Climate change has affected the geographical distributions of most species worldwide; in particular, insects of economic importance inhabiting tropical regions have been impacted. Current and future ...predictions of change in geographic distribution are frequently included in species distribution models (SDMs). The potential spatial distributions of the fruit fly Anastrepha striata Schiner, the main species of agricultural importance in guava crops, under current and possible future scenarios in Colombia were modeled, and the establishment risk was assessed for each guava-producing municipality in the country. SDMs were developed using 221 geographical records in conjunction with nine scenopoetic variables. The model for current climate conditions indicated an extensive suitable area for the establishment of A. striata in the Andean region, smaller areas in the Caribbean and Pacific, and almost no areas in the Orinoquia and Amazonian regions. A brief discussion regarding the area's suitability for the fly is offered. According to the results, altitude is one of the main factors that direct the distribution of A. striata in the tropics. The Colombian guava-producing municipalities were classified according to the degree of vulnerability to fly establishment as follows: 42 were high risk, 16 were intermediate risk, and 17 were low risk. The implementation of future integrated management plans must include optimal spatial data and must consider environmental aspects, such as those suggested by the models presented here. Control decisions should aim to mitigate the positive relationship between global warming and the increase in the dispersal area of the fruit fly.
The simulation of root water uptake in land surface models is affected by large uncertainties. The difficulty in mapping soil depth and in describing the capacity of plants to develop a rooting ...system is a major obstacle to the simulation of the terrestrial water cycle and to the representation of the impacts of drought. In this study, long time series of agricultural statistics are used to evaluate and constrain root water uptake models. The inter-annual variability of cereal grain yield and permanent grassland dry matter yield is simulated over France by the Interactions between Soil, Biosphere and Atmosphere, CO2-reactive (ISBA-A-gs) generic land surface model (LSM). The two soil profile schemes available in the model are used to simulate the above-ground biomass (Bag) of cereals and grasslands: a two-layer force-restore (FR-2L) bulk reservoir model and a multi-layer diffusion (DIF) model. The DIF model is implemented with or without deep soil layers below the root zone. The evaluation of the various root water uptake models is achieved by using the French agricultural statistics of Agreste over the 1994-2010 period at 45 cropland and 48 grassland departements, for a range of rooting depths. The number of departements where the simulated annual maximum Bag presents a significant correlation with the yield observations is used as a metric to benchmark the root water uptake models. Significant correlations (p value < 0.01) are found for up to 29 and 77% of the departements for cereals and grasslands, respectively. A rather neutral impact of the most refined versions of the model is found with respect to the simplified soil hydrology scheme. This shows that efforts should be made in future studies to reduce other sources of uncertainty, e.g. by using a more detailed soil and root density profile description together with satellite vegetation products. It is found that modelling additional subroot-zone base flow soil layers does not improve (and may even degrade) the representation of the inter-annual variability of the vegetation above-ground biomass. These results are particularly robust for grasslands, as calibrated simulations are able to represent the extreme 2003 and 2007 years corresponding to unfavourable and favourable fodder production, respectively.
A practical two-step quantitative clinical and electrophysiological assessment for the diagnosis and staging of diabetic neuropathy.
E L Feldman ,
M J Stevens ,
P K Thomas ,
M B Brown ,
N Canal and
D ...A Greene
Department of Neurology, University of Michigan, Ann Arbor 48109-0588.
Abstract
OBJECTIVE--Early diagnosis of distal symmetric sensorimotor polyneuropathy, a common complication of diabetes, may decrease
patient morbidity by allowing for potential therapeutic interventions. We have designed an outpatient program to facilitate
diagnosis of diabetic neuropathy. RESEARCH DESIGN AND METHODS--Patients are initially administered a brief questionnaire and
screening examination, designated the Michigan Neuropathy Screening Instrument (MNSI). Diabetic neuropathy is confirmed in
patients with a positive assessment by a quantitative neurological examination coupled with nerve conduction studies, designated
the Michigan Diabetic Neuropathy Score (MDNS). In this study, 56 outpatients with confirmed type I or II diabetes were administered
the standardized quantitative components required to diagnose and stage diabetic neuropathy according to the San Antonio Consensus
Statement (1) and the Mayo Clinic protocol (2). These same patients were then assessed with the MNSI and the MDNS. RESULTS--Of
29 patients with a clinical MNSI score > 2, 28 had neuropathy. Twenty-eight patients with an MDNS of > or = 7 had neuropathy,
while 21 non-neuropathic patients had a score < or = 6. Of 35 patients with diabetic neuropathy, 34 had > or = 2 abnormal
nerve conductions. Twenty-one normal patients and one patient with neuropathy had < or = 1 abnormal nerve conduction. CONCLUSIONS--The
results indicate that the MNSI is a good screening tool for diabetic neuropathy and that the MDNS coupled with nerve conductions
provides a simple means to confirm this diagnosis.
Objectives: Hepatitis C virus (HCV) infection is often associated with cryoglobulinaemia (CG). Peripheral neuropathy (PN) is a comparatively common complication of CG associated with HCV infection ...and it is thought to be attributable to nerve ischaemia. Only few HCV CG patients with PN have been reported. The recent finding of HCV RNA in nerve biopsy specimens has suggested a possible direct role of HCV in the pathogenesis of PN. The authors studied 51 HCV patients to determine the prevalence of CG and to clarify the possible mechanism by which HCV determines the PN. Methods: All the patients were studied clinically, by laboratory tests and electrophysiologically. Twenty eight patients underwent sural nerve biopsy where both morphological and morphometric evaluation of the biopsy specimen was performed, as well as statistical analysis. Results: CG was found in 40 of 51 cases (78%). Polyneuropathy was significantly prevalent in CG+ patients compared with CG− (18 of 40 compared with 1 of 11 patients; p=0.01). HCV CG− patients more frequently developed well defined mononeuropathy or multiple neuropathy when compared with HCV CG+ (10 of 11 compared with 22 of 40; p<0.03). HCV CG+ patients showed significantly higher proportion of rheumatoid factor positivity (p<0.001) and low C4 levels (p=0.001). Nerve biopsy was performed in 25 of 40 HCV CG+ patients and in 3 of 11 HCV CG− patients: epineurial vasculitis was present in 8 of 25 HCV CG+ (32%) and in 2 of 3 HCV CG−. Differential fascicular loss of axons was found in 10 of 25 CG+ (40%) and 1 of 3 CG−, signs of both demyelination and axonal degeneration were present in 7 of 25 CG+ (28%). No significant difference was found in neuropathological features, while histometrical analysis disclosed more severe involvement in CG+ patients. Conclusions: These findings suggest that the presence of CG is a negative predictive factor for the associated PN. Morphological findings in the sural nerve from HCV CG− and CG+ are consistent with an ischaemic mechanism of nerve damage and are against a direct role of the virus in causing the associated PN.
Purpose
To report healthcare resource use and associated costs in controlled versus uncontrolled carcinoid syndrome (CS) in patients with neuroendocrine tumours.
Methods
A cross-sectional, ...non-interventional multicentre study was conducted with retrospective data analysis. Resource use was compared between two patient groups: those with controlled CS (> 12 months with no uncontrolled CS episodes) and uncontrolled CS (< 12 months since last uncontrolled episode). Patients were matched for age, sex, and origin and grade of tumour. When no matching patients were available, data from deceased patients were used. Information on healthcare resource use came from review of medical records, patient history and physician reports. Working capacity was assessed using the Work Productivity and Activity Impairment General Health questionnaire.
Results
Twenty-six university hospitals in Spain participated, between July 2017 and April 2018. 137 patients were enrolled; 104 were analysed (2 groups of 52). Patients with uncontrolled CS had 10 times more emergency department (ED) visits (mean 1.0 vs 0.10 visits;
P
= 0.0167), were more likely to have a hospital admission (40.4% vs 19.2%;
P
= 0.0116) and had longer hospital stays (mean 7.87 vs 2.10 days;
P
= 0.0178) than those with controlled CS. This corresponded to higher annual hospitalisation costs (mean €5511.59 vs €1457.22;
P
= 0.028) and ED costs (€161.25 vs €14.85;
P
= 0.0236). The mean annual total healthcare costs were 60.0% higher in patients with uncontrolled than controlled CS (
P
= NS).
Conclusion
This study quantifies higher health resource use, and higher hospitalisation and ED costs in patients with uncontrolled CS. Better control of CS may result 3in lower medical costs.
The aim of the present study was to apply diffusion tensor MRI (DT-MRI), a quantitative MRI measure which reflects tissue organization, to dementia with Lewy bodies (DLB). DT-MRI scans were obtained ...from 15 patients with probable DLB and 10 sex- and age-matched healthy controls. Abnormalities were found in the corpus callosum, pericallosal areas and the frontal, parietal, occipital and, less prominently, temporal white matter of patients compared with controls. Abnormalities were also found in the caudate nucleus and the putamen. The average grey matter volume was lower in patients than in controls. These findings of concomitant grey matter atrophy and white matter abnormalities (as detected by DT-MRI) in regions with a high prevalence of long connecting fibre tracts might suggest the presence of neurodegeneration involving associative cortices. The modest involvement of the temporal lobe fits with the relative preservation of global neuropsychological measures and memory tasks in the early stage of DLB. The selective involvement of parietal, frontal and occipital lobes might explain some of the clinical and neuropsychological features of DLB, providing a possible distinctive marker for this disease. The abnormalities found in the subcortical grey matter may indicate that DLB and Parkinson's disease share a similar nigrostriatal involvement caused by common pathophysiological mechanisms.
Article abstract-We attempted to define the role of subtle changes in the normal-appearing white matter (NAWM) in the development of disability in multiple sclerosis (MS). Twenty-seven clinically ...definite MS patients with either relapsing-remitting or chronic-progressive courses and 10 sex- and age-matched controls entered the study. For each patient and control, we studied two NAWM areas in the frontal lobe with magnetization transfer imaging (MTI). For patients, we also calculated the MT ratios (MTRs) for three contiguous areas of NAWM progressively further from "isolated" lesions visible on conventional MRI. Frontal NAWM in MS patients had lower mean MTRs than the frontal white matter of the controls (p = 0.02). MTRs in the NAWM adjacent to isolated lesions increased with distance from them to the cortical gray matter (p = 0.04). This pattern was typical for patients with chronic-progressive MS whose MTRs in the first two regions of NAWM adjacent to lesions were lower than those of the same regions of patients with relapsing-remitting MS. This study confirms that there are alterations in the NAWM of MS patients and suggests that such changes might be relevant to the disability in MS.
NEUROLOGY 1995;45478-482
Anastrepha entodonta n. sp. and Anastrepha hadropickeli n. sp. are described and illustrated. The new species belong to the spatulata group. Both species occur sympatrically with Anastrepha pickeli ...Lima in the semiarid region of the state of Minas Gerais, Brazil. Anastrepha hadropickeli occurs also in the semiarid of the state of Rio Grande do Norte, Brazil, where it was misidentified as A. pickeli.
Two brothers had late-onset progressive ataxia, cerebellar atrophy, and hypergonadotropic hypogonadism associated with coenzyme Q10 (CoQ10) deficiency in skeletal muscle. Both patients improved on ...high-dose CoQ10 supplementation, stressing the importance of CoQ10 deficiency in the differential diagnosis of cerebellar ataxia, even when onset is late.
Background. Migraine attacks are often treated with simple analgesics or with ergotamme-containing preparations alone or in combination with anti-emetics. Although also sometimes used to treat ...migraine, nonsteroidal anti-inflammatory drugs (NSAIDs) have not been systematically evaluated in controlled clinical trials, particularly in comparison with the newer drug sumatriptan. Sumatriptan is a specific migraine treatment which has recently become among the most widely prescribed acute migraine therapies. However, while effective, it has low oral bioavailability and some problematic adverse effects. Diclofenac-potassium is a potent NSAID available as a fast-acting oral tablet, which has been shown to be safe and effective in several other acute pain indications. In the clinical trial reported here, the efficacy and safety of diclofenac-potassium in the acute treatment of migraine attacks has been tested in comparison with oral sumatriptan and placebo.
Methods. Single oral doses of 50 mg and 100 mg diclofenac-potassium were compared to a single oral dose of 100 mg sumatriptan and placebo in a double-blind randomized crossover trial in 156 adult patients suffering from migraine attacks, with or without aura, selected according to the International Headache Society diagnostic criteria. The primary efficacy criterion was migraine headache pain recorded on a visual analog scale at 2 h after dosing. Secondary endpoints included pain at other time points up to 8 h and the presence of accompanying symptoms (nausea, vomiting, photophobia, phonophobia).
Findings. Diclofenac-potassium was more effective than placebo in reducing migraine headache pain at 2 h after dosing, which was the primary endpoint. Secondary analyses showed that diclofenac-potassium provided significant pain relief from 60 min after dosing and for all remaining endpoints in the 8-h observation period. Both 50 and 100 mg doses of diclofenac-potassium were similarly effective. A similar effect was shown with sumatriptan; however, significant superiority to placebo was seen only from the 90-min time point. Diclofenac-potassium was generally superior to placebo or sumatriptan in reducing accompanying symptoms, particularly nausea. Diclofenac-potassium seemed to be as well tolerated as placebo, with fewer adverse events reported than after sumatriptan treatment and with more patients assessing the overall tolerability of diclofenac-potassium better than that of sumatriptan.
Interpretation. Compared with placebo and the reference therapy sumatriptan, diclofenac-potassium is an effective, fast-acting, and well-tolerated acute oral therapy for migraine attacks, with advantages over oral sumatriptan in terms of onset of analgesic effect, reduction of accompanying symptoms, and tolerability profile. It may therefore be useful as an alternative oral therapy for migraine attacks.
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