Integrative description of a new species of Dugesia (Platyhelminthes, Tricladida, Dugesiidae) from Shennongjia, Central China.

A new species of the genus Dugesia (Platyhelminthes, Tricladida, Dugesiidae) from Xiangxi River, Shennongjia Forestry District, Hubei Province, China, is described on the basis of an integrative approach, involving morphology, and molecular systematics. The new species Dugesia saccaria A-T. Wang & Sluys, sp. nov. is characterized by the following features: a dumb-bell-shaped, muscularized hump located just anterior to the knee-shaped bend in the bursal canal; a ventrally displaced ejaculatory duct, which, however, opens terminally through the dorsal portion of the blunt tip of the penis papilla; a ventrally located seminal vesicle, giving rise to a vertically running duct that eventually curves downwards to communicate with the ejaculatory duct via a small diaphragm; oviducts opening asymmetrically into the dorsal portion of the common atrium and at the knee-shaped part of the bursal canal. The phylogenetic position of the new species was determined using four molecular markers (18S rDNA; ITS-1; 28S rDNA; COI), which suggested that it groups with other species of Dugesia from the Australasian and Oriental biogeographical regions.

Effect of Alternatives to Opiates Program on Discharge Opioid Prescribing in Trauma Patients.

BACKGROUND: Opioid overdose deaths have increased over the last two decades, despite efforts to reduce prescribing. This study aimed to determine if a hospital-wide Alternatives to Opiates (ALTOSM) program reduced opioid prescribing in hospital and upon discharge after trauma. OBJECTIVES: The primary outcome was incidence of opioid prescribing at hospital discharge Pre- and Post-ALTO. Secondary outcomes were the percent of patients with in-hospital opioid, non-opioid and multimodal analgesia, and hospital and intensive care unit (ICU) length of stay (LOS). METHODS: This is a single-center, retrospective analysis of patients >/ = 18 years old admitted for >24 hours with the primary diagnosis of traumatic injury between August 2018 - October 2019. Patients with alcohol or polysubstance abuse, chronic opioid use, or in-hospital mortality were excluded. RESULTS: A total of 703 patients were included, 471 in Pre-ALTO and 232 in Post-ALTO groups. The mean age was 59 ± 22 years and most were male (58.7%). Mean initial Injury Severity Score (ISS) was 9.1 ± 7.7. Opioid prescribing at hospital discharge occurred more in the Post-ALTO group (132/332, 39.4% vs 90/203, 43.8%; P = .1237). Most patients were prescribed in-hospital opioid (332/471, 70.4% vs 203/232, 87.5%, P < .0001) and non-opioid (441/471, 93.6% vs 229/232, 98.7%; P = .0027) analgesics, or multimodal analgesia (397/471, 84.3% vs 203/232, 87.5%; P = .2591). Median hospital and ICU LOS were also similar between groups [5 (3-9) vs 4(3-7), P = .3427] and ICU [2(0-4) vs 3(2-5), P = .3461]. CONCLUSION: Opioids remain mainstay for trauma-related pain treatment. ALTOSM was not associated with less in-hospital or discharge opioid prescribing.

Opioid Prescribing at Discharge in Opioid-Naïve Trauma Patients.

BACKGROUND: Opioid analgesics remain mainstay of treatment for trauma-related pain despite growing concerns for opioid dependency or misuse. The purpose of this study was to evaluate opioid prescribing at hospital discharge after traumatic injury. METHODS: This is a single-center, retrospective analysis of patients ≥18 years of age admitted for ≥24 hours with a primary diagnosis of traumatic injury. Those with alcohol use disorder, polysubstance abuse, chronic opioid use, or in-hospital mortality were excluded. The primary outcome was the incidence of patients prescribed opioids at discharge. Secondary outcomes included percent of patients who received nonopioids, intensive care unit (ICU) admission, and hospital length of stay (LOS). RESULTS: Of the 927 encounters, 471 were included. The mean age was 60 ± 23 years, and 62.0% were male. The majority were blunt trauma, and 49.9% were falls. Mean initial injury severity score (ISS) was 9 ± 7.2. Of the 70.4% of patients prescribed opioids, 39.4% were discharged on opioids. Age ≥30 years, ICU admission, ISS <9, or Charlson Comorbidity Index >1 was less likely to have opioids prescribed at discharge. Most received nonopioids (93.6%) and multimodal analgesia (84.3%). The median hospital and ICU LOS were 5 (3-9) and 2 (0-4) days, respectively. DISCUSSION: Only 39.4% had opioids prescribed at discharge. Opioid-reductive strategies may decrease in-hospital and discharge opioid prescribing. While opioid analgesics remain a mainstay of trauma-associated pain management, institution-wide opioid-sparing strategies can further reduce discharge opioid prescribing after trauma.

Evaluation of levetiracetam for early post-traumatic seizure prophylaxis: A level II trauma center experience.

INTRODUCTION: Traumatic brain injury (TBI) can induce early or late post-traumatic seizures (PTS). While PTS incidence is low, prophylaxis is used despite a lack of consensus on agent or duration. Levetiracetam (LEV) for early PTS prophylaxis is preferred due to its safety and efficacy. The purpose of this study was to evaluate LEV for early PTS prophylaxis. METHODS AND MATERIALS: A single-center, retrospective chart review of TBI patients ≥18 years who received LEV for early PTS prophylaxis between August 2018-July 2019. The primary outcome was LEV duration. Secondary outcomes were incidence of seizure, intensive care unit (ICU) and hospital length of stay (LOS). RESULTS: Of the 137 included, mean age was 59 ± 20 years and 69.3% were male. The mean admission GCS was 13 ± 4 and 77.4% had mild TBI. Median LEV duration was 7 (IQR 4-10) days and 13.9% met recommended 7-day duration. Those prescribed LEV >7 days had more than twice the median LEV duration than those prescribed ≤7 days [10.25 (8.5-15.5) vs 4 (1.5-4.5) days, p < 0.0001]. Electroencephalography-confirmed PTS occurred in 2.2%, with an early PTS incidence of 0.73%. Median ICU and hospital LOS were 2 (IQR 1-7) and 7 (IQR 3-16) days, respectively. CONCLUSIONS: The incidence of PTS was low as most patients in our study had mild or moderate TBI. Early PTS prophylaxis with LEV for 7 days is appropriate, although the majority of patients did not meet the recommended duration. Efforts to standardize and implement PTS prophylaxis protocols are needed.

The complete mitochondrial genome of a marine triclad Miroplana shenzhensis (Platyhelminthes, Tricladida, Maricola).

The complete mitochondrial genome (mitogenome) of Miroplana shenzhensis Yu & Wang, 2013 is reported in the present study, representing the second mitogenome recorded in the suborder Maricola. The circular mitogenome is 14,344 bp in length, containing 12 protein-coding genes, 2 ribosomal RNAs and 22 transfer RNAs. Comparative analysis on mitochondrial gene order reveals a rearrangement in the suborder Maricola, indicating that mitochondrial gene order is conserved only in Continenticola, and is divergent across Tricladida. Phylogenetic analysis shows M. shenzhensis is clustered with an another marine triclad, forming a well-supported monophyletic group of Maricloan.

A New Species and New Record of Freshwater Turbellarians of the Genus Gieysztoria (Platyhelminthes: Rhabdocoela) from China.

A new species of Dalyelliidae, Gieysztoria pellucida Wang and You, is described based on material collected in southern China through an integrative approach combining morphological, histological, and molecular (18S and 28S rDNA) data. Gieysztoria pellucida sp. nov. is morphologically characterized by a fan-shaped (about 270° when pressed) stylet, consisting of 13 similar distal spines and a broad girdle without fenestrae region. This stylet is distinct from that of any other similar species in the Aequales group to which this species belongs. In addition, specimens identifiable as Gieysztoria garudae Van Steenkiste, Van Mulken, and Artois, 2012 were discovered from the same location as G. pellucida sp. nov. Gieysztoria garudae has previously been known only from India; the present study thus represents the first record of the species from China.

Comparative Analysis of Patients with Robotic Hiatal Hernia Repairs with and without Collis Gastroplasty.

INTRODUCTION: After extensive mediastinal dissection fails to achieve adequate intra-abdominal esophageal length, a Collis gastroplasty(CG) is recommended to decrease axial tension and reduce hiatal hernia recurrence. However, concerns exist about staple line leak, and long-term symptoms of heartburn and dysphagia due to the acid-producing neoesophagus which lacks peristaltic activity. This study aimed to assess long-term satisfaction and GERD-related quality of life after robotic fundoplication with CG (wedge fundectomy technique) and to compare outcomes to patients who underwent fundoplication without CG. Outcomes studied included patient satisfaction, resumption of proton pump inhibitors (PPI), length of surgery (LOS), hospital stay, and reintervention. METHODS: This was a single-center retrospective analysis of patients from January 2017 through December 2018 undergoing elective robotic hiatal hernia repair and fundoplication. 61 patients were contacted for follow-up, of which 20 responded. Of those 20 patients, 7 had a CG performed during surgery while 13 did not. There was no significant difference in size and type of hiatal hernias in the 2 groups. These patients agreed to give their feedback via a GERD health-related quality of life (GERD HRQL) questionnaire. Their medical records were reviewed for LOS, length of hospital stay (LOH), and reintervention needed. Statistical analysis was performed using SPSS v 25. Satisfaction and need for PPIs were compared between the treatment and control groups using the chi-square test of independence. RESULTS: Statistical analysis showed that satisfaction with outcome and PPI resumption was not significantly different between both groups (P > .05). There was a significant difference in the average ranks between the 2 groups for the question on postoperative dysphagia on the follow-up GERD HRQL questionnaire, with the group with CG reporting no dysphagia. There were no significant differences in the average ranks between the 2 groups for the remaining 15 questions (P > .05). The median LOS was longer in patients who had a CG compared to patients who did not (250 vs. 148 min) (P = .01). The LOH stay was not significantly different (P > .05) with a median length of stay of 2 days observed in both groups. There were no leaks in the Collis group and no reoperations, conversions, or blood transfusions needed in either group. CONCLUSION: Collis gastroplasty is a safe option to utilize for short esophagus noted despite extensive mediastinal mobilization and does not adversely affect the LOH stay, need for reoperation, or patient long-term satisfaction.

Three new species of Macrostomum (Platyhelminthes, Macrostomorpha) from China and Australia, with notes on taxonomy and phylogenetics.

In this paper, three species of the macrostomid free-living flatworm genus Macrostomum are described. Two species, Macrostomumlittorale Wang & Shi, sp. nov. and M.shekouense Wang & Shi, sp. nov., were collected from coastal water at Shenzhen, Guangdong Province, China. One species, M.brandi Wang & Shi, sp. nov., was collected from Perth, Western Australia and Queenscliff, Victoria, Australia. Macrostomumlittorale sp. nov. differs from congeneric species within the genus in the length of the stylet, diameter of stylet opening, and the bend of the stylet. Macrostomumshekouense sp. nov. and M.brandi sp. nov. differ from similar species within the genus in the stylet morphology, position of the female antrum and developing eggs, or presence or absence of the false seminal vesicle. Phylogenetic analysis based on cytochrome c oxidase subunit I (COI) gene shows that M.littorale sp. nov. and M.hystrix are sister clades on two well-separated branch, M.shekouense sp. nov. and M.brandi sp. nov. are sister clades on two well-separated branches. Accordingly, both morphological and molecular evidence support M.littorale sp. nov., M.shekouense sp. nov., and M.brandi sp. nov. as three new species.

Two New Brackish-Water Species of Macrostomum (Platyhelminthes: Macrostomorpha) from China and Their Phylogenetic Positions.

In this paper, two new brackish-water species of the macrostomid turbellarian genus Macrostomum, Macrostomum pseudosinense sp. nov. and Macrostomum taurinum sp. nov., collected from coastal water at Shenzhen, Guangdong Province, China, are described based on morphological, histological, and molecular phylogenetic analyses. Macrostomum pseudosinense sp. nov. differs from similar species within the genus in the length of the stylet (152 ± 15.0 µm), diameter of stylet opening (20 ± 4.0 µm proximally; 7 ± 0.5 µm distally), two bends of the stylet, and the non-spiral end of the stylet. Macrostomum taurinum sp. nov. differs from its congeners in the length of the stylet (81 ± 7.4 µm), the stylet bending position and angle (50% and 60°), diameter of stylet proximal opening (15 ± 3.0 µm), sperm with bristles and brush, and the smooth-walled ovaries. Phylogenetic analyses inferred from nuclear 18S and 28S rRNA genes support the establishments of these two new species. In addition, reciprocal mating behavior of M. pseudosinense sp. nov. was observed and documented.

Mechanisms of thermal treatment on two dominant copepod species in O3/BAC processing of drinking water.

Phyllodiaptomus tunguidus and Heliodiaptomus falxus are dominant copepods species in drinking water processing plants in southern China. With a potential penetration risk, the breeding and leakage of copepods are drawing more and more attention in recent years. The current study provided a thermal treatment method to control copepods and their eggs. Results showed that: (1) the immediate death rates of P. tunguidus and H. falxus after heated to 34-40 °C for 5 min are positively correlated to the treatment temperatures (P < 0.01), and all individuals of the both species were eliminated after heated at 40 °C for 5 min; (2) overall hatching rates of P. tunguidus eggs were negatively correlated with treatment temperatures (P < 0.01) between 39-45 °C, with zero percent hatched after treatment at 45 °C for 5 min; (3) hatching rates of H. falxus were negatively correlated with treatment temperatures (P < 0.01) between 37-41 °C, with no nauplii hatched when treated at 41 °C for 5 min; (4) paraffin section histological examination indicated that thermal treatment caused severe damage to internal organs and egg structure. Finally, based on the experimental data, the application of the thermal treatment method was discussed in ozonation combined with biological activated carbon (O3/BAC) processing of drink water treatment.

MitoFlex: an efficient, high-performance toolkit for animal mitogenome assembly, annotation and visualization.

SUMMARY: MitoFlex is a linux-based mitochondrial genome analysis toolkit, which provides a complete workflow of raw data filtering, de novo assembly, mitochondrial genome identification and annotation for animal High Throughput Sequencing data. The overall performance was compared between MitoFlex and its analogue MitoZ, in terms of protein-coding gene recovery, memory consumption and processing speed. AVAILABILITYAND IMPLEMENTATION: MitoFlex is available at https://github.com/Prunoideae/MitoFlex under GPLv3 license. SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

Estimation of the cumulative baseline hazard function for dependently right-censored failure time data.

In this paper, we study the properties of a special class of frailty models when the frailty is common to several failure times. The models are closely linked to Archimedean copula models. We establish a useful formula for cumulative baseline hazard functions and develop a new estimator for cumulative baseline hazard functions in bivariate frailty regression models. Based on our proposed estimator, we present a graphical model checking procedure. We fit a leukemia data set using our model and end our paper with some discussions.

Two new species of a new genus, Pseudorogneda, of Polycystididae discovered in Southern China.

Two new species of the new genus Pseudorogneda of Polycystididae were discovered in a brackish environment from Southern China. Pseudorogneda sinensis n. gen. n. sp., is distinguished by a semicircular double-walled prostate stylet type II that tapers in diameter from proximal to distal with a proximal-to-distal fold, and an inner wall with a funnel-shaped base originating at the midpoint of the outer wall; its flattened tubular prostate stylet type IV exhibits a horn-like base and a proximal-to-distal folded structure on its wall. For Pseudorogneda shenda n. gen. n. sp., its crescent-shaped prostate stylet type II is double-walled and the inner wall has a funnel-shaped base that starts at the proximal 2/3 position of the outer stylet and is fused with the outer stylet to form a sharp distal end; its tubular and slightly-curved prostate stylet type IV exhibits a slit and a distal fold. Phylogenetic analysis of 18S rDNA and 28S rDNA sequences shows that the two novel species are clustered to form an independent clade from other genera, which is consistent with morphological comparison in the establishment of two new species in a new genus.

Two new species of Rhabdocoela (Polycystididae and Trigonostomidae) from China.

Two new species of Rhabdocoela, namely Alcha sinensis n. sp. (Polycystididae) and Trigonostomum sinensis n. sp. (Trigonostomidae), were discovered from the intertidal zone of eastern Shenzhen City, China. For A. sinensis n. sp., the stylet consists of two symmetrical triangular plates and one lamellar plate. All three plates are jagged at their posterior ends. The anterior end of the stylet connects to a thick muscular layer, which causes its movement. For T. sinensis n. sp., the copulatory organ consists of a long-tubular stylet and two "T"-shaped plates (plate I and plate II). The stylet bends 120° at 25% of its length from the base and extends straight distally. Two "T" plates are connected to each other and surround the stylet. Plate I is hook-shaped at its distal end, and plate II has a similar length but only half the width of plate I. The phylogenetic (18S rDNA and 28S rDNA) results also support the establishment of these two new species. On the basis of the molecular phylogeny and morphology of the copulatory organ and bursa appendage, we propose a new categorization of the species of Trigonostomum.

Two new species of marine flatworm from southern China facilitate determination of the phylogenetic position of the genus Nerpa Marcus, 1948 and the histochemical structure of the nervous system in the genus Paucumara Sluys, 1989 (Platyhelminthes, Tricladida, Maricola).

Two new species of flatworm, collected from a beach at eastern Shenzhen, China, were studied through an integrative approach by combining morphological, histological, histochemical (acetylcholinesterase, AChE), and molecular (18S r- DNA) data. These species belong to two genera of marine triclads, previously unrecorded from China, viz. Nerpa Marcus, 1948 and Paucumara Sluys, 1989.        Nerpa fistulata Wang Chen, sp. nov. is characterized by: transparent body; principally pentamerous intestine with three distinct commissures; two very large, prepharyngeal testis follicles; a semi-circular lens in each eye cup; a penis papilla provided with a chitinized, pointed stylet; lateral bursae communicating with the oviduct and opening ventrally to the exterior via a duct. Phylogenetically N. fistulata groups with one member of the family Bdellouridae. This new, Chinese species of Nerpa introduces a major geographic disjunction, as the type species N. evelinae was described from the bay of Santos, Brazil, so that the genus is now known from both Atlantic as well as Pacific coasts.        The species Paucumara falcata Wang Li, sp. nov. is characterized by: three distinct pale yellow transverse pigmentation bands on its dorsal side, between which some snowflake-like specks are randomly distributed, and a brown transverse band anteriorly to the eyes; 8-11 testicular follicles on either side of the body, the follicles extending from immediately behind the ovaries to half-way along the pharyngeal pocket; a musculo-parenchymatic organ with a sclerotic, curved tip projecting from the anterior wall of the male atrium, ventrally to the root of the penis papilla. Phylogenetically P. falcata groups with its congener P. trigonocephala, with the genus Paucumara forming the sister taxon of the genus Ectoplana. Comparison of the nerve structure of P. falcata, as revealed by AChE histochemistry, with that of eight other species of triclad suggested that the nervous system of marine planarians is simpler than that of species of freshwater planarians, but revealed also that the nerve structure is rather variable among species.        The copulatory position exhibited by two partners in Paucumara falcata is remarkable in that they intertwine, with their heads pointing downwards and the tails pointing upwards, the entire process lasting about 10 min. Such a copulatory position has never before been reported for triclad flatworms.

Two new brackish-water species of Pogaina (Rhabdocoela: Provorticidae) from China.

Two new species of the genus Pogaina Marcus, 1954 (Provorticidae), namely Pogaina sinensis n. sp. and Pogaina shenzhenensis n. sp. are described from brackish water in the intertidal zone of Shenzhen Bay. For P. sinensis n. sp., the tubular stylet is slightly curved at the distal end and a fusiform structure with a flange is present at 66% of the stylet. The flange encircles the stylet, with its ends attached to the midpoint and the distal end of the stylet. For P. shenzhenensis n. sp., the stylet has a N-shaped overall morphology. A band provided with dense needle-like structures is present at the distal end of the stylet. Both the morphological (stylet) and phylogenetic (18S rDNA and 28S rDNA) analyses support the establishment of these two new species.

Macrostomum shenda and M. spiriger, two new brackish-water species of Macrostomum (Platyhelminthes: Macrostomorpha) from China.

In this study, two new brackish-water species of Macrostomum (M. shenda n. sp. and M. spiriger n. sp.) collected from Shenzhen, China, were described based on morphological, histological, and molecular phylogenetic analyses. Macrostomum shenda n. sp. differs from its congeners in the oblique and non-thickening distal opening of its narrow funnel-shaped stylet. In addition, its sperm have neither bristles nor brush, and are surrounded by an undulating membrane in the mid-body region. In M. spiriger n. sp., the stylet is spirally twisted. Its reproductive apparatus has a seminal bursal pore opening exteriorly. Results of the 18S and 28S rDNA phylogenetic analyses also support the establishments of these two new species. Moreover, the 18S and 28S rDNA sequences of some species within Macrostomum in previous studies have been revised to avoid ambiguity, while Macrostomum dongyuanensis Wang Sun, 2015 was re-identified as a new record of M. quiritium Kolasa, 1973 from China.

Four new species of the genus Paraustrorhynchus (Rhabdocoela: Kalyptorhynchia: Polycystididae).

Four new species of Paraustrorhynchus (Rhabdocoela: Kalyptorhynchia: Polycystididae) are described: two from Southern China (P. shenda n. sp., P. sinensis n. sp.), one from New Caledonia (P. isoldeae n. sp.), and one from India (P. smeetsae n. sp.). All four species show a typical dark blue dorsal pigmentation pattern, which is unique to the genus. This pigment forms a broad longitudinal line in P. shenda n. sp. and P. sinensis n. sp., shows an additional transverse band at the level of the pharynx in P. smeetsae n. sp. and forms a Y-shaped pattern in P. isoldeae n. sp. The four species can also be distinguished from each other and their congeners by the detailed morphology of the hard parts of the male system, which in all cases consists of an L-shaped (P. shenda n. sp., P. isoldeae n. sp) or slightly-curved (P. smeetsae n. sp., P. sinensis n. sp.) prostate stylet type II and a prostate stylet type III, which consists of three plates: a basal plate from which two longer plates depart, each with a distal serrated rim. A phylogenetic analysis based on 18S and 28S-rDNA data indicates that Paraustrorhynchus is a monophyletic taxon within Polycystidinae, with Alcha evelinae as the sister group.

A new species and new record of Polycystididae (Rhabdocoela: Kalyptorhynchia) from China.

One new species and one newly recorded species of Polycystididae from China, Paulodora sinensis n. sp. and Polycystis ali Schockaert, 1982, were described based on comprehensive morphological and molecular analyses. In Paulodora sinensis n. sp., the stylet is double-walled and is composed of a funnel-shaped proximal part and a spiral distal part, while the outer stylet forms a minor fold proximally. In Polycystis ali Schockaert, 1982, the stylet is also double-walled with a funnel-shaped proximal part. However, the collar-shaped distal part is partially concave and forms a jagged edge. The concatenated 18S rDNA and 28S rDNA phylogenetic analysis supports the establishment of the new species. Besides, based on the morphology of stylet, we have made detailed categorization among the recorded species within these two genera.

Two new species and the molecular phylogeny of eight species of Macrostomum (Platyhelminthes: Macrostomorpha) from southern China.

Two new species of Macrostomum (Platyhelminthes: Macrostomorpha), M. shiyanensis n. sp. and M. lankouensis n. sp. are described from Shiyan Reservoir and Lankou Town. Morphological characteristics of the penis stylets and sperm, as well as the phylogenetic analysis using concatenated sequences of 18S and 28S rDNA genes support the establishment of these two new species and indicate that they are closely related to M. sinensis and M. heyuanensis described from different regions of Guangdong province. Finally, the progress of molecular phylogenetics of Macrostomum worldwide is also discussed.