Months Of Delay Research Articles

Long-Term Spatial Memory and Learning Set Formation in Captive Capuchin Monkeys (Cebus libidinosus = Sapajus cay)

Researchers have long suspected that nonhuman primates have long-term spatial memory for locating food. However, few empirical studies have assessed spatial memory for a period longer than 1 day in nonhuman primates in a foraging context. We used a modified version of the radial maze to test long-term memory for periods of 2 days or longer in two groups of Cebus libidinosus = Sapajus cay (N = 10; N = 6) in captivity (environment completely human constructed) and semicaptivity (relatively natural environment with few human-made structures) at La Plata Zoo and Botanical Park, Buenos Aires, Argentina, between 2007 and 2010. The experimental design included a set of three accessible baited feeders interspersed among three nonaccessible baited feeders. We tested monkeys in one initial exposure period, four periods of long-term memory (2 days, 76 days, 76 + 2 days, and 4 months of delay), and one period of inversion of the experimental set location. We used the latter to analyze the monkeys’ abilities to develop learning sets. Captive subjects appeared to remember sites with accessible and nonaccessible food for periods of 2 days, 76 days, and 4 months, and used learning sets to reduce relearning times when exposed to a change in the learned locations. Although semicaptive subjects also appeared to remember sites with accessible and nonaccessible food, their performance was less accurate. We conclude that capuchins used spatial memory to improve their foraging efficiency.

Prevalence of Associated Lesions in Anterior Cruciate Ligament Reconstruction

Background: Knee instability resulting from anterior cruciate ligament (ACL) rupture is an important risk factor for the onset of meniscal tears and cartilage injuries. A delay of the ligament reconstruction further increases this risk. There is currently no agreement on the right time for surgical ACL reconstruction. Purpose: To verify the correlation of time to ACL reconstruction, patient age, sex, and body mass index (BMI) with the prevalence of meniscal tears and cartilage injuries, as well as to identify the proper surgical timing to decrease the risk of developing associated injuries. Study Design: Cohort study; Level of evidence, 3. Methods: The medical records of 988 patients who underwent primary ACL reconstruction between January 2010 and May 2014 were analyzed to collect data on the prevalence of meniscal tears and cartilage injuries, surgical timing, and patient sex, age, and BMI. Logistic regression was performed to estimate the association between the prevalence of intra-articular lesions and the independent variables of surgical timing, sex, age, and BMI. Results: The risk of developing at least an associated lesion increased by an average of 0.6% for each month of delay of surgical reconstruction. The odds ratio (OR) for developing an intra-articular lesion was 1.989 (95% CI, 1.403-2.820) in those waiting more than 12 months for ACL reconstruction. A 12-month delay for the intervention nearly doubled the risk of developing a medial meniscal tear (OR, 1.806 [95% CI, 1.317-2.475]) but did not modify the risk for the lateral meniscus (OR, 1.183 [95% CI, 0.847-1.653]). Concerning cartilage lesions, the risk after a 12-month delay increased in the medial compartment (femoral condyle: OR, 2.347 [95% CI, 1.499-3.676]; tibial plateau: OR, 5.574 [95% CI, 1.911-16.258]). In the lateral femoral condyle, the risk became significant in patients who underwent surgery more than 60 months after ACL injury as compared with those treated in the first 3 months (OR, 5.949 [95% CI, 1.825-19.385]). Lateral tibial plateau lesions did not seem to increase significantly. Male sex was a risk factor for the onset of lateral meniscal tears (OR, 2.288 [95% CI, 1.596-3.280]) and medial tears (OR, 1.752 [95% CI, 1.280-2.399]). Older age (OR, 1.017 [95% CI, 1.006-1.029]) and increased BMI (OR, 1.120 [95% CI, 1.072-1.169]) were risk factors for the occurrence of at least 1 associated lesion. Conclusion: ACL reconstruction within 12 months of injury can significantly reduce the risk of meniscal tears and chondral lesions. The close association between BMI and prevalence of associated lesions suggests that attention be paid to patients with an elevated BMI when considering the timing of ACL reconstruction surgery.

Adjuvant treatment delay in breast cancer patients.

to evaluate if time between surgery and the first adjuvant treatment (chemotherapy, radiotherapy or hormone therapy) in patients with breast cancer is a risk factor for lower overall survival (OS). data from a five-year retrospective cohort study of all women diagnosed with invasive breast cancer at an academic oncology service were collected and analyzed. three hundred forty-eight consecutive women were included. Time between surgery and the first adjuvant treatment was a risk factor for shorter overall survival (HR=1.3, 95CI 1.06-1.71, p=0.015), along with negative estrogen receptor, the presence of lymphovascular invasion and greater tumor size. A delay longer than 4 months between surgery and the first adjuvant treatment was also associated with shorter overall survival (cumulative survival of 80.9% for delays ≤ 4 months vs. 72.6% for delays > 4 months; p=0.041, log rank test). each month of delay between surgery and the first adjuvant treatment in women with invasive breast cancer increases the risk of death in 1.3-fold, and this effect is independent of all other well-established risk factors. Based on these results, we recommend further public strategies to decrease this interval.

Superior virologic and treatment outcomes when viral load is measured at 3 months compared to 6 months on antiretroviral therapy

IntroductionRoutine viral load (VL) monitoring is utilized to assess antiretroviral therapy (ART) adherence and virologic failure, and it is currently scaled-up in many resource-constrained settings. The first routine VL is recommended as late as six months after ART initiation for early detection of sub-optimal adherence. We aimed to assess the optimal timing of first VL measurement after initiation of ART.MethodsThis was a retrospective, cohort analysis of routine monitoring data of adults enrolled at three primary care clinics in Khayelitsha, Cape Town, between January 2002 and March 2009. Primary outcomes were virologic failure and switch to second-line ART comparing patients in whom first VL done was at three months (VL3M) and six months (VL6M) after ART initiation. Adjusted hazard ratios (aHR) were estimated using Cox proportional hazard models.ResultsIn total, 6264 patients were included for the time to virologic failure and 6269 for the time to switch to second-line ART analysis. Patients in the VL3M group had a 22% risk reduction of virologic failure (aHR 0.78, 95% CI 0.64–0.95; p=0.016) and a 27% risk reduction of switch to second-line ART (aHR 0.73, 95% CI 0.58–0.92; p=0.008) when compared to patients in the VL6M group. For each additional month of delay of the first VL measurement (up to nine months), the risk of virologic failure increased by 9% (aHR 1.09, 95% CI 1.02–1.15; p=0.008) and switch to second-line ART by 13% (aHR 1.13, 95% CI 1.05–1.21; p<0.001).ConclusionsA first VL at three months rather than six months with targeted adherence interventions for patients with high VL may improve long-term virologic suppression and reduce switches to costly second-line ART. ART programmes should consider the first VL measurement at three months after ART initiation.

English

Diagnostic delay and health seeking behaviour among Tuberculosis patients under Revised National Tuberculosis Control Programme were assessed in Kottayam district of Kerala. METHODOLOGY: Study design: cross sectional study .Study settings – District Tuberculosis Centre, Kottayam. RNTCP Centre, Medical College, Kottayam. Primary Health Centre, Ettumanoor. Primary Health Centre, Athirampuzha. Primary Health Centre, Kumarakom. Primary Health Centre, Kuddaloor. Data were collected by a pretested structured questionnaire and analyzed by SPSS 16. RESULTS: Maximum number of study subjects had one month delay (36.6%).26.2% of patients had up to 2 months of delay in their diagnosis. A considerable number of patients 9.1 % had a delay of 6 months or more. Mean delay – 73.98 Days (Standard Deviation – 73.88 Days) (Range 1day to 365 Days). Median Delay – 45 Days. Mean delay in diagnosis across the three treatment categories are significantly different with each other when analyzed by an one way Analysis of variance (ANOVA) Maximum mean delay in diagnosis was in category III patients.

Alberta College of Pharmacists confirms it will proceed with inducements ban but enabling mechanism still under review

After a few months of delay to digest a flood of comments on the issue, the Alberta College of Pharmacists (ACP) has confirmed it will not abandon plans to prohibit consumer inducements for prescription drugs and professional pharmacy services. The ACP first proposed banning coupons and loyalty programs in the fall of 2012—a move that prompted criticism by some patient groups and retailers. In late December of last year, the College said it needed more time to assess the complex issue and the extensive feedback it had received. In a statement issued April 18, 2013, the regulatory body stated it would go ahead with the proposed ban, noting that 75% of pharmacists and pharmacy technicians it surveyed support such action by the College. “This isn’t about any one pharmacy or any one type of reward. The prohibition would apply to all pharmacists, pharmacy technicians and pharmacies,” said Greg Eberhart, ACP Registrar, in the statement. “Pharmacists are making decisions about drug therapy; it’s not the same environment that we had 5 or 10 years ago. Our interest is around the practices of pharmacists and the new expectations and responsibilities they have. We want to make sure they are free from conflict.” The College is still considering the best mechanism for putting the ban into effect. It could be a new regulation, standard of practice or amendment to the Code of Ethics. No timeline for the change has been announced; the College says that will depend in part on which mechanism is to be used.

Relationship between Monthly Rainfall in NW Peru and Tropical Sea Surface Temperature

This study assesses the relationship between global sea surface temperature (SST) and a regional index of rainfall (NWPR) in Piura-Tumbes, a coastal region in northwestern Peru, over the period 1965–2008 by means of the Pearson product-moment correlation. The results show that this area is strongly influenced by three indices: El Niño-Southern Oscillation (ENSO) Niño3.4 region, the Indian Ocean Dipole (IOD), and the equatorial Atlantic Oscillation (ATL3). In particular, a positive correlation has been found with the two first indices (Niño3.4 and IOD) and a negative one with ATL3 with several months of delay. This allows developing a forecast regression model for monthly rainfall in NW Peru with months in advance. The results show that linear regression model is not enough to provide satisfactory results; however, a nonlinear regression model improves considerably the prediction of rainfall anomalies in NW Peru.

Serial Casting as a Delay Tactic in the Treatment of Moderate-to-Severe Early-onset Scoliosis

Serial casting can cure mild infantile idiopathic scoliosis. Its use in delaying surgery in older children and those with larger curves or syndromes is poorly defined. A review of a single center's experience with casting was performed. Patients were included if they had a syndromic, neuromuscular, or congenital scoliosis or were older than 2.5 years with an idiopathic scoliosis measuring >50 degrees. A retrospective review was performed on 29 patients meeting all inclusion criteria. Of these, 12 were idiopathic and 17 were nonidiopathic curves. Average age at first cast was 4.4 ± 2.1 years, and 3.0 ± 1.8 cast changes were performed over 1.4 ± 1.1 years. Patients were transitioned to a brace and followed up for 5.5 years (range, 2.2 to 11.4 y). The main thoracic Cobb angle before casting was 68.8 ± 12.3 degrees, which corrected to 39.1 ± 16.4 degrees in a cast. Cobb angle after cast removal was 60.9 ± 18.4 degrees, which increased to 76.3 ± 24.0 degrees at final follow-up. T1-T12 height increased to 1.1 ± 2.6 cm during the treatment period (P=0.05). There were 5 minor complications. Fifteen patients (51.7%) required surgical treatment for their scoliosis at most recent follow-up and an additional 7 patients (24.1%) were delayed until a definitive anterior/posterior spinal fusion could be performed. Surgery was delayed 39 ± 25 months from the first cast. Growing rods were required in 8 patients (27.6%). The patients who ultimately underwent surgical intervention (SG) were more likely to have a larger postcasting residual main thoracic Cobb angle than those who did not require surgery [NS; 69.5 ± 14.6 degrees (SG) vs. 51.6 ± 17.9 degrees (NS), P=0.007] and had a greater progression of their curves after cast removal [20.9 ± 13.5 degrees (SG) vs. 9.4 ± 11.0 degrees (NS), P=0.02]. Serial casting is a viable alternative to surgical growth sparing techniques in moderate-to-severe early-onset scoliosis and may help delay eventual surgical intervention. Although a cure cannot be expected, an average of 39 months of delay was achieved in this patient cohort and 72.4% have avoided growing spine surgery. Level IV, case series.

Sediment scour and deposition within harbors in California (USA), caused by the March 11, 2011 Tohoku-oki tsunami

Tsunamis have caused significant damage to boats and docks within harbors and ports along the California coast. Sediment scour and deposition within harbors by tsunamis, though not extensively studied, have produced long-term impacts to the recovery and resiliency of affected maritime communities. The March 11, 2011 Tohoku-oki teletsunami generated strong tsunami currents (up to 7m/s, or 14kn) within Crescent City and Santa Cruz harbors that triggered sedimentation problems, regulatory issues with sediment disposal, and months of delays in the reconstruction process. Evaluation of video, pre- and post-tsunami bathymetric surveys, and harbor sediment analysis data helped develop a better understanding of tsunami flow regime and sediment transport within these harbors. In Crescent City, the scour effects of large tsunami surges were amplified by the narrow entrance to the Small-Boat Basin, increasing the sediment supply and trapping this material within the basin, causing shoaling that made the harbor unusable and creating long-term disposal issues. Within the entire harbor, at least 289,400m3 of sediment was scoured in an area of 0.67km2. A minimum fill volume of 154,600m3 was calculated with the sediment covering 55% of that portion of the harbor included in the bathymetric surveys. In Santa Cruz, the long, constricting layout and shallow nature of the harbor increased current velocities and scour in confined areas, and exacerbated sedimentation in between and beneath docks. At the harbor entrance, estimated scour volumes range from 2550 to 14,800m3, and fill estimates range from 120 to 8750m3, depending upon the surveys used to characterize post-tsunami conditions, while the area of deposition ranges from 6 to 64% of the survey overlap areas. About 83m3 of sediment was scoured in Santa Cruz North Harbor, while a minimum of 75m3 was deposited across 50% of that portion of the harbor common to pre- and post-tsunami surveys. Fill estimates are considered minimums, due to sediment deposited in locales not covered by the various surveys. In general, the southern part of the harbor near the entrance jetties was erosional while most of the northern part of the harbor was depositional. Analyses of tsunami currents observed on videos collected during the tsunami provide excellent support for the bathymetric change analyses, and together the two lines of evidence provide a means to predict flow patterns and areas at risk of damage from the tsunami by assessing harbor dimensions and layout, and analyzing observations/video from past tsunamis. Reducing constrictions and deepening channels within harbors would greatly reduce tsunami current speeds and the potential for scour. The maritime community and state regulatory agencies should work together to streamline the review process to assist recovery efforts after significant tsunamis.

JMD’s Three-Month Review Policy Pledge

JMD’s Three-Month Review Policy Pledge

Historical comparisons on related features among newly registered leprosy patients in the endemic areas of Wenshan district, Yunnan province

To analyze the current situation and prevalence of leprosy in Wenshan district, Yunnan province. To collect various data on leprosy reported by the health workers at the county level. The number of newly registered patients did not decrease significantly in 1989, 1999 and 2009, respectively. The mean age of patients at detection was 33 - 35 years old. Time of delay between the disease onset and being diagnosed was shortened from 35.2 months in 1989 to 15.9 months in 2009. However, the proportion of patients with more than 12 months of delay still accounted for nearly 50%. The proportion of Grade II disability fluctuated between 15.2% - 17.7% and the proportion of child cases increased from 8.1% in 1989 to 13.1% in 2009. Clinics for skin diseases were the main locations for case detection. The proportion of new cases detected through 'active case finding' program accounted for 44.3% in 1999 and 42.6% in 2009, both higher than 17.7% in 1989. The situation of leprosy in Wenshan district, Yunnan province, was still serious and the reason for the occurrence of new cases was related to the fact that the infectious source of leprosy had not been under full control.

Long-Term Response to GH Therapy in Short Children With a Delayed Infancy-Childhood Transition (DICT)

Transition of growth from infancy to childhood is associated with activation of the GH-IGF-I axis. Children with a delayed infancy-childhood transition (DICT) are short as adults. Thus, age at ICT may impact on growth response to GH. The objective was to investigate associations between growth response to GH treatment and ICT timing in children with idiopathic short stature (ISS) in a randomized, controlled, multicenter trial, TRN 88-080. A total of 147 prepubertal children (mean age, 11.5 ± 1.4 y) were randomized to receive GH 33 μg/kg/d (GH33, n = 43), GH 67 μg/kg/d (GH67, n = 61), or no treatment (n = 43). Data on growth to final height (FH) were analyzed after categorization into those with normal (n = 76) or delayed ICT (n = 71). Within the GH33 group, significant height gain at FH was only observed in children with a DICT (p < 0.001), with each month of delay corresponding to gain of 0.13 SD score (SDS). For the GH67 group, the timing of the onset of the ICT had no impact on growth response. In conclusion, ISS children with a DICT responded to standard GH dose (better responsiveness), whereas those with a normal ICT required higher doses to attain a significant height gain to FH.

A multiparameter panel method for outcome prediction following aneurysmal subarachnoid hemorrhage

Accurate early anticipation of long-term irreversible brain damage during the acute phase of patients with aneurysmal subarachnoid hemorrhage (aSAH) remains difficult. Using a combination of clinical scores together with brain injury-related biomarkers (H-FABP, NDKA, UFD1 and S100beta), this study aimed at developing a multiparameter prognostic panel to facilitate early outcome prediction following aSAH. Blood samples of 141 aSAH patients from two separated cohorts (sets of 28 and 113 patients) were prospectively enrolled and analyzed with 14 months of delay. Patients were admitted within 48 h following aSAH onset. A venous blood sample was withdrawn within 12 h after admission. H-FABP, NDKA, UFD1, S100beta and troponin I levels were determined using classical immunoassays. The World Federation of Neurological Surgeons (WFNS) at admission and the Glasgow Outcome Score (GOS) at 6 months were evaluated. In the two cohorts, blood concentration of H-FABP, S100beta and troponin I at admission significantly predicted unfavorable outcome (GOS 1-2-3). A multivariate analysis identified a six-parameter panel, including WFNS, H-FABP, S100beta, troponin I, NDKA and UFD-1; when at least three of these parameters were simultaneously above cutoff values, prediction of unfavorable outcome reached around 70% sensitivity in both cohorts for 100% specificity. The use of this panel, including four brain injury-related proteins, one cardiac marker and a clinical score, could be a valuable tool to identify aSAH patients at risk of poor outcome.

ENVIRONMENT Satellite will help map Earth’s CO sources and sinks

After months of delays, a satellite designed to help generate the first detailed, time-resolved global maps of carbon dioxide sources and sinks is slated for launch on Feb. 23. The daily detailed measurements from NASA’s Orbiting Carbon Observatory (OCO) will give vastly more information than the sparse CO 2 -monitoring stations that now dot Earth. By knowing where and when CO 2 is being emitted and taken up, scientists may be able to understand how the gas influences climate change and, in particular, global warming. The orbiting observatory is “a huge stepping stone toward answering these questions,” said Anna M. Michalak, OCO scientist and engineering and atmospheric sciences professor at the University of Michigan, at a press conference at NASA headquarters on Jan. 29. Previously set to launch last fall, OCO was postponed after a series of technical problems. The craft carries near-infrared absorption spectrometers designed to monitor, in high resolution, concentrations of CO 2 from Earth’s surface to ...

Treatment Change as a Predictor of Outcome among Patients with Classic Chronic Graft-versus-Host Disease

We analyzed outcomes for 668 patients who had systemic treatment for chronic graft-versus-host disease (cGVHD) to assess the utility of early treatment change for exacerbation of cGVHD as a surrogate for survival endpoints in clinical trials. Fifty-six percent of patients had treatment change within 2 years after diagnosis of cGVHD. The median onset of treatment change was 4.4 months (range: 0.3-50 months). The cumulative incidence of nonrelapse mortality (NRM) at 2 years was 16%, and overall survival (OS) at 2 years was 74%. In time-dependent Cox models, treatment change was associated with an increase in risk of NRM (hazard ratio, 2.53; 95% confidence interval, 1.7-3.7; P < .0001). The hazard ratio was attenuated by 6% per month of delay in treatment change. Our results confirm that exacerbation of cGVHD is associated with an increased risk of NRM and with decreased OS, but the strength of this association is not large enough to allow the use of early exacerbation as a surrogate for survival endpoints in clinical trials. Other measures of clinical benefit, such as response, will need to be developed as endpoints in phase II trials for patients with cGVHD.

Delay in admission for elective coronary-artery bypass grafting is associated with increased in-hospital mortality

BackgroundMany health care systems now use priority wait lists for scheduling elective coronary artery bypass grafting (CABG) surgery, but there have not yet been any direct estimates of reductions in in-hospital mortality rate afforded by ensuring that the operation is performed within recommended time periods.MethodsWe used a population-based registry to identify patients with established coronary artery disease who underwent isolated CABG in British Columbia, Canada. We studied whether postoperative survival during hospital admission for CABG differed significantly among patients who waited for surgery longer than the recommended time, 6 weeks for patients needing semi-urgent surgery and 12 weeks for those needing non-urgent surgery.ResultsAmong 7316 patients who underwent CABG, 97 died during the same hospital admission, for a province-wide death rate at discharge of 1.3%. The observed proportion of patients who died during the same admission was 1.0% (27 deaths among 2675 patients) for patients treated within the recommended time and 1.5% (70 among 4641) for whom CABG was delayed. After adjustment for age, sex, anatomy, comorbidity, calendar period, hospital, and mode of admission, patients with early CABG were only 2/3 as likely as those for whom CABG was delayed to experience in-hospital death (odds ratio 0.61; 95% confidence interval [CI] 0.39 to 0.96). There was a linear trend of 5% increase in the odds of in-hospital death for every additional month of delay before surgery, adjusted OR = 1.05 (95% CI 1.00 to 1.11).ConclusionWe found a significant survival benefit from performing surgical revascularization within the time deemed acceptable to consultant surgeons for patients requiring the treatment on a semi-urgent or non-urgent basis.

Molecule of the Month

Is Zetia™ a A ‘Do Nothing’ Drug? After months of delays and on the eve of meetings with congressional investigators, results from the much anticpated ENHANCE clinical trial for Vytorin™ were finally disclosed (January 15, 2008) to the dismay of pharmacuetical giants Merck and Schering- Plough, with the announcement that VytorinTM conferred no medical benefit over Zocor™ alone [1-4]. The ENHANCE trial was launched to demomstrate superior cardiovascular protection (fewer heart attacks and strokes) with Vytorin™ versus Zocor™ and enrolled 720 patients with heterozygous familiar hypercholesterolemia, a rare condition that predisposes them to abnormally high blood cholesterol. The two year study measured the amount of artery-clogging plagues in three areas and compared patients taking Vytorin ™ versus high dose Zocor™ [1-4]. Vytroin™, approved by the FDA in 2004, is a combination drug consisting of Mercks Zocor™, an HMG-CoA reductase inhibitor (statin) that inhibits cholesterol production in the liver, and Zetia™, the first cholesterol absorption inhibitor (works in digestive track). These complimentary cholesterol lowering strategies in a single pill where touted to treat the two sources of cholesterol - heredity and diet and provide superior protection from heart attack and stroke versus stain alone therapy. Zocor™ has proven to be a safe and effective statin which lowers cholesterol and decreases the risk of adverse cardiovascular events. Zetia™, was shown to lower LDL (bad cholesterol) 15-20% in a surrogate goal trial, with no clinical support that its effects on LDL confer cardioprotection - the chief concern of patients [1-4]. These data raised questions about aggressive marketing tactics, the delays to announce negative clinical data and the issue of Brand versus cheaper Generic medications with Vytorin™ [2-4]. Many physicians and clinicians voiced their displeasure and referred to Zetia™ and Vytorin™ as ‘Do Nothing’ drugs [2-4]. Moreover, both Vytroin™ and Zetia™ had achieved blockbuster status with billions in sales/year and provided additional sales for Mercks Zocor™, which is now facing billion dollar generic competition, and a major component of Schering-Ploughs annual revenue. Mercks Zocor™ is an excellent example of the impact of the loss of patent protection and generic competition. In 2005, the statins LipitorTM and ZocorTM were ranked No.1 ($7.6 billion) and No.2 ($4.5 billion) in sales, and No. 1 and No. 11 in prescriptions dispensed, respectively. After generic variants of Zocor™ entered the market mid-year 2006, Pfizers Lipitor™ remained No. 1 in terms of both sales ($ 8.6 billion) and prescriptions dispensed (74,020) while Zocor™ slid to No.7 in sales ($3.2 billion) and No. 25 in prescriptions dispensed [5-7]. With an increasing market share in each quarter of 2007, Vytorin™ was poised to recoupe much of Zocors™ lost revenues for Merck, but the ENHANCE trial may derail this rally and drive more patients to request cheaper, generic simvastatin [1-7]. However, three larger clinical trials are underway, including the 10,000 patient IMPROVE IT trial, which Merck and Schering-Plough hope will conclusively demonstrate that Vytorin™ can reduce the number of detahs and major, adverse cardiac events versus Zocor™ alone [1-4]. Unfortunately, data from these trials will not be available for ∼ three years and the moniker of ‘Do Nothing’ drug may linger until conclusive data proves otherwise. REFERENCES [1] For information on the ENHANCE trial see: www.merck.com, www.sherng-plough.com [2] For information on the ENHANCE trial in the popular media see: www.cnn.com, keyword Vytorin and www. Healthrevolution.com, search Vytorin. [3] Sternberg, S. ‘Drug Trials Under Pressure’ USA Today, D1, January 17, 2008. [4] Rubin, R. ‘Surrogtae goals can defuddle patients’ USA Today, D2, January 17, 2008. [5] Lamb, E. Top 200 prescription drugs of 2006. Pharmacy Times, May 2007, pp.1-4, and reference therein. [6] IMS Health. Press release. March 8, 2007, www.imshealth.com. [7] For more information on generic drug approvals and impact on sales see the US Food and Drug [8] Adminstration: www.fda.gov.

Dynamics of suprabenthos-zooplankton communities around the Balearic Islands (western Mediterranean): Influence of environmental variables and effects on the biological cycle of Aristeus antennatus

Dynamics of suprabenthos and zooplankton were analyzed in two areas located in the NW (off Sóller harbour) and S (off Cabrera Archipelago) of Mallorca (Balearic Islands, western Mediterranean) at depths ranging between 135–780 m. Four stations situated respectively at 150 m (shelf-slope break), and at bathyal depths of 350, 650 and 750 m were sampled at bi-monthly intervals during six cruises performed between August 2003 and June 2004. Suprabenthos showed maximum biomass in both areas from late spring to summer (April to August), while minimum biomass was found in autumn (September–November). Though variable, temporal dynamics of zooplankton showed peaks of biomass in late winter and summer (February and June), while minimals occurred in autumn (August–September) and, at bathyal depths, in April. Suprabenthos (abundance; MDS analyses) showed a sample aggregation as a function of depth (3 groups corresponding to the shelf-slope break, upper slope — over 350 m; and the middle, deeper part of the slope — over 650–750 m), without any separation of hauls by season. By contrast, zooplankton samples were separated by season and not by depth. There was evidence of three seasonal groups corresponding to summer (June 2004–August 2003), autumn–winter (September and November 2003, February 2004), and spring (April 2004), being especially well established off Sóller. In general, suprabenthos was significantly correlated with the sediment variables (e.g. total organic matter content (% OM), potential REDOX), whereas zooplankton was almost exclusively dependent on Chl a at the surface, which suggests two different food sources for suprabenthos and zooplankton. The increase of suprabenthos abundance in April–June was paralleled by a sharp increase ( ca. 2.8 times) in the %OM on sediment during the same period, coupled ca. 1–2 months of delay with the peak of surface Chl a recorded in February–March (from satellite imagery data). Suprabenthos biomass was also correlated with salinity close to the bottom, suggesting a link between suprabenthos abundance and changes in the oceanographic condition of water masses close to the bottom. It is suggested that a higher suprabenthos biomass recorded off Sóller in comparison to that off Cabrera in June could, in turn, be related to a seasonal inflow of Levantine Intermediate Water (LIW) in April–June in this area at mid bathyal depths (350–650 m). This trend would be based on: 1) it was evident only at mid-slope depths between 350–750 m, coinciding with the LIW distribution, and 2) it was not recorded among zooplankton (collected throughout the water column). The possible effect of the fluctuations of suprabenthos and zooplankton on higher trophic levels has been explored studying the diet and food consumption rates of the red shrimp Aristeus antennatus, as indicator species by its dominance in bathyal communities. A. antennatus increased its food consumption from February to April–June 2004 off Sóller, which in the case of large (CL > 40 mm) specimens was found in both areas. In addition, there was a shift of diet from winter to spring–early summer. In this last period, A. antennatus preyed upon euphausiids and mesopelagic decapods and fish, while benthos (e.g. polychaetes and bivalves) decreased in the diet. This indicates an increase in the food consumption and probably in the caloric content of the diet in pre-spawning females in April–June 2004, which is synchronized with the period when gonad development begins in A. antennatus females (May–June). Anyway, macrozooplankton, and not suprabenthos, is crucial as a high energetic food source in the coupling between food intake and reproduction in the red shrimp.

Suprascapular Nerve Reconstruction in 118 Cases of Adult Posttraumatic Brachial Plexus

Shoulder stabilization is of utmost importance in upper extremity reanimation following paralysis from devastating brachial plexus injuries. The purpose of this report is to present the authors' experience with suprascapular nerve reconstruction in 118 cases of adult brachial plexus lesions. Outcomes were analyzed in relation to various factors, including patient age, denervation time, donor nerve used, and functional restoration achieved in the supraspinatus versus the infraspinatus muscles. The medical records of 118 adult patients operated on by a single surgeon between 1978 and 2002 who had suprascapular nerve reconstruction were reviewed; 102 patients had adequate follow-up. Direct neurotization of the suprascapular nerve was carried out in 78 patients, while in 40 patients, interposition nerve grafts were used. In 80 patients, the distal spinal accessory was used as the motor donor nerve for suprascapular nerve neurotization, while in 10 patients, other extraplexus motor donors were used. In 28 patients, intraplexus motor donors were used to reinnervate the suprascapular nerve. Results were good or excellent in 79 percent of the patients for the supraspinatus muscle and in 55 percent for the infraspinatus. There was a statistically significant difference between direct spinal accessory to suprascapular nerve neurotization and accessory to suprascapular via a nerve graft. Early surgery and less than 6 months of denervation time yielded significantly better results than late surgery and more than 6 months of delay in the treatment. Suprascapular nerve neurotization is a high priority in upper limb reanimation for restoration of glenohumeral joint stability, shoulder abduction, and external rotation. Concomitant neurotization of the axillary nerve yields improved outcomes in shoulder abduction function. The best results are seen when direct neurotization of the suprascapular nerve is performed within 6 months from the injury.

Does a delay between diagnosis and radical prostatectomy increase the risk of disease recurrence?

Men diagnosed with clinically localized prostate carcinoma have several treatment options. The investigation of these options may delay the initiation of definitive therapy. In the current study, the authors evaluated whether time from biopsy to radical prostatectomy (RP) was predictive of postoperative biochemical disease recurrence (BCR). A total of 3149 consecutive patients who underwent RP as their initial treatment for prostate carcinoma within a year of diagnosis were identified. The time between diagnosis and RP was entered as a predictor in a multivariate logistic regression model predicting BCR at 3 years, 5 years, 8 years, and 10 years. The year surgery was performed and the nomogram-predicted probability of recurrence, which incorporates stage of disease, Gleason grade, and prostate-specific antigen (PSA) level, were used as covariates. The authors found no clear evidence of a significant effect of delay to diagnosis on BCR. For those patients treated within 6 months (96% of the total sample) the odds ratio for each additional month of delay was 1.04, 1.07, 1.08, and 1.02, respectively, for 3-year, 5-year, 8-year, and 10-year BCR-free survival (P>0.2 for all analyses). However, the 95% confidence intervals were wide and included the possibility that even a minor delay in surgery might have a large impact on the probability of BCR. The time between biopsy and surgery does not appear to have a large effect on the risk of disease recurrence. Counseling patients on the importance of avoiding undue delay to surgery must be based on clinical judgment, particularly with respect to modifying advice based on the patient's risk.