Significance of Elecsys (R) S100 immunoassay for real-time assessment of traumatic brain damage in multiple trauma patients

Background: The neuroprotein S100 released into the circulation has been suggested as a reliable marker for primary brain damage. However, safe identification of relevant traumatic brain injury (TBI) may possibly be hampered by S100 release from peripheral tissue. The objective of this study was to measure early S100 levels using the Elecsys((R)) S100 immunoassay for real-time assessment of severe TBI in multiple trauma. Methods: Consecutively admitted multiple trauma patients (injury severity score >= 16 points) were stratified according to the results of the initial cerebral computed tomography (CCT) examination. S100 serum levels were determined at admission and at 6, 12, 24, 48 and 72 h after trauma. Data were correlated to creatine phosphokinase (CK) and lactate dehydrogenase (LDH) serum levels. Using receiver operating characteristic (ROC) analysis, the discriminating power of S100 measurement was calculated for the detection of CCT+ findings. Results: Median S100 levels of CCT+ patients (n=9; 37 years) decreased from 3.30 mu g/L at admission to 0.41 mu g/L 72 h after trauma. They revealed no significant differences to CCT- patients (n=18; 44 years), but remained elevated compared to controls. Median CK and LDH levels correlated with the corresponding S100 levels during the first 24 h after trauma. ROC analysis displayed a maximum area under the curve of only 0.653 at 12 h after trauma. No significant difference was calculated for the differentiation between CCT+ and CCT- patients. Conclusions: Measurements of S100 serum levels using the Elecsys((R)) S100 immunoassay are not reliable for the real-time detection of severe TBI in multiple trauma patients. Due to soft tissue trauma or bone fractures, S100 is mainly released from peripheral sources such as adipocytes or skeletal muscle cells

The Solar-Interior Equation of State with the Path-Integral Formalism I. Domain of Validity

This is the first paper in a series that deals with solar-physics applications of the equation-of-state formalism based on the formulation of the so-called "Feynman-Kac (FK) representation". Here, the FK equation of state is presented and adapted for solar applications. Its domain of validity is assessed. The practical application to the Sun will be dealt with in Paper II. Paper III will extend the current FK formalism to a higher order. Use of the FK equation of state is limited to physical conditions for which more than 90% of helium is ionized. This incudes the inner region of the Sun out to about .98 of the solar radius. Despite this limitation, in the parts of the Sun where it is applicable, the FK equation of state has the power to be more accurate than the equations of state currently used in solar modeling. The FK approach is especially suited to study physical effects such as Coulomb screening, bound states, the onset of recombination of fully ionized species, as well as diffraction and exchange effects. The localizing power of helioseismology allows a test of the FK equation of state. Such a test will be beneficial both for better solar models and for tighter solar constraints of the equation of state.Comment: Completely rewritten revised version. Accepted for publication in Astronomy & Astrophysic

“No Justice, No Peace”: Yard Signs as Public Pedagogy and Community Engagement at the Intersection of Public Health Crises

This paper examines yard signs as a site for public pedagogy that engages two concurrent, and comorbid, public health crises: the COVID-19 pandemic and racism. Specifically, I reflect on how yard signs responding to the George Floyd murder in my own Minneapolis neighborhood exist during a kairotic moment; as myself and my students are increasingly confined to our own homes, and as the boundaries between school and home are blurred, the public health crisis of racism and the specific community response of yard signs present opportunities for examining how these signs can act as entry points into difficult conversations among neighbors, classmates, and colleagues. While such signs are certainly examples of epideictic rhetoric, participating in either “praise or blame,” I suggest that communication teachers can frame them as public pedagogy that “strikes a harmony between learning through public engagement and understanding these public encounters in the space of the classroom” (Holmes, 2016). As such, they can act not only as artifacts of community belonging, but as artifacts to promote reflection, conversation, and inquiry

Voice in Composition Theory and Practice: The Epideictic Function of Metaphor in Radical Writing Pedagogies

University of Minnesota Ph.D. dissertation. January 2017. Major: Rhetoric and Scientific and Technical Communication. Advisors: Patrick Bruch, Thomas Reynolds. 1 computer file (PDF); v, 231 pages.In this dissertation, I develop a theoretical framework, based in understandings of epideictic theory, metaphor, and metonymy, to systematically investigate the metaphor of voice across representative expressivist, critical and feminist, and poststructuralist texts. This investigation focuses on the epideictic function that voice plays in such radical writing theory and demonstrates how voice celebrates and strengthens adherence to shared values in order to create communion with a reader and to move that reader toward the action of adopting a novel approach to understanding writing. In Chapters 2, 3, and 4, I identify the core value of power, which is celebrated across divergent theoretical texts and which is both strengthened and deconstructed through the use of the metaphor of voice. Although power is consistently celebrated, each major conversation conceptualizes power very differently, challenging various notions of individual agency and structural limitations to enacting power through writing. As voice works to celebrate and reconceptualize power across these conversations, it also displaces and introduces various other values, such as nature, authenticity, and multiplicity. At the same time, voice functions metonymically and, thus, various values attached to a written text are also attached to the writer. I argue that viewing voice through the lens of epideictic rhetoric can both shed light on the metaphor’s controversy and can provide a material, linguistic focus for a conversation about embedded values that inform theory and practice in the field of composition

Long term outcome and quality of life after open incisional hernia repair - light versus heavy weight meshes

<p>Abstract</p> <p>Background</p> <p>Mesh repair of incisional hernia is superior to the conventional technique. From all available materials for open surgery polypropylene (PP) is the most widely used. Development resulted in meshes with larger pore size, decreased mesh surface and lower weight. The aim of this retrospective non randomized study was to compare the quality of life in the long term follow up (> 72 month) after incisional hernia repair with "light weight"(LW) and "heavy weight"(HW) PP meshes.</p> <p>Methods</p> <p>12 patients who underwent midline open incisional hernia repair with a HW-PP mesh (Prolene^®109 g/m²pore size 1.6 mm) between January 1996 and December 1997 were compared with 12 consecutive patients who underwent the same procedure with a LW-PP mesh (Vypro^®54 g/m², pore size 4-5 mm) from January 1998. The standard technique was the sublay mesh-plasty with the retromuscular positioning of the mesh. The two groups were equal in BMI, age, gender and hernia size. Patients were routinely seen back in the clinic.</p> <p>Results</p> <p>In the long term run (mean follow up 112 ± 22 months) patients of the HW mesh group revealed no significant difference in the SF-36 Health Survey domains compared to the LW group (mean follow up 75 ± 16 months).</p> <p>Conclusions</p> <p>In this study the health related quality of life based on the SF 36 survey after open incisional hernia repair with light or heavy weight meshes is not related to the mesh type in the long term follow up.</p

Effect of stress doses of hydrocortisone on S-100B vs. interleukin-8 and polymorphonuclear elastase levels in human septic shock

Stress doses of hydrocortisone a re known to have immunomodulatory effects in patients with hyperdynamic septic shock. The prognosis correlates with the presence and severity of septic encephalopathy. However, neurological evaluation is influenced by the use of analgesia sedation during artificial ventilation. The objective of this study was to demonstrate the effect of stress doses of hydrocortisone during the initial phase of human septic shock on the serum values of the neurospecific protein S-100B in comparison to the inflammation markers interleukin (IL)-8 in serum and polymorphonuclear (PMN) elastase in plasma. A total of 24 consecutive patients, who met the American College of Chest Physicians/Society of Critical Care Medicine criteria for septic shock, were enrolled in this prospective, randomized, double-blind, single-center trial. The severity of illness at recruitment was graded using the Acute Physiology and Chronic Health Evaluation 11 and the Simplified Acute Physiology Score 11 scoring systems. Multi-organ dysfunction syndrome was described by the Sepsis-related Organ Failure Assessment (SOFA) score. All patients were prospectively randomized to receive either stress doses of hydrocortisone or placebo. Hydrocortisone was started in 12 patients with a loading dose of 100 mg and followed by a continuous infusion of 0.18 mg/kg/h for 6 days. Median S-100B serum levels of the hydrocortisone group decreased from 0.32 ng/mL at study entry to 0.07 ng/mL 6 days later without significant differences compared to the placebo group. Initial IL-8 serum levels were significantly higher in the hydrocortisone group up to 12 h after study entry, and significantly decreased from 715 to 17 pg/mL at the end of the observation period. Median PMN elastase plasma levels were not affected by hydrocortisone infusion. Patients with initial S-100B serum levels &gt;0.50 ng/mL revealed significantly higher SOFA scores up to 30 h, IL-8 serum levels up to 12 h, and PMN elastase plasma levels up to 36 h after study entry than those patients with &lt;= 0.50 ng/mL. These effects were independent of the amount of fluid correction for hemodilution. Starting S-100B, IL-8 and PMN elastase values of the hydrocortisone group were within the ranges already known in patients with out-of-hospital cardiac arrest or severe traumatic brain injury. Stress doses of hydrocortisone resulted in a significant reduction in IL-8 serum, but not in S-100B serum and PMN elastase plasma concentrations in patients with hyperdynamic septic shock. For the first time, a similar extent of S-100B increase in serum of septic patients at the time of diagnosis was shown as reported for cardiac arrest or severe traumatic brain injury

Effect of stress doses of hydrocortisone on S-100B vs. interleukin-8 and polymorphonuclear elastase levels in human septic shock

Stress doses of hydrocortisone a re known to have immunomodulatory effects in patients with hyperdynamic septic shock. The prognosis correlates with the presence and severity of septic encephalopathy. However, neurological evaluation is influenced by the use of analgesia sedation during artificial ventilation. The objective of this study was to demonstrate the effect of stress doses of hydrocortisone during the initial phase of human septic shock on the serum values of the neurospecific protein S-100B in comparison to the inflammation markers interleukin (IL)-8 in serum and polymorphonuclear (PMN) elastase in plasma. A total of 24 consecutive patients, who met the American College of Chest Physicians/Society of Critical Care Medicine criteria for septic shock, were enrolled in this prospective, randomized, double-blind, single-center trial. The severity of illness at recruitment was graded using the Acute Physiology and Chronic Health Evaluation 11 and the Simplified Acute Physiology Score 11 scoring systems. Multi-organ dysfunction syndrome was described by the Sepsis-related Organ Failure Assessment (SOFA) score. All patients were prospectively randomized to receive either stress doses of hydrocortisone or placebo. Hydrocortisone was started in 12 patients with a loading dose of 100 mg and followed by a continuous infusion of 0.18 mg/kg/h for 6 days. Median S-100B serum levels of the hydrocortisone group decreased from 0.32 ng/mL at study entry to 0.07 ng/mL 6 days later without significant differences compared to the placebo group. Initial IL-8 serum levels were significantly higher in the hydrocortisone group up to 12 h after study entry, and significantly decreased from 715 to 17 pg/mL at the end of the observation period. Median PMN elastase plasma levels were not affected by hydrocortisone infusion. Patients with initial S-100B serum levels &gt;0.50 ng/mL revealed significantly higher SOFA scores up to 30 h, IL-8 serum levels up to 12 h, and PMN elastase plasma levels up to 36 h after study entry than those patients with &lt;= 0.50 ng/mL. These effects were independent of the amount of fluid correction for hemodilution. Starting S-100B, IL-8 and PMN elastase values of the hydrocortisone group were within the ranges already known in patients with out-of-hospital cardiac arrest or severe traumatic brain injury. Stress doses of hydrocortisone resulted in a significant reduction in IL-8 serum, but not in S-100B serum and PMN elastase plasma concentrations in patients with hyperdynamic septic shock. For the first time, a similar extent of S-100B increase in serum of septic patients at the time of diagnosis was shown as reported for cardiac arrest or severe traumatic brain injury