Relaxing Floors: Fractal Fluency in the Built Environment.

This year's cover artists are members of a newly formed team of designers and scientists known as the Science and Design Laboratory, along with flooring manufacturing experts from the Mohawk Group. This unique collab-oration creates patterns for installation on the floors of versatile commercial, public and private spaces including airports, hospitals, offices and homes. Their goal is to create human-centered designs based on psychology experiments that investigate the positive impacts of viewing fractal patterns. These include reduced physiological stress levels, enhanced cognitive skills, and heightened concentration. Here, the fractal construction process and the resulting fractal characteristics of these designs are explained.

Hypertonic saline inhibits arachidonic acid priming of the human neutrophil oxidase.

BACKGROUND: Arachidonic acid (AA, and its leukotriene derivatives, e.g., LTB(4)) is an inflammatory mediator in post-shock mesenteric lymph that appears to act as an agonist on G-protein coupled receptors (GPCRs). These mediators prime neutrophils (PMNs) for an increased production of superoxide, implicated in the development of acute lung injury (ALI). Hypertonic saline (HTS) has also been shown to have immunomodulatory effects such as attenuation of PMN priming by precluding appropriate clathrin-mediated endocytosis of activated GPCRs, thereby potentially attenuating ALI. We hypothesize that HTS inhibits priming of the PMN oxidase by these lipid mediators. METHODS: After PMNs were isolated from healthy donors, incubation was done in either isotonic buffer (control) or HTS (180 mmol/L) for 5 min at 37°C. The PMNs were then primed for 10 min with AA [5 µM] or 5 min with LTB(4) [1 µM] and the oxidase was activated with 200 ng/mL of phorbol 12-myristate 13-acetate (PMA), a non-GPCR activator, and superoxide anion generation was measured via reduction of cytochrome c. RESULTS: Both AA [5 µM] and LTB(4) [1 µM] significantly primed the PMA activated respiratory burst (P < 0.05, ANOVA, Newman-Keuls, n = 4). HTS inhibited both AA and LTB(4) priming of the respiratory burst. CONCLUSIONS: These data indicate that HTS reduces the cytotoxicity of PMNs stimulated by these lipid mediators in vitro and further support the immunomodulatory effects of HTS.

Hafnia alvei pneumonia: from bees to human beings.

INTRODUCTION: Hafnia alvei is an enterobacteria that is a common inhabitant of the gastrointestinal flora of bees, birds, fish, and mammals. In humans this enterobacteria has been recovered from the oropharynx and the gastrointestinal tract but it has been rarely reported as a pathogen and usually identified as hospital-acquired enterobacteria. CASE REPORT: We describe a case of a 57-year-old woman, previously healthy, with a 7-day history of cough with brown sputum, sudden onset of chills, subjective fever, malaise, and pleuritic pain in the right hemithorax. A diagnosis of community-acquired pneumonia (CAP) was suspected and empiric antibiotic treatment was started. However, the patient showed no response and developed hemoptysis. A diagnosis of CAP by Hafnia alvei was confirmed with bronchoalveolar lavage and the patient was treated with i.v. cefepime 2 g TID with a good response. CONCLUSIONS: We presented a case of community-acquired pneumonia by Hafnia alvei in a previously healthy patient that, as far as our knowledge reaches, is the third reported case of CAP secondary to this pathogen.

Neuromuscular blockade in the elderly patient.

Neuromuscular blockade is a desirable or even essential component of general anesthesia for major surgical operations. As the population continues to age, and more operations are conducted in the elderly, due consideration must be given to neuromuscular blockade in these patients to avoid possible complications. This review considers the pharmacokinetics and pharmacodynamics of neuromuscular blockade that may be altered in the elderly. Compartment distribution, metabolism, and excretion of drugs may vary due to age-related changes in physiology, altering the duration of action with a need for reduced dosage (eg, aminosteroids). Other drugs (atracurium, cisatracurium) have more reliable duration of action and should perhaps be considered for use in the elderly. The range of interpatient variability that neuromuscular blocking drugs may exhibit is then considered and drugs with a narrower range, such as cisatracurium, may produce more predictable, and inherently safer, outcomes. Ultimately, appropriate neuromuscular monitoring should be used to guide the administration of muscle relaxants so that the risk of residual neuromuscular blockade postoperatively can be minimized. The reliability of various monitoring is considered. This paper concludes with a review of the various reversal agents, namely, anticholinesterase drugs and sugammadex, and the alterations in dosing of these that should be considered for the elderly patient.

It's not your grandfather's field plasma.

Initiating prehospital resuscitation with plasma in patients with trauma-associated hemorrhagic shock will result in more rapid and durable clot formation and, thus, the need for fewer packed cell infusions, less frequent use of cryoprecipitate, and more ventilator-free hospital days compared with those of patients randomized to standard crystalloid field resuscitation.

Hyperosmolarity attenuates TNF-α-mediated proinflammatory activation of human pulmonary microvascular endothelial cells.

Firm neutrophil (PMN)-endothelial (EC) adhesion is crucial to the PMN-mediated hyperinflammation observed in acute lung injury. Hypertonic saline (HTS) used for resuscitation of hemorrhagic shock has been associated with a decreased incidence of PMN-mediated lung injury/acute respiratory distress syndrome. We hypothesize that physiologically accessible hypertonic incubation (170 vs. 140 mM, osmolarity ranging from 360 to 300 mOsm/L) inhibits proinflammatory activation of human pulmonary microvascular endothelial cells (HMVECs). Proinflammatory activation of HMVECs was investigated in response to tumor necrosis factor-α (TNF-α), including interleukin 8 (IL-8) release, intercellular adhesion molecule 1 (ICAM-1) surface expression, PMN adhesion, and signaling mechanisms under both isotonic (control) and hypertonic conditions. Hyperosmolarity alone had no effect on either basal IL-8 release or ICAM-1 surface expression but did lead to concentration-dependent decreases in TNF-α-induced IL-8 release, ICAM-1 surface expression, and PMN-HMVEC adhesion. Conversely, HTS activated p38 mitogen-activated protein kinase (MAPK) and enhanced TNF-α activation of p38 MAPK. Despite this basal activation, hyperosmolar incubation attenuated TNF-α-stimulated IL-8 release and ICAM-1 surface expression and subsequent PMN adherence, while p38 MAPK inhibition did not further influence the effects of hyperosmolar conditions on ICAM-1 surface expression. In addition, TNF-α induced nuclear factor-κB DNA binding, but HTS conditions attenuated this by 31% (P < 0.01). In conclusion, HTS reduces PMN-HMVEC adhesion and TNF-α-induced proinflammatory activation of primary HMVECs via attenuation of nuclear factor-κB signaling.

Germ cell tumor metastatic to the oral cavity.

Neoplasms metastatic to the oral cavity are rare, accounting for less than 1% of all malignancies found there. When they do occur, they are usually found in the soft tissue or mandible. Metastatic malignancies involving the gingival, alveolar, or buccal mucosa are very rare. We present a case of what appeared to be a benign epulis in a 25-year-old man. Biopsy revealed that the lesion represented metastatic testicular cancer.

Mesenchymal hamartoma of the liver.

Mesenchymal hamartoma of the liver is the second most common benign liver tumor of childhood. Ultrasonography demonstrates a cystic lesion that may be very large. Computed tomographic scan will further establish the location and its relationship to vascular anatomy. Most will be amenable to gross total resection with clear margins. To illustrate the radiological and gross operative features, we present a 9-month-old male infant with a mesenchymal hamartoma with classic features.

Pérdidas óseas de la glenoides en las inestabilidades anteriores recurrentes del hombro / Shoulder recurrent instability associated with glenoid bone loss

Introducción: El objetivo de este trabajo es destacar la frecuencia e importancia de las perdidas óseas glenoideas que no fueron consideradas por mucho tiempo y las posibilidades terapéuticas teniendo en cuenta dicha lesión. Presentar nuestra experiencia en el tratamiento estandarizado de las luxaciones recurrentes anteriores del hombro, vírgenes de cirugía previa, enfatizando en las pérdidas óseas antero inferiores del reborde glenoideo. Objetivo: Determinar la importancia de las pérdidas óseas de la glenoides en inestabilidades recurrentes de hombro. Material y Métodos: Se estudiaron 22 pacientes sin tratamiento quirúrgico previo por la patología descripta, con edades entre 18 y 45 años, con un claro predominio del sexo masculino (proporción 8 a 2). Se operaron con la técnica abierta modificada de Bristow Latarjet. La base de nuestro enfoque es la correcta selección de los pacientes, la técnica aplicada y el programa de rehabilitación precoz. La serie la consideramos de homogeneidad aceptable entre sus integrantes, así como los procedimientos quirúrgicos y la evaluación efectuada. Resultados: Se realizó una evaluación retrospectiva objetiva y subjetiva de los resultados a los dos años en una cohorte de 22 pacientes. Se valoraron de acuerdo con exámenes físico, imagenológico y de resultados, por cuestionarios completados por médicos y pacientes con el Score de Constant y de la ASES. Las cifras obtenidas fueron: 86% presentó hombros estables, indoloros o con poco dolor con una mínima pérdida de la rotación externa considerada entre los 6 y 8°, con limitaciones menores para las actividades por encima de la cabeza. No observamos re luxaciones o problemas con la consolidación de la coracoides ni tampoco artrosis temprana. Los consideramos resultados excelentes o buenos. Los mismos encuentran su principal objeción en la falta de verificaciones a largo plazo, que es cuando puede observarse la aparición de artrosis secundaria...

Background: Treatment of recurrent anterior shoulder instability isin continuous development. This disabling condition requires allthe possible knowledge, skills and broad experience to be solved. The purpose of this study was emphasized the importance of the glenoid bone loss and to verify th e hypothesis that the open coracoid transfer as described by Bristow Latarjet is a highly successful for treating recurrent glenohumeral instability associated with glenoid bone losses.Objectives: To determine glenoid bone losses importance inshoulder recurrent instability. Material and Methods:We selected a cohort of 22 patients, ages between 18 and 45 y.o. with predominance of males over females (rate 8 to 2), with recurrent anterior glenohumeral instability. All of them were treated with open Bristow Latarjet technique. We considered there is acceptable homogeneity in this cohort as wellas in the surgical procedure and the final evaluation methods.Results: Our results were obtained with an average outcome of 2 years. We perform physical examination, images screening, surveys between patients performed by physicians, and the Constan and ASES scores. 85% showed a stable shoulder, painless, with minimal external rotation loss (between 6 and 8...

Es la placa de osteosíntesis bloqueada plamar la solución de las fracturas desplazadas del radio distal? / Is palmar-locking plate osteosynthesis the solution to distal radius displaced fractures?

Conclusión: No se ha podido demostrar aun la bondad de un método de tratamiento sobre otro. La tendencia actual es actuar en cada caso en particular, disponiendo de todas las variantes terapéuticas, aisladas o combinadas (10,7). No obstante lo señalado creemos que la posibilidad de la reducción abierta y la osteosíntesis con la placa volar bloqueada es una realidad en cuanto a la solución de muchos de los problemas que presentan las estas fracturas.

Conclusions: No treatment has been proven to be better than others. At present, the tendency is to act in each particular case, having available all therapeutic variants, whether isolated or combined (10,7). Despite the abovementioned, we believe that open reduction and osteosynthesis with locked volar plate is a reality as regards solving many of the problems these fractures present.

Tomografía axial computarizada en traumatismos craneoencefálicos leves / Computed tomography in mild craniocerebral trauma

Introducción: La indicación de tomografía axial computarizada (TAC) en el traumatismo cráneo encefálico (TCE) leve en edad pediátrica, es motivo de controversia en los servicios de urgencias pediátricas. Esta casuística muestra resultados de la TAC en los TCE leve. Material y Método: Descripción retrospectiva, de 115 expedientes pediátricos con TEC leve según escala de Glasgow 13-15/15 internados desde setiembre de 2001 a setiembre de 2004. Resultados: 115 pacientes (100%) fueron estudiados con TAC, dentro de las 24 h. del TCE, fueron lactantes 27(23,5%), preescolares 27 (23,5%), escolares 50(43,5%), adolescentes 11(9,6%); sexo masculino 79(68,7%), femenino 36(31,3%). Se obtuvo TAC normal 82(71%); anormal 33(29%); de los cuales fracturas de base de cráneo 3(2,6%), fracturalineal de calota 8(6,9%), fractura con hundimiento 1(0,8%); hemorragia subdural 2(1,7%), hemorragia epidural 10(8,6%), hemorragia parenquimatosa 3(2,6%); edema difuso 6(5,2%). Se requirió conducta quirúrgica en 2(1,7%) casos por deterioro del estado de conciencia y signos de hipertensión endocraneana y TAC que correspondían a hemorragias epidurales. Conclusión: En esta casuística en un alto porcentaje la TAC realizada dentro de las primeras 24 horas del TCE leve no evidenció lesión estructural. La clínica y el examen neurológico fueron anormales en los dos casos quirúrgicos en que la TAC también lo fue, la observación del paciente por más de 24 h. puede se un indicador óptimo para la realización de la TAC. Palabras Claves: Trauma Craneocerebral, tomografía computarizada. .