Symptomatic plate removal after treatment of facial fractures

Aims: To identify the rates and reasons for plate removal (PR) among patients treated for facial fractures. Materials and methods: A retrospective review of files of 238 patients. Results: Forty-eight patients (20.2%) had plates removed. The reason for removal was objective in 33.3% and subjective in 29.2%. The most common subjective reason was cold sensitivity, and the most common objective reason was wound dehiscence/infection. Women had PR for subjective reasons more often than men (p = 0.018). Removal was performed more often for subjective reasons after zygomatico-orbital fractures than after mandibular fractures (p = 0.002). Plates inserted in the mandible from an intraoral approach were removed more frequently than extraorally inserted mandibular plates, intraorally inserted maxillary plates, and extraorally inserted plates in other locations (p < 0.001). Orbital rim plates had a higher risk of being removed than maxillary or frontal bone plates (p = 0.02). Conclusions: Subjective discomfort is a notable reason for PR among Finnish patients, suggesting that the cold climate has an influence on the need for removal. Patients receiving mandibular osteosynthesis with miniplates from an intraoral approach are at risk of hardware removal because of wound dehiscence/infection and loose/broken hardware, reminding us that more rigid fixation devices should not be forgotten despite the widespread use of miniplates. (C) 2010 European Association for Cranio-Maxillo-Facial Surger

Blunt cerebrovascular injuries in the craniofacial fracture population - Are we screening the right patients?

Current knowledge of blunt cerebrovascular injuries (BCVIs) in craniomaxillofacial fracture (CMF) patients is limited. The purpose of this study was to determine the occurrence of BCVIs in patients with all types of CMF. This retrospective study included CMF patients in a level 1 trauma centre during a 3-year period. Patients who were not imaged with computed tomography angiography and patients with mechanisms other than blunt injury were excluded. The primary outcome variable was BCVI. A total of 753 patients were included in the analysis. A BCVI was detected in 4.4% of the patients screened. BCVIs occurred in 8.7% of cranial fracture patients, 7.1% of combined craniofacial fracture patients, and 3.1% of facial fracture patients. The risk of BCVI was significantly increased in patients with isolated cranial fractures (odds ratio (OR) 2.55, 95% confidence interval (CI) 1.18?5.50; P = 0.017), those involved in motor vehicle accidents (OR 3.42, 95% CI 1.63?7.17; P = 0.001), and those sustaining high-energy injuries (OR 3.17, 95% CI 1.57?6.40; P = 0.001). BCVIs in CMF patients are relatively common in highenergy injuries. However, these injuries also occur in minor traumas. Imaging thresholds should be kept low in this patient population when BCVIs are suspected.Peer reviewe

Cervical spine injuries in facial fracture patients - injury mechanism and fracture type matter

Evidence supports the notion that craniofacial fractures are significant predictors of cervical spine injuries (CSIs), but some debate remains on the injury mechanism of co-existing CSIs in craniofacial fractures and the relationship between CSI and specific facial fractures. In this retrospective study, we aim to assess the incidence rates of specific facial fracture types as well as other important variables and their relationship with CSIs. The primary outcome variable, CSI, and several predictor variables, including facial fracture type, were evaluated with logistic regression analyses. Of 2919 patients, the total CSI incidence rate was 3.0%. Rates of CSI in patients with isolated mandibular fractures (OR 0.26 CI 0.10, 0.63; p = 0.006) were lower than those previously reported, whereas isolated nasal fractures were strongly associated with CSI (OR 2.67 CI 1.36, 5.22; p = 0.004). Patients with concomitant cranial injuries were twice as likely to have CSI (OR 2.00, CI 1.22, 3.27; p = 0.006). Even though there is a strong occurrence rate of CSIs in patients with cranial injuries, clinicians should be aware that patients presenting with isolated facial fractures are at significant risk for sustaining CSIs also. (C) 2021 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.Peer reviewe

Man Bites Mosquito: Understanding the Contribution of Human Movement to Vector-Borne Disease Dynamics

In metropolitan areas people travel frequently and extensively but often in highly structured commuting patterns. We investigate the role of this type of human movement in the epidemiology of vector-borne pathogens such as dengue. Analysis is based on a metapopulation model where mobile humans connect static mosquito subpopulations. We find that, due to frequency dependent biting, infection incidence in the human and mosquito populations is almost independent of the duration of contact. If the mosquito population is not uniformly distributed between patches the transmission potential of the pathogen at the metapopulation level, as summarized by the basic reproductive number, is determined by the size of the largest subpopulation and reduced by stronger connectivity. Global extinction of the pathogen is less likely when increased human movement enhances the rescue effect but, in contrast to classical theory, it is not minimized at an intermediate level of connectivity. We conclude that hubs and reservoirs of infection can be places people visit frequently but briefly and the relative importance of human and mosquito populations in maintaining the pathogen depends on the distribution of the mosquito population and the variability in human travel patterns. These results offer an insight in to the paradoxical observation of resurgent urban vector-borne disease despite increased investment in vector control and suggest that successful public health intervention may require a dual approach. Prospective studies can be used to identify areas with large mosquito populations that are also visited by a large fraction of the human population. Retrospective studies can be used to map recent movements of infected people, pinpointing the mosquito subpopulation from which they acquired the infection and others to which they may have transmitted it

Quadrupole and octupole collectivity in the semi-magic nucleus 80206Hg126

The first low-energy Coulomb-excitation measurement of the radioactive, semi-magic, two proton-hole nucleus 206Hg, was performed at CERN's recently-commissioned HIE-ISOLDE facility. Two γ rays depopulating low-lying states in 206Hg were observed. From the data, a reduced transition strength B(E2;21+→01+)=4.4(6) W.u. was determined, the first such value for an N=126 nucleus south of 208Pb, which is found to be slightly lower than that predicted by shell-model calculations. In addition, a collective octupole state was identified at an excitation energy of 2705 keV, for which a reduced B(E3) transition probability of 30−13+10 W.u. was extracted. These results are crucial for understanding both quadrupole and octupole collectivity in the vicinity of the heaviest doubly-magic nucleus 208Pb, and for benchmarking a number of theoretical approaches in this key region. This is of particular importance given the paucity of data on transition strengths in this region, which could be used, in principle, to test calculations relevant to the astrophysical r-process

Data from: More future synergies and less trade‐offs between forest ecosystem services with natural climate solutions instead of bioeconomy solutions

To reach the Paris Agreement, societies need to increase the global terrestrial carbon sink. There are many climate change mitigation solutions (CCMS) for forests, including increasing bioenergy, bioeconomy and protection. Bioenergy and bioeconomy solutions use climate-smart, intensive management to generate high quantities of bioenergy and bioproducts. Protection of (semi-)natural forests is a major component of 'natural climate solution' (NCS) since forests store carbon in standing biomass and soil. Furthermore, protected forests provide more habitat for biodiversity and non-wood ecosystem services (ES). We investigated the impacts of different CCMS and climate scenarios, jointly or in isolation, on future wood ES, non-wood ES, and regulating ES for a major wood provider for the international market. Specifically, we projected future ES given by three CCMS scenarios for Sweden 2020-2100. In the long term, fulfilling the increasing wood demand through bioenergy and bioeconomy solutions will decrease ES multifunctionality, but the increased stand age and wood stocks induced by rising greenhouse gas (GHG) concentrations will partially offset these negative effects. Adopting bioenergy and bioeconomy solutions will have a greater negative impact on ES supply than adopting NCS. Bioenergy or bioeconomy solutions, as well as increasing GHG emissions, will reduce synergies and increase trade-offs in ES. NCS, by contrast, increases the supply of multiple ES in synergy, even transforming current ES trade-offs into future synergies. Moreover, NCS can be considered an adaptation measure to offset negative climate change effects on the future supplies of non-wood ES. In boreal countries around the world, forestry strategies that integrate NCS more deeply are crucial to ensure a synergistic supply of multiple ES