Pelagic larval duration predicts extinction risk in a freshwater fish clade.

Pelagic larval duration (PLD) can influence evolutionary processes ranging from dispersal to extinction in aquatic organisms. Using estimates of PLD obtained from species of North American darters (Percidae: Etheostomatinae), we demonstrate that this freshwater fish clade exhibits surprising variation in PLD. Comparative analyses provide some evidence that higher stream gradients favour the evolution of shorter PLD. Additionally, similar to patterns in the marine fossil record in which lower PLD is associated with greater extinction probability, we found a reduced PLD in darter lineages was evolutionarily associated with extinction risk. Understanding the causes and consequences of PLD length could lead to better management and conservation of organisms in our increasingly imperiled aquatic environments.

Sodium chloride or Plasmalyte-148 evaluation in severe diabetic ketoacidosis (SCOPE-DKA): a cluster, crossover, randomized, controlled trial.

PURPOSE: To determine whether treatment with Plasmalyte-148 (PL) compared to sodium chloride 0.9% (SC) results in faster resolution of diabetic ketoacidosis (DKA) and whether the acetate in PL potentiates ketosis. METHODS: We conducted a cluster, crossover, open-label, randomized, controlled Phase 2 trial at seven hospitals in adults admitted to intensive care unit (ICU) with severe DKA with hospital randomised to PL or SC as fluid therapy. The primary outcome, DKA resolution, was defined as a change in base excess to ≥ - 3 mEq/L at 48 h. RESULTS: Ninety-three patients were enrolled with 90 patients included in the modified-intention-to-treat population (PL n = 48, SC n = 42). At 48 h, mean fluid administration was 6798 ± 4850 ml vs 6574 ± 3123 ml, median anion gap 6 mEq/L (IQR 5-7) vs 7 mEq/L (IQR 5-7) and median blood ketones 0.3 mmol/L (IQR 0.1-0.5) vs 0.3 (IQR 0.1-0.5) in the PL and SC groups. DKA resolution at 48 h occurred in 96% (PL) and 86% (SC) of patients; odds ratio 3.93 (95% CI 0.73-21.16, p = 0.111). At 24 h, DKA resolution occurred in 69% (PL) and 36% (SC) of patients; odds ratio 4.24 (95% CI 1.68-10.72, p = 0.002). The median ICU and hospital lengths of stay were 49 h (IQR 23-72) vs 55 h (IQR 41-80) and 81 h (IQR 58-137) vs 98 h (IQR 65-195) in the PL and SC groups. CONCLUSION: Plasmalyte-148, compared to sodium chloride 0.9%, may lead to faster resolution of metabolic acidosis in patients with DKA without an increase in ketosis. These findings need confirmation in a large, Phase 3 trial.

Effects of topical emollient therapy on infants at or less than 27 weeks' gestation.

OBJECTIVE: To evaluate the effects of topical emollient therapy on fluid intake, urine output, serum electrolytes, glucose, bilirubin and other outcome measures of neonates < or = 27 weeks' gestational age (GA) with birthweight (BW) <1,000 g. METHODS: We reviewed medical records of 18 infants treated with topical emollient Aquaphor, and 36 BW- and GA-matched control infants that were not treated with similar topical emollient. RESULTS: Characteristics of the study and control infants were similar: BW: 698 +/- 144 g vs. 732 +/- 134 g, GA: 25.5 +/- 1.33 weeks vs. 25 +/- 1.6 weeks and Score for Neonatal Acute Physiology (SNAP) 14.3 +/- 5.1 vs. 14.6 +/- 7.8, respectively. Fluid intake was lower and urine output was significantly better in Aquaphor-treated infants during the first two weeks of life. Peak serum potassium and bilirubin values were also lower in the study infants. Insulin use, patent ductus arteriosus (PDA), inltraventricular hemorrhage (IVH), retinopathy of prematurity (ROP), sepsis and duration of ventilator/oxygen use weresimilar among the groups. CONCLUSION: Infants < or = 27 weeks' gestation who had Aquaphor applied to their skin from birth required less fluids and had better urine output. These infants had lower serum potassium and bilirubin values during their first two weeks of life. Therefore, we conclude that topical Aquaphor application to thee skin is beneficial for fluid and electrolyte balance in extreme preterm infants.