Sedation and analgesia for critically ill pediatric burn patients: the current state of practice.

The objective of this study was to assess current practice patterns and attitudes toward pediatric sedation and analgesia in United States (US) burn centers for critically ill patients. Survey-based questionnaire was sent to 119 Directors at US burn centers that care for pediatric patients. Forty-one surveys (34%) were analyzed.

Manipulating Carbohydrate Availability Between Twice-Daily Sessions of High-Intensity Interval Training Over 2 Weeks Improves Time-Trial Performance.

Commencing some training sessions with reduced carbohydrate (CHO) availability has been shown to enhance skeletal muscle adaptations, but the effect on exercise performance is less clear. We examined whether restricting CHO intake between twice daily sessions of high-intensity interval training (HIIT) augments improvements in exercise performance and mitochondrial content. Eighteen active but not highly trained subjects (peak oxygen uptake [VO2peak] = 44 ± 9 ml/kg/min), matched for age, sex, and fitness, were randomly allocated to two groups.

Selenium hyperaccumulators harbor a diverse endophytic bacterial community characterized by high selenium resistance and plant growth promoting properties.

Selenium (Se)-rich plants may be used to provide dietary Se to humans and livestock, and also to clean up Se-polluted soils or waters. This study focused on endophytic bacteria of plants that hyperaccumulate selenium (Se) to 0.5-1% of dry weight.

Multicenter Selective Lymphadenectomy Trial-I confirms the central role of sentinel node biopsy in contemporary melanoma management: response to 'No survival benefit for patients with melanoma undergoing sentinel lymph node biopsy: critical appraisal of the Multicenter Selective Lymphadenectomy Trial-I final report'.

Sentinel lymph node (SLN) biopsy has become a standard procedure for many patients with melanoma and is recommended in numerous national and professional melanoma guidelines. The Multicenter Selective Lymphadenectomy Trial (MSLT-1) confirms earlier large database studies and prospective clinical trials in demonstrating the independent and unequalled prognostic value of the SLN. It also demonstrates the ability of biopsy-directed management to provide effective regional disease control with the least possible morbidity.

Keratoacanthoma and squamous cell carcinoma are distinct from a molecular perspective.

Keratoacanthoma is a controversial entity. Some consider keratoacanthoma as a variant of squamous cell carcinoma, whereas others see it as a distinct self-resolving squamoproliferative lesion. Our objective is to examine the relationship of keratoacanthoma with squamous cell carcinoma and normal skin by using DNA microarrays.

Is sentinel node susceptibility to metastases related to nodal immune modulation?

Sentinel lymph nodes (SLNs), the initial site of regional metastases, directly receive lymph containing immune-modulatory cytokines and tumor cells from primary melanomas. Immune-suppressed SLNs are ideal for studies of tissue susceptibility to metastases. They show reduced antigen-presenting dendritic cells, activated T cells, high endothelial venules, and transvenular immigration of T cells.

Wilderness Medical Society practice guidelines for the prevention and treatment of frostbite: 2014 update.

The Wilderness Medical Society convened an expert panel to develop a set of evidence-based guidelines for the prevention and treatment of frostbite. We present a review of pertinent pathophysiology. We then discuss primary and secondary prevention measures and therapeutic management.

Deubiquitinase DUBA is a post-translational brake on interleukin-17 production in T cells.

T-helper type 17 (TH17) cells that produce the cytokines interleukin-17A (IL-17A) and IL-17F are implicated in the pathogenesis of several autoimmune diseases. The differentiation of TH17 cells is regulated by transcription factors such as RORγt, but post-translational mechanisms preventing the rampant production of pro-inflammatory IL-17A have received less attention. Here we show that the deubiquitylating enzyme DUBA is a negative regulator of IL-17A production in T cells.

Effects of disruptive surgeon behavior in the operating room.

Background: Surgeons are the physician group most commonly identified as "disruptive physicians." The aim of this study was to develop a conceptual model of the results of disruptive surgeon behavior and to identify the coping strategies used by perioperative staff.

Methods: Perspectives of 19 individuals of diverse occupations in the perioperative setting were drawn together using a grounded theory methodology.

Research priorities for multi-institutional collaborative research in surgical education.

Background: Research in surgical education has seen unprecedented growth but originates from single institutions and remains uncoordinated; this study aimed to generate a list of research priorities in surgical educational topics.

Methods: The membership of the Association for Surgical Education was asked to submit up to 5 research questions concerned with multi-institutional collaborative surgical education research and to identify challenges faced by surgical education researchers. A modified Delphi methodology was used to create the research agenda based on these responses.

Future perspectives in melanoma research: meeting report from the "Melanoma Bridge", Napoli, December 5th-8th 2013.

The fourth "Melanoma Bridge Meeting" took place in Naples, December 5 to 8th, 2013. The four topics discussed at this meeting were: Diagnosis and New Procedures, Molecular Advances and Combination Therapies, News in Immunotherapy, and Tumor Microenvironment and Biomarkers.

Protecting trauma patients from duplicated computed tomography scans: the relevance of integrated care systems.

Background: Duplicated computed tomography (CT) scans in transferred trauma patients have been described in university-based trauma systems. This study compares CT utilization between a university-based nonintegrated system (NIS) and a vertically integrated regional healthcare system (IS).

Methods: Trauma patients transferred to 2 Level I trauma centers were prospectively identified at the time of transfer.

Subungual melanoma: a review of current treatment.

Background: Subungual melanoma typically presents as a darkened longitudinal stripe under the nail plate; however, this disease is frequently misdiagnosed, which leads to a delay in proper diagnosis. Subsequently, subungual melanoma historically has a relatively poor prognosis compared with other cutaneous melanomas, with the 5-year survival rate ranging between 16 and 80 percent. Historically, these lesions were removed using aggressive amputation.

A model of disruptive surgeon behavior in the perioperative environment.

Background: Surgeons are the physicians with the highest rates of documented disruptive behavior. We hypothesized that a unified conceptual model of disruptive surgeon behavior could be developed based on specific individual and system factors in the perioperative environment.

Study Design: Semi-structured interviews were conducted with 19 operating room staff of diverse occupations at a single institution.

Tryonia, a new taenitidoid fern genus segregated from Jamesonia and Eriosorus (Pteridaceae).

The Neotropical fern genera Eriosorus and Jamesonia have long been thought of as close relatives. Molecular phylogenetic studies have confirmed this notion but have also revealed that neither genus is monophyletic with respect to the other. As a result, all known species of Eriosorus were recently subsumed under the older generic name Jamesonia.

Frostbite: a practical approach to hospital management.

Frostbite presentation to hospital is relatively infrequent, and the optimal management of the more severely injured patient requires a multidisciplinary integration of specialist care. Clinicians with an interest in wilderness medicine/freezing cold injury have the awareness of specific potential interventions but may lack the skill or experience to implement the knowledge. The on-call specialist clinician (vascular, general surgery, orthopaedic, plastic surgeon or interventional radiologist), who is likely to receive these patients, may have the skill and knowledge to administer potentially limb-saving intervention but may be unaware of the available treatment options for frostbite.

Averaging improves strain images of the biceps brachii using quasi-static ultrasound elastography.

Objective: Quasi-static ultrasound elastography is a technique for measuring tissue deformation (strain) under externally applied loading and can be used to identify the presence of abnormalities. The objective of this study was to demonstrate the efficacy of averaging strain images from repeated compression cycles in mitigating user-induced error using quasi-static ultrasound elastography.

Methods: Freehand compressions were performed with an ultrasound transducer on the biceps brachii of nine participants (five males and four females), as well as with a custom automated compression system.

Use of Twitter to document the 2013 Academic Surgical Congress.

Background: Social media is a cornerstone of modern society and its use in health care has rapidly expanded in recent years. "Live Tweeting" of professional meetings is a growing way for participants to communicate with peers. The goal of this study was to analyze the initial experience with implementation of a Twitter Team at the 2013 Academic Surgical Congress (ASC).

Adoptive transfer of MART-1 T-cell receptor transgenic lymphocytes and dendritic cell vaccination in patients with metastatic melanoma.

Purpose: It has been demonstrated that large numbers of tumor-specific T cells for adoptive cell transfer (ACT) can be manufactured by retroviral genetic engineering of autologous peripheral blood lymphocytes and expanding them over several weeks. In mouse models, this therapy is optimized when administered with dendritic cell (DC) vaccination. We developed a short 1-week manufacture protocol to determine the feasibility, safety, and antitumor efficacy of this double cell therapy.

Histomorphologic assessment and interobserver diagnostic reproducibility of atypical spitzoid melanocytic neoplasms with long-term follow-up.

Predicting clinical behavior of atypical Spitz tumors remains problematic. In this study, we assessed interobserver agreement of diagnosis by 13 expert dermatopathologists for atypical Spitz tumors (n=75). We determined which histomorphologic features were most heavily weighted for their diagnostic significance by the experts and also which histomorphologic features had a statistically significant correlation with clinical outcome.