Hypothenar hammer syndrome: Proposed etiology

AbstractPurpose: Finger ischemia caused by embolic occlusion of digital arteries originating from the palmar ulnar artery in a person repetitively striking objects with the heel of the hand has been termed hypothenar hammer syndrome (HHS). Previous reports have attributed the arterial pathology to traumatic injury to normal vessels. A large experience leads us to hypothesize that HHS results from trauma to intrinsically abnormal arteries. Methods: We reviewed the arteriography, histology, and clinical outcome of all patients treated for HHS in a university clinical research center study of hand ischemia, which prospectively enrolled more than 1300 subjects from 1971 to 1998. Results: Twenty-one men had HHS. All had occupational (mechanic, carpenter, etc) or avocational (woodworker) exposure to repetitive palmar trauma. All patients underwent upper-extremity and hand arteriography, unilateral in eight patients (38%) and bilateral in 13 patients (62%). By means of arteriogram, multiple digital artery occlusions were shown in the symptomatic hand, with either segmental ulnar artery occlusion in the palm or characteristic “corkscrew” elongation, with alternating stenoses and ectasia. Similar changes in the contralateral asymptomatic (and less traumatized) hand were shown by means of 12 of 13 bilateral arteriograms (92%). Twenty-one operations, consisting of segmental ulnar artery excision in the palm and vein grafting, were performed on 19 patients. Histology was compatible with fibromuscular dysplasia with superimposed trauma. Patency of arterial repairs at 2 years was 84%. One patient (5%) required amputative debridement of necrotic finger tips. No other tissue loss occurred. There have been no recurrences of ischemia in patients with patent bypass grafts. Conclusion: To our knowledge, this is the largest reported group of HHS patients. The characteristic angiographic appearance, histologic findings, and striking incidence of bilateral abnormalities in patients with unilateral symptoms lead us to conclude that HHS occurs when persons with preexisting palmar ulnar artery fibrodysplasia experience repetitive palmar trauma. This revised theory for the etiology of HHS explains why HHS does not develop in most patients with repetitive palmar trauma. (J Vasc Surg 2000;31:104-13.

A Global Vision and Strategy for Organic Farming Research. First Draft.

Organic agriculture world-wide offers the promise of a future to produce and distribute food and other farm products in a healthy, ecologically sound, truly sustainable and fair way. The full benefits of organic agriculture are just now being realized—from ecosystem services to the provision of healthier food - yet, to reach its full potential organic farming needs to address many challenges. While organic agriculture has grown in strength and is in the most favorable position it has ever been in with respect to market conditions, government policies and international institutional support, it still does not have adequate resources to continue its expansion. The Technology Innovation Platform of IFOAM (TIPI) has developed a vision and an agenda to advance organic agriculture through research, development, innovation and technology transfer. TIPI’s vision recognizes that current technologies based on heavy use of external inputs that are toxic and pollute the environment come with a price. Investments in ecosystem services and the development of technologies that are productive, stable, adaptable, resilient, and fairly shared are much more likely to sustain the world’s population in a rapidly changing environment. Sustainable pathways to innovation will require engagement of all stakeholders in a science driven multi-disciplinary approach. Such an approach seeks to (1) Empower rural areas, (2) Provide eco-functional intensification that produces food and ecosystem services, and (3) Provide food for the health and well-being available to all. Organic agriculture must build the capacity to fulfill the world’s food needs for the entire population if it is to fulfill its mission. The new paradigm proposed by TIPI is founded upon a whole systems approach, the engagement of farmers, researchers and other practitioners in a co-innovative approach; and open access technologies that are readily adapted to local conditions. While there are barriers and bottlenecks that will need to be overcome for this vision to be realized, TIPI calls upon the organic community to support its 14 point action plan to advance organic agriculture in a forward-thinking and innovative way

The HY5-PIF regulatory module coordinates light and temperature control of photosynthetic gene transcription

The ability to interpret daily and seasonal alterations in light and temperature signals is essential for plant survival. This is particularly important during seedling establishment when the phytochrome photoreceptors activate photosynthetic pigment production for photoautotrophic growth. Phytochromes accomplish this partly through the suppression of phytochrome interacting factors (PIFs), negative regulators of chlorophyll and carotenoid biosynthesis. While the bZIP transcription factor long hypocotyl 5 (HY5), a potent PIF antagonist, promotes photosynthetic pigment accumulation in response to light. Here we demonstrate that by directly targeting a common promoter cis-element (G-box), HY5 and PIFs form a dynamic activation-suppression transcriptional module responsive to light and temperature cues. This antagonistic regulatory module provides a simple, direct mechanism through which environmental change can redirect transcriptional control of genes required for photosynthesis and photoprotection. In the regulation of photopigment biosynthesis genes, HY5 and PIFs do not operate alone, but with the circadian clock. However, sudden changes in light or temperature conditions can trigger changes in HY5 and PIFs abundance that adjust the expression of common target genes to optimise photosynthetic performance and growth

Training Programmes Can Change Behaviour and Encourage the Cultivation of Over-Harvested Plant Species

Cultivation of wild-harvested plant species has been proposed as a way of reducing over-exploitation of wild populations but lack of technical knowledge is thought to be a barrier preventing people from cultivating a new species. Training programmes are therefore used to increase technical knowledge to encourage people to adopt cultivation. We assessed the impact of a training programme aiming to encourage cultivation of xaté (Chamaedorea ernesti-augusti), an over-harvested palm from Central America. Five years after the training programme ended, we surveyed untrained and trained individuals focusing on four potential predictors of behaviour: technical knowledge, attitudes (what individuals think about a behaviour), subjective norms (what individuals perceive others to think of a behaviour) and perceived behavioural control (self assessment of whether individuals can enact the behaviour successfully). Whilst accounting for socioeconomic variables, we investigate the influence of training upon these behavioural predictors and examine the factors that determine whether people adopt cultivation of a novel species. Those who had been trained had higher levels of technical knowledge about xaté cultivation and higher belief in their ability to cultivate it while training was not associated with differences in attitudes or subjective norms. Technical knowledge and perceived behavioural control (along with socio-economic variables such as forest ownership and age) were predictors of whether individuals cultivate xaté. We suggest that training programmes can have a long lasting effect on individuals and can change behaviour. However, in many situations other barriers to cultivation, such as access to seeds or appropriate markets, will need to be addressed

Temporal changes in clinical and radiographic variables in dogs with preclinical myxomatous mitral valve disease: The EPIC study

The Evaluation of pimobendan in dogs with cardiomegaly caused by preclinical myxomatous mitral valve disease (EPIC) study monitored dogs with myxomatous mitral valve disease (MMVD) as they developed congestive heart failure (CHF)

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

VARIABILITy IN LEAF MORpHOLOGICAL TRAITS OF AN ENDEMIC MEXICAN OAK (QuERcus MExicANA BONpL.) ALONG AN ENVIRONMENTAL GRADIENT

Background: Phenotypic and functional traits of plant populations vary with environmental conditions at local and regional scales. The analysis of these traits along environmental gradients provides information on the differential response of populations to climate changes.&#x0D; Objective: We analyzed the leaf morphological variation of an endemic oak to identify the degree of population differentiation along an environmental gradient.&#x0D; Study species: Quercus mexicana Bonpl. (Fagaceae).&#x0D; Study site and dates: Samples were collected from 39 populations in the Sierra Madre Oriental and east of the Trans-Mexican Volcanic Belt from 2014 to 2016.&#x0D; Methods: We measured eight macromorphological traits in 5,507 leaves and three micromorphological traits in 228 leaves. We performed univariate and multivariate statistical analyses to assess the morphological differentiation among populations, and the relationship between variation in leaf traits and environmental variables related to temperature and water availability.&#x0D; Results: Populations of Q. mexicana showed leaf morphological differentiation along its distribution. Significant linear correlations were found between leaf traits and environmental variables. Smaller and thicker leaves with lower density of trichomes and smaller stomata were found in populations located in more arid regions. In contrast, larger and thinner leaves with higher trichome density and larger stomata occurred in more humid places.&#x0D; Conclusions: Populations of Q . mexicana are adapted to a wide range of climatic conditions. Considering the predictive future climatic changes for the region ( i.e ., warmer and drier conditions), Q . mexicana populations with traits better adapted to a more humid and cooler environments could be negatively affected.</jats:p

Nesting ecology of Chelonia mydas Testudines: Cheloniidae on the Guanahacabibes Peninsula, Cuba

The nesting colony of green sea turtles Chelonia mydas at Guanahacabibes Peninsula Biosphere Reserve and National Park is one of the largest in the Cuban archipelago; however, little information about its nesting ecology is available. Temporal and spatial variation in nesting and reproductive success as well as morphometric characteristics of gravid females were used to ecologically characterize this colony. Nine beaches of the Southernmost coast of Guanahacabibes Peninsula were monitored for 14 years 1998-2012 to determine green turtle nesting activity, from May to September peak nesting season in this area. Beach dimensions were measured to determine nest density using the length and the area. Afterward the beaches were divided in two categories, index and secondary. Females were measured and tagged to compare new tagged females 823 with returning tagged females 140. Remigration interval was also determined. Temporal variation was identified as the annual number of nesting emergences and oviposits per female, with apparent peaks in reproductive activity on a biennial cycle in the first six years followed by periods of annual increase in nest number 2003-2008 and periods of decreasing number of nests 2010-2012. We also found intra-seasonal variation with the highest nesting activity in July, particularly in the second half of the month. The peak emergence time was 22:00-02:00hr. In terms of spatial variation, smaller beaches had the highest nest density and nesting was more frequent 6-9m from the high tide line, where hatchling production was maximized although hatchling success was high on average, above 80. Morphometric analysis of females was made and newly tagged turtles were smaller on average than remigrants. Our results are only a first attempt at characterizing Guanahacabibes populations but have great value for establishing conservation priorities within the context of national management plans, and for efficient monitoring and protection of nesting beaches