Financial Well-Being for Thoracic Surgeons.

The authors provide a brief overview for thoracic surgeons in topics essential to achieving financial well-being as a student, trainee, practicing surgeon, and beyond. While broad in nature, the authors' article is comprehensive, and they cover topics including student loans, asset and wealth management, investment opportunities, financial and estate planning, and insurances. It is hoped that the information provided will allow thoracic surgeons to become more familiar with the financial topics that pertain to thoracic surgeons and provide an introduction to explore financial wellness and literacy more thoroughly.

Key to the North American tribes and genera of herb, rose, bramble, and inquiline gall wasps (Hymenoptera, Cynipoidea, Cynipidaesensu lato).

Robust keys exist for the family-level groups of Cynipoidea. However, for most regions of the world, keys to genera are not available. To address this gap as it applies to North America, a fully illustrated key is provided to facilitate identification of the tribes and genera of rose gall, herb gall, and inquiline gall wasps known from the region. For each taxon covered, a preliminary diagnosis and an updated overview of taxonomy, biology, distribution, and natural history are provided.

Validation of a severe acute respiratory syndrome coronavirus 2 microneutralization assay for evaluation of vaccine immunogenicity.

As variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue to emerge, assessment of vaccine immunogenicity remains a critical factor to support continued vaccination. To this end, an in vitro microneutralization (MN50) assay was validated to quantitate SARS-CoV-2 neutralizing antibodies against prototype and variant strains (Beta, Delta, Omicron BA.1, Omicron BA.5, and XBB.1.5) in human serum. For the prototype strain, the MN50 assay met acceptance criteria for inter-/intra-assay precision, specificity, linearity, and selectivity. The assay was robust against changes to virus/serum incubation time, cell seeding density, virus content per well, cell passage number, and serum interference. Analyte in serum samples was stable up to five freeze/thaw cycles and for up to 12 months of storage at -80 ± 10 °C. Similar results were observed for the variant-adapted MN50 assays. The conversion factor to convert assay result units to WHO international standard units (IU/mL) was determined to be 0.62 for the prototype strain. This MN50 assay will be useful for vaccine immunogenicity analyses in clinical trial samples, enabling assessment of vaccine immunogenicity for ancestral and variant strains as variant-adapted vaccines are developed.

First report of a post-pneumonectomy nocardia empyema.

Post-pneumonectomy empyema (PPE) is an uncommon but serious complication that carries significant therapeutic challenges. We present a late-onset PPE due to Nocardia nova in an immunocompetent individual. Nine years after a right pneumonectomy for non-small cell lung cancer, surveillance scans revealed new right pleural thickening and FDG avidity concerning for recurrence. Thoracoscopic pleural biopsies were negative for malignancy, but tissue cultures grew N. nova. Nocardia empyema is rare with few reported cases. Most occur in immunocompromised hosts, and all were associated with pulmonary or disseminated nocardiosis. Our case describes the first report of a PPE secondary to Nocardia.

Diagnosing the Electrostatic Shielding Mechanism for Dendrite Suppression in Aqueous Zinc Batteries.

Aqueous zinc electrolytes offer the potential for cheaper rechargeable batteries due to their safe compatibility with the high capacity metal anode; yet, they are stymied by irregular zinc deposition and consequent dendrite growth. Suppressing dendrite formation by tailoring the electrolyte is a proven approach from lithium batteries; yet, the underlying mechanistic understanding that guides such tailoring does not necessarily directly translate from one system to the other. Here, it is shown that the electrostatic shielding mechanism, a fundamental concept in electrolyte engineering for stable metal anodes, has different consequences for the plating morphology in aqueous zinc batteries. Operando electrochemical transmission electron microscopy is used to directly observe the zinc nucleation and growth under different electrolyte compositions and reveal that electrostatic shielding additive suppresses dendrites by inhibiting secondary zinc nucleation along the (100) edges of existing primary deposits and encouraging preferential deposition on the (002) faces, leading to a dense and block-like zinc morphology. The strong influence of the crystallography of Zn on the electrostatic shielding mechanism is further confirmed with Zn||Ti cells and density functional theory modeling. This work demonstrates the importance of considering the unique aspects of the aqueous zinc battery system when using concepts from other battery chemistries.

Differing structures of galactoglucomannan in eudicots and non-eudicot angiosperms.

The structures of cell wall mannan hemicelluloses have changed during plant evolution. Recently, a new structure called ß-galactoglucomannan (ß-GGM) was discovered in eudicot plants. This galactoglucomannan has ß-(1,2)-Gal-α-(1,6)-Gal disaccharide branches on some mannosyl residues of the strictly alternating Glc-Man backbone. Studies in Arabidopsis revealed ß-GGM is related in structure, biosynthesis and function to xyloglucan. However, when and how plants acquired ß-GGM remains elusive. Here, we studied mannan structures in many sister groups of eudicots. All glucomannan structures were distinct from ß-GGM. In addition, we searched for candidate mannan ß-galactosyltransferases (MBGT) in non-eudicot angiosperms. Candidate AtMBGT1 orthologues from rice (OsGT47A-VII) and Amborella (AtrGT47A-VII) did not show MBGT activity in vivo. However, the AtMBGT1 orthologue from rice showed MUR3-like xyloglucan galactosyltransferase activity in complementation analysis using Arabidopsis. Further, reverse genetic analysis revealed that the enzyme (OsGT47A-VII) contributes to proper root growth in rice. Together, gene duplication and diversification of GT47A-VII in eudicot evolution may have been involved in the acquisition of mannan ß-galactosyltransferase activity. Our results indicate that ß-GGM is likely to be a eudicot-specific mannan.

Synthesis of Li1.20Mn0.432+Nb0.39O2 disordered rock-salt under reducing conditions for Li-ion batteries.

A Mn2+-Li-Nb disordered rock-salt oxide cathode is prepared by a solid-state reaction under 5% H2/N2, and its electrochemical property shows a high voltage plateau at 4.8 V, with irreversible structural changes in the 1st cycle due to O redox processes; this is supported by powder X-ray diffraction and ex situ laboratory Mn K-edge XANES data.

An in vivo model of ligamentum flavum hypertrophy from early-stage inflammation to fibrosis.

Multi-joint disease pathologies in the lumbar spine, including ligamentum flavum (LF) hypertrophy and intervertebral disc (IVD) bulging or herniation contribute to lumbar spinal stenosis (LSS), a highly prevalent condition characterized by symptomatic narrowing of the spinal canal. Clinical hypertrophic LF is characterized by a loss of elastic fibers and increase in collagen fibers, resulting in fibrotic thickening and scar formation. In this study, we created an injury model to test the hypothesis that LF needle scrape injury in the rat will result in hypertrophy of the LF characterized by altered tissue geometry, matrix organization, composition and inflammation. An initial pilot study was conducted to evaluate effect of needle size. Results indicate that LF needle scrape injury using a 22G needle produced upregulation of the pro-inflammatory cytokine Il6 at 1 week post injury, and increased expression of Ctgf and Tgfb1 at 8 weeks post injury, along with persistent presence of infiltrating macrophages at 1, 3, and 8 weeks post injury. LF integrity was also altered, evidenced by increases in LF tissue thickness and loss of elastic tissue by 8 weeks post injury. Persistent LF injury also produced multi-joint effects in the lumbar IVD, including disc height loss at the injury and adjacent to injury level, with degenerative IVD changes observed in the adjacent level. These results demonstrate that LF scrape injury in the rat produces structural and molecular features of LF hypertrophy and IVD height and histological changes, dependent on level. This model may be useful for testing of therapeutic interventions for treatment of LSS and IVD degeneration associated with LF hypertrophy.

The biosynthesis, degradation, and function of cell wall ß-xylosylated xyloglucan mirrors that of arabinoxyloglucan.

Xyloglucan is an abundant polysaccharide in many primary cell walls and in the human diet. Decoration of its α-xylosyl sidechains with further sugars is critical for plant growth, even though the sugars themselves vary considerably between species. Plants in the Ericales order - prevalent in human diets - exhibit ß1,2-linked xylosyl decorations. The biosynthetic enzymes responsible for adding these xylosyl decorations, as well as the hydrolases that remove them in the human gut, are unidentified. GT47 xyloglucan glycosyltransferase candidates were expressed in Arabidopsis and endo-xyloglucanase products from transgenic wall material were analysed by electrophoresis, mass spectrometry, and nuclear magnetic resonance (NMR) spectroscopy. The activities of gut bacterial hydrolases BoGH43A and BoGH43B on synthetic glycosides and xyloglucan oligosaccharides were measured by colorimetry and electrophoresis. CcXBT1 is a xyloglucan ß-xylosyltransferase from coffee that can modify Arabidopsis xyloglucan and restore the growth of galactosyltransferase mutants. Related VmXST1 is a weakly active xyloglucan α-arabinofuranosyltransferase from cranberry. BoGH43A hydrolyses both α-arabinofuranosylated and ß-xylosylated oligosaccharides. CcXBT1's presence in coffee and BoGH43A's promiscuity suggest that ß-xylosylated xyloglucan is not only more widespread than thought, but might also nourish beneficial gut bacteria. The evolutionary instability of transferase specificity and lack of hydrolase specificity hint that, to enzymes, xylosides and arabinofuranosides are closely resemblant.

Semaphorins and Their Roles in Breast Cancer: Implications for Therapy Resistance.

Breast cancer is the most common cancer worldwide and a leading cause of cancer-related deaths in women. The clinical management of breast cancer is further complicated by the heterogeneous nature of the disease, which results in varying prognoses and treatment responses in patients. The semaphorins are a family of proteins with varied roles in development and homoeostasis. They are also expressed in a wide range of human cancers and are implicated as regulators of tumour growth, angiogenesis, metastasis and immune evasion. More recently, semaphorins have been implicated in drug resistance across a range of malignancies. In breast cancer, semaphorins are associated with resistance to endocrine therapy as well as breast cancer chemotherapeutic agents such as taxanes and anthracyclines. This review will focus on the semaphorins involved in breast cancer progression and their association with drug resistance.

Delayed cardiac tamponade secondary to blast injury from gunshot wound.

Penetrating injuries are recognized for the direct tissue damage, which is typically evident on physical examination. Secondary injuries resulting from kinetic energy transfer in the case of gunshot wounds (GSWs), often referred to as "blast injuries", may affect tissues distant to the ballistic trajectory and are often occult. We present a case of delayed cardiac tamponade resulting from secondary blast injury. The patient sustained a thoraco-abdominal GSW with entry adjacent to the cardiac box. An Advanced Trauma Life Support (ATLS)-guided assessment revealed intra-abdominal injuries necessitating operative intervention without evidence of cardiac injury. On post-operative day four, the patient developed chest pain, tachycardia, and shortness of breath. Imaging revealed a large pericardial effusion with cardiac tamponade. Emergent exploration revealed hemopericardium secondary to a bleeding epicardial hematoma without evidence of pericardial violation. Clinicians must maintain a high clinical suspicion for occult, indirect blast injuries which may be life-threatening.

Sub-two-cycle gigawatt-peak-power LWIR OPA for ultrafast nonlinear spectroscopy of condensed state materials.

The application of high-power, few-cycle, long-wave infrared (LWIR, 8-20 µm) pulses in strong-field physics is largely unexplored due to the lack of suitable sources. However, the generation of intense pulses with >6 µm wavelength range is becoming increasingly feasible with the recent advances in high-power ultrashort lasers in the middle-infrared range that can serve as a pump for optical parametric amplifiers (OPA). Here we experimentally demonstrate the feasibility of this approach by building an OPA pumped at 2.4 µm that generates 93 µJ pulses at 9.5 µm, 1 kHz repetition rate with sub-two-cycle pulse duration, 1.6 GW peak power, and excellent beam quality. The results open a wide range of applications in attosecond physics (especially for studies of condensed phase samples), remote sensing, and biophotonics.

An investigation of patch occupancy and dispersal by third to final instar nymphs of Brachytrupes megacephalus Lefèbvre, 1827 (Orthoptera: Gryllidae: Gryllinae) across the sand dune biotope at the Ghadira Nature Reserve, Malta.

Dispersal patterns of third, fourth and fifth instar nymphs of the stenoecious gryllid, Brachytrupes megacephalus (Lefèbvre, 1827), are investigated on the sand dune within the Ghadira Nature Reserve, a remnant habitat patch forming part of the core area that supports the largest population of the species in Malta. Field investigations were carried out over a period of 11 weeks during a specific 75 minute time window, when nymphs are known to engage in subaerial activity at the mouth of their respective burrow. Climatic variables are examined in relation to abundance, while dispersal patterns are presented. The study shows that the predominant movement of nymphs across the terrain is northward, mainly to the northwest and the north-northeast. The present contribution also provides a summary of recommendations for conservation of the species, including an interdisciplinary approach to habitat management at multiple spatial scales.

High-order harmonic generation from a thin film crystal perturbed by a quasi-static terahertz field.

Studies of laser-driven strong field processes subjected to a (quasi-)static field have been mainly confined to theory. Here we provide an experimental realization by introducing a bichromatic approach for high harmonic generation (HHG) in a dielectric that combines an intense 70 femtosecond duration mid-infrared driving field with a weak 2 picosecond period terahertz (THz) dressing field. We address the physics underlying the THz field induced static symmetry breaking and its consequences on the efficient production/suppression of even-/odd-order harmonics, and demonstrate the ability to probe the HHG dynamics via the modulation of the harmonic distribution. Moreover, we report a delay-dependent even-order harmonic frequency shift that is proportional to the time derivative of the THz field. This suggests a limitation of the static symmetry breaking interpretation and implies that the resultant attosecond bursts are aperiodic, thus providing a frequency domain probe of attosecond transients while opening opportunities in precise attosecond pulse shaping.

Evaluation of remote digital postoperative wound monitoring in routine surgical practice.

Remote digital postoperative wound monitoring provides an opportunity to strengthen postoperative community care and minimise the burden of surgical-site infection (SSI). This study aimed to pilot a remote digital postoperative wound monitoring service and evaluate the readiness for implementation in routine clinical practice. This was a single-arm pilot implementational study of remote digital postoperative wound monitoring across two tertiary care hospitals in the UK (IDEAL stage 2b, clinicaltrials.gov: NCT05069103). Adults undergoing abdominal surgery were recruited and received a smartphone-delivered wound assessment tool for 30-days postoperatively. Patients received 30-day postoperative follow-up, including the Telehealth Usability Questionnaire (TUQ). A thematic mixed-methods approach was used, according to the WHO framework for monitoring and evaluating digital health interventions. 200 patients were enroled, of whom 115 (57.5%) underwent emergency surgical procedures. Overall, the 30-day SSI rate was 16.5% (n = 33/200), with 72.7% (n = 24) diagnosed post-discharge. Usage of the intervention was 83.0% (n = 166/200), with subsequently 74.1% (n = 123/166) TUQ completion. There were no issues reported with feasibility of the technology, with the reliability (3.87, 95% CI: 3.73-4.00) and quality of the interface rated highly (4.18, 95%: 4.06-4.30). Patient acceptance was similarly high with regards to ease of use (4.51, 95% CI: 4.41-4.62), satisfaction (4.27, 95% CI: 4.13-4.41), and usefulness (4.07, 95% CI: 3.92-4.23). Despite the desire for more frequent and personalised interactions, the majority viewed the intervention as providing meaningful benefit over routine postoperative care. Remote digital postoperative wound monitoring successfully demonstrated readiness for implementation with regards to the technology, usability, and healthcare process improvement.

A new subspecies of Papilio saharae Oberthür, 1879 (Lepidoptera: Papilionidae) from Lampedusa, Italy.

An investigation into the only representative of the genus Papilio on the island of Lampedusa, the largest island of the Pelagian group, was conducted as part of a broader Mediterranean-wide study on the machaon complex. Over a three-year period, adults, larvae and ova were collected for further research during field visits, while an in-house breeding programme involving wild-collected gravid females was initiated with a view to examine an adequately sized series of specimens. A total of 38 adults, including 23 male specimens, >150 ova, 233 larvae, and 220 pupae were examined. In addition to a thorough morphometric assessment, statistical tests were performed using one-way ANOVA and multivariate analysis. Results demonstrate morphological characters of P. saharae and, to a lesser degree, of P. machaon, suggesting that the taxon is plausibly the outcome of a hybrid swarm whose occurrence on the island was facilitated by Pleistocene lowstands (when the island was physically connected with the north African continental landmass, the taxon's centre of origin). Based on results, involving all four stages of metamorphosis, it is proposed to 'anchor' the taxon to Papilio saharae Oberthür, 1879 and assign it subspecific status, aferpilaggi ssp. nov.

Reproductive response of crossbred Bos taurus × Bos indicus cows to biostimulation by pre-pubertal and pubertal teasers.

Although the beneficial effect of biostimulation on reproduction has been reported, the influence of selectivity and social factors on the response to biostimulation has not received sufficient research attention in both Bos indicus and Bos indicus influenced cattle. Furthermore, 'green and cheap' strategies to improve cattle reproduction are currently in demand while Bos indicus influenced cattle with inferior reproductive performance, and farmers with economic limitations are common in tropical zones. Hence, to assess the reproductive response of crossbred taurus × indicus cows to biostimulation by pre-pubertal (PPM) or pubertal (PM) teasers males, two trials of 2 years each were conducted. Trial 1 n = 187 cows (Year 1:85 cows exposed to PPM and Year 2:102 cows exposed to PM). Trial 2 n = 196 cows (Year 1:101 cows exposed to PPM and Year 2:95 cows exposed to PM). The effect of exposing cows to PPM and PM on the intervals calving to first service (ICFS), calving to conception (ICC) and economic cost of days open (ECDO) was analysed using Kruskal-Wallis ANOVA and the effect of exposing cows to PPM and to PM on reproductive status at 90 days (RS90) and proportion of cows requiring hormonal protocols (PRH) was compared using χ2 analysis. Both ICFS and ICC were shorter (p < .0001) for PM-exposed females (96.12 ± 4.1 and 110.93 ± 2.9 days; respectively) compared with those PPM-exposed (134.41 ± 3.3 and 135.64 ± 2.4 days; respectively). With RS90, more (p < .0001) PM-exposed cows (50.7%) were pregnant compared with PPM-exposed cows (16.1%). The PRH was greater (p < .0001) in PPM-exposed cows (79.0%) compared with PM-exposed (27.9%). The ECDO was less (p < .0001) in PM-exposed cows (US$ 142.9 ± 3.8) compared with PPM-exposed (US$ 176.3 ± 2.9). In conclusion, cows exposed to PM had shorter ICFS and ICC compared with cows exposed to PPM. More cows exposed to PM were pregnant after 90 days, and PRH was less than cows exposed to PPM. Cows exposed to PM had a reduced ECDO than those exposed to PPM.

Resorbable Bioinductive Collagen Implant Is Cost Effective in the Treatment of Rotator Cuff Tears.

Purpose: This study was conducted to investigate whether the use of resorbable bioinductive collagen implant (RBI) in addition to conventional rotator cuff repair (conventional RCR) is cost-effective when compared to conventional RCR alone, in the treatment of full-thickness rotator cuff tears (FT RCT). Methods: We developed a decision analytic model to compare the expected incremental cost and clinical consequences for a cohort of patients with FT RCT. The probabilities for healing or failure to heal (retear) were estimated from the published literature. Implant and healthcare costs were estimated from a payor's perspective in 2021 U.S. prices. An additional analysis included indirect cost estimations (e.g., productivity losses). Sensitivity analyses explored the effect of tear size, as well as the impact of risk factors. Results: The base case analysis demonstrated that resorbable bioinductive collagen implant + conventional rotator cuff repair results in incremental costs of $232,468 and an additional 18 healed RCTs per 100 treated patients over 1 year. The estimated incremental cost-effectiveness ratio (ICER) is $13,061/healed RCT compared to conventional RCR alone. When return to work was included in the model, RBI + conventional RCR was found to be cost saving. Cost-effectiveness improved with tear size with the largest benefit seen in massive tears compared to large tears, as well as patients at higher risk of retearing. Conclusions: This economic analysis demonstrated that RBI + conventional RCR delivered improved healing rates at a marginal increase in costs when compared to conventional RCR alone and is, therefore, cost-effective in this patient population. Considering indirect costs, RBI + conventional RCR resulted in lower costs compared to conventional RCR alone and is, therefore, deemed to be cost saving. Level of Evidence: Level IV, economic analysis.

Diverse mechanisms of polysaccharide biosynthesis, assembly and secretion across kingdoms.

Polysaccharides are essential biopolymers produced in all kingdoms of life. On the cell surface, they represent versatile architectural components, forming protective capsules and coats, cell walls, or adhesives. Extracellular polysaccharide (EPS) biosynthesis mechanisms differ based on the cellular localization of polymer assembly. Some polysaccharides are first synthesized in the cytosol and then extruded by ATP powered transporters [1]. In other cases, the polymers are assembled outside the cell [2], synthesized and secreted in a single step [3], or deposited on the cell surface via vesicular trafficking [4]. This review focuses on recent insights into the biosynthesis, secretion, and assembly of EPS in microbes, plants and vertebrates. We focus on comparing the sites of biosynthesis, secretion mechanisms, and higher-order EPS assemblies.