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Introduction: Capnography aids assessment of the adequacy of mechanical patient ventilation. Physical and physiological changes in hyperbaric environments create ventilation challenges which make end-tidal carbon dioxide (ETCO2) measurement particularly important. However, obtaining accurate capnography in hyperbaric environments is widely considered difficult. This study investigated the EMMA capnograph for hyperbaric use. Methods: We compared the EMMA capnograph to sidestream capnography and the gold standard arterial carbon dioxide blood gas analysis in a hyperbaric chamber. In 12 resting subjects breathing air at 284 kPa, we recorded ETCO2 readings simultaneously derived from the EMMA and sidestream capnographs during two series of five breaths (total 24 measurements). An arterial blood gas sample was also taken simultaneously in five participants. Results: Across all measurements there was a difference of about 0.1 kPa between the EMMA and sidestream capnographs indicating a very slight over-estimation of ETCO2 by the EMMA capnograph, but fundamentally good agreement between the two end-tidal measurement methods. Compared to arterial blood gas pressure the non-significant difference was about 0.3 and 0.4 kPa for the EMMA and sidestream capnographs respectively. Conclusions: In this study, the EMMA capnograph performed equally to the sidestream capnograph when compared directly, and both capnography measures gave clinically acceptable estimates of arterial PCO2. [ABSTRACT FROM AUTHOR]

Introduction: Air flow in full-face snorkel masks (FFSMs) should be unidirectional to prevent rebreathing of exhaled air. This study evaluated rebreathing and its consequences when using FFSMs compared to a conventional snorkel. Methods: In a dry environment 20 participants wore three types of snorkel equipment in random order: Subea Easybreath FFSM; QingSong 180-degree panoramic FFSM; and a Beuchat Spy conventional snorkel (with nose clip), in three conditions: rest in a chair; light; and moderate intensity exercise on a cycle ergometer. Peripheral oxygen saturation, partial pressure of carbon dioxide (PCO2) and oxygen (PO2) in the end tidal gas and FFSM eye-pockets, respiratory rate, minute ventilation, were measured continuously. Experiments were discontinued if oxygen saturation dropped below 85%, or if end-tidal CO2 exceeded 7.0 kPa. Results: Experimental runs with the FFSMs had to be discontinued more often after exceeding 7.0 kPa end-tidal CO2 compared to a conventional snorkel e.g., 18/40 (45%) versus 4/20 (20%) during light intensity exercise, and 9/22 (41%) versus 3/16 (19%) during moderate intensity exercise. Thirteen participants exhibited peripheral oxygen saturations below 95% (nine using FFSMs and four using the conventional snorkel) and five fell below 90% (four using FFSMs and one using the conventional snorkel). The PCO2 and PO2 in the eye-pockets of the FFSMs fluctuated and were significantly higher and lower respectively than in inspired gas, which indicated rebreathing in all FFSM wearers. Conclusions: Use of FFSMs may result in rebreathing due to non-unidirectional flow, leading to hypercapnia and hypoxaemia. [ABSTRACT FROM AUTHOR]

Recent literature has shown the advantages of outpatient surgery for many shoulder and elbow procedures, including cost savings with equivalent safety in appropriately selected patients. Two common settings for outpatient surgeries are ambulatory surgery centers (ASCs), which function as independent financial and administrative entities, or hospital outpatient departments (HOPDs), which are owned and operated by hospital systems. The purpose of this study was to compare shoulder and elbow surgery costs between ASCs and HOPDs. Publicly available data from 2022 provided by the Centers for Medicare & Medicaid Services (CMS) was accessed via the Medicare Procedure Price Lookup Tool. Current Procedural Terminology (CPT) codes were used to identify shoulder and elbow procedures approved for the outpatient setting by CMS. Procedures were grouped into arthroscopy, fracture, or miscellaneous. Total costs, facility fees, Medicare payments, patient payment (costs not covered by Medicare), and surgeon's fees were extracted. Descriptive statistics were used to calculate means and standard deviations. Cost differences were analyzed using Mann-Whitney U tests. Fifty-seven CPT codes were identified. Arthroscopy procedures (n = 16) at ASCs had significantly lower total costs ($2667 ± $989 vs. $4899 ± $1917; P =.009), facility fees ($1974 ± $819 vs. $4206 ± $1753; P =.008), Medicare payments ($2133 ± $791 vs. $3919 ± $1534; P =.009), and patient payments ($533 ± $198 vs. $979 ± $383; P =.009) compared with HOPDs. Fracture procedures (n = 10) at ASCs had lower total costs ($7680 ± $3123 vs. $11,335 ± $3830; P =.049), facility fees ($6851 ± $3033 vs. $10,507 ± $3733; P =.047), and Medicare payments ($6143 ± $2499 vs. $9724 ± $3676; P =.049) compared with HOPDs, although patient payments were not significantly different ($1535 ± $625 vs. $1610 ± $160; P =.449). Miscellaneous procedures (n = 31) at ASCs had lower total costs ($4202 ± $2234 vs. $6985 ± $2917; P <.001), facility fees ($3348 ± $2059 vs. $6132 ± $2736; P <.001), Medicare payments ($3361 ± $1787 vs. $5675 ± $2635; P <.001), and patient payments ($840 ± $447 vs. $1309 ± $350; P <.001) compared with HOPDs. The combined cohort (n = 57) at ASCs had lower total costs ($4381 ± $2703 vs. $7163 ± $3534; P <.001), facility fees ($3577 ± $2570 vs. $6539.1 ± $3391; P <.001), Medicare payments ($3504 ± $2162 vs. $5892 ± $3206; P <.001), and patient payments ($875 ± $540 vs. $1269 ± $393; P <.001) compared with HOPDs. Shoulder and elbow procedures performed at HOPDs for Medicare recipients were found to have average total cost increase of 164% compared with those performed at ASCs (184% savings for arthroscopy, 148% for fracture, and 166% for miscellaneous). ASC use conferred lower facility fees, patient payments, and Medicare payments. Policy efforts to incentivize migration of surgeries to ASCs may translate into substantial health care cost savings. [ABSTRACT FROM AUTHOR]

Introduction: Hypoxia can cause central nervous system dysfunction and injury. Hypoxia is a particular risk during rebreather diving. Given its subtle symptom profile and its catastrophic consequences there is a need for reliable hypoxia monitoring. Electroencephalography (EEG) is being investigated as a real time monitor for multiple diving problems related to inspired gas, including hypoxia. Methods: A systematic literature search identified articles investigating the relationship between EEG changes and acute cerebral hypoxia in healthy adults. Quality of clinical evidence was assessed using the Newcastle-Ottawa scale. Results: Eighty-one studies were included for analysis. Only one study investigated divers. Twelve studies described quantitative EEG spectral power differences. Moderate hypoxia tended to result in increased alpha activity. With severe hypoxia, alpha activity decreased whilst delta and theta activities increased. However, since studies that utilised cognitive testing during the hypoxic exposure more frequently reported opposite results it appears cognitive processing might mask hypoxic EEG changes. Other analysis techniques (evoked potentials and electrical equivalents of dipole signals), demonstrated sustained regulation of autonomic responses despite worsening hypoxia. Other studies utilised quantitative EEG analysis techniques, (Bispectral index [BISTM], approximate entropy and Lempel-Ziv complexity). No change was reported in BISTM value, whilst an increase in approximate entropy and Lempel-Ziv complexity occurred with worsening hypoxia. Conclusions: Electroencephalographic frequency patterns change in response to acute cerebral hypoxia. There is paucity of literature on the relationship between quantitative EEG analysis techniques and cerebral hypoxia. Because of the conflicting results in EEG power frequency analysis, future research needs to quantitatively define a hypoxia-EEG response curve, and how it is altered by concurrent cognitive task loading. [ABSTRACT FROM AUTHOR]

Four-corner fusion (4CF) is a surgical option for refractory scapholunate advanced collapse and scaphoid nonunion advanced collapse wrist arthritis. Preoperative range of motion (ROM) predicts outcomes in many orthopedic procedures. This study investigates ROM in a cohort of 4CF patients to examine the relationship between preoperative and postoperative motion and identifies different clinical patterns. We performed a retrospective review of 4CF patients. Patients with a history of inflammatory arthritis and radiographic characteristics of inflammation were excluded. Demographics, prior wrist surgery history, and ROM data were collected at preoperative and postoperative intervals after cast removal at 8 weeks, 3 months, and 8 months. Regression analysis compared the motion before and after 4CF. Subsequent cluster analysis to reduce confounding compared postoperative motion differences in the top 20% to the bottom 20% of patients by preoperative motion. We included 148 patients; 27 had prior surgery on the ipsilateral wrist. Preoperative arc averaged 86° ± 28° (flexion 46° ± 17°, extension 40° ± 15°); 8-week arc 43° ± 19° (flexion 19° ± 12°, extension 24° ± 12°); 3-month arc 62° ± 17° (flexion 30° ± 12°, extension 32° ± 11°); and 8-month arc 74° ± 17° (flexion 36° ± 11°, extension 37° ± 12°). Preoperative and final arcs were (r = 0.39). Clustering by the preoperative arc, the top 20% (mean 124° ± 15°) achieved a mean final arc of 81° ± 16°, while the bottom 20% (mean 47° ± 16°) achieved a mean final arc of 65° ± 19°. Intercluster differences were statistically significant. The bottom 20% gained motion postoperatively. Most patients in the middle 60% did not differ significantly in postoperative motion. Although wrist motion following 4CF correlates positively with preoperative motion, most patients do not differ significantly in postoperative motion. Patients with substantial preoperative motion deficits gain motion after 4CF. This information is important when counseling patients, determining the timing of surgical intervention, and managing expectations related to motion outcomes. Prognostic II. [ABSTRACT FROM AUTHOR]

Introduction: Critical flicker fusion frequency (CFFF) has been used in various studies to measure the cognitive effects of gas mixtures at depth, sometimes with conflicting or apparently paradoxical results. This study aimed to evaluate a novel automatic CFFF method and investigate whether CFFF can be used to monitor gas-induced narcosis in divers. Methods: Three hyperbaric chamber experiments were performed: 1) Automated and manual CFFF measurements during air breathing at 608 kPa (n = 16 subjects); 2) Manual CFFF measurements during air and heliox breathing at sea level (101.3 kPa) and 608 kPa (n = 12); 3) Manual CFFF measurements during oxygen breathing at sea level, 142 and 284 kPa (n = 10). All results were compared to breathing air at sea level. Results: Only breathing oxygen at sea level, and at 284 kPa, caused a significant decrease in CFFF (2.5% and 2.6% respectively compared to breathing air at sea level. None of the other conditions showed a difference with sea level air breathing. Conclusions: CFFF did not significantly change in our experiments when breathing air at 608 kPa compared to air breathing at sea level pressure using both devices. Based on our results CFFF does not seem to be a sensitive tool for measuring gas narcosis in divers in our laboratory setting. [ABSTRACT FROM AUTHOR]

Introduction: In 2018 12 children and one adult were anaesthetised before being extricated through over a kilometre of flooded cave in Thailand. Full face dive masks (FFMs) putatively capable of maintaining constant positive airway pressure (CPAP) were employed. Here we describe the anaesthetic intervention and investigate the CPAP capability of the FFM. Methods: Pressure was measured inside and outside the Interspiro Divator FFM during 10 tidal and 10 vital capacity breaths in divers at the surface and submerged with the mask deployed on open-circuit scuba (10 divers); and a closed-circuit rebreather (five divers). Relative in-mask pressure was calculated as the difference between inside and outside pressures. We also measured the in-mask pressure generated by activation of the second stage regulator purge valve in open-circuit mode. Results: When submerged in open-circuit mode the mean relative in-mask pressure remained positive in normal tidal breathing (inhalation 0.6 kPa [95% CI 0.3–0.9]; exhalation 1.1 [0.8–1.4]) and vital capacity breathing (inhalation 0.8 [0.4–1.1]; exhalation 1.2 [0.9–1.4]). As expected, the relative in-mask pressure was predominantly negative when used on closed-circuit with back mounted counter-lungs due to a negative static lung load. Mean in-mask pressure during purge valve operation was 3.99 kPa (approximately equal to 40 cmH2O) (range: 2.56 to 5.3 kPa). Conclusions: The CPAP function of the Interspiro Divator FFM works well configured with open-circuit scuba. This may have contributed to the success of the Thailand cave rescue. Caution is required in generalising this success to other diving scenarios. [ABSTRACT FROM AUTHOR]

Introduction: Gas narcosis impairs divers when diving deeper. Pupillometry is sensitive to alcohol intoxication and it has been used in anaesthesia to assess nitrous oxide narcosis. It is a potential novel method to quantify narcosis in diving. The aim of this study was to evaluate pupillometry for objective measurement of narcosis during exposure to hyperbaric air or nitrous oxide. Method: Pupil size in 16 subjects was recorded directly at surface pressure and during air breathing at 608 kPa (equivalent to 50 metres’ seawater depth) in a hyperbaric chamber. Another 12 subjects were exposed to nitrous oxide at end-tidal percentages of 20, 30 and 40% in random order at surface pressure. Pupil size and pupil light reflex were recorded at baseline and at each level of nitrous oxide exposure. Results: Pupil size did not significantly change during exposure to hyperbaric air or nitrous oxide. The pupil light reflex, evaluated using percentage constriction and minimum diameter after exposure to a light stimulus, was affected significantly only during the highest nitrous oxide exposure – an end-tidal level of 40%. Conclusion: Pupillometry is insensitive to the narcotic effect of air at 608 kPa in the dry hyperbaric environment and to the effects of low dose nitrous oxide. Pupillometry is not suitable as a monitoring method for gas narcosis in diving. [ABSTRACT FROM AUTHOR]

Graphical abstract Highlights • Allelochemicals are described in leaves and inflorescences from Sambucus nigra. • First-ever report of the pheromone L-isoleucine methyl ester present in Adoxaceae plants. • The cyanogenic compound mandelonitrile is the most abundant in leaf extracts of Sambucus nigra. • n -Alkyl and benzylacyl esters, mandelonitrile and isoleucine methyl ester are characterized by GC-EIMS of their trimethylsilyl derivatives. Abstract Allelochemical compounds were detected in leaves and inflorescences of Sambucus nigra L. by means of GC-EIMS. The identified compounds were characterized by their mass spectra and relative retention times as their trimethylsilyl derivatives. The pheromone L-isoleucine methyl ester extracted from inflorescences can attract pollinator insects during the flowering period and together with uncommon n -alkyl and benzyl esters were firstly identified in S. nigra. On the other hand, mandelonitrile, which is used by the plant to avoid herbivore attack, was observed as the most abundant compound from the leaf extracts. In the present work are described 154 compounds from leaves and 196 from inflorescences including alkanes, alcohols, acids and terpenoids from elder aerial parts. [ABSTRACT FROM AUTHOR]

The VISAGE Enhanced Tool for Appearance and Ancestry (ET) has been designed to combine markers for the prediction of bio-geographical ancestry plus a range of externally visible characteristics into a single massively parallel sequencing (MPS) assay. We describe the development of the ancestry panel markers used in ET, and the enhanced analyses they provide compared to previous MPS-based forensic ancestry assays. As well as established autosomal single nucleotide polymorphisms (SNPs) that differentiate sub-Saharan African, European, East Asian, South Asian, Native American, and Oceanian populations, ET includes autosomal SNPs able to efficiently differentiate populations from Middle East regions. The ability of the ET autosomal ancestry SNPs to distinguish Middle East populations from other continentally defined population groups is such that characteristic patterns for this region can be discerned in genetic cluster analysis using STRUCTURE. Joint cluster membership estimates showing individual co-ancestry that signals North African or East African origins were detected, or cluster patterns were seen that indicate origins from central and Eastern regions of the Middle East. In addition to an augmented panel of autosomal SNPs, ET includes panels of 85 Y-SNPs, 16 X-SNPs and 21 autosomal Microhaplotypes. The Y- and X-SNPs provide a distinct method for obtaining extra detail about co-ancestry patterns identified in males with admixed backgrounds. This study used the 1000 Genomes admixed African and admixed American sample sets to fully explore these enhancements to the analysis of individual co-ancestry. Samples from urban and rural Brazil with contrasting distributions of African, European, and Native American co-ancestry were also studied to gauge the efficiency of combining Y- and X-SNP data for this purpose. The small panel of Microhaplotypes incorporated in ET were selected because they showed the highest levels of haplotype diversity amongst the seven population groups we sought to differentiate. Microhaplotype data was not formally combined with single-site SNP genotypes to analyse ancestry. However, the haplotype sequence reads obtained with ET from these loci creates an effective system for de-convoluting two-contributor mixed DNA. We made simple mixture experiments to demonstrate that when the contributors have different ancestries and the mixture ratios are imbalanced (i.e., not 1:1 mixtures) the ET Microhaplotype panel is an informative system to infer ancestry when this differs between the contributors. • 226 ancestry (BGA) markers compiled for VISAGE Enhanced Tool (ET) combined with 184 appearance markers in one MPS assay. • Autosomal BGA SNP number in ET reduced to allow inclusion of 85 Y-SNPs, 16 X-SNPs and 21 Microhaplotypes (MHs). • Extra BGA markers give enhanced detail of co-ancestry patterns in admixed males and MH loci allow ancestry-based mixed DNA. • Comprehensive reference population datasets and analyses of global distribution of variation in the ET BGA markers outlined. • Expanded Middle East-informative SNPs enhance differentiation of these populations particularly when combined with nested K:5 STRUCTURE runs. [ABSTRACT FROM AUTHOR]

The Amazonia rainforest, in South America, harbours native populations with high ethnic diversity. The evaluation of the genetic composition of these populations represents a challenge, and only few studies are available describing its native groups. In this work, the maternal inheritance of 170 Ashaninka individuals living in the Amazonia region of Pasco department, Peru, was evaluated by mtDNA control region sequencing. As previously observed for other native groups from Amazonia, low haplotype diversity was obtained, and only Native American haplogroups were found. Strong founder effects were observed, especially for sub haplogroups A2aa, B2b+152, C1b and D1. During the European colonial period, the Ashaninka population seems to have remained relatively isolated, which can be explained by its remote location in the tropical forest. A comparison with other native South American populations from different linguistic families showed a lack of geographic or linguistic affiliations, highlighting the importance of having specific mtDNA database for the native groups in South America. [ABSTRACT FROM AUTHOR]

Responding to the growing scientific and practical interest in forensic DNA phenotyping, the VISible Attributes through GEnomics (VISAGE) Consortium was founded in 2017 with the main goal of developing and validating new and reliable molecular and statistical tools to predict appearance, ancestry and age from DNA. Here, we describe the development and inter-laboratory evaluation and validation of the VISAGE Enhanced Tool for Appearance and Ancestry inference from DNA. The VISAGE Enhanced Tool for Appearance and Ancestry is the first forensic-driven genetic laboratory tool that comprises well-established markers for eye, hair and skin color with more recently discovered DNA markers for eyebrow color, freckling, hair shape and male pattern baldness and bio-geographic ancestry informative DNA markers. The bio-geographic ancestry markers include autosomal SNPs (bi- and tri-allelic SNPs), X-SNPs, Y-SNPs and autosomal Microhaplotypes. In total, primers targeting 524 SNPs (representing a 97.6% assay conversion rate) were successfully designed using AmpliSeq into a single primer pool (i.e., one multiplex assay) and sequenced with the Ion S5. In a collaborative framework, five VISAGE laboratories tested the VISAGE Enhanced Tool for Appearance and Ancestry on reproducibility, sensitivity, genotyping concordance, mixtures, species specificity and performance in relevant forensic conditions, including inhibitor-spiked, mock casework and artificially degraded samples. Based on our results, the VISAGE Enhanced Tool for Appearance and Ancestry is a robust, reproducible, and – for the large SNP number - fairly sensitive MPS assay with high concordance rates. With the VISAGE Enhanced Tool for Appearance and Ancestry introduced here, the VISAGE Consortium delivers the first single DNA-test for combined appearance prediction based on seven traits together with bio-geographic ancestry inference based on major continental regions for separated bi-parental and paternal ancestry, which represents the most comprehensive validated laboratory tool currently available for Forensic DNA Phenotyping. • Development of a new molecular assay composed of 524 SNPs for appearance and ancestry estimation. • An inter-laboratory exercise was conducted to evaluate the performance. • Forensic sensitivity (100 pg) despite a 3.5x increase in targeted markers compared to earlier tools. • Mixtures, challenging samples including GEDNAP, sonicated and inhibited samples were evaluated. [ABSTRACT FROM AUTHOR]

We have discovered that leaves from the halotolerant plant saltcedar ( Tamarix canariensis [Willd.]) are a source of resorcinols and guaiacols. Specifically, the waxes of the saltcedar leaves contained high amounts of 5 -n -alkylresorcinols (ARs; 17 g/kg dry weight), 5 -n -alkyl -m -guaiacols (AGs; 14 g/kg dw) and secondary alcohols (44 g/kg dw). Herein we provide the report of 5- n -alkylresorcinols with long side-alkyl chains as natural compounds in Tamaricaceae. These compounds are homologous to ones previously reported almost exclusively in cereals. The ARs span the formulas n -C 14 to n -C 27 , the most abundant of which is n -C 21 . Although the odd-C-numbered compounds dominate, there are non-negligible amounts of the even-numbered homologs. We also provide, the first-ever report of 11 homologs of 5 -n -alkyl -m -guaiacols (AGs) as natural compounds from the sample plant, which we characterized as the corresponding trimethylsilyl (TMS)-ether derivatives. The AGs contain a hydroxyl group at carbon 1 of the phenolic nucleus, a methoxy group at position 3, and a (predominantly odd-C-numbered) linear alkyl chain linked to the benzene ring at position 5. They span the formulas n -C 13 to n -C 27 , the most abundant of which is n -C 21 . Finally, we also isolated from saltcedar a series of eight asymmetric secondary alcohols, whose formulas range from n -C 25 to n -C 35 and whose major homolog is n -hentriacontan-12-ol. [ABSTRACT FROM AUTHOR]

The analysis of DNA methylation has become an established method for chronological age estimation. This has triggered interest in the forensic community to develop new methods for age estimation from biological crime scene material. Various assays are available for age estimation from somatic tissues, the majority from blood. Age prediction from semen requires different DNA methylation markers and the only assays currently developed for forensic analysis are based on SNaPshot or pyrosequencing. Here, we describe a new assay using massively parallel sequencing to analyse 13 candidate CpG sites targeted in two multiplex PCRs. The assay has been validated by five consortium laboratories of the VISible Attributes through GEnomics (VISAGE) project within a collaborative exercise and was tested for reproducible quantification of DNA methylation levels and sensitivity with DNA methylation controls. Furthermore, DNA extracts and stains on Whatman FTA cards from two semen samples were used to evaluate concordance and mimic casework samples. Overall, the assay yielded high read depths (> 1000 reads) at all 13 marker positions. The methylation values obtained indicated robust quantification with an average standard deviation of 2.8% at the expected methylation level of 50% across the 13 markers and a good performance with 50 ng DNA input into bisulfite conversion. The absolute difference of quantifications from one participating laboratory to the mean quantifications of concordance and semen stains of remaining laboratories was approximately 1%. These results demonstrated the assay to be robust and suitable for age estimation from semen in forensic investigations. In addition to the 13-marker assay, a more streamlined protocol combining only five age markers in one multiplex PCR was developed. Preliminary results showed no substantial differences in DNA methylation quantification between the two assays, indicating its applicability with the VISAGE age model for semen developed with data from the complete 13-marker tool. • Development of new targeted bisulfite MPS assays for age estimation from semen. • Bisulfite multiplex PCR design targeting 13 or 5 age markers. • Inter-laboratory validation showed stable and accurate DNA methylation quantification. • Robust results with 50 ng DNA input at bisulfite conversion level. [ABSTRACT FROM AUTHOR]

3:09 PM Abstract No. 4 FEATURED ABSTRACT Arterial embolization of the shoulder for pain secondary to adhesive capsulitis: interim results from an investigational device exemption US trial Neovascularity was identified in all patients by arteriography and AES was technically successful in all patients (16/16). Eleven patients were eligible for 1-month follow-up at present and demonstrated significant improvement in VAS (pre/post mean = 89/32, P = 0.00003), SANE (pre/post mean = 32/60, P = 0.02), and ASES (pre/post mean= 29/59, P = 0.004). [Extracted from the article]