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Background While rapid healing of diabetic foot ulcers (DFUs) is highly desirable to avoid infections, amputations and life-threatening complications, DFUs often respond poorly to standard treatment. GMP-manufactured skin-derived ABCB5+ mesenchymal stem cells (MSCs) might provide a new adjunctive DFU treatment, based on their remarkable skin wound homing and engraftment potential, their ability to adaptively respond to inflammatory signals, and their wound healing-promoting efficacy in mouse wound models and human chronic venous ulcers. Methods The angiogenic potential of ABCB5+ MSCs was characterized with respect to angiogenic factor expression at the mRNA and protein level, in vitro endothelial trans-differentiation and tube formation potential, and perfusion-restoring capacity in a mouse hindlimb ischemia model. Finally, the efficacy and safety of ABCB5+ MSCs for topical adjunctive treatment of chronic, standard therapy-refractory, neuropathic plantar DFUs were assessed in an open-label single-arm clinical trial. Results Hypoxic incubation of ABCB5+ MSCs led to posttranslational stabilization of the hypoxia-inducible transcription factor 1α (HIF-1α) and upregulation of HIF-1α mRNA levels. HIF-1α pathway activation was accompanied by upregulation of vascular endothelial growth factor (VEGF) transcription and increase in VEGF protein secretion. Upon culture in growth factor-supplemented medium, ABCB5+ MSCs expressed the endothelial-lineage marker CD31, and after seeding on gel matrix, ABCB5+ MSCs demonstrated formation of capillary-like structures comparable with human umbilical vein endothelial cells. Intramuscularly injected ABCB5+ MSCs to mice with surgically induced hindlimb ischemia accelerated perfusion recovery as measured by laser Doppler blood perfusion imaging and enhanced capillary proliferation and vascularization in the ischemic muscles. Adjunctive topical application of ABCB5+ MSCs onto therapy-refractory DFUs elicited median wound surface area reductions from baseline of 59% (full analysis set, n = 23), 64% (per-protocol set, n = 20) and 67% (subgroup of responders, n = 17) at week 12, while no treatment-related adverse events were observed. Conclusions The present observations identify GMP-manufactured ABCB5+ dermal MSCs as a potential, safe candidate for adjunctive therapy of otherwise incurable DFUs and justify the conduct of a larger, randomized controlled trial to validate the clinical efficacy. Trial registration: ClinicalTrials.gov, NCT03267784, Registered 30 August 2017, https://clinicaltrials.gov/ct2/show/NCT03267784

BACKGROUND There is increasing recognition of adverse mental health consequences of preterm birth and the impact on social-emotional development. However, the quality of the developing parent-infant relationship may be protective, with enhanced maternal sensitivity to infants' cues associated with improved outcomes. METHODS Eighty mothers and their preterm infants born

Increasingly, patients with early onset scoliosis (EOS) are completing a growth friendly surgical program followed by observation, removal of implants or a definitive spinal fusion. These patients are colloquially referred to as “graduates”. A standardized definition of a graduate is needed for research and comparing the outcomes, family counseling, and a better understanding of the population. A 15-question electronic survey was completed by 39 experienced pediatric spine surgeons to identify factors salient to the definition of a graduate of EOS surgical programs. A Delphi/Nominal group technique session with nine questions was then performed face-to-face with 21 members of the Pediatric Spine Study Group to discuss and refine the definition. A follow-up electronic survey was then distributed to these same 21 members to gain consensus on the final definition. From the initial survey, it was identified that a graduate did not require definitive spinal fusion after a growing program. From the Delphi session, it was determined that skeletal maturity was the most important factor in defining a graduate. A strictly defined minimum length of follow-up was not felt to be a prerequisite for qualification of graduation. After the final electronic version was distributed, > 80% of respondents agreed upon the final definition, thereby achieving consensus. The Pediatric Spine Study Group recommends adoption of the following definition: a “graduate” is a patient who has undergone any surgical program to treat early onset scoliosis, and has reached skeletal maturity and does not have a planned surgical intervention for EOS in the future. V.

Establishing a molecular diagnosis in patients with progressive ataxia is often challenging due to significant genetic and clinical heterogeneity and requires a methodical approach with expert clinical evaluation and investigations. We describe the 5-year experience of the National Ataxia Clinic (NAC), Ireland. All adults with ataxia attending the NAC between 2014 and 2019 were evaluated. All individuals underwent detailed clinical assessment and investigations including, where appropriate, genetic testing using next-generation sequencing. For all patients, acquired causes were ruled out. A total of 254 patients from 196 families were assessed; with growth of the clinic cohort by 82% from 133 to 242 over the 5-year period. The underlying genetic cause was identified in 128/196 probands (65.3%). The detection rate for repeat expansion disorder gene testing was 47.7% (82/172) and using NGS gene panel, a genetic diagnosis was obtained in 30/84 (35.7%). Whole exome sequencing identified the molecular diagnosis in 4/20 (20%), and whole genome sequencing provided genetic diagnosis in 1/5 (20%). The commonest diagnosis was Friedreich's ataxia (68/128, 53.1%). SPG7-associated ataxia was the second most common diagnosis (21/128, 16.4%), followed by ANO10-associated spastic ataxia, ataxia telangiectasia (AT), and other rarer phenotypes. Our results highlight that careful clinical phenotyping in a dedicated ataxia clinic is crucial for appropriate genetic testing in selected patients in a timely manner. Advanced genetic testing has significantly improved the diagnostic yield in patients with suspected genetic ataxia and should be considered in all individuals with negative repeat expansion testing.

At some point after children with early-onset scoliosis (EOS) undergo implantation of a distraction construct to control deformity and promote growth, a decision is made to discontinue lengthening. The purpose of this study was to evaluate surgeon indications for discontinuation of a lengthening program and to evaluate patient outcomes. As a part of a multicenter database, surgeons prospectively completed a questionnaire at the completion of growth-friendly treatment. Surgeon indications for discontinuation included patient age, pain/functional status, implant status, and spinal deformity parameters. Patient demographics, scoliosis type, deformity parameters, and length of time in a growing program were queried. Patients were treated with a final fusion or observation, and rate of secondary surgeries was analyzed. Questionnaires were completed on 121 patients (61% female). EOS etiology was 31% neuromuscular, 43% congenital, 16% idiopathic, and 10% syndromic. Average age at initiation of growing program was 6.8 ± 3.1 years, and average age at discontinuation was 12.7 ± 2.5 years. The most commonly cited indications for discontinuation of a lengthening program included bone age/skeletal maturity (n = 46), patient age (n = 33), and diminishing returns with expansions (n = 33). A larger coronal Cobb angle was found in patients who underwent definitive fusion (65°) when compared with continued observation (55°, p = 0.001). Twenty-nine (24%) patients were initially treated with observation after completion of a growing construct. In this subgroup, at a minimum of 2 years’ (average 3.8 years’) follow-up, 26/29 (90%) patients remained stable with observation alone; whereas, three (10%) underwent delayed final fusion surgery. The most common surgeon-cited indications for discontinuation of a lengthening program in EOS patients are skeletal maturity and patient age. The majority of patients (76%) underwent definitive spinal fusion after discontinuation of a lengthening program; whereas, those treated with observation alone had a survivorship of 90% at a minimum follow-up of two years.

A 9-year-old boy sustained an ulnohumeral dislocation with a medial epicondyle fracture and experienced incomplete post-traumatic median nerve palsy in addition to post-traumatic stiffness following closed reduction and cast immobilization. When his motor palsy and stiffness did not improve, MRI and ultrasound were obtained, which demonstrated entrapment of the median nerve in an osseous tunnel at the fracture site, compatible with type 2 median nerve entrapment. Subsequently, the patient underwent surgery to mobilize the medial epicondyle and free the median nerve, resulting in improved range of motion, near complete restoration of motor function, and complete restoration of sensory function in the median nerve distribution within 6 months of surgery. Median nerve entrapment, particularly intraosseous, is a rare complication of posterior elbow dislocation and medial epicondyle fracture that may result in significant, sometimes irreversible, nerve damage if there is a delay in diagnosis and treatment. A high degree of clinical suspicion with early imaging is indicated in patients with persistent stiffness or nerve deficits following reduction of an elbow dislocation. Intra-articular entrapment diagnosed on ultrasound has been reported and intraosseous entrapment diagnosed clinically and on MR neurography have been reported; however, to our knowledge, this is the first reported case of intraosseous (type 2) median nerve entrapment clearly visualized and diagnosed on traditional MRI and ultrasound. The use of ultrasound for diagnosing median nerve entrapment is an accurate, accessible, and non-invasive imaging option for patients presenting with suspected nerve entrapment following elbow dislocation.

Shotgun metagenomic sequencing is a valuable tool for the taxonomic and functional profiling of microbial communities. However, this approach is challenging in samples, such as milk, where a low microbial abundance, combined with high levels of host DNA, result in inefficient and uneconomical sequencing. Here we evaluate approaches to deplete host DNA or enrich microbial DNA prior to sequencing using three commercially available kits. We compared the percentage of microbial reads obtained from each kit after shotgun metagenomic sequencing. Using bovine and human milk samples, we determined that host depletion with the MolYsis complete5 kit significantly improved microbial sequencing depth compared to other approaches tested. Importantly, no biases were introduced. Additionally, the increased microbial sequencing depth allowed for further characterization of the microbiome through the generation of metagenome-assembled genomes (MAGs). Furthermore, with the use of a mock community, we compared three common classifiers and determined that Kraken2 was the optimal classifier for these samples. This evaluation shows that microbiome analysis can be performed on both bovine and human milk samples at a much greater resolution without the need for more expensive deep-sequencing approaches.

Bovington Camp has been a main training area for armoured vehicles since 1916. Over the years, this has resulted in the erosion and mobilisation of soil particles into watercourses draining the area. Sediment-rich water from a main tributary, the Bovington Stream, discolours the River Frome during high flows. Regulatory agencies and angling groups were concerned that the quality of the river was being affected by run-off from the military ranges. Macroinvertebrate communities were studied between 1998 and 2016 at two sites on the Bovington Stream above and below a sediment trapping pond and two sites on the River Frome above and below the confluence. Samples were collected in Spring and Autumn and ecological quality was assessed using the River Invertebrate Classification Tool (RICT). There were marked increases in the ecological quality of the Bovington sites over time with most change occurring in the period 1998 to 2004. The two Frome sites were consistently classed as high quality throughout the study period. Increases in taxon richness between 1998–2004 and 2011–2016 were significant in the Bovington Stream but no change was observed in the River Frome. Faunal abundance at all sites fluctuated but there were no significant trends. The Combined Fine Sediment Index (CoFSI), assesses the impact of fine sediment pressure on the macroinvertebrate community. Low CoFSI scores were recorded in the early years of the study (1998–2000) at both Bovington sites but showed a steady increase until around 2010–2011, suggesting a degree of improvement/recovery from fine sediment pressure. No similar changes in CoFSI scores occurred in the River Frome. In the absence of any major disturbances in the Bovington catchment other than sediment remediation we conclude that the observed ‘improvements’ in the Bovington Stream are in large part due to the sediment control measures (sediment trapping and diversion) implemented since 1998. The project has shown how relatively simple sediment control strategies can improve ecological quality and has provided information on long-term faunal responses which can help managers plan the extent and timing of effective mitigation measures.

The choice of alloying method for ferrous powder metallurgy alloys is often dictated by the oxidation potential of the alloying elements used in powder and compact manufacture. Silicon is effective in improving properties of ferrous PM steels; however, if added to the melt prior to atomization, the likelihood of oxidation is high. Alternatively, Si-rich and more complex particulates can be combined with the base powder, i.e., iron or low-alloy steel, with alloying occurring by solid-state diffusion during sintering. The effectiveness of these additives to improve material properties is dependent on their distribution throughout the material volume, as determined by diffusion of each added element. In this study, the distribution of silicon was quantified using energy-dispersive spectroscopy on an iron-based alloy composition. These data were compared with the volume fraction of the various transformation products in cross sections of hardenability samples using both light and electron microscopy. Predictions on the effects of local chemical composition, cooling rate, and microstructure are made.

A significant paravalvular leak (PVL) is estimated in at least 1–3% of patients undergoing surgical aortic and/or mitral valve replacement. Surgical repair of a PVL is associated with a 30-day mortality of approximately 10%. Percutaneous closure of PVL has emerged as an alternative to surgical repair. We sought to examine the clinical outcomes of patients treated with percutaneous closure of PVL at an Irish tertiary referral centre. A prospective registry was used to record patient and procedural characteristics at the time of the PVL procedure. Medical records were retrospectively reviewed to assess clinical outcomes during the index hospitalisation and at follow-up. A total of 26 PVL procedures were performed in 21 patients (mean age 68 ± 13 years, 76% male). Heart failure (HF), haemolysis (HL) or a combination of both was the presenting symptoms in 62%, 24% and 14% of patients, respectively. In the entire cohort, clinical success was achieved in 18 patients (86%). Clinical success was achieved more frequently when HF was the clinical indication compared to HL (100% versus 66%). Among patients presenting with isolated HF (n = 13), the mean NYHA class at baseline and follow-up was 2.5± 0.7 and 1.4± 0.7, respectively. Thirty-day mortality was 0%. There was one (3.8%) major adverse procedural complication (stroke). A total of six deaths (28%) occurred during follow-up (22 ± 13.4 months). Patients with PVL represent a high-risk patient cohort. Percutaneous PVL offers a safe alternative to surgical PVL repair and appears particularly effective in those patients who present primarily with HF.

Background We summarise the work of the Childhood Cancer Research Group, particularly in relation to the UK National Registry of Childhood Tumours (NRCT). Methods The Group was responsible for setting up and maintaining the NRCT. This registry was based on notifications from regional cancer registries, specialist children’s tumour registries, paediatric oncologists and clinical trials organisers. For a large sample of cases, data on controls matched by date and place of birth were also collected. Results Significant achievements of the Group include: studies of aetiology and of genetic epidemiology; proposals for, and participation in, international comparative studies of these diseases and on a classification system specifically for childhood cancer; the initial development of, and major contributions to, follow-up studies of the health of long-term survivors; the enhancement of cancer registration records by the addition of clinical data and of birth records. The Group made substantial contributions to the UK government’s Committee on Medical Aspects of Radiation in the Environment. Conclusion An important part of the ethos of the Group was to work in collaboration with many other organisations and individuals, both nationally and internationally: many of the Group’s achievements described here were the result of such collaborations.

Background High doses of ionising radiation are a known cause of childhood cancer and great public and professional interest attaches to possible links between childhood cancer and lower doses, particularly of man-made radiation. This paper describes work done by the Childhood Cancer Research Group (CCRG) on this topic MethodsMost UK investigations have made use of the National Registry of Childhood Tumours and associated controls. Epidemiological investigations have included national incidence and mortality analyses, geographical investigations, record linkage and case-control studies. Dosimetric studies use biokinetic and dosimetric modelling. ResultsThis paper reviews the work of the CCRG on the association between exposure to ionising radiation and childhood cancer, 1975–2014. ConclusionThe work of CCRG has been influential in developing understanding of the causes of 'clusters' of childhood cancer and the risks arising from exposure to ionising radiation both natural and man-made. Some clusters around nuclear installations have certainly been observed, but ionising radiation does not seem to be a plausible cause. The group’s work has also been instrumental in discounting the hypothesis that paternal preconception irradiation was a cause of childhood cancers and has demonstrated an increased leukaemia risk for children exposed to higher levels of natural gamma-ray radiation.

While the influence of antecedent conditions on watershed function is widely recognized under typical hydrologic regimes, gaps remain in the context of extreme climate events (ECEs). ECEs are those events that far exceed seasonal norms of intensity, duration, or impact upon the physical environment or ecosystem. In this synthesis, we discuss the role of source availability and hydrologic connectivity on antecedent conditions and propose a conceptual framework to characterize system response to ECEs at the watershed scale. We present four case studies in detail that span a range of types of antecedent conditions and type of ECE to highlight important controls and feedbacks. Because ECEs have the potential to export large amounts of water and materials, their occurrence in sequence can disproportionately amplify the response. In fact, multiple events may not be considered extreme in isolation, but when they occur in close sequence they may lead to extreme responses in terms of both supply and transport capacity. Therefore, to advance our understanding of these complexities, we need continued development of a mechanistic understanding of how antecedent conditions set the stage for ECE response across multiple regions and climates, particularly since monitoring of these rare events is costly and difficult to obtain. Through focused monitoring of critical ecosystems during rare events we will also be able to extend and validate modeling studies. Cross-regional comparisons are also needed to define characteristics of resilient systems. These monitoring, modeling, and synthesis efforts are more critical than ever in light of changing climate regimes, intensification of human modifications of the landscape, and the disproportionate impact of ECEs in highly populated regions.

Cranberry supplements are commonly used as a natural deterrent to urinary tract infection. However, one small study (n = 5) which showed an increase in urinary oxalate levels following cranberry supplementation has led to its use with caution among patients susceptible to nephrolithiasis. Furthermore, most commonly available cranberry tablet preparations contain vitamin C, which has been independently shown to increase urinary oxalate excretion. The aim of this study is to investigate the influence of cranberry supplementation on urinary oxalate excretion. Fifteen participants were randomised to receive cranberry tablets alone or cranberry tablets containing vitamin C. Tablets were taken at the manufacturers recommended dosage for a period of 14 days. Participants provided a 24 h urine collection at trial entry and day 14. Urinary variables were compared to assess for changes in oxalate levels. The median age was 27 years (21–43). There was no difference in the 24 h urine volume pre or post commencement of cranberry tablets (1.7 vs 2 L, p = 0.07). An increase in median urinary oxalate excretion was observed in participants taking both cranberry-only tablets (0.10 mmol/day) and tablets containing vitamin C (1.15 mmol/day). Dietary supplementation with cranberry increases urinary oxalate excretion and should be avoided in patients at risk of urolithiasis.

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potentially curative therapy for hematological malignancies. However, graft-versus-host disease (GVHD) and relapse after allo-HSCT remain major impediments to the success of allo-HSCT. Chimeric antigen receptors (CARs) direct tumor cell recognition of adoptively transferred T cells. CD19 is an attractive CAR target, which is expressed in most B cell malignancies, as well as in healthy B cells. Clinical trials using autologous CD19-targeted T cells have shown remarkable promise in various B cell malignancies. However, the use of allogeneic CAR T cells poses a concern in that it may increase risk of the occurrence of GVHD, although this has not been reported in selected patients infused with donor-derived CD19 CAR T cells after allo-HSCT. To understand the mechanism whereby allogeneic CD19 CAR T cells may mediate anti-lymphoma activity without causing a significant increase in the incidence of GVHD, we studied donor-derived CD19 CAR T cells in allo-HSCT and lymphoma models in mice. We demonstrate that alloreactive T cells expressing CD28-costimulated CD19 CARs experience enhanced stimulation, resulting in the progressive loss of both their effector function and proliferative potential, clonal deletion, and significantly decreased occurrence of GVHD. Concurrently, the other CAR T cells that were present in bulk donor T cell populations retained their anti-lymphoma activity in accordance with the requirement that both the T cell receptor (TCR) and CAR be engaged to accelerate T cell exhaustion. In contrast, first-generation and 4-1BB-costimulated CAR T cells increased the occurrence of GVHD. These findings could explain the reduced risk of GVHD occurring with cumulative TCR and CAR signaling.

Several decades of research in alpine ecosystems have demonstrated links among the critical zone, hydrologic response, and the fate of elevated atmospheric nitrogen (N) deposition. Less research has occurred in mid-elevation forests, which may be important for retaining atmospheric N deposition. To explore the fate of N in the montane zone, we conducted plot-scale experimental rainfall events across a north–south transect within a catchment of the Boulder Creek Critical Zone Observatory. Rainfall events mimicked relatively common storms (20–50% annual exceedance probability) and were labeled with 15N-nitrate ( $$ {\text{NO}}_{3}^{ - } $$ ) and lithium bromide tracers. For 4 weeks, we measured soil–water and leachate concentrations of Br−, $$ {}^{15}{\text{NO}}_{3}^{ - } , $$ and $$ {\text{NO}}_{3}^{ - } $$ daily, followed by recoveries of 15N species in bulk soils and microbial biomass. Tracers moved immediately into the subsurface of north-facing slope plots, exhibiting breakthrough at 10 and 30 cm over 22 days. Conversely, little transport of Br− or $$ {}^{15}{\text{NO}}_{3}^{ - } $$ occurred in south-facing slope plots; tracers remained in soil or were lost via pathways not measured. Hillslope position was a significant determinant of soil 15N- $$ {\text{NO}}_{3}^{ - } $$ recoveries, while soil depth and time were significant determinants of 15N recovery in microbial biomass. Overall, 15N recovery in microbial biomass and leachate was greater in upper north-facing slope plots than lower north-facing (toeslope) and both south-facing slope plots in August; by October, 15N recovery in microbial N biomass within south-facing slope plots had increased substantially. Our results point to the importance of soil properties in controlling the fate of N in mid-elevation forests during the summer season.

Complications following spine fusion for adolescent idiopathic scoliosis can be characterized as either intra-operative or post-operative. The most serious and feared complication is neurologic injury, both in the intra- and post-operative period. Other intra-operative complications include dural tears and ophthalmologic or peripheral nerve deficits, which may be related to positioning. Among the most common post-operative complications are surgical site infection, venous thromboembolism, gastrointestinal complications, and implant-related complications. Significant blood loss requiring transfusion, traditionally considered a known sequelae of spine fusion, is now being recognized as a “complication” in large national databases. Pediatric spine surgeons who care for patients with AIS must be thoroughly familiar with all potential complications and their management.

Chronic prostatitis/Chronic pelvic pain syndrome (CP/CPPS) is a common syndrome with limited therapies and an unknown etiology. Previously, our laboratory has defined a potential role for pathogenic infection in disease onset. Intra-urethral infection with a uropathogenic Escherichia coli strain isolated from a CP/CPPS patient, CP1, induces prostatic inflammation and tactile allodynia in mice. We have also demonstrated that a prostate specific Staphylococcus epidermidis bacterial isolate, NPI (non-pain inducing), from a healthy subject reduces pain and inflammation in an experimental autoimmune prostatitis (EAP) murine model. Here we focus on the interplay between these human isolates in the context of prostatitis development and resolution. NOD/ShiLtJ mice were inoculated with either NP1 or CP1, or combinations of both. Infection with CP1 induced pelvic tactile allodynia after 7 days, while NPI instillation alone induced no such response. Instillation with NPI 7 days following CP1 infection resolved pelvic tactile allodynia and prophylactic instillation 7 days prior to CPI infection prevented its onset. Prophylactic NPI instillation also prevented CP1 colonization of both prostate and bladder tissues. In vitro analyses revealed that CP1 and NPI do not directly inhibit the growth or invasive potential of one another. Immunological analyses revealed that specific markers associated with CP1-induced pelvic allodynia were decreased upon NPI treatment or repressed by prophylactic colonization. This study demonstrates that a commensal bacterial isolate can inhibit the colonization, pain responses, and immunological activation to uropathogenic bacteria, emphasizing the power of a healthy prostatic microflora in controlling health and disease.

The discharge letter is a key component of the communication pathway between the hospital and primary care. Accuracy and timeliness of delivery are crucial to ensure continuity of patient care. Electronic discharge summaries (EDS) and prescriptions have been shown to improve quality of discharge information for general practitioners (GPs). The aim of this study was to evaluate the effect of a new EDS on GP satisfaction levels and accuracy of discharge diagnosis. A GP survey was carried out whereby semi-structured interviews were conducted with 13 GPs from three primary care centres who receive a high volume of discharge letters from the hospital. A chart review was carried out on 90 charts to compare accuracy of ICD-10 coding of Non-Consultant Hospital Doctors (NCHDs) with that of trained Hopital In-Patient Enquiry (HIPE) coders. GP satisfaction levels were over 90 % with most aspects of the EDS, including amount of information (97 %), accuracy (95 %), GP information and follow-up (97 %) and medications (91 %). 70 % of GPs received the EDS within 2 weeks. ICD-10 coding of discharge diagnosis by NCHDs had an accuracy of 33 %, compared with 95.6 % when done by trained coders (p

The beet leafhopper (BLH, Circulifer tenellus Baker) is a frequent pest of potatoes in the Columbia Basin of Oregon and Washington. Beet leafhoppers vector the causal agent of potato Purple top disease, known as Beet Leafhopper Transmitted Virescence Agent (BLTVA). Over 70 % of BLH in the region can be infected with BLVTA. Current control methods include making regular insecticide applications beginning in May; however it is unclear if those applications are needed. Thus, are insecticide applications necessary to control BLH and reduce BLTVA through the entire season? To answer that question, a field study was conducted in 2008 and 2009 to assess season-long control of BLH. There were 14 treatments, including the control, that were based on gradually eliminating insecticide applications weekly. Plots were sampled weekly for BLH and surveyed for Purple Top disease. Beet leafhoppers were sampled using sweep nets and an inverted leaf blower. Natural BLH populations were low in 2008 and 2009, but differed significantly among treatments in 2009 for inverted leaf blower and sweep net samples. Yields were assessed at the end of each season and no significant differences were found. Trends in the yield, BLH populations and BLTVA incidence support early-season insecticide application when BLH populations are low. The practice of using a calendar spray regime was not supported as yields were similar regardless of insecticide applications. As BLH populations were low, the results emphasized the importance of monitoring before making insecticide applications.

Background More than 30% of the world’s population are anemic with serious medical and economic consequences. Red blood cell transfusion is the mainstay to correct anemia, but it is also one of the top five overused procedures and carries its own risk and cost burden. Patient blood management (PBM) is a patient-centered and multidisciplinary approach to manage anemia, minimize iatrogenic blood loss, and harness tolerance to anemia in an effort to improve patient outcome. Despite resolution 63.12 of the World Health Organization in 2010 endorsing PBM and current guidelines which include evidence-based recommendations on the use of diagnostic/therapeutic resources to provide better health care, many hospitals have yet to implement PBM in routine clinical practice. Method and results A number of experienced clinicians developed the following “Simplified International Recommendations for Patient Blood Management.” We propose a series of simple, cost-effective, best-practice, feasible, and evidence-based measures that will enable any hospital to reduce both anemia prevalence on the day of intervention/surgery and anemia-related unnecessary transfusion in surgical and medical patients, including obstetrics and gynecology.

El Nino-Southern Oscillation (ENSO) plays a dominant role in interannual climate variability in Pacific island countries, directly affecting lives there. Many countries show different rainfall responses depending on the sea surface temperature (SST) structure of different types of El Nino events. El Nino events are classified into three types based on previous studies: those with strongest SST anomalies in the eastern Pacific Cold Tongue region (CTE), in the Western Pacific Warm Pool region (WPE), and those in between, a “Mixed” El Nino (MxE), and results from 30 CMIP5 models are investigated. These models accurately reproduce observed SST and precipitation anomalies for the three El Nino types and La Nina. CMIP5 models simulate much larger ranges in the strength of ENSO events than observed. Results clarify the roles of both the different structures of El Nino SST anomalies and their magnitudes on rainfall in the Pacific, and demonstrate that each of the three El Nino types has different impacts on rainfall in the region. These impacts vary with location, with WPE and CTE producing very different impacts in most Pacific island countries. There is a linear intensification of both the mean and maximum rainfall anomalies in the equatorial Pacific as the events become stronger. Equatorial rainfall shifts eastward in CTE and MxE, westward in La Nina. Both the South Pacific and Intertropical Convergence Zones (SPCZ and ITCZ) shift equatorward in El Nino and poleward in La Nina, the shifts increasing as events strengthen. WPE show different behaviour to other events, with little east-west shift in equatorial rainfall, and the orientation angle of the convergence zones increases. Identification of models with no erroneous westward bias in SST anomalies has clarified the effect of strong CTE events producing “zonal” SPCZ and shifting rainfall away to the east from western equatorial countries.

The cause of chronic pelvic pain syndrome (CPPS) has yet to be established. Since the late 1980s, cytokine, chemokine, and immunological classification studies using human samples have focused on identifying biomarkers for CPPS, but no diagnostically beneficial biomarkers have been identified, and these studies have done little to deepen our understanding of the mechanisms underlying chronic prostatic pain. Given the large number of men thought to be affected by this condition and the ineffective nature of current treatments, there is a pressing need to elucidate these mechanisms. Prostatitis types IIIa and IIIb are classified according to the presence of pain without concurrent presence of bacteria; however, it is becoming more evident that, although levels of bacteria are not directly associated with levels of pain, the presence of bacteria might act as the initiating factor that drives primary activation of mast-cell-mediated inflammation in the prostate. Mast cell activation is also known to suppress regulatory T cell (Treg) control of self-tolerance and also activate neural sensitization. This combination of established autoimmunity coupled with peripheral and central neural sensitization can result in the development of multiple symptoms, including pelvic pain and bladder irritation. Identifying these mechanisms as central mediators in CPPS offers new insight into the prospective treatment of the disease.

The potato psyllid, Bactericera cockerelli (Sulc), is a vector of the bacterium ‘Candidatus Liberibacter solanacearum’ (Lso) that has been linked to the economically devastating zebra chip disease of potato. To date, four haplotypes of the potato psyllid have been identified and include Central, Western, Northwestern, and Southwestern haplotypes. Zebra chip was reported in potato crops in the Pacific Northwestern United States for the first time in 2011, and the Lso-infected psyllids collected from zebra chip-affected fields were identified as the Western haplotype. Additional studies have reported a mix of the Western and Northwestern psyllid haplotypes in the Pacific Northwest. The present study further examined psyllid population dynamics over the duration of the 2012 potato season in the Pacific Northwest by haplotype analysis of 864 potato psyllids collected from potato fields in Washington, Oregon, and Idaho. In the Yakima Valley of Washington and the lower Columbia Basin of Washington and Oregon, the Northwestern haplotype was predominant (78 %), and was detected earlier in the season than the Western haplotype. Interestingly, in south-central Idaho, all four psyllid haplotypes were identified, but the predominant haplotype was the Western haplotype (77 %). Here, Northwestern psyllids were detected early in the season from June to mid-August, whereas Central psyllids were detected in late July and thereafter. These results suggest that haplotype composition of psyllid populations in potato fields throughout the 2012 growing season in south-central Idaho differed greatly from those in Washington and Oregon. Additionally, all psyllids were analyzed for the presence of Lso, and no Lso-positive psyllids were found in Washington and Oregon, whereas Lso-positive psyllids were found in south-central Idaho. These Lso-positive psyllids consisted of the Western, Northwestern, and Central haplotypes.

Background: We extend our previous study of childhood leukaemia and proximity to high-voltage powerlines by including more recent data and cases and controls from Scotland, by considering 132-kV powerlines as well as 275 and 400 kV and by looking at greater distances from the powerlines. Methods: Case–control study using 53 515 children from the National Registry of Childhood Tumours 1962–2008, matched controls, and calculated distances of mother's address at child's birth to powerlines at 132, 275, and 400 kV in England, Wales and Scotland. Results: Our previous finding of an excess risk for leukaemia at distances out to 600 m declines over time. Relative risk and 95% confidence interval for leukaemia, 0–199 m compared with>1000 m, all voltages: 1960s 4.50 (0.97–20.83), 2000s 0.71 (0.49–1.03), aggregate over whole period 1.12 (0.90–1.38). Increased risk, albeit less strong, may also be present for 132-kV lines. Increased risk does not extend beyond 600 m for lines of any voltage. Conclusions: A risk declining over time is unlikely to arise from any physical effect of the powerlines and is more likely to be the result of changing population characteristics among those living near powerlines.

An examination of the relation between runoff rate, R, and concentration, C, of twelve major constituents in four small watersheds in eastern Puerto Rico demonstrates a consistent pattern of responses. For solutes that are not substantially bioactive (alkalinity, silica, calcium, magnesium, sodium, and chloride), the log(R)–log(C) relation is almost linear and can be described as a weighted average of two sources, bedrock weathering and atmospheric deposition. The slope of the relation for each solute depends on the respective source contributions to the total river load. If a solute were strictly derived from bedrock weathering, the slope would be −0.3 to −0.4, whereas if strictly derived from atmospheric deposition, the slope would be approximately −0.1. The bioactive constituents (dissolved organic carbon, nitrate, sulfate, and potassium), which are recycled by plants and concentrated in shallow soil, demonstrate nearly flat or downward-arched log(R)–log(C) relations. The peak of the arch represents a transition from dominantly soil-matrix flow to near-surface macropore flow, and finally to overland flow. At highest observed R (80 to >90 mm/h), essentially all reactive surfaces have become wetted, and the input rate of C becomes independent of R (log(R)–log(C) slope of –1). The highest R are tenfold greater than any previous study. Slight clockwise hysteresis for many solutes in the rivers with riparian zones or substantial hyporheic flows indicates that these settings may act as mixing end-members. Particulate constituents (suspended sediment and particulate organic carbon) show slight clockwise hysteresis, indicating mobilization of stored sediment during rising stage.

To assess the prevalence and the team interaction in cases of missed delirium in acute care veterans coded as not having a diagnosis of delirium in admission or discharge notes. In this retrospective study, the records of 183 hospitalized veterans admitted to the emergency department (ED), medicine, surgery and psychiatry services and coded as not having a diagnosis of delirium were analyzed. Clinical notes of each case were examined using DSM IV TR criteria for delirium. Of the 52 cases assessed to have delirium, 5 cases had been miscoded as not having delirium. In the remaining 47 cases the diagnosis of delirium had been missed. The rates of undiagnosed delirium were ED 46/160, medicine 39/132, surgery 4/17, psychiatry 4/29 and consult liaison (CL) 0/9. Of the 5 cases of delirium identified by the CL service, 2 consult diagnoses were accepted and 3 were rejected. Nursing notes had words suggesting delirium in 70.2 % of 47 cases compared to 41.3 and 43.6 % of the clinician case notes for these patients admitted to ED and medicine respectively. No delirium or cognitive screening scales were utilized in the work up of the 52 cases involving delirium. The study results suggest that continuing education by the CL service of all hospital personnel involved in patient care may improve the diagnosis of delirium. Also, increased clinician-nursing intra-team communication, in addition to careful scrutiny of the nursing and clinician notes may contribute to the reduced incidence of missed delirium.

Potato purple top disease is caused by a phytoplasma known as Beet Leafhopper Transmitted Virescence Agent (BLTVA), which is vectored by the beet leafhopper (BLH, Circulifer tenellus Baker). Previous studies determined that BLTVA can cause significant reductions in yield and tuber quality; however, quantifying the damage caused by BLTVA and the insect vector has been challenging. In 2009–2011, potato plants at different growth stages were exposed to varying densities of BLH in a screen house located at the Hermiston Agricultural Research and Extension Center in Hermiston, OR. The densities of potentially infective BLH were one BLH per plant (low), two BLH per plant (medium), and five BLH per plant (high). Releases occurred at the following growth stages: vegetative, tuber initiation, tuber bulking, and maturation. The treatments were arranged in a randomized complete block design with three replications per treatment. Disease incidence was monitored weekly and yield was assessed. When all 3 years were combined, we found that increasing rates of disease incidence correlated with decreasing yields. We also found that greater yield losses were observed with later BLH release times. With both correlations, differences between years were a strong contributing factor. There was a mean decrease in yield of 0–12 % at a density of one BLH per plant, 6–19 % at two BLH per plant, and 6–20 % for five BLH per plant. These general trends in yield loss suggest that economically relevant damage may occur at levels as low as one or two potentially infective BLH per plant in the Columbia Basin.

‘Candidatus Liberibacter solanacearum’ (Lso) is a bacterium that infects solanaceous crops and causes plant decline and yield losses, especially in potato and tomato. Lso is transmitted to these hosts by the potato psyllid (Bactericera cockerelli Sulc) vector. B. cockerelli host plants are not limited to crop plants, but also include many wild, solanaceous weeds. These wild hosts could potentially impact overwintering and breeding of the psyllids and serve as reservoirs for Lso. In the Pacific Northwestern United States, B. cockerelli was recently reported to overwinter on bittersweet nightshade (Solanum dulcamara L.). The present study utilized high resolution melting analysis of the B. cockerelli mitochondrial cytochrome c oxidase I gene to assess the psyllid populations occurring on S. dulcamara during the summer and winter months in Washington, Oregon, and Idaho. This technique has previously been used to analyze the cytochrome c oxidase I gene of B. cockerelli, and has identified four psyllid haplotypes. Lso infection was also determined for the psyllids collected from S. dulcamara. During both the summer and the winter months in the Pacific Northwest, the Northwestern psyllid haplotype was the predominant population found living on S. dulcamara. However, low levels of the Western psyllid population were also present in Washington and Oregon during the same period. No overwintering psyllids tested were Lso-infected, suggesting that these populations do not pose an imminent threat of Lso transmission to newly emerging potatoes and other solanaceous crops in the region, unless a source of Lso becomes available.

In some areas of clinical medicine, discussions about fertility preservation are routine, such as in the treatment of children and adolescents facing cancer treatments that will destroy their ability to produce gametes of their own. Certain professional organizations now offer guidelines for people who wish to modify their bodies and appearance in regard to sex traits, and these guidelines extend to recommendations about fertility preservation. Since the removal of testicles or ovaries will destroy the ability to have genetically related children later on, it is imperative to counsel transgender people seeking body modifications about fertility preservation options. Fertility preservation with transgender people will, however, lead to unconventional outcomes. If transgender men and women use their ova and sperm, respectively, to have children, they will function as a mother or father in a gametic sense but will function in socially reversed parental identities. There is nothing, however, about fertility preservation with transgender men and women that is objectionable in its motives, practices, or outcomes that would justify closing off these options. In any case, novel reproductive technologies may extend this kind of role reversal in principle to all people, if sperm and ova can be derived from all human beings regardless of sex, as has happened with certain laboratory animals.

The purpose of this study was to evaluate papillary lesions of the breast diagnosed at needle core biopsy and the outcomes of follow-up imaging and surgical findings.Retrospective review of 13,806 needle core biopsies performed from 2004 to 2010 revealed 352 patients with 368 papillary lesions; 137 of these lesions underwent surgical excision and 215 had a minimum of 2 year imaging follow-up. Outcomes of imaging follow-up and underestimation of carcinoma by comparison to surgical excision, as applicable, were determined. Patient demographics, clinical presentation, BI-RADS(®) breast density, palpability, biopsy methods, number of specimens, and pathology were recorded. A two-tailed Fisher exact test was used to assess associations between biopsy techniques and the results of surgical excision as well as the association between palpability and the results of surgical excision. SAS(®) V 9.1.3 was used to perform the calculations.One hundred and thirty-seven lesions proceeded to surgical excision. A total of 28 lesions were underestimated; 21 of these were underestimated carcinomas. When comparing biopsy devices in the underestimated group, 64 % were biopsied with directional vacuum-assisted devices and 36 % with automated large core devices (p0.0706). In total 18 % of the palpable lesions were underestimated, whereas 17 % of the nonpalpable lesions were underestimated (p0.6560); this was not a significant difference.Overall, carcinoma was underestimated at needle biopsy in 6 % (21/368) of papillary lesions diagnosed when compared to surgical excision. In cases that underwent excision, 34 % (47/137) revealed carcinoma; 45 % (21/47) of these were underestimated carcinomas. Lesion palpability and biopsy method did not affect underestimation in this study population.

Technological and conceptual advances in inflammatory bowel disease research have uncovered new mechanisms that contribute to the pathogenesis of these disorders. It is becoming increasingly clear that the microbiota of the gut and the response of intestinal cells to that microbiota can initiate or contribute to intestinal inflammation. Evidence from genetic studies have identified IBD-associated genes implicated in autophagy and innate sensing of microbes. These genes also play key roles in the homeostasis of a cell type that stands at the interface of host-microbial interaction – the Paneth cell. Here we discuss recent findings that underscore the importance of the microbiome, Paneth cells and autophagy in inflammatory bowel disease.

BACKGROUND: Record-based studies have generally reported association of higher childhood leukaemia incidence with higher socioeconomic status (SES), but recent findings are less consistent. METHODS: We examined records from the National Registry of Childhood Tumours for evidence of this association in England and Wales during 1976-2005. All eligible leukaemia registrations (N=11940) were grouped by year of diagnosis in decades centred on census years 1981, 1991 and 2001 (N=3748, 3922, 4270, respectively). Using data from the census appropriate to the decade, SES for each case was measured by the child-population-weighted quintile of the Carstairs deprivation index of the census ward containing the address at diagnosis. RESULTS: In each decade, the age-standardised leukaemia rate in the poorest quintile was ∼90% of the rate in the most affluent. Using Poisson regression, the age-adjusted rate ratio per quintile decrease in SES was 0.96 (95% confidence interval 0.94-0.98; P

Despite developments in surgical technique, radiation treatment, and chemotherapeutic agents, tumor recurrence and distant disease have remained a major concern in breast cancer management. Breast imaging after mastectomy in the screening arena remains a controversial topic for breast imagers. Many feel the yield of finding a recurrent cancer with imaging in the asymptomatic patient is too low to be beneficial; others believe imaging should be performed on these patients as the risk of recurrence exists. Patients after a mastectomy procedure are considered high risk and, when they present with clinical symptoms, will require evaluation by the radiologist. In this diagnostic/symptomatic scenario, imaging becomes the routine and current imaging tools, such as mammography, ultrasound, and magnetic resonance imaging (MRI), can easily be incorporated to diagnose recurrent cancer. Our facility has a large population of patients that undergo mastectomy after a carcinoma diagnosis as well as a number of patients that have undergone a mastectomy procedure because of their high-risk status (whether family history or genetic predisposition). A certain percentage of these patients have proceeded to reconstructive surgery. We image these patients routinely as part of our screening protocol. Over the years we have become familiar with the appearance of remaining tissue along the chest wall after mastectomy as well as the reconstructed breasts. This familiarity is important as the imaging of these patients with mammography and other modalities available today can be challenging. This manuscript will discuss the benefits and some limitations surrounding imaging these patients, in both the asymptomatic and symptomatic scenarios, as well as what imaging protocols can be integrated within a facility's standard evaluation.

Squamate reptiles (lizards and snakes) offer a unique model system for testing hypotheses about the evolutionary transition from oviparity (egg-laying) to viviparity (live-bearing) in amniote vertebrates. The evolution of squamate viviparity has occurred remarkably frequently (>108 times) and has resulted in major changes in reproductive physiology. Such frequent changes in reproductive strategy pose two questions: (1) what are the molecular mechanisms responsible for the evolution of squamate viviparity? (2) Are these molecular mechanisms the same for separate origins of viviparity? Molecular approaches, such as RT-PCR, in situ hybridisation, Western blotting and immunofluorescence, have been invaluable for identifying genes and proteins that are involved in squamate placental development, materno-foetal immunotolerance, placental transport, placental angiogenesis, hormone synthesis and hormone receptor expression. However, the candidate-gene or -protein approach that has been used until now does not allow for de novo gene/protein discovery; results to date suggest that the reproductive physiologies of mammals and squamate reptiles are very similar, but this conclusion may simply be due to a limited capacity to study the subset of genes and proteins that are unique to reptiles. Progress has also been slowed by the lack of appropriate molecular and genomic resources for squamate reptiles. The advent of next-generation sequencing provides a relatively inexpensive way to conduct rapid high-throughput sequencing of genomes and transcriptomes. We discuss the potential use of next-generation sequencing technologies to analyse differences in gene expression between oviparous and viviparous squamates, provide important sequence information for reptiles, and generate testable hypotheses for the evolution of viviparity.

To examine the prognostic importance of absolute values and change in values of BNP in patients with stable heart failure (HF).Five-hundred and fifty-nine patients attending a disease management programme were categorized into tertiles of BNP (group 1; ≤ 95 pg/ml, group 2; 96-249 pg/ml and group 3; ≥ 250 pg/ml). A change in BNP between two stable visits was recorded. Patients were followed up for 1 year for death and a composite morbidity measure of HF hospitalization, all-cause hospitalization, unscheduled visits for clinical deterioration(UC) of HF using survival analysis.The risk of the combined morbidity outcome increased with increasing tertiles of BNP (Log rank = 17.8 (2), p0.001). Furthermore, a 50 and 25% increase in BNP predicted morbidity in stable HF patients with an initial BNP200 pg/ml (p = 0.02) and450 pg/ml (p = 0.03), respectively.In a stable community HF population, an elevated BNP or an increase in BNP predicts an adverse prognosis thereby potentially identifying a population in need of closer clinical follow-up.

ICD implantation for primary prevention of sudden cardiac death in patients with left ventricular systolic dysfunction (ejection fraction ≤35%) has increased since the publication of the SCD-HEFT and MADIT-II data. The aim of this study is to examine the effectiveness and safety of prophylactic ICD use in a community heart failure population and to assess the impact on patient’s quality of life. Seventy-one ICDs were inserted between the years 2002 and 2006. The mean follow-up from time of insertion was 24 ± 11 months. Eighteen patients (25%) had potentially life-saving therapy. Seven (10%) patients received inappropriate shocks. Complications were encountered in five patients (7%). In a community heart failure population, prophylactic ICD implantation is associated with a high incidence of life-saving therapy, a low complication rate and a high level of tolerability. These data indicate translation of clinical trial benefits to the general heart failure population.

Experimental and clinical studies suggest an association between small intestinal bacterial overgrowth (SIBO) and nonalcoholic steatohepatitis (NASH). Liver injury and fibrosis could be related to exposure to bacterial products of intestinal origin and, most notably, endotoxin, including lipopolysaccharide (LPS). To compare the prevalence of SIBO and its relationships to LPS receptor levels and systemic cytokines in NASH patients and healthy control subjects. Eighteen NASH patients (eight males) and 16 age-matched and gender-matched healthy volunteers were studied. SIBO was assessed by the lactulose breath hydrogen test (LHBT), plasma lipopolysaccharide binding protein (LBP) levels by ELISA, and expression (as a percentage) of TLR-2 and 4 on CD14-positive cells by flow cytometry. Pro-inflammatory cytokines (IL-1β, IL-6, IL-8, and TNF-α) were measured in plasma. SIBO was more common in NASH patients than control subjects (77.78% vs. 31.25%; P

The clinical implementation of needle core biopsies has given radiologists an invaluable tool for the diagnostic evaluation of suspicious breast lesions. Despite improvements made to the technology of breast biopsy, the underestimation of disease in tissue samples retrieved continues. This can be attributed to many factors, including variability between different needle gauges. This study was undertaken to assess the pathological underestimation for 9 and 12 gauge breast needle core biopsies at surgical excision. A retrospective review of image-guided consecutive core needle biopsies performed from 2003 to 2006 yielded a total of 1,201 needle core biopsies: 837 twelve gauge and 364 nine gauge. Further analysis was completed to distinguish needle biopsies whose pathological outcome was underestimated at core needle biopsy when compared to their subsequent surgical excision. Ninety-seven lesions in 88 patients were reviewed and comprise the study cohort. Underestimation was found in 97 needle core procedures in 88 patients. Of the 97, 67 were performed with 12 gauge vacuum-assisted biopsy devices and 30 with 9 gauge vacuum-assisted biopsy devices, resulting in an underestimation rate of 8.00 and 8.24% for 12 gauge and 9 gauge, respectively. The difference in underestimation rate was not statistically significant per Pearson’s chi squared test (P = 0.8898). In this analysis, the underestimation of needle biopsy results with surgical pathology was found to be 8.00% for the 12 gauge group and 8.24% for the 9 gauge group. These results support our current clinical practice of utilizing either needle gauge.

Problems associated with the large file sizes of digital mammograms have impeded the integration of digital mammography with picture archiving and communications systems. Digital mammograms irreversibly compressed by the novel wavelet Access Over Network (AON) compression algorithm were compared with lossless-compressed digital mammograms in a blinded reader study to evaluate the perceived sufficiency of irreversibly compressed images for comparison with next-year mammograms. Fifteen radiologists compared the same 100 digital mammograms in three different comparison modes: lossless-compressed vs 20:1 irreversibly compressed images (mode 1), lossless-compressed vs 40:1 irreversibly compressed images (mode 2), and 20:1 irreversibly compressed images vs 40:1 irreversibly compressed images (mode 3). Compression levels were randomly assigned between monitors. For each mode, the less compressed of the two images was correctly identified no more frequently than would occur by chance if all images were identical in compression. Perceived sufficiency for comparison with next-year mammograms was achieved by 97.37% of the lossless-compressed images and 97.37% of the 20:1 irreversibly compressed images in mode 1, 97.67% of the lossless-compressed images and 97.67% of the 40:1 irreversibly compressed images in mode 2, and 99.33% of the 20:1 irreversibly compressed images and 99.19% of the 40:1 irreversibly compressed images in mode 3. In a random-effect analysis, the irreversibly compressed images were found to be noninferior to the lossless-compressed images. Digital mammograms irreversibly compressed by the wavelet AON compression algorithm were as frequently judged sufficient for comparison with next-year mammograms as lossless-compressed digital mammograms.

Over the past decade, the percentage of children who are obese has rapidly increased. As weight has been shown to correlate strongly with the size of various organs, we have observed that obese children have larger kidneys than their normal-weight counterparts. This study sought to quantify this observation by establishing the normal limits of renal length for this population. We examined 204 healthy patients seen for benign hematuria between January 2000 and May 2008. Both right and left kidney lengths significantly correlated with age, height, weight, body mass index and body surface area in our obese patients (n = 59). Height was also found to be a significant predictor of kidney length, in the obese group, by multiple linear regression analysis and was used to create renal length nomograms for the obese pediatric population (P < 0.01). According to this analysis, obese patients had significantly larger kidneys than those of normal-weight patients (P < 0.01). By defining the normal limits of renal length for this group, unnecessary evaluation for nephromegaly will be avoided.

PURPOSE: Cisplatin, carboplatin, and oxaliplatin are chemically reactive anticancer drugs with modest activity in brain tumors. Previously, we have demonstrated that drug exposure in cerebrospinal fluid (CSF) for these platinum analogs is

The converging thermal wave, flash technique for measuring thermal diffusivity is suitable for use on samples that are sufficiently thick or thin in comparison to the annular heat source, to be described by a three-dimensional or two-dimensional approximation of the heat conduction equation, and sufficiently absorbing to ensure generation of a heat source at the surface. However, samples of intermediate thickness, which lie between these regimes, cannot be analyzed. In this article, heat diffusion in the samples of varying thicknesses is modeled, and a semi-analytic expression is used to describe the dimensionality of any thickness, allowing the converging wave method to be extended to intermediate thickness samples. Applying the analysis to anisotropic samples, a method is proposed to find the anisotropy ratio of the in-plane to perpendicular-to-plane diffusivity using the converging wave method.

Sustainable engineering is a conceptual and practical challenge to all engineering disciplines. Although the profession has experience with environmental dimensions of engineering activities that in some cases are quite deep, extending the existing body of practice to sustainable engineering by including social and cultural domains is a significant and non-trivial challenge. Nonetheless, progress is being made, as a recent study undertaken by the Center for Sustainable Engineering in the United States demonstrates.

We analysed the sensitivity of European Trichoptera (caddisfly) species to climate change impacts based on their distribution and ecological preferences, and compared the fraction of species potentially endangered by climate change between the European ecoregions. The study covers 23 European ecoregions as defined by Illies (1978). For 1134 Trichoptera species and subspecies, we coded 29 parameters describing biological and ecological preferences and distribution based on the evaluation of more than 1400 literature references. Five parameters served to describe the species’ sensitivity to climate change impacts: endemism, preference for springs, preference for cold water temperatures, short emergence period, and restricted ecological niches in terms of feeding types. Of the European Trichoptera species and subspecies, 47.9% are endemic, 23.1% have a strong preference for springs, 21.9% are cold stenothermic, 35.5% have a short emergence period, and 43.7% are feeding type specialists. The fraction of endemic species meeting at least one of the four other sensitivity criteria mentioned above is highest in the Iberic-Macaronesian Region (30.2% of all species), about 20% in several other south European ecoregions, and about 10% in high mountain ranges. In 15 out of 23 ecoregions (including all northern European and lowland ecoregions) the proportion is less than 3%.