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Recently, large numbers of Polyclad flatworms (Stylochus mediterraneus) have been observed in Istrian County shellfish farms connected to intensive ascidian fouling. To assess a possible threat and determine whether the flatworm feeds only on weakened dead mussels or can also infest healthy mussels, we have conducted a field research and laboratory mussel predation experiments. Performed field observations (August 2022–May 2023) indicated increased mussel mortality and, at the same time, increased abundance of flatworms from 70 % time filtrating with the valve open > 50 %, with 1–5 resting periods), the behavioural changes of exposed mussels compared to control mussels, the timing of flatworm attack, the response of mussels during predation, and the timing of mussel death. We conclude that the flatworm S. mediterraneus is most likely a very opportunistic species that prefers weaker mussels but can also feed on healthy mussels. This investigation brings new knowledge and assumptions on the behavioural patterns of investigated flatworms. Further studies should consider that ''experienced'' flatworms attack and kill the mussels, while the rest simply eat a free meal using the strategy of the predator pack.

Do-not-resuscitate (DNR) orders are necessary if resuscitation, the default option in hospitals, should be avoided because a patient is known to be dying and attempted resuscitation would be inappropriate. To avoid inappropriate resuscitation at night, if no DNR order has been recorded, after-hours medical staff are often asked to have a DNR discussion with patients whose condition is deteriorating, but with whom they are unfamiliar. Participants in two qualitative studies of cancer patients’ views on how to present DNR discussions recognized that such patients are at different stages of understanding of their situation and may not be ready for a DNR discussion; therefore, a one-policy-fits-all approach was thought to be inappropriate. To formulate a policy that incorporates the patient’s views, we propose that a standard form which mandates a DNR discussion is replaced by a “blank sheet” with instructions to record the progress of the discussion with the patient, and a medical recommendation for a DNR decision to guide the nursing staff in case of a cardiac arrest. Such an advance care directive would have to honor specifically expressed patient or guardian wishes whilst allowing for flexibility, yet would direct nurses or other staff so that they can avoid inappropriate cardiopulmonary resuscitation of a patient dying of cancer.

BackgroundTHE USE OF DIRECT OBSERVATION TO MONITOR TUBERCULOSIS TREATMENT IS CONTROVERSIAL: cost, practical difficulties, and lack of patient acceptability limit effectiveness. Telehealth is a promising alternative delivery method for improving implementation. This study aimed to evaluate the clinical and cost-effectiveness of a telehealth service delivering direct observation, compared to an in-person drive-around service.Methodology/principal findingsThe study was conducted within a community nursing service in South Australia. Telehealth patients received daily video calls at home on a desktop videophone provided by the nursing call center. A retrospective cohort study assessed the effectiveness of the telehealth and traditional forms of observation, defined by the proportion of missed observations recorded in case notes. This data was inputted to a model, estimating the incremental cost-effectiveness ratio (ICER) of telehealth. Semi-structured interviews were conducted with current patients, community nursing and Chest Clinic staff, concerning service acceptability, usability and sustainability. The percentage of missed observations for the telehealth service was 12.1 (n = 58), compared to 31.1 for the in-person service (n = 70). Most of the difference of 18.9% (95% CI: 12.2 - 25.4) was due to fewer pre-arranged absences. The economic analysis calculated the ICER to be AUD$1.32 (95% CI: $0.51 - $2.26) per extra day of successful observation. The video service used less staff time, and became dominant if implemented on a larger scale and/or with decreased technology costs. Qualitative analysis found enabling factors of flexible timing, high patient acceptance, staff efficiency, and Chest Clinic support. Substantial technical problems were manageable, and improved liaison between the nursing service and Chest Clinic was an unexpected side-benefit.Conclusions/significanceHome video observation is a patient-centered, resource efficient way of delivering direct observation for TB, and is cost-effective when compared with a drive-around service. Future research is recommended to determine applicability and effectiveness in other settings.

Abstract Background Although the importance of clinical ethics in contemporary clinical environments is established, development of formal clinical ethics services in the Australia health system has, to date, been ad hoc. This study was designed to systematically follow and reflect upon the first 18 months of activity by a newly established service, to examine key barriers and facilitators to establishing a new service in an Australian hospital setting. Methods: how the study was performed and statistical tests used A qualitative case study approach was utilised. The study gathered and analysed data using observations of service committee meetings, document analysis of agendas and minutes, and semi-structured interviews with committee members to generate semantic themes. By interpreting the thematic findings in reference to national capacity building resources, this study also aimed to provide practice-based reflections for other health agencies. Results: the main findings An overarching theme identified in the data was a strong commitment to supporting clinicians facing difficult patient care decisions and navigating difficult discussions with patients and families. Another key theme was the role of the new clinical ethics support service in providing clinicians with a pathway to raise system-wide issues with the organisation Executive. While there was strong clinical engagement, consumer and community participation remained a challenge, as did unresolved governance issues and a need for clearer policy relationship between the service and the organisation. Conclusions: brief summary and potential implications Considering these themes in relation to the national capacity building resources, the study identifies three areas likely to require ongoing development and negotiation. These are: the role of the clinical ethics support service as a link between the workforce and the Executive; the incorporation of consumers and patients; and ethical reasoning. To improve the effectiveness of the service, it is necessary to increase clarity on the service’s role at the governance and policy level, as well as develop strategies for engaging consumers, patients and families. Finally, the capacity of the service to reflect on complex cases may be enhanced through explicit discussions of various different ethical frameworks and ways of deliberating.

IntroductionThyroid dysfunction is the most frequent endocrine immune related adverse event (irAE) in non-small cell lung cancer (NSCLC), typically arising 3-6 months into immune checkpoint inhibitor (ICI) therapy, but arising after ICI cessation, in some cases. Due to limited post-treatment adverse event reporting requirements on ICI trials, the incidence of ICI-induced thyroid dysfunction arising after therapy is unclear. We investigated ICI-induced thyroid dysfunction in a cohort of 294 NSCLC patients, with a specific focus on the post-treatment setting.MethodsRetrospective analysis of ICI-induced thyroid dysfunction (clinically acted upon or laboratory only) was performed in 294 UCLA NSCLC patients treated 2012-2018. Clinically acted upon thyroid dysfunction was defined as thyroid diagnosis documentation and/or thyroid medication administration. Laboratory only dysfunction was defined as abnormal thyroid labs in the absence of clinical action. Timing of thyroid dysfunction relative to ICI treatment and thyroid monitoring patterns were also assessed.Results82% (241/294) of ICI treated NSCLC patients had thyroid labs during treatment. Of these 241 patients, 13% (31/241) had clinically acted upon thyroid dysfunction prior to, 8% (18/241) during, and 4% (9/241) after ICI. Most patients, 66% (159/241), did not have thyroid labs after ICI, but in the 53 patients with labs and no prior clinical dysfunction, 17% (9/53) developed clinical dysfunction after ICI. In these 9 patients, median time from ICI initiation to dysfunction was 253 days. Two patients with post-treatment laboratory only dysfunction were observed.ConclusionsICI-induced thyroid dysfunction arising post-treatment appears more common than previously appreciated, warranting additional evaluation.

Background: Lipedema is a subcutaneous adipose tissue disorder characterized by increased pathological adipocytes mainly in the extremities. Vitamin D is stored in adipocytes, and serum levels inversely correlate with BMI. As adipocytes are removed during liposuction, lipedema patients might be prone to further substantial vitamin D loss while their levels are already decreased. Therefore, we examined the effect of liposuction on perioperative serum 25-hydroxyvitamin D levels. Methods: In patients undergoing lipedema liposuction, blood samples were obtained pre- and postoperatively. Statistical analyses were performed to correlate the volume of lipoaspirate, patients’ BMI and number of sessions to vitamin D levels. Results: Overall, 213 patients were analyzed. Mean liposuction volume was 6615.33 ± 3884.25 mL, mean BMI was 32.18 ± 7.26 kg/m2. mean preoperative vitamin D levels were 30.1 ± 14.45 ng/mL (borderline deficient according to the endocrine society) and mean postoperative vitamin D levels were 21.91 ± 9.18 ng/mL (deficient). A significant decrease in serum vitamin D was seen in our patients (p < 0.001) of mean 7.83 ng/mL. The amount of vitamin D loss was not associated with BMI or aspiration volume in our patients (p > 0.05). Interestingly, vitamin D dynamics showed a steady drop regardless of volume aspirated or preoperative levels. Conclusions: Many lipedema patients have low vitamin D levels preoperatively. Liposuction significantly reduced these levels additionally, regardless of aspirated volume or BMI. However, vitamin D loss was constant and predictable; thus, patients at risk are easily identified. Overall, lipedema patients undergoing liposuction are prone to vitamin D deficiency, and the long-term effects in this population are currently unknown.

Prior studies on sex addiction have mostly relied on a narrow range of risk factors among small and heterogeneous samples. The purpose of the present study was to examine the psychological markers related to sex addiction in a large-scale community sample of Turkish adults. A total of 24,380 individuals completed a survey comprising the Sex Addiction Risk Questionnaire, the Brief Symptom Inventory, the Positive and Negative Affect Schedule, the Personal-Wellbeing Index Adult Form, the Toronto Alexithymia Scale, and the Experiences in Close Relationships-Revised (50% males; mean age = 31.79 years; age range = 18 to 81 years). Utilizing hierarchical regression analysis, sex addiction was associated with being male, being younger, having a lower education level, being single, being an alcohol and nicotine user, psychiatric distress, low personal wellbeing, positive and negative affect, alexithymia, and anxious attachment. This study suggests that socio-demographic factors and aforementioned detrimental psychological factors exacerbate higher engagement in addictive sexual behaviors among the Turkish community. However, more studies are needed to better understand the factors associated with sex addiction in Turkey., Author(s): Kagan Kircaburun [sup.1] [sup.2] , Hüseyin Ünübol [sup.3] , Gökben H. Sayar [sup.4] , Jaklin Çarkçi [sup.3] , Mark D. Griffiths [sup.1] Author Affiliations: (1) grid.12361.37, 0000 0001 0727 [...]

Cancer is a growing threat to human and animal health, The use of synthetic chemotherapy in the treatment of cancer is short because of lack of appropriate safety due to their drastic side effects. So, this study evaluated the ameliorative effect of Chrysanthemum on genotoxicity as well as renal and hepatic toxicity of Capecitabine (xeloda), as a model of anticancer drug. Thirty six male albino rat were divided into 6 groups. Serum samples were taken at 21 and 45 days and bone marrow samples at 45 days. Comet assay, biochemical tests for liver and kidney functions were done also serum oxidative biomarker were measured. The results of the present study revealed that capecitabine (xeloda) caused harmful genotoxic effect, biochemical changes in oxidative biomarkers, liver and kidney function, however the use of capecitabine (xeloda) in combination with Chrysanthemum ameliorated these changes especially with high dose. In conclusion, capecitabine adverse effects could be successfully alleviated through the co-administration of the natural antioxidant Chrysanthemum.

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Abstract SARS-CoV-2 virus has rapidly spread worldwide since December 2019, causing COVID-19 disease. In-hospital mortality is a common indicator for evaluating treatment outcomes. Therefore, the developing and validating a simple score system from observational data could assist in modulating the management procedures. A retrospective cohort study included all data records of patients with positive PCR for SARS-CoV-2. The factors that associated with mortality were analyzed, then allocation of potential predictors of mortality was executed using different logistic regression modeling, subsequently scoring system was developed from the most weighted predictors. The mortality rate of patients with COVID-19 pneumonia was 28.5% and 28.74%, respectively. The most significant factors that affected in-hospital mortality were old age (> 60 years), delay in hospital admission (> 4 days), high neutrophil/lymphocyte ratio “NLR” (> 3); higher computed tomography severity score; and CT-SS (> 20), in addition to using remdesivir and tocilizumab in the treatment protocol (P

Basic behaviors, such as swallowing, speech, and emotional expressions are the result of a highly coordinated interplay between multiple muscles of the head. Control mechanisms of such highly tuned movements remain poorly understood. Here, we investigated the neural components responsible for motor control of the facial, masticatory, and tongue muscles in humans using specific molecular markers (ChAT, MBP, NF, TH). Our findings showed that a higher number of motor axonal population is responsible for facial expressions and tongue movements, compared to muscles in the upper extremity. Sensory axons appear to be responsible for neural feedback from cutaneous mechanoreceptors to control the movement of facial muscles and the tongue. The newly discovered sympathetic axonal population in the facial nerve is hypothesized to be responsible for involuntary control of the muscle tone. These findings shed light on the pivotal role of high efferent input and rich somatosensory feedback in neuromuscular control of finely adjusted cranial systems.

Available research on invertebrates in Corallina officinalis settlements shows a high level of biodiversity due to a complex habitat structure. Our aim was to examine seasonal changes in the invertebrate population, considering the algae’s growth patterns. Nine locations with over 90% algal coverage were selected in southern Istria, where quantitative sampling was performed using six replicates of 5 × 5 cm quadrats in each location. Results showed that 29,711 invertebrates were found during winter (maximum algae growth) and 22,292 during summer (minimum algae growth), with an extrapolated average density of 220,000 and 165,200 individuals per square meter, respectively. The total number of individuals showed a linear increase as the algae biomass increased. The highest density, 586,000 individuals, was recorded in the Premantura area during winter. Dominant groups such as amphipods, polychaetes, bivalves and gastropods made up over 80% of the invertebrates. Our study confirms high invertebrate richness in the C. officinalis settlements, with the maximum density being the highest when compared to previously published data.

A very common intertidal alga, Corallina officinalis, serves as a refuge for numerous invertebrates within its settlements. The composition and structure of invertebrates may differ in relation to different natural or human-induced stress, and this study examined the effects of anthropogenic impact on the abundance and diversity of mollusks residing within C. officinalis settlements. Sampling was conducted during two seasons (Season 1 = algae’s maximum vegetation growth and Season 2 = algae’s minimum vegetation growth). Gastropods and bivalves made up 50% of all invertebrates identified, with a total of 47 species of gastropods, 25 species of bivalves, and one polyplacophoran species recorded. Considering the overall count of individuals, 4562 gastropods, 21,738 bivalves, and 260 polyplacophorans were collected from all available Corallina samples. The results indicated that locations under human impact showed a reduced number of the most abundant gastropod and bivalve species and a reduced average number of individuals.

The intensive colonial tunicate Clavelina oblonga invasion was observed in the summer of 2020 at shellfish farms located on the western and eastern coasts of the Istrian peninsula (NE, Adriatic, Croatia). Aquaculture facilities create an ideal environment for ascidians, therefore, as a possible environmentally friendly eradication measure, laboratory experimental exposure of C. oblonga to different reduced seawater salinities of 37, 30, 20 and 11 was examined in November 2020. During the total observation time (14 days exposure + 14 days of recovery at 37) at all seawater salinities, there was no sexual reproduction of Clavelina specimens and larvae settlement in general. Salinities of 37 and 30 didn’t provoke any significant effect in colonial corpus weight change and morphology. Salinities of 20 and 11 caused disorder in specimens feed uptake and feeding itself which led to change of colour, tissue necrosis and finally body fragmentation. Similar separate laboratory exposure of mussel Mytilus galloprovincialis specimens did not provoke significant differences in meat yield between control 37 salinity (14.0 %) and reduced salinities of 30 (14.2 %), 20 (14.6 %) and 11 (15.3 %) measured at the end of the recovery experiment. Based on our experimental results of C. oblonga salinity susceptibility and field observations (2020–2021), we can assume that field translocation of overgrown mussels and infrastructures to locations of seawater