Amphibian breeding phenology and reproductive outcome: an examination using terrestrial and aquatic sampling

Worldwide amphibian declines highlight the need for programs that monitor species presence and track population trends. We sampled larval amphibians with a box trap at 3-week intervals for 23 months in eight wetlands, and concurrently trapped adults and juveniles with drift fences, to examine spatiotemporal patterns of tadpole occurrence; explore relationships between breeding effort, tadpole abundance, and recruitment; and compare the efficacy of both methods in detecting species presence and reproductive outcome. Intermittent detection of species within and among wetlands suggested high mortality, followed by deposition of new eggs and tadpole cohorts. Breeding effort, tadpole abundance, and juvenile recruitment were generally not correlated. The reasons for this may include differential bias in detecting species or life stages between methods and high incidence of egg or tadpole mortality. Drift fences detected more species than box traps, but each provided insights regarding amphibian presence and recruitment. Our results illustrate shortfalls in the ability of infrequent aquatic sampling to detect local species richness of larval amphibians, as occurrence of many species is spatially and temporally variable. We also show the importance of using different sampling methods to detect species’ presence, as well as difficulties associated with both methods in tracking breeding effort, tadpole occurrence, or reproductive outcome.

Correction: Temporal Patterns of Influenza A and B in Tropical and Temperate Countries: What Are the Lessons for Influenza Vaccination?

[This corrects the article DOI: 10.1371/journal.pone.0152310.].

Pelvic Artery Embolization in the Management of Obstetrical Hemorrhage: Predictive Factors for Clinical Outcomes

PURPOSE

To evaluate clinical outcomes of pelvic artery embolization (PAE) for treatment of obstetric hemorrhage, and determine the predictive factors associated with failure.

MATERIALS AND METHODS

This retrospective study included all consecutive patients who underwent PAE for obstetric hemorrhage (not only in the post-partum setting), between January 2003 and January 2013 at three tertiary care centers. Medical records and imaging were reviewed to identify the study population and collect data on patient characteristics, PAE characteristics, and outcomes. Multiple parameters were compared between the failed and successful PAE groups, and univariate analysis was performed to determine the predictive factors for PAE failure.

RESULTS

A total of 74 PAE procedures were performed in 68 patients. Primary clinical success rate was 78%. On univariate analysis, three factors were associated with PAE failure: hemodynamic instability (p < 0.022), hemoglobin level <95 g/dL (p < 0.024), and disseminated intravascular coagulation (DIC) (p < 0.046). Other factors, including maternal characteristics, antecedent history, angiographic finding, embolic agent, operator experience, procedure done after hours, and unilateral versus bilateral embolization, did not show any statistically significant association with PAE failure. Only one major complication was encountered, which was fetal demise in a pregnant patient with a uterine arteriovenous malformations. Out of the 68 patients, there were 61 total pregnancies at follow-up.

CONCLUSION

PAE is an effective treatment for obstetric hemorrhage, with a low complication rate, and preserves fertility. Factors significantly associated with PAE failure include hemodynamic instability, hemoglobin level <95 g/dL, and DIC.

The use of telemedicine in burn care: development of a mobile system for TBSA documentation and remote assessment

The requirements for accurate documentation within the process of burn assessment have increased dramatically over the years. TBSA (total body surface area) and burn depth are commonly determined by visual inspection, especially in the emergency or acute care setting. However, inexperience often results in incorrect estimation of these factors. In 2001, BurnCase 3D was initiated in order to develop a tool for objective burn assessment and documentation on mobile devices (Apple iPhoneTM). The centerpiece is a 3D model representing the actual patient. At two international burn meetings, a survey containing three pictures of patients was conducted and this data was collected. A patient-specific 3D model adapted to the height and weight of the real patient was created and the digital picture was superimposed in the computer system. The burns were transferred to the model and the TBSA in % was calculated by the software BurnCase 3D. The preferred methods of the 80 respondents for burn extent estimation were: the Rule of Nines (38%), the Rule of Palm (37%) and the Lund-Browder chart (18%). Analysis showed very high deviations of TBSA within the participants, even among the group of experts. In comparison to a computer-aided method we found massive overestimation of up to 230%. The use of BurnCase 3D could have a true impact on the quality of treatment in burns. In the acute care setting for burn injuries, telemedicine has great potential to help guide decisions regarding triage and transfer based on TBSA, burn depth, patient age and injury mechanism.

Smartphones and burn size estimation: "Rapid Burn Assessor"

Estimation of the total body surface area burned (%TBSA) following a burn injury is used in determining whether to transfer the patient to a burn center and the required fluid resuscitation volumes. Unfortunately, the commonly applied methods of estimation have revealed inaccuracies, which are mostly related to human error. To calculate the %TBSA (quotient), it is necessary to divide the burned surface area (Burned BSA) (numerator in cm2) by the total body surface area (Total BSA) (denominator in cm2). By using everyday objects (eg. credit cards, smartphones) with well-defined surface areas as reference for estimations of Burned BSA on the one hand and established formulas for Total BSA calculation on the other (eg. Mosteller), we propose an approximation method to assess %TBSA more accurately than the established methods. To facilitate distribution, and respective user feedback, we have developed a smartphone app integrating all of the above parameters, available on popular mobile device platforms. This method represents a simple and ready-to-use clinical decision support system which addresses common errors associated with estimations of Burned BSA (=numerator). Following validation and respective user feedback, it could be deployed for testing in future clinical trials. This study has a level of evidence of IV and is a brief report based on clinical observation, which points to further study.

United Kingdom Myeloma Forum (UKMF) position statement on the use of bendamustine in myeloma

Bendamustine is a unique bifunctional alkylating agent with promising activity in myeloma. Despite the increasing number of studies demonstrating its efficacy in both the upfront and relapse settings, including patients with renal insufficiency, the optimal use of bendamustine, in terms of dosage, schedule and combination with other agents, has yet to be defined. It is currently licensed for use as frontline treatment with prednisolone for patients with myeloma who are unsuitable for transplantation and who are contraindicated for thalidomide and bortezomib. Studies in relapsed/refractory patients are currently ongoing with other combinations. Given the increasing data to date, the UK Myeloma Forum believes that bendamustine with steroids alone or in combination with a novel agent could be considered for patients with multiply relapsed myeloma. This document provides guidance for the use of bendamustine for patients with myeloma until the results of definitive studies are available.

Abstract P3-06-09: Test of association between Ki67 index of early breast cancer and local relapse after adjuvant hypofractionated radiotherapy

Introduction: There is a strong inverse association between the proliferation indices of early- and late-responding normal tissues and their sensitivity to radiotherapy fraction size. The aim of this study is to test for association between Ki67 index and the fractionation sensitivity of breast cancer. The hypothesis is that tumours with high Ki67 indices are relatively insensitive to fraction size and be over-represented in tumours relapsing after hypofractionated, radiotherapy.

Methods: Between 1986 and 2003, the START pilot and START A trials tested 2 test dose levels of a 13-fraction regimen (3.0 or 3.3 Gy & 3.0 or 3.2 Gy fractions, respectively) in 5 weeks against 25 fractions of 2.0 Gy following primary surgery for early breast cancer. Primary tumour blocks of patients with local tumour relapse were collected for immunohistochemistry (IHC) for Ki67 (manual counting in whole sections), HER2, ER & PR (Allred quick scores in tissue sections). Ki67 was assumed to be log normally distributed with a standard deviation of 0.5–0.9. Assuming evaluable blocks for 240 patients, a standardised detectable difference of 0.45 (90%+ power, 5% significance level) corresponded to a detectable difference in geometric means of 5–10%.

Results: From a total of 3646 patients entered into the START pilot and START A trials, 261 local tumour relapses were recorded at a median follow up of 8.4 years (range 0.9–17.5) and 7.2 (range 0.7–11.9) years respectively. Blocks from 213 patients were recovered, of which 176 were evaluable by IHC. There was no significant difference in proliferation between tumours relapsing after conventional and hypofractionated radiotherapy, with mean Ki67 scores of 7.63 (95%CI: 5.06–11.5) and 5.33 (95CI%: 3.86–7.35), respectively. Mean Ki67 scores in 48 primary triple negative tumours (TNT) that relapsed locally were 15.74 (95%CI: 8.53–29.06) after conventional and 7.52 (95%CI: 3.51–16.1) after hypofractionated radiotherapy, but TNT were equally represented (28%) in both groups.

Conclusion: An association between proliferative indices and fractionation sensitivity in breast tumours has not been demonstrated. If confirmed, it suggests that genetic and epigenetic features unrelated to proliferation are sources of inter-tumour variation in fractionation sensitivity.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-06-09.