Although back pain is common among horticulture workers, effective prevention and management strategies are lacking. The first phase of a study using the Exploration, Preparation, Implementation, and Sustainment Framework is described with aims to characterize stakeholder perceptions of: 1) the need to address back pain, 2) attitudes towards pain medication including opioids, 3) contextual factors, and 4) preferences for training related to musculoskeletal injury prevention. In-depth interviews were completed in English or Spanish (n = 14) with consultants, owners, supervisors, and workers and in English or Spanish. Transcripts were recorded, transcribed, and coded, followed by qualitative inductive-deductive thematic analysis. While back pain is widespread, productivity requirements and working through pain may lead to de-emphasizing awareness and practices to prevent and manage back pain. Nursery and landscape workers tend to work regardless of pain, often using over-the-counter pain relievers to get through the day. Use of pain medication is seldom discussed, including risks of opioids and owners and consultants were hesitant to provide Naloxone in the workplace. Non-modifiable but variable contextual factors to consider when designing training are seasons and weather, type of horticulture, business models, productivity goals, and income needs. Training, policies, administrative controls, and worker knowledge and attitudes towards pain are potentially modifiable. Most current training is informal and on-the-job, and supervisors play a critical intermediary role. Integrating training into current work practices could minimize reductions in work time. Proactive interventions to limit and manage back pain and increase awareness of medication risks are needed for horticulture workers. Themes will be useful to design horticulture-specific training: 1) variability in contextual factors (weather, seasons, business models) requires training options that can be used at down-times and in different locations, 2) productivity drivers and worker tendencies to work through pain to protect their income require short, practical strategies and training without disrupting workflow, and appropriate messaging, 3) need for a supportive workplace culture, and 4) importance of involving supervisors. The non-modifiable and modifiable contextual findings from this study will be helpful for designing prevention training in the horticulture industry and could potentially apply to other outdoor physically challenging occupations.
This Viewpoint discusses the ethics of civil commitment for substance use disorders and advocates for expansion of access to voluntary treatment instead.
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Tetralogy of Fallot with absent pulmonary valve (TOF/APV) is a rare form of congenital heart disease that has both cardiac and respiratory implications. While some patients are asymptomatic at birth, others have significant airway disease requiring mechanical ventilation and urgent surgical repair. To compare the relationship between preoperative mechanical ventilation on durations of both total invasive mechanical ventilation and non-invasive ventilation in patients undergoing TOF/APV repair. Secondary aims include comparing echocardiographic parameters with clinical predictors and outcomes. Retrospective chart review of 23 neonates and infants less than one year-old undergoing initial repair for TOF/APV. Patients were stratified by whether they required mechanical ventilation for cardiopulmonary stabilization in the immediate preoperative period. Patients were assessed for the durations of invasive and non-invasive ventilation. Echocardiographic parameters including main pulmonary artery, branch pulmonary arteries, and pulmonary valve z-scores were compared to clinical outcomes as well.  RESULTS: Patients intubated preoperatively had significantly longer initial intubations (383.28 [211.47, 500.30] vs. 33 [23.93, 140.0] hours, p < 0.001) and total duration of intubation (599.82 [441.83, 3324.22] vs. 33 [23.93, 141.17] hours, p < 0.001). Patients intubated preoperatively had significantly longer durations of non-invasive ventilation (173.33 [89.33, 585] vs. 0 [0, 72.57] hours, p = 0.004). Only LPA z-scores were associated with the need for preoperative intubation. Preoperative intubation was associated with longer CICU and hospital length of stay.  CONCLUSIONS: In patients with TOF/APV, the need for preoperative intubation is a predictor of postoperative respiratory complexity and length of stay. Echocardiographic data must be interpreted within the broader clinical context. Recognizing the potential implications in patients requiring preoperative respiratory support may help clinical teams anticipate postoperative ventilatory needs, inform perioperative planning, and guide family counseling.
Evidence supporting the use of conduction system pacing (CSP) in bradycardia is currently predominantly based on observational data. We performed a meta-analysis of recent propensity-score matched (PSM) studies and randomized controlled trials (RCTs) evaluating outcomes of CSP and right ventricular pacing (RVP) in bradycardia indications. We systematically searched three databases for eligible studies. Risk ratios (RRs) and mean differences (MDs) with their 95% confidence intervals (CI) were pooled using a random-effects model. Subgroup analyses of RCTs were performed for key outcomes. Fifteen studies (8 RCTs, 7 PSM) comprising 6,064 patients were included. Compared to RVP, CSP significantly reduced heart failure hospitalizations (RR:0.31; 95% CI:0.21-0.46; p < 0.001) and the need for cardiac resynchronization therapy (CRT) upgrades (RR:0.31; 95% CI:0.12-0.78; p = 0.01), while modestly improving left ventricular ejection fraction (MD:3.98%; 95% CI:2.22-5.74; p < 0.001) and resulting in narrower QRS durations (MD:-27.3 ms; 95% CI:-35.9 to -18.6; p < 0.001). These findings were consistent in sub-analyses of RCTs. CSP was associated with reduction of all-cause mortality in the overall analysis (RR:0.51; 95% CI:0.34-0.78; p = 0.002), but not in the RCT and PSM subgroups. No significant differences between groups were observed for cardiovascular mortality (RR:0.49; 95% CI:0.23-1.04; p = 0.06), procedural complications, or atrial fibrillation. CSP was associated with longer procedural and fluoroscopy times. CSP significantly reduces the risk of heart failure hospitalizations and the need for CRT upgrades compared to RVP in patients with bradycardia indications. Ongoing, large-scale RCTs are needed to verify the effect of CSP on mortality and its long-term safety.
Antibiotic resistance genes (ARGs) can be rapidly disseminated via bacterial conjugation, resulting in a substantial decline in the clinical efficacy of antibiotics. Novel therapeutic strategies independent of conventional antimicrobials are urgently needed. In this study, we identified rhein (RHE), a natural anthraquinone compound, as an effective IncFII plasmid transfer-reducing agent. At sub-inhibitory concentrations, RHE significantly reduced the conjugative transfer of IncFII plasmids in Escherichia coli. Importantly, the inhibitory effect of RHE extended to clinically relevant contexts, where it markedly impeded the transfer of the mcr-1 gene among clinical isolates and reduced plasmid dissemination in multiple organs in mouse models, demonstrating its in vivo potential. Mechanistic investigations revealed a dual mode of action that distinguishes RHE from traditional antimicrobials. Specifically, RHE compromises bacterial membrane integrity, leading to dissipation of the proton motive force and depletion of intracellular ATP, and concurrently disrupts the bacterial quorum-sensing system. Collectively, these findings establish RHE as a promising lead compound for the development of non-antibiotic therapeutics aimed at limiting the environmental and clinical spread of antimicrobial resistance. This study provides a novel and feasible strategy to address the escalating crisis of ARG transmission. Antimicrobial resistance in bacteria has become an increasingly severe global health challenge. The widespread dissemination of colistin resistance genes has markedly compromised the clinical efficacy of colistin, underscoring an urgent need for novel strategies to limit the spread of resistance determinants. In this study, we investigated the regulatory effects of rhein on IncFII-type plasmids and evaluated its intervention potential in the transmission of the colistin resistance gene mcr-1. Our results demonstrate that RHE effectively reduces mcr-1 transfer in both in vitro and in vivo models, highlighting its potential as a promising therapeutic candidate for the prevention and control of antimicrobial resistance gene dissemination.
Breast cancer risk prediction tools are increasingly used in clinical practice to guide early detection, prevention, and shared decision-making. Unlike population-level screening, personalised risk estimates incorporate individual factors (family history, genetics, lifestyle, breast density), providing tailored assessments. These tools show promise for improving patient engagement and targeted prevention, but require effective implementation to ensure they enhance rather than complicate care. This review explores healthcare professionals' experiences with providing personalised breast cancer risk estimates and women's experiences of receiving them in clinical settings. Four online databases were searched for qualitative studies on the use of personalised risk estimates in clinical practice. Data were analysed using inductive thematic analysis. Seven papers were included; the majority based in the UK screening setting. Most used interview and focus-groups, with thematic analysis. Both healthcare professionals and women expressed high acceptance of personalised risk estimates. Women found the information empowering and useful for future health planning. Effective communication and prompt follow-up from healthcare professionals were crucial for positive experiences. Professionals highlighted challenges in implementation, including the need for additional healthcare professionals, safe care pathways, and technology. The studies focused on stratified breast screening, raising questions about offering less frequent screening to lower-risk women. This approach must be supported by strong evidence, and women should retain choice in screening intervals. Personalised risk estimates are favourably viewed in clinical practice, but studies mainly examined research settings. Further research is needed to understand real-world implementation, identify barriers, and optimise use across diverse clinical environments.
Cunninghamella bertholletiae and Rhizopus microsporus are clinically important Mucorales that frequently exhibit mixed peaks in chromatograms from conventional Sanger sequencing of the internal transcribed spacer (ITS) region. Intragenomic ITS heterogeneity has been reported in R. microsporus but has not yet been characterized in Cunninghamella species. This study investigated ITS patterns in nine C. bertholletiae, three Cunninghamella echinulata, and two R. microsporus isolates collected in Taiwan. The ITS-D1/D2 regions were examined by PCR, cloning, and Sanger sequencing; one C. bertholletiae isolate was further studied using PacBio HiFi sequencing. In C. bertholletiae, cloning and Sanger sequencing revealed length variation at six homopolymeric tracts ≥ 8 bp within the ITS region, consistent with PacBio findings. C. echinulata exhibited none or minimal intragenomic ITS variation. Both R. microsporus isolates contained divergent ITS and D1/D2 sequence patterns; one strain showed substantial indels, resulting in intragenomic divergence of 27.4% in ITS and 3.10% in D1/D2. These hybrid ITS sequence patterns were highly similar to those observed in strains from Hong Kong, suggesting that ancient hybridization has been stably inherited. Overall, intragenomic divergence ranged 0.14%-0.55% in C. bertholletiae, 0%-0.23% in C. echinulata, and 1.19%-27.37% in R. microsporus for ITS, and 0%-0.41%, 0%-0.41 %, and 1.43%-3.10% for D1/D2, respectively. In conclusion, our study revealed the patterns of ITS heterogeneity, including length variation in long homopolymeric tracts in C. bertholletiae and hybrid ITS patterns in R. microsporus, which contribute to Sanger chromatogram ambiguity and pose challenges for ITS-based identification. Although D1/D2 sequencing offers an alternative, its utility may also be affected by intragenomic divergence in R. microsporus, highlighting the need for single-copy genes to improve species identification.IMPORTANCECunninghamella bertholletiae and Rhizopus microsporus are clinically important Mucorales that often yield ambiguous internal transcribed spacer (ITS) chromatograms in Sanger sequencing. We showed that in C. bertholletiae, chromatogram ambiguity arises from length variation in six long homopolymeric tracts (≥8 bp), while in R. microsporus, it results from hybrid ITS types, as observed in isolates from Hong Kong. Such intragenomic ITS sequence heterogeneity poses challenges to ITS-based identification. Although D1/D2 sequencing offers an alternative, its utility may also be affected by intragenomic divergence in R. microsporus, highlighting the need for single-copy genes to improve species identification.
Diabetes mellitus (DM) represents an increasing global health burden with type 2 diabetes mellitus (T2DM) accounting for most cases. T2DM is associated with microvascular and macrovascular complications including myocardial ischemia and contributes to the development of a distinct form of cardiac dysfunction referred to as diabetic cardiomyopathy (DCM). Importantly, DCM contributes to 50-80% of mortality in patients with diabetes independent of other vascular comorbidities and is characterized by structural and functional alterations of the myocardium. Notably, these outcomes exhibit sex-specific differences in patients with T2DM. Despite this, most preclinical rodent studies fail to incorporate female subjects. This is truly the case of the Zucker diabetic fatty (ZDF) rat model, where the left ventricular contractile and morphological properties have been investigated almost exclusively in males. This review aims to: a) synthesize existing data on myocyte shortening and morphology in ZDF male and female rats; b) identify critical gaps in current knowledge and define priorities for future experiments; and c) emphasize the urgent need for longitudinal studies assessing cardiomyocyte contractility and structural remodeling in both sexes. Cardiac myocyte contractility and calcium dynamics data are entirely lacking in ZDF female rats, while findings in males remain limited and, in some cases, inconsistent. For morphological and ultrastructural alterations in cardiac myocytes information is scarce for both ZDF males and females. Overall, this review highlights the need for comprehensive longitudinal investigations spanning the early and advanced stages of DCM including progression to heart failure in both male and female ZDF rats.
Amyloidosis is a rare disease characterized by the extracellular deposition of misfolded amyloid proteins in various organs and tissues, leading to progressive organ dysfunction. Due to the complexity of its management, the high symptom burden it generates, and the difficulty in determining prognosis, palliative care plays a fundamental role in comprehensive management and in improving patients' quality of life. This article presents a narrative review aimed at examining the available evidence on palliative interventions in patients with amyloidosis for symptom control, psychosocial support, and shared decision-making. The findings suggest that a patient-centered interdisciplinary approach enables more effective management of pain, dyspnea, fatigue, and other associated symptoms, in addition to enhancing emotional well-being and facilitating advance care planning. The importance of early assessment of palliative care needs and the integration of specialized teams from the initial stages of diagnosis is emphasized, in order to optimize symptom management and provide comprehensive support to patients and their families. Despite progress, gaps remain in the literature regarding specific palliative care interventions and their long-term impact, highlighting the need for further research in this field.
Virtual screening (VS) and de novo design (DN) are powerful computational approaches used to identify and refine potential drug-lead candidates against clinically relevant targets. However, many software programs used for VS and DN, including our codebase DOCK6, can be difficult to use and deploy for users lacking experience with command-line environments. To make such tools easier to use, we are developing a full-stack web application, termed DOCKweb, to help streamline the DOCK6 experience for users of all skill levels. As outlined in this work, we employed web-based tools such as React.js and Express.js to develop an online interactive graphical user-interface (GUI), streamlining key setup procedures and submission of DOCK6 calculations. Importantly, the DOCKweb GUI eliminates the need for users to download and compile their own version of the program. Further, calculations submitted through DOCKweb are currently executed at the Texas Advanced Computer Center (TACC) which removes the requirement that users need access to a local supercomputer.
Endosymbiotic bacteria such as Wolbachia pose significant challenges to genetic and molecular investigation due to their obligate intracellular lifestyle and complex growth requirements. Current understanding of their protein biology relies heavily on functional assignments inferred by homology, which may not reflect the specific roles endosymbiont proteins play within the host. This work addresses the need for robust genetic perturbation by demonstrating the successful application and detection of chemical mutagenesis in the genome of the wMel strain of Wolbachia grown within a stably infected Drosophila melanogaster JW18 cell line. To accurately detect ethyl methanesulfonate (EMS)-induced mutations in a large, unsorted cell culture population, in which mutations remain at very low allele frequency, we implemented an ultra-low error rate sequencing strategy, circle sequencing. This technique enables confident detection of EMS-induced single-nucleotide polymorphisms (SNPs) that would be swamped by the inherent error rates of standard next-generation sequencing. Circle sequencing library preparations successfully revealed a clear EMS mutation signal in treated cells, characterized by a significant enrichment of canonical C/G > T/A transitions. Furthermore, we present a model explaining observed EMS mutation rates across the genome for different sequence contexts. These findings show that EMS-treatment can successfully leave detectable mutation signals in intracellular genomes and offer promise for the future development of protocols to make targeted edits in Wolbachia genomes.IMPORTANCEAs the use of intracellular symbionts for bioengineering projects grows, so does the need for foundational protocols for the genetic manipulation of intracellular genomes. Ethyl methanesulfonate (EMS), a chemical mutagen, has been a research tool for initial genomic analysis of gene function in plant and animal systems for decades and represents an established way of generating mutations for future functional testing. This study demonstrates that EMS can be used to induce mutations in the genome of the unculturable symbiont Wolbachia. This approach may help overcome a key barrier in Wolbachia biology-namely, the lack of forward genetic tools-and could provide a foundation for genetic manipulation of intracellular symbionts, including those used in pest and disease control.
Recent randomized trials such as INSEMA and SOUND identified patients with breast cancer for whom axillary surgery omission appears to have no detrimental oncologic impact. However, some have questioned the safety of omitting axillary surgery in patients with invasive lobular carcinoma (ILC), the most common special histology type. We analyzed a prospectively maintained institutional ILC database containing 1029 tumor records. We identified those meeting INSEMA and SOUND criteria for axillary surgery omission (clinically node negative with axillary ultrasound, cT1-2 for INSEMA-eligible, cT1 for SOUND-eligible, no neoadjuvant therapy). We used chi-square and Wilcoxon rank-sum tests to evaluate factors associated with pathologic nodal positivity. Local and distant recurrence free survival for those omitting axillary surgery were explored using the Kaplan-Meier method. Overall, 205 patients with ILC met preoperative criteria for the INSEMA or SOUND trials, of whom 189 (92%) underwent axillary surgery. Of 189 INSEMA-eligible patients, 19.8% were node positive and 30.2% upstaged in T category. Of 99 SOUND-eligible patients, 18.4% were node positive and 34.6% upstaged in T category. Younger age was significantly associated with nodal positivity (INSEMA p = 0.003, SOUND p = 0.002). For the subset of patients who omitted axillary surgery, distant recurrence free survival was significantly worse compared to those who underwent axillary surgery in both INSEMA-eligible (p = 0.001) and SOUND-eligible cohorts (p = 0.0495). High rates of occult nodal positivity in ILC patients suggest the need for ILC-specific selection criteria for axillary surgery omission. Further studies are needed to evaluate potential impact on oncologic outcomes in this patient population.
ICRP initiated a review of the System of Radiological Protection. Contributing to this the World Nuclear Association (WNA) organised a workshop in collaboration with ICRP covering optimisation and communication as main topics. This article summarises the outcome of the optimisation part. ICRP and WNA addressed the expectations referred to the review and corresponding challenges. In this context ICRP mentioned the TG114 work, whereas WNA underpinned the need to include industry expertise in the review. A regulatory perspective and several examples of successful applications of the optimisation principle were presented. As an outcome, four main areas were identified, which need to be looked at more closely. These were the all-hazards approach as radiation was not always the primary hazard, graded approach as too much focus on very low doses doesn't deliver reasonable 'value for money' for society, balanced regulations for the different hazards as over-conservatism in one field hampers an all-hazards approach, and simplicity as the existing system in some parts confuses society and practitioners. ICRP isn't expected to develop an all-embracing 'all-hazards approach' to protection. A clear upfront top-tier statement in the revised Recommendations recognising that radiation cannot be considered in isolation would allow authorities to implement such an approach into the national regulations.
Disease intervention specialists (DISs) provide critical support within the public health workforce. The newly launched Certificate in Disease Intervention (CDI) program is designed to validate their skills. We assessed interest in and feasibility of establishing pathways into DIS certification for undergraduate students in the United States. To qualitatively assess perspectives on undergraduate DIS pathways, we conducted a series of 11 voluntary, semistructured listening sessions with educators who work with undergraduate students who are completing public health training. Interviews took place virtually from January through March 2025. We used data from the 2021 and 2024 Public Health Workforce Interests and Needs Survey (PH WINS) to assess educational backgrounds of DISs. Capacity for and interest in establishing DIS pathways varied among participating institutions. Among the 2577 DISs from the PH WINS sample, a weighted estimate of 76.7% of DISs reported having at least a bachelor's degree. Approximately half (n = 1372) of the sampled DISs reported having any type of additional certification(s). Listening session findings suggest some readiness to integrate DIS pathways within some undergraduate educational settings and the need for future implementation support. The educational background of the current DIS workforce suggests that undergraduate pathways into this career may be appropriate and that certification(s) in disease intervention-specific skills are somewhat common but currently lack a DIS-specific pathway. US undergraduate institutions may be equipped to integrate such pathways into their programs but will require support to increase awareness of the DIS field and feasibility of implementation.
The use of multiple wires or wireless seeds to bracket large areas of breast lesions is an effective way to avoid mastectomy in patients. However, direct comparisons between wire and wireless bracketed localization are not well studied. We aimed to compare wireless and wire bracketed localization and identify factors associated with positive or close margins. Patients undergoing bracketed localization for malignancy from 2019 to 2024 were identified. Data collected included demographics, radiographic features, pathology, and margin status. Patients with benign pathology and those undergoing oncoplastic surgery were excluded. Characteristics were compared between patient groups by localization type and margin status. In total, 240 patients were identified. Of these, 175 (72.9%) underwent wire bracketed localization and 65 (27.1%) underwent wireless bracketed localization. There were no significant differences in final margin status, distance from the closest margin, or need for additional surgery. A total of 66 patients (28.5% of wire bracketed localization and 24.6% of wireless bracketed localization) had close or positive margins, which was associated with size of disease, grade, atypical ductal hyperplasia on core biopsy, ductal carcinoma in situ or invasive lobular carcinoma on final pathology, number of biopsy sites, and a lack of discrete mass or calcifications on imaging. In this large single-institution study, wireless and wire bracketed localization had similar final margin status. Although we could not control completely for selection bias between methods, we were able to demonstrate factors associated with positive or close margins to determine scenarios in which wider margins or additional surgery may be necessary.
The excessive reliance on synthetic fertilizers and pesticides has undeniably enhanced crop productivity; however, it has also led to long-term environmental degradation, highlighting the urgent need for sustainable alternatives. Bioinoculants, particularly siderophore-producing fungi, represent a potential eco-friendly approach to improving nutrient acquisition, plant health, and resistance to pathogens. In the present study, 23 fungal species were isolated from agricultural and non-agricultural soils, among which four exhibited plant growth-promoting fungal (PGPF) activity. Of these, Aspergillus awamori (SA2) and Aspergillus terreus (SA3), identified through ITS gene sequencing, demonstrated the highest PGPF potential. Both strains synthesized hydroxamate-type siderophores, as confirmed by Chrome Azurol S (CAS) assay, HPLC, FTIR, and NMR analyses. In addition, they exhibited multiple plant growth-promoting (PGP) traits, including indole-3-acetic acid and ammonia production, as well as phosphate solubilizing activity. Treatment of Vigna unguiculata (L.) Walp. seeds with the filtrate of siderophore- producing isolates significantly enhanced germination rate, biomass accumulation, chlorophyll content, and levels of secondary metabolites (phenolics and flavonoids), while also displaying antagonistic activity against Fusarium oxysporum and Rhizoctonia solani under controlled conditions. These findings suggest that Aspergillus awamori and Aspergillus terreus have potential as plant growth-promoting and biocontrol agents; however, further validation under field conditions is required.
Robotic nephrectomy has emerged as an alternative to laparoscopic nephrectomy, offering enhanced surgical precision, reduced blood loss, and faster recovery. However, its clinical effectiveness and cost-efficiency remain debated. This study aims to perform a bibliometric analysis of the 100 most-cited publications comparing robotic and laparoscopic nephrectomy, focusing on clinical, technological, and economic aspects. A bibliometric search was conducted in the Scopus database on July 26, 2025, using the keywords "robotic nephrectomy" AND "laparoscopic nephrectomy" AND "human". Articles were sorted by citation count and screened based on clinical relevance. The top 100 most-cited studies were selected, and data on authorship, institutions, countries, journals, and keywords were extracted. A total of 435 publications from 43 countries were identified, with the United States leading in publication count (n=110) and citations (n=2,497), followed by China and Italy. The studies showed comparable oncologic outcomes (positive surgical margin, 1.6%-5.4%; 3-year disease-free survival, up to 94.9%), with robotic-assisted partial nephrectomy (RAPN) associated with improved perioperative outcomes, including shorter warm ischemia time, lower blood loss, and fewer complications (odds ratio, 0.55). Functional outcomes favored RAPN, particularly in complex tumors (estimated glomerular filtration rate, 96% vs. 90%), though robotic approaches were more costly. Robotic nephrectomy offers perioperative and functional advantages with comparable oncologic outcomes to laparoscopic approaches, though at higher cost. This bibliometric analysis provides clinical implications for decision-making and highlights the growing support for RAPN, emphasizing the need for high-quality prospective studies to guide future research.
Slow lorises (Nycticebus bengalensis and Xanthonycticebus spp.) are endangered small nocturnal prosimians that are frequently rescued from the illegal wildlife trade in Southeast Asia. Routine health examinations under anesthesia are essential for their care but anesthetic protocols are based largely on protocols established for other prosimians, with limited species-specific data. This study evaluated the efficacy and safety of adding butorphanol to a ketamine (6 mg/kg IM)-medetomidine (0.05 mg/kg IM)-midazolam (0.15 mg/kg IM) (KMM) anesthetic combination (KMMB) during health examinations of two loris species: Bengal slow loris (N. bengalensis) and pygmy slow loris (Xanthonycticebus spp.). Anesthesia was induced in 27 lorises (12 N. bengalensis, 15 Xanthonycticebus spp.), using either KMM (5 N. bengalensis and 4 Xanthonycticebus spp.) or KMMB (7 N. bengalensis and 11 Xanthonycticebus spp.). At the end of procedures, atipamezole (0.2 mg/kg IM) was administered to antagonize medetomidine. Induction and recovery times, vital parameters, and isoflurane supplementation requirements were recorded. In N. bengalensis, the addition of butorphanol (0.05 mg/kg IM) significantly shortened induction and recovery times without significantly influencing heart rate or oxygen saturation. In Xanthonycticebus spp., a higher butorphanol dose (0.1 mg/kg) was necessary to reach an adequate anesthetic plane. This species exhibited decreased heart rate, increased oxygen saturation, and shorter recovery times with the use of KMMB compared to KMM alone. Both species maintained spontaneous respirations without respiratory depression or apnea. Supplementation with isoflurane for the maintenance of anesthesia did not affect vital parameters but lengthened recovery times in both species. Although the need for isoflurane supplementation could not be completely prevented, KMMB reduced its requirement, potentially reducing adverse effects associated with inhalant anesthetics. These findings support the use of a species-adapted KMMB protocol, supplemented with isoflurane for maintenance of anesthesia as a safe and effective anesthetic option for health evaluations in rescued slow lorises.
Salmonella enterica serovar Infantis has emerged as a globally disseminated multidrug-resistant (MDR) pathogen, largely driven by the spread of the plasmid of emerging Salmonella Infantis (pESI)-like megaplasmid. In our study, we investigated the prevalence, antimicrobial resistance (AMR) phenotypes, and genomic features of S. Infantis isolates collected from poultry farms in Lebanon. A total of 72 isolates were recovered during a nationwide surveillance effort, among which 67 (93%) were MDR based on antimicrobial susceptibility testing (disk diffusion and broth microdilution) results, including resistance to critically important agents such as quinolones, and highly important classes such as tetracyclines and sulfonamides. Whole-genome sequencing was performed on 19 isolates selected through a stratified approach to encompass all identified AMR phenotypes; this analysis revealed a conserved pESI-like backbone together with MDR-associated determinants, including sul1, tet(A), and aadA. Plasmid marker analysis confirmed the presence of pESI in the majority of isolates, with plasmid-associated genes (ardA and trbA) and replicon markers (IncP and IncFIB(pN55391)) among the most prevalent. Comparative plasmid alignments with representative pESI sequences from Italy, Turkey, and the United States revealed strong conservation of the backbone alongside regional variation in AMR gene content. These findings highlight the role of poultry production systems in Lebanon as reservoirs for pESI-like megaplasmids and MDR S. Infantis, underscoring the zoonotic and public health risks posed at the human-animal-environment interface. Strengthened surveillance, antimicrobial stewardship, and biosecurity interventions are urgently needed to mitigate the spread of MDR S. Infantis within agriculture and beyond. The emergence of plasmid of emerging Salmonella Infantis (pESI)-like megaplasmids has transformed Salmonella Infantis into a globally distributed multidrug-resistant (MDR) clone with the capacity to persist in livestock and disseminate resistance genes across ecological boundaries. Our study provides the first genomic characterization of pESI-positive S. Infantis from poultry farms in Lebanon, a region with high antimicrobial usage and limited stewardship frameworks. By integrating phenotypic susceptibility testing and whole-genome sequencing, we demonstrate that Lebanese isolates harbor conserved pESI-like backbone markers together with antimicrobial resistance determinants, aligning them with internationally circulating lineages. Comparative analysis with isolates from Italy, Turkey, and the United States highlights both the evolutionary stability and geographic diversity of pESI. These findings emphasize the urgent need for integrated surveillance and stewardship strategies to curb the spread of MDR S. Infantis and reduce the zoonotic risk at the human-animal-environment interface.