Summary Osteoarthritis is a major source of pain, disability, and socioeconomic cost worldwide. The epidemiology of the disorder is complex and multifactorial, with genetic, biological, and ...biomechanical components. Aetiological factors are also joint specific. Joint replacement is an effective treatment for symptomatic end-stage disease, although functional outcomes can be poor and the lifespan of prostheses is limited. Consequently, the focus is shifting to disease prevention and the treatment of early osteoarthritis. This task is challenging since conventional imaging techniques can detect only quite advanced disease and the relation between pain and structural degeneration is not close. Nevertheless, advances in both imaging and biochemical markers offer potential for diagnosis and as outcome measures for new treatments. Joint-preserving interventions under development include lifestyle modification and pharmaceutical and surgical modalities. Some show potential, but at present few have proven ability to arrest or delay disease progression.
Enhancing water provision services is a common target in forest restoration projects worldwide due to growing concerns over freshwater scarcity. However, whether or not forest cover expansion or ...restoration can improve water provision services is still unclear and highly disputed.
The goal of this review is to provide a balanced and impartial assessment of the impacts of forest restoration and forest cover expansion on water yields as informed by the scientific literature. Potential sources of bias on the results of papers published are also examined.
English, Spanish and Portuguese peer-review articles in Agricola, CAB Abstracts, ISI Web of Science, JSTOR, Google Scholar, and SciELO. Databases were searched through 2015.
Intervention terms included forest restoration, regeneration/regrowth, forest second-growth, forestation/afforestation, and forestry. Target terms included water yield/quantity, streamflow, discharge, channel runoff, and annual flow.
Articles were pre-selected based on key words in the title, abstract or text. Eligible articles addressed relevant interventions and targets and included quantitative information.
Most studies reported decreases in water yields following the intervention, while other hydrological benefits have been observed. However, relatively few studies focused specifically on forest restoration, especially with native species, and/or on projects done at large spatial or temporal scales. Information is especially limited for the humid tropics and subtropics.
While most studies reported a decrease in water yields, meta-analyses from a sub-set of studies suggest the potential influence of temporal and/or spatial scales on the outcomes of forest cover expansion or restoration projects. Given the many other benefits of forest restoration, improving our understanding of when and why forest restoration can lead to recovery of water yields is crucial to help improve positive outcomes and prevent unintended consequences. Our study identifies the critical types of studies and associated measurements needed.
River restoration is an increasingly common approach utilized to reverse past degradation of freshwater ecosystems and to mitigate the anticipated damage to freshwaters from future development and ...resource-extraction activities. While the practice of river restoration has grown exponentially over the last several decades, there has been little empirical evaluation of whether restoration projects individually or cumulatively achieve the legally mandated goals of improving the structure and function of streams and rivers. New efforts to evaluate river restoration projects that use channel reconfiguration as a methodology for improving stream ecosystem structure and function are finding little evidence for measurable ecological improvement. While designed channels may have less-incised banks and greater sinuousity than the degraded streams they replace, these reach-scale efforts do not appear to be effectively mitigating the physical, hydrological, or chemical alterations that are responsible for the loss of sensitive taxa and the declines in water quality that typically motivate restoration efforts. Here we briefly summarize this new literature, including the collection of papers within this Invited Feature, and provide our perspective on the limitations of current restoration.
Ecological restoration has grown rapidly and now encompasses not only classic ecological theory but also utilitarian concerns, such as preparedness for climate change and provisioning of ecosystem ...services. Three dominant perspectives compete to influence the science and practice of river restoration. A strong focus on channel morphology has led to approaches that involve major Earth-moving activities, such as channel reconfiguration with the unmet assumption that ecological recovery will follow. Functional perspectives of river restoration aim to regain the full suite of biogeochemical, ecological, and hydrogeomorphic processes that make up a healthy river, and though there is well-accepted theory to support this, research on methods to implement and assess functional restoration projects is in its infancy. A plethora of new studies worldwide provide data on why and how rivers are being restored as well as the project outcomes. Measurable improvements postrestoration vary by restoration method and measure of outcome.
Summary
A state-transition microsimulation model was used to project the substantial economic burden to the Chinese healthcare system of osteoporosis-related fractures. Annual number and costs of ...osteoporosis-related fractures were estimated to double by 2035 and will increase to 5.99 (95 % CI 5.44, 6.55) million fractures costing $25.43 (95 % CI 23.92, 26.95) billion by 2050. Consequently, cost-effective intervention policies must urgently be identified in an attempt to minimize the impact of fractures.
Introduction
The aim of the study was to project the osteoporosis-related fractures and costs for the Chinese population aged ≥50 years from 2010 to 2050.
Methods
A state-transition microsimulation model was used to simulate the annual incident fractures and costs. The simulation was performed with a 1-year cycle length and from the Chinese healthcare system perspective. Incident fractures and annual costs were estimated from 100 unique patient populations for year 2010, by multiplying the age- and sex-specific annual fracture risks and costs of fracture by the corresponding population totals in each of the 100 categories. Projections for 2011–2050 were performed by multiplying the 2010 risks and costs of fracture by the respective annual population estimates. Costs were presented in 2013 US dollars.
Results
Approximately 2.33 (95 % CI 2.08, 2.58) million osteoporotic fractures were estimated to occur in 2010, costing $9.45 (95 % CI 8.78, 10.11) billion. Females sustained approximately three times more fractures than males, accounting for 76 % of the total costs from 1.85 (95 % CI 1.68, 2.01) million fractures. The annual number and costs of osteoporosis-related fractures were estimated to double by 2035 and will increase to 5.99 (95 % CI 5.44, 6.55) million fractures costing $25.43 (95 % CI 23.92, 26.95) billion by 2050.
Conclusions
Our study demonstrated that osteoporosis-related fractures cause a substantial economic burden which will markedly increase over the coming decades. Consequently, healthcare resource planning must consider these increasing costs, and cost-effective screening and intervention policies must urgently be identified in an attempt to minimize the impact of fractures on the health of the burgeoning population as well as the healthcare budget.
Background
Reducing operative blood loss improves patient outcomes and reduces healthcare costs. The aim of this article was to review current surgical, anaesthetic and haemostatic intraoperative ...blood conservation strategies.
Methods
This narrative review was based on a literature search of relevant databases up to 31 July 2019 for publications relevant to reducing blood loss in the surgical patient.
Results
Interventions can begin early in the preoperative phase through identification of patients at high risk of bleeding. Directly acting anticoagulants can be stopped 48 h before most surgery in the presence of normal renal function. Aspirin can be continued for most procedures. Intraoperative cell salvage is recommended when anticipated blood loss is greater than 500 ml and this can be continued after surgery in certain situations. Tranexamic acid is safe, cheap and effective, and routine administration is recommended when anticipated blood loss is high. However, the optimal dose, timing and route of administration remain unclear. The use of topical agents, tourniquet and drains remains at the discretion of the surgeon. Anaesthetic techniques include correct patient positioning, avoidance of hypothermia and regional anaesthesia. Permissive hypotension may be beneficial in selected patients. Promising haemostatic strategies include use of pharmacological agents such as desmopressin, prothrombin complex concentrate and fibrinogen concentrate, and use of viscoelastic haemostatic assays.
Conclusion
Reducing perioperative blood loss requires a multimodal and multidisciplinary approach. Although high‐quality evidence exists in certain areas, the overall evidence base for reducing intraoperative blood loss remains limited.
Antecedentes
La reducción de la pérdida hemática operatoria mejora los resultados y reduce los costes sanitarios. El objetivo de este artículo es revisar las estrategias actuales intraoperatorias quirúrgicas, anestésicas y hemostáticas de ahorro de sangre.
Métodos
Revisión descriptiva basada en publicaciones destacadas que analizaban la forma de reducir la pérdida de sangre en el paciente quirúrgico, seleccionadas a partir de una búsqueda bibliográfica en bases de datos relevantes hasta el 31 de julio de 2019.
Resultados
Las intervenciones se pueden iniciar precozmente en el período preoperatorio a través de la identificación de pacientes con elevado riesgo de hemorragia. Se pueden suspender los anticoagulantes de acción directa 48 horas antes de la mayoría de las operaciones quirúrgicas si la función renal es normal. Se puede continuar la administración de aspirina en la mayoría de las intervenciones. En el período intraoperatorio, se recomienda el uso de rescate celular cuando la pérdida de sangre prevista es superior a 500 ml y este método se puede continuar después de la operación en determinadas situaciones. La administración de ácido tranexámico es segura, barata y eficaz y se recomienda de forma rutinaria cuando la pérdida hemática prevista es alta. Sin embargo, la dosis óptima, el momento y la vía de administración no están bien establecidos. El uso de agentes tópicos, torniquetes y drenajes queda a discreción del cirujano. Las técnicas anestésicas incluyen la correcta posición del paciente, así como evitar la hipotermia y la anestesia regional. La hipotensión controlada puede ser beneficiosa en casos seleccionados. Las estrategias hemostáticas innovadoras incluyen agentes farmacológicos como la desmopresina, los concentrados del complejo de protrombina y concentrados de fibrinógeno, y el uso de hemostáticos viscoelásticos, pero se requiere disponer de evidencia sobre su beneficio.
Conclusión
La reducción de la pérdida hemática perioperatoria requiere un enfoque multimodal y multidisciplinario. Aunque existe evidencia de alta calidad en ciertas áreas, la evidencia general para reducir la pérdida hemática intraoperatoria sigue siendo limitada.
Reducing perioperative blood loss is a key component of patient blood management. Multimodal surgical, anaesthetic and haemostatic interventions are available, and implementation requires a multidisciplinary approach.
Things that work to reduce bleeding
Hagfish depart so much from other fishes anatomically that they were sometimes considered not fully vertebrate. They may represent: (i) an anatomically primitive outgroup of vertebrates (the ...morphology-based craniate hypothesis); or (ii) an anatomically degenerate vertebrate lineage sister to lampreys (the molecular-based cyclostome hypothesis). This systematic conundrum has become a prominent case of conflict between morphology- and molecular-based phylogenies. To date, the fossil record has offered few insights to this long-branch problem or the evolutionary history of hagfish in general, because unequivocal fossil members of the group are unknown. Here, we report an unequivocal fossil hagfish from the early Late Cretaceous of Lebanon. The soft tissue anatomy includes key attributes of living hagfish: cartilages of barbels, postcranial position of branchial apparatus, and chemical traces of slime glands. This indicates that the suite of characters unique to living hagfish appeared well before Cretaceous times. This new hagfish prompted a reevaluation of morphological characters for interrelationships among jawless vertebrates. By addressing nonindependence of characters, our phylogenetic analyses recovered hagfish and lampreys in a clade of cyclostomes (congruent with the cyclostome hypothesis) using only morphological data. This new phylogeny places the fossil taxon within the hagfish crown group, and resolved other putative fossil cyclostomes to the stem of either hagfish or lamprey crown groups. These results potentially resolve the morphological–molecular conflict at the base of the Vertebrata. Thus, assessment of character nonindependence may help reconcile morphological and molecular inferences for other major discords in animal phylogeny.
Because of its simplicity, the binary-switch nature of left-right asymmetry permits meaningful comparisons among many different organisms. Phylogenetic analyses of asymmetry variation, inheritance, ...and molecular mechanisms reveal unexpected insights into how development evolves. First, directional asymmetry, an evolutionary novelty, arose from nonheritable origins almost as often as from mutations, implying that genetic assimilation ("phenotype precedes genotype") is a common mode of evolution. Second, the molecular pathway directing hearts leftward-the nodal cascade-varies considerably among vertebrates (homology of form does not require homology of development) and was possibly co-opted from a preexisting asymmetrical chordate organ system. Finally, declining frequencies of spontaneous asymmetry reversal throughout vertebrate evolution suggest that heart development has become more canalized.
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