Outcomes in patients with gunshot wounds to the brain.

Introduction:Gunshot wounds to the brain (GSWB) confer high lethality and uncertain recovery. It is unclear which patients benefit from aggressive resuscitation, and furthermore whether patients with GSWB undergoing cardiopulmonary resuscitation (CPR) have potential for survival or organ donation. Therefore, we sought to determine the rates of survival and organ donation, as well as identify factors associated with both outcomes in patients with GSWB undergoing CPR. Methods:We performed a retrospective, multicenter study at 25 US trauma centers including dates between June 1, 2011 and December 31, 2017. Patients were included if they suffered isolated GSWB and required CPR at a referring hospital, in the field, or in the trauma resuscitation room. Patients were excluded for significant torso or extremity injuries, or if pregnant. Binomial regression models were used to determine predictors of survival/organ donation. Results:825 patients met study criteria; the majority were male (87.6%) with a mean age of 36.5 years. Most (67%) underwent CPR in the field and 2.1% (n=17) survived to discharge. Of the non-survivors, 17.5% (n=141) were considered eligible donors, with a donation rate of 58.9% (n=83) in this group. Regression models found several predictors of survival. Hormone replacement was predictive of both survival and organ donation. Conclusion:We found that GSWB requiring CPR during trauma resuscitation was associated with a 2.1% survival rate and overall organ donation rate of 10.3%. Several factors appear to be favorably associated with survival, although predictions are uncertain due to the low number of survivors in this patient population. Hormone replacement was predictive of both survival and organ donation. These results are a starting point for determining appropriate treatment algorithms for this devastating clinical condition. Level of evidence:Level II

Conocimiento etnoecólogico de los hongos entre los indígenas Uitoto, Muinane y Andoke de la Amazonía Colombiana Conhecimento etnoecológico de fungos entre os indígenas Uitoto, Muinane e Andoke da Amazônia Colombiana

El presente texto es el resultado de un compartir de conocimientos acerca de los hongos y sus relaciones ecológicas con animales y plantas, con las etnias Uitoto, Andoke y Muinane que habitan la región del medio Caquetá. Gran parte de la información ecológica encontrada está contenida en la tradición oral de estas etnias, y refleja la capacidad integradora y descriptiva que tienen los indígenas sobre el medio natural circundante. En la zona de estudio la madera es un sustrato muy abundante debido principalmente al tipo de agricultura que tienen los indígenas, y por tanto se desarrollan una gran cantidad de especies de hongos lignícolas. Muinanes, Uitotos y Andokes conocen algunas de las especies vegetales que sirven de sustrato para los hongos, sobretodo aquellas utilizadas en la alimentación tales como Lentinula raphanica y Lentinus scleropus, entre otros. El conocimiento ecológico que tienen estos indígenas sobre los hongos, incluye además datos acerca de cucarrones (Coleoptera) y larvas (Diptera), mamíferos como venados (Mazama americana y M. gouazoubira) y ardillas (Microsciurus flaviventer) y tortugas que incluyen los hongos en su dieta, así como sobre especies de hongos que parasitan plantas e insectos.<br>O presente texto é o resultado de um intercâmbio de conhecimentos sobre os fungos e as suas relações ecológicas com animais e plantas, com as etnias Uitoto, Andoke e Muinane que habitam a região do Medio Caquetá. Grande parte da informação ecológica encontrada está contida na tradição oral destas etnias e reflete a capacidade integradora e descritiva que os indígenas possuem sobre o meio natural que os circunda. Na zona de estudo a madeira é um substrato abundante devido principalmente ao tipo de agricultura que os indígenas têm, portanto uma grande quantidade de espécies de fungos lignícolas se desenvolve perto dessas tribos. Os Muinanes, Uitotos e Andokes conhecem algumas das espécies vegetais que servem de subtstrato para os fungos, principalmente daquelas que eles utilizam na alimentação, como Lentinula raphanica e Lentinus scleropus, entre outros. O conhecimento ecológico que estes indígenas possuem sobre fungos inclui ainda dados de besouros (Coleoptera) e larvas (Diptera), mamíferos, como veados (Mazama americana e M. gouazoubira) e esquilos (Microsciurus flaviventer), e tartarugas que incluem fungos nas suas dietas, assim como sobre espécies de fungos que parasitam plantas e insetos

Immediate versus deferred treatment for advanced prostatic cancer: Initial results of the Medical Research Council trial

Objective To compare the effect on the course of advanced prostate cancer of hormone treatment commenced on diagnosis with that deferred until clinically significant progression occurs. Patients and methods Nine hundred and thirty-eight patients with locally advanced or asymptomatic metastatic prostate cancer were randomized either to immediate treatment (orchidectomy or luteinizing hormone-releasing hormone analogue) or to the same treatment deferred until an indication occurred, Follow-up and management were otherwise according to the participating clinician's normal practice. Information was collected annually on survival, local and distant progression, and major complications (pathological fracture, spinal cord compression, ureteric obstruction and extra-skeletal metastases). Results Follow-up data were returned on 934 patients; 51 deferred patients died from causes other than prostate cancer before treatment was started (but only five of these presented at age <70 years) and 29 died from prostate cancer before treatment could be started, Treatment was commenced for local progression almost as frequently as for metastatic disease, Progression from M0 to M1 disease (P<0.001, two-tailed) and development of metastatic pain occurred more rapidly in deferred patients; 141 deferred patients needed transurethral resection for local progression compared with 65 treated immediately (P<0.001, two-tailed). Pathological fracture, spinal cord compression, ureteric obstruction and development of extra-skeletal metastases were twice as common in deferred patients. Of the patients who died, 67% did so from prostate cancer; 361 patients died in the deferred arm compared with 328 in the immediate arm (P=0.02, two-tailed), where 257 and 203 were deaths from prostate cancer, respectively (P=0.001 two-tailed). This difference was seen largely in M0 patients, with 119 and 81 deaths from prostate cancer, respectively (P<0.001 two-tailed). Conclusions The results consistently favour immediate treatment, although some of the data, especially on M0 patients, are immature. The implications for management of advanced prostate cancer are discussed