Rare high branching pattern from the first part of the right axillary artery.

A 77-year-old female cadaver was observed to have a rare branching pattern of the right axillary artery (AA). The first part of the AA typically gives off only a superior thoracic artery (STA) but was observed to give off three branches in the case: a lateral thoracic artery (LTA), a thoracoacromial trunk, and a large common trunk (CT). The LTA travelled to provide a variant STA to the 1st and 2nd intercostal spaces. The CT provided an accessory LTA and accessory thoracodorsal artery before bifurcating into a subscapular artery (SA) and posterior humeral circumflex artery. As expected, the SA further divided into the circumflex scapular artery and thoracodorsal artery. A pectoral artery and the anterior humeral circumflex artery originated directly from the second and third parts of the AA, respectively. Knowledge of AA branching variations is of great clinical significance to anatomists, radiologists, and surgeons due to the high rate of injury to this artery.

A Cross-Sectional Study of Occupational Noise Exposure and Hypertension in Malaysia.

Introduction Noise is an occupational hazard that has been linked to negative effects beyond the auditory system, including hypertension. This study investigated the associations between occupational noise exposure and the risk of hypertension. Methods This cross-sectional study was conducted among state government employees. Data were collected through an online, self-administered questionnaire. Participants were divided into noise-exposed and non-noise-exposed groups based on their self-reported speech communication effort. Hypertension status was also self-reported. Descriptive analysis was performed on sociodemographic, lifestyle, medical history, and occupational characteristics to determine frequency and prevalence. Multiple logistic regression was conducted to compute the odds ratio (OR) and 95% confidence interval (CI) while adjusting for potential confounders. Results A total of 1005 state government employees were analyzed. The prevalence of hypertension was 18.8% among noise-exposed employees. After adjusting for age, sex, diabetes, dyslipidemia, BMI, and family history of hypertension, diabetes, and dyslipidemia, noise-exposed employees had a higher risk of hypertension, with an OR of 1.70 (95% CI = 1.09-2.66, p = 0.020), compared to non-exposed employees. Noise-exposed employees who had been exposed to occupational noise hazards for more than 10 years had a higher risk of hypertension (OR 2.04, 95% CI = 1.26-3.29, p = 0.004) compared to those who were unexposed. Conclusion Occupational noise exposure was associated with an increased risk of hypertension. These findings underscore the need to address noise exposure in the workplace and implement appropriate strategies to reduce its potential negative impact on employees' health.

The Extremes of Constipation: A Case of Stercoral Perforation From Fecal Impaction in a Teenager.

Stercoral perforation is a rare sequela of poorly controlled constipation that is more commonly seen in older, bedridden patients than in pediatric patients. We present the case of a 13-year-old patient requiring a divided sigmoid colostomy following rectal perforation, one of the few examples in the pediatric literature of stercoral perforation from chronic constipation. The current report highlights the importance of appropriate treatment of functional constipation at onset and the life-threatening complications that can occur without appropriate follow-up.

Vacuum-Assisted Closure Treats Refractory Esophageal Leak in a Pediatric Patient.

Esophageal perforations can have iatrogenic and non-iatrogenic causes. Early identification is a predictor of good outcomes. When identified, perforations can be managed conservatively with wide drainage or repaired surgically. Endoscopic esophageal vacuum-assisted closure may be used as a definitive treatment, particularly in scenarios where conservative management and primary surgical repair fail to achieve complete healing. We present such a scenario advocating for the consideration of endoscopic esophageal vacuum-assisted closure in patients with refractory esophageal leaks.

Positive Vibes are Not Always Easy: Examining the Association Between Covid-19 Stress and Mental Well-Being.

The virus known as Covid-19 caused a global pandemic in 2019 and was found to have a devastating impact on mental well-being. Individuals around the world had difficulty retaining positive emotions such as gratitude, mindfulness, and hope in the face of this disaster. These feelings diminished their sense of mental well-being. This study examined the mediational model of gratitude, mindfulness, and hope as parallel mediators of the relationship between Covid-19 stress and mental well-being. In total, 289 adults from the general population completed the scales of Covid stress, gratitude, mindfulness, hope, and mental well-being. Results indicated that Covid-19 stress was related to mental well-being, with mindfulness and hope acting as mediators. Gratitude, on the other hand, did not mediate the relationship. The study provides evidence that targeting gratitude, mindfulness, and hope may have a meaningful effect on Covid-19 stress as a related symptom and potentially have a negative impact on mental well-being during the pandemic.

Traumatic Left Anterior Descending Artery Dissection in a Case of Pediatric Blunt Chest Trauma.

Despite the reserve for recovery in pediatric trauma, blunt force chest trauma can cause insidious injuries that are easy to miss. Coronary artery dissection is a rare injury associated with blunt force chest trauma in the pediatric population and can present with vague or atypical symptoms. Pediatric patients can be unreliable in reporting symptoms, and providers can mistake coronary artery injuries for myocardial contusion, especially with improving laboratory tests and equivocal imaging. We report a case showing the importance of a high index of suspicion when presented with this trauma pattern in a pediatric patient.

Therapy Dogs in Educational Settings: Guidelines and Recommendations for Implementation.

Therapy dogs in educational settings have gained increase traction in recent years. Despite its potential benefits and popularity, there remain concerns of perceived risks such as sanitation, allergies, and safety issues, as well as a lack of guidelines, regulations and support resources available to school staff. Research is further lacking into the implementation process of therapy dog programs in educational settings. To construct a set of recommendations for school staff to achieve successful implementation of a therapy dog program, the present study investigated the perceived facilitative and impeding factors when implementing a therapy dog program. A total of 13 school staff and 2 coordinators from therapy dog organisations took part in an open-ended online survey and/or a semi-structured interview over the phone, with the aim of gathering their perspectives of implementing a therapy dog program in schools. The thematic analysis of the data indicated facilitative factors such as program flexibility, whole-school support, the need for communication and training for all staff, as well as dog welfare. Successful implementation of therapy dogs in an education setting appear to revolve around (1) flexibility of the dog therapy program to target school's needs, (2) qualities of program instigator, (3) whole-school support, (4) communication, training and education, (5) considerations for dog's welfare. Key barriers identified included a high workload, lack of guidelines on processes, lack of support from the school community, as well as the need for better understanding of the role of a therapy dog. The results highlighted the importance of a whole-school effort when implementing a therapy dog program, as well as the need for guidelines for assessing school readiness, key factors for consideration, and strategies to overcome challenges associated with program implementation.

Regulation of a Cytochrome P450 Gene CYP94B1 by WRKY33 Transcription Factor Controls Apoplastic Barrier Formation in Roots to Confer Salt Tolerance.

Salinity is an environmental stress that causes decline in crop yield. Avicennia officinalis and other mangroves have adaptations such as ultrafiltration at the roots aided by apoplastic cell wall barriers to thrive in saline conditions. We studied a cytochrome P450 gene from A. officinalis, AoCYP94B1, and its putative ortholog in Arabidopsis (Arabidopsis thaliana), AtCYP94B1, which are involved in apoplastic barrier formation. Both genes were induced by 30 min of salt treatment in the roots. Heterologous expression of AoCYP94B1 in the atcyp94b1 Arabidopsis mutant and wild-type rice (Oryza sativa) conferred increased NaCl tolerance to seedlings by enhancing root suberin deposition. Histochemical staining and gas chromatography-tandem mass spectrometry quantification of suberin precursors confirmed the role of CYP94B1 in suberin biosynthesis. Using chromatin immunoprecipitation and yeast one-hybrid and luciferase assays, we identified AtWRKY33 as the upstream regulator of AtCYP94B1 in Arabidopsis. In addition, atwrky33 mutants exhibited reduced suberin and salt-sensitive phenotypes, which were rescued by expressing 35S::AtCYP94B1 in the atwrky33 background. This further confirmed that AtWRKY33-mediated regulation of AtCYP94B1 is part of the salt tolerance mechanism. Our findings may help efforts aimed at generating salt-tolerant crops.