392 research outputs found

    Head Injury-A Neglected Public Health Problem: A Four-Month Prospective Study at Jimma University Specialized Hospital, Ethiopia

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    Background: Trauma, especially head trauma, is an expanding major public health problem and the leading cause of death of the young and productive part of the world’s population. Research is mainly done in high-income countries where only a small proportion of the worldwide fatalities occur. The intention of this study was to analyze head injury in a setting where most patients in low- and middleincome countries receive treatment, a referral hospital with general but no neurosurgical service like Jimma University Specialized Hospital. The study aims to provide surgeons, hospital managers and health planners working in similar set-ups with baseline information for further investigation and prevention programs intending to reduce the burden of head injury.Methods: All head injury patients presented to Jimma University Specialized Hospital between March and June 2010 were included in this prospective research. Epidemiological, clinical and management data were collected for the study.Results: Out of 52 patients, 47 were males. The median age was 20.0 years (SD=13.3). Fights (n=20, 38.5%) and road traffic accidents (n=19, 36.5%) were the most common causes of head injury. Half of the patients sustained mild and 36.5% sustained severe head injury. The initial GCS had a significant correlation with the outcome. The mortality rate was 21.2%. Of all patients 76.9% were managed conservatively.Conclusion: Prevention of road traffic accidents and improvement of conservative care were identified as major methods to reduce the burden of head injury in a set-up similar to Jimma. Further studies on head injury patients in low-income countries should be done.Keywords: Head injury, Traffic accidents, Violence, Lo

    The sequential trauma score - a new instrument for the sequential mortality prediction in major trauma*

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    <p>Abstract</p> <p>Background</p> <p>There are several well established scores for the assessment of the prognosis of major trauma patients that all have in common that they can be calculated at the earliest during intensive care unit stay. We intended to develop a sequential trauma score (STS) that allows prognosis at several early stages based on the information that is available at a particular time.</p> <p>Study design</p> <p>In a retrospective, multicenter study using data derived from the Trauma Registry of the German Trauma Society (2002-2006), we identified the most relevant prognostic factors from the patients basic data (P), prehospital phase (A), early (B1), and late (B2) trauma room phase. Univariate and logistic regression models as well as score quality criteria and the explanatory power have been calculated.</p> <p>Results</p> <p>A total of 2,354 patients with complete data were identified. From the patients basic data (P), logistic regression showed that age was a significant predictor of survival (AUC<sub>model p</sub>, area under the curve = 0.63). Logistic regression of the prehospital data (A) showed that blood pressure, pulse rate, Glasgow coma scale (GCS), and anisocoria were significant predictors (AUC<sub>model A </sub>= 0.76; AUC<sub>model P + A </sub>= 0.82). Logistic regression of the early trauma room phase (B1) showed that peripheral oxygen saturation, GCS, anisocoria, base excess, and thromboplastin time to be significant predictors of survival (AUC<sub>model B1 </sub>= 0.78; AUC<sub>model P +A + B1 </sub>= 0.85). Multivariate analysis of the late trauma room phase (B2) detected cardiac massage, abbreviated injury score (AIS) of the head ≥ 3, the maximum AIS, the need for transfusion or massive blood transfusion, to be the most important predictors (AUCmodel B2 = 0.84; AUCfinal model P + A + B1 + B2 = 0.90). The explanatory power - a tool for the assessment of the relative impact of each segment to mortality - is 25% for P, 7% for A, 17% for B1 and 51% for B2. A spreadsheet for the easy calculation of the sequential trauma score is available at: <url>http://www.sequential-trauma-score.com</url></p> <p>Conclusions</p> <p>This score is the first sequential, dynamic score to provide a prognosis for patients with blunt major trauma at several points in time. With every additional piece of information the precision increases. The medical team has a simple, useful tool to identify patients at high risk and to predict the prognosis of an individual patient with major trauma very early, quickly and precisely.</p

    Concentration Kinetics of Serum MMP-9 and TIMP-1 after Blunt Multiple Injuries in the Early Posttraumatic Period

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    Metalloproteinases are secreted in response to a variety of inflammatory mediators and inhibited by tissue inhibitors of matrixmetalloproteinases (TIMPs). Two members of these families, MMP-9 and TIMP-1, were differentially expressed depending on clinical parameters in a previous genomewide mRNA analysis. The aim of this paper was now to evaluate the posttraumatic serum levels and the time course of both proteins depending on distinct clinical parameters. 60 multiple traumatized patients (ISS > 16) were included. Blood samples were drawn on admission and 6 h, 12 h, 24 h, 48 h, and 72 h after trauma. Serum levels were quantified by ELISA. MMP-9 levels significantly decreased in the early posttraumatic period (P < 0.05) whereas TIMP-1 levels significantly increased in all patients (P < 0.05). MMP-9 and TIMP-1 serum concentration kinetics became manifest in an inversely proportional balance. Furthermore, MMP-9 presented a stronger decrease in patients with severe trauma and non-survivors in contrast to minor traumatized patients (ISS ≤ 33) and survivors, initially after trauma

    Spectroscopy of 35^{35}P using the one-proton knockout reaction

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    The structure of 35^{35}P was studied with a one-proton knockout reaction at88~MeV/u from a 36^{36}S projectile beam at NSCL. The γ\gamma rays from thedepopulation of excited states in 35^{35}P were detected with GRETINA, whilethe 35^{35}P nuclei were identified event-by-event in the focal plane of theS800 spectrograph. The level scheme of 35^{35}P was deduced up to 7.5 MeV usingγγ\gamma-\gamma coincidences. The observed levels were attributed to protonremovals from the sdsd-shell and also from the deeply-bound p_1/2p\_{1/2} orbital.The orbital angular momentum of each state was derived from the comparisonbetween experimental and calculated shapes of individual (γ\gamma-gated)parallel momentum distributions. Despite the use of different reactions andtheir associate models, spectroscopic factors, C2SC^2S, derived from the36^{36}S (1p)(-1p) knockout reaction agree with those obtained earlier from36^{36}S(dd,\nuc{3}{He}) transfer, if a reduction factor R_sR\_s, as deducedfrom inclusive one-nucleon removal cross sections, is applied to the knockout transitions.In addition to the expected proton-hole configurations, other states were observedwith individual cross sections of the order of 0.5~mb. Based on their shiftedparallel momentum distributions, their decay modes to negative parity states,their high excitation energy (around 4.7~MeV) and the fact that they were notobserved in the (dd,\nuc{3}{He}) reaction, we propose that they may resultfrom a two-step mechanism or a nucleon-exchange reaction with subsequent neutronevaporation. Regardless of the mechanism, that could not yet be clarified, thesestates likely correspond to neutron core excitations in \nuc{35}{P}. Thisnewly-identified pathway, although weak, offers the possibility to selectivelypopulate certain intruder configurations that are otherwise hard to produceand identify.Comment: 5 figures, 1 table, accepted for publication in Physical Review

    The Role of the Subgenual Anterior Cingulate Cortex and Amygdala in Environmental Sensitivity to Infant Crying

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    This work was supported by the Swiss National Science Foundation (SNF): Grant 51A240-104890 to FHW and ES, and the Swiss National Science Foundation (SNF): Grant PA00P1_145418 to IM and the Freiwillige Akademische Gesellschaft to IM

    Spectroscopy of 28^{28}Na: shell evolution toward the drip line

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    Excited states in 28^{28}Na have been studied using the β\beta-decay of implanted 28^{28}Ne ions at GANIL/LISE as well as the in-beam γ\gamma-ray spectroscopy at the NSCL/S800 facility. New states of positive (Jπ^{\pi}=3,4+^+) and negative (Jπ^{\pi}=1-5^-) parity are proposed. The former arise from the coupling between 0d_5/2\_{5/2} protons and a 0d_3/2\_{3/2} neutron, while the latter are due to couplings with 1p_3/2\_{3/2} or 0f_7/2\_{7/2} neutrons. While the relative energies between the Jπ^{\pi}=1-4+^+ states are well reproduced with the USDA interaction in the N=17 isotones, a progressive shift in the ground state binding energy (by about 500 keV) is observed between 26^{26}F and 30^{30}Al. This points to a possible change in the proton-neutron 0d_5/2\_{5/2}-0d_3/2\_{3/2} effective interaction when moving from stability to the drip line. The presence of Jπ^{\pi}=1-4^- negative parity states around 1.5 MeV as well as of a candidate for a Jπ^{\pi}=5^- state around 2.5 MeV give further support to the collapse of the N=20 gap and to the inversion between the 0f_7/2\_{7/2} and 1p_3/2\_{3/2} levels below Z=12. These features are discussed in the framework of Shell Model and EDF calculations, leading to predicted negative parity states in the low energy spectra of the 26^{26}F and 25^{25}O nuclei.Comment: Exp\'erience GANIL/LISE et NSCL/S80

    Impact of STAT/SOCS mRNA Expression Levels after Major Injury

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    Background. Fulminant changes in cytokine receptor signalling might provoke severe pathological alterations after multiple trauma. The aim of this study was to evaluate the posttraumatic imbalance of the innate immune system with a special focus on the STAT/SOCS family. Methods. 20 polytraumatized patients were included. Blood samples were drawn 0 h–72 h after trauma; mRNA expression profiles of IL-10, STAT 3, SOCS 1, and SOCS 3 were quantified by qPCR. Results. IL-10 mRNA expression increased significantly in the early posttraumatic period. STAT 3 mRNA expressions showed a significant maximum at 6 h after trauma. SOCS 1 levels significantly decreased 6 h–72 h after trauma. SOCS 3 levels were significantly higher in nonsurvivors 6 h after trauma. Conclusion. We present a serial, sequential investigation in human neutrophil granulocytes of major trauma patients evaluating mRNA expression profiles of IL-10, STAT 3, SOCS 1, and SOCS 3. Posttraumatically, immune disorder was accompanied by a significant increase of IL-10 and STAT 3 mRNA expression, whereas SOCS 1 mRNA levels decreased after injury. We could demonstrate that death after trauma was associated with higher SOCS 3 mRNA levels already at 6 h after trauma. To support our results, further investigations have to evaluate protein levels of STAT/SOCS family in terms of posttraumatic immune imbalance

    Tomato: a crop species amenable to improvement by cellular and molecular methods

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    Tomato is a crop plant with a relatively small DNA content per haploid genome and a well developed genetics. Plant regeneration from explants and protoplasts is feasable which led to the development of efficient transformation procedures. In view of the current data, the isolation of useful mutants at the cellular level probably will be of limited value in the genetic improvement of tomato. Protoplast fusion may lead to novel combinations of organelle and nuclear DNA (cybrids), whereas this technique also provides a means of introducing genetic information from alien species into tomato. Important developments have come from molecular approaches. Following the construction of an RFLP map, these RFLP markers can be used in tomato to tag quantitative traits bred in from related species. Both RFLP's and transposons are in the process of being used to clone desired genes for which no gene products are known. Cloned genes can be introduced and potentially improve specific properties of tomato especially those controlled by single genes. Recent results suggest that, in principle, phenotypic mutants can be created for cloned and characterized genes and will prove their value in further improving the cultivated tomato.
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