Lactate clearance and survival following injury

Previous reports cite optimization of O2 delivery (DO2) to 660 mL/min/m2, O2 consumption (VO2) to 170 mL/min/m2, and cardiac index (CI) of 4.5 L/min as predicting survival. We prospectively evaluated 76 consecutive patients with multiple trauma admitted directly to the ICU from the operating room or emergency department. Patients had serum lactate levels and oxygen transport measured on ICU admission and at 8, 16, 24, 36, and 48 hours. Patients were analyzed with respect to survival (S) versus nonsurvival (NS), lactate clearance to normal (< or = 2 mmol/L) by 24 and 48 hours, hemodynamic optimization as defined above, as well as Injury Severity Score (ISS), ICU stay (LOS), and admission blood pressure. All patients achieved non-flow-dependent VO2. There was no difference in CI, DO2, VO2, or ISS when S was compared with NS. All 27 patients whose lactate level normalized in 24 hours survived. If lactate levels cleared to normal between 24 and 48 hours, the survival rate was 75%. Only 3 of the 22 patients who did not clear their lactate level to normal by 48 hours survived. Ten of the 25 nonsurvivors (40%) achieved the above arbitrary optimization criteria. Fifteen of the survivors never achieved any of these criteria. Optimization alone does not predict survival. However, the time needed to normalize serum lactate levels is an important prognostic factor for survival in severely injured patients.     

Pharmacokinetic and pharmacodynamic effects of vaginal rings releasing levonorgestrel at a rate of 27 micrograms/24 hours: a pilot study

The pharmacokinetic and pharmacodynamic effects of vaginal rings releasing levonorgestrel (L-NOG) at an initial rate of 27 micrograms/24 h were studied in a group of 12 normally menstruating women during 90 days of continuous use (i.e., during three 30-day treatment segments). Blood samples were drawn immediately before insertion, 15 and 30 min, as well as 1, 2, 4, 8, 12 and 24 h after insertion of the rings, and thereafter three times weekly throughout the study for the analysis of L-NOG, estradiol, progesterone and sex hormone-binding globulin (SHBG). Endometrial biopsies were obtained for a morphometric analysis in a pre-treatment (control) cycle and in the 6th and 10th weeks of treatment. The peak of average L-NOG levels was reached within two hours after the insertion of rings. Until 24 h after insertion, the levels did not change significantly. Thereafter, a decrease at a rate of 0.2% per day was initiated. The L-NOG and SHBG levels were highly correlated. This was seen for both the pre-treatment SHBG vs L-NOG (r = 0.96) and the treatment SHBG vs L-NOG levels (r = 0.92). There was a significant (p < 0.001) decrease of SHBG levels due to treatment. During the total of 36 treatment segments, a normal ovarian function was seen in 47% of the segments. The women were anovulatory and had an inadequate lutal function in 28% and 25% of segments, respectively. No correlation between the L-NOG levels and ovarian reaction to treatment was found. The use of L-NOG induced significant changes in the endometrium; the number of glands/mm2 decreased after 6 (p < 0.02) and 10 weeks of use (p < 0.01). Also, the diameter of glands and the occurrence of vacuolated cells decreased significantly (p < 0.02 and p < 0.005, respectively). None of the endometrial parameters or dating was correlated with the ovarian reaction to treatment, indicating independent endometrial effects of L-NOG.     

Adeno-associated virus 2-mediated high efficiency gene transfer into immature and mature subsets of hematopoietic progenitor cells in human umbilical cord blood

Recombinant adeno-associated virus 2 (AAV) virions were constructed containing a gene for resistance to neomycin (neoR), under the control of either the herpesvirus thymidine kinase (TK) gene promoter (vTK-Neo), or the human parvovirus B19 p6 promoter (vB19-Neo), as well as those containing an upstream erythroid cell-specific enhancer (HS-2) from the locus control region of the human beta-globin gene cluster (vHS2-TK-Neo; vHS2-B19-Neo). These recombinant virions were used to infect either low density or highly enriched populations of CD34+ cells isolated from human umbilical cord blood. In clonogenic assays initiated with cells infected with the different recombinant AAV-Neo virions, equivalent high frequency transduction of the neoR gene into slow-cycling multipotential, erythroid, and granulocyte/macrophage (GM) progenitor cells, including those with high proliferative potential, was obtained without prestimulation with growth factors, indicating that these immature and mature hematopoietic progenitor cells were susceptible to infection by the recombinant AAV virions. Successful transduction did not require and was not enhanced by prestimulation of these cell populations with cytokines. The functional activity of the transduced neo gene was evident by the development of resistance to the drug G418, a neomycin analogue. Individual high and low proliferative colony-forming unit (CFU)-GM, burst-forming unit-erythroid, and CFU-granulocyte erythroid macrophage megakaryocyte colonies from mock-infected, or the recombinant virus-infected cultures were subjected to polymerase chain reaction analysis using a neo-specific synthetic oligonucleotide primer pair. A 276-bp DNA fragment that hybridized with a neo-specific DNA probe on Southern blots was only detected in those colonies cloned from the recombinant virus-infected cells, indicating stable integration of the transduced neo gene. These studies suggest that parvovirus-based vectors may prove to be a useful alternative to the more commonly used retroviral vectors for high efficiency gene transfer into slow or noncycling primitive hematopoietic progenitor cells, without the need for growth factor stimulation, which could potentially lead to differentiation of these cells before transplantation.     

Dense Al2O3/ZrO2 Particulate Composites by Free Sintering of Coated Powders

Composite powders, prepared by coating coarse ZrO₂ particles with fine Al₂O₃ powder using a chemical precipitation technique, were compacted and sintered freely at a constant heating rate of 4°C/min to ∼1600°C. Composites containing up to ∼30 vol% inclusions were sintered to nearly full density under the same conditions used for the unreinforced matrix. Furthermore, the sintering kinetics were not influenced significantly by the inclusion volume fraction. The sinterability of the composites formed from the coated powders was significantly better than that for similar composites formed from mechanically mixed powders. The present data provide a further demonstration that the use of coated powders may have widespread applicability for the fabrication, by free sintering, of dense ceramic particulate composites.     

Sintering of Ceramic Particulate Composites: Effect of Matrix Density

Composites consisting of a fine-grained, polycrystalline zinc oxide matrix and <10 vol% coarse, rigid silicon carbide inclusions were prepared by the same mixing procedure and then compacted to produce samples with matrix densities of 0.45 and 0.68 of the theoretical. The samples were sintered under identical temperature profiles in separate experiments that employed either a constant rate of heating of 4°C/min or near isothermal heating at 735°C. The ratio of the densification rate of the composite matrix to the densification rate of the unreinforced zinc oxide was found to be independent of the initial matrix density. This ratio increased significantly with temperature in the constant-heating-rate experiments but was relatively constant in the isothermal experiments. The results indicate that microstructural coarsening may be an important mechanism for explaining the reduced sinterability of polycrystalline matrix composites.     

Ceramics for Prosthetic Hip and Knee Joint Replacement

The most commonly used bearing couple in prosthetic hip or knee joint replacements consists of a cobalt–chrome (CoCr) metal alloy articulating against ultrahigh-molecular-weight polyethylene. Ceramics have been used as an alternative to metal-on-polyethylene in joint replacement surgery of arthritic hips and knees since the 1970s. In prosthetic hip and knee bearings, ceramic surfaces offer a major benefit of drastically reduced wear rates and excellent long-term biocompatibility, which can increase the longevity of prosthetic hip and knee joints. This benefit is important clinically because hip and knee replacement has become a very common surgical procedure, particularly in the United States, and because these procedures are being increasingly performed in younger patients who place greater demands on the prosthetic bearings. However, ceramics are brittle and the risk of catastrophic bearing failure in vivo , while rare, is a major concern. Improvements in material quality, manufacturing methods, and implant design have resulted in a drastic reduction of the incidence of such failures, so that modern ceramic bearings are safe and reliable if used with components of proven design and durability. Future material improvements are actively being investigated to reduce the risk of ceramic-bearing failures even further. The purpose of this article is to review the structure, properties, applications, and limitations of the ceramics that have been used in orthopedic bearings, and to describe the new ceramic composite materials and surface treatments that will be available for joint replacement surgery in the near future.     

Creep-sintering of polycrystalline ceramic particulate composites

The sintering of particulate composites consisting of a polycrystalline zinc oxide matrix with 10 vol % zirconia inclusions of two different sizes (3 and 14 m) was investigated at a constant heating rate of 4 °C min^–1 under an applied stress of 300 kPa. The presence of the inclusions produced a decrease in both the creep rate and the densification rate but the ratio of the densification to creep rate remained constant during the experiment. The ratio of the densification rate to creep rate for the composites was 1.5 times greater than that of the unreinforced matrix regardless of inclusion size. The creep viscosity of the composites was higher than that of the unreinforced matrix and increased slightly with decreasing inclusion size.     

Optimal Machine Learning Enabled Performance Monitoring for Learning Management Systems

Learning Management System (LMS) is an application software that is used in automation, delivery, administration, tracking, and reporting of courses and programs in educational sector. The LMS which exploits machine learning (ML) has the ability of accessing user data and exploit it for improving the learning experience. The recently developed artificial intelligence (AI) and ML models helps to accomplish effective performance monitoring for LMS. Among the different processes involved in ML based LMS, feature selection and classification processes find beneficial. In this motivation, this study introduces Glowworm-based Feature Selection with Machine Learning Enabled Performance Monitoring (GSO-MFWELM) technique for LMS. The key objective of the proposed GSO-MFWELM technique is to effectually monitor the performance in LMS. The proposed GSO-MFWELM technique involves GSO-based feature selection technique to select the optimal features. Besides, Weighted Extreme Learning Machine (WELM) model is applied for classification process whereas the parameters involved in WELM model are optimally fine-tuned with the help of Mayfly Optimization (MFO) algorithm. The design of GSO and MFO techniques result in reduced computation complexity and improved classification performance. The presented GSO-MFWELM technique was validated for its performance against benchmark dataset and the results were inspected under several aspects. The simulation results established the supremacy of GSO-MFWELM technique over recent approaches with the maximum classification accuracy of 0.9589.     

Localization of atrial natriuretic peptide receptors in the rat tongue and hard palate

The effect of a naturally occurring plant phenolic constituent (the acylphloroglucinol derivative, jensenone, derived from Eucalyptus jensenii) on the food intake of two folivorous marsupials, the common ringtail (Pseudocheirus peregrinus) and the common brushtail possum (Trichosurus vulpecula) was studied. When fed diets containing varying concentrations of jensenone, both species regulated their intake of jensenone so as not to exceed a ceiling intake. This ceiling was about twice as high for common ringtails as for common brushtails from northern Australia. Southern populations of common ringtails showed greatly reduced capacities to tolerate jensenone. When common brushtails were injected (0.5 mg.kg-0.75 body mass) with ondansetron (a selective antagonist of serotonin 5HT3 receptors), they ate significantly more jensenone than animals injected with physiological saline. The same pattern was observed when common ringtails were fed diets containing both jensenone and ondansetron (0.0035 mg.g-1 wet mass of diet). Ondansetron injection had no effect on food intake when the food did not contain jensenone while the addition of higher doses of ondansetron to diets of common ringtails very slightly reduced food intakes of a non-jensenone diet. When common brushtails were given 50 mg of jensenone by gastric lavage, their average subsequent intake of dietary jensenone matched the difference between the daily threshold and the dose given, although the response of individuals was highly variable. Lavage with water alone had no effect on subsequent jensenone intake compared with the pre-dose period. We interpret these results as evidence that the antifeedant effects of jensenone and related compounds are partly mediated by serotonin action on 5HT3 receptors most likely via "nausea" to condition a food aversion.