This editorial aims to refine the severe polytrauma management principles. While keeping ABCDE priorities, the termination of futile resuscitation and the early use of tourniquet to stop exsanguinating limb bleeding are crucial. Difficult-airway-management (DAM) is by a structured 5-level approach. The computerised tomography (CT) scanner is the tunnel to death for hemodynamically unstable patients. Focused Abdominal Sonography for Trauma–Ultrasonography (FAST USG) has replaced diagnostic peritoneal lavage (DPL) and is expanding to USG life support. Direct whole-body multidetector-row computed tomography (MDCT) expedites diagnosis & treatment. Non-operative management is a viable option in rapid responders in shock. Damage control resuscitation comprising of permissive hypotension, hemostatic resuscitation & damage control surgery (DCS) help prevent the lethal triad of trauma. Massive transfusion protocol reduces mortality and decreases the blood requirement. DCS attains rapid correction of the deranged physiology. Mortality reduction in major pelvic disruption requires a multi-disciplinary protocol, the novel pre-peritoneal pelvic packing and the angio-embolization. When operation is the definitive treatment for injury, prevention is best therapy.

Methods: A total of 20 consecutive live patients awaiting lumbar surgery were subjected to two magnetic resonance imaging scans on the same day in both supine and lateral decubitus positions at a single center to investigate the anterior L5/S1 disk space. Results: The bare anterior L5/S1 disk window was present in all patients of this study population, and the mean width was 27 mm in the supine and 22 mm in the lateral decubitus position, with a mean reduction of 5.2 mm between the positions. The oblique corridor angle was measured at a mean of 33°. Conclusions The bare window of L5/S1 disk space was present within this population group, and it was found to be mobile and changed significantly with patient positioning. Therefore, the spine surgeon or the access surgeon must consider the increased potential vascular risk during disk access in lateral decubitus anterior lumbar interbody spinal fusion surgery.

Methods: In this retrospective study, 43 consecutive patients who underwent SI joint fusion between August 2017 and February 2020 were enrolled; 60 SI joints were fused. The patients’ fusion was documented on computed tomography or X-rays, and Visual Analog Scale (VAS) scores were used to determine patient subjective clinical outcomes. Results: A total of 60 joints were fused, including 26 joints fused using robotic guidance and 34 joints fused using the Stealth Navigation System. Student t-test was used to compare the mean preoperative VAS score (7.52±1.3) with the mean postoperative VAS score at the 12-month follow-up (1.43±1.22) (p<0.05). The SI joint fusion rate using this technique was 61% at 6 months, 96.4% at 12 months, and 100% at 18 months. Conclusions The use of navigation guidance or robotic assistance enables accurate percutaneous screw placement across the SI joint. The use of bone morphogenetic protein in the screw bore hastens fusion across the joint, improving patient-perceived pain.

PURPOSE: The objective of our study was to evaluate the immunohistochemical expression of p53 and bax proteins as prognostic markers in FIGO stage IIb invasive squamous cell carcinoma of the uterine cervix. MATERIALS AND METHODS: Sixty-five cases of squamous cell carcinoma of the cervix (stage IIb) that were diagnosed from October 1996 to December 2003 were analyzed retrospectively for the bax and p53 expression. These expressions were determined immunohistochemically and they were correlated to the patients' overall survival and disease-free survival. RESULTS: The overall 5-year survival (OS) rate and the disease-free survival (DFS) rate were 65.1% and 62.9%, respectively. p53 and bax immunoreactivity was seen in 26.2% and 52.3% of cases, respectively, with variable levels of expression. On the univariate analysis, only p53 positivity correlated with poor survival in DFS (log-rank test p=0.027), but this significance was not maintained on multivariated analysis by Cox's regression. The nine cases with the immunophenotype p53+/bax- had the poorest survival. CONCLUSION: Neither p53 nor bax expression are independent predictors of the prognosis for stage IIb cervical squamous cancers. Evaluation of p53 and bax co-expression may affect the clinical outcome and further investigation is needed.
bcl-2-Associated X Protein ; Carcinoma, Squamous Cell ; Cervix Uteri ; Disease-Free Survival ; Female ; Humans ; Prognosis ; Retrospective Studies

Although bipolar disorder is highly heritable, the identification of specific genetic variations is limited because of the complex traits underlying the disorder. We performed a genome-wide association study of bipolar disorder using a subphenotype that shows hypersomnia symptom during a major depressive episode. We investigated a total of 2,191 cases, 1,434 controls, and 703,012 single nucleotide polymorphisms (SNPs) in the merged samples obtained from the Translational Genomics Institute and the Genetic Association Information Network. The gene emerging as the most significant by statistical analysis was rs1553441 (odds ratio=0.4093; p=1.20x10-5; Permuted p=6.0x10-6). However, the 5x0-8 threshold for statistical significance required in a genome-wide association study was not achieved. The functional enrichment pathway analysis showed significant enrichments in the adhesion, development-related, synaptic transmission-related, and cell recognition-related pathways. For further evaluation, each gene of the enriched pathways was reviewed and matched with genes that were suggested to be associated with psychiatric disorders by previous genetic studies. We found that the cadherin 13 and hypocretin (orexin) receptor 2 genes may be involved in the hypersomnia symptom during a major depressive episode of bipolar disorder.
Bipolar Disorder* ; Disorders of Excessive Somnolence* ; Genetic Variation ; Genome-Wide Association Study ; Genomics ; Information Services ; Polymorphism, Single Nucleotide ; Orexins

PURPOSE: To evaluate the safety and efficacy of Medpor(R) SST(TM). The implant is composed of porous polyethylene with a smooth anterior surface with pre-drilled suture tunnels (SST) for attachment of extraocular muscles. METHODS: METHODS: Eight patients undergoing enucleation surgery received the unwrapped Medpor(R) SST(TM) orbital implant between August 2001 and December 2001. For each patient, data was acquired regarding complications, socket appearance and motility. RESULTS: Patients have been followed for 11 to 15 months. Socket healing was uneventful with no evidence of implant extrusion or migration. The socket motilities were better than grade 3 in all cases. The motilities of the prosthesis were grade 2 without peg insertion. CONCLUSIONS: The Medpor(R) SST(TM) orbital implant appears to be safe and to offer advantages over conventional implants.
Humans ; Muscles ; Orbital Implants ; Polyethylene ; Prostheses and Implants ; Sutures

BACKGROUND: Increasing rates of Clostridium difficile infection (CDI) have been reported mainly in Europe and North America; however, only limited reports have originated in Korea. The current epidemiology of CDI in the community could help to understand the outpatient healthcare environment and to extend infection control measures to outpatient settings. METHODS: C. difficile isolates in NHIS Ilsan Hospital from 2012 to 2014 were included in this study. Clinical characteristics, acquisition types, and previous antimicrobial therapy were obtained via Electronic Medical Records. C. difficile culture was performed only in unformed stool. Toxin was positive by enzyme-linked fluorescent immunoassay (ELFA) in 247 specimens. In addition, toxin B and binary toxin gene were detected by PCR in 57 specimens. CDI was defined by toxigenic C. difficile isolation in unformed stool. RESULTS: In the previous 3 years, 251 unduplicated C. difficile cases have been detected; 168 healthcare facility- associated hospital onset (HCFA-HO), 45 healthcare facility-associated community onset (HCFA-CO), and 38 community-associated (CA). Toxin positive rates by ELFA for toxin A&B were HCFA-HO 50.6% (84/166), HCFA-CO 41.9% (18/43), and CA 42.1% (16/38). Toxin positive rate by PCR for tcdB were HCFA-HO 62.9% (22/35), HCFA-CO 69.2% (9/13), and CA 100% (9/9). No binary toxin (cdtA/cdtB) was detected in 57 cases. CONCLUSION: Community-associated CDI may be underestimated in Goyang province, Korea, especially by commonly used ELFA toxin assay. The spread of community-associated CDI should be recognized as an increasing burden of public health.
Clostridium difficile* ; Clostridium* ; Community-Acquired Infections ; Delivery of Health Care ; Electronic Health Records ; Epidemiology ; Europe ; Humans ; Immunoassay ; Infection Control ; Korea ; North America ; Outpatients ; Polymerase Chain Reaction ; Public Health*

Primary papillary serous carcinoma of the peritoneum(PPSCP) is vere rare. It has been suggested that PPSCP derives from embryonal coelomic epithelium with m llerian ducts potential. PPSCP can develop from a single or multicentric focus. The clinical and histologic disease entities are similar to those of primary papillary serous carcinoma of the ovary, but PPSCP involves the ovarian surface only minimally(microscopic disease) or spares the ovaries entirely. We have experienced a case of primary papillary serous carcinoma of the peritoneum and report this case with brief review of the concerned literature.
Epithelium ; Female ; Ovary ; Peritoneum*

Avian pathogenic Escherichia coli (APEC) are known to cause extraintestinal disease in poultry, leading to substantial losses in the industry. IutA, iron-regulated aerobactin receptor is firmly associated with APEC. To assess the potential of IutA to induce protective immune responses, attenuated Salmonella Typhimurium strain expressing IutA was constructed and administered orally to BALB/c mice. The IutA-specific immune responses were measured with sera, vaginal and fecal samples by an enzyme-linked immunosorbent assay. We found that the Salmonella-IutA vaccine induced significantly higher immune responses as compared to the control inoculated with the attenuated S. Typhimurium containing the plasmid only. The IutA-specific immune responses were increased by second immunization at third week after initial immunization, whereas triple immunization induced lower immune responses than those induced by the double immunization. The Salmonella-IutA vaccine induced a nature of immunity biased to the Th1-type, as judged by the ratio of IutA-specific IgG isotypes (IgG2a/IgG1). Overall, these results suggest that the Salmonella-IutA vaccine appear to be suitable candidate for a vaccine against APEC.
Animals ; Bacterial Outer Membrane Proteins ; Bias (Epidemiology) ; Enzyme-Linked Immunosorbent Assay ; Escherichia coli ; Immunity, Mucosal* ; Immunization ; Immunoglobulin G ; Mice* ; Plasmids ; Poultry ; Salmonella typhimurium* ; Salmonella*

No abstract available.
Bone Marrow/pathology ; Burkitt Lymphoma/*diagnosis/genetics ; Child ; Chromosomes, Human, Pair 1 ; Female ; Flow Cytometry ; Humans ; Immunoglobulin Heavy Chains/genetics ; Isochromosomes/*genetics ; Karyotype ; Karyotyping ; Proto-Oncogene Proteins c-myc/genetics ; Republic of Korea ; Translocation, Genetic