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To describe a novel syphon ureteral access sheath (UAS) intended for use during flexible uretero-renoscopy (fURS). We aimed to report on a pilot study as well as intrarenal pressures (IRP) and irrigant flow volumes compared to traditional UAS. Patients undergoing routine fURS for single, <2cm intrarenal nephrolithiasis were identified, and written informed consent was obtained. Irrigation via the fURS was instilled through the novel 11/13 Fr UAS without (a proxy for a traditional UAS) and with the novel syphon box attached. Measured minute irrigant flow volume, steady state and bolus IRP were compared. Ten participants (6 males and 4 females) were treated with the syphon UAS. All procedures were completed safely without intraoperative complications. The mean baseline IRP with and without the syphon was 18 vs 29 mmHG (P <.001, SD 4.0 vs 4.8). The mean minute irrigant flow volume with and without the syphon was 31 vs 21 ml (P <.001, SD 6.4 vs 3.3). The mean peak IRP following a 10 ml bolus with and without the syphon was 71 vs 104 mmHg (P =.03, SD 74 vs 59). The described novel UAS is different from traditional devices by incorporating a syphon mechanism. This pilot trial demonstrates that the novel syphon UAS may hold clinical potential to reduce IRP and increase irrigant flow compared to traditional UAS. Firm conclusions about efficacy and safety require assessment of the device in a larger clinical trial. [ABSTRACT FROM AUTHOR]

Objective: To describe a novel syphoning ureteric access sheath (UAS) intended for use during flexible ureterorenoscopy (URS). We aimed to assess if in vitro it could reduce intrarenal pressure (IRP) and increase irrigant flow compared to traditional UASs. Materials and Methods: A validated phantom kidney with fibre optic pressure sensing capabilities was used to assess the IRP. Standardised 80 cmH2O irrigation via a ureterorenoscope was instilled through traditional UASs (11/13 and 12/14 F) and compared to the novel 11/13‐F syphoning UAS. The measured minute volume, calculated hourly flow volume, and steady state IRP were compared. Results: The traditional 11/13 and 12/14‐F UASs had statistically poorer irrigant flow than the novel syphoning UAS, at 19.3 vs 29.3 mL/min (P < 0.001) and 22.7 vs 29.3 mL/min (P = 0.002), respectively. The steady state IRP was 20 mmHg for the traditional 11/13 F and 13 mmHg for the 12/14 F compared to 0 mmHg for the novel UAS. Conclusion: The described novel UAS is different from traditional devices by incorporating a syphon mechanism. Our in vitro assessment demonstrates that the novel UAS holds clinical potential to reduce IRP while allowing a significant increase in irrigant flow compared to larger diameter traditional UASs. [ABSTRACT FROM AUTHOR]

Background and Aim: Precise needle puncture of the renal collecting system is an essential step for effective percutaneous nephrolithotomy (PCNL). The use of ultrasound for puncture is receiving increased attention. Ultrasound has recognized limitations related to poor observation of the needle tip. We aimed to assess whether an affordable open-source computerized needle navigation training system, using optically tracked ultrasonography, could improve performance of simulated PCNL puncture by urologic trainees, compared with conventional free hand manual sonographic puncture. Materials and Methods: This study describes a PCNL navigation system that can be recreated with any standard ultrasound machine using relatively inexpensive components. The system allows the needle tip to be precisely appreciated in the ultrasound image, its trajectory planned, and the appreciation of needle tip to target calix proximity sound effect. Eight participants (six trainees and two qualified urologists) assessed the PCNL training model. Alternating starting with freehand (control) and tracked needle (experimental) punctures were performed on a phantom kidney. Total procedure and the number of reinsertions required were recorded. Results: The mean time for freehand puncture was 89 seconds (range 13–173), whereas that of the optically tracked needle was 36 seconds (range 12–72). Thus, puncture time was significantly reduced by an average of 53 seconds (p = 0.045) in the experimental arm. The mean number of needle reinsertions was 3.3 with freehand compared with 1.3 in the optically tracked puncture (p = 0.005). The mean square root error of the optical tracking system was 1.8 mm (four calibrations averaged). Conclusion: This study demonstrates that affordable hardware and open-source software can be used to construct an optically tracked ultrasound navigation system for PCNL training. Statistically significant reduced puncture time and number of passes required for effective puncture are demonstrated. We feel that computerized needle tracking during PCNL puncture deserves further evaluation in a training and, potentially, in a clinical setting. [ABSTRACT FROM AUTHOR]

Majority of patients with unilateral hydronephrosis (HN) detected on ultrasound do not require pyeloplasty. The measurement of the cortical transit time (CTT) has been demonstrated by several authors to predict the need for patients who may require pyeloplasty. The study aimed to assess if CTT would have predicted a drop in differential renal function (DRF) in patients with unilateral HN on the affected side and to assess whether CTT would differ on the first renogram between those patients who had a pyeloplasty and those who did not have a pyeloplasty. Sixty-eight patients with at least two renograms with unilateral HN with a normal contralateral kidney were observed retrospectively. The CTT was recorded for each kidney. Renograms were processed three times to measure the DRF. The mean of the three DRF measurements was used for analysis. The mean CTT of the left and right hydronephrotic kidneys was 6.0 min and 6.7 min, respectively. The relationship between CTT and DRF as well as CTT and anterior posterior diameter in the first renogram of those patients who did not have a pyeloplasty was statistically significant (P < 0.05). In the 20 patients who had a pyeloplasty, there was a drop of more than 10% in the DRF of three patients. No significant difference was found in CTT or DRF when comparing the group who had surgery against the group who did not have surgery. The current study was unable to demonstrate in our series of patients that CTT can predict a drop in DRF in those patients who would require pyeloplasty. [ABSTRACT FROM AUTHOR]

Background: If untreated, paediatric neurogenic bladder can cause renal failure and urinary incontinence. It is usually caused by neural tube defects such as myelomeningocele. Children with a neurogenic bladder should be monitored from birth and management should aim to preserve renal function and achieve social continence. This article outlines the management options appropriate for these children in resource-poor settings. Assessment: In most low- and middle-income countries, a general lack of awareness of the neurological effects on the urinary tract results in late presentation, usually with urological complications even when spina bifida is diagnosed early. Physical examination must include neurological examination for spinal deformities and intact sacral reflexes. About 90% of children with occult spinal dysraphisms will have cutaneous sacral lesions. The work-up includes urinalysis, serial ultrasound of the urinary tracts and urodynamics. Urodynamic assessment is essential for the diagnosis and prognosis of the paediatric neurogenic bladder. In poorly resourced settings, simple eyeball urodynamics can be performed in the absence of a conventional urodynamic set-up. Treatment: Clean intermittent catheterisation (CIC), the mainstay of treatment, is most suitable for resource-poor settings because it is effective and inexpensive. Antimuscarinic drugs such as oxybutynin complement CIC by reducing detrusor overactivity. Intravesical injection of Botox and bladder augmentation surgery is required by a small subset of patients who fail to respond to combined CIC and oxybutynin therapy. Conclusion: Children with neurogenic bladder in resource-poor settings should have early bladder management to preserve renal function and provide social continence. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 50-year-old male admitted in 2013 with methicillin-sensitive Staphylococcus aureus bacteremia and aortic valve endocarditis. Other medical history includes paroxysmal atrial fibrillation, end stage renal disease, and hypertension. The patient underwent intraoperative pulmonary vein isolation, epicardial left atrial appendage closure, and bioprosthetic aortic valve replacement.

Examines the occurrence thyroid disease in pregnancy. Role of human chorionic gonadotrophin in the physiology of pregnancy; Effect of iron deficiency on thyroid disease; Increase of sialic acid residues.

Abstract: Blunt abdominal trauma results in renal injury in 10% of paediatric cases. Over the last twenty years, the management of paediatric renal trauma has shifted towards a primarily non-operative approach that is now well-established for children up to 18 years old. This retrospective study reviews our experiences of non-operatively managing blunt renal trauma in a very young cohort of patients up to 11 years old. Between June 2006 and June 2010, 118 children presented to the Red Cross War Memorial Children''s Hospital in Cape Town with blunt abdominal trauma. 16 patients shown to have sustained renal injury on abdominal computed tomography (CT) scanning were included in this study. Medical records were reviewed for the mechanism of injury, severity of renal injury, clinical presentation, associated injuries, management method and clinical outcomes. All renal injuries were graded (I–V) according to the American Association for the Surgery of Trauma Organ Injury Severity Scale. All renal trauma patients included in this study were aged between 1 and 11 years (mean of 6.5 years). 1 patient sustained grade V injuries; 2 grade IV, 6 grade III and 7 grade I injuries. The majority of injuries (9/16) were caused by motor vehicle crashes, whilst 5 children fell from height, 1 was struck by a falling tree and 1 hit by a moving train. 1 of 16 patients was haemodynamically unstable on presentation as a result of multiple splenic and hepatic lacerations. He was resuscitated and underwent immediate laparotomy. However, his renal injuries were not indications for surgical management. 15 haemodynamically stable patients were non-operatively managed for their renal injuries. Following lengths of admissions ranging from 4 to 132 days, all 16 patients were successfully discharged with no mortalities. No significant complications of renal trauma, such as new-onset hypertension, were detected during their first follow up outpatient appointments. Our findings successfully extend non-operative management of haemodynamically stable renal injuries to a very young cohort up to 11 years old. However, we still advocate immediate resuscitation and surgical intervention for any haemodynamically unstable child who had sustained any abdominal injury. We also argue for a limited role for abdominal CT imaging for diagnosing renal injury and routine follow up, instead recommending a greater emphasis on clinical observations for possible complications. [Copyright &y& Elsevier]

This article focuses on the role of urodynamics in the diagnosis, treatment planning and surveillance of patients with neurogenic lower urinary tract dysfunction (UDS). The causes of neurogenic bladder dysfunction include neural tube defects, anorectal malformations and spinal cord trauma and tumours. To assess the disorder, it recommends that the medical history be based on the past and present bladder, bowel and sexual function.

Background: Children born to women with low thyroid hormone levels have been reported to have decreased cognitive function. Methods: We conducted a randomized trial in which pregnant women at a gestation of 15 weeks 6 days or less provided blood samples for measurement of thyrotropin and free thyroxine (T4). Women were assigned to a screening group (in which measurements were obtained immediately) or a control group (in which serum was stored and measurements were obtained shortly after delivery). Thyrotropin levels above the 97.5th percentile, free T4 levels below the 2.5th percentile, or both were considered a positive screening result. Women with positive findings in the screening group were assigned to 150 μg of levothyroxine per day. The primary outcome was IQ at 3 years of age in children of women with positive results, as measured by psychologists who were unaware of the group assignments. Results: Of 21,846 women who provided blood samples (at a median gestational age of 12 weeks 3 days), 390 women in the screening group and 404 in the control group tested positive. The median gestational age at the start of levothyroxine treatment was 13 weeks 3 days; treatment was adjusted as needed to achieve a target thyrotropin level of 0.1 to 1.0 mIU per liter. Among the children of women with positive results, the mean IQ scores were 99.2 and 100.0 in the screening and control groups, respectively (difference, 0.8; 95% confidence interval [CI], −1.1 to 2.6; P=0.40 by intention-to-treat analysis); the proportions of children with an IQ of less than 85 were 12.1% in the screening group and 14.1% in the control group (difference, 2.1 percentage points; 95% CI, −2.6 to 6.7; P=0.39). An on-treatment analysis showed similar results. Conclusions: Antenatal screening (at a median gestational age of 12 weeks 3 days) and maternal treatment for hypothyroidism did not result in improved cognitive function in children at 3 years of age. (Funded by the Wellcome Trust UK and Compagnia di San Paulo, Turin; Current Controlled Trials number, ISRCTN46178175.) [ABSTRACT FROM PUBLISHER]

Borrelia burgdorferi is a spirochetal bacterium that causes Lyme disease. These studies address whether current research methods using either ELISA to detect seroconversion to B. burgdorferi antigens or PCR quantification of bacterial DNA within tissues can accurately distinguish between a productive infection versus a B. burgdorferi exposure that is rapidly cleared by the innate responses. Mice receiving even minimal doses of live B. burgdorferi produced significantly more B. burgdorferi-specific IgM and IgG than groups receiving large inocula of heat-killed bacteria. Additionally, sera from mice injected with varied doses of killed B. burgdorferi recognized unique borrelial antigens compared to mice infected with live B. burgdorferi. Intradermal injection of killed B. burgdorferi resulted in rapid DNA clearance from skin, whereas DNA was consistently detected in skin inoculated with viable B. burgdorferi. These data indicate that both ELISA-based serological analyses and PCR-based methods of assessing B. burgdorferi infection clearly distinguish between an established infection with live bacteria and exposure to large numbers of bacteria that are promptly cleared by the innate responses. [ABSTRACT FROM AUTHOR]

Thyroid hormones are important in the development of the fetus and the placenta as well as in maintaining maternal wellbeing. Thyroid disorders are common in the population as a whole, particularly in women, and therefore are common during pregnancy and the puerperium. Biochemical derangement of thyroid function tests are present in approximately 2.5–5% of pregnant women. [ABSTRACT FROM PUBLISHER]

The article presents a study on the iodine status of schoolgirls in Great Britain. It states that iodine deficiency is the most common cause of mental impairment worldwide and the country has no mandate of food or salt iodination. It discusses how the study was conducted, its findings, and interpretation of the results. The findings reportedly suggest that Great Britain is iodine deficient and highlights the need for immediate measures as developing fetus are susceptible to its effects.

AbstractBackground and Purpose:Precise needle puncture of the renal collecting system is an essential step for successful percutaneous nephrolithotomy (PCNL). Puncture is technically challenging and has many pitfalls for the urologic surgeon. We describe the development of a novel navigation system, the Locator, to assist accurate percutaneous needle placement and compare this with conventional manual techniques.Materials and Methods:The essence of the device is that it stabilizes the needle for PCNL puncture. It relies on an adjustable lockable multidirectional head that is securely fixed to the operating table. The radiolucent head holds a 10F metal guide that allows renal collecting system puncture. The system uses the traditional fluoroscopic “bull's-eye sign” to achieve precise and fixed alignment. Objective assessment was obtained by in vitrotesting using simulated PCNL puncture with and without using the Locator. Time to successful puncture and fluoroscopy screening time (FST) was assessed.Results:Six urologic trainees were recruited to test the Locator. Simulated PCNL puncture was quicker and with reduced fluoroscopy when the apparatus was used. The mean FST for traditional hand vsLocator puncture was 46 vs16 seconds (P= 0.03), and the mean time to puncture was 225 vs118 seconds (P= 0.26).Conclusion:The Locator is a simple, cheap, and novel assistant to achieving successful PCNL puncture. It achieves this by stabilizing the needle during puncture. Preliminary in vitrotesting suggests that the device may reduce fluoroscopy exposure and be quicker. The device warrants further evaluation in the clinical setting. [ABSTRACT FROM AUTHOR]

There is a high incidence of thyroid dysfunction during pregnancy resulting in adverse maternal (miscarriages, anaemia in pregnancy, preeclampsia, abruptio placenta and post-partum haemorrhage) and fetal effects (premature birth, low birth weight, increased neonatal respiratory distress) which may justify screening for thyroid function during early pregnancy with interventional levothyroxine therapy for thyroid hypofunction. There is a greater prevalence of subclinical hypothyroidism in women with delivery before 32 weeks and there is even an association between thyroid autoimmunity and adverse obstetric outcome, which is independent of thyroid function. Higher maternal TSH levels even within the normal reference range are associated with an increased risk of miscarriages, fetal and neonatal distress and preterm delivery. There are few prospective randomised trials to substantiate the benefit of screening and the recently reported CATS study did not show a benefit in child IQ at age 3 years. Nevertheless there seems to be a case for screening to prevent adverse obstetric outcomes. The clinical epidemiological evidence base does not justify universal screening at the present time. However, it is probable that more evidence will be produced which may alter this view in the future. [ABSTRACT FROM AUTHOR]

Explaining human cooperation continues to present a challenge because it goes beyond what is predicted by established theories of kinship and reciprocal altruism. Little attention has been paid to the sexual selection hypothesis that proposes that cooperation can act as a display that attracts mates. The costs of cooperating are then offset not by kinship or reciprocation but by increased mating success. Here we present results from a series of experiments which show that, as predicted by the sexual selection hypothesis, people preferentially direct cooperative behavior towards more attractive members of the opposite sex. Furthermore, cooperative behavior increases the perceived attractiveness of the cooperator. Economically costly behaviors can therefore bring benefits through mate choice and sexual selection should be regarded as an evolutionary mechanism capable of promoting cooperation. [ABSTRACT FROM AUTHOR]

Background: A major cornerstone of evolutionary biology theory is the explanation of the emergence of cooperation in communities of selfish individuals. There is an unexplained tendency in the plant and animal world -- with examples from alpine plants, worms, fish, mole-rats, monkeys and humans -- for cooperation to flourish where the environment is more adverse (harsher) or more unpredictable. Results: Using mathematical arguments and computer simulations we show that in more adverse environments individuals perceive their resources to be more unpredictable, and that this unpredictability favours cooperation. First we show analytically that in a more adverse environment the individual experiences greater perceived uncertainty. Second we show through a simulation study that more perceived uncertainty implies higher level of cooperation in communities of selfish individuals. Conclusion: This study captures the essential features of the natural examples: the positive impact of resource adversity or uncertainty on cooperation. These newly discovered connections between environmental adversity, uncertainty and cooperation help to explain the emergence and evolution of cooperation in animal and human societies. [ABSTRACT FROM AUTHOR]

Pregnancy has an effect on thyroid economy with significant changes in iodine metabolism, serum thyroid binding proteins, and the development of maternal goiter especially in iodine-deficient areas. Pregnancy is also accompanied by immunologic changes, mainly characterized by a shift from a T helper-1 (Th1) lymphocyte to a Th2 lymphocyte state. Thyroid peroxidase antibodies are present in 10% of women at 14 weeks’ gestation, and are associated with (i) an increased pregnancy failure (i.e. abortion), (ii) an increased incidence of gestational thyroid dysfunction, and (iii) a predisposition to postpartum thyroiditis. Thyroid function should be measured in women with severe hyperemesis gravidarum but not in every patient with nausea and vomiting during pregnancy. Graves hyperthyroidism during pregnancy is best managed with propylthiouracil administered throughout gestation. Thyroid-stimulating hormone-receptor antibody measurements at 36 weeks’ gestation are predictive of transient neonatal hyperthyroidism, and should be checked even in previously treated patients receiving thyroxine. Postpartum exacerbation of hyperthyroidism is common, and should be evaluated in women with Graves disease not on treatment. Radioiodine therapy in pregnancy is absolutely contraindicated. Hypothyroidism (including subclinical hypothyroidism) occurs in about 2.5% of pregnancies, and may lead to obstetric and neonatal complications as well as being a cause of infertility. During the last few decades, evidence has been presented to underpin the critical importance of adequate fetal thyroid hormone levels in order to ensure normal central and peripheral nervous system maturation. In iodine-deficient and iodine-sufficient areas, low maternal circulating thyroxine levels have been associated with a significant decrement in child IQ and development. These data suggest the advisability of further evaluation for a screening program early in pregnancy to identify women with hypothyroxinemia, and the initiation of prompt treatment for its correction. Hypothyroidism in pregnancy is treated with a larger dose of thyroxine than in the nonpregnant state. Postpartum thyroid dysfunction (PPTD) occurs in 50% of women found to have thyroid peroxidase antibodies in early pregnancy. The hypothyroid phase of PPTD is symptomatic and requires thyroxine therapy. A high incidence (25–30%) of permanent hypothyroidism has been noted in these women. Women having transient PPTD with hypothyroidism should be monitored frequently, as there is a 50% chance of these patients developing hypothyroidism during the next 7 years. [ABSTRACT FROM AUTHOR]

Socially monogamous birds pursuing extra-pair reproductive strategies may be in conflict, both sexes seeking new mates or copulations outside the pair, while simultaneously attempting to prevent infidelity by the partner. Intra-pair conflicts are augmented by inter-pair conflicts when pairs meet, when all four individuals may be sexually attracted to one member of the other pair while seeking to prevent their mate from copulating, or deserting, with the other. We studied the dynamics, signalling and resolution of these conflicts in a field experiment with the harlequin duck, recording responses to single model birds of both sexes, and to model pairs. Both sexes mate guarded by placing themselves between the mate and a model competitor, and by signalling with the head nod display. Females were closer to model pairs than their mates. Female mate guarding responded adaptively to infidelity risk, increasing to models of paired females, single females and single females inviting copulation, respectively. Males head nodded to signal the goal of (extra-pair) copulation, pairing or mate switching. Courtship by unpaired males increased to models of paired females, single females and single females inviting copulation, respectively. Paired males courted these models equally, perhaps inhibited by the parallel increase in mate guarding of their mates. Males signalled mate guarding using the head nod more than females, but this predicted difference in mate guarding was not shown for the measure of relative proximity to the models. In spite of male extra-pair courtship the harlequin is strictly monogamous, due to female fidelity and close mate guarding. The use of models revealed mate guarding by females, and failed extra-pair reproductive attempts by males, neither of which were apparent from observational studies alone. [ABSTRACT FROM AUTHOR]

The issue regarding patients with subclinical hypothyroidism and whether they should be treated has been debated for many years in clinical endocrinology. The main concerns are the cardiovascular and hyperlipidaemic risks associated with this condition, in addition to the risk that these patients have of developing neuropyschiatric features while progressing to overt hypothyroidism. Early detection, potential benefits of longterm treatment and patient satisfaction associated with the alleviation of symptoms are all important aspects of therapy. Here, we detail many studies, including randomized control trials and case–control studies, that demonstrate the benefits of thyroxine replacement therapy on cognition, symptoms such as dry skin and low mood (among others), the cardiovascular system and plasma lipids. We conclude that it is better to treat this not uncommon condition by showing the benefits of early replacement therapy in selected groups. [Copyright &y& Elsevier]

Endourology plays an important role in modern urological practice. Compared to open surgery, it offers many advantages. In Africa, endourology is not widely practiced or non‐existent in some referral centres. Several factors have been linked to this challenge. This article explores and proposes strategies to improve endourology practice in the African context. Recognising the unique challenges and opportunities in the region, the document discusses key initiatives and recommendations to promote the growth and development of endourological practices, including the identification of local needs, training, technological adaptation, etc. It aims to provide valuable information on the advancement of endourology in Africa. [ABSTRACT FROM AUTHOR]

To report on the design of a novel 3D-printed retrograde intrarenal surgery (RIRS) benchtop trainer and detail its validation against real-life experiences. Digital Imaging and Communications in Medicine (DICOM) files of 2 patients with normal computed tomography of the kidney and bladder were converted into stereolithography files to create 3D triangular mesh models. These images were further refined using Autodesk Meshmixer. These 3D models were fabricated through additive manufacturing, a process commonly known as 3D printing, and assembled in a polypropylene case. After development, the model was validated by 40 experienced urologists and urology residents in their final year of training. They were asked to rate the components of the simulation using a 9-point questionnaire. The model's value in understanding the principles of RIRS and simulating contextual anatomy had mean scores of 9.43 (standard deviation [SD] = 0.74) and 9.21 (SD = 1.03), respectively. Mean scores for specific steps in RIRS were 8.07 (SD 1.47) for cannulating the ureteric orifice, 8.61 (SD 1.24) for inserting the ureteric access sheath, 9.29 (SD 0.97) for performing a renoscopy and evaluating all the calyces, 9.46 (SD 0.87) for laser lithotripsy, and 9.17 (SD 0.94) for manual stone retrieval. Participants scored the model with a mean score of 9.04 (SD 0.87) regarding realism and a mean score of 9.18 (SD 0.89) when evaluating its ability to enhance a trainee's confidence in RIRS. The model performed well for all components of RIRS. This model allows high fidelity of the simulation and is cost-effective, portable, durable, reusable, and compatible with standard ureteroscopes. [ABSTRACT FROM AUTHOR]

• Hypothesis: negativity bias evolves when fitness is a concave function of state. • Threat explanation of negativity bias unsound if based on incommensurate stimuli. • Incommensurate stimuli can be studied for bias using the loss aversion paradigm. • The 'potency equivalence function' measures equipotency of incommensurate stimuli. Across many psychological domains there is evidence of negativity bias: the greater subjective potency of negative events when compared with positive events of the same objective magnitude. Here I propose a general evolutionary explanation for the phenomenon: the concave fitness-state (CFS) hypothesis. The CFS hypothesis proposes, with evidence from feeding, drinking and economic domains, that various motivational, emotional and cognitive states – through which stimuli activate responses – have a concave downwards (diminishing returns) relationship with fitness. Where this is the case it follows that a reduction in state, due to a negative stimulus, reduces fitness more than a positive stimulus of equal objective magnitude increases it, producing – the hypothesis consequently predicts – a negativity bias due to the difference in subjective stimulus potency. In discussing other approaches to understanding the phenomenon I critique the proposal that negativity bias can be explained as an adaptive response to the particular importance and urgency of dealing with threat, by arguing that: (1) where negative stimuli interpretable as threat, and contrasting positive stimuli, cannot be measured in a commensurate manner they cannot be validly tested for negativity bias; and (2) since threat stimuli and positive stimuli generally impact different states a greater potency for threat stimuli should generally be interpreted in terms of motivational competition rather than negativity bias. I suggest two ways of circumventing the problem of incommensurate stimuli when studying stimulus bias. The first is to use the loss aversion paradigm: rating the value of the same stimulus when presented as either a gain or a loss in relation to a reference value. Second, understanding the relative subjective potencies of positive and negative stimuli across a range of objective stimulus magnitudes, even when incommensurate, can be achieved experimentally by finding pairs of positive and negative stimuli which, though measured on different scales of magnitude, are equipotent. That is, they have equal and opposite effects on fitness, well-being or stimulus evaluation. These stimulus pairs constitute a potency equivalence function , which describes the shape of the relationship between equipotent positive and negative stimulus magnitudes. [ABSTRACT FROM AUTHOR]

Body size in male animals has profound effects on fitness; large males are commonly favored by sexual selection. However, if body size is a stable trait, then advantages of large size must be balanced by disadvantages. In males of the midge Chironomus plumosus we identified the trade-offs that result in stabilizing selection on body size. The smallest individuals have the greatest mating advantage in swarms, perhaps due to their greater agility in capturing females. This measure of mating success in the individual's own swarm was corrected to a population-level measure to take account of the positive correlation between body size and swarm size, the relationship between swarm size and mating success, and the distribution of swarm sizes on an evening. The small male advantage is maintained in the population-level measure. In contrast, large males have greater fecundity and, when unfed, live longer and can remain longer in the swarm each evening (due to their greater stamina). Consequently, lifetime reproductive success is greatest for males of intermediate size, and the most successful body-size class dosely matches the most frequent class in the wild. This represents, to our knowledge, the first evidence of stabilizing selection on body size in males of an insect species, as measured by trade-offs in lifetime reproductive success. [ABSTRACT FROM AUTHOR]

Reports on the moment-to-moment behavioral dynamics of sticklebacks. Search for possible strategies of cooperative behavior during predator inspection; Predation risk; Sequence analysis of behavioral exchanges during pair-wise inspection visits; Selective forces that favor the behavioral adjustments in stickleback populations; Sites for inspection.

Discusses hyperthyroidism, the excess circulating concentrations of thyroid hormones. Prevalence of hyperthyroidism in women; Its clinical features; Its pathophysiology; Diagnosis and management of hyperthyroidism. INSET: Aetiology of hyperthyroidism..

This report describes the use of a biosynthetic graft (Permacol) derived from porcine dermal collagen to reconstruct the abdominal wall of a 2-year-old boy with classic bladder exstrophy. The child had undergone 2 previous failed attempts at closure. [ABSTRACT FROM AUTHOR]

Adult survivors of childhood Wilms tumor are at an increased risk of a second malignancy. Renal cell carcinoma is not thought to be an associated late malignancy. We present a case report of an adult survivor of Wilms tumor who was treated for renal cell carcinoma. The present case, along with the published data, indicates the possibility of such an association. Our findings highlight the need for renal surveillance and to consider nephron-sparing surgery in future Wilms tumor treatment protocols. [Copyright &y& Elsevier]

Introduction: Retrograde intrarenal surgery (RIRS) is associated with complications, many of which are related to the intrarenal pressure (IRP). We aim to describe the design of a novel isoprenaline-eluting guidewire ("IsoWire") and present the results from the first in vitro release studies and the first animal studies showing its effect on IRP. Materials and Methods: The IsoWire comprises a Nitinol core surrounded by a stainless-steel wire wound into a tight coil. The grooves created by this coil provided a reservoir for adding a hydrogel coating into which isoprenaline, a beta-agonist, was loaded. Animal studies were performed using a porcine model. For the control, IRP, heart rate (HR), and mean arterial pressure (MAP) were measured continuously for 6 minutes with a standard guidewire in place. For the experiment, the standard hydrophilic guidewire was removed, the IsoWire was inserted into the renal pelvis, and the same parameters were measured. Results:In vitro analysis of the isoprenaline release profile showed that most (63.9 ± 5.9%) of the loaded drug mass was released in the 1st minute, and almost all of the drug was released in the first 4 minutes exponentially. Porcine studies showed a 25.1% reduction in IRP in the IsoWire that released 10 μg in the 1st minute; however, there was a marked increase in HR. The average percentage reduction in IRP was 8.95% and 21.3% in the IsoWire that released 5 and 7.5 μg of isoprenaline, respectively, with no changes in HR or MAP. Conclusions: The IsoWire, which releases 5 and 7.5 μg of isoprenaline in the 1st minute, appears to be safe and effective in reducing the IRP. Further studies are needed to establish whether the isoprenaline-induced ureteral relaxation will render easier insertion of a ureteral access sheath, reduce IRP during sheathless RIRS, or even promote the practice of sheathless RIRS. [ABSTRACT FROM AUTHOR]

Explores the disease entity transient neonatal hyperthyrotrophinemia, a serum disorder due to transplacentally acquired antibody to thyroid stimulating hormone. Increase in high concentration of thyroid to both fetal and maternal serum; Inhibition of the action of the hormone in an in vitro bioassay; Need for the maternal serum to be assayed.

Reports on an experiment on wild house sparrows, Passer domesticus, and starlings, Sturnus vulgaris, in which distance from protective and obstructive cover had contrasting effects on vigilance as predicted by compensatory logic. Methods; Results.

A letter to the editor is presented in response to the article "Iodine in Malt Whisky: A Preliminary Analysis" by John H. Lazarus and colleagues from the previous issue.

We report the case of an 8-year-old boy who presented with a painless paratesticlar mass. At surgery, contrary to the clinical suspicion of a nonbenign lesion, granulomatous inflammation of an indirect inguinal hernia was observed. Tubercles were seen to line a patent processus vaginalis. Histopathologic analysis confirmed the diagnosis of tuberculosis. We review abdominal tuberculosis and discuss the diagnostic difficulties it presents particularly in the context of the unusual presentation in our patient. [ABSTRACT FROM AUTHOR]

BACKGROUND Pregnant women who are thyroid peroxidase antibody (TPOAb)-positive have an increased risk of postpartum thyroid dysfunction (PPTD) and permanent hypothyroidism. OBJECTIVE To determine whether selenium supplementation can ameliorate thyroid autoimmunity and dysfunction during pregnancy and the postpartum period. DESIGN AND INTERVENTION This was a prospective, randomized, placebo-controlled study of pregnant women who attended a single center in Italy. Women with pre-existing or newly diagnosed thyroid dysfunction were excluded from the study, as were those prescribed medication known to affect thyroid function. After 12 weeks of gestation, TPOAb-positive women were randomly allocated to receive 200 Hg seleno-methionine or placebo daily. A control group of age-matched TPOAb-negative women did not receive either treatment; however, all participants were advised to consume iodized salt in their diet. Thyroid function tests were performed at enrollment, at 20 and 30 weeks of gestation, at delivery, and at months 1-2, 5, 9, and 12 postpartum. Levothyrexine therapy was initiated during pregnancy if TSH and/or free T4 levels were abnormal. Postpartum hypothyroidism was defined as a TSH level above the normal range, whereas postpartum hyperthyroidism was defined as a TSH level below the normal range. Thyroid ultrasonography was performed during pregnancy, at delivery, and at 12 months postpartum. Thyroid echogenicity was classified as normal or as mild, moderate, or advanced thyroiditis. OUTCOME MEASURE The primary outcome measure was the prevalence of PPTD. RESULTS The selenium, placebo, and control groups comprised 85, 84, and 84 women, respectively. TSH levels at enrollment were higher in the TPOAb-positive women than in the TPOAb-negative women (P

Comments on V.J. Pop and colleagues' article about the role of thyroid hormones in fetal neurodevelopment. Association of free thyroxine levels with antithyroid peroxidase antibodies; Clinical correlate of hypothyroxinemia; Indentification of thyroid-dependent proteins.

Background Isolated maternal hypothyroxinaemia ( IH) is defined as low maternal FT4 (<5th percentile) and normal thyroid-stimulating hormone. There is concern on its potential negative effects on the mother and offspring. Objective We aimed to evaluate the prevalence of IH and to assess the consequences of hypothyroxinaemia on the maternal and foetal outcomes. Subjects and methods From a total of 1300 consecutive pregnant women recruited during the prenatal screen (mean gestational age, 11·8 weeks), thyroid function parameters were assessed in 879 women. After exclusion of women with T4 supplements, with twin pregnancies and with diabetes, data from 783 women were included. Maternal and neonatal outcomes in 55 selected women with IH and negative thyroid auto-antibodies without thyroid disorders or pregnancy achieved through assisted reproductive techniques were compared with a selected euthyroid control group ( N = 165). Results Among the 783 non diabetic singleton pregnant women, 68 women (8·7%) were identified with IH. When compared to the selected euthyroid controls, selected women with hypothyroxinaemia had significantly increased body mass index ( BMI) in preconception ( P = 0·003), in the first trimester ( P = 0·004) and at the time of delivery ( P = 0·001). At term, foetal breech presentation and caesarean section rate were significantly higher ( P = 0·006 and P = 0·026, respectively) than in the euthyroid controls. A significant increase in macrosomia was also noted ( P = 0·026). Conclusion The prevalence of hypothyroxinaemia in early pregnancy was of 8·7%. IH is associated with an increased maternal BMI and is related with a risk of breech presentation, a significant increase in macrosomia and caesarean sections. Screening should consider overweight as risk factor for hypothyroxinaemia. [ABSTRACT FROM AUTHOR]

This letter to the editor comments on an editorial printed in the July 12, 2008 issue regarding the consumption of iodised salt.

Operational sex ratio (OSR) is the correct sex ratio measure for predicting sociosexuality, but it is unclear whether this is the measure used. It would be valuable to know how OSR and sociosexuality correlate separately for males and females. The relationship between sociosexuality and OSR should also be examined with OSR measured at the local level of the mating market, where sex ratio must be having its psychological effects. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor in response to the article " Postpartum psychiatric disorders, " by A. Kashyap and colleagues in the March 27, 2004 issue.

Context Adequate iodine intake is essential throughout life. Key dietary sources are iodized salt and animal products, but dietary patterns in Europe are changing, for example toward lower salt intake and a more plant-based diet. Objective To review iodine intake (not status) in European populations (adults, children, and pregnant women) to identify at-risk groups and dietary sources. Data sources PubMed, Embase, and Cochrane databases, as well as European national nutrition surveys were searched for data on had iodine intake (from dietary assessment) and sources of iodine, collected after 2006. Data selection In total, 57 studies were included, comprising 22 national surveys and 35 sub-national studies. Iodine intake data were available from national surveys of children aged <10 years (n = 11), 11–17 years (n = 12), and adults (n = 15), but data from pregnancy were only available from sub-national studies. Results Iodine intake data are lacking—only 17 of 45 (38%) European countries had iodine-intake data from national surveys. Iodine intake reported from national surveys was below recommendations for: (1) children aged <10 years in 2 surveys (18%), (2) boys and girls aged 11–17 years in 6 (50%) and 8 (68%) surveys, respectively, and (3) adult men and women in 7 (47%) and 12 (80%) surveys, respectively. In pregnant women, intake was below recommendations except where women were taking iodine-containing supplements. Just 32% of national surveys (n = 7) included iodized salt when estimating iodine intake. Milk, dairy products, fish, and eggs were important contributors to intake in many countries, suggesting limited sources in plant-based diets. Conclusion Results are limited by the challenges of dietary assessment for measuring iodine intake. Future national surveys should include iodine intake. Policy makers should consider dietary sources alongside any iodized salt policies when considering methods for improving population iodine intake. Systematic Review Registration PROSPERO 2017 CRD42017075422. [ABSTRACT FROM AUTHOR]

Objective: Thyroid status in the months following radioiodine (RI) treatment for Graves' disease can be unstable. Our objective was to quantify frequency of abnormal thyroid function post‐RI and compare effectiveness of common management strategies. Design: Retrospective, multicentre and observational study. Patients: Adult patients with Graves' disease treated with RI with 12 months' follow‐up. Measurements: Euthyroidism was defined as both serum thyrotropin (thyroid‐stimulating hormone [TSH]) and free thyroxine (FT4) within their reference ranges or, when only one was available, it was within its reference range; hypothyroidism as TSH ≥ 10 mU/L, or subnormal FT4 regardless of TSH; hyperthyroidism as TSH below and FT4 above their reference ranges; dysthyroidism as the sum of hypo‐ and hyperthyroidism; subclinical hypothyroidism as normal FT4 and TSH between the upper limit of normal and <10 mU/L; and subclinical hyperthyroidism as low TSH and normal FT4. Results: Of 812 patients studied post‐RI, hypothyroidism occurred in 80.7% and hyperthyroidism in 48.6% of patients. Three principal post‐RI management strategies were employed: (a) antithyroid drugs alone, (b) levothyroxine alone, and (c) combination of the two. Differences among these were small. Adherence to national guidelines regarding monitoring thyroid function in the first 6 months was low (21.4%–28.7%). No negative outcomes (new‐onset/exacerbation of Graves' orbitopathy, weight gain, and cardiovascular events) were associated with dysthyroidism. There were significant differences in demographics, clinical practice, and thyroid status postradioiodine between centres. Conclusions: Dysthyroidism in the 12 months post‐RI was common. Differences between post‐RI strategies were small, suggesting these interventions alone are unlikely to address the high frequency of dysthyroidism. [ABSTRACT FROM AUTHOR]

Background: Burkholderia pseudomallei and Burkholderia mallei cause the diseases melioidosis and glanders, respectively. A well-studied aspect of pathogenesis by these closely-related bacteria is their ability to invade and multiply within eukaryotic cells. In contrast, the means by which B. pseudomallei and B. mallei adhere to cells are poorly defined. The purpose of this study was to identify adherence factors expressed by these organisms. Results: Comparative sequence analyses identified a gene product in the published genome of B. mallei strain ATCC23344 (locus # BMAA0649) that resembles the well-characterized Yersinia enterocolitica autotransporter adhesin YadA. The gene encoding this B. mallei protein, designated boaA, was expressed in Escherichia coli and shown to significantly increase adherence to human epithelial cell lines, specifically HEp2 (laryngeal cells) and A549 (type II pneumocytes), as well as to cultures of normal human bronchial epithelium (NHBE). Consistent with these findings, disruption of the boaA gene in B. mallei ATCC23344 reduced adherence to all three cell types by ∼50%. The genomes of the B. pseudomallei strains K96243 and DD503 were also found to contain boaA and inactivation of the gene in DD503 considerably decreased binding to monolayers of HEp2 and A549 cells and to NHBE cultures. A second YadA-like gene product highly similar to BoaA (65% identity) was identified in the published genomic sequence of B. pseudomallei strain K96243 (locus # BPSL1705). The gene specifying this protein, termed boaB, appears to be B. pseudomallei-specific. Quantitative attachment assays demonstrated that recombinant E. coli expressing BoaB displayed greater binding to A549 pneumocytes, HEp2 cells and NHBE cultures. Moreover, a boaB mutant of B. pseudomallei DD503 showed decreased adherence to these respiratory cells. Additionally, a B. pseudomallei strain lacking expression of both boaA and boaB was impaired in its ability to thrive inside J774A.1 murine macrophages, suggesting a possible role for these proteins in survival within professional phagocytic cells. Conclusions: The boaA and boaB genes specify adhesins that mediate adherence to epithelial cells of the human respiratory tract. The boaA gene product is shared by B. pseudomallei and B. mallei whereas BoaB appears to be a B. pseudomallei-specific adherence factor. [ABSTRACT FROM AUTHOR]

Abstract: The electoral impact of the environment issue has been debated for years. Thus far, evidence regarding the issue''s electoral impact has concentrated on the 1996 presidential election. Two of the three inquiries into that contest found that the environment had a significant impact on voters’ candidate choices. In an effort to clarify the environment''s electoral impact, this research expands the inquiry to include five presidential elections, 1984 through 2000. Findings indicate that the environment had a significant impact in four of these five elections—all but in 2000. The research goes on to examine reasons for variability in the environment''s impact, concluding that candidates who play the role of environmental villain/adversary have a surprisingly important role in the issue''s electoral strength. [Copyright &y& Elsevier]

The article presents an overview of the management of hyperthyroidism in pregnancy, which can lead to an increased risk of fetal loss, pre-eclampsia, heart failure and premature labor in pregnant women. A discussion of the prevalence of the disorder in pregnant women, and of the impact it can have on pregnancy, is presented. The differences between fetal and neonatal thyroid disorder are discussed. The treatment of hyperthyroidism in pregnant women, which involves the introduction of a choice of medications, is examined.

Background: This study was performed to determine clinical features of dysthyroid optic neuropathy (DON) across Europe. Methods: Forty seven patients with DON presented to seven European centres during one year. Local protocols for thyroid status, ophthalmic examination and further investigation were used. Each eye was classified as having definite, equivocal, or no DON. Results: Graves' hyperthyroidism occurred in the majority; 20% had received radioiodine. Of 94 eyes, 55 had definite and 17 equivocal DON. Median Clinical Activity Score was 4/7 but 25% scored 3 or less, indicating severe inflammation was not essential. Best corrected visual acuity was 6/9 (Snellen) or worse in 75% of DON eyes. Colour vision was reduced in 33 eyes, of which all but one had DON. Half of the DON eyes had normal optic disc appearance. In DON eyes proptosis was > 21 mm (significant) in 66% and visual fields abnormal in 71%. Orbital imaging showed apical muscle crowding in 88% of DON patients. Optic nerve stretch and fat prolapse were infrequently reported. Conclusion: Patients with DON may not have severe proptosis and orbital inflammation. Optic disc swelling, impaired colour vision and radiological evidence of apical optic nerve compression are the most useful clinical features in this series. [ABSTRACT FROM AUTHOR]

Evidence from the 1950s showed that Macedonia was iodine deficient. After the introduction of mandatory universal salt iodisation, the country saw a steady increase in iodine intake and decline in goitre prevalence, earning iodine-deficiency free status in 2003. Iodine status assessments in 2007 and 2016 showed adequate iodine intake among school age children (median urinary iodine concentration of 241 μg/L and 236 μg/L respectively). Macedonia participated in piloting the Iodine Global Network Programme Guidance on the use of iodised salt in industrially processed foods to better understand potential iodised salt intake from processed foods. One objective of implementation was to identify the need, opportunities, and required actions to strengthen the processed food component of the national salt iodisation policy. Data from the 2017 Household Consumption and Expenditure Survey (HCES) was used to determine household salt consumption, to identify widely-consumed, salt-containing industrially processed foods, and estimate typical daily intake of these foods. Their estimated contribution to iodine intake was estimated based on their salt content and the percentage of food industry salt that is iodised. Although the study has limitations, including a relatively small selection of foods, the results indicate potential iodine intake from iodised household salt and iodised salt in the selected foods of nearly 300% of the Estimated Average Requirement and over 220% of the Recommended Nutrient Intake for adults. This was approximately 50% of the tolerable safe Upper Level for iodine intake. The study confirmed high daily salt intake (11.2 grams from household salt only). Successful salt reduction would be expected to reduce iodine intake, however, modelling with 10% and 30% reduction implied this is unlikely to put any population group at risk of deficiency. It is recommended that implementation of salt iodisation and salt reduction policies are harmonized, alongside continued regular iodine status monitoring for different population groups. [ABSTRACT FROM AUTHOR]

Investigates a possible association between life events, postnatal depression and the development of thyroid dysfunction in women who are positive for thyroid antibodies. Definition of hyperthyroidism; Mean life event scores in depressed and non-depressed women; Association between life events, thyroid antibody status and Research Diagnostic Criteria depression.