About the distance between random walkers on some graphs

We consider two or more simple symmetric walks on some graphs, e.g. the real line, the plane or the two dimensional comb lattice, and investigate the properties of the distance among the walkers.Comment: 27 page

The fibration method over real function fields

Let R(C) be the function field of a smooth, irreducible projective curve over R. Let X be a smooth, projective, geometrically irreducible variety equipped with a dominant morphism f onto a smooth projective rational variety with a smooth generic fibre over R(C). Assume that the cohomological obstruction introduced by Colliot-Thelene is the only one to the local-global principle for rational points for the smooth fibres of f over R(C)-valued points. Then we show that the same holds for X, too, by adopting the fibration method similarly to Harpaz-Wittenberg

The Influence of Transthoracic Impedance on Electrical Cardioversion and Defibrillation: Current Data

Sudden cardiac death (SCD) is a leading cause of death globally, often caused by malignant ventricular arrhythmias. Rapid termination by direct current defibrillation (DF) is the best way to treat pulseless ventricular tachycardia and ventricular fibrillation. Atrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice. External cardioversion (ECV) is an immediate, effective, and safe procedure for the treatment of arrhythmias with high ventricular rate, for example, AF. The success of both ECV and DF is dependent on the delivery of sufficient current, influenced by energy and transthoracic impedance (TTI). TTI depends on patient characteristics, and the exact factors affecting it are still a matter of debate. Influencing factors such as respiration phase, contact pressure, coupling agent, and total energy delivered are commonly identified. However, there are multiple studies with controversial results concerning the effect of age, gender, body mass index, hemoglobin concentration, the presence of chronic heart failure, and fluid accumulation as independent predictors of TTI. The review emphasizes refining energy dosage during ECV and while minimizing complications caused by an unnecessarily high energy delivery. The value of TTI should be predicted to optimize the energy dosage and the number of shocks for successful ECV and DF

Phenotypic convergence of Menkes and Wilson disease.

Menkes disease is an X-linked multisystem disorder with epilepsy, kinky hair, and neurodegeneration caused by mutations in the copper transporter ATP7A. Other ATP7A mutations have been linked to juvenile occipital horn syndrome and adult-onset hereditary motor neuropathy.1,2 About 5%-10% of the patients present with "atypical Menkes disease" characterized by longer survival, cerebellar ataxia, and developmental delay.2 The intracellular copper transport is regulated by 2 P type ATPase copper transporters ATP7A and ATP7B. These proteins are expressed in the trans-Golgi network that guides copper to intracellular compartments, and in copper excess, it relocates copper to the plasma membrane to pump it out from the cells.3ATP7B mutations cause Wilson disease with dystonia, ataxia, tremor, and abnormal copper accumulation in the brain, liver, and other organs.4

Thyroglobulin level at week 16 of pregnancy is superior to urinary iodine concentration in revealing preconceptual and first trimester iodine supply

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A multiplex endokrin neoplasia-2A szindrómáról egy család kapcsán

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Variation in neurosurgical management of traumatic brain injury: A survey in 68 centers participating in the CENTER-TBI study

Background Neurosurgical management of traumatic brain injury (TBI) is challenging, with only low-quality evidence. We aimed to explore differences in neurosurgical strategies for TBI across Europe. Methods A survey was sent to 68 centers participating in the Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. The questionnaire contained 21 questions, including the decision when to operate (or not) on traumatic acute subdural hematoma (ASDH) and intracerebral hematoma (ICH), and when to perform a decompressive craniectomy (DC) in raised intracranial pressure (ICP). Results The survey was completed by 68 centers (100%). On average, 10 neurosurgeons work in each trauma center. In all centers, a neurosurgeon was available within 30 min. Forty percent of responders reported a thickness or volume threshold for evacuation of an ASDH. Most responders (78%) decide on a primary DC in evacuating an ASDH during the operation, when swelling is present. For ICH, 3% would perform an evacuation directly to prevent secondary deterioration and 66% only in case of clinical deterioration. Most respondents (91%) reported to consider a DC for refractory high ICP. The reported cut-off ICP for DC in refractory high ICP, however, differed: 60% uses 25 mmHg, 18% 30 mmHg, and 17% 20 mmHg. Treatment strategies varied substantially between regions, specifically for the threshold for ASDH surgery and DC for refractory raised ICP. Also within center variation was present: 31% reported variation within the hospital for inserting an ICP monitor and 43% for evacuating mass lesions. Conclusion Despite a homogeneous organization, considerable practice variation exists of neurosurgical strategies for TBI in Europe. These results provide an incentive for comparative effectiveness research to determine elements of effective neurosurgical care

Variation in general supportive and preventive intensive care management of traumatic brain injury: a survey in 66 neurotrauma centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study

Abstract Background General supportive and preventive measures in the intensive care management of traumatic brain injury (TBI) aim to prevent or limit secondary brain injury and optimize recovery. The aim of this survey was to assess and quantify variation in perceptions on intensive care unit (ICU) management of patients with TBI in European neurotrauma centers. Methods We performed a survey as part of the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. We analyzed 23 questions focused on: 1) circulatory and respiratory management; 2) fever control; 3) use of corticosteroids; 4) nutrition and glucose management; and 5) seizure prophylaxis and treatment. Results The survey was completed predominantly by intensivists (n = 33, 50%) and neurosurgeons (n = 23, 35%) from 66 centers (97% response rate). The most common cerebral perfusion pressure (CPP) target was > 60 mmHg (n = 39, 60%) and/or an individualized target (n = 25, 38%). To support CPP, crystalloid fluid loading (n = 60, 91%) was generally preferred over albumin (n = 15, 23%), and vasopressors (n = 63, 96%) over inotropes (n = 29, 44%). The most commonly reported target of partial pressure of carbon dioxide in arterial blood (PaCO2) was 36–40 mmHg (4.8–5.3 kPa) in case of controlled intracranial pressure (ICP) < 20 mmHg (n = 45, 69%) and PaCO2 target of 30–35 mmHg (4–4.7 kPa) in case of raised ICP (n = 40, 62%). Almost all respondents indicated to generally treat fever (n = 65, 98%) with paracetamol (n = 61, 92%) and/or external cooling (n = 49, 74%). Conventional glucose management (n = 43, 66%) was preferred over tight glycemic control (n = 18, 28%). More than half of the respondents indicated to aim for full caloric replacement within 7 days (n = 43, 66%) using enteral nutrition (n = 60, 92%). Indications for and duration of seizure prophylaxis varied, and levetiracetam was mostly reported as the agent of choice for both seizure prophylaxis (n = 32, 49%) and treatment (n = 40, 61%). Conclusions Practice preferences vary substantially regarding general supportive and preventive measures in TBI patients at ICUs of European neurotrauma centers. These results provide an opportunity for future comparative effectiveness research, since a more evidence-based uniformity in good practices in general ICU management could have a major impact on TBI outcome

The fibration method over real function fields

Let R(C) be the function field of a smooth, irreducible projective curve over R. Let X be a smooth, projective, geometrically irreducible variety equipped with a dominant morphism f onto a smooth projective rational variety with a smooth generic fibre over R(C). Assume that the cohomological obstruction introduced by Colliot-Thélène is the only one to the local-global principle for rational points for the smooth fibres of f over R(C)-valued points. Then we show that the same holds for X, too, by adopting the fibration method similarly to Harpaz--Wittenberg. We also show that the strong vanishing conjecture for n-fold Massey products holds for fields of virtual cohomological dimension at most 1 using a theorem of Haran