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Abstract Bioaccumulation of toxic heavy metals in the human body can give rise to adverse health effects, the severity of which depends upon their dosage and duration of exposure. In this study, yearlings of two different species of edible fish, i.e., Tor putitora (Mahseer) and Ctenopharyngodon Idella (grass carp), were exposed to different concentrations of lead nitrate in a controlled environment of aquarium for three different lengths of duration (14, 28, and 60 days). The bioaccumulation of lead in different organs, including gills, skin, muscles, liver, intestine, and swim bladder of the fish, was assessed using atomic absorption spectrometry. Generally, the highest lead concentration was observed in the gills and lowest in the muscles for both species at each experimental dosage and duration. In 14-days exposure, the relative pattern of bioaccumulation in different organs was observed as gill > liver > skin > intestine > swim bladder > muscle for both fish species. Similarly, the pattern of bioaccumulation observed in 28-days exposure was as: gill > liver > intestine > skin > swim bladder > muscle in both species. Whereas, pattern in 60-days exposure was observed as gill > liver > intestine > swim bladder > muscle > skin. The data shows that grass carp had stored higher concentrations of lead than Mahseer, which may be attributed to the fact that they are omnivorous. Furthermore, the lowest bioaccumulation was recorded in the muscles until the 56th day of the exposure, after which the concentration steadily increased in the muscles. The observed pattern highlights the importance of exposure’s duration to lead; chronic exposure could result in its bioaccumulation at toxic concentrations in the muscles, which is particularly of concern because the fish muscles are heavily consumed as food worldwide.

Background: Effective communication is a critical and fundamental element of a successful medical practice and exerts a substantial influence on patient contentment, adherence, and disease outcome. This study was planned to identify domains for improvement in doctor–patient communication to enhance good practices in the future. Methods: A cross-sectional study was carried out involving 500 randomly selected samples of clinicians from government or private medical colleges across India. Data collection about current communication practices was carried out using google questionnaire forms and analysed. Results: Among the practitioners, there were 315 males and 185 females. The average time spent on patients’ consultation is 9.8 minutes. Nearly 80% of doctors do not introduce themselves to the patients, while half of the doctors consistently employ the patient’s name throughout discussion. The majority (82.8%) of the doctors listen to the patients attentively and showed empathy and positive attitude towards them. The maximum number of the doctors (55%) check that they comprehend what the patient explains about the disease, explain the need of prescribed tests (78%), and inform the result of the examination to the patient (68.8%). Approximately half of the study participants did not discuss the advantages and disadvantages of given treatments, but 78% of them agreed to do so in the future. More than half of clinicians schedule patient interviews to break unpleasant news. The majority of the doctors (60.8%) communicate the future treatment strategy and prognosis to patients. Conclusion: Overall, a positive attitude was observed; however, a few domains that needed improvements were discussing awareness of the disease, advantages and disadvantages of treatment, and patient satisfaction.

Low ventilation rates used to conserve energy in pig nurseries in winter can worsen air quality, harming piglet health. A recirculating air cleaner consisting of a dust filter and ultraviolet C (UVC) lamps was evaluated in a pig nursery. It had a recirculation rate of 6.4 air changes per hour, residence time of 0.43 s, and UVC volumetric dose of 150 J·m−3. Reduced ventilation led to high particulate matter (PM) concentrations in the nursery. During the first 9 d, the air cleaner increased floor temperature in its vicinity by 1.9 °C vs. a more distant location. The air cleaner had average removal efficiencies of 29 and 27% for PM2.5 (PM with aerodynamic equivalent diameter or AED < 2.5 µm) and PM10 (PM with AED < 10 µm), respectively. It reduced PM2.5 and PM10 concentrations by 38 and 39%, respectively, in its vicinity vs. a more distant location. The air cleaner was mostly inconsistent in inactivating heterotrophic bacteria, but it eliminated fungi. It trapped 56% of the ammonia but did not trap nitrous oxide, methane, or carbon dioxide. The air cleaner demonstrated the potential for reducing butanoic, propanoic, and pentanoic acids. Design improvements using modeling and further testing are required.

Field pennycress (Thlaspi arvense) is a new biofuel winter annual crop with extreme cold hardiness and a short life cycle, enabling off-season integration into corn and soybean rotations across the U.S. Midwest. Pennycress fields are susceptible to winter snow melt and spring rainfall, leading to waterlogged soils. The objective of this research was to determine the extent to which waterlogging during the reproductive stage affected gene expression, morphology, physiology, recovery, and yield between two pennycress lines (SP32-10 and MN106). In a controlled environment, total pod number, shoot/root dry weight, and total seed count/weight were significantly reduced in SP32-10 in response to waterlogging, whereas primary branch number, shoot dry weight, and single seed weight were significantly reduced in MN106. This indicated waterlogging had a greater negative impact on seed yield in SP32-10 than MN106. We compared the transcriptomic response of SP32-10 and MN106 to determine the gene expression patterns underlying these different responses to seven days of waterlogging. The number of differentially expressed genes (DEGs) between waterlogged and control roots were doubled in MN106 (3,424) compared to SP32-10 (1,767). Functional enrichment analysis of upregulated DEGs revealed Gene Ontology (GO) terms associated with hypoxia and decreased oxygen, with genes in these categories encoding proteins involved in alcoholic fermentation and glycolysis. Additionally, downregulated DEGs revealed GO terms associated with cell wall biogenesis and suberin biosynthesis, indicating suppressed growth and energy conservation. Interestingly, MN106 waterlogged roots exhibited significant stronger regulation of these genes than SP32-10, displaying a more robust transcriptomic response overall. Together, these results reveal the reconfiguration of cellular and metabolic processes in response to the severe energy crisis invoked by waterlogging in pennycress.

Background Diagnosis of hereditary amyloid transthyretin (hATTR) amyloidosis with cardiomyopathy is frequently delayed, in large part because of symptom overlap with other cardiovascular diseases and limited provider knowledge of this disease. The sponsored and provider referred hATTR Compass Genetic Testing Program (Ionis, Carlsbad, CA; Ambry Genetics, Aliso Viejo, CA) provided no‐cost genetic testing to adults with a family history or clinical suspicion of hATTR amyloidosis. This study aims to characterize patients with hATTR amyloidosis and increase awareness of genetic testing for hATTR. Methods and Results Patients were referred to the hATTR genetic testing program, and a cross‐sectional post hoc analysis was performed. A pathogenic TTR variant was identified in 1503 (6.6%) of 22 886 patients referred for genetic testing between June 2018 and March 2022. Patients were identified in all US states, 3 US territories, and Canada. Median age at testing was 63 years, and 44% were female. The p.V142I TTR variant was the most common (n=1263, 84.0%). Only 32% of patients with a pathogenic TTR variant reported a known family history; a lower percentage of Black individuals reported a known family history compared with other racial and ethnic groups. Black patients accounted for 23.7% of all patients referred and 81.9% of patients with the p.V142I variant. Conclusions This sponsored genetic testing program identified a large number of patients with a pathogenic TTR variant, notably, in geographic regions not previously reported, and demographic groups that are historically underrepresented in the literature.

Background: As triple-organ transplantation (TOT) has become more common, we evaluate patient characteristics, risk factors, and clinical outcomes of patients undergoing thoracoabdominal TOT. Methods: This retrospective study utilized data from heart-lung-liver (HLL), heart-lung-kidney (HLK), heart-kidney-liver (HKL), and heart-kidney-pancreas (HKP) recipients from the United Network for Organ Sharing registry between 1989 and 2023. Recipient and donor characteristics and risk factors for mortality were analyzed using Cox regression hazard models. Recipient survival up to 10 years was analyzed using the Kaplan-Meier method. Results: During the study period, 81 TOTs were performed (13 HLLs, 13 HLKs, 46 HKLs, and 9 HKPs). There were no statistically significant differences in long-term survival between TOTs (p = 0.13). However, HLL and HLK recipients had significantly worse (p < 0.0001) and improved (p < 0.0001) survival, respectively, when compared to heart-lung, isolated heart, and lung transplant recipients. HLK was associated with improved survival (hazard ratios [HR]: 0.22, p = 0.033). We found no differences in survival among HKL (p = 0.24) and HKP (p = 0.19) recipients compared to their dual- and single-organ counterparts. TOTs after 2007 (HR: 0.29, p = 0.003) were associated with improved survival, whereas increased recipient age (HR: 1.06, p = 0.037), estimated glomerular filtration rate (HR: 1.02, p = 0.005), and donor age (HR:1.05, p = 0.031) were associated with higher mortality. Conclusions: The prevalence of TOTs has dramatically increased over the past decade. While overall survival between TOTs appears similar, adding a liver to a heart-lung transplant may be associated with a poorer prognosis compared to adding a kidney. A careful, multidisciplinary approach to patient selection and management remains paramount in optimizing outcomes for high-risk patients undergoing TOTs.

Background and Aims: Empirically adjusted, standard drug doses fail to address interindividual pharmacokinetic and pharmacodynamics variability. Target-controlled infusion (TCI) delivers drugs in calibrated boluses to achieve and maintain a selected target plateau drug level (plasma or effect site). Interactive total intravenous anesthesia (iTIVA™) smartphone software simulates TCI and employs 31 established pharmacokinetic models for 11 different intravenous agents and is coupled with standard volumetric infusion pumps for administering TCI. Material and Methods: This prospective, observational, study investigates the degree of agreement between iTIVA and a conventional TCI pump (CTP) for the volume of propofol infused using the Schnider pharmacokinetic model in adult patients of either sex undergoing oncosurgery lasting 1–3 h under total intravenous anesthesia. Bland–Altman analysis of 124 data pairs from 30 patients provided bias, precision, and limits of agreement between the volumes infused by CTP and iTIVA (V-CTP and V-iTIVA) during specific identical time periods. Spearman’s rho and Kendall’s tau rank correlation coefficients provided the degree of association between V-CTP and V-iTIVA. Results: Spearman’s rho and Kendall’s tau were 0.996 and 0.964, respectively. Bias or the mean of differences was −0.02, while the limits of agreement were 0.58 and −0.63, respectively (Bland–Altman plot). The maximum allowed difference of 2 ml was much larger than the 95% confidence intervals for the limits of agreement. The Mountain plot was short tailed (−1.28 to 1.55) and centred over zero (0.01). Conclusion: The volume of propofol infused using TCI pump was similar to that calculated by iTIVA in identical time periods, confirming the clinical applicability of iTIVA.

The purpose of this review is to provide an up-to-date understanding of the literature describing the impact of body composition on renal cell carcinoma (RCC) prognosis and outcomes. Although obesity is recognized as a risk factor for RCC development, overweight patients with localized and advanced RCC display more favorable outcomes than normal-weight individuals. However, obesity as measured by body mass index is a poor indicator of total body fat, fails to account for lean muscle mass, and inconsistently predicts perioperative and survival outcomes in RCC. Recent studies have suggested that objective measurements of lean and fat body masses from various compartments have strong prognostic utility. Low muscle mass (i.e., sarcopenia) and low visceral adiposity are often associated with poorer survival outcomes in localized and advanced RCC. These patients tend to experience higher rates of recurrence, progression, treatment failure, and death from kidney cancer. Given the influence of body composition in RCC outcomes, further characterization of the role of prehabilitation programs is warranted to evaluate the feasibility and efficacy of interventions targeting these modifiable factors.

ABSTRACT: “Cases of SCMR” is a case series on the SCMR website (https://www.scmr.org) for the purpose of education. The cases reflect the clinical presentation and the use of cardiovascular magnetic resonance in the diagnosis and management of cardiovascular disease. The 2023 digital collection of cases is presented in this article.