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Plants vs. zombies. Lawn of doom
\"Halloween in Neighborville is weird enough, but now Zomboss and his zombie army want to turn the holiday into their own scarier Lawn of Doom celebration! With Zomboss filling everyone's yards with traps and special zombies, Crazy Dave, Patrice, Nate, and a batch of brave, boisterous plants fight back in contests of best tricks, best treats, and best costumes!\"-- Provided by publisher.
Book
Tranexamic Acid in Patients Undergoing Coronary-Artery Surgery
In a randomized trial, over 4500 patients undergoing cardiac surgery were assigned to receive tranexamic acid or placebo. There was no difference between groups in the rate of death or thrombotic complications. The tranexamic acid group had less bleeding and more seizures.
Excessive bleeding and blood transfusions are common in patients undergoing cardiac surgery,
1
and in some of these patients, there is a need for reoperation because of life-threatening bleeding.
2
Both blood transfusion and reoperation are strongly associated with poor outcomes after cardiac surgery.
2
,
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Antifibrinolytic therapy reduces the risk of blood loss and transfusion among patients undergoing cardiac surgery,
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,
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but it is unclear whether such therapy reduces the risk of reoperation for bleeding.
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Antifibrinolytic agents that have been used in patients undergoing cardiac surgery include aprotinin
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,
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and the lysine analogues tranexamic acid and aminocaproic acid.
8
–
11
These agents may . . .
Journal Article
Emerging ecologies : architecture and the rise of environmentalism : a field guide
\"During the 1960s, as Western notions of endless progress and growth gave way to concerns over industrial pollution, resource depletion and ecological limits, attitudes toward the environment became social, political and ideological. Published to accompany the first expansive survey of the history of environmental thinking in architecture, Emerging Ecologies: Architecture and the Rise of Environmentalism looks at the role architects have played in defining our understanding of 'nature' and the 'environment,' specifically during the rise of environmental discourse. The richly illustrated publication presents over 45 architectural contributions--from Eleanor Raymond and Mária Telkes' groundbreaking work on solar houses to Buckminster Fuller's world resource management system and the environmental symbolism of Emilio Ambasz--to explore the role designers played in both promoting ecological concerns and in outlining the very terms of this nascent field. Through an introductory essay by curator Carson Chan and brief texts on each of the featured projects, Emerging Ecologies documents the proximity between ecology, design and statecraft, allowing readers to take stock of historic milestones as architecture confronts today's climate emergencies\"-- Provided by publisher.
Book
Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery
Patients undergoing major abdominal surgery received restrictive or liberal intravenous fluids during surgery and up to 24 hours thereafter. The restrictive regimen did not improve disability-free survival and resulted in increased acute kidney injury.
Journal Article
Dexamethasone and Surgical-Site Infection
In this trial involving patients undergoing noncardiac surgery, dexamethasone was noninferior to placebo with respect to the incidence of surgical-site infection within 30 days after surgery, including in patients with diabetes mellitus.
Journal Article
Short-term preoperative smoking cessation and postoperative complications: a systematic review and meta-analysis
Purpose
The literature was reviewed to determine the risks or benefits of short-term (less than four weeks) smoking cessation on postoperative complications and to derive the minimum duration of preoperative abstinence from smoking required to reduce such complications in adult surgical patients.
Source
We searched MEDLINE, EMBASE, Cochrane, and other relevant databases for cohort studies and randomized controlled trials that reported postoperative complications (i.e., respiratory, cardiovascular, wound-healing) and mortality in patients who quit smoking within six months of surgery. Using a random effects model, meta-analyses were conducted to compare the relative risks of complications in ex-smokers with varying intervals of smoking cessation
vs
the risks in current smokers.
Principal findings
We included 25 studies. Compared with current smokers, the risk of respiratory complications was similar in smokers who quit less than two or two to four weeks before surgery (risk ratio [RR] 1.20; 95% confidence interval [CI] 0.96 to 1.50
vs
RR 1.14; CI 0.90 to 1.45, respectively). Smokers who quit more than four and more than eight weeks before surgery had lower risks of respiratory complications than current smokers (RR 0.77; 95% CI 0.61 to 0.96 and RR 0.53; 95% CI 0.37 to 0.76, respectively). For wound-healing complications, the risk was less in smokers who quit more than three to four weeks before surgery than in current smokers (RR 0.69; 95% CI 0.56 to 0.84). Few studies reported cardiovascular complications and there were few deaths.
Conclusion
At least four weeks of abstinence from smoking reduces respiratory complications, and abstinence of at least three to four weeks reduces wound-healing complications. Short-term (less than four weeks) smoking cessation does not appear to increase or reduce the risk of postoperative respiratory complications.
Journal Article
HULC: an oncogenic long non‐coding RNA in human cancer
Highly up‐regulated in liver cancer (HULC) was originally identified as the most overexpressed long non‐coding RNA in hepatocellular carcinoma. Since its discovery, the aberrant up‐regulation of HULC has been demonstrated in other cancer types, including gastric cancer, pancreatic cancer, osteosarcoma and hepatic metastasis of colorectal cancer. Recent discoveries have also shed new light on the upstream molecular mechanisms underlying HULC deregulation. As an oncogene, HULC promotes tumorigenesis by regulating multiple pathways, such as down‐regulation of EEF1E1, promotion of abnormal lipid metabolism, and up‐regulation of sphingosine kinase 1. Pertinent to clinical practice, a genetic variant in the HULC gene has been found to alter the risk for hepatocellular carcinoma and oesophageal cancer, whereas cancer patients with high or low expression of HULC exhibit different clinical outcome. These findings highlighted the pathogenic role and clinical utility of HULC in human cancers. Further efforts are warranted to promote the development of HULC‐directed therapeutics.
Journal Article
High-Sensitivity Troponin I after Cardiac Surgery and 30-Day Mortality
A prospective cohort study of 13,862 patients showed that among those who underwent isolated coronary-artery bypass grafting or aortic-valve replacement or repair, the threshold high-sensitivity cardiac troponin I level (within 1 day after surgery) associated with an adjusted hazard ratio for death within 30 days of more than 1.00 was 5670 ng per liter — 218 times the upper reference limit.
Journal Article
The safety of addition of nitrous oxide to general anaesthesia in at-risk patients having major non-cardiac surgery (ENIGMA-II): a randomised, single-blind trial
Nitrous oxide is commonly used in general anaesthesia but concerns exist that it might increase perioperative cardiovascular risk. We aimed to gather evidence to establish whether nitrous oxide affects perioperative cardiovascular risk.
We did an international, randomised, assessor-blinded trial in patients aged at least 45 years with known or suspected coronary artery disease having major non-cardiac surgery. Patients were randomly assigned via automated telephone service, stratified by site, to receive a general anaesthetic with or without nitrous oxide. Attending anaesthetists were aware of patients' group assignments, but patients and assessors were not. The primary outcome measure was a composite of death and cardiovascular complications (non-fatal myocardial infarction, stroke, pulmonary embolism, or cardiac arrest) within 30 days of surgery. Our modified intention-to-treat population included all patients randomly assigned to groups and undergoing induction of general anaesthesia for surgery. This trial is registered at ClinicalTrials.gov, number NCT00430989.
Of 10 102 eligible patients, we enrolled 7112 patients between May 30, 2008, and Sept 28, 2013. 3543 were assigned to receive nitrous oxide and 3569 were assigned not to receive nitrous oxide. 3483 patients receiving nitrous oxide and 3509 not receiving nitrous oxide were assessed for the primary outcome. The primary outcome occurred in 283 (8%) patients receiving nitrous oxide and in 296 (8%) patients not receiving nitrous oxide (relative risk 0·96, 95% CI 0·83–1·12; p=0·64). Surgical site infection occurred in 321 (9%) patients assigned to nitrous oxide, and in 311 (9%) patients in the no-nitrous oxide group (p=0·61), and severe nausea and vomiting occurred in 506 patients (15%) assigned to nitrous oxide and 378 patients (11%) not assigned to nitrous oxide (p<0·0001).
Our findings support the safety profile of nitrous oxide use in major non-cardiac surgery. Nitrous oxide did not increase the risk of death and cardiovascular complications or surgical-site infection, the emetogenic effect of nitrous oxide can be controlled with antiemetic prophylaxis, and a desired effect of reduced volatile agent use was shown.
Australian National Health and Medical Research Council; Australian and New Zealand College of Anaesthetists; Heart and Stroke Foundation of Quebec, Heart and Stroke Foundation of Ontario, Canada; General Research Fund of the Research Grant Council, Hong Kong Special Administrative Region, China.
Journal Article
Miller Fisher syndrome associated with COVID-19: an up-to-date systematic review
Recently, during the pandemic infection of the novel SARS-CoV-2, some cases of Miller Fisher syndrome (MFS) have been reported. We want to summarize the main features of patients with MFS and COVID-19. A PubMed search was performed on 8 October to identify references reporting cases with MFS associated with COVID-19 from the first report of COVID-19 to 8 October 2020 using the following keywords: “Miller Fisher syndrome” AND “COVID-19” OR “SARS-CoV-2”. A systematic review from the first report of coronavirus disease 2019 (COVID-19) to 8 October 2020 revealed 7 cases with Miller Fisher syndrome (MFS) associated with COVID-19. The 7 cases came from 5 countries but most of these patients were from Europe (85.7%), especially Spain. There are 5 cases of MFS diagnosed after the laboratory confirmation of SARS-CoV-2 infection. The mean onset time of MFS-associated neurological symptoms was 14.75 days after the diagnosis of COVID-19. However, the two remaining cases presented initially with MFS-associated neurological symptoms followed by the diagnosis of COVID-19. The most common symptoms of COVID-19-associated MFS were perioral paresthesias (57.1%), ataxia (57.1%), blurred vision (42.9), ophthalmoplegia (42.9), and generalized areflexia (42.9). However, more cohort and case-control studies are required to establish the epidemiological linkage.
Journal Article