Incidence Location Research Articles

Natural History and Characteristics of Hand Exostoses in Multiple Hereditary Exostoses

Multiple hereditary exostoses (MHEs) comprise a rare skeletal disorder. This study aimed to elucidate the natural history and characteristics of hand exostoses by focusing on their progression or regression and their association with shortening and angular deformation of the finger bones. Of 60 MHE patients who presented to our hospital between 2005 and 2019, 32 patients (62 hands) who underwent hand x-ray examinations were included in a study of initial presentation. Among them, 15 patients (30 hands) who underwent consecutive x-ray examinations before epiphyseal closure were included in a subsequent follow-up study (follow-up period, 6.9 years). We investigated the incidence and common location of hand involvement by exostoses during the initial examination study. We further investigated the progression or regression of hand exostoses and the influence of hand exostoses on longitudinal bone growth and the angular deformation of finger bones during the follow-up study. In the initial study, we observed exostoses in 30 (60 hands) of 32 (62 hands) patients. The average number of exostoses per hand was 5.2. Exostoses developed more frequently in the middle and ring proximal phalanges and the fifth metacarpal. In the follow-up study, 3.1 exostoses per hand spontaneously regressed and 2.9 exostoses per hand occurred de novo with growth. Progression of exostoses was mainly observed by approximately age 15 years; thereafter, spontaneous regression became dominant. Regression of exostoses was frequently observed in metacarpals, whereas de novo exostoses frequently occurred in phalangeal bones, particularly in distal phalanges. Growth plate involvement by exostoses did not influence the longitudinal growth of finger bones, but it increased their angulation. The hand is a common location of exostoses development for MHE patients. Although some exostoses in the hands regress with skeletal maturity, hand involvement by exostoses can result in angular deformity. Diagnostic IV.

Does skin surface temperature variation account for Buruli ulcer lesion distribution?

BackgroundBuruli ulcer is a necrotising infection of skin and soft tissue caused by Mycobacterium ulcerans (M. ulcerans). Buruli ulcer most often occurs on limbs, and it is hypothesized this is explained by direct exposure to the environment. However, even on exposed areas Buruli ulcer is not randomly distributed. M. ulcerans prefers an in vitro temperature of 30–33°C and growth is inhibited at higher temperatures. This study investigated whether variations in skin surface temperature distribution in healthy volunteers could partly account for Buruli ulcer lesion distribution.Methodology/Principal findingsIn this observational study, a thermal camera (FLIR E8) was used to measure skin surface temperature at the sternal notch and at 44 predetermined locations on the limbs of 18 human participants. Body locations of high, middle and low Buruli ulcer incidence were identified from existing density maps of lesion distribution. Skin temperature of the three incidence location groups were compared, and differences in age and sex groups were also analysed.We found an inverse relationship between skin temperature and lesion distribution, where high incidence locations were significantly cooler and low incidence locations significantly warmer (Kruskal-Wallis test p<0.0001). Linear mixed effects regression analysis estimated that skin surface temperature accounts for 22.0% of the variance in Buruli ulcer lesion distribution (marginal R-squared = 0.219) in the anterior location group, and 0.6% in the posterior group (marginal R-squared 0.006). Men had warmer upper and lower limbs than females (Mann-Whitney U test p = 0.0003 and p<0.0001 respectively).Conclusions/SignificanceWe have found an inverse relationship between skin temperature and Buruli ulcer lesion distribution, however this association is weak. Additional unknown factors are likely to be involved that explain the majority of the variation in Buruli lesion distribution.

Photometry of Kuiper belt object (486958) Arrokoth from New Horizons LORRI

On January 1st 2019, the New Horizons spacecraft flew by the classical Kuiper belt object (486958) Arrokoth (provisionally designated 2014 MU69), possibly the most primitive object ever explored by a spacecraft. The I/F of Arrokoth is analyzed and fit with a photometric function that is a linear combination of the Lommel-Seeliger (lunar) and Lambert photometric functions. Arrokoth has a geometric albedo of pv=0.21−0.04+0.05 at a wavelength of 550 nm and ≈0.24 at 610 nm. Arrokoth's geometric albedo is greater than the median but consistent with a distribution of cold classical Kuiper belt objects whose geometric albedos were determined by fitting a thermal model to radiometric observations. Thus, Arrokoth's geometric albedo adds to the orbital and spectral evidence that it is a cold classical Kuiper belt object. Maps of the normal reflectance and hemispherical albedo of Arrokoth are presented. The normal reflectance of Arrokoth's surface varies with location, ranging from ≈0.10–0.40 at 610 nm with an approximately Gaussian distribution. Both Arrokoth's extrema dark and extrema bright surfaces are correlated to topographic depressions. Arrokoth has a bilobate shape and the two lobes have similar normal reflectance distributions: both are approximately Gaussian, peak at ≈0.25 at 610 nm, and range from ≈0.10–0.40, which is consistent with co-formation and co-evolution of the two lobes. The hemispherical albedo of Arrokoth varies substantially with both incidence angle and location, the average hemispherical albedo at 610 nm is 0.063 ± 0.015. The Bond albedo of Arrokoth at 610 nm is 0.062 ± 0.015.

Analysis of the Behavior of Stomach Adenocarcinomas in Asian and Non-Asian Patients

The patterns of incidence, mortality, biological, and gastric cancer location are not uniform among ethnicities around the world...

Aneurysmal benign fibrous histiocytoma of the anal canal: a rare differential diagnosis

BackgroundTo our knowledge, we report the first case of an aneurysmal benign fibrous histiocytoma occurring in the anal canal.MethodsClinical, histological, radiological and surgical data pertaining to this patient were analysed. Additionally, a literature review on aneurysmal benign fibrous histiocytoma was conducted.ResultsWe describe a 48-year-old Caucasian male presenting with a 2-week history of a painful anus, fresh rectal bleeding and tenesmus. Digital rectal examination identified a tender firm mass in the anal verge. Magnetic resonance imaging revealed high signal in the anal canal. Flexible sigmoidoscopy revealed an ulcerated 3-cm indurated lesion at the four o’clock position. Biopsies taken of the mass confirmed the diagnosis of an aneurysmal benign fibrous histiocytoma (BFH). Following a discussion in the colorectal multi-disciplinary team, the patient was counselled for an excision of the lesion. Diathermy dissection was performed to completely excise the tumour with a margin involving the fibres of the anal sphincter. The patient made a full recovery and had no residual symptoms. Histology of the excised specimen confirmed clear margins of the BFH.ConclusionsThis paper aims to highlight a rare differential diagnosis for an anal mass. An aneurysmal BFH most often presents as a painless mass within the dermis and subcutaneous tissue. As such, this case presents a diagnostic challenge to both colorectal surgeon and histopathologist due to its low incidence and unusual location. We further present the clinical and radiographic evidence to confirm the diagnosis. Additionally, we discuss the literature pertaining to this condition and its optimal management.

Data from national media reports of 'Acid attacks' in England: A new piece in the Jigsaw.

There has been considerable concern in the UK with what seems to have been an increase in so-called 'Acid Attacks'. The key data sources (Police data, Hospital admissions and Burns unit data) have limitations in capturing the acid attacks comprehensively. Incidents not reported to the police are missed in the Police data. The more serious injuries are included in the hospital admissions data, with no information on people with less severe injuries, not accessing health care. Burns unit data reveals detailed information on the burns treatment but represents only a small percent of all the acid attacks. Our aim was to explore the role of media reports as an additional data source. Data was obtained from the public domain using generic online search engines along with a formal medical literature review. Search parameters included any news articles on 'Acid Attacks' printed between 01/01/2016 and 31/12/2017 in England and Articles in National Press only. We compared the data from media reports to the only other data sources available on these crimes which were (a) Crime statistics from police (b) the proportion treated in hospital (c) the subgroup treated in the burns service in the highest incidence location in the UK. Two hundred and Thirty media articles in total were found in the preliminary search. Following the application of the exclusion criteria, sixty attacks were analysed. The demographic data, the geographic data were obtained from the articles and the results were analysed using Microsoft Excel. There were a total of 118 survivors with an average age of 29.5 years and a male to female ratio of 5.1:1. There were no reported deaths. In the assailants group, the average age was 21.6 years with a male to female ratio of 15.7:1. All the data sources revealed higher male survivor predominance. The average age of the survivors was similar in the media reports, police data and the Burns centre data and was higher in the hospital data. Information on assailants and motives, available only on media reports and police data, corroborated well with each other. Media reports gave further information on the circumstances of the incident, the location and the number of survivors per assault, which was not available on any other data source. Though there was a rise in chemical assaults reported in media reports and MPS data in 2017 compared to the previous year, there was no rise in chemical assault related hospital admissions. The majority of the survivors were males, which is consistent between all UK data sources. Media reports revealed that the South east of England had the majority of chemical assaults in England. Data from this source provides a further piece in the jigsaw especially in relation to the circumstances, the geographic location of the chemical assault and number of survivors per incident. We acknowledge the limitations of media reporting. In the absence of a formal database for such injuries and incomplete data from various sources, we have to consider all possible data sources to provide new information. We have discussed the utility, pros & cons of media reports as one of the additional sources of information to better understand these injuries.

Incidence, Type and Anatomical Location of Gastric Polyp: Experience of a Tertiary Level Hospital in Bangladesh

Background: Gastric polyps are small gastric mucosal lesions, usually asymptomatic in most cases and are generallydiscovered incidentally during upper Gastro Intestinal (GI) tract endoscopy. But some polyps have malignant potential.We observed the characteristics and frequency of gastric polyps, derived from the gastric mucosal epithelium in a seriesof endoscopies.&#x0D; Method: Fifty three patients were studied in a series of 2890 consecutive upper GI endoscopies done over one yearperiod. Each patient had only one examination and were analyzed on the basis of their location, size, type and histopathological findings. All patients had at least one gastric polyp, as confirmed by histological examination.&#x0D; Result: Among 2890 endoscopies we found gastric polyps in 53 cases. So the incidence was 1.83 %. Mean age of thestudy population was 50.25±11.75. Polyp was more prevalent among female (64%). Most of the patients were presentedwith anemia, heartburn and abdominal pain, 57%, 42% and 36% respectively. Other less common clinical features areanorexia (13%), melaena (9.4%) and hematemesis (1.9%). 64% patients were diabetic and 76% patients used PPI withduration of 19.00±9.78 months.Most of the polyps were located at the body of stomach (47.1%), less common sites were antrum (15.1%), cardia(7.6%), fundus (7.6%), Gastro Esophageal (GE) junction (3.8%) and duodenum (1.9%). Majority of the polyps weresmall and medium sized (37.7%, 35.8%) and large (11.3%). Sessile polyp was found in 49.1% cases, other common typewas pedunculated (39.5%). Only 28% patient had surface ulceration on polyp and commonest histological type washyperplastic 75.4%, 18.9% patient had adenomatous polyp. Brunner’s gland adenoma and carcinoid were rare, 3.8%and 1.9% respectively. Multiple polyps were found in 30% patient.&#x0D; Conclusion: Gastric epithelial polyps are infrequent and most of them measure less than 1 cm. The upper GI tractendoscopy is the safest and efficient method for the diagnosis of the gastric polyps, as in most of the patients does notshow characteristic symptoms. The histopathological definition is necessary to classify the polyps as well as detectionof dysplastic changes. Biopsy from different part of the stomach is necessary to find out the gastritis and dysplasticchanges.&#x0D; Bangladesh Crit Care J September 2019; 7(2): 90-94

Increasing colorectal cancer incidence in individuals aged < 50years-a population-based study.

Data on the incidence of colorectal cancer (CRC) is conflicting, and it is unknown if the incidence is constant, declining, or increasing. Proximal colon cancer is considered to be more common among older individuals, but recent data have shown that rectal cancer and distal colon cancer have been increasing in the younger population. The aim of this study was to determine the trends regarding CRC incidence and tumour location in Sweden. CRC statistics from the National Board of Health and Welfare 1995-2015 were used. CRC incidence rates by age group (< 50years, 50-79years, ≥80years), sex, and tumour localisation (proximal colon, distal colon, or rectum) were calculated and analysed using Poisson regression. The age-standardised incidence of CRC increased in Sweden during the study period. This increase was significant (P< 0.0001) for colon cancer during the study period for all age groups regardless of tumour localisation. The greatest increase (27-52% per decade) in the colon cancer incidence rate was seen among men and women < 50years of age. The incidence rate for rectal cancer increased for men < 50years (P< 0.0001), decreased for both men and women aged ≥80years (P < 0.005), and did not change for the remaining groups. The CRC incidence in Sweden, in particular colon cancer, is increasing regardless of tumour localisation for individuals < 50years of age. This paper supports the implementation of population-based colorectal cancer screening. A diagnostic workup should be performed in symptomatic individuals < 50years of age.

Optimal routing for automated emergency vehicle response for incident intervention in a traffic network

Congestion constitutes a major problem in modern urban traffic networks if not well managed. Its monstrous effects, on occasions, can paralyze a traffic network eating deep into the productive hours of commuters as well as vehicles and persons on essential services. Particularly affected are incidence-intervention vehicles such as emergency vehicles and fire-fighting vehicles. Whatever the cause of the congestion, its effect is counter-productive and an indication of an inefficient traffic network. This work, as presented in this paper, is concerned about the issue of traffic route management for emergency service (emergency vehicle) for which a delay of few minutes may cause tremendous loss of lives and properties. The route management scheme built for this purpose integrates information obtained from the use of Radio Frequency Signals for Traffic Light Preemption at Intersections in a Proteus Simulator environment and the use Arc GIS as a mode of routing the emergency vehicle from base to the incidence location, then to Health Facilities and from thence back to the emergency vehicle base in an optimal routing time. Traffic information are loaded into the Arc GIS environment which predicts the required tri-legged optimal routing and its duration using Dijkstra’s algorithm. Different scenarios of emergency vehicle, incidence and health facility locations were exploited using the scheme and compared with situations without their implementation. The proposed scheme outperforms the trial and error routing of emergency vehicles and can be embedded into traffic advisory system or as stand-alone emergency vehicle management system. Keywords: GIS, Dijkstra’s algorithm, Facility Location, Emergency-Vehicle, Optimal Routing

Impact of age at diagnosis of head and neck cancer on incidence of metachronous cancer

BackgroundMetachronous cancer in patients with head and neck cancer (HNC) is common and is associated with a poor prognosis. We aimed to evaluate the incidence of metachronous cancer at different sites according to age at diagnosis of index HNC.MethodsWe collected data on 2011 patients with oral cancer, oropharynx cancer, hypopharyngeal cancer, and laryngeal cancer as index cancers using the Osaka International Cancer Institute Cancer Registry database between 2005 and 2016. Among these, we analyzed 1953 patients after excluding 5 patients who were not followed-up and 53 patients with simultaneous multiple index cancers. We evaluated the cumulative incidence of metachronous cancer in the esophagus, lung, and other sites according to age at diagnosis of the index HNC using the Kaplan–Meier method. Multivariate logistic regression analysis was performed to identify factors that influenced the incidence of metachronous cancers following HNC.ResultsThe cumulative incidence of metachronous esophageal cancer in young patients (< 65 years) was significantly higher than that in old patients (≥ 65 years) (12.1% vs 8.5% at 5 years, and 16.5% vs 11.2% at 10 years; p = 0.015). On the other hand, the cumulative incidence of the other cancers in young patients was significantly lower than that in old patients (7.8% vs 12.2% at 5 years, and 13.9% vs 15.3% at 10 years; p = 0.017). The cumulative incidence of lung cancer was not significance according to age at diagnosis of the index HNC. In the multivariate analysis, histological type (squamous cell carcinoma) and lesion location (hypopharynx and larynx) were independently associated with metachronous cancers. Moreover, age at diagnosis of the index HNC (< 65 years), histological type (squamous cell carcinoma) and lesion location (hypopharynx) were significant predictors of metachronous esophageal cancer incidence and lesion location (hypopharynx) was a significant predictor of metachronous lung cancer incidence.ConclusionRisk stratification of metachronous cancers with age and other predictors may help to properly manage patients with HNC.Trial registrationThe present study is a non-intervention trial.

Overuse injuries in Swedish elite athletics\u2013 a study protocol for a prospective multifactorial cohort study

BackgroundOveruse injuries (OI) are common in elite athletics. Previous studies have had athletes self-report injuries rather than having a medical professional provide a clear diagnosis. This might be a major reason for the inconsistencies in reported incident proportions of OI in elite athletics, in addition to the varying definitions of OI in current literature.Risk factors or combinations of risk factors (biomechanical, clinical, and training-related) have been shown to be important in the developmental process of OI. However, no studies have examined these relationships using a multifactorial and prospective approach in elite athletics.The purpose of this study protocol is to describe OI incidence proportion, injury severity, location, and occurrence during a complete athletics season. Moreover, possible discipline specific and injury specific risk factors that might be associated with OI will be examined.MethodsThis study will be an explorative prospective cohort study including approximately 120 elite athletes. All athletes will be screened twice during one complete athletics season. The screening will consist of a body composition scan to measure muscle mass, fat free mass, lean mass, bone density, and bone mineral content. In addition, clinical examination will measure range of motion for the lower back, hip, knee, shoulder, and elbow and ankle joints. A running analysis will measure the 3D motions of the hip, knee, and ankle joints. Finally, maximal isometric strength tests of the main core and lower extremity muscles will be carried out.To record injuries, each athlete will consult a physiotherapist or sports medicine doctor affiliated with the study to get a clear diagnosis. Injury data will be recorded according to the previously published athletics consensus statement.DiscussionResults from this study protocol will contribute more insight and detailed knowledge regarding the extent of OI occurrence among elite athletes during a complete athletics season. It will also provide further insights into which risk factors are associated with the development of OI in elite athletics.

Optimisation of Trajectories for Wireless Power Transmission to a Quadrotor Aerial Robot

Unmanned aircraft such as multirotors are typically limited in endurance by the need to minimise weight, often sacrificing power plant mass and therefore output. Wireless power transmission is a method of delivering power to such aircraft from an off-vehicle transmitter, reducing weight whilst ensuring long-term endurance. However, transmission of high-powered lasers in operational scenarios carries significant risk. Station-keeping of the laser spot on the receiving surface is crucial to both ensuring the safety of the procedure and maximising efficiency. This paper explores the use of trajectory optimisation to maximise the station-keeping accuracy. A multi-agent model is presented, employing a quadrotor unmanned rotorcraft and energy transmission system, consisting of a two-axis gimbal, camera sensor and laser emitter. Trajectory is parametrised in terms of position and velocity at the extremes of the flight path. The optimisation operates on a cost function which considers target range, beam angle of incidence and laser spot location on the receiving surface. Several cases are presented for a range of variables in the trajectory and different conditions in the model and optimisation algorithm. Results demonstrate the viability of this approach in minimising station-keeping errors.

Dysgeusia in deep brain stimulation for essential tremor

Dysgeusia, or foul taste, is a rarely reported side effect in patients who have undergone deep brain stimulation (DBS) in the thalamus for essential tremor. This retrospective study evaluated the incidence, nature, neurophysiological and anatomical location of dysgeusia following DBS. Of 52 patients who had undergone DBS for essential tremor, eight (15%) reported dysgeusia, which was described as a “metallic,” “sour,” “foul,” or “cold” taste in the mouth. Dysgeusia was separate and distinguishable from paresthesia. Dysgeusia was more frequently reported with bilateral than unilateral DBS implants (6 of 27 (22%) vs. 2 of 25 (8%) patients, respectively). The anatomical locations of the contacts causing dysgeusia were measured on postoperative MRI, and compared to those from seven control patients who did not experience dysgeusia after receiving bilateral DBS implants. Leads causing dysgeusia were more posterior than non-dysgeusia-associated leads (4.5 ± 1.2 vs. 5.7 ± 1.8 mm anterior to the posterior commissure, respectively, P < .001). Intraoperative microelectrode recording indicated that these contacts were in the sensory region of the thalamus. Intraoperative testing found that low sensory threshold for paresthesia predicted the development of dysgeusia postoperatively (1.5 ± 0.5 V vs. 3.3 ± 1.9 V; P < .05). These data indicate that taste perception can be altered in the human through DBS, with posterior leads likely within the sensory region of the thalamus. Dysgeusia can be reduced by changing stimulation parameters, or surgical revision of the lead.

Retrieval outcome of separated endodontic instruments by Saudi endodontic board residents: A Clinical retrospective study

Aim: This study aims to evaluate the retrieval outcome of the separated endodontic instrument by endodontic board residents. Materials and Methods: Records of 450 endodontic cases with separated endodontic instruments treated by endodontic Saudi board residents were randomly selected. The evaluation was based on the tooth type, type of fractured instrument, incidence and anatomical location in the root canal and if the instrument was retrieved, bypassed, or left. Data were statistically analyzed using IBM-SPSS.22. Results: A total of 84 (19%) separated instruments were identified. Thirty-four cases (7.55%) with separated instruments out of the total evaluated cases were done by residents. The incidence between hand stainless steel and nickel-titanium instruments was statistically significant (P Conclusions: Regardless of little experience of the endodontic residents, they were successfully managed to remove or bypass most of the separated instruments. Ultrasonic device was very helpful in removing the separated instrument.

Epidemiology of Injuries in Women Playing Competitive Team Bat-or-Stick Sports: A Systematic Review and a Meta-Analysis.

Team bat-or-stick sports, including cricket, softball and hockey, are popular among women. However, little is known about the injury profile in this population. The aim was to describe the incidence, nature and anatomical location of injuries in bat-or-stick sports played by women in a competitive league. This review was prospectively registered (PROSPERO CRD42015026715). CINAHL, MEDLINE, PsycINFO, PubMed, SPORTDiscus were systematically searched from January 2000 to September 2016, inclusive. Peer-reviewed original research articles reporting the incidence, nature and anatomical location of injuries sustained by women aged 18+years in competitive bat-or-stick sports were included. Two meta-analyses based on injury incidence proportions (injury IP) and injury rates per 1000 person-days of athletic exposure (AE) were performed. A total of 37 studies satisfied the inclusion criteria, and five had low risk of bias. The weighted injury IP was 0.42 [95% confidence interval (CI) 0.39-0.45]. The weighted injury rate was 6.12 (95% CI 6.05-6.18) overall, and greater in games [15.79 (95% CI 15.65-15.93)] than in practice [3.07 (95% CI 2.99-3.15)]. The ankle was the most commonly injured anatomical location, followed by the hand (including wrist and fingers), knee and head. Soft tissue and ligament injuries were most common types of injuries. Injury prevention in women's sports is a novel and emerging field of research interest. This review highlights that injury incidence is high among female bat-or-stick players, but little information is known about direct causal mechanisms. This review clearly establishes the need for enhancements to injury data collection. Without this information, it will not be possible to develop evidence-based injury prevention interventions.

Injury Pattern in Icelandic Elite Male Handball Players.

To examine the incidence, type, location, and severity of injuries in Icelandic elite male handball players and compare across factors like physical characteristics and playing position. Prospective cohort study. The latter part of the preseason and the competitive season of Icelandic male handball. Eleven handball teams (185 players) from the 2 highest divisions in Iceland participated in the study. Six teams (109 players) completed the study. Injuries were recorded by the players under supervision from their team physiotherapists or coaches. Coaches recorded training exposure, and match exposure was obtained from the Icelandic and European Handball Federations. The players directly recorded potential risk factors, such as age, height, weight, previous injuries, and player position. Injury incidence and injury location and number of injury days. Recorded time-loss injuries were 86, of which 53 (62%) were acute and 33 (38%) were due to overuse. The incidence of acute injuries was 15.0 injuries/1000 hours during games and 1.1 injuries/1000 hours during training sessions. No significant difference was found in injury incidence between teams, but number of injury days did differ between teams (P = 0.0006). Acute injuries were most common in knees (26%), ankles (19%), and feet/toes (17%), but overuse injuries occurred in low back/pelvic region (39%), shoulders (21%), and knees (21%). Previous knee injuries were the only potential risk factor found for knee injury. The results indicate a higher rate of overuse injuries in low back/pelvic region and shoulders than in comparable studies.

Incidence and body location of reported acute sport injuries in seven sports using a national insurance database.

Sports with high numbers of athletes and acute injuries are an important target for preventive actions at a national level. Both for the health of the athlete and to reduce costs associated with injury. The aim of this study was to identify injuries where injury prevention should focus, in order to have major impact on decreasing acute injury rates at a national level. All athletes in the seven investigated sport federations (automobile sports, basketball, floorball, football (soccer), handball, ice hockey, and motor sports) were insured by the same insurance company. Using this insurance database, the incidence and proportion of acute injuries, and injuries leading to permanent medical impairment (PMI), at each body location, was calculated. Comparisons were made between sports, sex, and age. In total, there were 84754 registered injuries during the study period (year 2006-2013). Athletes in team sports, except in male ice hockey, had the highest risk to sustain an injury and PMI in the lower limb. Females had higher risk of injury and PMI in the lower limb compared to males, in all sports except in ice hockey. This study recommends that injury prevention at national level should particularly focus on lower limb injuries. In ice hockey and motor sports, head/neck and upper limb injuries also need attention.

Pediatric ATV Injuries in a Statewide Sample: 2004 to 2014.

To establish the incidence, mortality rate, and fracture location of pediatric patients injured while using an all-terrain vehicle (ATV) over an 11-year period. A retrospective study using a state trauma database for patients ages 0 to 17 years who sustained injuries while using an ATV. Thirty-two pediatric and adult trauma centers within the state were evaluated from January 1, 2004, to December 31, 2014. The inclusion criteria were met by 1912 patients. The estimated mean annual incidence during the period of the study was 6.2 patients per 100 000 children in the pediatric population <18 years of age. There was a decrease of 13.4% in the mean incidence when comparing the first 5 years of the study with the last 6 years. The median age of patients was 14 years. The median hospital length of stay and injury severity score were 3 days and 9, respectively. There were 28 fatalities (1.5%). The mean mortality incidence was 0.09 deaths per 100 000 children and remained relatively constant. The majority of patients (55.4%) sustained at least 1 bone fracture at or below the cervical spine. The femur and tibia were more commonly fractured (21.6% and 17.7% of the patients, respectively). Despite current guidelines by the American Academy of Pediatrics, patients younger than 16 years of age remain victims of ATV injuries. Although there was a 13.4% reduction in the incidence of ATV-related injuries in recent years, continued preventive guidelines are still necessary to avert these injuries in children and adolescents.

Development of zebrafish medulloblastoma-like PNET model by TALEN-mediated somatic gene inactivation.

Genetically engineered animal tumor models have traditionally been generated by the gain of single or multiple oncogenes or the loss of tumor suppressor genes; however, the development of live animal models has been difficult given that cancer phenotypes are generally induced by somatic mutation rather than by germline genetic inactivation. In this study, we developed somatically mutated tumor models using TALEN-mediated somatic gene inactivation of cdkn2a/b or rb1 tumor suppressor genes in zebrafish. One-cell stage injection of cdkn2a/b-TALEN mRNA resulted in malignant peripheral nerve sheath tumors with high frequency (about 39%) and early onset (about 35 weeks of age) in F0 tp53e7/e7 mutant zebrafish. Injection of rb1-TALEN mRNA also led to the formation of brain tumors at high frequency (58%, 31 weeks of age) in F0 tp53e7/e7 mutant zebrafish. Analysis of each tumor induced by somatic inactivation showed that the targeted genes had bi-allelic mutations. Tumors induced by rb1 somatic inactivation were characterized as medulloblastoma-like primitive neuroectodermal tumors based on incidence location, histopathological features, and immunohistochemical tests. In addition, 3′ mRNA Quanti-Seq analysis showed differential activation of genes involved in cell cycle, DNA replication, and protein synthesis; especially, genes involved in neuronal development were up-regulated.

Population-based study demonstrating an increase in colorectal cancer in young patients.

New Zealand has among the highest rates of colorectal cancer in the world and is an unscreened population. The aim of this study was to determine the trends in incidence and tumour location in the New Zealand population before the introduction of national colorectal cancer screening. Data were obtained from the national cancer registry and linked to population data from 1995 to 2012. Incidence rates for colorectal cancer by sex, age (less than 50 years, 50-79 years, 80 years or more) and location (proximal colon, distal colon and rectum) were assessed by linear regression. Among patients aged under 50 years, the incidence of distal colonic cancer in men increased by 14 per cent per decade (incidence rate ratio (IRR 1·14), 95 per cent c.i. 1·00 to 1·30; P = 0·042); the incidence of rectal cancer in men increased by 18 per cent (IRR 1·18, 1·06 to 1·32; P = 0·002) and that in women by 13 per cent (IRR 1·13, 1·02 to 1·26; P = 0·023). In those aged 50-79 years, there was a reduction in incidence per decade of proximal, distal and rectal cancers in both sexes. In the group aged 80 years and over, proximal cancer incidence per decade increased by 19 per cent in women (IRR 1·19, 1·13 to 1·26; P < 0·001) and by 25 per cent in men (IRR 1·25, 1·18 to 1·32; P < 0·001); among women, the incidence of distal colonic cancer decreased by 8 per cent (IRR 0·92, 0·86 to 0·98); P = 0·012), as did that of rectal cancer (IRR 0·92, 0·86 to 0·97; P = 0·005). The increasing incidence of rectal cancer among younger patients needs to be considered when implementing screening strategies.