Immediate sonography and intervention in blunt chest trauma:A case report

Cardiac tamponade is a leading cause of death in blunt thoracic trauma. Ultrasound improved the recognition of cardiac tamponade and therefore has a vital role in acute critical situations in the Emergency Department and in the Intensive Care Unit. Besides recognition of cardiac tamponade, treatment protocols are important. In trauma patients with hemodynamic stable cardiac tamponade, time should be taken for a proper workup for an explorative sternotomy. In hemodynamic unstable trauma patients, the pericardium should be drained, and fluid resuscitation should be performed followed by emergency sternotomy. In this case report we describe a blunt thoracic trauma victim, a 28-year-old male patient without any medical history. He suffered from the unique combination of a tear in the left atrial appendage and a papillary muscle rupture of the right ventricle because of blunt thoracic trauma. Transthoracic echocardiography revealed massive pericardial effusion with diastolic collapse of the right ventricle in our patient. Due to his hemodynamic situation, the patient was brought into the OR for immediate sternotomy and cardiac repair. The patient made a full recovery, was discharged home, and is back to work. This case report emphasizes the relevance of early recognition and treatment of cardiac tamponade in blunt thoracic trauma victims and suggests a multidisciplinary management strategy.</p

Immediate sonography and intervention in blunt chest trauma:A case report

Cardiac tamponade is a leading cause of death in blunt thoracic trauma. Ultrasound improved the recognition of cardiac tamponade and therefore has a vital role in acute critical situations in the Emergency Department and in the Intensive Care Unit. Besides recognition of cardiac tamponade, treatment protocols are important. In trauma patients with hemodynamic stable cardiac tamponade, time should be taken for a proper workup for an explorative sternotomy. In hemodynamic unstable trauma patients, the pericardium should be drained, and fluid resuscitation should be performed followed by emergency sternotomy. In this case report we describe a blunt thoracic trauma victim, a 28-year-old male patient without any medical history. He suffered from the unique combination of a tear in the left atrial appendage and a papillary muscle rupture of the right ventricle because of blunt thoracic trauma. Transthoracic echocardiography revealed massive pericardial effusion with diastolic collapse of the right ventricle in our patient. Due to his hemodynamic situation, the patient was brought into the OR for immediate sternotomy and cardiac repair. The patient made a full recovery, was discharged home, and is back to work. This case report emphasizes the relevance of early recognition and treatment of cardiac tamponade in blunt thoracic trauma victims and suggests a multidisciplinary management strategy.</p

Immediate sonography and intervention in blunt chest trauma:A case report

Cardiac tamponade is a leading cause of death in blunt thoracic trauma. Ultrasound improved the recognition of cardiac tamponade and therefore has a vital role in acute critical situations in the Emergency Department and in the Intensive Care Unit. Besides recognition of cardiac tamponade, treatment protocols are important. In trauma patients with hemodynamic stable cardiac tamponade, time should be taken for a proper workup for an explorative sternotomy. In hemodynamic unstable trauma patients, the pericardium should be drained, and fluid resuscitation should be performed followed by emergency sternotomy. In this case report we describe a blunt thoracic trauma victim, a 28-year-old male patient without any medical history. He suffered from the unique combination of a tear in the left atrial appendage and a papillary muscle rupture of the right ventricle because of blunt thoracic trauma. Transthoracic echocardiography revealed massive pericardial effusion with diastolic collapse of the right ventricle in our patient. Due to his hemodynamic situation, the patient was brought into the OR for immediate sternotomy and cardiac repair. The patient made a full recovery, was discharged home, and is back to work. This case report emphasizes the relevance of early recognition and treatment of cardiac tamponade in blunt thoracic trauma victims and suggests a multidisciplinary management strategy.</p

Smart Mobility & Urban Development in Haven-Stad, Amsterdam:

Cities are in transition. Most cities, like Amsterdam, are growing in terms of inhabitants, visitors, and jobs, which cause an increase in the movement of people and goods to, from, and around the city. Next to that, socio-economical factors, new insights, policies, and technology innovations change how we live and work in our cities. Mobility operates as the intersection between the city’s infrastructure and its inhabitants; it is the central link in the well-functioning of a city and a key element in the organization of multi-modal transport. We have seen a rise of, among others, Mobility as a Service (MaaS), ride-sharing, and micro-mobility, and even though not implemented yet, autonomous vehicles are one of the relevant technologies to consider when looking at our future cities. How does mobility in the future impact the way our cities are being developed? Just like cities in general, the area of Haven-Stad is in transition as well. From being a harbor area at the edge of the city center, it will be developed into a mixed-use neighborhood and will be the biggest urban generator for future developments in Amsterdam. To gain insight and to better understand the interrelationships between urban development and urban mobility and to show perspectives on integration of future mobility scenarios in an actual urban environment, we asked each of the three groups to elaborate on a specific part of Haven-Stad. Each group came up with a perspective for their area, while looking at a wide variety of aspects: the role and function of smart urban mobility, including Mobility as a Service (MaaS) and emerging mobility options; the travel behavior of a growing number of users; the sustainability challenges and fairness in transport planning; the public and semipublic spaces (and social dynamics therein); the exploration of alternative, marginal and emerging social uses of urban developments as meeting places and culture; the urban integration in the overall mobility system; the interface between architecture and infrastructure within the urban fabric; the programming of future transport nodes and the access and egress to and from such transport hubs of all types of smart mobilities (e.g. conventional public transport, shared mobility, autonomous taxis, et cetera). As the development of Haven-Stad will take over 30 years, the factor time and phasing in the approaches and scenarios is key in each of the three proposals. The eight-day program covered different didactical components. Firstly, participants were introduced to Amsterdam, the current status of the Haven-Stad project, mobility, and future developments. Through various presentations by city representatives, participants were informed on the history, general information and mobility policies on Amsterdam and Haven-Stad. Next to that, experts from TU Delft gave presentations on smart mobility, different modes of mobility, behavioral aspects, and the state of the art of mobility-related research. During an afternoon bike tour, participants had the chance to explore the area and get a better feeling for its size and current atmosphere of the project location. During intensive and interactive work sessions with the seven tutors, analyses were made and the perspectives, approaches, and scenarios were refined. The three groups presented the final results for a group of visiting critics.&nbsp; With this publication, we want to show the richness of perspectives and insights on Haven-Stad, that were developed during this short but very intensive Summer School. We are proud to present the three different projects, each with their own focus. The invited experts provided the participants with background knowledge lectures and a workshop. Excerpts of these sessions are included in this publication. We thank all participants, tutors and involved stakeholders for their efforts that have made this Summer School a success

La Memoria social campesina frente a los procesos de territorialización en Comalcalco, Tabasco

The aim of this study is to analyze the processes of territorialization through social memory&nbsp;in part of the Chontalpa (Tabasco region in southeastern Mexico). The approach involved the&nbsp;application of semi-structured interviews in various communities in the year 2017 and 2021.&nbsp;The collection of information allowed for the identification of diverse variables for the social&nbsp;study of the region. The elements addressed focus on the processes of territorialization by the&nbsp;state and local elites that influenced the formation of social vulnerability to social inequality&nbsp;and insecurity. Consequently, the reflections and actions taken by the communities to confront&nbsp;social, economic, and territorial changes are explored. Despite the various responses to these&nbsp;impositions, the majority group presented here has been compelled to integrate into the labor&nbsp;and service market, as well as to migrate when internal economic conditions have demanded&nbsp;it. Nevertheless, a strong&nbsp;link exists between a significant local attachment, along with strong&nbsp;support in family units.El objetivo de este estudio es analizar los procesos de territorialización desde la memoria social&nbsp;en parte de la Chontalpa (región tabasqueña en el sureste de México). La forma de aproximación&nbsp;fue a través de la aplicación de entrevistas semiestructuradas en distintas comunidades en los&nbsp;años de 2017 y 2021. La recolección de información permitió encontrar diversas variables&nbsp;para el estudio social de la región. Los elementos que se retoman se centran en los procesos&nbsp;de territorialización por parte del Estado y élites locales que influyeron en la formación de la&nbsp;vulnerabilidad social a la desigualdad social e inseguridad social. Y con ello, las reflexiones&nbsp;y acciones tomadas por las comunidades para afrontar los cambios sociales, económicos y&nbsp;territoriales. Y aunque existen diversas respuestas a estas imposiciones, el grupo mayoritario&nbsp;que aquí presentamos se ha visto obligado a insertarse en el mercado laboral y de servicios,&nbsp;así como a migrar cuando las condiciones económicas internas lo han exigido. Pese a todo,&nbsp;existe un importante arraigo local, lo mismo que un fuerte apoyo en las unidades familiares

Crecimiento de langosta espinosa en jaulas flotantes en el Refugio de Vida Silvestre Cayos Perla, municipio de Laguna de Perlas, RACCS, Nicaragua

The common lobster (Panulirus argus) is a species with high commercial value in the Nicaraguan Caribbean. In recent decades its production has reached its maximum values, coupled with the fluctuations associated with climate variability and its use, demand the need to enter into complementary forms of production, such as aquaculture. In the Cayos Perla Wildlife Refuge, Nicaragua, the growth of 85 lobsters (P. argus), grown in a floating cage of 2 x 2 x 2.30 m, was evaluated during the period from December 21, 2018 to May 23 of 2019, fed daily with sardines at a rate of 7% of its weight. During this period the water presented average temperature values ​​of 28.5 ºC, pH 7.6, salinity of 34.4 g L-1, turbidity greater than one meter and current velocity of 0.2 to 0.4 ft s-1. Two stages of lobster growth were observed, 89 and 64 days, each. The first characterized by zero growth, density of 10.6 organisms m3 and high mortality at the end (39%); the second by a growth similar to that observed in its natural state, high survival (100%), with a density of 6.3 m3 organisms. The weight (W) - cephalothorax (LC) ratio of lobsters during cultivation was adjusted to equation W = 0.02788 LC 2.2074. From the above it can be said that lobster cultivation in this region has a high potential.La langosta común (Panulirus argus) es una especie con alto valor comercial en el Caribe nicaragüense. En las últimas décadas su producción ha alcanzado sus valores máximos, aunado a las fluctuaciones asociadas a la variabilidad climática y su mismo aprovechamiento, demandan la necesidad de incursionar en formas complementarias de producción, como lo es la acuicultura. En el Refugio de Vida Silvestre Cayos Perla, Nicaragua, se evaluó el crecimiento de 85 langostas (P. argus), cultivadas en una jaula flotante de 2 x 2 x 2.30 m, durante el período del 21 de diciembre de 2018 al 23 de mayo de 2019, alimentadas diariamente con sardinas a razón del 7% de su peso. Durante este período el agua presentó valores promedios de temperatura de 28.5 ºC, pH de 7.6, salinidad de 34.4 g L-1, turbidez mayor a un metro y velocidad de la corriente de 0.2 a 0.4 ft s-1. Se observaron dos etapas de crecimiento de la langosta, de 89 y 64 días, cada una. La primera caracterizada por nulo crecimiento, densidad de 10.6 organismos m3 y mortalidad alta al final (39%); la segunda por un crecimiento similar al observado en su estado natural, sobrevivencia alta (100%), con una densidad de 6.3 organismos m3.La relación peso (W) – longitud del cefalotórax (LC) de las langostas durante el cultivo se ajustó a la ecuación W = 0.02788 LC 2.2074. De lo anterior se puede decir que el cultivo de la langosta en ésta región tiene un alto potencial

Serum potassium levels and outcome in acute heart failure (data from the PROTECT and COACH trials)

Serum potassium is routinely measured at admission for acute heart failure (AHF), but information on association with clinical variables and prognosis is limited. Potassium measurements at admission were available in 1,867 patients with AHF in the original cohort of 2,033 patients included in the Patients Hospitalized with acute heart failure and Volume Overload to Assess Treatment Effect on Congestion and Renal FuncTion trial. Patients were grouped according to low potassium (&lt;3.5 mEq/l), normal potassium (3.5 to 5.0 mEq/l), and high potassium (&gt;5.0 mEq/l) levels. Results were verified in a validation cohort of 1,023 patients. Mean age of patients was 71 – 11 years, and 66% were men. Low potassium was present in 115 patients (6%), normal potassium in 1,576 (84%), and high potassium in 176 (9%). Potassium levels increased during hospitalization (0.18 – 0.69 mEq/l). Patients with high potassium more often used angiotensin-converting enzyme inhibitors and mineralocorticoid receptor antagonists before admission, had impaired baseline renal function and a better diuretic response (p [ 0.005), independent of mineralocorticoid receptor antagonist usage. During 180-day follow-up, a total of 330 patients (18%) died. Potassium levels at admission showed a univariate linear association with mortality (hazard ratio [log] 2.36, 95% confidence interval 1.07 to 5.23; p [ 0.034) but not after multivariate adjustment. Changes of potassium levels during hospitalization or potassium levels at discharge were not associated with outcome after multivariate analysis. Results in the validation cohort were similar to the index cohort. In conclusion, high potassium levels at admission are associated with an impaired renal function but a better diuretic response. Changes in potassium levels are common, and overall levels increase during hospitalization. In conclusion, potassium levels at admission or its change during hospitalization are not associated with mortality after multivariate adjustment

The association of having a monitoring or blunting coping style with psychological distress, health-related quality of life and satisfaction with healthcare in gastrointestinal stromal tumour (GIST) patients

Background: There are two main coping styles regarding information seeking under medical threat; monitoring (information-seeking) and blunting (information-avoiding). The aim of this study is to (1) determine factors associated with a monitoring or blunting coping style in gastro-intestinal stromal tumour (GIST) patients and (2) investigate its association with psychological distress, cancer-related concerns, health-related quality of life and satisfaction with healthcare. Methods: In a cross-sectional study, Dutch GIST patients completed the shortened version of the Threatening Medical Situations Inventory to determine their coping style, the Hospital Anxiety and Depression Scale, Cancer Worry Scale, EORTC QLQ-C30 and part of the EORTC QLQ-INFO25. Results: A total of 307 patients were classified as blunters (n = 175, 57%) or monitors (n = 132, 43%). Coping style was not associated with tumour or treatment variables, but being a female (OR 2.5; 95%CI 1.5–4.1; p= &lt;.001) and higher educated (OR 5.5; 95%CI 2.5–11.9, p= &lt;.001) were associated with higher odds of being a monitor. Monitors scored significantly lower on emotional functioning (mean = 86.8 vs mean = 90.9, p=.044), which is considered a trivial difference, more often experienced severe fear of cancer recurrence or progression (53.0% vs 37.7%, p=.007), and had more concerns about dying from GIST in the future (60.6% vs 47.4%, p=.025). Compared to blunters, monitors were less satisfied with the received healthcare and information, and would have liked to receive more information.Conclusion: GIST patients with a monitoring coping style experience a higher emotional burden. Additionally, monitors exhibit a greater need for information. Although this need for information could potentially result in fears and concerns, recognising it may also create an opening for tailored communication and information.</p

GAA Deficiency in Pompe Disease Is Alleviated by Exon Inclusion in iPSC-Derived Skeletal Muscle Cells

Pompe disease is a metabolic myopathy caused by deficiency of the acid α-glucosidase (GAA) enzyme and results in progressive wasting of skeletal muscle cells. The c.-32-13T>G (IVS1) GAA variant promotes exon 2 skipping during pre-mRNA splicing and is the most common variant for the childhood/adult disease form. We previously identified antisense oligonucleotides (AONs) that promoted GAA exon 2 inclusion in patient-derived fibroblasts. It was unknown how these AONs would affect GAA splicing in skeletal muscle cells. To test this, we expanded induced pluripotent stem cell (iPSC)-derived myogenic progenitors and differentiated these to multinucleated myotubes. AONs restored splicing in myotubes to a similar extent as in fibroblasts, suggesting that they act by modulating the action of shared splicing regulators. AONs targeted the putative polypyrimidine tract of a cryptic splice acceptor site that was part of a pseudo exon in GAA intron 1. Blocking of the cryptic splice donor of the pseudo exon with AONs likewise promoted GAA exon 2 inclusion. The simultaneous blocking of the cryptic acceptor and cryptic donor sites restored the majority of canonical splicing and alleviated GAA enzyme deficiency. These results highlight the relevance of cryptic splicing in human disease and its potential as therapeutic target for splicing modulation using AONs

Prenatal screening for congenital anomalies: exploring midwives’ perceptions of counseling clients with religious backgrounds

BACKGROUND: In the Netherlands, prenatal screening follows an opting in system and comprises two non-invasive tests: the combined test to screen for trisomy 21 at 12 weeks of gestation and the fetal anomaly scan to detect structural anomalies at 20 weeks. Midwives counsel about prenatal screening tests for congenital anomalies and they are increasingly having to counsel women from religious backgrounds beyond their experience. This study assessed midwives’ perceptions and practices regarding taking client’s religious backgrounds into account during counseling. As Islam is the commonest non-western religion, we were particularly interested in midwives’ knowledge of whether pregnancy termination is allowed in Islam. METHODS: This exploratory study is part of the DELIVER study, which evaluated primary care midwifery in the Netherlands between September 2009 and January 2011. A questionnaire was sent to all 108 midwives of the twenty practices participating in the study. RESULTS: Of 98 respondents (response rate 92%), 68 (69%) said they took account of the client’s religion. The two main reasons for not doing so were that religion was considered irrelevant in the decision-making process and that it should be up to clients to initiate such discussions. Midwives’ own religious backgrounds were independent of whether they paid attention to the clients’ religious backgrounds. Eighty midwives (82%) said they did not counsel Muslim women differently from other women. Although midwives with relatively many Muslim clients had more knowledge of Islamic attitudes to terminating pregnancy in general than midwives with relatively fewer Muslim clients, the specific knowledge of termination regarding trisomy 21 and other congenital anomalies was limited in both groups. CONCLUSION: While many midwives took client’s religion into account, few knew much about Islamic beliefs on prenatal screening for congenital anomalies. Midwives identified a need for additional education. To meet the needs of the changing client population, counselors need more knowledge of religious opinions about the termination of pregnancy and the skills to approach religious issues with clients