Splenic trauma: WSES classification and guidelines for adult and pediatric patients

Spleen injuries are among the most frequent trauma-related injuries. At present, they are classified according to the anatomy of the injury. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic derangement, and the associated injuries. The management of splenic trauma patients aims to restore the homeostasis and the normal physiopathology especially considering the modern tools for bleeding management. Thus, the management of splenic trauma should be ultimately multidisciplinary and based on the physiology of the patient, the anatomy of the injury, and the associated lesions. Lastly, as the management of adults and children must be different, children should always be treated in dedicated pediatric trauma centers. In fact, the vast majority of pediatric patients with blunt splenic trauma can be managed non-operatively. This paper presents the World Society of Emergency Surgery (WSES) classification of splenic trauma and the management guidelines

The trans-ancestral genomic architecture of glycemic traits

Glycemic traits are used to diagnose and monitor type 2 diabetes and cardiometabolic health. To date, most genetic studies of glycemic traits have focused on individuals of European ancestry. Here we aggregated genome-wide association studies comprising up to 281,416 individuals without diabetes (30% non-European ancestry) for whom fasting glucose, 2-h glucose after an oral glucose challenge, glycated hemoglobin and fasting insulin data were available. Trans-ancestry and single-ancestry meta-analyses identified 242 loci (99 novel; P < 5 x 10(-8)), 80% of which had no significant evidence of between-ancestry heterogeneity. Analyses restricted to individuals of European ancestry with equivalent sample size would have led to 24 fewer new loci. Compared with single-ancestry analyses, equivalent-sized trans-ancestry fine-mapping reduced the number of estimated variants in 99% credible sets by a median of 37.5%. Genomic-feature, gene-expression and gene-set analyses revealed distinct biological signatures for each trait, highlighting different underlying biological pathways. Our results increase our understanding of diabetes pathophysiology by using trans-ancestry studies for improved power and resolution.A trans-ancestry meta-analysis of GWAS of glycemic traits in up to 281,416 individuals identifies 99 novel loci, of which one quarter was found due to the multi-ancestry approach, which also improves fine-mapping of credible variant sets.Diabetes mellitus: pathophysiological changes and therap

Transfer of visual information after unilateral input to the brain

Discusses the physiological bases of the method of lateralized visual presentations, a technique used to infer hemispheric asymmetries in normal humans. Evidence on the cortical representation of the visual field in primates and cats is reviewed. Representation of the ipsilateral visual hemifield and the neural mechanisms responsible for it are discussed. The author then presents the available evidence on the sites of callosal transfer of visual information and the nature of such information. It is concluded that visual callosal connections are more numerous and widespread in the association areas than in the primary visual cortex and adjoining visual areas. Thus, the amount of "wrong" ipsilateral visual field that is represented in the various cortical areas of primates and cats increases as one goes from primary visual cortex to extraoccipital areas. It is argued that transfer of unilaterally presented visual stimuli occurs mainly at the temporal and parietal cortical level. (46 ref) (PsycLIT Database Copyright 1987 American Psychological Assn, all rights reserved

Two brains, one clock.

A recent study has shown that information about the duration of brief time intervals acquired by one side of the brain is readily available to the other cerebral hemisphere in a patient in which the corpus callosum and the other forebrain commissures have been sectioned. This strongly suggests that the internal clock that measures time duration is subcortical, and that its output can be easily projected to both hemispheres via subcortical commissures

Why is blindsight blind?

It is proposed that there are at least two categories of blindsight. One is present in visually guided behaviour in normals as well as in brain-damaged patients, while the other is present only following cortical lesions. It is also proposed that blindsight is blind because residual visual functions are banned from consciousness either when they are subserved by subcortical centres alone or when they are mediated by cortical areas that have never been exclusively associated with such functions before brain injury