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Crimean-Congo hemorrhagic fever virus (CCHFV) causes severe human disease. The CCHFV medium RNA encodes a polyprotein which is proteolytically processed to yield the glycoprotein precursors PreGn and PreGc, followed by structural glycoproteins Gn and Gc. Subtilisin kexin isozyme-1/site-1 protease (SKI-1/S1P) plays a central role in Gn processing. Here we show that CCHFV-infected cells deficient in SKI-1/S1P produce no infectious virus, although PreGn and PreGc accumulated normally in the Golgi apparatus, the site of virus assembly. Only nucleoprotein-containing particles which lacked virus glycoproteins (Gn/Gc or PreGn/PreGc) were secreted. Complementation of SKI-1/S1P-deficient cells with a SKI-1/S1P expression vector restored release of infectious virus (>10(6) PFU/ml), confirming that SKI-1/S1P processing is required for incorporation of viral glycoproteins. SKI-1/S1P may represent a promising antiviral target.

We discuss the case of a 72-year-old female, Asiatic patient who had transdiaphramatic migration of stones after laparoscopic cholecystectomy for a gangrenous cholecystitis. The patient presented with a right thoracic empyema and underwent thoracic decortication. The pertinent literature is reviewed. Pathology and clinical presentation are discussed.

Background: This study was designed to show the importance of age, presence of premorbid conditions, and the type of injury on time and location of adult inhospital trauma mortality., Methods: All acute blunt trauma deaths at a Level I urban trauma center between April 1, 1993 and March 31, 2003 were individually reviewed to collect data on the following variables: age, gender, presence and number of premorbid conditions, mechanisms of trauma, location of death, acute transfer from another hospital, delay to death, initial Glasgow Coma Score (GCS), Abbreviated Injury Score (AIS), Injury Severity Score (ISS), and revised trauma score (RTS). Bivariate analysis using simple logistic regression was used to show the association between each variable and delay to death. Variables significantly associated with death underwent multivariate analysis to yield adjusted odds ratios (aORs) with 95% confidence interval (CI)., Results: During the study period there were 463 blunt trauma deaths (6.8%). Their mean age was 67.5 years, mean ISS was 22.6, mean GCS was 11.0, and 55.3% were male. Most deaths occurred in either the intensive care unit (45.8%) or the ward (46.4%); there were few deaths in the emergency department (6.8%) or the operating room (0.4%). The following were significant bivariate predictors for death: presence of premorbid conditions, number of premorbid conditions, age >60, pulmonary diseases, cardiac diseases, diabetes mellitus, neurologic diseases, GCS, AIS > or =4, and ISS. Multivariate analysis demonstrated the following significant findings: patients with severe thoracic injuries were significantly more likely to die in the first 6 hours (aOR = 1.37; CI = 1.12-1.68; p = 0.002); and patients with severe head injuries were more likely to die after 48 hours (aOR = 1.275; CI = 1.158-1.405; p = 0.0001). Older patients and those with neurologic diseases were more likely to die later and in a hospital ward (aOR = 2.18; CI = 1.25-3.81; p = 0.006). Men and women differed as to age, ISS, mechanism of injury, and type of injury, but not as to delay to death., Conclusions: Age, body area injured, and presence and type of premorbid conditions are significant predictors of location of and delay to death after blunt trauma. We think that incorporating information on premorbid conditions is essential for mortality analysis in an aging population.

Background: Trauma care of thoracic and abdominal injuries is currently in turmoil because of both a decrease in the number of these injuries and a concomitant increase in their nonsurgical management. The goal of this study was to evaluate the incidence of thoracic and abdominal injuries in the province of Quebec and the number of associated surgical procedures., Methods: Patients with blunt thoracic or abdominal injuries taken to a tertiary trauma center in the province of Quebec from April 1, 1998 to March 31, 2002 were identified. Patients who were dead on arrival were excluded. Only patients with an Abbreviated Injury Scale score > or =2 for the thoracic or abdominal regions were included., Results: During the study period, a total of 16,430 blunt trauma patients were admitted to one of the four trauma centers. A total of 2,660 (16.2%) patients sustained thoracic and/or abdominal injuries with an Abbreviated Injury Scale score >1. Among these, the median Injury Severity Score was 24 (range: 4-75) and the in-hospital mortality rate was 11.0%. There were 2,196 patients (82.5%) with thoracic injuries, 977 patients (36.7%) with abdominal injuries, and 520 patients (19.5%) with injuries to both regions. A surgical intervention was undertaken in 76 patients with thoracic injuries (3.5%) and in 414 patients with abdominal injuries (42.3%). On average, 4.7 thoracic and 28.8 abdominal trauma procedures were performed per center, yearly. Each trauma surgeon performed, on average, less than one thoracic and less than five abdominal trauma procedures yearly., Conclusions: The incidence of blunt thoracic and abdominal injuries needing surgical intervention is low in Quebec tertiary trauma centers. The competence of general surgeons in trauma-related procedures might be compromised by such low patient volume unless they frequently perform non-trauma surgical procedures. We think that in Quebec, trauma care must be provided by surgeons who practice both acute emergency and elective surgical care in addition to trauma care. These findings should have an important impact on the development of on-going education and resident training programs.

Purpose: To compare the in vitro bactericidal and anti-adhesion properties of vancomycin-based microparticles and lyophilized vancomycin and estimate their relevance to perioperative antibiotic prophylaxis and endophthalmitis prevention., Setting: University research laboratory, Lyon, France., Methods: The bactericidal and anti-adhesion properties of a newly designed drug-delivery system were assessed on Staphylococcus epidermidis clinical strain N890074 containing the intercellular adhesion locus ica. Lyophilized vancomycin at 20 mug/mL was used as a standard. The new drug-delivery system, designed for the study, consisted of sterile, biocompatible, and biodegradable microparticles with continuous release of vancomycin. To obtain bacterial killing and anti-adhesion curves, experiments were first performed in a bacterial suspension containing 1000 colony-forming units per milliliter. Experiments were then performed with intraocular lenses incubated in the suspension. Efficacy was investigated by bacterial counts and scanning electron microscopy observations., Results: The bactericidal and anti-adhesion effects of vancomycin-based microparticles started after 3 hours (P<.002) and 1 hour (P<.001), respectively, and of lyophilized vancomycin, after 1 hour (P = .004) and 1 hour (P<.001), respectively. There was no difference between the 2 forms of vancomycin in the bactericidal effect starting at 21 hours and the anti-adhesion effect starting at 6 hours (P>.05)., Conclusions: The newly designed vancomycin-based microparticles showed relevant antibacterial and anti-adhesion properties after releasing a sufficient antibacterial quantity, proving that vancomycin remains efficient after undergoing the encapsulation process.

Background: The International Classification of Disease Injury Severity Score (ICISS) and the Trauma Registry Abbreviated Injury Scale Score (TRAIS) are trauma injury severity scores based on probabilities of survival. They are widely used in logistic regression models as raw probability scores to predict the logit of mortality. The aim of this study was to evaluate whether these severity indicators would offer a more accurate prediction of mortality if they were used with a logit transformation., Methods: Analyses were based on 25,111 patients from the trauma registries of the four Level I trauma centers in the province of Quebec, Canada, abstracted between 1998 and 2005. The ICISS and TRAIS were calculated using survival proportions from the National Trauma Data Bank. The performance of the ICISS and TRAIS in their widely used form, proportions varying from 0 to 1, was compared with a logit transformation of the scores in logistic regression models predicting in-hospital mortality. Calibration was assessed with the Hosmer-Lemeshow statistic., Results: Neither the ICISS nor the TRAIS had a linear relation with the logit of mortality. A logit transformation of these scores led to a near-linear association and consequently improved model calibration. The Hosmer-Lemeshow statistic was 68 (35-192) and 69 (41-120) with the logit transformation compared with 272 (227-339) and 204 (166-266) with no transformation, for the ICISS and TRAIS, respectively., Conclusions: In logistic regression models predicting mortality, the ICISS and TRAIS should be used with a logit transformation. This study has direct implications for improving the validity of analyses requiring control for injury severity case mix.

Background: Benchmarks are used in trauma care for program evaluation, quality improvement, and research. National outcome benchmarks relevant to the Canadian trauma population need to be defined for evaluation of trauma care in Canada. The purpose of this study was to derive survival probabilities associated with trauma diagnoses using International Classification of Diseases, Ninth Revision (ICD-9) codes., Methods: All patients admitted to an acute care hospital with nonpenetrating trauma and submitted to the National Trauma Registry of Canada between 1994 through 2000 inclusively were included in analyses. Both inclusive and exclusive survival risk ratios (SRRs) were calculated for groups of ICD-9 injury codes between 800 to 959., Results: For the study period, there were 1,003,905 and 803,776 eligible trauma patients used to calculate inclusive SRRs and exclusive SRRs, respectively. Survival probabilities for injuries are given according to ICD-9 codes., Conclusion: This is the first study to define national survival benchmarks for the Canadian trauma population. These results can be used to assess survival of patients using the ICISS [(ICD-9) based Injury Severity Score (ISS)] methodology. With regular updates, these data can further be developed for continual trauma outcome assessment, quality improvement, and research into trauma care in Canada.

Bone morphogenetic proteins (BMPs) and 45S5 Bioglass microspheres (bioactive GM) can increase the differentiation of osteoblasts. Recombinant human BMP-2 (rhBMP-2) is presently the BMP most frequently used in delivery systems and it has already been used in clinical bone healing studies. We have developed a delivery system that combines a collagen Type I gel, BMP and bioactive GM. Since BMP-9 seems to be more osteogenic than BMP-2, we compared the differentiation of MC3T3-E1 preosteoblasts induced by our delivery system containing either a peptide derived from BMP-9 (pBMP-9), or rhBMP-2, both at 100 ng/mL. After 5 days, alkaline phosphatase staining showed that pBMP-9 induced more differentiation than rhBMP-2 in all experimental conditions. Also, bioactive GM increased this BMP effect. Since preosteoblasts secreted matrix metalloproteinases (MMPs) that can degrade collagen, we then studied the influence of the delivery system on MMPs production. We observed that MMP-2 was the major MMP involved in all experimental conditions. In addition, pBMP-9 with bioactive GM generated less MMP-2 than did rhBMP-2 on days 3 and 5. Thus, a delivery system using collagen Type I gel with pBMP-9 and bioactive GM seems to be a promising system for bone regeneration.

In the last few years, regulations for biomolecule production, and especially for extraction and purification of animal molecules such as collagen, have been reinforced to ensure the sanitary safety of the materials. To be authorized to market biomaterials based on collagen, manufacturers now have to prove that at least one step of their process is described in guidelines to inactivate prion, viruses, and bacteria. The present study focuses on the inactivation step performed during the extraction and purification of porcine type I atelocollagen. We chose to determine the reduction factor of a 1 M NaOH step on porcine parvovirus and four bacterial strains inactivation. During the extraction step, we deliberately inoculated the collagen suspension with the different microorganisms tested. Then, 1 M NaOH was added to the suspension for 1 hour at 20 degrees C. We demonstrated that this treatment totally inactivated S. aureus, P. aeruginosa, C. albicans and A. niger which are bacterial strains responsible of severe human pathology. The reduction factors reached more than 4 logs for B. cereus spores and 4 logs for the porcine parvovirus. are encouraging as those two microorganisms are known to be very resistant to inactivation.

The permanent contact between the nipple part of pacifiers and the oral microflora offers ideal conditions for the development of biofilms. This study assessed the microbial contamination on the surface of 25 used pacifier nipples provided by day-care centers. Nine were made of silicone and 16 were made of latex. The biofilm was quantified using direct staining and microscopic observations followed by scraping and microorganism counting. The presence of a biofilm was confirmed on 80% of the pacifier nipples studied. This biofilm was mature for 36% of them. Latex pacifier nipples were more contaminated than silicone ones. The two main genera isolated were Staphylococcus and Candida. Our results confirm that nipples can be seen as potential reservoirs of infections. However, pacifiers do have some advantages; in particular, the potential protection they afford against sudden infant death syndrome. Strict rules of hygiene and an efficient antibiofilm cleaning protocol should be established to answer the worries of parents concerning the safety of pacifiers.

Biofilms develop inside endoscope channels even when valid endoscope reprocessing protocols are applied. The use of an efficient biocide is not sufficient if the channels are not cleaned thoroughly prior to disinfection. This study compared new anti-biofilm combinations of detachment promoting agents with a cleaning product in current use. Tests were performed using Teflon tubing and a contamination device that reproduces conditions that are prevalent during endoscopy. Products were subjected to static+brushing or dynamic treatments, and their ability to remove a preformed biofilm was assessed. The residual biofilm after treatment was assessed and compared with untreated controls. The percentage of surface covered by biofilm was measured after staining with crystal violet. Culturable bacteria levels were determined by plating the bacteria scraped from the tubing surface and counting the colony-forming units (CFU). Further tests were performed on actual endoscopes that had been contaminated artificially. Biofilm removal was confirmed by scanning electron microscopy. This study showed that the new anti-biofilm products prevented the build-up of biofilm and removed a mature biofilm (approximately 10(8)CFU/cm(2)), whereas protocols based on detergent-disinfectants containing quaternary ammonium compounds showed low efficacy as these protocols and products fixed the biofilm on the endoscope surfaces. The new procedure and agents represent a new approach to biofilm control that may improve the efficacy of endoscope reprocessing, and reduce the risk of transmitting infections.

Background: The Revised Trauma Score (RTS) calculated with Major Outcome Trauma Study weights (MTOS-RTS) is currently the standard physiologic severity score in trauma research and quality control. It is often confused with the Triage-RTS (T-RTS), a version that is easier to calculate but only intended for clinical triage., Objectives: To compare the accuracy of the MTOS-RTS to the RTS calculated with weights derived from the study population (POP-RTS) and the T-RTS, for predicting mortality in a trauma population., Methods: The study population consists of 22,388 patients, drawn from the trauma registries of three Level I trauma centers. The predictive accuracy of the MTOS-RTS, POP-RTS, and the T-RTS were compared using measures of discrimination and model fit from logistic regression models., Results: The MTOS-RTS, the POP-RTS, and the T-RTS had the same discrimination (Area under the Receiver Operating Curve [AUC] = 0.841). The POP-RTS and the T-RTS had a slightly better model fit than the MTOS-RTS (AIC = 8010, 8010, and 8067, respectively). The T-RTS had equal discrimination and equal or better model fit than the MTOS-RTS in the whole sample, in each of the three trauma centers and in the population of patients with severe head trauma. The T-RTS was also equivalent to the POP-RTS in all of these population sub-groups., Conclusions: The T-RTS could replace the MTOS-RTS as the standard physiologic severity score for trauma outcome prediction. The advantages of using the T-RTS over the MTOS-RTS are ease of calculation, the need for only one measure for triage and mortality prediction purposes and universal adaptation to a broad range of trauma populations.

Background: To validate the predictive value of the Glasgow Coma Score (GCS) and find the best way to model the score in a logistic regression model predicting mortality., Methods: Analyses were based on 20,494 patients from the trauma registries of three urban Level I trauma centers in the province of Quebec, Canada. The predictive value of the GCS and its components was evaluated in logistic regression models predicting in-hospital mortality with measures of discrimination and calibration. The performance of the GCS with no transformation and as an ordered categorical variable was compared with two transformation techniques: fractional polynomials and spline regression., Results: The GCS had excellent discrimination (area under Receiving Operator Characteristic Curve=0.833 95% confidence interval=0.820-0.846) but fairly poor calibration (Pearson's Chi-squared statistic=122 on 11 df). The eye component added no predictive information to the verbal and motor components in the whole sample but was important in certain sub-populations. Using the three components separately, rather than the sum, did not improve the predictive model. Fractional polynomial transformation of the GCS improved calibration and spline regression performed even better. GCS modeled as an ordered categorical variable performed badly both in terms of discrimination and calibration., Conclusions: The GCS in its present form is an efficient predictor of in-hospital mortality, which could benefit from statistical transformation in logistic regression models when the accuracy of estimated probabilities of mortality is important. The common use of GCS categories for modeling mortality leads to loss of information and should be discarded.

Livestock diversity contributes in many ways to human survival and well-being, while its loss reduces options for attaining sustainable agriculture and universal food security. The current rapid rate of loss of this diversity is the result of a number of underlying factors. While in some cases changes in production systems and consumer preferences reflect the natural evolution of developing economies and markets, in other cases production systems, breed choice and consumer preferences have been distorted by local, national and international policy. In the context of a widespread threat to local pig breeds in Vietnam, this paper identifies and quantifies the level of agricultural subsidies that are currently contributing to this process of breed substitution. Producer subsidies-which tend to improve the competitiveness of imported breeds and their crosses over local breeds--are shown to be considerable, and mitigating measures are now urgently needed to avoid an irreversible loss of livestock diversity.

Background: The Injury Severity Score (ISS) accounts for only one injury in each body region. The New Injury Severity Score (NISS) considers all injuries in a body region. Despite a big difference between the two scores in patients with multiple injuries, the NISS does not offer significant improvement in mortality prediction. This paper hypothesizes that two injuries in different body regions are associated with higher mortality than two injuries in the same body region, independently of injury severity., Methods: The population consisted of 15,200 patients with two or more injuries from the Quebec Trauma Registry, Canada, abstracted between 1998 and 2004. The two worst injuries were considered. Logistic regression analysis was used to assess the mortality odds ratio of having two worst injuries in different body regions (DR) compared with two worst injuries in the same body region (SR), while adjusting for the severity and the body region of the two worst injuries and age., Results: A total of 5,869 patients (49%) had their worst injuries in DR. DR patients had 75% higher risk of mortality than SR patients (odds ratio = 1.75, 95% confidence interval = 1.42-2.15)., Conclusion: After accounting for differing injury severity, patients with their two worst injuries in different body regions have higher mortality than those with their two worst injuries in the same region. Results suggest that the observed effect is not due to a foible in the Abbreviated Injury Scale system but rather to physiologic, clinical, or organizational elements. The results of this study should be considered in the development of future injury severity instruments and may have implications for the care of patients with multiple injuries.

Background: Adverse outcomes for patients with isolated hip fracture have been documented when preoperative delay is longer than 48 hours. An efficient system will have the capacity to repair all hip fractures within 48 hours. We hypothesized that in an efficient system, there would be a medical justification for a delay greater than 48 hours. The purpose of this study was to identify the causes and outcome of delay for hip surgery in an efficient system., Methods: All patients with isolated hip fracture admitted to a regional trauma center from April 1993 to March 2003 were reviewed. Demographics, presence of comorbidity, preoperative delay, complications, and mortality were collected. Univariate and multivariate analysis were carried out., Results: The cohort included 977 patients. Overall mortality was 12.2%. Surgery was performed within 24 hours in 53% of cases and within 48 hours in 87% of cases. The presence of comorbidity partly explained longer (>48 hours) surgical delays. Multivariate analysis revealed that age greater than 65, male sex, and the presence of pulmonary and cardiac comorbid conditions or an active cancer but not surgical delay were associated with mortality and complications. However, surgical delay was associated with longer postsurgical hospital stay, independently of the presence of comorbidity or increasing age., Conclusions: Preoperative delay does not entail adverse outcomes when the surgery is delayed to allow for treatment of comorbid medical conditions. Preoperative delay is associated with a longer hospital stay. The presence of comorbidity only partly explains preoperative delay and adverse outcomes. A prospective study coding for the severity of comorbid conditions and the justification of the preoperative delay will be required to fully elucidate the link between delay and outcome.

Introduction: The purpose of this study was to identify, through recursive partitioning, clinically relevant criteria which predict the need for acute neurosurgical intervention in a group of patients with mild head injury., Materials and Methods: A retrospective cohort of all adult patients, from April 2000 to March 2001, who sustained a blunt trauma and underwent head CT scan, was reviewed. The following inclusion criteria for mild head injury were used: initial Glasgow Coma Scale (GCS) ranging from 13 to 15; no loss of consciousness lasting more than one hour; no obvious skull fracture; a cranial CT scan performed. We collected demographic and trauma related data, interventions and outcome. Univariate and multivariate analyses were undertaken. In parallel, recursive partitioning was carried out using all variables to elaborate a decision algorithm., Results: There were 405 patients in the sample. CT identified lesions in 12% of patients. Twelve patients (3%) required acute neurosurgical intervention. The recursive partitioning analysis identified three significant sequential nodes: deterioration of the GCS; an initial GCS of 13 vs 14 or 15; and the presence of associated injuries or comorbid conditions., Conclusions: A simple three step rule predicts the need for acute neurosurgical intervention based on clinical findings: a deteriorating GCS; an initial GCS of 13; and the presence of associated injuries or comorbid conditions.

Background: To validate the accuracy of the Revised Trauma Score (RTS) and its components for predicting in-hospital mortality., Methods: Analyses were based on 22,388 patients from the trauma registries of three urban Level I trauma centers in the province of Quebec, Canada. The accuracy of RTS coded variables for the Glasgow Coma Score (GCSc), Systolic Blood Pressure (SBPc), and Respiratory Rate (RRc) for predicting mortality was evaluated in logistic regression models with measures of discrimination and model fit and compared with Fractional Polynomial (FP) transformations of each component., Results: RTS coded variables were associated with sparse data distributions and did not accurately represent the relation of GCS, SBP, and RR to mortality. FP models were always associated with significantly better discrimination (all p < 0.00001) and model fit. Survival probability estimates generated by the model with FP transformations were significantly different to those generated by the model with RTS-coded variables., Conclusions: The RTS in its present form does not accurately describe the relation of GCS, SBP, and RR to mortality. FP transformation would improve the accuracy of predicted survival probabilities used for performance evaluation and may improve control of confounding caused by of physiologic severity case mix in trauma research.

Background: The goal of this study was to evaluate the burden of falls in the elderly in a Canadian tertiary trauma center., Methods: Patients admitted to Charles-LeMoyne Hospital with a low velocity fall (LVF) from April 1, 1993 to March 31, 2000 were individually reviewed. Elderly was defined as age 65 years and older. A region was considered to be injured if Abbreviated Injury Scale was greater than or equal to 2., Results: There were 2,333 patients with LVF, 41.4% of all blunt trauma admissions. Median Injury Severity Score was 9 for elderly compared with 5 for young (p < 0.001). Injuries were significantly more frequent to head, face, thorax, and lower limbs in the elderly. Mortality (13.4% versus 0.9%; p < 0.001), length of stay (median = 15 versus 3 days; p < 0.001) and long-term care facility reference (19.3% versus 1.1%, p < 0.001) were significantly higher in the elderly., Conclusions: LVF is a frequent cause of admission for trauma in the elderly. Despite the apparent benign nature of the mechanism, LVF is associated with more severe injuries and worse outcome.

Background: To survey surgeon opinion regarding the management of the open abdomen (OA) and abdominal compartment syndrome (ACS) to assess current practice and direct future prospective clinical studies., Methods: Opinions of self-designated trauma, general, pediatric, and vascular surgeons belonging to the Trauma Association of Canada (TAC), were surveyed through a mixed-mode (mail and Web based) questionnaire., Results: Among 102 eligible candidates, 86 (84%) responded; 83% did regular trauma call, 45% regular critical care call being a separate call 79% of the time; 79% worked in centers serving >500,000 people; the median year of practice entry was 1997. There was no standard definition of what constituted an "open abdomen", preferred time for re-operation, or preferred method for alternate fascial closure, although 90% reported having not closing the fascia after a trauma laparotomy. Being "physically unable" was reported as an indication twice as often as objective measures of airway or bladder pressures. The decision to proceed with OA was reported as rarely or never being made preoperatively by 78% of respondents. None reported an institutional policy regarding OA. Eighty-four percent reported (re)opening an abdomen for primary ACS, 46% for secondary ACS, 28% for tertiary ACS. Self-assessed familiarity for the ACS was 6/7 on a Likert scale. Physical examination was reported as a diagnostic criterion for ACS by 66%, and used to screen by 21% of respondents., Conclusions: There is no consensus regarding definition, functional indications, or management of an open abdomen in the perceptions of Canadian trauma providers despite a high self reported level of familiarity with the abdominal compartment syndrome. This is an area of practice with potential and requirements for further multi-center study.

Background: The optimal abdominal closure in critically ill surgical/trauma patients remains controversial with a wide variety of commonly employed techniques. We sought to evaluate clinical equipoise by surveying Canadian surgeons regarding the use of temporary abdominal closure strategies in damage control and emergency situations., Methods: A structured mixed-mode (Website and paper), scenario-based questionnaire was developed by members of the Canadian Trauma Trials Collaborative and directed to surgical members of the Trauma Association of Canada (TAC)., Results: The overall response rate was 84% (86 out of 102). In resuscitated hemodynamically stable trauma patients, 42% (29 out of 69) of respondents elected to primarily close an "extremely tight" abdominal cavity while only 23% (16 out of 70) would primarily close the same patient when physiologic exhaustion (Damage control (DC) conditions-hypothermia, acidosis, and coagulopathy) supervened. Although the majority reported preference for temporizing abdominal closures [73% (51 out of 70) non-DC, 75% (52 out of 69) DC] when the fascia was physically impossible to close; the reported primary use of mesh in these situations was quite high [24.6% (17 out of 69) non-DC, 24% (16 out of 69) DC], including a reported 7% (5 out of 69) nonabsorbable mesh usage in a contaminated octogenarian abdomen., Conclusion: Reported opinions suggest an overall appreciation for markers of "Damage Control," although clinical equipoise exists regarding the preferred technique and a frequent early use of mesh. These results highlight the necessity for further research but suggest challenges in defining a common standard for multicenter trials.

Background: The goal of this study was to evaluate the impact of different trauma registry exclusion criteria on the assessment of trauma populations and outcome., Methods: All patients admitted to a Canadian regional trauma center from April 1, 1993 to March 31, 2002 with a diagnosis of trauma (ICD-9 codes 800 to 959) were reviewed. TOTAL included everyone. REGISTRY included only patients meeting any of four criteria: death during hospital stay, transfer received from another hospital, admission to the intensive care unit, or hospital stay of 3 days or more. NOHIP excluded patients with isolated hip fracture. REG/NOHIP combined both. ISS12 and ISS15 excluded patients with ISS <12 and 15, respectively., Results: There were 6,839 trauma patients. The percentage of excluded patients by group was: REGISTRY, 21.2%; NOHIP, 14.7%; REG/NOHIP, 34.9%; ISS12, 75%; and ISS15, 80.3%. Median length of stay was 7 days. Exclusions represented a total number of hospitalization days varying from 1.9% to 65.5% of TOTAL. Mortality was 6.9% for TOTAL, 8.6% for REGISTRY (p < 0.001), 5.7% for NOHIP (p = 0.009), 7.5% for REG/NOHIP (p=NS), 16.1% for ISS12 (p < 0.001), and 20.4% for ISS15 (p < 0.001). In groups with exclusions, transfer to long-term care varied from 0.14% to 23.5% in the excluded patients. For rehabilitation, these percentages varied from 0.14% to 17.6%., Conclusions: Registry exclusion criteria significantly alter the apparent severity of injury and resource utilization. The use of divergent exclusion criteria in the analysis of trauma registry data may be misleading.

We aimed to compare the predictive accuracy of consensus-derived and data-derived injury severity scores when considered alone and in combination with age and physiological status. Analyses were based on 25,111 patients. The predictive validity of each severity score was evaluated in logistic regression models predicting in-hospital mortality using measures of discrimination and calibration. Data-derived scores had consistently better predictive accuracy than consensus-derived scores in univariate models (p<0.0001) but very little difference between scores was observed in models including information on age and physiological status. Data-derived scores provide more accurate mortality prediction than consensus-derived scores when only anatomic injury severity is considered but offer little advantage if age and physiological status are taken into account.

The new Vitek 2 GN card (bioMérieux, Marcy-l'Etoile, France) was developed for better identification of fermenting and nonfermenting bacilli. This new card allows the identification of 159 taxa. A total of 426 isolates (331 fermenting and 95 nonfermenting gram-negative bacilli) belonging to 70 taxa covered by the database were evaluated. All isolates were identified in parallel with the ID 32 GN, the API 20E, and the API 20NE methods. The system correctly identified 97.4% (n=415) of the strains. Only 2.1% (n=9) needed additional testing. One strain (0.25%) was misidentified (Klebsiella pneumoniae subsp. pneumoniae), and another one (0.25%) was not identified (Morganella morganii subsp. morganii). The new GN card gives more accurate identifications overall for gram-negative bacilli when compared to the systems described in other similar studies.

Objective: To identify the determinants of service use by young Canadians with mental health problems., Methods: Data were drawn from a recent large Canadian mental health survey. The analyses were conducted on a subsample of 1092 Canadians aged 15 to 24 years and identified as presenting a mood disorder, an anxiety disorder, or a substance-related disorder in the 12 months preceding the survey. We classified variables potentially associated with any type of service use for a mental health problem over a 12-month period according to predisposing, enabling, and need factors. We conducted weighted multivariate logistic regressions to determine the association of each factor with service use., Results: In the final model, being female and living alone were the predisposing factors associated with service use. None of the enabling factors predicted help seeking. In regard to the perceived need factors, those who had difficulties with social situations were more likely to use services. Having a mood disorder and (or) having a diagnosed chronic illness were the evaluated need factors associated with service use., Conclusion: Certain groups of young Canadians are less likely to seek help for mental health problems and could be the target of interventions aimed at increasing service use.

Background: Severe acute respiratory syndrome (SARS) is caused by a newly discovered coronavirus (SARS-CoV). No effective prophylactic or post-exposure therapy is currently available., Results: We report, however, that chloroquine has strong antiviral effects on SARS-CoV infection of primate cells. These inhibitory effects are observed when the cells are treated with the drug either before or after exposure to the virus, suggesting both prophylactic and therapeutic advantage. In addition to the well-known functions of chloroquine such as elevations of endosomal pH, the drug appears to interfere with terminal glycosylation of the cellular receptor, angiotensin-converting enzyme 2. This may negatively influence the virus-receptor binding and abrogate the infection, with further ramifications by the elevation of vesicular pH, resulting in the inhibition of infection and spread of SARS CoV at clinically admissible concentrations., Conclusion: Chloroquine is effective in preventing the spread of SARS CoV in cell culture. Favorable inhibition of virus spread was observed when the cells were either treated with chloroquine prior to or after SARS CoV infection. In addition, the indirect immunofluorescence assay described herein represents a simple and rapid method for screening SARS-CoV antiviral compounds.

Background: Patients with isolated hip fractures are frequently excluded from trauma registries. The goal of this study was to show that patients with these injuries have higher resource use and poorer outcomes than the rest of the trauma population., Methods: The Quebec Trauma Registry was used to identify all trauma patients from April 1, 1998, to March 31, 2003. Patients who were dead on arrival at the emergency room were excluded. Isolated hip fracture (HIP) was defined as a diagnosis of a single fracture to the neck of the femur (Abbreviated Injury Scale 1990 codes 851808.3, 851810.3, 851812.3, and 851818.3) secondary to a fall and for which the Injury Severity Score was 9 or 10 (no other Abbreviated Injury Scale code higher than 1). Patients with all other trauma diagnosis (OT) were used for comparison. Outcome variables were length of hospital stay, length of intensive care unit (ICU) stay, in-hospital complications, and status and orientation at discharge. Chi-square and Wilcoxon rank-sum tests were used., Results: There were 68,422 patients: 14,426 (21.1%) HIP patients and 53,996 (78.9%) OT patients. The median Injury Severity Score was 9 for HIP (range, 9-10) and 9 for OT (range, 1-75). Mean length of hospital stay was 18.4 days for HIP compared with 11.7 days for OT (p < 0.0001). HIP patients represented 29.5% of the total hospital stay. ICU stay was required for 1,353 HIP patients (9.4%) and for 12,395 (23.0%) OT patients (p < 0.0001). Mean ICU stay was 3.9 days for HIP compared with 5.5 days for OT (p = 0.0006). In-hospital mortality was 8.5% in HIP compared with 3.7% in OT (p < 0.0001). HIP represented 62.7% of patients referred for long-term care and 39.3% of patients referred to a rehabilitation center., Conclusion: Patients with HIP represented 21.1% of admissions while accounting for 42% of total days of hospitalization and 38% of deaths. Patients with hip fractures have a significantly higher risk of death, prolonged hospital stay, and complication rate, and are more often transferred to a rehabilitation center or to a long-term nursing home than the rest of the trauma population despite lower severity. They require multidisciplinary care typical of the rest of the trauma population and should be included in the trauma registry if the registry is to document the full outcome and resource use of the trauma population.

Severe acute respiratory syndrome coronavirus (SARS-CoV) is the etiological agent of SARS. Analysis of SARS-CoV spike glycoprotein (S) using recombinant plasmid and virus infections demonstrated that the S-precursor (proS) exists as a approximately 190 kDa endoplasmic reticulum form and a approximately 210 kDa Golgi-modified form. ProS is subsequently processed into two C-terminal proteins of approximately 110 and approximately 80 kDa. The membrane-bound proprotein convertases (PCs) furin, PC7 or PC5B enhanced the production of the approximately 80 kDa protein. In agreement, proS processing, cytopathic effects, and viral titers were enhanced in recombinant Vero E6 cells overexpressing furin, PC7 or PC5B. The convertase inhibitor dec-RVKR-cmk significantly reduced proS cleavage and viral titers of SARS-CoV infected cells. In addition, inhibition of processing by dec-RVKR-cmk completely abrogated the virus-induced cellular cytopathicity. A fluorogenically quenched synthetic peptide encompassing Arg(761) of the spike glycoprotein was efficiently cleaved by furin and the cleavage was inhibited by EDTA and dec-RVKR-cmk. Taken together, our data indicate that furin or PC-mediated processing plays a critical role in SARS-CoV spread and cytopathicity, and inhibitors of the PCs represent potential therapeutic anti-SARS-CoV agents.

Hypothesis: A second injury in the same body region is associated with lower mortality than a second injury in a different body region, independently of injury severity and body region., Methods: The population consisted of 15,200 patients with two or more injuries from level I trauma centers in Quebec. The mortality odds ratio of having a same-region second injury (SR) as opposed to a different-region second injury (DR) was assessed., Results: Patients with a SR had 43% lower odds of mortality when compared to patients with a DR., Conclusion: A second injury in the same body region is associated with lower mortality than a second injury in a different body region.

Background: This study aimed to determine the impact of warfarin use on the severity of injury among elderly patients presenting with closed head injuries., Methods: A cohort of patients 55 years of age or older with closed head injuries taken to a tertiary trauma center between April 1993 and March 2001 was retrospectively identified. Patient characteristics, mechanism of injury, type and severity of injury, and hospital survival data were obtained from the trauma registry. Each case then was reviewed for completeness of information, assessment of preinjury warfarin use, and comorbidity., Results: Among the 384 patients presenting with closed head injuries, 35 (9%) were receiving warfarin before their trauma. As compared with nonusers, anticoagulated patients had a higher frequency of isolated head trauma (54% vs. 32%; p = 0.008), more severe head injuries (65.7% vs. 44.1%; p = 0.02), and a higher rate of mortality (40% vs. 21%, p = 0.01). These associations remained evident even after population differences in age, gender, comorbidities, and mechanism of injury were taken into account. Indeed, according to multivariate logistic regression models, warfarin use was associated with a statistically significant risk of death (odds ratio [OR], 2.73; 95% confidence interval [CI], 1.22-6.12), statistically significant odds for more severe head injury (OR, 2.39; 95% CI, 1.10-5.17), and odds for isolated head injury that almost reached statistical significance (OR, 1.79; 95% CI, 0.82-3.90)., Conclusions: Among patients 55 years of age or older who present with closed head injury, the use of warfarin before trauma appears to be associated with a higher frequency of isolated head trauma, more severe head trauma, and a higher likelihood of death. The findings of this retrospective study support the concern about the adverse effects of anticoagulants in cases of head trauma.

Background: The Trauma and Injury Severity Score (TRISS) methodology was developed to predict the probability of survival after trauma. Despite many criticisms, this methodology remains in common use. The purpose of this study was to show that improving the stratification for age and adding an adjustment for comorbidity significantly increases the predictive accuracy of the TRISS model., Methods: The trauma registry and the hospital administrative database of a regional trauma center were used to identify all blunt trauma patients older than 14 years of age admitted with International Classification of Diseases, Ninth Revision codes 800 to 959 from April 1993 to March 2001. Each individual medical record was then reviewed to ascertain the Revised Trauma Score, the Injury Severity Score, the age of the patients, and the presence of eight comorbidities. The outcome variable was the status at discharge: alive or dead. The study population was divided into two subsamples of equal size using a random sampling method. Logistic regression was used to develop models on the first subsample; a second subsample was used for cross-validation of the models. The original TRISS and three TRISS-derived models were created using different categorizations of Revised Trauma Score, Injury Severity Score, and age. A new model labeled TRISSCOM was created that included an additional term for the presence of comorbidity., Results: There were 5,672 blunt trauma patients, 2,836 in each group. For original TRISS, the Hosmer-Lemeshow statistic (HL) was 179.1 and the area under the receiver operating characteristic (AUROC) curve was 0.873. Sensitivity and specificity were 99.0% and 27.8%, respectively. For the best modified TRISS model, the HL statistic was 20.35, the AUROC curve was 0.902, the sensitivity was 99.0%, and the specificity was 27.8%. For TRISSCOM, the HL statistic was 14.95 and the AUROC curve was 0.918. Sensitivity and specificity were 99.0% and 29.7%, respectively. The difference between the two models almost reached statistical significance (p = 0.086). When TRISSCOM was applied to the cross-validation group, the HL statistic was 10.48 and the AUROC curve was 0.914. The sensitivity was 98.6% and the specificity was 34.9%., Conclusion: TRISSCOM can predict survival more accurately than models that do not include comorbidity. A better categorization of age and the inclusion of comorbid conditions in the logistic model significantly improves the predictive performance of TRISS.

The proprotein convertases (PCs) participate in the limited proteolysis of integrin alpha4 subunit at the H(592)VISKR(597) downward arrow ST site (where underlined residues indicate positively charged amino acids important for PC-mediated cleavage and downward arrow indicates the cleavage site), since this cleavage is inhibited by the serpin alpha1-PDX (alpha1-antitrypsin Portland). Co-expression of alpha4 with each convertase in LoVo (furin-deficient human colon carcinoma) cells revealed that furin and proprotein convertase 5A (PC5A) are the best pro-alpha4 convertases. In agreement, processing of endogenous pro-alpha4 in human lymphoblastoid CEM-T4 cells was enhanced greatly in stable transfectants overexpressing either enzyme. In many leucocyte cell lines, the expression of furin closely correlated with the endogenous processing efficacy, suggesting that furin is a candidate pro-alpha4 convertase. Mutational analysis showed that replacement of P1 Arg(597) with alanine (R597A) abrogated cleavage, whereas the P6 mutant H592R is even better processed by the endogenous convertases of Chinese-hamster ovary CHO-K1 cells. In vitro kinetic studies using synthetic peptides confirmed the importance of a positively charged residue at P6 and showed that wild-type alpha4 processing is performed best by furin and PC5A at acidic and neutral pHs, respectively. Biosynthetic analysis of pro-alpha4 and its H592R and H592K mutants in the presence or absence of the weak base, NH(4)Cl, revealed that the P6 histidine residue renders its processing by furin sensitive to cellular pH. This suggests that pro-alpha4 cleavage occurs preferentially in acidic compartments. In conclusion, although the accepted furin processing motif is Arg-Xaa-(Lys/Arg)-Arg downward arrow, our data further extend it to include a regulatory histidine residue at P6 in precursors that lack a basic residue at P4.

Background: The purpose of this study was to show that elderly patients admitted with rib fractures after blunt trauma have increased mortality., Methods: Demographic, injury severity, and outcome data on a cohort of consecutive adult trauma admissions with rib fractures to a tertiary care trauma center from April 1, 1993, to March 31, 2000, were extracted from our trauma registry., Results: Among 4,325 blunt trauma admissions, there were 405 (9.4%) patients with rib fractures; 113 were aged > or = 65. Injuries were severe, with Injury Severity Score (ISS) > or = 16 in 54.8% of cases, a mean hospital stay of 26.8 +/- 43.7 days, and 28.6% of patients requiring mechanical ventilation. Mortality (19.5% vs. 9.3%; p < 0.05), presence of comorbidity (61.1% vs. 8.6%; p < 0.0001), and falls (14.6% vs. 0.7%; p < 0.0001) were significantly higher in patients aged > or = 65 despite significantly lower ISS (p = 0.031), higher Glasgow Coma Scale score (p = 0.0003), and higher Revised Trauma Score (p < 0.0001). After adjusting for severity (i.e., ISS and Revised Trauma Score), comorbidity, and multiple rib fractures, patients aged > or = 65 had five times the odds of dying when compared with those < 65 years old., Conclusion: Despite lower indices of injury severity, even after taking account of comorbidities, mortality was significantly increased in elderly patients admitted to a trauma center with rib fractures.

Casein phosphatase activities have been identified in five yeast strains grown on Pi-deficient medium. Maximal endocellular activities appeared in the exponential phase. Exocellular phosphatases were significantly produced from Yarrowia lipolytica W-29 and Kluyveromyces marxianus, in the early stationary phase. Major phosphatases from K. marxianus were one heavy acid phosphatase composed of 64-67 kDa subunits, which could be secreted in the medium, and one type 2A protein phosphatase with an apparent molecular mass of 147 kDa and a 52 kDa catalytic subunit dissociated by 80% ethanol treatment. The characteristics of phosphatases purified from K. marxianus were compared with those previously purified from Y. lipolytica.

In the growth course of the lipolytic yeast Yarrowia lipolytica, the activities of protein phosphatase 2A (PP2A) and glycogen synthase (GS) rise during the exponential phase and concomitantly glycogen storage occurs in the cells. There is also an increase in the independence ratio (RI) indicating a shift from an inactive phosphorylated GS form to an active dephosphorylated GS form. During the early stationary phase, an increase in protein kinase CK2 (CK2) activity, a reversion of RI variation and a glycogen content decrease are observed. GS activity proved to be a good indicator of early culture growth phase. Experiments carried out with enzymes purified from Y. lipolytica show strong RI variations upon the action of CK2 and PP2Ac, and 32P incorporation into GS protein through phosphorylation by CK2. GS activity would be controlled by the sequential action of PP2A and CK2.

Background: Acute appendicitis remains a clinical entity. Reports of negative appendectomies range from 9% to 40%. The goal of this study is to evaluate clinical performance and factors associated with complicated appendicitis., Methods: Records of patients with a preoperative or postoperative diagnosis of appendicitis between January 1994 and December 1997 were reviewed. Demographic, clinical, and paraclinical data were collected. Multivariate analysis was carried out by logistical regression., Results: Two hundred and thirty-seven consecutive cases were reviewed (male 132, female 105). The mean age was 31.4 +/- 16.8. Twenty-three cases had other surgical conditions. In the remaining cases (n = 214), 127 (59.4%) had noncomplicated appendicitis, 69 (32.2%) had complicated appendicitis, and 18 (8.4%) had negative exploration. Delays occurring before first medical consultation were significantly longer in patients with complicated appendicitis (3.30 days) and negative exploration (3.00 days) compared to patients with noncomplicated appendicitis (1.24 days) (P < 0.001)., Conclusions: Acceptable rates of negative appendix and complicated appendicitis can be obtained from clinical data. The presence of complicated appendicitis is primarily associated with a longer delay before first medical consultation.

In previous work, the major endocellular protein phosphatase activity has been identified in the secretory yeast Yarrowia lipolytica as a PP2A. The aim of the present work was to seek the presence of one protein phosphatase excreted in the exocellular medium and to study its activity during yeast growth in media supplemented or not supplemented with inorganic phosphate. Protein phosphatase was purified and activity was assayed by following the dephosphorylation of three substrates, [32P]casein, phosphotyrosine and a synthetic tyrosine-phosphorylated peptide. Phosphatase activity recovered in the medium after 25 h culture was greatly enhanced by Pi-deficiency. After several purification steps, the enzyme preparation presents an apparent electrophoretic homogeneity on SDS-PAGE with associated phosphoseryl/threonyl and phosphotyrosyl activities. The kinetic properties exclude contamination by a copurified protein and it is concluded that the two activities are carried by the same single proteic species. It was characterized by gel filtration as a 33 kDa protein with one single subunit demonstrated by SDS-PAGE. An absolute requirement for reducing-agents is observed suggesting that the enzyme contains at least one essential reactive cysteinyl residue. Optimum pH value is 6.1, apparent K(m) for phosphotyrosine was calculated to be 760 microM and Hill coefficient 3.2 indicating a rather high cooperativity. These results showed that the involvement of alkaline and/or acid phosphatase was unlikely. In conclusion, a protein phosphatase distinct from endocellular PP2A is secreted by Yarrowia lipolytica and characterized as a phosphotyrosine protein phosphatase with associated phosphoseryl/threonyl activity.

Polyethylene glycol (PEG) electrolyte solution can induce potentially fatal complications when used as a lavage in preoperative bowel preparation. A 60-year-old man with carcinoma of the esophagogastric junction had a Mallory-Weiss tear after bowel preparation with PEG. He was successfully resuscitated, first with balanced salt solution then by transfusion. The literature on the subject is reviewed and recommendations are made, which include consideration of alternative methods of bowel preparation (e.g., sodium phosphate solution) in patients with esophageal obstruction.

Purpose: This study was designed to highlight the significant morbidity related to undetected hypothyroidism in the elderly who are undergoing emergency surgery., Method: Case reports of six patients who presented with acute colonic surgical conditions are reviewed., Results: Six cases of undetected hypothyroidism in a group of elderly patients was unmasked at the time of surgery for acute colonic conditions or in the perioperative period. These patients experienced increased morbidity, but once detected and treated, all but one had an uneventful recovery., Conclusion: Unrecognized hypothyroidism may lead to unnecessary surgery or even a potentially fatal outcome. A heightened awareness of this not so uncommon entity is mandatory.

The efficacy of SDZ IMM 125 in preventing allograft rejection was evaluated in kidney transplantation in the dog and orthotopic small bowel and heterotopic pancreas transplantation in the rat. Seven groups (n = 6) were involved in dog kidney transplantation. Untreated recipients rejected kidney allografts with a mean survival time (MST) of 8.0 +/- 1.8 days. There was a graded dose response in SDZ IMM 125-treated groups: 10 mg/kg/day, MST 11.3 +/- 3.5 days, P = 0.065; 15 mg/kg/day, MST 44.8 +/- 10.8 days, P = 0.0001; and 20 mg/kg/day, MST 47.3 +/- 5.6 days, P = 0.0001, same as in cyclosporin A (CsA)-treated groups: 10 mg/kg/day, MST 25.8 +/- 13.7 days, P = 0.001; 15 mg/kg/day, MST 38.3 +/- 18.1 days, P = 0.002; and 20 mg/kg/day, MST 38.7 +/- 17.7 days, P = 0.002. Low dose of SDZ IMM 125 (10 mg/kg/day) was less effective in prolonging the graft survival than low dose of CsA. High dose (20 mg/kg/day) treatment of both SDZ IMM 125 and CsA led to abnormal recipient liver enzymes alanine aminotransferase and aspartate aminotransferase postoperatively. A histopathological study demonstrated fatty degeneration of hepatic cells in both 20 mg/kg/day SDZ IMM 125- and CsA-treated groups. We also tested the effect of SDZ IMM 125 in orthotopic small bowel transplantation with three combinations, namely host-versus-graft (HVG), graft-versus-host (GVH), and combined HVG and GVH immune responses and pancreas transplantation in the rat with different doses. The results indicate that SDZ IMM 125 is a potent immunosuppressant to prolong the kidney allograft survival in the dog, to alleviate HVG and GVH responses in small bowel transplantation, and to delay pancreas allograft rejection in the rat. Low dose of SDZ IMM 125 is less effective than a similar dose of CsA to prevent kidney allograft rejection in the dog.

Infections were reviewed among 118 patients (M = 64, F = 54) undergoing peritoneal dialysis (PD) from 01-86 to 12-91. One hundred and fifty-five catheters were installed during the study period. Twenty-seven (23%) had more than one catheter. Forty-seven patients (39.8%) were diabetics. Mean follow-up was 460 days per catheter and 540 days per patient. Factors were collected and analyzed by multiple logistic regression. Survival curves were drawn according to the Kaplan-Meyer method. One year survival was 73.8%. Respective incidence of the different infections are presented. Fourteen percent of peritonitis, 48% of tunnel infections and 2.1% of exit site infections led to catheter removal. Younger patients had more catheter infections (p < 0.05). The different types of infections were significantly influenced by the system of dialysis employed (p < 0.005). Perioperative antibiotic coverage diminished the incidence of peritonitis during the first three months (p < 0.05). With our data and our literature review, we have attempted to make some recommendations in order to reduce the occurrence of infections under PD.

The movement towards trauma care regionalization in Québec was initiated in 1990, with formal designation of three level I trauma centers in 1993. The purpose of this study is to evaluate the impact of trauma center designation on mortality. The study design is that of a two-cohort study, one assembled during 1987 when designation was not in effect, and the other during the first 5 months of designation. The study focuses on patients that fulfilled the following criteria: i) arrived alive at the hospital, and ii) were admitted. The outcome measures are adjusted mortality, and excess mortality as measured by the TRISS methodology. A total of 158 patients treated in 1987, and 288 treated in 1993, were identified. The mean age of the patients treated in 1993 was significantly higher (40.0, +/- 18.1), when compared with the 1987 group (30.9 +/- 18.1; p < 0.001). Patients in the 1987 cohort had a significantly higher proportion of injuries caused by stabbing (p = 0.02), and a significantly lower proportion caused by falls (p = 0.003). The 1987 cohort had a higher rate of abdominal injuries (p = 0.0001), and external injuries (p = 0.0001), and a significantly lower rate of head or neck injuries (p = 0.003), and injuries to the extremities (p = 0.0001). The mean Injury Severity Score (ISS) for the 1987 cohort was 14.96 (+/- 12.36), and 15.49 (+/- 11.61) in 1993 (p = 0.65). The crude mortality rate was 20% for 1987, and 10% for 1993. The crude odds ratio for mortality in 1987 was 2.10 with 95% confidence intervals between 1.22 and 3.62 (p = 0.006).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute tubular necrosis (ATN) represents a serious problem in kidney transplantation. We have reviewed the causes and effects of ATN on kidney transplant patients treated in our hospital between June 1981 and December 1992. We analyzed 359 consecutive kidney transplants performed in 338 patients (213 male and 125 female). There were 311 first grafts. The actuarial functional graft survival (AFGS) was 85% at 1 year and 58.2% at 10 years. The incidence of long-term chronic rejection, the 1-year creatinine blood level (CBL) and the AFGS are summarized: [table: see text] The donor age and the PRA level were significantly correlated with ATN occurrence. ATN after transplantation was associated with a poorer function and survival of the kidney graft. Better donor and patient selection could decrease the occurrence of ATN, thus improving the graft outcome.

With the advent of feminist ideology, women believed they could fashion made-to-measure tools to end their oppression and emancipate themselves. However, passing from ideology to practice has led to a certain number of difficulties. On the other hand, the feminist viewpoint has made a major and undeniable contribution to society. This article discusses the trials and tribulations as well as the successes of feminist practice.

Chloroplasts have been isolated from Wheat shoots by density gradient centrifugation. When added to a linoleic acid and Tween 20 suspension these chloroplasts induce an oxygen consumption. The hydroperoxides synthesized from linoleic and oxygen have been characterized by spectrophotometry and thin layer chromatography.