Background: Blunt traumatic brain injury (bTBI) and uncontrolled hemorrhagic shock (UCHS) are common causes of mortality in polytrauma. We studied the influence of fresh frozen plasma (FFP) resuscitation in a rat model with both bTBI and UCHS before achieving hemorrhage control.
Methods: The bTBI was induced by an external weight drop (200 g) onto the bare skull of anesthetized male Lewis (Lew/SdNHsd) rats; UCHS was induced by resection of two-thirds of the rats’ tails. Fifteen minutes following trauma, bTBI+UCHS rats underwent resuscitation with FFP or lactated Ringer’s solution (LR). Eight groups were evaluated: (1) Sham; (2) bTBI; (3) UCHS; (4) UCHS+FFP; (5) UCHS+LR; (6) bTBI+UCHS; (7) bTBI+UCHS+FFP; and (8) bTBI+UCHS+LR. Bleeding volume, hematocrit, lactate, mean arterial pressure (MAP), heart rate, and mortality were measured.
Results: The study included 97 rats that survived the immediate trauma. Mean blood loss up to the start of resuscitation was similar among UCHS only and bTBI+UCHS rats (P=0.361). Following resuscitation, bleeding was more extensive in bTBI+UCHS+FFP rats (5.2 mL, 95% confidence interval [CI] 3.7, 6.6) than in bTBI+UCHS+LR rats (2.5 mL, 95% CI 1.2, 3.8) and bTBI+UCHS rats (1.9 mL, 95% CI -0.2, 3.9) (P=0.005). Similarly, non-significant increases in blood loss were observed in UCHS+FFP rats (P=0.254). Overall mortality increased if bleeding was above 4.5 mL (92.3% versus 8%; P<0.001). Mortality was 83.3% (10/12) in bTBI+UCHS+FFP rats, 41.7% (5/12) in bTBI+UCHS+LR rats, and 64.3% (9/14) in bTBI+UCHS rats.
Conclusion: The bTBI did not exacerbate bleeding in rats undergoing UCHS. Compared to LR, FFP resuscitation was associated with a significantly increased blood loss in bTBI+UCHS rats.
Introduction: When authorship disputes arise in academic publishing, research institutions may be asked to investigate the circumstances. We evaluated the association between the prevalence of misattributed authorship and trust in the institution involved.
Methods: We measured trust using a newly validated Opinion on the Institution’s Research and Publication Values (OIRPV) scale (range 1–4). Mayer and Davies’ Organizational Trust for Management Instrument served as control. Association between publication misconduct, gender, institution type, policies, and OIRPV-derived Trust Scores were evaluated.
Results: A total of 197 responses were analyzed. Increased reporting of authorship misconduct, such as gift authorship, author displacement within the authors’ order on the byline, and ghost authorship, were associated with low Trust Scores (P<0.001). Respondents from institutions whose administration had made known (declared or published) their policy on authorship in academic publications awarded the highest Trust Scores (median 3.06, interquartile range 2.25 to 3.56). Only 17.8% favored their administration as the best authority to investigate authorship dispute honestly. Of those who did not list the administration as their preferred option for resolving disputes, 58.6% (95/162) provided a Trust Score <2.5, which conveys mistrust in the institution.
Conclusions: Increased reporting of publication misconducts such as gift authorship, author displacement within the order of the authors’ byline, and ghost authorship was associated with lower Trust Scores in the research institutions. Institutions that made their policies known were awarded the highest Trust Scores. Our results question whether the research institutions’ administrations are the appropriate authority for clarifying author disputes in all cases.
Background: Human papillomavirus HPV is considered to be responsible for 95% of virus-related cancers in many organs. Oropharyngeal carcinoma (OC) is distinguished by the transformation of the healthy epithelium into precancerous cells.
Aim: The current study sought to examine the uneven gene expression of 20 genes among those scanned by microarray for oropharyngeal cancer patients.
Materials and Methods: GSE56142 dataset was extracted from the GEO in NCBI. 24 specimens were evaluated. Gene Ontology (GO), KEGG, and the protein-protein interaction (PPI) were used to depict the biological roles of the genes under investigation using types of software.
Results: Six genes out of 20 in invasive patients had a binding correlation with high expression (PDGFRS, COL6A3, COL1A1, COL3A1, COL2A1, and COL4A1), and only two genes with low expression (CRCT1 and KRT78). The expression levels of 20 genes were examined between patients with OC and head and neck squamous cell carcinoma (HNSCC). The correlation coefficient between highly expressed genes was statistically significant at the p < 0.05 level.
Conclusions: It is crucial to evaluate the high expression of particular genes as diagnostic tumor markers, particularly in the early stages.
Xenotransplantation represents a viable solution to meet the great need to provide organ donors at a time when there are not enough human organ donors. A lot of clinical studies have focused on using genetically engineered pigs as the prime source for organ transplantation. However, several religions, such as Judaism and Islam, have restrictions on the use of pigs for food or in business. In this article, we review the Jewish perspectives on xenotransplantation. Overall, the preservation of human life trumps most of the potential religious concerns associated with xenotransplantation. However, there are religious nuances related to xenotransplantation that are highlighted here, and that must be addressed by rabbinical scholars.
There is a rich history of surgery for cardiac arrhythmias, spanning from atrial fibrillation and Wolff–Parkinson–White syndrome to inappropriate sinus tachycardia and ventricular tachycardia. This review describes the history of these operations, their evolution over time, and the current state of practice. We devote considerable time to the discussion of atrial fibrillation, the most common cardiac arrhythmia addressed by surgeons. We discuss ablation of atrial fibrillation as a stand-alone operation and as a concomitant operation performed at the time of cardiac surgery. We also discuss the emergence of newer procedures to address atrial fibrillation in the past decade, such as the convergent procedure and totally thoracoscopic ablation, and their outcomes relative to historic approaches such as the Cox maze procedure.
It has been the policy of Rambam Maimonides Medical Journal to limit the number of editorials published. However, silence and standing on the sidelines is not an option in light of the atrocities and inhumanity we witnessed on October 7. The savagery of the Hamas massacre was executed indiscriminately upon children, women, older people (some of whom are Holocaust survivors), infants, and even medical professionals caring for the casualties. Currently, there are about 230 women, men, children, and babies being held hostage by Hamas; among them are cancer patients and others with serious disorders, doctors, and other medical professionals. We cannot rest and must address the plight of our hostages who are being held by terrorists motivated by hatred and showing no respect for life, whether that of their enemies, their own people, or even themselves. ...
Background: Halacha is the corpus of Jewish law which serves as a life blueprint for observant Jewish individuals. Health professionals counseling halachically observant populations at risk for breast cancer gene (BRCA) mutations should be well informed of the halachic approach to screening for BRCA mutations and subsequent interventions.
Aim: To address the intersection of halacha with ethical norms and current medical evidence-based data as they relate to potential and identified BRCA mutation carriers at their various stages of decision-making.
Results: Halacha, ethics, and medicine have much in common, but there are specific principles which guide halacha; decision-making in light of halacha is complex and varies with respect to the multi-faceted aspects of screening and intervention. Halacha encourages the exercise of autonomy regarding situations in which beneficence is not clear-cut and dependent on subjective perceptions.
Conclusions: Health professionals knowledgeable of halacha are better equipped to counsel the observant Jewish population at risk of BRCA mutations or identified as mutation carriers, enabling them to present targeted questions to halachic authorities and thus achieve optimal decision-making.
Objectives: This study aims to investigate the efficacy and outcomes of transurethral resection of the prostate (TURP) in the context of younger male patients.
Methods: Males aged ≤55 who underwent TURP at Rambam Health Care Campus from January 2011 to August 2023 were retrospectively reviewed. Clinicodemographic characteristics, indications for surgery, uroflowmetry, pressure-flow study, and early and late postoperative outcomes were collected. Patients with urethral or bladder abnormalities were excluded. Chi-square and Fisher’s exact tests were employed for bivariate analysis.
Results: Inclusion criteria were met by 58 men who underwent TURP at a median age of 52 years (interquartile range [IQR] 49.5–54). Median prostate size was 35 mL (24.5–56), with median prostate-specific antigen of 1.4 ng/mL (0.65–3.1). A total of 60% of patients used α-blockers, and 19% used 5α-reductase inhibitors pre-surgery. Overall, 54 (93.1%) had severe lower urinary tract symptoms (LUTS), with 34 (59%) being predominantly emptying and 20 (35%) storage. Most surgeries were performed for refractory LUTS in 38 (66%), followed by urinary retention in 16 (28%). At 6 weeks, 57 (98%) patients were catheter-free. The maximum flow rate and residual volume showed significant improvement from 9 mL/s to 21 mL/s (P=0.01), and from 171 mL to 61 mL (P=0.006), respectively. Pathology revealed benign prostatic hyperplasia in 53 (91.4%), and inflammation in 5 (8.5%). A total of 13 auxiliary procedures were required in 12 patients (20.7%) during follow-up: 7 transurethral bladder neck incisions, 3 re-TURP, 1 meatus widening, and 1 patient required artificial urinary sphincter implantation followed by simple cystectomy for end-stage bladder.
Conclusions: In young men, TURP showed short-term gains in flowmetry and catheter removal rates, but a sustained need for subsequent procedures in the long run. In this unique population, patients should be carefully selected, and alternative, less aggressive, interventions should be considered.
There is a long history of starvation, including reports dated back to antiquity. Despite exceptional scientific developments, starvation still exists today. The medical aspects of starvation were well established in the twentieth century, particularly following studies related to the 1943–1944 Bengal famine in India and starved prisoners of war and survivors of World War 2. The refeeding of the starved victims provided disappointing results. Nevertheless, those studies eventually led to the development of a new branch of research in medicine and to the definition of what is now known as refeeding syndrome. This paper briefly reviews the history and groundwork that led to today’s understanding of starvation and refeeding, with a particular emphasis on the observations from studies on starved Holocaust survivors and prisoners of war after World War 2. The relevance of these studies for modern times is briefly discussed.
Objective: A single layer of tightly spaced cells, known as the endothelium, rests on the posterior side of the cornea. This endothelium regulates the stroma’s relative dehydration, which is essential for corneal clarity. Cell therapy is an innovative method being used to repair various corneal abnormalities. Mesenchymal stem cells (MSCs) are now one of the most significant types of stem cells scientists have studied. This study aimed to evaluate the role of MSCs for corneal endothelial regeneration.
Methods: A systematic review was performed by searching for articles from reputable databases with many study-type references, including PubMed, Cochrane Library, Science Direct, and Google Scholar, up to January 2024. The resulting data were displayed using the 2020 PRISMA flowchart and evaluated using the PRISMA 2020 checklist. Most of the included studies were in vivo and used topical application and anterior chamber injection as the administration routes.
Results: Based on the findings of this review, MSCs increased corneal endothelial cell density, improved the defect area and corneal transparency, facilitated endothelial cell regeneration and wound healing, and decreased neovascularization and corneal pro-inflammatory cytokines as compared to controls.
Conclusion: Administration of MSCs into the anterior chamber could increase regeneration and proliferation of corneal endothelial tissue.
