The association between delinquent peer affiliation and disruptive behavior interacts with functional brain correlates of reward sensitivity: a biosocial interaction study in adolescent delinquents.

BACKGROUND: Affiliating with delinquent peers may stimulate the development of antisocial behavior, especially for adolescents who are sensitive to social rewards. The current study examines whether the association between delinquent peer affiliation (DPA) and disruptive behavior interacts with functional brain correlates of reward sensitivity in early onset male adolescents delinquents. METHODS: Childhood arrestees (n = 126, mean age = 17.7 [s.d. 1.6]) completed a DPA questionnaire, and participated in an fMRI study in which reward sensitivity was operationalized through responsiveness of the ventral striatum (VS), amygdala, and medial prefrontal cortex (mPFC) during the monetary incentive delay paradigm (reward anticipation and outcome). Symptoms of disruptive behavior disorders (DBD) were assessed through structured psychiatric interviews (Diagnostic Interview Schedule for Children) with adolescents. RESULTS: DPA had a main effect on DBD symptoms. Adolescents with high VS reward responses showed a stronger significant positive association between DPA and DBD symptoms compared to low VS responders. No evidence for an interaction effect was found for the amygdala and mPFC. Post-hoc analyses revealed the positive association between DPA and DBD was only present in males, with a diminishing effect as age increased. CONCLUSIONS: We found evidence for a biosocial interaction between DPA and reward sensitivity of the VS in relation to DBD symptom severity. This study provides the first evidence of an interaction effect between a brain mechanism and an environmental factor in relation to DBD symptoms, implying that susceptibility to influences of delinquent peers may intertwine with individual biological differences.

International trade drives biodiversity threats in developing nations.

Human activities are causing Earth's sixth major extinction event-an accelerating decline of the world's stocks of biological diversity at rates 100 to 1,000 times pre-human levels. Historically, low-impact intrusion into species habitats arose from local demands for food, fuel and living space. However, in today's increasingly globalized economy, international trade chains accelerate habitat degradation far removed from the place of consumption. Although adverse effects of economic prosperity and economic inequality have been confirmed, the importance of international trade as a driver of threats to species is poorly understood. Here we show that a significant number of species are threatened as a result of international trade along complex routes, and that, in particular, consumers in developed countries cause threats to species through their demand of commodities that are ultimately produced in developing countries. We linked 25,000 Animalia species threat records from the International Union for Conservation of Nature Red List to more than 15,000 commodities produced in 187 countries and evaluated more than 5 billion supply chains in terms of their biodiversity impacts. Excluding invasive species, we found that 30% of global species threats are due to international trade. In many developed countries, the consumption of imported coffee, tea, sugar, textiles, fish and other manufactured items causes a biodiversity footprint that is larger abroad than at home. Our results emphasize the importance of examining biodiversity loss as a global systemic phenomenon, instead of looking at the degrading or polluting producers in isolation. We anticipate that our findings will facilitate better regulation, sustainable supply-chain certification and consumer product labelling.

Ankylosing Spondylitis Response to TNF Inhibition Is Gender Specific: A 6-Year Cohort Study

Aim Recent studies have suggested gender-specific differences with respect to both baseline disease activity and severity in ankylosing spondylitis (AS). Tumour necrosis factor inhibitors (TNFi) have shown significant benefit in AS but there may be gender-specific differences regarding responses to TNFi therapy. Methods AS patients with active disease despite adequate trials of NSAIDs were commenced on TNFi and followed in a biologic clinic between 2004 and 2011. Response to treatment was measured based on clinical and serological outcomes. Baseline radiographic data were also collected where available. Results 147 AS patients commenced TNFi therapy and were followed in a biologic clinic between 2004 and 2011. One-hundred and six (72%) of the patients were male and 90 (61%) were current or ex-smokers. The specific TNFi prescribed included etanercept (74 patients, 50.3%), adalimumab (51 patients, 34.7%), infliximab (21 patients, 14.2%) and golimumab (1 patient, 0.7%). The median mSASSS score was 11 (interquartile range 5-35). At baseline, the metrology indices (BASMI) were significantly lower in women (2.6 v 4; p=0.01) but all other clinical indices were similar. At 3 months, female patients had significantly worse median disease activity and functional indices (BASDAI: 4 v 2; p<0.01; BASFI: 3 v 2; p=0.03) than male patients. In addition, females had higher median ESR (19 v 6; p<0.01) which correlated with their disease activity indices (r=0.42, p=0.02). Discussion Despite similar disease activity at baseline, post-TNFi therapy women had significantly higher disease activity. Furthermore, ESR levels in women during therapy correlated with their clinical disease activity scores. Further exploration of these gender-specific differences is crucial for a greater understanding of the pathogenesis of AS as well as development of targeted therapies.

Knowledge, attitudes and practices regarding rabies risk in community members and healthcare professionals: Pétionville, Haiti, 2013.

Haiti has the highest human rabies burden in the Western Hemisphere. There is no published literature describing the public's perceptions of rabies in Haiti, information that is critical to developing effective interventions and government policies. We conducted a knowledge, attitudes and practices survey of 550 community members and 116 health professionals in Pétionville, Haiti in 2013 to understand the perception of rabies in these populations. The majority of respondents (85%) knew that dogs were the primary reservoir for rabies, yet only 1% were aware that bats and mongooses could transmit rabies. Animal bites were recognized as a mechanism of rabies transmission by 77% of the population and 76% were aware that the disease could be prevented by vaccination. Of 172 persons reporting a bite, only 37% sought medical treatment. The annual bite incidence rate in respondents was 0·9%. Only 31% of bite victims reported that they started the rabies vaccination series. Only 38% of respondents reported that their dog had been vaccinated against rabies. The majority of medical professionals recognized that dogs were the main reservoir for rabies (98%), but only 28% reported bats and 14% reported mongooses as posing a risk for rabies infection. Bites were reported as a mechanism of rabies transmission by 73% of respondents; exposure to saliva was reported by 20%. Thirty-four percent of medical professionals reported they would wash a bite wound with soap and water and 2·8% specifically mentioned rabies vaccination as a component of post-bite treatment. The majority of healthcare professionals recommended some form of rabies assessment for biting animals; 68·9% recommended a 14-day observation period, 60·4% recommended a veterinary consultation, and 13·2% recommended checking the vaccination status of the animal. Fewer than 15% of healthcare professionals had ever received training on rabies prevention and 77% did not know where to go to procure rabies vaccine for bite victims. Both study populations had a high level of knowledge about the primary reservoir for rabies and the mode of transmission. However, there is a need to improve the level of knowledge regarding the importance of seeking medical care for dog bites and additional training on rabies prevention for healthcare professionals. Distribution channels for rabies vaccines should be evaluated, as the majority of healthcare providers did not know where rabies vaccines could be obtained. Canine rabies vaccination is the primary intervention for rabies control programmes, yet most owned dogs in this population were not vaccinated.

Accuracy of 64-section MDCT in the diagnosis of cruciate ligament tears.

AIM: To evaluate the accuracy of non-arthrographic 64-section multidetector computed tomography (CT) in the assessment of cruciate ligament tears. A secondary goal was to determine its accuracy in the diagnosis of additional soft-tissue injuries around the knee. MATERIALS AND METHODS: Forty consecutive outpatients underwent same-day magnetic resonance imaging (MRI) and 64-slice multidetector CT (MDCT) of the knee in this prospective study. MDCT images were independently evaluated for integrity of the anterior (ACL) and posterior cruciate ligaments (PCL), medial and lateral menisci, and medial and lateral collateral ligaments. Recognised secondary signs of ACL tears were also documented. MRI images were subsequently assessed by two radiologists and a consensus reached. RESULTS: The sensitivity of MDCT for ACL tears was 87.5-100%, with a specificity of 100%. The presence of one or more secondary signs of ACL tears on MDCT had a sensitivity of 50-87.5% with a specificity of 100%. The sensitivity of MDCT for PCL tears was 0-25% with a specificity of 100%. The sensitivity for meniscal tears was 9.1-23.1% with a specificity of 96.3-100%. CONCLUSION: 64-section MDCT has very high sensitivity and specificity for ACL tears and, as on MRI, secondary signs, such as buckling of the PCL, are also useful in their diagnosis. MDCT has a low sensitivity for other soft-tissue injuries at the knee; however, its high specificity indicates that apparent PCL, meniscal, and collateral ligament tears can reliably be treated as true-positive findings.

Integrating livestock health measures into marginal abatement cost curves.

Improving livestock health offers both private and social benefits. Among the potential social benefits is a reduction in the greenhouse gas (GHG) emissions arising from livestock production. Reductions in emissions intensity (the amount of GHG produced per kilogram of meat, milk or eggs) may occur, as improving health can lead to improvements in the parameters that emissions intensity is sensitive to, such as (for ruminants): maternal fertility and abortion rates, calf and lamb mortality rates and growth rates, milk yields and feed conversion rates. However, improved health is not yet widely recognised as a GHG mitigation measure due, in part, to difficulties in reliably quantifying the financial and GHG effects of disease control options. This paper discusses how the GHG effects of disease control can be quantified and included in a marginal abatement cost curve (MACC). To illustrate some of the challenges, it draws on the experience of including health measures in the most recent (2015) agricultural MACCs in the United Kingdom.

L'amélioration de la santé des animaux d'élevage apporte des bénéfices non seulement aux personnes et entreprises privées mais aussi à la société en général. La réduction des émissions de gaz à effet de serre est l'un des bénéfices potentiels apportés à la société par les élevages. Il est ainsi possible de réduire l'intensité des émissions (c'est-à-dire la quantité de gaz à effet de serre générée par kilogramme de viande, de lait ou d'oeufs), dans la mesure où l'amélioration de la santé animale s'accompagne d'une amélioration des paramètres qui influent sur l'intensité de ces émissions ; par exemple, chez les ruminants, le taux de fécondité, le taux d'avortements, le taux de mortalité néonatale et le taux de croissance chez les ovins et les caprins, la production de lait et le taux de conversion des aliments donnés aux animaux. Or, l'amélioration de la santé n'est pas toujours reconnue comme étant une mesure de réduction des gaz à effet de serre, en raison notamment de la difficulté de quantifier de manière fiable les effets des différentes stratégies zoosanitaires en termes financiers et d'émissions de gaz à effet de serre. Les auteurs proposent une méthode permettant de quantifier les effets des mesures de lutte contre les maladies animales sur les émissions de gaz à effet de serre et de les intégrer dans une courbe de coût marginal d'abattement. Afin d'illustrer certains enjeux en la matière, les auteurs présentent l'expérience conduite récemment (2015) au Royaume-Uni pour intégrer les mesures sanitaires dans les courbes de coût marginal d'abattement du secteur agricole.

El hecho de mejorar el estado de salud del ganado reporta beneficios de índole tanto privada como social. Entre los posibles beneficios sociales figura una reducción de las emisiones de gases de efecto invernadero resultantes de la producción pecuaria. Esas emisiones también pueden ser menos intensas (volumen de gases generados por kilogramo de carne, leche o huevos), pues la intensidad de las emisiones es sensible a una serie de parámetros cuyo valor mejora al hacerlo el estado de salud, tales como (en el caso de los rumiantes): tasas de fertilidad materna y de abortos; tasas de mortalidad y crecimiento en terneros y corderos; y tasas de producción de leche y de conversión alimenticia. Sin embargo, todavía no ha arraigado la idea de que la mejora del estado de salud es una medida de lucha contra los gases de efecto invernadero, debido en parte a las dificultades existentes para cuantificar con fiabilidad los efectos de los métodos de lucha zoosanitaria sobre parámetros económicos o sobre las emisiones. Los autores explican cómo cuantificar los efectos del control de enfermedades sobre los gases de efecto invernadero y a partir de ahí incluirlos en una curva del costo marginal de reducción. Para ilustrar algunos de los problemas que pueden surgir se refieren a la experiencia británica destinada a incluir parámetros que miden el estado de salud en las más recientes (2015) curvas del costo marginal de reducción en el ámbito agropecuario.

Differential relations between juvenile psychopathic traits and resting state network connectivity.

Traditionally, neurobiological research on psychopathy has focused on categorical differences in adults. However, there is evidence that psychopathy is best described by a set of relatively independent personality dimensions, that is, callous-unemotional, grandiose-manipulative, and impulsive-irresponsible traits, which can be reliably detected in juveniles, allowing investigation of the neural mechanisms leading to psychopathy. Furthermore, complex psychiatric disorders like psychopathy are increasingly being conceptualized as disorders of brain networks. The intrinsic organization of the brain in such networks is reflected by coherent fluctuations in resting state networks (RSNs), but these have not been studied in sufficient detail in relation to juvenile psychopathic traits yet. The current study investigated the distinct associations of juvenile psychopathic traits dimensions with RSN connectivity. Resting-state functional MRI and independent component analysis were used to assess RSN connectivity in a large sample of adolescents (n = 130, mean age 17.8 years) from a childhood arrestee cohort. Associations between scores on each of the three psychopathic traits dimensions and connectivity within and between relevant RSNs were investigated. Callous-unemotional traits were related to aberrant connectivity patterns of the default mode network, which has been implicated in self-referential and moral processes. Impulsive-irresponsible traits were associated with altered connectivity patterns in the frontoparietal cognitive control networks. Grandiose-manipulative traits were not associated with altered connectivity patterns. These findings confirm the association between psychopathic traits and brain network connectivity, and considerably add to emerging evidence supporting neurobiological heterogeneity in the processes leading to psychopathy.

Transurethral resection of the prostate--"now and then".

The number of transurethral resections of the prostate (TURP) performed each year is decreasing. The aim of this study was to assess a cohort of patients undergoing TURP and compare this to one twenty years earlier in terms of procedure, complications and outcomes. A retrospective comparative analysis of one hundred consecutive TURPs performed in 2010 was compared to one hundred cases performed in 1990. Fifty-five (55%) had a urinary catheter (UC) in situ pre-operatively in 2010 compared to 22 (22%) in 1990. The length of catheterisation time was significantly longer in 2010 compared with 1990 (average 65 days vs 20 days). Infective complications occurred in six (6%) patients in 2010 and three (3%) in the 1990 cohort. Patients who had UCs in situ preoperatively for longer periods had a higher rate of infective complications and more serious complications. This highlights the importance of early specialist referral for patients diaqnosed with urinary retention.

Medial joint line bone bruising at MRI complicating acute ankle inversion injury: what is its clinical significance?

AIM: To assess the incidence and clinical significance of medial joint line bone bruising following acute ankle inversion injury. MATERIALS AND METHODS: Forty-five patients who underwent ankle magnetic resonance imaging (MRI) within 2 weeks of acute ankle inversion injury were included in this prospective study. Integrity of the lateral collateral ligament complex, presence of medial joint line bone bruising, tibio-talar joint effusion, and soft-tissue swelling were documented. Clinical follow-up at 6 months was carried out to determine the impact of injury on length of time out of work, delay in return to normal walking, delay in return to sports activity, and persistence of medial joint line pain. RESULTS: Thirty-seven patients had tears of the anterior talofibular ligament (ATFL). Twenty-six patients had medial joint line bone bruising with altered marrow signal at the medial aspect of the talus and congruent surface of the medial malleolus. A complete ATFL tear was seen in 92% of the patients with medial joint line bone bruising (p = 0.05). Patients with an ATFL tear and medial joint line bone bruising had a longer delay in return to normal walking (p = 0.0002), longer delay in return to sports activity (p = 0.0001), and persistent medial joint line pain (p = 0.0003). There was no statistically significant difference in outcome for the eight patients without ATFL tears. CONCLUSION: Medial joint line bone bruising following an acute ankle inversion injury was significantly associated with a complete ATFL tear, longer delay in the return to normal walking and sports activity, as well as persistent medial joint line pain. Its presence should prompt detailed assessment of the lateral collateral ligament complex, particularly the ATFL.

Physical and psychological stressors linked with stress fractures in recruit training.

This study aimed to measure ambulation in infantry army basic training, and to evaluate if covering more distance can explain stress fractures in a stressor-stress model. Forty-four male combat recruits (18.7 ± 0.7 years) participated in a 6-month rigorous high intensity combat training program. Baseline data included anthropometric measurements, VO(2)max, and psychological questionnaires. Actual distance covered was measured using a pedometer over an 11-week training period. Psychological questionnaires were repeated after 2 months. Sixteen recruits were diagnosed with stress fractures by imaging (SFi = 36.4%). Statistical analysis included comparing measured variables between SFi and those without stress fractures (NSF). The recruits covered 796 ± 157 km, twofold the distance planned of 378 km (P < 0.001). The SFi group covered a distance 16.4% greater than that of the NSF group (866 ± 136 and 744 ± 161 km, respectively, P < 0.01), and also demonstrated greater psychological stress. These data reveal the importance of adherence to or enforcement of military training programs. In the light of these data, the Israeli Defense Forces program needs reappraisal. A stressor-stress response might explain the susceptibility of certain recruits for injury. Using advanced technology, monitoring ambulation may prevent stress fracture development by limiting subjects exceeding a certain level. Psychological profile may also play a role in predicting stress fracture development.

Prevalence and clinical significance of chondromalacia isolated to the anterior margin of the lateral femoral condyle as a component of patellofemoral disease: observations at MR imaging.

OBJECTIVE: To determine the prevalence of chondromalacia isolated to the anterior margin of the lateral femoral condyle as a component of patellofemoral disease in patients with anterior knee pain and to correlate it with patient demographics, patellar shape, and patellofemoral alignment. MATERIALS AND METHODS: Retrospective study over a 1-year period reviewing the MR knee examinations of all patients who were referred for assessment of anterior knee pain. Only patients with isolated lateral patellofemoral disease were included. Age, gender, distribution of lateral patellofemoral chondromalacia, and grade of cartilaginous defects were documented for each patient. Correlation between the distribution of lateral patellofemoral chondromalacia and patient demographics, patellar shape, and indices of patellar alignment (femoral sulcus angle and modified Q angle) was then ascertained. RESULTS: There were 50 patients (22 males, 28 females) with anterior knee pain and isolated patellofemoral disease. The majority of the patients (78 %) had co-existent disease with grade 1 chondromalacia. No significant correlation was found between patients with chondromalacia isolated to the anterior margin of the lateral femoral condyle and age, gender, patellar shape, or modified Q angle (p > 0.05). However, patients with chondromalacia isolated to the anterior margin of the lateral femoral condyle had a shallower femoral sulcus angle (mean 141.8°) compared to the patients with lateral patellar facet disease (mean 133.8°) (p = 0.002). CONCLUSIONS: A small percentage of patients with anterior knee pain have chondromalacia isolated to the anterior margin of the lateral femoral condyle. This was associated with a shallower femoral sulcus angle.

Application of the WFD cost proportionality principle to diffuse pollution mitigation: a case study for Scottish Lochs.

The Water Framework Directive (WFD) aims to deliver good ecological status (GES) for Europe's waters. It prescribes the use of economic principles, such as derogation from GES on grounds of disproportionate costs of mitigation. This paper proposes an application of the proportionality principle to mitigation of phosphorus (P) pollution of 544 Scottish lochs at national and local water body scales. P loading estimates were derived from a national diffuse pollution screening tool. For 293 of these lochs (31% of the loch area), GES already occurred. Mitigation cost-effectiveness was assessed using combined mitigation cost curves for managed grassland, rough grazing, arable land, sewage and septic tank sources. These provided sufficient mitigation (92% of national P load) for GES to be achieved on another 31% of loch area at annualised cost of £2.09 m/y. Mitigation of the residual P loading preventing other lochs achieving GES was considered by using a "mop-up" cost of £200/kg P (assumed cost effectiveness of removal of P directly from lochs), leading to a total cost of £189 m/y. Lochs were ranked by mitigation costs per loch area to give a national scale marginal mitigation cost curve. A published choice experiment valuation of WFD targets for Scottish lochs was used to estimate marginal benefits at national scale and combined with the marginal cost curve. This gave proportionate costs of £5.7 m/y leading to GES in 72% of loch area. Using national mean marginal benefits with a scheme to estimate changes in individual loch value with P loading gave proportionate costs of £25.6 m/y leading to GES in 77% of loch area (491 lochs).

Detection and discrimination of electrical stimuli from an upper limb cuff electrode inM. Mulatta.

Objective.Peripheral nerve interfaces seek to restore nervous system function through electrical stimulation of peripheral nerves. In clinical use, these devices should function reliably for years or decades. In this study, we assessed evoked sensations from multi-channel cuff electrode stimulation in macaque monkeys up to 711 d post-implantation.Approach.Three trained macaque monkeys received multi-channel cuff electrode implants at the median or ulnar nerves in the upper arm. Electrical stimuli from the cuff interfaces evoked sensations, which we measured via standard psychophysical tasks. We adjusted pulse amplitude or pulse width for each block with various electrode channel configurations to examine the effects of stimulus parameterization on sensation. We measured detection thresholds and just-noticeable differences (JNDs) at irregular, near-daily intervals for several months using Bayesian inferencing from trial data. We examined data trends using classical models such as Weber's Law and the strength-duration relationship using linear regression.Main results.Detection thresholds were similar between blocks with pulse width modulation and blocks with pulse amplitude modulation when represented as charge per pulse, the product of the amplitude and the pulse width. Conversely, Weber fractions-calculated as the slope of the regression between JND charge values and reference stimulus charge-were significantly different between pulse width and pulse amplitude modulation blocks for the discrimination task.Significance.Weber fractions were lower in blocks with amplitude modulation than in blocks with pulse width modulation, suggesting that pulse amplitude modulation allows finer resolution of sensory encoding above threshold. Consequently, amplitude modulation may enable a greater dynamic range for sensory perception with neuroprosthetic devices.

Excision and primary closure using the Karydakis flap for the treatment of pilonidal disease: outcomes from a single institution.

BACKGROUND: Chronic pilonidal disease is a debilitating condition that typically affects young adults. There is a wide variety of available therapeutic strategies reflecting the inconsistent outcomes attributed to the various operative approaches. The majority involve excision of the sinus tract followed by either primary closure or healing by secondary intention. A variety of closure approaches exist. There remains uncertainty as to which is more effective. The aim of the current study was to determine subjective and objective outcomes following excision and Karydakis flap closure in a unit where this technique is the standard of care in the management of chronic pilonidal disease. METHODS: This study involving consecutive patients with chronic pilonidal disease was conducted over a 4-year period. A tailored patient satisfaction questionnaire was given to each patient. Postoperative primary and secondary outcomes were evaluated. The mean follow-up time was 30 months. RESULTS: One hundred six consecutive patients (33 female, 73 male) underwent excision and primary closure using the Karydakis flap. Ninety-two completed questionnaires were returned (87% response rate). Patients consulted their general practitioner 2.8 times (mean) and 46% received empirical oral antimicrobial therapy prior to referral for a surgical opinion. The mean time lost to work/school following the Karydakis flap repair was 13 days (range 3-33). Successful treatment was achieved in 96.3% of cases and 92% of patients were satisfied with their operative result. CONCLUSION: Excision and primary closure with Karydakis flap is an effective treatment for chronic pilonidal disease. It is associated with low morbidity, early return to premorbid functioning, and a high degree of patient satisfaction (92%).

Review: Sustainable livestock systems: anticipating demand-side challenges.

A sustainable livestock economy depends on both production and consumption, inextricably linked in local, national and global markets. At each scale, technical innovation and production practices need to respond to evolving demand for both market and non-market attributes of livestock systems. This review considers recent and evolving demand-side challenges focussing on emerging preferences related to environmental, dietary and health impacts, arising from both production and consumption. It suggests that these attributes need to be integral to any definition of high-producing animal systems. This discussion is mostly framed using neoclassical economic theory, which highlights market failure and the role of negative and positive external effects or social costs. It examines how our understanding of the demand for these attributes is evolving, leading to market segmentation in some cases, and an existential threat to livestock production as consumption decisions change, investors seek to avoid potential liabilities related to greenhouse gas emissions and potentially antimicrobial resistance, and governments intervene to control other undesirable social costs. The discussion distinguishes between market imperatives in high- and lower-income countries, and how income and consumption trajectories may be less deterministic in a more hyperlinked world where product information may accelerate the evolution of preferences towards and away from livestock products. The review acknowledges the limits of a neoclassical approach, drawing attention to more fundamental concepts of biophysical limits to growth and value pluralism, which indicates values (e.g. intrinsic) that lie beyond the neoclassical framing of demand and value.

Comparison of technical success and safety of transbronchial versus percutaneous CT-guided fiducial placement for SBRT of lung tumors.

OBJECTIVE: To evaluate the technical success and safety of transbronchial (bronchoscopic) fiducial placement compared to percutaneous CT-guided fiducial placement for stereotactic body radiotherapy (SBRT) of lung tumors. MATERIALS AND METHODS: This IRB-approved, HIPAA-compliant retrospective study was performed at a single tertiary institution. Consecutive patients undergoing lung fiducial placement for purposes of guiding SBRT (CyberKnife®, Accuray, Inc.) between September 2005 to January 2013 were included in the study. Fiducial seeds were placed percutaneously with CT guidance or transbronchially with bronchoscopic guidance. We compared procedure-related complications (pneumothorax, chest tube placement), technical success (defined as implantation enabling adequate treatment planning with CT simulation) and migration rate. The need for repeat procedures and their mode was noted. Statistical analysis was performed using Fisher exact and Chi square probability tests. RESULTS: Two hundred and forty-four patients with lung tumors and 272 fiducial seed placements were included in the study. Two hundred and twenty-one of the 272 (81.2%) fiducial markers were placed percutaneously and 51/272 (18.8%) were placed transbronchially. Pneumothorax was seen in 73/221 (33%) of percutaneously-placed fiducials and in 4/51 (7.8%) of transbronchial placements (p<0.001). No significant difference was seen in the rate of chest tube placement between the two groups: 20/221 (9%) of percutaneously placed fiducials and 2/51 (3.9%) of transbronchially placed fiducials (p=0.39). Fifteen of the 51 (29%) of fiducial placements with transbronchial approach were unsuccessful, as discovered at radiotherapy planning session, and required a repeat procedure. Nine of the 15 (60%) of repeat procedures were performed percutaneously, 5/15 (33%) were placed during repeat bronchoscopy, and 1/15 (7%) was placed at transesophageal endoscopic ultrasound. No repeat fiducial placements were required for patients who had the fiducials placed percutaneously (p<0.001), with a technical success rate of 100%. CONCLUSION: Transbronchial fiducial marker placement has a significantly higher rate of failed seed placements requiring repeat procedures in comparison to percutaneous placement. Complication rate of pneumothorax requiring chest drain placement is similar between the two approaches.

Acclimation to heat interpreted from the analysis of heart-rate variability by the Multipole Method.

The Multipole Method is a recently developed method to describe time series with highly complex time evolution, such as cardiac rhythm. We hypothesized that applying this method in the analysis of heart rate variability (HRV) could provide valuable physiological information that usually cannot be extracted from the commonly used time and frequency domains analyses. The hypothesis was tested during a 12-day heat acclimation process on four young healthy, male subjects. On the first and the last day of acclimation, HRV was investigated by two different measures: the conventional Standard Deviation of Normal to Normal R-R intervals (SDNN), and the Multipole Method. The analyses revealed that stress on the cardiovascular system was still evident after the 12th day of acclimation, but both methods showed that stress was diminished. Using the Multipole analysis, following acclimation to heat, the autonomic nervous system shows a more effective response. We conclude that the Multipole Method is a very valuable tool for investigating the series of R-R intervals, which are a non-stationary and non-linear complex time series, reflecting a complex regulatory physiological mechanism. Specifically, we showed that stress on the cardiovascular system diminishes following the course of acclimation, but not to its complete relief, which indicates that acclimation to heat is a much longer process than can be judged from the early phenotypic picture.

"The challenge facing renal artery revascularization: what have we not proven and why we must"?

Endovascular renal artery stent therapy for atherosclerotic renal artery stenosis (RAS) is associated with excellent acute technical success, low complication rates and acceptable long-term patency. However, the clinical benefits to patients of renal artery stenting remain uncertain. To facilitate debate regarding the treatment of RAS, we need to understand the epidemiology, basic physiology and clinical consequences of renal artery stenosis. We must attempt to determine which patients are likely to benefit from renal artery stenting, assess the nuances of the percutaneous procedure and review the current literature pertaining to renal artery stenting.

Synthesis of controlled size starch nanoparticles (SNPs).

Starch nanoparticles (SNPs) are a promising choice for the strategic development of new renewable and biodegradable nanomaterials for novel biomedical and pharmaceutical applications when loaded with antibiotics or with anticancer agents as target drug delivery systems. The final properties of the SNPs are strongly influenced by the synthesis method and conditions being a controlled and monodispersed size crucial for these applications. The aim of this work was to synthesize controlled size SNPs through nanoprecipitation and microemulsion methods by modifying main operating parameters regarding the effect of amylose and amylopectin ratio in maize starches. SNPs were characterized by size and shape. SNPs from 59 to 118 nm were obtained by the nanoprecipitation method, registering the higer values when surfactant was added to the aqueous phase. Microemulsion method led to 35-147 nm sizes observing a higher particle formation capacity. The composition of the maize used influenced the final particle size and shape.