Impact of Holidays on Pediatric Trauma Admissions to a Community Hospital in South Florida.

OBJECTIVES: The data from temperate regions indicate increases in pediatric traumatic injuries during the spring and summer months with anticipated admission spikes on warm weather holidays; hospitals in southern subtropical regions should not anticipate the same trends. The objectives of this study were to identify holiday-specific spikes in pediatric traumatic injury admissions at a community hospital in South Florida and report injury patterns in age, mechanism of injury, and surgical consults. METHODS: A 5-year retrospective review of pediatric traumatic injuries during holiday periods was conducted; patterns in age, mechanism of injury, and surgical consults were described. A ratio of the mean number of patients seen per day for holiday periods versus nonholiday days of the same month was calculated for each holiday. RESULTS: The most notable spikes in injury volume were for autumn and winter holidays; average volume doubled during the holiday periods for New Year's Day, Super Bowl weekend, Valentine's Day, St Patrick's Day, and Halloween. Holiday periods had increases in the proportion of injuries related to motorcycle crashes. CONCLUSIONS: Hospitals located in southern subtropical climates should consider increasing staffing as necessary during select autumn and winter holidays.

A selective USP1-UAF1 inhibitor links deubiquitination to DNA damage responses.

Protein ubiquitination and deubiquitination are central to the control of a large number of cellular pathways and signaling networks in eukaryotes. Although the essential roles of ubiquitination have been established in the eukaryotic DNA damage response, the deubiquitination process remains poorly defined. Chemical probes that perturb the activity of deubiquitinases (DUBs) are needed to characterize the cellular function of deubiquitination. Here we report ML323 (2), a highly potent inhibitor of the USP1-UAF1 deubiquitinase complex with excellent selectivity against human DUBs, deSUMOylase, deneddylase and unrelated proteases. Using ML323, we interrogated deubiquitination in the cellular response to UV- and cisplatin-induced DNA damage and revealed new insights into the requirement of deubiquitination in the DNA translesion synthesis and Fanconi anemia pathways. Moreover, ML323 potentiates cisplatin cytotoxicity in non-small cell lung cancer and osteosarcoma cells. Our findings point to USP1-UAF1 as a key regulator of the DNA damage response and a target for overcoming resistance to the platinum-based anticancer drugs.

Synthesis and SAR studies of 5-(pyridin-4-yl)-1,3,4-thiadiazol-2-amine derivatives as potent inhibitors of Bloom helicase.

Human cells utilize a variety of complex DNA repair mechanisms in order to combat constant mutagenic and cytotoxic threats from both exogenous and endogenous sources. The RecQ family of DNA helicases, which includes Bloom helicase (BLM), plays an important function in DNA repair by unwinding complementary strands of duplex DNA as well as atypical DNA structures such as Holliday junctions. Mutations of the BLM gene can result in Bloom syndrome, an autosomal recessive disorder associated with cancer predisposition. BLM-deficient cells exhibit increased sensitivity to DNA damaging agents indicating that a selective BLM inhibitor could be useful in potentiating the anticancer activity of these agents. In this work, we describe the medicinal chemistry optimization of the hit molecule following a quantitative high-throughput screen of >355,000 compounds. These efforts lead to the identification of ML216 and related analogs, which possess potent BLM inhibition and exhibit selectivity over related helicases. Moreover, these compounds demonstrated cellular activity by inducing sister chromatid exchanges, a hallmark of Bloom syndrome.

Yellow mustard bran attenuates glycaemic response of a semi-solid food in young healthy men.

In a randomized, repeated-measures design, the glycaemic response and satiety ratings of a potato and leek soup were compared with and without the addition of 5 g of yellow mustard bran. Ten healthy, non-smoking, moderately active male subjects (mean age of 21.1 years and mean body mass index 23.2 kg/m(2)) were recruited to the study. Capillary blood glucose and satiety were measured at 0, 15, 30, 45, 60, 90 and 120 min, postprandial of each food. The incremental area under the blood glucose curve, blood glucose at each time point and satiety rating were calculated and compared via paired t-test. Mean blood glucose values at 15, 30 and 90 min (p < 0.0001, p < 0.0001 and p = 0.0059, respectively) were all significantly lower with the addition of 5 g of yellow mustard bran. In conclusion, this study demonstrated the attenuation of postprandial glycaemic response following the addition of 5 g of yellow mustard bran to a soup.

Dimensions of food texture: A conceptual discussion.

Food texture is a collective term for all texture-related features of a food product. A comprehensive description of food texture is therefore practically challenging due to too many parameters that are associated simultaneously with the food. Using every day, non-technical (layman's) language, we attempt in this work to rationalize the different dimensions that contribute to the texture of foods, and we explain the rheological reasons behind the concept. For solid foods, three dimensions are identified being the "hard-soft," "strong-weak," and "brittle-plastic." For liquid foods, three further dimensions are suggested, being "elastic-viscous," "thick-thin," and "shear thinning-shear thickening." As these dimensions are bipolar, for foods where any of the dimensions are not relevant, we conceive that dimension takes on a zero value, aligning at the center of the scale.

Low Threshold for Laparoscopic Exploration in Dementia Patients With Unexplained Abdominal Pain and Risk Factors for Acute Mesenteric Ischemia.

Acute mesenteric ischemia (AMI) is associated with a high mortality and morbidity. There are limited studies on the presentation and management of elderly dementia patients with AMI. The following case of an 88-year-old female with dementia presenting with AMI highlights the challenges in the care of elderly dementia patients with AMI, the importance of identifying risk factors and hallmarks of acute mesenteric ischemia early in the clinical course, and suggests that aggressive workup with diagnostic laparoscopy is crucial to timely diagnosis and effective care.

Financial Toxicity in Emergency General Surgery: Novel Propensity-Matched Outcome Comparison.

BACKGROUND: Financial toxicity describes the harmful effect of individual treatment costs and fiscal burdens that have a compounding negative impact on outcomes in surgery. While this phenomenon has been widely studied in surgical oncology, the purpose of this study was to perform a novel exploration of the impact of financial toxicity in emergency general surgery (EGS) patients throughout the US. STUDY DESIGN: The Nationwide Readmissions Database for January and February 2018 was queried for all EGS patients aged 18 to 65 years. One-to-one propensity matching was performed with and without risk for financial toxicity. The primary outcome was mortality, and the secondary outcomes were venous thromboembolism (VTE), prolonged length of stay (LOS), and readmission within 30 days. RESULTS: There were 24,154 EGS patients propensity matched. The mortality rate was 0.2% (n = 39), and the rate of VTE was 0.5% (n = 113). With financial toxicity, there was no statistically significant difference for mortality (p = 0.08) or VTE (p = 0.30). The rate of prolonged LOS was 6.2% (n = 824), and the risk was increased with financial toxicity (risk ratio 1.24 [1.12 to 1.37]; p < 0.001). The readmission rate was 7.0% (n = 926), and the risk with financial toxicity was increased (risk ratio 1.21 [1.10 to 1.33]; p < 0.001). The mean count of comorbidities per patient per admission during readmission within 1 year with financial toxicity was 2.1 ± 1.9 versus 1.8 ± 1.7 without (p < 0.001). CONCLUSIONS: Despite little difference in the rate of mortality or VTE, EGS patients at risk for financial toxicity have an increased risk of readmission and longer LOS. Fewer comorbidities were identified at index admission than during readmission in patients at risk for financial toxicity. Future studies aimed at reducing this compounding effect of financial toxicity and identifying missed comorbidities have the potential to improve EGS outcomes.

Comparing Payments to Surgeons From Drug and Medical Device Corporations Reveals Inequalities Between Genders and Specialties.

INTRODUCTION: Maintaining trust in the patient-doctor relationship requires transparency in the details of the financial relationships between physicians and drug and medical device corporations. These details are publicly available through the Open Payments database, and patients are encouraged to ask surgeons to interpret their implications. The purpose of this study was to better equip surgeons in responding to these inquiries and to compare the distribution of these payments by gender and specialty. METHODS: The 2021 Open Payments dataset was searched for all payments to surgeons from the 14 different specialties recognized by the American College of Surgeons. The total payments per surgeon were compared by calculating the mean and median payments. The Gini index, a measure of income inequality, was also calculated for each specialty. RESULTS: There were 96 724 surgeons who received over $755 million in payments from drug and medical device companies. There were 72 245 (74.7%) men and 24 479 (25.3%) women. The total amount of payments to men was $712 million (94.2%) and for women it was $44 million (5.8%). The overall Gini index was .9508. The specialty with the highest Gini index was pediatric surgery (.9844) and the lowest was cardiothoracic surgery (.8656). DISCUSSION: Male surgeons received disproportionately higher payments from drug and device corporations than female surgeons. Surgeons should be aware of their own standing within the Open Payments database in order to respond appropriately to patient inquiries.

Comparing Severely Injured Trauma Patients Admitted to Investor-Owned versus Public and Not-For-Profit Hospitals Reveals Opportunities for Improvement in the US.

BACKGROUND: Non-elderly trauma patients represent the largest portion of preventable years of life loss in the US. The purpose of this study was to compare outcomes in patients admitted to investor-owned vs public and not-for-profit hospitals across the US. MATERIAL AND METHODS: The Nationwide Readmissions Database 2018 was queried for trauma patients with an Injury Severity Score greater than 15 and age 18-65 years. The primary outcome was mortality; secondary outcomes were prolonged length of stay (LOS) greater than 30 days, readmission within 30 days, and readmission to a different hospital. Patients admitted to investor-owned hospitals were compared to public and not-for-profit hospitals. Univariable analysis was performed using chi-squared tests. Multivariable logistic regression was performed for each outcome. RESULTS: 157 945 patients were included with 11.0% (n = 17 346) admitted to investor-owned hospitals. The overall mortality rate and prolonged LOS were similar for both groups. The overall readmission rate was 9.2% (n = 13 895), with the rate in investor-owned hospitals at 10.5% (n = 1,739, P < .001). Multivariable logistic regression revealed investor-owned hospitals had an increased risk of readmission (OR 1.2 [1.1-1.3] P < .001) and readmission to a different hospital (OR 1.3 [1.2-1.5] P < .001). DISCUSSION: Severely injured trauma patients have similar rates of mortality and prolonged length of stay in investor-owned vs public and not-for-profit hospitals. However, patients admitted to investor-owned hospitals have an increased risk of readmission and readmission to different hospitals. Efforts to improve outcomes after trauma must consider hospital ownership and readmission to different hospitals.

Diagnosis and treatment of coagulopathy using thromboelastography with platelet mapping is associated with decreased risk of pulmonary failure in COVID-19 patients.

INTRODUCTION: Treatment of coronavirus disease 2019 (COVID-19) patients may require antithrombotic and/or anti-inflammatory medications. We hypothesized that individualized anticoagulant (AC) management, based on diagnosis of coagulopathy using thromboelastography with platelet mapping (TEG-PM), would decrease the frequency of pulmonary failure (PF) requiring mechanical ventilation (MV), mitigate thrombotic and hemorrhagic events, and, in-turn, reduce mortality. METHODS: Hospital-admitted COVID-19 patients, age 18 or older, with escalating oxygen requirements were included. Prospective and supplemental retrospective chart reviews were conducted during a 2-month period. Patients were stratified into two groups based on clinician-administered AC treatment: TEG-PM guided vs. non-TEG guided. RESULTS: Highly-elevated inflammatory markers (D-dimer, C-reactive protein, ferritin) were associated with poor prognosis but did not distinguish coagulopathic from noncoagulopathic patients. TEG-guided AC treatment was used in 145 patients vs. 227 treated without TEG-PM guidance. When managed by TEG-PM, patients had decreased frequency of PF requiring MV (45/145 [31%] vs. 152/227 [66.9%], P  < 0.0001), fewer thrombotic events (2[1.4%] vs. 39[17.2%], P  = 0.0019) and fewer hemorrhagic events (6[4.1%] vs. 24[10.7%], P  = 0.0240), and had markedly reduced mortality (43[29.7%] vs. 142[62.6%], P  < 0.0001). Platelet hyperactivity, indicating the need for antiplatelet medications, was identified in 75% of TEG-PM patients. When adjusted for confounders, empiric, indiscriminate AC treatment (not guided by TEG-PM) was shown to be an associated risk factor for PF requiring MV, while TEG-PM guided management was associated with a protective effect (odds ratio = 0.18, 95% confidence interval 0.08-0.4). CONCLUSIONS: Following COVID-19 diagnosis, AC therapies based on diagnosis of coagulopathy using TEG-PM were associated with significantly less respiratory decompensation, fewer thrombotic and hemorrhagic complications, and improved likelihood of survival.

Glycaemic response to barley porridge varying in dietary fibre content.

The interest in barley as a food is increasing worldwide because of its high dietary fibre (DF) content and low glycaemic index (GI). DF in cereals may prove beneficial in improving blood glucose response in the long term. However, a dose-dependent effect of insoluble fibre on reducing postprandial blood glucose levels is yet to be proven. The objective of the present study was to determine the glycaemic response to two barley porridges prepared from whole barley grains varying in fibre content. In two separate non-blind randomised crossover trials, ten human subjects consumed barley porridge with 16 g/100 g and 10 g/100 g fibre content provided in different serving sizes (equivalent to 25 and 50 g available carbohydrate). The glycaemic response to both barley porridges was significantly lower than the reference glucose (P < 0·05). There was no significant difference between the glucose areas under the curve or GI for the two barley porridges. We concluded that irrespective of the difference in total fibre content or serving size of barley porridges, their GI values did not differ significantly.

Hemipelvectomy as a Salvage Procedure in Massive Pelvic Trauma.

"Pedestrian struck by train" represents one of the highest magnitude blunt force traumas. Despite the severity of injuries, these patients can have good outcomes. A 25-year-old male presented after being struck by a train. He had several injuries, including extensive complex pelvic fractures, right external iliac artery and vein laceration, and right femur and tibia fracture. He was taken to the operating room for damage control surgery and attempted revascularization of the right lower extremity. The extremity became ischemic and required above knee amputation followed by hip disarticulation and hemipelvectomy. His pelvic wounds were treated with negative pressure wound therapy and gradually closed. He was eventually discharged to a rehab facility for continued recovery. This case highlights the interventions that allowed a young man who was struck by a train to survive. He improved significantly since undergoing hemipelvectomy, indicating that severe pelvic injuries from high energy trauma may necessitate hemipelvectomy.

Artifacts and errors in the measurement of the stickiness of liquid foods with tack tests.

We encounter stickiness in many areas of our daily life and as humans, we are able to discriminate different levels of stickiness. Yet attempts to measure stickiness with instruments have been challenging. One of the commonest approaches has been the "tack test" in which a probe is brought into contact with the sticky food and then pulled away while measuring the resisting force-various indices, such as the maximum force or the area below the force curve have been used to describe stickiness. This work rationalizes results from tack tests for liquid foods and helps us explain the influence of probe geometry. Photographic evidence of the way that the liquid adheres/detaches from the probe suggests that the terms "cohesive" and "adhesive" failure depend on the speed of the test. Application of a fixed deformation with time shows rapid loss of adhesive force suggesting that liquid samples flow from the probe. We propose that stickiness of liquid foods is entirely due to the liquid's viscosity and surface tension, and that measurements of tack for liquid foods-while highly reproducible-are entirely artifacts of the test method employed and are in effect snapshots in time of non-equilibrium processes.

Jejuno-jejunal intussusception secondary to recurrent/metastatic melanoma.

Intussusception is uncommon in adults, and usually secondary to a neoplasm. Small bowel obstruction (SBO) is prevalent in adults but rarely due to intussusception. A 55-year-old woman with history of melanoma (four years in remission) presented with abdominal pain and melena. Upper and lower endoscopy was normal. She developed bilious emesis and worsening pain, so she presented to the emergency department. CT abdomen/pelvis identified a SBO with transition point at a small bowel intussusception; she was taken to the operating room. A mid-jejunal intussusception was reduced revealing a mass; resection and primary anastomosis was performed. Final pathology demonstrated a 5.5 cm melanoma, likely metastatic. She required no additional therapy and remains in remission eighteen months later. Intussusception due to metastatic melanoma is rare but should be on the differential for patients with SBO and history of melanoma. Knowledge of this history should prompt consideration for oncologic resection to optimize outcome.

Pneumothorax in the Setting of Spinal Surgery: A Case Report and Review of the Literature.

The purpose of this paper is to review the occurrence and management of a tension pneumothorax, which was exacerbated status post posterior spinal surgery. A retrospective review of intraoperative reports, imaging, and pertinent medical records was conducted for a patient who underwent posterior spinal surgery with a tiny apical pneumothorax, which subsequently developed into a major pneumothorax. The clinical signs imperative to recognition and prompt treatment are discussed. Our case report demonstrates that the unrecognized disruption of the pleural cavity during posterior spinal surgery caused the exacerbation of the patient's bilateral pneumothoraces. The patient was successfully treated with finger thoracostomy and chest tube insertion. In conclusion, posterior spinal surgery is an invasive procedure with the potential for serious complications such as the exacerbation of a previous non-surgical pneumothorax. A low index of suspicion is imperative due to the potentially lethal nature of pneumothoraces. Vital signs, pulmonary exam findings, portable radiography, and sonography equipment are all invaluable to the accurate diagnosis and early intervention of patients with pneumothoraces.

Cerebral Fat Embolism via a Patent Foramen Ovale.

Fat embolism syndrome (FES) is a multisystem process predominantly secondary to long bone/pelvic fractures and orthopedic procedures. A 19-year-old man presents after motor vehicle collision with trace right pneumothorax, right grade 3 kidney laceration, left pubic rami, and right femoral shaft fractures. Right femur closed reduction ensued and he underwent intramedullary nailing; his other injuries were managed nonoperatively. Upon awakening in recovery, he was newly aphasic. Despite negative repeat CT brain, he continued to worsen and became tachycardic and hypoxemic. MRI/MRA brain demonstrated innumerable bilateral frontal, parietal, and occipital acute ischemic infarcts in a starfield pattern. Echocardiogram revealed a PFO. With supportive care, he improved and was discharged with planned outpatient PFO closure. One month later, he had complete symptom resolution with return to neurologic baseline. FES is a potentially devastating condition which may include cerebral fat embolism (CFE) with outcomes varying widely from mortality to complete recovery.

Nationwide Analysis of Hospital Admissions Prior to Hartmann's Procedure for Acute Diverticulitis.

INTRODUCTION: Diverticular disease is one of the most common gastrointestinal diseases that require hospital admission. This study aims to identify trends in prior hospital admissions for patients that ultimately require a Hartmann's procedure for complicated diverticulitis. METHODS: The Nationwide Readmissions Database for 2010-2014 was queried for all patients aged 18 years or older admitted with an ICD-9 code for colonic diverticulitis and end colostomy creation. Patients with prior hospital admissions were identified. The primary outcome was mortality after Hartmann's procedure. Secondary outcomes were prior hospital admission and previous percutaneous drain placement. Multivariable logistic regression was performed to control for confounding factors for each outcome and results were weighted for national estimates. RESULTS: There were 90,162 patients admitted with complicated diverticulitis requiring end colostomy creation. Prior hospital admissions were found in 28.1% (n = 25,307) and 14.4% (n = 12,947) had a previous percutaneous drain placed during a prior admission. The overall mortality rate was 5.9% (n = 5314) after Hartman's procedure. The mortality rate for patients with prior hospital admissions was 8.7% (P < .001), and the mortality rate for patients with previous percutaneous drain placement was 4.3% (P < .001). After controlling for confounding factors including comorbidities, patients with prior admission had an increased risk of mortality (OR 1.48 [1.40-1.58], P < .001) and patients with previous percutaneous drain placement had a decreased risk of mortality (OR .66 [.60-.72], P < .001). CONCLUSIONS: Hospitalizations for complications of diverticulitis are a costly burden to our healthcare system. By identifying those patients at high risk for readmission and emergency surgery, perioperative outcomes may be improved.

Potent and selective small molecule inhibitors of specific isoforms of Cdc2-like kinases (Clk) and dual specificity tyrosine-phosphorylation-regulated kinases (Dyrk).

Continued examination of substituted 6-arylquinazolin-4-amines as Clk4 inhibitors resulted in selective inhibitors of Clk1, Clk4, Dyrk1A and Dyrk1B. Several of the most potent inhibitors were validated as being highly selective within a comprehensive kinome scan.

What is cohesiveness?-A linguistic exploration of the food texture testing literature.

Cohesiveness is a widely used term in the food texture literature. Authors of this literature employ divergent methodologies, and can be divided into those who assess texture through sensory evaluation and those who use instrumental techniques. Within each of these disciplines, there are some specialized uses of the word, creating discipline specific terms such as "cohesiveness of mass." The fact that many researchers attempt to (re)define cohesiveness, does suggest that the term is not universally understood. This blurring arises partly from the abstract nature of what it describes and also from ill matching measurements being used to quantify it. A widely agreed definition is that cohesiveness is "the strength of the internal bonds making up the body of the product," yet a challenge continues to be how we can measure it. Using the Sketch Engine corpus analysis interface to examine a corpus of articles from the food texture literature in the periods 2002-2017, the contexts in which the word stem "cohes*" is used were explored. Collocation analysis suggests that in addition to considerable commonality in the way that "cohesiveness" combines with other terms, differences reflect the foci of the disciplines with the instrumental community predominantly dealing with physical measurement while the sensory community relate "cohesiveness" more to oral processing and texture perception.

Muscle activity during oral processing of sticky-cohesive foods.

We investigated muscle activity during oral processing of sticky model foods. Chewing Time extracted from the EMG data distinguished the most sticky and least sticky model foods from the others, but was not a good discriminator between the other models. Mean chew work declined by 25.4%, while the median frequency shift (which is related to muscle fatigue) increased by 54.9% during oral processing for all the model foods, with the effect being greatest for the stickiest foods. We conclude that the degree of stickiness is not a trigger for swallowing and changes in the other bolus properties, such as softness, may influence muscle activity to a level at which we can swallow.