Neurocutaneous sural flap in paraplegic patients.

Neurocutaneous flaps have been demonstrated to be a reliable option in different groups of patients but it remains unclear if distally-based sural flaps can be safely used in paraplegic patients because they suffer from significant nervous system alterations. The aim of this proof-of-concept study is to demonstrate that these flaps are reliable in paraplegic patients. We prospectively analysed a group (n=6) of paraplegic patients who underwent reversed sural flap surgery for ulcers on the lateral malleolus. Measurement of area and photographic documentation techniques have been employed to quantify the defect area. Sural nerve biopsies have been analysed histologically with several different staining techniques to assess the neurovascular network and the myelinisation of the nerve. The patients showed uneventful wound healing, except one case that suffered a partial flap necrosis that healed by secondary intention. Histologic analysis revealed an intact neurovascular network and myelinated nerve fibres. In this small series of paraplegic patients that underwent a distally-based sural flap, the complication rate was low, with only one case of superficial partial necrosis demonstrating the reliability and safety of the flap in this subset of patients. Histologic evaluation of sural nerve biopsies revealed an almost normal morphology. A possible explanation of this phenomenon is that the dorsal root ganglia remain intact in paraplegic patients and can preserve neural characteristics in the peripheral sensory nerve system.

Statistical dynamics of dislocation systems: The influence of dislocation-dislocation correlations.

During plastic deformation of crystalline materials, the collective dynamics of interacting dislocations gives rise to various patterning phenomena. A crucial and still open question is whether the long range dislocation-dislocation interactions which do not have an intrinsic range can lead to spatial patterns which may exhibit well-defined characteristic scales. It is demonstrated for a general model of two-dimensional dislocation systems that spontaneously emerging dislocation pair correlations introduce a length scale which is proportional to the mean dislocation spacing. General properties of the pair correlation functions are derived, and explicit calculations are performed for a simple special case, viz pair correlations in single-glide dislocation dynamics. It is shown that in this case the dislocation system exhibits a patterning instability leading to the formation of walls normal to the glide plane. The results are discussed in terms of their general implications for dislocation patterning.

Effect of management systems and cover crops on organic matter dynamics of soil under vegetables

Vegetable production in conservation tillage has increased in Brazil, with positive effects on the soil quality. Since management systems alter the quantity and quality of organic matter, this study evaluated the influence of different management systems and cover crops on the organic matter dynamics of a dystrophic Red Latosol under vegetables. The treatments consisted of the combination of three soil tillage systems: no-tillage (NT), reduced tillage (RT) and conventional tillage (CT) and of two cover crops: maize monoculture and maize-mucuna intercrop. Vegetables were grown in the winter and the cover crops in the summer for straw production. The experiment was arranged in a randomized block design with four replications. Soil samples were collected between the crop rows in three layers (0.0-0.05, 0.05-0.10, and 0.10-0.30 m) twice: in October, before planting cover crops for straw, and in July, during vegetable cultivation. The total organic carbon (TOC), microbial biomass carbon (MBC), oxidizable fractions, and the carbon fractions fulvic acid (C FA), humic acid (C HA) and humin (C HUM) were determined. The main changes in these properties occurred in the upper layers (0.0-0.05 and 0.05-0.10 m) where, in general, TOC levels were highest in NT with maize straw. The MBC levels were lowest in CT systems, indicating sensitivity to soil disturbance. Under mucuna, the levels of C HA were lower in RT than NT systems, while the C FA levels were lower in RT than CT. For vegetable production, the C HUM values were lowest in the 0.05-0.10 m layer under CT. With regard to the oxidizable fractions, the tillage systems differed only in the most labile C fractions, with higher levels in NT than CT in the 0.0-0.05 m layer in both summer and winter, with no differences between these systems in the other layers. The cabbage yield was not influenced by the soil management system, but benefited from the mulch production of the preceding maize-mucuna intercrop as cover plant.

Chemical and physical-hydric characterisation of a red latosol after five years of management during the summer between-crop season

Agricultural production systems that include the production of mulch for no-tillage farming and structural improvement of the soil can be considered key measures for agricultural activity in the Cerrado region without causing environmental degradation. In this respect, our work aimed to evaluate the chemical and physical-hydric properties of a dystrophic Red Latosol (Oxisol) in the municipality of Rio Verde, Goias, Brazil, under different soil management systems in the between-crop season of soybean cultivation five years after first planting. The following conditions were evaluated: Brachiaria brizantha cv. Marandu as a cover crop during the between-crop season; Second crop of maize intercropped with Brachiaria ruziziensis; Second crop of grain alone in a no-tillage system; Fallow soil after the soybean harvest; and Forest (natural vegetation) located in an adjacent area. Soil samples up to a depth of 40 cm were taken and used in the assessment of chemical properties and soil structure diagnostics. The results demonstrated that the conversion of native vegetation areas into agricultural fields altered the chemical and physical-hydric properties of the soil at all the depths evaluated, especially up to 10 cm, due to the activity of root systems in the soil structure. Cultivation of B. brizantha as a cover crop during the summer between-crop season increased soil water availability, which is important for agricultural activities in the region under study.

Biomass decomposition and nutrient release from black oat and hairy vetch residues deposited in a vineyard

A significant quantity of nutrients in vineyards may return to the soil each year through decomposition of residues from cover plants. This study aimed to evaluate biomass decomposition and nutrient release from residues of black oats and hairy vetch deposited in the vines rows, with and without plastic shelter, and in the between-row areas throughout the vegetative and productive cycle of the plants. The study was conducted in a commercial vineyard in Bento Gonçalves, RS, Brazil, from October 2008 to February 2009. Black oat (Avena strigosa) and hairy vetch (Vicia villosa) residues were collected, subjected to chemical (C, N, P, K, Ca, and Mg) and biochemical (cellulose - Cel, hemicellulose - Hem, and lignin - Lig content) analyses, and placed in litter bags, which were deposited in vines rows without plastic shelter (VPRWS), in vines rows with plastic shelter (VPRS), and in the between-row areas (BR). We collected the residues at 0, 33, 58, 76, and 110 days after deposition of the litter bags, prepared the material, and subjected it to analysis of total N, P, K, Ca, and Mg content. The VPRS contained the largest quantities and percentages of dry matter and residual nutrients (except for Ca) in black oat residues from October to February, which coincides with the period from flowering up to grape harvest. This practice led to greater protection of the soil surface, avoiding surface runoff of the solution derived from between the rows, but it retarded nutrient cycling. The rate of biomass decomposition and nutrient release from hairy vetch residues from October to February was not affected by the position of deposition of the residues in the vineyard, which may especially be attributed to the lower values of the C/N and Lig/N ratios. Regardless of the type of residue, black oat or hairy vetch, the greatest decomposition and nutrient release mainly occurred up to 33 days after deposition of the residues on the soil surface, which coincided with the flowering of the grapevines, which is one of the phenological stages of greatest demand for nutrients.

Dislocation jamming and Andrade creep

We simulate the glide motion of an assembly of interacting dislocations under the action of an external shear stress and show that the associated plastic creep relaxation follows Andrades law. Our results indicate that Andrade creep in plastically deforming crystals involves the correlated motion of dislocation structures near a dynamic transition separating a flowing from a jammed phase. Simulations in the presence of dislocation multiplication and noise confirm the robustness of this finding and highlight the importance of metastable structure formation for the relaxation process.

Key electrophysiological, molecular, and metabolic signatures of sleep and wakefulness revealed in primary cortical cultures.

Although sleep is defined as a behavioral state, at the cortical level sleep has local and use-dependent features suggesting that it is a property of neuronal assemblies requiring sleep in function of the activation experienced during prior wakefulness. Here we show that mature cortical cultured neurons display a default state characterized by synchronized burst-pause firing activity reminiscent of sleep. This default sleep-like state can be changed to transient tonic firing reminiscent of wakefulness when cultures are stimulated with a mixture of waking neurotransmitters and spontaneously returns to sleep-like state. In addition to electrophysiological similarities, the transcriptome of stimulated cultures strikingly resembles the cortical transcriptome of sleep-deprived mice, and plastic changes as reflected by AMPA receptors phosphorylation are also similar. We used our in vitro model and sleep-deprived animals to map the metabolic pathways activated by waking. Only a few metabolic pathways were identified, including glycolysis, aminoacid, and lipids. Unexpectedly large increases in lysolipids were found both in vivo after sleep deprivation and in vitro after stimulation, strongly suggesting that sleep might play a major role in reestablishing the neuronal membrane homeostasis. With our in vitro model, the cellular and molecular consequences of sleep and wakefulness can now be investigated in a dish.

High-density collagen gel tubes as a matrix for primary human bladder smooth muscle cells.

Tissue-engineered grafts for the urinary tract are being investigated for the potential treatment of several urologic diseases. These grafts, predominantly tubular-shaped, usually require in vitro culture prior to implantation to allow cell engraftment on initially cell-free scaffolds. We have developed a method to produce tubular-shaped collagen scaffolds based on plastic compression. Our approach produces a ready cell-seeded graft that does not need further in vitro culture prior to implantation. The tubular collagen scaffolds were in particular investigated for their structural, mechanical and biological properties. The resulting construct showed an especially high collagen density, and was characterized by favorable mechanical properties assessed by axial extension and radial dilation. Young modulus in particular was greater than non-compressed collagen tubes. Seeding densities affected proliferation rate of primary human bladder smooth muscle cells. An optimal seeding density of 10(6) cells per construct resulted in a 25-fold increase in Alamar blue-based fluorescence after 2 wk in culture. These high-density collagen gel tubes, ready seeded with smooth muscle cells could be further seeded with urothelial cells, drastically shortening the production time of graft for urinary tract regeneration.

Foam pore size is a critical interface parameter of suction-based wound healing devices.

BACKGROUND: Suction-based wound healing devices with open-pore foam interfaces are widely used to treat complex tissue defects. The impact of changes in physicochemical parameters of the wound interfaces has not been investigated. METHODS: Full-thickness wounds in diabetic mice were treated with occlusive dressing or a suction device with a polyurethane foam interface varying in mean pore size diameter. Wound surface deformation on day 2 was measured on fixed tissues. Histologic cross-sections were analyzed for granulation tissue thickness (hematoxylin and eosin), myofibroblast density (α-smooth muscle actin), blood vessel density (platelet endothelial cell adhesion molecule-1), and cell proliferation (Ki67) on day 7. RESULTS: Polyurethane foam-induced wound surface deformation increased with polyurethane foam pore diameter: 15 percent (small pore size), 60 percent (medium pore size), and 150 percent (large pore size). The extent of wound strain correlated with granulation tissue thickness that increased 1.7-fold in small pore size foam-treated wounds, 2.5-fold in medium pore size foam-treated wounds, and 4.9-fold in large pore size foam-treated wounds (p < 0.05) compared with wounds treated with an occlusive dressing. All polyurethane foams increased the number of myofibroblasts over occlusive dressing, with maximal presence in large pore size foam-treated wounds compared with all other groups (p < 0.05). CONCLUSIONS: The pore size of the interface material of suction devices has a significant impact on the wound healing response. Larger pores increased wound surface strain, tissue growth, and transformation of contractile cells. Modification of the pore size is a powerful approach for meeting biological needs of specific wounds.

Fluid-rock-strain feedbacks in extensional shear zones

La présence de fluide météorique synchrone à l'activité du détachement (Farmin, 2003 ; Mulch et al., 2007 ; Gébelin et al., 2011), implique que les zones de cisaillement sont des systèmes ouverts avec des cellules de convections à l'échelle crustale et un intense gradient géothermique au sein du détachement (Morrison et Anderson, 1998, Gottardi et al., 2011). De plus, les réactions métamorphiques liées à des infiltrations fluides dans les zones de cisaillement extensionnel peuvent influencer les paramètres rhéologiques du système (White and Knipe, 1978), et impliquer la localisation de la déformation dans la croûte. Dans ce manuscrit, deux zones de cisaillement infiltrées par des fluides météoriques sont étudiées, l'une étant largement quartzitique, et l'autre de nature granitique ; les relations entre déformation, fluides, et roches s'appuient sur des approches structurales, microstructurales, chimiques et isotopiques. L'étude du détachement du Columbia river (WA, USA) met en évidence que la déformation mylonitique se développe en un million d'années. La phase de cisaillement principal s'effectue à 365± 30°C d'après les compositions isotopiques en oxygène du quartz et de la muscovite. Ces minéraux atteignent l'équilibre isotopique lors de leur recristallisation dynamique contemporaine à la déformation. La zone de cisaillement enregistre une baisse de température, remplaçant le mécanisme de glissement par dislocation par celui de dissolution- précipitation dans les derniers stades de l'activité du détachement. La dynamique de circulation fluide bascule d'une circulation pervasive à chenalisée, ce qui engendre localement la rupture des équilibres d'échange isotopiques. La zone de cisaillement de Bitterroot (MT, USA) présente une zone mylonitique de 600m d'épaisseur, progressant des protomylonites aux ultramylonites. L'intensité de la localisation de la déformation se reflète directement sur l'hydratation des feldspaths, réaction métamorphique majeure dite de « rock softening ». Une étude sur roche totale indique des transferts de masse latéraux au sein des mylonites, et d'importantes pertes de volume dans les ultramylonites. La composition isotopique en hydrogène des phyllosilicates met en évidence la présence (1) d'une source magmatique/métamorphique originelle, caractérisée par les granodiorites ayant conservé leur foliation magmatique, jusqu'aux protomylonites, et (2) une source météorique qui tamponne les valeurs des phyllosilicates des fabriques mylonitiques jusqu'aux veines de quartz non-déformées. Les compositions isotopiques en oxygène des minéraux illustrent le tamponnement de la composition du fluide météorique par l'encaissant. Ce phénomène cesse lors du processus de chloritisation de la biotite, puisque les valeurs des chlorites sont extrêmement négatives (-10 per mil). La thermométrie isotopique indique une température d'équilibre isotopique de la granodiorite entre 600-500°C, entre 500-300°C dans les mylonites, et entre 300 et 200°C dans les fabriques cassantes (cataclasites et veines de quartz). Basé sur les résultats issus de ce travail, nous proposons un modèle général d'interactions fluide-roches-déformation dans les zones de détachements infiltrées par des fluides météoriques. Les zones de détachements évoluent rapidement (en quelques millions d'années) au travers de la transition fragile-ductile ; celle-ci étant partiellement contrôlée par l'effet thermique des circulations de fluide météoriques. Les systèmes de détachements sont des lieux où la déformation et les circulations fluides sont couplées ; évoluant rapidement vers une localisation de la déformation, et de ce fait, une exhumation efficace. - The presence of meteoric fluids synchronous with the activity of extensional detachment zones (Famin, 2004; Mulch et al., 2007; Gébelin et al., 2011) implies that extensional systems involve fluid convection at a crustal scale, which results in high geothermal gradients within active detachment zones (Morrison and Anderson, 1998, Gottardi et al., 2011). In addition, the metamorphic reactions related to fluid infiltration in extensional shear zones can influence the rheology of the system (White and Knipe, 1978) and ultimately how strain localizes in the crust. In this thesis, two shear zones that were permeated by meteoric fluids are studied, one quartzite-dominated, and the other of granitic composition; the relations between strain, fluid, and evolving rock composition are addressed using structural, microstructural, and chemical/isotopic measurements. The study of the Columbia River detachment that bounds the Kettle core complex (Washington, USA) demonstrates that the mylonitic fabrics in the 100 m thick quartzite- dominated detachment footwall developed within one million years. The main shearing stage occurred at 365 ± 30°C when oxygen isotopes of quartz and muscovite equilibrated owing to coeval deformation and dynamic recrystallization of these minerals. The detachment shear zone records a decrease in temperature, and dislocation creep during detachment shearing gave way to dissolution-precipitation and fracturing in the later stages of detachment activity. Fluid flow switched from pervasive to channelized, leading to isotopic disequilibrium between different minerals. The Bitterroot shear zone detachment (Montana, USA) developed a 600 m thick mylonite zone, with well-developed transitions from protomylonite to ultramylonite. The localization of deformation relates directly to the intensity of feldspar hydration, a major rock- softening metamorphic reaction. Bulk-rock analyses of the mylonitic series indicate lateral mass transfer in the mylonite (no volume change), and significant volume loss in ultramylonite. The hydrogen isotope composition of phyllosilicates shows (1) the presence of an initial magmatic/metamorphic source characterized by the granodiorite in which a magmatic, and gneissic (protomylonite) foliation developed, and (2) a meteoric source that buffers the values of phyllosilicates in mylonite, ultramylonite, cataclasite, and deformed and undeformed quartz veins. The mineral oxygen isotope compositions were buffered by the host-rock compositions until chloritization of biotite started; the chlorite oxygen isotope values are negative (-10 per mil). Isotope thermometry indicates a temperature of isotopic equilibrium of the granodiorite between 600-500°C, between 500-300°C in the mylonite, and between 300 and 200°C for brittle fabrics (cataclasite and quartz veins). Results from this work suggest a general model for fluid-rock-strain feedbacks in detachment systems that are permeated by meteoric fluids. Phyllosilicates have preserved in their hydrogen isotope values evidence for the interaction between rock and meteoric fluids during mylonite development. Fluid flow generates mass transfer along the tectonic anisotropy, and mylonites do not undergo significant volume change, except locally in ultramylonite zones. Hydration of detachment shear zones attends mechanical grain size reduction and enhances strain softening and localization. Self-exhuming detachment shear zones evolve rapidly (a few million years) through the transition from ductile to brittle, which is partly controlled by the thermal effect of circulating surface fluids. Detachment systems are zones in the crust where strain and fluid flow are coupled; these systems. evolve rapidly toward strain localization and therefore efficient exhumation.

Changes in Soil Organic Carbon Fractions in Response to Cover Crops in an Orange Orchard

ABSTRACT The cultivation of cover crops intercropped with fruit trees is an alternative to maintain mulch cover between plant rows and increase soil organic carbon (C) stocks. The objective of this study was to evaluate changes in soil total organic C content and labile organic matter fractions in response to cover crop cultivation in an orange orchard. The experiment was performed in the state of Bahia, in a citrus orchard with cultivar ‘Pera’ orange (Citrus sinensis) at a spacing of 6 × 4 m. A randomized complete block design with three replications was used. The following species were used as cover crops: Brachiaria (Brachiaria decumbes) – BRAQ, pearl millet (Pennisetum glaucum) – MIL, jack bean (Canavalia ensiformis) – JB, blend (50 % each) of jack bean + millet (JB/MIL), and spontaneous vegetation (SPV). The cover crops were broadcast-seeded between the rows of orange trees and mechanically mowed after flowering. Soil sampling at depths of 0.00-0.10, 0.10-0.20, and 0.20-0.40 m was performed in small soil trenches. The total soil organic C (SOC) content, light fraction (LF), and the particulate organic C (POC), and oxidizable organic C fractions were estimated. Total soil organic C content was not significantly changed by the cover crops, indicating low sensitivity in reacting to recent changes in soil organic matter due to management practices. Grasses enabled a greater accumulation of SOC stocks in 0.00-0.40 m compared to all other treatments. Jack bean cultivation increased LF and the most labile oxidizable organic C fraction (F1) in the soil surface and the deepest layer tested. Cover crop cultivation increased labile C in the 0.00-0.10 m layer, which can enhance soil microbial activity and nutrient absorption by the citrus trees. The fractions LF and F1 may be suitable indicators for monitoring changes in soil organic matter content due to changes in soil management practices.

Phosphorus Forms in Ultisol Submitted to Burning and Trituration of Vegetation in Eastern Amazon

ABSTRACT The use of fire to prepare agricultural areas is a technique still used by small farmers in eastern Amazon. This type of management changes the dynamics of soil nutrients, especially phosphorus, which constitutes the most limiting nutrient for crop production in tropical soils. This study was carried out to evaluate changes in phosphorus forms in an Argissolo Amarelo Distrófico (Ultisol) submitted to burning and trituration of secondary forest in eastern Amazon. The evaluated systems were: slash-and-burn of vegetation; slash-and-mulch of vegetation; and secondary vegetation. The labile, moderately labile, moderately recalcitrant, available and total phosphorus fractions were assessed at the soil depths of 0.00-0.05, 0.05-0.10 and 0.10-0.20 m. The results showed a predominance of soluble P in acid (moderately labile P) over other forms in all management systems. The management systems influence the content and distribution of the forms of P, where the slash-and-mulch system presented the prevalence of the labile fraction, and the slash-and-burn system contained less labile forms. The slash-and-mulch system favored the accumulation of labile P and total organic P.

Novel anesthetics and other treatment strategies for refractory status epilepticus

Refractory status epilepticus (RSE)-that is, seizures resistant to at least two antiepileptic drugs (AEDs)-is generally managed with barbiturates, propofol, or midazolam, despite a low level of evidence (Rossetti, 2007). When this approach fails, the need for alternative pharmacologic and nonpharmacologic strategies emerges. These have been investigated even less systematically than the aforementioned compounds, and are often used, sometimes in succession, in cases of extreme refractoriness (Robakis & Hirsch, 2006). Several possibilities are reviewed here. In view of the marked heterogeneity of reported information, etiologies, ages, and comedications, it is extremely difficult to evaluate a given method, not to say to compare different strategies among them. Pharmacologic Approaches Isoflurane and desflurane may complete the armamentarium of anesthetics,' and should be employed in a ''close'' environment, in order to prevent intoxication of treating personnel. c-Aminobutyric acid (GABA)A receptor potentiation represents the putative mechanism of action. In an earlier report, isoflurane was used for up to 55 h in nine patients, controlling seizures in all; mortality was, however, 67% (Kofke et al., 1989). More recently, the use of these inhalational anesthetics was described in seven subjects with RSE, for up to 26 days, with an endtidal concentration of 1.2-5%. All patients required vasopressors, and paralytic ileus occurred in three; outcome was fatal in three patients (43%) (Mirsattari et al., 2004). Ketamine, known as an emergency anesthetic because of its favorable hemodynamic profile, is an N-methyl-daspartate (NMDA) antagonist; the interest for its use in RSE derives from animal works showing loss of GABAA efficacy and maintained NMDA sensitivity in prolonged status epilepticus (Mazarati & Wasterlain, 1999). However, to avoid possible neurotoxicity, it appears safer to combine ketamine with GABAergic compounds (Jevtovic-Todorovic et al., 2001; Ubogu et al., 2003), also because of a likely synergistic effect (Martin & Kapur, 2008). There are few reported cases in humans, describing progressive dosages up to 7.5 mg/kg/h for several days (Sheth & Gidal, 1998; Quigg et al., 2002; Pruss & Holtkamp, 2008), with moderate outcomes. Paraldehyde acts through a yet-unidentified mechanism, and appears to be relatively safe in terms of cardiovascular tolerability (Ramsay, 1989; Thulasimani & Ramaswamy, 2002), but because of the risk of crystal formation and its reactivity with plastic, it should be used only as fresh prepared solution in glass devices (Beyenburg et al., 2000). There are virtually no recent reports regarding its use in adults RSE, whereas rectal paraldehyde in children with status epilepticus resistant to benzodiazepines seems less efficacious than intravenous phenytoin (Chin et al., 2008). Etomidate is another anesthetic agent for which the exact mechanism of action is also unknown, which is also relatively favorable regarding cardiovascular side effects, and may be used for rapid sedation. Its use in RSE was reported in eight subjects (Yeoman et al., 1989). After a bolus of 0.3 mg/kg, a drip of up to 7.2 mg/kg/h for up to 12 days was administered, with hypotension occurring in five patients; two patients died. A reversible inhibition of cortisol synthesis represents an important concern, limiting its widespread use and implying a careful hormonal substitution during treatment (Beyenburg et al., 2000). Several nonsedating approaches have been reported. The use of lidocaine in RSE, a class Ib antiarrhythmic agent modulating sodium channels, was reviewed in 1997 (Walker & Slovis, 1997). Initial boluses up to 5 mg/kg and perfusions of up to 6 mg/kg/h have been mentioned; somewhat surprisingly, at times lidocaine seemed to be successful in controlling seizures in patients who were refractory to phenytoin. The aforementioned dosages should not be overshot, in order to keep lidocaine levels under 5 mg/L and avoid seizure induction (Hamano et al., 2006). A recent pediatric retrospective survey on 57 RSE episodes (37 patients) described a response in 36%, and no major adverse events; mortality was not given (Hamano et al., 2006 Verapamil, a calcium-channel blocker, also inhibits P-glycoprotein, a multidrug transporter that may diminish AED availability in the brain (Potschka et al., 2002). Few case reports on its use in humans are available; this medication nevertheless appears relatively safe (under cardiac monitoring) up to dosages of 360 mg/day (Iannetti et al., 2005). Magnesium, a widely used agent for seizures elicited by eclampsia, has also been anecdotally reported in RSE (Fisher et al., 1988; Robakis & Hirsch, 2006), but with scarce results even at serum levels of 14 mm. The rationale may be found in the physiologic blockage of NMDA channels by magnesium ions (Hope & Blumenfeld, 2005). Ketogenic diet has been prescribed for decades, mostly in children, to control refractory seizures. Its use in RSE as ''ultima ratio'' has been occasionally described: three of six children (Francois et al., 2003) and one adult (Bodenant et al., 2008) were responders. This approach displays its effect subacutely over several days to a few weeks. Because ''malignant RSE'' seems at times to be the consequence of immunologic processes (Holtkamp et al., 2005), a course of immunomodulatory treatment is often advocated in this setting, even in the absence of definite autoimmune etiologies (Robakis & Hirsch, 2006); steroids, adrenocorticotropic hormone (ACTH), plasma exchanges, or intravenous immunoglobulins may be used alone or in sequential combination. Nonpharmacologic Approaches These strategies are described somewhat less frequently than pharmacologic approaches. Acute implantation of vagus nerve stimulation (VNS) has been reported in RSE (Winston et al., 2001; Patwardhan et al., 2005; De Herdt et al., 2009). Stimulation was usually initiated in the operation room, and intensity progressively adapted over a few days up to 1.25 mA (with various regimens regarding the other parameters), allowing a subacute seizure control; one transitory episode of bradycardia/asystole has been described (De Herdt et al., 2009). Of course, pending identification of a definite seizure focus, resective surgery may also be considered in selected cases (Lhatoo & Alexopoulos, 2007). Low-frequency (0.5 Hz) transcranial magnetic stimulation (TMS) at 90% of the resting motor threshold has been reported to be successful for about 2 months in a patient with epilepsia partialis continua, but with a weaning effect afterward, implying the need for a repetitive use (Misawa et al., 2005). More recently, TMS was applied in a combination of a short ''priming'' high frequency (up to 100 Hz) and longer runs of low-frequency stimulations (1 Hz) at 90-100% of the motor threshold in seven other patients with simple-partial status, with mixed results (Rotenberg et al., 2009). Paradoxically at first glance, electroconvulsive treatment may be found in cases of extremely resistant RSE. A recent case report illustrates its use in an adult patient with convulsive status, with three sessions (three convulsions each) carried out over 3 days, resulting in a moderate recovery; the mechanism is believed to be related to modification of the synaptic release of neurotransmitters (Cline & Roos, 2007). Therapeutic hypothermia, which is increasingly used in postanoxic patients (Oddo et al., 2008), has been the object of a recent case series in RSE (Corry et al., 2008). Reduction of energy demand, excitatory neurotransmission, and neuroprotective effects may account for the putative mechanism of action. Four adult patients in RSE were cooled to 31_-34_C with an endovascular system for up to 90 h, and then passively rewarmed over 2-50 h. Seizures were controlled in two patients, one of whom died; also one of the other two patients in whom seizures continued subsequently deceased. Possible side effects are related to acid-base and electrolyte disturbances, and coagulation dysfunction including thrombosis, infectious risks, cardiac arrhythmia, and paralytic ileus (Corry et al., 2008; Cereda et al., 2009). Finally, anecdotic evidence suggests that cerebrospinal fluid (CSF)-air exchange may induce some transitory benefit in RSE (Kohrmann et al., 2006); although this approach was already in use in the middle of the twentieth century, the mechanism is unknown. Acknowledgment A wide spectrum of pharmacologic (sedating and nonsedating) and nonpharmacologic (surgical, or involving electrical stimulation) regimens might be applied to attempt RSE control. Their use should be considered only after refractoriness to AED or anesthetics displaying a higher level of evidence. Although it seems unlikely that these uncommon and scarcely studied strategies will influence the RSE outcome in a decisive way, some may be interesting in particular settings. However, because the main prognostic determinant in status epilepticus appears to be related to the underlying etiology rather than to the treatment approach (Rossetti et al., 2005, 2008), the safety issue should always represent a paramount concern for the prescribing physician. Conclusion The author confirms that he has read the Journal's position on issues involved in ethical publication and affirms that this paper is consistent with those guidelines.

Evaluation of the RapidAir 457 Air Void Analyzer, March 2012

An adequate air void system is imperative to produce concrete with freeze-thaw durability in a wet freeze environment such as found in Iowa. Specifications rely on a percentage of air obtained in the plastic state by the pressure meter. Actual, in place air contents, of some concrete pavements in Iowa, have been found with reduced air content due to a number of factors such as excessive vibration and inadequate mixing. Determining hardened air void parameters is a time consuming process involving potential for human error. The RapidAir 457 air void analyzer is an automated device used to determine hardened air void parameters. The device is used in Europe and has been shown to quickly produce accurate and repeatable hardened air results. This research investigates how well the RapidAir 457 results correlate to plastic air content and the image analysis air technique. The repeatability and operator variation were also investigated, as well as, the impact of aggregate porosity and selection of threshold value on hardened air results.

Self-Consolidating Concrete—Applications for Slip-Form Paving: Phase II, May 2011

The goal of the project was to develop a new type of self-consolidating concrete (SCC) for slip-form paving to simplify construction an make smoother pavements. Developing the new SCC involved two phases: a feasibility study (Phase I sponsored by TPF-5[098] and concrete admixtures industry) and an in-depth mix proportioning and performance study and field applications (Phase II). The phase I study demonstrated that the new type of SCC needs to possess not only excellent self-consolidating ability before a pavement slab is extruded, but also sufficient “green” strength (the strength of the concrete in a plastic state) after the extrusion. To meet these performance criteria, the new type of SCC mixtures should not be as fluid as conventional SCC but just flowable enough to be self-consolidating. That is, this new type of SCC should be semi-flowable self-consolidating concrete (SFSCC). In the phase II study, effects of different materials and admixtures on rheology, especially the thixotropy, and green strength of fresh SFSCC have been further investigated. The results indicate that SFSCC can be designed to (1) be workable enough for machine placement, (2) be self-consolidating without segregation, (3) hold its shape after extrusion from a paver, and (4) have performance properties (strength and durability) comparable with current pavement concrete. Due to the combined flowability (for self-consolidation) and shape-holding ability (for slip-forming) requirements, SFSCC demands higher cementitious content than conventional pavement concrete. Generally, high cementitious content is associated with high drying shrinkage potential of the concrete. However, well-proportioned and well-constructed SFSCC in a bike path constructed at Ames, IA, has not shown any shrinkage cracks after approximately 3 years of field service. On the other hand, another SFSCC pavement with different mix proportions and construction conditions showed random cracking. The results from the field SFSCC performance monitoring implied that not only the mix proportioning method but also the construction practice is important for producing durable SFSCC pavements. A carbon footprint, energy consumption, and cost analysis conducted in this study have suggested that SFSCC is economically comparable to conventional pavement concrete in fixed-form paving construction, with the benefit of faster, quieter, and easier construction.