Retroperitoneal pelvic packing for haemodynamically unstable pelvic fractures in children and adolescents: A level-one trauma-centre experience

Purpose

This study aims to review the outcomes of haemodynamically unstable paediatric patients with pelvic fractures undergoing protocol intervention of retroperitoneal pelvic packing (RPP) with external fixation and angiography.

Methods

From 2004 to 2011, consecutive patients younger than 19 years treated in our centre for haemodynamically unstable pelvic fractures were retrospectively reviewed. From 2008, protocol intervention triad of external fixation, RPP, and angiography with embolization was implemented.

Results

Before 2008, only 2 boys with fall injuries received intervention. One received initial angiography showing extravasation near iliac bifurcation. Laparotomy proceeded without embolization for multiple visceral injuries, but he succumbed postoperatively. The other had persistent bleeding after external fixation but became stabilized after embolization. After 2008 protocol implementation, 5 youngsters received the triad of interventions for unstable pelvic fractures. Mean age was 15.4 yrs. The mean injury severity score was 42 (18–66) with 62.5% mean probability of survival (6.8–98.8%). The mean operating time for RPP was 23 mins (20–35 mins). One boy died of rapid exanguination intraoperatively. The other 4 youngsters recovered for rehabilitation.

Conclusion

Fall from heights is a major cause for severe pelvic injuries in our locality. RPP is a simple effective procedure to include in protocol intervention for pelvic fractures. This case series suggests it helps improve haemostasis and survival in unstable young patients, although larger cohorts will be necessary to validate this.     

Influence of Point-of-Sale Tobacco Displays and Graphic Health Warning Signs on Adults: Evidence From a Virtual Store Experimental Study

Objectives. We tested the impact of banning tobacco displays and posting graphic health warning signs at the point of sale (POS).Methods. We designed 3 variations of the tobacco product display (open, enclosed [not visible], enclosed with pro-tobacco ads) and 2 variations of the warning sign (present vs absent) with virtual store software. In December 2011 and January 2012, we randomized a national convenience sample of 1216 adult smokers and recent quitters to 1 of 6 store conditions and gave them a shopping task. We tested for the main effects of the enclosed display, the sign, and their interaction on urge to smoke and tobacco purchase attempts.Results. The enclosed display significantly lowered current smokers’ (B = −7.05; 95% confidence interval [CI] = −13.20, −0.91; P < .05) and recent quitters’ (Β = −6.00, 95% CI = −11.00, −1.00; P < .01) urge to smoke and current smokers’ purchase attempts (adjusted odds ratio = 0.06; 95% CI = 0.03, 0.11; P < .01). The warning sign had no significant main effect on study outcomes or interaction with enclosed display.Conclusions. These data show that POS tobacco displays influence purchase behavior. Banning them may reduce cues to smoke and unplanned tobacco purchases.Smoking is the leading cause of preventable mortality in the United States, accounting for approximately 443 000 deaths each year.1 Currently, 19.3% of US adults smoke cigarettes, and nearly half attempt to quit smoking each year.2 However, approximately 90% of smokers who attempt to quit relapse within 6 months,3–6 and relapses may occur years after quitting.7 The tobacco industry aggressively markets its products to consumers, spending nearly 90% of its $8 billion marketing budget on promotional allowances to retailers and advertising and price promotions at the point of sale (POS), making retail stores the most important advertising channel for the industry.8 Retail cigarette advertising and promotions have increased over time,9,10 and cigarette products are prominently placed on shelves behind checkout counters, exposing all store customers to tobacco products, including youths and adults who do not smoke or have recently quit.Tobacco ads and displays may act as cues to smoke,11–13 stimulate purchases among customers who did not intend to buy cigarettes,14,15 and influence relapse among recent quitters by stimulating cravings for cigarettes.16 In a telephone survey of Australian adults, Wakefield et al. found that 55.3% noticed POS displays often or always and 25.2% bought cigarettes as a result of seeing displays when shopping for something other than cigarettes.15 Among respondents who had attempted to quit smoking in the past 12 months, 37.7% reported that seeing the tobacco displays increased their urge to purchase cigarettes and 60.9% bought cigarettes even though they were trying to quit. Carter et al. conducted intercept surveys with shoppers outside supermarkets to examine the influence of tobacco displays at the time of purchase and found similar patterns: approximately 22% reported unplanned cigarette purchases, with nearly half (47%) influenced by tobacco displays.14 In a cohort study, Germain et al. found that smokers with moderate or high sensitivity to tobacco displays at baseline were significantly less likely to quit smoking at follow-up than were those with low sensitivity (moderate, odds ratio [OR] = 0.32; 95% confidence interval [CI] = 0.14, 0.74; P = .007; high, OR = 0.27; 95% CI = 0.08, 0.91; P = .035).16 Laboratory-based cue reactivity studies show that drug-dependent individuals react strongly to cues associated with past or current drug use, including nicotine; viewing images such as cigarette packs or other people smoking can elicit subjective cigarette craving and psychophysiological arousal (e.g., increased heart rate).17,18The federal Family Smoking Prevention and Tobacco Control Act of 200919 gives state and local governments legal authority to regulate the time, place, and manner of tobacco advertising. To date, state and local governments have attempted to ban tobacco displays and mandate graphic health warning signs at the POS. Tobacco product displays have been banned in Ireland, Canada, and Australia, but not in the United States. Studies show that graphic antismoking advertising can elicit strong emotional responses from smokers and influence them to quit.20 However, these studies have largely focused on media campaign advertising and cigarette pack warning labels, and it is unclear whether posting similar messages at the POS will have the same impact. In 2009, New York City required licensed tobacco retailers to post graphic warning signs at the POS. Coady et al. conducted street intercept surveys with adult smokers and recent quitters before and after policy implementation and found that signs increased awareness about the health risks of smoking and thoughts about quitting smoking but did not deter smokers from purchasing cigarettes.21 However, street intercept interviews are subject to social response bias and cannot adequately control for potential confounders.To test the potential impact of these policies on US adults, we designed a virtual store experiment. Virtual reality applications simulate real-world environments and are useful for studying behavioral responses to environmental cues that may be difficult to assess in a real-life setting.22–24 Virtual environments have been used to examine the impact of banning POS tobacco displays and ads on youths,25 consumer food-purchasing decisions,26 and the effects of smoking cues on cigarette cravings among adults.27,28 Virtual reality studies examining cravings in smokers suggest that these techniques may be more effective and have stronger ecological validity than traditional methods (e.g., photos) for triggering and assessing craving.28–32 We randomized adult smokers and recent quitters to virtual store conditions and had them conduct a shopping task to assess whether exposure to an enclosed tobacco product display and a graphic health warning sign decreased urges to smoke and tobacco purchase attempts.     

Role of the trauma nurse coordinator in Hong Kong

Background: Trauma is one of the leading causes of death for all ages in Hong Kong. In 2003, the Hospital Authority designated five hospitals as trauma centres. Five Trauma Nurse Coordinators (TNCs) were employed to facilitate multidisciplinary care and to coordinate all aspects of quality improvement for injured patients. The present paper investigates the characteristics and roles of TNCs in Hong Kong. Methods: A questionnaire was developed and sent to all TNCs in HK to ascertain information about demographic characteristics, education, job training, roles and the TNCs’ position within the organizational structure. Results: The TNCs were 30–40 years of age (four females); are experienced registered graduate nurses; hold post‐registration certificates or diplomas in emergency/critical care; and have 11–18 years nursing experience. All TNCs have pursued masters degrees, with two completed. Four of the TNCs had received formal training on computerized data management, abbreviated injury scale coding and trauma nurse coordination. TNCs averaged 2.5 years experience in their post. TNCs manage the trauma registry, are involved in clinical patient management, quality assurance activities, professional and public education and research. Conclusion: TNCs play an important role in trauma management in Hong Kong.     

Chronic allograft nephropathy in athymic nude rats after adoptive transfer of primed T lymphocytes

The impact of presensitized T lymphocytes on the development of chronic allograft nephropathy (CAN) was investigated in nude athymic LEW.RNU recipients of F344 renal allografts. The recipients (n = 8) were reconstituted with 5 x 10(7) T lymphocytes primed against donor skin grafts to induce graft rejection. LEW.RNU (n = 8) and euthymic LEW recipients (n = 6) which underwent no further intervention after transplantation served as control groups. Adoptive transfer of primed T cells induced CAN in LEW.RNU rats. Their kidney function decreased progressively. After 90 days a moderate glomerulopathy, tubular atrophy and interstitial fibrosis were observed, vascular changes were only mild or absent. Cellular infiltrates were predominated by CD4+ T cells and ED1+ macrophages. Deposition of tenascin and laminin was enhanced. Grafts of euthymic recipients displayed only mild signs of CAN according to the Banff criteria. These data implicate an important role for the cellular immune response in the development of CAN.     

Cooking birch pollen-related food: divergent consequences for IgE- and T cell-mediated reactivity in vitro and in vivo

BACKGROUND: The major birch pollen allergen Bet v 1 cross-reacts with homologous food allergens, resulting in IgE-mediated oral allergy syndromes (OASs). To avoid this food, allergy allergologists and guidebooks advise patients to consume birch pollen-related foods after heating. OBJECTIVE: We sought to evaluate whether cooked Bet v 1-related food allergens induce IgE- and T cell-mediated reactions in vitro and in vivo. METHODS: Recombinant Bet v 1, Mal d 1 (apple), Api g 1 (celery), and Dau c 1 (carrot) were incubated at increasing temperatures. Protein structures were determined by means of circular dichroism. Mediator release was tested in basophil activation assays. PBMCs and Bet v 1-specific T-cell lines with known epitope specificity were stimulated with native and cooked food allergens. Patients with birch pollen allergy who experienced OAS and the exacerbation of atopic dermatitis (AD) on ingestion of fresh apple, celery, or carrot were retested in double-blind, placebo-controlled food challenges with the respective foods in cooked form. RESULTS: In vitro, cooked food allergens lost the capacity to bind IgE and to induce mediator release but had the same potency to activate Bet v 1-specific T cells as native proteins. In vivo, ingestion of cooked birch pollen-related foods did not induce OAS but caused atopic eczema to worsen. CONCLUSION: T-cell cross-reactivity between Bet v 1 and related food allergens occurs independently of IgE cross-reactivity in vitro and in vivo. In patients with AD, the resulting immune reaction can even manifest as late eczematous skin reactions. Therefore the view that cooked pollen-related foods can be consumed without allergologic consequences should be reconsidered. CLINICAL IMPLICATIONS: Symptom-free consumed pollen-related food allergens might cause T cell-mediated late-phase skin reactions in patients with pollen allergy and AD.     

Parents' Contributions to Knowledge and Attitudes Regarding AIDS

Examined, in a sample of 170 students in Grades 1–12,relationships between parental background and socializationvariables and children's knowledge of AIDS risk factors andwillingness to interact with people who have AIDS. Most parentshad talked to their children about AIDS and supported earlyAIDS education, but were susceptible to common transmissionmyths. Age was the strongest predictor of a child's knowledgeand attitudes, but parent ethnicity, education, and occupationalstatus also contributed. Moreover, consistent with a "potentiation"model of socialization, parent knowledge of common transmissionmyths predicted child knowledge of those same myths only whenparent-child communication about AIDS was relatively frequent.     

Abnormal bone mineral content and density in people with tetrasomy 18p

Tetrasomy 18p is a rare chromosomal abnormality, resulting from an additional iso‐chromosome composed of two copies of the short arm. It is characterized by craniofacial abnormalities, neuromuscular dysfunction, and developmental delay. The Chromosome 18 Clinical Research Center has established the largest cohort of individuals with this rare genetic condition. Here, we describe a case series of 21 individuals with tetrasomy 18p who have a previously unreported clinical finding: low bone mineral density. Most individuals met criteria for low bone density despite being relatively young (mean age of 21 years). Clinicians providing care to individuals affected by Tetrasomy 18p should be aware of their increased risk for decreased bone density and pathological fractures.