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A mesocosm study of stranded Sargassum shows considerable volatilization and arsenic dominating in inorganic forms
No full textPelagic Sargassum seaweed is known to bioaccumulate arsenic, yet limited information exists about the fate of this arsenic once Sargassum strands on beaches. The objective of this study was to evaluate the transfer of arsenic from Sargassum to sand, leachate, and the atmosphere, as well as arsenic speciation, during a simulated stranding scenario. Two sets of mesocosms were used to measure the transfer: one containing Sargassum and sand (SS), and a control containing sand only (SO). Initial arsenic concentrations in Sargassum (34 mg/kg) increased during drying (peaking at 66.7 mg/kg), then declined to a steady level of 7.7 mg/kg by day 70. Of the arsenic lost from Sargassum in the SS mesocosms, 41% was detected in leachate, 5% was absorbed by the underlying sand, and 54% was volatilized. The sand, which was split for each mesocosm, had statistically different arsenic concentrations by the end of the experiment (p = 0.003) with sand beneath the Sargassum in the SS mesocosms showing a slight increase in arsenic concentrations, while the sand in the SO mesocosms experienced a slight decrease. The leachates from both mesocosms were compared to the mean rainfall arsenic concentration (2.2 μg/L). Only the SS mesocosm leachates were significantly elevated (p = 0.0067, maximum at 322 μg/L), while the SO mesocosm leachates were not significantly different (p = 0.97, maximum at 4.1 μg/L) from rainfall. Across all compartments (Sargassum, sand, and leachate), the dominant arsenic species was inorganic As(V), followed by dimethylarsinic acid, DMA(V). Overall, these findings demonstrate that Sargassum acts as a source of arsenic, primarily as inorganic As(V), to coastal environments, with most being lost through volatilization and leaching, and a smaller portion retained in sand. These results highlight the complex role of Sargassum in coastal arsenic cycling and its potential to serve as a source of arsenic exposures for beachgoers.[Display omitted]•Sargassum volatilized ∼54% of its arsenic content•Leachate arsenic peaked at 322 μg/L, above drinking standards•Sand under Sargassum had higher arsenic than control sand•As(V) dominated; DMA(V) increased over time in Sargassum•Volatilization is a major arsenic loss pathway from Sargassu
Sperm DNA fragmentation and its influence on mammalian reproduction
No full textSperm DNA fragmentation is a recognized factor in male infertility with direct implications for embryo development, implantation and pregnancy outcomes. Historically, standard semen analysis has not included assessments of DNA integrity, creating a clear need for advanced diagnostic tools. DNA damage can arise through pathways such as apoptosis, oxidative stress and exposure to environmental toxins, all of which compromise reproductive potential. Several methodologies exist for measuring sperm DNA fragmentation, including the sperm chromatin structure assay, terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL), the Comet assay and sperm chromatin dispersion, each of which has unique advantages and limitations. Novel automated imaging platforms incorporating machine learning algorithms have emerged, enabling high-throughput, single-sperm assessment and reducing subjectivity associated with manual scoring. Species differences further complicate the understanding of DNA stability and sperm quality, especially in livestock and models of artificial insemination; nonetheless, physiological similarities between humans and species close to humans provide useful translational insights. Emerging sperm selection technologies, including microfluidics, hyaluronic acid affinity systems and magnetic-activated cell sorting, show promise in reducing DNA fragmentation, improving reproductive outcomes and decreasing pregnancy loss. As the field progresses toward increasingly personalized fertility treatments, measures of DNA integrity will remain central to optimizing assisted reproduction success rates across species
A myeloma identity crisis yields daratumumab resistance
No full textIn this issue of Blood, Meads et al1 conducted a response-adapted phase 2 study of daratumumab for older, transplant-ineligible patients with newly diagnosed multiple myeloma (NDMM) and demonstrated that dynamic loss of plasma cell transcriptional programs and immunosuppressive features are associated with resistance.</p
Evidence for Asian Swamp Eels as an Emerging Threat to Everglades Amphibians
No full textAs amphibian populations around the globe continue to shrink and suffer enigmatic declines, it is critical to use systematic studies to isolate causes and provide management targets for key environmental variables. We sampled the amphibian community at 30 sites dispersed across four large regions of the Everglades (FL, USA). The sites were chosen a priori to include a wide range of values for potentially important environmental gradients. We used a series of passive and active collection techniques at each site and then used model selection to determine which factors could best explain amphibian abundance and community composition. Our results show significant differences in both amphibian abundance and community composition across the four regions. Initial analyses indicated that amphibian abundance in the Everglades is correlated with nutrient levels and pH, while amphibian community composition is correlated with nutrient levels and variation between the four regions. In the midst of this project, evidence emerged that the Asian Swamp Eel, a relatively new invader of the Everglades, was decimating crayfish and small fish populations in the most southerly wetlands where it first arrived and had been spreading across some of our survey sites. Thus, while not initially structured to test this new invasive species gradient, addition of Asian Swamp Eel catch‐per‐unit‐effort data revealed that relative abundances of this novel invader replaced nutrient levels as the best predictor of both amphibian abundance and community composition. This suggests that Asian Swamp Eels are reinforcing, even exaggerating, a north–south gradient in Everglades amphibian communities that was already present due to natural variation in nutrients and water chemistry. Historical records reveal that the contemporary lack of aquatic amphibians within the Taylor Slough sub‐region of Everglades National Park is an unnatural condition, and likely the result of ecosystem collapse driven by Asian Swamp Eels. Future management in the Everglades should focus on mitigating the impact of invasive fish and limiting future human disturbance, as well as monitoring any anthropogenic shifts in nutrient levels to better understand how to restore the amphibian community of this naturally oligotrophic system
Migration of Primary Total Knee Replacement from Inpatient to Outpatient Facilities in the US (2019–2022): Trends, Demographics, and Comorbidities
No full textPrimary total knee arthroplasty (TKA) has shifted from inpatient to outpatient facilities in the United States, driven by surgical advances, the 2018 Center for Medicare & Medicaid Services inpatient-only list change, and COVID-19 pressures. Limited national data and unclear patient profiles in outpatient facilities versus hospitals prompt this study. Outpatient TKA patients are often younger and have fewer comorbidities, but safety debates persist. Using a national database, we examined (1) trends in knee arthroplasty settings, (2) demographic differences, and (3) comorbidity variations to inform patient selection, outcomes, and policy.
We conducted a retrospective analysis using two national databases from 2019 to 2022. Adult patients undergoing elective, unilateral, primary TKA were identified using validated coding algorithms. We analyzed temporal trends in procedure location and compared demographic and comorbidity profiles between patients treated in hospitals versus outpatient facilities.
A total of 50% of the volume of primary TKA migrated to outpatient centers from 2019 to 2022. The proportion of hospital-based TKAs declined from 64 to 14%, while Ambulatory Surgical Center (ASC) based procedures rose from 36 to 86%. The ASC patients were younger (67.2 versus 67.6 years, P < 0.01), more likely to be White (78.6 versus 77.6%, P < 0.01), and more likely to have commercial insurance (P < 0.01). Hospital-based patients had significantly higher rates of nearly all comorbidities than those in outpatient facilities.
There has been a dramatic national migration of TKA procedures from inpatient hospitals to ASCs over the last four years. Patients selected for ASC-based TKA tend to be healthier and demographically distinct. These findings underscore the need for careful patient selection and ongoing evaluation of outcomes to ensure safety and equity in the delivery of outpatient TKA
Gender-Affirming Genital Masculinization: Part 3 of the Plastic Surgeon's Perspective of Gender-Affirming Surgery
No full textOver the last few decades, great strides have been made in surgical techniques and access to care for transgender and nonbinary individuals. An important step for many transgender patients is the ability to undergo masculinizing bottom surgery. This allows improved alignment of physical appearance with gender identity and improvement in symptoms of gender incongruence. The main options involved in transmasculine bottom surgery are metoidioplasty and total phalloplasty. The surgical decision is adapted to the patient and their preferences along with the clinical opinion of the provider. While bottom surgery is complex and may require multiple operations, gender-affirming surgery decreases rates of gender incongruence, depression, and suicidality, and significantly improves quality-of-life measures
Intubating conditions based on the time from rocuronium administration versus the train-of-four count: A randomized, prospective, clinical trial
No full textThe use of quantitative neuromuscular monitoring during induction of anesthesia to establish a baseline neuromuscular response and ensure paralysis of the vocal cords during laryngoscopy and tracheal intubation has yet to become standard practice. The current study compared intubating conditions based on quantitative measurements (train-of-four count) with intubating conditions based on the time since rocuronium administration.
Consenting adult patients undergoing general anesthesia requiring neuromuscular block were randomized into 2 groups. Following placement of a quantitative electromyographic neuromuscular monitor, general anesthesia was induced with propofol 1–1.5 mg/kg followed by rocuronium 0.6 mg/kg. In one group, intubation commenced 2 min after rocuronium administration (Time Group). In the other, intubation commenced when the first train-of-four (TOF) count was ≤1 (Count Group). Video laryngoscopy was used in both groups and the intubating conditions were noted. A Wilcoxon rank sum test or Fisher's exact test was used to compare intubating conditions between the 2 groups. Spearman's rank correlation test was used to describe the relationship between intubation conditions and the ratio of the amplitude of the first twitch of the TOF sequence, T1, to the control T1 amplitude (T1/Tc).
There were 84 patients in the Count Group and 83 in the Time Group. More patients had ideal intubating conditions (relaxed jaw, abducted vocal cords, and no response to tracheal intubation) in the Count Group (61/84, 73 %) than the Time Group (47/83, 57 %, P = 0.036). The mean composite intubating score was better (lower) in the Count Group than in the Time Group (3.5 vs. 3.9, respectively, P = 0.016). The T1/Tc at intubation correlated with the composite intubating conditions score (Spearman's ρ = 0.34, P < 0.001).
Intubating conditions were better when the timing of intubation was guided by quantitative neuromuscular monitoring to ensure a TOF count ≤1 versus waiting a fixed time interval of 2 min following administration of rocuronium.
[Display omitted]
•Quantitative neuromuscular monitoring is recommended to confirm adequate recovery.•The role of monitoring at induction of anesthesia is not well-described.•Monitoring predicted better conditions than waiting 2 min after rocuronium
The telomerase vaccine UV1 combined with ipilimumab and nivolumab versus ipilimumab and nivolumab in advanced melanoma (INITIUM): A randomized open-label phase 2 study
No full textImmune checkpoint inhibitor (ICI) combinations have improved outcomes in patients with advanced melanoma; however, long term survival remains poor. The addition of therapeutic cancer vaccines to ICI combinations represents a promising strategy to enhance efficacy.
In this phase 2, randomized, open-label trial, 156 patients with unresectable or metastatic melanoma were randomized 1:1 to receive 4 cycles of ipilimumab 3mg/kg and nivolumab 1mg/kg with or without UV1, a telomerase-targeted therapeutic cancer vaccine, followed by maintenance nivolumab 480 mg every 4 weeks. The primary endpoint was progression-free survival (PFS) based on blinded independent central review. Secondary endpoints included overall survival (OS), response assessments, and safety.
At a minimum follow-up of 18 months, the projected median PFS was 34.3 months (95 % confidence interval [CI], 7.95 to NR) with ipilimumab-nivolumab-UV1 and 38.4 months (95 % CI, 8.15–38.37) with ipilimumab-nivolumab (hazard ratio, 0.95 [95 % CI, 0.59–1.55]). PFS at 12 months was 57 % (95 % CI, 45.0–68.1) and 57 % (95 % CI, 44.6–67.0) in the ipilimumab-nivolumab-UV1 and ipilimumab-nivolumab arms, respectively. Objective response rates were 59.7 % (ipilimumab-nivolumab-UV1) and 59.2 % (ipilimumab-nivolumab; odds ratio, 1.12; 95 % CI, 0.58–2.16). Median overall survival was not reached in either arm (hazard ratio, 1.15 [95 % CI, 0.60–2.20]). Grade > 3 treatment-emergent adverse events were reported in 64.5 % and 65.4 % of patients respectively.
For patients with treatment naïve advanced melanoma, the addition of UV1 to ipilimumab-nivolumab did not result in improved efficacy compared with ipilimumab-nivolumab alone.
•Randomised Phase 2 trial of ipilimumab + nivolumab + /- UV1 in metastatic melanoma.•No difference in response rate, progression free survival or overall survival.•No significant additional toxicity.•Independently verified responses confirm activity ipilimumab + nivolumab
Perspectives on hepatitis A and B screening and immunization at a syringe services program: a mixed-methods study
No full textPeople who inject drugs (PWID) are at increased risk for viral hepatitis, yet hepatitis A virus (HAV) and hepatitis B virus (HBV) screening and immunization rates remain low. Although offering HAV and HBV services at syringe services programs (SSPs) is effective, few U.S. SSPs currently offer them. Limited qualitative research exists on the advantages and optimization of these services at SSPs. This study explored PWID and SSP staff perspectives regarding barriers to HAV and HBV prevention and care services in traditional healthcare, facilitators for SSP-based provision, and opportunities to improve service delivery.This study was conducted at an SSP in Miami, Florida serving over 2500 PWID annually. Quantitative data on vaccine administration from August 2023 to May 2025 were abstracted from the SSP database. Prior to implementation, in May 2022, we conducted in-depth interviews with 15 PWID and 11 SSP staff. Transcripts were analyzed using codebook thematic analysis in Dedoose.From August 2023 to May 2025, the SSP administered 114 HAV and 176 HBV vaccine doses. Qualitative interviews from May 2022 revealed several key findings. Barriers included limited knowledge, stigma and discrimination, resource and transportation challenges, navigation difficulties, and limited prioritization. Facilitators for SSP-based services included the benefits of co-located, on-demand care, and non-stigmatizing and supportive environment. Opportunities for improvement included offering incentives, expanding outreach, and increasing communication.PWID face significant barriers to HAV and HBV services in traditional healthcare, including stigma, logistical challenges, and limited awareness of viral hepatitis. Integrating these services into SSPs enhanced accessibility and uptake by leveraging trust, convenience, and harm reduction principles
Understanding Medical Decision-Making in Urogynecology: Insights from a Predominantly Hispanic Patient Population
No full textTo explore the role of health literacy in surgical decision making in a predominately Hispanic population, we designed a mixed-methods approach to assess patient's literacy and explore what drives their choices for their healthcare. Understanding these factors will guide physicians to improve patient education, engagement and provide equitable care. In this IRB-approved study, English- and Spanish-speaking patients offered urogynecology surgery at our tertiary center were recruited. Participants completed the Short Assessment of Health Literacy (SAHL), a demographic survey, and a semi-structured interview to gain insight into their medical decision-making process. Data were analyzed using chi-square and t-tests, with p < 0.05 considered statistically significant. Grounded theory guided qualitative analysis of interview transcripts. Among 62 participants, most patients (90.3%) had sufficient health literacy. Mean SAHL scores did not differ between those electing for surgery and those declining. While Hispanic patients did tend to have lower SAHL scores (16.3) than non-Hispanic patients (17.1) (p = 0.04), the average still suggested adequate literacy. Interviews revealed that patients electing surgery often cited comfort with their physician (p = 0.01), definitive treatment (p = < 0.01), and friends' experiences (p = 0.04) as influential factors. The influence of personal faith was brought up by nineteen participants (13 electing for surgery, 6 declining surgery, p = 0.11). Our research revealed that our patient population tends to have adequate health literacy. Interviews revealed themes that influence choices, such as trust in their physician and patient's faith. Further investigation into the role that social factors play will be critical for better understanding patient surgical decision making