New European Directive on clinical trials.
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Clinical Trials as Topic↗
Biomedical subjects
Lennart Persson
Publications and source records attributed to Lennart Persson.
Emergent Allee effects in top predators feeding on structured prey populations.
Top predators that forage in a purely exploitative manner on smaller stages of a size-structured prey population have been shown to exhibit an Allee effect. This Allee effect emerges from the changes that predators induce in the prey-population size distribution and represents a feedback of predator density on its own performance, in which the feedback operates through and is modified by the life history of the prey. We demonstrate that these emergent Allee effects will occur only if the prey, in the absence of predators, is regulated by density dependence in development through one of its juvenile stages, as opposed to regulation through adult fecundity. In particular, for an emergent Allee effect to occur, over-compensation is required in the maturation rate out of the regulating juvenile stage, such that a decrease in juvenile density will increase the total maturation rate to larger/older stages. If this condition is satisfied, predators with negative size selection, which forage on small prey, exhibit an emergent Allee effect, as do predators with positive size selection, which forage on large adult prey. By contrast, predators that forage on juveniles in the regulating stage never exhibit emergent Allee effects. We conclude that the basic life-history characteristics of many species make them prone to exhibiting emergent Allee effects, resulting in an increased likelihood that communities possess alternative stable states or exhibit catastrophic shifts in structure and dynamics.
Age Factors↗
Gigantic cannibals driving a whole-lake trophic cascade.
Trophic cascades have been a central paradigm in explaining the structure of ecological communities but have been demonstrated mainly through comparative studies or experimental manipulations. In contrast, evidence for shifts in trophic cascades caused by intrinsically driven population dynamics is meager. By using empirical data of a cannibalistic fish population covering a 10-year period and a size-structured population model, we show the occurrence of a dynamic trophic cascade in a lake ecosystem, in which the community over time alternates between two different configurations. The intrinsically driven change in the size structure of the fish population from a dominance of stunted individuals to a dominance of gigantic cannibals among adult individuals is the driving force behind distinct abundance switches observed in zooplankton and phytoplankton. The presence of the phase with gigantic cannibals depends critically on the energy they extract from their victims, allowing strong reproduction for a number of years.
Animals↗
On the issue of early and aggressive treatment in grade 2 gliomas.
PURPOSE: To study the effects of surgery and timing of radiotherapy on patient survival in grade 2 gliomas. METHODS: One hundred and eighty-nine patients with diffuse astrocytomas, oligoastrocytomas, and oligodendrogliomas, World Health Organization grade 2, treated between 1982 and 2000 were identified. The impact of treatment given and clinical parameters were studied in univariate- and multivariate survival analyses. RESULTS: Median survival for the whole patient sample was 6.4 years and the 5-year survival rate was 60%. Macroscopic total resection was beneficial in the univariate analysis (P=0.03) but not when adjusting for confounders. Early subtotal resection did not prolong survival. Early radiotherapy was associated with a shorter survival time compared to delayed or no irradiation (P=0.004). However, this difference was mainly due to an unequal distribution of prognostic factors and was not significant in the multivariate analysis. The most important predictors for long survival time were young age ( P<0.001), oligodendroglioma histology ( P<0.001), and small tumour size ( P=0.02). CONCLUSIONS: Early conventional treatment with surgery and radiotherapy had no positive effect on patient survival. This opens up the possibility of trying and evaluating other first-line treatment regimens in this disease.
Adult↗
Competition in size-structured populations: mechanisms inducing cohort formation and population cycles.
In this paper we investigate the consequences of size-dependent competition among the individuals of a consumer population by analyzing the dynamic properties of a physiologically structured population model. Only 2 size-classes of individuals are distinguished: juveniles and adults. Juveniles and adults both feed on one and the same resource and hence interact by means of exploitative competition. Juvenile individuals allocate all assimilated energy into development and mature on reaching a fixed developmental threshold. The combination of this fixed threshold and the resource-dependent developmental rate, implies that the juvenile delay between birth and the onset of reproduction may vary in time. Adult individuals allocate all assimilated energy to reproduction. Mortality of both juveniles and adults is assumed to be inversely proportional to the amount of energy assimilated. In this setting we study how the dynamics of the population are influenced by the relative foraging capabilities of juveniles and adults. In line with results that we previously obtained in size-structured consumer-resource models with pulsed reproduction, population cycles primarily occur when either juveniles or adults have a distinct competitive advantage. When adults have a larger per capita feeding rate and are hence competitively superior to juveniles, population oscillations occur that are primarily induced by the fact that the duration of the juvenile period changes with changing food conditions. These cycles do not occur when the juvenile delay is a fixed parameter. When juveniles are competitively superior, two different types of population fluctuations can occur: (1) rapid, low-amplitude fluctuations having a period of half the juvenile delay and (2) slow, large-amplitude fluctuations characterized by a period, which is roughly equal to the juvenile delay. The analysis of simplified versions of the structured model indicates that these two types of oscillations also occur if mortality and/or development is independent of food density, i.e. in a situation with a constant juvenile developmental delay and a constant, food-independent background mortality. Thus, the oscillations that occur when juveniles are more competitive are induced by the juvenile delay per se. When juveniles exert a larger foraging pressure on the shared resource, maturation implies an increase not only in adult density, but also in food density and consequently fecundity. Our analysis suggests that this correlation in time between adult density and fecundity is crucial for the occurrence of population cycles when juveniles are competitively superior.
Animals↗
Cerebral blood flow and metabolism after cardiopulmonary resuscitation. A pathophysiologic and prognostic positron emission tomography pilot study.
BACKGROUND: Prolonged coma is not an uncommon clinical problem following resuscitation from cardiac arrest. Early and precise prediction of outcome is highly desirable for ethical and economical reasons. The aims of this study were to use positron emission tomography (PET) to investigate the regional dynamic changes of cerebral blood flow and metabolism during the early period after cardiopulmonary resuscitation (CPR) in unconscious patients and to evaluate if PET may be a potential prognostic evaluator. METHODS AND RESULTS: PET and Glasgow Coma Scale examinations were sequentially performed on days 1, 3 and 7 in seven patients remaining comatose post CPR. Each PET included regional determinations of cerebral blood flow (rCBF), oxygen metabolism (rCMRO(2)), oxygen extraction ratio (rOER), and cerebral blood volume (rCBV). One patient was excluded due to complex trauma problems. Three patients remained unconscious until death and three woke up. All patients initially exhibited low CMRO(2) and CBF. Increased OER was only found exceptionally and when present was predominantly in focal areas. The comatose patients showed progressive depression of CMRO(2) and after 1 week had lower CMRO(2) than those patients who woke up. This difference was most pronounced in the putamen and occipital cortex. Two of the seven patients developed large focal infarcts. CONCLUSIONS: An initially low CMRO(2) was common to all patients. Early development of subclinical focal ischemic lesions was also common. The progressive depression of CMRO(2) over the first week in those patients remaining unconscious may be an indication of prolonged but not necessarily permanent coma. Further studies are required to identify pathophysiological features that can predict the long-term clinical outcome in patients who remain unconscious after 1 week.
Aged↗
Microdialysis for neurochemical monitoring of the human brain.
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Brain Chemistry↗
Size-dependent life-history traits promote catastrophic collapses of top predators.
Catastrophic population collapses such as observed in many exploited fish populations have been argued to result from depensatory growth mechanisms (i.e., reduced reproductive success at low population densities, also known as Allee effect). Empirical support for depensation from population-level data is, however, hard to obtain and inconclusive. Using a size-structured, individual-based model we show that catastrophic population collapses may nonetheless be an intrinsic property of many communities, because of two general aspects of individual life history: size- and food-dependent individual growth and individual mortality decreasing with body size. Positive density dependence, characteristic for depensatory growth mechanisms and catastrophic behavior, results as a direct and robust consequence of the interplay between these individual life-history traits, which are commonly found in many species.
Animals↗
[BNCT--neutron radiotherapy of brain tumors].
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Boron Neutron Capture Therapy↗
Traumatic subarachnoid hemorrhage: demographic and clinical study of 750 patients from the European brain injury consortium survey of head injuries.
OBJECTIVE: Previous reports identified the presence of traumatic subarachnoid hemorrhage (tSAH) on admission computed tomographic (CT) scans as an independent prognostic factor in worsening outcomes. The mechanism underlying the link between tSAH and prognosis has not been clarified. The aim of this study was to investigate the association between CT evidence of tSAH and outcomes after moderate or severe head injuries. METHODS: In a survey organized by the European Brain Injury Consortium, data on initial severity, treatment, and subsequent outcomes were prospectively collected for 1005 patients with moderate or severe head injuries who were admitted to one of the 67 European neurosurgical units during a 3-month period in 1995. The CT findings were classified according to the Traumatic Coma Data Bank classification system, and the presence or absence of tSAH was recorded separately in the initial CT scan forms. RESULTS: Complete data on early clinical features, CT findings, and outcomes at 6 months were available for 750 patients, of whom 41% exhibited evidence of tSAH on admission CT scans. There was a strong, highly statistically significant association between the presence of tSAH and poor outcomes. In fact, 41% of patients without tSAH achieved the level of good recovery, whereas only 15% of patients with tSAH achieved this outcome. Patients with tSAH were significantly older (median age, 43 yr; standard deviation, 21.1 yr) than those without tSAH (median age, 32 yr; standard deviation, 19.5 yr), and there was a significant tendency for patients with tSAH to exhibit lower Glasgow Coma Scale scores at the time of admission. A logistic regression analysis of favorable/unfavorable outcomes demonstrated that there was still a very strong association between tSAH and outcomes after simultaneous adjustment for age, Glasgow Coma Scale Motor Scores, and admission CT findings (odds ratio, 2.49; 95% confidence interval, 1.74-3.55; P < 0.001). Comparison of the time courses for 164 patients with early (within 14 d after injury) deaths demonstrated very similar patterns, with an early peak and a subsequent decline; there was no evidence of a delayed increase in mortality rates for either group of patients (with or without tSAH). CONCLUSION: These findings for an unselected series of patients confirm previous reports of the adverse prognostic significance of tSAH. The data support the view that death among patients with tSAH is related to the severity of the initial mechanical damage, rather than to the effects of delayed vasospasm and secondary ischemic brain damage.
Adult↗
Dwarfs and Giants: Cannibalism and Competition in Size-Structured Populations.
Cannibals and their victims often share common resources and thus potentially compete. Smaller individuals are often competitively superior to larger ones because of size-dependent scaling of foraging and metabolic rates, while larger ones may use cannibalism to counter this competition. We study the interplay between cannibalism and competition using a size-structured population model in which all individuals consume a shared resource but in which larger ones may cannibalize smaller conspecifics. In this model, intercohort competition causes single-cohort cycles when cannibalism is absent. Moderate levels of cannibalism reduce intercohort competition, enabling coexistence of many cohorts. More voracious cannibalism, in combination with competition, produces large-amplitude cycles and a bimodal population size distribution with many small and few giant individuals. These coexisting ``dwarfs'' and ``giants'' have very different life histories, resulting from a reversal in importance of cannibalism and competition. The population structure at time of birth determines whether individuals suffer severe cannibalism, with the few survivors reaching giant sizes, or whether they suffer intense intracohort competition, with all individuals remaining small. These model results agree remarkably well with empirical data on perch population dynamics. We argue that the induction of cannibalistic giants in piscivorous fish is a population-dynamic emergent phenomenon that requires a combination of size-dependent cannibalism and competition.
Perca fluviatilis↗