The Chronic Leukemias: A Review of Disease Manifestations and the Aims of Therapy

Certain aspects of the chronic leukemias that may influence future therapeutic trials are reviewed. In chronic lymphocytic leukemia (CLL), there is minimal mitotic activity in lymphoid tissues; indolent, long-lived lymphocytes, unresponsive to antigenic or phytohemagglutinin (PHA) stimulation accumulate. In many patients, erythroid precursors fail to proliferate despite the stimulus of a severe anemia, but a proliferative response can be initiated by prednisone. We need to know how the normal proliferative responses of these cells are modified, because the correction of these abnormalities would relieve most of the disease manifestations. CLL may not be a neoplastic disorder. In chronic myelogenous leukemia (CML), the leukocyte doubling time shortens as the disease duration lengthens; a significant correlation between this time and survival is demonstrated. Before therapy designed to eliminate the Ph¹-positive (Philadelphia chromosome) stem cell is tried, we need to know whether a normal hematopoietic stem cell exists in Ph¹-positive CML.     

LCA for Site Remediation: A Literature Review

Remediation of contaminated sites provides a cleaner local environment, but may also have negative environmental impacts on the local, regional, and global scales. Methods based on Life Cycle Assessment (LCA) are designed to take the negative effects into consideration when deciding how to treat a site, and to improve the environmental efficiency of remediation techniques. This paper reviews nine case studies that use LCA tools to evaluate alternative remediation techniques to summarize the findings of methodologies and results. The methodologies were found to differ in the limitation of the LCA for space, time and secondary processes. This strongly influenced the results. Bioremediation was the worst when the secondary process of producing electron acceptors was included; otherwise it was the best. The choice of impact categories heavily affected the results. Inclusion of land use was especially important in site remediation studies. In general, the negative impact of site remediation was due to energy consumption. For excavation combined with ex-situ treatment, the transport of contaminated soil to the treatment facility or landfill required the most energy. For in-situ treatment of soil and groundwater, pumping consumed the most energy. It is proposed that different methods be applied to the same site.     

Clinical Manifestations of Human Brucellosis: A Systematic Review and Meta-Analysis

Background

The objectives of this systematic review, commissioned by WHO, were to assess the frequency and severity of clinical manifestations of human brucellosis, in view of specifying a disability weight for a DALY calculation.

Methods/Principal Findings

Thirty three databases were searched, with 2,385 articles published between January 1990–June 2010 identified as relating to human brucellosis. Fifty-seven studies were of sufficient quality for data extraction. Pooled proportions of cases with specific clinical manifestations were stratified by age category and sex and analysed using generalized linear mixed models. Data relating to duration of illness and risk factors were also extracted. Severe complications of brucellosis infection were not rare, with 1 case of endocarditis and 4 neurological cases per 100 patients. One in 10 men suffered from epididymo-orchitis. Debilitating conditions such as arthralgia, myalgia and back pain affected around half of the patients (65%, 47% and 45%, respectively). Given that 78% patients had fever, brucellosis poses a diagnostic challenge in malaria-endemic areas. Significant delays in appropriate diagnosis and treatment were the result of health service inadequacies and socioeconomic factors. Based on disability weights from the 2004 Global Burden of Disease Study, a disability weight of 0.150 is proposed as the first informed estimate for chronic, localised brucellosis and 0.190 for acute brucellosis.

Conclusions

This systematic review adds to the understanding of the global burden of brucellosis, one of the most common zoonoses worldwide. The severe, debilitating, and chronic impact of brucellosis is highlighted. Well designed epidemiological studies from regions lacking in data would allow a more complete understanding of the clinical manifestations of disease and exposure risks, and provide further evidence for policy-makers. As this is the first informed estimate of a disability weight for brucellosis, there is a need for further debate amongst brucellosis experts and a consensus to be reached.     

Factors Influencing Site Abandonment and Site Selection in a Sit-and-Wait Predator: A Review of Pit-Building Antlion Larvae

There is a large body of evidence indicating that predator behavior may strongly influence patterns and processes at the population and community level. Site selection is a major component of fitness in sit-and-wait predators, especially when relocation is rare. Although several review articles dealt with these issues in web-building spiders, this is the first attempt to summarize the effects of biotic and abiotic factors on site selection and relocation in another group of sit-and-wait predators, the pit-building antlions (Neuroptera: Myrmeleontidae). Our synthesis shows that prey abundance may have relatively little effect on pit relocation and that physical properties of the habitat or competition often override its effect. We suggest that owing to a variety of constraints such as physiological constraints or difficulties in assessing site quality, site selection and relocation are not necessarily optimal and thus food intake rate is not maximized. We call for a multi-factorial study on a single species in order to pinpoint the dominant factors and to assess to what extent they influence site selection and relocation. We conclude by proposing new research directions, such as studying whether pit relocation is an adaptive response, when controlling for possible phylogenetic effects.     

Structure and Organization of a Burned Rock Midden: The Indian Creek Site,Real County,Texas

Abstract

Excavation of a Central Texas burned rock midden was conducted to test hypotheses generated by study of a systematic surface collection. Some significant findings on social organization and function of the midden are verified by multiple typologies. The structure of the midden is attributed to successive cooking devices. The economic organization was entirely a matter of nuclear families.     

A Statistical Examination Of Caddoan Vessel Design And Shape From The Ben Mckinney Site,Marion County,Texas

Abstract

The statistical analysis reported here was done to set mathematical criteria for typologies of Caddoan ceramics. A fifty-vessel sample was analyzed through contingency table analysis, factor analysis, and canonical analysis to isolate design variables that would be statistically valid for assigning vessels to established types and to delineate statistically significant relationships between design attributes and vessel shape. Further work on this project canbe expected to establish a numerical method for ceramic typology for archeologists working in the Caddo area.     

Dual Atrioventricular Nodal Pathways Physiology: A Review of Relevant Anatomy,Electrophysiology, and Electrocardiographic Manifestations

More than half a century has passed since the concept of dual atrioventricular (AV) nodal pathways physiology was conceived. Dual AV nodal pathways have been shown to be responsible for many clinical arrhythmia syndromes, most notably AV nodal reentrant tachycardia. Although there has been a considerable amount of research on this topic, the subject of dual AV nodal pathways physiology remains heavily debated and discussed. Despite advances in understanding arrhythmia mechanisms and the widespread use of invasive electrophysiologic studies, there is still disagreement on the anatomy and physiology of the AV node that is the basis of discontinuous antegrade AV conduction. The purpose of this paper is to review the concept of dual AV nodal pathways physiology and its varied electrocardiographic manifestations.     

Skeletal Manifestations of Hydatid Disease in Serbia: Demographic Distribution,Site Involvement,Radiological Findings,and Complications

Although Serbia is recognized as an endemic country for echinococcosis, no information about precise incidence in humans has been available. The aim of this study was to investigate the skeletal manifestations of hydatid disease in Serbia. This retrospective study was conducted by reviewing the medical database of Institute for Pathology (Faculty of Medicine in Belgrade), a reference institution for bone pathology in Serbia. We reported a total of 41 patients with bone cystic echinococcosis (CE) during the study period. The mean age of 41 patients was 40.9±18.8 years. In 39% of patients, the fracture line was the only visible radiological sign, followed by cyst and tumefaction. The spine was the most commonly involved skeletal site (55.8%), followed by the femur (18.6%), pelvis (13.9%), humerus (7.0%), rib (2.3%), and tibia (2.3%). Pain was the symptom in 41.5% of patients, while some patients demonstrated complications such as paraplegia (22.0%), pathologic fracture (48.8%), and scoliosis (9.8%). The pathological fracture most frequently affected the spine (75.0%) followed by the femur (20.0%) and tibia (5.0%). However, 19.5% of patients didn''t develop any complication or symptom. In this study, we showed that bone CE is not uncommon in Serbian population. As reported in the literature, therapy of bone CE is controversial and its results are poor. In order to improve the therapy outcome, early diagnosis, before symptoms and complications occur, can be contributive.     

The Localization Problem: A Review

SYNOPSIS. The localization problem is the problem of the segregationof determinants into different cells of the embryo; the historyof this idea is reviewed and recent approaches to the studyof the localization of morphogenetic determination are discussed.     

The Fungi of Texas

Abstract  T he communication of which the following is an abstract contained an enumeration of a small collection of Fungi made by Mr. H. W. Ravenal in a trip to Texas some few years since. In addition to this, all previously recorded species for that State were collated, and the result was the determination of a total of 149 species as all which, up to the present, have been recorded. This number is exceedingly small, and only serves to prove how very little is known of the mycologic flora of a state which probably is as rich in fungi as South Carolina.     

Incised and Painted Pebbles from the Levi Site,Travis County,Texas

Abstract

Altered streamworn pebbles have been found in the Pedernales River drainage of inentral Texas. Three pebbles have linear black painted designs; eight others have one to 12 very fine parallel incised lines and are distinctively different from previously described forms. An additional specimen is both painted and incised in such a way as to suggest that the two techniques are related. Distributional data tentatively suggest association with the Austin focus, about A.D. 800-1375.     

The Extrarenal Manifestations of Hypernephroma

The extrarenal manifestations of hypernephroma in 34 medical patients are described, and the literature on this subject is reviewed. One case presented with hematuria and 11 other cases with metastases. Presentation was not obviously related to metastases in 22 patients. Eight were first seen because of fever or general weakness. Vascular disturbances in six included hypertension, thrombophlebitis, inferior vena caval obstruction and varicocele. Four patients had gastrointestinal complaints; one had hypercalcemia and another musculoskeletal symptoms. Two cases had neurological syndromes, one of which proved to be due to metastases. The overall incidence of systemic features was greater and included anemia, eosinophilia, a leukemoid reaction and thrombocytosis. Polycythemia, amyloidosis and hyponatremia were not encountered. Urographic procedures were performed in half of the patients, most of whom had an abdominal mass. Calcium was visible radiologically in the tumour in five cases. The diagnosis was not made in 19 and was an unexpected finding at autopsy in 10. Appreciation of the extrarenal manifestations of hypernephroma might lead to earlier diagnosis.     

Wound Edge Protectors in Open Abdominal Surgery to Reduce Surgical Site Infections: A Systematic Review and Meta-Analysis

Importance

Surgical site infections remain one of the most frequent complications following abdominal surgery and cause substantial costs, morbidity and mortality.

Objective

To assess the effectiveness of wound edge protectors in open abdominal surgery in reducing surgical site infections.

Evidence Review

A systematic literature search was conducted according to a prespecified review protocol in a variety of data-bases combined with hand-searches for randomized controlled trials on wound edge protectors in patients undergoing laparotomy. A qualitative and quantitative analysis of included trials was conducted.

Findings

We identified 16 randomized controlled trials including 3695 patients investigating wound edge protectors published between 1972 and 2014. Critical appraisal uncovered a number of methodological flaws, predominantly in the older trials. Wound edge protectors significantly reduced the rate of surgical site infections (risk ratio 0.65; 95%CI, 0.51–0.83; p = 0.0007; I² = 52%). The results were robust in a number of sensitivity analyses. A similar effect size was found in the subgroup of patients undergoing colorectal surgery (risk ratio 0.65; 95%CI, 0.44–0.97; p = 0.04; I² = 56%). Of the two common types of wound protectors double ring devices were found to exhibit a greater protective effect (risk ratio 0.29; 95%CI, 0.15–0.55) than single-ring devices (risk ratio 0.71; 95%CI, 0.54–0.92), but this might largely be due to the lower quality of available data for double-ring devices. Exploratory subgroup analyses for the degree of contamination showed a larger protective effect in contaminated cases (0.44; 95%CI, 0.28–0.67; p = 0.0002, I² = 23%) than in clean-contaminated surgeries (0.72, 95%CI, 0.57–0.91; p = 0.005; I² = 46%) and a strong effect on the reduction of superficial surgical site infections (risk ratio 0.45; 95%CI, 0.24–0.82; p = 0.001; I² = 72%).

Conclusions and Relevance

Wound edge protectors significantly reduce the rate of surgical site infections in open abdominal surgery. Further trials are needed to explore their effectiveness in different risk constellations.     

Manifestations of multicellularity: Dictyostelium reports in

The recent release of the Dictyostelium genome sequence is important because Dictyostelium has become a much-favoured model system for cell and developmental biologists. The sequence has revealed a remarkably high total number of approximately 12 500 genes, only a thousand fewer than are encoded by Drosophila. Previous protein-sequence comparisons suggested that Dictyostelium is evolutionarily closer to animals and fungi than to plants, and the global protein sequence comparison, now made possible by the genome sequence, confirms this. This review focuses on several classes of proteins that are shared by Dictyostelium and animals: a highly sophisticated array of microfilament components, a large family of G-protein-coupled receptors and a diverse set of SH2 domain-containing proteins. The presence of these proteins strengthens the case for a relatively close relationship with animals and extends the range of problems that can be addressed using Dictyostelium as a model organism.     

A Systematic Review of Risk Factors Associated with Surgical Site Infections among Surgical Patients

Importance

Surgical site infection (SSI) complicates 2-5% of surgeries in the United States. Severity of SSI ranges from superficial skin infection to life-threatening conditions such as severe sepsis, and SSIs are responsible for increased morbidity, mortality, and economic burden associated with surgery. Staphylococcus aureus (S. aureus) is a commonly-isolated organism for SSI, and methicillin-resistant S. aureus SSI incidence is increasing globally.

Objective

The objective of this systematic review was to characterize risk factors for SSI within observational studies describing incidence of SSI in a real-world setting.

Evidence Review

An initial search identified 328 titles published in 2002-2012; 57 were identified as relevant for data extraction. Extracted information included study design and methodology, reported cumulative incidence and post-surgical time until onset of SSI, and odds ratios and associated variability for all factors considered in univariate and/or multivariable analyses.

Findings

Median SSI incidence was 3.7%, ranging from 0.1% to 50.4%. Incidence of overall SSI and S. aureus SSI were both highest in tumor-related and transplant surgeries. Median time until SSI onset was 17.0 days, with longer time-to-onset for orthopedic and transplant surgeries. Risk factors consistently identified as associated with SSI included co-morbidities, advanced age, risk indices, patient frailty, and surgery complexity. Thirteen studies considered diabetes as a risk factor in multivariable analysis; 85% found a significant association with SSI, with odds ratios ranging from 1.5-24.3. Longer surgeries were associated with increased SSI risk, with a median odds ratio of 2.3 across 11 studies reporting significant results.

Conclusions and Relevance

In a broad review of published literature, risk factors for SSI were characterized as describing reduced fitness, patient frailty, surgery duration, and complexity. Recognition of risk factors frequently associated with SSI allows for identification of such patients with the greatest need for optimal preventive measures to be identified and pre-treatment prior to surgery.     

The Jarisch-Herxheimer Reaction in Leptospirosis: A Systematic Review

Background

Leptospirosis is an endemo-epidemic zoonotic disease associated with potentially fatal renal, cardiovascular or pulmonary failure. Recommended treatment includes antibiotics, which may induce a Jarisch-Herxheimer reaction (JHR). Since little information on the importance of this adverse event is available, we performed this review to quantify frequency and impact of JHR in leptospirosis management.

Methodology/Principal Findings

This review systematically summarizes the literature on the JHR in leptospirosis. To approach the broader aspects of the subject, articles considering the treatment of leptospirosis, national leptospirosis guidelines and textbook and technical reports of the World Health Organisation were reviewed. Publications describing JHR in leptospirosis are very limited and consist mainly of single case reports and small case series. A single randomized control trial specifically assessed the JHR occurrence, but it has never been systematically investigated in large trials. Not all guidelines and not all literature on leptospirosis mention this reaction which can be fatal.

Conclusions/Significance

Although generally assumed to be a rare event, the true prevalence of JHR in leptospirosis is unknown and the awareness of this event is insufficient. All leptospirosis guidelines and local leptospirosis protocols should stress on systematic monitoring for clinical status early after antibiotic administration. Large well designed studies are required to precise the incidence and the impact of JHR as well as the severity and rates between various antibiotics.