A Rab6 to Rab11 transition is required for dense-core granule and exosome biogenesis in Drosophila secondary cells.

Secretory cells in glands and the nervous system frequently package and store proteins destined for regulated secretion in dense-core granules (DCGs), which disperse when released from the cell surface. Despite the relevance of this dynamic process to diseases such as diabetes and human neurodegenerative disorders, our mechanistic understanding is relatively limited, because of the lack of good cell models to follow the nanoscale events involved. Here, we employ the prostate-like secondary cells (SCs) of the Drosophila male accessory gland to dissect the cell biology and genetics of DCG biogenesis. These cells contain unusually enlarged DCGs, which are assembled in compartments that also form secreted nanovesicles called exosomes. We demonstrate that known conserved regulators of DCG biogenesis, including the small G-protein Arf1 and the coatomer complex AP-1, play key roles in making SC DCGs. Using real-time imaging, we find that the aggregation events driving DCG biogenesis are accompanied by a change in the membrane-associated small Rab GTPases which are major regulators of membrane and protein trafficking in the secretory and endosomal systems. Indeed, a transition from trans-Golgi Rab6 to recycling endosomal protein Rab11, which requires conserved DCG regulators like AP-1, is essential for DCG and exosome biogenesis. Our data allow us to develop a model for DCG biogenesis that brings together several previously disparate observations concerning this process and highlights the importance of communication between the secretory and endosomal systems in controlling regulated secretion.

Confirmed Case of Longstanding Respiratory Francisella tularensis holarctica Infection: Nebraska, 2022.

A male patient with distant history of extensive rabbit contact and pulmonary nodules for 6 years developed empyema. Francisella tularensis holarctica was isolated from thoracentesis fluid. Retrospective immunohistochemical examination of a pulmonary nodule, biopsied 3 years prior, was immunoreactive for F. tularensis. These findings suggest the potential for chronic tularemia.

Innovations in the Assessment of Skeletal Muscle Health: A Glimpse into the Future.

Skeletal muscle is the largest organ system in the human body and plays critical roles in athletic performance, mobility, and disease pathogenesis. Despite growing recognition of its importance by major health organizations, significant knowledge gaps remain regarding skeletal muscle health and its crosstalk with nearly every physiological system. Relevant public health challenges like pain, injury, obesity, and sarcopenia underscore the need to accurately assess skeletal muscle health and function. Feasible, non-invasive techniques that reliably evaluate metrics including muscle pain, dynamic structure, contractility, circulatory function, body composition, and emerging biomarkers are imperative to unraveling the complexities of skeletal muscle. Our concise review highlights innovative or overlooked approaches for comprehensively assessing skeletal muscle in vivo. We summarize recent advances in leveraging dynamic ultrasound imaging, muscle echogenicity, tensiomyography, blood flow restriction protocols, molecular techniques, body composition, and pain assessments to gain novel insight into muscle physiology from cellular to whole-body perspectives. Continued development of precise, non-invasive tools to investigate skeletal muscle are critical in informing impactful discoveries in exercise and rehabilitation science.

Extensive Familiarization Is Required Before Assessing Acute Changes in Multiple Object Tracking Performance.

CONTEXT: The Neurotracker CORE assessment is an 8-minute multiple object tracking (MOT) program used in sport science research and clinical rehabilitation as a perceptual-cognitive training tool; however, it has garnered interest for its potential use as an acute assessment of cognitive performance. Although some data exist regarding the learning effect of repeated exposures, it is often overlooked with investigators focusing primarily on the presence of transfer effects to other cognitive realms. As a result, exclusive data on the effect of repeated testing, or subsequent periods of no testing (ie, detraining) on test-retest reliability, and on MOT performance are sparse. DESIGN: Repeated-measures/reliability. METHODS: Twenty-three recreationally active men and women completed 15 training sessions consisting of 2 CORE assessments per session (30 assessments). Participants were randomized to either 1 or 2 weeks of detraining prior to completing 15 retraining sessions (30 assessments). Training and retraining periods were divided into 10 blocks (3 assessments/block) for analysis. MOT speed threshold (MOT-ST), consistency, fastest trial score success speed, lowest trial score miss speed, the number of perfect, near misses, and significant miss trials within each block were used to determine performance. Intraclass correlation coefficient, standard error of measurement, and minimal detectable change were used to determine reliability. RESULTS: Significant improvements in MOT-ST and fastest trial score success speed were noted within training blocks 1 to 6 and 1 to 7, respectively (P < .05). MOT-ST and fastest trial score success speed demonstrated excellent test-retest reliability between blocks 8 and 9. There was no effect of detraining period on performance during retraining. CONCLUSIONS: Eighteen tests are necessary to overcome training effects and establish a reliable baseline when MOT-ST is used as the performance outcome. Detraining periods up to 2 weeks did not impact performance. The average of 3 discrete tests should be used when assessing MOT-ST performance.

The geographic diversity of authorship in leading general surgery journals; A study of 24,332 authors.

BACKGROUND: Research guides evidence-based general surgery practice, advocacy, policy and resource allocation, but is seemingly lacking representation from those countries with greatest disease burden and mortality. Accordingly, we conducted a geographic study of publications in the most impactful general surgery journals worldwide. METHODS: The six general surgery journals with the highest 2020 impact factors were selected. Only journals specific to general surgery were included. For all original articles over the past five years, the affiliated country and city were extracted for the first, second and last author. Number of publications were adjusted per capita, and compared to Human Development Index (HDI) using logistic regression. RESULTS: 8274 original articles were published in the top six ranked general surgery journals over 2016-2020, with 24,332 affiliated authors. Authors were most commonly associated with the US (27.88%), Japan (9.09%) and China (8.46%), or per capita, The Netherlands, Sweden and Singapore. There is a linear association between publishing in a top six journal and HDI of country of affiliation. Just four publications were from medium or low HDI countries over the period. CONCLUSION: Authorship in leading general surgery journals is predominantly from wealthy, Western countries. Authorship is associated with affiliation with a high HDI country, with few authors from medium or low HDI countries. There is a lack of representation in literature from Africa, Russia, and parts of Southeast Asia, and thus a lack of locally relevant evidence to guide surgical practice in these areas of high disease burden and low life expectancy.

Time of Day Effects on Anaerobic Performance Using a Nonmotorized Treadmill.

ABSTRACT: Renziehausen, JM, Bergquist, AM, Park, J-H, Hill, EC, Wells, AJ, Stout, JR, and Fukuda, DH. Time of day effects on anaerobic performance using a nonmotorized treadmill. J Strength Cond Res 37(10): 2002-2007, 2023-The purpose of this study was to determine the effects of time of day on performance during a maximal effort sprinting assessment (30nmt) and determine potential differences based on chronotype and sex. Twenty-six recreationally active men (n = 12) and women (n = 14) between the ages of 18 and 35 years old (21.5 ± 2.4 years) completed the 30nmt at 9:00 am, 2:00 pm, and 7:00 pm in a randomized order over a 24-hour period. Resting heart rate and temperature assessments were taken at each visit. A dietary recall and the Morningness-Eveningness Questionnaire were used to assess kilocalories (kcals) and chronotype, respectively. Two-way (time x sex) repeated measures analyses of variance were conducted to determine differences in peak/mean power, peak/mean velocity, distance, resting heart rate, temperature, and kcals at each time point. Paired sample t tests were used to assess peak and nadir of each performance variable. A significance level was set at p < 0.05. There was a significant main effect for temperature (p < 0.001), resting heart rate (p = 0.007), and pre-exercise caloric intake (p = 0.021) throughout the day. No significant main effects for time were found for peak power (p = 0.766), mean power (p = 0.094), peak velocity (p = 0.497), mean velocity (p = 0.193), or distance (p = 0.262). There were no significant time × sex interactions for any dependent performance variables (p > 0.05). Significant differences were shown between the peak and nadir of each performance variable (p < 0.001). There were no significant differences in performance during maximal effort anaerobic assessments shown throughout the day; however, peak/nadir of performance times may be individualized and differ between morning types and intermediate types.

Emergency Neurosurgery Performed by General Surgeons: A Systematic Review.

BACKGROUND: In under-resourced settings, general surgeons may be called upon to perform emergency operations within other specialties. Accordingly, we aimed to characterise patient outcomes after emergency neurosurgery performed by a general surgeon or general surgery trainee. METHODS: PubMed, Embase and the Cochrane Library were searched to 30 May 2021 for observational studies reporting outcomes after emergency neurosurgery performed by a general surgeon. Study screening, data extraction, and risk of bias using the Downs and Black checklist were performed in duplicate. Data on setting, operation undertaken, mortality rates and complications were extracted. Meta-analysis was planned but not possible due to heterogeneity. This study is registered with PROSPERO, CRD42021258097. RESULTS: From 632 records, 14 retrospective observational studies were included, covering a total sample of 1,988 operations. Four studies were from Australia, and the remaining 10 were, respectively, from 10 other countries. Most common operations performed were decompressive surgery with burr holes or craniectomy for head trauma and insertion of intracranial pressure monitors. Rural hospitals were the most common settings. Mortality rates for procedures performed by general surgeons at latest follow-up were heterogenous, ranging from 5% for evacuation of chronic subdural haematoma in Kenya to 81% in head injured patients in a Hong Kong study. CONCLUSIONS: This is the first systematic review that synthesises the literature to characterise patient outcomes after neurosurgical operations performed by a general surgeon. Findings from this study may benefit global surgery performed in rural, remote, military or humanitarian settings.

Geographical distribution of authorship for leading cardiothoracic surgery journals.

BACKGROUND: Evolution of surgical practice is influenced by publications in the leading journals of that field. If the authorship of a publication lacks geographical diversity, this could create bias and limit generalizability of the evidence. Accordingly, we conducted a geographical analysis of the leading Cardiothoracic Surgery journals worldwide. METHODS: Using 2020 Impact Factor, we searched the leading Cardiothoracic Surgery journals over the past decade. Only original articles were included. Data regarding first, second and last authors were extracted from every article. From this, we analysed country of affiliation, highest academic degree obtained and author location by metropolitan or rural setting. RESULTS: A total of 12,706 original articles were published in the top 5 ranked Cardiothoracic journals between 2011 and 2020. Authors originated from 69 countries, with the majority being from North America and Western Europe. The United States was the most common country of affiliation (42.8%) in all five journals, with New York City the most prominent city. A total of  63.7% of the authorship originated from large metropolitan areas (estimated as population greater than 500,000 residents), and the most common degrees obtained by authors were MD and PhD. CONCLUSION: The prominent Cardiothoracic authorship is predominantly located in Western countries, most commonly large metropolitan centers in the United States. This raises questions as to whether the literature adequately reflects populations in other geographical areas such as the continents of South America and Africa and rural settings. Leading journals should consider policies which encourage publication by authors from geographical locations that are underrepresented globally.

Test-Retest Reliability, Training, and Detraining Effects Associated With the Dynavision D2™ Mode A Visuomotor Reaction Time Test.

CONTEXT: The Dynavision D2™ Mode A test (ModeA) is a 1-minute reaction time (RT) test commonly used in sports science research and clinical rehabilitation. However, there is limited data regarding the effect of repeated testing (ie, training) or subsequent periods of no testing (ie, detraining) on test-retest reliability and RT performance. Therefore, the purpose of this study was to examine the test-retest reliability, training, and detraining effects associated with the D2™ ModeA test. DESIGN: Repeated measures/reliability. METHODS: Twenty-four recreationally active men and women completed 15 training sessions consisting of 2 ModeA tests per session (30 tests). The participants were then randomized to either 1 or 2 weeks of detraining prior to completing 15 retraining sessions (30 tests). The training and retraining periods were separated into 10 blocks for analysis (3 tests per block). The number of hits (hits) and the average RT per hit (AvgRT) within each block were used to determine RT performance. Intraclass correlation coefficients, SEM, and minimum difference were used to determine reliability. Repeated-measures analysis of variance/analysis of covariance were used to determine training and detraining effects, respectively. RESULTS: The ModeA variables demonstrated excellent test-retest reliability (intraclass correlation coefficient2,3 > .93). Significant improvements in hits and AvgRT were noted within training blocks 1 to 5 (P < .05). No further improvements in RT performance were noted between training blocks 6 through 10. There was no effect of detraining period on RT. The RT performance was not different between blocks during retraining. CONCLUSIONS: It appears that 15 tests are necessary to overcome the training effect and establish reliable baseline performance for the ModeA test. Detraining for 1 to 2 weeks did not impact RT performance. The authors recommend that investigators and clinicians utilize the average of 3 tests when assessing RT performance using the D2 ModeA test.

Influence of muscle depth and thickness on ultrasound echo intensity of the vastus lateralis.

BACKGROUND: Ultrasonography is used to evaluate muscle quality (i.e. echo intensity [EI]), but an attenuation of ultrasound waves occurs in deeper tissues, potentially affecting these measures. PURPOSE: To determine whether muscle thickness (MT) affects EI and if EI varies between the superficial and deep portions of the muscle. MATERIALS AND METHODS: MT, EI, subcutaneous adipose tissue thickness (SAT), tissue depth (DISDEEP), and EI of the overall (EIFULL) as well as deep (EIDEEP) and superficial (EISUPF) portions of the vastus lateralis (VL) were assessed in 33 resistance-trained males using ultrasonography. The difference (EIDIFF) between EISUPF and EIDEEP was calculated. Mean differences between EIFULL, EISUPF, and EIDEEP were analyzed using a repeated-measures analysis of variance (ANOVA). Relationships between measures of muscle depth/ thickness and EI were examined using Pearson's r. RESULTS: EISUPF was greater than EIDEEP (P < 0.001) and EIFULL (P < 0.001). MT was negatively correlated with EIFULL (P < 0.001) and positively correlated with EIDIFF (P < 0.001). SAT was not correlated with any EI measure, but DISDEEP was positively correlated with EIDIFF (P < 0.001). CONCLUSION: EI of the VL is heterogeneous, as the deeper portion produces lower values than the superficial portion. Thicker muscles present lower EI but have greater discrepancies in EI between the superficial and deep portions. Although SAT was not correlated with EI, DISDEEP was related to EIDIFF, demonstrating that the combination of MT and SAT should be considered when evaluating muscle quality. Future research is necessary to determine if changes in EI following resistance training are driven by increases in MT.

The therapeutic efficacy of adjunct therapeutic plasma exchange for septic shock with multiple organ failure: a single-center experience.

BACKGROUND: Sepsis remains a common condition with high mortality when multiple organ failure develops. The evidence for therapeutic plasma exchange (TPE) in this setting is promising but inconclusive. Our study aims to evaluate the efficacy of adjunct TPE for septic shock with multiple organ failure compared to standard therapy alone. METHODS: A retrospective, observational chart review was performed, evaluating outcomes of patients with catecholamine-resistant septic shock and multiple organ failure in intensive care units at a tertiary care hospital in Winston-Salem, NC, from August 2015 to March 2019. Adult patients with catecholamine-resistant septic shock (≥ 2 vasopressors) and evidence of multiple organ failure were included. Patients who received adjunct TPE were identified and compared to patients who received standard care alone. A propensity score using age, gender, chronic co-morbidities (HTN, DM, CKD, COPD), APACHE II score, SOFA score, lactate level, and number of vasopressors was used to match patients, resulting in 40 patients in each arm. RESULTS: The mean baseline APACHE II and SOFA scores were 32.5 and 14.3 in TPE patients versus 32.7 and 13.8 in control patients, respectively. The 28-day mortality rate was 40% in the TPE group versus 65% in the standard care group (p = 0.043). Improvements in baseline SOFA scores at 48 h were greater in the TPE group compared to standard care alone (p = 0.001), and patients receiving adjunct TPE had a more favorable fluid balance at 48 h (p = 0.01). Patients receiving adjunct TPE had longer ICU and hospital lengths of stay (p = 0.003 and p = 0.006, respectively). CONCLUSIONS: Our retrospective, observational study in adult patients with septic shock and multiple organ failure demonstrated improved 28-day survival with adjunct TPE compared to standard care alone. Hemodynamics, organ dysfunction, and fluid balance all improved with adjunct TPE, while lengths of stay were increased in survivors. The study design does not allow for a generalized statement of support for TPE in all cases of sepsis with multiple organ failure but offers valuable information for a prospective, randomized clinical trial.

Dynamic post-activation potentiation protocol improves rowing performance in experienced female rowers.

Post-activation potentiation likely acutely improves power-based performance; however, few studies have demonstrated improved endurance performance. Forty collegiate female rowers performed isometric potentiating (ISO), dynamic potentiating (DYN) and control (CON) warm-up protocols on a rowing ergometer, followed by a three-minute all-out test to evaluate their total distance, peak power, mean power, critical power, anaerobic working capacity (W') and stroke rate. Fifteen-second splits were also analysed. ISO consisted of 5 × 5-second static muscle actions with the ergometer handle rendered immovable with a nylon strap, while DYN consisted of 2 × 10-second all-out rowing bouts, separated by a 2-minute rest interval. The participants were divided into high and low experience groups by median experience level (3.75 years) for statistical analysis. Significant differences (DYN > CON; p < 0.05) were found for distance (+5.6 m), mean power (+5.9 W) and W' (+1561.6 J) for more experienced rowers (n = 19) and no differences for less experienced rowers (n = 18). Mean power in DYN was significantly greater than CON and ISO in the 15-30, 30-45, 45-60 and 60-75 second intervals independent of experience level. These results suggest that DYN may benefit experienced female rowers and that these strategies might benefit a greater power output over shorter distances regardless of experience.

Single procedure revision cranioplasty with intra-operative autoclave following titanium plate exposure.

Background: Patients with titanium cranioplasties can develop skin defects and plate exposure requiring revision surgery to prevent infection. The management of these patients has historically been staged surgery to remove the exposed plate followed by re-implantation of a sterile plate at a later date.Objectives: We describe an alternative where the exposed plate is removed, sterilised by autoclaving and re-implanted, in one operation.Methods: Patients with exposed titanium cranioplasties who underwent single-stage revisions were identified over a 30-month period. All patients received antibiotics post-procedure and were followed up.Results: Between June 2015 and December 2017 four patients had five single-stage revision cranioplasties with intraoperative autoclave sterilisation (SSRC). The mean time from initial procedure to revision was 5.6years. The mean time from plate exposure to surgery was 7 days. Plate exposure recurred in 60% (3/5) of cases post-SSRC. Two of these had the plate removed. The other had a second SSRC. On average recurrent plate exposure developed 17 months after SSRC. The 2 cases who had the plate removed remained complication-free to last follow up at 25 and 52 months after SSRC.Conclusions: Single procedure revision cranioplasty with intra-operative autoclave following titanium plate exposure may be considered as an option in patients with plate exposure who do not have other evidence on infection but we found recurrent plate exposure occurred in 50%.

Effect of Heat Stress on Measures of Running Performance and Heart Rate Responses During a Competitive Season in Male Soccer Players.

Coker, NA, Wells, AJ, and Gepner, Y. The effect of heat stress on measures of running performance and heart rate responses during a competitive season in male soccer players. J Strength Cond Res 34(4): 1141-1149, 2020-Measures of running performance and heart rate (HR) responses to match play during 3 different heat stress (HS) conditions were assessed in 7 National Collegiate Athletic Association (NCAA) Division I male soccer players. Total distance and distance covered within distinct velocity zones (walking [WALK], jogging [JOG], low-speed running, high-speed running, sprinting [SPRINT], low-intensity running [LIR], and high-intensity running [HIR]) were assessed using global positioning system units for more than 12 matches. Heat stress was monitored during each match, and matches were defined as low (HSlow, n = 4), moderate (HSmod, n = 4), or high (HShigh, n = 4) HS. Minutes played were significantly different across HS conditions (p = 0.03). Therefore, distance covered within each movement velocity was assessed relative to minutes played and as a percentage of total playing time. WALKrel was significantly greater during HShigh compared with HSlow (p = 0.035). LIRrel was significantly greater during HSmod (p = 0.015) compared with HSlow. A trend was observed for %WALK being higher during HShigh compared with HSlow (p = 0.066). %LIR was significantly greater during HShigh compared with HSlow (p = 0.048). High-intensity running was not significantly different across HS conditions. Percent of time spent >85% HRmax was significantly greater during HShigh (p = 0.002) and HSmod (p < 0.001) compared to HSlow. Percent of time spent between 65-84% HRmax was significantly greater during HSlow compared to HShigh (p < 0.001). Results indicate that HS resulted in increased LIR and %HR≥85, while HIR was maintained. High-intensity running performance may be conserved through decreased playing time or the adoption of pacing strategies. This may assist coaches in altering player management strategies to optimize team performance.

Effect of ß-Alanine Supplementation on Monocyte Recruitment and Cognition During a 24-Hour Simulated Military Operation.

Wells, AJ, Varanoske, AN, Coker, NA, Kozlowski, GJ, Frosti, CL, Boffey, D, Harat, I, Jahani, S, Gepner, Y, and Hoffman, JR. Effect of ß-alanine supplementation on monocyte recruitment and cognition during a 24-hour simulated military operation. J Strength Cond Res 34(11): 3042-3054, 2020-Sustained military operations (SUSOPs) result in psychological stress and cognitive dysfunction, which may be related to the recruitment of classical monocytes into the brain. This study examined the effect of beta-alanine (BA) on cognition and monocyte recruitment during a simulated 24-hour SUSOP. Nineteen healthy men ingested 12-g/d BA or placebo for 14 days before an SUSOP. Monocyte chemoattractant protein-1 (MCP-1), C-C chemokine receptor-2 (CCR2), and macrophage-1-antigen (CD11b) expression were assessed through multiplex assay and flow cytometry. Psychological stress and cognition were assessed through Automated Neuropsychological Assessment Metrics (ANAM). A composite measure of cognition (COGcomp) was generated from throughput scores extracted from 7 ANAM cognitive tests. Assessments occurred at baseline (0H), 12 hours (12H), 18 hours (18H), and 24 hours (24H). Significance was accepted at p ≤ 0.05. No significant effect of BA was noted for any variable (p's > 0.05). The frequency and severity of symptoms of psychological stress increased significantly at 18 and 24H compared with 0 and 12H (p's < 0.05). COGcomp decreased significantly at 18 and 24H compared with 0 and 12H (p's ≤ 0.001). MCP-1 peaked at 18H was significantly lower at 24H compared with 18H but remained elevated at 24H compared with 0H (p's < 0.001). CCR2 expression was significantly lower at 12 (p = 0.031), 18, and 24H (p's < 0.001). CD11b expression was significantly higher at 12H (p = 0.039) and 24H (p's = 0.003). MCP-1 was negatively associated with COGcomp (ß = -0.395, p = 0.002, r2 = 0.174). Neither CCR2 or CD11b was related to COGcomp (p's > 0.05). Cognitive dysfunction during SUSOPs is related to serum concentrations of MCP-1 but is not influenced by BA supplementation.

A case series of early and late cranioplasty-comparison of surgical outcomes.

BACKGROUND: Cranioplasty is an increasingly common procedure performed in neurosurgical centres following a decompressive craniectomy (DC), however, timing of the procedure varies greatly. OBJECTIVES: The aim of this study is to compare the surgical outcomes of an early compared to a late cranioplasty procedure. METHODS: Ninety adult patients who underwent a prosthetic cranioplasty between 2014 and 2017 were studied retrospectively. Timing of operation, perioperative complications and length of stay were assessed. Early and late cranioplasties were defined as less or more than 3 months since craniectomy respectively. RESULTS: Of the 90 patients, 73% received a late cranioplasty and 27% received an early cranioplasty. The median interval between craniectomy and cranioplasty was 13 months [range 3-84] in late group versus 54 days [range 33-90] in early group. Twenty-two patients in the early group (91%) received a cranioplasty during the original admission while undergoing rehabilitation. Complications were seen in 25 patients (28%). These included wound or cranioplasty infection, hydrocephalus, symptomatic pneumocephalus, post-operative haematoma and cosmetic issues. The complication rate was 21% in the early group and 30% in the late group (P value 0.46). There was no significant difference in the rate of infection or hydrocephalus between the two groups. Length of stay was not significantly increased in patients who received an early cranioplasty during their initial admission (median length of stay 77 days versus 63 days, P value 0.28). CONCLUSION: We have demonstrated the potential for early cranioplasty to be a safe and viable option, when compared to delayed cranioplasty.

Consensus statement from the International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury : Consensus statement.

BACKGROUND: Two randomised trials assessing the effectiveness of decompressive craniectomy (DC) following traumatic brain injury (TBI) were published in recent years: DECRA in 2011 and RESCUEicp in 2016. As the results have generated debate amongst clinicians and researchers working in the field of TBI worldwide, it was felt necessary to provide general guidance on the use of DC following TBI and identify areas of ongoing uncertainty via a consensus-based approach. METHODS: The International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury took place in Cambridge, UK, on the 28th and 29th September 2017. The meeting was jointly organised by the World Federation of Neurosurgical Societies (WFNS), AO/Global Neuro and the NIHR Global Health Research Group on Neurotrauma. Discussions and voting were organised around six pre-specified themes: (1) primary DC for mass lesions, (2) secondary DC for intracranial hypertension, (3) peri-operative care, (4) surgical technique, (5) cranial reconstruction and (6) DC in low- and middle-income countries. RESULTS: The invited participants discussed existing published evidence and proposed consensus statements. Statements required an agreement threshold of more than 70% by blinded voting for approval. CONCLUSIONS: In this manuscript, we present the final consensus-based recommendations. We have also identified areas of uncertainty, where further research is required, including the role of primary DC, the role of hinge craniotomy and the optimal timing and material for skull reconstruction.

Alpha-1 Antitrypsin Replacement in Patients With COPD.

Chronic obstructive pulmonary disease can be attributed to genetic conditions and predispositions, among other factors. Alpha-1 antitrypsin deficiency (AATD) is a significant risk factor for COPD development and progression, and aggressive screening for all patients with COPD or adult-onset asthma is encouraged.

Navigating snowscapes: scale-dependent responses of mountain sheep to snowpack properties.

Winters are limiting for many terrestrial animals due to energy deficits brought on by resource scarcity and the increased metabolic costs of thermoregulation and traveling through snow. A better understanding of how animals respond to snow conditions is needed to predict the impacts of climate change on wildlife. We compared the performance of remotely sensed and modeled snow products as predictors of winter movements at multiple spatial and temporal scales using a data set of 20,544 locations from 30 GPS-collared Dall sheep (Ovis dalli dalli) in Lake Clark National Park and Preserve, Alaska, USA from 2005 to 2008. We used daily 500-m MODIS normalized difference snow index (NDSI), and multi-resolution snow depth and density outputs from a snowpack evolution model (SnowModel), as covariates in step selection functions. We predicted that modeled snow depth would perform best across all scales of selection due to more informative spatiotemporal variation and relevance to animal movement. Our results indicated that adding any of the evaluated snow metrics substantially improved model performance and helped characterize winter Dall sheep movements. As expected, SnowModel-simulated snow depth outperformed NDSI at fine-to-moderate scales of selection (step scales < 112 h). At the finest scale, Dall sheep selected for snow depths below mean chest height (<54 cm) when in low-density snows (100 kg/m3 ), which may have facilitated access to ground forage and reduced energy expenditure while traveling. However, sheep selected for higher snow densities (>300 kg/m3 ) at snow depths above chest height, which likely further reduced energy expenditure by limiting hoof penetration in deeper snows. At moderate-to-coarse scales (112-896 h step scales), however, NDSI was the best-performing snow covariate. Thus, the use of publicly available, remotely sensed, snow cover products can substantially improve models of animal movement, particularly in cases where movement distances exceed the MODIS 500-m grid threshold. However, remote sensing products may require substantial data thinning due to cloud cover, potentially limiting its power in cases where complex models are necessary. Snowpack evolution models such as SnowModel offer users increased flexibility at the expense of added complexity, but can provide critical insights into fine-scale responses to rapidly changing snow properties.

Foix-Chavany-Marie syndrome secondary to bilateral traumatic operculum injury.

This report describes a case of a 62-year-old man who developed Foix-Chavany-Marie syndrome subsequent to traumatic brain injury. The initial presentation of the syndrome was profound loss of voluntary control of orofacial muscles, causing a loss of speech and impairment of swallow. Over subsequent months, a remarkable recovery of these functions was observed. The natural history of FCMS in this case was favourable, with good improvement in function over months. Furthermore, the pattern of bilateral opercular injury was more readily recognised on MRI than on CT, supporting the role of MRI in cases of traumatic brain injury.