Impacts of forest-to-agriculture conversion on aboveground and soil carbon and nitrogen stocks along a bioclimatic gradient in Costa Rica

Tropical forest-to-agriculture conversions contribute to ~20% of contemporary global C emissions. Current global C flux estimates assume C is lost from vegetation and soils over time due to this conversion, and that C stocks in agricultural lands are fairly uniform across the tropics. Global C stock and flux estimates may contain large errors if these assumptions are incorrect. I asked the following research questions: (1) Do aboveground and soil C and N stocks and their net changes due to forest-to-agricultural conversion differ among life zones and agricultural land use types in Costa Rica?; (2) Do aboveground and soil C and N stocks and their net changes due to forest-to-pasture conversion differ by pasture age?; and (3) Can life zone specific-estimates reduce potential biases and uncertainty of regional and global C flux estimates for forest-to-agricultural conversions? I sampled soil and aboveground C and N stocks at 62 agricultural sites in Costa Rica stratified by land use and life zone and compared them to mature forests. Ecosystem and soil C and N stocks varied more by life zone than by land use. Net soil C and N stock changes due to forest-to-pasture conversion differed by life zone; soil stocks decreased in the Tropical dry forest and Lower Montane rain forest life zones and increased in the other life zones. Generally, ecosystem C and N stocks in pastures decreased with pasture age, but the effect of age was smaller than life zone and conversion effects. My estimates of Costa Rican ecosystem C stocks in agricultural lands were 2-fold greater and my ecosystem C flux estimates due to forest-to-agricultural conversions were 8-19% lower than Intergovernmental Panel on Climate Change (IPCC)-endorsed estimates. Therefore to reduce uncertainty and bias, incorporation of ecosystem C stock variability related to life zone into regional and global models is more important than including variability related to pasture age or land use type. Overall, my results confirm that forest-to-agriculture conversions represent a significant alteration to global C cycles, and contribute to reducing uncertainty in the magnitude of such changes

Klinische presentatie van het chronisch subduraal hematoom bij ouderen

Een 87- jarige man werd opgenomen in verband met cognitieve stoornissen, hallucinaties en achteruitgang in mobiliteit. Een CT scan van de hersenen liet een bilateraal subduraal hematoom zien. Het hematoom is waarschijnlijk ontstaan na een recente val bij gebruik van acenocoumarol. Het chronisch subduraal hematoom (CSDH) is een frequent voorkomende intracraniële bloeding op oudere leeftijd. Het ontstaat vaak na een gering trauma en kan zich met een grote verscheidenheid aan symptomen presenteren. Wanneer het zich presenteert met cognitieve achteruitgang en neuropsychiatrische verschijnselen zoals hallucinaties, kan het onderscheid met andere aandoeningen zoals dementie of delier moeilijk zijn. Dit kan leiden tot vertraging van de diagnosestelling of onderdiagnosticering

Het effect van galantamine op de ecg- geleidingstijden

Achtergrond Galantamine, een acethylcholinesterase-remmer (AChE-remmer), is geregistreerd voor de symptomatische behandeling van lichte tot matig ernstige dementie van het Alzheimer-type. In de literatuur zijn associaties beschreven tussen het gebruik van AChE – remmers en het optreden van cardiovasculaire bijwerkingen. Het doel van deze prospectieve, observationele studie is om te onderzoeken of er een verband bestaat tussen het gebruik van galantamine en het optreden van cardiale geleidingsstoornissen. Methode In totaal werden 64 patiënten geïncludeerd, bij wie gestart werd met een behandeling met galantamine nadat de diagnose waarschijnlijk Alzheimer-dementie was gesteld. De startdosering was 8 mg/ dag, welke dosering, indien er geen bijwerkingen optraden, per vier weken opgehoogd werd met 8 mg tot een einddosering van 24 mg/ dag. Een electrocardiogram werd verricht voor aanvang en tijdens de therapie met galantamine. De waarden van de nulmeting werden vergeleken met die bij gebruik van 8, 16 en 24 mg galantamine. Resultaten Er werden geen significante veranderingen in de ecg- geleidingstijden gevonden tijdens het ophogen van galantamine tot de maximale dosering van 24 mg. Ook niet na correctie voor gebruik van negatief- chronotrope middelen en cardiale voorgeschiedenis

Anterior Cervical Infection: Presentation and Incidence of an Uncommon Postoperative Complication.

STUDY DESIGN: Retrospective multi-institutional case series. OBJECTIVE: The anterior cervical discectomy and fusion (ACDF) affords the surgeon the flexibility to treat a variety of cervical pathologies, with the majority being for degenerative and traumatic indications. Limited data in the literature describe the presentation and true incidence of postoperative surgical site infections. METHODS: A retrospective multicenter case series study was conducted involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network, selected for their excellence in spine care and clinical research infrastructure and experience. Medical records for 17 625 patients who received cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011, inclusive, were reviewed to identify the occurrence of 21 predefined treatment complications. Patients who underwent an ACDF were identified in the database and reviewed for the occurrence of postoperative anterior cervical infections. RESULTS: A total of 8887 patients were identified from a retrospective database analysis of 21 centers providing data for postoperative anterior cervical infections (17/21, 81% response rate). A total of 6 postoperative infections after ACDF were identified for a mean rate of 0.07% (range 0% to 0.39%). The mean age of patients identified was 57.5 (SD = 11.6, 66.7% female). The mean body mass index was 22.02. Of the total infections, half were smokers (n = 3). Two patients presented with myelopathy, and 3 patients presented with radiculopathic-type complaints. The mean length of stay was 4.7 days. All patients were treated aggressively with surgery for management of this complication, with improvement in all patients. There were no mortalities. CONCLUSION: The incidence of postoperative infection in ACDF is exceedingly low. The management has historically been urgent irrigation and debridement of the surgical site. However, due to the rarity of this occurrence, guidance for management is limited to retrospective series

Misplaced Cervical Screws Requiring Reoperation.

STUDY DESIGN: A multicenter, retrospective case series. OBJECTIVE: In the past several years, screw fixation of the cervical spine has become commonplace. For the most part, this is a safe, low-risk procedure. While rare, screw backout or misplaced screws can lead to morbidity and increased costs. We report our experiences with this uncommon complication. METHODS: A multicenter, retrospective case series was undertaken at 23 institutions in the United States. Patients were included who underwent cervical spine surgery from January 1, 2005, to December 31, 2011, and had misplacement of screws requiring reoperation. Institutional review board approval was obtained at all participating institutions, and detailed records were sent to a central data center. RESULTS: A total of 12 903 patients met the inclusion criteria and were analyzed. There were 11 instances of screw backout requiring reoperation, for an incidence of 0.085%. There were 7 posterior procedures. Importantly, there were no changes in the health-related quality-of-life metrics due to this complication. There were no new neurologic deficits; a patient most often presented with pain, and misplacement was diagnosed on plain X-ray or computed tomography scan. The most common location for screw backout was C6 (36%). CONCLUSIONS: This study represents the largest series to tabulate the incidence of misplacement of screws following cervical spine surgery, which led to revision procedures. The data suggest this is a rare event, despite the widespread use of cervical fixation. Patients suffering this complication can require revision, but do not usually suffer neurologic sequelae. These patients have increased cost of care. Meticulous technique and thorough knowledge of the relevant anatomy are the best means of preventing this complication

Quantification of the novel N-methyl-D-aspartate receptor ligand [11C]GMOM in man

[11C]GMOM (carbon-11 labeled N-(2-chloro-5-thiomethylphenyl)-N0-(3-[11C]methoxy-phenyl)-N0-methylguanidine) is a PET ligand that binds to the N-methyl-D-aspartate receptor with high specificity and affinity. The purpose of this first in human study was to evaluate kinetics of [11C]GMOM in the healthy human brain and to identify the optimal pharmacokinetic model for quantifying these kinetics, both before and after a pharmacological dose of S-ketamine. Dynamic 90 min [11C]GMOM PET scans were obtained from 10 subjects. In six of the 10 subjects, a second PET scan was performed following an S-ketamine challenge. Metabolite corrected plasma input functions were obtained for all scans. Regional time activity curves were fitted to various single- and two-tissue compartment models. Best fits were obtained using a two-tissue irreversible model with blood volume parameter. The highest net influx rate (Ki) of [11C]GMOM was observed in regions with high N-methyl-D-aspartate receptor density, such as hippocampus and thalamus. A significant reduction in the Ki was observed for the entire brain after administration of ketamine, suggesting specific binding to the N-methyl-D-aspartate receptors. This initial study suggests that the [11C]GMOM could be used for quantification of N-methyl-D-aspartate receptors

C5 Palsy After Cervical Spine Surgery: A Multicenter Retrospective Review of 59 Cases.

STUDY DESIGN: A multicenter, retrospective review of C5 palsy after cervical spine surgery. OBJECTIVE: Postoperative C5 palsy is a known complication of cervical decompressive spinal surgery. The goal of this study was to review the incidence, patient characteristics, and outcome of C5 palsy in patients undergoing cervical spine surgery. METHODS: We conducted a multicenter, retrospective review of 13 946 patients across 21 centers who received cervical spine surgery (levels C2 to C7) between January 1, 2005, and December 31, 2011, inclusive. P values were calculated using 2-sample t test for continuous variables and χ(2) tests or Fisher exact tests for categorical variables. RESULTS: Of the 13 946 cases reviewed, 59 patients experienced a postoperative C5 palsy. The incidence rate across the 21 sites ranged from 0% to 2.5%. At most recent follow-up, 32 patients reported complete resolution of symptoms (54.2%), 15 had symptoms resolve with residual effects (25.4%), 10 patients did not recover (17.0%), and 2 were lost to follow-up (3.4%). CONCLUSION: C5 palsy occurred in all surgical approaches and across a variety of diagnoses. The majority of patients had full recovery or recovery with residual effects. This study represents the largest series of North American patients reviewed to date

Who Are Hospice Patients and What Care Is Provided in Hospices?: A Pilot Study

Background: Hospices provide multidimensional care. In the Netherlands, patients with <3 months estimated life expectancy have access to hospice care. Insight into patients admitted to hospices and the care provided is lacking. In preparation for a national multicenter study, a pilot study was performed. Objective: The primary objective was to test the appropriateness of the study procedures and the availability of hospice patient records (HPRs), and patient and care characteristics. Method: A cross-sectional pilot study was performed using a descriptive exploratory design. Sixteen hospices were invited to participate, and HPRs from 8 deceased patients per hospice were selected. Data were collected using self-developed electronic case report forms. Outcomes: (1). Appropriateness of procedures: availability of HPRs and identified barriers and strategies. (2) Availability of patient and care characteristics in HPRs. Results: In total, 104 HPRs of patients from 13 hospices were enrolled. Various types of HPRs were found with different availabilities: nurses’ records were most available (98%) compared to volunteers’ records (62%). Overarching barriers were as follows: ethical issues, lack of knowledge, and lack of communication. Information about the illness was most available (97%), whereas descriptions of experienced symptoms were least available (10%). Conclusion: Collecting HPRs is difficult and time-consuming. Specifically, data from separate records of home care nurses and general practitioners were difficult to come by. Patient and care characteristics were alternately present, which led to an extension of data collection in HPRs to 3 time periods. Piloting is essential to adjust study procedures and outcome measures to ensure a feasible national multicenter hospice study

Determinants of lenalidomide response with or without erythropoiesis-stimulating agents in myelodysplastic syndromes:the HOVON89 trial

A randomized phase-II study was performed in low/int-1 risk MDS (IPSS) to study efficacy and safety of lenalidomide without (arm A) or with (arm B) ESA/G-CSF. In arm B, patients without erythroid response (HI-E) after 4 cycles received ESA; G-CSF was added if no HI-E was obtained by cycle 9. HI-E served as primary endpoint. Flow cytometry and next-generation sequencing were performed to identify predictors of response. The final evaluation comprised 184 patients; 84% non-del(5q), 16% isolated del(5q); median follow-up: 70.7 months. In arm A and B, 39 and 41% of patients achieved HI-E; median time-to-HI-E: 3.2 months for both arms, median duration of-HI-E: 9.8 months. HI-E was significantly lower in non-del(5q) vs. del(5q): 32% vs. 80%. The same accounted for transfusion independency-at-week 24 (16% vs. 67%), but similar in both arms. Apart from presence of del(5q), high percentages of bone marrow lymphocytes and progenitor B-cells, a low number of mutations, absence of ring sideroblasts, and SF3B1 mutations predicted HI-E. In conclusion, lenalidomide induced HI-E in patients with non-del(5q) and del(5q) MDS without additional effect of ESA/G-CSF. The identified predictors of response may guide application of lenalidomide in lower-risk MDS in the era of precision medicine. (EudraCT 2008-002195-10).</p