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  1. Fulltext Quality of life among women with breast cancer from Universiti Kebangsaan Malaysia Medical Centre, Malaysia
    Redhwan, A.A., Md Idris, M.N., Zaleha, M.I., Robert, C., Fuad, I., Sami, R.A.
    Malaysian Journal of Community Health, 2008;14(2):46-55.
    MyJurnal
    Introduction : The purpose of this study was to determine the quality of life (QOL) of breast cancer survivors based on socio-demographic and clinical characteristics.
    Methods : A cross-sectional study was performed on 125 breast cancer survivors from the outpatient clinics. FACT-B (Functional Assessment of Cancer Therapy-Breast) questionnaire was used to assess survivors’ QOL.
    Results : Survivors with low body mass index (BMI) (underweight) were found to have the lowest overall QOL. Those who were overweight had a higher overall QOL, and those who were normal-weight had the highest QOL. Low educational level, being underweight and low monthly household income were significantly associated with lower overall QOL Tamoxifen use and employment status were significantly associated with QOL in some domains. Time since diagnosis to QOL interview was significantly associated with greater scores in emotional well-being (EWB). Multiple linear regression indicated that age, marital status, monthly household income, surgery and histological grade were indicative of the patients QOL.
    Conclusion : The four primary factors related to better QOL were high educational level, high income, normal body weight and greater duration from the time of diagnosis to the time of interview. Age, marital status, income, lumpectomy and histological grade were indicative of the patient QOL.
    Study site: Oncology and Surgical clinics; Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
  2. Fulltext Dietary and lifestyle changes of Malaysian breast cancer survivors: a qualitative study
    Redhwan, A.A., Md Idris, M.N., Robert, C.
    Malaysian Journal of Community Health, 2008;14(1):24-31.
    MyJurnal
    Objective :This study was performed to determine changes in diet and lifestyle among breast cancer survivors in Malaysia.
    Methods :This was a qualitative study done on fifteen survivors (8 Malays and 7 non-Malays) obtained from the Oncology and Surgery Department, National University of Malaysia Hospital. The study was conducted using a semi-structured interview format. The data obtained were sorted into various categories via content analysis.
    Results :Majority of breast cancer survivors increased their fruit and vegetable intake following diagnosis. Some non-Malays changed to vegetarian whereas all the Malays remained on the same dietary pattern. As far as exercise was concerned, all Malays did not exercise before diagnosis, but did so after diagnosis, whereas most of non- Malays did not exercise either before or after diagnosis.
    Conclusion : Some changes were noticed in dietary and lifestyle behaviors after diagnosis among some survivors. The differences were due to their different cultural and religious backgrounds.
  3. Fulltext Co-benefits of sustainable forest management in biodiversity conservation and carbon sequestration
    Imai N, Samejima H, Langner A, Ong RC, Kita S, Titin J, et al.
    PLoS One, 2009;4(12):e8267.
    PMID: 20011516 DOI: 10.1371/journal.pone.0008267
    Sustainable forest management (SFM), which has been recently introduced to tropical natural production forests, is beneficial in maintaining timber resources, but information about the co-benefits for biodiversity conservation and carbon sequestration is currently lacking.
  4. Fulltext The differences between the quality of life of Malays and non-Malays breast cancer survivors women from a teaching hospital, Kuala Lumpur: a qualitative study
    Redhwan, A.A., Idris, M.N., Fuad, I., Hairol, O., Robert, C.
    Malaysian Journal of Community Health, 2009;15(2):98-105.
    MyJurnal
    Introduction : The purpose of this study is to explore the differences of quality of life (QOL) of Malay and non-Malay breast cancer survivors using qualitative method.
    Methods : Data was collected using in-depth face to face interview. List of the patients were obtained from Oncology & Surgery Departments and contact numbers were obtained from the medical record. The interviews were conducted either in their home or in the hospital after the appointment has been made.
    Results : The majority of the Malays were unable to fulfill the needs of their families. However, the non-Malays were able to fulfill the needs of their families. The majority were satisfied with social interaction and the relationships with their families and friends. In terms of feelings, most survivors felt sad, angry and sometimes they feel like they were going to die early. However the majority coped well with their illness. Regarding sleep, all Malays did not have any sleeping problems, but most of the non-Malays reported serious problems. All survivors were worried about the other female members of the family of getting the same illness. Most survivors did not have any problems with altered body image.
    Conclusion : Malays did not have any sleeping problems, but most of the non-Malays reported serious problems. However, the majority of survivors coped well with their illnesses.
  5. Differences in serum creatinine concentration between Caucasians, Chinese, Indians and Malays
    Hawkins RC
    Clin Chim Acta, 2010 Sep 6;411(17-18):1393.
    PMID: 20580697 DOI: 10.1016/j.cca.2010.05.027
  6. Differences in serum potassium concentrations between Chinese, Indians and Malays
    Hawkins RC
    Clin Chem Lab Med, 2010;48(1):105-8.
    PMID: 19929751 DOI: 10.1515/CCLM.2010.010
    It has been suggested that potassium concentrations may vary between different geographical regions, possibly reflecting ethnic differences in potassium status. This study compared the serum potassium concentrations of three Asian ethnicities in a single geographical location.
  7. Fulltext Perceptions about food allergy among medical science students in a university in Shah Alam, Selangor, Malaysia
    Redhwan AA, Low WY, Mustafa FM, Robert C, Ali A
    International Food Research Journal, 2011;18(1):451-458.
    MyJurnal
    This study aimed to determine the perceptions and opinions of medical students about food allergy. Universal sampling was used to conduct focus group discussions. The majority of the participants 40 (67%) mentioned that the common symptoms of food allergy are: skin rashes, swollen lips, diarrhea, vomiting, bronchospasm, redness, itchiness, difficulty in breathing, stomach ache and fever. Majority of participants mentioned that seafood is the food that can cause most food allergies 52 (87%), followed by tree nuts 25 (42%), peanuts and dairy products 19 (32%). Regarding the most allergenic food named by the participants are seafood 23 (38%); followed by milk and dairy products 5 (8%) and nuts 5 (8%). The majority of participants mentioned that food allergy can be fatal 48 (80%), a child can catch food allergy 57 (95%), and 10 of 100 people would have food allergy 31 (52%). Half of the participants 30 (50%) mentioned that it is very hard to care for children with food allergy. The majority of participants mentioned that food allergies do run in families 50 (83%), avoiding allergenic food is the best preventive methods 36 (60%) and that food allergy can be treated and will go away and 32 (53%). This study showed that in spite of sufficient knowledge among medical students about food allergy, some misconceptions still exist such as the high prevalence of food allergy and that food allergy can be treated and will go away. Therefore, there is a need for improving the continuous medical education among medical students with regard to food allergy because they are our future physicians.
  8. Fulltext Carbon stocks and fluxes in tropical lowland dipterocarp rainforests in Sabah, Malaysian Borneo
    Saner P, Loh YY, Ong RC, Hector A
    PLoS One, 2012;7(1):e29642.
    PMID: 22235319 DOI: 10.1371/journal.pone.0029642
    Deforestation in the tropics is an important source of carbon C release to the atmosphere. To provide a sound scientific base for efforts taken to reduce emissions from deforestation and degradation (REDD+) good estimates of C stocks and fluxes are important. We present components of the C balance for selectively logged lowland tropical dipterocarp rainforest in the Malua Forest Reserve of Sabah, Malaysian Borneo. Total organic C in this area was 167.9 Mg C ha⁻¹±3.8 (SD), including: Total aboveground (TAGC: 55%; 91.9 Mg C ha⁻¹±2.9 SEM) and belowground carbon in trees (TBGC: 10%; 16.5 Mg C ha⁻¹±0.5 SEM), deadwood (8%; 13.2 Mg C ha⁻¹±3.5 SEM) and soil organic matter (SOM: 24%; 39.6 Mg C ha⁻¹±0.9 SEM), understory vegetation (3%; 5.1 Mg C ha⁻¹±1.7 SEM), standing litter (<1%; 0.7 Mg C ha⁻¹±0.1 SEM) and fine root biomass (<1%; 0.9 Mg C ha⁻¹±0.1 SEM). Fluxes included litterfall, a proxy for leaf net primary productivity (4.9 Mg C ha⁻¹ yr⁻¹±0.1 SEM), and soil respiration, a measure for heterotrophic ecosystem respiration (28.6 Mg C ha⁻¹ yr⁻¹±1.2 SEM). The missing estimates necessary to close the C balance are wood net primary productivity and autotrophic respiration.Twenty-two years after logging TAGC stocks were 28% lower compared to unlogged forest (128 Mg C ha⁻¹±13.4 SEM); a combined weighted average mean reduction due to selective logging of -57.8 Mg C ha⁻¹ (with 95% CI -75.5 to -40.2). Based on the findings we conclude that selective logging decreased the dipterocarp stock by 55-66%. Silvicultural treatments may have the potential to accelerate the recovery of dipterocarp C stocks to pre-logging levels.
  9. Fulltext Linking Ayurveda and Western medicine by integrative analysis
    Fauzi FM, Koutsoukas A, Lowe R, Joshi K, Fan TP, Glen RC, et al.
    J Ayurveda Integr Med, 2013 Apr;4(2):117-9.
    PMID: 23930045 DOI: 10.4103/0975-9476.113882
    In this article, we discuss our recent work in elucidating the mode-of-action of compounds used in traditional medicine including Ayurvedic medicine. Using computational ('in silico') approach, we predict potential targets for Ayurvedic anti-cancer compounds, obtained from the Indian Plant Anticancer Database given its chemical structure. In our analysis, we observed that: (i) the targets predicted can be connected to cancer pathogenesis i.e. steroid-5-alpha reductase 1 and 2 and estrogen receptor-β, and (ii) predominantly hormone-dependent cancer targets were predicted for the anti-cancer compounds. Through the use of our in silico target prediction, we conclude that understanding how traditional medicine such as Ayurveda work through linking with the 'western' understanding of chemistry and protein targets can be a fruitful avenue in addition to bridging the gap between the two different schools of thinking. Given that compounds used in Ayurveda have been tested and used for thousands of years (although not in the same approach as Western medicine), they can potentially be developed into potential new drugs. Hence, to further advance the case of Ayurvedic medicine, we put forward some suggestions namely: (a) employing and integrating novel analytical methods given the advancements of 'omics' and (b) sharing experimental data and clinical results on studies done on Ayurvedic compounds in an easy and accessible way.
  10. Fulltext Mechanisms of environmental chemicals that enable the cancer hallmark of evasion of growth suppression
    Nahta R, Al-Mulla F, Al-Temaimi R, Amedei A, Andrade-Vieira R, Bay SN, et al.
    Carcinogenesis, 2015 Jun;36 Suppl 1:S2-18.
    PMID: 26106139 DOI: 10.1093/carcin/bgv028
    As part of the Halifax Project, this review brings attention to the potential effects of environmental chemicals on important molecular and cellular regulators of the cancer hallmark of evading growth suppression. Specifically, we review the mechanisms by which cancer cells escape the growth-inhibitory signals of p53, retinoblastoma protein, transforming growth factor-beta, gap junctions and contact inhibition. We discuss the effects of selected environmental chemicals on these mechanisms of growth inhibition and cross-reference the effects of these chemicals in other classical cancer hallmarks.
  11. Fulltext Assessing the carcinogenic potential of low-dose exposures to chemical mixtures in the environment: the challenge ahead
    Goodson WH, Lowe L, Carpenter DO, Gilbertson M, Manaf Ali A, Lopez de Cerain Salsamendi A, et al.
    Carcinogenesis, 2015 Jun;36 Suppl 1:S254-96.
    PMID: 26106142 DOI: 10.1093/carcin/bgv039
    Lifestyle factors are responsible for a considerable portion of cancer incidence worldwide, but credible estimates from the World Health Organization and the International Agency for Research on Cancer (IARC) suggest that the fraction of cancers attributable to toxic environmental exposures is between 7% and 19%. To explore the hypothesis that low-dose exposures to mixtures of chemicals in the environment may be combining to contribute to environmental carcinogenesis, we reviewed 11 hallmark phenotypes of cancer, multiple priority target sites for disruption in each area and prototypical chemical disruptors for all targets, this included dose-response characterizations, evidence of low-dose effects and cross-hallmark effects for all targets and chemicals. In total, 85 examples of chemicals were reviewed for actions on key pathways/mechanisms related to carcinogenesis. Only 15% (13/85) were found to have evidence of a dose-response threshold, whereas 59% (50/85) exerted low-dose effects. No dose-response information was found for the remaining 26% (22/85). Our analysis suggests that the cumulative effects of individual (non-carcinogenic) chemicals acting on different pathways, and a variety of related systems, organs, tissues and cells could plausibly conspire to produce carcinogenic synergies. Additional basic research on carcinogenesis and research focused on low-dose effects of chemical mixtures needs to be rigorously pursued before the merits of this hypothesis can be further advanced. However, the structure of the World Health Organization International Programme on Chemical Safety 'Mode of Action' framework should be revisited as it has inherent weaknesses that are not fully aligned with our current understanding of cancer biology.
  12. Fulltext Common variation at 2p13.3, 3q29, 7p13 and 17q25.1 associated with susceptibility to pancreatic cancer
    Childs EJ, Mocci E, Campa D, Bracci PM, Gallinger S, Goggins M, et al.
    Nat Genet, 2015 Aug;47(8):911-6.
    PMID: 26098869 DOI: 10.1038/ng.3341
    Pancreatic cancer is the fourth leading cause of cancer death in the developed world. Both inherited high-penetrance mutations in BRCA2 (ref. 2), ATM, PALB2 (ref. 4), BRCA1 (ref. 5), STK11 (ref. 6), CDKN2A and mismatch-repair genes and low-penetrance loci are associated with increased risk. To identify new risk loci, we performed a genome-wide association study on 9,925 pancreatic cancer cases and 11,569 controls, including 4,164 newly genotyped cases and 3,792 controls in 9 studies from North America, Central Europe and Australia. We identified three newly associated regions: 17q25.1 (LINC00673, rs11655237, odds ratio (OR) = 1.26, 95% confidence interval (CI) = 1.19-1.34, P = 1.42 × 10(-14)), 7p13 (SUGCT, rs17688601, OR = 0.88, 95% CI = 0.84-0.92, P = 1.41 × 10(-8)) and 3q29 (TP63, rs9854771, OR = 0.89, 95% CI = 0.85-0.93, P = 2.35 × 10(-8)). We detected significant association at 2p13.3 (ETAA1, rs1486134, OR = 1.14, 95% CI = 1.09-1.19, P = 3.36 × 10(-9)), a region with previous suggestive evidence in Han Chinese. We replicated previously reported associations at 9q34.2 (ABO), 13q22.1 (KLF5), 5p15.33 (TERT and CLPTM1), 13q12.2 (PDX1), 1q32.1 (NR5A2), 7q32.3 (LINC-PINT), 16q23.1 (BCAR1) and 22q12.1 (ZNRF3). Our study identifies new loci associated with pancreatic cancer risk.
  13. Fulltext CCoAOMT Down-Regulation Activates Anthocyanin Biosynthesis in Petunia
    Shaipulah NF, Muhlemann JK, Woodworth BD, Van Moerkercke A, Verdonk JC, Ramirez AA, et al.
    Plant Physiol, 2016 Feb;170(2):717-31.
    PMID: 26620524 DOI: 10.1104/pp.15.01646
    Anthocyanins and volatile phenylpropenes (isoeugenol and eugenol) in petunia (Petunia hybrida) flowers have the precursor 4-coumaryl coenzyme A (CoA) in common. These phenolics are produced at different stages during flower development. Anthocyanins are synthesized during early stages of flower development and sequestered in vacuoles during the lifespan of the flowers. The production of isoeugenol and eugenol starts when flowers open and peaks after anthesis. To elucidate additional biochemical steps toward (iso)eugenol production, we cloned and characterized a caffeoyl-coenzyme A O-methyltransferase (PhCCoAOMT1) from the petals of the fragrant petunia 'Mitchell'. Recombinant PhCCoAOMT1 indeed catalyzed the methylation of caffeoyl-CoA to produce feruloyl CoA. Silencing of PhCCoAOMT1 resulted in a reduction of eugenol production but not of isoeugenol. Unexpectedly, the transgenic plants had purple-colored leaves and pink flowers, despite the fact that cv Mitchell lacks the functional R2R3-MYB master regulator ANTHOCYANIN2 and has normally white flowers. Our results indicate that down-regulation of PhCCoAOMT1 activated the anthocyanin pathway through the R2R3-MYBs PURPLE HAZE (PHZ) and DEEP PURPLE, with predominantly petunidin accumulating. Feeding cv Mitchell flowers with caffeic acid induced PHZ expression, suggesting that the metabolic perturbation of the phenylpropanoid pathway underlies the activation of the anthocyanin pathway. Our results demonstrate a role for PhCCoAOMT1 in phenylpropene production and reveal a link between PhCCoAOMT1 and anthocyanin production.
  14. Fulltext Female chromosome X mosaicism is age-related and preferentially affects the inactivated X chromosome
    Machiela MJ, Zhou W, Karlins E, Sampson JN, Freedman ND, Yang Q, et al.
    Nat Commun, 2016 06 13;7:11843.
    PMID: 27291797 DOI: 10.1038/ncomms11843
    To investigate large structural clonal mosaicism of chromosome X, we analysed the SNP microarray intensity data of 38,303 women from cancer genome-wide association studies (20,878 cases and 17,425 controls) and detected 124 mosaic X events >2 Mb in 97 (0.25%) women. Here we show rates for X-chromosome mosaicism are four times higher than mean autosomal rates; X mosaic events more often include the entire chromosome and participants with X events more likely harbour autosomal mosaic events. X mosaicism frequency increases with age (0.11% in 50-year olds; 0.45% in 75-year olds), as reported for Y and autosomes. Methylation array analyses of 33 women with X mosaicism indicate events preferentially involve the inactive X chromosome. Our results provide further evidence that the sex chromosomes undergo mosaic events more frequently than autosomes, which could have implications for understanding the underlying mechanisms of mosaic events and their possible contribution to risk for chronic diseases.
  15. Fulltext Three new pancreatic cancer susceptibility signals identified on chromosomes 1q32.1, 5p15.33 and 8q24.21
    Zhang M, Wang Z, Obazee O, Jia J, Childs EJ, Hoskins J, et al.
    Oncotarget, 2016 Oct 11;7(41):66328-66343.
    PMID: 27579533 DOI: 10.18632/oncotarget.11041
    Genome-wide association studies (GWAS) have identified common pancreatic cancer susceptibility variants at 13 chromosomal loci in individuals of European descent. To identify new susceptibility variants, we performed imputation based on 1000 Genomes (1000G) Project data and association analysis using 5,107 case and 8,845 control subjects from 27 cohort and case-control studies that participated in the PanScan I-III GWAS. This analysis, in combination with a two-staged replication in an additional 6,076 case and 7,555 control subjects from the PANcreatic Disease ReseArch (PANDoRA) and Pancreatic Cancer Case-Control (PanC4) Consortia uncovered 3 new pancreatic cancer risk signals marked by single nucleotide polymorphisms (SNPs) rs2816938 at chromosome 1q32.1 (per allele odds ratio (OR) = 1.20, P = 4.88x10 -15), rs10094872 at 8q24.21 (OR = 1.15, P = 3.22x10 -9) and rs35226131 at 5p15.33 (OR = 0.71, P = 1.70x10 -8). These SNPs represent independent risk variants at previously identified pancreatic cancer risk loci on chr1q32.1 ( NR5A2), chr8q24.21 ( MYC) and chr5p15.33 ( CLPTM1L- TERT) as per analyses conditioned on previously reported susceptibility variants. We assessed expression of candidate genes at the three risk loci in histologically normal ( n = 10) and tumor ( n = 8) derived pancreatic tissue samples and observed a marked reduction of NR5A2 expression (chr1q32.1) in the tumors (fold change -7.6, P = 5.7x10 -8). This finding was validated in a second set of paired ( n = 20) histologically normal and tumor derived pancreatic tissue samples (average fold change for three NR5A2 isoforms -31.3 to -95.7, P = 7.5x10 -4-2.0x10 -3). Our study has identified new susceptibility variants independently conferring pancreatic cancer risk that merit functional follow-up to identify target genes and explain the underlying biology.
  16. Menstrual and Reproductive Factors, Hormone Use, and Risk of Pancreatic Cancer: Analysis From the International Pancreatic Cancer Case-Control Consortium (PanC4)
    Lujan-Barroso L, Zhang W, Olson SH, Gao YT, Yu H, Baghurst PA, et al.
    Pancreas, 2016 11;45(10):1401-1410.
    PMID: 27088489
    OBJECTIVES: We aimed to evaluate the relation between menstrual and reproductive factors, exogenous hormones, and risk of pancreatic cancer (PC).

    METHODS: Eleven case-control studies within the International Pancreatic Cancer Case-control Consortium took part in the present study, including in total 2838 case and 4748 control women. Pooled estimates of odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated using a 2-step logistic regression model and adjusting for relevant covariates.

    RESULTS: An inverse OR was observed in women who reported having had hysterectomy (ORyesvs.no, 0.78; 95% CI, 0.67-0.91), remaining significant in postmenopausal women and never-smoking women, adjusted for potential PC confounders. A mutually adjusted model with the joint effect for hormone replacement therapy (HRT) and hysterectomy showed significant inverse associations with PC in women who reported having had hysterectomy with HRT use (OR, 0.64; 95% CI, 0.48-0.84).

    CONCLUSIONS: Our large pooled analysis suggests that women who have had a hysterectomy may have reduced risk of PC. However, we cannot rule out that the reduced risk could be due to factors or indications for having had a hysterectomy. Further investigation of risk according to HRT use and reason for hysterectomy may be necessary.

  17. Influence of Genotype on Warfarin Maintenance Dose Predictions Produced Using a Bayesian Dose Individualization Tool
    Saffian SM, Duffull SB, Roberts RL, Tait RC, Black L, Lund KA, et al.
    Ther Drug Monit, 2016 12;38(6):677-683.
    PMID: 27855133
    BACKGROUND: A previously established Bayesian dosing tool for warfarin was found to produce biased maintenance dose predictions. In this study, we aimed (1) to determine whether the biased warfarin dose predictions previously observed could be replicated in a new cohort of patients from 2 different clinical settings, (2) to explore the influence of CYP2C9 and VKORC1 genotype on predictive performance of the Bayesian dosing tool, and (3) to determine whether the previous population used to develop the kinetic-pharmacodynamic model underpinning the Bayesian dosing tool was sufficiently different from the test (posterior) population to account for the biased dose predictions.

    METHODS: The warfarin maintenance doses for 140 patients were predicted using the dosing tool and compared with the observed maintenance dose. The impact of genotype was assessed by predicting maintenance doses with prior parameter values known to be altered by genetic variability (eg, EC50 for VKORC1 genotype). The prior population was evaluated by fitting the published kinetic-pharmacodynamic model, which underpins the Bayesian tool, to the observed data using NONMEM and comparing the model parameter estimates with published values.

    RESULTS: The Bayesian tool produced positively biased dose predictions in the new cohort of patients (mean prediction error [95% confidence interval]; 0.32 mg/d [0.14-0.5]). The bias was only observed in patients requiring ≥7 mg/d. The direction and magnitude of the observed bias was not influenced by genotype. The prior model provided a good fit to our data, which suggests that the bias was not caused by different prior and posterior populations.

    CONCLUSIONS: Maintenance doses for patients requiring ≥7 mg/d were overpredicted. The bias was not due to the influence of genotype nor was it related to differences between the prior and posterior populations. There is a need for a more mechanistic model that captures warfarin dose-response relationship at higher warfarin doses.

  18. The value of biodiversity for the functioning of tropical forests: insurance effects during the first decade of the Sabah biodiversity experiment
    Tuck SL, O'Brien MJ, Philipson CD, Saner P, Tanadini M, Dzulkifli D, et al.
    Proc Biol Sci, 2016 Dec 14;283(1844).
    PMID: 27928046
    One of the main environmental threats in the tropics is selective logging, which has degraded large areas of forest. In southeast Asia, enrichment planting with seedlings of the dominant group of dipterocarp tree species aims to accelerate restoration of forest structure and functioning. The role of tree diversity in forest restoration is still unclear, but the 'insurance hypothesis' predicts that in temporally and spatially varying environments planting mixtures may stabilize functioning owing to differences in species traits and ecologies. To test for potential insurance effects, we analyse the patterns of seedling mortality and growth in monoculture and mixture plots over the first decade of the Sabah biodiversity experiment. Our results reveal the species differences required for potential insurance effects including a trade-off in which species with denser wood have lower growth rates but higher survival. This trade-off was consistent over time during the first decade, but growth and mortality varied spatially across our 500 ha experiment with species responding to changing conditions in different ways. Overall, average survival rates were extreme in monocultures than mixtures consistent with a potential insurance effect in which monocultures of poorly surviving species risk recruitment failure, whereas monocultures of species with high survival have rates of self-thinning that are potentially wasteful when seedling stocks are limited. Longer-term monitoring as species interactions strengthen will be needed to more comprehensively test to what degree mixtures of species spread risk and use limited seedling stocks more efficiently to increase diversity and restore ecosystem structure and functioning.
  19. Fulltext Guidelines for the use and interpretation of assays for monitoring autophagy (3rd edition)
    Klionsky DJ, Abdelmohsen K, Abe A, Abedin MJ, Abeliovich H, Acevedo Arozena A, et al.
    Autophagy, 2016;12(1):1-222.
    PMID: 26799652 DOI: 10.1080/15548627.2015.1100356
  20. Fulltext Long-term outcomes in leadless Micra transcatheter pacemakers with elevated thresholds at implantation: Results from the Micra Transcatheter Pacing System Global Clinical Trial
    Piccini JP, Stromberg K, Jackson KP, Laager V, Duray GZ, El-Chami M, et al.
    Heart Rhythm, 2017 05;14(5):685-691.
    PMID: 28111349 DOI: 10.1016/j.hrthm.2017.01.026
    BACKGROUND: Device repositioning during Micra leadless pacemaker implantation may be required to achieve optimal pacing thresholds.

    OBJECTIVE: The purpose of this study was to describe the natural history of acute elevated Micra vs traditional transvenous lead thresholds.

    METHODS: Micra study VVI patients with threshold data (at 0.24 ms) at implant (n = 711) were compared with Capture study patients with de novo transvenous leads at 0.4 ms (n = 538). In both cohorts, high thresholds were defined as >1.0 V and very high as >1.5 V. Change in pacing threshold (0-6 months) with high (1.0 to ≤1.5 V) or very high (>1.5 V) thresholds were compared using the Wilcoxon signed-rank test.

    RESULTS: Of the 711 Micra patients, 83 (11.7%) had an implant threshold of >1.0 V at 0.24 ms. Of the 538 Capture patients, 50 (9.3%) had an implant threshold of >1.0 V at 0.40 ms. There were no significant differences in patient characteristics between those with and without an implant threshold of >1.0 V, with the exception of left ventricular ejection fraction in the Capture cohort (high vs low thresholds, 53% vs 58%; P = .011). Patients with an implant threshold of >1.0 V decreased significantly (P < .001) in both cohorts. Micra patients with high and very high thresholds decreased significantly (P < .01) by 1 month, with 87% and 85% having 6-month thresholds lower than the implant value. However, when the capture threshold at implant was >2 V, only 18.2% had a threshold of ≤1 V at 6 months and 45.5% had a capture threshold of >2 V.

    CONCLUSIONS: Pacing thresholds in most Micra patients with elevated thresholds decrease after implant. Micra device repositioning may not be necessary if the pacing threshold is ≤2 V.

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