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0%). The urotype distribution was significantly different (P less then 0.05), as 16% of the IC/PBS cohort, but 0% of controls, were Streptococcus urotype (P less then 0.01). Symptom-free IC/PBS participants were less likely to be EQUC positive (12.5%) than IC/PBS participants with moderate or severe symptoms (68.8% and 46.2%) and the control cohort (60%; P less then 0.05). CONCLUSION Lactobacillus was the most common urotype. However, the presence of Lactobacillus did not differ between cohorts, and it did not impact IC/PBS symptom severity. Bacteria were not isolated from most participants with active IC/PBS symptoms. These findings suggest that bacteria may not be an etiology for IC/PBS.OBJECTIVES Two white matter tracts (WMTs) are proposed to be involved in bladder function anterior thalamic radiation and superior longitudinal fasciculus. Multiple sclerosis (MS) patients with voiding dysfunction (VD) may have distinct changes in these 2 WMTs. This study aims to compare the fractional anisotropy (FA) and mean diffusivity (MD) from diffusion tensor imaging of MS females with and without VD versus healthy controls (HCs). METHODS Prospective observational cohorts of 28 female MS patients and 11 HCs were recruited. Multiple sclerosis patients were divided into 2 groups voiders (patients without VD, n = 14) and VD (patients with VD, n = 14). Diffusion tensor imaging of each subject was obtained, from which FA and MD maps were generated. The mean FA and MD of each WMT on both sides were analyzed using one-way analysis of variance and pairwise comparison with adjusted P values. RESULTS Overall MS patients had significantly lower mean FA (loss of coherence) and significantly higher mean MD (increased free diffusion) than HCs in both WMTs, indicating more damage. Furthermore, VD showed a trend of loss of integrity in both WMTs when compared with voiders with lower FA and higher MD. check details CONCLUSIONS There is damage reflected by lower FA and higher MD values in the proposed WMTs involved in bladder function in MS women. Voiding dysfunction in this patient population can be attributed to these damages considering women with VD demonstrated a trend of deterioration in these WMTs compared with women without VD. Future studies with larger sample sizes should be done to further confirm this correlation. Ultrasound for diagnostic and procedural purposes is becoming a standard in daily clinical practice including anaesthesiology and peri-operative medicine. The project of European Society of Anaesthesiology (ESA) Task Force for the development of clinical guidelines on the PERioperative uSE of Ultra-Sound (PERSEUS) project has focused on the use of ultrasound in two areas that account for the majority of procedures performed routinely in the operating room vascular access and regional anaesthesia. Given the extensive literature available in these two areas, this paper will focus on the use of ultrasound-guidance for vascular access. A second part will be dedicated to peripheral nerve/neuraxial blocks. The Taskforce identified three main domains of application in ultrasound-guided vascular cannulation adults, children and training. The literature search were performed by a professional librarian from the Cochrane Anaesthesia and Critical and Emergency Care Group in collaboration with the ESA Taskforce. The Grading of Recommendation Assessment (GRADE) system for assessing levels of evidence and grade of recommendations were used. For the use of ultrasound-guided cannulation of the internal jugular vein, femoral vein and arterial access, the level evidence was classified 1B. For other accesses, the evidence remains limited. For training in ultrasound guidance, there were no studies. The importance of proper training for achieving competency and full proficiency before performing any ultrasound-guided vascular procedure must be emphasised.BACKGROUND Wilderness activities expose outdoor enthusiasts to austere environments with injury potential, including falls from height. The majority of published data on falls while climbing or hiking are from emergency departments. We sought to more accurately describe the injury pattern of wilderness falls that lead to serious injury requiring trauma center evaluation, and to further distinguish climbing as a unique pattern of injury. METHODS Data were collected from 17 centers in 11 states on all wilderness falls (fall from cliff ICD-9 e884.1, ICD-10 w15.xx) from 2006-2018 as a Western Trauma Association multicenter investigation. Demographics, injury characteristics, and care delivery were analyzed. Comparative analyses were performed for climbing vs non-climbing mechanisms. RESULTS Over the 13 year study period, 1176 wilderness fall victims were analyzed (301 climbers, 875 non-climbers). Fall victims were male (76%), young (33 years) and moderately injured (Injury Severity Score 12.8). Average fall height was 48 feet and average rescue/transport time was over 4 hours. 19% were intoxicated. The most common injury regions were soft tissue (57%), lower extremity (47%), head (40%) and spine (36%). Non-climbers had a higher incidence of severe head and facial injuries despite having equivalent overall ISS. On multivariate analysis, climbing remained independently associated with increased need for surgery but lower odds of composite ICU admission/death. Contrary to studies of urban falls, height of fall in wilderness falls was not independently associated with mortality or ISS. CONCLUSION Wilderness falls represent a unique population with distinct patterns of predominantly soft tissue, head, and lower extremity injury. Climbers are younger, usually male, more often discharged home, and require more surgery but less critical care. LEVEL OF EVIDENCE Level 3, retrospective case control.BACKGROUND Tranexamic acid (TXA) has been demonstrated to decrease mortality in adult trauma, particularly in those with massive transfusions needs sustained in combat injury. Limited data is available for the efficacy of TXA in pediatric trauma patients outside of a single Combat Support Hospital in Afghanistan. METHODS The Department of Defense Trauma Registry (DODTR) was queried for trauma patients less then 18 yo from Iraq and Afghanistan requiring ≥ 40 ml/kg of blood product within 24 hours of injury. Burns and fatal head traumas were excluded. Primary outcome was in-hospital mortality. Secondary outcomes were hospital, ventilator, and ICU free days as well as total blood product volume. RESULTS Amongst those pediatric patients receiving massive transfusions those who received TXA were less likely to die in hospital (8.5 vs 18.3%). Patients who received TXA and those who did not had similar hospital free days (19 vs 20), ventilator free days (27 vs 27), ICU free days (25 vs 24). Those who received TXA had higher 24 hour blood product administration (100 vs 75 ml/kg).