Are severity and location of facial trauma risk factors for cervical spine injuries? 10-year analysis based on the use of the AO spine injury classification and the comprehensive facial injury (CFI) score.

PURPOSE: This study aims to demonstrate a correlation between cervical spine injury and location and severity of facial trauma. METHODS: We did a 10-year retrospective analysis of prospectively collected patients with at least one facial and/or cervical spine injury. We classified facial injuries using the Comprehensive Facial Injury (CFI) score, and stratified patients into mild (CFI < 4), moderate (4 ≤ CFI < 10) and severe facial trauma (CFI ≥ 10). The primary outcome was to recognize the severity and topography of the facial trauma which predict the probability of associated cervical spine injuries. RESULTS: We included 1197 patients: 78% with facial injuries, 16% with spine injuries and 6% with both. According to the CFI score, 48% of patients sustained a mild facial trauma, 35% a moderate one and 17% a severe one. The midface was involved in 45% of cases, then the upper facial third (13%) and the lower one (10%). The multivariate analysis showed multiple independent risk factors for associated facial and cervical spine injuries, among them an injury of the middle facial third (OR 1.11 p 0.004) and the facial trauma severity, having every increasing point of CFI score a 6% increasing risk (OR 1.06 p 0.004). CONCLUSIONS: Facial trauma is a risk factor for a concomitant cervical spine injury. Among multiple risk factors, severe midfacial trauma is an important red flag. The stratification of facial injuries based on the CFI score through CT-scan images could be a turning point in the management of patients at risk for cervical spine injuries before imaging is available.

Pressure induced modification of the electronic properties of stilbene by two-photon spectroscopy.

Carbon nanothreads are the most exciting carbon based nanomaterials recently discovered. Obtained by compressing aromatics around 20 GPa, they are characterized by potentially exceptional mechanical properties. The reaction mechanisms have been partly elucidated through computational studies and x-ray diffraction experiments. However, in all these studies, the electronic modifications to which the molecule is subjected with increasing pressure are neglected as also if, and to which extent, the electronic excited states are involved in the high-pressure reactivity. In fact, the pressure increase induces remarkable changes in the electronic properties of molecular crystals, which are often directly related to the reaction's onset and path. We report the pressure evolution of the two-photon induced emission spectrum of crystalline stilbene, the archetype of a class of molecules from which double-core nanothreads are obtained, with the twofold purpose of gaining insight into the reaction mechanism and monitoring if the structural changes observed in x-ray diffraction studies have a detectable counterpart in the electronic properties of the system. The freezing of the spectral diffusion observed on rising pressure is ascribed to a hampered conformational rearrangement because of the larger stiffness of the local environment. The transition to the high pressure phase where the nanothreads form is revealed by the slope change of the pressure shift of all spectral components, while the progressive intensification with pressure of the 0-0 transition suggests a strengthening of the ethylenic bond favoring the charge delocalization on the benzene moieties, which is likely the trigger of the chemical instability.

High pressure behavior of ethylene and water: From clathrate hydrate to polymerization in solid ice mixtures.

Among the ice mixtures that can be found in our universe, those involving ethylene are poorly studied even though ethylene reportedly exists in the presence of water in several astrochemical domains. Here, we report on the chemistry of ethylene and water mixtures in both pressure (0-15 GPa) and temperature (300-370 K) ranges relevant to celestial bodies conditions. The behavior of the binary mixture has been tracked, starting from the ethylene clathrate hydrate and following its evolution through two different crystalline phases up to 2.10 GPa, where it decomposes into a solid mixture of water ice and crystalline ethylene. The pressure and temperature evolution of this mixture has been studied up to the complete transformation of ethylene into polyethylene and compared with that of the pure hydrocarbon, reporting here for the first time its spectroscopic features upon compression. The spectroscopic analysis of the recovered polymers from the ice mixtures provided hints about the reactivity of the monomer under the environmental stress exerted by the water network. The results of this study are expected to be significant in a variety of fields ranging from astrochemistry to material science and also to fundamental chemistry, particularly regarding the study and modelization of the behavior of complex mixtures.

Sequence-complementarity dependent co-assembly of phosphodiester-linked aromatic donor-acceptor trimers.

We have created sequenced phosphoester-linked trimers of aromatic donor/acceptors which participate in charge-transfer interactions. Each sequence displays characteristic self-assembly, and complementary sequences interact with each other to produce new nanostructures and thermochromism. This paves the way towards new functional nanomaterials which make bio-analogous use of sequence to tune structure.

Measured turbulent mixing in a small-scale circuit breaker model.

The performance of high voltage gas circuit breakers depends on the temperature distribution of hot gas or plasma from the arc zone mixed with cold gas that is present, for example, in the exhausts and mixing volume. Understanding the details of the mixing process is imperative to estimate the temperature distribution within the entire breaker volume. Design studies rely on computational fluid dynamics (CFD) simulations to search for the best way to achieve satisfactory mixing. One key uncertainty in the CFD simulations is the role of turbulence in this process and how to properly account for it. To gain knowledge of the mixing process between hot and cold gases, we have constructed a simplified breaker geometry that is flexible and accessible to diagnostics. Apart from standard measurements of current and arc voltage, we measure pressure in the arc zone and the mixing volume. Further, the mixing volume is specially designed to be transparent, allowing us to make shadowgraphy measurements of the turbulent mixing during and after the arcing phase. We report on experiments performed in air at atmospheric pressure.

Shock attenuation characteristics of three different military boots during gait.

Musculoskeletal injuries are related to the cushioning properties of boots in military populations. This study aimed to compare ground reaction force (GRF) and subjective perceived comfort from two different military boots supplied by the Brazilian Army with a commercial boot. Twenty army recruits volunteered for a GRF assessment during walking on a 10-m walkway and a perceived comfort test after 20min walking on a treadmill. Both experiments were conducted with three different military boots: CC10 (styrene-butadiene rubber - SBR - midsole 30mm thickness, 65 Shore A; 631.8g weight; supplied by the Brazilian Army); CC13 (SBR midsole 20.6mm thickness, 66 Shore A; 530.3g weight; supplied by the Brazilian Army) and CAT (polyurethane - PU - midsole 31.7mm thickness, 55 Shore A; 423g weight; commercially available). GRF was analyzed in the time (principal component analysis - PCA) and frequency (Blackman-Tukey) domains. No difference was found for the first and second peak forces or loading rate; however, significant influence from the military boots' design on GRF was found by PCA and frequency analysis. Loading factor presented higher values at early stance with lower force for CC10 compared to CC13 at these epochs. CC13 also presented higher power spectral density compared to CC10 at higher frequency bands. However, CAT was significantly more comfortable than CC10. These results suggest that the thicker SBR midsole boot was more effective in reducing impact, while the lightest boot with softer midsole hardness made with PU was the most comfortable.

Absence of gene mutations in a case of concomitant presence of carcinoid of the ampulla of vater pheochromocytoma and Von Recklinghausen disease.

The rare association between Von Recklin-ghausen's disease (VRD) and tumours other than in central nervous system is well recognized. However, the concomitance of VRD, a carcinoid of the ampulla of Vater, and a pheochromocytoma has been described very rarely in literature. Furthermore, the possible role of the genes usually involved in multiple endocrine neoplasia (MEN) syndromes, in this association, is unclear. We report the case of a patient affected by VRD and extra-adrenal pheochromocytoma, operated on in the past for a carcinoid of the ampulla of Vater. To determine if genes involved in MEN syndromes might play a role in this particular triad, we investigated the presence of somatic or germline mutations in the RET proto-oncogene and menin gene by non isotopic polymerase chain reaction single stranded conformation polymorphism (PCR-SSCP) and heteroduplex gel electro-phoresis. The results demonstrated that no somatic or germline mutations in the MEN-1 and MEN-2 genes were involved in the pathogenesis of these tumours.

Investigation and management of primary cardiac tumors in infants and children.

Seven children with primary cardiac tumors are discussed. The diagnosis was achieved by cardiac catheterization in all seven patients. In four patients, surgical excision was undertaken with one long-term good result. One of the other three surgical patients died of acute heart failure at the discontinuation of cardiopulmonary bypass. One of the other two surgical patients died suddenly late postoperatively, presumably from arrhythmia. The other, affected by fibrosarcoma, also died suddenly while undergoing chemotherapy. The histologic findings on the tumor masses were available in six patients. There were three rhabdomyomas, one fibrosarcoma, one fibroma and one hamartomatous mass. In one patient with tuberous sclerosis, a presumptive diagnosis of rhabdomyoma was made clinically on the basis of multiple masses infiltrating the left ventricle. Two-dimensional echocardiography is the best noninvasive tool to determine the extent and location of the tumor and suitability for surgery. When surgery is indicated, cardiac catheterization for pressure data is also required. Surgery is recommended in symptomatic solitary lesions that most likely are fibromas and have an overall good surgical outcome.

Relationship between pedal force asymmetry and performance in cycling time trial.

AIM: It remains unclear if cyclists with better performance have less asymmetry. Therefore, this study aimed at assessing the relationship between cycling time trial performance and bilateral asymmetries in pedal forces. METHODS: Ten cyclists/triathletes performed an incremental cycling test to exhaustion to measure maximal oxygen uptake and power output. In a second session, bilateral pedal forces were acquired during a 4-km cycling time trial on the stationary cycle ergometer. Resultant and effective forces were computed along with the index of effectiveness at 500 m sections of the time trial using instrumented pedals. Intra-limb variability and the asymmetry index were calculated for each force variable. RESULTS: Multivariate analysis assessed bilateral differences in pedal forces accounting for power output, pedalling cadence and oxygen uptake of each cyclist. Force variables did not change throughout the test (effective - P=0.98, resultant - P=0.90 and index of effectiveness - P=0.99) with larger force applied by the dominant limb (11-21%). The relationship between asymmetries and performances was strong for the effective force (r=-0.72) but weak for the resultant force (r = 0.01) and for the index of effectiveness (r=-0.29). Substantial asymmetries were observed for the effective force (36-54%), resultant force (11-21%) and for the index of effectiveness (21-32%) at greater range than intra-limb variability (effective force =8-22%, resultant force =5-10% and index of effectiveness =1-3%). CONCLUSION: Larger asymmetries in effective force were related to better performances during the 4-km time trial with low intra-limb variability for force measures suggesting consistence in asymmetries for individual cyclists.

Usefulness of transesophageal echocardiography in the pediatric catheterization laboratory.

Transesophageal echocardiography was performed in 51 children (aged 2 to 14 years, mean 4; weight 9 to 50 kg, mean 21) undergoing elective diagnostic or therapeutic cardiac catheterization. The interventional procedures were percutaneous balloon dilation of pulmonary (n = 8) and aortic (n = 2) valve stenosis, percutaneous closure of patent ductus arteriosus (n = 8), and attempted occlusion of Pott's anastomosis by the double umbrella device (n = 1). The diagnostic catheterizations were performed on preoperative children of whom 5 had undergone previous palliative procedures. Precise placement of the balloon across the valve, timing of balloon inflation and deflation according to real-time monitoring of ventricular function and immediate evaluation of results and complications were accomplished with transesophageal monitoring. The exact position of distal and proximal umbrellas of patent ductus occlusive devices was checked on transesophageal imaging and completeness of occlusion controlled on color Doppler. The only relevant information in the preoperative cases was the detection of a septic thrombus in a severely ill patient. With more experience and smaller probes, transesophageal echocardiography may become a new method of monitoring cardiac catheterization also in smaller children where it may reduce duration of the procedure and amount of contrast material.

Congenital pulmonary vein stenosis.

Congenital pulmonary vein stenosis is a rare and serious form of congenital heart disease. Between 1969 and 1982 10 patients with this lesion were studied. In 2 patients the condition was diagnosed at autopsy; these patients died before the presence of congenital heart disease was suspected. Of the 8 in whom the condition was diagnosed during life, it was suspected clinically in 6 and found unexpectedly at cardiac catheterization in 2. All underwent operation, and 5 were hospital survivors. In all survivors rapid and progressive restenosis of the pulmonary veins occurred over the next several months. Three of the 5 underwent reoperation, but progressive restenosis recurred and all eventually died of this condition. Thus, despite partial surgical relief of pulmonary vein stenosis, the lesion is apparently one of relentless progression. No surgical repair has been successful in the cure or long-term palliation of this lethal lesion.

Tetralogy of Fallot with atrioventricular canal. An angiographic study.

Tetralogy of Fallot associated with atrioventricular (AV) canal is a well-recognized cardiac malformation; its surgical repair carries a high mortality, which is related partly to the complexity of the defect and partly to incomplete diagnosis. Hence an accurate preoperative diagnosis is essential. This communication describes the angiographic features observed in 17 patients with tetralogy of Fallot and AV canal with emphasis on the morphology of the right AV valve as seen during the right ventriculogram. A complete anatomic diagnosis can be consistently made from right and left ventriculograms performed in axial projections.

Tricuspid atresia with double-outlet left atrium.

Clinical and pathologic findings of an unusual case of cardiac malformation are presented. The main features were those of atresia of the right atrioventricular valve associated with two distinct atrioventricular orifices connecting the morphologically left atrium to the underlying morphologically left ventricle. Other distinguishing characteristics were ostium secundum atrial septal defect, normally related great arteries, with the aorta arising from the main ventricular chamber and the pulmonary artery from the anterior and right-sided outlet chamber, and infundibular and valvular pulmonary atresia.

Repair of congenital pulmonary venous stenosis with living autologous atrial tissue.

Repair of localized bilateral congenital pulmonary venous stenosis with living autologous atrial tissue was accomplished in two patients, 3 and 4 months of age. The tip of the left atrial appendage was opened and used as an onlay patch to widen the stenotic area of the left pulmonary veins, leaving a double pathway for venous return. A flap of interatrial septum was evaginated through an incision in the right side of the left atrium and used as an onlay patch to widen the stenotic area of the right pulmonary veins. Effective relief of obstruction was demonstrated by nearly normal postrepair pulmonary artery pressure in each and early postoperative angiography in one. Although we believe this method of repair will increase the probability of a lasting result, further experience and subsequent late reevaluation are needed to demonstrate its long-term effectiveness.

Late left atrioventricular valve insufficiency after repair of partial atrioventricular septal defects: anatomical and surgical determinants.

Risk factors for late left atrioventricular (AV) valve insufficiency, which occurred in 16 (18%) of 90 patients evaluated after repair of partial AV septal defect, were examined. The operative findings in 9 patients undergoing reoperation were also examined. Preoperative left AV valve insufficiency was significantly more common in the group with late left AV valve incompetence, as were associated valvular malformations as a whole and fenestrations of valve leaflets in particular. Conversely, the higher incidence of malformed or malpositioned papillary muscles, accessory clefts, and double-orifice left AV valves in the group with late left AV valve insufficiency did not reach significance. The method of surgical treatment of the septal commissure was not a significant factor. In the group having reoperation, additional valvular malformations were found in association with inappropriate treatment of the septal commissure in 7 patients. The 2 remaining patients had either a directly sutured ostium primum or dilatation of the annulus. Three re-repairs were successful. Five patients required prosthetic valve replacement. Preoperative left AV valve insufficiency and associated valvular malformations are major determinants of late left AV valve insufficiency in partial AV septal defect.

Overriding atrioventricular valves. An angiographic-anatomical correlate.

An analysis of 6 patients with overriding atrioventricular valve was performed in order to correlate the anatomic and angiographic features of this malformation. The atrial arrangement was usual (situs solitus) in each patient. The ventricular chambers were normally related in 4 and the mirror image of normal in 2. The atrioventricular connexion was concordant in parallel fashion in 4, discordant in 1 and double inlet left ventricle in 1 heart. In 2 of 4 hearts with concordant atrioventricular connexion, the right atrioventricular valve (tricuspid) overrode the septum and connected partially to the left ventricle. In 2, the left atrioventricular valve (mitral) overrode the septum and partially connected with the right ventricle. One heart with discordant atrioventricular connexion had its right atrioventricular valve (mitral) overriding the septum. The remaining heart with double inlet left ventricle had an overriding left atrioventricular valve. Each overriding atrioventricular valve had its "septal" leaflet (the one committed to the contralateral ventricle) divided into 2 segments by a large cleft. Ventricular septal defects at different locations were present in all cases. The ventriculoarterial connexion was double outlet right ventricle in 5 patients and was discordant in 1. Malalignment of the atrial and ventricular septa was present to some degree in all cases. This was well depicted on ventriculograms in four chamber view in those with an overriding tricuspid valve. It was not detected in those with an overriding mitral valve. The displaced leaflets of the overriding and/or stradding valve had a vertical motion on cineangiograms similar to those observed in atrioventricular septal defects. Abnormal morphology and motion of the septal leaflet of the overriding atrioventricular valve and malalignment of the atrial and ventricular septal structures were the most important angiographic findings in this series.

Plasma levels of atrial natriuretic factor (ANF) and urinary excretion of ANF, arginine vasopressin and catecholamines in children with congenital heart disease: effect of cardiac surgery.

We studied the changes in the plasma concentration of atrial natriuretic factor (ANF) and the urinary excretion of ANF, arginine vasopressin (AVP) and catecholamines in 22 children with congenital heart disease, divided into two groups. Group 1 included 11 children with congestive heart failure (CHF), treated with digitalis and diuretics. Group 2 included 11 children without CHF and without medical treatment. Each group was compared with a control group of 15 healthy, age-matched children. The plasma concentration of ANF was raised in both groups, but it was significantly higher in group 1 (235.5 +/- 82.9 pg/ml), compared to group 2 (48.4 +/- 29.4 pg/ml, P < 0.002). Urinary excretion of ANF was measurable in both groups and higher in group 1 (185.9 +/- 116.2 pg/kg per h) than in group 2 (48.5 +/- 30.7 pg/kg per h), but not significantly so. Urinary excretion of AVP and catecholamines was not different in children with congenital heart disease and healthy children. Twenty-four hours after surgery, plasma ANF diminished in group 1 (from 235.5 +/- 82.9 to 93.4 +/- 53.8 pg/ml, P < 0.003), but did not change in group 2. The urinary excretion of ANF was unchanged in both groups. In contrast, urinary excretion of AVP and catecholamines rose significantly in both groups. These data show that plasma ANF is increased in children with congenital heart disease, even in the absence of CHF. The measurement of urinary ANF is less reliable than a plasma assay. The postoperative increases in AVP and catecholamine urinary excretions could be responsible for the vasoconstriction and water retention typical of the postoperative period.

Transfer of Chernobyl fallout radionuclides from feed to growing rabbits: cesium-137 balance.

Intake, excretion and retention of gamma-emitting radionuclides were assessed in male rabbits fed a radioactive pelleted diet (137Cs = 858 Bq kg-1 as fed) containing 40% dehydrated alfalfa meal contaminated by Chernobyl fallout. In order to evaluate radionuclide retention, an experiment was carried out on 33 animals as follows: nine rabbits were slaughtered at the beginning of the trial, six were fed a radioactive diet for 42 days, six a radioactive diet for 21 days, six a radioactive diet for 21 days and a normal diet (137Cs = 112 Bq kg-1 as fed) for the following 21 days and six a normal diet for 42 days. All the animals were housed in individual metabolism cages throughout the trial. All faeces and urine were collected and analyzed separately and live weight and feed intake were measured on a weekly basis. At the end of the trial all the animals were slaughtered and the activities of net body and muscles were determined. Cesium-137, 134Cs, 103Ru, 106Ru, 125Sb, 110mAg and 40K were measured by gamma spectroscopy. More than 85% of ingested cesium was excreted through faeces and urine (fecal much greater than urinary) and the retained 137Cs in the carcass of the more contaminated animals was only 3% of the total ingested. The concentration of total cesium in muscle reached a maximum value of 156 Bq kg-1, much lower than the EEC guideline (600 Bq kg-1), and the biological half-life for 137Cs was calculated to be 11 days. The feed-body accumulation factors were determined in net body and muscle.

Effect of age, diet and sex on muscle energy metabolism and on related physicochemical traits in the rabbit.

Muscle energy metabolism and related physicochemical traits of the meat were studied in 84 Provisal hybrid rabbits of both sexes. From weaning (30 days) to 55 days of age, the rabbits were divided into 4 groups which were given ad libitum one of the following diets: H diet with high digestible energy (DE) level, L diet with low DE level, F diet with high DE level, obtained by supplementing with animal fats, and W diet with moderate DE level. The H, L and F diet were suitable for lactating does and weaning rabbits; the W diet for weaned young rabbits. From 55 days to slaughter age, the rabbits were given a G diet suitable for growing and fattening. The rabbits were slaughtered at 55 days (23 rabbits), 80 days (31 rabbits) or 87 days (30 rabbits) of age. The activity of a representative enzyme of the glycolytic (fructose-1,6-diP aldolase) and oxidative (NADP-isocitrate dehydrogenase: ICDH) energy metabolism pathways and two related physicochemical traits, namely lightness (L (∗)) and ultimate pH (pH(u)), were determined in the biceps femoris (BF) and longissimus lumborum (LL) muscles. The chemical composition of whole longissimus dorsi (LD) and total hindleg (HL) muscles was also determined. In BF and LL muscles, the activity of the glycolytic energy metabolism increased during the fattening period, as a result of metabolic differentiation. The increase stopped earlier in BF than in LL muscle. Variations in pH(u) values followed the same trend. The dietary effect on biochemical and physicochemical traits was moderate. A slight decrease in muscle pH(u) was observed under the less energetic diets. Aldolase activity was significantly higher in females. The significant correlations between metabolic and physicochemical traits confirmed that as glycolytic energy metabolism increases, the protein content increases, whereas pH(u) decreases. Slaughter weight was positively correlated to glycolytic energy metabolism.

[Timely detection of premature closure of the ductus arteriosus in a full-term fetus. Important role of fetal echocardiography]. / Tempestivo riconoscimento della chiusura prematura del dotto di Botallo in feto a termine. Ruolo cruciale dell'ecocardiografia fetale.

Patency of the ductus arteriosus (DA) is maintained during gestation by locally produced and circulating prostaglandins (PGE's). As gestation proceeds, the ductus becomes less sensitive to dilating prostaglandins and more sensitive to constricting factors such as PGE's synthetase inhibitors. This case report describes a fetus at term (38 weeks) with signs of severe right ventricular failure due to constriction of DA. Maternal history documented 5 day assumption of a non-steroid antiinflammatory agent to relieve skeletal-muscle pain. Careful echocardiogram ruled out a structural heart disease, such as coarctation of the aorta. A gradient of 41 mmHg across the ductus was recorded. A cesarean section delivery was immediately undertaken. The 3.5 kg newborn delivered appeared to be in good health, with Apgar score of 8/9 at 1 and 5'. There were no signs of congestive heart failure and mild respiratory distress. An echocardiogram showed a dilated, well contractile right ventricle, with a pressure of 50 mmHg. DA was already closed. The fetal echocardiogram was the most relevant investigation in the decision-making process of this case treatment. Any different evaluation of this fetal heart, delaying the delivery would have very seriously compromised the survival of the fetus. Fetal echocardiography is the most important diagnostic tool in the evaluation of the fetal heart; non steroid antiinflammatory drugs to mother at term should be avoided or given with close echocardiographic assessment of DA patency.