A Retrospective Study at Two Level One Trauma Centers on the Association of Internal Injuries with Femoral Fractures

Abstract: Injuries capable of fracturing the femur often involve concurrent internal organ damage. However, up to 25% of injuries are initially missed. Prior studies evaluating the association of femur fractures with internal injury included only automobile trauma, were skewed toward more severe injuries, and were broad database studies. To our knowledge, there are no studies of this kind that include bicycle, motorcycle, and motor vehicle-pedestrian trauma, excluding those deceased at the scene, and which included chart reviews. We hypothesized that in the trauma setting, the presence of a femur fracture would correlate with an increase in concomitant internal organ injuries. Data was retrospectively queried from two Level I Trauma Centers. Patients presenting between January 1, 2005 and December 31, 2012 with trauma activation met inclusion criteria. Patients were stratified based on presence of a femur fracture, open/closed fracture status, and shaft versus non-shaft fractures. Internal organ injuries were documented. Logistic regression analysis was used to determine if the presence of a femur fracture, open fractures, or shaft fractures were predictive of internal injuries. Results were reported as odds ratios with 95% confidence intervals (CI). A p-value \u3c 0.05 was statistically significant. Femur fracture and open fracture were associated with additional internal injury. Shaft fractures were not associated with additional injury. Subjects ≤18 years with femur fracture were more likely to sustain additional injury compared to older age groups. The current study reveals that fractures of the femur in this setting may be associated with additional internal injuries. Open fractures may portend more severe organ injury compared to closed fractures. Femoral fracture in age ≥65 may not be as predictive for associated internal injuries. Development of a standardized grading system may aid in alerting the provider to the potential for these life-threatening injuries. Level of evidence: IV

Evaluation of three 3ABC ELISAs for foot-and-mouth disease non-structural antibodies using latent class analysis

BACKGROUND: Foot-and-mouth disease (FMD) is a highly contagious viral disease of even-toed ungulates. Serological diagnosis/surveillance of FMD presents several problems as there are seven serotypes worldwide and in the event of vaccination it may be necessary to be able to identify FMD infected/exposed animals irrespective of their vaccination status. The recent development of non-structural 3ABC protein (NSP) ELISA tests has greatly advanced sero-diagnosis/surveillance as these tests detect exposure to live virus for any of the seven serotypes of FMD, even in vaccinated populations. This paper analyses the performance of three NSP tests using a Bayesian formulation of the Hui-Walter latent class model to estimate test sensitivity and specificity in the absence of a "gold-standard" test, using sera from a well described cattle population in Cameroon with endemic FMD. RESULTS: The analysis found a high sensitivity and specificity for both the Danish C-ELISA and the World Organisation for Animal Health (O.I.E.) recommended South American I-ELISA. However, the commercial CHEKIT kit, though having high specificity, has very low sensitivity. The results of the study suggests that for NSP ELISAs, latent class models are a useful alternative to the traditional approach of evaluating diagnostic tests against a known "gold-standard" test as imperfections in the "gold-standard" may give biased test characteristics. CONCLUSION: This study demonstrates that when applied to naturally infected zebu cattle managed under extensive rangeland conditions, the FMD ELISAs may not give the same parameter estimates as those generated from experimental studies. The Bayesian approach allows for full posterior probabilities and capture of the uncertainty in the estimates. The implications of an imperfect specificity are important for the design and interpretation of sero-surveillance data and may result in excessive numbers of false positives in low prevalence situations unless a follow-up confirmatory test such as the enzyme linked immunoelectrotransfer blot (EITB) is used

How effective is the early support program Babylotse-Plus for psychosocially burdened mothers and their infants? A comparative intervention study

Objectives: Our aim was to examine the effects of an early perinatal prevention program offered to mothers and families suffering from significant psychosocial burden. Methods: All mothers giving birth in a Berlin university hospital during Jan-Aug 2013 were screened with a standardized 27-item questionnaire by trained staff. Mothers with a screening-score ≥ 3, who were not enrolled in other public support programs, were defined as psychosocially burdened. They received a detailed needs assessment and were followed up with counseling. When necessary, affected mothers were voluntarily guided through to specialized 'early support' institutions during the 12-month-intervention period. The historical control group (care-as-usual) consisted of children born at the same hospital the year before.At 12 months postnatally, we interviewed mothers in both groups to assess their stress burden and coping skills by Parenting Stress Index and assessed the current childcare condition. Differences between the groups were compared by multivariable logistic regression analyses adjusting for potential confounders. Results: The intervention group and the control group included 225 and 157 families, respectively. After 12-months, mothers in the 'early support' intervention group had significantly less often depression (adjusted odds ratio 0.25, 95%-confidence interval 0.07-0.94), less often a disturbed relationship with the parenting partner (0.34, 0.10-1.14) and reported reduced stress due to the child's demands (0.40, 0.15-1.10) compared to the control group. Childcare indicators did not differ between the 2 groups. Conclusions: In mothers at high psychosocial risk, the 'early support' intervention program Babylotse-Plus seemed to reduce the occurrence of depression and several stress indicators in the first postnatal year

Combination of linear classifiers using score function -- analysis of possible combination strategies

In this work, we addressed the issue of combining linear classifiers using their score functions. The value of the scoring function depends on the distance from the decision boundary. Two score functions have been tested and four different combination strategies were investigated. During the experimental study, the proposed approach was applied to the heterogeneous ensemble and it was compared to two reference methods -- majority voting and model averaging respectively. The comparison was made in terms of seven different quality criteria. The result shows that combination strategies based on simple average, and trimmed average are the best combination strategies of the geometrical combination

Gas inflows in the polar ring of NGC 4111 : the birth of an AGN

We have used Hubble Space Telescope (HST) images, SAURON Integral Field Spectroscopy (IFS), and adaptative optics assisted Gemini NIFS near-infrared K-band IFS to map the stellar and gas distribution, excitation and kinematics of the inner few kpc of the nearby edge-on S0 galaxy NGC 4111. The HST images map its ≈450 pc diameter dusty polar ring, with an estimated gas mass ≥107 M . The NIFS data cube maps the inner 110 pc radius at ≈7 pc spatial resolution, revealing a ≈220 pc diameter polar ring in hot (2267 ± 166 K) molecular H2 1–0 S(1) gas embedded in the polar ring. The stellar velocity field shows disc-dominated kinematics along the galaxy plane both in the SAURON large scale and in the NIFS nuclear-scale data. The large-scale [O III] λ5007 Å velocity field shows a superposition of two disc kinematics: one similar to that of the stars and another along the polar ring, showing non-circular motions that seem to connect with the velocity field of the nuclear H2 ring, whose kinematics indicate accelerated inflow to the nucleus. The estimated mass inflow rate is enough not only to feed an active galactic nucleus (AGN) but also to trigger circumnuclear star formation in the near future. We propose a scenario in which gas from the polar ring, which probably originated from the capture of a dwarf galaxy, is moving inwards and triggering an AGN, as supported by the local X-ray emission, which seems to be the source of the H2 1–0 S(1) excitation. The fact that we see neither near-UV nor Br γ emission suggests that the nascent AGN is still deeply buried under the optically thick dust of the polar ring

Improved Upper Limit on the Neutrino Mass from a Direct Kinematic Method by KATRIN.

We report on the neutrino mass measurement result from the first four-week science run of the Karlsruhe Tritium Neutrino experiment KATRIN in spring 2019. Beta-decay electrons from a high-purity gaseous molecular tritium source are energy analyzed by a high-resolution MAC-E filter. A fit of the integrated electron spectrum over a narrow interval around the kinematic end point at 18.57 keV gives an effective neutrino mass square value of (-1.0_{-1.1}^{+0.9})  eV^{2}. From this, we derive an upper limit of 1.1 eV (90% confidence level) on the absolute mass scale of neutrinos. This value coincides with the KATRIN sensitivity. It improves upon previous mass limits from kinematic measurements by almost a factor of 2 and provides model-independent input to cosmological studies of structure formation

Latent class analysis reveals clinically relevant atopy phenotypes in 2 birth cohorts

Background: Phenotypes of childhood-onset asthma are characterized by distinct trajectories and functional features. For atopy, definition of phenotypes during childhood is less clear. Objective: We sought to define phenotypes of atopic sensitization over the first 6 years of life using a latent class analysis (LCA) integrating 3 dimensions of atopy: allergen specificity, time course, and levels of specific IgE (sIgE). Methods: Phenotypes were defined by means of LCA in 680 children of the Multizentrische Allergiestudie (MAS) and 766 children of the Protection against allergy: Study in Rural Environments (PASTURE) birth cohorts and compared with classical nondisjunctive definitions of seasonal, perennial, and food sensitization with respect to atopic diseases and lung function. Cytokine levels were measured in the PASTURE cohort. Results: The LCA classified predominantly by type and multiplicity of sensitization (food vs inhalant), allergen combinations, and sIgE levels. Latent classes were related to atopic disease manifestations with higher sensitivity and specificity than the classical definitions. LCA detected consistently in both cohorts a distinct group of children with severe atopy characterized by high seasonal sIgE levels and a strong propensity for asthma; hay fever; eczema; and impaired lung function, also in children without an established asthma diagnosis. Severe atopy was associated with an increased IL-5/IFN-gamma ratio. A path analysis among sensitized children revealed that among all features of severe atopy, only excessive sIgE production early in life affected asthma risk. Conclusions: LCA revealed a set of benign, symptomatic, and severe atopy phenotypes. The severe phenotype emerged as a latent condition with signs of a dysbalanced immune response. It determined high asthma risk through excessive sIgE production and directly affected impaired lung function.Peer reviewe

Plantar calcaneal spurs in older people: longitudinal traction or vertical compression?

<p>Abstract</p> <p>Background</p> <p>Plantar calcaneal spurs are common, however their pathophysiology is poorly understood. This study aimed to evaluate the prevalence and correlates of plantar calcaneal spurs in a large sample of older people.</p> <p>Methods</p> <p>Weightbearing lateral foot radiographs of 216 people (140 women and 76 men) aged 62 to 94 years (mean age 75.9, <smcaps>SD</smcaps> 6.6) were examined for plantar calcaneal and Achilles tendon spurs. Associations between the presence of spurs and sex, body mass index, radiographic measures of foot posture, self-reported co-morbidities and current or previous heel pain were then explored.</p> <p>Results</p> <p>Of the 216 participants, 119 (55%) had at least one plantar calcaneal spur and 103 (48%) had at least one Achilles tendon spur. Those with plantar calcaneal spurs were more likely to have Achilles tendon spurs (odds ratio [OR] = 2.0, 95% confidence interval [CI] 1.2 to 3.5). Prevalence of spurs did not differ according to sex. Participants with plantar calcaneal spurs were more likely to be obese (OR = 7.9, 95% CI 3.6 to 17.0), report osteoarthritis (OR = 2.6, 95% CI 1.6 to 4.8) and have current or previous heel pain (OR = 4.6, 95% CI 2.3 to 9.4). No relationship was found between the presence of calcaneal spurs and radiographic measures of foot posture.</p> <p>Conclusion</p> <p>Calcaneal spurs are common in older men and women and are related to obesity, osteoarthritis and current or previous heel pain, but are unrelated to radiographic measurements of foot posture. These findings support the theory that plantar calcaneal spurs may be an adaptive response to vertical compression of the heel rather than longitudinal traction at the calcaneal enthesis.</p

Ischemia-Reperfusion Injury and Pregnancy Initiate Time-Dependent and Robust Signs of Up-Regulation of Cardiac Progenitor Cells

To explore how cardiac regeneration and cell turnover adapts to disease, different forms of stress were studied for their effects on the cardiac progenitor cell markers c-Kit and Isl1, the early cardiomyocyte marker Nkx2.5, and mast cells. Adult female rats were examined during pregnancy, after myocardial infarction and ischemia-reperfusion injury with/out insulin like growth factor-1(IGF-1) and hepatocyte growth factor (HGF). Different cardiac sub-domains were analyzed at one and two weeks post-intervention, both at the mRNA and protein levels. While pregnancy and myocardial infarction up-regulated Nkx2.5 and c-Kit (adjusted for mast cell activation), ischemia-reperfusion injury induced the strongest up-regulation which occurred globally throughout the entire heart and not just around the site of injury. This response seems to be partly mediated by increased endogenous production of IGF-1 and HGF. Contrary to c-Kit, Isl1 was not up-regulated by pregnancy or myocardial infarction while ischemia-reperfusion injury induced not a global but a focal up-regulation in the outflow tract and also in the peri-ischemic region, correlating with the up-regulation of endogenous IGF-1. The addition of IGF-1 and HGF did boost the endogenous expression of IGF and HGF correlating to focal up-regulation of Isl1. c-Kit expression was not further influenced by the exogenous growth factors. This indicates that there is a spatial mismatch between on one hand c-Kit and Nkx2.5 expression and on the other hand Isl1 expression. In conclusion, ischemia-reperfusion injury was the strongest stimulus with both global and focal cardiomyocyte progenitor cell marker up-regulations, correlating to the endogenous up-regulation of the growth factors IGF-1 and HGF. Also pregnancy induced a general up-regulation of c-Kit and early Nkx2.5+ cardiomyocytes throughout the heart. Utilization of these pathways could provide new strategies for the treatment of cardiac disease