Factors affecting transfusion requirement after hip fracture: Can we reduce the need for blood?

© 2014 Association médicale canadienne. Background: Hip fractures are common injuries that result in blood loss and frequently require the transfusion of blood products. We sought to identify risk factors leading to increased blood transfusion in patients presenting with hip fractures, especially those factors that are modifiable. Methods: We retrospectively reviewed the cases of all patients who had fixation of their hip fractures between October 2005 and February 2010. The need for transfusion was correlated with potential risk factors, including age, sex, preoperative hemoglobin, fracture type, fixation method and more. Results: A total of 835 patients had fixation of their hip fractures during the study period; 631 met the inclusion criteria and 249 of them (39.5%) were transfused. We found an association between need for blood transfusion and female sex (p = 0.018), lower preoperative hemoglobin (p \u3c 0.001), fracture type (p \u3c 0.001) and fixation method (p \u3c 0.001). Compared with femoral neck fractures, there was a 2.37 times greater risk of blood transfusion in patients with intertrochanteric fractures (p \u3c 0.001) and a 4.03 times greater risk in those with subtrochanteric fractures (p \u3c 0.001). Dynamic hip screw (DHS) fixation decreased the risk of transfusion by about half compared with intramedullary nail or hemiarthroplasty. We found no association with age, delay to operation (p = 0.17) or duration of surgery (p = 0.30). Conclusion: The only modifiable risk factor identified was fixation method. When considering blood transfusion requirements in isolation, we suggest a potential benefit in using a DHS for intertrochanteric and femoral neck fractures amenable to DHS fixation

Effect of vitamin B17 on experimentally induced colon cancer in adult male albino rat

Background: Colon cancer is considered to be the third most common cancer worldwide. At diagnosis of colon cancer, 3.7–11% developed bone metastasis. Diet based strategies are important for prevention and treatment of colon cancer. This study investigated the effect of vitamin B17 on a DMH induced rat model of colon cancer. Materials and methods: Eighty young adult male albino rats were divided into five groups: group I (control group), group II (vitamin B17), group III (colon cancer), group IV (protected) and group V (treated). Distal colon sections were prepared for light and scanning electron microscopic examination. Lumbar vertebrae specimens were prepared for light microscopic study. Morphometric and statistical analysis were done. Results: In comparison with the control, both colon cancer and treated groups showed invasion of the colonic tissue by pleomorphic branching colonic glands of variable shapes and sizes lined with dysplastic elongated hyperchromatic nuclei with frequent mitotic figures or stratified multi-layered crowded nuclei with an extremely significant (p < 0.0001) reduction of goblet cell number when compared to the control together with major pathological bone changes were observed in colon cancer and the treated groups. Conclusions: While the protected group showed impressive improvement of all previously mentioned diameters

Fate of the Universe, Age of the Universe, Dark Matter, and the Decaying Vacuum Energy

It is shown that in the cosmological models based on a vacuum energy decaying as a^{-2}, where a is the scale factor of the universe, the fate of the universe in regard to whether it will collapse in future or expand forever is determined not by the curvature constant k but by an effective curvature constant k_{eff}. It is argued that a closed universe with k=1 may expand forever, in other words simulate the expansion dynamics of a flat or an open universe because of the possibility that k_{eff}=0 or -1, respectively. Two such models, in one of which the vacuum does not interact with matter and in another of which it does, are studied. It is shown that the vacuum equation of state p_{vac}= -\rho_{vac} may be realized in a decaying vacuum cosmology provided the vacuum interacts wuth matter. The optical depths for gravitational lensing as a function of the matter density and other parameters in the models are calculated at a source redshift of 2. The age of the universe is discussed and shown to be compatible with the new Hipparcos lower limit of 11Gyr. The possibility that a time-varying vacuum energy may serve as dark matter is suggested.Comment: AAS LaTex, 29 pages, published in the Astrophysical Journal, 520, 45, 199

Frequentist Interpretation of Probability

Three series of azole piperazine derivatives that mimic dicyclotyrosine (cYY), the natural substrate of the essential Mycobacterium tuberculosis cytochrome P450 CYP121A1, were prepared and evaluated for binding affinity and inhibitory activity (MIC) against M. tuberculosis. Series A replaces one phenol group of cYY with a C3-imidazole moiety, series B includes a keto group on the hydrocarbon chain preceding the series A imidazole, whilst series C explores replacing the keto group of the piperidone ring of cYY with a CH2-imidazole or CH2-triazole moiety to enhance binding interaction with the heme of CYP121A1. The series displayed moderate to weak type II binding affinity for CYP121A1, with the exception of series B 10a, which displayed mixed type I binding. Of the three series, series C imidazole derivatives showed the best, although modest, inhibitory activity against M. tuberculosis (17d MIC = 12.5 μg/mL, 17a 50 μg/mL). Crystal structures were determined for CYP121A1 bound to series A compounds 6a and 6b that show the imidazole groups positioned directly above the haem iron with binding between the haem iron and imidazole nitrogen of both compounds at a distance of 2.2 Å. A model generated from a 1.5 Å crystal structure of CYP121A1 in complex with compound 10a showed different binding modes in agreement with the heterogeneous binding observed. Although the crystal structures of 6a and 6b would indicate binding with CYP121A1, the binding assays themselves did not allow confirmation of CYP121A1 as the target

Thermodynamics of Decaying Vacuum Cosmologies

The thermodynamic behavior of vacuum decaying cosmologies is investigated within a manifestly covariant formulation. Such a process corresponds to a continuous irreversible energy flow from the vacuum component to the created matter constituents. It is shown that if the specific entropy per particle remains constant during the process, the equilibrium relations are preserved. In particular, if the vacuum decays into photons, the energy density $\rho$ and average number density of photons $n$ scale with the temperature as $\rho \sim T^{4}$ and $n \sim T^{3}$. The temperature law is determined and a generalized Planckian type form of the spectrum, which is preserved in the course of the evolution, is also proposed. Some consequences of these results for decaying vacuum FRW type cosmologies as well as for models with ``adiabatic'' photon creation are discussed.Comment: 21 pages, uses LATE

Causal Bulk Viscous Dissipative Isotropic Cosmologies with Variable Gravitational and Cosmological Constants

We consider the evolution of a flat Friedmann-Robertson-Walker Universe, filled with a causal bulk viscous cosmological fluid, in the presence of variable gravitational and cosmological constants. The basic equation for the Hubble parameter, generalizing the evolution equation in the case of constant gravitational coupling and cosmological term, is derived, under the supplementary assumption that the total energy of the Universe is conserved. By assuming that the cosmological constant is proportional to the square of the Hubble parameter and a power law dependence of the bulk viscosity coefficient, temperature and relaxation time on the energy density of the cosmological fluid, two classes of exact solutions of the field equations are obtained. In the first class of solutions the Universe ends in an inflationary era, while in the second class of solutions the expansion of the Universe is non-inflationary for all times. In both models the cosmological "constant" is a decreasing function of time, while the gravitational "constant" increases in the early period of evolution of the Universe, tending in the large time limit to a constant value.Comment: 14 pages, 15 figure

Treatment of streptococcal pharyngitis with once-daily amoxicillin versus intramuscular benzathine penicillin g in low-resource settings : A randomized controlled trial

Background: Primary prevention of acute rheumatic fever is achieved by proper antibiotic treatment of group A β -hemolytic streptococcal (GAS) pharyngitis. Methods: To assess noninferiority of oral amoxicillin to intramuscular benzathine penicillin G (IM BPG). Children (2 to 12 years) meeting enrollment criteria were randomized 1:1 to receive antibiotic treatment in 2 urban outpatient clinics in Egypt and Croatia. Results: A total of 558 children (Croatia = 166, Egypt = 392) were randomized, with 368 evaluable in an intention-to-treat (ITT) analysis, and 272 evaluable in the per protocol (PP) analysis. In Croatia, ITT and PP treatment success rates were comparable for IM BPG and amoxicillin (2.5% difference vs 1.1% difference, respectively). In Egypt, amoxicillin was not comparable with IM BPG in ITT analysis (15.1% difference), but was comparable in PP analysis (-9.3% difference). Conclusion: If compliance is a major issue, a single dose of IM BPG may be preferable for treatment of GAS pharyngitis.publishersversionPeer reviewe

Another exact inflationary solution

A new closed-form inflationary solution is given for a hyperbolic interaction potential. The method used to arrive at this solution is outlined as it appears possible to generate additional sets of equations which satisfy the model. In addition a new form of decaying cosmological constant is presented.Comment: 10 pages, 0 figure

Highly-Sensitive Thin Film THz Detector Based on Edge Metal-Semiconductor-Metal Junction

Terahertz (THz) detectors have been extensively studied for various applications such as security, wireless communication, and medical imaging. In case of metal-insulator-metal (MIM) tunnel junction THz detector, a small junction area is desirable because the detector response time can be shortened by reducing it. An edge metal-semiconductor-metal (EMSM) junction has been developed with a small junction area controlled precisely by the thicknesses of metal and semiconductor films. The voltage response of the EMSM THz detector shows the clear dependence on the polarization angle of incident THz wave and the responsivity is found to be very high (similar to 2,169 V/W) at 0.4 THz without any antenna and signal amplifier. The EMSM junction structure can be a new and efficient way of fabricating the nonlinear device THz detector with high cut-off frequency relying on extremely small junction area

Gradients of orientation, composition and hydration of proteins for efficient light collection by the cornea of the horseshoe crab

The lateral eyes of the horseshoe crab, Limulus polyphemus, are the largest compound eyes within recent Arthropoda. While this visual system has been extensively described before, the precise mechanism allowing vision has remained controversial. Correlating quantitative refractive index (RI) mapping and detailed structural analysis, we demonstrate how gradients of RI in the cornea result from the hierarchical organization of chitin-protein fibers, heterogeneity in protein composition and bromine doping, as well as spatial variation in water content. Combining the realistic cornea structure and measured RI gradients with full-wave optical modelling and ray-tracing approaches, we show that the light collection mechanism depends on both refraction-based graded index (GRIN) optics and total internal reflection. The optical properties of the cornea are governed by different mechanisms at different hierarchical levels, demonstrating the remarkable versatility of arthropod cuticle.One-sentence summary Structural hierarchy and protein hydration determine the optical performance of the cornea of L. polyphemus.Competing Interest StatementTS and MAKAR are employed by TELIGHT. All other authors declare that they have no competing interests