Comprehensive molecular and morphological resolution of blubber stratification in a deep-diving, fasting-adapted seal.

Blubber is a modified subcutaneous adipose tissue in marine mammals that provides energy storage, thermoregulation, hydrodynamic locomotion, and buoyancy. Blubber displays vertical stratification by lipid content, fatty acid composition, and vascularization, leading to the assumption that deeper blubber layers are metabolically active, while superficial layers are mainly structural and thermoregulatory. However, few studies have examined functional stratification of marine mammal blubber directly, especially in pinnipeds. We characterized morphological and transcriptional differences across blubber layers in the northern elephant seal, a deep-diving and fasting-adapted phocid. We collected blubber from seals early in their fasting period and divided blubber cores into three similarly sized portions. We hypothesized that the innermost blubber portion would have higher 1) heterogeneity in adipocyte size, 2) microvascular density, and 3) expression of genes associated with metabolism and hormone signaling than outer blubber. We found that adipocyte area and variance increased from outermost (skin-adjacent) to innermost (muscle-adjacent) blubber layers, suggesting that inner blubber has a higher capacity for lipid storage and turnover than outer blubber. Inner blubber had a higher proportion of CD144+ endothelial cells, suggesting higher microvascular density. In contrast, outer blubber had a higher proportion of CD4+ immune cells than inner blubber, suggesting higher capacity for response to tissue injury. Transcriptome analysis identified 61 genes that were differentially expressed between inner and outer blubber layers, many of which have not been studied previously in marine mammals. Based on known functions of these genes in other mammals, we suggest that inner blubber has potentially higher 1) adipogenic capacity, 2) cellular diversity, and 3) metabolic and neuroendocrine signaling activity, while outer blubber may have higher 1) extracellular matrix synthesis activity and 2) responsiveness to pathogens and cell stressors. We further characterized expression of nine genes of interest identified by transcriptomics and two adipokines with higher precision across blubber layers using targeted assays. Our study provides functional insights into stratification of blubber in marine mammals and a molecular key, including CD144, CD4, HMGCS2, GABRG2, HCAR2, and COL1A2, for distinguishing blubber layers for physiological and functional studies in seals.

An assessment of the effect of contact time on cadmium phytoavailability in a pasture soil.

The length of time cadmium (Cd) is in contact with the soil has been recognised as a factor affecting phytoavailability, but the extent of this process is currently poorly understood. This study used isotopic dilution techniques (E and L values) to determine the effect of contact time on Cd phytoavailability from soil collected from a long-term phosphorus (P) fertiliser trial. Cadmium phytoavailability was determined in soil that was last fertilised with soluble Cd from P fertiliser 17 years prior to sampling (residual plots) and soil that received annual applications of P fertiliser until sampling (continuous plots). It was found that both E values and L values increased with P fertiliser (viz Cd) inputs and were significantly related to each other (r 2 = 0.82 P < 0.005). There was however no significant difference (P < 0.05) in the percentage of total Cd that was phytoavailable calculated using E values (E%) between the continuous (mean 51 %) and the residual plots (mean 51 %). There was also no significant difference (P < 0.05) in the percentage of total soil Cd that was phytoavailable calculated using L values (L%) between the continuous (mean 77 %) and residual plots (mean 87 %). These results suggest that despite Cd being in contact with the soil for 17 years, there was no difference in the size of the phytoavailable Cd pool compared to recent Cd inputs. This study should be repeated for other soil types and factored into any analysis for the long-term implications of ongoing Cd accumulation in soil on future landuse.

The Patient Outcomes of Surgery-Head/Neck (POS-head/neck): a new patient-based outcome measure.

OBJECTIVES: To develop a new patient-based outcome measure in plastic surgery for head/neck skin lesions for use in audit, clinical trials and effectiveness studies. DESIGN AND SUBJECTS: Questionnaire development and validation study. Qualitative methods, including interviews with 27 patients, were carried out to develop a preliminary version of the questionnaire. The questionnaire was then field tested by postal survey of 141 pre- and 250 post-surgery patients to produce a shortened (item-reduced) questionnaire and to evaluate acceptability, reliability, validity and responsiveness. A second field test was carried out by postal survey in an independent sample of 67 pre-surgery patients to further evaluate the reliability and validity of the questionnaire. MAIN OUTCOME MEASURES: Psychometric properties of acceptability, reliability, validity, and responsiveness were assessed. RESULTS: We developed a new measure, the Patient Outcomes of Surgery-Head/Neck (POS-Head/Neck), which includes a six- and nine-item pre- and post-surgery questionnaire, respectively. Results confirmed the acceptability (missing data <10%, evenly distributed endorsement frequencies), reliability (Cronbach alphas >0.76, item-total correlations >0.22), validity (scale inter-correlations r=0.50, scaling assumptions, correlations with age and sex < -0.25) and responsiveness (effect size=0.63) of the questionnaire. CONCLUSIONS: The POS-Head/Neck is a new surgical outcome measure that can be used to evaluate outcomes in malignant and benign head/neck skin lesions before and after surgery is acceptable to patients and satisfies rigorous scientific criteria.

The Patient Outcomes of Surgery-Hand/Arm (POS-Hand/Arm): a new patient-based outcome measure.

The purpose of this study was to develop and validate a new patient-based outcome measure for hand/arm disorders for use in audit, clinical trials and effectiveness studies. There were three stages. First, we carried out interviews with 40 patients with hand/arm disorders to develop and pilot questionnaire content. Second, in a postal survey with 165 pre- and 181 post-surgery patients, we reduced the number of items and identified scales. Third, in a postal survey with 132 pre- and 204 post-surgery patients we evaluated the psychometric properties of the measure. Findings confirmed the acceptability, reliability, validity and responsiveness to clinical change of the questionnaire. The Patient Outcomes of Surgery-Hand/Arm (POS-Hand/Arm) is a new surgical outcome measure that can be used before and after surgery (29 and 33 items, respectively) to evaluate and compare new techniques, surgical teams and units.

Fluoride accumulation in pasture forages and soils following long-term applications of phosphorus fertilisers.

Ingestion of soils with high fluoride (F) concentration may cause chronic fluorosis in grazing animals. Analysis of New Zealand pasture soils with long-term phosphorus (P) fertilisation histories showed that total surface soil (0-75 mm depth) F concentration increased up to 217-454 mg kg-1 with P fertiliser application. One-third to two-thirds of F applied in fertilisers resides in the top 75 mm soil depth. Pasture forage accumulation of F was low, and therefore, F intake by grazing animals through pasture consumption is expected to be much lower than F intake by soil ingestion. Ten annual applications of single superphosphate (30 and 60 kg P ha-1 year-1) to a Pallic Soil (Aeric Fragiaqualf) significantly increased total F and labile F (0.01 M CaCl2 extract) concentrations to 200 and 120 mm depths, respectively, of the 300 mm depth investigated. The mobility of F in the soil profile was similar to two other elements, P and cadmium derived from the fertiliser.

The influence of body mass index on burn surface area estimated from the area of the hand.

It is well recognised that initial estimates of the area involved in a burn injury by inexperienced clinicians are frequently excessive. In Britain the palmar surface area of the hand is taught to approximate 1% of the total body surface area (TBSA), but no allowance is made for variations in individual body weight. This study aimed to evaluate the relationship between hand surface area (HSA) and body mass index (BMI) using healthy volunteers. We found that mean HSA diminished significantly as BMI increased in both sexes (P<0.001). This effect was, however, more pronounced in women, particularly those with a BMI greater than 31 kg/m(2) in whom the HSA represented only 0.64%. Awareness of the potential for over-estimation of burn surface area using this method alone may improve the accuracy of burn area estimation and consequent need for commencing resuscitation.

Dermal cellular inflammation in burns. an insight into the function of dermal microvascular anatomy.

The damage caused by thermal trauma is augmented by the subsequent inflammatory response in a similar fashion to reperfusion injury. Animal studies have demonstrated a significant role for neutrophils in this delayed damage, but little is known about the numbers of neutrophils or other leucocytes that enter human skin following burns. We have longitudinally examined profiles of leucocyte migration into five cases of human partial thickness burns in relation to continued dermal microvascular destruction during the acute post-burn period. All burn wounds had a rapid influx of neutrophils that was followed by a delayed influx of macrophages. Compared to the controls, the two superficial burns also had rapid and sustained influx of CD4 and CD8 lymphocytes via patent post capillary venules in the dermal superficial vascular plexus, whilst in the three deeper burns, in which this superficial vascular plexus was occluded, the number of lymphocytes decreased. These results suggest that the patterns of leucocyte extravasation were dependent on the initial level of vascular occlusion, indicating that the dermal microvascular anatomy plays a pivotal role in determining the composition of the extravascular inflammatory cell infiltrates. The potential importance of this finding is highlighted by the differences in wound behaviour associated with the different leucocyte profiles.

Burn depth and its histological measurement.

This paper describes a new technique for burn depth measurement, based on the histological assessment of dermal microvascular occlusion in burn biopsies. The technique was validated in a preliminary study of acute progressive microvascular damage in five adults with partial thickness burns. Burn depth was calculated at three time points post burn from the mean histological measurement of the most superficial patent and the deepest blocked vessels in five separate sections from each biopsy. The results were expressed as a percentage of the total dermal thickness and correlated well with the laser Doppler measurement of dermal blood flow and clinical estimation of burn depth. The reproducibility of the technique was tested by the repeated blind analysis of five randomly chosen biopsies on a separate occasion. Altman-Bland plot analysis demonstrated a median variation of 0.1% (95% confidence interval -1 to 2%). A second independent observer (MPHT), who carried out a blind analysis of the same randomly chosen biopsies, tested the precision of the technique. The median variation was 2% (95% confidence interval -5 to 8.5%).

Burns sustained by hot bath and shower water.

An 8-year retrospective review of patients admitted to Stoke Mandeville Hospital (Aylesbury, UK) because of burns sustained by hot bath and shower water was undertaken. Fifty-seven patients of all ages were identified and stratified into paediatric (< 16 years) and adult groups. Nine patients died. The main characteristics of the burns, causes and outcomes of treatment were analysed for each group. Children were predominantly under three years of age (83%), sustaining most frequently only superficial burns (41%) with areas of less than 10% total body surface area (72%). Parents' supervision was inadequate in 85% of cases. Eighty-three percent of the adults were over the age of 60. Two thirds had some form of psycho-motor disorder that predisposed to an accident which should have been anticipated. In comparison to children, adults suffered more extensive and deeper burns that resulted in a mortality of 44% (8/18). In both groups, the lower parts of the body were most frequently involved. The observed decline in the number of admissions for the period of investigation is encouraging. It supports an ultimate need for further development and actual implementation of preventative measures for hot water burns in the homes of people who are at greatest risk.

Frostbite: pathogenesis and treatment.

Frostbite, once almost exclusively a military problem, is becoming more prevalent among the general population and should now be considered to be within the scope of the civilian physician's practice. Studies into the epidemiology of civilian frostbite have identified several risk factors that may aid the clinician in the diagnosis and management of cold injuries. Research into the pathophysiology has revealed marked similarities in inflammatory processes to those seen in thermal burns and ischemia/reperfusion injury. Evidence of the role of thromboxanes and prostaglandins has resulted in more active approaches to the medical treatment of frostbite wounds. Although the surgical management of frostbite involves delayed debridement 1 to 3 months after demarcation, recent improvements in radiologic assessment of tissue viability have led to the possibility of earlier surgical intervention. In addition, several adjunctive therapies, including vasodilators, thrombolysis, hyperbaric oxygen, and sympathectomy, are discussed.

Spontaneous rupture of extensor pollicis longus tendon in a kick boxer.

A 23 year old male kick boxer presented with a 24 hour history of pain and being unable to extend the interphalangeal joint of the left thumb. There was no history of trauma or any other risk factor for spontaneous rupture of the extensor pollicis longus tendon. On the previous day, he had been doing reverse press ups on the dorsum of his hands with his wrists hyperflexed as part of his training for kick boxing. At operation the extensor pollicis longus tendon was found to be divided at the level of the dorsal tubercle of the radius and was not directly repairable. The treatment was an extensor indicis proprius transfer. We suggest that the cause of the tendon rupture was direct pressure on the dorsal tubercle of the radius sustained while performing reverse press ups.

Pleomorphic lipoma of the parotid gland.

Lipomata are rare tumours of the parotid gland. The pleomorphic lipoma represents an unusual histological variant of the benign lipoma. We report a case of a pleomorphic lipoma arising in the parotid gland. Only one case of a similar nature has previously been recorded. This tumour is benign, was fully excised and recurrence is not expected.

Grip and pinch strength variations in different types of workers.

We measured grip and pinch strengths in non-manual, light manual and heavy manual workers using a Jamar dynamometer and a pinch measuring device. Heavy manual workers had the strongest grips with the least difference between sides. Office workers had the weakest grips and the greatest difference between sides. Light manual workers were between these two groups. Consequently, the occupation of the patient must be taken into account when using grip and pinch strength measurements to assess the need for rehabilitation and in medicolegal reports.