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Background Up to 20–40% of survivors of any traumatic injury develop post-traumatic stress disorder (PTSD) or depression after injury. Firearm injury survivors may be at even higher risk for adverse outcomes. We aimed to characterize PTSD and depression risk, pain symptoms, and ongoing functional limitations in firearm injury survivors early after hospital discharge.Methods Firearm injury survivors seen in the Trauma Quality of Life (TQOL) outpatient follow-up clinic 1–2 weeks after discharge were invited to participate in a survey assessing both mental and physical health outcomes. The survey included the Brief Pain Inventory (BPI), the Injured Trauma Survivor Screen (ITSS), the Beck Depression Inventory (BDI), the PTSD Checklist for DSM-5 (PCL-5), and the 12-item Short Form Survey Physical Health component (SF-12)Results 306 patients were seen in the TQOL Clinic, and 175 responded to the survey. The mean age was 32 years (SD=12), 81% were male, and 79% were black. On the ITSS, 69% and 48% of patients screened risk positive for PTSD and depression, respectively. Patients reported mild depression symptoms with an average BDI score of 14.3 (SD=11.8) and elevated PTSD symptoms with an average PCL-5 score of 43.8 (SD=12.8). Patients with severe BPI scores were more likely to screen positive for depression and PTSD. Respondents scored >2 SD below the US national average on the SF-12 for physical quality of life (M=28.7). 12% of patients were at risk across all four domains of pain, PTSD, depression, and physical function.Conclusion Early after discharge, over two-thirds of firearm injury survivors were at risk for the development of PTSD, nearly half were at risk of depression, and physical function was significantly decreased. Trauma centers need to prioritize early, outpatient multidisciplinary care to treat and prevent the development of poor chronic physical and mental health for firearm injury survivors.Level of evidence III.

Background This project analyzed risk factors for emergency department (ED) utilization without readmission within 2 weeks post-discharge for survivors of gun violence.Methods A hundred gun violence survivors admitted to a Level 1 trauma center were surveyed. Descriptive analyses and group comparisons were conducted between patients who did and did not use the ED. Factors analyzed are rooted in social determinants of health and clinical care related to the index hospitalization.Results Of the 100 patients, 31 had an ED visit within 6 weeks, although most (87.1%) returned within 2 weeks of discharge. Factors significantly associated (p≤0.05) with a return ED visit included: not having an identified primary care provider, not having friends or family to count on for help, not having enough money to support themselves before return to work, and not feeling able to read discharge instructions.Conclusion Lack of a primary care provider, low health literacy and social support were associated with increased ED visits without readmission post-discharge.Level of Evidence Level III, Prognostic and Epidemiological

Background Outpatient follow-up represents a crucial opportunity to re-engage with gun violence survivors (GVS) and to facilitate positive health outcomes. Current outpatient models for firearm-related injuries and trauma care are inconsistent and unstandardized across trauma centers. This project describes the patient population served by the multidisciplinary Trauma Quality of Life (TQoL) Clinic for GVS. Also of primary interest was the outpatient follow-up services used by patients prior to their clinic appointment. Subsequent referrals placed during Clinic, as well as rate of attendance, was a secondary aim.Methods This was a descriptive retrospective analysis of a quality improvement project of the TQoL Clinic. Data were extracted from the electronic medical record and were supplemented with information from the trauma registry and the hospital-based violence intervention program database. Descriptive statistics characterized the patient population served. A Χ2 analysis was used to compare no-show rates for the TQoL Clinic against two historical cohorts of trauma clinic attendees.Results Most attendees were young (M=32.0, SD=1.8, range=15–88 years), Black (80.1%), and male (82.0%). Of the 306 total TQoL Clinic attendees, 82.3% attended their initial scheduled appointment. Most non-attendee patients rescheduled their appointments (92.1%), and 89.5% attended the rescheduled appointment. TQoL Clinic demonstrated a significantly lower no-show rate than the traditional trauma clinic model, including after the implementation of the hospital’s inpatient violence intervention program (χ2(2)=75.52, p

Abstract Three-dimensional hydrogel-based organ-like cultures can be applied to study development, regeneration, and disease in vitro. However, the control of engineered hydrogel composition, mechanical properties and geometrical constraints tends to be restricted to the initial time of fabrication. Modulation of hydrogel characteristics over time and according to culture evolution is often not possible. Here, we overcome these limitations by developing a hydrogel-in-hydrogel live bioprinting approach that enables the dynamic fabrication of instructive hydrogel elements within pre-existing hydrogel-based organ-like cultures. This can be achieved by crosslinking photosensitive hydrogels via two-photon absorption at any time during culture. We show that instructive hydrogels guide neural axon directionality in growing organotypic spinal cords, and that hydrogel geometry and mechanical properties control differential cell migration in developing cancer organoids. Finally, we show that hydrogel constraints promote cell polarity in liver organoids, guide small intestinal organoid morphogenesis and control lung tip bifurcation according to the hydrogel composition and shape.

Objectives Annually, approximately 27 million individuals in the United States are admitted to hospitals for emergency general surgery (EGS). Approximately 50% develop postoperative complications and 22% require unplanned readmission within 90 days, highlighting a need to understand factors impacting well-being and recovery. Psychiatric comorbidity can impact medical treatment adherence, cost, and premature mortality risk. Despite the severity of illness in EGS, there is limited research on psychiatric comorbidity in EGS patients. Thus, the purpose of the current study was to characterize EGS patient mental health and to assess its relationship with pain, social support, and healthcare utilization (ie, length of stay, readmission).Methods Adult EGS patients were screened for participation during hospitalization. Inclusion criteria included: (1) 18 years or older, (2) communicate fluently in English, and (3) assessed within 7 days of admission. Participants (n=95) completed assessment, which included a structured clinical diagnostic interview. Record review captured medical variables, including length of stay, discharge disposition, narcotic prescription, and 90-day readmission rates.Results Ninety-five patients completed the assessment, and 31.6% met criteria for at least one current psychiatric diagnosis; 21.3% with a major depressive episode, 9.6% with a substance use disorder, and 7.5% with post-traumatic stress disorder (PTSD). Lower perceived social support and greater pain severity and interference were significantly related to more severe depression and anxiety. Depression was associated with longer length of stay, and those with PTSD were more likely to be re-admitted.Conclusion The EGS patient sample exhibited psychiatric disorder rates greater than the general public, particularly regarding depression and anxiety. Screening protocols and incorporation of psychological and social interventions may assist in recovery following EGS.Level of evidence Level II, prognostic.

La esofagitis necrotizante aguda es un trastorno poco común que puede ser causa de hemorragia digestiva alta. Predomina en el sexo masculino en la sexta década de la vida. El diagnóstico es endoscópico y muestra una mucosa esofágica de apariencia negra que afecta al esófago distal en toda su circunferencia y se detiene abruptamente en la unión gastroesofágica. Clínicamente suele presentarse con hematemesis y melenas, shock hipovolémico por sangrado masivo, siendo otras manifestaciones el dolor epigástrico, molestia retroesternal y disfagia. Se vincula a pacientes con antecedentes de enfermedad cardiovascular, alcoholismo, diabetes mellitus, desnutrición, hernia hiatal, estenosis gastroduodenal, cáncer, así como pacientes en shock, traumatizados, sometidos a cirugía mayor e inmunosuprimidos. El tratamiento se basa en fluidoterapia, inhibidores de la bomba de protones y suspensión de la vía oral, siendo controvertido el uso de antibioticoterapia. Su pronóstico es malo y dependerá de la gravedad de la enfermedad esofágica y del terreno del paciente, con una mortalidad de hasta el 36%. Presentamos el caso clínico de un paciente de 81 años, hipertenso, que presenta hematemesis, confirmándose en la endoscopía una esofagitis necrotizante aguda, que evoluciona favorablemente con tratamiento médico.

SARS-CoV-2 has affected millions of people around the world in recent years. Among susceptible patients, pregnant women seem to be prone to serious complications. The possibility of SARS-CoV-2 vertical transmission represents one of the most debated topics in the literature, providing inconclusive results. We present a case of a confirmed vertical transmission in a monochorial diamniotic twin pregnancy complicated by a selective intrauterine growth restriction and gestational diabetes mellitus. The analysis of different biological specimens identifies the presence of the SARS-CoV-2 genome in the umbilical cord blood of both twins, and the placental histologic examination confirmed indirect signs of viral infection, supporting the hypothesis that a transplacental infection can occur. Despite the devastating impact that SARS-CoV-2 has worldwide, neonatal infections have been infrequently reported, but they can occur under certain biologic conditions. Deep knowledge of the biological mechanisms underlying the risk of SARS-CoV-2 vertical transmission might be useful to understand the pathophysiological bases and the possible long-term implication of a mother-to-child vertical transmission.

The gap in resolution between existing global climate model output and that sought by decision-makers drives an ongoing need for climate downscaling. Here we test the extent to which developments in deep learning can out-perform existing statistical approaches for downscaling historical rainfall in the highly complex terrain setting of New Zealand. While deep learning removes the need for manual feature selection when extracting spatial-temporal information from predictor fields, several key considerations need to be addressed. These include: the chosen complexity of the network architecture, suitable loss functions tailored to the problem, as well as input data considerations of domain size and amount of training data required to provide adequate out-of-sample generalization. Sensitivity testing to these considerations reveals that a relatively simple convolutional neural network (CNN) architecture with carefully selected loss functions can considerably outperform existing statistical downscaling models based on multiple linear regression with manual feature selection. When aggregated across the entire region, the fraction of explained variance on wet days increased from 0.35 to 0.52, the root-mean-squared error reduced by over 20% and percentage biases for the 90th percentile of rainfall improved by over 25%. Using interpretable machine learning methods, we demonstrate that the CNN has been capable of self-learning physically plausible relationships between the large-scale atmospheric environment and extreme localized rainfall events. The historical performance and physical interpretability documented here lends support for wider development and application of deep learning in climate downscaling.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS- CoV-2) represents an emerging infection that is spreading around the world. Among susceptible patients, pregnant women are more likely to develop serious complications and negative obstetric outcomes. Vertical transmission constitutes a debating issue which has not been completely understood. This review aims at describing the currently available evidence on SARS-CoV2 vertical transmission. We carried out a computerized literature search in the Cochrane Library, PubMed, Scopus and Web of Science, selecting the most relevant studies on vertical transmission from the outbreak onset until February 2022. The analysis of the available literature identifies the presence of SARS-CoV2 genome in different biological specimens, confirming the hypothesis that a transplacental infection can occur. In spite of the high number of infected people around the world, mother-to-child infections have been infrequently reported but it can be observed under certain biologic conditions. A deep knowledge of the underlying mechanisms of SARS-CoV2 vertical transmission is of paramount importance for planning an adequate management for the affected mothers and newborns.

In 1820 Karl Witte discovered a "Greek" speaking population in southern Ionian Calabria. It is a restricted cultural enclave where, still today, linguistic residues of the ancient Grecanico remain. The essay is a summary of research aimed at the analysis and enhancement of the material and immaterial heritage of this area, searching residual traces of the Greek-Byzantine tradition in Calabria: cultural and anthropological matrices; recurring features in buildings and in landscape; craft traditions. The study refers to the 2030 Agenda Strategy, Goal 11.4 (strengthen efforts to protect and safeguard the world’s cultural and natural heritage). It is developed through surveys, drawings, analysis and reflections, aimed at deepening the following topics: • Urban squares and collective spaces: places of permanence and sharing of cultural and anthropological heritage. • Artifice and nature: virtuous and sustainable integration between spontaneous architecture and landscape. • Textile craftsmanship and wood carving: the tangible memory of an ancient Greek-Byzantine iconographic tradition. The research highlighted, in the more internal areas, a widespread quality of the buildings. It is a poor and spontaneous architecture, but built in harmony with the landscape. However, we can find the most identity characteristics in artisanal productions: objects of "ethnic design" created on recurrent models in which popular spontaneity intertwines with the unconscious memory of Byzantine iconographic traditions. Among the analysed villages, Roghudi Vecchio – now abandoned – could be a pilot project for the enhancement of the territory and the Grecanica traditions. Luoghi, permanenze e tradizioni iconografiche nella Calabria Greca Nel 1820 Karl Witte scopre una popolazione di lingua “greca” nella Calabria meridionale ionica. È una ristretta enclave culturale in cui, ancora oggi, permangono residui linguistici dell’antico "Grecanico". Il saggio è sintesi di una ricerca volta all’analisi e alla valorizzazione del patrimonio materiale e immateriale di tale area, alla ricerca di tracce residue della tradizione greco-bizantina in Calabria: matrici culturali e antropologiche; caratteri ricorrenti nel costruito e nel paesaggio; tradizioni artigianali. Lo studio fa riferimento alla Strategia Agenda 2030, goal 11.4 (rafforzare gli impegni per proteggere e salvaguardare il patrimonio culturale e naturale del mondo), e si sviluppa attraverso rilievi, disegni, analisi e riflessioni, volti ad approfondire i seguenti temi: • Piazze urbane e spazi collettivi: i luoghi della permanenza e della condivisione del patrimonio culturale e antropologico. • Artificio e natura: integrazione virtuosa e sostenibile tra architettura spontanea e paesaggio. • Artigianato tessile e intaglio del legno: la memoria tangibile di un’antica tradizione iconografica greco-bizantina. La ricerca ha evidenziato, nelle aree più interne, una diffusa qualità del costruito. È un’architettura povera e spontanea ma realizzata in armonia con il paesaggio. I caratteri maggiormente identitari si riscontrano, però, nelle produzioni artigianali: oggetti di “design etnico” realizzati su modelli ricorrenti in cui la spontaneità popolare s’intreccia con l’inconsapevole memoria di tradizioni iconografiche bizantine. Tra i borghi analizzati, Roghudi Vecchio – oggi abbandonato – potrebbe rappresentare un progetto pilota per la valorizzazione del territorio e delle tradizioni grecaniche.

Objective: This study aimed to assess the role of Tocilizumab therapy (TCZ) in terms of ICU admission and mortality rate of critically ill patients with severe COVID-19 pneumonia. Design: Patients with COVID-19 pneumonia were prospectively enrolled in SMAtteo COvid19 REgistry (SMACORE). A retrospective analysis of patients treated with TCZ matched using propensity score to patients treated with Standard Of Care (SOC) was conducted. Setting: The study was conducted at IRCCS Policlinico San Matteo Hospital, Pavia, Italy, from March 14, 2020 to March 27, 2020. Participants: Patients with a confirmed diagnosis of COVID-19 hospitalized in our institution at the time of TCZ availability. Interventions: TCZ was administered to 21 patients. The first administration was 8 mg/kg (up to a maximum 800 mg per dose) of Tocilizumab intravenously, repeated after 12 h if no side effects were reported after the first dose. Main Outcomes and Measures: ICU admission and 7-day mortality rate. Secondary outcomes included clinical and laboratory data. Results: There were 112 patients evaluated (82 were male and 30 were female, with a median age of 63.55 years). Using propensity scores, the 21 patients who received TCZ were matched to 21 patients who received SOC (a combination of hydroxychloroquine, azithromycin and prophylactic dose of low weight heparin). No adverse event was detected following TCZ administration. This study found that treatment with TCZ did not significantly affect ICU admission (OR 0.11; 95% CI between 0.00 and 3.38; p = 0.22) or 7-day mortality rate (OR 0.78; 95% CI between 0.06 and 9.34; p = 0.84) when compared with SOC. Analysis of laboratory measures showed significant interactions between time and treatment regarding C-Reactive Protein (CRP), alanine aminotransferase (ALT), platelets and international normalized ratio (INR) levels. Variation in lymphocytes count was observed over time, irrespective of treatment. Conclusions: TCZ administration did not reduce ICU admission or mortality rate in a cohort of 21 patients. Additional data are needed to understand the effect(s) of TCZ in treating patients diagnosed with COVID-19.

BackgroundPatients with implantable devices such as pacemakers (PMs) and implantable cardiac defibrillators (ICDs) should be followed up every 3–12 months, which traditionally required in-clinic visits. Innovative devices allow data transmission and technical or medical alerts to be sent from the patient's home to the physician (remote monitoring). A number of studies have shown its effectiveness in timely detection and management of both clinical and technical events, and endorsed its adoption. Unfortunately, in daily practice, remote monitoring has been implemented in uncoordinated and rather fragmented ways, calling for a more strategic approach. ObjectiveThe objective of the study was to analyze the impact of remote monitoring for PM and ICD in a “real world” context compared with in-clinic follow-up. The evaluation focuses on how this service is carried out by Local Health Authorities, the impact on the cardiology unit and the health system, and organizational features promoting or hindering its effectiveness and efficiency. MethodsA multi-center, multi-vendor, controlled, observational, prospective study was conducted to analyze the impact of remote monitoring implementation. A total of 2101 patients were enrolled in the study: 1871 patients were followed through remote monitoring of PM/ICD (I-group) and 230 through in-clinic visits (U-group). The follow-up period was 12 months. ResultsIn-clinic device follow-ups and cardiac visits were significantly lower in the I-group compared with the U-group, respectively: PM, I-group = 0.43, U-group = 1.07, P

Analizamos la experiencia de nuestro equipo de trabajo en “Hernias de la Pared Torácica” durante un período de 10 años. Destacamos que se trata de una patología de baja frecuencia aunque no exótica. Tiene características clínicas y anatomopatológicas definidas y típicas que permiten hacer un diagnóstico preciso.

Uncontrolled activation of the innate immune system promotes the deterioration of neurons in different neurodegenerative diseases, including amyotrophic lateral sclerosis (ALS). T-cell vaccination (TCV) was developed by Irun Cohen and coworkers at the Weizmann Institute of Science (Israel) during the late 1970s and has been demonstrated to be an effective treatment for human autoimmune diseases and a regulator of macrophage activation in animal models. We treated seven ALS patients with this cell therapy and were able to slow or stop disease progression in the affected individuals. The median survival, which is 3.5 years, was extended to 6 years. They were also treated with autologous adult neural stem cells associated with effector T cells. The observed neurologic improvements after treatment lasted for at least 1 year. Clinical recovery in the treated ALS patients was confirmed by an independent, skilled neurologist using the ALS Functional Rating Scale-Revised (ALSFRS-R). TCV in conjunction with an autologous neural stem cell treatment might be a feasible, minimally invasive, safe, and effective approach to obtain enduring therapeutic effects in ALS patients.

Introducción: las lesiones esofágicas tienen una alta mortalidad y un tratamiento aún controvertido. Por su baja frecuencia de presentación estas lesiones tienen un problema diagnóstico y terapéutico importante. El objetivo es mostrar los resultados de nuestra serie y distintas opciones de tratamiento. Material y método: se analizaron en forma retrospectiva 20 pacientes con perforación esofágica excluyendo las fístulas esófago-aéreas, las perforaciones neoplásicas espontáneas y las fallas de sutura. Se estudia la mortalidad en relación con la forma clínica de presentación, tiempo de evolución y al procedimiento terapéutico realizado. Resultados: las causas más frecuentes de la serie fueron la instrumental (35%) y la ruptura espontánea (30%). El dolor torácico, el derrame pleural y la fiebre fueron los síntomas más constantes. Se señalan distintas opciones terapéuticas, siendo la sutura primaria con o sin refuerzo el procedimiento más utilizado. La mortalidad global fue de 40%. Conclusiones: el tratamiento debe adecuarse a cada paciente y situación, reservándose el tratamiento médico para casos seleccionados. La forma clínica de presentación tiene un importante valor pronóstico.

a cirugía trqueal ofrece cada día mayores posibdes terapéuticas. Exige para su realización un quipo quúrgico bien enrenado, en el cual la cola·borción y complementación entre el cirujano y el nesssa s undmental para asegurar una correca ventlación del paciente en todo el desarrollo de la operación. Debe estblecerse siempre un plan quiúrico pevio, que partiendo de una correcta oporunidd operatoria, no ólo asegure una ventilación decuda, ino también un abordaje preciso, una exposición suficiente, con consevación de la irrigación trqueal y una r

El empiema pleural crónico sigue siendo un grave problema asistencial por lo complejo de las soluciones terapéuticas. Se presentan 41 pacientes, 15 de ellos sometidos a toracostomía abierta temporaria; en nueve se procedió al cierre quirúrgico, en seis el cierre fue espontáneo. En 26 casos la toracostomía abierta fue definitiva.

El tema se encara considerando las dificultades técnicas que se le presentan al cirujano general durante el transcurso de las resecciones pulmonares más frecuentes o factibles: las resecciones parciales atípicas, y las lobectomías superiores derecha e izquierda

Se presentan 11 casos de embolización terapéutica de las arterias brónquicas e intercostales en enfermos con hemóptisis, analizándose el método, complicaciones y resultados, concluyendo en la importancia del método en la detención de las hemóptisis graves cuando existe una contraindicación quirúrgica.

El tórax en embudo es una malformación esternocondrocostal que adopta dos formas predominante, una central profunda y simétrica y otra ancha y asimétrica. Se presentan once casos operados de la primera, se hacen consideraciones sobre su patogenia, indicaciones de la cirugía y la técnica quirúrgica. Los resultados obtenidos fueron muy buenos. Se presentó una complicación inflamatoria que se resolvió con la extracción de la barra tutora y un hematoma alejado sin consecuencias.

Los a u tores analizan su experi enc ia c on 41 mediastinopleurotomías, señalando el valor diagnóstico del procedimíento en procesos mediastinales topografiados por delante del plano de la via aérea, con ausencia, en la serie presentada, de morbimortalidad.

Se presentan 15 hemoneumotórax espontáneos, 14 hombres y una mujer. Se consideran los aspectos patológicos, las características clínicas y radiológicas. Se insiste en la necesidad del avenamiento pleural de urgencia, en el estricto control clínico y radiológico; y se preconiza la necesidad de toracotomía precoz ante la persistencia de un sangrado activo, o de un coagulo• ma residual. La finalidad del tratamiento quirúrgico es efectuar hemostasis, ligar las vesículas de enfisema y provocar una pleurodesis por abrasión pleural

La perforación del esófago en la cavidad pleural como complicación alejada luego de una neumonectomía, es una complicación rara y a menudo fatal. Se presenta, un caso que la padece 4 años después de una neumonectomía izquierda. Se discuten los mecanismos patogénicos, el tratamiento empleado y se insiste en la necesidad de efectuar una terapéutica agresiva, debido a los habituales fracasos de las medidas conservadoras

Los autores realizan un estudio sobre 100 nódulos solitarios del pulmón sometidos a toracotomía y control anatomopatológico y comparan sus hallazgos con los de diferentes autores. Se insiste en la particularidad geográfica con predominio en esta serie del Q.H. o sus secuelas ( 53 % ) . Del estudio realizado surge que el mejor procedimiento diagnóstico es la toracotomía exploradora que expone además a un muy bajo riesgo ( 1 % ) por lo cual debe ser planteada sin dilaciones. La incidencia del cáncer en este tipo de lesiones es alta sobre todo por encima de los 50 años (44 % ) y la resección efectuada e.n esta etapa es la que da mayores posibilidades de sobrevida alejada.

En la cirugía por cáncer de pulmón la resección ampliada a la vía canalicular se plantea en dos situaciones: lobectomía ensanchada a bronquio fuente y neumonectomía ensanchada a carina. Se establecen las indicaciones de la lobectomía con resección anastómosis brónquica. Se define el candidato ideal y se concluye que existen indicaciones de necesidad y de elección. En la mayoría de los casos se realiza en los lóbulos superiores, fundamentalmente en el derecho. Las neumonectomías ensanchadas a carina son operaciones que se realizan con baja frecuencia y tienen una elevada morbimortalidad. Deben indicarse en pacientes rigurosamente seleccionados. Se insiste en la estrecha cooperación de un equipo integrado con anestesistas y patólogos. Se discute la necesidad de tratamiento complementario con radioterapia. La existencia de metástasis ganglionares en el sector subcarinal ó laterotraqueal bajo no constituyen contraindicaciones a la resección.

Se presenta un caso de perforación espontánea de esófago que fallece por hemorragia masiva, por ulceración de la aorta torácica consecutiva a una úlcera por decúbito, por tubo de drenaje.