The great fluid debate: saline or so-called "balanced" salt solutions?

BACKGROUND Intravenous fluids are commonly prescribed in childhood. 0.9 % saline is the most-used fluid in pediatrics as resuscitation or maintenance solution. Experimental studies and observations in adults suggest that 0.9 % saline is a poor candidate for fluid resuscitation. Although anesthesiologists, intensive care specialists, perioperative physicians and nephrologists have been the most active in this debate, this issue deserves some physiopathological considerations also among pediatricians. RESULTS As compared with so-called "balanced" salt crystalloids such as lactated Ringer, administration of large volumes of 0.9 % saline has been associated with following deleterious effects: tendency to hyperchloremic metabolic acidosis (called dilution acidosis); acute kidney injury with reduced urine output and salt retention; damaged vascular permeability and stiffness, increase in proinflammatory mediators; detrimental effect on coagulation with tendency to blood loss; detrimental gastrointestinal perfusion and function; possible uneasiness at the bedside resulting in unnecessary administration of more fluids. Nevertheless, there is no firm evidence that these adverse effects are clinically relevant. CONCLUSIONS Intravenous fluid therapy is a medicine like insulin, chemotherapy or antibiotics. Prescribing fluids should fit the child's history and condition, consider the right dose at the right rate as well as the electrolyte levels and other laboratory variables. It is unlikely that a single type of fluid will be suitable for all pediatric patients. "Balanced" salt crystalloids, although more expensive, should be preferred for volume resuscitation, maintenance and perioperatively. Lactated Ringer appears unsuitable for patients at risk for brain edema and for those with overt or latent chloride-deficiency. Finally, in pediatrics there is a need for new fluids to be developed on the basis of a better understanding of the physiology and to be tested in well-designed trials.

A retrospective cohort study of the duration of hepatitis B vaccine immunity and associated factors in pediatric dialysis patients

Dialysis patients are at high risk for hepatitis B infection, which is a serious but preventable disease. Prevention strategies include the administration of the hepatitis B vaccine. Dialysis patients have been noted to have a poor immune response to the vaccine and lose immunity more rapidly. The long term immunogenicity of the hepatitis B vaccine has not been well defined in pediatric dialysis patients especially if administered during infancy as a routine childhood immunization.^ Purpose. The aim of this study was to determine the median duration of hepatitis B immunity and to study the effect of vaccination timing and other cofactors on the duration of hepatitis B immunity in pediatric dialysis patients.^ Methods. Duration of hepatitis B immunity was determined by Kaplan-Meier survival analysis. Comparison of stratified survival analysis was performed using log-rank analysis. Multivariate analysis by Cox regression was used to estimate hazard ratios for the effect of timing of vaccine administration and other covariates on the duration of hepatitis B immunity.^ Results. 193 patients (163 incident patients) had complete data available for analysis. Mean age was 11.2±5.8 years and mean ESRD duration was 59.3±97.8 months. Kaplan-Meier analysis showed that the total median overall duration of immunity (since the time of the primary vaccine series) was 112.7 months (95% CI: 96.6, 124.4), whereas the median overall duration of immunity for incident patients was 106.3 months (95% CI: 93.93, 124.44). Incident patients had a median dialysis duration of hepatitis B immunity equal to 37.1 months (95% CI: 24.16, 72.26). Multivariate adjusted analysis showed that there was a significant difference between patients based on the timing of hepatitis B vaccination administration (p<0.001). Patients immunized after the start of dialysis had a hazard ratio of 6.13 (2.87, 13.08) for loss of hepatitis B immunity compared to patients immunized as infants (p<0.001).^ Conclusion. This study confirms that patients immunized after dialysis onset have an overall shorter duration of hepatitis B immunity as measured by hepatitis B antibody titers and after the start of dialysis, protective antibody titer levels in pediatric dialysis patients wane rapidly compared to healthy children.^

Tramas intergenéricas en el relato Lucaniano del 'día después' (B.C., VII, 786-846)

La escena del campo de batalla tras el enfrentamiento entre pompeyanos y cesarianos en el libro VII del Bellum Ciuile de Lucano (786-846) deja al descubierto el proceso de refuncionalización del tópico tradicional del día después de la lucha. Desde una perspectiva estilística mostramos que la intersección entre los códigos historiográfico, épico y trágico y la manipulación de diversos motivos literarios y culturales en dicho relato pueden leerse como uno de los principales mecanismos de la poética lucaniana del ciuile nefas.

Tramas intergenéricas en el relato Lucaniano del 'día después' (B.C., VII, 786-846)

La escena del campo de batalla tras el enfrentamiento entre pompeyanos y cesarianos en el libro VII del Bellum Ciuile de Lucano (786-846) deja al descubierto el proceso de refuncionalización del tópico tradicional del día después de la lucha. Desde una perspectiva estilística mostramos que la intersección entre los códigos historiográfico, épico y trágico y la manipulación de diversos motivos literarios y culturales en dicho relato pueden leerse como uno de los principales mecanismos de la poética lucaniana del ciuile nefas.

Tramas intergenéricas en el relato Lucaniano del 'día después' (B.C., VII, 786-846)

La escena del campo de batalla tras el enfrentamiento entre pompeyanos y cesarianos en el libro VII del Bellum Ciuile de Lucano (786-846) deja al descubierto el proceso de refuncionalización del tópico tradicional del día después de la lucha. Desde una perspectiva estilística mostramos que la intersección entre los códigos historiográfico, épico y trágico y la manipulación de diversos motivos literarios y culturales en dicho relato pueden leerse como uno de los principales mecanismos de la poética lucaniana del ciuile nefas.

Chemical composition of pumices from the Great Meteor Seamount

Two samples of pumice, obtained by trawling from depths of 3100 and 4300 m on the eastern slope of the Great Meteor Seamount in the Atlantic Ocean, have been examined. Their petrochemical composition has been studied. The pumice is probably a product of youthful explosive volcanism on the Azores, displaced southward by surface currents.

Sedimentation across the Great Barrier Reef

The continental margin off northeast Australia, comprising the Great Barrier Reef (GBR) platform and Queensland Trough, is the largest tropical mixed siliciclastic/carbonate depositional system in existence. We describe a suite of 35 piston cores and two Ocean Drilling Program (ODP) sites from a 130*240 km rectangular area of the Queensland Trough, the slope and basin setting east of the central GBR platform. Oxygen isotope records, physical property (magnetic susceptibility and greyscale) logs, analyses of bulk carbonate content and radiocarbon ages at these locations are used to construct a high resolution stratigraphy. This information is used to quantify mass accumulation rates (MARs) for siliciclastic and carbonate sediments accumulating in the Queensland Trough over the last 31,000 years. For the slope, highest MARs of siliciclastic sediment occur during transgression (1.0 Million Tonnes per year; MT/yr), and lowest MARs of siliciclastic (<0.1 MT/yr) and carbonate (0.2 MT/yr) sediment occur during sea level lowstand. Carbonate MARs are similar to siliciclastic MARs for transgression and highstand (1.1-1.4 MT/yr). In contrast, for the basin, MARs of siliciclastic (0-0.1 MT/yr) and carbonate sediment (0.2-0.4 MT/yr) are continuously low, and within a factor of two, for lowstand, transgression, and highstand. Generic models for carbonate margins predict that maximum and minimum carbonate MARs on the slope will occur during highstand and lowstand, respectively. Conversely, most models for siliciclastic margins suggest maximum and minimum siliciclastic MARs will occur during lowstand and transgression, respectively. Although carbonate MARs in the Queensland Trough are similar to those predicted for carbonate depositional systems, siliciclastic MARs are the opposite. Given uniform siliciclastic MARs in the basin through time, we conclude that terrigenous material is stored on the shelf during sea level lowstand, and released to the slope during transgression as wave driven currents transport shelf sediment offshore.

Seguidillas nueuas y curiosas por el A, B, C ; con otras a una Josefa, que pueden aplicarse a otros nombres [Texto impreso]

Hay un ejemplar encuadernado con: Discret rahonament, quiexa formal que fan contra el Micalet de la Seu, la Torre de Espioca, y la Torre de Paterna, sobre la gran visita que éste tingué en lo dia cinc de Deembre [sic] ... per veure y admirar tan magnífica obra y deliciosa vista ... Carlos Quart (que Deu guart) y el señor Don Fernando de Borbó ... : (XVIII/1105).

Coplas por las folias, y otras por el A, B, C. [Texto impreso]

Contiene: Glosas de un amante, que se despide de su dama, hechas por el A, B, C ; Respuesta de la Dama en las otras letras restantes del abecedario

Mass spectrometric determination of dioxygen bond splitting in the “peroxy” intermediate of cytochrome c oxidase

The “peroxy” intermediate (P form) of bovine cytochrome c oxidase was prepared by reaction of the two-electron reduced mixed-valence CO complex with 18O2 after photolytic removal of CO. The water present in the reaction mixture was recovered and analyzed for 18O enrichment by mass spectrometry. It was found that approximately one oxygen atom (18O) per one equivalent of the P form was present in the bulk water. The data show that the oxygen–oxygen dioxygen bond is already broken in the P intermediate and that one oxygen atom can be readily released or exchanged with the oxygen of the solvent water.