For deep partial-thickness burns no consensus on the optimal treatment has been reached due to conflicting study outcomes with low quality evidence. Treatment options in high- and middle-income ...countries include conservative treatment with delayed excision and grafting if needed; and early excision and grafting. The majority of timing of surgery studies focus on survival rather than on quality of life. This study protocol describes a study that aims to compare long-term scar quality, clinical outcomes, and patient-reported outcomes between the treatment options. A multicentre prospective study will be conducted in the three Dutch burn centres (Rotterdam, Beverwijk, and Groningen). All adult patients with acute deep-partial thickness burns, based on healing potential with Laser Doppler Imaging, are eligible for inclusion. During a nine-month baseline period, standard practice will be monitored. This includes conservative treatment with dressings and topical agents, and excision and grafting of residual defects if needed 14-21 days post-burn. The subsequent nine months, early surgery is advocated, involving excision and grafting in the first week to ten days post-burn. The primary outcome compared between the two groups is long-term scar quality assessed by the Patient and Observer Scar Assessment Scale 3.0 twelve months after discharge. Secondary outcomes include clinical outcomes and patient-reported outcomes like quality of life and return to work. The aim of the study is to assess long-term scar quality in deep partial-thickness burns after conservative treatment with delayed excision and grafting if needed, compared to early excision and grafting. Adding to the ongoing debate on the optimal treatment of these burns. The broad range of studied outcomes will be used for the development of a decision aid for deep partial-thickness burns, to fully inform patients at the point of consent to surgery and support optimal person-centred care.
Premature wind turbine gearbox bearing failures in the form of white structure flaking (WSF) can occur in as little as 6–24 months of operation. WSF is not fully understood but is thought to be due ...to hydrogen release and diffusion into the bearing steel and/or transient operating conditions not fully understood. The initiation mechanisms of white etching cracks (WECs) are contested, where amongst others mechanisms, subsurface initiation at non-metallic inclusions (perhaps associated with extension of butterfly cracks) and surface crack initiation are cited. For the first time this study applies serial sectioning to map WEC networks in wind turbine gearbox bearings to elucidate WEC initiation mechanisms. A comparison is made between WEC data for inner rings of an industrial transient test gearbox bearing and a planet bearing that spalled in service. It is proposed that one mechanism of WEC formation in wind turbine gearbox bearings is due to subsurface WEC initiation from inclusions, either in a butterfly manner or non-butterfly manner; where these small WECs link together to form larger WEC networks, these eventually propagating to the surface resulting in WSF. Small size/length inclusions were found to be likely WEC initiators, therefore the data suggests that steel cleanliness standards analysing inclusion density (as opposed to maximum inclusion lengths) are more relevant in understanding butterfly/WEC initiation in wind turbine gearbox bearings. However standards used should be able to differentiate pure sulfides from sulfides+oxide encapsulations and record inclusions that are only a couple of mircometer’s in length/diameter.
Summary
Mycosis fungoides is the most prevalent form of primary cutaneous T‐cell lymphoma. Patients frequently present with early‐stage disease typically associated with a favourable prognosis and ...survival of 10–35 years, but over 25% may progress to advanced disease with a median survival < 4 years, and just 13 months in those with nodal involvement. Sézary syndrome presents in advanced disease with erythroderma, blood involvement and lymphadenopathy. The Bunn and Lamberg staging system (1979) includes stages IA–IIA (early‐stage disease) and IIB–IVB (advanced‐stage disease) and provides prognostic information, but some patients with tumour‐stage disease (IIB) have a worse prognosis than those with erythrodermic‐stage (III). Conversely, patients with plaque‐stage (IB) folliculotropic mycosis fungoides may have a worse outcome than those with tumour‐stage (IIB). The more recent staging system of the European Organisation for the Research and Treatment of Cancer/International Society for Cutaneous Lymphoma has been designed to reflect tumour burden at different sites. However, this staging system has not been validated prospectively for prognosis. Furthermore, this staging system does not include a detailed measurement of skin tumour burden, as indicated by the modified skin weighted severity assessment tool. This assessment measures body surface area of disease and is weighted to record patch, plaque and tumour to produce a numerical value from 0·5 to 400 and is an established endpoint for clinical studies. Nor does this staging include clinicopathological features associated with a poor prognosis such as folliculotropism. Here we review the clinical, haematological, pathological and genotypic parameters outside the staging system, which may affect survival in mycosis fungoides and Sézary syndrome. Most studies are retrospective and single centre. The identification of poor prognostic factors may be used to develop a prognostic index to use alongside staging, which may be of benefit in mycosis fungoides/Sézary syndrome to identify patients with a potentially poor prognosis.
What's already known about topic?
The European Organization for the Research and Treatment of Cancer/International Society for Cutaneous Lymphoma published a revised staging system for mycosis fungoides/Sézary syndrome (MF/SS) in 2007 to include tumour, node, metastasis and blood involvement at diagnosis.
Survival in MF/SS is diverse and ranges from months to decades.
Factors outside staging affect survival.
What does this study add?
This is a review of clinical, haematological, pathological and genotypic changes affecting survival in MF/SS.
The development of an international prognostic index to be adopted alongside staging may aid the management of patients.
The formation of white etching cracks (WECs) in steel rolling element bearings can lead to the premature rolling contact fatigue (RCF) failure mode called white structure flaking. Driving mechanisms ...are still debated but are proposed to be combinations of mechanical, tribochemical and electrical effects. A number of studies have been conducted to record and map WECs in RCF-tested samples and bearings failed from the field. For the first time, this study uses serial sectioning metallography techniques on non-hydrogen charged test samples over a range of test durations to capture the evolution of WEC formation from their initiation to final flaking. Clear evidence for subsurface initiation at non-metallic inclusions was observed at the early stages of WEC formation, and with increasing test duration the propagation of these cracks from the subsurface region to the contact surface eventually causing flaking. In addition, an increase in the amount of associated microstructural changes adjacent to the cracks is observed, this being indicative of the crack being a prerequisite of the microstructural alteration.
Microorganisms employ quorum sensing (QS) mechanisms to communicate with each other within microbial ecosystems. Emerging evidence suggests that intraspecies and interspecies QS plays an important ...role in antimicrobial resistance in microbial communities. However, the relationship between interkingdom QS and antimicrobial resistance is largely unknown. Here, we demonstrate that interkingdom QS interactions between a bacterium, Pseudomonas aeruginosa and a yeast, Candida albicans, induce the resistance of the latter to a widely used antifungal fluconazole. Phenotypic, transcriptomic, and proteomic analyses reveal that P. aeruginosa's main QS molecule, N-(3-Oxododecanoyl)-L-homoserine lactone, induces candidal resistance to fluconazole by reversing the antifungal's effect on the ergosterol biosynthesis pathway. Accessory resistance mechanisms including upregulation of C. albicans drug-efflux, regulation of oxidative stress response, and maintenance of cell membrane integrity, further confirm this phenomenon. These findings demonstrate that P. aeruginosa QS molecules may confer protection to neighboring yeasts against azoles, in turn strengthening their co-existence in hostile polymicrobial infection sites.
Butterflies are microscopic damage features forming at subsurface material imperfections induced during rolling contact fatigue (RCF) in rolling element bearings. Butterflies can lead to degradation ...of the load bearing capacity of the material by their associated cracks causing premature spalling failures. Recently, butterfly formation has been cited to be related to a premature failure mode in wind turbine gearbox bearings; white structure flaking (WSF). Butterflies consist of cracks with surrounding microstructural change called ‘white etching area’ (WEA) forming wings that revolve around their initiators. The formation mechanisms of butterflies in bearing steels have been studied over the last 50 years, but are still not fully understood. This paper presents a detailed microstructural analysis of a butterfly that has initiated from a void in standard 100Cr6 bearing steel under rolling contact fatigue on a laboratory two-roller test rig under transient operating conditions. Analysis was conducted using focused ion beam (FIB) tomography, 3D reconstruction and transmission electron microscopy (STEM/TEM) methods. FIB tomography revealed an extensive presence of voids/cavities immediately adjacent to the main crack on the non-WEA side and at the crack tip. This provides evidence for a void/cavity coalescence mechanism for the butterfly cracks formation. Spherical M3C carbide deformation and dissolution as part of the microstructural change in WEA were observed in both FIB and STEM/TEM analyses, where TEM analyses also revealed the formation of superfine nano-grains (3–15nm diameter) intersecting a dissolving spherical M3C carbide. This is evidence of the early formation of nano-grains associated with the WEA formation mechanism.
Over-based calcium sulfonate (OBCaSul) additives in oils are considered potentially critical in driving WEC formations, this ‘driving’ effect being unclear. Rolling contact fatigue testing of 100Cr6 ...steel using FE8 and PCS Micro-Pitting-Rig lubricated with oils containing varying OBCaSul concentrations have been conducted, tested samples being analysed using serial sectioning, Thermal desorption analysis (TDA) to measure hydrogen diffusion, and SEM/EDX of the tribofilms formed. Results show that OBCaSul concentration appears to affect WEC formation propensity, a reversal relationship of formations being shown between test rigs. Evidence shows oils containing OBCaSul form thick Ca dominated tribofilms, potentially promoting hydrogen diffusion and WEC formations in the FE8 rollers, where thinner ZnS tribofilms on the FE8 raceways may demote hydrogen diffusion and WEC formations.
•Over-based calcium sulfonate concentration affected WEC formation propensity.•Reversal relationship of number of WEC formations between the tests rigs used.•Positive link between hydrogen and over-based calcium sulfonate concentration.•Thick Ca dominated films may promote hydrogen diffusion and WEC formations.•Thinner ZnS film may demote hydrogen diffusion and WEC formations.
Falls are a major health and injury problem for people with Parkinson disease (PD). Despite the severe consequences of falls, a major unresolved issue is the identification of factors that predict ...the risk of falls in individual patients with PD. The primary aim of this study was to prospectively determine an optimal combination of functional and disease-specific tests to predict falls in individuals with PD.
A total of 101 people with early-stage PD undertook a battery of neurologic and functional tests in their optimally medicated state. The tests included Tinetti, Berg, Timed Up and Go, Functional Reach, and the Physiological Profile Assessment of Falls Risk; the latter assessment includes physiologic tests of visual function, proprioception, strength, cutaneous sensitivity, reaction time, and postural sway. Falls were recorded prospectively over 6 months.
Forty-eight percent of participants reported a fall and 24% more than 1 fall. In the multivariate model, a combination of the Unified Parkinson's Disease Rating Scale (UPDRS) total score, total freezing of gait score, occurrence of symptomatic postural orthostasis, Tinetti total score, and extent of postural sway in the anterior-posterior direction produced the best sensitivity (78%) and specificity (84%) for predicting falls. From the UPDRS items, only the rapid alternating task category was an independent predictor of falls. Reduced peripheral sensation and knee extension strength in fallers contributed to increased postural instability.
Falls are a significant problem in optimally medicated early-stage PD. A combination of both disease-specific and balance- and mobility-related measures can accurately predict falls in individuals with PD.
Forest edges influence more than half of the world's forests and contribute to worldwide declines in biodiversity and ecosystem functions. However, predicting these declines is challenging in ...heterogeneous fragmented landscapes. Here we assembled a global dataset on species responses to fragmentation and developed a statistical approach for quantifying edge impacts in heterogeneous landscapes to quantify edge-determined changes in abundance of 1,673 vertebrate species. We show that the abundances of 85% of species are affected, either positively or negatively, by forest edges. Species that live in the centre of the forest (forest core), that were more likely to be listed as threatened by the International Union for Conservation of Nature (IUCN), reached peak abundances only at sites farther than 200-400 m from sharp high-contrast forest edges. Smaller-bodied amphibians, larger reptiles and medium-sized non-volant mammals experienced a larger reduction in suitable habitat than other forest-core species. Our results highlight the pervasive ability of forest edges to restructure ecological communities on a global scale.
Hydrogen diffusion during rolling contact fatigue (RCF) is considered a potential root cause or accelerator of white etching cracks (WECs) in wind turbine gearbox bearing steels. Hydrogen entry into ...the bearing steel during operation is thought to occur either through the contact surface itself or through cracks that breach the contact surface, in both cases by the decomposition of lubricant through catalytic reactions and/or tribochemical reactions of water. Thermal desorption analysis (TDA) using two experimental set-ups has been used to measure the hydrogen concentration in non-hydrogen-charged bearings over increasing RCF test durations for the first time. TDA on both instruments revealed that hydrogen diffused into the rolling elements, increasing concentrations being measured for longer test durations, with numerous WECs having formed. On the other hand, across all test durations, negligible concentrations of hydrogen were measured in the raceways, and correspondingly no WECs formed. Evidence for a relationship between hydrogen concentration and either the formation or the acceleration of WECs is shown in the rollers, as WECs increased in number and severity with increasing test duration. It is assumed that hydrogen diffusion occurred at wear-induced nascent surfaces or areas of heterogeneous/patchy tribofilm, since most WECs did not breach the contact surface, and those that did only had very small crack volumes for entry of lubricant to have occurred.
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