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Introduction: Cannabinoid-related emergency department (ED) visits are increasing, yet little has been published about how the route of cannabinoid use (inhaled versus oral) affects ED presentations. We sought to compare ED visits from inhaled versus oral cannabinoid use. Methods: We performed a retrospective cohort study using ED patients with a cannabinoid related diagnosis from January 1, 2020 and May 31, 2023 from a single hospital system in Florida. We performed manual chart review to categorize visits into "unlikely", "possibly", or "highly likely" to be due to acute cannabinoid use. For our primary analysis, we used the "highly likely" group to compare the presentations and outcomes of patients who had used oral cannabinoids versus inhaled. Our primary outcome was hospital admission. Results: We deemed 303 patient visits "highly likely" to be from acute cannabinoids: 59 (19.5%) inhaled and 244 (80.5%) oral. Zero patients in the inhaled group were admitted compared to 15 (6.2%) in the oral group, a difference of 6.2% (95% CI 3.1–9.2%), p = 0.05. Additionally, 65 (26.7%) of the oral group reported using cannabinoids unintentionally including 8 housekeepers who ate food products left by hotel guests. Comparatively, 4 (6.8%) of the inhaled group unintentionally used cannabinoids (difference 19.9% [95% CI 11.4–28.3]). Conclusions: Most patients who presented to the ED for the effects of acute cannabinoids had used them orally. Compared to patients who had inhaled cannabinoids, those who used them orally required more ED diagnostic resources and were more likely to be admitted to the hospital for additional evaluation or treatment. From a public health perspective, increased regulation of edible cannabinoid products may be needed. [ABSTRACT FROM AUTHOR]

Purpose: Stroke, the second leading cause of death globally, often involves ischemia in the vertebrobasilar territory. This condition is underexplored, despite significant morbidity and mortality risks. The purpose of this study is to present a case of occipital artery to V3 segment vertebral artery bypass, emphasizing the role of quantitative magnetic resonance angiography (qMRA) in assessing flow and guiding surgical intervention. Methods: A 66-year-old man with bilateral vertebral artery occlusion presented acute symptoms. qMRA was employed to evaluate flow dynamics and determine the feasibility of a flow augmentation bypass surgery. The occipital artery to left vertebral artery bypass (OA-to-VA) was performed, utilizing an inverted hockey-stick incision and an antegrade inside-out technique. The patency of the bypass was confirmed using both Doppler probe and Indocyanine green. Results: Postoperative assessments, including computed tomography angiography (CTA) and qMRA, demonstrated the patency of the bypass with improved flow in the basilar artery and left vertebral artery. The patient's condition remained stable postoperatively, with residual peripheral palsy of the left facial nerve. Conclusion: In conclusion, the presented case illustrates the efficacy of the OA-to-VA bypass in addressing symptomatic bilateral vertebral artery occlusion. The study underscores the pivotal role of qMRA in pre- and postoperative assessments, providing noninvasive flow quantification for diagnostic considerations and long-term follow-up in patients with vertebrobasilar insufficiency. [ABSTRACT FROM AUTHOR]

The palmaris profundus muscle is a rare anatomical variation of the forearm muscles. It has been described in both cadaveric and clinical studies as a possible cause of carpal tunnel syndrome. We observed three cases of this variant in recent years and decided to perform a scoping review of this uncommon anatomical entity. Major databases were searched to identify all relevant clinical and anatomical studies containing anatomical descriptions of the muscle, including its origin, insertion, and concomitant presence of the proper palmaris longus muscle or the bifid median nerve. In clinical cases, we studied the surgical approach. Sixty-four articles met our inclusion criteria and contained 88 cases of palmaris profundus muscle. The most common origin was the ventral aspect of the radius in the area of insertion of the pronator teres muscle observed in 11 cases (12.5 %). We found 65 cases (73.3%) in which the tendon was inserted into the palmar aponeurosis or palmar fascia after entering the carpal canal. The concomitant presence of the proper palmaris longus muscle was described in 47 cases (53.4%). We identified 10 cases (10.8%) of the bifid median nerve. In 49 of 69 clinical cases (71%), the surgical approach was to resect the variant muscle. The importance of this variant should not be underestimated due to its potential to compress the median nerve. We found a significant disparity in the muscle origin sites, but uniformity of muscle insertion. In cases where the muscle is found during carpal canal surgery, it should be partially resected to ensure complete nerve decompression. [ABSTRACT FROM AUTHOR]

Purpose: We sought to determine the test characteristics of biliary point-of-care ultrasound (POCUS) and to assess the usefulness of obtaining radiology ultrasound (RUS) or cholescintigraphy (HIDA) after biliary POCUS. Methods: We conducted a retrospective review of emergency department patients who underwent biliary POCUS between May 4, 2018 and November 28, 2021. To be included, patients had to have at least one of the following confirmatory evaluations (considered in this order): surgery, HIDA, RUS, or abdominal CT scan. When a discrepancy existed between the POCUS and the RUS or HIDA, they were compared to a higher criterion standard (if available). Results: Using 348 patients who had a confirmatory evaluation after biliary POCUS, we found the sensitivity and specificity of biliary POCUS for gallstones to be 97.0% (95% CI 92.6 to 99.2%) and 99.5% (95% CI 97.3 to 100%), respectively. For cholecystitis, the sensitivity and specificity were 83.8% (95% CI 72.9 to 91.6%) and 98.6% (95% CI 96.4 to 99.6%), respectively. RUS and POCUS were concordant in 72 (81.8%) of 88 cases in which the patient had both studies while HIDA and POCUS were concordant in 24 (70.6%) of 34 cases. POCUS was deemed correct in at least 50% of discrepant cases with RUS and at least 30% of discrepant cases with HIDA. Conclusion: Biliary POCUS has excellent sensitivity and specificity for cholelithiasis; it has lower sensitivity for cholecystitis, but the specificity remains high. Performing a confirmatory RUS or cholescintigraphy after a positive biliary POCUS adds little value, but additional imaging may be useful when POCUS is negative for cholecystitis. [ABSTRACT FROM AUTHOR]

This study presents a chemometric protocol for the determination of site-specific elemental and strontium isotopic fingerprints in sturgeon caviar. The elemental and strontium isotopic composition of water, fish feed, salt, raw (i.e., unsalted) and salted sturgeon caviar samples from six fish farms in Europe and Iran was determined by (multi-collector) inductively coupled plasma mass spectrometry ((MC) ICP–MS). Multiple linear regression revealed six site-specific markers absorbed from water into sturgeon caviar (n(87Sr)/n(86Sr) isotope ratio and content of Na, Mn, Cu, Mo, Fe/Ca). Salting changed the chemical composition of four (n(87Sr)/n(86Sr), Na, Mn, Fe/Ca) of the six site-specific markers significantly. Washing of salted caviar could not fully remove the influence of salt on the affected site-specific markers. Therefore, a novel mathematical procedure based on mass balance calculations was developed for determining the n(87Sr)/n(86Sr) isotope ratio absorbed from water into sturgeon caviar. The resulting variable is an estimate for the environmental strontium isotopic signal and independent of the production process. Hierarchical cluster analysis showed that the combination of the mathematically determined n(87Sr)/n(86Sr) isotope ratio of water in sturgeon caviar and two site-specific markers, which were not affected by salting (Cu, Mo), allowed differentiating salted caviar samples from six fish farms into five distinct clusters. The proposed combination of statistical and mathematical tools provides the basis for origin determination of salted sturgeon caviar using site-specific elemental and strontium isotopic fingerprints, even in cases where the initial environmental signature was altered by the production process. [ABSTRACT FROM AUTHOR]

This paper presents a combination of elemental and isotopic spatial distribution imaging with near-infrared hyperspectral imaging (NIR-HSI) to evaluate the diagenetic status of skeletal remains. The aim is to assess how areas with biogenic n(87Sr)/n(86Sr) isotope-amount ratios may be identified in bone material, an important recorder complementary to teeth. Elemental (C, P, Ca, Sr) and isotopic (n(87Sr)/n(86Sr)) imaging were accomplished via laser ablation (LA) coupled in a split stream to a quadrupole inductively coupled plasma mass spectrometer (ICP-QMS) and a multicollector inductively coupled plasma mass spectrometer (MC ICP-MS) (abbreviation for the combined method LASS ICP-QMS/MC ICP-MS). Biogenic areas on the bone cross section, which remained unaltered by diagenetic processes, were localized using chemical indicators (I(C)/I(Ca) and I(C) × 10/I(P) intensity ratios) and NIR-HSI at a wavelength of 1410 nm to identify preserved collagen. The n(87Sr)/n(86Sr) isotope signature analyzed in these areas was in agreement with the biogenic bulk signal revealed by solubility profiling used as an independent method for validation. Elevated C intensities in the outer rim of the bone, caused by either precipitated secondary minerals or adsorbed humic materials, could be identified as indication for diagenetic alteration. These areas also show a different n(87Sr)/n(86Sr) isotopic composition. Therefore, the combination of NIR-HSI and LASS ICP-QMS/MC ICP-MS allows for the determination of preserved biogenic n(87Sr)/n(86Sr) isotope-amount ratios, if the original biogenic material has not been entirely replaced by diagenetic material.ᅟ [ABSTRACT FROM AUTHOR]

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The effect of restoring connectivity for fish by the construction of 11 fish ladders in the Pielach and Melk rivers, both tributaries to the Danube in Austria, was monitored using electric fishing and fish traps between 1999 and 2004. In order to assess the efficiency of connectivity rehabilitation measures pre- and post-project data combining electric fishing and trap catch data were analyzed by means of three fish-based assessment methods: a MUlti-Level concept for a Fish-based, river-type-specific Assessment of ecological integrity (MULFA), the Fish Index Austria (FIA) and the European Fish Index (EFI). The effect of adding qualitative trap catch data to electric fishing data on metrics and indices was also tested and the magnitude of the effect was related to the distance of the sites from the river mouth. The results clearly demonstrated the significant contribution of connectivity rehabilitation measures to the ecological integrity of rivers like the River Pielach where morphological conditions are good, whereas remaining channelization still limits the success of connectivity measures in the River Melk. Trap catch data were found to represent an essential source of additional information to assess the efficiency of connectivity measures shortly after their implementation. The negative correlations of the magnitude of the effect of different indices and metrics with the distance of assessment sites from river mouths obviously underline the importance of the river Danube as a source for the re-colonization process. While the indices tested were found to have limited ability to reflect short-term response of fish assemblages to continuum rehabilitation, guild metrics were able to detect improvements of the ecological status shortly after the implementation of connectivity measures. Six metrics showed significant differences between pre and post-project data reflecting the expected increase of the ecological integrity: (1) Fish Region Index (FRI; FIA, MULFA), (2) number of subdominant species and (3) number of flow-guilds (FIA), (4) number of type specific species (MULFA), (5) number of benthic species and (6) number of potamodromous species (EFI); the FRI differences were only significant when trap catch data were added. The EFI indicated a decline of ecological integrity through increases in the density of omnivorous species and the relative number of tolerant species as well as a decrease in the relative number of intolerant species. Significantly decreasing responses with the distance from the river mouth were documented by the EFI and MULFA-index, the FRI (FIA, MULFA), total biomass and for the number of type specific species (MULFA). [ABSTRACT FROM AUTHOR]

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The authors focus on analytical ecogeochemistry. They state that the discipline deals with analytical method for measuring compounds, elements and isotopes at trace levels in abiotic and biological media, and mention that it can be described as interdisciplinary field of research. They note the need of development and application of isotope research, and acknowledge authors for their contribution in the issue.

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Surveys conducted in Eilat's upper mesophotic coral ecosystem (MCE) revealed protruding columnar calcareous structures with a Sinularia octocoral colony growing atop of each. The current study addressed the hypothesis that these colonies produce spiculites, and sought to determine (a) the spatial occurrence and dimensions of the spiculite-forming colonies and their species affiliation; (b) their microstructural features; and (c) the elemental composition of the columnar spiculites in comparison to the sclerites of the colonies. All the spiculite-forming colonies were exclusively found in the upper MCEs and produced by S. vrijmoethi. This type of spiculite, including its elemental analysis, is reported here for the first time for coral reefs in general and for the MCE in particular. Examination of the spiculites by scanning electron microscopy and energy-dispersive X-ray spectroscopy revealed spindle shaped-sclerites cemented by crystallites. The elemental composition of the sclerites differed from that of the cementing crystallites, in featuring ~8% Mg in the former and none in the latter. Inductively coupled plasma mass spectrometry revealed fragments of spiculite to be composed of 35% sclerites and 65% crystallites. X-ray powder diffraction analysis of individual sclerites indicated that they are composed exclusively of magnesium-calcite, and the spiculite fragments to also feature 9.3 ± 4% aragonite and 5-7% amorphous calcium carbonate. Consequently, it is proposed that the formation of the crystallites, which lithify the sclerites, is caused by a non-biogenic aragonite precipitation, and that the living colony might benefit from this protruding spiculite structure by means of enhanced exposure to water flow. [ABSTRACT FROM AUTHOR]