A differently managed Spleen Injury

Introduction: Treatment of symptomatic splenic injury after more than 1 month of the trauma is not very specific. Moreover, here, we are reporting such a case where the patient was treated laparoscopically salvaging the spleen.

Case report: A 26-year-old young male presented with persistent pain in the left upper abdomen and back, following a splenic injury while playing football 1 month ago. Abdominal ultrasound showed subcapsular hematoma with intact hilum. Contrast-enhanced computed tomography of whole abdomen showed large subcapsular hematoma grade III with intact hilar vessels. In view of persistent pain and discomfort, which debilitated and restrained him from daily as well as professional activity, even after 1 month of trauma, the patient was planned for diagnostic laparoscopy and proceed, which revealed hemoperitoneum and was aspirated. Omentum was separated from splenic capsule, breech in the capsule was extended, and hematoma was sucked out. The drain was removed on 4th postoperative day after ultrasound to exclude any fresh hemorrhage. The patient soon started daily activity and resumed his job after 15 days.

Conclusion: Surgical intervention in a hemodynamically stable splenic-injury patient may sometimes be required depending upon the condition and symptoms of the patient.

Management of Chylothorax After Coronary Artery Bypass Grafting: Two Case Reports and Review of Literature

Chylothorax following coronary artery bypass graft (CABG) surgery is a very rare complication and its management is debatable. Opinions vary from early aggressive management to prolonged conservative treatment. We describe two cases of post-operative chylothorax following CABG and its management with intravenous octreotide.

Zinc oxide thin film based nonenzymatic electrochemical sensor for the detection of trace level catechol

In the present work, a novel zinc oxide thin film based nonenzymatic, electrochemical sensor is developed for the detection of catechol.

Hierarchical zinc oxide nano-tips and micro-rods: hydrothermal synthesis and improved chemi-resistive response towards ethanol

In the present work, a novel hierarchical architecture of zinc oxide has been synthesized through a spherical carbon template assisted two step hydrothermal process.

Insulin resistance increases before ventilator-associated pneumonia in euglycemic trauma patients

BACKGROUND

Hyperglycemia caused by stress-induced insulin resistance is associated with both infection and mortality in critically injured patients. The onset of infection may increase stress-induced insulin resistance, leading to hyperglycemia. Hyperglycemia has been shown to precede the diagnosis of ventilator-associated pneumonia (VAP) in critically injured adults and has been suggested to have potential diagnostic importance. However, glycemic control (GC) protocols in critically ill patients limit the development of hyperglycemia despite increasing insulin resistance. Our computer-assisted GC protocol achieves excellent GC, limiting infection-related hyperglycemia while capturing prospectively all glucose values, insulin infusion rates, and the multiplier (M) used to calculate the insulin rate. We hypothesized that surrogate measures of insulin resistance, the insulin infusion rate and multiplier M, would increase prior to the clinical suspicion of VAP, even in euglycemic critically injured patients.

METHODS

All critically injured patients (2,656) on the computerized glycemic control protocol were included in the analysis and categorized by those developing VAP and those without pneumonia on days 3-10 of their intensive care unit (ICU) stay. Median blood glucose concentration (BG), insulin infusion rate (IDR), and multiplier (M) [Insulin Drip Rate=M*(BG-60)] were determined for VAP patients (n=329) and non-infected ventilated (NIV) patients (n=2,327) on each day of mechanical ventilation. The day of VAP diagnosis according to U.S. Centers for Disease Control and Prevention (CDC) criteria was defined as day zero and VAP patients matched with NIV patients according to ventilator day from -10 to +10. Comparisons were conducted using the Mann-Whitney U test.

RESULTS

Baseline characteristics between VAP and NIV groups did not differ. Measures of insulin resistance increased from the time of injury in both groups. Patients with VAP had significantly greater change in both measures of insulin resistance, IDR and M, in the 48 hours preceding the diagnosis of VAP. These changes occurred despite the fact that the computer-assisted GC protocol achieved lower glucose values in VAP patients for the majority of study days.

CONCLUSIONS

Measures of insulin resistance increase in the two days prior to the clinical suspicion of VAP for critically injured patients on the GC protocol. These changes occur despite the protocol maintaining euglycemia. This data suggests that markers of insulin resistance may provide clinically useful information in the early diagnosis of VAP.

Visible light absorption and photo-sensitizing properties of spinach leaves and beetroot extracted natural dyes

Herein, chlorophyll and betalain dyes are extracted from fresh spinach leaves and beetroots. Fourier transform infrared spectra are used to identify the characteristic peaks of the extracted dyes. UV-vis light absorption characteristics of the dyes and their mixed counterpart are investigated by varying their pH and temperature. These dyes are used as photo sensitizer for fabrication of zinc oxide photo-anode based dye sensitized solar cells (DSSCs). The photo-voltaic characteristics of the developed DSSCs are measured under simulated solar light (power of incident light 100 mW cm(-2) from Air Mass 1.5G). The solar to electric conversion efficiencies for the chlorophyll, betalain and mixed dye based solar cells are estimated as 0.148%, 0.197% and 0.294% respectively. The highest conversion efficiency for mixed dye based solar cell is attributed due to the absorption of wider range of solar spectrum.

Insulin Resistance in Critically Injured Adults: Contribution of Pneumonia, Diabetes, Nutrition, and Acuity

PURPOSE

Changes in insulin resistance (IR) cause stress-induced hyperglycemia after trauma, but the numerous factors involved in IR have not been delineated clearly. We hypothesized that a statistical model could help determine the relative contribution of different clinical co-variates to IR in critically injured patients.

PATIENTS AND METHODS

We retrospectively studied 726 critically injured patients managed with a computer-assisted glycemic protocol at an academic level I trauma center (639 ventilated controls without pneumonia (VWP) and 87 patients with ventilator-associated pneumonia (VAP). Linear regression using age, gender, body mass index (BMI), diabetes mellitus, pneumonia, and glycemic provision was used to estimate M, a marker of IR that incorporates both the serum blood glucose concentration (BG) and insulin dose.

RESULTS

Increasing M (p<0.001) was associated with age (1.62%; 95% confidence interval [CI] 1.27%-1.97% per decade), male gender (9.78%; 95% CI 8.28%-12.6%), BMI (4.32% [95% CI 4.02%-4.62%] per 5 points), diabetes mellitus (21.2%; 95% CI 19.2%-23.2%), pneumonia (10.9%; 95% CI 9.31%-12.6%), and glycemic provision (27.3% [95% CI 6.6%-28.1%] per 100 g of glucose). Total parenteral nutrition was associated with a decrease in M of 10.3%; 95% CI 8.52%-12.1%; p<0.001.

CONCLUSIONS

Clinical factors can be used to construct a model of IR. Prospective validation might enable early detection and treatment of infection or other conditions associated with increased IR.

Intrapulmonary teratoma: Report of a case and review of literature

Intrapulmonary teratomas are rare tumors that are presumed to develop in association with mediastinal teratomas. This report describes the management of a rare case of a benign cystic intrapulmonary teratoma in the left upper lobe in a 26-year-old lady, which was successfully treated by lobectomy, with no recurrence after 4 years of follow-up.

A rare combination of hepatic and pericardial hydatid cyst and review of literature

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This case presentation, emphasizes the typical manifestations of hepatic but associated asymptomatic pericardial HCs.

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Hepatic hydatid cyst presenting as a painless abdominal lump preceded painful presentation for a few months.

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Asymptomatic pericardial hydatid cyst could have presented with pericardial tamponade due to rupture, if ignored further.

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The origin of the pericardial hydatid cyst could have been due to trans diaphragmatic passage of scolices from the hepatic location, as the usual pulmonary involvement was absent.

Hydatid disease in human beings, as in all intermediate hosts, manifest as hydatid cyst (HC). It is an important cyclozoonotic disease, endemic in various sheep and cattle raising areas of the world, including India. The tapeworm commonly involved is Echinococcus granulosus. HC can occur almost anywhere in the body, most common organs being liver and lungs, and are usually solitary. In 25% of cases combination of liver HC with HC in other extra pulmonary locations are found. Cardiac HCs comprise of 0.5–2% of all HC cases. Within the heart, HCs are usually situated in the left or right ventricle and rarely found in the peri-cardium. Pericardial HC does not produce symptoms and is often painless and silent, until the cysts grow to a large size over the years, when the usual complications develop, such as cyst rupture, cardiac compression, atrial fibrillation, and even sudden death. We describe the case of a 39 year old house wife, of rural origin, with proximity to livestock, who had an asymptomatic pericardial HC along with a symptomatic hepatic HC. She clinically presented with an abdominal lump for one year with recent onset of abdominal pain for 1 month, when radiological imaging confirmed the diagnosis of an unruptured hepatic HC and a pericardial HC. The patient recovered after pericardiectomy along with excision of the HC over the left ventricle and enucleation of hepatic HC, by thoracoabdominal approach. She is doing well after 5 years of followup without recurrence.

Elevated serum creatine phosphokinase is associated with mortality and inotropic requirement in critically injured adults

BACKGROUND

Hemeproteins such as free myoglobin can undergo autoxidation and catalyse lipid peroxidation, increasing oxidative stress. Creatine phosphokinase (CPK) elevation is a marker for free myoglobin after myocyte damage. Since oxidative injury is a key mechanism of injury-related organ dysfunction, we hypothesised that serum CPK levels correlate with mortality and need for inotropic medication and duration of inotropic support, i.e. shock, among critically injured patients.

METHODS

We conducted a retrospective review of 17,847 patients admitted to a single Trauma Intensive Care Unit over 9 years. 2583 patients with serum CPK levels were included in the analysis. Patient data were collected continuously into an electronic ICU repository. Univariate analysis was accomplished using Spearman correlation and the Mann–Whitney U test. Propensity score adjustment models accounting for potential confounders were used to assess the independent effect of CPK level on mortality, need for inotropic support, and duration of inotropic support.

RESULTS

Median CPK was significantly higher in patients who died (916 [IQR 332, 2472] vs. 711 [253, 1971], p = 0.004) and in those who required inotropic medications (950 [353, 2525] vs. 469 [188, 1220], p < 0.001). After adjusting for propensity score and potential confounders the odds of mortality increased by 1.10 (95% CI 1.02–1.19, p = 0.020) and the odds of inotropic medication use increased by 1.30 (95% CI 1.22–1.38, p < 0.001) per natural log unit increase in CPK. There was a significant association between CPK level and duration of inotropic support (Spearman's rho .237, p < 0.001) that remained significant in a propensity score-adjusted model.

CONCLUSION

In critically injured patients, elevated serum CPK level is independently associated with mortality, need for inotropic medication, and duration of inotropic support. This study is the first to evaluate the relationship of CPK level and mortality in addition to surrogate measures of shock in a population of critically injured patients. If these associations are verified prospectively, there may be a role for treatment with hemeprotein reductants, such as paracetamol, to mitigate the effects of shock and end-organ dysfunction.

Infected internal jugular vein thrombus in a case of infected arterio-venous fistula for dialysis access

Infected internal jugular vein (IJV) thrombus is rare and is sometimes seen in association with jugular vein catheterization and rarely with suppurative upper aero-digestive tract infection. We describe a very rare association of left Infected Internal jugular vein thrombus with an infected arterio-venous fistula in the left elbow region created for dialysis access in a renal failure patient. The infected arterio-venous fistula was addressed surgically by excision and a reverse saphenous vein graft was placed between proximal and distal brachial artery just above it's bifurcation. The patient was put on i.v Clindamycin and Metronidazole for six weeks. Patient recovered uneventfully.

Identification of RAPD-SCAR marker linked to white spot syndrome virus resistance in populations of giant black tiger shrimp, Penaeus monodon Fabricius

White spot disease (WSD) caused by white spot syndrome virus (WSSV) creates severe epizootics in shrimp aquaculture industry worldwide. Despite several efforts, no such permanent remedy was yet developed. Selective breeding using DNA markers would be a cost-effective strategy for long-term solution of this problem. In the present investigation, out of 30 random primers, only one primer produced a statistically significant (P < 0.01) randomly amplified polymorphic DNA (RAPD) marker of 502 bp, which provided a good discrimination between disease resistant and disease susceptible populations of Penaeus monodon from three geographical locations along the East coast of India. Because RAPD markers are dominant, a sequence characterized amplified region (SCAR) marker was developed by cloning and sequencing of 502 bp RAPD fragment, which generates a single 457 bp DNA fragment after PCR amplification only in the disease resistant shrimps. Challenge experiment was also conducted to validate this 457 bp SCAR marker, and the results suggested that the WSSV loads were 2.25 × 10(3) fold higher in disease susceptible than that in disease resistant shrimps using real-time PCR. Therefore, this 457 bp DNA SCAR marker will be very valuable towards the development of disease-free shrimp aquaculture industry.

Facile synthesis of pseudo-peanut shaped hematite iron oxide nano-particles and their promising ethanol and formaldehyde sensing characteristics

Herein, pseudo-peanut shaped hematite iron oxide nano-particles are prepared through a facile cost effective wet chemical synthesis route.

Giant chondrosarcoma of chest wall

Primary chest wall tumours are very rare. Chondrosarcoma is the most common tumour arising from the chest wall. We describe the occurrence of a slow-growing chondrosarcoma arising from the anterior chest wall in a 35-year-old male patient. The tumour was resected successfully and chest wall was reconstucted with prolene mesh and muscle flap. The patient was discharged uneventfully without any respiratory compromise. There was no recurrence after a three-year follow-up. Wide surgical resection with chest wall reconstruction appears to be the preferred treatment option for this rare tumour of the chest wall.

Imaging analysis of hepatoblastoma resectability across neoadjuvant chemotherapy

PURPOSE

Hepatoblastomas often require neoadjuvant chemotherapy to facilitate partial hepatectomy, which necessitates freedom of tumor borders from the confluence of hepatic veins (COHV), portal vein bifurcation (PVB), and retrohepatic inferior vena cava (IVC). This study aimed to clarify the effect of incremental neoadjuvant cycles on the AHEP0731 protocol criteria of hepatoblastoma resectability.

METHODS

Hepatoblastoma responses to neoadjuvant chemotherapy were analyzed among patients (n=23) treated at two children's hospitals between 1996 and 2010. Using digital imaging data, ellipsoid and point-based models were created to measure tumor volume regression and respective distances from tumor borders nearest to the COHV, PVB, and IVC.

RESULTS

Hepatoblastoma volumes regressed with incremental neoadjuvant chemotherapy cycles (p<0.001). Although tumor borders regressed away from the COHV (p=0.008), on average only 1.1mm was gained. No change from tumor borders to the PVB was detected (p=0.102). Distances from tumor borders to the IVC remained stable at one hospital (p=0.612), but increased only 0.15 mm every 10 days of therapy at the other (p=0.002). Neoadjuvant chemotherapy induced slightly more tumors to meet the threshold vascular margin of 1cm (baseline to completion): COHV, 11 (47.8%) to 17 (73.9%; p=0.058); PVB, 11 (47.8%) to 15 (65.2%; p=0.157); and IVC, 4 (17.4%) to 10 (43.5%; p=0.034). No differences were detected in demographic or disease-specific characteristics between patients who did or did not achieve this 1-cm margin after conclusion of chemotherapy.

CONCLUSION

Hepatoblastoma volumes regress significantly with increasing neoadjuvant chemotherapy cycles. However, tumors often remain anchored to the major hepatic vasculature, showing marginal improvement in resectability criteria.

More than a colour change: insect melanism, disease resistance and fecundity

A 'dark morph' melanic strain of the greater wax moth, Galleria mellonella, was studied for its atypical, heightened resistance to infection with the entomopathogenic fungus, Beauveria bassiana. We show that these insects exhibit multiple intraspecific immunity and physiological traits that distinguish them from a non-melanic, fungus-susceptible morph. The melanic and non-melanic morphs were geographical variants that had evolved different, independent defence strategies. Melanic morphs exhibit a thickened cuticle, higher basal expression of immunity- and stress-management-related genes, higher numbers of circulating haemocytes, upregulated cuticle phenoloxidase (PO) activity concomitant with conidial invasion, and an enhanced capacity to encapsulate fungal particles. These insects prioritize specific augmentations to those frontline defences that are most likely to encounter invading pathogens or to sustain damage. Other immune responses that target late-stage infection, such as haemolymph lysozyme and PO activities, do not contribute to fungal tolerance. The net effect is increased larval survival times, retarded cuticular fungal penetration and a lower propensity to develop haemolymph infections when challenged naturally (topically) and by injection. In the absence of fungal infection, however, the heavy defence investments made by melanic insects result in a lower biomass, decreased longevity and lower fecundity in comparison with their non-melanic counterparts. Although melanism is clearly correlated with increased fungal resistance, the costly mechanisms enabling this protective trait constitute more than just a colour change.

Bone remodelling around uncemented metallic and ceramic acetabular components

Stress shielding–induced bone resorption around cementless acetabular components has been indicated as a potential failure mechanism that may threaten long-term fixation. Using a bone remodelling algorithm in combination with three-dimensional finite element models of intact and implanted pelvises and musculoskeletal loading during normal walking, the objectives of the study were to investigate the deviations in load transfer due to implantation and bone adaptation around cementless metallic and ceramic acetabular components. Variations in implant–bone interfacial condition affected strain shielding and bone remodelling; strain shielding was higher for the bonded condition as compared to the debonded condition. For bonded interfacial condition, severe bone resorption, 20%–50% bone density reduction, was observed within the acetabulum. Considering debonded implant–bone interface, bone density increase of 50%–60% was observed around the supero-posterior part of acetabulum, whereas bone density reductions were low (2%–15%) in other locations. The implant–bone interface appeared less likely to fail, post-operatively and after bone remodelling. Moreover, the implant–bone micromotion was found to be low, less than 100 µm. Strain shielding and bone remodelling were almost similar for the metallic and ceramic components. Based on the results of this study, the ceramic acetabular component appeared to be a viable alternative to metal.

A foe incognito: an interesting case of pleurisy

Though pleuritis and pleural effusion are common in lupus patients they are distinctly rare as the initial manifestation of lupus. Diagnosis of lupus pleuritis is also a difficult task and often costly and lengthy immunological panels are employed to diagnose it. We report one case of systemic lupus erythematosus (SLE) presenting with lupus pleuritis as the first manifestation. We propose that demonstration LE cells have a very prominent role in differentiating lupus pleuritis from other causes of pleural effusions in SLE patients. We believe that our case is the first report from India which shows pleuritis may be a first manifestation of lupus.

Enteric fever in an HIV/AIDS patient: Atypical manifestations

Bloodstream infections with Salmonella typhi, is uncommon in human immunodeficiency virus (HIV)-infected persons. The symptoms in such patients are often non-specific and have a rather insidious onset and progression. We report a patient with sepsis and lower limb gangrene due to Salmonella typhi infection in an HIV-infected patient.

Statistical Mechanics-Inspired Modeling of Heterogeneous Packet Transmission in Communication Networks

This paper presents the qualitative nature of communication network operations as abstraction of typical thermodynamic parameters (e.g., order parameter, temperature, and pressure). Specifically, statistical mechanics-inspired models of critical phenomena (e.g., phase transitions and size scaling) for heterogeneous packet transmission are developed in terms of multiple intensive parameters, namely, the external packet load on the network system and the packet transmission probabilities of heterogeneous packet types. Network phase diagrams are constructed based on these traffic parameters, and decision and control strategies are formulated for heterogeneous packet transmission in the network system. In this context, decision functions and control objectives are derived in closed forms, and the pertinent results of test and validation on a simulated network system are presented.

The nature of 4f electron magnetism in the diluted ferromagnetic Kondo lattice, CeIr2B2

We report on the physical properties of the series Ce(1-x)La(x)Ir(2)B(2) (x = 0-0.9), obtained by means of magnetization, heat capacity and electrical resistivity measurements as a function of temperature (down to 0.7 K for the latter two measurements). The Curie temperature of CeIr(2)B(2) (~5 K) is lowered due to La substitution, as expected. However, no quantum critical point or 'non-Fermi liquid' behavior was observed even in the dilute limit of x = 0.9. Interestingly, ferromagnetic ordering persists even for Ce(0.1)La(0.9)Ir(2)B(2), below 0.8 K. Among the Ce systems, CeIr(2)B(2) is one of the compounds in which direct 4f-4f interaction does not appear to play any role in the magnetism, which is controlled by the indirect exchange interaction alone. In this compound, the Kondo effect persists in the ferromagnetic ordered state, as inferred from the entropy data.

Magnetic anomalies in CeIn(2)

The magnetic behavior of binary compound CeIn(2) has been reported to be unusual in the sense that this compound appears to exhibit a first-order ferromagnetic transition at a rather high temperature of (T(C)=)22 K, which is not so common for Ce systems. In order to throw more light on the magnetic behavior of this compound, we have carried out detailed magnetization, and electrical resistivity studies as a function of temperature, magnetic field and external pressure, in addition to heat-capacity measurements. The plots of H/M versus M(2) at low fields are interestingly characterized by negative slopes, not only near T(C), but also at lower temperatures, a source of which could be attributed to magnetic-field-induced transitions at much lower temperatures. The sign of magnetoresistance tends to change from positive to negative with increasing temperature, as though there is a gradual change in the magnetic character. Finally, the magnetic ordering temperature increases with increasing pressure (until 20 kbar), as though this compound lies at the left-hand side of the peak in Doniach’s magnetic phase diagram.

A first-order magnetic phase transition near 15 K with novel magnetic-field-induced effects in Er5Si3

We present magnetic characterization of a binary rare-earth intermetallic compound Er(5)Si(3), crystallizing in Mn(5)Si(3)-type hexagonal structure, through magnetization, heat capacity, electrical resistivity and magnetoresistance measurements. Our investigations confirm that the compound exhibits two magnetic transitions with decreasing temperature, the first one at 35 K and the second one at 15 K. The present results reveal that the second magnetic transition is a disorder-broadened first-order transition, as shown by thermal hysteresis in the measured data. Another important finding is that, below 15 K, there is a magnetic-field-induced transition with a hysteretic effect with the electrical resistance getting unusually enhanced at this transition and the magnetoresistance is found to exhibit intriguing magnetic-field dependence, indicating novel magnetic phase coexistence phenomenon. It thus appears that this compound is characterized by interesting magnetic anomalies in the temperature-magnetic-field phase diagram.

Incidence of pars defects in adolescent idiopathic scoliosis: an MRI study

OBJECTIVE

In this study, our aim was to present the incidence rate of pars defect in patients with adolescent idiopathic scoliosis, based on MRI findings.

METHODS

Two-hundred twenty adolescent idiopathic scoliosis (AIS) patients with MRI scans, taken either as a preoperative investigation or due to other symptoms between 2006 and 2008, were included in the study. The scans were reviewed for pars defect independently by two experienced musculoskeletal radiology consultants.

RESULTS

Among the 220 patients, 9 patients (4.09%; 8 female, 1 male) were found to have a pars defect. The mean age of the affected patients was 14 (range: 11-20) years. We noted two lumbar/thoracolumbar curves (Lenke 5), four King Type 1, one King Type 2 and two King Type 3 curves. All scoliotic deformities were non-structural. Bilateral pars defect was noted in eight (89%) of these patients. All of the pars defects were at the L5 vertebral level.

CONCLUSION

Our study revealed a 4.09% incidence rate of pars defect in AIS patients which appeared similar to those previously reported in roentgenographic studies.

Evolution of a metastable phase with a magnetic phase coexistence phenomenon and its unusual sensitivity to magnetic field cycling in the alloys Tb(5 - x)Lu(x)Si3 (x ≤ 0.7)

Recently, we reported an anomalous enhancement of the positive magnetoresistance beyond a critical magnetic field in Tb(5)Si(3) in the magnetically ordered state, attributable to 'inverse metamagnetism'. This results in unusual magnetic hysteresis loops for the pressurized specimens, which are relevant to the topic of 'electronic phase separation'. In this paper, we report the influence of small substitutions of Lu for Tb, to show the evolution of these magnetic anomalies. We find that, at low temperatures, the high-field high-resistivity phase could be partially stabilized on returning the magnetic field to zero in many of these Lu substituted alloys, as measured through the electrical resistivity (ρ). Also, the relative fractions of this phase and the virgin phase appear to be controlled by a small tuning of the composition and temperature. Interestingly, at 1.8 K a sudden 'switch-over' of the value of ρ for this mixed phase to that for the virgin phase for some compositions is observed at low fields after a few field cycles, indicating metastability of this mixed phase.

Magnetism of fine particles of Kondo lattices, obtained by high-energy ball-milling

Despite intense research in the field of strongly correlated electron behavior for the past few decades, there has been very little effort to understand this phenomenon in nanoparticles of the Kondo lattices. In this paper, we review the results of our investigation on the fine particles (<<1 μm) of some of the alloys obtained by high-energy ball-milling, to bring out that this synthetic method paves a way to study strong electron correlations in nanocrystals of such alloys. We primarily focus on the alloys of the series CeRu(2 - x)Rh(x)Si2, lying at different positions in Doniach's magnetic phase diagram. While CeRu2Si2, a bulk paramagnet, appears to become magnetic (of a glassy type) below about 8 K in fine particle form, in CeRh2Si2, an antiferromagnet (T(N) = 36 K) in bulk form, magnetism is destroyed (at least down to 0.5 K) in fine particles. In the alloy CeRu0.8Rh1.2Si2, at the quantum critical point known to exhibit non-Fermi liquid behavior in the bulk form, no long range magnetic ordering is found.

Enhanced electrical resistance at the field-induced magnetic transitions in some non-stoichiometric and stoichiometric Tb-based ternary germanides

We present the magnetic and transport behavior of some Tb compounds, namely TbIrGe(2), TbFe(0.4)Ge(2) and TbCo(0.4)Ge(2). The stoichiometric germanide TbIrGe(2) exhibits at least two distinct magnetic transitions in a close temperature interval around 10 K. Non-stoichiometric compounds, TbFe(0.4)Ge(2) and TbCo(0.4)Ge(2), undergo magnetic ordering around 17 and 19 K, respectively. The magnetic state of these compounds appears to be antiferromagnetic-like. Qualitatively there is a correlation between the field response of the magnetization (M), the magnetoresistance (MR) and the entropy change (ΔS) curve in all three compounds. That is, these Tb compounds exhibit a positive MR and ΔS beyond a magnetic field where M also shows a field-induced transition. On the basis of this correlation, we conclude that magnetic disorder/fluctuations beyond a critical field-a phenomenon called 'inverse metamagnetism'-rather than metamagnetism is induced in these compounds.

Esophageal adenocarcinoma: treatment modalities in the era of targeted therapy

Esophageal adenocarcinoma is an aggressive malignancy with a poor outcome, and its incidence continues to rise at an alarming rate. Current treatment strategies combining chemotherapy, radiation, and surgery are plagued with high rates of recurrence and metastasis. Multiple molecular pathways including the epidermal growth factor receptor, vascular endothelial growth factor, v-erb-b2 erythroblastic leukemia viral oncogene homolog (ERBB2), and Aurora kinase pathways are activated in many esophageal adenocarcinomas. In many cases, these pathways have critical roles in tumor progression. Research on the mechanisms by which these pathways contribute to disease progression has resulted in numerous biologic agents and small molecules with the potential to improve outcome. The promise of targeted therapy and personalized medicine in improving the clinical outcome is now closer than it has ever been.

All trauma surgeons are not created equal: asymmetric distribution of malpractice claims risk

BACKGROUND

Trauma surgery is perceived to have high malpractice risk. Unsolicited patient complaints (UPCs) can predict increased malpractice risk. An ex ante analysis of UPCs was performed to determine the risk profile for trauma surgeons compared with nontrauma surgeons.

METHODS

UPCs from 14 health systems over 4 years were retrospectively studied. Surgeons were divided into nontrauma surgeons (NTS) and trauma surgeons (TS). Inclusion criteria for TS were practice at a Level I or geographically isolated Level II adult trauma center and either surgical critical care certification or American Association for the Surgery of Trauma, Eastern Association for the Surgery of Trauma, or Western Trauma Association membership. Standardized risk scores were generated using a weighted sum algorithm from UPC data. Mann-Whitney U test, Kolvogorov-Smirnov two-sample test for distribution, χ for linear trend, and relative risk analysis were performed.

RESULTS

A total of 16,518 UPCs were filed against 4,244 surgeons, including 55 TS. 18% of TS and 57% of NTS had 0 UPCs. Mean risk score was higher for TS (29.2 ± 29.0 vs. 10.2 ± 19.5, p < 0.001), and more TS (20.0% vs. 3.15%) were at moderate (score 50-69) or at high risk (score >70) (7.27% vs. 2.57%; p < 0.001), reflecting a shifted risk distribution (p < 0.001) compared with NTS. TS have a relative risk of 6.17 (95% CI: 3.36-11.33) for score >50.

CONCLUSIONS

TS are at increased risk of UPCs compared with NTS, but this risk is still largely borne by a minority of TS. UPCs seem to be a reasonable proxy for malpractice risk, so targeted interventions for TS associated with disproportionate shares of UPCs may reduce patient dissatisfaction and, perhaps, malpractice claims.