Fluid resuscitation in adults with severe burns at risk of secondary abdominal compartment syndrome—An evidence based systematic review

Background: Secondary abdominal compartment syndrome (sACS) in adults with severe burns is commonly unsuspected, can be rapidly fatal and seriously compromises the reliability of urine output as an indicator of perfusion and resuscitation status. Current literature lacks an exhaustive, evidence-based review critically appraising all retrieved literature on which clinical decisions may be based. Methods: The evidence on three inter-related concepts was evaluated: fluid-volume management and its contribution to sACS; the role of urinary bladder pressure monitoring; and awareness of the burns community to sACS. Literature published over the last ten years across the major databases was retrieved, and the search strategy was fully reported to reduce the retrieval bias ubiquitous in previous literature. Each article was individually appraised and classified into a framework of evidence, enabling the formulation of specific, graded recommendations. Results: Current best evidence supports recommendations to reduce fluid-volume administered through use of colloids or hypertonic saline especially if the projected resuscitation volume surpasses a ‘volume ceiling’. Continuous intra-vesical monitoring is recommended: to guide fluid resuscitation for early diagnosis of sACS; and as a guide to reliability of urine output as indicator of organ perfusion. A priming volume of 75 cm3 or less is recommended. Conclusion: Fluid resuscitation volume is causative to sACS, especially once a predetermined maxima is reached. Continuous intra-vesical pressure monitoring is a cheap, reliable, userfriendly monitoringmethod recommended in high-risk patients. Poor awareness among the burns community requires urgent dissemination of evidence based information

Anisotropic Cardiac Conduction.

Anisotropy is the property of directional dependence. In cardiac tissue, conduction velocity is anisotropic and its orientation is determined by myocyte direction. Cell shape and size, excitability, myocardial fibrosis, gap junction distribution and function are all considered to contribute to anisotropic conduction. In disease states, anisotropic conduction may be enhanced, and is implicated, in the genesis of pathological arrhythmias. The principal mechanism responsible for enhanced anisotropy in disease remains uncertain. Possible contributors include changes in cellular excitability, changes in gap junction distribution or function and cellular uncoupling through interstitial fibrosis. It has recently been demonstrated that myocyte orientation may be identified using diffusion tensor magnetic resonance imaging in explanted hearts, and multisite pacing protocols have been proposed to estimate myocyte orientation and anisotropic conduction in vivo. These tools have the potential to contribute to the understanding of the role of myocyte disarray and anisotropic conduction in arrhythmic states

Medicinal leeches and the microsurgeon: A four-year study, clinical series and risk benefit review

Background: There are case reports and small series in the literature relating to the use of medicinal leeches by plastic surgeons; however, larger series from individual units are rare. The aim of this article is to present a comprehensive 4-year case series of the use of medicinal leeches, discuss the current evidence regarding indications, risks, and benefits and highlight the recent updates regarding leech speciation. Methods: Patients prescribed leeches in a 4-year period (July 2004–2008) were collated from hospital pharmacy records (N = 35). The number of leeches used, demographic, clinical, and microbiological details were retrospectively analyzed. Results: Thirty-five patients were treated with leeches. The age range was 2 to 98 years (mean = 49.3). Leeches were most commonly used for venous congestion in pedicled flaps and replantations. Blood transfusions were necessary in 12 cases (34%) [mean = 2.8 units, range 2–5 units]. Our infection rate was 20% (7/35) including five infections with Aeromonas spp. (14.2%). The proportion of patients becoming infected after leech therapy was significantly greater in the group of patients that did not receive prophylactic antibiotic treatment (Fisher's Exact test P = 0.0005). In total, 14 cases (40%) were salvaged in entirety, in 7 cases 80% or more, in 2 cases 50 to 79%, and in 1 case less than 50% of the tissues were salvaged. In 11 cases (31%), the tissues were totally lost. Conclusion: Our study highlights both the benefits and the risks to patients in selected clinical situations and also the potential risks. The routine use of antibiotic prophylaxis is supported. In view of the emerging evidence that Hirudo verbana are now used as standard leech therapy, and the primary pathogen is Aeromonas veronii, until a large prospective multicenter study is published, large series of patients treated with leeches should be reported. © 2011 Wiley-Liss, Inc. Microsurgery, 2011

Fractional Quantum Hall Effect and vortex lattices

It is demonstrated that all observed fractions at moderate Landau level fillings for the quantum Hall effect can be obtained without recourse to the phenomenological concept of composite fermions. The possibility to have the special topologically nontrivial many-electron wave functions is considered. Their group classification indicates the special values of of electron density in the ground states separated by a gap from excited states

Comprehensive epigenetic landscape of rheumatoid arthritis fibroblast-like synoviocytes.

Epigenetics contributes to the pathogenesis of immune-mediated diseases like rheumatoid arthritis (RA). Here we show the first comprehensive epigenomic characterization of RA fibroblast-like synoviocytes (FLS), including histone modifications (H3K27ac, H3K4me1, H3K4me3, H3K36me3, H3K27me3, and H3K9me3), open chromatin, RNA expression and whole-genome DNA methylation. To address complex multidimensional relationship and reveal epigenetic regulation of RA, we perform integrative analyses using a novel unbiased method to identify genomic regions with similar profiles. Epigenomically similar regions exist in RA cells and are associated with active enhancers and promoters and specific transcription factor binding motifs. Differentially marked genes are enriched for immunological and unexpected pathways, with "Huntington's Disease Signaling" identified as particularly prominent. We validate the relevance of this pathway to RA by showing that Huntingtin-interacting protein-1 regulates FLS invasion into matrix. This work establishes a high-resolution epigenomic landscape of RA and demonstrates the potential for integrative analyses to identify unanticipated therapeutic targets

Application of Focal Conflict Theory to Psychoeducational Groups: Implications for Process, Content, and Leadership

Group psychoeducation is a common group type used for a range of purposes. The literature presents balancing content and process as a challenge for psychoeducational group leaders. While the significance of group psychoeducation is supported, practitioners are given little direction for addressing process in these groups. Focal Conflict Theory (FCT) is a model for conceptualizing and intervening in group process that has been applied to therapy and work groups. This article presents the challenges of psychoeducational groups, describes FCT, and discusses its application to psychoeducational groups using case examples. Implications for leaders of psychoeducation groups are discussed

Geometry of Star-Forming Galaxies from SDSS, 3D-HST and CANDELS

We determine the intrinsic, 3-dimensional shape distribution of star-forming galaxies at 0<z<2.5, as inferred from their observed projected axis ratios. In the present-day universe star-forming galaxies of all masses 1e9 - 1e11 Msol are predominantly thin, nearly oblate disks, in line with previous studies. We now extend this to higher redshifts, and find that among massive galaxies (M* > 1e10 Msol) disks are the most common geometric shape at all z < 2. Lower-mass galaxies at z>1 possess a broad range of geometric shapes: the fraction of elongated (prolate) galaxies increases toward higher redshifts and lower masses. Galaxies with stellar mass 1e9 Msol (1e10 Msol) are a mix of roughly equal numbers of elongated and disk galaxies at z~1 (z~2). This suggests that galaxies in this mass range do not yet have disks that are sustained over many orbital periods, implying that galaxies with present-day stellar mass comparable to that of the Milky Way typically first formed such sustained stellar disks at redshift z~1.5-2. Combined with constraints on the evolution of the star formation rate density and the distribution of star formation over galaxies with different masses, our findings imply that, averaged over cosmic time, the majority of stars formed in disks.Comment: Published in ApJ Letter

Reply to Letter to the Editor : Is HPV-18 present in human breast cancer cell lines

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Modeling outcomes of soccer matches

We compare various extensions of the Bradley–Terry model and a hierarchical Poisson log-linear model in terms of their performance in predicting the outcome of soccer matches (win, draw, or loss). The parameters of the Bradley–Terry extensions are estimated by maximizing the log-likelihood, or an appropriately penalized version of it, while the posterior densities of the parameters of the hierarchical Poisson log-linear model are approximated using integrated nested Laplace approximations. The prediction performance of the various modeling approaches is assessed using a novel, context-specific framework for temporal validation that is found to deliver accurate estimates of the test error. The direct modeling of outcomes via the various Bradley–Terry extensions and the modeling of match scores using the hierarchical Poisson log-linear model demonstrate similar behavior in terms of predictive performance