Angiographic embolization in the treatment of arterial pelvic hemorrhage: evaluation of prognostic mortality-related factors

PURPOSE: The control of arterial bleeding associated with pelvic ring and acetabular fractures (PRAF) remains a challenge for emergency trauma care. The aim of the present study was to uncover early prognostic mortality-related factors in PRAF-related arterial bleedings treated with transcatheter angiographic embolization (TAE). METHODS: Forty-nine PRAF patients (46 pelvic ring and three acetabular fractures) with arterial pelvic bleeding controlled with TAE (within 24 h) were evaluated. RESULTS: All large arterial disruptions (n = 7) were seen in type C pelvic ring injuries. The 30-day mortality in large vessel (iliac artery) bleeding was higher (57 %) than in medium- or small-size artery bleeding (24 %). Overall 30-day mortality was 29 %. No statistically significant difference in the first laboratory values between the survivors and nonsurvivors was found. However, after excluding patients dying of head injuries (n = 5), a reasonable cut-off value was identified for the base excess (BE; lower than −10 mmol/l) obtained on admission. CONCLUSIONS: PRAF patients with exsanguinating bleeding from the large pelvic artery have the worst prognosis. Very low BE values (<−10.0 mmol/l) on admission for exsanguinating patients have a negative predictive value for survival, thus anticipating a poor outcome in bleeding controlled with TAE only and an increased risk of death. In critical cases, an aggressive bleeding control protocol prompts extraperitoneal pelvic packing prior to TAE. PRAF-related rupture of the external iliac artery is rare and indicates surgical techniques in controlling and restoring blood supply to the lower leg

The role of outpatient visit after operative treatment of ankle fractures

It is a common practice that patients have a scheduled follow-up visit with radiographs following ankle fracture surgery. The aim of this study was to evaluate whether an early outpatient visit ( A change in treatment plan was observed in 9.8% of operatively treated ankle fracture patients. The mean age of the patients was 48 years and the mean follow-up time was 64 months. Of the changes in treatment plan, 91% were exclusively due to clinical findings such as infection. Only three of 878 patients required a change in their treatment plan based merely on the findings of the radiographs taken at the outpatient visit. Only 37% of the patients requiring a change in their postoperative management had solicited an unanticipated visit before the scheduled outpatient visit due to clinical problems such as infection or a cast-related issue. Our study showed that every tenth operatively treated ankle fracture patient requires a change in their treatment plan due to a clinical problem such as infection or a cast-related issue. Although at hospital discharge all patients are provided with written instructions on where to contact if problems related to the operated ankle emerge, only one third of the patients are aware of the clinically alarming symptoms and seek care when problems present. Our findings do not support obtaining routine radiographs at the early outpatient visit in an ankle fracture patient without clinical signs of a complication. (C) 2016 Published by Elsevier Ltd.Peer reviewe

Data-Driven Reachability Analysis of Pedestrians Using Behavior Modes

In this paper, we present a data-driven approach for safely predicting the future state sets of pedestrians. Previous approaches to predicting the future state sets of pedestrians either do not provide safety guarantees or are overly conservative. Moreover, an additional challenge is the selection or identification of a model that sufficiently captures the motion of pedestrians. To address these issues, this paper introduces the idea of splitting previously collected, historical pedestrian trajectories into different behavior modes for performing data-driven reachability analysis. Through this proposed approach, we are able to use data-driven reachability analysis to capture the future state sets of pedestrians, while being less conservative and still maintaining safety guarantees. Furthermore, this approach is modular and can support different approaches for behavior splitting. To illustrate the efficacy of the approach, we implement our method with a basic behavior-splitting module and evaluate the implementation on an open-source data set of real pedestrian trajectories. In this evaluation, we find that the modal reachable sets are less conservative and more descriptive of the future state sets of the pedestrian

A three-group study, internet-based, face-to-face based and standard- management after acute whiplash associated disorders (WAD) – choosing the most efficient and cost-effective treatment: study protocol of a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>The management of Whiplash Associated Disorders is one of the most complicated challenges with high expenses for the health care system and society. There are still no general guidelines or scientific documentation to unequivocally support any single treatment for acute care following whiplash injury.</p> <p>The main purpose of this study is to try a new behavioural medicine intervention strategy at acute phase aimed to reduce the number of patients who have persistent problems after the whiplash injury. The goal is also to identify which of three different interventions that is most cost-effective for patients with Whiplash Associated Disorders. In this study we are controlling for two factors. First, the effect of behavioural medicine approach is compared with standard care. Second, the manner in which the behavioural medicine treatment is administered, Internet or face-to-face, is evaluated in it's effectiveness and cost-effectiveness.</p> <p>Methods/Design</p> <p>The study is a randomized, prospective, experimental three-group study with analyses of cost-effectiveness up to two-years follow-up. <it>Internet – based programme </it>and <it>face-to-face group treatment programme </it>are compared to <it>standard-treatment </it>only. Patient follow-ups take place three, six, twelve and 24 months, that is, short-term as well as long-term effects are evaluated. Patients will be enrolled via the emergency ward during the first week after the accident.</p> <p>Discussion</p> <p>This new self-help management will concentrate to those psychosocial factors that are shown to be predictive in long-term problems in Whiplash Associated Disorders, i.e. the importance of self-efficacy, fear of movement, and the significance of catastrophizing as a coping strategy for restoring and sustaining activities of daily life. Within the framework of this project, we will develop, broaden and evaluate current physical therapy treatment methods for acute Whiplash Associated Disorders. The project will contribute to the creation of a cost-effective behavioural medicine approach to management of acute Whiplash Associated Disorders. The results of this study will answer an important question; on what extent and how should these patients be treated at acute stage and how much does the best management cost.</p> <p>Trial registration number</p> <p>Current Controlled Trials ISRCTN61531337</p

Activation of brain interleukin-1β in schizophrenia

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Reorganizing the familyParvoviridae : a revised taxonomy independent of the canonical approach based on host association

Parvoviridae, a diverse family of small single-stranded DNA viruses was established in 1975. It was divided into two subfamilies,ParvovirinaeandDensovirinae, in 1993 to accommodate parvoviruses that infect vertebrate and invertebrate animals, respectively. This relatively straightforward segregation, using host association as the prime criterion for subfamily-level classification, has recently been challenged by the discovery of divergent, vertebrate-infecting parvoviruses, dubbed "chapparvoviruses", which have proven to be more closely related to viruses in certainDensovirinaegenera than to members of theParvovirinae. Viruses belonging to these genera, namelyBrevi-,Hepan- andPenstyldensovirus, are responsible for the unmatched heterogeneity of the subfamilyDensovirinaewhen compared to theParvovirinaein matters of genome organization, protein sequence homology, and phylogeny. Another genus ofDensovirinae,Ambidensovirus, has challenged traditional parvovirus classification, as it includes all newly discovered densoviruses with an ambisense genome organization, which introduces genus-level paraphyly. Lastly, current taxon definition and virus inclusion criteria have significantly limited the classification of certain long-discovered parvoviruses and impedes the classification of some potential family members discovered using high-throughput sequencing methods. Here, we present a new and updated system for parvovirus classification, which includes the introduction of a third subfamily,Hamaparvovirinae, resolves the paraphyly within genusAmbidensovirus, and introduces new genera and species into the subfamilyParvovirinae. These proposals were accepted by the ICTV in 2020 March.Peer reviewe

Investigation of human apoB48 metabolism using a new, integrated non-steady-state model of apoB48 and apoB100 kinetics

Background Triglyceride-rich lipoproteins and their remnants have emerged as major risk factors for cardiovascular disease. New experimental approaches are required that permit simultaneous investigation of the dynamics of chylomicrons (CM) and apoB48 metabolism and of apoB100 in very low-density lipoproteins (VLDL). Methods Mass spectrometric techniques were used to determine the masses and tracer enrichments of apoB48 in the CM, VLDL1 and VLDL2 density intervals. An integrated non-steady-state multicompartmental model was constructed to describe the metabolism of apoB48- and apoB100-containing lipoproteins following a fat-rich meal, as well as during prolonged fasting. Results The kinetic model described the metabolism of apoB48 in CM, VLDL1 and VLDL2. It predicted a low level of basal apoB48 secretion and, during fat absorption, an increment in apoB48 release into not only CM but also directly into VLDL1 and VLDL2. ApoB48 particles with a long residence time were present in VLDL, and in subjects with high plasma triglycerides, these lipoproteins contributed to apoB48 measured during fasting conditions. Basal apoB48 secretion was about 50 mg day?1, and the increment during absorption was about 230 mg day?1. The fractional catabolic rates for apoB48 in VLDL1 and VLDL2 were substantially lower than for apoB48 in CM. Discussion This novel non-steady-state model integrates the metabolic properties of both apoB100 and apoB48 and the kinetics of triglyceride. The model is physiologically relevant and provides insight not only into apoB48 release in the basal and postabsorptive states but also into the contribution of the intestine to VLDL pool size and kinetics.Peer reviewe

Palaeomagnetic, geochronological and geochemical study of Mesoproterozoic Lakhna Dykes in the Bastar Craton, India: Implications for the Mesoproterozoic supercontinent

Palaeomagnetic analysis of the Lakhna Dykes (Bastar Craton, India) yields a palaeopole at 36.6°N, 132.8°E, dp=12.4°, dm=15.9°, and the U--Pb zircon age obtained from one of the rhyolitic dykes is 1466.4±2.6 Ma (MSWD=0.21, concordia age based on two analyses with identical Pb--U ages), similar to previously published U\Pb ages. Major and trace element analyses of the Lakhna Dykes show shoshonitic and high-K calc-alkaline affinities consistent with a subduction related characteristics suggesting an active continental margin setting. This is in keeping with the Palaeo- to Mesoproterozoic tectonic environments in the eastern Indian margin. The new 1460 Ma Indian palaeopole was used to test possible palaeopositions of India within the Mesoproterozoic supercontinent Columbia. Of the four palaeomagnetically permissible reconstructions, juxtaposing western India against south-west Baltica is geologically the most reliably constrained and best fitting model. Our preferred reconstruction implies a long Palaeo- to Mesoproterozoic accretionary orogen stretching from south-eastern Laurentia through south-western Baltica to south-eastern India. Breakup of India and Baltica probably occurred in the Late Mesoproterozoic, but additional constraints are needed