Evolving the narrative for protecting a rapidly changing ocean, post-COVID-19.

The ocean is the linchpin supporting life on Earth, but it is in declining health due to an increasing footprint of human use and climate change. Despite notable successes in helping to protect the ocean, the scale of actions is simply not now meeting the overriding scale and nature of the ocean's problems that confront us.Moving into a post-COVID-19 world, new policy decisions will need to be made. Some, especially those developed prior to the pandemic, will require changes to their trajectories; others will emerge as a response to this global event. Reconnecting with nature, and specifically with the ocean, will take more than good intent and wishful thinking. Words, and how we express our connection to the ocean, clearly matter now more than ever before.The evolution of the ocean narrative, aimed at preserving and expanding options and opportunities for future generations and a healthier planet, is articulated around six themes: (1) all life is dependent on the ocean; (2) by harming the ocean, we harm ourselves; (3) by protecting the ocean, we protect ourselves; (4) humans, the ocean, biodiversity, and climate are inextricably linked; (5) ocean and climate action must be undertaken together; and (6) reversing ocean change needs action now.This narrative adopts a 'One Health' approach to protecting the ocean, addressing the whole Earth ocean system for better and more equitable social, cultural, economic, and environmental outcomes at its core. Speaking with one voice through a narrative that captures the latest science, concerns, and linkages to humanity is a precondition to action, by elevating humankind's understanding of our relationship with 'planet Ocean' and why it needs to become a central theme to everyone's lives. We have only one ocean, we must protect it, now. There is no 'Ocean B'.

Elevated trace elements in sediments and seagrasses at CO2 seeps.

Seagrasses often occur around shallow marine CO2 seeps, allowing assessment of trace metal accumulation. Here, we measured Cd, Cu, Hg, Ni, Pb and Zn levels at six CO2 seeps and six reference sites in the Mediterranean. Some seep sediments had elevated metal concentrations; an extreme example was Cd which was 43x more concentrated at a seep site than its corresponding reference site. Three seeps had metal levels that were predicted to adversely affect marine biota, namely Vulcano (for Hg), Ischia (for Cu) and Paleochori (for Cd and Ni). There were higher-than-sediment levels of Zn and Ni in Posidonia oceanica and of Zn in Cymodocea nodosa, particularly in roots. High levels of Cu were found in Ischia seep sediments, yet seagrass was abundant there, and the plants contained low levels of Cu. Differences in bioavailability and toxicity of trace elements helps explain why seagrasses can be abundant at some CO2 seeps but not at others.

Changes in the biochemical and nutrient composition of seafood due to ocean acidification and warming.

Ocean acidification and warming may threaten future seafood production, safety and quality by negatively impacting the fitness of marine species. Identifying changes in nutritional quality, as well as species most at risk, is crucial if societies are to secure food production. Here, changes in the biochemical composition and nutritional properties of the commercially valuable oysters, Magallana gigas and Ostrea edulis, were evaluated following a 12-week exposure to six ocean acidification and warming scenarios that were designed to reflect the temperature (+3 °C above ambient) and atmospheric pCO2 conditions (increase of 350-600 ppm) predicted for the mid-to end-of-century. Results suggest that O. edulis, and especially M. gigas, are likely to become less nutritious (i.e. containing lower levels of protein, lipid, and carbohydrate), and have reduced caloric content under ocean acidification and warming. Important changes to essential mineral composition under ocean acidification and warming were evident in both species; enhanced accumulation of copper in M. gigas may be of concern regarding consumption safety. In light of these findings, the aquaculture industry may wish to consider a shift in focus toward species that are most robust to climate change and less prone to deterioration in quality, in order to secure future food provision and socio-economic benefits of aquaculture.

Assessing larval connectivity for marine spatial planning in the Adriatic.

There are plans to start building offshore marine renewable energy devices throughout the Mediterranean and the Adriatic has been identified as a key location for wind farm developments. The development of offshore wind farms in the area would provide hard substrata for the settlement of sessile benthos. Since the seafloor of the Adriatic is predominantly sedimentary this may alter the larval connectivity of benthic populations in the region. Here, we simulated the release of larvae from benthic populations along the coasts of the Adriatic Sea using coupled bio-physical models and investigated the effect of pelagic larval duration on dispersal. Our model simulations show that currents typically carry particles from east to west across the Adriatic, whereas particles released along western coasts tend to remain there with the Puglia coast of Italy acting as a sink for larvae from benthic populations. We identify areas of high connectivity, as well as areas that are much more isolated, and discuss how these results can be used to inform marine spatial planning and the licensing of offshore marine renewable energy developments.

Geochemical survey of Levante Bay, Vulcano Island (Italy), a natural laboratory for the study of ocean acidification.

Shallow submarine gas vents in Levante Bay, Vulcano Island (Italy), emit around 3.6t CO2 per day providing a natural laboratory for the study of biogeochemical processes related to seabed CO2 leaks and ocean acidification. The main physico-chemical parameters (T, pH and Eh) were measured at more than 70 stations with 40 seawater samples were collected for chemical analyses. The main gas vent area had high concentrations of dissolved hydrothermal gases, low pH and negative redox values all of which returned to normal seawater values at distances of about 400m from the main vents. Much of the bay around the vents is corrosive to calcium carbonate; the north shore has a gradient in seawater carbonate chemistry that is well suited to studies of the effects of long-term increases in CO2 levels. This shoreline lacks toxic compounds (such as H2S) and has a gradient in carbonate saturation states.

Benthic foraminifera show some resilience to ocean acidification in the northern Gulf of California, Mexico.

Extensive CO2 vents have been discovered in the Wagner Basin, northern Gulf of California, where they create large areas with lowered seawater pH. Such areas are suitable for investigations of long-term biological effects of ocean acidification and effects of CO2 leakage from subsea carbon capture storage. Here, we show responses of benthic foraminifera to seawater pH gradients at 74-207m water depth. Living (rose Bengal stained) benthic foraminifera included Nonionella basispinata, Epistominella bradyana and Bulimina marginata. Studies on foraminifera at CO2 vents in the Mediterranean and off Papua New Guinea have shown dramatic long-term effects of acidified seawater. We found living calcareous benthic foraminifera in low pH conditions in the northern Gulf of California, although there was an impoverished species assemblage and evidence of post-mortem test dissolution.

Distribution of sea urchins living near shallow water CO2 vents is dependent upon species acid-base and ion-regulatory abilities.

To reduce the negative effect of climate change on Biodiversity, the use of geological CO2 sequestration has been proposed; however leakage from underwater storages may represent a risk to marine life. As extracellular homeostasis is important in determining species' ability to cope with elevated CO2, we investigated the acid-base and ion regulatory responses, as well as the density, of sea urchins living around CO2 vents at Vulcano, Italy. We conducted in situ transplantation and field-based laboratory exposures to different pCO2/pH regimes. Our results confirm that sea urchins have some ability to regulate their extracellular fluid under elevated pCO2. Furthermore, we show that even in closely-related taxa divergent physiological capabilities underlie differences in taxa distribution around the CO2 vent. It is concluded that species distribution under the sort of elevated CO2 conditions occurring with leakages from geological storages and future ocean acidification scenarios, may partly be determined by quite subtle physiological differentiation.

Psoriasis prevalence among the 2009 AAD National Melanoma/Skin Cancer Screening Program participants.

BACKGROUND: Validated epidemiological estimates of the prevalence of skin diseases remain an unmet challenge. Most patients in many health care systems do not see dermatologists for skin problems. Assessments based on claims data or self-report are likely to contain substantial misclassification. Population-based in-person dermatological exams have proven impractical because of the number of patients required. However, in the US, there is a large skin cancer screening program where volunteer dermatologists assess almost 100,000 people annually. OBJECTIVE: To evaluate the utility of this program for the assessment of other diseases. METHODS: Information concerning prior diagnosis of psoriasis, type of insurance and physician's current assessment of psoriasis was captured as part of the American Academy of Dermatology National Melanoma/Skin Cancer Screening Program. A modified form was provided to a subset of participant sites. Overall and subgroup prevalence of psoriasis was analysed. Crude and adjusted results are presented for comparison to the US population. RESULTS: Among the 2991 participants, 86% answered the self-report psoriasis question. A previous diagnosis of psoriasis was reported by 5.1% of them. This proportion was greater than the prevalence of physician documented diagnosis of psoriasis (2.8%). Analyses with different assumptions to account for missing values and weighting based on US population estimates yielded prevalence values ranging from 1.2% to 3.4%. CONCLUSION: This project, although limited by missing data, is consistent with previous findings that psoriasis prevalence is between 2.2% and 4.6% in the US. It demonstrates the potential to evaluate prevalence of other skin conditions through existing national activities.

Computer navigation versus conventional total knee replacement: no difference in functional results at two years.

We previously compared the component alignment in total knee replacement using a computer-navigated technique with a conventional jig-based method. We randomly allocated 71 patients to undergo either computer-navigated or conventional replacement. An improved alignment was seen in the computer-navigated group. The patients were then followed up post-operatively for two years, using the Knee Society score, the Short Form-36 health survey, the Western Ontario and McMaster Universities osteoarthritis index, the Bartlett Patellar pain questionnaire and the Oxford knee score, to assess functional outcome. At two years post-operatively 60 patients were available for assessment, 30 in each group and 62 patients completed a postal survey. No patient in either group had undergone revision. All variables were analysed for differences between the groups either by Student's t-test or the Mann-Whitney U test. Differences between the two groups did not reach significance for any of the outcome measures at any time point. At two years postoperatively, the frequency of mild to severe anterior pain was not significantly different (p = 0.818), varying between 44% (14) for the computer-navigated group, and 47% (14) for the conventionally-replaced group. The Bartlett Patellar score and the Oxford knee score were also not significantly different (t-test p = 0.161 and p = 0.607, respectively). The clinical outcome of the patients with a computer-navigated knee replacement appears to be no different to that of a more conventional jig-based technique at two years post-operatively, despite the better alignment achieved with computer-navigated surgery.

Computer navigation of the acetabular component: a cadaver reliability study.

Our aim was to assess the intra- and inter-observer reliability in the establishment of the anterior pelvic plane used in imageless computer-assisted navigation. From this we determined the subsequent effects on version and inclination of the acetabular component. A cadaver model was developed with a specifically-designed rod which held the component tracker at a fixed orientation to the pelvis, leaving the anterior pelvic plane as the only variable. Eight surgeons determined the anterior pelvic plane by palpating and registering the bony landmarks as reference points. The exact anterior pelvic plane was then established by using anatomically-placed bone screws as reference points. The difference between the surgeons was found to be highly significant (p < 0.001). The variation was significantly larger for anteversion (sd 9.6 degrees ) than for inclination (sd 6.3 degrees ). The present method for registering pelvic landmarks shows significant inaccuracy, which highlights the need for improved methods of registration before this technique is considered to be safe.

The evaluation of aluminum oxide crystal microdermabrasion for photodamage.

BACKGROUND: Aluminum oxide crystal microdermabrasion has recently become popular for facial rejuvenation. Although it is a widely used technique with perceptible benefits, the clinical efficacy on photodamaged skin has yet to be established. OBJECTIVE: To measure and quantify the effect of microdermabrasion on photodamaged skin. METHODS: Ten subjects underwent one treatment a week for five to six treatments. Skin surface roughness, topography, elasticity, stiffness, compliance, temperature, sebum content, and histology were analyzed. RESULTS: Subjectively, seven patients noticed a mild improvement. Physician analysis of clinical photography indicated mild improvement in the majority of patients. Objectively, immediately following treatment skin temperature increased, sebum content decreased, and a temporary increase in skin roughness and mild flattening of some wrinkles occurred. Dynamic skin analysis demonstrated a perceptible decrease in skin stiffness and an increase in skin compliance. Histology showed slight orthokeratosis and flattening of rete ridges and a perivascular mononuclear cell infiltrate, edema, and vascular ectasia in the upper reticular dermis 1 week after completion of the series of treatments. CONCLUSION: Immediately following the procedure, changes occurring in skin characteristics can be measured that are consistent with mild abrasion and increased blood flow. Objective biomechanical analysis demonstrated a statistically significant decrease in skin stiffness and an increase in skin compliance consistent with persistent edema. Subjectively, patients and physicians report a mild improvement in the majority of subjects. Histology showed dramatic vascular changes in the reticular dermis below the level of direct abrasion. The effect of negative pressure may result in these vascular changes.

Sebaceous carcinoma of the eyelid treated with Mohs micrographic surgery.

BACKGROUND: Sebaceous carcinoma is an aggressive neoplasm that commonly arises from the meibomian glands of the eyelids and other sebaceous glands of the ocular adnexa. Historic data indicate a nearly 30% local recurrence rate with standard surgical excision. Excision by means of Mohs micrographic surgery may be more efficacious. However, reports documenting the effectiveness of this technique for the treatment of eyelid sebaceous carcinoma have been limited to a few cases. OBJECTIVE: We report our experience in the treatment of ocular sebaceous carcinoma with the Mohs fresh tissue technique. METHODS: Eighteen patients with a diagnosis of sebaceous carcinoma of the eyelid who underwent resection by means of the Mohs fresh tissue technique during the years 1988-1998 were reviewed. RESULTS: Sixteen of the 18 patients were free of disease after an average follow-up of 37 months (11.1% recurrence rate). One patient who experienced local recurrence also had metastatic disease of the parotid lymph nodes (5.6% metastatic rate). The recurrence and metastasis were noted 9 months after excision. The other patient experienced a local recurrence 19 months postoperatively. Both patients exhibited pagetoid spread and involvement of both the upper and lower eyelid at the time of Mohs excision. CONCLUSION: Mohs surgery offers excellent results when used as the primary treatment modality for sebaceous carcinoma of the eyelid. When compared with historic series of standard surgical excision, Mohs micrographic surgery has a significantly lower recurrence rate and metastatic rate.

Effective management of difficult surgical defects using tissue-engineered skin.

BACKGROUND: Graftskin, a bilayered living skin construct, is an effective therapeutic option in the management of chronic venous ulcerations and simple acute surgical excisions. However, it is not routinely used in the management of complicated surgical wound defects. OBJECTIVE: To determine the effectiveness of graftskin as a therapeutic modality in difficult surgical defects. METHODS: Two patients with complex surgical wound defects after Mohs micrographic surgery underwent a single application of graftskin. The engineered skin was fenestrated and sutured in place. The wounds were examined on a weekly basis. One hundred percent healing was defined as complete reepithelialization (wound coverage). RESULTS: Graftskin was well tolerated by these patients and resulted in complete wound healing within 9 weeks of application. CONCLUSION: Graftskin is an excellent alternative for difficult surgical wounds not amenable to other therapies. Graftskin results in a shortened healing time and decreased morbidity. It should be considered for wounds in which healing by secondary intention is preferably avoided.

Replacement of the proximal aorta and aortic valve using a composite bileaflet prosthesis and gelatin-impregnated polyester graft (Carbo-Seal): early results in 143 patients.

OBJECTIVE: We report the combined early results from two centers in the United Kingdom using a composite conduit consisting of a bileaflet mechanical valve incorporated into a gelatin-impregnated, ultra-low porosity, woven polyester graft (Carbo-Seal; Sulzer Carbomedics, Inc, Austin, Tex). METHODS: Between August 1992 and March 1997, 143 patients underwent aortic root replacement with the Carbo-Seal composite prosthesis. The indication for surgery was acute type A dissection in 31 (22%), chronic type A dissection in 9 (6%), ascending aortic aneurysm without dissection in 100 (70%), and false aneurysm of the ascending aorta in 3 (2%). Twenty-seven patients (19%) had undergone previous sternotomy, and 40 (28%) were seen as emergencies. Concomitant procedures were performed in 38 (27%), including 18 aortic arch or hemiarch replacements. Total follow-up is 270 patient-years. Follow-up is 100% complete. RESULTS: The early (30-day) mortality was 7% (10 patients). Permanent neurologic events occurred in 2%. At a mean follow-up of 23 months, 94% of survivors were in New York Heart Association functional class I. Freedom from reoperation was 97.2% +/- 1.6% (1 standard error [1 SE]) at 12 months and 95.7% +/- 2.2% at 48 months. Including early mortality, survival was 90.1% +/- 2.6% at 12 months and 83.1% +/- 3. 5% at 48 months. CONCLUSIONS: Aortic root replacement with use of the Carbo-Seal prosthesis can be undertaken with a relatively low early mortality and morbidity. A low reoperation rate and high intermediate-term survival can be expected, but continued follow-up is needed to determine the long-term efficacy of this prosthesis.

Erbium:YAG laser resurfacing of the hands, arms, and neck.

BACKGROUND: Resurfacing procedures to improve photodamage, rhytides, and scars have been developed and refined over the last century. Laser resurfacing is a relatively new procedure in the resurfacing spectrum. It has been appreciated that resurfacing of nonfacial skin by dermabrasion, chemical peels, or carbon dioxide (CO2) laser carries an unacceptably high risk of scarring. More recently, the erbium:YAG (Er:YAG) laser has been developed and marketed for facial and nonfacial resurfacing. Specifically, manufacturers have promoted Er:YAG lasers as safe for resurfacing photodamaged skin on the hands, forearms, and neck. Surprisingly, there is little evidence to support these claims. OBJECTIVE: To evaluate the safety and efficacy of resurfacing photodamaged skin on the dorsum of the hands, forearms, and neck with an Er:YAG laser. METHODS: Twelve patients with photodamage of the neck or of the hands and forearms participated in this study. Seven patients received laser resurfacing of the hands and forearms utilizing the Er:YAG laser with a 5 mm spot size at an energy of 1 J (5 J/cm2). These patients received 2 to 3 passes. Five patients received resurfacing of photodamaged neck skin with a 5 mm spot size at 1 J (5 J/cm2). These patients received one to 2 passes. Patients were evaluated for time to healing, cosmetic improvement, and satisfaction with the procedure. RESULTS: Several observations of note are reported in patients receiving nonfacial resurfacing. Despite previous reports of patients receiving Er:YAG laser treatment with topical anesthesia alone, all patients required some intralesional anesthesia during the procedure for some areas. All patients required significantly longer to heal as compared to the face. Both the hands and forearms and the neck require 2-3 weeks to heal. Two of 7 hand and forearm patients developed bacterial infections during healing. One of 5 neck resurfacing patients developed transitory hyperpigmentation. Cosmetic improvement was mild, with 6 of 7 hand and forearm patients showing poor (0-25%) cosmetic improvement and one of 7 showing fair (25-50%) improvement. In the neck resurfacing group, 3 of 5 had poor (0-25%) improvement, one of 5 had fair (25-50%) improvement, and one of 5 had good (50-75%) results. CONCLUSION: Er:YAG laser resurfacing of the hands, forearms, and neck may be safely performed. Topical anesthesia alone is inadequate, healing takes up to 3 weeks, and cosmetic improvement is minimal with the parameters used in this study.

Comparison of the 585 nm pulse dye laser and the short pulsed CO2 laser in the treatment of striae distensae in skin types IV and VI.

BACKGROUND: Striae distensae, or stretch marks, are a very common cosmetic problem. The successful management of stretch marks has long been a source of frustration and curiosity for both the clinician and the researcher. Recent studies suggest lasers may have a role in their management. As yet, no study has reported on the effects of either of these lasers in the treatment of stretch marks on persons with skin types 4 to 6. OBJECTIVE: To assess the efficacy of short pulsed CO2 laser and pulsed dye laser for the treatment of stretch marks in skin types 4, 5, and 6. METHODS: Four patients were initially enrolled in the study. All were female with abdominal stretch marks, present for a range of 8 to 19 years. The patients had skin types ranging from 4 to 6. The test area consisted of a stretch mark long enough to be divided into three contiguous 2 cm sections, labeled A, B, and C. Section A served as the short pulsed CO2 test site, section B served as a control, while section C served as the 585 nm pulsed dye site. Patients were seen for evaluation after 1 week, then every 4 weeks for a total of 20 weeks. Patients were evaluated subjectively by the investigators, and the patients' own self-evaluation was reported as well. RESULTS: Following the 585 nm pulse dye laser, at 20 week follow-up patients with type 4 skin showed no improvement, while type 6 skin showed hyperpigmentation. The short pulsed CO2 test site showed persistent erythema in type 4 skin and marked hyperpigmentation in type 6 skin. CONCLUSIONS: For patients with types 4, 5, and 6 skin, laser treatment of striae should be avoided or used with great caution.

Does wound healing contribute to the eradication of basal cell carcinoma following curettage and electrodessication?

BACKGROUND: Histologic studies indicate that C&D fails to mechanically remove all the tumor in a percentage of cases that far exceeds the 5-year recurrence rate. This raises the question that if C&D does not mechanically remove the tumor in a significant number of patients, why don't we observe tumor recurrence in most of these patients? Our previous study indicates that inflammation occurring over 1 month following C&D does not clear residual tumor. It may be some other process, requiring more time, that clears the residual tumor. Perhaps the proliferative or maturation phase of wound healing or, alternatively, a slow-acting process such as a low-grade immune response set in motion earlier, clears the residual tumor. OBJECTIVE: To test the hypothesis that wound healing and maturation following C&D clear residual tumor that has not mechanically removed by the procedure. METHODS: The frequency of residual BCC detected histologically immediately following C&D was compared with the frequency 3 months after the C&D, an amount of time in which the maturation phase of wound healing is well under way. RESULTS: Twenty-two of 29 primary BCC less than 1 cm in size were tumor-free immediately following the procedure (clearance rate 75.9%). Twelve primary BCC <1 cm were treated by C&D, allowed to heal for 3 months, and then excised and checked histologically. Ten of the twelve BCC were free of tumor, for a clearance rate of 83.3%, which is not a statistically significant difference (p = 0.7187). CONCLUSION: By 3 months, the proliferative phase of wound healing is complete, and our study indicates that this phase has no effect on clearing the tumor. The maturation phase is well under way three months following C&D, and no statistically significant effect was observed.

Bednar tumor (pigmented dermatofibrosarcoma protuberans) occurring in a site of prior immunization: immunochemical findings and therapy.

Bednar tumor is a rare pigmented variant of dermatofibrosarcoma protuberans (DFSP). Because of its rarity, information is lacking regarding the optimal therapy and potential utility of immunohistochemistry in diagnosis. We report a case of Bednar tumor in which the diagnosis was aided by immunohistochemistry for CD34, an antigen known to be expressed in DFSP but not previously reported in Bednar tumor. Our case was also striking because it represents the first reported appearance of a Bednar tumor at a site of prior immunization, a phenomenon previously noted in some cases of DFSP. The patient was treated effectively with Mohs surgery and is without recurrence at 9 months.