Evolution of the clinical presentation and outcomes after radical prostatectomy for patients with clinically localized prostate cancer--changing trends over a ten year period

We demonstrate the evolution of the clinical presentation and outcomes for patients with clinically localized prostate cancer (PC) treated with radical retropubic prostatectomy (RRP) at our department, emphasizing epidemiologic significance of changes during the 10-year period. We assessed the annual trends for changes in patients age, preoperative prostate specific antigen (PSA), preoperative versus postoperative stages and Gleason grades, organ confined status and surgical margin status. A total of 488 RRPs were performed from January 1996 to December 2005 with the annual frequency increased from 8 to 129 (1512.5%). Mean patient age increased from 61.5 to 66.12 years in 2005, with the percentage of men aged more than 70 years increased from 12.5 to 26.5%, respectively. The detection of PC based solely on pathological PSA levels (as indication for prostate biopsy) rose impressively from 25.5 to 70% and the rates of postoperative organ-confined disease also increased significantly from 25 to 74.7%. Mean preoperative PSA decreased from 16.7 to 9.89 ng/mL. On the contrary, there was an increase in percentage of patients with preoperative PSA values ranging from 4 to 10 ng/mL (from 20 to 65.4%). Positive surgical margin rate decreased from 49.4 to 25% and percent of patients receiving neoadjuvant therapy decreased from 78.5 to 5.4%. Proportion of patients who were undergraded decreased from 75.1 to 31.7%. The rates of understaging have remained relatively stable over the years. During the study period, PC was increasingly detected by prostate biopsy on the basis of a pathological PSA level only and shifted significantly to more organ-confined stages with more favourable outcomes for pathological variables due to a more accurate assessment of clinical stage prior to surgery, reduced use of neoadjuvant therapy and improved surgical technique. Our data also argue strongly that routine PSA testing should be expanded and not restricted.     

Carbonate facies evolution from the late albian to Middle Cenomanian in Southern Istria (Croatia): influence of synsedimentary tectonics and extensive organic carbonate production

Summary During the Late Albian, Early and Middle Cenomanian in the NW part of the Adriatic Carbonate Platform (presentday Istria) specific depositional systems characterised by frequent lateral and vertical facies variations were established within a formerly homogeneous area, ranging from peritidal and barrier bars to the offshore-transition zone. In southern Istria this period is represented by the following succession: thin-bedded peritidal peloidal and stromatolitic limestones (Upper Albian); well-bedded foreshore to shoreface packstones/grainstones with synsedimentary dliding and slumping (Vraconian-lowermost Cenomanian); shoreface to off-shore storm-generated limestones (Lower Cenomanian); massive off-shore to shoreface carbonate sand bodies (Lower Cenomanian); prograding rudist bioclastic subaqueous dunes (Lower to Middle Cenomanian); rudist biostromes (Lower to Middle Cenomanian), and high-energy rudist and ostreid coquina beds within skeletal wackestones/packstones (Middle Cenomanian). Rapid changes of depositional systems near the Albian/Cenomanian transition in Istria are mainly the result of synsedimentary tectonics and the establishment of extensive rudist colonies producing enormous quantities of bioclastic material rather than the influence of eustatic changes. Tectonism is evidenced by the occurrence of sliding scars, slumps, small-scale synsedimentary faults and conspicuous bathymetric changes in formerly corresponding environments. Consequently, during the Early Cenomanian in the region of southern Istria, a deepening of the sedimentary environments occurred towards the SE, resulting in the establishment of a carbonate ramp system. Deeper parts of the ramp were below fair-weather wave base (FWWB), while the shallower parts were characterised by high-energy environments with extensive rudist colonies, and high organic production leading to the progradation of bioclastic subaqueous dunes. This resulted in numerous shallowing- and coarsening-upwards clinostratified sequences completely infilling formerly deeper environments, and the final re-establishment of the shallow-water environments over the entire area during the Middle Cenomanian.     

A network approach for inferring species associations from co‐occurrence data

Positive and negative associations between species are a key outcome of community assembly from regional species pools. These associations are difficult to detect and can be caused by a range of processes such as species interactions, local environmental constraints and dispersal. We integrate new ideas around species distribution modeling, covariance matrix estimation, and network analysis to provide an approach to inferring non‐random species associations from local‐ and regional‐scale occurrence data. Specifically, we provide a novel framework for identifying species associations that overcomes three challenges: 1) correcting for indirect effects from other species, 2) avoiding spurious associations driven by regional‐scale distributions, and 3) describing these associations in a multi‐species context. We highlight a range of research questions and analyses that this framework is able to address. We show that the approach is statistically robust using simulated data. In addition, we present an empirical analysis of > 1000 North American tree communities that gives evidence for weak positive associations among small groups of species. Finally, we discuss several possible extensions for identifying drivers of associations, predicting community assembly, and better linking biogeography and community ecology.     

The role of fat dormouse (Glis glis L.) as reservoir host for spirochete Borrelia burgdorferi sensu lato in the region of Gorski Kotar, Croatia

To determine whether some of the B. burgdorferi sensu lato genospecies associate with fat dormouse as a reservoir host, we investigated the prevalence of infection in questing animals. A total of 45 adult fat dormice (30 female and 15 male) were captured by hunters during their hunting season in the region of Gorski Kotar, Croatia. Dead animals were aseptically dissected, and the urinary bladder tissue was used for isolation attempt and for deoxyribonucleic acid (DNA) extraction. Out of 45 DNA samples extracted from urine bladder tissue, we found four (8.88%) to be polymerase chain reaction (PCR) positive. The RFLP analysis of the PCR product after cleavage with DraI and MseI distinguished between the three major genospecies: B. burgdorferi sensu stricto, B. garinii and B. afzelii. All positive samples were typed as B. afzelii with a unique DraI or MseI pattern. The results of the analysis of urinary bladder tissue samples culture for the presence of Borrelia were negative. Results showed that a prevalence of the Borrelia infection among population of fat dormice indicated their epizootiological involvement as a reservoir of Borrelia spirochetes. Furthermore, this work is an initial step in the investigation of the molecular epidemiology/epizootiology of Lyme borreliosis in Croatia.     

Effects of war aggression in Croatia on some forms and manifestations of breast cancer

The aim of this study was to determine the differences in epidemiological and clinical manifestations of breast cancer in time of war in Croatia and in peacetime before and after the war, in the defined population of Pozesko-Slavonska County. The methods used in this study were the evaluation of relative predictive value of variables by means of chi 2-test and the analysis of variance, while the survival studies were tested by Long Rank test according to Kaplan-Meier analysis of survival. This work encompasses 660 patients who had breast cancer. The differences between three time periods were evaluated: the war period (1991-1995), and two control periods: before the war (1981-1990) and after the war (1996-2000). The patients were grouped by age, localization of tumor and survival. During the war period the patients were, on the average, 4.2 years younger than those who acquired the disease in control periods, and the mean age of patients was between 50 and 59 years (36.5% of patients). Although the difference in tumor distribution by sides (left or right breast) and quadrants was statistically significant (war period vs. control periods; p < 0.001), there was no statistically significant difference in the survival of patients according to the results of Kaplan-Meier analysis of localization of tumor (p > 0.05). The length of survival in terms of age of patients in time of surgical procedure was significantly different (p < 0.001). This study confirms the effects of war on some epidemiological and clinical manifestation of breast cancer in the defined population of Pozesko-Slavonska County.     

Human neuropsychology and the concept of culture

American anthropology is distinguished by a four-fields approach in which biological, cultural, archaeological, and linguistic dimensions of behavior are examined in evolutionary and cross-cultural perspective. Nevertheless, assumptions of mind-body dualism pervade scholarly thinking in anthropology and have prevented the development of a truly integrated science of human experience. This dualism is most exemplified by the lack of consideration of the role of the brain in both “physical” and “mental” processes, including phenomena labeled as cultural. In this paper, I review neural mechanisms of learning, communication, and emotion, and discuss the implications of these findings for culture theory. Lee Xenakis Blonder is an assistant professor in the Department of Behavioral Science and the Sanders-Brown Center on Aging, University of Kentucky Medical School, Lexington. She is currently examining the effects of stroke in different regions of the brain on language, nonverbal communication, and emotional processing in an attempt to better understand human brain and behavior relations. Recent publications include “Neuropsychological Functioning in Hemiparkinsonism” (with R. E. Gur, R. C. Gur, A. J. Saykin, and H. I. Hurtig),Brain and Cognition 9:244–257 (1989).     

Effects of war aggression in Croatia on histopathological manifestations of breast cancer in defined population of one county

The aim of the present study was to determine the differences in epidemiological and clinical manifestations of breast cancer during the war in Croatia and in peacetime. 660 consecutive patients were recorded (656 female and 4 male patients) from Pozesko-Slavonska County. The changes in histopathological features were recorded in war period (1991-1995, 156 patients) and through two control periods, before the war (1981-1990, 282 patients) and after the war (1995-2000, first five months, 223 patients). The relative predictive value was calculated using chi 2-test. The survival was calculated according to Kaplan-Meier analysis of survival. The histopathological analysis showed an equal distribution of noninvasive cancer (in situ cancer) across periods. In the war period, the level of the most common invasive cancer, ductal breast cancer, was lower (57.7%), compared to control periods (71.2%:63.7%:68.2%). Opposite to that, invasive lobular cancer was more common in the war period (3.2%), compared to control periods (0.7%-1.3%). Furthermore, mixed cancer was also increased in the war period (7.1%) compared to control periods (0.7%-2.2%), as was medullar cancer (10.9% vs. 5.5%-5.9%). The study showed statistically significant differences in the survival of patients with different histopathological diagnoses (Log Rank = 47.49, df = 7, p < 0.0001), while the histological grade of tumor, as a predictive factor was not proved to be statistically significant (p > 0.05). This study confirmed the influence of war of war on histopathological incidence of some forms of breast cancer.     

Integrating prevention of mother-to-child HIV transmission programs to improve uptake: a systematic review

Background

We performed a systematic review to assess the effect of integrated perinatal prevention of mother-to-child transmission of HIV interventions compared to non- or partially integrated services on the uptake in low- and middle-income countries.

Methods

We searched for experimental, quasi-experimental and controlled observational studies in any language from 21 databases and grey literature sources.

Results

Out of 28 654 citations retrieved, five studies met our inclusion criteria. A cluster randomized controlled trial reported higher probability of nevirapine uptake at the labor wards implementing HIV testing and structured nevirapine adherence assessment (RRR 1.37, bootstrapped 95% CI, 1.04–1.77). A stepped wedge design study showed marked improvement in antiretroviral therapy (ART) enrolment (44.4% versus 25.3%, p<0.001) and initiation (32.9% versus 14.4%, p<0.001) in integrated care, but the median gestational age of ART initiation (27.1 versus 27.7 weeks, p = 0.4), ART duration (10.8 versus 10.0 weeks, p = 0.3) or 90 days ART retention (87.8% versus 91.3%, p = 0.3) did not differ significantly. A cohort study reported no significant difference either in the ART coverage (55% versus 48% versus 47%, p = 0.29) or eight weeks of ART duration before the delivery (50% versus 42% versus 52%; p = 0.96) between integrated, proximal and distal partially integrated care. Two before and after studies assessed the impact of integration on HIV testing uptake in antenatal care. The first study reported that significantly more women received information on PMTCT (92% versus 77%, p<0.001), were tested (76% versus 62%, p<0.001) and learned their HIV status (66% versus 55%, p<0.001) after integration. The second study also reported significant increase in HIV testing uptake after integration (98.8% versus 52.6%, p<0.001).

Conclusion

Limited, non-generalizable evidence supports the effectiveness of integrated PMTCT programs. More research measuring coverage and other relevant outcomes is urgently needed to inform the design of services delivering PMTCT programs.