Interannual adjustments in stomatal and leaf morphological traits of European beech (Fagus sylvatica L.) demonstrate its climate change acclimation potential.

The current projections of climate change might exceed the ability of European forest trees to adapt to upcoming environmental conditions. However, stomatal and leaf morphological traits could greatly influence the acclimation potential of forest tree species subjected to global warming, including the single most important forestry species in Europe, European beech. We analysed stomatal (guard cell length, stomatal density and potential conductance index) and leaf (leaf area, leaf dry weight and leaf mass per area) morphological traits of ten provenances from two provenance trials with contrasting climates between 2016 and 2020. The impact of meteorological conditions of the current and preceding year on stomatal and leaf traits was tested by linear and quadratic regressions. Ecodistance was used to capture the impact of adaptation after the transfer of provenances to new environments. Interactions of trial-provenance and trial-year factors were significant for all measured traits. Guard cell length was lowest and stomatal density was highest across beech provenances in the driest year, 2018. Adaptation was also reflected in a significant relationship between aridity ecodistance and measured traits. Moreover, the meteorological conditions of the preceding year affected the interannual variability of stomatal and leaf traits more than the meteorological conditions of the spring of the current year, suggesting the existence of plant stress memory. High intraspecific variability of stomatal and leaf traits controlled by the interaction of adaptation, acclimation and plant memory suggests a high acclimation potential of European beech provenances under future conditions of global climate change.

Treatment outcomes of bladder stones in children with intact bladders in developing countries: A systematic review of >1000 cases on behalf of the European Association of Urology Bladder Stones Guideline panel.

INTRODUCTION: Bladder stones (BS) are still endemic in children in developing nations and account for a high volume of paediatric urology workload in these areas. The aim of this systematic review is to comparatively assess the benefits and risks of minimally invasive and open surgical interventions for the treatment of bladder stones in children. METHODS: This systematic review was conducted in accordance with Cochrane Guidance. Database searches (January 1970- March 2021) were screened, abstracted, and assessed for risk of bias for comparative randomised controlled trials (RCTs) and non-randomised studies (NRSs) with >10 patients per group. Open cystolithotomy (CL), transurethral cystolithotripsy (TUCL), percutaneous cystolithotripsy (PCCL), extracorporeal shock wave lithotripsy (ESWL) and laparoscopic cystolithotomy (LapCL) were evaluated. RESULTS: In total, 3040 abstracts were screened, and 8 studies were included. There were 7 retrospective non-randomised studies (NRS's) and 1 quasi-RCT with 1034 eligible patients (CL: n=637, TUCL: n=196, PCCL: n=138, ESWL: n=63, LapCL n=0). Stone free rate (SFR) was given in 7 studies and measured 100%, 86.6%-100%, and 100% for CL, TUCL and PCCL respectively. CL was associated with a longer duration of inpatient stay than PCCL and TUCL (p<0.05). One NRS showed that SFR was significantly lower after 1 session with outpatient ESWL (47.6%) compared to TUCL (93.5%) and CL (100%) (p<0.01 and p<0.01 respectively). One RCT compared TUCL with laser versus TUCL with pneumatic lithotripsy and found that procedure duration was shorter with laser for stones <1.5cm (n=25, p=0.04). CONCLUSION: In conclusion, CL, TUCL and PCCL have comparable SFRs but ESWL is less effective for treating stones in paediatric patients. CL has the longest duration of inpatient stay. Information gathered from this systematic review will enable paediatric urologists to comparatively assess the risks and benefits of all urological modalities when considering surgical intervention for bladder stones.

Predicting the risk of Clostridium difficile infection following an outpatient visit: development and external validation of a pragmatic, prognostic risk score.

Increasing morbidity related to Clostridium difficile infection (CDI) has heightened interest in the identification of patients who would most benefit from recognition of risk and intervention. We sought to develop and validate a prognostic risk score to predict CDI risk for individual patients following an outpatient healthcare visit. We assembled a cohort of Kaiser Permanente Northwest (KPNW) patients with an index outpatient visit between 2005 and 2008, and identified CDI in the year following that visit. Applying Cox regression, we synthesized a priori predictors into a CDI risk score, which we validated among a Kaiser Permanente Colorado (KPCO) cohort. We calculated and plotted the observed 1-year CDI risk for each decile of predicted risk for both cohorts. Among 356 920 KPNW patients, 608 experienced CDI, giving a 1-year incidence of 2.2 CDIs per 1000 patients. The Cox model differentiated between patients who do and do not develop CDI: there was a C-statistic of 0.83 for KPNW. The simpler points-based risk score, derived from the Cox model, was validated successfully among 296 550 KPCO patients, with no decline in the area under the receiver operating characteristic curve: 0.785 (KPNW) vs. 0.790 (KPCO). The predicted risk for CDI agreed closely with the observed risk. Our CDI risk score utilized data collected during usual care to successfully identify patients who developed CDI, discriminating them from patients at the lowest risk for CDI. Our prognostic CDI risk score provides a decision-making tool for clinicians in the outpatient setting.

[Comparison of the efficacy of ESWL and ureteroscopy in the treatment of lower ureteric stone]. / Porovnání ucinností extrakorporální litotrypse a ureteroskopie pri primární terapii ureterolitiázy dolní tretiny ureteru.

BACKGROUND: The efficacy of ESWL and ureteroscopy in the treatment of lower ureteric stone is still discussed. The aim of the study is to compare efficacy and safeness of both methods. METHODS AND RESULTS: A retrospective study comparing the treatment results of distal ureteric stones was performed. The inclusion criteria were: distal ureteric stones with no previous treatment and an accomplished three months follow-up after the treatment. There were 395 cases (390 patients) included in the ESWL group and 509 cases (501 patients) in the ureteroscopy group. Higher efficacy of ureteroscopy as opposed to ESWL therapy was marked. There is no significant difference in stone free rate in three months after the treatment (97.72% vs. 98.40%, p = 0.4675), but there is a significant difference in EQ according to Rassweiler (43.52 vs. 89.60, p < 0.0001). The main difference is in evaluation in 48 hours after the treatment (stone free rate 64.81% vs. 96.46%, p < 0.0001). Ureteroscopy has a higher incidence of complications during the therapy 0.67% vs. 6.36%, p < 0.0001) as well as after the therapy (6.55% vs. 11.95%, p = 0.0018), but the complications are minor. On the contrary ESWL treatment is accompanied by a higher re-treatment rate (51% vs. 2%, p < 0.0001) and higher incidence of auxiliary procedures (25.87% vs. 6.36%, p < 0.0001). CONCLUSIONS: It has been clearly proven that ureteroscopy is more efficient in the treatment of distal ureteric stones than ESWL. The main advantage of ureteroscopy is the immediate effect, low re-treatment rate and low incidence of auxiliary procedures, except the need of removing the J-J stent. The disadvantage of ureteroscopy is the requirement of general anaesthesia and a higher incidence of complications after the treatment, though only minor ones in most of the cases.

[Metaphylaxis in the first occurrence of urolithiasis]. / Metafylaxe primourolitiázy.

BACKGROUND: Urolithiasis is a socially important disease with a high tendency to recurrences. By specific medicamentous metaphylaxis it is possible to achieve an as high as tenfold reduction of recurrences, however, regular check-ups focussed on possible side-effects are required. The objective of the project was to assess prospectively the effectiveness of non-medicamentous metaphylaxis in patients with the first kidney stone. In 113 patients, a fluid and specific dietary regimen were recommended based on a comprehensive diagnosis of metabolic disorders (Table 1) and the regimen was modified with regard to results of metabolic check-up examinations after 6, 18, and 36 months (group 1). Ninety-four patients were recommended a fluid and non-specific dietary regimen after a limited metabolic evaluation with a subsequent check-up after 36 months (group 2). The two groups were clinically comparable. A stone recurrence developed in 7 (6%) patients of the group 1 and in 18 (19%) of the group 2 (p < 0.01). The difference was even greater after including the growth of the concrement (7% and 23%). The patients with a recurrence or growth of a stone had more frequently weddellite in the concrement and had also more frequently a bilateral residual or conservatively managed urolithiasis (p < 0.0001). Half the recurrencies were asymptomatic. The development of metabolic disorders in the group 1 indicated a gradual decrease of uric acid in serum and urine (p < 0.01) although it was not yet significant after 6 months. There was also a significant increase of calciuria (p < 0.01), most probably in conjunction with a regular calcium intake. CONCLUSION: Specific non-medicamentous metaphylaxis with an adequate calcium intake leads to a lower incidence of stone recurrences than a non-specific fluid and dietary regimen. It is justified to introduce the specific metaphylaxis in all patients after the first diagnosis of a kidney stone. It ensures subsequent adjustment of the individual diet which the patient is more likely to adhere to than to general non-specific instructions.

A prospective study of nonmedical prophylaxis after a first kidney stone.

OBJECTIVE: To assess, in a multicentre prospective randomized study, the effectiveness of specific nonmedical prophylaxis and nonspecific dietary prophylaxis in patients treated after experiencing their first idiopathic calcium-containing kidney stone. PATIENTS AND METHODS: From 1991 to 1994, 242 patients with idiopathic calcium urinary stones from three urological centres were randomly assigned into two groups. In group 1 (intervention, 113 patients), a specific dietary regimen was recommended and thereafter corrected according to a comprehensive metabolic evaluation. Group 2 (control, 94 patients) underwent only minimal metabolic screening and used general dietary measures, with no regular follow-up. An increased fluid intake was recommended in both groups. After 3 years, the effectiveness of the prophylactic and dietary regimens was evaluated in 207 patients. RESULTS: At entry, the clinical characteristics were comparable in the two groups, with only extracorporeal lithotripsy being more frequent in group 2. Almost 80% of patients reported a high intake of meat and a low intake of dairy products. In group 1 and 2, a recurrent stone was encountered in seven (6%) and 18 (19%) patients, respectively; recurrent and growing stones were found in eight (8%) and 22 (23%) patients, respectively (P<0. 01). There was a higher incidence of bilateral residual (or untreated) stones, and Weddellite stones (P<0.001) among patients with a recurrent or growing stone. An analysis of the dynamics of the metabolic variables indicated the significance of repeated dietary counselling. CONCLUSION: Specific dietary therapy, adjusted according to a metabolic evaluation, is more effective than nonspecific general dietary recommendations in preventing the formation of a second urinary stone.

[Hereditary pathology load of the population and regional medical-genetic counseling]. / Otiagoshchennost' populiatsii nasledstvennoi patologiei i regional'noe mediko-geneticheskoe konsul'tirovanie.

Analysis of hereditary disease load of the populations with different genetic structure has demonstrated the necessity of a regional approach to the organization of the medico-genetic aid to the community. It has been shown that in Central Asia, the requirement of the medico-genetic aid is almost 2 times higher than in the Russian Federation. Bearing in mind the age-associated reproduction data, those differences are three times as higher. To make the work of the medico-genetic consultations more efficient, it is necessary to increase the portion of prospective counselling at the expense of an active approach to identifying patients in the populations.