Young women and elderly men at risk of severe faecal incontinence: results of a French nationwide database analysis : Faecal incontinence in France.

PURPOSE: The incidence of severe faecal incontinence (FI) in young people is likely underestimated. The objective of this study is to assess the incidence of FI by using the French national insurance information system (SNDS). METHODS: The SNDS was used, including 2 health insurance claims databases. The study included 49,097,454 French people who were ≥ 20 years old in 2019. The main outcome measure was the occurrence of FI. RESULTS: In 2019, 123,630 patients out of the entire French population (n = 49 097 454) (0.25%) were treated for FI. The numbers of male and female patients were similar. The data showed a dramatic increase in the incidence of FI between the ages of 20 and 59 in female patients, compared to 60 and 79 in male patients. The risk of FI increased with age (OR of 3.6 to 11.3 depending on age). Women had a higher risk of severe FI compared to men between the ages of 20 and 39 (OR = 1.3; 95%CI:1.3-1.4) and the ages of 40 and 59 (OR = 1.1; 95%CI:1.08-1.13). This risk decreased after the age of 80 (OR = 0.96; 95%CI:0.93-0.99). The rate of diagnosis of FI also increased where there were greater numbers of proctologists practising in the region of residence in question (OR of 1.07 to 1.35 depending on the number of proctologists). CONCLUSION: Young women who have given birth and elderly men are at risk of FI and must be targeted by public health information campaigns. The development of coloproctology networks should be encouraged.

Increasing Medical Students' Confidence in Delivering Bad News Using Different Teaching Modalities.

Opportunities to learn how to deliver bad news and practice this important skill are limited in most medical school programs. To address this gap, an integrated curriculum was created for first-year medical students at the University of Hawai'i John A. Burns School of Medicine that used a problem-based learning case, a didactic session, and a simulated patient experience to teach students how to deliver bad news using the 6-step SPIKES protocol. Students' competency was evaluated using a video-recorded simulated patient encounter. Students also completed a post-experience questionnaire to assess their confidence in delivering bad news before and after the simulation as well as the perceived benefit of different teaching modalities. A sample of 60 students completed an average of 16/17 (94%) tasks on the 17-item SPIKES checklist. Students' confidence in delivering bad news improved from 32% to 91%, before and after the educational experience. The majority of students agreed or strongly agreed that the simulated patient encounter helped them learn how to deliver bad news (96%), felt that the presentation prepared them to deliver bad news (87%), and expressed desire to have more simulated patient experiences in the future (87%). Overall, this curricular improvement project showed that students had a positive perception of the different teaching modalities, increased confidence at delivering bad news following the simulated patient encounter, and a preference for more simulated patient encounters linked to problem-based learning cases in the future.

Central arterial stiffness, wave reflection, and heart rate variability following 4-week high-intensity resistance training intervention in young active women.

PURPOSE: Arterial stiffness, expedited wave reflection, and autonomic dysfunction are risk factors for cardiovascular disease, which is the leading cause of death in women in the United States. Evaluation of the effects of resistance training on these factors has been inconclusive, and even less is known about the effects of high-intensity resistance training (HIRT). This study evaluated the effects of a 4-week HIRT intervention on central arterial stiffness, wave reflection, and heart rate variability in young healthy and active women. METHODS: 9 women were recruited and underwent a 4-week control period followed by the intervention. Measurements were recorded pre-control, post-control/pre-intervention, and post-intervention. RESULTS: There were no significant changes to central arterial stiffness, wave reflection, or heart rate variability. There was a significant increase in resting heart rate (bpm: 62 ± 7, 66 ± 10; p = 0.003) and a significant decrease in baroreceptor sensitivity (30 ± 7, 21 ± 7; p = 0.018) pre- to post-intervention. There was a significant decrease in total peripheral resistance pre- to post-intervention (1.076 ± 0.281, 0.916 ± 0.250; p = 0.002). Squat, bench press, and deadlift increased pre- to post-intervention (kg: 62 ± 11, 71 ± 9, p = 0.000; 37 ± 7, 40 ± 7, p = 0.002; 76 ± 19, 84 ± 19, p = 0.000). CONCLUSION: 4 weeks of HIRT can supplement a healthy lifestyle in women by increasing strength while decreasing peripheral resistance and preserving arterial pressures. Further evaluation is necessary to investigate the observed increase in resting heart rate and decrease in baroreceptor sensitivity and to determine long-term effects of this training.

A learned embedding for efficient joint analysis of millions of mass spectra.

Computational methods that aim to exploit publicly available mass spectrometry repositories rely primarily on unsupervised clustering of spectra. Here we trained a deep neural network in a supervised fashion on the basis of previous assignments of peptides to spectra. The network, called 'GLEAMS', learns to embed spectra in a low-dimensional space in which spectra generated by the same peptide are close to one another. We applied GLEAMS for large-scale spectrum clustering, detecting groups of unidentified, proximal spectra representing the same peptide. We used these clusters to explore the dark proteome of repeatedly observed yet consistently unidentified mass spectra.

T cell receptor sequencing identifies prior SARS-CoV-2 infection and correlates with neutralizing antibodies and disease severity.

BACKGROUNDMeasuring the immune response to SARS-CoV-2 enables assessment of past infection and protective immunity. SARS-CoV-2 infection induces humoral and T cell responses, but these responses vary with disease severity and individual characteristics.METHODSA T cell receptor (TCR) immunosequencing assay was conducted using small-volume blood samples from 302 individuals recovered from COVID-19. Correlations between the magnitude of the T cell response and neutralizing antibody (nAb) titers or indicators of disease severity were evaluated. Sensitivity of T cell testing was assessed and compared with serologic testing.RESULTSSARS-CoV-2-specific T cell responses were significantly correlated with nAb titers and clinical indicators of disease severity, including hospitalization, fever, and difficulty breathing. Despite modest declines in depth and breadth of T cell responses during convalescence, high sensitivity was observed until at least 6 months after infection, with overall sensitivity ~5% greater than serology tests for identifying prior SARS-CoV-2 infection. Improved performance of T cell testing was most apparent in recovered, nonhospitalized individuals sampled > 150 days after initial illness, suggesting greater sensitivity than serology at later time points and in individuals with less severe disease. T cell testing identified SARS-CoV-2 infection in 68% (55 of 81) of samples with undetectable nAb titers (<1:40) and in 37% (13 of 35) of samples classified as negative by 3 antibody assays.CONCLUSIONThese results support TCR-based testing as a scalable, reliable measure of past SARS-CoV-2 infection with clinical value beyond serology.TRIAL REGISTRATIONSpecimens were accrued under trial NCT04338360 accessible at clinicaltrials.gov.FUNDINGThis work was funded by Adaptive Biotechnologies, Frederick National Laboratory for Cancer Research, NIAID, Fred Hutchinson Joel Meyers Endowment, Fast Grants, and American Society for Transplantation and Cell Therapy.

The effect of case nodes in problem-based learning on the length and quality of discussion: a 2x2 factorial study.

Background: Problem-based learning (PBL) relies heavily on case structure for their success. To make more meaningful cases, faculty introduced a "case node" that requires students to make a group decision on the action they will take at a given point in the case. The purpose of this study was to determine whether case nodes enhance PBL discussions. Methods: Two PBL cases were designed with and without a node. In 2011, 2012, and 2015, first-year medical students were assigned one PBL case with a node and one without a node. In total, 26 groups processed cases with a node while 27 groups processed the same cases without the node. All sessions were audio recorded and analyzed to determine the length and quality of discussions. Results: Groups with a node, regardless of case (M = 25.62, SD = 12.25) spent significantly more time in discussion on the node topic than those without a node (M = 16.54, SD = 10.33, p=.005, d = .80). Groups with a node, regardless of case (M = 14.38, SD = 8.04) expressed an opinion significantly more frequently than those without a node (M = 6.07, SD = 5.80, p < .001, d = 1.19). Conclusions: Case nodes increased both the length and depth of discussion on a topic and may be an effective way to enhance case-based instruction.

Contexte: Le succès de l'apprentissage par problèmes (APP) repose en grande partie sur la structure des cas. Pour rendre les cas plus significatifs, les membres du corps professoral ont introduit dans les scénarios un «nœud¼, ou un point nodal, marquant un moment où les étudiants doivent prendre une décision de groupe quant à l'action à entreprendre. L'objectif de cette étude était de déterminer si les cas comportant de tels points nodaux amélioraient la discussion dans le cadre de l'APP. Méthodes: On a conçu deux cas d'APP en deux versions, l'une comportant un nœud, l'autre non. En 2011, 2012 et 2015, on a soumis à des étudiants en première année de médecine un cas d'APP avec un nœud et un cas sans nœud. Au total, 26 groupes ont travaillé sur le cas avec un nœud et 27 groupes sur le cas sans nœud. Toutes les séances ont été enregistrées et analysées afin de déterminer la durée et la qualité des discussions. Résultats: Les groupes qui ont travaillé sur un cas comportant un nœud, quel que soit le cas (M = 25.62, SD = 12.25), ont consacré significativement plus de temps à la discussion que ceux qui avaient un cas sans nœud (M = 16.54, SD =1 0.33, p = .005, d = .80). Les premiers ont également exprimé des opinions significativement plus fréquemment, quel que soit le cas (M = 14.38, SD = 8.04), que les seconds (M = 6.07, SD = 5.80, p < .001, d = 1.19). Conclusions: Les nœuds introduits dans les cas ont entraîné des discussions à la fois plus longues et plus approfondies sur le sujet abordé. Par conséquent, ils constitueraient un moyen efficace d'améliorer l'enseignement fondé sur l'étude de cas.

Multiple early factors anticipate post-acute COVID-19 sequelae.

Post-acute sequelae of COVID-19 (PASC) represent an emerging global crisis. However, quantifiable risk factors for PASC and their biological associations are poorly resolved. We executed a deep multi-omic, longitudinal investigation of 309 COVID-19 patients from initial diagnosis to convalescence (2-3 months later), integrated with clinical data and patient-reported symptoms. We resolved four PASC-anticipating risk factors at the time of initial COVID-19 diagnosis: type 2 diabetes, SARS-CoV-2 RNAemia, Epstein-Barr virus viremia, and specific auto-antibodies. In patients with gastrointestinal PASC, SARS-CoV-2-specific and CMV-specific CD8+ T cells exhibited unique dynamics during recovery from COVID-19. Analysis of symptom-associated immunological signatures revealed coordinated immunity polarization into four endotypes, exhibiting divergent acute severity and PASC. We find that immunological associations between PASC factors diminish over time, leading to distinct convalescent immune states. Detectability of most PASC factors at COVID-19 diagnosis emphasizes the importance of early disease measurements for understanding emergent chronic conditions and suggests PASC treatment strategies.

The impact of coronavirus 2019 on trauma.

PURPOSE OF REVIEW: The relationship between trauma and the ongoing global coronavirus 2019 (COVID-19) pandemic is still largely unclear. This comprehensive review of recent studies examining overall trauma volumes, mechanisms of injury, and outcomes after trauma during the COVID-19 pandemic was performed to better understand the impact of the pandemic on trauma patients. RECENT FINDINGS: In the early stages of the pandemic, the overall volumes of patients seen in many major trauma centers had decreased; however, these rates largely returned to historical baselines after the cessation of stay-at-home orders. An increasing proportion of trauma patients were injured by penetrating mechanisms during the pandemic. Being a victim of interpersonal violence was an independent risk factor for COVID-19 infection. In two studies utilizing propensity score-matched analysis among trauma patients, COVID-19 infection was associated with a five- to sixfold increase in mortality risk as compared to uninfected patients. SUMMARY: Consequences of the COVID-19 pandemic include increased financial stressors, job loss, mental illness, and illegal drug use, all of which are known risk factors for trauma. This is particularly true among vulnerable patient populations such as racial minority groups and low socioeconomic status patients. To lessen the impact of COVID-19 on trauma patients, increased awareness of the problem and heightened emphasis on injury prevention must be made.

Penetrating injuries to the vertebral artery: interventions and outcomes from US Trauma Centers.

PURPOSE: Penetrating injuries to the vertebral artery are rare and incompletely studied. Operative, angioembolic, and nonoperative strategies are management options, although the association between management strategy and outcomes is unknown. This study endeavored to define the epidemiology, management strategy, and outcomes after penetrating injuries to the vertebral artery presenting to trauma centers nationwide. METHODS: Patients with veterbral artery injuries were identified from the National Trauma Data Bank (NTDB) (2016-2017) using ICD-10-CM codes. Only those with penetrating mechanisms of injury were included in the study. Transferred patients were excluded. Study groups were defined by management strategy (Operative management, OM; angioembolization, AE; and nonoperative management, NOM). Patient demographics, injury characteristics, and outcomes were compared between groups using univariate analysis. Multivariate analysis with logistic regression was used to examine independent risk factors for mortality and stroke. RESULTS: Penetrating injuries to the vertebral artery were rare (n = 476, < 1% of NTDB patient population). Median age was 28 [IQR 21-37] years and 81% (n = 385) of patients were male. Interpersonal violence was the most common injury intent (n = 374, 79%). Most patients were managed with NOM (n = 409, 86%), with AE and OM utilized less frequently (8% and 6%, respectively). Stab wounds were the most frequent mechanism of injury among patients managed with OM (62%), while gunshot wounds were most common among patients managed with NOM (84%) or AE (79%). Multivariate analysis of risk factors for stroke revealed only associated carotid artery injury (OR 4.236, 95% CI 1.284-13.970, p = 0.018) and AE (OR 6.342, 95% CI 1.417-28.399, p = 0.016) were independent predictors. Independent risk factors for mortality were advanced age (OR 1.026, 95% CI 1.001-1.052, p = 0.044); elevated ISS (OR 1.030, 95% CI 1.008-1.052, p = 0.006); and associated traumatic brain injury (OR 3.020, 95% CI 1.333-6.843, p = 0.008). Higher ED GCS was independently associated with reduced mortality (OR 0.788, 95% CI 0.731-0.849, p < 0.001). CONCLUSIONS: Vertebral artery injuries after penetrating mechanisms are infrequent in the United States. Patients with these injuries tend to be young adult men who were injured by gunshot wounds as a result of interpersonal violence. The majority of these injuries were managed nonoperatively, with operative intervention required most commonly for patients injured by stab wounds. Risk factors for both stroke and mortality were principally due to patient factors and associated injuries. Increased risk of stroke among patients managed with angioembolization will need to be further investigated with future study to determine if this risk is imparted from the management strategy itself or from underlying injury characteristics.

Association between convalescent plasma treatment and mortality in COVID-19: a collaborative systematic review and meta-analysis of randomized clinical trials.

BACKGROUND: Convalescent plasma has been widely used to treat COVID-19 and is under investigation in numerous randomized clinical trials, but results are publicly available only for a small number of trials. The objective of this study was to assess the benefits of convalescent plasma treatment compared to placebo or no treatment and all-cause mortality in patients with COVID-19, using data from all available randomized clinical trials, including unpublished and ongoing trials (Open Science Framework, https://doi.org/10.17605/OSF.IO/GEHFX ). METHODS: In this collaborative systematic review and meta-analysis, clinical trial registries (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform), the Cochrane COVID-19 register, the LOVE database, and PubMed were searched until April 8, 2021. Investigators of trials registered by March 1, 2021, without published results were contacted via email. Eligible were ongoing, discontinued and completed randomized clinical trials that compared convalescent plasma with placebo or no treatment in COVID-19 patients, regardless of setting or treatment schedule. Aggregated mortality data were extracted from publications or provided by investigators of unpublished trials and combined using the Hartung-Knapp-Sidik-Jonkman random effects model. We investigated the contribution of unpublished trials to the overall evidence. RESULTS: A total of 16,477 patients were included in 33 trials (20 unpublished with 3190 patients, 13 published with 13,287 patients). 32 trials enrolled only hospitalized patients (including 3 with only intensive care unit patients). Risk of bias was low for 29/33 trials. Of 8495 patients who received convalescent plasma, 1997 died (23%), and of 7982 control patients, 1952 died (24%). The combined risk ratio for all-cause mortality was 0.97 (95% confidence interval: 0.92; 1.02) with between-study heterogeneity not beyond chance (I2 = 0%). The RECOVERY trial had 69.8% and the unpublished evidence 25.3% of the weight in the meta-analysis. CONCLUSIONS: Convalescent plasma treatment of patients with COVID-19 did not reduce all-cause mortality. These results provide strong evidence that convalescent plasma treatment for patients with COVID-19 should not be used outside of randomized trials. Evidence synthesis from collaborations among trial investigators can inform both evidence generation and evidence application in patient care.

Association of Body Mass Index on Injuries and Outcomes After Ground-Level Falls.

BACKGROUND: The impact of body mass index (BMI) on trauma severity after ground-level falls (GLF) is currently unclear. This study aimed to examine the associations between BMI, injuries, and outcomes after GLF. STUDY DESIGN: All patients ≥16 years of age injured by GLF were queried from the TQIP database (2013-2017). Exclusions were transfers, emergency department death, AIS 6 in any region, and missing data. Body mass index defined study groups: Underweight (BMI<18.5), Normal (BMI 18.5-24.9), Overweight (25.0-29.9), and Obese (≥30). RESULTS: After exclusions, 131 570 patients remained for analysis. Most patients had a normal BMI (n = 58 503, 44%). Median ISS was 9 [IQR 9-10] in all groups. The Obese group had significantly lower rates of fractures than the Normal group, particularly femur fractures (53% vs. 64%, P < .001), but required orthopedic surgical intervention more frequently (45% vs. 41%, P < .001). On multivariate analysis, being overweight was protective against mortality (OR .881, P = .005), while obesity was not associated with mortality (OR 1.012, P = .821). CONCLUSION: Increasing BMI may be protective against both fracture risk and mortality after GLF. However, obese patients require operative fixation more frequently. Particularly as fracture diagnosis may be more challenging in the obese, special care should be taken during their tertiary surveys after GLF to ensure injuries are not missed.

Contemporary utility of diagnostic peritoneal aspiration in trauma.

BACKGROUND: Focused Assessment with Sonography for Trauma (FAST) has supplanted diagnostic peritoneal lavage (DPL) as the preferred bedside evaluation for traumatic hemoperitoneum. Diagnostic peritoneal aspiration (DPA) is a simpler, faster modification of DPL with an unclear role in contemporary practice. This study delineated modern roles for DPA and defined its diagnostic yield. METHODS: All trauma patients presenting to our Level I center who underwent DPA were included (May 2015 to May 2020). Demographics, comorbidities, clinical/injury data, and outcomes were collected. The diagnostic yield and accuracy of DPA were calculated against the criterion standard of hemoperitoneum at exploratory laparotomy or computed tomography scan. RESULTS: In total, 41 patients underwent DPA, typically after blunt trauma (n = 37, 90%). Patients were almost exclusively hypotensive (n = 20, 49%) or in arrest (n = 18, 44%). Most patients had an equivocal or negative FAST and hypotension or return of spontaneous circulation after resuscitative thoracotomy (n = 32, 78%); or had a positive FAST and known cirrhosis (n = 4, 10%). In two (5%) patients, one obese, the catheter failed to access the peritoneal cavity. Diagnostic peritoneal aspiration sensitivity, specificity, positive predictive value, and negative predictive value were 80%, 100%, 100%, and 90%, with an accuracy of 93%. One (2%) complication, a small bowel injury, occurred. CONCLUSION: Despite near ubiquitous FAST availability, DPA remains important in diagnosing or excluding hemoperitoneum with exceedingly low rates of failure and complications. Diagnostic peritoneal aspiration is most conclusive when positive, without false positives in this study. Diagnostic peritoneal aspiration was most used among blunt hypotensive or postarrest patients who had an equivocal or negative FAST, in whom the preliminary diagnosis of hemoperitoneum is a critically important decision making branch point. LEVEL OF EVIDENCE: Diagnostic, level III.

Laser Tattoo Removal: A New Tool for Hospital-based Violence Prevention?

INTRODUCTION: Gang-related tattoos may increase an individual's risk for violent victimization. We present our early experience using a physician-staffed tattoo removal initiative as 1 component of a violence prevention program. METHODS: Surgeons from our trauma department in partnership with a community advocacy group performed voluntary laser tattoo removal for individuals within our catchment area. Clients were asked to complete a voluntary, anonymous survey. This survey addressed tattoo acquisition, identified motives and goals for tattoo removal, and reported if those goals were met by the tattoo removal service. Issues involving gang affiliation and interpersonal violence were specifically queried. Results are listed as simple percentages. RESULTS: 81 of 122 (66%) program enrollees completed the survey. The average number of laser removal sessions at the time of questionnaire was 3 (range 1-15). 41% of respondents possessed gang or "crew" related tattoos. 22% of respondents possessed a tattoo related to an intimate partner who was gang affiliated. 21% of respondents desired tattoo removal for the motive of leaving gang affiliation with 94% of those respondents reporting success. 59% of respondents sought tattoo removal to improve employment opportunities with 81% of those respondents reporting success. 30% of respondents desired tattoo removal to improve personal safety or avoid violence with 80% of those respondents reporting success. CONCLUSION: Stated client goals for tattoo removal and their subjective reports of success achieving these goals demonstrate the possible effectiveness of laser tattoo removal as a tool to help clients avoid future violence and progress toward gang disengagement. Trauma departments should consider laser tattoo removal as part of future violence prevention initiatives.

Complications Following Brachial Arterial Catheterization in the Surgical Intensive Care Unit.

Clinically, complication rates of brachial arterial catheterization appear to far exceed those of the radial or common femoral arteries. The study objective was to define the complication rate after brachial arterial line insertion. All patients undergoing arterial line placement to the brachial artery in the surgical intensive care units (SICUs) at our institution were retrospectively identified and included in the study (January 2016-December 2018). Demographics, complications (distal ischemia, thrombosis/dissection, brachial sheath hematoma, catheter-related sepsis, and inadvertent dislodgement), and outcomes were collected and analyzed. Over the study period, 53 patients underwent brachial arterial catheterization. Common admitting services were cardiothoracic surgery (n = 31, 58%), transplant surgery (n = 7, 13%), and neurosurgery (n = 4, 7%). The mean age was 55 ± 17 58 (24-84) years, and 58% (n = 31) were male. The hospital length of stay (LOS) was 37 ± 35 23 (1-132) days, and ICU LOS was 30 ± 27 20 (1-127) days. Mortality was 57% (n = 30). Complications of brachial arterial line placement occurred in 21 patients (40%). In summary, brachial arterial catheters were associated with high mortality and prolonged ICU length of stay. This likely reflects the critically ill nature of patients in whom conventional-site arterial line placement is not possible. Complications following brachial arterial catheterization were unacceptably high. On this basis, we recommend that the brachial artery be avoided whenever possible for arterial line placement in the SICU.

Magnitude and Dynamics of the T-Cell Response to SARS-CoV-2 Infection at Both Individual and Population Levels.

T cells are involved in the early identification and clearance of viral infections and also support the development of antibodies by B cells. This central role for T cells makes them a desirable target for assessing the immune response to SARS-CoV-2 infection. Here, we combined two high-throughput immune profiling methods to create a quantitative picture of the T-cell response to SARS-CoV-2. First, at the individual level, we deeply characterized 3 acutely infected and 58 recovered COVID-19 subjects by experimentally mapping their CD8 T-cell response through antigen stimulation to 545 Human Leukocyte Antigen (HLA) class I presented viral peptides (class II data in a forthcoming study). Then, at the population level, we performed T-cell repertoire sequencing on 1,815 samples (from 1,521 COVID-19 subjects) as well as 3,500 controls to identify shared "public" T-cell receptors (TCRs) associated with SARS-CoV-2 infection from both CD8 and CD4 T cells. Collectively, our data reveal that CD8 T-cell responses are often driven by a few immunodominant, HLA-restricted epitopes. As expected, the T-cell response to SARS-CoV-2 peaks about one to two weeks after infection and is detectable for at least several months after recovery. As an application of these data, we trained a classifier to diagnose SARS-CoV-2 infection based solely on TCR sequencing from blood samples, and observed, at 99.8% specificity, high early sensitivity soon after diagnosis (Day 3-7 = 85.1% [95% CI = 79.9-89.7]; Day 8-14 = 94.8% [90.7-98.4]) as well as lasting sensitivity after recovery (Day 29+/convalescent = 95.4% [92.1-98.3]). These results demonstrate an approach to reliably assess the adaptive immune response both soon after viral antigenic exposure (before antibodies are typically detectable) as well as at later time points. This blood-based molecular approach to characterizing the cellular immune response has applications in clinical diagnostics as well as in vaccine development and monitoring.

The Impact of Seat Belt Use in Pregnancy on Injuries and Outcomes After Motor Vehicle Collisions.

BACKGROUND: Seat belt use during motor vehicle collisions (MVCs) has been shown to alter adults' intra-abdominal injury patterns, although the effect of seat belt use in pregnant women is unclear. The objective of this study was to determine the impact of seat belt use in pregnancy on injuries and outcomes after MVCs. METHODS: Patients injured by MVCs were identified from the National Trauma Data Bank (2007-2014). The exclusion criteria were transfer from an outside hospital, male or unspecified sex, missing restraint data, and nonchildbearing age. Demographics, clinical/injury data, pregnancy status, seat belt use, and outcomes were collected. Study groups were dichotomized by pregnancy status with subgroup analysis by seat belt use. Univariate/multivariate analyses compared outcomes and determined predictors of seat belt use. RESULTS: After exclusions, 162,964 women were included, of which 680 (<1%) were pregnant. Intra-abdominal injuries during pregnancy did not vary according to seat belt use (P > 0.05). Unrestrained pregnant women were more injured (Injury Severity Score: 13 versus 7, P < 0.001), more likely to need emergent operation (14% versus 10%, P < 0.001), and had a longer hospital stay (6 versus 4 d, P = 0.012) than restrained counterparts. On multivariate analysis among pregnant women, seat belt use was associated with age ≥25 y (odds ratio: 2.033, P = 0.001). The lack of restraint use was associated with the position in the passenger seat (odds ratio: 0.521, P = 0.001). CONCLUSIONS: Seat belt use in pregnancy does not alter abdominal injury patterns but is associated with lower injury severity, reduced need for emergent surgery, and shortened hospital stay. Public health interventions emphasizing the importance of seat belts could be focused on younger patients and vehicle passengers to reach the high-risk pregnant subset.

Shotgun Wounds: Nationwide Trends in Epidemiology, Injury Patterns, and Outcomes from US Trauma Centers.

BACKGROUND: Shotguns represent a distinct form of ballistic injury because of projectile scatter and variable penetration. Due in part to their rarity, existing literature on shotgun injuries is scarce. OBJECTIVE: This study defined the epidemiology, injury patterns, and outcomes after shotgun wounds at a national level. METHODS: Patients with shotgun injury were identified from the National Trauma Data Bank (2007-2014). Transferred patients and those with missing procedure data were excluded. Demographics, injury data, and outcomes were collected and analyzed. Categorical variables are presented as number (percentage) and continuous variables as median (interquartile range). RESULTS: Shotgun wounds comprised 9% of all firearm injuries. After exclusions, 11,292 patients with shotgun injury were included. The median age was 29 years (21-43) and most were male (n = 9887, 88%). Most injuries occurred in the South (n = 4092, 36%) and among white patients (n = 4945, 44%). The median Injury Severity Score was 9 (3-16). Overall in-hospital mortality was 14% (n = 1341), with 669 patients (7%) dying in the emergency department. Assault was the most common injury intent (n = 6762, 60%), followed by accidental (n = 2081, 19%) and self-inflicted (n = 1954, 17%). The lower and upper extremities were the most commonly affected body regions (n = 4071, 36% and n = 3422, 30%, respectively), while the head was the most severely injured (median Abbreviated Injury Scale score 4 [2-5]). CONCLUSIONS: In the United States, shotgun wounds are an infrequent mechanism of injury. Shotgun wounds as a result of interpersonal violence far outweigh self-inflicted and accidental injuries. White men in their 20s in the southern parts of the country are most commonly affected and thereby delineate the high-risk patient population for injury by this mechanism at a national level.

Gut Microbial Protein Expression in Response to Dietary Patterns in a Controlled Feeding Study: A Metaproteomic Approach.

Although the gut microbiome has been associated with dietary patterns linked to health, microbial metabolism is not well characterized. This ancillary study was a proof of principle analysis for a novel application of metaproteomics to study microbial protein expression in a controlled dietary intervention. We measured the response of the microbiome to diet in a randomized crossover dietary intervention of a whole-grain, low glycemic load diet (WG) and a refined-grain, high glycemic load diet (RG). Total proteins in stools from 9 participants at the end of each diet period (n = 18) were analyzed by LC MS/MS and proteins were identified using the Human Microbiome Project (HMP) human gut microbiome database and UniProt human protein databases. T-tests, controlling for false discovery rate (FDR) <10%, were used to compare the Gene Ontology (GO) biological processes and bacterial enzymes between the two interventions. Using shotgun proteomics, more than 53,000 unique peptides were identified including microbial (89%) and human peptides (11%). Forty-eight bacterial enzymes were statistically different between the diets, including those implicated in SCFA production and degradation of fatty acids. Enzymes associated with degradation of human mucin were significantly enriched in the RG diet. These results illustrate that the metaproteomic approach is a valuable tool to study the microbial metabolism of diets that may influence host health.

Metaproteomics reveal that rapid perturbations in organic matter prioritize functional restructuring over taxonomy in western Arctic Ocean microbiomes.

We examined metaproteome profiles from two Arctic microbiomes during 10-day shipboard incubations to directly track early functional and taxonomic responses to a simulated algal bloom and an oligotrophic control. Using a novel peptide-based enrichment analysis, significant changes (p-value < 0.01) in biological and molecular functions associated with carbon and nitrogen recycling were observed. Within the first day under both organic matter conditions, Bering Strait surface microbiomes increased protein synthesis, carbohydrate degradation, and cellular redox processes while decreasing C1 metabolism. Taxonomic assignments revealed that the core microbiome collectively responded to algal substrates by assimilating carbon before select taxa utilize and metabolize nitrogen intracellularly. Incubations of Chukchi Sea bottom water microbiomes showed similar, but delayed functional responses to identical treatments. Although 24 functional terms were shared between experimental treatments, the timing, and degree of the remaining responses were highly variable, showing that organic matter perturbation directs community functionality prior to alterations to the taxonomic distribution at the microbiome class level. The dynamic responses of these two oceanic microbial communities have important implications for timing and magnitude of responses to organic perturbations within the Arctic Ocean and how community-level functions may forecast biogeochemical gradients in oceans.

Growth phase proteomics of the heterotrophic marine bacterium Ruegeria pomeroyi.

The heterotrophic marine bacterium, Ruegeria pomeroyi, was experimentally cultured under environmentally realistic carbon conditions and with a tracer-level addition of 13C-labeled leucine to track bacterial protein biosynthesis through growth phases. A combination of methods allowed observation of real-time bacterial protein production to understand metabolic priorities through the different growth phases. Over 2000 proteins were identified in each experimental culture from exponential and stationary growth phases. Within two hours of the 13C-labeled leucine addition, R. pomeroyi significantly assimilated the newly encountered substrate into new proteins. This dataset provides a fundamental baseline for understanding growth phase differences in molecular physiology of a cosmopolitan marine bacterium.