Evaluation of Nonvolatile Chemistry Affecting Sensory Bitterness Intensity of Highly Hopped Beers.

The range of different nonvolatile constituents extracted from hops in highly hopped beers suggests that isohumulones may not be the sole contributor to beers' bitterness. Among brewers producing hop-forward beer styles, there is concern that the bitterness unit (BU) is no longer an accurate predictor of beer bitterness. This study examined factors within the beer matrix that influence sensory bitterness perception in highly hopped beers. Over 120 commercial beers were evaluated using sensory and instrumental techniques. Chemical analysis consisted of the BU via spectrophotometry, hop acids via high-performance liquid chromatography, total polyphenols via spectrophotometry, and alcohol content plus real extract via an Alcolyzer. Sensory analysis was conducted over two studies, and the beers' overall bitterness intensities were rated using a 0-20 scale. This study identified that the BU measurement predicts sensory bitterness with a nonlinear response, and it proposed an alternative approach to predicting bitterness based on isohumulones, humulinones, and ethanol concentrations. The study also revealed the importance of oxidized hop acids, humulinones, as a significant contributor to beer bitterness intensity.

Accuracy and Reliability of Triage at the Point of Injury During Operation Enduring Freedom.

BACKGROUND: Accurate point-of-injury reports and casualty evacuation requests allow for optimal resource utilization. However, the accuracy of these reports has not been previously studied. METHODS: All trauma patients treated at one of three forward surgical elements (FSE) in Western Afghanistan during May-August 2012 were prospectively included. North American Treaty Organization (NATO) 9-line medical evacuation request and mechanism, injuries, signs, and treatments (MIST) reports were compared to the initial findings on arrival to the FSE. RESULTS: There were 179 casualty evacuation reports and 298 patients. NATO 9-line and/or MIST reports were available for 70% of these. Triage was accurate for 77%, but there was 17% overtriage and 6% undertriage (k = .619). The number of patients was accurate in 95% of reports, the mechanism of injury was accurate for 98%, and the body region involved was accurate for 92% (k = .850, .943, and .870, respectively). There was no difference between the mean vital signs at the point of injury or on arrival at the FSE. When analyzed individually, however, there was no correlation between each casualty's pulse, mean arterial pressure, or respiratory rate between the two time points. DISCUSSION: There was a high degree of correlation between the triage category of casualty evacuation reports and the patient's actual medical needs. There was also a highly significant association with the number of patients, mechanism of injury, and bodily injuries. However, there was discordance between the vital signs at an individual level, which may represent regression toward the resuscitation threshold.

Presacral epidermoid cyst in a male: a case report and literature review.

Presacral cysts are an uncommon entity most often found incidentally in women. These tumors can arise from any of the 1 or more cell lines present in the presacral space during embryogenesis. We present a case of a 46-year-old male patient who was found to have a well-circumscribed presacral mass on computed tomography (CT) scan, which was obtained for his complaint of vague lower back pain. He underwent transabdominal excision, and pathology revealed a presacral epidermoid cyst filled with keratinaceous material. Presacral cysts are rare, especially in male patients. These tumors originate from an embryologic error during development. Because of the risk of infection and malignant transformation, they should be excised. Surgical options include a posterior approach, transabdominal approach, combined approach, or transrectal approach. The approach is dictated by the tumor size, location, presence of malignancy, and bony invasion.

Pneumoperitoneum due to gastric perforation after cardiopulmonary resuscitation: case report.

BACKGROUND: Pneumoperitoneum after cardiopulmonary resuscitation may be due to mediastinal air tracking into the peritoneal cavity via the diaphragmatic hiatus or to gastric perforation. CASE REPORT: A 79-year-old woman received Advanced Cardiac Life Support measures in the intensive care unit. Chest compressions and endotracheal intubation were performed; a stable cardiac rhythm and perfusion were restored. A chest radiograph after resuscitation revealed pneumoperitoneum without pneumomediastinum. The patient underwent laparotomy; a 6-cm perforation of the posterior gastric wall along the lesser curve was detected and repaired. CONCLUSION: Gastric perforation after cardiopulmonary resuscitation should be suspected when chest radiographs obtained after resuscitation show pneumo-peritoneum without pneumomediastinum. Prompt laparotomy allows detection of gastric perforations and decreases the morbidity associated with rupture of a hollow organ. The incidence of gastric perforation after cardiopulmonary resuscitation may be decreased with early endotracheal intubation, avoidance of esophageal intubation, and expeditious placement of an orogastric tube.