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The mercury pollution status in the northwestern Sea of Okhotsk remains largely unexplored. In this study, hair samples were collected from 40 bearded seals harvested between August and October 2021 in the region. Total mercury (THg) concentrations in the samples exhibited a wide range from 137 to 1885 ng/g (median: 407 ng/g). While no significant differences in THg concentrations were found between male and female seals, distinctions were observed between young and potentially mature seals. Stable nitrogen isotope analysis indicated that juveniles and mature adults did not differ, although sample sizes were limiting. The higher THg concentrations in juveniles were attributed to variations in the seals' diets and/or variations in foraging locations during the juvenile stage which likely contribute to THg differences due to greater seasonal migration to offshore habitats. Notably, THg levels in bearded seals from the northwestern Sea of Okhotsk were lower in comparison to other pinniped species in the North Pacific. These findings, representing the first dataset for this pinniped species in the Russian segment of its habitat, contribute insights into mercury exposure in the Sea of Okhotsk mammalian population.

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The Danish Christmas Seal Homes offer a 10-week residential stay for socially vulnerable children. We aimed to examine the effects on body composition and cardiometabolic fitness variables of the standard program (SG) and whether substituting physical activity sessions with sessions from a football-based health education program is beneficial for the participants ("11 for Health"; SG+). Three hundred and nine children participated in SG (12.4 [1.6] y) and 305 in SG+ (12.4 [1.4] y). Fat percentage was lowered by 6% for females (from 37% to 31%) and 8% for males (from 36% to 28%), with no between-group differences. We observed improvements in systolic and diastolic blood pressure (3 and 5 mm Hg, respectively), resting heart rate (10 beats/min), aerobic fitness, jump performance, and relative muscle mass with no between-group differences. Furthermore, there were between-group differences in insulin levels for females (1.7 pmol/L; 95% CI, 0.3 to 3.0) and postural balance for males (1.0 s; 95% CI, 0.0 to 2.0), both in favor of SG+, and covered distance in the Andersen test for females (26 m; 95% CI, 3 to 49) in favor of SG. In conclusion, a 10-week stay at the Danish Christmas Seal Home resulted in clinically relevant improvement in fat percentage and cardiometabolic fitness in socially vulnerable children, regardless of the program type.

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We report the effects of varying physiological and other properties on the heat and water exchange in the maxilloturbinate structure (MT) of the bearded seal (Erignathus barbatus or Eb) in realistic environments, using a computational fluid dynamics (CFD) model. We find that the water retention in percent is very high (about 90 %) and relatively unaffected by either cold (-30 °C) or warm (10 °C) conditions. The retention of heat is also high, around 80 % . Based on a consideration of entropy production by the maxilloturbinate system, we show that anatomical and physiological properties of the seal provide good conditions for heat and water exchange at the mucus lining in the seal's nasal cavity. At normal values of tidal volume and maxilloturbinate (MT) length, the air temperature in the MT reaches the body temperature before the air has left the MT channels. This confers a safety factor which is expected to be helpful in exercise, when ventilation increases.

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Nitrile Butadiene Rubber (NBR) is widely used as a sealing material due to its excellent mechanical properties and good oil resistance. However, when using NBR material, the seal structure is unable to avoid the negative effects of rubber aging. Hence, the influence of oil and thermal aging on the characteristics of NBR seals was studied by coupling the mechanical behavioral changes with the tribological behavioral changes of NBR in oil and the thermal environment. For this paper, aging testing and compression testing of NBR were carried out. Additionally, friction testing between friction pairs under different aging times was carried out. The surface morphology of the NBR working surface under different aging conditions was also observed. Finally, coefficients of different test conditions were introduced into the finite element model of NBR seals. It can be seen from the results that the elastic modulus increased with the increase in aging time in the thermal oxidative aging testing. The elastic modulus after 7 days of thermal oxidative aging increased by 135.45% compared to the unaged case, and the elastic modulus after 7 days of oil aging increased by 15.03% compared to the unaged case. The compression set rate of NBR increased significantly with the increase in aging time and temperature. The coefficient of friction (COF) between friction pairs increased first and then decreased with the increase in aging time. The maximum contact pressure decreased by 2.43% between the shaft and sealing ring and decreased by 4.01% between the O-ring and groove. The proportion of the effective sealing area decreased by 3.05% between the shaft and sealing ring and decreased by 6.11% between the O-ring and groove. Furthermore, the sealing characteristics between the O-ring and groove were better than those between the shaft and sealing ring.

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For space missions to either the Moon or Mars, protecting mechanical moving parts from the abrasive effects of prevailing surface dust is crucial. This paper compares the abrasive effects of two lunar and two Martian simulant regoliths using special pin-on-disc tests on a stainless steel/polytetrafluoroethylene (PTFE) sealing material pair. Due to the regolith particles entering the contact zone, a three-body abrasion mechanism took place. We found that friction coefficients stabilised between 0.2 and 0.4 for all simulants. Wear curves, surface roughness measurements, and microscopic images all suggest a significantly lower abrasion effect of the Martian regoliths than that of the lunar ones. It applies not only to steel surfaces but also to the PTFE pins. The dominant abrasive micro-mechanism of the disc surface is micro-ploughing in the case of all tests, while the transformation of the counterface is mixed. The surface of pin material is plastically transformed through micro-ploughing, while the material is removed through micro-cutting due to the slide over hard soil particles.

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Vessel traffic is the greatest contributor to marine anthropogenic noise pollution, and particularly affects species utilising coastal areas. Seal Rocks (Victoria), the largest Australian fur seal breeding colony, has a relatively small vessel exclusion zone during the pupping and breeding season, when vessel traffic is at its peak. It is necessary to understand the impacts of visitation at sensitive marine sites to ensure they are adequately protected from human disturbance. This study assessed the behavioural response of hauled-out Australian fur seals at Seal Rocks to controlled vessel noise exposure during peak and off-peak vessel visitation periods. High level noise exposure (76-80 dB) resulted in increased vigilance and interruption to vital behaviours in both peak and off-peak periods. These behavioural responses were limited to the period of noise exposure but are nevertheless indicative of disturbance. It is important to ensure regulations intended to protect sensitive sites are up-to-date and evidence based.

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Seal lice, unique among insects, show remarkable adaptability to the extreme conditions of the deep sea. Evolving with their seal and sea lion hosts, they have managed to tolerate hypoxia, high salinity, low temperature, and elevated hydrostatic pressure. Given the diving capabilities of their mammalian hosts, which can reach depths of hundreds to thousands of meters, our study examines the morphological variation among closely related seal lice species infesting hosts with different maximum diving depths. In particular, our research reveals a significant morphological difference between lice associated with regular and deep-diving hosts, where lice from deep-diving hosts tend to be rounder. This could be an adaptation to withstand the high hydrostatic pressures found in the deep ocean. The rounded shape optimizes the louse's ability to withstand external pressure by redistributing it over a larger ventral/dorsal plane. This in turn minimizes the internal energy required to support body deformations, thereby increasing the louse's resilience in the deep sea environment.

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OBJECTIVES: To assess and compare the clinical, radiological, and histological outcomes of socket seal surgery between two protocols: deproteinized demineralized tooth matrix (dpDTM) and freeze-dried bone allograft (FDBA) each covered with a free gingival graft. MATERIALS AND METHODS: Twenty extraction sockets in the anterior or premolar region were randomly allocated to either the dpDTM or FDBA protocol (n = 10 per group). Measurements of the alveolar ridge changes were obtained using an intraoral scanner and cone-beam computed tomography at 3 months post-operation. Three-month post surgery, the dental implant was installed (n = 5 per group), bone biopsies were obtained for histomorphometrical and micro-computed tomography analyses. Implant stability quotients (ISQs) were determined and compared at 3 months post-implant. RESULTS: Lower significant reductions in buccal alveolar ridge height and hard tissue volume were observed in dpDTM group compared to FDBA group at 3 months (0.25 ± 0.35 mm vs. 1.60 ± 0.66 mm [p = .000] and 9.64 ± 15.39% mm3 vs. 31.45 ± 18.11% mm3 [p = .010], respectively). At the same time, lower soft tissue volume reduction was detected in the dpDTM group compared to FDBA group (4.21 ± 5.25% mm3 vs. 5.25 ± 5.79% mm3). No statistically significant difference in the percentage of mineralized tissue formation was found between dpDTM group (53.39 ± 11.16%) and FDBA group (49.90 ± 3.27%). Even though the ISQ in the dpDTM group showed a higher value than the FDBA group at 3 months post-implant, the results were without statistical significance. CONCLUSIONS: Alveolar ridge preservation using dpDTM is an efficacious procedure for providing the conditions for the development of functional and esthetic implants.

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OBJECTIVE: To reveal need for prosthodontics in permanent teeth in children aged 8-18 years. MATERIALS AND METHODS: The study was performed in Khimki Dental Municipal Clinic. Dental examination and radiological studies were conducted in 97 primary patients aged 8-18 years. Indications for prosthodontics in permanent teeth were occlusal deterioration index more than 40% and crown decay of more than 50% in incisors and canines. Additional features were registered including DMFT index, the presence of extracted teeth and teeth after root canal treatment, as well and teeth with extensive restorations with resins and marginal seal quality. RESULTS: From 97 primary patients (27.8%) children needed prosthodontics in permanent teeth (in average 2.3±2.1 teeth): 1 tooth in 10 children, 2 teeth in 11 children, 3 teeth in 1 child, 4 teeth in 3 children and 4 teeth in 2 children. Mean DMFT was 8.1±4.5 teeth. Six children already had extracted permanent teeth (9 teeth in total). Half of the teeth (49.2%) which needed orthodontic treatment had history of root canal treatment while 46% needed primary or secondary endodontic treatment. Occlusal deterioration index was more than 40% in 41.3% of cases, more than 60% in 49.2% of teeth and more than 80% in 9.52% of teeth. From all the teeth restored with composite resins 41.7% had good marginal seal but 58.3% showed macroscopic signs of marginal leakage. CONCLUSION: Our study shows high percentage of adolescents having need for prosthodontics in permanent teeth and unjustified widening of indications for direct resin restorations in this group of patients.

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INTRODUCTION: Our retrospective study aimed at assessing safety of vascular closure devices (VCDs) used in a large single-centre Interventional Radiology (IR) department. Complication and deployment failure rates using collagen-based (Angio-seal) and suture-based (ProGlide) devices for common femoral artery haemostasis were compared. MATERIALS AND METHODS: Data from VCDs deployed over a 6-year period were retrospectively analysed for patient age, procedure indication, puncture mode (antegrade/retrograde), sheath size, deployment failure and complications (haematoma, pseudoaneurysm formation, limb occlusion). Numerical and statistical analysis was undertaken. RESULTS: Overall, 1321 common femoral artery punctures in 1217 patients were closed using VCDs. Failure rate using ProGlide was significantly higher when compared with Angio-seal (P=<0.001) in sheath sizes ≤8 Fr. Heparin was not administered in embolisation procedures compared with angioplasty with or without stenting. Therefore, haematoma tended to occur more frequently following angioplasty without stenting (P = 0.003) and angioplasty with stenting (P = 0.001), when compared with embolisation. Deployment failure occurred more frequently when heparin was used during the procedure (P = 0.005). CONCLUSION: Although complications relating to sheath size are well established in the literature, there remains a paucity of data assessing the impact of procedure specific factors when comparing VCDs. Our study challenges that size is the sole determinant of VCD success and invites a more holistic view of VCD deployment strategies. This study advocates continued research into the nuances of other potential confounding variables to optimise patient outcomes.

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Short-, medium-, and long-chain chlorinated paraffins (CPs) (SCCPs, MCCPs, and LCCPs) and dechloranes are chemicals of emerging concern; however, little is known of their bioaccumulative potential compared to legacy contaminants in marine mammals. Here, we analyzed SCCPs, MCCPs, LCCPs, 7 dechloranes, 4 emerging brominated flame retardants, and 64 legacy contaminants, including polychlorinated biphenyls (PCBs), in the blubber of 46 individual marine mammals, representing 10 species, from Norway. Dietary niche was modeled based on stable isotopes of nitrogen and carbon in the skin/muscle to assess the contaminant accumulation in relation to diet. SCCPs and dechlorane-602 were strongly positively correlated with legacy contaminants and highest in killer (Orcinus orca) and sperm (Physeter macrocephalus) whales (median SCCPs: 160 ng/g lw; 230 ng/g lw and median dechlorane-602: 3.8 ng/g lw; 2.0 ng/g lw, respectively). In contrast, MCCPs and LCCPs were only weakly correlated to recalcitrant legacy contaminants and were highest in common minke whales (Balaenoptera acutorostrata; median MCCPs: 480 ng/g lw and LCCPs: 240 ng/g lw). The total contaminant load in all species was dominated by PCBs and legacy chlorinated pesticides (63-98%), and MCCPs dominated the total CP load (42-68%, except 11% in the long-finned pilot whale Globicephala melas). Surprisingly, we found no relation between contaminant concentrations and dietary niche, suggesting that other large species differences may be masking effects of diet such as lifespan or biotransformation and elimination capacities. CP and dechlorane concentrations were higher than in other marine mammals from the (sub)Arctic, and they were present in a killer whale neonate, indicating bioaccumulative properties and a potential for maternal transfer in these predominantly unregulated chemicals.

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BACKGROUND: The i-gel® Plus is a modified version of the i-gel® supraglottic airway device. It contains a wider drainage port; a longer tip; ramps inside the breathing channel; and an additional port for oxygen delivery. There has been no prospective evaluation of this device in clinical practice. METHODS: This international, multicentre, prospective cohort study aimed to evaluate the performance of the i-gel Plus in adult patients undergoing elective procedures under general anaesthesia. The primary outcome was overall insertion success rate, defined as the ability to provide effective airway management through the device from insertion until the end of the surgical procedure. Secondary outcomes included device performance and incidence of postoperative adverse events. Data from the first 1000 patients are reported. RESULTS: In total, 1012 patients were enrolled; 12 forms were excluded from the final analysis due to incomplete data leaving 1000 included patients (545 female). Overall insertion success rate was 98.6%, with a first-attempt success rate of insertion of 88.2%. A significant difference between females and males was seen for the overall success rate (97.4% vs. 99.6% respectively) but not for first-attempt successful insertion. Mean (SD) oropharyngeal seal pressure was 32 (7) cmH2O. The only independent factor that increased the risk of first-attempt failure was low operator experience. Complications included desaturation < 85% in 0.6%; traces of blood on the device in 7.4%; laryngospasm in 0.5%; and gastric contents inside the bowl in 0.2% of patients. CONCLUSIONS: The i-gel Plus appears to be an effective supraglottic airway device that is associated with a high insertion success rate and a reasonably low incidence of complications.

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Seals, sea lions, and other aquatic animals rely on their whiskers to identify and track underwater targets, offering valuable inspiration for the development of low-power, portable, and environmentally friendly sensors. Here, we design a single seal-whisker-like cylinder and conduct experiments to measure the forces acting on it with nine different upstream targets. Using sample sets constructed from these force signals, a convolutional neural network (CNN) is trained and tested. The results demonstrate that combining the seal-whisker-style sensor with a CNN enables the identification of objects in the water in most cases, although there may be some confusion for certain targets. Increasing the length of the signal samples can enhance the results but may not eliminate these confusions. Our study reveals that high frequencies (greater than 5 Hz) are irrelevant in our model. Lift signals present more distinct and distinguishable features than drag signals, serving as the primary basis for the model to differentiate between various targets. Fourier analysis indicates that the model's efficacy in recognizing different targets relies heavily on the discrepancies in the spectral features of the lift signals.

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The key technologies for the ultrathin small outline package (TSOP) of large-sized high-speed chips have been designed and developed in this paper. The designing techniques, such as a 25 µm precise positioning dice attaching technique, a lead frame unit structure without a base island, and a lead co-plane layout inside the frame, were developed. The TSO package outline with a large number of leads, a frame unit arrangement, and a frame distribution with a base island and without one were improved. The technological problems, including the reduction in thickness, wafer cutting, chip sticking bonding, and plastic sealing, were successfully solved. The designed large-sized package products have many advantages, such as high availability, low cost, high reliability, and a short production cycle. This package technique can be widely used in various intellectual application regions.

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Despite decreasing anthropogenic mercury (Hg) emissions in Europe and the banning and restriction of many persistent organic pollutants (POPs) under the Stockholm Convention, Mediterranean marine mammals still have one of the highest body burdens of persistent pollutants in the world. Moreover, the Mediterranean basin is one of the most sensitive to climate change, with likely changes in the biogeochemical cycle and bioavailability of Hg, primary productivity, and the length and composition of pelagic food webs. The availability of food resources for marine mammals is also affected by widespread overfishing and the increasing number of alien species colonizing the basin. After reporting the most recent findings on the biogeochemical cycle of Hg in the Mediterranean Sea and the physico-chemical and bio-ecological factors determining its exceptional bioaccumulation in odontocetes, this review discusses possible future changes in the bioavailability of the metal. Recent ocean-atmosphere-land models predict that in mid-latitude seas, water warming (which in the Mediterranean is 20% faster than the global average) is likely to decrease the solubility of Hg and favor the escape of the metal to the atmosphere. However, the basin has been affected for thousands of years by natural and anthropogenic inputs of metals and climate change with sea level rise (3.6 ± 0.3 mm year-1 in the last two decades), and the frequency of extreme weather events will likely remobilize a large amount of legacy Hg from soils, riverine, and coastal sediments. Moreover, possible changes in pelagic food webs and food availability could determine dietary shifts and lower growth rates in Mediterranean cetaceans, increasing their Hg body burden. Although, in adulthood, many marine mammals have evolved the ability to detoxify monomethylmercury (MMHg) and store the metal in the liver and other organs as insoluble HgSe crystals, in Mediterranean populations more exposed to the metal, this process can deplete the biological pool of Se, increasing their susceptibility to infectious diseases and autoimmune disorders. Mediterranean mammals are also among the most exposed in the world to legacy POPs, micro- and nanoplastics, and contaminants of emerging interest. Concomitant exposure to these synthetic chemicals may pose a much more serious threat than the Se depletion. Unfortunately, as shown by the literature data summarized in this review, the most exposed populations are those living in the NW basin, the main feeding and reproductive area for most Mediterranean cetaceans, declared a sanctuary for their protection since 2002. Thus, while emphasizing the adoption of all available approaches to mitigate anthropogenic pressure with fishing and maritime traffic, it is recommended to direct future research efforts towards the assessment of possible biological effects, at the individual and population levels, of chronic and simultaneous exposure to Hg, legacy POPs, contaminants of emerging interest, and microplastics.

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Introduction The primary goal of endodontic therapy is to achieve a three-dimensional filling of the root canal. The sealer plays a crucial role in filling the residual gaps between the gutta-percha and the canal wall, which prevents fluids and bacteria from entering the canal and causing complications. This study evaluates and compares the sealing ability of four root canal sealers to the root dentin. Methods and materials In this study, forty single-rooted mandibular premolar teeth with fully-formed apices were collected. The teeth were decoronated and instrumented. Later, the teeth were randomly divided into four groups, each comprising ten specimens, based on the sealer used for obturation. The first group was obturated with BioRoot RCS (Septodont, Septodont Holding, Paris, France), the second group with MTA-Fillapex (Angelus, Angelus Indústria de Produtos Odontológicos S/A, Brazil), the third group with EpoxySeal (Safe Endo, SafeEndo Dental India Pvt. Ltd., Gujarat, India), and the fourth group with Sealapex (Kerr, Kerr Corporation, Brea, CA). Following obturation, the teeth were sectioned vertically using a diamond disc, and the marginal adaptation of these sealers to the root dentin was assessed using scanning electron microscopy (SEM). The values were then statistically analyzed. Results EpoxySeal showed the maximum amount of marginal adaptation (5.22±0.47), followed by BioRoot RCS (5.48±0.58) and MTA-Fillapex (8.24±0.74), and the least amount of marginal adaptation was shown by Sealapex (11.64±1.35). Based on the analysis of variance (ANOVA), a statistically significant difference (p≤0.001) was observed. According to Tukey's post hoc test, the mean difference between all groups showed statistical significance (p≤0.05) except between BioRoot RCS and EpoxySeal. Conclusion Within the limitations of this in vitro study, it is concluded that EpoxySeal and BioRoot RCS exhibited superior marginal adaptation to the root dentin. BioRoot RCS can be recommended as a sealer of choice owing to its additional properties, such as antimicrobial and hydrophilic affinity during setting.

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Background: Hemostasis for transfemoral transcatheter aortic valve replacement (TAVR) is typically achieved using a suture-mediated vascular closure device (VCD) prior to large-bore sheath insertion (preclosure technique). Recently, the addition of a hybrid closure technique using a preclose technique with the addition of a collagen-plug VCD after sheath removal in cases of failed hemostasis has been utilized. Methods: Data were collected from the Northwell TAVR registry, including 3 high-volume TAVR centers. We evaluated a preclose strategy with suture-mediated vascular closure alone ("legacy strategy") and standard bailout techniques versus a contemporary hybrid strategy of suture-mediated closure with collagen-mediated closure bailout. The primary end point was major or minor vascular complications as defined by the VARC-3 criteria. Results: A total of 1327 patients were included, of which 791 patients underwent TAVR with suture-mediated closure alone and 536 with contemporary strategy. The primary end point (major or minor vascular complication) was lower in the contemporary strategy (5.44% vs 1.31%; P < .001). Both minor (3.92% vs 1.12%; P = .002) and major (1.14% vs 0.19%; P = .0196) vascular complications were reduced and the total length of stay was less in the contemporary strategy (median of 3 days vs 2 days; P < .0001). Using multivariable analysis, we observed that vascular management strategy significantly improved the composite primary outcome when adjusted for sheath size, peripheral artery disease, carotid disease, and site of procedure. In the contemporary group, bailout collagen-plug VCD with an Angio-Seal (Terumo Medical) was used in 68 patients (12.69%) and bailout MANTA (Teleflex) was required in 4 patients (0.75%). There were no major or minor vascular complications among the patients who received bailout collagen-plug VCD. Conclusions: A contemporary hybrid strategy of suture-mediated closure with collagen-mediated closure bailout reduces the risk of vascular complications among patients undergoing transfemoral TAVR.

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OBJECTIVES: Examine the histomorphometric bone composition, following alveolar ridge preservation techniques and unassisted socket healing. MATERIALS AND METHODS: Forty-two patients (42) requiring a single rooted tooth extraction were randomly allocated into three groups (n = 14 per group): Group 1: Guided Bone Regeneration (GBR) using deproteinised bovine bone mineral (DBBM) and a porcine collagen membrane; Group 2: Socket Seal (SS) technique using DBBM and a porcine collagen matrix; Group 3: Unassisted socket healing (Control). Trephined bone biopsies were harvested following a 4-month healing period. Forty-two samples underwent Back-Scattered Electrons -Scanning Electron Microscopy (BSE-SEM) imaging, with 15 samples examined using Xray Micro-Tomography (XMT) (n = 6 for each GBR/SS and n = 3 Control). Images were analysed to determine the percentage (%) of connective tissue, new bone formation, residual DBBM particles and direct bone to DBBM particle contact (osseointegration). RESULTS: BSE-SEM analysis demonstrated that new bone formation was higher in the Control (45.89% ± 11.48) compared to both GBR (22.12% ± 12.7/p < .004) and SS (27.62% ± 17.76/p < .005) groups. The connective tissue percentage in GBR (49.72% ± 9), SS (47.81% ± 12.57) and Control (47.81% ± 12.57) groups was similar. GBR (28.17% ± 16.64) and SS (24.37% ± 18.61) groups had similar levels of residual DBBM particles. XMT volumetric analysis indicated a lower level of bone and DBBM particles in all test groups, when matched to the BSE-SEM area measurements. Osseointegration levels (DBBM graft and bone) were recorded at 35.66% (± 9.8) for GBR and 31.18% (± 19.38) for SS. CONCLUSION: GBR and SS ARP techniques presented with less bone formation when compared to unassisted healing. GBR had more direct contact/osseointegration between the DBBM particles and newly formed bone.

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Tissue contamination with persistent organic pollutants (POPs) in organisms proved possible to comprehensively characterize in a single test by combining gas chromatography and high-resolution accurate mass spectrometry. Adipose tissue samples were collected from two Caspian seals (Pusa caspica Gmelin, 1788) found dead on the Caspian Sea shore in 2020. Organochlorine pesticides, primarily DDT and HCH, and polychlorinated biphenyls (PCBs) were major pollutants found in the Caspian seals. The distribution of metabolites indicated the absence of recent pesticide use. The PCB content was relatively high, but still at the lower limit of the range of values determined previously, as was also the case with pesticides. Chlordanes, polychlorinated naphthalenes, and polybrominated diphenyl ethers were detected in minor quantities and were therefore not considered to be major pollutants of the Caspian seal. The pollutant levels were below a threshold at which a distinct effect on seal health can be expected. High-resolution accurate mass (HRAM) spectrometry was found to provide a convenient tool for both targeted and nontargeted analyses of a wide range of organic pollutants in a single experiment.

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PURPOSE: This single-center study aimed to assess patients who underwent intentional percutaneous endovascular aortic aneurysm repair (pEVAR) with Hybrid Technique combining a single Perclose (Abbott, Abbott Park, Illinois) Suture-Mediated Closure Device + single Angio-Seal VIP 8F (Terumo, Tokyo, Japan) and compare outcomes with the standard Dual Perclose technique. Materials and Methods: Consecutive elective pEVAR patients treated from November 2022 to November 2023, with healthy femoral accesses and introducer sheaths ≤20 French (F) outer diameter, were included. Coin-toss randomization determined whether a combination of single Perclose Device + single Angio-Seal VIP 8F (Hybrid Technique) or the standard double Perclose Devices (Dual Perclose) was used. In Hybrid Technique, a single Perclose device was positioned at 12 o'clock; a single Angio-Seal VIP 8F was placed after sheaths removal. Dual Perclose followed standard procedure. Primary endpoints included immediate hemostasis, sheath diameter differences, access conversion rate, technical success, and cost analysis. RESULTS: The study involved 60 pEVAR patients (median age=78, interquartile range [IQR]=72-85 years) within the inclusion criteria. In 14 (24%) cases, only 1 femoral access was studied. There were 106 pEVAR accesses, with 58 (54.7%) in the Hybrid Technique group and 48 (45.3%) in the Dual Perclose group. Both groups exhibited homogeneity in pre-operative characteristics and sheath diameter (Hybrid Technique-16F vs Dual Perclose-18F; p=0.202). Immediate hemostasis was achieved in 100% of the Hybrid Technique group vs 87.5% for the Dual Perclose group (p=0.006). Surgical access conversion was unnecessary. Technical success was 100%, with all 6 femoral bleeding cases after Dual Perclose resolved endovascularly, using additional devices. Cost analysis showed a median cost of 330 euros (IQR=0) for the Hybrid Technique group vs 384 euros (IQR=360-456) for the Dual Perclose group (p<0.001). Thirty-day mortality was 3%, in 2 fragile patients, without access-related complications. Multivariate analysis identified Dual Perclose access (odds ratio [OR]=35.6; 95% confidence interval [CI]=18.3-36.8; p<0.001) and obesity (OR=19.7; 95% CI=1.4-23.9.5; p<0.001) as independent risk factors for immediate hemostasis failure. Median follow-up was 134 days (IQR=41-227), with 1 Hybrid Technique case (2%) successfully treated with thrombin injection for a small femoral pseudoaneurysm after 62 days. CONCLUSIONS: The elective Hybrid Technique with combination of single Perclose Device + single Angio-Seal VIP 8F during pEVAR in selected patients appears to be non-inferior to the standard Dual Perclose procedure. It demonstrates a positive trend in reducing immediate hemostasis failure and costs. Both procedures achieved technical success and avoiding surgical access conversions. CLINICAL IMPACT: This study introduces a novel elective hybrid technique combining a single Perclose device with a single Angio-Seal VIP 8Fr for percutaneous endovascular abdominal aortic interventions. Results for hybrid technique showed 100% technical success and efficient immediate hemostasis, while costing less than standard dual Perclose procedure. Both procedures did not require surgical conversions. Despite being a single-center study, it demonstrates potential benefits of the intentional application of this hybrid technique towards minimally invasiveness. Obesity and dual Perclose technique were identified as independent risk factors for hemostasis failure, reaffirming the hybrid technique procedure's efficacy as well as and non-inferiority to standard procedure.