The Use Of Corticosteroid For The Prophylaxis Of Fat Embolism Syndrome In Patients With Long Bone Fracture [uso De Corticoide Na Profilaxia Para Síndrome De Embolia Gordurosa Em Pacientes Com Fratura De Osso Longo]

The "Evidence-based Telemedicine - Trauma & Acute Care Surgery" (EBT-TACS) Journal Club conducted a critical review of the literature and selected three recent studies on the use of corticosteroids for the prophylaxis of fat embolism syndrome (FES). The review focused on the potential role of corticosteroids administration to patients admitted to the intensive care unit (ICU) at risk of developing post-traumatic fat embolism. The first study was prospective and aimed at identifying reliable predictors, which could be detected early and were associated with the onset of fat embolism syndrome in trauma patients. The second manuscript was a literature review on the role of corticosteroids as a prophylactic measure for FES. The last manuscript was a meta-analysis on the potential for corticosteroids to prophylactically reduce the risk of fat embolism syndrome in patients with long bone fractures. The main conclusions and recommendations reached were that traumatized patients should be monitored with non-invasive pulse oximetry and lactate levels since these commonly-available tests may predict the development of FES, and the lack of evidence to recommend the use of steroids for the prophylaxis of this syndrome.405423426Gopinathan, N.R., Sen, R.K., Viswanathan, V.K., Aggarwal, A., Mallikarjun, H.C., Rajaram Manoharan, S.R., Early, reliable, utilitarian predictive factors for fat embolism syndrome in polytrauma patients (2013) Indian J Crit Care Med., 17 (1), pp. 38-42Sen, R.K., Tripathy, S.K., Krishnan, V., Role of corticosteroid as a prophylactic measure in fat embolism syndrome: A literature review (2012) Musculoskelet Surg., 96 (1), pp. 1-8Bederman, S.S., Bhandari, M., McKee, M.D., Schemitsch, E.H., Do corticosteroids reduce the risk of fat embolism syndrome in patients with long-bone fractures? A meta-analysis (2009) Can J Surg., 52 (5), pp. 386-393Moore, F.A., Haenel, J.B., Moore, E.E., Whitehill, T.A., Incommensurate oxygen consumption in response to maximal oxygen availability predicts postinjury multiple oxygen failure (1992) J Trauma., 33 (1), pp. 58-65. , discussion 65-7Kim, P.K., Deutschman, C.S., Inflammatory responses and mediators (2000) Surg Clin North Am., 80 (3), pp. 885-894Kallenbach, J., Lewis, M., Zaltzman, M., Feldman, C., Orford, A., Zwi, S., 'Low-dose' corticosteroid prophylaxis against fat embolism (1987) J Trauma., 27 (10), pp. 1173-1176Lindeque, B.G., Schoeman, H.S., Dommisse, G.F., Boeyens, M.C., Vlok, A.L., Fat embolism and the fat embolism syndrome. A double-blind therapeutic study (1987) J Bone Joint Surg Br., 69 (1), pp. 128-131Schonfeld, S.A., Ploysongsang, Y., DiLisio, R., Crissman, J.D., Miller, E., Hammerschmidt, D.E., Fat embolism prophylaxis with corticosteroids. A prospective study in high-risk patients (1983) Ann Intern Med., 99 (4), pp. 438-44

Critical exponents and equation of state of the three-dimensional Heisenberg universality class

We improve the theoretical estimates of the critical exponents for the three-dimensional Heisenberg universality class. We find gamma=1.3960(9), nu=0.7112(5), eta=0.0375(5), alpha=-0.1336(15), beta=0.3689(3), and delta=4.783(3). We consider an improved lattice phi^4 Hamiltonian with suppressed leading scaling corrections. Our results are obtained by combining Monte Carlo simulations based on finite-size scaling methods and high-temperature expansions. The critical exponents are computed from high-temperature expansions specialized to the phi^4 improved model. By the same technique we determine the coefficients of the small-magnetization expansion of the equation of state. This expansion is extended analytically by means of approximate parametric representations, obtaining the equation of state in the whole critical region. We also determine a number of universal amplitude ratios.Comment: 40 pages, final version. In publication in Phys. Rev.

The forward physics facility at the high-luminosity LHC

High energy collisions at the High-Luminosity Large Hadron Collider (LHC) produce a large number of particles along the beam collision axis, outside of the acceptance of existing LHC experiments. The proposed Forward Physics Facility (FPF), to be located several hundred meters from the ATLAS interaction point and shielded by concrete and rock, will host a suite of experiments to probe standard model (SM) processes and search for physics beyond the standard model (BSM). In this report, we review the status of the civil engineering plans and the experiments to explore the diverse physics signals that can be uniquely probed in the forward region. FPF experiments will be sensitive to a broad range of BSM physics through searches for new particle scattering or decay signatures and deviations from SM expectations in high statistics analyses with TeV neutrinos in this low-background environment. High statistics neutrino detection will also provide valuable data for fundamental topics in perturbative and non-perturbative QCD and in weak interactions. Experiments at the FPF will enable synergies between forward particle production at the LHC and astroparticle physics to be exploited. We report here on these physics topics, on infrastructure, detector, and simulation studies, and on future directions to realize the FPF's physics potential

Non-operative Management Of Blunt Major Hepatic Injury In A Young Adult With Severe Haemophilia A

[No abstract available]183e84e86Carrillo, E.H., Platz, A., Miller, F.B., Richardson, J.D., Polk Jr., H.C., Non-operative management of blunt hepatic trauma (1998) Br J Surg, 85, pp. 461-468Kozar, R.A., McNutt, M.K., Management of adult blunt hepatic trauma (2010) Curr Opin Crit Care, 16, pp. 596-601English, P.J., Sheppard, E.M., Wensley, R.T., Traumatic rupture of the liver in a haemophilic patient with factor-VIII inhibitors (1976) Lancet, 1, pp. 1299-1300Sarihan, H., Erduran, E., Abes, M., Nonsurgical therapy of hepatic injury in a hemophilic child (1994) Eur J Pediatr Surg, 4, pp. 366-367Sartorelli, K.H., Rogers, F.B., Vane, D.W., Nonoperative treatment of a major hepatic injury in a hemophiliac (1995) J Trauma, 38, pp. 246-247Tinkoff, G., Esposito, T.J., Reed, J., American Association for the Surgery of Trauma Organ Injury Scale I: spleen, liver, and kidney, validation based on the National Trauma Data Bank (2008) J Am Coll Surg, 207, pp. 646-655Jona, J.Z., Cox-Gill, J., Nonsurgical therapy of splenic rupture in a hemophiliac (1992) J Pediatr Surg, 27, pp. 523-524Fort, D.W., Bernini, J.C., Johnson, A., Cochran, C.J., Buchanan, G.R., Splenic rupture in hemophilia (1994) Am J Pediatr Hematol Oncol, 16, pp. 255-259Zieg, P.M., Cohn, S.M., Beardsley, D.S., Nonoperative management of a splenic tear in a Jehovah's Witness with hemophilia (1996) J Trauma, 40, pp. 299-301Sharma, O.P., Oswanski, M.F., Issa, N.M., Stein, D.T., Role of non-operative management of spleen injury in patients with hemophilia: report of two patients with review of literature (2011) J Emerg Med, 41, pp. e59-e6

Anti-carbamylated protein antibodies positivity and disease activity in Hispanic patients with established rheumatoid arthritis: An observational study

Objectives We aimed to determine the prevalence of anti-carbamylated protein (anti-CarP) antibodies in Mexican Hispanics with established rheumatoid arthritis (RA) and to assess their relationship with disease activity. Methods A cohort study was conducted in 278 patients with established RA during an 18-month follow-up. We measured IgG/IgM/IgA rheumatoid factor (RF), IgG anticitrullinated protein antibodies (ACPA) and IgG/IgM/IgA anti-CarP antibodies using enzyme-linked immunosorbent assay (ELISA). For disease activity, we performed the 28-joint disease activity score with erythrocyte sedimentation rate (DAS28-ESR). Repeated measures one-way ANOVA was used to test the association between anti-CarP IgG antibody status and longitudinal DAS28-ESR scores. Patients were evaluated at baseline and at 6, 12, and 18 months during follow-up. Results Anti-CarP IgG antibodies were positive in 47.8% of patients and, accounting for all isotypes, in 9.5% of patients with negative RF and ACPA. Triple antibody positivity was present in 42.6% of patients in our sample. Anti-CarP IgG antibody positivity did not show statistically significant differences in mean DAS28-ESR when compared to anti-CarP IgG antibody negative patients at baseline, 6, 12 or 18 months. Conclusion Anti-CarP IgG antibodies are not associated to a higher disease activity in Hispanic patients with established RA. Our findings suggest that the clinical value of measuring anti-CarP antibodies in RA diminishes over time.Transplantation and autoimmunit

The effects of positive end-expiratory pressure on respiratory system mechanics and hemodynamics in postoperative cardiac surgery patients

We prospectively evaluated the effects of positive end-expiratory pressure (PEEP) on the respiratory mechanical properties and hemodynamics of 10 postoperative adult cardiac patients undergoing mechanical ventilation while still anesthetized and paralyzed. The respiratory mechanics was evaluated by the inflation inspiratory occlusion method and hemodynamics by conventional methods. Each patient was randomized to a different level of PEEP (5, 10 and 15 cmH2O), while zero end-expiratory pressure (ZEEP) was established as control. PEEP of 15-min duration was applied at 20-min intervals. The frequency dependence of resistance and the viscoelastic properties and elastance of the respiratory system were evaluated together with hemodynamic and respiratory indexes. We observed a significant decrease in total airway resistance (13.12 ± 0.79 cmH2O l-1 s-1 at ZEEP, 11.94 ± 0.55 cmH2O l-1 s-1 (P<0.0197) at 5 cmH2O of PEEP, 11.42 ± 0.71 cmH2O l-1 s-1 (P<0.0255) at 10 cmH2O of PEEP, and 10.32 ± 0.57 cmH2O l-1 s-1 (P<0.0002) at 15 cmH2O of PEEP). The elastance (Ers; cmH2O/l) was not significantly modified by PEEP from zero (23.49 ± 1.21) to 5 cmH2O (21.89 ± 0.70). However, a significant decrease (P<0.0003) at 10 cmH2O PEEP (18.86 ± 1.13), as well as (P<0.0001) at 15 cmH2O (18.41 ± 0.82) was observed after PEEP application. Volume dependence of viscoelastic properties showed a slight but not significant tendency to increase with PEEP. The significant decreases in cardiac index (l min-1 m-2) due to PEEP increments (3.90 ± 0.22 at ZEEP, 3.43 ± 0.17 (P<0.0260) at 5 cmH2O of PEEP, 3.31 ± 0.22 (P<0.0260) at 10 cmH2O of PEEP, and 3.10 ± 0.22 (P<0.0113) at 15 cmH2O of PEEP) were compensated for by an increase in arterial oxygen content owing to shunt fraction reduction (%) from 22.26 ± 2.28 at ZEEP to 11.66 ± 1.24 at PEEP of 15 cmH2O (P<0.0007). We conclude that increments in PEEP resulted in a reduction of both airway resistance and respiratory elastance. These results could reflect improvement in respiratory mechanics. However, due to possible hemodynamic instability, PEEP should be carefully applied to postoperative cardiac patients