Association of Early Norepinephrine Administration With 24-Hour Mortality Among Patients With Blunt Trauma and Hemorrhagic Shock.

Hemorrhagic shock is a common cause of preventable death after injury. Vasopressor administration for patients with blunt trauma and hemorrhagic shock is often discouraged. To evaluate the association of early norepinephrine administration with 24-hour mortality among patients with blunt trauma and hemorrhagic shock. This retrospective, multicenter, observational cohort study used data from 3 registries in the US and France on all consecutive patients with blunt trauma from January 1, 2013, to December 31, 2018. Patients were alive on admission with hemorrhagic shock, defined by prehospital or admission systolic blood pressure less than 100 mm Hg and evidence of hemorrhage (ie, prehospital or resuscitation room transfusion of packed red blood cells, receipt of emergency treatment for hemorrhage control, transfusion of >10 units of packed red blood cells in the first 24 hours, or death from hemorrhage). Blunt trauma was defined as any exposure to nonpenetrating kinetic energy, collision, or deceleration. Statistical analysis was performed from January 15, 2021, to February 22, 2022. Continuous administration of norepinephrine in the prehospital environment or resuscitation room prior to hemorrhage control, according to European guidelines. The primary outcome was 24-hour mortality, and the secondary outcome was in-hospital mortality. The average treatment effect (ATE) of early norepinephrine administration on 24-hour mortality was estimated according to the Rubin causal model. Inverse propensity score weighting and the doubly robust approach with 5 distinct analytical strategies were used to determine the ATE. A total of 52 568 patients were screened for inclusion, and 2164 patients (1508 men [70%]; mean [SD] age, 46 [19] years; median Injury Severity Score, 29 [IQR, 17-36]) presented with acute hemorrhage and were included. A total of 1497 patients (69.1%) required emergency hemorrhage control, 128 (5.9%) received a prehospital transfusion of packed red blood cells, and 543 (25.0%) received a massive transfusion. Norepinephrine was administered to 1498 patients (69.2%). The 24-hour mortality rate was 17.8% (385 of 2164), and the in-hospital mortality rate was 35.6% (770 of 2164). None of the 5 analytical strategies suggested any statistically significant association between norepinephrine administration and 24-hour mortality, with ATEs ranging from -4.6 (95% CI, -11.9 to 2.7) to 2.1 (95% CI, -2.1 to 6.3), or between norepinephrine administration and in-hospital mortality, with ATEs ranging from -1.3 (95% CI, -9.5 to 6.9) to 5.3 (95% CI, -2.1 to 12.8). The findings of this study suggest that early norepinephrine infusion was not associated with 24-hour or in-hospital mortality among patients with blunt trauma and hemorrhagic shock. Randomized clinical trials that study the effect of early norepinephrine administration among patients with trauma and hypotension are warranted to further assess whether norepinephrine is safe for patients with hemorrhagic shock

Le musée français: guerras napoleônicas, coleções artísticas e o longínquo destino de um livro

This paper is about Le Musée Français [The French Museum], a book found in the collection of the library of the Imperial Academy of Fine Arts in Rio de Janeiro. As a catalog of the Napoleon Museum, it bears witness to the reorganization of the arts in Europe as a result of the Napoleonic wars and the project of making Paris a true successor to Athens and Rome, as the center of a new republic of the arts. This process was the object of a dispute where Quatremère de Quincy and Joachim Lebreton played an important role. It was also one of the causes leading to the exile of a group of artists who then helped to lay the foundations for an academic environment in Rio de Janeiro.O artigo trata de Le musée français, livro que fez parte da coleção da biblioteca da Academia Imperial das Belas Artes, no RiodeJaneiro. Como catálogo do Museu Napoleão, é testemunho do processo de reordenamento, resultante das guerras napoleônicas, do universo das artes na Europa e do projeto de fazer de Paris a legítima herdeira de Atenas e Roma, como centro de uma nova idéia de república das artes. Processo esse que foi objeto de disputa, em que se destacaram Quatremère de Quincy eJoachim Lebreton, e foi uma das causas do exílio do grupo de artistas que esteve na origem da formação do ambiente acadêmico no Rio de Janeiro

Where less may be more: how the rare biosphere pulls ecosystems strings

Rare species are increasingly recognized as crucial, yet vulnerable components of Earth’s ecosystems. This is also true for microbial communities, which are typically composed of a high number of relatively rare species. Recent studies have demonstrated that rare species can have an over-proportional role in biogeochemical cycles and may be a hidden driver of microbiome function. In this review, we provide an ecological overview of the rare microbial biosphere, including causes of rarity and the impacts of rare species on ecosystem functioning. We discuss how rare species can have a preponderant role for local biodiversity and species turnover with rarity potentially bound to phylogenetically conserved features. Rare microbes may therefore be overlooked keystone species regulating the functioning of host-associated, terrestrial and aquatic environments. We conclude this review with recommendations to guide scientists interested in investigating this rapidly emerging research area

Contribuciones al conocimiento de la flora del País Vasco, III

Se presentan algunas adiciones y modificaciones que se recogerán en la segunda edición de las Claves ilustradas de la flora del País Vasco y territorios limítrofes (Aizpuru, I., C. Aseginolaza, P.M. Uribe-Echebarría, P. Urrutia and I. Zorrakin, eds., 1999). En concreto se realiza la revisión de algunos géneros (Arum, Asphodelus, Doronicum, Rhinantus) junto con la aportación de nuevos datos corológicos y correcciones de nomenclaturas. Se combina D. carpetanum Boiss and Reuter ex Willk. subsp. pubescens (C. Pérez Morales, A. Penas, F. Llamas and C. Acedo) Aizpuru aomb. and stat. nov

Contribuciones al conocimiento de la flora del País Vasco (VI)

Nuevos datos de interés acerca de la distribución de 11 táxones de plantas, raras en el País Vasco. Además rectificamos los datos previos de Arum cylindraceum Gasp. y Arum maculatum L., aportamos un mapa de su distribución en el País Vasco y en el Pirineo

Contribuciones al conocimiento de la flora del País Vasco, II

Continúa la aportación de nuevos datos de interés acerca de las plantas vasculares del País Vasco y zonas próximas ; en esta ocasión se recogen datos corológicos de 65 taxones ; a destacar,   Cuscuta scandens Brot. subsp. cesatiana (BERTOL.) Soó, Fallopia sachalinensis (FRIEDERICH SCHMIDT PETROP.) Ronse Decraene, Galium debile Desv., Geum hispidum Fries y Myosurus minimus L.; se combina, además, Apium graveolens L. subsp. butronensis (D. GOMEZ and G. MONTSERRAT) I. AIZPURU, stat. nov

Pyrenees-Atlantiques d´Ossau et Pyrenees Aragonaises d´Huesca: Notice et itineraires

15 páginas.- Societe Botanique de France, 3ª Session Extraordinaire, 3-10 de agosto de 1980Peer reviewe

Contribuciones al conocimiento de la flora del País Vasco, IV

Nuevos datos para el conocimiento de la flora del País Vasco y los territorios limítrofes, entre ellos el Pirineo aragonés. Se aportan 31 novedades regionales o de sentido más amplio, entre las que destacan como novedades para la Península Ibérica Callitriche hamulata, Carex strigosa y Salix foetida. Además, Lamium album, Colutea arborescens, Leucojum aestivum subspp. aestivum, Lotus corniculatus subsp. carpetanus, Myosotis secunda, Najas gracillima, Periploca graeca, Pistia stratiotes, Rorippa islandica y Wisteria sinesis, son táxones nuevos para la flora del País Vasco y territorios limítrofes. Se revisan también Anthyllis vulneraria L. s.l. y Stipa L., delineando la distribución de los táxones que comprende

Contribuciones al conocimiento de la flora del País Vasco (V)

Se comentan los hallazgos correspondientes a 110 táxones de flora, de los que 17 resultan novedosos para el catálogo florístico del País Vasco, entre ellos tres -Anoda cristata, Erodium manescavi, Sedum sexangulare - lo son tambien para el conjunto de la Península Ibérica, mientras que otros dos, Ranunculus lingua y Epipogium aphyllum, sólo se conocían de una y tres respectivamente en dicha Penínsul