Characterization and Evaluation of the Artemis Camera for Fluorescence-Guided Cancer Surgery

Purpose: Near-infrared (NIR) fluorescence imaging can provide the surgeon with real-time visualization of, e.g., tumor margins and lymph nodes. We describe and evaluate the Artemis, a novel, handheld NIR fluorescence camera.Procedures: We evaluated minimal detectable cell numbers (FaDu-luc2, 7D12-IRDye 800CW), preclinical intraoperative detection of sentinel lymph nodes (SLN) using indocyanine green (ICG), and of orthotopic tongue tumors using 7D12-800CW. Results were compared with the Pearl imager. Clinically, three patients with liver metastases were imaged using ICG.Results: Minimum detectable cell counts for Artemis and Pearl were 2 × 105 and 4 × 104 cells, respectively. In vivo, seven SLNs were detected in four mice with both cameras. Orthotopic OSC-19-luc2-cGFP tongue tumors were clearly identifiable, and a minimum FaDu-luc2 tumor size of 1 mm3 could be identified. Six human malignant lesions were identified during three liver surgery procedures.Conclusions: Based on this study, the Artemis system has demonstrated its utility in fluorescence-guided cancer surgery

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

A late Pleistocene gastropod fauna from the northern Caspian Sea with implications for Pontocaspian gastropod taxonomy

The present paper details a very diverse non-marine gastropod fauna retrieved from Caspian Pleistocene deposits along the Volga River north of Astrakhan (Russia). During time of deposition (early Late Pleistocene, late Khazarian regional substage), the area was situated in shallow water of the greatly expanded Caspian Sea. The fauna contains 24 species, of which 16 are endemic to the Pontocaspian region and 15 to the Caspian Sea. The majority of the species (13) belongs to the Pyrgulinae (Hydrobiidae), a group famous for its huge morphological variability in the Pontocaspian region. The phenotypic diversity has led to an inflation of genus and species names in the literature. New concepts are proposed for many of the genera and species found in the present material, with implications for the systematics and taxonomy of the entire Pontocaspian gastropod fauna. Laevicaspia vinarskii sp. n. is described as a new species. This contribution is considered a first step in revising the Pontocaspian gastropod fauna

A late Pleistocene gastropod fauna from the northern Caspian Sea with implications for Pontocaspian gastropod taxonomy

The present paper details a very diverse non-marine gastropod fauna retrieved from Caspian Pleistocene deposits along the Volga River north of Astrakhan (Russia). During time of deposition (early Late Pleistocene, late Khazarian regional substage), the area was situated in shallow water of the greatly expanded Caspian Sea. The fauna contains 24 species, of which 16 are endemic to the Pontocaspian region and 15 to the Caspian Sea. The majority of the species (13) belongs to the Pyrgulinae (Hydrobiidae), a group famous for its huge morphological variability in the Pontocaspian region. The phenotypic diversity has led to an inflation of genus and species names in the literature. New concepts are proposed for many of the genera and species found in the present material, with implications for the systematics and taxonomy of the entire Pontocaspian gastropod fauna. Laevicaspia vinarskii sp. n. is described as a new species. This contribution is considered a first step in revising the Pontocaspian gastropod fauna

Didacna cristata Bogachev 1932

Didacna cristata Bogachev, 1932 (Fig. 5: 6). *1932 Didacna praetrigonoides var. cristata Bogachev: 44, pl. 4, figs. 9–14. 1948 Didacna cristata Bogachev – Fedorov: 19, pl. 1, figs. 4–6, pl. 2, figs. 4–8. 1953 Didacna cristata Bogachev – Fedorov: 127, pl. 16, figs. 1– 11. 1983 Didacna cristata Bogachev, 1932 – Popov: 201, pl. 12, figs. 9–22. Dimensions – max. L 19.8 mm, H 16.3 mm. Characterization – Medium-sized, relatively high, subtrigonate to subovate convex and robust Didacna. Beak clearly defined. Posterodorsal margin steep, thin, well delimited. Semidiameter located on posterior ridge that is well developed and sharp. In about half of the specimens two elevated ribs form the posterior ridge. Posterior margin rounded angular. Between 15 and 21 posterior ribs that are wide and flat and about three times as wide as the interspaces. Juveniles have a wide trapezoid outline with a rounded lower margin and a subtruncate posterior margin. The hinge plate and cardinal teeth are robust. Taxonomic notes – Bogachev (1932) distinguished the new variety D. praetrigonoides var. cristata from typical D. praetrigonoides by its smaller size, more triangular outline and sharper keel. Fedorov (1953) showed that the variety not only differs in shape and size from D. praetrigonoides but also in its stratigraphic position. While D. praetrigonoides is characteristic for the upper Khvalynian deposits, D. praetrigonoides var. cristata is an index fossil of the lower Khvalynian of the east coast of the Caspian Sea. Fedorov (1953) mentioned that the juvenile D. praetrigonoides forms are similar to D. cristata. Nevesskaja (1958) disagreed with Fedorov while studying a collection of mollusks from the Khvalynian deposits of West Turkmenistan. She stated that the Khvalynian beds of Turkmenistan yielded relatively small shells (up to 50 mm long), with a well-developed plate like a keel and a small number of ribs (23–27). Nevesskaja (1958) concluded that the variety should not be regarded as a distinct taxon because it only shows the plasticity of the species but cannot be well delineated in time or space (see also Nevesskaja, 2007). In contrast, Popov (1983) supported the opinion of Fedorov (1953) based on a comparative statistical analysis of shell dimensions of D. cristata and D. praetrigonoides (Table 41 in Popov, 1983). He demonstrated that the differences between D. cristata and D. praetrigonides were bigger than between many others Quaternary Didacna species. Here, we follow the view of Fedorov (1953) and Popov (1983). Ecology – Unknown (extinct). In general trigonoid Didacna species prefer low salinities (Yanina, 2012), but since D. cristata is extinct the paleosalinities can only be inferred.Published as part of van de Velde, Sabrina, Yanina, Tamara A., Neubauer, Thomas A. & Wesselingh, Frank P., 2020, The Late Pleistocene mollusk fauna of Selitrennoye (Astrakhan province, Russia): A natural baseline for endemic Caspian Sea faunas, pp. 1227-1239 in Journal of Great Lakes Research 46 (5) on pages 1231-1232, DOI: 10.1016/j.jglr.2019.04.001, http://zenodo.org/record/501920

Monodacna semipellucida

Monodacna semipellucida (Logvinenko and Starobogatov, 1967) (Fig. 4: 3). *1967 Hypanis semipellucida Logvinenko and Starobogatov: 232 –233. 1973 Hypanis semipellucida Logvinenko and Starobogatov, 1967 – Grossu: 144, fig. 27. 2013 Adacna (Monodacna) semipellucida Logvinenko and Starobogatov, 1967 – Kijashko in Bogutskaya et al.: 384, fig. 161, photo 55. Dimensions – max. L 23 mm, H 16 mm. Characterization – This species is relatively thin-walled and low, often has an elliptical outline in adult stages with low, broad and smooth ribs and narrow interspaces. The ribs and interspaces are well visible on the shell’s interior. The most distinct character is the cardinal tooth that is a very narrow but well delimited knob that is located well towards the base of the hinge platform. Ecology – Monodacna semipellucida lives in the Middle Caspian Sea (Bogutskaya et al., 2013; Logvinenko and Starobogatov, 1969; Wesselingh et al., 2019), down to 40 m water depth and minimum salinities of 5–8 psu (Bogutskaya et al., 2013; Logvinenko and Starobogatov, 1969).Published as part of van de Velde, Sabrina, Yanina, Tamara A., Neubauer, Thomas A. & Wesselingh, Frank P., 2020, The Late Pleistocene mollusk fauna of Selitrennoye (Astrakhan province, Russia): A natural baseline for endemic Caspian Sea faunas, pp. 1227-1239 in Journal of Great Lakes Research 46 (5) on pages 1235-1236, DOI: 10.1016/j.jglr.2019.04.001, http://zenodo.org/record/501920

Adacna laeviuscula

Adacna laeviuscula (Eichwald, 1829) (Fig. 4: 1). *1829 G. [lycymeris] laeviuscula Eichwald: 279, pl. 5, fig. 1. 1986 Adacna (Adacna) laeviuscula (Eichwald, 1831). – Yakhimovich et al.: 85, pl. 11, fig. 8. 2013 Adacna laeviuscula (Eichwald, 1829). – Bogutskaya et al.: 377, fig. 154, photo 48. Dimensions – max. L 32 mm, H 21 mm. Characterization – Large, subquadrate to subtrigonal thinshelled flat cardiid with strong posterior and slight anterior gape; dorsal margins relatively straight; relatively few ribs that are thin in juvenile stages and become very flat and separated by barely perceptible grooves in adult stages; hinge is a mostly edentulous, straight and flat ridge; in juvenile specimens a small cardinal tooth may be present that disappears in adult stages. Ecology – This species has been listed from the entire CS from water depths between 35 and 100 m in salinities of at least 4 psu (Bogutskaya et al., 2013; Logvinenko and Starobogatov, 1969). The common occurrence of fresh, paired specimens on exposed beaches of the middle Caspian (Turali, Russia; Sirvan, Azerbaijan: pers. observ. FW) demonstrates that A. laeviuscula has viable populations in foreshore settings above storm wave base indicating shallower habitats than previously reported.Published as part of van de Velde, Sabrina, Yanina, Tamara A., Neubauer, Thomas A. & Wesselingh, Frank P., 2020, The Late Pleistocene mollusk fauna of Selitrennoye (Astrakhan province, Russia): A natural baseline for endemic Caspian Sea faunas, pp. 1227-1239 in Journal of Great Lakes Research 46 (5) on pages 1230-1231, DOI: 10.1016/j.jglr.2019.04.001, http://zenodo.org/record/501920