Background: Observational studies have suggested that accelerated surgery is associated with improved outcomes in patients with a hip fracture. The HIP ATTACK trial assessed whether accelerated surgery could reduce mortality and major complications. Methods:We randomised 2970 patients from 69 hospitals in 17 countries. Patients with a hip fracture that required surgery and were ≥45 years of age were eligible. Patients were randomly assigned to accelerated surgery (goal of surgery within 6 hours of diagnosis; 1487 patients) or standard care (1483 patients). The co-primary outcomes were 1.) mortality, and 2.) a composite of major complications (i.e., mortality and non-fatal myocardial infarction, stroke, venous thromboembolism, sepsis, pneumonia, life-threatening bleeding, and major bleeding) at 90 days after randomisation. Outcome adjudicators were masked to treatment allocation, and patients were analysed according to the intention-to-treat principle; ClinicalTrials.gov, NCT02027896. Findings:The median time from hip fracture diagnosis to surgery was 6 hours (interquartile range [IQR] 4-9) in the accelerated-surgery group and 24 hours (IQR 10-42) in the standard-care group, p<0.0001. Death occurred in 140 patients (9%) assigned to accelerated surgery and 154 patients (10%) assigned to standard care; hazard ratio (HR) 0.91, 95% CI 0.72-1.14; absolute risk reduction (ARR) 1%, 95% CI -1-3%; p=0.40. The primary composite outcome occurred in 321 patients (22%) randomised to accelerated surgery and 331 patients (22%) randomised to standard care; HR 0.97, 95% CI 0.83-1.13; ARR 1%, 95% CI -2-3%; p=0.71.Interpretation: Among patients with a hip fracture, accelerated surgery did not significantly lower the risk of mortality or a composite of major complications compared to standard care.

Since 1968, when Baxter and Shires developed the Parkland formula, little progress has been made in the field of fluid therapy for burn resuscitation, despite advances in haemodynamic monitoring, establishment of the 'goal-directed therapy' concept, and the development of new colloid and crystalloid solutions. Burn patients receive a larger amount of fluids in the first hours than any other trauma patients. Initial resuscitation is based on crystalloids because of the increased capillary permeability occurring during the first 24 h. After that time, some colloids, but not all, are accepted. Since the emergence of the Pharmacovigilance Risk Assessment Committee alert from the European Medicines Agency concerning hydroxyethyl starches, solutions containing this component are not recommended for burns. But the question is: what do we really know about fluid resuscitation in burns? To provide an answer, we carried out a non-systematic review to clarify how to quantify the amount of fluids needed, what the current evidence says about the available solutions, and which solution is the most appropriate for burn patients based on the available knowledge.

Setting fi res is an old practice of land management in the Mediterranean region of central Chile. Fire in the region is currently of predominantly human origin and previously published material suggests that the scheduling of these activities is associated with the spread of naturalized exotic species. Research into the effects of fi re on both native and exotic Mediterranean vegetation in central Chile has increased notably over recent years. The objective of our review is to highlight new knowledge in this area of research from the last 30 years and to contribute to systematization and an explicit conceptual model which takes into account the effect of a fi re regimen on the spread of exotic plants and the mechanisms involved. We begin with analyses of the fi re regimen which is currently obser ved in one Region of central Chile and a subsequent exploration of the literature to identify the attributes mainly of the germination of seeds which are sensitive to fi re and which apply to the exotic species that are abundantly naturalized in central Chile. According to the studies consulted, diverse mechanisms have been described which involve the effect of fi re on the spread of exotic plants in central Chile. Life-histor y traits, tolerance, facilitation, and positive feedback between exotic plants and fi re frequency have been mechanisms reported in the literature. Finally, we propose a conceptual model which represents dispersal assisted by humans of exotic species and the spread of species naturalized by the effect of fi re regimens, which helps explain the composition and structure of the matorral of central Chile in an early successional state.Key words: central Chile, exotic plant, fi re, germination, naturalized plant. RESUMENLos incendios son una antigua práctica del uso del suelo en la región mediterránea de Chile central. Actualmente en esta región, los incendios son principalmente de origen humano y los antecedentes publicados permiten sugerir que su régimen está asociado a la expansión de especies exóticas naturalizadas. Las investigaciones sobre el efecto de los incendios sobre la vegetación mediterránea tanto nativa como exótica en Chile central ha incrementado notablemente durante los últimos años. El objetivo de nuestra revisión fue resaltar los nuevos conocimientos en esta área de la investigación durante los últimos 30 años y contribuir a una sistematización y a un modelo conceptual explícito que incorpore los efectos del régimen de incendios en la expansión de plantas exóticas y en los mecanismos involucrados. Para ello se describe el régimen de incendios que actualmente se presenta en una región de Chile central y se realiza una exploración de la literatura para conocer principalmente los atributos de la germinación de las semillas sensibles a incendio que se encuentran en especies exóticas que están naturalizadas abundantemente en Chile central. De acuerdo a los estudios abordados, se han descrito diversos mecanismos que involucran el efecto de los incendios sobre la expansión de plan...

Patients with major burn injury undergo a series of pathophysiologic changes that begin with a systemic inflammatory response and coagulation abnormalities, similar to those experienced by patients with sepsis or severe trauma. Coagulation changes in patients with burns are generally characterized by procoagulant abnormalities, but alterations in fibrinolysis and anticoagulation factors have also been observed. Around 40% of patients with major burn show changes on standard coagulation tests, and these have been related to the severity of the lesions, smoke inhalation, and administration of intensive fluid resuscitation therapy. Current surgical techniques for debridement of burn lesions are aggressive and associated with considerable blood loss. A fast-acting selective enzymatic debriding agent based on bromelain has been recently developed. NexoBrid is indicated for removing eschar in adults with deep partial- and full-thickness thermal burns. A potential effect of oral bromelain on hemostasis has been described, but it is uncertain whether NexoBrid application has a clinically relevant impact in this regard. We present the clinical case of a patient with burns who showed a coagulation abnormality shortly after NexoBrid use.

El objetivo de la investigación fue identificar los datos de producción, a nivel macro, del cultivo de la piña fresca en Costa Rica, con el fin de analizar aspectos generales sobre la evolución de la producción entre 1984 y el 2014. Los datos utilizados están disponibles en las estadísticas oficiales de la Organización de las Naciones Unidas para la Alimentación y la Agricultura (FAO-FAOSTAT) e INFOAGRO de Costa Rica. La principal conclusión fue que la producción de la piña en Costa Rica experimentó incrementos significativos, al pasar de un volumen de producción de 24 200 toneladas, en 1984, a 2 915 628 toneladas, en el 2014, lo cual ubica al país entre los principales países productores y exportadores de piña fresca. La productividad pasó de un rendimiento físico de 24,2 Tm/ha, en 1984, a 77,4 Tm/ha, en el 2014. Estos datos muestran un crecimiento en el rendimiento físico de un 220 %, lo cual representa, en términos generales, un logro importante para las empresas dedicadas a la producción y exportación de la piña fresca en Costa Rica.