Is Sub-occipital Padding Necessary to Maintain Optimal Alignment of the Unstable Spine in the Prehospital Setting? A Preliminary Report

Background

As prehospital emergency rescuers prepare cervical spine-injured adult patients for immobilization and transport to hospital, it is essential that patients be placed in a favorable position. Previously, it was recommended that patients with cervical spine injuries be immobilized in a slightly flexed position using pads placed beneath the head. However, it is unknown how neck flexion created with pad placement affects the unstable spine.

Objective

To determine the effects of three different head positions on the alignment of unstable vertebral segments.

Methods

Five cadavers with a complete segmental instability at the C5 and C6 level were included in the study. The head was either placed directly on the ground (or spine board) or on foam pads. Three conditions were tested: no pad; pads 2.84 cm thick; and pads 4.26 cm thick. Pads were positioned beneath the head to determine their effect on spinal alignment. Anterior-posterior translation, flexion-extension motion, and axial displacement across the unstable segment were compared between conditions.

Results

Although statistical tests failed to identify any significant differences between pad conditions, some meaningful results were noted. In general, the “no pad” condition aligned the spine in a position that best replicated the intact spine.

Conclusions

Because the goal of emergency rescuers is to conserve whatever physiologic or structural integrity of the spinal cord and spinal column that remains, the outcome of this study suggests that this goal may be best achieved using the “no pad” condition. However, it is recommended that more research be conducted to confirm these preliminary findings.     

P REHOSPITAL A IRWAY M ANAGEMENT WITH THE L ARYNGEAL M ASK A IRWAY IN P OLYTRAUMATIZED P ATIENTS

Abstract

Background. Thermal protective clothing (TPC) worn by firefighters provides considerable protection from the external environment during structural fire suppression. However, TPC is associated with physiologic derangements that may have adverse cardiovascular consequences. These derangements should be treated during on-scene rehabilitation periods. Objective. To examine heart rate and core temperature responses during the application of four active cooling devices, currently being marketed to the fire service for on-scene rehabilitation, and compare them with passive cooling in a moderate temperature (approximately 24°C) and with an infusion of cold (4°C) saline. Methods. Subjects exercised while they were wearing TPC in a heated room. Following an initial exercise period (bout 1), the subjects exited the room, removed the TPC, and for 20 minutes cooled passively at room temperature, received an infusion of cold normal saline, or were cooled by one of four devices (fan, forearm immersion in water, hand cooling, or water-perfused cooling vest). After cooling, the subjects donned the TPC and entered the heated room for another 50-minute exercise period (bout 2). Results. The subjects were not able to fully recover core temperature during a 20-minute rehabilitation period when provided rehydration and the opportunity to completely remove the TPC. Exercise durations were shorter during bout 2 when compared with bout 1 but did not differ by cooling intervention. The overall magnitudes and rates of cooling and heart rate recovery did not differ by intervention. Conclusions. No clear advantage was identified when active cooling devices and cold intravenous saline were compared with passive cooling in a moderate temperature after treadmill exercise in TPC.     

A fast and effective method of quantifying myocardial perfusion by magnetic resonance imaging

The quantification of global myocardial blood flow (MBF) by measuring coronary sinus flow by magnetic resonance (MRI) was demonstrated to be very well correlated with positron emission tomography (PET). We proposed a new method for the quantification of regional myocardial perfusion with MRI by the integration of MBF and first pass technique. The aim of this study was to validate this new method for quantification of regional perfusion by comparing it with 13NH13-PET in swine models of myocardial infarction and in humans in resting and hyperemic conditions. MRI and 13NH3-PET was performed in 2 healthy swine, 11 swine models of myocardial infarction (5 reperfused, 6 non reperfused) and in 12 humans at rest and during hyperemia. MBF was estimated by MRI through the quantification of coronary sinus flow and left ventricular (LV) mass. The upslope of signal intensity (SI-upslope) of each myocardial segment was obtained by the first pass gadolinium technique. Regional SI-upslope was indexed by the upslope of the entire left ventricular myocardium (global upslope). Regional myocardial perfusion was estimated as the product of MBF and SI-upslope/global upslope. Regional perfusion was also estimated by 13NH3-PET. A close agreement of the MRI and PET techniques for measurement of regional myocardial perfusion was found in all myocardial segments by Bland–Altman analysis (mean difference 5.1 %; limits of agreement, ?37.2–27.5 %). With the integration of the first pass technique and the measurement of global MBF by coronary sinus flow/LV mass, MRI allows direct quantification of regional myocardial perfusion.     

Long-term outcomes from the phase II L-MIND study of tafasitamab (MOR208) plus lenalidomide in patients with relapsed or refractory diffuse large B-cell lymphoma

Tafasitamab (MOR208), an Fc-modified, humanized, anti-CD19 monoclonal antibody, combined with the immunomodulatory drug lenalidomide was clinically active with a good tolerability profile in the open-label, single-arm, phase II L-MIND study of patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL) ineligible for autologous stem-cell transplantation. To assess long-term outcomes, we report an updated analysis with ≥35 months’ follow-up. Patients were aged >18 years, had received one to three prior systemic therapies (including ≥1 CD20-targeting regimen) and Eastern Cooperative Oncology Group performance status 0-2. Patients received 28-day cycles of tafasitamab (12 mg/kg intravenously), once weekly during cycles 1-3, then every 2 weeks during cycles 4-12. Lenalidomide (25 mg orally) was administered on days 1-21 of cycles 1-12. After cycle 12, progression-free patients received tafasitamab every 2 weeks until disease progression. The primary endpoint was best objective response rate. After ≥35 months’ follow-up (data cut-off: October 30, 2020), the objective response rate was 57.5% (n=46/80), including a complete response in 40.0% of patients (n=32/80) and a partial response in 17.5% of patients (n=14/80). The median duration of response was 43.9 months (95% confidence interval [95% CI]: 26.1-not reached), the median overall survival was 33.5 months (95% CI: 18.3-not reached) and the median progression-free survival was 11.6 months (95% CI: 6.3-45.7). There were no unexpected toxicities. Subgroup analyses revealed consistent long-term efficacy results across most subgroups of patients. This extended follow-up of L-MIND confirms the long duration of response, meaningful overall survival, and well-defined safety profile of tafasitamab plus lenalidomide followed by tafasitamab monotherapy in patients with relapsed/refractory diffuse large B-cell lymphoma ineligible for autologous stem cell transplantation. ClinicalTrials.gov identifier: {"type":"clinical-trial","attrs":{"text":"NCT02399085","term_id":"NCT02399085"}}NCT02399085.     

Oxidative stress and the pathogenesis of scleroderma: the Murrell’s hypothesis revisited

Systemic sclerosis (SSc, scleroderma) is a devastating, immune-mediated, multisystem disorder characterized by microvasculature damage, circulating autoantibodies, and fibroblast activation, leading to massive fibrosis of skin, vessels, muscles, and visceral organs. Scleroderma causes disability and death as the result of end-stage organ failure. At present, no specific diagnostic nor therapeutic tools are available to handle the disease. In spite of significant effort, the etiology and pathogenesis of SSc remain obscure and, consequently, the disease outcome is unpredictable. Several years ago, Murrell suggested a unifying hypothesis linking the pathogenesis of scleroderma to the generation of a large excess of reactive oxygen species. This hypothesis has been substantiated by several reports indicating the presence of an abnormal redox state in patients with scleroderma. This review will summarize the available evidence supporting the link between free radicals and the main pathological features of scleroderma.     

A novel multiphase anodic spark deposition coating for the improvement of orthopedic implant osseointegration: an experimental study in cortical bone of sheep

The effect of a new three-step anodic spark deposition process, labeled TiSpark, including two consecutive treatments performed first in a P solution and second in Ca solution, followed by an additional alkali etching step, was investigated for the improvement of osseointegration of commercial grade 2 titanium, machined (Ti) or Al(2)O(3) sandblasted (Ti-SA), cylindrical implants (12 mm in length and 4 mm in diameter) in cortical bone of 12 adult sheep. Histomorphometric and microhardness measurements were carried out at each experimental time (4, 8, and 12 weeks) to quantify the bone-to-implant contact around the implants as well as the newly bone hardness and bone maturation index. TiSpark treated surfaces were covered by a thick layer of crystalline anatase TiO(2) and by a further Ca/P layer. Bone tissue extends and grows on the surface of the TiSpark treated implants without any fibrous tissue, enhancing the short-term osseointegration properties of implant. Bone mineralization rate was also influenced by the chemical composition of implants and sandblasted materials presented the lowest bone maturation rate at the interface. Data suggests that the TiSpark treatment produces a modification of the Ti surface, which presents good bioactivity and may be suitable for achieving a stable implant osseointegration.     

A subset of lung adenocarcinomas and atypical adenomatous hyperplasia-associated foci are genotypically related: an EGFR, HER2, and K-ras mutational analysis

Atypical adenomatous hyperplasia (AAH) is considered the preinvasive lesion of pulmonary adenocarcinoma, and mutations of EGFR, HER2, and K-ras are involved in the early stage of lung adenocarcinoma carcinogenesis, also predicting clinical response to anti-EGFR small molecule inhibitors. We analyzed 18 cases of primary lung adenocarcinoma with concomitant AAH foci from 13 patients for mutations of EGFR (exons 18-21), HER2 (exons 19-20), and K-ras (exon 2) by direct sequencing polymerase chain reaction. Among mutated cases, concordant mutations of EGFR or K-ras in adenocarcinoma and related AAH were observed in 5 (63%) of 8 cases. In particular, 3 of 4 adenocarcinomas with EGFR mutations (all L858R point mutations in women, never or former smokers) had a concomitant and identical mutation in AAH, and 2 of 4 adenocarcinomas with K-ras mutations (both at codon 12 in women, a never and a current smoker) showed the same mutation in concomitant AAH. All cases were wild-type for HER2. Mutations of EGFR and K-ras genes represent an early event in lung adenocarcinomagenesis, and AAH convincingly seems to be a precursor lesion in a subset of cases of adenocarcinoma.     

Impact of anxiety disorder comorbidity on quality of life in euthymic bipolar disorder patients: differences between bipolar I and II subtypes

BACKGROUND: Few studies investigated the impact of anxiety disorder comorbidity on health-related quality of life (HRQoL) of bipolar patients and none examined bipolar subtypes differences. The aim of the study was 1) to determine comorbidity rates for anxiety disorders in euthymic bipolar subjects, comparing bipolar type I and II disorders (BDI and BDII), and 2) to compare within each group HRQoL measures in subjects with and without anxiety comorbidity. METHODS: Comorbidity was evaluated through the SCID-I; HRQoL was assessed using the 36-Item Short-Form Health Survey (SF-36). All subjects were euthymic since at least 2 months, as confirmed by a HAM-D <8 and a YMRS <6. A comparison was made for SF-36 scores between subjects (all bipolars, BDI and BDII) with and without anxiety disorders. RESULTS: 105 patients were enrolled: 44 with BDI and 61 with BDII. Current and lifetime anxiety disorders comorbidities were 32.4% and 41.0% for all bipolars, 31.8% and 40.9% for BDI and 32.8% and 41.0% for BDII. BDI patients differed in several SF-36 domains from BDII subjects, which reported a poorer HRQoL. A current and lifetime comorbid anxiety disorder was associated with a poorer HRQoL considering all bipolars; when examining separately BDI and II subjects, however, the deleterious effect was restricted to BDI patients. LIMITATIONS: The cross-sectional assessment of HRQoL, the generic instrument used (SF-36) and the small sample size. CONCLUSIONS: Our study confirms the high comorbidity rates for anxiety disorders in bipolar subjects and provides evidence that anxiety comorbidity impacts HRQoL in subjects with BDI and not BDII.     

Reference frame conversions for repeated arm movements

The aim of this study was to further understand how the brain represents spatial information for shaping aiming movements to targets. Both behavioral and neurophysiological studies have shown that the brain represents spatial memory for reaching targets in an eye-fixed frame. To date, these studies have only shown how the brain stores and updates target locations for generating a single arm movement. But once a target's location has been computed relative to the hand to program a pointing movement, is that information reused for subsequent movements to the same location? Or is the remembered target location reconverted from eye to motor coordinates each time a pointing movement is made? To test between these two possibilities, we had subjects point twice to the remembered location of a previously foveated target after shifting their gaze to the opposite side of the target site before each pointing movement. When we compared the direction of pointing errors for the second movement to those of the first, we found that errors for each movement varied as a function of current gaze so that pointing endpoints fell on opposite sides of the remembered target site in the same trial. Our results suggest that when shaping multiple pointing movements to the same location the brain does not use information from the previous arm movement such as an arm-fixed representation of the target but instead mainly uses the updated eye-fixed representation of the target to recalculate its location into the appropriate motor frame.     

Prevalence and risk factors for viral hepatitis in the Kosovarian population: implications for health policy

The prevalence of hepatitis infection among the Kosovarian population is largely unknown. The aim of the study was to evaluate the prevalence and risk factors of hepatitis A, B, C, and D (HAV, HBV, HCV, HDV) infection among the general population and in a group of health care workers in the Kosovo region. Overall, 1,287 participants were recruited, 460 males (36%) and 827 females (64%). Health care workers accounted for 253 individuals (20%), 301 were blood donor candidates (23%), 334 were pregnant women (26%), and 399 (31%) were subjects who had been examined in two clinics for routine laboratory testing. The prevalence of total anti-HAV was 88.6% (95% CI: 86.69-90.25). Prevalence of anti-HAV among children up to 10 years was 40.5% (95% CI: 29.6-53.15), reaching 70% (95% CI: 62.25-77.10) in the 11-20 age group. Age, living in rural areas and unemployment were factors associated with higher risk of HAV infection. HBsAg was detected in 2.4% (95% CI: 1.57-3.38%) of the study sample, with a significant age trend (P-value:0.0110). Positivity for total anti-HBc was detected in 18.4% (95% CI = 16.27-20.59) of the subjects. Ninety-three subjects (7.2%) were positive for anti-HBs alone. An association between age, HSV-2 positivity, working nurses and HBV infection has been observed. One patient was HDV positive. The prevalence for HCV was 0.5% (95% CI: 0.22-1.12%). HAV infection seems to be high-intermediate, while HBV shows an intermediate endemicity. It is necessary to highlight the importance of an immunization strategy against HAV and HBV in reducing the incidence of the infection. The prevalence for HCV was very low.