Pathophysiology and prophylaxis of stress ulcer in intensive care unit patients

Abstract Gastrointestinal complications frequently occur in patients admitted to the intensive care unit. Of these, ulceration and bleeding related to stress-related mucosal disease (SRMD) can lengthen hospitalization and increase mortality. The purpose of this review is to discuss the many risk factors and underlying illnesses that have a role in the pathophysiology of SRMD and evaluate the evidence pertaining to SRMD prophylaxis in the intensive care unit population. Suppressing acid production is fundamental to preventing stress-related mucosal ulceration and clinically important gastrointestinal bleeding. Traditional prophylactic options for SRMD in critically ill patients include antacids, sucralfate, histamine 2 -receptor antagonists (H 2 RAs), and proton pump inhibitors. Many clinicians prescribe intermittent infusions of H 2 RAs for stress ulcer prophylaxis, a practice that has not been approved for this indication and may not provide the necessary degree or duration of acid suppression required to prevent stress ulcer-related bleeding. New data suggest that proton pump inhibitors suppress acid production more completely in critically ill patients, but more studies are required to assess their clinical effectiveness and safety for this indication. The prophylactic regimen chosen to prevent stress ulcer bleeding should take into account the risk factors and underlying disease state of individual patients to provide the best therapy to those most likely to benefit.

Territoriality and Inter-Pack Aggression in Gray Wolves: Shaping a Social Carnivore\u27s Life History \u3ci\u3eRudyard Kipling\u27s Law of the Jungle Meets Yellowstone\u27s Law of the Mountains\u3c/i\u3e

When Rudyard Kipling wrote The Jungle Book in 1894 and included the famous line For the strength of the Wolf is the Pack, and the strength of the Pack is the Wolf, he would have had no idea that over a century later, scientific research would back up his poetic phrase. Recent studies in Yellowstone have found that both the individual wolf and the collective pack rely on each other and play important roles in territoriality. At a time when most fairy tales and fables were portraying wolves as demonic killers or, at best, slapstick gluttons, Kipling seemed to have a respect or even reverence for the wolf. Wolves in The Jungle Book raise and mentor the main character Mowgli, with the pack\u27s leader eventually dying to save the man-cub from a pack of wolves. Kipling may have extended intra-pack benevolence to a human boy for literary sake, but he was clearly enthralled with how pack members treat each other. As wolf packs are almost always family units, most commonly comprised of a breeding pair and their offspring from several years, amiable behavior within the pack is unsurprising. By contrast, wolf packs are fiercely intolerant of their neighbors, their rivals. And this competition is proving to be an important facet in the life of a wolf and its pack

Apparatus and method for centrifugation and robotic manipulation of samples

A device for centrifugation and robotic manipulation of specimen samples, including incubating eggs, and uses thereof are provided. The device may advantageously be used for the incubation of avian, reptilian or any type of vertebrate eggs. The apparatus comprises a mechanism for holding samples individually, rotating them individually, rotating them on a centrifuge collectively, injecting them individually with a fixative or other chemical reagent, and maintaining them at controlled temperature, relative humidity and atmospheric composition. The device is applicable to experiments involving entities other than eggs, such as invertebrate specimens, plants, microorganisms and molecular systems

A Vast Thin Plane of Co-rotating Dwarf Galaxies Orbiting the Andromeda Galaxy

Dwarf satellite galaxies are thought to be the remnants of the population of primordial structures that coalesced to form giant galaxies like the Milky Way. An early analysis noted that dwarf galaxies may not be isotropically distributed around our Galaxy, as several are correlated with streams of HI emission, and possibly form co-planar groups. These suspicions are supported by recent analyses, and it has been claimed that the apparently planar distribution of satellites is not predicted within standard cosmology, and cannot simply represent a memory of past coherent accretion. However, other studies dispute this conclusion. Here we report the existence (99.998% significance) of a planar sub-group of satellites in the Andromeda galaxy, comprising approximately 50% of the population. The structure is vast: at least 400 kpc in diameter, but also extremely thin, with a perpendicular scatter <14.1 kpc (99% confidence). Radial velocity measurements reveal that the satellites in this structure have the same sense of rotation about their host. This finding shows conclusively that substantial numbers of dwarf satellite galaxies share the same dynamical orbital properties and direction of angular momentum, a new insight for our understanding of the origin of these most dark matter dominated of galaxies. Intriguingly, the plane we identify is approximately aligned with the pole of the Milky Way's disk and is co-planar with the Milky Way to Andromeda position vector. The existence of such extensive coherent kinematic structures within the halos of massive galaxies is a fact that must be explained within the framework of galaxy formation and cosmology.Comment: Published in the 3rd Jan 2013 issue of Nature. 19 pages, 4 figures, 1 three-dimensional interactive figure. To view and manipulate the 3-D figure, an Adobe Reader browser plug-in is required; alternatively save to disk and view with Adobe Reade

Seasonality of reproduction in an ever-wet lowland tropical forest in Amazonian Ecuador

We thank Pablo Alvia, Alvaro Pérez, Zornitza Aguilar, Paola Barriga, Matt Priest, Caroline Whitefoord, and Gorky Villa for assistance in collecting data or identifying species; Elina Gomez for entry of trap data; Hugo Navarrete, Katya Romoleroux and the QCA herbarium staff, and David Lasso and the ECY staff for help with logistics and needed permitting; Rick Condit, Elizabeth Losos, Robin Foster, and Henrik Balslev for initial encouragement to work within the Yasuní Forest Dynamics Plot; Hugo Romero for initially summarizing the YFDP and SSP weather data sets; Pablo Jarrin for setting up the TEAM weather station, and David Lasso and Carlos Padilla for maintaining that equipment and making the data available; and the Ecuadorian Ministerio del Ambiente for permission to work in Yasuní National Park [No 014-2019-IC-PNY-DPAO/AVS, No 012-2018-IC-PNY593-DPAO/AVS, No 008-2017-IC-PNY-DPAO/AVS, No 012-2016-IC-FAU-FLO-DPAO-PNY, No 594-014-2015-FLO-MAE-DPAO-PNY, and earlier permits]. The Forest Dynamics Plot of Yasuní National Park has been made possible through the generous support of the Pontifical Catholic University of Ecuador (PUCE) funds of donaciones del impuesto a la renta, the Government of Ecuador, the US National Science Foundation, the Andrew W. Mellon Foundation, the Smithsonian Tropical Research Institute, and the University of Aarhus of Denmark. The phenology project began while NCG was at the Natural History Museum, London, with funding (2000–2004) from the Department of Botany (NHM), the Andrew W. Mellon Foundation, British Airways, and the Natural Environment Research Council (GR9/04037). It continued with NCG at Southern Illinois University Carbondale (2005–2023). We thank the Center for Tropical Forest Science for transitional funding (2006–2008, 2017–2018) and the National Science Foundation LTREB program for long-term funding (2006–2020; DEB-0614525, DEB-1122634, DEB-1754632, DEB-1754668).Peer reviewedPublisher PD

The efficacy of endoscopic therapy in bleeding peptic ulcer patients

Background. Endotherapy is the primary modality for the control of bleeding from peptic ulceration. Objective. To assess the efficacy of endoscopic intervention for high-risk bleeding peptic ulcer disease and to benchmark our surgical and mortality rates. Methods. Two hundred and twenty-seven patients with peptic ulcers stratified by Rockall and Forrest scores as at high risk for re-bleeding underwent therapeutic intervention (adrenalin injection) between January 2004 and December 2009. The median age of the patients was 57 years (range 19 - 87 years); 60% were males. Results. Primary endoscopic haemostasis failed in 51/227 patients (22.5%); 18 patients (7.9%) required surgery for bleeding not controlled at initial or second endoscopy; and 29 patients (12.8%) died, 12 by day 3 and 17 by day 30. Fifteen patients, all with significant medical co-morbidity, died after successful primary endotherapy, and 4 died after surgery. Surgical patients required more blood (odds ratio (OR) 1.45, p=0.0001) than those not undergoing surgery, but had similar mortality. Rebleeding was the only predictor of death in patients who died by day 3 (OR 18.77). A high Rockall score was the only predictor of death by day 30 (OR 1.98). Conclusion. The overall surgical and mortality rates were 7.9% and 12.8%, respectively. Over half the deaths resulted from medical co-morbidity, despite successful primary endotherapy. This finding is supported by the use of the Rockall score as a predictor of mortality at day 30. Improving the technical success of primary endoscopic haemostasis, currently 77.5%, has the potential to reduce rebleeding after primary endotherapy, a predictor of death at day 3 in this study

Identification of hip fracture patients from radiographs using Fourier analysis of the trabecular structure: a cross-sectional study

Peer reviewedPublisher PD

Transgenerational programming of maternal behaviour by prenatal stress

Sherpa Romeo green journal. Open access, distributed under the terms of the Creative Commons Attribution (CC-BY) LicensePeripartum events hold the potential to have dramatic effects in the programming of physiology and behaviour of offspring and possibly subsequent generations. Here we have characterized transgenerational changes in rat maternal behaviour as a function of gestational and prenatal stress. Pregnant dams of the parental generation were exposed to stress from days 12-18 (F0-S). Their daughters and grand-daughters were either stressed (F1-SS, F2-SSS) or non-stressed (F1-SN, F2-SNN). Maternal antepartum behaviours were analyzed at a time when pregnant dams usually show a high frequency of tail chasing behaviours. F1-SS, F2-SNN and F2-SSS groups showed a significant reduction in tail chasing behaviours when compared with controls. The effects of multigenerational stress (SSS) slightly exceeded those of transgenerational stress (SNN) and resulted in absence of tail chasing behaviour. These findings suggest that antepartum maternal behaviour in rats is programmed by transgenerational inheritance of stress responses. Thus, altered antepartum maternal behaviour may serve as an indicator of an activated stress response during gestation.Ye