Homogenized and Lyophilized Amniotic Membrane Dressings for the Treatment of Diabetic Foot Ulcers in Ambulatory Patients.

BACKGROUND: Diabetic foot ulcers (DFUs) constitute a complication that occurs in 19% to 34% of patients with diabetes mellitus (DM). The aim of this study is to describe median days to healing, average velocity of wound closure, and percentage of wound surface closed at 3, 6, and 12 weeks through the use of homogenized and lyophilized amniotic membrane (hAMpe) dressings for the treatment of DFUs in ambulatory patients. METHODS: An observational, descriptive, longitudinal study was performed. Patients presenting with granulation-based DFU, after proper debridement, were included from August 19, 2021, until July 14, 2023. hAMpe dressings placed every 3 days were used for the treatment of these ulcers. RESULTS: Sixteen patients were included with a mean age of 52.38 (8.07) years. The analyzed lesions were postsurgical ulcers in 15 of the 16 included patients. Median ulcer size was 19.5 cm2 (6.12-36). The median ABI was 1.10 (1-1.14). The median days to healing was 96 (71-170). The median percentage closure of the wound at 3 weeks was 41% (28.9%-55.3%), at 6 weeks it was 68.2% (48.6%-74.2%), and at 12 weeks it was 100% (81%-100%). The average velocity closure was 1.04% per day (95% CI 0.71%-1.31%). It was higher during the closure of the first 50% of the ulcer, 2.12% per day (95% CI 0.16%-4.09%), and decreased from 50% to 25% of the ulcer size to 0.67% per day (95% CI 0.23%-1.10%) and from 25% to closure to 0.47% per day (95% CI 0.14%-0.80%), P < .001. CONCLUSION: These results are difficult to compare to other studies given the higher surface area of the ulcers included in our sample. The development of hAMpe dressings enables patients to apply them without requiring assistance from health care teams and was not associated with any recognized complications. LEVEL OF EVIDENCE: Level IV, case series.

Comparing acoustic and satellite telemetry: an analysis quantifying the space use of Chelonia mydas in Bimini, Bahamas.

Passive acoustic and Argos satellite telemetry are common methods for tracking marine species and are often used similarly to quantify space use. However, data-driven comparisons of these methods and their associated ecological inferences are limited. To address this, we compared temporal durations, spatial resolutions, financial costs and estimates of occurrence and range distributions for each tracking approach using nine juvenile green turtles (Chelonia mydas) in Bimini, Bahamas. Tracking durations were similar, although acoustic tracking provided higher spatiotemporal resolution than satellite tracking. Occurrence distributions (95%) estimated from satellite telemetry were 12 times larger than those from acoustic telemetry, while satellite range distributions (95%) were 89 times larger. While individuals generally remained within the extent of the acoustic receiver array, gaps in coverage were identified. These gaps, combined with the lower accuracy of satellite telemetry, were likely drivers for the larger satellite distributions. Costs differed between telemetry methods, with acoustic telemetry being less expensive at larger sample sizes with a previously established array. Our results suggest that acoustic and satellite telemetry may not provide similar inferences of individual space use. As such, we provide recommendations to identify telemetry methods appropriate for specific study objectives and provide discussion on the biases of each.

Plantar Thermography in High-Risk Patients With Diabetes Mellitus Compared to Nondiabetic Individuals.

Diabetic foot (DF) is one of the most devastating complications of diabetes mellitus (DM). Infrared thermography has been studied for its potential in early diagnosis and preventive measures against DF ulcers, although its role in the management and prevention of DF complications remains uncertain. The objective of this study was to determine the average temperatures of different points of the plantar foot using infrared thermography in patients with DM and history of DF (DFa group, at the highest risk of developing foot ulcers) and compare them to people without DM (NoDM group). One hundred and twenty-three feet were included, 63 of them belonged to DFa Group and the other 60 to NoDM Group. The average temperature in the NoDM Group was 27.4 (26.3-28.5) versus 28.6 (26.8-30.3) in the DFa Group (p = .002). There were differences between both groups in temperatures at the metatarsal heads and heels, but not in the arch. Average foot temperatures did not relate to sex, ankle-brachial index, and age, and had a mild correlation with daily temperature (Spearman 0.51, p < .001). Data provided in our study could be useful in establishing a parameter of normal temperatures for high-risk patients. This could serve as a foundational framework for future research and provide reference values, not only for preventative purposes, as commonly addressed in most studies, but also to assess the applicability of thermography in clinical scenarios particularly when one foot cannot serve as a reference, suspected osteomyelitis of the remaining bone, or instances of increased temperature in specific areas which may necessitate adjustments to the insoles in secondary prevention.

Isotopic niche overlap among foraging marine turtle species in the Gulf of Mexico.

Sympatric species may overlap in their use of habitat and dietary resources, which can increase competition. Comparing the ecological niches and quantifying the degree of niche overlap among these species can provide insights into the extent of resource overlap. This information can be used to guide multispecies management approaches tailored to protect priority habitats that offer the most resources for multiple species. Stable isotope analysis is a valuable tool used to investigate spatial and trophic niches, though few studies have employed this method for comparisons among sympatric marine turtle species. For this study, stable carbon, nitrogen, and sulfur isotope values from epidermis tissue were used to quantify isotopic overlap and compare isotopic niche size in loggerhead (Caretta caretta), green (Chelonia mydas), and Kemp's ridley (Lepidochelys kempii) turtles sampled from a shared foraging area located offshore of Crystal River, Florida, USA. Overall, the results revealed high degrees of isotopic overlap (>68%) among species, particularly between loggerhead and Kemp's ridley turtles (85 to 91%), which indicates there may be interspecific competition for resources. Samples from green turtles had the widest range of isotopic values, indicating they exhibit higher variability in diet and habitat type. Samples from loggerhead turtles had the most enriched mean δ34S, suggesting they may forage in slightly different micro-environments compared with the other species. Finally, samples from Kemp's ridley turtles exhibited the smallest niche size, which is indicative of a narrower use of resources. This is one of the first studies to investigate resource use in a multispecies foraging aggregation of marine turtles using three isotopic tracers. These findings provide a foundation for future research into the foraging ecology of sympatric marine turtle species and can be used to inform effective multispecies management efforts.

Fine-scale intraspecific niche partitioning in a highly mobile, marine megafauna species: implications for ecology and conservation.

A species may partition its realized ecological niche along bionomic and scenopoetic axes due to intraspecific competition for limited resources. How partitioning manifests depends on resource needs and availability by and for the partitioning groups. Here we demonstrate the utility of analysing short- and long-term stable carbon and nitrogen isotope ratios from imperiled marine megafauna to characterize realized niche partitioning in these species. We captured 113 loggerhead sea turtles (Caretta caretta) at a high-use area in the eastern Big Bend, Florida, between 2016 and 2022, comprising 53 subadults, 10 adult males and 50 adult females. We calculated trophic niche metrics using established and novel methods, and constructed Bayesian ellipses and hulls, to characterize loggerhead isotopic niches. These analyses indicated that loggerheads partition their realized ecological niche by lifestage, potentially along both bionomic (e.g. trophic) and/or scenopoetic (e.g. habitat, latitude or longitude) axes, and display different characteristics of resource use within their niches. Analysis of stable isotopes from tissues with different turnover rates enabled this first characterization of intraspecific niche partitioning between and within neritic lifestages in loggerhead turtles, which has direct implications for ongoing research and conservation efforts for this and other imperiled marine species.

Uncertain future for global sea turtle populations in face of sea level rise.

Sea level rise has accelerated during recent decades, exceeding rates recorded during the previous two millennia, and as a result many coastal habitats and species around the globe are being impacted. This situation is expected to worsen due to anthropogenically induced climate change. However, the magnitude and relevance of expected increase in sea level rise (SLR) is uncertain for marine and terrestrial species that are reliant on coastal habitat for foraging, resting or breeding. To address this, we showcase the use of a low-cost approach to assess the impacts of SLR on sea turtles under various Intergovernmental Panel on Climate Change (IPCC) SLR scenarios on different sea turtle nesting rookeries worldwide. The study considers seven sea turtle rookeries with five nesting species, categorized from vulnerable to critically endangered including leatherback turtles (Dermochelys coriacea), loggerhead turtles (Caretta caretta), hawksbill turtles (Eretmochelys imbricata), olive ridley turtles (Lepidochelys olivacea) and green turtles (Chelonia mydas). Our approach combines freely available digital elevation models for continental and remote island beaches across different ocean basins with projections of field data and SLR. Our case study focuses on five of the seven living sea turtle species. Under moderate climate change scenarios, by 2050 it is predicted that at some sea turtle nesting habitats 100% will be flooded, and under an extreme scenario many sea turtle rookeries could vanish. Overall, nesting beaches with low slope and those species nesting at open beaches such as leatherback and loggerheads sea turtles might be the most vulnerable by future SLR scenarios.

Origins of juvenile green sea turtles (Chelonia mydas) in the Bahamas: A comparison of recent and historical rookery contributions.

Conservation of green sea turtles (Chelonia mydas) benefits from knowledge of population connectivity across life stages. Green turtles are managed at the level of genetically discrete rookeries, yet individuals from different rookeries mix at foraging grounds; therefore, rookeries may be impacted by processes at foraging grounds. Bimini, Bahamas, hosts an important foraging assemblage, but rookery contributions to this assemblage have never been resolved. We generated mitochondrial DNA sequences for 96 foraging green turtles from Bimini and used Mixed Stock Analysis to determine rookery contributions to this population using 817 and 490 base pair (bp) rookery baseline data. The MSA conducted with 817 bp data indicated that Quintana Roo, Mexico, and Central Eastern Florida contributed most to the Bimini population. The MSA conducted with 490 bp data indicated that Southwest Cuba and Central Eastern Florida contributed the most to Bimini. The results of the second MSA differ from a previous study undertaken with 490 bp data, conducted in Great Inagua, Bahamas, which suggested that Tortuguero, Costa Rica, contributed the most to that foraging assemblage. Large credible intervals in our results do not permit explicit interpretation of individual rookery contributions, but our results do indicate substantial relative differences in rookery contributions to two Bahamian foraging assemblages which may be driven by oceanic currents, rookery sizes, and possibly juvenile natal homing. Our findings may implicate a shift in contributions to the Bahamas over two decades, highlighting the importance of regularly monitoring rookery contributions and resolving regional recruitment patterns to inform conservation.

Three-Component Synthesis of 2-Amino-3-cyano-4H-chromenes, In Silico Analysis of Their Pharmacological Profile, and In Vitro Anticancer and Antifungal Testing.

Chromenes are compounds that may be useful for inhibiting topoisomerase and cytochrome, enzymes involved in the growth of cancer and fungal cells, respectively. The aim of this study was to synthesize a series of some novel 2-amino-3-cyano-4-aryl-6,7-methylendioxy-4H-chromenes 4a-o and 2-amino-3-cyano-5,7-dimethoxy-4-aryl-4H-chromenes 6a-h by a three-component reaction, and test these derivatives for anticancer and antifungal activity. Compounds 4a and 4b were more active than cisplatin (9) and topotecan (7) in SK-LU-1 cells, and more active than 9 in PC-3 cells. An evaluation was also made of the series of compounds 4 and 6 as potential antifungal agents against six Candida strains, finding their MIC50 to be less than or equal to that of fluconazole (8). Molecular docking studies are herein reported, for the interaction of 4 and 6 with topoisomerase IB and the active site of CYP51 of Candida spp. Compounds 4a-o and 6a-h interacted in a similar way as 7 with key amino acids of the active site of topoisomerase IB and showed better binding energy than 8 at the active site of CYP51. Hence, 4a-o and 6a-h are good candidates for further research, having demonstrated their dual inhibition of enzymes that participate in the growth of cancer and fungal cells.

Validating the use of stereo-video cameras to conduct remote measurements of sea turtles.

Point 1: Stereo-video camera systems (SVCSs) are a promising tool to remotely measure body size of wild animals without the need for animal handling. Here, we assessed the accuracy of SVCSs for measuring straight carapace length (SCL) of sea turtles. Point 2: To achieve this, we hand captured and measured 63 juvenile, subadult, and adult sea turtles across three species: greens, Chelonia mydas (n = 52); loggerheads, Caretta caretta (n = 8); and Kemp's ridley, Lepidochelys kempii (n = 3) in the waters off Eleuthera, The Bahamas and Crystal River, Florida, USA, between May and November 2019. Upon release, we filmed these individuals with the SVCS. We performed photogrammetric analysis to extract stereo SCL measurements (eSCL), which were then compared to the (manual) capture measurements (mSCL). Point 3: mSCL ranged from 25.9 to 89.2 cm, while eSCL ranged from 24.7 to 91.4 cm. Mean percent bias of eSCL ranged from -0.61% (±0.11 SE) to -4.46% (±0.31 SE) across all species and locations. We statistically analyzed potential drivers of measurement error, including distance of the turtle to the SVCS, turtle angle, image quality, turtle size, capture location, and species. Point 4: Using a linear mixed effects model, we found that the distance between the turtle and the SVCS was the primary factor influencing measurement error. Our research suggests that stereo-video technology enables high-quality measurements of sea turtle body size collected in situ without the need for hand-capturing individuals. This study contributes to the growing knowledge base that SVCS are accurate for body size measurements independent of taxonomic clade.

PLASMA BIOCHEMISTRY PROFILES OF JUVENILE GREEN TURTLES (CHELONIA MYDAS) FROM THE BAHAMAS WITH A POTENTIAL INFLUENCE OF DIET.

Plasma biochemistry profiles aid health assessment of marine turtles, but knowledge of the influence of regional biological factors (e.g., habitat, diet) on marine turtle blood plasma values is limited. To investigate the influence of diet on plasma biochemistry values in juvenile green turtles (Chelonia mydas), we used carbon and nitrogen stable isotopes to provide a quantitative estimate of forage items in green turtles feeding at two distinct areas (Bonefish Hole and South Flats) in Bimini, Bahamas. Plasma samples were obtained from 13 turtles in Bonefish Hole (a mangrove tidal estuary) and 15 turtles in South Flats (an open water seagrass bed) in 2018. All turtles appeared outwardly healthy. Sessile filter feeders contributed the largest proportion of diet in Bonefish Hole, and seagrass contributed the highest proportion of diet in South Flats. Turtles at Bonefish Hole presented significantly lower cholesterol, total protein, phosphorus, triglycerides, and aspartate transaminase compared to South Flats. Across all turtles, those feeding primarily on red algae presented the highest uric acid and alkaline phosphatase, and turtles with a seagrass-dominated diet had the highest cholesterol. Understanding dietary influence on plasma biochemistry may help explain variances seen in local health and nutritional evaluations, and the trends reported can aid the interpretation of plasma analyte values in marine turtles.

Effects of local climate on loggerhead hatchling production in Brazil: Implications from climate change.

Sea turtle eggs are heavily influenced by the environment in which they incubate, including effects on hatching success and hatchling viability (hatchling production). It is crucial to understand how the hatchling production of sea turtles is influenced by local climate and how potential changes in climate may impact future hatchling production. Generalized Additive Models were used to determine the relationship of six climatic variables at different temporal scales on loggerhead turtle (Caretta caretta) hatchling production at seventeen nesting beaches in Bahia, Espirito Santo, and Rio de Janeiro, Brazil. Using extreme and conservative climate change scenarios throughout the 21st century, potential impacts on future hatching success (the number of hatched eggs in a nest) were predicted using the climatic variable(s) that best described hatchling production at each nesting beach. Air temperature and precipitation were found to be the main drivers of hatchling production throughout Brazil. CMIP5 climate projections are for a warming of air temperature at all sites throughout the 21st century, while projections for precipitation vary regionally. The more tropical nesting beaches in Brazil, such as those in Bahia, are projected to experience declines in hatchling production, while the more temperate nesting beaches, such as those in Rio de Janeiro, are projected to experience increases in hatchling production by the end of the 21st century.

Marine debris at nesting grounds used by the Northern Gulf of Mexico loggerhead recovery unit.

Anthropogenic marine debris (AMD) can cause obstructions for nesting marine turtles and hatchlings, increase their exposure to toxicants, and potentially alter the incubating environment of clutches. Given the potential impacts of AMD on marine turtles, this study provides baseline information on the abundance and distribution of AMD at the ten highest density nesting beaches in Florida used by the Northern Gulf of Mexico Loggerhead Recovery Unit. Monitoring for AMD at nesting beaches was conducted in 2017 following protocols from the International Coastal Cleanup. AMD was present at all the nesting beaches, with the majority of AMD observed at the westernmost sites beginning with St. Joseph Peninsula State Park (363 AMD/km) with a gradual decrease of abundance to the easternmost site, Alligator Point (16 AMD/km). Plastic and foam items accounted for 92% (n = 13,566) of all AMD found.

Anterior composite resin crown in an adverse situation: A dental technique with a 3-year follow-up.

Endodontically treated teeth often exhibit severe coronal structure loss. Given the reversibility and tissue conservation of adhesive procedures, a conservative approach using an indirect resin crown with an adhesively cemented custom fiber-reinforced composite resin post provided a predictable and esthetic solution. The 24-hour and 3-year follow-ups of this technique showed good function, marginal adaptation, and esthetics.

Warmer and wetter conditions will reduce offspring production of hawksbill turtles in Brazil under climate change.

Climate change is expected to impact animals that are heavily reliant on environmental factors, such as sea turtles, since the incubation of their eggs, hatching success and sex ratio are influenced by the environment in which eggs incubate. As climate change progresses it is therefore important to understand how climatic conditions influence their reproductive output and the ramifications to population stability. Here, we examined the influences of five climatic variables (air temperature, accumulated and average precipitation, humidity, solar radiation, and wind speed) at different temporal scales on hawksbill sea turtle (Eretmochelys imbricata) hatchling production at ten nesting beaches within two regions of Brazil (five nesting beaches in Rio Grande do Norte and five in Bahia). Air temperature and accumulated precipitation were the main climatic drivers of hawksbill hatching success (number of eggs hatched within a nest) across Brazil and in Rio Grande do Norte, while air temperature and average precipitation were the main climatic drivers of hatching success at Bahia. Solar radiation was the main climatic driver of emergence success (number of hatchlings that emerged from total hatched eggs within a nest) at both regions. Warmer temperatures and higher solar radiation had negative effects on hatchling production, while wetter conditions had a positive effect. Conservative and extreme climate scenarios show air temperatures are projected to increase at this site, while precipitation projections vary between scenarios and regions throughout the 21st century. We predicted hatching success of undisturbed nests (no recorded depredation or storm-related impacts) will decrease in Brazil by 2100 as a result of how this population is influenced by local climate. This study shows the determining effects of different climate variables and their combinations on an important and critically endangered marine species.

Microplastic at nesting grounds used by the northern Gulf of Mexico loggerhead recovery unit.

Microplastics can impact key habitats used by endangered species, such as marine turtles. They impact the environment by transporting toxicants and altering sediment properties affecting temperature and sediment permeability. Our study determined the exposure of the ten most important nesting sites for the Northern Gulf of Mexico Loggerhead Recovery Unit to microplastic. Sand samples were obtained at each nesting site during the 2017 nesting season and analyzed for abundance and characteristics of microplastic. Microplastic was found at all sites, with an average abundance of 61.08 ±â€¯34.61 pieces/m2, and 59.9% located at the dunes, where turtles primarily nest. A gradual decrease in microplastics abundance was observed from the most western nesting ground to the east. The results from this study indicate that microplastic accumulation on nesting sites for the Northern Gulf of Mexico may be of great concern, and could negatively affect the incubating environment for marine turtles.

Does behaviour affect the dispersal of flatback post-hatchlings in the Great Barrier Reef?

The ability of individuals to actively control their movements, especially during the early life stages, can significantly influence the distribution of their population. Most marine turtle species develop oceanic foraging habitats during different life stages. However, flatback turtles (Natator depressus) are endemic to Australia and are the only marine turtle species with an exclusive neritic development. To explain the lack of oceanic dispersal of this species, we predicted the dispersal of post-hatchlings in the Great Barrier Reef (GBR), Australia, using oceanographic advection-dispersal models. We included directional swimming in our models and calibrated them against the observed distribution of post-hatchling and adult turtles. We simulated the dispersal of green and loggerhead turtles since they also breed in the same region. Our study suggests that the neritic distribution of flatback post-hatchlings is favoured by the inshore distribution of nesting beaches, the local water circulation and directional swimming during their early dispersal. This combination of factors is important because, under the conditions tested, if flatback post-hatchlings were entirely passively transported, they would be advected into oceanic habitats after 40 days. Our results reinforce the importance of oceanography and directional swimming in the early life stages and their influence on the distribution of a marine turtle species.

Conservation hotspots for marine turtle nesting in the United States based on coastal development.

Coastal areas provide nesting habitat for marine turtles that is critical for the persistence of their populations. However, many coastal areas are highly affected by coastal development, which affects the reproductive success of marine turtles. Knowing the extent to which nesting areas are exposed to these threats is essential to guide management initiatives. This information is particularly important for coastal areas with both high nesting density and dense human development, a combination that is common in the United States. We assessed the extent to which nesting areas of the loggerhead (Caretta caretta), the green (Chelonia mydas), the Kemp's ridley (Lepidochelys kempii), and leatherback turtles (Dermochelys coriacea) in the continental United States are exposed to coastal development and identified conservation hotspots that currently have high reproductive importance and either face high exposure to coastal development (needing intervention), or have low exposure to coastal development, and are good candidates for continued and future protection. Night-time light, housing, and population density were used as proxies for coastal development and human disturbance. About 81.6% of nesting areas were exposed to housing and human population, and 97.8% were exposed to light pollution. Further, most (>65%) of the very high- and high-density nesting areas for each species/subpopulation, except for the Kemp's ridley, were exposed to coastal development. Forty-nine nesting sites were selected as conservation hotspots; of those high-density nesting sites, 49% were sites with no/low exposure to coastal development and the other 51% were exposed to high-density coastal development. Conservation strategies need to account for ~66.8% of all marine turtle nesting areas being on private land and for nesting sites being exposed to large numbers of seasonal residents.

Spatial and Temporal Variation in the Effects of Climatic Variables on Dugong Calf Production.

Knowledge of the relationships between environmental forcing and demographic parameters is important for predicting responses from climatic changes and to manage populations effectively. We explore the relationships between the proportion of sea cows (Dugong dugon) classified as calves and four climatic drivers (rainfall anomaly, Southern Oscillation El Niño Index [SOI], NINO 3.4 sea surface temperature index, and number of tropical cyclones) at a range of spatially distinct locations in Queensland, Australia, a region with relatively high dugong density. Dugong and calf data were obtained from standardized aerial surveys conducted along the study region. A range of lagged versions of each of the focal climatic drivers (1 to 4 years) were included in a global model containing the proportion of calves in each population crossed with each of the lagged versions of the climatic drivers to explore relationships. The relative influence of each predictor was estimated via Gibbs variable selection. The relationships between the proportion of dependent calves and the climatic drivers varied spatially and temporally, with climatic drivers influencing calf counts at sub-regional scales. Thus we recommend that the assessment of and management response to indirect climatic threats on dugongs should also occur at sub-regional scales.

Spatio-temporal variation in the incubation duration and sex ratio of hawksbill hatchlings: implication for future management.

Climate change poses a unique threat to species with temperature dependent sex determination (TSD), such as marine turtles, where increases in temperature can result in extreme sex ratio biases. Knowledge of the primary sex ratio of populations with TSD is key for providing a baseline to inform management strategies and to accurately predict how future climate changes may affect turtle populations. However, there is a lack of robust data on offspring sex ratio at appropriate temporal and spatial scales to inform management decisions. To address this, we estimate the primary sex ratio of hawksbill hatchlings, Eretmochelys imbricata, from incubation duration of 5514 in situ nests from 10 nesting beaches from two regions in Brazil over the last 27 years. A strong female bias was estimated in all beaches, with 96% and 89% average female sex ratios produced in Bahia (BA) and Rio Grande do Norte (RN). Both inter-annual (BA, 88 to 99%; RN, 75 to 96% female) and inter-beach (BA, 92% to 97%; RN, 81% to 92% female) variability in mean offspring sex ratio was observed. These findings will guide management decisions in Brazil and provide further evidence of highly female-skew sex ratios in hawksbill turtles.