A Primer on the Acute Management of Intravenous Extravasation Injuries for the Plastic Surgeon

Intravenous therapy is a common practice among many specialties. Intravenous therapy extravasation is a potential complication to such therapy. Hospitals without a dedicated wound care team trained in these interventions will often default to plastic surgical consultation, making an understanding of available interventions essential to the initial evaluation and management of these injuries. The goal of this article was to provide plastic surgeons and health care providers with a general overview of the acute management of intravenous infiltration and extravasation injuries. Though the decision for surgical versus nonsurgical management is often a clear one for plastic surgeons, local interventions, and therapies are often indicated and under-utilized in the immediate postinfiltration period. Thorough knowledge of these interventions should be a basic requirement in the armamentarium of plastic surgery consultants

Arqueología al oeste de Homs: sondeos en los yacimientos de Jeftelik (Natufiense), Tell Marj (Neolítico cerámico) y prospecciones de monumentos megalíticos: campaña 2009

RESUMEN: En el artículo se presentan los resultados de los trabajos de campo desarrollados en el marco del proyecto "Arqueología al oeste de Homs" en 2009. Se han excavado los yacimientos de Jeftelik y Tell Marj y se ha continuado la prospección de las necrópolis megalíticas en la región. Jeftelik es un yacimiento natufiense antiguo en el que se ha localizado una probable estructura de habitación a la que está asociado una gran cantidad de material lítico tallado. Sus características y cronología ponen en cuestión los modelos convencionales sobre el origen y expansión del natufiense. Tell Marj es un poblado construido al final del neolítico en el que las casas cuentan con muros de basalto bien escuadrados. En el lugar se han reconocido dos fases de ocupación por el momento, la más antigua de las cuales muestra varias reconstrucciones y superposiciones de casas. Entre el material arqueológico destaca la extraordinaria abundancia de puntas de proyectil y la presencia de restos que sugieren la implantación de formas económicas y sociales complejas, con intercambios a larga distancia y almacenamiento a gran escala. Las necrópolis megalíticas reconocidas destacan por la gran extensión de las áreas ocupadas, de decenas de km., y por la existencia de monumentos complejos que a veces asocian otro tipo de estructuras a las construcciones funerarias propiamente dichas.ABSTRACT: This paper presents the results of the fieldwork carried out within the Project "Archaeology to the West of Homs" in 2009. The sites at Jeftelik and Tell Marj have been excavated and the work surveying the megalithic necropolis in the área has continued. Jeftelik is an early Natufian site, with a probable habitation structure associated with a large amount of knapped lithic objects. Its characteristics and chronology question conventional models about the origin and expansion of the Natufian. Tell Marj is a late Neolithic settlement, with houses with well-built rectangular basalt walls. Two occupation phases have been identified to date, in which the older phase exhibits several stages of re-building and superimposition of houses. The archaeological material found includes large numbers of projectile points and remains suggesting the incorporation of complex economic and social forms, with long-distance exchange networks and large-scale storage. The megalithic necropolises that have been studied cover large areas, several tens of square kilometres. Complex monuments have been identified, sometimes, associated with other types of structures apart from the funerary constructions themselves.Este proyecto está financiado por el Ministerio de Educación y Ciencia (proyectos i+D+i HUM2007-66128-C02-01 y 02), el Instituto de Patrimonio Cultural de España del Ministerio de Cultura, el programa EXCAVA de la Generalitat de Catalunya, la Universidad Saint-Joseph de Beirut y la Universidad de Cantabria

Multiproxy approach to reconstruct fossil primate feeding behavior: Case study for macaque from the Plio-Pleistocene site Guefaït-4.2 (eastern Morocco)

The genus Macaca belongs to Cercopithecidae (Old World monkeys), Cercopithecinae, Papionini. The presence of Macaca in North Africa is well known from the Late Miocene to the Late Pleistocene. However, the diet of fossil Macaca has been poorly described in the literature. In this study, we investigated the feeding habits of Macaca cf. sylvanus (n = 4) from the Plio-Pleistocene site Guefaït-4.2 in eastern Morocco through multiproxy analysis combining analyses of stable carbon and oxygen isotopes from tooth enamel, buccal microtexture, and low-magnification occlusal dental microwear. For both microwear analyses, we compared the macaques with a new reference collection of extant members of Cercopithecoidea. Our occlusal microwear results show for the fossil macaque a pattern similar to the extant Cercocebus atys and Lophocebus albigena, African forest-dwelling species that are characterized by a durophagous diet based mainly on hard fruit and seed intake. Buccal microtexture results also suggest the consumption of some grasses and the exploitation of more open habitats, similar to that observed in Theropithecus gelada. The δ13C of M. cf. sylvanus indicates a C3 based-diet without the presence of C4 plants typical of the savanna grassland in eastern Africa during this period. The high δ18O values of M. cf. sylvanus, compared with the contemporary ungulates recovered from Guefaït-4.2, could be associated with the consumption of a different resource by the primate such as leaves or fresh fruits from the upper part of trees. The complementarity of these methods allows for a dietary reconstruction covering a large part of the individual’s life.This work has been funded by Palarq Foundation, Spanish Ministry of Culture and Sport (Ref: 42-T002018N0000042853 and 170-T002019N0000038589), Direction of Cultural Heritage (Ministry of Culture and Communication, Morocco), Faculty of Sciences (Mohamed 1r University of Oujda, Morocco), INSAP (Institut National des Sciences de l’Archéologie et du Patrimoine), Spanish Ministry of Science, Innovation and Universities (Ref: CGL2016-80975-P, CGL2016-80000-P, PGC2018-095489-B-I00, and PID2021- 122355NB-C33), Research Groups Support of the Generalitat de Catalunya (2017 SGR 836, 2017 SGR 1040, 2017 SGR 102, and 2017 SGR 859) and PDC2021-121613-I00 and PID2020-112963GB-I00 by ERDF A way of making Europe, by the European Union. RS-R, MC, AR-H, and CT research was funded by CERCA Programme Generalitat de Catalunya. IR-P is beneficiary of predoctoral fellowship (2020-FI-B-00731) funded by AGAUR and the Fons Social Europeu (FSE). AA and is beneficiary of a fellowship from the Erasmus Mundus Program to do the Master in Quaternary and Prehistory at the Universitat Rovira i Virgili (Tarragona, Spain). CT was supported by the Spanish Ministry of Science and Innovation through the “Ramón y Cajal” program (RYC2020-029404-I). The Institut Català de Paleoecologia Humana i Evolució Social (IPHES-CERCA) has received financial support from the Spanish Ministry of Science and Innovation through the “María de Maeztu” program for Units of Excellence (CEX2019-000945-M), including the postdoctoral fellowships of AR-H.With funding from the Spanish government through the "Severo Ochoa Center of Excellence" accreditation CEX2019-000945-M.Peer reviewe

Wild-type and mutant SOD1 share an aberrant conformation and a common pathogenic pathway in ALS.

Many mutations confer one or more toxic function(s) on copper/zinc superoxide dismutase 1 (SOD1) that impair motor neuron viability and cause familial amyotrophic lateral sclerosis (FALS). Using a conformation-specific antibody that detects misfolded SOD1 (C4F6), we found that oxidized wild-type SOD1 and mutant SOD1 share a conformational epitope that is not present in normal wild-type SOD1. In a subset of human sporadic ALS (SALS) cases, motor neurons in the lumbosacral spinal cord were markedly C4F6 immunoreactive, indicating that an aberrant wild-type SOD1 species was present. Recombinant, oxidized wild-type SOD1 and wild-type SOD1 immunopurified from SALS tissues inhibited kinesin-based fast axonal transport in a manner similar to that of FALS-linked mutant SOD1. Our findings suggest that wild-type SOD1 can be pathogenic in SALS and identify an SOD1-dependent pathogenic mechanism common to FALS and SALS

Identification of CIITA Regulated Genetic Module Dedicated for Antigen Presentation

The class II trans-activator CIITA is a transcriptional co-activator required for the expression of Major Histocompatibility Complex (MHC) genes. Although the latter function is well established, the global target-gene specificity of CIITA had not been defined. We therefore generated a comprehensive list of its target genes by performing genome-wide scans employing four different approaches designed to identify promoters that are occupied by CIITA in two key antigen presenting cells, B cells and dendritic cells. Surprisingly, in addition to MHC genes, only nine new targets were identified and validated by extensive functional and expression analysis. Seven of these genes are known or likely to function in processes contributing to MHC-mediated antigen presentation. The remaining two are of unknown function. CIITA is thus uniquely dedicated for genes implicated in antigen presentation. The finding that CIITA regulates such a highly focused gene expression module sets it apart from all other transcription factors, for which large-scale binding-site mapping has indicated that they exert pleiotropic functions and regulate large numbers of genes

Molecular biology of the blood-brain and the blood-cerebrospinal fluid barriers: similarities and differences

Efficient processing of information by the central nervous system (CNS) represents an important evolutionary advantage. Thus, homeostatic mechanisms have developed that provide appropriate circumstances for neuronal signaling, including a highly controlled and stable microenvironment. To provide such a milieu for neurons, extracellular fluids of the CNS are separated from the changeable environment of blood at three major interfaces: at the brain capillaries by the blood-brain barrier (BBB), which is localized at the level of the endothelial cells and separates brain interstitial fluid (ISF) from blood; at the epithelial layer of four choroid plexuses, the blood-cerebrospinal fluid (CSF) barrier (BCSFB), which separates CSF from the CP ISF, and at the arachnoid barrier. The two barriers that represent the largest interface between blood and brain extracellular fluids, the BBB and the BCSFB, prevent the free paracellular diffusion of polar molecules by complex morphological features, including tight junctions (TJs) that interconnect the endothelial and epithelial cells, respectively. The first part of this review focuses on the molecular biology of TJs and adherens junctions in the brain capillary endothelial cells and in the CP epithelial cells. However, normal function of the CNS depends on a constant supply of essential molecules, like glucose and amino acids from the blood, exchange of electrolytes between brain extracellular fluids and blood, as well as on efficient removal of metabolic waste products and excess neurotransmitters from the brain ISF. Therefore, a number of specific transport proteins are expressed in brain capillary endothelial cells and CP epithelial cells that provide transport of nutrients and ions into the CNS and removal of waste products and ions from the CSF. The second part of this review concentrates on the molecular biology of various solute carrier (SLC) transport proteins at those two barriers and underlines differences in their expression between the two barriers. Also, many blood-borne molecules and xenobiotics can diffuse into brain ISF and then into neuronal membranes due to their physicochemical properties. Entry of these compounds could be detrimental for neural transmission and signalling. Thus, BBB and BCSFB express transport proteins that actively restrict entry of lipophilic and amphipathic substances from blood and/or remove those molecules from the brain extracellular fluids. The third part of this review concentrates on the molecular biology of ATP-binding cassette (ABC)-transporters and those SLC transporters that are involved in efflux transport of xenobiotics, their expression at the BBB and BCSFB and differences in expression in the two major blood-brain interfaces. In addition, transport and diffusion of ions by the BBB and CP epithelium are involved in the formation of fluid, the ISF and CSF, respectively, so the last part of this review discusses molecular biology of ion transporters/exchangers and ion channels in the brain endothelial and CP epithelial cells

EPIdemiology of Surgery-Associated Acute Kidney Injury (EPIS-AKI) : Study protocol for a multicentre, observational trial

More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369