International survey of primary and revision total knee replacement

Purpose Total knee arthroplasty (TKA) is currently the international standard of care for treating degenerative and rheumatologic knee joint disease, as well as certain knee joint fractures. We sought to answer the following three research questions: (1) What is the international variance in primary and revision TKA rates around the world? (2) How do patient demographics (e.g., age, gender) vary internationally? (3) How have the rates of TKA utilization changed over time? Methods The survey included 18 countries with a total population of 755 million, and an estimated 1,324,000 annual primary and revision total knee procedures. Ten national inpatient databases were queried for this study from Canada, the United States, Finland, France, Germany, Italy, the Netherlands, Portugal, Spain, and Switzerland. Inpatient data were also compared with published registry data for eight countries with operating arthroplasty registers (Denmark, England & Wales, Norway, Romania, Scotland, Sweden, Australia, and New Zealand). Results The average and median rate of primary and revision (combined) total knee replacement was 175 and 149 procedures/100,000 population, respectively, and ranged between 8.8 and 234 procedures/100,000 population. We observed that the procedure rate significantly increased over time for the countries in which historical data were available. The compound annual growth in the incidence of TKA ranged by country from 5.3% (France) to 17% (Portugal). We observed a nearly 27-fold range of TKA utilization rates between the 18 different countries included in the survey. Conclusion It is apparent from the results of this study that the demand for TKA has risen substantially over the past decade in countries around the world.

Unprotected left main stenting in the real world: two-year outcomes of the French left main taxus registry

BACKGROUND: Cardiac surgery is the reference treatment for patients with left main (LM) disease, although percutaneous coronary intervention with drug-eluting stents is emerging as a possible alternative. The objective of this registry was to evaluate the 2-year outcome of elective percutaneous coronary intervention for unprotected LM disease with paclitaxel-eluting stents. METHODS AND RESULTS: A total of 291 patients were prospectively included from 4 centers. Acute myocardial infarction and cardiogenic shock were the only exclusion criteria. Patients were 69+/-11 years old, 29% were diabetic, and 25% had 3-vessel disease. For distal LM lesions (78%), the provisional side-branch T-stenting approach was used in 92% of cases and final kissing balloon inflation in 97%. Angiographic success was obtained in 99.7% of cases. At 2-year follow-up, the total cardiac death rate was 5.4% (1 EuroSCORE point was associated with a 15% [95% confidence interval 2.9% to 28.2%, P=0.013] higher risk of cardiac death), target-lesion revascularization was 8.7%, and incidence of Q-wave or non-Q-wave myocardial infarction was 0.9% and 3.1%, respectively. The combined end point occurred in 15.8% of cases and stroke in 0.7%. The incidence of definite and probable LM stent thrombosis was 0.7%, whereas the incidence of any stent thrombosis was 3.8%, with a higher risk in patients with side-branch stenting in the presence of LM bifurcation lesions (hazard ratio 9.6, 95% confidence interval 1.2 to 77.7, P=0.035). CONCLUSIONS: Unprotected LM stenting with paclitaxel-eluting stents, with a strategy of provisional side-branch T-stenting for distal lesions, provides excellent acute angiographic results and good mid-term clinical outcomes, with a 15.8% rate of major adverse cardiac events at 2-year follow-up.

Ecosystem impacts of feral rabbits on World Heritage sub-Antarctic Macquarie Island: A palaeoecological perspective

The introduction and establishment of non-indigenous species through human activities often poses a major threat to natural biodiversity. In many parts of the world management efforts are therefore focused on their eradication. The environment of World Heritage sub-Antarctic Macquarie Island has been severely damaged by non-indigenous species including rabbits, rats and mice, introduced from the late AD 1800s. An extensive eradication programme is now underway which aims to remove all rabbits and rodents. To provide a long-term context for assessing the Island's pre-invasion state, invasion impacts, and to provide a baseline for monitoring its recovery, we undertook a palaeoecological study using proxies in a lake sediment core. Sedimentological and diatom analyses revealed an unproductive catchment and lake environment persisted for ca. 7100 years prior to the introduction of the invasive species. After ca. AD 1898, unprecedented and statistically significant environmental changes occurred. Lake sediment accumulation rates increased >100 times due to enhanced catchment inputs and within-lake production. Total carbon and total nitrogen contents of the sediments increased by a factor of four. The diatom flora became dominated by two previously rare species. The results strongly suggest a causal link between the anthropogenic introduction of rabbits and the changes identified in the lake sediments. This study provides an example of how palaeoecology may be used to determine baseline conditions prior to the introduction of non-indigenous species, quantify the timing and extent of changes, and help monitor the recovery of the ecosystem and natural biodiversity following successful non-indigenous species eradication programmes.

Evidence from the real world: N-15 natural abundances reveal enhanced nitrogen use at high plant diversity in Central European grasslands

Complementarity that leads to more efficient resource use is presumed to be a key mechanism explaining positive biodiversity–productivity relationships but has been described solely for experimental set-ups with controlled environmental settings or for very short gradients of abiotic conditions, land-use intensity and biodiversity. Therefore, we analysed plant diversity effects on nitrogen dynamics across a broad range of Central European grasslands. The 15N natural abundance in soil and plant biomass reflects the net effect of processes affecting ecosystem N dynamics. This includes the mechanism of complementary resource utilization that causes a decrease in the 15N isotopic signal. We measured plant species richness, natural abundance of 15N in soil and plants, above-ground biomass of the community and three single species (an herb, grass and legume) and a variety of additional environmental variables in 150 grassland plots in three regions of Germany. To explore the drivers of the nitrogen dynamics, we performed several analyses of covariance treating the 15N isotopic signals as a function of plant diversity and a large set of covariates. Increasing plant diversity was consistently linked to decreased δ15N isotopic signals in soil, above-ground community biomass and the three single species. Even after accounting for multiple covariates, plant diversity remained the strongest predictor of δ15N isotopic signals suggesting that higher plant diversity leads to a more closed nitrogen cycle due to more efficient nitrogen use. Factors linked to increased δ15N values included the amount of nitrogen taken up, soil moisture and land-use intensity (particularly fertilization), all indicators of the openness of the nitrogen cycle due to enhanced N-turnover and subsequent losses. Study region was significantly related to the δ15N isotopic signals indicating that regional peculiarities such as former intensive land use could strongly affect nitrogen dynamics. Synthesis. Our results provide strong evidence that the mechanism of complementary resource utilization operates in real-world grasslands where multiple external factors affect nitrogen dynamics. Although single species may differ in effect size, actively increasing total plant diversity in grasslands could be an option to more effectively use nitrogen resources and to reduce the negative environmental impacts of nitrogen losses.

Controversy Total War

Total war is a controversial term used in the past by politicians, publicists and military officers as well as by computer specialists and academics in the present. Since its conception by French politicians during the First World War in a time of severe crisis (1916/17), it has become a term used by historians and other academics to cover a wide array of elements when looking at wars of the past. A real total war was and is impossible. Elements of total war – total war aims, total methods of warfare, total mobilization and total control – can, however, be identified and can serve as a useful tool for further transnational research on war.

Plant diversity moderates drought stress in grasslands: Implications from a large real-world study on 13C natural abundances

Land-use change and intensification play a key role in the current biodiversity crisis. The resulting species loss can have severe effects on ecosystem functions and services, thereby increasing ecosystem vulnerability to climate change. We explored whether land-use intensification (i.e. fertilization intensity), plant diversity and other potentially confounding environmental factors may be significantly related to water use (i.e. drought stress) of grassland plants. Drought stress was assessed using δ13C abundances in aboveground plant biomass of 150 grassland plots across a gradient of land-use intensity. Under water shortage, plants are forced to increasingly take up the heavier 13C due to closing stomata leading to an enrichment of 13C in biomass. Plants were sampled at the community level and for single species, which belong to three different functional groups (one grass, one herb, two legumes). Results show that plant diversity was significantly related to the δ13C signal in community, grass and legume biomass indicating that drought stress was lower under higher diversity, although this relation was not significant for the herb species under study. Fertilization, in turn, mostly increased drought stress as indicated by more positive δ13C values. This effect was mostly indirect by decreasing plant diversity. In line with these results, we found similar patterns in the δ13C signal of the organic matter in the topsoil, indicating a long history of these processes. Our study provided strong indication for a positive biodiversity-ecosystem functioning relationship with reduced drought stress at higher plant diversity. However, it also underlined a negative reinforcing situation: as land-use intensification decreases plant diversity in grasslands, this might subsequently increases drought sensitivity. Vice-versa, enhancing plant diversity in species-poor agricultural grasslands may moderate negative effects of future climate change.

Weishenme Zhongguo zai diyi ci shijie dazhan zhong juyou zhongyao zuoyong 为什么中国在第一次世界大战中具有重要作用 (Why China Played an Important Role in the First World War)

Aufbauend auf dem analytischen Tool des Totalen Krieges (vgl. den Artikel des Autors zu Controversy Total War in 1914-1918-Online) werden im vorliegenden Beitrag die Anstrengungen Chinas im Ersten Weltkrieg zu denjenigen anderer nicht europäischer Länder wie Australien, Südafrika oder Indien in Bezug gesetzt. Dabei wird das Ziel verfolgt, den globalen Charakter eines Konfliktes deutlich zu machen, der zurecht als erster Weltkrieg bezeichnet wird und in welchem China sicherlich eine weit bedeutsamere Rolle spielte, als es gemeinhin in der Historiographie dargestellt wird. Ursprünglich wurde der Beitrag als Antwort auf die Frage konzipiert, warum nicht nur China für eine Globalgeschichte des Ersten Weltkrieges von Bedeutung war. Im Verlauf der Übersetzung wurde der Titel dahingehend angepasst, dass stärker die Bedeutung von Chinas Rolle im Ersten Weltkrieg betont wurde.