A civilian perspective on ballistic trauma and gunshot injuries

<p>Abstract</p> <p>Background</p> <p>Gun violence is on the rise in some European countries, however most of the literature on gunshot injuries pertains to military weaponry and is difficult to apply to civilians, due to dissimilarities in wound contamination and wounding potential of firearms and ammunition. Gunshot injuries in civilians have more focal injury patterns and should be considered distinct entities.</p> <p>Methods</p> <p>A search of the National Library of Medicine and the National Institutes of Health MEDLINE database was performed using PubMed.</p> <p>Results</p> <p>Craniocerebral gunshot injuries are often lethal, especially after suicide attempts. The treatment of non space consuming haematomas and the indications for invasive pressure measurement are controversial. Civilian gunshot injuries to the torso mostly intend to kill; however for those patients who do not die at the scene and are hemodynamically stable, insertion of a chest tube is usually the only required procedure for the majority of penetrating chest injuries. In penetrating abdominal injuries there is a trend towards non-operative care, provided that the patient is hemodynamically stable. Spinal gunshots can also often be treated without operation. Gunshot injuries of the extremities are rarely life-threatening but can be associated with severe morbidity.</p> <p>With the exception of craniocerebral, bowel, articular, or severe soft tissue injury, the use of antibiotics is controversial and may depend on the surgeon's preference.</p> <p>Conclusion</p> <p>The treatment strategy for patients with gunshot injuries to the torso mostly depends on the hemodynamic status of the patient. Whereas hemodynamically unstable patients require immediate operative measures like thoracotomy or laparotomy, hemodynamically stable patients might be treated with minor surgical procedures (e.g. chest tube) or even conservatively.</p

Анализ применения пневмоударного бурения в условиях катастрофических поглощений бурового раствора

В процессе исследования проводились анализ и обобщение существующих способов и методов предупреждения и ликвидации поглощений бурового раствора. В работе рассмотрено буровое оборудование для реализации технологии ударно-вращательного бурения с очисткой забоя газожидкостными смесями.В результате исследования выбрано оборудование на базе мобильной буровой установки с погружным пневмоударником со специальной обвязкой устья скважины, произведен расчет распределения аэродинамических давлений при реализации пневмоударного бурения.In the course of the study, the analysis and generalization of existing methods and methods for preventing and eliminating mud absorption was carried out. In work the drilling equipment for realization of technology of shock-rotary drilling with cleaning of face with gas-liquid mixtures is considered.As a result of the research, the equipment was selected on the basis of a mobile drilling rig with a submersible hammer with a special piping of the wellhead, a calculation of the distribution of aerodynamic pressures in the implementation of pneumatic impact drilling was performed

Inhalative IL-10 Attenuates Pulmonary Inflammation following Hemorrhagic Shock without Major Alterations of the Systemic Inflammatory Response

Several studies report immunomodulatory effects of endogenous IL-10 after trauma. The present study investigates the effect of inhalative IL-10 administration on systemic and pulmonary inflammation in hemorrhagic shock. Male C57/BL6 mice (8 animals per group) were subjected to pressure-controlled hemorrhagic shock for 1.5 hrs followed by resuscitation and inhalative administration of either 50 μL PBS (Shock group) or 50 μg/kg recombinant mouse IL-10 dissolved in 50 μL PBS (Shock + IL-10 group). Animals were sacrificed after 4.5 hrs of recovery and serum IL-6, IL-10, KC, and MCP-1 concentrations were measured with ELISA kits. Acute pulmonary inflammation was assessed by pulmonary myeloperoxidase (MPO) activity and pulmonary H&E histopathology. Inhalative IL-10 administration decreased pulmonary inflammation without altering the systemic concentrations of IL-6, IL-10, and KC. Serum MCP-1 levels were significantly reduced following inhalative IL-10 administration. These findings suggest that inhalative IL-10 administration may modulate the pulmonary microenvironment without major alterations of the systemic inflammatory response, thus minimizing the potential susceptibility to infection and sepsis

Multi-product Firms and Product Variety

A preliminary version of this paper was circulated under the title "Too many or too few varieties: the role of multi-product firms" (CEPR Discussion Papers; 5938, Nov. 2006).-- Trabajo publicado como artículo en Economica 79(314): 303-328 (2012).-- http://dx.doi.org/10.1111/j.1468-0335.2011.00897.xThe goal of this paper is to study the role of multi-product firms in the market provision of product variety. The analysis is conducted using the spokes model of non-localized competition proposed by Chen and Riordan (2007). Firstly, we show that multi-product firms are at a competitive disadvantage vis-a-vis single-product firms and can only emerge if economies of scope are sufficiently strong. Secondly, under duopoly product variety may be higher or lower with respect to both the first best and the monopolistically competitive equilibrium. However, within a relevant range of parameter values duopolists drastically restrict their product range in order to relax price competition, and as a result product variety is far below the efficient level.We thank the CREA Barcelona Economics Program and the Spanish Ministry of Education and Science (grants SEJ2005-01427 and SEJ2006-13768) for their support.Peer reviewe

Non-Invasive Diagnostics in Acute Compartment Syndrome

Diagnosis of acute compartment syndrome (ACS) of the extremities is based on clinical signs with or without complementary measurement of muscle compartmental pressure. However, in cases of imminent compartment syndrome, unconscious patients or children the appropriate diagnose remains challenging. Despite all efforts to improve technical devices to objectify the signs by measurements of numerous parameters, needle compartment pressure measurement is to date accepted as the gold standard to facilitate decision making. But its invasiveness, the controversy about pressure thresholds and its potentially limited validity due to a single measurement support the need for further developments to diagnose ACS. Numerous technical improvements have been published and revealed promising new applications for non-invasive diagnostics. Since the pathology of an ACS is well characterized two approaches of measurements are described: to detect either increasing compartmental pressure or decreasing perfusion pressure. In the following, currently known investigations are reviewed and related to their pathophysiological principals, modes of clinical application, value and reliability

Изучение влияния природно-климатических условий на скорость гравитационного оседания частиц выбросов промышленных предприятий

Целью данной работы является изучение влияния природно-климатических условий на скорость гравитационного оседания частиц выбросов промышленных предприятий. Настоящее исследование показало, что наряду с турбулентной диффузией одним из основных механизмов оседания частиц выбросов промышленных предприятий может являться их движение в вертикальных восходящих или нисходящих потоках. На скорость оседания частиц влияют характеристики природно-климатических условий. Одним из основных природных факторов является скорость ветра.The aim of this work is to study the influence of natural and climatic conditions on the rate of gravitational sedimentation of particles emitted by industrial enterprises. The study shows that, along with turbulent diffusion, the movement of particles in ascending or descending flows can be one of the main mechanisms of sedimentation. The sedimentation rate of particles is affected by the characteristics of climatic conditions. Wind speed is one of the main natural factors

IL-6 predicts organ dysfunction and mortality in patients with multiple injuries

<p>Abstract</p> <p>Background</p> <p>Although therapeutic concepts of patients with major trauma have improved during recent years, organ dysfunction still remains a frequent complication during clinical course in intensive care units. It has previously been shown that cytokines are upregulated under stress conditions such as trauma or sepsis. However, it is still debatable if cytokines are adequate parameters to describe the current state of trauma patients. To elucidate the relevance of cytokines, we investigated if cytokines predict development of multiple organ dysfunction syndrome (MODS) or outcome.</p> <p>Methods</p> <p>A total of 143 patients with an injury severity score ≥ 16, between 16 and 65 years, admitted to the Hannover Medical School Level 1 Trauma Center between January 1997 and December 2001 were prospectively included in this study. Marshall Score for MODS was calculated for at least 14 days and plasma levels of TNF-α, IL-1β, IL-6, IL-8 and IL-10 were measured. To determine the association between cytokine levels and development of MODS the Spearman rank correlation coefficient was calculated and logistic regression and analysis were performed.</p> <p>Results and Discussion</p> <p>Patients with MODS had increased plasma levels of IL-6, IL-8 and IL-10. IL-6 predicted development of MODS with an overall accuracy of 84.7% (specificity: 98.3%, sensitivity: 16.7%). The threshold value for development of MODS was 761.7 pg/ml and 2176.0 pg/ml for mortality during the in patient time.</p> <p>Conclusion</p> <p>We conclude that plasma IL-6 levels predict mortality and that they are a useful tool to identify patients who are at risk for development of MODS.</p

Open Posterior Reduction and Stabilization of AO Spine C3 Sacral Fractures.

AO Spine C3 sacral fractures are defined by separation of the spine including S1 from the pelvic ring and are usually result of a high-energy injury. Besides their high biomechanical instability and high rate of associated neurological impairment, these fractures are often extremely difficult to reduce due to severe bony impaction and dislocation. Additional difficulties in management of these fractures arise from only a thin-layer of soft-tissue coverage overlying the injured area