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Search Results: 1 - 10 of 204420 matches for " Ronald P Mlcak "
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Are serum cytokines early predictors for the outcome of burn patients with inhalation injuries who do not survive?
Gerd G Gauglitz, Celeste C Finnerty, David N Herndon, Ronald P Mlcak, Marc G Jeschke
Critical Care , 2008, DOI: 10.1186/cc6932
Abstract: Thirteen severely burned children with inhalation injury who did not survive and 15 severely burned pediatric patients with inhalation injury who survived were enrolled in the study. Blood was collected within 24 hours of admission and 5 to 7 days later. Cytokine levels were profiled using multiplex antibody coated beads. Inhalation injury was diagnosed by bronchoscopy during the initial surgery. The number of days on the ventilator, peak inspiratory pressure rates, arterial oxygen tension (PaO2)/fraction of inspired oxygen (FiO2) ratio and incidence of acute respiratory distress syndrome were recorded for those patients.Significantly altered levels of IL-4, IL-6, IL-7, IL-10, and IL-13 were detected within the first 7 days after admission in serum from burn pediatric patients with concomitant inhalation injury who did not survive when compared with similar patients who did (P < 0.05). Alterations in these cytokines were associated with increased incidence of acute respiratory distress syndrome, number of days under ventilation, increased peak inspiratory pressure, and lower PaO2/FiO2 ratio in this patient population. Multiple logistic regression analysis revealed that patients with increased IL-6 and IL-10 as well as decreased IL-7 serum levels had a significantly greater risk for mortality (P < 0.05).Early alterations in serum levels of IL-6, IL-7 and IL-10 may constitute useful predictive markers for identifying patients those who have sustained a burn with concomitant inhalation injury and who have high mortality.Mortality from major burns has significantly decreased during the past 20 years. Inhalation injury, however, still constitutes one of the most critical adverse factors after thermal insult and has remained associated with a mortality rate of 25% to 50% when patients require ventilator support for more than 1 week after injury [1-3]. Although many organ systems are affected by a burn, the pulmonary system often sustains the most damage [4]. Because inhal
Long-Term Persistance of the Pathophysiologic Response to Severe Burn Injury
Marc G. Jeschke, Gerd G. Gauglitz, Gabriela A. Kulp, Celeste C. Finnerty, Felicia N. Williams, Robert Kraft, Oscar E. Suman, Ronald P. Mlcak, David N. Herndon
PLOS ONE , 2011, DOI: 10.1371/journal.pone.0021245
Abstract: Background Main contributors to adverse outcomes in severely burned pediatric patients are profound and complex metabolic changes in response to the initial injury. It is currently unknown how long these conditions persist beyond the acute phase post-injury. The aim of the present study was to examine the persistence of abnormalities of various clinical parameters commonly utilized to assess the degree hypermetabolic and inflammatory alterations in severely burned children for up to three years post-burn to identify patient specific therapeutic needs and interventions. Methodology/Principal Findings Patients: Nine-hundred seventy-seven severely burned pediatric patients with burns over 30% of the total body surface admitted to our institution between 1998 and 2008 were enrolled in this study and compared to a cohort non-burned, non-injured children. Demographics and clinical outcomes, hypermetabolism, body composition, organ function, inflammatory and acute phase responses were determined at admission and subsequent regular intervals for up to 36 months post-burn. Statistical analysis was performed using One-way ANOVA, Student's t-test with Bonferroni correction where appropriate with significance accepted at p<0.05. Resting energy expenditure, body composition, metabolic markers, cardiac and organ function clearly demonstrated that burn caused profound alterations for up to three years post-burn demonstrating marked and prolonged hypermetabolism, p<0.05. Along with increased hypermetabolism, significant elevation of cortisol, catecholamines, cytokines, and acute phase proteins indicate that burn patients are in a hyperinflammatory state for up to three years post-burn p<0.05. Conclusions Severe burn injury leads to a much more profound and prolonged hypermetabolic and hyperinflammatory response than previously shown. Given the tremendous adverse events associated with the hypermetabolic and hyperinflamamtory responses, we now identified treatment needs for severely burned patients for a much more prolonged time.
Burn size determines the inflammatory and hypermetabolic response
Marc G Jeschke, Ronald P Mlcak, Celeste C Finnerty, William B Norbury, Gerd G Gauglitz, Gabriela A Kulp, David N Herndon
Critical Care , 2007, DOI: 10.1186/cc6102
Abstract: Pediatric burned patients were divided into four burn size groups: <40% total body surface area (TBSA) burn, 40–59% TBSA burn, 60–79% TBSA burn, and >80% TBSA burn. Demographic and clinical data, hypermetabolism, the inflammatory response, body composition, the muscle protein net balance, serum and urine hormones and proteins, and cardiac function and changes in liver size were determined.One hundred and eighty-nine pediatric patients of similar age and gender distribution were included in the study (<40% TBSA burn, n = 43; 40–59% TBSA burn, n = 79; 60–79% TBSA burn, n = 46; >80% TBSA burn, n = 21). Patients with larger burns had more operations, a greater incidence of infections and sepsis, and higher mortality rates compared with the other groups (P < 0.05). The percentage predicted resting energy expenditure was highest in the >80% TBSA group, followed by the 60–79% TBSA burn group (P < 0.05). Children with >80% burns lost the most body weight, lean body mass, muscle protein and bone mineral content (P < 0.05). The urine cortisol concentration was highest in the 80–99% and 60–79% TBSA burn groups, associated with significant myocardial depression and increased change in liver size (P < 0.05). The cytokine profile showed distinct differences in expression of IL-8, TNF, IL-6, IL-12p70, monocyte chemoattractant protein-1 and granulocyte–macrophage colony-stimulating factor (P < 0.05).Morbidity and mortality in burned patients is burn size dependent, starts at a 60% TBSA burn and is due to an increased hypermetabolic and inflammatory reaction, along with impaired cardiac function.The stress response to burn injury is similar to severe trauma or critical care but differs in its severity and duration. The inflammatory response starts immediately after trauma and persists for almost 5 weeks postburn [1]. The hypermetabolic response after a major burn is characterized by a hyperdynamic response with increased body temperature, increased oxygen and glucose consumption, in
PPAR-α agonism improves whole body and muscle mitochondrial fat oxidation, but does not alter intracellular fat concentrations in burn trauma children in a randomized controlled trial
Melanie G Cree, Bradley R Newcomer, David N Herndon, Ting Qian, Dayoung Sun, Beatrice Morio, Jennifer J Zwetsloot, G Lynis Dohm, Ricki Y Fram, Ronald P Mlcak, Asle Aarsland, Robert R Wolfe
Nutrition & Metabolism , 2007, DOI: 10.1186/1743-7075-4-9
Abstract: A double blind placebo controlled trial was conducted in 18 children with severe burn injury. Metabolic studies to assess whole body palmitate oxidation and insulin sensitivity, muscle biopsies for mitochondrial palmitate oxidation, diacylglycerol, fatty acyl Co-A and fatty acyl carnitine concentrations, and magnetic resonance spectroscopy for muscle and liver triglycerides were compared before and after two weeks of placebo or PPAR-α agonist treatment.Insulin sensitivity and basal whole body palmitate oxidation as measured with an isotope tracer increased significantly (P = 0.003 and P = 0.004, respectively) after PPAR-α agonist treatment compared to placebo. Mitochondrial palmitate oxidation rates in muscle samples increased significantly after PPAR-α treatment (P = 0.002). However, the concentrations of muscle triglyceride, diacylglycerol, fatty acyl CoA, fatty acyl carnitine, and liver triglycerides did not change with either treatment. PKC-θ activation during hyper-insulinemia decreased significantly following PPAR-α treatment.PPAR-α agonist treatment increases palmitate oxidation and decreases PKC activity along with reduced insulin sensitivity in acute trauma, However, a direct link between these responses cannot be attributed to alterations in intracellular lipid concentrations.Significant alterations in both glucose and fat metabolism occur following burn trauma. Hyperglycemia, due to increased hepatic gluconeogenesis and peripheral insulin resistance, is common [1]. Free fatty acid (FFA) cycling is increased up to three fold, and triglyceride (TAG) deposition in the liver is common [2]. Studies in burned animals indicate that mitochondrial number and oxidative capacity are severely reduced following burn, but how these changes relate to in vivo fatty acid oxidation is unclear [3]. Further, the relation between fat metabolism and insulin sensitivity is not well understood in the severely burned population.Decreased β-oxidation of FFA's and increased circula
Intensive Insulin Therapy Has No Effect on Mortality and Morbidity in Cardiac Surgery Patients: A Meta-Analysis  [PDF]
Kedar P. Kulkarni, Ronald S. Chamberlain
International Journal of Clinical Medicine (IJCM) , 2016, DOI: 10.4236/ijcm.2016.78057
Abstract: Introduction: Optimal glycemic control in cardiac surgery patients remains a laudable but confusing practice. Existing studies have primarily employed two maintenance strategies using either intensive insulin therapy (IIT) (maintain glucose < 120 mg/dl) or conventional insulin therapy (CIT) (<200 mg/dl) with conflicting outcomes. This meta-analysis evaluates the impact of IIT and CIT in regards to the incidence of mortality, length of stay (LOS), intensive care unit (ICU) LOS, atrial fibrillation (AF), and infections. Methods: A comprehensive literature search in PubMed, Google Scholar and the Cochrane Central Registry of Controlled Trials was completed between 1966 and 2016. Keywords searched were “insulin”, “bypass”, “coronary”, “CABG”, “glucose”, “artery”, “intensive”, “cardiac”, and “surgery”. Eligible studies were randomized control trials (RCTs) comparing IIT (BGL 80-120 mg/dL) and CIT (BGL < 200 mg/dL). Primary outcomes were mortality, ICU LOS, and hospital LOS. Results: 8 RCTs were included in this study. IIT strategies did not significantly affect overall mortality (RR = 0.905, 95% CI = 0.604 to 1.356; p = 0.628), ICU LOS (MD = -0.073 days, 95% CI = -0.324 to 0.178; p = 0.568), or hospital LOS (MD = 0.269, 95% CI = -2.158 to 2.696; p = 0.828). No difference in AF rates (RR = 0.887, 95% CI = 0.681 to 1.155; p = 0.375) or deep sternal infection (RR = 0.985, 95% CI = 0.357 to 2.720; p = 0.977) were observed. Conclusion: IIT targeting blood sugar levels of 80 - 120 mg/dl have no effect on perioperative outcomes in cardiac surgery patients. IIT is associated with similar mortality, ICU LOS, hospital LOS, AF rates, and deep sternal infection rates compared to more liberal glycemic strategies. IIT should not replace CIT as the standard of care in cardiac surgery patients.
Recent advances in fish hatchery management
Phelps, Ronald P.;
Revista Brasileira de Zootecnia , 2010, DOI: 10.1590/S1516-35982010001300011
Abstract: the advancement of aquaculture has often been bottlenecked because of the lack of seed, but once that bottleneck was overcome there was rapid growth. recent examples of advances in hatchery technology leading to increased production are sea bream and pangasius. three areas contributing to the advancement of hatchery management are: brood stock management, induced spawning and larval feeding. formulated diets have been developed for marine brood fish that are equal or better than the traditional raw fish diets. the importance of lipids and their composition in brood fish diets, particularly n-3 hufas has received much attention. the lipid composition of the brood diet is reflected in egg composition and egg quality. protein quantity and quality in brood diets also impacts reproductive success and egg quality. the use of gonadotropin-releasing hormone agonists (gnrha) given as an injection or a slow release implant for induced spawning is becoming more widely used. the addition of dopamine antagonists with gnrha may not be necessary to successfully induce spawn some species of fish. the use of gnrha can advance the maturation of oocytes allowing such fish to be successfully induced spawned. significant advances have been made in the development of formulated microdiets for larval fish. such microdiets have been used successfully with young larvae reducing the need for live foods such as artemia. the quality of both live foods and formulated diets has been enriched with the use of fatty acids. not only the quantity of n-3 hufas added to a diet impacts larval growth and survival but the ratios of specific n-3 hufas has an impact. enrichment of live foods with amino acids can also improve larval fish growth and survival.
Type 2 diabetes in practice
Ronald P. Stolk
International Journal of Integrated Care , 2002,
Abstract:
Pandiagonal and Knut Vik Sudoku Squares
Ronald P. Nordgren
Mathematics , 2013,
Abstract: We present systematic methods of constructing pandiagonal sudoku squares of order k*k and Knut Vik sudoku squares of order k*k not divisible by 2 or 3. Pandiagonal magic squares are constructed from these squares. Examples of all these squares are given.
Interval-Based Decisions for Reasoning Systems
Ronald P. Loui
Computer Science , 2013,
Abstract: This essay looks at decision-making with interval-valued probability measures. Existing decision methods have either supplemented expected utility methods with additional criteria of optimality, or have attempted to supplement the interval-valued measures. We advocate a new approach, which makes the following questions moot: 1. which additional criteria to use, and 2. how wide intervals should be. In order to implement the approach, we need more epistemological information. Such information can be generated by a rule of acceptance with a parameter that allows various attitudes toward error, or can simply be declared. In sketch, the argument is: 1. probability intervals are useful and natural in All. systems; 2. wide intervals avoid error, but are useless in some risk sensitive decision-making; 3. one may obtain narrower intervals if one is less cautious; 4. if bodies of knowledge can be ordered by their caution, one should perform the decision analysis with the acceptable body of knowledge that is the most cautious, of those that are useful. The resulting behavior differs from that of a behavioral probabilist (a Bayesian) because in the proposal, 5. intervals based on successive bodies of knowledge are not always nested; 6. if the agent uses a probability for a particular decision, she need not commit to that probability for credence or future decision; and 7. there may be no acceptable body of knowledge that is useful; hence, sometimes no decision is mandated.
Defeasible Decisions: What the Proposal is and isn't
Ronald P. Loui
Computer Science , 2013,
Abstract: In two recent papers, I have proposed a description of decision analysis that differs from the Bayesian picture painted by Savage, Jeffrey and other classic authors. Response to this view has been either overly enthusiastic or unduly pessimistic. In this paper I try to place the idea in its proper place, which must be somewhere in between. Looking at decision analysis as defeasible reasoning produces a framework in which planning and decision theory can be integrated, but work on the details has barely begun. It also produces a framework in which the meta-decision regress can be stopped in a reasonable way, but it does not allow us to ignore meta-level decisions. The heuristics for producing arguments that I have presented are only supposed to be suggestive; but they are not open to the egregious errors about which some have worried. And though the idea is familiar to those who have studied heuristic search, it is somewhat richer because the control of dialectic is more interesting than the deepening of search.
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