Variation in Access to Kidney Transplantation Across Renal Programs in Ontario, Canada.

In the United States, kidney transplant rates vary significantly across end-stage renal disease (ESRD) networks. We conducted a population-based cohort study to determine whether there was variability in kidney transplant rates across renal programs in a health care system distinct from the United States. We included incident chronic dialysis patients in Ontario, Canada, from 2003 to 2013 and determined the 1-, 5-, and 10-year cumulative incidence of kidney transplantation in 27 regional renal programs (similar to U.S. ESRD networks). We also assessed the cumulative incidence of kidney transplant for "healthy" dialysis patients (aged 18-50 years without diabetes, coronary disease, or malignancy). We calculated standardized transplant ratios (STRs) using a Cox proportional hazards model, adjusting for patient characteristics (maximum possible follow-up of 11 years). Among 23 022 chronic dialysis patients, the 10-year cumulative incidence of kidney transplantation ranged from 7.4% (95% confidence interval [CI] 4.8-10.7%) to 31.4% (95% CI 16.5-47.5%) across renal programs. Similar variability was observed in our healthy cohort. STRs ranged from 0.3 (95% CI 0.2-0.5) to 1.5 (95% CI 1.4-1.7) across renal programs. There was significant variation in kidney transplant rates across Ontario renal programs despite patients having access to the same publicly funded health care system.

Utility of human amniotic membrane allograft in re-epithelialization of the nasal tip.

Variations in skin thickness and contours pose significant challenges to reconstruction of the lower third of the nose. Human amniotic membrane allograft offers a potential alternative to tissue transfer in reconstruction of the lower third of the nose. We reviewed the procedure and photographs of a healthy 56-year-old male with a 22 × 18 mm lower third nasal defect involving full thickness skin and subcutaneous tissue. Following preparation for grafting, dehydrated human amniotic membrane was fashioned to the dimensions of the defect and applied. No further surgical intervention was provided for 3 months. Complete re-epithelialization of the nasal and adjacent defects was achieved with minimal scar formation. Human amniotic membrane allograft provides an efficacious and cosmetically acceptable alternative to local and regional tissue transfer.

Sinks for nitrogen inputs in terrestrial ecosystems: a meta-analysis of 15N tracer field studies.

Effects of anthropogenic nitrogen (N) deposition and the ability of terrestrial ecosystems to store carbon (C) depend in part on the amount of N retained in the system and its partitioning among plant and soil pools. We conducted a meta-analysis of studies at 48 sites across four continents that used enriched 15N isotope tracers in order to synthesize information about total ecosystem N retention (i.e., total ecosystem 15N recovery in plant and soil pools) across natural systems and N partitioning among ecosystem pools. The greatest recoveries of ecosystem 15N tracer occurred in shrublands (mean, 89.5%) and wetlands (84.8%) followed by forests (74.9%) and grasslands (51.8%). In the short term (< 1 week after 15N tracer application), total ecosystem 15N recovery was negatively correlated with fine-root and soil 15N natural abundance, and organic soil C and N concentration but was positively correlated with mean annual temperature and mineral soil C:N. In the longer term (3-18 months after 15N tracer application), total ecosystem 15N retention was negatively correlated with foliar natural-abundance 15N but was positively correlated with mineral soil C and N concentration and C:N, showing that plant and soil natural-abundance 15N and soil C:N are good indicators of total ecosystem N retention. Foliar N concentration was not significantly related to ecosystem 15N tracer recovery, suggesting that plant N status is not a good predictor of total ecosystem N retention. Because the largest ecosystem sinks for 15N tracer were below ground in forests, shrublands, and grasslands, we conclude that growth enhancement and potential for increased C storage in aboveground biomass from atmospheric N deposition is likely to be modest in these ecosystems. Total ecosystem 15N recovery decreased with N fertilization, with an apparent threshold fertilization rate of 46 kg N x ha(-1) x yr(-1) above which most ecosystems showed net losses of applied 15N tracer in response to N fertilizer addition.

Disruption of ClC-2 expression is associated with progressive neurodegeneration in aging mice.

Heterozygous mutations in ClC-2 have been associated in rare cases with increased susceptibility to generalized, idiopathic epilepsy. Initially, it was hypothesized that mutations in ClC-2 may be associated with epilepsy due to a direct role for ClC-2 in the modification of hippocampal neuronal excitability. However, the absence of an overt seizure-susceptibility phenotype in young ClC-2 knockout (KO) mice rendered this hypothesis- implausible. A recent study of older ClC-2 KO mice (>6 months) revealed abnormalities in the myelin of central axons and a subtle defect in the neuronal function in the central auditory pathway. These findings prompted us to re-examine hippocampal neuron morphology and excitability in older ClC-2 KO mice. Interestingly, electrocorticographic recordings obtained in older mice revealed spontaneous interictal spikes which are a marker of perturbed hippocampal neurotransmission with a resultant increase in excitation. This electrophysiological defect was associated with astrocyte activation and evidence of neuronal degeneration in the CA3 region of the hippocampus of these older mice. Together, these findings raise the possibility that ClC-2 expression plays a subtle neuroprotective role in the aging hippocampus.

A case of protracted hypotension as unique symptom of a biphasic anaphylaxis to amoxicillin.

We are reporting a case of one patient who have experienced itching of palms and soles, thorax erythema, conjunctive injection immediately after oral administration of amoxicillin, and hypotension after 3 hours. In E.D. hypotension was monitored because he was a cardiopatic but it wasn't treated even if it was protracted. A positive result of immediate-reading intradermal test with amoxicillin at 2 mg/ml concentration was found confirming the diagnosis of allergic biphasic anaphylaxis to amoxicillin.

Substance P activates a non-selective cation channel in murine pacemaker ICC.

Interstitial cells of Cajal (ICC) associated with Auerbach's plexus in the small intestine, provide pacemaker activity to orchestrate peristalsis and mixing. Despite the close apposition between ICC and enteric nerves, little is known about the neural regulation of pacemaker activity. The present study pursues the hypothesis that substance P can affect pacemaker activity through action on non-selective cation channels. Cell-attached and inside-out patch clamp studies were performed on isolated ICC in short-term cultures that provided evidence that substance P increases open probability or initiates activity in non-selective cation channels in ICC. The single-channel conductance is approximately 25 pS and in the on-cell configuration the activity can occur in a rhythmic fashion. Patches contained 1-10 channels and were most often accompanied by a approximately 12 pS chloride channel that was also activated by substance P. In a recently developed preparation that allows patch clamping in ICC in their natural environment within tissue, i.e. in situ, the presence of the channel and substance P activation was confirmed. The non-selective cation channel is one of the channels that initiate intestinal pacemaker activity and the present study provides further single-channel data on this critical channel. Because of the close proximity of enteric motor and sensory nerves to ICC, these data provide a potential mechanism underlying neural regulation of pacemaker activity. The data also indicate that neurokinergic pharmacology is a promising avenue for excitation of the intestinal pacemaker system.

[Iron deficiency anemia due to stromal tumor of the ileum]. / Anemia ferropénica debida a tumor del estroma de localización ileal.

Iron-deficiency anemia occurs in 3.5 to 5.3% of adult men and postmenopausal women. Occult gastrointestinal bleeding is the cause in the vast majority of cases. After endoscopic examinations have ruled out lesions in colon and upper gastrointestinal tract, 5 to 20% of those patients remain without diagnosis. Angiodysplasias and tumors are the most common causes of occult bleeding arising from the small bowel. Their diagnosis requires complex studies with quite low yield. However, it is necessary to perform them when anemia becomes severe or persistent. We report the case of a male patient with severe and persistent iron-deficiency anemia who had a stromal gastrointestinal tumor located in the ileum.

Forecasting agriculturally driven global environmental change.

During the next 50 years, which is likely to be the final period of rapid agricultural expansion, demand for food by a wealthier and 50% larger global population will be a major driver of global environmental change. Should past dependences of the global environmental impacts of agriculture on human population and consumption continue, 10(9) hectares of natural ecosystems would be converted to agriculture by 2050. This would be accompanied by 2.4- to 2.7-fold increases in nitrogen- and phosphorus-driven eutrophication of terrestrial, freshwater, and near-shore marine ecosystems, and comparable increases in pesticide use. This eutrophication and habitat destruction would cause unprecedented ecosystem simplification, loss of ecosystem services, and species extinctions. Significant scientific advances and regulatory, technological, and policy changes are needed to control the environmental impacts of agricultural expansion.

Anemia ferropénica debida a tumor del estroma de localización ileal / Iron deficiency anemia due to stromal tumor of the ileum

La anemia ferropénica ocurre en el 3,5% al 5,3% de los varones adultos y de las mujeres menopáusicas. La pérdida digestiva crónica es la causa en la mayoría de los casos. Cinco a 20% de los pacientes quedan sin diagnóstico tras haberse descartado por estudios endoscópicos lesiones en el colon y en el tracto digestivo superior. En el intestino delgado, las angiodisplasias y los tumores son las causas más frecuentes de sangrado intestinal oculto. Su diagnóstico requiere la realización de estudios complejos con bajo rendimiento que necesariamente hay que instrumentar en los casos anemia ferropénica.

Plant invasions--the role of mutualisms.

Many introduced plant species rely on mutualisms in their new habitats to overcome barriers to establishment and to become naturalized and, in some cases, invasive. Mutualisms involving animal-mediated pollination and seed dispersal, and symbioses between plant roots and microbiota often facilitate invasions. The spread of many alien plants, particularly woody ones, depends on pollinator mutualisms. Most alien plants are well served by generalist pollinators (insects and birds), and pollinator limitation does not appear to be a major barrier for the spread of introduced plants (special conditions relating to Ficus and orchids are described). Seeds of many of the most notorious plant invaders are dispersed by animals, mainly birds and mammals. Our review supports the view that tightly coevolved, plant-vertebrate seed dispersal systems are extremely rare. Vertebrate-dispersed plants are generally not limited reproductively by the lack of dispersers. Most mycorrhizal plants form associations with arbuscular mycorrhizal fungi which, because of their low specificity, do not seem to play a major role in facilitating or hindering plant invasions (except possibly on remote islands such as the Galapagos which are poor in arbuscular mycorrhizal fungi). The lack of symbionts has, however, been a major barrier for many ectomycorrhizal plants, notably for Pinus spp. in parts of the southern hemisphere. The roles of nitrogen-fixing associations between legumes and rhizobia and between actinorhizal plants and Frankia spp. in promoting or hindering invasions have been virtually ignored in the invasions literature. Symbionts required to induce nitrogen fixation in many plants are extremely widespread, but intentional introductions of symbionts have altered the invasibility of many, if not most, systems. Some of the world's worst invasive alien species only invaded after the introduction of symbionts. Mutualisms in the new environment sometimes re-unite the same species that form partnerships in the native range of the plant. Very often, however, different species are involved, emphasizing the diffuse nature of many (most) mutualisms. Mutualisms in new habitats usually duplicate functions or strategies that exist in the natural range of the plant. Occasionally, mutualisms forge totally novel combinations, with profound implications for the behaviour of the introduced plant in the new environment (examples are seed dispersal mutualisms involving wind-dispersed pines and cockatoos in Australia; and mycorrhizal associations involving plant roots and fungi). Many ecosystems are becoming more susceptible to invasion by introduced plants because: (a) they contain an increasing array of potential mutualistic partners (e.g. generalist frugivores and pollinators, mycorrhizal fungi with wide host ranges, rhizobia strains with infectivity across genera); and (b) conditions conductive for the establishment of various alien/alien synergisms are becoming more abundant. Incorporating perspectives on mutualisms in screening protocols will improve (but not perfect) our ability to predict whether a given plant species could invade a particular habitat.

Germination and growth responses of hybridizing Carpobrotus species (Aizoaceae) from coastal California to soil salinity.

Germination, growth, and physiological responses of hybridizing Carpobrotus from coastal California to soil salinity were studied. Hybrids are presumably the result of hybridization and introgression between the exotic Carpobrotus edulis, a succulent perennial invading coastal habitats, and the native or long-naturalized C. chilensis. Germination responses were investigated at 0, 10, 20, and 50% seawater. Seedling growth and physiology were compared by irrigating seedlings with solutions of the same seawater concentrations and in low and high nutrients. Germination was inhibited in the presence of salt, but recovered after transferring the seeds to fresh water. Seeds exposed to salt had higher final germination rates than control. Growth of Carpobrotus was slightly enhanced by low seawater concentrations but reduced at high salinity at both nutrient regimes. Leaf cell sap osmolarity increased with increasing soil salinity, and taxa did not differ significantly in this physiological adjustment. Leaf carbon isotope ratios (∂(13)C) ranged from -28 to -22‰ and became less negative at higher salinities, indicating an improved water use efficiency in the seedlings at high salt concentrations. In addition, ∂(13)C values were generally less negative at high than at low nutrients. Differences among taxa were generally small. The results show that salinity affects both establishment and growth of hybridizing Carpobrotus. The overall weak species differences in salt tolerance indicate that the exotic C. edulis can occupy the same sites as C. chilensis in terms of salinity. The similarity of hybrids in their response to salinity suggests that they may contribute to the invasion by Carpobrotus.

Impacts of biological invasions on disturbance regimes.

Human management activities have altered the frequency and intensity of ecosystem disturbance often with enormous impacts on landscape structure and composition. One additional and under-appreciated way in which humans have altered disturbance regimes is through the introduction of invasive non-native species, themselves capable of modifying existing disturbance regimes or introducing entirely new disturbances. In many cases, modifications of disturbance regimes results in maintenance of ecosystems in a new or transitional state. There is now evidence that alteration of disturbance regime may be the most profound effect that a species or functional group can have on ecosystem structure and function.

Hybridization and introgression in Carpobrotus spp. (Aizoaceae) in California. I. Morphological evidence.

Individuals of the invasive non-native plant species Carpobrotus edulis, its native or naturalized congener C. chilensis, and putative hybrids are found throughout coastal California. This study characterized morphological variation within the genus and assessed the extent of hybridization and direction of introgression between C. edulis and C. chilensis. Twelve randomly selected Carpobrotus individuals from each of 49 sample locations were classified as "C. edulis," "C. chilensis," or one of three intermediate morphotype classes, and compared for clonal, vegetative, and fruit characters. Univariate comparisons showed that C. edulis individuals had deeper mats with more cover within the mat boundary, longer, wider, more serrate leaves, and wider fruits with more carpels than intermediate and C. chilensis morphotype classes. Carpobrotus edulis and intermediates had more lateral branches than did C. chilensis, suggesting that hybrids tend to vary toward C. edulis. Discriminant function analysis (DFA) identified the following characters as discriminating significantly among Carpobrotus groups: leaf length, leaf width, leaf length/width, number of lateral branches, number of carpels, and fruit diameter. Using these characters, DFA correctly classified 98% of apparently pure C. edulis and C. chilensis, but only 76% of all Carpobrotus individuals when putative hybrids were included. Principal components analysis showed that C. edulis and C. chilensis cluster into distinct morphotypes, but that hybrids overlap with both groups, particularly with C. edulis. The genus Carpobrotus in California resembles a large hybrid swarm, with putative hybrids forming a large portion of the overall population and tending to vary toward C. edulis.

Hybridization and introgression in Carpobrotus spp. (Aizoaceae) in California. II. Allozyme evidence.

Morphological evidence has indicated that hybridization and introgression are occurring between Carpobrotus edulis L., a nonindigenous, invasive species in California (Bolus), and its putative native congener, C. chilensis. The identification of allozyme markers has enabled us to quantify hybridization and the extent of introgression between these species. Samples from 20 individuals of each of five morphological types (both parent species and three hybrid phenotypes) were collected from 39 populations along the coast of California from the Mexico to Oregon borders. Ten enzyme systems revealed a total of 17 resolvable loci, eight of which were polymorphic for the genus. Five of the polymorphic loci easily differentiate C. edulis and C. chilensis. Allele frequencies among the morphologically defined types are consistent with estimations of allele frequency changes due to first- and second-generation backcrossing. In comparison to long-lived, herbaceous perennials and widespread species, C. edulis and intermediate types have more variation in their populations (P = 41.73, Ap = 2.11, Ho = 0.246, and P = 38.13, Ap = 2.06, Ho = 0.216, respectively) than C. chilensis (P = 11.76, Ap = 2.00, Ho = 0.082). Indirect estimates of gene flow indicate four of the five morphological types are outcrossing. Gene flow between previously allopatric species may have broad implications if it results in an increase in fitness; further experimentation is needed to determine the ultimate ecological consequences of this phenomenon and its possible threat to limited, remaining natural habitat in California.

Pure red cell aplasia in a patient with systemic lupus erythematosus.

Pure red cell aplasia developed in a female patient with systemic lupus erythematosus (SLE). Erythroid colony growth was assessed in semisolid medium culture of bone marrow obtained from a normal donor and cultured in the presence of normal and patient sera. Colony forming units of erythropoiesis and burst forming units of erythropoiesis obtained from a normal donor were inhibited in the presence of patient sera. Our findings support the concept that circulating inhibitors might influence the proliferation of erythroid progenitor cells and erythroid aplasia may be an immunologically mediated syndrome.

[Plasma lipoprotein levels in relation to dietary habits]. / Livello delle lipoproteine plasmatiche in rapporto alle abitudini alimentari.

We carried out a nutritional and haematological survey on 130 pupils of a boarding school in Cagliari in order to determine the relationship between plasma lipoprotein and nutritional habits, particularly, we determined beta/alpha ratio of lipoprotein comparing it with plasma values in hospitalized patients, suffering from metabolic and cardiovascular disease. The results allowed us to observe that 92% of hospitalized patients and 17% of subjects, presumably in good health, showed beta/alpha ratio greater than 2,5. The latter, apparently insignificant, is very important because it was detected in young subjects; as their diet was high-fat and high-carbohydrate, a nutritional and haematological survey will be always necessary in order to prevent illnesses.

[Transposition of the myocutaneous flap of the latissimus muscle of the back in reconstruction of the breast after radical mastectomy. Indications and technic studied in 2 operated cases]. / La trasposizione del lembo miocutaneo del latissimo del dorso nella ricostruzione della mammella dopo mastectomia radicale. Indicazioni e technica su due casi operati.

For repair of radical mastectomy defects the surgical approach with the latissimus dorsi myocutaneous flap is presented. The application of this flap and complication are described. In addition 2 cases are presented illustrating a personal modification of the technics.

[Treatment of hepatic metastases in tumors of the gastrointestinal tract. Considerations on 25 cases]. / Il trattamento delle metastasi epatiche nei tumori del tubo gastroenterico. Considerazioni su 25 casi.

Results with liver resection over a period of 3 yr in the treatment of metastases derived from tumours of the gastroenteric tube are reported. An account is given of the data and the techniques used by Italian and foreign workers for this purpose. A personal series of 25 cases is presented and its 2-yr survival figure is stated.