None of our results rose to the level of statistical significance. TXA administration significantly reduced odds of death on logistic regression (OR, 0.35; 95% CI, 0.123-0.995; p = 0.0488). CONCLUSIONS Use of TXA in pediatric patients with combat trauma requiring massive transfusions trended towards a significant improvement in in-hospital mortality (p-value 0.055). This mortality benefit is similar to that seen in adult studies and less well characterized cohort in another pediatric study suggesting TXA administration confers mortality benefit in massively transfused pediatric combat trauma victims. LEVEL OF EVIDENCE (STUDY TYPE) Level IV evidence (retrospective cohort).BACKGROUND Death from injury occurs predominantly in prehospital settings. Injury prevention and prehospital care of military forces is the responsibility of combatant commanders. Medical examiner and trauma systems should routinely study fatalities and inform commanders of mortality trends. METHODS Data reported on US Special Operations Command (USSOCOM) fatalities who died while performing duties from September 11, 2001 to September 10, 2018, were reevaluated to compare subcommands, units, and trends. Injury was assessed by mechanism, severity, operational posture, and survivability. Death was assessed by manner, cause, classification, mechanism, and preventability. RESULTS Of 614 USSOCOM fatalities (median age 30; male 98.5%), 67.6% occurred in the Army command, of which 49.2% occurred in the Special Forces command. Battle injury accounted for 60.1% of USSOCOM fatalities. Most battle-injured fatalities in each subcommand had non-survivable injuries and non-preventable deaths. For each subcommand except Marional risk matrices and advance casualty prevention and response efforts. Prevention, assessment, and treatment strategies must evolve to reduce death from hemorrhage plus coexisting mechanisms. LEVEL OF EVIDENCE Performance Improvement and Epidemiological, Level IV.Long noncoding RNAs (LncRNAs) lncRNA H19 has been shown to be involved in the chemotherapy resistance of cancer cells. However, the role of lncRNA H19 in chemotherapy resistance of melanoma cells remains unknown. Here, we determined lncRNA H19, miR-18b, and insulin-like growth factor 1 (IGF1) expression by utilizing quantitative real-time PCR. Cell proliferation ability and chemosensitivity were assessed by colony formation assay and MTT assay. selleck inhibitor Flow cytometry assay was applied to detect cell apoptosis. We discovered that lncRNA H19 was upregulated, but miR-18b was downregulated in melanoma tissues and cisplatin (DDP)-resistant melanoma cells. The overall survival for the group with lower lncRNA H19 was significantly better than the group with higher H19. IGF1 mRNA level was higher in melanoma tissues than that in normal tissues. miR-18b expression level A negative correlation was observed between the expression levels of miR-18b, lncRNA H19, and IGF1 mRNA. Functionally, knockdown of lncRNA H19 sensitized resistant A375/DDP and M8/DDP cells to DDP. Silencing lncRNA H19 inhibited colony formation ability and promoted apoptosis of DDP-resistant melanoma cells, which was abrogated by miR-18b inhibition and IGF1 upregulation. Mechanistically, lncRNA H19 directly interacted with miR-18b to regulate its expression. IGF1 was identified as a target of miR-18b. These findings highlight the fact that lncRNA H19 could influence DDP-resistance by modulating the miR-18b/IGF axis in melanoma cells, suggesting a new potential therapeutic target for melanoma patient treatment.PURPOSE To report the indications and outcomes of 8.5/8.6-mm excimer laser-assisted penetrating keratoplasties (PKPs) at a tertiary corneal subspecialty referral center. METHODS This retrospective, descriptive, observational study included 107 PKPs performed in 96 patients (mean age, 53 ± 12 years). The patients' indications for surgery, best-corrected visual acuity, surface regularity index, surface asymmetry index, topographic astigmatism, central endothelial cell density, central corneal thickness, and graft status were recorded preoperatively, 6 weeks postoperatively, and before (12 ± 2 months) and after (19 ± 4 months) the suture removal. RESULTS The surgeries included 48 primary PKPs and 59 repeat PKPs. The main indications were corneal ectatic disorders (50%), severe corneal keratitis (21%), and corneal scars (16%) in the primary PKP group and highly irregular astigmatism after PKP (51%) and previous graft decompensation (37%) in the repeat PKP group. From preoperative measurements to the last follow-up visit without sutures, we found significant improvements (P less then 0.001 for all) in visual acuity (0.7 ± 0.3 LogMAR to 0.3 ± 0.2 LogMAR), surface regularity index (1.5-1.0), and surface asymmetry index (2.59-1.1). At the last follow-up, the mean outcome measurements did not significantly differ between the primary and repeat PKP groups. Overall, 89 grafts (83%) remained clear at the last follow-up. CONCLUSIONS In cases of ectatic disorders and highly irregular astigmatism after keratoplasty, 8.5/8.6-mm excimer laser-assisted PKP seems to be an excellent treatment option, achieving a significant improvement in visual acuity.PURPOSE To compare the long-term outcomes of living-related conjunctival limbal allograft (lr-CLAL) with keratolimbal allograft (KLAL) in patients with limbal stem cell deficiency. METHODS A retrospective, comparative, interventional cohort of patients with bilateral total limbal stem cell deficiency who underwent surgical treatment with a KLAL or lr-CLAL procedure alone (not combined with any other ocular surface stem cell transplantation procedures) with a minimum follow-up of 1 year and who received systemic immunosuppression. Ocular surface stability, best-corrected visual acuity (BCVA), and postoperative complications at the last follow-up were the main outcome measures. RESULTS There were 224 eyes that underwent KLAL alone and 63 eyes that underwent lr-CLAL alone, with a mean follow-up time for all eyes of 7.2 years (range 1.0-16.0 years). For lr-CLAL eyes, 82.5% maintained a stable ocular surface compared with 64.7% of KLAL eyes at the last follow-up. Only 6.3% of lr-CLAL eyes demonstrated a failed ocular surface compared with 15.selleck inhibitor