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Copyright of Österreichische Wasser- und Abfallwirtschaft is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The bulking agent NASHA Dx injected into the submucosal layer is effective in the treatment of fecal incontinence (FI) at short-and medium-term follow-up but efficacy after injection in the intersphincteric location is unknown. The aim of this study was to determine the short- and long-term efficacy and safety of NASHA Dx injected into the intersphincteric location for FI. Methods: Patients were recruited from referrals to our Department for treatment of FI in November 2008–January 2010. Eligible patients were injected with 8 ml of NASHA Dx. Patients with a subtotal treatment effect were retreated after 2–4 weeks. The change in number of fecal incontinence episodes, the proportion of responders defined as at least 50% decrease in number of FI episodes and side effects were the main outcome measures. Results: Sixteen patients, 15 women and 1 man with a median age of 68, 5 (range 44–80) years and a median CCFIS of 15 (range 10–19) were included in the study. The median number of incontinence episodes decreased from 21.5 (range 8–61) at baseline to 10 (range 0–30) at 6 months (p = 0.003) and 6 (range 0–44) at 12 months (p = 0.05). The median number of incontinence episodes in the 11 patients completing the 10-year follow-up was 26.5 (range 0–68). The percentage of responders at 12 months and 10 years were 56% and 27%, respectively. Mild to moderate pain at the injection site was described by 69%. There was one case of mild infection, successfully treated with antibiotics and one implant had to be removed due to dislocation. Conclusions: NASHA Dx as an intersphincteric implant improves incontinence symptoms in the short term with moderate side effects and can be used alone or as an adjunct to other treatment modalities. Long-term efficacy was observed in 27%. [ABSTRACT FROM AUTHOR]

Background Several different procedures have been described for surgical treatment of rectal prolapse and consensus on the optimal approach has not been reached. The Swedish Rectal Prolapse Trial was performed with the aim to compare the outcomes after the most common surgical approaches to rectal prolapse. Method A multicentre randomized trial was conducted from 2000 to 2009. Patients were randomized between a perineal or an abdominal approach for correction of rectal prolapse (randomization A) if eligible for any procedures. Patients considered unsuitable for random allocation were only included in randomizations B or C. Patients in randomization B (perineal group) were randomized to Delorme's or Altemeier's procedures and those in randomization C (abdominal group) to suture rectopexy or resection rectopexy. Primary outcomes were bowel function and quality of life, measured using Wexner incontinence score and RAND-36, and secondary outcomes were complications and recurrence at 3 years. Results During the study period, 134 patients were randomized: 18 in randomization A group, 80 in randomization B group and 54 in randomization C group; of these, 122 patients underwent surgery. Mean follow-up was 2.6 years. Improvements in Wexner and RAND-36 scores were seen but with no significant difference between the groups. Health change scores were significantly improved from baseline up to 1 year after surgery (P < 0.001). At 3 years, recurrence rates were two of seven patients for abdominal versus five of eight patients for perineal approach (P = 0.315), 18 of 31 patients (58 per cent) for Delorme's versus 15 of 30 patients (50 per cent) for Altemeier's (P = 0.611) and four of 19 patients (21 per cent) for suture rectopexy versus two of 21 patients (10 per cent) for resection rectopexy (P = 0.398). There were no significant differences regarding postoperative complications. Conclusion For all procedures, significant improvements from baseline in health change scores were noted after surgery. Recurrence rates were higher than previously reported. Registration number: NCT04893642 (http://www.clinicaltrials.gov). [ABSTRACT FROM AUTHOR]

This study tested genetic microbial source tracking (MST) methods for identifying ruminant‐ (BacR) and human‐associated (HF183/BacR287, BacHum) bacterial faecal contaminants in Ethiopia in a newly created regional faecal sample bank (n = 173). BacR performed well, and its marker abundance was high (100% sensitivity (Sens), 95% specificity (Spec), median log10 8·1 marker equivalents (ME) g−1 ruminant faeces). Human‐associated markers tested were less abundant in individual human samples (median: log10 5·4 and 4·2 (ME + 1) g−1) and were not continuously detected (81% Sens, 91% Spec for BacHum; 77% Sens, 91% Spec for HF183/BacR287). Furthermore, the pig‐associated Pig2Bac assay was included and performed excellent (100% Sens, 100% Spec). To evaluate the presence of MST targets in the soil microbiome, representative soil samples were tested during a whole seasonal cycle (n = 60). Only BacR could be detected, but was limited to the dry season and to sites of higher anthropogenic influence (log10 3·0 to 4·9 (ME + 1) g−1 soil). In conclusion, the large differences in marker abundances between target and non‐target faecal samples (median distances between distributions ≥log10 3 to ≥log10 7) and their absence in pristine soil indicate that all tested assays are suitable candidates for diverse MST applications in the Ethiopian area. [ABSTRACT FROM AUTHOR]

Isoperla nagyi sp. n. is described on the basis of morphology of male and female adults and eggs. The new species is classified as an isolated species within the West Palaearctic Isoperla. It was found in the lower elevations of the Ţarcu Mts that is forming a high range of the westernmost Southern Carpathians. Further contributions are given on the stonefly fauna of the Ţarcu Mts, including notes on the Romanian distribution of Brachyptera bulgarica Raušer, and the taxonomy and distribution of Isoperla pusilla (Klapálek). [ABSTRACT FROM AUTHOR]

Aim: The aim of this work was to perform a long‐term evaluation of a randomized trial focusing on functional aspects after excisional haemorrhoidectomy with a minimum follow‐up of 9 years. Method: A questionnaire‐based study including patients operated on for haemorrhoids in Sweden between 1999 and 2003. A total of 225 patients were randomized to Milligan's or Ferguson's operation. Twenty‐six patients had died and 151 (76%) participated after a median follow‐up of 10.7 years (range 9.2–12.6 years). Results: Seventy‐seven patients were in the Milligan group and 74 in the Ferguson group. Forty‐eight (32%) reported recurrence. Anal bleeding was reported in 80% at baseline but in 28% at long‐term follow‐up (P < 0.0001). At baseline, 49% had spontaneous anal pain and 25% pain at defaecation. At follow‐up, these figures were 17% and 11%. At follow‐up, 19% described a sense of anal stenosis. At baseline, soiling was reported in 51% but in 20% at long‐term follow‐up (P < 0.001). Nineteen per cent used pads preoperatively and 6% at follow‐up (P < 0.0001). Straining at defaecation was reported by 35% at baseline. At follow‐up, this figure was 25% (P = 0.055). Conclusion: Symptoms associated with haemorrhoids were reduced at long‐term follow‐up. The most common problems were perceived recurrence and a sense of anal stenosis. [ABSTRACT FROM AUTHOR]

Purpose: Colectomy with ileorectal anastomosis (IRA) is the most common surgical procedure for slow transit constipation (STC). A hemicolectomy has been suggested as an alternative to IRA with good short-term results. However, long-term results are unknown. The aim of this study was to evaluate the long-term results after hemicolectomy as a treatment for STC. Methods: Fifty patients with STC were selected for right- or left-sided hemicolectomy after evaluation with colonic scintigraphy from 1993 to 2008. Living patients (n = 43) received a bowel function questionnaire and a questionnaire about patient-reported outcome. Results: After a median follow-up of 19.8 years, 13 patients had undergone rescue surgery (n = 12) or used irrigation (n = 1) and were classified as failures. In all, 30 were evaluable for functional outcome and questionnaire data for 19 patients (due to 11 non-responding) could be analysed. Two reported deterioration after several years and were also classified as failures. Median stool frequency remained increased from 1 per week at baseline to 5 per week at long-term follow-up (p = 0.001). Preoperatively, all patients used laxatives, whereas 12 managed without laxatives at long-term follow-up (p = 0.002). There was some reduction in other constipation symptoms but not statically significant. In the patients' global assessment, 10 stated a very good result, seven a good result and two a poor result. Conclusions: Hemicolectomy for STC increases stool frequency and reduces laxative use. Long-term success rate could range between 17/50 (34%) and 35/50 (70%) depending on outcome among non-responders. [ABSTRACT FROM AUTHOR]

For centuries, rivers have experienced massive changes of their hydromorphic structures due to human activities. The Danube River, the second largest river in Europe, is a case in point for long‐term societal imprint. Resulting human‐induced pressures are a key issue for river management, aiming to improve the ecological conditions and guarantee the provision of ecosystem services. As the most international river basin in the world, the management of the Danube is particularly challenging and needs a well‐organized cooperation of 19 nations. The recent river basin management plan has identified pollution and hydromorphological alterations as most pressing problems, but it has also acknowledged newly emerging issues. In this article, we present 3 specific examples of highly relevant issues for the future river basin management of the Danube: (a) long‐term impacts in the catchment such as changes in flood patterns and potential ecological consequences; (b) complex feedback loops linking the spread of neozoa with intertwined stressor responses due to river engineering for different purposes; and (c) linkages between different assessment approaches based on European legal frameworks to analyse the specific pressures at different spatial scales. These examples highlight the need for a more integrated approach in future Danube River Basin management schemes. Furthermore, large‐scale effects such as climate change and interactions of multiple pressures need to be addressed in future management to increase resilience of the river system and to allow a sustainable ecosystem‐based management of rivers. [ABSTRACT FROM AUTHOR]

The complete pathophysiology of decompression illness is not yet fully understood. What is known is that the longer a diver breathes pressurized air at depth, the more likely nitrogen bubbles are to form once the diver returns to surface [1]. These bubbles have varying mechanical, embolic and biochemical effects on the body. The symptoms produced can be as mild as joint pain or as significant as severe neurologic dysfunction, cardiopulmonary collapse or death. Once clinically diagnosed, decompression illness must be treated rapidly with recompression therapy in a hyperbaric chamber. This case report involves a middle-aged male foreign national who completed three dives, all of which incurred significant bottom time (defined as: "the total elapsed time from the time the diver leaves the surface to the time he/she leaves the bottom)" [2]. The patient began to develop severe abdominal and back pain within 15 minutes of surfacing from his final dive. This case is unique, as his presentation was very concerning for other medical catastrophes that had to be quickly ruled out, prior to establishing the diagnosis of severe decompression illness. After emergency department resuscitation, labs and imaging were obtained; abdominal decompression illness was confirmed by CT, revealing a significant abdominal venous gas burden. [ABSTRACT FROM AUTHOR]

Copyright of Österreichische Wasser- und Abfallwirtschaft is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: Faecal incontinence (FI) is distressing, significantly reduces quality of life (QoL) and has few pharmacological treatments. The α-adrenoceptor agonist NRL001 (1R,2S-methoxamine hydrochloride) improves anal sphincter tone. NRL001 efficacy was evaluated by changes in Wexner scores at week 4 vs. baseline in NRL001-treated patients compared with placebo. Impact of NRL001 on QoL and safety were also assessed. Methods: Four hundred sixty-six patients received NRL001 (5, 7.5 or 10 mg) or placebo as suppository, once daily over 8 weeks. Wexner score, Vaizey score and QoL were analysed at baseline, week 4 and week 8. FI episodes and adverse events were recorded in diaries. Results: At week 4, mean reductions in Wexner scores were −3.0, −2.6, −2.6 and −2.4 for NRL001 5, 7.5, 10 mg and placebo, respectively. All reduced further by week 8. As placebo responses also improved, there was no significant treatment effect at week 4 ( p = 0.6867) or week 8 ( p = 0.5005). FI episode frequency improved for all patients, but not significantly compared with placebo (week 4: p = 0.2619, week 8: p = 0.5278). All patients' QoL improved, but not significantly for all parameters ( p > 0.05) except depression/self-perception at week 4 ( p = 0.0102) and week 8 ( p = 0.0069), compared with placebo. Most adverse events were mild and judged probably or possibly related to NRL001. Conclusions: All groups demonstrated improvement in efficacy and QoL compared with baseline. NRL001 was well-tolerated without serious safety concerns. Despite the improvement in all groups, there was no statistically significant treatment effect, underlining the importance of relating results to a placebo arm. [ABSTRACT FROM AUTHOR]

Anthropogenically induced siltation has serious effects on micro-habitat diversity and thus on aquatic organisms in lotic systems. The present study deals with the impact of siltation on the macroinvertebrate community in the River Lafnitz, south-eastern Austria. Our aim was to examine various ecological parameters in a meandering river stretch. The results significantly show (1) a generally lower taxa diversity, (2) a dominance of tolerant taxa such as Chironomidae and a clear reduction of sensitive taxa such as Ephemeroptera, Plecoptera, Trichoptera (EPT-taxa) and (3) overall lower abundances and biomass in sandy fractions. The present case study highlights various processes of fine sediment sources and sinks. While in most cases, fine sediment input is locally caused by erosion of adjacent terrestrial areas, even small-scale channelization of meandering rivers leads to subsequent trapping of huge sandy fractions especially in morphologically natural river sections. This inconspicuous but steady process is a risk to biodiversity and masks serious ecological degradation. Suitable management and restoration measures for anthropogenically silted rivers are therefore strongly recommendable. In summary, the study underlines the sensitivity of meandering systems and its dependence on catchment scale degradation and questions the reversibility of human impacts. [ABSTRACT FROM AUTHOR]

Aim Treatment of Crohn's anal fistula remains challenging and little is known about factors associated with healing. The aim of this study was to assess the rate of healing after surgical treatment and analyse clinical variables related to healing. Method A total of 119 patients [63 women, mean age 36 (±13.7) years] with histopathologically verified Crohn's disease underwent a surgical procedure for anal fistula at four main referral centres in Sweden, January 1998 to December 2009. Baseline and treatment-related variables were recorded and analysed for correlation with fistula healing at a final follow-up after a mean of 7.2 (median 7.1, 1.0-17.5) years. Results Of the 119 patients 62 (52%) were healed at final follow-up. Fourteen healed after one procedure and the remaining 48 healed after a further median of 4.0 (2-20) procedures. Ten (8%) patients were subjected to a proctectomy. Final healing was more common in patients operated with a procedure aiming at eradicating the fistula (P = 0.0001), without proctitis (P = 0.02) and a shorter duration of Crohn's disease (P= 0.0019). Conclusion Long-term healing of a Crohn's anal fistula can be expected in about half of the patients, usually after repeated surgical treatment. The probability for cure was higher when a curative operation was performed in a patient without proctitis and with a shorter duration of Crohn's disease. An attempt to close a Crohn's anal fistula is thus often worthwhile. [ABSTRACT FROM AUTHOR]

Background Sacral nerve stimulation is an established treatment for fecal incontinence and initial reports describe successful results also in subjects with chronic constipation. Methods Consecutive patients with slow transit or outlet obstruction type constipation were offered external stimulation through a test electrode inserted in a sacral foramen during a 3-week period. The symptomatic evaluation was based on the number of bowel movements and a validated obstructed defecation score ( ODS). A permanent implant was performed provided an overall 50% decrease in symptoms was observed. Key Results In total, 44 patients with chronic constipation were treated with a 3-week test stimulation. Fifteen experienced a 50% reduction of symptoms and received a permanent implant. Four of the 15 with permanent implants were explanted during the course of the study. Five subjects (11% of original group) reported sustained symptom relief at final follow-up after a mean of 24 months (range 4-81). Mean ODS score did not change during the treatment. Patients with predominantly slow transit constipation or outlet obstruction did not differ concerning success rate. Conclusions & Inferences Sacral nerve stimulation has limited efficacy in unselected patients with chronic constipation and cannot be recommended for treatment on routine basis. [ABSTRACT FROM AUTHOR]

Background Injectable bulking treatment for fecal incontinence ( FI) is intended to expand tissue in the anal canal and prevent fecal leakage. Use of injectable bulking agents is increasing because it can be performed in an outpatient setting and with low risk for morbidity. This study evaluated the long-term (36-month) clinical effectiveness and safety of injection of non-animal stabilized hyaluronic acid/dextranomer ( NASHA Dx) on FI symptoms. Methods In a prospective multicenter trial, 136 patients with FI received the NASHA Dx bulking agent. Treatment success defined as a reduction in number of FI episodes by 50% or more compared with baseline (Responder50). Change from baseline in Cleveland Clinic Florida Fecal Incontinence Score ( CCFIS) and Fecal Incontinence Quality of Life Scale (FIQL), and adverse events were also evaluated. Key Results Successful decrease in symptoms was achieved in 52% of patients at 6 months and this was sustained at 12 months (57%) and 36 months (52%). Mean CCFIS decreased from 14 at baseline to 11 at 36 months ( p < 0.001). Quality-of-life scores for all four domains improved significantly between baseline and 36 months of follow-up. Severe adverse events were rare and most adverse events were transient and pertained to minor bleeding and pain or discomfort. Conclusions & Inferences Submucosal injection of NASHA Dx provided a significant improvement of FI symptoms in a majority of patients and this effect was stable during the course of the follow-up and maintained for 3 years. [ABSTRACT FROM AUTHOR]

Based upon our previous reviews on the phylogenetic species concept, initial split criteria and fine structure analysis here we summarize population and model thinking as support to our diverged structure matrix procedure to test simply visually or, if required, by geometric morphometrics the stability of sexual selection-driven adaptive, non-neutral traits of the phallic organ. Complexity review helped us to establish plesiomorphic and apomorphic states of parameres of the phallic organ. Fine structure diversity of the adaptive traits of paramere and the apical portion of aedeagus has been applied to revise the Allogamus genus. All the known 22 taxa, 19 species and 3 subspecies, have been revised. Apomorphic fusion of parameres and complexity evolution of aedeagus directed us to erect 2 rediagnosed species groups, 1 new species group, 4 new species subgroups, 1 new species complex, 10 new species and 4 new or revised species status as follows: Allogamus auricollis species group, rediagnosed. Allogamus antennatus new subgroup: A. antennatus (McLachlan, 1876), A. ausoniae Moretti, 1991, stat. rev., A. morettii DePietro & Cianficconi, 2001, stat. rev., A. silanus Moretti 1991, stat. nov. Allogamus auricollis new subgroup: A. alpensis Oláh, Lodovici & Valle sp. nov., A. auricollis (Pictet, 1834), A. despaxi Decamps, 1967, A. zomok Oláh & Coppa sp. nov. Allogamus hilaris new subgroup: A. hilaris (McLachlan, 1876). Allogamus ligonifer new subgroup: A. gibraltaricus Gonzalez & Ruiz, 2001, A. kefes Coppa & Oláh sp. nov., A. laureatus (Navas, 1918), A. ligonifer (McLachlan, 1876), A. pertuli Malicky, 1974, A. pupos Coppa & Oláh sp. nov. Allogamus mortoni new species complex: A. kampos Oláh & Ruiz sp. nov., A. kettos Oláh & Ruiz sp. nov., A. kurtas Oláh & Zamora-Muñoz sp. nov., A. mortoni (Navas, 1907), A. pohos Oláh & Zamora-Muñoz sp. nov., A. tuskes Oláh & Sáinz-Bariáin sp. nov. Allogamus corsicus new species group: A. corsicus (Ris, 1897). A. illiesorum Botosaneanu, 1980 stat. rev. Allogamus uncatus species group, rediagnosed: A. botosaneanui Moretti, 1991, A. dacicus (Schmid, 1951), A. fuesunae Malicky, 2004, A. mendax (McLachlan, 1876), A. pantinii Oláh, Lodovici & Valle sp. nov.,A. periphetes Malicky, 2004, A. stadleri (Schmid, 1951), A. starmachi Szczesny, 1967, A. tomor Oláh, 2012, A. uncatus (Brauer 1857). [ABSTRACT FROM AUTHOR]

Applying the phylogenetic species concept and the sexual selection theory we have reviewed some natal aspects of incipient species and their accelerated evolution. How can we recognise early stages of divergence? Which selection pressures are at work during speciation? Which pathways accelerate the speed of speciation? Which kinds of trait variabilities makes difficult to find initial split criteria? Elaborating the principles of Fine Structure Analysis (FSA) and the morphological Initial Split Criteria (ISP) it was discovered that the European spring dwelling caddisfly Potamophylax nigricornis doesn't belong to a single species. It represents an entire species group with seventeen peripatric species evolving on the southern peripheries of the distributional area. Four new species subgroups have been erected: Potamophylax nigricornis new species subgroup, P. elegantulus new species subgroup, P. horgos new species subgroup, P. simas new species subgroup. Eleven new species have been described: Potamophylax apados sp. nov., P. fules sp. nov., P. fureses sp. nov., P. hasas sp. novov., P. horgos sp. nov., P. kethas sp. nov., P. lemezes sp. nov., P. peremes sp. nov., P. simas sp. nov., P. tuskes sp. nov., P. ureges sp. nov. One Potamophylax sp. nov. has been differentiated and three new species status have been documented: Potamophylax elegantulus (Klapálek) stat. n., P. mista (Navás) stat. nov., P. testaceus (Zetterstedt) stat. nov. [ABSTRACT FROM AUTHOR]

Background: Stabilized non-animal hyaluronic acid/dextranomer (NASHA Dx) gel as injectable bulking therapy has been shown to decrease symptoms of faecal incontinence, but the durability of treatment and effects and influence on quality of life (QoL) is not known. The aim of this study was to assess the effects on continence and QoL and to evaluate the relationship between QoL and efficacy up to 2 years after treatment. Methods: Thirty-four patients (5 males, mean age 61, range 34-80) were injected with 4 × 1 ml NASHA Dx in the submucosal layer. The patients were followed for 2 years with registration of incontinence episodes, bowel function and QoL questionnaires. Results: Twenty-six patients reported sustained improvement after 24 months. The median number of incontinence episodes before treatment was 22 and decreased to 10 at 12 months ( P = 0.0004) and to 7 at 24 months ( P = 0.0026). The corresponding Miller incontinence scores were 14, 11 ( P = 0.0078) and 10.5 ( P = 0.0003), respectively. There was a clear correlation between the decrease in the number of leak episodes and the increase in the SF-36 Physical Function score but only patients with more than 75 % improvement in the number of incontinence episodes had a significant improvement in QoL at 24 months. Conclusions: Anorectal injection of NASHA Dx gel induces improvement of incontinence symptoms for at least 2 years. The treatment has a potential to improve QoL. A 75 % decrease in incontinence episodes may be a more accurate threshold to indicate a successful incontinence treatment than the more commonly used 50 %. [ABSTRACT FROM AUTHOR]

Aim Ligation of the intersphincteric fistula tract ( LIFT) is a novel sphincter-preserving technique for anal fistula. This pilot study was designed to evaluate the results in patients with a recurrent fistula. Method Seventeen patients [nine men; median age 49 (range, 30-76) years] with a recurrent trans-sphincteric fistula were treated with a LIFT procedure between June 2008 and February 2011. All were followed prospectively for a median of 16 (range, 5-27) weeks with clinical examination. Fifteen followed for 13.5 (range, 8-26) months by clinical examination also had three-dimensional (3 D) anal ultrasound. Results The duration of the procedure was 35 (range, 18-70) min. One patient developed a small local haematoma and one had a subcutaneous infection, but otherwise there was no morbidity. At follow up, 11 (65%) patients had a successful closure, two (12%) had a remaining sinus and four (23%) had a persistent fistula. The incidence of persistent or recurrent fistulae at 13.5 months was six (40%) of 15 patients. No de novo faecal incontinence was reported. Conclusion LIFT is a safe procedure for patients with recurrent anal fistula, with healing at short-term and medium-term follow-up comparable with or superior to that of other sphincter-preserving techniques. Larger studies with a longer follow up are needed to define the ultimate role of LIFT in patients with recurrence. [ABSTRACT FROM AUTHOR]

Aim Perineal wound sepsis is a common problem after abdominoperineal resection of the rectum (APR), with a reported incidence of 10-15% in previously non-irradiated patients, 20-30% in patients given preoperative radiation and 50% among patients submitted to preoperative radiation combined with chemotherapy. The local application of gentamicin-collagen was evaluated to determine whether its use in the perineal wound reduced risk complications and had an effect on cancer recurrence. Method In this prospective multicentre (seven hospitals) randomized controlled trial, 102 patients undergoing APR due to cancer or benign disease were randomized into two groups including surgery with gentamicin-collagen (GS+, n = 52) or surgery without gentamicin-collagen (GS−, n = 50). Patients were followed at 7, 30 and 90 days and at 1 and 5 years. Results There were no statistically significant differences between the two groups regarding perineal wound complications, infectious or non-infectious, or cancer recurrence. Conclusion There was no statistically significant effect on perineal wound complications or cancer recurrence following the local administration of gentamicin-collagen during APR. [ABSTRACT FROM AUTHOR]

In catastrophe risk and probabilistic hazard evaluations, one overarching issue is how to account for uncertainties. One influential school of thought employs a sharp distinction between aleatory (pertaining to randomness) uncertainty and epistemic (pertaining to knowledge) uncertainty, and uses this distinction to derive total uncertainty in risk and probabilistic hazard evaluations. This paper first critiques two quantitative versions of this sharp distinction. The first version applies only to single models. The second version applies to a weighted combination of rival models. This paper shows that serious contradictions and biases arise for each version, as elaborated by its advocates. Given these contradictions and the need to address the overarching issue of uncertainties in risk evaluations, this paper goes on to sketch an alternative approach called robust simulation, which applies to catastrophe risk and probabilistic hazard results. Robust simulation first develops results from a single preferred model, and then proceeds to find and evaluate results from the most divergent yet credible rival models. In addition to producing many simulations from models, this approach also tests resulting distributions in terms of their stability. [ABSTRACT FROM AUTHOR]

Copyright of Zeitschrift für Epileptologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In the article, a new approach is presented utilizing artificial neural networks for uncertain time-dependent structural behavior. Recurrent neural networks (RNNs) for fuzzy data can be trained by uncertain experimental data to describe arbitrary stress-strain-time dependencies. The benefit is a generalized formulation, which can be applied to describe the behavior of several materials without definition of a specific material model. Model-free material descriptions can be used as numerical efficient material formulations within the finite element method. To perform fuzzy or fuzzy stochastic finite element analyses, a new approach is introduced. An -level optimization is utilized for signal computation and training of RNNs for fuzzy data. The applicability is demonstrated by means of examples. [ABSTRACT FROM AUTHOR]

The aims of this study were to create a copy number variant (CNV) profile of human chromosome 22 and to establish a genotype-phenotype correlation for patients with genomic abnormalities on chromosome 22. Thus, 1,654 consecutive pediatric patients with a diversity of clinical findings were evaluated by high-resolution chromosomal microarray analysis (CMA). We identified 25 individuals with abnormal CNVs on chromosome 22, representing 1.5% of the cases analyzed in this cohort. Meanwhile, we detected 1,298 benign CNVs on this chromosome in these individuals. Twenty-one of the 25 abnormal CNVs and the majority of the benign CNVs occurred through involvement of the 8 unstable genomic regions enriched with low copy repeats (LCR22A-H). The highly dynamic status of LCR22s within the 22q11 region facilitates the formation of diverse genomic abnormalities. This CNV profile provides a general perspective of the spectrum of chromosome 22 genomic imbalances and subsequently improves the CNV-phenotype correlations. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The paper focuses on numerical approaches valuable in the design of strengthening layers made of textile reinforced concrete (TRC) applied on surfaces of RC structures. The presented methods aim at the design of structures that are components of significant buildings, e.g. power stations, historic valuable buildings and life lines. The generally existing uncertainty of material and geometry parameters of the RC structures and the TRC layers is modelled by imprecise probability. Reliability, lifetime and robustness are assessed by means of generalised uncertainty measures and considered as design objectives or constraints. Three computational methods are developed for the computation of preferential designs under consideration of imprecise probability. The methods are applied for the design of a porch roof strengthening comparing the robustness of different variants and for the reliability-based design of a T-beam strengthening. [ABSTRACT FROM AUTHOR]

Due to reduced evaporation and diffusion of water molecules containing heavier isotopes, leaf water possesses an elevated 18O or 2H steady-state content. This enrichment has been exploited in plant physiology and ecology to assess transpiration and leaf water relations. In contrast to these studies, in this work the 2H content of the medium of hydroponically grown Arabidopsis thaliana was artificially raised, and the kinetics of 2H increase in the aerial parts recorded during a short phase of 6–8 h, until a new equilibrium at a higher level was reached. A basic version of the enrichment models was modified to establish an equation that could be fitted to measured leaf 2H content during uptake kinetics. The fitting parameters allowed estimation of the relative water flux q leaf into the Arabidopsis rosette. This approach is quasi-non-invasive, since plants are not manipulated during the uptake process, and therefore, offers a new tool for integrated analysis of plant water relations. The deuterium tracer method was employed to assess water relocation in Arabidopsis pip2;1 and pip2;2 aquaporin knockout plants. In both cases, q leaf was significantly reduced by about 20%. The organ and cellular expression patterns of both genes imply that changes in root hydraulic conductivity, as previously demonstrated for pip2;2 mutants, and leaf water uptake and distribution contributed in an integrated fashion to this reduced flux in intact plants. [ABSTRACT FROM AUTHOR]

We report 4 interstitial inverted duplications with associated terminal deletions (inv dup del) involving the short arms of chromosomes 5 and 8, and the long arm of chromosome 13 by microarray-based comparative genomic hybridization (aCGH) combined with chromosome banding (GTG banding) and fluorescence in situ hybridization (FISH) analyses. Formation of the intermediate dicentric chromosomes in 3 of them occurred through breakage-fusion-bridge cycle mechanism (U-type exchange mechanism) and in the fourth one it occurred through the mediation of the inverted low-copy repeats on chromosome 8p23.1. Two of these 4 inv dup del were confirmed and a third one was suspected to be associated with telomere capture for the healing of the terminal deletions. These findings indicate that a telomere capture mechanism is frequently used for stabilizing the broken chromosome ends in this type of genomic rearrangements. In addition, the inv dup del(13) represents the first observation of inv dup del on chromosome 13 in humans, the inv dup del(5) represents the first observation of inv dup del(5p) with an associated telomere capture, and unique features of the remaining two inv dup del(8p) were also discussed. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

We evaluated 516 species and/or subspecies of European stoneflies for vulnerability to climate change according to autoecological data. The variables considered were stream zonation preference, altitude preference, current preference, temperature range preference, endemism and rare species. Presence in ecoregions was used to analyse the vulnerability of taxa in relation to their distribution. We selected the variables that provided information on vulnerability to change in climate. Thus, we chose strictly crenal taxa, high-altitude taxa, rheobionts, cold stenotherm taxa, micro-endemic taxa and rare taxa. Our analysis showed that at least 324 taxa (62.79%) can be included in one or more categories of vulnerability to climate change. Of these, 43 taxa would be included in three or more vulnerability categories, representing the most threatened taxa. The most threatened species and the main factors affecting their distribution are discussed. Endangered potamal species, with populations that have decreased mainly as a consequence of habitat alteration, also could suffer from the effects of climate change. Thus, the total number of taxa at risk is particularly high. Not only are a great diversity of European stoneflies concentrated in the Alps, Pyrenees and Iberian Peninsula, but so are the most vulnerable taxa. These places are likely to be greatly affected by climate change according to climate models. In general, an impoverishment of European Plecoptera taxa will probably occur as a consequence of climate change, and only taxa with wide tolerance ranges will increase in abundance, resulting in lower overall faunal diversity. [ABSTRACT FROM AUTHOR]

Despite many studies of the N2O emission, there is a lack of knowledge on the role of subsoil for N2O emission, particularly in sandy soils. To obtain insight into the entrapment, diffusion, convection and ebullition of N2O in the soil, the N2O concentration in the soil atmosphere was measured over a period of 1 year in 4 lysimeters (agricultural soil monoliths of 1 m2 × 2 m) at 30, 50, 80, 155, and 190 cm depth with altogether 86 gas probes. Additionally the N2O emission into the atmosphere was measured in 20 closed chambers at the soil surface. Concurrently the soil temperature and soil water content were recorded in order to quantify their effects on the fate of N2O in the soil. Results of the continuous measurements between January and December 2006 were: N2O concentrations were highest in the deeper soil; maximum concentration was found at a depth of 80 cm, where the water content was high and the gas transport reduced. The highest N2O concentration was recorded after ‘special events’ like snowmelt, heavy rain, fertilization, and grubbing. The combination of fertilization and heavy rain led to an increase of up to 2,700 ppb in the subsoil. [ABSTRACT FROM AUTHOR]

Peritonectomy with heated intraperitoneal chemotherapy (HIPEC) has shown a survival benefit in selected patients with peritoneal carcinomatosis. This prospective non-randomized study was designed to identify factors associated with postoperative morbidity and survival after peritonectomy HIPEC in patients with this condition. Data were prospectively collected from all patients with peritoneal carcinomatosis treated by means of peritonectomy and HIPEC at Uppsala University Hospital between October 2003 and September 2006. Depending on the primary tumor, mitomycin C or a platinum compound was used as a chemotherapeutic agent for perfusion. A total of 103 patients were treated. Primary tumors were pseudomyxoma peritonei (47 patients), colorectal cancer (38 patients), gastric cancer (6 patients), ovarian cancer (6 patients) and mesothelioma (5 patients). Postoperative morbidity was 56.3% and was significantly lower in patients treated with mitomycin C for pseudomyxoma peritonei (42%) than in those with another diagnosis treated with platinum compound (71%, P < 0.05). Postoperative mortality was less than 1%. At 2 years, overall survival was estimated to be 72.3%, and disease-free survival was 33.5%. Factors influencing overall and disease-free survival were tumor type and optimal cytoreduction. Postoperative morbidity is dependent mainly on a tumor type; however, the chemotherapeutic agent used might also influence morbidity. Survival is determined by optimal cytoreduction and tumor type. Irrespective of age, patients with good performance status benefit from this treatment. [ABSTRACT FROM AUTHOR]

Colectomy with ileorectal anastomosis for slow transit constipation (STC) is being challenged by other operations, such as segmental resections. The importance of preoperative anorectal physiology testing may therefore be increased. The aim of this study was to identify anorectal abnormalities in patients with STC, which may influence the surgical approach. Fifty consecutive patients with STC (43 women; median age, 49 years) and 28 controls (23 women; median age, 50 years) were examined with anorectal manovolumetry. Anal pressures and rectal volumes were recorded, at stepwise rectal distension. Anal resting pressure was lower in patients (median, 54 cm H2O; range, 22–130) than in controls (median, 68 cm H2O; range, 35–100) ( p<0.05). Squeeze pressure tended to be lower in patients (median, 147 cm H2O; range, 53–382) than in controls (median, 177 cm H2O; range, 65–423) ( p=0.09). Rectal sensory thresholds did not differ significantly between patients and controls, although 10 patients had a threshold for filling above the 95th percentile of controls. Rectal compliance was increased in patients in the pressure interval 5–35 cm H2O ( p<0.05–0.01). The threshold and amplitude of the recto-anal inhibitory reflex did not differ significantly, but the recovery of resting pressure after eliciting the reflex was lower in patients than in controls in the pressure interval 10–50 cm H2O ( p<0.05–0.001). More than half of the patients with STC deviated in some parameter. An impaired internal sphincter function and increased rectal compliance were seen. One fifth of the patients had impaired rectal sensation. [ABSTRACT FROM AUTHOR]

Objective Colonic transit studies are used to diagnose slow transit constipation (STC) and to evaluate segmental colonic transit before segmental or subtotal colectomy. The aim of the study was to compare a single X-ray radio-opaque marker method with a scintigraphic technique to assess total and segmental colonic transit in patients with STC. Method Thirty-one female patients (median age 46 years) with severe constipation and a prolonged or borderline prolonged colonic transit time on radio-opaque marker study were included in the study. They were subsequently investigated with 111Indium-DTPA colonic transit scintigraphy, with a median time between the investigations of 4(range 1–27) months. Normal values of healthy female controls were used for comparison. Results There was no difference between the two methods in terms of prolonged or normal total colonic transit time. Twenty-nine of 31 female patients had a prolonged transit time only in one or two segments on the marker study. On scintigraphy, the transit time was prolonged for patients in the left ( P < 0.05 to P < 0.001), but not in the right colon. With respect to prolonged or normal segmental transit time, there was a significant difference between the two methods only in the descending colon ( P = 0.02). However, the results varied considerably for individual patients. Conclusion Segmental colonic delay was a common finding. The two methods gave similar results for groups of patients, except in the descending colon. The variation of the results for individuals suggests that a repeated transit test may improve the assessment of total and segmental transit. [ABSTRACT FROM AUTHOR]

Background: Studies of haemorrhoidectomy usually report postoperative pain, healing and complications, but rarely consider anal function in the longer term. The primary aim of this randomized trial was to compare long-term changes in anal function after open (Milligan-Morgan) and closed (Ferguson) haemorrhoidectomy. Methods: A total of 225 patients were included in the trial, 115 in the open group and 110 in the closed group. Continence changes were recorded by means of validated questions and an incontinence score. Pain was self-reported using a visual analogue scale. Results: Postoperative pain and complications did not differ between the groups. Time to recovery was 17 days in the Milligan-Morgan group and 15 days in the Ferguson group. After 1 month the wounds were healed in 57.0 per cent of patients in the open group and 70.6 per cent of those in the closed group (P = 0.058). At 1 year, 78.9 per cent of the Milligan-Morgan group and 85.3 per cent of the Ferguson group reported no continence disturbance (P = 0.072). The incontinence score was improved at 1 year in the closed group (P = 0.015), but was unchanged in the open group (P = 0.645). Patients who had the Ferguson procedure were more satisfied with the outcome of surgery (P = 0.047). Conclusion: Closed Ferguson haemorrhoidectomy was superior to the open Milligan-Morgan procedure with respect to long-term anal continence and patient satisfaction. [ABSTRACT FROM AUTHOR]

Background: Endoanal advancement flap repair is widely used in sphincter-preserving surgery for anal fistula, but the high recurrence rate is a major problem. A possible cause of non-healing is local infection of the flap. The aim of this study was to evaluate whether local antibiotic treatment with gentamicin-collagen improves healing after endoanal advancement flap repair for anal fistula. Methods: Eighty-three patients (52 men and 31 women; mean age 47 (range 17-71) years) who had endoanal advancement flap repair for anal fistula between September 1998 and January 2004 were randomized to surgery with (42 patients) or without (41 patients) application of gentamicin-collagen beneath the flap. Patients were evaluated at 1-3 and 12 months after surgery for healing and/or recurrence. Results: The overall healing rate with no recurrence at 1 year after surgery was 57 per cent (47 of 83). Twenty-six of 42 patients randomized to gentamicin-collagen healed primarily compared with 21 of 41 patients randomized to surgery only. There were no overall differences in healing rate according to sex, previous fistula surgery, complexity of fistula, smoking habit or body mass index. Conclusion: Endoanal advancement flap repair for anal fistula has a fairly high primary recurrence rate. Healing was not significantly improved by local application of gentamicin-collagen. [ABSTRACT FROM AUTHOR]

Subtotal colectomy and ileorectal anastomosis for slow transit constipation has several side-effects. The motor abnormality in some patients may be segmental which could motivate a limited resection of the colon. Therefore a diagnostic tool to identify a segmental colonic motor dysfunction is needed. The aim of this study was to evaluate a scintigraphic method to assess colonic transit with special reference to right- or left-sided delay.Twenty-three constipated patients (19 women, mean age 50 years) with slow colonic transit on radio-opaque marker studies and 13 healthy individuals (11 women, mean age 46 years) were studied. All subjects were examined with oral111Indium-DTPA scintigraphy. The scintigraphic results for patients and controls were presented as geometric centre of radioactivity and percent activity over time in the right, the left and the recto-sigmoid colon. The inter-observer variation in the interpretation of the scans was also evaluated.There was no difference in transit time between the groups of patients and controls in the right colon whereas the patients had a significant delay in the left colon (P < 0.05). Two patients had a marked delay in the right colon followed by relatively rapid transit in the left colon. The inter-observer correlation was good comparing the right, the left and the recto-sigmoid colon (r =0.58–0.98,P < 0.01–0.001).The results indicate that colonic scintigraphy with oral111Indium-DTPA may help to select patients for a left or, in a few cases, a right hemicolectomy for slow transit constipation. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate anorectal physiology in relation to clinically defined subgroups of patients with idiopathic constipation and to analyse relationships between anorectal physiology and rectal evacuation. One hundred consecutive patients with idiopathic constipation were clinically categorized as slow transit ( n = 19), outlet obstruction ( n = 52) and a group with mixed symptoms ( n = 29). They were examined by recording anal pressures and also rectal volumes in response to stepwise increases in rectal pressure (5–60 cm H2O). The manovolumetric results were compared with 28 sex and aged matched controls. Rectal evacuation was measured by computer-based image analysis of rectal emptying rate in defaecography. The rectal pressure thresholds for filling, urge and pain did not differ between the groups but there were proportionally more patients in the slow transit and mixed group with thresholds for filling exceeding 25 cm H2O ( P = 0.04). In total, 18% of patients had impaired sensitivity which was associated with long duration of symptoms ( P < 0.05). Patients with grossly impaired rectal sensitivity (filling threshold > 40 cm H2O) had impaired rectal evacuation ( P < 0.05). The rectal compliance was increased in the slow transit and mixed group ( P < 0.01–0.05) in the pressure interval 5–15 cm H2O. Anal resting and squeeze pressures did not differ between the groups although 7/19 in the slow transit group had values around the lower limit of controls. Slow wave frequency was lower in all patient groups ( P < 0.001 vs. controls). Rectal evacuation was not related to sphincter function or to rectal compliance. Clinical categorization of constipated patients defines groups where altered anorectal physiology is not uncommon. Constipation with symptoms of infrequent defaecation may be associated with impaired rectal sensitivity and increased rectal compliance whereas outlet obstruction symptoms are not clearly related to changes in anorectal physiology. [ABSTRACT FROM AUTHOR]

Transanal endoscopic microsurgery (TEM) has become increasingly common in the management of rectal adenomas and also in selected cases of rectal carcinomas. The aim of this study was to assess the results in a consecutive series of patients after introducing the TEM technique. All 58 patients operated with TEM from January 1996 to January 1999 were evaluated in a retrospective review. Forty-eight patients answered a clinically validated questionnaire a median of 22 months after TEM. Eighty patients who had undergone transanal excision and 12 who had undergone York Mason's procedure served as a reference group with respect to recurrence rates. The complication rate was 5% (immediate) and 14% (long-term). The overall 30-day mortality rate was zero. An impairment of continence was seen in 18 (37%) patients. Of these, all 18 experienced varying degree of incontinence to liquid stool, 14 also to flatus and 5 of them even to solid stool. The recurrence rate was 11% in adenomas and 14% in cancers; T1, 1 (10%) recurrence and T2, 1 (50%) recurrence. There was a correlation between operating time and impairment of continence as well as recurrence rate. TEM is a safe procedure, having a low recurrence rate and an acceptable functional outcome. [ABSTRACT FROM AUTHOR]

Compares the use of anal plug electrostimulation of the pelvic floor with anterior levatorplasty for the treatment of idiopathic faecal incontinence in a randomized trial with functional outcome and physiological measurements as endpoints. Relation of neurogenic or idiopathic faecal incontinence to pudendal nerve neuropathy.

We used the [14C]-2-deoxyglucose method to study the location and extent of primate frontal lobe areas activated for saccades and fixation and the retrograde transneuronal transfer of rabies virus to determine whether these regions are oligosynaptically connected with extraocular motoneurons. Fixation-related increases of local cerebral glucose utilization (LCGU) values were found around the fundus of the inferior limb of the arcuate sulcus (AS) just ventral to its genu, in the dorsomedial frontal cortex (DMFC), cingulate cortex, and orbitofrontal cortex. Significant increases of LCGU values were found in and around both banks of the AS, DMFC, and caudal principal, cingulate, and orbitofrontal cortices of monkeys executing visually guided saccades. All of these areas are oligosynaptically connected to extraocular motoneurons, as shown by the presence of retrogradely transneuronally labeled cells after injection of rabies virus in the lateral rectus muscle. Our data demonstrate that the arcuate oculomotor cortex occupies a region considerablylarger than the classic, electrical stimulation-defined, frontal eye field. Besides a large part of the anterior bank of the AS, it includes the caudal prearcuate convexity and part of the premotor cortex in the posterior bank of the AS. They also demonstrate that the oculomotor DMFC occupies a small area straddling the ridge of the brain medial to the superior ramus of the AS. Our results support the notion that a network of several interconnected frontal lobe regions is activated during rapid, visually guided eye movements and that their output is conveyed in parallel to subcortical structures projecting to extraocular motoneurons. [ABSTRACT FROM AUTHOR]

Patients with peritoneal or local metastases from colorectal cancer have a poor prognosis. However, aggressive treatments by debulking surgery and infusional intraperitoneal (i.p.) chemotherapy have been tried and appear to benefit selected patients. We assayed the effects of debulking surgery and i.p. chemotherapy with respect to survival and compared the results with matched control patients treated by intravenous (i.v.) chemotherapy. In all, 18 patients with peritoneal and/or local metastases from colorectal adenocarcinoma underwent debulking surgery followed by 5-fluorouracil (5-FU) 550?mg?m-2?day-1 i.p. and leucovorin (LV) 60?mg?m-2?day-1 i.v. The chemotherapy was started the day after surgery and was given daily for 6 days and repeated monthly for totally eight courses. The control patients, matched for age, gender, performance status and metastatic site, were randomly selected from controlled clinical chemotherapy trials and treated with i.v. 5-FU+LV or i.v. methotrexate+5-FU+LV. There was no treatment-related mortality. The median survival among i.p. patients was 32 months compared to 14 months in the control group. In all, 11 patients who underwent macroscopically radical surgery had a longer survival than those who were not radically operated (P=0.02). These results indicate that patients with peritoneal metastases and/or locally advanced cancers but without distant metastases may benefit from cytoreductive surgery combined with i.p. chemotherapy.British Journal of Cancer (2004) 90, 403-407. doi:10.1038/sj.bjc.6601586 www.bjcancer.com [ABSTRACT FROM AUTHOR]