Renal replacement and extracorporeal therapies in critical care: current and future directions.

There are a wide number of indications for extracorporeal therapies in the critical care environment. A common indication seen by the acute physician is continuous renal replacement therapy (CRRT) in a proportion of patients with acute kidney injury. It is therefore important that acute physicians have a sound understanding of the principles of CRRT in the acutely unwell patient. This review will outline the indications for its use, commonly used methods and anticoagulation considerations. It will discuss when to start and stop CRRT as well as describing potential treatment complications. This review will also discuss the role of therapeutic plasma exchange in critical care and novel extracorporeal therapies including blood purification in sepsis and carbon dioxide removal in acute respiratory distress syndrome and acute exacerbations of obstructive lung disease. Extracorporeal membrane oxygenation is outside of the scope of this article.

Quantum Confined High-Entropy Lanthanide Oxysulfide Colloidal Nanocrystals.

We have synthesized the first reported example of quantum confined high-entropy (HE) nanoparticles, using the lanthanide oxysulfide, Ln2SO2, system as the host phase for an equimolar mixture of Pr, Nd, Gd, Dy, and Er. A uniform HE phase was achieved via the simultaneous thermolysis of a mixture of lanthanide dithiocarbamate precursors in solution. This was confirmed by powder X-ray diffraction and high-resolution scanning transmission electron microscopy, with energy dispersive X-ray spectroscopic mapping confirming the uniform distribution of the lanthanides throughout the particles. The nanoparticle dispersion displayed a significant blue shift in the absorption and photoluminescence spectra relative to our previously reported bulk sample with the same composition, with an absorption edge at 330 nm and a λmax at 410 nm compared to the absorption edge at 500 nm and a λmax at 450 nm in the bulk, which is indicative of quantum confinement. We support this postulate with experimental and theoretical analysis of the bandgap energy as a function of strain and surface effects (ligand binding) as well as calculation of the exciton Bohr radiii of the end member compounds.

Hydrocarbon-Based Statistical Copolymers Outperform Block Copolymers for Stabilization of Ethanol-Water Foams.

Well-defined block copolymers have been widely used as emulsifiers, stabilizers, and dispersants in the chemical industry for at least 50 years. In contrast, nature employs amphiphilic proteins as polymeric surfactants whereby the spatial distribution of hydrophilic and hydrophobic amino acids within the polypeptide chains is optimized for surface activity. Herein, we report that polydisperse statistical copolymers prepared by conventional free-radical copolymerization can provide superior foaming performance compared to the analogous diblock copolymers. A series of predominantly (meth)acrylic comonomers are screened to identify optimal surface activity for foam stabilization of aqueous ethanol solutions. In particular, all-acrylic statistical copolymers comprising trimethylhexyl acrylate and poly(ethylene glycol) acrylate, P(TMHA-stat-PEGA), confer strong foamability and also lower the surface tension of a range of ethanol-water mixtures to a greater extent than the analogous block copolymers. For ethanol-rich hand sanitizer formulations, foam stabilization is normally achieved using environmentally persistent silicone-based copolymers or fluorinated surfactants. Herein, the best-performing fully hydrocarbon-based copolymer surfactants effectively stabilize ethanol-rich foams by a mechanism that resembles that of naturally-occurring proteins. This ability to reduce the surface tension of low-surface-energy liquids suggests a wide range of potential commercial applications.

High entropy metal chalcogenides: synthesis, properties, applications and future directions.

Metal oxides, sulphides, selenides and tellurides have routinely been investigated and utilised for a wide range of applications, in particular in the areas of energy (photovoltaic, thermoelectric) and catalysis (thermocatalysis, electrocatalysis and photoelectrocatalysis). A recent development in this chemical space is high entropy and entropy-stabilised inorganic materials, which took inspiration from preceding work on high entropy metal alloys (multicomponent alloys). High entropy inorganic materials typically have many (often ≥6) different cations or anions to yield a high configurational entropy, which can give unexpected structures and properties that are conducive to a broad range of applications in energy and catalysis. More recently still, high entropy metal chalcogenides have been developed and have been investigated for thermoelectric energy generation, batteries for energy storage and electrocatalysis. This review sets out to define entropic stabilisation in high entropy materials, along with a discussion of synthetic techniques to produce these compounds, focusing on high entropy metal chalcogenides including extant routes to high entropy sulfides, selenides and tellurides. The resulting advantageous properties of these materials due to their multi-element nature and the currently proposed and investigated applications of these materials are reviewed. We end the perspective with an opinion on future directions.

Synthesis of High Entropy Lanthanide Oxysulfides via the Thermolysis of a Molecular Precursor Cocktail.

High entropy (HE) materials have received significant attention in recent years, due to their intrinsically high levels of configurational entropy. While there has been significant work exploring HE alloys and oxides, new families of HE materials are still being revealed. In this work we present the synthesis of a novel family of HE materials based on lanthanide oxysulfides. Here, we implement lanthanide dithiocarbamates as versatile precursors that can be mixed at the molecular scale prior to thermolysis in order to produce the high entropy oxysulfide. The target of our synthesis is the HE Ln2SO2 phase, where Ln = Pr, Nd, Gd, Dy, Er and where Ln = Pr, Nd, Gd, Dy for 5 and 4 lanthanide samples, respectively. We confirmed the structure of samples produced by powder X-ray diffraction, electron microscopy, and high-resolution energy dispersive X-ray spectroscopy. Optical spectroscopy shows a broad emission feature centered around 450 nm as well as a peak in absorption at around 280 nm. From this data we calculate the band gap and Urbach energies of the materials produced.

The Use of the S-MART Tourniquet in Hand Surgery: A Safe and Effective Way to Provide a Bloodless Field.

We have retrospectively reviewed our use of the S-MART sterile silicon ring self-exsanguinating tourniquet in 300 consecutive minor hand surgical procedures. A total of 3 postoperative complications were identified, only 1 of which was directly related to the tourniquet's use. We outline the reasons of why we feel that this device provides a safe and effective bloodless field and the benefits of its use.

A randomized, placebo-controlled, double-blind trial of sertraline for postpartum depression.

RATIONALE: Postpartum depression (PMD) occurs in roughly 10 % of postpartum women and negatively impacts the mother and her offspring, but there are few placebo-controlled studies of antidepressant treatment in this population. OBJECTIVE: The objective was this study is to compare the selective serotonin reuptake inhibitor (SSRI) sertraline to placebo for treating PMD. METHODS: This was a single-center, 6-week, randomized double-blind placebo-controlled trial of sertraline with a 1-week placebo lead-in. The participants (n = 38) were women with depression onset within 3 months of delivery; a subset (n = 27) met strict DSM-IV criteria for PMD (onset within 4 weeks of delivery). The participants were prescribed sertraline 50 mg or placebo daily to a maximum of 200 mg/day. Primary outcome variables were the Hamilton Depression Rating Scale (HAM-D) and Clinical Global Impressions (CGI) scores, which were used to determine the rates of response and remission. RESULTS: Sertraline produced a significantly greater response rate (59 %) than placebo (26 %) and a more than twofold increased remission rate (53 % vs. 21 %). Mixed models did not reveal significant group by time effects, although in the subset of women who met the DSM-IV criteria, there was a statistically significant group by time effect for the HAM-D, Hamilton Anxiety Rating Scale (HAM-A), and CGI. CONCLUSIONS: Women with PMD are more likely to have a remission of their depression with sertraline treatment, a finding that is more pronounced in women who have onset of depression within 4 weeks of childbirth. These data support the continued use of 4 weeks for the DSM-5 postpartum onset specifier for major depressive disorder.

Rheumatic fever in Ireland: the role of Dr Monica Lea Wilson (1889-1971).

In 1869 William Stokes pointed out that the severity of rheumatic fever in Dublin had declined over recent decades. Similar worldwide decline led to the closure of many internationally famous rheumatic fever centres. The discovery by Robert Collis that rheumatic fever was a sequel to haemolytic streptococcal infection and the subsequent discovery of penicillin accelerated the decline. St Gabriel's Hospital in Dublin opened in 1951 under the clinical direction of Dr Monica Lea Wilson. Contrary to contemporary medical opinion a regimen of very prolonged bed rest was enforced. From 1961 the family doctors became concerned at the adverse psychological effects of the unnecessarily prolonged hospital stay. Twenty-seven of the 56 inpatients were re-assessed. None of them showed any evidence of active rheumatic fever and their parents took them home. The hospital closed in 1968. Dr Lea Wilson distanced herself from mainstream medicine and she is best remembered for having presented an unrecognized Caravaggio painting to the Jesuit Order in recognition of their pastoral support at the time of the controversial assassination in 1920 of her husband Percival, an Inspector in the Royal Irish Constabulary.

Victorian medical politics: the fate of Dr Alfred Stephens (1821-90).

Dr Alfred Stephens was the co-founder of the Liverpool Children's Infirmary. The institution was funded initially by Matthew Gregson (1800-76) and later by public subscription. Opened in 1851, it was the second Children's Hospital in England. Alfred Stephens was a general practitioner without higher qualifications. In due course he perceived that the free treatment of children at the Infirmary affected his income and he redirected patients to his practice. This led to confrontation with his colleagues and the Board of the Infirmary, and good relations were never restored. His name has not been commemorated nor his charitable work remembered.

Play, copulation, anatomy, and testosterone in gonadally intact male rats prenatally exposed to flutamide.

The role of prenatal androgen on the differentiation of sexually dimorphic juvenile play and adult copulatory patterns was evaluated in male offspring of rats injected with 5 mg of the androgen receptor blocker flutamide (4'-nitro-3'-trifluoromethylisobutyranilide) from Days 11-21 of pregnancy. Rough-and-tumble play was incompletely masculinized in flutamide-exposed males at 31 days of age. The copulatory potential tested at 70 days of age was severely attenuated by prenatal flutamide. There was no ejaculatory behavior, low levels of intromissions, and depressed levels of nonintromittive mounting when the animals were tested while gonadally intact. Adult plasma levels of testosterone (T) were not different in flutamide-exposed males and controls, but testicular and epididymal weight, anogenital (AG) distance, and penile length were reduced. While reductions in intromittive mounting and ejaculatory behavior may be due to the abnormalities in the external genitalia, the incomplete masculinization of play and the reduction in nonintromittive mounting probably resulted from effects the androgen antagonist exerted on sexual differentiation of the central nervous system. These data suggest that androgen released prior to birth is needed for the full masculinization of juvenile play behaviors in the rat, just as it is for the adult copulatory pattern.

Fetal testosterone surge: specific modulations induced in male rats by maternal stress and/or alcohol consumption.

Plasma testosterone (T) was measured in control male and female rats on gestational days 16, 17, 18, 19, and 20 and on days 17-20 in males from dams who were fed ethanol and/or were stressed during pregnancy. Circulating T in control males showed an earlier rise, yielding a longer period of prenatal T elevation, than was reported previously (Endocrinology 106 (1980)306). Compared to control males, exposure to alcohol-alone augmented T on days 18 and 19, stress-alone attenuated prenatal T, and the combination of stress and alcohol completely blocked the normal rise in T between days 17 and 18. When these prenatal alterations in T are viewed along with effects these same treatments have on the postparturient T surge (Horm. Behav. 41 (2002) 229), a possible explanatory mechanism emerges for the uniquely different behavioral patterns of sexual behavior differentiation induced in males by prenatal exposure to alcohol, stress, or both factors. Whereas the potential for feminine behavior is retained to the extent that either the prenatal or the neonatal T surge is attenuated, the male potential is more sensitive to reductions in the fetal surge and is maximally disrupted if both the prenatal and the postparturitional T surges are suppressed.

The Royal College of Surgeons 19th-century textbook of paediatrics and its authors Evanson and Maunsell.

Richard T. Evanson, Professor of Medicine in the RCSI and Henry Maunsell, Professor of Obstetrics, jointly published a textbook of paediatrics which went through five editions between 1836 and 1847. The textbook was based on their practical experience in the treatment of children in the Institution of the Diseases, founded in 1821. This was probably the first Children's Hospital in these islands. The textbook reviews neonatal care, normal development, and the diagnosis and treatment of childhood illnesses. It was well received at home and abroad and it was a major contribution to contemporary literature.