Body Regions Research Articles

Roflumilast Cream 0.3% in Patients With Chronic Plaque Psoriasis: Individual Patient PASI and PASI-HD Responses: Pooled DERMIS-1 and DERMIS-2 Phase 3 Trials

Background: Roflumilast cream 0.3% is a highly potent phosphodiesterase 4 inhibitor approved as a nonsteroidal, once-daily treatment for patients with plaque psoriasis. Pooled efficacy and safety results from two Phase 3 clinical trials (DERMIS-1 and DERMIS-2) have been presented previously. The Psoriasis Area and Severity Index (PASI) is used to assess the severity of plaque psoriasis in clinical trials; however, PASI is not precise when the area of involvement is <10% of a given anatomic region. A modified version of the PASI, the PASI-high discrimination (PASI-HD), allows more precise assessment of psoriasis in body regions where <10% area is affected. We present individual patient responses using PASI and PASI-HD.
 Methods: Patients aged ≥2 years with at least mild plaque psoriasis involving 2-20% body surface area were randomized 2:1 to apply roflumilast cream 0.3% or vehicle cream once daily for 8 weeks. The primary efficacy endpoint was Investigator Global Assessment (IGA) Success (score of Clear or Almost Clear plus ≥2-grade improvement from baseline) at Week 8. PASI and PASI-HD were used to measure disease severity; individual patient PASI and PASI-HD responses were plotted graphically. Safety and tolerability were also evaluated and were reported previously.
 Results: Roflumilast- and vehicle-treated patients had similar baseline demographic and disease characteristics. At Week 8, statistically significantly more roflumilast- than vehicle-treated patients achieved IGA Success (39.9% vs. 6.5%; P<0.0001). Statistically significant differences favoring roflumilast were observed at Week 8 for percentages of patients achieving a 50% reduction in PASI (72.1% vs. 25.5%; P<0.0001), 75% reduction (40.3% vs. 6.5%, P<0.0001), 90% reduction (19.7% vs 2.3%; P<0.0001), and 100% reduction (12.3% vs 0.8%; P<0.001). Likewise, statistically significant differences favoring roflumilast were observed at Week 8 for percentages of patients achieving 50% reduction in PASI-HD (79.4% vs. 33.1%; P<0.0001), 75% reduction (59.9% vs. 17.9%, P<0.0001), 90% reduction (39.9% vs 9.1%; P<0.0001), and 100% reduction (12.3% vs 0.8%; P<0.0001). Roflumilast cream demonstrated low rates of application-site adverse events (AEs), treatment-related AEs, and discontinuations due to AEs, comparable to vehicle. At the first application of roflumilast cream 0.3% (day 1), 96% of patients reported no or mild sensation, increasing to 99% of patients at Weeks 4 and 8.
 Conclusions: Roflumilast cream 0.3% provided greater improvement in IGA Success, PASI, and PASI-HD versus vehicle with favorable safety and tolerability in patients with psoriasis in two Phase 3 trials. PASI-HD provided higher discrimination of effects of treatment in areas with <10% involvement than the traditional PASI.
 ClinicalTrials.gov Identifiers: DERMIS-1: NCT04211363; DERMIS-2: NCT04211389
 Financial Disclosures: Arcutis Biotherapeutics, Inc.

Groundwaters in the Auvergne-Rhône-Alpes Region, France: Grouping Homogeneous Groundwater Bodies for Optimized Monitoring and Protection

The number and diversity of groundwater bodies (GWBs) in large French administrative regions pose challenges to their monitoring and protection by regional health agencies. To overcome this obstacle, we propose, for the Auvergne-Rhône-Alpes region (about 70,000 km2), a grouping of GWBs into homogeneous groups based on the sources of variability within a large dataset of groundwater physico-chemical and bacteriological characteristics (8078 observations and 13 parameters). This grouping involved a dimensional reduction in the data hyperspace by principal component analysis (PCA) and a clustering based on the mean values of each GWB on the factorial axes. The information lost when clustering from the sample point scale to the GWB scale and then to that of the GWB group was quantified by analysis of variance and showed that grouping GWBs is accompanied by a small loss of information. A discriminant analysis confirmed the high spatial and temporal variability within the dataset, as well as the effectiveness of the proposed method for establishing homogeneous sets. Some roadmaps for more targeted monitoring of water resources were briefly proposed.

Trauma Profile in Shahroud: An 8-Year Report of a Hospital-Based Trauma Registry.

Trauma is a significant public health concern in Iran, with high mortality and morbidity rates. This study aimed to assess trauma patients' profiles in Shahroud, Iran. Study Design: A cross-sectional study. The study involved trauma patients who met specific criteria at Imam Hossein hospital in Shahroud, Iran, between 2016 and 2023, using the National Trauma Registry of Iran (NTRI). The relationship between injury characteristics and the cause of injury was analyzed using chi-square test and post hoc analysis. Quintile regression models assessed the association of demographic and clinical variables with length of stay. Among 3513 trauma patients, road traffic crashes (RTCs) had a higher percentage of injuries with the Glasgow Coma Scale (GCS) between 9 and 12 (1.7%) compared to falls (0.3%) (P<0.001). Falls caused more moderate cases with injury severity scores (ISS) ranging from 9 to 15 (22.7%) than RTCs (17.1%) (P<0.001). RTC-related injuries required more ventilation (2.7%) and intensive care unit (ICU) admissions (11.1%) than falls (P<0.001). After adjusting for age, GCS, ISS, and body region, fall had a median length of stay nine hours shorter than RTCs (95% CI = -16.2, -1.8). Significant injury pattern differences were observed between RTCs and falls. RTCs had higher frequencies of injuries resulting in GCS scores between 9 and 12, while falls had higher frequencies of moderate ISS scores. In addition, patients with RTC-related injuries required more mechanical ventilation and ICU admissions. Moreover, after adjusting for various factors, patients with RTC-related injuries had a significantly longer hospital stay compared to those with fall-related injuries.

Influence of oral motor tasks on postural muscle activity during dynamic reactive balance.

Jaw clenching improves dynamic reactive balance on an oscillating platform during forward acceleration and is associated with decreased mean sway speed of different body regions. It is suggested that jaw clenching as a concurrent muscle activity facilitates human motor excitability, increasing the neural drive to distal muscles. The underlying mechanism behind this phenomenon was studied based on leg and trunk muscle activity (iEMG) and co-contraction ratio (CCR). Forty-eight physically active and healthy adults were assigned to three groups, performing three oral motor tasks (jaw clenching, tongue pressing against the palate or habitual lower jaw position) during a dynamic one-legged stance reactive balance task on an oscillating platform. The iEMG and CCR of posture-relevant muscles and muscle pairs were analysed during platform forward acceleration. Tongue pressing caused an adjustment of co-contraction patterns of distal muscle groups based on changes in biomechanical coupling between the head and trunk during static balancing at the beginning of the experiment. Neither iEMG nor CCR measurement helped detect a general neuromuscular effect of jaw clenching on the dynamic reactive balance. The findings might indicate the existence of robust fixed patterns of rapid postural responses during the important initial phases of balance recovery.

Sound elicits stereotyped facial movements that provide a sensitive index of hearing abilities in mice

Sound elicits rapid movements of muscles in the face, ears, and eyes that protect the body from injury and trigger brain-wide internal state changes. Here, we performed quantitative facial videography from mice resting atop a piezoelectric force plate and observed that broadband sounds elicited rapid and stereotyped facial twitches. Facial motion energy (FME) adjacent to the whisker array was 30 dB more sensitive than the acoustic startle reflex and offered greater inter-trial and inter-animal reliability than sound-evoked pupil dilations or movement of other facial and body regions. FME tracked the low-frequency envelope of broadband sounds, providing a means to study behavioral discrimination of complex auditory stimuli, such as speech phonemes in noise. Approximately 25% of layer 5-6 units in the auditory cortex (ACtx) exhibited firing rate changes during facial movements. However, FME facilitation during ACtx photoinhibition indicated that sound-evoked facial movements were mediated by a midbrain pathway and modulated by descending corticofugal input. FME and auditory brainstem response (ABR) thresholds were closely aligned after noise-induced sensorineural hearing loss, yet FME growth slopes were disproportionately steep at spared frequencies, reflecting a central plasticity that matched commensurate changes in ABR wave 4. Sound-evoked facial movements were also hypersensitive in Ptchd1 knockout mice, highlighting the use of FME for identifying sensory hyper-reactivity phenotypes after adult-onset hyperacusis and inherited deficiencies in autism risk genes. These findings present a sensitive and integrative measure of hearing while also highlighting that even low-intensity broadband sounds can elicit a complex mixture of auditory, motor, and reafferent somatosensory neural activity.

Aquatic Insects (Ephemeroptera, Plecoptera and Trichoptera) Metric as an Important Tool in Water Quality Assessment in Hilly and Mountain Streams

The aim of the study was to test the significance of the EPT index in the water quality assessment of three types of water bodies in hilly and mountainous region of Serbia. The aquatic macroinvertebrate community was dominated by the group of insects, of which 95 taxa represent the EPT group. We compared the obtained values of biological indices used for the assessment of water quality according to the national legislation with the overall status assessment represented by the ecological quality classes (EQC). The results of the Spearman correlation test showed a negative correlation of EQC with the EPT index, BMWP score, H′, total number of taxa and number of sensitive taxa, while a positive correlation was observed for the values of SI and Tubificinae %. The values of EQC and biological indices were subjected to principal component analysis (PCA). The results showed that the parameters that contributed most to the differences were the EPT index, the BMWP score and the number of sensitive taxa. The results indicate that the EPT index is an excellent indicator of changes in water quality and an important tool for the ecological categorization of water bodies in mountain regions.

Rib and sternum fracture risks for restrained occupants in frontal car crashes

Objective Most car occupant fatalities occur in frontal crashes and the thorax is the most frequently injured body region. The objectives of the study were, firstly, to quantify the relation between risk factors (such as speed and occupant age) and rib and sternum fracture injury probability in frontal car crashes, and, secondly, to evaluate whether rib fracture occurrence can predict sternum fractures. Methods Weighted German data from 1999-2021 were used to create the injury risk curves to predict both, at least moderate and at least serious, rib and sternum fracture risks. A contingency table for rib and sternum fractures allowed the calculation of sensitivity, specificity, and precision, as well as testing for the association. Results Elderly occupants (≥65 years old) had increased rib and sternum fracture risk compared to mid aged occupants (18-64 years old). Besides occupant age, delta-V was always and sex sometimes a significant predictor for skeletal thoracic injury. Sternum fractures were more common than rib fractures and more likely to occur at any given delta-V. Sternum fractures occurred often in isolation. Female occupants were at higher risk than males to sustain at least moderate rib and sternum fractures together and sternum fractures in isolation. Rib and sternum fractures were associated, but low sensitivity and precision show that rib fractures do not predict sternum fractures well. Conclusions Elderly and female occupants were at the highest risk and should be targeted by thoracic injury criteria and thresholds for frontal crash occupant protection. Rib and sternum fractures were not associated. Therefore, sternum fractures need to be predicted and evaluated separately from rib fractures.

Kinematic analysis of an unrestrained passenger in an autonomous vehicle during emergency braking.

Analyzing human body movement is a critical aspect of biomechanical studies in road safety. While most studies have traditionally focused on assessing the head-neck system due to the restraint provided by seat belts, it is essential to examine the entire pelvis-thorax-head kinematic chain when these body regions are free to move. The absence of restraint systems is prevalent in public transport and is also being considered for future integration into autonomous vehicles operating at low speeds. This article presents an experimental study examining the movement of the pelvis, thorax and head of 18 passengers seated without seat belts during emergency braking in an autonomous bus. The movement was recorded using a video analysis system capturing 100 frames per second. Reflective markers were placed on the knee, pelvis, lumbar region, thorax, neck and head, enabling precise measurement of the movement of each body segment and the joints of the lumbar and cervical spine. Various kinematic variables, including angles, displacements, angular velocities and accelerations, were measured. The results delineate distinct phases of body movement during braking and elucidate the coordination and sequentiality of pelvis, thorax and head rotation. Additionally, the study reveals correlations between pelvic rotation, lumbar flexion, and vertical trunk movement, shedding light on their potential impact on neck compression. Notably, it is observed that the elevation of the C7 vertebra is more closely linked to pelvic tilt than lumbar flexion. Furthermore, the study identifies that the maximum angular acceleration of the head and the maximum tangential force occur during the trunk's rebound against the seatback once the vehicle comes to a complete stop. However, these forces are found to be insufficient to cause neck injury. While this study serves as a preliminary investigation, its findings underscore the need to incorporate complete trunk kinematics, particularly of the pelvis, into braking and impact studies, rather than solely focusing on the head-neck system, as is common in most research endeavors.

The paediatric polytrauma CT-indication (PePCI)-score–Development of a prognostic model to reduce unnecessary CT scans in paediatric trauma patients

BackgroundWhole-Body CT (WBCT) is frequently used in emergency situations for promptly diagnosing paediatric polytrauma patients, given the challenges associated with obtaining precise details about the mechanism and progression of trauma. However, WBCT does not lead to reduced mortality in paediatric patients, but is associated with high radiation exposure. We therefore wanted to develop a screening tool for CT demand-driven emergency room (ER)-trauma diagnostic to reduce radiation exposure in paediatric patients. MethodsA retrospective study in a Level I trauma centre in Germany was performed. Data from 344 paediatric emergency patients with critical mechanism of injury who were pre-announced by the ambulance for the trauma room were collected. Patients’ symptoms, clinical examination, extended Focused Assessment with Sonography for Trauma (eFAST), routinely, laboratory tests and blood gas and - when obtained - WBCT images were analysed. To identify potential predictors of severe injuries (ISS > 23), 300 of the 344 cases with complete data were subjected to regression analyses model. ResultsMultiple regression analysis identified cGCS, base excess (BE), medically abnormal results from eFAST screening, initial unconsciousness, and injuries involving three or more body regions as significant predictors for a screening tool for decision-making to perform WBCT or selective CT. The developed Paediatric polytrauma CT-Indication (PePCI)-Score was divided into three risk categories and achieved a sensitivity of 87 % and a specificity of 71 % when comparing the low and medium risk groups with the high risk group. Comparing only the low-risk group with the high-risk group for the decision to perform WBCT, 32/35 (91 %) of patients with an ISS >23 were correctly identified, as were 124/137 (91 %) with lower ISS scores. ConclusionWith the newly developed PePCI-Score, the frequency of WBCT in a paediatric emergency patients collective can be significantly reduced according to our data. After prospective validation, the initial assessment of paediatric trauma patients in the future could be made not only by the mechanism of injury, but also by the new PePCI-Score, deriving on clinical findings after thorough clinical assessment and the discretion of the trauma team.

Central versus distal pancreatectomy for low-grade and benign pancreatic neck-body tumours.

Central pancreatectomy (CP) offers parenchymal preservation compared to conventional distal pancreato-splenectomy for pancreatic neck and body tumours. However, it is associated with more morbidity. This study is aimed at evaluating the peri-operative and long-term functional outcomes, comparing central and distal pancreatectomies (DPs). Retrospective analysis of patients undergoing pancreatic resections for low-grade malignant or benign tumours in pancreatic neck and body was performed (from January 2007 to December 2022). Preoperative imaging was reviewed for all cases, and only patients with uninvolved pancreatic tail, whereby a CP was feasible, were included. Peri-operative outcomes and long-term functional outcomes were compared between CP and DP. One hundred twenty-two (5.2%) patients, amongst the total of 2304 pancreatic resections, underwent central or distal pancreatectomy for low-grade malignant or benign tumours. CP was feasible in 55 cases, of which 23 (42%) actually underwent CP and the remaining 32 (58%) underwent DP. CP group had a significantly longer operative time [370min (IQR 300-480) versus 300min (IQR 240-360); p = 0.002]; however, the major morbidity (43.5% versus 37.5%; p = 0.655) and median hospital stay (10 versus 11days; p = 0.312) were comparable. The long-term endocrine functional outcome was favourable for the CP group [endocrine insufficiency rate was 13.6% in central versus 42.8% in distal (p = 0.046)]. Central pancreatectomy offers better long-term endocrine function without any increased morbidity in low malignant potential or benign pancreatic tumours of neck and body region.

Occupational orthopedic problems and its relation to personal radiation protection in interventional radiology

PurposeSeveral studies report occupational orthopedic problems among interventional cardiologists. These health problems are usually multifactorial. However, the personal protective equipment used should play a major role. An online survey was conducted to determine the frequency of such health problems among interventional radiologists and to correlate them with the use of personal radiation protective clothing. Material and MethodsAn anonymous online survey that comprised of 17 questions was sent via e-mail to 1427 members of the German Society for Interventional Radiology (DeGIR) in Germany, Austria and Switzerland. The questions were focused on interventional workload, the use of personal radiation protection apparel and orthopedic problems. Given the different scale levels, the associations between the variables were analyzed using different statistical methods. A significance level of p < 0.05 was chosen. ResultsThere were 221 survey responders (15.5% response rate). About half of responders (47.7%) suffered from more than five episodes of orthopedic problems during their interventional career. Lumbar spine was involved in 81.7% of these cases, cervical spine in 32.8%, shoulder in 28.5% and knee in 24.7%. Because of orthopedic problems, 16.1% of the responders had to reduce and 2.7% had to stop their interventional practice.The number of affected body regions correlates with the fit of the radiation protection means (p < 0.05, r = 0.135) and the reduction of activity as an interventional radiologist (p < 0.05, r = −0.148). ConclusionOverall, the survey reveals widespread orthopedic problems at several body regions among interventional radiologists, associated with the fit of radiation protection systems, among other factors. A connection between the orthopaedic complaints and the radiation protection system used could not be established.

AI-Assisted X-ray Fracture Detection in Residency Training: Evaluation in Pediatric and Adult Trauma Patients.

Background: This study aimed to evaluate the impact of an AI-assisted fracture detection program on radiology residents' performance in pediatric and adult trauma patients and assess its implications for residency training. Methods: This study, conducted retrospectively, included 200 radiographs from participants aged 1 to 95 years (mean age: 40.7 ± 24.5 years), encompassing various body regions. Among these, 50% (100/200) displayed at least one fracture, totaling one hundred thirty-five fractures, assessed by four radiology residents with different experience levels. A machine learning algorithm was employed for fracture detection, and the ground truth was established by consensus among two experienced senior radiologists. Fracture detection accuracy, reporting time, and confidence were evaluated with and without AI support. Results: Radiology residents' sensitivity for fracture detection improved significantly with AI support (58% without AI vs. 77% with AI, p < 0.001), while specificity showed minor improvements (77% without AI vs. 79% with AI, p = 0.0653). AI stand-alone performance achieved a sensitivity of 93% with a specificity of 77%. AI support for fracture detection significantly reduced interpretation time for radiology residents by an average of approximately 2.6 s (p = 0.0156) and increased resident confidence in the findings (p = 0.0013). Conclusion: AI support significantly enhanced fracture detection sensitivity among radiology residents, particularly benefiting less experienced radiologists. It does not compromise specificity and reduces interpretation time, contributing to improved efficiency. This study underscores AI's potential in radiology, emphasizing its role in training and interpretation improvement.

Assessing injury risks of reclined occupants in a frontal crash preceded by braking with varied seatbelt designs using the SAFER Human Body Model

Objective This study investigated the effects of different seatbelt geometries and load-limiting levels on the kinematics and injury risks of a reclined occupant during a whole-sequence frontal crash scenario, using simulations with the Active SAFER Human Body Model (Active SHBM). Methods The Active SHBM was positioned in a reclined position (50°) on a semi-rigid seat model. A whole-sequence frontal crash scenario, an 11 m/s2 Automated Emergency Braking (AEB) phase followed by a frontal crash at 50 km/h, was simulated. The seatbelt geometry was varied using either a B-pillar-integrated (BPI) or Belt-in-seat (BIS) design. The shoulder belt load-limiting level of the BPI seatbelt was also varied to achieve either similar shoulder belt forces (BPI_Lower_LL) or comparable upper body displacements (BPI_Higher_LL) to the BIS seatbelt. Kinematics of different body regions and seatbelt forces were compared. The risks of sustaining a mild traumatic brain injury (mTBI), two or more fractured ribs (NFR2+), and lumbar spine vertebral fractures were also compared. Results During the pre-crash phase, head, first thoracic vertebra, and first lumbar vertebra displacements were greater with the BPI seatbelt than with the BIS, mainly due to the lack of initial contact between the torso and the seatbelt. Pelvis pre-crash displacements, however, remained consistent across seatbelt types. In the in-crash phase, variations in shoulder belt forces were directly influenced by the different load-limiting levels of the shoulder belt. The mTBI (around 20%) and NFR2+ (around 70–100%) risks were amplified with BPI seatbelts, especially at higher load-limiting force. However, the BPI design demonstrated reduced lumbar spine fracture risks (from 30% to 1%). Conclusions The BIS seatbelt appears promising, as seen with the reduced mTBI and NFR2+ risks, for ensuring the protection of reclined occupants in frontal crashes. However, additional solutions, such as lap belt load limiting, should be considered to reduce lumbar spine loading.

Perforating trauma with the presence of a foreign body in the cervical region: case report

The escalating incidence of urban violence has positioned physical aggression as a predominant catalyst for head and neck injuries, constituting a significant etiological factor in mortality. Indeed, half of all deaths associated with harm involve the head and neck region. The current report elucidates a specific case stemming from physical aggression, wherein a 52-year-old male manifested post-incident swelling on the left side of the jaw. Clinical examination unveiled the presence of a cylindrical foreign body, subsequently identified as a wooden skewer, situated between the mandible and hyoid bone. Successful surgical intervention was conducted to remove the foreign object. This case accentuates the critical importance of precise diagnostic procedures and meticulous surgical planning in instances of neck trauma.

Deep Learning-Based Psoriasis Assessment: Harnessing Clinical Trial Imaging for Accurate Psoriasis Area Severity Index Prediction

Introduction: Image-based machine learning holds great promise for facilitating clinical care; however, the datasets often used for model training differ from the interventional clinical trial-based findings frequently used to inform treatment guidelines. Here, we draw on longitudinal imaging of psoriasis patients undergoing treatment in the Ultima 2 clinical trial (NCT02684357), including 2,700 body images with psoriasis area severity index (PASI) annotations by uniformly trained dermatologists. Methods: An image-processing workflow integrating clinical photos of multiple body regions into one model pipeline was developed, which we refer to as the “One-Step PASI” framework due to its simultaneous body detection, lesion detection, and lesion severity classification. Group-stratified cross-validation was performed with 145 deep convolutional neural network models combined in an ensemble learning architecture. Results: The highest-performing model demonstrated a mean absolute error of 3.3, Lin’s concordance correlation coefficient of 0.86, and Pearson correlation coefficient of 0.90 across a wide range of PASI scores comprising disease classifications of clear skin, mild, and moderate-to-severe disease. Within-person, time-series analysis of model performance demonstrated that PASI predictions closely tracked the trajectory of physician scores from severe to clear skin without systematically over- or underestimating PASI scores or percent changes from baseline. Conclusion: This study demonstrates the potential of image processing and deep learning to translate otherwise inaccessible clinical trial data into accurate, extensible machine learning models to assess therapeutic efficacy.

Analyzing body dissatisfaction and gender dysphoria in the context of minority stress among transgender adolescents

BackgroundGender dysphoria among transgender adolescents has predominantly been examined in relation to body dissatisfaction. While in adult transgender samples, body dissatisfaction is higher than in cisgender controls, this has so far rarely been investigated for adolescents. In the context of a cisnormative society, the impact of influences from the social environment on body dissatisfaction and gender dysphoria has been neglected in research. Therefore, this study aimed to (1) provide a detailed analysis of body dissatisfaction among young transgender people and (2) investigate whether body dissatisfaction and gender dysphoria are associated with experiences of minority stress such as trans hostility and poor peer relations (PPR).MethodsThe paper presents a cross-sectional study among a sample of transgender adolescents, presenting at a specialized outpatient counseling clinic (N = 99; age M = 15.36, SD = 1.85). First, body dissatisfaction (assessed by the Body-Image-Scale; BIS), was explored and compared to data from a population-based control group of cisgender peers (N = 527; age M = 14.43, SD = 0.97). Second, within a clinic-referred transgender subsample (n = 74), associations between body dissatisfaction and gender dysphoria (measured by Utrecht Gender Dysphoria Scale; UGDS), PPR (measured by the Youth-Self-Report; YSR-R), and trans hostile experiences (assessed in clinical interview) were examined by correlations, t-tests and multivariate regression.ResultsTransgender adolescents reported more body dissatisfaction than cisgender peers. The dissatisfaction with sex characteristics, non-hormonal reactive body regions and the total score for body dissatisfaction were positively related with gender dysphoria. The majority had experienced trans hostility in the present and/or past (54.1%) and PPR (63.5%). More body dissatisfaction was correlated with more PPR regarding visible body parts i.e., hair, overall appearance and muscles, whilst PPR and gender dysphoria were not associated. Transgender adolescents who experienced trans hostility showed higher gender dysphoria and PPR, but not more body dissatisfaction. In multiple regression, trans hostility predicted gender dysphoria, whilst age and PPR predicted body dissatisfaction.DiscussionExperiences of minority-stress differentially interact with body dissatisfaction and gender dysphoria among transgender adolescents. Social correlates of body dissatisfaction and gender dysphoria must be considered when working with young transgender people.

The organization of the muscle system of the causative agent of dicrocoeliosis, Dicrocoelium dendriticum

AbstractThe musculature of parasitic flatworms plays a central role in locomotory movement, attachment to the host, and in the function of the digestive, reproductive, and excretory systems. We examine for the first time the muscle system of the flatworm Dicrocoelium dendriticum, a causative agent of the parasitic disease dicrocoeliosis, by use of fluorescently labeled phalloidin and confocal laser scanning microscopy. Somatic musculature of D. dendriticum consists of the circular, longitudinal, and diagonal muscles. The distribution of the muscle fibers in the body wall differed among the anterior, middle, and posterior body regions of the worm. The musculature of the attachment organs, the oral and ventral suckers, includes several types of muscles: the external equatorial and meridional muscles, internal circular and semicircular muscles, and radial muscles. Inside of the ventral sucker the diagonally located muscles were revealed and the supplementary u‐shaped muscles were found adjoined to the base of the sucker from outside. The musculature of the internal organs composed of the excretory, reproductive, and digestive systems were characterized. Our results increase our knowledge of the morphology of trematodes and the arrangement of their muscle system.

Do they stay, or do they go? Children presenting to five emergency departments across New South Wales, Australia with acute burn injuries: a retrospective review

ObjectiveThe overall objective of the study was to describe the disposition status of children presenting with a burn injury to five emergency departments (ED) across New South Wales (NSW), Australia.DesignA...

Predictive Factors for First-Pass Intubation Failure in Trauma Patients.

The primary objective of this study was to elucidate risk factors for multiple intubation attempts (MIA) in trauma patients requiring emergent tracheal intubation (ETI). Risk factors for mortality, intensive care unit (ICU) admission, and prolonged ventilation were assessed as secondary outcomes. The association between multiple intubation attempts and adverse outcomes has been well described in the literature. Though previous studies have identified anatomical risk factors for difficult airways, no study to date has investigated predictors for MIA in a trauma setting. The retrospective study involved 174 adult patients who required ETI and who presented to a Level 1 Trauma Center's emergency department between January 2019 and December 2022. Comorbidities, demographic information, triage vitals, intubation characteristics, and patient outcomes were identified to ascertain predictive risk factors for MIA. Variables were assessed for statistical significance on unadjusted analysis. Significant variables were entered into multivariate logistic regression models to test for adjusted associations, with p≤.0.05 as statistically significant, and presented as adjusted odds ratios with 95% confidence intervals. Twenty-six (14.9%) of the 174 patients required multiple intubation attempts. There were no significant associations between MIA and patient gender, age, BMI, race, injury mechanism, or specific body region injuries. On univariate analysis, the MIA group had a statistically significant elevation in mean systolic blood pressure (151.71 ± 45.96 vs 133.55 ± 32.11, p = 0.019) and heart rate (106.30 ± 34.92 vs 93.35 ± 24.82, p < 0.032) compared to subjects with first-pass success. Elevation in systolic blood pressure (SBP) (151.71 ± 45.96 vs 133.55 ± 32.11, aOR 1.03 (1.01-1.06), p < 0.015) was an independent predictor of multiple intubation attempts. Elevation in SBP was a significant predictor of multiple intubation attempts. Critical appraisal of patients requiring ETI with elevated SBP may mitigate risk in trauma settings.

Risk and mechanisms of phosphorus release at the sediment-water interface of lakes in cold and arid regions during non-frozen seasons.

In recent years, the eutrophication of lakes has accelerated in cold arid regions; the release of nutrients from sediments is an important contributor. The sequential extraction method, high-resolution peeper (HR-Peeper), and diffusive gradients in thin films (DGT) techniques were used to study the occurrence characteristics, release risk, and release mechanism of phosphorus (P) at the sediment-water interface (SWI) of Ulanor Wetland in the Hulun Lake Basin, Inner Mongolia, China. The mean total P concentration in overlying water was lower in August than that in May. Dissolved organic P (DOP) or particulate P (PP) was the main form of P in the overlying water. PP dominates in May and DOP in August. Refractory P was the main form of P in sediments. The concentrations of soluble reactive P and DGT-active P in the pore water of the sediment column were higher than those in the overlying water, and the concentrations were higher in August than those in May. Release of P in the wetland sediments occurred during the non-frozen seasons, with a higher risk in August than in May. The good linear correlation between dissolved P, Fe, and Mn in the DGT profiles verified their co-release due to the anaerobic reduction of Fe/Mn oxides. Moreover, alkaline sediments are also conducive to the release of sediment P. This study can provide data and theoretical support for eutrophication control in Ulanor Wetland and other similar water bodies in cold and arid regions.