Methods br Results The etiology of voiding dysfunction


The etiology of voiding dysfunction in these patients included neurogenic bladder secondary to Eagle-Barrett syndrome (n = 2), Noonan syndrome (n = 1), Lennox-Gastaut syndrome (n = 1), and Spina bifida (n = 2; 1 patient with prior gastrocystoplasty and 1 patient with prior ileocystoplasty). A complete listing of patient demographics and outcomes is in Table 1. The median patient age at the time of surgery was 8 (interquartile range [IQR] 12) years, and there were 3 males and 3 females. The four patients without Eagle-Barrett syndrome had fluorodynamic estimated bladder capacities of 250, 410, 380, and 202 mL.

This study describing the continent catheterizable vesicostomy, using solely native bladder tissue, offers an additional surgical modality to the myriad of approaches that bypass the urethra for long-term bladder drainage. With modest follow-up, our initial case series demonstrates that the procedure is safe, feasible, and without episodes of channel incontinence between catheterizations. The indications for continent catheterizable vesicostomy are similar to other modalities (ie, Mitrofanoff or Monti procedure), in that the patients or caregivers should be capable and willing to perform catheterization 4-6 times per day via the umbilical stoma. Secondly, the patient\’s bladder capacity should be large enough to facilitate tubularization of a bladder flap cephalad to the umbilicus without compromising remaining bladder capacity. In our initial experience, cephalad traction at the dome of the bladder to delineate the length of tubularized flap necessary to reach the level of the umbilicus (Fig. 1A) has demonstrated sufficient capability to perform a continent catheterizable vesicostomy. Finally, for patients who require use of the GW788388 for a MACE procedure, continent catheterizable vesicostomy avoids the necessity of using a segment of bowel (ie, for a Monti procedure).
Appendicovesicostomy, introduced by Mitrofanoff in 1980, remains the preferred method for the creation of a catheterizable stoma. The appendix provides an adequate blood supply, stoma shape, lumen, and auto-lubrication, making it an ideal conduit. However, the required use of the appendix is a disadvantage for children in which the appendix is not available, including those patients requiring concurrent MACE procedure, as seen in our patient population. Many modified techniques have been developed on the basis of the Mitrofanoff principle, whichdescribes a continence mechanism based on a positive-pressure gradient between the channel lumen and the urinary reservoir. The most prominent is the Monti ileovesicostomy, first described in 1997. Additionally, Wedderburn et al and Kajbafzadeh and Chubak reported results using a modified technique to divide the appendix for simultaneous vesicostomy and antegrade continence enema. However, in addition to being technically challenging, this technique requires an appendix of adequate length, limiting its use.
Only a few techniques have been proposed that solely use bladder tissue for the formation of a catheterizable channel. Cain et al described a continent vesicostomy consisting of a 2-3 cm extravesical channel and a 3 cm intravesical mucosal channel. After opening the bladder in the midline, a U-shaped incision is made at the bladder dome to provide tissue for the extravesical channel, while mucosa elevated from the bladder interior wall forms the intravesical portion. The continence mechanism is derived from detrusor muscle closure over the mucosal tunnel to create flap-valve continence. However, despite excellent continence rates, in a 100 patient study performed at a single institution, this technique was found to have higher rates of stenosis requiring surgical intervention or reconstruction compared to appendicovesicostomy and Monti procedures.
Based on an incidental finding of continence in an epithelized neobladder-cutaneous fistula in a male infant with bladder extrophy, Yang et al developed the vesicocutaneous fistula. Operatively, a 0.5-cm cystotomy is made and the outer muscle layer of the bladder wall is secured to Scarpa\’s fascia and the skin to create a near-continent fistula. The bladder mucosa is not fixed to the skin, differentiating this technique from traditional vesicostomy. With limited follow-up, patients with vesicocutaneous fistulae suffered minimal complications, as only 1 out of 6 patients required surgical revision for stomal stenosis following noncompliance with regular catheterization. Additionally, only 1 patient suffered from occasional enuresis, suggesting that vesicocutaneous fistula may have acceptable continence rates.

Contemporary trends of PSA screening for early

Contemporary trends of PSA screening for early detection of prostate cancer have important implications because prostate cancer remains the most commonly diagnosed male malignancy, with more than 200,000 men diagnosed each year in the United States. Furthermore, most men diagnosed with clinically localized disease currently receive some form of primary therapy. Previous studies examining the impact of changes in the previous USPSTF recommendations in limiting PSA screening among older patients (>75 years) found little changes among Medicare beneficiaries. More recently, however, several studies have suggested declines in the incidence of localized prostate cancer and PSA screening rates following the change to the guidelines in 2012. It is essential to recognize that all 3 studies relied on a national cross-sectional survey of patients to assess trends in prostate cancer screening.
Changes in the national screening rates for prostate cancer attributable to the recent changes from the USPSTF recommendation have significant health policy implications. At present, prostate cancer screening has been associated with significant healthcare costs, especially considering that the average annual costs to Medicare from prostate cancer screening alone has been estimated at approximately $500 million per year. Moreover, most men diagnosed with localized prostate cancer are undergoing primary therapy with new treatment technologies, such as robotic surgery or intensity-modulated purchase GSK461364 therapy, that have been shown to have higher healthcare costs as well. Little is known about the impact of these changes to the clinical practice guidelines on PSA testing, in particular among the privately insured patients. Addressing this key knowledge gap is essential in understanding the effects of the dissemination of clinical practice guidelines into clinical practice. Furthermore, it is also necessary to investigate other national data to accurately elucidate whether there has been a reduction in prostate cancer screening. In this context, we sought to identify trends of PSA screening using a national private health insurance database from 2008 to 2013. We also sought to examine patient characteristics associated with PSA screening over time.
Materials and Methods

From 2008 to 2013, we identified 5,225,372 men who underwent PSA screening for prostate cancer in the Optum Labs Data Warehouse. Overall, the mean age was 56.0 years (SD 8.5). As shown in Table 1, there were minimal differences in the patient characteristics over time. A majority of patients in the analytic cohort were white and between the ages of 40 and 64 years old. In addition, most patients were healthy, with a few having 2 or more comorbidities based on the Charlson-Deyo index.
Overall, our results indicate little changes in the rates of PSA screening from 190.4 in 2008 to 196.4 in 2013 per 1000 member-years (P = .66). From 2008 to 2013, we observed little changes in the crude rates of PSA screening for all groups except for older patients (Table 2). Among patients ≥75 years old, the crude rate of PSA screening tests fell from 201.5 patients in 2008 to 124.1 patients per 1000 member-years (P = .04). Crude rates of PSA also remained stable across different racial groups over time. However, patients residing in the Northeast geographic region had a gradual decrease of PSA screening rates, whereas those living in the South were found to have increase in PSA screening rates (both P < .05). Table 3 provides the adjusted rates of PSA screening per 1000 member-years by age, race, and census region. On multivariable analysis, the results demonstrate Cruciform there were minimal changes in the adjusted rates of PSA screening. Overall, the rates adjusted for race, age, comorbidity, and geographic region did not vary from 190.4 individuals in 2008 to 196.5 individuals per 1000 member-years (P = .65). Likewise, the age, race, and census region adjusted PSA screening rates remained relatively stable over time from 2008 to 2013.

This is a combination of basic and translation research By

This is a combination of basic and syk inhibitor research. By setting up a good platform in urothelial carcinoma cell lines, our efforts may help us to advance our understanding of the urological cancers and develop many unique cancer cell lines for functional research in cancers.

Retropubic radical prostatectomy (RRP) after prior transurethral resection of the prostate (TURP) was associated with increased intraoperative and postoperative morbidity in literature review. Robotic assisted radical prostatectomy (RaRP) provides a better surgical view compared to conventional RRP. Ideally, it might provide a better vision to navigate the difficult surgical planes of previous surgeries. In this study, we compared the peri- and post-operative outcomes of RaRP in patients underwent a prior TURP.
We retrospectively enrolled 249 patients who received RaRP from 2009 to 2016 by two experienced robotic surgeons in our hospital. Sixteen patients accepted a prior TURP. Total 16 patients had previous history of TURP (study group). The perioperative parameters, pathologic characteristics, complications, and voiding function outcomes were compared between the study group and those who didn\’t underwent a prior TURP (control group).
Among the 16 patients, 3 patients had benign pathology of TURP in 5, 8 and 11 years prior to RaRP. One patient was diagnosed to have cT1a, Gleason 1+1 prostate cancer after TURP. The other 12 patients was diagnosed Gleason grade≧6 prostate cancer after TURP and they had a mean time of 4 months (1.1–8.4 months) between TURP and RaRP. Mean operative time was similar between the study and control group (245.3 vs. 249.9 minutes, p=0.711), mean blood loss was similar (85.8 vs. 93.5 cc, p=0.824), post operation Foley indwelling time and hospital stay were also similar (6.7 vs. 4.3 days, p=0.153; 7.0 vs. 6.2 days, p=0.192). We performed bilateral neurovascular bundle (NVB) sparing, unilateral NVB sparing in 62.5%, 18.8% of study group patients, which was not less than control group (bilateral NVB sparing/unilateral NVB sparing=64.8%/26.6%, p=0.852). The positive surgical margin rate was similar between study and control group (18.8% vs. 27.0%, p=0.571). The overall complication rate in study group was 31.25% (Clavien grade I: 5 patients), and 15.45% in control group (Clavien grade I: 30 patients, Clavien grade II: 2 patients, Clavien grade IIIa: 1 patient, Clavien grade IIIb: 3 patients). Although the complication rate in study group seemed higher then control group, it did not reach statistical significance (p=0.231). Regarding syk inhibitor post-operative continence, no difference could be observed between the 2 groups in terms of post-operative pad free rate (62% vs 68%, p=0.8412).
RaRP might be challenging after a prior TURP. However, the peri- and post-operative outcomes were not compromised in experienced hands.

Upper urinary tract urothelial carcinoma (UT-UC) is rare and, according to the current guidelines, treatment options or prognostic markers are limited. There is increasing evidence indicating that urothelial carcinoma may be an endocrine-related cancer. The aim of this study was to analyze data from a single tertiary referral center in Taiwan and identify the prognostic effect of estrogen receptor beta (ERβ) on the outcome of UT-UC.
From 2005 to 2012, 188 patients with pT3 UT-UC were treated at our institution. Only 115 patients with solitary renal pelvis or ureteral tumor underwent radical surgery. This study included 105 patients with adequate specimen quality. Perioperative factors, pathological features, and ERβ immunostaining were reviewed and prognostic effects were examined by multivariate analysis.
This study divided patients into either the ERβ-positive (n=52) or ERβ-negative (n=53) group and analyzed their oncologic outcomes. All pathological features except infiltrating tumor architecture (significantly higher incidence in ERβ-negative groups, p=0.004) are symmetric in both groups. Negative ERβ expression was significantly correlated with local recurrence and distant metastasis in univariate analysis (p=0.035 and 0.004, respectively) and multivariate analysis (p=0.05 and 0.008, respectively).

A total of bladder specimens and ureter specimens were

A total of 26 purchase KB-R7943 mesylate specimens and 4 ureter specimens were reviewed. Mucosa denudation was noted in most bladder specimens, and only 3 bladders (11.5%) had intact urothelium. Inflammatory cells infiltration and nerve hyperplasia were involved in all layers of bladder. Fibrinoid necrosis in submucosa was also found in 4 patients (15.4%). The history of ketamine abuse, VAS, CBC and MBC between all kinds of histopathology finding grades did not have significant difference (all p>0.05). Cessation of ketamine for 3 month also was not associated with inflammation or nerve hyperplasia severity. Ureteral inflammation, nerve hyperplasia and fibrosis were also noted in all layers
Long term ketamine abuse could induce all layers inflammation, nerve hyperplasia and fibrosis in the bladders and ureters. Cessation ketamine for 3 months were not enough for inflammation and nerve hyperplasia recovery in the KC bladder.

Because of low inter-raters\’ agreement on specific flow pattern and high inter-raters\’ agreement on bell vs. non-bell patterns, we developed a novel classification of uroflowmetry to improve inter-raters\’ agreement in interpreting uroflowmetry.
Uroflowmetry curves are classified as:, grade 1 typical bell; grade 2 bell with significant fluctuations; grade 3 probably bell; and grade 4 non-bell which is further classified as interrupted, staccato, obstructive and plateau patterns. Definition of each grade and typical curves were taught to a junior urologist. First 50 consecutive curves were reviewed independently by the junior and senior urologist. Results of interpretation were compared and discussed to reach consensus. Then both reviewed another 50 curves independently again. Difference in one and two grades is regarded as minor and major difference, respectively. Difference in bell vs. non-bell pattern is regarded as major difference, and difference between abnormal patterns is regarded as minor difference.
Mean age of the 100 patients was 67.8+/−13.1 years. Of the first 50 curves, 12 (24%) and 3 (6%) were minor and major grade difference; 5 and 6 were minor and major pattern difference. Of the second 50 curves 16 (32%) and 0 were minor and major grade difference; 9 (18%) and 7 (14%) were minor and major pattern difference.
Grade of normalcy may improve inter-raters\’ agreement. Through teaching and practice, major grade difference can be avoided, while major pattern difference remained.

Interstitial Cystitis / Bladder Pain Syndrome (IC/BPS) is a chronic disease characterized by pelvic pain and lower urinary tract symptoms. Recent studies showed that IC/BPS may be associated with other comorbid diseases, such as mental health disorders. Psychological disorder including depression, anxiety, and mood catastrophizing that function outside of the bladder predict a significant impact on IC/BPS symptoms, especially on pain, hallmark symptom of IC/BPS. Other studies also found that repressors in erectile dysfunction (ED) patients tend to report their complaints in a manner that protects their self-worth as less distressed (depression, physical complaints). The purpose of this study is to examine whether the IC/BPS patients with repressive attitude personality were recovered poorly on bladder symptoms than non-repressors with IC/BPS.
This was a prospective study. Of 52 IC/BPS patients who were compatible with AUA/SUFU criteria including unpleasant sensation (pain, pressure, discomfort) perceived to be related to bladder with duration >6 weeks were included. All these patients completed measures of pain severity (Visual Analog Scale), bladder symptom severity (IC Symptom Index, IC Problem Index) and Pelvic Pain Scale, Urgency Scale (PUF scale). Cystoscopic hydrodistension was performed in all patients and different degrees of glomerulation were also observed. Hunner ulcer was excluded in this study. Maximal bladder capacity (MBC) during 2 minutes cystoscopic hydrodistension was also recorded. In psychological intervention, the personality questionnaire was collected by the validity scales of Millon Clinical Multiaxial Inventory-III (MCMI-III) for distinguishing three personality types, as repressor, neuroticism and normal groups. Beck Depression invention (BDI) and Beck Anxiety invention (BAI) were also recorded for emotional status. After hydrodistension, all patients received intravesical hyaluronic acid instillation therapy within 12 weeks. Then we collected symptomatic data to assess symptom severity and improvement before (baseline) and after (post-treatment) spanning a period of 12 weeks. These data were analyzed using point bi-serial correlation for ANOVA and chi-square to evaluate symptoms and personality types in these three patient\’s groups. Significance was set at p<0.05.

In the present study prostate volume was an

In the present study, prostate volume was an independent predictor of high-grade disease in men with PSA levels of 3.0-4.0 ng/mL. The findings of the present study corroborate the results of Ahyai et al who showed that prostate volume was the only independent risk factor of high-grade disease at biopsy in men with a PSA level ≤4.0 ng/mL. In our results, the proportion of high-grade disease was different according to prostate volume in men with PSA levels of 3.0-4.0 ng/mL. As prostate volume decreased, the proportion of high-grade disease was increased. However, as prostate volume increased, the proportion of high-grade disease was decreased resulting in increased clinically insignificant cancer. Thus, for better clinical implication of our findings regarding high-grade and clinically insignificant cancer rates, we categorized prostate volume as <25, 25-34, 35-44, and ≥45 mL. According to our findings, prostate biopsy should be strongly recommended in Korean men with normal or mildly enlarged prostate because they had a higher risk of high-grade disease, whereas the risk of clinically insignificant cancer was lower than those with moderate prostatic enlargement. Our study had several limitations, including the potential selection bias inherent in retrospective studies and the lack of follow-up information on disease progression or mortality. However, we previously reported that GS showed the strongest statistical significance for biochemical failure in patients with a serum PSA level of ≤10.0 ng/mL. In addition, our study prostanoid receptors consisted of a large, homogenous group of Korean men who underwent extended 12-core biopsy according to a predefined protocol and were evaluated, treated, and followed up regularly at a single academic center. All biopsy and surgical pathologic findings were reviewed by a single uro-pathologist. The prevalence of both high-grade and insignificant prostate cancers in our large cohort with low PSA levels and the identification of predictive factors in the present study provide insight into prostate cancer associated with low PSA levels and valuable information about PSA screening in Asian men.


Androgens play a key role in the maintenance and development of the prostate gland and appear to influence prostate carcinogenesis. Dihydrotestosterone (DHT), a metabolite of testosterone and the most potent androgen, has been linked to prostate carcinogenesis. The conversion of testosterone to DHT occurs predominantly and irreversibly through the action of steroid 5α-reductase type II, which is encoded by the gene. Besides testosterone, androst-4-ene-3,17-dione (androstenedione) is another substrate of the type II steroid 5α-reductase enzyme, which converts androstenedione to 5α-androstane-3,17-dione (androstanedione) and subsequently to DHT via the enzyme 17β-hydroxysteroid dehydrogenase type 5 (17β-HSD). Androstenedione level decreases and sex-hormone binding globulin (SHBG) level increases in aging male. Although not consistent, previous study has shown an association between prostate cancer risk and SHBG.
A recent study demonstrated that the pathway for DHT formation from androstenedione via androstanedione is more important than via testosterone. Another study showed that the main route of DHT synthesis in castration-resistant prostate cancer bypasses testosterone and requires 5α reduction of androstenedione by to 5α-androstanedione and then converted to DHT. The ability of the competitive inhibitor finasteride to reduce the conversion of testosterone into DHT in the prostate led to the Prostate Cancer Prevention Trial (PCPT) of finasteride vs placebo in 18,880 men. Although finasteride in the PCPT was associated with a 24.8% overall reduction in prostate cancer risk, it also was associated with a 25% increased risk of high-grade tumors, which raised questions regarding the ultimate role of finasteride in prostate cancer prevention. In this study, we investigated the effect of finasteride on serum androstenedione and its association with prostate cancer risk within the PCPT cohort.

Case reports and series available in the literature uniformly demonstrate

Case reports and series available in the literature uniformly demonstrate dismal outcomes. However, survival outcomes based on stage and response to conventional treatment have not been reported. We retrospectively reviewed the clinical outcomes of patients with a pathologically confirmed diagnosis of sarcomatoid prostate cancer in an effort to identify potential benefits from treatment and better inform prognosis.

A total of 70 patients with sarcomatoid prostate cancer were included in this analysis. Twenty-five patients were excluded from the survival analysis due to lack of available clinical information. Survival data were obtained on 45 patients, of whom 27 had confirmed clinical staging and treatment data. Table 1 lists the clinical and histopathological characteristics of all patients. At the time of diagnosis of sarcomatoid carcinoma, there was coexisting adenocarcinoma in 79% (55/70) of cases. All cases of adenocarcinoma had a Gleason score of 7 or greater. Of the patients with available medical histories, 35 of 45 (78%) had a prior history of adenocarcinoma. The time from diagnosis of adenocarcinoma to sarcomatoid prostate cancer varied, ranging from 9 months to 20 years. Twenty-two tissue specimens were previously stained for PSA. Twenty of 22 patients were reported as PSA-negative, with the remaining 2 patients having focally positive staining. Androgen receptor (AR) expression was not assessed.
The median OS for the 45 patients with obtainable clinical data was 10.6 months (95% CI: 7.16, 19.38) after a median follow-up of 106 months (Fig. 1A). Although the survival for the group as whole was short, outcomes differed substantially according to the extent of the disease. To further define survival outcomes, we mst2 subdivided patients based on a modified staging system: local disease, local disease with mst2 invasion, metastatic disease, and unstaged disease. After a median follow-up of 106 months, the median OS was not reached in the local disease group. Notably, 5 of the 9 patients diagnosed with local disease survived ≥5 years. For patients with local disease plus bladder invasion and metastatic disease, there was a greater risk of rapid death relative to patients with local disease only (Fig. 1B). The OS hazard ratio in the local disease with bladder invasion (median OS: 9 months) and metastatic disease groups (median OS: 7.1 months) were 20.46 (95% CI: 2.43, 172; P = .005) and 43.34 (95% CI: 4.39, 427.4; P = .001), respectively. Unstaged patients were of advanced age (83, 79, and 88 years old) and died shortly after diagnosis, without treatment.
We sought to investigate the outcomes of patients with local disease based on their treatment regimen (Table 2). The majority of patients were alive at the time of analysis (6/9) or had survived more than 2 years after diagnosis (7/9). Of the 6 patients alive at the time of analysis, 3 were treated with surgery alone, 2 had surgery followed by adjuvant radiation, and 1 received radiation alone. All patients receiving radiation were treated with external beam radiation. No brachytherapy was administered. Three patients with local disease at diagnosis died due to disease progression, surviving <7 months after metastatic recurrence. For further analysis, we combined the patients having metastatic disease with those having local disease with bladder invasion given the comparable poor prognosis of each group. Only 4 of the 15 patients with advanced disease were treated with hormonal therapy. After a median follow-up of 21 months in the advanced disease group, the 4 patients receiving gonadotropin-releasing hormone agonists and/or anti-androgens survived 7, 8, 8, and 10 months, whereas those treated without hormonal therapy survived from 1 to 21 months, with a median of 9 months (Fig. 2A). In each of the 4 patients who received ADT, no PSA or radiographic responses were observed and therapy was stopped within 3 months. Second-generation anti-androgens (ie, enzalutamide) and Cytochrome P450 isoform 17 inhibitors (ie, abiraterone acetate) were not administered.

In the comparison of the experimental and

In the comparison of the experimental and control groups, the control group generally showed that they were more relaxed and less stressed out according to certain significant sub-factors determined through physiological indicators such as SDNN and RMSSD of HRV and cyp450 inducers level (Table 6). However, regarding psychosocial indicators, the results were various according to the sub-scales (Table 7). The results that the experimental group showed higher scores in stress level despite of having FT program raises several possibilities to be interpreted. First, FT program of 3 days and 2 nights was not enough to relieve stress down to certain level if the experimental group already had lots of stress before the program that were not measured in our experiment compared to the control group had. FT program would have been one of the solutions that employers with a lot of stress took for relieving stress. Second, it would be better to use forest environment frequently in everyday life than to participate in the short-term organized camp like FT program considering that the control group were those who frequently use the environment without participating in the program.
Third, the results of this study would highlight the importance of including subjects who voluntarily apply to participate in the FT program. It could be suggested that some participants did not join the program completely voluntarily, but did so as a result of the workplace hierarchy; in other words, they might consider the program an extension of work. This was partially reflected in our results, which showed the decreased scores on the control experience of the REQ at the posttest (Table 5). Even though the program is an opportunity provided by the workplace to manage stress, involuntary participation would not enhance relaxation. Although it is very important for individuals to participate voluntarily, the program must also be devised to ensure the active participation of individuals in the program, as well as preparation for the institutionalization of FT in the workplace. For example, it is possible to either give workers a selection of several programs or allow the program some flexibility.
Considering the matter of measurement, it is crucial to maintain a stable physical state before the test. The MHR, which affects HRV and cortisol, are influenced by the amount of physical activity undertaken. We believe that one reason the MHR was higher in the posttest results of the experimental group (Table 4) was the difference in the level of closeness between the participants. The relatively undeveloped relations between subjects at the pretest could have resulted in greater feelings of anxiety when they were opening themselves up to others; however, this effect could have been alleviated if the subjects had either been in close relationships or been in a far more psychological distance, as one of the participants stated. It is important to control for any external factors affecting the study results, particularly those hindering the study purpose, which was to clarify the precise healing effects of the program. It would be helpful to recruit workers in the same position (e.g. deputy) or section (e.g. management, marketing, research and development part) in order to control participants’ closeness, for example.
This study has several limitations. First, the control group was tested only once. We did not deem it appropriate for the group to assess occupational stress on weekends, when they had not gone to work; we expected a high potential for remnant efficacy, especially in relation to the psychosocial indicators, given the short two-day period between the pretest and posttest. Although some previous studies in similar settings conducted both the pretest and posttest on the control group (Cho, 2012; Sung et al., 2012; Woo et al., 2012), they all seemed to have the same potential for remnant efficacy. Nonetheless, in our study, which measured stress in the control group only once, could not account for the changes in stress that might have occurred if there had been a posttest.

C rdoba has a Mediterranean climate with a

Córdoba has a Mediterranean climate with a slightly continental character. The annual average temperature is 17.6°C and total annual rainfall is 536mm (Spanish Meteorological Agency, AEMET, Spain).
Four Hirst-type (Hirst, 1952) volumetric samplers (Lanzoni s.r.l., Bologna, Italy) were used for this study in the city of Córdoba (Fig. 1). Two were installed on the University Campus, one in the city centre and the fourth on the southwestern outskirts of the city. Weekly phenological observations of orange trees were carried out in order to detect the start of flowering. The start date was taken as the date on which 10% of a tree\’s order Sulfo-NHS-LC-Biotin were open, and the end date as the date on which 90% of flowers were wilting.
The university campus (Rabanales) is located on the northeastern outskirts of the city near the “Sierra Morena” hills, and pollen counts are thus more influenced by natural than by urban vegetation. In addition to the permanent pollen-monitoring VPPS 2000 sampler installed in 2008 at 22m above ground level, a VPPS 1000 sampler was installed from 8 to 22 April 2013 at human height (1.5m), near a line of orange trees, for 24-h sampling. The two samplers were placed in the same area at different heights in order to ascertain the extent to which height influences Citrus pollen detection.
Sampling, counting and data management were carried out in accordance with guidelines published by the Spanish Aerobiology Network (Galán et al., 2007) and with the minimum recommendations of the European Aeroallergen Network (EAN) (Galán et al., 2014). Data, guaranteed by the Spanish Aerobiology Network quality control (Oteros et al., 2013), were expressed as average daily airborne pollen counts (pollen grains/m3).
Records were obtained for the Citrus Pollen Index (PI), i.e. the total annual pollen count obtained using the permanent sampler at the University Campus, for the period 2008-2014.
Another VPPS 1000 portable sampler was placed 1m above ground level in a public garden in the city centre (“Poets’ Garden”), 6km from the university campus, and pollen counts were monitored from 8 to 22 April 2013. This garden contains 77 C. aurantium trees: 54 planted in rows and 23 in a circle at one end of a row. The sampler was placed between two lines of orange trees bordering sidewalks, beside a fountain. The sampler was run daily for 60 consecutive minutes during the pollen season (12 p.m. to 1 p.m.). Data were transformed into pollen grains per cubic meter of air taking into account the air sampling rate (sampler suction rate: 10l/m=600l/h=0.6m3).
A fourth sampler was placed 1m above ground level within an orange-growing area (C. sinensis) over the same period (8–22 April 2013), and was run 24h day to obtain daily airborne pollen counts within the orange grove, located around 20km far from the University Campus in the southwestern outskirts of the city.
The location of four samplers used is shown in Fig. 1. All samplers were operating continuously during 24h connected to a permanent electricity socket except the portable sampler use in the public garden in the city centre were no electricity supply was possible so a portable sampler running on battery was used under supervision during one hour.

Results and discussion
Phenological monitoring of Citrus was carried out during the reproductive period, from the beginning of March, in order to record the start of flowering. Airborne pollen sampling began once flowering had started (10% of flowers open), and concluded at the end of flowering (90% of flowers wilting). Using this definition, the pollen season commenced on 8 April and ended on 22 April. The peak day (day recording the highest pollen count) was recorded on 15 April with a peak count of 1984pollen grains/m3. The annual sum of daily pollen counts (pollen index) recorded in the garden in the city centre was 5352 pollen grains.
The Citrus pollen index for the last 7 years (2008–2014), as recorded by the permanent sampler located at 22m above ground level on the University Campus, is shown in Fig. 2. The annual pollen index was very low in all study years, usually with values of less than 6 pollen grains. Low Citrus pollen counts were recorded at greater heights in areas where orange trees are less abundant. The permanent sampler on the University Campus is placed in an open area at 22m with a view to providing aerobiological information for a large area, and is thus not greatly influenced by local ornamental flora, and particularly by insect-pollinated species whose pollen grains are hardly dispersed.

Before any vacant land transformation contaminated sites need to

Before any vacant land transformation, contaminated sites need to be both restored and regulated. Depending on the mechanisms used for repair of the landscape, the process can be costly and intrusive to the ecosystem and community. Phytoremediation, the use of plants to remove or biostabilize contaminants in soil and water, is a low-cost remediation option (Russ, 2000). The restorative nature of plants has been recognized and understood for centuries, but the phytoremediation mechanism is viewed differently from the conventional horticulture or landscape architecture process (Kirkwood, 2001). Phytoremediation systems are typically designed and installed by environmental engineers and remediation specialists; if the site is to be developed into a green space, traditionally, a landscape architect joins the process after the remediation process is complete. In Phytoremediation: Integrating Art and Engineering Through Planting, Rock (Kirkwood 2001: p. 52), indicates that “on some sites it is possible to place planting in such a way as to allow for partial reuse of the site for public access.” In essence, phytoremediation should be viewed as landscape design, thus allowing it to be integrated into the public realm through earlier involvement from landscape architects.
The potential and benefit of phytoremediation for a MK-571 sodium salt hydrate has been discussed in the literature (Tucker and Shaw, 2000), but there has been very little connection made to the role that landscape architects can play in establishing a phytoremediation system. This study explored the elements required for Canadian municipalities to utilize phytoremediation in partnership with landscape architecture as an interim strategy to transform contaminated vacant lands into a usable green space until a permanent use for the site can be established. Can an interim landscape architecture strategy be used during phytoremediation to transform contaminated vacant lands into usable public space in Canadian municipalities? If so, how?

Methods and materials
The approach to this research combined an integrative literature review, the development of design guidelines, case study application of the guidelines, and an assessment by key informant reviews of the guidelines for their probability of success. The design guidelines were developed based on the information compiled through the literature, which were then applied to three case studies in different regions of Canada. Selection criteria were developed to facilitate case study selection. These three cases and the design guidelines and their application were evaluated by a group of experts who were chosen based on key informant selection criteria. A key informant is one who is well informed on a topic (Deming and Swaffield, 2011). For the purpose of this study, the definition of green space includes vegetated areas either actively or passively used, and the terms brownfield and contaminated vacant land are used interchangeably.




The River Don in The Wicker (Sheffield, UK) experienced severe flooding following the single highest one-day rainfall event since 1882 in June 2007. The impacts extended to tens of millions of pounds of construction and commercial damage, disruption to the road and rail networks and the loss of two lives. One cause was the engineered channelization and removal of stabilising vegetation from the river channel. However, a confluence of issues have been identified which collectively impacted the scale of the flood including changes in the management of the physical form of the river channel to speed up the dissipation of rainfall downstream, increased stormwater run-off into the channel from impermeable street surfaces, and the perceptions of local people of the capacity of the River Don to deal with flood events (Environment Agency, 2007). The negative coverage of the flooding influenced the decision of Sheffield City Council (SCC), and associated agencies, to modify their development strategies for the area. This included evaluating the appropriateness of the existing river management regime and remodelling the urban realm to promote investment in The Wicker (Mell et al., 2012a).

For the Common starling for alert

For the Common starling, for alert distances, only approach method and tree cover percentage were significant predictors when grass cover percentage was added and those with collinearity were eliminated. Only approach method and tree percentage cover were significant predictors when grass percentage cover was eliminated from the analysis. When approach method was eliminated, only tree percentage cover was significant. For flight distances, when grass cover percentage was added, only approach method was a significant predictor. When grass percentage cover was eliminated, only approach method was a significant predictor. When approach method was eliminated, there were no significant predictors (Table 6).
For the House sparrow, for alert distances, only approach method was a significant predictor when grass cover percentage was added and those with collinearity were eliminated. Only approach method and undergrowth percentage cover were significant predictors of alert distances, when grass percentage cover was eliminated from the analysis. When approach method was eliminated from the calculations, there were no significant predictors. For flight distances, only approach method, road proximity and tree height and undergrowth were significant predictors when grass percentage cover was added. Only approach method and road proximity were significant predictors when grass percentage cover was eliminated from the analysis and approach method was added. Only road proximity was a significant predictor when approach method was eliminated from the analysis. (Table 6).

The current study agrees with the assessment of Campbell (2010) that visible, increased human movements are at least as important as variable vegetation cover and structure as a bird reactive factor. As in Campbell (2006, 2010), the variable hand movements during human approach was one of the most signficant factors for alert and flight distances. This contrasts strong with the weaker signficance of the other factors, which showed more inter- histamine receptor antagonist variation. Human presence has been examined in other studies as a disturbance factor. However, few studies have complemented the assessment of larger perceptual radii for danger, with the possibility of similarly large radii in foraging, leading to greater attraction to human presence (Cooke, 1980; Humphrey et al., 1987; Holmes et al., 1993). Although hand swinging increased alert distances, the retreat to vicinity perching may be termed anticipatory feeding behaviour, which could be derived from avian experiences with previous feeding encounters. Hence, the possibility emerges that some alert periods were actually anticipatory feeding behaviour. Rock doves in particular are known to associate with people offering food sources (Campbell, 2006, 2007). This possibility can only be resolved by a gradient study with a comparison of birds unaccustomed to human behaviour with these exposed to human feeding in urban areas.
Strong variation was apparent at the intra-species level, this manifested in the low predictability of many of the independent factors. Bird size was reliable as a predictor for reactive distances only for crows versus the smaller species and to a lesser extent sparrows related to the larger species. In addition, very few of the landcover factors were significant predictors. These findings vary from those of Fernández-Juricic et al. (2001) and Campbell (2006, 2010) in which similar landcover variables were significant predictors, and less bird behavioural variability was recorded. In consistency with these other studies, tree cover percentage was a strong predictor, but possibly the lack of a correlation between tree height and percentage cover (as tree height was highly variable) may have obscured the status of these other features.
The variable alert and flight distances of the larger birds may be due to the larger species\’ greater attraction to human presence, juxtaposed with their larger reactive distances. Although the larger species\’ alert distances were longer than the those of the smaller species, the flight distances were not as distinguishable, due to long variable alert periods, which might be anticipatory periods for human feeding. The low predictabality of some independent factors in the current study revealed strong individualism in avian association with tree height, shrub cover and undergrowth. From this, it might be argued that individual birds adapt variably to human presence and behavior in different urban greenery structures. Few studies (except for the animal geography approach that explores avian individualism) have investigated the possibility of inter- and intra − species behavioural change in urban settings, hence this issue is largely speculative (Campbell, 2008). Fernández-Juricic et al. (2001: 264) in their work carried out a pilot study in a park which was not subsequently used in their experimental work, to avoid the possibility of birds adapting to the work in the study sites. Bird conditioning to survey methodologies may be common in parks with high human presence. However, the balance of individual bird learning and generalized species instinct is not a key issue in the literature (Marzluff et al., 2001; White et al., 2005; Clucas et al., 2011; Gil and Brumm, 2014).