Head-injured patients admitted to a trauma center may or may not have associated facial fractures. Most head-injured patients undergo head computed tomography (CT) scan early in their evaluation. The ...question of adding a facial CT at the time of the head CT can be unclear. The aims of our study are 1) to analyze how the facial CT is used in conjunction with the head CT in facial fracture trauma patients, 2) to recognize unique identifiers that would aid the surgeon’s decision-making process to order a facial CT in continuity with a head CT, and 3) to examine what is characteristic of head trauma patients who receive a facial CT separately, at some point after the head CT.
Data were retrospectively reviewed for a 5-year period at a level I trauma center in which all patients who present with craniomaxillofacial trauma are managed by the oral and maxillofacial surgery (OMFS) service. Included patients must have obtained a head CT during initial resuscitation and be diagnosed with a facial fracture during the same hospital stay. These patients were divided into 3 groups: those who had a 1) head CT only, 2) head CT and facial CT at the same time, and 3) head CT with the facial CT performed at a later time.
A total of 9,871 patients were admitted to the trauma service during a 5-year period and 4,926 patients (49.9%) had head CT performed. Of this group, 12% had facial fractures, and the most common associated injury in this group was facial lacerations and concussions. The nasal fracture followed by the orbital fracture was the most common fracture type. Eighty-four percent of the time, the facial CT was used to help diagnose facial fractures in this patient population. The 3 different groups showed unique trends.
Six points were identified in our study that can augment the physical examination in patients who require head CT. The following points can help prompt the clinician to order a combination head and facial CT: 1) 12% of trauma patients who require a head CT will have a facial fracture, whereas half of these patients will have multiple facial fractures. 2) Orbital fractures are commonly missed in this group and often require a secondary scan such as coronal views for accurate diagnosis. 3) Facial lacerations correlate with ordering a combination head and facial CT. 4) The most common facial fracture identified among patients receiving a trauma head CT is the nasal fracture. 5) The use of the facial CT in more severely injured patients tended to be delayed and was related to increased hospital and intensive care unit days. 6) Only 16% of facial fracture patients who had received an initial trauma head CT did not require further facial CT scanning.
Measurements are presented of the properties of high transverse momentum jets, produced in proton-proton collisions at a center-of-mass energy of radicals = 7 TeV. The data correspond to an ...integrated luminosity of 35 pb super(-1) and were collected with the ATLAS detector in 2010. Jet mass, width, eccentricity, planar flow and angularity are measured for jets reconstructed using the anti-kt algorithm with distance parameters R = 0.6 and 1.0, with transverse momentum pT > 300 GeV and pseudorapidity eta < 2. The measurements are compared to the expectations of Monte Carlo generators that match leading-logarithmic parten showers to leading-order, or next-to-leading-order, matrix elements. The generators describe the general features of the jets, although discrepancies are observed in some distributions.
Cholera is a major global health problem, causing approximately 100,000 deaths annually, about half of which occur in sub-Saharan Africa. Although early-generation parenteral cholera vaccines were ...abandoned as public health tools owing to their limited efficacy, newer-generation oral cholera vaccines have attractive safety and protection profiles. Both killed and live oral vaccines have been licensed, although only killed oral vaccines are currently manufactured and available. These killed oral vaccines not only provide direct protection to vaccinated individuals, but also confer herd immunity. The combination of direct vaccine protection and vaccine herd immunity effects makes these vaccines highly cost-effective and, therefore, attractive for use in developing countries. Administration of these oral vaccines does not require qualified medical personnel, which makes their use practical--even in developing countries. Although new-generation oral cholera vaccines should not be considered in isolation from other preventive approaches, especially improved water quality and sanitation, they represent important tools in the public health armamentarium to control both endemic and epidemic cholera.
Angiogenesis is activated during multistage tumorigenesis prior to the emergence of solid tumors. Using a transgenic mouse model, we have tested the proposition that treatment with angiogenesis ...inhibitors can inhibit the progression of tumorigenesis after the switch to the angiogenic phenotype. In this model, islet cell carcinomas develop from multifocal, hyperproliferative nodules that show the histological hallmarks of human carcinoma in situ. Mice were treated with a combination of the angiogenesis inhibitor AGM-1470 (TNP-470), the antibiotic minocycline, and interferon α /β . The treatment regimen markedly attenuated tumor growth but did not prevent tumor formation; tumor volume was reduced to 11% and capillary density to 40% of controls. The proliferation index of tumor cells in treated and control mice was similar, whereas the apoptotic index was doubled in treated tumors. This study shows that de novo tumor progression can be restricted solely by antiangiogenic therapy. The results suggest that angiogenesis inhibitors represent a valid component of anticancer strategies aimed at progression from discrete stages of tumorigenesis and demonstrate that transgenic mouse models can be used to evaluate efficacy of candidate antiangiogenic agents.
Background The long-term risk of stroke after surgical treatment of atrial fibrillation is not well known. We performed an observational cohort study with long follow-up after the “cut-and-sew” ...Cox-maze III procedure (CM-III), including left atrial appendage excision. The aim was to analyze the incidence of stroke/transient ischemic attack (TIA) and the association to preoperative CHA2 DS2 -VASc (age in years, sex, congestive heart failure history, hypertension history, stroke/TIA, thromboembolism history, vascular disease history, diabetes mellitus) score. Methods Preoperative and perioperative data were collected in 526 CM-III patients operated in four centers 1994 to 2009, 412 men, mean age of 57.1 ± 8.3 years. The incidence of any stroke/TIA was identified through analyses of the Swedish National Patient and Cause-of-Death Registers and from review of individual patient records. The cumulative incidence of stroke/TIA and association with CHA2 DS2 -VASc score was estimated using methods accounting for the competing risk of death. Results Mean follow-up was 10.1 years. There were 29 patients with any stroke/TIA, including 6 with intracerebral bleedings (2 fatal) and 4 with perioperative strokes (0.76%). The remaining 13 ischemic strokes and six TIAs occurred at a mean of 7.1 ± 4.0 years postoperatively, with an incidence of 0.36% per year (19 events per 5,231 patient-years). In all CHA2 DS2 -VASc groups, observed ischemic stroke/TIA rate was lower than predicted. A higher risk of ischemic stroke/TIA was seen in patients with CHA2 DS2 -VASc score 2 or greater compared with score 0 or 1 (hazards ratio 2.15, 95% confidence interval: 0.87 to 5.32) but no difference by sex or stand-alone versus concomitant operation. No patient had ischemic stroke as cause of death. Conclusions This multicenter study showed a low incidence of perioperative and long-term postoperative ischemic stroke/TIA after CM-III. Although general risk of ischemic stroke/TIA was reduced, patients with CHA2 DS2 -VASc score 2 or greater had a higher risk compared with score 0 or 1. Complete left atrial appendage excision may be an important reason for the low ischemic stroke rate.
A suite of analyses was performed on sediments accumulated during the last 10 700 years in Lake Spaime, a small, hydrologically open water body in the modem alpine tundra zone of the Scandes ...Mountains, west-central Sweden. The study aimed to evaluate (1) the nature of climate changes that forced the late-Holocene lowering of altitudinal tree limit in the region, the timing of which is known from prior studies based on radiocarbon dating of subfossil wood, and (2) the impact of these vegetational changes on an aquatic ecosystem. Arboreal pollen and plant macrofossil data confirm the persistence of trees in the lake catchment at least from c. 9700 cal. BP until c. 3700 cal. BP. Although growing-season temperature is commonly believed to be the dominant factor driving boreal forest tree-limit variations in the region, a chironomid-based reconstruction of mean July air temperature suggests that local deforestation during the late Holocene was not accompanied by a significant cooling. The tree-limit retreat was more likely caused by increasing effective moisture and declining length of the growing season. The ecohydrological response of Lake Spaime to this combination of climate and vegetational changes included a decline in primary productivity, as indicated by an abrupt decrease in sediment organic matter content, while associated increases in organic 613C, 615N and C/N point to diminished fluxes and altered balance of catchment derived nutrients following deforestation. The decline in aquatic productivity is also marked by a distinct change in the mineral magnetic properties, from a high magnetic concentration assemblage dominated by fine-grained magnetite of biogenic origin to one dominated by background levels of coarse-grained detrital magnetite.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
The Oregon Health Plan was created to be a sustainable program that could weather budgetary storms without having to cut enrollees from Medicaid. A 2003 redesign of the program increased premiums, ...raised cost sharing, and imposed rigid premium payment deadlines for members in the "Standard" version of the program but not for members of the "Plus" version. This paper adds two years of longitudinal data to a previous study on the impacts of these changes. It shows that the redesign was a key factor driving a 77 percent disenrollment rate in the Standard program, from a high of 104,000 enrollees in February 2003 to just 24,000 by the end of the study period, November 2005. Those who were in the Standard plan when the reduced benefits and higher member costs went into effect were also nearly twice as likely to have unmet health care needs compared to those in the Plus plan. These changes underscore that in a period of economic downturn, policy makers must understand the impact of increased cost sharing on vulnerable populations.
Redox properties and evolution of human glutaredoxins Sagemark, Johan; Elgán, Tobias H.; Bürglin, Thomas R. ...
Proteins, structure, function, and bioinformatics,
September 2007, Letnik:
68, Številka:
4
Journal Article
Few studies have examined the time between onset of myocardial infarction (MI) symptoms and arrival at hospital (prehospital delay time) and symptoms in men vs. women.
To describe prehospital delay ...time and symptoms in men vs. women with MI and to analyse trends over time and according to age.
The Northern Sweden MONICA myocardial infarction registry, 1989-2003, included 5,072 men and 1,470 women with a confirmed MI.
Typical pain was present in 86% of the men and 81% of the women. The proportion with typical symptoms decreased over time for men and increased for women. Typical symptoms were more common among younger persons than older persons. Insufficiently reported symptoms was unchanged in men over time and decreased among women. Up to the age of 65, no gender differences were seen in the prehospital delay. In the oldest age group (65-74 years) time to hospital was longer than among the younger groups, especially among women.
There were no major gender differences in prehospital delay or type of symptoms. However, over time the proportion with typical symptoms decreased in men and increased in women. Older patients had longer prehospital delay and less typical symptoms.
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