bluuebunny/crossref_metadata_2025_split huggingface dataset:
A clinical prediction model for raised intracranial pressure in patients with traumatic brain injuries
Authors: Pace Jacob , Parry Neil , Vogt Kelly , Hilsden Rich , Leeper R. Robert , Markova Zarina , Priestap Fran , Younan Julia , Ball Ian 
Published: May 2018

BACKGROUND
Intracranial hypertension is believed to contribute to secondary brain insult in traumatically brain injured patients. Currently, the diagnosis of intracranial hypertension requires intracranial monitoring or advanced imaging. Unfortunately, prehospital transport times can be prolonged, delaying time to the initial radiographic assessment. The aim of this study was to identify clinical variables associated with raised intracranial pressure (ICP) prior to the completion of neuroimaging.

METHODS
We performed a retrospective cohort study of head injured patients over a 3-year period. Patients were labeled as having increased ICP if they had a single reading of ICP greater than 20 mm Hg within 1 hour of ICP monitor insertion or computed tomography findings suggestive of raised ICP. Patient and clinical characteristics were analyzed using stepwise multivariable logistic regression with ICP as the dependent variable.

RESULTS
Of 701 head injured patients identified, 580 patients met inclusion criteria. Mean age was 48.65 ± 21 years, 73.3% were male. The mean Injury Severity Score was 22.71 ± 12.38, and the mean Abbreviated Injury Scale for body region head was 3.34 ± 1.06. Overall mortality was 14.7%. Only 46 (7.9%) patients had an ICP monitor inserted; however, a total of 107 (18%) patients met the definition of raised ICP. The mortality rate for patients with raised ICP was 50.4%. Independent predictors of raised ICP were as follows: age, older than 55 years (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.35–3.76), pupillary fixation (OR, 5.76; 95% CI, 3.16–10.50), signs of significant head trauma (OR, 2.431; 95% CI, 1.39–4.26), and need for intubation (OR, 3.589; 95% CI, 2.10–6.14).

CONCLUSION
This study identified four independent variables associated with raised ICP and incorporated these findings into a preliminary risk assessment scale that can be implemented at the bedside to identify patients at significant risk of raised ICP. Future work is needed to prospectively validate these findings prior to clinical implementation.

LEVEL OF EVIDENCE
Prognostic, Epidemiological, level III.
Recent advances in austere combat surgery: Use of aortic balloon occlusion as well as blood challenges by special operations medical forces in recent combat operations
Authors: Northern David Marc , Manley Justin D. , Lyon Regan , Farber Daniel , Mitchell Benjamin J. , Filak Kristopher J. , Lundy Jonathan , DuBose Joe J. , Rasmussen Todd E. , Holcomb John B. 
Published: May 2018

BACKGROUND
Resuscitative endovascular balloon occlusion of the aorta (REBOA) for control of noncompressible torso hemorrhage is a technology that is increasingly being utilized in the combat casualty setting. Its use in the resource restricted environment holds potential to improve hemorrhage control, decrease blood product utilization, decrease morbidity, and improve combat mortality. The objective of this report is to present the single largest series of REBOA use on severely injured combat casualties.

METHODS
Over an 18-month period, austere surgical teams comprised of coalition partners provided initial damage control resuscitation (DCR) and surgical stabilization for over 2,300 combat casualties prior to transferring patients to the next level of trauma care.

RESULTS
Twenty patients presented with injuries from explosion and gunshot wounds with mean initial heart rate of 129 bpm and mean initial systolic blood pressure of 71 mm Hg. Femoral cutdowns were used in six patients. Aortic occlusion was achieved with REBOA catheter placement in Zone 1 (n = 17) and Zone 3 (n = 2). Systolic blood pressure increased an average of 56 mm Hg with aortic occlusion. There were no access related site complications. All patients survived transport to the next level of care. The majority of blood products transfused in this cohort were whole blood, largely supported by emergent blood drives.

CONCLUSION
This series demonstrates the potential for REBOA as a lifesaving technique for the patient who presents with hemodynamic instability and noncompressible torso hemorrhage. Resuscitative endovascular balloon occlusion of the aorta allows austere surgical teams to rapidly stabilize severely injured combat casualties, expand capability, and provide enhanced DCR while minimizing personnel, resources, and blood product utilization. The use of “whole blood only” strategy for DCR shows potential to be superior to traditional component therapy, and when combined with “proactive” REBOA utilization, provides significant improvements in hemodynamics and hemorrhage control.

LEVEL OF EVIDENCE
Case series, level V.
Transfusion of cryopreserved platelets exacerbates inflammatory liver and lung injury in a mice model of hemorrhage
Authors: Zhao Jingxiang , Sun Zhenwei , You Guoxing , Wang Ying , Chen Gan , Zhao Lian , Zhou Hong 
Published: May 2018

BACKGROUND
Platelets are essential for primary hemostasis and also play an important role in inflammatory reactions. The hemostatic property of cryopreserved platelets (CPPs) has been confirmed in the treatment of bleeding casualties, but inflammatory injury induced by CPP transfusion is relatively unclear. We aim to investigate the effects of CPP transfusion on inflammatory organ injury in mice after hemorrhage.

METHODS
Mice were subjected to a volume-controlled hemorrhage over 1 hour, and then were transfused with fresh platelets (FPs), Liquid-stored platelets (LPPs), CPPs, or fresh frozen plasma (FFP, control). At 6 hours posttransfusion, mice were sacrificed, and blood and tissues were sampled. Tissue sections were examined histologically and by immunohistochemical staining of neutrophils and macrophages. Plasma alanine aminotransferase, hepatic myeloperoxidase activity and inflammatory cytokine levels were measured.

RESULTS
Transfusion of stored platelets (LPPs and CPPs) caused more serious histological injury in liver and lung compared with FPs and FFP (p < 0.05). However, kidney histological injury was similar among groups. Significantly higher numbers of Ly-6G–positive neutrophils were detected in liver and of F4/80-positive macrophages in liver and lung of mice transfused with LPPs or CPPs compared with FPs or FFP (p < 0.05). Transfusion of CPPs caused the most severe inflammatory liver injury, as reflected by alanine aminotransferase levels, hepatic macrophage infiltration, and hepatic myeloperoxidase activity and inflammatory cytokine levels (macrophage inflammatory protein-2, tumor necrosis factor-α, and interleukin-1β).

CONCLUSION
Cryopreserved platelet transfusion is more likely to aggravate hemorrhage-induced liver and lung injury by activating macrophage and facilitating neutrophil infiltration into hepatic tissues.
Unrealized potential of the US military battlefield trauma system: DOW rate is higher in Iraq and Afghanistan than in Vietnam, but CFR and KIA rate are lower
Authors: Nessen Shawn C. , Gurney Jennifer , Rasmussen Todd E. , Cap Andrew P. , Mann-Salinas Elizabeth , Le Tuan D. , Shackelford Stacy , Remick Kyle N. , Akers Kevin S. , Eastridge Brian J. , Jenkins Donald , Stockinger Zsolt T. , Murray Clinton K. , Gross Kirby R. , Seery Jason , Mabry Robert , Holcomb John B. 
Published: May 2018

Level of Evidence
Observational/retrospective/historic controls, level IV.
A metal organic framework reduces thrombus formation and platelet aggregation ex vivo
Authors: Roberts Teryn R. , Neufeld Megan J. , Meledeo Michael A. , Cap Andrew P. , Cancio Leopoldo C. , Reynolds Melissa M. , Batchinsky Andriy I. 
Published: May 2018

BACKGROUND
Management of hemostasis is a key challenge during extracorporeal life support (ECLS). Metal organic frameworks are being investigated for use as nitric oxide (NO) catalysts for incorporation into ECLS circuitry to prevent thrombosis at the blood–biomaterial interface. A specific metal organic framework, CuBTTri, has been shown to accelerate NO release from bioavailable donors like S-nitrosoglutathione (GSNO). We hypothesized that CuBTTri would reduce thrombus formation in whole blood (WB) and inhibit platelet aggregation.

METHODS
CuBTTri particles were added to WB and analyzed by thromboelastography. Biostable metal-based frameworks (MIL-100, Zeolite USY) were added to blood as controls, in addition to a saline vehicle control. Reaction time (R), clot formation time (K), alpha-angle, clot strength (MA), and percent fibrinolysis (LY30/LY60) were recorded. The effect of CuBTTri on platelet aggregation was assessed in WB and platelet-rich plasma (PRP), both with and without addition of GSNO.

RESULTS
CuBTTri significantly prolonged R and K and decreased alpha-angle and MA relative to the metal framework controls. Dose escalation results suggest that the control metal-based particles induce thrombus formation, as R and K were significantly reduced compared with the saline control; however, this did not occur in the CuBTTri group. LY30/LY60 were elevated in the CuBTTri group versus saline (p = 0.014) but were not different from metal framework controls. CuBTTri alone and with GSNO reduced platelet aggregation in WB (p < 0.0001), whereas GSNO alone had no effect. In PRP, GSNO and CuBTTri inhibited platelet aggregation separately, and together decreased aggregation by 35% relative to GSNO alone (p = 0.004).

CONCLUSIONS
CuBTTri reduced thrombus formation and inhibited platelet aggregation. CuBTTri enhanced platelet inhibition with GSNO, which was consistent with reports that CuBTTri accelerates NO release from endogenous NO donors. This initial characterization of CuBTTri demonstrated its potential as an antithrombogenic agent to be further evaluated with incorporation into ECLS circuitry.
Motor vehicle crash fatalaties and undercompensated care associated with legalization of marijuana
Authors: Steinemann Susan , Galanis Daniel , Nguyen Tiffany , Biffl Walter 
Published: May 2018

BACKGROUND
Half of the US states have legalized medical cannabis (marijuana), some allow recreational use. The economic and public health effects of these policies are still being evaluated. We hypothesized that cannabis legalization was associated with an increase in the proportion of motor vehicle crash fatalities involving cannabis-positive drivers, and that cannabis use is associated with high-risk behavior and poor insurance status.

METHODS
Hawaii legalized cannabis in 2000. Fatality Analysis Reporting System data were analyzed before (1993–2000) and after (2001–2015) legalization. The presence of cannabis (THC), methamphetamine, and alcohol in fatally injured drivers was compared. Data from the state's highest level trauma center were reviewed for THC status from 1997 to 2013. State Trauma Registry data from 2011 to 2015 were reviewed to evaluate association between cannabis, helmet/seatbelt use, and payor mix.

RESULTS
THC positivity among driver fatalities increased since legalization, with a threefold increase from 1993–2000 to 2001–2015. Methamphetamine, which has remained illegal, and alcohol positivity were not significantly different before versus after 2000. THC-positive fatalities were younger, and more likely, single-vehicle accidents, nighttime crashes, and speeding. They were less likely to have used a seatbelt or helmet. THC positivity among all injured patients tested at our highest level trauma center increased from 11% before to 20% after legalization. From 2011 to 2015, THC-positive patients were significantly less likely to wear a seatbelt or helmet (33% vs 56%). They were twice as likely to have Medicaid insurance (28% vs 14%).

CONCLUSION
Since the legalization of cannabis, THC positivity among MVC fatalities has tripled statewide, and THC positivity among patients presenting to the highest level trauma center has doubled. THC-positive patients are less likely to use protective devices and more likely to rely on publically funded medical insurance. These findings have implications nationally and underscore the need for further research and policy development to address the public health effects and the costs of cannabis-related trauma.

LEVEL OF EVIDENCE
Prognostic, level III.
Crisis under the radar: Illicit amphetamine use is reaching epidemic proportions and contributing to resource overutilization at a Level I trauma center
Authors: Gemma Vincent A. , Chapple Kristina M. , Goslar Pamela W. , Israr Sharjeel , Petersen Scott R. , Weinberg Jordan A. 
Published: May 2018

INTRODUCTION
Trauma centers reported illicit amphetamine use in approximately 10% of trauma admissions in the previous decade. From experience at a trauma center located in a southwestern metropolis, our perception is that illicit amphetamine use is on the rise and that these patients utilize in-hospital resources beyond what would be expected for their injuries. The purposes of this study were to document the incidence of illicit amphetamine use among our trauma patients and to evaluate its impact on resource utilization.

METHODS
We conducted a retrospective cohort study using 7 consecutive years of data (starting July 2010) from our institution's trauma registry. Toxicology screenings were used to categorize patients into one of three groups: illicit amphetamine, other drugs, or drug-free. Adjusted linear and logistic regression models were used to predict hospital cost, length of stay, intensive care unit admission, and ventilation between drug groups. Models were conducted with combined injury severity (Injury Severity Score [ISS]) and then repeated for ISS of less than 9, ISS 9 to 15, and ISS 16 or greater.

RESULTS
Eight thousand five hundred eighty-nine patients were categorized into the following three toxicology groups: 1,255 (14.6%) illicit amphetamine, 2,214 (25.8%) other drugs, and 5,120 (59.6%) drug-free. Illicit amphetamine use increased threefold over the course of the study (from 7.85% to 25.0% of annual trauma admissions). Adjusted linear models demonstrated that illicit amphetamine among patients with ISS of less than 9 was associated with 4.6% increase in hospital cost (p = 0.019) and 7.4% increase in length of stay (p = 0.043). Logistic models revealed significantly increased odds of ventilation across all ISS groups and increased odds of intensive care unit admission when all ISS groups were combined (p = 0.001) and within the group with ISS of less than 9 (p = 0.002).

CONCLUSIONS
Hospital resource utilization of amphetamine patients with minor injuries is significant. Trauma centers with similar epidemic growth in proportion of amphetamine patients face a potentially significant resource strain relative to other centers.

LEVEL OF EVIDENCE
Prognostic/Epidemiological, level II; Therapeutic, level III.
Increased trauma activation is not equally beneficial for all elderly trauma patients
Authors: Carr Bryan W. , Hammer Peter M. , Timsina Lava , Rozycki Grace , Feliciano David V. , Coleman Jamie J. 
Published: May 2018

BACKGROUND
Physiologic changes in the elderly lead to higher morbidity and mortality after injury. Increasing level of trauma activation has been proposed to improve geriatric outcomes, but the increased cost to the patient and stress to the hospital system are significant downsides. The purpose of this study was to identify the age at which an increase in activation status is beneficial.

METHODS
A retrospective review of trauma patients 70 years or older from October 1, 2011, to October 1, 2016, was performed. On October 1, 2013, a policy change increased the activation criteria to the highest level for patients 70 years or older with a significant mechanism of injury. Patients who presented prior to (PRE) were compared with those after the change (POST). Data collected included age, Injury Severity Score (ISS), length of stay (LOS), complications, and mortality. Primary outcome was mortality, and secondary outcome was LOS. Multivariable regressions controlled for age, ISS, injury mechanism, and number of complications.

RESULTS
A total of 4,341 patients met the inclusion criteria, 1,919 in PRE and 2,422 in POST. Mean age was 80.4 and 81 years in PRE and POST groups, respectively (p = 0.0155). Mean ISS values were 11.6 and 12.4 (p < 0.0001) for the PRE and POST groups. POST had more Level 1 activations (696 vs. 220, p < 0.0001). After controlling for age, ISS, mechanism of injury, and number of complications, mortality was significantly reduced in the POST group 77 years or older (odds ratio, 0.53; 95% confidence interval, 0.3–0.87) (Fig. 1). Hospital LOS was significantly reduced in the POST group age 78 years or older (regression coefficient, −0.55; 95% confidence interval, −1.09 to −0.01) (Fig. 2).

CONCLUSIONS
This study suggests geriatric trauma patients 77 years or older benefit from the highest level of trauma activation with shorter LOS and lower mortality. A focused approach to increasing activation level for elderly patients may decrease patient cost.

LEVEL OF EVIDENCE
Therapeutic/Care Management, level IV.
The Impact of Implantation Time During Liver Transplantation on Outcome: A Eurotransplant Cohort Study
Authors: Jochmans Ina , Fieuws Steffen , Tieken Ineke , Samuel Undine , Pirenne Jacques 
Published: May 2018

Background
The liver graft quickly rewarms during transplantation when the vascular anastomoses are being performed, potentially impacting on outcomes.

Methods
We investigated the relationship between implantation time and outcome in 5223 recipients of deceased-donor livers transplanted in Eurotransplant (2004-2013). Cox regression analyses were corrected for donor, preservation, and recipient variables. Transplant loss represents all-cause graft failure.

Results
Median implantation time was 41 minutes (interquartile range, 34-51). Implantation time independently associated with transplant loss (adjusted hazard ratio, 1.04 for every 10-minute increase; 95% confidence interval, 1.01-1.07; P = 0.007). The magnitude of the implantation time effect was comparable to the effect of each additional hour of cold ischemia (adjusted hazard ratio, 1.03; 95% confidence interval, 1.02-1.05; P < 0.001). The effect was most pronounced early posttransplant with no evidence of a significant effect beyond 3 months. A similar detrimental effect of implantation time was seen for graft and patient survivals. The increased risk for transplant loss in livers donated after circulatory determination of death could be attributed to donor warm ischemia time.

Conclusions
Implantation time associates with inferior liver transplant outcome in a continuous way. These findings need confirmation and further study of confounding factors is needed so steps toward improving outcomes can be made.
Microrna-184 is Induced by Store-Operated Calcium Entry and Regulates Early Keratinocyte Differentiation
Authors: Richardson Adam , Powell Andrew , Sexton Darren W. , Parsons Jason L. , Reynolds Nicholas J. , Ross Kehinde 
Published: May 2018

ABSTRACTExtracellular calcium (Ca2+) and store-operated Ca2+ entry (SOCE) govern homeostasis in the mammalian epidermis. Multiple microRNAs (miRNA) also regulate epidermal differentiation, and raised external Ca2+ modulates the expression of several such miRNAs in keratinocytes. However, little is known about the regulation of miR-184 in keratinocytes or the roles of miR-184 in keratinocyte differentiation. Here we report exogenous Ca2+ stimulates miR-184 expression in primary epidermal keratinocytes and that this occurs in a SOCE-dependent manner. Levels of miR-184 were raised by about 30-fold after exposure to 1.5 mM Ca2+ for 5 days. In contrast, neither phorbol ester nor 1, 25-dihydroxyvitamin D3 had any effect on miR-184 levels. Pharmacologic and genetic inhibitors of SOCE abrogated Ca2+-dependent miR-184 induction by 70% or more. Ectopic miR-184 inhibited keratinocyte proliferation and led to a 4-fold increase in the expression of involucrin, a marker of early keratinocyte differentiation. Exogenous miR-184 also triggered a 3-fold rise in levels of cyclin E and doubled the levels of γH2AX, a marker of DNA double strand breaks. The p21 cyclin-dependent kinase (CDK) inhibitor, which supports keratinocyte growth arrest, was also induced by miR-184. Together our findings point to a SOCE:miR-184 pathway that targets a cyclin E/DNA damage regulatory node to facilitate keratinocyte differentiation.
Supplemental vibrotactile feedback of real-time limb position enhances precision of goal-directed reaching
Authors: Risi Nicoletta , Shah Valay , Mrotek Leigh A. , Casadio Maura , Scheidt Robert A. 
Published: May 2018

AbstractWe examined vibrotactile stimulation as a form of supplemental limb state feedback to enhance on-going control goal-directed movements. Subjects wore a two-dimensional vibrotactile display on their non-dominant arm while performing horizontal planar reaching movements with their dominant arm. The vibrotactile display provided feedback of hand position such that small hand displacements were more easily discriminable using vibrotactile feedback than with intrinsic proprioceptive feedback. When subjects relied solely on proprioceptive feedback to capture visuospatial targets, target capture performance was degraded by proprioceptive drift and an expansion of task space. By contrast, reach accuracy was enhanced immediately when subjects were provided vibrotactile feedback, and further improved over two days of training. Improvements reflected a resolution of proprioceptive drift which occurred only when vibrotactile feedback was active, demonstrating that the benefits of vibrotactile feedback are due in part to its integration into the ongoing control of movement. A partial resolution of task space expansion that persisted even when the vibrotactile feedback was inactive demonstrated that training with vibrotactile feedback also induced changes in movement planning. However, the benefits of vibrotactile feedback come at a cognitive cost. All subjects adopted a stereotyped, movement decomposition strategy wherein they attempted to capture targets by moving first along one axis of the vibrotactile display and then the other. For most subjects, this inefficient movement approach did not resolve over two bouts of training performed on separate days, suggesting that additional training is needed to fully integrate vibrotactile feedback into the planning and online control of goal-directed reaching.