.4 ± 9.2 years; 82.5% male) underwent isolated CABG. The median EuroScore II was 1.4 [interquartile range (IQR), 0.9-2.3]. MACE and MACCE rates at 1 year were 6.6% and 7.8%, respectively. The rates of allcause death, MI, RR, and stroke were 4.4, 2.0, 2.2, and 1.9%, respectively. The 30-day mortality rate was 2.3%. Age, extracardiac arteriopathy, left ventricular ejection fraction less than 50%, critical operative state, and left main disease were independent risk factors for MACE. QoL index values improved from 0.84 [IQR, 0.72-0.92] at baseline to 0.92 [IQR, 0.82-1.00] at 1 year (P <0.0001). Conclusion: Contemporary European patients undergoing isolated CABG have a low 1-year clinical event rate and an improved QoL. [ABSTRACT FROM AUTHOR]

Background: Patients undergoing surgical treatment for solid tumors are at risk for development of secondary lymphedema due to intraoperative lymphatic vessel injury. The damaged lymphatic vessels fail to adequately regenerate and lymphatic obstruction leads to fluid and protein accumulation in the interstitial space and chronic lymphedema develops as a result. There are currently no effective pharmacological agents that reduce the risk of developing lymphedema or treat pre-existing lymphedema, and management is largely palliative. The present study investigated the efficacy of various 9-cis retinoic acid (9-cis RA) dosing strategies in reducing postsurgical lymphedema by utilizing a well-established mouse tail lymphedema model. Methods and Results: Short-duration treatment with 9-cis RA did not demonstrate a significant reduction in postoperative tail volume, nor an improvement in lymphatic clearance. However, long-term treatment with 9-cis RA resulted in decreased overall tail volume, dermal thickness, and epidermal thickness, with an associated increase in functional lymphatic clearance and lymphatic vessel density, assessed by LYVE-1 immunostaining, compared with control. These effects were seen at the site of lymphatic injury, with no significant changes observed in uninjured sites such as ear skin and the diaphragm. Conclusions: Given the reported results indicating that 9-cis RA is a potent promoter of lymphangiogenesis and improved lymphatic clearance at sites of lymphatic injury, investigation of postoperative 9-cis RA administration to patients at high risk of developing lymphedema may demonstrate positive efficacy and reduced rates of postsurgical lymphedema. [ABSTRACT FROM AUTHOR]

The ketone β-hydroxybutyrate (BHB) serves as an energy source when bodily energy stores are low. Concentrations of this blood analyte are often determined by spectrophotometric quantitative assays with a dry chemistry analyzer; however, rapid assessment with point-of-care devices have the potential to improve assessment of animals in the field or in clinical settings. We measured BHB concentrations in whole blood samples from 54 leatherback (Dermochelys coriacea), 27 loggerhead (Caretta caretta), and 14 green (Chelonia mydas) sea turtles in Florida, US with a point-of-care device and validated its use with corresponding plasma samples and dry chemistry analyzer as the gold standard. Concentrations of BHB highly correlated between the two methods for all three species, with loggerheads showing the best agreement and lowest bias. Therefore, the point-of-care device used for this study (Lucidplus β-ketone monitoring system) is probably appropriate for sea turtle BHB measurements. [ABSTRACT FROM AUTHOR]

• 50 classroom plants improved college student perceived air quality and productivity. • Going from 50 to 100 plants did not further improve perceptions. • Objectively measured indoor air quality parameters were unaffected by placed plants. We examined a dose-response relationship of plants placed in a university classroom with college students' self-reported cognitive performance, mental and psychosomatic health, environmental quality perceptions, and objectively measured indoor air quality (IAQ) parameters. This quasi-experimental design study involved two university classrooms, a Comparison Classroom (CC) and a Biophilic Classroom (BC). In the BC, but not in the CC, 50 plants were placed in Week 4 (W4), an additional 51 in W10, and all plants removed in W14. Surveys were administered at 4 time points (T1: W3 [baseline]; T2: W7; T3: W13, and T4: W16) to assess students' perceptions and health outcomes, including perceived stress, cognitive performance, nature connectedness, indoor environmental quality, air freshness, odor intensity, productivity, and sleepiness, with scores ranging from 0–40 (stress), 1–7 (sleepiness), or 1–5 (other variables). IAQ was monitored continuously using TSI AirAssure™ Monitors. At Baseline, 257 students completed the survey in the CC and 80 in the BC. Plants in the BC significantly improved students' perceived indoor environmental quality (T2: 4.04 vs. 3.51, p<.001; T3: 4.00 vs. 3.52, p<.001), air freshness (T2: 4.07 vs. 3.41, p<.001; T3: 3.91 vs. 3.48, p<.01), and productivity (T2: 3.33 vs. 2.91, p<.01; T3: 3.33 vs. 2.90, p<.01). However, adding more plants did not further improve these perceptions. No significant differences were found in students' cognitive performance, perceived stress, sleepiness, nature connectedness, or IAQ parameters between CC and BC. Plants in the classroom improved students' perceived classroom environment and productivity but did not affect the objectively measured IAQ parameters. [ABSTRACT FROM AUTHOR]

• 50 classroom plants improved college student perceived air quality and productivity. • Going from 50 to 100 plants did not further improve perceptions. • Objectively measured indoor air quality parameters were unaffected by placed plants. We examined a dose-response relationship of plants placed in a university classroom with college students' self-reported cognitive performance, mental and psychosomatic health, environmental quality perceptions, and objectively measured indoor air quality (IAQ) parameters. This quasi-experimental design study involved two university classrooms, a Comparison Classroom (CC) and a Biophilic Classroom (BC). In the BC, but not in the CC, 50 plants were placed in Week 4 (W4), an additional 51 in W10, and all plants removed in W14. Surveys were administered at 4 time points (T1: W3 [baseline]; T2: W7; T3: W13, and T4: W16) to assess students' perceptions and health outcomes, including perceived stress, cognitive performance, nature connectedness, indoor environmental quality, air freshness, odor intensity, productivity, and sleepiness, with scores ranging from 0–40 (stress), 1–7 (sleepiness), or 1–5 (other variables). IAQ was monitored continuously using TSI AirAssure™ Monitors. At Baseline, 257 students completed the survey in the CC and 80 in the BC. Plants in the BC significantly improved students' perceived indoor environmental quality (T2: 4.04 vs. 3.51, p<.001; T3: 4.00 vs. 3.52, p<.001), air freshness (T2: 4.07 vs. 3.41, p<.001; T3: 3.91 vs. 3.48, p<.01), and productivity (T2: 3.33 vs. 2.91, p<.01; T3: 3.33 vs. 2.90, p<.01). However, adding more plants did not further improve these perceptions. No significant differences were found in students' cognitive performance, perceived stress, sleepiness, nature connectedness, or IAQ parameters between CC and BC. Plants in the classroom improved students' perceived classroom environment and productivity but did not affect the objectively measured IAQ parameters. [ABSTRACT FROM AUTHOR]

Background: Post-operative AF (POAF) is the most common complication following cardiac surgery, occurring in 30% to 60% of patients undergoing bypass and/or valve surgery. POAF is associated with longer intensive care unit/hospital stays, increased healthcare utilization, and increased morbidity and mortality. Injection of botulinum toxin type A into the epicardial fat pads resulted in reduction of AF in animal models, and in two clinical studies of cardiac surgery patients, without new safety observations.Methods: The objective of NOVA is to assess the use of AGN-151607 (botulinum toxin type A) for prevention of POAF in cardiac surgery patients. This randomized, multi-site, placebo-controlled trial will study one-time injections of AGN-151607 125 U (25 U / fat pad) and 250 U (50 U / fat pad) or placebo during cardiac surgery in ∼330 participants. Primary endpoint: % of patients with continuous AF ≥ 30 s. Secondary endpoints include several measures of AF frequency, duration, and burden. Additional endpoints include clinically important tachycardia during AF, time to AF termination, and healthcare utilization. Primary and secondary efficacy endpoints will be assessed using continuous ECG monitoring for 30 days following surgery. All patients will be followed for up to 1 year for safety.Conclusions: The NOVA Study will test the hypothesis that injections of AGN-151607 will reduce the incidence of POAF and associated resource utilization. If demonstrated to be safe and effective, the availability of a one-time therapy for the prevention of POAF would represent an important treatment option for patients undergoing cardiac surgery. [ABSTRACT FROM AUTHOR]

At the time of hatchling emergence from a nest laid on Juno Beach, Florida, US, by a normally pigmented green turtle (Chelonia mydas), 23 albino hatchlings and 75 normally pigmented hatchlings were observed. This condition is rarely seen in sea turtles, and little is known about blood analytes and genetics of albino wildlife to date. Therefore, the objective of our study was to assess and compare morphometric measurements (mass, minimum straight carapace length, body condition index), carapacial scute anomalies, a suite of hematologic and plasma biochemical analytes, and two glucose analysis methodologies (glucometer and dry chemistry analysis) in albino (n=20) versus normally pigmented (n=24) hatchlings from this nest. Genetic analyses were completed to identify paternal contributions of hatchlings and to test Mendelian inheritance assumptions. Although morphometric measurements, scute anomalies, and leukocyte morphology were similar between albino and normally pigmented hatchlings, several differences were observed in blood analyte data: immature erythrocytes, packed cell volume, heterophil:lymphocyte ratio, and glucose concentrations (by both methodologies) were significantly higher, whereas absolute immature heterophils, absolute lymphocytes, number of erythrocyte micronuclei, sodium, and chloride were significantly lower in albino hatchlings compared with normally pigmented hatchlings. Considerations for these differences include a stress response from sampling (e.g., timing of procedures or possibly from photosensitivity or reduced visual acuity in albinos) and different osmoregulation, which may reflect physiologic variations or stress. There was a small positive bias (0.10 mmol/L) with glucose by glucometer, similar to reports in other sea turtle species and confirming its suitability for use in hatchlings. All albino hatchlings analyzed (n=10) were from the same father, but the normally pigmented hatchlings (n=24) were from two other fathers. These findings provide insight into the physiology and genetics of albinism in sea turtles. [ABSTRACT FROM AUTHOR]

[Display omitted] [ABSTRACT FROM AUTHOR]

Late Medieval Limoges (Haute-Vienne department, Central France) represents an example of medium-sized city that relied on timber resources for e.g., construction, heating and crafting. Timber-framed buildings are abundant in the city centre, and although it is generally assumed that the wood used in these structures was sourced locally, historical records lack specific details in this regard. The aim of this study was to gain insight into the organisation of the timber ly for construction purposes in Limoges, a town surrounded by woodlands and connected by rivers to a hinterland of timber sources, using dendrochronological methods. To this end, we sampled 212 oak (Quercus sp.) wooden elements from 13 historic timber-framed houses and used a Hierarchical Cluster Analysis (HCA) approach to identify the origin of wood. Indeed, the HCA can offer insight into the origin of timbers of unknown provenance by grouping them with timbers of known provenance. No clear evidence of timber rafting was observed on the sampled elements. The collected material provided a 419-year-long tree-ring chronology spanning from 1317 to 1735 C.E. Tree-ring analyses revealed that most of the targeted houses date back to the 15th century, and that most of the timber originated from woodlands located in the Haute-Vienne department, within a 50-km radius around the city of Limoges. These results support the assumption that the wood was sourced locally. However, the study does not allow to determine more precisely the origin of individual timbers, highlighting the complexity of wood provenance studies at a local scale in densely forested areas with low environmental variation, such as Central France. We expect future studies combining geochemical tracers with tree-ring analysis to improve the spatial accuracy of the dendroprovenancing analysis presented here. [ABSTRACT FROM AUTHOR]

Blood glucose measurements provide important diagnostic information regarding stress, disease, and nutritional status. Glucose analytical methodologies include dry chemistry analysis (DCA) of plasma and point-of-care (POC) glucometer analysis of whole blood; however, these 2 methods differ in cost, required sample volume, and processing time. Because POC glucometers use built-in equations based on features of mammalian blood to convert whole blood measurements to plasma equivalent units, obtained glucose data must be compared and validated using gold-standard chemistry analytical methodology in reptiles. For in-water, trawl-captured, immature Kemp's ridley sea turtles (Lepidochelys kempii) from Georgia, USA, we observed significant, positive agreement between the 2 glucose determination methods; however, the glucometer overestimated glucose concentrations by 1.4 mmol/L on average in comparison to DCA and produced a wider range of results. The discordance of these results suggests that POC glucometer glucose data should be interpreted in the context of methodology- and brand-specific reference intervals along with concurrent packed cell volume data. [ABSTRACT FROM AUTHOR]

Background: Patients seek information from numerous sources before choosing a primary care provider; two of the most popular sources are providers' own online biographies and patient rating websites. However, prior research has generally only examined how these sources influence patients' decisions in isolation.Objective: This study aimed to determine how primary care providers' online biographies and online patient ratings interact to affect patients' decision making, especially in the face of negative reviews.Methods: An 8-condition online experiment (n=866) was conducted, manipulating patient ratings and the timing of viewing a provider's online biographical video (pre- or postrating viewing).Results: When participants were shown a short video introduction of a provider after reading predominantly negative reviews a positive expectancy violation occurred, which was also related to more positive perceptions of the provider. When exposed to all negative reviews, 43% of participants indicated they would still choose to make an appointment with the provider, with many indicating that the video provided the evidence needed to help make up their own minds.Conclusions: These findings are especially relevant to health care organizations seeking to combat a recent rise in fake patient reviews. Providing patients with realistic expectations of the care that clinicians can offer via their own online biographical videos can help counteract negative patient comments online. [ABSTRACT FROM AUTHOR]

Agarose gel electrophoresis (AGE) has been widely implemented throughout veterinary medicine and for analysis of plasma proteins of avian and reptile species. Capillary zone electrophoresis (CZE) is becoming a standard method in human clinical pathology laboratories but has not widely been used for the analysis of animal samples. The objective of the present study was to compare protein fractions derived from AGE and CZE methods using plasma from the green turtle (Chelonia mydas). Plasma samples were analyzed by AGE and CZE per manufacturer guidelines. The methods were assessed by CV analysis, Spearman's correlation, Passing-Bablok regression, and Bland Altman plots. CZE consistently resolved more fractions than AGE with three fractions observed in the prealbumin migrating region versus one for AGE and two fractions in the c globulin region versus one for AGE. Compared with AGE, CZE showed a lower CV in intra-assay tests (1.0-4.9% vs 2.0-28.3%) and a lower or overlapping CV in interassay tests (1.0-10.6 vs 2.3-22.0). The prealbumin, a2 globulin, and b globulin fractions correlated the least between the methods (for all three fractions: rs ≤ 0.28, P . 0.21). Moderate, significant correlations between AGE and CZE methods were observed for albumin (rs ≤ 0.78, P, 0.0001) and c globulins (rs¼0.78, P, 0.0001). CZE has a higher precision and ease of use over AGE and offers the opportunity to resolve additional protein fractions. This will necessitate the development of new conventions in placement of fraction delimits, definition of species-specific reference intervals, and evaluation of clinical utility in abnormal turtles. [ABSTRACT FROM AUTHOR]

Background: Given the media saturated world today's college students occupy, novel messaging needs to be utilized to cut through the noise to influence their perceptions of a perennial issue facing their population – problematic drinking behaviors. Method: The current study developed and implemented a year-long, multi-channel campaign effort by using the well-worn social norms framework in combination with a messaging tool all students are aware of – emojis – to produce messages seen by about half of the student body. Results: Campaign exposure was related to increased perceptions of the prevalence of safe partying behaviors, as well as the number of students who reported being more aware of what gets put into their drinks while partying. A non-social norms message – one with a percentage less than 50% of the population – also was related to increased perceptions, indicating that buttressing numerous social norms messages with one that is not may lead to a halo effect. Conclusions: Future research should strive to isolate emojis' efficacy within health campaign messaging to determine if they can be used as a useful strategy to engage with college students, or just a passing fad. [ABSTRACT FROM AUTHOR]

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Fine needle aspiration is the standard method for the pathological evaluation of pancreatic masses. In the following context, rare variants of such masses might present a challenge. Our goal is to describe the clinical, cytological, and histological findings of two cases of undifferentiated carcinoma with osteoclast-like giant cells (UCOCGC) a rare variant of pancreatic ductal adenocarcinoma (PDAC). Two cases were identified. Cytological findings exhibit similarities between the two cases. One patient received multiple chemotherapy regimens and a surgery and recurred within three years of diagnosis, while the other succumbed to cholangitis resulting from hepatic metastases a year after their initial surgery. UCOCGC is a rare variant of pancreatic cancer, characterized by a unique cytological aspect. Recognizing this variant is essential considering its distinct prognosis compared to usual pancreatic adenocarcinoma. We presented two cases of UCOCGC a rare pancreatic cancer variant, exposing diagnostic particularities and clinical evolution. • Importance of differentiating UCOCGC a very rare form of cancer between other PDAC. • Strongly suggested to generate future tests for patients with PDAC. • Reduce the use of valuable resources and risks associated with irrelevant procedures. [ABSTRACT FROM AUTHOR]

The effects of stroke and delirium on postdischarge cognition and patient-centered health outcomes after surgical aortic valve replacement (SAVR) are not well characterized. Here, we assess the impact of postoperative stroke and delirium on these health outcomes in SAVR patients at 90 days. Patients (N = 383) undergoing SAVR (41% received concomitant coronary artery bypass graft) enrolled in a randomized trial of embolic protection devices underwent serial neurologic and delirium evaluations at postoperative days 1, 3, and 7 and magnetic resonance imaging at day 7. Outcomes included 90-day functional status, neurocognitive decline from presurgical baseline, and quality of life. By postoperative day 7, 25 (6.6%) patients experienced clinical stroke and 103 (28.5%) manifested delirium. During index hospitalization, time to discharge was longer in patients experiencing stroke (hazard ratio, 0.62; 95% confidence interval [CI], 0.42-0.94; P =.02) and patients experiencing delirium (hazard ratio, 0.68; 95% CI, 0.54-0.86; P =.001). At day 90, patients experiencing stroke were more likely to have a modified Rankin score >2 (odds ratio [OR], 5.9; 95% CI, 1.7-20.1; P =.01), depression (OR, 5.3; 95% CI, 1.6-17.3; P =.006), a lower 12-Item Short Form Survey physical health score (adjusted mean difference −3.3 ± 1.9; P =.08), and neurocognitive decline (OR, 7.8; 95% CI, 2.3-26.4; P =.001). Delirium was associated with depression (OR, 2.2; 95% CI, 0.9-5.3; P =.08), lower 12-Item Short Form Survey physical health (adjusted mean difference −2.3 ± 1.1; P =.03), and neurocognitive decline (OR, 2.2; 95% CI, 1.2-4.0; P =.01). Stroke and delirium occur more frequently after SAVR than is commonly recognized, and these events are associated with disability, depression, cognitive decline, and poorer quality of life at 90 days postoperatively. These findings support the need for new interventions to reduce these events and improve patient-centered outcomes. [Display omitted] [ABSTRACT FROM AUTHOR]

Temporary epicardial pacing wires are universally used in cardiac surgery and are associated with very low morbidity and mortality. Although rare, serious complications can occur with pacing wires. We present a case of avulsion of a saphenous vein graft side branch caused by removal of pacing wires and leading to pericardial tamponade. Our case favors the use of silk ties rather than hemoclips for occlusion of saphenous vein side branches and illustrates the importance of the location of pacing wires relative to the grafts at the time of coronary artery bypass surgery. [ABSTRACT FROM AUTHOR]