Immediate sonography and intervention in blunt chest trauma: A case report.

Cardiac tamponade is a leading cause of death in blunt thoracic trauma. Ultrasound improved the recognition of cardiac tamponade and therefore has a vital role in acute critical situations in the Emergency Department and in the Intensive Care Unit. Besides recognition of cardiac tamponade, treatment protocols are important. In trauma patients with hemodynamic stable cardiac tamponade, time should be taken for a proper workup for an explorative sternotomy. In hemodynamic unstable trauma patients, the pericardium should be drained, and fluid resuscitation should be performed followed by emergency sternotomy. In this case report we describe a blunt thoracic trauma victim, a 28-year-old male patient without any medical history. He suffered from the unique combination of a tear in the left atrial appendage and a papillary muscle rupture of the right ventricle because of blunt thoracic trauma. Transthoracic echocardiography revealed massive pericardial effusion with diastolic collapse of the right ventricle in our patient. Due to his hemodynamic situation, the patient was brought into the OR for immediate sternotomy and cardiac repair. The patient made a full recovery, was discharged home, and is back to work. This case report emphasizes the relevance of early recognition and treatment of cardiac tamponade in blunt thoracic trauma victims and suggests a multidisciplinary management strategy.

Strong floristic distinctiveness across Neotropical successional forests.

Forests that regrow naturally on abandoned fields are important for restoring biodiversity and ecosystem services, but can they also preserve the distinct regional tree floras? Using the floristic composition of 1215 early successional forests (≤20 years) in 75 human-modified landscapes across the Neotropic realm, we identified 14 distinct floristic groups, with a between-group dissimilarity of 0.97. Floristic groups were associated with location, bioregions, soil pH, temperature seasonality, and water availability. Hence, there is large continental-scale variation in the species composition of early successional forests, which is mainly associated with biogeographic and environmental factors but not with human disturbance indicators. This floristic distinctiveness is partially driven by regionally restricted species belonging to widespread genera. Early secondary forests contribute therefore to restoring and conserving the distinctiveness of bioregions across the Neotropical realm, and forest restoration initiatives should use local species to assure that these distinct floras are maintained.

Home gardens' agrobiodiversity and owners' knowledge of their ecological, economic and socio-cultural multifunctionality: a case study in the lowlands of Tabasco, México.

BACKGROUND: Home gardens (HGs) are hotspots of in situ agrobiodiversity conservation. We conducted a case study in Tabasco, México, on HG owners' knowledge of HG ecological, economical and socio-cultural multifunctionality and how it relates to agrobiodiversity as measured by species richness and diversity. The term multifunctionality knowledge refers to owners' knowledge on how HGs contribute to ecological processes, family economy, as well as human relations and local culture. We hypothesized a positive correlation between owners' multifunctionality knowledge and their HGs' agrobiodiversity. METHODS: We inventoried all perennial species in 20 HGs, determined observed species richness, calculated Shannon diversity indexes and analysed species composition using non-metric multidimensional scaling (NMDS). Based on literature, semi-structured interviews and a dialogue of knowledge with HG owners, we catalogued the locally recognized functions in the ecological, economic and socio-cultural dimensions. We determined the score of knowledge on each function in the three dimensions on explicit scales based on the interviews and observed management. We determined Spearman rs correlations of HGs' observed species richness, Shannon diversity index (H) and of HGs' scores on NMDS-axis and multifunctionality knowledge scores. We dialogued on the results and implications for agrobiodiversity conservation at workshops of HG owners, researchers and local organizations. RESULTS: HG agrobiodiversity and owners' multifunctionality knowledge in the study area showed large variation. Average richness was 59.6 perennial species, varying from 21 to 107 species, and total observed richness was 280 species. A total of 38 functions was distinguished, with 14, 12 and 12 functions in the ecological, economic and socio-cultural dimensions. Total multifunctionality knowledge scores varied from 64.1 to 106.6, with an average of 87.2. Socio-cultural functionality knowledge scores were the highest, followed by scores in the ecological and economic dimensions. Species richness and Shannon H were significantly correlated with ecological functionality knowledge (rs = 0.68 and P < 0.001 in both cases), and species richness was also correlated with economic functionality knowledge (rs = 0.47, P = 0.03). Species composition scores on the first and second axes of NMDS was significantly correlated with knowledge of ecological multifunctionality, with rs = 0.49 resp-0.49 and P = 0.03 in both cases. Other functionality knowledge scores showed no correlation with NMDS scores. Dialogue in workshops confirmed the interwovenness of multifunctionality knowledge and agrobiodiversity. CONCLUSION: The rich agrobiodiversity of home gardens cherished by rural families in Tabasco relates with the knowledge about HG functionality in the ecological and economic dimensions. Also, species composition relates with ecological functionality knowledge. The socio-cultural functionality knowledge, which includes many elements beyond the individual HG, is not correlated with agrobiodiversity, but had the highest scores. Our results show that multifunctionality knowledge provides many opportunities for the participative conception and planning of policies and actions necessary to conserve agrobiodiversity.

Colorectal anastomotic leakage: a new experimental model.

BACKGROUND: Anastomotic leakage is the major complication after colorectal surgery. To date, animal experiments concerning colorectal anastomosis focus on anastomotic healing instead of anastomotic leakage. This study aims to develop a new experimental model for colorectal anastomotic leakage. METHODS: A control group, receiving an anastomosis with 12 interrupted sutures, was compared to a group receiving an anastomosis with 6 interrupted sutures. When the leakage rate was observed to be too low, the number of sutures was decreased stepwise, to 5 or less. Each group contained 9 "C57Bl6-mice". After 7 d the Anastomotic Bursting Pressure (ABP) was determined. RESULTS: In the first experiment, one mouse (11.1%) in the case group and none in the control group developed leakage. Average ABP was 152.2 mmHg in the control group and 138,8 mmHg in the case group (P=0.111). In the second experiment, case group receiving an anastomosis with 5 sutures, 4 mice (44.4%) in the case group developed leakage. This experiment was repeated twice resulting in leakage rates of 33.3% and 44.4%. The average overall ABP in the case group was 142.7 mmHg vs. 179.9 mmHg (P=0.022) in the control group. The mice without leakage showed a stabilization of average weight loss around day 2 and 3 and a decrease afterwards. The mice with leakage showed a decrease only after day 5. The difference in wellness-scores between the groups with- and without leakage was 2 points, increasing during follow-up. CONCLUSIONS: The model of anastomotic leakage caused by creating an anastomosis with 5 interrupted sutures is feasible. Weight loss and wellness-scores are good predictors of leakage.