A novel animal model of primary blast lung injury and its pathological changes in mice

alexandrossfakianakis shared this article with you from Inoreader A novel animal model of primary blast lung injury and its pathological changes in mice via Journal of Trauma and Acute Care Surgery - Current Issue BACKGROUND Primary blast lung injury (PBLI) is a major cause of death in military conflict and terrorist attacks on civilian populations. However, the mechanisms of PBLI are not well understood, and a standardized animal model is urgently needed. This study aimed to establish an animal model of PBLI for laboratory study. METHODS The animal model of PBLI was established using a self-made mini shock tube simulation device. In brief, mice were randomly divided into two groups: the control group and the model group, the model group were suffered 0.5 bar shock pressures. Mice were sacrificed at 2 hours, 4 hours, 6 hours, 12 hours, and 24 hours after injury. Lung tissue gross observation, hematoxylin and eosin staining and lung pathology scoring were performed to evaluated lung tissue damage. Evans blue dye leakage and bronchoalveolar lavage fluid examination were performed to evaluated pulmonary edema. The relative expression levels of inflammation factors were measured by real-time quantitative polymerase chain reaction and Western blotting analysis. The release of neutrophil extracellular traps was observed by immunofluorescence stain. RESULTS In the model group, the gross observation and hematoxylin and eosin staining assay showed the inflammatory cell infiltration, intra-alveolar hemorrhage, and damaged lung tissue structure. The Evans blue dye and bronchoalveolar lavage fluid examination revealed that the lung tissue permeability and edema was significantly increased after injury. Real-time quantitative polymerase chain reaction and Western blotting assays showed that IL-1β, IL-6, TNF-α were upregulated in the model group. Immunofluorescence assay showed that the level of neutrophil extracellular traps in the lung tissue increased significantly in the model group. CONCLUSION The self-made mini shock tube simulation device can be used to establish the animal model of PBLI successfully. Pathological changes of PBLI mice were characterized by mechanical damage and inflammatory response in lung tissue. View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Ventilator-associated pneumonia and intubation location in adults with traumatic injuries: Systematic review and meta-analysis

alexandrossfakianakis shared this article with you from Inoreader Ventilator-associated pneumonia and intubation location in adults with traumatic injuries: Systematic review and meta-analysis via Journal of Trauma and Acute Care Surgery - Current Issue BACKGROUND Ventilator-associated pneumonia (VAP) is an important cause of morbidity and mortality among critically ill patients, particularly those who present with traumatic injuries. This review aims to determine whether patients with traumatic injuries who are intubated in the prehospital setting are at higher risk of developing VAP compared with those intubated in the hospital. METHODS A systematic review of Medline, Scopus, and Cochrane electronic databases was conducted from inception to January 2021. Inclusion criteria were patients with traumatic injuries who were intubated in the prehospital or hospital settings with VAP as an outcome. Using a random-effects model, the risk of VAP across study arms was compared by calculating a summary relative risk with 95% confidence intervals. The results of individual studies were also summarized qualitatively. RESULTS The search identified 754 articles of which 6 studies (N = 2,990) met the inclusion criteria. All studies were good quality based on assessment with the Newcastle Ottawa scale. Prehospital intubation demonstrated an increased risk of VAP development in two of the six studies. Among the six studies, the overall quality weighted risk ratio was 1.09 (95% confidence interval, 0.90–1.31). CONCLUSION Traumatically injured patients who are intubated in the prehospital setting have a similar risk of developing VAP compared with those that are intubated in the hospital setting. LEVEL OF EVIDENCE Systematic review and meta-analysis; Level IV. View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The anchor point algorithm: A morphometric analysis of anatomic landmarks to guide placement of temporary aortic Rescue stent grafts for noncompressible torso hemorrhage

alexandrossfakianakis shared this article with you from Inoreader The anchor point algorithm: A morphometric analysis of anatomic landmarks to guide placement of temporary aortic Rescue stent grafts for noncompressible torso hemorrhage via Journal of Trauma and Acute Care Surgery - Current Issue BACKGROUND Noncompressible hemorrhage remains a high-mortality injury, which requires rapid damage control within minutes to avoid exsanguination. Retrievable stent grafts offer perfusion preserving hemorrhage damage control, and yet algorithms for device selection and positioning are lacking for an anatomically diverse human population. We hypothesized that easily acquired external measurements could be used to rapidly triage patients to receive one of several presized stents and that these metrics may further predict a single target on the aorta by which to optimize both mesenteric perfusion and aortic hemorrhage control. METHODS Metrics were acquired from computed tomography imaging of 203 male and female patients aged 18 to 50 years. Algorithms for metric based triage and stent sizing were examined against the cohort for effectiveness. Linear regression was used to predict a single target on the aorta for alignment of a multitiered stent. Next, the relationship of the anchor point to the palpable xiphoid was determined. RESULTS Clavicle to pubis measurements correlated with aortic length and was used to triage patients to one of three stent grafts. Stents for each triage group were sized to achieve >75% coverage of aortic Zones 1 and 3 in most patients while preserving carotid and visceral perfusion. A metric/sex-based equation that predicts the location of the superior mesenteric artery relative to the palpable xiphoid was derived. By alignment of a single point on the stent with this target, known as the anchor point, the remainder of the stent can be rapidly deployed while minimizing coverage of critical branches. When applied back to the cohort, only 10.4% had potential serious branch coverage events predicted. CONCLUSION Simple anatomic metrics offer rapid triage in this study population to one of three presized stent grafts and predict the location of key vascular branches. Confirmatory human trials will be essential to demonstrate safety and effectiveness of this approach. LEVEL OF EVIDENCE Prognostic/Epidemiological; Level IV. View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Scalable deep learning algorithm to compute percent pulmonary contusion among patients with rib fractures

alexandrossfakianakis shared this article with you from Inoreader Scalable deep learning algorithm to compute percent pulmonary contusion among patients with rib fractures via Journal of Trauma and Acute Care Surgery - Current Issue BACKGROUND Pulmonary contusion exists along a spectrum of severity, yet is commonly binarily classified as present or absent. We aimed to develop a deep learning algorithm to automate percent pulmonary contusion computation and exemplify how transfer learning could facilitate large-scale validation. We hypothesized that our deep learning algorithm could automate percent pulmonary contusion computation and that greater percent contusion would be associated with higher odds of adverse inpatient outcomes among patients with rib fractures. METHODS We evaluated admission-day chest computed tomography scans of adults 18 years or older admitted to our institution with multiple rib fractures and pulmonary contusions (2010–2020). We adapted a pretrained convolutional neural network that segments three-dimensional lung volumes and segmented contused lung parenchyma, pulmonary blood vessels, and computed percent pulmonary contusion. Exploratory analysis evaluated associations between percent pulmonary contusion (quartiles) and odds of mechanical ventilation, mortality, and prolonged hospital length of stay using multivariable logistic regression. Sensitivity analysis included pulmonary blood vessel volumes during percent contusion computation. RESULTS A total of 332 patients met inclusion criteria (median, 5 rib fractures), among whom 28% underwent mechanical ventilation and 6% died. The study population's median (interquartile range) percent pulmonary contusion was 4% (2%–8%). Compared to the lowest quartile of percent pulmonary contusion, each increasing quartile was associated with higher adjusted odds of undergoing mechanical ventilation (odds ratio [OR], 1.5; 95% confidence interval [95% CI], 1.1–2.1) and prolonged hospitalization (OR, 1.6; 95% CI, 1.1–2.2), but not with mortality (OR, 1.1; 95% CI, 0.6–2.0). Findings were similar on sensitivity analysis. CONCLUSION We developed a scalable deep learning algorithm to automate percent pulmonary contusion calculating using chest computed tomography scans of adults admitted with rib fractures. Open code sharing and collaborative research are needed to validate our algorithm and exploratory analysis at a large scale. Transfer learning can help harness the full potential of big data and high-performing algorithms to bring precision medicine to the bedside. LEVEL OF EVIDENCE Prognostic and epidemiological, Level III. View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Burnout reduction in acute care surgeons: Impact of faculty schedule change at a level 1 trauma and tertiary care center

alexandrossfakianakis shared this article with you from Inoreader Burnout reduction in acute care surgeons: Impact of faculty schedule change at a level 1 trauma and tertiary care center via Journal of Trauma and Acute Care Surgery - Current Issue BACKGROUND Acute care surgeons are prone to burnout because of heavy workload, concurrent clinical responsibilities, and busy in-house call. Modifiable burnout factors have been identified, but few studies have looked for longitudinal effects after change is implemented. We hypothesized that optimizing faculty workflow could decrease burnout without compromising productivity. METHODS We streamlined the faculty schedule at our institution to eliminate 24-hour call by creating weekly blocks of 12-hour day and night call, free from other clinical obligations. Protected academic time was added. The Maslach Burnout Inventory and Areas of Worklife Survey for health care providers were given to faculty, as well as close friends or family, at baseline, 6 months, and 12 months. Maslach Burnout Inventory and Areas of Worklife Survey proprietary formulas were used to assess change in factors contributing to burnout. Our primary outcome measure was the presence of factors contributing to burnout. Chart delinquency, relative value units, and academic projects were secondary outcome measures assessing clinical productivity change. RESULTS Survey completion rates were 92% for faculty and 80% for family. All burnout risk factors improved at 6 and 12 months. In surgeon and family groups, the following improvements were noted in the mean scores of risk factors at 1 year: workload (74%, 68%), control (38%, 16%), reward (14%, 24%), fairness (69%, 22%), emotional exhaustion (27.5%, 24%), depersonalization (37.5%, 14%), personal accomplishment (12.5%, 2%), community (3%, 5%), values (10%, 15%), and over-all burnout (12.5%, 23.3%). There was a reduction in charts reaching delinquent status. Relative value unit production did not decrease. CONCLUSION This study demonstrates that implementing a weekly, 12-hour call schedule can improve factors leading to burnout. Improvements were noted in surgeon and family groups alike, signifying both subjective improvements and observed change in the surgeons' behavior, without compromising clinical productivity. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III. View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Description of Opioid Involved Hospital Deaths that Do Not Have a Subsequent Autopsy

alexandrossfakianakis shared this article with you from Inoreader Description of Opioid Involved Hospital Deaths that Do Not Have a Subsequent Autopsy via Epidemiology - Published Ahead-of-Print Background: Surveillance systems rely on death records to monitor the most severe outcome of the opioid epidemic. However, few studies have linked data from hospital systems with death records to determine potential undercount of opioid involved deaths occurring in hospitals. This study describes characteristics of decedents less likely to have an autopsy following an opioid-involved death in hospitals and estimates the resulting undercount. Methods: A probabilistic data linkage of hospital and medical examiner data involving 4,936 opioid involved deaths among residents of Cook County, Illinois, US from 2016 to 2019. We included only hospital deaths that met a national case definition and presented with clinical signs of opioid overdose. Results: Decedents had higher odds of not having an autopsy if they were 50+ years, admitted to the hospital (aOR=3.7: 2.1, 6.5), hospitalized for 4+ days (aOR=2.2: 1.5, 3.1), and had a comorbid diagnosis of malignant cancer (aOR=4.3: 1.8, 10.1). However, decedents exposed to heroin and synthetic opioids (aOR=0.39: 0.28, 0.55), and concurrent exposure to stimulants (aOR=0.44: 0.31, 0.64) were more likely to have an autopsy). Compared to estimates from the US Centers for Disease Control and Prevention (CDC), we observed undercounts of opioid overdose deaths ranging from 6%-15%. Conclusions: Surveillance systems may undercount decedents that do not meet the typical profile of those more likely to have an autopsy, particularly older patients with chronic health conditions. Our undercount estimate likely exists in addition to the estimated 20-40% undercount reported elsewhere. Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Handgun divestment and risk of suicide

alexandrossfakianakis shared this article with you from Inoreader Handgun divestment and risk of suicide via Epidemiology - Published Ahead-of-Print Background: Firearm ownership is strongly related to suicide risk, yet little is known about how much risk declines when ownership ends ("divestment"). Methods: Using data from 523,182 handgun owners, we estimated the effect of divesting and remaining divested versus never divesting on the risk of suicide and firearm-specific suicide. We used pooled logistic regression with inverse probability weighting, adjusting for demographic and area-level measures. Results: The 5-year risk of suicide death was 25.6 (95% CI: 15.1 to 37.2) per 10,000 persons with divestment and 15.2 (95% CI: 13.2 to 17.3) per 10,000 persons with no divestment, corresponding to a risk difference of 10.4 (95% CI: 0.7 to 21.1) per 10,000 persons. The 5-year risk of firearm-specific suicide death was 6.3 (95% CI: 1.4 to 11.9) per 10,000 persons with divestment and 12.9 (95% CI: 11.0 to 14.6) per 10,000 persons with no divestment, corresponding to a risk difference of -6.6 (95% CI: -11.4 to -0.1) per 10,000 persons. Comparing divestment to no divestment, risks were elevated for deaths due to other causes proposed as negative control outcomes; we incorporated these estimates into a series of bias derivations to better understand the magnitude of unmeasured confounding. Conclusions: Collectively, these estimates suggest that divestment reduces firearm suicide risk by 50% or more, and likely reduces overall suicide risk as well, though future data collection is needed to fully understand the extent of biases such as unmeasured confounding. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved. View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Environmental exposures and anti-Müllerian hormone: a mixture analysis in the Nurses’ Health Study II

alexandrossfakianakis shared this article with you from Inoreader Environmental exposures and anti-Müllerian hormone: a mixture analysis in the Nurses' Health Study II via Epidemiology - Published Ahead-of-Print Background: Previous studies have linked environmental exposures with anti-Müllerian hormone (AMH), a marker of ovarian reserve. However, associations with multiple environment factors has to our knowledge not been addressed. Methods We included a total of 2,447 premenopausal women in the Nurses' Health Study II (NHSII) who provided blood samples during 1996-1999. We selected environmental exposures linked previously with reproductive outcomes that had measurement data available in NHSII, including greenness, particulate matter, noise, outdoor light at night, ultraviolet radiation, and six hazardous air pollutants (1,3-butadiene, benzene, diesel particulate matter, formaldehyde, methylene chloride, and tetrachloroethylene). For these we calculated cumulative averages from enrollment (1989) to blood draw and estimated associations with AMH in adjusted single exposure models, principal component analysis (PCA), and hierarchical Bayesian kernel machine regression (BKMR). Results Single exposure models showed negative associations of AMH with benzene (percentage reduction in AMH per interquartile range (IQR) increase = 5.5%, 95%CI=1.0, 9.8) and formaldehyde (6.1%, 95%CI=1.6, 10). PCA identified four major exposure patterns but only one with high exposure to air pollutants and light at night was associated with lower AMH. Hierarchical BKMR pointed to benzene, formaldehyde, and greenness, and suggested an inverse joint association with AMH (percentage reduction comparing all exposures at the 75th percentile to median= 8.2%, 95%CI=0.7, 15.1. Observed associations were mainly among women above age 40. Conclusions We found exposure to benzene and formaldehyde to be consistently associated with lower AMH levels. The associations among older women are consistent with the hypothesis that environmental exposures accelerate reproductive aging. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved. View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Approaches to estimating clearance rates for Human Papillomavirus groupings: a systematic review and real data examples

alexandrossfakianakis shared this article with you from Inoreader Approaches to estimating clearance rates for Human Papillomavirus groupings: a systematic review and real data examples via Epidemiology - Published Ahead-of-Print Introduction: Approaches to estimating clearance rates, an important metric of human papillomavirus (HPV) clearance, for HPV groupings differ between studies. We aimed to identify the approaches used in literature for estimating grouped HPV clearance rates. We investigated whether these approaches resulted in different estimations, using data from existing studies. Methods: In this systematic review, we included articles that reported clearance rates of HPV groupings. We identified approaches to data in the HAVANA cohort, comprising adolescent girls, and the H2M cohort, comprising men who have sex with men. We estimated clearance rates for six HPV groupings (bivalent-, quadrivalent- and nonavalent vaccine-related, and low-risk, high-risk, and any HPV). Results: From 26 articles, we identified 54 theoretically possible approaches to estimating clearance rates. These approaches varied regarding definitions of clearance events and person–time, and prevalence or incidence of infections included in analysis. Applying the nine most-used approaches to the HAVANA (n=1,394) and H2M (n=745) cohorts demonstrated strong variation in clearance rate estimates depending on the approach used. For example, for grouped high-risk HPV in the H2M cohort, clearance rates ranged from 52.4 to 120.0 clearances/1000 person–months. Clearance rates also varied in the HAVANA cohort, but differences were less pronounced, ranging from 24.1 to 57.7 clearances/1000 person–months. Conclusions: Varied approaches from the literature for estimating clearance rates of HPV groupings yielded different clearance rate estimates in our data examples. Estimates also varied between study populations. We advise clear reporting of methodology and urge caution in comparing clearance rates between studies. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved. View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.