Young climbers successfully avoid predators: survival behavioural strategy of juveniles of the land snail Ezohelix gainesi

Predation risk has a great influence on animal behaviour. Juveniles are often more susceptible to predation than adults owing to their small body size and limited locomotive ability. Ezohelix gainesi (Camaenidae) is a ground-dwelling land snail that swings its shell as a strategy to avoid predation by beetles. This strategy, however, does not seem to work in juveniles, probably because of their small shell size. Instead, small individuals climb plants as an alternative strategy that is likely to avoid predation; to examine this, we initially made an experimental comparison of the rates of predation by beetles on land snails of different sizes. In these conditions, smaller snails were preyed upon more frequently than larger ones. Next, we compared the size distribution of snails on plants with those on the forest floor. Small snails occurred more frequently on plants than on the ground, and the shell diameter of land snails at 50% probability of occurring on plants was similar to that at 50% probability of predation. Climbing behaviour by small snails was also confirmed in the laboratory in the absence of predators. Therefore, plant-climbing by juvenile E. gainesi is probably an adaptive strategy to avoid predation by ground-dwelling beetles.

Geographic variation in shoot structure in association with fruit size in an evergreen woody species

The generality of scaling relationships between multiple shoot traits, known as Corner's rules, has been considered to reflect the biomechanical limits to trees and tree organs among the species of different leaf sizes. Variation in fruit size within species would also be expected to affect shoot structure by changing the mechanical and hydraulic stresses caused by the mass and water requirement of fruits. We investigated the differences in shoot structure and their relationship with fruit size in Camellia japonica from 12 sites in a wide geographic range in Japan. This species is known to produce larger fruits with thicker pericarps in more southern populations because warmer climates induce more intensive arms race between the fruit size and the rostrum length of its obligate seed predator. We found that, in association with the change in fruit size, the diameter and mass of 1-year-old stems were negatively associated with latitude, but the total mass and area of 1-year-old leaves did not change with latitude. Consequently, the length of 1-year-old stems and the total mass and area of 1-year-old leaves at a given stem diameter were positively associated with latitude in the allometric relationships. In contrast, the allometric relationships between stem diameter and total mass of the 1-year-old shoot complex (the leaves, stems and fruits that were supported by a 1-year-old stem) did not differ across the trees of different latitudes. Thus, natural selection on fruit size is considered to influence the other traits of Corner's rules in C. japonica, but all of the traits of Corner's rules do not necessarily change in a similar manner across latitudinal gradients.

Differential springtime branch warming controls intra-crown nitrogen allocation and leaf photosynthetic traits in understory saplings of a temperate deciduous species

Between-branch nitrogen competition is expected to be important during spring in temperate deciduous trees as nitrogen allocation would be higher in branches from earlier budburst than in those from later budburst. Such phenology-induced branch interaction would influence plant photosynthesis, but this has not been evaluated. Warming experiments were conducted on whole crowns (warmed trees; trunks and all branches of the same tree were warmed) or parts of the crowns (warmed branches with unwarmed control branches in the same tree), with unwarmed control trees, in saplings of the deciduous species Fraxinus lanuginosa. Spring leaf phenology and leaf photosynthetic traits were investigated to determine how the difference in temperature affects leaf phenology and photosynthetic traits. The timing of budburst was influenced by temperature-budburst was earlier in warmed trees and warmed branches than in control trees and control branches, but budburst timing did not differ between control trees and control branches or between warmed trees and warmed branches. In contrast, leaf traits were affected by the variation in phenology within crowns-nitrogen content and photosynthetic capacity were greater in the leaves of the warmed branches than in the control branches, but they did not differ between the leaves of warmed trees and control trees. Thus, branch warming altered the distribution of nitrogen between warmed and unwarmed branches as warmed branches developed faster, resulting in intracrown variation in leaf photosynthetic traits.

Ignoring non-English-language studies may bias ecological meta-analyses

Meta-analysis plays a crucial role in syntheses of quantitative evidence in ecology and biodiversity conservation. The reliability of estimates in meta-analyses strongly depends on unbiased sampling of primary studies. Although earlier studies have explored potential biases in ecological meta-analyses, biases in reported statistical results and associated study characteristics published in different languages have never been tested in environmental sciences. We address this knowledge gap by systematically searching published meta-analyses and comparing effect-size estimates between English- and Japanese-language studies included in existing meta-analyses. Of the 40 published ecological meta-analysis articles authored by those affiliated to Japanese institutions, we find that three meta-analysis articles searched for studies in the two languages and involved sufficient numbers of English- and Japanese-language studies, resulting in four eligible meta-analyses (i.e., four meta-analyses conducted in the three meta-analysis articles). In two of the four, effect sizes differ significantly between the English- and Japanese-language studies included in the meta-analyses, causing considerable changes in overall mean effect sizes and even their direction when Japanese-language studies are excluded. The observed differences in effect sizes are likely attributable to systematic differences in reported statistical results and associated study characteristics, particularly taxa and ecosystems, between English- and Japanese-language studies. Despite being based on a small sample size, our findings suggest that ignoring non-English-language studies may bias outcomes of ecological meta-analyses, due to systematic differences in study characteristics and effect-size estimates between English- and non-English languages. We provide a list of actions that meta-analysts could take in the future to reduce the risk of language bias.

TRY plant trait database - enhanced coverage and open access

Plant traits-the morphological, anatomical, physiological, biochemical and phenological characteristics of plants-determine how plants respond to environmental factors, affect other trophic levels, and influence ecosystem properties and their benefits and detriments to people. Plant trait data thus represent the basis for a vast area of research spanning from evolutionary biology, community and functional ecology, to biodiversity conservation, ecosystem and landscape management, restoration, biogeography and earth system modelling. Since its foundation in 2007, the TRY database of plant traits has grown continuously. It now provides unprecedented data coverage under an open access data policy and is the main plant trait database used by the research community worldwide. Increasingly, the TRY database also supports new frontiers of trait-based plant research, including the identification of data gaps and the subsequent mobilization or measurement of new data. To support this development, in this article we evaluate the extent of the trait data compiled in TRY and analyse emerging patterns of data coverage and representativeness. Best species coverage is achieved for categorical traits-almost complete coverage for 'plant growth form'. However, most traits relevant for ecology and vegetation modelling are characterized by continuous intraspecific variation and trait-environmental relationships. These traits have to be measured on individual plants in their respective environment. Despite unprecedented data coverage, we observe a humbling lack of completeness and representativeness of these continuous traits in many aspects. We, therefore, conclude that reducing data gaps and biases in the TRY database remains a key challenge and requires a coordinated approach to data mobilization and trait measurements. This can only be achieved in collaboration with other initiatives.

Intraspecific differences in spring leaf phenology in relation to tree size in temperate deciduous trees

Spring leaf phenology strongly influences plant productivity in temperate deciduous forests. Many studies have detected earlier budburst and leaf maturation in smaller trees within species, and have discussed the adaptive significance of increasing carbon gain before canopy closure in small trees. However, some previous studies have found the opposite pattern, and the physiological and environmental bases for this discrepancy are incompletely understood. We investigated the spring leaf phenology of 11 deciduous species in a cool-temperate forest in Japan for 2 years with different amounts of snowfall, and also gathered data on the day of budburst from multiple studies to assess whether and how the timing of budburst is related to tree size, phylogeny, temperature and annual snowfall of study sites. We found that differences in the timing of budburst and leaf maturation between saplings (<1 m height) and short trees (1-10 m height) are larger than those between short trees and tall trees (>10 m height), resulting in non-linear relationships between timing and height in most species. Cumulative degree-days to the day of budburst were smaller in saplings than in tall trees, probably because saplings are selected to outcompete the other individuals/species to become established. Moreover, phylogenetic relatedness did not explain the difference in spring leaf phenology between saplings and tall trees in the literature survey. In addition, our literature survey showed that budburst occurred earlier in saplings of most species in sites with less snowfall, whereas budburst occurred earlier in tall trees at sites with heavy snowfall. These results suggest that the opposite patterns found in some studies may be due to (i) differences in the target size, as saplings show larger phenological discrepancies than short and tall trees, and (ii) the microclimate experienced by the tree, as sites with heavy snow show delayed sapling phenology.

Genetic differentiation in the timing of budburst in Fagus crenata in relation to temperature and photoperiod

Climate change is expected to influence plant productivity particularly through changes in the timing of budburst. Nonetheless, knowledge about the intraspecific variation of the timing of budburst and its relationship with climate is insufficient for most tree species. Based on the common garden experiments of Fagus crenata, we investigated the interrelationships between the day of budburst, cumulative degree-days (temperature sum), chilling duration, and photoperiod at the timing of budburst for the trees of different combinations of 11 sites of seed origin and seven experimental sites in Japan. We found that the relationship between the latitude of experimental sites and the timing of budburst differed for the trees of different latitudes of origins. The timing of budburst was earlier for the trees of more northern populations throughout the latitudes of experimental sites. Variation in the timing of budburst among the trees of different seed origins was smaller for more northern experimental sites. Such patterns were caused by directional changes in the relationships between temperature sum, chilling duration, and photoperiod among the trees of different origins: the asymptotes of the curvilinear relationship between chilling duration and temperature sum, chilling duration and photoperiod, and temperature sum and photoperiod, decreased for more northern populations. With the northward expansion of species distribution, the responses of budburst to climate probably changed genetically in such ways in this species. Our results suggest that intraspecific variations in the relationships between the timing of budburst and associated meteorological factors inevitably influence the overall pattern of the timing of budburst at the geographic scale, and the timing of budburst might deviate from predictions when intraspecific variations are not considered.

The Clinic-specific Thesaurus: a Means of “Lean Documentation in Pediatric Surgery

A one-hundred percent documentation rate of diagnoses and patient data is unfeasible and should not be pursued. Therefore, a “lean documentation” of diagnoses and basic patient data was introduced. Coding is done by a clinic-specific list of diagnoses (thesaurus) with a minimum of diagnostic codes, combined with optional free text. By recording the frequency of diagnoses for two years, a thesaurus of 188 diagnostic codes was developed. Bedside coding by treating physicians reduced medical and semantic mistakes of documentation. Cooperation of the clinicians was obtained by shortening the time required for coding to less than two minutes per patient. A documentation assistant supplemented incomplete data in collaboration with the treating surgeons. During a ten-year testing period 93.7% of the hospital-specific codes of our thesaurus were required for documentation, as compared to 13.1% if the same patients were coded by ICD-9. Consequently, coding by a clinic-specific code thesaurus is quick, flexible and accurate.

Development of genotyping method for functionally relevant variants of cytochromes P450 in cynomolgus macaques

In cynomolgus macaques (Macaca fascicularis), widely used in drug metabolism studies, CYP2C9, CYP2C76, CYP2D6, CYP3A4, and CYP3A5, important drug-metabolizing enzymes, are abundantly expressed in liver and metabolize cytochrome P450 substrates. CYP2C9 (c.334A>C), CYP2C76 (c.449TG>A), CYP2D6 (c.891A>G), CYP3A4 (IVS3 + 1G>del), and CYP3A5 (c.625A>T) substantially influence metabolic activity of enzymes, and thus are important variants in drug metabolism studies. In this study, a real-time PCR method was developed for genotyping these variants. The validity of the methods was verified by genotyping two wild type, two heterozygous, and two homozygous DNAs and was used to genotype 41 cynomolgus macaques (from Cambodia, Indonesia, the Philippines, or Vietnam) for the five variants, along with another important variant CYP2C19 (c.308C>T). The CYP2C9 and CYP2C19 variants were found only in Cambodian and Vietnamese animals, while the CYP2C76 and CYP2D6 variants were found only in Indonesian and Philippine animals. The CYP3A4 and CYP3A5 variants were not found in any of the animals analyzed. Mauritian animals, genotyped using next-generation sequencing data for comparison, possessed the CYP2C19 and CYP2D6 variants, but not the other variants. These results indicated differences in prevalence of these important variants among animal groups. Therefore, the genotyping tool developed is useful for drug metabolism studies using cynomolgus macaques.

Relationships between the timing of budburst, plant traits, and distribution of 24 coexisting woody species in a warm-temperate forest in Japan

PREMISE OF THE STUDY

Timing of budburst (D_BB) may be related to the functional traits and distributions of woody species in temperate regions. Although many previous studies have investigated D_BB in a number of temperate species, it has seldom been linked to multiple plant trait relationships.

METHODS

D_BB and plant traits were investigated for 24 woody species for 2 years in a warm-temperate secondary forest in Japan. Particular attention was paid to differences in trait relationships between coexisting deciduous and evergreen broad-leaved species.

KEY RESULTS

D_BB was correlated with plant traits in deciduous but not evergreen broad-leaved species; D_BB was later for deciduous species with greater leaf mass, leaf area, vessel diameter, and leaf nitrogen content per unit mass. In addition, D_BB was later for species with more northern distributions in deciduous and evergreen species.

CONCLUSIONS

Clear differences in the trait relationships between deciduous and evergreen broad-leaved species might be caused by different selection pressures on D_BB; selection is expected to be more severe in deciduous species. Overall, the continuous variable of vessel diameter might be used as a simple and effective trait to predict D_BB of deciduous species regardless of wood anatomy; however, no such traits were detected as effective predictors of D_BB in evergreen species at this study site. In addition, D_BB was earlier for the species of more southern distributions, suggesting that such species benefit more from warming.

Inconsistent intraspecific pattern in leaf life span along nitrogen-supply gradient

PREMISE OF THE STUDY

Leaf life span (LLS) has long been hypothesized to plastically increase with decreasing nitrogen (N) supply from soil to maximize N retention, carbon assimilation, and fitness; however, accumulating evidence shows no consistent trend. The apparent inconsistencies are explained by a recent model that assumes LLS has a hump-shaped quadratic response to the N-supply gradient. The available evidence mostly originates from comparisons of LLS at only two levels of N availability, and the hypothesis remains unanswered.

METHODS

We investigated LLS of two asteraceous forbs (Adenocaulon himalaicum and Xanthium canadense) experimentally grown at eight levels of N supply, which covered a range of N supply in their natural habitats. We additionally conducted a literature search to retrieve studies reporting LLS response along an N-supply gradient.

KEY RESULTS

The LLS of neither species showed a hump-shaped response along the N-supply gradient. Past studies examining the LLS of an aquatic forb and terrestrial shrubs and trees along the N-supply gradient (more than four levels of N supply) also refuted the hypothesis.

CONCLUSIONS

The LLS of a single species exhibited neither an increase nor a hump-shaped response to decreased N supply in a variety of life forms. Comparisons at only a few N levels are misleading with regard to LLS response to N supply.

Geographic variation in shoot traits and branching intensity in relation to leaf size in Fagus crenata: A common garden experiment

PREMISE OF THE STUDY

Differences in leaf size are expected to be coordinated with various shoot traits and branching intensity because these relationships will influence light capture efficiency, water use, and biomechanics. Previous studies have mainly focused on interspecific patterns of these trait relationships, but not on intraspecific patterns at the geographic scale. We investigated intraspecific variation in shoot traits and branching intensity of Fagus crenata in Japan.

METHODS

Allometric relationships between the traits of current-year shoots and branching intensity per branch unit of 1-m length on the main axis (BI) and its coordination with latitude were investigated using trees from 10 provenances in a common garden.

KEY RESULTS

Individual trees originating from lower latitudes have smaller leaves with greater leaf mass per area and nitrogen content per area, greater Huber value (stem cross-sectional area per total leaf area [ATL]) of current-year shoots, and greater BI. Notably, the slope of the log-log relationship between BI and ATL was close to -1.0 across the trees from different source sites, implying that branching in this species occurs to control leaf area.

CONCLUSIONS

Shoot traits and branching intensity were apparently coordinated with leaf size to control leaf area deployment in this species. Such patterns probably reflect differences in competition for hydraulic conductance among nearby shoots within crowns, as a consequence of different meteorological conditions across the source sites.

The effects of posture on the ventilatory responses during exercise

This study was undertaken to evaluate the postural effect on ventilatory responses during both supine and sitting exercise. Seven healthy men performed two exercise tests utilizing the ramp protocol (20 watts/min) with a cycle ergometer in each position. The results were as follows: The oxygen uptake and the oxygen pulse measured at 180 watts and at anaerobic threshold in the sitting were significantly higher compared with those in the supine position. The average of carbon-dioxide output, minute ventilation and tidal volume at lower exercise intensities showed higher values in the sitting compared with those in the supine position, whereas there were no significant differences for respiratory rate. There was significant difference in the slope of the minute ventilation to carbon-dioxide output plot between sitting and supine position. In conclusion, the higher minute ventilation in the sitting position was mainly performed by higher tidal volume which may counteract the effects of an increase in physiological dead space. The lower slope of the minute ventilation to carbon-dioxide output plot which shows more effective ventilation in the supine position may be due to decreased physiological dead space and higher diffusion capacity.

Long-term outcome of femoropopliteal stenting. Results of a prospective study

AIM

Aim of the study was to assess the long-term clinical results of primary stent placement in patients with femoro-popliteal lesions and intermittent claudication (IC) or critical limb ischemia (CLI).

METHODS

Prospectively collected data of 517 patients (543 limbs) treated for IC (N.=422; 77.5%) and CLI (N.=121; 22.5%), between September 2006 and December 2010 were evaluated. Survival, limb salvage and patency rates were analyzed and multivariate analysis was performed to evaluate possible risk factors for the development of restenosis.

RESULTS

Mean patients' age was 70.6 years (SD ±10); 64.8% of the patients (N.=335) were male. Angiography revealed TASC A or B lesions in 64.5% (N.=350), TASC C or D lesions in 35.5% (N.=193) of the patients. Two hundred thirty-two patients had evidence of occluded femoropopliteal artery (42.7%) and the remaining patients had evidence of high grade (>70%) stenosis. In total, 827 bare metal nitinol stents (1.53±0.9 per limb) were used. No early (<30-day) procedure-related death was recorded. After a mean follow-up period of 60 months (SD ±13.5), 69 patients died (13.4%). Eight (1.5%) patients underwent major amputation. The amputation rate was significantly higher in the CLI group compared to the IC group (P=0.03). Primary patency rates were 86.2%, 79.1%, 75.1% and 62.2% after 1, 2, 3 and 5 years, respectively. No difference in terms of patency rates was found between the results of the treatment of TASC A/B versus TASC C/D lesions and the patient groups with IC versus CLI.

CONCLUSION

The endovascular-first line treatment with use of nitinol stents for patients with femoropopliteal artery lesions is associated with acceptable long-term patency rates, even in patients with long lesions.

Relation between maximum phonation time and exercise capacity in chronic heart failure patients

BACKGROUND

Patients with chronic heart failure (CHF) commonly fatigue easily due to low peak oxygen uptake (peak VO(2)), an important index of exercise capacity. Maximum phonation time (MPT) is widely used to evaluate maximum vocal capabilities because it is non-invasive, quick, and inexpensive.

AIM

The aim of this study was to determine the relation between MPT and exercise capacity, and MPT required to attain an exercise capacity of ≥5 metabolic equivalents (METs) in CHF outpatients.

DESIGN

Cross-sectional study.

SETTING

Outpatient cardiac rehabilitation unit.

POPULATION

We enrolled 111 CHF outpatients (mean age 54.2±10.1 years).

METHODS

Peak VO(2) was assessed during cardiopulmonary exercise testing (CPX) as the index of exercise capacity. After CPX, we divided the patients into two groups according to exercise capacity: ≥5 METs group (N.=68) and <5 METs group (N.=43). Measurements of MPT were taken in the seated position. All patients were asked to produce a sustained vowel /a:/ for as long as possible and were verbally encouraged during respiratory effort.

RESULTS

After adjustment for patient clinical characteristics, MPT in the CHF patients was found to be significantly higher in the ≥5 METs group than in the <5 METs group (22.1±8.4 vs. 17.0±11.6 s, F=13.5, P<0.001). Receiver-operating characteristic curve analysis of exercise capacity of ≥5 METs extracted a cutoff value for MPT of 18.27 s, with a sensitivity of 0.76, 1-specificity of 0.33, and AUC value of 0.81 (95% CI: 0.70-0.87, P<0.001).

CONCLUSION

There were differences in MPT in relation to an exercise capacity threshold of ≥5 METs in CHF outpatients. A MPT of 18.27 sec may be the best cutoff value to identify people with or without exercise capacity of ≥5 METs.

CLINICAL REHABILITATION IMPACT

Measurement of MPT may be a useful method for estimating exercise capacity in CHF outpatients.

Blockade of I(Ca) suppresses early afterdepolarizations and reduces transmural dispersion of repolarization in a whole heart model of chronic heart failure

BACKGROUND AND PURPOSE Chronic heart failure (CHF) is associated with action potential prolongation and Ca(2+) overload, increasing risk of ventricular tachyarrhythmias (VT). We therefore investigated whether I(Ca) blockade was anti-arrhythmic in an intact perfused heart model of CHF. EXPERIMENTAL APPROACH CHF was induced in rabbits after 4 weeks of rapid ventricular pacing. Hearts from CHF and sham-operated rabbits were isolated and perfused (Langendorff preparation), with ablation of the AV node. VT was induced by erythromycin and low [K(+) ] (1.5mM). Electrophysiology of cardiac myocytes, with block of cation currents, was simulated by a mathematical model. KEY RESULTS Repolarization was prolonged in CHF hearts compared with sham-operated hearts. Action potential duration (APD) and overall dispersion of repolarization were further increased by erythromycin (300 µM) to block I(Kr) in CHF hearts. After lowering [K(+) ] to 1.5mM, CHF and sham hearts showed spontaneous episodes of polymorphic non-sustained VT. Additional infusion of verapamil (0.75 µM) suppressed early afterdepolarizations (EAD) and VT in 75% of sham and CHF hearts. Verapamil shortened APD and dispersion of repolarization, mainly by reducing transmural dispersion of repolarization via shortening of endocardial action potentials. Mathematical simulations showed that EADs were more effectively reduced by verapamil assuming a state-dependent block than a simple block of I(Ca) . CONCLUSIONS AND IMPLICATIONS Blockade of I(Ca) was highly effective in suppressing VT via reduction of transmural dispersion of repolarization and suppression of EAD. Such blockade might represent a novel therapeutic option to reduce risk of VT in structurally normal hearts and also in heart failure. LINKED ARTICLE This article is commented on by Stams et al., pp. 554-556 of this issue. To view this commentary visit http://dx.doi.org/10.1111/j.1476-5381.2011.01818.x.

[Effectiveness of nephroprotection by the selection of contrast media used during vascular interventions in patients with chronic renal failure?]

BACKGROUND

The increasing number of endovascular procedures made aware of a kidney disease induced by contrast media (CM). Contrast-induced nephropathy (= CIN) can develop in 0.6-44 % of the treated patients by angiography and / or endovascular intervention. The incidence in high-risk patients ranges from 50 to 70 %. In most cases CIN is inconspicuous and reversible. But pre-existing chronic kidney disease, diabetes mellitus, age and variable different risk factors (e. g., PAOD) can induce irreversible renal impairment. The purpose of the presented trial is to investigate incidence, predictors, and out-come of CIN in chronic renal failure patients using two different CM; one non-ionic isoosmolar -iodixanol and the other non-ionic low-osmolar iopromide.

METHODS

To evaluate the incidence of CIN after endovascular diagnostics and intervention two collectives of 100  patients with chronic renal insufficiency were treated with different contrast media (CM). Inclusion followed prospectively in two collectives. One collective received iopromide (Ultravist™, Bayer Health Care, Lever-kusen, Germany), and the second hundred patients received iodixanol (Visipaque™, Nycomed Amersham, Princeton, New Jersey). Demographics, comorbidities, procedure-related data were completed by serum creatinine levels and GFR (= glomerular filtration rate). Inclusion criteria were a serum creatinine level ≥ 1.5 mg% and a GFR ≤ 60 mL / min. Those parameters were measured twice pre-interventionally, and one time 48-72  hours after the endovascular procedure.

RESULTS

Collectives were homogenous and comparable concerning pre-existing risk factors, age and gender. Renal function stayed at a constant level and was independent of contrast medium selection, repectively. Average creatinine levels ranged around 1.77 mg% ± 0.75  standard deviation (SD) pre-interventionally; postinterventional measurement exposed a creatinine level of 1.74 mg% ± 0.74 SD as mean of both collectives. GFR (preinterventional 39.64 mL / min ± 12.48 SD) increased non-significantly to 45.48 mL / min ± 16.82 SD. Pre-existing chronic kidney disease had no effect on renal function parameters; no other risk factors could be evaluated.

CONCLUSION

According to cost-effectiveness a low-osmolar monomeric contrast medium (LOCM) is a sufficient selection, under careful renal function control.

["Münsteraner foot- and shoe score"--objectivation of patient satisfaction after provision with orthopedic shoes]

BACKGROUND

Means to improve patient satisfaction and their compliance are essential for the successful outcome of medical interventions, e.g. supply of orthopedic shoes or orthoses in orthopedic patients. A useful validated questionnaire to monitor the subjective opinion of the patients is still lacking.

METHODS

In a randomised single blinded study we created a new questionnaire with two parts. Part one deals with ten questions on patient data and illness. Part two consists of 13 questions about pain, disabilities in activities of daily life (ADL), use of painkillers, satisfaction, history of ulceration, correction of shoes and orthoses, handling and compliance using a scale of 1-6. Questions were chosen by asking a group of experts (four experienced physicians of two universities and four shoemaker master-craftsmen). Then an items reduction was performed. The reliability was tested in a pre- and retest in 20 patients of our orthopedic clinic. Then the questionnaire was validated by comparing 40 patients of our orthopedic clinic (intervention group) with 180 subjects without orthopedic treatment (control group) chosen at random. The questionnaire was always done anonymously and without the help of the interviewer. Exclusion criteria for the control group were any kind of orthopedic treatment of the lower limb in the last 2 years, orthopedic shoes or lumbar sciatic pain. Exclusion criteria for both groups were minor or major amputations, inability to walk outdoors without help.

RESULTS

We demonstrated highly significant differences for each single question and the total score between orthopedic patients and healthy probands. Additionally, we saw significantly poorer scores for patients suffering from diabetes in the control group, patients with polyneuropathy and those without polyneuropathy, as well as for women vs. men. There was a high rate of diabetics (11 %) in the control group in analogy to the current literature.

DISCUSSION

The new questionnaire discriminates highly significantly between healthy and ill probands. Interindividually a screening of people at risk is possible or a comparison of different interventions. Intraindividually it could be used to monitor patient satisfaction after interventions. Objectivation of patient satisfaction is important to improve their compliance and outcome.

Erythrocyte magnesium and prostaglandin dynamics in chronic sleep deprivation

BACKGROUND AND HYPOTHESIS

The mechanism of sudden cardiac death occurring in patients with chronic fatigue is controversial. This study was designed to define a hypothesis that coronary arterial spasm and thrombus formation can occur during chronic fatigue.

METHODS

For evaluating the feasibility of coronary arterial spasm, erythrocyte magnesium (Mg) was measured. Blood coagulability was evaluated by the change of prostaglandin concentration. Subjects included 16 healthy male volunteers (mean age 21.6 +/- 2.5 years). Test conditions were as follows: (A) control state: a day following a night of good sleep; (B) temporary sleep deprivation: a day preceded by < 3 h of sleep; (C) chronic sleep deprivation: a day preceded by a month during which sleep lasted < 60% of that in condition (A) above. The erythrocyte Mg concentration was measured by the atomic absorption method. The plasma concentration of thromboxane B2 and 6-keto-prostaglandin F1 alpha were measured in eight subjects by radioimmunoassay method.

RESULTS

(1) Mean erythrocyte Mg concentration was significantly less in chronic sleep deprivation (1.1 +/- 0.4 mg/dl) than in the control state (1.8 +/- 0.4 mg/dl, p < 0.01) or in temporary sleep deprivation (1.6 +/- 0.4, p < 0.01). (2) The level of thromboxane B2 was significantly higher during chronic sleep deprivation than under control conditions (104.4 +/- 78.0 vs. 20.4 +/- 9.0 pg/ml, p < 0.05). (3) There were no significant intergroup differences in 6-keto-prostaglandin F1 alpha level.

CONCLUSION

These findings could support the hypothesis that coronary arterial spasm and thrombus formation occur in chronic sleep deprivation.

Positive and negative regulation of adenovirus infection by CAR-like soluble protein, CLSP

Coxsackievirus and adenovirus receptor (CAR) is a member of the immunoglobulin (Ig) superfamily and a component of epithelial tight junction. CAR also functions as a primary receptor for coxsackievirus B and adenovirus (Ad) infection. In this study, we report the identification of a novel protein, CAR-like soluble protein (CLSP), which is closely related to CAR. Mouse CLSP (mCLSP) was composed of 390 amino acids, including three Ig domains, and showed strong homology to the IgV domain of CAR. Interestingly, mCLSP lacks a transmembrane domain, indicating that this is a soluble protein. mCLSP mRNA was detected primarily in the brain and ovary. When mCLSP cDNA was introduced into SK HEP-1 cells, which were known to be CAR positive and easily infected with Ad vector, the infection with Ad vector was severely inhibited. On the other hand, mCLSP promoted the infection with Ad vector in CAR-negative NIH3T3 cells. Furthermore, recombinant CLSP directly bound to Ad and inhibited the Ad vector-mediated transduction in SK HEP-1 cells. Computational analysis for a genome database showed that the CLSP gene is rodent-specific, and that human and bovine lack this gene. These results suggest that CLSP may play a role in the antiviral defense of the host in rodent animals.

[Changes in shape and size of the foot during pregnancy]

Many women report an increase in foot size during their pregnancy. Our objective was to verify this anecdotal evidence. In an initial survey of 21 mothers in 2 Münster nursery schools we found a tendency towards an increase in foot size during pregnancy. We therefore developed a measuring system to measure changes in foot length, width, height and volume. A total of 40 women recruited from the antenatal clinic of the University Hospital of Münster and a participating practice were seen three times during their pregnancy. The results were analysed using the Wilcoxon test. We found a statistically significant increase in foot length, width and volume, whereas foot height decreased slightly. This difference was, however, not significant. Especially in diabetic women with polyneuropathy it is important to pay attention to shoe size to prevent pressure sores.

[The influence of proprioceptive insoles (Bourdiol) on the sagittal curvature and inclination of the trunk]

Proprioceptive insoles rely on the concept of Réné-Jaques Bourdiol, a French neurologist. The aim is to modulate plantar surface sensibility and to influence posture and statics of patients: it is hypothesized that the effect of modified afferent sensory input through proprioceptive stimulation of terminal muscle chains will have either a relaxing or stimulating effect on the whole body, which may be realized by affecting the posture. Small pads with a thickness of typically 1-3 mm are embedded into the insole to provide a specific stimulation. In fitting the insoles selectively to the individual patient the effect of the insoles on the trunk posture is taken as a feedback. This study investigates the influence of proprioceptive insoles on the sagittal curve in 20 selected patients. The protocol used a repeated measures research design. The measures of the sagittal curve were obtained using raster stereography. The four different conditions were: (1) barefoot, (2) convenient shoes without the insoles, (3) the same shoes with a placebo insole, and (4) the same shoes with neurological insoles. Evaluation of raster stereographs provided the kyphotic angle between T4 and T12 and lordotic angle between T12 and S1. Statistical evaluation was performed with the t-test for paired measurements. No significant differences were found in the sagittal profile. Only trunk inclination in normal posture was found to yield a significant difference (0.38 degrees) between placebo and neurological insoles. However, no clear statement on the efficiency of neurological insoles can be made.

Perivascular axillary brachial plexus block and patient positioning: the influence of a lateral, head-down position

The aim of this study was to examine the effect of a 20 degrees Trendelenburg position on the blockade of nerves that exit the brachial plexus proximally in patients undergoing single-injection axillary brachial plexus block. After a pilot study of eight cadavers suggested that a head-down and lateral position would encourage the proximal spread of local anaesthetic, 72 patients undergoing elective surgery were divided into two equal groups: a Supine group and a Modified Position group (lateral position, 20 degrees head-down tilt). Patients were left in the allocated position for 30 min after an axillary block had been performed with alkalinised mepivacaine 1% 49.5 ml. Sensory and motor blockade evaluation showed that there was a significantly higher proportion of axillary nerve (76% vs. 0%, p < 0.001), thoracodorsal nerve (86% vs. 0%, p < 0.001) and subscapular nerve (89% vs. 0%, p < 0.001) blockade in the Modified Position group. Sensory block of the radial nerve was also improved by the modified position (100% vs. 86%, p < 0.05).

Langfristiger Einfluss der anatomisch angepassten spongiösen Endoprothese auf den periprothetischen Knochen

INTRODUCTION

The anatomically shaped, cementless total hip replacement (THR) (S and G, ESKA Lübeck) has a fully porous coating for secondary osseointegration. The aim of the present study was to analyse the long-term effect of the prosthesis on periprosthetic bone remodelling.

METHODS

137 THR in 117 patients were analysed clinically and radiographically 12.8 years (10-14.9 years) postoperatively. The average age at the last follow-up was 71.8 years (range: 34-87 years). Osteodensitometric DEXA measurements of the periprosthetic bone in comparison to the contralateral non-operated femora were performed.

RESULTS

Cumulative survival rates of all implanted THR (n = 231) at 14.9 years were 86.2 % (+/-5.3 %) for the fully porous coated stem and 90.1 % (+/- 8 %) for the cup. Five stem fractures (3.6 %) at the middle part were recorded. The Harris hip score of the non-revised THR at the last follow-up averaged 88.3 (34-100) points. Bony atrophy in the proximal periprosthetic femora in Gruen zones I (16.8 %) and VII (34.6 %) confirmed a proximal stress-shielding. Osteodensitometric analyses demonstrated in comparison to the contralateral femora (BMD 1.3 g/cm (2)) a significantly reduced bone density at the calcar femoris (BMD 0.9 g/cm (2)) (p < 0.001).

CONCLUSION

The original goal of a physiological load transfer has not been realised with this fully porous, cementless THR. The anatomic S & G stem will mainly be osseointegrated by distal load transfer.

Crown development in a pioneer tree, Rhus trichocarpa, in relation to the structure and growth of individual branches

Based on an allometric reconstruction, the structure and biomass-allocation patterns of branches and current-year shoots were investigated in branches of various heights in the pioneer tree Rhus trichocarpa, to evaluate how crown development is achieved and limited in association with height. Path analysis was conducted to explore the effects of light availability, basal height and size of individual branches on branch structure and growth. Branch angle was affected by basal height, whereas branch mass was influenced primarily by light availability. This result suggests that branch structure is strongly constrained by basal height, and that trees mediate such constraints under different light environments. Previous-year leaf area and light availability showed positive effects on current-year stem mass. In contrast, branch basal height and mass negatively affected current-year stem mass. Moreover, the length of stems of a given diameter decreased with increasing branch height. Therefore the cost of biomass investment for a unit growth in length is greater for branches of larger size and at upper positions. Vertical growth rate in length decreased with increasing height. Height-dependent changes in stem allometry and angle influenced the reduction in vertical growth rate to a similar degree.

Branching, biomass distribution, and light capture efficiency in a pioneer tree, Rhus trichocarpa, in a secondary forest

Crown architecture and biomass distribution patterns were investigated in relation to branching and tree size in a pioneer species, Rhus trichocarpa Miq. (Anacardiaceae), in a Japanese secondary forest. Crown architecture changed with tree size and with branching. Crown depth and area were greater in taller trees. In addition, branched trees had crowns of greater depth, and crown area increased more rapidly with increasing height in branched trees as compared with unbranched trees. In contrast, biomass distribution to nonphotosynthetic and photosynthetic organs changed only with tree size and was similar in unbranched and branched trees of similar size. Light capture efficiency was related to neither height nor branching status for trees with heights of 1–2.5 m. Coexistence of unbranched and branched trees at the height around the onset of branching is possible because these trees realize similar biomass distribution patterns and light capture efficiencies. Individual leaf area and leaf area index increased with tree size in unbranched trees but decreased with tree size in branched trees. These results suggest that several leaf clusters of limited size are sparsely arranged in a large three-dimensional space in tall trees.