Femoral fractures in road traffic accidents

Abstract: The purpose of this study is to describe and analyze the severity of road traffic accidents in which a femoral fracture was identified, comparatively, in ante and post-mortem cases. For this purpose we have conducted a retrospective study, using the archives of the National Institute of Legal Medicine from which were selected 82 consecutive cases of clinical medicallegal expertises and 100 cases of autopsy (AR) reports for road traffic accidents. Femoral fractures were identified in 34 cases, of which 12 were in clinical cases and 22 in necropsy cases. Femoral shaft fractures were significantly associated with a lethal outcome, whilst fractures of the proximal extremity were significantly associated with a non-fatal outcome. Femoral fractures have a tendency to occur at younger ages compared with the cases in which such a lesion was not identified. Conclusions. Femoral shaft fractures were more frequent in younger males and fractures of the proximal extremity in older female patients. The presence of a femoral fracture (especially if it is involved the femoral shaft) is associated with an increased risk for an unfavorable outcome

Combination of 30% salicylic acid peels and mechanical comedo extraction for the treatment of Favre-Racouchot syndrome

No abstract available</p

Investigation of the combustion and emissions of lignin‐derived aromatic oxygenates in a marine diesel engine

As a hard-to-decarbonize sector, the shipping industry is experiencing demands to accelerate the transition from fossil fuels to alternative low-carbon fuels, to significantly reduce the negative impacts on the environment. Biofuels are regarded as one of the solutions for decarbonization in the marine sector. This paper introduces a lignin-derived drop-in biofuel, 2-methoxy-4-propylphenol (2M4PP), from non-edible feedstocks and investigates engine performance using its 10% (by volume) blend with standard diesel fuel (DF) at variable engine speeds and loads. Results show insignificant difference between the in-cylinder pressures of the proposed blend and DF. The diesel-2M4PP blend emits less carbon monoxide (CO) and nitric oxide (NOx) than DF at all speeds by up to 39.6% and 10.7% respectively, although its brake-specific fuel consumption (BSFC) is higher. A Ricardo wave model, which is validated with engine experimental data at 2400 rpm speed and full load, is investigated by adjusting injection pressure, injection timing, injection duration and nozzle diameter. The optimal parameters, i.e., 214 bar injection pressure, 6° injection timing, 41.4° injection duration, and 0.37 mm injector orifice, lead to the best engine performance with improved brake power, reduced NOx emissions, and limited influence on BSFC and hydrocarbon emissions compared to DF

Bevacizumab-associated sudden onset of multiple monomorphic comedones on the scalp successfully treated with 30% salicylic acid peels.

Bevacizumab is a humanized monoclonal antibody against vascular endothelial factor (VEGF) that targets tumor cell angiogenesis and proliferation. Although it is usually well tolerated, many side-effects have been reported. These include hypertension, bleeding, and thromboembolic events among others. Drug-associated cutaneous adverse effects are less common and include itching, exfoliative dermatitis, and acneiform eruptions. A man with bevacizumab-associated monomorphic skin eruption successfully was treated with 30% salicylic acid peels. To the author’s knowledge, this is the first report of open comedones with no further inflammatory acne lesions that developed in a patient treated with bevacizumab. Complete remission of the rash was achieved after performing 30% salicylic peels, and the patient continued the chemotherapy as planned with no need of either dose reduction or discontinuation of bevacizumab. </p

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Recent methodologies for estimating traditional structures

In this Doctoral Thesis the inelastic behaviour of traditional unreinforced masonry(URM) structures, with emphasis on towers, is investigated. The behaviour of theseslender structures is examined up to the state of collapse. It is common knowledge thatthe main defect of URM walls is their low tensile strength; as a consequence URM hasthe tendency to crack when subjected to seismic forces. Under gravitational forcesstructural elements are mainly in compression, whrereas the inertial forces developprincipal stresses that are tensile in one of the main directions. This kind of cracks mayalso appear due to differential settlement of the soil. When a URM structure is crackedand there is no other connection between the adjacent members, then its body is split inseveral parts. The most critical portion of the structure would have the tendency to moveapart and hence, a vibration which has the characteristics of rocking. This type ofvibration is very frequent in URM towers and drives to out-of-plane collapse.In the Thesis eight towers and campanile structures are investigated. The selection wasmade upon the basis to represent this kind of structures among a population of around35 monuments. This number of towers and campaniles in Mount Athos can be classifiedin these eight representative types. Modelling of the cracks is achieved with non-linearfinite elements, while for the URM material the gradient elasticity is firstly applied andthen the classical elasticity.The investigation of the rocking phenomenon is applied with two distinct methods. Inthe first place the rocking is examined analytically and the equations of vibration areextracted for the case of dynamic response. The capacity curves under the action ofinertial forces are estimated assuming a variety of possible collapse mechanisms. Thecritical collapse mechanism(s) is(are) identified between them as the one(s) with thelowest capacity in terms of displacements and shear forces. Hence, the critical collapsemechanism may involve more than one mechanism which sequentially becomes thecritical one.Then, rocking response is investigated applying the method of incremental dynamicanalysis (IDA). The structure is modeled using finite elements (FE's) for URM and nonlinearsmooth contact interfaces for the cracks. URM bodies can slide or rotate about thecontact interfaces or even move totally apart in the ultimate state of collapse.Seven seismic time-histories were selected to investigate the response of the structures.One of them is from the nearby fault of Volvi which was recorded during theThessaloniki 1978 earthquake. This seismic event can be considered quite representativein terms of the seismicity of the region. Then, another six seismic recordings have beenadopted which present different frequency characteristics so as to the response of thestructure would be as much as possible complete.In the last step of the Thesis, the vulnerability of the towers and the campaniles isestimated to investigate damage in statistical terms. Damage states were identified and thedamage thresholds were defined using the analyses. A lognormal distribution was adoptedto describe damage with seismic intensity and a group of vulnerability curves weregenerated for the current classification of the structures.Στο διδακτορικό αυτό ερευνήθηκε η ανελαστική δυναμική συμπεριφορά παραδοσιακώνκατασκευών, με έμφαση στις πυργοειδείς, μέχρι τη κατάρρευση. Ως γνωστόν, η άοπληφέρουσα τοιχοποιία (ΑΦΤ) πάσχει από χαμηλή εφελκυστική αντοχή που έχει ως συνέπειατη δημιουργία σχετικά εύκολα ρηγμάτων όταν υφίσταται τη δράση αδρανειακών φορτίων.Αυτό οφείλεται στο γεγονός ότι, υπό τα κατακόρυφα φορτία τα στατικά μέλη είναι υπό θλίψηενώ, οι οριζόντιες δυνάμεις προκαλούν κύριες τάσεις που στη μία διεύθυνση είναιεφελκυστικές. Τέτοιου είδους ρηγματώσεις μπορούν ακόμη να προκληθούν λόγωδιαφορικών καθιζήσεων. Όταν μία κατασκευή έχει ρηγματωθεί και δεν υπάρχει άλλου είδουςσύνδεσμος τότε το τμήμα εκείνο που έχει διαχωριστεί θα παρουσιάσει μία ταλάντωση πουέχει τα χαρακτηριστικά λικνισμού. Αυτός ο τύπος ταλάντωσης είναι ιδιαίτερα συχνός στιςπυργοειδείς κατασκευές και έχει ως συνέπεια την εκτός επιπέδου κατάρρευση.Στη Διατριβή μελετώνται λεπτομερώς οκτώ πύργοι και κωδωνοστάσια. Έγινε μία επιλογήπου καλύπτει όσο το δυνατόν πιο αντιπροσωπευτικά αυτόν τον τύπο της κατασκευής.Υπάρχει ένας μεγάλος αριθμός τέτοιων πύργων και κωδωνοστασίων στο Άγιον Όρος,περίπου 35 τον αριθμό, που όμως μπορεί να ταξινομηθεί σε αυτούς τους οκτώαντιπροσωπευτικού τύπους. Η προσομοίωση των ρηγμάτων των κωδωνοστασίων έγινε με τηνμέθοδο των πεπερασμένων στοιχείων θεωρώντας ανελαστική συμπεριφορά, ενώ το υλικό απόΑΦΤ κατ’ αρχήν μελεθητήθηκε με την βαθμιδική ελαστικότητα και στην συνέχεια με τηνκλασσική ελαστικότητα.Η μελέτη του φαινομένου του λικνισμού γίνεται με δύο μεθόδους. Κατ' αρχήν ο λικνισμόςμελετάται αναλυτικά και εξάγονται οι εξισώσεις της δυναμικής κινήσεως στη περίπτωσηδυναμικών φορτίων. Η καμπύλη αντιστάσεως υπό τη δράση αδρανειακών φορτίων εξάγεταιθεωρώντας μία σειρά πιθανών μηχανισμών αστοχίας. Κρίσιμος μηχανισμός (ή κρίσιμοιμηχανισμοί) θεωρείται εκείνος ο οποίος έχει τη μικρότερη ικανότητα από πλευράςτέμνουσας και μετακινήσεως. Ο κρίσιμος μηχανισμός αστοχίας καθορίζεται με σύνθεση τωνκαμπυλών αντιστάσεως ώστε ο τελικός κρίσιμος μηχανισμός για προοδευτική αύξηση τωνμετακινήσεων μπορεί να είναι διαφορετικός.Στη συνέχεια ο λικνισμός θεωρείται με τη μέθοδο της αυξητικής δυναμικής αναλύσεως(ΑΔΑ). Η κατασκευή προσομοιώνεται με τη μέθοδο των πεπερασμένων στοιχείων (ΜΠΣ)χρησιμοποιώντας μη-γραμμικές διεπιφάνειες επαφής για τα ρήγματα. Η τοιχοποιίαεπιτρέπεται να περιστραφεί, να ολισθήσει και εν τέλει να αποχωρισθεί πλήρως από το σώμαεν επαφή σηματοδοτώντας τη κατάρρευση.Για τη μελέτη του φαινομένου του σεισμού επελέγησαν επτά σεισμικές δονήσεις. Η μία εξαυτών προέρχεται από το σεισμό της Θεσσαλονίκης (Βόλβη, 1978) που λόγω γειτνιάσεωςείναι αντιπροσωπευτικός της σεισμικότητας της περιοχής. Στη συνέχεια επελέγησαν καιάλλοι σεισμοί με διαφορετικά συχνοτικά χαρακτηριστικά ώστε η απόκριση των κατασκευώννα είναι όσο το δυνατόν πληρέστερη.Στο τελευταίο βήμα έγινε η ανάλυση τρωτότητας των πύργων και των κωδωνοστασίων για ναεκτιμηθεί η βλάβη με πιθανοτικούς όρους. Ορίστηκαν οι στάθμες βλάβης και από τιςπροηγούμενες αναλύσεις καθορίστηκαν τα κατώφλια βλάβης. Υιοθετήθηκε μία πιθανοτικήκατανομή (λογαριθμοκανονική κατανομή) για τη μεταβολή των βλαβών με τη σεισμικήένταση και παρήχθησαν καμπύλες τρωτότητας για ομάδες κωδωνοστασίων

Advances in stem cell therapy in Alzheimer’s disease: a comprehensive clinical trial review.

Alzheimer&apos;s disease (AD) is the most common type of dementia responsible for more than 121,499 deaths from AD in 2019 making AD the sixth-leading cause in the United States. AD is a progressive neurodegenerative disorder characterized by decline of memory, behavioral impairments that affects a person&apos;s ability to function independently ultimately leading to death. The current pressing need for a treatment for (AD) and advances in the field of cell therapy, has rendered stem cell therapeutics a promising field of research. Despite advancements in stem cell technology, confirmed by encouraging pre-clinical utilization of stem cells in AD animal models, the number of clinical trials evaluating the efficacy of stem cell therapy is limited, with the results of many ongoing clinical trials on cell therapy for AD still pending. Mesenchymal stem cells (MSCs) have been the main focus in these studies, reporting encouraging results concerning safety profile, however their efficacy remains unproven. In the current article we review the latest advances regarding different sources of stem cell therapy and present a comprehensive list of every available clinical trial in national and international registries. Finally, we discuss drawbacks arising from AD pathology and technical limitations that hinder the transition of stem cell technology from bench to bedside. Our findings emphasize the need to increase clinical trials towards uncovering the mode of action and the underlying therapeutic mechanisms of transplanted cells as well as the molecular mechanisms controlling regeneration and neuronal microenvironment

The Ice Pack Test in the Differential Diagnosis of Myasthenic Diplopia

Purpose: To investigate the diagnostic value and to establish threshold criteria for the ice pack test as an office preliminary test in the differential diagnosis of myasthenic diplopia in comparison with blepharoptosis. Design: Prospective, comparative cohort study. Participants: Eighty-nine patients with a recent onset of diplopia, blepharoptosis, or both were evaluated with orbital cooling in a prospective manner. Forty-eight patients presented with diplopia, 25 patients with both blepharoptosis and ophthalmoplegia and 16 patients with blepharoptosis. Testing: All patients had the ice pack applied for 5 minutes on both eyelids at the initial orthoptic evaluation. Increasing the duration of cooling to 10 minutes was investigated in 36 diplopic patients. A complete diagnostic work-up was ordered and patients were followed up for a minimum of 6 months before diagnosis of myasthenia gravis was ascertained. Main Outcome Measures: Difference in cover test measurements in primary position or marginal reflex distance before and after the application of the ice pack, specific cause for diplopia and blepharoptosis. Results: Fifteen patients were diagnosed as myasthenic. The optimal cutoff point for a positive response to the ice pack test proved to be a reduction in ocular deviation in primary position by 50% or by 10 prism diopters (PD) or more for presenting deviations larger than 20 PD. By this criterion, sensitivity for the detection of myasthenic diplopia was 76.9% (95% confidence interval [CI], 49.06%-92.50%) for the 5-minute application, compared with 92.3% (95% CI, 63.5%-98.9%) sensitivity demonstrated for blepharoptosis. Increasing the time of application to 10 minutes did not improve the diagnostic value of the test. Specificity was high (98.3%; 95% CI, 90.3%-99.9%) and was demonstrated even in patients with coexisting myasthenic and dysthyroid ophthalmopathy. Patients with oculomotor nerve paresis and Horner syndrome invariably were nonresponsive to the test. Conclusions: The ice pack test demonstrated high specificity and an acceptable sensitivity in the differential diagnosis of myasthenic diplopia. Data from this series suggest that a partial rather than a complete response to the ice pack test may be expected for myasthenic diplopia. Standardization of the method of application of the ice pack is critical for the interpretation of its effect. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. Ophthalmology 2009;116:2236-2243 (C) 2009 by the American Academy of Ophthalmology

Thoracic Aortic Injury: Embolization of the Tenth Intercostal Artery and Endovascular Treatment in a Young Woman after Posterior Spinal Instrumentation

Iatrogenic aortic injuries are rare and well-recognized complications of a variety of procedures, including spinal surgery. The placement of pedicle screws is sometimes associated with devastating consequences. Aortic perforation with rapid hematoma formation and delayed aortic trauma leading to pseudoaneurysm formation have been described in the literature. A case describing a significant time interval between iatrogenic aortic injury and diagnosis in the absence of pseudoaneurysm formation is described in this paper and, according to our knowledge, is unique in the literature. The aortic injury was successfully treated, selecting the appropriate graft and, as a consequence, normal spinal cord blood flow was achieved

A Case of Reed's Syndrome: An Underdiagnosed Tumor Disorder

Cutaneous leiomyomas are uncommon, benign smooth muscle tumors originating from the arrector pili muscle of the hair follicle that are frequently unrecognized and underdiagnosed by clinicians. They sometimes coexist with common uterine fibroids in an inherited disorder named multiple cutaneous and uterine leiomyomatosis, also referred to as Reed's syndrome. We report a case of Reed's syndrome in a young woman who had been misdiagnosed for many years