Rapid maxillary expansion versus watchful waiting in pediatric OSA: A systematic review.

[EN] Spontaneous resolution of pediatric obstructive sleep apnea (OSA) may stand behind the observed benefit of rapid maxillary expansion (RME), mainly supported by uncontrolled case series. We aimed to review the controlled, ideally randomized, evidence on the effectiveness of RME as compared to watchful waiting or alternative treatment of pediatric OSA. We only found one randomized clinical trial comparing RME with watchful waiting. The other four studies compared RME with the gold-standard treatment adenotonsillectomy, three of them in a non-randomized fashion. The results of the RCT showed no statistically significant differences in the enhancement of main (apnea hypopnea index, AHI) and secondary outcomes between RME and watchful waiting. Furthermore, reproducibility of the published studies was limited by insufficient description of their patients' inclusion criteria. We could not find convincing evidence of the benefit of RME over watchful waiting in patients with pediatric OSA. RCTs with reproducible inclusion criteria comparing RME with watchful waiting are still critically needed to support this intervention for the treatment of pediatric OSA. In the absence of solid evidence with RCT, RME should not be recommended for the treatment of pediatric OSA. PROSPERO REGISTRATION NUMBER: CRD42021249261. RUNNING SUMMARY: This systematic review explores the benefits of rapid maxillary expansion compared to spontaneous resolution of pediatric obstructive sleep apnea

Health-Related Quality of Life after Cystectomy and Urinary Diversion for Bladder Cancer

With multiple options for urinary diversion after radical cystectomy for bladder cancer that have comparable cancer control and complication rates, health-related quality of life (HRQOL) has become an important consideration. This article reviews the methods for defining HRQOL, the challenges in measuring HRQOL in bladder cancer, and the literature comparing HRQOL after various methods of urinary diversion. Recent contributions include the validation of HRQOL instruments specific to bladder cancer and the publication of several prospective studies measuring HRQOL outcomes after cystectomy and urinary diversion. There is no convincing evidence from existing literature that any particular method of urinary diversion offers superior HRQOL outcomes. Rather, there is growing evidence that good HRQOL can be achieved with patient education and consideration of each patient's clinical and psychosocial situation. Future research should utilize the validated bladder cancer specific HRQOL instruments and perhaps explore the impact of preoperative counseling on postoperative HRQOL

Evaluating Summer Flounder Spatial Sex-Segregation in a Southern New England Estuary

Marine fish species can exhibit sex-specific differences in their biological traits. Not accounting for these characteristics in the stock assessment or management of a species can lead to misunderstanding its population dynamics and result in ineffective regulatory strategies. Summer Flounder Paralichthys dentatus, a flatfish that supports significant commercial and recreational fisheries along the northeastern U.S. shelf, expresses variation in several traits between the sexes, including growth and habitat preference. To further understand these patterns, 1,302 Summer Flounder were collected and sexed in 2016 and 2017 from fisheries-independent surveys conducted in Rhode Island state waters. Female flounder were more prevalent in shallow waters (15 m) from May through September. The probability of a collected flounder being female was evaluated with generalized linear models and covariates representing depth, temperature, month, year, and TL. Summer Flounder were more likely to be female at larger sizes, in shallower waters, and late in the season. When compared with landings data in the recreational fishery over the sampling period, the results suggest that nearly all flounder harvested in the sector were female. This work provides further evidence for and characterization of Summer Flounder sex-segregation and highlights, for management purposes, the importance of considering fine-scale spatial dynamics in addition to broader distribution patterns. The fitted model represents an effective first step toward understanding the implications of an aggregated fishing effort for disproportionate removals of male or female flounder and for exploring resulting consequences for regional spawning stock biomass and stock resiliency

Impact of Regional Systems of Care on Disparities in Care Among Female and Black Patients Presenting With ST‐Segment–Elevation Myocardial Infarction

BACKGROUND: The American Heart Association Mission: Lifeline STEMI (ST-segment-elevation myocardial infarction) Systems Accelerator program, conducted in 16 regions across the United States to improve key care processes, resulted in more patients being treated within national guideline goals (time from first medical contact to device: <90 minutes for direct presenters to hospitals capable of performing percutaneous coronary intervention; <120 minutes for transfers). We examined whether the effort reduced reperfusion disparities in the proportions of female versus male and black versus white patients. METHODS AND RESULTS: In total, 23 809 patients (29.3% female, 82.3% white, and 10.7% black) presented with acute STEMI between July 2012 and March 2014. Change in the proportion of patients treated within guideline goals was compared between sex and race subgroups for patients presenting directly to hospitals capable of performing percutaneous coronary intervention (n=18 267) and patients requiring transfer (n=5542). The intervention was associated with an increase in the proportion of men treated within guideline goals that presented directly (58.7-62.1%, P=0.01) or were transferred (43.3-50.7%, P<0.01). An increase was also seen among white patients who presented directly (57.7-59.9%, P=0.02) or were transferred (43.9-48.8%, P<0.01). There was no change in the proportion of female or black patients treated within guideline goals, including both those presenting directly and transferred. CONCLUSION: The STEMI Systems Accelerator project was associated with an increase in the proportion of patients meeting guideline reperfusion targets for male and white patients but not for female or black patients. Efforts to organize systems of STEMI care should implement additional processes targeting barriers to timely reperfusion among female and black patients

Alternative reproductive tactics in snail shell-brooding cichlids diverge in energy reserve allocation

Life history theory predicts that the amount of resources allocated to reproduction should maximize an individual's lifetime reproductive success. So far, resource allocation in reproduction has been studied mainly in females. Intraspecific variation of endogenous energy storage and utilization patterns of males has received little attention, although these patterns may vary greatly between individuals pursuing alternative reproductive tactics (ARTs). ARTs are characterized by systematic variation of behavioral, physiological, and often morphological traits among same-sex conspecifics. Some individuals may rely on previously accumulated reserves, because of limited foraging opportunities during reproduction. Others may be able to continue foraging during reproduction, thus relying on reserves to a lesser extent. We therefore predicted that, if male tactics involve such divergent limitations and trade-offs within a species, ARTs should correspondingly differ in energy reserve allocation and utilization. To test this prediction, we studied short-term and long-term reserve storage patterns of males in the shell-brooding cichlid Lamprologus callipterus. In this species, bourgeois males investing in territory defense, courtship, and guarding of broods coexist with two distinct parasitic male tactics: (1) opportunistic sneaker males attempting to fertilize eggs by releasing sperm into the shell opening when a female is spawning; and (2) specialized dwarf males attempting to enter the shell past the spawning female to fertilize eggs from inside the shell. Sneaker males differed from other male types by showing the highest amount of accumulated short-term and long-term fat stores, apparently anticipating their upcoming adoption of the nest male status. In contrast, nest males depleted previously accumulated energy reserves with increasing nest holding period, as they invest heavily into costly reproductive behaviors while not taking up any food. This conforms to a capital breeder strategy. Dwarf males did not accumulate long-term fat stores at all, which they can afford due to their small behavioral effort during reproduction and their continued feeding activity, conforming to an income breeder strategy. Our data confirm that the resource storage patterns of males pursuing ARTs can diverge substantially, which adds to our understanding of the coexistence and maintenance of alternative reproductive patterns within species

Consistent size-independent harvest selection on fish body shape in two recreationally exploited marine species

Harvesting wild animals may exert size-independent selection pressures on a range of morphological, life history, and behavioral traits. Most work so far has focused on selection pressures on life history traits and body size as morphological trait. We studied here how recreational fishing selects for morphological traits related to body shape, which may correlate with underlying swimming behavior. Using landmark-based geometric morphometrics, we found consistent recreational fishing-induced selection pressures on body shape in two recreationally exploited marine fish species. We show that individuals with larger-sized mouths and more streamlined and elongated bodies were more vulnerable to passively operated hook-and-line fishing independent of the individual's body size or condition. While the greater vulnerability of individuals with larger mouth gapes can be explained by the direct physical interaction with hooks, selection against streamlined and elongated individuals could either involve a specific foraging mode or relate to underlying elevated swimming behavior. Harvesting using passive gear is common around the globe, and thus, size-independent selection on body shape is expected to be widespread potentially leaving behind individuals with smaller oral gapes and more compact bodies. This might have repercussions for food webs by altering foraging and predation. © 2014 The Authors. Ecology and Evolution published by John Wiley & Sons Ltd.This study was financed by the research project REC2 (grant#CTM2011-23835) funded by the Spanish Ministry of Economy and Competiveness (MINECO) and a Marie Curie Post-Doc grant to JA (FP7-PEOPLE-2012-IEF, Grant Number 327160). RA received funding from the German Federal Ministry for Education and Research (BMBF) through the Program for Social-Ecological Research for the project Besatzfisch (Grant Number 01UU0907, www.besatz-fisch.de) and the University of Florida, School of Forest Resources and Conservation, during a sabbatical stay during which this manuscript was drafted. The finalization of the project was financially supported by the BTypes project funded through the Leibniz Competition (SAW-2013-IGB-2) to R.A.Peer Reviewe

Management of Hypertension in High-Risk Ethnic Minority with Heart Failure

Hypertension (HTN) is the most common co-morbidity in the world, and its sequelae, heart failure (HF) is one of most common causes of mortality and morbidity in the world. Current understanding of pathophysiology and management of HTN in HF is mainly based on studies, which have mainly included whites. Among racial groups, African-American adults have the highest rates (44%) of hypertension in the world and are more resistant to treatment. There is an emerging consensus on the significance of racial disparities in the pathophysiology and treatment options of hypertension and heart failure. However, African Americans had been underrepresented in all the trials until the initiation of the A-HEFT trial. Since the recognition of obstructive sleep apnea (OSA) as an important medical condition, large clinical trials have shown benefits of OSA treatment among patients with HTN and HF. This paper focuses on the pathophysiology, causes of secondary hypertension, and treatment of hypertension among African-American patients with heart failure. There is increasing need for randomized clinical trials testing innovative treatment options for African-American patients

Reduced global genetic differentiation of exploited marine fish species

Knowledge on genetic structure is key to understand species connectivity patterns and to define the spatiotemporal scales over which conservation management plans should be designed and implemented. The distribution of genetic diversity (within and among populations) greatly influences species ability to cope and adapt to environmental changes, ultimately determining their long-term resilience to ecological disturbances. Yet, the drivers shaping connectivity and structure in marine fish populations remain elusive, as are the effects of fishing activities on genetic subdivision. To investigate these questions, we conducted a meta-analysis and compiled genetic differentiation data (FST/ΦST estimates) for more than 170 fish species from over 200 published studies globally distributed. We modeled the effects of multiple life-history traits, distance metrics, and methodological factors on observed population differentiation indices and specifically tested whether any signal arising from different exposure to fishing exploitation could be detected. Although the myriad of variables shaping genetic structure makes it challenging to isolate the influence of single drivers, results showed a significant correlation between commercial importance and genetic structure, with widespread lower population differentiation in commercially exploited species. Moreover, models indicate that variables commonly used as proxy for connectivity, such as larval pelagic duration, might be insufficient, and suggest that deep-sea species may disperse further. Overall, these results contribute to the growing body of knowledge on marine genetic connectivity and suggest a potential effect of commercial fisheries on the homogenization of genetic diversity, highlighting the need for additional research focused on dispersal ecology to ensure long-term sustainability of exploited marine species.MAR-01.04.02-FEAMP-0015, UIDB/04326/2020, PTDC/BIA-CBI/6515/2020, DL57/2016/CP1361/CT0035, DL 57/2016/CP1361/CT0036info:eu-repo/semantics/publishedVersio

Distribution and taxonomic notes of Eunotia Ehrenberg 1837 (Bacillariophyceae) in rivers and streams of Northern Spain

Between August and October of 2003, a total of 397 samples of epilithic diatoms were collected from different stations belonging to the control network of the North Hydrographical Confederation of Spain (CHN). One hundred and seventeen sites with Eunotia diatom species were found. Galicia, with 78 localities, was the region with higher representation. Eighteen taxa of the Eunotia genus were identified, 17 of them to the species level. Eunotia minor (Kützing), Grunow in van Heurck and Eunotia implicata Nörpel, Lange-Bertalot &amp;amp; Alles were the most common species, present in 59 %and 50.4 %of the samples, respectively. Conductivity and water acidity were the most important factors in determining Eunotia distribution in the studied area. The main objective of this work was to contribute to the knowledge, from the taxonomic and distribution viewpoints, of the diatoms of the genus Eunotia Ehrenberg that were found in the Iberian Peninsula. It is the first comprehensive study on the Eunotia genus of northern Spain.Entre agosto y octubre del 2003, se recogieron un total de 397 muestras de diatomeas epilíticas en distintas estaciones pertenecientes a la red de control de la Confederación Hidrográfica del Norte (CHN). En un total de 117 localidades se encontraron diatomeas del género Eunotia. Galicia, con 78 estaciones, es la región con más representación. 18 taxones del género Eunotia han sido determinados, 17 de ellos a nivel específico. Eunotia minor (Kútzing) Grunow in van Heurck y Eunotia implicata Nörpel, Lange-Bertalot &amp;amp; Alles han sido las especies con más representación encontrándose en el 59 % y 50.4 % respectivamente de las muestras. La conductividad y la acidez del agua han resultado ser factores importantes que determinan la distribución de especies del género Eunotia en la zona de estudio. El objetivo principal de este trabajo es contribuir al conocimiento desde el punto de vista taxonómico y de distribución de las especies del género Eunotia Ehrenberg en la península Ibérica. Corresponde al primer trabajo exhaustivo del género Eunotia en el norte de España

Decades of warming alters maturation and reproductive investment in fish

How does warming affect maturation and reproductive investment in ectotherms? Younger age and smaller size at maturation, as well as altered reproduction processes, have been found in a few species subjected to elevated temperatures. These observations, however, come from studies that do not distinguish effects of warming on maturation from those on growth, are also restricted to single generation responses to warming, or have additional stressors besides warming in the study system. Here, we study warming effects on maturation and reproductive investment in wild, unexploited fish populations using a whole-ecosystem heating experiment. The experiment is conducted on Eurasian perch (Perca fluviatilis) in a heated and control area (with > 5 degrees C temperature difference) in the Baltic Sea. We compare female perch size at maturation using estimated probabilistic maturation reaction norms (PMRNs) and the gonado-somatic index over 17 years of heating, spanning approximately five to eight perch generations. Using the PMRN approach, we show that warming has substantial effects on maturation size independent of warming-induced changes in body growth. We found that young fish mature at a smaller size and invest more in developing their gonads in the heated population than in the unheated population. Our findings suggest that warming effects on reproductive investment may initially compensate for the cost of warming-induced decrease in maturation size caused by the trade-off between early maturation and size-dependent fecundity. After multiple additional generations of warming, maturation and reproduction traits in perch differed from those in the first generations following the onset of warming, which suggests that warming-induced evolution may have occurred. Our study is particularly relevant in the context of climate change because of the unusually large temperature difference between the areas and the fact that the heating occurred on an ecosystem level. We call for experimental studies resolving mechanisms of trait responses to warming across generations, complemented with genomic analyses, to aid understanding of organisms' long-term responses to climate change