Primary management of maxillofacial hard and soft tissue gunshot and shrapnel injuries

PURPOSE: A 10-year retrospective study was undertaken of all patients treated for facial gunshot and shrapnel wounds at our medical center to evaluate the outcomes and assess the results of simultaneous management to treat the hard and soft tissue injuries primarily. PATIENTS AND METHODS: A total of 44 patients were treated. Medical documentation of the patients was compiled. All maxillofacial gunshot, shrapnel, and warfare injuries were treated by the oral and maxillofacial surgeon. Other concomitant bodily injuries were treated by pertinent consultant specialists. Patients ranged in age from 8 to 53 years, with a mean age of 24.7 years. Maxillofacial hard and soft tissue injuries were treated definitively in the first operation except when gross contamination, infection, extensive comminution, or general condition precluded this. RESULTS: There were 2 shotgun, 28 bullet, 10 shrapnel, 3 land mine, and 1 breech block injuries. Overall postadmission mortality in this series was 2.2%. Of the 97.7% of the patients who had an injury to the underlying craniofacial skeleton, all required surgical intervention. The soft tissue and underlying bony injuries were addressed concomitantly (in a single stage at the time of primary surgical debridement) in 86.3% of the patients. Nine percent of the patients had a tracheostomy emergently for management of the airway, 6.8% had an intracranial injury, and 2.2% of them required neurosurgery. In the series, 4.5% of the patients had neck wounds that required exploration. Comprehensive treatment was rendered in 1 to 3 major operations (average, 1.5). CONCLUSION: All patients in this series required surgical intervention for treatment of their facial gunshot wounds. Primary treatment of hard and soft tissue injuries of the face at the time of surgical debridement was possible in the majority of our patients. This minimized the number of admissions and did not bear a higher complication rate than other reported series that advocate multiple staged operations to treat such injuries despite the fact that, in our series, flaps were also mobilized for wound closure in the primary phase.     

Probiotic Supplementation and High-Intensity Interval Training Modify Anxiety-Like Behaviors and Corticosterone in High-Fat Diet-Induced Obesity Mice

Evidence supports the role of exercise training and probiotics on reducing obesity. Considering the relationship between obesity and high-fat diet with anxiety indices, the aim of this study was to assess the effect of probiotic supplementation and high-intensity interval training (HIIT) on anxiety-like behaviors, corticosterone and obesity indices in high-fat diet (HFD)-induced obesity mice. Thirty male adult C57BL/6 mice were randomly divided into five groups: (1) Control with normal diet (CON), (2) High-fat diet (HFD), (3) HFD + exercise training (HT), (4) HFD + probiotics supplement (HP) and (5) HFD + exercise training +probiotics (HTP). Exercise training consisted of 8 weeks of high-intensity interval training (HIIT) programs. Probiotics supplement included 0.2 mL Lactobacillus rhamnosus GG. Anxiety-like behaviors were measured by open field (OF) and Elevated plus maze (EPM). OF and EPM tests, visceral fat mass (VFM) measurement, and blood sampling for corticosterone were performed after the intervention. Bodyweight was measured at different stages during the intervention. HFD regime in C57BL/6 mice increased bodyweight, VFM, and serum corticosterone levels and anxiety-like behaviors (p < 0.05). HIIT, probiotic and their combination, decreased bodyweight, VFM, and serum corticosterone levels and improved anxiety-like behavior in the HFD mice (p < 0.05). The effect of a combination of HIIT and probiotic on most of the anxiety indices was more than each one separately (p < 0.5). HIIT and probiotic supplements separately or above all in combination, may have beneficial effects in reducing obesity and anxiety indices.     

Screening for neurocognitive impairment in HIV-positive adults aged 50 years and older: Montreal Cognitive Assessment relates to self-reported and clinician-rated everyday functioning

As the HIV+ population ages, the risk for and need to screen for HIV-associated neurocognitive disorders (HAND) increases. The aim of this study is to determine the utility and ecological validity of the Montreal Cognitive Assessment (MoCA) among older HIV+ adults. A total of 100 HIV+ older adults aged 50 years or over completed a comprehensive neuromedical and neurocognitive battery, including the MoCA and several everyday functioning measures. The receiver operating characteristic curve indicates ≤26 as the optimal cut-off balancing sensitivity (84.2%) and specificity (55.8%) compared to “gold standard” impairment as measured on a comprehensive neuropsychological battery. Higher MoCA total scores are significantly (p < .01) associated with better performance in all individual cognitive domains except motor abilities, with the strongest association with executive functions (r = ?0.49, p < .01). Higher MoCA total scores are also significantly (p <.01) associated with fewer instrumental activities of daily living declines (r = ?0.28), fewer everyday cognitive symptoms (r = ?0.25), and better clinician-rated functional status (i.e., Karnofsky scores; r = 0.28); these associations remain when controlling for depressive symptoms. HIV+ individuals who are neurocognitively normal demonstrate medium-to-large effect size differences in their MoCA performance compared to those with asymptomatic neurocognitive impairment (d = 0.85) or syndromic HAND (mild neurocognitive disorder or HIV-associated dementia; d = 0.78), while the latter two categories do not differ. Although limited by less than optimal specificity, the MoCA demonstrates good sensitivity and ecological validity, which lends support to its psychometric integrity as a brief cognitive screening tool among older HIV+ adults.