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Abstract Effective chemotherapy delivery for glioblastoma multiforme (GBM) is limited by drug transport across the blood–brain barrier and poor efficacy of single agents. Polymer–drug conjugates can be used to deliver drug combinations with a ratiometric dosing. However, the behaviors and effectiveness of this system have never been well investigated in GBM models. Here, we report flexible conjugates of hyaluronic acid (HA) with camptothecin (CPT) and doxorubicin (DOX) delivered into the brain using focused ultrasound (FUS). In vitro toxicity assays reveal that DOX‐CPT exhibited synergistic action against GBM in a ratio‐dependent manner when delivered as HA conjugates. FUS is employed to improve penetration of DOX‐HA‐CPT conjugates into the brain in vivo in a murine GBM model. Small‐angle x‐ray scattering characterizations of the conjugates show that the DOX:CPT ratio affects the polymer chain flexibility. Conjugates with the highest flexibility yield the highest efficacy in treating mouse GBM in vivo. Our results demonstrate the association of FUS‐enhanced delivery of combination chemotherapy and the drug‐ratio‐dependent flexibility of the HA conjugates. Drug ratio in the polymer nanocomplex may thus be employed as a key factor to modulate FUS drug delivery efficiency via controlling the polymer flexibility. Our characterizations also highlight the significance of understanding the flexibility of drug carriers in ultrasound‐mediated drug delivery systems.

Vaccine equity holds the key to ending the coronavirus disease 2019 (COVID-19) pandemic. Yet most prior work on vaccine equity has compared vaccine uptake across neighborhoods with varying sociodemographic composition or assessed whether vaccine disparity across neighborhoods has diminished over time. Researchers seldom examine the extent to which vaccination helps reduce inequalities in the prevalence of COVID-19 across neighborhoods. Using administrative data from the City of Toronto, the authors compare the vaccine trajectories of neighborhoods with low, moderate, and high COVID-19 rates. The authors also examine whether disparities in COVID-19 rates have narrowed or widened as vaccinations have become more available. By mid-June 2021, differences in vaccination rates by neighborhoods’ COVID-19 levels were small, but disparities in COVID-19 rates across neighborhoods persisted. Equality in vaccination rates is not a silver bullet to reducing inequalities in COVID-19 infections across neighborhoods with varying sociodemographic characteristics and likely variations in exposure to the COVID-19 virus.

Abstract Colorectal cancer, common in both men and women, occurs when tumors form in the linings of the colon. Common treatments of colorectal cancer include surgery, chemotherapy, and radiation therapy; however, many colorectal cancer treatments often damage healthy tissues and cells, inducing severe side effects. Conventional chemotherapeutic agents such as doxorubicin (Dox) can be potentially used for the treatment of colorectal cancer; however, they suffer from limited targeting and lack of selectivity. Here, we report that doxorubicin complexed to hyaluronic acid (HA) (HA‐Dox) exhibits an unusual behavior of high accumulation in the intestines for at least 24 hr when injected intravenously. Intravenous administrations of HA‐Dox effectively preserved the mucosal epithelial intestinal integrity in a chemical induced colon cancer model in mice. Moreover, treatment with HA‐Dox decreased the expression of intestinal apoptotic and inflammatory markers. The results suggest that HA‐Dox could effectively inhibit the development of colorectal cancer in a safe manner, which potentially be used a promising therapeutic option.

INTRODUCTION: : Medical resources may be overwhelmed in a mass disaster situation. Intensive care resources may be limited even further. When the demand for a certain resource, like ventilators, exceeds its availability, caregivers are faced with the task of deciding how to distribute this resource.Ethical dilemmas arise when a practical decision necessitates ranking the importance of several ethical principles. In a disaster area, the greatest good for the greatest number principle and the goal of equal distribution of resources may take priority over the needs of the individual. Nonetheless, regardless of the interventions available, it is a prime goal to keep the patients' comfort and dignity as much as possible. BACKGROUND: : In the mass disaster of the Haiti earthquake of January 2010, The Israeli Defense Forces Medical Corps field hospital was one of the first to respond to the call for help of the Haitian people with surgical and intensive care capabilities. It was the only facility able to ventilate children and neonates in the first week after the earthquake, although this ability was relatively limited. SPECIAL ARTICLE:: Five case scenarios that we confronted at the pediatric ward of the field hospital are presented: two children with respiratory compromise due to pulmonary infection, one premature baby with respiratory distress syndrome, an asphyxiated neonate, and a baby with severe sepsis of a probable abdominal origin. In normal circumstances all of them would have been ventilated but with limited resources we raised in each case the question of ventilating or not.To help in the evaluation of each case we used a decision-support tool that was previously developed for ventilator allocation during an influenza pandemic. This tool takes into account several factors, including the illness severity, prognosis, and the expected duration of ventilation. CONCLUSIONS: : Applying ethical priorities to analyze the decision-making problems leads to the understanding that an individualized approach with an ongoing assessment of the patient condition and the availability of resources, rather than a strict predefined decision rule, will give patients a better chance of survival, and will assist in allocating scarce resources. [ABSTRACT FROM AUTHOR]

Multiple neurocognitive processes are involved in the highly complex task of producing written words. Yet, little is known about the neural pathways that support spelling in healthy adults. We assessed the associations between performance on a difficult spelling-to-dictation task and microstructural properties of language-related white matter pathways, in a sample of 73 native English-speaking neurotypical adults. Participants completed a diffusion magnetic resonance imaging scan and a cognitive assessment battery. Using constrained spherical deconvolution modeling and probabilistic tractography, we reconstructed dorsal and ventral white matter tracts of interest, bilaterally, in individual participants. Spelling associations were found in both dorsal and ventral stream pathways. In high-performing spellers, spelling scores significantly correlated with fractional anisotropy (FA) within the left inferior longitudinal fasciculus, a ventral stream pathway. In low-performing spellers, spelling scores significantly correlated with FA within the third branch of the right superior longitudinal fasciculus, a dorsal pathway. An automated analysis of spelling errors revealed that high- and low- performing spellers also differed in their error patterns, diverging primarily in terms of the orthographic distance between their errors and the correct spelling, compared to the phonological plausibility of their spelling responses. The results demonstrate the complexity of the neurocognitive architecture of spelling. The distinct white matter associations and error patterns detected in low- and high- performing spellers suggest that they rely on different cognitive processes, such that high-performing spellers rely more on lexical-orthographic representations, while low-performing spellers rely more on phoneme-to-grapheme conversion., Competing Interests: Declarations. Conflict of interest: The authors declare that they have no competing interests. Ethics approval: The study was approved by the Ethics Committee of the Royal Holloway, University of London. Consent to participate: Participants were paid for their participation in the research. All participants signed a written informed consent before participating., (© 2024. The Author(s).)

Background: Mood disorders, particularly depression and anxiety, are associated with zinc dyshomeostasis and aberrant GABAergic signaling. Activation of ZnR/GPR39 by synaptic zinc in the hippocampus triggers phosphorylation of extracellular regulated kinase (ERK1/2), which regulates the K + /Cl - cotransporter (KCC2) and thereby GABAergic inhibitory neurotransmission and seizure activity. Therefore, we studied whether impaired ZnR/GPR39 signaling is linked to anxiety-related behavior in male or female mice., Results: Using the acoustic startle response, elevated plus maze, and open field test, we found increased anxiety-related behavior in ZnR/GPR39 knockout (KO) mice. Despite a well-established sex difference, where females are typically more prone to anxiety, both male and female ZnR/GPR39 KO mice exhibited increased anxiety-related behavior compared to wildtype (WT) mice. Additionally, ZnR/GPR39 KO mice displayed impaired motor coordination in the pole and rotarod tests but did not show reduced muscle strength, as indicated by a grip test. Finally, we found intrinsic alterations in the expression level of KCC2, a major Cl - transporter regulating GABAergic signaling, in the amygdala of naïve ZnR/GPR39 KO mice compared to controls., Conclusions: Our findings indicate that loss of ZnR/GPR39 enhances anxiety-related behavior in both male and female mice. Moreover, ZnR/GPR39 KO mice exhibit impaired motor coordination, which may be associated with increased anxiety. Finally, we demonstrate that loss of ZnR/GPR39 modulates the expression of KCC2 in the amygdala. Thus, we propose that ZnR/GPR39 can serve as a target for regulating GABAergic signaling in anxiety treatment., Competing Interests: Declarations. Ethical approval: All experimental procedures involving animals were performed according to approved protocols and in accordance with the committee for Ethical Care and Use of Animal in Experiments at the Faculty of Health Sciences at Ben-Gurion University, and according to ARRIVE guidelines. Animals were housed on a 12/12 h light/dark cycle, at a temperature of 20–24 °C and 30–70% relative humidity and were provided with mice chow and water ad libitum. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Explosive desorption of guest molecules embedded in amorphous solid water upon its crystallization is known as the "molecular volcano." Here, we describe an abrupt ejection of NH_{3} guest molecules from various molecular host films toward a Ru(0001) substrate upon heating, utilizing both temperature programmed contact potential difference and temperature programmed desorption measurements. NH_{3} molecules abruptly migrate toward the substrate due to either crystallization or desorption of the host molecules, following an "inverse volcano" process considered a highly probable phenomenon for dipolar guest molecules that strongly interact with the substrate.

Mixtures of methanol and amorphous solid water (ASW) ices are observed in the interstellar medium (ISM), where they are subject to irradiation by UV photons and bombardment by charged particles. The charged particles, if at high enough density, induce a local electric field in the ice film that potentially affects the photochemistry of these ices. When CD 3 OD@ASW ices grown at 38 K on a Ru(0001) substrate are irradiated by 193 nm (6.4 eV) photons, products such as HD, D 2 , CO, and CO 2 are formed in large abundances relative to the initial amount of CD 3 OD. Other molecules such as D 2 O, CD 4 , acetaldehyde, and ethanol and/or dimethyl ether are also observed, but in smaller relative abundances. The reactivity cross sections range from (2.6 ± 0.3) × 10 -21 to (3.8 ± 0.3) × 10 -25 cm 2 /photon. The main products are formed through two competing mechanisms: direct photodissociation of methanol and water and dissociative electron attachment (DEA) by photoelectrons ejected from the Ru(0001) substrate. An electric field of 2 × 10 8 V/m generated within the ASW film during Ne + ions bombardment is apparently not strong enough to affect the relative abundances (selectivity) of the photochemical products observed in this study.

Understanding the distribution and mixing of atoms and molecules in amorphous solid water (ASW) at low temperatures is relevant to the exploration of the astrochemical environment in the interstellar medium (ISM) that leads to the formation of new complex molecules. In this study, a combination of temperature programmed desorption (ΔP-TPD) experiments and Ne + ion sputtering is used to determine the extent of mixing and distribution of guest atoms and molecules within thin ASW films deposited at 35 K on a Ru(0001) substrate, prior to sputtering. The mixing of krypton atoms and methyl chloride molecules within thin ASW films is directed by the physical properties of the respective species and the nature of their interaction with the host water molecules. While the Kr-H 2 O interaction may be described as a weak van der Waals attraction, the CD 3 Cl-H 2 O interaction can be characterized as weakly hydrophobic in nature. This leads to differences in the level of homogeneity in mixing and distribution of the guest species in the ASW film. Both krypton atoms and methyl chloride molecules reveal a propensity to migrate toward the ASW-vacuum interface. The krypton atoms migrate through both diffusion and displacement by incoming H 2 O molecules, while the methyl chloride molecules tend to move toward the vacuum interface primarily via displacement. This behavior results in more homogeneous mixing of Kr in ASW at 35 K compared to the dipole moment containing molecule CD 3 Cl. As a general outcome of our study, it is observed that mixing in ASW at low temperatures is more homogeneous when the guest atom/molecule is inert and does not possess a constant dipole moment.

Background: Coronavirus disease 2019 was first diagnosed in Israel at the end of February 2020. By the end of June 2021, there were 842 536 confirmed cases and 6428 deaths. Our aim in this multicenter, retrospective, cohort study is to describe the demographic and clinical characteristics of hospitalized patients and compare the pandemic waves before immunization., Methods: Of 22 302 patients hospitalized in general medical centers, we randomly selected 6329 for the study. Of these, 3582 and 1106 were eligible for the study in the first period (first and second waves) and in the second period (third wave), respectively., Results: Thirty-day mortality was higher in the second period than in the first period, 25.20% vs 13.68% (P < .001). Invasive mechanical ventilation supported 9.19% and 14.21% of patients in the first period and second period, respectively. Extracorporeal membrane oxygenation (ECMO) was used more than twice as often in the second period., Conclusions: Invasive ventilation, use of ECMO, and mortality rate were 1.5 to 2 times higher in the second period than in the first period. In the second period, patients had a more severe presentation and higher mortality than those in the first period., (© The Author(s) 2022. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)

Photochemical and photocatalytic activity of adsorbates on surfaces is strongly dependent on the nature of a given substrate and its resonant absorption of the (visible) light excitation. An observation is reported here of the visible light photochemical response of formamidinium lead bromide (FAPbBr 3 ) halide perovskite and carbon nitride (CN) thin-film materials (deposited on a SiO 2 /Si(100) substrate), both of which are known for their photovoltaic and photocatalytic properties. The goal of this study was to investigate the role of the substrate in the photochemical reactivity of an identical probe molecule, ethyl chloride (EC), when excited by pulsed 532 nm laser under ultrahigh vacuum (UHV) conditions. Postirradiation temperature-programmed desorption (TPD) measurements have indicated that the C-Cl bond dissociates following the visible light excitation to form surface-bound fragments that react upon surface heating to form primarily ethane and butane. Temperature-dependent photoluminescence (PL) spectra of the FAPbBr 3 films were recorded and decay lifetimes were measured, revealing a correlation between length of PL decay and the photoreactivity yield. We conclude that the FAPbBr 3 material with its absorption spectrum in resonance with visible light excitation (532 nm) and longer PL lifetime leads to three times faster (larger cross-section) photoproduct formation compared with that on the CN substrate. These results contrast the behavior under ambient conditions where the CN materials are photochemically superior due, primarily, to their stability within humid environments.

UV photons and low-energy electrons play an important role in the evolution of various molecules in the interstellar medium (ISM). Here, we examined the product molecule formation as a result of irradiation of 193 nm photons and 6.4 eV electrons (same energy under identical laboratory conditions) on D 2 O|CH 4 + ND 3 |D 2 O sandwiched films deposited on Ru(0001) substrate at 25 K in ultrahigh vacuum as a model for processes in the ISM. Temperature-programmed desorption spectra performed following the irradiation revealed the signature of hydrazine and formamide product molecules. These molecules were, however, formed exclusively following the photons' irradiation. These results were compared with the products obtained from a D 2 O|CH 4 |D 2 O sample without ammonia, where deuterated formaldehyde was the dominant product, formed also by photons only. Our results indicate that the photon-induced activation of the cofrozen molecules within D 2 O occurs via direct (partial) dissociation of the host and embedded molecules, followed by sample annealing. The electron-induced activation occurs through a direct dissociative electron attachment mechanism. The results presented here suggest possible pathways to generate various C-N, C-O, C-C, N-O, and N-H bonds containing molecules in the ISM.

Monitoring thermal processes occurring in molecular films on surfaces can provide insights into physical events such as morphology changes and phase transitions. Here, we demonstrate that temperature-programmed contact potential difference (TP-∆CPD) measurements employed by a Kelvin probe under ultrahigh vacuum conditions and their temperature derivative can track films' restructure and crystallization occurring in amorphous solid water (ASW) at temperatures well below the onset of film desorption. The effects of growth temperature and films' thickness on the spontaneous polarization that develops within ASW films grown at 33 K-120 K on top of a Ru(0001) substrate are reported. Electric fields of ∼10 6 V/m are developed within the ASW films despite low average levels of molecular dipole alignment (<0.01%) normal to the substrate plane. Upon annealing, an irreversible morphology-dependent depolarization has been recorded, indicating that the ASW films keep a "memory" of their thermal history. We demonstrate that TP-∆CPD measurements can track the collapse of the porous structure at temperatures above the growth and the ASW-ice I c and ASW-ice I h transitions at 131 K and 157 K, respectively. These observations have interesting implications for physical and chemical processes that take place at the interstellar medium such as planetary formation and photon- and electron-induced synthesis of new molecules.

Ammonia molecules have an important role in the radiation-induced chemistry that occurs on grains in the cold interstellar medium and leads to the formation of nitrogen containing molecules. Such grains and surfaces are primarily covered by water ices; however, these conditions allow the growth of solid ammonia films as well. Yet, solid ammonia know-how lags the vast volume of research that has been invested in the case of films of its "sibling" molecule water, which, in the porous amorphous phase, spontaneously form polar films and can cage coadsorbed molecules within their hydrogen-bonded matrix. Here, we report on the effect of growth temperature on the spontaneous polarization of solid ammonia films (leading to internal electric fields of ∼10 5 V/m) within the range of 30 K-85 K on top of a Ru(0001) substrate under ultra-high vacuum conditions. The effect of growth temperature on the films' depolarization upon annealing was recorded as well. By demonstrating the ability of ammonia to cage coadsorbed molecules, as water does, we show that temperature-programmed contact potential difference measurements performed by a Kelvin probe and especially their temperature derivative can track film reorganization/reconstruction and crystallization at temperatures significantly lower than the film desorption.

Introduction: Type 2 diabetes (T2D) is a risk factor for dementia. Ischemia due to vascular pathology is hypothesized to be an underlying mechanism for this association. Hyperbaric oxygen therapy (HBOT) is a treatment in which oxygen-enriched air (up to 100%) is administered to patients in a chamber at a pressure above one atmosphere absolute. HBOT is approved for the treatment of T2D ischemic non-healing wounds. Evidence from animal studies and small clinical trials suggests that HBOT improves hypoxic/ischemic brain injuries, consequently inducing brain angiogensis, leading to cognitive improvement., Methods: We present the design of the first double-blind, placebo-controlled, clinical trial on brain and cognitive outcomes in elderly (n = 154) with T2D and mild cognitive impairment to compare the effects of HBOT versus sham (normal air with 1.1 ATA pressure in the first and last 5 minutes of the session). Eligible candidates are randomized with equal probability to HBOT and sham. Outcomes are assessed before and after treatment, and at 6- and 12-month follow-up. The primary cognitive outcome is global cognitive change, indexed by a composite sum of z-scores of four executive functions and four episodic memory tests. The primary neurobiological outcome is cerebral blood flow (CBF; via arterial spin labeling magnetic resonance imaging [ASL-MRI]) and cerebral glucose utilization via fluorodeoxyglucose positron emission tomography (FDG-PET). Secondary outcome measures are specific cognitive domains (executive function and episodic memory) and functional measures (Clinical Dementia Rating sum of boxes, activities of daily living). Efficacy analyses will be performed for the intent-to-treat sample., Discussion: Recent studies suggest that HBOT induces neuroplasticity and improves cognition in post-stroke and traumatic brain injury patients. However, its effect on cognition, cerebral blood flow, and brain glucose utilization in T2D patients at high dementia risk is yet to be determined. If effective, this study may provide strong evidence for the brain and cognitive benefits of HBOT in this population., (© 2020 The Authors. Alzheimer's & Dementia: Translational Research & Clinical Interventions published by Wiley Periodicals, Inc. on behalf of Alzheimer's Association.)

Distinguishing bacterial from viral infections is often challenging, leading to antibiotic misuse, and detrimental ramifications for the patient, the healthcare system and society. A novel ELISA-based assay that integrates the circulating levels of three host-response proteins (TRAIL, IP-10 and CRP) was developed to assist in differentiation between bacterial and viral etiologies. We developed a new protocol for measuring the host-based assay biomarkers using an automated ELISA workstation. The automated protocol was validated and was able to reduce technician hands-on time by 76%, while maintaining high analytical performance. Following automation, the assay has been incorporated into the routine workflow at a pediatric department, and is performed daily on admitted and emergency department patients. The automation protocol reduces the overall burden on the hospital laboratory performing the assay. This benefit has potential to promote adoption of the host-based assay, facilitating timely triage of febrile patients and prudent use of antibiotics.

The intense focus in the clinical literature on the mental and neurocognitive sequelae of explosive blast-wave exposure, especially when comorbid with post-traumatic stress-related disorders (PTSD) is justified, and warrants the design of translationally valid animal studies to provide valid complementary basic data. We employed a controlled experimental blast-wave paradigm in which unanesthetized animals were exposed to visual, auditory, olfactory, and tactile effects of an explosive blast-wave produced by exploding a thin copper wire. By combining cognitive-behavioral paradigms and ex vivo brain MRI to assess mild traumatic brain injury (mTBI) phenotype with a validated behavioral model for PTSD, complemented by morphological assessments, this study sought to examine our ability to evaluate the biobehavioral effects of low-intensity blast overpressure on rats, in a translationally valid manner. There were no significant differences between blast- and sham-exposed rats on motor coordination and strength, or sensory function. Whereas most male rats exposed to the blast-wave displayed normal behavioral and cognitive responses, 23.6% of the rats displayed a significant retardation of spatial learning acquisition, fulfilling criteria for mTBI-like responses. In addition, 5.4% of the blast-exposed animals displayed an extreme response in the behavioral tasks used to define PTSD-like criteria, whereas 10.9% of the rats developed both long-lasting and progressively worsening behavioral and cognitive "symptoms," suggesting comorbid PTSD-mTBI-like behavioral and cognitive response patterns. Neither group displayed changes on MRI. Exposure to experimental blast-wave elicited distinct behavioral and morphological responses modelling mTBI-like, PTSD-like, and comorbid mTBI-PTSD-like responses. This experimental animal model can be a useful tool for elucidating neurobiological mechanisms underlying the effects of blast-wave-induced mTBI and PTSD and comorbid mTBI-PTSD.

Background: Regulation of hepatic glucose production has been a target for antidiabetic drug development, due to its major contribution to glucose homeostasis. Previous pre-clinical study demonstrated that peripheral electrical stimulation (PES) may stimulate glucose utilization and improve hepatic insulin sensitivity. The aim of the present study was to evaluate safety, tolerability, and the glucose-lowering effect of this approach in patients with type 2 diabetes (T2DM)., Methods: Twelve patients with T2DM were recruited for an open label, interventional, randomized trial. Eleven patients underwent, in a crossover design, an active, and a no-intervention control periods, separated with a two-week washout phase. During the active period, the patients received a daily lower extremity PES treatment (1.33Hz/16Hz burst mode), for 14 days. Study endpoints included changes in glucose levels, number of hypoglycemic episodes, and other potential side effects. Endpoints were analyzed based on continuous glucose meter readings, and laboratory evaluation., Results: We found that during the active period, the most significant effect was on nocturnal glucose control (P < 0.0004), as well as on pre-meal mean glucose levels (P < 0.02). The mean daily glucose levels were also decreased although it did not reach clinical significance (P = 0.07). A reduction in serum cortisol (P < 0.01) but not in insulin was also detected after 2 weeks of treatment. No adverse events were recorded., Conclusions: These results indicate that repeated PES treatment, even for a very short duration, can improve blood glucose control, possibly by suppressing hepatic glucose production. This effect may be mediated via hypothalamic-pituitary-adrenal axis modulation., Trial Registration: ClinicalTrials.gov NCT02727790., Competing Interests: The authors have declared that no competing interests exist.

Background: This article summarizes the experience with Role 1 care for 135 Syrian children who received medical care during the year 2013 as part of an ongoing humanitarian effort., Methods: The database included demographic information, point-of-injury assessment and outcome, and was analyzed using SPSS., Results: Trauma casualties were the majority of the group (84 cases), and mostly male. Almost one-third of casualties arrived more than 6 hours after injury, and time of injury was unknown in another third. The most common mechanism of injury was shrapnel (51.2%), followed by gunshot wounds (22.6%). Gunshot wound victims were significantly older than shrapnel and artillery victims (p < 0.01, < 0.05, respectively). Only 14 cases (14.28%) underwent previous interventions in Syria. Most of the casualties (44 cases, 52.4%) underwent at least one procedure during Role 1 treatment with a high overall success rate (93.18%) that was not correlated to Advanced Life Support provider type (physician [MD], emergency medical technician-paramedic, or both). Mortality was low (3 cases)., Conclusion: The study cohort exhibits several unique features, including a delay in arrival to medical care, paucity of prior care and information, and the specific mechanisms of injury. Our study suggests that Advanced Life Support providers do not differ significantly in Role 1 treatment choices and procedure success., (Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.)

Background: Following the 2010 earthquake in Haiti, the Israel Defense Forces Medical Corps deployed a field hospital in Port au Prince. The purpose of this study was to characterize the injuries sustained by the pediatric population treated in the hospital and examine the implications for planning deployment in future similar disasters., Methods: Medical records of children treated in the hospital were reviewed and compared with medical records of the adult population., Results: A total of 1,111 patients were treated in the hospital. Thirty-seven percent were aged 0 to 18 years. Earthquake-related injuries were the cause of admission in 47% of children and 66% of adults. Forty-seven percent of children with traumatic injuries sustained fractures. Seventy-two percent were in the lower limbs, 19% were in the upper limbs, and 9% were in the axial skeleton, with the femur being the most common long bone fractured compared with the tibia in adults. There were four functional operating theaters, and treatment guidelines were adjusted to the rapidly changing situation. Soft tissue injuries were treated by aggressive debridement. Fractures were stabilized by external fixation or casting. Amputation was performed only for nonviable limbs or life-threatening sepsis. Children were more likely than adults to undergo surgery (44% vs. 29% of trauma patients). To maximize hospital surge capacity, minor procedures were performed in the wards under sedation, and patients were discharged after an average of 1.4 days, with subsequent follow-up in the clinic., Conclusion: Children constitute a high percentage of patients in a developing country. The epidemiology of pediatric injuries following an earthquake differs significantly from that encountered in everyday practice and compared with that in adults. Children sustain a significantly higher percentage of femoral fractures and are more likely to require surgery. The shift to nontraumatic reasons for admission occurred earlier in the pediatric population than in adults. Organizations providing post-earthquake relief are usually geared toward adult populations and will require supplementation of both manpower and equipment specifically suited for treatment of pediatric patients. Early deployment teams should be adequately staffed with adult and pediatric orthopedists., (Copyright © 2013 by Lippincott Williams & Wilkins) LEVEL OF EVIDENCE:: Epidemiologic study, level IV.)

Background: Urine alkalinization is indicated for various medical conditions. Alkalinization is usually achieved by intravenous administration of alkali substances titrated by repeated urinalyses. Some situations such as mass casualty events might require urine alkalinization by the oral route. We evaluated the efficacy of oral sodium bicarbonate administration for urine alkalinization., Methods: In a prospective open-label trial, 4 g of sodium bicarbonate was administered orally 3 times daily to 9 healthy volunteers for 24 hours. Serial blood and urine samples were collected, and urine pH was evaluated. Plasma electrolytes and pH were also measured for safety purposes., Results: All participants had a urine pH of at least 7 after 10 hours. At 20 hours, all participants had a urine pH of at least 8. No adverse effects or abnormal blood results were documented during the 24-hour follow-up., Conclusions: Oral administration of a standard dose of sodium bicarbonate tablets resulted in effective urine alkalinization. Further research is needed to investigate the natural course of urine pH after cessation of our protocol and the efficacy of longer periods of treatment., (© 2013.)

Background: Following the 2010 earthquake in Haiti, the Israel Defense Forces Medical Corps deployed a field hospital in Port au Prince. The purpose of this study was to characterize the injuries sustained by the pediatric population treated in the hospital and examine the implications for planning deployment in future similar disasters., Methods: Medical records of children treated in the hospital were reviewed and compared with medical records of the adult population., Results: A total of 1,111 patients were treated in the hospital. Thirty-seven percent were aged 0 to 18 years. Earthquake-related injuries were the cause of admission in 47% of children and 66% of adults. Forty-seven percent of children with traumatic injuries sustained fractures. Seventy-two percent were in the lower limbs, 19% were in the upper limbs, and 9% were in the axial skeleton, with the femur being the most common long bone fractured compared with the tibia in adults.There were four functional operating theaters, and treatment guidelines were adjusted to the rapidly changing situation. Soft tissue injuries were treated by aggressive debridement. Fractures were stabilized by external fixation or casting. Amputation was performed only for nonviable limbs or life-threatening sepsis. Children were more likely than adults to undergo surgery (44% vs. 29% of trauma patients). To maximize hospital surge capacity, minor procedures were performed in the wards under sedation, and patients were discharged after an average of 1.4 days, with subsequent follow-up in the clinic., Conclusion: Children constitute a high percentage of patients in a developing country. The epidemiology of pediatric injuries following an earthquake differs significantly from that encountered in everyday practice and compared with that in adults. Children sustain a significantly higher percentage of femoral fractures and are more likely to require surgery. The shift to nontraumatic reasons for admission occurred earlier in the pediatric population than in adults. Organizations providing post-earthquake relief are usually geared toward adult populations and will require supplementation of both manpower and equipment specifically suited for treatment of pediatric patients. Early deployment teams should be adequately staffed with adult and pediatric orthopedists., Level of Evidence: Epidemiologic study, level IV.