bluuebunny/crossref_metadata_2025 huggingface dataset:
Adipocytokine Profile Reveals Resistin Forming a Prognostic-Related Cytokine Network in the Acute Phase of Sepsis
Authors: Ebihara Takeshi , Matsumoto Hisatake , Matsubara Tsunehiro , Matsuura Hiroshi , Hirose Tomoya , Shimizu Kentaro , Ogura Hiroshi , Kang Sujin , Tanaka Toshio , Shimazu Takeshi
Published: February 2021

Introduction:

Cytokines compose a network and play crucial roles in the pathogenesis and prognosis of sepsis. Adipose tissue is an important immune endocrine organ that releases adipocytokines. This study aimed to evaluate adipocytokines in sepsis from a network perspective.

Materials and Methods:

This retrospective study of 37 patients with sepsis and 12 healthy controls was conducted from February 2014 to July 2015. Blood samples were collected from patients on days 1 (within 24 h of diagnosis), 2, 4, 6, 8, 11, and 15 and from healthy controls. Adipocytokines (adiponectin, leptin, resistin, chemerin, visfatin, vaspin, CXCL-12/SDF-1, angiotensinogen), inflammatory cytokines (IL-1β, IL-4, IL-6, IL-8, IL-10, IL-12/IL-23p40, TNF-α, monocyte chemotactic protein [MCP-1]), and plasminogen activator inhibitor-1 were measured. Acute Physiology and Chronic Health Evaluation II score was evaluated on day 1, and Sequential Organ Failure Assessment (SOFA) score and Japanese Association for Acute Medicine (JAAM) and International Society of Thrombosis and Hemostasis overt disseminated intravascular coagulation (DIC) scores were assessed at the times of blood sampling.

Results:

Hierarchical clustering analysis showed the cluster formed by resistin, IL-6, IL-8, MCP-1, and IL-10 on days 1, 2, and 4 represented the cytokine network throughout the acute phase of sepsis. Each cytokine in this network was significantly associated with SOFA and JAAM DIC scores over the acute phase. A Cox proportional hazards model focusing on the acute phase showed a significant relation of these five cytokines with patient prognosis.

Conclusions:

Adipocytokines and an inflammatory cytokine profile assessed over time in sepsis patients showed that resistin was involved in an inflammatory cytokine network including IL-6, IL-8, IL-10, and MCP-1 in the acute phase of sepsis, and this network was associated with severity and prognosis of sepsis.
Does Chloride Intake at the Early Phase of Septic Shock Resuscitation Impact on Renal Outcome?
Authors: Chapalain Xavier , Huet Olivier , Balzer Thibault , Delbove Agathe , Martino Frédéric , Jacquier Sophie , Egreteau Pierre-Yves , Darreau Cédric , Saint-Martin Marjorie , Lerolle Nicolas , Aubron Cécile
Published: February 2021

Introduction:

Fluid administration is one of the first lines of treatment for hemodynamic management of sepsis and septic shock. Studies investigating the effects of chloride-rich fluids including normal saline on renal function report controversial findings.

Methods:

This is a prospective, observational, multicenter study. Patients with septic shock, defined according to Sepsis-2 definition, were eligible. A “high-dose” of chloride was defined as a chloride intake greater than 18 g administrated within the first 48 h of septic shock management. The purpose of this study was to investigate the impact of cumulative chloride infusion within the first 48 h of septic shock resuscitation on acute kidney injury (AKI).

Results:

Two hundred thirty-nine patients with septic shock were included. Patients who received a “high-dose” of chloride had significantly higher Sequential Organ Failure Assessment score at the time of enrolment (P < 0.001). Cumulative chloride load was higher in patients requiring renal replacement therapy (RRT) (31.1 vs. 25.2 g/48 h; P < 0.005). Propensity score-weighted regression did not find any association between “high-dose” of chloride and AKI requiring RRT (OR: 0.97 [0.88–1.1]; P = 0.69). There was no association between “high-dose” of chloride and worsening kidney function at H48 (OR: 0.94 [0.83–1.1]; P = 0.42). There was also no association between “high-dose” of chloride and ICU length of stay (P = 0.61), 28-day mortality (P = 0.83), or hospital mortality (P = 0.89).

Conclusion:

At the early stage of resuscitation of critically ill patients with septic shock, administration of “high-dose” of chloride (> 18 g/48 h) was not associated with renal prognosis.
Hemorrhagic Shock and Resuscitation Causes Glycocalyx Shedding and Endothelial Oxidative Stress Preferentially in the Lung and Intestinal Vasculature
Authors: Abdullah Sarah , Karim Mardeen , Legendre Mark , Rodriguez Laura , Friedman Jessica , Cotton-Betteridge Aaron , Drury Robert , Packer Jacob , Guidry Chrissy , Duchesne Juan , Taghavi Sharven , Jackson-Weaver Olan
Published: February 2021

Introduction:

Hemorrhagic shock has recently been shown to cause shedding of a carbohydrate surface layer of endothelial cells known as the glycocalyx. This shedding of the glycocalyx is thought to be a mediator of the coagulopathy seen in trauma patients. Clinical studies have demonstrated increases in shed glycocalyx in the blood after trauma, and animal studies have measured glycocalyx disruption in blood vessels in the lung, skeletal muscle, and mesentery. However, no study has measured glycocalyx disruption across a wide range of vascular beds to quantify the primary locations of this shedding.

Methods:

In the present study, we used a rat model of hemorrhagic shock and resuscitation to more comprehensively assess glycocalyx disruption across a range of organs. Glycocalyx disruption was assessed by fluorescent-labeled wheat germ agglutinin or syndecan-1 antibody staining in flash frozen tissue.

Results:

We found that our model did elicit glycocalyx shedding, as assessed by an increase in plasma syndecan-1 levels. In tissue sections, we found that the greatest glycocalyx disruption occurred in vessels in the lung and intestine. Shedding to a lesser extent was observed in vessels of the brain, heart, and skeletal muscle. Liver vessel glycocalyx was unaffected, and kidney vessels, including the glomerular capillaries, displayed an increase in glycocalyx. We also measured reactive oxygen species (ROS) in the endothelial cells from these organs, and found that the greatest increase in ROS occurred in the two beds with the greatest glycocalyx shedding, the lungs, and intestine. We also detected fibrin deposition in lung vessels following hemorrhage-resuscitation.

Conclusions:

We conclude that the endothelium in the lungs and intestine are particularly susceptible to the oxidative stress of hemorrhage-resuscitation, as well as the resulting glycocalyx disruption. Thus, these two vessel beds may be important drivers of coagulopathy in trauma patients.
Using Motion Tracking to Analyze Forceps Paths During Simulated Forceps-Assisted Vaginal Deliveries
Authors: Bramblet Rachel , Altman Alan , Holbert Michael
Published: February 2021

Objective

The purpose of this study was to evaluate the ability of motion tracking to discern variation in forceps paths during standardized simulated forceps-assisted vaginal deliveries among experienced and inexperienced obstetric providers.

Methods

This is a pilot study involving 24 obstetrics and gynecology residents and 6 faculty at a single institution. Each participant was filmed performing standardized simulated forceps-assisted vaginal deliveries on a high-fidelity model. Motion tracking software (Kinovea, Medoc, France) was used to track the path of the forceps shank. Data were analyzed for total path length, total x-plane displacement, total y-plane displacement, and final forceps angle. One-way analysis of variance was used to evaluate for statistically significant differences between groups based on education year, with Turkey HSD post hoc test to identify interactions.

Results

Statistically significant differences were noted between groups in the total path length (F = 7.57, P < 0.001) and total y-plane displacement (F = 5.79, P < 0.001). On pairwise comparison, significant differences were noted between faculty and postgraduate year 1 as well as faculty and postgraduate year 2 for total y-plane displacement and total path length. Significant differences were not observed between groups for total x-plane displacement (F = 0.89, P = 0.475) and final forceps angle (F = 2.45, P = 0.052).

Conclusions

Motion tracking of standardized simulated forceps-assisted vaginal deliveries identifies statistically significant differences between experienced and inexperienced obstetric providers. Our findings suggest that motion tracking can be used to design an educational intervention to improve forceps technique among obstetrics and gynecology residents.
Simulation Use in Outreach Setting
Authors: Nader Marie , Tasdelen-Teker Gulsen , DeStephens Anthony J. , Lampotang Samsun , Prelipcean Irina , Smith Robert D. , Bortcosh William H. , Chiriboga Salazar Nicolas R. , Martinez Schlurmann Natalia I. , Hamdan Usama S. , Munoz Pareja Jennifer M.
Published: February 2021

Summary Statement

Simulation is a well-studied teaching tool for multidisciplinary teamwork, crisis resource management, and communication skills. These attributes are essential for successful international medical missions, which include healthcare providers with different familiarities with the outreach environment and each team member's role. However, immersive simulation remains underused in similar settings. Our team designed a simulation-based curriculum that focuses on multidisciplinary teamwork and crisis resource management skills. In this commentary, we describe its implementation during high-risk cleft care outreach missions conducted by the Global Smile Foundation. We discuss the importance of a simple, feasible, and flexible platform to successfully overcome the limitations of time and resources inherent to outreach mission work while addressing the clinical and geographic needs specific to each site. We highlight challenges, including unpredictability of the outreach environment, a language barrier, and the short duration of missions. Finally, we offer a roadmap for groups involved in similar global health efforts.
Learning Curves of Ivor Lewis Totally Minimally Invasive Esophagectomy by Hospital and Surgeon Characteristics
Authors: Claassen Linda , Hannink Gerjon , Luyer Misha D. P. , Ainsworth Alan P. , van Berge Henegouwen Mark I. , Cheong Edward , Daams Freek , van Det Marc J. , van Duijvendijk Peter , Gisbertz Suzanne S. , Gutschow Christian A. , Heisterkamp Joos , Kauppi Juha T. , Klarenbeek Bastiaan R. , Kouwenhoven Ewout A. , Langenhoff Barbara S. , Larsen Michael H. , Martijnse Ingrid S. , Nieuwenhoven Ernst Jan van , van der Peet Donald L. , Pierie Jean-Pierre E. N. , Pierik Robert E. G. J. M. , Polat Fatih , Räsänen Jari V. , Rouvelas Ioannis , Sosef Meindert N. , Wassenaar Eelco B. , Wildenberg Frits J. H. van den , van der Zaag Edwin S. , Nilsson Magnus , Nieuwenhuijzen Grard A. P. , van Workum Frans , Rosman Camiel
Published: February 2021

Objective:

To describe the pooled learning curves of Ivor Lewis totally minimally invasive esophagectomy (TMIE) in hospitals stratified by predefined hospital- and surgeon-related factors.

Background:

Ivor Lewis (TMIE is known to have a long learning curve which is associated with considerable learning associated morbidity. It is unknown whether hospital and surgeon characteristics are associated with more efficient learning.

Methods:

A retrospective analysis of prospectively collected data of consecutive Ivor Lewis TMIE patients in 14 European hospitals was performed. Outcome parameters used as proxy for efficient learning were learning curve length, learning associated morbidity, and the plateau level regarding anastomotic leakage and textbook outcome. Pooled incidences were plotted for the factor-based subgroups using generalized additive models and 2-phase models. Casemix predicted outcomes were plotted and compared with observed outcomes. The investigated factors included annual volume, TMIE experience, clinic visits, courses and fellowships followed, and proctor supervision.

Results:

This study included 2121 patients. The length of the learning curve was shorter for centers with an annual volume >50 compared to centers with an annual volume <50. Analysis with an annual volume cut-off of 30 cases showed similar but less pronounced results. No outcomes suggesting more efficient learning were found for longer experience as consultant, visiting an expert clinic, completing a minimally invasive esophagectomy fellowship or implementation under proctor supervision.

Conclusions:

More efficient learning was observed in centers with higher annual volume. Visiting an expert clinic, completing a fellowship, or implementation under a proctor's supervision were not associated with more efficient learning.
Symptom Assessment Following Surgery for Lung Cancer
Authors: Hirpara Dhruvin H. , Coburn Natalie G. , Darling Gail E. , Kidane Biniam , Rousseau Mathieu , Gupta Vaibhav , Doherty Mark , Zuk Victoria , Delibasic Victoria , Chan Wing , Hallet Julie
Published: February 2021

Objective:

To conduct a population-level analysis of temporal trends and risk factors for high symptom burden in patients receiving surgery for non-small cell lung cancer (NSCLC).

Background:

A population-level overview of symptoms after curative intent surgery is necessary to inform decision making and supportive care for patients with lung cancer.

Methods:

Retrospective cohort study of patients receiving surgery for stages I to III NSCLC between January 2007 and September 2018. Prospectively collection Edmonton Symptom Assessment System (ESAS) scores, linked to provincial administrative data, were used to describe the prevalence, trajectory, and predictors of moderate-to-severe symptoms in the year following surgery.

Results:

A total of 5350 patients, with 28,490 unique ESAS assessments, were included in the analysis. Moderate-to-severe tiredness (68%), poor wellbeing (63%), and shortness of breath (60%) were the most common symptoms reported. The rise and fall in the proportion of patients experiencing moderate-to-severe symptoms after surgery coincided with the median time to first (58 days, interquartile range: 47–72) and last cycle of chemotherapy (140 days, interquartile range: 118–168), respectively. There was eventual stabilization, albeit above the preoperative baseline, within 6 to 7 months after surgery. Female sex (relative risk [RR] 1.09– 1.26), lower income (RR 1.08–1.23), stage III disease (RR 1.15-1.43), adjuvant therapy (RR 1.09–1.42), chemotherapy within 2 weeks of an ESAS assessment (RR 1.14–1.73), and pneumonectomy (RR 1.05–1.15) were associated with moderate-to-severe symptoms following surgery.

Conclusions:

Knowledge of population-level prevalence, trajectory, and predictors of moderate-to-severe symptoms after surgery for NSCLC can be used to facilitate shared decision making and improve symptom management throughout the course of illness.
Impact of Obesity on Surgical Outcomes of Laparoscopic Appendectomy: Lessons Learned From 2000 Cases in an Urban Teaching Hospital
Authors: Angeramo Cristian A. , Laxague Francisco , Castagnino Bruno , Sadava Emmanuel E. , Schlottmann Francisco
Published: February 2021

Background:

As the prevalence of obesity continues to increase worldwide, we aimed to determine the surgical outcomes of obese patients with acute appendicitis undergoing laparoscopic appendectomy (LA).

Materials and Methods:

A retrospective analysis of patients undergoing LA during the period 2006 to 2019 was performed. The cohort was divided into 2 groups: G1, patients with body mass index ≥30 kg/m2 and G2: patients with body mass index <30 kg/m2.

Results:

A total of 2009 LA were performed; 114 (6%) were included in G1 and 1895 (94%) in G2. Complicated acute appendicitis rate (G1: 39% vs. G2: 20%, P<0.0001), conversion rates (G1: 12% vs. 1.69%, P<0.0001), overall 30-day morbidity rates (G1: 27% vs. G2: 14%, P=0.0001), and postoperative intra-abdominal abscess rates (G1: 8% vs. (2%), P<0.0001) were higher in obese patients. Furthermore, obesity was an independent risk factor for overall morbidity, postoperative intra-abdominal abscess, and conversion to open surgery.

Conclusion:

In obese patients, LA had inferior clinical outcomes compared with nonobese patients.
Utilization of a Mirror During Pelvic Examinations: Does it Improve the Patient’s Experience?
Authors: Tam Tiffanie , Crisp Catrina C. , Hill Austin M. , Aldrich Emily , Ghodsi Vivian , Yook Eunsun , Yeung Jennifer , Pauls Rachel N.
Published: February 2021

Objective

This study was conducted to assess the utility of a mirror in improving pain and vulnerability during a pelvic examination.

Methods

In this prospective, institutional review board-approved, 2-cohort trial, all “new” patients presenting to a urogynecology office were offered to have a mirror or no-mirror present during their pelvic examination. Patients completed 100-mm visual analog scales regarding pain, anxiety, knowledge, control, embarrassment, and vulnerability before and after examination. The primary outcome was difference in level of pain and vulnerability between groups. Secondary outcomes included comparisons from baseline to postexamination scores within groups, patient satisfaction, and examination duration. A sample size of 68 participants in each arm was planned.

Results

From April 2019 to May 2020, 147 participants were enrolled. Two participants were excluded, 145 were included in the final analysis; 74 in the no-mirror group and 71 in the mirror group. The average age was 55.9 (±13) years, and the groups were overall similar. There was no difference in primary outcomes of pain or vulnerability, but the mirror group showed improved levels of control (P = 0.006) and knowledge (P = 0.018) following examination. All participants reported high satisfaction, and those that selected a mirror reported strong preference for future use.

Conclusions

Patients who chose to use the mirror did not demonstrate a difference in pain or vulnerability scores; however, they exhibited benefit to their sense of control and knowledge after the pelvic examination. Although the mirror did not benefit all patients, this is a simple option that could improve the examination experience for some.

Clinical Trial Registration:
ClinicalTrials.gov, NCT03785548
Twice-Daily Nitrofurantoin Administration Following Short-term Transurethral Catheterization After Pelvic Reconstructive Surgery: A Randomized Clinical Trial
Authors: Bastawros Dina , Kaczmarski Kelley , Zhao Jing , Bender Ryan , Myers Erinn , Tarr Megan E.
Published: February 2021

Objective

The objective of this study was to evaluate if twice-daily nitrofurantoin for 5 days after discontinuation of transurethral catheterization decreases the rate of urinary tract infection (UTI) in women with postoperative urinary retention (POUR) after pelvic reconstructive surgery.

Methods

This was a double-blind, placebo-controlled, randomized trial conducted across 2 clinical sites between October 2017 and April 2019. Women with acute POUR after pelvic reconstructive surgery were included and randomized to nitrofurantoin (100 mg) or placebo twice-daily for 5 days. The primary outcome was clinically suspected UTI (defined as dysuria, frequency, and irritation in the absence of vaginal discharge) and/or culture-proven UTI (defined as greater than 105 colony forming units of a single organism) within 30 days of surgery. Secondary outcomes included evaluation of adverse events related to study medication and medication adherence.

Results

Data from 164 participants were eligible for intention-to-treat analysis (nitrofurantoin, n = 82; placebo, n = 82). There were no significant demographic or intraoperative differences except for body mass index and race. Median duration of catheterization was 3 days (interquartile range, 2–5 days, P = 0.12). Fifteen women in the nitrofurantoin group and 14 women in the placebo group experienced UTI within 30 days (18.3% vs 17.1%; P = 0.84; odds ratio, 1.09; 95% confidence interval, 0.49–2.43). There were no study medication allergies; however, nausea was the most common intolerance. Most women in each group completed the study drug treatment (91.5% vs 86.4%, P = 0.30).

Conclusions

Nitrofurantoin prophylaxis after transurethral catheter removal did not reduce the risk of UTI in women with acute POUR after pelvic reconstructive surgery.
A Randomized Controlled Trial Assessing the Impact of Opioid-Specific Patient Counseling on Opioid Consumption and Disposal After Reconstructive Pelvic Surgery
Authors: Buono Kristen , Whitcomb Emily , Guaderrama Noelani , Lee Elizabeth , Ihara Jun , Sudol Neha , Lane Felicia , Lee Jennifer , Heliker Bhumy Davé , Brueseke Taylor
Published: February 2021

Objectives

This study aims to determine the effect of opioid-specific counseling on postdischarge opioid consumption and opioid storage/disposal patterns after reconstructive pelvic surgery.

Methods

In this multicenter randomized-controlled trial, participants were randomized to standard generalized counseling or opioid-specific perioperative counseling. Opioid-specific counseling was provided at the preoperative and 2-week postoperative visits with educational handouts about the risks of opioids and U.S. Food and Drug Administration recommendations for appropriate opioid storage and disposal. The primary outcome was morphine milligram equivalent (MME) consumption between hospital discharge and 2 weeks postoperatively. Secondary outcomes included opioid storage 2 weeks postoperatively, opioid disposal 6 weeks postoperatively, and rate of opioid refills.

Results

Among 70 opioid-specific and 65 standard counseling participants, there were no significant differences in demographic characteristics, type of surgery, concomitant hysterectomy, or perioperative complications. For the primary outcome, there was no significant difference in median opioid consumption between the 2 arms. Median (interquartile range) postdischarge MME consumption for all participants was 15 mg (0–75). Forty percent of participants denied postdischarge MME consumption. For secondary outcomes, there were no significant differences in appropriate opioid storage between groups. The appropriate disposal rate of unused opioid tablets 6 weeks after surgery was higher among participants who received opioid-specific counseling. The rate of opioid refill was 7.4%.

Conclusions

Opioid-specific counseling did not affect postdischarge consumption but increased the disposal rate of unused opioid tablets 6 weeks postoperatively. Opioid-specific counseling could minimize the potential for opioid misuse by reducing the number of unused opioid tablets in patients’ possession after surgery.
Preoperative Counseling Method and Postoperative Opioid Usage: A Secondary Analysis of the PREOP Study
Authors: Sassani Jessica C. , Artsen Amanda M. , Grosse Philip J. , Baranski Lindsey , Kunkle Lauren , Ackenbom Mary F.
Published: February 2021

Objective

The purpose of this analysis is to determine if postoperative opioid usage differs among women randomized to office or phone preoperative counseling for pelvic organ prolapse surgery.

Methods

This was a planned exploratory analysis of the Patient Preparedness for Pelvic Organ Prolapse Surgery study, which randomized women to standardized preoperative counseling by office visit or phone call before prolapse surgery. Inclusion criteria were the completion of the assigned counseling intervention and submission of a 7-day postoperative pain and medication diary. Multivariable logistic regression was done to assess the association between counseling method and total opioid use while controlling for variables significant on univariate analysis (surgery type and county of residence).

Results

There were 84 participants with postoperative data (41 office, 43 phone). Median total number of 5-mg oxycodone tablets used was higher for the office group (5 [interquartile range, 0–10]) than the phone group (0 [interquartile range, 0–2], P = 0.002). On multivariable logistic regression, women who underwent phone counseling were less likely to be in the highest third of opioid use when controlling for surgery type and county of residence (odds ratio, 0.23; P = 0.012; 95% confidence interval, 0.07–0.72). Daily pain scores and nonopioid medication use (nonsteroidal anti-inflammatory medications and acetaminophen) were similar between groups (P > 0.05).

Conclusions

Despite similar pain scores, women who received preoperative phone counseling before pelvic organ prolapse surgery had lower opioid utilization than those with office counseling. Further research is needed to determine the optimal method of preoperative counseling and its role in postoperative pain management.
Racial Distribution and Characterization of Pelvic Organ Prolapse in a Hospital-Based Subspecialty Clinic
Authors: Brito Katherine S. , Madueke-Laveaux Obianuju Sandra , Glass Dianne , Hellman Kevin M. , Gao Guimin , Iyer Shilpa
Published: February 2021

Objectives

Prior literature has suggested a decreased prevalence of pelvic organ prolapse (POP) in Black women. We sought to describe POP rates by race, investigate whether specific types of prolapse differ based on race, and investigate the role of uterine weight and fibroids on POP.

Methods

We conducted a retrospective cohort study of new patients seen between April 2017 and April 2019 at a tertiary urogynecology clinic. Variables collected included POP quantification, race, age, smoking history, medical history, gravity, parity, vaginal delivery, hysterectomy, fibroids, and uterine weight. χ2 tests were used to compare the proportions of types of POP between Black and non-Black women. Binary and ordinal logistic regression tested the association between types of prolapse and race, adjusting for covariates.

Results

Nine hundred thirty-six patients were identified by ICD codes, 768 met inclusion criteria. There were 85.3% of the women identified as non-Black and 14.7% identified as Black. There were 39.8% of the Black women that had a fibroid diagnosis compared with 20.8% of non-Black women (P < 0.001). Black women had a higher median uterine weight, 112.2 g versus 56 g (P = 0.002), and median fibroid size, 3.4 cm versus 1.92 cm (P = 0.0001). 56.9% of women presented with anterior prolapse. No difference was found in POP type between Black and non-Black women after adjusting for age, body mass index, parity, and delivery route (P = 0.45).

Conclusions

Black women had increased body mass index, rates of comorbidities (diabetes and hypertension), higher uterine weight and fibroid size than non-Black women in our study. However, there was no significant difference in POP type based on race.
Impact of Repeat Dosing and Mesh Exposure Chronicity on Exosome-Induced Vaginal Tissue Regeneration in a Porcine Mesh Exposure Model
Authors: Kisby Cassandra K. , Shadrin Ilya Y. , Peng Lillian T. , Stalboerger Paul G. , Trabuco Emanuel C. , Behfar Atta , Occhino John A.
Published: February 2021

Objective

The aim of the study was to compare vaginal wound healing after exosome injection in a porcine mesh exposure model with (1) single versus multiple dose regimens and (2) acute versus subacute exposure.

Methods

Six 80-kg Yorkshire-crossed swine each had 2 polypropylene meshes implanted to create the vaginal mesh exposure model. Animals were divided into 3 groups based on number and timing of exosome injection: (1) single purified exosome product (PEP) injection (acute-single), (2) weekly PEP injections (acute-weekly, 4 total injections), and (3) delayed single injection (subacute-single). Acute and subacute injections occurred 1 and 8 weeks after mesh implantation, respectively. EdU, a thymidine analog, was given twice weekly after the first injection to track tissue regeneration. Euthanasia and tissue analysis occurred 4 weeks after the first injection. ImageJ was used to quantify epithelial thickness, cellular proliferation, and capillary density. Statistical analysis was performed using analysis of variance and post hoc Tukey test.

Results

Acute-single PEP injection tissues mirrored pilot study results, validating replication of protocol. Within the acute groups, weekly dosing resulted in 1.5× higher epithelial thickness (nonsignificant), 1.8× higher epithelial proliferation (P < 0.05), and 1.5× higher regenerated capillary density (P < 0.05) compared with single injection. Regarding chronicity of the exposure, the subacute group showed 1.7× higher epithelial proliferation (nonsignificant) and similar capillary density and epithelial thickness as compared with the acute group.

Conclusions

Exosome redosing resulted in significantly greater epithelial proliferation with significantly higher regenerated capillary density, leading to a trend toward thicker epithelium. Subacute exposure exhibited similar regeneration to acute exposure despite a delayed injection timeline. These results contribute to a growing body of preclinical research demonstrating utility of exosomes in pelvic floor disorders.
Postoperative Pain and Urinary Retention After Vaginal Reconstructive Surgery
Authors: Yadav Menaka , Patel Kunal , Turrentine Mark A. , Orejuela Francisco , Jackson Elisha , Kilpatrick Charles
Published: February 2021

Objective

The objective of this study was to evaluate the effect of patients’ immediate prevoiding pain level after vaginal pelvic reconstructive surgery on their ability to void.

Methods

We conducted a retrospective cohort study of women with and without urinary retention after urogynecologic procedures. Postoperative pain, measured by a visual analog scale, was recorded for each patient before a voiding trial. Demographic, surgical characteristics, prevoiding trial pain, and rate of postoperative urinary retention were compared. Multiple-logistic regression analysis was used with all analyses controlled for univariate variables with a P value of ≤0.1 to estimate adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Two-tailed tests were used, with P < 0.05.

Results

A total of 458 patients were identified, of which 21% (97/458) failed their voiding trial. In our study, 62% (284/458) of women had a voiding trial on postoperative day 1, and 38% (174/458) underwent a same-day voiding trial. No differences were noted between groups comparing race, ethnicity, hysterectomy, urinary sling, estimated surgical blood loss, utilization of intraoperative or postoperative narcotics, or the proportion of same-day voiding trials. Women with postoperative urinary retention had higher mean prevoiding pain when compared with women without urinary retention (pain visual analog scale, 25 mm vs 12 mm [P < 0.001], respectively). After multiple-logistic regression analysis, a significant association between postoperative urinary retention persisted for prevoiding trial pain score (aOR, 1.02; 95% CI, 1.01–1.03), age (aOR, 1.05; 95% CI, 1.02–1.02), and anterior colporrhaphy (aOR, 2.13; 95% CI, 1.18–3.8).

Conclusions

Prevoiding pain after pelvic surgery is significantly associated with increased rates of postoperative urinary retention.
Comparison of 100 U With 200 U of Intradetrusor OnabotulinumToxinA for Nonneurogenic Urgency Incontinence
Authors: Hendrickson Whitney K. , Amundsen Cindy L. , Rahn David D. , Meyer Isuzu , Bradley Megan S. , Smith Ariana L. , Myers Deborah L. , Jelovsek J. Eric , Lukacz Emily S.
Published: February 2021

Objectives

The objective of this study was to compare efficacy and adverse events between 100 U and 200 U of onabotulinumtoxinA for 6 months in women with nonneurogenic urgency incontinence.

Methods

This is a secondary analysis of 2 multicenter randomized controlled trials assessing efficacy of onabotulinumtoxinA in women with nonneurogenic urgency incontinence; one compared 100 U to anticholinergics and the other 200 U to sacral neuromodulation. Of 307 women who received onabotulinumtoxinA injections, 118 received 100 U, and 189 received 200 U. The primary outcome was mean adjusted change in daily urgency incontinence episodes from baseline over 6 months, measured on monthly bladder diaries. Secondary outcomes included perceived improvement, quality of life, and adverse events. The primary outcome was assessed via a multivariate linear mixed model.

Results

Women receiving 200 U had a lower mean reduction in urgency incontinence episodes by 6 months compared with 100 U (−3.65 vs −4.28 episodes per day; mean difference, 0.63 episodes per day [95% confidence interval (CI), 0.05–1.20]). Women receiving 200 U had lower perceptions of improvement (adjusted odds ratio, 0.32 [95% CI, 0.14–0.75]) and smaller improvement in severity score (adjusted mean difference, 12.0 [95% CI, 5.63–18.37]). Upon subanalysis of only women who were treated with prior anticholinergic medications, these differences between onabotulinumtoxinA doses were no longer statistically significant. There was no statistically significant difference in adverse events in women receiving 200 U (catheterization, 32% vs 23%; adjusted odds ratio, 1.4 [95% CI, 0.8–2.4]; urinary tract infection, 37% vs 27%; adjusted odds ratio, 1.5 [95% CI, 0.9–2.6]).

Conclusions

A higher dose of onabotulinumtoxinA may not directly result in improved outcomes, but rather baseline disease severity may be a more important prediction of outcomes.
The Influence of Patients’ Goals on Surgical Satisfaction
Authors: Gillingham Akira , Collins Sarah A. , Kenton Kimberly , Bretschneider C. Emi , Lewicky-Gaupp Christina , Mueller Margaret G. , Brown Oluwateniola , Mou Tsung , Geynisman-Tan Julia
Published: February 2021

Objective

The objectives of this study were to describe patients’ surgical goals and determine if goal attainment is associated with postoperative satisfaction and regret.

Methods

Women undergoing surgery for pelvic floor disorders between June and December 2019 were recruited. At their initial visit, patients listed up to 4 surgical goals. Three months after surgery, patients completed the Pelvic Floor Distress Inventory, Patient Global Impression of Improvement, Satisfaction with Decision Scale, and Decision Regret Scale. They were also shown their initial goals and asked, “Did you achieve this goal by having surgery?” Women who achieved all goals were designated “goal achievers,” and those who did not achieve even 1 goal were “goal nonachievers” (GNAs).

Results

Ninety-nine patients listed a median of 1 (range, 1–4) goals. Goals were categorized as follows: symptom improvement (52%), treatment achievement (23%), lifestyle improvement (17%), and information gathering (6%). Ninety-one percent of patients were goal achievers, and 9% were GNAs. Goal achievers had higher Satisfaction with Decision Scale scores (5.0 [4.7–5.0] vs 4.0 [3.8–4.8], P = 0.002), lower Decision Regret Scale scores (1.0 [1.0–1.4] vs 2.0 [1.1–2.7], P = 0.001), and better Patient Global Impression of Improvement scores (1.0 [1.0–2.0] vs 2.0 [1.0–4.0], P = 0.004). In prolapse surgery patients, postoperative Pelvic Floor Distress Inventory scores were similar; however, GNAs had higher postoperative Urinary Distress Inventory scores (17.0 ± 18.0 vs 45.8 ± 20.8, P = 0.01).

Conclusions

Ninety-one percent of women achieved their presurgical goals, the most common being symptom relief. Goal achievers have higher satisfaction and less regret; however, those with worsening or de novo urinary symptoms are more likely to be GNAs and be unsatisfied.
Post-traumatic brain injury antithrombin III recovers Morris water maze cognitive performance, improving cued and spatial learning
Authors: ElSaadani Mohamed , Ahmed Syed M. , Jacovides Christina , Lopez Alfonso , Johnson Victoria E. , Kaplan Lewis J. , Smith Douglas H. , Pascual Jose L.
Published: February 2021

BACKGROUND

Neuroinflammation and cerebral edema development following severe traumatic brain injury (TBI) affect subsequent cognitive recovery. Independent of its anticoagulant effects, antithrombin III (AT-III) has been shown to block neurovascular inflammation after severe TBI, reduce cerebral endothelial-leukocyte interactions, and decrease blood-brain barrier permeability. We hypothesized that AT-III administration after TBI would improve post-TBI cognitive recovery, specifically enhancing learning, and memory.

METHODS

Fifteen CD1 male mice were randomized to undergo severe TBI (controlled cortical impact [CCI]: velocity, 6 m/s; depth, 1 mm; diameter, 3 mm) or sham craniotomy and received either intravenous AT-III (250 IU/kg) or vehicle (VEH/saline) 15 minutes and 24 hours post-TBI. Animals underwent Morris water maze testing from 6 to 14 days postinjury consisting of cued learning trials (platform visible), spatial learning trials (platform invisible, spatial cues present), and probe (memory) trials (platform removed, spatial cues present). Intergroup differences were assessed by the Kruskal-Wallis test (p < 0.05).

RESULTS

Morris water maze testing demonstrated that cumulative cued learning (overall mean time in seconds to reach the platform on days 6–8) was worst in CCI-VEH animals (26.1 ± 2.4 seconds) compared with CCI–AT-III counterparts (20.3 ± 2.1 seconds, p < 0.01). Cumulative noncued spatial learning was also worst in the CCI-VEH group (23.4 ± 1.8 seconds) but improved with AT-III (17.6 ± 1.5 seconds, p < 0.01). In probe trials, AT-III failed to significantly improve memory ability. Animals that underwent sham craniotomy demonstrated preserved learning and memory compared with all CCI counterparts (p < 0.05).

CONCLUSION

Antithrombin III improves neurocognitive recovery weeks after TBI. This improvement is particularly related to improvement in learning but not memory function. Pharmacologic support of enhanced learning may support new skill acquisition or relearning to improve outcomes after TBI.

LEVEL OF EVIDENCE

Therapeutic/care management, level II.
Never-frozen liquid plasma transfusion in civilian trauma: a nationwide propensity-matched analysis
Authors: Chehab Mohamad , Ditillo Michael , Obaid Omar , Nelson Adam , Poppe Brandon , Douglas Molly , Anand Tanya , Bible Letitia , Joseph Bellal
Published: February 2021

BACKGROUND

Never-frozen liquid plasma (LQP) was found to reduce component waste, decrease health care expenses, and have a superior hemostatic profile compared with fresh frozen plasma (FFP). Although transfusing LQP in hemorrhaging patients has become more common, its clinical effectiveness remains to be explored. This study aims to examine outcomes of trauma patients transfused with LQP compared with thawed FFP.

METHODS

Adult (≥18 years) trauma patients receiving early (≤4 hours) plasma transfusions were identified in the Trauma Quality Improvement Program 2017. Patients were stratified into those receiving LQP versus FFP. Propensity-score matching in a 1:2 ratio was performed. Primary outcome measures were mortality and time to first plasma unit transfusion. Secondary outcome measures were major complications and hospital length of stay.

RESULTS

A total of 107 adult trauma patients receiving LQP were matched to 214 patients receiving FFP. Mean age was 48 ± 19 years, 73% were male, and median Injury Severity Score was 27 [23–41]. A total of 42% of patients were in shock, 22% had penetrating injuries, and 31% required surgical intervention for hemorrhage control. Patients received a median of 4 [2–6] units of PRBC, 2 [1,3] units of LQP or FFP, and 1 [0–1] unit of platelets. The median time to the first LQP unit transfused was significantly shorter compared with the first FFP unit transfused (54 [28–79] minutes vs. 98 [59–133] minutes; p < 0.001). Rates of 24-hour mortality (2.8% vs. 3.7%; p = 0.664) and in-hospital mortality (16.8% vs. 20.1%; p = 0.481) were not different between the LQP and FFP groups. Similarly, there was no difference in major complications (15.9% vs. 21.5%; p = 0.233) and hospital length of stay (12 [6–21] vs. 12 [6–23] days; p = 0.826).

CONCLUSION

Never-frozen liquid plasma is safe and effective in resuscitating trauma patients. Never-frozen liquid plasma has the potential to expand our transfusion armamentarium given its longer storage time and immediate availability.

LEVEL OF EVIDENCE

Therapeutic, Level IV.
Genome-wide landscape of mRNAs, microRNAs, lncRNAs, and circRNAs in hemorrhagic shock-induced ALI/ARDS in rats
Authors: Wang Zhiwei , Chang Panpan , Ye Jingjing , Ma Wei , Zhou Jing , Zhang Peng , Chen Xiaokun , Jia Bo , Zheng Ming , Huang Wei , Wang Tianbing
Published: February 2021

BACKGROUND

Hemorrhagic shock (HS) can develop into multiple organ dysfunction syndrome, among which acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) usually lead to poor outcomes. The underlying molecular mechanisms of HS-induced ALI/ARDS remain unclear. This study sought to investigate gene expression profiles and predict competing endogenous RNA (ceRNA) regulatory networks in an HS-induced ALI/ARDS preclinical model.

METHODS

Sprague Dawley rats were subjected to a fixed volume of hemorrhage (HS, 40% estimated total blood volume) or not (sham) randomly. After 8 hours of observation, left lung tissue was harvested to evaluate lung injury. Right lung was collected for RNA sequencing. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway analyses were performed and the long noncoding RNA (lncRNA)/circular RNA (circRNA)-microRNA (miRNA)-messenger RNA (mRNA) linkages were predicted using the ceRNA theory. Quantitative real-time polymerase chain reaction was used to validate the RNA sequencing findings.

RESULTS

Hemorrhagic shock lungs showed noticeable ALI/ARDS features, and 437 mRNAs, 31 miRNAs, 734 lncRNAs, and 29 circRNAs were differentially expressed. In Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway analyses, the differentially expressed transcripts were enriched in the following terms: the metabolic pathways, signal transduction pathways, necroptosis, DNA damage recognition and repair, inflammatory cell migration and chemotaxis, the NOD-like receptor signaling pathway, the Janus kinase/signal transducer and activator of transcription signaling pathway, the mitogen-activated protein kinase signaling pathway, the phosphatidylinositol-3-kinase/protein kinase B signaling pathway, and so on. Also, this study identified lncRNA-miRNA-mRNA linkages with 12 lncRNAs, 5 miRNAs, 15 mRNAs, and circRNA-miRNA-mRNA linkages with 10 circRNAs, 16 miRNAs, 39 mRNAs. These networks might play important regulatory roles.

CONCLUSION

This is the first high-throughput analysis of gene expression profiles in HS-induced ALI/ARDS. It shows that metabolism, cell signaling, DNA damage and repair, and necroptosis-related RNAs altered, and inflammatory response-associated RNAs and pathways have pivotal roles in HS-induced ALI/ARDS progression. It also prompts some important RNAs and regulatory networks for future research.

LEVEL OF EVIDENCE

Basic science article.
Field-Triage, Hospital-Triage and Triage-Assessment: A Literature Review of the Current Phases of Adult Trauma Triage
Authors: Morris Rachel S. , Karam Basil S. , Murphy Patrick B. , Jenkins Peter , Milia David J. , Hemmila Mark R. , Haines Krista L. , Puzio Thaddeus J. , de Moya Marc A. , Tignanelli Christopher J.
Published: February 2021

Despite major improvements in the United States trauma system over the past two decades, prehospital trauma triage is a significant challenge. Undertriage is associated with increased mortality, and overtriage results in significant resource overuse. The American College of Surgeons Committee on Trauma benchmarks for undertriage and overtriage are not being met. Many barriers to appropriate field triage exist, including lack of a formal definition for major trauma, absence of a simple and widely applicable triage mode, and emergency medical service adherence to triage protocols. Modern trauma triage systems should ideally be based on the need for intervention rather than injury severity. Future studies should focus on identifying the ideal definition for major trauma and creating triage models that can be easily deployed. This narrative review article presents challenges and potential solutions for prehospital trauma triage.
Blunt cerebrovascular injuries: Outcomes from the American Association for the Surgery of Trauma PROspective Observational Vascular Injury Treatment (PROOVIT) multicenter registry
Authors: Russo Rachel M. , Davidson Anders J. , Alam Hasan B. , DuBose Joseph J. , Galante Joseph M. , Fabian Timothy C. , Savage Stephanie , Holcomb John B. , Scalea Thomas M. ,   AAST PROOVIT Study Group, Rasmussen Todd E.
Published: February 2021

BACKGROUND

Administering antithrombotics (AT) to the multiply injured patient with blunt cerebrovascular injury (BCVI) requires a thoughtful assessment of the risk of stroke and death associated with nontreatment. Large, multicenter analysis of outcomes stratified by injury grade and vessel injured is needed to inform future recommendations.

METHODS

Nine hundred and seventy-one BCVIs were identified from the PROspective Vascular Injury Treatment registry in this retrospective analysis. Using multivariate analysis, we identified predictors of BCVI-related stroke and death. We then stratified these risks by injury grade and vessel injured. We compared the risk of adverse outcomes in the nontreatment group with those treated with antiplatelet agents and/or anticoagulants.

RESULTS

Stroke was identified in 7% of cases. Overall mortality was 12%. Both increased with increasing BCVI grade. Treatment with ATs was associated with lower mortality and was not significantly affected by the choice of agent. Withholding ATs was associated with an increased risk of stroke and/or death across all subgroups (Grade I/II: odds ratio [OR], 4.66; 95% confidence interval [CI], 2.48–8.75; Grade III: OR, 7.0; 95% CI, 2.01–24.5; Grade IV: OR, 4.43; 95% CI, 1.76–11.1) even after controlling for covariates. Predictors of death included more severe trauma, Grade IV injury, and the occurrence of stroke. Arterial occlusion, hypotension, and endovascular intervention were significant predictors of stroke. Patients that experienced a BCVI-related stroke were at a 4.2× increased risk of death. The data set lacked the granularity necessary to evaluate AT timing or dosing regimen, which limited further analysis of stroke prevention strategies.

CONCLUSION

Stroke and death remain significant risks for all BCVI grades regardless of the vessel injured. Antithrombotics represent the only management strategy that is consistently associated with a lower incidence of stroke and death in all BCVI categories. In the multi-injured BCVI patient with a high risk of bleeding on anticoagulation, antiplatelet agents are an efficacious alternative. Given the 40% mortality rate in patients who survived their initial trauma and developed a BCVI-related stroke, nontreatment may no longer be a viable option.

LEVEL OF EVIDENCE

Epidemiological III; Therapeutic IV.