Lower Admission Prealbumin and Albumin Levels in Unhoused Burn Patients is a Marker for Poorer Outcomes.

Unhoused (UH) individuals experience burn injuries at a higher rate than domiciled individuals, and have poorer outcomes following injuries. One such mechanism proposed for worsened outcomes is secondary to poor nutrition. Access to proper nutrition and food insecurity are major barriers. Malnutrition has been shown to decrease wound tensile strength, increase infection rates, and prolong healing. The purpose of this study was to understand if albumin and prealbumin could help determine outcomes in UH patients and identify at-risk patients earlier in their hospital course A retrospective chart review was conducted of UH patients from 2015 through 2023 at a large urban safety net hospital. Data collected included admission laboratory values including albumin and prealbumin. Outcomes studied included length of stay, ICU days, ventilator days, and mortality. Data analysis for the effect of albumin and prealbumin included a zero-truncated negative binomial model for length of stay, a negative binomial hurdle model for ICU length of stay and ventilator days, and logistic regression for mortality. 385 patients met inclusion criteria and of these, 366 had albumin and 361 had prealbumin information. Adjusting for age, gender, and TBSA, the fewest days in the hospital and lowest odds of admission to the ICU occurred for those with admission albumin values of approximately 3.4-3.5 g/dL. Each unit (g/dL) decrease in albumin was associated with 3.19 times the odds of death (95% CI 1.42, 7.69). Each unit (mg/dL) decrease in prealbumin was associated with 1.19 times the odds of death (95% CI 1.06, 1.35). Decreased admission albumin and prealbumin levels are associated with worse burn outcomes in UH patients. These nutritional biomarkers may aid in determining which UH patients are suffering from food insecurity at injury onset. Obtaining these values on admission may help burn providers target nutritional goals in their most vulnerable patients.

Assessing Scar Outcomes Using Objective Scar Measurement Tools: An Adjunct to Validated Scar Evaluation Scales.

INTRO: The assessment of scar outcomes is important to both patient care and research focused on understanding the results of medical and surgical interventions. The Vancouver Scar Scale and Patient and Observer Scar Assessment Scale are validated and simple instruments to assess scars. However, these subjective scales have shortcomings. The VSS fails to capture patient perception and has indeterminate validity and reliability. The POSAS captures patient perception, but the observer scale has been shown to have moderate amounts of inter-rater variability. Studies highlighting the ability of objective scar assessment tools to produce reliable and reproducible results are needed. In this study, we aimed to validate the use of the Fibrometer ®, Elastimeter ®, and SkinColorCatch ® as an objective adjunct in the assessment of hypertrophic scar and keloid outcomes. METHODS: This was a prospective single-center study which assessed patient scars using the Vancouver Scar Scale, the Patient and Observer Scar Assessment scale, and the aforementioned objective study tools. Correlations between the different methods of scar assessment were measured. RESULTS: The Fibrometer ® and SkinColorCatch ® showed significant correlations with the VSS total and the Observer POSAS total. The Elastimeter ® showed significant correlations with both the Patient and Observer POSAS totals. Unexpected correlations between Elastimeter ® measurements and the vascularity/pigmentation of scars indicate that scoring of these categories may be influenced by how severe the scar looks to the observer subjectively, further necessitating the need for reliable objective scar assessment tools. CONCLUSION: These results highlight the ability of these devices to assess scars and demonstrate their potential in serving as an important adjunct to previously validated scar assessment scales.

Cory's shearwater as a key bioindicator for monitoring floating plastics.

The potential of using organisms as bioindicators of marine litter has been an area of general interest in multiple scientific and monitoring programs across the globe. Procellariiformes seabirds are particularly vulnerable to plastic contamination, which makes them a research focus group. This study investigated plastic ingestion in deceased fledglings and adults Cory's shearwaters (Calonectris borealis) collected over eight years (2015 to 2022) at two Atlantic archipelagos: the Azores and the Canaries. Necropsies were carried out in a total of 1,238 individuals showing a high prevalence of plastic ingestion (90%), with approximately 80% of items recovered from the gizzard. Fledglings carried greater plastic loads compared to adults, yet plastic morphologies were similar between both age classes. The temporal analyses conducted with generalised additive mixed-effect models revealed a distinct temporal trend in plastic numbers, but not in terms of plastic mass. In addition, the spatial analyses showed that Cory's shearwaters from the Canary Islands ingest a higher quantity of plastic and a greater proportion of threadlike items than the Azorean birds. These results suggest higher contamination at the NW Africa foraging grounds next to the Canaries and highlight fisheries as a potential source of marine litter in that region. On the other hand, the information gathered from the Azorean birds suggests they would be able to monitor changes in the composition of the plastic items floating in the North Atlantic Subtropical Gyre. Overall, our outcomes support the use of Cory's shearwater fledglings that are victims of light pollution as a key bioindicator of plastic contamination in the North Atlantic. For its policy application, the presented threshold value in combination with the assessment method will enable effective tracking of floating plastic litter in the framework of the MSFD and OSPAR.

Microplastics in beach sediments of the Azores archipelago, NE Atlantic.

Oceanic islands are exposed to plastic debris that has accumulated in the open ocean, particularly in the subtropical gyres. This study investigates the abundance and typology of microplastics (from 0.1 to 5 mm) on 19 sandy beaches spread across 8 oceanic islands of the Azores archipelago. Between January and April 2016, a total of 341 particles retrieved from all beaches, were identified as microplastics. The highest concentration (50.19 ± 21.93 particles kg-1 dw) was found in Terceira Island. Beach morphology and grain size were important factors explaining microplastic concentration. Fibres were the most dominant morphology recovered (80.9 %), followed by fragments (12.3 %). Fourier transform infrared spectroscopy (FTIR) revealed that 41 % of the fibres consisted of polyester and 60 % of the fragments were polyethylene. This research underlines the widespread contamination of microplastics in oceanic islands of the Atlantic Ocean.

Laser-Assisted Drug Delivery in the Treatment of Hypertrophic Scars and Keloids: A Systematic Review.

Hypertrophic scars and keloids are the results of an exaggerated healing process and are often associated with significant patient morbidity. Fractional ablative lasers create microchannels in the skin and penetrate into the substance of the scar, inducing a normal healing response in zones of created damage. Focal delivery of scar-modulating agents into the scar through these microchannels-a process termed laser-assisted drug delivery (LADD)-is a promising and developing treatment modality. In this systematic review, we aim to critically examine the evidence of LADD in the treatment of hypertrophic scars and keloids. The evidence suggests that LADD improves outcomes in hypertrophic scars and keloids. LADD is a more effective treatment modality than the topical application of agents in hypertrophic scars and equally effective as the intralesional injection of agents in keloids. There were few reports of adverse events. Evidence supports the use of LADD as an adjunct to non-surgical measures or a treatment modality to be used before more invasive measures such as surgical excision. However, the quality of evidence supporting this conclusion is inconsistent and lacks power. Additional studies are required to optimize dosages, laser settings, and agent choices for the treatment of these lesions.

A pleiotropic role of sialidase in the pathogenicity of Porphyromonas gingivalis.

As one of the keystone pathogens of periodontitis, the oral bacterium Porphyromonas gingivalis produces an array of virulence factors, including a recently identified sialidase (PG0352). Our previous report involving loss-of-function studies indicated that PG0352 plays an important role in the pathophysiology of P. gingivalis. However, this report had not been corroborated by gain-of-function studies or substantiated in different P. gingivalis strains. To fill these gaps, herein we first confirm the role of PG0352 in cell surface structures (e.g., capsule) and serum resistance using P. gingivalis W83 strain through genetic complementation and then recapitulate these studies using P. gingivalis ATCC33277 strain. We further investigate the role of PG0352 and its counterpart (PGN1608) in ATCC33277 in cell growth, biofilm formation, neutrophil killing, cell invasion, and P. gingivalis-induced inflammation. Our results indicate that PG0352 and PGN1608 are implicated in P. gingivalis cell surface structures, hydrophobicity, biofilm formation, resistance to complement and neutrophil killing, and host immune responses. Possible molecular mechanisms involved are also discussed. In summary, this report underscores the importance of sialidases in the pathophysiology of P. gingivalis and opens an avenue to elucidate their underlying molecular mechanisms.

Lagrangian tracking of long-lasting plastic tags: From lobster fisheries in the USA and Canada to Macaronesia.

Plastic waste from the fishing industry, particularly lobster trap identification tags from the USA and Canada, poses a significant threat to marine ecosystems due to its resilience. This study unveils a novel link between North American fisheries and the appearance of these plastic tags in Macaronesia. Collected in the Azores and Canary Islands, these tags offer a unique insight into the sources and spatio-temporal scales of marine plastic pollution. Ocean model data indicates the Labrador Current and Gulf Stream as key forces transporting these tags. Virtual particle simulations show a small fraction reaching Macaronesia (4.12 % in the Azores, 0.76 % in the Canary Islands), suggesting real ocean drift. The Azores, with more collected tags, are more susceptible, and tags can reach Macaronesia in under a year. These findings underscore the urgency of better waste management and emphasize the role of citizen science in monitoring and combating marine pollution.

Combining scar-modulating agents for the treatment of hypertrophic scars and keloids: A systematic review.

Injury to the skin can cause abnormal wound healing and continuous inflammation that leads to the formation of hypertrophic scars and keloids. These lesions often cause significant negative impact on a patient's life due to aesthetic, physical, social, and psychological consequences. Numerous treatment modalities exist for these hypertrophic scars and keloids, which include silicone sheeting, pressure garments, intralesional injection/topical application of scar-modulating agents, laser therapy, and surgical excision. Due to increased efficacy, an evolving treatment paradigm encourages the use of multiple treatment modalities instead of one treatment modality. However, no gold standard treatment exists for these lesions, leaving many people with unsatisfactory results. Adding scar-modulating agents such as 5-Fluorouracil, bleomycin, or Botulinum Toxin A to triamcinolone monotherapy has emerged as a potential drug combination for treating hypertrophic scars and keloids. We sought to critically analyze the evidence that exists for the use of more than one scar-modulating agent. This was done by conducting a systematic review to determine the efficacy of these combined drug regimens. We found that many of these combinations show evidence of increased efficacy and fewer/similar adverse events to triamcinolone monotherapy. Triamcinolone and 5-Fluorouracil showed the strongest and most consistent evidence out of all combinations. With this review, we intend to encourage more research into unique drug combinations that may improve outcomes for patients with symptomatic hypertrophic scars or keloids.

A Cadaveric Case of Palmaris Longus Agenesis and Reversal.

The palmaris longus frequently exhibits anatomical variations with palmaris longus agenesis and reversal being the most prevalent. These variations are relevant clinically, as the muscle is often used during plastic surgeries for grafting tendons. They are also relevant in pathology, as hypertrophy of the reversed muscle is related to median nerve compression. In this report, we describe an unusual case in which a male cadaver-donor exhibited a right-sided palmaris longus reversal and left-sided palmaris longus agenesis. Review of the literature documents no previous co-occurrence of these anomalies. Since the muscle has relevance in a variety of contexts within medicine and surgery, reporting on a variation like this carries significant educational and clinical value.

A recipe for plastic: Expert insights on plastic additives in the marine environment.

The production and consumption of plastic products had been steadily increasing over the years, leading to more plastic waste entering the environment. Plastic pollution is ubiquitous and comes in many types and forms. To enhance or modify their properties, chemical additives are added to plastic items during manufacturing. The presence and leakage of these additives, from managed and mismanaged plastic waste, into the environment are of growing concern. In this study, we gauged, via an online questionnaire, expert knowledge on the use, characteristics, monitoring and risks of plastic additives to the marine environment. We analysed the survey results against actual data to identify and prioritise risks and gaps. Participants also highlighted key factors for future consideration, including gaining a deeper understanding of the use and types of plastic additives, how they leach throughout the entire lifecycle, their toxicity, and the safety of alternative options. More extensive chemical regulation and an evaluation of the essentiality of their use should also be considered.

Functional and structural analyses reveal that a dual domain sialidase protects bacteria from complement killing through desialylation of complement factors.

The complement system is the first line of innate immune defense against microbial infections. To survive in humans and cause infections, bacterial pathogens have developed sophisticated mechanisms to subvert the complement-mediated bactericidal activity. There are reports that sialidases, also known as neuraminidases, are implicated in bacterial complement resistance; however, its underlying molecular mechanism remains elusive. Several complement proteins (e.g., C1q, C4, and C5) and regulators (e.g., factor H and C4bp) are modified by various sialoglycans (glycans with terminal sialic acids), which are essential for their functions. This report provides both functional and structural evidence that bacterial sialidases can disarm the complement system via desialylating key complement proteins and regulators. The oral bacterium Porphyromonas gingivalis, a "keystone" pathogen of periodontitis, produces a dual domain sialidase (PG0352). Biochemical analyses reveal that PG0352 can desialylate human serum and complement factors and thus protect bacteria from serum killing. Structural analyses show that PG0352 contains a N-terminal carbohydrate-binding module (CBM) and a C-terminal sialidase domain that exhibits a canonical six-bladed ß-propeller sialidase fold with each blade composed of 3-4 antiparallel ß-strands. Follow-up functional studies show that PG0352 forms monomers and is active in a broad range of pH. While PG0352 can remove both N-acetylneuraminic acid (Neu5Ac) and N-glycolyl-neuraminic acid (Neu5Gc), it has a higher affinity to Neu5Ac, the most abundant sialic acid in humans. Structural and functional analyses further demonstrate that the CBM binds to carbohydrates and serum glycoproteins. The results shown in this report provide new insights into understanding the role of sialidases in bacterial virulence and open a new avenue to investigate the molecular mechanisms of bacterial complement resistance.

Cetaceans playing with single-use plastics (SUPs): A widespread interaction with likely severe impacts.

Play is a common behaviour in wild cetaceans that includes the manipulation of natural, as well as artificial objects such as marine debris. Yet, very little is known about these interactions despite the potential impacts on cetacean health. We combined a detailed review of the scientific literature and social media with 12 years of observations to examine cetacean interactions with plastic litter. A total of 11 odontocete species (Tursiops truncatus, Stenella longirostris, Delphinus delphis, Grampus griseus, Steno bredanensis, Stenella frontalis, Sotalia guianensis, Pseudorca crassidens, Orcinus orca, Globicephala melas and Physeter macrocephalus) were documented in 59 events carrying or throwing plastic litter with their head and/or flippers suggesting a form of play. Interactions occurred in the Atlantic, Pacific, Indian Ocean, Mediterranean, and Red Sea, with single-use plastics composing the main typology registered. While these interactions appeared harmless to the observers, they can pose a significant risk through subsequent entanglement or ingestion.

Predicting the distribution and abundance of abandoned, lost or discarded fishing gear (ALDFG) in the deep sea of the Azores (North Atlantic).

Abandoned, lost, or discarded fishing gear (ALDFG), represents a significant percentage of the global plastic pollution, currently considered one of the major sources from sea-based activities. However, there is still limited understanding of the quantities of ALDFG present on the seafloor and their impacts. In this study, data on the presence of ALDFG was obtained from a large archive of seafloor video footage (351 dives) collected by different imaging platforms in the Azores region over 15 years (2006-2020). Most ALDFG items observed in the images relate to the local bottom longline fishery operating in the region, and include longlines but also anchors, weights, cables and buoys. A generalized additive mixed model (GAMM) was used to predict the distribution and abundance of ALDFG over the seafloor within the limits of the Azores Exclusive Economic Zone (EEZ) using a suite of environmental and anthropogenic variables. We estimated an average of 113 ± 310 items km-2 (597 ± 756 per km-2 above 1000 m depth), which could imply that over 20 million ALDFG items are present on the deep seafloor of the Azores EEZ. The resulting model identified potential hotspots of ALDFG along the seabed, some of them located over sensitive benthic habitats, such as specific seamounts. In addition, the interactions between ALDFG and benthic organisms were also analysed. Numerous entanglements were observed with several species of large anthozoans and sponges. The use of predictive distribution modelling for ALDFG should be regarded as a useful tool to support ecosystem-based management, which can provide indirect information about fishing pressure and allow the identification of potential high-risk areas. Additional knowledge about the sources, amounts, fates and impacts of ALDFG will be key to address the global issue of plastic pollution and the effects of fishing on marine ecosystems.

Three-dimensional evaluation of beaches of oceanic islands as reservoirs of plastic particles in the open ocean.

The quantification of plastic debris on beaches has been extensively used as an indicator of plastic pollution in the marine environment. However, most efforts have focused on surface layers, with few investigations looking deeper into the substrate, thus underestimating total standing stocks. Such information is crucial to improve our understanding of where plastic accumulates in the oceans. In this study, we investigated the three-dimensional distribution of plastic (>1 mm) in three sandy beaches located in oceanic islands of the North Atlantic (Azores and the Canary Islands) that are known to accumulate significant quantities of small plastic debris at the surface layer. On each beach, we collected a total of 16 sediment cores down to 1 m depth, from the high tide line up to the backshore following a stratified random sampling design spread across four different levels across the beach. Samples were taken every 10 cm down to 1 m into the sand. Our results revealed the presence of plastic items in the deepest layers with subsurface layers accounting for 84 % of the total plastic abundance and with a similar pattern in terms of size, shape, colour and composition. Furthermore, we found increasing plastic concentrations towards the upper levels of the beach, indicating longer term accumulation in the backshore. Collectively, this study suggests that the plastic items reaching sandy beaches of the Macaronesia are being incorporated into its deepest layers, acting as reservoirs of plastic in the open ocean.

iSleepFirst: burnout, fatigue, and wearable-tracked sleep deprivation among residents staffing the medical intensive care unit.

PURPOSE: This study aimed to evaluate the relationship between sleep, burnout, and psychomotor vigilance in residents working in the medical intensive care unit (ICU). METHODS: A prospective cohort study of residents was implemented during a consecutive 4-week. Residents were recruited to wear a sleep tracker for 2 weeks before and 2 weeks during their medical ICU rotation. Data collected included wearable-tracked sleep minutes, Oldenburg burnout inventory (OBI) score, Epworth sleepiness scale (ESS), psychomotor vigilance testing, and American Academy of Sleep Medicine sleep diary. The primary outcome was sleep duration tracked by the wearable. The secondary outcomes were burnout, psychomotor vigilance (PVT), and perceived sleepiness. RESULTS: A total of 40 residents completed the study. The age range was 26-34 years with 19 males. Total sleep minutes measured by the wearable decreased from 402 min (95% CI: 377-427) before ICU to 389 (95% CI: 360-418) during ICU (p < 0.05). Residents overestimated sleep, logging 464 min (95% CI: 452-476) before and 442 (95% CI: 430-454) during ICU. ESS scores increased from 5.93 (95% CI: 4.89, 7.07) to 8.33 (95% CI: 7.09,9.58) during ICU (p < 0.001). OBI scores increased from 34.5 (95% CI: 32.9-36.2) to 42.8 (95% CI: 40.7-45.0) (p < 0.001). PVT scores worsened with increased reaction time while on ICU rotation (348.5 ms pre-ICU, 370.9 ms post-ICU, p < 0.001). CONCLUSIONS: Resident ICU rotations are associated with decreased objective sleep and self-reported sleep. Residents overestimate sleep duration. Burnout and sleepiness increase and associated PVT scores worsen while working in the ICU. Institutions should ensure resident sleep and wellness checks during ICU rotation.

Current levels of microplastic pollution impact wild seabird gut microbiomes.

Microplastics contaminate environments worldwide and are ingested by numerous species, whose health is affected in multiple ways. A key dimension of health that may be affected is the gut microbiome, but these effects are relatively unexplored. Here, we investigated if microplastics are associated with changes in proventricular and cloacal microbiomes in two seabird species that chronically ingest microplastics: northern fulmars and Cory's shearwaters. The amount of microplastics in the gut was significantly correlated with gut microbial diversity and composition: microplastics were associated with decreases in commensal microbiota and increases in (zoonotic) pathogens and antibiotic-resistant and plastic-degrading microbes. These results illustrate that environmentally relevant microplastic concentrations and mixtures are associated with changes in gut microbiomes in wild seabirds.

A Concise Review on the Potential Applications of Rugulopteryx okamurae Macroalgae.

The brown macroalgae of the species Rugulopteryx okamurae has reached European waters and the Strait of Gibraltar as an invasive species. The proliferation and colonization of the species in subtidal and intertidal zones of these regions imposes significant threats to local ecosystems and additionally represents a significant socioeconomic burden related to the large amounts of biomass accumulated as waste. As a way to minimize the effects caused by the accumulation of algae biomass, investigations have been made to employ this biomass as a raw material in value-added products or technologies. The present review explores the potential uses of R. okamurae, focusing on its impact for biogas production, composting, bioplastic and pharmaceutical purposes, with potential anti-inflammatory, antibacterial and α-glucosity inhibitory activities being highlighted. Overall, this species appears to present many attributes, with remarkable potential for uses in several fields of research and in various industries.

Mucormycosis following burn injuries: A systematic review.

INTRODUCTION: Mucormycosis is an opportunistic fungal infection with a high mortality rate. Though typically associated with diabetes and other conditions that affect innate immune function, infections can also be precipitated by conditions such as trauma and burns. Burn patients are particularly susceptible to fungal infections due to the immune dysfunction that often accompany their wounds. Indeed case series have described mucormycosis to occur in patients with burn injuries, however the factors contributing to mortality have not been well described. Thus, the purpose of our review was to identify factors contributing to morbidity and mortality in burn patients with Mucormycosis. METHODS: A systematic review of the literature of mucormycosis infection in burn injury patients was performed on Pubmed and Google Scholar using the keywords: Mucor, Mucorales, Mucormycosis, Mucormycotina, Zygomycosis and burn or thermal injury. Clinical trials, observational studies, case reports, and case reviews were included if they provided information regarding mortality in adult and pediatric burn patients diagnosed with mucormycosis, review articles, non-English articles, and articles without patient information were excluded. No time limit was placed on our review. Individual patient data was stratified based on mortality. Statistical analysis was performed to investigate the relationship between patient risk factors and mortality, and the Oxford Level of Evidence was used to evaluate study quality. RESULTS: 46 articles were included in our final review, encompassing 114 patients. On average, survivors had a total body surface area (TBSA)% of 46 (SD 19.8) while non-survivors had a TBSA of 65% (SD 16.4), and this difference was significant (p < .001). Patients with disseminated mucormycosis experienced an 80% mortality rate compared to 36% mortality rate in patients with localized disease (p < .001). We found no statistically significant difference in mean age (p > .05), diabetes (p > .05), mean delay in diagnosis (p > .05), time to antifungal therapy (p > .05), or type of therapy used (p > .05) between survivors and non-survivors. Our review was limited by the lack of prospective, controlled trials; thus, our review primarily consists of case reports. CONCLUSION: Disseminated infections and higher TBSA both increased the risk of mortality in burn patients with mucormycosis, while diabetes did not increase mortality risk. The severity of the initial injury and infection locations must be taken into consideration to inform patient prognosis.

Drivers of litter ingestion by sea turtles: Three decades of empirical data collected in Atlantic Europe and the Mediterranean.

Sea turtles are considered as bio-indicators for monitoring the efficiency of restoration measures to reduce marine litter impacts on health. However, the lack of extended and standardised empirical data has prevented the accurate analysis of the factors influencing litter ingestion and the relationships with individual health. Historic data collected from 1988 and standard data collected from 2016 were harmonised to enable such analyses on necropsied loggerhead turtles (Caretta caretta) in eight Mediterranean and North-East Atlantic countries. Litter was found in 69.24 % of the 1121 individuals, mostly single-use and fishing-related plastics. Spatial location, sex and life history stage explained a minor part of litter ingestion. While no relationships with health could be detected, indicating that all individuals can be integrated as bio-indicators, the mechanistic models published in literature suggest that the high proportion of plastics in the digestive contents (38.77 % per individual) could have long-term repercussions on population dynamics.