Efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs) for the treatment of acute pain after orthopedic trauma: a practice management guideline from the Eastern Association for the Surgery of Trauma and the Orthopedic Trauma Association

OBJECTIVES: Fracture is a common injury after a traumatic event. The efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs) to treat acute pain related to fractures is not well established. METHODS: Clinically relevant questions were determined regarding NSAID use in the setting of trauma-induced fractures with clearly defined patient populations, interventions, comparisons and appropriately selected outcomes (PICO). These questions centered around efficacy (pain control, reduction in opioid use) and safety (non-union, kidney injury). A systematic review including literature search and meta-analysis was performed, and the quality of evidence was graded per the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The working group reached consensus on the final evidence-based recommendations. RESULTS: A total of 19 studies were identified for analysis. Not all outcomes identified as critically important were reported in all studies, and the outcome of pain control was too heterogenous to perform a meta-analysis. Nine studies reported on non-union (three randomized control trials), six of which reported no association with NSAIDs. The overall incidence of non-union in patients receiving NSAIDs compared with patients not receiving NSAIDs was 2.99% and 2.19% (p=0.04), respectively. Of studies reporting on pain control and reduction of opioids, the use of NSAIDs reduced pain and the need for opioids after traumatic fracture. One study reported on the outcome of acute kidney injury and found no association with NSAID use. CONCLUSIONS: In patients with traumatic fractures, NSAIDs appear to reduce post-trauma pain, reduce the need for opioids and have a small effect on non-union. We conditionally recommend the use of NSAIDs in patients suffering from traumatic fractures as the benefit appears to outweigh the small potential risks

Fabrication and characterization of gold nanoparticle reinforced Chitosan nanocomposites for biomedical applications

Chitosan is a naturally derived polymer, which represents one of the most technologically important classes of active materials with applications in a variety of industrial and biomedical fields. Polymeric materials can be regarded as promising candidates for next generation devices due to their low energy payback time. These devices can be fabricated by high-throughput processing methodologies, such as spin coating, inkjet printing, gravure and flexographic printing onto flexible substrates. However, the extensive applications of polymeric films are still limited because of disadvantages such as poor electromechanical properties, high brittleness with a low strain at break, and sensitivity to water. For certain critical applications the need for modification of physical, mechanical and electrical properties of the polymer is essential. When blends of polymer films with other materials are used, as is commonly the case, device performance directly depends on the nanoscale morphology and phase separation of the blend components. To prepare nanocomposite thin films with the desired functional properties, both the film composition and microstructure have to be thoroughly characterized and controlled. Chitosan reinforced bio-nanocomposite films with varying concentrations of gold nanoparticles were prepared through a solution casting method. Gold nanoparticles (∼ 32 nm diameter) were synthesized via a citrate reduction method from chloroauric acid and incorporated in the prepared Chitosan solution. Uniform distribution of gold nanoparticles was achieved throughout the chitosan matrix and was confirmed by SEM images. Synthesis outcomes and prepared nanocomposites were characterized using TEM, SAED, SEM, EDX, XRD, UV-Vis, particle size analysis, zeta potential and FT-IR for their physical, morphological and structural properties. Nanoscale mechanical properties of the nanocomposite films were characterized at room temperature, human body temperatures and higher temperatures using instrumented indentation techniques. The obtained films were confirmed to be biocompatible by their ability to support the growth and proliferation of human tissue cells in vitro. Statistical analysis on mechanical properties and biocompatibility results, were conducted. Results revealed significant enhancement on both the mechanical properties and cell adherence and proliferation. The results will enhance our understanding of the effect of nanostructures reinforcement on these important functional polymeric thin films for potential biomedical applications

Deepfake Video Detection using Neural Networks

In today’s era, software tools based on deep learning have made the people work easier to make credible faces exchanges in video with little signs of manipulation, nicknamed “DeepFake” videos. Manipulation in digital media has been performed for decades through the appropriate use of visual effects; nevertheless, current breakthroughs occurred in deep learning have resulted in a significant rise to gain reality of fake material or contents using the simple ways. This are Artifical Intelligence-generated media (known as DF). Using tools of artificial intelligence to create the DF is an easy task. However, detecting these DF poses a significant barrier. Because it is difficult to teach the algorithm to detect the DF. Using Convolutional Neural Networks and Recurrent Neural Networks, we have made progress in detecting the DF. The system employs a Convolutional Neural network (CNN) on frame level to extract features. These observations are noted and this can train a Recurrent Neural Network (RNN), which has the ability to learn and classify whether or not a video has been tampered with and identified the temporal irregularities in the frame introduced by DF tools. We demonstrate how utilizing a simple architecture, our system may get competitive outcomes in this job

Management of simple and retained hemothorax: A practice management guideline from the Eastern Association for the Surgery of Trauma

BACKGROUND: Traumatic hemothorax poses diagnostic and therapeutic challenges both acutely and chronically. A working group of the Eastern Association for the Surgery of Trauma convened to formulate a practice management guideline for traumatic hemothorax. METHODS: We formulated four questions: whether tube thoracostomy vs observation be performed, should pigtail catheter versus thoracostomy tube be placed to drain hemothorax, should thrombolytic therapy be attempted versus immediate thoracoscopic assisted drainage (VATS) in retained hemothorax (rHTX), and should early VATS (≤4 days) versus late VATS (\u3e4 days) be performed? A systematic review was undertaken from articles identified in multiple databases. RESULTS: A total of 6391 articles were identified, 14 were selected for guideline construction. Most articles were retrospective with very low-quality evidence. We performed meta-analysis for some of the outcomes for three of the questions. CONCLUSIONS: For traumatic hemothorax we conditionally recommend pigtail catheters, in hemodynamically stable patients. In patients with rHTX, we conditionally recommend VATS rather than attempting thrombolytic therapy and recommend that it should be performed early (≤4 days)

SMC1 is a downstream effector in the ATM/NBS1 branch of the human S-phase checkpoint

Structural maintenance of chromosomes (SMC) proteins (SMC1, SMC3) are evolutionarily conserved chromosomal proteins that are components of the cohesin complex, necessary for sister chromatid cohesion. These proteins may also function in DNA repair. Here we report that SMC1 is a component of the DNA damage response network that functions as an effector in the ATM/NBS1-dependent S-phase checkpoint pathway. SMC1 associates with BRCA1 and is phosphorylated in response to IR in an ATM- and NBS1-dependent manner. Using mass spectrometry, we established that ATM phosphorylates S957 and S966 of SMC1 in vivo. Phosphorylation of S957 and/or S966 of SMC1 is required for activation of the S-phase checkpoint in response to IR. We also discovered that the phosphorylation of NBS1 by ATM is required for the phosphorylation of SMC1, establishing the role of NBS1 as an adaptor in the ATM/NBS1/SMC1 pathway. The ATM/CHK2/CDC25A pathway is also involved in the S-phase checkpoint activation, but this pathway is intact in NBS cells. Our results indicate that the ATM/NBS1/SMC1 pathway is a separate branch of the S-phase checkpoint pathway, distinct from the ATM/CHK2/CDC25A branch. Therefore, this work establishes the ATM/NBS1/SMC1 branch, and provides a molecular basis for the S-phase checkpoint defect in NBS cells

Management of rhabdomyolysis: A practice management guideline from the Eastern Association for the Surgery of Trauma

BACKGROUND: The treatment of rhabdomyolysis remains controversial. Although there is no question that any associated compartment syndrome needs to be identified and released, debate persists regarding the benefit of further therapy including aggressive intravenous fluid resuscitation (IVFR), urine alkalization with bicarbonate, and the use of mannitol. The goal of this practice management guideline was to evaluate the effects of bicarbonate, mannitol, and aggressive intravenous fluids on patients with rhabdomyolysis. METHODS: A systematic review and meta-analysis comparing treatments in patients with rhabdomyolysis was performed. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was applied to assess the quality of evidence and to create evidence-based recommendations regarding the use of bicarbonate, mannitol, and aggressive IVFR in patients with rhabdomyolysis. RESULTS: A total of 12 studies were identified for analysis. On quantitative analysis, IVFR decreased the incidence of acute renal failure (ARF) and need for dialysis in patients with rhabdomyolysis. Neither bicarbonate nor mannitol administration improved the incidence of acute renal failure and need for dialysis in patients with rhabdomyolysis. Quality of evidence was deemed to be very low, with the vast majority of the literature being retrospective studies. CONCLUSION: In patients with rhabdomyolysis, we conditionally recommend for aggressive IVFR to improve outcomes of ARF and lessen the need for dialysis. We conditionally recommend against treatment with bicarbonate or mannitol in patients with rhabdomyolysis

Duration of Antimicrobial Treatment for Complicated Intra-abdominal Infections after Definitive Source Control: A Systematic Review, Meta-Analysis, and Practice Management Guideline from the Eastern Association for the Surgery of Trauma

BACKGROUNDRecent studies have evaluated outcomes associated with duration of antimicrobial treatment for complicated intra-abdominal infections (cIAI). The goal of this guideline was to help clinicians better define appropriate antimicrobial duration in patients who have undergone definitive source control for cIAI. METHODSA working group of Eastern Association for the Surgery of Trauma (EAST) performed a systematic review and meta-analyses of the available data pertaining to the duration of antibiotics after definitive source control of cIAI in adult patients. Only studies that compared patients treated with short vs long duration antibiotic regimens were included. The critical outcomes of interest were selected by the group. Non-inferiority of short compared to long duration of antimicrobial treatment was defined as an indicator for a potential recommendation in favor of shorter antibiotics course. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was utilized to assess the quality of the evidence and to formulate recommendations. RESULTSSixteen studies were included. The short duration ranged from 1 dose to ≤10 days, with an average of 4 days, and the long duration ranged >1-28 days, with an average of 8 days. There were no differences between short and long duration of antibiotics in terms of mortality (odd ratio (OR) .90; 95% confidence interval (CI) 0.56-1.44), rate of surgical site infection (OR 0.88; 95% CI 0.56 to 1.38); persistent/recurrent abscess (OR 0.76, CI 0.45, 1.29); unplanned interventions (OR 0.53, CI 0.12, 2.26); hospital length of stay (mean difference -2.62 days, CI -7.08, 1.83); or readmissions (OR 0.92, CI 0.50, 1.69). The level of evidence was assessed as very low. CONCLUSIONThe group made a recommendation for shorter (four or less days) versus longer duration (eight or more days) of antimicrobial treatment in adult patients with cIAIs who had definitive source control.Level of Evidence: Systematic Review and Meta-Analysis, III

Management of simple and retained hemothorax: A practice management guideline from the Eastern Association for the Surgery of Trauma: Hemothorax Management Guideline

Background: Traumatic hemothorax poses diagnostic and therapeutic challenges both acutely and chronically. A working group of the Eastern Association for the Surgery of Trauma convened to formulate a practice management guideline for traumatic hemothorax. Methods: We formulated four questions: whether tube thoracostomy vs observation be performed, should pigtail catheter versus thoracostomy tube be placed to drain hemothorax, should thrombolytic therapy be attempted versus immediate thoracoscopic assisted drainage (VATS) in retained hemothorax (rHTX), and should early VATS (≤4 days) versus late VATS (\u3e4 days) be performed? A systematic review was undertaken from articles identified in multiple databases. Results: A total of 6391 articles were identified, 14 were selected for guideline construction. Most articles were retrospective with very low-quality evidence. We performed meta-analysis for some of the outcomes for three of the questions. Conclusions: For traumatic hemothorax we conditionally recommend pigtail catheters, in hemodynamically stable patients. In patients with rHTX, we conditionally recommend VATS rather than attempting thrombolytic therapy and recommend that it should be performed early (≤4 days)