Context-dependent roles for ubiquitous mitochondrial creatine kinase CKMT1 in breast cancer progression.

Metabolic reprogramming is a hallmark of cancer, enabling cancer cells to rapidly proliferate, invade, and metastasize. We show that creatine levels in metastatic breast cancer cell lines and secondary metastatic tumors are driven by the ubiquitous mitochondrial creatine kinase (CKMT1). We discover that, while CKMT1 is highly expressed in primary tumors and promotes cell viability, it is downregulated in metastasis. We further show that CKMT1 downregulation, as seen in breast cancer metastasis, drives up mitochondrial reactive oxygen species (ROS) levels. CKMT1 downregulation contributes to the migratory and invasive potential of cells by ROS-induced upregulation of adhesion and degradative factors, which can be reversed by antioxidant treatment. Our study thus reconciles conflicting evidence about the roles of metabolites in the creatine metabolic pathway in breast cancer progression and reveals that tight, context-dependent regulation of CKMT1 expression facilitates cell viability, cell migration, and cell invasion, which are hallmarks of metastatic spread.

Central retinal vein occlusion in a patient using the antipsychotic drug olanzapine: a case report.

BACKGROUND: We report our findings in a patient who developed central retinal vein occlusion (CRVO) and was a chronic user of olanzapine, an antipsychotic medication. CASE PRESENTATION: A 50-year-old Caucasian man, non-smoker, was referred to our clinic with the chief complaint of floater appearance in his left eye for the past 3 days. His past medical history indicated that he had been taking antipsychotic drugs (olanzapine) for about 3 years, with no other systemic disease or risk factors for CRVO. In the examination, his best-corrected visual acuity (BCVA) was 0.7 in the left eye. The fundus showed signs of nonischemic CRVO with subhyaloid hemorrhage and intraretinal hemorrhage in the posterior pole and superior and inferior retina, without macular edema, confirmed by optical coherence tomography (OCT). We ruled out other probable differential diagnoses and risk factors which lead to CRVO through a complete physical exam and blood analysis (complete blood count, glucose, urea, creatinine, lipid profile, erythrocyte sedimentation rate, C-reactive protein, prothrombin time, partial thromboplastin time, Bleeding time (BT), fibrinogen level, proteins, antiphospholipid antibodies, homocysteine blood level, antithrombin III, protein C and S, factor V Leiden, prothrombin mutation, angiotensin-converting enzyme level, other autoantibodies, and human leukocyte antigen [HLA]-B51). Finally, we confirmed the probable side effect of olanzapine in CRVO, which has not been previously reported. A possible pro-thrombogenic mechanism of olanzapine at the molecular level is an affinity for 5-HT2Aserotonin receptors. Blocking these receptors results in increased platelet aggregation and increased blood coagulability. CONCLUSIONS: These results indicate that CRVO can be a complication of chronic use of antipsychotic medications such as olanzapine, as shown for the first time in our case report. Clinicians should question patients who develop a sudden CRVO whether they are using antipsychotic medications such as olanzapine.

MicroRNAs of Human Herpesvirus 6A and 6B in Serum and Cerebrospinal Fluid of Multiple Sclerosis Patients.

Human herpesvirus-6A (HHV-6A) and -6B (HHV-6B) might be involved in the etiopathogenesis of multiple sclerosis (MS), especially the HHV-6A. We aim at assessing, for the first time in the scientific literature, the HHV-6A/B microRNAs in MS patients. We analyzed the miRNAs of HHV-6A: miR-U86, and -6B: hhv6b-miR-Ro6-1, -2, -3-3p, -3-5p, and -4 in paired samples of serum and CSF of 42 untreated MS patients and 23 patients with other neurological diseases (OND), using Taqman MicroRNA Assays. Intrathecal HHV-6A/B antibody production and anti-HHV-6A/B IgG/IgM levels in serum were measured. MS clinical data were available. We detected the following miRNAs: hhv6b-miR-Ro6-2 (serum: MS:97.7%, OND:95.7%; CSF: MS:81%, OND:86.4%), 3-3p (serum: MS:4.8%, OND:0%; CSF: MS:2.4%, OND:4.5%), -3-5p (serum: MS:95.2%, OND:91.3%; CSF: MS:50%, OND:54.5%), and miR-U86 (serum: MS:54.8%, OND:47.8%; CSF: MS:11.9%, OND:9.1%). In the serum of the whole population (MS and OND patients) we found a significant correlation between the levels of hhv6b-miR-Ro6-2 and -3-5p (Spearman r = 0.839, pcorr = 3E-13), -2 and miR-U86 (Spearman r = 0.578, pcorr = 0.001) and -3-5p and miR-U86 (Spearman r = 0.698, pcorr = 1.34E-5); also in the CSF, between hhv6b-miR-Ro6-2 and -3-5p (Spearman r = 0.626, pcorr = 8.52E-4). These correlations remained statistically significant when both populations were considered separately. The anti-HHV-6A/B IgG levels in CSF and the intrathecal antibody production in positive MS patients for hhv6b-miR-Ro6-3-5p were statistically significant higher than in the negative ones (pcorr = 0.006 and pcorr = 0.036). The prevalence of miR-U86 (30.8%) in the CSF of individuals without gadolinium-enhancing lesions was higher (p = 0.035) than in the ones with these lesions (0%); however, the difference did not withstand Bonferroni correction (pcorr = 0.105). We propose a role of HHV-6A/B miRNAs in the maintenance of the viral latency state. Further investigations are warranted to validate these results and clarify the function of these viral miRNAs.

Best Practices for Obtaining Genomic Consent in Pediatric Traumatic Brain Injury Research.

BACKGROUND: Precision health relies on large sample sizes to ensure adequate power, generalizability, and replicability; however, a critical first step to any study is the successful recruitment of participants. OBJECTIVES: This study seeks to explore how the enrollment strategies used in a parent study contributed to the high consent rates, establish current best practices that can be used in future studies, and identify additional factors that contribute to consent into pediatric traumatic brain injury biobanks. METHODS: Retrospective secondary analysis of data from a parent study with high consent rates was examined to explore factors affecting consent into biobanking studies. RESULTS: Of the 76 subjects who were approached, met the eligibility criteria, and reviewed the consent form, only 16 (21.1%) declined to participate. The consented group (n = 60) represents 64.5% of those who met the eligibility criteria upon initial screening (n = 93) and 78.9% of those with confirmed eligibility (n = 76). Analysis of screening data suggested there were no major barriers to consenting individuals into this pediatric traumatic brain injury biobank. DISCUSSION: There were no demographic or research-related characteristics that significantly explained enrollment. Ethically, to obtain true informed consent, parents need to understand only their child's diagnosis, prognosis, and medical care, as well as the purpose of the proposed research and its risks and benefits. Researchers need to implement best practices, including a comprehensive review of census data to identify eligible participants to approach, a prescreening protocol, and effective consenting process to obtain informed consent so that precision care initiatives can be pursued.

Costo-efectividad de la reanimación cardiopulmonar con el uso del desfibrilador externo automático, comparado con reanimación cardiopulmonar básica, para personas con pérdida de conciencia en espacios de afluencia masiva de público / Cost-effectiveness of cardiopulmonary resuscitation using an automated external defibrillator compared with a basic defibrillator in unconscious patients in crowded public spaces in Colombia

Resumen Objetivo: Estimar la razón de costo-efectividad de la reanimación cardiopulmonar con el uso del desfibrilador externo automático (DEA), comparado con la reanimación cardiopulmonar básica, para la reanimación de personas con pérdida de conciencia en espacios de afluencia masiva de público en Colombia. Métodos: Para estimar los costos y desenlaces de las dos alternativas de comparación, se diseñó un árbol de decisiones en el cual se reflejan los principales desenlaces posterior a la pérdida de conciencia y la reanimación con cualquiera de las dos alternativas. Se asumió la perspectiva del sistema de salud colombiano en un horizonte temporal comprendido entre el momento de la pérdida de conciencia de la persona hasta el ingreso al hospital. Las probabilidades de los eventos se obtuvieron de un meta-análisis de ensayos clínicos y la información de costos de fuentes oficiales y consulta directa a proveedores de DEA en Colombia. Los costos fueron expresados en pesos colombianos de 2016 y la efectividad en muertes evitadas. Se realizaron análisis de sensibilidad determinísticos y probabilísticos para estimar el impacto de la incertidumbre sobre las conclusiones. Resultados: La razón de costo-efectividad de la reanimación cardiopulmonar con DEA fue de $3.267.777 por muerte evitada. La probabilidad de que esta intervención sea costo-efectiva es superior al 90% para un umbral de costo-efectividad superior a 10 millones de pesos. Conclusión: Un programa de reanimación cardiopulmonar con desfibrilación temprana mediante el uso de DEA, en espacios de afluencia masiva de público, es una alternativa costo-efectiva para el sistema de salud colombiano.

Abstract Objective: To estimate the cost-effectiveness of cardiopulmonary resuscitation using an automated external defibrillator (AED) compared with basic cardiopulmonary resuscitation, for the resuscitation of unconscious patients in crowded public spaces in Colombia. Methods: A decision tree was designed in order to estimate the costs and outcomes of the two alternatives. This included the main outcomes after the loss of consciousness and resuscitation by any of the two alternatives. The perspective of the Colombian Health System was adopted in a time scale consisting of the time of loss of consciousness until hospital admission. The probabilities of the events were obtained from a meta-analysis of clinical trials, and the information on costs from official sources and direct consultations with AED providers in Colombia. The costs were expressed in Colombian pesos of 2016, and the effectiveness in deaths prevented. Deterministic and probabilistic sensitivity analyses were performed to estimate the impact of uncertainty on the conclusions. Results: The cost-effectiveness of cardiopulmonary resuscitation with AED was COP $3,267,777 per death avoided. The probability that this intervention would be cost-effective is greater than 90% for cost-effectiveness threshold greater than 10 million Colombian pesos. Conclusion: A cardiopulmonary resuscitation program with early defibrillation using an AED in crowded public spaces is a cost-effective alternative for the Colombian Health System.

School Area Road Safety Assessment and Improvements (SARSAI) programme reduces road traffic injuries among children in Tanzania.

PURPOSE: To determine the impact of a paediatric road traffic injury (RTI) prevention programme in urban Sub-Saharan Africa. SETTING: Dares Salaam, Republic of Tanzania. METHODS: Household surveys were conducted in catchment areas around 18 primary schools in Dar es Salaam, Republic of Tanzania; the catchment areas were divided into control and intervention groups. Collected data included basic demographic information on all school-aged household members and whether or not they had been involved in an RTI in the previous 12 months, and, if so, what the characteristics of that RTI were. Based on these findings, a separate road safety engineering site analysis and consultation with the communities and other stakeholders, an injury-prevention programme was developed and implemented, consisting of infrastructure enhancements and a site-specific educational programme. The programme was initially implemented at the intervention schools. After 1 year, data were collected in the same manner. The control group received the same intervention after follow-up data were collected. RESULTS: Data were collected on 12 957 school-aged children in the baseline period and 13 555 school-aged children in the post-intervention period, in both the control and intervention communities. There was a statistically significant reduction in RTIs in the intervention group and a non-significant increase in RTI in the control group. The greatest reduction was in motorcycle-pedestrian RTI, private vehicle-pedestrian RTI and morning RTI. CONCLUSION: The programme demonstrated a significant reduction in paediatric RTI after its implementation, in very specific ways. This study demonstrates that for a reasonable investment, scientifically driven injury-prevention programmes are feasible in resource-limited settings with high paediatric RTI rates.

Porosity Effect on Thermal Properties of Al-12 wt % Si/Graphite Composites.

The effect of porosity on the thermal conductivity and the coefficient of thermal expansion of composites obtained by infiltration of Al-12 wt % Si alloy into graphite particulate preforms has been determined. Highly irregular graphite particles were used to fabricate the preforms. The thermal conductivity of these composites gradually increases with the applied infiltration pressure given the inherent reduction in porosity. A simple application of the Hasselman-Johnson model in a two-step procedure (that accounts for the presence of both graphite particles and voids randomly dispersed in a metallic matrix) offers a good estimation of the experimental results. As concerns the coefficient of thermal expansion, the results show a slight increase with saturation being approximately in the range 14.6-15.2 × 10-6 K-1 for a saturation varying from 86% up to 100%. Results lie within the standard Hashin-Strikman bounds.

[Intrarectal povidone-iodine to reduce the risk of genitourinary infections after transrectal prostate biopsy]. / Iodopovidona intrarrectal y riesgo de infección genito- urinaria posterior a biopsia prostática transrectal.

BACKGROUND: The aim of this study is to compare two different preparations in patients undergoing transrectal prostate biopsies samples (TPBS) and assess the prevalence of genitourinary infections (GUI). METHODS: A historical cohort of patients undergoing TBPS for suspected prostate cancer. Two groups were compared: one with endorectal lubricant jelly and another with the addition of a povidone-iodine lubricating jelly. Complications were evaluated at three weeks. A bivariate analysis was performed by calculating the OR (95 % CI) to determine if the additional endorectal povidone-iodine pre-TBPS reduced GUI and other complications. RESULTS: 185 patients (Group I n = 86, Group II n = 96) were evaluated. 45 and 25 % had genitourinary tract infection (OR: 0.4, CI: 0.2-0.9, p = 0.004); fever was presented in 21 and 10 % respectively (OR: 0.42, CI: 0.1-0.9, p = 0.04). CONCLUSIONS: A reduction was observed in the presence of genitourinary infections in patients who had intrarectal povidone-iodine preparation applied.

Introducción: el objetivo de este estudio es comparar dos preparaciones distintas en pacientes sometidos a la toma de biopsias prostáticas transrectales (BPTR) y evaluar la prevalencia de infecciones genitourinarias (IGU). Métodos: se compararon dos grupos de pacientes con sospecha de cáncer de próstata sometidos a Biopsia Prostática Transrectal (BPTR): Con jalea lubricante endorrectal (grupo l, cohorte histórica) y con jalea lubricante más iodopovidona (grupo II, cohorte prospectiva). Se evaluaron las complicaciones a las tres semanas. Se realizó un análisis bivariado, calculando su OR (IC: 95 %) para determinar si la iodopovidona endorrectal adicional previa a la BPTR disminuye las IGU y otras complicaciones. Resultados: Se evaluaron 185 pacientes (Grupo I n = 86; grupo II n = 96). Tuvieron infección del tracto genitourinario el 45 y 25 % (OR: 0.4, IC: 0.2-0.9, p = 0.004); la fiebre se presentó en el 21 y 10 % respectivamente (OR: 0.42, IC: 0.1-0.9, p = 0.04). Conclusiones: Se observó una reducción en la presencia de infecciones genitourinarias en pacientes a quienes se aplicó en su preparación iodopovidona intrarrectal.

Santiago Ramón y Cajal, neurocientífico y pintor / Santiago Ramon y Cajal, neuroscientist and painter

La vida de este extraordinario científico y pintor ha sido motivo de estudio por generaciones, pues fascinó la manera de poder unir armoniosamente sus pasiones. Santiago Felipe Ramón y Cajal, más conocido como don Santiago Ramón y Cajal (el "don" por un título de importancia de la época e "y" como una forma de darle renombre a sus apellidos), o referido por muchos simplemente como Cajal (por la sonoridad del apellido y la costumbre en España de utilizar el apellido materno). Nació en la provincia de Cataluña, primer hijo de la unión de Justo Ramón Casasús y Antonia Cajal Puentes. Su padre, médico del pueblo, vio en él un sucesor de la profesión, razón por la cual desde muy pequeño le exigió académicamente y le reprochó su fascinación por el arte. Su infancia fue marcada por múltiples sucesos que lo llevarían a tener un encanto por la naturaleza y querer plasmarla en sus dibujos. La influencia de su padre fue exitosa, ya que se convirtió en un prestigioso médico. Ansioso de conocer otros lugares y su sed de aventurero lo llevaron a viajar a Cuba para dar apoyo médico a las tropas españolas. A su regreso se encontró con múltiples oportunidades que forjaron su carrera como científico y le dieron solidez como persona. Se casó a la edad de 27 años con Silveria Fañanás, el motor de su vida y la madre de sus seis hijos. Su incansable curiosidad y su espíritu de pintor le permitieron describir y dibujar las células nerviosas de manera detallada, incluyendo su estructura magnífica y las relaciones de estas, comparándolas de manera muy acertada con la naturaleza, referidas por él mismo como "El jardín de la neurología". Siempre fue un paisajista romántico, que se intrigó tanto de lo macro (con sus dibujos sobre la naturaleza y la anatomía), como de lo micro (la histología) (Figura 1).

The life of this extraordinary scientist and painter has been studied by multiple generations, fascinated by the way he harmoniously mixes his passions. Santiago Felipe Ramón y Cajal, better known as Don Santiago Ramón y Cajal (the "Don" as a title of the importance of the age and the "Y" as a way to give renown to their surnames) or referred by many simply as "Cajal" - by the sound of the surname). He was born in the province of Catalonia, first child of the union of Justo Ramón Casasús and Antonia Cajal. His father, a physician, saw in him a successor of the profession, which is why at very young age, he demanded of him the best academic performance and reproached him for his fascination with art. His childhood was marked by many events that would lead him to be charmed with nature and want to translate this into his drawings. The influence of his father was successful because he became a physician. Eager to know other places and with the thirst of an adventurer, he travelled to Cuba, but it was not the experience he had imagined. On his return he found many opportunities that forged his career as a scientist and gave him strength as a person. He married at the age of 27 years with Silveria Fañanás, who became the mother of his six children, and was the engine of his life. With his insatiable curiosity, his painter´s spirit and with some help, he described in detail the nerve cells and portrayed in his drawings the magnificent structure and relationships thereof, successfully comparing them with nature, referring to "The Garden of Neurology". He was always a romantic landscape painter, intrigued as much by the macro (with his drawings of nature and anatomy) as the micro (histology); the latter was his greatest passion. All his work bore many fruits, which still amaze us today. Through his hard work and his refusal to placate his inner painter, he managed to mix his passions to their maximum potential, leaving behind a priceless legacy.

Road traffic injury on rural roads in Tanzania: measuring the effectiveness of a road safety program.

OBJECTIVE: Road traffic injuries (RTIs) are a major public health burden, especially in low- and middle-income countries. There is limited data on RTIs in low-volume, rural African settings. This study attempted to survey all individuals living in households within 200 m of two low-volume rural roads in Tanzania and to collect data on RTIs. METHODS: Local communities and users of the Bago to Talawanda road (intervention site) and Kikaro to Mihuga road (control site) were targeted and received an intensive program of road safety measures tailored using the crash characteristics of the baseline sample. Demographic data on all household members were collected, and those individuals who suffered an RTI in the previous 3 months had comprehensive information collected about the crash characteristics and the socioeconomic impact. The follow-up data collection occurred nine months after the baseline data were collected. RESULTS: The majority of crashes that caused an RTI involved a motorcycle (71%) and the majority of victims were male (82%) with an average age of 27. Injuries to the legs (55%) were most common and the average length of time away from normal activity was 27 (±33) days. RTI incidence at the intervention site increased during the course of the study (incidence before vs. incidence after) and was unchanged in the community control (incidence before vs. incidence after). CONCLUSION: The incidence of RTIs in the low-volume rural setting is unacceptably high and most commonly associated with motorcycles. The change in incidence is unreliable due to logistic restraints of the project and more research is needed to quantify the impact of various RTI prevention strategies in this setting. This study provides insight into road traffic injuries on low-volume rural roads, areas where very little research has been captured. Additionally, it provides a replicable study design for those interested in collecting similar data on low-volume rural roads.

Análisis de costo-efectividad del uso del Desfibrilador Externo Automático (DEA) comparado con Reanimación Cardiopulmonar Básica (RCP) en Colombia / Cost-effectiveness analysis of the use of Automatic External Defibrillator (AED) compared to Basic Cardiopulmonary Resuscitation (CPR) in Colombia

Problema de investigación: Analizar los costos y la efectividad de los desfibriladores automático y semiautomático en espacios de afluencia masiva y ambulancias básicas en Colombia. Tipo de evaluación \r\neconómica: Análisis de costo-efectividad. Población objetivo: Personas que presentan pérdida de conciencia (no tose, no se mueve, no respira, no responde) en espacios de afluencia masiva de público (aeropuertos, centros comerciales, estadios, centros de convenciones, colegios, universidades, medios masivos de trasporte público, cárceles, entre otros) y en ambulancias básicas. Intervención y comparadores: I: Desfibrilador automático/semiautomático externo, C: Reanimación cardiopulmonar (RCP).Horizonte temporal: Un año. Perspectiva Sistema: General de Seguridad Social en Salud (SGSSS). Estructura del modelo: Árbol de decisión, que incluye los eventos de sobrevida y muerte. Fuentes de datos de efectividad y seguridad: Ensayos clínicos y meta-análisis. Desenlaces y valoración: Mortalidad, Años de vida ganados. Costos incluidos: Costo del dispositivo, Costo de medicamentos, Costo de procedimientos e insumos. Fuentes de datos de costos: Consulta a proveedores, SISMED, Manual tarifario ISS 2001. Resultados del caso base: En el escenario de espacios públicos, el costo de una muerte evitada es de $87.492.099. Al expresar estas cifras en costo por año de vida ganado, el DEA sería una estrategia altamente costo-efectivo. En el caso específico de ambulancias básicas, no se dispone de información suficiente que permita extraer conclusiones sólidas. Análisis de sensibilidad: Los análisis de sensibilidad y el diagrama de tornado mostraron que las \r\nvariables con mayor impacto sobre las estimaciones de costo-efectividad en espacios públicos son la probabilidad de sobrevida al alta hospitalaria y el costo del desfibrilador externo automático (DEA). Conclusión y discusión: El uso del DEA en espacios de afluencia masiva de público es una \r\nestrategia altamente costo-efectiva en Colombia. No obstante, es necesario tener en cuenta que la implementación de un programa de desfibrilación de acceso enfrenta múltiples barreras, por lo cual es \r\nfundamental fortalecer los tres primeros eslabones de la cadena de supervivencia, entre los cuales se encuentra el uso del DEA en espacio de afluencia masiva del público y la optimización de los tiempos de respuesta.(AU)

A meta-analysis approach to the effects of fish farming on soft bottom polychaeta assemblages in temperate regions.

Marine fish farms could cause environmental disturbances on the sediment due to uneaten food and fish faeces that impact the marine benthos. Polychaete assemblages are considered good indicators of environmental perturbations. The present study aimed to establish groups of polychaetes as potential indicators of fish farm pollution. This study was carried out in ten fish farms along the Spanish coast. Changes in polychaete assemblage were analyzed with meta-analysis and multivariate techniques. Abundance, richness and diversity showed significant decreases under fish farm conditions. Distribution patterns of polychaetes responded to combinations of physicochemical variables. The main ones are sulfide concentration, silt and clays percentage, and stable nitrogen isotope ratio. The results showed that some families are tolerant, Capitellidae, Dorvilleidae, Glyceridae, Nereididae, Oweniidae and Spionidae; while others are sensitive to fish farm pollution, Magelonidae, Maldanidae, Nephtyidae, Onuphidae, Paralacydoniidae, Paraonide, Sabellidae and also Cirratulidae in spite of being reported as a tolerant family.

Road traffic injury incidence and crash characteristics in Dar es Salaam: a population based study.

Road traffic injuries (RTI) are a public health threat and a major source of disability in developing countries. A population-based analysis of RTIs in a testimonially high-risk area of Dar es Salaam, the largest city in the East African country of Tanzania, was carried out with the goal of establishing an RTI incidence and to identify RTI characteristics that may be used for a targeted injury prevention program in these communities. Geographic cluster sampling was completed in 2 adjacent wards of Dar es Salaam with household surveys administered in person to determine a denominator. Any household members involved in an RTI within the previous 12 months received an in-depth questionnaire. Demographics, incident characteristics, medical attention, injuries and disability days were noted. These are described and compared to injury severity and age specific tendencies. Within the 30 clusters, 6001 individuals were interviewed. Of them, 196 were involved in non-fatal RTIs within the previous 12 months, resulting in a non-fatal incidence rate of 32.7 RTIs per 1000 person years. There were 4 deaths noted. Injuries resulting in a fracture correlated with a disability of more than 30 days. Children were injured as pedestrians 93% of the time and were more likely to be injured on small, unpaved side streets than adults. Most RTIs occurred on a highway and affected the lower extremities, required treatment at a hospital, and resulted in a police report being filed 50.2% of the time. In conclusion, RTIs in this urban East African setting are a major source of disability. This study provides incidence data and crash characteristics that may be used to construct prevention programs and could validate secondary data sources.

Trauma and burn education: a global survey.

BACKGROUND: The World Health Assembly recently adopted a resolution to urge improved competency in the provision of injury care through medical education. This survey sought to investigate trauma education experience and competency among final year medical students worldwide. METHODS: An Internet survey was distributed to medical students and conducted from March 2008 to January 2009. Demographic data and questions pertaining to both instruction and attainment of specific skills in burn and trauma care were assessed. RESULTS: There were 776 responses from final year medical students in 77 countries, with at least 10 countries from each economic stratum. Over 93% of final year students reported receiving some form of trauma or burn training, with 79% reporting a minimum compulsory requirement. Students received theoretical instruction without practical exposure. Few felt prepared to undertake basic procedures, such as laceration repair (19%), vascular access (8%), or endotracheal intubation (21%). Over 99% agreed that trauma education should be mandatory, but only half felt prepared to provide basic care. Those from low income and low middle income countries felt better prepared to provide trauma care than students from high middle and high income countries. CONCLUSIONS: Trauma education and experience varies among medical students in different countries. Many critical concepts are not formally taught and practical experience with many basic procedures is often lacking. The present study confirms that the trauma care training received by medical students needs to be strengthened in countries at all economic levels.

Paediatric road traffic injuries in urban Ghana: a population-based study.

OBJECTIVE/SETTING: To provide a population-based analysis of childhood road traffic injuries (RTI) in two communities of the greater Accra region of Ghana, with the goal of establishing an RTI incidence baseline in these communities and to identify RTI characteristics in order to model a targeted injury prevention programme. STUDY DESIGN: Geographical cluster sampling was performed in two separate communities with household surveys administered in person to determine a denominator. The guardian responsible for any household members below the age of 15 years involved in an RTI within the previous 12 months received an in-depth questionnaire. Demographics, incident characteristics, medical attention, injuries and disability days were noted. These are described and compared with injury severity and age-specific tendencies. RESULTS: 5128 children were interviewed in 60 clusters. Of them, 172 were involved in an RTI within the previous 12 months. This resulted in a rate of 34 RTI/1000 person-years, and 43 RTI/1000 person-years in the 5-14-year-old age group. RTI involving a mini-bus taxi, as a pedestrian, correlated with a disability of greater than 30 days, as did fractures. 35.8% of injuries occurred at sunset. Most RTI occurred on a highway and involved the lower extremities. There were two deaths resulting in an incidence of 39.0/100,000 person-years. CONCLUSION: Childhood RTI in this urban west African setting are a major source of disability. Specific injury circumstances are reviewed in detail. This study provides baseline incidence data that may be used to measure injury prevention efforts and to validate secondary data sources.

Major vascular neck injury from a handgun cartridge casing.

We present a case from the Johannesburg General Hospital of a zone II low-velocity penetrating neck injury with involvement of the ipsilateral subclavian artery. When the "bullet" was retrieved, it was noted not to be an actual bullet but rather a cartridge casing. We speculate that this injury represents one of several possible misfiring scenarios from a homemade firearm. Injuries from homemade firearms are infrequent in the literature, and only one other similar case of a cartridge casing causing a penetrating injury was found. A brief review of homemade handheld firearms is offered.

[A case of the calcifying epithelial odontogenic tumor (Pindborg's tumor). Reported and literature review]. / Tumor odontogénico epitelial calcificante (tumor de Pindborg). Informe de un caso y revisión de la literatura.

The calcifying epithelial odontogenic tumor known as Pindborg's tumor, is a rare odontogenic neoplasm of the jaws. One of their characteristics is the cortical expansion and the relationship with a non erupted tooth. Since the original description in 1955, only 200 cases approximately have been described in the world literature. This article reviews the literature and describes a case of patient who presented calcifying epithelial odontogenic tumor in the jaw undergoing surgical excision treatment with an evolution without complications.

The development of the epicardium in the sturgeon Acipenser naccarii.

This article reports on the development of the epicardium in alevins of the sturgeon Acipenser naccarii, aged 4-25 days post-hatching (dph). Epicardial development starts at 4 dph with formation of the proepicardium (PE) that arises as a bilateral structure at the boundary between the sinus venosus and the duct of Cuvier. The PE later becomes a midline organ arising from the wall of the sinus venosus and ending at the junction between the liver, the sinus venosus and the transverse septum. This relative displacement appears related to venous reorganization at the caudal pole of the heart. The mode and time of epicardium formation is different in the various heart chambers. The conus epicardium develops through migration of a cohesive epithelium from the PE villi, and is completed through bleb-like aggregates detached from the PE. The ventricular epicardium develops a little later, and mostly through bleb-like aggregates. The bulbus epicardium appears to derive from the mesothelium located at the junction between the outflow tract and the pericardial cavity. Strikingly, formation of the epicardium of the atrium and the sinus venosus is a very late event occurring after the third month of development. Associated to the PE, a sino-ventricular ligament develops as a permanent connection. This ligament contains venous vessels that communicate the subepicardial coronary plexus and the sinus venosus, and carries part of the heart innervation. The development of the sturgeon epicardium shares many features with that of other vertebrate groups. This speaks in favour of conservative mechanisms across the evolutionary scale.