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Background It is estimated that around 450,000 traumatic brain injury cases have occurred in the 21st century with possible under-reporting. Computational simulations are increasingly used to study the pathophysiology of traumatic brain injuries among US military personnel. This approach allows for investigation without ethical concerns surrounding live subject testing. Methodology The pertinent data on head acceleration is applied to a detailed 3D model of a patient-specific head, which encompasses all significant components of the brain and its surrounding fluid. The use of finite element analysis and smoothed-particle hydrodynamics serves to replicate the interaction between these elements during discharge through simulation of their fluid-structure dynamics. Results The stress levels of the brain are assessed at varying time intervals subsequent to the explosion. The regions where there is an intersection between the skull and brain are observed, along with the predominant orientations in which displacement of the brain occurs resulting in a brain injury. Conclusions It has been determined that the cerebrospinal fluid is inadequate in preventing brain damage caused by multiple abrupt directional shifts of the head. Accordingly, additional research must be undertaken to enhance our comprehension of the injury mechanisms linked with consecutive changes in acceleration impacting the head.
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This paper provides a review of engineering applications and computational methods used to analyze the dynamics of heart valve closures in healthy and diseased states. Computational methods are a cost-effective tool that can be used to evaluate the flow parameters of heart valves. Valve repair and replacement have long-term stability and biocompatibility issues, highlighting the need for a more robust method for resolving valvular disease. For example, while fluid-structure interaction analyses are still scarcely utilized to study aortic valves, computational fluid dynamics is used to assess the effect of different aortic valve morphologies on velocity profiles, flow patterns, helicity, wall shear stress, and oscillatory shear index in the thoracic aorta. It has been analyzed that computational flow dynamic analyses can be integrated with other methods to create a superior, more compatible method of understanding risk and compatibility.
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Autoimmune hepatitis (AIH) is a condition that affects the liver which, potentially, may render it fibrotic and eventually cirrhotic. This condition has many etiologies ranging from genetic predispositions and immunological defects to medication and environmental side effects. Essentially, we will explore the risks, presentation, diagnosis, and treatment of this condition as it relates to a medication-induced etiology. Here we report a case where a patient developed this condition from taking the antibiotic minocycline. The patient was treated with prednisone therapy and went into complete remission with no reoccurrence of AIH. The purpose of this case report is to highlight the fact that these cases have the potential to occur fairly sooner than expected, in a matter of weeks or months, after the induction of minocycline. Hence, carefully monitoring liver functions more frequently may aide in the prevention of minocycline-induced AIH.
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Chilaiditi sign is a rare incidental radiographic finding where bowel is interposed between the diaphragm and the liver, often seen as air under the right hemidiaphragm. A majority of patients with Chilaiditi sign are asymptomatic and remain so throughout their lifetime. Chilaiditi sign is recategorized as Chilaiditi syndrome if it becomes symptomatic and is a very rare etiology of bowel obstruction. As bowel obstruction confers a huge financial burden to the health care system, studies of even the rarer etiologies are of significant value. Particularly in the case of Chilaiditi syndrome, the free air under the right hemidiaphragm can lead physicians to prematurely conclude pneumoperitoneum, which would require an emergent surgical evaluation. It is through the incorporation of a broad differential and clinical presentation that physicians can decrease the inappropriate allocation of hospital resources and unnecessary surgical procedures; additionally, keeping Chilaiditi syndrome on the differential may prevent unnecessary surgical intervention, cost to the patient, and downstream complications. Bowel obstruction secondary to Chilaiditi syndrome is most commonly treated with conservative management including intravenous fluids, bowel rest, decompression, and laxatives. If the symptoms worsen and progress to full bowel obstruction, surgical intervention has shown great efficacy. We report a case of a 69-year-old male who presented to the emergency department for progressively worsening abdominal pain, nausea, and vomiting incidentally found to have colonic interposition with mild colonic dilatation on computed tomography (CT) imaging. The patient was diagnosed with bowel obstruction secondary to Chilaiditi syndrome and treated non-surgically with rapid recovery.
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The U.S. National Strategy for Suicide Prevention calls for states to identify supportive structures that encourage efficient, effective, and sustainable suicide prevention programming at the state, territorial, tribal, and local levels (HHS & Action Alliance, 2012). To meet this objective, the Suicide Prevention Resource Center (SPRC) completed a literature review and environmental scan, convened an advisory panel of suicide prevention experts, and conducted interviews with suicide prevention and policy experts to identify six essential state-level infrastructure elements: Authorize-Designate a lead organization for suicide prevention in the state and give it the resources to put a state plan into practice. Lead-Maintain a dedicated leadership and core staff positions in order to enact the plan. Create collaboration within state government. Partner-Ensure a state-level public-private partnership with a shared vision for suicide prevention. Examine-Encourage the collection and analysis of high-quality suicide data. Build-Support a multifaceted lifespan approach to suicide prevention across the state. Guide-Build state and local capacity for prevention. In this commentary, we recommend a framework for organizing an emerging evidence base on the infrastructure and systems that are needed to support an effective, sustainable, public health approach to suicide prevention.
