Earth's ambipolar electrostatic field and its role in ion escape to space.

Cold plasma of ionospheric origin has recently been found to be a much larger contributor to the magnetosphere of Earth than expected1-3. Numerous competing mechanisms have been postulated to drive ion escape to space, including heating and acceleration by wave-particle interactions4 and a global electrostatic field between the ionosphere and space (called the ambipolar or polarization field)5,6. Observations of heated O+ ions in the magnetosphere are consistent with resonant wave-particle interactions7. By contrast, observations of cold supersonic H+ flowing out of the polar ionosphere8,9 (called the polar wind) suggest the presence of an electrostatic field. Here we report the existence of a +0.55 ± 0.09 V electric potential drop between 250 km and 768 km from a planetary electrostatic field (E∥⊕ = 1.09 ± 0.17 µV m-1) generated exclusively by the outward pressure of ionospheric electrons. We experimentally demonstrate that the ambipolar field of Earth controls the structure of the polar ionosphere, boosting the scale height by 271%. We infer that this increases the supply of cold O+ ions to the magnetosphere by more than 3,800%, in which other mechanisms such as wave-particle interactions can heat and further accelerate them to escape velocity. The electrostatic field of Earth is strong enough by itself to drive the polar wind9,10 and is probably the origin of the cold H+ ion population1 that dominates much of the magnetosphere2,3.

Buprenorphine-Sustained Release Alters Hemodynamic Parameters in a Rat Burn Model.

BACKGROUND: It has been previously shown that anesthesia and analgesia can affect outcomes in the rat burn model and that buprenorphine alleviated pain without drastically altering the outcomes of interest. Recently, the use of a sustained release (SR) formulation of buprenorphine has been promoted over conventional buprenorphine. In this study, we assessed whether buprenorphine-SR altered hemodynamic parameters in our rat model of severe burn injury. MATERIALS AND METHODS: Adult male Sprague-Dawley rats were randomized to receive either conventional buprenorphine (0.05 mg/kg) or buprenorphine-SR (1 mg/kg). Buprenorphine-SR was administered 24 h before the experiment. Buprenorphine was administered on the day of experiment. These groups were further randomized to control or scald burn (60% of total body surface area). Systolic and diastolic blood pressure (SBP, DBP) and heart rate (HR) were measured using a noninvasive blood pressure system before receiving analgesia and after 72 h. RESULTS: As expected, HR was significantly higher after burn injury regardless of analgesic (P <0.0001). Both SBP and DBP were significantly decreased in burned animals receiving conventional buprenorphine (P < 0.0001), but neither was altered in the buprenorphine-SR-treated burned animals. However, SBP, DBP, and HR were significantly increased after 72 h in control animals receiving buprenorphine-SR (P < 0.0001). CONCLUSIONS: These data indicate that buprenorphine-SR alters the hemodynamic response to injury and may not be an appropriate choice for a model of severe burn injury. If this analgesic is used, investigators must cautiously form conclusions, especially in experimental conditions that would be expected to alter cardiac hemodynamics.

Excellent Survival and Good Outcomes at 15 Years Using the Press-Fit Condylar Sigma Total Knee Arthroplasty.

BACKGROUND: We report 15-year survival, clinical, and radiographic follow-up data for the Press-Fit Condylar Sigma total knee arthroplasty. METHODS: Between October 1998 and October 1999, 235 consecutive TKAs were performed in 203 patients. Patients were reviewed at a specialist nurse-led clinic before surgery and at 5, 8-10, and 15 years postoperatively. Clinical outcomes, including Knee Society Score, were recorded prospectively at each clinic visit, and radiographs were obtained. RESULTS: Of our initial cohort, 99 patients (118 knees) were alive at 15 years, and 31 patients (34 knees) were lost to follow-up. Thirteen knees (5.5%) were revised; 5 (2.1%) for infection, 7 (3%) for instability, and 1 (0.4%) for aseptic loosening. Cumulative survival with the end point of revision for any reason was 92.3% at 15 years and with revision for aseptic failure as the end point was 94.4%. The mean Knee Society Score knee score was 77.4 (33-99) at 15 years, compared with 31.7 (2-62) preoperatively. Of 71 surviving knees for which X-rays were available, 12 (16.9%) had radiolucent lines and 1 (1.4%) demonstrated clear radiographic evidence of loosening. CONCLUSION: The Press-Fit Condylar Sigma total knee arthroplasty represents a durable, effective option for patients undergoing knee arthroplasty, with excellent survival and good clinical and radiographic outcomes at 15 years.

The use of skin substitutes and burn care-a survey.

OBJECTIVE: The aim of our Internet survey was to assess the preferences of burn specialists who use skin substitutes in patients with burns covering 20% or more of their total body surface area (TBSA). METHODS: An open, voluntary Internet-based cross-sectional survey was performed. Responses to 19 noncompulsory questions, and participant career and location information were collected. RESULTS: One hundred eleven specialists from 36 countries responded to our questionnaire. Sixty participants were located in Europe (54%), followed by 31 (28%) in North America, 15 (14%) in Asia, three (3%) in South America, one (1%) in Africa, and one (1%) in Australia. The importance of skin substitutes in medium-sized burns (covering 20%-60% TBSA) was rated as "essential" by 28% and "desirable" by 56% of the respondents. In severe burns >60% of TBSA, 81% of responders rated the use of skin substitutes as "essential" and 14% as "desirable". Skin substitutes were used in daily clinical practice by 96% of all participants. Biological and synthetic dressings were used by 53%. A majority (86%) think that biological dressings do not pose a risk to patients. Allografts represent the most frequently used wound coverage (51%), followed by xenografts (28%). All participants of the survey indicated that as of yet, there is no ideal skin substitute available. CONCLUSIONS: Split-thickness autografts still represent the most used wound cover for definitive treatment of severe burns. However, creation and implementation of an ideal skin substitute have yet to be achieved and therefore should be the focus of future work.

Oxygen isotope anomaly observed in water vapor from Alert, Canada and the implication for the stratosphere.

To identify the possible anomalous oxygen isotope signature in stratospheric water predicted by model studies, 25 water vapor samples were collected in 2003-2005 at Alert station, Canada (82°30'N), where there is downward transport of stratospheric air to the polar troposphere, and were analyzed for δ(17)O and δ(18)O relative to Chicago local precipitation (CLP). The latter was chosen as a reference because the relatively large evaporative moisture source should erase any possible oxygen isotope anomaly from the stratosphere. A mass-dependent fractionation coefficient for meteoric waters, λMDF(H2O) = 0.529 ± 0.003 [2σ standard error (SE)], was determined from 27 CLP samples collected in 2003-2005. An oxygen isotopic anomaly of Δ(17)O = 76 ± 16 ppm (2σ SE) was found in water vapor samples from Alert relative to CLP. We propose that the positive oxygen isotope anomalies observed at Alert originated from stratospheric ozone, were transferred to water in the stratosphere, and subsequently mixed with tropospheric water at high latitudes as the stratospheric air descended into the troposphere. On the basis of this ground signal, the average Δ(17)O in stratospheric water vapor predicted by a steady-state box model is ∼40‰. Seven ice core samples (1930-1991) from Dasuopu glacier (Himalayas, China) and Standard Light Antarctic Precipitation did not show an obvious oxygen isotope anomaly, and Vienna Standard Mean Ocean Water exhibited a negative Δ(17)O relative to CLP. Six Alert snow samples collected in March 2011 and measured at Laboratoire des Sciences du Climat et de l'Environnement, Gif sur Yvette, France, had (17)Oexcess of 45 ± 5 ppm (2σ SE) relative to Vienna Standard Mean Ocean Water.

Cardiovascular Dysfunction Following Burn Injury: What We Have Learned from Rat and Mouse Models.

Severe burn profoundly affects organs both proximal and distal to the actual burn site. Cardiovascular dysfunction is a well-documented phenomenon that increases morbidity and mortality following a massive thermal trauma. Beginning immediately post-burn, during the ebb phase, cardiac function is severely depressed. By 48 h post-injury, cardiac function rebounds and the post-burn myocardium becomes tachycardic and hyperinflammatory. While current clinical trials are investigating a variety of drugs targeted at reducing aspects of the post-burn hypermetabolic response such as heart rate and cardiac work, there is still a paucity of knowledge regarding the underlying mechanisms that induce cardiac dysfunction in the severely burned. There are many animal models of burn injury, from rodents, to sheep or swine, but the majority of burn related cardiovascular investigations have occurred in rat and mouse models. This literature review consolidates the data supporting the prevalent role that ß-adrenergic receptors play in mediating post-burn cardiac dysfunction and the idea that pharmacological modulation of this receptor family is a viable therapeutic target for resolving burn-induced cardiac deficits.

Reactive oxygen species-caspase-3 relationship in mediating blood-brain barrier endothelial cell hyperpermeability following oxygen-glucose deprivation and reoxygenation.

OBJECTIVE: Microvascular hyperpermeability that occurs due to breakdown of the BBB is a major contributor of brain vasogenic edema, following IR injury. In microvascular endothelial cells, increased ROS formation leads to caspase-3 activation following IR injury. The specific mechanisms, by which ROS mediates microvascular hyperpermeability following IR, are not clearly known. We utilized an OGD-R in vitro model of IR injury to study this. METHODS: RBMEC were subjected to OGD-R in presence of a caspase-3 inhibitor Z-DEVD, caspase-3 siRNA or an ROS inhibitor L-AA. Cytochrome c levels were measured by ELISA and caspase-3 activity was measured fluorometrically. TJ integrity and cytoskeletal assembly were studied using ZO-1 immunofluorescence and rhodamine phalloidin staining for f-actin, respectively. RESULTS: OGD-R significantly increased monolayer permeability, ROS formation, cytochrome c levels, and caspase-3 activity (p < 0.05) and induced TJ disruption and actin stress fiber formation. Z-DEVD, L-AA and caspase-3 siRNA significantly attenuated OGD-R-induced hyperpermeability (p < 0.05) while only L-AA decreased cytochrome c levels. Z-DEVD and L-AA protected TJ integrity and actin cytoskeletal assembly. CONCLUSIONS: These results suggest that OGD-R-induced hyperpermeability is ROS and caspase-3 dependent and can be regulated by their inhibitors.

The identification of new biomarkers for identifying and monitoring kidney disease and their translation into a rapid mass spectrometry-based test: evidence of presymptomatic kidney disease in pediatric Fabry and type-I diabetic patients.

Using label-free quantative proteomics, we have identified 2 potential protein biomarkers that indicate presymptomatic kidney disease in the urine of pediatric patients with type-I diabetes and Fabry disease (n = 20). Prosaposin and GM2 activator protein (GM2AP) were observed to be elevated in the urine of these patient groups compared to age- and sex-matched controls. These findings were validated by development of a rapid MRM-based tandem mass spectrometry test. Prosaposin was observed to be both significantly elevated in the urine of patients with Fabry disease compared to controls (p = 0.02) and reduced after 12 months enzyme replacement therapy (ERT, p = 0.01). Similarly, GM2AP concentrations were observed to be significantly higher compared to controls in the diabetic group (p = 0.049) and the pretreatment Fabry group (p = 0.003). In addition, this observed to be reduced significantly in the Fabry group following 12 months of ERT (p = 0.01). The process of detection of the biomarkers, development into a test and implications for monitoring patients and treatment are discussed.

Perceived barriers and facilitators of day-case surgery for major foot and ankle procedures? A cross-sectional survey of United Kingdom surgeons.

BACKGROUND: Advances in minimally invasive surgery and improved post-operative pain management make it possible to consider performing even major foot/ankle operations as day-case. This could have significant benefits for patients and the health service. However there are theoretical concerns about post-operative complications and patient satisfaction due to pain. AIM: To scope the current practice of foot and ankle surgeons on day-case surgery for major foot and ankle procedures in the United Kingdom (UK). METHODS: An online survey (19 questions) was sent to UK foot and ankle surgeons via the British Orthopaedic Foot & Ankle Society membership list in August 2021. Major foot and ankle procedures were defined as surgery that is usually performed as an inpatient in majority of centres and day-case as same day discharge, with day surgery as the intended treatment pathway. RESULTS: 132 people responded to the survey invitation with 80% working in Acute NHS Trusts. Currently 45% of respondents perform less than 100 day-case surgeries per year for these procedures. 78% felt that there was scope to perform more procedures as day-case at their centre. Post-operative pain (34%) and patient satisfaction (10%) was not highly measured within their centres. Lack of adequate physiotherapy input pre/post-operatively (23%) and lack of out of hours support (21%) were the top perceived barriers to performing more major foot and ankle procedures as day-case. CONCLUSION: There is consensus among UK surgeons to do more major foot/ankle procedures as day-case. Out of hours support and physiotherapy input pre/ post-op were perceived as the main barriers. Despite theoretical concerns about post-operative pain and satisfaction this was only measured by a third of those surveyed. There is a need for nationally agreed protocols to optimise the delivery of and measurement of outcomes in this type of surgery. At a local level, the provision of physiotherapy and out of hours support should be explored at sites where this is a perceived barrier.

Seismic wave simulation using a 3D printed model of the Los Angeles Basin.

Studying seismic wave propagation through complex media is crucial to numerous aspects of geophysics and engineering including seismic hazard assessment. In particular, small-scale structure such as sedimentary basins and their edges can have significant effects on high-frequency earthquake ground motion, which is the main cause for the damage to buildings and infrastructure. However, such structural effects are poorly understood due to limitations in numerical and analytical methods. To overcome this challenge, for the first time, we utilize the 3D printing technique to build a scaled-down physical representation of geological structure and perform lab-scale seismic experiments on it. Specifically, a physical model based on the Los Angeles Basin is printed and used as synthetic medium to propagate ultrasonic waves, to mimic seismic wave propagation from local earthquakes. Our results show clear body and surface waves recorded at expected time and locations, as well as waves that are scattered from the basin edges. We find that high-frequency energies are significantly reduced at the basin, which is at odds with the conventional view of basins as ground motion amplifiers. This novel waveform modeling approach with 3D printed Earth models is largely automated and provides an effective means to tackle geophysical problems of significance.

Structural allograft as an option for treating infected hip arthroplasty with massive bone loss.

BACKGROUND: Revision of the infected hip arthroplasty with major bone loss is difficult. Attempts to restore bone stock with structural allograft are controversial. QUESTIONS/PURPOSES: We assessed the (1) reinfection rate; (2) rerevision rate; (3) radiographic graft union, resorption, and implant migration; (4) Harris hip scores at 1 year and at last followup compared with before surgery; and (5) other major complications associated with the use of bulk structural allograft to treat massive bone loss in infected hip arthroplasty. METHODS: We retrospectively reviewed 27 patients who underwent two-stage revision arthroplasty using structural allograft to treat massive bone defects in infected hip arthroplasty. There were 17 proximal femoral grafts, three acetabular major column grafts, two acetabular minor column grafts, and 10 cortical strut grafts used. Five patients had combinations of two allografts. The minimum followup was 1.1 years (mean, 8.2 years; range, 1.1-16.8 years). RESULTS: One of 27 patients had reinfection. The Kaplan-Meier survivorship was 93% at 10 years with rerevision for aseptic loosening as the end point. Radiographically, three patients had nonunion at the graft-host junction. All patients except two had graft resorption, of which all were mild except two, which were severe. Three patients had implant migration. The mean modified Harris hip scores were 39.2 points (range, 25-60) preoperatively, 67.3 points (range, 40-91) at 1-year followup, and 70.3 points (range, 46-81) at last followup. Other major complications included one patient with dislocation and one patient with transient sciatic nerve injury. CONCLUSIONS: Based on our data, we believe the use of structural allografts is a reasonable option for treating massive bone loss in infected hip arthroplasties. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Urine proteomics analysis of patients with neuronal ceroid lipofuscinoses.

The neuronal ceroid lipofuscinoses (NCL) are a group of 13 rare neurodegenerative disorders characterized by accumulation of cellular storage bodies. There are few therapeutic options, and existing tests do not monitor disease progression and treatment response. However, urine biomarkers could address this need. Proteomic analysis of CLN2 patient urine revealed activation of immune response pathways and pathways associated with the unfolded protein response. Analysis of CLN5 and CLN6 sheep model urine showed subtle changes. To confirm and investigate the relevance of candidate biomarkers a targeted LC-MS/MS proteomic assay was created. We applied this assay to additional CLN2 samples as well as other patients with NCL (CLN1, CLN3, CLN5, CLN6, and CLN7) and demonstrated that hexosaminidase-A, aspartate aminotransferase-1, and LAMP1 are increased in NCL samples and betaine-homocysteine S-methyltransferase-1 was specifically increased in patients with CLN2. These proteins could be used to monitor the effectiveness of future therapies aimed at treating systemic NCL disease.

Calibration of delta(17)O and delta(18)O of international measurement standards - VSMOW, VSMOW2, SLAP, and SLAP2.

Due to exhaustion of the two primary calibration materials, Vienna Standard Mean Ocean Water (VSMOW) and Standard Light Antarctic Precipitation (SLAP), two replacement materials, VSMOW2 and SLAP2, were created with isotopic compositions as close as possible to the original standards in their D/H and (18)O/(16)O ratios. Measurements of the delta(17)O composition constitute therefore an appropriate independent check of the achieved isotopic adjustment. Aliquots from ampoules of VSMOW, VSMOW2, SLAP, and SLAP2 were fluorinated by BrF(5) and analyzed using a dual-inlet Delta E mass spectrometer. VSMOW2 and SLAP2 were found to be indistinguishable from VSMOW and SLAP, respectively, in their delta(17)O and delta(18)O values within measurement uncertainties. This result is a confirmation of the successful isotopic matching of VSMOW2 and SLAP2 to their predecessors. Further checks of the delta(17)O value of SLAP2 seem desirable.

Auroral ionospheric plasma flow extraction using subsonic retarding potential analyzers.

Thermal ion retarding potential analyzers (RPAs) are used to measure in situ auroral ionospheric plasma parameters. This article analyzes data from a low-resource RPA in order to quantify the capability of the sensor. The RPA collects a sigmoidal current-voltage (I-V) curve, which depends on a non-linear combination of Maxwellian plasma parameters, so a forward-modeling procedure is used to match the best choice plasma parameters for each I-V curve. First, the procedure is used, given constraining information about the flow moment, to find scalar plasma parameters-ion temperature, ion density, and spacecraft sheath potential-for a single I-V curve interpreted in the context of a Maxwellian plasma distribution. Second, two azimuthally separated I-V curves from a single sensor on the spinning spacecraft are matched, given constraining information on density and sheath potential, to determine the bulk plasma flow components. These flows are compared to a high-fidelity, high-resource flow diagnostic. In both cases, the procedure's sensitivity to variations in constraining diagnostics is tested to ensure that the matching procedure is robust. Finally, a standalone analysis is shown, providing plasma scalar and flow parameters using known payload velocity and International Reference Ionosphere density as input information. The results show that the sensor can determine scalar plasma measurements as designed, as well as determine plasma DC flows to within hundreds of m/s error compared to a high-fidelity metric, thus showing their capability to replace higher-resource methods for determining DC plasma flows when coarse-resolution measurements at in situ spatial scales are suitable.

Seismic anisotropy reveals crustal flow driven by mantle vertical loading in the Pacific NW.

Buoyancy anomalies within Earth's mantle create large convective currents that are thought to control the evolution of the lithosphere. While tectonic plate motions provide evidence for this relation, the mechanism by which mantle processes influence near-surface tectonics remains elusive. Here, we present an azimuthal anisotropy model for the Pacific Northwest crust that strongly correlates with high-velocity structures in the underlying mantle but shows no association with the regional mantle flow field. We suggest that the crustal anisotropy is decoupled from horizontal basal tractions and, instead, created by upper mantle vertical loading, which generates pressure gradients that drive channelized flow in the mid-lower crust. We then demonstrate the interplay between mantle heterogeneities and lithosphere dynamics by predicting the viscous crustal flow that is driven by local buoyancy sources within the upper mantle. Our findings reveal how mantle vertical load distribution can actively control crustal deformation on a scale of several hundred kilometers.

Kinetic isotope effects in oxygen in the laboratory dehydration of magnesian minerals.

Laboratory studies of vacuum dehydration of Mg-O-H units in minerals and rocks reveal large kinetic isotope effects in oxygen, with light-isotope enrichment in the liberated water, and concomitant heavy-isotope enrichment in the residual solids. Application of the same techniques to a meteorite assemblage including hydrous magnesium silicates shows a much more complex behavior, probably due to isotopic heterogeneity inherited from processes on the meteorite parent body. Measurements of both the (17)O/(16)O variations and the (18)O/(16)O variations confirm theoretical predictions that slopes of three-isotope correlation lines are systematically larger for equilibrium isotope effects than for kinetic isotope effects.

Thromboembolic disease after total knee replacement: experience of 5100 cases.

The aim of the study was to quantify the incidence and timing of venous thromboembolic events (VTE) after total knee replacement (TKR). Data from 5100 consecutive TKRs performed over 10 years were prospectively collected. Cases were reviewed to identify thromboprophylaxis given, the diagnosis of VTE, treatment and adverse outcomes. There were 3 deaths (0.059%) from pulmonary embolism (PE). Of 123 VTEs identified, 55 had PE, 17 had above knee deep vein thrombosis (DVT), 28 had calf DVT and 14 had been incorrectly coded as VTE. There was considerable inappropriate treatment of calf DVT with resultant morbidity. There was an increase in diagnosis of PE between days 1 and 5 post surgery in the later part of the study, corresponding with increasing use of CT Pulmonary Angiography. Increasing diagnosis of PE may be due to detection of embolic debris from surgery due to greater vigilance rather than post-operative thromboembolism. Death from PE is rare following TKR.

The Effect of Burn Trauma on Lipid and Glucose Metabolism: Implications for Insulin Sensitivity.

Severe burns represent a unique form of trauma in terms of the magnitude and persistence of the stress response they incur. Given advances in acute burn care in the last quarter of a century and the resultant reduction in mortality rates, even for those with massive burns, greater emphasis is now placed on understanding the metabolic stress response to severe burn trauma in order to devise strategies that promote recovery and reduce morbidity. Derangements in metabolism including protein and lipid redistribution and altered glucose handling are hallmarks of the pathophysiological response to burn trauma. In this review article, we aim to distill and discuss the c urrent literature concerning the effect of burn trauma on lipid and glucose metabolism. Furthermore, we will discuss the implications of altered lipid metabolism with regards to insulin sensitivity and glucose control, while discussing the utility of agents and strategies aimed at restoring normal lipid and glucose metabolism in burned patients.

Intermediate results of a cemented femoral stem with a PMMA premantle.

This retrospective study evaluated the intermediate clinical results ot a series of 143 patients after total hip arthroplasty using the Definition PM femoral component. One hundred twenty-two patients had a mean follow-up of 5 years (range, 23-77 months), died (mean 30 months; range, 6-56 months), or were revised (mean 20 months; range, 9-40 months). The mechanical failure rate of the femoral stem was 0.8% for those patients with an average 5-year follow-up. Radiographic examination revealed that 1 (0.8%) femoral component was possihly loose, while none had evidence of dehonding. Follow-up radiographs revealed 2.50% (anteroposterior) and 5% (lateral) of the femoral components to have radiolucencies at the cement-bone interface. At a mean of 5 years. 2 of the 122 femoral romnonents imnlanted renuired revision.