Physiologic-Based Cord Clamping Maintains Core Temperature vs. Immediate Cord Clamping in Near-Term Lambs

Background: Physiologic-based cord clamping (PBCC) involves deferring umbilical cord clamping until after lung aeration. It is unclear if infant is at risk of becoming hypothermic during PBCC. Objectives: To test if PBCC would maintain core temperature more effectively than immediate cord clamping (ICC). Design: At 0.93 gestation, fetal lambs were surgically exteriorized and instrumented from pregnant ewes under general anesthesia. Prior to the start of the experiment, lambs were thoroughly dried, placed on hot water bottles, and core temperature was continuously monitored using a rectal thermometer. PBCC lambs (n = 21), received intermittent positive pressure ventilation (iPPV) for ≥5 min prior to umbilical cord clamping. In ICC lambs (n = 23), iPPV commenced within 60 s after umbilical cord clamping. iPPV was provided with heated/humidified gas. Lambs were moved under a radiant warmer after umbilical cord clamping. Additional warmth was provided using a plastic overlay, hairdryer, and extra water bottles, as needed. Two-way mixed and repeated measures one-way ANOVAs were used to compare temperature changes between and within a single group, respectively, over time. Results: Basal fetal parameters including core temperature were similar between groups. ICC lambs had a significant reduction in temperature compared to PBCC lambs (p < 0.001), evident by 1 min (p = 0.002). ICC lambs decreased temperature by 0.51◦C (± 0.42) and 0.79◦C (± 0.55) at 5 and 10 min respectively (p <

Posterolateral or direct lateral surgical approach for hemiarthroplasty after a hip fracture

IMPORTANCE Hip fractures in older adults are serious injuries that result in disability, higher rates of illness and death, and a substantial strain on health care resources. High-quality evidence to improve hip fracture care regarding the surgical approach of hemiarthroplasty is lacking. OBJECTIVE To compare 6-month outcomes of the posterolateral approach (PLA) and direct lateral approach (DLA) for hemiarthroplasty in patients with acute femoral neck fracture. DESIGN, SETTING, AND PARTICIPANTS This multicenter, randomized clinical trial (RCT) comparing DLA and PLA was performed alongside a natural experiment (NE) at 14 centers in the Netherlands. Patients aged 18 years or older with an acute femoral neck fracture were included, with or without dementia. Secondary surgery of the hip, pathological fractures, or patients with multitrauma were excluded. Recruitment took place between February 2018 and January 2022. Treatment allocation was random or pseudorandom based on geographical location and surgeon preference. Statistical analysis was performed from July 2022 to September 2022. EXPOSURE Hemiarthroplasty using PLA or DLA. MAIN OUTCOME AND MEASURES The primary outcome was health-related quality of life 6 months after surgery, quantified with the EuroQol Group 5-Dimension questionnaire (EQ-5D-5L). Secondary outcomes included dislocations, fear of falling and falls, activities of daily living, pain, and reoperations. To improve generalizability, a novel technique was used for data fusion of the RCT and NE. RESULTS A total of 843 patients (542 [64.3%] female; mean [SD] age, 82.2 [7.5] years) participated, with 555 patients in the RCT (283 patients in the DLA group; 272 patients in the PLA group) and 288 patients in the NE (172 patients in the DLA group; 116 patients in the PLA group). In the RCT, mean EQ-5D-5L utility scores at 6 months were 0.50 (95% CI, 0.45-0.55) after DLA and 0.49 (95% CI, 0.44-0.54) after PLA, with 77% completeness. The between-group difference (-0.04 [95% CI, -0.11 to 0.04]) was not statistically significant nor clinically meaningful. Most secondary outcomes were comparable between groups, but PLA was associated with more dislocations than DLA (RCT: 15 of 272 patients [5.5%] in PLA vs 1 of 283 patients [0.4%] in DLA; NE: 6 of 113 patients [5.3%]) in PLA vs 2 of 175 patients [1.1%] in DLA). Data fusion resulted in an effect size of 0.00 (95% CI, -0.04 to 0.05) for the EQ-5D-5L and an odds ratio of 12.31(95% CI, 2.77 to 54.70) for experiencing a dislocation after PLA. CONCLUSIONS AND RELEVANCE This combined RCT and NE found that among patients treated with a cemented hemiarthroplasty after an acute femoral neck fracture, PLA was not associated with a better quality of life than DLA. Rates of dislocation and reoperation were higher after PLA. Randomized and pseudorandomized data yielded similar outcomes, which suggests a strengthening of these findings. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04438226Orthopaedics, Trauma Surgery and Rehabilitatio

Molecular epidemiology and evolutionary trajectory of emerging echovirus 30, Europe

In 2018, an upsurge in echovirus 30 (E30) infections was reported in Europe. We conducted a large-scale epidemiologic and evolutionary study of 1,329 E30 strains collected in 22 countries in Europe during 2016-2018. Most E30 cases affected persons 0-4 years of age (29%) and 25-34 years of age (27%). Sequences were divided into 6 genetic clades (G1-G6). Most (53%) sequences belonged to G1, followed by G6 (23%), G2 (17%), G4 (4%), G3 (0.3%), and G5 (0.2%). Each clade encompassed unique individual recombinant forms; G1 and G4 displayed >= 2 unique recombinant forms. Rapid turnover of new clades and recombinant forms occurred over time. Clades G1 and G6 dominated in 2018, suggesting the E30 upsurge was caused by emergence of 2 distinct clades circulating in Europe. Investigation into the mechanisms behind the rapid turnover of E30 is crucial for clarifying the epidemiology and evolution of these enterovirus infections.Molecular basis of virus replication, viral pathogenesis and antiviral strategie

Effects of Plasticizer and Strain on the Percolation Threshold in Polyisoprene–Carbon Nanocomposites: Positron Annihilation Lifetime Spectroscopy and Electrical Resistance Measurements

A study of the effects of plasticizer and stretching strain on the percolation transition in polyisoprene–carbon nanocomposites (PCNC) is reported. The ortho-positronium (oPs) accessible free volume sites are measured by positron annihilation lifetime spectroscopy (PALS) in relaxed and stretched PCNC samples containing different amounts of plasticizer. The lifetime of oPs, s3, is related to the size of the free volume, and the intensity, I3, to the concentration of free volume sites. The number of free volume cavities is found to decrease during stretching regardless of the content of either carbon nanoparticles (CNP) or plasticizer. The free volume cavity size reaches its maximum value in the region of percolation transition. The percolation threshold is determined by measurements of electrical resistance (ERM). Both PALS and ERM show that the percolation threshold shifts to higher concentration of CNP under stretching strain. A shift of the percolation threshold to lower concentration of CNP was observed for addition of plasticizer. It is interesting that addition of CNP increases the mean size of free volume cavities below the percolation threshold and decreases it at CNP concentrations exceeding the percolation threshold. The relative number of free volume cavities represented by I3 also decreases at CNP concentrations exceeding the percolation threshold. The results are interpreted as filling of cavities above the percolation threshold. ERM during application of cyclic tensile stress revealed fatigue of the tensoresistance effect in samples containing 10 m.p. of CNP with and without added plasticizer

The Influence of Both Plasticizer and Streching Strain on the Percolation Threshold in Polyisoprene-Carbon Nanocomposites: Positron Annihilation Lifetime Spectroscopy and Electric Resistance Measurements

A study of the effect of both plasticizer and streching strain on the percolation transition in polyisoprene-carbon nanocomposites (PCNC) is reported. The orthopositronium (oPs) accessible free volume sites in the unstreched and streched PCNC without plasticizer as well as with plasticizer have been measured by positron annihilation lifetime spectroscopy (PALS). The lifetime of oPs, 3, is related to the size of the free volume, and the intensity, I3, to the number concentration of free volume sites. It was found that streching decreases the number of free volume cavities independent of the both mass parts carbon nano-particles (CNP) and plasticizer. The free volume cavity size has maximum value in the region of percolation transition. Percolation threshold was determined by electric resistance measurements (ERM). Both PALS and ERM show that the percolation threshold shifts to greater values of mass parts of CNP under streching strain. An opposite shift of percolation threshold was found under adding plasticizer. It is interesting that adding of CNP increases mean free volume cavity size at mass parts < percolation threshold. Decrease in cavity number (I3) was observed at mass parts of CNP > percolation threshold. It means that filling of cavities occurs above the percolation threshold. The fatigue of tenso-resistive effect for PCNC samples, containing 10 m.p. of CNP with plasticizer added and without plasticizer has been examined

Assisted natural recovery: a novel approach to enhance Diadema antillarum recruitment

The massive die-off of the sea urchin Diadema antillarum in 1983–1984 is one the main reasons for low coral recruitment and little coral recovery in the Caribbean. As the natural recovery of D. antillarum is slow to non-existent, multiple restoration studies have been attempted. There are currently three different approaches to obtain individuals for restocking: the translocation of wild-collected juveniles or adults, lab-reared juveniles cultured from wild-collected settlers, or lab-reared juveniles cultured from gametes. All three methods are costly and can only be applied on a relatively small scale. We here propose a fourth, new, approach, which we term assisted natural recovery (ANR) of D. antillarum populations. ANR, a concept already applied in terrestrial restoration to restore forests and grasslands, can accelerate succession by removing barriers to natural recovery. In this study, performed on the Dutch Caribbean island of Saba, suitable settlement substrate was provided in the form of bio ball streamers that were attached to the reef shortly before the settlement season. At the end of the experiment, reefs with streamers had significantly higher D. antillarum recruit densities than control reefs without additional settlement substrate, indicating that the lack of settlement substrate is an important factor constraining natural recovery. However, D. antillarum recruit abundance was low compared to the measured settlement rates, possibly due to low post-settlement survival. The size distribution of recruits showed that recruits almost never became larger than 20 mm, which is likely due to predation. We conclude that, next to low settlement availability, low post-settlement survival and high predation on recruits also constrain the natural recovery of D. antillarum populations on Saba. To improve the survival of settlers till adults, we propose to 1) reduce predation on settlers by using bio balls or other substrates that can provide shelter to larger individuals and 2) optimize the reef habitat by removing macroalgae, either manually or by facilitating other herbivores. To improve the survival of recruits, we suggest to 1) choose sites with a known lower predation density or 2) protect recruits with a corral around the reef underneath the streamers. The combination of these measures could improve prospects for ANR, and we expect this new approach can contribute to the recovery of D. antillarum populations in the future