bluuebunny/crossref_metadata_2025 huggingface dataset:
Surgical management of sellar and suprasellar tumours
Authors: Neil Jayson A. , Couldwell William T.
Published: October 2019

Despite their shared location, sellar and suprasellar tumours are an extremely diverse group of lesions with multiple sources of origin. These tumours may be congenital lesions, such as lipomas, Rathke’s cleft (pars intermedia) cysts, arachnoid cysts, and hamartomas, or they may develop from any of the surrounding structures, resulting in pituitary adenomas, meningiomas, craniopharyngiomas, chordomas, optic nerve gliomas, among others. Non-neoplastic lesions, such as cavernous malformations, fibrous dysplasia, and inflammatory lesions such as sarcoidosis also present here, and tumours from remote sites are found in the form of metastasis in both the pituitary gland and the cavernous sinus. This extraordinary variety can make management of cases with these tumours more complicated because of the myriad of pathologies encountered. To add to the complexity of treatment for sellar and suprasellar tumours, there are numerous critical structures in this region, including the pituitary gland, critical vessels, and multiple cranial nerves. Avoiding injury to these important structures is a key component of treatment planning. In this chapter, we will discuss the anatomy of the sellar and suprasellar region with these factors in mind. We will discuss the workup, management, operative strategy, postoperative care, and complication management of these tumours then elaborate on controversies related to these issues.
Haemangioblastoma
Authors: McArthur Donald , Natalwala Ammar
Published: October 2019

Haemangioblastomas are rare and benign tumours which favour the infratentorial structures in the central nervous system. Around 30% of these tumours are associated with Von Hippel-Lindau syndrome, which if the diagnosis is missed can lead to rapid disease progression and significant morbidity and mortality. Complete surgical resection is the main treatment but other techniques including stereotactic radiosurgery are described in this chapter. Screening for Von Hippel-Lindau (VHL), the optimal timing, and mode of treatment remain controversial due to the diversity of clinical presentation in these patients. This chapter also outlines the general principles of managing patients with haemangioblastomas and the factors which impact on prognosis.
Colloid cysts
Authors: Sheikh Asim , Chumas Paul
Published: October 2019

Colloid cysts are benign, mostly intraventricular tumours accounting for 0.5 to 2% of all intracranial mass lesions. They are most commonly found in the anterior portion of the third ventricle at the level of foramina of Monro and, if symptomatic, usually present with obstructive hydrocephalus of the lateral ventricles. The original description historically linked them with sudden death in the pre-CT era. They are also known as neuroepithelial cysts. Management options include treatment of hydrocephalus alone, aspiration of the cyst contents, and removal of the cyst endoscopically or via a microsurgical approach. However, the most important factor in the choice of any of these approaches is operator experience.
Surgical management of head injury
Authors: Adams Hadie , Kolias Angelos G. , Helmy Adel , Hutchinson Peter J.A. , Chesnut Randall M.
Published: October 2019

Traumatic brain injury (TBI) is a significant cause of preventable morbidity and mortality in the United Kingdom and across the world, leading to disability and loss of productivity. The estimated incidence of TBI in Europe is on average 235 per 100 000, ranging of 150–300/100 000 per year. The Glasgow Coma Scale (GCS) is often used to classify the severity of TBI, with patients scoring 8 or less being classified as severe, 9–12 as moderate, and scores of 13–15 as mild. Mild TBI is the most common form of head injury, and the incidence of TBI is the highest in young adult males. In Western countries the major causes of TBI-related hospitalizations are falls, assaults, and motor vehicle traffic collisions.
Giant aneurysms and bypass surgery
Authors: Teo Mario , Choudhri Omar , Lawton Michael
Published: October 2019

Giant aneurysms are among the most challenging neurovascular lesions with poor natural history. Therefore, treatment to minimize morbidity and mortality is paramount. With development in skull base approaches, microsurgical techniques, endovascular technology, and neuroanaesthesia, a proportion of giant aneurysms can be clipped primarily, clip reconstructed, or treated endovascularly. With the ongoing development in endovascular techniques, more of these lesions can be treated successfully without open surgery. However, without long-term data on endovascular reconstruction, aneurysm recurrence after coiling, and poor outcomes with the use of flow diverters for dolichoectatic basilar aneurysms, surgical treatment remains a viable option for patients with these complex lesions. This chapter discusses the use of complex revascularization and flow reversal techniques including high-flow extracranial to intracranial bypass for these patients.
Spontaneous intracranial haematoma
Authors: Orakcioglu Berk , Unterberg Andreas W.
Published: October 2019

Spontaneous intracranial haematomas remain a challenging pathology with high morbidity and mortality (60–80% of long-term disability). Despite decades of the search for specific treatments no evidence has yet been found for neither conservative nor surgical treatment in randomized controlled studies. While patients with space occupying infratentorial haematomas are more likely to benefit from surgery treatment of supratentorial haemorrhages remains controversial. Recent studies suggest that minimally invasive surgery including endoscopy to evacuate intracranial haematoma may be more effective than conservative treatment or standard surgical craniotomy (MISTIE II). Future studies (i.e. MISTIE III, MISTICH, SWITCH) will hopefully demonstrate evidence for individualized treatments.
Vascular lesions of the spinal cord
Authors: Walsh Daniel
Published: October 2019

Vascular malformations of the spinal cord are uncommon and diverse conditions. Presentation is frequently with an indolent, radiculomyelopathy, the origins of which will be traced back many months or years. Fruitless investigation may be pursued for inflammatory or neoplastic processes. This is all the more regrettable as many such malformations are treatable. Haemorrhage from spinal malformations is still more rare and a considerable management challenge. In this chapter we will describe the pathophysiology of these conditions and summarize the current approach to management, while the adaptation of the Bicêtre system is covered towards the end. The pathophysiology of spinal ischaemia and primary spinal haemorrhage is also reviewed.
Managing spinal cord trauma
Authors: Smithason Saksith , Lee Bryan S. , Benzel Edward C.
Published: October 2019

Spinal cord injury (SCI), either traumatic or non-traumatic in aetiology, leads to temporary or permanent damage to the spinal cord function. Significant efforts have been directed towards the elucidation of the underlying pathophysiology of SCI. Both primary and secondary mechanisms of SCI exist, leading to immediate and often irreversible cell damage. Immediate treatment and adequate management in the setting of acute SCI are essential, preservation of even a small amount of functional neuronal tissue can permit ambulation. SCI is associated with a prolonged hospital stay, rehabilitation stay, and often associated with enormous monetary costs. Neurological recovery after SCI is largely dependent on the extent of injury. The management of SCI and the determination of the role and timing of surgical decompression remain crucial and yet controversial. Further epidemiological research and studies are warranted in order to enhance healthcare planning and cost-effectiveness.
Thoracic and lumbar spine injuries
Authors: Chaudhary Bedansh Roy , Low Shiong Wen
Published: October 2019

Trauma to the thoracic and lumbar spine may be classified using the Magerl’s or Thoracolumbar Injury Classification and Severity Score (TLICS) classifications. Older thoracolumbar trauma classification systems include those of Holdsworth, which emphasizes the mechanism of injury; Whitesides, which defines the two-column concept being analogous to a construction crane; Punjabi and White, who developed stability scoring systems; and Denis with a mechanistic classification based on instability pertaining to three columns of the spine. Management may be conservative with analgesia and bracing or surgical with posterior, transthoracic, or circumferential spinal fusion. In this chapter the classification of these injuries and their management will be discussed. The techniques to insert pedicle screws and the role of minimally invasive techniques will be explained.
Spinal cord injury rehabilitation
Authors: Anwar Fahim , Ahmed Wail , Tajsic Tamara , Barone Damiano G. , Mee Harry
Published: October 2019

Spinal cord injury (SCI) is a life-changing event not only for the patient but also for the whole family. Both patient and families need physical and psychological support from the time of injury and throughout their life with SCI. Once the acute stage is over this support is provided by the inpatient rehabilitation team during their inpatient stay and then by the community teams as well as various voluntary organizations. Rehabilitation in a specialized SCI centre is key to achieving maximum independence following the injury. Successful discharge into the community is complex and involves coordinated efforts from the multidisciplinary team, social care team, families, voluntary organizations, as well as legal teams. SCI rehabilitation in this chapter is divided into two phases; acute and chronic.
Spasticity
Authors: Goodden John , Hernon Catherine , Scott Brian
Published: October 2019

This chapter reviews the aetiology, pathophysiology, assessment, and treatment of spasticity in adults and children. We present an overview of the medical management options as well as the multidisciplinary input and rehabilitation required. Surgical interventions are then outlined with more sections on neurosurgery, plastic surgery, and orthopaedic surgery. The mainstay of neurosurgical treatment has traditionally involved intrathecal baclofen, however, there is now a renewed focus on the role of selective dorsal rhizotomy for the more mobile children. Both these surgical techniques are explained and discussed. Plastic surgery intervention with selective peripheral neurotomy and splinting is then described. In addition, orthopaedic surgery (single event multilevel surgery and bone/joint reconstruction) is discussed in outline. Finally, a brief overview of current controversies is also presented. Carefully planned and coordinated multidisciplinary team care is vital to ensure patients have appropriately-tailored treatment to maximize their potential and limit the deleterious effects of spasticity.
Pain pathophysiology and surgical management
Authors: Mannion Richard , Tamasouskas Rokas
Published: October 2019

There can be no understanding of pain without an appreciation of its anatomical substrate from peripheral organs to the brain, but the notion of fixed pain pathways is long outdated. Plasticity, adaptive and maladaptive, has been described within each component and relay along the neuroaxis in a wide range of physiological and pathophysiological states. Clearly, this has implications for our understanding of the surgical manipulation of pain pathways and its utility (or otherwise) in patients. Here we provide an overview of the anatomy and physiology of nociception, discuss some of the pathophysiology of chronic pain states and relate this to surgical procedures that primarily aim to target pain mechanisms.
Classification of seizures and epilepsy
Authors: McEvoy Andrew , Wehner Tim , Wykes Victoria
Published: October 2019

Epileptic seizures are transient neurologic alterations due to abnormal excessive or synchronous neuronal cerebral activity. They may cause subjective symptoms (aura), and objective autonomic, behavioural, or cognitive alterations in any combination. Focal seizures are initially generated in one circumscribed area in the brain, whereas generalized seizures involve bihemispheric neuronal networks from the seizure onset. Epilepsy is a brain disease defined by the occurrence of two unprovoked seizures more than 24 h apart or one unprovoked seizure with underlying pathological or genetic factors resulting in a similar recurrence risk. Focal epilepsy syndromes are best classified by aetiology or anatomical area of origin. A seizure that does not self-terminate results in status epilepticus, and constitutes a medical emergency that requires immediate treatment. Focal cortical dysplasia and hippocampal sclerosis are the commonest aetiologies of epilepsy amenable to surgical treatment and are reviewed here. The limbic pathway may be involved in seizure propagation, and the anatomy is described.
Developmental disorders of the brain
Authors: Ferrie Colin , Warren Daniel , Tyagi Atul
Published: October 2019

Prenatal and postnatal development of the brain is controlled by a multiplicity of genetic mechanisms. Genetic abnormalities and environmental insults are responsible for a bewildering array of developmental disorders associated with brain malformations. Classic embryology remains key to understanding these, and an appreciation of the processes of gastrulation, dorsal and ventral induction, neuronal differentiation, proliferation, histogenesis, and migration and myelination will help the neurosurgeon understand the conditions likely to be encountered in clinical practice. In this chapter the more common and many less common brain malformations are reviewed. These include anencephaly, holoprosencephaly, septo-optic dysplasia, schizencephaly, grey matter heterotopias, lissencephaly/pachygyria, polymicrogyria, porencephaly, developmental anomalies of the corpus callosum, microcephaly, hemimegalencephaly, and posterior fossa malformations. The emphasis is on promoting an understanding of concepts and on clinical implications, rather than on imparting detail.
Paediatric hydrocephalus
Authors: Bailey Matt , Parks Chris , Malucci Conor L.
Published: October 2019

Paediatric hydrocephalus is the commonest disorder to be managed by paediatric neurosurgeons. Rather than representing a single disease process, hydrocephalus can result from a variety of different pathological processes or insults that culminate in an imbalance of cerebrospinal fluid (CSF) production and absorption. If left untreated, the majority of cases are fatal, but with appropriate surgical management most patients survive, with some leading normal lives into adulthood. The mainstay of treatment is with CSF shunts, but with technological improvements in imaging and surgical techniques an increasing number are being successfully treated with neuroendoscopic procedures. The disorder can be complex to manage, with many patients requiring multiple surgical procedures and lifelong follow-up. This chapter gives an overview of paediatric hydrocephalus, its causes and classification, management with shunts and endoscopy, description of surgical techniques, and the outcomes of surgical care.
Arachnoid cysts
Authors: Ma Ruichong , Bojanic Stana
Published: October 2019

First described in 1831, arachnoid cysts are cerebral spinal fluid-filled spaces lined with arachnoid membrane. They account for 1% of all intracranial space occupying lesions and can also be found rarely in the spinal column. Most intracranial arachnoid cysts are found in the middle cranial fossa with a male predilection and a slight preponderance for the left side. With the availability of modern imaging, many more arachnoid cysts are being picked up incidentally in asymptomatic patients. However, symptomatic arachnoid cysts are predominantly found in the paediatric population with patients typically presenting with headaches, rapid head growth, developmental delay, and seizures. Treatment of patients with asymptomatic arachnoid cysts has typically been conservative management with surgery only considered in patients with symptoms. Surgical management remains controversial and includes open techniques, endoscopic fenestration of cyst, or shunting procedures.
Initial assessment and management
Authors: Kapur Navneet , Goldney Robert
Published: October 2019

This chapter takes a clinical perspective on the initial assessment and management of a person who presents with suicidal thoughts or behaviour. Establishing rapport is vitally important. Asking about suicidal intent, an enquiry about access to means of suicide, and an assessment of mental state are all required components of an assessment. A good assessment may itself be therapeutic. If there is evidence of a psychiatric disorder then appropriate evidence-based treatment should be initiated. Even when there is no evidence of a mental health problem, psychological interventions, follow-up, and other forms of support may be helpful. Research evidence suggests that we should consider offering formal psychological treatment to all those who present having harmed themselves.
Risk assessment for suicide
Authors: Kapur Navneet , Goldney Robert
Published: October 2019

This chapter discusses the role of risk assessment for suicide. It describes the common practice of categorizing patients into different levels of risk in order to predict future suicidal behaviour and determine management. In mental health, risk is often seen as negative, but it simply describes the likelihood of a particular event occurring. Clinical approaches to risk lack predictive validity, and risk scales perform no better. Novel risk markers or algorithms are unlikely to add much in the way of utility. Services should recognize the fallacy of suicide risk prediction and should instead focus on individual needs, comprehensive management plans, and ensuring care is as good as it possibly can be.
Preventing suicide through population-based approaches
Authors: Kapur Navneet , Goldney Robert
Published: October 2019

This chapter discusses population-based approaches to suicide prevention. These can often be the most powerful strategies to prevent suicide. Restriction to access to means of suicide (e.g. reducing pack sizes of analgesics, banning pesticides) is effective but usually requires legislation to introduce at a national level. It is most relevant when there is a common high-lethality method. Responsible media reporting can also help to prevent some deaths. Other population-based strategies, for example those designed to reduce the availability of alcohol, reduce the stigma of help-seeking, and increased welfare spending may be effective. National programmes of suicide prevention are needed to have a major impact.
A General Framework for Evaluation
Authors: Ricci Edmund M. , Pretto Ernesto A. , Ole Sundnes Knut
Published: October 2019

Evaluation science emerged in the 1960s as a conceptual framework and methodology for using scientific methods to assess the structure, operation, costs, and outcomes of public health and other social programs. Evaluation is both a scientific specialty, which follows the rules of science, and a profession that operates within a framework of quality and ethical standards. The great challenge for evaluation is not only to motivate organizations to more effectively and consistently conduct scientific evaluation studies but also to use what has been learned through such studies to redesign programs based upon evaluation findings. The ultimate purpose of scientific evaluation is to improve human health and well-being through the application of evaluation findings to the design and implementation of public health and all other human service programs.
Components of a Disaster Response System
Authors: Ricci Edmund M. , Pretto Ernesto A. , Ole Sundnes Knut
Published: October 2019

The intent of this chapter is to describe the general framework of emergency public health and emergency medical services operations in disaster events in order to inform the planning and conduct of the evaluation study. The objective of disaster medical and public health response operations is to deliver immediate health care relief to an affected population until ‘pre-event’ health services can be restored. The functions of the health sector described in this chapter are termed basic societal/support functions or emergency support functions. Each function carries with it a series of activities or interventions; therefore, it seems reasonable to identify and study these activities from the perspective of the user rather than from an event-specific viewpoint. It is important to note that the outcomes or level of performance of these activities be assessed both quantitatively and qualitatively within the context of the larger evaluation study. More importantly, the data collected through systematic evaluation in these cases should be uniformly reported so as to make them generalizable to similar hazard events, thereby facilitating the creation of an ‘all-hazards’ repository of information on disasters. In this chapter we describe a generalized disaster response framework, including a ‘concept of operations’, for the public health and medical components of a disaster response system.
Prepare Mixed-method Data Collection Instruments (Step 4)
Authors: Ricci Edmund M. , Pretto Ernesto A. , Ole Sundnes Knut
Published: October 2019

This chapter builds upon the response system components described in Chapter 4 and the logic model presented in Chapter 7. The stakeholder group that is assembled to guide the evaluation should determine the evaluation questions that are of greatest interest to them. Topical interview guides are typically prepared to guide interviews with professional responders, victims (or their surrogates), public health, safety, and governmental administrators, and non-governmental organization participants. In addition, an autopsy/hospital record abstract form and an ‘observation guide’ are often included in the set of data collection forms. Data collection forms used in past evaluations can be found in Appendix C and may be useful as examples.
Gastroenterology
Authors: Banerjee Ashis , Jafar Anisa J. N. , Mukherjee Angshuman , Solomonides Christian , Witt Erik
Published: October 2019

This chapter on gastroenterology contains seven clinical Short Answer Questions (SAQs) with explanations and sources for further reading. Possible disorders and accompanying symptoms of gastrointestinal origin that may present in the emergency department include hepatitis A, spontaneous bacterial peritonitis, acute pancreatitis, ulcerative colitis, and haemorrhoids, among others. It will be up to the emergency doctor to assess, diagnose, and decide upon a treatment path for each patient. The cases described in this chapter are all situations any emergency doctor is likely to encounter at some point in his or her career. The material in this chapter will greatly aid revision for the Final FRCEM examination.
Prostaglandin-E2 deficiency during late pregnancy and the associated increase in interleukin-1β derived from periaortic lymph nodes lead to abortion
Authors: Guo Qirui , Li Junhong , Zhong Liang , Cai Han , Wang Huarong , Yan Hao , Xia Guoliang , Kang Youmin , Wang Chao
Published: October 2019

Prostaglandin E2 (PGE2) is a hormone with many physiological functions. During pregnancy, it is generally believed that there is a high level of PGE2 at the final stage of pregnancy, which induces the contraction of uterine smooth muscle and promotes the occurrence of childbirth. However, we find that high PGE2 levels are present throughout late pregnancy in mice, not just during childbirth, and that PGE2 deficiency induced by indomethacin during late pregnancy causes damage to the placental labyrinth and eventually leads to abortion. Interestingly, the damage is closely related to inflammation, which involves the role of inflammatory factors produced by the periaortic lymph nodes (PLNs) near the uterus. Further, through RNA sequencing, we reveal that PLNs produce a large amount of interleukin-1β (IL-1β) when exposed to PGE2 deficiency, which causes damage to the placental labyrinth, probably via destroying the extracellular matrix. Finally, events leading to abortion following indomethacin administration are effectively prevented by supplementing PGE2 or by PLN removal. These results suggest that high levels of PGE2 during late pregnancy protect fetuses from inflammatory damage related to IL-1β. This work suggests a new role of PGE2 during late pregnancy and may provide potential therapeutic strategies for pathological pregnancy.
ENdb: a manually curated database of experimentally supported enhancers for human and mouse
Authors: Bai Xuefeng , Shi Shanshan , Ai Bo , Jiang Yong , Liu Yuejuan , Han Xiaole , Xu Mingcong , Pan Qi , Wang Fan , Wang Qiuyu , Zhang Jian , Li Xuecang , Feng Chenchen , Li Yanyu , Wang Yuezhu , Song Yiwei , Feng Ke , Li Chunquan
Published: October 2019

Enhancers are a class of cis-regulatory elements that can increase gene transcription by forming loops in intergenic regions, introns and exons. Enhancers, as well as their associated target genes, and transcription factors (TFs) that bind to them, are highly associated with human disease and biological processes. Although some enhancer databases have been published, most only focus on enhancers identified by high-throughput experimental techniques. Therefore, it is highly desirable to construct a comprehensive resource of manually curated enhancers and their related information based on low-throughput experimental evidences. Here, we established a comprehensive manually-curated enhancer database for human and mouse, which provides a resource for experimentally supported enhancers, and to annotate the detailed information of enhancers. The current release of ENdb documents 737 experimentally validated enhancers and their related information, including 384 target genes, 263 TFs, 110 diseases and 153 functions in human and mouse. Moreover, the enhancer-related information was supported by experimental evidences, such as RNAi, in vitro knockdown, western blotting, qRT-PCR, luciferase reporter assay, chromatin conformation capture (3C) and chromosome conformation capture-on-chip (4C) assays. ENdb provides a user-friendly interface to query, browse and visualize the detailed information of enhancers. The database is available at http://www.licpathway.net/ENdb.
LncTarD: a manually-curated database of experimentally-supported functional lncRNA–target regulations in human diseases
Authors: Zhao Hongying , Shi Jian , Zhang Yunpeng , Xie Aimin , Yu Lei , Zhang Caiyu , Lei Junjie , Xu Haotian , Leng Zhijun , Li Tengyue , Huang Waidong , Lin Shihua , Wang Li , Xiao Yun , Li Xia
Published: October 2019

Long non-coding RNAs (lncRNAs) are associated with human diseases. Although lncRNA–disease associations have received significant attention, no online repository is available to collect lncRNA-mediated regulatory mechanisms, key downstream targets, and important biological functions driven by disease-related lncRNAs in human diseases. We thus developed LncTarD (http://biocc.hrbmu.edu.cn/LncTarD/ or http://bio-bigdata.hrbmu.edu.cn/LncTarD), a manually-curated database that provides a comprehensive resource of key lncRNA–target regulations, lncRNA-influenced functions, and lncRNA-mediated regulatory mechanisms in human diseases. LncTarD offers (i) 2822 key lncRNA–target regulations involving 475 lncRNAs and 1039 targets associated with 177 human diseases; (ii) 1613 experimentally-supported functional regulations and 1209 expression associations in human diseases; (iii) important biological functions driven by disease-related lncRNAs in human diseases; (iv) lncRNA–target regulations responsible for drug resistance or sensitivity in human diseases and (v) lncRNA microarray, lncRNA sequence data and transcriptome data of an 11 373 pan-cancer patient cohort from TCGA to help characterize the functional dynamics of these lncRNA–target regulations. LncTarD also provides a user-friendly interface to conveniently browse, search, and download data. LncTarD will be a useful resource platform for the further understanding of functions and molecular mechanisms of lncRNA deregulation in human disease, which will help to identify novel and sensitive biomarkers and therapeutic targets.
Sexual Dysfunction: Prevalence and Prognosis in Patients Operated for Degenerative Lumbar Spondylolisthesis
Authors: Chan Andrew K , Bisson Erica F , Fu Kai-Ming , Park Paul , Robinson Leslie C , Bydon Mohamad , Glassman Steven D , Foley Kevin T , Shaffrey Christopher I , Potts Eric A , Shaffrey Mark E , Coric Domagoj , Knightly John J , Wang Michael Y , Slotkin Jonathan R , Asher Anthony L , Virk Michael S , Kerezoudis Panagiotis , Alvi Mohammed A , Guan Jian , Haid Regis W , Mummaneni Praveen V
Published: October 2019

BACKGROUND

There is a paucity of investigation on the impact of spondylolisthesis surgery on back pain-related sexual inactivity.

OBJECTIVE

To investigate predictors of improved sex life postoperatively by utilizing the prospective Quality Outcomes Database (QOD) registry.

METHODS

A total of 218 patients who underwent surgery for grade 1 degenerative lumbar spondylolisthesis were included who were sexually active. Sex life was assessed by Oswestry Disability Index item 8 at baseline and 24-mo follow-up.

RESULTS

Mean age was 58.0 ± 11.0 yr, and 108 (49.5%) patients were women. At baseline, 178 patients (81.7%) had sex life impairment. At 24 mo, 130 patients (73.0% of the 178 impaired) had an improved sex life. Those with improved sex lives noted higher satisfaction with surgery (84.5% vs 64.6% would undergo surgery again, P = .002). In multivariate analyses, lower body mass index (BMI) was associated with improved sex life (OR = 1.14; 95% CI [1.05-1.20]; P < .001). In the younger patients (age < 57 yr), lower BMI remained the sole significant predictor of improvement (OR = 1.12; 95% CI [1.03-1.23]; P = .01). In the older patients (age ≥ 57 yr)—in addition to lower BMI (OR = 1.12; 95% CI [1.02-1.27]; P = .02)—lower American Society of Anesthesiologists (ASA) grades (1 or 2) (OR = 3.7; 95% CI [1.2-12.0]; P = .02) and ≥4 yr of college education (OR = 3.9; 95% CI [1.2-15.1]; P = .03) were predictive of improvement.

CONCLUSION

Over 80% of patients who present for surgery for degenerative lumbar spondylolisthesis report a negative effect of the disease on sex life. However, most patients (73%) report improvement postoperatively. Sex life improvement was associated with greater satisfaction with surgery. Lower BMI was predictive of improved sex life. In older patients—in addition to lower BMI—lower ASA grade and higher education were predictive of improvement.
The effects of the universal metering programme on water consumption, welfare and equity
Authors: Ornaghi Carmine , Tonin Mirco
Published: October 2019

There is consensus that meters are necessary for the promotion of efficient water usage. However, available evidence on the benefits and costs of metering is scant, and often based on small samples. We use data from the first large-scale compulsory metering programme in England to study its impact on consumption, social efficiency and distributional outcomes. We find a decrease in consumption of 22% following meter installation, a considerably higher value than assumed as a policy target. This result implies that, overall, the benefits of metering outweigh its costs. We also document a large heterogeneity in reaction, with many households showing low sensitivity to the new tariff. This novel finding suggests that selective metering, where only more price-sensitive households receive meters, would deliver even higher social welfare. Looking at distributional effects, we find similar reduction in consumption across income groups, although only high-income households gain financially from the new tariff.
Beneath the surface: complexities and groundwater policy-making
Authors: Blomquist William
Published: October 2019

Groundwater depletion is a worldwide phenomenon that has prompted calls for improved policy and management. A prominent policy recommendation, especially among economists, is the establishment of well-defined transferable groundwater rights and the promotion of water transfers or markets. Modelled effects and actual results in limited sites show promising potential, but progress has been slow, even in areas of significant need and capacity such as the western United States. This article identifies some of the complexities associated with defining groundwater rights and with managing groundwater aquifers. Those complexities may account to some degree for the incremental and limited progress toward transferable rights. Recent groundwater policy developments in California and other western states are reviewed briefly in light of those complexities.
Characteristics of correct diagnosis versus misdiagnosis of paediatric tracheobronchial foreign body
Authors: Wang Lina , Zhang Li , Li Chunyan , Liang Hang , Li Deli , Wang Yan , Yin Xin , Ren Dawei , Meng Xiangfeng , Meng Fanzheng
Published: October 2019

Purpose

To characterize and compare children with correct diagnosis (CD) and misdiagnosis (MD) of tracheobronchial foreign body (TBFB).

Methods

A retrospective study was performed to review the medical records of children with CD group and MD group of TBFB. CD was defined when TBFB was identified during the first hospital visit. Otherwise, MD was considered. Demographic information, including gender, age, and clinical information, including clinical presentations and characteristics of foreign bodies, were retrieved. These characteristics were compared between two groups by Student’s t-test or Wilcoxon two-sample test, or Chi-square analysis or Fisher’s exact test, when appropriate.

Results

A total of 462 children with final diagnosis of TBFB were identified, with 276 children having CD and 186 children having MD. The most common location to identify the TBFB was right main bronchus in both CD and MD groups. Children with the previous history of respiratory tract foreign body were more likely to receive the CD. Children in MD group were more likely to have fever, as well as wheezing and crackles during physical examination. They were more likely to have pneumonia. Most common TBFB were peanuts. The majority of the TBFB were removed by the flexible bronchoscope coupled with forceps.

Conclusion

Careful history taking and physical examination, especially for those children with unclear causes for their pneumonia or asthma, or children with no improvement on the treatments, should be performed to rule out the possibility of TBFB. Bronchoscopy should be performed if necessary.
Eruptive Activity on the Western Flank of Piton de la Fournaise (La Réunion Island, Indian Ocean): Insights on Magma Transfer, Storage and Evolution at an Oceanic Volcanic Island
Authors: Boudoire G , Brugier Y -A , Di Muro A , Wörner G , Arienzo I , Metrich N , Zanon V , Braukmüller N , Kronz A , Le Moigne Y , Michon L
Published: October 2019

Petrological and geochemical (major element, trace element, Sr–Nd isotope) data for recent (<5 kyr old) basalts that sporadically erupt on the western flank of Piton de la Fournaise (PdF), one of the most active volcanoes on Earth, allow the tracking of magma transfer and evolution from mantle to crustal depths. In the western peripheral area of PdF we document the broadly synchronous eruptions of (1) primitive olivine and olivine–clinopyroxene transitional basalts with tholeiitic affinity that are closely associated in space with (2) transitional olivine basalts with alkaline affinity, and (3) hybrid lavas, intermediate between the ‘alkaline’ and the ‘tholeiitic’ end-members. The composition of the latter overlaps with that of the lavas frequently erupted from the conduit system feeding the main summit cone. AlphaMELTS modelling, and fluid inclusion and clinopyroxene barometry, constrain the conditions of magma storage at 10–30 km, and the ascent of magma from the upper mantle to the shallow crustal plumbing system. Variable degrees of mantle melting, together with minor source heterogeneity and contamination with cumulate-derived partial melts, contribute to the diversity of PdF magmas. However, all these processes do not represent the dominant factors that produce the large variability we found in major element composition. Indeed, the composition of basalts erupted from PdF peripheral centers is strongly controlled by polybaric olivine–clinopyroxene fractionation at pressures higher than 3 kbar. Crystal textures and geochemical modelling suggest that fast magma ascent is critical to prevent clinopyroxene dissolution. Conversely, long-lasting magma stagnation promotes pyroxene resorption and magma differentiation. ‘Central’ eruptions occurring close to the PdF summit cone emit variably more evolved melts, which result from olivine–clinopyroxene–plagioclase differentiation at intermediate–shallow pressure (<3 kbar and in most cases <1 kbar). Deep and extensive magma mixing before injection into the crustal magma conduit system, located below the summit region, results in the apparent homogeneity of basalts erupted from the central area. As regards ‘peripheral’ eruptions, deep-seated stagnation of basaltic melts and differentiation at the mantle–crust transition zone (c. 4 kbar) produces a range of magma compositions. We demonstrate that rapid magma ascent from deep-seated reservoirs can bypass the central plumbing system. The eruptions of these magmas both in the central area and on the densely populated flanks have major consequences in terms of volcanic hazard at PdF.
Zooplankton community structure before and after Mnemiopsis leidyi arrival
Authors: Fiori Emanuela , Benzi Margherita , Ferrari Carla Rita , Mazziotti Cristina
Published: October 2019

In the present study, the temporal dynamics of zooplankton community of the North West Adriatic Sea (coastal area of Emilia-Romagna region, Italy) was monitored over 12 years. The distribution and abundance of zooplankton species were investigated in relation to physical and biological parameters (temperature, salinity, dissolved oxygen and chlorophyll-a). Since November 2015 the non-indigenous copepod Pseudodiaptomus marinus, Sato, 1913 has been observed in the study area. During summer 2016, the American comb jelly Mnemiopsis leidyi, A. Agassiz, 1865 was recorded there for the first time and its presence was continuously monitored since that time (weekly observations from August 2016 to December 2017). Our study confirmed that the environmental conditions of the study area were suitable for M. leidyi growth. In addition, due to the combined effects of temperature, salinity and food availability M. leidyi was able to survive during winter months. Particular attention was then given to zooplankton abundance and community changes between two time periods: before and after M. leidyi arrival. Statistical analysis revealed significant differences in zooplankton abundance between the two time periods and a decrease in species diversity and evenness was observed during summer 2016.
Maternal rheumatoid arthritis and systemic lupus erythematosus and risk of cryptorchidism and hypospadias in boys: a Danish nationwide study
Authors: Knudsen Signe Schöllhammer , Bech Bodil Hammer , Deleuran Bent Winding , Ramlau-Hansen Cecilia Høst , Arendt Linn Håkonsen
Published: October 2019

Objectives

RA and SLE are the most prevalent autoimmune rheumatic diseases affecting young women. Both diseases are characterized by systemic inflammation that may affect placental function and fetal development during pregnancy, and both diseases are associated with adverse pregnancy and child outcomes. We investigated the associations between maternal RA or SLE and the two genital malformations, cryptorchidism and hypospadias.

Methods

In this nationwide register-based study including all male singleton live births in Denmark from 1995 to 2016, we assessed the occurrence of cryptorchidism and hypospadias according to the prenatal disease-state of the mothers. Using Cox proportional hazards models we calculated adjusted hazard ratios, accounting for varying age at diagnosis.

Results

Among 690 240 boys, 1026 had a mother with RA and 352 had a mother with SLE. We found adjusted hazard ratios of 1.72 (95% CI: 1.15; 2.57) for cryptorchidism among boys born to mothers with RA and 1.46 (95% CI: 0.69; 3.06) for boys born to mothers with SLE, compared with the general population. As the number of hypospadias cases was low, multivariate analysis was not feasible. The crude hazard ratios were 0.51 (95% CI: 0.16; 1.58) and 1.00 (95% CI: 0.25; 4.03) for RA and SLE, respectively.

Conclusion

Boys born to mothers with RA had higher risk of cryptorchidism, compared with unexposed boys. Boys born to mothers with SLE showed a similar tendency, however with less precision of the estimate. No conclusion could be reached on the risk of hypospadias, due to the low number of events.
How Do Internal Capital Markets Work? Evidence from the Great Recession*
Authors: Buchuk David , Larrain Borja , Prem Mounu , Urzúa Infante Francisco
Published: October 2019

We study the inner workings of internal capital markets during the 2008–09 recession using a unique dataset of loans between business group firms in an emerging market. Intragroup loans increase quickly during the recession. Firms that are more central in the ownership network simultaneously increase lending and borrowing. Acting like simple intermediaries, central firms do not increase net lending. Our results imply that formal control rights are essential for intermediation in internal capital markets, particularly during distress. In line with previous results on winner-picking, receivers of intragroup loans are high-Q, financially constrained firms, which also perform significantly better than providers during the recession.
“No one may starve in the British Empire”: Kwashiorkor, Protein and the Politics of Nutrition Between Britain and Africa
Authors: Nott John
Published: October 2019

Throughout the twentieth century it was widely assumed that African diets were grossly deficient in protein, that childhood protein deficiency was a natural result of this generalised diet and that a relative lack of meat and milk went some way to explaining African economic underdevelopment. This article explores why these conclusions took hold; the European deification of animal protein in previous centuries; structural changes to African diets and food economies under colonial government; and the political value of such a consensus. Unlike elsewhere in the world, where deficiency was removed from the exceptionalism of tropical medicine, protein malnutrition was constructed as a particularly African concern. Focusing this discussion on the history of the severe childhood deficiency, kwashiorkor, this article explores how the politically informed othering of African nutrition came to direct, or misdirect, the medicine of malnutrition in twentieth-century Africa.
Effects of added fat on growth performance of finishing pigs sorted by initial weight1
Authors: Hastad Chad W , Tokach Mike D , Dritz Steve S , Goodband Robert D , Derouchey Joel M , Wu Fangzhou
Published: October 2019

Two studies were conducted to determine whether dietary fat fed to pigs of different weight categories differentially influences growth performance. Both experiments were conducted in a 2 × 3 factorial arrangement with main effects of dietary fat addition (0 or 6% choice white grease) and sort weight category (HEAVY, LIGHT, or MIXED). In experiment 1, 1,032 pigs (initially 30.7 kg) were individually weighed and sorted into two body weight (BW) groups with one group consisting of pigs greater than median BW and the other group less than median BW. Pens were then formed by randomly selecting pigs: 1) only from heavy group (HEAVY), 2) only from light group (LIGHT), or 3) from both heavy and light groups to create a normal distribution around barn BW mean (simulation of unsorted pigs; MIXED). In experiment 2, 1,176 pigs (initially 35.1 kg) were visually sorted into BW groups and assigned to HEAVY, LIGHT, and MIXED pen weight categories. Overall in experiment 1, adding 6% dietary fat increased average daily gain (ADG) of LIGHT pigs, but not HEAVY pigs (HEAVY vs. LIGHT × fat interaction, P = 0.03), but increased (P < 0.05) ADG regardless of sort category in experiment 2. In both experiments, HEAVY pigs had greater (P < 0.05) overall ADG and average daily feed intake (ADFI), but decreased (P < 0.05) G:F compared with LIGHT pigs. However, when HEAVY and LIGHT treatment groups were combined, growth performance and carcass characteristics were similar to MIXED pigs. Sorting decreased coefficient of variation (CV) of final BW but did not affect CV of ADG. In conclusion, because adding fat to the diets of lightweight pigs improved ADG in both experiments, dietary fat could be used selectively in the barn to increase the weight of the lightest 50% of the pigs. However, the sorting pigs into light and heavy weight groups did not improve growth performance or carcass characteristics.
The Effects of Gene-Environment Interactions Between Cadmium Exposure and Apolipoprotein E4 on Memory in a Mouse Model of Alzheimer’s Disease
Authors: Zhang Liang , Wang Hao , Abel Glen M , Storm Daniel R , Xia Zhengui
Published: October 2019

Cadmium (Cd) is a heavy metal of great public health concern. Recent studies suggested a link between Cd exposure and cognitive decline in humans. The ε4 allele, compared with the common ε3 allele, of the human apolipoprotein E gene (ApoE) is associated with accelerated cognitive decline and increased risks for Alzheimer’s disease (AD). To investigate the gene-environment interactions (GxE) between ApoE-ε4 and Cd exposure on cognition, we used a mouse model of AD that expresses human ApoE-ε3 (ApoE3-KI [knock-in]) or ApoE-ε4 (ApoE4-KI). Mice were exposed to 0.6 mg/l CdCl2 through drinking water for 14 weeks and assessed for hippocampus-dependent memory. A separate cohort was sacrificed immediately after exposure and used for Cd measurements and immunostaining. The peak blood Cd was 0.3–0.4 µg/l, within levels found in the U.S. general population. All Cd-treated animals exhibited spatial working memory deficits in the novel object location test. This deficit manifested earlier in ApoE4-KI mice than in ApoE3-KI within the same sex and earlier in males than females within the same genotype. ApoE4-KI but not ApoE3-KI mice exhibited reduced spontaneous alternation later in life in the T-maze test. Finally, Cd exposure impaired neuronal differentiation of adult-born neurons in the hippocampus of male ApoE4-KI mice. These data suggest that a GxE between ApoE4 and Cd exposure leads to accelerated cognitive impairment and that impaired adult hippocampal neurogenesis may be one of the underlying mechanisms. Furthermore, male mice were more susceptible than female mice to this GxE effect when animals were young.