After adjusting for unbalanced baseline characteristics, survival was similar between IHSCA and OHSCA survivors (hazard ratio 1.1, 95% confidence interval 0.9 to 1.3, p = 0.4). In conclusion, survivors of IHSCA and OHSCA differed in baseline characteristic, potential SCA triggers, and treatment interventions but their adjusted survival was comparable. OBJECTIVE Regional and global longitudinal strain (RLS-GLS) are considered reliable indexes of myocardial viability in chronic ischemic patients and prediction of left ventricular (LV) functional recovery after acute myocardial infarction (MI) with preserved left ventricular ejection fraction (LVEF). We tested in the present study whether RLS and GLS could also identify transmural extent of myocardial scar and predict LV functional recovery and remodeling in patients with reduced LVEF after acute MI. METHODS Echocardiography and late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) were performed in 71 patients with reduced LVEF (≤45%) after acute MI treated with acute percutaneous coronary intervention. At 8-month follow-up, echocardiography was repeated to determine global LV functional recovery and remodeling. RESULTS RLS was worse in transmural than in non-transmural infarcted segments (-6.6 ± 6.1% vs -10.3 ± 5.9%, p  -11.5% was associated with a poor prognosis. CONCLUSIONS In patients with reduced LVEF after acute MI, RLS and GLS allow (1) identification of transmural extent of myocardial scar and (2) predict LV global functional recovery and remodeling at 8-month follow-up. Homophobia, prejudice against homosexuals, and heteronormativity the belief that heterosexuality is normative, have both decreased over the decades. Until recently, both were common in Star Trek. This is surprising since while ostensibly writing about the future, cultural norms from the 20th and 21st centuries were still imposed on these narratives. Star Trek Discovery is the most recent series in the francise (commenced in 2017) and is set circa a decade before Captain Kirk’s five year mission in the Star Trek timeline. This is the first series to deliberately include homosexual couples within the Star Trek universe for the first time in its decades of existence. Discovery depicts the ship’s chief engineer and ship’s physician as a happily married male couple who are acknowledged and accepted in their marriage, with their own living quarters. This a simple and highly effective way to include queer people. Once again, the doctor has taken the series into an avenue where no other Star Trek series has gone before. Doctors are pivotal characters in Star Trek. This paper will review Dr. Julian Bashir, a unique medic who is genetically engineered to superhuman capacities while deliberately designed to have human failings, which he successfully overcomes. His genetic enhancements allow him to excel in whatever he does and although initially portrayed as callow, arrogant, brash and naïve, his open mind permits him to eventually discard these negative traits to become a more rounded, if superhuman, doctor, who forms staunch friendships among the crew of the space station. Like all other Trek doctors, Bashir has firm deontological ideals and ethics that lead him to side with and protect his patient, come what may. He is compassionate but cool and collected, performing brilliantly under pressure. This doctor reflects a patient’s ideal a superhuman who knows it all. It is abundantly clear that we, the viewers and prospective patients, wish our doctors to boldly go where no medic has gone before – just as long as we are cured! BACKGROUND The Injury Severity Score and Trauma and Injury Severity Score are used commonly to quantify the severity of injury, but they require comprehensive data collection that is impractical in many low- and middle-income countries . We sought to develop an injury score that is more feasible to implement in low- and middle-income countries with discrimination similar to the Injury Severity Score and the Trauma and Injury Severity Score. METHODS Clinical data from KwaZulu-Natal, South Africa were used to compare the discrimination of the Injury Severity Score and the Trauma and Injury Severity Score with that of the 5, simple injury scores that rely primarily on physiologic data Revised Trauma Score for Triage, „Mechanism, Glasgow Coma Scale, Age, Pressure” Score, Kampala Trauma Score, modified Kampala Trauma Score, and „Reversed Shock Index Multiplied by Glasgow Coma Scale” Score. RESULTS Data for 3,991 patients were analyzed. The Trauma and Injury Severity Score, the Injury Severity Score, and Kampala Trauma Score had similar discrimination (area under the receiver operating curve 0.85, 0.84, and 0.84, respectively). The simple injury scores demonstrated worse discrimination among patients presenting more than 6 hours postinjury, although Kampala Trauma Score maintained the best discrimination of the simple injury scores. CONCLUSION In this patient population, Kampala Trauma Score demonstrated discrimination similar to the Injury Severity Score and the Trauma and Injury Severity Score and may be useful to quantify the severity of injury when calculation of the Injury Severity Score or the Trauma and Injury Severity Score is not feasible. Delay in presentation can degrade the discrimination of simple injury scores that rely primarily on physiologic data. Phlegmasia cerulea dolens (PCD) results from near complete venous thrombosis and occlusion in an extremity resulting in pain, cyanosis, and edema and potentially death. While PCD can result from a variety of mechanisms including trauma, iatrogenic instrumentation, the majority of cases occur in the setting of malignancy. PCD is often managed medically with anticoagulation. However, in certain circumstances, surgical intervention may be warranted. Here, we present a unique case of phlegmasia cerulea dolens occurring following an internal hemipelvectomy requiring emergent surgical intervention to salvage life and limb. A review of the literature regarding diagnosis and treatment is also presented. BACKGROUND Optimal health is demanded for service members in military operations. However, the strains of deployment can result in a deterioration, moreover when combat-related injuries are sustained, affecting level of participation and health related quality of life (HRQOL). Secondary health conditions may occur in time, however existing studies measure coping, level of activity and participation and HRQOL at one point in time. AIM To assess the change over time concerning coping, mobility, level of participation and HRQOL in Dutch service members with combat-related injuries sustained during operation Task Force Uruzgan (TFU). METHODS The lower extremity functional scale (LEFS), the cognitive emotion regulation questionnaire (CERQ), the assessment of life habits short version (LIFE-H) and the EuroQol-5D (EQ-5D), measuring HRQOL, were administered in 2010 and 2014. Change of scores between the two time points was tested with the Wilcoxon signed rank test. RESULTS The response rate was 53% (28/53). The score on the coping strategy self-blame showed a significant increase over time with low scores on both occasions. The coping strategies positive reappraisal and acceptance showed the highest scores. No significant change is shown in mobility, the level of participation or HRQOL. CONCLUSION service members with combat-related injuries remain stable in level of activity and participation and HRQOL in time and they use adaptive coping strategies. INTRODUCTION Pulled elbow (PE) is one of the most common injury in children under the age of five years. Diagnosis of PE is usually based on the typical anamnesis and clinical symptoms. A simple reduction maneuver without the need of any imaging modality can eliminate the problem. Certain fractures however can mimic the physical findings of PE and in this cases reduction should not be attempted. The aim of our prospective diagnostic study was to evaluate the accuracy of a sonographic testing method in the differential diagnosis of PE. METHODS 205 children aged 0-5 with clinical suspicion for PE were enrolled in our study. Inclusion criteria were the typical clinical sign of PE painful, motionless, extended or slightly flexed and pronated arm following a traumatic event under the age of five. We excluded older children and patients with pronounced elbow swelling and initially flexed and supinated upper arm position. A two plane point of care sonographic examination was carried out at each patient immediately aethod is an effective tool for confirming the diagnosis of PE and excluding the presence of fractures. It is an easy, standard and objective procedure which can be used as a fast diagnostic test before reduction attempts. BACKGROUND Traumatic coagulopathy is a major public health issue globally with undefined mechanisms. We established rat models of hemorrhagic shock (HS), multiple injury (MI) and traumatic brain injury (TBI) to investigate the diversity of traumatic coagulopathy, especially platelet dysfunction. METHODS Seventy male SD rats were divided randomly into seven groups(n = 10) control, HS30min, HS3h, MI30min, MI3h, TBI30min and TBI3h. Plasma or whole blood was collected for conventional coagulation tests, thromboelastography and platelet mapping. X-ray, 7T magnetic resonance imaging and hematoxylin-eosin staining of injured tissues were conducted to confirm the injuries of rats model. RESULTS The activated partial thromboplastin time (aPTT) prolonged significantly in HS30min and MI3h groups, compared with those in control (P = 0.0403 and P = 0.0076, respectively). R values decreased in HS30min and HS3h groups, compared with those in control (P  less then  0.0001 and P  less then  0.0001, respectively). The maximum ot instead of the prolonged clot time, which contributed to traumatic coagulopathy. The platelet dysfunctions might contribute to trauma-induced coagulopathy in different ways. The loss of platelets might be the main reason for HS-induced coagulopathy. While, AA-dependent pathway inhibition might account for MI-induced coagulopathy. ADP-dependent pathway inhibition might be the major contributor for TBI-induced coagulopathy. BACKGROUND Adult isolated ulnar shaft fractures (IUSF) are rare. There remains a need to establish the best methods to manage these fractures. The aim of this study was to compare two forms of treatment for IUSF intramedullary stabilization by k-wire (IMF) versus Open Reduction Internal Fixation by plating (ORIF), in order to identify differences in clinical (1) and radiological outcomes (2), as well as comparative costs (3). HYPOTHESIS The hypothesis of this study was assessing whether intramedullary stabilization was as feasible as plating in the treatment of isolated ulnar shaft fractures in clinical practice. PATIENTS AND METHODS A retrospective analysis was undertaken on patients diagnosed IUSF between January 2015 and March 2017 with a minimum of 2 years follow-up. They were treated with IMF (group 1) or ORIF (group 2). Demographic information, clinical outcomes and complications were collected. Cost, including implant cost, operative time, sterilization and inpatient stay were compared. Radiographs were reviewed to evaluate axial angulation, shortening, displacement and residual deformity.