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Various species of Alexandrium can produce a number of bioactive compounds, e.g., paralytic shellfish toxins (PSTs), spirolides, gymnodimines, goniodomins, and also uncharacterised bioactive extracellular compounds (BECs). The latter metabolites are released into the environment and affect a large range of organisms (from protists to fishes and mammalian cell lines). These compounds mediate allelochemical interactions, have anti-grazing and anti-parasitic activities, and have a potentially strong structuring role for the dynamic of Alexandrium blooms. In many studies evaluating the effects of Alexandrium on marine organisms, only the classical toxins were reported and the involvement of BECs was not considered. A lack of information on the presence/absence of BECs in experimental strains is likely the cause of contrasting results in the literature that render impossible a distinction between PSTs and BECs effects. We review the knowledge on Alexandrium BEC, (i.e., producing species, target cells, physiological effects, detection methods and molecular candidates). Overall, we highlight the need to identify the nature of Alexandrium BECs and urge further research on the chemical interactions according to their ecological importance in the planktonic chemical warfare and due to their potential collateral damage to a wide range of organisms.

Our planet is changing, and one of the most pressing challenges facing the scientific community revolves around understanding how ecological communities respond to global changes. From coastal to deep-sea ecosystems, ecologists are exploring new areas of research to find model organisms that help predict the future of life on our planet. Among the different categories of organisms, meiofauna offer several advantages for the study of marine benthic ecosystems. This paper reviews the advances in the study of meiofauna with regard to climate change and anthropogenic impacts. Four taxonomic groups are valuable for predicting global changes: foraminifers (especially calcareous forms), nematodes, copepods and ostracods. Environmental variables are fundamental in the interpretation of meiofaunal patterns and multistressor experiments are more informative than single stressor ones, revealing complex ecological and biological interactions. Global change has a general negative effect on meiofauna, with important consequences on benthic food webs. However, some meiofaunal species can be favoured by the extreme conditions induced by global change, as they can exhibit remarkable physiological adaptations. This review highlights the need to incorporate studies on taxonomy, genetics and function of meiofaunal taxa into global change impact research.

Background Post-operative atrial fibrillation (POAF) occurs in up to 40% of patients following coronary artery bypass grafting (CABG) and is associated with a higher risk of stroke and mortality. This study investigates how POAF may be mitigated by epicardial placement of aseptically processed human placental membrane allografts (HPMAs) before pericardial closure in CABG surgery. This study was conducted as a pilot feasibility study to collect preliminary for a forthcoming multi-center randomized controlled trial. Methods This retrospective observational study of patients undergoing CABG surgery excluded patients with pre-operative heart failure, chronic kidney disease, or a history of atrial fibrillation. The “treatment” group ( n  = 24) had three HPMAs placed epicardially following cardiopulmonary bypass decannulation but before partial pericardial approximation and chest closure. The only difference in clinical protocol for the control group ( n  = 54) was that they did not receive HPMA. Results HPMA-treated patients saw a significant, greater than four-fold reduction in POAF incidence compared to controls (35.2–8.3%, p  = 0.0136). Univariate analysis demonstrated that HPMA treatment was associated with an 83% reduction in POAF (OR = 0.17, p  = 0.0248). Multivariable analysis yielded similar results (OR = 0.07, p  = 0.0156) after controlling for other covariates. Overall length of stay (LOS) between groups was similar, but ICU LOS trended lower with HPMA treatment ( p  = 0.0677). Post-operative inotrope and vasopressor requirements were similar among groups. There was no new-onset post-operative heart failure, stroke, or death reported up to thirty days in either group. Conclusions Epicardial HPMA placement can be a simple intervention at the end of CABG surgery that may provide a new approach to reduce post-operative atrial fibrillation by modulating local inflammation, possibly reducing ICU and hospital stay, and ultimately improving patient outcomes.

IntroductionCurrent guidelines suggest upper and lower GI endoscopy to investigate iron deficiency anaemia (IDA) because of a perceived low risk of small bowel pathology. We aimed to identify the Bleeding Location In The Gastrointestinal Tract (BLITGIT) in patients with IDA.MethodsPatients referred to three centres (Sheffield, Hong Kong and Szekesfehervar, Hungary) for the investigation of IDA underwent small bowel (SB) capsule endoscopy (Navicam, AnX Robotica, Plano, US) in the week prior to upper and lower gastrointestinal endoscopy. All lesions were described using terms selected from a predetermined diagnostic list and according to the perceived likelihood of bleeding (P0: unlikely; P1: suspected; P2: likely. Saurin et al., Endoscopy 2003).Results92 patients (median age 61 years (IQR 45–72); 54.3% male) had a median haemoglobin of 107.5 g/L (IQR 93.2–121.7), ferritin 8(IQR 8- 18) and iron 3.8(IQR 3.8- 6.4). Completion rates for gastroscopy, colonoscopy and capsule endoscopy were 98.9%, 95.6% and 84.7% respectively. Diagnostic yield of P1/P2 lesions by SB capsule (48.9%) was higher than gastroscopy (27.1%) and colonoscopy (29.3%; p=0.003). On multivariant analysis there was no correlation between age, haemoglobin level, symptoms or medication on pathology. A few patients had more than one P1/P2 lesions. In 25 (27.1%) patients P1/P2 pathology was identified on gastroscopy. In 45 (48.9%) patients P1/P2 pathology was identified in the SB. On colonoscopy 27 (29.3%) patients had P1/P2 pathology. Three patients had colorectal cancer and two patients had a new diagnosis of ulcerative colitis.Abstract P167 Table 1Number of patients with P1/P2 pathology identified at gastroscopy, SB capsule and colonoscopy. Dy= diagnostic yield Gastroscopy pathology (P1/P2) Small bowel pathology (P1/P2) Colon pathology (P1/P2) Oesophagitis- 2Oesophageal ulcer- 1Oesophageal varices- 2Gastric erosions- 9Gastric ulcer- 5Gastric polyp with blood- 1Gastric antral vascular ectasia -2Portal hypertensive gastropathy – 1Duodenal ulcer- 3 Angioectasia- 23Erosion - 18Ulcers- 16Polyp with eroded surface- 1Single diverticula- 1Fresh blood- 3Portal hypertensive enteropathy- 1 Haemorrhoids- 15Colorectal cancer- 3Ulcerative colitis- 2Diverticulitis-2NSAID induced Ulcers- 1Angioectasia- 2Radiation proctitis- 2 ConclusionsThe diagnostic yield in the small bowel is higher as compared to the upper and lower GI tract and examination should be considered routinely.

IntroductionCurrent guidelines suggest upper and lower GI endoscopy to investigate iron deficiency anaemia (IDA) because of a perceived low risk of small bowel pathology. This is the first study to investigate the entire gastrointestinal tract to localise lesions suspected of causing blood loss in patients with IDA.MethodsPatients referred to three centres (Sheffield, Hong Kong and Szekesfehervar, Hungary) for the investigation of IDA underwent small bowel (SB) capsule endoscopy (Navicam, AnX Robotica, Plano, US) a week prior to upper and lower gastrointestinal endoscopy. All lesions were described using terms selected from a predetermined diagnostic list and according to the perceived likelihood of bleeding (P0: unlikely; P1: suspected; P2: likely. Saurin et al., Endoscopy 2003).ResultsAssuming a true prevalence of small bowel lesions of 10% in patients with IDA, a sample size required to have 80% power of getting a 95% confidence interval for the prevalence no wider than 10 percentage points is 160 patients. 167 patients (median age 60 years (IQR 46–72); 53.0% male) had a median haemoglobin of 102.5 g/L (IQR 92.5–117.0), ferritin 11(IQR 7- 18) and iron 6 (IQR 4- 10). Completion rates for gastroscopy, colonoscopy and capsule endoscopy were 99.4%, 95.0% and 90.0% respectively. Diagnostic yield of P1/P2 lesions by SB capsule (46.7%) was higher than gastroscopy (28.0%) and colonoscopy (31.0%); p<0.001. Four patients were diagnosed with coeliac disease based on capsule endoscopy and duodenal biopsy. A further three patients had fresh blood seen on capsule the source of which was unclear.Abstract O10 Table 1Number of patients with P1/P2 pathology identified at gastroscopy, SB capsule and colonoscopy Gastroscopy pathology Small bowel pathology Colonoscopy pathology Oesophageal ulcer:Oesophageal Varices:Gastric tumour:Gastric ulcers:Gastric angioectasia:Gastric erosions:Gastric polyp with eroded surface:GAVE:PHG:Large friable duodenal adenoma:Duodenal ulcerDuodenal erosions:Duodenal angioectasia: 72251243311252 Angioectasia:Small bowel ulcers:Ulcerated stenosis:Polyp with eroded surface:Small bowel erosions: 512132 30 Colorectal cancer:Haemorrhoids:NSAID induced ulcer:Terminal ileal ulceration:Terminal ileal erosions:Angioectasia:IBD:Radiation proctitis: 822143222ConclusionPathology suspected of, or likely to be, causing blood loss in patients with IDA appears to be commoner in the small bowel than the proximal GI tract or colon. Small bowel examination should be performed routinely to maximise diagnostic yield.

Cardiac ischemic reperfusion injury (IRI) is paradoxically instigated by reestablishing blood‐flow to ischemic myocardium typically from a myocardial infarction (MI). Although revascularization following MI remains the standard of care, effective strategies remain limited to prevent or attenuate IRI. We hypothesized that epicardial placement of human placental amnion/chorion (HPAC) grafts will protect against IRI. Using a clinically relevant model of IRI, swine were subjected to 45 min percutaneous ischemia followed with (MI + HPAC, n = 3) or without (MI only, n = 3) HPAC. Cardiac function was assessed by echocardiography, and regional punch biopsies were collected 14 days post‐operatively. A deep phenotyping approach was implemented by using histological interrogation and incorporating global proteomics and transcriptomics in nonischemic, ischemic, and border zone biopsies. Our results established HPAC limited the extent of cardiac injury by 50% (11.0 ± 2.0% vs. 22.0 ± 3.0%, p = 0.039) and preserved ejection fraction in HPAC‐treated swine (46.8 ± 2.7% vs. 35.8 ± 4.5%, p = 0.014). We present comprehensive transcriptome and proteome profiles of infarct (IZ), border (BZ), and remote (RZ) zone punch biopsies from swine myocardium during the proliferative cardiac repair phase 14 days post‐MI. Both HPAC‐treated and untreated tissues showed regional dynamic responses, whereas only HPAC‐treated IZ revealed active immune and extracellular matrix remodeling. Decreased endoplasmic reticulum (ER)‐dependent protein secretion and increased antiapoptotic and anti‐inflammatory responses were measured in HPAC‐treated biopsies. We provide quantitative evidence HPAC reduced cardiac injury from MI in a preclinical swine model, establishing a potential new therapeutic strategy for IRI. Minimizing the impact of MI remains a central clinical challenge. We present a new strategy to attenuate post‐MI cardiac injury using HPAC in a swine model of IRI. Placement of HPAC membrane on the heart following MI minimizes ischemic damage, preserves cardiac function, and promotes anti‐inflammatory signaling pathways.

IntroductionGuidelines recommend upper and lower GI endoscopy to investigate the cause of iron deficiency anaemia (IDA). This practice is based on small, retrospective studies of select populations in which small bowel pathology was rarely identified. This study aimed to localise and grade all lesions with bleeding potential by performing panenteric endoscopy.MethodsPatients with IDA able to attend for capsule endoscopy in the week prior to upper and lower GI endoscopy and who had no risk factors for capsule retention were recruited from Sheffield (UK), Székesfehérvár (Hungary) and Hong Kong. Images of all upper and lower GI and small bowel lesions were assessed by a three member expert consensus panel, described using terminology from a pre-defined diagnostic register and the Saurin classification (P0: bleeding unlikely; P1: bleeding possible; P2: bleeding likely). The true prevalence of small bowel lesions in patients with IDA was assumed to be 10%, such that a sample size required to have 80% power of getting a 95% confidence interval for the prevalence no wider than 10 percentage points was 160 patients.ResultsAll gastroscopy, capsule endoscopy and colonoscopy (completion rates 99.4%, 88.2% and 95.2% respectively) data from 170 patients (median age 61 years (IQR 46- 71); 44% female) was analysed. Per-patient diagnostic yields of P1 and P2 lesions by gastroscopy, small bowel capsule endoscopy and colonoscopy were 27.6%, 49.4% and 20% (P<0.0001) and for P2 lesions alone, 6.5%, 10% and 9.4% respectively (P=0.48). P1 and P2 lesions were localised to oesophagus, stomach, small bowel, and colon in 5.5%, 18.3%, 63.0% and 13.2% respectively. P1 or P2 lesions occurred in more than one location in 27.6%.Oesophageal lesions were erosions (2.7%), ulcers (1.8%) and varices (0.9%); gastric lesions were erosions (10.5%), ulcers (2.3%), eroded polyp (2.3%), gastric antral vascular ectasia (1.4%), neoplasia (0.9%: one cancer, one a secondary lesion from lymphoma diagnosed by breast biopsy), angioectasia (0.5%), portal hypertensive gastropathy (0.5%); small bowel lesions were angioectasia (30.6%), erosions (16.4%), ulcers (10.5%), ulcerated stenosis (1.8%), fresh blood (1.8%), eroded polyp (1.4%), vascular lesion (0.9%); colonic lesions were cancer (4.1%), haemorrhoids (4.1%), angioectasia (1.8%), ulcers (1.8%) and eroded polyps (1.4%).ConclusionsThe commonest location of lesions causing IDA was the small bowel and malignant causes, the colon. A low threshold to exclude patients with possible obstructive symptoms may partly explain the absence of small bowel neoplasia. Nonetheless, important small bowel pathologies likely to cause recurrent bleeding were common and should be sought routinely in patients with IDA.