International Study of the Epidemiology of Paediatric Trauma : PAPSA Research Study

Objectives: Trauma is a significant cause of morbidity and mortality worldwide. The literature on paediatric trauma epidemiology in low- and middle-income countries (LMICs) is limited. This study aims to gather epidemiological data on paediatric trauma. Methods: This is a multicentre prospective cohort study of paediatric trauma admissions, over 1 month, from 15 paediatric surgery centres in 11 countries. Epidemiology, mechanism of injury, injuries sustained, management, morbidity and mortality data were recorded. Statistical analysis compared LMICs and high-income countries (HICs). Results: There were 1377 paediatric trauma admissions over 31 days; 1295 admissions across ten LMIC centres and 84 admissions across five HIC centres. Median number of admissions per centre was 15 in HICs and 43 in LMICs. Mean age was 7 years, and 62% were boys. Common mechanisms included road traffic accidents (41%), falls (41%) and interpersonal violence (11%). Frequent injuries were lacerations, fractures, head injuries and burns. Intra-abdominal and intra-thoracic injuries accounted for 3 and 2% of injuries. The mechanisms and injuries sustained differed significantly between HICs and LMICs. Median length of stay was 1 day and 19% required an operative intervention; this did not differ significantly between HICs and LMICs. No mortality and morbidity was reported from HICs. In LMICs, in-hospital morbidity was 4.0% and mortality was 0.8%. Conclusion: The spectrum of paediatric trauma varies significantly, with different injury mechanisms and patterns in LMICs. Healthcare structure, access to paediatric surgery and trauma prevention strategies may account for these differences. Trauma registries are needed in LMICs for future research and to inform local policy

A high-order FEM formulation for free and forced vibration analysis of a nonlocal nonlinear graded Timoshenko nanobeam based on the weak form quadrature element method

The purpose of this paper is to provide a high-order finite element method (FEM) formulation of nonlocal nonlinear nonlocal graded Timoshenko based on the weak form quadrature element method (WQEM). This formulation offers the advantages and flexibility of the FEM without its limiting low-order accuracy. The nanobeam theory accounts for the von Kármán geometric nonlinearity in addition to Eringen’s nonlocal constitutive models. For the sake of generality, a nonlinear foundation is included in the formulation. The proposed formulation generates high-order derivative terms that cannot be accounted for using regular first- or second-order interpolation functions. Hamilton’s principle is used to derive the variational statement which is discretized using WQEM. The results of a WQEM free vibration study are assessed using data obtained from a similar problem solved by the differential quadrature method (DQM). The study shows that WQEM can offer the same accuracy as DQM with a reduced computational cost. Currently the literature describes a small number of high-order numerical forced vibration problems, the majority of which are limited to DQM. To obtain forced vibration solutions using WQEM, the authors propose two different methods to obtain frequency response curves. The obtained results indicate that the frequency response curves generated by either method closely match their DQM counterparts obtained from the literature, and this is despite the low mesh density used for the WQEM systems

DO EXPRESSIONS OF OLIG2, PTEN AND DMBT1 GENES PLAY A ROLE IN HIGH-GRADE GLIOMAS PROGRESSION?

8th Congress of the European-Association-for-Neuro-Oncology (EANO) -- SEP 12-14, 2008 -- Barcelona, SPAINWOS: 000261695800202European Assoc Neuro Onco

Extreme hypofractionated radiosurgery in recurrent inoperable High-Grade Ultra-Large gliomas

Background: To elucidate the efficacy and toxicity of brain re-radiotherapy for recurrent large inoperable gliomas using radiosurgery. Materials and Methods: Between 2014 and 2018, extreme hypofractionated radiosurgery was performed using Accuray's Cyberknife (R) system on 14 lesions (12 patients) grade 4 recurrence lesions of 6 patients with anaplastic astrocytoma and 6 patients with glioblastoma who had previously undergone surgery and cranial radiotherapy and had a local-regional recurrence. Six patients (8 lesions) were given a biologic effective dose (BED10) of 48 Gy and lower, and six patients were given a BED10 of 59.5 Gy and higher. The Response Assessment in Neuro-Oncology Criteria (RANO) were used for tumor response, and the Common Terminology for Adverse Events (CTCAE) was used for adverse effect assessment. The primary endpoint was determined as overall survival, and first treatment and salvage treatment time. Results: The median age of the patients was 43 years, and the median Karnofsky Performance Status (KPS) was 70. The median time from the first radiotherapy to death was 34 months. The median time from the previous radiotherapy was 29.5 months (R:17-40). The median survival was 10 months for those with recurrence before 29.5 months and 11 months for those with recurrence after 29.5 months. The median total tumor volume was 29.224 mL (similar to 30 mL). One grade 4 toxicity was observed. Conclusion: Radiosurgery can be used effectively as salvage therapy in ultra-large inoperable gliomas