Search

Background:. Electrocautery has been a useful, fundamental instrument utilized for surgical procedures since its implementation in the 1920s. However, concerns exist regarding the health hazards of the by-product smoke associated with the use of electrocautery. Methods:. A comprehensive review of articles on the composition, mitigation, and effects of smoke was conducted using the PubMed search engine and excluding articles that did not meet the predetermined inclusion criteria. From January 1963 to December 2021, a total of 264 articles resulted, and a total of 69 articles were included in this narrative review. Results:. Surgical smoke contains volatile organic compounds, polycyclic aromatic compounds, viral particles, and ultrafine particles. There has been some evidence of mutagenicity to bacterial cells during animal in vivo studies, and one human survey study has shown similar mutagenic effects. We also discuss additional hemostatic techniques that can be used, including the use of hemostatic and antithrombolytic agents, epinephrine infiltration, and the use of tourniquet when appropriate. Conclusions:. Further studies should be conducted regarding human effects, but until the data are available, we recommend precautionary measures and actions to protect operating room staff from cautery smoke exposure.

Abstract Leucine-rich repeat containing 10 (LRRC10) is a cardiomyocyte-specific protein, but its role in cardiac biology is little understood. Recently Lrrc10 was identified as required for endogenous cardiac regeneration in zebrafish; however, whether LRRC10 plays a role in mammalian heart regeneration remains unclear. In this study, we demonstrate that Lrrc10 –/– knockout mice exhibit a loss of the neonatal mouse regenerative response, marked by reduced cardiomyocyte cytokinesis and increased cardiomyocyte binucleation. Interestingly, LRRC10 deletion disrupts the regenerative transcriptional landscape of the regenerating neonatal mouse heart. Remarkably, cardiac overexpression of LRRC10 restores cardiomyocyte cytokinesis, increases cardiomyocyte mononucleation, and the cardiac regenerative capacity of Lrrc10 –/– mice. Our results are consistent with a model in which LRRC10 is required for cardiomyocyte cytokinesis as well as regulation of the transcriptional landscape during mammalian heart regeneration.

Background:. Traumatic ballistic injury is an unfortunate and commonly encountered problem seen by surgeons. An estimated 85,694 nonfatal ballistic injuries occur annually, and in 2020 there were 45,222 firearm-related deaths in the United States. Surgeons of all subspecialties may provide necessary care. Acute care injuries are generally reported to authorities immediately; however, delayed presentation of ballistic injuries may go unreported despite regulations to do so. We present a case of a delayed ballistic injury and a comparative review of individual states’ reporting requirements to highlight statutory obligations and penalties as an educational reference for surgeons treating ballistic injuries. Methods:. Google and PubMed searches were performed utilizing keywords “ballistic,” “gunshot,” “physician,” and “reporting” as terms. Inclusion criteria included the English language, official state statute sites, legal and scientific articles, and websites. Exclusion criteria included nongovernmental sites and information sources. Data collected were analyzed to include statute numbers, time to report, infraction consequences, and monetary fines. The resultant data are reported by state and region. Results:. All but two state jurisdictions mandate healthcare providers to report knowledge and/or treatment of ballistic injuries, regardless of the timeline of injury. Violations of mandatory reporting may lead to fines or imprisonment, depending on the specific state. The timeline for reporting, fines, and subsequent legal action varies by state and region. Conclusions:. Requirements for reporting injuries exist in 48 of 50 states. The treating physician/surgeon should thoughtfully question patients with a chronic ballistic injury history and provide reports to local law enforcement.

Clean energy research and development (R and D) leading to commercial technologies is vital to economic development, technology competitiveness, and reduced environmental impact. Over the past 30 years, such efforts have advanced technology performance and reduced cost by leveraging network effects and economies of scale. After demonstrating promise in applied R and D, successful clean energy and energy efficiency technologies are incorporated into an initial product sold by the private sector. Despite its importance, processes by which first commercialization occurs are difficult to generalize while capturing specific insights from practitioners in markets and technologies. This paper presents a policy-focused qualitative assessment of the first commercialization of four diverse energy technologies: thin film photovoltaics, wind turbine blades, dual-stage refrigeration evaporators, and fuel cells for material handling equipment. Each technology presents distinct value propositions, markets, and regulatory drivers. The case studies indicate three common characteristics of successful first commercialization for new energy technologies: 1) good fit between the technology, R&D infrastructure, and public-private partnership models; 2) high degree of alignment of government regulations and R&D priorities with market forces; and 3) compatibility between time scales required for R&D, product development, and opportunities. These findings may inform energy investment decision-making, maximize benefits from R&D, and advance the transition to a low-emission future.

Heart failure is the leading cause of death worldwide. The inability of the adult mammalian heart to regenerate following injury results in the development of systolic heart failure. Thus, identifying novel approaches toward regenerating the adult heart has enormous therapeutic potential for adult heart failure. Mitochondrial metabolism is an essential homeostatic process for maintaining growth and survival. The emerging role of mitochondrial metabolism in controlling cell fate and function is beginning to be appreciated. Recent evidence suggests that metabolism controls biological processes including cell proliferation and differentiation, which has profound implications during development and regeneration. The regenerative potential of the mammalian heart is lost by the first week of postnatal development when cardiomyocytes exit the cell cycle and become terminally differentiated. This inability to regenerate following injury is correlated with the metabolic shift from glycolysis to fatty acid oxidation that occurs during heart maturation in the postnatal heart. Thus, understanding the mechanisms that regulate cardiac metabolism is key to unlocking metabolic interventions during development, disease, and regeneration. In this review, we will focus on the emerging role of metabolism in cardiac development and regeneration and discuss the potential of targeting metabolism for treatment of heart failure.

INTRODUCTION I. DECARBONIZATION'S PARTICIPATORY GAP A. Decarbonization's Transformative Potential B. Community Opposition, "NIMBYism," and NEPA Reform II. NEPA'S POTENTIAL AS A TOOL FOR COMMUNITY EMPOWERMENT A. NEPA's Structural Misfit B. [...], This Article addresses a potential tension between two ambitions for the transition to clean energy: reducing regulatory red-tape to quickly build out renewable energy, and leveraging that build-out to empower low-income communities and communities of color. Each ambition carries a different view of communities' role in decarbonization. To those focused on rapid build-out of renewable energy infrastructure, communities are a potential threat who could slow or derail renewable energy projects through opposition during the regulatory process. To those focused on leveraging the transition to clean energy to advance racial and economic justice, communities are necessary partners in the key decisions of the transition--including the development of renewable energy projects. The Biden Administration has committed to both ambitions, but there is a gap regarding what role communities will play in policies designed to implement decarbonization. This Article articulates this "participatory gap" in decarbonization policy and proposes changes to the regulations implementing the National Environmental Policy Act of 1969 (NEPA) that start bridging these ambitions. The Article offers proposals that would leverage NEPA's unique structure to empower communities in decarbonization. Specifically, it argues that NEPA's regulations should be reformed to require meaningful community engagement and enforce that commitment through a revitalized executive enforcement structure. Contrary to views that more community engagement will slow decarbonization, this Article argues that these reforms would support the rapid transition to renewable energy while also empowering communities and elevating justice as a central value in environmental policy.

We assessed the safety and efficacy of Formulated Collagen Gel (FCG) alone and with Ad5PDGF-B (GAM501) compared with Standard of Care (SOC) in patients with 1.5-10.0 cm(2) chronic diabetic neuropathic foot ulcers that healed

To avoid the most catastrophic impacts of climate change, most of the world's oil and gas reserves must remain in the ground. In the United States, this would require a dramatic phaseout of oil and gas extraction nationwide over the coming decades. How could we accomplish this? While recent legal scholarship emphasizes the importance of a just transition away from oil and gas extraction, little work has been done to navigate the legal, political, and equity hurdles associated with phasing out oil and gas extraction. This Article seeks to start this conversation by offering one way to approach phaseouts of oil and gas extraction in the United States: prioritize phasing out extraction closest to people. This intuitive approach builds on the success of frontline communities in California and Colorado advocating for statewide setbacks that prioritize regulating oil and gas extraction closest to their communities. Among other virtues, this advocacy has successfully drawn the connection between the localized harms of oil and gas extraction on communities of color and low-income communities to the larger climate impacts of continued oil and gas extraction. This Article argues that phaseout policies should follow these communities' lead and articulates several priorities for doing so: (1) stopping new extraction closest to people, (2) monitoring continued extraction closest to people, (3) plugging and reclaiming wells closest to people, and (4) matching proximity-based phaseouts with decarbonization programs. This approach to managing the decline of oil and gas extraction in the United States places such policies on the strongest footing against legal challenges while also targeting the roots of political support for extraction by reducing local dependency and supporting communities that have borne the direct impacts of fossil fuel extraction. [ABSTRACT FROM AUTHOR]

Abstract Transportation accounts for one-quarter of all energy related greenhouse gas emissions. As it pertains to transport electrification, higher education institutions—such as universities—can model solutions that affect broader society. Despite this, higher education’s role in fleet electrification adoption has been understudied. We, therefore, modeled an archetypical higher education institution to analyze the carbon and economic payback periods of three electrification scenarios (Business-as-Usual, Targeted Electrification, and Full Electrification) using a cradle-to-grave lifecycle and technoeconomic approach. Given the archetypical higher education institution fleet of 368 vehicles, results show an economic ratio plateau point of about 8 years at 20 fuel-based cars replaced by electric vehicles and a carbon payback period peak of roughly 10 months at 50 fuel-based cars replaced. We then performed a multi-scalar analysis by leveraging implementation theory. We find that higher education institutions that adhere to the tenets of implementation theory are poised to be pro-environmental change agents in many regions and countries. The methods and findings herein can be adapted to other institutions, regardless of fleet size, and can bolster relevant decision-making outcomes now.

Introduction/Purpose: Avascular necrosis (AVN) is a complication of talar neck fractures associated with chronic pain and poor functional outcomes. Hawkins sign, the radiographic presence of subchondral lucency seen in the talar dome 6 to 8 weeks after trauma, is considered to be a strong predictor of preserved talus vascularity. The study sought to assess the accuracy of the Hawkins sign in a large, contemporary cohort and assess factors associated with inaccuracy. Methods: A retrospective review of all talar neck fractures from a single level I trauma center from 2008 to 2016 was performed. The presence of Hawkins sign and AVN were determined based on ankle radiographs 8 weeks after injury and at final follow-up, respectively. Patients with less than 6 months follow-up were excluded. Hawkins sign accuracy was assessed using proportions with 95% confidence intervals (C.I.) and associations were examined with Fisher’s exact testing. Results: In total, 137 talar neck fractures were identified with 105 having adequate follow-up. Hawkins sign was observed in 21 tali, 3 (14%) of which later developed AVN (95% C.I., 3 – 36%). In the remaining 84 tali without Hawkins sign, 32 (38%) developed AVN (95% C.I., 28 – 49%). Of the 3 tali that developed AVN following observation of Hawkins sign, all patients were smokers. There were no cases of AVN in non-smokers with Hawkins sign (P=0.21), and smoking was not associated with AVN in patients without Hawkins sign (41% vs 36%, P=0.82). Conclusion: Hawkins sign may not be a reliable predictor of preserved talus vascularity in all patients. We identified three patients with positive Hawkins signs who developed AVN, all of whom were smokers. Factors impairing microvascular blood supply to the talus may lead to AVN even in the presence of preserved macrovascular blood flow and an observed Hawkins sign. Close monitoring of select patients with Hawkins sign should be considered and further research is needed to understand the factors limiting Hawkins sign accuracy. Prognostic accuracy of the Hawkins sign in predicting talar AVN

Abstract The morphogenetic process of apical constriction, which relies on non-muscle myosin II (NMII) generated constriction of apical domains of epithelial cells, is key to the development of complex cellular patterns. Apical constriction occurs in almost all multicellular organisms, but one of the most well-characterized systems is the Folded-gastrulation (Fog)-induced apical constriction that occurs in Drosophila. The binding of Fog to its cognizant receptors Mist/Smog results in a signaling cascade that leads to the activation of NMII-generated contractility. Despite our knowledge of key molecular players involved in Fog signaling, we sought to explore whether other proteins have an undiscovered role in its regulation. We developed a computational method to predict unidentified candidate NMII regulators using a network of pairwise protein–protein interactions called an interactome. We first constructed a Drosophila interactome of over 500,000 protein–protein interactions from several databases that curate high-throughput experiments. Next, we implemented several graph-based algorithms that predicted 14 proteins potentially involved in Fog signaling. To test these candidates, we used RNAi depletion in combination with a cellular contractility assay in Drosophila S2R + cells, which respond to Fog by contracting in a stereotypical manner. Of the candidates we screened using this assay, two proteins, the serine/threonine phosphatase Flapwing and the putative guanylate kinase CG11811 were demonstrated to inhibit cellular contractility when depleted, suggestive of their roles as novel regulators of the Fog pathway.

Introduction/Purpose: Avascular necrosis (AVN) is a complication of talar neck fractures associated with chronic pain and poor functional outcomes. Hawkins sign, the radiographic presence of subchondral lucency seen in the talar dome 6 to 8 weeks after trauma, is considered to be a strong predictor of preserved talus vascularity. The study sought to assess the accuracy of the Hawkins sign in a large, contemporary cohort and assess factors associated with inaccuracy. Methods: A retrospective review of all talar neck fractures from a single level I trauma center from 2008 to 2016 was performed. The presence of Hawkins sign and AVN were determined based on ankle radiographs 8 weeks after injury and at final follow-up, respectively. Patients with less than 6 months follow-up were excluded. Hawkins sign accuracy was assessed using proportions with 95% confidence intervals (C.I.) and associations were examined with Fisher's exact testing. Results: In total, 137 talar neck fractures were identified with 105 having adequate follow-up. Hawkins sign was observed in 21 tali, 3 (14%) of which later developed AVN (95% C.I., 3 - 36%). In the remaining 84 tali without Hawkins sign, 32 (38%) developed AVN (95% C.I., 28 - 49%). Of the 3 tali that developed AVN following observation of Hawkins sign, all patients were smokers. There were no cases of AVN in non-smokers with Hawkins sign (P=0.21), and smoking was not associated with AVN in patients without Hawkins sign (41% vs 36%, P=0.82). Conclusion: Hawkins sign may not be a reliable predictor of preserved talus vascularity in all patients. We identified three patients with positive Hawkins signs who developed AVN, all of whom were smokers. Factors impairing microvascular blood supply to the talus may lead to AVN even in the presence of preserved macrovascular blood flow and an observed Hawkins sign. Close monitoring of select patients with Hawkins sign should be considered and further research is needed to understand the factors limiting Hawkins sign accuracy. [ABSTRACT FROM AUTHOR]