A Propensity-Matched Analysis of Tranexamic Acid and Acute Respiratory Distress Syndrome in Trauma Patients.

INTRODUCTION: Tranexamic acid (TXA) protects the vasculature endothelium after hemorrhage, resulting in a decreased capillary leak. These properties may protect patients receiving TXA from acute respiratory distress syndrome (ARDS), however, clinical studies have yet to examine this topic. We hypothesized that trauma patients receiving TXA would have lower incidence of ARDS. METHODS: This was a retrospective review of adult (18+ y) patients who presented to a large Level I trauma center with an injury severity score ≥ 16 from admit years 2012-2020. Propensity matching was employed to examine how TXA administration is associated with ARDS. RESULTS: There were a total of 2751 patients meeting study criteria, with 162 (5.9%) received TXA. Of the 162 patients that received TXA, only 12 (7.4%) received pre-hospital TXA, while 4 (2.5%) received TXA both pre-hospital and in hospital. Of the 63 patients developing ARDS, 62 (98.4%) did not receive TXA. After propensity matching, 304 patients remained, with 152 in each cohort. The incidence of ARDS (P = 0.08), pneumonia (P = 0.68), any pulmonary complication (P = 0.33), and mortality (P = 0.37) were not different in patients receiving TXA on propensity matching. CONCLUSIONS: TXA did not protect trauma patients from pulmonary complications; however, nearly all patients developing ARDS did not receive TXA. Larger studies should examine this relationship to improve understanding of therapies that may prevent ARDS.

Never judge an iguana by its spines: Systematics of the Yucatan spiny tailed iguana, Ctenosaura defensor (Cope, 1866).

Spiny tailed iguanas are highly diverse clade of lizards in Mesoamerica, ranging from northern Mexico through Panama. Utilizing 2 regions of mitochondrial DNA (1948bp) and 4 nuclear loci (2232bp) we explored the relationships between these species and the phylogeographic history of the major clades. We discovered that the lineage endemic to the Yucatan Peninsula renders the genus Ctenosaura paraphyletic. To resolve this non-monophyly, we resurrect the taxon Cachryx Cope, 1866, and provide a new diagnosis for the genus. We also find that small body-size and highly spinose tails in the species previously referred to the subgenus Enyaliosaurus, have evolved independently 3 times. Cachryx were recovered as sister to the lineage of iguanines endemic to the Galapagos Islands, and we discuss biogeographic scenarios to explain this relationship as well as those among the primary clades of Ctenosaura in Mesoamerica.

Managing an Advanced Heart Failure Patient at Home With a Long-Term Continuous Intravenous Furosemide Infusion.

Objective: To describe a simple therapeutic intervention for persistent congestion in an advanced heart failure patient using a continuous intravenous furosemide infusion in the home setting with a non-powered elastomeric pump that can be managed by the patient. Key Steps: Patient selected as a known intravenous furosemide responder with a supportive home environment. Shared care decision making with patient, cardiologist, heart failure nurse practitioner, palliative care physician, and general practitioner. Initiate this method of furosemide administration as an inpatient to test feasibility and determine choice of intravenous access. Communication links among lead prescriber, patient, hospital pharmacy, community nursing coordinator, patient's primary care practitioners. Community intravenous nursing support to initially change pumps, maintain intravenous line and site dressing, blood draw, teach patient to self-manage the prefilled pump changes. Baxter for compounding prefilled pumps. Potential Pitfalls: Permanent intravenous lines carry the risk of thrombosis, migration, and infection. High dose furosemide may cause ototoxicity, renal injury, electrolyte disturbance and hypotension. Take-Home Messages: Persistent congestion from chronic heart failure can be safely managed in the home with a continuous high dose intravenous furosemide infusion. In our experience, the use of elastomeric pumps has provided a simple, safe, and effective method of delivering intravenous diuretic therapy when coordinated by heart failure nurses.

ANZACS-QI Heart Failure Registry: a new approach using age-stratified sampling of hospital discharges to guide quality improvement (ANZACS-QI 79).

Heart failure is a major healthcare problem in New Zealand. The Acute Decompensated Heart Failure (ADHF) Registry was introduced in 2015, and has identified the need for quality improvement strategies to improve care of patients hospitalised with heart failure. In this paper, we describe the implementation of the revised ANZACS-QI Heart Failure Registry, which has a primary aim to support evidence-based management of and quality improvement measures for patients who are hospitalised with heart failure in New Zealand. Taking the learnings from the initial experience with the ADHF Registry, the revised ANZACS-QI Heart Failure Registry i) utilises age-stratified sampling of hospital discharge coding to identify a representative heart failure cohort, ii) utilises existing ANZACS-QI infrastructure for data-linkage to reduce the burden of manual data entry, iii) receives governance from the Heart Failure Working Group, and iv) focusses on established quality improvement indicators for heart failure management.

Investigating correlations between the PAT and three hand-skill exercises to performance in preclinical laboratory courses.

OBJECTIVES: Perceptual ability test (PAT) is a valid determinant for spatial perceptions. However, proven psychomotor skill tests for dentistry do not currently exist. This study aimed to determine whether performance on the PAT, Operation game, mirror tracing, and wax carving exercises correlate to preclinical laboratory performance in Dental Anatomy and Restorative Dentistry courses. METHODS: First-year dental students (n = 96) participated in the study. Final laboratory grades were obtained from course directors of preclinical Restorative Dentistry and Dental Anatomy courses. Admissions committee provided participants' PAT results. Participants completed a wax carving exercise by carving a cube and a semicircle into a wax block using the wax subtraction method. Two calibrated faculty graded the carvings as Ideal (5), Satisfactory (3), or Unsatisfactory (1). Time to complete the Operation game and number of infractions were recorded. Participants traced the six-pointed star pattern on the Auto Scoring Mirror Tracer instrument in both clockwise and counterclockwise directions. Completion times and number of instances outside the pattern were recorded. Spearman Rank Correlations were used to determine associations at 0.05 confidence interval. RESULTS: Mean PAT score was 21.7; mean times to complete the Operation game and mirror tracing exercise were 4:20 and 1:30, respectively. Mean score on the wax carving exercise was 3.19. Correlations between the independent and dependent variables were minimal to weak. The wax carving exercise was the most reliable predictor of performance. CONCLUSIONS: When PAT scores are striated into low (less than 20), middle (21-22), and high (23-30), it was possible to predict performance in both preclinical laboratory courses.

Mood-congruent true and false memory: effects of depression.

The Deese/Roediger-McDermott paradigm was used to investigate the effect of depression on true and false recognition. In this experiment true and false recognition was examined across positive, neutral, negative, and depression-relevant lists for individuals with and without a diagnosis of major depressive disorder. Results showed that participants with major depressive disorder falsely recognised significantly more depression-relevant words than non-depressed controls. These findings also parallel recent research using recall instead of recognition and show that there are clear mood congruence effects for depression on false memory performance.

Valence and the development of immediate and long-term false memory illusions.

Across five experiments we examined the role of valence in children's and adults' true and false memories. Using the Deese/Roediger-McDermott paradigm and either neutral or negative-emotional lists, both adults' (Experiment 1) and children's (Experiment 2) true recall and recognition was better for neutral than negative items, and although false recall was also higher for neutral items, false recognition was higher for negative items. The last three experiments examined adults' (Experiment 3) and children's (Experiments 4 and 5) 1-week long-term recognition of neutral and negative-emotional information. The results replicated the immediate recall and recognition findings from the first two experiments. More important, these experiments showed that although true recognition decreased over the 1-week interval, false recognition of neutral items remained unchanged whereas false recognition of negative-emotional items increased. These findings are discussed in terms of theories of emotion and memory as well as their forensic implications.

Characterisation of breast cancer cell lines and establishment of a novel isogenic subclone to study migration, invasion and tumourigenicity.

The process of tumour invasion and subsequent metastasis represents the most lethal aspect of cancer. In this study the invasive and migratory activity of four human breast cancer cell lines; MCF-7, MDA-MB-231, BT474 and Hs578T was investigated. Isogenic subclones were isolated from the Hs578T cell line using sequential passages through the BD Matrigel Invasion Chamber assay system. A new invasive subclone designated, Hs578Ts(i)8 was isolated and shown to be 3-fold more invasive and 2.5-fold more migratory than the parental cell line. The variant cells formed up to 25 times more colonies in soft agar and also produced tumours in vivo in nude mice. Flow cytometry analysis showed that the Hs578Ts(i)8 cells had 30% more CD44+/CD24-/low cells than the parental Hs578T cell line. The presence of a breast cancer stem cell population within the variant cell line may provide an explanation for the increased anchorage independent growth and tumourigenicity.

Polymyalgia rheumatica as an unusual cause of pleural and pericardial effusion.

We report a patient with polymyalgia rheumatica (PMR) who initially presented with chest pain pleural and pericardial effusions. A history was then obtained of shoulder girdle aching and stiffness, suggestive of PMR, and laboratory investigations supported the diagnosis. A rapid response to 15 mg prednisolone once daily was noted, with resolution of effusion and symptoms. Although pericardial effusion has previously been reported, this is the first reported case of pleuropericardial effusions in PMR. Rheumatologists should be aware that PMR may occasionally be the explanation for pleuropericardial effusion in the elderly.