Contaminants of Concern and Spatiotemporal Metabolomic Changes in Quagga Mussels (Dreissena bugensis rostriformis) from the Milwaukee Estuary (Wisconsin, USA).

Environmental metabolomics has emerged as a promising technique in the field of biomonitoring and as an indicator of aquatic ecosystem health. In the Milwaukee Estuary (Wisconsin, USA), previous studies have used a nontargeted metabolomic approach to distinguish between zebra mussels (Dreissena polymorpha) collected from sites of varying contamination. To further elucidate the potential effects of contaminants on bivalve health in the Milwaukee Estuary, the present study adopted a caging approach to study the metabolome of quagga mussels (Dreissena bugensis rostriformis) deployed in six sites of varying contamination for 2, 5, or 55 days. Caged mussels were co-deployed with two types of passive sampler (polar organic chemical integrative samplers and semipermeable membrane devices) and data loggers. In conjunction, in situ quagga mussels were collected from the four sites studied previously and analyzed for residues of contaminants and metabolomics using a targeted approach. For the caging study, temporal differences in the metabolomic response were observed with few significant changes observed after 2 and 5 days, but larger differences (up to 97 significantly different metabolites) to the metabolome in all sites after 55 days. A suite of metabolic pathways were altered, including biosynthesis and metabolism of amino acids, and upmodulation of phospholipids at all sites, suggesting a potential biological influence such as gametogenesis. In the caging study, average temperatures appeared to have a greater effect on the metabolome than contaminants, despite a large concentration gradient in polycyclic aromatic hydrocarbons residues measured in passive samplers and mussel tissue. Conversely, significant differences between the metabolome of mussels collected in situ from all three contaminated sites and the offshore reference site were observed. Overall, these findings highlight the importance of contextualizing the effects of environmental conditions and reproductive processes on the metabolome of model organisms to facilitate the wider use of this technique for biomonitoring and environmental health assessments. Environ Toxicol Chem 2024;43:307-323. © 2023 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.

Robotic-assisted surgery in high-risk surgical patients with endometrial cancer.

Many patients diagnosed with an endometrial cancer are at high-risk for surgery due to factors such as advanced age, raised body mass index or frailty. Minimally-invasive surgery, in particular robotic-assisted, is increasingly used in the surgical management of endometrial cancer however, there are a lack of clinical trials investigating outcomes in high-risk patient populations. This article will review the current evidence and identify areas of uncertainty where future research is needed.

Untargeted Metabolomics Analyses and Contaminant Chemistry of Dreissenid Mussels at the Maumee River Area of Concern in the Great Lakes.

Bivalves serve as an ideal ecological indicator; hence, their use by the NOAA Mussel Watch Program to monitor environmental health. This study aimed to expand the baseline knowledge of using metabolic end points in environmental monitoring by investigating the dreissenid mussel metabolome in the field. Dreissenids were caged at four locations along the Maumee River for 30 days. The mussel metabolome was measured using nuclear magnetic resonance spectroscopy, and mussel tissue chemical contaminants were analyzed using gas or liquid chromatography coupled with mass spectrometry. All Maumee River sites had a distinct mussel metabolome compared to the reference site and revealed changes in the energy metabolism and amino acids. Data also highlighted the importance of considering seasonality or handling effects on the metabolome at the time of sampling. The furthest upstream site presented a specific mussel tissue chemical signature of pesticides (atrazine and metolachlor), while a downstream site, located at Toledo's wastewater treatment plant, was characterized by polycyclic aromatic hydrocarbons and other organic contaminants. Further research into the dreissenid mussel's natural metabolic cycle and metabolic response to specific anthropogenic stressors is necessary before successful implementation of metabolomics in a biomonitoring program.

Impact of Patient Body Mass Index on Post-Operative Recovery from Robotic-Assisted Hysterectomy.

A longitudinal, descriptive, prospective, and prolective study of individuals with endometrial or cervical cancer/pre-cancer diagnoses and high BMI (over 35 kg/m2) undergoing RH was conducted. Of the 53 participants recruited, 3 (6%) were converted to open surgery. The 50 RH participants had median BMI 42 kg/m2 (range 35 to 60): the range 35-39.9 kg/m2 had 17 cases; the range 40-44.9 kg/m2 had 15 cases; 45-49.9 kg/m2 8 cases; and those ≥50 kg/m2 comprised 10 cases. The mean RH operating time was 128.1 min (SD 25.3) and the median length of hospital stay was 2 days (range 1-14 days). Increased BMI was associated with small, but statistically significant, increases in operating time and anaesthetic time, 65 additional seconds and 37 seconds, respectively, for each unit increase in BMI. The median self-reported time for individuals who underwent RH to return to their pre-operative activity levels was 4 weeks (range 2 to >12 weeks). There was a significant improvement in pain and physical independence scores over time (p = 0.001 and p < 0.001, respectively) and no significant difference in scores for overall QOL, pain, or physical independence scores was found between the BMI groups. Patient-reported recovery and quality of life following RH is high in individuals with high BMI (over 35 kg/m2) and does not appear to be impacted by the severity of obesity.

COVID-19 - Initial Lockdown: Implications on Cancer Treatment among Palliative Care Outpatients.

Objectives: The pandemic and the lockdown has challenged palliative care patients especially those on palliative oncological treatments. This study aims to understand the effect of COVID-19 and initial lockdown on palliative oncological treatments among palliative care patients. Materials and Methods: A retrospective chart review of patients who attended the palliative care outpatient clinic, between 21 April and 12 May 2020, was done. Sociodemographic and palliative oncological treatment details were reviewed. Results: Of the 107 patients included, 53.7% were between 40 and 60 years of age, and 58.3% were women. A large proportion (63%) was unemployed and 40.2% had to rent vehicles for hospital travel. During this period, palliative oncological treatment was interrupted or deferred in 20% and 3.5%, respectively. During this period, homecare services were also affected in about 12.2% of our patients. Conclusion: The COVID-19 pandemic and the lockdown have affected the palliative oncological treatment of palliative care outpatients with cancer. The implications of interrupted and deferred treatment on patient outcomes would be seen in the months and years to follow. Palliative care teams should enhance patient and caregiver support and promote non-abandonment and continuum of care during such unprecedented times.

Characterization of polycyclic aromatic hydrocarbons in the Great Lakes Basin using dreissenid mussels.

The National Oceanic and Atmospheric Administration (NOAA), National Centers for Coastal Ocean Science (NCCOS) Mussel Watch Program (MWP), conducts basin-wide monitoring and place-based assessments using dreissenid mussels as bioindicators of chemical contamination in the Laurentian Great Lakes. Polycyclic aromatic hydrocarbons (PAHs) body burden results for the period 2009-2018 were combined into one dataset from multiple MWP studies allowing for a robust characterization of PAH contamination. Patterns in PAH data were identified using descriptive statistics and machine learning techniques. Relationships between total PAH concentration in dreissenid mussel tissue, impervious surface percentages, and PAH relative concentration were identified and used to build a predictive model for the Great Lakes Basin. Significant positive correlation was identified by the Spearman's rank correlation test between total PAH concentration and percent impervious surface. The findings support the paradigm that PAHs are primarily derived from land-based sources. Offshore and riverine locations had the lowest and highest median total PAH concentrations, respectively. PAH assemblages and ratios indicated that pyrogenic sources were more predominant than petrogenic sources and that PAHs at offshore sites exhibited relatively more weathering compared to inshore sites.

Bioextractive Removal of Nitrogen by Oysters in Great Bay Piscataqua River Estuary, New Hampshire, USA.

Eutrophication is a challenge to coastal waters around the globe. In many places, nutrient reductions from land-based sources have not been sufficient to achieve desired water quality improvements. Bivalve shellfish have shown promise as an in-water strategy to complement land-based nutrient management. A local-scale production model was used to estimate oyster (Crassostrea virginica) harvest and bioextraction of nitrogen (N) in Great Bay Piscataqua River Estuary (GBP), New Hampshire, USA, because a system-scale ecological model was not available. Farm-scale N removal results (0.072 metric tons acre-1 year-1) were up-scaled to provide a system-wide removal estimate for current (0.61 metric tons year-1), and potential removal (2.35 metric tons year-1) at maximum possible expansion of licensed aquaculture areas. Restored reef N removal was included to provide a more complete picture. Nitrogen removal through reef sequestration was ~ 3 times that of aquaculture. Estimated reef-associated denitrification, based on previously reported rates, removed 0.19 metric tons N year-1. When all oyster processes (aquaculture and reefs) were included, N removal was 0.33% and 0.54% of incoming N for current and expanded acres, respectively. An avoided cost approach, with wastewater treatment as the alternative management measure, was used to estimate the value of the N removed. The maximum economic value for aquaculture-based removal was $105,000 and $405,000 for current and expanded oyster areas, respectively. Combined aquaculture and reef restoration is suggested to maximize N reduction capacity while limiting use conflicts. Comparison of removal based on per oyster N content suggests much lower removal rates than model results, but model harvest estimates are similar to reported harvest. Though results are specific to GBP, the approach is transferable to estuaries that support bivalve aquaculture but do not have complex system-scale hydrodynamic or ecological models.

Role of Shellfish Aquaculture in the Reduction of Eutrophication in an Urban Estuary.

Land-based management has reduced nutrient discharges; however, many coastal waterbodies remain impaired. Oyster "bioextraction" of nutrients and how oyster aquaculture might complement existing management measures in urban estuaries was examined in Long Island Sound, Connecticut. Eutrophication status, nutrient removal, and ecosystem service values were estimated using eutrophication, circulation, local- and ecosystem-scale models, and an avoided-costs valuation. System-scale modeling estimated that 1.31% and 2.68% of incoming nutrients could be removed by current and expanded production, respectively. Up-scaled local-scale results were similar to system-scale results, suggesting that this up-scaling method could be useful in bodies of water without circulation models. The value of removed nitrogen was estimated using alternative management costs (e.g., wastewater treatment) as representative, showing ecosystem service values of $8.5 and $470 million per year for current and maximum expanded production, respectively. These estimates are conservative; removal by clams in Connecticut, oysters and clams in New York, and denitrification are not included. Optimistically, the calculation of oyster-associated removal from all leases in both states (5% of bottom area) plus denitrification losses showed increases to 10%-30% of annual inputs, which would be higher if clams were included. Results are specific to Long Island Sound, but the approach is transferable to other urban estuaries.

Biomarkers of oxidatively induced DNA damage in dreissenid mussels: A genotoxicity assessment tool for the Laurentian Great Lakes.

Activities of fast growing human population are altering freshwater ecosystems, endangering their inhabitants and public health. Organic and trace compounds have a high potential for adverse impacts on aquatic organisms in some Great Lakes tributaries. Toxic compounds in tissues of organisms living in contaminated environments change their metabolism and alter cellular components. We measured oxidatively induced DNA damage in the soft tissues of dreissenid mussels to check on the possible contaminant-induced impact on their DNA. The animals were obtained from archived samples of the National Oceanic and Atmospheric Administration (NOAA) Mussel Watch Program. Mussels were collected from the harbor of Ashtabula River in Ohio, and a reference area located at the Lake Erie shore. Using gas chromatography-tandem mass spectrometry with isotope dilution, we identified and quantified numerous oxidatively modified DNA bases and 8,5'-cyclopurine-2'-deoxynucleosides. We found significant differences in the concentrations of these potentially mutagenic and/or lethal lesions in the DNA of mussels from the harbor as compared to the animals collected at the reference site. These results align NOAA's data showing that elevated concentrations of polycyclic aromatic hydrocarbons (PAHs), polychlorinated biphenyls (PCBs), and heavy metals were found in mussels within the harbor as compared to mussels collected in the reference site. The measured DNA lesions can be used as biomarkers for identifying DNA damage in mussels from polluted and reference sites. Such biomarkers are needed to identify the bioeffects of contaminants in affected organisms, as well as whether remedial actions have proven successful in reducing observed toxic effects.

The patient who 'must not be told': demographic factors associated with collusion in a retrospective study in South India.

BACKGROUND: Patients with cancer need adequate information about diagnosis, treatment options, and possible outcomes and prognosis to make therapeutic decisions. In cultures where the family plays the dominant role in healthcare decisions, doctors are often requested to collude in withholding distressing information from the patient. This challenging situation has not been well studied and there is limited knowledge on the different factors that may contribute to collusion. OBJECTIVE: To study the prevalence of collusion among adult cancer patients attending a palliative care outpatient clinic and the contributing factors. METHODS: The healthcare records of 306 adult cancer patients who had visited the palliative care outpatient clinic at least three times with follow-up until death were retrospectively reviewed. Details on information shared and why it was not shared were retrieved from the documentation in the communication sheet in the patient chart. The prevalence, sociodemographic and clinical factors that could contribute to collusion in doctor-patient communication were studied. RESULTS: Collusion was present in 40% of cases at the time of referral to the palliative care outpatient clinic (collusion regarding diagnosis in 18%; collusion regarding prognosis in 40%). Collusion was later addressed in 35%. Collusion was significantly higher among female patients (p=0.005), manual workers (p=0.035), those not accompanied by a spouse (p=0.000) and with no oncological treatment (p=0.001). CONCLUSIONS: Collusion regarding diagnosis or prognosis is common among cancer patients referred for palliative care. It was more prevalent among female patients, manual workers, patients who had not received oncological treatment, and patients not accompanied by a spouse.

Ecological impacts of fluridone and copper sulphate in catfish aquaculture ponds.

Fluridone and copper sulphate are often used for controlling macrophytes and algae in aquaculture ponds. The present study examined the ecological effects of these chemicals on macrophyte, phytoplankton, and zooplankton biomass; plankton community structure; water quality parameters; and fish survival and yield in catfish culture ponds using a randomized complete block design. The estimated half-life of fluridone in the individual ponds ranged from 1.6 d to 10.8 d. Free copper ion activity in ponds treated with copper sulphate was dynamic, ranging from pCu of 7.7 to 8.9 after each application and decreasing to approximately 12 (1 × 10(-12) M) within 1 wk after each application, approaching observed values in control ponds (pCu = 12.3-13.4). No difference in macrophyte biomass was observed among treatments. Fluridone and copper treatments elicited different responses within the phytoplankton community. Copper treatments reduced Cyanophyta biomass but increased biomass of more tolerant taxa among the Chlorophyta and Chrysophyta. Fluridone treatments reduced total phytoplankton biomass including Cyanophyta and increased the sensitivity of Chlorophyta and Chrysophyta to copper. Copper also affected zooplankton community composition as a result of direct toxic effects on sensitive zooplankton taxa (e.g., Cladocera), whereas Copepoda biomass in copper-treated ponds exceeded that in controls. Catfish survival and yield were not significantly different among treatments. The results of the present study suggest that fluridone and copper interact at realistic application rates, increasing the ability to control algae compared with treatments where they are applied alone.