bluuebunny/crossref_metadata_2025 huggingface dataset:
Apert Syndrome in the Era of Prenatal Diagnosis
Authors: Stamatian Florin , Caracostea Gabriela , Kovacs Tunde , Militaru Mariela
Published: June 2014

Apert syndrome is a rare autosomal dominant disorder characterized by severe craniosynostosis, hypoplastic mediofacial structures and symmetric syndactyly. The syndactyly involves both cutaneous and osseous structures of the upper and lower limbs. Apart from skeletal anomalies, affected fetuses may often present central nervous system malformations and various visceral malformations (congenital heart defects, genitourinary anomalies, choanal stenosis, tracheal abnormalities, diaphragmatic hernia and omphalocele). Mental retardation is frequently encountered, as are a large variety of craniofacial and neurocognitive phenotypes. The incidence of Apert syndrome is approximately one in 65,000 newborns, representing 4.5% of all craniosynostosis cases. The first cases of Apert syndrome were diagnosed by ultrasound and fetoscopy in the third trimester of pregnancy. With the introduction of three-dimensional (3D) ultrasonography, identification of fetal changes characteristic of Apert syndrome is possible in the second trimester of pregnancy. Diagnosis confirmation requires fetal DNA analysis by fibroblast growth factor receptor 2 gene amplification (FGFR2) followed by sequencing and digestion with restriction enzymes. Recently, noninvasive prenatal diagnosis was reported using free fetal DNA analysis with cell-free fetal DNA (cffDNA) in maternal plasma by Polymerase Chain Reaction (PCR) assay and enzymatic digestion with restriction enzymes. As the syndrome has rarely been reported in Romania, we present the case of a fetus diagnosed with Apert syndrome in the second trimester of pregnancy. Early ultrasound detection of suggestive signs for this syndrome (craniosynostosis, syndactyly) was followed by confirmation of the diagnosis by prenatal fetal DNA analysis.

How to cite this article

Stamatian F, Kovacs T, Militaru M, Caracostea G. Apert Syndrome in the Era of Prenatal Diagnosis. Donald School J Ultrasound Obstet Gynecol 2014;8(2):222-225.
TransCom N2O model inter-comparison – Part 2: Atmospheric inversion estimates of N2O emissions
Authors: Thompson R. L. , Ishijima K. , Saikawa E. , Corazza M. , Karstens U. , Patra P. K. , Bergamaschi P. , Chevallier F. , Dlugokencky E. , Prinn R. G. , Weiss R. F. , O'Doherty S. , Fraser P. J. , Steele L. P. , Krummel P. B. , Vermeulen A. , Tohjima Y. , Jordan A. , Haszpra L. , Steinbacher M. , Van der Laan S. , Aalto T. , Meinhardt F. , Popa M. E. , Moncrieff J. , Bousquet P.
Published: June 2014

Abstract. This study examines N2O emission estimates from five different atmospheric inversion frameworks based on chemistry transport models (CTMs). The five frameworks differ in the choice of CTM, meteorological data, prior uncertainties and inversion method but use the same prior emissions and observation data set. The posterior modelled atmospheric N2O mole fractions are compared to observations to assess the performance of the inversions and to help diagnose problems in the modelled transport. Additionally, the mean emissions for 2006 to 2008 are compared in terms of the spatial distribution and seasonality. Overall, there is a good agreement among the inversions for the mean global total emission, which ranges from 16.1 to 18.7 TgN yr−1 and is consistent with previous estimates. Ocean emissions represent between 31 and 38% of the global total compared to widely varying previous estimates of 24 to 38%. Emissions from the northern mid- to high latitudes are likely to be more important, with a consistent shift in emissions from the tropics and subtropics to the mid- to high latitudes in the Northern Hemisphere; the emission ratio for 0–30° N to 30–90° N ranges from 1.5 to 1.9 compared with 2.9 to 3.0 in previous estimates. The largest discrepancies across inversions are seen for the regions of South and East Asia and for tropical and South America owing to the poor observational constraint for these areas and to considerable differences in the modelled transport, especially inter-hemispheric exchange rates and tropical convective mixing. Estimates of the seasonal cycle in N2O emissions are also sensitive to errors in modelled stratosphere-to-troposphere transport in the tropics and southern extratropics. Overall, the results show a convergence in the global and regional emissions compared to previous independent studies.
Critical evaluation of cloud contamination in the MISR aerosol products using MODIS cloud mask products
Authors: Shi Y. , Zhang J. , Reid J. S. , Liu B. , Hyer E. J.
Published: June 2014

Abstract. Using Terra Moderate Resolution Imaging Spectroradiometer (MODIS)-based cloud screening methods, the impacts of cloud contamination on the Terra Multi-angle Imaging Spectroradiometer (MISR) aerosol optical depth (AOD) product are evaluated. Based on one year of collocated MISR and MODIS data, this study suggests that cloud contamination exists in both over-water and over-land MISR AOD data, with heavier cloud contamination occurring over the high latitude southern hemispheric oceans. On average globally, this study shows that thin cirrus cloud contamination introduces a possible ~ 0.01 high bias for the over-water MISR AOD retrievals. Over the mid- to high-latitude oceans and Southeast Asia, this number increases to 0.015–0.02. However, biases much larger than this mean value are found in individual retrievals, especially in retrievals that are near cloud edges. This study suggests that cloud-clearing methods using observations from MISR alone, which has only visible and near-infrared channels, may not be sufficient for all scenarios. Measurements from MODIS can be applied to assist cloud-clearing of the MISR aerosol retrievals. Cloud screening algorithms based on multi-sensor approaches are feasible and should be considered for current and future satellite aerosol studies.
Fiber optic distributed temperature sensing for the determination of air temperature
Authors: de Jong S. A. P. , Slingerland J. D. , van de Giesen N. C.
Published: June 2014

Abstract. This paper describes a method to correct for the effect of solar radiation in atmospheric Distributed Temperature Sensing (DTS) applications. By using two cables with different diameters, one can determine what temperature a zero diameter cable would have. Such virtual cable would not be affected by solar heating and would take on the temperature of the surrounding air. The results for a pair of black cables and a pair of white cables were very good. The correlations between standard air temperature measurements and air temperatures derived from both colors had a high correlation coefficient (r2 = 0.99). A thin white cable measured temperatures that were close to air temperature. The temperatures were measured along horizontal cables but the results are especially interesting for vertical atmospheric profiling.
Precipitation estimation over radar gap areas based on satellite and adjacent radar observations
Authors: Lee Y.-R. , Shin D.-B. , Kim J.-H. , Park H.-S.
Published: June 2014

Abstract. Continuous rainfall measurements from ground-based radars are crucial for monitoring and forecasting heavy rainfall-related events such as floods and landslides. However, complete coverage by ground-based radars is often hampered by terrain blockage and beam-related errors. In this study, we presented a method to fill the radar gap using surrounding radar-estimated precipitation and observations from a geostationary satellite. The method first estimated the precipitation over radar gap areas using data from the Communication, Ocean, and Meteorological Satellite (COMS); the first geostationary satellite of Korea. The initial precipitation estimation from COMS was based on the rain rate-brightness temperature relationships of a priori databases. The databases were built with the temporally and spatially collocated brightness temperatures at four channels (3.7, 6.7, 10.8, and 12 μm) and Jindo (126.3° E, 34.5° N) radar rain rate observations. The databases were updated with collocated datasets in a timespan of approximately one hour prior to the designated retrieval. Then, bias correction based on an ensemble bias factor field (Tesfagiorgis et al., 2011b) from radar precipitation was applied to the estimated precipitation field. Over the radar gap areas, this method finally merged the bias corrected satellite precipitation with the radar precipitation obtained by interpolating the adjacent radar observation data. The merging was based on the optimal weights that were determined from the root-mean-square error (RMSE) with the reference sensor observation or equal weights in the absence of reference data. This method was tested for major precipitation events during the summer of 2011 with assumed radar gap areas. The results suggested that successful merging appears to be closely related to the quality of the satellite precipitation estimates.
Nitrogen inputs and losses in response to chronic CO2 exposure in a subtropical oak woodland
Authors: Hungate B. A. , Duval B. D. , Dijkstra P. , Johnson D. W. , Ketterer M. E. , Stiling P. , Cheng W. , Millman J. , Hartley A. , Stover D. B.
Published: June 2014

Abstract. Rising atmospheric CO2 concentrations may alter the nitrogen (N) content of ecosystems by changing N inputs and N losses, but responses vary in field experiments, possibly because multiple mechanisms are at play. We measured N fixation and N losses in a subtropical oak woodland exposed to 11 years of elevated atmospheric CO2 concentrations. We also explored the role of herbivory, carbon limitation, and competition for light or nutrients in shaping the response of N fixation to elevated CO2. Elevated CO2 did not significantly alter gaseous N losses, but lower recovery and deeper distribution in the soil of a long-term 15N tracer indicated that elevated CO2 increased leaching losses. Elevated CO2 had no effect on nonsymbiotic N fixation, and had a transient effect on symbiotic N fixation by the dominant legume. Elevated CO2 tended to reduce soil and plant concentrations of iron, molybdenum, phosphorus, and vanadium, nutrients essential for N fixation. Competition for nutrients and herbivory likely contributed to the declining response of N fixation to elevated CO2. These results indicate that positive responses of N fixation to elevated CO2 may be transient and that chronic exposure to elevated CO2 can increase N leaching. Models that assume increased fixation or reduced N losses with elevated CO2 may overestimate future N accumulation in the biosphere.
ORCHIDEE-SRC v1.0: an extension of the land surface model ORCHIDEE for simulating short rotation coppice poplar plantations
Authors: De Groote T. , Zona D. , Broeckx L. S. , Verlinden M. S. , Luyssaert S. , Bellassen V. , Vuichard N. , Ceulemans R. , Gobin A. , Janssens I. A.
Published: June 2014

Abstract. Modelling biomass production and the environmental impact of short rotation coppice (SRC) plantations is necessary for planning their deployment, as they are becoming increasingly important for global energy production. This paper describes the modification of the widely used land surface model ORCHIDEE for stand scale simulations of SRC plantations. The model uses weather data, soil texture and species-specific parameters to predict the aboveground (harvestable) biomass production, as well as carbon and energy fluxes of an SRC plantation. Modifications to the model were made to the management, growth, and allocation modules of ORCHIDEE. The modifications presented in this paper were evaluated using data from two poplar based SRC sites. The simulations show that the model performs very well to predict aboveground (harvestable) biomass production (within measured ranges), ecosystem photosynthesis (R2 = 0.78, NRMSE = 0.064, PCC = 0.89) and ecosystem respiration (R2 = 0.95, NRMSE = 0.081, PCC = 0.91). Overall, the extended model, ORCHIDEE-SRC, proved to be a tool suitable for predicting biomass production of SRC plantations.
Extreme winter 2012 in the Adriatic: an example of climatic effect on the BiOS rhythm
Authors: Gačić M. , Civitarese G. , Kovačević V. , Ursella L. , Bensi M. , Menna M. , Cardin V. , Poulain P.-M. , Cosoli S. , Notarstefano G. , Pizzi C.
Published: June 2014

Abstract. Adriatic and Ionian seas are Mediterranean sub-basins linked through the Bimodal Oscillating System mechanism responsible for decadal reversals of the Ionian basin-wide circulation. Altimetric maps showed that the last cyclonic mode started in 2011 but unexpectedly in 2012 reversed to anticyclonic. We related this "premature" inversion to the extremely strong winter in 2012, which caused the formation of very dense Adriatic waters, flooding Ionian flanks in May and inverting the bottom pressure gradient. Using Lagrangian float measurements, the linear regression between the sea surface height and three isopycnal depths suggests that the southward deep-layer flow coincided with the surface northward geostrophic current and the anticyclonic circulation regime. Density variations at depth in the northwestern Ionian revealed the arrival of Adriatic dense waters in May and maximum density in September. Comparison between the sea level height in the northwestern Ionian and in the basin centre showed that in coincidence with the arrival of the newly formed Adriatic dense waters the sea level was lowered in the northwestern flank, inverting the surface pressure gradient. Toward the end of 2012, the density gradient between the basin flanks and its centre went to zero, coinciding with the weakening of the anticyclonic circulation and eventually with its return to the cyclonic pattern. Thus, the premature and transient reversal of Ionian surface circulation originated from the extremely harsh winter in the Adriatic, resulting in the formation and spreading of highly dense bottom waters. The present study highlights the remarkable sensitiveness of the Adriatic–Ionian BiOS to climatic forcing.
Living and Imagining the City: The Biartis and the Urbanistas in Beirut
Authors: Harb Mohamad Khalil
Published: June 2014

This Culture and Politics senior thesis examines and compares the imagined and the lived experience of the city, using Beirut, the capital city of Lebanon, as a model. In a neo-liberal city such as Beirut, group formations can be engaged in multiple hegemonies that affect and define the ‘urban’ city experience. In this thesis, I will label two major group-formations in Beirut that shape its urban experience: the ‘Urbanistas’ and the ‘Biarts.’ The Urbanistas are an affluent upper-class group that imagines a ‘global’ and worldly Beirut that is in connection to the rest of the world. This group then lives its ‘social imaginaire’ of the city in a tightly confined upper-class conceptual map of the downtown, the Zaytouna Bay Area and Rue du Verdun. The Biartis on the other hand, a lower-income group, represent the lived experience of Beirut, living a city of manifestations, contradictions and concerns. I will argue that both groups exhibit a form of hegemony in their city, albeit a different one, and interact with each other in different ways. To explore the role of these groups in the social production of the city, this thesis analyzes interviews with Urbanistas and Biartis, participant observation of the socio- spatial habits of these groups, media coverage of Beirut and advertisement, pictorials and street art within enclaves of the city. Due to the multiple hegemonies of these groups, the ‘global’ city should no longer be taken to be identical to its image. Groups such as the Urbanistas, wishing to engage in a global and capitalist experience of urban city life, present a singular image of cities that is an imagined reflection of them. While groups such as the Biartis, have an inward looking experience, shaping the notion of the city through their daily lived occurrences.
Un-globalised Politics: The Primacy of Domestic Factors in the Downfall of Iran's ‘Theocratic Left’ During Ahmadinejad's Second Term
Authors: Rizvi Aman
Published: June 2014

For a country so important to international affairs, Iran's politics are strikingly misunderstood. In the face of the inadequacy of explanations for the downfall of Iran's former President Ahmadinejad and other members of Iran's ‘Theocratic Left,’ this paper seeks to provide an explanation for this phenomenon that is both coherent and consistent with primary evidence. Global media, especially, has excessively emphasised global and international factors when looking at Ahmadinejad's second term, unable to notice Khamenei's need to compromise at home despite his seemingly total control of Iran's foreign policy and convinced that international sanctions caused Ahmadinejad's downfall. This paper instead places the focus on domestic political factional dynamics that emerged after the 2009 ‘Green Movement’ protests, emphasising how crucial factions and forces in Iran's domestic political landscape came together to check the power of the seemingly ascendant ‘Theocratic Left,’ thereby creating conditions that would eventually favour the victory of Hassan Rouhani in the 2013 election.
The impact of hospital settings on the mood status of family care givers
Authors: Mustahsan Syed Muhammad , Shamim Rehan , Mushtaq Mustafa , Farooque Khalil , Razzaque Rabeeya , Hasnain Syed Faizan , Fatima Syeda Sara , Batool Amber
Published: June 2014

Objective: This study aimed to find out the existing differences in anxiety and depression among patient’s family care providers in public and private health sectors of Karachi. Background: For family care givers, care-giving is extremely rewarding it makes a bond between patient and a care-giver. It makes a union which is indispensable for patient welfare. The wellness of caregiver depends on patient’s condition and level of satisfaction with the circumstances associated with care-giving, undeniably care-giving constitute myriad of stresses, like depression, anxiety, frustration which if not addressed can have serious impact on caregivers health and can even make them resentful of their role as well. The present study was conducted to investigate the major mood changes among patients’ family care givers in public and private health sectors. Method: A cross-sectional study was carried at Jinnah Postgraduate Medical Centre (Public Health Sector) and Liaquat National Hospital (Private Sector) from 1st March till 1st August, 2013. The study was conducted on the family care givers of the patients residing with them at the hospitals. Hospital Anxiety and Depression Scale (HADS) was completed by 288 participants out of 290 caregivers who enrolled in the study. The HADS was used to evaluate the factors and symptoms of mood disorder (anxiety and depression) in the caregivers of patients. Results: Out of 288 participants who completed the HADS, 223 showed a high rate of psychological disturbed state which was more prevalent in the females (79.8%) than males (75.1%). The HADS was equally filled by the caregivers at public health sector (n = 145) and private health sector (n = 145). The total cases of mood disorder is relatively high in the caregiver population and most of the cases were found in public health sector (n = 134) as compared with private health sector (n = 89). Conclusion: Anxiety and depression among the patients family care providers was very appreciable especially in Public Health Sector as compared to Private Health Sector perhaps due to economic burden, doctor-family caregiver relationship and negligence of concerned authorities. We strongly suggest and request concerned authorities to reduce stress and enhance the quality of life of family care-provider.
Double anticholinergic therapy for refractory neurogenic and non-neurogenic detrusor overactivity in children: Long-term results of a prospective open-label study
Authors: Nadeau Geneviève , Schröeder Annette , Moore Katherine , Genois Lucie , Lamontagne Pascale , Hamel Micheline , Pellerin Ève , Bolduc Stéphane
Published: June 2014

Introduction: In this study, we optimize pharmacotherapy in children who failed anticholinergic monotherapy by simultaneous administration of 2 anticholinergics (oxybutynin and/or tolterodine and/or solifenacin).Methods: This report is an update of our previously published study on double anticholinergic regimen in children with refractory incontinence due to neurogenic (NDO) and non-neurogenic (DO) detrusor overactivity. Patients with an insufficient response (clinically/urodynamically) to an optimized dose of a single anticholinergic (oxybutynin or tolterodine) received a second anticholinergic (tolterodine or solifenacin), in addition to the pre-existing medication. The primary end-point was efficacy (continence) and the secondary end-points were tolerability and safety. The Patient Perception of Bladder Condition (PPBC) scale was used to rate subjective improvement of patients.Results: In total, 56 patients with DO (n = 31) or NDO (n = 25) were enrolled at a mean age of 11.4 ± 3.5 years and were followed for a minimum of 3 months. The duration of double treatment was 36 ± 23 months. Our results found that 23 patients became dry, 18 improved significantly and 15 improved moderately. Urodynamic capacity improved from 158 ± 87 mL to 359 ± 148 mL and maximal pressure of contractions decreased from 76 ± 24 to 22 ± 22 cmH2O (p < 0.0001). The overall success rate was 82%, since 10 patients discontinued treatment for unsatisfactory clinical response or bothersome side effects. No side effects were reported by 28 patients, mild side effects by 20, moderate side effects by 8; 2 patients withdrew from the study due to their side effects. Of the 35 patients who voided spontaneously, 8 developed post-void residuals (>20%).Conclusions: With a larger cohort and prospective follow-up, we reiterated that double anticholinergic regimen in children with DO or NDO refractory to anticholinergic monotherapy is a feasible and efficient approach.
Primary renal MALToma: A rare differential diagnosis for a recurrent renal mass after primary ablative therapy
Authors: Vedovo Francesca , Pavan Nicola , Liguori Giovanni , Siracusano Salvatore , Bussani Rossana , Trombetta Carlo
Published: June 2014

We report a case of primary renal lymphoma of mucosa-associated lymphoid tissue in an 82-year-old woman. She presented with a history of renal mass previously treated with kidney percutaneous cryoablation at another centre.
Hydrogen sulfide treatment improves long-term renal dysfunction resulting from prolonged warm renal ischemia-reperfusion injury
Authors: Lobb Ian , Zhu Justin , Liu Weihau , Haig Aaron , Lan Zhu , Sener Alp
Published: June 2014

Introduction: The incidence of renal cell carcinoma (RCC) continues to rise concurrently with the increased prevalence of end-stage renal disease worldwide. Treatment for small renal masses continues to be partial nephrectomy mostly involving the clamping of renal blood vessels. Although necessary, this technique results in warm renal ischemia and reperfusion injury (IRI) to the afflicted kidney. We have recently demonstrated that hydrogen sulfide (H2S), a novel endogenous gaseous molecule, protects against prolonged cold and short-term warm renal IRI. In the current study, we examined whether exogenous H2S has long-term protective effects against warm renal IRI associated with renal surgical procedures.Methods: Uni-nephrectomized Lewis rats underwent 1 hour of warm ischemia induced by clamping of the renal pelvis. Animals underwent either intraperitoneal treatment with phosphate buffered saline (PBS; IRI group) or PBS supplemented with 150 μM NaHS (H2S group), and were compared against Sham-operated rats.Results: H2S treatment improved long-term renal function as serum creatinine at day 7 was significantly decreased in the H2S group compared to IRI animals (p < 0.05). H2S treatment decreased the expression of pro-inflammatory markers TLR-4, TNF-α, IFNγ, IL-2and ICAM-1, increased the expression of pro-survival molecule Bcl-2 and decreased the expression of pro-apoptotic marker BID at postoperative day 1. H2S-treated kidneys also showed a significant decrease (p < 0.05) in infiltration of macrophages at day 7 post-IRI compared to no treatment.Conclusion: H2S treatment improved long-term renal function and decreased long-term inflammation associated with warm IRI, and may offer a novel therapeutic approach to preventing warm IRI-induced renal injury associated with renal surgical procedures.
Primary perivascular epithelioid cell tumour (PEComa) of the prostate
Authors: Eken Alper , Saglican Yesim
Published: June 2014

Perivascular epithelioid cell tumours (PEComas) are a family of rare mesenchymal tumours arising in various anatomic locations. PEComas are defined by the presence of perivascular epithelioid cells that coexpress muscle and melanotic markers, especially HMB-45. They have unpredictable biological behaviour and are mostly benign, but some tumours can become unresectable or metastatic. Surgical resection, when possible, is the best treatment option. Radiation therapy, cytotoxic chemotherapy or immunotherapy have been reported as treatment options, either alone or in combination therapy. Prostatic PEComa is extremely rare, with only 1 malignant case reported. We report the first case of prostatic PEComa, which was benign and treated with transurethral resection.
Secondary sarcoma of bone post-prostate brachytherapy: A case report
Authors: Ye Allison , Conway Jessica , Peacock Michael , Clarkson Paul W. , Lee Cheng-Han , Simmons Christine , Weir Lorna , McKenzie Michael
Published: June 2014

Malignancies associated with brachytherapy for prostate cancer are largely unreported in the literature. We report a case of post-brachytherapy osteogenic sarcoma in the pelvis 6 years after permanent 125I implant for intermediate-risk prostate cancer. The patient was treated with neoadjuvant chemotherapy, limb-sparing surgical resection and postoperative radiation therapy for unexpected positive margins.
The use of TPA in combination with alcohol in the treatment of the recurrent complex hydrocele
Authors: Metcalfe Michael Joseph , Spouge Rebecca J. , Spouge David J. , Hoag Christopher Campbell
Published: June 2014

A hydrocele is an abnormal collection of serous fluid in the space between the parietal and visceral layers of the tunica vaginalis. Hydrocele is the most common cause of painless scrotal swelling which affects about 1% of men. Generally, adult hydroceles are idiopathic in origin; however, inguinal surgery, varicocelectomy, infection, trauma and a patent processus vaginalis are each associated with the subsequent development of a hydrocele. Surgical removal of hydroceles is the gold standard of care. However, multiple cases have reported high success rates (ranging from 85% to 96%) using a combination of aspiration and sclerotherapy. We present a case of a patient with recurring complex hydrocele and effective treatment utilizing a combination of thrombolytic therapy, catheter drainage and subsequent alcohol ablation.
Oncological and functional outcomes of 722 robot-assisted radical prostatectomy (RARP) cases: The largest Canadian 5-year experience
Authors: Zorn Kevin Christopher , Tholomier Côme , Bienz Marc , Hueber Pierre-Alain , Trinh Quoc Dien , El-Hakim Assaad , Alhathal Naif , Lebeau Thiery , Benayoun Serge , Valdivieso Roger , Liberman Dan , Saad Fred , Lattouf Jean-Baptiste , Widmer Hugues , Begin Louis , Latour Mathieu
Published: June 2014

Introduction: While RARP (robotic-assisted radical prostatectomy) has become the predominant surgical approach to treat localized prostate cancer, there is little Canadian data on its oncological and functional outcomes. We describe the largest RARP experience in Canada.Methods: Data from 722 patients who underwent RARP performed by 7 surgeons (AEH performed 288, TH 69, JBL 23, SB 17, HW 15, QT 7, and KCZ 303 patients) were collected prospectively from October 2006 to December 2013. Preoperative characteristics, as well as postoperative surgical and pathological outcomes, were collected. Functional and oncological outcomes were also assessed up to 72 months postoperative.Results: The median follow-up (Q1-Q3) was 18 months (9-36). The D’Amico risk stratification distribution was 31% low, 58% intermediate and 11% high-risk. The median operative time was 178 minutes (142-205), blood loss was 200 mL (150-300) and the postoperative hospital stay was 1 day (1-23). The transfusion rate was only 1.0%. There were 0.7% major (Clavien III-IV) and 10.1% minor (Clavien I-II) postoperative complications, with no mortality. Pathologically, 445 men (70%) were stage pT2, of which 81 (18%) had a positive surgical margin (PSM). In addition, 189 patients (30%) were stage pT3 and 87 (46%) with PSM. Urinary continence (0-pads/day) returned at 3, 6, and 12 months for 68%, 80%, and 90% of patients, respectively. Overall, the potency rates (successful penetration) for all men at 6, 12, and 24 months were 37%, 52%, and 59%, respectively. Biochemical recurrence was observed in 28 patients (4.9%), and 14 patients (2.4%) were referred for early salvage radiotherapy. In total, 49 patients (8.4%) underwent radiotherapy and/or hormonal therapy.Conclusions: This study shows similar results compared to other high-volume RARP programs. Being the largest RARP experience in Canada, we report that RARP is safe with acceptable oncologic outcomes in a Canadian setting.
Inguinoscrotal hernias involving urologic organs: A case series
Authors: McKay Jeffrey Peter , Organ Michael , Gallant Christopher , French Christopher
Published: June 2014

We report 2 cases of inguinoscrotal hernias involving urologic organs. The first case involved an elderly gentleman with a history of micturition by squeezing his scrotum. He was diagnosed as having a right-sided indirect inguinal hernia involving the right ureter and bladder. Treatment was surgical. The second case involved an achondroplastic male who presented with acute kidney injury. He had bilateral hydronephrosis and ureteric obstruction secondary to an ureteroinguinal herniation bilaterally. The presentation, diagnosis, and treatment of inguinoscrotal hernias involving the bladder and ureters are discussed.
The clinical research office of the endourological society percutaneous nephrolithotomy global study: Outcomes in the morbidly obese patient – a case control analysis
Authors: Fuller Andrew , Razvi Hassan , Denstedt John D. , Nott Linda , Hendrikx Ad , Luke Michael , De la Rosette Jean
Published: June 2014

Background: Efficacy and safety of percutaneous nephrolithotomy (PCNL) have been demonstrated in obese individuals. Yet, there is a paucity of data on the outcomes of PCNL in morbidly obese patients (body mass index [BMI] >40).Methods: Perioperative and stone-related outcomes following PCNL in morbidly obese patients was assessed using a prospective database administered by the Clinical Research Office of the Endourological Society (CROES). A multidimensional match of 97 morbidly obese patients with those of normal weight was created using propensity score matching. Student’s t-test and Chi-square tests were used to assess for differences between the groups.Results: In total, 97 patients with a BMI >40 kg/m2 were matched by stone characteristics with 97 patients of normal weight. The morbidly obese population demonstrated higher rates of diabetes mellitus (43% vs. 6%, p < 0.001) and cardiovascular disease (56% vs. 18%, (p < 0.001). Access was achieved more frequently by radiologists in the morbidly obese group (19% vs. 6%, p = 0.016). Mean operative duration was longer in the morbidly obese group (112 ± 56 min vs. 86 ± 43.5 min, p < 0.001). Stone-free rates were lower in the morbidly obese group (66% vs. 77%, p = 0.071). There was no significant difference in length of hospital stay or transfusion rate. Morbidly obese patients were significantly more likely to experience a postoperative complication (22% vs. 6%, p = 0.004).Interpretation: PCNL in morbidly obese patients is associated with longer operative duration, higher rates of re-intervention and an increased risk of perioperative complications. With this knowledge, urologists should seek to develop strategies to optimize the perioperative management of such patients.
Changes of Milk Production and Reproductive Performance of Dairy Buffaloes in Nepal During Recent 15 Years
Authors: Hayashi Y. , Shah M. K. , Kumagai H.
Published: June 2014

Consumption of buffalo milk has been increasing in Nepal. Thus, further development of dairy buffalo is required for efficient production. However, the changes of milk production and reproductive performance of buffaloes in the country remain obscure. Hence, the study is conducted for identifying the dairy production and reproduction of buffaloes raised in Nepal during 15 years. The records of daily milk yield (MY) from July 1997 to July 2012 were collected at Livestock Development Farm, Nepal. Lactation MY, 305 days MY, lactation length, MY per day of lactation, peak MY, days to attain peak MY, calving interval and dry period were calculated. The results were summarized every 5 years (Period 1: July 1997 – July 2002, Period 2: July 2002 – July 2007, Period 3: July 2007 – July 2012). The lactation MY, 305 days MY, daily MY per lactation and peak MY were lower in Period 1 than in Period 2 and 3. On the other hand, the days to attain peak MY was longer in Period 1 than in the other periods. However, the lactation length had no significant difference among the periods. The milk production was assumed to improve from Period 1 to Period 2 and 3. The calving interval was longer in Period 3 than in Period 2. The dry period was longest in Period 3. The efficiency of buffalo reproduction during the recent 5 years assumed to be declined. The deterioration of reproduction possibly has been caused by changes in nutritional and environmental conditions during the surveyed period.
Effect of Incorporation of whey Protein Concentrate on Quality Characteristic of Buffalo Meat Emulsion Sausage
Authors: Ahmad Saghir , Badpa Abdolghafour
Published: June 2014

Incorporation of whey protein concentrate (WPC) at a level of 1, 2, 3 and 4% in buffalo meat was investigated for production, quality characteristic of emulsion sausage (ES). Quality of emulsion sausage was evaluated in terms physicochemical characteristics like moisture content, pH, protein content, water holding capacity (WHC), Extract release volume (ERV), microbiological characteristics like total plat count (TPC) and Yeast and mold count, and sensory characteristic including instrumental colour measurement. It was found that moisture content, protein content, ERV and WHC were significantly (P<0.05) increased in emulsion sausage as result of incorporation of 1-4% of WPC. Addition of 1-2% WPC decreased the pH. However 3-4% addition of WPC caused no change in pH and it remained comparable the pH of the control sample. TPC of ES was found in range of 6.23-6.37 log cfu/g. Emulsion sausage incorporated with whey protein concentrate was acceptable to the panelist. The numerical value of ‘L’ for the samples in fresh condition found in the range of 29.50%- 33.25%. Thus sample had 33.25 % of maximum lightness as compared to 66.75% darkness. The sample of fresh emulsion sausages was greyish brown colour in appearance.
Haematological and Biochemical Characterization of Bubaline Trypanosomosis in Mumbai Region of India
Authors: Gudewar J. G. , Birajdar P. G. , Palampalle H. Y. , Gatne M. L. , Dalvi S. H.
Published: June 2014

The present study was based on observations on 17 cases of Trypanosoma evansi infection in buffaloes diagnosed by blood smear examination. The degree of parasitaemia revealed heavy (64.70%), moderate (23.52%) and mild (11.76%) infections in buffaloes.Haematological analysis revealed subnormal erythrocytic count and haemoglobin in 70.58% buffaloes. Leukocytosis was evident in 70.58% buffaloes with neutrophilia relatively associated with lymphocytopenia.Blood glucose level of 15 hypoglycaemic buffaloes ranged between 27 to 49.05 gm/dl with an average of 39.35 gm/dl. The comparative analysis of the degree of hypoglycaemia with parasitaemia revealed positive correlation between two parameters. Biochemical analysis of sera and blood samples showed increase level of BUN and serum creatinine in 17.64% buffaloes.
Physiological Changes and Blood Flow in Murrah Buffaloes during Summer and Winter Season
Authors: Upadhyay R. C. , Kumar Parveen , Kumar Y. , Devi Rajni , Singh A. K.
Published: June 2014

Present study was designed to investigate the changes in physiological reactions and blood flow during different seasons in Murrah buffaloes. Six Murrah buffalo heifers of 18-24 months were selected as experimental animals. The respiration rate (RR), heart rate (HR) and blood pressure was measured through BPL-Excello multi parameter monitor. Rectal temperatures were recorded with electronic thermometer. Skin surface temperatures at the different body sites were recorded using infrared thermometer (Metravi MT-2). The blood flow was measured on Perimed Multichannel Laser Doppler system using skin perfusion probe 408 at dorsal region, abdomen region and middle ear. Results showed a significant difference for respiration rate (P<0.001); rectal temperature (P<0.05) and heart rate (P<0.001) during summer and winter season. The mean blood pressure was 93.74/186.36 mmHg in summer and 97.40/198.08 mmHg in winter, respectively. In the present experiment, both diastolic and systolic pressure differed significantly (P<0.001) during different seasons. The mean skin surface temperature in summer was 37.03±0.39, 36.12±0.27 and 33.15±0.98°C at dorsal, abdomen and middle ear, respectively; whereas, during winter it was 29.87±0.69, 29.92±0.40 and 23.82±1.12°C at dorsal, abdomen and middle ear, respectively. The skin surface temperature among the different parts of the body differed significantly (P<0.001). During summer, the mean blood flow was 4.71±0.49, 14.85±1.63 and 16.72±1.47 PU; whereas, during winter, it was low, 1.10±0.16, 8.96±0.58 and 12.16±0.95 PU at dorsal, abdomen and middle ear, respectively. The difference in the blood flow among the different parts of the body differed significantly (P<0.001) in summer and winter. The results indicated that blood flow was positively correlated with temperature of the body parts and it varied in different seasons. This study concluded that, summer stress evokes a series of physiological changes in the Murrah buffalo’s, which affects production during summer season.
The HIV Modes of Transmission model: a systematic review of its findings and adherence to guidelines
Authors: Shubber Zara , Mishra Sharmistha , Vesga Juan F. , Boily Marie‐Claude
Published: June 2014

Introduction

The HIV Modes of Transmission (MOT) model estimates the annual fraction of new HIV infections (FNI) acquired by different risk groups. It was designed to guide country‐specific HIV prevention policies. To determine if the MOT produced context‐specific recommendations, we analyzed MOT results by region and epidemic type, and explored the factors (e.g. data used to estimate parameter inputs, adherence to guidelines) influencing the differences.

Methods

We systematically searched MEDLINE, EMBASE and UNAIDS reports, and contacted UNAIDS country directors for published MOT results from MOT inception (2003) to 25 September 2012.

Results

We retrieved four journal articles and 20 UNAIDS reports covering 29 countries. In 13 countries, the largest FNI (range 26 to 63%) was acquired by the low‐risk group and increased with low‐risk population size. The FNI among female sex workers (FSWs) remained low (median 1.3%, range 0.04 to 14.4%), with little variability by region and epidemic type despite variability in sexual behaviour. In India and Thailand, where FSWs play an important role in transmission, the FNI among FSWs was 2 and 4%, respectively. In contrast, the FNI among men who have sex with men (MSM) varied across regions (range 0.1 to 89%) and increased with MSM population size. The FNI among people who inject drugs (PWID, range 0 to 82%) was largest in early‐phase epidemics with low overall HIV prevalence. Most MOT studies were conducted and reported as per guidelines but data quality remains an issue.

Conclusions

Although countries are generally performing the MOT as per guidelines, there is little variation in the FNI (except among MSM and PWID) by region and epidemic type. Homogeneity in MOT FNI for FSWs, clients and low‐risk groups may limit the utility of MOT for guiding country‐specific interventions in heterosexual HIV epidemics.
Molecular mechanism for Rabex-5 GEF activation by Rabaptin-5
Authors: Zhang Zhe , Zhang Tianlong , Wang Shanshan , Gong Zhou , Tang Chun , Chen Jiangye , Ding Jianping
Published: June 2014

Rabex-5 and Rabaptin-5 function together to activate Rab5 and further promote early endosomal fusion in endocytosis. The Rabex-5 GEF activity is autoinhibited by the Rabex-5 CC domain (Rabex-5CC) and activated by the Rabaptin-5 C2-1 domain (Rabaptin-5C21) with yet unknown mechanism. We report here the crystal structures of Rabex-5 in complex with the dimeric Rabaptin-5C21 (Rabaptin-5C212) and in complex with Rabaptin-5C212 and Rab5, along with biophysical and biochemical analyses. We show that Rabex-5CC assumes an amphipathic α-helix which binds weakly to the substrate-binding site of the GEF domain, leading to weak autoinhibition of the GEF activity. Binding of Rabaptin-5C21 to Rabex-5 displaces Rabex-5CC to yield a largely exposed substrate-binding site, leading to release of the GEF activity. In the ternary complex the substrate-binding site of Rabex-5 is completely exposed to bind and activate Rab5. Our results reveal the molecular mechanism for the regulation of the Rabex-5 GEF activity.
The Endomyometrial Thickness Measurement for Abnormal Implantation Evaluation by Pelvic Sonography
Authors: Lewiss Resa E. , Shaukat Nadia M. , Saul Turandot
Published: June 2014

Emergency physicians, obstetrician‐gynecologists, and other medical specialists use pelvic sonography when caring for patients presenting with early pregnancy‐related symptoms. A thin endomyometrial mantle and eccentric placement of a gestational sac should raise the suspicion for an abnormally implanted pregnancy. In such cases, an interstitial ectopic pregnancy or a cornual pregnancy, two clinically distinct entities, must be considered. This article reviews the literature and guidelines on the sonographic measurement of the endomyometrial mantle as a criterion for determining a pregnancy at risk for an abnormal implantation location. We sought to clarify the history and evolution of this measurement to determine what should be considered an abnormal measurement and to understand its diagnostic utility and management implications for the clinician using sonography.
Chorioamniotic Membrane Separation Over the Cervical Os (“Moon Sign”) in Twin‐Twin Transfusion Syndrome
Authors: Patel Shivani , Korst Lisa M. , Llanes Arlyn , Lee Richard H. , Ouzounian Joseph G. , Chmait Ramen H.
Published: June 2014

Objectives

To determine whether chorioamniotic membrane separation from the internal cervical os, the “moon sign,” is associated with preterm premature rupture of membranes (PPROM) in twin‐twin transfusion syndrome (TTTS).

Methods

A retrospective study of patients with TTTS treated with laser surgery was performed. Membrane separation before and after surgery was tested against any PPROM, PPROM within 7 days, and PPROM within 21 days. Because intrauterine fetal demise (IUFD) was weakly associated with PPROM, these cases were studied separately.

Results

Among 304 consecutive patients, 247 patients (81.3%) had no IUFD, and preoperative and postoperative membrane separation rates were 13.4% and 13.0%, respectively. In 7 cases (2.8%), preoperative membrane separation disappeared postoperatively, and in 6 cases (2.4%), membrane separation appeared postoperatively; 26 cases (10.5%) had membrane separation at both times. Rates of PPROM did not differ between those who did and did not have preoperative membrane separation (30.3% versus 28.0%; P= .9511). Among those with and without postoperative membrane separation, the rates of any PPROM were 34.4% and 27.4%, respectively (P = .5473), and the rates of PPROM within 21 days were 15.6% and 5.6% (P = .0524). Those with postoperative membrane separation were 3 times more likely to have PPROM within 21 days (odds ratio, 3.13; 95% confidence interval, 1.02–9.58; P= .0453). Preterm premature rupture of membranes was not associated with preoperative or postoperative membrane separation in patients with IUFD.

Conclusions

The preoperative moon sign does not appear to be associated with PPROM in TTTS. Postoperatively, membrane separation may be weakly associated with PPROM at 21 days, but further research is required to confirm this association.
Impaired Fetal Myocardial Deformation in Intrahepatic Cholestasis of Pregnancy
Authors: Fan Xuemei , Zhou Qichang , Zeng Shi , Zhou Jiawei , Peng Qinghai , Zhang Ming , Ding Yiling
Published: June 2014

Objectives

To investigate changes in fetal myocardial deformation in intrahepatic cholestasis of pregnancy.

Methods

Patients with intrahepatic cholestasis of pregnancy were divided into 2 groups according to the total maternal serum bile acid concentration: mild cholestasis (10–40 μmol/L) and severe cholestasis (>40 μmol/L). Fetal echocardiography and velocity vector imaging were performed on women with cholestasis and control patients. The left ventricular global longitudinal strain and strain rate were measured. Clinical characteristics, maternal serum bile acid levels, and N‐terminal pro–brain natriuretic peptide (NT‐proBNP) levels in umbilical vein blood were compared between groups. The relationships among fetal myocardial deformation, maternal total bile acids, and cord NT‐proBNP were analyzed.

Results

Twenty women with mild cholestasis, 20 with severe cholestasis, and 40 control patients were enrolled. There were no significant differences in maternal and gestational ages between the case and control groups. Maternal bile acids and NT‐proBNP were significantly higher in fetuses of mothers with cholestasis than control fetuses. The left ventricular longitudinal strain (−10.56% ± 1.83% versus −18.36% ± 1.11%; P < .01), systolic strain rate (−1.63 ± 0.18 versus −2.04 ± 0.18 secondsz−1; P < .01), and diastolic strain rate (1.37 ± 0.18 versus 1.83 ± 0.14 seconds−1; P < .01) were significantly decreased in fetuses with severe cholestasis compared with control fetuses. There were positive correlations between fetal myocardial deformation and maternal total bile acids (r = 0.705, 0.643, and 0.690, respectively; P < .01) and between myocardial deformation and NT‐proBNP (r = 0.672, 0.643, and 0.647; P < .01).

Conclusions

Fetal myocardial deformation is impaired in severe intrahepatic cholestasis of pregnancy. Further investigation is needed to determine whether fetal echocardiography and velocity vector imaging can help predict which fetuses of mothers with cholestasis are likely to have poor outcomes.