Nikolai Miklouho-Maclay was a renowned Russian ethnologist who spent most of his life in the Pacific and was one of the first Europeans to live among and study the Melanesian people of Papua New Guinea. He is regarded as one of the first scientific anti-racists. New Guinea at this time was one of the remotest places on earth and had little contact with Europeans, mainly occasional missionaries and explorers. In September 1871, Maclay landed at Garagassi Point, Astrolabe Bay, on the north coast of New Guinea. Travelling with him were two assistants: Ohlsen – a Swede, and Boy – a young Samoan. Boy then proceeded to become very ill and his constant groaning was silenced only when Maclay administered morphia. Maclay was threatened by the local indigenous tribal people who wanted his belongings. They knew his two companions were possibly dying and Maclay tried to appear normal despite being ill with malaria. On the night of 13 December, Maclay poured chloroform onto cotton wool and held it over Boy’s airway – he died soon after. Maclay, as an anthropologist, wanted a Polynesian brain for study. Despite Ohlsen’s protests, Maclay removed part of Boy’s forehead and scalp but then abandoned this as he did not have a container to hold a brain. Maclay had promised Prof Karl Gegenbaur of Germany that he would obtain a ‘dark man’s’ larynx, tongue and related muscles, which he resected. Maclay came to Australia in 1878, becoming a prominent member of the Australian scientific community.
Nucleated red blood cells are early erythroid precursors typically confined to the bone marrow. Their appearance in peripheral blood reflects stress erythropoiesis and has been linked to hypoxia and systemic inflammation. While nucleated red blood cells have prognostic value in sepsis and critical illness, their significance in trauma remains poorly understood. This study aimed to evaluate the prognostic value of nucleated red blood cells during the first 10 days in the intensive care unit following severe trauma, and their association with 30-day mortality. We conducted a retrospective observational cohort study including 1636 adult trauma patients admitted to the Reims Level-1 Trauma Center between January 2019 and March 2025, recorded in the TraumaBase © registry. Nucleated red blood cell counts were measured daily for the first 10 intensive care unit days. K-means clustering identified four nucleated red blood cell phenotypes based on temporal patterns. Outcomes included 10- and 30-day mortality, incidence of acute respiratory distress syndrome, septic shock, mechanical ventilation, and length of stay. Survival analyses used Cox proportional hazards models adjusted for age, Injury Severity Score, Simplified Acute Physiology Score II, and the Sequential Organ Failure Assessment, and propensity-weighted regression assessed dichotomised nucleated red blood cell status. Nucleated red blood cells were detected in 221 patients (13.5%). Phenotype classification revealed: transient early nucleated red blood cells (phenotype 1), single peak (phenotype 2), multiple intermittent peaks (phenotype 3), and persistent elevation (phenotype 4). Phenotype 2 was associated with reduced 10-day mortality (adjusted hazard ratio 0.06, 95% confidence intervals 0.01–0.46), while phenotype 4 exhibited markedly increased mortality (adjusted hazard ratio 9.6, 95% confidence intervals 2.23–41.4, P < 0.001). Nucleated red blood cell+ patients had higher risks of acute respiratory distress syndrome, septic shock, mechanical ventilation, and 30-day mortality. Kaplan–Meier curves confirmed significant differences in survival across phenotypes (log-rank P < 0.001). Nucleated red blood cell presence, particularly persistent elevation, identifies trauma patients at higher risk of adverse outcomes. Routine, daily nucleated red blood cell monitoring may serve as a simple, low-cost prognostic tool in intensive care unit trauma care. Prospective studies are needed to validate these findings and integrate nucleated red blood cell dynamics into risk stratification.
Volatile sedatives are increasingly utilised for sedation in critically ill patients receiving invasive mechanical ventilation. Despite numerous randomised controlled trials and observational studies comparing volatile sedation to intravenous sedation, questions regarding its safety and efficacy persist. A systematic search was performed in PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science databases for studies published up to July 2025. The analysis included randomised controlled trials and observational studies that compared the use of volatile sedation with intravenous sedation in patients admitted to the intensive care unit for mechanical ventilation. Eligible studies involved adults aged ⩾18 years, requiring mechanical ventilation, and utilising either volatile or intravenous sedatives. They also needed to report at least one outcome of interest: incidence of delirium, mortality, intensive care unit length of stay, or duration of mechanical ventilation. From 3182 identified publications, fifteen studies were included in the systematic review. Volatile sedation was not associated with a significant difference in the incidence of delirium compared to intravenous sedation (risk ratio 0.72; 95% confidence interval 0.38–1.34), mortality (risk ratio 0.97; 95% confidence interval 0.80–1.17), intensive care unit length of stay (mean difference 0.28 days; 95% confidence interval −1.74 to 2.30), or duration of mechanical ventilation (mean difference −37.20 h; 95% confidence interval −78.60 to 4.20). Volatile sedation was not associated with significant differences in mechanical ventilation duration, delirium incidence, intensive care unit length of stay, or mortality compared to intravenous sedation. Further large-scale, high-quality randomised trials are needed to clarify its clinical benefit in critical care settings.
Day case surgery is changing, with older and sicker patients presenting, new procedures occurring and many previously inpatient procedures converted to day-stay. The impact of these changes and additions, especially the management of elderly patients, was assessed using a digital survey of patient-reported measures commencing in March 2018. Running initially in two hospitals, spreading to include a large group of Private Hospitals in Melbourne, the survey was offered to all patients attending the facilities, following an introduction of the survey process in patient admission papers with consent obtained on the day of surgery. A 15-question digital questionnaire was sent to each consenting patient by text and email 24 h post-discharge. The patient could opt out at that stage by not opening the message; 242,025 adult patients responded (response rate of 84%), with 4.5% opting out and 9% failing to complete the survey. An ‘Alert,’ generated digitally for any problem identified in the response, was emailed to the treating anaesthetist and to an oversight group comprised of an anaesthetist, a nurse and an administrator to facilitate appropriate action and early resolution. This digital survey saves the staff costs associated with initiating individual patient contact and fully satisfied the requirements for patient-reported outcome measures and experience measures. As well as early indication of the patient’s postoperative course, confirmation of the ability to manage the elderly patient and the reliability of transferring inpatient procedures to day case management were indicated.
