Drones or Unmanned Aerial Vehicles (UAVs) have huge potential to improve the safety and efficiency of sample collection from wild animals under logistically challenging circumstances. Here we present a method for surveying population health that uses UAVs to sample respiratory vapor, 'whale blow,' exhaled by free-swimming humpback whales (Megaptera novaeangliae), and coupled this with amplification and sequencing of respiratory tract microbiota. We developed a low-cost multirotor UAV incorporating a sterile petri dish with a remotely operated 'blow' to sample whale blow with minimal disturbance to the whales. This design addressed several sampling challenges: accessibility; safety; cost, and critically, minimized the collection of atmospheric and seawater microbiota and other potential sources of sample contamination. We collected 59 samples of blow from northward migrating humpback whales off Sydney, Australia and used high throughput sequencing of bacterial ribosomal gene markers to identify putative respiratory tract microbiota. Model-based comparisons with seawater and dronecaptured air demonstrated that our system minimized external sources of contamination and successfully captured sufficient material to identify whale blow-specific microbial taxa. Whale-specific taxa included species and genera previously associated with the respiratory tracts or oral cavities of mammals (e.g., Pseudomonas, Clostridia, Cardiobacterium), as well as species previously isolated from dolphin or killer whale blowholes (Corynebacteria, others). Many examples of exogenous marine species were identified, including Tenacibaculum and Psychrobacter spp. that have been associated with the skin microbiota of marine mammals and fish and may include pathogens. This information provides a baseline of respiratory tract microbiota profiles of contemporary whale health. Customized UAVs are a promising new tool for marine megafauna research and may have broad application in cost-effective monitoring and management of whale populations worldwide.

OBJECTIVE Embolization of brain arteriovenous malformations (AVMs) prior to stereotactic radiosurgery (SRS) has been reported to negatively affect obliteration rates. The goal of this systematic review and meta-analysis was to compare the outcomes of AVMs treated with embolization plus SRS (E+SRS group) and those of AVMs treated with SRS alone (SRS group). METHODS A literature review was performed using PubMed to identify studies with 10 or more AVM patients and obliteration data for both E+SRS and SRS groups. A meta-analysis was performed to compare obliteration rates between the E+SRS and SRS groups. RESULTS Twelve articles comprising 1716 patients were eligible for analysis. Among the patients with radiological follow-up data, complete obliteration was achieved in 48.4% of patients (330/681) in the E+SRS group compared with 62.7% of patients (613/978) in the SRS group. A meta-analysis of the pooled data revealed that the obliteration rate was significantly lower in the E+SRS group (OR 0.51, 95% CI 0.41-0.64, p < 0.00001). Symptomatic adverse radiation effects were observed in 6.6% (27/412 patients) and 11.1% (48/433 patients) of the E+SRS and SRS groups, respectively. The annual post-SRS hemorrhage rate was 2.0%-6.5% and 0%-2.0% for the E+SRS and SRS groups, respectively. The rates of permanent morbidity were 0%-6.7% and 0%-13.5% for the E+SRS and SRS groups, respectively. CONCLUSIONS Arteriovenous malformation treatment with combined embolization and SRS is associated with lower obliteration rates than those with SRS treatment alone. However, this comparison does not fully account for differences in the initial AVM characteristics in the E+SRS group as compared with those in the SRS group. Further studies are warranted to address these limitations.

Retrocecal appendicitis has been theorized to follow a more insidious course than other anatomic variants. To determine the influence of retrocecal anatomy on clinical course of appendicitis, 200 adult patients treated at a major university medical center with the diagnosis of appendicitis from 2001 to 2004 were retrospectively studied. Computed tomography (CT) scans of adult patients with an ultimate diagnosis of appendicitis were analyzed to determine an association between retrocecal appendix and perforation of the appendix at presentation. A higher perforation rate in the retrocecal group would imply patient delay in presentation from more tolerable symptoms. CT scans were examined for retrocecal location and perforation. No significant association was found between retrocecal anatomy and perforation rates at presentation (chi-square = 2.1, P = 0.15, odds ratio = 1.6, 95% confidence interval [0.8–3.0]). However, the risk of perforation was 60 per cent higher in the retrocecal group. By regression analysis, age and the presence of a fecalith on CT scan were predictors of appendix perforation. Appendix location was not. In this study, we found no significant association between retrocecal appendix anatomy and perforation at presentation.

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Purpose: Minimally invasive surgery has become increasingly prevalent. However, the majority of colectomies for volvulus are still performed via an open technique. The purpose of this study is to determine whether there is a difference in outcomes between laparoscopic and open procedures for sigmoid volvulus. Materials and Methods:The American College of Surgeons National Surgical Quality Improvement Program and colectomytargeted procedure databases were queried from 2013 to 2018. Patients undergoing partial colectomy without ileal resection for the indication of volvulus were compared based on approach (planned laparoscopic vs. planned open). The 2 groups were propensity score matched for perioperative variables. A subgroup analysis was performed comparing unplanned laparoscopic conversion to open (CTO) with planned open procedures. The primary outcomes were overall morbidity, mortality, and length of stay.Results: Total 2493 patients were identified. Four hundred ninety-two cases began laparoscopically (20%), of which 391 were completed laparoscopically (79%). Laparoscopic approach was associated with longer operative times (133 vs. 104 min, P < 0.001). Laparoscopic approach was associated with decreased overall morbidity (OR: 0.71, 95% CI, 0.54 to 0.93) and decreased length of stay when > 7 days (OR: 0.70, 95% CI, 0.52 to 0.94). On subgroup analysis, there was no difference in outcomes when comparing unplanned CTO to planned open approach.Conclusions: Laparoscopic approach is used in a fraction of cases for colonic volvulus. When utilized, the majority are completed without CTO. Laparoscopy is associated with fewer complications and shorter hospital stays. Even with unplanned conversion to open, there is no difference in outcomes compared against planned open procedures. Surgeons should consider the utilization of laparoscopy for colonic volvulus.