747 research outputs found
Performance Assessment of Out-of-Hospital Use of Pelvic Circumferential Compression Devices for Severely Injured Patients in Switzerland: A Nationwide Retrospective Cross-Sectional Study.
Patients with severe pelvic fractures carry a greater risk of severe bleeding, and pelvic compression devices (PCCD) are used to stabilize the pelvis on the pre-hospital scene. The aim of this study was to describe the use of PCCD in the pre-hospital setting on a nationwide scale (Switzerland) and determine the sensitivity, specificity and rates of over- and under-triage of the current application practices. The secondary objective was to identify pre-hospital factors associated with unstable pelvic fractures.
Retrospective cross-sectional study using anonymized patient data (1 January 2015-31 December 2020) from the Swiss Trauma Registry (STR). Based on AIS scores, patients were assigned a unique principal diagnosis among three categories (unstable pelvic fracture-stable pelvic fracture-other) and assessed for use or not of PCCD. Secondarily, patient characteristics, initial pre-hospital vital signs, means of pre-hospital transport and trauma mechanism were also extracted from the database.
2790 patients were included for analysis. A PCCD was used in 387 (13.9%) patients. In the PCCD group, 176 (45.5%) had an unstable pelvic fracture, 52 (13.4%) a stable pelvic fracture and 159 (41.1%) an injury unrelated to the pelvic region. In the group who did not receive a PCCD, 214 (8.9%) had an unstable pelvic fracture, 182 (7.6%) a stable pelvic fracture and 2007 (83.5%) an injury unrelated to the pelvic region. The nationwide sensitivity of PCCD application was 45.1% (95% CI 40.1-50.2), the specificity 91.2% (95% CI 90-92.3), with both over- and under-triage rates of 55%. The prevalence of unstable fractures in our population was 14% (390/2790). We identified female sex, younger age, lower systolic blood pressure, higher shock index, pedestrian hit and fall ≥3 m as possible risk factors for an unstable pelvic fracture.
Our results demonstrate a nationwide both over- and under-triage rate of 55% for out-of-hospital PCCD application. Female gender, younger age, lower blood pressure, higher shock index, pedestrian hit and fall >3 m are possible risk factors for unstable pelvic fracture, but it remains unclear if those parameters are relevant clinically to perform pre-hospital triage
Seniorenläufer werden schneller und gewinnen Ultramarathons
Quintessenz
• Seniorensportler (Läufer über 35 Jahre) dominieren Ultramarathons, also Läufe, die länger sind als die klassische Marathondistanz von 42,195 km.
• Aus physiologischer Sicht wird mit ca. 35 Jahren der Leistungszenit im Langstrecken-Laufsport überschritten.
• Das Alter der Spitzenleistung im Ultralaufen steigt mit zunehmender Distanz und/oder der Dauer eines Ultramarathons.
• Lebenslanger Ausdauersport vermindert die altersbedingte Abnahme der maximalen Sauerstoffaufnahme um ca. 50%.
• Eine Abnahme der Muskelmasse ist kein unabwendbares Schicksal, denn regelmässiges Training lässt den altersbedingten jährlichen Abbau auf bis zu 0,5% schrumpfen
Holographic Superconductors with Lifshitz Scaling
Black holes in asymptotically Lifshitz spacetime provide a window onto finite
temperature effects in strongly coupled Lifshitz models. We add a Maxwell gauge
field and charged matter to a recently proposed gravity dual of 2+1 dimensional
Lifshitz theory. This gives rise to charged black holes with scalar hair, which
correspond to the superconducting phase of holographic superconductors with z >
1 Lifshitz scaling. Along the way we analyze the global geometry of static,
asymptotically Lifshitz black holes at arbitrary critical exponent z > 1. In
all known exact solutions there is a null curvature singularity in the black
hole region, and, by a general argument, the same applies to generic Lifshitz
black holes.Comment: 23 pages, 4 figures; v2: added references; v3: matches published
versio
The evolution of pebble size and shape in space and time
We propose a mathematical model which suggests that the two main geological
observations about shingle beaches, i.e. the emergence of predominant pebble
size ratios and strong segregation by size are interrelated. Our model is a
based on a system of ODEs called the box equations, describing the evolution of
pebble ratios. We derive these ODEs as a heuristic approximation of Bloore's
PDE describing collisional abrasion. While representing a radical
simplification of the latter, our system admits the inclusion of additional
terms related to frictional abrasion. We show that nontrivial attractors
(corresponding to predominant pebble size ratios) only exist in the presence of
friction. By interpreting our equations as a Markov process, we illustrate by
direct simulation that these attractors may only stabilized by the ongoing
segregation process.Comment: 22 pages, 8 figure
Komplexe proximale Humerusfraktur beim alten Menschen: Winkelstabile Plattenosteosynthese vs. Hemiarthroplastik
Zusammenfassung: Hintergrund: Ziel der vorliegenden Untersuchung ist ein direkter Vergleich der Schulterhemiarthroplastik (SHA) mit der winkelstabilen Plattenosteosynthese (WSPOS) beim alten Patienten mit komplexer proximaler Humerusfraktur. Patienten und Methoden: Zwischen 2003 und 2005 wurden alle Patienten (n=52, Alter ≥70Jahre) mit 3- und 4-Segment-Frakturen des proximalen Humerus, welche mit einer WSPOS (PHILOS®) versorgt wurden, prospektiv erfasst und nach einem Jahr mittels Constant-Score (CS), Oxford Shoulder Score (OSS) und radiologisch nachkontrolliert. Verglichen wurde die WSPOS mit einem historischen Kollektiv mit identischen Einschlusskriterien, welches zwischen 1995 und 1997 an der gleichen Institution mittels SHA versorgt wurde (n=59). Ergebnisse: Beide Patientenkollektive zeigten keine Unterschiede bezüglich Alter, Geschlechterverteilung und Frakturtypen. Der CS war signifikant besser für die WSPOS (median 71 vs. 41). Bezüglich Schmerzen zeigte sich im OSS kein Unterschied zwischen den Gruppen. In der WSPOS-Gruppe mussten signifikant mehr Revisionseingriffe durchgeführt werden (25% vs. 2%). Schlussfolgerung: Die WSPOS liefert beim alten Patienten, bei komplexen proximalen Humerusfrakturen deutlich bessere funktionelle Resultate, ist jedoch mit mehr Rezidiveingriffen behaftet. Die Selbständigkeit der Patienten kann bei beiden Operationsmethoden bei guter Schmerzfreiheit meist erhalten werde
The interior solution of axially symmetric, stationary and rigidly rotating dust configurations
It is shown that the interior solution of axially symmetric, stationary and
rigidly rotating dust configurations is completely determined by the mass
density along the axis of rotation. The particularly interesting case of a mass
density, which is cylindrical symmetric in the interior of the dust
configuration, is presented. Among other things, this proves the non-existence
of homogeneous dust configurations.Comment: minor corrections to the published version, 10 page
Thermodynamics of Dyonic Lifshitz Black Holes
Black holes with asymptotic anisotropic scaling are conjectured to be gravity
duals of condensed matter system close to quantum critical points with
non-trivial dynamical exponent z at finite temperature. A holographic
renormalization procedure is presented that allows thermodynamic potentials to
be defined for objects with both electric and magnetic charge in such a way
that standard thermodynamic relations hold. Black holes in asymptotic Lifshitz
spacetimes can exhibit paramagnetic behavior at low temperature limit for
certain values of the critical exponent z, whereas the behavior of AdS black
holes is always diamagnetic.Comment: 26 pages, 4 figure
Neuroblastic tumors of the adrenal gland in elderly patients: a case report and review of the Literature
Background: Neuroblastic neoplasms (NN) include ganglioneuromas (GN), ganglioneuroblastomas (GNB), and neuroblastomas (NB). They generally arise in childhood from primitive sympathetic ganglion cells. Their incidence in adults, especially among elderly, is extremely low. Case Presentation: This is the case of a 74-year-old woman with history of abdominal pain, weakness and night sweating since several months. Blood pressure was normal. CT-scan showed a 10 cm left adrenal mass, without other pathologic findings. An open left-sided adrenalectomy was performed. Recovery was uneventful with hospital length of stay of 8 days. Based on morphological, immunohistochemical, and molecular features the diagnosis was a nodular GNB. A positron emission tomography (PET) performed 6 weeks after the resection did not show any residual tumor or distant metastases. The patient was followed-up with annual clinical and radiological exams. Conclusion: This case presentation, associated with a review of the literature, illustrates the importance to include NN in the preoperative differential diagnosis of adrenal tumors in adults and highlights the need for multidisciplinary patient work-up and management
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