bluuebunny/crossref_metadata_2025 huggingface dataset:
Trends in Management of Pediatric Distal Radius Buckle Fractures
Authors: Lindsay Sarah E. , Holmes Stephanie , Swarup Ishaan , Halsey Matthew
Published: May 2022

Background:

Distal radius buckle fractures (DRBFx) represent nearly half of the pediatric wrist injuries. DRBFx are stable injury patterns that can typically be successfully managed with brief immobilization. The purpose of this study was to evaluate opinions and preferences of pediatric orthopaedic specialists regarding the management of DRBFx.

Methods:

The POSNA Trauma Quality, Safety, and Value Initiative (QSVI) Committee developed a 20-question survey regarding the treatment of DRBFx in children. The survey was sent twice to all active and candidate POSNA members in June 2020 (n=1487). Questions focused on various aspects of treatment, including type and length of immobilization, follow-up, and radiographs and on potential concerns regarding patient/family satisfaction and pain control, medicolegal concerns, misdiagnosis, and mismanagement.

Results:

A total of 317 participants completed the survey (response rate=21.3%). In all, 69% of all respondents prefer to use a removable wrist splint, with 76% of those in practice <20 years preferring removable wrist splints compared with 51% of those in practice >20 years (χ2=21.7; P<0.01). Overall, 85% of participants utilize shared decision-making in discussing management options with patients and their families. The majority of participants felt that the risk of complications associated with DRBFx was very low, but concern for misdiagnosis and mismanagement have required some respondents to perform closed or open reductions.

Conclusions:

In 2020, the majority of respondents treat DRBFx with removable splints (69%) for 3 or fewer weeks (55%), minimal follow-up (85%), and no reimaging (64%). This marks a dramatic shift from the 2012 POSNA survey when only 29% of respondents used removable splinting for DRBFx.

Level of Evidence:

Level II.
Sacroiliac Joint Degeneration and Pain After Spinal Arthrodesis
Authors: Manzetti Marco , Ruffilli Alberto , Barile Francesca , Fiore Michele , Viroli Giovanni , Cappello Lorenzo , Faldini Cesare
Published: May 2022

Study Design:

This was a systematic review.

Objective:

The present study aims to review the available literature concerning sacroiliac joint (SIJ) pain and degeneration after lumbosacral fixation to identify the prevalence and potential risk factors.

Summary of Background Data:

Although numerous factors can predispose patients to SIJ degeneration and pain various clinical studies indicate lumbosacral arthrodesis as a major cause.

Materials and Methods:

The PubMed-MEDLINE, Cochrane Central Registry of Controlled Trials, and Embase Biomedical database were searched. Peer-reviewed comparative studies, cohort studies, case series studies and case control studies, conducted either in a retrospective or prospective design, that registered data about SIJ pain and degeneration after lumbosacral fixation were included.

Results:

Twenty-one studies including 2678 patients met the inclusion criteria. The percentage of SIJ pain after lumbosacral fixation diagnosed with injections and physical examination varied widely, from 3% to 90%. Among patients who underwent spinal fusion, SIJ pain prevalence was higher when arthrodesis was fixed compared with floating fusions (59% vs. 10%, P-value >0.05). The prevalence of SIJ degenerative changes at computed tomography scan was more frequent in patients who underwent spinal arthrodesis than in those who did not (75% vs. 38.2%, P-value ≤0.05).

Conclusion:

According to current evidence, patients who received lumbosacral fixation are at risk of SIJ pain. Number of fused levels, involvement of pelvis or sacrum in the arthrodesis area, inadequate lumbosacral sagittal alignment, and site of bone graft harvesting could be possible risk factor leading to sacroiliac degeneration and pain after lumbar spine fixation that should be investigated by physicians. However, there is a lack of homogeneity of the studies that address the problem, therefore, further prospective comparative studies, with a homogeneous architecture and cohorts are needed.

Level of Evidence:

Level III.
Single-string, closed-loop fixation modification to reposit a dislocated triple-looped haptic intraocular lens
Authors: Yi Quan-Yong , Ying Jia-Ning , Wu Shan-Jun , Wu Guo-Hai , Su Zhi-Tao , Wang Sang-Sang , Gong Yan
Published: May 2022

A technique using the single-string, closed-loop fixation method to reposit dislocated triple-looped haptic intraocular lens (IOL)–capsular bag complex is described. The long needle or curved needle with a 10-0/8-0 polypropylene suture and a 27/30-gauge needle were used as the guide needle to pass through the fenestrated haptics twice. The scleral interlaminar course was used as the fixed point. Last, a fixation knot was created in the sclerotomy by the 2 ends of the thread to close the suture loop for IOL fixation. Another knot was created about 2 to 3 mm from the exit point and was intrasclerally anchored by the aid of the attached needle. 4 eyes from 4 consecutive patients were studied retrospectively; during all follow-up visits, the IOLs were well centered and stable, and no suture erosion, hypotony, scleral atrophy, chronic inflammation, retinal tears, and/or detachments were observed.
Comparison of the actual diameter of capsulotomy and predicted diameter of capsulotomy after femtosecond laser–assisted capsulotomy
Authors: Luo Wen Jing , Hu Shu Qiong , Wang Yong , Zheng Han song , Zhou Suo Wang , Ortega-Usobiaga Julio
Published: May 2022

Purpose:

To compare the consistency between the actual diameter of capsulotomy (ADC) and the predicted diameter of capsulotomy (PDC) in femtosecond laser–assisted cataract surgery (FLACS) and analyze the factors that influence the deviation of the diameter of capsulotomy (DDC) between the actual and predicted.

Setting:

Aier Eye Hospital of Wuhan University, China.

Design:

Retrospective observational case series.

Methods:

Patients who underwent FLACS from March 2020 to March 2021 were reviewed. The ADC in FLACS was measured and compared with the PDC. The effects of age, sex, and biometrics on DDC were analyzed.

Results:

412 eyes of 336 patients were included. The mean age was 53.0 ± 0.91 years (range 3 to 91 years). When the PDC was set to 4.50 mm, the results showed that the ADC was 5.21 ± 0.21 mm with a significant difference between them (P < .05). However, when the PDC was set to 5.2 mm, the ADC was 5.10 ± 0.38 mm without a significant difference between them (P > .05). No correlation (P > .05) was found between the DDC and the axial length, the DDC and the anterior chamber depth (ACD), and the DDC and the mean keratometry (Km), but a negative correlation was found between the DDC and the lens thickness (LT) (r = −0.21; P < .05) and the DDC with age (r = −0.70; P < .05). Using curvilinear regression analysis, a development of an age-depending correction formula was predicted: ADC = PDC + 1.23 − 0.30 ln (x) (x = age ≥3) (R
2 = 0.65; F = 752.39; P = .00).

Conclusions:

The consistency of the ADC and PDC was influenced by age and LT. For patients aged 40 years or younger, the younger the patient, the wider the DDC; for patients older than 40 years, the DDC was small. The thicker the LT, the smaller the DDC.
The role of prostate-specific membrane antigen PET/computed tomography in the management of prostate cancer patients: could we ask for more?
Authors: Mei Riccardo , Farolfi Andrea , Morigi Joshua James , Fanti Stefano
Published: May 2022

Purpose of review

Thanks to the development of novel PSMA-based peptides, molecular imaging, such as PET/CT paired with theranostic-based approaches have recently been proposed for treatment of prostate cancer. Patient selection, however, remains challenging because of the absence of strong prospective data to interpret and translate imaging scans into effective and well tolerated treatment regimens.

Recent findings

In this review, we discuss the latest findings in PSMA imaging in prostate cancer patients. Particularly, we go into detail into the impact of PSMA imaging on the treatment management in primary staging, biochemical recurrence and in advanced prostate cancer.

For primary prostate cancer staging, PSMA PET/CT seems crucial for primary therapy assessment, being able in some cases to detect lesions outside the surgical template, thus permitting a change in management. Moreover, N+ condition at PSMA has been correlated with a worse biochemical recurrence-free and therapy-free survival. The early detection of PSMA-positive findings in recurrent prostate cancer is associated with a better time to relapse survival. Similarly, for advanced prostate cancer patients, accurate restaging with PSMA imaging is gaining importance for early prediction of response to systemic therapies and to assure the best outcome possible. With regards to theranostics, appropriate selection of patients eligible for 177Lu-PSMA requires PSMA imaging, whereas the role of added FDG-PET for discriminating those with PSMA/FDG discordance needs to be further evaluated.
Review of second-generation androgen receptor inhibitor therapies and their role in prostate cancer management
Authors: Jazayeri Seyed Behzad , Srivastava Abhishek , Shore Neal
Published: May 2022

Purpose of review

We review the published literature on the indications of second-generation androgen receptor inhibitors, Poly(ADP-Ribose) Polymerase (PARP) inhibitors, combination therapies, and their evolution throughout the advanced prostate cancer continuum.

Recent findings

Enzalutamide trials have published data supporting its use in metastatic hormone-sensitive prostate cancer (mHSPC), nonmetastatic castration-resistant prostate cancer (nmCRPC), and metastatic castration-resistant prostate cancer (mCRPC). Apalutamide trials have supported its indication for mHSPC and nmCRPC. Darolutamide trials currently support its use for nmCRPC. Abiraterone trials have supported its use in mCRPC and mHSPC. Olaparib and rucaparib have shown clinical benefit in heavily pretreated patients with mCRPC and DNA repair mutation genes.

Phase 3 trials and peer-reviewed literature demonstrate that enzalutamide, apalutamide, and darolutamide prolong overall survival (OS) in men with nmCRPC. Abiraterone, enzalutamide, and apalutamide improve OS in men with mHSPC. Abiraterone and enzalutamide have data supporting improvement in OS in men with mCRPC
The role of chemotherapy in metastatic prostate cancer
Authors: Riaz Irbaz B. , Sweeney Christopher J.
Published: May 2022

Purpose of review

To summarize the role of chemotherapy and offer some guidance regarding the selection of chemotherapy in mPC.

Recent findings

Patients with mHSPC have varied prognoses with testosterone suppression alone (androgen deprivation therapy, ADT) and differential responses to docetaxel with ADT. Patients with de novo and metachronous high-volume disease have a robust survival benefit with the addition of docetaxel to hormonal therapies. Patients with synchronous low-volume disease have a more modest survival benefit from docetaxel and there is no evidence of survival benefit with docetaxel in patients with metachronous low-volume disease. Integration of biomarkers may refine treatment selection regardless of volume of disease. Docetaxel and cabazitaxel also impart an OS benefit in patients with metastatic castration-resistant prostate cancer (mCRPC). The choice of chemotherapy in mCRPC depends on treatment received in mHSPC setting. Docetaxel remains the first line chemotherapy in castration-resistant patients who have not received it in mHSPC followed by cabazitaxel, otherwise cabazitaxel can be deployed without docetaxel retreatment.

Chemotherapy is a key class of therapy for selected patients with mHSPC and mCRPC.
Autopsy-Diagnosed Injury Deaths in Persons With Acute or Chronic Alcohol Use
Authors: Stahl-Herz Jay , Pasquale-Styles Melissa
Published: May 2022

Acute and chronic alcohol use is associated with injury, and autopsies may be performed to ascertain injury deaths in persons with acute or chronic alcohol use. This study sought to determine how many decedents with a history of acute or chronic alcohol use had an internal physical injury diagnosed only at autopsy that caused or contributed to the death. The study reviewed medicolegal investigation and autopsy reports at the New York City Office of Chief Medical Examiner between January 1 and October 11, 2018, to identify 1000 consecutive persons with suspected acute or chronic alcohol use who were autopsied to ascertain whether internal physical injury caused or contributed to the death. Of 1000 persons with known or suspected acute or chronic alcohol use, 390 (39.0%) had an external injury. Although 115 (11.5%) had an internal injury at autopsy, only 29 (2.9%) had an injury that caused or contributed to the death. Only 1 decedent had an internal injury that caused the death with no associated external evidence of injury (0.1%). This study demonstrates the rarity of occult lethal injury diagnosed at autopsy in persons with acute or chronic alcohol use.
SARcopenia Assessment in Hypertension: The SARAH Study
Authors: Kara Murat , Kara Özgür , Ceran Yasin , Kaymak Bayram , Kaya Tuğçe Cansu , Çitir Beyza Nur , Durmuş Mahmut Esad , Durmuşoğlu Esra , Razaq Sarah , Doğan Yahya , Shehab Dia , Alkandari Salem A. , Abdulsalam Ahmad J. , Ata Ayşe Merve , Koyuncu Esra Gizem , Coşkun Evrim , Turan Gökhan , Dilek Banu , Culha Mehmet Ali , Yildirim Pelin , Mezian Kamal , Doğu Beril , Kiliç Gamze , Ünlü Zeliha , Barbosa Jorge , Pinho Sérgio , Analay Pelin , Palamar Deniz , Güvener Orhan , Ocak Hasan , Malas Fevziye Ünsal , Baday Murat , Çakir Banu , Özçakar Levent
Published: May 2022

Objective

To investigate the relationship between sarcopenia and RAS-related disorders and to explore the effects of angiotensin converting enzyme inhibitors (ACEIs) and angiotensin-II receptor blockers (ARBs) on muscle mass/function and physical performance.

Design

This multi-center, cross-sectional study was performed using ISarcoPRM algorithm for the diagnosis of sarcopenia.

Results

Of the 2613 participants (mean age; 61.0 ± 9.5 years), 1775 (67.9%) were hypertensive. All sarcopenia-related parameters [except chair stand test (CST) in males] were worse in hypertensive group than in normotensive group (all p < 0.05). When clinical/potential confounders were adjusted; HT was found to be an independent predictor of sarcopenia in males [OR = 2.403 (95%CI: 1.514-3.813)] and females [OR = 1.906 (95%CI: 1.328-2.734)] (both p < 0.001). After adjusting for confounding factors, we found that all sarcopenia-related parameters (except grip strength and CST in males) were independently/negatively related with HT (all p < 0.05). In females, ACEIs users had higher grip strength and CST performance values but had lower muscle thickness and gait speed values, as compared to those using ARBs (all p < 0.05).

Conclusions

Hypertension was associated with increased risk of sarcopenia at least two times. Among antihypertensives; while ACEIs had higher muscle values, ARBs had higher muscle mass and physical performance values only in females.
“We're playing on the same team”: Communication (dis)connections between trauma patients and surgical residents
Authors: Huang Anna K. , Campbell Paige-Ashley , Chaudhary Mihir J. , Soklaridis Sophie , Miller Doriane , Dinizulu Sonya , Stolbach Bradley , Cosey Gay Franklin , Washington Stephanie , Olivera Perez Henry , Chalmers Kristen , Tessema Frazer , Henry Marion , Slidell Mark , Richardson Joseph , Bailey Zinzi , Owens Tyra , Wilkins Eric , Burgest Valerie , Hardaway Cragg , Francis Myles X. , Asom Anase , Lopez Hinojosa Itzel , Roggin Jake , Hamzat Ibraheem , Zakrison Tanya
Published: May 2022

BACKGROUND

Patient-physician communication is key to better clinical outcomes and patient well-being. Communication between trauma patients and their physicians remains relatively unexplored. We aimed to identify and characterize the range of strengths and challenges in patient-physician communication in the setting of trauma care.

METHODS

A qualitative, grounded theory approach was used to explore communication strengths and challenges for patients and residents. Patients previously admitted to the trauma service for violent injuries were recruited and interviewed in-person during their trauma clinic appointments. Surgical residents were recruited via email and interviewed virtually via Zoom. Anonymous, semistructured interviews were conducted until thematic saturation was reached.

RESULTS

Twenty-nine interviews with patients and 14 interviews with residents were conducted. Patients reported feeling ignored and misunderstood and having inadequate communication with physicians. Residents cited lack of time, patients' lack of health literacy, differences in background, and emotional responses to trauma as barriers to effective communication with patients. Patients and residents reported an understanding of each other's stressors, similar emotional experiences regarding traumatic stress, and a desire to communicate with each other in greater depth both inside and outside of the hospital.

CONCLUSION

Trauma patients and residents can feel disconnected due to the lack of time for thorough communication and differences in background; however, they understand each other's stressors and share similar emotional responses regarding trauma and a desire for increased communication, connection, and solidarity. Leveraging these shared values to guide interventions, such as a resident curriculum, may help bridge disconnects and improve their communication.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level IV.
Developing a National Trauma Research Action Plan: Results from the injury prevention research gap Delphi survey
Authors: Cooper Zara , Herrera-Escobar Juan P. , Phuong Jimmy , Braverman Maxwell A. , Bonne Stephanie , Knudson Mary Margaret , Rivara Frederick P. , Rowhani-Rahbar Ali , Price Michelle A. , Bulger Eileen M. ,   the NTRAP Injury Prevention Panel
Published: May 2022

BACKGROUND

In its 2016 report on trauma care, the National Academies of Sciences, Engineering, and Medicine called for the establishment of a National Trauma Research Action Plan to strengthen and guide future trauma research. To address this recommendation, the Department of Defense funded the Coalition for National Trauma Research to generate a comprehensive research agenda spanning the continuum of trauma and burn care. We describe the gap analysis and high priority research questions generated from the National Trauma Research Action Plan panel on injury prevention.

METHODS

Experts in injury prevention research were recruited to identify current gaps in injury prevention research, generate research questions and establish the priority of these questions using a consensus-driven Delphi survey approach from December 2019 through September 2020. Participants were identified using established Delphi recruitment guidelines to ensure heterogeneity and generalizability with both military and civilian representatives. Participants were encouraged, but not required, to use a Patient/Population, Intervention, Comparison, and Outcome format to generate research questions: Patient/Population; Intervention; Compare/Control; Outcome model. On subsequent surveys, participants were asked to rank the priority of each research question on a nine-point Likert scale, categorized to represent low-, medium-, and high-priority items. Consensus was defined as 60% or greater of panelists agreeing on the priority category.

RESULTS

Twenty-eight subject matter experts generated 394 questions in 12 topic areas. By round 3 of the Delphi, 367 (93.1%) questions reached consensus, of which 169 (46.1%) were determined to be high priority, 196 (53.4%) medium priority, and 2 (0.5%) low priority. Among the 169 high priority questions, suicide (29.6%), firearm violence (20.1%), and violence prevention (18.3%) were the most prevalent topic areas.

CONCLUSION

This Delphi gap analysis of injury prevention research identified 169 high priority research questions that will help guide investigators in future injury prevention research. Funding agencies and researchers should consider these gaps when they prioritize future research.

LEVEL OF EVIDENCE

Therepeutic/Care Management; Level IV.
The physiology of aortic flow and pressures during partial resuscitative endovascular balloon occlusion of the aorta in a swine model of hemorrhagic shock
Authors: Marble Jacob , Patel Nathan T.P. , Lane Magan R. , Williams Timothy K. , Neff Lucas P. , Johnson M. Austin
Published: May 2022

BACKGROUND

Partial resuscitative endovascular balloon occlusion of the aorta (REBOA) has shown promise as a method to extend REBOA, but there lacks a standard definition of the technique. The purpose of this study was to investigate the relationships between distal and proximal mean arterial pressure (MAP) and distal aortic flow past a REBOA catheter. We hypothesize that a relationship between distal aortic flow and distal MAP in Zone 1 partial REBOA (pREBOA) is conserved and that there is no apparent relationship between aortic flow and proximal MAP.

METHODS

A retrospective data analysis of swine was performed. Cohort 1 underwent 20% controlled hemorrhage and then randomized to aortic flow of 400 mL/min or complete occlusion for 20 minutes (n = 11). Cohort 2 underwent 30% controlled hemorrhage followed by complete aortic occlusion for 30 minutes (n = 29). Then, they all underwent REBOA wean in a similar stepwise fashion. Blood pressure was collected from above (proximal) and below (distal) the REBOA balloon. Aortic flow was measured using a surgically implanted supraceliac aortic perivascular flow probe. The time period of balloon wean was taken as the time point of interest.

RESULTS

A linear relationship between distal MAP and aortic flow was observed (R
2 value, 0.80), while no apparent relationship appeared between proximal MAP and aortic flow (R
2 value, 0.29). The repeated-measures correlation coefficient for distal MAP (0.94; 95% confidence interval, 0.94–0.94) was greater than proximal MAP (−0.73; 95% confidence interval, −0.74 to −0.72).

CONCLUSION

The relationship between MAP and flow will be a component of next-generation pREBOA control inputs. This study provides evidence that pREBOA techniques should rely on distal rather than proximal MAP for control of distal aortic flow. These data could inform future inquiry into optimal flow rates and parameters based on distal MAP in both translational and clinical contexts.
Tracheostomy decreases continuous analgesia and sedation requirements
Authors: Wallen Taylor E. , Elson Nora C. , Singer Kathleen E. , Hayes Hannah V. , Salvator Ann , Droege Christopher A. , Nomellini Vanessa , Pritts Timothy A. , Goodman Michael D.
Published: May 2022

BACKGROUND

The goals of sedation in the critically ill surgical patient are to minimize pain, anxiety, and agitation without hindering cardiopulmonary function. One potential benefit of tracheostomy during endotracheal intubation is the reduction of sedation and analgesia; however, there are little data to support this supposition. We hypothesized that patients undergoing tracheostomy would have a rapid reduction in sedation and analgesia following tracheostomy.

METHODS

A retrospective review of tracheostomies performed at a single Level I trauma center from January 2013 to June 2018 was completed. An evaluation of Glasgow Coma Scale, Richmond Agitation-Sedation Scale, and Confusion Assessment Method for the intensive care unit 72 hours pretracheostomy to 72 hours posttracheostomy was performed. The total daily dose of sedation, anxiolytic, and analgesic medications administered were recorded. Mixed-effects models were used to evaluate longitudinal drug does over time (hours).

RESULTS

Four hundred sixty-eight patients included for analysis with a mean age of 58.8 ± 18.3 years. There was a significant decrease in propofol and fentanyl utilization from 24 hours pretracheostomy to 24 hours posttracheostomy in both dose and number of patients receiving these continuous intravenous medications. Similarly, total morphine milligram equivalents (MME) use and continuous midazolam significantly decreased from 24 hours pretracheostomy to 24 hours posttracheostomy. By contrast, intermittent enteral quetiapine and methadone administration increased after tracheostomy. Importantly, Richmond Agitation-Sedation Scale, Glasgow Coma Scale, and Confusion Assessment Method scoring were also significantly improved as early as 24 hours posttracheostomy. Total MME use was significantly elevated in patients younger than 65 years and in male patients pretracheostomy compared with female patients. Patients admitted to the medical intensive care unit had significantly higher MME use compared with those in the surgical intensive care unit pretracheostomy.

CONCLUSION

Tracheostomy allows for a rapid and significant reduction in intravenous sedation and analgesia medication utilization. Posttracheostomy sedation can transition to intermittent enteral medications, potentially contributing to the observed improvements in postoperative mental status and agitation.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level III.
A combat casualty relevant dismounted complex blast injury model in swine
Authors: Cralley Alexis L. , Moore Ernest E. , Kissau Daniel , Coleman Julia R. , Vigneshwar Navin , DeBot Margot , Schaid Terry R. , Moore Hunter B. , Cohen Mitchell J. , Hansen Kirk , Silliman Christopher C. , Sauaia Angela , Fox Charles J.
Published: May 2022

BACKGROUND

Improvised explosive devices have resulted in a unique polytrauma injury pattern termed dismounted complex blast injury (DCBI), which is frequent in the modern military theater. Dismounted complex blast injury is characterized by extremity amputations, junctional vascular injury, and blast traumatic brain injury (bTBI). We developed a combat casualty relevant DCBI swine model, which combines hemorrhagic shock (HS) and tissue injury (TI) with a bTBI, to study interventions in this unique and devastating military injury pattern.

METHODS

A 50-kg male Yorkshire swine were randomized to the DCBI or SHAM group (instrumentation only). Those in the DCBI group were subjected to HS, TI, and bTBI. The blast injury was applied using a 55-psi shock tube wave. Tissue injury was created with bilateral open femur fractures. Hemorrhagic shock was induced by bleeding from femoral arteries to target pressure. A resuscitation protocol modified from the Tactical Combat Casualty Care guidelines simulated battlefield resuscitation for 240 minutes.

RESULTS

Eight swine underwent the DCBI model and five were allocated to the SHAM group. In the DCBI model the mean base excess achieved at the end of the HS shock was −8.57 ± 5.13 mmol·L−1. A significant coagulopathy was detected in the DCBI model as measured by prothrombin time (15.8 seconds DCBI vs. 12.86 seconds SHAM; p = 0.02) and thromboelastography maximum amplitude (68.5 mm DCBI vs. 78.3 mm in SHAM; p = 0.0003). For the DCBI models, intracranial pressure (ICP) increased by a mean of 13 mm Hg, reaching a final ICP of 24 ± 7.7 mm Hg.

CONCLUSION

We created a reproducible large animal model to study the combined effects of severe HS, TI, and bTBI on coagulation and ICP in the setting of DCBI, with significant translational applications for the care of military warfighters. Within the 4-hour observational period, the swine developed a consistent coagulopathy with a concurrent brain injury evidenced by increasing ICP.
Reading the signs in penetrating cervical vascular injuries: Analysis of hard/soft signs and initial management from a nationwide vascular trauma database
Authors: Marrotte Alexander , Calvo Richard Y. , Badiee Jayraan , Rooney Alexandra S. , Krzyzaniak Andrea , Sise Michael , Bansal Vishal , DuBose Joseph , Martin Matthew J. ,   the AAST PROOVIT Study Group
Published: May 2022

BACKGROUND

Algorithms for management of penetrating cervical vascular injuries (PCVIs) commonly call for immediate surgery with “hard signs” and imaging before intervention with “soft signs.” We sought to analyze the association between initial examination and subsequent evaluation and management approaches.

METHODS

Analysis of PCVIs from the American Association for the Surgery of Trauma Prospective Observational Vascular Injury Treatment vascular injury registry from 25 US trauma centers was performed. Patients were categorized by initial examination findings of hard signs or soft signs, and subsequent imaging and surgical exploration/repair rates were compared.

RESULTS

Of 232 PCVI patients, 110 (47%) had hard signs (hemorrhage, expanding hematoma, or ischemia) and 122 (53%) had soft signs. With hard signs, 61 (56%) had immediate operative exploration and 44% underwent computed tomography (CT) imaging. After CT, 20 (18%) required open surgical repair, and 7% had endovascular intervention. Of note, 21 (19%) required no operative intervention. A total of 122 patients (53%) had soft signs on initial examination; 37 (30%) had immediate surgery, and 85 (70%) underwent CT imaging. After CT, 9% had endovascular repair, 7% had open surgery, and 65 (53%) were observed. No difference in mortality was observed for hard signs patients undergoing operative management versus observation alone (23% vs. 17%, p = 0.6). Those with hemorrhage as the primary hard signs most often required surgery (76%), but no interventions were required in 19% of hemorrhage, 20% of ischemia, and 24% of expanding hematoma.

CONCLUSION

Although hard signs in PCVIs are associated with the need for operative intervention, initial CT imaging can facilitate endovascular options or nonoperative management in a significant subgroup. Hard signs should not be considered an absolute indication for immediate surgical exploration.

LEVEL OF EVIDENCE

Prognostic/Epidemiological; Level IV.
Prehospital factors predict outcomes in pediatric trauma: A principal component analysis
Authors: Ting Tiffany , Wakeman Derek S. , Arca Marjorie J. , Wilson Nicole A.
Published: May 2022

BACKGROUND

Trauma team activation leveling decisions are complex and based on many variables. Accurate triage decisions improve patient safety and resource utilization. Our purpose was to establish proof-of-concept for using principal component analysis (PCA) to identify multivariate predictors of injury severity and to assess their ability to predict outcomes in pediatric trauma patients. We hypothesized that we could identify significant principal components (PCs) among variables used for decisions regarding trauma team activation and that PC scores would be predictive of outcomes in pediatric trauma.

METHODS

We conducted a retrospective review of the trauma registry (January 2014 to December 2020) at our pediatric trauma center, including all pediatric patients (age <18 years) who triggered a trauma team activation. Data included patient demographics, prehospital report, Injury Severity Score, and outcomes. Four significant principal components were identified using PCA. Differences in outcome variables between the highest and lowest quartile for PC score were examined.

RESULTS

There were 1,090 pediatric patients included. The four significant PCs accounted for greater than 96% of the overall data variance. The first PC was a composite of prehospital Glasgow Coma Scale and Revised Trauma Score and was predictive of outcomes, including injury severity, length of stay, and mortality. The second PC was characterized primarily by prehospital systolic blood pressure and high PC scores were associated with increased length of stay. The third and fourth PCs were characterized by patient age and by prehospital Revised Trauma Score and systolic blood pressure, respectively.

CONCLUSION

We demonstrate that, using information available at the time of trauma team activation, PCA can be used to identify key predictors of patient outcome. While the ultimate goal is to create a machine learning-based predictive tool to support and improve clinical decision making, this study serves as a crucial step toward developing a deep understanding of the features of the model and their behavior with actual clinical data.

LEVEL OF EVIDENCE

Diagnostic Test or Criteria; Level III.
Determining resuscitation outcomes in combat casualties: Design of the Deployed Hemostatic Emergency Resuscitation of Traumatic Exsanguinating Shock (Deployed HEROES) study
Authors: Gurney Jennifer M. , Staudt Amanda M. , del Junco Deborah J. , Holcomb John , Martin Matthew , Spinella Phil , Trevino Jennifer D. , Corley Jason B. , Taylor Audra L. , Rohrer Andrew , Schreiber Martin , Cap Andrew
Published: May 2022

BACKGROUND

During the course of the recent conflicts, the recommendations for resuscitation practices have evolved, but there has been no comprehensive comparative effectiveness study of these resuscitation strategies. The objective of this study was to describe the development and study design of the Deployed Hemostatic Emergency Resuscitation of Traumatic Exsanguinating Shock (Deployed HEROES) study—the first comprehensive analysis of military resuscitation practices in the deployed environment from October 2001 to October 2019.

METHODS

This retrospective cohort study uses the Department of Defense Trauma Registry, Armed Services Blood Program database, and Military Trauma Mortality Review, while abstractors will use Theater Medical Data Store and Web Interface Patient Records to collect transfusion timing data. This study includes patients, who received blood products or died before receiving blood, treated at US military medical treatment facilities. The primary endpoints are survival at 6 hours, 24 hours, and 30 days postinjury. Secondary outcomes include infection, renal dysfunction, pulmonary dysfunction, and thromboembolic event. Exposure will be defined by blood product transfusion. Study groups will be frequency matched. Cox proportional hazards will compare patients who received warm fresh whole blood, low titer type-O whole blood, or only component therapy, while using adjustment for type of blood product transfused as a time-dependent covariate. Multilevel mixed-effects logistic regression will determine the effect of incompatible plasma in low titer type-O whole blood.

RESULTS

An analysis plan for the Deployed HEROES study was developed with the aim of minimizing bias.

CONCLUSION

This study will inform the optimal resuscitation strategies, which will potentially have a substantial impact on combat mortality. If whole blood is found to be the optimal transfusion strategy, this finding will be crucial in future operating environments involving dispersed medical assets. These results will provide critical information necessary for combat casualty care guidelines.

LEVEL OF EVIDENCE

Prognostic and epidemiological; Level III.
Management of the open abdomen: A systematic review with meta-analysis and practice management guideline from the Eastern Association for the Surgery of Trauma
Authors: Mahoney Eric J. , Bugaev Nikolay , Appelbaum Rachel , Goldenberg-Sandau Anna , Baltazar Gerard A. , Posluszny Joseph , Dultz Linda , Kartiko Susan , Kasotakis George , Como John , Klein Eric
Published: May 2022

BACKGROUND

Multiple techniques describe the management of the open abdomen (OA) and restoration of abdominal wall integrity after damage-control laparotomy (DCL). It is unclear which operative technique provides the best method of achieving primary myofascial closure at the index hospitalization.

METHODS

A writing group from the Eastern Association for the Surgery of Trauma performed a systematic review and meta-analysis of the current literature regarding OA management strategies in the adult population after DCL. The group sought to understand if fascial traction techniques or techniques to reduce visceral edema improved the outcomes in these patients. The Grading of Recommendations Assessment, Development and Evaluation methodology was utilized, meta-analyses were performed, and an evidence profile was generated.

RESULTS

Nineteen studies met inclusion criteria. Overall, the use of fascial traction techniques was associated with improved primary myofascial closure during the index admission (relative risk, 0.32) and fewer hernias (relative risk, 0.11.) The use of fascial traction techniques did not increase the risk of enterocutaneous fistula formation nor mortality. Techniques to reduce visceral edema may improve the rate of closure; however, these studies were very limited and suffered significant heterogeneity.

CONCLUSION

We conditionally recommend the use of a fascial traction system over routine care when treating a patient with an OA after DCL. This recommendation is based on the benefit of improved primary myofascial closure without worsening mortality or enterocutaneous fistula formation. We are unable to make any recommendations regarding techniques to reduce visceral edema.

LEVEL OF EVIDENCE

Systematic Review and Meta-Analysis; Level IV.
Blunt splenic injury in adults: Association between volumetric quantitative CT parameters and intervention
Authors: Dreizin David , Champ Kathryn , Dattwyler Matthew , Bodanapally Uttam , Smith Elana B. , Li Guang , Singh Rohan , Wang Ze , Liang Yuanyuan
Published: May 2022

Computed tomography volumetry of blunt splenic injury-related features predicts splenectomy and angioembolization in adults and identifies clinically important target features for computer vision and automation research.

BACKGROUND

Several ordinal grading systems are used in deciding whether to perform angioembolization (AE) or splenectomy following blunt splenic injury (BSI). The 2018 American Association for the Surgery of Trauma (AAST) Organ Injury Scale incorporates vascular lesions but not hemoperitoneum, which is considered in the Thompson classifier. Granular and verifiable quantitative measurements of these features may have a future role in facilitating objective decision making.

PURPOSE

The purpose of this study is to compare performance of computed tomography (CT) volumetry-based quantitative modeling to the 1994 and 2018 AAST Organ Injury Scale and Thompson classifier for the following endpoints: decision to perform splenectomy (SPY), and the composite of SPY or AE.

MATERIALS AND METHODS

Adult BSI patients (age ≥18 years) scanned with dual-phase CT prior to intervention at a single Level I trauma center from 2017 to 2019 were included in this retrospective study (n = 174). Scoring using 2018 AAST, 1994 AAST, and Thompson systems was performed retrospectively by two radiologists and arbitrated by a third. Endpoints included (1) SPY and (2) the composite of SPY or AE. Logistic regression models were developed from segmented active bleed, contained vascular lesion, splenic parenchymal disruption, and hemoperitoneum volumes. Area under the receiver operating characteristic curve (AUC) for ordinal systems and volumetric models were compared.

RESULTS

Forty-seven BSI patients (27%) underwent SPY, and 87 patients (50%) underwent SPY or AE. Quantitative model AUCs (0.85—SPY, 0.82—composite) were not significantly different from 2018 AAST AUCs (0.81, 0.88, p = 0.66, 0.14) for both endpoints and were significantly improved over Thompson scoring (0.76, p = 0.02; 0.77, p = 0.04).

CONCLUSION

Quantitative CT volumetry can be used to model intervention for BSI with accuracy comparable to 2018 AAST scoring and significantly higher than Thompson scoring.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level IV.
A de novo transcription-dependent TAD boundary underpins critical multiway interactions during antibody class switch recombination
Authors: Costea Julia , Schoeberl Ursula E. , Malzl Daniel , von der Linde Maximilian , Fitz Johanna , Makharova Marina , Goloborodko Anton , Pavri Rushad
Published: May 2022

Conflicts between transcription and cohesin-mediated loop extrusion can majorly influence 3D chromatin architecture but whether these structural changes affect biological function is unknown. Here, we show that a critical step in antibody class switch recombination (CSR) in activated B cells, namely, the juxtaposition (synapsis) of donor and acceptor switch (S) recombination sequences at the immunoglobulin heavy chain locus (Igh), occurs at the interface of a de novo topologically associating domain (TAD) boundary formed via transcriptional activity at acceptor S regions. Using Tri-C to capture higher-order multiway chromatin conformations, we find that synapsis occurs predominantly in the proximity of distal 3’ CTCF-binding sites and that this multiway conformation is abolished upon downregulation of transcription and loss of the TAD boundary at the acceptor S region. Thus, an insulating de novo TAD boundary created by the conflict between transcription and loop extrusion plays a direct role in the mechanism of CSR.
Decreased cerebral blood flow in non-hospitalized adults who self-isolated due to COVID-19
Authors: Kim William S.H. , Ji Xiang , Roudaia Eugenie , Chen J. Jean , Gilboa Asaf , Sekuler Allison , Gao Fuqiang , Lin Zhongmin , Jegatheesan Aravinthan , Masellis Mario , Goubran Maged , Rabin Jennifer S. , Lam Benjamin , Cheng Ivy , Fowler Robert , Heyn Chris , Black Sandra E. , Graham Simon J. , MacIntosh Bradley J.
Published: May 2022

The long-term consequences of coronavirus disease 2019 (COVID-19) on brain physiology and function are not yet well understood. From the recently described NeuroCOVID-19 study, we examined cerebral blood flow (CBF) in 50 participants recruited to one of two groups: 1) adults who previously self-isolated at home due to COVID-19 (n = 39; 116.5 ± 62.2 days since positive diagnosis), or 2) controls who experienced flu-like symptoms but had a negative COVID-19 diagnosis (n = 11). Participants underwent arterial spin labeling magnetic resonance imaging at 3 T to yield measures of CBF. Voxel-wise analyses of CBF were performed to assess for between-group differences, after controlling for age and sex. Relative to controls, the COVID-19 group exhibited decreased CBF in the thalamus, orbitofrontal cortex, and regions of the basal ganglia. Within the COVID-19 group, CBF differences in occipital and parietal regions were observed between those with (n = 11) and without (n = 28) self-reported on-going fatigue. These results suggest long-term changes in brain physiology in adults across the post-COVID-19 timeframe. Moreover, CBF may aid in understanding the heterogeneous symptoms of the post-COVID-19 condition. Future longitudinal studies are needed to further characterize the consequences of COVID-19 on the brain.
A quasi-experimental evaluation of a financial incentive for first-dose COVID-19 vaccination among adults aged ≥ 60 years in South Africa
Authors: Chetty-Makkan Candice M , Thirumurthy Harsha , Bair Elizabeth F , Bokolo Simamkele , Day Candy , Wapenaar Korstiaan , Werner Jesse , Long Lawrence , Maughan-Brown Brendan , Miot Jacqui , Pascoe Sophie J S , Buttenheim Alison M
Published: May 2022

Introduction

COVID-19 vaccination coverage in South Africa (RSA) remains low despite increased access to vaccines. On November 1, 2021, RSA introduced the Vooma Voucher program which provided a small guaranteed financial incentive, a Vooma Voucher redeemable at grocery stores, for COVID-19 vaccination among older adults, a population most vulnerable to serious illness, hospitalization, and death. However, the association of financial incentives with vaccination coverage remains unclear.

Methods

We evaluated the association of the conditional economic incentive program with first-dose vaccination rates among adults (aged ≥60 years) through a quasi-experimental cohort study. The Vooma Voucher program was a nationwide vaccination incentive program implemented for adults aged ≥60 years from November 1, 2021 to February 28, 2022. We ran interrupted time series models to evaluate the Vooma Voucher program at national and provincial levels. We used data between October 1, 2021 and November 27, 2021 in models estimated at the daily level. Individuals who received their first vaccine dose received a text message to access a ZAR100 ($∼7) voucher that was redeemable at grocery stores.

Results

The Vooma Voucher program was associated with a 7.15-12.01% increase in daily first-dose vaccinations in November 2021 compared to late October 2021. Overall, the incentive accounted for 6,476-10,874 additional first vaccine doses from November 1-27, 2021, or 8.31-13.95% of all doses administered to those aged ≥60 years during that period. This result is robust to the inclusion of controls for the number of active vaccine delivery sites and for the nationwide Vooma vaccination weekend initiative (November 12-14), both of which also increased vaccinations through expanded access to vaccines and demand creation activities.

Conclusions

Financial incentives for COVID-19 vaccination led to a modest increase in first dose vaccinations among older adults in RSA. Financial incentives and expanded access to vaccines may result in higher vaccination coverage.

Trial registration number (SANCTR)

DOH-27-012022-9116

Key points (3-5 sentences)

What is already known about this topic?

There is a lack of evidence on whether financial incentives for COVID-19 vaccinations are effective in low- and middle-income countries.

What does this study add?

We found that a ZAR100 (∼US$7) incentive for adults aged ≥60 years increased additional first vaccine doses between November 1-27, 2021 to those aged ≥60 years during that period.

How this study might affect research, practice or policy?

Small guaranteed financial incentives may be an effective strategy to increase vaccine demand among older adults in low- and middle-income countries.
The effects of topic familiarity on college students' learning search process
Authors: Chen Yijin , Qiu Yue , Lin Hanming , Zhao Yiming
Published: May 2022

Purpose

This study aims to explore the influence of topic familiarity on the four stages of college students' learning search process.

Design/methodology/approach

This study clarified the effects of topic familiarity on students' learning search process by conducting a simulation experiment based on query formulation, information item selection, information sources and learning output.

Findings

The results characterized users' interaction behaviors in increasing topic familiarity through their use of more task descriptions as queries, increased reformulation of queries, construction of more purposeful query formulation, reduced attention to a topic's basic concept content and increased exploration of academic platform contents.

Originality/value

This study proposed three innovative indicators which were proposed to evaluate the effects of topic familiarity on college students' learning search process, and the adopted metrics were useful for observing differences in college students' learning output as their topic familiarity increased. It contributes to the understanding of a user's search process and learning output to support the optimization function of learning-related information search systems and improve their effect on the user's search process for learning.