Variation in neurosurgical management of traumatic brain injury

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

Environmental and historical constraints on global patterns of amphibian richness

Our knowledge of the broad-scale ecology of vertebrate ectotherms remains very limited. Despite ongoing declines and sensitivity to environmental change, amphibian distributions are particularly poorly understood. We present a global analysis of contemporary environmental and historical constraints on amphibian richness, the first for an ectotherm clade at this scale. Amphibians are presumed to experience environmental constraints distinct from those of better studied endothermic taxa due to their stringent water requirements and the temperature dependence of their energetic costs and performance. Single environmental predictors set upper bounds on, but do not exclusively determine, amphibian richness. Accounting for differing regional histories of speciation and extinction helps resolve triangular or scattered relationships between core environmental predictors and amphibian richness, as the relationships' intercepts or slopes can vary regionally. While the magnitude of richness is strongly determined by regional history, within-region patterns are consistently jointly driven by water and temperature. This confirms that ecophysiological constraints extend to the broad scale. This coupling suggests that shifts in climatic regimes will probably have dramatic consequences for amphibians. Our results illustrate how the environmental and historical explanations of species richness gradients can be reconciled and how the perspectives are complements for understanding broad-scale patterns of diversity

Tolerancia termica de algunos peces marinos tropicales: estudio preliminar

The critical thermal maximum (CTM) and the first equilibrium loss (FEL) of six tropical marine fishes were determined. CTM were Mugil curema (41.4º C), Genres sp. (39.2ºC), Orthopristis ruber (38.7ºC), Archosargus rhomboidalis (39.39ºC), Gobioides sp. (38.6ºC).and Chilomycterus sp (39.3ºC). FEL's were Mugil curema (40.7ºC), Gerres sp. (38.5ºC), Orthopristis ruber (37.2ºC), Gobioides sp. (36.0ºC), and Chilomycterus sp. (38.3ºC). The mean difference between CTM and FEL ranged from 0.93 to 2.66ºC and was significantly different