It is not always chlorhexidine: Identification of benzoxonium chloride and lauramine oxide as culprit allergens in a popular antiseptic in Switzerland.

BACKGROUND: A popular antiseptic spray in Switzerland (Merfen spray), containing chlorhexidine digluconate, benzoxonium chloride and lauramine oxide, is frequently used to treat skin wounds. However, it is also increasingly reported as a major cause of adverse skin reactions, including allergic contact dermatitis (ACD). OBJECTIVES: To investigate the contact allergens responsible for ACD from this antiseptic. PATIENTS/METHODS: Patch tests were performed on seven patients with a clinical history compatible with contact dermatitis from this antiseptic mixture. RESULTS: All patients presented with acute eczematous reactions following contact with either Merfen spray alone, or with multiple products including this spray. Patients showed positive reactions to this product in both patch tests and repeated open application tests (ROATs). Four patients showed dose-dependent reactions to both benzoxonium chloride and lauramine oxide. One patient showed a dose-dependent reaction to the former and a non-dose-dependent reaction to the latter. Finally, two subjects showed responses only to lauramine oxide. One patient reacted to chlorhexidine digluconate 0.5% aq. in addition to both other allergens. CONCLUSIONS: Two commercially unavailable allergens, that is, benzoxonium chloride and/or lauramine oxide were identified as major causes of ACD from Merfen antiseptic spray, whereas chlorhexidine digluconate was a contributing culprit in only one patient.

Suicidality in family caregivers of people with long-term illnesses and disabilities: A scoping review.

An emerging body of international research suggests family caregivers may be a high-risk group for suicide, but the evidence has not been synthesised. Forty-eight peer-reviewed journal articles were included in this review, spanning low-, middle-, and high-income countries and a variety of illnesses and disabilities. The proportion of caregivers experiencing suicidal ideation ranged from 2.7% to 71%, with evidence of suicide attempts, deaths by suicide, and deaths by homicide-suicide also reported. Risk and protective factors varied across studies and there was little consideration of differences by caregiving relationship, type of illness/disability, or country. There is sufficient evidence to warrant concern for caregivers around the world and prompt action in policy and practice, but more rigorous research is required to draw clear, nuanced conclusions about risk and inform evidence-based prevention and intervention.

Black spot gill syndrome in the northern shrimp, Pandalus borealis, caused by the parasitic ciliate Synophrya sp.

Black spot gill syndrome in the northern shrimp, Pandalus borealis, is caused by an apostome ciliate, Synophrya sp., found within the gill lamellae. Whole mount staining, thin section histology, electron microscopy, and molecular studies were carried out on infected gills. The Synophrya 18S rRNA from Pandalus borealis (Genbank accession no. KX906568) and from two portunid crab species, Achelous spinimanus (Genbank accession no. MH395150) and Achelous gibbesii (Genbank accession no. MH395151) was sequenced. Phylogenetic analyses confirmed the identity of these ciliates as apostomes. The 18S rRNA sequence recovered from P. borealis shared 95% nucleotide similarity with the sequences recovered from the portunid crab species suggesting that it is a different species of Synophrya. The invasive hypertrophont stages, with a distinctive macronuclear reticulum, ranged in size from 300 to 400 µm with as many as 5 large forms/mm2 of gill tissue. Histotrophic hypertrophont stages and hypertomont stages were observed in these studies. The presence of the parasite was linked to the formation of melanized nodules (up to 9 nodules/mm2 of gill tissue) by the host and in some cases to extensive necrosis. Other studies have reported Synophrya sp. infections in P. borealis from Greenland, Labrador and Newfoundland, but further studies are necessary to determine the prevalence of this parasite in the dense schools of northern shrimp in the North Atlantic. Questions remain as to the possibility of epizootics of this pathogen and its impact on northern shrimp populations.

Renal Medullary Carcinoma and Sickle Cell Trait: A Push for Early Diagnosis and Intervention Report of Two Cases.

Renal medullary carcinoma (RMC) is a rare but highly aggressive neoplasm that primarily affects young African Americans with sickle cell trait. Most patients present with macroscopic hematuria and have metastases at diagnosis. Chemotherapy, biologics directed against the more common renal cell carcinomas and radiation have all shown limited efficacy in treating patients with advanced RMC. We report two patients with RMC. Both had Stage IV disease. One underwent radical nephrectomy followed by radiation and biologic drug therapy but died five months later; the other underwent multiple cycles of chemotherapy plus anti-angiogenesis treatment but died 15 months after diagnosis. Review of the literature suggests that early diagnosis and surgical intervention while the tumor is confined to the kidney offer the best prospect for long term survival. Since newborn screening for sickle cell is now mandated in the US, the at-risk population for RMC could be identified and followed by yearly urine dipstick testing for microscopic hematuria. Those who test positive can be further evaluated to rule out RMC.

Illuminating Firefly Diversity: Trends, Threats and Conservation Strategies.

Fireflies are a diverse group of bioluminescent beetles belonging to the family Lampyridae. Recent research on their diversity, evolution, behavior and conservation has greatly advanced our scientific understanding of these charismatic insects. In this review, we first summarize new discoveries about their taxonomic and ecological diversity, then focus on recent endeavors to identify and protect threatened fireflies around the world. We outline the main threats linked to recent population declines (habitat loss and degradation, light pollution, pesticide overuse, climate change and tourism) and describe relevant risk factors that predict which species will be particularly vulnerable to these threats. Although global coordination of firefly conservation efforts has begun only recently, considerable progress has already been made. We describe work by the IUCN SSC Firefly Specialist Group to identify species currently facing elevated extinction risks and to devise conservation strategies to protect them. To date, IUCN Red List assessments have been completed for 150 firefly taxa, about 20% of which face heightened extinction risks. The conservation status for many species has yet to be determined due to insufficient information, although targeted surveys and community science projects have contributed valuable new data. Finally, we highlight some examples of successful firefly habitat protection and restoration efforts, and we use the framework of the IUCN SSC Species Conservation Cycle to point out high-priority actions for future firefly conservation efforts.

Suicidal Thoughts and Behaviors in Parents Caring for Children with Disabilities and Long-Term Illnesses.

OBJECTIVE: There is a growing body of evidence on suicide risk in family carers, but minimal research on parents caring for children with disabilities and long-term illnesses. The aim of this study was to conduct the first dedicated research on suicide risk in parent carers and identify: (1) the number of parent carers experiencing suicidal thoughts and behaviors, and (2) the risk and protective factors for suicidality in this population. METHOD: A cross-sectional survey of parent carers in England (n = 750), co-produced with parent carers. Suicidal thoughts and behaviors were measured with questions from the Adult Psychiatric Morbidity Survey. Frequencies summarized the proportion of carers experiencing suicidal thoughts and behaviors. Logistic regressions identified risk and protective factors. RESULTS: 42% of parents had experienced suicidal thoughts and behaviors while caring for a disabled or chronically ill child. Only half had sought help for these experiences. Depression, entrapment, dysfunctional coping, and having a mental health diagnosis prior to caring, were significant risk factors. CONCLUSION: Parent carers contemplate suicide at levels that exceed those of other family carers and the general public. There is an urgent need, in policy and practice, to recognize parent carers as a priority group for prevention and intervention.

This is the first dedicated study of suicide risk in parent carers.More than 40% of parents had considered suicide while caring for a disabled or chronically ill child.The risk factors for suicidal ideation in parent carers were depression, entrapment, dysfunctional coping strategies, and having a mental health diagnosis prior to becoming a carer.Parent carers may be a high-risk group for suicide and need urgent support.

Cost-effectiveness of single-dose tamsulosin and dutasteride combination therapy compared with tamsulosin monotherapy in patients with benign prostatic hyperplasia in the UK.

OBJECTIVE: To estimate the long-term cost-effectiveness of single-dose dutasteride/tamsulosin combination therapy as a first-line treatment for benign prostatic hyperplasia (BPH) from the perspective of the UK National Health Service (NHS). METHODS: A Markov state transition model was developed to estimate healthcare costs and patient outcomes, measured by quality-adjusted life years (QALYs), for patients aged ≥50 years with diagnosed BPH and moderate to severe symptoms. Costs and outcomes were estimated for two treatment comparators: oral, daily, single-dose combination therapy (dutasteride 0.5 mg + tamsulosin 0.4 mg), and oral daily tamsulosin (0.4 mg) over a period up to 25 years. The efficacy of comparators was taken from results of the Combination of Avodart and Tamsulosin (CombAT) trial. RESULTS: Cumulative discounted costs per patient were higher with combination therapy than with tamsulosin, but QALYs were also higher. After 25 years, the incremental cost-effectiveness ratio for combination therapy was £12,219, well within the threshold range (£20,000-£30,000 per QALY) typically applied in the NHS. Probabilistic sensitivity analysis showed that the probability of combination therapy being cost-effective given the threshold range is between 78% and 88%. CONCLUSION: Single-dose combination dutasteride/tamsulosin therapy has a high probability of being cost-effective in comparison to tamsulosin monotherapy in the UK's NHS.

Plecanatide for the treatment of chronic idiopathic constipation and irritable bowel syndrome with constipation: Post hoc analyses of placebo-controlled trials in adults with severe constipation.

BACKGROUND: Patients with chronic idiopathic constipation (CIC) and irritable bowel syndrome with constipation (IBS-C) often experience severe symptoms. The current aim was to evaluate plecanatide in adults with CIC or IBS-C with severe constipation. METHODS: Data were analyzed post hoc from randomized, placebo-controlled trials (CIC [n = 2], IBS-C [n = 2]) of plecanatide 3 mg, 6 mg, or placebo administered for 12 weeks. Severe constipation was defined as no complete spontaneous bowel movements (CSBMs) and an average straining score ≥3.0 (CIC; 5-point scale) or ≥8.0 (IBS-C; 11-point scale) during a 2-week screening. Primary efficacy endpoints were durable overall CSBM responders (CIC: ≥3 CSBMs/week, plus increase from baseline of ≥1 CSBM/week, for ≥9 of 12 weeks, including ≥3 of the last 4 weeks) and overall responders (IBS-C: ≥30% reduction from baseline in abdominal pain and ≥1 CSBM/week increase for ≥6 of 12 weeks). KEY RESULTS: Severe constipation was observed in 24.5% (646/2639) and 24.2% (527/2176) of CIC and IBS-C populations, respectively. The CIC durable overall CSBM response rate (plecanatide 3 mg, 20.9%; plecanatide 6 mg, 20.2%; placebo, 11.3%) and IBS-C overall response rate (plecanatide 3 mg, 33.0%; plecanatide 6 mg, 31.0%; placebo, 19.0%) were significantly greater with plecanatide versus placebo (p ≤ 0.01 for all). Median time to first CSBM in CIC and IBS-C populations were significantly shorter with plecanatide 3 mg versus placebo (p = 0.01 for both). CONCLUSIONS AND INFERENCES: Plecanatide was effective in the treatment of severe constipation in adults with CIC or IBS-C.

Toxin-antitoxin loci vapBC-1 and vapXD contribute to survival and virulence in nontypeable Haemophilus influenzae.

BACKGROUND: Nontypeable Haemophilus influenzae (NTHi) is a significant human pathogen responsible for respiratory tract infections and the most common cause of recurrent otitis media. Type II toxin-antitoxin (TA) systems are genetic elements that code for a stable protein toxin and a labile antitoxin that are thought to be involved in metabolic regulation of bacteria by enabling a switch to a dormant state under stress conditions. The contribution to infection persistence of the NTHi TA loci vapBC-1 and vapXD was examined in this study. RESULTS: Deletions in vapBC-1, vapXD and vapBC-1 vapXD significantly decreased the survival of NTHi co-cultured with primary human respiratory tissue at the air-liquid interface and in the chinchilla model of otitis media. The TA deletions did not affect the growth dynamics of the mutants in rich media, their ultra-structural morphology, or display appreciable synergy during NTHi infections. The toxin and antitoxin proteins of both pairs heterodimerized in vivo. Consistent with our previous findings regarding the VapC-1 toxin, the NTHi VapD toxin also displayed ribonuclease activity. CONCLUSIONS: We conclude that the vapBC-1 and vapXD TA loci enhance NTHi survival and virulence during infection in vitro and in vivo using a mechanism of mRNA cleavage, and that these conserved TA pairs represent new targets for the prophylaxis and therapy of otitis media and other NTHi-caused mucosal diseases.

What Is the Relation between Circular Economy and Sustainability? Answers from Frontrunner Companies Engaged with Circular Economy Practices.

The circular economy (CE) concept has become a major interest for companies, promising new business opportunities and a decrease in environmental impacts. Though research on circular business models has recently increased, few scholars have investigated how companies engaged with CE view the connection between CE and sustainability. To address this gap, this paper uses a semi-quantitative survey and semi-structured interviews conducted with companies based in Italy and the Netherlands. Purposive sampling was employed to target firms associated with national and international CE networks, as these companies already engage with CE practices. The survey was distributed online to over 800 firms, of which 155 provided information on their understanding of the CE concept and its relationship with sustainability. The survey results are complemented through findings from 43 interviews with a subset of the survey respondents. The survey answers show that companies view CE as one of the tools to achieve sustainable development, particularly in the environmental domain, where the focus lies on environmentally friendly resource use. Yet, the respondents are less confident whether CE increases economic and social benefits of firms. Interviews show that a majority of respondents position sustainability as the overarching concept. However, most companies advocate that the private sector should strive for both sustainability and circularity, though the distinction between the two concepts in daily business operations seems synthetic and futile to some. These findings provide an important stepping stone for better understanding how firms could apply CE practices to move towards a more sustainable society.

Evaluating firefly extinction risk: Initial red list assessments for North America.

Fireflies are a family of charismatic beetles known for their bioluminescent signals. Recent anecdotal reports suggest that firefly populations in North America may be in decline. However, prior to this work, no studies have undertaken a systematic compilation of geographic distribution, habitat specificity, and threats facing North American fireflies. To better understand their extinction risks, we conducted baseline assessments according to the categories and criteria of the International Union for Conservation of Nature (IUCN) Red List for 132 species from the United States and Canada (approximately 79% of described species in the region). We found at least 18 species (14%) are threatened with extinction (e.g. categorized as Critically Endangered, Endangered, or Vulnerable) due to various pressures, including habitat loss, light pollution, and climate change (sea level rise and drought). In addition, more than half of the species (53%) could not be evaluated against the assessment criteria due to insufficient data, highlighting the need for further study. Future research and conservation efforts should prioritize monitoring and protecting populations of at-risk species, preserving and restoring habitat, gathering data on population trends, and filling critical information gaps for data deficient species suspected to be at risk.

Morphologic effects of in vivo acute exposure to the pesticide methoprene on the hepatopancreas of a non-target organism, Homarus americanus.

Methoprene is a pesticide widely used for mosquito control. It is an endocrine disruptor, acting as an analog of juvenile hormone. While targeting insect larvae, it also impacts non-target animals including crustaceans. Anecdotal reports suggested that methoprene has unintended effects on adult arthropods. Earlier, we documented effects in adult lobsters at the metabolic and gene expression levels. In this study we have documented morphologic corollaries to our prior observations. We examined the light and electron microscopic changes in the hepatopancreas of adult lobsters following in vivo acute exposure to methoprene. Changes by light and electron microscopy levels were evident following exposure to sub-lethal concentrations of methoprene for 24h. Tissue from exposed animals showed the formation of extensive cytoplasmic spaces (vesiculation) with disruption and loss of specific subcellular organelles. The findings provide morphologic correlates to the metabolic and genomic alterations we have observed in previous investigations.

Hyalophysa lynni n. sp. (Ciliophora, Apostomatida), a new pathogenic ciliate and causative agent of shrimp black gill in penaeid shrimp.

The parasitic ciliate causing shrimp black gill (sBG) infections in penaeid shrimp has been identified. The sBG ciliate has a unique life cycle that includes an encysted divisional stage on the host's gills. The ciliature of the encysted trophont stage has been determined and is quite similar to that of the closely related apostomes Hyalophysa bradburyae and H. chattoni. Hyalophysa bradburyae is a commensal ciliate associated with freshwater caridean shrimp and crayfish, while H. chattoni is a common commensal found on North American marine decapods. Based on 18S rRNA gene sequence comparisons, the sBG ciliate is more closely related to the marine species H. chattoni than to the freshwater species H. bradburyae. The unique life cycle, morphology, 18S rRNA gene sequence, hosts, location, and pathology of the sBG ciliate distinguish this organism as a new species, Hyalophysa lynni n. sp.

Transmission of the parasitic dinoflagellate Hematodinium sp. infection in blue crabs Callinectes sapidus by cannibalism.

Infection with the parasitic dinoflagellate Hematodinium sp. can be devastating to blue crab Callinectes sapidus populations. Morbidity and mortality appear to depend on the burden of parasitic organisms. Heavily infected crabs become lethargic and, if not preyed upon, succumb to overwhelming infection. We report on the transmission of Hematodinium sp. into blue crabs that were fed pieces of infected tissues and examined for evidence of infection at time periods from 1 to 48 h and for the general state of their health after 4 d. During the first 16 h after feeding, Hematodinium sp. was found in the gut, followed by large increases in hemolymph hemocytes and the appearance of hemocytic nodules in tissues. By 16 h, the hemocytic nodules appeared poorly circumscribed and disorganized. No nodules were seen in a heavily infected crab after 24 h. By the end of the 48 h after feeding, 73% (11 of 15) of the crabs had shown evidence of infection with Hematodinium sp. Those crabs with infection intensities (Hematodinium sp. as percent of cells in hemolymph) higher than 20% were dead within 4 d.

Cutaneous Rosai-Dorfman disease of the forearm: case report.

Sinus histiocytosis with massive lymphadenopathy, also known as Rosai-Dorfman disease (RDD), is a rare non-neoplastic pathologic condition that frequently pursues a prolonged clinical course marked by exacerbations and remissions. Cutaneous RDD is even less common than cases involving lymph nodes. We present the case of a patient with long-standing Crohn's disease who developed cutaneous RDD in the forearm.

The utilization of lipovitellin during blue crab (Callinectes sapidus) embryogenesis.

Embryos of the blue crab Callinectes sapidus develop in egg sacs carried on the abdomen of the female. They develop over a period of 10-13 days at 28 degrees C and are nutritionally dependent on yolk until they emerge from the egg sacs as free-swimming zoeae. The principal component of blue crab yolk is lipovitellin (LpII), a water-soluble lipoprotein composed of approximately equal amounts of lipid and protein. We followed changes in the concentration of apoproteins of LpII during embryogenesis by ELISA and Western blots, using monoclonal antibodies against two LpII apoprotein associated peptides identified as Protein A (107 kDa) and Protein B (75 kDa). During embryogenesis there was a decrease in Protein B but an increase in two smaller peptides (52 and 35 kDa) that reacted with the Protein B antibody. Utilization of LpII during embryogenesis was also followed morphologically by immunohistochemistry. Utilization of LpII was slow in early embryonic stages, followed by rapid utilization in late embryonic stages, such that only traces of LpII were present at the end of embryogenesis. The cells of the developing hepatopancreas appear to play an important role in the utilization of LpII.

Effect of trotting velocity on work patterns of the hind limbs of Greyhounds.

OBJECTIVE: To quantify the effects of trotting velocity on joint angular excursions, net joint moments, and powers across the hind limb joints in Greyhounds. ANIMALS: 5 healthy Greyhounds with no history of lameness of the hind limbs. PROCEDURES: Small reflective markers were applied to the skin over the joints of the hind limbs, and a 4-camera kinematic system was used to record positional data at 200 Hz in tandem with force platform data while the dogs trotted on a runway at slow, medium, and fast velocities. Breed-specific morphometric data were combined with kinematic and force data in an inverse-dynamics solution for net joint moments and powers at the hip, stifle, tarsal, and metatarsophalangeal joints. RESULTS: Angle, moment, and power patterns at the various joints were conserved among the 3 velocities. With increasing velocity, moments and powers at the tarsal, stifle, and hip joints during the stance phase were increased in amplitude, whereas amplitudes during the swing phase were not. The main contributors to increased velocity were the hip extensors and stifle flexors during the early part of the stance phase and the tarsal extensors during the late part of the stance phase. CONCLUSIONS AND CLINICAL RELEVANCE: Increases in trotting velocity in Greyhounds do not alter the basic patterns of work and power for various joints of the hind limbs, but local burst amplitudes during the stance phase increase incrementally.