Do children with Glasgow 13/14 could be identified as mild traumatic brain injury? Pacientes pediátricos com Glasgow 13 ou 14 podem ser identificados como traumatismo craniano leve?

OBJECTIVE: To identify in mild head injured children the major differences between those with a Glasgow Coma Scale (GCS) 15 and GCS 13/14. METHOD: Cross-sectional study accomplished through information derived from medical records of mild head injured children presented in the emergency room of a Pediatric Trauma Centre level I, between May 2007 and May 2008. RESULTS: 1888 patients were included. The mean age was 7.6±5.4 years; 93.7% had GCS 15; among children with GCS 13/14, 46.2% (p<0.001) suffered multiple traumas and 52.1% (p<0.001) had abnormal cranial computed tomography (CCT) scan. In those with GCS 13/14, neurosurgery was performed in 6.7% and 9.2% (p=0.001) had neurological disabilities. CONCLUSION: Those with GCS 13/14 had frequently association with multiple traumas, abnormalities in CCT scan, require of neurosurgical procedure and Intensive Care Unit admission. We must be cautious in classified children with GCS 13/14 as mild head trauma victims.<br>OBJETIVO: Identificar as principais diferenças entre os pacientes com Escala de Coma de Glasgow (GCS) 15 e aqueles com escore 13/14. MÉTODO: Estudo realizado por meio da revisão de prontuários médicos de crianças vítimas de traumatismo craniencefálico leve, admitidas em Centro de Urgências Pediátricas nível I, durante um ano. RESULTADOS: Incluídas 1888 vítimas; idade média de 7,6±5,4 anos; 93,7% apresentaram pontuação 15 na GCS. Naqueles com pontuação 13/14, 46,2% (p<0,001) sofreram traumas múltiplos e 52,1% (p<0,001) apresentaram alterações na tomografia de crânio. Tratamento neurocirúrgico foi necessário em 6,7% dos pacientes com GCS 13/14 e 9,2% (p=0,001) apresentaram seqüelas neurológicas no momento da alta hospitalar. CONCLUSÃO: Crianças com escore 13/14 apresentam maior prevalência de traumas múltiplos, alterações na tomografia de crânio, necessidade de tratamento neurocirúrgico e internação em Unidade de Terapia Intensiva. Devemos ser cautelosos ao classificar crianças com pontuação 13/14 na GCS como vítimas de traumatismo craniano leve

The Chara Genome: secondary complexity and implications for plant terrestrialization

Land plants evolved from charophytic algae, among which Charophyceae possess the most complex body plans. We present the genome of Chara braunii; comparison of the genome to those of land plants identified evolutionary novelties for plant terrestrialization and land plant heritage genes. C. braunii employs unique xylan synthases for cell wall biosynthesis, a phragmoplast (cell separation) mechanism similar to that of land plants, and many phytohormones. C. braunii plastids are controlled via land-plant-like retrograde signaling, and transcriptional regulation is more elaborate than in other algae. The morphological complexity of this organism may result from expanded gene families, with three cases of particular note: genes effecting tolerance to reactive oxygen species (ROS), LysM receptor-like kinases, and transcription factors (TFs). Transcriptomic analysis of sexual reproductive structures reveals intricate control by TFs, activity of the ROS gene network, and the ancestral use of plant-like storage and stress protection proteins in the zygote