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1.  The unsuitability of html-based colour charts for estimating animal colours – a comment on Berggren and Merilä (2004) 
Frontiers in Zoology  2005;2:14.
A variety of techniques are used to study the colours of animal signals, including the use of visual matching to colour charts. This paper aims to highlight why they are generally an unsatisfactory tool for the measurement and classification of animal colours and why colour codes based on HTML (really RGB) standards, as advocated in a recent paper, are particularly inappropriate. There are many theoretical arguments against the use of colour charts, not least that human colour vision differs markedly from that of most other animals. However, the focus of this paper is the concern that, even when applied to humans, there is no simple 1:1 mapping from an RGB colour space to the perceived colours in a chart (the results are both printer- and illumination-dependent). We support our criticisms with data from colour matching experiments with humans, involving self-made, printed colour charts.
Colour matching experiments with printed charts involving 11 subjects showed that the choices made by individuals were significantly different between charts that had exactly the same RGB values, but were produced from different printers. Furthermore, individual matches tended to vary under different lighting conditions. Spectrophotometry of the colour charts showed that the reflectance spectra of the charts varied greatly between printers and that equal steps in RGB space were often far from equal in terms of reflectance on the printed charts.
In addition to outlining theoretical criticisms of the use of colour charts, our empirical results show that: individuals vary in their perception of colours, that different printers produce strikingly different results when reproducing what should be the same chart, and that the characteristics of the light irradiating the surface do affect colour perception. Therefore, we urge great caution in the use of colour charts to study animal colour signals. They should be used only as a last resort and in full knowledge of their limitations, with specially produced charts made to high industry standards.
PMCID: PMC1201160  PMID: 16131394
2.  Punch biopsy of iris lesions: a novel technique for obtaining histology samples 
To obtain iris biopsy samples of sufficient quality and quantity for histopathological analysis using a novel punch biopsy technique.
Two patients underwent iris tumour biopsy at an ocular oncology service. A trabeculectomy punch (Kelly Descemet's membrane punch) with a 1.0 mm diameter head and a 0.75 mm deep bite was inserted through a clear cornea perforated by a SatinSlit 3.2 mm angled slit knife into a viscoelastic‐filled anterior chamber. The Kelly punch was placed over the lesion and pressed down before the punch was made. After obtaining the sample, the Kelly punch was removed from the eye and then opened over a dry cellulose sponge. Tissue samples were placed in 4% formalin and processed routinely for standard staining with H&E, periodic acid Schiff and immunostains.
In both patients, by using the punch biopsy technique with the Kelly punch, we were able to obtain a 0.8×0.6 mm piece of tissue, large enough for any histological analysis. H&E staining showed spindle cell melanoma. Tissue sections, stained positive with MART‐1 (melanoma antigen recognised by T cells) and negative with cytokeratin, established the diagnosis of melanoma of the iris in each of these patients.
Iris biopsy with the punch technique yields a tissue biopsy specimen, as opposed to cytology samples obtained by fine needle aspiration biopsy. This technique is quick, simple to perform and requires non‐expensive and easily available equipment. The tissue obtained is of sufficient quality and quantity to enable routine and special stainings.
PMCID: PMC1954730  PMID: 17446506
3.  A grand convergence in mortality is possible: comment on Global Health 2035 
The grand challenge in global health is the inequality in mortality and life expectancy between countries and within countries. According to Global Health 2035, the Lancet Commission celebrating the 20th anniversary of the World Development Report (WDR) of 1993, the world now has the unique opportunity to achieve a grand convergence in global mortality within a generation. This article comments on the main findings and recommendations of the Global Health 2035.
PMCID: PMC3937948  PMID: 24596900
Global Health; Investing in Health; Macro-Economic Benefits; Mortality Inequality
4.  Comment: Applications of robotics in the clinical laboratory 
The implementation of a robotic workstation in the clinical laboratory involves considerations and compromises common to any instrument design and development activity. The trade-off between speed and flexibility not only affects the way the instrument interacts with human operators and other devices (the ‘real-world interface’), but also places limitations on the adaptation of chemistries to the given instrument. Mechanical optimization for speed and reproducibility places restrictions on the imprecision of consumables. Attempts to adapt a robot to a constrained system may entail compromises that either degrades the theoretically-attainable quality of results, or requires human interaction to compensate for physical or mechanical limitations. The general considerations of function and workflow, programming and support, and reliability place practical limits on the implementation of robotic workstations in the clinical laboratory.
PMCID: PMC2547824  PMID: 18925267
5.  Response to Comment on “Log or Linear? Distinct Intuitions of the Number Scale in Western and Amazonian Indigene Cultures” 
Science (New York, N.Y.)  2009;323(5910):38.
The performance of the Mundurucu on the number-space task may exemplify a general competence for drawing analogies between space and other linear dimensions, but Mundurucu participants spontaneously chose number when other dimensions were available. Response placement may not reflect the subjective scale for numbers, but Cantlon et al.'s proposal of a linear scale with scalar variability requires additional hypotheses that are problematic.
PMCID: PMC3393850  PMID: 19119201
6.  Adolescents' experience of comments about their weight – prevalence, accuracy and effects on weight misperception 
BMC Public Health  2009;9:271.
Weight comments are commonly received by adolescents, but the accuracy of the comments and their effects on weight misperception are unclear. We assessed the prevalence and accuracy of weight comments received by Chinese adolescents from different sources and their relation to weight misperception.
In the Hong Kong Student Obesity Surveillance (HKSOS) project 2006–07, 22612 students aged 11–18 (41.5% boys) completed a questionnaire on obesity. Students responded if family members, peers and professionals had seriously commented over the past 30 days that they were "too fat" or "too thin" in two separate questions. The accuracy of the comments was judged against the actual weight status derived from self-reported height and weight. Self-perceived weight status was also reported and any discordance with the actual weight status denoted weight misperception. Logistic regression yielded adjusted odd ratios for weight misperception by the type of weight comments received.
One in three students received weight comments, and the mother was the most common source of weight comments. Health professional was the most accurate source of weight comments, yet less than half the comments were correct. Adolescents receiving incorrect comments had increased risk of having weight misperception in all weight status groups. Receiving conflicting comments was positively associated with weight misperception among normal weight adolescents. In contrast, underweight and overweight/obese adolescents receiving correct weight comments were less likely to have weight misperception.
Weight comments, mostly incorrect, were commonly received by Chinese adolescents in Hong Kong, and such incorrect comments were associated with weight misperception.
PMCID: PMC2731749  PMID: 19642972
7.  Can Social Contagion Help Global Health ‘Jump the Shark’? Comment on “How to Facilitate Social Contagion?”  
The instrumental use of social networks has become a central tenet of international health policy and advocacy since the Millennium project. In asking, ‘How to facilitate social contagion?’, Karl Blanchet of the London School of Hygiene and Tropical Medicine therefore reflects not only on the recent success, but also hints to growing challenges; the tactics of partnerships, alliances and platforms no longer seem to be delivering at the same rate and maybe reversing. A better understanding of how social networks work may therefore be needed to strengthen a tactical instrument that has been used to remarkable recent effect. But in focusing on the unbounded rhetoric and narrative options of Global Health, the danger will surely be on missing the fundamental factors constraining network growth. Future growth will depend on understanding these constraints, and Global Health may do well to think of social networks not only instrumentally, but also analytically in terms of the strategic contexts and environments in which such instruments are deployed.
PMCID: PMC3937907  PMID: 24596889
Health Systems; Social Network Analysis; Network Theory; Health Co-Production
8.  Comments on the nature of the bonding in oxygenated dinuclear copper enzyme models 
Journal of molecular structure  2006;764(1-3):77-86.
The nature of the bonding in model complexes of di-copper metalloenzymes has been analyzed by means of the electronic localization function (ELF) and by the quantum theory of atoms in molecules (QTAIM). The constrained space orbital variations (CSOV) approach has also been used. Density functional theory (DFT) and CASSCF calculations have been carried out on several models of tyrosinase such as the sole Cu2O22+ central core, the Cu2O2(NH3)62+ complex and the Cu2O2(Imidazol)62+ complex. The influence on the central Cu2O2 moiety of both levels of calculation and ligand environment have been discussed. The distinct bonding modes have been characterized for the two major known structures: [Cu2(μ–η2: η2–O2)]2+ and [Cu2(μ–O2)]2+. Particular attention has been given to the analysis of the O–O and Cu–O bonds and the nature of the bonding modes has also been analyzed in terms of mesomeric structures. The ELF topological approach shows a significant conservation of the topology between the DFT and CASSCF approaches. Particularly, three-center Cu–O–Cu bonds are observed when the ligands are attached to the central core. At the DFT level, the importance of self interaction effects are emphasized. Although, the DFT approach does not appear to be suitable for the computation of the electronic structure of the isolated Cu2O2 central core, competitive self interaction mechanisms lead to an imperfect but acceptable model when using imidazol ligands. Our results confirm to a certain extent the observations of [M.F. Rode, H.J. Werner, Theoretical Chemistry Accounts 4–5 (2005) 247.] who found a qualitative agreement between B3LYP and localized MRCI calculations when dealing with the Cu2O2 central core with six ammonia ligands.
PMCID: PMC1993802  PMID: 17893747
Copper; ELF; QTAIM; Topological analysis; Tyrosinase; Hemocyanin; DFT; CASSCF
9.  Permeability of dura mater: a possible link between cortical spreading depression and migraine pain? A comment 
In the wake of cortical spreading depression (CSD) it has been suggested that noxious substances diffuse through the dura with resulting firing of epidural nerves. In my view this is unlikely because there are good reasons to suggest that there must be a dura-brain barrier. Alternatively collateral branches from the trigeminal nerve to the pia and the dura may signal what is happening with ions and substances on the brain surface during CSD to the epidural space.
PMCID: PMC3072496  PMID: 20821244
10.  Permeability of dura mater: a possible link between cortical spreading depression and migraine pain? A comment 
In the wake of cortical spreading depression (CSD) it has been suggested that noxious substances diffuse through the dura with resulting firing of epidural nerves. In my view this is unlikely because there are good reasons to suggest that there must be a dura-brain barrier. Alternatively collateral branches from the trigeminal nerve to the pia and the dura may signal what is happening with ions and substances on the brain surface during CSD to the epidural space.
PMCID: PMC3072496  PMID: 20821244
11.  Comments on an obstructed death -- a case conference revisited: commentary 1. 
Journal of Medical Ethics  1990;16(2):88-89.
The paper comments on Scott Dunbar's "An obstructed death and medical ethics," arguing contra Dunbar that we should not view truth-telling to the terminally ill as primarily governed by principles of veracity and respect for autonomy. All such rules are of limited value in medical ethics. We should instead turn to an ethics deriving from the centrality of moral relationships and virtues. A brief analysis of the connections between moral relationships and moral rules is offered. Such an ethics would lower the value that philosophical fashion places on truth-telling and autonomy and leave decisions about truth-telling and the terminally ill more dependent on the circumstances of particular cases.
PMCID: PMC1375936  PMID: 11642780
12.  Some comments on Dr Iglesias's paper, 'In vitro fertilisation: the major issues'. 
Journal of Medical Ethics  1986;12(1):32-35.
In an article in an earlier edition of the Journal of Medical Ethics (1) Dr Iglesias bases her analysis upon the mediaeval interpretation of Platonic metaphysics and Aristotelian logic as given by Aquinas. Propositional forms are applied to the analysis of experience. This results in a very abstract analysis. The essential connection of events and their changing temporal relationships are ignored. The dichotomy between body and soul is a central concept. The unchanging elements in experience are assumed to be more real than the actual world of experienced process. Such a view makes the analysis of the temporal factors in experience impossible. Its abstractness is quite unsuitable for the analysis of the ontological structure and development of the neonate from fertilisation to birth. A N Whitehead made the notion of organism central to his philosophy. He refused to place human experience outside nature, or admit dualism. His philosophy of organism is an attempt to uncover the essential elements connecting human experience with the physical and biological sciences. Time, change and process are, in his view, more real than the static abstractions obtainable by the use of the fallacy of misplaced concreteness. Use of the latter negates the essential connectedness of events and the importance of temporarily and change (2). In this paper I argue that the embryo, being an organism, is not analysable in terms of thinghood. It is a process. To apply Aristotelian logical concepts to it is to distort the real nature of the datum.
PMCID: PMC1375292  PMID: 3959039
13.  8-METHOXYPSORALEN—A Short Review and Comment 
California Medicine  1960;92(2):139-142.
8-Methoxypsoralen is a purified extract of the root ammi majus lynn, which was used in a crude form for centuries in the Middle East in the treatment of various skin diseases. In recent years it has been found that the purified extract, when taken internally, increases all skin responses to sunlight, including tanning. When too much drug is taken or when the patient is exposed to sunlight too long, the preliminary erythema may be painful, and blistering may occur. In some patients with vitiligo, islands of pigmentation appear around the hair follicles when the drug is taken, and in favorable cases these islands may coalesce to form continuous areas of pigmented skin. The drug has been found nontoxic, but successful treatment of vitiligo takes place in only a small proportion of patients.
Promiscuous use of the drug for cosmetic tanning is to be deplored. The constant irritation of the skin due to the increased action of sunlight when the drug is used may possibly increase the incidence of sun-induced skin cancers.
A topical preparation is available, which, when used with great care, may help to repigment small areas of vitiligo.
PMCID: PMC1578011  PMID: 18732266
14.  Comment: ‘The Problem Surgical Colleague’ 
The review of ‘The problem surgical colleague’ by Mr John Mosley is both timely and relevant. All surgeons are naturally concerned about the mechanisms in place, both locally and through the General Medical Council (GMC) to deal with fitness-to-practise issues. It is inevitable that criticisms, often unfounded, are voiced by the profession. Most surgeons welcome a fair and transparent system to deal with such matters whilst maintaining the principle of self-regulation. We must accept that there are a small number of surgeons whose practice is impaired to such a degree that they represent a serious patient-safety risk and they must be dealt with appropriately.
As a GMC medical case examiner since 2003, and having dealt with over 600 fitness-to-practise cases, I wish to comment on some of the important issues raised by Mr Mosley, specifically in relation to the surgeon and his or her practice. In doing so, I will set out the investigative process to be followed when fitness-to-practise concerns are brought to the attention of the GMC.
PMCID: PMC2048590
15.  Floral Ontogeny of the Afro-Madagascan Genus Mitrasacmopsis with Comments on the Development of Superior Ovaries in Rubiaceae 
Annals of Botany  2007;100(1):41-49.
Background and Aims
Members of Rubiaceae are generally characterized by an inferior ovary. However, Mitrasacmopsis is cited in the literature as having a semi-inferior to superior ovary. It has previously been hypothesized that the gynoecial development of Rubiaceae with semi-inferior to superior ovaries takes place in the same way as in Gaertnera, one of the most commonly cited rubiaceous genera with a superior ovary. To test this hypothesis, a floral ontogenetic study of Mitrasacmopsis was carried out with special attention paid to the gynoecial development.
Floral ontogeny and anatomy of Mitrasacmopsis were examined using scanning electron and light microscopy.
Key Results
At an early developmental stage, a concavity becomes visible in the centre of the floral apex simultaneously with the perianth initiation. A ring primordium surrounding this concavity expands vertically forming the corolla tube (early sympetaly). Stamen primordia develop inside the corolla. From the bicarpellate gynoecium only two carpel tips are visible because the ovary is formed by a gynoecial hypanthium. In the basal part of each carpel, a placenta primordium is initiated. Two septa divide the ovary into two locules. In each locule, the placenta becomes mushroom shaped and distinctly stalked. Eventually, the inferior ovary of Mitrasacmopsis develops into a beaked capsule. Only very late in the fruiting stage, the continuously expanding ovary is raised above the insertion point of the persistent calyx, changing the ovary position of Mitrasacmopsis from basically inferior to secondarily semi-inferior.
Mitrasacmopsis follows an epigynous pattern of floral development. However, the presence of a prominent beak in the fruiting stage gives the whole ovary a semi-inferior appearance. This kind of secondarily semi-inferior ovary is shown to be different from the secondarily superior ovary observed in Gaertnera.
PMCID: PMC2735299  PMID: 17557833
Mitrasacmopsis quadrivalvis; Gaertnera; floral ontogeny; gynoecial development; epigyny; secondary semi-inferior; secondary superior; scanning electron and light microscopy
16.  The Question of Questions: What is a Gene? Comments on Rolston and Griffths & Stotz 
If the question “What is a gene?” proves to be worth asking it must be able to elicit an answer which both recognizes and address the reasons why the concept of the gene ever seemed to be something worth getting excited about in the first place as well analyzing and evaluating the latest develops in the molecular biology of DNA. Each of the preceding papers fails to do one of these and sufferrs the consequences. Where Rolston responds to the apparent failure of molecular biology to make good on the desideratum of the classical gene by veering off into fanciful talk about “cybernetic genes,” Griffiths and Stotz lose themselves in the molecular fine print and forget to ask themselves why “genes” should be of any special interst anyway.
PMCID: PMC2798033  PMID: 17139449
Aristotle; telo; final cause; formal cause; epigenesis; preformationism; information; cybernetic genes; Gene-P; Marfan Syndrome; nominal genes; instrumental genes; Kirshner and Gerhart; West-Eberhard
17.  Top-down causation and emergence: some comments on mechanisms 
Interface Focus  2011;2(1):126-140.
Both bottom-up and top-down causation occur in the hierarchy of structure and causation. A key feature is multiple realizability of higher level functions, and consequent existence of equivalence classes of lower level variables that correspond to the same higher level state. Five essentially different classes of top-down influence can be identified, and their existence demonstrated by many real-world examples. They are: algorithmic top-down causation; top-down causation via non-adaptive information control, top-down causation via adaptive selection, top-down causation via adaptive information control and intelligent top-down causation (the effect of the human mind on the physical world). Through the mind, abstract entities such as mathematical structures have causal power. The causal slack enabling top-down action to take place lies in the structuring of the system so as to attain higher level functions; in the way the nature of lower level elements is changed by context, and in micro-indeterminism combined with adaptive selection. Understanding top-down causation can have important effects on society. Two cases will be mentioned: medical/healthcare issues, and education—in particular, teaching reading and writing. In both cases, an ongoing battle between bottom-up and top-down approaches has important consequences for society.
PMCID: PMC3262299  PMID: 23386967
top down causation; emergence of complexity; adaptive selection
18.  A New Machairodont from the Palmetto Fauna (Early Pliocene) of Florida, with Comments on the Origin of the Smilodontini (Mammalia, Carnivora, Felidae) 
PLoS ONE  2013;8(3):e56173.
South-central Florida’s latest Hemphillian Palmetto Fauna includes two machairodontine felids, the lion-sized Machairodus coloradensis and a smaller, jaguar-sized species, initially referred to Megantereon hesperus based on a single, relatively incomplete mandible. This made the latter the oldest record of Megantereon, suggesting a New World origin of the genus. Subsequent workers variously accepted or rejected this identification and biogeographic scenario. Fortunately, new material, which preserves previously unknown characters, is now known for the smaller taxon. The most parsimonious results of a phylogenetic analysis using 37 cranio-mandibular characters from 13 taxa place it in the Smilodontini, like the original study; however, as the sister-taxon to Megantereon and Smilodon. Accordingly, we formally describe Rhizosmilodon fiteae gen. et sp. nov. Rhizosmilodon, Megantereon, and Smilodon ( =  Smilodontini) share synapomorphies relative to their sister-taxon Machairodontini: serrations smaller and restricted to canines; offset of P3 with P4 and p4 with m1; complete verticalization of mandibular symphysis; m1 shortened and robust with widest point anterior to notch; and extreme posterior “lean” to p3/p4. Rhizosmilodon has small anterior and posterior accessory cusps on p4, a relatively large lower canine, and small, non-procumbent lower incisors; all more primitive states than in Megantereon and Smilodon. The former also differs from Megantereon and Smilodon gracilis by having a very small mandibular flange. Rhizosmilodon is the oldest known member of the Smilodontini, suggesting that the tribe originated in North America. Two more derived, similar-sized species evolved in parallel during the Blancan, Megantereon hesperus and Smilodon gracilis. The former is rarer, known only from the north-central and northwestern US, and presumably dispersed into the Old World. The latter is known from the eastern and southern US, and dispersed into South America.
PMCID: PMC3596359  PMID: 23516394
19.  Factoring Health Equations Comment on “Do You Recommend an Interdisciplinary Field to Your Graduate Student?”  
The International Journal of Health Policy and Management (IJHPM) is a new journal that aims to stimulate not only inter-disciplinary research relating to health, but even an entire new generation of such journals. The challenges of improving human health worldwide clearly suggest ‘why’ such a journal is needed, but ‘how’ bridges and junctions across fields of study towards this end might be found poses other questions. From the agnosticism of many sciences with respect to human health, to the great faith others place in more esoteric movements for human well-being, both suggest finding common factors in the many equations that affect human health. Particularly, as it is typically defined professionally, it might pose more fundamental challenges than those which appear first. However, the first editorial and edition quietly assure that the journal is in good hands, and that the search for a new generation of journals has begun.
PMCID: PMC3937909  PMID: 24596860
Health Co-Production; Quasi-Health Professional; Inter-Disciplinary Research
20.  Comments on the process and product of the health impacts assessment component of the national assessment of the potential consequences of climate variability and change for the United States. 
Environmental Health Perspectives  2001;109(Suppl 2):177-184.
In 1990 Congress formed the U.S. Global Change Research Program and required it to conduct a periodic national assessment of the potential impacts of climate variability and change on all regions and select economic/resource sectors of the United States. Between 1998 and 2000, a team of experts collaborated on a health impacts assessment that formed the basis for the first National Assessment's analysis of the potential impacts of climate on human health. The health impacts assessment was integrated across a number of health disciplines and involved a search for and qualitative expert judgment review of data on the potential links between climate events and population health. Accomplishments included identification of vulnerable populations, adaptation strategies, research needs, and data gaps. Experts, stakeholders, and the public were involved. The assessment is reported in five articles in this issue; a summary was published in the April 2000 issue of Environmental Health Perspectives. The assessment report will enhance understanding of ways human health might be affected by various climate-associated stresses and of the need for further empirical and predictive research. Improved understanding and communication of the significance and inevitability of uncertainties in such an assessment are critical to further research and policy development.
PMCID: PMC1240664  PMID: 11359684
21.  First Fossil Record of Alphonsea Hk. f. & T. (Annonaceae) from the Late Oligocene Sediments of Assam, India and Comments on Its Phytogeography 
PLoS ONE  2013;8(1):e53177.
A new fossil leaf impression of Alphonsea Hk. f. & T. of the family Annonaceae is described from the Late Oligocene sediments of Makum Coalfield, Assam, India. This is the first authentic record of the fossil of Alphonsea from the Tertiary rocks of South Asia. The Late Oligocene was the time of the last significant globally warm climate and the fossil locality was at 10°–15°N palaeolatitude. The known palaeoflora and sedimentological studies indicate a fluvio-marine deltaic environment with a mosaic of mangrove, fluvial, mire and lacustrine depositional environments. During the depositional period the suturing between the Indian and Eurasian plates was not complete to facilitate the plant migration. The suturing was over by the end of the Late Oligocene/beginning of Early Miocene resulting in the migration of the genus to Southeast Asia where it is growing profusely at present. The present study is in congruence with the earlier published palaeofloral and molecular phylogenetic data. The study also suggests that the Indian plate was not only a biotic ferry during its northward voyage from Gondwana to Asia but also a place for the origin of several plant taxa.
PMCID: PMC3551915  PMID: 23349701
22.  Taxing Sugar-Sweetened Beverages: Not a “Holy Grail” but a Cup at Least Half Comment on “Food Taxes: A New Holy Grail?”  
In this commentary, we argue for the implementation of a sugar-sweetened beverage (SSB) tax as a tool to help address the global obesity and diabetes epidemics. Consumption of SSBs has increased exponentially over the last several decades, a trend that has been an important contributor to the obesity and diabetes epidemics. Prior evidence demonstrates that a SSB tax will likely decrease SSB consumption without significantly increasing consumption of other unhealthy food or beverages. Further, this tax is unlikely to have effects on income inequality and should not contribute to weight-based discrimination. A SSB tax also should raise revenue for government entities that already pay, through health care expenditures and health programs, for the consequences of excess SSB consumption.
PMCID: PMC3937927  PMID: 24596861
Sugar-Sweetened Beverages; Tax; Economics; Obesity; Overweight
23.  Tension free vaginal tape underneath bladder base: does it prevent cystocele recurrence? 
Hippokratia  2008;12(2):108-112.
Objective: The target of the current prospective study was to assess the effectiveness of the polypropylene tapes in preventing recurrence of cystocele formation when placed underneath the bladder base.
Materials and Methods: Twenty-two Caucasian women, predominantly postmemopausal with marked descent of the anterior, middle and/or posterior pelvic segment, participated in the study. Vaginal reconstructive surgery including anterior colporrhaphy and Kelly placation, posterior colpoperineorrhaphy and/or hysterectomy, was undertaken in all subjects. The polypropylene tape was placed not under the midurethra, as often performed in stress urine incontinence (SUI) cases, but underneath the bladder base as an adjunct to the anterior colporrhaphy sutures. The postoperative follow up lasted 2 years and was carried out every 4 months. The assessment of the anatomic result included evaluation of the operated sites and the position of the tapes inserted on clinical grounds and after perineal sonography. Urodynamic assessment was performed in the presence of urinary incontinence.
Results: In all patients the postoperative correction of the anterior vaginal wall was sufficient, 14 subjects did not present genitourinary symptoms and therefore were considered as cured; three patients were designated as improved because despite sufficient anatomic correction of the anterior vaginal segment they reported urinary incontinence symptoms. Retropubic haematoma occurred in 1 patient, transient urge incontinence in 1, transient stress incontinence in 1, and persistent stress incontinence also in 1. There was no erosion of the tape noticed. Mean residual urine was 30 ml, mean bladder base distance to the inferior edge of the symphysis pubis was 1.2 cm and the mean total vaginal length was 7 cm.
Conclusion: Despite the relative short follow up period and the limited number of patients enrolled, we conclude from our study that the use of polypropylene tapes as an adjunct for fortification of the anterior pelvic segment could provide an option in preventing recurrence of cystocele formation.
PMCID: PMC2464310  PMID: 18923661
cystocele; tension free vaginal tapes; urinary incontinence
24.  Local Mobile Gene Pools Rapidly Cross Species Boundaries To Create Endemicity within Global Vibrio cholerae Populations 
mBio  2011;2(2):e00335-10.
Vibrio cholerae represents both an environmental pathogen and a widely distributed microbial species comprised of closely related strains occurring in the tropical to temperate coastal ocean across the globe (Colwell RR, Science 274:2025–2031, 1996; Griffith DC, Kelly-Hope LA, Miller MA, Am. J. Trop. Med. Hyg. 75:973–977, 2006; Reidl J, Klose KE, FEMS Microbiol. Rev. 26:125–139, 2002). However, although this implies dispersal and growth across diverse environmental conditions, how locally successful populations assemble from a possibly global gene pool, relatively unhindered by geographic boundaries, remains poorly understood. Here, we show that environmental Vibrio cholerae possesses two, largely distinct gene pools: one is vertically inherited and globally well mixed, and the other is local and rapidly transferred across species boundaries to generate an endemic population structure. While phylogeographic analysis of isolates collected from Bangladesh and the U.S. east coast suggested strong panmixis for protein-coding genes, there was geographic structure in integrons, which are the only genomic islands present in all strains of V. cholerae (Chun J, et al., Proc. Natl. Acad. Sci. U. S. A. 106:15442–15447, 2009) and are capable of acquiring and expressing mobile gene cassettes. Geographic differentiation in integrons arises from high gene turnover, with acquisition from a locally cooccurring sister species being up to twice as likely as exchange with conspecific but geographically distant V. cholerae populations.
Functional predictions of integron genes show the predominance of secondary metabolism and cell surface modification, which is consistent with a role in competition and predation defense. We suggest that the integron gene pool’s distinctness and tempo of sharing are adaptive in allowing rapid conversion of genomes to reflect local ecological constraints. Because the integron is frequently the main element differentiating clinical strains (Chun J, et al., Proc. Natl. Acad. Sci. U. S. A. 106:15442–15447, 2009) and its recombinogenic activity is directly stimulated by environmental stresses (Guerin E, et al., Science 324:1034, 2009), these observations are relevant for local emergence and subsequent dispersal.
PMCID: PMC3073641  PMID: 21486909
25.  A new balloon dissector for totally extraperitoeneal hernia repair 
Balloon dissectors (BD) find their use in totally extraperitoneal (TEP) and retroperitoneoscopic procedures. Commercial BD is prohibitively expensive. The author uses an indigenously assembled BD and describes the same.
The author assembles the BD by tying glove-fingers on an NG tube and then tying this assembly in the concavity of a Kelly's clamp, premounted with peanut gauze (KC-BD).
The author has used it in the last 75 cases of TEP. A large working space is created, without any iatrogenic injuries or balloon rupture. This cheap indigenous BD can be assembled easily and in no time at all.
KC-BD offers several advantages because of its unique design. It is effective, totally nontraumatic, inexpensive, and easy to assemble.
PMCID: PMC2699071  PMID: 19547684
Balloon dissector; retroperitoneoscopy; totally extraperitoneal

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