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Purpose: Haemorrhagic shock remains a leading preventable cause of death amongst trauma patients. Failure to identify retroperitoneal haemorrhage (RPH) can lead to irreversible haemorrhagic shock. The arteries of the middle retroperitoneal region (i.e., the 1st to 4th lumbar arteries) are complicit in haemorrhage into the retroperitoneal space. However, predictive injury patterns and subsequent management implications of haemorrhage secondary to bleeding of these arteries is lacking., Materials and Methods: We performed a retrospective cohort study of patients diagnosed with retroperitoneal haemorrhage who presented to our Level-1 Trauma Centre (2009-2019). We described the associated injuries, management and outcomes relating to haemorrhage of lumbar arteries (L1-4) from this cohort to assess risk and management priorities in non-cavitary haemorrhage compared to RPH due to other causes., Results: Haemorrhage of the lumbar arteries (LA) is associated with a higher proportion of lumbar transverse process (TP) fractures. Bleeding from branches of these vessels is associated with lower systolic blood pressure, increased incidence of massive transfusion, higher shock index, and a higher Injury Severity Score (ISS). A higher proportion of patients in the LA group underwent angioembolisation when compared to other causes of RPH., Conclusion: This study highlights the injury patterns, particularly TP fractures, in the prediction, early detection and management of haemorrhage from the lumbar arteries (L1-4). Compared to other causes of RPH, bleeding of the LA responds to early, aggressive haemorrhage control through angioembolisation. These injuries are likely best treated in Level-1 or Level-2 trauma facilities that are equipped with angioembolisation facilities or hybrid theatres to facilitate early identification and management of thoracolumbar bleeds., Competing Interests: Declaration of Competing Interest We declare no financial or personal interest or belief that could affect the objectivity and validity of this research., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Low muscularity and malnutrition at intensive care unit (ICU) admission have been associated with negative clinical outcomes. There are limited data available evaluating the validity of bedside techniques to measure muscle mass in critically ill adults. We aimed to compare bedside methods for muscle mass assessment [bioimpedance spectroscopy (BIS), arm anthropometry and subjective physical assessment] against reference technology [computed tomography (CT)] at ICU admission., Methods: Adults who had CT scanning at the third lumbar area <72 h after ICU admission were prospectively recruited. Bedside methods were performed within 48 h of the CT scan. Pearson's correlation compared CT muscle area with BIS-derived fat-free mass (FFM) (kg) and FFM-Chamney (kg) (adjusted for overhydration), mid-upper arm circumference (cm) and mid-arm muscle circumference (cm). Depleted muscle stores were determined using published thresholds for each method. Cohen's kappa (κ) was used to evaluate the agreement between bedside and CT assessment of muscularity status (normal or low)., Results: Fifty participants were enrolled. There were strong correlations between CT muscle area and FFM values and mid-arm muscle circumference (P < 0.001). Using FFM-Chamney, all six (100%) participants with low CT muscle area were detected (κ = 0.723). FFM-BIS, arm anthropometry and subjective physical assessment methods detected 28%-38% of participants with low CT muscle area., Conclusions: BIS-derived FFM using an adjustment algorithm for overhydration was correlated with CT muscle area and had good agreement with muscularity status assessed by CT image analysis. Arm anthropometry and subjective physical assessment techniques were not able to reliably detect participants with low CT muscle area., (© 2020 The British Dietetic Association Ltd.)

Artificial seawater and freshwater microcosms inoculated with raw sewage were set up to compare the persistence of microbial source tracking (MST) markers (i.e. Bacteroides thetaiotaomicron (B. theta), Methanobrevibacter smithii (M. smithii), human polyomaviruses JC and BK (HPyVs)) and human adenoviruses under different sunlight intensity and salinity. PMA pretreatment successfully eliminated the false-positive detection of dead bacterial cells in the model-development experiment. The results were then validated using real environmental matrices in microcosms inoculated with raw sewage. The genome concentrations of the targets followed a first-order decay pattern with 90% reduction of the initial amounts in <5days for both artificial and natural surface waters. Decay rate constant (k 1 ) were developed microorganisms in artificial water matrices. Due to the different water environment conditions, improved decay rates (k 2 ) incorporated with sunlight, TSS and TOC adjustment coefficients were used for validation of the natural water matrices. Based on the predictive squared correlation coefficient (Q 2 F ) and root-mean-square error (RMSE) validation criteria, the improved k 2 were able to provide better prediction on the survival of target microorganisms in environmental surface waters (Q 2 F >0.6 and RMSE ranged from 0.05 to 1.81). For microbial source tracking purposes, HPyVs are suggested to be better MST markers in freshwater, while B. theta is recommended for seawater based on the decay models developed in this study. The targeted DNA of M. smithii should only be used to indicate recent human faecal pollution in surface waters due to their faster decay than human adenoviruses., (Copyright © 2016 Elsevier B.V. All rights reserved.)