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Evaluate the utility of routine rescanning of older, mild head trauma patients with an initial negative brain computed tomography (CT), who is on a preinjury antithrombotic (AT) agent by assessing the rate of delayed intracranial hemorrhage (dICH), need for surgery, and attributable mortality.

The enzyme-mimicking activity of iron oxide based nanostructures has provided a significant advantage in developing advanced molecular sensors for biomedical and environmental applications. Herein, we introduce the horseradish peroxidase (HRP)-like activity of gold-loaded nanoporous ferric oxide nanocubes (Au–NPFe2O3NC) for the development of a molecular sensor with enhanced electrocatalytic and colorimetric (naked eye) detection of autoantibodies. The results showed that Au–NPFe2O3NC exhibits enhanced peroxidase-like activity toward the catalytic oxidation of 3,3′,5,5′-tertamethylbenzidine (TMB) in the presence of H2O2at room temperature (25 °C) and follows the typical Michaelis–Menten kinetics. The autoantibody sensor based on this intrinsic property of Au–NPFe2O3NC resulted in excellent detection sensitivity [limit of detection (LOD) = 0.08 U/mL] and reproducibility [percent relative standard deviation (% RSD) = <5% for n= 3] for analyzing p53-specific autoantibodies using electrochemical and colorimetric (naked eye) readouts. The clinical applicability of the sensor has been tested in detecting p53-specific autoantibody in plasma obtained from patients with epithelial ovarian cancer high-grade serous subtype (EOCHGS, number of samples = 2) and controls (benign, number of samples = 2). As Au–NPFe2O3NC possess high peroxidase-like activity for the oxidation of TMB in the presence of H2O2[TMB is a common chromogenic substrate for HRP in enzyme-linked immunosorbent assays (ELISAs)], we envisage that our assay could find a wide range of application in developing ELISA-based sensing approaches in the fields of medicine (i.e., detection of other biomarkers the same as p53 autoantibody), biotechnology, and environmental sciences.

As part of the American Society of Anesthesiology Brain Health Initiative goal of improving perioperative brain health for older patients, over 30 experts met at the fifth International Perioperative Neurotoxicity Workshop in San Francisco, CA, in May 2016, to discuss best practices for optimizing perioperative brain health in older adults (ie, >65 years of age). The objective of this workshop was to discuss and develop consensus solutions to improve patient management and outcomes and to discuss what older adults should be told (and by whom) about postoperative brain health risks. Thus, the workshop was provider and patient oriented as well as solution focused rather than etiology focused. For those areas in which we determined that there were limited evidence-based recommendations, we identified knowledge gaps and the types of scientific knowledge and investigations needed to direct future best practice. Because concerns about perioperative neurocognitive injury in pediatric patients are already being addressed by the SmartTots initiative, our workshop discussion (and thus this article) focuses specifically on perioperative cognition in older adults. The 2 main perioperative cognitive disorders that have been studied to date are postoperative delirium and cognitive dysfunction. Postoperative delirium is a syndrome of fluctuating changes in attention and level of consciousness that occurs in 20%–40% of patients >60 years of age after major surgery and inpatient hospitalization. Many older surgical patients also develop postoperative cognitive deficits that typically last for weeks to months, thus referred to as postoperative cognitive dysfunction. Because of the heterogeneity of different tools and thresholds used to assess and define these disorders at varying points in time after anesthesia and surgery, a recent article has proposed a new recommended nomenclature for these perioperative neurocognitive disorders. Our discussion about this topic was organized around 4 key issues: preprocedure consent, preoperative cognitive assessment, intraoperative management, and postoperative follow-up. These 4 issues also form the structure of this document. Multiple viewpoints were presented by participants and discussed at this in-person meeting, and the overall group consensus from these discussions was then drafted by a smaller writing group (the 6 primary authors of this article) into this manuscript. Of course, further studies have appeared since the workshop, which the writing group has incorporated where appropriate. All participants from this in-person meeting then had the opportunity to review, edit, and approve this final manuscript; 1 participant did not approve the final manuscript and asked for his/her name to be removed.

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•Parry-Romberg syndrome (PRS) is a rare degenerative disorder.•We present a case of PRS complicated with lagophthalmus and corneal ulceration.•The orbit was reconstructed using a myofascial flap, iliac crest, and cranial bone grafts.•Reconstruction led to resolution of the ocular injuries.

ABSTRACTA public health response relies upon rapid and reliable confirmation of disease by diagnostic assays. Here, we detail the design and validation of two variola virus-specific real-time PCR assays, since previous assays cross-reacted with newly identified cowpox viruses. The assay specificity must continually be reassessed as other closely related viruses are identified.

Coding Perspective for this article is on page 1278.

Surgery induces a variety of metabolic, endocrine, and immune changes collectively known as the “stress response,” which may often lead to prolonged postoperative convalescence. Anesthetic management may modulate this physiological response, thus affecting the postoperative course. We hypothesized that the intraoperative administration of dexmedetomidine (DEX), a sympatholytic agent, would reduce the stress response and improve the quality of recovery in patients undergoing major surgery.

Injured patients who are not transported by an ambulance to the hospital are often not included in trauma registries. The outcomes of these patients have until now been unknown. Understanding what happens to nontransports is necessary to better understand triage validity, patient outcomes, and costs associated with injury. We hypothesized that a subset of patients who were not transported from the scene would later present for evaluation and that these patients would have a nonzero mortality rate.

Acute blood pressure (BP) elevations in neurosurgical patients are associated with serious neurologic, cardiovascular, or surgical site complications. Clevidipine, an ultra-short-acting dihydropyridine calcium antagonist, has been shown to be efficacious and safe for acute hypertension in cardiac surgery. This study assessed the efficacy and safety of clevidipine in controlling perioperative hypertension in the neurosurgical setting.

Perforator flap breast reconstruction is an accepted surgical option for breast cancer patients electing to restore their body image after mastectomy. Since the introduction of the deep inferior epigastric perforator flap, microsurgical techniques have evolved to support a 99 percent success rate for a variety of flaps with donor sites that include the abdomen, buttock, thigh, and trunk. Recent experience highlights the perforator flap as a proven solution for patients who have experienced failed breast implant–based reconstructions or those requiring irradiation. Current trends suggest an application of these techniques in patients previously felt to be unacceptable surgical candidates with a focus on safety, aesthetics, and increased sensitization. Future challenges include the propagation of these reconstructive techniques into the hands of future plastic surgeons with a focus on the development of septocutaneous flaps and vascularized lymph node transfers for the treatment of lymphedema.

•High temperature increases 8-OHdG and dsDNA expressions in tissues of American oyster•High temperature induces cellular apoptosis and oxidative stress in oysters•High temperature decreases extrapallial fluid protein concentrations in oysters.

This study was designed to characterize the amount of androgen implant and the time period necessary to cause sexual inversion in sevenband grouper Epinephelus septemfasciatusand to determine whether administration of follicle-stimulating hormone (FSH) with or without androgens had any effect on the sexual state of this species. Seventy-two fish were treated with 10 µg of recombinant FSH/kg body weight (BW) or saline control in cocoa butter. Two days later, cocoa butter and a-cellulose pellet implants of control, 0.1 mg of low-androgen mixture (LoAN)/kg BW, or 5 mg of high-androgen mixture (HiAN)/kg BW were injected into the same fish. Fish were sampled after 3 and 5 weeks. Gonadosomatic indices (GSIs) at 3 weeks for FSH, HiAN, and FSH+HiAN treatment groups were significantly lower than the control values. At 5 weeks, no significant difference was observed, although the GSIs for HiAN treatment groups were lowest at both sampling points. The highest GSI values recorded were in the FSH-only treatment group at 5 weeks. All the controls remained in the immature female state throughout the study. High-dose androgen levels caused sexual transition of gonadal tissue at 3 weeks with spermatocytes present in all individuals. At 5 weeks, all individuals in the HiAN treatment group had complete inversion to male gonad, and sperm sinus development occurred in four individuals. However, incomplete sexual inversion was observed in the FSH+HiAN treatment groups with some ovarian tissue persisting even at 5 weeks. Exogenous FSH treatment alone appears to stimulate ovarian growth in the postspawning period. The 3-week period of sexual transition in this study is one of the shortest time periods recorded for grouper sexual inversion. This may be due to androgen treatment in the postspawning period, the proposed period of natural sex change in several grouper species.

The article discusses the advantage of applying a back-to-basics approach to firefighting training and tactics to improve fireground safety. Risks associated with firefighting may be decreased by identifying elements that lead to injury or death, particularly by taking an introspective view of how firefighters prepare and perform on the fireground. The 16 Firefighter Life Safety Initiative were organized and produced by fire service leaders in the U.S. to help reduce injuries and death.

The article focuses on the approach developed to secure safety of firefighters when in the line-of-duty in the U.S. Fire Administrator deputy Charles Dickinson emphasized that fatalities among firefighters could be avoided by enhancing safety procedures such as using seat belts or reducing speed while responding or better training. The fundamental key to address responder safety is by establishing department leadership with identified apparatus response and operations. A roadway safety regulation has been adopted to reduce the risk while working in traffic.

Objective: To test the hypothesis that comorbid medical conditions can predict length of hospital stay and incidence of postoperative complications.

Capturing the sun's awesome energy in space, above the earth's dense, cloudy atmosphere, has been a dream of solar-energy proponents for more than a decade. In the 1960s the success of the space program and the interest in solar energy led to the proposed synergism of solar energy conversion and space technology to send power from space to earth. Thus was born the concept for the Solar Power Satellite (SPS). As conceived, the SPS would convert solar energy to microwaves and beam the energy to collecting antennas on the ground for conversion to usable electricity.

Cardiac Purkinje fibres are important in cardiac electrophysiology and pathology due to their specialized role in the ventricular conducting system, and their properties as a second cardiac pacemaker1. Changes in extracellular K+activity (K0) affect the conduction velocity2and the natural automatic rate of the Purkinje fibre3. Both anatomical4and electrophysiological5,6studies of the Purkinje fibres have demonstrated the possibility of K0fluctuations in the narrow intercellular clefts. We investigated, using K+selective electrodes, the effect of the K0fluctuations observed during activity in canine Purkinje fibres. Summation of K0fluctuations during single action potentials leads to elevation of baseline K0during rapid trains. However, unlike in ventricular muscle where depolarization is seen7,8, membrane potential in non-automatic Purkinje fibres hyperpolarizes in response to rapid beating. Prolonged depletions of extracellular K+following long periods of overdrive are associated with slowly changing membrane currents, which markedly influence automaticity, action potential duration, and membrane potential.

When patients with gynecologic malignancies undergo exploratory surgery, hepatic lesions suggestive of malignancy are occasionally encountered. In 18 patients undergoing laparotomy for gynecologic cancer, visible liver lesions suggestive of malignancy were biopsied with the loop electrosurgical excision procedure (LEEP). Hemostatic suture placement was required in 3 of these 18 patients, and in 15, hemostasis was achieved with electrocautery only. Three of the 18 biopsies (16.7%) were positive for malignancy. No intraoperative or postoperative complications were attributed to the liver biopsy. One patient required postoperative transfusion of 2 units packed red blood cells. A new technique is described using the LEEP to remove suspicious lesions during exploratory laparotomy in patients with gynecologic malignancies.

Postoperative intravenous pyelography was performed in 233 patients with stage IB cervical carcinoma treated with radical hysterectomy and pelvic lymphadenectomy between January 1962 and December 1985. Four patients developed symptoms of ureteral injury, two (0.8) ureteral fistulae, and one (0.4) stricture and obstruction due to recurrent carcinoma. No ureteral injuries were observed in 229 asymptomatic patients. A 5.2 incidence of transient severe ureteral dilatation occurred in asymptomatic patients, but resolved within a median of 94 days. A significant urinary tract anomaly was observed in 3.4 of preoperative pyelograms. All of these anomalies were apparent at surgery and presented no intraoperative difficulties. Three patients (1.3) sustained intraoperative ureteral transections, which were diagnosed and repaired without sequelae. In patients with early cervical carcinoma having primary operative treatment, the role of routine preoperative and postoperative intravenous pyelography is questionable.

1. Double barrel potassium‐sensitive micro‐electrodes were used to measure fluctuations in extracellular potassium ion concentration in large automatic canine Purkinje fibres.

Two hundred twenty-nine patients with Stage IB cervical cancer treated with radical hysterectomy were assigned to the new FIGO substages IB1 (n= 181) and IB2 (n= 48) based on clinical tumor diameter. Our purpose was to determine the impact of the new staging system for IB1 and IB2 cervical cancer on nodal status and survival. Additionally, we analyzed the morbidity of radical hysterectomy in light of the new staging system. The complications were similar between the two groups. Para-aortic lymphadenectomy was the only independent predictor of complications (P= 0.00026). Stage IB2 patients did have a significantly worse 5-year survival (72.8%) when compared with IB1 (90.0%) (P= 0.0265). Multivariate stepwise logistical regression analysis indicated that the new staging system did not have an independent impact on survival. Stage acts through nodal status in its impact on survival. Positive lymph nodes, tumor diameter, and Ponderal Index are all independent predictors of survival (P= 0.0001). Patients with Stage IB2 carcinoma of the cervix undergoing radical hysterectomy showed no significant increase in morbidity when compared with patients with Stage IB1 disease treated with the same procedure.

During cesarean section, operative complications include injury to the uterus, urinary tract, and bowel. A variety of types of fetal injuries have been reported, and some are associated with permanent handicap. The relative risk of intraoperative complications varies widely depending on such clinical variables as gestational age, station of the presenting part, and the experience of the operating physician. Ideally, each physician should be able to review his or her rate and type of complications so that continuous improvement in technique is fostered.

Unscreened blood transfusions continue to be one of the major modes of transmission of the human immunodeficiency virus (HIV) in developing countries, such as in Central Africa, where 5% to 18% of blood donors are HIV seropositive. We evaluated a rapid latex agglutination assay using a novel recombinant envelope polypeptide of HIV for the detection of HIV antibodies among 2820 blood donors and clinical patients from diverse geographic regions, including on-site testing in Central Africa of 1600 blood donors. Overall, 29.2% of the serum samples were positive by Western blot assay. On a single determination, the latex agglutination slide test was found to be highly sensitive and specific compared with Western blot results in these populations with a relatively high prevalence of infection. Use of this assay will allow the immediate implementation of serologic screening for HIV in developing areas of the world, where standard screening procedures are impractical or not available, and in many other clinical settings, such as sexually transmitted diseases clinics and hospitals, where testing and counseling could be promptly implemented.(JAMA 1988;260:510-513)

The turbo-gracilis flap, which has been described previously for the purpose of extending the unreliable gracilis skin island, and previously applied in forearm reanimation surgery, is now adapted for reconstruction in the perineal region. We present a case report of a patient with previous vulvar carcinoma treated with resection and radiation who presented with a very large defect of the perineal region. Reconstruction was carried out using a turbo-gracilis flap. The advantages of the flap are well demonstrated in the successful reconstruction, in that it provides an extensive amount of well-vascularized tissue due to an extended gracilis skin island which is vascularized by way of a vein graft from the proximal pedicle blood supply to a distal gracilis pedicle which, in turn, supplies the extended skin island. This allows an extensive amount of tissue to be harvested from a single donor site and ensures the viability of the skin island. A review of the advantages and disadvantages of various types of perineal reconstruction is also presented and contrasted with the turbo-gracilis method.

The authors evaluated the impact of body mass on survival and morbidity of patients with new International Federation of Gynecology and Obstetrics (FIGO) Stage IB1 and IB2 cervical carcinoma managed with radical hysterectomy. Two hundred twenty-nine patients with Stage IB1 or IB2 cervical carcinoma treated with radical hysterectomy were studied in a multivariate logistic regression analysis. The body mass index (BMI) and the ponderal index (PI) were used as measures of body mass and were analyzed as predictors of recurrence, survival, and complications in light of the new staging system. Twenty-seven of 229 patients died of recurrent disease. A low BMI or a high PI were predictive of poor survival. Tumor greatest dimension, lymph node involvement, BMI, and PI were all independent predictors of survival (P = 0.0006). The only independent predictor of complications was para-aortic lymph node dissection (P = 0.0026). Cervical carcinoma patients with a low body mass, as indicated by a low BMI or a high PI, were found to have poor survival after undergoing radical hysterectomy. Additional predictors of poor survival included lymph node metastases and increased tumor size. BMI and PI are more important predictors of survival than the new FIGO Stages IB1 and IB2. Body mass is not predictive of complications. Cancer 1998;83:98-102. © 1998 American Cancer Society.

Arrhythmias occur 24 h after occlusion of the left anterior descending (LAD) coronary artery in the canine heart and have been attributed to the abnormal spontaneous activity in subendocardial Purkinje fibers, which are markedly depolarized. The major current underlying normal automaticity in these fibers is if. Although the ifactivation range is generally considered to be more negative than the diastolic membrane potential in these depolarized fibers in infarcts, this activation range has been shown to shift in a positive direction in response to hormonal influences. Thus ifcould still mediate automaticity in these fibers in infarcts. Furthermore, recent reports indicate that a depolarizing diastolic current, probably if, also can be measured in ventricular muscle during abnormal experimental conditions, which may occur during ischemia. To test whether there is a role of ifcurrents in sustaining ventricular ectopy, we administered the selective ifchannel blocker, zatebradine, 24 h after LAD ligation in canine hearts. We report that intravenous injections of zatebradine (0.25 or 1.0 mg/kg) significantly slow ventricular rhythms (with average reductions of 19 or 26%, respectively). Moreover, because zatebradine also slows sinus nodal rate, it can lead to an increased incidence of ectopic beats. However, during right atrial pacing, when sinus slowing has no effect on ventricular rhythms, capture of ventricular rhythms occurs at lower rates in the presence of zatebradine. The reduction of capture threshold is comparable to the reduction in the rate of the ectopic rhythm. Thus zatebradine eliminated the arrhythmia when the right atrium was paced at the original sinus rate.

Although fistula-in-ano was one of the earliest diseases to affect mankind, its association with carcinoma was not reported in the medical literature until the early part of this century. This association may manifest itself in several ways: (1) a fistula may be associated with cancer elsewhere in the colon; (2) cancer, either primary or recurrent, may present as a fistula; or (3) cancer may develop in a fistula-in-ano. This paper concerns the third situation.The development of cancer in fistulous tracts or draining sinuses has not been limited to fistula-in-ano. McAnally and Dockerty reported nine cases of carcinoma in sinuses of chronic osteomyelitis and one in a chronic empyema tract. Gillis and Lee described 34 cases in which carcinoma appeared at the site of war wounds sustained 18 to 31 years previously. A squamous-cell carcinoma arising in a pilonidal sinus which had been present for 20 years was reported by

The article focuses on the International City/County Management Association's (ICMA) seminar which aimed at asking the right questions of police and fire chiefs to offer a means to continuous improvement for public safety providers. The seminar is being marketed to ICMA members as an outline to qualify service levels and determine department right-sizing. The reasons for offering the assessment of the ICMA seminar are cited.

SEVERAL investigations have suggested a role for K+in the generation of the transmembrane potential during spontaneous rhythm1,2and following vagal inhibition3,4of the sinoatrial node (SA node) of the heart5. Voltage-clamp studies1,2in the rabbit SA node have shown a voltage- and time-dependent increase in the outward current on depolarisation and a slow decay of the outward current on repolarisation to the holding potential. The hyperpolarisation and slowing of automaticity following vagal stimulation or acetylcholine (Ach) application is believed to be due to an increase in potassium permeability3,4. The purpose of the present study was to use K+-sensitive microelectrodes6,7to examine the time course and the magnitude of K+efflux and extracellular accumulation in the isolated rabbit SA node during spontaneous rhythm and following vagal stimulation. Our results confirm that K+permeability of the sinoatrial pacemaker cell is increased following vagal stimulation and demonstrate K+accumulation in the extracellular space for several seconds. Beat-to-beat extracellular potassium transients are linked to the repolarisation process as well as to diastolic depolarisation.

The article discusses issues related to structural firefighting activities and potential risks associated to combat fire. Topics discussed include ways to decrease entanglement during structural fire attack, reducing the potential of entanglement to streamline turn-out-gear (TOG), reducing dangling items to remain streamlined and factors responsible for promoting entanglement and how firefighter can combat that.

The article offers information on the 2015 International Fire/Emergency Medical Service (EMS) Safety and Health Week to be held in the U.S. from June 14-20. The event will highlight themes such as emergency management, highway safety measures, cancer awareness, and firefighter training safety. The author believes that firefighter injuries can be reduced by implementing a Training Safety Officer (TSO) program.

The article offers information on the Training Safety Officer (TSO) program which aims to lessen injuries during the fire department training activities in Minnesota. Topics include the importance of the TSO program, the role of the safety officer in the American fire service, and the development of a safety plan for the training session among firefighters.

The article examines whether traditionally accepted aggressive fire attack techniques can coexist with fire-ground safety. It discusses the cultural shift within the fire service of finding balance between fire-ground aggressiveness and safety. It also considers the changes in the dynamics of the modern fire-ground and the shift from legacy type construction to modern light-weight construction.

The article offers the author's insights on the importance of safety and responsibility, which are central to becoming a firefighter. Topics discussed include the culture of safety develops the core of a sound risk management program, the impact of firefighter's commitment on safety outcomes, and the existing 16 Firefighter Life Safety Initiatives.

The G protein-coupled receptor 54 (GPR54) and its natural ligand Kisspeptin have been shown to exert a strong stimulatory influence on gonadotropin-releasing hormone (GnRH) release in several mammalian species. In addition, GPR54 mRNA has been localized on the neurons expressing three forms of GnRH in tilapia. However, a natural ligand for GPR54 has not been identified in any non-mammalian species. In the present study, the cDNA of GPR54 was isolated from the brain of Atlantic croaker, Micropogonias undulatus and levels of GPR54 and three GnRH mRNAs were quantified in dissected brain areas by real-time quantitative RT-PCR. This study revealed expression of three GnRH mRNAs in discrete brain areas consistent with their localization by in situ hybridization. Interestingly, GPR54 mRNA expression also was higher in anterior brain regions where GnRH neurons have been localized. In addition, GPR54 protein was co-localized on GnRH neuronal elements by immunocytochemistry, thereby providing a morphological basis for GPR54-mediated actions on the GnRHs in fish at multiple levels of the neuroendocrine organization, including the preoptic-anterior hypothalamic area (POAH) and pituitary gland. The GPR54 protein concentration determined by Western blots was higher in the brains of gonadally mature croaker when compared to that in immature fish suggesting that the up regulation of GPR54 may be related to reproductive maturation in this species. Moreover, initial studies demonstrate that mammalian Kisspeptin stimulates both the in vivo synthesis of seabream GnRH (GnRH-I) in the POAH and its release from POAH and pituitary slices incubated in vitro. Taken together, these data strongly suggest that the Kisspeptin- GPR54 neuroendocrine pathway controlling GnRH may be functional also in fish. To our knowledge, this is the first report of the stimulatory effects of Kisspeptin on both the synthesis and release of GnRH in a nonmammalian vertebrate. This novel finding will help expedite the search for Kisspeptin or Kisspeptin-like ligand of GPR54 in fish, and possibly in other non-mammalian vertebrates. This study was supported by grants from NIH and Sid Richardson Memorial Fund. (platform)

The article focuses on various fire-fighter safety initiatives implemented and planned by fire services in the U.S. The U.S. Navy developed the Human Factor Analysis and Classification System (HFACS) to analyze near-miss events. Information sharing is adopted by the Minnesota State Fire Chiefs Association as one of its primary goals for 2007.