Sources of Mortality in Bald Eagles in Michigan, 1986–2017

As bald eagle populations recover, defining major sources of mortality provides managers important information to develop management plans and mitigation efforts. We obtained data from necropsies on 1,490 dead bald eagles (Haliaeetus leucocephalus) collected in Michigan, USA, conducted from 1986 to 2017 to determine causes of death (COD). Trauma and poisoning were the most common primary COD categories, followed by disease. Within trauma and poisoning, vehicular trauma (n = 532) and lead poisoning (n = 176) were the leading COD subcategories, respectively. Females comprised a greater number of carcasses for most COD diagnoses. The proportion of trauma and poisoning CODs significantly increased in the last few years of the study in comparison to a select few years at the beginning. Trauma CODs were greater in autumn months during whitetail deer (Odocoileus virginianus) breeding and hunting seasons and in February, when aquatic foraging is unavailable and eagles are likely forced to scavenge along roadsides. Poisoning CODs were greatest in late winter and early spring months, when deer carcasses containing lead ammunition, which are preserved by the cold weather, also become a supplemental food source. The major infectious disease CODs, West Nile virus and botulism (Clostridium botulinum type E), were more prevalent during summer months. We recommend moving road-killed carcasses, especially white-tailed deer, from the main thoroughfare to the back of the right-of-way, and the transition from lead ammunition and fishing tackle to non-toxic alternatives to decrease these main anthropogenic sources of mortality for bald eagles, and other scavenger species. © 2020 The Wildlife Society.     

Trepanation in South‐Central Peru during the early late intermediate period (ca. AD 1000–1250)

This study evaluates trepanations from five well‐contextualized prehistoric sites in the south‐central highlands of Andahuaylas, Peru. The emergence of trepanation in this region coincides with the collapse of the Wari Empire, ca. ad 1000. Thirty‐two individuals from Andahuaylas, AMS radiocarbon dated to the early Late Intermediate Period (ca. ad 1000–1250), were found to have 45 total trepanations. Various surgical techniques were being employed concurrently throughout the region. Scraping trepanations evinced the highest survival rate; circular grooving, drilling and boring, and linear cutting were far less successful. Evidence of perioperative procedures like hair shaving, poultice application, and possible cranioplasty use aimed to ensure the survival of a trepanation recipient. Postmortem trepanations, also present in Andahuaylas, were likely executed on corpses as a means of better understanding cranial anatomy and improving techniques. Similarities in trepanation patterns throughout the region attest to common motivations to engage in surgery. Although moderate physical head trauma seems to be the impetus for intervention in many cases of trepanation, other motivations included physiological and possibly psychosomatic factors. Nevertheless, treatment was not for everyone. In Andahuaylas, trepanations were withheld from subadults, females, and those individuals who practiced cranial modification. Am J Phys Anthropol 152:484–494, 2013. © 2013 Wiley Periodicals, Inc.     

Brain trauma and autophagy: What flies and mice can teach us about conserved responses

Drosophila models have been successfully used to identify many genetic components that affect neurodegenerative disorders. Recently, there has been a growing interest in identifying innate and environmental factors that influence the individual outcomes following traumatic brain injury (TBI). This includes both severe TBI and more subtle, mild TBI (mTBI), which is common in people playing contact sports. Autophagy, as a clearance pathway, exerts protective effects in multiple neurological disease models. In a recent publication, we highlighted the development of a novel repetitive mTBI system using Drosophila, which recapitulates several phenotypes associated with trauma in mammalian models. In particular, flies subjected to mTBI exhibit an acute impairment of the macroautophagy/autophagy pathway that is restored 1 wk following traumatic injury exposure. These phenotypes closely resemble temporary autophagy defects observed in a mouse TBI model. Through these studies, we also identified methods to directly assess autophagic responses in the fly nervous system and laid the groundwork for future studies designed to identify genetic, epigenetic and environmental factors that have an impact on TBI outcomes.     

Clinical,socio‐demographic and psychological characteristics in individuals with persistent psychotic experiences with and without a “need for care”

Individuals reporting persistent psychotic experiences (PEs) in the general population, but without a “need for care”, are a unique group of particular importance in identifying risk and protective factors for psychosis. We compared people with persistent PEs and no “need for care” (non‐clinical, N=92) with patients diagnosed with a psychotic disorder (clinical, N=84) and controls without PEs (N=83), in terms of their phenomenological, socio‐demographic and psychological features. The 259 participants were recruited from one urban and one rural area in the UK, as part of the UNIQUE (Unusual Experiences Enquiry) study. Results showed that the non‐clinical group experienced hallucinations in all modalities as well as first‐rank symptoms, with an earlier age of onset than in the clinical group. Somatic/tactile hallucinations were more frequent than in the clinical group, while commenting and conversing voices were rare. Participants in the non‐clinical group were differentiated from their clinical counterparts by being less paranoid and deluded, apart from ideas of reference, and having fewer cognitive difficulties and negative symptoms. Unlike the clinical group, they were characterized neither by low psychosocial functioning nor by social adversity. However, childhood trauma featured in both groups. They were similar to the controls in psychological characteristics: they did not report current emotional problems, had intact self‐esteem, displayed healthy schemas about the self and others, showed high life satisfaction and well‐being, and high mindfulness. These findings support biopsychosocial models postulating that environmental and psychological factors interact with biological processes in the aetiology of psychosis. While some PEs may be more malign than others, lower levels of social and environmental adversity, combined with protective factors such as intact IQ, spirituality, and psychological and emotional well‐being, may reduce the likelihood of persistent PEs leading to pathological outcomes. Future research should focus on protective factors and determinants of well‐being in the context of PEs, rather than exclusively on risk factors and biomarkers of disease states.     

数字化外科技术在颌面部外伤修复重建中的应用与展望

近年来,数字化外科技术在颌面部外伤修复重建临床应用中得到不断发展和完善,极大地提高了手术的精确性和可靠性,节约了手术时间。本文主要从术前手术模拟、快速打印3D头模、术中导航、导板制作、个性化修复体及机器人的临床应用等六个方面来阐述数字化外科技术在颌面部骨折修复重建中的应用,总结了各个技术的原理、优缺点及应用现状,回顾了我们单位应用数字化技术提高颌面部外伤修复手术的精确度和可行性以及恢复了患者良好的面型及功能的临床应用经验。同时,本文对未来数字化外科在颌面部骨折修复重建中的应用提出了新的展望,我们认为,结合术前手术模拟、术中导航及术中机器人技术依据术中具体情况自动调整手术方案进行颌面部骨折修复重建的完全自动化智能机器人的实现将是最终的目标。     

救治人员总协调制度在严重多发伤早期救治中的作用

目的 探讨院内救治人员总协调制度对严重多发伤早期救治的作用,以进一步优化创伤病患救治流程。方法 选取2013—2014年在苏州市立医院救治的严重多发伤病人共130例为研究组,同时回顾2011—2012年苏州市立医院救治的严重多发伤病人共123例为对照组,比较研究组与对照组在院内术前时间、在院监护时间、早期漏诊率、早期死亡率及并发症发生率等指标的变化。结果 研究组病人的院内术前时间、在院监护时间较对照组显著缩短,早期漏诊率、早期死亡率和并发症发生率均显著降低。结论 院内救治人员总协调制度的执行可有效提高严重多发伤早期救治效率。     

Robust human body model injury prediction in simulated side impact crashes

This study developed a parametric methodology to robustly predict occupant injuries sustained in real-world crashes using a finite element (FE) human body model (HBM). One hundred and twenty near-side impact motor vehicle crashes were simulated over a range of parameters using a Toyota RAV4 (bullet vehicle), Ford Taurus (struck vehicle) FE models and a validated human body model (HBM) Total HUman Model for Safety (THUMS). Three bullet vehicle crash parameters (speed, location and angle) and two occupant parameters (seat position and age) were varied using a Latin hypercube design of Experiments. Four injury metrics (head injury criterion, half deflection, thoracic trauma index and pelvic force) were used to calculate injury risk. Rib fracture prediction and lung strain metrics were also analysed. As hypothesized, bullet speed had the greatest effect on each injury measure. Injury risk was reduced when bullet location was further from the B-pillar or when the bullet angle was more oblique. Age had strong correlation to rib fractures frequency and lung strain severity. The injuries from a real-world crash were predicted using two different methods by (1) subsampling the injury predictors from the 12 best crush profile matching simulations and (2) using regression models. Both injury prediction methods successfully predicted the case occupant's low risk for pelvic injury, high risk for thoracic injury, rib fractures and high lung strains with tight confidence intervals. This parametric methodology was successfully used to explore crash parameter interactions and to robustly predict real-world injuries.     

体外反搏治疗小儿急性脑外伤的临床应用分析

目的:探讨以体外反搏为主的综合康复治疗对脑外伤后偏瘫患儿运动功能和日常生活活动能力(ADL)的影响。方法:选择2015年7月至2017年7月我院神经外科收治的脑外伤后偏瘫患儿46例,将其随机分为对照组和治疗组。两组患者均采用常规的康复治疗和护理,对照组采取常规的物理治疗(PT治疗),治疗组患者给予以体外反搏为主的综合康复治疗。于治疗1、3个月后,评价和比较两组患者粗大运动能力(GMFM)评分、精细运动能力(FMFM)评分和日常生活能力(ADL)评分的变化。结果:治疗1、3个月后,两组患儿GMFM、FMFM评分均较治疗前明显增加(均P0.01),而治疗组治疗后GMFM、FMFM评分均明显高于对照组(均P0.01)。两组治疗一个月后ADL总有效率(显效率与有效率之和)分别为90.48%和76.19%,治疗三个月后分别为95.24%和85.71%,治疗组均显著高于对照组(均P0.05)。结论:以体外反搏为主的综合康复治疗有利于促进脑外伤后偏瘫患者ADL及部分运动功能的提高。     

Evaluation of helmet and goggle designs by modeling non-penetrating projectile impacts

Despite the progress in developing personal combat-protective gear, eye and brain injuries are still widely common and carry fatal or long-term repercussions. The complex nature of the cranial tissues suggests that simple methods (e.g. crash-dummies) for testing the effectiveness of personal protective gear against non-penetrating impacts are both expensive and ineffective, and there are ethical issues in using animal or cadavers. The present work presents a versatile testing framework for quantitatively evaluating protective performances of head and eye combat-protective gear, against non-penetrating impacts. The biomimetic finite element (FE) head model that was developed provides realistic representation of cranial structure and tissue properties. Simulated crash impact results were validated against a former cadaveric study and by using a crash-phantom developed in our lab. The model was then fitted with various helmet and goggle designs onto which a non-penetrating ballistic impact was applied. Example data show that reduction of the elastic and shear moduli by 30% and 80% respectively of the helmet outer Kevlar-29 layer, lowered intracranial pressures by 20%. Our modeling suggests that the level of stresses that develop in brain tissues, which ultimately cause the brain damage, cannot be predicted solely by the properties of the helmet/goggle materials. We further found that a reduced contact area between goggles and face is a key factor in reducing the mechanical loads transmitted to the optic nerve and eye balls following an impact. Overall, this work demonstrates the simplicity, flexibility and usefulness for development, evaluation, and testing of combat-protective equipment using computational modeling.

• Highlights

• A finite element head model was developed for testing head gear.

• Reduced helmet’s outer layer elastic and shear moduli lowered intracranial stresses.

• Gear material properties could not fully predict impact-related stress in the brain.

• Reduced goggles-face contact lowered transmitted loads to the optic nerve and eyes.

     

重症创伤患者ICU后综合征心理障碍影响因素分析

摘要 目的：探究重症创伤患者ICU后综合征（PICS）心理障碍影响因素。方法：本次研究纳入60例重症创伤患者,按照是否存在PICS分为对照组（20例）和PICS组（40例）。进行不同治疗情况PICS心理障碍影响因素单因素分析。PICS心理障碍患者急性生理与慢性健康状况评分系统（APACHEII）和医院焦虑和抑郁量表（HADS）评分、Ogawa改良创伤评分系统、匹兹堡睡眠质量指数量表（PSQI）评分进行单因素分析,并进行PICS心理障碍的相关性分析,PICS心理障碍影响因素Logistic回归分析。结果：（1）PICS组年龄<30比例较对照组升高,30-50患者比例较对照组降低（P<0.05）。PICS组文化程度文盲和小学患者比例较对照组升高,初中和高中及以上患者比例较对照组降低（P<0.05）。（2）PICS组手术、手术时间1~3 h和＞3 h、ICU时间10~14 d、镇静药物和有创机械通气患者比例较对照组升高（P<0.05）。（3）PICS组APACHEII评分<20和20~25患者比例较对照组降低,APACHEII评分25~30和＞30患者比例较对照组升高（P<0.05）;PICS组HADS评分<5和5~15患者比例较对照组降低,HADS评分15~25和≥25患者比例较对照组升高（P<0.05）;PICS组得分低于9分的轻度损伤者和得分10~16分的中度损伤的患者比例较对照组降低,得分≥17分为重度损伤的患者比例较对照组升高（P<0.05）;PICS组得分≤7分的睡眠质量较好的患者比例较对照组降低（P<0.05）,得分>7分的睡眠障碍的患者比例较对照组升高（P<0.05）。（4）PICS组年龄、手术时间、ICU时间、APACHEII评分、HADS评分、PSQI得分以及创伤指数评分较对照组升高（P<0.05）;（5）PICS心理障碍与年龄、文化程度、手术时间、ICU时间、镇静药物、无创机械通气、有创机械通气、APACHEII评分、HADS评分、创伤指数评分以及PSQI评分相关（P<0.05）。结论：PICS组年龄、手术时间、ICU时间、APACHEII评分和HADS评分较对照组升高;PICS心理障碍与年龄、文化程度、手术时间、ICU时间、镇静药物、无创机械通气、有创机械通气、APACHEII评分、HADS评分、创伤指数评分以及PSQI评分相关。