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The need to reduce the effects of climate change has been increasing. One of the pathways to answer such a need is green construction. Hybrid wood–soil (HWS) structures are eco-friendly in addition to being cost-effective. Within this study, a single-storey building has been architecturally and structurally designed and tested. A conventional reinforced concrete (RC) structural system was designed and considered as a control case to be compared to the design at hand, which is an HWS system incorporating locally cultivated Casuarina Glauca wood and an in situ earth-based mixture. The two design alternatives are compared in terms of cost and carbon emissions. The HWS has proven to be economically viable and eco-friendly when compared to RC. The following stage within the research was to validate that the HWS structure will be structurally sound when erected. First, the effectiveness of the finger jointing process of the wooden members was experimentally assessed through performing bending tests on a finger-jointed specimen. Furthermore, half-scale models of one room within the structure have been manufactured from Casuarina Glauca wood and tested laterally to investigate the resistance of the HWS structural system to lateral loads. The first model was tested laterally without the earth-based infill and plaster materials to assess the behavior of the structural elements and measure its deformations. The second model was tested after applying the earth-based materials to obtain the true structural behavior of the system and the effect of the earth-based materials on its resistance to lateral loads. The results were used to assess the degree of the structural effectiveness of this HWS and the contribution of its components to its lateral stiffness.

Limited data exists on the safety and efficacy with the concomitant use of 4 factor prothrombic complex concentrate (4F-PCC) and andexanet alfa (AA). This case series describes 7 patients at our institution who received both 4F-PCC and AA for the management of life-threatening bleeding associated with apixaban or rivaroxaban. Four patients received AA due to worsening bleeding after 4F-PCC. Of the 7 patients in this case series, 1 had a documented thrombotic event which was an acute ischemic stroke. The thrombotic event rate in our case series was similar to the incidence of thrombotic events reported with the use of AA alone. In-hospital mortality occurred in 2 of 7 patients with 1 additional patient discharged to hospice care. [ABSTRACT FROM AUTHOR]

Introduction: A mainstay in the acute management of diabetic ketoacidosis (DKA) is fluid resuscitation. Normal saline is recommended by the American Diabetes Association; however, it has been associated with hyperchloremic metabolic acidosis and acute kidney injury. Limited literature is available to determine the most appropriate crystalloid fluid to treat patients with DKA. Objective: The purpose of this study was to compare lactated Ringer's (LR) to normal saline (NS) in the acute management of DKA. Methods: This was a retrospective, multicenter single health system cohort study. The primary outcome was to evaluate the time to high anion gap metabolic acidosis (HAGMA) resolution using LR compared to NS. Secondary outcomes included the incidence of nongap metabolic acidosis, hyperchloremia, acute kidney injury, and new renal replacement therapy. Other secondary outcomes included insulin infusion duration and hospital and intensive care unit length of stay. The Cox proportional hazards model was used for the primary outcome. Results: A total of 771 patient encounters were included. Lactated Ringer's was associated with faster time to HAGMA resolution compared to NS (adjusted hazard ratio 1.325; 95% confidence interval 1.121–1.566; p < 0.001). No difference was found in complications such as incidence of nongap metabolic acidosis, hyperchloremia, acute kidney injury, and new renal replacement therapy between the LR and NS groups. Additionally, there was no difference in insulin infusion duration and hospital or intensive care unit length of stay. Conclusion: Treatment with LR as the primary crystalloid for acute DKA management was associated with faster HAGMA resolution compared with NS. Similar incidence in complications and length of stay was observed between the two groups. The findings of this study add to the accumulating literature suggesting that balanced crystalloids may offer an advantage over NS for the treatment of patients with DKA. [ABSTRACT FROM AUTHOR]

Orexin-A has been shown to modulate pain sensation and increase appetite. Rheumatoid arthritis (RA) is characterized by joint destruction, deformity, hyperalgesia, and weight reduction. Aim: Evaluate the possible effect of orexin-A on hyperalgesic and cachectic manifestations in an adjuvant-induced arthritis (AIA) rat model. Methods: Forty adult male Wistar rats were distributed among 4 groups; I, normal controls; II, rats with AIA induced by intradermal injection of Mycobacterium butyricum, but with no other treatment; III, AIA rats treated daily with an intravenous injection of orexin-A for 8 days; and IV, AIA rats treated orally with dexamethasone for 8 days. The parameters we assessed were pain- associated behavior, body mass, hind paw volume, serum levels of nerve growth factor (NGF) and neuropeptide Y (NPY). Results: Orexin-A caused a significant reduction in pain sensation and NGF levels, and increased body mass and the levels of NPY, whereas treatment with dexamethasone led to significant reductions in paw swelling and pain sensation. Conclusion: Orexin-A has hypoalgesic properties and increases body mass, whereas dexamethasone has a potent anti-inflammatory effect. Therefore, the combination of orexin-A and dexamethasone should have a greater effect with respect to attenuating the manifestations and complications associated with RA. Key words: adjuvant-induced arthritis, cachexia, neuropeptide Y, nerve growth factor, hind paw swelling, dexamethasone. L'orexine-A s'est montree capable de moduler la sensation de douleur et d'augmenter l'appetit. L'arthrite rhumatoide (AR) se caracterise par la destruction des articulations, leur deformation, l'hyperalgesie et la perte de poids. But : Evaluer l'effet possible de l'orexine-A sur l'hyperalgesie et les manifestations de cachexie dans un modele d'AR induite par adjuvant (AIA) chez le rat. Methodes : Quarante rats Wistar males ont ete repartis en 4 groupes : I, controles normaux; II, rats avec AIA induite par injection intradermique de Mycobacterium butyricum, non traites; III, rats avec AIA traites quotidiennement par une injection intraveineuse d'orexine-A pendant 8 jours et IV, rats AIA traites a la dexamethasone par voie orale pendant 8 jours. Parametres evalues : les comportements associes a la douleur, le poids corporel, le volume de la patte arriere, les niveaux seriques du facteur de croissance neural (NGF, nerve growth factor) et du neuropeptide Y (NPY). Resultats : L'orexine-A a reduit significativement la sensation de douleur et les niveaux de NGF, et elle a augmente les niveaux de NPY et le poids corporel, tandis que la dexamethasone a reduit significativement l'enflure de la patte et la sensation de douleur. Conclusion : L'orexine-A exerce un effet hypoalgesique et augmente le poids corporel alors que la dexamethasone exerce un effet anti-inflammatoire puissant. Ainsi, la combinaison d'orexine-A et de dexamethasone pourrait attenuer davantage les manifestations et les complications de l'AR. [Traduit par la Redaction] Mots-cles : arthrite induite par adjuvant, cachexie, neuropeptide Y, facteur de croissance neural, enflure de la patte arriere, dexamethasone., Introduction Orexins (A and B), also known as hypocretins (1 and 2, respectively) are novel hypothalamic neuropeptides, cleaved from a common precursor molecule, pro-orexin (130 residues), forming orexin-A (33 amino [...]