Outcomes after pneumonectomy versus limited lung resection in adults with traumatic lung injury.

Pneumonectomy after traumatic lung injury (TLI) is associated with shock, increased pulmonary vascular resistance, and eventual right ventricular failure. Historically, trauma pneumonectomy (TP) mortality rates ranged between 53 and 100%. It is unclear if contemporary mortality rates have improved. Therefore, we evaluated outcomes associated with TP and limited lung resections (LLR) (i.e., lobectomy and segmentectomy) and aimed to identify predictors of mortality, hypothesizing that TP is associated with greater mortality versus LLR. We queried the Trauma Quality Improvement Program (2010-2016) and performed a multivariable logistic regression to determine the independent predictors of mortality in TLI patients undergoing TP versus LLR. TLI occurred in 287,276 patients. Of these, 889 required lung resection with 758 (85.3%) undergoing LLR and 131 (14.7%) undergoing TP. Patients undergoing TP had a higher median injury severity score (26.0 vs. 24.5, p = 0.03) but no difference in initial median systolic blood pressure (109 vs. 107 mmHg, p = 0.92) compared to LLR. Mortality was significantly higher for TP compared to LLR (64.9% vs 27.2%, p < 0.001). The strongest independent predictor for mortality was undergoing TP versus LLR (OR 4.89, CI 3.18-7.54, p < 0.001). TP continues to be associated with a higher mortality compared to LLR. Furthermore, TP is independently associated with a fivefold increased risk of mortality compared to LLR. Future investigations should focus on identifying parameters or treatment modalities that improve survivability after TP. We recommend that surgeons reserve TP as a last-resort management given the continued high morbidity and mortality associated with this procedure

Acquiring Unique Collections: Collaborative Approaches to Metadata

Acquisition of unique digital material is an ongoing challenge for Special Collections units—often unique digital material comes with little or no metadata associated with the digital objects. Using two ongoing projects at the University of Oregon Libraries as case studies, this paper explores strategies archivists and librarians can use to increase descriptive metadata coming in with unique born-digital collections. Library staff involved with the Latino Roots and University of Oregon Veterans Oral History projects work with the content creators, in this case faculty and students, to build collections with rich descriptive information that is relevant both to librarians and to the communities being documented

Post-modernism's use and abuse of Nietzsche

I focus on Nietzsche's architectural metaphor of self-construction in arguing for the claim that postmodern readings of Nietzsche misunderstand his various attacks on dogmatic philosophy as paving the way for acceptance of a self characterized by fundamental disunity. Nietzsche's attack on essentialist dogmatic metaphysics is a call to engage in a purposive self-creation under a unifying will, a will that possesses the strength to reinterpret history as a pathway to "the problem that we are". Nietzsche agrees with the postmodernists that unity is not a pre-given, however he would disavow their rejection of unity as a goal. Where the postmodernists celebrate "the death of the subject" Nietzsche rejects this valorization of disunity as a form of Nihilism and prescribes the creation of a genuine unified subjectivity to those few capable of such a goal. Postmodernists are nearer Nietzsche's idea of the Last Man than his idea of the Overman.Articl

Regenerating 1 and 3b Gene Expression in the Pancreas of Type 2 Diabetic Goto-Kakizaki (GK) Rats

International audienceRegenerating (REG) proteins are associated with islet development, b-cell damage, diabetes and pancreatitis. Particularly, REG-1 and REG-3-beta are involved in cell growth/survival and/or inflammation and the Reg1 promoter contains interleukin-6 (IL-6)-responsive elements. We showed by transcriptome analysis that islets of Goto-Kakizaki (GK) rats, a model of spontaneous type 2 diabetes, overexpress Reg1, 3a, 3b and 3c, vs Wistar islets. Goto-Kakizaki rat islets also exhibit increased cytokine/chemokine expression/release, particularly IL-6. Here we analyzed Reg1 and Reg3b expression and REG-1 immuno-localization in the GK rat pancreas in relationship with inflammation. Isolated pancreatic islets and acinar tissue from male adult Wistar and diabetic GK rats were used for quantitative RT-PCR analysis. REG-1 immunohistochemistry was performed on paraffin sections with a monoclonal anti-rat REG-1 antibody. Islet cytokine/chemokine release was measured after 48 h-culture. Islet macrophage-positive area was quantified on cryostat sections using anti-CD68 and major histocompatibility complex (MHC) class II antibodies. Pancreatic exocrine-to-endocrine Reg1 and Reg3b mRNA ratios were markedly increased in Wistar vs GK rats. Conversely, both genes were upregulated in isolated GK rat islets. These findings were unexpected, because Reg genes are expressed in the pancreatic acinar tissue. However, we observed REG-1 protein labeling in acinar peri-ductal tissue close to islets and around large, often disorganized, GK rat islets, which may retain acinar cells due to their irregular shape. These large islets also showed peri-islet macrophage infiltration and increased release of various cytokines/ chemokines, particularly IL-6. Thus, IL-6 might potentially trigger acinar REG-1 expression and secretion in the vicinity of large diabetic GK rat islets. This increased acinar REG-1 expression might reflect an adaptive though unsuccessful response to deleterious microenvironment

SITUACIÓN DEL ENSEÑANZA DE LAS PRÁCTICAS INTEGRATIVAS Y COMPLEMENTARIAS EN LOS CURSOS DE GRADUACIÓN EN ENFERMERÍA, FISIOTERAPIA Y MEDICINA

O objetivo foi analisar a situação do ensino das Práticas Integrativas e Complementares em faculdadesde Enfermagem, Medicina e Fisioterapia no Brasil. A amostra foi constituída de faculdades públicas e a busca dedados ocorreu nos sites das instituições investigadas entre maio de 2012 a março de 2013. Das 209 instituiçõespúblicas de ensino superior, somente 43 (32,3%) oferecem disciplinas relacionadas com o tema. Dentre os trêscursos, as escolas de Enfermagem oferecem mais disciplinas, seguidas pela Medicina e Fisioterapia; 26,4%,17,5% e 14,6%, respectivamente. A média da carga horária é de 46 horas e a maioria delas são oferecidas deforma optativa, ficando boa parte dos profissionais de saúde sem nenhuma aproximação acadêmica com essessaberes. As instituições de ensino, que formam profissionais para o mercado de trabalho e para o Sistema Únicode Saúde, precisam rever as grades curriculares.This study aimed to analyze the situation ofthe teaching of Integrative and Complementary Practicesin faculties of Nursing, Medicine and Physiotherapy inBrazil. The sample was constituted of public facultiesand the data search occurred on the websites of theinstitutions investigated, between May 2012 and March2013. Of the 209 public higher education institutions, only43 (32.3%) offered courses related to this topic. Amongthese three courses, the schools of Nursing offer the mostcourses, followed by Medicine and Physiotherapy; 26.4%,17.5% and 14.6%, respectively. The mean course load is46 hours, and the majority are offered as options, witha large proportion of health professionals not studyingthese knowledges. The teaching institutions, which trainprofessionals for the job market and for the Unified HealthSystem, need to review the curriculum frameworks.Fue objetivo del estudio analizar la situación de la enseñanza de las Prácticas Integrativas y Complementarias en facultades de Enfermería, Medicina y Fisioterapia en el Brasil. La muestra fue constituida de facultades públicas y la búsqueda de datos ocurrió en los sites de las instituciones investigadas entre mayo de 2012 y marzode 2013. De las 209 instituciones públicas de enseñanza superior, solamente 43 (32,3%) ofrecen asignaturas acerca del tema. Entre los tres cursos, las escuelas de Enfermería ofrecen más asignaturas, seguidas por la Medicina y Fisioterapia; 26,4%, 17,5% y 14,6%, respectivamente. La media de horas es de 46 y la mayoría de ellas son ofrecidas de forma optativa, quedándose una grande parte de losprofesionales de salud sin aproximación académica con eses saberes. Las instituciones de enseñanza, que forman profesionales para el mercado de trabajo y para el Sistema Único de Salud, necesitan analizar los currículos

Navigae : un outil polyvalent pour valoriser et visualiser les données géographiques patrimoniales

Navigae est une plateforme de recherche permettant de consulter des données issues de travaux en géographie et de valoriser la dimension spatiale des données. Elle permet de diffuser et de visualiser des données numériques issues de structures de recherche ou de bibliothèques, selon des modes d’interrogation et de visualisation cartographique. Son objectif est de favoriser l’ouverture des données grâce à de nombreux services d’exposition et de récupération de données, ainsi qu’à travers un travail de curation permettant la conservation, la maintenance et l’enrichissement des données des différents fonds documentaires géographiques présents dans la plateforme.Navigae is a research platform allowing to consult data resulting from work in geography and to enhance the spatial dimension of the data. It makes it possible to access and visualize digital data from research structures or libraries, according to query and cartographic visualization modes. Its objective is to promote the opening of data, thanks to numerous data exposure and recovery services as well as through curation work allowing the preservation, maintenance and enrichment of data from the various geographical documentary collections present in the platform.Navigae es una plataforma de investigación que permite consultar los datos de los trabajos geográficos potenciando la dimensión espacial de su información. Permite el acceso y visualización digital de fondos de investigación o bibliotecas mediante consultas y visores cartográficos. Pretende promover el acceso a las fuentes de información gracias a los servicios de captura de datos y mediante procedimientos de conservación, mantenimiento y enriquecimiento de las fuentes de los distintos fondos documentales geográficos presentes en la plataform

Pancreatic Hormone Expression in the Murine Thymus : Localization in Dendritic Cells and Macrophages

The expression of preproinsulin (ppIns), proglucagon, prosomatostatin, and propancreatic polypeptide was investigated in thymic extracts, thymic cells, and thymic cell lines from C57BL/6 mice by RT-PCR. The expression of pancreatic hormones was similar in thymic extracts taken from neonatal and 2-, 4-, and 8-week-old animals, but was decreased in 20-week-old animals. Pancreatic hormone expression was not observed in mouse liver, salivary gland, or spleen. Analysis of thymic cell populations revealed a 10- to 20-fold enrichment in expression of all hormones in low buoyant density cells. No expression was detected in high buoyant density cells (predominantly thymocytes) or in thymic epithelial cell lines, primary cultures of epithelial cells, or peripheral macrophages. In addition, immunoreactive insulin, measured by specific RIA, was detectable in the low buoyant density population, but not in high buoyant density cells. The enriched cell population was depleted of contaminating lymphocytes and sorted based on reactivity to the cell surface markers F4/80 (macrophage) or N418 (dendritic cells). Cells gated for N418 demonstrated expression for ppIns, but not the other pancreatic hormones. Conversely, expression for proglucagon, prosomatostatin, and propancreatic polypeptide, but not ppIns, was detected in F4/80-gated cells. Our data indicate that pancreatic endocrine hormones are differentially expressed by dendritic cells and macrophages in a normal mice.Instituto de Investigaciones Bioquímicas de La Plat