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Decellularized extracellular matrix in the form of patches and locally injected hydrogels has long been used as therapies in animal models of disease. Here we report the safety and feasibility of an intravascularly infused extracellular matrix as a biomaterial for the repair of tissue in animal models of acute myocardial infarction, traumatic brain injury and pulmonary arterial hypertension. The biomaterial consists of decellularized, enzymatically digested and fractionated ventricular myocardium, localizes to injured tissues by binding to leaky microvasculature, and is largely degraded in about 3 d. In rats and pigs with induced acute myocardial infarction followed by intracoronary infusion of the biomaterial, we observed substantially reduced left ventricular volumes and improved wall-motion scores, as well as differential expression of genes associated with tissue repair and inflammation. Delivering pro-healing extracellular matrix by intravascular infusion post injury may provide translational advantages for the healing of inflamed tissues 'from the inside out'.

Introduction Glioblastoma is one of the most common brain tumors in adult populations, usually carrying a poor prognosis. While several studies have researched the impact of anti-angiogenic therapies, especially anti VEFG treatments in glioblastoma, few have attempted to assess its progress using imaging studies. Purpose We attempted to analyze whether cerebral blood volume (rCBV) from dynamic susceptibility-weighted contrast-enhanced MRI (DSC-MRI) could predict a response in patients with glioblastoma undergoing Bevacizumab (BVZ) treatment. Methods We performed a retrospective study evaluating patients with recurrent glioblastoma receiving anti-angiogenic therapy with BVZ between 2012 and 2017 in our institution. Patients were scheduled for routine MRI at baseline and first month follow up visits. Studies were processed for DSC-MRI, cT1 and FLAIR images, from which relative cerebral blood volume measurements were obtained. We assessed patient response using the Response Assessment in Neuro-Oncology (RANO) working group criteria and overall survival. Results 40 patients were included in the study and were classified as Bevacizumab responders and non-responders. Average rCBV before treatment was 4.5 for both groups and average rCBV was 2.5 for responders and 5.4 for non-responders. ROC curve set a cutoff point of 3.7 for rCBV predictive of response to BVZ. Cox Multivariate analysis only showed rCBV as a predictive factor of OS. Conclusion A statistically significant difference was found in rCBV between patients who responded and those who did not respond to BVZ treatment. rCBV may be a low cost and effective marker to assess response to Bevacizumab treatment in GBM.

Wheat is an important food crop, yet its value is reduced by fungal infections (ex.

Biomaterials, such as extracellular matrix (ECM) hydrogels, have been widely used in preclinical studies as injectable tissue engineering therapies; however, injectable therapies are limited as they can cause localized trauma or organ perforation. We have developed a new ECM therapy, the low molecular weight fraction derived from decellularized, digested ECM, for intravascular infusion. This new form of ECM can be infused after injury, specifically localize to injured tissues by coating the leaky microvasculature, and promote cell survival and tissue repair. In this study, we show the feasibility and targeting of intravascular ECM infusions using models of acute myocardial infarction (MI), traumatic brain injury, and pulmonary arterial hypertension. Furthermore, safety and efficacy were demonstrated in small and large animal models of acute MI following intracoronary infusion, which included using a clinically-relevant catheter in the large animal model. Functional improvements, specifically reduced left ventricular volumes and improved wall motion scores were observed after ECM infusions post-MI. Genes related to tissue repair and inflammation were differential expressed in response to ECM infusions. This study shows proof-of-concept for a new paradigm of delivering pro-healing ECM biomaterials via intravascular infusion to heal tissue from the inside out.

Benzo[a]pyrene (B[a]P), the most extensively studied carcinogen in cigarette smoke, has been regarded as a critical mediator of lung cancer. It is known that B[a]P-mediated Aryl hydrocarbon Receptor (AhR) activation stimulates the mitogen activated protein kinases (MAPK) signaling cascade in different cell models. MAPK pathway disturbances drive alterations in cellular processes, such as differentiation, proliferation, and apoptosis, and the disturbances may also modify the AhR pathway itself. However, MAPK involvement in B[a]P metabolic activation and toxicity in lung tissues is not well understood. Here, we used a non-transformed human bronchial epithelial lung cell line, BEAS-2B, to study the participation of ERK 1/2 kinases in the metabolic activation of B[a]P and in its related genotoxic effects. Our results indicate that B[a]P is not cytotoxic to BEAS-2B cells at relatively low concentrations, but it enhances CYP1A1 gene transcription and protein induction. Additionally, B[a]P promotes Src and ERK 1/2 phosphorylation. Accordingly, inhibition of both Src and ERK 1/2 phosphorylation decreases CYP1A1 protein induction, AhR nuclear translocation and production of B[a]P adducts. Together, these data suggest a crosstalk between AhR and the members of the MAPK pathway, ERK 1/2 mediated by Src kinase. This interaction is important for the adequate AhR pathway signaling that in turn induces transcription and protein induction of CYP1A1 and B[a]P-induced DNA damage in BEAS-2B cells.

This paper presents an implementation of the conformal voting scheme using a reconfigurable hardware approach in the frame of conformal geometric algebra $\mathcal {G}_{3,1}$ . This algorithm is able to extract geometric entities, such as circles and lines from edged images. The conformal voting scheme is divided into two main stages: a local stage computed using neighborhoods in the image, and a global stage using the results of the local voting stage. In this implementation, we focused on the most computationally demanding stage: the local stage, which is computed in the field-programmable gate array, while the global voting stage continues to be executed on the PC. The results show an average speedup of 3x depending on the features of the input image and a coefficient of variation near to zero in the times of repeated experiments. Finally, our method can be used for multiple applications in real-time image processing.

Ferroptosis is widely involved in degenerative diseases in various tissues including kidney, liver and brain, and is a targetable vulnerability in clear-cell carcinomas and therapy-resistant cancers. Accumulation of phospholipid hydroperoxides in cellular membranes is recognized as the hallmark and rate-limiting step of ferroptosis; however, the enzymes contributing to lipid peroxidation remain poorly characterized. Using genome-wide, CRISPR/Cas9-mediated suppressor screens, we identify cytochrome P450 oxidoreductase (POR) as a contributor to ferroptotic cell death in cancer cells exhibiting inherent and induced susceptibility to ferroptosis. By genetic depletion of POR in cancer cells, we reveal that POR contributes to ferroptosis across a wide range of lineages and cell-states, and in response to distinct mechanisms of ferroptosis induction. Using systematic lipidomic profiling, we further map POR’s activity to the lipid peroxidation step in ferroptosis. Hence, our work suggests POR as a key mediator of ferroptosis and a potential druggable target for developing anti-ferroptosis therapeutics.

Background Mycetoma is a neglected tropical disease characterized by nodules, scars, abscesses, and fistulae that drain serous or purulent material containing the etiological agent. Mycetoma may be caused by true fungi (eumycetoma) or filamentous aerobic bacteria (actinomycetoma). Mycetoma is more frequent in the so-called mycetoma belt (latitude 15° south and 30° north around the Tropic of Cancer), especially in Sudan, Nigeria, Somalia, India, Mexico, and Venezuela. The introduction of new antibiotics with fewer side effects, broader susceptibility profiles, and different administration routes has made information on actinomycetoma treatment and outcomes necessary. The objective of this report was to provide an update on clinical, therapeutic, and outcome data for patients with actinomycetoma attending a reference center in northeast Mexico. Methodology/principal findings This was a retrospective, cross-sectional, descriptive study of 31 patients (male to female ratio 3.4:1) diagnosed with actinomycetoma by direct grain examination, histopathology, culture, or serology from January 2009 to September 2018. Most lesions were caused by Nocardia brasiliensis (83.9%) followed by Actinomadura madurae (12.9%) and Actinomadura pelletieri (3.2%). About 50% of patients had bone involvement, and the right leg was the most commonly affected region in 38.7% of cases. Farmers/agriculture workers were most commonly affected, representing 41.9% of patients. The most commonly used treatment regimen was the Welsh regimen (35.5% of cases), a combination of trimethoprim/sulfamethoxazole (TMP/SMX) plus amikacin, which had a 90% cure rate, followed by TMP/SMX plus amoxicillin/clavulanic acid in 19.4% of cases with a cure rate of 100%. In our setting, 28 (90.3%) patients were completely cured and three (9.7%) were lost to follow-up. Four patients required multiple antibiotic regimens due to recurrences and adverse effects. Conclusions/significance In our sample, actinomycetoma was predominantly caused by N. brasiliensis. Most cases responded well to therapy with a combination of TMP/SMX with amikacin or TMP/SMX and amoxicillin/clavulanic acid. Four patients required multiple antibiotics and intrahospital care., Author summary Mycetoma is a chronic skin disease that can invade bone or underlying organs. Inadequate treatment may lead to long-lasting disability. Information about treatment is scarce. We report the outcomes of 31 patients with a diagnosis of bacterial actinomycetoma attending a tertiary care hospital in northeast Mexico. Most cases were treated with a combination of antibiotics including TMP/SMX plus amikacin or TMP/SMX plus amoxicillin/clavulanic acid. Cure was achieved in 90% of patients and only one required surgery.

Alopecia areata (AA) is an autoimmune disease of the hair follicle. Keratinocytes of the hair follicle generate an immunosuppressive environment by the local secretion of hormones of the hypothalamic-pituitary-adrenal axis of the skin (skin HPA analog). Our objective was to measure the local production of corticotropin-releasing hormone (CRH), adrenocorticotropic hormone (ACTH), and α-melanocyte-stimulating hormone (α-MSH) in the scalp tissue of patients with AA before and after ultraviolet A1 (UVA-1) phototherapy to determine their role in the pathogenesis of AA and the effect of UVA-1 on the AA hormonal environment. This was a retrospective and descriptive study of skin samples from 22 patients with AA before and after UVA-1 treatment. We compared the changes in the local hormonal environment by measuring CRH, ACTH, type 2 melanocortin receptor (ACTH receptor) and α-MSH with immunohistochemical stains. The positivity of MSH was significantly higher (P = .037) in the post-treatment samples compared with the baseline value. ACTH was significantly higher in intensity (P = .032) in the post-treatment samples compared with the initial value. CRH was significantly higher in intensity (P = .013) in baseline samples compared with the final biopsies. The positivity of the ACTH receptor MC2R was not different between the two groups (P = .626). In AA, an interruption in the signalling of CRH could decrease the local concentration of ACTH and MSH, and consequently, the immunosuppressive effect of these hormones. This phenomenon is normalized in the skin treated with UVA-1. A defective signalling system in the cutaneous HPA axis may be involved in the pathogenesis of AA.

This work was evaluated in the laboratory, the mechanical resistance under monotonic loads and the compression of several test bodies, by additions of lime and fly ash at 2%, 4%, 6% and 8%, based on the proctor test standard and the study soil (kaolin); prior to this, a characterization of the materials was made, and finally the objective was to determine the improvement of the soil through the comparisons, which refers to what is due to the best that is given to the best. Ash is not a significant improvement in the soil. In general, if a stabilization of a soil is required quickly, the data is published as a better option for soil improvement

This paper demonstrates an AC electrowetting-on-dielectric (EWOD) based platform to manipulate water droplets using anisotropic patterning of electrodes, without the need of complex control circuits. Only two electrodes are required to transport the droplet. Different droplet sizes (5~15 μL) have been tested and the droplet transport speed can reach 20 mm/s for 15 μL at 20 Hz external AC frequency. By introducing DC EWOD electrodes, we can perform multiple droplet manipulating functionalities including droplet synchronizing, merging, and mixing, which provides potential applications including active self-cleaning surfaces and lab-on-chip instruments.

Polycyclic aromatic hydrocarbons (PAHs) are widespread environmental contaminants that interact in a complex manner with both the aryl hydrocarbon receptor (AhR) and estrogen receptors (ER). Their potential endocrine-disrupting activities may depend on both inhibitory AhR-ER cross-talk and on AhR-dependent metabolic production of estrogenic PAH metabolites. Here, we analyzed the impact of AhR on estrogen-like effects of PAHs, such as benzo[a]pyrene (BaP), in particular, on control of cell cycle progression/cell proliferation. Using AhR knockout variant of estrogen-sensitive human breast cancer MCF-7 cells (MCF-7 AhR(KO) cells), we observed that the AhR-dependent control of cytochrome P450 family 1 (CYP1) expression played a major role in formation of estrogenic BaP metabolites, most notably 3-OH-BaP, which contributed to the ER-dependent induction of cell cycle progression/cell proliferation. Both BaP metabolism and the BaP-induced S-phase transition/cell proliferation were inhibited in MCF-7 AhR(KO) cells, whereas these cells remained sensitive towards both endogenous estrogen 17β-estradiol or hydroxylated BaP metabolites. BaP was found to increase the activity of ER-dependent luciferase reporter gene in wild-type MCF-7 cells; however, unlike its hydroxylated metabolite, BaP failed to stimulate luciferase activity in MCF-7 AhR(KO) cells. Similarly, estrogen-like effects of other known estrogenic PAHs, such as benz[a]anthracene or 3-methylcholanthrene, were diminished in MCF-7 AhR(KO) cells. Ectopic expression of human CYP1A1 and CYP1B1 enzymes partly restored both BaP metabolism and its effects on cell proliferation. Taken together, our data suggest that the AhR-dependent metabolism of PAHs contributes significantly to the impact of PAHs on cell proliferation in estrogen-sensitive cells.

RESUMENEl benzo[a]pireno (b[a]p), es un hidrocarburo aromático policíclico (PAH) producto de combustiones incompletas de materia orgánica. Es considerado como carcinógeno debido a que los metabolitos derivados de su biotransformación, como el benzo [a] pireno diol epóxido (b[a]pDE), tienen propiedades mutagénicas y carcinogénicas. El b[a]p es metabolizado por las enzimas citocromos P450 1A1 (CYP1A1) y el citocromo P450 1B1 (CYP1B1) cuya expresión es inducida por la vía de señalización del receptor de hidrocarburos de arilo (AhR). Algunos estudios sugieren que el AhR es capaz de modular otros procesos celulares, además de la desintoxicación de xenobióticos como el desarrollo, diferenciación, proliferación, respuesta inmune, promoción del cáncer y apoptosis. Esto mediante la modulación de vías de señalización mediadas por proteínas cinasas como la del receptor del factor de crecimiento epidermal (EGFR, por sus siglas en inglés). Sin embargo, no es clara la función del AhR en estos procesos ni cómo el AhR es capaz de interactuar con otras vías de señalización. Las alteraciones celulares inducidas por b[a]p son complejas y pueden estar mediadas por más de una vía de señalización y la activación de múltiples genes, por lo que es esencial saber qué vías están involucradas en el metabolismo de los PAH para una mejor comprensión de las bases moleculares de enfermedades como el cáncer.ABSTRACTBenzo[a]pyrene (b[a]p), is a polycyclic aromatic hydrocarbon (PAH) product of incomplete combustion of organic matter. B[a]p is considered as a carcinogen due to the mutagenic and carcinogenic properties of its biotransformation derivatives, such as benzo[a]pyrene diol epoxide (b[a]pDE). B[a]p is metabolized by cytochrome P450 enzymes 1A1 (CYP1A1) and 1B1 (CYP1B1), whose expression is regulated by the aryl hydrocarbon receptor (AhR) signaling pathway. Studies suggest that AhR is involved in the regulation of other cellular processes, in addition to detoxification of xenobiotics, such as development, differentiation, proliferation, immune response, cancer development, and apoptosis, by modulating signaling pathways mediated by protein kinases such as the epidermal growth factor (EGFR). However it is not clear the role of AhR in these processes nor the mechanisms of AhR interaction with other signaling pathways. Cellular changes induced by b[a]p are complex and may be mediated by more than one signaling pathway and by the activation of multiple genes, so it is essential to know which pathways are involved in the metabolism of PAHs for a better understanding of the molecular basis of diseases such as cancer.

The policy of routine angiography (ANG) for all penetrating neck wounds results in a high rate of negative studies. The medical records of all patients who presented to Wishard Memorial Hospital and Methodist Hospital of Indiana with penetrating injuries to the neck from January 1992 to April 2001 were reviewed. All patients who were hemodynamically stable underwent four-vessel ANG to evaluate for vascular injury irrespective of findings on physical examination (PE). A total of 216 patients sustained penetrating neck injuries. Patients were divided according to positive or negative PE findings and the results of ANG. Of the 63 patients with a positive PE, 40 (68%) also had a positive ANG finding. Of the 89 patients with negative PE, only 3 had a positive ANG and none of these injuries required operative repair. PE therefore had a 93 per cent sensitivity (SEN) and a 97 per cent negative predictive value (NPV) for predicting the results of ANG. The SEN and NPV of PE for detecting vascular injuries requiring operative repair were both 100 per cent. In this series, no patient with a negative PE had a vascular injury that required operative repair, irrespective of zone of injury. Routine ANG may therefore be unnecessary for patients with penetrating neck injuries and a negative PE.

The purpose of this study was to evaluate whether 1995 study conclusions influenced patient selection and subsequent survival and whether indications for emergency room thoracotomy (ERT) could be further limited on the basis of patient physiologic status. A retrospective review of patient demographics, physiologic status both at the scene and on arrival to the emergency room (ER), and survival was performed on those who underwent ERT from July 1995 to December 1999. Sixty-five patients underwent ERT for sustained gunshot wounds and 14 patients for stab wounds. There were no survivors from Class I or II at the scene or Class I on presentation to the ER. Although there was a significant decrease in patients of Class I at the scene (27% vs 8%) and in the ER (58.3% vs 35.4%) the overall survival rate remained the same (2.6%). ERT could be eliminated for patients of Class I or II at the scene and for those of Class I on arrival to the ER without negating survivors; survival would improve to 16.2 per cent.

The objective of this study is to analyze the possible relationship between the degree of flexibility or rigidity of the organizational culture and the use of competitive strategies in the industry of paper, cardboard and pulp in Mexico. Currently the volatile and competitive environment in which firms are inserted forces them to explore on the fundamentals that give sustenance to their organizational culture, and to study the competitive strategies that take to respond to the demands of the market, if they want to remain in them. To achieve this, a questionnaire based on Yeung, Ulrich, Nason and Von Glinow (2000) and Gomez (2008) was applied on a sample of 25 companies across the country, obtaining 420 observations. It was used to culture the focus of Cameron and Quinn (2006) and for the strategy the focus of Porter (1982). A Pearson correlation test was applied to test the hypothesis. We found that the dominant culture is the market and the dominant strategy is cost, and the construct rigid culture better associates to strategies, particularly with the differentiation and that there is evidence of the association between the two variables in the studied industry. The results found no doubt will be useful to managers in industry, and then assist them to rethink their strategies and seek to find an appropriate balance of cultural strengths. For the academic research sector found empirical results are important, because they strengthen the findings of the literature., El objetivo de este trabajo es analizar la posible relación entre el grado de flexibilidad o rigidez de la Cultura Organizacional y el uso de las Estrategias Competitivas en la industria del papel, el cartón y la celulosa en México. En la actualidad, el entorno volátil y competitivo en el que están insertas las empresas les obliga a explorar en los fundamentos que dan sustento a su cultura organizacional y a estudiar las estrategias competitivas que adoptarán para responder a las exigencias del mercado, si es que quieren permanecer en él. Para lograr lo anterior, se aplicó un cuestionario, basado en Yeung, Ulrich, Nason y Von Glinow (2000), y Gómez (2008), a una muestra de 25 empresas en todo el país, logrando obtener 420 observaciones. Se utilizó, para la cultura, el enfoque de Cameron y Quinn (2006) y, para la estrategia, el enfoque de Porter (1982). Se aplicó una prueba de correlación de Pearson para probar la hipótesis. Se encontró que la cultura dominante es la de mercado y la estrategia dominante es la de costos, el constructo “cultura rígida” se asocia de mejor manera con las estrategias, particularmente con la de diferenciación, y que sí existe evidencia de la asociación entre las dos variables en la industria estudiada. Los resultados encontrados, sin duda, serán de utilidad para los directivos del sector industrial, pues les auxiliará a replantear sus estrategias y a buscar cómo encontrar un adecuado equilibrio de fortalezas culturales. Para el sector de investigación académico los resultados empíricos encontrados son importantes, pues fortalecen los hallazgos de la literatura existente.

The purpose of this study was to attempt to identify those blunt trauma patients in whom expensive diagnostic studies such as computed tomography and diagnostic peritoneal lavage are unnecessary to exclude intra-abdominal injury. The medical records of 1096 blunt trauma patients evaluated at an urban level I trauma center were reviewed. Because of the urgent need to exclude intra-abdominal hemorrhage in patients with hypotension (blood pressure < 90 mm Hg), and the difficulty in obtaining reliable information from abdominal examination in patients with Glasgow Coma Scale scores < 11 or spinal cord injury, 140 patients meeting these criteria were reviewed but excluded from statistical analysis. Six groups of major associated injuries felt to be potential risk factors for the prediction of intra-abdominal injury were analyzed in the 956 remaining patients. Only two of these potential risk factors, namely chest injury (p = 0.0001) and gross hematuria (p = 0.0003) attained statistical significance. All of the 44 significant intra-abdominal injuries occurred in the group of 253 patients that had either an abnormal abdominal examination, one of the statistically significant risk factors, or both, for a sensitivity of 100%. Of the 703 patients with a normal abdominal examination and no risk factors, none had a significant abdominal injury, for a negative predictive value of 100%. This study suggests that patients with either an abnormal abdominal examination or one of the two statistically derived risk factors require adjunctive diagnostic evaluation with diagnostic peritoneal lavage or computed tomography scan to exclude intra-abdominal injury. Conversely, the incidence of significant intra-abdominal injury in patients with both a normal abdominal examination and no risk factors is negligible and this group, which accounted for 65% of all blunt trauma patients, may not require adjunctive diagnostic tests.

Objective: To characterize fatal blunt aortic injury (BAI). Methods: A retrospective chart review of 242 cases of fatal BAI in patients who underwent an autopsy at our institution between 1984 and 1997 was performed. Comparisons were made for statistical differences using the z-test. Results: Two hundred forty-two cases of fatal BAI were reviewed, making this the largest BAI autopsy study to date. Mechanisms of BAI included driver/passenger in motor vehicle crash (MVC) (68%), pedestrian versus MVC (17%), and motorcycle crash (8%). When comparing the mechanisms in the time period 1984 to 1988 to the time period 1989 to 1997, only the pedestrian versus MVC mechanism was significantly different (12% vs. 23%, p < 0.05). MVC direction of impact included head-on (45%), lateral (35%), and complex (20%). Two thirds of the victims sustained head injuries, rib fractures, and/or hepatic trauma. Only 58% of the victims had the classic isthmus laceration. There was one preventable death secondary to delay in diagnosis. Conclusion: BAI is not limited to frontal impact crashes; there should be a high index of suspicion of BAI in lateral impact crashes as well as pedestrian versus MVC mechanisms. Nonisthmus and complex aortic lacerations are common in fatal BAI. Finally, BAI is a highly lethal injury with few preventable deaths in this series.

Hospital diversion is a critical issue for hospitals that affects safety and overall patient care. At Wishard Hospital, a public hospital with a level 1 trauma center, we critically reviewed our diversion policies and implemented a series of changes. This hospital-wide process significantly decreased our diversion rates, thereby providing consistent and safe care to our community.

The use of pancreatic duct ligation (DL) during a Whipple procedure for trauma has been reported but not analyzed. We reviewed 13 cases of DL and compared the results with that reported for the Whipple procedure for trauma with pancreaticojejunostomy (PJ). The mortality rate of DL was 53.8%. Pancreatitis occurred in three cases (23.1%) and caused one death. Pancreatic fistulae occurred in 50% of patients surviving two or more days after DL. No long-term survivor developed overt diabetes mellitus. Malabsorption occurred in 50% of the long-term survivors of DL. When the DL and PJ groups were compared no statistically significant difference could be found in either mortality or pancreatic morbidity. The 46.2% survival rate for DL warrants its consideration as a technique available to trauma surgeons when faced with an unstable patient unable to tolerate further operative therapy.

We evaluated a technique for treating hypothermia that uses extracorporeal circulation but does not require heparin or pump assistance. Hypothermia to 29.5°C was induced in eight anesthesized dogs, and thermistors placed in the pulmonary artery, liver, bladder, esophagus, rectum, muscle, and skin

The medical, legal, and ethical problems associated with routine HIV screening have led to the recommendation that all patients should be presumed to be seropositive and thus protective measures should be taken by all health care workers. This philosophy, termed “universal precautions,” has been dif

BACKGROUND: Suicide is an important public health concern. Firearms are the most common mechanism of suicide death. This study describes the epidemiology of fatal and nonfatal firearm suicide injuries (FSI) in one metropolitan area from 2002 through 2004 using a firearm injury surveillance system. METHODS: Records were obtained of all victims of firearm injuries from hospitals, police, and the coroner. All injuries categorized as suicide were included. RESULTS: Local age adjusted suicide rates were significantly higher than state or national rates for ages 15 to 24, and significantly higher than national rates for ages 25 to 44. Men were FSI victims more than five times as often as women were. There was no seasonal pattern identified. Handguns were used nearly three out of four times. Eighty-six percent of FSI victims died, two-thirds at the scene. Most wounds were in the head or chest. Mental illness or relationship problems were common. Most suicides occurred in a residence. CONCLUSIONS: Community level firearm injury surveillance effectively identifies local trends that may differ from national statistics. Collaboration among various groups is used to support injury prevention programs. These data can both complement and contribute to national statistics. Language: en

Obesity is rapidly becoming the most important public health issue in USA and Europe. Roux-en-Y gastric bypass is now established as the gold standard for treating intractable morbid or super obesity. We reviewed the imaging findings following this surgery in 234 patients. In this pictorial essay we present the CT and upper gastrointestinal contrast study appearances of the expected postoperative anatomy as well as a range of abdominal complications. The complications are classified into leaks, fistula and obstruction. Postoperative gastric outlet and small bowel obstruction can be caused by anastomotic stenosis, mesocolic tunnel stenosis, adhesions, stomal ulcer, obturation, intussusception and internal or external hernia. Small bowel obstruction may be of a simple, closed loop and/or strangulating type. The radiologist should be able to diagnose the type and possible cause of obstruction.

Background: The medical benefits of trauma centers have been well documented; studies have reported substantial financial losses attributed to trauma care. This study demonstrates the dependence of Level I trauma centers on Disproportionate Share Hospital (DSH) governmental funds and tax dollars. Furthermore, specific injury groups have greater dependence on these funds. Methods: Records of 553 trauma patients admitted to a public urban Level I trauma center during a 6-month period were reviewed. Patients were grouped according to blunt, penetrating, and thermal injuries. Data for each group included charges, costs, payments, and the source of reimbursement. Profit and loss margins were compared with and without government funds. Results: With diminished DSH funds and tax dollars, a net loss over $2.1 million was incurred. The greatest disparity originates from Medicaid, self-pay, and prisoner patient groups. Inclusion of government funds provided a positive return of over $600,000. Conclusion: The financial stability of urban public level I trauma centers without additional funding is tenuous because of a high proportion of uninsured and underinsured patients. Government tax dollars and DSH funds are required for their continued solvency.

Objective : To analyze the indications for and the success rate, complications, and neurologic outcomes of surgical cricothyroidotomy when performed in the field by ambulance paramedics. Methods : The ambulance and hospital records of all trauma patients on whom a surgical cricothyroidotomy was attempted in the field by ambulance paramedics over a 5-year period were reviewed. A telephone survey of survivors was used to assess long-term complications and neurologic outcome. Results : Surgical cricothyroidotomy was attempted on 50 patients, or 9.8% of those requiring definitive airway control. The most common indications were clenched teeth, blood or vomit obscuring visualization of the upper airway, severe maxillofacial injuries, and inaccessibility because the patient was trapped. Airway establishment was successful in 47 patients (94%). Major complications occurred in 2 patients (4%), where inadvertent dislodgement of the tube developed, requiring replacement. No patient developed significant subglottic stenosis. Nineteen patients (38%) survived and no patient died because of an inadequate airway. Evaluation of neurologic outcome revealed 12 patients (63%) with no significant deficits, 3 (16%) with moderate disability, 2 (10%) with severe disability, and only 2 in a persistent vegetative state. Conclusions : Surgical cricothyroidotomy can be performed on the critically injured patient in the field by ambulance paramedics with a high success rate and a low complication rate. The use of surgical cricothyroidotomy should be included in airway protocols for well-trained, ambulance Advanced Life Support paramedics.

There is no universally accepted standard classification for liver injuries, and thus accurate comparison of reports on the subject is impossible. Most published reports on liver trauma suggest that both morbidity and mortality have a linear correlation with not only the amount of liver parenchyma injured but also with the magnitude of the surgical intervention. The exceptions are retrohepatic vein injuries, which have a mortality independent of associated parenchymal injury but should be integrated in any classification of liver injury. The classification proposed is based on the segmental anatomy of the liver (as defined by Couinaud): Grade I--Injuries requiring no operative intervention, or any injury that requires operative intervention limited to a segment or less. Grade II--Any injury that requires operative intervention involving two or more segments. Grade III--Any injury with an associated juxta- or retrohepatic vein injury. We reviewed all patients with isolated liver injuries during the past 5 years and prospectively reviewed all patients for the 6-month period from January to June 1988 and applied this classification. Sixty-nine patients had grade I injuries, with one death (1%); thirteen patients had grade II injuries, with six deaths (46%); and 13 patients had grade III injuries with nine deaths (69%). Postoperative morbidity was 7% for grade I, 57% for grade II, and 50% for grade III. This study supports the conclusion that morbidity and mortality from liver injury are directly related to the volume of parenchyma involved, and that segmental anatomy can be applied to define this volume. Mortality from retrohepatic vein injuries is independent of associated parenchymal injury. We believe that this proposed classification will provide a simple, reproducible, and accurate means for reporting and comparing liver injuries.

Because of difficulties in rapid exposure and control, injuries of the retrohepatic veins and retrohepatic vena cava continue to have mortality rates approaching 100%. Current strategies include shunt and finger fracture techniques, with controversy continuing over the optimal approach. We describe a new technique which involves mobilization of the liver by transecting the superhepatic vena cava, and affords a posterior approach to these injuries. Cadaveric dissection and clinical experience are described.