Early Postoperative Vital Signs Predict Subsequent 90-Day Mortality After Pancreaticoduodenectomy.

BACKGROUND: While complication rates after pancreaticoduodenectomy (PD) have improved in recent decades, surgical-related death remains a possibility. Postoperative vital signs offer an untapped opportunity to identify predictors of 90-day mortality. METHODS: We performed a retrospective chart review interrogating postoperative day (POD 0-7) vital sign measurements from patients undergoing a PD at Thomas Jefferson University Hospital, Philadelphia, PA (2009-2014). Five specific vital signs were examined as predictors of mortality: temperature, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure. Statistical analyses and logic algorithms were employed to rank vital sign parameters, with cut-points, to identify those associated with the highest risk of mortality and the most clinical relevance. RESULTS: In our cohort, 11/750 patients (1.5%) died within 30 days of surgery, and 21/750 patients (2.8%) died within 90 days of surgery. Vital sign perturbations associated with the highest risk of mortality included mean SBP < 95 mmHg on POD 7 (odds ratio 51.46) and the mean temperature < 96.9℉ on POD 3 (odds ratio 22.63) with specificities exceeding 99%. The most clinically relevant predictor (i.e., a higher sensitivity) was DBP < 60.5 mmHg on POD 7 (odds ratio 12.45, sensitivity of 75%). These predictors remained statistically significant in a multivariable model. CONCLUSIONS: Vital signs can be more effectively utilized to predict 90-day mortality after pancreaticoduodenectomy. Values beyond an informative threshold can potentially identify patients for more intensive monitoring with a goal of rescuing patients and preventing death.

Science Revealing Ancient Magic: Phytolith Evidence from the Early Chalcolithic Site of Isaiia (Eastern Romania).

The article presents the palaeobotanical investigations of a remarkable discovery from the Early Chalcolithic settlement of Isaiia-Balta Popii (Romania), a multi-layered site. The excavation of a dwelling brought to light a rather rare finding, meaning a medium sized ceramic vessel having deposited inside two objects of burnt clay: an anthropomorphic figurine depicting pregnancy attributes and a small cone. Given the special character of the deposition, several samples from the vessel and near it were collected for phytolith analysis. Our results highlighted a ritual plant deposition: Elongate dendritic and Blocky morphotypes suggest that cereals and probably Artemisia seem to have been used for this purpose. These plants are known, aside from their practical uses, as powerful symbols, used through the ages in magic practices. All of these facts are strong arguments to interpret this find as a result of a ritual related to fertility involving both feminine and masculine symbols and plant use.

Neutrophil Extracellular Traps in Coronavirus Disease-19-Associated Ischemic Stroke: A Novel Avenue in Neuroscience.

Ischemic stroke is one of the catastrophic neurological events that are being increasingly recognized among Coronavirus Disease (COVID)-19 patients. The recent studies have revealed about a possible connection among COVID-19, ischemic stroke, and excessive Neutrophil Extracellular Traps (NETs) formation. This paper establishes an overview of coronaviruses and NETs, NETs in pathogenesis of COVID-19 induced-ischemic stroke, and future directions using related recent literatures. NETs are normally functioned for a defense against pathogens, but in immoderate amount, they can trigger series of destructive events. Vasculopathy and neuroinflammation are the pathological mechanisms of NETs suggested to link COVID-19 and ischemic stroke. Based on newly discovered possible mechanisms, the potential clinical implications that could be applied consists of inhibition of NET formation, disrupting cholesterol synthesis, and interfering inflammatory pathway. A considerable number of scientific works are needed in order to complete the current understanding of the emerging relationship among COVID-19, NETs, and ischemic stroke. Although the exact mechanism is still unknown, these novel findings are a worthwhile contribution in defining future studies, suitable future frameworks, and therapeutic strategies.

OM, SEM-EDX, and micro-FTIR analysis of the Bronze Age pottery from the Baile Figa salt production site (Transylvania, Romania).

This article presents the results of analyses carried out on a lot of 11 fragments of Bronze Age ceramics discovered in the site from Baile Figa (Beclean town, Transylvania, Romania), where salt exploitation occurred. The samples were analyzed by means of optical microscopy, on the basis of which the morphology and distribution of the inclusions in the ceramic paste was established. Likewise, the samples were analyzed by scanning electron microscopy with energy-dispersive X-ray spectrometry, producing microphotographs for each sample, and on the basis of the X-ray spectra, the elemental composition in gravimetric percentages was established. Through the micro-Fourier-transform infrared spectroscopy analysis, on the basis of characteristic group vibrations, it was possible to ascertain the nature of the compounds from the ceramic samples. These analyses will contribute to the reconstruction of the prehistoric technologies for salt exploitation.

Establishing the archaeo-metallurgic ornamentation process of an axe from the bronze age by OM, SEM-EDX, and micro-FTIR.

Our article presents the results of the analyses we performed by corroborating the Optical Microscopy, Scanning Electron Microscopy, Energy Dispersive Xray Analysis and micro Fourier Transformed InfraRed Analysis techniques to identify the archaeo-metallurgic casting and ornamentation procedure of a decorated disk-butted axe, which was discovered recently east of the Carpathian mountains, in the Moldavian Plateau. There are few known axes of that type found (A1, according to the usual typologies), as they are specific to the Middle Bronze Age period west of the Carpathians-the Wietenberg, Suciu de Sus, and Otomani-Füzesabony cultures. The experimental data on the item under study revealed the fact that after casting it in molds made from porous silicone-based stone, the object was coated with a thin layer, by immersing it in a lightly fusible tin alloy, whose main alloy component was copper and arsenic and iron as secondary components. After refining the shiny white layer, they applied a beautiful decoration pattern made by incision and engraving. This battle axe was an indication of higher status, such items usually being owned by community leaders. This important fact proves that the ancient metallurgic craftsmen were able to elaborate and manufacture various alloys from which they made beautiful objects and it also offers a new insight into the social and symbolic function of certain antique bronze items.