Lymph Node Harvest in Dukes' A Cancer Pathologist May Need to Consider Fat Dissolving Technique: An Observational Study

Background. National institute of clinical excellence (NICE) recommends that a median of 12 lymph nodes be examined in patients operated on with curative intent- to- treat colorectal cancer (CRC). Patients with lymph node harvest less than this may be considered under staged and may receive adjuvant chemotherapy. The aim of our study was to ascertain median number of lymph nodes examined in early colorectal cancers. Method. Patients undergoing colorectal resection between June 2007 and May 2008 were identified and pathological staging obtained using pathology database. Results. 146 patients underwent standardised laparoscopic or open resection of colorectal cancers during this period. Overall median number of lymph nodes harvested/patient was 14 (3–40). When analysed by stage, median number of lymph nodes harvested in Dukes' A, B, and C cancers was 10, 14, and 15, respectively. 11/18 (61%) patients with Dukes' A carcinoma had lymph node harvest of less than 12 compared with 15/55 (27%) patients with Dukes' B. Conclusion. Lymph node harvest in Dukes' A cancers using standard techniques tends to be low. Pathologists may have to consider special techniques in harvesting lymph nodes for early colorectal cancers

Chapter 08: Vulnerability of seagrasses in the Great Barrier Reef to climate change

Seagrasses are flowering plants and, along with mangroves, have greater affinities to terrestrial plants than other marine macrophytes such as algae. Approximately 55 species of seagrass occur in five different plant families and represent at least three independent evolutionary lineages. Thus, seagrasses are not a taxonomically unified group but a ‘biological’ or ‘ecological’ group85,149. The evolutionary adaptations required for survival in the marine environment have led to convergence in morphology. Seagrasses evolved under differing ambient CO2 and temperature conditions so may have different tolerances to changing environmental conditions. A wide range of tolerances across marine environments exist amongst the extant diversity of seagrasses, reflecting their substantial adaptive capacity as a group.This is Chapter 8 of Climate change and the Great Barrier Reef: a vulnerability assessment. The entire book can be found at http://hdl.handle.net/11017/13

Monitoring Seagrass within the Reef 2050 Integrated Monitoring and Reporting Program: final report of the Seagrass Expert Group

Seagrass is widely distributed throughout the Great Barrier Reef (the Reef), with a documented 35,000 square kilometres and a potential habitat area of 228,300 square kilometres. Seagrass meadows occur in many different environmental conditions, both within and beyond the impact of flood plumes, and are common in areas of high anthropogenic activity, such as ports and areas adjacent to urban centres. Many processes and services that maintain the exceptional values of the Reef occur in seagrass meadows. To provide the services that support these values seagrass habitats include a range of species, growth forms and benthic landscapes, that respond to pressures in different ways. In many cases seagrasses also modify their environments to improve environmental conditions on the Reef. Seagrasses vary spatially and temporally in their distribution and abundance across the Reef, occurring in different water quality types (estuaries, coastal, reefal and offshore) and at different water depths (intertidal, shallow subtidal, deep water). The diversity of potential seagrass habitats is one reason they support so many of the environmental services and values of the Great Barrier Reef World Heritage Area (World Heritage Area), including: habitat for crabs, prawns and fish –– supporting recreational and commercial fishing; primary food resource for species of conservation significance (dugong, green turtles, migratory shore birds); shoreline stabilisation by binding sediment to slow erosion; water clarity improvement, by promoting the settlement of fine particulate matter; and providing a natural carbon sink. To deliver the seagrass components of the knowledge system required to deliver Reef 2050 Long-Term Sustainability Plan (Reef 2050 Plan) reporting and other management activities, there will need to be modifications and enhancements made to the current seagrass monitoring programs. The Drivers, Pressures, State, Impact, Response (DPSIR) framework was used to facilitate the identification of linkages between the pressures on seagrass, state of the seagrass, the impact a decline in seagrass would have on community values, and the responses management agencies can take to mitigate loss of values. We have also defined twelve seagrass habitat types that occur on the Reef, identified by a matrix of water body type and water depth. The seagrasses occurring in each habitat are exposed to different pressures and require different management actions (responses) to protect and enhance the values of the community and Reef ecosystems. The proposed monitoring program has three spatial and temporal scales, with each scale providing different information (knowledge) to support resilience-based management of the Reef. 1. Habitat assessment: will occur across the Reef at all sites where seagrass has a potential of occurring. It will determine seagrass abundance, species composition and spatial extent of each habitat type within the World Heritage Area. This scale will be focused on supporting future outlook reports, but will also provide information for operational and strategic management and contribute towards other reports. 2. Health assessment: will take place at representative regional sites, for each habitat type. These sites will provide managers with annual and seasonal trends in seagrass condition and resilience at a regional scale for each habitat. This scale will provide higher temporal detail (i.e. at least annually) of seagrass condition and resilience, supporting tactical, operational and strategic management applications. This scale will provide the majority of information for regional/catchment report cards and the assessment of management effectiveness at a catchment wide scale. It will also contribute important trends in condition and resilience to Outlook reports and other communication products with more frequent reporting. 3. Process monitoring: will take place at the fewest number of sites, nested within habitat and health assessment sites. Due to the time-consuming and complex nature of these measurements the sampling sites will be chosen to focus on priority knowledge gaps. This scale will provide managers with information on cause-and-effect relationships and linkages between different aspects of the Reef’s processes and ecosystems. This scale will include measures of seagrass resilience (for example, feedback loops, recovery time after disturbance, history of disturbance and thresholds for exposure to pressures). The attributes measured at these sites will also provide confidence to managers regarding the impact a change in seagrass condition is likely to have on other values of the Reef (for example, fish, megafauna, coral, Indigenous heritage, and human dimensions). To ensure that future seagrass monitoring delivers the information required to report on the Reef 2050 Plan and meets the other knowledge requirements of managers, a spatially balanced random sampling design needs to be implemented on the Reef. Existing monitoring programs can and should be integrated into this design. However, current seagrass monitoring programs do not provide a balanced assessment of seagrass condition across the entire Reef, hence are not suitable to meet the Reef 2050 Plan reporting requirements and many other management information needs. Existing sites within current monitoring are focused on habitat types that are intertidal and shallow sub-tidal and lie close to the coast. These habitats have been previously selected because they face high levels of cumulative anthropogenic risk and therefore have higher levels of management demand for information. The current sites are likely to decline more rapidly, in response to catchment run-off and other anthropogenic pressures, than the average for seagrass meadows across the entire Reef. They also have a greater potential to show improvements from Reef catchment management actions that reduce pollution associated with run-off. This report sets out the framework for a recommended new seagrass monitoring program, highlighting the substantial improvements in knowledge and confidence this new program will deliver, and provides a scope for the statistical design work required to support implementation of this program

Nutrition care processes across hospitalisation in critically ill patients with COVID-19 in Australia: a multicentre prospective observational study

Background: The COVID-19 pandemic highlighted major challenges with usual nutrition care processes, leading to reports of malnutrition and nutrition-related issues in these patients. Objective: The objective of this study was to describe nutrition-related service delivery practices across hospitalisation in critically ill patients with COVID-19 admitted to Australian intensive care units (ICUs) in the initial pandemic phase. Methods: This was a multicentre (nine site) observational study in Australia, linked with a national registry of critically ill patients with COVID-19. Adult patients with COVID-19 who were discharged to an acute ward following ICU admission were included over a 12-month period. Data are presented as n (%), median (interquartile range [IQR]), and odds ratio (OR [95% confidence interval {CI}]). Results: A total of 103 patients were included. Oral nutrition was the most common mode of nutrition (93 [93%]). In the ICU, there were 53 (52%) patients seen by a dietitian (median 4 [2–8] occasions) and malnutrition screening occurred in 51 (50%) patients most commonly with the malnutrition screening tool (50 [98%]). The odds of receiving a higher malnutrition screening tool score increased by 36% for every screening in the ICU (1st to 4th, OR: 1.39 [95% CI: 1.05–1.77] p = 0.018) (indicating increasing risk of malnutrition). On the ward, 51 (50.5%) patients were seen by a dietitian (median time to consult: 44 [22.5–75] hours post ICU discharge). The odds of dietetic consult increased by 39% every week while on the ward (OR: 1.39 [1.03–1.89], p = 0.034). Patients who received mechanical ventilation (MV) were more likely to receive dietetic input than those who never received MV. Conclusions: During the initial phases of the COVID-19 pandemic in Australia, approximately half of the patients included were seen by a dietitian. An increased number of malnutrition screens were associated with a higher risk score in the ICU and likelihood of dietetic consult increased if patients received MV and as length of ward stay increased

Expert consensus statements for the management of COVID-19-related acute respiratory failure using a Delphi method.

Coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented pressure on healthcare system globally. Lack of high-quality evidence on the respiratory management of COVID-19-related acute respiratory failure (C-ARF) has resulted in wide variation in clinical practice. Using a Delphi process, an international panel of 39 experts developed clinical practice statements on the respiratory management of C-ARF in areas where evidence is absent or limited. Agreement was defined as achieved when > 70% experts voted for a given option on the Likert scale statement or > 80% voted for a particular option in multiple-choice questions. Stability was assessed between the two concluding rounds for each statement, using the non-parametric Chi-square (χ <sup>2</sup> ) test (p < 0·05 was considered as unstable). Agreement was achieved for 27 (73%) management strategies which were then used to develop expert clinical practice statements. Experts agreed that COVID-19-related acute respiratory distress syndrome (ARDS) is clinically similar to other forms of ARDS. The Delphi process yielded strong suggestions for use of systemic corticosteroids for critical COVID-19; awake self-proning to improve oxygenation and high flow nasal oxygen to potentially reduce tracheal intubation; non-invasive ventilation for patients with mixed hypoxemic-hypercapnic respiratory failure; tracheal intubation for poor mentation, hemodynamic instability or severe hypoxemia; closed suction systems; lung protective ventilation; prone ventilation (for 16-24 h per day) to improve oxygenation; neuromuscular blocking agents for patient-ventilator dyssynchrony; avoiding delay in extubation for the risk of reintubation; and similar timing of tracheostomy as in non-COVID-19 patients. There was no agreement on positive end expiratory pressure titration or the choice of personal protective equipment. Using a Delphi method, an agreement among experts was reached for 27 statements from which 20 expert clinical practice statements were derived on the respiratory management of C-ARF, addressing important decisions for patient management in areas where evidence is either absent or limited. The study was registered with Clinical trials.gov Identifier: NCT04534569

Ice core chemistry database: an Antarctic compilation of sodium and sulfate records spanning the past 2000 years

Changes in sea ice conditions and atmospheric circulation over the Southern Ocean play an important role in modulating Antarctic climate. However, observations of both sea ice and wind conditions are limited in Antarctica and the Southern Ocean, both temporally and spatially, prior to the satellite era (1970 onwards). Ice core chemistry data can be used to reconstruct changes over annual, decadal, and millennial timescales. To facilitate sea ice and wind reconstructions, the CLIVASH2k (CLimate Variability in Antarctica and the Southern Hemisphere over the past 2000 years) working group has compiled a database of two species, sodium [Na+] and sulfate [SO2− 4 ], commonly measured ionic species. The database (https://doi.org/10.5285/9E0ED16E-F2AB4372-8DF3-FDE7E388C9A7; Thomas et al., 2022) comprises records from 105 Antarctic ice cores, containing records with a maximum age duration of 2000 years. An initial filter has been applied, based on evaluation against sea ice concentration, geopotential height (500 hPa), and surface wind fields to identify sites suitable for reconstructing past sea ice conditions, wind strength, or atmospheric circulation

Genome wide mapping reveals PDE4B as an IL-2 induced STAT5 target gene in activated human PBMCs and lymphoid cancer cells

IL-2 is the primary growth factor for promoting survival and proliferation of activated T cells that occurs following engagement of the Janus Kinase (JAK)1-3/and Signal Transducer and Activator of Transcription (STAT) 5 signaling pathway. STAT5 has two isoforms: STAT5A and STAT5B ( commonly referred to as STAT5) which, in T cells, play redundant roles transcribing cell cycle and survival genes. As such, inhibition of STAT5 by a variety of mechanisms can rapidly induce apoptosis in certain lymphoid tumor cells, suggesting that it and its target genes represent therapeutic targets to control certain lymphoid diseases. To search for these molecules we aligned IL-2 regulated genes detected by Affymetrix gene expression microarrays with the STAT5 cistrome identified by chip-on-ChIP analysis in an IL-2-dependent human leukemia cell line, Kit225. Select overlapping genes were then validated using qRT(2)PCR medium-throughput arrays in human PHA-activated PBMCs. Of 19 putative genes, one key regulator of T cell receptor signaling, PDE4B, was identified as a novel target, which was readily up-regulated at the protein level (3 h) in IL-2 stimulated, activated human PBMCs. Surprisingly, only purified CD8+ primary T-cells expressed PDE4B, but not CD4+ cells. Moreover, PDE4B was found to be highly expressed in CD4+ lymphoid cancer cells, which suggests that it may represent a physiological role unique to the CD8+ and lymphoid cancer cells and thus might represent a target for pharmaceutical intervention for certain lymphoid diseases