👤 Israel

Resuscitative thoracotomy (RT) is a last-resort intervention for traumatic cardiac arrest or impending cardiovascular collapse. Although outcomes after RT are well described in civilian trauma, data from modern warfare-characterized by high-energy penetrating mechanisms, advanced prehospital care, and rapid evacuation-remain limited. This study evaluated the characteristics and outcomes of RT performed during recent combat operations within a combined military-civilian trauma system. We conducted a retrospective cohort study of all combat casualties who underwent emergency department (ED) RT during the Israel-Hamas conflict (October 27, 2023, to October 27, 2025). Data were extracted from prehospital and ED medical records and postmortem computed tomography reports. RT was defined as a thoracotomy performed in the ED in a pulseless patient with the intent to restore spontaneous circulation. The primary outcome was 30-day survival. Secondary outcomes included return of spontaneous circulation (ROSC) and 24-hour survival. Among 2,335 combat trauma admissions, 27 patients (1.2%) underwent RT. All were young male casualties with penetrating injuries, predominantly from explosive mechanisms (74.1%). Severe trauma was common (ISS ≥25 in 92.6%). Prehospital blood products were administered in 77.8% of patients, and 66.7% arrived at the ED within 60 minutes of injury. ROSC was achieved in 40.7%, of whom 90.9% were transferred to the operating room. Two patients (7.4%) survived to 24 hours and 30 days, both with good neurologic outcomes. No patient who lost pulse before hospital arrival survived. Among modern warfare casualties treated at civilian trauma centers, survival after RT is comparable to that reported in civilian series, despite severe and complex injury patterns. RT should not be considered futile for penetrating abdominal, pelvic, or extremity hemorrhage, even in the presence of associated head injury. In contrast, prehospital circulatory arrest is associated with an extremely poor prognosis.(J Trauma Acute Care Surg. 2026;000:000-000. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). Show less

Interstitial deletions of 11p13 involving MPPED2, DCDC5, DCDC1, DNAJC24, IMMP1L, and ELP4 are previously reported to have downstream transcriptional effects on the expression of PAX6, due to a downstream regulatory region (DRR). Currently, no clear genotype-phenotype correlations have been established allowing for conclusive information regarding the exact location of the PAX6 DRR, though its location has been approximated in mouse models to be within the Elp4 gene. Of the clinical reports currently published examining patients with intact PAX6 genes but harboring deletions identified in genes downstream of PAX6, 100% indicate phenotypes which include aniridia, whereas approximately half report additional eye deformities, autism, or intellectual disability. In this clinical report, we present a 12-year-old male patient, his brother, and mother with pericentric inversions of chromosome 11 associated with submicroscopic interstitial deletions of 11p13 and duplications of 11q22.3. The inversions were identified by standard cytogenetic analysis; microarray and FISH detected the chromosomal imbalance. The patient's phenotype includes intellectual disability, speech abnormalities, and autistic behaviors, but interestingly neither the patient, his brother, nor mother have aniridia or other eye anomalies. To the best of our knowledge, these findings in three family members represent the only reported cases with 11p13 deletions downstream of PAX6 not demonstrating phenotypic characteristics of aniridia or abnormal eye development. Although none of the deleted genes are obvious candidates for the patient's phenotype, the absence of aniridia in the presence of this deletion in all three family members further delineates the location of the DRR for PAX6. Show less

Increased dietary ratios of ω6/ω3 polyunsaturated fatty acids have been implicated in the pathogenesis of Crohn's disease (CD), but epidemiologic data are limited. We investigated whether variants of genes that control polyunsaturated fatty acid metabolism (CYP4F3, FADS1, and FADS2), along with the dietary ratio of ω6/ω3, confers susceptibility to CD. Based on data from 182 children newly diagnosed with CD and 250 controls, we found that children who consumed a higher dietary ratio of ω6/ω3 were susceptible for CD if they were also carriers of specific variants of CYP4F3 and FADS2 genes. Our findings implicate diet-gene interactions in the pathogenesis of CD. Show less

Current concepts and recommended treatment for temporomandibular disorders (TMDs) and temporomandibular joint pain and dysfunction have evolved over time. This article attempts to distill the current information for this often confusing topic into relevant clinical issues that will allow the general dental practitioner to be better able to diagnose and interpret clinical findings, and institute a therapeutic regimen that will provide needed relief to patients suffering from TMD dysfunction. Current management methods, both surgical and nonsurgical, are reviewed and discussed. Show less