Isolated liver gunshot injuries: nonoperative management is feasible?

ABSTRACTObjective:to evaluate the safety and effectiveness of non-operative management (NOM) of liver injury, being the only abdominal injury, from gunshot wounds to the abdomen.Methods:patients who had liver damage diagnosed as single abdominal injury caused by PAF in the right thoracoabdominal region, hemodynamically stable were studied. All underwent examination with computed tomography. Were analyzed: age, gender, levels of trauma, hemodynamic condition and the abdominal examination on admission, the results of the CT scan, the extra-abdominal lesions found, the serum levels of hemoglobin, clinical course, complications, length of hospital stay, outpatient treatment and death.Results:during the study period 169 patients, treated non-operatively, presented liver gunshot wounds. Of these, only 28 patients (16.6%) had liver injury as the only abdominal injury and consequently met the inclusion criteria for this study. The average age was 27.7 years and 25 patients (89.2%) were male. The overall average of verified trauma scores were: RTS 7.45, ISS 10.9, and TRISS 98.7%. The most frequent injuries were grade II and grade III (85.7%). Complications occurred in only one patient who presented a progressive decline in hemoglobin. He underwent a CT scan which showed blush in the liver parenchyma. An arteriography was performed, which showed a successfully embolized arteriovenous fistula. There were no deaths in the patient sample. The average hospital stay was 5.3 days.Conclusion:isolated hepatic injury in gunshot abdominal trauma is uncommon. However, the NOM protocol for this type of injury is safe and has low morbidity. This approach should only be followed in institutions with adequate infrastructure, where an experienced and cohesive team is able to follow a specific protocol, with rigorous periodic evaluation of its results.

Predictors of "occult" intra-abdominal injuries in blunt trauma patients

Objective: to assess predictors of intra-abdominal injuries in blunt trauma patients admitted without abdominal pain or abnormalities on the abdomen physical examination. Methods: We conducted a retrospective analysis of trauma registry data, including adult blunt trauma patients admitted from 2008 to 2010 who sustained no abdominal pain or abnormalities on physical examination of the abdomen at admission and were submitted to computed tomography of the abdomen and/or exploratory laparotomy. Patients were assigned into: Group 1 (with intra-abdominal injuries) or Group 2 (without intra-abdominal injuries). Variables were compared between groups to identify those significantly associated with the presence of intra-abdominal injuries, adopting p<0.05 as significant. Subsequently, the variables with p<0.20 on bivariate analysis were selected to create a logistic regression model using the forward stepwise method. Results: A total of 268 cases met the inclusion criteria. Patients in Group I were characterized as having significantly (p<0.05) lower mean AIS score for the head segment (1.0±1.4 vs. 1.8±1.9), as well as higher mean AIS thorax score (1.6±1.7 vs. 0.9±1.5) and ISS (25.7±14.5 vs. 17,1±13,1). The rate of abdominal injuries was significantly higher in run-over pedestrians (37.3%) and in motorcyclists (36.0%) (p<0.001). The resultant logistic regression model provided 73.5% accuracy for identifying abdominal injuries. The variables included were: motorcyclist accident as trauma mechanism (p<0.001 - OR 5.51; 95%CI 2.40-12.64), presence of rib fractures (p<0.003 - OR 3.00; 95%CI 1.47-6.14), run-over pedestrian as trauma mechanism (p=0.008 - OR 2.85; 95%CI 1.13-6.22) and abnormal neurological physical exam at admission (p=0.015 - OR 0.44; 95%CI 0.22-0.85). Conclusion Intra-abdominal injuries were predominantly associated with trauma mechanism and presence of chest injuries.

Epidemiological analysis of polytrauma patients with kidney injuries in a university hospital

Objective: To analyze the characteristics of trauma patients with renal lesions treated at a university hospital in Curitiba. Methods: We conducted a retrospective, cross-sectional study guided by review of medical records of trauma victims who underwent surgical treatment. The variables analyzed were age, gender, mechanism of injury, degree of kidney damage, conduct individualized according to the degree of renal injury, associated injuries, complications and deaths. We classified lesions according to the American Association of Trauma Surgery (TSAA). Results: We analyzed 794 records and found renal lesions in 33 patients, with mean age 29.8 years, most (87.8%) being male. Penetrating trauma accounted for 84.8% of cases. The most common renal injuries were grade II (33.3%), followed by grade I (18.1%), III, IV and V. Nephrectomy treated 45.4% of injuries, 73.3% being total nephrectomy, and 45.4% by nephrorraphy. In 9% treatment was non-surgical. Only 12.1% of patients had isolated renal lesions. Complications ensued in 15.1% and mortality was 6.06%. Conclusion: The surgical approach was preferred due to penetrating trauma mechanism. We achieved low rates of complications and deaths, and neither case could be directly related to kidney damage, and there were patients with multiple lesions. In this sample, we could not observe a direct relationship between kidney damage and complications, deaths or the type of conduct employed.

Paralisia facial periférica e gestação: abordagem e tratamento

OBJETIVO: Comparar o grau da paralisia facial periférica de gestantes e puérperas no momento da admissão e na alta e avaliar outros fatores associados. MÉTODOS: Estudo retrospectivo, transversal, com análise dos prontuários de gestantes e puérperas atendidas no ambulatório de paralisia facial, em um período de 12 meses, com aplicação de protocolo padronizado de avaliação das pacientes e da escala de House-Brackmann na primeira consulta e na data da alta. RESULTADOS: Foram identificadas 6 pacientes, com média de idade de 22,6 anos. Cinco casos foram classificados com estadiamento IV e um com II na escala de House-Brackmann, sendo que duas eram puérperas e quatro gestantes. Todas evoluíram com melhora na escala de House-Brackmann. CONCLUSÃO: A paralisia de Bell tem bom prognóstico mesmo em gestantes e puérperas, sendo importante realizar tratamento adequado para diminuir as sequelas neste grupo apontado como mais susceptível à paralisia facial periférica.

Facial paralysis and vestibular syndrome in feedlot cattle in Argentina

This paper reports 6 outbreaks of neurological disease associated with paralysis of the facial and vestibulocochlear nerves caused by intracranial space occupying lesions in feedlot cattle. The clinical signs observed were characterized by head tilt, uni or bilateral drooping and paralysis of the ears, eyelid ptosis, keratoconjunctivitis, and different degrees of ataxia. Morbidity and mortality rates ranged from 1.1 to 50% and 0 to 1%, respectively. Gross lesions observed included yellow, thickened leptomeninges, and marked enlargement of the roots of cranial nerves VII (facial) and VIII (vestibulocochlear). Histopathologically, there was severe, chronic, granulomatous meningitis and, in one case, chronic, granulomatous neuritis of the VII and VIII cranial nerves. Attempts to identify bacterial, viral, or parasitic agents were unsuccessful. Based on the morphologic lesions, the clinical condition was diagnosed as facial paralysis and vestibular syndrome associated with space occupying lesions in the meninges and the cranial nerves VII and VIII. Feedlot is a practice of growing diffusion in our country and this is a first report of outbreaks of facial paralysis and vestibular disease associated with space occupying lesions in Argentina.

A study of the facial aging - a multidisciplinary approach

This paper describes a mathematical and graphical model for face aging. It considers the possibility of predicting the aging process by offering an initial quantification of this process as it applies to the face. It is concerned with physical measurements and a general law of time dependence. After measuring and normalizing a photograph of a person, one could predict, with a known amount of error, the appearance of that person at a different age. The technique described has served its purpose successfully, with a representative amount of patient data behaving sufficiently near the general aging curve of each parameter. That model uses a warping technique to emulate the aging changes on the face of women. Frequently the warping methods are based on the interpolation between images or general mathematical functions to calculate the pixel attributes. The implemented process considers the age features of selected parts of a face such as the face outline and the shape of the lips. These age features were obtained by measuring the facial regions of women that have been photographed throughout their lives. The present work is first concerned with discussing a methodology to define the aging parameters that can be measured, and second with representing the age effects graphically.

Deep generative models for facial keypoints detection

A new area of machine learning research called deep learning, has moved machine learning closer to one of its original goals: artificial intelligence and general learning algorithm. The key idea is to pretrain models in completely unsupervised way and finally they can be fine-tuned for the task at hand using supervised learning. In this thesis, a general introduction to deep learning models and algorithms are given and these methods are applied to facial keypoints detection. The task is to predict the positions of 15 keypoints on grayscale face images. Each predicted keypoint is specified by an (x,y) real-valued pair in the space of pixel indices. In experiments, we pretrained deep belief networks (DBN) and finally performed a discriminative fine-tuning. We varied the depth and size of an architecture. We tested both deterministic and sampled hidden activations and the effect of additional unlabeled data on pretraining. The experimental results show that our model provides better results than publicly available benchmarks for the dataset.

Activation of endogenous angiotensin converting enzyme 2 prevents early injuries induced by hyperglycemia in rat retina

Diabetic retinopathy (DR) is a serious complication of diabetes mellitus that may result in blindness. We evaluated the effects of activation of endogenous angiotensin converting enzyme (ACE) 2 on the early stages of DR. Rats were administered an intravenous injection of streptozotocin to induce hyperglycemia. The ACE2 activator 1-[[2-(dimethylamino) ethyl] amino]-4-(hydroxymethyl)-7-[[(4-methylphenyl) sulfonyl] oxy]-9H-xanthone 9 (XNT) was administered by daily gavage. The death of retinal ganglion cells (RGC) was evaluated in histological sections, and retinal ACE2, caspase-3, and vascular endothelial growth factor (VEGF) expressions were analyzed by immunohistochemistry. XNT treatment increased ACE2 expression in retinas of hyperglycemic (HG) rats (control: 13.81±2.71 area%; HG: 14.29±4.30 area%; HG+XNT: 26.87±1.86 area%; P<0.05). Importantly, ACE2 activation significantly increased the RCG number in comparison with HG animals (control: 553.5±14.29; HG: 530.8±10.3 cells; HG+XNT: 575.3±16.5 cells; P<0.05). This effect was accompanied by a reduction in the expression of caspase-3 in RGC of the HG+XNT group when compared with untreated HG rats (control: 18.74±1.59; HG: 38.39±3.39 area%; HG+XNT: 27.83±2.80 area%; P<0.05). Treatment with XNT did not alter the VEGF expression in HG animals (P>0.05). Altogether, these findings indicate that activation of ACE2 reduced the death of retinal ganglion cells by apoptosis in HG rats.

Sensitivity to differences between posed and genuine facial expressions : are children easily fooled? /

Adults and children can discriminate various emotional expressions, although there is limited research on sensitivity to the differences between posed and genuine expressions. Adults have shown implicit sensitivity to the difference between posed and genuine happy smiles in that they evaluate T-shirts paired with genuine smiles more favorably than T-shirts paired with posed smiles or neutral expressions (Peace, Miles, & Johnston, 2006). Adults also have shown some explicit sensitivity to posed versus genuine expressions; they are more likely to say that a model i?,feeling happy if the expression is genuine than posed. Nonetheless they are duped by posed expressions about 50% of the time (Miles, & Johnston, in press). There has been no published study to date in which researchers report whether children's evaluation of items varies with expression and there is little research investigating children's sensitivity to the veracity of facial expressions. In the present study the same face stimuli were used as in two previous studies (Miles & Johnston, in press; Peace et al., 2006). The first question to be addressed was whether adults and 7-year-olds have a cognitive understanding of the differences between posed and genuine happiness {scenario task). They evaluated the feelings of children who expressed gratitude for a present that they did or did not want. Results indicated that all participants had a fundamental understanding of the difference between real and posed happiness. The second question involved adults' and children's implicit sensitivity to the veracity of posed and genuine smiles. Participants rated and ranked beach balls paired with faces showing posed smiles, genuine smiles, and neutral expressions. Adults ranked.but did not rate beach balls paired with genuine smiles more favorably than beach balls paired with posed smiles. Children did not demonstrate implicit sensitivity as their ratings and rankings of beach balls did not vary with expressions; they did not even rank beach balls paired with genuine expressions higher than beach balls paired with neutral expressions. In the explicit (show/feel) task, faces were presented without the beach balls and participants were first asked whether each face was showing happy and then whether each face wasfeeling happy. There were also two matching trials that presented two faces at once; participants had to indicate which person was actuallyfeeling happy. In the show condition both adults and 7-year-olds were very accurate on genuine and neutral expressions but made some errors on posed smiles. Adults were fooled about 50% of the time by posed smiles in thefeel condition (i.e., they were likely to say that a model posing happy was really feeling happy) and children were even less accurate, although they showed weak sensitivity to posed versus genuine expressions. Future research should test an older age group of children to determine when explicit sensitivity to posed versus genuine facial expressions becomes adult-like and modify the ranking task to explore the influence of facial expressions on object evaluations.

Non-invasive measurement of trigeminal nerve somatosensory evoked potentials

Whiplash injuries are common yet enigmatic to substantiate clinically. Trigeminal somatosensory evoked potentials (TSEPs) were posited as an indicator of trigeminal nerve conduction damage resulting from whiplash. Alternating polarity square-wave current stimuli were applied transcutaneously in the facial region. 379 recorded pilot trials from 27 participants (8 male and 19 female) were utilized to develop a non-invasive recording capability for TSEPs. Stimulus intensity and artifact, cortical recording sites, stimulation electrode design and placement were explored. Statistically significant differences in amplitude of TSEP waveform components at 13, 19 and 27 ms between uninjured and whiplashed participants were noted. Increased stimulus intensity in whiplashed participants was observed to increase TSEP amplitude. The present methodology and hardware are discussed and directions for future advancement of the current process are outlined.

Electrophysiological and behavioural correlates of facial identity and expression perception deficits following a closed head injury /

A large variety of social signals, such as facial expression and body language, are conveyed in everyday interactions and an accurate perception and interpretation of these social cues is necessary in order for reciprocal social interactions to take place successfully and efficiently. The present study was conducted to determine whether impairments in social functioning that are commonly observed following a closed head injury, could at least be partially attributable to disruption in the ability to appreciate social cues. More specifically, an attempt was made to determine whether face processing deficits following a closed head injury (CHI) coincide with changes in electrophysiological responsivity to the presentation of facial stimuli. A number of event-related potentials (ERPs) that have been linked specifically to various aspects of visual processing were examined. These included the N170, an index of structural encoding ability, the N400, an index of the ability to detect differences in serially presented stimuli, and the Late Positivity (LP), an index of the sensitivity to affective content in visually-presented stimuli. Electrophysiological responses were recorded while participants with and without a closed head injury were presented with pairs of faces delivered in a rapid sequence and asked to compare them on the basis of whether they matched with respect to identity or emotion. Other behavioural measures of identity and emotion recognition were also employed, along with a small battery of standard neuropsychological tests used to determine general levels of cognitive impairment. Participants in the CHI group were impaired in a number of cognitive domains that are commonly affected following a brain injury. These impairments included reduced efficiency in various aspects of encoding verbal information into memory, general slower rate of information processing, decreased sensitivity to smell, and greater difficulty in the regulation of emotion and a limited awareness of this impairment. Impairments in face and emotion processing were clearly evident in the CHI group. However, despite these impairments in face processing, there were no significant differences between groups in the electrophysiological components examined. The only exception was a trend indicating delayed N170 peak latencies in the CHI group (p = .09), which may reflect inefficient structural encoding processes. In addition, group differences were noted in the region of the N100, thought to reflect very early selective attention. It is possible, then, that facial expression and identity processing deficits following CHI are secondary to (or exacerbated by) an underlying disruption of very early attentional processes. Alternately the difficulty may arise in the later cognitive stages involved in the interpretation of the relevant visual information. However, the present data do not allow these alternatives to be distinguished. Nonetheless, it was clearly evident that individuals with CHI are more likely than controls to make face processing errors, particularly for the more difficult to discriminate negative emotions. Those working with individuals who have sustained a head injury should be alerted to this potential source of social monitoring difficulties which is often observed as part of the sequelae following a CHI.

The influence of emotional body posture on adults' and 8-year-olds' perception facial expressions

The present set of experiments was designed to investigate the development of children's sensitivity of facial expressions observed within emotional contexts. Past research investigating both adults' and children's perception of facial expressions has been limited primarily to the presentation of isolated faces. During daily social interactions, however, facial expressions are encountered within contexts conveying emotions (e.g., background scenes, body postures, gestures). Recently, research has shown that adults' perception of facial expressions is influenced by these contexts. When emotional faces are shown in incongruent contexts (e.g., when an angry face is presented in a context depicting fear) adults' accuracy decreases and their reaction times increase (e.g., Meeren et a1. 2005). To examine the influence of emotional body postures on children's perception of facial expressions, in each of the experiments in the current study adults and 8-year-old children made two-alternative forced choice decisions about facial expressions presented in congruent (e.g., a face displayed sadness on a body displaying sadness) and incongruent (e.g., a face displaying fear on a body displaying sadness) contexts. Consistent with previous studies, a congruency effect (better performance on congruent than incongruent trials) was found for both adults and 8-year-olds when the emotions displayed by the face and body were similar to each other (e.g., fear and sad, Experiment l a ) ; the influence of context was greater for 8-year-olds than adults for these similar expressions. To further investigate why the congruency effect was larger for children than adults in Experiment 1 a, Experiment 1 b was conducted to examine if increased task difficulty would increase the magnitude of adults' congruency effects. Adults were presented with subtle facial and despite successfully increasing task difficulty the magnitude of the. congruency effect did not increase suggesting that the difference between children's and adults' congruency effects in Experiment l a cannot be explained by 8-year-olds finding the task difficult. In contrast, congruency effects were not found when the expressions displayed by the face and body were dissimilar (e.g., sad and happy, see Experiment 2). The results of the current set of studies are examined with respect to the Dimensional theory and the Emotional Seed model and the developmental timeline of children's sensitivity to facial expressions. A secondary aim of the series of studies was to examine one possible mechanism underlying congruency effe cts-holistic processing. To examine the influence of holistic processing, participants completed both aligned trials and misaligned trials in which the faces were detached from the body (designed to disrupt holistic processing). Based on the principles of holistic face processing we predicted that participants would benefit from misalignment of the face and body stimuli on incongruent trials but not on congruent trials. Collectively, our results provide some evidence that both adults and children may process emotional faces and bodies holistically. Consistent with the pattern of results for congruency effects, the magnitude of the effect of misalignment varied with the similarity between emotions. Future research is required to further investigate whether or not facial expressions and emotions conveyed by the body are perceived holistically.

Sir Isaac Brock Facial Reconstruction Project, n.d.

Christian Cardell Corbet, a descendant of Guernsey, Channel Islands, was born in 1966 at Pickering Beach on Lake Ontario. He developed his talents as a landscape artist and at the young age of 14 he began his informal education in commercial signage from his paternal grandfather. He studied at the University of Guelph and McMaster University Anatomy Laboratory. Corbet traveled to England where he began to experiment more in abstraction and non-objective work. In 1995, he presented a portrait of HM Queen Elizabeth the Queen Mother at Clarence House. This brought his career to an international level. He also creates two-dimensional works and has received acclaim for his bronze art medallions. He has gained international recognition as a Forensic Artist working as Artist in Residence for the University of Western Ontario. He does facial reconstructions for special assignments. These original drawings relate to a sculpted medallion of Brock which was authorized by Sir Geoffrey Rowland, Bailiff, Guernsey, Channel Islands and Minister of Education of the States of Guernsey. This is the first time in known recorded history that a forensic analysis and sculpture has been created to accurately depict the facial likeness of Sir Isaac Brock. This project has been established to mark the 2012 anniversary of the death of Brock.

Asymmetries of Influence: Differential Effects of Body Postures on Perceptions of Emotional Facial Expressions

The accuracy and speed with which emotional facial expressions are identified is influenced by body postures. Two influential models predict that these congruency effects will be largest when the emotion displayed in the face is similar to that displayed in the body: the emotional seed model and the dimensional model. These models differ in whether similarity is based on physical characteristics or underlying dimensions of valence and arousal. Using a 3- alternative forced-choice task in which stimuli were presented briefly (Exp 1a) or for an unlimited time (Exp 1b) we provide evidence that congruency effects are more complex than either model predicts; the effects are asymmetrical and cannot be accounted for by similarity alone. Fearful postures are especially influential when paired with facial expressions, but not when presented in a flanker task (Exp 2). We suggest refinements to each model that may account for our results and suggest that additional studies be conducted prior to drawing strong theoretical conclusions.