Early Group Research Articles

Acute Ischemic Stroke Brainwave Classification Using Relative Power Ratio Cluster Analysis

This study proposed the application of cluster analysis to classify the brainwaves of stroke level based on the Relative Power Ratio (RPR) techniques. RPR was performed to determine the brainwave characteristics due to group of stroke level. In this research, we determined seventy four stroke patients brainwave activity with open eyes (OE) session. Then group them into Advance Group (AG), Intermediate Group (IG) and Early Group (EG). Simultaneously, their Electroencephalogram (EEG) was recorded from which the EEG dataset will be calculated using the RPR formula. Beta, Alpha, Theta and Delta Power Spectrum Density (PSD) are used as input for RPR. The results show that by implementing RPR technique, the pattern of group stroke level, especially in the cognitive or thinking abilities can be clearly observed. Then cluster analysis using a factorial ANOVA (analysis of variance) design with factors Group will be deployed to cluster RPR towards the corresponding group of stroke level. It can be concluded that the AG are higher in the cluster 1 for RPR Beta (RPRB) while IG and EG were grouped together because they do not differ from each other in cluster 2. For RPR Alpha (RPRA), EG are higher in the cluster 2 while AG and IG were grouped together in cluster 1. AG was found in both clusters for RPR Theta (RPRT) and AG are lower in cluster 1 for RPR Delta (RPRD). This indicates that the group stroke level can discriminate due to the brainwaves characteristics.

Feasibility and safety of intracorporeal esophagojejunostomy after laparoscopic total gastrectomy: Inverted T-shaped anastomosis using linear staplers

Although laparoscopic distal gastrectomy has been widely accepted in clinical practice, laparoscopic total gastrectomy (LTG) is not yet familiar because of the difficulty in esophagojejunostomy. The purpose of this study was to evaluate perioperative and short-term outcomes of our procedure of intracorporeal gastrojejunostomy using linear staplers after LTG. Of 98 consecutive patients who underwent LTG for gastric cancer in our department between August 2002 and December 2010, 94 patients underwent esophagojejunostomy with a linear stapling device. After October 2007, we modified the esophagojejunostomy; ie, the most recent 57 patients underwent transection of the esophagus in the ventrodorsal direction and insertion of a linear stapler from the anterior wall of the Roux limb to the posterior wall so as to make an inverted T-shaped anastomosis. We evaluated the results in these 57 patients (recent group) and compared them with the results in the earlier 37 patients (early group). The mean operative time in the recent group was 368 to 94.6 min, and the mean estimated blood loss was 57 to 33 g; both were comparable with those in the early group. Neither open conversion nor intraoperative complications were encountered. Two patients experienced anastomotic leakage in the earlier group, but anastomotic leakage did not occur in the recent group. No mortality was encountered. We herein report our procedure of intracorporeal gastrojejunostomy using linear staplers after LTG. Our procedure of esophagojejunostomy using linear staplers is safe and feasible and has acceptable morbidity.

Rising Incidence of Small Size Papillary Thyroid Cancers with No Change in Disease-Specific Survival in Finnish Thyroid Cancer Patients

The aim of this study was to investigate trends in the incidence, diagnostics, treatment and survival of thyroid cancer in Tampere University Hospital (TAUH) region in recent decades. New thyroid cancer cases from 1981 to 2002 were ascertained from the Finnish Cancer Registry. Follow-up data was collected from medical records of TAUH. Differentiated thyroid cancer (DTC; consisting of papillary thyroid cancer (PTC) and follicular thyroid cancer (FTC)) patients' data was analyzed and divided into two equal time periods (1981-1991 and 1992-2002). The total amount of thyroid cancer cases was 553, of which 427 (77%) were papillary and 72 (13%) follicular. Thyroid cancer was four times more common in females than in males and the median age at the time of diagnosis was 52 years. The incidence of DTC was 4.5/100,000 in the earlier group and 6.0/100,000 in the later group (IRR 1.33, CI 1.11-1.60). The proportion of papillary thyroid cancer rose from 81% to 89% (p=0.02) in two study periods. Median tumour size became smaller, from 25 mm to 15 mm (p<0.001). Surgery became more radical as total thyroidectomies were performed almost exclusively on the later group (p<0.001). Median cumulative dose of radioiodine (I131) therapy was higher in the later group (p=0.04). There was no difference in number of cancer recurrences (p=0.54). The prognosis of DTC was good; 10-year disease-specific survival was 92% in the earlier group and 94% in the later group (p=0.43). The incidence of thyroid cancer has risen and proportion of papillary cancer has increased, however, median size of tumour has decreased. No difference was seen in either all-cause or disease-specific survival.

Using quality indicators to monitor changes in adherence to clinical practice guidelines for treatment of ductal carcinoma in situ (DCIS) of the breast.

246 Background: Evaluation of the management of DCIS poses challenges, as standard breast cancer outcome measures such as mortality do not apply. Therefore, quality indicators (QIs) were previously developed through an interprovincial, multidisciplinary Delphi process to assess the quality of DCIS treatment and adherence to clinical practice guidelines. Population based treatment of DCIS was then compared over time using these QIs. Methods: Patients diagnosed with DCIS from 2000 to 2001 and 2009 to 2011 were identified on a population basis from the Alberta Cancer Registry and a province-wide prospectively collected synoptic medical report (WebSMR) in Alberta, Canada. Patient charts were reviewed retrospectively and QIs abstracted. Results: A total of 620 patients were identified in the study periods. Results are summarized in the table. In comparison to the earlier group, the recent cohort showed significant improvement in radiation oncology referral, radiation post lumpectomy, and complete pathology reporting. Axillary staging significantly increased from 20% (axillary dissection in 2000 to 2001) to 73% (sentinel node biopsy 2009 to 2011). Other QIs did not differ significantly. Conclusions: Adherence to clinical practice guidelines for DCIS in Alberta measured using developed QIs have shown significant improvements, particularly in pathology reporting, referral to radiation oncologists and uptake of radiation therapy for patients treated with breast conserving surgery. Rates of sentinel node biopsy seem unacceptably high, which requires further investigation. [Table: see text]

Refinement in Patient Selection to Reduce Treatment-Related Mortality From Stem Cell Transplantation in Amyloidosis

AbstractAbstract ▪599▪This icon denotes a clinically relevant abstract Purpose:This study was undertaken to develop selection guidelines for transplant centers to determine eligibility for stem cell transplantation in patients with light chain amyloidosis. Patients and Methods:Patients with biopsy-confirmed immunoglobulin light chain amyloidosis who underwent stem cell transplantation between March 8, 1996, and December 31, 2011, were reviewed in 2 cohorts: those who underwent transplantation between March 8, 1996, and June 30, 2009, and those who underwent transplantation between July 1, 2009, and December 31, 2011 (table 1). A second comparison was undertaken among patients who died before posttransplant day 100 to determine features predictive of early death (table 2). Results:A total of 499 patients were identified, 410 in the earlier group and 89 in the later group. After July 1, 2009, significantly fewer transplant recipients had Mayo stage III cardiac involvement. Mortality before posttransplant day 100 was 10.5% (43/410) in the earlier group and 1.1% (1/89) in the later group. In the earlier group, one-quarter of transplant recipients with N-terminal pro-brain natriuretic peptide (NT-proBNP) levels higher than 5,000 pg/mL died by 10.3 months (fig 1, left). When the serum troponin T level was > 0.06 ng/mL, 25% died at 3.7 months (fig 2, right). Conclusion:The Mayo staging system is highly predictive for overall survival but not useful for selecting transplant recipients. Patients with serum troponin T levels higher than 0.06 ng/mL or NT-proBNP levels >5,000 pg/mL (not on dialysis) should not be considered acceptable candidates for stem cell transplantation because of unacceptable early mortality.Table 1Comparison of Patients Receiving Transplants Before and After July 1, 2009Characteristic ComparedTransplant Before 7/1/09 (n=410)Transplant After 7/1/09 (n=89)P ValueMayo stage, No. (%)a.02I104/281 (37)44/85 (52)II115/281 (41)31/85 (36)III62/281 (22)10/85 (12)Male, No. (%)245 (60)54 (61).78Heart involved, No. (%)208 (51)31 (35).006Kidney involved, No. (%)285 (70)61 (69).90Albumin, median (IQR), g/dL2.7 (1.9–3.3)2.6 (2.1–3.3).43Creatinine, median (IQR, mg/dL)1.8 (0.9–1.3)1.0 (0.8–1.2).002(10%>1.8)(10%>1.5)Marrow PC, median (IQR), %7 (3–13)8.5 (4–14).04Septal thickness, median (IQR), mm12 (10–14)11 (10–14).08EF, median (IQR), %65 (60–69)64 (61–67).31Age, median (IQR), y57.5 (51–63)58.4 (54–63).18Troponin T, median (IQR), ng/mL0.01 (0.01–0.03)0.01 (0.01–0.02).1iFLC, median (IQR), mg/dL15.5 (7.3–37.4)11.4 (5.8–29.8).05NT-proBNP, median (IQR), pg/mL662 (166–2,766)322 (125–1,100).02(10%>6,537)(10%>4,023)Table 2Survival (Before/After Posttransplant Day 100) in 410 Patients Who Received Transplants Before July 1, 2009Characteristic ComparedDied Before Day 100 (n=43)Survived After Day 100 (n=367)P ValueMayo stage, No. (%)a.002I4/28 (14)100/253 (40)II13/28 (46)102/253 (40)III11/28 (39)51/253 (20)Kidney involved, No. (%)33 (77)252 (69).30Heart involved, No. (%)32 (74)191 (52)<.001Albumin, median (IQR), g/dL2.3 (1.7–3.0)2.7 (2.0–3.3).02Creatinine, median (IQR), mg/dL1.2 (1.0–1.7)1.1 (0.9–1.3).001Marrow PC, median (IQR), %6 (4–12)7 (3–13).90Septal thickness, median (IQR), mm14 (12–16)12 (10–14)<.001EF, median (IQR), %66 (56–70)65 (60–69).97Age, median (IQR), y56 (49–65)57 (51–62).60Troponin T, median (IQR), ng/mL0.03 (0.01–0.08)0.01 (0.01–0.06)<.001(10%>0.125)(10%>0.05)iFLC, median (IQR), mg/dL21.3 (15–43.7)15.2 (6.4–36.5).004NT-proBNP, median (IQR), pg/mL2,752 (666–4,645)600 (170–1,969)<.001(10%>10,753)(10%>5,383) [Display omitted] [Display omitted] Disclosures:No relevant conflicts of interest to declare.

Refinement in patient selection to reduce treatment-related mortality from autologous stem cell transplantation in amyloidosis

This study sought to develop selection guidelines to determine the eligibility for SCT of patients with light-chain amyloidosis. Patients with biopsy-confirmed lightchain amyloidosis who underwent SCT between 8 March 1996 and 31 December 2011 were reviewed in two cohorts by date of transplantation: between 8 March 1996 and 30 June 2009 (n=410) and between 1 July 2009 and 31 December 2011 (n=89). Also evaluated were patients who died before post-transplant day 100 to determine the features predictive of early death. After 1 July 2009, fewer transplant recipients had Mayo stage III cardiac involvement. Mortality before post-transplant day 100 was 10.5% (43/410) in the earlier group and 1.1% (1/89) in the later group. In the earlier group, one-quarter of transplant recipients with N-terminal pro-brain natriuretic peptide (NT-proBNP) >5000 pg/mL died by 10.3 months. When serum troponin T was >0.06 ng/mL, 25% died at 3.7 months. The Mayo staging system is predictive for OS but not useful for selecting transplant recipients. Patients with serum troponin T >0.06 ng/mL or NT-proBNP >5000 pg/mL (not on dialysis) should not be considered candidates for SCT because of early mortality.

Syntactic Development in Japanese Hearing-Impaired Children

This study examined syntactic development of auditory comprehension of sentences in Japanese-speaking school-age children with and without hearing impairment. In total, 592 preschool and school-age children (421 normal-hearing and 171 hearing-impaired) were included in this cross-sectional observation study conducted using the Syntactic Processing Test for Aphasia for Japanese language users. Linear regression analysis was used to determine the estimated age at which each syntactic structure was acquired. Acquisition of syntactic structures was observed in hearing-impaired and normal-hearing children. Basic word order sentences of agent-object-verb and the goal benefactive construction were acquired at preschool age (earlier group), whereas reverse word order sentences of object-agent-verb, source benefactive construction, passive voice, and relative clauses were acquired at school age (later group). The results showed that many hearing-impaired children may not acquire Japanese grammatical structures until the age of 12 years. Adequate screening for language development for school-age hearing-impaired children is required for an effective intervention.

Oncologic and Functional Outcomes of Supraglottic Partial Laryngectomy: 18 Years Experience

Received February 20, 2012 Revised March 25, 2012 Accepted April 1, 2012 Address for correspondence Eun Chang Choi, MD, PhD Department of Otorhinolaryngology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea Tel +82-2-2228-3608 Fax +82-2-393-0580 E-mail eunchangmd@yuhs.ac Background and ObjectivesZZSupraglottic partial laryngectomy (SPL), which provides the removal of selected tumors involving the upper structure of the glottis, shows equivalent oncologic outcome when compared to total laryngectomy with functional preservation. We report our 18-year experience of applying supraglottic partial laryngectomy in the Yonsei Head and Neck Cancer Clinic. Subjects and MethodZZWe retrospectively reviewed the charts of 78 patients who underwent SPL. We divided the patients into two groups, the early and the recent, and performed Kaplan-Meier survival analysis and χ2-test on the groups. The post-operative functional outcome was assessed. ResultsZZThe 3-year-disease-specific survival rate of the early and recent period was 87% and 84.6%, respectively. Decannulation and tolerability of an oral diet was possible in 93% and 95% of the earlier group, and 95% and 98% in the recent group, respectively. There was no statistically significant difference in survival rate, recurrence pattern, decannulation and tolerability of oral diet between the two groups. ConclusionZZWe achieved a satisfactory survival rate through SPL. In addition, almost all patients could be decannulated and eventually tolerated an oral diet. Our results confirm that SPL is an oncologically & functionally sound procedure for selected supraglottic tumors. Korean J Otorhinolaryngol-Head Neck Surg 2012;55:295-300

The Younger Dryas and Late Pleistocene peoples of the Great Lakes region

The Late Pleistocene archaeological record of the Great Lakes drainage area shows that there were several, albeit spatially variable, changes in that record in a time period corresponding to the Younger Dryas (YD) climatic reversal at ca. 10,800–10,000 14C BP. Notable here are declines in some areas in the mobility of Paleoindian groups as measured by distance to the main lithic source employed, declines in the overall frequency of sites/findpots, particularly in the western Great Lakes where some northern areas seem to have been largely abandoned, and an increasing association of occupation locales with glacial lake shores or extensive wetlands left by recently drained glacial lakes. Some of the changes, as in range mobility, most likely relate to the colonization of new areas rather than directly to the YD. Specifically, the earliest groups were able to target rich, but widely dispersed, resource locales due to an absence of competing groups. However, the declines in locale frequencies and shifting distributions of those locales may be due to YD influence, notably to an eventual drying out of the area that resulted in less productive environments overall and made the lake shores and wetland areas more attractive environmental niches for human occupation.

Intracranial Dural Arteriovenous Shunts: Transarterial Glue Embolization—Experience in 115 Consecutive Patients

To evaluate the effectiveness and safety of transarterial glue embolization of intracranial dural arteriovenous shunts (DAVS). Institutional review board approval was obtained, with waiver of informed consent, for this retrospective study. From a single-center database of information on 371 intracranial DAVS, data in 115 consecutive patients treated with transarterial glue embolization were identified and assessed. Clinical and angiographic features, including cure rate, complications, and outcome, were evaluated. The treatment results were also compared between the patients in the first half of the consecutive series and those in the second half. The mean glue concentrations used were compared between the first and second halves of the patient series by using the Student t test. One hundred twenty-one lesions were treated with transarterial glue embolization. There were 31 (25.6%) Borden type I lesions, 39 (32.2%) Borden type II lesions, and 51 (42.1%) Borden type III lesions. Angiographic cure with glue embolization was achieved for 36 lesions (29.8%); 17 (14.0%) lesions were cured immediately, and 19 (15.7%) showed progressive thrombosis at follow-up. The angiographic cure rate for Borden type III lesions improved from 10% to 55% in the later group of patients as compared with the earlier group. The mean concentration of glue was significantly lower in the later group of patients. One (0.9%) of the 115 patients suffered permanent morbidity from aggravation of left extremity weakness due to venous thrombosis. Eight patients experienced nonpermanent morbidities, including transient worsening of neurologic status due to venous thrombosis (n = 4), alopecia (n = 2), scalp ulcer (n = 1), and pulmonary embolism (n = 1). Overall, improvement (n = 65) or stabilization (n = 32) of symptoms was seen in 84.3% of the patients. Transarterial glue embolization is a safe and effective method of primary treatment for intracranial DAVS, especially Borden type III lesions. Improvement of cure rates in the latter half of this study suggest that technical advances and experience may enhance outcomes.

The Rate of Development of Complicated Crohnʼs Disease (Penetrating or Stricturing) Increases with Calendar Decade of Diagnosis: Reality or Bias?

Purpose: The rate of development of complicated (penetrating or stricturing) Crohn's disease (CD) may be influenced by patient characteristics but also bias of patient selection or inaccurate classification in historical cohort studies. We determined if calendar decade of diagnosis influenced rate of development of complicated disease. Methods: 207 patients with non-stricturing non-penetrating CD were followed from diagnosis to development of complications or last clinic follow-up. The influences of decade of diagnosis and patient specific characteristics including Montreal classification and medication use on the rate of development of complicated disease in a historical cohort were determined. Results: Duration of disease was far longer in patients diagnosed before 1990 compared to after 1990 (24.6 vs. 6.8 years; p<0.001). The proportion diagnosed before age 40 was lower (30 vs. 48%, p=0.02) and surgery rates higher (68 vs. 30%; p<0.001) in the earlier diagnosis group. Immunomodulator use was equal in both groups (34%) yet time to first immunomodulator prescription was significantly longer in the earlier group (17.6 vs. 3.5 yrs; p<0.001). Kaplan Meier analysis was performed to study the rate of development of complications by decade of diagnosis (Figure). Rates of development of complicated disease were unusually low among patients diagnosed before 1990. In a Cox proportional hazards model, only calendar decade of diagnosis (HR 6.9; p<0.001) and age at diagnosis after age 40 (HR 0.29; p=0.006) influenced the hazard of development of complications. Conclusion: Earlier calendar decade of diagnosis of CD is associated with a lower rate of progression to complicated disease. While this might reflect changes in disease course with calendar time, it likely represents a bias in patient selection (survival bias) or inaccurate behavior classification because of differences in technology to detect and define disease complications. Such biases must be taken into account in historical cohort studies.Figure

Concentrations of bovine lactoferrin and citrate in milk during experimental endotoxin mastitis in early-versuslate-lactating dairy cows

Lactoferrin (Lf) is a molecule naturally present in bovine milk that affects the availability and transport systems of iron. Lf also binds endotoxin (lipopolysaccharide, LPS) of Gram-negative bacteria and modulates the immunological response. In the present study, concentrations of bovine Lf (bLf) and citrate in milk were determined in early (EL) and late (LL) lactating dairy cows, using an experimentally induced endotoxin mastitis model and a crossover design. Nine clinically healthy Finnish Ayrshire cows were challenged twice with 100 μg endotoxin infused into one udder quarter. Milk samples were collected from the challenged and control quarters of each cow before and after endotoxin infusion during 3 d, and bLf and citrate concentrations were measured. In all cows, clinical signs of mastitis were seen at both times of challenge, but the response was more severe in EL than in LL. Concentration of bLf in the milk started to rise approximately 8 h after endotoxin infusion and was still higher than normal on the third day, especially in the late-lactating cows. In milk of the LL group, concentrations of bLf were significantly higher than in the EL group. In contrast, concentrations of citrate were higher in milk of the EL cows compared with the LL cows. Concentration of bLf and citrate varied substantially among cows. The molar ratio of citrate to bLf before and after challenge was significantly higher during the EL period. The results of this study partly explain why cows in early lactation are more susceptible to intramammary infections and why mastitis is more severe in them.

Abstract B58: Decreasing the time to activate clinical trials: Initial data from the Multiple Myeloma Research Consortium (MMRC) model

Abstract Background: Activation of oncology trials is a lengthy and complex process. Recent literature has identified numerous opportunities to improve activation timelines1, 2. The Multiple Myeloma Research Consortium (MMRC) has implemented several processes to identify and overcome myeloma clinical trial activation barriers within the consortium network of 14 North American cancer centers. We examined the impact of these processes preand post- implementation and also compared activation times with published clinical trial metrics data. Methods/Results: 12 MMRC-facilitated trials had sufficient trial data available for review within the study period of May 2006 to March 2009. Activation time was defined as the time from a center's receipt of the final clinical trial protocol from the sponsor, to the time the first patient was enrolled into a trial at any MMRC participating center. The earlier group (EG) of MMRC trials (n=7) required a mean of 257 calendar days for activation, comparable to the mean published data of 251 calendar days1. The more recent group (RG) of MMRC trials (n=5) required a mean of 158 calendar days for activation, representing a 38% shortening of activation time. Additionally, implementation of standardized processes and rigorous project management resulted in a reduction in activation times for all MMRC centers in a given trial from a mean of 7.5 months to a mean of 5.1 months. Improving the mean time of several several specific steps in the process including time to initial protocol review submission from receipt (EG=37 vs. RG=19 days), scientific review committee time (EG=98 vs. RG=55 days), and the time from trial opening to first patient dosed (EG=74 vs. RG=27 days) contributed to the overall decrease in activation times. The EG metrics data are comparable to published data1 for each process step. Conclusion: The MMRC member institutions have seen substantial improvements in trial activation times and are in the process of implementing additional processes to further improve protocol development and trial conduct metrics. The efficiencies and process improvements realized from application of rigorous MMRC project management resources and the standardization of contracting and other key activities may be applied in other areas of oncology clinical trials beyond multiple myeloma. With increasing numbers of new oncology agents to be evaluated and greater pressure on trial sponsors to introduce efficiencies into trial timelines, overcoming such barriers is of critical importance. Citation Information: Mol Cancer Ther 2009;8(12 Suppl):B58.

Using Material Flow Analysis for Sustainable Materials Management

Using Material Flow Analysis for Sustainable Materials Management

A new species of crown-antlered deerStephanocemas(Artiodactyla, Cervidae) from the middle Miocene of Qaidam Basin, northern Tibetan Plateau, China, and a preliminary evaluation of its phylogeny

Stephanocemas Colbert, 1939 is one of the earliest groups of deer (Cervidae) that shows indications of shedding their antlers, and as such, occupies a special position in the transition from nondeciduous to deciduous antlers in the evolution of cervids. Despite this basal position in cervid phylogeny, however, it has a highly peculiar, palmate antler morphology that is easily recognized in the fossil records of the early to middle Miocene of Eurasia. A new species, Stephanocemas palmatus sp. nov., is described based on three partial antlers ranging from juvenile to full adult individuals, recently collected from the late middle Miocene Lower Youshashan Formation in the Qaidam Basin of northern Tibetan Plateau. Another indeterminate species (Stephanocemas sp.) of much smaller size and primitive characteristics is described from more fragmentary materials in strata lower than the level of S. palmatus but still middle Miocene in age. To the extent that it was possible, we also attempted to place into modern stratigraphical context historical collections of Stephanocemas from Qinghai Province that were obtained during the Sino-Swedish Expeditions in the 1930s. These materials were described by Birger Bohlin in 1937 but their stratigraphical context has been in question ever since. A species-level phylogeny suggests that S. palmatus is the most derived among known species, with its large size, great expansion of the palm part of the antler, and horizontally radiating tines. We recognize a Paradicrocerus clade that includes P. flerovi Gabuniya, 1959, P. elegantulus (Roger, 1898), and P. brevistephanos (Baschanov & Nurumov, 1955); the latter two were traditionally regarded as belonging to Stephanocemas. As a result, the Paradicrocerus clade is largely European and western Asian, whereas the restricted Stephanocemas is now Asiatic in geographical distribution. © 2009 The Linnean Society of London, Zoological Journal of the Linnean Society, 2009, 156, 680–695.

THE ETHNIC HISTORY OF MEDIEVAL NOVGOROD (BASED ON CRANIOMETRIC DATA)

Cranial series from cemeteries on the territory of the medieval Novgorod Republic were subjected to multivariate analysis. Northwestern Russia is the region where important population changes occurred in the early 2nd millennium AD. As a rule, earlier groups (11th – early 13th centuries) are dolichocranic and exhibit a sharp horizontal facial profile. In those series whose lower chronological limit is 11th–12th centuries, diachronic morphological changes can be traced. In later groups (13th–14th centuries), the cranial index is higher than in earlier ones (11th – early 13th centuries), whereas cranial height and nasal protrusion angle decrease, and the orbits become narrower. Series from the 13th– 16th century cemeteries apparently attest to an admixture. A combination of traits, correlated mostly at the between- group level (orbital breadth, nasal height, and nasal prominence angle), points to the presence of two components. This combination separates early and late Novgorod groups, at the same time opposing neighboring non-Slavic populations. While early groups (11th–13th centuries) resemble the 10th–18th century Balts, late ones (late 13th – early 20th centuries) resemble various Finnic groups of the same period.

Early Hospital Arrival Improves Outcome at Discharge in Ischemic but Not Hemorrhagic Stroke: A Prospective Multicenter Study

Background: Our purpose was to determine whether the onset-to-arrival time affects the outcome of stroke patients. Methods: We carried out a prospective multicenter study involving 1,817 patients with ischemic stroke and 1,226 with intracerebral hemorrhage who presented to hospitals within 24 h of symptom onset. The primary outcome was independent activity of daily living corresponding to a modified Rankin Scale (mRS) score ≤2 at discharge approximately 3 weeks after stroke. Results: In ischemic stroke patients, the initial NIH Stroke Scale (NIHSS) score decreased as the onset-to-arrival time increased: 9 (median) in the earliest tertile group (<3 h), 5 in the second tertile group (3–8 h) and 4 in the latest tertile group (≥8 h, p < 0.001). The median mRS scores at discharge in these groups were 3, 2 and 2, respectively (p < 0.001). After adjustment for underlying features and the initial NIHSS score, the independent activity of daily living at discharge was 1.73 times more common in patients in the earliest group than in the latest group (95% CI = 1.24–2.42, p = 0.001). A similar tendency was shown in the subanalysis for large-artery atherosclerosis and cardioembolic stroke. In intracerebral hemorrhage patients, both the initial NIHSS score and the mRS score at discharge decreased as the onset-to-arrival time increased. After multivariate adjustment, the independent activity of daily living was 2.33 times (p < 0.001) and 1.69 times (p = 0.006) less common in patients in the earliest (<1.2 h) and second tertile groups (1.2–3.5 h), respectively, than in the latest tertile group (≥3.5 h). Conclusions: Early hospital arrival improved the clinical outcome in ischemic stroke patients but not in patients with intracerebral hemorrhage.

Development of Laparoscopic Donor Nephrectomy: A Strategy to Increase Living Kidney Donation Incentive and Maintain Equivalent Donor/Recipient Outcome

Laparoscopic donor nephrectomy (LDN) has emerged as the preferred technique worldwide, and has contributed to a dramatic increase in living kidney donation during the past decade. We adopted LDN in 2002 with the intention of increasing living kidney donation incentive and maintaining equivalent donor/recipient outcome. Forty-five LDNs were performed between September 2002 and November 2007. Donor demographics, operative characteristics, perioperative complications and donor/recipient outcome were reviewed retrospectively. The LDN series was divided into earlier and later groups for comparison. To confirm the safety and efficacy of LDN, we compared the results with those of previous series and our open donor nephrectomy (ODN) series. All 45 LDN kidneys were procured and transplanted successfully. Mean donor operation time was 327.7+/-10.2 minutes, blood loss was 286.0+/-48.3 mL, and warm ischemia time was 233.9+/-19.6 seconds. Two (4.4%) open conversions happened in the earlier group. There was a significant decrease in warm ischemia time and donor intraoperative complications in the later group. There was no donor mortality and there were no repeat surgical procedures. Delayed graft function occurred in 8.9% of cases and three (6.7%) recipients developed ureteral complications. All but one recipient was discharged with adequate renal function. Graft function continued in 41 of the 43 harvested kidneys (95.3%). Compared with ODN, there was a significant decrease in donor postoperative stay in the LDN series (p=0.00). There was no difference between the series with regard to donor safety, donor outcome, and immediate and long-term recipient outcome. The number of living kidney donations increased significantly after adopting LDN in our series. The equivalent donor/recipient outcome of the LDN series compared with that of previous and ODN series was achieved with increasing experience.

Extensive presence of serotonergic cells and fibers in the peripheral nervous system of lampreys

Lampreys are suitable animal models for studying the evolution of the vertebrate nervous system because they belong to the earliest group of extant vertebrates, the agnathans. The general organization of the serotonergic central nervous system is well known in lampreys, but information about its peripheral organization is lacking. In the present study, high-performance liquid chromatography and immunohistochemistry with an antibody against serotonin were used to study the presence and peripheral distribution of serotonergic elements in the head of larval sea lampreys. Adult lampreys were also analyzed in order to compare the organization of the system in larval and postmetamorphic stages. Serotonergic cells were observed in the cranial nerve ganglia, the musculature, the taste buds, and in the gills. Serotonergic fibers were extensive in all tissues except the epidermis. Possible roles were proposed for the different cell types observed in relation to their location, structure, and innervation patterns. The serotonergic cells appear to be involved in the oxygen and taste chemoreception processes, the modulation of musculature contraction, and in the regulation of cilia beat frequency and mucus secretion in lampreys. The extensive presence of serotonergic elements in the peripheral nervous system of lampreys suggests a close relationship with the organization of this system in invertebrate groups.

Changes in the North Korean Economy Reported by North Korean Refugees

Research Purpose and SummaryThis research is designed to assess the current state of the North Korean economy caused by the July 1 measures in 2002, through interviews with North Korean refugees, whose numbers have recently increased dramatically (see Table 1).* Research target: North Korean refugees who fled into South Korea in 2006 and who currently reside in Seoul, Gyeonggi Province, and Busan* Research period and methodology: November to December 2006, survey and in-depth interviews with ten refugees* Numbers: 335 refugees, or 1 7 percent of the total number of North Korean refugees who fled into South Korea in 2006.* We interviewed 21 9 North Koreans who fled from North Korea between 1997 and 1999 and between 2004 and 2006, to ascertain changes in the North Korean economy after the July 1 measures (see Table 2).* Contents of research: profile of North Korean refugees, income and consumption, and market activitiesResearch FindingsA Profile of the North Korean RefugeesOur findings concerning gender are shown in Table 3:* Among the refugees, the proportion of men increased remarkably, from an average of 7 percent during 1997-9 to an average of 44 percent during 2004-6.* The particularly high proportion of women among those refugees who had left North Korea before the July 1 measures results from the fact that women were allowed to retire early and therefore it was easier for them to escape from North Korea.* The number of male refugees has gradually increased since the July 1 measures, because the increased number of men engaged in trade has made it easier for them to move, and female refugees have helped their families and relatives to leave North Korea.Age profiles are shown in Table 4:* Overall, the proportion of those refugees in their twenties is highest, but in recent years the proportions of the youngest age cohort (those aged between ten and nineteen) and of those in their forties have increased, while the proportion of those in their twenties has decreased.* The shares of the youngest age group and of those in their forties among the total number of refugees have increased since the July 1 measures, because those in their forties engaged in trade and they helped their families to move to South Korea.The educational background of the refuges is shown in Table 5:* The percentage of refuges who had not finished high school has decreased, while the proportion of those refugees who had completed high school and college education has increased.The occupations of refugees when they were in North Korea are shown in Table 6:* The proportion of production workers has declined, whereas that of the unemployed has risen.* This is largely attributable to the gradual increase in the early retirement of women engaged in production.Income StructureIncome structure is shown in Table 7:* As shown in the table, there is not much difference in the income structure of those two groups of refugees who had fled North Korea before and after the July 1 measures.* Wage income amounts to less than 10 percent of total income, and trade income accounts for about 90 percent of total income.* Table 7 indicates that it is difficult even for workers with a job to earn enough money to live on their wages alone.Income level is shown in Table 8:* The income level of the refugees after the July 1 measures is substantially higher than that of the earlier group of refugees.* The average monthly income per capita more than tripled, from $6 for the three years from 1997 to 1999 to $20 for three years from 2004 to 2006.Consumption Structure and LevelThe consumption structure is shown in Table 9:* The table shows that food consumption as a percentage of refugees' total expenditure fell after the July 1 measures, while expenditure on clothing increased after the July 1 measures; food accounted for the largest portion of refugees' total expenditure before and after the July 1 measures. …