Why Rudolph's nose is red: Observational study

Objective: To characterise the functional morphology of the nasal microcirculation in humans in comparison with reindeer as a means of testing the hypothesis that the luminous red nose of Rudolph, one of the most well known reindeer pulling Santa Claus's sleigh, is due to the presence of a highly dense and rich nasal microcirculation. Design: Observational study. Setting: Tromsø, Norway (near the North Pole), and Amsterdam, the Netherlands. Participants: Five healthy human volunteers, two adult reindeer, and a patient with grade 3 nasal polyposis. Main outcome measures: Architecture of the microvasculature of the nasal septal mucosa and head of the inferior turbinates, kinetics of red blood cells, and real time reactivity of the microcirculation to topical medicines. Results: Similarities between human and reindeer nasal microcirculation were uncovered. Hairpin-like capillaries in the reindeers' nasal septal mucosa were rich in red blood cells, with a perfused vessel density of 20 (SD 0.7) mm/mm2. Scattered crypt or gland-like structures surrounded by capillaries containing flowing red blood cells were found in human and reindeer noses. In a healthy volunteer, nasal microvascular reactivity was demonstrated by the application of a local anaesthetic with vasoconstrictor activity, which resulted in direct cessation of capillary blood flow. Abnormal microvasculature was observed in the patient with nasal polyposis. Conclusions: The nasal microcirculation of reindeer is richly vascularised, with a vascular density 25% higher than that in humans. These results highlight the intrinsic physiological properties of Rudolph's legendary luminous red nose, which help to protect it from freezing during sleigh rides and to regulate the temperature of the reindeer's brain, factors essential for flying reindeer pulling Santa Claus's sleigh under extreme temperatures

Changes in labial capillary density on ascent to and descent from high altitude

Present knowledge of how the microcirculation is altered by prolonged exposure to hypoxia at high altitude is incomplete and modification of existing analytical techniques may improve our knowledge considerably. We set out to use a novel simplified method of measuring in vivo capillary density during an expedition to high altitude using a CytoCam incident dark field imaging video-microscope. The simplified method of data capture involved recording one-second images of the mucosal surface of the inner lip to reveal data about microvasculature density in ten individuals. This was done on ascent to, and descent from, high altitude. Analysis was conducted offline by two independent investigators blinded to the participant identity, testing conditions and the imaging site. Additionally we monitored haemoglobin concentration and haematocrit data to see if we could support or refute mechanisms of altered density relating to vessel recruitment. Repeated sets of paired values were compared using Kruskall Wallis Analysis of Variance tests, whilst comparisons of values between sites was by related samples Wilcoxon Signed Rank Test. Correlation between different variables was performed using Spearman’s rank correlation coefficient, and concordance between analysing investigators using intra-class correlation coefficient. There was a significant increase in capillary density from London on ascent to high altitude; median capillaries per field of view area increased from 22.8 to 25.3 (p=0.021). There was a further increase in vessel density during the six weeks spent at altitude (25.3 to 32.5, p=0.017). Moreover, vessel density remained high on descent to Kathmandu (31.0 capillaries per field of view area), despite a significant decrease in haemoglobin concentration and haematocrit. Using a simplified technique, we have demonstrated an increase in capillary density on early and sustained exposure to hypobaric hypoxia at thigh altitude, and that this remains elevated on descent to normoxia. The technique is simple, reliable and reproducible

Global Variation of Nutritional Status in Children Undergoing Chronic Peritoneal Dialysis : A Longitudinal Study of the International Pediatric Peritoneal Dialysis Network

While children approaching end-stage kidney disease (ESKD) are considered at risk of uremic anorexia and underweight they are also exposed to the global obesity epidemic. We sought to investigate the variation of nutritional status in children undergoing chronic peritoneal dialysis (CPD) around the globe. The distribution and course of body mass index (BMI) standard deviation score over time was examined prospectively in 1001 children and adolescents from 35 countries starting CPD who were followed in the International Pediatric PD Network (IPPN) Registry. The overall prevalence of underweight, and overweight/obesity at start of CPD was 8.9% and 19.7%, respectively. Underweight was most prevalent in South and Southeast Asia (20%), Central Europe (16.7%) and Turkey (15.2%), whereas overweight and obesity were most common in the Middle East (40%) and the US (33%). BMI SDS at PD initiation was associated positively with current eGFR and gastrostomy feeding prior to PD start. Over the course of PD BMI SDS tended to increase on CPD in underweight and normal weight children, whereas it decreased in initially overweight patients. In infancy, mortality risk was amplified by obesity, whereas in older children mortality was markedly increased in association with underweight. Both underweight and overweight are prevalent in pediatric ESKD, with the prevalence varying across the globe. Late dialysis start is associated with underweight, while enteral feeding can lead to obesity. Nutritional abnormalities tend to attenuate with time on dialysis. Mortality risk appears increased with obesity in infants and with underweight in older children.Peer reviewe

The IDENTIFY study: the investigation and detection of urological neoplasia in patients referred with suspected urinary tract cancer - a multicentre observational study

Objective To evaluate the contemporary prevalence of urinary tract cancer (bladder cancer, upper tract urothelial cancer [UTUC] and renal cancer) in patients referred to secondary care with haematuria, adjusted for established patient risk markers and geographical variation. Patients and Methods This was an international multicentre prospective observational study. We included patients aged ≥16 years, referred to secondary care with suspected urinary tract cancer. Patients with a known or previous urological malignancy were excluded. We estimated the prevalence of bladder cancer, UTUC, renal cancer and prostate cancer; stratified by age, type of haematuria, sex, and smoking. We used a multivariable mixed-effects logistic regression to adjust cancer prevalence for age, type of haematuria, sex, smoking, hospitals, and countries. Results Of the 11 059 patients assessed for eligibility, 10 896 were included from 110 hospitals across 26 countries. The overall adjusted cancer prevalence (n = 2257) was 28.2% (95% confidence interval [CI] 22.3–34.1), bladder cancer (n = 1951) 24.7% (95% CI 19.1–30.2), UTUC (n = 128) 1.14% (95% CI 0.77–1.52), renal cancer (n = 107) 1.05% (95% CI 0.80–1.29), and prostate cancer (n = 124) 1.75% (95% CI 1.32–2.18). The odds ratios for patient risk markers in the model for all cancers were: age 1.04 (95% CI 1.03–1.05; P < 0.001), visible haematuria 3.47 (95% CI 2.90–4.15; P < 0.001), male sex 1.30 (95% CI 1.14–1.50; P < 0.001), and smoking 2.70 (95% CI 2.30–3.18; P < 0.001). Conclusions A better understanding of cancer prevalence across an international population is required to inform clinical guidelines. We are the first to report urinary tract cancer prevalence across an international population in patients referred to secondary care, adjusted for patient risk markers and geographical variation. Bladder cancer was the most prevalent disease. Visible haematuria was the strongest predictor for urinary tract cancer

Investigation of mechanical and microstructural properties of AA5754/AA6013 dissimilar aluminium alloys joined by GMAW and FSW methods

Aluminium alloys AA5XXX and AA6XXX have low density and high yield strength and are frequently used to make air, sea, and land vehicles/technology lighter. Different types of aluminium alloys need to be adaptively assembled together. Therefore, it is important but difficult to weld aluminium alloys. This study investigated the microstructural and mechanical properties of two dissimilar aluminium alloys, AA5754 and AA6013, which were welded using gas metal arc welding (GMAW) and friction stir welding (FSW). Hardness, tensile, bending, and fatigue tests were done on the welded samples. The test results were evaluated and interpreted according to the literature. The weld zone (weld metal, HAZ) of AA5754 and AA6013 aluminium alloys joined by GMAW and FSW showed significant differences. The highest tensile strength and fatigue life were obtained from the FSWed sample after the base metals. The welded samples joined using both welding methods were successfully deformed by 180 degrees without damaging their upper or lower surfaces.Karabuk University Scientific Research Project CommitteeKarabuk University [KBUBAP-17-DR-406]The authors would like to thank the Karabuk University Scientific Research Project Committee for funding KBUBAP-17-DR-406.WOS:0007035186000052-s2.0-8511579940

Investigation of mechanical and microstructural properties of AA5754/AA6013 dissimilar aluminium alloys joined by GMAW and FSW methods

Aluminium alloys AA5XXX and AA6XXX have low density and high yield strength and are frequently used to make air, sea, and land vehicles/technology lighter. Different types of aluminium alloys need to be adaptively assembled together. Therefore, it is important but difficult to weld aluminium alloys. This study investigated the microstructural and mechanical properties of two dissimilar aluminium alloys, AA5754 and AA6013, which were welded using gas metal arc welding (GMAW) and friction stir welding (FSW). Hardness, tensile, bending, and fatigue tests were done on the welded samples. The test results were evaluated and interpreted according to the literature. The weld zone (weld metal, HAZ) of AA5754 and AA6013 aluminium alloys joined by GMAW and FSW showed significant differences. The highest tensile strength and fatigue life were obtained from the FSWed sample after the base metals. The welded samples joined using both welding methods were successfully deformed by 180 degrees without damaging their upper or lower surfaces.Karabuk University Scientific Research Project CommitteeKarabuk University [KBUBAP-17-DR-406]The authors would like to thank the Karabuk University Scientific Research Project Committee for funding KBUBAP-17-DR-406.WOS:0007035186000052-s2.0-8511579940