Liver Disease in Burn Injury: Evidence From a National Sample of 31,338 Adult Patients

Objective: To assess mortality risk and extent of increased length of hospital stay in patients with burn injury with preexisting liver disease. Methods: Records of 31,338 adults who were admitted with burns to 70 burn centers were reviewed from the American Burn Association National Burn Repository. Demographics, percentage burn, and medical characteristics of 180 patients with liver disease were compared with all patients without liver disease and to a propensity score–matched sample of 180 patients without liver disease. Risk of mortality as well as lengths of both intensive care and total stay were compared after matching for demographics, burn injury, and preexisting medical conditions. Results: Patients with liver disease were significantly more likely to have a history of a number of medical comorbidities, including alcohol abuse, drug abuse, a psychiatric diagnosis, chronic pulmonary disease, hypertension, and diabetes. Patients with liver disease were significantly more likely to die in the hospital (27.2% vs 6.9%, odds ratio = 5.0, 95% confidence interval = 3.6–7.0, P < .01), and this held even when compared with a propensity score–matched group of patients without liver disease, but with similar demographics, burn injury, and medical profiles. Lengths of both intensive care and total hospital stay were 122.5% (P < .01) and 86.7% (P < .01) longer, respectively, among patients with liver disease than among all other patients. In a matched sample, lengths of both intensive care and total stays were longer, albeit not significantly so (41.6%, P = .12; 35.5%, P = .07). Conclusions: Liver impairment worsens the prognosis in patients with thermal injury

Upregulation of Defensins in Burn Sheep Small Intestine

Objective: The aim of this study was to visualize and localize the sheep antimicrobials, β-defensins 1, 2, and 3, (SBD-1, SBD-2, SBD-3), sheep neutrophil defensin alpha (SNP-1), and the cathelicidin LL-37 in sheep small intestine after burn injury, our hypothesis being that these compounds would be upregulated in an effort to overcome a compromised endothelial lining. Response to burn injury includes the release of proinflammatory cytokines and systemic immune suppression that, if untreated, can progress to multiple organ failure and death, so protective mechanisms have to be initiated and implemented. Methods: Tissue sections were probed with antibodies to the antimicrobials and then visualized with fluorescently labeled secondary antibodies and subjected to fluorescence deconvolution microscopy and image reconstruction. Results: In both the sham and burn samples, all the aforementioned antimicrobials were seen in each of the layers of small intestine, the highest concentration being localized to the epithelium. SBD-2, SBD-3, and SNP-1 were upregulated in both enterocytes and Paneth cells, while SNP-1 and LL-37 showed increases in both the inner circular and outer longitudinal muscle layers of the muscularis externa following burn injury. Each of the defensins, except SBD-1, was also seen in between the muscle layers of the externa and while burn caused slight increases of SBD-2, SBD-3, and SNP-1 in this location, LL-37 content was significantly decreased. Conclusion: That while each of these human antimicrobials is present in multiple layers of sheep small intestine, SBD-2, SBD-3, SNP-1, and LL-37 are upregulated in the specific layers of the small intestine

Severe hyperkalaemia: demographics and outcome

Background. Few studies have evaluated the prevalence of severe hyperkalaemia in unselected patient populations.We identified all episodes of severe hyperkalaemia occurring in 1 year, and described patient demographics, clinical response and outcome. We also assessed junior doctor knowledge of its causes and significance. Materials and methods. A retrospective interrogation of the database of the regional biochemical laboratory identified all episodes of severe hyperkalaemia (K ≥ 6.5 mmol/L) occurring in 2011. The understanding of trainee doctors of the importance, causes and treatment of severe hyperkalaemia was assessed by structured questionnaire. Results. Severe hyperkalaemia was recorded in 433 samples (365 patients) giving a prevalence of 0.11%. Thirty-six per cent of episodes occurred in patients under the care of a nephrologist, who were significantly younger than those not under the care of a nephrologist. In the nephrology cohort, 86% occurred in patients with chronic kidney disease (CKD), the majority of which had CKD Stage 5. In the non-nephrology cohort, only 65% occurred in the context of CKD, which was equally distributed between Stages 3 and 5 CKD. In both patient groups, roughly 50% of episodes occurred in association with acute kidney injury (AKI). Acute mortality (death within 48 h of documented severe hyperkalaemia) was higher in the non-nephrology compared with the nephrology cohort. Time to repeat serum potassium was influenced by the clinical setting with shorter time to repeat for acute care compared with ward settings. Assessment of trainee doctor’s knowledge suggested significant deficiencies in relation to severe hyperkalaemia. Conclusions. The prevalence of severe hyperkalaemia was low and occurred predominantly in the context of CKD and/or AKI. The majority of episodes occurred in patients not under the care of a nephrologist. Variability in time to repeat serum potassium levels suggested deficiencies in care, and assessment of trainee doctor’s knowledge suggests the need for further educational initiatives to highlight its importance

Enteric Absorption of Ciprofloxacin During Tube Feeding in the Critically Ill

To determine the pharmacokinetic properties of ciprofloxacin in the critically ill, we studied seven mechanically ventilated patients with pneumonia during entcral feedings. Subjects received ciprofloxacin 750 mg every 12 h via nasogastric tube and serial serum drug concentrations were measured after the first and fourth dose. After the initial dose, the maximum serum concentration ranged from 1.24–3.06 mg/L, and the area under the time curve from 0–12 h ranged from 3.2–19.65 mg.h/L. Similar levels were noted after dose four. Gastrointestinal absorption of ciprofloxacin in tube fed critically ill patients was decreased, but well above MIC values for many pathogenic bacteria

Arctic river temperature dynamics in a changing climate

Climate change in the Arctic is expected to have a major impact on stream ecosystems, affecting hydrological and thermal regimes. Although temperature is important to a range of in‐stream processes, previous Arctic stream temperature research is limited—focused on glacierised headwaters in summer—with limited attention to snowmelt streams and winter. This is the first high‐resolution study on stream temperature in north‐east Greenland (Zackenberg). Data were collected from five streams from September 2013 to September 2015 (24 months). During the winter, streams were largely frozen solid and water temperature variability low. Spring ice‐off date occurred simultaneously across all streams, but 11 days earlier in 2014 compared with 2015 due to thicker snow insulation. During summer, water temperature was highly variable and exhibited a strong relationship with meteorological variables, particularly incoming shortwave radiation and air temperature. Mean summer water temperature in these snowmelt streams was high compared with streams studied previously in Svalbard, yet was lower in Swedish Lapland, as was expected given latitude. With global warning, Arctic stream thermal variability may be less in summer and increased during the winter due to higher summer air temperature and elevated winter precipitation, and the spring and autumn ice‐on and ice‐off dates may extend the flowing water season—in turn affecting stream productivity and diversity

Virtually Instantaneous, Room-Temperature [11C]-Cyanation Using Biaryl Phosphine Pd(0) Complexes

A new radiosynthetic protocol for the preparation of [[superscript 11]C]aryl nitriles has been developed. This process is based on the direct reaction of in situ prepared L·Pd(Ar)X complexes (L = biaryl phosphine) with [[superscript 11]C]HCN. The strategy is operationally simple, exhibits a remarkably wide substrate scope with short reaction times, and demonstrates superior reactivity compared to previously reported systems. With this procedure, a variety of [[superscript 11]C]nitrile-containing pharmaceuticals were prepared with high radiochemical efficiency.National Institutes of Health (U.S.) (NIH GM46059)National Science Foundation (U.S.) (NSF predoctoral fellowship (2010094243))Amgen Inc. (Educational donation)National Institutes of Health (U.S.) (NIH-NIDA postdoctoral fellowship (2T32DA015036)

A non-interleaving process calculus for multi-party synchronisation

We introduce the wire calculus. Its dynamic features are inspired by Milner's CCS: a unary prefix operation, binary choice and a standard recursion construct. Instead of an interleaving parallel composition operator there are operators for synchronisation along a common boundary and non-communicating parallel composition. The (operational) semantics is a labelled transition system obtained with SOS rules. Bisimilarity is a congruence with respect to the operators of the language. Quotienting terms by bisimilarity results in a compact closed category