An Updated Review of Ciguatera Fish Poisoning: Clinical, Epidemiological, Environmental, and Public Health Management.

Ciguatera Fish Poisoning (CFP) is the most frequently reported seafood-toxin illness in the world. It causes substantial human health, social, and economic impacts. The illness produces a complex array of gastrointestinal, neurological and neuropsychological, and cardiovascular symptoms, which may last days, weeks, or months. This paper is a general review of CFP including the human health effects of exposure to ciguatoxins (CTXs), diagnosis, human pathophysiology of CFP, treatment, detection of CTXs in fish, epidemiology of the illness, global dimensions, prevention, future directions, and recommendations for clinicians and patients. It updates and expands upon the previous review of CFP published by Friedman et al. (2008) and addresses new insights and relevant emerging global themes such as climate and environmental change, international market issues, and socioeconomic impacts of CFP. It also provides a proposed universal case definition for CFP designed to account for the variability in symptom presentation across different geographic regions. Information that is important but unchanged since the previous review has been reiterated. This article is intended for a broad audience, including resource and fishery managers, commercial and recreational fishers, public health officials, medical professionals, and other interested parties.

Stromal Vascular Fraction from Lipoaspirate Infranatant: Comparison Between Suction-Assisted Liposuction and Nutational Infrasonic Liposuction.

INTRODUCTION: Lipoaspirate has shown great promise as a source of progenitor cells for use in regenerative medicine. The stromal vascular fraction (SVF) can be isolated from lipoaspirate using enzyme digestion and centrifugation, but this approach may be limited by the labor-intensive nature of the technique as well as ambiguities in current governmental regulations. An alternative approach to obtain SVF from lipoaspirate was studied. METHOD: Paired (collected from contralateral regions) lipoaspirate specimens were acquired from 30 consenting patients (age 24-62; 22 females, 8 males) by suction-assisted liposuction (SAL) and nutational infrasonic liposuction (NIL). The infranatant from 50 ml of adipose tissue (LAF) was centrifuged at 400g × 5 min and the resultant pellet was collected with a pipette. Time = 15-20 min. The respective SVFs cell populations were counted using an optical fluorescent cell counter (Nexcelom A2000) and the fluorescent stains-acridine orange (AO) and propidium iodide (PI). RESULTS: The number of nucleated, live cells from SAL infranatant was 97,345 ± 23,435 per ml of adipose tissue and from NIL infranatant was 335,621 ± 81,274 per ml of adipose tissue. The p value is <0.00001, n = 30. CONCLUSION: Regenerative cells can be isolated from the lipoaspirate infranatant from either SAL or NIL, although in lower quantities than from enzyme digestion. NIL acquisition yielded 3.5× the number of cells over that acquired from SAL. The time, skill, and cost of producing SVF from infranatant is less than using enzyme digestion, which potentially make these regenerative therapies accessible to more physicians and patients. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A novel approach to ablative fractional treatment of mature thermal burn scars.

This report details the use of a fractionated ablative Er:YAG laser in treating two cases of thermal burn injuries using a novel approach which matches the energy required to the depth of the burn scar. This method is termed "selective objective fractional technique (SOFT)".

Statistics of heart failure and mechanical circulatory support in 2020.

Heart failure is increasing in prevalence, with approximately 26 million patients affected worldwide. This represents a significant cause of morbidity and mortality. Statistics regarding heart failure patient age, hospitalization likelihood, and mortality differ significantly by country. Heart failure patients are typically classified by ejection fraction, with distinct phenotypes associated with reduced ejection fraction (rEF) or preserved ejection fraction (pEF). Heart failure has a significant financial impact related to hospitalization, medication, and procedural expenses. The costs of heart failure also extend to the reduced quality of life conferred by heart failure symptoms. Management of heart failure includes a variety of interventions, including mechanical circulatory support (MCS). MCS, including left ventricular assist devices (LVADs), right ventricular assist devices (RVADs) and extracorporeal membrane oxygenation (ECMO), has been a means of managing end stage heart failure. Given the relative scarcity of transplant organs, the utilization of MCS, particularly as a bridge to transplantation (BTT) has grown significantly. In this review, we discuss statistics related to heart failure and MCS. We evaluate how patients are classified and examine global trends and regional differences. We then address MCS therapies, the costs associated with heart failure, the impact of heart failure on patient quality of life, and data regarding morbidity and mortality.

Chain of custody as an organizing framework in seafood risk reduction.

Changes in the terms and direction of international trade in seafood, an increased understanding of and concern for the public health risk imposed by seafood products, and advances in information management technology combine to open opportunities to manage more effectively seafood-borne risk. Present regulatory mandates and programs lack sufficient integration for effective risk mitigation and do not adequately reflect the trans-national nature of seafood trade or the increased complexity of seafood production. This paper argues that the concept of a "chain of custody" - from the ocean to the final consumer - provides a useful integrating framework for understanding and refining efforts to reduce public health concerns surrounding the consumption of seafood.

Rapid Assessment of Marine Pollution (RAMP).

RAMP embraces the integrated use of methods for the rapid measurement, assessment and access to information on the nature, sources and influences of coastal environmental change. It embraces approaches held in the literature, research and programs of RAMP (Rapid Assessment of Marine Pollution) and the emerging work described as RASE (Rapid Assessment of Socio-Economic Indicators). To protect coastal ecosystems and the health of communities effectively, management infrastructure requires the tools and resources necessary to detect damage to coastal ecosystems and their components, identify causative agents, impose remedial action, and demonstrate that measures have been effective. Pragmatic monitoring and prediction capabilities must also be built to provide further confidence that human impacts are being minimized and that threats to human health have been contained. For most of the world, however, the ability to build such capability is a technical challenge and often cost prohibitive. These constraints point to the need to develop and expand the integrated use of simple, robust, cost-effective environmental assessment procedures. This paper suggests that a system built around the Rapid Assessment of Marine Pollution (RAMP) and the Rapid Assessment of Socio-Economic Indicators (RASE) can, should and in some cases already has been effective in meeting such informational and management needs.

The sum is greater than its parts: clinical evaluations and grade inflation in the surgery clerkship.

BACKGROUND: This study examines grading component distributions to determine whether alterations in clinical grade determination reduce skew and improve predictive capability of the clinical evaluation. METHODS: Rotation evaluations, examination scores, and final grades were collected for third-year medical students over a 2-year period. Conditional logistic regression and ordinary least squares regression models were run using SAS 9.3. RESULTS: Conditional logistic regression demonstrated significant association between global clinical score and final grade and between average clinical evaluation score and final grade. Inclusion of shelf score into either model demonstrated increase in overall final grade. CONCLUSIONS: Regressions using global and average clinical evaluation score indicate that average score is a better fit for a norm-based grading system. Arguably, the Shelf measures clinical knowledge more objectively than clinical evaluation, but both were significant. Clinical evaluation is prone to inflation because of its subjective nature; conceivably, inflation leads to the decreased correlation with shelf score.

Indicators of ocean health and human health: developing a research and monitoring framework.

We need to critically assess the present quality of the marine ecosystem, especially the connection between ecosystem change and threats to human health. In this article we review the current state of indicators to link changes in marine organisms with eventual effects to human health, identify research opportunities in the use of indicators of ocean and human health, and discuss how to establish collaborations between national and international governmental and private sector groups. We present a synthesis of the present state of understanding of the connection between ocean health and human health, a discussion of areas where resources are required, and a discussion of critical research needs and a template for future work in this field. To understand fully the interactions between ocean health and human health, programs should be organized around a "models-based" approach focusing on critical themes and attributes of marine environmental and public health risks. Given the extent and complex nature of ocean and human health issues, a program networking across geographic and disciplinary boundaries is essential. The overall goal of this approach would be the early detection of potential marine-based contaminants, the protection of marine ecosystems, the prevention of associated human illness, and by implication, the development of products to enhance human well-being. The tight connection between research and monitoring is essential to develop such an indicator-based effort.

Biaxial mechanical properties of the human thoracic and abdominal aorta, common carotid, subclavian, renal and common iliac arteries.

The biomechanics of large- and medium-sized arteries influence the pathophysiology of arterial disease and the response to therapeutic interventions. However, a comprehensive comparative analysis of human arterial biaxial mechanical properties has not yet been reported. Planar biaxial extension was used to establish the passive mechanical properties of human thoracic (TA, [Formula: see text]) and abdominal (AA, [Formula: see text]) aorta, common carotid (CCA, [Formula: see text]), subclavian (SA, [Formula: see text]), renal (RA, [Formula: see text]) and common iliac (CIA, [Formula: see text]) arteries from 11 deceased subjects ([Formula: see text] years old). Histological evaluation determined the structure of each specimen. Experimental data were used to determine constitutive parameters for a structurally motivated nonlinear anisotropic constitutive model. All arteries demonstrated appreciable anisotropy and large nonlinear deformations. Most CCA, SA, TA, AA and CIA specimens were stiffer longitudinally, while most RAs were stiffer circumferentially. A switch in anisotropy was occasionally demonstrated for all arteries. The CCA was the most compliant, least anisotropic and least frequently diseased of all arteries, while the CIA and AA were the stiffest and the most diseased. The severity of atherosclerosis correlated with age, but was not affected by laterality. Elastin fibers in the aorta, SA and CCA were uniformly and mostly circumferentially distributed throughout the media, while in the RA and CIA, elastin was primarily axially aligned and concentrated in the external elastic lamina. Constitutive modeling provided good fits to the experimental data for most arteries. Biomechanical and architectural features of major arteries differ depending on location and functional environment. A better understanding of localized arterial mechanical properties may support the development of site-specific treatment modalities for arterial disease.