Exertional heat stroke in a marathon runner with extensive healed deep burns: a case report

Exertional heat illness typically occurs over hours in younger athletic patients or military recruits who exercise at elevated temperatures for a sufficient period of time to cause the rate of heat production to exceed the capacity of the body to dissipate heat. Since the physiological response to exercise includes cutaneous vasodilation and sweating, any limitation of such a response can cause rapid hyperthermia and thus heat stroke. One such condition is extensive burns healed by cicatrisation of the skin where the scar and grafted skin surface do not have functional sweat glands and are unable to lose heat in response to high temperatures. The authors report one unique case of a female marathon runner with exertional heat stroke who had recovered from deep second and third degree burns over approximately 50% of her body a few years ago

Leukaemia exposure alters the transcriptional profile and function of BCR::ABL1 negative macrophages in the bone marrow niche

Macrophages are fundamental cells of the innate immune system that support normal haematopoiesis and play roles in both anti-cancer immunity and tumour progression. Here we use a chimeric mouse model of chronic myeloid leukaemia (CML) and human bone marrow (BM) derived macrophages to study the impact of the dysregulated BM microenvironment on bystander macrophages. Utilising single-cell RNA sequencing (scRNA-seq) of Philadelphia chromosome (Ph) negative macrophages we reveal unique subpopulations of immature macrophages residing in the CML BM microenvironment. CML exposed macrophages separate from their normal counterparts by reduced expression of the surface marker CD36, which significantly reduces clearance of apoptotic cells. We uncover aberrant production of CML-secreted factors, including the immune modulatory protein lactotransferrin (LTF), that suppresses efferocytosis, phagocytosis, and CD36 surface expression in BM macrophages, indicating that the elevated secretion of LTF is, at least partially responsible for the supressed clearance function of Ph- macrophages

Non-Standard Errors

In statistics, samples are drawn from a population in a data-generating process (DGP). Standard errors measure the uncertainty in estimates of population parameters. In science, evidence is generated to test hypotheses in an evidence-generating process (EGP). We claim that EGP variation across researchers adds uncertainty: Non-standard errors (NSEs). We study NSEs by letting 164 teams test the same hypotheses on the same data. NSEs turn out to be sizable, but smaller for better reproducible or higher rated research. Adding peer-review stages reduces NSEs. We further find that this type of uncertainty is underestimated by participants

Calibration of the CMS hadron calorimeters using proton-proton collision data at root s=13 TeV

Methods are presented for calibrating the hadron calorimeter system of theCMSetector at the LHC. The hadron calorimeters of the CMS experiment are sampling calorimeters of brass and scintillator, and are in the form of one central detector and two endcaps. These calorimeters cover pseudorapidities vertical bar eta vertical bar ee data. The energy scale of the outer calorimeters has been determined with test beam data and is confirmed through data with high transverse momentum jets. In this paper, we present the details of the calibration methods and accuracy.Peer reviewe

Analyzing pressure interference between fractured wells in unconventional reservoirs

In conventional reservoirs, pressure transient analysis has been well studied and is based on hydraulic diffusion in the reservoir. In such high permeability reservoirs, pressure interference tests have been widely used to gather information about inter-well communication and reservoir permeability in the vicinity of the tested wells. However, in unconventional ultra-low permeability reservoirs (100 nD - 1μD), hydraulic diffusion through the reservoir matrix is negligible, instead poroelastic deformation of the rock dominates the pressure transient response. This renders traditional pressure interference analyses and well testing techniques ineffective in unconventional reservoirs. Horizontal wells drilled in unconventional reservoirs are hydraulically fractured during multiple stages of injection to increase the surface area available for production of hydrocarbons from these reservoirs, and similar to conventional reservoirs, pressure interference is often observed between fractured wells drilled in close proximity in unconventional reservoirs. However, unlike conventional reservoirs, pressure interference between fractured wells in unconventional reservoirs is not well understood. In this research, pressure interference between fractured wells in unconventional reservoirs is analyzed by developing numerical simulation models and investigating field data to understand the mechanisms that result in pressure communication between fractured wells, both during stimulation and production. Additionally, pressure interference analysis has been applied as a fracture diagnostics technique to investigate real field scenarios at multiple locations (Hydraulic Fracturing Test Site #1, DJ Basin and Permian Basin). A 3-D, fully-coupled geomechanical model that can simulate fracture propagation from the treatment well while monitoring pressure changes inside a compliant fracture in a nearby offset well has been developed. Numerical simulations and field data analyses show that in unconventional reservoirs, pressure interference between fractured wells is caused either by reservoir stress alterations during hydraulic fracture propagation, or high-permeability fracture connections (hydraulic communication) between the wells. The application of pressure interference analysis to diagnose inter-well communication during production and as a fracture diagnostics tool during stimulation to estimate fracture geometry, SRV permeability, diagnose diversion effectiveness and stimulation efficiency is demonstrated. Compared to other techniques such as micro-seismic monitoring and fiber optics that are expensive and require additional equipment, pressure interference analysis is presented as a novel and inexpensive tool that enables fracture diagnostics during both production and stimulation in unconventional reservoirsPetroleum and Geosystems Engineerin

Case series of necrotizing fasciitis presenting to the Department of Emergency Medicine, Singapore General Hospital, from 2006 to 2012

Introduction: We aim to review the clinical course of patients with necrotizing fasciitis (NF) presenting to the emergency department, hence determining the need for close monitoring for deterioration, and the need for urgent and rapid surgical intervention. Methods: A retrospective review of electronic medical records of patients with the main diagnosis of NF presenting to the Department of Emergency Medicine, Singapore General Hospital, from 2006 to 2012 was performed. Data was collected in standardized forms and used for analysis. Patients’ demographics, LRINEC scores, time to disposition, and clinical course and outcome were reviewed. Results: A total of 27 cases with the main diagnosis of NF were reviewed. The median age was 56 years (range 20–79). Twenty-four (88.9%) cases had significant underlying comorbidities. Only 18 (66.7%) cases had a LRINEC score of six or more, mandating careful evaluation for NF. Seven (25.9%) cases were managed in the resuscitation room, with median time taken from registration to resuscitation room being 14 min (range 0–231). Four (14.8%) cases were sent to the operation theater from the emergency department with a median time 321.5 min (range 286–436). Case fatality rate in this series was 14.8%. Conclusions: NF can result in gross morbidity and mortality if not treated in the early stages. The emergency physician needs to have a high index of suspicion to recognize the disease early and initiate prompt resuscitative efforts in septic patients, including urgent referral for surgical debridement

Protocol for preparing Thiopropyl Sepharose resin used for capturing S-nitrosylated proteins

Summary: S-nitrosothiol (SNO)-Resin Assisted Capture (SNO-RAC) relies on a Thiopropyl Sepharose resin to identify S-nitrosylated proteins (SNO-proteins) and sites of S-nitrosylation. Here, we present a protocol for preparing Thiopropyl Sepharose resin with efficiency of SNO-protein capture comparable to the discontinued commercial version. We describe steps for amine coupling, disulfide reduction, and generation of thiol reactive resin. We then detail quality control procedures. This resin is also suitable for Acyl-RAC assays to capture palmitoylated proteins.For complete details on the use and execution of the SNO-RAC protocol, please refer to Forrester et al.,1 Fonseca et al.,2 and Seth et al.3 : Publisher’s note: Undertaking any experimental protocol requires adherence to local institutional guidelines for laboratory safety and ethics

Myval: A Novel Transcatheter Heart Valve for the Treatment of Severe Aortic Stenosis

Transcatheter aortic valve implantation (TAVI) performed using femoral arterial access is now a guideline recommended treatment for severe calcific aortic stenosis (AS) in elderly patients. Technological advancements and procedural refinements have focused on making TAVI simpler, safer, more effective and durable. Myval (Meril Lifesciences) is a new generation balloon-expandable transcatheter heart valve (THV) developed in India that possesses novel features to improve deliverability and aid precise deployment. Following the first-in-human study, Myval was approved in India for commercial implantation in October 2018 and was subsequently given a CE mark in April 2019. This article reviews the science, technology and up-to-date clinical evidence for the Myval THV