Shock volume: Patient-specific cumulative hypoperfusion predicts organ dysfunction in a prospective cohort of multiply injured patients

BACKGROUND: Multiply injured patients are at risk of developing hemorrhagic shock and organ dysfunction. We determined how cumulative hypoperfusion predicted organ dysfunction by integrating serial Shock Index measurements. METHODS: In this study, we calculated shock volume (SHVL) which is a patient-specific index that quantifies cumulative hypoperfusion by integrating abnormally elevated Shock Index (heart rate/systolic blood pressure ≥ 0.9) values acutely after injury. Shock volume was calculated at three hours (3 hr), six hours (6 hr), and twenty-four hours (24 hr) after injury. Organ dysfunction was quantified using Marshall Organ Dysfunction Scores averaged from days 2 through 5 after injury (aMODSD2–D5). Logistic regression was used to determine correspondence of 3hrSHVL, 6hrSHVL, and 24hrSHVL to organ dysfunction. We compared correspondence of SHVL to organ dysfunction with traditional indices of shock including the initial base deficit (BD) and the lowest pH measurement made in the first 24 hr after injury (minimum pH). RESULTS: SHVL at all three time intervals demonstrated higher correspondence to organ dysfunction (R2 = 0.48 to 0.52) compared to initial BD (R2 = 0.32) and minimum pH (R2 = 0.32). Additionally, we compared predictive capabilities of SHVL, initial BD and minimum pH to identify patients at risk of developing high-magnitude organ dysfunction by constructing receiver operator characteristic curves. SHVL at six hours and 24 hours had higher area under the curve compared to initial BD and minimum pH. CONCLUSION: SHVL is a non-invasive metric that can predict anticipated organ dysfunction and identify patients at risk for high-magnitude organ dysfunction after injury. LEVEL OF EVIDENCE: Prognostic study, level III

Dairy intakes in older Irish adults and effects on vitamin micronutrient status: Data from the TUDA study

Consumption of dairy products has been associated with positive health outcomes including a lower risk of hypertension, improved bone health and a reduction in the risk of type 2 diabetes. The suggested dairy intake for health in older adults is three servings per day but recent analysis of the NHANES data for older adults reported 98% were not meeting these recommendations. No studies have investigated the consequences of such declines in the dairy intakes of Irish older adults and the subsequent effects on vitamin micronutrient status

Atom probe tomography and correlative microscopy: Key techniques for future planetary science studies

Our Galaxy is vast and awe-inspiring. The stars, planets, and our sun capture our imagination as children. For many of us, that wonder never ceases. It continues to inspire us throughout our careers and prompts us to question the evolution of our Solar System, to question what our place is within it, and how we may maintain longevity in a relatively volatile environment. To answer these questions planetary scientists turn to the study of extraterrestrial material. They analyze meteorites, impact craters, and materials returned by sample return missions for the evidence of events that are known to induce crystallographic and/or elemental changes, or for evidence of extraterrestrial isotopic abundances that point to the age and the original source of the material. Through these studies, we can constrain timelines of events that have occurred throughout the Solar System’s extensive history. Recently, atom probe tomography (APT) has been applied to the study of these materials. APT in correlation with larger-scale analysis techniques has provided insights into isotopic ratios or nanoscale distribution of elements, enriching our knowledge, and minimizing uncertainties in the time frame of critical cosmic events. The continued use of correlative microscopy with APT for the study of planetary science, including studies of small amounts of pristine materials delivered to the Earth by exciting sample return missions, promises to provide key information into the history of our Solar System. Here, we highlight the implications of correlative microscopy with APT for the future pursuits of planetary science, we reflect on the groundbreaking research already achieved, the challenges that have been overcome to achieve these outcomes and the challenges yet to come

Post-Prior discrepancies in CDW-EIS calculations for ion impact ionization fully differential cross sections

In this work we present fully differential cross sections (FDCSs) calculations using post and prior version of CDW--EIS theory for helium single ionization by 100 MeV C$^{6+}$ amu$^{-1}$ and 3.6 MeV amu$^{-1}$ Au$^{24+}$ and Au$^{53+}$ ions. We performed our calculations for different momentum transfer and ejected electron energies. The influence of internuclear potential on the ejected electron spectra is taken into account in all cases. We compare our calculations with absolute experimental measurements. It is shown that prior version calculations give better agreement with experiments in almost all studied cases.Comment: 9 pages, 7 figure

Are there enormous age-trends in stable carbon isotope ratios of oak tree rings?

We test a recent prediction that stable carbon isotope ratios from UK oaks will display age-trends of more than 4‰ per century by measuring >5400 carbon isotope ratios from the late-wood alpha-cellulose of individual rings from 18 modern oak trees and 50 building timbers spanning the 9th to 21st centuries. After a very short (c.5 years) juvenile phase with slightly elevated values, the number of series that show rising and falling trends is almost equal (33:35) and the average trend is almost zero. These results are based upon measuring and averaging the trends in individual time-series; the ‘mean of the slopes’ approach. We demonstrate that the more conventional ‘slope of the mean’ approach can produce strong but spurious ‘age-trends’ even when the constituent series are flat, with zero slope and zero variance. We conclude that it is safe to compile stable carbon isotope chronologies from UK oaks without de-trending. The isotope chronologies produced in this way are not subject to the ‘segment length curse’, which applies to growth measurements, such as ring width or density, and have the potential to retain very long-term climate signals

T. brucei cathepsin-L increases arrhythmogenic sarcoplasmic reticulum-mediated calcium release in rat cardiomyocytes

Aims: African trypanosomiasis, caused by Trypanosoma brucei species, leads to both neurological and cardiac dysfunction and can be fatal if untreated. While the neurological-related pathogenesis is well studied, the cardiac pathogenesis remains unknown. The current study exposed isolated ventricular cardiomyocytes and adult rat hearts to T. brucei to test whether trypanosomes can alter cardiac function independent of a systemic inflammatory/immune response. Methods and results: Using confocal imaging, T. brucei and T. brucei culture media (supernatant) caused an increased frequency of arrhythmogenic spontaneous diastolic sarcoplasmic reticulum (SR)-mediated Ca2+ release (Ca2+ waves) in isolated adult rat ventricular cardiomyocytes. Studies utilising inhibitors, recombinant protein and RNAi all demonstrated that this altered SR function was due to T. brucei cathepsin-L (TbCatL). Separate experiments revealed that TbCatL induced a 10–15% increase of SERCA activity but reduced SR Ca2+ content, suggesting a concomitant increased SR-mediated Ca2+ leak. This conclusion was supported by data demonstrating that TbCatL increased Ca2+ wave frequency. These effects were abolished by autocamtide-2-related inhibitory peptide, highlighting a role for CaMKII in the TbCatL action on SR function. Isolated Langendorff perfused whole heart experiments confirmed that supernatant caused an increased number of arrhythmic events. Conclusion: These data demonstrate for the first time that African trypanosomes alter cardiac function independent of a systemic immune response, via a mechanism involving extracellular cathepsin-L-mediated changes in SR function

Pneumomediastinum from nasal insufflation of cocaine

Chest pain is a common presenting symptom of cocaine users to the emergency department that requires a thorough work up. Pneumomediastinum is an uncommon complication of cocaine abuse that occurs more commonly when cocaine is smoked, but can also occur when cocaine is nasally insufflated. Our case report presents a patient with pneumomediastinum secondary to cocaine insufflation and reviews the necessary diagnostic tests that must be performed to rule out secondary pneumomediastinum, a severe life-threatening condition. Our case is unique, as it is one of a few reported cases of pneumomediastinum occurring after the use of intranasal cocaine