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We focus on the occlusion problem in person re-identification (re-id), which is one of the main challenges in real-world person retrieval scenarios. Previous methods on the occluded re-id problem usually assume that only the probes are occluded, thereby removing occlusions by manually cropping. However, this may not always hold in practice. This article relaxes this assumption and investigates a more general occlusion problem, where both the probe and gallery images could be occluded. The key to this challenging problem is depressing the noise information by identifying bodies and occlusions. We propose to incorporate the pose information into the re-id framework, which benefits the model in three aspects. First, it provides the location of the body. We then design a Pose-Masked Feature Branch to make our model focus on the body region only and filter those noise features brought by occlusions. Second, the estimated pose reveals which body parts are visible, giving us a hint to construct more informative person features. We propose a Pose-Embedded Feature Branch to adaptively re-calibrate channel-wise feature responses based on the visible body parts. Third, in testing, the estimated pose indicates which regions are informative and reliable for both probe and gallery images. Then we explicitly split the extracted spatial feature into parts. Only part features from those commonly visible parts are utilized in the retrieval. To better evaluate the performances of the occluded re-id, we also propose a large-scale data set for the occluded re-id with more than 35 000 images, namely Occluded-DukeMTMC. Extensive experiments show our approach surpasses previous methods on the occluded, partial, and non-occluded re-id data sets.

The parasitic infection caused by miteSarcoptes scabiei, scabies, is widely known as one of the world's highest morbidity of skin infections. WHO classified scabies as one of the Neglected-Tropical-Disease. Scabies has several risk factors, and one of them is malnutrition. This study aimed to know the scabies infection profile and the nutritional status of patients in pediatric dermatology division, general hospital Dr. Soetomo Surabaya. This is a retrospective study from secondary data collected by evaluating medical records from pediatric patient aged 0 – 60 months. The data were analyzed using the descriptive methodology to measure the frequency and percentage of each variable. The results showed that most of the patients are male, below 1 year old, and had good nutritional status (31.6%)measured using the weight-height index from WHO. Furthermore, most of the samples had upper extremity as the common region with scabies lesion, and papule is the most common lesion found on patients.

Introduction: Road traffic injuries and deaths caused by motor vehicles is a growing public health problem all over the world. Head injury and blunt abdominal trauma are major health problems and are frequent causes of death among Road Traffic Accident (RTA) victims. Methods: A total of 348 cases were examined in Emergency department and the Department of Forensic Medicine and Toxicology at B.P Koirala Institute of Health Sciences, Dharan during the period of one year. Data were collected using proforma and analyzed using Statistical Package for Social Sciences (SPSS) 11.5. Injury Severity Score (ISS) was used to assess the severity of injuries. Result: There were 318 morbidity and 30 mortality cases. Male to female ratio was 2.2:1. The commonest age group involved was 21-30 years i.e.32.1%. The most common vehicle involved was two wheelers (60.9%) followed by heavy four or more wheelers (20.9%) and the most common nature of accident was through collision of the vehicles. Abrasion was the most common injury occurred during the RTA (61.2%). 34.1% of the victims had laceration, 8.6% had contusion and 20.9% had fractures. Median Injury Severity Score was 31.5 in mortality and 1 in morbidity cases. Conclusion: Road traffic accident is one of the major causes of morbidity and mortality. Injuries in various body regions are frequent findings in victims of RTA. The median Injury Severity Score (ISS) of mortality cases was significantly high compared to that of morbidity cases.

To assess whether padded headgear was associated with incidence of suspected sports-related concussion, non-sports-related concussion head injury, and injuries to other body regions in junior Australian football.Prospective cohort injury surveillance.There were 400 junior players (42.5% female) enrolled across two seasons. Suspected sports-related concussion was defined by detection of observable signs on the field and medical assessment or missed match(es) due to suspected sports-related concussion. Non-sports-related concussion head injury and injuries to other body regions were defined as those that received medical assessment or resulted in a missed match.There were 20 teams monitored over 258 matches. 204 players (2484 player hours) wore mandated headgear throughout the season and 196 (2246 player hours) did not. The incidence rate of suspected sports-related concussion was 3.17 (95% confidence interval: 3.04-3.30) per 1000 player-hours and no differences were observed between males and females (risk ratio 1.11; 95% confidence interval: 0.40-3.06). Headgear use was not associated with suspected sports-related concussion (risk ratio 1.09; 95% confidence interval: 0.41-2.97), non-sports-related concussion head injury (risk ratio 0.27; 95% confidence interval: 0.06-1.31), or injuries to other body regions (risk ratio 1.41; 95% confidence interval: 0.79-2.53).Headgear use was not associated with reduced risk of suspected sports-related concussion, non-sports-related concussion head injury or injuries to other body regions. There was no difference in the rate of suspected sports-related concussion in female compared to male players, however, rates of non-sports-related concussion head injury and injuries to other body regions were higher in male players.

Non-accidental trauma (NAT) is one of the common causes of injury in children in the United States (US). Abuse and maltreatment affect 2 per 100,000 children annually and may go unrecognized. The aim of this study to quantify the recidivistic nature of NAT in the US pediatric population.The National Readmissions Database (2007-2015) was queried for pediatric (≤18y) trauma patients. Children presenting for non-accidental trauma were further identified. Data was obtained on demographic, clinical, and hospital-level characteristics. Body regions with an Abbreviated Injury Scale (AIS) greater than three were further identified. Multivariable logistic regression analysis (adjusting for age, gender, insurance status, year, Injury Severity Score [ISS], hospital region, and mechanism of injury) was utilized to determine factors influencing unintentional and intentional (assault) non-accidental traumatic injuries.NAT represents 1.6% (n = 4,634/286,508) of all pediatric trauma. The median age of presentation was1y [IQR:0-3] with a male predominance (56.2%). Median ISS was 9 [IQR:2-16]. 87.5% of incidents represented assault (intentional). The most commonly affected body region was the head and neck (32.8%), followed by the extremities (11.4%) and soft tissue trauma or burns (6.3%). Penetrating trauma accounted for 18% of these injuries. 3.2% were readmitted to the hospital for a recurrent episode. 85.5% presented to the hospital for their initial evaluation. Mortality rates were 3.8% for those re-admitted to the hospital. The most common perpetrators were other specified persons known to the family, followed by fathers and mothers.Although uncommon, recidivism, after an initial episode of NAT, can have devastating consequences. The majority of the perpetrators of abuse are individuals known to the patient or family. Health policy aimed towards developing preventative strategies is needed to facilitate early recognition and tackle abuse in children.III.Case Control Study.

Objectives To quantify the incidence, location and severity of injuries in Gaelic football and to identify potential moderators of those injuries. Design Systematic review and meta-analysis. Methods A comprehensive search strategy of six electronic databases was undertaken independently by two researchers in March 2020. Studies must have prospectively investigated injuries sustained by Gaelic footballers over a minimum duration of six months. The Newcastle-Ottawa Scale was used to assess risk of bias. Studies were combined in a pooled analysis using an inverse variance method. Results Twelve prospective cohort studies were eligible. The total injury incidence was 10.7 injuries/1000 h of exposure. Match incidence (55.9 injuries/1000 h) was much higher than training (4.6 injuries/1000 h). The lower limb accounted for over 70% of all injuries, with hamstring injuries ranging from 22 to 24% of all injuries. Non-contact injuries were the most common injury mechanism. Players aged >30 were at greatest risk of injury with incidence risk ratios ranging from 1.2 to 2.3. High aerobic fitness and chronic workloads were associated with reduced risk of injury in elite Gaelic footballers. Conclusions Elite Gaelic football athletes are twelve times more likely to get injured during match play compared to training. The lower limb is the most affected body region, and most injuries occur by non-contact mechanisms. Athlete age of greater than 30, poor aerobic fitness and sudden increments in training workload all increase the likelihood of injury. By understanding the incidence and nature of injuries in Gaelic football, targeted injury prevention strategies can be developed and implemented.

Objective: The objective of this paper is to model and experimentally validate the path loss benefits of magnetic human body communication (mHBC) using small form-factor-accurate coils operating under realistic conditions. Methods: A radiating near-field coupling model and numerical simulations are presented to show that the magnetic-dominant near-field coupling between resonant coils offers low path loss across the body and exhibits extra robustness to antenna misalignment compared to far-field RF schemes. To overcome the pitfalls in conventional vector-network-analyzer-based measurement configurations, we propose a standardized setup applied to broadband channel loss measurement with portable instruments. Two types of PCB coils for mHBC communication, designed for large devices such as smartphones and small devices such as earbuds, respectively, are built and measured. Results: The mHBC link for the ear-to-ear non-line-of-sight (NLOS) path measures up to -23.1 dB and -31.2dB with large and small coils, respectively, which is 50 dB more efficient than the conventional Bluetooth channels utilizing antennas of similar sizes. Ear-to-pocket and pocket-to-pocket channels also show at least 16 dB higher transmission than the Bluetooth channel. Conclusion: In terms of path loss, the mHBC approach offers compelling performance for short-range applications over the body region. For coils with dimensions of several centimeters, working between 100 MHz and 200 MHz minimizes the channel loss while keeping the bandwidth above 1 MHz. Significance: The extremely high efficiency of the proposed mHBC channel provides a solution to the energy problem for miniaturized wearables, potentially leading to new wearable device designs.

Made available in DSpace on 2022-04-28T19:44:33Z (GMT). No. of bitstreams: 0 Previous issue date: 2022-02-01 Background: Depression has been associated with episodes of musculoskeletal pain. However, it is not clear whether such relationships could be mitigated according to the physical activity level. Aim: To describe, during the COVID-19 pandemic, the relationship between depression and musculoskeletal pain according to the physical activity levels. Design: Cross-sectional study. Methods: This research was conducted in Brazil between May 5 and March 17, 2020. Participants (N = 1872; 58% women) were invited through social media to answer a structured online questionnaire. Depressive symptoms were assessed through self-report of perception of depression during quarantine. Musculoskeletal pain was assessed based on the Nordic questionnaire identifying nine possible pain points in the body. Physical activity was assessed based on the weekly frequency, intensity, and duration of each session of physical activity the participants engaged in during COVID-19. The logistic binary regression analyzed the associations between depressive symptoms and musculoskeletal pain according to the participants’ level of physical activity. Results: Depressive symptoms were associated with pain in six different regions of the body in physically inactive participants. In physically inactive participants, those with depressive symptoms 1.51 (95% CI = 1.04-2.19) and 2.78 (95% CI = 1.81-4.26) times more likely to have pain in one or two and ≥three regions body regions, respectively. In active participants, depressive symptoms were not associated with pain. Conclusion: During the COVID-19 pandemic, depression was associated with musculoskeletal pain in physically inactive participants. São Paulo State University (Unesp) School of Technology and Sciences, SP Department of Sport Exercise and Rehabilitation Northumbria University, England Human Movement Science and Rehabilitation Graduation Program. Sao Paulo Federal University Universidade Nove de Julho California State University Independent researcher São Paulo State University (Unesp) School of Technology and Sciences, SP

PURPOSE The coronavirus outbreak delivered the condition of dying from infection and forced people (especially university student computer users) to perform all working and non-working activities during homestay. In this situation, the device usage for a longer duration is mainly responsible for work-related health issues. This study aims to discover the effect of physical activity intervention (PAI) on computer users' musculoskeletal health during homestay. MATERIAL AND METHODS The investigation was performed on 40 university student computer users. To measure body discomfort before and after using the PAI, the body part discomfort scale of Corlett and Bishop was applied. RESULTS After implementing the PAI, the musculoskeletal disorder (MSD) decrement in major body regions was reported as: wrist/forearm (8.17 ± 1.45 to 4.57 ± 1.10), lower back (8.01 ± 1.42 to 4.40 ± 1.14), elbow (7.57 ± 1.71 to 3.49 ± 1.13), and neck (7.40 ± 1.71 to 4.02 ± 0.81). CONCLUSIONS It can be concluded that PAI significantly decreased the discomfort among users in various body regions. This research suggested that PAIs may reduce the risk of MSDs in the long term for different body regions.

BackgroundThe majority of combat deaths occur in the prehospital setting. Efforts to increase survival including blood transfusions are made in the prehospital setting. The blood products available in the Role 1 setting include whole blood (WB), red blood cells (RBCs), fresh frozen plasma (FFP), and lyophilized (freeze-dried) plasma (FDP).MethodsThis is a secondary analysis of a previously published dataset within the Prehospital Trauma Registry (PHTR) from 2003 through May 2019. Deterministic linking was used when possible with the DoD Trauma Registry for outcome data. Descriptive statistics were used to analyze the data.ResultsWe identified 1,357 patient encounters in the PHTR. Within that group, 28 patients received a prehospital blood product, with 41 total administrations: WB (18), RBCs (12), FFP (6), FDP (3), and blood not otherwise specified (2). Outcome data were available for 17 of the 28 patients. The median injury severity score was 20, with the thorax being the most frequent seriously injured body region. Most (94%) patients survived to discharge. The median ICU days was 11 (Interquartile Range [IQR] 3-19), and the median hospital days was 19 (IQR 8-29). The average volume (units) of RBCs was 6.0 (95% CI 1.9-10.1), WB 2.8 (95% CI 0.0-5.6), platelets 0.7 (95% CI 0.0-1.4), and FFP 5.0 (95% CI 1.2-8.8).ConclusionsThe use of prehospital blood products is uncommon in U.S. combat settings. Patients who received blood products sustained severe injuries but had a high survival rate. Given the infrequent but critical use and potentially increased need for adequate prolonged casualty care in future near-peer conflicts, optimizing logistical chain circulation is required.

In this paper, we propose a pose transfer framework that can deal with large body motion to generate dance videos. To solve the problem of body shape deformation from large movements, a Multiple Scale Region Extractor (MSRE) is proposed. The features of each body region can be extracted from multiple layers of the encoder according to the body key points and passed through shortcuts to the decoder to reduce the spatial information loss. We add a region style loss calculated by the style representations of the body regions to the loss function to improve the quality of the generated images. In addition, the concept of learnable region normalization is integrated in the proposed framework to prevent introducing undesired mean and variance shifts by the corrupted regions during normalization. The experiments have shown that the proposed system can significantly improve the pose generation results compared with existing methods, especially when there are large body movements in the dancing poses.

Contains fulltext : 248292.pdf (Publisher’s version ) (Open Access) BACKGROUND: Skin microvasculature changes are crucial in psoriasis development and correlate with perfusion. The noninvasive Handheld Perfusion Imager (HAPI) examines microvascular skin perfusion in large body areas using laser speckle contrast imaging (LSCI). OBJECTIVES: To (i) assess whether increased perilesional perfusion and perfusion inhomogeneity are predictors for expansion of psoriasis lesions and (ii) assess feasibility of the HAPI system in a mounted modality. METHODS: In this interventional pilot study in adults with unstable plaque psoriasis, HAPI measurements and color photographs were performed for lesions present on one body region at week 0, 2, 4, 6 and 8. The presence of increased perilesional perfusion and perfusion inhomogeneity was determined. Clinical outcome was categorized as increased, stable or decreased lesion surface between visits. Patient feedback was collected on a 10-point scale. RESULTS: In total, 110 lesions with a median follow-up of 6 (IQR 6.0) weeks were assessed in 6 patients with unstable plaque psoriasis. Perfusion data was matched to 281 clinical outcomes after two weeks. A mixed multinomial logistic regression model revealed a predictive value of perilesional increased perfusion (OR 9.90; p

BACKGROUND: Lack of standardization in CT protocol choice contributes to radiation dose variation. PURPOSE: To create a framework to assess radiation doses within broad CT categories defined according to body region and clinical imaging indication and to cluster indications according to the dose required for sufficient image quality. MATERIALS AND METHODS: This was a retrospective study using Digital Imaging and Communications in Medicine metadata. CT examinations in adults from January 1, 2016 to December 31, 2019 from the University of California San Francisco International CT Dose Registry were grouped into 19 categories according to body region and required radiation dose levels. Five body regions had a single dose range (ie, extremities, neck, thoracolumbar spine, combined chest and abdomen, and combined thoracolumbar spine). Five additional regions were subdivided according to dose. Head, chest, cardiac, and abdomen each had low, routine, and high dose categories; combined head and neck had routine and high dose categories. For each category, the median and 75th percentile (ie, diagnostic reference level [DRL]) were determined for dose-length product, and the variation in dose within categories versus across categories was calculated and compared using an analysis of variance. Relative median and DRL (95% CI) doses comparing high dose versus low dose categories were calculated. RESULTS: Among 4.5 million examinations, the median and DRL doses varied approximately 10 times between categories compared with between indications within categories. For head, chest, abdomen, and cardiac (3 266 546 examinations [72%]), the relative median doses were higher in examinations assigned to the high dose categories than in examinations assigned to the low dose categories, suggesting the assignment of indications to the broad categories is valid (head, 3.4-fold higher [95% CI: 3.4, 3.5]; chest, 9.6 [95% CI: 9.3, 10.0]; abdomen, 2.4 [95% CI: 2.4, 2.5]; and cardiac, 18.1 [95% CI: 17.7, 18.6]). Results were similar for DRL doses (all P < .001). CONCLUSION: Broad categories based on image quality requirements are a suitable framework for simplifying radiation dose assessment, according to expected variation between and within categories. © RSNA, 2021 See also the editorial by Mahesh in this issue.

Background A near-fall is defined as a loss of balance that would result in a fall if sufficient balance recovery manoeuvres are not executed. Compared to falls, near-falls and its associated balance recovery manoeuvres have been understudied. Older adults may not recognise a near-fall or identify the use of their balance recovery manoeuvres to prevent a fall. The consensus on the methods to collect near-fall data is lacking. The primary objective of this study was to determine the feasibility of recruitment and retention. Secondary objectives were to establish evidence that Singapore community-dwelling older adults can identify near-falls and associated balance recovery manoeuvres. Texting and calling methods were explored as reporting methods. Methods This study took place in Singapore (September to October 2019). Participants were healthy, community-dwelling adults aged 65 or older. Recruitment was done through poster advertisement, and all participants gave informed consent. Participants attended a briefing session and reported their near-fall or fall incidence over 21 days using either daily texting or calling. The primary outcome measures were the recruitment rate, retention rate, preferred modes for data reporting and ability to report near-falls or falls. Secondary outcomes included the self-reported incidence of falls and near-falls. Results Thirty older adults were recruited in 5 weeks. All participants completed the study. They understood near-fall concepts and were able to report the occurrence and relevant balance recovery manoeuvres used to prevent a fall. 87% (26/30) chose to text while 13% (4/30) selected calling as their reporting method. One actual fall (0.16%) out of 630 responses was reported. Thirty-six incidents (5.7%) of near-falls were recorded. Sixteen participants (53.3%) experienced near-falls and half of this group experienced two or more near-falls. The use of reach-to-grasp strategy (36%), compensatory stepping (52.8%), and other body regions (11.2%) were used to prevent the fall. Conclusions The study provided evidence that studying near-falls in Singapore community-dwelling older adults is feasible and can be applied to a large-scale study. Recruitment and retention rates were good. Older adults were able to identify near-falls and balance recovery manoeuvres. Both texting and calling were feasible reporting methods, but texting was preferred. Trial registration ClinicalTrials identifier: NCT04087551. Registered on September 12, 2019

The Abbreviated Injury Scale (AIS) score is used widely to quantify injury severity by body region. The maximal AIS score is 6, which defines a nonsurvivable injury. This study was undertaken to define mortality after AIS-6 injuries in order to determine if they are uniformly lethal and, if not, if differences between survivors and nonsurvivors exist which may aid in prognostication or refinement of the current AIS system.All patients in the National Trauma Data Bank (2007-2017) with ≥1 AIS-6 injury were included. Exclusions were age16 years, AIS-6 coding in the face/extremities (i.e., coding errors, as there are no AIS-6 injuries in these regions), and missing data. In-hospital mortality defined study groups, i.e., survivors vs. nonsurvivors. Univariable analysis compared clinical/injury data and outcomes. Multivariable analysis examined independent factors associated with mortality.19,247 patients met inclusion/exclusion criteria. Of these, 25% (n=4,886) survived to hospital discharge and 75% (n=14,361) died. The most common discharge destination among survivors was home (n=2,187,45%) Nonsurvivors had significantly worse GCS in the field (3 vs. 14, p0.001) and ED (3 vs. 15, p0.001). Median AIS was higher among nonsurvivors in the Head (5 vs. 3, p0.001), Abdomen (3 vs. 2, p0.001), and External regions (1 vs. 1, p0.001). Median time to death was 0.65h, with maximum time to death 8.76h. Multivariable analysis revealed External AIS-6 injuries were associated with greatest odds of mortality (OR 34.002, p0.001) followed by Head AIS-6 (OR 10.501, p0.001).AIS-6 injuries are not uniformly fatal, with 25% of such patients surviving to hospital discharge. Therefore, AIS-6 injuries may not be as catastrophic as previously considered. External and Head AIS-6, i.e. extensive burns and severe traumatic brain injuries, were associated with greatest odds of mortality. When death occurs after AIS-6 injury, it occurs rapidly, with all mortalities in this series occurring9h after arrival. We suggest that the AIS-6 verbiage be revised to remove 'nonsurvivable'.

Background Trauma patients often have complex injuries treated by multidisciplinary providers with wide-ranging expertise. We hypothesized that trauma patients would frequently incorrectly identify both their injuries and care teams. We also hypothesized that low health literacy level would be correlated with low levels of comprehension about injuries or care teams. Materials and methods We performed a prospective study of adult trauma inpatients >18 years. Participants were surveyed to report on 1) injured body regions 2) their care teams, and 3) health literacy via a validated survey. Self-reported injuries and care teams were compared to the patient's medical record. We also studied whether health literacy was associated with patient knowledge of injuries and care teams. Results Fifty participants were surveyed; thirty-two percent could not identify ≥50% of their injuries. Patients reliably identified injuries to the head, but injuries to other body areas were often misidentified. Forty-two percent of patients were not able to identify ≥50% of their medical teams, and 28% could not identify ≥75% of their medical teams. Patients often did not recognize teams such as nutrition, physical/occupationalt, or social work as part of their care. Thirteen participants reported adequate health literacy. Health literacy was not related to participant knowledge of injuries or care teams (both P = 0.9). Conclusion Many trauma inpatients were unable to correctly identify their injuries and care teams despite a range of self-reported health literacy scores.

Objectives: Available evidence implies that unfavorable changes in the distribution of adipose tissue resulting from hormonal imbalance associated with ovarian insufficiency might influence bone mineral density (BMD). The purpose of our study was to verify if volumes of visceral (VAT), female (FAT) and android (AAT) body fat as determined by densitometry determined influence BMD in women with functional menstrual disorders, and if these correlates some endocrine factors. Material and methods: We examined 293 women (mean age 26.7 ± 4.4 years) who have had psychogenic type of functional hypothalamic secondary amenorrhea for at least three months (mean 5.82 ± 0.94). A variety of hormonal tests, determination of BMD and both distribution and volume of adipose tissue were performed. Results: Volume of adipose tissue in all analyzed body regions indicated a positive correlation with BMD in lumbar spine (VAT: R = 0.277, FAT: R = 0.345, AAT: R = 0.336) and entire skeleton (VAT: R = 0.453, FAT: R = 0.527, AAT: R = 0.529). BMD in both the lumbar spine and entire skeleton had positive correlation with body mass index (R = 0.380 and R = 0.599, respectively) and free androgen index values (R = 0.150 and R = 0.279). It showed a negative correlation with sex hormone-binding globulin (R = –0.191 and R = –0.326). We did not find a parameter that could be an independent predictor of BMD. Conclusions: Distribution of body fat is only one of numerous determinants of BMD in women with functional menstrual disorders and should not be treated as the only predictor for bone mass deficiency. Determination of adipose tissue distribution in these patients has probably minor clinical impact.

Purpose Traumatic brain injury (TBI) continues to be a significant cause of mortality and morbidity worldwide. As cardiovascular events are among the most common extracranial causes of death after a severe TBI, the Revised Cardiac Risk Index (RCRI) could potentially aid in the risk stratification of this patient population. This investigation aimed to determine the association between the RCRI and in-hospital deaths among isolated severe TBI patients. Methods All adult patients registered in the TQIP database between 2013 and 2017 who suffered an isolated severe TBI, defined as a head AIS ≥ 3 with an AIS ≤ 1 in all other body regions, were included. Patients were excluded if they had a head AIS of 6. The association between different RCRI scores (0, 1, 2, 3, ≥ 4) and in-hospital mortality was analyzed using a Poisson regression model with robust standard errors while adjusting for potential confounders, with RCRI 0 as the reference. Results 259,399 patients met the study’s inclusion criteria. RCRI 2 was associated with a 6% increase in mortality risk [adjusted IRR (95% CI) 1.06 (1.01–1.12), p = 0.027], RCRI 3 was associated with a 17% increased risk of mortality [adjusted IRR (95% CI) 1.17 (1.05–1.31), p = 0.004], and RCRI ≥ 4 was associated with a 46% increased risk of in-hospital mortality [adjusted IRR(95% CI) 1.46 (1.11–1.90), p = 0.006], compared to RCRI 0. Conclusion An elevated RCRI ≥ 2 is significantly associated with an increased risk of in-hospital mortality among patients with an isolated severe traumatic brain injury. The simplicity and bedside applicability of the index makes it an attractive choice for risk stratification in this patient population.

Precision handicraft workers are often exposed to stressful postures and poor working conditions while performing different jobs, that are directly associated with the development of musculoskeletal disorders (MSDs). This cross-sectional study aimed at evaluating the prevalence of MSDs and contributing risk factors among male precision handicraft workers. 334 handicraft workers involved in different precision activities: 125 gemstone cutters, 98 miniature painters, and 111 metal craft workers, were surveyed. Information about the prevalence of musculoskeletal symptoms and work-related factors was collected using the self-reported questionnaire and direct observation methods, viz. rapid upper limb assessment (RULA) and rapid entire body assessment (REBA). Chi-square test was performed to analyze the association of MSD symptoms between the handicraft occupations. Further, binary logistic regression was used to identify the potential risk factors for MSD symptoms among workers. In all occupational groups, most participants reported high prevalence of MSDs primarily in the neck (61.6%), lower back (74.8%), and knee (54.7%) regions. Results revealed that age, work experience, prolonged work hours, sustained awkward posture, continuous work without break, extensive work pressure, and poor job control increased the risk of MSD symptoms in different body regions, while with a higher level of education, MSDs in the neck and lower back regions reduced. The findings indicated incompatibility between precision handicraft workers and the occupational environment. Logistic regression models showed significant contribution of physical and psychosocial work-related factors in developing MSD symptoms. Ergonomic interventions are imperative to evade adverse consequences on the occupational health of precision craft workers.

PURPOSE: In the multi-atlas segmentation (MAS) method, a large enough atlas set, which can cover the complete spectrum of the whole population pattern of the target object will benefit the segmentation quality. However, the difficulty in obtaining and generating such a large set of atlases and the computational burden required in the segmentation procedure make this approach impractical. In this paper, we propose a method called SOMA to select subject-, object-, and modality-adapted precision atlases for automatic anatomy recognition in medical images with pathology, following the idea that different regions of the target object in a novel image can be recognized by different atlases with regionally best similarity, so that effective atlases have no need to be globally similar to the target subject and also have no need to be overall similar to the target object. METHODS: The SOMA method consists of three main components: atlas building, object recognition, and object delineation. Considering the computational complexity, we utilize an all-to-template strategy to align all images to the same image space belonging to the root image determined by the minimum spanning tree (MST) strategy among a subset of radiologically near-normal images. The object recognition process is composed of two stages: rough recognition and refined recognition. In rough recognition, subimage matching is conducted between the test image and each image of the whole atlas set, and only the atlas corresponding to the best-matched subimage contributes to the recognition map regionally. The frequency of best match for each atlas is recorded by a counter, and the atlases with the highest frequencies are selected as the precision atlases. In refined recognition, only the precision atlases are examined, and the subimage matching is conducted in a nonlocal manner of searching to further increase the accuracy of boundary matching. Delineation is based on a U-net-based deep learning network, where the original gray scale image together with the fuzzy map from refined recognition compose a two-channel input to the network, and the output is a segmentation map of the target object. RESULTS: Experiments are conducted on computed tomography (CT) images with different qualities in two body regions – head and neck (H&N) and thorax, from 298 subjects with nine objects and 241 subjects with six objects, respectively. Most objects achieve a localization error within two voxels after refined recognition, with marked improvement in localization accuracy from rough to refined recognition of 0. 6–3 mm in H&N and 0. 8–4. 9 mm in thorax, and also in delineation accuracy (Dice coefficient) from refined recognition to delineation of 0. 01–0. 11 in H&N and 0. 01–0. 18 in thorax. CONCLUSIONS: The SOMA method shows high accuracy and robustness in anatomy recognition and delineation. The improvements from rough to refined recognition and further to delineation, as well as immunity of recognition accuracy to varying image and object qualities, demonstrate the core principles of SOMA where segmentation accuracy increases with precision atlases and gradually refined object matching.

The purpose of this study was to identify the prevalence of musculoskeletal problems in bio-pharmaceutical industry workers. A cross sectional survey was conducted on 33 bio-pharmaceutical industry workers by administering the Extended Nordic Musculoskeletal Questionnaire to quantify the musculoskeletal pain and activity limitation in 9 body regions. The Rapid Office Strain Assessment was used to assess the work-related postures and ergonomics of the computer operators in this industry. A Self-Designed Questionnaire was administered to obtain data regarding the various musculoskeletal problems faced by Bio-pharmaceutical industrial workers, work-related risk factors and various postures attained throughout the day. Out of the 33 workers investigated, 21 workers (63%) of the workers experienced musculoskeletal pain. Isolated spine pain was the commonest, and was reported in 8 out of 21 individuals (38%). Spine with upper and lower limb pain was the next most common, and was reported in 5 out of 21 individuals (24%). 4 out of 21 individuals had spine and lower limb pain (19%). The Rapid Office Strain Assessment scores of all the workers was above 5 indicating “high risk” which implied that immediate ergonomic change was necessary. This study concluded that there was 63% prevalence of musculoskeletal pain. The most common site of pain were the spine, followed by pain in the spine with both upper and lower extremities. All the workers were exposed to different ergonomic risk factors. The study concluded that implementation of ergonomic interventions may minimize the risks of work related musculoskeletal pain. Key words: Work-related musculoskeletal disorders, Extended Nordic Musculoskeletal Questionnaire, Rapid Office Strain Assessment, Ergonomic hazards.

The setal abundances and distributions of the spider crab Libinia are examined, using two species. These spider crabs decorate their bodies with environmental materials and camouflage from predators. These decorations attach to hooked setae, but other types setae are prevalent in body regions where decorations occur. Adult crabs undergo a terminal molt and lose the ability to regrow setae. Little is known about setal changes over the lifetime in these crabs and if hooked setae abundance decreases with age, resulting in a loss of camouflage strategy in larger individuals. The objective of this study is to determine the prevalence and abundance of hooked and non-hooked setae in the decorated body regions and if these setal patterns vary by species and body size. Scanning electron microscopy is used along with computer software to describe, count, and measure the setal coverage of hooked and non-hooked setae in body regions. Small individuals have more hooked setae than larger individuals and the two species have different setal abundances of hooked and non-hooked setae. Non-hooked setae cover much surface areas of crabs, attach decorations, and remain on the crabs even when hooked setae are damaged and broken. Setal morphologies and fouling are described among different sized crabs and the two species, with setal types and morphologies being similar but fouling being different. Large individuals likely employ a different camouflage strategy than small individuals due to losing hooked setae but retaining non-hooked setae.

Background: Given the rising prevalence of subways in combination with an increasing incidence of subway-related injuries, understanding subway-related trauma is becoming ever more relevant. The aim of this study was to characterize the potential causes, injury characteristics and outcomes of subway-related trauma at a level 1 adult trauma centre in Toronto, Ontario. Methods: We conducted a retrospective cohort study to identify patients who presented to the emergency department a level 1 adult trauma centre with a subway-related injury between Jan. 1, 2010, and Dec. 31, 2018. Patients were identified via International Statistical Classification of Diseases and Related Health Problems, 10th Revision E-codes (X81, Y02, V050, V051 and W17). We then further screened for descriptions of subway-related injuries. Patients whose injuries did not involve a moving subway train were excluded. Results: We identified 51 patients who presented to the emergency department after being hit by a moving subway train. The majority of incidents (39 [76%]) were due to self-harm, 10 (20%) were unintentional injuries, and 2 (4%) were due to assault. The presence of alcohol was detected in 8 patients (80%) with unintentional injuries and 3 (8%) of those with self-inflicted injuries. Thirteen patients (25%) had a systolic blood pressure less than 90 mm Hg. The median Injury Severity Score was 17 (interquartile range 9–29). Seventeen patients (33%) presented with severe injuries (Abbreviated Injury Scale score ≥ 3) in 1 body region, and 19 (37%) had severe injuries in 2 or more body regions. The most common isolated severe injury was in the lower extremity, and the most common combinations of severe injuries were in the head and lower extremity, and head and thorax. Ten patients (20%) were declared dead in the emergency department. Of the 41 patients who survived their initial presentation, 12 (29%) went directly to the operating room, and 17 (41%) were transferred to the intensive care unit. The overall mortality rate was 29%. Conclusion: Patients with subway-related injuries experienced high mortality rates and severe injuries. Most incidents were due to self-harm or alcohol-related. Further research into early identification of those at risk and optimal prevention strategies is necessary to curb further incidents.

SUMMARY OBJECTIVE: This study aims to analyze the level of disability and pain in capoeira practitioners. METHODS: This is a cross-sectional study. Data collection took place at the training sites of participants. The Self-Estimated Functional Inability because of Pain questionnaire for athletes (SEFIP-sport) was used to assess the pain and disability. Descriptive analysis was performed with the presentation of variables through mean and standard deviation (SD) or absolute number and percentage. RESULTS: The sample consisted of 65 capoeira practitioners. Of these, 42 (64.61%) reported pain or discomfort. The total score of the SEFIP-sport presented an average of 2.28 points (SD=2.65). The body regions with the highest reports of pain and disability were the knees, lower back, and wrist/hands. However, we observed a mild degree of disability measured by SEFIP-sport. CONCLUSIONS: The knees, lower back, and wrists/hands were the regions of the body with the highest reports of pain and disability. However, the disability presented by capoeira practitioners was slight.

Abbreviated Injury Scale (AIS)-based systems such as injury severity score (ISS), exponential injury severity score (EISS), trauma mortality prediction model (TMPM), and injury mortality prediction (IMP), classify anatomical injuries with limited accuracy. The widely accepted alternative, trauma and injury severity score (TRISS), improves the prediction rate by combining an anatomical index of ISS, physiological index (the Revised Trauma Score, RTS), and the age of patients. The study introduced the traumatic injury mortality prediction (TRIMP) with the inclusion of extra clinical information and aimed to compare the ability against the TRISS as predictors of survival. The hypothesis was that TRIMP would outperform TRISS in prediction power by incorporating clinically available data. This was a retrospective cohort study where a total of 1,198,885 injured patients hospitalized between 2012 and 2014 were subset from the National Trauma Data Bank (NTDB) in the United States. A TRIMP model was computed that uses AIS 2005 (AIS_05), physiological reserve and physiological response indicators. The results were analysed by examining the area under the receiver operating characteristic curve (AUC), the Hosmer–Lemeshow (HL) statistic, and the Akaike information criterion. TRIMP gave both significantly better discrimination (AUCTRIMP, 0.964; 95% confidence interval (CI), 0.962 to 0.966 and AUCTRISS, 0.923; 95% CI, 0.919 to 0.926) and calibration (HLTRIMP, 14.0; 95% CI, 7.7 to 18.8 and HLTRISS, 411; 95% CI, 332 to 492) than TRISS. Similar results were found in statistical comparisons among different body regions. TRIMP was superior to TRISS in terms of accurate of mortality prediction, TRIMP is a new and feasible scoring method in trauma research and should replace the TRISS.

Background This study used surveillance data from 2018 and 2020 to test the stability of work-related strain symptoms (high stress, sleep deprivation, exhaustion) with demographic factors, work characteristics, and musculoskeletal symptoms among farm and ranch operators in seven midwestern states of the United States. Methods Cross-sectional surveys were conducted among farm and ranch operators in 2018 (n = 4423) and 2020 (n = 3492). Operators were asked whether, in the past 12 months, they experienced extended work periods that resulted in high stress levels, sleep deprivation, exhaustion/fatigue, or other work-related strain symptoms. Covariates included personal and demographic factors, work characteristics, number of injuries, work-related health conditions, and exposures on the operation. Summary statistics were tabulated for explanatory and outcome variables. The classification (decision) tree approach was used to assess what variables would best separate operators with and without reported strain symptoms, based on a set of explanatory variables. Regularized regression was used to generate effect estimates between the work strain variables and explanatory variables. Results High stress level, sleep deprivation, and exhaustion were reported more frequently in 2018 than 2020. The classification tree reproduced the 2018 model using 2020 data with approximately 80% accuracy. The mean number of reported MSD symptoms increased slightly from 1.23 in 2018 to 1.41 in 2020. Older age, more time spent in farm work, higher gross farm income (GFI), and MSD symptoms in six body regions (ankles/feet, knees, lower back, neck, shoulders, wrists/hands) were associated with all three work strain symptoms. Conclusions Musculoskeletal pain and discomfort was a strong predictor for stress, sleep deprivation, and exhaustion among farmers and ranchers. This finding indicates that reducing MSD pain and discomfort is beneficial for both physical and mental health.

Introduction In a 52-week, phase 3 clinical trial (LIBERTY AD CHRONOS) in adult patients with moderate-to-severe atopic dermatitis (AD), dupilumab in combination with topical corticosteroids (TCS) resulted in a significant improvement in overall Eczema Area and Severity Index (EASI) compared with placebo plus TCS. In a post hoc analysis, dupilumab significantly improved the overall extent and severity of AD across four anatomic regions (head and neck, trunk, upper extremities, lower extremities) over 16 weeks. However, as AD severity and presentation may vary by body region, this analysis sought to determine whether there are regional variations in dupilumab efficacy. Methods Using data from the LIBERTY AD CHRONOS study, we performed a post hoc analysis of the mean percentage change in individual EASI signs (erythema, infiltration/papulation, excoriation, lichenification) from baseline through week 52 across four anatomic regions (head and neck, trunk, upper extremities, lower extremities). Results Dupilumab plus TCS, compared with placebo plus TCS, significantly improved the severity of all individual AD signs to a similar extent across the four anatomic regions. Significant improvements in each sign were seen early, within the first 2–4 weeks of treatment, and were sustained through week 52 across all regions. Conclusions In adult patients with moderate-to-severe AD, treatment with dupilumab resulted in rapid and sustained improvement in the signs of AD across all anatomic regions. Trial registration LIBERTY AD CHRONOS (NCT02260986).

Person Re-identification (ReID) is an important yet challenging task in computer vision. Due to diverse background clutters, variations of viewpoints and body poses, it is far from being solved. How to extract discriminative and robust features invariant to background clutters is one of the core problems. In this paper, we first introduce a set of binary segmentation masks to construct synthetic RGB-Mask pairs as inputs, and then design a mask-guided contrastive attention model (MGCAM) to learn features separately from the body and background regions. Moreover, we propose a novel region-level triplet loss to guide the features learning, i.e., pulling the features from the full image and body region close, whereas pushing the features from backgrounds away. To learn the similarities from multiple features of the proposed MGCAM, we further introduce the instance-level two-stream metric co-learning (TSMCL) to help learn pair-wise relations between features from not only different regions but also different instances. TSMCL could help learn more compact features across full and body streams, enhancing the performance of MGCAM. We evaluate the proposed method on four public datasets, including MARS, Market-1501, CUHK03, and DukeMTMC-reID. Extensive experiments show that the proposed method is effective and achieves satisfying results.

The insurance status of pediatric trauma patients is associated with access to post-discharge resources, including inpatient rehabilitation. Our goal was to understand the impact of changes in insurance coverage on access to post-acute care resources for pediatric trauma patients.We utilized the National Trauma Data Bank from 2012 to 2016 for all pediatric trauma patients with a highest body region abbreviated injury score2. Our primary outcome was hospital discharge disposition location. We used multivariable regression to adjust for salient patient and trauma center characteristics. Additionally, we performed a sensitivity analysis including only high-volume hospitals to examine the relationship between the magnitude of facility level expansion in coverage and changes in patient disposition.We identified 195,649 pediatric trauma patients meeting inclusion criteria. From 2012 to 2016 the proportion of patients with Medicaid (35% versus 39%, P0.001) and private insurance (39% versus 45%, P0.001) increased. Increased discharges with home health (HH) (+0.6% adjusted risk difference 2012 to 2016, P0.001) and decreased discharges to inpatient rehabilitation and skilled nursing facilities (-0.6% adjusted risk difference 2012 to 2016, P = 0.01) were associated with changes in insurance coverage. After stratifying high volume facilities by magnitude of increase in Medicaid and private insurance, we found that, for all groups, discharge to inpatient rehabilitation and skilled nursing facilities decreased (P0.01).Expanded insurance coverage for children was paradoxically associated with decreased discharge to inpatient rehabilitation and skilled nursing facilities after severe traumatic injury. These findings suggest that additional barriers may drive limitations in access to pediatric post-discharge services.

The P2X4 receptor is a ligand-gated ion channel activated by extracellular ATP. P2X4 activity is associated with neuropathic pain, vasodilation, and pulmonary secretion and is therefore of therapeutic interest. The structure-activity relationship of P2X4 antagonists is poorly understood. Here we elucidate the structure-activity of 5-(3-bromophenyl)-1,3-dihydro-2H-benzofuro[3,2-e]-1,4-diazepin-2-one (5-BDBD) at human P2X4 by combining pharmacology, electrophysiology, molecular modeling, and medicinal chemistry. 5-BDBD antagonized P2X4 in a noncompetitive manner but lacked effect at human P2X2. Molecular modeling and site-directed mutagenesis suggested an allosteric binding site for 5-BDBD located between two subunits in the body region of P2X4, with M109, F178, Y300, and I312 on one subunit and R301 on the neighboring subunit as key residues involved in antagonist binding. The bromine group of 5-BDBD was redundant for the antagonist activity of 5-BDBD, although an interaction between the carbonyl group of 5-BDBD and R301 in P2X4 was associated with 5-BDBD activity. 5-BDBD could inhibit the closed channel but poorly inhibited the channel in the open/desensitizing state. We hypothesize that this is due to constriction of the allosteric site after transition from closed to open channel state. We propose that M109, F178, Y300, R301, and I312 are key residues for 5-BDBD binding; provide a structural explanation of how they contribute to 5-BDBD antagonism; and highlight that the limited action of 5-BDBD on open versus closed channels is due to a conformational change in the allosteric site. SIGNIFICANCE STATEMENT: Activity of P2X4 receptor is associated with neuropathic pain, inflammation, and vasodilatation. Molecular information regarding small-molecule interaction with P2X4 is very limited. Here, this study provides a structural explanation for the action of the small-molecule antagonist 5-BDBD at the human P2X4 receptor.

Kinesio taping is widely used in musculoskeletal conditions. We performed a systematic review and meta-analysis on the efficacy of kinesio taping in musculoskeletal disorders compared to other interventions. Twelve electronic databases were used for systemic search and data relevant to pain and disability were extracted. The protocol was registered in PROSPERO (CRD42018087606). Meta-analysis was performed to compare the efficacy of kinesio taping to other modalities of musculoskeletal disorders. As a result, 36 studies were included in the quantitative analysis. Kinesio taping was found to provide an improvement of both pain and disability when applied to any region of the body. In the first five days of application, kinesio taping significantly reduced the pain in all body regions (SMD = -0.63, 95%CI: -0.87, -0.39). This was also noted after four-to-six weeks of application (SMD = -0.76, 95%CI: -1.07, -0.45). When kinesio taping was used for disability in low back pain patients, it significantly reduced the disability within five days of application (SMD = -0.70, 95%CI: -1.29, -0.11). Finally, kinesio taping has shown an improvement of the disability in all body regions after four-to-six weeks of application (SMD = -0.59, 95%CI: -0.96, -0.22). Our findings support kinesio taping as an adjuvant to other treatments for musculoskeletal disorders. Abbreviations KT = Kinesio taping; MSK = musculoskeletal; SD = standard deviation; CR = conventional rehabilitation; NDI = Neck Disability Index; NPS = Numerical Pain Scale; CTM = Cervical Thrust Manipulation; PIR = Post-isometric muscle relaxation; NPRS Numerical Pain Rating Scale; OA = osteoarthritis; ROM = Range of motion; VAS = visual analogue scale; VAS-W = visual analogue scale-worst pain; VAS-U = visual analogue scale-usual pain; VAS-R = visual analogue scale-resting pain; VAS-A = visual analogue scale-activity pain; VAS-N = visual analogue scale-night pain; NPDS = Neck Pain Disability Scale; QA = Quality assessment.

Background/aim We evaluated the feasibility of producing splints with 3D printer technology to prevent contractures in burned children in our clinical prospective study. Materials and methods After approvals, children with burns greater than 2nd degree were included in the study. Age, sex, burn percentages, printing time, filament types, number of filament trials, splint suitability, patient and doctor comments, preclinical trials’ significances and financial impact were evaluated statistically. Results Seventy-six trials were conducted on 18 patients. Fourteen of the patients were male and 4 are female. Average ages of boys and girls were 5 and 3, respectively. Burn percentage was 36.9 ± 13. Polylactic acid (PLAFlex), polyurethane (PolyFlex), semiflexible copolyester (nGenFlex), and thermoplastic polyurethane (TPU) were the main filaments that were used in the study. Printing time differed from 4 to 29 h according to body regions. Splints were suitable for 81.25% in upper extremity, for 66.7% in lower extremity, and for 100% in mouth. Burn percentage was significantly correlated with total number of filament (p = 0.049). Other statistical evaluations were insignificant. Conclusion The 3D printer seems to be useful in children with burns. However, difficulties caused by some reasons like production must be overcome. By increasing clinical experience, this emerging custom-made technology may become standard, and documented problems can be solved.

Objectives. Coronavirus (COVID-19) is affecting people throughout the world. People are forced to conduct various activities at home using mobile devices (MDs) as a result of the outbreak. In this case, prolonged use of MDs is the major cause for work-related health problems. Methods. We used systematic cluster random sampling to sample a diverse group of Indians from India's various states. Subjects filled out a questionnaire with questions about their demographics, MD usage and musculoskeletal symptoms (MSSs) faced. The relationship between MSSs and various factors was investigated using χ2 and binomial logistic regression analysis. Results. An online survey yielded 720 responses. More than half of employees registered MSSs in their upper body regions. Age, gender and MD usage were correlated with MSSs in various body regions. According to the binomial logistic regression findings, gender was significantly linked to MSSs in each body region. Conclusions. Results show that MDs can be used effectively in intermediate leisure activities if they are used in accordance with their basic needs.

ObjectivesTo investigate sensitivity of brain MRI and neurological examination for detection of upper motor neuron (UMN) degeneration in patients with amyotrophic lateral sclerosis (ALS).MethodsWe studied 192 patients with ALS and 314 controls longitudinally. All patients visited our centre twice and underwent full neurological examination and brain MRI. At each visit, we assessed UMN degeneration by measuring motor cortex thickness (CT) and pyramidal tract fibre density (FD) corresponding to five body regions (bulbar region and limbs). For each body region, we measured degree of clinical UMN and lower motor neuron (LMN) symptom burden using a validated scoring system.ResultsWe found deterioration over time of CT of motor regions (p≤0.0081) and progression of UMN signs of bulbar region and left arm (p≤0.04). FD was discriminative between controls and patients with moderate/severe UMN signs (all regions, p≤0.034), but did not change longitudinally. Higher clinical UMN burden correlated with reduced CT, but not lower FD, for the bulbar region (p=2.2×10−10) and legs (p≤0.025). In the arms, we found that severe LMN signs may reduce the detectability of UMN signs (p≤0.043). With MRI, UMN degeneration was detectable before UMN signs became clinically evident (CT: p=1.1×10−10, FD: p=6.3×10−4). Motor CT, but not FD, deteriorated more than UMN signs during the study period.ConclusionsMotor CT is a more sensitive measure of UMN degeneration than UMN signs. Motor CT and pyramidal tract FD are discriminative between patients and controls. Brain MRI can monitor UMN degeneration before signs become clinically evident. These findings promote MRI as a potential biomarker for UMN progression in clinical trials in ALS.

For the current study, an existing theater injury data set was compared to component and whole body experiments meant to replicate the theater high rate vertical loading environment. The theater injury data set was derived from real world events that were within the design range of the Warrior Injury Assessment Manikin. A qualitative and quantitative assessment of the whole body fracture patterns was developed to determine whether the laboratory loading was correctly representing the resulting injuries seen in theater Underbody Blast (UBB) events. Results indicated that most of the experimental test fracture patterns were similar to the theater injuries for Abbreviated Injury Scale body regions of interest (lower extremities, pelvis, and spine); however, some of the body regions had higher similarity scores compared to others. Whole body fracture distribution was less similar than the component tests because of differences in injury distributions. The lower extremity whole body similarity was lower than spine and pelvis similarity. This analysis was able to identify some experimental tests that might not represent theater loading. In conclusion, this analysis confirmed that some laboratory testing produced skeletal injury patterns that are seen in comparable theater UBB events.

Somatosensory autonomic reflexes allow electroacupuncture stimulation (ES) to modulate body physiology at distant sites1–6 (for example, suppressing severe systemic inflammation6–9). Since the 1970s, an emerging organizational rule about these reflexes has been the presence of body-region specificity1–6. For example, ES at the hindlimb ST36 acupoint but not the abdominal ST25 acupoint can drive the vagal–adrenal anti-inflammatory axis in mice10,11. The neuroanatomical basis of this somatotopic organization is, however, unknown. Here we show that PROKR2Cre-marked sensory neurons, which innervate the deep hindlimb fascia (for example, the periosteum) but not abdominal fascia (for example, the peritoneum), are crucial for driving the vagal–adrenal axis. Low-intensity ES at the ST36 site in mice with ablated PROKR2Cre-marked sensory neurons failed to activate hindbrain vagal efferent neurons or to drive catecholamine release from adrenal glands. As a result, ES no longer suppressed systemic inflammation induced by bacterial endotoxins. By contrast, spinal sympathetic reflexes evoked by high-intensity ES at both ST25 and ST36 sites were unaffected. We also show that optogenetic stimulation of PROKR2Cre-marked nerve terminals through the ST36 site is sufficient to drive the vagal–adrenal axis but not sympathetic reflexes. Furthermore, the distribution patterns of PROKR2Cre nerve fibres can retrospectively predict body regions at which low-intensity ES will or will not effectively produce anti-inflammatory effects. Our studies provide a neuroanatomical basis for the selectivity and specificity of acupoints in driving specific autonomic pathways. Neuroanatomical findings demonstrate why electroactupuncture at only specific acupoints can drive the vagal–adrenal axis and treat inflammation in mice.

Every year, more than 20,000 patients with polytrauma are treated in Germany. The term polytrauma refers to simultaneous injury to several body regions that are individually or collectively life-threatening for the patient. However, this assessment is made based on appropriate scoring systems. Adequate treatment of these patients requires not only medical care at the highest level, but also coordination of organizational/logistical processes. The link between preclinical and clinical care is treatment in the shock room, which should be led by a defined, experienced "trauma leader". Treatment algorithms are based on the current S3 guideline Polytrauma/Serious Injury Treatment of the AWMF and the White Paper on Serious Injury Care. Here, recommendations are defined regarding personnel, spatial, logistical and material requirements. Every shock room team should be trained regularly and have theoretical and practical knowledge on the application of shock room algorithms. This can improve the quality of treatment and thus the probability of survival of critically ill patients. In the shock room itself, the focus is on standardized and priority-oriented assessment and stabilization of the patient. Due to the varying quality of care for severely injured patients in Germany, the TraumaNetwork DGU® initiative was implemented by the German Society of Trauma Surgery to improve the treatment of polytrauma patients by defining standards and improving processes and organization in the care of severely injured patients. In Germany, there are currently 615 participating hospitals that are organized in 52 local trauma networks, some of which are cross state borders.