•Pediatric traumatic brain injury represents a spectrum of disease from concussion to coma.•Treatment ranges from clinical observation to intracranial pressure monitoring to surgical ...decompression.•This pediatric brain injury guideline stratifies injury based upon neurologic exam and bleed characteristics on CT.•Management using a modified brain injury guideline may reduce repeat head CTs and neurosurgical consultations in mild and moderate cases.
Brain Injury Guidelines (BIG) were developed to stratify traumatic brain injuries (TBIs) by severity to decrease unnecessary CT imaging and neurosurgical consultation in low-risk cases. This study evaluated the potential effect of a modified pediatric BIG (pBIG) algorithm would have on resource utilization.
Isolated TBIs (<18 years) were queried from our Pediatric Trauma Registry from 2017 to 2020. Injuries were classified as mild (pBIG 1), moderate (pBIG 2), or severe (pBIG 3) based on neurologic status, skull fractures, size, and the number of bleeds. Modifications from the institutional adult algorithm were upgrading <4 mm epidural hematomas to pBIG 2 and eliminating interfacility transfer as a pBIG 2 criteria. The proposed pBIG 1 and 2 care plans do not include routine repeat CTs or neurosurgical consultation.
A total of 314 children with a mean age of 4.9 years were included. Skull fractures (213, 68%) and subdural hematomas (162, 52%) were the most common injuries. 89 (28%) children had repeat head CTs (2 (7%) pBIG 1, 26 (25%) pBIG 2, 61 (34%) pBIG 3). Neurosurgical consultation was obtained in 306 (98%), with 50 (16%) requiring intervention (1 (1%) pBIG 2 and 49 (27%) pBIG 3). Following the proposed pBIG would decrease neurosurgical consults to 181 (58%) and repeat CTs to 63 (20%). Following the algorithm, 91 (29%) kids would have been admitted to a higher level of care and 45 (14.3%) to a lower level.
Implementation of our pBIG algorithm would decrease neurosurgery consults (40% reduction) and repeat head CTs (29% reduction).
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
It is debatable whether high-flexion (HF) total knee arthroplasty (TKA) designs will improve postoperative flexion and function or will diminish the need for manipulation under anaesthesia (MUA). We ...retrospectively analysed range of motion (ROM), flexion, Knee Society Score (KSS), and rate of MUA in a consecutive group of patients who underwent TKA with a conventional posterior stabilised (PS) insert or an HF insert using identical surgical technique, implant design, and postoperative care. Fifty TKAs with a standard PS insert were matched for patient’s age, gender, preoperative ROM, and KSS with 50 TKA performed with an HF insert. The patient’s ROM and KSS were evaluated at six weeks, four months, and one year postoperatively. The outcome variables (flexion, ROM, KSS, and manipulation rate) in both groups were compared using the generalised estimating equations method. A second analysis of patients with preoperative flexion ≥120° was performed. The ROM, flexion, and patient-reported KSS was similar in both groups at each time period. The rate of MUA was also similar. Patients with a preoperative ROM of at least 120° showed similar results. Our study found that one year after surgery, patients who underwent TKA with a PS or an HF insert achieved similar flexion, ROM, and function.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Total hip and knee arthroplasties carry an increased risk for thromboembolic disease. A multimodal prophylaxis protocol developed at the Hospital for Special Surgery and fully implemented since 1995, ...consists of stratifying the individual patient's risk and implementing a series of safe preventive measures before, during, and after surgery to reduce the risk of venous thromboembolism and bleeding. The measures include discontinuation of procoagulant medication and autologous blood donation before surgery; the use of hypotensive epidural anesthesia and intraoperative intravenous heparin after acetabular work during total hip arthroplasty; the use of pneumatic compression devices, elastic stockings, and frequent, vigorous dorsiflexion of the ankles; and prompt mobilization of the patient after surgery to diminish venous stasis. If these safe measures are observed, postoperative pharmacologic prophylaxis does not need to be aggressive in the patients without predisposing factors for venous thromboembolism and who mobilize promptly, thus diminishing the morbidity and mortality associated with the routine use of potent anticoagulants and the overall cost of care. Our clinical experience with close to 10,000 total hip and knee replacements demonstrates that this multimodal prophylaxis is safe and effective, resulting in a very low prevalence of thromboembolism, bleeding, and all-cause mortality.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Olive (Olea europaea L.) inflorescences, formed in lateral buds, flower in spring. However, there is some debate regarding time of flower induction and inflorescence initiation. Olive juvenility and ...seasonality of flowering were altered by overexpressing genes encoding flowering locus T (FT). OeFT1 and OeFT2 caused early flowering under short days when expressed in Arabidopsis. Expression of OeFT1/2 in olive leaves and OeFT2 in buds increased in winter, while initiation of inflorescences occurred i n late winter. Trees exposed to an artificial warm winter expressed low levels of OeFT1/2 in leaves and did not flower. Olive flower induction thus seems to be mediated by an increase in FT levels in response to cold winters. Olive flowering is dependent on additional internal factors. It was severely reduced in trees that carried a heavy fruit load the previous season (harvested in November) and in trees without fruit to which cold temperatures were artificially applied in summer. Expression analysis suggested that these internal factors work either by reducing the increase in OeFT1/2 expression or through putative flowering repressors such as TFL1. With expected warmer winters, future consumption of olive oil, as part of a healthy Mediterranean diet, should benefit from better understanding these factors.
Olive oil, as part of a healthy Mediterranean diet, is becoming an essential commodity worldwide. Olive production is strongly correlated with the number of flowers produced by trees in the spring. The flowering extent for each olive tree is highly variable between years. Here, using physiological experiments and molecular tools, we studied flower induction in olives. Induction, which occurs in late winter, was found to be influenced by previous fruit load and by cold winter temperatures.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
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