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Metabolism symptoms and the probability of COVID-19 disease: Any across the country population-based case-control review.
HR increased significantly in the three combat situations, and close quarter combat produced the highest sympathetic modulation of the three situations analysed. CONCLUSION Symmetrical, asymmetrical and close quarter combat situations produced an increase in sympathetic modulation, being highest in the close quarter combat situation, where actions are performed at a close distance and in closed spaces. © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.BACKGROUND This article describes a novel patient care algorithm which provides a Role 1 (R1) medic with a structured approach to delivering prolonged field care (PFC) in a resource-limited environment. PFC is a vital component of the operational patient care pathway providing the continuum of care from completion of a primary survey to the delivery to hospital care. Future operational environments are likely to have more fragile or extended lines of communication, potentially delaying evacuation to hospital care. This delay may lead to increases in patient morbidity and mortality. Effective PFC offers an opportunity to improve patient outcomes and help mitigate against this risk. METHODS An initial prototype model of a PFC care process was developed using existing hospital-based guidance. A series of medical and trauma vignettes and best available evidence were used to refine the algorithm. RESULTS The algorithm has been designed be used in conjunction with patient specific clinical guidance making the approach generalisable for all patient groups. For UK military, clinical guidance is provided by clinical guidelines for operations. The algorithm can be downloaded into a convenient format to be used on mobile devices or printed as an aide memoire. © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.INTRODUCTION To accomplish the peacekeeping mission in Lebanon, China has deployed a level 1+ (CHN L1+) medical treatment facility (MTF) as per the new memorandum. click here The aim of this study was to review and analyse the skin diseases managed by Chinese dermatological service so as to gain the latest prevalence of different types of skin diseases in this mission area. METHODS All patients assessed and treated by the dermatological service of CHN L1+ MTF from January 2018 to May 2019 were included. A comparative analysis was made between this study and data published by other peacekeeping medical facilities. RESULTS A total of 549 patients were included (87.4% men, with an average age of 35 years old), consisting of 399 military personnel and 150 civilians. Dermatitis and eczema (27.1%) were the most common category of skin diseases, followed by cutaneous mycoses (13.3%) and disorders of skin appendages (10.6%). Among these categories, unspecified dermatitis (9.3%), acne vulgaris (6.6%), tinea corporis (5.3%), folliculitis (5.1%) and tinea pedis (4.7%) were the top five most common reasons for dermatological consultation. CONCLUSIONS To get a clearer understanding of the disease-type profile in this mission area was beneficial for peacekeeping doctors to make more accurate diagnosis, as well as to prepare more comprehensive medicines during the predeployment period. As dermatological service was lacking in basic medical troops, we would recommend the use of telemedicine to promote dermatological consultations when a specialist was not deployed. © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.BACKGROUND The Syrian Civil War has caused over 400 000 traumatic deaths. Understanding the nature of war casualties is crucial to deliver healthcare improvement. Historic regional conflicts and Syrian mortality data have been characterised by blast injuries. The aim of this novel review is to assess the trauma epidemiology of Syrian Civil War casualties from the perspective of healthcare facilities. METHODS This review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method. Studies addressing Syria, trauma and war were investigated. Eligibility criteria included being conducted from a healthcare facility, published in English and peer reviewed. The outcomes were demography, mechanism of injury and anatomical injury site. RESULTS 38 papers satisfied the eligibility criteria. 13 842 casualties were reported across the entire data set. Casualties were 88.8% male (n=4035 of 4544). Children contributed to 16.1% of cases (n=398 of 2469). Mortality rate was 8.6% (n=412 of 4774). Gunshot wound was the most common mechanism of injury representing 66.3% (n=7825 of 11799). Head injury was the most common injured site at 26.6% (n=719 of 2701). CONCLUSIONS This conflict has a distinct trauma profile compared with regional modern wars. The prevalence of gunshot wounds represents a marked change in mechanism of injury. This may be related to higher mortality rate and proportion of head injuries identified. This review cannot correlate mechanism of injury, demographics or injuries sustained to outcomes. The quality of data from the included studies lacked standardisation; future research and consistent reporting tools are required to enable further analysis. © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.Asymmetric cell division (ACD) and positional signals play critical roles in the tissue patterning process. In the Arabidopsis root meristem, two major phloem cell types arise via ACDs of distinct origins one for companion cells (CCs) and the other for proto- and metaphloem sieve elements (SEs). The molecular mechanisms underlying each of these processes have been reported; however, how these are coordinated has remained elusive. Here, we report a novel phloem development process coordinated via the SHORTROOT (SHR) transcription factor. The well-characterized movement of SHR into the endodermis regulates the ACD for CC formation by activating microRNA165/6, while SHR moving into the phloem regulates the ACD involved in the generation of the two phloem SEs. In the phloem, SHR sequentially activates NARS1 and SND2, encoding NAC domain transcription factors, and these three together form a positive feedforward loop. Under this regulatory scheme, NARS1, generated in the CCs of the root differentiation zone, establishes a top-down signal to drive the ACD for phloem SEs in the meristem.
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