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PurposeMetabolic surgery remains underutilized for treating type 2 diabetes, as less invasive alternative interventions with improved risk profiles are needed. We conducted a pilot study to evaluate the feasibility of a novel magnetic compression device to create a patent limited caliber side-to-side jejunoileal partial diversion in a nonhuman primate model.Materials and methodsUsing an established nonhuman primate model of diet-induced insulin resistance, a magnetic compression device was used to create a side-to-side jejunoileal anastomosis. Primary outcomes evaluated feasibility (e.g., device mating and anastomosis patency) and safety (e.g., device-related complications). Secondary outcomes evaluated the device's ability to produce metabolic changes associated with jejunoileal partial diversion (e.g., homeostatic model assessment of insulin resistance [HOMA-IR] and body weight).ResultsDevice mating, spontaneous detachment, and excretion occurred in all animals (n = 5). There were no device-related adverse events. Upon completion of the study, ex vivo anastomoses were widely patent with healthy mucosa and no evidence of stricture. At 6 weeks post-device placement, HOMA-IR improved to below baseline values (p

Background: The minimum weight for enterostomy closure (EC) in infants remains debated with the current acceptable cut-off of >2 kg. As enterostomy-related complications or high enterostomy output (>30cc/kg/d) may prohibit a premature infant fromreaching 2 kg, additional data is needed to evaluate the safety of EC in infants <2 kg. The objective of this study was to evaluate postoperative outcomes in low body weight (<2 kg) infants undergoing EC compared to larger infants. Methods: We performed a multi-center retrospective analysis from 1/1/2012-12/31/2022 of all infants (age <1 year) who were <4 kg at time of EC. Primary outcomes included postoperative complications and 30-day mortality. Nonparametric analysis was performed using the Kruskal-Wallis one-way analysis of variance and chi-square tests. Univariable logistic regression was performed to identify factors associated with postoperative complications. Results: Of 92 infants, 15 infants (16.3%) underwent EC at <2 kg, 16 (17.4%) at 2-2.49 kg, 31 (33.7%) at 2.5-2.99 kg, and 30 (32.6%) at ≥3 kg. Infants <2 kg at time of EC exhibited higher rates of hyperbilirubinemia (P = .030), neurologic comorbidities (P = .030), and high enterostomy output (P = .041). There was no difference in postoperative complications (P = .460) or 30-day mortality (P = .460) between the <2 kg group and larger weight groups. Low body weight was not associated with an increased risk for developing a postoperative complication (OR: 1.001, 95% CI: 1.001-1.001; P = .032). Conclusion: Our findings suggest that EC in infants <2 kg may be safe with comparable postoperative outcomes to larger weight infants. Thus, the timing of EC should be based on the infant's physiologic status, in contrast to a pre-determined minimum weight cut-off. [ABSTRACT FROM AUTHOR]

Past climate changes have had large impacts on modern ecological patterns. Understanding if legacies are distinguishable in the climatic niches of extant and locally extinct taxa can provide insight into the importance of climate in extinction events. To better understand mid‐ to late‐Cenozoic New Zealand plant extinctions, which are often attributed to Cenozoic climate cooling, we identify 13 con‐familial extinct and extant New Zealand genus pairs, which have modern distributions in Australia. Using climatic niches derived from current geographic distributions in Australia, we compared (i) total niche breadth, (ii) niche overlap, and (iii) individual climate parameters, to investigate potential climate drivers of intrafamilial extinction and persistence patterns in New Zealand. A majority of New Zealand extinct genera (9 out of 13 pairs) do not indicate climate niche legacies consistent with susceptibility to extinction from changing climates, while the remaining four extinct/extant pairs show slight climatic niche legacies. Three extinct genera have warmer niches than their extant counterpart, which is consistent with extinction reflecting intolerance of cooling Cenozoic climates. The other genus pair with a climatic niche legacy has an extinct genus that is distinguished by a niche with smaller precipitation seasonality than its extant counterpart, suggesting that climate metrics other than temperature may also be important extinction drivers in some taxa. Our results show that the mechanisms of Cenozoic extinctions of New Zealand genera are likely more complex than taxa reaching environmental tolerances due to cooling climates. Comparisons of current climatic niches between extant and extinct sister taxa can provide useful insights into large‐scale, long‐term climatic legacies but more analyses, including trait and phylogeographic patterns, would lead to additional insights into alternative pathways of extinction. [ABSTRACT FROM AUTHOR]

Background: Surgical resection is a mainstay of treatment in high-risk neuroblastoma (HR-NB), but there exists wide variability in perioperative management practices. The aim of this study was to evaluate two standardized adult perioperative enhanced recovery practices (ERPs) in pediatric patients undergoing open resection of abdominal HR-NB. Methods: All patients with abdominal HR-NB surgically resected at a free-standing children's hospital between 12/2010 and 7/2020 were retrospectively reviewed. Perioperative ERPs of interest included avoidance of routine nasogastric tube (NGT) use and the use of neuraxial anesthesia. Primary outcomes included time to enteral intake, urinary catheter use, opioid utilization, and length of stay (LOS). Results: Overall, 37 children, median age 33 months (IQR: 20-48 months), were identified. Avoidance of an NGT allowed for earlier feeding after surgery (P =.03). Neuraxial anesthesia use more frequently required an indwelling urinary catheter (P <.01) for a longer duration (P =.02), with no difference in total opioid utilization (P =.77) compared to patients without neuraxial anesthesia. Postoperative LOS was unaffected by avoidance of routine NGT use (P =.68) or use of neuraxial anesthesia (P =.89). Conclusion: Children undergoing open resection of abdominal HR-NB initiated diet sooner when an NGT was not left postoperatively, and the need for a urinary catheter was significantly higher in patients who received neuraxial anesthesia. However, these two ERP components did not decrease postoperative LOS. To optimize the postoperative management of NB patients, postoperative NGTs should be avoided, while the benefit of neuraxial anesthesia is less clear as it necessitates the placement of a urinary catheter without decreasing opioid utilization. [ABSTRACT FROM AUTHOR]

Diversification of woody plant lineages in New Zealand has unfolded in complex physiographic, climatic, and environmental contexts. Many tree and shrub lineages have existed in New Zealand since the late Cenozoic when Forest was the dominant biome, subsequently diversifying (or continuing to diversify) during the Pliocene/Pleistocene as Open (below treeline) and Alpine biomes emerged. We examine the links between biomes occupied, traits, and diversification. In particular, whether traits are phylogenetically conserved or ecologically constrained and their relationship to biomes occupied. We focus on Melicytus, Myrsine and Pseudopanax which occur across Forest, Open, and Alpine biomes. Our approach combines measured traits and modelled niche traits of extant species to examine the importance of biome occupancy and biome shifts on trait evolution in these lineages. Our results demonstrate trait values are filtered by biomes in these lineages and can predict biomes occupied. However, few biome shifts were associated with trait evolution, typically only biome shifts into extreme environments (Alpine) involved trait innovations. In addition to biomes, trait evolution can also be influenced by species age, trait lability and broad climatic change. Integrating functional traits in a phylogenetic framework can identify how evolutionary and ecological features create modern biogeographic patterns in New Zealand. [ABSTRACT FROM AUTHOR]