bluuebunny/crossref_metadata_2025 huggingface dataset:
Shareholder Votes and Proxy Advisors: Evidence from Say on Pay
Authors: ERTIMUR YONCA , FERRI FABRIZIO , OESCH DAVID
Published: August 2013

We investigate the economic role of proxy advisors (PAs) in the context of mandatory “say on pay” votes, a novel and complex item requiring significant firm‐specific analysis. PAs are more likely to issue an Against recommendation at firms with poor performance and higher levels of CEO pay and do not appear to follow a “one‐size‐fits‐all” approach. PAs’ recommendations are the key determinant of voting outcome but the sensitivity of shareholder votes to these recommendations varies with the institutional ownership structure, and the rationale behind the recommendation, suggesting that at least some shareholders do not blindly follow these recommendations. More than half of the firms respond to the adverse shareholder vote triggered by a negative recommendation by engaging with investors and making changes to their compensation plan. However, we find no market reaction to the announcement of such changes, even when material enough to result in a favorable recommendation and vote the following year. Our findings suggest that, rather than identifying and promoting superior compensation practices, PAs' key economic role is processing a substantial amount of executive pay information on behalf of institutional investors, hence reducing their cost of making informed voting decisions. Our findings contribute to the literature on shareholder voting and the related policy debate.
Use of Myoglobin as a Marker and Predictor in Myoglobinuric Acute Kidney Injury
Authors: Premru Vladimir , Kovač Janko , Ponikvar Rafael
Published: August 2013

Serum creatine kinase (CK) is routinely used as a marker in the assessment of rhabdomyolysis and acute myoglobinuric kidney injury (Mb‐AKI), while the use of myoglobin is much less explored in this respect. We retrospectively analyzed the incidence of Mb‐AKI (creatinine [Cr] > 200 μmol/L) and the need for hemodialysis (HD) in 484 patients (70.5% males) with suspected rhabdomyolysis, grouped according to peak serum myoglobin (A: 1–5 mg/L, B: 5–15 mg/L, C: >15 mg/L). The median peak myoglobin was 7163 μg/L. Both peak Cr and peak CK were significantly higher in group C. The incidence of Mb‐AKI was 24.6% in group A, 38.6% in group B (P < 0.01 vs. group A), and significantly higher (64.9%) in group C (P < 0.001 vs. groups A and B). Fifty‐one patients (10.5%) needed HD, the proportion increasing from 6.7% in group A, and 12.3% in group B (NS), to 28.1% in group C (P < 0.001 vs. group A, P 0.01 vs. group B), and reaching 36.8% with myoglobin >20 mg/L. Creatine kinase correlated with the severity of rhabdomyolysis, but less so with Mb‐AKI. The peak Cr levels were not significantly different between patients divided by CK 60 μkat/L, or grouped into CK tertiles or quartiles. A significant proportion of patients with rhabdomyolysis experienced Mb‐AKI, whose frequency increased in parallel with myoglobin levels. Myoglobin levels above 15 mg/L were most significantly related to the development of AKI and the need for HD. Blood myoglobin could serve as a valuable early predictor and marker of rhabdomyolysis and Mb‐AKI.
Some Kinetic Considerations in High Cut‐Off Hemodiafiltration for Acute Myoglobinuric Renal Failure
Authors: Premru Vladimir , Kovač Janko , Buturović‐Ponikvar Jadranka , Ponikvar Rafael
Published: August 2013

The kinetics of myoglobin in severe rhabdomyolysis and dialysis‐dependent myoglobinuric acute kidney injury (Mb‐AKI) is still not well elucidated, and more detailed knowledge could improve the now empiric use of rapid extracorporeal myoglobin removal by high cut‐off (HCO) hemodialysis treatments. Eighteen adult patients with severe dialysis‐dependent Mb‐AKI (median serum concentration of myoglobin 57.4 mg/L) participated in the prospective clinical study, assessing myoglobin kinetics during HCO hemodiafiltration (HCO HDF). High initial serum concentrations of myoglobin (median 57.4 mg/L), together with protracted myoglobin appearance in the blood, indicated a large accumulation of myoglobin in body fluids. Extra‐renal endogenous metabolic myoglobin clearance was delayed, with a slow exponential fall in serum myoglobin (t½ 35 h). A mean myoglobin clearance of 90–94 mL/min, a reduction ratio of 80%, and a rapid exponential fall (t½ 1 h) in serum and dialysate myoglobin were achieved by HCO HDF. Half of the cumulative myoglobin removal was accomplished in 3–5 h, with an additional removal of 7% each hour thereafter. A 2.4‐fold rebound in serum myoglobin followed the HCO procedures. Large amounts of myoglobin are released into the circulation, and its endogenous metabolic clearance in dialysis‐dependent Mb‐AKI is slow. Owing to its rapid and highly efficient myoglobin elimination, HCO HDF may represent a valuable tool in the initial management of severe Mb‐AKI, with a potential for earlier application in the future.
Successful Treatment of Severe Hantavirus Nephritis With Corticosteroids: A Case Report and Literature Review
Authors: Martinuč Bergoč Maja , Lindič Jelka , Kovač Damjan , Ferluga Dušan , Pajek Jernej
Published: August 2013

Hantaviruses can be associated with severe form of hemorrhagic fever with renal syndrome although there are only a few cases reporting chronic kidney disease after hantavirus infection. We report a severe nonresolving chronic renal failure after protracted Dobrava hantavirus infection successfully treated with corticosteroids. Ten days after working in a basement a 33‐year‐old man fell seriously ill, with high fever, chills, diffuse myalgia, headache and abdominal pain. After hospital admission a diagnosis of hemorrhagic fever with renal syndrome caused by Dobrava hantavirus was made. Acute oliguric kidney injury developed in the first 3 days after admission, in a few days diuresis restored and he became polyuric. Nevertheless renal failure persisted and he needed hemodialysis. Because of nonresolving kidney failure, nephrogenic diabetes insipidus and renoparenchymal arterial hypertension persisting 2 months after onset of symptoms, a kidney biopsy was performed, showing severe necrotizing tubulointerstitial nephritis. High dose methylprednisolone therapy was started and his renal function significantly improved. Two months later a second renal biopsy showed persisting elements of active necrotizing tubulointerstitial nephritis. We decided to stop corticosteroid treatment and introduced aldosterone antagonist eplerenon as anti‐fibrotic agent, and his renal function further improved and remained stable. Nine months later his serum creatinine concentration was 227 μmol/L, proteinuria 0.156 g/day and well controlled nephrogenic diabetes insipidus.
Fibroblast Growth Factor 23 and Left Ventricular Mass Index in Maintenance Hemodialysis Patients: Standard Versus Long Nocturnal Hemodialysis
Authors: Knap Bojan , Večerić‐Haler Željka , Benedik Miha , Buturović‐Ponikvar Jadranka , Ponikvar Rafael , Bren Andrej F
Published: August 2013

Elevated levels of fibroblast growth factor 23 (FGF23) and phosphorus (P) have been linked to greater risks of left ventricular hypertrophy (LVH) in patients with end stage renal disease (ESRD). The aim of this study was to test if differences exist in a long nocturnal HD group in comparison with a group treated with standard daily thrice weekly dialysis. The attempt was to evaluate if elevated FGF‐23 levels, intact parathyroid hormone and P might be associated with left ventricular mass index (LVMI). Quantitative echocardiographic analyses were performed at baseline in 50 maintenance HD patients (17 women and 33 men, mean age: 56.4 ± 15.35 years, mean HD vintage: 9.06 ± 8.86 years, all patients are on HD thrice a week‐median duration 15 h/week, 10 of them on long nocturnal HD, median duration 24 h/week). LVMIs were calculated. FGF23 was measured in duplicate using a second generation C‐terminal enzyme‐linked immunosorbent assay and log of FGF‐23 values were computed. Mean LVMI was 136.44 ± 44.44 g/m2. Serum FGF‐23 levels were elevated when compared to population data with preserved kidney function (median 1388.5 RU/mL, range 252 to 24 336 RU/mL). There were no correlations recorded between log FGF‐23 levels and LVMI (r = 0.2, P = 0.66). LVMI was significantly lower in HD patients on long nocturnal dialysis procedure (r = −0.31, P = 0.05). Patients treated with long nocturnal HD showed lower LV mass, lower P‐values and higher 25‐OH‐D3 supply. Plasma FGF‐23 concentration was comparable between the groups and was not associated with LVMI in our maintenance HD patients.
Fulminant Peritonitis Presumably Caused by Panton‐Valentine Leukocidin‐Positive Staphylococcus aureus in a Girl on Peritoneal Dialysis
Authors: Battelino Nina , Pokorn Marko , Švent‐Kučina Nataša , Križan‐Hergouth Veronika , Novljan Gregor
Published: August 2013

Peritonitis is a significant complication of peritoneal dialysis (PD) and the most common cause of technique failure. Panton‐Valentine leukocidin (PVL), a cytotoxin produced by certain strains of Staphylococcus aureus (SA), causes destruction of neutrophils, and is associated with severe invasive infections. We present a 2.5‐year‐old girl on PD, who presented suddenly with an unusually fulminant and protracted course of peritonitis. Only a few hours after the onset of clinical signs, septic shock developed. PVL‐positive methicillin‐sensitive SA (MSSA) was grown and initial empiric antibiotic treatment changed to flucloxacillin and rifampicin in order to minimize toxin production. In spite of adequate antibiotic treatment and PD‐catheter removal, recovery was slow. No PD‐related peritonitis in children associated with PVL‐producing strains have been reported so far and no specific recommendation exists for treatment. We speculate that PVL contributed to the severity and outcome of peritonitis in our patient.
Plasmapheresis and Immunoadsorption for Treatment and Prophylaxis of Recurrent Focal Segmental Glomerulosclerosis in Adult Recipients of Deceased Donor Renal Grafts
Authors: Kandus Aljoša , Ponikvar Rafael , Buturović‐Ponikvar Jadranka , Bren Andrej F. , Oblak Manca , Mlinšek Gregor , Kmetec Andrej , Arnol Miha
Published: August 2013

Recurrent focal segmental glomerulosclerosis has a great impact on kidney graft survival. This retrospective study presents immunoadsorption‐plasmapheresis treatment and outcome in our renal graft recipients with significant post‐transplant proteinuria (>1 g/day) and focal segmental glomerulosclerosis in native kidneys. Recurrence was defined as occurrence of nephrotic range proteinuria or biopsy‐confirmed diagnosis. Successful treatment was defined as sustained reduction of proteinuria to <1 g/day. From 2000 through 2011, 548 adult patients received kidney grafts from deceased donors. In 20 of these patients (3.6%) end‐stage renal disease was a consequence of focal segmental glomerulosclerosis. Recurrence was confirmed in five of seven treated patients. Immunoadsorption‐plasmapheresis treatment was successful in five patients (70%). Their age at disease diagnosis in native kidneys was 12 to 44 years. Time to end‐stage renal disease was 3 to 14 years. Recipient age at transplantation was 21 to 61 years. Onset of significant proteinuria was 2 to 87 days after transplantation. Immunoadsorption or plasmapheresis started 1 to 7 days after recurrence of significant proteinuria. Treatment period was 1 to 103 months and 12 to 206 procedures were performed per patient. Follow‐up period after cessation of plasmapheresis was 11 to 58 months. Final urine protein/creatinine ratio was 8.8 to 98.0 mg/mmol and final serum creatinine was 63 to 148 μmol/L. Follow‐up after transplantation was 18 to 135 months. One patient was still on treatment. One graft was lost to recurrence. No serious adverse effects occurred during immunoadsorption and plasmapheresis. Immunoadsorption and plasmapheresis appears to be successful in the majority of patients, probably due to their early start.
Comparison of three algorithms for initiation and titration of insulin glargine in insulin‐naive patients with type 2 diabetes mellitus (既往从未使用过胰岛素的2型糖尿病患者使用三种不同的启用与滴定甘精胰岛素剂量方案的比较)
Authors: Dailey George , Aurand Lisa , Stewart John , Ameer Barbara , Zhou Rong
Published: August 2013

Background

Several titration algorithms can be used to adjust insulin dose and attain blood glucose targets. We compared clinical outcomes using three initiation and titration algorithms for insulin glargine in insulin‐naive patients with type 2 diabetes mellitus (T2DM); focusing on those receiving both metformin and sulfonylurea (SU) at baseline.

Methods

This was a pooled analysis of patient‐level data from prospective, randomized, controlled 24‐week trials. Patients received algorithm 1 (1 IU increase once daily, if fasting plasma glucose [FPG] > target), algorithm 2 (2 IU increase every 3 days, if FPG > target), or algorithm 3 (treat‐to‐target, generally 2–8 IU increase weekly based on 2‐day mean FPG levels). Glycemic control, insulin dose, and hypoglycemic events were compared between algorithms.

Results

Overall, 1380 patients were included. In patients receiving metformin and SU at baseline, there were no significant differences in glycemic control between algorithms. Weight‐adjusted dose was higher for algorithm 2 vs algorithms 1 and 3 (P = 0.0037 and P < 0.0001, respectively), though results were not significantly different when adjusted for reductions in HbA1c (0.36 IU/kg, 0.43 IU/kg, and 0.31 IU/kg for algorithms 1, 2, and 3, respectively). Yearly hypoglycemic event rates (confirmed blood glucose <56 mg/dL) were higher for algorithm 3 than algorithms 1 (P = 0.0003) and 2 (P < 0.0001).

Conclusions

Three algorithms for initiation and titration of insulin glargine in patients with T2DM resulted in similar levels of glycemic control, with lower rates of hypoglycemia for patients treated using simpler algorithms 1 and 2.
DifferInt: compositional differentiation among populations at three levels of genetic integration
Authors: Gillet Elizabeth M.
Published: August 2013

In many fields of study, it is important to know how different populations are genetically. Commonly used measures such as and its derivatives based on gene identity probabilities do not reliably reflect difference, as they can be maximal when almost all populations are identical and very small when populations are completely distinct. Compositional differentiation, in contrast, is maximal only for completely distinct populations. Moreover, underlying forces of fragmentation that act on single‐ and multilocus genotypes may be missed if only the allelic level is viewed. For these reasons, descriptive measures of compositional differentiation based on untransformed distributions of genetic types at different levels of genetic integration (alleles, single‐ and multilocus genotypes) were derived. Here, two measures of complementary differentiation and two new measures of dispersive differentiation are described. One of each considers genic differences between individuals, ensuring their consistency across integration levels. An increase from one level to the next indicates differences among the populations in their forms of gene association. The computer program DifferInt calculates these measures for one or more codominantly expressed gene loci at the gene‐pool, single‐locus and multilocus levels. Effects of gene pools and gene association on differentiation are compared by permutation analysis. Snail diagrams depict the contribution of each population to differentiation. Results are demonstrated using a numerical example. The applicability of the measures calculated by this program in conservation, phylogeography, mating system analysis and adaptation studies is discussed.
Factors influencing detection of eDNA from a stream‐dwelling amphibian
Authors: Pilliod David S. , Goldberg Caren S. , Arkle Robert S. , Waits Lisette P.
Published: August 2013

Environmental DNA (eDNA) methods for detecting and estimating abundance of aquatic species are emerging rapidly, but little is known about how processes such as secretion rate, environmental degradation, and time since colonization or extirpation from a given site affect eDNA measurements. Using stream‐dwelling salamanders and quantitative PCR (qPCR) analysis, we conducted three experiments to assess eDNA: (i) production rate; (ii) persistence time under different temperature and light conditions; and (iii) detectability and concentration through time following experimental introduction and removal of salamanders into previously unoccupied streams. We found that 44–50 g individuals held in aquaria produced 77 ng eDNA/h for 2 h, after which production either slowed considerably or began to equilibrate with degradation. eDNA in both full‐sun and shaded treatments degraded exponentially to <1% of the original concentration after 3 days. eDNA was no longer detectable in full‐sun samples after 8 days, whereas eDNA was detected in 20% of shaded samples after 11 days and 100% of refrigerated control samples after 18 days. When translocated into unoccupied streams, salamanders were detectable after 6 h, but only when densities were relatively high (0.2481 individuals/m2) and when samples were collected within 5 m of the animals. Concentrations of eDNA detected were very low and increased steadily from 6–24 h after introduction, reaching 0.0022 ng/L. Within 1 h of removing salamanders from the stream, eDNA was no longer detectable. These results suggest that eDNA detectability and concentration depend on production rates of individuals, environmental conditions, density of animals, and their residence time.
Impact of Cilostazol on the Progression of Carotid Atherosclerosis in Patients with Retinal Vascular Occlusion
Authors: Kim Seong‐Man , Cho Kyoung‐Im
Published: August 2013

Background

Cilostazol, a selective phosphodiesterase three inhibitor, has been proposed to have beneficial effects in the prevention of atherosclerosis.

Aims

We aimed to investigate the effects of cilostazol on carotid intima‐media thickening (IMT) and total plaque area (TPA) in patients with retinal vascular occlusion.

Methods

A total of 63 consecutive vascular occlusive retinopathy patients with carotid atherosclerosis were enrolled. We examined changes in the carotid IMT/TPA and visual acuity/macular thickness before and after 1‐year treatment with cilostazol (200 mg/day).

Results

The mean IMT of both common carotid arteries (CCAs) and internal carotid arteries (ICAs) were significantly reduced after cilostazol treatment. There was no significant difference in the TPA of both CCAs before and after the treatment (before; 0.61 ± 0.94 vs. after; 0.45 ± 0.79 cm2, P = 0.291); however, significant plaque regression (before; 0.14 ± 0.15 vs. after; 0.25 ± 0.14 cm2, P = 0.004) was observed in selected patients (n = 30) with a TPA <0.5 cm2. The improvement in macular thickness was significantly associated with an improvement in carotid IMT (r = 0.42, P = 0.001) and TPA (r = 0.23, P = 0.04).

Conclusion

Cilostazol potently inhibited the progression of carotid IMT and may play a role in the early carotid plaque regression in patients with retinal vascular occlusion.
Enhanced bone formation during healing process of tooth sockets filled with demineralized human dentine matrix
Authors: de Oliveira GS , Miziara MN , Silva ER da , Ferreira EL , Biulchi APF , Alves JB
Published: August 2013

Background

Orthodontic procedures are often limited by the presence of bone defects caused by trauma, periodontal diseases or surgeries, thus requiring the development of materials capable to compensate such deficiencies. Since bone morphogenetic proteins (BMPs) are indicative of bone reconstitution, this study aimed to evaluate histological and immunohistochemically the temporal location of BMP‐2 and BMP‐4 in osteoblasts of rat alveolar wounds filled with demineralized human dentine matrix (DHDM), used as a graft material.

Methods

After extraction of the upper second molars, the left side alveoli were filled with DHDM and the right side served as the control. The animals were euthanized after 3, 5, 10 and 14 days of surgery. After fixation, demineralization and paraffin embedding, representative samples of each group were stained with H&E and immunohistochemically evaluated.

Results

The data showed a statistically significant (p < 0.05) increased number of osteoblasts positively immunostained for BMP‐2 and BMP‐4 on the experimental side (left) at 10 days. Our results also showed that even when not degraded, dentine matrix was incorporated to new bone formation after 14 days of surgery.

Conclusions

The results suggest that DHDM acts as a scaffold for osteoblast differentiation, actively yielding new bone formation, and it may represent an effective bone implant material.
Model highlights likely long‐term influences of mesobrowsers versus those of elephants on woodland dynamics
Authors: O'Kane Christopher A. J. , Duffy Kevin J. , Page Bruce R. , Macdonald David W.
Published: August 2013

The potential long‐term influences of mesobrowsers versus those of savannah elephants on woodland dynamics have not been explored. This may be a critical omission especially in southern African savannahs, where efforts to preserve existing woodlands are typically directed at elephant management. We describe a simple browse–browser model, parameterized from an extensive review of the literature and our own data, including quantitative assessment of impala impact, from the study site, iMfolozi Park, South Africa. As there is a paucity of species‐specific demographic data on savannah woody species, we modelled, in a novel approach, functional groups of plant species typical of Acacia woodlands. Outputs suggest that over the long term (100 years), low‐to‐moderate densities of impala will have a similar impact on woodland structure, in terms of density of adult trees, as low‐to‐moderate densities of elephant. Further, the outputs highlight the apparently strong synergistic effect impala and elephant impacts combined have on woodland dynamics, suggesting that reduction or removal of either impala or elephant will radically reduce long‐term destruction of savannah woodlands. Recorded changes in adult tree numbers in iMfolozi broadly supported the model's outputs.
The Power of Partisanship in Brazil: Evidence from Survey Experiments
Authors: Samuels David , Zucco Cesar
Published: August 2013

To what extent do party labels influence individuals’ policy positions? Much research has examined this question in the United States, where party identification can generate both in‐group and out‐group pressures to conform to a party's position. However, relatively little research has considered the question's comparative generalizability. We explore the impact of party labels on attitudes in Brazil, a relatively new democracy with a fragmented party system. In such an environment, do parties function as in‐groups, out‐groups, or neither? We answer this question through two survey experiments, one conducted on a nationally representative sample and another on a convenience sample recruited via Facebook. We find that both in‐ and out‐group cues shape the opinions of identifiers of Brazil's two main parties but that cues have no effect on nonpartisans. Results suggest that party identification can structure attitudes and behavior even in “party‐averse” electoral environments.
Young women's perceptions of fertility‐related information and fertility distress before surgery for ovarian cysts
Authors: Lind Tekla , Lampic Claudia , Hammarström Margareta , Rodriguez‐Wallberg Kenny
Published: August 2013

Objective

To investigate young women's reproductive desire and perceptions of fertility‐related information when scheduled for ovarian cyst surgery with a possible impact on fertility.

Design

Cross‐sectional study.

Setting

University Hospital.

Population

Women of reproductive age (n = 106, mean age 32.3 years, range 18–44 years) with a diagnosis of ovarian cyst and scheduled ovarian cyst surgery between March 2011 and September 2012 were included.

Methods

The women answered a questionnaire after the presurgery consultation with the gynecologist. The questionnaire included study‐specific measures of reproductive desire, perception of fertility‐related information received, worry about future fertility and sociodemographic characteristics.

Main outcome measure

Reproductive desire and recalled information on the impact of surgery on fertility.

Results

A high proportion of the women (72%) reported a desire for having children in the future and more than half of them (58%) recalled receiving information about the impact of surgery on fertility. In a multivariable logistic regression model adjusted for parity, education and age, a desire to have children increased the likelihood of recalling having received fertility‐related information (odds ratio 3.2, 95% CI 1.1–9.2).

Conclusions

Almost half of women with reproductive desire had ovarian surgery without recalling a discussion of fertility issues. Development of written information or interactive information might improve women's perception of fertility‐related information.
Preoperative serum albumin is associated with mortality and complications after radical cystectomy
Authors: Garg Tullika , Chen Ling Y. , Kim Philip H. , Zhao Philip T. , Herr Harry W. , Donat S. Machele
Published: August 2013

Objective

To determine the association between preoperative serum albumin and mortality and postoperative complications after radical cystectomy (RC) and urinary diversion.

Patients and Methods

We conducted a retrospective review of 1097 RCs performed for the treatment of bladder cancer between 1992 and 2005.

All data were entered prospectively into a hospital‐based complications database.

We used multivariable logistic regression to assess the association between preoperative serum albumin and complications and mortality ≤90 days of RC, while controlling for preoperative patient and disease characteristics.

Results

Low preoperative serum albumin was identified in 14% of the cohort.

Preoperative serum albumin was a predictor of postoperative complications (adjusted odds ratio [OR] per unit increase in albumin: 0.61, 95% confidence interval [CI] 0.42–0.90) and 90‐day mortality (OR 0.33, 95% CI 0.14–0.75) when controlling for sex, race, age‐adjusted Charlson score, body mass index, prior history of abdominal surgery, clinical stage, and neoadjuvant chemotherapy.

As serum albumin decreased, the risk of complications and mortality increased.

Conclusions

In addition to age‐adjusted Charlson score, low preoperative serum albumin is a significant predictor of complications and mortality after RC.

Serum albumin testing can be used to identify individuals at high‐risk of morbidity and mortality.
Paraneoplastic neurological syndromes
Authors: Leypoldt F , Wandinger K-P
Published: August 2013

Paraneoplastic neurological syndromes are immune-mediated erroneous attacks on the central or peripheral nervous systems, or both, directed originally against the tumour itself. They have been known for more than 40 years, but recently the discovery of new subgroups of paraneoplastic encephalitis syndromes with a remarkably good response to immune therapy has ignited new clinical and scientific interest. Knowledge of these subgroups and their associated autoantibodies is important in therapeutic decision-making. However, the abundance of new autoantibodies and syndromes can be confusing. This review paper summarizes current knowledge and new developments in the field of paraneoplastic neurological syndromes, their classification, pathophysiology and treatment.
The DULK (Dutch leakage) and modified DULK score compared: actively seek the leak
Authors: den Dulk M. , Witvliet M. J. , Kortram K. , Neijenhuis P. A. , de Hingh I. H. , Engel A. F. , van de Velde C. J. H. , de Brauw L. M. , Putter H. , Brouwers M. A. M. , Steup W.‐H.
Published: August 2013

Aim

A standardized postoperative score, the DULK (Dutch leakage) score, has been demonstrated to be a useful clinical tool in the diagnosis of anastomotic leakage. It is complicated, however, and a simplification (the modified DULK score) based on fewer parameters derived from multiple logistic regression analyses has been developed. These include clinical condition, abdominal pain not localized at the wound, C‐reactive protein level and respiratory rate. The accuracy of each was compared.

Method

Data of all patients from five Dutch centres operated on between 16 October 2007 and 1 November 2009 with an anastomosis in the colon or rectum were entered into a prospectively maintained database.

Results

In total, 782 patients were included of whom 81 (10.4%) had a clinically relevant anastomotic leakage. The DULK score gave an overall sensitivity of 97% for anastomotic leakage, overall specificity of 53%, a positive predictive value (PPV) of 16% and a negative predictive value (NPV) of 99%. The modified DULK score used clinical condition, abdominal pain not localized at the wound, C‐reactive protein level and respiratory rate. With at least one parameter present, overall sensitivity was 97%, overall specificity 57%, PPV 17% and NPV 99.5%. With at least two points PPV was 41% and with three points 57%.

Conclusion

Both the original and modified DULK scores are useful for the early diagnosis of clinically relevant anastomotic leakage. The modified DULK score offers the benefit of fewer parameters and so can easily be used in a clinical environment to estimate the likelihood of anastomotic leakage. However, the early diagnosis of anastomotic leakage remains difficult.
Completion surgery following transanal endoscopic microsurgery: assessment of quality and short‐ and long‐term outcome
Authors: Hompes R. , McDonald R. , Buskens C. , Lindsey I. , Armitage N. , Hill J. , Scott A. , Mortensen N. J. , Cunningham C. ,   The Association of Coloproctology of Great Britain and Ireland Transanal Endoscopic Microsurgery Collaboration
Published: August 2013

Aim

Patients with unfavourable pathology after transanal endoscopic microsurgery (TEM) should be offered completion surgery (CS) if appropriate. The aim of this retrospective cohort study was to assess the short‐term outcome and long‐term oncological results of CS and identify factors compromising the quality of resection specimens.

Method

Data were retrieved and analysed on patients who underwent CS from a comprehensive national TEM database (1992–2008) and the institutional prospective database from the Oxford University Hospitals (2008–2011).

Results

There were 36 patients eligible for analysis. Postoperative complications occurred in 19 and were minor (grade I–II) in 13 and major (grade III–V) in six patients. The quality of the resected specimen was graded as good in 23 (64%), moderate in six (16.6%) and poor in seven (19.4%). Full‐thickness excision by TEM (P = 0.03), an interval to CS greater than 7 weeks (P = 0.05) and distally located lesions (P = 0.04) were associated with increased risk for an inferior surgical specimen. Overall survival after CS was 91% at 1 year and 83% at 5 years. Patients with a ‘good’ TME specimen had significantly improved disease‐free survival compared with patients with an ‘inferior’ specimen (100 vs 51%, P = 0.001).

Conclusion

Patients having full‐thickness TEM excision, distally placed lesions and a long interval (> 7 weeks) to CS were likely to have an inferior TME specimen. The results confirm that CS after TEM does not negatively influence local recurrence and survival, but the reduced disease‐free survival in patients with an inferior specimen is of concern.
Climate change, non‐indigenous species and shipping: assessing the risk of species introduction to a high‐Arctic archipelago
Authors: Ware Chris , Berge Jørgen , Sundet Jan H. , Kirkpatrick Jamie B. , Coutts Ashley D. M. , Jelmert Anders , Olsen Steffen M. , Floerl Oliver , Wisz Mary S. , Alsos Inger G.
Published: August 2013

Aim

Anticipated changes in the global ocean climate will affect the vulnerability of marine ecosystems to the negative effects of non‐indigenous species (NIS). In the Arctic, there is a need to better characterize present and future marine biological introduction patterns and processes. We use a vector‐based assessment to estimate changes in the vulnerability of a high‐Arctic archipelago to marine NIS introduction and establishment.

Location

Global, with a case study of Svalbard, Norway.

Methods

We base our assessment on the level of connectedness to global NIS pools through the regional shipping network and predicted changes in ocean climates. Environmental match of ports connected to Svalbard was evaluated under present and future environmental conditions (2050 and 2100 predicted under the RCP8.5 emissions scenario). Risk of NIS introduction was then estimated based on the potential for known NIS to be transported (in ballast water or as biofouling), environmental match, and a qualitative estimate of propagule pressure.

Results

We show that Svalbard will become increasingly vulnerable to marine NIS introduction and establishment. Over the coming century, sea surface warming at high latitudes is estimated to increase the level of environmental match to nearly one‐third of ports previously visited by vessels travelling to Svalbard in 2011 (n = 136). The shipping network will then likely connect Svalbard to a much greater pool of known NIS, under conditions more favourable for their establishment. Research and fishing vessels were estimated to pose the highest risk of NIS introduction through biofouling, while ballast water discharge is estimated to pose an increased risk by the end of the century.

Main conclusions

In the absence of focused preventative management, the risk of NIS introduction and establishment in Svalbard, and the wider Arctic, will increase over coming decades, prompting a need to respond in policy and action.
Symptom patterns can distinguish diverticular disease from irritable bowel syndrome
Authors: Cuomo Rosario , Barbara Giovanni , Andreozzi Paolo , Bassotti Gabrio , Casetti Tino , Grassini Mario , Ierardi Enzo , Maconi Giovanni , Marchi Santino , Sarnelli Giovanni , Savarino Vincenzo , Usai Paolo , Vozzella Letizia , Annibale Bruno
Published: August 2013

Background

Diverticular disease (DD) and irritable bowel syndrome (IBS) share a similar symptom pattern. However, comparative studies are flawed by different age at onset of symptoms. We aimed to verify whether clinical features distinguish DD from IBS.

Materials and methods

Patients with DD or IBS, matched for age and gender (1/1) were consecutively recruited. Data on demographic parameters, voluptuary habits, inheritance of disease and symptoms were collected. Moreover, the association between pain > 24 h, and clinical parameters were evaluated.

Results

Ninety patients with DD and 90 patients with IBS (DD: F/M: 46/44; age: 50.9 years; IBS: 46/44; 50.4) were selected from an overall population of 1275 patients. Only nine patients with DD (10%) fulfilled the criteria for IBS diagnosis. Abdominal pain > 24 h was more prevalent in SDD than in patients with IBS (20 vs. 6 patients; P < 0·01). Furthermore, compared with IBS, patients with DD showed more episodes of pain > 24 h requiring medical attention (80% vs. 33%; P < 0·01).

Conclusions

Abdominal pain lasting for more than 24 h discriminates patients with DD compared with those with IBS. Identifying this symptom could be an appropriate strategy to define the diagnosis and management.
Editorial: conceptualising Early School Leaving
Authors: Ross Alistair , Leathwood Carole
Published: August 2013

A video abstract of this article can be viewed at http://www.youtube.com/watch?v=KEFSZYaNbzk
Is There Anything Specific about Early School Leaving in Southeast Europe? A Review of Research and Policy
Authors: Jugović Ivana , Doolan Karin
Published: August 2013

Studies on early school leaving (ESL) from countries such as Bosnia and Herzegovina, Croatia, Montenegro, Serbia and Slovenia have been missing from the international early school leaving research map. As a contribution to remedying this, the article reviews research papers and strategic documents from these countries, guided by the general question whether there is anything specific about ESL in this region in comparison to the wider European research and policy context. The aspects of ESL examined include definitional similarities and differences, extent of ESL, dominant theoretical and methodological approaches, factors identified as impacting ESL as well as policy solutions. We find that Croatia and Slovenia are among the countries which have the lowest ESL rates in Europe. The findings of the reviewed research studies correspond to international research papers in terms of the following frequent risk factors for ESL: low economic and cultural family background, ethnic minority and migration status, type of school enrolled and motivation and academic achievement. There is a strong focus on Roma children early school leavers in all of the countries examined and Bosnia and Herzegovina stands out in the broader European context with the finding that girls from large, low socio‐economic status families, who live more than three kilometres away from school, are at particular risk of ESL. In discussing ESL, the reviewed studies tend to emphasise individual and family characteristics rather than also broader social constraints as ESL determinants, a practice also reflected in policy documents which do not mention the role of broader social and economic conditions shaping early school leaving.
Ligand‐independent epidermal growth factor receptor hyperactivation increases sebaceous gland size and sebum secretion in mice
Authors: Dahlhoff Maik , de Angelis Martin Hrabe , Wolf Eckhard , Schneider Marlon R.
Published: August 2013

The epidermal growth factor receptor (EGFR) system is an established regulator of the development and homeostasis of the hair follicle and interfollicular epidermis. Here, we evaluated EGFR actions on the sebaceous glands (SGs) by employing Dsk5 mice, a mutant line in which the EGFR is constitutively activated in a ligand‐independent manner. Compared to control littermates, Dsk5 mice showed increased sebum levels and enlarged SGs, which contained a higher number of cells and showed stronger proliferation. c‐myc transcript levels were increased in Dsk5 skin, suggesting that c‐myc mediates the proliferative stimuli of the EGFR in the SG. Analysis of differentiation markers revealed deregulated expression of Scd1 and Scd3, indicating that sebaceous lipogenesis is affected in Dsk5 mice. In conclusion, our study indicates that the EGFR is an important regulator of presebocyte proliferation, contributing to the final cell number, to the size and to the lipid output of SGs.
The power of integrating kinetic isotope effects into the formalism of the Michaelis–Menten equation
Authors: Klinman Judith P.
Published: August 2013

The final arbiter of enzyme mechanism is the ability to establish and test a kinetic mechanism. Isotope effects play a major role in expanding the scope and insight derived from the Michaelis–Menten equation. The integration of isotope effects into the formalism of the Michaelis–Menten equation began in the 1970s and has continued until the present. This review discusses a family of eukaryotic copper proteins, including dopamine β‐monooxygenase, tyramine β‐monooxygenase and peptidylglycine α‐amidating enzyme, which are responsible for the synthesis of neuroactive compounds, norepinephrine, octopamine and C‐terminally carboxamidated peptides, respectively. The review highlights the results of studies showing how combining kinetic isotope effects with initial rate parameters permits the evaluation of: (a) the order of substrate binding to multisubstrate enzymes; (b) the magnitude of individual rate constants in complex, multistep reactions; (c) the identification of chemical intermediates; and (d) the role of nonclassical (tunnelling) behaviour in C–H activation.
MeCP2 R168X male and female mutant mice exhibit Rett‐like behavioral deficits
Authors: Schaevitz L. R. , Gómez N. B. , Zhen D. P. , Berger‐Sweeney J. E.
Published: August 2013

Rett syndrome (RTT) is a regressive developmental disorder characterized by motor and breathing abnormalities, anxiety, cognitive dysfunction and seizures. Approximately 95% of RTT cases are caused by more than 200 different mutations in the X‐linked gene encoding methyl‐CpG‐binding protein 2 (MeCP2). While numerous transgenic mice have been created modeling common mutations in MeCP2, the behavioral phenotype of many of these male and, especially, female mutant mice has not been well characterized. Thorough phenotyping of additional RTT mouse models will provide valuable insight into the effects of Mecp2 mutations on behavior and aid in the selection of appropriate models, ages, sexes and outcome measures for preclinical trials. In this study, we characterize the phenotype of male and female mice containing the early truncating MeCP2 R168X nonsense point mutation, one of the most common in RTT individuals, and compare the phenotypes to Mecp2 null mutants. Mecp2R168X mutants mirror many clinical features of RTT. Mecp2R168X/y males exhibit impaired motor and cognitive function and reduced anxiety. The behavioral phenotype is less severe and with later onset in Mecp2R168X/+ females. Seizures were noted in 3.7% of Mecp2R168X mutant females. The phenotype in Mecp2R168X/y mutant males is remarkably similar to our previous characterizations of Mecp2 null males, whereas Mecp2R168X/+ females exhibit a number of phenotypic differences from females heterozygous for a null Mecp2 mutation. This study describes a number of highly robust behavioral paradigms that can be used in preclinical drug trials and underscores the importance of including Mecp2 mutant females in preclinical studies.
Plant species identity surpasses species richness as a key driver of N2O emissions from grassland
Authors: Abalos Diego , De Deyn Gerlinde B. , Kuyper Thomas W. , van Groenigen Jan Willem
Published: August 2013

Grassland ecosystems worldwide not only provide many important ecosystem services but they also function as a major source of the greenhouse gas nitrous oxide (N2O), especially in response to nitrogen deposition by grazing animals. To explore the role of plants as mediators of these emissions, we tested whether and how N2O emissions are dependent on grass species richness and/or specific grass species composition in the absence and presence of urine deposition. We hypothesized that: (i) N2O emissions relate negatively to plant productivity; (ii) four‐species mixtures have lower emissions than monocultures (as they are expected to be more productive); (iii) emissions are lowest in combinations of species with diverging root morphology and high root biomass; and (iv) the identity of the key species that reduce N2O emissions is dependent on urine deposition. We established monocultures and two‐ and four‐species mixtures of common grass species with diverging functional traits: Lolium perenne L. (Lp), Festuca arundinacea Schreb. (Fa), Phleum pratense L. (Php) and Poa trivialis L. (Pt), and quantified N2O emissions for 42 days. We found no relation between plant species richness and N2O emissions. However, N2O emissions were significantly reduced in specific plant species combinations. In the absence of urine, plant communities of Fa+Php acted as a sink for N2O, whereas the monocultures of these species constituted a N2O source. With urine application Lp+Pt plant communities reduced (P < 0.001) N2O emissions by 44% compared to monocultures of Lp. Reductions in N2O emissions by species mixtures could be explained by total biomass productivity and by complementarity in root morphology. This study shows that plant species composition is a key component underlying N2O emissions from grassland ecosystems. Selection of specific grass species combinations in the context of the expected nitrogen deposition regimes may therefore provide a key for mitigation of N2O emissions.
Extinction debt and the species–area relationship: a neutral perspective
Authors: Halley John M. , Sgardeli Vasiliki , Triantis Kostas A.
Published: August 2013

Aim

To estimate the magnitude of delayed relative to imminent extinctions and to assess the importance of delay as a potential source of error in forecasts of extinction. To formulate a simple mechanistic model using neutral theory that links extinction debt with the species–area relationship (SAR).

Location

World‐wide.

Methods

We use the neutral model of biodiversity to describe how a community subject to immigration responds to an insular contraction. We investigate the species richness at different times after the habitat‐loss event. We compare this with observed species losses in avian studies.

Results

From the model, two SARs emerge: one with a shallow slope for a habitat area before habitat loss and another with a steeper slope for the habitats that remain after habitat loss. From these curves, the first predicts imminent extinctions while the second predicts total extinctions. The difference between the two curves gives the delayed extinctions, namely the number of species that are lost during the relaxation of the community to equilibrium. The model agrees well with observed relaxation rates in communities of birds. The lag times for relaxation are often very large, with half‐lives in the order of thousands of years for remnant areas above 5000 km2. In many parameter combinations explored, the majority of extinctions are delayed extinctions, and may exceed imminent extinctions by orders of magnitude.

Main conclusions

Extinction debt is a major reason for failures to observe extinctions following habitat loss. Our modelling approach supports the view that a significant proportion of extinctions are delayed, so that the predictions of SARs (as currently applied) are liable to underestimate total extinctions. SARs are a valuable instrument for conservation but must be used with caution.
Island mammal extinctions are determined by interactive effects of life history, island biogeography and mesopredator suppression
Authors: Hanna Emily , Cardillo Marcel
Published: August 2013

Aim

Understanding extinction on islands is critical for biodiversity conservation. Introduced predators are a major cause of island extinctions, but there have been few large‐scale studies of the complexity of the effects of predators on island faunas, or how predation interacts with other factors. Using a large database of island mammal populations, we describe and explain patterns of island mammal extinctions as a function of introduced predators, life history and geography.

Location

Three hundred and twenty‐three Australian islands.

Methods

We built a database of 934 island mammal populations, extinct and extant, including life history and ecology, island geography and the presence of introduced predators. To test predictors of extinction probability, we used generalized linear mixed models to control partially for phylogenetic non‐independence, and decision trees to more fully explore interactive effects.

Results

The decision trees identified large mammals (> 2.7 kg) as having higher extinction probabilities than small species (< 2.7 kg). In large species, extinction patterns are consistent with island biogeography theory, with distance from the mainland being the primary predictor of extinction. For small species, the presence of introduced black rats is the primary predictor of extinction. As predicted by mesopredator suppression theory, extinction probabilities are lower on islands with both black rats and a larger introduced predator (cats, foxes or dingoes), compared with islands with rats but no larger predator. Similarly, extinction probabilities are lower on islands with both a mid‐sized (cats or foxes) and a larger (dingoes) predator, compared with islands with cats or foxes only.

Main conclusions

Island mammal extinctions result from complex interactions of introduced predators, island geography and prey biology. One conservation implication of our results is that eradication of introduced apex predators (cats, foxes or dingoes) from islands could precipitate the expansion of black rat populations, potentially leading to extinction of native mammal species whose remaining populations are confined to islands.