Using a Fluid Resuscitation Algorithm to Reduce the Incidence of Abdominal Compartment Syndrome in the Burn Intensive Care Unit.

BACKGROUND: Patients with large burns must be carefully resuscitated to balance adequate tissue perfusion with the risk of end-organ damage. One devastating complication of overresuscitation is abdominal compartment syndrome. Reducing the volume of fluids given during resuscitation may reduce the incidence of abdominal compartment syndrome and improve outcomes. OBJECTIVE: To determine whether decreasing fluid resuscitation volume in a burn center reduced the incidence of abdominal compartment syndrome. METHODS: This retrospective cohort study involved all patients with severe burns (total body surface area ≥20%) who were admitted to a burn intensive care unit over 4 years (n = 166). Primary outcomes were required fluid volume, whether differences in the patient characteristics measured affected outcomes, rate of abdominal compartment syndrome, and incidence of abdominal hypertension. After the first 2 years, the Parkland fluid resuscitation algorithm was modified to decrease the volume goal, and patients were assessed for the incidence of abdominal compartment syndrome and related complications such as kidney failure, abdominal hypertension, and ventilator days. RESULTS: A total of 16% of patients resuscitated using the Parkland equation experienced abdominal compartment syndrome compared with 10% of patients resuscitated using the modified algorithm, a difference of 6 percentage points (P = .39). Average volume administered was 11.8 L using the Parkland formula and 9.4 L using the modified algorithm (P = .03). CONCLUSION: Despite a significant decrease in the amount of fluid administered, no significant difference was found in incidence of abdominal compartment syndrome or urine output. Matched prospective studies are needed to improve resuscitation care for patients with large burns.

Glioblastoma extracellular vesicles influence glial cell hyaluronic acid deposition to promote invasiveness.

Background: Infiltration of glioblastoma (GBM) throughout the brain leads to its inevitable recurrence following standard-of-care treatments, such as surgical resection, chemo-, and radiotherapy. A deeper understanding of the mechanisms invoked by GBM to infiltrate the brain is needed to develop approaches to contain the disease and reduce recurrence. The aim of this study was to discover mechanisms through which extracellular vesicles (EVs) released by GBM influence the brain microenvironment to facilitate infiltration, and to determine how altered extracellular matrix (ECM) deposition by glial cells might contribute to this. Methods: CRISPR was used to delete genes, previously established to drive carcinoma invasiveness and EV production, from patient-derived primary and GBM cell lines. We purified and characterized EVs released by these cells, assessed their capacity to foster pro-migratory microenvironments in mouse brain slices, and evaluated the contribution made by astrocyte-derived ECM to this. Finally, we determined how CRISPR-mediated deletion of genes, which we had found to control EV-mediated communication between GBM cells and astrocytes, influenced GBM infiltration when orthotopically injected into CD1-nude mice. Results: GBM cells expressing a p53 mutant (p53R273H) with established pro-invasive gain-of-function release EVs containing a sialomucin, podocalyxin (PODXL), which encourages astrocytes to deposit ECM with increased levels of hyaluronic acid (HA). This HA-rich ECM, in turn, promotes migration of GBM cells. Consistently, CRISPR-mediated deletion of PODXL opposes infiltration of GBM in vivo. Conclusions: This work describes several key components of an EV-mediated mechanism though which GBM cells educate astrocytes to support infiltration of the surrounding healthy brain tissue.

Wild and weedy Hesperis matronalis hosts turnip mosaic virus across heterogeneous landscapes in upstate New York.

Turnip mosaic virus (TuMV) is a widespread and economically important pathogen in agricultural crops and has the widest known host range in the virus family Potyviridae. While management of the virus and its aphid vectors in agricultural fields decreases virus incidence, many alternative wild hosts for TuMV may serve as source populations for crop infection through spillover. Over thirty years ago, research demonstrated that the introduced brassica, Dame's Rocket (Hesperis matronalis) hosts several viruses, including TuMV. Here, we use both enzyme-linked immunosorbent assays (ELISA) and next generation sequencing to document the frequent infection by TuMV of Dame's Rocket, which is common and widespread in disturbed areas around crop fields in upstate New York. Deep sequencing of multiple tissue types of symptomatic hosts indicate that the infection is systemic and causes diagnostic, visible symptoms. In a common garden experiment using host populations from across upstate New York, we found evidence for genetic tolerance to TuMV infection in H. matronalis. Field surveys show that TuMV prevalence varies across populations, but is generally higher in agricultural areas. Examining disease dynamics in this and other common alternative hosts will enhance our understanding of TuMV epidemiology and, more broadly, virus distribution in wild plants.

Ecology of Yellow Dwarf Viruses in Crops and Grasslands: Interactions in the Context of Climate Change.

Our understanding of the ecological interactions between plant viruses, their insect vectors, and their host plants has increased rapidly over the past decade. The suite of viruses known collectively as the yellow dwarf viruses infect an extensive range of cultivated and noncultivated grasses worldwide and is one of the best-studied plant virus systems. The yellow dwarf viruses are ubiquitous in cereal crops, where they can significantly limit yields, and there is growing recognition that they are also ubiquitous in grassland ecosystems, where they can influence community dynamics. Here, we discuss recent research that has explored (a) the extent and impact of yellow dwarf viruses in a diversity of plant communities, (b) the role of vector behavior in virus transmission, and (c) the prospects for impacts of climate change-including rising temperatures, drought, and elevated CO2-on the epidemiology of yellow dwarf viruses.

The Impact of Race/Ethnicity on the Outcomes of Burn Patients: A Systematic Review of the Literature.

Racial and ethnic disparities are endemic to the United States and are only beginning to attract the attention of researchers. With an increasingly diverse population, focused and tailored medicine to provide more equitable care is needed. For surgical trauma populations, this topic is a small but expanding field and still rarely mentioned in burn medicine. Disparities in prevention, treatment, and recovery outcomes between different racial and ethnic minorities who are burned are rarely discussed. The purpose of this study is to determine the current status of identified disparities of care in the burn population literature and areas of future research. A systematic review was conducted of literature utilizing PubMed for articles published between 2000 and 2020. Searches were used to identify articles that crossed the burn term (burn patient OR burn recovery OR burn survivor OR burn care) and a race/ethnicity and insurance status-related term (race/ethnicity OR African-American OR Black OR Asian OR Hispanic OR Latino OR Native American OR Indigenous OR Mixed race OR 2 or more races OR socioeconomic status OR insurance status). Inclusion criteria were English studies in the United States that discussed disparities in burn injury outcomes or risk factors associated with race/ethnicity. One thousand one hundred and sixty-nine papers were populated, 55 were reviewed, and 36 articles met inclusion criteria. Most studies showed minorities had poorer inpatient and outpatient outcomes. While this is a concerning trend, there is a paucity of literature in this field and more research is needed to create culturally tailored medical care and address the needs of disadvantaged burn survivors.