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· Differences in the clinical course of intensive care unit (ICU) admitted male and female patients with serve coronavirus disease 2019 (COVID-19) has not been investigated. · We aimed to investigate, in a large global population of ICU admitted COVID-19 patients, the impact of sex on ICU mortality and complications. · Males experienced critical illness that was protracted and required intervention more often than females. · Males had higher odds of developing cardiac arrest and pulmonary embolism, as a complication of COVID-19. · Future investigators ought to evaluate sex-differences in the long-term recovery of patients admitted to ICU with COVID-19. Sex differences in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) susceptibility, illness severity, and hospital course are widely acknowledged. The effects of sex on outcomes experienced by patients with severe Coronavirus Disease 2019 (COVID-19) admitted to the intensive care unit (ICU) remains unknown. To determine the effects of sex on ICU mortality in patients with COVID-19 This retrospective analysis of an international multi-center prospective observational database included adults admitted to ICU for treatment of acute COVID-19 between 1st January 2020 and 30th June 2022. The primary outcome was ICU mortality. Multivariable Cox regression was used to ascertain the hazard of death (Hazard Ratio=HR) adjusted for pre-selected covariates. The secondary outcome was sex differences in complications of COVID-19 during hospital stay. Overall, 10,259 patients (3,314 females, 6,945 males) were included with a median age of 60 (interquartile range [IQR]=49–68) and 59 (IQR=49–67) years, respectively. Baseline characteristics were similar between sexes. More females were non-smokers (65% vs. 44 %, p < 0.01) and obese (39% vs. 30 %, p < 0.01), compared to males. Also, males received greater ICU intervention (mechanical ventilation, prone ventilation, vasopressors, and tracheostomy) than females. Males had a greater hazard of death (compared to females, HR=1.14; 95 % CI=1.02–1.26). Adjustment for complications during hospital stay did not alter the hazard of death (HR=1.16; 95 % CI=1.05–1.28). Males had a significantly elevated hazard of death among patients who received ECMO (HR=1.24; 95 % CI=1.01–1.53). Male sex was associated with cardiac arrest (adjusted OR [aOR]=1.37; 95 % CI=1.16–1.62) and PE (aOR=1.28; 95 % CI=1.06–1.55). Among patients admitted to ICU for severe COVID-19, males experienced higher severity of illness and more frequent intervention than females. Ultimately, the hazard of death was moderately elevated in males compared to females despite greater PE and cardiac arrest. [ABSTRACT FROM AUTHOR]

• Global income inequality and disparities of healthcare resources have been exacerbated by the pandemic. • Coronavirus disease-2019 (COVID-19) causes severe respiratory distress as well as a slew of additional systemic consequences that affect several organ systems, including neurological complications. Ischemic stroke represents the most common neurological complication of respiratory failure due to COVID-19. • Stroke incidence per admitted days in patients with respiratory failure due to COVID-19 was low in high income countries (HICs) and low-middle income countries (LMICs) although the stroke risk was higher in LMICs. • Both LMIC status and stroke increased the risk of death in patients with respiratory failure due to COVID-19. We aimed to compare the incidence of stroke in low-and middle-income countries (LMICs) versus high-income countries (HICs) in critically ill patients with COVID-19 and its impact on in-hospital mortality. International observational study conducted in 43 countries. Stroke and mortality incidence rates and rate ratios (IRR) were calculated per admitted days using Poisson regression. Inverse probability weighting (IPW) was used to address the HICs vs. LMICs imbalance for confounders. 23,738 patients [20,511(86.4 %) HICs vs. 3,227(13.6 %) LMICs] were included. The incidence stroke/1000 admitted-days was 35.7 (95 %CI = 28.4–44.9) LMICs and 17.6 (95 %CI = 15.8–19.7) HICs; ischemic 9.47 (95 %CI = 6.57–13.7) LMICs, 1.97 (95 %CI = 1.53, 2.55) HICs; hemorrhagic, 7.18 (95 %CI = 4.73–10.9) LMICs, and 2.52 (95 %CI = 2.00–3.16) HICs; unspecified stroke type 11.6 (95 %CI = 7.75–17.3) LMICs, 8.99 (95 %CI = 7.70–10.5) HICs. In regression with IPW, LMICs vs. HICs had IRR = 1.78 (95 %CI = 1.31–2.42, p < 0.001). Patients from LMICs were more likely to die than those from HICs [43.6% vs 29.2 %; Relative Risk (RR) = 2.59 (95 %CI = 2.29–2.93), p < 0.001)]. Patients with stroke were more likely to die than those without stroke [RR = 1.43 (95 %CI = 1.19–1.72), p < 0.001)]. Stroke incidence was low in HICs and LMICs although the stroke risk was higher in LMICs. Both LMIC status and stroke increased the risk of death. Improving early diagnosis of stroke and redistribution of healthcare resources should be a priority. ACTRN12620000421932 registered on 30/03/2020. [ABSTRACT FROM AUTHOR]

We sought to characterize the association between venovenous extracorporeal membrane oxygenation (VV-ECMO) bridging duration and outcomes in patients listed for lung transplantation. A retrospective observational study was conducted using the Organ Procurement and Transplantation Network (OPTN) database to identify adults (aged ≥18 years) who were listed for lung transplantation between 2016 and 2020 and were bridged with VV-ECMO. Patients were then stratified into groups, determined by risk inflection points, depending on the amount of time spent on pretransplant ECMO: group 1 (≤5 days), group 2 (6-10 days), group 3 (11-20 days), and group 4 (>20 days). Waiting list survival between groups was analyzed using Fine-Gray competing risk models. Posttransplant survival was compared using Cox regression. Of 566 eligible VV-ECMO bridge-to-lung-transplant patients (median age, 54 years, 49% men), 174 (31%), 124 (22%), 130 (23%), and 138 (24%) were categorized as groups 1, 2, 3, and 4, respectively. Overall, median duration of VV-ECMO was 10 days (interquartile range, 1-211 days), and 178 patients (31%) died on the waiting list. In the Fine-Gray model, compared with group 1, patients bridged with longer ECMO durations in group 2 (subdistribution hazard ratio [SHR], 2.95; 95% CI, 1.63-5.35), group 3 (SHR, 3.96; 95% CI, 2.36-6.63), and group 4 (SHR, 4.33; 95% CI, 2.59-7.22, all P <.001) were more likely to die on the waiting list. Of 388 patients receiving a transplant, pretransplant ECMO duration was not associated with 1-year survival in Cox regression. Prolonged duration of ECMO bridging was associated with worse waiting list mortality but did not impact survival after lung transplant. Prioritization of very early transplantation may improve waiting list outcomes in this population. [ABSTRACT FROM AUTHOR]

Cannulation strategy, vasopressors, and hemolysis are important physiological factors that influence hemodynamics in extracorporeal membrane oxygenation (ECMO). We hypothesized these factors influence the discrepancy between oxygen saturation measured by pulse oximetry (Sp o 2) and arterial blood gas (Sa o 2) in patients on ECMO. We retrospectively analyzed adults (aged ≥18 years) on venoarterial or venovenous ECMO at a tertiary academic ECMO center. Sp o 2 −Sa o 2 pairs with oxygen saturation ≥70% and measured within 10 minutes were included. Occult hypoxemia was defined as Sa o 2 ≤88% with a time-matched Sp o 2 ≥92%. Adjusted linear mixed-effects modeling was used to assess the Sp o 2 −Sa o 2 discrepancy with preselected demographics and time-matched laboratory variables. Vasopressor use was quantified by vasopressor dose equivalences. Of 139 venoarterial-ECMO and 88 venovenous-ECMO patients, we examined 20,053 Sp o 2 −Sa o 2 pairs. The Sp o 2 −Sa o 2 discrepancy was greater in venovenous-ECMO (1.15%) vs venoarterial-ECMO (−0.35%, P <.001). Overall, 81 patients (35%) experienced occult hypoxemia during ECMO. Occult hypoxemia was more common in venovenous-ECMO (65%) than in venoarterial-ECMO (17%, P <.001). In linear mixed-effects modeling, Sp o 2 underestimated Sa o 2 by 9.48% in central vs peripheral venoarterial-ECMO (95% CI, −17.1% to −1.79%; P =.02). Higher vasopressor dose equivalences significantly worsened the Sp o 2 −Sa o 2 discrepancy (P <.001). In linear mixed-effects modeling, Sp o 2 overestimated Sa o 2 by 25.43% in single lumen–cannulated vs double lumen–cannulated venovenous-ECMO (95% CI, 5.27%-45.6%; P =.03). Higher vasopressor dose equivalences and lactate dehydrogenase levels significantly worsened the Sp o 2 −Sa o 2 discrepancy (P <.001). Venovenous-ECMO patients are at higher risk for occult hypoxemia compared with venoarterial-ECMO. A higher vasopressor requirement and different cannulation strategies (central venoarterial-ECMO; single-lumen venovenous-ECMO) were significant factors for clinically significant Sp o 2 −Sa o 2 discrepancy in both ECMO modes. [Display omitted] [ABSTRACT FROM AUTHOR]

The primary purpose of this study was to identify factors associated with the development of arterial line–related limb ischemia in patients on extracorporeal membrane oxygenation (ECMO). The authors also sought to characterize and report the outcomes of patients who developed arterial line–related limb ischemia. Retrospective cohort study. A single academic tertiary referral ECMO center. Consecutive patients who were treated with ECMO over 6 years. Use of arterial line. A total of 278 consecutive ECMO patients were included, with 19 (7%) patients developing arterial line–related limb ischemia during the ECMO run. Postcannulation Sequential Organ Failure Assessment (SOFA) (adjusted odds ratio [aOR] 1.20, 95% CI 1.08-1.32), Acute Physiology and Chronic Health Evaluation–II (aOR 0.84, 95% CI 0.74-0.95), and adjusted Vasopressor Dose Equivalence (aOR 1.03, 95% CI 1.01-1.05) scores were independently associated with the development of arterial line–associated limb ischemia. A SOFA score of ≥17 at the time of ECMO cannulation had an 80% sensitivity and 87% specificity for predicting arterial line–related limb ischemia. Arterial line–related limb ischemia is much more common in ECMO patients than in the typical intensive care unit setting. The SOFA score may be useful in identifying which patients may be at risk for arterial line–related limb ischemia. As this was a single-center retrospective study, these results are inherently exploratory, and prospective multicenter studies are necessary to validate these results. [ABSTRACT FROM AUTHOR]

Objective: There are no effective clinically applicable treatments for neuronal dysfunction after mild traumatic brain injury (TBI). Here, we evaluated the therapeutic effect of a new delivery method of mouse neural stem cell (mNSC) spheroids using a hydrogel, in terms of improvement in damaged cortical lesions and cognitive impairment after mild TBI. Methods: mNSCs were isolated from the subventricular zone and subgranular zone by a hydrogel-based culture system. GFP-transduced mNSCs were generated into spheroids and wrapped into a sheet for transplantation. Male C57BL/6J mice were randomly divided into four groups: sham operation, TBI, TBI with mNSC spheroids, and TBI with mNSC spheroid sheet transplantation covering the damaged cortex. Histopathological and immunohistochemical features and cognitive function were evaluated 7, 14, and 28 days after transplantation following TBI. Results: Hydrogel-based culture systems and mNSC isolation were successfully established from the adult mice. Essential transcription factors for NSCs, such as SOX2, PAX6, Olig2, nestin, and doublecortin (DCX), were highly expressed in the mNSCs. A transplanted hydrogel-based mNSC spheroid sheet showed good engraftment and survival ability, differentiated into TUJ1-positive neurons, promoted angiogenesis, and reduced neuronal degeneration. Also, TBI mice treated with mNSC spheroid sheet transplantation exhibited a significantly increased preference for a new object, suggesting improved cognitive function compared to the mNSC spheroids or no treatment groups. Conclusion: Transplantation with a hydrogel-based mNSC spheroid sheet showed engraftment, migration, and stability of delivered cells in a hostile microenvironment after TBI, resulting in improved cognitive function via reconstruction of the damaged cortex. : This study presents the therapeutic effect of a new delivery method of mouse neural stem cells spheroids using a hydrogel, in terms of improvement in damaged cortical lesions and cognitive impairment after traumatic brain injury. Collagen/fibrin hydrogel allowed long-term survival and migratory ability of NSCs spheroids. Furthermore, transplanted hydrogel-based mNSCs spheroids sheet showed good engraftment, migration, and stability of delivered cells in a hostile microenvironment, resulting in reconstruction of the damaged cortex and improved cognitive function after TBI. Therefore, we suggest that a hydrogel-based mNSCs spheroids sheet could help to improve cognitive impairment after TBI. [Display omitted] [ABSTRACT FROM AUTHOR]

As survival with extracorporeal membrane oxygenation (ECMO) therapy improves, it is important to study patients who do not survive secondary to withdrawal of life-sustaining therapy (WLST). The purpose of the present study was to determine the population and clinical characteristics of those who experienced short latency to WLST. Retrospective cohort study. Single academic hospital center. Adult ECMO patients. None. During the study period, 150 patients (mean age 54.8 ± 15.9 y, 43.3% female) underwent ECMO (80% venoarterial ECMO and 20% venovenous ECMO). Seventy-three (48.7%) had WLST from ECMO support (median five days), and 33 of those (45.2%) had early WLST (≤five days). Patients who underwent WLST were older (60.3 ± 15.3 y v 49.6 ± 14.7 y; p < 0.001) than those who did not undergo WLST and had greater body mass index (31.7 ± 7.6 kg/m2 v 28.3 ± 5.5 kg/m2; p = 0.002), longer ECMO duration (six v four days; p = 0.01), and higher Acute Physiology and Chronic Health Evaluation (25 v 21; p < 0.001) and Sequential Organ Failure Assessment (12 v 11; p = 0.037) scores. Family request frequently (91.7%) was cited as part of the WLST decision. WLST patients experienced more chaplaincy (89% v 65%; p < 0.001), palliative care consults (53.4% v 29.9%; p = 0.003), and code status change (do not resuscitate: 83.6% v 7.8%; p < 0.001). Nearly 50% of ECMO patients underwent WLST, with approximately 25% occurring in the first 72 hours. These patients were older, sicker, and experienced a different clinical context. Unlike with other critical illnesses, neurologic injury was not a primary reason for WLST in ECMO patients. [ABSTRACT FROM AUTHOR]

This study aims to find the evidence that polyethylene terephthalate (PET) is pertinent, with respect to the risk of thermal degradation during fueling, as a liner material of a type-4 composite cylinder for storing 6.8 L of compressed hydrogen. In particular, one type-4 cylinder with the PET liner of thickness 0.6 mm and one type-3 cylinder for comparison have simultaneously undergone 6 cycles of fast fueling (0.15 MPa/s) and fast defueling (0.55 MPa/s) with hydrogen gas in the range of 2 to 45 MPa. The hydrogen temperatures in cylinders, which were measured by a specially-devised thermocouple inserted in each cylinder, change within the range of −30.0 to 70.0 °C. Although the temperature in the type-4 cylinder rises higher than that in the type-3 cylinder due to the lower heat conductivity of PET, it does not exceed 85 °C, which is the limit set by the international standards, EC No. 79. Furthermore, from the measurements of the deformation by the laser displacement sensors, the type-4 cylinder swells less than the type-3 cylinder. The pressure-displacement analysis shows that the deformation of type-4 cylinders occurs reversibly, i.e., defueling makes the cylinder regain its previous shape. In essence, PET is safe against thermal degradation when applied as a liner of a 6.8 L type-4 cylinder for hydrogen storage. • Application of PET as a liner material of type-4 cylinder for compressed hydrogen storage up to 6.8 L and 30 MPa. • Hydrogen cycling test conducted simultaneously with type-4 cylinder for testing and type-3 cylinder for comparison. • Hydrogen temperatures and deformations of type-3 and type-4 cylinders are measured during the cycling test. • PET liner is not degraded by the repeated fueling. [ABSTRACT FROM AUTHOR]

[Display omitted] • The explosive puffing process affected the chemical properties of ginseng. • The explosive puffing after fermentation showed increased ginsenoside metabolites. • Puffed ginseng after fermentation showed better antioxidant activities. • Higher metabolite conversion of ginseng was associated with absorption rate. In this study, explosion puffing was attempted to convert ginsenosides after fermentation. Fermented ginseng was used to measure changes in ingredients including ginsenosides before and after explosive puffing, and changes in radical scavenging capacity and intestinal absorption were evaluated. Explosive puffing process (7.5 and 10 kgf cm−2) after fermentation showed significant changes in the content of major and minor ginsenosides and the radical scavenging activities compared to normal or fermentation ginseng. In the case of ginseng treated with puffing after fermentation, the amount of polyphenols absorbed into the intestine tended to increase significantly compared to normal or fermentation ginseng. In the transmittance of ginsenoside metabolite, explosive puffed ginseng showed a significant increase in transmittance after 3 h compared to normal and fermentation-treated ginseng. These results are expected that ginseng with increased absorption rate by explosive puffing treatment after fermentation will have higher activity than existing ginseng or fermented ginseng. [ABSTRACT FROM AUTHOR]

Background Context: Laminoplasty of the cervical spine is widely used as an effective surgical method to treat compressive myelopathy of the cervical spine; however, there is an adverse effect of kyphosis after surgery. The risk factors or predictors of kyphosis have not been sufficiently evaluated.Purpose: To assess the risk factors for kyphosis following laminoplasty.Study Design: Retrospective study.Patient Sample: Patients diagnosed with cervical spondylotic myelopathy (CSM) or ossification of the posterior longitudinal ligament (OPLL) who underwent laminoplasty between May 2011 and October 2018 were enrolled.Outcome Measures: Changes in lordosis and range of motion (ROM).Methods: Radiological imaging data were collected from simple neutral and flexion-extension radiographs at baseline and at 2-year follow-up. The ROM from the neutral position to complete flexion was defined as the flexion capacity, and the ROM from the neutral position to complete extension was defined as the extension capacity.Results: This study included 53 patients (mean age, 59.3 years). Multivariate linear regression analysis revealed that, the smaller the preoperative extension capacity, the greater was the decrease in lordosis (p=.025), while the larger the T1 slope, the greater was the decrease in lordosis following laminoplasty (p= .008). Correlation analysis revealed that C2-7 lordosis increased with increasing baseline T1 slope before surgery (p< .01). In patients with large preoperative C2-7 lordosis, the postoperative decrease in ROM tended to be greater (p= .028). However, the degree of lordosis and ROM reduction did not demonstrate a clear correlation with the clinical outcomes at 2 years after surgery.Conclusions: Kyphotic changes in the cervical spine following laminoplasty were related to preoperative radiological parameters. The greater the preoperative extension capacity, the lower was the decrease in lordosis, and the greater the T1 slope, the greater was the decrease in lordosis. [ABSTRACT FROM AUTHOR]

Acute brain injury (ABI) is common in venoarterial extracorporeal membrane oxygenation (VA-ECMO). One of the most common indications for use of VA-ECMO is postcardiotomy shock (PCS). The authors aimed to characterize the prevalence of ABI and its association with outcomes in this population. prospective observational. Single-center tertiary care university hospital. Fifty-two consecutive patients treated for PCS with VA-ECMO from November 2017 to March 2020. None. The median age of patients was 64 (interquartile range 44-84), 62% were male. Of 52 PCS patients treated with extracorporeal membrane oxygenation, 38% (n = 20) experienced acute brain injury. Ischemic stroke was the most common (n = 13, 25%). Patients with central versus peripheral cannulation experienced more ischemic and hemorrhagic strokes (8% v 38%, p = 0. 04). Patients with intracardiac thrombus experienced more brain injury (n = 4, 8% p = 0. 02). The in-hospital mortality in patients with brain injury was 90% (n = 18/20) compared to 78% (n = 25/32) in patients without brain injury. ABI is common in postcardiotomy VA-ECMO and associated with worse outcome. Patients with central recanalization experienced the majority of acute strokes. Intracardiac thrombus was significantly associated with acute brain injury. [ABSTRACT FROM AUTHOR]

• Syringomyelia is a rare but serious complication of tuberculous meningitis. • TB syringomyelia is often refractory to both surgical and medical management. • Surgery does not have significantly better outcomes than medical management. Determinants of tuberculosis (TB) syringomyelia, its management options and outcomes are still under investigation. The aim of this study is to present a case of TB syringomyelia with markedly improved symptoms status-post surgery and to understand the clinical characteristics and outcomes of 33 TB syringomyelia cases reported in the literature. Specifically, we examined the differences between patients who were managed medically and those who underwent surgical intervention. Inclusion criteria for the cases were (1) syringomyelia caused by TB infection rather than co-occurrence of these conditions, (2) management protocol described, and (3) post-treatment outcome described. The median age was 30 years (interquartile range (IQR): 23–40) with 55% males. The median time between TB onset to syringomyelia diagnosis was 2 years. Nineteen patients were surgically treated, 11 were medically treated, and 3 received no treatment. Twenty-one patients showed improvement in at least one prior symptom, but no patient experienced a full recovery. Those that underwent surgical intervention were more likely to have TB meningitis (95% vs. 64%, p < 0.05) upon initial TB presentation and have a greater interval between TB onset and syringomyelia presentation (median of 2.6 vs. 0.33 years, ns). A greater proportion of the surgically managed patients experienced improvement in any symptom (74% vs. 45%, ns). Future case-controlled studies with larger sample sizes are required to validate and further understand the outcomes of surgically-managed TB syringomyelia. [ABSTRACT FROM AUTHOR]

A lightweight type 4 vessel with a polyethylene terephthalate (PET) liner is analyzed. The derived heat transfer coefficients between the gas and wall are applied, and a parametric study is performed. An optimized charging strategy is also developed. Firstly, when the injected hydrogen temperature decreases, the charging time increases, and the charged gas temperature decreases. Secondly, the higher the ambient temperature, the shorter the charging time, and the higher the charged gas temperature. Thirdly, the larger the mass flow rate, the shorter the charging time, and the higher charged gas temperature. Fourthly, as the initial pressure inside the vessel increases, the charging time shortens, and the charged gas temperature decreases. Fifthly, using the formulated charging strategy, during summer, the charged gas temperature decreases by approximately 9 °C. In winter, the charging time is reduced by approximately 58 s. The results provide important information of temperature control for ensuring vessel safety. • The temperature characteristics of a lightweight type 4 vessel are analyzed. • The parametric study is performed using the formulated heat transfer coefficient. • The optimized charging strategy lowers the gas temperature after charging in summer. • The optimized charging strategy lowers the charging time in winter. [ABSTRACT FROM AUTHOR]

Stroke is a devastating morbidity associated with left ventricular assist device (LVAD) support. We report a comprehensive analysis of stroke subtypes in the ENDURANCE destination therapy (DT) and ENDURANCE Supplemental (DT2) trials. Patients in the combined HeartWare LVAD (HVAD) cohorts of the DT and DT2 trials were included. Neurologic events included ischemic stroke (ischemic cerebrovascular accident [ICVA]), hemorrhagic stroke (hemorrhagic cerebrovascular accident [HCVA]), and transient ischemic attack (TIA). Peri-operative strokes were defined as occurring within 2 weeks of the implant. A total of 604 patients received an HVAD in the DT (n = 296) and DT2 (n = 308) trials. Over 2 years, 178 (29.5%) had at least 1 cerebrovascular accident (CVA). Forty-four (7.3%) had HCVAs, 116 (19.2%) had ICVAs, and 44 (7.3%) had TIAs. Thirty (5.0%) had peri-operative stroke. In multivariable analysis, sub-therapeutic international normalized ratio (INR) values were independently associated with peri-operative stroke. Supra- and/or sub-therapeutic INR values, peripheral vascular disease, and presence of left ventricular thrombus were independently associated with ICVA. No aspirin and supra- and/or sub-therapeutic INR values were independently associated with TIA. No aspirin, supra- and/or sub-therapeutic INR values, and prior stroke and/or TIA were associated with HCVA. In further analysis, mean arterial pressure (MAP) was higher in the ICVA (86.8mm Hg, p = 0.002 4) and TIA (88.8mm Hg, p <0.0001) groups, but not in HCVA, than in the No-CVA group (81.4mm Hg). Time in therapeutic range for INR was 65.3% for the No-CVA group, 62.9% (p = 0.59) for HCVA, 65.1% (p = 0.97) for ICVA, and 63.2% (p = 0.62) for TIA. Supra- and sub-therapeutic INR values at the time of CVA were associated with all stroke subtypes >14 days post-implant. MAP was higher among those with ICVA and TIA but not with HCVA compared to without CVA. Our study demonstrates the challenges of anti-thrombotic therapy and blood pressure management in LVAD population. [ABSTRACT FROM AUTHOR]

• Self-reported patient hand hygiene rates are suboptimal. • There are knowledge gaps among patients as to when to perform hand hygiene. • Patients are not receptive to receiving traditional educational interventions. • Intervention foci may include bedside hand sanitizer, reminders, or role modeling. Pathogens may be transmitted in hospitals via patients' own hands, but little is known about the facilitators and barriers of hand hygiene among inpatients. This study aimed to assess the hand hygiene knowledge, attitudes, and practices of adult inpatients at 5 hospitals. The study consisted of a cross-sectional survey distributed followed by structured interviews with randomly selected inpatients. Qualitative data were analyzed independently by 2 researchers using the Theoretical Domains Framework. A total of 268 surveys were completed, with 66.4% of patients reporting always performing hand hygiene after toileting and 49.2% before eating. The majority of patients (74.6%) stated that they did not want to receive more information about hand hygiene while in the hospital. Key themes identified from 23 interviews include knowledge; environmental context and resources; memory, attention, and decision processes; and social influences. Self-reported patient hand hygiene rates are suboptimal and there are knowledge gaps among patients as to when to perform hand hygiene, but patients are not receptive to receiving traditional educational interventions. Future interventions to improve patient hand hygiene should focus on other behavior change domains, including environmental context and resources (eg, access to hand sanitizer at the bedside), memory, attention, and decision processes (eg, posters or other reminders), and social influences (eg, role modeling). [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the safety of acute ischemic stroke (AIS) therapy in patients with infective endocarditis (IE) with intravenous thrombolysis (IVT) or endovascular therapy (EVT) such as mechanical thrombectomy.Methods: We conducted a retrospective study of patients who underwent AIS therapy with IVT or EVT at a tertiary referral center from 2013 to 2017, that were later diagnosed with acute IE as the causative mechanism. We then performed a systematic review of reports of acute ischemic reperfusion therapy in IE since 1995 for their success rates in terms of neurological outcome, and mortality, and their risk of hemorrhagic complication.Results: In the retrospective portion, 8 participants met criteria, of whom 4 received IVT and 4 received EVT. Through systematic review, 24 publications of 32 participants met criteria. Combined, a total of 40 participants were analyzed: 18 received IVT alone, 1 received combined IVT plus EVT, and 21 received EVT alone. IVT compared to EVT were similar in rates of good neurologic outcomes (58% versus 76%, P= .22) and mortality (21% versus 19%, P= .87), but had higher post-therapy intracranial hemorrhage (63% versus 18% [P= .006]).Conclusion: IV thrombolysis has a higher rate of post-therapy intracranial hemorrhage compared to EVT. EVT should be considered as first-line AIS therapy for patients with known, or suspected, IE who present with a large vessel occlusion. [ABSTRACT FROM AUTHOR]

Little data exist regarding reversal and resumption of antithrombotics after left ventricular assist device (LVAD)–associated intracranial hemorrhage. Prospectively collected data of LVAD patients with intracranial hemorrhage were reviewed. Coagulopathy reversal agents, antithrombotic regimens, and thrombotic (venous thromboembolism, ischemic stroke, myocardial infarction) and hemorrhagic (recurrent intracranial hemorrhage, gastrointestinal bleed, anemia requiring transfusion) complications were recorded. Of 405 patients, intracranial hemorrhage occurred in 39 (10%): 23 intracerebral hemorrhages, 10 subarachnoid hemorrhages, and 6 subdural hematomas. Of 27 patients who received antithrombotic reversal, 8 (30%) had inadequate coagulopathy reversal, and 3 of these patients had hemorrhage expansion or died before repeat imaging. One (4%) patient had a thrombotic complication (deep vein thrombosis). Antithrombotic therapy was resumed in 17 (100%) survivors in a median time 8 days for antiplatelet agents and 14 days for warfarin. Recurrent intracranial hemorrhage occurred within a median of 7 days of antithrombotic resumption, while ischemic stroke occurred in a median of 428 days. Patients who resumed antiplatelets alone (n = 4) had a trend toward more thrombotic events (1.37 versus 0.14 events/patient-year [EPPY]; p = 0.08), including more fatal thrombotic events (0.34 EPPY versus 0.08 EPPY; p = 0.89) compared with those resuming warfarin ± antiplatelet (n = 14). Nonfatal hemorrhage event rates were 0.34 EPPY in the warfarin ± antiplatelet versus 0 EPPY in the antiplatelet-alone group (p = 0.16). No fatal hemorrhagic events occurred. Reversal of anticoagulation appears safe after LVAD-associated intracranial hemorrhage, though inadequate reversal was common. Resumption of warfarin ± antiplatelet was associated with fewer fatal and nonfatal thrombotic events compared with antiplatelets alone, though more nonfatal hemorrhage events occurred. [ABSTRACT FROM AUTHOR]

Skull fractures caused by birth injury are mainly compression and linear fractures, but the incidence is known to be rare. It has been recently suggested, however, that greenstick fractures (GSFs) are more common than compression or linear fractures that are detected through 3-dimensional reconstructed computed tomography. Therefore, this study was conducted to determine the correlation of GSF with perinatal factors, the accompanying head injury factors, and the long-term outcomes in neonates. A retrospective study was conducted on correlations between GSF and perinatal and head injury factors for 295 neonates. In 160 neonates, the correlation with long-term outcome was investigated. In 295 neonates, 47 cases had 3 or fewer GSFs, 66 cases had 4–6, 82 cases had 7–9, and 100 cases had 10 or more. The number of GSFs was significantly associated with gestational age and mode of delivery among the perinatal factors, with brain swelling and cephalohematoma among the head injury factors. It was also associated with long-term outcomes. The cut-off value of the number of GSFs for a poor outcome by the area under the receiver operating characteristic curve was 6 or greater. It was concluded that GSF most commonly occurs as a birth-related skull fracture and that birth-related GSF is associated with perinatal factors, birth-related head injuries, and deterioration of long-term development. Therefore, efforts should be made to prevent GSF at birth. [ABSTRACT FROM AUTHOR]