Targeted temperature management in acute liver failure: A systematic review

Abstract Background:Targeted temperature management is the modern term for therapeutic hypothermia, where cooling is induced by intensive care clinicians to achieve body temperatures below 36C. Its use in acute liver failure to improve refractory intracranial hypertension and patient outcomes is not supported by strong quality evidence.Aim:This systematic review aims to determine if targeted temperature management improves patient outcome as opposed to normothermia in acute liver failure. Methods A computerized and systematic search of six academic and medical databases was conducted using the following keywords: “acute liver failure", “fulminant hepatic injury", “targeted temperature management", “therapeutic hypothermia", and “cooling". Broad criteria were applied to include all types of primary observational studies, from case reports to randomized controlled trials. Standardized tools were used throughout to critically appraise and extract data. Findings Nine studies published between 1999 and 2016 were included. Early observational studies suggest a benefit of targeted temperature management in the treatment of refractory intracranial hypertension and in survival. More recent controlled studies do not show such a benefit in the prevention of intracranial hypertension. All studies revealed that the incidence of coagulopathy is not higher in patients treated with targeted temperature management. There remains some uncertainty regarding the increased risk of infection and dysrhythmias. Heterogeneity was found between study types, design, sample sizes, and quality. Conclusion Although it does not significantly improve survival, targeted temperature management is efficient in treating episodes of intracranial hypertension and stabilizing an unstable critical care patient without increasing the risk of bleeding. It does not, however, prevent intracranial hypertension. Data heterogeneity may explain the contradictory findings. Relevance to Clinical Practice Controlled studies are needed to elucidate the true clinical benefit of targeted temperature management in improving patient outcome

Impact of comorbidity indexes on non-relapse mortality.

Comorbidity indexes (CI) have been reported to predict non-relapse mortality (NRM) and overall survival after allogeneic hematopoietic stem cell transplantation (HSCT) (Charlson's comorbidity index (CCI), hematopoietic cell transplantation CI (HCT-CI) and the pre-transplantation assessment of mortality (PAM) score). Which of these indexes best predict survival is unknown yet. We retrospectively studied 286 patients who underwent allogeneic HSCT. HCT-CI and PAM scores required grading according to pre-transplant pulmonary function tests (PFTs), which were lacking for some patients. We thus designed a reduced HCT-CI and an adjusted PAM, without results of PFTs. Using CCI, 25% of patients had indexes of 1 or more; median reduced HCT-CI score was 1; median adjusted PAM score was 24. The discriminative properties of the three CIs were rather low in our population. Comparison of patients and transplant characteristics between our and Seattle group's cohorts, however, revealed significant differences in more children, in more cord blood HSCT and in HSCT for Fanconi anemia in St Louis. Finally, multivariate analysis of scoring items revealed that age, matched unrelated or mismatched donor and hepatic disease were associated with NRM in our cohort. Translating use for patient's counseling or decision to proceed to transplant of these CIs will need prospective studies in a large independent cohort

Early stage adoption of ISO/IEC 29110 software project management practices: a case study

The ISO/IEC 29110 standard has at its core a Management and Engineering Guide [1] which are targeted at very small entities (enterprises, organizations, departments or projects) having up to 25 people [2], to assist them unlock the potential benefits of using standards which are specifically designed to address their needs. This paper discusses the role and structure of Project Management in the ISO/IEC 29110 standard and the design and development of project management support documentation. In particular this paper describes a case study of an early adopter of ISO/IEC 29110 project management practices and their experiences with implementing these in an industrial context

Advances in the Direct Study of Carbon Burning in Massive Stars

The C12+C12 fusion reaction plays a critical role in the evolution of massive stars and also strongly impacts various explosive astrophysical scenarios. The presence of resonances in this reaction at energies around and below the Coulomb barrier makes it impossible to carry out a simple extrapolation down to the Gamow window-the energy regime relevant to carbon burning in massive stars. The C12+C12 system forms a unique laboratory for challenging the contemporary picture of deep sub-barrier fusion (possible sub-barrier hindrance) and its interplay with nuclear structure (sub-barrier resonances). Here, we show that direct measurements of the C12+C12 fusion cross section may be made into the Gamow window using an advanced particle-gamma coincidence technique. The sensitivity of this technique effectively removes ambiguities in existing measurements made with gamma ray or charged-particle detection alone. The present cross-section data span over 8 orders of magnitude and support the fusion-hindrance model at deep sub-barrier energies

Role of thermodynamic and turbulence processes on the fog life cycle during SOFOG3D experiment

In this study, we use a synergy of in situ and remote sensing measurements collected during the SOuthwest FOGs 3D experiment for processes study (SOFOG3D) field campaign in autumn and winter 2019–2020 to analyse the thermodynamic and turbulent processes related to fog formation, evolution, and dissipation across southwestern France. Based on a unique measurement dataset (synergy of cloud radar, microwave radiometer, wind lidar, and weather station data) combined with a fog conceptual model, an analysis of the four deepest fog episodes (two radiation fogs and two advection–radiation fogs) is conducted. The results show that radiation and advection–radiation fogs form under deep and thin temperature inversions, respectively. For both fog categories, the transition period from stable to adiabatic fog and the fog adiabatic phase are driven by vertical mixing associated with an increase in turbulence in the fog layer due to mechanical production (turbulence kinetic energy (TKE) up to 0.4 m2 s−2 and vertical velocity variance (σw2) up to 0.04 m2 s−2) generated by increasing wind and wind shear. Our study reveals that fog liquid water path, fog top height, temperature, radar reflectivity profiles, and fog adiabaticity derived from the conceptual model evolve in a consistent manner to clearly characterise this transition. The dissipation time is observed at night for the advection–radiation fog case studies and after sunrise for the radiation fog case studies. Night-time dissipation is driven by horizontal advection generating mechanical turbulence (TKE at least 0.3 m2 s−2 and σw2 larger than 0.04 m2 s−2). Daytime dissipation is linked to the combination of thermal and mechanical turbulence related to solar heating (near-surface sensible heat flux larger than 10 W m−2) and wind shear, respectively. This study demonstrates the added value of monitoring fog liquid water content and depth (combined with wind, turbulence, and temperature profiles) and diagnostics such as fog liquid water reservoir and adiabaticity to better explain the drivers of the fog life cycle.</p

Global existence for a system of non-linear and non-local transport equations describing the dynamics of dislocation densities

In this paper, we study the global in time existence problem for the Groma-Balogh model describing the dynamics of dislocation densities. This model is a two-dimensional model where the dislocation densities satisfy a system of transport equations such that the velocity vector field is the shear stress in the material, solving the equations of elasticity. This shear stress can be expressed as some Riesz transform of the dislocation densities. The main tool in the proof of this result is the existence of an entropy for this syste

Postoperative complications after pancreatoduodenectomy for malignancy: results from the Recurrence After Whipple’s (RAW) study

Background Pancreatoduodenectomy (PD) is associated with significant postoperative morbidity. Surgeons should have a sound understanding of the potential complications for consenting and benchmarking purposes. Furthermore, preoperative identification of high-risk patients can guide patient selection and potentially allow for targeted prehabilitation and/or individualized treatment regimens. Using a large multicentre cohort, this study aimed to calculate the incidence of all PD complications and identify risk factors. Method Data were extracted from the Recurrence After Whipple’s (RAW) study, a retrospective cohort study of PD outcomes (29 centres from 8 countries, 2012–2015). The incidence and severity of all complications was recorded and potential risk factors for morbidity, major morbidity (Clavien–Dindo grade > IIIa), postoperative pancreatic fistula (POPF), post-pancreatectomy haemorrhage (PPH) and 90-day mortality were investigated. Results Among the 1348 included patients, overall morbidity, major morbidity, POPF, PPH and perioperative death affected 53 per cent (n = 720), 17 per cent (n = 228), 8 per cent (n = 108), 6 per cent (n = 84) and 4 per cent (n = 53), respectively. Following multivariable tests, a high BMI (P = 0.007), an ASA grade > II (P II patients were at increased risk of major morbidity (P < 0.0001), and a raised BMI correlated with a greater risk of POPF (P = 0.001). Conclusion In this multicentre study of PD outcomes, an ASA grade > II was a risk factor for major morbidity and a high BMI was a risk factor for POPF. Patients who are preoperatively identified to be high risk may benefit from targeted prehabilitation or individualized treatment regimens