Abstract A survey of members of the International Society of Burn Injuries (ISBI) and the American Burn Association (ABA) indicated that although there was difference in burn resuscitation protocols, ...they all fulfilled their functions. This study presents the findings of the same survey replicated in Africa, the only continent not included in the original survey. One hundred and eight responses were received. The mean annual number of admissions per unit was ninety-eight. Fluid resuscitation was usually initiated with total body surface area burns of either more than ten or more than fifteen percent. Twenty-six respondents made use of enteral resuscitation. The preferred resuscitation formula was the Parkland formula, and Ringer's Lactate was the favoured intravenous fluid. Despite satisfaction with the formula, many respondents believed that patients received volumes that differed from that predicted. Urine output was the principle guide to adequate resuscitation, with only twenty-one using the evolving clinical picture and thirty using invasive monitoring methods. Only fifty-one respondents replied to the question relating to the method of adjusting resuscitation. While colloids are not available in many parts of the African continent on account of cost, one might infer than African burn surgeons make better use of enteral resuscitation.
Background: Cardiac murmurs associated with valvular regurgitation occur commonly in conditioned performance horses, but their association with athletic performance is unknown.
Hypothesis: Cardiac ...valvular regurgitation has a negative association with race performance.
Animals: Five hundred and twenty‐six “race fit” Thoroughbred racehorses engaged in either flat (race distance 1,000–2,500 m) or jump racing (race distance 3,200–6,400 m).
Methods: Cardiac auscultation and color flow Doppler (CFD) echocardiography were performed on 777 occasions. The associations between the presence and severity of either an audible cardiac murmur or valvular regurgitation assessed by CFD, and published, objective measures of race performance were determined using a standard regression approach.
Results: The prevalence of murmurs and of regurgitation varied significantly between racetypes (P<.02), generally increasing from 2‐year olds to chasers. There were no consistent associations between racing performance and either grade of murmur or regurgitation, whether the presence or absence of regurgitation or murmur, or only murmurs ≥3/6 or regurgitation ≥6/9, were considered.
Conclusions and Clinical Importance: There were differences in prevalence and severity of murmurs of atrioventricular and aortic valve regurgitation between racehorses in different disciplines. Data also showed that neither regurgitation nor murmurs were negatively associated with Timeform rating, an index of UK racehorse quality, in any of the groups of racehorses studied.
Predictors of the progression of renal disease in the Modification of Diet in Renal Disease Study. The Modification of Diet in Renal Disease (MDRD) Study examined the effects of dietary protein ...restriction and strict blood pressure control on the decline in glomerular filtration rate (GFR) in 840 patients with diverse renal diseases. We describe a systematic analysis to determine baseline factors that predict the decline in GFR, or which alter the efficacy of the diet or blood pressure interventions. Univariate analysis identified 18 of 41 investigated baseline factors as significant (P < 0.05) predictors of GFR decline. In multivariate analysis, six factors—greater urine protein excretion, diagnosis of polycystic kidney disease (PKD), lower serum transferrin, higher mean arterial pressure, black race, and lower serum HDL cholesterol—independently predicted a faster decline in GFR. Together with the study interventions, these six factors accounted for 34.5% and 33.9% of the variance between patients in GFR slopes in Studies A and B, respectively, with proteinuria and PKD playing the predominant role. The mean rate of GFR decline was not significantly related to baseline GFR, suggesting an approximately linear mean GFR decline as renal disease progresses. The 41 baseline predictors were also assessed for their interactions with the diet and blood pressure interventions. A greater benefit of the low blood pressure intervention was found in patients with higher baseline urine protein. None of the 41 baseline factors were shown to predict a greater or lesser effect of dietary protein restriction.
Although disturbances of the circadian system are strongly linked to affective disorders, no known studies have examined melatonin profiles in young people in early stages of illness. In this study, ...44 patients with an affective disorder underwent clinical and neuropsychological assessments. They were then rated by a psychiatrist according to a clinical staging model and were categorized as having an 'attenuated syndrome' or an 'established disorder'. During the evening, salivary melatonin was sampled under dim light conditions over an 8-h interval and for each patient, the time of melatonin onset, total area under the curve and phase angle (difference between time of melatonin onset and time of habitual sleep onset) were computed. Results showed that there was no difference in the timing of melatonin onset across illness stages. However, area under the curve analyses showed that those patients with 'established disorders' had markedly reduced levels of melatonin secretion, and shorter phase angles, relative to those with 'attenuated syndromes'. These lower levels, in turn, were related to lower subjective sleepiness, and poorer performance on neuropsychological tests of verbal memory. Overall, these results suggest that for patients with established illness, dysfunction of the circadian system relates clearly to functional features and markers of underlying neurobiological change. Although the interpretation of these results would be greatly enhanced by control data, this work has important implications for the early delivery of chronobiological interventions in young people with affective disorders.
IntroductionSurgery (oesophagectomy), with neoadjuvant chemo(radio)therapy, is the main curative treatment for patients with oesophageal cancer. Several surgical approaches can be used to remove an ...oesophageal tumour. The Ivor Lewis (two-phase procedure) is usually used in the UK. This can be performed as an open oesophagectomy (OO), a laparoscopically assisted oesophagectomy (LAO) or a totally minimally invasive oesophagectomy (TMIO). All three are performed in the National Health Service, with LAO and OO the most common. However, there is limited evidence about which surgical approach is best for patients in terms of survival and postoperative health-related quality of life.Methods and analysisWe will undertake a UK multicentre randomised controlled trial to compare LAO with OO in adult patients with oesophageal cancer. The primary outcome is patient-reported physical function at 3 and 6 weeks postoperatively and 3 months after randomisation. Secondary outcomes include: postoperative complications, survival, disease recurrence, other measures of quality of life, spirometry, success of patient blinding and quality assurance measures. A cost-effectiveness analysis will be performed comparing LAO with OO. We will embed a randomised substudy to evaluate the safety and evolution of the TMIO procedure and a qualitative recruitment intervention to optimise patient recruitment. We will analyse the primary outcome using a multi-level regression model. Patients will be monitored for up to 3 years after their surgery.Ethics and disseminationThis study received ethical approval from the South-West Franchay Research Ethics Committee. We will submit the results for publication in a peer-reviewed journal.Trial registration numberISRCTN10386621.
Waking neurobehavioural or cognitive functioning is largely dependent on two mechanisms both in synchrony and in opposition to each other: the sleep homeostatic and circadian systems. The influences ...of these systems are particularly evident during periods of sustained wakefulness or sleep deprivation. Although the effects of these two systems on neurobehavioural functioning during periods of extended wakefulness have been demonstrated experimentally, there does not exist an adequate theory to describe the underlying brain mechanisms responsible for these neurobehavioural deficits. Much research has in fact concentrated not on understanding the nature of these deficits, but rather in counteracting them, via the use of countermeasures, such as naps and wake promoting compounds.
Given the considerable time and research cost of analyzing biomedical images to quantify adipose tissue volumes, automated image analysis methods are highly desirable. Hippo Fat is a new software ...program designed to automatically quantify adipose tissue areas from magnetic resonance images without user inputs. Hippo Fat has yet to be independently validated against commonly used image analysis software programs.
Our aim was to compare estimates of VAT (visceral adipose tissue) and SAT (subcutaneous adipose tissue) using the new Hippo Fat software against those from a widely used, validated, computer-assisted manual method (slice-O-matic version 4.2, Tomovision, Montreal, CA, USA) to assess its potential utility for large-scale studies.
A Siemens Magnetom Vision 1.5-T whole-body scanner and a T1-weighted fast-spin echo pulse sequence were used to collect multiple, contiguous axial images of the abdomen from a sample of 40 healthy adults (20 men) aged 18-77 years of age, with mean body mass index of 29 kg/m(2) (range=19-43 kg/m(2)).
Hippo Fat provided estimates of VAT and SAT that were highly correlated with estimates using slice-O-matic (R (2)>0.9). Average VAT was 9.4% lower and average SAT was 3.7% higher using Hippo Fat compared to slice-O-matic; the overestimation of SAT tended to be greater among individuals with greater adiposity. Individual-level differences for VAT were also substantial; Hippo Fattrade mark gave estimates of VAT ranging from 1184 cm(3) less to 566 cm(3) more than estimates for the same person using slice-O-matic.
Hippo Fat provides a rapid method of quantifying total VAT, although the method does not provide estimates that are interchangeable with slice-O-matic at either the group (mean) or individual level.
Ibrutinib has been approved by the Food and Drug Administration for the treatment of patients with untreated chronic lymphocytic leukemia (CLL) since 2016 but has not been compared with ...chemoimmunotherapy. We conducted a phase 3 trial to evaluate the efficacy of ibrutinib, either alone or in combination with rituximab, relative to chemoimmunotherapy.
Patients 65 years of age or older who had untreated CLL were randomly assigned to receive bendamustine plus rituximab, ibrutinib, or ibrutinib plus rituximab. The primary end point was progression-free survival. The Alliance Data and Safety Monitoring Board made the decision to release the data after the protocol-specified efficacy threshold had been met.
A total of 183 patients were assigned to receive bendamustine plus rituximab, 182 to receive ibrutinib, and 182 to receive ibrutinib plus rituximab. Median progression-free survival was reached only with bendamustine plus rituximab. The estimated percentage of patients with progression-free survival at 2 years was 74% with bendamustine plus rituximab and was higher with ibrutinib alone (87%; hazard ratio for disease progression or death, 0.39; 95% confidence interval CI, 0.26 to 0.58; P<0.001) and with ibrutinib plus rituximab (88%; hazard ratio, 0.38; 95% CI, 0.25 to 0.59; P<0.001). There was no significant difference between the ibrutinib-plus-rituximab group and the ibrutinib group with regard to progression-free survival (hazard ratio, 1.00; 95% CI, 0.62 to 1.62; P=0.49). With a median follow-up of 38 months, there was no significant difference among the three treatment groups with regard to overall survival. The rate of grade 3, 4, or 5 hematologic adverse events was higher with bendamustine plus rituximab (61%) than with ibrutinib or ibrutinib plus rituximab (41% and 39%, respectively), whereas the rate of grade 3, 4, or 5 nonhematologic adverse events was lower with bendamustine plus rituximab (63%) than with the ibrutinib-containing regimens (74% with each regimen).
Among older patients with untreated CLL, treatment with ibrutinib was superior to treatment with bendamustine plus rituximab with regard to progression-free survival. There was no significant difference between ibrutinib and ibrutinib plus rituximab with regard to progression-free survival. (Funded by the National Cancer Institute and Pharmacyclics; ClinicalTrials.gov number, NCT01886872 .).
We present multiwavelength measurements of the thermal, chemical, and cloud contrasts associated with the visibly dark formations (also known as 5‐μm hot spots) and intervening bright plumes on the ...boundary between Jupiter's Equatorial Zone (EZ) and North Equatorial Belt (NEB). Observations made by the TEXES 5‐ to 20‐μm spectrometer at the Gemini North Telescope in March 2017 reveal the upper‐tropospheric properties of 12 hot spots, which are directly compared to measurements by Juno using the microwave radiometer (MWR), JIRAM at 5 μm, and JunoCam visible images. MWR and thermal‐infrared spectroscopic results are consistent near 0.7 bar. Mid‐infrared‐derived aerosol opacity is consistent with that inferred from visible‐albedo and 5‐μm opacity maps. Aerosol contrasts, the defining characteristics of the cloudy plumes and aerosol‐depleted hot spots, are not a good proxy for microwave brightness. The hot spots are neither uniformly warmer nor ammonia‐depleted compared to their surroundings at p<1 bar. At 0.7 bar, the microwave brightness at the edges of hot spots is comparable to other features within the NEB. Conversely, hot spots are brighter at 1.5 bar, signifying either warm temperatures and/or depleted NH3 at depth. Temperatures and ammonia are spatially variable within the hot spots, so the precise location of the observations matters to their interpretation. Reflective plumes sometimes have enhanced NH3, cold temperatures, and elevated aerosol opacity, but each plume appears different. Neither plumes nor hot spots had microwave signatures in channels sensing p>10 bars, suggesting that the hot spot/plume wave is a relatively shallow feature.
Plain Language Summary
To date, our only direct measurement of Jupiter's gaseous composition came from the descent of the Galileo probe in 1995. However, the results from Galileo appeared to be biased due to the unusual meteorological conditions of its entry location: a dark, cloud‐free region just north of the equator, known as a hot spot. One of the aims of NASA's Juno mission was to place the findings of the Galileo probe into broader context, which requires a detailed characterization of these equatorial hot spots and their neighboring plumes. We combine (a) data from Juno (microwave observations sounding conditions below the clouds and visible/infrared observations revealing variations in cloud opacity) with (b) observations from amateur observers (to track the hot spots over time) and (c) observations from the TEXES infrared spectrometer mounted on the Gemini‐North telescope. The latter provides the highest‐resolution thermal maps of Jupiter's tropics ever obtained and reveals contrasts within and between the individual hot spots and plumes. We find that the hot spots are distinguishable from their surroundings for relatively shallow pressures but that the deep measurements from Juno and Galileo are probably more representative of Jupiter's North Equatorial Belt than previously thought.
Key Points
Gemini TEXES spectral mapping reveals temperature, aerosol, and ammonia contrasts associated with plumes and hot spots on Jupiter's NEB jetstream
Juno microwave measurements are consistent with the infrared mapping and reveals that hot spot ammonia contrasts are confined to pressures less than 8–10 bars
Hot spots and plumes are primarily contrasts in aerosols, with only subtle upper‐tropospheric ammonia and temperature variations
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