Cytokine changes in patients with heatstroke during pilgrimage to Makkah

Circulating levels and role of IL-6, IL-1ra, TNFsr-II and CRP in patients with heatstroke is not fully known. This study correlated levels of these mediators with outcome in 26 patients. In survivors (n=20), IL-6 concentration declined on cooling, whereas in non-survivors levels continued to increase at 6 h following admission before declining. Admission TNFsr-II concentrations in survivors were significantly lower than non-survivors and levels continued to rise in both groups. IL-1ra levels were markedly elevated in both groups. Changes in cytokine levels were not influenced by renal function. Elevated C-reactive protein levels were observed for both groups and remained so despite cooling, furthermore, there was no correlation with alanine aminotransferase levels. The study demonstrated the elevation of the above mediators and suggested a role in the pathogenesis of heatstroke. Markedly elevated levels or those that remained elevated despite cooling were associated with mortality

Systematic reviews: guidance relevant for studies of older people

Systematic reviews and meta-analyses are increasingly common. This article aims to provide guidance for people conducting systematic reviews relevant to the healthcare of older people. An awareness of these issues will also help people reading systematic reviews to determine whether the results will influence their clinical practice. It is essential that systematic reviews are performed by a team which includes the required technical and clinical expertise. Those performing reviews for the first time should ensure they have appropriate training and support. They must be planned and performed in a transparent and methodologically robust way: guidelines are available. The protocol should be written—and if possible published—before starting the review. Geriatricians will be interested in a table of baseline characteristics, which will help to determine if the studied samples or populations are similar to their patients. Reviews of studies of older people should consider how they will manage issues such as different age cut-offs; non-specific presentations; multiple predictors and outcomes; potential biases and confounders. Systematic reviews and meta-analyses may provide evidence to improve older people's care, or determine where new evidence is required. Newer methodologies, such as meta-analyses of individual level data, network meta-analyses and umbrella reviews, and realist synthesis, may improve the reliability and clinical utility of systematic reviews

Terrestrial laser scanning to reconstruct branch architecture from harvested branches

Quantifying whole branch architecture is critical to understanding tree function, for example, branch surface area controls woody gas exchange. Yet, due to measurement difficulty, branch architecture of small diameter branches (e.g. <10 cm ø) is either modelled, subsampled or ignored. Methods that use Terrestrial Laser Scanning (TLS) are now being widely applied to analyse tree and plot level tree architecture; however, resolving small diameter branches in-situ remains a challenge. Currently, it is suggested accurate reconstruction of small diameter branches can only be achieved by harvest and measurement in controlled conditions. Here we present a new TLS workflow for rapid and accurate reconstruction of complete branch architecture from harvested branches. The workflow sets out scan configuration, post processing (including a novel reectance filter) and fitting of Quantitative Structure Models (QSM) to reconstruct topologically coherent branch models. This is demonstrated on 595 branches (scanned indoors to negate the impact of wind) and compared with 65 branches that were manually measured (i.e. with measuring tape and callipers). Comparison of a suite of morphological and topological traits reveals a good agreement between TLS derived metrics and manual measurements where RMSE (%RMSE) for total branch length = 0.7 m (10%), volume = 0.09 litres (43%), surface area = 0.04 m2 (26%) and N tips = 6.4 (35%). Scanning was faster and invariant to branch size compared with manual measurements which required significantly more personnel time. We recommend measuring a subsample of tip-widths to constrain the QSM taper function as the TLS workflow tends to overestimate tip-width. The workflow presented here allows for a rapid characterisation of branch architecture from harvested branches. Increasing the number of branches analysed (e.g. many branches from a single tree or branches from many species globally) could allow for a comprehensive analysis of the “missing link" between the leaves and larger diameter branches

New perspectives on the ecology of tree structure and tree communities through terrestrial laser scanning

Terrestrial laser scanning (TLS) opens up the possibility of describing the three-dimensional structures of trees in natural environments with unprecedented detail and accuracy. It is already being extensively applied to describe how ecosystem biomass and structure vary between sites, but can also facilitate major advances in developing and testing mechanistic theories of tree form and forest structure, thereby enabling us to understand why trees and forests have the biomass and three-dimensional structure they do. Here we focus on the ecological challenges and benefits of understanding tree form, and highlight some advances related to capturing and describing tree shape that are becoming possible with the advent of TLS. We present examples of ongoing work that applies, or could potentially apply, new TLS measurements to better understand the constraints on optimization of tree form. Theories of resource distribution networks, such as metabolic scaling theory, can be tested and further refined. TLS can also provide new approaches to the scaling of woody surface area and crown area, and thereby better quantify the metabolism of trees. Finally, we demonstrate how we can develop a more mechanistic understanding of the effects of avoidance of wind risk on tree form and maximum size. Over the next few years, TLS promises to deliver both major empirical and conceptual advances in the quantitative understanding of trees and tree-dominated ecosystems, leading to advances in understanding the ecology of why trees and ecosystems look and grow the way they do

Finite element analysis of trees in the wind based on terrestrial laser scanning data

Wind damage is an important driver of forest structure and dynamics, but it is poorly understood in natural broadleaf forests. This paper presents a new approach in the study of wind damage: combining terrestrial laser scanning (TLS) data and finite element analysis. Recent advances in tree reconstruction from TLS data allowed us to accurately represent the 3D geometry of a tree in a mechanical simulation, without the need for arduous manual mapping or simplifying assumptions about tree shape. We used this simulation to predict the mechanical strains produced on the trunks of 21 trees in Wytham Woods, UK, and validated it using strain data measured on these same trees. For a subset of five trees near the anemometer, the model predicted a five-minute time-series of strain with a mean cross-correlation coefficient of 0.71, when forced by the locally measured wind speed data. Additionally, the maximum strain associated with a 5 ms−1 or 15 ms-1 wind speed was well predicted by the model (N = 17, R2 = 0.81 and R2 = 0.79, respectively). We also predicted the critical wind speed at which the trees will break from both the field data and models and find a good overall agreement (N = 17, R2 = 0.40). Finally, the model predicted the correct trend in the fundamental frequencies of the trees (N = 20, R2 = 0.38) although there was a systematic underprediction, possibly due to the simplified treatment of material properties in the model. The current approach relies on local wind data, so must be combined with wind flow modelling to be applicable at the landscape-scale or over complex terrain. This approach is applicable at the plot level and could also be applied to open-grown trees, such as in cities or parks