Traumatic thoracic aortic transection is one of the most lethal consequences of blunt chest trauma; it is commonly associated with high-speed deceleration injuries in road traffic collisions. Despite advances in trauma management, survival rates remain poor due to rapid internal haemorrhage and the presence of multiple associated injuries. We report a fatal case of thoracic aortic transection in a 50-year-old restrained male driver involved in a high-velocity head-on collision with a truck. Following admission, he presented with hypotension, left-sided flail chest, multiple long bone fractures and reduced consciousness. Although emergency resuscitation was initiated, he developed sudden cardiovascular collapse during radiological evaluation and could not be revived. Medico-legal autopsy revealed a patterned seat belt contusion across the anterior chest wall, multiple rib fractures, extensive mediastinal haemorrhage, left-sided haemothorax and a circumferential full-thickness transection of the proximal descending thoracic aorta distal to the left subclavian artery. Toxicological analysis detected alcohol and morphine. This case highlights the characteristic pathological features of traumatic thoracic aortic injury and emphasises the medico-legal significance of the seat belt sign in identifying severe underlying thoracic trauma and reconstructing fatal motor vehicle collisions.

The erector spinae plane block (ESPB) is a promising regional technique for cardiac surgery. We evaluated the efficacy of ESPB regarding analgesia and in-hospital outcomes in patients undergoing coronary artery bypass grafting (CABG). We conducted a systematic review and meta-analysis comparing ESPB versus control in adults undergoing CABG (CRD42025645045). Primary outcomes were opioid consumption (24 h/48 h) and pain intensity. Secondary outcomes included extubation time and intensive care unit (ICU) length of stay. Data were pooled using random-effects models. Meta-regression and trial sequential analysis (TSA) were used to assess sources of heterogeneity and robustness, respectively, while the Grading of Recommendations, Assessment, Development, and Evaluations framework provided the certainty of the evidence for each outcome. Twelve studies (704 patients) were analyzed. ESPB significantly reduced the morphine milligram equivalent consumption at 24 h (mean difference (MD) -19.05 mg; 95% confidence interval (CI) [-22.50 to -15.61]; P < 0.001; high certainty) and 48 h (MD -19.42 mg; 95% CI [-28.75 to -10.09]; P < 0.001; moderate certainty). Pain scores, by the Numerical Rating Scale, were lower within 12 h (MD -0.93; P < 0.001; moderate certainty) and at 24 h (MD -0.58; P = 0.016; low certainty). ESPB shortened extubation time (MD -2.50 h; high certainty) and ICU stay (MD -12.55 h; moderate certainty). TSA confirmed robust evidence for opioid reduction, early pain relief, and extubation benefits. ESPB provides effective early analgesia, reduces perioperative opioid requirements, and accelerates recovery in CABG, representing a fundamental complement to conventional isolated intravenous analgesia. Future research should investigate continuous techniques.

Climate-related disasters can disrupt health-care delivery and treatment continuity. Evidence on their effects on opioid dispensing in middle-income countries remains scarce. We assessed whether the May 2024 floods were associated with changes in outpatient opioid dispensing in Rio Grande do Sul, Brazil.

The high cost and poor portability of external infrared thermal imagers have limited the widespread adoption of photothermal lateral flow immunoassays (PT-LFIAs) in on-site testing. To address this, we developed a smartphone-based handheld Thermal Contrast Amplification (TCA) Reader, eliminating the need for costly external hardware. Compared with existing recent external thermal imager-based PT-LFIA readout, this reader integrates a selected thermal-sensor-equipped smartphone, a motorized laser module, Bluetooth-enabled control, and a fixed 3D-printed holder into a compact device. The reader enables automated thermal signal acquisition with a same-strip measurement CV below 1% and supports multiple PT-LFIA formats. Using Au@Ag core-shell nanoparticles (Au@Ag NPs) as reliable photothermal labels, the handheld TCA reader-based PT-LFIAs (hT-PT-LFIAs) offers higher sensitivity compared to conventional LFIAs. The hT-PT-LFIAs can be used for the multiplex detection of viral antigens (Influenza A/B, SARS-CoV-2), small molecule drugs (morphine, methamphetamine, ketamine) and nucleic acids (HPV 16/18), demonstrating versatility across various LFIA formats, good clinical performance in training cohort, and high repeatability for small molecule assay. By seamlessly integrating micro-engineering, nanotechnology, and smartphone-based sensing, this work provides a low-cost, portable, and broadly applicable PT-LFIAs detection strategy that bridges a critical technological gap.

This study presents a novel design of a millifluidic chip that integrates liquid phase microextraction with analyte detection through an electrochemical sensor. Upon incorporating the sample solution that includes the model analyte, morphine, into the donor part of the millifluidic chip, passive diffusion occurs as it traverses the supported liquid membrane, influenced by the pH gradient. The innovative sensor utilizes a platinum electrode (Pt) that is modified with a synthesized covalent organic framework (COF) based on 4,4'-methylenedianiline and 4,4',4''-((1,3,5-triazine-2,4,6-triyl) tris(oxy)) tribenzaldehyde (MDA-Trz-COF, referred to as MDA-Trz-COF/Pt. Following the extraction duration in the acceptor part, a differential pulse voltammetry determination of morphine was conducted. The parameters influencing the electrochemical-liquid phase microextraction (LPME) chip were refined through one-variable-at-a-time and central composite design methodologies. In ideal circumstances, the maximum current responses were observed during the oxidation of morphine on the MDA-Trz-COF/Pt electrode versus various concentrations of morphine within two distinct linear ranges of 5.0-120.0 and 120.0-700.0 pmol L[-1], with a limit of detection of 1.5 pmol L[-1] and a limit of quantification of 5.0 pmol L[-1], respectively. The efficacy of the proposed method for the preconcentration and quantification of morphine in urine samples was thoroughly examined.

Mu opioid agonists, the most widely used opioids, produce analgesia, respiratory depression, constipation, and reward leading to substance abuse. Like all opioid receptor family members, mu receptors are Gi/o-coupled and inhibitory, yet mu-mediated disinhibition of GABAergic neurons propagates downstream activation that differs between naive and dependent animals and across receptor subtypes. Here we used TRAP2/Ai9 reporter mice, which deposit tdTomato in active neurons via the c-Fos locus, with tissue clearing and light sheet microscopy to map whole-brain neuronal activation after acute morphine (10 mg/kg), an escalating twice-daily morphine regimen producing dependence, or the NOP receptor agonist Ro 64-6198. Despite Gi/o coupling, all treatments raised global activation relative to vehicle, though this whole-brain increase reached significance only in males, and acute morphine engaged the largest number of regions, all increased with none decreased. Sex differences were prominent: males were more sensitive than females across treatments, with morphine engaging mainly pain- and reward-related midbrain circuitry in males and hypothalamic circuitry in females. In dependent mice, activation was lower across several regions, including a cluster of cerebellar regions that trended toward being turned off relative to acute morphine. NOP receptor activation produced a far weaker profile. Although chronic morphine produced less activation than acute morphine, it produced more widespread co-activation, and while hub composition differed across conditions, global network organization was preserved. These results reveal whole-brain changes in neuronal activation and establish a TRAP2/Ai9 model that renders activated regions genetically accessible for future site-directed investigation.