An improved design for the skin graft board

A modified design is described for the skin graft board, which improves its performance when used in conjunction with the skin graft knife.     

Recent advances in recognition of low-level methylmercury poisoning

Clinically evident neurologic damage from methylmercury exposure was well described following poisoning episodes in Japan and Iraq several decades ago. Paresthesias have been considered to be an early effect; however, additional data raise questions about whether this is the most sensitive adverse effect among adults. Fetuses are considered the most sensitive subpopulation because of the vulnerability of the developing nervous system. Over the past 5 years questions have been raised about what is an appropriate level of exposure for sensitive groups. A recent evaluation by a committee for the US National Research Council found that 0.1 microg/kg body weight per day is a scientifically justified level of methylmercury exposure for maternal-fetal pairs. The conclusions of this report and other issues are discussed in the present review. Because of anthropogenic release of mercury into the environment, methylmercury exposure from fish consumption is a pathway that is of increasing concern.     

Insights from CREDENCE trial indicate an acute drop in estimated glomerular filtration rate during treatment with canagliflozin with implications for clinical practice

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MAD2 associates with the cyclosome/anaphase-promoting complex and inhibits its activity

Cell cycle progression is monitored by checkpoint mechanisms that ensure faithful duplication and accurate segregation of the genome. Defects in spindle assembly or spindle-kinetochore attachment activate the mitotic checkpoint. Once activated, this checkpoint arrests cells prior to the metaphase-anaphase transition with unsegregated chromosomes, stable cyclin B, and elevated M phase promoting factor activity. However, the mechanisms underlying this process remain obscure. Here we report that upon activation of the mitotic checkpoint, MAD2, an essential component of the mitotic checkpoint, associates with the cyclin B-ubiquitin ligase, known as the cyclosome or anaphase-promoting complex. Moreover, purified MAD2 causes a metaphase arrest in cycling Xenopus laevis egg extracts and prevents cyclin B proteolysis by blocking its ubiquitination, indicating that MAD2 functions as an inhibitor of the cyclosome. Thus, MAD2 links the mitotic checkpoint pathway to the cyclin B destruction machinery which is critical in controlling the metaphase-anaphase transition.     

Forecasting mortality: dynamic assessment of risk in ST-segment elevation acute myocardial infarction.

AIMS: To demonstrate the feasibility and clinical utility of developing dynamic risk assessment models for ST-segment elevation myocardial infarction (STEMI) patients. METHODS AND RESULTS: In 6066 STEMI patients enrolled in the Assessment of the Safety and Efficacy of a New Thrombolytic-3 (ASSENT-3) trial with complete electrocardiographic data, we assessed the probability of 30-day mortality over the following forecasting periods beginning at day 0 (baseline), 3 h, day 2, and day 5 using multiple-logistic regression. These models were validated and simplified in independent samples of 1622 similar fibrinolytic-treated patients from the ASSENT-3 PLUS trial and in 814 STEMI patients undergoing primary percutaneous coronary intervention in the COMplement inhibition in Myocardial infarction treated with Angioplasty (COMMA) trial. The discriminatory power of these predictive models, from baseline to day 5, was excellent (c-statistics 0.80 to 0.87); and their predictive ability was supported by strong gradients in mortality outcomes as the risk score increased. Dynamic modelling also provided information on the change in prognosis over time which may be used to advise more appropriate therapeutic decisions, e.g. the identification of high-risk patients for possible co-interventions. CONCLUSION: Dynamic modelling for STEMI patients enhances the risk assessment and stratification and should provide valuable ongoing guidance for their management.