Spreading of complex regional pain syndrome: not a random process

Complex regional pain syndrome (CRPS) generally remains restricted to one limb but occasionally may spread to other limbs. Knowledge of the spreading pattern of CRPS may lead to hypotheses about underlying mechanisms but to date little is known about this process. The objective is to study patterns of spread of CRPS from a first to a second limb and the factors associated with this process. One hundred and eighty-five CRPS patients were retrospectively evaluated. Cox’s proportional hazards model was used to evaluate factors that influenced spread of CRPS symptoms. Eighty-nine patients exhibited CRPS in multiple limbs. In 72 patients spread from a first to a second limb occurred showing a contralateral pattern in 49%, ipsilateral pattern in 30% and diagonal pattern in 14%. A trauma preceded the onset in the second limb in 37, 44 and 91%, respectively. The hazard of spread of CRPS increased with the number of limbs affected. Compared to patients with CRPS in one limb, patients with CRPS in multiple limbs were on average 7 years younger and more often had movement disorders. In patients with CRPS in multiple limbs, spontaneous spread of symptoms generally follows a contralateral or ipsilateral pattern whereas diagonal spread is rare and generally preceded by a new trauma. Spread is associated with a younger age at onset and a more severely affected phenotype. We argue that processes in the spinal cord as well as supraspinal changes are responsible for spontaneous spread in CRPS

Ancillary human health benefits of improved air quality resulting from climate change mitigation

<p>Abstract</p> <p>Background</p> <p>Greenhouse gas (GHG) mitigation policies can provide ancillary benefits in terms of short-term improvements in air quality and associated health benefits. Several studies have analyzed the ancillary impacts of GHG policies for a variety of locations, pollutants, and policies. In this paper we review the existing evidence on ancillary health benefits relating to air pollution from various GHG strategies and provide a framework for such analysis.</p> <p>Methods</p> <p>We evaluate techniques used in different stages of such research for estimation of: (1) changes in air pollutant concentrations; (2) avoided adverse health endpoints; and (3) economic valuation of health consequences. The limitations and merits of various methods are examined. Finally, we conclude with recommendations for ancillary benefits analysis and related research gaps in the relevant disciplines.</p> <p>Results</p> <p>We found that to date most assessments have focused their analysis more heavily on one aspect of the framework (e.g., economic analysis). While a wide range of methods was applied to various policies and regions, results from multiple studies provide strong evidence that the short-term public health and economic benefits of ancillary benefits related to GHG mitigation strategies are substantial. Further, results of these analyses are likely to be underestimates because there are a number of important unquantified health and economic endpoints.</p> <p>Conclusion</p> <p>Remaining challenges include integrating the understanding of the relative toxicity of particulate matter by components or sources, developing better estimates of public health and environmental impacts on selected sub-populations, and devising new methods for evaluating heretofore unquantified and non-monetized benefits.</p

A two million year record of low-latitude aridity linked to continental weathering from the Maldives

Indian-Asian monsoon has oscillated between warm/wet interglacial periods and cool/dry glacial periods with periodicities closely linked to variations in Earth’s orbital parameters. However, processes that control wet versus dry, i.e. aridity cyclical periods on the orbital time-scale in the low latitudes of the Indian-Asian continent remain poorly understood because records over millions of years are scarce. The sedimentary record from International Ocean Discovery Program (IODP) Expedition 359 provides a well-preserved, high-resolution, continuous archive of lithogenic input from the Maldives reflecting on low-latitude aridity cycles. Variability within the lithogenic component of sedimentary deposits of the Maldives results from changes in monsoon-controlled sedimentary sources. Here, we present X-ray fluorescence (XRF) core-scanning results from IODP Site U1467 for the past two million years, allowing full investigation of orbital periodicities. We specifically use the Fe/K as a terrestrial climate proxy reflecting on wet versus dry conditions in the source areas of the Indian-Asian landmass, or from further afield. The Fe/K record shows orbitally forced cycles reflecting on changes in the relative importance of aeolian (stronger winter monsoon) during glacial periods versus fluvial supply (stronger summer monsoon) during interglacial periods. For our chronology, we tuned the Fe/K cycles to precessional insolation changes, linking Fe/K maxima/minima to insolation minima/maxima with zero phase lag. Wavelet and spectral analyses of the Fe/K record show increased dominance of the 100 kyr cycles after the Mid Pleistocene Transition (MPT) at 1.25 Ma in tandem with the global ice volume benthic δ 18 O data (LR04 record). In contrast to the LR04 record, the Fe/K profile resolves 100-kyr-like cycles around the 130 kyr frequency band in the interval from 1.25 to 2 million years. These 100-kyr-like cycles likely form by bundling of two or three obliquity cycles, indicating that low-latitude Indian-Asian climate variability reflects on increased tilt sensitivity to regional eccentricity insolation changes (pacing tilt cycles) prior to the MPT. The implication of appearance of the 100 kyr cycles in the LR04 and the Fe/K records since the MPT suggests strengthening of a climate link between the low and high latitudes during this period of climate transition. The Correction to this article has been published in Progress in Earth and Planetary Science 2019 6:21 - https://doi.org/10.1186/s40645-019-0259-

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

Meeting abstrac

Search for new physics in the multijet and missing transverse momentum final state in proton-proton collisions at √s=8 Tev

Peer reviewe