Impact of comorbidities in severely injured patients with blunt chest injury: A population-based retrospective cohort study

INTRODUCTION

Blunt chest injuries result in up to 10 % of major trauma admissions. Comorbidities can complicate recovery and increase the mortality rate in this patient cohort. A better understanding of the association between comorbidities and patient outcomes will facilitate enhanced models of care for particularly vulnerable groups of patients, such as older adults.

AIMS

i) compare the characteristics of severely injured patients with blunt chest injury with and without comorbidities and ii) examine the relationship between comorbidities and key patient outcomes: prolonged length of stay, re-admission within 28 days, and mortality within 30 days in a cohort of patients with blunt chest injury admitted after severe trauma.

METHODS

A retrospective cohort study using linked data from the NSW Trauma Registry and NSW mortality and hospitalisation records between 1st of January 2012 and 31st of December 2019.

RESULTS

After adjusting for potential confounding factors, patients with severe injuries, chest injuries, and comorbidities were found to have a 34 % increased likelihood of having a prolonged length of stay (OR = 1.34, 95 %I = 1.17-1.53) compared to patients with no comorbidities. There was no difference in 30-day mortality for patients with a severe chest injury who did or did not have comorbidities (OR = 1.05, 95 %CI = 0.80-1.39). No significant association was found between comorbidities and re-admission within 28 days.

CONCLUSION

Severely injured patients with blunt chest injury and comorbidities are at risk of prolonged length of stay.

Application of virtual reality for peritoneal dialysis exchange learning in patients with end-stage renal disease and cognitive impairment

Cognitive impairment is not uncommon in patients with end-stage renal disease and can make it more difficult for these patients to carry out peritoneal dialysis (PD) on their own. Their attempts to do so may result in adverse consequences such as peritonitis. PD exchange is a complex procedure demanding knowledge and skill which requires close supervision and guidance by a renal nurse specialist. In this study, a non-immersive virtual reality (VR) training program using a Leap motion hand tracking device was developed to facilitate patients' understanding and learning of the PD exchange procedure before attempting real task practice. This study was a two-center single-blinded randomized controlled trial on 23 incident PD patients. Patients in the experimental group received 8 sessions of VR training, while patients in the control were provided with printed educational materials. The results showed that there were significant differences between the two groups in performance of the overall PD exchange sequence, especially on the crucial steps. VR had a patient satisfaction rate of 89%, and all patients preferred to have the VR aid incorporated in PD training. Our findings conclude VR can be a useful aid in the training and reinforcement of PD exchange procedures, with distinct merits of being free from restrictions of time, space, and manpower.

Cerebral Vasoreactivity: A Comparison of Color Velocity Imaging Quantification and Stable Xenon-Enhanced CT

OBJECTIVE

Compromised cerebral vasoreactivity increases the risk of stroke. In this study, we sought to determine whether extracranial arterial blood flow volume measured on color velocity imaging quantification could be predictive of cerebral vasoreactivity after the administration of acetazolamide.

SUBJECTS AND METHODS

Cerebral blood flow and extracranial arterial blood flow volume of 35 patients with symptomatic carotid occlusive disease were measured before and after the administration of acetazolamide on stable xenon CT and color velocity imaging quantification, respectively. The changes in unilateral extracranial arterial blood flow volume and respective hemispheric cerebral blood flow were compared. The mean difference in the percentage of change in flow volume, the 95% limit of agreement, and Cohen's kappa coefficient were calculated.

RESULTS

A total of 64 unilateral extracranial arterial blood flow volume changes were successfully compared with the changes in the ipsilateral hemispheric cerebral blood flow. The mean difference in percentage of change in flow volume between the two techniques was 4.7%, with the 95% limit of agreement ranging from -90.2% to 99.7%. Cohen's kappa coefficient was 0.41 (95% confidence interval, 0.13-0.68; p = 0.001).

CONCLUSION

The performance of color velocity imaging quantification for evaluating cerebral vasoreactivity is comparable to that of transcranial Doppler sonography. Because color velocity imaging quantification is not as limited as transcranial Doppler sonography, it could be an ideal complementary tool to transcranial Doppler sonography. More studies are required to define its clinical value.

Tethered pyrazolyl phosphinate: pyrazolyl-N- and phosphoryl-O-metal coordination in Ph(2)P(O)[OCH(2)CH(2)(3,5-Me(2)Pz)]

Phosphorus pyrazolides, P(O)(3,5-Me(2)Pz)(3) or RP(E)(3,5-Me(2)Pz)(2) [E = S or O, R = Me or Ph], are hydrolytically sensitive particularly upon interaction with transition metal ions. In this paper, we report a new tethered pyrazolyl phosphinate, Ph(2)P(O)[OCH(2)CH(2)(3,5-Me(2)Pz)] DPEP (1), where the pyrazolyl group is separated from the phosphorus by means of an ethyleneoxy spacer. 1 has two potential coordination sites in the form of a phosphoryl oxygen atom and a pyrazolyl nitrogen atom. 1 forms hydrolytically stable complexes, (DPEP-CoCl(2))(n)(2), (DPEP)(2)-CuCl(2) (3), (DPEP-ZnCl(2))(n )(4), and (DPEP)(2)-PdCl(2) (5). The cobalt(II) and the zinc(II) complexes 2 and 4 show a zigzag polymeric structure in the solid state with a tetrahedral coordination geometry around the metal ion; the ligand DPEP coordinates through its phosphoryl oxygen and the pyrazolyl nitrogen to two neighboring metal ions and functions as a bridging ligand to form the polymeric structure. In contrast to 2 and 4, the copper(II) and the palladium(II) complexes 3 and 5 show a square-planar geometry around the metal ion. Exclusive coordination through the pyrazolyl nitrogens of the ligand 1 is observed. An extensive supramolecular sheetlike two-dimensional polymeric network is observed in the solid-state structures of 3 and 5 as a result of two weak interactions: (a) an intermolecular C-H- - -O interaction involving the phosphoryl oxygen and an aromatic C-H and (b) a pi-pi face-to-face stacking interaction between the phenyl groups of two adjacent molecules.

The comparative impact of video-consultation on neurosurgical health services

This study evaluated the impact of telemedicine technology on the provision of neurosurgical health services. We focused on the differences between the use of real time audio-visual teleconferencing and teleradiology versus conventional telephone consultations in the referral of neurosurgical patients from a large district general hospital. All patients requiring emergency neurosurgical consultation were included for randomization into telephone consultation only (Mode A), teleradiology and telephone consultation (Mode B) and video-consultation (Mode C). Measures of effectiveness included diagnostic accuracy and adverse events during the transfer and Glasgow Outcome Score. In a 10-month period, 327 patients were recruited and randomized into the study: the male/female ratio was 2:1 and the number of patients required to be transferred to the neurosurgical unit was 125 (38%). There was a trend towards a more favourable outcome in the video-consultation mode (44%, Mode C), versus teleradiology (31%, Mode B), versus telephone consultation (38%, Mode A). The interim data of this prospective randomized trial suggests that video-consultation may have a favourable impact on emergency neurosurgical consultations.

The impact of an armless frameless neuronavigation system on routine brain tumour surgery: a prospective analysis of 51 cases

A passive infrared armless and frameless neuronavigation system was introduced in routine intracranial and skull base surgery, and its impact on 51 cases in a one year period was assessed. No cases were rejected by the operating surgeon for lack of accuracy (> 3 mm). Operating time was not significantly lengthened, except in transphenoidal cases (255 +/- SD 168 min versus 185 +/- SD 119 min, p = 0.02). Length of stay was shorter in navigation cases in supratentorial glioma (12 +/- SD 7.3 days versus 15 +/- SD 7.9 days) and meningioma (11 +/- SD 5.3 days versus 16 +/- SD 6.7 days, p = 0.01). Outcome at 3 months was comparable in both the supratentorial glioma and meningioma group. Problems such as setup time and brain shift are addressed and discussed.

Cloning of the MHC class II DRB cDNA from the brushtail possum (Trichosurus vulpecula)

The cell-surface glycoproteins encoded by the major histocompatibility complex (MHC) bind to processed foreign antigens and present them to T lymphocytes. Two classes of MHC molecules and their corresponding gene sequences have been extensively studied in eutherian mammals and birds, but data on the marsupial MHC are limited. Marsupials split from eutherian mammals about 125 million years ago and represent a distinct branch in mammalian evolution. Here the cDNA cloning of MHC class II genes of the brushtail possums (Trichosurus vulpecula) is reported. The sequences obtained were found to be relatively conserved when compared to the red-necked wallaby (Macropus rufogriseus) and an South American marsupial, Monodelphis domestica. The T. vulpecula sequence shared an average overall sequence identity of 75.4% at the deduced amino acid level with M. rufogriseus and M. domestica, respectively.

Second generation effects of maternal alcohol consumption during pregnancy in rats

1. Previous studies have shown that when female rats are administered alcohol during pregnancy there are adverse effects on their progeny, including decreased birth weight and delayed neuromotor development. Evidence from several sources suggests alcohol exposure may contribute to cytogenetic abnormalities, suggesting the possibility of cross generational effects from prenatal exposure. 2. On day 1 of gestation female rats were randomly allocated to the Alcohol group, which received a liquid diet containing 5% (v/v) ethanol solution until parturition, the Sucrose control group, which received an identical diet, except that sucrose had been isocalorically substituted for ethanol, or the Chow control, which received standard laboratory chow. 3. When the offspring of these rats reached adulthood they were mated with drug-free rats and the development of their offspring was monitored. 4. In comparison with female pups whose sires had been exposed to alcohol in utero, the weight of pups descended from fetally-exposed dams increased more slowly from day 1 to day 7. 5. At five days of age, significant differences favouring the two control groups were found in latency to right for pups descended from fetally-exposed dams. 6. These data suggest that the effects of prenatal exposure to alcohol are more pervasive than previously thought and affect female pups to a greater extent than males.

Evoked potential estimation using modified time-sequenced adaptive filter

A method called modified time-sequenced adaptive filtering (MTSAF) is applied to estimate evoked potential (EP) signals and track the temporal variations of EPs. The MTSAF consists of a set of adaptive filters (AFs), with each processing a time segment of EP data. After convergence, each AF reaches the best estimation of EP signals over its own time segment in terms of minimum mean squared error (MMSE). Numerical results of simulated and human EP data show that the MTSAF reaches better estimation of EPs than a conventional adaptive signal enhancer (ASE). With the MTSAF, the temporal variations of EPS across trials can be estimated to reveal more subtle variations of EPs, which may be of clinical value.

Water and sodium disorders following surgical excision of pituitary region tumours

A prospective observational study of the pathophysiology of sodium and water disorders in patients with pituitary region tumours after surgical excision was carried out in 20 patients. Serial pre-operative and post-operative fluid and sodium balance, plasma and urine elctrolyte biochemistry and their derived parameters, and circulating hormones associated with fluid balance, atrial natriureic peptide (ANP) and antidiuretic hormone (ADH) were documented to correlate with the patients' clinical conditions. Ten out of these twenty cases developed diabetes insipidus (DI) requiring ADH replacement therapy, although in the majority (6 cases), this way only a transient event. Of the nine patients who developed hyponatraemia, six had symptoms such as impaired consciousness and convulsions. Four patients developed alternating hypoatraemia and hypernatraemia, which constituted a difficult group, where appropriate sodium and fluid management, and ADH replacement therapy were based upon twice daily plasma and urine biochemistry and their derived parameters. Whilst DI in this group of patients was the result of a low circulating ADH level, hyponatraemia was not associated with an exaggerated ADH activity (6.0 +/- 2.3 vs 7.4 +/- 2.3 pmol/ml, mean +/- SEM). Rather, hyponatraemia was strongly associated with an elevated circulating ANP concentration (82.4 +/- 10.5 vs 30.0 +/- 3.1 pmol/ml, mean +/- SEM, p < 0.001), resulting in salt wasting and hypovolaemia.

Blood-retinal barrier breakdown following experimental retinal ischemia and reperfusion

The purpose of this study was to examine the effects of acute ischemia and reperfusion on blood-retinal barrier (BRB) function in the rabbit eye. Hydrostatic pressure (140 mmHg) was used to create total retinal ischemia for intervals of 20, 40, 60, 80 or 100 min in the rabbit eye. The location, size and permeability-surface-area product normalized to the area of retinal leakage (PS') of ischemia-induced BRB lesions were then measured using contrast-enhanced magnetic resonance imaging (MRI) after various intervals of reperfusion. Diffuse outer BRB leakage occurred in most eyes subjected to 80 or 100 min of ischemia. A posterior region of outer BRB sparing was found in eyes that underwent lesser durations of ischemia. On day 1 after retinal ischemia, a linear relationship was found between mean PS' and duration of ischemia for periods of ischemia between 20 and 100 min [slope: 5.65 x 10(-6) to 5.96 x 10(-6) cm min-1 (min ischemia)-1; r2 > or = 0.69]. Lesion size also increased between 20 and 100 min of ischemia. In a longitudinal study, eyes exposed to 60 min of ischemia showed a decrease in PS' and a lesion size over an 8-week period of observation. However, leakage was still present on post-ischemia day 57 in two of three eyes examined. Data obtained in these experiments are expected to prove useful in future studies aimed at understanding how BRB damage relates to neuroretinal damage after ischemia-reperfusion injury.

Measurement of blood-retinal barrier breakdown in endotoxin-induced endophthalmitis

PURPOSE

Endophthalmitis is a severe inflammatory disorder with profound visual consequences. Treatment of this disorder has been limited by the lack of quantitative information regarding retinal responses to severe inflammation. The purpose of this study was to measure the effect of endotoxin-induced endophthalmitis on blood-retinal barrier (BRB) function in vivo using contrast-enhanced magnetic resonance imaging (MRI).

METHODS

Endophthalmitis was produced by injecting Escherichia coli endotoxin into the midvitreous of pigmented rabbits. Contrast-enhanced MRI was performed at selected intervals thereafter. In all cases, a clinical grading system was used to assess the severity of inflammation before imaging. In a dose-response experiment, total vitreous protein was measured from vitreous specimens obtained 1 day after endotoxin injection and immediately after the imaging procedure.

RESULTS

At 1 day after injection, endotoxin produced a selective breakdown of the inner BRB at all doses evaluated (0.01 microgram to 500 micrograms). Permeability-surface area product normalized to the area of leaky retina (PS') increased from 1.35 +/- 0.78 x 10(-4) cm/minute (mean +/- SEM, n = 4 eyes) at a dose of 0.01 microgram to 8.15 +/- 2.22 x 10(-4) cm/minute n = 4) eyes) at a dose of 10 micrograms. Inner BRB integrity was restored by day 28 after injection. In general, changes in PS', blood-aqueous barrier leakage, mean clinical score, and vitreous protein concentration were found, but the correlation between any two of these parameters was poor.

CONCLUSION

Leakage of contrast appears early in the course of endotoxin-induced endophthalmitis and is a self-limited process. In future studies, these quantifiable changes in BRB permeability should prove useful in the assessment of various therapeutic interventions.

Developing a Chinese version of the psychoeducational profile (CPEP) to assess autistic children in Hong Kong

The Psychoeducational Profile (PEP) has been used to assess the developmental functioning and behavior of autistic children in the West. To examine its suitability for assessing autistic children in Hong Kong, the PEP was translated into Chinese and certain items were adapted for local conditions. The Chinese version of the PEP (CPEP) was administered to 23 autistic children and 40 children with normal development, ranging in age from 3 to 7 years. Some of the children were also given the Merrill-Palmer Scale of Mental Tests. Results indicated that CPEP scores correlated significantly with Merrill Palmer scores, demonstrating criterion-related validity. Significant positive correlations were also found between age and CPEP scores for children with normal development, verifying that the CPEP has properties of a developmental scale. There was also a significant difference between children with normal development and children with autism on the Pathology scale, suggesting that the scale has discriminant validity.

Relationship between dietary and biochemical measures of nutritional status in HANES I data

Data from the first National Health and Nutrition Examination Survey were examined for individual 24-h dietary intakes of protein, vitamin A, thiamin, riboflavin, and iron, and for laboratory indices of the same nutrients in blood and urine. Mean intake values were close to or above reference standards for all nutrients except iron. Substandard laboratory values were recorded for: serum albumin and vitamin A--less than 3% of subjects; urinary thiamin/creatinine excretion--3 and 8% of white and Black subjects, respectively; Hb, hematocrit, and percentage transferrin saturation--5 to 15% of whites and 18 to 27% of Black subjects; serum iron--less than 6% of subjects. Individual dietary recall data were of limited value in predicting the laboratory indices; regression analyses indicated that sociodemographic variables may be of greater predictive value.