Routine computed tomography after recent operative exploration for penetrating trauma

BACKGROUND Patients with penetrating trauma who cannot be stabilized undergo operative intervention without preoperative imaging. In such cases, postoperative imaging may reveal additional injuries not identified during the initial operative exploration. The purpose of this study is to explore the utility of postoperative CT imaging in the setting of penetrating trauma. METHODS This was a retrospective analysis of patients with penetrating trauma treated at an urban Level 1 trauma center between 2010 and 2015. Patients were included if they underwent an emergent laparotomy without preoperative imaging. Patients were excluded if they had prior imaging or concomitant blunt injury. For the purposes of this study, occult injury was defined as a CT scan finding not mentioned in the first operative report. Descriptive statistics were used to compare patient characteristics who had received imaging immediately postoperatively with those who had not. RESULTS During the 5-year study period, 328 patients who had a laparotomy for penetrating trauma over the study period, 225 patients met the inclusion criteria. Seventy-three (32%) patients underwent CT scanning immediately postoperatively with occult injuries identified in 38 (52%) patients. The most frequent occult injuries were orthopedic (20 of 43) and genitourinary (9 of 43). Importantly, 10 (26%) of the 38 patients required an intervention for these occult injuries. Those selected for immediate postoperative imaging were more likely to have sustained gunshot wounds and were significantly more severely injured (higher Injury Severity Score and longer length of hospital stay) when compared to patients who did not receive immediate imaging. CONCLUSION We recommend the use of immediate postoperative CT after emergent laparotomy especially when there is a high index of suspicion for spine or genitourinary injuries and in patients who have sustained ballistic penetrating injuries. LEVEL OF EVIDENCE Therapeutic/care management, level IV diagnostic tests or criteria, level IV

Del (9q) AML: clinical and cytological characteristics and prognostic implications

Del (9q) is a recurrent cytogenetic abnormality in acute myeloid leukaemia (AML). We report an analysis of 81 patients with del(9q) as a diagnostic karyotypic abnormality entered into the Medical Research Council AML trials 10, 11 and 12. Patients were divided into three groups: (i) Sole del (9q), 21 patients; (ii) Del(9q) in association with t(8;21), 29 patients; (iii) Del(9q) in association with other cytogenetic abnormalities, 31 patients. Sole del(9q) was associated with a characteristic bone marrow phenotype at diagnosis: a single Auer rod was found in all cases examined. There was also an association with erythroid dysplasia (74%) and granylocytic lineage vacuolation (90%). The incidence of all three of these features was significantly higher (P < 0·05) in the sole del(9q) group compared with control cases lacking del(9q). The overall survival (OS) of all 81 patients was compared with a control group of 1738 patients with normal cytogenetics entered in the same trials over the period of investigation. The 5-year OS for patients with del(9q) was 45%, compared with 35% for the control group (P = 0·09). Patients with del(9q) in association with t(8;21) had a 5-year OS of 75%, which was significantly better than the groups with either sole del(9q) (40%) and del(9q) with other abnormalities (26%; P = 0·008). Karyotyping indicated a common area of deletion in the region 9q21–22, which was present in 94% of cases. It is likely that the deletion of single or multiple tumour suppressor genes located in this region may underlie the pathogenesis of del (9q) AML

Life Underground: Investigating Microbial Communities and Their Biomarkers in Mars-Analog Lava Tubes at Craters of the Moon National Monument and Preserve

Craters of the Moon National Monument and Preserve (CotM) is a strong terrestrial analog for lava tube formations on Mars. The commonality of its basalt composition to Martian lava tubes makes it especially useful for probing how interactions between water, rock, and life have developed over time, and what traces of these microbial communities may be detectable by current flight-capable instrumentation. Our investigations found that secondary mineral deposits within these caves contain a range of underlying compositions that support diverse and active microbial communities. Examining the taxonomy, activity, and metabolic potential of these communities revealed largely heterotrophic life strategies supported by contributions from chemolithoautotrophs that facilitate key elemental cycles. Finally, traces of these microbial communities were detectable by flight-capable pyrolysis and wet chemistry gas chromatography-mass spectrometry methods comparable to those employed by the Sample Analysis at Mars (SAM) instrument aboard the Curiosity rover and the Mars Organic Molecule Analyzer (MOMA) on the upcoming Rosalind Franklin rover. Using a suite of methods for chemical derivatization of organic compounds is beneficial for resolving the greatest variety of biosignatures. Tetramethylammonium hydroxide (TMAH), for example, allowed for optimal resolution of long chain fatty acids. Taken together, these results have implications for the direction of mass spectrometry as a tool for biosignature detection on Mars, as well as informing the selection of sampling sites that could potentially host biosignatures. © 2022. American Geophysical Union. All Rights Reserved.6 month embargo; first published: 03 November 2022This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]