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Singer KE, Wallen TE, Youngs J, Blakeman TC, Schuster RM, Stuever MF, Goodman MD. Partial Resuscitative Endovascular Balloon Occlusion of the Aorta Limits Ischemia-Reperfusion Injury After Simulated Aeromedical Evacuation. J Surg Res 2023; 283:118-126. [PMID: 36403405 DOI: 10.1016/j.jss.2022.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/04/2022] [Accepted: 10/18/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION One of the advantages of partial Resuscitative Endovascular Balloon Occlusion of the Aorta (pREBOA) compared to the original model is the mitigation of reperfusion injury. The safety and efficacy of pREBOA have not been demonstrated in the setting of aeromedical evacuation. We hypothesized that the pREBOA would result in less ischemia-reperfusion injury after altitude exposure. METHODS Twenty-four swine underwent femur fracture with hemorrhage for 20 min, followed by resuscitative endovascular balloon occlusion of the aorta (REBOA) deployment to Zone 1 and were randomized to pREBOA-PRO (Prytime Medical Devices Inc) full inflation, partial inflation, or sham inflation and then an altitude exposure of ground level or 8000 ft for 15 min. The primary endpoint was to examine if the balloon functioned at altitude. Our secondary endpoint was investigating evidence of ischemia-reperfusion by hemodynamic instability, electrolyte derangements, and acidosis. Comparisons were made by ANOVA. RESULTS After deflation, the partially inflated group maintained a higher mean arterial pressure (MAP) compared to fully inflated group (P = 0.026). Full REBOA pigs were more tachycardic compared to sham pREBOA at ground (P < 0.001) and this was exacerbated at altitude (P < 0.001). Full REBOA pigs were more acidotic than sham and pREBOA at ground pigs (P = 0.0006 and P = 0.0002, respectively). Altitude increased the acidosis in full REBOA pigs, resulting in a greater base deficit (P < 0.0001), lactate (P < 0.0001), and IL-6 (P = 0.006). CONCLUSIONS PREBOA resulted in less severe ischemia-reperfusion injury at both altitude and ground, while full balloon inflation at altitude exacerbated acidosis and ischemia-reperfusion injury. Efforts should therefore be made to utilize partial balloon occlusion when employing the REBOA catheter.
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Affiliation(s)
- Kathleen E Singer
- Section of General Surgery, Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Taylor E Wallen
- Section of General Surgery, Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Jackie Youngs
- Section of General Surgery, Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - T Christopher Blakeman
- Section of General Surgery, Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Rebecca M Schuster
- Section of General Surgery, Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Mary F Stuever
- Section of General Surgery, Department of Surgery, University of Cincinnati, Cincinnati, Ohio; Center for the Sustainment of Trauma And Readiness Skills, United States Air Force, Cincinnati, Ohio
| | - Michael D Goodman
- Section of General Surgery, Department of Surgery, University of Cincinnati, Cincinnati, Ohio.
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Wallen TE, Youngs J, Baucom MR, Turner K, Schuster R, England L, Pritts TA, Goodman MD. Aspirin Administration Mitigates Platelet Hyperaggregability After Splenectomy in a Murine Model. J Surg Res 2022; 279:548-556. [PMID: 35921721 DOI: 10.1016/j.jss.2022.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 05/24/2022] [Accepted: 06/09/2022] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Patients who undergo splenectomy (SPLN) have an estimated 10%-35% risk of venous thromboembolic events; however, the underlying mechanism and strategy for prevention have yet to be identified. The goals of this study were to 1) investigate platelet aggregation after SPLN, 2) examine if aspirin administration could mitigate this effect, and 3) determine if concomitant hemorrhage would affect post-SPLN platelet function and response to aspirin. METHODS Murine models of operative SPLN and submandibular bleed (SMB) were utilized. Mice were randomized to eight groups as follows: untouched, SPLN, sham (laparotomy only), SMB, SPLN + SMB, SPLN + aspirin (ASA), SMB + ASA, and SPLN + SMB + ASA. Aspirin (50 mg/kg) was administered on postoperative days (PODs) one and two via oral gavage. Mice were euthanized on POD 3, platelet counts were obtained, and blood samples were analyzed via rotational thromboelastometry and impedance aggregometry with adenosine diphosphate (ADP) and arachidonic acid (AA) as agonists. RESULTS By POD 3, SPLN mice displayed a significant thrombocytosis compared to untouched, SMB, and sham SPLN mice. Clotting time and clot formation time were significantly decreased in SPLN and SPLN + SMB cohorts compared to untouched and sham controls with elevated mean clot firmness. SPLN mice also displayed a significant increase in ADP- and AA-mediated platelet aggregability compared to untouched controls, SMB, and SPLN + SMB. ASA significantly decreased platelet aggregation via both ADP and AA signaling in SPLN and SPLN + SMB cohorts without affecting viscoelastic coagulation testing. CONCLUSIONS Platelet hyperaggregability after SPLN is mediated by both ADP and AA signaling. Early aspirin administration may prevent increased platelet aggregation exacerbated after polytrauma.
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Affiliation(s)
- Taylor E Wallen
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio.
| | - Jackie Youngs
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Matthew R Baucom
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Kevin Turner
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Rebecca Schuster
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Lisa England
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Timothy A Pritts
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
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Baucom MR, Wallen TE, Singer KE, Youngs J, Schuster RM, Blakeman TC, McGuire JL, Strilka R, Goodman MD. Postinjury Treatment to Mitigate the Effects of Aeromedical Evacuation After TBI in a Porcine Model. J Surg Res 2022; 279:352-360. [PMID: 35810552 DOI: 10.1016/j.jss.2022.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/14/2022] [Accepted: 05/21/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Early aeromedical evacuation after traumatic brain injury (TBI) has been associated with worse neurologic outcomes in murine studies and military populations. The goal of this study was to determine if commonly utilized medications, including allopurinol, propranolol, or tranexamic acid (TXA), could mitigate the secondary traumatic brain injury experienced during the hypobaric and hypoxic environment of aeromedical evacuation. METHODS Porcine TBI was induced via controlled cortical injury. Twenty nonsurvival pigs were separated into four groups (n = 5 each): TBI+25 mL normal saline (NS), TBI+4 mg propranolol, TBI+100 mg allopurinol, and TBI+1g TXA. The pigs then underwent simulated AE to an altitude of 8000 ft for 4 h with an SpO2 of 82-85% and were sacrificed 4 h later. Hemodynamics, serum cytokines, and hippocampal p-tau accumulation were assessed. An additional survival cohort was partially completed with TBI/NS (n = 5), TBI/propranolol (n = 2) and TBI/allopurinol groups (n = 2) survived to postinjury day 7. RESULTS There were no significant differences in hemodynamics, tissue oxygenation, cerebral blood flow, or physiologic markers between treatment groups and saline controls. Transient differences in IL-1b and IL-6 were noted but did not persist. Neurological Severity Score (NSS) was significantly lower in the TBI + allopurinol group on POD one compared to NS and propranolol groups. P-tau accumulation was decreased in the nonsurvival animals treated with allopurinol and TXA compared to the TBI/NS group. CONCLUSIONS Allopurinol, propranolol, and TXA, following TBI, do not induce adverse changes in systemic or cerebral hemodynamics during or after a simulated postinjury flight. While transient changes were noted in systemic cytokines and p-tau accumulation, further investigation will be needed to determine any persistent neurological effects of injury, flight, and pharmacologic treatment.
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Affiliation(s)
- Matthew R Baucom
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Taylor E Wallen
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | | | - Jackie Youngs
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | | | | | | | - Richard Strilka
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
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Youngs J, Planche T, Carrington D. Reply to: Concerns regarding the validity of the conclusion in a recently published paper on Roche Liat implementation. J Hosp Infect 2019; 102:356-357. [PMID: 30880266 DOI: 10.1016/j.jhin.2019.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 03/06/2019] [Indexed: 10/27/2022]
Affiliation(s)
- J Youngs
- Infection Care Group, St George's University Hospitals NHS Foundation Trust, London, UK.
| | - T Planche
- Infection Care Group, St George's University Hospitals NHS Foundation Trust, London, UK; Institute of Infection, St George's University of London, London, UK
| | - D Carrington
- Infection Care Group, St George's University Hospitals NHS Foundation Trust, London, UK
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Youngs J, Iqbal Y, Glass S, Riley P, Pope C, Planche T, Carrington D. Implementation of the cobas Liat influenza point-of-care test into an emergency department during a high-incidence season: a retrospective evaluation following real-world implementation. J Hosp Infect 2018; 101:285-288. [PMID: 30562558 PMCID: PMC7124296 DOI: 10.1016/j.jhin.2018.12.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 12/11/2018] [Indexed: 01/05/2023]
Abstract
The cobas Liat influenza A/B and respiratory syncytial virus (RSV) assay (Liat) was used in the adult emergency department of a large London hospital from 21st January 2018 to 14th April 2018. Influenza was detected in 308 of 1027 (30%) samples tested; influenza A in 157 (15.3%), influenza B in 149 (14.5%) and RSV in 28 (2.7%). When compared against Fast Track Diagnostics Respiratory Pathogens 21 multiplex polymerase chain reaction and Cepheid Xpert Xpress Flu/RSV assay, Liat performance for the detection of influenza A or B was: sensitivity 85% [95% confidence interval (CI) 76–92)], specificity 98% (95% CI 97–99), negative predictive value 94% (95% CI 92–96) and positive predictive value 95% (95% CI 91–97).
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Affiliation(s)
- J Youngs
- Infection Care Group, St George's University Hospitals NHS Foundation Trust, London, UK.
| | - Y Iqbal
- Department of Emergency Medicine, St George's University Hospitals NHS Foundation Trust, London, UK
| | - S Glass
- Department of Microbiology, East Kent Hospitals University NHS Foundation Trust, Ashford, UK
| | - P Riley
- Infection Care Group, St George's University Hospitals NHS Foundation Trust, London, UK
| | - C Pope
- Infection Care Group, St George's University Hospitals NHS Foundation Trust, London, UK; Institute of Infection, St George's University of London, London, UK
| | - T Planche
- Infection Care Group, St George's University Hospitals NHS Foundation Trust, London, UK; Institute of Infection, St George's University of London, London, UK
| | - D Carrington
- Infection Care Group, St George's University Hospitals NHS Foundation Trust, London, UK
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Youngs J, Marshall B, Farragher M, Whitney L, Glass S, Pope C, Planche T, Riley P, Carrington D. Implementation of influenza point-of-care testing and patient cohorting during a high-incidence season: a retrospective analysis of impact on infection prevention and control and clinical outcomes. J Hosp Infect 2018; 101:276-284. [PMID: 30471317 DOI: 10.1016/j.jhin.2018.11.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 11/12/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND During high-incidence influenza seasons, a robust infection prevention and control policy is imperative to reduce nosocomial transmission of influenza. AIM To assess the impact of influenza point-of-care testing (POCT) in an emergency department (ED) and patient cohorting on an influenza ward on infection prevention and control and clinical outcomes. METHODS Influenza POCT was operational in the study ED from 21st January 2018 and patient cohorting was operational on an influenza ward from 25th January 2018. A retrospective 'before-after' analysis was performed with pre-intervention defined as 1st November 2017 to 20th January 2018 and post-intervention defined as 21st January 2018 to 30th April 2018. The primary outcome was the rate of hospital-acquired influenza. Secondary outcomes included antiviral prescription and length of stay. The length of time that inpatients remained influenza-positive was estimated by polymerase chain reaction (PCR). FINDINGS There were 654 inpatients with confirmed influenza during the 2017/18 influenza season: 223 pre- and 431 post-intervention. Post-intervention, there were fewer cases of hospital-acquired influenza per day (0.66 vs 0.95, P < 0.0001), median length of stay was shorter (5.5 vs 7.5 days, P = 0.005) and antiviral prescription was more frequent (80% vs 64.1%, P < 0.0001). Cohorting released 779 single rooms for use elsewhere in the trust. The fixed probability of being PCR-negative by the next day (P) was 0.14 [95% confidence interval (CI) 0.12-0.16] for immunocompetent patients. This implies that half of immunocompetent patients are PCR-negative by five days post-diagnosis (95% CI 5-6). CONCLUSION Influenza POCT in an ED and patient cohorting on an influenza ward were associated with reduced nosocomial transmission of influenza and improved patient flow. A policy of retesting immunocompetent patients five days post-diagnosis could allow half of these patients to come out of respiratory isolation earlier.
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Affiliation(s)
- J Youngs
- Infection Care Group, St George's University Hospitals NHS Foundation Trust, London, UK.
| | - B Marshall
- Analytical Services, Ministry of Justice, London, UK
| | - M Farragher
- Infection Prevention and Control Team, St George's University Hospitals NHS Foundation Trust, London, UK
| | - L Whitney
- Pharmacy Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - S Glass
- Department of Microbiology, East Kent Hospitals University NHS Foundation Trust, Ashford, UK
| | - C Pope
- Infection Care Group, St George's University Hospitals NHS Foundation Trust, London, UK; Institute of Infection and Immunity, St George's University of London, London, UK
| | - T Planche
- Infection Care Group, St George's University Hospitals NHS Foundation Trust, London, UK; Institute of Infection and Immunity, St George's University of London, London, UK
| | - P Riley
- Infection Care Group, St George's University Hospitals NHS Foundation Trust, London, UK; Institute of Infection and Immunity, St George's University of London, London, UK
| | - D Carrington
- Infection Care Group, St George's University Hospitals NHS Foundation Trust, London, UK; Institute of Infection and Immunity, St George's University of London, London, UK
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Youngs J, Nicoloff DM. Medical versus surgical management of esophageal perforation. Geriatrics (Basel) 1971; 26:100-5. [PMID: 5101654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Youngs J, Nicoloff D. Management of esophageal perforation. Surgery 1969; 65:264-8. [PMID: 5765348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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