Anatomical variations of the hand extensors

This study was performed to investigate the anatomy and variations of the humanextensor tendons of the fingers and their intertendinous connections. Ninetyfive upper limbs of adult cadavers were dissected. The variations in the extensortendons of the fingers, both proximal and distal to the extensor retinaculum, andtheir mode of insertion were observed. Also, the intertendinous connections wereexplored and the obtained data were analysed. The extensor pollicis longus andbrevis tendons were found to be single, doubled or, rarely, absent. Their insertioncould be traced to either the proximal phalanx, or through the extensor expansionto both phalanges, or rarely to the distal phalanx of thumb. The extensor indicishad a single tendon in all specimens. In the majority of specimens, extensor digitorumhad no independent slip to the little finger; it gave off a single tendonto the index, double tendons to the middle finger and triple tendons to the ringfinger. Extensor digiti minimi muscle often had double or triple tendons distal tothe extensor retinaculum. Three types of juncturae tendinum (JT) were identifiedbetween the tendons of extensor digitorum in the 2nd, 3rd and 4th intermetacarpalspaces (IMS) of hands. Types 1 and 2 JT were seen in the three IMS. Type 3 JTwas the most frequently identified of all juncturae and was always absent in the2nd IMS. The percentages of the present data were compared with other researchers’data

Stepping up. What will it take to accelerate a step-change in sustainability for water, energy and food?

Joined-up research can reveal positive, but also negative impacts of future policy decisions. Collecting and examining data, engaging stakeholders and mapping out scenarios across the nexus of water, energy and food can highlight the unintended negative consequences of possible future policies as well as the perceived benefits and these must be accounted for within the decision-making process. Blurred boundaries between sectors signal a need for more integrated planning and management to tackle environmental challenges. There needs to be wider acceptance that boundaries between energy, water and food systems are increasingly blurred, both physically and politically. Analysis across these boundaries allows for greater understanding of how innovations may or may not work. Adaptive forms of governance can also help, as can a multi-stage decisionmaking process. Responses to global environmental challenges must consider a range of contexts. Policymakers and organisations must ensure that social, geographical and governance considerations are factored into decision-making to ensure the successful uptake and sustainable development of innovations designed to respond to environmental challenges. "One size fits all" solutions are unlikely to achieve sustained success. Designing context-specific solutions to environmental problems flexible enough to adapt as conditions and circumstances change may be complex and challenging for policymakers, but it offers a more sustainable pathway than the “one size fits all” approach often adopted today. Stakeholder engagement is critical when seeking solutions to social and environmental challenges. Giving a range of stakeholders opportunities to reflect, challenge and contribute throughout a decision-making process is key to creating a framework that encompasses a wider context, delivers realistic insights and avoids the common prioritisation of financial concerns that can stifle innovation. Good decision-making requires reflexivity to manage complexity and uncertainty. An awareness of the extent to which policy- and decisionmaking within one area of the water-energy-food nexus can impact other areas can help to mitigate and manage unintended consequences of those decisions. To support a step-change in sustainability, governance must find space for continuous and transdisciplinary reflection. Relationships between producers, consumers and the environment matter. For an innovation to be up-scaled, there is a need to reconfigure systems of production, provision and consumption to create space for new emergent systems. This raises questions over risk, justice, equality, prosperity and societal wellbeing that researchers and decision makers must engage with. To be sustainable, change must be made across multiple domains. In order to maximise the potential benefits of innovation in the areas of water, food and energy, focus must be on changing socio-tech-environmental conditions in multiple domains.Engineering and Physical Sciences Research Council (EPSRC

An overview of NMR-based metabolomics to identify secondary plant compounds involved in host plant resistance

Secondary metabolites provide a potential source for the generation of host plant resistance and development of biopesticides. This is especially important in view of the rapid and vast spread of agricultural and horticultural pests worldwide. Multiple pests control tactics in the framework of an integrated pest management (IPM) programme are necessary. One important strategy of IPM is the use of chemical host plant resistance. Up to now the study of chemical host plant resistance has, for technical reasons, been restricted to the identification of single compounds applying specific chemical analyses adapted to the compound in question. In biological processes however, usually more than one compound is involved. Metabolomics allows the simultaneous detection of a wide range of compounds, providing an immediate image of the metabolome of a plant. One of the most universally used metabolomic approaches comprises nuclear magnetic resonance spectroscopy (NMR). It has been NMR which has been applied as a proof of principle to show that metabolomics can constitute a major advancement in the study of host plant resistance. Here we give an overview on the application of NMR to identify candidate compounds for host plant resistance. We focus on host plant resistance to western flower thrips (Frankliniella occidentalis) which has been used as a model for different plant species

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Systematic Review of Potential Health Risks Posed by Pharmaceutical, Occupational and Consumer Exposures to Metallic and Nanoscale Aluminum, Aluminum Oxides, Aluminum Hydroxide and Its Soluble Salts

Aluminum (Al) is a ubiquitous substance encountered both naturally (as the third most abundant element) and intentionally (used in water, foods, pharmaceuticals, and vaccines); it is also present in ambient and occupational airborne particulates. Existing data underscore the importance of Al physical and chemical forms in relation to its uptake, accumulation, and systemic bioavailability. The present review represents a systematic examination of the peer-reviewed literature on the adverse health effects of Al materials published since a previous critical evaluation compiled by Krewski et al. (2007). Challenges encountered in carrying out the present review reflected the experimental use of different physical and chemical Al forms, different routes of administration, and different target organs in relation to the magnitude, frequency, and duration of exposure. Wide variations in diet can result in Al intakes that are often higher than the World Health Organization provisional tolerable weekly intake (PTWI), which is based on studies with Al citrate. Comparing daily dietary Al exposures on the basis of “total Al”assumes that gastrointestinal bioavailability for all dietary Al forms is equivalent to that for Al citrate, an approach that requires validation. Current occupational exposure limits (OELs) for identical Al substances vary as much as 15-fold. The toxicity of different Al forms depends in large measure on their physical behavior and relative solubility in water. The toxicity of soluble Al forms depends upon the delivered dose of Al+ 3 to target tissues. Trivalent Al reacts with water to produce bidentate superoxide coordination spheres [Al(O2)(H2O4)+ 2 and Al(H2O)6 + 3] that after complexation with O2•−, generate Al superoxides [Al(O2•)](H2O5)]+ 2. Semireduced AlO2• radicals deplete mitochondrial Fe and promote generation of H2O2, O2 • − and OH•. Thus, it is the Al+ 3-induced formation of oxygen radicals that accounts for the oxidative damage that leads to intrinsic apoptosis. In contrast, the toxicity of the insoluble Al oxides depends primarily on their behavior as particulates. Aluminum has been held responsible for human morbidity and mortality, but there is no consistent and convincing evidence to associate the Al found in food and drinking water at the doses and chemical forms presently consumed by people living in North America and Western Europe with increased risk for Alzheimer\u27s disease (AD). Neither is there clear evidence to show use of Al-containing underarm antiperspirants or cosmetics increases the risk of AD or breast cancer. Metallic Al, its oxides, and common Al salts have not been shown to be either genotoxic or carcinogenic. Aluminum exposures during neonatal and pediatric parenteral nutrition (PN) can impair bone mineralization and delay neurological development. Adverse effects to vaccines with Al adjuvants have occurred; however, recent controlled trials found that the immunologic response to certain vaccines with Al adjuvants was no greater, and in some cases less than, that after identical vaccination without Al adjuvants. The scientific literature on the adverse health effects of Al is extensive. Health risk assessments for Al must take into account individual co-factors (e.g., age, renal function, diet, gastric pH). Conclusions from the current review point to the need for refinement of the PTWI, reduction of Al contamination in PN solutions, justification for routine addition of Al to vaccines, and harmonization of OELs for Al substances