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AIM: The challenges posed by the assessment of elderly trauma patients increase the reliance on emergency CT scanning to diagnose an injury. The COVID-19 pandemic posed challenges to image service delivery. We sought to assess the effect of the COVID-19 pandemic on the imaging of elderly trauma. MATERIALS AND METHODS: All trauma patients aged 65 and over who underwent whole-body CT scanning in the same 3-month period (April-June) in 2019 and 2022 were included in our study. Data was collected on demographics, time of scanning, clinical request details and positive report findings. Anatomical injury distribution, abbreviated injury scale (AIS) and injury severity scores (ISS) were calculated. Consensus judgment was obtained on scan justification and significance of findings. Chi-squared test of association was applied to the categorical outcomes of interest. Associations were considered significant if p<0.05. RESULTS: 79 patients were scanned in the pre-pandemic assessment period versus 217 post-pandemic, an increase of 175%, including a 248% rise in fall-from-standing requests. There was a statistically significant reduction of trauma CT requests meeting fulfilment criteria post-pandemic (95% vs 83%) (p=0.008), with significantly fewer positive findings (45.6% vs 29%) (p=0.024). There was a decrease in median ISS score in the post-pandemic group (p=0.062). CONCLUSION: Despite increased scanning, there was a reduction in both the number and severity of positive traumatic imaging findings. The pandemic has increased reliance on CT without a concomitant increase in the detection of positive findings nor clinically significant findings. This single-centre study demonstrates the need to further evaluate pan-CT trauma scanning in silver trauma patients.
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COVID-19 , Hospitales de Enseñanza , SARS-CoV-2 , Tomografía Computarizada por Rayos X , Heridas y Lesiones , Humanos , COVID-19/epidemiología , COVID-19/diagnóstico por imagen , Anciano , Femenino , Masculino , Tomografía Computarizada por Rayos X/métodos , Anciano de 80 o más Años , Heridas y Lesiones/diagnóstico por imagen , Pandemias , Puntaje de Gravedad del Traumatismo , Imagen de Cuerpo Entero/métodos , Estudios RetrospectivosRESUMEN
Emerging evidence suggests switching between foods during an eating event is positively associated with intake. However, it is unclear whether switching is a stable behavior that predicts consumption across multiple eating events. The current study explored whether switching is consistent within children and reliably associated with intake across varied eating events. We analyzed data from 88 (45 F), 7-8-year-old children without obesity participating in a 7-visit prospective cohort study (ClinicalTrials.gov NCT03341247). Amount consumed and energy intake were measured at 4 separate meals of foods that varied by portion sizes served. Meals included macaroni and cheese, chicken nuggets, broccoli, and grapes (all 0.7-2.5 kcal/g). Children's intake was also assessed during 2 eating in the absence of hunger (EAH) paradigms separated by ≥ 1 year. The EAH paradigm included 9 sweet and savory snack foods (all 1.9-5.7 kcal/g). All eating events were video-recorded and switching was assessed by counting the number of times a child shifted between different food items. Results demonstrated that switching was reliably associated with intake at both the meals and the EAH paradigms (ps < 0.01). Specifically, at meals each additional switch was associated with 11.7 ± 1.3 kcal (7.7 ± 0.8 g) more consumed, and during EAH each additional switch was associated with 8.1 ± 2.1 kcal (2.1 ± 0.5 g) more consumed. Switching behavior was also moderately consistent across meals (ICC = 0.70) and EAH paradigms (ICC = 0.50). However, switching at meals was not related to switching at EAH paradigms. This study demonstrates the consistency of switching behavior and its reliable association with intake across eating events, highlighting its potential to contribute to chronic overconsumption and childhood obesity.
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Obesidad Infantil , Humanos , Niño , Obesidad Infantil/etiología , Estudios Prospectivos , Conducta Alimentaria , Ingestión de Energía , Hambre , Ingestión de AlimentosRESUMEN
Prior studies evaluating a single meal in children characterized an "obesogenic" style of eating marked by larger bites and faster eating. It is unclear if this style is consistent across portion sizes within children so we examined eating behaviors in 91 children (7-8 years, 45 F) without obesity (BMI<90th percentile). Children consumed 4 ad libitum meals in the laboratory consisting of chicken nuggets, macaroni, grapes, and broccoli that varied in portion size (100%, 133%, 166%, 200%) with a maximum of 30 min allotted per meal. Anthropometrics were assessed using age and sex adjusted body mass index (BMI) percentile and dual energy x-ray absorptiometry. Bites, sips, active eating time, and meal duration were coded from meal videos; bite size (kcal and g/bite), proportion of active eating (active eating time/meal duration), and eating rate (kcal and g/meal duration) were computed. Intraclass correlation coefficients (ICC) showed that most eating behaviors were moderately consistent across portions (>0.50). The consistency of associations between eating behaviors and total meal intake and adiposity were assessed with general linear models adjusted for food liking, pre-meal fullness, age, and sex. Across all portions, more bites, faster eating rate, and longer meal duration were associated with greater intake. While higher BMI percentile was associated with faster eating rates across all meals, greater fat mass index was only associated with faster eating at meals with portions typical for children (i.e., 100% and 133%). In a primarily healthy weight sample, an 'obesogenic' style of eating was a consistent predictor of greater intake across meals that varied in portion size. The consistent relationship of these behaviors with intake makes them promising targets to reduce overconsumption.
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Ingestión de Energía , Tamaño de la Porción , Niño , Humanos , Conducta Alimentaria , Comidas , Obesidad , Ingestión de AlimentosRESUMEN
Background: Prolonged Exposure (PE), a trauma-focused therapy, is one of the most efficacious treatments available for PTSD. However, many people with PTSD do not lose their diagnosis following delivery of PE. The Unified Protocol (UP) for Transdiagnostic Treatment of Emotional Disorders is a non-trauma focused treatment that may offer an alternative treatment for PTSD. Methods: This paper describes the study protocol for IMPACT, an assessor-blinded randomized controlled trial that examines the non-inferiority of UP relative to PE for participants who meet DSM-5 criteria for current PTSD. One hundred and twenty adult participants with PTSD will be randomized to receive either 10 × 90-min sessions of UP or PE with a trained provider. The primary outcome is severity of PTSD symptoms assessed by the Clinician Administered PTSD Scale for DSM-5 (CAPS-5) at post-treatment. Discussion: While evidence-based treatments are available for PTSD, high levels of treatment dropout and non-response require new approaches to be tested. The UP is based on emotion regulation theory and is effective in treating anxiety and depressive disorders, however, there has been limited application to PTSD. This is the first rigorous study comparing UP to PE in a non-inferiority randomized controlled trial and may help improve clinical outcomes for those with PTSD. Trial registration: This trial was prospectively registered with the Australian New Zealand Clinical Trials Registry, Trial ID (ACTRN12619000543189).
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Head and neck squamous cell carcinoma (HNSCC) patients treated with high-dose cisplatin concurrently with radiotherapy (hdCis-RT) commonly suffer kidney injury leading to acute and chronic kidney disease (AKD and CKD, respectively). We conducted a retrospective analysis of renal function and kidney injury-related plasma biomarkers in a subset of HNSCC subjects receiving hdCis-RT in a double-blinded, placebo-controlled clinical trial (NCT02508389) evaluating the superoxide dismutase mimetic, avasopasem manganese (AVA), an investigational new drug. We found that 90 mg AVA treatment prevented a significant reduction in estimated glomerular filtration rate (eGFR) three months as well as six and twelve months after treatment compared to 30 mg AVA and placebo. Moreover, AVA treatment may have allowed renal repair in the first 22 days following cisplatin treatment as evidenced by an increase in epithelial growth factor (EGF), known to aid in renal recovery. An upward trend was also observed in plasma iron homeostasis proteins including total iron (Fe-blood) and iron saturation (Fe-saturation) in the 90 mg AVA group versus placebo. These data support the hypothesis that treatment with 90 mg AVA mitigates cisplatin-induced CKD by inhibiting hdCis-induced renal changes and promoting renal recovery.
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Neoplasias de Cabeza y Cuello , Insuficiencia Renal Crónica , Humanos , Benchmarking , Cisplatino/efectos adversos , Neoplasias de Cabeza y Cuello/tratamiento farmacológico , Neoplasias de Cabeza y Cuello/metabolismo , Hierro/metabolismo , Riñón/metabolismo , Insuficiencia Renal Crónica/inducido químicamente , Insuficiencia Renal Crónica/tratamiento farmacológico , Estudios Retrospectivos , Carcinoma de Células Escamosas de Cabeza y Cuello/tratamiento farmacológico , Carcinoma de Células Escamosas de Cabeza y Cuello/metabolismo , Carcinoma de Células Escamosas de Cabeza y Cuello/patologíaRESUMEN
There is significant interest in the use of terbium radioisotopes for applications in cancer therapy and diagnosis. Of these, 161Tb, as a medium energy beta-emitter, is being investigated as a potential alternative to 177Lu. The relatively high proportion of conversion electron and Auger electron emissions per decay make 161Tb an attractive targeted therapeutic. As a product of nuclear fission, 161Tb is also of importance to nuclear forensics. The standard uncertainty of the current evaluated half-life of 6.89(2) d contributes significantly to the standard uncertainty of any decay corrected activity determination made. Furthermore, the accuracy of this evaluated half-life has been called into question by measurements reported in 2020 at the Institute of Radiation Physics (IRA), Switzerland, who reported a half-life of 6.953(2) d. In the current work, the half-life of the 161Tb ground state decay has been measured at three independent laboratories located in the United Kingdom and the United States of America for a total of six determinations using three independent measurement techniques; gamma-ray spectrometry, ionisation chamber measurement and liquid scintillation counting. The half-life determined for 161Tb of 6.9637(29) d confirms the observed 1% relative increase observed by IRA, though the reported half-lives in this work and at IRA are significantly different (ζ-score = 3.1).
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Semivida , Radioisótopos/química , Terbio/química , Radiofármacos/químicaRESUMEN
Injury scoring systems can be used for triaging, predicting morbidity and mortality, and prognosis in mass casualty incidents. Recent conflicts and civilian incidents have highlighted the unique nature of blast injuries, exposing deficiencies in current scoring systems. Here, we classify and describe deficiencies with current systems used for blast injury. Although current scoring systems highlight survival trends for populations, there are several major limitations. The reliable prediction of mortality on an individual basis is inaccurate. Other limitations include the saturation effect (where scoring systems are unable to discriminate between high injury score individuals), the effect of the overall injury burden, lack of precision in discriminating between mechanisms of injury, and a lack of data underpinning scoring system coefficients. Other factors influence outcomes, including the level of healthcare and the delay between injury and presentation. We recommend that a new score incorporates the severity of injuries with the mechanism of blast injury. This may include refined or additional codes, severity scores, or both, being added to the Abbreviated Injury Scale for high-frequency, blast-specific injuries; weighting for body regions associated with a higher risk for death; and blast-specific trauma coefficients. Finally, the saturation effect (maximum value) should be removed, which would enable the classification of more severe constellations of injury. An early accurate assessment of blast injury may improve management of mass casualty incidents.
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Traumatismos por Explosión/fisiopatología , Puntaje de Gravedad del Traumatismo , Incidentes con Víctimas en Masa , Traumatismos por Explosión/clasificación , Traumatismos por Explosión/mortalidad , Atención a la Salud/organización & administración , Humanos , Pronóstico , Factores de Tiempo , Triaje/métodosRESUMEN
In our search for new antibiotic adjuvants as a novel strategy to deal with the emergence of multi-drug resistant (MDR) bacteria, a series of succinylprimaquine-polyamine (SPQ-PA) conjugates and derivatives of a cationic amphiphilic nature have been prepared. Evaluation of these primaquine conjugates for intrinsic antimicrobial properties and the ability to restore the antibiotic activity of doxycycline identified two derivatives, SPQ-PA3-8-3 and SPQ-PA3-10-3 that exhibited intrinsic activity against the Gram-positive bacteria Staphylococcus aureus and the yeast Cryptococcus neoformans. None of the analogues were active against the Gram-negative bacterium Pseudomonas aeruginosa. However, in the presence of a sub-therapeutic amount of doxycycline (4.5 µM), both SPQ-PA3-4-3 and SPQ-PA3-10-3 compounds displayed potent antibiotic adjuvant properties against P. aeruginosa, with MIC's of 6.25 µM. A series of derivatives were prepared to investigate the structure-activity relationship that explored the influence of both a simplified aryl lipophilic substituent and variation of the length of the polyamine scaffold on observed intrinsic antimicrobial properties and the ability to potentiate the action of doxycycline against P. aeruginosa.
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Adyuvantes Farmacéuticos/farmacología , Antibacterianos/farmacología , Bacterias Grampositivas/efectos de los fármacos , Poliaminas/farmacología , Primaquina/farmacología , Adyuvantes Farmacéuticos/síntesis química , Adyuvantes Farmacéuticos/química , Antibacterianos/síntesis química , Antibacterianos/química , Relación Dosis-Respuesta a Droga , Pruebas de Sensibilidad Microbiana , Estructura Molecular , Poliaminas/química , Primaquina/síntesis química , Primaquina/química , Relación Estructura-ActividadRESUMEN
Emerging evidence of brain injury on risk of neurodegenerative diseases such as Alzheimer's disease (AD) and chronic traumatic encephalopathy (CTE) have resulted in interest in therapeutic potential of omega-3 fatty acids (n-3FA). We conducted a systematic review of n-3FA therapeutic efficacy for ageing adults at risk of AD/CTE following a history of repeated head trauma. Databases for articles between 1980-June 2020 were examined for studies reporting on n-3 FAs in adults (≥ 45 years) with a history of repeated brain injury. Following an initial screen of 175 articles, 12 studies were considered but were eventually rejected, as they did not meet inclusion criteria. Our review could find no evidence to support, or disprove, effectiveness of n-3FA intervention in older adults with a history of head trauma. With animal studies showing neuro-restorative potential of n-3FA following brain injury, this review highlights the urgent need for human research in this area.
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Enfermedad de Alzheimer/prevención & control , Encefalopatía Traumática Crónica/prevención & control , Ácidos Grasos Omega-3/uso terapéutico , Envejecimiento , Enfermedad de Alzheimer/etiología , Animales , Conmoción Encefálica/complicaciones , Encefalopatía Traumática Crónica/etiología , Humanos , RecurrenciaRESUMEN
OBJECTIVE: To investigate the use of the King-Devick (K-D) test for sideline assessment of concussive injuries in a New Zealand amateur women's rugby union team. DESIGN: Prospective cohort observational. METHODS: All players were K-D tested during pre-season using a tablet (iPad; Apple Inc., Cupertino, CA). Differences in K-D scores and test-retest reliability were calculated for baseline test scores, baseline, and post-injury (concussion) sideline assessment and baseline and post-season testing scores for tests by year and as a combined score. RESULTS: One training-related (0.3 per 1000 training-hrs) and nine match-related (16.1 per 1000 match-hrs) concussions were recorded. The K-D post-injury (concussion) sideline test score were significantly slower than established baseline (-4.4 [-5.8 to -3.4] s; χ2(1) = 42.2; p < 0.0001; t(9) = -4.0; p = 0.0029; d = -0.8). There was good-to-excellent reliability of the K-D test for baseline (ICC: 0.84 to 0.89), post-injury (concussion) sideline assessment (ICC: 0.82 to 0.97) and post-season evaluation (ICC: 0.79 to 0.83). DISCUSSION: By utilising the baseline to post-injury (concussion) assessment comparisons, any player with a post-injury (concussion) assessment slowing of their K-D test time, regardless of whether the player has, or has not had a witnessed insult, should be withheld from any further participation until they are evaluated by a medical professional trained in the management of concussion. CONCLUSION: This study has provided additional evidence to support the use of the K-D test as a frontline method of assessing concussion with good to excellent reliability of the test for baseline, side-line assessment and post-season evaluation.
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Traumatismos en Atletas , Conmoción Encefálica , Fútbol Americano , Traumatismos en Atletas/diagnóstico , Traumatismos en Atletas/epidemiología , Conmoción Encefálica/diagnóstico , Conmoción Encefálica/epidemiología , Femenino , Humanos , Pruebas Neuropsicológicas , Nueva Zelanda/epidemiología , Estudios Prospectivos , Reproducibilidad de los Resultados , Estaciones del AñoRESUMEN
INTRODUCTION: The temporal patterns and unit-based distributions of trauma patients requiring surgical intervention are poorly described in the UK. We describe the distribution of trauma patients in the UK and assess whether changes in working patterns could provide greater exposure for operative trauma training. METHODS: We searched the Trauma Audit and Research Network database to identify all patients between 1 January 2014 to 31 December 2016. Operative cases were defined as all patients who underwent laparotomy, thoracotomy or open vascular intervention. We assessed time of arrival, correlations between mechanism of injury and surgery, and the effect of changing shift patterns on exposure to trauma patients by reference to a standard 10-hour shift assuming a dedicated trauma rotation or fellowship. RESULTS: There were 159,719 patients from 194 hospitals submitted to the Network between 2014 and 2016. The busiest 20 centres accounted for 57,568 (36.0%) of cases in total. Of these 2147/57,568 patients (3.7%) required a general surgical operation; 43% of penetrating admissions (925 cases) and 2.2% of blunt admissions (1222 cases). The number of operations correlated more closely with the number of penetrating rather than blunt admissions (r = 0.89 vs r = 0.51). A diurnal pattern in trauma admissions enabled significant increases in trauma exposure with later start times. CONCLUSIONS: Centres with high volume and high penetrating rates are likely to require more general surgical input and should be identified as locations for operative trauma training. It is possible to improve the number of trauma patients seen in a shift by optimising shift start time.
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Educación de Postgrado en Medicina/métodos , Cirugía General/educación , Admisión del Paciente/estadística & datos numéricos , Traumatología/educación , Heridas y Lesiones/etiología , Adulto , Anciano , Anciano de 80 o más Años , Inglaterra , Femenino , Hospitales de Alto Volumen , Humanos , Irlanda , Masculino , Persona de Mediana Edad , Admisión y Programación de Personal/organización & administración , Admisión y Programación de Personal/estadística & datos numéricos , Estudios Retrospectivos , Horario de Trabajo por Turnos/estadística & datos numéricos , Factores de Tiempo , Centros Traumatológicos/organización & administración , Centros Traumatológicos/estadística & datos numéricos , Gales , Lugar de Trabajo/organización & administración , Lugar de Trabajo/estadística & datos numéricos , Heridas y Lesiones/cirugíaRESUMEN
An acetylenic 2-amino-3-alcohol, distaminolyne B (2), isolated from the New Zealand ascidian Pseudodistoma cereum, is reported. The isolation and structure elucidation of 2 and assignment of 2S,3S absolute configuration (AC) using the exciton coupled circular dichroism technique are described. Using a methodologically facile workflow, the same AC was also established by analysis of specific rotation, terminal methyl C-1 δC chemical shift, and NH δH and J values of the N,O-diacetate derivative.
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Acetileno/química , Alquenos/química , Lípidos/química , Urocordados/química , Alcaloides , Animales , HumanosRESUMEN
BACKGROUND: Childhood unintentional injuries (UI) are common but continue to happen more often to children living in less advantaged socioeconomic circumstances (SEC). Our aim was to explore how early life factors mediate the association between SEC and UIs, using the UK Millennium Cohort Study. METHODS: We calculated risk ratios (RR) and 95% confidence intervals (95%CI) for parental report of UI occurring between age 3 and 5 years, using Poisson regression according to family income as a measure of SEC. We explored potentially mediating pathways by controlling associations between SEC and UI for groups of early life risks in three domains: factors that may influence environmental safety, supervision and the MCS child's abilities and behaviours. RESULTS: Twenty eight percent of children had a UI from 3 to 5 years old. Children from the lowest income quintile were more likely to be injured compared to those from the highest (RR 1.20 95%CI 1.05, 1.37). Sequentially controlling for early life factors that may influence environmental safety (RR 1.19 95%CI 1.02, 1.38), then supervision (RR 1.18, 95%CI 1.02, 1.36), and finally adding child's behaviour and abilities (RR 1.15, 95%CI 1.00, 1.34) into the model reduced the RR by 5, 10 and 25% respectively. CONCLUSIONS: Addressing factors that may influence environmental safety and supervision, and the child's abilities and behaviours only partly explains the increased UI risk between the highest and lowest income quintiles. Further research is required to explore factors mediating associations between SEC and specific mechanisms and types of injuries.
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Lesiones Accidentales/diagnóstico , Lesiones Accidentales/epidemiología , Protección a la Infancia , Renta , Factores de Edad , Distribución de Chi-Cuadrado , Preescolar , Estudios de Cohortes , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Estudios Longitudinales , Masculino , Oportunidad Relativa , Prevalencia , Medición de Riesgo , Factores Socioeconómicos , Reino Unido/epidemiologíaRESUMEN
The 2 S configuration of the marine natural product distaminolyne A was recently disputed based upon total synthesis, yet paradoxically supported by a second independent total synthesis from a different research group. We now verify the 2 S configuration of distaminolyne A by extensive chiroptical studies and support the veracity of the EC ECD method originally used to prove it. The origin of the apparent paradox appears to lie in the limits of precision of polarimetry in the context of weakly rotatory molecules, which strikes a cautionary note on the reliability of "reassignment" of natural product configurations based solely on specific rotation.
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Alquenos/química , Dicroismo Circular/métodos , Conformación MolecularRESUMEN
At the time of publication, radiopharmaceuticals labelled with thorium-227 are in clinical trials in Europe for the treatment of various types of cancer. In part I of this two-part series the primary standardisation of an aqueous solution of 227Th was reported. In part II, the activity derived from the recommended absolute γ-ray emission intensities have been compared to that from the primary standardisation techniques. This comparison showed a negative bias of 4% in the determined activity per unit mass with an 11% spread in the activities determined for the eight most intense γ-ray emissions (Iγ > 1%) from the 227Th α decay. Using the standardised 227Th, measurements of the characteristic γ-ray emissions from the 223Ra excited states were made using a calibrated HPGe γ-ray spectrometer. This has enabled the absolute intensities of 70 γ ray emissions from the 227Th α-decay to be experimentally determined. A significant improvement over the precision of the recommended normalisation scaling factor has been made, with a value of 12.470 (35) % determined. Typically, the precision of the intensities has been improved by an order of magnitude or greater than current recommended values. The correlation matrices for pairs of the most intense γ-ray emission intensities are presented.
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Radiofármacos/uso terapéutico , Torio/uso terapéutico , Partículas alfa/uso terapéutico , Calibración , Rayos gamma/uso terapéutico , Humanos , Neoplasias/radioterapia , Radioinmunoterapia/métodos , Radioinmunoterapia/normas , Radiofármacos/normas , Radio (Elemento)/química , Estándares de Referencia , Conteo por Cintilación , Espectrometría gamma , Torio/normasRESUMEN
OBJECTIVES: To provide epidemiological data and related costs for moderate-to-serious and serious injury claims for women's rugby union in New Zealand. DESIGN: A retrospective analytical review of injury entitlement claims for women's rugby from 2013 to 2017. METHODS: Data were analysed by year of competition, age, body site and injury type for total and moderate-to-severe (MSC) Accident Compensation Corporation (ACC) claims and costs. RESULTS: Over 2013 to 2017 there were 26,070 total claims for female rugby union costing $18,440,812 [AD$16,956,998]. The 15-19-year age group recorded 40% (n=1,009) of the total female rugby union Moderate-to-serious and serious (MSC) claims and 41% ($5,419,157 [AD$4,983,112]) of the total female rugby union MSC costs. The knee was the most commonly recorded injury site accounting for 40.3% (n=1,007) of MSC claims and 46.9% ($6,229,714 [AD$5,728732]) of MSC costs with an average cost of $1,245,943 ±$217,796 [AD$595,351 ±AD$104,070] per-year for female rugby union. CONCLUSIONS: This is the first study to report the nature and related costs for moderate-to-serious and serious injury claims for women's rugby union in New Zealand. A total of 26,070 injury claims were lodged over the duration of the study but only 9.6% (n=2,501) of these were classified as MSC injury entitlement claims. Participants 25 years and older accounted for 31% of the female rugby union player claims. Females in the over 35-year age groups compete against younger participants which may account for the higher mean cost per-claim seen as the age groups increase in years until they retire from the game.
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Traumatismos en Atletas/economía , Compensación y Reparación , Fútbol Americano/lesiones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Traumatismos en Atletas/epidemiología , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Traumatismos de la Rodilla/economía , Traumatismos de la Rodilla/epidemiología , Persona de Mediana Edad , Nueva Zelanda , Estudios Retrospectivos , Adulto JovenRESUMEN
Thorium-227 is a potential therapeutic radionuclide for applications in targeted α-radioimmunotherapy for the treatment of various types of cancer. To provide nuclear medicine departments involved in Phase I clinical trials traceability to the SI unit of radioactivity (Bq), a standardisation of a radiochemically pure 227Th aqueous solution has been performed at the National Physical Laboratory. This was achieved via two primary liquid scintillation (LS) techniques -4π(LS)-γ digital coincidence counting (DCC) and 4π LS counting. These absolute techniques were supported by the indirect determination of the 227Th activity via the measurement of the ingrowth and decay rate of the decay progeny by both ionisations chambers and high purity germanium (HPGe) gamma-ray spectrometry. The results of the primary techniques were found to be consistent, both with each other (zeta score =â¯1.1) and to the decay progeny ingrowth measurements. An activity per unit mass of 20.726 (51) kBq g-1 was determined for the solution. A procedure has been developed that provided an effective separation of the 227Th from its decay progeny, which was shown by the effective time zero of the 227Th-223Ra nuclear chronometer measured by HPGe gamma-ray spectrometry.
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Radiofármacos/normas , Torio/normas , Partículas alfa/uso terapéutico , Germanio , Semivida , Humanos , Neoplasias/radioterapia , Radioinmunoterapia/métodos , Radioinmunoterapia/normas , Radiometría/instrumentación , Radiofármacos/análisis , Radiofármacos/uso terapéutico , Estándares de Referencia , Conteo por Cintilación/métodos , Espectrometría gamma , Torio/análisis , Torio/uso terapéuticoRESUMEN
INTRODUCTION: Death as a consequence of underbody blast (UBB) can most commonly be attributed to central nervous system injury. UBB may be considered a form of tertiary blast injury but is at a higher rate and somewhat more predictable than injury caused by more classical forms of tertiary injury. Recent studies have focused on the transmission of axial load through the cervical spine with clinically relevant injury caused by resultant compression and flexion. This paper seeks to clarify the pattern of head and neck injuries in fatal UBB incidents using a pragmatic anatomical classification. METHODS: This retrospective study investigated fatal UBB incidents in UK triservice members during recent operations in Afghanistan and Iraq. Head and neck injuries were classified by anatomical site into: skull vault fractures, parenchymal brain injuries, base of skull fractures, brain stem injuries and cervical spine fractures. Incidence of all injuries and of each injury type in isolation was compared. RESULTS: 129 fatalities as a consequence of UBB were identified of whom 94 sustained head or neck injuries. 87 casualties had injuries amenable to analysis. Parenchymal brain injuries (75%) occurred most commonly followed by skull vault (55%) and base of skull fractures (32%). Cervical spine fractures occurred in only 18% of casualties. 62% of casualties had multiple sites of injury with only one casualty sustaining an isolated cervical spine fracture. CONCLUSION: Improvement of UBB survivability requires the understanding of fatal injury mechanisms. Although previous biomechanical studies have concentrated on the effect of axial load transmission and resultant injury to the cervical spine, our work demonstrates that cervical spine injuries are of limited clinical relevance for UBB survivability and that research should focus on severe brain injury secondary to direct head impact.