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Purpose: Equitable inclusion of racial and ethnic participation in clinical trials is crucial to improving disparities in health care, especially for historically marginalized populations. Our study aims to describe the racial and ethnic demographics of patients enrolled in published phase 2 clinical trials involving proton therapy in the United States. Materials and Methods: Published manuscripts were identified in PubMed, Embase, World of Science, and Cochrane. Phase 2 trials evaluating proton therapy for US patients were included. For each article in the study, data were collected comprising authors, title, and publication year, and clinical trial numbers were verified. Additional data included tumor site, primary institution, sample size, reported race/ethnicity, and raw number/percentile of race/ethnicity. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were used. Results: Overall, 970 titles were identified; 636 remained after duplicate screening, and 75 full-text articles were assessed. We identified 38 eligible manuscripts for inclusion comprising 2648 patients. Only 15 (39%) of the publications reported race/ethnicity. Of these, 8 (21%) and 10 (26%) documented Hispanic or Black trial participants, respectively; however, only 6 (16%) documented trial participation for both Hispanic and Black patients. Of the 1409 patients with a documented race/ethnicity, 89.0% (n = 1254) were non-Hispanic white, 5.3% (n = 75) were Black, and 2.2% (n = 31) were Hispanic. Other and unknown race/ethnicity comprised the remaining patients (3.5%; n = 49). Conclusion: We identified underreporting of demographic data in published phase 2 proton therapy trials, which unfortunately mirrored underreporting for cancer drug clinical trials. We also noted dramatic Black and Hispanic patient underrepresentation across the trials in which race and ethnicity are reported. Findings highlight the urgent need to identify and address barriers to proton therapy trials for Black and Hispanic patients ensuring clinical trials in radiation oncology are representative of the patients seen in clinical practice.

Staphylococcus Sp.is the most common type of bacteria found in contamination place, we design this study to compare the contamination accident between two hospitals in Baghdad.One of them isthe Burns Specialist Hospital in the Medical CityinRusafa and another one is Al-Karama Hospital in Karkh. The samples were collected fromOperativeWard No1 (OW1), Operative Ward No2 (OW2), Consulting Pharmacy (CP), Emergency Room (ER), Reception Room (RR), Women's Ward (WW) and Men's Ward (MW).The samples were taken from inside each clinical unit, surfaces, food, and air. The results showed that the number of samples containing Staphylococcus sp. bacteria is 81, including 45 belonging to Al-Karama Burns Ward Hospital and 36 belonging to the Medical City Hospital, Burns Special Hospital. The results of Medical City Hospital showed that Staphylococcus sp.isolates resist many antibiotics, 99.99% of the isolates from patient samples were resistant to(CLR, P, AMP); 92.30% of the isolates from air samples were resistant to(P, MET) and 85.71%of isolates from surfaces and food samples were resist for (AMP, MET). Also the results of Al-KaramaHospital showed that the highest resistance in the staphylococcus sp.isolateswere in patient samplesfor (AMP, SXT), in surface samples for (E), in food samples for (E,P) and in air samples for (P) and the resistance rates were 100% to all these antibiotics.

Background: Lumbar spinal canal stenosis (LSCS) is a disorder that causes neurologic deficit, pain and disability. It is common in the elderly, and increasingly encountered as the population ages. Because other causes of back pain are common and difficult to prove, it is possible that mechanical backache, in conjunction with coincident neuropathy or other unrelated leg complaint, might lead to inappropriate treatment including surgery. Thus, accurate diagnosis of the clinical syndrome of spinal stenosis using paraspinal mapping technique may be of critical importance. Objectives: Asses the utility of paraspinal mapping technique in detecting the level of lumbar radiculopathies in patients with lumbar spinal canal stenosis. Subjects and methods: Ninety seven (97) patients with LSCS with a mean age of (46.3±11.2) years and thirty four (34) healthy control subjects with a mean age of (42.8±8.8) years involved in the study. Needle EMG of lumbar paraspinal muscles in addition to eight lower limbs muscles were performed. Results: Paraspinal muscles scores greater than 4 significantly differentiate the patients with LSCS from the control groups. The percentages of each level of lumbar radiculopathy by using paraspinal mapping technique differ from those by using lower limbs electromyography (EMG) for example right and left L5 radiculopathy 19.6%, 18.6% using EMG of PSM when compared with 78.2%, 79.4% using EMG of lower limbs muscles, and the percentages will increase by combination of both tests in such a way that RT and LT L5 radiculopathy increase to 84.5%, 82.5%. Conclusion: Paraspinal mapping technique is a sensitive, useful, quantifiable and quite effective method in the diagnosis of lumbar spinal canal stenosis when compared with lower limbs EMG.

Aim: To analyse the various imaging features of invasive micropapillary carcinoma (IMPC), a distinct variant of breast cancer, by mammography, ultrasound, and contrast-enhanced mammography., Materials and Methods: This study included 68 female patients with histopathologically proven invasive micropapillary carcinoma who underwent mammography, ultrasound, and contrast-enhanced mammography examinations. The findings encountered by each imaging tool were analysed using the Breast Imaging Reporting and Data System (BI-RADS) lexicon., Results: In this retrospective study, 64.7% of cases were of the pure form of IMPC. Most of the cases showed an aggressive clinical course, with lymphovascular invasion noted in 76.5% of cases, while 60.3% of cases showed associated pathological lymphadenopathy. The N3 stage was reported in 25% of cases. On analysing the mammographic and ultrasound imaging findings, a significant association between irregular shape and a non-circumscribed margin with IMPC was found. Associated calcification was noted in 47% of cases. Pathological enhancement of moderate or marked conspicuity was noted in cases that underwent contrast-enhanced mammography, with the most commonly encountered finding being enhancing irregular and non-circumscribed masses., Conclusion: The mammographic and ultrasound imaging features of IMPC are indistinguishable from other aggressive types of breast cancer. At contrast-enhanced mammography examination, pathological enhancement of moderate to marked conspicuity was shown in all cases. The observed strong association of IMPC with lymphovascular invasion and lymph node metastasis with higher nodal stage in this study mandate meticulous sonographic examination of the axilla, as well as the infra, and supraclavicular regions if pathological axillary lymphadenopathy was noted., (Copyright © 2023. Published by Elsevier Ltd.)

Breast cancer is one of the most prevalent cancers among women. It is the second leading cause of death in cancer-related deaths. Early detection and personalized risk assessment can reduce the mortality rate and improve survival rates. Classical risk prediction models which rely on traditional risk factors produce inconsistent results among the different populations. Thus, they are not routinely used in screening programs. Deep learning was proven to improve the results of breast cancer risk prediction. CNNs can detect risk cues from screening mammograms. However, the deep learning models utilize the spatial information of each screening mammogram independently. This study aims to further improve the risk prediction models by exploiting the spatiotemporal information in multiple screening time points. We implemented a Siamese neural network for spatiotemporal risk prediction and compared the results against CNN trained using two different time points (T1 and T2) independently. We tested our results on 191 cases, 61 of which were diagnosed with cancer. The Siamese model showed a superior AUC of 0.81 against 0.75 and 0.77 at T1 and T2 respectively. The Siamese network also exhibited higher accuracy and F1-score with values of 0.78 and 0.61 while CNNs have the same accuracy of 0.76 with an F1-score of 0.54 at T1, and 0.59 at T2. The results suggest that spatiotemporal risk prediction can be a more reliable risk assessment tool.

Objectives: Since being declared a global pandemic, the SARS-CoV-2 virus had a significant impact on the entire globe. The pandemic has placed a heavy burden on healthcare systems worldwide, and cancer patients are particularly prone. Despite the fact that initial international reports suggest delays in breast cancer (BC) diagnosis and screening programs, the Egyptian context requires additional research on this topic. To examine whether COVID-19 has changed the pattern of disease presentation before and after the pandemic, focusing on the tumor, node, and metastasis (TNM) staging of the disease at the initial presentation., Methods: This single-center, retrospective study of female BC patients initially diagnosed at Baheya Foundation was conducted during the following time frames: from Jan 2019 to Jan 2020 (Pre COVID-19 cohort) and from Mar 2020 to Mar 2021 (post-COVID-19 cohort). We compared the two cohorts in terms of clinical characteristics, tumor characteristics, and the number of days from presentation to treatment. Our primary endpoint was the difference in the TNM stage of BC at the initial presentation., Results: This analysis included 710 BC patients, 350 from the pre-COVID cohort and 360 from the post-COVID group. We detected a 27.9% increase in late-stage BC (stages III-IV) in the post-pandemic cohort compared to the pre-pandemic (60.1% vs. 47%, p < 0.001). The time from diagnosis to commencement of treatment was significantly longer (28.34 ± 18.845 vs 36.04 ± 23.641 days, p < 0.001) in the post-COVID cohort (mean difference = 7.702, 95% CI 4.54-10.85, p < 0.001). A higher percentage of patients in the post-pandemic cohort received systemic neoadjuvant therapy ( p -value for Exact's test for all treatment options = 0.001)., Conclusions: The number of patients requiring systemic neoadjuvant chemotherapy increased dramatically in the post-pandemic group with advanced stages of BC at presentation. This study highlights the need for proper management of cancer patients during any future pandemic.

Breast cancer is one of the leading causes of death among women. Early prediction of breast cancer can significantly improve the survival rates. Breast density was proven as a reliable risk factor. Deep learning models can learn subtle cues in the mammogram images. CNN models were recently shown to improve the risk discrimination in full-field mammograms. This study aims to improve risk prediction models using bilateral analysis. Bilateral analysis is the process of comparing two breasts to verify presence of anomalies. We developed a Siamese neural network to leverage the bilateral information and asymmetries between the two mammograms of the same patient. We tested our model on 271 patients and compared the results of our Siamese model against the traditional unilateral CNN model. Our results showed AUCs of 0.75 and 0.70 respectively (p = 0.0056). The Siamese model also exhibits higher sensitivity, specificity, precision, and false positive rate with values of 0.68, 0.69, 0.71, 0.31 respectively. While the CNN values were 0.61, 0.66, 0.67, 0.34 respectively. We merged both models by two techniques using pre-trained weights and weighted voting ensemble. The merging technique boosted the AUC to 0.78. The results suggest that bilateral analysis can significantly improve the risk discrimination.

Background: Risk factors are traits or behaviors that have an influence on the development of breast cancer (BC). Awareness of the prevalent risk factors can guide in developing prevention interventions., Purpose: To evaluate the correlation between the breast density, body mass index, and the risk of breast cancer development in relation to the menopausal status in a native African-Arab population., Material and Methods: The study included 30,443 screened females who were classified into cancer and non-cancer groups and each group was further sub-classified into pre- and postmenopausal groups. The breast density (BD) was reported and subjectively classified according to the 2013 ACR BI-RADS breast density classification. The weight and height were measured, and the body mass index (BMI) was calculated and classified according to the WHO BMI classification., Results: A statistically significant difference was calculated between the mean BMI in the cancer and non-cancer groups ( p : .027) as well as between the pre- and postmenopausal groups ( p < .001). A positive statistically insignificant correlation was calculated between the breast density and the risk of breast cancer in the premenopausal group (OR: 1.062, p : .919) and a negative highly significant correlation was calculated in the postmenopausal group (OR: 0.234, p < .001)., Conclusion: BMI and BD are inversely associated with each other. The current studied population presented unique ethnic characteristics, where a decreased BD and an increased BMI were found to be independent risk factors for developing breast cancer., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

The strong demand for plastic and polymeric materials continues to grow year after year, making these industries critical to address sustainability. By functioning as a filler in either a synthetic or natural starch matrix, nanoclay enables significant reductions in the impact of nonbiodegradable materials. The effect of treated nanoclay (NC) loading on the mechanical and morphological properties (EP) of epoxy is investigated in this research. The NC-EP nanocomposites were prepared via casting. The investigation begins with adding NC at concentrations of 1, 2, and 3 weight percent, followed by the effect of acid treatment on the same nanocomposites. The evaluation is focused on four mechanical tensile strength parameters: Young's modulus, maximum load, and % elongation. The addition of NC improved the mechanical properties of the four components by 27.2%, 33.38%, 46.98%, and 43.58%, respectively. The acid treatment improved 35.9%, 42.8%, 51.1%, and 83.5%, respectively. These improvements were attributed to NC's ability to alter the structural morphology as assessed by field emission scanning electron microscopy (FESEM), a tool for analysing the microstructure. FESEM images were used to visualise the interaction between the NC and EP nanocomposites. The dynamic mechanical properties of the hybrid nanocomposites were investigated using storage modulus, loss modulus, and tan(delta). The results have shown that the viscoelastic properties improved as the fraction of NC increased. The overall findings suggest that these nanocomposites could be used in various industrial and biomedical applications.

This series of reviews has been produced to assist both the experienced surgeon and coder, as well as those just starting practice that may have little formal training in this area. Understanding this complex system will allow the provider to work 'smarter, not harder' and garner the maximum compensation for their work. We hope we have been successful in achieving that goal and that this series will provide useful information and be worth the time invested in reading it by bringing tangible benefits to the efficiency of practice and its reimbursement., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

This series of reviews has been produced to assist both the experienced surgeon and coder, as well as those just starting practice that may have little formal training in this area. Understanding this complex system will allow the provider to work "smarter, not harder" and garner the maximum compensation for their work. We hope we have been successful in achieving that goal and that this series will provide useful information and be worth the time invested in reading it by bringing tangible benefits to the efficiency of practice and its reimbursement. This second section deals with postoperative documentation and coding, documentation and coding in conjunction with trainees and advanced practitioners, and coding of select procedures., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

This series of reviews has been produced to assist both the experienced surgeon and coder, as well as those just starting practice that may have little formal training in this area. Understanding this complex system will allow the provider to work "smarter, not harder" and garner the maximum compensation for their work. We hope we have been successful in achieving and that goal that this series will provide useful information and be worth the time invested in reading it by bringing tangible benefits to the efficiency of practice and its reimbursement. This third section deals with coding of additional select procedures, modifiers, telemedicine coding, and robotic surgery., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: The main purpose of this article is to produce a French-Canadian translation of the Consolidated criteria for reporting qualitative studies (COREQ) scale under the proposed name "échelle COREQ" and to assess the transcultural validity of its content. The secondary purpose is to examine the inter-rater reliability of the French-Canadian version of the COREQ scale. Method: A modified approach to Vallerand's methodology (1989) for cross-cultural validation was used. First, a parallel back-translation of the COREQ scale was performed, by both professionals and clinicians. Next, a first committee of experts(P1) examined the translations to create a first draft of the French-Canadian version of the COREQ scale. This draft was then evaluated and modified by a second committee of experts (P2). Finally, 28future professionals (master's students in physiotherapy) rated this second draft of the tool for clarity using a seven-point scale (1:very clear; 7:very ambiguous). The principal co-investigators then reviewed the problematic elements and proposed final changes. Two independent raters used this French-Canadian version of the COREQ scale to assess 13qualitative studies that were published in French after the year2007. The kappa coefficient was used to examine inter-rate reliability. Results: The different elements of the final version of the COREQ scale received an average ambiguity rating between 1.04 and 2.56. These low values show a high level of clarity for the French-Canadian version of the COREQ scale. In relation to the total score of the COREQ scale, inter-rater reliability ( n  = 2) is considered to be average to excellent for 62.5% of individual elements, according to the kappa values obtained. Conclusions: A valid French-Canadian version of the COREQ scale was created using this rigorous five-step process., (© Canadian Physiotherapy Association.)

Postintensive care syndrome (PICS) is a heterogeneous syndrome marked by physical, cognitive, and mental health impairments experienced by critical care survivors. It is a syndrome that bears significant human and health care costs. Additional research is needed to identify risk factors and diagnostic, preventative, and treatment strategies for PICS. Trauma intensive care unit patients are particularly vulnerable to posttraumatic stress disorder, which shares some of the adverse long-term consequences of PICS and also requires additional research into effective preventative and management strategies., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: There is a lack of information on annual healthcare expenditures both per person and for the U.S. population associated with trauma, as identified by International Classification of Disease Ninth Revision, Clinical Modification (ICD-9-CM) codes., Methods: This paper employed a two-part model to estimate the unadjusted and adjusted annual per individual expenditures and population burden of trauma exposure for the U.S. population, using a nationally representative survey of medical care expenditures. In addition, we estimated a logit model to examine the demographic and comorbidity factors associated with the likelihood of experiencing trauma., Results: Approximately 18.2% of U.S. adults were found to have trauma exposure during the survey year of 2011. The most frequent trauma ICD-9-CM code was injury not elsewhere classified/not otherwise specified. Adjusted likelihood of trauma was higher among individuals under the age of 65; males; non-Hispanic whites; nonmarried or never married; and individuals living with comorbidities of stroke, joint pain, arthritis, and asthma. The most expensive of the top 10 ICD-9-CM trauma codes was dislocation of the knee. Significant differences in expenditure categories were found for office-based, outpatient, emergency department (ED), dental, and other medical care. After adjustment for comorbidities and demographics, the adjusted per-person burden of trauma was estimated to be $1,689 (95% confidence interval [CI] = $1,006 to $2,372), with an incremental burden on the U.S. population of $60.8 billion per year., Conclusions: Trauma results in a significant healthcare expenditure burden, both per person and on the U.S., Population: Clinicians should be aware that individuals in the U.S. population with certain comorbidities such as stroke, joint pain, arthritis, and asthma are more likely to have trauma and that differences exist in expenditures for office-based, outpatient, dental, and the ED., (© 2016 by the Society for Academic Emergency Medicine.)

Background: Postpartum Depression affects a considerable number of women worldwide. This condition inflicts severe consequences to mother and child health. Thus far, available treatments have low response and high relapse rates. We designed this trial to evaluate a safe and more efficacious innovative therapy., Aims: To report a feasible and ethical study design to assess the safety and efficacy of a high frequency repetitive Transcranial Magnetic Stimulation 10 Hz (rTMS) compared to sham rTMS in women with moderate to severe Post-Partum Depression using standard treatment (sertraline).To conduct an ancillary, exploratory, randomized, active controlled, double blind study with a hypothesis to assess the safety and efficacy of 10 Hz rTMS compared to sertraline., Methods: A multicenter, parallel arm, randomized, placebo-controlled, double-blind design to assess safety and efficacy of 10 Hz rTMS compared to sham.An ancillary study will be conducted with parallel arm, randomized, active controlled and double dummy design to assess safety and efficacy of 10 Hz rTMS compared to sertraline.

The total number, morbidity and mortality attributed to viraemic hepatitis C virus (HCV) infections change over time making it difficult to compare reported estimates from different years. Models were developed for 15 countries to quantify and characterize the viraemic population and forecast the changes in the infected population and the corresponding disease burden from 2014 to 2030. With the exception of Iceland, Iran, Latvia and Pakistan, the total number of viraemic HCV infections is expected to decline from 2014 to 2030, but the associated morbidity and mortality are expected to increase in all countries except for Japan and South Korea. In the latter two countries, mortality due to an ageing population will drive down prevalence, morbidity and mortality. On the other hand, both countries have already experienced a rapid increase in HCV-related mortality and morbidity. HCV-related morbidity and mortality are projected to increase between 2014 and 2030 in all other countries as result of an ageing HCV-infected population. Thus, although the total number of HCV countries is expected to decline in most countries studied, the associated disease burden is expected to increase. The current treatment paradigm is inadequate if large reductions in HCV-related morbidity and mortality are to be achieved., (© 2015 John Wiley & Sons Ltd.)

Detailed, country-specific epidemiological data are needed to characterize the burden of chronic hepatitis C virus (HCV) infection around the world. With new treatment options available, policy makers and public health officials must reconsider national strategies for infection control. In this study of 15 countries, published and unpublished data on HCV prevalence, viraemia, genotype, age and gender distribution, liver transplants and diagnosis and treatment rates were gathered from the literature and validated by expert consensus in each country. Viraemic prevalence in this study ranged from 0.2% in Iran and Lebanon to 4.2% in Pakistan. The largest viraemic populations were in Pakistan (7 001 000 cases) and Indonesia (3 187 000 cases). Injection drug use (IDU) and a historically unsafe blood supply were major risk factors in most countries. Diagnosis, treatment and liver transplant rates varied widely between countries. However, comparison across countries was difficult as the number of cases changes over time. Access to reliable data on measures such as these is critical for the development of future strategies to manage the disease burden., (© 2015 John Wiley & Sons Ltd.)

The hepatitis C virus (HCV) epidemic was forecasted through 2030 for 15 countries in Europe, the Middle East and Asia, and the relative impact of two scenarios was considered: increased treatment efficacy while holding the annual number of treated patients constant and increased treatment efficacy and an increased annual number of treated patients. Increasing levels of diagnosis and treatment, in combination with improved treatment efficacy, were critical for achieving substantial reductions in disease burden. A 90% reduction in total HCV infections within 15 years is feasible in most countries studied, but it required a coordinated effort to introduce harm reduction programmes to reduce new infections, screening to identify those already infected and treatment with high cure rate therapies. This suggests that increased capacity for screening and treatment will be critical in many countries. Birth cohort screening is a helpful tool for maximizing resources. Among European countries, the majority of patients were born between 1940 and 1985. A wider range of birth cohorts was seen in the Middle East and Asia (between 1925 and 1995)., (© 2015 John Wiley & Sons Ltd.)

Objective: To evaluate the effects of rapid maxillary expansion (RME) on nocturnal enuresis (NE) related to the nasal airway, nasal breathing, and plasma osmolality (as an indicator for antidiuretic hormone)., Materials and Methods: Nineteen patients with monosymptomatic primary NE, aged 6-15 years, were treated with RME for 10-15 days. To exclude a placebo effect of the RME appliance, seven patients were first treated with a passive appliance. Computed tomography of nasal cavity, rhinomanometric, and plasma osmolality measurements were made 2-3 days before and 2-3 months after the RME period. RME effects on NE were followed for three more years., Results: Two to three months after the expansion there were significant improvements in the breathing function and a decrease in the plasma osmolality. NE decreased significantly in all patients after the RME period, and all patients showed full dryness after 3 years., Conclusions: This study demonstrates that RME causes complete dryness in all patients, with significant effects on pathophysiological mechanisms related to NE.

Background: Telemedicine technology can improve care to patients in rural and medically underserved communities yet adoption has been slow. The objective of this study was to study organizational readiness to participate in an academic-community hospital partnership including clinician education and telemedicine outreach focused on sepsis and trauma care in underserved, rural hospitals., Methods: This is a multi-method, observational case study. Participants included staff from 4 participating rural South Carolina hospitals. Using a readiness-for-change model, we evaluated 5 general domains and the related factors or topics of organizational context via key informant interviews (n=23) with hospital leadership and staff, compared these to data from hospital staff surveys (n=86) and triangulated data with investigators' observational reports. Survey items were grouped into 4 categories (based on content and fit with conceptual model) and scored, allowing regression analyses for inferential comparisons to assess factors related to receptivity toward the telemedicine innovation., Results: General agreement existed on the need for the intervention and feasibility of implementation. Previous experience with a telemedicine program appeared pivotal to enthusiasm. Perception of need, task demands and resource need explained nearly 50% of variation in receptivity. Little correlation emerged with hospital or ED leadership culture and support. However qualitative data and investigator observations about communication and differing support among disciplines and between staff and leadership could be important to actual implementation., Conclusions: A mixed methods approach proved useful in assessing organizational readiness for change in small organizations. Further research on variable operational definitions, potential influential factors, appropriate and feasible methods and valid instruments for such research are needed.

In order to perform selective isolation of bacteria tightly bound to the human gut, ileal biopsies of healthy volunteers were treated to wash out the mucus layer and loosely bound bacterial cells. Rod-shaped anaerobic bacteria that had remained attached to the epithelial cells were isolated and identified at the species level. One isolate was identified as belonging to the Bifidobacterium breve species, while all the others were lactobacilli of only two species, Lactobacillus mucosae and Lactobacillus gasseri. Members of these species were found previously in intestinal samples, but their predominance among bacteria strictly associated with the epithelium was not suspected before and suggests that these species may represent a specific subpopulation of tissue-bound bacteria. Physiological analysis indicated that all isolates were able to produce antimicrobials, grow and form biofilm in simulated intestinal fluid after exposure to gastric conditions. Some isolates were able to degrade mucin while none showed cytotoxicity in vitro on HT29 cells. The tight association of the strains isolated with ileal epithelial cells is presumably indicative of a direct interaction with the host cells. For this reason and for the absence of cytotoxicity in vitro, those isolates can be proposed as potential probiotic strains for human use.

The location, type, and local mechanism of tibial shaft fracture were determined for 66 drivers injured in frontal automobile crashes. The results from the analyses showed that the distal third is the most common fracture location (p<0.05) and that bending is responsible for the majority of these fractures regardless of the fracture site. These findings indicate that the current injury criterion for predicting the occurrence of tibial shaft fracture in crash tests with anthropometric test devices is appropriate in terms of accounting for the primary mechanism of fracture but that increased protective effectiveness could be achieved by redefining the criterion for the distal third shaft section instead of the currently specified mid-shaft section of the tibia.

In trauma practice, basilar skull fracture is an extremely common finding while transverse/sigmoid venous sinus thrombosis is generally considered quite a rare complication. During evaluation of cervical computed tomography (CT) angiography after trauma, we identified five patients in just three months with unexpected transverse/sigmoid venous sinus obstruction ipsilateral to a basilar skull fracture. This number represented a surprisingly high percentage of our neurosurgical trauma consults for the study period (31%). Three of the five patients were found to have sinus thrombosis: two with right transverse/sigmoid sinus thrombosis experienced significant neurological deficits and prolonged hospital courses even with anti-coagulation therapy; one patient with a left transverse/sigmoid sinus thrombosis had a good outcome with anti-coagulation therapy. The other two of the five patients had outflow obstruction, likely from focal epidural bleeding and extrinsic compression: one patient with partial obstruction in the right transverse-sigmoid junction, due to epidural bleeding, experienced a difficult recovery; one patient with a right sigmoid sinus obstruction presented and remained asymptomatic and experienced a benign hospital course. Two of the five patients had a posterior temporal hemorrhagic area ipsilateral to the affected sinus, suggesting that this finding may have represented hemorrhagic venous infarction rather than traumatic contusion. We propose that a basilar skull fracture in the region of temporal or occipital bone should be considered as a significant risk factor for the development of transverse/sigmoid venous sinus obstruction and may be an under-recognized and treatable cause of increased intracranial pressure. Failure to detect this complication may explain, in part, unexpected clinical outcomes.

Background: Blunt injury to the colon is rare. Few studies of adequate size and design exist to allow clinically useful conclusions. The Eastern Association for the Surgery of Trauma Multi-institutional Hollow Viscus Injury (HVI) Study presents a unique opportunity to definitively study these injuries., Methods: Patients with blunt HVI were identified from the registries of 95 trauma centers over 2 years (1998-1999). Patients with colon injuries (cases) were compared with blunt trauma patient undergoing a negative laparotomy (controls). Data were abstracted by chart review., Results: Of the 227,972 patients represented, 2,632 (1.0%) had an HVI and 798 had a colonic/rectal injury (0.3%). Of patients diagnosed with HVI, 30.2% had a colon injury. No physical findings or imaging modalities were able to discriminate colonic injury. Logistic regression modeling yielded no clinically useful combination of findings that would reliably predict colonic injury. In patients undergoing laparotomy, presence of colon injury was associated with a higher risk of some complications but not mortality. Colon injury was associated with increased hospital (17.4 vs. 13.1, p < 0.001) and intensive care unit (9.7 vs. 6.9, p = 0.003) length of stay. Almost all colon patients (92.0%) underwent laparotomy within 24 hours of injury., Conclusion: Colonic injury after blunt trauma is rare and difficult to diagnose. No diagnostic test or combination of findings reliably excluded blunt colonic injury. Despite the inadequacy of current diagnostic tests, almost all patients with colonic injury were taken to the operating room within 24 hours. Even with relatively prompt surgery, patients with colon injury were at significantly higher risk for serious complications and increased length of stay. In contrast to small bowel perforation, delay in operative intervention appears to be less common but is still associated with serious morbidity.

Considerable controversy persists regarding the optimal technique for hypopharyngeal reconstruction. The ideal procedure should provide low mortality and morbidity, short hospitalization, a high success rate, few complications, and the greatest potential for neopharyngeal speech and deglutition. In this study, a variety of fasciocutaneous free flaps were used for reconstruction of the hypopharynx. Over a two-year period, fasciocutaneous flaps were used for reconstruction of pharyngoesophageal segments following total laryngopharyngectomies in 16 patients at The National Cancer Institute, Cairo University, Cairo, Egypt. Flap survival, recipient vessels used, and complications were examined. The ultimate functional and cosmetic outcomes of free flaps were compared. Of the 16 patients included in this study, nine were males, and seven were females. Free flaps used for reconstruction included the radial forearm (8), lateral arm (2), anterolateral thigh (3), and posterolateral thigh (3) flaps. Free flaps were successful in 15 patients. One patient had total flap loss. Salvage surgery was successful for one flap that developed venous congestion. Eleven patients received adjuvant radiation therapy. The commonly used recipient vessels were the small arteries of the neck and the external jugular vein. Five patients developed minor pharyngocutaneous fistulas that healed spontaneously. Six patients developed anastomotic line stricture. Donor-site morbidity was more significant with the radial forearm flap, compared to other flaps. Fasciocutaneous free flaps have a definite place in pharyngoesophageal reconstruction. The flap should be selected with reference to the type of the defect and patient obesity; however, donor-site morbidity should also be considered.

Background: Falls from windows in urban areas cause a significant number of pediatric injuries. Window falls have not been well described in the nonurban setting. We describe the epidemiology of window falls from residential homes among pediatric patients at a suburban Level I trauma center., Methods: A review of patients admitted from January 1991 through November 1999 to a center serving a rapidly growing suburban area was performed., Results: A total of 2,322 children, ages 0-14 years, were admitted during the study period. Falls comprised 41% of these admissions, and 11% of falls were from windows, greater than twice the national average. More than 39% of children who fell from windows were admitted directly to the intensive care unit. Overall mortality rate was 4%. Ages 0 to 4 years comprised the largest percentage (83%), and all children who died were in this age group. Children < or = 4 years were more likely to have an Abbreviated Injury Score > or = 2 (head injury) than those ages 10 to 14 years (p = 0.032). More than 31% of all children injured in window falls seen at the study institution between 1991 and 1999 were admitted in the last 2 years., Conclusion: Pediatric falls from windows in this suburban area appear to be increasing, with an incidence greater than the national average. Children at greatest risk are less than 4 years old. Further research in injury prevention at the national level aimed at suburban areas may be warranted.

Dental stains can be broadly classified as intrinsic or extrinsic. Intrinsic stains are a result of defects in tooth development, fluorosis, or acquired through the use of tetracycline. Extrinsic stains are localized mainly in the pellicle and are generated by the reaction between sugars and amino acids or acquired from the retention of exogenous chromophores in the pellicle. Three clinical methods are currently used for measuring stain removal and tooth whitening in the development of new whitening technologies: Lobene Stain Index, Shade Guide Color Change, and Minolta ChromaMeter. Professional tooth whitening products rely on proven technologies--35% hydrogen peroxide for in-office power bleaching or 10% to 15% carbamide peroxide for at-home bleaching--to reduce intrinsic stain and change the inherent tooth color. Over-the-counter tooth whitening products use a combination of surfactants, abrasives, anticalculus agents, and low levels of hydrogen peroxide to reduce extrinsic stain and help maintain tooth whiteness after professional treatment. Future technologies for whitening teeth could involve the use of activating agents to enhance the performance of hydrogen peroxide and natural enzymes.