Eleven-patients had to be intubated at the trauma site. Three patients were resuscitated after onset of pulseless-electrical-activity. Two-patients died in the resuscitation room. In 116-cases, surgery was indicated including 55-emergency surgeries. Another 19 patients (8.1%) were transferred to the intensive care unit. CONCLUSION Paragliders are most commonly affected, although the highest injury severities were identified for Building, Antenna, Span and Earth-jumping athletes. First responders, treating physicians and pilots should be aware of the risk for potentially serious and life-threatening injury with an in-hospital mortality of 0.9%. ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.BACKGROUND Postoperative delirium (POD) is one of the most common complications in older adult patients undergoing elective surgery. Few studies have compared, within the same institution, the type of surgery, risk factors and type of anesthesia and analgesia associated with the development of POD. AIM To investigate the following three questions (1) What is the incidence of POD after non-ambulatory orthopedic surgery at a high-volume orthopedic specialty hospital? (2) Does surgical procedure influence incidence of POD after non-ambulatory orthopedic surgery? And (3) For POD after non-ambulatory orthopedic surgery, what are modifiable risk factors? METHODS A retrospective cohort study was conducted of all non-ambulatory orthopedic surgeries at a single orthopedic specialty hospital between 2009 and 2014. Patients under 18 years were excluded from the cohort. Patient characteristics and medical history were obtained from electronic medical records. Patients with POD were identified using International Classifi5, P less then 0.001). CONCLUSION POD is lower (1.2%) than previously reported; likely due to the use of multi-modal regional anesthesia and early ambulation. Both fixed and modifiable factors are identified. ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.The demand for revision total hip arthroplasty (THA) is increasing. Information quality on the internet has been extensively analysed in relation to primary THA but no such analysis has ever been performed for revision THA. Our aim was to assess the quality and readability of this information. Three major internet search engines were searched for information on revision THA. All websites were assessed for quality of information using the DISCERN score, the Journal of the American Medical Association benchmark criteria and a novel scoring system specific to revision THA [Vancouver Revision Arthroplasty Information (VRAI) score]. Website readability was assessed, as was presence of the Health On the Net Foundation (HON) seal. The majority of websites (52%) were academic with a post-graduate reading level. Only 6.5% of websites had the HON seal. Twenty-eight percent of websites had a 'good' DISCERN score and only 28% had a 'good' score with the novel VRAI scoring system. Health information websites had significantly higher rates of 'good' VRAI scores (P = 0.008). Websites with the HON seal had significantly higher DISCERN scores (P = 0.01). All governmental websites were at a reading level suitable for patient review. Information on the internet relating to revision THA is of low quality, much lower than the quality of information on primary THA. We recommend governmental websites for their readability and health information websites for their quality of information specific to revision THA. Websites with the HON seal provide higher quality information and should be recommended to patients as reading material regarding revision THA. ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.On September 20, 2017 Hurricane Maria, a category 4 hurricane, made landfall on the eastern coast of Puerto Rico. This was preceded by Hurricane Irma, a category 5 hurricane, which passed just off the coast 13 d prior. The destruction from both Hurricane Irma and Maria precipitated a coordinated federal response which included the Federal Emergency Management Agency (FEMA) and the United States military. The United States Army dispatched the 14th Combat Support Hospital (CSH) to Humacao, a city on the eastern side of the island where Maria made landfall. The mission of the 14th CSH was to provide medical humanitarian aid and conduct disaster relief operations in support of the government of Puerto Rico and FEMA. During the 14th CSH deployment to Puerto Rico, 1157 patients were evaluated and treated. Fifty-seven operative cases were performed to include 23 orthopaedic cases. The mean age of the orthopaedic patients treated was 45.7 years (range 13-76 years). Tozasertib The most common operation was irrigation and debridement of open contaminated and/or infected wounds. Patients presented a mean 10.8 d from their initial injury (range 1-40 d). Fractures and infections were the most common diagnoses with the greatest delay in treatment from the initial date of injury. The deployment of the 14th CSH to Puerto Rico was unique in its use of air transport, language and local customs encountered, as well as deployment to a location outside the continental United States. These factors coupled with the need for rapid deployment of the 14th CSH provided valuable experience which will undoubtedly enable future success in similar endeavors. ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.Tacrolimus is an immunosuppressant produced by several Streptomyces species, widely used in transplantolgy and dermatology. In this report, attempts have been made to enhance tacrolimus productivity by altering the primary carbon source on culture media. In order to better understand the effects of glucose and maltose on tacrolimus biosynthesis, different carbon contents of these sugars were evaluated in the culture media, thus altering the carbonnitrogen ratio. The highest specific production achieved on this report was 10.46 mg/g at a carbonnitrogen ratio of 8.71.0 and maltose as carbon source. Using glucose as primary carbon source, the highest specific production achieved was 9.06 mg/g at a carbonnitrogen ratio of 8.51.0. The range of carbonnitrogen ratios evaluated for each sugar presented distinct behaviors. Glucose containing-media exhibited an initial linear downward trend, by the other hand, maltose containing-media exhibited an increasing tendency. Both glucose and maltose presented the highest specific production at 3 % of carbon source on media.