The Effect of an Abnormal BMI on Orthopaedic Trauma Patients: A Systematic Review and Meta-Analysis

Aims: The aim of this systemic review is to identify the complications that arise in operating on orthopaedic trauma patients with an abnormal body mass index (BMI). Materials and Methods: Systematic literature search using a combination of MESH subject headings and free text searching of Medline, Embase, SCOPUS and Cochrane databases in August 2019. Any orthopaedic injury requiring surgery was included. Papers were reviewed and quality assessed by two independent reviewers to select for inclusion. Where sufficiently homogenous, meta-analysis was performed. Results: A total of 26 articles (379,333 patients) were selected for inclusion. All complications were more common in those with a high BMI (>30). The odds ratio (OR) for high BMI patients sustaining post-operative complication of any type was 2.32 with a 23% overall complication rate in the BMI > 30 group, vs. 14% in the normal BMI group (p < 0.05). The OR for mortality was 3.5. The OR for infection was 2.28. The OR for non-union in tibial fractures was 2.57. Thrombotic events were also more likely in the obese group. Low BMI (<18.5) was associated with a higher risk of cardiac complications than either those with a normal or high BMI (OR 1.56). Conclusion: Almost all complications are more common in trauma patients with a raised BMI. This should be made clear during the consent process, and strategies developed to reduce these risks where possible. Unlike in elective surgery, BMI is a non-modifiable risk factor in the trauma context, but an awareness of the complications should inform clinicians and patients alike. Underweight patients have a higher risk of developing cardiac complications than either high or normal BMI patient groups, but as few studies exist, further research into this group is recommende

Ground-state properties of the spin-1/2 antiferromagnetic Heisenberg model on the triangular lattice: A variational study based on entangled-plaquette states

We study, on the basis of the general entangled-plaquette variational ansatz, the ground-state properties of the spin-1/2 antiferromagnetic Heisenberg model on the triangular lattice. Our numerical estimates are in good agreement with available exact results and comparable, for large system sizes, to those computed via the best alternative numerical approaches, or by means of variational schemes based on specific (i.e., incorporating problem dependent terms) trial wave functions. The extrapolation to the thermodynamic limit of our results for lattices comprising up to N=324 spins yields an upper bound of the ground-state energy per site (in units of the exchange coupling) of $-0.5458(2)$ [$-0.4074(1)$ for the XX model], while the estimated infinite-lattice order parameter is $0.3178(5)$ (i.e., approximately 64% of the classical value).Comment: 8 pages, 3 tables, 2 figure

A dynamic explanation for the origin of the western Mediterranean organic-rich layers

The eastern Mediterranean sapropels are among the most intensively investigated phenomena in the paleoceanographic record, but relatively little has been written regarding the origin of the equivalent of the sapropels in the western Mediterranean, the organic-rich layers (ORLs). ORLs are recognized as sediment layers containing enhanced total organic carbon that extend throughout the deep basins of the western Mediterranean and are associated with enhanced total barium concentration and a reduced diversity (dysoxic but not anoxic) benthic foraminiferal assemblage. Consequently, it has been suggested that ORLs represent periods of enhanced productivity coupled with reduced deep ventilation, presumably related to increased continental runoff, in close analogy to the sapropels. We demonstrate that despite their superficial similarity, the timing of the deposition of the most recent ORL in the Alboran Sea is different than that of the approximately coincident sapropel, indicating that there are important differences between their modes of formation. We go on to demonstrate, through physical arguments, that a likely explanation for the origin of the Alboran ORLs lies in the response of the western Mediterranean basin to a strong reduction in surface water density and a shoaling of the interface between intermediate and deep water during the deglacial period. Furthermore, we provide evidence that deep convection had already slowed by the time of Heinrich Event 1 and explore this event as a potential agent for preconditioning deep convection collapse. Important differences between Heinrich-like and deglacial-like influences are highlighted, giving new insights into the response of the western Mediterranean system to external forcing

Abstraction-based Malware Analysis Using Rewriting and Model Checking

International audienceWe propose a formal approach for the detection of high-level malware behaviors. Our technique uses a rewriting-based abstraction mechanism, producing abstracted forms of program traces, independent of the program implementation. It then allows us to handle similar be- haviors in a generic way and thus to be robust with respect to variants. These behaviors, defined as combinations of patterns given in a signa- ture, are detected by model-checking on the high-level representation of the program. We work on unbounded sets of traces, which makes our technique useful not only for dynamic analysis, considering one trace at a time, but also for static analysis, considering a set of traces inferred from a control flow graph. Abstracting traces with rewriting systems on first order terms with variables allows us in particular to model dataflow and to detect information leak

Cross-Generational Reproductive Fitness Enforced by Microchimeric Maternal Cells

SummaryExposure to maternal tissue during in utero development imprints tolerance to immunologically foreign non-inherited maternal antigens (NIMA) that persists into adulthood. The biological advantage of this tolerance, conserved across mammalian species, remains unclear. Here, we show maternal cells that establish microchimerism in female offspring during development promote systemic accumulation of immune suppressive regulatory T cells (Tregs) with NIMA specificity. NIMA-specific Tregs expand during pregnancies sired by males expressing alloantigens with overlapping NIMA specificity, thereby averting fetal wastage triggered by prenatal infection and non-infectious disruptions of fetal tolerance. Therefore, exposure to NIMA selectively enhances reproductive success in second-generation females carrying embryos with overlapping paternally inherited antigens. These findings demonstrate that genetic fitness, canonically thought to be restricted to Mendelian inheritance, is enhanced in female placental mammals through vertically transferred maternal cells that promote conservation of NIMA and enforce cross-generational reproductive benefits

Managing the Socially Marginalized: Attitudes Towards Welfare, Punishment and Race

Welfare and incarceration policies have converged to form a system of governance over socially marginalized groups, particularly racial minorities. In both of these policy areas, rehabilitative and social support objectives have been replaced with a more punitive and restrictive system. The authors examine the convergence in individual-level attitudes concerning welfare and criminal punishment, using national survey data. The authors\u27 analysis indicates a statistically significant relationship between punitive attitudes toward welfare and punishment. Furthermore, accounting for the respondents\u27 racial attitudes explains the bivariate relationship between welfare and punishment. Thus, racial attitudes seemingly link support for punitive approaches to opposition to welfare expenditures. The authors discuss the implications of this study for welfare and crime control policies by way of the conclusion

High Temperature Matter and Gamma Ray Spectra from Microscopic Black Holes

The relativistic viscous fluid equations describing the outflow of high temperature matter created via Hawking radiation from microscopic black holes are solved numerically for a realistic equation of state. We focus on black holes with initial temperatures greater than 100 GeV and lifetimes less than 6 days. The spectra of direct photons and photons from $\pi^0$ decay are calculated for energies greater than 1 GeV. We calculate the diffuse gamma ray spectrum from black holes distributed in our galactic halo. However, the most promising route for their observation is to search for point sources emitting gamma rays of ever-increasing energy.Comment: 33 pages, 13 figures, to be submitted to PR

Increasing Concentrations of 17β-Estradiol Has Differential Effects on Secretion of Luteinizing Hormone and Follicle-Stimulating Hormone and Amounts of mRNA for Gonadotropin Subunits during the Follicular Phase of the Bovine Estrous Cycle

The hypothesis tested was that 17β-estradiol (E2) would increase amounts of mRNA for α, LHβ, and FSHβ subunits during the follicular phase of the estrous cycle prior to the preovulatory surge of gonadotropins in cows. On Day 16 (Day 0 = estrus) of the estrous cycle, all cows were treated with prostaglandin F2α (PGF2α). Cows served as intact controls (CONT, n = 4) were ovariectomized (OVX, n = 5), or were ovariectomized and administered E2 (OVXE, n = 6) in increasing doses starting at the time of treatment with PGF2α. Cows were bled for 6 h before and for 40 h after PGF2α treatment to characterize pulsatile secretion of LH and FSH. Forty hours after PGF2α treatment, pituitaries were collected for evaluation of amounts of mRNA for α, LHβ, and FSHβ subunits. Amplitude of LH pulses was greater (p \u3c 0.05) in cows from the OVXE than from the CONT group. Concentrations of FSH were greater in cows from both the OVXE and OVX (p \u3c 0.01) groups than from the CONT group. Amounts of mRNA for α and FSHβ subunits were greater (p \u3c 0.01) in pituitaries of cows from the OVX than from the CONT or OVXE groups. Amounts of mRNA for LHP subunit in pituitaries of cows from the OVX group tended to be greater (p \u3c 0.08) than from the CONT group. Cows in the OVXE group tended (p \u3c 0.08) to have greater amounts of mRNA for FSHβ subunit than did CONT cows. Amounts of mRNA for α and LHβ subunits in cows from the OVXE and CONT groups did not differ (p \u3e 0.10). Pituitary weight and content of LH and FSH were not different (p \u3e 0.10) among cows of the different groups. Ovariectomy resulted in enhanced secretion of gonadotropins and increased amounts of mRNA for gonadotropin subunits above values detected in CONT cows. Ovariectomized cows administered E2, in follicular-phase patterns had amounts of mRNA for a and LHβ similar to those in CONT cows even though secretion of LH was enhanced in the OVXE group. We reject our hypothesis and conclude that E2 has a divergent role in regulation of gonadotropins. Release of LH is enhanced by E2, but E2 reduced mRNA for gonadotropin subunits (tended to reduce mRNA for FSHβ subunit) in ovariectomized cows to amounts detected in intact cows during the follicular phase of the bovine estrous cycle

Changing Dose of Progesterone Results in Sudden Changes in Frequency of Luteinizing Hormone Pulses and Secretion of 17β-Estradiol in Bovine Females

The aim of the present study was to elucidate the time course according to which changes in circulating concentrations of progesterone influence pulsatile secretion of LH and secretion of 17β-estradiol. Our working hypothesis was that changing the dose of progesterone would result in changes in frequency of LH pulses and secretion of 17β-estradiol within 72 h. Five days after behavioral estrus, thirty-three cows were randomly assigned to one of five groups: 1) control, no treatment (CONT, n = 5); 2) treatment with two progesterone-releasing intravaginal devices (PRIDs) for 11 days (2PRID, 5-6 ng/ml plasma progesterone, n = 7); 3) treatment with a 0.5 PRID for 11 days (0.5PRID, 1-2 ng/ml plasma progesterone, n = 7); 4) treatment with 2 PRIDs for 8 days followed by treatment with a 0.5 PRID for 3 days (2-0.5PRID, n = 7); and 5) treatment with a 0.5 PRID for 8 days followed by treatment with 2 PRIDs for 3 days (0.5-2PRID, n = 7). Cows subject to PRID treatments received injections of prostaglandin F2 on Days 1 and 2 (Day 0 = day of initiation of PRID treatments, fifth day of the estrous cycle in CONT cows) to lyse the existing corpus luteum. Cows were bled for 12 h at 15-min intervals on Day 7.5 of the treatment period (twelfth day of the estrous cycle in CONT cows). The dose of progesterone was changed on Day 8 in cows that were assigned to the 2-0.5PRID and 0.5-2PRID groups, and blood collections continued an additional 72 h to characterize profiles of circulating concentrations of LH and 17β-estradiol. Cows treated with a 0.5 PRID had a greater (p \u3c 0.05) number of LH pulses and higher (p \u3c 0.05) concentrations of 17β-estradiol throughout the entire blood collection period than cows in the 2PRID and CONT groups. An increase in the number of LH pulses was detected within 6 h after the change from the high to the low dose of progesterone (2-0.5PRID), and frequency of LH pulses was similar to that of cows in the 0.5PRID group for the remainder of the period of blood collection. LH pulse frequency declined within 6 h after the shift from the low to the high dose of progesterone (0.5-2PRID) and was similar to that of cows in the 2PRID group by 12 h after the dose was changed. Within 6 h after the dose of progesterone was changed, circulating concentrations of 17p-estradiol increased (p \u3c 0.05) in cows shifted from the high to low dose (2-0.5PRID) and declined (p \u3c 0.05) after the dose of progesterone was changed from low to high (0.5-2PRID). We conclude that changing the circulating concentrations of progesterone concurrently affects frequency of pulsatile LH release and secretion of 17β-estradiol within 6-24 h