The risk of deterioration in GCS13-15 patients with traumatic brain injury identified by CT imaging : a systematic review and meta-analysis

The optimal management of mild traumatic brain injury (TBI) patients with injuries identified by computed tomography (CT) brain scan is unclear. Some guidelines recommend hospital admission for an observation period of at least 24 h. Others argue that selected lower-risk patients can be discharged from the Emergency Department (ED). The objective of our review and meta-analysis was to estimate the risk of death, neurosurgical intervention, and clinical deterioration in mild TBI patients with injuries identified by CT brain scan, and assess which patient factors affect the risk of these outcomes. A systematic review and meta-analysis adhering to PRISMA standards of protocol and reporting were conducted. Study selection was performed by two independent reviewers. Meta-analysis using a random effects model was undertaken to estimate pooled risks for: clinical deterioration, neurosurgical intervention, and death. Meta-regression was used to explore between-study variation in outcome estimates using study population characteristics. Forty-nine primary studies and five reviews were identified that met the inclusion criteria. The estimated pooled risk for the outcomes of interest were: clinical deterioration 11.7% (95% confidence interval [CI]: 11.7%-15.8%), neurosurgical intervention 3.5% (95% CI: 2.2%-4.9%), and death 1.4% (95% CI: 0.8%-2.2%). Twenty-one studies presented within-study estimates of the effect of patient factors. Meta-regression of study characteristics and pooling of within-study estimates of risk factor effect found the following factors significantly affected the risk for adverse outcomes: age, initial Glasgow Coma Scale (GCS), type of injury, and anti-coagulation. The generalizability of many studies was limited due to population selection. Mild TBI patients with injuries identified by CT brain scan have a small but clinically important risk for serious adverse outcomes. This review has identified several prognostic factors; research is needed to derive and validate a usable clinical decision rule so that low-risk patients can be safely discharged from the ED

Berlin’s Ethnological Museum: The California Indian Collection

The Ethnologisches Museum: Staatliche Museen zu Berlin (formerly the Museum für Völkerkunde, and referred to here as the Berlin Ethnological Museum) contains over 1,000 artifacts fashioned by California Indians, collected between 1837 and 1914. The collection is rich and varied; it represents one of the earliest ethnographic collections from Native California and includes ethnological treasures of great aesthetic quality and rarity. The collection is an invaluable source of scientific information and cultural renewal. The objects are highly regarded by living descendants of the Native Californians who long ago sold, traded, and exchanged these artifacts with collectors. They are heirlooms reflecting tribal history and culture, and are worthy of remembrance and study. In this paper we offer first-hand observations on a small sample (n =10) of the Berlin Ethnological Museum’s California Indian collection, with a particular emphasis on baskets. We describe and discuss these objects in detail in order to bring to life the people and cultures that brilliantly produced such exquisite, artistic objects and ethnographic treasures. We also attempt to identify their historical context and the circumstances motivating their collection, so as to better understand how they came to be curated in Berlin. Finally, we provide a brief overview of the history and development of the Berlin Ethnological Museum’s California Indian collection, because the intriguing interconnections and influential coincidences associated with it provide insights into the history and nature of the early development of California Indian studies and particularly illuminate the evolution of the science of anthropology as an academic discipline in America

Immunological effects of the TGFβ-blocking antibody GC1008 in malignant pleural mesothelioma patients.

We evaluated a neutralizing anti-TGFβ antibody (GC1008) in cancer patients with malignant pleura mesothelioma (MPM). The goal of this study was to assess immunoregulatory effects in relation to clinical safety and clinical response. Patients with progressive MPM and 1-2 prior systemic therapies received GC1008 at 3mg/kg IV over 90 min every 21 d as part of an open-label, two-center Phase II trial. Following TGFβ blockade therapy, clinical safety and patient survival were monitored along with the effects of anti-TGFβ antibodies on serum biomarkers and peripheral blood mononuclear cells (PBMC). Although designed as a larger trial, only 13 patients were enrolled when the manufacturer discontinued further development of the antibody for oncology indications. All participants tolerated therapy. Although partial or complete radiographic responses were not observed, three patients showed stable disease at 3 mo. GC1008 had no effect in the expression of NK, CD