Age over 40 years increases the failure rate of non-operative management of blunt splenic injuries

Objective: Non-operative management (NOM) of blunt splenic injuries (BSI) is nowadays considered the standard treatment. The study aimed to determine the criteria applied for NOM and to identify risk factors for its failure. Methods: Review of all adult patients with BSI treated at the University Hospital Bern, Switzerland, between 2000 and 2008. Results: There were 206 patients (146 men, 70·9%) with a mean age of 38·2 ± 19·1 years and an Injury Severity Score of 30·9 ± 11·6. The American Association for the Surgery of Trauma classification of the splenic injury was: grade I, n=43 (20·9%); grade II, n=52 (25·2%); grade III, n=60 (29·1%); grade IV, n=42 (20·4%) and grade V, n=9 (4·4%). 47 patients (22·8%) required immediate surgery. Five or more units of red cell transfusions (P<0·001), Glasgow Coma Scale<11 (P=0·009) and age ≥55 years (P=0·038) were associated with primary operative management (OM). 159 patients (77·2%) qualified for NOM, which was successful in 89·9% (143/159). The overall splenic salvage rate was 69·4% (143/206). Multivariate analysis found age ≥40 years to be the only factor independently related to the failure of NOM (P=0·001). Conclusion: Advanced age is associated with an increased failure rate ofNOM in patients with BSI.

A double layer model of the gas bubble/water interface

Zeta potential is a physico-chemical parameter of particular importance to describe sorption of contaminants at the surface of gas bubbles. Nevertheless, the interpretation of electrophoretic mobilities of gas bubbles is complex. This is due to the specific behavior of the gas at interface and to the excess of electrical charge at interface, which is responsible for surface conductivity. We developed a surface complexation model based on the presence of negative surface sites because the balance of accepting and donating hydrogen bonds is broken at interface. By considering protons adsorbed on these sites followed by a diffuse layer, the electrical potential at the head-end of the diffuse layer is computed and considered to be equal to the zeta potential. The predicted zeta potential values are in very good agreement with the experimental data of H-2 bubbles for a broad range of pH and NaCl concentrations. This implies that the shear plane is located at the head-end of the diffuse layer, contradicting the assumption of the presence of a stagnant diffuse layer at the gas/water interface. Our model also successfully predicts the surface tension of air bubbles in a KCl solution. (c) 2012 Elsevier Inc. All rights reserved.

The circadian rhythm of the perinatal mortality rate in Switzerland.

The authors examine the relation between the perinatal mortality rate (PMR), birth weight in four categories, and hour of birth throughout the week in Switzerland, using data on 672,013 births and 5,764 perinatal deaths recorded between 1979 and 1987. From Monday to Friday, the PMR follows a circadian rhythm with a regular increase from early morning to evening, with a peak for babies born between 7 and 8 p.m. This pattern of variation has two main components: The circadian rhythms for the proportion of births in the four weight categories and the PMR circadian rhythm for babies weighing more than 2.5 kg. According to a cosinor model, which describes about 40% of the total variation in the PMR, the most important determinants are changes in the proportions of births: Low birth weight increases toward the afternoon and night. Mechanisms underlying the weight-specific timing of birth are discussed, including time selection of birth according to obstetric risks, the direct effect of neonatal and obstetric care, and chronobiologic behavior.

Carvedilol inhibits the cardiostimulant and thermogenic effects of MDMA in humans.

BACKGROUND AND PURPOSE: The use of ± 3,4-methylenedioxymethamphetamine (MDMA, 'ecstasy') is associated with cardiovascular complications and hyperthermia. EXPERIMENTAL APPROACH: We assessed the effects of the α(1) - and β-adrenoceptor antagonist carvedilol on the cardiostimulant, thermogenic and subjective responses to MDMA in 16 healthy subjects. Carvedilol (50 mg) or placebo was administered 1 h before MDMA (125 mg) or placebo using a randomized, double-blind, placebo-controlled, four-period crossover design. KEY RESULTS Carvedilol reduced MDMA-induced elevations in blood pressure, heart rate and body temperature. Carvedilol did not affect the subjective effects of MDMA including MDMA-induced good drug effects, drug high, drug liking, stimulation or adverse effects. Carvedilol did not alter the plasma exposure to MDMA. CONCLUSIONS AND IMPLICATIONS: α(1) - and β-Adrenoceptors contribute to the cardiostimulant and thermogenic effects of MDMA in humans but not to its psychotropic effects. Carvedilol could be useful in the treatment of cardiovascular and hyperthermic complications associated with ecstasy use.

Breeding rate is associated with pheomelanism in male and with eumelanism in female barn owls

Melanin-based coloration exists in 2 types: black eumelanism and reddish-brown pheomelanism, which both have a strong heritable component. To test whether these 2 types of melanism are associated with alternative adaptations, we carried out a correlative study over 8 years and an experiment in a Swiss population of barn owls, Tyto alba. This species varies in coloration from reddish-brown to white and from lightly to heavily marked with black spots. Based on the fact that plumage coloration and spottiness are male- and female-specific secondary sexual characters, respectively, we examined whether the probability of breeding is associated with the degree of pheomelanism in males and of eumelanism in females. In males, recruited nestlings were significantly less reddish-brown than their nonrecruited nest mates. In females, individuals displaying larger black spots started to breed at a younger age and had a higher survival, and females with experimentally reduced plumage spottiness bred less often than control females. Therefore, in the barn owl, the degree of male pheomelanism is associated with the probability of being recruited in the local population, whereas the degree of female eumelanism correlates with age at sexual maturity, survival probability, and also the probability of skipping reproduction.

Concepts and Rationale for Regional Nitrogen Rate Guidelines for Corn, April 2006

Nitrogen (N) is typically one of the largest corn fertilization expenses. Nitrogen application is critical because it signifi cantly improves corn yield in many crop rotations. When choosing N rates, producers need to carefully consider both achieving most profi table economic return and advancing environmental stewardship. In 2004, university agronomists from the Corn Belt states began discussions regarding N rate use for corn production. The reasons for the discussions centered on apparent differences in methods for determining N rates across states, misperceptions regarding N rate guidelines, and concerns about application rates as corn yields have climbed to historic levels. An outcome of those discussions was an effort with the objectives to: ▪ develop N rate guidelines that could be applicable on a regional basis and ▪ identify the most profi table fertilizer N rates for corn production across the Corn Belt. This publication provides an overview of corn N fertilization in regard to rate of application, investigates concepts for determining economic application rates, and describes a suggested regional approach for developing corn N rate guidelines directly from recent research data.

Managing hypertension in high-risk patients: lessons and promises from the STRATHE and ADVANCE trials.

Pharmacological treatment of hypertension represents a cost-effective way of preventing cardiovascular and renal complications. To benefit maximally from antihypertensive treatment, blood pressure should be brought to below 140/90 mmHg in every hypertensive patient, and even lower (< 130/80 mmHg) if diabetes or renal disease co-exists. Such targets cannot usually be reached using monotherapies. This is especially true in patients who present with a high cardiovascular risk. The co-administration of two agents acting by different mechanisms considerably increases the blood pressure control rate. Such combinations are not only efficacious, but are also well tolerated, and some fixed low-dose combinations even have a placebo-like tolerability. This is the case for the preparation containing the angiotensin-converting enzyme inhibitor perindopril (2 mg) and the diuretic indapamide (0.625 mg), a fixed low-dose combination that has been shown in controlled trials to be more effective than monotherapies in reducing albuminuria, regressing cardiac hypertrophy and improving the stiffness of large arteries. Using this combination to initiate antihypertensive therapy has been shown in a double-blind trial (Strategies of Treatment in Hypertension: Evaluation; STRATHE) to normalize blood pressure (< 140/90 mmHg) in significantly more patients (62%) than a sequential monotherapy approach based on atenolol, losartan and amlodipine (49%) and a stepped-care strategy based on valsartan and hydrochlorothiazide (47%), with no difference between the three arm groups in terms of tolerability. An ongoing randomized trial (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation; ADVANCE) is a study with a 2 x 2 factorial design assessing the effects of the fixed-dose perindopril-indapamide combination and of the intensive gliclazide modified release-based glucose control regimen in type 2 diabetic patients, with or without hypertension. A total of 11 140 patients were randomly selected. Within the first 6 weeks of treatment (run-in phase), the perindopril-indapamide combination lowered blood pressure from 145/81 +/- 22/11 mmHg (mean +/- SD) to 137/78 +/- 20/10 mmHg. Fixed-dose combinations are becoming more and more popular for the management of hypertension, and are even proposed by hypertension guidelines as a first-line option to treat hypertensive patients.

Decreased binding of peptides-MHC class I (pMHC) multimeric complexes to CD8 affects their binding avidity for the TCR but does not significantly impact on pMHC/TCR dissociation rate.

The CD8 coreceptor plays a crucial role in both T cell development in the thymus and in the activation of mature T cells in response to Ag-specific stimulation. In this study we used soluble peptides-MHC class I (pMHC) multimeric complexes bearing mutations in the CD8 binding site that impair their binding to the MHC, together with altered peptide ligands, to assess the impact of CD8 on pMHC binding to the TCR. Our data support a model in which CD8 promotes the binding of TCR to pMHC. However, once the pMHC/TCR complex is formed, the TCR dominates the pMHC/TCR dissociation rates. As a consequence of these molecular interactions, under physiologic conditions CD8 plays a key role in complex formation, resulting in the enhancement of CD8 T cell functions whose specificity, however, is determined by the TCR.

Œuvres de s. Denis, double traduction et commentaires.

Jacobins de la rue Saint-Jacques.

Leading Double Lives: The History of the Double House in Des Moines, 2005

How people choose to live depends on a variety of social and economic circumstances. Single family dwellings, extended family compounds, and communal apartment blocks are all forms of residential architecture that have ancient roots and occur in every culture. Each form both reflects and affects the living styles of the people who reside there. The double house, which shelters two families in units separated by a wall or floor, balances the convenience of an apartment with the psychological comforts of a home. During the mid to late nineteenth and early twentieth centuries in the United States, the double house was hugely popular in some cities, such as Minneapolis and Milwaukee, but only a minimal presence in Des Moines

O impacto das energias renováveis na economia dos países emergentes: o caso de Cabo Verde

A elevada dependência dos combustíveis fósseis é uma das principais dificuldades sentidas no actual sistema energético de Cabo Verde. O preço dos combustíveis constitui um peso significativo, representando cerca de 70%, da estrutura de custos do preço de energia eléctrica. Com este trabalho, pretende-se analisar o impacto das energias renováveis no sistema energético e na economia de Cabo Verde, destacando a sua contribuição para a formação do PIB, no Preço, na Balança de Pagamentos, no Emprego, e no Serviço da Dívida, e estabelecer uma comparação com as ilhas da Macaronésia, em particular a Região Autónoma dos Açores. Contribuindo assim, para a discussão que poderá demonstrar que o potencial de renováveis por explorar, trará benefícios económicos para o país, pois a expectativa é superar os 50% de taxa de penetração de Energias Renováveis na produção de electricidade em Cabo Verde até 2020. Prevê-se que o consumo de electricidade que em 2010 era de 335 MWh, duplique até o ano de 2020, atingindo os 670 GWh. Segundo estudos efectuados, o país possui um potencial estimado de 2.600 MW de Energias Renováveis, tendo sido analisados mais de 650 MW em projectos concretos com custos de produção possivelmente inferiores aos dos combustíveis fósseis. Cabo Verde goza de boas condições para o aproveitamento de Energias Renováveis, mas a contribuição desse potencial, sobretudo eólica e solar, continuam muito limitado, pelo que o país deverá apostar no incremento da utilização dessas formas de energia para reduzir a dependência externa em matéria de energia. The high dependence on fossil fuels is one of the main difficulties in the current energy system in Cape Verde. The price of fuel is a significant, accounting for about 70%, and the cost structure of the price of electricity. With this work, seeks to analyze the impact of renewable energy in the energy system and the economy of Cape Verde, highlighting their contribution to the formation of BIP, in the Balance of Payments, in Employment, and the Service of Debt, and to draw a comparison with the islands of Macaronésia, in particular the Autonomous Region of Azores. Thus contributing to the discussion that may show that the potential of renewable energy by exploring will bring economic benefits to the country, because the expectation is to exceed the 50% penetration rate of Renewable Energy in the production of electricity in Cape Verde until 2020. It is estimated that the consumption of electricity in 2010 was 335 MWh, will double by the year 2020, reaching the 670 GWh. According to studies carried out, the country has an estimated potential of 2,600 MW of Renewable Energy, having been analyzed more than 650 MW in concrete projects with production costs possibly less than the fossil fuels. Cape Verde enjoys good conditions for the use of renewable energy, but the contribution of this potential, especially wind and solar, are still very limited, so that the country should invest in increasing the use of these forms of energy to reduce the dependence on foreign sources of energy.

Rapid Improvement in Health-Related Quality of Life in Gouty Arthritis Patients Treated with Canakinumab (ACZ885) Compared to Triamcinolone Acetonide

Background: Gout patients initiating urate lowering therapy have an increased risk of flares. Inflammation in gouty arthritis is induced by interleukin (IL)-1b. Canakinumab inhibits IL-1b effectively in clinical studies. This study compared different doses of canakinumab vs colchicine in preventing flares in gout patients initiating allopurinol therapy.Methods: In this 24 wk double blind study, gout patients (20-79 years) initiating allopurinol were randomized (1:1:1:1:1:1:2) to canakinumab s.c. single doses of 25, 50, 100, 200, 300 mg, or 150mg divided in doses every 4 wks (50þ50þ25þ25mg [q4wk]) or colchicine 0.5mg p.o. daily for 16 wks. Primary outcome was to determine the canakinumab dose giving comparable efficacy to colchicine with respect to number of flares occurring during first 16 wks. Secondary outcomes included number of patients with flares and C-reactive protein (CRP) levels during the first 16 wks.Results: 432 patients were randomized and 391 (91%) completed the study. All canakinumab doses were better than colchicine in preventing flares and therefore, a canakinumab dose comparable to colchicine couldn't be determined. Based on a negative binomialmodel, all canakinumab groups, except 25 mg, reduced the flare rate ratio per patient significantly compared to colchicine group (rate ratio estimates 25mg 0.60, 50mg 0.34, 100mg 0.28, 200mg 0.37, 300mg 0.29, q4wk 0.38; p_0.05). Percentage of patients with flares was lower for all canakinumab groups (25mg 27.3%, 50mg 16.7%, 100mg 14.8%, 200mg 18.5%, 300mg 15.1%, q4wk 16.7%) compared to colchicine group (44.4%). All patients taking canakinumab were significantly less likely to experience at least one gout flare than patients taking colchicine (odds ratio range [0.22 - 0.47]; p_0.05 for all). Median baseline CRP levels were 2.86 mg/L for 25 mg, 3.42 mg/L for 50 mg, 1.76 mg/L for 100 mg, 3.66 mg/L for 200 mg, 3.21 mg/L for 300 mg, 3.23 mg/L for q4wk canakinumab groups and 2.69 mg/L for colchicine group. In all canakinumab groups with median CRP levels above the normal range at baseline, median levels declined within 15 days of treatment and were maintained at normal levels (ULN¼3 mg/L) throughout the 16 wk period. Adverse events (AEs) occurred in 52.7% (25 mg), 55.6% (50 mg), 51.9% (100 mg), 51.9% (200 mg), 54.7% (300 mg), 58.5% (q4wk) of patients on canakinumab vs 53.7% of patients on colchicine. Serious AEs (SAE) were reported in 2 (3.6%; 25 mg), 2 (3.7%, 50 mg), 3 (5.6%, 100 mg), 3 (5.6%, 200 mg), 3 (5.7%, 300 mg), 1 (1.9%, q4wk) patients on canakinumab and in 5 (4.6%) patients on colchicine. 1 fatal SAE (myocardial infarction, not related to study drug) occurred in colchicine group.Conclusions: In this randomized, double-blind active controlled study of flare prevention in gout patients initiating allopurinol therapy, treatment with canakinumab led to a statistically significant reduction in flares compared with colchicine and was well tolerated.Disclosure statement: U.A., A.B., G.K., D.R. and P.S. are employees of and have stock options or bold holdings with Novartis Pharma AG. E.M. is a principal investigator for Novartis Pharmaceuticals Corporation. E.N. has received consulting fees from Roche. N.S. has received research grants from Novartis Pharmaceuticals Corporation. A.S. has received consultancy fees from Novartis Pharma AG, Abbott, Bristol-Myers Squibb, Essex, Pfizer, MSD, Roche, UCB and Wyeth. All other authors have declared no conflicts of interest.