Fellowship training in Acute Care Surgery: from inception to current state.

Recognizing the need for urgent and emergent surgical care across America, the American Association for the Surgery of Trauma developed and implemented, and oversees, the Acute Care Surgery Fellowship Training Program. Now in its 10th year, the fellowship has become an established post-General Surgery Fellowship Training Program, with 20 approved programs and 82 fellows trained. Consistent with the desire to have this non-Accreditation Council for Graduate Medical Education (ACGME) fellowship one with the highest standards, several educational improvements have occurred since its origin. The following is an account of the background and evolution of what has become a significant educational contribution to surgery

Factor VIIa administration in traumatic brain injury: an AAST-MITC propensity score analysis.

Background:Recombinant factor VIIa (rFVIIa) has been used off-label as an adjunct in the reversal of warfarin therapy and management of hemorrhage after trauma. Only a handful of these reports are rigorous studies, from which results regarding safety and effectiveness have been mixed. There remains no clear consensus as to the role of rFVIIa in traumatic brain injury (TBI). Methods:Eleven level 1 trauma centers provided clinical data and head CT scans of patients with a Glasgow Coma Scale (GCS) score of ≤13 and radiographic evidence of TBI. A propensity score (PS) to receive rFVIIa in those surviving ≥2 days was calculated for each patient based on patient demographics, comorbidities, physiology, Injury Severity Score, admission GCS score, and treatment center. Patients receiving rFVIIa within 24 hours of admission were matched to patients who did not receive rFVIIa for outcomes assessment. Subgroup analysis evaluated patients with primary head injury with PS matching. Results:There were 4284 patient observations; 129 received rFVIIa. Groups were comparable after matching. No differences in mortality or morbidity were found. Improvement in GCS score from admission to discharge was less among those receiving rFVIIa (5.5 vs. 2.4; P value 0.001); however, there was no difference in average GCS score at discharge. No significant differences in outcomes were identified in patients with isolated TBI receiving rFVIIa. Discussion:rFVIIa in early management of TBI is not associated with a decreased risk of mortality or morbidity, and may negatively impact recovery and functional status at discharge in the severely injured patient with polytrauma. Level of evidence:Level III. Study type:Therapeutic/care management

Ingvar Ekesbo and Stefan Gunnarsson: Farm Animal Behaviour Characteristics for Assessment of Health and Welfare. Book Review

Ingvar Ekesbo and Stefan Gunnarsson: Farm Animal Behaviour Characteristics for Assessment of Health and Welfare. Second edition. CABI Wallingford, Oxfordshire, UK, 2018. 341 pages, with innumerable photo illustrations. 18 × 24 cm. ISBN-13: 978 1 78639 139 1. Price: 60

Flow visualization of shock-boundary layer interaction

Two and three-dimensional shock-boundary layer interaction data were obtained from supersonic wind tunnel tests. These interactions are studied both with and without boundary layer bleed. The data verify computational fluid dynamic codes. Surface static pressure, pitot pressure, flow angularity, and bleed rates, are studied by flow visualization techniques. Surface oil flow using fluorescent dye and laser sheet using water droplets as the scattering material are used for flow visualization

The in vitro effect of Garden Thyme (Thymus vulgaris L.) extract on Brachyspira hyodysenteriae

Filtrates of a water extract of commercially available garden thyme (Thymus vulgaris L.) were used for studying its possible bactericidal effect on Brachyspira hyodysenteriae, the causative agent of swine dysentery, by agar-diffusion technique. Five of the six studied Brachyspira strains have proven to be sensitive and one moderately sensitive in the in vitro tests. It was concluded that water extract of garden thyme possesses inhibitory effects against B. hyodysenteriae. In vivo experiments are needed to check the validity of this conclusion

Examination of the redox status of calves during the milk feeding period in a Hungarian large-scale dairy farm

During the milk feeding period (from birth to weaning, generally for 60-70 days), calves receive feed milk or milk replacer rich in both protein and energy. Young animals show intense physical development and growth. Intensive oxidative metabolic processes, inadequate antioxidant defense system, oxidative stress can develop, which adversely affects the health and productivity of calves due to its cell-damaging effects. This justifies continuous monitoring of the redox status of the animals during the calf rearing period for early detection of oxidative stress. This may provide a basis for targeted antioxidant treatments to reduce calf disease-related losses

The impact of trauma-center care on mortality and function following pelvic ring and acetabular injuries

ABSTRACT Background: Lower mortality and improved physical function following major polytrauma have been associated with treatment at level-1 trauma centers (TC) compared with that at non-trauma centers (NTC). This study investigates the impact of TC care on outcomes after pelvic and acetabular injuries. Methods: Mortality and quality of life-related measures were compared among patients treated in 18 hospitals with level-1 trauma centers and 51 hospitals without trauma centers in 14 U.S. states. Complete data were obtained on 829 adult trauma patients (18-84 years old) with at least one pelvic ring or acetabular injury (OTA 61 or 62). We used inverse probability of treatment weighting to adjust for observable confounding. Results: After adjustment for case mix, in-hospital mortality was significantly lower at TC versus NTC (RR 0.10, 95% CI 0.02-0.47), as was death by 90 days (RR 0.10, 95% CI 0.02-0.47), and one year (RR 0.21, 95% CI 0.06-0.76) for patients with more severe acetabular injuries (OTA 62-B or 62-C). Patients with combined pelvic ring and acetabular injuries treated at TC had lower mortality by 90 days (RR 0.34, 95% CI 0.14-0.82) and one year (RR 0.30 95% CI 0.14-0.68). Care at TC was also associated with mortality risk reduction for those with unstable pelvic ring injuries (OTA 61-B or 61-C) at one year (RR 0.21, 95%CI 0.06-0.76). Seventy-eight percent of included subjects discharged alive was available for interview at twelve months. Average absolute differences in SF-36 physical functioning and Musculoskeletal Functional Assessment at one year were 11.4 (95%CI 5.3 – 17.4) and 13.2 (1.7 – 24.7) respectively, indicating statistically and clinically significant improved outcomes with TC treatment for more severe acetabular injuries. Conclusions: Mortality is reduced for patients with unstable pelvic and severe acetabular injuries when care is provided in a TC compared to NTC. Moreover, those with severe acetabular fractures experience improved physical function at one year. Patients with these injuries represent a well-defined subset of trauma patients that should be preferentially triaged or transferred to a Level-1 trauma center

Effects of subclinical Mycobacterium avium ssp. paratuberculosis infection on some physiological parameters, health status and production in dairy cows

Milk yield, milk ingredients, health and other, production-related parameters of subclinically infected, Mycobacterium avium ssp. paratuberculosis (MAP-) shedding (positive faecal PCR, n = 20) and non-shedding (negative faecal PCR, n = 10) dairy cows were compared in the period from 10 days prepartum to 120 days postpartum. Body condition, rumen fill and faeces scores were lower in the MAP-shedding cows. There was no significant difference in plasma or urine metabolic parameters between the groups. Milk yield and lactose content tended to be lower (P = 0.074 and 0.077, respectively), somatic cell count tended to be higher (P = 0.097), while milk fat content was significantly higher (P = 0.006) in MAP-shedding cows than in the controls. Milk protein content did not differ between the groups. All other health and production parameters [number of reproductive tract treatments, number of udder treatments, number of artificial inseminations (AIs), calving interval, and service period] were significantly better in the control group. It is concluded that MAP infection, even in a subclinical form, has a significant impact on some production and health parameters of dairy cows