Modern aspects of the diagnosis of severe combined trauma using computed tomography

Relevance. The variety of options for combining injuries and disorders occurring in the body with a combined injury, the need for rapid decision-making on treatment require rapid diagnosis of the entire volume of injuries and determining the severity of the injury, but there is still no single protocol for examining such victims. The aim of the work was to present a modern CT study protocol for patients with concomitant trauma.Materials and methods. The results of computed tomography of 30 patients with severe concomitant trauma were analyzed. All the victims were admitted in the first hours after the injury. Men were 30 (67 %), women – 10 (33 %), the average age was 41.3 ± 7.6 (22–79) years. Traditional multiphase full-body MSCT was performed in 20 patients, in 10 patients a special protocol was used for the study of the "whole body" by the method of divided bolus.The results of the study. Craniocerebral injuries were detected in 15 (50 %), spinal injuries – in 7 (23.3 %). Simultaneous injuries to the chest and abdomen were detected in 19 (63.3 %) of the victims. When subjectively evaluated, the quality of the images obtained using the full-body MSCT protocol with bolus separation and the standard multiphase protocol for the diagnosis of traumatic injuries was equivalent. The average radiation load per patient with traditional multiphase full-body MSCT is 66 % higher than with the split-bolus protocol.Conclusions. Full-body MSCT using a split bolus is a modern technique that fully meets the diagnostic conditions for severe combined trauma and, with a decrease in the radiation dose, allows you to determine all possible injuries in the victim in a single study.

Why are supercentenarians so frequently found in French Overseas Departments? The cases of Guadeloupe and Martinique

Many more cases of supercentenarians are observed in the French Départements d’Outre-Mer (DOM) than in metropolitan France. A first possible explanation is that the standard French protocol for validating age does not sufficiently cover DOMs. However, if additional checks can confirm the verity of this phenomenon, forming explanatory hypotheses can be relevant and quite interesting. Thanks to an INED research funding, a special protocol of deep age checking has been established to be applied to the two DOMs where the phenomenon is the most pronounced: Guadeloupe and Martinique. First results not only show that combining several additional checks does not leave much room for further doubting the ages of supercentenarians but they also support some arguments in favor of a possible fundamental explanation: genetic selection due to the extreme severity of mortality inflicted on their slave ancestors.

A Case of Suspected Hyperphenylalaninemia at Newborn Screening by Tandem Mass Spectrometry during Total Parenteral Nutrition

Phenylketonuria (PKU) is a rare autosomal recessive condition affecting about 1 in 10,000 people in the Europe, with a higher rate in some countries, like Ireland and Italy. In Italy, newborn screening (NBS) by MS/MS allows the diagnostic suspicion of PKU and its variants (Hyperphenylalaninemia (HPA), Tetrahydrobiopterin (BH4) synthesis deficiency, and Tetrahydrobiopterin (BH4) recycling deficiency) through the quantification of Phenylalanine (Phe) and the Phenylalanine/Tyrosine (Phe/Tyr) ratio in dried blood Spot (DBS) samples. Here, we report a case of an HPA whose suspicion was possible with expanded NBS, even if the normal-weight newborn was in total parenteral nutrition (TPN). It is known that TPN may present metabolic alterations, mainly for amino acids at NBS in MS/MS, frequently causing false positives. Actually, TPN is considered a special protocol in NBS, requiring several sample collections. In particular, a DBS sample is required before TPN, at basal time point (48 h after birth) and 72 h after the end of the procedure. In the case we report, even if the first DBS sample (before TPN) resulted negative, the repeated NBS tests revealed increased levels of Phe and dramatically high Phe/Tyr ratio. Thus, the newborn was recalled, and the NBS test was repeated several times before that HPA suspicion was confirmed by other specific biochemical tests. This case highlights the importance of Phe/Tyr ratio, only detectable by MS/MS analysis, in supporting the diagnostic suspicion during amino acids administration in the neonatal period.

Locking Two Rigid-body Bundles in an Outward-Facing Conformation: The Ion-coupling Mechanism in a LeuT-fold Transporter

Secondary active transporters use electrochemical gradient of ions to fuel the “uphill” translocation of the substrate following the alternating-access model. The coupling of ions to conformational dynamics of the protein remains one of the least characterized aspects of the transporter function. We employ extended molecular dynamics (MD) simulations to examine the Na+-binding effects on the structure and dynamics of a LeuT-fold, Na+-coupled secondary transporter (Mhp1) in its major conformational states, i.e., the outward-facing (OF) and inward-facing (IF) states, as well as on the OF ↔ IF state transition. Microsecond-long, unbiased MD simulations illustrate that Na+ stabilizes an OF conformation favorable for substrate association, by binding to a highly conserved site at the interface between the two helical bundles and restraining their relative position and motion. Furthermore, a special-protocol biased simulation for state transition suggests that Na+ binding hinders the OF ↔ IF transition. These synergistic Na+-binding effects allosterically couple the ion and substrate binding sites and modify the kinetics of state transition, collectively increasing the lifetime of an OF conformation with high substrate affinity, thereby facilitating substrate recruitment from a low-concentration environment. Based on the similarity between our findings for Mhp1 and experimental reports on LeuT, we propose that this model may represent a general Na+-coupling mechanism among LeuT-fold transporters.

RANCANG BANGUN “TELEGRAM BOT API” UNTUK LAYANAN SISTEM INFORMASI AKADEMIK DI UNWAHA MENGGUNAKAN METODE LONG POLLING

Today, the information system needs are not limited to the importance of the information, but the ease and speed of getting the information is a priority that must be fulfilled. This makes many instant messaging applications appear. One of them is a telegram that has features the BOT telegram API, which is a special protocol for connecting information from a system to a user through Instant Messaging. In this research, the researcher used BOT features of the instant messaging application for Academic Information system at KH. A Wahab Hasbullah University includes data KHS, KRS, information dissemination, transcripts of the score, lecture schedules and others. This research used the Long Polling method. This method is used because it can be implemented on a local PC server that is owned by KH. A Wahab Hasbullah University. This telegram BOT has a better speed compared to conventional web versions, this speed testing is done in two steps. First, Use of a BOT of this Telegram has better speeds compared to conventional web version, this speed test is carried out by two steps, 1) the result of BOT telegram using 512 kb Bandwidth with average is 2.98 seconds, conventional web is 5.39 seconds; 2) the result of BOT Telegram using 1 MB bandwidth with average is 2.44 seconds, conventional web is 3.15 seconds.

Hounded Women: The IPV Protocol and the Autonomy of Abuse Victims

In the early 90s, many jurisdictions adopted a special protocol in an effort to stop and punish intimate partner abuse. This article focuses on the particular form this policy has taken in the New York County jurisdiction, as it is a source of deep disagreement among feminists. In this article, I explore this disagreement in order to demonstrate two things. First, that like many other contentious issues, this controversy revolves around the question of how oppressed individuals’ autonomy should be conceived. Second, that a structural understanding of autonomy, such as the one pioneered by the philosopher Joseph Raz, can be of great use to resolve disagreements on this protocol. I offer an interpretation of his account which enables us to acknowledge the agency of ‘hounded women’ while legitimizing interventions aimed at eradicating the coercion they are victims of.

УЛОГА И ЗНАЧАЈ ШКОЛСКОГ СПОРТА У ПРЕВЕНЦИЈИ НАСИЉА

The aim of this paper is the proposal considering the importance of school sport as a measure of prevention of violence among students in schools. In the introduction the authoresses discuss the basic definitions of violence, numerous forms of violence in sport, violence in schools, youth violence and juvenile delinquency as the forms of violence which are studied in sociology, psychology, pedagogy and other humanities. The authoresses present the results of the research of prevalence and forms of violence in schools in Serbia according to the report from 2011. Despite the implementation of certain strategic documents (Special Protocol for the Protection of Children and Students from Violence, Abuse and Neglect in Educational Institutions, 2007, Rule book on the Protocol for Treatment in the Institution in the Response to Violence, Abuse and Neglect, 2010) which specify measures for the prevention of violence in schools, the level of violence has remained unchanged compared to the previous researches. These strategic documents do not recognize the importance of the possibility of school sport as the measure of prevention of violence. The authoresses suggest the possibility of designing programmes within the system of school sport as the measure of prevention of violence in schools and the way of improving sport culture and physical culture in the broadest sense.

Tappas: An adaptive enrichment phase 3 trial of TRC105 and pazopanib versus pazopanib alone in patients with advanced angiosarcoma (AAS).

TPS11081 Background: AAS is an aggressive soft tissue sarcoma (STS) of endothelial cell origin with an expected median overall survival of 8-12 months. Pazopanib (P) is approved for treatment of advanced STS following progression on chemotherapy. In a retrospective study of 40 AAS patients treated with single agent P the median PFS was 3.1 months and median OS 9.9 months with no complete responses. Endoglin is an essential angiogenic receptor expressed on AAS that is upregulated following VEGF inhibition, and TRC105, an endoglin antibody, given with P produced durable complete responses in AAS patients with median PFS of 5.6 months in refractory patients including those receiving prior P. The TAPPAS trial is the first randomized Phase 3 trial performed in AAS, and was initiated following protocol assistance from the EMA and Special Protocol Assessment from the FDA. Methods: TAPPAS is a randomized multicenter study of TRC105/P vs P alone in the United States and Europe that is actively enrolling cutaneous and non-cutaneous AAS patients and incorporates an adaptive enrichment design. Key inclusion criteria: 0, 1 or 2 prior lines of therapy, ECOG ≤ 1. Primary endpoint is PFS and secondary endpoints include ORR and OS. The initial sample size of 124 patients, followed until 95 PFS events, provides more than 80% power to detect a hazard ratio of 0.55. At the time of interim analysis, projected to occur upon the occurrence of 40 events in approximately 70 patients, the result will be classified as belonging to either the favorable, promising, enrichment or unfavorable zones, based on conditional power. The sample size and PFS events will be unchanged in the favorable and unfavorable zones, and will be increased to a total of 200 patients followed for 170 PFS events in the promising zone. The trial will enroll 100 additional patients, with cutaneous disease only, in the enrichment zone and will follow them until 110 events are observed in the total cutaneous population. An independent DMC will follow the trial for safety and futility. The adaptive design requires the enrollment of fewer patients, preserves type-1 error, and protects power to detect a clinically meaningful survival benefit. (NCT 02979899). Clinical trial information: NCT02979899.