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.

Purpose: The aim of the study was to investigate whether wearing a forearm compression sleeve during robotic surgery (RS) reduces muscle fatigue. Methods: A randomized controlled study of consecutive RS cases was performed with three right-handed surgeons randomly allocated to wear a non-graduated compression sleeve over either his right or left forearm. Hand-grip strength was assessed at the beginning and at the 2-hour mark during the robotic console component of surgery, using a handgrip dynamometer.The maximum strength (Fmax ) and mean grip strength (Fmean ) were calculated after 10 measurements. Effectiveness of the forearm sleeve was tested primarily by the difference in mean grip strength, and secondarily by the difference in fatigue ratio (Fmax /Fmean ) and recovery ratio at the two time points. Results: Thirty-two robotic cases were performed during the study period. Wearing of a compression sleeve (compared with no sleeve) on the left forearm resulted in an increase (rather than a decrease) in mean hand-grip strength after 2 hours of RS (0.5 kg increase vs.1.3 kg decrease, p = 0.03; 95% confidence interval, 0.20–∞). Wearing a compression sleeve (compared with no sleeve) on the right forearm did not result in an improvement in grip strength reduction (1.7 kg decrease vs. 1.1 kg decrease, p = 0.79). Conclusion There was a statistically significant reduction in muscle fatigue with wearing a forearm compression sleeve on the nondominant left forearm during RS.

Purpose: The aim of the study was to investigate whether wearing a forearm compression sleeve during robotic surgery (RS) reduces muscle fatigue. Methods: A randomized controlled study of consecutive RS cases was performed with three right-handed surgeons randomly allocated to wear a non-graduated compression sleeve over either his right or left forearm. Hand-grip strength was assessed at the beginning and at the 2-hour mark during the robotic console component of surgery, using a handgrip dynamometer.The maximum strength (Fmax ) and mean grip strength (Fmean ) were calculated after 10 measurements. Effectiveness of the forearm sleeve was tested primarily by the difference in mean grip strength, and secondarily by the difference in fatigue ratio (Fmax /Fmean ) and recovery ratio at the two time points. Results: Thirty-two robotic cases were performed during the study period. Wearing of a compression sleeve (compared with no sleeve) on the left forearm resulted in an increase (rather than a decrease) in mean hand-grip strength after 2 hours of RS (0.5 kg increase vs.1.3 kg decrease, p = 0.03; 95% confidence interval, 0.20–∞). Wearing a compression sleeve (compared with no sleeve) on the right forearm did not result in an improvement in grip strength reduction (1.7 kg decrease vs. 1.1 kg decrease, p = 0.79). Conclusion There was a statistically significant reduction in muscle fatigue with wearing a forearm compression sleeve on the nondominant left forearm during RS.

Purpose: The aim of the study was to investigate whether wearing a forearm compression sleeve during robotic surgery (RS) reduces muscle fatigue. Methods: A randomized controlled study of consecutive RS cases was performed with three right-handed surgeons randomly allocated to wear a non-graduated compression sleeve over either his right or left forearm. Hand-grip strength was assessed at the beginning and at the 2-hour mark during the robotic console component of surgery, using a handgrip dynamometer.The maximum strength (Fmax ) and mean grip strength (Fmean ) were calculated after 10 measurements. Effectiveness of the forearm sleeve was tested primarily by the difference in mean grip strength, and secondarily by the difference in fatigue ratio (Fmax /Fmean ) and recovery ratio at the two time points. Results: Thirty-two robotic cases were performed during the study period. Wearing of a compression sleeve (compared with no sleeve) on the left forearm resulted in an increase (rather than a decrease) in mean hand-grip strength after 2 hours of RS (0.5 kg increase vs.1.3 kg decrease, p = 0.03; 95% confidence interval, 0.20–∞). Wearing a compression sleeve (compared with no sleeve) on the right forearm did not result in an improvement in grip strength reduction (1.7 kg decrease vs. 1.1 kg decrease, p = 0.79). Conclusion There was a statistically significant reduction in muscle fatigue with wearing a forearm compression sleeve on the nondominant left forearm during RS.

BACKGROUNDIn general vagus nerve stimulation (VNS) can serve as an adjunctive treatment for patients with refractory partial-onset seizures. And we evaluated the long-term efficacy and safety of VNS in a group of Chinese patients with refractory epilepsy.

METHODSOf 127 patients with refractory epilepsy, 13 patients who were not eligible for surgical intervention were implanted with the Cyberonics VNS system. Seizure frequency, physical examination and side effects profile were recorded at follow-up visits for a minimum of 18 months.

RESULTSMean duration of treatment was 47.4 months, and the longest follow-up period was 71 months. Mean baseline seizure frequency was 26.6 seizures per month. The mean percentage reductions in convulsions were 33.2%, 47.1% and 40.0% at 6, 12 and 18 months, respectively. One patient became seizure free, and six (46%) had 50% or more reduction in seizure frequency. Response was poor (< 20% reduction) in five patients (39%). Side effects were uncommon.

CONCLUSIONSThe effectiveness of VNS was sustained and was well tolerated but benefited only a sub-group of patients with intractable convulsions.

Adolescent ; Adult ; Electric Stimulation Therapy ; methods ; Epilepsy ; therapy ; Female ; Follow-Up Studies ; Humans ; Male ; Prospective Studies ; Prostheses and Implants ; Treatment Outcome ; Vagus Nerve ; physiology

Vitamin D is essential for maintaining calcium and phosphate homeostasis, and vitamin D analogues have been prescribed to treat osteoporosis and hyperparathyroidism. Emerging evidence suggests that cardiovascular and chronic kidney diseases are closely associated with vitamin D deficiency resulting from either decreased sunshine exposure or inadequate intake. Vitamin D is through stimulating vitamin D receptor to form a transcriptional complex with cofactors to modulate approximately 3% gene transcription. For example, renin, matrix metalloprotease, and tumor necrosis factor-α are regulated by vitamin D. Both experimental and clinical studies support the health benefits of vitamin D in the cardiovascular system, and such benefits include protecting cardiac function, lowering blood pressure, improving endothelial function, inhibiting oxidative stress, and reducing the activity of renin-angiotensin system. This article will briefly review the cardiovascular benefits of vitamin D and its bioactive analogues and discuss the novel cellular and molecular mechanisms accounting for cardiovascular protection.
Blood Pressure ; Calcium ; physiology ; Cardiovascular Diseases ; physiopathology ; Cardiovascular Physiological Phenomena ; Endothelium, Vascular ; physiology ; physiopathology ; Humans ; Oxidative Stress ; Receptors, Calcitriol ; physiology ; Renin-Angiotensin System ; Vitamin D ; analogs & derivatives ; physiology ; Vitamin D Deficiency ; physiopathology

Outdoor air pollution has been recently classified as a class I human carcinogen by the World Health Organization (WHO). Cumulative evidence from across the globe shows that polluted air is associated with increased risk of lung, head and neck, and nasopharyngeal cancers--all of which affect the upper aerodigestive tract. Importantly, these cancers have been previously linked to smoking. In this article, we review epidemiologic and experimental evidence of the genotoxic and mutagenic effects of air pollution on DNA, purportedly a key mechanism for cancer development. The alarming increase in cancers of the upper aerodigestive tract in Asia suggests a need to focus government efforts and research on reducing air pollution, promoting clean energy, and investigating the carcinogenic effects of air pollution on humans.
Air Pollution ; adverse effects ; Asia ; Carcinogens ; DNA Damage ; Head and Neck Neoplasms ; Humans ; Lung Neoplasms ; Mutagenesis ; Nasopharyngeal Neoplasms ; Smoking

Background: s/Aims: Plasma pregenomic hepatitis B virus RNA (pgRNA) is a novel biomarker in chronic hepatitis B infection (CHB). We aimed to describe the longitudinal profile of pgRNA and factors influencing its levels in CHB patients on nucleoside analogue (NUC). Methods: Serial plasma samples from 1,354 CHB patients started on first-line NUC were evaluated. Time of NUC initiation was taken as baseline (year 0), followed by 1-year, 3-year and 5-year of NUC therapy. pgRNA was measured by Research Use Only RealTime HBV RNA v2.0 (0.2 mL) (Abbott Diagnostics) with lower limit of detection of 0.8 log U/mL (~20 copies/mL). Results: Among 1,354 subjects (median age at baseline 49.8 [interquartile range, IQR 40.2–57.3]) years, 65.2% male, 16.1% hepatitis B e antigen (HBeAg)-positive, 28.6% cirrhotic), baseline median HBV RNA was 3.68 (IQR 2.42–5.19) log U/mL. Upon NUC therapy, median pgRNA levels were 2.45 (IQR 1.82–3.62), 2.23 (IQR 1.67–3.05) and 2.14 (IQR 1.48–2.86) log U/mL at 1, 3 and 5 years, respectively, with the corresponding log U/mL reductions of 0.82, 1.20 and 1.54. Undetectable/ unquantifiable pgRNA was achieved in 13.5%, 15.9% and 20.1% of patients at 1, 3 and 5 years, respectively. Older age, male sex, HBeAg-negativity and high PAGE-B score were associated with lower pgRNA. Conclusions Plasma pgRNA declines are modest under NUC therapy, with only 16.3% achieving RNA undetectability after 5 years of first-line NUC indicating cccDNA silencing has not been achieved in the majority of patients. Clinical characteristics should be taken into consideration when interpreting the plasma pgRNA level.

Background: s/Aims: Plasma pregenomic hepatitis B virus RNA (pgRNA) is a novel biomarker in chronic hepatitis B infection (CHB). We aimed to describe the longitudinal profile of pgRNA and factors influencing its levels in CHB patients on nucleoside analogue (NUC). Methods: Serial plasma samples from 1,354 CHB patients started on first-line NUC were evaluated. Time of NUC initiation was taken as baseline (year 0), followed by 1-year, 3-year and 5-year of NUC therapy. pgRNA was measured by Research Use Only RealTime HBV RNA v2.0 (0.2 mL) (Abbott Diagnostics) with lower limit of detection of 0.8 log U/mL (~20 copies/mL). Results: Among 1,354 subjects (median age at baseline 49.8 [interquartile range, IQR 40.2–57.3]) years, 65.2% male, 16.1% hepatitis B e antigen (HBeAg)-positive, 28.6% cirrhotic), baseline median HBV RNA was 3.68 (IQR 2.42–5.19) log U/mL. Upon NUC therapy, median pgRNA levels were 2.45 (IQR 1.82–3.62), 2.23 (IQR 1.67–3.05) and 2.14 (IQR 1.48–2.86) log U/mL at 1, 3 and 5 years, respectively, with the corresponding log U/mL reductions of 0.82, 1.20 and 1.54. Undetectable/ unquantifiable pgRNA was achieved in 13.5%, 15.9% and 20.1% of patients at 1, 3 and 5 years, respectively. Older age, male sex, HBeAg-negativity and high PAGE-B score were associated with lower pgRNA. Conclusions Plasma pgRNA declines are modest under NUC therapy, with only 16.3% achieving RNA undetectability after 5 years of first-line NUC indicating cccDNA silencing has not been achieved in the majority of patients. Clinical characteristics should be taken into consideration when interpreting the plasma pgRNA level.

Background: s/Aims: Plasma pregenomic hepatitis B virus RNA (pgRNA) is a novel biomarker in chronic hepatitis B infection (CHB). We aimed to describe the longitudinal profile of pgRNA and factors influencing its levels in CHB patients on nucleoside analogue (NUC). Methods: Serial plasma samples from 1,354 CHB patients started on first-line NUC were evaluated. Time of NUC initiation was taken as baseline (year 0), followed by 1-year, 3-year and 5-year of NUC therapy. pgRNA was measured by Research Use Only RealTime HBV RNA v2.0 (0.2 mL) (Abbott Diagnostics) with lower limit of detection of 0.8 log U/mL (~20 copies/mL). Results: Among 1,354 subjects (median age at baseline 49.8 [interquartile range, IQR 40.2–57.3]) years, 65.2% male, 16.1% hepatitis B e antigen (HBeAg)-positive, 28.6% cirrhotic), baseline median HBV RNA was 3.68 (IQR 2.42–5.19) log U/mL. Upon NUC therapy, median pgRNA levels were 2.45 (IQR 1.82–3.62), 2.23 (IQR 1.67–3.05) and 2.14 (IQR 1.48–2.86) log U/mL at 1, 3 and 5 years, respectively, with the corresponding log U/mL reductions of 0.82, 1.20 and 1.54. Undetectable/ unquantifiable pgRNA was achieved in 13.5%, 15.9% and 20.1% of patients at 1, 3 and 5 years, respectively. Older age, male sex, HBeAg-negativity and high PAGE-B score were associated with lower pgRNA. Conclusions Plasma pgRNA declines are modest under NUC therapy, with only 16.3% achieving RNA undetectability after 5 years of first-line NUC indicating cccDNA silencing has not been achieved in the majority of patients. Clinical characteristics should be taken into consideration when interpreting the plasma pgRNA level.