bluuebunny/crossref_metadata_2025 huggingface dataset:
The impact of body mass index on surgical outcomes of robotic partial nephrectomy
Authors: Isac Wahib E. , Autorino Riccardo , Hillyer Shahab P. , Hernandez Adrian V. , Stein Robert J. , Kaouk Jihad H.
Published: October 2012

Study Type – Therapy (case series)

Level of Evidence 4

“What's known on the subject?” and “What does the study add?”

Obesity is associated with higher incidence of renal cell carcinoma. Laparoscopic and robotic partial nephrectomy (RPN) was shown to be technically feasible in the obese population. In the present study we evaluated the impact of obesity on outcome of RPN, in a large cohort of patients.

In the present study, obese patients had a higher American Society of Anesthesiologists score and larger tumour size. We evaluated obesity as a categorical and a continuous variable, and we adjusted for confounding factors. We categorized obesity based according to the WHO classification of obesity. We described our technical modifications to overcome difficulties that can be encountered during the surgery. Obese patients had a higher estimated blood loss, but no difference in blood transfusion rate, operation duration or warm ischaemia time.

OBJECTIVE

To assess the impact of body mass index (BMI) on the surgical outcomes of robotic partial nephrectomy (RPN).

PATIENTS AND METHODS

Medical charts of 250 consecutive patients who underwent RPN at our institution between 2006 and 2010 were reviewed.

Patients were categorized based on their BMI into four groups per international classification of obesity into: normal (BMI < 25 kg/m2), overweight (25–29.9), obese (30–39.9) and morbidly obese (≥40).

Preoperative characteristics as well as perioperative and postoperative outcomes were analysed and compared between the groups.

RESULTS

Of the 250 patients, 43 (17.2% of the entire cohort) were non‐obese, 104 (41.6%) were overweight, 75 (30%) were obese, and 28 (11.2%) were morbidly obese.

Groups were similar in terms of age, gender, history of previous surgery and nephrometry score (P= 0.5).

Patients with higher BMI had a higher American Society of Anesthesiologists (ASA) score (median 3 for obese and morbidly obese groups vs 2 for non‐obese groups; P= 0.002) and tumour size (median 3.6, 2.9, 2.5 and 2.3 cm in those who were morbidly obese, obese, overweight and with normal BMI, respectively; P= 0.005).

Patients within the morbidly obese group had a higher estimated blood loss (median 250 mL) than other groups (median: 200, 200, 150 mL, respectively) (P= 0.03).

No significant difference was detected between the groups in terms of operation duration, warm ischaemia time, transfusion rate and postoperative complications.

CONCLUSION

Robotic partial nephrectomy represents an effective treatment modality for renal tumours providing equivalent surgical outcomes even for patients with BMI up to 60 kg/m2.
Diagnostic tests in urology: percentage of free prostate‐specific antigen (PSA)
Authors: Yi Yooni , Breau Rodney H. , Witiuk Kelsey , Neuberger Molly M. , Dahm Philipp
Published: October 2012

What's known on the subject? and What does the study add?

Free to total PSA ratios are commonly used as an adjunct to total PSA levels to better define an individual's risk for prostate cancer; however, its strengths and weaknesses are not well understood.

This article illustrates the use of likelihood ratios that can be generated from the reported sensitivities and specificities from given free to total PSA thresholds in either increasing or decreasing an individual patient's probability of prostate cancer. Understanding the strengths and limitations of free to total PSA testing will help clinicians anticipate whether its use is indicated or not.
A systematic review of stereotactic radiotherapy ablation for primary renal cell carcinoma
Authors: Siva Shankar , Pham Daniel , Gill Suki , Corcoran Niall M. , Foroudi Farshad
Published: October 2012

Study Type – Therapy (systematic review)

Level of Evidence 1a

What's known on the subject? and What does the study add?

At present, little is known about the role of stereotactic ablative body radiotherapy in the treatment of primary renal cell carcinoma. The published evidence to date totals 126 patients worldwide. The majority of evidence is retrospective in nature.

The present study adds context to the current literature by providing an overall summary of the evidence.

OBJECTIVE

To critically assess the use of stereotactic ablative body radiotherapy (SABR) for the treatment of primary renal cell carcinoma with particular focus on local control and toxicity outcomes.

METHODS

A systematic search on PubMed was performed in January 2012 independently by two radiation oncologists using structured search terms.

Secondary manual searches were performed on citations in relevant publications and abstracts in major radiotherapy journals.

Outcomes, techniques, biological doses and scientific rigour of the studies were analysed.

RESULTS

In total 10 publications (seven retrospective and three prospective) were identified. A wide range of techniques, doses and dose fractionation schedules were found.

A total of 126 patients were treated with between one and six fractions of SABR. Median or mean follow‐up ranged from 9 to 57.5 months. A weighted local control was reported of 93.91% (range 84%–100%).

The weighted rate of severe grade 3 or higher adverse events was 3.8% (range 0%–19%). The weighted rate of grade 1–2 minor adverse events was 21.4% (range 0%–93%). The most commonly employed fractionation schedule was 40 Gy delivered over five fractions.

CONCLUSIONS

Current literature suggests that SABR for primary renal cell carcinoma can be delivered with promising rates of local control and acceptable toxicity.

However, there was insufficient evidence to recommend a consensus view for dose fractionation or technique.

This indicates the need for further prospective studies assessing the role of this technique in medically inoperable patients.
Influence of achieved paternity on quality of life in testicular cancer survivors
Authors: Stoehr Brigitte , Schachtner Lydia , Pichler Renate , Holzner Bernhard , Giesinger Johannes , Oberguggenberger Anne , Leonhartsberger Nicolai , Horninger Wolfgang , Steiner Hannes
Published: October 2012

What's known on the subject? and What does the study add?

It is known that testicular cancer, as with any malignancy, influences many different aspects of quality of life and that surgical treatment and chemotherapy negatively influence male fertility.

The study shows the importance of achieved paternity in those testicular cancer survivors with a declared wish to father a child. The study used a QoL questionnaire EORTC QLQ‐TC 26 to supplement the existing QoL questionnaire QLQ‐C30 of the European Organisation for the Research and Treatment of Cancer in patients with cancer.

OBJECTIVE

To investigate the influence of achieved/non‐achieved paternity on quality of life (QoL) in testicular cancer (TC) survivors.

PATIENTS AND METHODS

We invited TC survivors treated at our department between 1989 and 2006 to complete a QoL assessment, including the European Organisation for the Research and Treatment of Cancer QoL questionnaire, EORTC QLQ‐C30 (version 3.0©)/+ TC26, and follow‐up questions.

A total of 311 TC survivors answered the questionnaire, of whom 207 patients who did not desire paternity were excluded. The remaining 104 patients who stated a desire for paternity after TC treatment were further divided in group A (TC survivors who achieved paternity; n= 51) and group B (TC survivors who did not achieve paternity; n= 53).

The data obtained were statistically analysed.

RESULTS

Significant differences between groups regarding QoL were detected for social functioning (P= 0.002), emotional functioning (P= 0.001), general QoL (P= 0.018), fatigue (P= 0.025), pain (P= 0.01), sleeping problems (P= 0.024), treatment satisfaction (P= 0.039), financial aspects (P= 0.006), sexual problems (P= 0.017), body image problems (P< 0.001), dyspnoea (P= 0.005) and cognitive functioning (P= 0.019).

For all scales except ‘sexual enjoyment’, patients in group A were found to have a better long‐term QoL than those in group B.

CONCLUSIONS

Whilst acknowledging the shortcomings in retrospective analyses, we believe our data clearly underline the important impact on QoL for TC survivors of achieved paternity.

Counselling patients early at diagnosis as well as using cryopreservation of semen in all potential patients before treatment (only excluding patients definitely claiming they do not wish to achieve paternity) should therefore be regarded as the standard of care.
Chimpanzees and bonobos exhibit divergent spatial memory development
Authors: Rosati Alexandra G. , Hare Brian
Published: October 2012

Spatial cognition and memory are critical cognitive skills underlying foraging behaviors for all primates. While the emergence of these skills has been the focus of much research on human children, little is known about ontogenetic patterns shaping spatial cognition in other species. Comparative developmental studies of nonhuman apes can illuminate which aspects of human spatial development are shared with other primates, versus which aspects are unique to our lineage. Here we present three studies examining spatial memory development in our closest living relatives, chimpanzees (Pan troglodytes) and bonobos (P. paniscus). We first compared memory in a naturalistic foraging task where apes had to recall the location of resources hidden in a large outdoor enclosure with a variety of landmarks (Studies 1 and 2). We then compared older apes using a matched memory choice paradigm (Study 3). We found that chimpanzees exhibited more accurate spatial memory than bonobos across contexts, supporting predictions from these species’ different feeding ecologies. Furthermore, chimpanzees – but not bonobos – showed developmental improvements in spatial memory, indicating that bonobos exhibit cognitive paedomorphism (delays in developmental timing) in their spatial abilities relative to chimpanzees. Together, these results indicate that the development of spatial memory may differ even between closely related species. Moreover, changes in the spatial domain can emerge during nonhuman ape ontogeny, much like some changes seen in human children.
Influence of bilingualism on memory generalization during infancy
Authors: Brito Natalie , Barr Rachel
Published: October 2012

Very few studies have examined the cognitive advantages of bilingualism during the first two years of development, and a majority of the studies examining bilingualism throughout the lifespan have focused on the relationship between multiple languages and cognitive control. Early experience with multiple language systems may influence domain‐general processes, such as memory, that may increase a bilingual child’s capacity for learning. In the current study, we found that bilingual, but not monolingual, infants were able to generalize across cues at 18 months. This is the first study to show a clear bilingual advantage in memory generalization, with more equal or balanced exposure to each language significantly predicting ability to generalize.

A video abstract of this article can be viewed athttp://www.youtube.com/watch?v=31QsMqYtGGo&feature=plcp
Beyond the body mass index: tracking body composition in the pathogenesis of obesity and the metabolic syndrome
Authors: Müller M. J. , Lagerpusch M. , Enderle J. , Schautz B. , Heller M. , Bosy‐Westphal A.
Published: October 2012

Body composition is related to various physiological and pathological states. Characterization of individual body components adds to understand metabolic, endocrine and genetic data on obesity and obesity‐related metabolic risks, e.g. insulin resistance. The obese phenotype is multifaceted and can be characterized by measures of body fat, leg fat, liver fat and skeletal muscle mass rather than by body mass index. The contribution of either whole body fat or fat distribution or individual fat depots to insulin resistance is moderate, but liver fat has a closer association with (hepatic) insulin resistance. Although liver fat is associated with visceral fat, its effect on insulin resistance is independent of visceral adipose tissue. In contrast to abdominal fat, appendicular or leg fat is inversely related to insulin resistance. The association between ‘high fat mass + low muscle mass’ (i.e. ‘sarcopenic adiposity’) and insulin resistance deserves further investigation and also attention in daily clinical practice. In addition to cross‐sectional data, longitudinal assessment of body composition during controlled under‐ and overfeeding of normal‐weight healthy young men shows that small decreases and increases in fat mass are associated with corresponding decreases and increases in insulin secretion as well as increases and decreases in insulin sensitivity. However, even under controlled conditions, there is a high intra‐ and inter‐individual variance in the changes of (i) body composition; (ii) the ‘body composition–glucose metabolism relationship’ and (iii) glucose metabolism itself. Combining individual body components with their related functional aspects (e.g. the endocrine, metabolic and inflammatory profiles) will provide a suitable basis for future definitions of a ‘metabolically healthy body composition’.
Impaired protein metabolism: interlinks between obesity, insulin resistance and inflammation
Authors: Guillet C. , Masgrau A. , Walrand S. , Boirie Y.
Published: October 2012

Metabolic and structural changes in skeletal muscle that accompany obesity are often associated with the development of insulin resistance. The first events in the pathogenesis of this disorder are considered as an accumulation of lipids within skeletal muscle due to blunted muscle capacity to oxidize fatty acids. Fat infiltration is also associated with muscle fibre typology modification, decrease in muscle mass and impairments in muscle strength. Thus, as a result of obesity, mobility and quality of life are affected, and this is in part due to quantitative and qualitative impairments in skeletal muscle. In addition, the insulin resistance related to obesity results not only in defective insulin‐stimulated glucose disposal but has also detrimental consequences on protein metabolism at the skeletal muscle level and whole‐body level. This review highlights the involvement of fat accumulation and insulin resistance in metabolic disorders occurring in skeletal muscle during the development of obesity, and the impairments in the regulation of protein metabolism and protein turnover in the links between obesity, metabolic inflammation and insulin resistance.
The adipose organ: white‐brown adipocyte plasticity and metabolic inflammation
Authors: Smorlesi A. , Frontini A. , Giordano A. , Cinti S.
Published: October 2012

White adipocytes can store energy, whereas brown adipocytes dissipate energy for thermogenesis. These two cell types with opposing functions are contained in multiple fat depots forming the adipose organ. In this review, we outline the plasticity of this organ in physiological (cold exposure, physical exercise and lactation) and pathological conditions (obesity). We also highlight molecules and signalling pathways involved in the browning phenomena of white adipose tissue. This phenotypic change has proved to be effective in the protection against the metabolic disorders associated to obesity and diabetes, not only because brown adipocytes are more ‘healthy’ than white adipocytes, but also because the simple size reduction of white adipocytes that characterizes the first steps of transdifferentiation can be useful in determining how to avoid triggering death based on critical size and the consequent chronic low‐grade inflammation due to macrophage infiltration. Thus, a better understanding of the molecular mechanisms at the basis of white‐brown transdifferentiation can be extremely useful to exploit new therapeutic strategies to combat the increasing incidence of metabolic diseases.
Core temperature: a forgotten variable in energy expenditure and obesity?
Authors: Landsberg L.
Published: October 2012

A substantial proportion of energy expenditure is utilized for maintenance of the ‘warm‐blooded’ or homoeothermic state. In normally active humans, this compartment of energy output approximates 40% of total energy expenditure. Many mammalian species utilize regulated decreases in temperature, such as hibernation or shallow torpor, as a means of energy conservation. Inherited forms of rodent obesity (ob/ob mouse, fa/fa rat) have lower core temperatures and withstand cold poorly. Obese humans, however, have normal core temperatures. This review addresses the role of core temperature in the metabolic economy of the obese state and raises the possibility that (i) lower temperatures may contribute to the increase in metabolic efficiency that accompanies weight loss in the obese; and (ii) that lower core temperatures may have initiated weight gain in the pre‐obese state and that the normal temperatures in the obese may represent metabolic compensation to restore energy balance and limit further weight gain.
Evidence and Contestation in the Indigenous Policy Domain: Voice, Ideology and Institutional Inequality
Authors: Maddison Sarah
Published: October 2012

There is a tension in the evidence‐based policy paradigm as it concerns Aboriginal and Torres Strait Islander people, particularly with regard to their standing as evidence providers. Aboriginal people in Australia have primarily been seen as a ‘problem to be solved’ and racialised views of Aboriginal competence have allowed for past policy, now recognised as harmful, to be justified as being ‘for their own good’. This article considers some of the complexities of the evidence‐based policy paradigm as it applies to the Indigenous policy domain, arguing that in such a turbulent field the use of evidence is inevitably ideological and selective. The article concludes that, in light of persistent institutional inequalities, including Aboriginal and Torres Strait Islander voices and perspectives in genuine dialogue about policy is the only way to navigate this difficult terrain with any chance of success.
A Missed Opportunity to Promote Community Resilience? – The Queensland Floods Commission of Inquiry
Authors: McGowan Jim
Published: October 2012

This commentary piece argues that the recent Queensland Floods Commission of Inquiry of 2011 remained trapped in a reactive, inquisitorial mindset that led the commissioners to produce prescriptive recommendations aimed at increased regulation and modelling. It largely ignored the parallel discourse around disaster management emphasising community resilience, which has been endorsed by governments across Australia through the Council of Australian Governments’ recent national strategy. Consequently, my argument, as a former director‐general of community safety in Queensland, is that the recent commission of inquiry missed a great opportunity both to reinforce the resilience policy approach and redirect funds from response and recovery endeavours to better ways of securing preparedness, prevention and mitigation.
Grand Designs? The ‘Managerial’ Role of Ministers Within Westminster‐Based Public Management Policy
Authors: Di Francesco Michael
Published: October 2012

This article explores the design of public management policies in Westminster‐based systems, with a focus on Australia. It argues that orthodox analysis of public management policy is deficient in two ways: first, policy change directed at bureaucratic structures tends to ignore the critical role that ministers must play in making ‘management’ reforms work; second, such policy change tends to assume away key ‘inherencies’ that inhibit behavioural changes in politicians that might otherwise be expected from enhanced management structures. The article examines the under‐conceptualised managerial role that requires ministers to be an integral part of departmental leadership, and contends that key aspects of public management – in particular, performance control – are dependent on this ministerial role orientation becoming more prominent. In effect, the article raises a public management ‘heresy’ by profiling the need for ministers to conform more with their own prescriptions for improved management.
Australian Councils Unelected by the Citizens in an Indigenous Setting: The Case of Nhulunbuy in the Northern Territory
Authors: Pearson Cecil A. L.
Published: October 2012

Within the Australian democratic nation there are towns where the citizens are governed by administrations that have not been democratically elected by the residents. These unique residential centres are termed ‘special purpose towns’ that can be transformed to a permanent community governed by a democratic structure through a process termed normalisation. This paper examines the special purpose mining town of Nhulunbuy in the Northern Territory of Australia, which is on the cusp of the normalisation process. The paper outlines the similarities and differences of local government roles and responsibilities with Australian towns or shires that have publicly elected executive members. How Indigenous people are facilitating the normalisation of Nhulunbuy, through cultural perceptions of opportunity, is discussed. A concluding focus challenges well established conventional frameworks endorsing the roles of governments and miners in the normalisation phenomenon.
Effects of Leadership Style, Creativity Technique and Personal Initiative on Employee Creativity
Authors: Herrmann Daniel , Felfe Jörg
Published: October 2012

Transformational leadership is assumed to enhance employees' creativity. However, results of meta‐analytic research on the relations between transformational leadership and creativity have fallen short of expectations. The authors argue that, besides leadership style, the creativity technique that a leader employs is an important means of stimulating employees' creativity. In addition, it is assumed that leadership styles and creativity techniques may have different effects, depending on the measure of creativity output (quantitative vs qualitative). Therefore, in an experimental setting, the effects of different creativity techniques (provocation technique vs brainwriting) and leadership styles (transformational vs transactional) on both quantitative and qualitative creativity were examined. Results showed that transformational leadership and provocation technique led to higher levels of qualitative creativity than transactional leadership and brainwriting, respectively. Conversely, transactional leadership and brainwriting were more effective for quantitative creativity. The additional benefit of the provocation technique in qualitative creativity was found to be higher in the transactional leadership condition than in the transformational leadership condition. Moreover, personal initiative made a significant and independent contribution to both qualitative and quantitative creativity. Implications for practice and future research are discussed.
Assumed infectiousness, treatment adherence and sexual behaviours: applying the Swiss Statement on infectiousness to HIV‐positive alcohol drinkers
Authors: Kalichman SC , Grebler T , Amaral CM , McKerey M , White D , Kalichman MO , Cherry C , Eaton L
Published: October 2012

Objectives

The success of antiretroviral therapy (ART) for treating HIV infection is now being turned towards HIV prevention. The Swiss Federal Commission for HIV/AIDS has declared that HIV‐positive persons who are treated with ART, have an undetectable viral load, and are free of co‐occurring sexually transmitted infections (STIs) should be considered noninfectious for sexual transmission of HIV. This study examined the implications of these assumptions in a sample of HIV‐positive individuals who drink alcohol.

Methods

People living with HIV/AIDS (n = 228) were recruited through community sampling. They completed confidential computerized interviews and underwent monthly unannounced pill counts for ART adherence. HIV viral loads were obtained from medical records.

Results

One hundred and eighty‐five HIV‐positive drinkers were currently receiving ART and 43 were untreated. Among those receiving ART, one in three were not virally suppressed and one in five had recently been diagnosed with an STI. Adherence was generally suboptimal, including among those assumed to be less infectious. As many as one in four participants reported engaging in unprotected intercourse with an HIV‐uninfected partner in the past 4 months. There were few associations between assumed infectiousness and sexual practices.

Conclusions

Less than half of people who drank alcohol and took ART met the Swiss criteria for noninfectiousness. Poor adherence and prevalent STI threaten the long‐term potential of using ART for prevention. In the absence of behavioral interventions, the realities of substance use and other barriers call into question the use of ART as prevention among alcohol drinkers.
Imitating Christ's Cross: Lonergan and Girard on How and Why
Authors: Miller Mark T.
Published: October 2012

The article begins with the gospels’ admonition to take up one's cross and asks how Christians might understand Christ's work on the cross so that we might better imitate or participate in it. Using tools from recent advances in literary analysis and systematic theology, the article attempts to provide some answer to this question. It considers contemporary feminist and liberation theologians’ criticism of the common but problematic interpretation of Christ's cross, what is often called ‘substitutionary penal atonement.’ It compares this with Anselm's atonement theory of satisfaction and Bernard Lonergan's and René Girard's analysis of the cross as a communication of love that invites others into loving relationship. With these interpretations of Christ's work, it concludes with some thoughts on how Christians might take up their own daily crosses.
Admission base excess as a predictor of transfusion requirement and mortality in dogs with blunt trauma: 52 cases (2007–2009)
Authors: Stillion Jenefer R. , Fletcher Daniel J.
Published: October 2012

Objective

To evaluate the ability of admission base excess (ABE) to predict blood transfusion requirement and mortality in dogs following blunt trauma.

Design

Retrospective study 2007–2009.

Setting

University Veterinary Teaching Hospital.

Animals

Fifty‐two dogs admitted to the intensive care unit for treatment following blunt trauma.

Measurements and main results

Animals requiring red blood cell transfusion (N = 8) had significantly lower ABE than those not requiring transfusion (N = 44; median base excess [BE] = −8.4 versus −4.7, P = .0034), while there was no difference in admission packed cell volume (PCV) or age. Animals that died or were euthanized due to progression of signs (N = 5) had lower median ABE than those that survived (N = 47; median BE = −7.3 versus −4.9, P = 0.018). Admission PCV and age were not significantly different between survivors and nonsurvivors. Receiver operator characteristic curve analysis showed an ABE cutoff of −6.6 was 88% sensitive and 73% specific for transfusion requirement (P < 0.001), and a cutoff of −7.3 was 81% sensitive and 80% specific for survival (P < 0.001). Multivariate logistic regression analysis demonstrated that ABE was a predictor of transfusion requirement that was independent of overall severity of injury as measured by the Animal Triage Trauma (ATT) score, but a similar analysis showed that only ATT was an independent predictor of survival.

Conclusions

The ABE in dogs with blunt trauma was a predictor of mortality and blood transfusion requirement within 24 hours.
Population Trends in Pacific Oceanic Sharks and the Utility of Regulations on Shark Finning
Authors: Clarke Shelley C. , Harley Shelton J. , Hoyle Simon D. , Rice Joel S.
Published: October 2012

Accurate assessment of shark population status is essential for conservation but is often constrained by limited and unreliable data. To provide a basis for improved management of shark resources, we analyzed a long‐term record of species‐specific catches, sizes, and sexes of sharks collected by onboard observers in the western and central Pacific Ocean from 1995 to 2010. Using generalized linear models, we estimated population‐status indicators on the basis of catch rate and biological indicators of fishing pressure on the basis of median size to identify trends for blue (Prionace glauca), mako (Isurus spp.), oceanic whitetip (Carcharhinus longimanus), and silky (Carcharhinus falciformis) sharks. Standardized catch rates of longline fleets declined significantly for blue sharks in the North Pacific (by 5% per year [CI 2% to 8%]), for mako sharks in the North Pacific (by 7% per year [CI 3% to 11%]), and for oceanic whitetip sharks in tropical waters (by 17% per year [CI 14% to 20%]). Median lengths of silky and oceanic whitetip sharks decreased significantly in their core habitat, and almost all sampled silky sharks were immature. Our results are consistent with results of analyses of similar data sets. Combined, these results and evidence of targeted fishing for sharks in some regional fisheries heighten concerns for sustainable utilization, particularly for oceanic whitetip and North Pacific blue sharks. Regional regulations that prohibit shark finning (removal of fins and discarding of the carcass) were enacted in 2007 and are in many cases the only form of control on shark catches. However, there is little evidence of a reduction of finning in longline fisheries. In addition, silky and oceanic whitetip sharks are more frequently retained than finned, which suggests that even full implementation of and adherence to a finning prohibition may not substantially reduce mortality rates for these species. We argue that finning prohibitions divert attention from assessing whether catch levels are sustainable and that the need for management of sharks should not be addressed by measures that are simple to implement but complex to enforce and evaluate.

Tendencias Poblacionales de Tiburones del Océano Pacífico y la Utilidad de Regulaciones sobre Cercenamiento de Aletas
A pilot clinical study of hair grafting in chronic leg ulcers
Authors: Jiménez Francisco , Garde Carmen , Poblet Enrique , Jimeno Begoña , Ortiz Jesús , Martínez María L. , Gutiérrez‐Rivera Araika , Pérez‐López Virginia , Etxaniz Usue , Naveda Corina , Higuera José L. , Egüés Nerea , Escario Eduardo , Izeta Ander
Published: October 2012

Epidermal sheets spread centrifugally postinjury from the hair follicle infundibulum to reepithelialize the wound bed. Healing progresses faster in skin areas rich in terminal hair follicles. These observations are consistent with the role of the hair follicle as a major reservoir for progenitor cells. To evaluate the feasibility and potential healing capacity of autologous scalp follicular grafts transplanted into the wound bed of chronic leg ulcers, 10 patients with ulcers of an average 36.8 cm2 size and a 10.5‐year duration were included in this pilot study. Within each ulcer we randomly assigned a 2 × 2 cm “experimental” square to receive 20 hair grafts and a nongrafted “control” square of equal size. The procedure seemed to be safe, although major unrelated complications occurred in two patients. At the 18‐week end point, we observed a 27.1% ulcer area reduction in the experimental square as compared with 6.5% in the control square (p = 0.046) with a maximum 33.5% vs. 9.7% reduction at week 4 (p = 0.007). Histological analyses showed enhanced epithelialization, neovascularization, and dermal reorganization. We conclude that terminal hair follicle grafting into wound beds is feasible in an outpatient setting and represents a promising therapeutic alternative for nonhealing chronic leg ulcers.
Low‐energy extracorporeal shock wave therapy enhances skin wound healing in diabetic mice: A critical role of endothelial nitric oxide synthase
Authors: Hayashi Denso , Kawakami Kazuyoshi , Ito Kenta , Ishii Keiko , Tanno Hiromasa , Imai Yoshimichi , Kanno Emi , Maruyama Ryoko , Shimokawa Hiroaki , Tachi Masahiro
Published: October 2012

Low‐energy extracorporeal shock wave (LE‐ESW) treatment has been shown to accelerate wound repair; however, the mechanisms of treatment remain unclear. In the present study, we addressed the role of endothelial nitric oxide synthase (eNOS). A single LE‐ESW treatment accelerated the healing of wounds in diabetic mice caused by the injection of streptozotocin. This accelerated healing was accompanied by the increased expression of eNOS and vascular endothelial growth factor (VEGF) and the generation of new vessels at the wound tissues. These results raised the possibility that eNOS may be involved in the beneficial effects of LE‐ESW treatment. To address this possibility, we compared the effects of this treatment between mice with a genetic disruption of eNOS knockout (eNOS‐KO mice) and wild‐type (WT) control mice. Interestingly, the LE‐ESW‐induced acceleration of wound closure and the increase in VEGF expression and neovascularization was significantly attenuated in eNOS‐KO mice compared with WT mice. Considered collectively, these results showed that eNOS was induced at the wound tissues by LE‐ESW treatment and played a critical role in the therapeutic effects of this treatment by accelerating the wound healing by promoting VEGF expression and neovascularization.
Branchiooculofacial Syndrome and Bilateral Ectopic Thymus: Report of a Family
Authors: Loh James , El‐Hakim Hamdy , Sergi Consolato Maria , Fiorillo Loretta
Published: October 2012

Branchiooculofacial syndrome (BOFS) is a rare autosomal‐dominant condition characterized by branchial cleft sinus and ophthalmologic and craniofacial abnormalities that can range from mild to severe forms. Ectopic thymus, an uncommon condition with just over 100 cases reported in the literature, is seen in BOFS. We report a family with BOFS affecting the mother and two daughters, showing the dominant inheritance and variable phenotypical expression of BOFS.
Road Test and Naturalistic Driving Performance in Healthy and Cognitively Impaired Older Adults: Does Environment Matter?
Authors: Davis Jennifer D. , Papandonatos George D. , Miller Lindsay A. , Hewitt Scott D. , Festa Elena K. , Heindel William C. , Ott Brian R.
Published: October 2012

Objectives

To relate the standardized road test to video recordings of naturalistic driving in older adults with a range of cognitive impairment.

Design

Cross‐sectional observational study.

Setting

Academic medical center memory disorders clinic.

Participants

One hundred three older drivers (44 healthy, 59 with cognitive impairment) who passed a road test.

Measurements

Error rate and global ratings of safety (pass with and without recommendations, marginal with restrictions or training, or fail) made by a professional driving instructor.

Results

There was fair agreement between global ratings on the road test and naturalistic driving. More errors were detected in the naturalistic environment, but this did not affect global ratings. Error scores between settings were significantly correlated, and the types of errors made were similar. History of crashes corrected for miles driven per week was related to road test error scores but not naturalistic driving error scores. Global cognition (Mini‐Mental State Examination) was correlated with road test and naturalistic driving errors. In healthy older adults, younger age was correlated with fewer errors on the road test and more errors in naturalistic driving.

Conclusion

Road test performance is a reasonable proxy for estimating fitness to drive in older individuals' typical driving environments, but differences between performance assessed using these two methods remain poorly understood and deserve further study.
Antiepileptic Drug Monotherapy Exposure and Suicide‐Related Behavior in Older Veterans
Authors: Pugh Mary Jo V. , Copeland Laurel A. , Zeber John E. , Wang Chen‐Pin , Amuan Megan E. , Mortensen Eric M. , Tabares Jeffrey V. , Van Cott Anne C. , Cooper Toby L. , Cramer Joyce A.
Published: October 2012

Objectives

To examine the association between antiepileptic drug (AED) receipt and suicide‐related behavior (SRB) in older veterans.

Design

Retrospective database analysis.

Setting

Veterans Health Administration (VHA) inpatient and outpatient care.

Participants

Veterans aged 65 and older in 2004 to 2006.

Measurements

SRB was identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes, and new AED monotherapy was identified using the VHA product variable in pharmacy data. Comorbid conditions and medications were also identified as potential confounders using previously validated algorithms. Cox proportional hazards models controlling for the propensity to receive AEDs examined the association between any AED exposure, specific AEDs, and time to SRB.

Results

Within the eligible sample of 2.15 million individuals, 332 cases of SRB were found. Overall, 98% of participants were male, and 67% were non‐Hispanic white. Affective disorders and severe psychiatric conditions were strongly associated with SRB and were included in the propensity score. AED exposure displayed a significant association with SRB (odds ratio = 4.10, 95% confidence interval (CI) = 3.85–6.63) after adjusting for propensity to receive AEDs. Stratified analyses found similar results for those with (hazard ratio (HR) = 4.00, 95% CI = 2.9–5.5) and without (HR = 4.57, 95% CI = 1.15–18.20) mental health comorbidities. Gabapentin, phenytoin, lamotrigine, levetiracetam, topiramate, and valproate were significantly associated with SRB.

Conclusion

Exposure to five common AEDs was associated with SRB in older VHA beneficiaries. Given the strong associations between psychiatric comorbidity and SRB, clinicians treating elderly adults should weigh this potential adverse effect into their consideration for treatment of those receiving AEDs. Particular attention should be given to depression and suicidality screening in people prescribed AEDs.
Clinical and Economic Burden of Community‐Acquired Pneumonia in the Medicare Fee‐for‐Service Population
Authors: Yu Holly , Rubin Jaime , Dunning Stephan , Li Suying , Sato Reiko
Published: October 2012

Objectives

To estimate current community‐acquired pneumonia (CAP) incidence and its associated economic burden in the Medicare fee‐for‐service (FFS) population.

Design

Retrospective.

Setting

The 2007/08 Medicare Standard Analytic Files, a nationally representative random sample (5%) of Medicare beneficiaries enrolled in the FFS program.

Participants

Residents of one of the 50 U.S. states or the District of Columbia aged 18 and older on July 1, 2007, with continuous Part A and Part B coverage during calendar year 2007.

Measurements

Incidence, episode length, mortality, and costs were assessed. All‐cause costs were assessed using three methodologies: costs during the episode, and incremental costs using CAP cases as self‐control (before–after) and with matched controls (case–control).

Results

Sixty‐five thousand eight hundred four CAP episodes (39% inpatient‐treated episodes) were identified. Average inpatient and outpatient episode lengths were 32.8 ± 46.9 and 12.4 ± 27.3 days, respectively, and overall incidence was 4,482/100,000 person‐years. Thirty‐day case fatality was 8.5% for inpatient and 3.8% for outpatient CAP. The average CAP episode cost was $8,606 ($18,670 for inpatient, $2,394 for outpatient). The incremental cost of a CAP episode in the before‐and‐after and case–control analyses was approximately $10,000.

Conclusion

An estimated 1.3 million CAP cases and 74,000 CAP‐related deaths were found, with an economic burden of $13 billion annually in the Medicare fee‐for‐service population. Preventing CAP in this population may substantially reduce healthcare costs.
Factors Associated with the Enactment of Safety Belt and Motorcycle Helmet Laws
Authors: Law Teik Hua , Noland Robert B. , Evans Andrew W.
Published: October 2012

It has been shown that road safety laws, such as motorcycle helmet and safety belt laws, have a significant effect in reducing road fatalities. Although an expanding body of literature has documented the effects of these laws on road safety, it remains unclear which factors influence the likelihood that these laws are enacted. This study attempts to identify the factors that influence the decision to enact safety belt and motorcycle helmet laws. Using panel data from 31 countries between 1963 and 2002, our results reveal that increased democracy, education level, per capita income, political stability, and more equitable income distribution within a country are associated with the enactment of road safety laws.
Neolithic cremation in south‐east Arabia: archaeological and anthropological observations at FAY‐NE10 in the Emirate of Sharjah (UAE)
Authors: Kutterer Adelina U. , Doppler Stefanie , Uerpmann Margarethe , Uerpmann Hans‐Peter
Published: October 2012

Small fragments of cremated human bone, clearly representing numerous individuals, were found in a stratified Neolithic context in a small cave at Jebel Faya in the Central Region of the Emirate of Sharjah, United Arab Emirates. With radiocarbon dates between 6500 and 5800 cal BC, they are among the earliest well‐documented cases of cremations in south‐west Asia. Taxonomic identification of the small burned bone fragments is based on morphological and histological analysis. The deposits are to date the oldest human remains found in south‐east Arabia and represent a phase during the Middle Neolithic for which no other types of burials have yet been documented.
Rates and consequences of relaying in little auks Alle alle breeding in the High Arctic an experimental study with egg removal
Authors: Jakubas Dariusz , Wojczulanis‐Jakubas Katarzyna
Published: October 2012

Most seabirds have a small clutch size. Thus, replacement of a clutch after loss can make important contributions to an individual’s lifetime reproductive success. However, in the condition of short polar summer, relaying propensity may be time‐constrained. In this study, we investigated rates and consequences of relaying in a small High Arctic seabird, the little auk Alle alle. We performed an experiment in which we removed the single egg from 20 nests of early‐laying breeders. We measured relaying rates, and compared chick body mass and breeding success between the experimental and control nests. Despite the narrow window of the Arctic summer and the closely synchronized breeding, 75% of females produced a replacement egg just 2.7% smaller in volume than the first egg. This indicates that in little auks, the demographic effects of disruptions to breeding attempts (by predators, adverse weather or human activity) may be mitigated to some extent by replacement clutches. However, peak body mass and fledging body mass were lower in the experimental than the control chicks. This effect was rather a consequence of late hatching – chicks from replacement clutches followed seasonal decline in peak body mass and fledging mass. Finally, breeding success and chick survival up to 20 d in the experimental nests were respectively 34 and 37% lower than in the control nests. Thus, the quality and post‐fledging survival of chicks from the replacement clutches were probably lower compared to the chicks hatched from the first‐laid eggs.
Establishment and spatial associations of recruits in meadow gaps
Authors: Fibich Pavel , Vítová Alena , Macek Petr , Lepš Jan
Published: October 2012

Questions

What is the spatio‐temporal dynamics of recruit (seedlings and vegetative sprouts) establishment in meadow gaps? What processes prevail during recruit establishment? At what spatio‐temporal scales do they operate?

Location

A wet meadow in South Bohemia, a region of the Czech Republic.

Methods

We studied spatio‐temporal dynamics in pattern of recruits (seedlings and vegetative sprouts) to characterize development and underlying ecological processes during gap colonization. We established four types of artificial gaps laid out in ten replicated blocks. To distinguish the effects of generative vs vegetative reproduction we used gaps with sterilized and non‐sterilized soil (manipulating the seed bank), and manipulated the possibility of clonal spread by inserting mesh or felting along the borders of the gaps.

Results

The majority of recruits appeared during July and August. Recruits were surrounded by empty spaces of 5–9 mm, and formed clumps of 20 mm or more. Clumping of even‐aged seedlings and a lower number of vegetative recruits were observed in the gaps with non‐sterilized soil. Overall, clonal spread was limited to the gap borders, being far less common than recruit establishment from seeds. The recruits emerged preferentially close to the gap centre where the temperature was highest as was the red to far–red ratio (R:FR). However, during the season, the majority of late recruits were observed in the southern, coolest parts of the gaps, reflecting the increasing importance of the facilitative effect of the surrounding vegetation.

Conclusions

Gaps were colonized predominantly from seeds; vegetative propagation was very slow and appeared at the end of the season. The presence of a seed bank enabled earlier gap colonization; the effect of seed rain became increasingly important during the season. The recruits were clumped, which further supports environmentally driven establishment, although other factors (e.g. facilitation) cannot be excluded. For the shortest distances, recruits were absent close neighbours due to the strongest competition. We therefore suggest that there was a spatial continuum between competition and facilitative effects among individual recruits.
Termite mounds as islands: woody plant assemblages relative to termitarium size and soil properties
Authors: Joseph Grant S. , Seymour Colleen L. , Cumming Graeme S. , Cumming David H.M. , Mahlangu Zacheus
Published: October 2012

Questions

We investigated whether soils of small mounds resembled large mound or matrix soils, whether changes in plant composition reflected changes in soils, and the sequence in which plants colonize and disappear from mounds of increasing size.

Location

Miombo woodland in northwest Zimbabwe.

Methods

Macrotermitinae termitaria vary in size and soil nutrient concentrations, harbouring distinct woody plant assemblages, making them foci for plant and animal diversity, and also influencing primary, secondary and tertiary productivity. In spite of the importance of termitaria to heterogeneity and diversity, no studies have investigated changes in plant species assemblages as mound surface area increases to the point where mound vegetation is distinct from that of the matrix. We compared woody plant assemblages on 43 matrix plots with 95 Macrotermes termitaria across a range of surface areas, using ANOSIM, cluster analysis and MDS ordination. We compared soil nutrients, pH and clay, from ten large and ten small termitaria, and ten matrix sites. We also assessed how relative representation of large mound or matrix indicator species changed with mound area.

Results

Change was apparent even at mound sizes of >10 m2, where both soils and plant assemblages on mounds were significantly different to those of the matrix. Plant assemblages fell into two main groups at 20% similarity; the first comprised of matrix plots, mounds <10 m2 and some mounds between 10 and 30 m2; the second, the remainder of the mounds between 10 and 30 m2 and all mounds >30 m2. At 40% similarity, four groups emerged: matrix, mounds <10 m2, mounds 10–30 m2 and mounds >30 m2. Woody plant composition changed gradually as mound area increased. On termitaria <10 m2, only 25% of indicators were mound indicator species, but on mounds between 10 and 30 m2 in size, 62.5% were mound indicators. On termitaria >30 m2 in surface area, only mound indicator species were found.

Conclusions

Through termite activities in concentrating nutrients and clay, termitaria provide habitat for species usually excluded from the matrix. The process of mound building and the nature of the plants that establish on them seem to establish a positive feedback for establishment of other non‐woodland matrix species.