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Abdominal seat belt sign (SBS) has historically entailed admission and observation because of the diagnostic limitations of computed tomography (CT) imaging and high rates of hollow viscus injury (HVI). Recent single-institution, observational studies have questioned the utility of this practice.To evaluate whether a negative CT scan can safely predict the absence of HVI in the setting of an abdominal SBS.This prospective, observational cohort study was conducted in 9 level I trauma centers between August 2020 and October 2021 and included adult trauma patients with abdominal SBS.Inclusion in the study required abdominal CT as part of the initial trauma evaluation and before any surgical intervention, if performed. Results of CT scans were considered positive if they revealed any of the following: abdominal wall soft tissue contusion, free fluid, bowel wall thickening, mesenteric stranding, mesenteric hematoma, bowel dilation, pneumatosis, or pneumoperitoneum.Presence of HVI diagnosed at the time of operative intervention.A total of 754 patients with abdominal SBS had an HVI prevalence of 9.2% (n = 69), with only 1 patient with HVI (0.1%) having a negative CT (ie, none of the 8 a priori CT findings). On bivariate analysis comparing patients with and without HVI, there were significant associations between each of the individual CT scan findings and the presence of HVI. The strongest association was found with the presence of free fluid, with a more than 40-fold increase in the likelihood of HVI (odds ratio [OR], 42.68; 95% CI, 20.48-88.94; P .001). The presence of free fluid also served as the most effective binary classifier for presence of HVI (area under the receiver operator characteristic curve [AUC], 0.87; 95% CI, 0.83-0.91). There was also an association between a negative CT scan and the absence of HVI (OR, 41.09; 95% CI, 9.01-727.69; P .001; AUC, 0.68; 95% CI, 0.66-0.70).The prevalence of HVI among patients with an abdominal SBS and negative findings on CT is extremely low, if not zero. The practice of admitting and observing all patients with abdominal SBS should be reconsidered when a high-quality CT scan is negative, which may lead to significant resource and cost savings.

YouTube is the most used platform for case preparation by surgical trainees. Despite its popular use, studies have noted limitations in surgical technique, safety, and vetting of these videos. This study identified the most viewed laparoscopic cholecystectomy (LC) videos on YouTube and analyzed the ability of attendings, residents, and medical students to identify critical portions of the procedure, technique, and limitations of the videos. An incognito search was conducted on YouTube using the term “laparoscopic cholecystectomy.” Results were screened for length, publication date, and language. The top ten most viewed videos were presented to general surgery attendings, residents, and medical students at a single academic institution. Established rubrics were used for evaluation, including the Critical View of Safety (CVS) for LC, a modified Global Operative Assessment of Laparoscopic Skills (GOALS) score, a task-specific checklist, and visual analog scales for case difficulty and operator competence. Educational quality and likelihood of video recommendation for case preparation were evaluated using a Likert scale. Attending assessments were considered the gold standard. Six attending surgeons achieved excellent internal consistency on CVS, educational quality, and likelihood of recommendation scales, with Cronbach alpha (⍺) of 0.93, 0.92, and 0.92, respectively. ⍺ was ≥ 0.7 in all the other scales measured. Attending evaluations revealed that only one of the ten videos attained all three established CVS criteria. Four videos demonstrated none of the CVS criteria. The mean educational quality (mEQ) was 4.63 on a 10-point scale. The mean likelihood of recommendation (mLoR) for case preparation was 2.3 on a 5-point scale. Senior resident assessments (Postgraduate Year (PGY)4 + , n = 12) aligned with attending surgeons, with no statistically significant differences in CVS attainment, mEQ, and mLoR. Junior residents (PGY1-3, n = 17) and medical students (MS3-4, n = 20) exhibited significant difference with attendings in CVS attainment, mEQ, and mLoR for more than half the videos. Both groups tended to overrate videos compared to attendings. YouTube is the most popular unvetted resource used for case presentation by surgical trainees. Attending evaluations revealed that the most viewed LC videos on YouTube did not attain the CVS, and were deemed as inappropriate for case preparation, with low educational value. Senior resident video assessments closely aligned with attendings, while junior trainees were more likely to overstate video quality and value. Attending guidance and direction of trainees to high-quality, vetted resources for surgical case preparation is needed. This may also suggest a need for surgical societies with platforms for video sharing to prioritize the creation and dissemination of high-quality videos on easily accessible public platforms.

Implosions of Hohlraum-driven double shell targets as an alternative inertial confinement fusion concept are underway at the National Ignition Facility. The double shell system relies on a series of energy transfer processes starting from thermal x-ray absorption by the outer shell, followed by collisional transfer of kinetic energy to a heavy metal inner shell, and finally, conversion to the internal energy of the deuterium-tritium fuel. During each of these energy transfer stages, low-mode asymmetries can act to reduce the ideal transfer efficiency degrading double shell performance. Mechanisms, such as hard x-ray preheat from the Hohlraum, not only decrease the efficiency of kinetic energy transfer but may also be a source of low-mode asymmetry. In this article, we evaluate the shape transfer processes through the time of shell collision using two-dimensional integrated Hohlraum and capsule computations. We find that the dominant mode of the shape transfer is well described using a “radial impulse” model from the shape of the foam pressure reservoir. To evaluate the importance of preheat on inner shell shape, we also report on first measurements of Au L-shell preheat asymmetry in a double shell with a tungsten pusher. These measurements showed a 65% higher preheat velocity at the pole of the capsule relative to the equator. We also found that the experiments provided rigorous constraints by which to test the Hohlraum model settings that impact the amount and symmetry of Au L-shell preheat via the plasma conditions inside the outer cone Au bubble.

Actinobacteria isolated from less studied sites on our planet represent a huge opportunity for the discovery of novel microorganisms that may produce unique compounds with biological activity. The class actinobacteria encompasses 80% of the microbes that produce the antibacterial compounds used in medicine today. However, the resistance acquired/showed by pathogenic microorganisms opens the opportunity to explore Mexican ecosystems as a source of novel actinobacteria. Air samples have shown to be an excellent site of study, marine ecosystems which include sediments and marine organisms are important sources of novel actinobacteria and soil samples are still a promising source to isolate this microbial group. The isolation of novel actinobacteria is a dynamic strategy that depends on the expertise, patience, and talent of the techniques applied and needs to be fully explored to untap the unknown actinobacterial diversity with potential in biology.

Free-standing, composite hydrogels containing the visible-light responsive metal-free semiconductor graphitic carbon nitride (g-C3N4) as an integral component have been fabricated by direct casting...

Prior observational studies suggest that aspirin use may be associated with reduced mortality in high-risk hospitalized patients with COVID-19, but aspirin's efficacy in patients with moderate COVID-19 is not well studied.To assess whether early aspirin use is associated with lower odds of in-hospital mortality in patients with moderate COVID-19.Observational cohort study of 112 269 hospitalized patients with moderate COVID-19, enrolled from January 1, 2020, through September 10, 2021, at 64 health systems in the United States participating in the National Institute of Health's National COVID Cohort Collaborative (N3C).Aspirin use within the first day of hospitalization.The primary outcome was 28-day in-hospital mortality, and secondary outcomes were pulmonary embolism and deep vein thrombosis. Odds of in-hospital mortality were calculated using marginal structural Cox and logistic regression models. Inverse probability of treatment weighting was used to reduce bias from confounding and balance characteristics between groups.Among the 2 446 650 COVID-19-positive patients who were screened, 189 287 were hospitalized and 112 269 met study inclusion. For the full cohort, Median age was 63 years (IQR, 47-74 years); 16.1% of patients were African American, 3.8% were Asian, 52.7% were White, 5.0% were of other races and ethnicities, 22.4% were of unknown race and ethnicity. In-hospital mortality occurred in 10.9% of patients. After inverse probability treatment weighting, 28-day in-hospital mortality was significantly lower in those who received aspirin (10.2% vs 11.8%; odds ratio [OR], 0.85; 95% CI, 0.79-0.92; P .001). The rate of pulmonary embolism, but not deep vein thrombosis, was also significantly lower in patients who received aspirin (1.0% vs 1.4%; OR, 0.71; 95% CI, 0.56-0.90; P = .004). Patients who received early aspirin did not have higher rates of gastrointestinal hemorrhage (0.8% aspirin vs 0.7% no aspirin; OR, 1.04; 95% CI, 0.82-1.33; P = .72), cerebral hemorrhage (0.6% aspirin vs 0.4% no aspirin; OR, 1.32; 95% CI, 0.92-1.88; P = .13), or blood transfusion (2.7% aspirin vs 2.3% no aspirin; OR, 1.14; 95% CI, 0.99-1.32; P = .06). The composite of hemorrhagic complications did not occur more often in those receiving aspirin (3.7% aspirin vs 3.2% no aspirin; OR, 1.13; 95% CI, 1.00-1.28; P = .054). Subgroups who appeared to benefit the most included patients older than 60 years (61-80 years: OR, 0.79; 95% CI, 0.72-0.87; P .001;80 years: OR, 0.79; 95% CI, 0.69-0.91; P .001) and patients with comorbidities (1 comorbidity: 6.4% vs 9.2%; OR, 0.68; 95% CI, 0.55-0.83; P .001; 2 comorbidities: 10.5% vs 12.8%; OR, 0.80; 95% CI, 0.69-0.93; P = .003; 3 comorbidities: 13.8% vs 17.0%, OR, 0.78; 95% CI, 0.68-0.89; P .001;3 comorbidities: 17.0% vs 21.6%; OR, 0.74; 95% CI, 0.66-0.84; P .001).In this cohort study of US adults hospitalized with moderate COVID-19, early aspirin use was associated with lower odds of 28-day in-hospital mortality. A randomized clinical trial that includes diverse patients with moderate COVID-19 is warranted to adequately evaluate aspirin's efficacy in patients with high-risk conditions.

Agricultural soil erosion, both mechanical and eolic, may impact cloud processes, as some aerosol particles are able to facilitate ice crystal formation. Given the large agricultural sector in Mexico, this study investigates the ice nucleating abilities of agricultural dust collected at different sites and generated in the laboratory. The immersion freezing mechanism of ice nucleation was simulated in the laboratory via the Universidad Nacional Autónoma de México (UNAM) microorifice uniform deposit impactor (MOUDI) droplet freezing technique (DFT), i.e., UNAM-MOUDI-DFT. The results show that agricultural dust from the Mexican territory promote ice formation in the temperature range from −11.8 to −34.5 ∘C, with ice nucleating particle (INP) concentrations between 0.11 and 41.8 L−1. Furthermore, aerosol samples generated in the laboratory are more efficient than those collected in the field, with T50 values (i.e., the temperature at which 50 % of the droplets freeze) higher by more than 2.9 ∘C. Mineralogical analysis indicated a high concentration of feldspars, i.e., K-feldspar and plagioclase (>40 %), in most of the aerosol and soil samples, with K-feldspar significantly correlated with the T50 of particles with aerodynamic diameters between 1.8 and 3.2 µm. Similarly, the organic carbon (OC) was correlated with the ice nucleation efficiency of aerosol samples from 3.2 to 5.6 and from 1.0 to 1.8 µm. Finally, a decrease in INP efficiency after heating the samples at 300 ∘C for 2 h indicates that the organic matter from agricultural soils plays a predominant role in the ice nucleating abilities of this type of aerosol sample.

The Staphylococcus aureus’ SdrG protein is glycosylated by SdgA and SdgB for their protection against its degradation by the neutrophil’s cathepsin G. So far, there is not information about the role of Staphylococcus epidermidis’ SdgA nor SdgB in the production of biofilm, therefore the main of this work was to determine the distribution and expression of sdrG, sdgA and sdgB genes in S. epidermidis in conditions of biofilm. The frequency of the genes sdrG, sdgA and sdgB were evaluated by PCR in a collection of 75 isolates. The isolates were grown in dynamic conditions (in agitation) or static conditions (biofilm productor: planktonic or sessile cells). The expression of sdrG, sdgA and sdgB were determined by RT-qPCR in cells grown under dynamic conditions (CGDC), as well as planktonic and sessile cells, and in cells adhered to a catheter (in vivo). The genes sdrG and sdgB were detected in 100% of isolates, meanwhile the gene sdgA was detected in 71% of the samples (psdrG, sdgA and sdgB mRNAs. The planktonic and sessile cells expressed sdrG and sdgB, and the same was seen in cells adhered to the catheter. In particular, one isolate, able to induce biofilm under cathepsin G treatment, expressed sdrG and sdgB in planktonic, sessile and in cells adhered to the catheter. This suggests that the state of cells adherence is an important factor for the transcription of sdgA, sdgB and sdrG.

The Staphylococcus aureus SdrG protein is glycosylated by SdgA and SdgB for protection against its degradation by the neutrophil cathepsin G. So far, there is no information about the role of Staphylococcus epidermidis SdgA or SdgB in biofilm-forming; therefore, the focus of this work was to determine the distribution and expression of the sdrG, sdgA and sdgB genes in S. epidermidis under in vitro and in vivo biofilm conditions. The frequencies of the sdrG, sdgA and sdgB genes were evaluated by PCR in a collection of 75 isolates. Isolates were grown in dynamic (non-biofilm-forming) or static (biofilm-forming) conditions. The expression of sdrG, sdgA and sdgB was determined by RT-qPCR in cells grown under dynamic conditions (CGDC), as well as in planktonic and sessile cells from a biofilm and cells adhered to a catheter implanted in Balb/c mice. The sdrG and sdgB genes were detected in 100% of isolates, while the sdgA gene was detected in 71% of the sample (p 0.001). CGDC did not express sdrG, sdgA and sdgB mRNAs. Planktonic and sessile cells expressed sdrG and sdgB, and the same was observed in cells adhered to the catheter. In particular, one isolate, capable of inducing a biofilm under treatment with cathepsin G, expressed sdrG and sdgB in planktonic and sessile cells and cells adhering to the catheter. This suggests that bacteria require biofilm conditions as an important factor for the transcription of the sdgA, sdgB and sdrG genes.

A strain isolated from potato common scab superficial lesions in El Fuerte Valley in northern Sinaloa, Mexico, was identified by 16S rRNA and morphological methods. Moreover, the effects of the crude extract of strain V2 was evaluated on radish and potato. The isolate was similar to Streptomyces acidiscabies in its morphological properties; however, the 16S rRNA gene sequence of strain V2 was neither 100% identical to this species nor to the streptomycetes previously reported in Sinaloa, Mexico. Strain V2 did not amplify any specific PCR products for genes necl and tomA, which have been found and reported in S. acidiscabies. Strain V2 produced a PCR product for the txtAB operon, which is related to the production of thaxtomin. In vitro assays using crude thaxtomin extract and a spore suspension of the organism caused necrotic symptoms on radish and potato, which were highly virulent in potato. This study reports that Streptomyces sp. V2 has a toxigenic region (TR) that is associated with the thaxtomin gene cluster. Resumen Se aisló una cepa de una lesión superficial de sarna común de la papa en un ejemplar procedente del Valle del Fuerte, en el norte de Sinaloa, México. La cepa fue identificada por secuenciación del gen 16S ARNr, y por sus características morfológicas. Los efectos del extracto crudo de dicha cepa, llamada V2, fue evaluado en papa y rábano. El aislado fue similar a Streptomyces acidiscabies en sus características morfológicas, pero la secuencia del gen 16S ARNr de la cepa V2 no fue 100% idéntica a la de dicha especie, ni tampoco a las de cepas identificadas dentro de este taxón previamente en Sinaloa, México. La cepa V2 no amplificó los productos específicos de PCR de los genes nec1 y tomA, los cuales sí se han reportado en S. acidiscabies. La cepa V2 amplificó el producto de PCR para del operón txtAB, relacionado con la producción de taxtomina. A través de ensayos in vitro usando un extracto crudo de taxtomina y una suspensión de esporas del organismo aislado se verificó la producción de síntomas necróticos en rábano y papa, con mayor virulencia en esta última especie. Este estudio indica que Streptomyces sp. V2 tiene una región toxigénica (TR) asociada con el cluster de genes de taxtomina.

The three-component apsXRS system senses and responds to cationic antimicrobial peptides (CAMPs), which induces the expression of the dlt operon and the genes mprF and vrafG, modifying the surface net charge in Staphylococcus epidermidis, resulting in the repulsion of CAMPs. The apsXRS system has been only studied in the S. epidermidis 1457 strain, and there are no studies of prevalence and level of expression of apsXRS in commensal and clinical isolates. From 60 isolates, those selected from commensal healthy skin (n = 20), commensal healthy conjunctive (n = 10), and clinical ocular infection (n = 30) presented the apsX, apsR, and apsS genes in their genomes. Constitutive expression of apsX, apsR, and apsS genes was determined by RT-qPCR in all isolates. It was found that expression of apsX, apsR, and apsS was 3.3–5.9-fold higher in commensal isolates stimulated with LL-37 (15 µg/mL) than in clinical isolates. Similarly, expression of the dlt operon and the genes mprF, and vraFG was 8–10-fold higher in commensal isolates than in clinical. However, LL-37 did not increase the addition of lysine in the phospholipids of the cytoplasmic membrane in any of the isolates. Mutations in the apsS loop region, apsR, and their promoter sequence were not found. These results demonstrated that apsXRS system is essential in all isolates for its constitutive expression; however, LL-37 caused an increase of apsXRS expression in commensal isolates, suggesting that S. epidermidis isolates do not respond in the same way to the presence of LL-37.

Background Race is associated with differences in quality of care process measures and incidence of venous thromboembolism (VTE) in trauma patients. We aimed to investigate if racial disparities exist in the administration of VTE prophylaxis in trauma patients. Methods We queried the Trauma Quality Improvement Project database from 2017 to 2019. Patients ages ≥16 years old with ISS ≥15 were included. Patients with no signs of life on arrival, any AIS ≥6, hospital length of stay Results A total of 285,341 patients were included. Black patients had the highest rates of VTE prophylaxis exposure (73.8%), shortest time to administration (1.6 days), and highest use of low molecular weight heparin (56%). Black patients also had the highest incidence of deep vein thrombosis (2.8%) and pulmonary embolism (1.4%). Black patients were 4% more likely to receive VTE prophylaxis than white patients [adj. IRR (95% CI): 1.04 (1.03-1.05), P < .001]. American Indians were 8% less likely to receive VTE prophylaxis [adj. IRR (95% CI): .92 (.88-.97), P < .001] than white patients. No differences between white and Asian or Native Hawaiian or Pacific Islander patients existed. Discussion While black patients had the highest incidence of DVT and PE, they had higher administration rates and earlier initiation of VTE prophylaxis. Further work can elucidate modifiable causes of these differences.

YouTube is the most used platform for case preparation by surgical trainees. Despite its popular use, studies have noted limitations in surgical technique, safety, and vetting of these videos. This study identified the most viewed laparoscopic cholecystectomy (LC) videos on YouTube and analyzed the ability of attendings, residents, and medical students to identify critical portions of the procedure, technique, and limitations of the videos.An incognito search was conducted on YouTube using the term "laparoscopic cholecystectomy." Results were screened for length, publication date, and language. The top ten most viewed videos were presented to general surgery attendings, residents, and medical students at a single academic institution. Established rubrics were used for evaluation, including the Critical View of Safety (CVS) for LC, a modified Global Operative Assessment of Laparoscopic Skills (GOALS) score, a task-specific checklist, and visual analog scales for case difficulty and operator competence. Educational quality and likelihood of video recommendation for case preparation were evaluated using a Likert scale. Attending assessments were considered the gold standard.Six attending surgeons achieved excellent internal consistency on CVS, educational quality, and likelihood of recommendation scales, with Cronbach alpha (⍺) of 0.93, 0.92, and 0.92, respectively. ⍺ was ≥ 0.7 in all the other scales measured. Attending evaluations revealed that only one of the ten videos attained all three established CVS criteria. Four videos demonstrated none of the CVS criteria. The mean educational quality (mEQ) was 4.63 on a 10-point scale. The mean likelihood of recommendation (mLoR) for case preparation was 2.3 on a 5-point scale. Senior resident assessments (Postgraduate Year (PGY)4 + , n = 12) aligned with attending surgeons, with no statistically significant differences in CVS attainment, mEQ, and mLoR. Junior residents (PGY1-3, n = 17) and medical students (MS3-4, n = 20) exhibited significant difference with attendings in CVS attainment, mEQ, and mLoR for more than half the videos. Both groups tended to overrate videos compared to attendings.YouTube is the most popular unvetted resource used for case presentation by surgical trainees. Attending evaluations revealed that the most viewed LC videos on YouTube did not attain the CVS, and were deemed as inappropriate for case preparation, with low educational value. Senior resident video assessments closely aligned with attendings, while junior trainees were more likely to overstate video quality and value. Attending guidance and direction of trainees to high-quality, vetted resources for surgical case preparation is needed. This may also suggest a need for surgical societies with platforms for video sharing to prioritize the creation and dissemination of high-quality videos on easily accessible public platforms.

Background Traumatic duodenal injury is a rare, potentially devastating condition with challenging management decisions. Contemporary literature on operative management of duodenal injury is lacking. The purpose of this study is to assess optimal management strategies based on outcomes of patients with traumatic duodenal injury at a single trauma center. Methods A retrospective study of patients with traumatic duodenal injury from 2013-2020 at a level 1 trauma center was performed. Patient demographics, grade of injury as noted on CT scan or intraoperatively, surgical procedure(s) performed, and resultant outcomes were extracted. Results After excluding one patient due to death on arrival, 23 patients met inclusion criteria. Injuries consisted of grade 1 (n = 7), grade 2 (n = 2), grade 3 (n = 12), and grade 5 (n = 2); there were no grade 4 injuries. Patients were predominantly male (83%) with a median age of 30 years old. Nineteen patients (82%) underwent surgery. Four of nine patients (44%) with grade 1/2 injuries had hematomas and were managed non-operatively. The remaining five patients (56%) with grade 1/2 injuries underwent operation, which included primary repair (n = 3), duodenal exclusion (n = 1), and periduodenal drainage (n = 1). Of 12 patients with grade 3 injury, 6 underwent primary repair and 6 underwent resection. Three patients who underwent primary repair and one who underwent resection developed a duodenal leak. All patients with grade 5 injury (n = 2) underwent pancreaticoduodenectomy. Conclusion Grade 1 and 2 duodenal hematomas can be managed non-operatively, while lacerations require operative repair. Outcomes may be better following resection in patients with grade 3 injury.

Thoracic trauma continues to cause at least 25% of traumatic deaths in the USA, and many of these injuries cause death within the first minutes to hours following trauma. Mortality of thoracic injuries is second only to head injuries. Many deaths are preventable by prompt diagnosis and treatment given the vital structures that reside within the thoracic cavity. Injuries from chest trauma range from rib fractures requiring only pain control to cardiac lacerations with tamponade or exsanguinating hemorrhage. Given the range of injuries, acuity and clinical presentation, multiple diagnostic modalities, and treatment options exist for thoracic trauma. Thoracoscopic techniques have evolved from simple cavity washout through an existing chest tube site with evaluation of diaphragmatic injury to the currently used video-assisted thoracic surgery (VATS). Management of critical injuries by means of sternotomy or thoracotomy remains valuable procedures.

Biofouling causes major problems and economic losses to marine and shipping industries. In the search for new antifouling agents, marine bacteria with biosurfactants production capability can be an excellent option, due to the amphipathic surface-active characteristic that confers antimicrobial and antibiofilm activities. The aim of this study was to evaluate the antifouling activity of biosurfactants producing marine bacteria from the Gulf of California. The cell free culture supernatant (CFCS) of Bacillus niabensis (S-69), Ralstonia sp. (S-74) (isolated from marine sediment) and of B. niabensis (My-30) (bacteria associated to the sponge Mycale ramulosa) were screened for production of biosurfactants (using hemolysis and drop collapse test, oil displacement and emulsifying activity). The toxicity and antifouling activity were evaluated against biofoulers (bacteria forming biofilm and macrofoulers) both in laboratory and field assays. The results indicate that all bacteria were biosurfactant producers, but the higher capability was shown by B. niabensis (My-30) with high emulsifying properties (E24) of 71%. The CFCS showed moderate toxicity but were considered non-toxic against Artemia franciscana at low concentrations. In the antifouling assay, the CFCS of both strains of B. niabensis showed the best results for the reduction of the biofilm formation (up 50%) against all Gram-positive bacteria and most Gram-negative bacteria with low concentrations. In the field assay, the CFCS of B. niabensis (My-30) led to the reduction of 30% of biofouling compared to the control. The results indicate that the biosurfactant produced by B. niabensis (My-30) has promising antifouling activity.

Background Trauma centers are receiving increasing numbers of older trauma patients. There is a lack of literature on the outcomes for elderly trauma patients who undergo damage control laparotomy (DCL). We hypothesized that trauma centers with geriatric protocols would have better outcomes in elderly patients after DCL. Methods A retrospective chart review of consecutive adult trauma patients with DCL at 8 level 1 trauma centers was conducted from 2012 to 2018. Patients aged 40 or older were included. Age ≥ 55 years was defined as elderly. Demographics, injury information, clinical outcomes, including mortality, and complications were recorded. Univariate and multivariate analyses were performed. Results A total of 379 patients with DCLs were identified with an average age of 54.8 ± 0.4 years with 39.3% (n = 149/379) of patients aged ≥ 55. Geriatric protocols or a consulting geriatric service was present at 37.5% (n = 3/8) of institutions. Age ≥ 55 was a significant risk factor for in-hospital mortality (OR 2, 95% CI 1.0-4.0, P = .04). Institutions without dedicated geriatric trauma protocols/services had higher overall in-hospital mortality on both univariate (57.9% vs 34.3%, P = .02) and multivariate analyses (OR 2.1, 95% CI 1.3-3.4, P < .001). Conclusions Surgical management of older trauma patients remains a challenge. Geriatric protocols or dedicated services were found to be associated with improved outcomes. Future efforts should focus on standardizing the availability of these resources at trauma centers.

Objectives: To determine the presence of post-needling induced pain in subjects who had suffered a stroke and received trigger point (TrP) dry needling (DN), and to investigate the effects of including TrP-DN into a rehabilitation program for shoulder pain in this population. Methods: A randomized clinical trial was conducted. Sixteen patients who had suffered a stroke and presented with shoulder pain were randomly assigned to receive rehabilitation alone or rehabilitation combined with DN. Both groups received a neurorehabilitation session including modulatory interventions targeting the central nervous system. Patients in the DN group also received a single session of DN over active TrPs in the shoulder musculature. A numerical pain rating scale (NPRS, 0–10) was used to asses post-needling induced pain at 1 min, 24 h, and 72 h after needling. Shoulder pain (NPRS, 0–10) was assessed at baseline, and 3 and 7 days after DN in both groups. Results: Five (62%) patients receiving TrP-DN reported post-needling induced pain. Post hoc analysis found that post-needling induced pain decreased significantly at 24 and 72 h (both p Conclusion: This trial found that 50% of stroke patients receiving DN experienced post-needling induced pain, a side effect that almost disappeared 72 h after the intervention without any additional therapeutic action. In addition, the inclusion of TrP-DN into a rehabilitation session was effective at decreasing shoulder pain in these patients.

Rationale The contractile dysfunction that underlies heart failure involves perturbations in multiple biological processes ranging from metabolism to electrophysiology. Yet the epigenetic mechanisms that are altered in this disease state have not been elucidated. SWI/SNF chromatin-remodeling complexes are plausible candidates based on mouse knockout studies demonstrating a combined requirement for the BRG1 and BRM catalytic subunits in adult cardiomyocytes. Brg1 / Brm double mutants exhibit metabolic and mitochondrial defects and are not viable although their cause of death has not been ascertained. Objective To determine the cause of death of Brg1 / Brm double-mutant mice, to test the hypothesis that BRG1 and BRM are required for cardiac contractility, and to identify relevant downstream target genes. Methods and results A tamoxifen-inducible gene-targeting strategy utilizing αMHC-Cre-ERT was implemented to delete both SWI/SNF catalytic subunits in adult cardiomyocytes. Brg1 / Brm double-mutant mice were monitored by echocardiography and electrocardiography, and they underwent rapidly progressive ventricular dysfunction including conduction defects and arrhythmias that culminated in heart failure and death within 3 weeks. Mechanistically, BRG1/BRM repressed c - Myc expression, and enforced expression of a DOX-inducible c - MYC trangene in mouse cardiomyocytes phenocopied the ventricular conduction defects observed in Brg1 / Brm double mutants. BRG1/BRM and c-MYC had opposite effects on the expression of cardiac conduction genes, and the directionality was consistent with their respective loss- and gain-of-function phenotypes. To support the clinical relevance of this mechanism, BRG1/BRM occupancy was diminished at the same target genes in human heart failure cases compared to controls, and this correlated with increased c - MYC expression and decreased CX43 and SCN5A expression. Conclusion BRG1/BRM and c-MYC have an antagonistic relationship regulating the expression of cardiac conduction genes that maintain contractility, which is reminiscent of their antagonistic roles as a tumor suppressor and oncogene in cancer.

Healthcare-associated infections (HAIs) in critically ill patients are a serious public health problem. Extracorporeal membrane oxygenation (ECMO) has been used increasingly for patients with severe cardiac or respiratory failure, but it may increase HAI risk. The goal of our study was to characterize HAIs in ECMO patients at an ECMO referral center.This institutional review board-approved study identified all consecutive adult ECMO patients admitted to the cardiac surgery intensive care unit (CSICU) between January 1, 2015, and December 31, 2017. Demographic data, diagnosis, ECMO cannulation technique, and survival were collected. Urinary tract infection, pneumonia, and bacteremia incidence during ECMO and within 3 months of decannulation were collected. Outcomes of patients with HAIs were compared with noninfected patients, the CSICU infection incidence, and overall Extracorporeal Life Support Organization survival data.There were 288 ECMO patients and 3396 CSICU admissions during this period. Survival was 72.3% for venoarterial ECMO, 85.3% for venovenous ECMO, and 57.1% for multimodality or veno-arteriovenous ECMO, with discharge survival of 60.2%, 72.0%, and 28.6%, respectively. Bacteremia incidence while cannulated was 6.8% for venoarterial ECMO and 9.3% for venovenous ECMO. Bacteremia occurred in 22 of 288 (7.6%) ECMO patients, compared with 48 of 3109 (1.5%) in non-ECMO CSICU patients, which was statistically significant (P.002). Bacteremia and pneumonia were associated with decreased VA-ECMO survival, with prolonged overall requirements for ECMO support.Nosocomial ECMO infections are significantly higher than in other CSICU patients. Infection risk remains significant even after decannulation. Infection is associated with increased mortality and longer duration of ECMO support. Further efforts are needed to determine HAI reduction strategies in this high-risk patient population.

BACKGROUND Primary ovarian insufficiency (POI) and diminished ovarian reserve are two conditions that affect women’s fertility. Oocyte donation remains an option for these patients; however, the development of certain novel technologies, such as in vitro activation of ovarian cortex (IVA), enables the possibility of activating the pool of resting primordial follicles, increasing the chance of pregnancy. OBJECTIVE AND RATIONALE Here, we review the main pathways (PI3K and Hippo signaling) that govern the activation of primordial follicles and its application through the development of culture systems that support ovarian cortex for autologous transplantation. We also review the available data from case reports regarding outcomes of pregnancy and live birth rates with IVA. SEARCH METHODS A PubMed search was conducted using the PubMed-NCBI database to identify literature pertinent to the pathways involved in the activation of primordial follicles and the outcomes of IVA techniques from 2013 to the present. OUTCOMES Women with POI have around a 5% chance of spontaneous pregnancy. Recently, novel techniques involving the activation of primordial follicles through molecular pathways have been developed, thus increasing the odds of these patients. More recently, the introduction of a drug-free IVA technique has shown to increase the number of antral follicles with successful oocyte maturation after gonadotropin treatment, reaching pregnancy rates over 30%, either through spontaneous conception or by the implementation of assisted reproductive technology. LIMITATIONS The evidence of this review is based on a few small series, so data should be interpreted with caution, and only randomized controlled trials could estimate the real magnitude and success of the procedure. REASONS FOR CAUTION IVA technique remains an experimental strategy, with limited available data and the requirement of invasive procedures. Moreover, possible carcinogenic effects not yet determined after transplantation require special caution. WIDER IMPLICATIONS In view of the results achieved, IVA could provide a promising option for the preservation of fertility in some cancer patients and prepuberal girls where the only alternative is tissue cryopreservation. STUDY FUNDING/COMPETING INTERESTS The authors received no specific funding for this work and declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Exsanguinating trauma is a major cause of death from trauma. Fluid resuscitation strategies have evolved remarkably since the 1980’s. Crystalloids, particularly lactated Ringer’s solution, were the initial fluids of choice before administering blood products. Subsequent studies have demonstrated that balanced crystalloids are likely better than normal saline and that hypertonic saline or colloids have little benefit. For patients with severe hemorrhagic shock, however, early administration of blood products, including packed red blood cells, plasma, and platelets, as part of a damage control resuscitation strategy, improves outcomes. Large amounts of crystalloids should be avoided. Monitoring thromboelastography may help. In select patients, this strategy may include administration of tranexamic acid or prothrombin complex concentrates. For patients with evidence of ongoing hemorrhage, hypotensive or limited fluid resuscitation is appropriate until hemostasis has been achieved. Details of optimal fluids or blood pressure goals still need to be determined. Once hemostasis has been achieved, fluid resuscitation should continue in order to achieve appropriate endpoints, which may include normalization of vital signs and urine output, decreasing lactate level or base deficit, or a minimization of additional fluid responsiveness based upon echocardiography or pulse waveform analysis.

Three actinomycete strains, designated BL1, BL4, and CV4, were isolated from sediment samples from the Gulf of California in 2009 together with nearly 300 other actinobacteria. Genome mining and analysis of their ∼6.4-Mb sequences confirmed the bioprospecting potential of these three bacteria belonging to the genus Micromonospora.

Atmospheric aerosol particles that can nucleate ice are referred to as ice-nucleating particles (INPs). Recent studies have confirmed that aerosol particles emitted by the oceans can act as INPs. This very relevant information can be included in climate and weather models to predict the formation of ice in clouds, given that most of them do not consider oceans as a source of INPs. Very few studies that sample INPs have been carried out in tropical latitudes, and there is a need to evaluate their availability to understand the potential role that marine aerosol may play in the hydrological cycle of tropical regions. This study presents results from the first measurements obtained during a field campaign conducted in the tropical village of Sisal, located on the coast of the Gulf of Mexico of the Yucatan Peninsula in Mexico in January–February 2017, and one of the few data sets currently available at such latitudes (i.e., 21∘ N). Aerosol particles sampled in Sisal are shown to be very efficient INPs in the immersion freezing mode, with onset freezing temperatures in some cases as high as −3 ∘C, similarly to the onset temperature from Pseudomonas syringae. The results show that the INP concentration in Sisal was higher than at other locations sampled with the same type of INP counter. Air masses arriving in Sisal after the passage of cold fronts have surprisingly higher INP concentrations than the campaign average, despite their lower total aerosol concentration. The high concentrations of INPs at warmer ice nucleation temperatures (T>-15 ∘C) and the supermicron size of the INPs suggest that biological particles may have been a significant contributor to the INP population in Sisal during this study. However, our observations also suggest that at temperatures ranging between −20 and −30 ∘C mineral dust particles are the likely source of the measured INPs.

Objectives Fasciotomy to treat or prevent compartment syndromes in patients with truncal or peripheral arterial injuries is a valuable adjunct. The objective of this study was to document the current incidence, indications, and outcomes of below knee fasciotomy in patients with femoropopliteal arterial injuries. Methods The PROspective Observational Vascular Injury Treatment registry of the American Association for the Surgery of Trauma was utilized to identify patients undergoing two-incision four-compartment fasciotomy of the leg after repair of a femoropopliteal arterial injury. Outcomes after therapeutic versus prophylactic (surgeon label) fasciotomy were compared as was the technique of closure, that is, primary skin closure or application of a split-thickness skin graft (STSG). Results From 2013 to 2018, fasciotomy was performed in 158 patients overall, including 95.6% (151/158) at the initial operation. In the group of 139 patients who survived to discharge, fasciotomies were labeled as therapeutic in 58.3% (81/139) and prophylactic in 41.7% (58/139). There were no significant differences between the therapeutic and prophylactic groups in amputation rates (14.8% vs. 8.6%, P = .919). Primary skin closure was achieved at a median of 5.0 days vs. 11.0 days for STSG ( P = .001). Conclusions Over 55% of patients undergoing repair of an injury to a femoral or popliteal artery have a fasciotomy performed at the same operation. A “therapeutic” indication for fasciotomy continues to be more common than “prophylactic,” while outcomes are identical in both groups.

Desert mule deer (Odocoileus hemionus eremicus) densities in central Arizona are below historic levels, likely due to neonatal mortality influencing desert mule deer population dynamics. However, no direct assessments have been made into causes and timing of neonatal mortalities in central Arizona. The objectives of our study were to determine the causes and timing of mortalities of desert mule deer fawns, estimate the annual survival rate of adult females and fawns, and quantify predator effects on fawn survival. In 2007 and 2008 we captured 52 adult female desert mule deer and equipped pregnant females with vaginal implant transmitters to aid in capturing fawns. We performed survival analyses using Program MARK and compared competing models with Akaike's information criterion. We captured 44 desert mule deer fawns; summer survival was 0.432 (95% CI = 0.292–0.584) and annual fawn survival was 0.071 (95% CI = 0.013–0.303). Predation accounted for 64% of fawn mortality. Probability of fawn surviva...

The three-component apsXRS system senses and responds to cationic antimicrobial peptides (CAMPs), which induces the expression of the dlt operon and the genes mprF and vrafG, modifying the surface net charge in Staphylococcus epidermidis, resulting in the repulsion of CAMPs. The apsXRS system has been only studied in the S. epidermidis 1457 strain, and there are no studies of prevalence and level of expression of apsXRS in commensal and clinical isolates. From 60 isolates, those selected from commensal healthy skin (n = 20), commensal healthy conjunctive (n = 10), and clinical ocular infection (n = 30) presented the apsX, apsR, and apsS genes in their genomes. Constitutive expression of apsX, apsR, and apsS genes was determined by RT-qPCR in all isolates. It was found that expression of apsX, apsR, and apsS was 3.3–5.9-fold higher in commensal isolates stimulated with LL-37 (15 µg/mL) than in clinical isolates. Similarly, expression of the dlt operon and the genes mprF, and vraFG was 8–10-fold higher in commensal isolates than in clinical. However, LL-37 did not increase the addition of lysine in the phospholipids of the cytoplasmic membrane in any of the isolates. Mutations in the apsS loop region, apsR, and their promoter sequence were not found. These results demonstrated that apsXRS system is essential in all isolates for its constitutive expression; however, LL-37 caused an increase of apsXRS expression in commensal isolates, suggesting that S. epidermidis isolates do not respond in the same way to the presence of LL-37.

The concentration of biological particles in the atmosphere is widely variable because it depends on several meteorological and geographical factors. Meteorological conditions in tropical coastal cities are unique due to both marine and terrestrial influences that can strongly modify the concentration and diversity of airborne microorganisms. Nevertheless, very few studies have been conducted in tropical coastal cities. This study presents the comparative results from four field campaigns carried out between 2017 and 2018 in two tropical cities located in the Yucatan Peninsula (Mexico): Sisal (a village right on the coast) and Merida (the State capital, 48 km from the coastline). The concentration of bacteria and fungal propagules, in colony-forming units or CFU per m3, sampled in Merida and Sisal are not comparable despite their proximity (i.e., 48 km away); however, both show similar seasonality and inter-annual trends. The results indicate that terrestrial microbiota dominates over that of marine origin, and show that fungal propagules are the dominant microorganism present at both sites. Also, these results indicate that meteorological conditions in the rainy season are more favorable for the growth of microorganisms than dry cold conditions. The predominant culturable bacterial phylum sampled during the four field campaigns carried out in 2017 and 2018 in the Yucatan Peninsula were Actinobacteria, Firmicutes, and Proteobacteria. The fraction of bacteria that reacted to a Gram positive stain was 62% and to Gram negative 38%. The fungal propagules genera relative concentration varied between both sampling sites, with Cladosporium and Penicillium being the most common at the coast in Sisal and Aspergillus in Merida.

Atmospheric aerosol particles that can nucleate ice are referred to as ice nucleating particles (INP). Recent studies have confirmed that aerosol particles emitted by mid- and high-latitude oceans can act as INPs. This very relevant information can be included in climate and weather models to predict the formation of ice in clouds, given that most of them do not consider the oceans as a source of INPs. Very few studies to sample INPs have been carried out in tropical latitudes, and there is a need to evaluate their availability to understand the potential role that marine aerosol may play in the hydrological cycle of tropical regions. This study presents results from the first measurements obtained during a field campaign conducted in the topical village of Sisal, located on the coast of the Gulf of Mexico of the Yucatan peninsula in Mexico in January–February 2017, and one of the few data sets currently available at similar latitudes. Aerosol particles sampled in Sisal are shown to be very efficient INPs, with onset freezing temperatures as high as −3 °C (in some cases), similar to the onset temperature for Pseudomonas syringae. The results show that the INP concentration in Sisal is higher than at other locations sampled with the same type of INP counter. Air masses arriving in Sisal during the passage of cold fronts have, surprisingly, higher INP concentrations than the campaign-average, despite their lower total aerosol concentration. Biological particles were likely found to be very important in ice cloud formation at this tropical location, given the large concentration of INPs above −12 °C. A variety of bacteria and fungi were identified. Although the majority are of terrestrial origin, some of them are clearly oceanic.

Streptomyces sp. strain V2 was isolated from potato scab lesions in the state of Sinaloa, Mexico, and appears to be responsible for outbreaks in the area., Streptomyces sp. strain V2 was isolated from potato scab lesions in the state of Sinaloa, Mexico, and appears to be responsible for outbreaks in the area. The thaxtomin cluster was found in the ∼10.2-Mb genome; this cluster is associated with potato common scab disease in other potato pathogens.

Plantactinospora sp. strains BB1 and BC1 were isolated in 2009 from sediment samples of the Gulf of California from among almost 300 actinobacteria. Genome mining of their ∼8.5-Mb sequences showed the bioprospecting potential of these rare actinomycetes, providing an insight to their ecological and biotechnological importance.

We tested whether hardness or different wood carbon densities, considered as the concentration of carbon structural compounds, influence functional feeding groups and species richness of aquatic insects in a tropical stream. We expected that harder woods would harbor aquatic insect communities with species richness and functional food group profile different from softwoods. We also expected that collector-gatherers and collector-filterers will be more abundant in softwood because harder woods are less substrate suitable for biofilm production. Aquatic insects associated with the following plants were analyzed: Gomidesia lindeniana with high-density, Psychotria grandis with medium-density, and Meriania leucantha with low-density wood. Diptera and Ephemeroptera were the most abundant groups sampled in the woods. Psychotria grandis shows higher concentrations of lignin, cellulose, and hemicellulose, followed by G. lindeniana and M. leucantha. Breakdown rates are different among plant species with M. leucantha having four times highest breakdown rates and on average three more species in the species richness value. We did not find significant differences in the composition of insect species associated with the plants. We found evidence that the richness and functional organization of aquatic insect communities were mostly related to the breakdown rates and lignin amount of the woods. Plants that decompose faster on average have three more species and two more insect functional groups. Our findings suggest that the loss of high carbon density trees in tropical forests can affect aquatic biodiversity.

Acute myocardial infarction (AMI) results in systolic dysfunction, myocarditis and fibrotic remodeling, which causes irreversible pathological remodeling of the heart. Associated cell death and inflammation cause cytokine release, which activates the p38 MAPK signaling pathway to propagate damaging signals via MAPKAP kinase 2 (MK2). Previously we showed that intraperitoneal injection of a cell permeable peptide inhibitor of MK2, MMI-0100, protects against fibrosis, apoptosis and systolic dysfunction in a mouse model of AMI induced by left-anterior descending coronary artery (LAD) ligation. Here we tested a new route of administration of MMI-0100: inhalation of nebulized peptide. When given within 30 min of AMI and daily for 2 weeks thereafter, both inhaled and injected MMI-0100 improved cardiac function as measured by conscious echocardiography. Limited fibrosis was observed after 2 weeks by Massons trichrome staining, suggesting that MMI-0100 protects the heart prior to the formation of significant fibrosis. These results support a nebulized route of administration of MMI-0100 can protect the myocardium from ischemic damage.