The effects of thermal stress on the early development of the lizard Anolis sagrei.

Across the globe terrestrial ectotherms-amphibians and non-avian reptiles-are facing a range of emerging challenges. Increasing global temperatures, in particular, are affecting all aspects of ectotherm biology and life history. Embryonic development is a thermally sensitive period of the organismal lifecycle, yet the impacts of thermal stress on the early development of ectotherms have significantly lagged behind studies of later stages and adult thermal physiology. Morphogenesis, the stage where the major anatomical systems are actively forming, is particularly sensitive to thermal stress, yet is not studied as often as later stages where growth is the primary process happening within the egg. Here, we focus on the effects of thermal stress on the first 12 days of development, the stages of morphogenesis, in the lizard Anolis sagrei. We examine the resiliency of the early developmental stages to heat stress by incubating eggs at temperatures that parallel conditions observed today and predicted over the next 50-100 years of projected climate change. Our results suggest that some anole nests are currently at the thermal limits for which the early embryonic stages can properly develop. Our results emphasize the importance of studying early embryonic stages of development and the importance of studying stage-specific effects of thermal stress on squamate development.

"Awake" clipping of cerebral aneurysms: report of initial series.

OBJECTIVE Risk of ischemia during aneurysm surgery is significantly related to temporary clipping time and final clipping that might incorporate a perforator. In this study, the authors attempted to assess the potential added benefit to patient outcomes of "awake" neurological testing when compared with standard neurophysiological testing performed under general anesthesia. The procedure is performed after the induction of conscious sedation, and for the neurological testing, the patient is fully awake. METHODS The authors conducted an institutional review board-approved prospective study of clipping unruptured intracranial aneurysms (UIAs) in 30 consecutive adult patients who underwent awake clipping. The end points were the incidence of stroke/cerebrovascular accident (CVA), death, discharge to a long-term facility, length of stay, and 30-day modified Rankin Scale score. All clinical and neurophysiological intraoperative monitoring data were recorded. RESULTS The median patient age was 52 years (range 27-63 years); 19 (63%) female and 11 (37%) male patients were included. Twenty-seven (90%) aneurysms were anterior, and 3 (10%) were posterior circulation aneurysms. Five (17%) had been coiled previously, 3 (10%) had been clipped previously, 2 (7%) were partially calcified, and 2 (7%) were fusiform aneurysms. Three patients developed synchronous clinical neurological and neurophysiological changes during temporary clipping with consequent removal of the temporary clip and reversal of those clinical and neurophysiological changes. Three patients developed asynchronous clinical neurological and neurophysiological changes. These 3 patients developed hemiparesis without changes in neurophysiological monitoring results. One patient developed linked clinical neurological and neurophysiological changes during final clipping that were not reversed by reapplication of the clip, and the patient had a CVA. Four patients with internal carotid artery ophthalmic segment aneurysms underwent visual testing with final clipping, and 1 of these patients required repositioning of the clip. Three patients who required permanent occlusion of a vessel as part of their aneurysm treatment underwent a 10-minute intraoperative clinical respective-vessel test occlusion. The median length of stay was 3 days (range 1-5 days). The median modified Rankin Scale score was 1 (range 0-3). All of the patients were discharged to home from the hospital except for 1 who developed a CVA and was discharged to a rehabilitation facility. There were no deaths in this series. CONCLUSIONS The 3 patients who developed neurological deterioration without a concomitant neurophysiological finding during temporary clipping revealed a potential advantage of awake aneurysm surgery (i.e., in decreasing the risk of ischemic injury).

Rapid survey protocol that provides dynamic information on reef condition to managers of the Great Barrier Reef.

Managing to support coral reef resilience as the climate changes requires strategic and responsive actions that reduce anthropogenic stress. Managers can only target and tailor these actions if they regularly receive information on system condition and impact severity. In large coral reef areas like the Great Barrier Reef Marine Park (GBRMP), acquiring condition and impact data with good spatial and temporal coverage requires using a large network of observers. Here, we describe the result of ~10 years of evolving and refining participatory monitoring programs used in the GBR that have rangers, tourism operators and members of the public as observers. Participants complete Reef Health and Impact Surveys (RHIS) using a protocol that meets coral reef managers' needs for up-to-date information on the following: benthic community composition, reef condition and impacts including coral diseases, damage, predation and the presence of rubbish. Training programs ensure that the information gathered is sufficiently precise to inform management decisions. Participants regularly report because the demands of the survey methodology have been matched to their time availability. Undertaking the RHIS protocol we describe involves three ~20 min surveys at each site. Participants enter data into an online data management system that can create reports for managers and participants within minutes of data being submitted. Since 2009, 211 participants have completed a total of more than 10,415 surveys at more than 625 different reefs. The two-way exchange of information between managers and participants increases the capacity to manage reefs adaptively, meets education and outreach objectives and can increase stewardship. The general approach used and the survey methodology are both sufficiently adaptable to be used in all reef regions.

When to use the combined sensory index.

A recently developed electrodiagnostic technique, the combined sensory index (CSI), has been recommended for its greater sensitivity in diagnosing carpal tunnel syndrome (CTS). The CSI requires a greater number of procedures and therefore involves greater time, cost, and patient discomfort than does conventional electrodiagnostic testing. The CSI is composed of three commonly used electrodiagnostic techniques. There is a close correlation between the components of the CSI, and in most cases, all three components of the CSI are in agreement. We performed a study to develop and validate an algorithm that could be used to identify subsets of patients with CTS in whom CSI testing is particularly useful. Subjects were consecutive outpatient veterans referred by a heterogeneous group of specialists and generalists for electrodiagnostic evaluation of paresthesias in a median distribution with nocturnal exacerbation of symptoms. The CSI served as our gold standard. Using our simple algorithm, we found that in approximately 95% of cases, it was unnecessary to perform the CSI. This management strategy improves patient comfort and reduces electrodiagnostic cost while identifying the minority of patients for whom the CSI is indicated.

Carpal compression test and pressure provocative test in veterans with median-distribution paresthesias.

We investigated the value of the carpal compression test (CCT) and the pressure provocative test (PPT) in predicting carpal tunnel syndrome (CTS) in a predominantly male population of veterans. We performed a prospective, blinded comparison of these clinical diagnostic tests with neurophysiological testing. One cohort of 135 consecutive patients was assessed with the CCT; a separate cohort of 134 consecutive patients was assessed with the PPT. Of these 269 patients, 58.4% had electrodiagnostically confirmed CTS. The sensitivity of the CCT was 52.5%, specificity was 61.8%, positive predictive value was 66.6%, and the negative predictive value was 47. 2%. The sensitivity of the PPT was 54.5%, specificity was 68.4%, positive predictive value was 70%, and the negative predictive value was 52.7%. The CCT and PPT had minimal utility in predicting electrodiagnostically confirmed CTS. In a subset of the CCT cohort, 86 consecutive veterans were also evaluated in relation to a clinical gold standard. Of these patients, 60% had CTS based on this gold standard. CCT sensitivity was 53.8%, specificity was 61.8%, positive predictive value was 68.3%, and negative predictive value was 46.7%. The CCT thus had marginal utility in predicting CTS based on a clinical gold standard.

Lack of predictive power of the "tethered" median stress test in suspected carpal tunnel syndrome.

OBJECTIVE: To investigate the value of the "tethered" median nerve stress test (TMST) in predicting electrodiagnostically confirmed carpal tunnel syndrome (CTS) in patients with symptoms suggestive of CTS. STUDY DESIGN: Blinded comparison of a clinical diagnostic test with neurophysiologic testing. SETTING: Portland (OR) Veterans Administration Medical Center Electrodiagnostic Laboratory. PATIENTS: One hundred two consecutive patients referred for symptoms suggestive of CTS. Study inclusion criteria were referral for evaluation of symptoms of paresthesia (with or without pain) inclusive of the median nerve distribution distal to the wrist. RESULTS: Fifty-seven percent of referred patients had electrodiagnostically confirmed CTS. The sensitivity of the TMST was 50%. The specificity was 59.1%. The positive predictive value was 61.7%. The negative predictive value was 47.3%. CONCLUSION: The TMST does not have utility in predicting electrodiagnostic consult results in veteran patients with symptoms suggestive of CTS.

Intentional replantation. A viable alternative for selected cases.

When conventional endodontic treatment or retreatment is not possible, the operator may choose to intentionally extract and replant the involved tooth. Intentional replantation consists of extracting the tooth, finding and correcting the defect, and replanting the tooth in its socket. This article discusses the indications, contraindications, and recommended techniques for intentional replantation. Several successful case reports are described in which intentional replantation was used as a last resort.

Intentional replantation.

When conventional endodontic treatment or retreatment and surgery are not feasible, a clinician may choose to replant the defective tooth. Intentional replantation consists of extracting the tooth, finding and correcting the defect, and replanting the tooth in its socket. This article describes five case reports in which intentional replantation was used as a last resort. Four (80%) of the five patients were successfully treated.

Incidence of postoperative pain after single- and multiple-visit endodontic procedures.

A series of 359 endodontic cases were followed and evaluated by the frequency of reported postoperative pain. A statistical analysis of the data obtained attempted to identify a relationship between pain experienced and the anatomic location, the pulpal vitality as determined by hemorrhage, or the number of treatment visits used in completing the case. Data obtained indicated no relationship between pain experience and pulpal vitality, no statistically significant relationship to the anatomic location, and a significant relationship to the number of visits used. The data indicate a 2 to 1 higher frequency of pain reported following treatment completed in multiple visits as compared to that reported for those completed in one visit.