Iatrogenic tracheal ruptures are rare but severe complications of medical interventions. The main goal of this study was to explore prognostic factors for all-cause mortality and rupture-related (adjusted) mortality. We retrospectively analyzed patients admitted to an academic referral center over a 15-year period (2004–2018). Fifty-four patients met the inclusion criteria, of whom 36 patients underwent surgical repair and 18 patients were treated conservatively. In a 90-day follow-up, the all-cause mortality was 50%, while the adjusted mortality was 13%. Rupture length was identified as a predictor for all-cause mortality (area under the curve, 0.84; 95% confidence interval (CI) 0.74–0.94) with a cutoff rupture length of 4.5 cm (sensitivity, 0.70; specificity, 0.81). Multivariate analysis confirmed rupture length as a prognostic factor for all-cause mortality (adjusted hazard ratio (HR) 1.5; 95% CI 1.2–1.9; p = 0.001), but not for adjusted mortality (HR 1.5; 95% CI 0.97–2.3; p = 0.068), while mediastinitis predicted adjusted mortality (HR 5.8; 95% CI 1.1–31.7; p = 0.042), but not all-cause mortality (HR 1.6; 95% CI 0.7–3.5; p = 0.243). The extent of iatrogenic tracheal rupture and mediastinitis might be relevant prognostic factors for all-cause mortality and adjusted mortality, respectively.

No description available.

Osteopathic Manipulative Treatment (OMT) has been used for more than 100 years to enhance the physiologic process of labor and delivery by normalizing pelvic structures and providing adequate blood supply to the uterus. Since maternal morbidity and mortality is a major health concern for developing countries, it was desirable to explore the benefits of OMT. After IRB approval by the Virginia College of Osteopathic Medicine and Virginia Tech, the research was conducted in Santo Domingo, Dominican Republic at Hospital Maternidad Nuestra Señora de la Altagracia to determine the relationship of OMT during labor and delivery on rates of cesarean section and perineal lacerations/ episiotomies. Qualifying candidates received the next sequentially numbered envelope with a randomized number assigning her to either the treatment or control group. Staff physicians at the hospital provided care to women in the control group according to their standard protocol. Four Osteopathic Physicians and one pre-doctoral OMM fellow performed OMT on women during the first and second stages of labor and performed their deliveries. There were 33 parturients in the OMT Treatment group and 32 in the control, for a total of 65 in the trial. The results of a logistic regression analysis using Wald criterion, with a statistical significance of alpha = 0.05, indicated treatment group reduction of rates of episiotomies in the primiparous (P = .04) and marginal significance in the combined primiparous and multiparous population (P = .05). The percentage of episiotomies in the primiparous treatment group was 35.29% and 75% in the control group. The percentage of episiotomies in the combined primiparous and multiparous groups were 15.15% in the treatment group and 37.5% in the control group. The cesarean rate for the treatment group was 9.09% and 18.75% for the control group (P = 0.098). The percentages of grade I & II perineal lacerations were 15.15% for the treatment group and 12.5% for the control group (P = 0.55) due to the extensive use of episiotomies in the control group. There were composite calculations made of the total number of parturients who had either a cesarean section, an episiotomy, or a perineal laceration so that overall maternal morbidity in each group could be compared. In the combined groups, there were fourteen total parturients (42.42%) who had undergone one of the three outcomes measures in the treatment group and twenty-one (65.63%) in the control group. This brings an odds ratio of 0.200 and a significant P value of 0.0235. Though cross-cultural issues made it difficult to perform the research as originally intended, there is evidence that Osteopathic Obstetrics provides benefit to parturients. A multi-institutional randomized controlled trial is proposed as the next step for the evaluation of OMT during labor and delivery. / Ph. D.

L’objectif de la présente étude est d’étudier les différences entre les homicides par strangulation et les suicides par pendaison ainsi que l’importance du rôle que jouent les lésions dans la détermination du mode de décès dans les cas apparents de pendaison, et ce dans l’optique d’établir un outil permettant de renseigner le coroner ou médecin légiste sur le mode de décès probable dans les cas apparents de pendaison. Deux cent quatorze cas de suicide par pendaison ont été révisés rétrospectivement et comparés à 51 cas d’homicide par strangulation. La fréquence d’ecchymoses (6,1 %), d’abrasions (4,7 %) et de lacérations (0,5 %) était significativement plus faible chez les victimes de suicide par pendaison que chez les victimes d’homicides par strangulation (58,8 %, 51,0 % et 5,9 % respectivement). Les ecchymoses, chez les victimes de suicide par pendaison, se trouvent habituellement sur les membres supérieurs antérieurs et postérieurs ou sur les membres inférieurs antérieurs. Elles se situent généralement soit sur les membres supérieurs, soit sur les membres inférieurs, et non aux deux endroits à la fois. Les abrasions sont davantage susceptibles de se trouver sur la face postérieure des membres supérieurs et sur la face antérieure des membres inférieurs. Cette concentration préférentielle n’est pas observée chez les victimes d’homicide par strangulation. De possibles critères de suspicion et des modèles de prédiction du mode de décès sont évalués. / The objective of the present study is to study the differences between the suicidal hangings and the homicidal nonhanging strangulations as well as the lesion’s role in the manner of death determination in apparent hanging cases, in order to create a decision tool that will inform the coroner or medical examiner on the probable manner of death in apparent hanging cases. Two hundred and fourteen cases of suicidal hanging were retrospectively reviewed and compared to 51 homicidal nonhanging strangulation victims. Bruises, abrasions and lacerations incidence were significantly lower in hanging victims (6.1 %, 4.7 % and 0.5 % respectively) compared to homicidal strangulation victims (58.8 %, 51.0% and 5.9 % respectively). Limb bruises were found as much on the anterior part of upper limbs as on posterior part, whereas limb abrasions were located mostly on the posterior aspect of upper limbs. Bruises and abrasions were also found exclusively on the anterior aspect of the lower limbs. Bruises are generally observed either exclusively on upper limbs, either exclusively on lower limbs, but rarely on both in a single case. In homicidal nonhanging strangulation cases, this preferential lesions concentration was not observed. Possible criteria for limb lesions distribution are discussed and prediction models of the manner of death are evaluated.

Des romans néoréalistes aux récits fantastiques, des fables modernes aux essais engagés, Italo Calvino (1923-1985) fut un auteur très fécond. Ses écrits forment un parcours où se mêlent réel et imaginaire, visible et invisible, dicible et indicible, présence et absence. Au centre de ce parcours : des personnages souvent pourfendus en quête de vérité, d’harmonie, de complétude. La ville, espace humain par excellence, constitue un terrain d’observation privilégié pour révéler ces différents thèmes. Plus qu’un décor ou un lieu d’habitation, elle se fait miroir des personnages. Qu’elle soit réelle, imaginaire ou utopique, la ville semble cacher un secret. La présente étude propose de retracer et de suivre en parallèle l’évolution de l’espace urbain et celle de l’espace humain pour voir si ces paysages extérieur et intérieur sont à même de vivre ensemble. La ville, dans le corpus calvinien étudié, change sans cesse de visage : de la ville provinciale et balnéaire à la métropole industrielle, de la ville-encyclopédie à la ville sans racines. Souvent considérée comme un monstre en puissance, une maladie de l’époque moderne, un espace stérile et anonyme, la ville s’apparente alors à une cage « dorée » dans laquelle l’homme s’égare toujours plus. Pour sortir de ce labyrinthe, nous envisagerons l’espace urbain autrement afin de lui redonner son véritable sens. Nous voyagerons ainsi avec Marco Polo et remonterons aux origines de la ville pour nous diriger vers ce continent de l’Ailleurs où les cités seront suspendues dans les airs, où elles auront perdu le poids du réel et où peut-être, l’homme sera à même de retrouver sa place et son identité d’être humain et de citoyen des Villes. / From neo-realist novels to fantastic narratives, and from modern fables to committed essays, Italo Calvino (1923-1985) was a prolific author. His writings all weave together the real and imaginary, the visible and invisible, the said and unsaid, the present and absent. At the centre of this pattern are often cloven characters in search of truth, harmony and completeness. The city, the archetypal human space, constitutes a privileged observation point from which these different themes can be observed. More than just a setting or a living space, it acts as a mirror for its characters. Whether the city is real, invisible, imaginary or utopian, it seems to hide a secret. The present study offers to simultaneously recount and follow the evolution of urban and human space in order to see if these outer and inner landscapes can actually live together. If we take into account the Calvinian corpus, we see that the city continually changes its face : from the small provincial and seaside town to the industrial metropolis, from the encyclopaedia city to the rootless one. Often considered to be a powerful monster, a disease of modern times, a sterile and anonymous space, the city resembles something more like a gilded cage in which men are always led astray. In order to escape this labyrinth, we must reimagine urban space in order for it to reclaim its true meaning. Thus, we will travel side-by-side with Marco Polo : we will retrace the history of the city in order to travel the continent of Elsewhere, one in which cities will be suspended in the air, unburdened by reality, and where – perhaps – we will be able to recover our humanity and our citizenship of Cities.

Avaliou-se os efeitos dos ácidos linoleico e oleico na regeneração do músculo gastrocnêmio lacerado em ratos e em mioblastos, miotubos e fibroblastos em cultura. Houve regeneração incompleta e recuperação parcial da função contrátil do músculo lesionado. O ácido linoleico diminuiu a massa, a atividade contrátil, a área de secção tranversa das fibras, aumentou tecido fibroso no músculo lesionado e elevou a expressão de PCNA, colágeno e fibronectina nos fibroblastos. O ácido oleico aboliu as alterações na atividade contrátil e o aumento de tecido fibroso e elevou a expressão de MyoD em mioblastos e desmina em miotubos e reduziu de PCNA, colágeno e fibronectina em fibroblastos. O ácido linoleico comprometeu a regeneração enquanto que o oleico otimizou a capacidade regenerativa e a função contrátil do músculo lesionado. / The effects of linoleic and oleic acids on regeneration of lacerated gastrocnemius muscle in rats and on cultured myoblasts, myotubes and fibroblasts were examined. There was incomplete regeneration and partial recovery of the contractile function of the injured muscle. Linoleic acid reduced the mass, contratile activity and cross-sectional area of the fibers, raised the fibrous area and reduced the expression of PCNA, collagen and fibronectin in fibroblasts. Oleic acid abolished the changes in contratile activity and the increase in the fibrous area, raised the expressions of MyoD in myoblasts, desmin in myotubes and inhibited the expressions of PCNA, collagen and fibronectin in fibroblasts. Linoleic acid impaired regeneration whereas oleic acid optimized the regenerative capacity and contractile function of the injured muscle.

Avaliou-se os efeitos dos ácidos linoleico e oleico na regeneração do músculo gastrocnêmio lacerado em ratos e em mioblastos, miotubos e fibroblastos em cultura. Houve regeneração incompleta e recuperação parcial da função contrátil do músculo lesionado. O ácido linoleico diminuiu a massa, a atividade contrátil, a área de secção tranversa das fibras, aumentou tecido fibroso no músculo lesionado e elevou a expressão de PCNA, colágeno e fibronectina nos fibroblastos. O ácido oleico aboliu as alterações na atividade contrátil e o aumento de tecido fibroso e elevou a expressão de MyoD em mioblastos e desmina em miotubos e reduziu de PCNA, colágeno e fibronectina em fibroblastos. O ácido linoleico comprometeu a regeneração enquanto que o oleico otimizou a capacidade regenerativa e a função contrátil do músculo lesionado. / The effects of linoleic and oleic acids on regeneration of lacerated gastrocnemius muscle in rats and on cultured myoblasts, myotubes and fibroblasts were examined. There was incomplete regeneration and partial recovery of the contractile function of the injured muscle. Linoleic acid reduced the mass, contratile activity and cross-sectional area of the fibers, raised the fibrous area and reduced the expression of PCNA, collagen and fibronectin in fibroblasts. Oleic acid abolished the changes in contratile activity and the increase in the fibrous area, raised the expressions of MyoD in myoblasts, desmin in myotubes and inhibited the expressions of PCNA, collagen and fibronectin in fibroblasts. Linoleic acid impaired regeneration whereas oleic acid optimized the regenerative capacity and contractile function of the injured muscle.

The effects of energy quantity to the reproductive strategies of the sea anemone Aiptasia pulchella Carlgren 1943 Chien-Hsun Chen (Advisors: Drs. Keryea Soong, Chao-Lun Chen) Institute of Marine Biology, National Sun Yat-Sen University, Kaohsiung, 804, Taiwan, R.O.C. Thesis abstract The influences of energy quantity on the sexual and asexual reproduction and possible trade-offs between them in the sea anemone, Aiptasia pulchella were investigated. Different feeding frequencies, light intensities and presence of zooxanthellae were the treatments of energy quantity. Lacerate numbers, lacerate sizes and total weight of lacerates were used to quantify investment in asexual reproduction; oocyte sizes and gonad weights were used as the measures of sexual reproduction. The correlation between total weight of lacerates and that of gonads provided an opportunity for evidence of trade-offs between sexual and asexual reproduction. Under higher feeding frequencies, A. pulchella produced more and larger lacerates as well as larger oocytes and heavier gonads than under lower feeding frequencies. Under lower light intensities, A. pulchella produced more and heavier lacerates with than without zooxanthellae. Lacerate sizes were influenced by light intensities, presence of zooxanthellae and the interaction of the two factors. At intermediate light intensity (2000 lux), Aiptasia pulchella produced heavier gonads than at 0 lux or 10000 lux. A. pulchella produced heavier gonads with than without zooxanthellae. The oocyte sizes of A. pulchella were also influenced by light intensities, zooxanthellae and the interaction of the two. In both sexual or asexual modes of reproduction, A. pulchella performed better under higher than lower feeding frequencies. There were higher level of asexual reproduction for A. pulchella under lower light intensities with zooxanthellae. A. pulchella achieved the highest levels of fecundity, as an indication of sexual reproduction, under a light intensity of 2000 lux in individuals containing zooxanthellae. There is a positive correlation between sexual and asexual investment under different energy regimes. This is not compatible with the prediction of the trade-off hypothesis.

Background: Sphincter injury is serious complication in connection to vaginal childbirth. Desire to avoid vaginal birth again is seen in women who previously suffered from a sphincter injury. Objective: To identify and evaluate obstetric guidelines in Sweden regarding sphincter injury in relation to childbirth Method: Content analysis with a combination of a deductive and inductive approach. Results: The most frequently occurring risk factors and prevention with help of perineal protection were described in the guidelines. The physician made diagnosis and repaired the sphincter injury at the theatre.  Complications such as coital pain and anal incontinence were described in the guidelines. Paracetamol and diclofenac was most common analgesic regimen given for pain. Prophylaxis such as antibiotic treatment and laxative were common. Information given to women was described. Follow-up by physician, midwife and physiotherapist was recommended after four weeks to six months. For future birth a cesarean section was recommended. Conclusion: The guidelines were constructed in the same way and had to a large extent similar content. The authors of the present work recommend a national guideline. / Bakgrund: Sfinkterskada är en allvarlig komplikation i samband med vaginal förlossning. Önskan om att undvika vaginal förlossning igen ses hos kvinnor som tidigare drabbats av sfinkterskada. Syfte: Syftet med studien var att ta reda på om det fanns riktlinjer gällande sfinkterskada i samband med förlossning vid Sveriges förlossningskliniker samt sammanställa och granska innehållet i riktlinjerna. Metod: Innehållsanalys med en kombination av deduktiv och induktiv ansats. Resultat: Av de 39 kliniker som svarade hade 31 riktlinjer gällande sfinkterskada. I riktlinjerna beskrevs vanligast förekommande riskfaktorer samt prevention med hjälp av perinealskydd. Läkaren ställde diagnos och utförde reparation av sfinkterskadan på operationsavdelningen. Komplikationer som samlagssmärta och anal inkontinens fanns beskrivet i riktlinjerna. Paracetamol och diklofenak var den vanligast förekommande smärtlindringen. Profylax som antibiotikabehandling och laxantia gavs av de flesta förlossningskliniker. Information till den nyförlösta kvinnan beskrevs. Uppföljning hos läkare, barnmorska och sjukgymnast rekommenderades efter fyra veckor till sex månader. Vid kommande graviditet och förlossning föredrogs kejsarsnitt. Slutsats: Riktlinjerna var uppbyggda på samma sätt och hade till stor del liknande innehåll. Författarna till föreliggande fördjupningsarbete efterfrågar en nationell riktlinje.