The pattern of paediatric blast injury in Afghanistan.

INTRODUCTION: Between 2009 and 2015, 3746 children died, and 7904 were injured as a result of armed conflict within Afghanistan. Improvised explosive devices (IEDs) and explosive remnants of war accounted for 29% of child casualties in 2015. The aim of this study was to review the burden of paediatric blast injuries admitted to Camp Bastion, Afghanistan, and to investigate the hypothesis that children suffer proportionally more head injuries than adults. METHOD: A retrospective analysis was undertaken of prospectively collected data derived from the UK Joint Theatre Trauma Registry of ambulant paediatric (aged 2-15 years) admissions with blast injuries at the Role 3 Field Hospital, Camp Bastion from June 2006 to March 2013. The data set included demographic information, injury profile and severity (New Injury Severity Score) and operative findings. The pattern of injuries were investigated by looking at trends in the number and severity of injuries sustained by each body region. RESULTS: During this period, 295 admissions were identified, 76% of whom were male, with an overall mortality rate of 18.5%. The most common blast mechanism was an IED (68%) causing 80% of fatalities. The lower extremities were the most commonly injured body region, accounting for 31% of total injuries and occurring in 62% of cases. 24.3% of children between 2 and 7 years suffered severe head or neck injuries compared with 19.8% of children aged between 8 and 15 years. 34% of head injuries were rated unsurvivable and accounted for 88% of fatalities. 77% of cases required an operation with a mean operating time of 125 min. The most common first operations were debridement of soft tissues (50%), laparotomy (16%) and lower limb amputation (11%). CONCLUSION: Although paediatric blast casualties represented a small percentage of the overall workload at Camp Bastion Role 3 Medical Facility, the pattern of injuries seen suggests that children are more likely to sustain severe head, face and neck injuries than adults.

Anatomic-imaging correlations of lumbar disk-vertebral morphometric indices / Correlaciones anatomopatológicas de los índices morfométricos disco-vertebral lumbar

SUMMARY: This study represents a morphometric assessment of the anterior segment of the lumbar spine, focused on the vertebral body - intervertebral disk assembly, calculating some specific indicators and then completing direct morphometry data with the data resulting from the imaging interpretation and subsequently correlating the same to map an anatomic-imaging model. The study was carried out with anatomic items from personal archive and images obtained from Computer Tomography (CT) and Magnetic Resonance Imaging (MRI) assessment. The morphometric assessment was carried out for intervertebral disks, the disk height in the anterior and posterior sections and correlated with the disk angle degree. Direct morphometric data was compared and correlated with the data resulting from the imaging interpretation. Direct morphometric assessment was carried out for 11 vertebral blocks; the vertebral blocks were sectioned and turned into 22 vertebral semi-blocks allowing easy access to absolutely all dimensional values pursued, including the ones covered by the posterior arc. The assessment of imaging data was made with CT, CT 3D and MRI investigations from the 120 subjects in the study. The disk sizes were assessed by direct measurements on the anatomic items and directly measured by means of the software for modern imaging examination. In case of significant differences between the vertebral bodies, the calculation of disk sizes was made indirectly, on grounds of the geometric interpretation of the vertebral body face sizes. The vertebral body / intervertebral disk (IVD) assembly represents a dynamic structure, permanently subject to changes and adaptation, IVD being capable of incurring changes for the entire life time, including growth changes; the growth, however, is not lineal, but a succession of thickening and getting thinner, in full concordance with the structural stresses and changes occurring inside.

RESUMEN: El estudio representa una evaluación morfométrica del segmento anterior de la columna lumbar, centrado en el conjunto del cuerpo vertebral - disco intervertebral, calculando algunos indicadores específicos y completando los datos morfométricos directos. El objetivo del trabajo fue mapear un modelo de imagen anatómica con los datos de la interpretación de la imagen, posteriormente correlacionando los datos. El estudio se llevó a cabo con artículos anatómicos de archivos personales y de las imágenes obtenidas de tomografía computarizada (TC) y resonancia magnética (RM) de evaluación. La evaluación morfométrica se realizó en los discos intervertebrales, la altura del disco en las secciones anterior y posterior y se correlacionó con el grado del ángulo del disco. Se compararon los datos morfométricos directos y se correlacionaron con los datos resultantes de la interpretación de la imagen. Se realizó una evaluación morfométrica directa de 11 bloques vertebrales; Los bloques vertebrales se seccionaron y se convirtieron en 22 semibloques vertebrales permitiendo el fácil acceso a todos los valores dimensionales, incluyendo aquellos cubiertos por el arco posterior. La evaluación de los datos de imagen se realizó en 120 sujetos con CT, CT 3D y MRI. Los tamaños de los discos se evaluaron mediante medidas directas de los elementos anatómicos y se midieron con el software para la examinación de imágenes. En caso de diferencias significativas entre los cuerpos vertebrales, el cálculo de los tamaños de los discos se realizó indirectamente, debido a la interpretación geométrica de los tamaños de la cara del cuerpo vertebral. El conjunto cuerpo vertebral / disco intervertebral (CVDV) representa una estructura dinámica, permanentemente sujeta a transformaciones y adaptación, siendo (CVDV) capaz de incurrir en cambios durante toda la vida, incluyendo aquellos relacionados con crecimiento. El crecimiento, sin embargo, no es lineal, sino una sucesión de engrosamiento y adelgazamiento, en plena concordancia con las tensiones estructurales y los cambios que se producen en su interior.

Biperiodic nanostructured waveguides for wavelength-selectivity of hybrid photonic devices.

A biperiodic nanostructuration consisting of a super-periodicity added to a nanohole lattice of subwavelength pitch is demonstrated to provide both modal confinement and wavelength selectivity within a hybrid III-V on a silicon waveguide. The wavelength-selective behavior stems from finely tuned larger holes. Such biperiodic hybrid waveguides have been fabricated by oxide-free bonding III-V material on silicon and display well-defined stop bands. Such nanostructured waveguides offer the versatility for designing advanced optical functions within hybrid devices. Moreover, keeping the silicon waveguide surface planar, such nanostructured waveguides are compatible with electrical operation across the oxide-free hybrid interface.

The efficacy of the Peginterferon treatment in chronic hepatitis HDV and compensate liver cirrhosis.

AIM: To evaluate the efficiency of the treatment with Peginterferon alfa 2a 180 mcg/week, 48 weeks in patients with chronic hepatitis or compensated liver cirrhosis HDV and predictive factors of response to treatment. MATERIAL AND METHODS: Prospective study that enrolled 50 patients with chronic hepatitis or compensated cirrhosis HDV between the 1st of January 2011 - 3st of December 2011. The diagnosis of chronic HDV infection was made based on the presence of detectable anti HDV IgG antibodies and HDV-RNA. Patients were evaluated at baseline by CBC, liver function tests, HBV profile, HDV RNA, and by liver biopsy/Fibrotest for evaluating fibrosis and necroinflammatory activity. At 24 weeks CBC (count blood cells), liver function tests, quantitative HBsAg and at 48 and 72 weeks biochemical tests, HDV RNA, HBV DNA, quantitative HBsAg, were performed. Adverse reactions to the treatment were recorded. RESULTS: SVR (sustained virologic response) was recorded in 12 patients (24%) and biochemical response in 28 patients (56%). SVR was correlated with low-grade fibrosis, age, the aminotransferase value and the value of HBsAg at the beginning of the treatment. In week 48 HDV RNA was undetectable in 20 patients (40%). The therapy was well tolerated, except two patients for whom the discontinuation of the treatment was decided for severe exacerbation of cytolysis, respectively hepatic decompensation. CONCLUSIONS: In a representative group of patients, the treatment with Peginterferon once again proves its efficacy in treating chronic HDV.

In vitro toxicity evaluation of Ti(4+)-stabilized γ-Bi2O3 sillenites.

We report results regarding the in vitro toxicology of γ-Bi2O3 represented by its isomorphous phase Bi12TiO20 (γ-BTO). The γ-BTO microparticles were synthesized by two methods: coprecipitation from a bismuth nitrate-tetrabutyl titanate solution and solid state reaction of Bi2O3 and TiO2 oxides. The structural and morphological characteristics of the obtained materials were determined using X-ray diffraction (XRD), selected area electron diffraction (SAED), transmission (TEM) and scanning (SEM) electron microscopy. The elemental composition was investigated using energy dispersive spectrometry (EDS). The cytotoxicity and oxidative/nitrosative stress (intracellular reactive oxygen species (ROS) and nitric oxide (NO) release) induced by the studied microparticles in HepG2, SH-SY5Y and 3T3-L1 cell cultures were determined using the MTT, DCF-DA (2',7'-dichlorfluorescein-diacetate) and Griess methods respectively. Depending on the cell type and γ-BTO concentration, results showed only weak cytotoxic effects after 24h of γ-BTO exposure and cell proliferation effects for longer treatment times. Only reduced NO release increases (corresponding to high γ-BTO concentrations) were detected in case of SH-SY5Y and 3T3-L1 cells. The intracellular ROS production (higher for HepG2 cells) appeared inversely proportional to the γ-BTO concentration. The obtained results indicated a promising in vitro biocompatibility of γ-BTO and encourage further studies regarding its potential for biomedical applications.

TNFα inhibitor induced lupus-like syndrome (TAILS) in a patient with IBD.

BACKGROUND: In patients with autoimmune diseases like inflammatory bowel diseases there has been reported a drug-induced lupus like syndrome secondary to TNFα inhibitors. OBJECTIVE: clinical case presentation and literature review of patients who develop lupus-like syndrome in relation to TNFα antagonists and their future therapeutic options. MATERIALS AND METHODS: we report the case of a 27-year old woman with colonic Crohn's disease on combo-therapy (infliximab+azathioprine) for nearly two years who developed peripheral arthritis and malar rash in the context of TAILS. RESULTS: our patient had positive anti-nuclear antibody, arthritis, malar rash, anemia and leukopenia. Her symptomes remited after discontinuation of infliximab and subsequently she started adalimumab for her Crohn's colitis; more than a year after switching between TNFα inhibitor molecules and stopping azathioprine she is feeling very well. TAILS is a rare condition described in the literature that can affect 0.5-1% of individuals, more often in association with etanercept and infliximab. Several pathogenic routes have been incriminated in the apparition of this syndrome there is still no definite mechanism up to date. Management options include discontinuation of the drug, corticosteroids, hydroxycloroquine sulfate and switching for other immunosupressives. CONCLUSIONS: TAILS can appear even a long time after first exposure to TNFα antagonists. In our case, the association with azathioprine was not a primary prophylactic solution.

Lessons learned from the first 50 thyroidectomies with Harmonic Focus Curved Shears - technical note.

Precise and safe hemostasis is necessary for successful thyroid surgery. In this respect, the advent of the ultrasonic surgical device Harmonic Focus Curved Shears (HFCS) from Ethicon Endo-Surgery constituted a major progress in the domain by its multiple capabilities of dissection, grasping, vessel sealing and transecting. The paper presents the initial experience of 50 cases with this device of a surgical team with special interest in endocrine surgery, mostly thyroid and parathyroid. The thyroid conditions for which surgery was indicated were: diffuse toxic goiter in 8 patients; multinodular toxic and nontoxic goiter in 30 patients; autonomous nodule in 2 patients; 2 patients with benign nodules at fine needle aspiration biopsy (FNAB); 4 patients with nodules positive for carcinoma at FNAB, among them 2 with unilateral cervical lymph nodes enlargement; 4 patients with highly suspect nodule on FNAB. The types of surgery performed were 4 hemithyroidectomies and 46 total thyroidectomies, 2 in association with unilateral functional neck dissections. We had 4 intraoperative hemorrhagic incidents, all in the first 15 cases and imputable to lack of expertise and improper usage of the device. We registered the following noticeable postoperative complications: 1 cervical hematoma from an arteriolar source in sternothyroid muscle demanding prompt reintervention; 8 hypocalcemias and 2 vocal cord paresis, none of which permanent. We remarked several advantages with HFCS: no necessity of changing instruments, fluentness of the intervention and more comfort for the operating team, reduced operating time, safe hemostasis. Some important tips and tricks with the usage of the instrument are presented.

Hepatocellular carcinoma among cirrhotics--utility of screening and surveillance programs--review article.

Screening of known cirrhotics for hepatocellular cancer (HCC) has long been a contentious topic. Studies to date have failed to conclusively prove or disprove the validity of α-fetoprotein (AFP) and hepatic ultrasound as screening mechanisms for HCC among cirrhotics. It is not clear whether these screening mechanisms provide any benefit in terms of reduced morbidity and mortality. Screening for HCC among cirrhotics by using AFP and/or imaging at every 6 months correlate with HCC diagnosis, thus portending better treatment options and an improved prognosis. Screening all the known cirrhotics for HCC may lead to decreased mortality.

Structural properties of silver doped hydroxyapatite and their biocompatibility.

The aim of this study was to obtain a novel hydroxyapatite-based material with high biocompatibility. The structural properties of the samples were well characterized by X-ray diffraction (XRD), scanning electron microscopy (SEM) and X-ray Photoelectron Spectroscopy (XPS). The X-ray diffraction studies revealed the characteristic peaks of hydroxyapatite in each sample. Other phases or impurities were not observed. The scanning electron microscopy observations suggest that the doping components have no influence on the surface morphology of the samples, which reveals a homogeneous aspect of the synthesized particles for all samples. The presence of calcium (Ca), phosphor (P), oxygen (O) and silver (Ag) in the Ag:HAp is confirmed by energy dispersive X-ray (EDAX) and X-ray Photoelectron Spectroscopy analyses. Nanocrystalline silver doped HAp stimulated viability and potentiated the activation of murine macrophages.

The noncellular reduction of MTT tetrazolium salt by TiO2 nanoparticles and its implications for cytotoxicity assays.

We report results of noncellular tests, revealing the occurrence of photocatalytic interactions between titanium dioxide (TiO2, titania) nanoparticles and the MTT [3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium-bromide] cytotoxicity indicator. These interactions induce the reduction of MTT and formation of purple formazan under biologically relevant conditions. Classical MTT assays have been performed to evaluate the production of formazan in DMEM-F12 and RPMI-1640 cell culture media (containing 10% fetal bovine serum-FBS) treated with Degussa-P25 TiO2 nanoparticles, in the absence of cells. The colorimetric determinations revealed the noncellular MTT to formazan transformation induced by TiO2 nanoparticles, under conditions commonly used for in vitro cytotoxicity testing of nanomaterials. The formazan precipitation was found to be proportional to the TiO2 concentration, being enhanced under laboratory daylight exposure. The photocatalytic nature of the studied effect was assessed under UV irradiation at 365nm. The biological significance of the reported reaction was established with respect to cellular reference experiments performed on V79-4, HeLa and B16 cell lines. The results show false viability increases with up to 14% (for TiO2 concentrations generally higher than 50µg/ml), induced by the TiO2-MTT reaction. This type of artifacts may lead to underestimated toxicity or false proliferation results.

Endoscopic therapy with curative intent for neoplastic epithelial lesions: indications rewiew and the role of "water-jet" technology.

Neoplastic lesions of the gastrointestinal tract have a large prevalence worldwide and in Romania. Their therapy is tailored to their TNM stage, which can be estimated using non invasive or minimally invasive imaging studies. Precursor lesions and superficial carcinomas are amenable to endoscopic therapy, providing that their endoscopic and/or endoscopic ultrasound aspect suggest a maximal extension to the submucosal layer. Polypectomy, endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are ablative techniques used for their curative intent treatment. Large superficial carcinomas are to be removed by ESD as "en bloc" resection is essential to post procedure histological appraisal of the curative oncology nature of their resection. ESD complications rates and duration are nowadays reduced with the aid of "water-jet" technology, by combining submucosal fluid jet injection and electro-resection in a single knife.

Electroabsorption and refractive index modulation induced by intersubband transitions in GaN/AlN multiple quantum wells.

The aim of the present paper was to determine the index variation in the GaN/AlN heterostructures related to the population/depletion of the quantum well fundamental state leading to the absorption variation in the spectral domain around 1.5 µm. The variation of the refractive index was deduced from the shift of the position of the beating interference maxima of different order modes in a guided wave configuration. The obtained index variation with bias from complete depletion to full population of the quantum wells is around -5 × 10(-3). This value is similar to the typical index variation achieved in InP and is an order of magnitude higher than the index variation obtained in silicon.

Etiopathogenesis and prognostic implications of autoimmune hemolytic anemia association with chronic lymphocytic leukemia B.

Biological complexity of mechanisms of autoimmune hemolytic anemia (AHAI) in chronic lymphocytic leukemia B (CLL) and the relation cause / effect between these two diseases has been extensively researched, but currently is still far from being completely understood. It is known that the immune system has an important role in the pathogenesis of autoimmune diseases but also in the chronic lymphoproliferative malignancies. In this process of autoimmunity associated with immunodeficiency, the CLL neoplastic cells, the non-malignant B cells, T cells, and the cellular microenvironment cells are also involved. CLL pathological lymphocytes change peripheral immune tolerance acting as an antigen presenting cells and / or cells expressing inhibitory cytokines. The two subpopulations of T cells also have an important place: self-reactive T helper cells (TH) and regulatory T cells (Treg). The Fas / Fas ligand - cell death mechanism has a significant role both in maintaining cellular homeostasis, malignant hematopoietic cell expansion and the development of autoimmune disorders, including AIHA. The article reviews the etiopathogenesis of the autoimmune mechanism of AIHA in CLL, and its impact on the prognosis and long - term survival of patients with chronic lymphocytic leukemia B.

Prognosis Factors in Chronic Lymphocytic Leukemia.

Chronic lymphocytic leukemia is still one of the most common hematologic malignancies. Finding a curative solution is the objective of numerous followed cases and clinical trials. Diagnosis is based on the interlocking of classic elements and newly identified prognostic factors but time to first treatment is still an open issue. CD38, ZAP 70, IgHV gene mutational status and cytogenetic changes are proven negatively influence the evolution of chronic lymphocytic leukemia. Whether through aggressive rapid evolution or by the difficulty of obtaining a complete remission or risk of early relapse, CLL is still important. Adapted to these prognostic factors, combined therapeutic regimens have proved to be effective in achieving a durable complete remission, new agents, with encouraging partial results, being studied. Requiring initial screening, for comparative purposes, a current and growing importance has minimal residual disease; its absence at the end of treatment represents a strong positive prognostic factor.

Importance of assessing cytogenetic and molecular risk factors in acute myeloid leukemia therapy.

Acute myeloid leukemia (AML) is a heterogeneous disease in clinical presentation, outcome and therapeutic response. Cytogenetic and molecular characteristics are important prognostic indicators allowing the identification of distinct subtypes of AML, prognostic stratification and risk-adapted treatment. We present our experience during 5 years, in which we treated 245 patients with AML, of which we could genetically characterize 48 cases (26 females, 22 males) with a median age of 52 years. Cytogenetic analysis was performed by GTG banding on cultures of marrow cells treated with colcemid. Molecular analysis used RT-PCR performed on ABI 9700 platform in order to identify the following fusion genes: E2A-PBX1, TEL-AML1, AML1-ETO, PML-RARα, MLL-AF4, CBFC-MYH11, BCR-ABL, SIL-TAL, and MLL-AF9as well as mutations in Flt3, NPM1, WT1 genes. Fourteen patients were older than 60 years. In 12 we performed cytogenetic analysis showing 5 cases with complex karyotype, 2 normal karyotypes, 1 case of del(21), del (9), 11q- and t(3;15) respectively as well as 2 unevaluable karyotypes. These anomalies were associated with a high incidence of secondary AMLs (10/14) and with a low remission (CR) rate (5/14). Out of the 35 patients younger than 60 years, 25 were evaluated by cytogenetics showing a high incidence of favorable cytogenetic changes: 6 anomalies of chromosome 16 (5 inv (16) and 1 t (16; 16)), 3 t (15; 17), 3 cases of t (8; 21) of which 2 with additional abnormalities, 7 normal karyotypes and 1 case of 7q-, -y,-3 and respectively -8 associated with +18. In 25 cases molecular analysis was performed showing alterations in 21 patients: 6 cases with AML/ETO, 3 PML/RAR, 7 Flt3 mutations (2 associated with NPM1 mutation) as well as 1 case of isolated mutation of NPM1 and respectively WT1. CR rate was of 28/35. All cases with t (15; 17) and PML/RAR as well all cases with t (8; 21) and/or AML/ETO achieved CR. Out of the 7 cases with Flt3 mutations only 4 achieved CR including the 2 cases with associated NPM1 mutations. In our experience, genetic characteristics correlate with other prognostic markers such as age and secondary leukemia; "favorable" genetic anomalies were associated with a high CR rate; association of t (8; 21) with additional abnormalities did not influence CR rate.

Metal-dielectric metamaterials for guided wave silicon photonics.

The aim of the present paper is to investigate the potential of metallic metamaterials for building optical functions in guided wave optics at 1.5 µm. A significant part of this work is focused on the optimization of the refractive index variation associated with localized plasmon resonances. The minimization of metal related losses is specifically addressed as well as the engineering of the resonance frequency of the localized plasmons. Our numerical modeling results show that a periodic chain of gold cut wires placed on the top of a 100 nm silicon waveguide makes it possible to achieve a significant index variation in the vicinity of the metamaterial resonance and serve as building blocks for implementing optical functions. The considered solutions are compatible with current nano-fabrication technologies.

Efficient control of a 3D optical mode using a thin sheet of transformation optical medium.

We report on a mode adapter that transitions light between two SOI waveguides having different widths. The device has been designed using a two-dimensional embedded coordinate transformation and consists of a thin sheet of a controlled anisotropic material directly placed on top of the Si slab. We demonstrate that this layer effectively controls the flow of energy propagating in the Si slab by performing three-dimensional full-wave simulations. The proposed geometry can be implemented with planar optical metamaterials for various applications in guided optics.

Adaptive differentiation of thermotolerance in Drosophila along a microclimatic gradient.

We examined whether a remarkable occurrence - the physiological evolution of two Drosophila melanogaster populations, despite a spatial separation of only 100-400 m, was idiosyncratic and temporary, or persisted over multiple years. We ascertained the high-temperature tolerance of Drosophila descended from populations on the north-facing slope (NFS) and south-facing slope (SFS) of 'Evolution Canyon' (Lower Nahal Oren, Mt Carmel, Israel), which were collected in 1997, 1999, and 2000. Results for these Drosophila uniformly resembled other studies in many respects: an inverse relationship between survival and heat-shock temperature, male-female differences in thermotolerance, and inducible thermotolerance. Importantly, for all years of collection, SFS flies consistently exceeded NFS flies in basal and inducible thermotolerance after diverse heat shocks, with and without thermal pretreatment, and whether isofemale lines, synthetic populations, or inbred lines were compared. Inbred lines, however, had lower thermotolerance than outbred lines. Several nonexclusive processes may explain the evolution of such physiological differentiation.

Carbon film electrodes for oxidase-based enzyme sensors in food analysis.

Carbon film resistor electrodes have been evaluated as transducers for the development of multiple oxidase-based enzyme electrode biosensors. The resistor electrodes were first modified with Prussian Blue (PB) and then covered by a layer of covalently immobilized enzyme. Electrochemical impedance spectroscopy was used to characterize the interfacial behaviour of the Prussian Blue modified and enzyme electrodes; the spectra demonstrated that the access of the substrates is essentially unaltered by application of the enzyme layer. These enzyme electrodes were used to detect the substrate of the oxidase (glucose, ethanol, lactate, glutamate) via reduction of hydrogen peroxide at +50mV versus Ag/AgCl in the low micromolar range. Response times were 1-2min. Finally, the glucose, ethanol and lactate electrochemical biosensors were used to analyse complex food matrices-must, wine and yoghurt. Data obtained by the single standard addition method were compared with a spectrophotometric reference method and showed good correlation, indicating that the electrodes are suitable for food analysis.

Experimental evidence for superprism phenomena in SOI photonic crystals.

A first experimental demonstration of a planar superprism in silicon microphotonics technology using silicon on insulator (SOI) substrates is presented. Experimental results for anomalous wavelengthdependent angular dispersion in SOI triangular lattice planar photonic crystals are reported. An angular swing of 14 degrees is measured for light propagating near the Gamma-K direction as the input wavelength is changed from 1295 nm to 1330 nm, which corresponds to an angular dispersion of 0.4 degrees /nm. For the Gamma-M direction, a negative wavelength dispersion has been recorded. An opposite sign angular deviation of 21 degrees is observed as the input wavelength is changed from 1316 nm to 1332 nm, i.e. a dispersion of 1.3 degrees /nm.