Local intensity of artisanal gold mining drives mercury accumulation in neotropical oxbow lake fishes.

Driven by surges in global gold prices and additional socio-economic factors, artisanal small-scale gold mining (ASGM) in the Global South is increasing and driving emissions of significant quantities of mercury (Hg) into the air and freshwater. Hg can be toxic to animal and human populations and exacerbate the degradation of neotropical freshwater ecosystems. We examined drivers of Hg accumulation in fish that inhabit oxbow lakes of Peru's Madre de Dios, a region with high biodiversity value and increasing human populations that depend on ASGM. We hypothesized that fish Hg levels would be driven by local ASGM activities, by environmental Hg exposure, by water quality, and by fish trophic level. We sampled fish in 20 oxbow lakes spanning protected areas and areas subject to ASGM during the dry season. Consistent with previous findings, Hg levels were positively associated with ASGM activities, and were higher in larger, carnivorous fish and where water had lower dissolved oxygen levels. In addition, we found a negative relationship between fish mercury levels associated with ASGM and the occurrence of the piscivorous giant otter. The link between fine-scale quantification of spatial ASGM activity and Hg accumulation, as indicated by the result that in the lotic environment, localized effects of gold mining activities are stronger drivers (77 % model support) of Hg accumulation than environmental exposure (23 %) constitutes a novel contribution to a growing body of literature on Hg contamination. Our findings provide additional evidence of high Hg exposure risks to neotropical human and top carnivore populations subject to the impacts of ASGM, which depend on freshwater ecosystems undergoing gradual degradation. The documented spatial variation in Hg accumulation and increased Hg levels in carnivorous fish should serve as a warning to human communities in Madre de Dios to avoid the proximity of high-intensity gold mining areas and minimize local carnivorous fish consumption.

Evidence-Based Consensus Guidelines Series for MicroPulse Transscleral Laser Therapy - Surgical Technique, Post-Operative Care, Expected Outcomes and Retreatment/Enhancements.

Purpose: To provide expert consensus and evidence-based current guidelines on treatment technique, postoperative care, expected outcomes and retreatment for MicroPulse Transscleral Laser Treatment (TLT). Methods: A comprehensive search of PubMed led to the identification and analysis of 61 studies on MicroPulse TLT. To provide guidance in areas where there was not enough available literature, a three-round Delphi method was conducted involving 10 international experts in MicroPulse TLT. Results: The response rate was 70% in the first round, 70% in the second round, and 80% in the third round of the Delphi method. Once all responses were aggregated, a live meeting was held with 90% attendance, and consensus was achieved on each of the findings detailed in this manuscript. Conclusion: Used within appropriate treatment parameters, with proper technique and patient selection, MicroPulse TLT is a safe and effective treatment for many types and severities of glaucoma. MicroPulse TLT represents a useful addition to the glaucoma armamentarium.

Electronic Waste Low-Temperature Processing: An Alternative Thermochemical Pretreatment to Improve Component Separation.

The production of electronic waste due to technological development, economic growth and increasing population has been rising fast, pushing for solutions before the environmental pressure achieves unprecedented levels. Recently, it was observed that many extractive metallurgy alternatives had been considered to recover value from this type of waste. Regarding pyrometallurgy, little is known about the low-temperature processing applied before fragmentation and subsequent component separation. Therefore, the present manuscript studies such alternative based on scanning electron microscopy characterization. The sample used in the study was supplied by a local recycling center in Rio de Janeiro, Brazil. The mass loss was constant at around 30% for temperatures higher than 300 °C. Based on this fact, the waste material was then submitted to low-temperature processing at 350 °C followed by attrition disassembling, size classification, and magnetic concentration steps. In the end, this first report of the project shows that 15% of the sample was recovered with metallic components with high economic value, such as Cu, Ni, and Au, indicating that such methods could be an interesting alternative to be explored in the future for the development of alternative electronic waste extraction routes.

Assessing soil erosion risk at national scale in developing countries: The technical challenges, a proposed methodology, and a case history.

Through an extensive bibliographic review, this contribution underlines the urgency and challenges to quantify soil erosion rates (ERs) in developing countries. It subsequently elaborates on the combined application of GIS-based RUSLE, generalized likelihood uncertainty estimation (GLUE) principles and sediment delivery ratio functions (SDR) to quantify ERs at country scale for these countries, as they commonly have limited measurements to that purpose. The methodology, termed RUSLE-GGS (RUSLE-GIS-GLUE-SDR) herein, comprises the following sequence: (1) construction of ER samples using RUSLE-GIS based on freely available local/global geoenvironmental observations and field relations, (2) construction of area-specific sediment yield samples utilizing SDR transfer functions, and (3) assessment of the most behavioral samples by means of bias analysis and cross validation. Its application to Peru allows obtaining 5-km resolution ER and potential erosion maps for the years 1990, 2000, and 2010. RUSLE-GGS is highly replicable and could potentially be used as an initial standard and systematic method to estimate ERs in developing countries through the active participation of local scientists. Thus, it potentially can contribute to improve the capacity building in such countries and set an initial frame to compare the evolution of soil erosion in their territories towards attaining Goal 15 of the UN 2030 Agenda for Sustainable Development.

Antiretroviral therapy immunologic non-response in a Brazilian population: association study using pharmaco- and immunogenetic markers.

BACKGROUND: Antiretroviral therapy (ART) saved millions from HIV-1 infection and AIDS, but some patients do not experience adequate CD4+ T cells gain despite achieving viral suppression. The genetic component of this condition is not yet completely elucidated. OBJECTIVE: To identify predictive genetic markers of immune response to ART. METHODS: Case-control study. Out of 176 HIV-infected patients recruited in the city of Recife, Northeast Brazil, 67 patients with no immunologic response were the cases and the remaining 109 patients who responded were the controls. A set of 94 selected single nucleotide polymorphisms (SNPs) involved in antiretroviral drugs pharmacodynamic pathways and immune system homeostasis were genotyped, while the remaining 48 were ancestry informative markers (AIMs) for controlling for eventual hidden population structure. RESULTS: Male patients were overrepresented in non-responder group (p=0.01). Non-responders also started with lower absolute CD4+ T cell counts (p<0.001). We found five SNPs significantly associated with the outcome, being three more frequent in non-responders than responders: rs2243250 (IL4) A allele (p=0.04), rs1128503 (ABCB1) A allele (p=0.03) and rs707265 (CYP2B6) A allele (p=0.02), whereas the other two were less frequent in non-responders: rs2069762 (IL2) C allele (p=0.004) and rs4646437 (CYP3A4) A allele (p=0.04). CONCLUSION: Some significant univariate associations remained independently associated at multivariate survival analysis modeling, such as pre-treatment CD4+ T cells counts, IL2 and ABCB1 genotypes, and use of protease inhibitors, yielding a predictive model for the probability for immune response. More studies are needed to unravel the genetic basis of ART immunological non-response.

Antiretroviral therapy immunologic non-response in a Brazilian population: association study using pharmaco- and immunogenetic markers

ABSTRACT Background: Antiretroviral therapy (ART) saved millions from HIV-1 infection and AIDS, but some patients do not experience adequate CD4+ T cells gain despite achieving viral suppression. The genetic component of this condition is not yet completely elucidated. Objective: To identify predictive genetic markers of immune response to ART. Methods: Case-control study. Out of 176 HIV-infected patients recruited in the city of Recife, Northeast Brazil, 67 patients with no immunologic response were the cases and the remaining 109 patients who responded were the controls. A set of 94 selected single nucleotide polymorphisms (SNPs) involved in antiretroviral drugs pharmacodynamic pathways and immune system homeostasis were genotyped, while the remaining 48 were ancestry informative markers (AIMs) for controlling for eventual hidden population structure. Results: Male patients were overrepresented in non-responder group (p = 0.01). Non-responders also started with lower absolute CD4+ T cell counts (p < 0.001). We found five SNPs significantly associated with the outcome, being three more frequent in non-responders than responders: rs2243250 (IL4) A allele (p = 0.04), rs1128503 (ABCB1) A allele (p = 0.03) and rs707265 (CYP2B6) A allele (p = 0.02), whereas the other two were less frequent in non-responders: rs2069762 (IL2) C allele (p = 0.004) and rs4646437 (CYP3A4) A allele (p = 0.04). Conclusion: Some significant univariate associations remained independently associated at multivariate survival analysis modeling, such as pre-treatment CD4+ T cells counts, IL2 and ABCB1 genotypes, and use of protease inhibitors, yielding a predictive model for the probability for immune response. More studies are needed to unravel the genetic basis of ART immunological non-response.

Low Estrogen Receptor (ER)-Positive Breast Cancer and Neoadjuvant Systemic Chemotherapy: Is Response Similar to Typical ER-Positive or ER-Negative Disease?

OBJECTIVES: Pathologic complete response (pCR) rate after neoadjuvant chemotherapy was compared between 141 estrogen receptor (ER)-negative (43%), 41 low ER+ (13%), 47 moderate ER+ (14%), and 98 high ER+ (30%) tumors. METHODS: Human epidermal growth factor receptor 2-positive cases, cases without semiquantitative ER score, and patients treated with neoadjuvant endocrine therapy alone were excluded. RESULTS: The pCR rate of low ER+ tumors was similar to the pCR rate of ER- tumors (37% and 26% for low ER and ER- respectively, P = .1722) but significantly different from the pCR rate of moderately ER+ (11%, P = .0049) and high ER+ tumors (4%, P < .0001). Patients with pCR had an excellent prognosis regardless of the ER status. In patients with residual disease (no pCR), the recurrence and death rate were higher in ER- and low ER+ cases compared with moderate and high ER+ cases. CONCLUSIONS: Low ER+ breast cancers are biologically similar to ER- tumors. Semiquantitative ER H-score is an important determinant of response to neoadjuvant chemotherapy.

Characterization and Optimal Management of High-risk Pancreatic Anastomoses During Pancreatoduodenectomy.

OBJECTIVE: The aim of this study was to identify the optimal fistula mitigation strategy following pancreaticoduodenectomy. BACKGROUND: The utility of technical strategies to prevent clinically relevant postoperative pancreatic fistula (CR-POPF) following pancreatoduodenectomy (PD) may vary by the circumstances of the anastomosis. The Fistula Risk Score (FRS) identifies a distinct high-risk cohort (FRS 7 to 10) that demonstrates substantially worse clinical outcomes. The value of various fistula mitigation strategies in these particular high-stakes cases has not been previously explored. METHODS: This multinational study included 5323 PDs performed by 62 surgeons at 17 institutions. Mitigation strategies, including both technique related (ie, pancreatogastrostomy reconstruction; dunking; tissue patches) and the use of adjuvant strategies (ie, intraperitoneal drains; anastomotic stents; prophylactic octreotide; tissue sealants), were evaluated using multivariable regression analysis and propensity score matching. RESULTS: A total of 522 (9.8%) PDs met high-risk FRS criteria, with an observed CR-POPF rate of 29.1%. Pancreatogastrostomy, prophylactic octreotide, and omission of externalized stents were each associated with an increased rate of CR-POPF (all P < 0.001). In a multivariable model accounting for patient, surgeon, and institutional characteristics, the use of external stents [odds ratio (OR) 0.45, 95% confidence interval (95% CI) 0.25-0.81] and the omission of prophylactic octreotide (OR 0.49, 95% CI 0.30-0.78) were independently associated with decreased CR-POPF occurrence. In the propensity score matched cohort, an "optimal" mitigation strategy (ie, externalized stent and no prophylactic octreotide) was associated with a reduced rate of CR-POPF (13.2% vs 33.5%, P < 0.001). CONCLUSIONS: The scenarios identified by the high-risk FRS zone represent challenging anastomoses associated with markedly elevated rates of fistula. Externalized stents and omission of prophylactic octreotide, in the setting of intraperitoneal drainage and pancreaticojejunostomy reconstruction, provides optimal outcomes.

Oncologist-hospital alignment models built to compensate oncologists fairly.

Reimbursement for services is down; practice overhead is up; community oncologist take-home income continues to erode-that is a common scenario today. No wonder community oncologists are interested in exploring alignment relationships with hospitals and academic medical centers. It can actually work too: fragmented services can be consolidated; oncologist incomes can be stabilized; communities can be better served. But what can oncologists entering into these relationships expect to be paid for their professional contribution? This article describes approaches to structuring an oncologist-hospital alignment relationship and compensation methodologies applicable to each.

Consumption of camel's milk by patients intolerant to lactose. A preliminary study.

OBJECTIVE: To determine whether camel's milk can be consumed by patients intolerant to lactose without undesirable reactions. PATIENTS AND METHOD: Twenty-five patients with clinical and laboratorial diagnosis of lactose intolerance underwent provocation tests with growing amounts of cow's milk and subsequently with camel's milk. RESULTS: Except for two patients, who had mild reactions to the maximum dosage of camel's milk (250 mL), the acceptance was excellent. Pasteurization of camel's milk did not affect tolerance. Also, most of the patients showed significant clinical reactions when drinking very low amounts of cow's milk. CONCLUSION: Camel's milk can be considered an option for the individuals intolerant to lactose who present symptoms when ingesting cow's milk.

Mutation of SDHB is a cause of hypoxia-related high-altitude paraganglioma.

PURPOSE: Paragangliomas of the head and neck are neuroendocrine tumors and are associated with germ line mutations of the tricarboxylic acid cycle-related genes SDHB, SDHC, SDHD, and SDHAF2. Hypoxia is important in most solid tumors, and was directly implicated in tumorigenesis over 40 years ago when it was shown that dwelling at high altitudes increases the incidence of carotid body hyperplasia and paragangliomas. Although recent research has now elucidated several pathways of hypoxia in paragangliomas, nothing is currently known of the genetics or of gene-environment interactions in high-altitude paraganglioma. We postulated that SDH mutations might play a role in these tumors. EXPERIMENTAL DESIGN: Patients from a Mexican family, originating and resident in Guadalajara, were tested for mutations of SDHD, and subsequently, for mutations of SDHB followed by immunohistochemical confirmation of SDHB loss. RESULTS: Two patients, born and resident at altitudes of between 1,560 and 2,240 m, were found to have head and neck paragangliomas, including a remarkably aggressive recurrent tumor. Mutation analysis identified a pathogenic missense mutation in exon 7 of SDHB, c.689G>A, p.Arg230His, and loss of the SDHB protein was confirmed by immunohistochemistry. CONCLUSIONS: This is the first report of a SDH gene mutation in paraganglioma at high altitude. A rapidly recurrent head and neck paraganglioma is a very rare finding in an SDH mutation carrier, suggesting a gene-environment interaction. Neither patient showed evidence of sympathetic paraganglioma.

Chorioamnionitis alters the response to surfactant in preterm infants.

OBJECTIVE: To study the association between antenatal exposure to chorioamnionitis and the neonatal response to surfactant. STUDY DESIGN: Prospective observational cohort of 301 preterm infants of gestational age < or = 32.0 weeks, 146 of whom received surfactant according to standardized criteria. Fraction of inspired oxygen (FiO(2)) requirement (using analysis of variance) and time to extubation (using Kaplan-Meier and Cox regression analyses) were compared between groups based on the presence of histological chorioamnionitis (HC) with or without fetal involvement (HC-, n = 88; HC + F-, n = 25; HC + F+, n = 33) and between infants who developed bronchopulmonary dysplasia (BPD) or died (n = 57) and BPD-free survivors (n = 89). Multiple logistic regression was performed to investigate the association between HC and BPD. RESULTS: Compared with HC- infants, HC + F+ infants had significantly greater FiO(2) requirement and prolonged time to extubation postsurfactant, not accounted for by differences in gestational age and birth weight. Infants with BPD/death had a strikingly similar pattern of increased FiO(2) requirement postsurfactant. Moreover, in infants who received surfactant, HC + F+ status was associated with increased risk for BPD (odds ratio [OR] = 3.40; 95% confidence interval [CI] = 1.02-11.3; P = .047) and for BPD/death (OR = 2.72; 95% CI = 1.00-7.42; P = .049). CONCLUSIONS: An impaired surfactant response was observed in preterm infants with severe chorioamnionitis and may be involved in the association between chorioamnionitis, mechanical ventilation, and the development of BPD.

Central and peripheral corneal thickness measured with optical coherence tomography, Scheimpflug imaging, and ultrasound pachymetry in normal, keratoconus-suspect, and post-laser in situ keratomileusis eyes.

PURPOSE: To compare central (CCT) and peripheral corneal thickness (PCT) using Scheimpflug imaging (Pentacam), high-speed optical coherence tomography (Visante OCT), and ultrasound (US) pachymetry (Sonogage Corneo-Gage Plus) in normal, keratoconus-suspect, and post-laser in situ keratomileusis (LASIK) eyes. SETTING: Department of Refractive Surgery, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA. METHODS: The CCT and PCT were retrospectively measured using US pachymetry, Scheimpflug imaging, and high-speed OCT from January 2006 to March 2008. The influence of age and absolute magnitude of corneal thickness were also analyzed. Analysis was by multivariate generalized estimating equations, multivariate linear regression, and linear regression plots. RESULTS: One hundred sixty-three eyes were analyzed. Ultrasound pachymetry CCT measurements were consistently higher than Scheimpflug and OCT measurements (mean difference 6.5 microm +/- 1.8 [SD] and 7.5 +/- 1.4 microm, respectively) (both P<.0005) in normal eyes; the difference was statistically similar and not greater with keratoconus suspicion, age, or absolute magnitude of corneal thickness (P>.05). Scheimpflug measurements were significantly lower than US pachymetry in post-LASIK eyes (P<.0005). There was no statistically significant difference (mean 0.9 +/- 1.4 microm) in Scheimpflug and OCT CCT measurements (P>.5), although Scheimpflug measurements were significantly lower in post-LASIK eyes (P<.0005). Scheimpflug PCT measurements were higher than OCT measurements, showing more agreement with increasing age (P = .017). CONCLUSIONS: Scheimpflug and OCT CCT measurements were reproducible but always thinner than US pachymetry in normal and keratoconus-suspect eyes. In post-LASIK eyes, OCT pachymetry maps were more accurate than Scheimpflug maps. The influence of age on PCT requires further study.

Genomics of growth traits in forest trees.

Growth traits in trees are fundamental components of adaptation in a forest ecosystem and of productivity in planted forests. A number of processes determine tree growth, which are controlled by genetic and epigenetic factors that respond dynamically to environmental signals throughout centuries. Advances in genomics have allowed an increased comprehension of the complex mechanisms of tree growth and adaptation. Yet, the application of genomics to improving forest productivity and sustainability still entails capturing a large proportion of the total genetic variation controlling the component traits. Nonetheless, genetics and genomics are unifying disciplines that will serve well to dissect the variables and mechanisms of tree growth and development.

Effects of Zernike wavefront aberrations on visual acuity measured using electromagnetic adaptive optics technology.

PURPOSE: This study measured the changes in visual acuity induced by individual Zernike ocular aberrations of various root-mean-square (RMS) magnitudes. METHODS: A crx1 Adaptive Optics Visual Simulator (Imagine Eyes) was used to modify the wavefront aberrations in nine eyes. After measuring ocular aberrations, the device was programmed to compensate for the eye's wavefront error up to the 4th order and successively apply different individual Zernike aberrations using a 5-mm pupil. The generated aberrations included defocus, astigmatism, coma, trefoil, and spherical aberration at a level of 0.1, 0.3, and 0.9 microm. Monocular visual acuity was assessed using computer-generated Landolt-C optotypes. RESULTS: Correction of the patients' aberrations improved visual acuity by a mean of 1 line (-0.1 logMAR) compared to best sphero-cylinder correction. Aberrations of 0.1 microm RMS resulted in a limited decrease in visual acuity (mean +0.05 logMAR), whereas aberrations of 0.3 microm RMS induced significant visual acuity losses with a mean reduction of 1.5 lines (+0.15 logMAR). Larger aberrations of 0.9 microm RMS resulted in greater visual acuity losses that were more pronounced with spherical aberration (+0.64 logMAR) and defocus (+0.62 logMAR), whereas trefoil (+0.22 logMAR) was found to be better tolerated. CONCLUSIONS: The electromagnetic adaptive optics visual simulator effectively corrected and generated wavefront aberrations up to the 4th order. Custom wavefront correction significantly improved visual acuity compared to best-spectacle correction. Symmetric aberrations (eg, defocus and spherical aberration) were more detrimental to visual performance.