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We report a case of a newborn with two synchronous tumors—sialoblastoma and hepatoblastoma—diagnosed at 20 weeks of gestation by magnetic resonance imaging (MRI) and ultrasonography (US). The aim of this study was to describe the management of this case together with a review of the literature. Our patient had a large facial tumor associated with extremely high alpha-fetoprotein levels. Diagnosis of the tumors was made by surgical biopsy, showing typical features in both. Sialoblastoma is a potentially aggressive tumor. In our case, the Ki67 index in the sialoblastoma was between 20 and 30%, indicating a possibly unfavorable behavior. The infant underwent surgery and chemotherapy in different steps. Complete surgical resection with clean margins is considered to be the best treatment option for sialoblastoma. Only four similar cases were previously reported. Timely management by a multidisciplinary team is essential in these difficult cases. In our patient, outcome was good at the time of this report.

Introduction Clinical trials of personalized cancer vaccines have shown that on-demand therapies that are manufactured for each patient, result in activated T cell responses against individual tumor neoantigens. However, their use has been traditionally restricted to adjuvant settings and late-stage cancer therapy. There is growing support for the implementation of PCV earlier in the cancer therapy timeline, for reasons that will be discussed in this review.Areas covered The efficacy of cancer vaccines may be to some extent dependent on treatment(s) given prior to vaccine administration. Tumors can undergo radical immunoediting following treatment with immunotherapies, such as checkpoint inhibitors, which may affect the presence of the very mutations targeted by cancer vaccines. This review will cover the topics of neoantigen cancer vaccines, tumor immunoediting, and therapy timing.Expert opinion Therapy timing remains a critical topic to address in optimizing the efficacy of personalized cancer vaccines. Most personalized cancer vaccines are being evaluated in late-stage cancer patients and after treatment with checkpoint inhibitors, but they may offer a greater benefit to the patient if administered in earlier clinical settings, such as the neoadjuvant setting, where patients are not facing T cell exhaustion and/or a further compromised immune system.

Abstract Host-associated microbiota are critical for eukaryotic host functioning, to the extent that hosts and their associated microbial communities are often considered “holobionts”. Most studies of holobionts have focused on descriptive approaches or have used model systems, usually in the laboratory, to understand host-microbiome interactions. To advance our understanding of host-microbiota interactions and their wider ecological impacts, we need experimental frameworks that can explore causation in non-model hosts, which often have highly diverse microbiota, and in their natural ecological setting (i.e. in the field). We used a dominant habitat-forming seaweed, Hormosira banksii, to explore these issues and to experimentally test host-microbiota interactions in a non-model holobiont. The experimental protocols were aimed at trying to disentangle microbially mediated effects on hosts from direct effects on hosts associated with the methods employed to manipulate host-microbiota. This was done by disrupting the microbiome, either through removal/disruption using a combination of antimicrobial treatments, or additions of specific taxa via inoculations, or a combination of thew two. The experiments were done in mesocosms and in the field. Three different antibiotic treatments were used to disrupt seaweed-associated microbiota to test whether disturbances of microbiota, particularly bacteria, would negatively affect host performance. Responses of bacteria to these disturbances were complex and differed substantially among treatments, with some antibacterial treatments having little discernible effect. However, the temporal sequence of responses antibiotic treatments, changes in bacterial diversity and subsequent decreases in host performance, strongly suggested an effect of the microbiota on host performance in some treatments, as opposed to direct effects of the antibiotics. To further test these effects, we used 16S-rRNA-gene sequencing to identify bacterial taxa that were either correlated, or uncorrelated, with poor host performance following antibiotic treatment. These were then isolated and used in inoculation experiments, independently or in combination with the previously used antibiotic treatments. Negative effects on host performance were strongest where specific microbial antimicrobials treatments were combined with inoculations of strains that were correlated with poor host performance. For these treatments, negative host effects persisted the entire experimental period (12 days), even though treatments were only applied at the beginning of the experiment. Host performance recovered in all other treatments. These experiments provide a framework for exploring causation and disentangling microbially mediated vs. direct effects on hosts for ecologically important, non-model holobionts in the field. This should allow for better predictions of how these systems will respond to, and potentially mitigate, environmental disturbances in their natural context.

Abstract Background Bladder cancer poses a significant public health burden, with high recurrence and progression rates in patients with non-muscle-invasive bladder cancer (NMIBC). Current treatment options include bladder-sparing therapies (BST) and radical cystectomy, both with associated risks and benefits. However, evidence supporting optimal management decisions for patients with recurrent high-grade NMIBC remains limited, leading to uncertainty for patients and clinicians. The CISTO (Comparison of Intravesical Therapy and Surgery as Treatment Options) Study aims to address this critical knowledge gap by comparing outcomes between patients undergoing BST and radical cystectomy. Methods The CISTO Study is a pragmatic, prospective observational cohort trial across 36 academic and community urology practices in the US. The study will enroll 572 patients with a diagnosis of recurrent high-grade NMIBC who select management with either BST or radical cystectomy. The primary outcome is health-related quality of life (QOL) at 12 months as measured with the EORTC-QLQ-C30. Secondary outcomes include bladder cancer-specific QOL, progression-free survival, cancer-specific survival, and financial toxicity. The study will also assess patient preferences for treatment outcomes. Statistical analyses will employ targeted maximum likelihood estimation (TMLE) to address treatment selection bias and confounding by indication. Discussion The CISTO Study is powered to detect clinically important differences in QOL and cancer-specific survival between the two treatment approaches. By including a diverse patient population, the study also aims to assess outcomes across the following patient characteristics: age, gender, race, burden of comorbid health conditions, cancer severity, caregiver status, social determinants of health, and rurality. Treatment outcomes may also vary by patient preferences, health literacy, and baseline QOL. The CISTO Study will fill a crucial evidence gap in the management of recurrent high-grade NMIBC, providing evidence-based guidance for patients and clinicians in choosing between BST and radical cystectomy. The CISTO study will provide an evidence-based approach to identifying the right treatment for the right patient at the right time in the challenging clinical setting of recurrent high-grade NMIBC. Trial registration ClinicalTrials.gov, NCT03933826. Registered on May 1, 2019.

Ocean warming can affect the development and physiological responses of kelps, and under future climate change scenarios, increasing seawater temperatures pose a major threat to these habitat-forming species. However, little is known about the effects of warming on epiphytic bacterial communities and how an altered microbiome may interact with temperature stress, affecting the condition and survival of kelp, particularly of the potentially more vulnerable early life stages. Here, we tested the effects of thermal stress on the growth and physiological responses of juvenile kelp Ecklonia radiata in which their epiphytic bacterial community was experimentally disrupted using antimicrobials, simulating dysbiosis. We hypothesized that, under thermal stress (23°C, simulating a extreme scenario of ocean warming in Tasmania), kelp with a disrupted bacterial community would be more strongly affected than kelp with an undisrupted microbiome or kelp under ambient temperature (14°C) but with a disrupted microbiota. Thermal stress reduced growth, increased tissue bleaching and negatively affected net photosynthesis of kelp. In addition, a substantial change in the epiphytic bacterial community structure was also found under thermal stress conditions, with an increase in the abundance of potentially pathogenic bacterial groups. However, microbial disruption did not act synergistically with thermal stress to affect kelp juveniles. These results suggest that effects of elevated temperature on juvenile kelps is not microbially-mediated and that juveniles may be less susceptible to disruptions of their microbiome.

Abstract While marine kelp forests have provided valuable ecosystem services for millennia, the global ecological and economic value of those services is largely unresolved. Kelp forests are diminishing in many regions worldwide, and efforts to manage these ecosystems are hindered without accurate estimates of the value of the services that kelp forests provide to human societies. Here, we present a global estimate of the ecological and economic potential of three key ecosystem services - fisheries production, nutrient cycling, and carbon removal provided by six major forest forming kelp genera (Ecklonia, Laminaria, Lessonia, Macrocystis, Nereocystis, and Saccharina). Each of these genera creates a potential value of between $64,400 and $147,100/hectare each year. Collectively, they generate between $465 and $562 billion/year worldwide, with an average of $500 billion. These values are primarily driven by fisheries production (mean $29,900, 904 Kg/Ha/year) and nitrogen removal ($73,800, 657 Kg N/Ha/year), though kelp forests are also estimated to sequester 4.91 megatons of carbon from the atmosphere/year highlighting their potential as blue carbon systems for climate change mitigation. These findings highlight the ecological and economic value of kelp forests to society and will facilitate better informed marine management and conservation decisions.

IntroductionThe collapse of macroalgal habitats is altering the structure of benthic communities on rocky shores globally. Nonetheless, how the loss of canopy-forming macroalgae influences the structure of epilithic microbial communities is yet to be explored. MethodsHere, we used experimental field manipulations and 16S-rRNA-gene amplicon sequencing to determine the effects of macroalgal loss on the understory bacterial communities and their relationship with epiphytic bacteria on macroalgae. Beds of the fucoid Hormosira banksii were exposed to different levels of disturbance resulting in five treatments: (i) 100% removal of Hormosira individuals, (ii) 50% removal, (iii) no removal, (iv) a procedural control that mimicked the removal process, but no Hormosira was removed and (v) adjacent bare rock. Canopy cover, bacterial communities (epilithic and epiphytic) and benthic macroorganisms were monitored for 16 months.ResultsResults showed that reductions in canopy cover rapidly altered understory bacterial diversity and composition. Hormosira canopies in 50% and 100% removal plots showed signs of recovery over time, but understory epilithic bacterial communities remained distinct throughout the experiment in plots that experienced full Hormosira removal. Changes in bacterial communities were not related to changes in other benthic macroorganisms.DiscussionThese results demonstrate that understory epilithic bacterial communities respond rapidly to environmental disturbances at small scales and these changes can be long-lasting. A deeper knowledge of the ecological role of understory epilithic microbial communities is needed to better understand potential cascading effects of disturbances on the functioning of macroalgal-dominated systems.

There is a critical need to establish reference response rates following bladder-sparing therapies administered in the setting of bacillus Calmete-Guerin (BCG)-unresponsive non–muscle-invasive bladder cancer (NMIBC). We sought to determine the efficacy of different interventions in recent trials accruing patients fulfilling the strict BCG-unresponsive definition established by the US Food and Drug Administration. We performed a systematic review and meta-analysis for clinical trials in the BCG-unresponsive disease space to include published and presented results. The primary endpoints were complete response rate for CIS±Ta/T1 tumors, recurrence-free rate for patients with papillary-only disease, and disease-free rate in studies enrolling both papillary CIS tumors (Ta/T1/CIS). I2 was used for assessing heterogeneity. Eleven studies using 9 different therapeutic agents in a total of 909 patients with BCG-unresponsive NMIBC were identified. The resulting outcomes at 3, 6, and 12 months were 44%, 38%, and 25% complete response rate in CIS±Ta/T1 tumors; 73%, 58%, and 48% recurrence-free rate in papillary-only; and 48%, 22%, and 43% disease-free rate in combined Ta/T1/CIS, respectively. Relatively low levels of heterogeneity were observed amongst studies restricted to papillary-only or CIS±Ta/T1 tumors. Future randomized controlled studies are needed and will likely require stratification between papillary-only and CIS±Ta/T1 tumors.

Swine plasma low density lipoprotein (LDL) isolated ultracentrifugally (d 1.019-1.063) was labeled with 125-I, dialyzed, and reisolated by centrifugation at d 1.063. Over 96% of the radioactivity was shown to be associated with the apoprotein. After reinjection into the donor animal, disapperance of 125-I was followed for up to 122 hr. At all time intervals examined, over 95% of the total plasma 125-I was recovered in LDL (D 1.006-1.063), i.e., there was apparently no transfer of radioactivity to high density or very low density lipoproteins. The disappearance curve was biexponential, with half-lives of 0.83 plus or minus 0.06 and 22.5 plus or minus 1.7 hr for the first and second phases, respectively (13 studies). The mean calculated fractional catabolic rate was 0.041 plus or minus 0.003 hr-minus 1. Similar results were obtained in three dogs using autologous LDL of density 1.020-1.050; fractional catabolic rates were 0.031, 0.031, and 0.029 hr-minus 1. Tissue distribution of 125-I was determined in swine killed at various time intervals after [125-I]LDL injection with corrections for radioactivity in trapped plasma. Of the tissues examined, the liver showed by far the highest concentration. Total hepatic radioactivity, expressed as a percentage of total plasma radioactivity, was rather constant and independent of the time of killing from 3 to 122 hr (15.8 plus or minus 1.9%). The total extravascular LDL pool calculated from analysis of the plasma disappearance curves was about 20-30% of the size of the plasma LDL pool. These data are consistent with the conclusion that the liver accounts for a very large fraction of the total extravascular LDL pool. These data are consistent with the conclusion that the liver accounts for a very large fraction of the total extravascular LDL pool and that it is infairly rapid equilibrium with the plasma pool. To what extent the liver is involved in irreversible degradation cannot be inferred from these findings.

Abstract Background, context and purpose In spite of the mixed evidence for their impact, survivorship Care Plans (SCPs) are recommended to enhance quality of care for cancer survivors. Data on the feasibility of SCPs in bladder cancer (BC) is sparse. Using a mixed-methods approach, this study describes the iterative development, acceptability and feasibility of BC specific SCP (BC-SCP) in clinical settings. Methods In Phase I, we developed the BC-SCP. In Phase II, we conducted four focus groups with 19 patients and 15 providers to examine its acceptability and usability challenges. Data analyses using the Atlas.ti program, informed refinement of the BC-SCP. In Phase III, we conducted feasibility testing of the refined BC-SCP with 18 providers from 12 health-centers. An encounter survey was completed after each assessment to examine the feasibility of the BC-SCP. Chi-square and Fisher Exact tests were used for comparative analyses. Results During phase I, we observed high patient and provider acceptability of the BC-SCP and substantial engagement in improving its content, design, and structure. In Phase II, providers completed 59 BC-SCPs. Mean time for BC-SCP completion was 12.3 min. Providers reported that BC-SCP content was clear, did not hamper clinic flow and was readily completed with easy-to-access information. Comparative analyses to examine differences in SCP completion time by patient clinico-demographic characteristics and provider type revealed no significant differences. Conclusions Our BC-SCP has clinical relevance, and can be used in an active practice setting. However, considerable progress will be necessary to achieve implementation of and sharing the BC-SCP with patients and care providers, particularly within the electronic medical record. In summary, BC-SCPs are essential to improve the follow up care of BC survivors. Clinical resources are required to ensure appropriate implementation of BC-SCPs. Trial registration Study HUM00056082.

The serious nature of post-vaccination anaphylaxis requires healthcare professionals to be adequately trained to respond to these hypersensitivity emergencies. The aim of this study was to compare outcomes reported with cases of vaccine anaphylaxis stratified by administration setting. We queried reports in the Vaccine Adverse Event Reporting System (VAERS) database from 2017 to 2022 and identified cases involving anaphylaxis with an onset within one day of vaccine administration. The primary outcome was the combined prevalence of death or disability for each setting while the secondary outcome was the prevalence of hospitalization. Adjusted (age, sex, prior history of allergy, vaccine type) odds ratios (aOR) and associated 95% confidence intervals (CI) were calculated using logistic regression analysis. A total of 2041 cases of anaphylaxis comprised the primary study cohort with representation in the sample from all 50 US states and the District of Columbia. The mean age was 43.3 ± 17.5 years, and most cases involved women (79.9%). Cases of anaphylaxis were reported after receiving a coronavirus vaccine (85.2%), influenza vaccine (5.9%), tetanus vaccine (2.2%), zoster vaccine (1.6%), measles vaccine (0.7%), and other vaccine (4.5%). Outcomes associated with reports of vaccine anaphylaxis included 35 cases of death and disability and 219 hospitalizations. Compared with all other settings, the aOR of death and disability when anaphylaxis occurred was 1.92 (95% CI, 0.86–4.54) in a medical provider’s office, 0.85 (95% CI, 0.26–2.43) in a pharmacy and 1.01 (95% CI, 0.15–3.94) in a public health clinic. Compared with all other settings, the aOR of hospitalization when anaphylaxis occurred was 1.02 (95% CI, 0.71–1.47) in a medical provider’s office, 1.06 (95% CI, 0.72–1.54) in a pharmacy, and 1.12 (95% CI, 0.61–1.93) in a public health clinic. An analysis of a national database across six years revealed no significant differences in the odds of death/disability and odds of hospitalization associated with post-vaccination anaphylaxis in the medical office, pharmacy, and public health clinic compared with all other settings. This study expands our understanding of the safety of immunization services and reinforces that all settings must be prepared to respond to such an emergency.

Administration of rabies postexposure prophylaxis (PEP) is expensive and time-consuming. In suburban Cook County, Illinois, USA, administration of 55.5% of PEP treatments did not follow Advisory Committee on Immunization Practices guidelines. Health department consultation lowered the odds of inappropriate PEP administration by 87%. Providers should consult their health department before prescribing PEP.

Abstract Background Thoracic and head and neck cancer radiation therapy (RT) can cause damage to nearby healthy organs such as the esophagus, causing acute radiation-induced esophageal damage (ARIED). A non-invasive method to detect and monitor ARIED can facilitate optimizing RT to avoid ARIED while improving local tumor control. Current clinical guidelines are limited to scoring the esophageal damage based on the symptoms of patients. Magnetic resonance imaging (MRI) is a non-invasive imaging modality that may potentially visualize radiation-induced organ damage. We investigated the feasibility of using T2-weighted MRI to detect and monitor ARIED using a two-phased study in mice. Methods The first phase aimed to establish the optimal dose level at which ARIED is inducible and to determine the time points where ARIED is detectable. Twenty four mice received a single dose delivery of 20 and 40 Gy at proximal and distal spots of 10.0 mm (in diameter) on the esophagus. Mice underwent MRI and histopathology analysis with esophageal resection at two, three, and 4 weeks post-irradiation, or earlier in case mice had to be euthanized due to humane endpoints. In the second phase, 32 mice received a 40 Gy single dose and were studied at two, three, and 7 days post-irradiation. We detected ARIED as a change in signal intensity of the MRI images. We measured the width of the hyperintense area around the esophagus in all mice that underwent MRI prior to and after irradiation. We conducted a blind qualitative comparison between MRI findings and histopathology as the gold standard. Results/conclusions A dose of 40 Gy was needed to induce substantial ARIED. MRI detected ARIED as high signal intensity, visible from 2 days post-irradiation. Quantitative MRI analysis showed that the hyperintense area around the esophagus with severe ARIED was 1.41 mm wider than with no damage and MRI-only mice. The overall sensitivity and specificity were 56 and 43% respectively to detect any form of ARIED. However, in this study MRI correctly detected 100% of severe ARIED cases. Our two-phased preclinical study showed that MRI has the potential to detect ARIED as a change in signal intensity and width of enhancement around the esophagus.

Abstract Background Clinically localized renal cell carcinoma is treated primarily with surgery followed by observation or adjuvant sunitinib in selected high-risk patients. The checkpoint inhibitor immunotherapeutic agents nivolumab and ipilimumab have recently shown a survival benefit in the first-line metastatic setting. To date, there have been no reports on the response of localized renal cancer to modern immunotherapy. We report a remarkable response of an advanced tumor thrombus to combined immunotherapy which facilitated curative-intent resection of the non-responding primary renal tumor. We characterized the tumor microenvironment within the responding and non-responding tumors. Case presentation A 54-year-old female was diagnosed with a locally advanced clear cell renal cell carcinoma with a level IV tumor thrombus of the vena cava. She was initially deemed unfit for surgical resection due to poor performance status. She underwent neoadjuvant immunotherapy with nivolumab and ipilimumab with a complete response of the vena cava and renal vein tumor thrombus, but had stable disease within her renal mass. She underwent complete surgical resection with negative margins and remains disease-free longer than 1 year after her diagnosis with no further systemic therapy. Notably, pathologic analysis showed a complete response within the vena cava and renal vein, but substantial viable cancer remained in the kidney. Multichannel immunofluorescence was performed and showed marked infiltration of immune cells including CD8+ T cells and Batf3+ dendritic cells in the thrombus, while the residual renal tumor showed a non-T cell-inflamed phenotype. Conclusions Preoperative immunotherapy with nivolumab and ipilimumab for locally advanced clear cell renal cancer resulted in a complete response of an extensive vena cava tumor thrombus, which enabled curative-intent resection of a non-responding primary tumor. If validated in larger cohorts, preoperative immunotherapy for locally advanced renal cell carcinoma may ultimately impact surgical planning and long-term prognosis.

Kelps form extensive underwater forests that underpin valuable ecosystem goods and services in temperate and polar rocky coastlines globally. Stressors, such as ocean warming and pollution are causing regional declines of kelp forests and their associated services worldwide. Kelp forest restoration is becoming a prominent management intervention, but we have little understanding of what drives restoration success at appropriate spatial scales. Though most restoration guidelines stress the importance of planning, stressor mitigation and ecological knowledge, other factors, such as lack of resources or institutional support are rarely discussed despite being potentially critical to achieving desired restoration outcomes. In this paper, we work to understand the importance of finances and institutions in the context of four of the world’s largest kelp restoration projects. These projects span four countries, six kelp genera and were initiated in response to different causes of decline. We argue that to restore kelp at desired scales, adequate financing, and institutional support are critical to overcome ecological and environmental limitations. Acknowledging limitations, we outline ways to mobilize resources and encourage institutions to support kelp restoration.

Kelp forests are highly productive foundation species along much of the world’s coastline. As a result, kelp are crucial to the ecological, social, and economic well-being of coastal communities. Yet, due to a combination of acute and chronic stressors, kelp forests are under threat and have declined in many locations worldwide. Active restoration of kelp ecosystems is an emerging field that aims to reverse these declines by mitigating negative stressors and then, if needed, introducing biotic material into the environment. To date, few restoration efforts have incorporated positive species interactions. This gap presents a potential shortcoming for the field as evidence from other marine ecosystems illustrates that the inclusion of positive species interactions can enhance restoration success. Additionally, as the climate continues to warm, this approach will be particularly pertinent as positive interactions can also expand the range of physical conditions under which species can persist. Here, we highlight how practitioners can use positive density dependence within and amongst kelp species to increase the chances of restoration success. At higher trophic levels, we emphasize how co-restoring predators can prime ecosystems for restoration. We also investigate how emerging technologies in genetic and microbial selection and manipulation can increase the tolerance of target species to warming and other stressors. Finally, we provide examples of how we can use existing anthropogenic activities to facilitate restoration while performing alternative purposes. As kelp forests continue to decline and the field of kelp restoration continues to develop, it is also important that we monitor these potential advancements and ensure they do not have unintended ecosystem effects, particularly with untested techniques such as genetic and microbial manipulations. Nevertheless, incorporating positive species interactions into future restoration practice stands to promote a more holistic form of restoration that also increases the likelihood of success in a shifting seascape.

Kelp forests dominate the rocky coasts of temperate Australia and are the foundation of the Great Southern Reef. Much like terrestrial forests, these marine forests create complex habitat for diverse communities of flora and fauna. Kelp forests also support coastal food-webs and valuable fisheries and provide a suite of additional ecosystem services. In many regions of Australia and around the world, kelp forests are in decline due to ocean warming, overgrazing, and pollution. One potential tool in the conservation and management of these important ecosystems is habitat restoration, the science and practice of which is currently undergoing substantial expansion. We summarize the present state of Australian kelp forests and emphasize that consideration of the initial drivers of kelp decline is a critical first step in restoration. With a focus on Australian examples, we review methods, implementation and outcomes of kelp forest restoration, and discuss suitable measures of success and the estimated costs of restoration activities. We propose a workflow and decision system for kelp forest restoration that identifies alternative pathways for implementation and acknowledges that under some circumstances restoration at scale is not possible or feasible. As a case study, we then apply the Society for Ecological Restoration’s 5-star evaluation to Operation Crayweed, Australia’s primary example of kelp forest restoration. Overall, no single method of kelp forest restoration is suitable for all situations, but outcomes can be optimized by ameliorating the driver(s) of kelp decline and achieving ongoing natural recruitment of kelp. Whilst scalability of kelp forest restoration to the seascape-scale remains a considerable challenge, the present review should provide a platform for future restoration efforts. However, it is also crucial to emphasize that the challenges of restoration place a high value on preventative conservation and protection of existing kelp forest ecosystems – prevention is invariably better than cure.

Competitive interactions between corals and macroalgae play an important role in determining benthic community structure on coral reefs. While it is known that macroalgae may negatively affect corals, the relative influence of contact- versus water-mediated macroalgal interactions on corals – such as via an influence on coral-associated microbiomes – is less well understood. Further, the impacts of macroalgae on corals that have persisted in a heavily urbanized reef system have not been explored previously. We examined the effects of the macroalgae Lobophora sp. and Hypnea pannosa on the physiology and microbiome of three Indo-Pacific coral species (Merulina ampliata, Montipora stellata, and Pocillopora acuta) collected from two reefs in Singapore (Pulau Satumu and Kusu Island), and compared how these effects varied between direct contact and water-mediated interactions. Direct contact by Lobophora sp. caused visible tissue bleaching and reduced maximum quantum yield (Fv/Fm) in all three coral species, while direct contact by H. pannosa only led to slight, but significant, suppression of Fv/Fm. No detrimental effects on coral physiology were observed when corals were in close proximity to the macroalgae or when in direct contact with algal mimics. However, both direct contact and water-mediated interactions with Lobophora sp. and H. pannosa altered the prokaryotic community structures in M. stellata. For M. ampliata and P. acuta, the changes in their microbiomes in response to algal treatments were more strongly influenced by the source reefs from which the coral colonies were collected. In particular, coral colonies collected from Kusu Island had proportionately more initial abundances of potentially pathogenic bacteria in their microbiomes than those collected from Pulau Satumu; nevertheless, coral fragments from Kusu Island had the same physiological responses to macroalgal interactions as corals from Pulau Satumu. Overall, our results reveal that, for the species tested, the coral microbiomes were sensitive to both direct contact and water-mediated interactions with macroalgae, while coral physiology was only compromised when in direct contact. Further, the presence of high levels of potentially pathogenic bacteria in some of the coral samples did not lead to the corals being more susceptible to impacts from macroalgae.

Purpose: Our prospective, randomized clinical study aims to evaluate the utility of intraoperative transesophageal echocardiography (TEE) in patients undergoing radical cystectomy. Materials and Methods: Eighty patients were randomized to a standard of care group or the intervention group that received continuous intraoperative TEE. Data are presented as means ± standard deviations, median (25th percentile, 75th percentile), or numbers and percentages. Characteristics were compared between groups using independent sample t-tests, Wilcoxon–Mann–Whitney tests or Chi-square tests, as appropriate. All tests were two-sided and P < 0.05 was considered to indicate statistical significance. Results: Both groups had similar preoperative demographic characteristics. There was a significant difference between central line insertion with all insertions in the control group (15%, 6 vs. 0%, 0; P < 0.003). Of all the perioperative complications, 80% occurred in the control group versus 20% in the TEE group, with 21% of controls experiencing a cardiac or pulmonary complication compared to 5% in the TEE group (8 vs. 2, P < 0.04). The control group patients were more likely to have adverse cardiac complications than the TEE group (15%, 6 vs. 3%, 1; P < 0.040). Postoperative cardiac arrhythmia was observed only in the control group (13%, 5 vs. 0%, 0; P