68Ga-PSMA PET/CT based primary staging and histological correlation after extended pelvic lymph node dissection at radical prostatectomy.

INTRODUCTION: Prostate-specific membrane antigen positron emission tomography-computed tomography (PSMA PET/CT) represents the upcoming standard for the staging of prostate cancer (PCa). However, there is still an unmet need for the validation of PSMA PET/CT at primary staging and consecutive histological correlation. Consequently, we decided to analyze the prediction parameter of PSMA PET/CT at primary staging. METHODS: We relied on 90 ≥ intermediate-risk PCa patients treated with radical prostatectomy (RP) and extended pelvic lymph node dissection. All patients were administered to 68Ga-PSMA PET/CT prior to surgery. 68Ga-PSMA PET/CT data were retrospectively reevaluated by a single radiologist and consequently compared to histological results from RP. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the detection of lymph node metastases were analyzed per-patient (n = 90), per-pelvic side (n = 180), and per-anatomic-region (external iliac artery and vein left/right vs. obturator fossa left/right vs. internal iliac artery left/right) (n = 458), respectively. RESULTS: Sensitivity, specificity, PPV, and NPV per-patient were: 43.8, 96.0, 70.0, and 88.8%, respectively. Sensitivity, specificity, PPV, and NPV per-pelvic-side were: 42.9, 95.6, 56.3, and 92.7%, respectively. Sensitivity, specificity, PPV, and NPV per-anatomic-region were: 47.6, 98.9, 66.7, and 97.5%, respectively. CONCLUSIONS: Negative 68Ga-PSMA PET/CT results were highly reliable in our study. Positive 68Ga-PSMA PET/CT results, however, revealed less reliable results. Larger and ideally prospective trials are justified to clarify the potential role of PSMA PET/CT based primary staging.

Urban growth and water access in sub-Saharan Africa: Progress, challenges, and emerging research directions.

For the next decade, the global water crisis remains the risk of highest concern, and ranks ahead of climate change, extreme weather events, food crises and social instability. Across the globe, nearly one in ten people is without access to an improved drinking water source. Least Developed Countries (LDCs) especially in sub-Saharan Africa (SSA) are the most affected, having disproportionately more of the global population without access to clean water than other major regions. Population growth, changing lifestyles, increasing pollution and accelerating urbanization will continue to widen the gap between the demand for water and available supply especially in urban areas, and disproportionately affect informal settlements, where the majority of SSA's urban population resides. Distribution and allocation of water will be affected by climate-induced water stresses, poor institutions, ineffective governance, and weak political will to address scarcity and mediate uncertainties in future supply. While attempts have been made by many scientists to examine different dimensions of water scarcity and urban population dynamics, there are few comprehensive reviews, especially focused on the particular situation in Sub-Saharan Africa. This paper contributes to interdisciplinary understanding of urban water supply by distilling and integrating relevant empirical knowledge on urban dynamics and water issues in SSA, focusing on progress made and associated challenges. It then points out future research directions including the need to understand how alternatives to centralized water policies may help deliver sustainable water supply to cities and informal settlements in the region.

Still childless at the age of 28 to 40 years: a cross-sectional study of Swedish women's and men's reproductive intentions.

BACKGROUND: Delayed childbearing is associated with adverse reproductive outcomes. Our aim was to investigate Swedish women's and men's childbearing intentions at the age of 28, 32, 36 and 40 years, in terms of: (1) time point for a first child, (2) number of children, and (3) reasons for not yet having children. METHODS: Cross-sectional data from the Swedish Young Adult Panel Study, including 365 childless women and 356 childless men aged 28, 32, 36 and 40 years who responded to a questionnaire in 2009. Descriptive and multivariate logistic regression analyses were conducted. RESULTS: Most 28- and 32-year-olds intended to have children, but only 32% of women and 37% of men aged 36/40 years (merged), many of whom still postponed childbearing. Reasons for remaining childless differed by age. Most prominent in the 36/40-year-olds were: lack of a partner (women 60%, men 59%), no desire for children (women 44%, men 44%), not mature enough (women 29%, men 35%), and wanting to do other things before starting a family (women 26%, men 33%). The 36/40-year-olds had the highest odds for infertility problems (OR 3.8; CI 95% 1.8-7.9) and lacking a suitable partner (OR 1.8 CI 95% 1.1-3.0), and lower odds for reasons related to work and financial situation. CONCLUSIONS: Many childless 36- and 40-year-olds intended to have children but seemed to overestimate their fecundity. The most prominent reasons for being childless were: not having wanted children up to now, lack of a partner, infertility problems, and prioritising an independent life.

Lymphocyte reconstitution following allogeneic hematopoietic stem cell transplantation: a retrospective study including 148 patients.

Here we investigated the influence of parameters known before hematopoietic stem cell transplantation (HSCT) as well as the relevance of graft-versus-host disease (GvHD) and cytomegalovirus (CMV) reactivation on post transplant lymphocyte reconstitution in 148 patients treated in our institution between 1996 and 2003. Median patient age was 42 (19-68) years, HSCT followed standard high dose (n=91) or reduced-intensity conditioning regimens (n=57) with bone marrow (BM, n=67) or peripheral blood stem cells (PBSC, n=81) from related (n=71) or unrelated (n=77) donors. In the first months, we observed a partially faster reconstitution of CD3+4+, CD3+8+ and CD4+45RA+ T cells in patients following peripheral blood stem cell transplantation when compared to bone marrow transplantation. Prolonged CD3+4+ and CD4+45RA+ lymphopenia was noted after unrelated donor HSCT and GvHD prophylaxis containing anti-T-lymphocyte globulin. Lymphocyte subset counts in patients older than the median age were comparable to those in patients transplanted at a younger age and not influenced by the conditioning regimen. CD3+8+ T cell reconstitution was strongly correlated with CMV reactivation, but not significantly affected by CMV serostatus before HSCT. Incidence or extent of GvHD did not significantly influence lymphocyte reconstitution. Therefore, the source of graft is the most predictive parameter in early lymphocyte reconstitution, but the differences in lymphocyte recovery completely resolved within the first year after HSCT.

Inequalities in under-five mortality in Mozambique: differentials by region of residence and ethnic affiliation of the mother.

OBJECTIVE: To explore regional and ethnic differentials in under-five mortality in Mozambique in relation to other determinants. DESIGN: Retrospective follow-up study. SETTING: Mozambique. RESULTS: Compared to children of Xitsonga mother's, children of Emakua and Cisena mother's had a mortality risk of 1.47 (CI = 1.06-1.90) and 1.21 (CI = 1.00-1.62) respectively. The excess mortality risks were partly explained by demographic, household environment, socioeconomic factors including region of residence. CONCLUSION: Ethnic affiliation of the mother (measured by the first language the mother spoke) was statistically associated with under-five mortality in Mozambique. Children of mothers of Emakua and Cisena ethnic affiliations and living in the North and Central regions had the worst survival chances. The relation between mother's ethnicity and under-five mortality was largely explained by demographic, socioeconomic and environmental factors.

Contribution of household environment factors to urban childhood mortality in Mozambique.

OBJECTIVES: Household environment factors are known to be associated with child mortality in urban and rural areas of many developing countries. In Mozambique, no study to date has addressed this relationship. This study is aimed to access the contribution of household environment factors to urban childhood mortality in Mozambique. DESIGN: Retrospective follow-up study. SETTING: Urban Mozambique. SUBJECTS: One thousand and forty eight children born in urban areas of Monzambique within five years of the 1997 Demographic and Health Survey. METHODS: Cox regression analysis was performed on a sample of 1048 children born in urban areas of Mozambique within five years of the 1997 Demographic and Health Survey. RESULTS: Children of mother's who lived in households with no toilet facility or with well as a source of drinking water had a high risk of dying compared to children who lived in households with flush toilet and piped water. CONCLUSION: Type of toilet facility and source of drinking water play an important role in the risk of childhood mortality in urban areas of Mozambique and the relationship seems to be mediated partly by demographic and socioeconomic factors.

In-stream uptake dampens effects of major forest disturbance on watershed nitrogen export.

Between January 4 and 10, 1998, a severe ice storm impacted large areas of northern New York, New England, and eastern Canada. This storm struck the Hubbard Brook Experimental Forest in New Hampshire on January 7-8, 1998, and caused extensive forest crown damage (>30%) in a narrow elevation band (600-740 m) across the south-facing experimental watersheds. Stream water has been collected and chemically analyzed since 1963 in six experimental watersheds at Hubbard Brook Experimental Forest; thus, we were able to examine the effect of this severe natural disturbance on watershed nutrient export and changes in instream nitrate (NO3-) processing. The ice storm caused large increases in watershed export of NO3- for 2 years after the disturbance, but our examination of in-stream processing suggests that NO3- losses would have been much more dramatic had there not been an increase in in-stream, nitrogen-processing efficiency after the ice storm. The canopy damage that resulted from the ice storm led to increased light availability and large inputs of woody debris to the stream. We suspect that increases in algal production and storage and processing of terrestrial litter account for the increase in inorganic nitrogen processing in these streams. Our results indicate that, without in-stream processing, export of NO3- from the damaged watersheds would have been 80-140% higher than was observed. These results point to an intriguing negative feedback mechanism whereby the same disturbance that causes watershed NO3- loss may simultaneously lead to increased in-stream retention and transformation.

Biotransformation of insulin glargine after subcutaneous injection in healthy subjects.

OBJECTIVE: It is important to establish pharmacokinetic or pharmacodynamic differences between novel insulin analogues and human insulin. This study examined the primary metabolic degradation products of insulin glargine (LANTUS) in humans. DESIGN: In this single dose, open-label study, insulin glargine was administered subcutaneously at a dose of 0.6 IU/kg; placebo was administered to one control subject. PATIENTS: Four healthy male subjects, plus one control subject, aged 18-50 years were enrolled in this study. MEASUREMENTS: Following insulin glargine administration, blood glucose levels were clamped at the subjects' fasting concentration for 6 h and the amount of 20% glucose infused to maintain this baseline concentration was recorded. Metabolite profiling was performed in plasma and injection site tissue using HPLC and radioimmunoassay (RIA). Pharmacokinetics were evaluated by RIA of serum and plasma immunoreactive insulin levels. The primary pharmacodynamic measure was the glucose infusion rate (GIR). Safety was evaluated by measuring blood glucose concentrations during the clamp and adverse events were observed by the investigator or reported by the subject. RESULTS: Metabolic profiling revealed a clear pattern: insulin glargine is metabolised by sequential cleavage at the carboxy terminus of the B chain, to yield products M1 and M2, which are both structurally similar to human insulin. These degradation products are present both at the injection site and in plasma. CONCLUSION: Thus, during treatment with a subcutaneous injection of insulin glargine, metabolic degradation is likely to be initiated at the injection site and continued within the circulatory system.

First Report of Root and Crown Rot Caused by Phytophthora cinnamomi Affecting Native Stands of Arctostaphylos myrtifolia and A. viscida in California.

Ione manzanita (Arctostaphylos myrtifolia) is a rare, endemic, evergreen shrub restricted to Ione formation soils (infertile, acidic, sedimentary oxisols) in the foothills of the Sierra Nevada. The widely distributed A. viscida (whiteleaf manzanita) intermixes with A. myrtifolia at the margins of Ione formation soils. In 2002, we observed extensive mortality within two mixed stands of A. myrtifolia and A. viscida near Ione, CA. At one site, nearly all plants of both species in a 0.25-ha area had died recently. At a second site, most of the A. myrtifolia and A. viscida plants on several hectares died at least 5 years earlier. Dying plants of both species exhibited wilting and desiccation of the foliage; dark brown discoloration and necrosis of the root crown, taproot, and some large roots; and loss of fine roots. Plants of all age classes were affected. We consistently isolated a Phytophthora sp. from symptomatic plants of both species using PARP (1) and acidified potato dextrose agar. We recovered the same Phytophthora sp. from soil collected under dead plants using green pears to bait flooded soil samples. The pathogen was not recovered from soil collected under healthy plants 50 m from the nearest dead plant. Based on the morphology of the hyphae, chlamydospores, sporangia, and the sequence of the internal transcribed spacer rDNA, we identified the pathogen as P. cinnamomi Rands (GenBank Accession No. AY267370; ATCC No. MYA-2989). To test pathogenicity, we poured zoospore suspensions (4 × 104 zoospores per pot) on the soil of eight pots with rooted A. myrtifolia cuttings and four pots with rooted A. viscida cuttings (1 14-month-old plant per pot). The soil in inoculated and uninoculated control pots (eight A. myrtifolia and two A. viscida) was flooded for 20 to 23 h. All inoculated A. myrtifolia developed severe root and crown rot, and seven of eight died within 17 days. All inoculated A. viscida developed severe root rot, and three of four developed 5- to 10-cm long basal cankers. After 17 days, we isolated P. cinnamomi from inoculated A. myrtifolia (eight of eight) and A. viscida (two of four) but not from controls, which remained healthy. We tested pathogenicity in native soil by transplanting rooted cuttings (eight A myrtifolia and six A. viscida) into pots of naturally infested soil from one of the disease centers. Controls (four and three plants, respectively) were planted in soil collected from under healthy plants. Pots were flooded for 12 to 13 h for 11 days (A. myrtifolia) or 6 weeks (A. viscida) after transplanting. All plants grown in naturally infested soil developed root and crown rot, and all A. myrtifolia and one A. viscida died within 5 weeks of transplanting. Plants grown in field soil collected near healthy plants remained asymptomatic. We isolated P. cinnamomi from all eight A. myrtifolia and three A. viscida plants grown in infested soil but not from the controls. To our knowledge, this is the first report of root and crown rot caused by P. cinnamomi on A. myrtifolia and A. viscida. P cinnamomi was first isolated in the state in 1942 (2), but it has not previously been reported to caused significant mortality in natural stands of California native species. This disease will significantly impact conservation of the already threatened A. myrtifolia. References: (1) D. C. Erwin and O. K. Ribeiro, Phytophthora Diseases Worldwide. American Phytopathological Society, St. Paul, MN 1996. (2) V. A. Wager. Hilgardia 14:519, 1942.

Social differentials in the decline of child mortality in nineteenth century Stockholm.

BACKGROUND: Mortality had declined dramatically by the end of the nineteenth century and the early twentieth century. Little is known about the development of social differentials in infant and child mortality in Stockholm at the turn of the century. This study investigates social differentials in child mortality during the years 1885, 1891 and 1910 in one parish in Stockholm. METHODS: Individual entries from computerised records originally collected for civil registration purposes in Stockholm for 1878-1925 (the Roteman Archives) were analysed with respect to social class of the head of household and marital status of the mother for 36,718 children aged 0-14 years. Age- and cause-specific mortality rates were calculated for each year of study. Cox' regression analysis was used to analyse the mortality risk (relative rates (RRs) of mortality) by socioeconomic group and by marital status of the mother. RESULTS: Child mortality rates were nearly halved between 1885 and 1910. Socioeconomic differentials in mortality between the four social classes emerged from 1891 as the overall mortality declined. The decline was sharpest in the upper and middle social classes. Children born out of wedlock had higher mortality rates than children of married mothers in all 3 years studied. CONCLUSION: The social differentials in child mortality risk were substantial and the gradient emerged sharper from 1891 to 1910. The results are in line with studies from England and Wales, Germany and the USA for the same time period. The differentials mostly increased because of a greater decline in mortality among higher socioeconomic groups.

Synthesis and properties of the tetrakis(trifluoromethyl)borate anion, [b(CF3)4]-: structure determination of Cs[B(CF3)4] by single-crystal X-ray diffraction.

Salts of the tetrakis(trifluoromethyl)borate anion, M[B(CF3)4], M=Li, K, Cs, Ag, have been prepared by two different routes for the first time. The colorless compounds are thermally stable up to 425 C (Cs salt) and soluble in anhydrous HF, water, and most organic solvents. Single crystals of Cs[B(CF3)4] were grown from diethyl ether by diffusion of CH2Cl2 vapor into the solution. The molecular structure was obtained by single-crystal X-ray diffraction. Crystal data: rhombohedral space group R3m (no. 160); a =7.883(1), c=13.847(4) A: V=748.2 A3; Z=3; T=150K; R1=0.0118, wR2=0.0290. The internal bond parameters of the [B(CF3)4] ion were compared to those of the C(CF3)4 molecule. Due to a disorder of the anions in the cesium salt, it is not possible to distinguish between T and Td symmetry by X-ray diffraction experiments alone. However, a comprehensive IR and Raman study demonstrated that in the potassium and cesium salt as well as in aqueous solution, the anion exhibits T symmetry with all CF3 groups rotated off the staggered position required for Td symmetry. The vibrational study is supported by DFT calculations, which provide, in addition to the equilibrium structure and vibrational wavenumbers, estimates of IR and Raman band intensities. The anion is resistant against strong oxidizing (e.g., F2) as well as reducing agents (e.g., Na) and is not affected by nucleophiles like C2H5O or electrophiles such as H3O+. It is very weakly coordinating, as demonstrated by the low-equilibrium CO pressure over the [Ag(CO)x][B(CF3)4] (x=1, 2) co-adducts and the formation of [Ag(CO)x][B(CF3)4] (x=3,4) at higher CO pressure. The 11B, 13C, and 19F NMR data as well as the structural parameters of the anion are compared with those for other borates containing F, CN, and CF3 ligands.

The Tetrakis(carbonyl)dioxoosmium(VI) Cation: trans-

The first carbonyl compound of a transition metal in the oxidation state +6 was obtained by reductive carbonylation of OsO(4) in SbF(5). Through the use of extensive IR, NMR, and UV/Vis spectroscopic studies as well as density functional calculations it was determined that the trans-[OsO(2)(CO)(4)](2+) cation adopts the octahedral structure shown in the picture with trans oxygen atoms.

Use of a historical register in social epidemiology: child mortality in Stockholm at the turn of the 19th century.

This study describes the age- and cause-specific levels and social determinants of high child mortality in Stockholm around the turn of the century. The study is based on computerized individual level sociodemographic information and the death certificates of children aged 0-15 years residing in Maria parish in Stockholm during the years 1885, 1891 and 1910 (n = 36,718) from a historical register (the Roteman archives). The usefulness of such data for further studies in social epidemiology is discussed. Age-specific rates and major causes of death compared well with other studies. Low social class and being born out of wedlock increased the overall risk of death in early childhood. Data appear valid and may be useful in social epidemiology. Further analyses of data from the Roteman archives may contribute to the understanding of causes behind high levels of cause- specific child mortality and trends in mortality in relation to societal change.

Spontaneous perforation of the ureter: a rare complication of urolithiasis.

The spontaneous rupture of the ureter is a rare condition. A case of a girl is reported with a spontaneous perforation caused by ureteral and renal calculi. The concomitant urinoma was drained and the ureter splinted with a double-J catheter. The calculi were destroyed by extracorporal piezoelectric lithotripsy without anesthesia.

The choice of part-time work among Swedish one-child mothers.

PIP: In Sweden, demographers studied labor force participation of 1 child mothers based on data from interviews with 4300 women aged 20-44 in 1981. In 1982, 2 million women and 2.3 million men were employed in Sweden, but 47% of the women worked part time ( 35 hours/week) while only 7% of the men did. The research showed that women are becoming more and more apt to work part time after the birth of their 1st child (prior to 1967, mean 12%; 1968-1974, mean 22%; 1975-1980, mean 35.7%). In addition, 1 child mothers who return to work full time following the 1st birth have a tendency to reduce working hours. Therefore, full time employment for 1 child mothers has become more temporary. On the other hand, 1 child mothers who work part time are more inclined to continue working part time until the next child is born. A positive correlation exists between length of work experience prior to 1st birth and part time work, especially if the length is 5 years. Further, the work experience of women with a low level of education increases the probability of part time work, and less so for highly educated women. Women who have worked for a while and have a more established position in their place of employment are more likely to find and keep a part time job after 1st birth than are women who do not fit this category. This new option for Swedish women of caring for the 1st child and performing domestic duties, and yet still be able to have 1 foot in the door by working part time, is called the combination strategy. Women who are opting for the combination strategy include women, who if lived in the past, would have clearly chosen the homemaker strategy of the career strategy. Further analyses, such as work-life transitions of 2 or child mothers, are needed.^ieng