Trauma centers: an underfunded but essential asset to the community.

Research indicates that specialized trauma centers, especially those of level I and II designation, can generate revenue if financial support is provided, and most importantly provide better outcomes for an injured patient by reducing length of stay and mortality when compared with treatment at hospitals without trauma center designation. Costs associated with trauma center operation have risen over the past few years in association with growing patient volumes and inflation. Documentation regarding costs for trauma center operations is sparse, and there exists a large variance between reported numbers based on their region. In most cases, the greatest proportion of funds are spent on clinical personnel while the smallest fraction is dedicated to educational and prevention programs. Studies confirm that as a product of these rising costs and a lack of state and federal funding that trauma centers remain uniquely financially vulnerable. Multiple strategies have been implemented to mitigate these costs but have proven insufficient. Legislations providing patients with expanded access to healthcare such as the Affordable Healthcare Act have failed to deliver on their intended purposes, and managed care organizations have moved to protect their own interest at the expense of trauma patient mortality. In lieu of concerted federal support, states and municipalities have explored solutions to support trauma centers such as small fees added to fines or encouraging charitable donations, although these programs have not seen ubiquitous implementation. Most trauma centers have begun incorporating activation costs to recoup losses from their low reimbursement rate, but these have continued to inflate, and pose a growing burden on vulnerable patients. Lack of funding from external sources such as state or federal appropriations poses a tangible threat to trauma centers for closure, and with multiple trauma centers acting as critical pillars of healthcare infrastructure for disadvantaged communities as well as the impact of this lack of funding being so broad and systemic, multiple 'trauma deserts' may emerge, leaving communities-especially disadvantaged communities which rely on the safety-net function of many high designation trauma centers-deprived of an essential treatment resource and increasing annual mortalities that could have otherwise been averted.

Outcomes of early versus late irrigation and debridement of pediatric open long bone fractures.

BACKGROUND: Open long bone fractures are a major concern for pediatric patients due to the risk of surgical site infection (SSI). Early studies have recommended irrigation and debridement of open fractures within 6 hours-8 hours for the prevention of SSI. According to the American College of Surgeons (ACS) Best Practice Guidelines, in 2015, irrigation and debridement should be done within 24 hours. AIM: To identify whether early irrigation and debridement, within 8 hours, vs late, between 8 hours and 24 hours, for pediatric open long bone fractures impacts rate of SSI. METHODS: Using retrospective data review from the National Trauma Data Bank, Trauma Quality Improvement Project (TQIP) of 2019. TQIP database is own by the ACS and it is the largest database for trauma quality program in the world. Propensity matching analysis was performed for the study. RESULTS: There were 390 pediatric patients with open long bone fractures who were included in the study. After completing propensity score matching, we had 176 patients in each category, irrigation and debridement within 8 hours and irrigation and debridement between 8 hours and 24 hours. We found no significant differences between each group for the rate of deep SSI which was 0.6% for patients who received surgical irrigation and debridement within 8 hours and 1.1% for those who received it after 8 hours [adjusted odd ratio (AOR): 0.5, 95%CI: 0.268-30.909, P > 0.99]. For the secondary outcomes studied, in terms of length of hospital stay, patients who received irrigation and debridement within 8 hours stayed for an average of 3.5 days, and those who received it after 8 hours stayed for an average of 3 days, with no significant difference found, and there were also no significant differences found between the discharge dispositions of the patients. CONCLUSION: Our findings support the recommendation for managing open long bone fractures from the ACS: Complete surgical irrigation and debridement within 24 hours.

The experimental significance of isorhamnetin as an effective therapeutic option for cancer: A comprehensive analysis.

Isorhamnetin (C16H12O7), a 3'-O-methylated derivative of quercetin from the class of flavonoids, is predominantly present in the leaves and fruits of several plants, many of which have traditionally been employed as remedies due to its diverse therapeutic activities. The objective of this in-depth analysis is to concentrate on Isorhamnetin by addressing its molecular insights as an effective anticancer compound and its synergistic activity with other anticancer drugs. The main contributors to Isorhamnetin's anti-malignant activities at the molecular level have been identified as alterations of a variety of signal transduction processes and transcriptional agents. These include ROS-mediated cell cycle arrest and apoptosis, inhibition of mTOR and P13K pathway, suppression of MEK1, PI3K, NF-κB, and Akt/ERK pathways, and inhibition of Hypoxia Inducible Factor (HIF)-1α expression. A significant number of in vitro and in vivo research studies have confirmed that it destroys cancerous cells by arresting cell cycle at the G2/M phase and S-phase, down-regulating COX-2 protein expression, PI3K, Akt, mTOR, MEK1, ERKs, and PI3K signaling pathways, and up-regulating apoptosis-induced genes (Casp3, Casp9, and Apaf1), Bax, Caspase-3, P53 gene expression and mitochondrial-dependent apoptosis pathway. Its ability to suppress malignant cells, evidence of synergistic effects, and design of drugs based on nanomedicine are also well supported to treat cancer patients effectively. Together, our findings establish a crucial foundation for understanding Isorhamnetin's underlying anti-cancer mechanism in cancer cells and reinforce the case for the requirement to assess more exact molecular signaling pathways relating to specific cancer and in vivo anti-cancer activities.

Dominance of Cotton leaf curl Multan virus-Rajasthan strain associated with third epidemic of cotton leaf curl disease in Pakistan.

Cotton (Gossypium hirsutum) is an economically potent crop in many countries including Pakistan, India, and China. For the last three decades, cotton production is under the constant stress of cotton leaf curl disease (CLCuD) caused by begomoviruses/satellites complex that is transmitted through the insect pest, whitefly (Bemisia tabaci). In 2018, we identified a highly recombinant strain; Cotton leaf curl Multan virus-Rajasthan (CLCuMuV-Raj), associated with the Cotton leaf curl Multan betasatellite-Vehari (CLCuMuBVeh). This strain is dominant in cotton-growing hub areas of central Punjab, Pakistan, causing the third epidemic of CLCuD. In the present study, we have explored the CLCuD diversity from central to southern districts of Punjab (Faisalabad, Lodhran, Bahawalpur, Rahimyar Khan) and the major cotton-growing region of Sindh (Tandojam), Pakistan for 2 years (2020-2021). Interestingly, we found same virus (CLCuMuV-Raj) and associated betasatellite (CLCuMuBVeh) strain that was previously reported with the third epidemic in the central Punjab region. Furthermore, we found minor mutations in two genes of CLCuMuV-Raj C4 and C1 in 2020 and 2021 respectively as compared to its isolates in 2018, which exhibited virus evolution. Surprisingly, we did not find these mutations in CLCuMuV-Raj isolates identified from Sindh province. The findings of the current study represent the stability of CLCuMuV-Raj and its spread toward the Sindh province where previously Cotton leaf curl Kokhran virus (CLCuKoV) and Cotton leaf curl Shahdadpur virus (CLCuShV) have been reported. The findings of the current study demand future research on CLCuD complex to explore the possible reasons for prevalence in the field and how the virus-host-vector compatible interaction can be broken to develop resistant cultivars.

Resuscitative Endovascular Balloon Occlusion of The Aorta (REBOA) And Mortality in Hemorrhagic Shock Associated with Severe Pelvic Fracture: a National Data Analysis.

BACKGROUND: The purpose of the study was to evaluate the mortality of patients who received Resuscitative Endovascular Balloon Occlusion of The Aorta (REBOA) in severe pelvic fracture with hemorrhagic shock. METHODS: The American College of Surgeon Trauma Quality Improvement Program (ACS-TQIP) database for the calendar years 2017-2019 was accessed for the study. The study included all patients aged 15 years and older who sustained severe pelvic fractures, defined as an injury with an abbreviated injury scale (AIS) score of ≥ 3, and who presented with the lowest systolic blood pressure (SBP) of < 90 mmHg. Patients with severe brain injury were excluded from the study. Propensity score matching was used to compare the patients who received REBOA with similar characteristics to patients who did not receive REBOA. RESULTS: Out of 3,186 patients who qualified for the study, 35(1.1%) patients received REBOA for an ongoing hemorrhagic shock with severe pelvic fracture. The propensity matching created 35 pairs of patients. The pair-matched analysis showed no significant differences between the group who received REBOA and the group that did not receive REBOA regarding patients' demography, injury severity, severity of pelvic fractures, lowest blood pressure at initial assessment and laparotomies. There was no significant difference found between REBOA versus no REBOA group in overall in-hospital mortality (34.3% vs. 28.6, P = 0.789). CONCLUSION: Our study did not identify any mortality advantage in patients who received REBOA in hemorrhagic shock associated with severe pelvic fracture compared to a similar cohort of patients who did not receive REBOA. A larger sample size prospective study is needed to validate our results. CASE-CONTROL RETROSPECTIVE STUDY: Level of Evidence IV.

Levetiracetam or Phenytoin as Prophylaxis for Status Epilepticus: Secondary Analysis of the "Approaches and Decisions in Acute Pediatric Traumatic Brain Injury Trial" Dataset, 2014-2017.

OBJECTIVES: To compare levetiracetam and phenytoin as prophylaxis for the short-term development of status epilepticus (SE) during care of pediatric patients with acute severe traumatic brain injury (TBI). DESIGN: Nonprespecified secondary analysis using propensity score matching. SETTING: We used the Approaches and Decisions in Acute Pediatric TBI Trial (ADAPT NCT04077411) dataset (2014-2017). SUBJECTS: Patients less than 18 years old with Glasgow Coma Scale Score less than or equal to 8 who received levetiracetam or phenytoin as a prophylactic anticonvulsant therapy. INTERVENTION: None. MEASUREMENT AND MAIN RESULTS: Of the 516 total patients who qualified for the case-control study, 372 (72.1%) patients received levetiracetam, and 144 (27.9%) received phenytoin. After propensity score matching, the pair-matched analysis with 133 in each group failed to identify an association between levetiracetam versus phenytoin use and occurrent of SE (3.8% vs. 0.8%, p = 0.22), or mortality (i.e., in-hospital, 30-d and 60-d). However, on closer inspection of the statistical testing, we cannot exclude the possibility that selecting levetiracetam rather than phenytoin for prophylaxis was associated with the following: up to a mean difference of 7.3% greater prevalence of SE; up to a mean difference of 13.9%, 12.1%, and 13.9% greater mortality during the hospital stay, and 30-, and 60-days after hospital arrival, respectively. Last, analysis of 6 months Glasgow Outcome Scale Extended score in those without premorbid comorbidities, there was an association between favorable outcomes and use of phenytoin rather than levetiracetam prophylaxis. CONCLUSIONS: In ADAPT, the decision to use prophylactic levetiracetam versus phenytoin failed to show an association with occurrence of subsequent SE, or mortality. However, we are unable to exclude the possibility that selecting levetiracetam rather than phenytoin for prophylaxis was associated with greater prevalence of SE and mortality. We are unable to make any recommendation about one prophylactic anticonvulsant medication over the other, but recommend that further larger, contemporary studies in severe pediatric TBI are carried out.

Surgical Outcomes of Epidural Hematoma in Trauma Patients with Absent Pupillary Reactions: A National Trauma Data Analysis.

BACKGROUND: Absent pupillary reaction occasionally heralds a poor prognosis following severe head injury. The purpose of the study was to evaluate the outcome of all patients who underwent acute evacuation of epidural hematoma (EDH) despite absent bilateral pupillary reaction. METHODS: The Trauma Quality Improvement Program (TQIP) database for the calendar years 2017 and 2018 was accessed for the study. Adult patients ≥18 years of age who sustained severe traumatic brain injury (TBI) with the diagnosis of EDH and underwent evacuation of the hematoma were included in the study. The patients' characteristics, injury severity score (ISS), Glasgow Coma Scale (GCS) score, midline shift, and comorbidities were compared between patients who had absence of both pupillary reaction (ABPR) and those who presented with presence of both pupillary reaction (PBPR). The primary outcome of the study was in-hospital mortality. Propensity score matching analyses were performed for the study. RESULTS: No significant differences were found between the ABPR and PBPR groups regarding the median age (37 years [interquartile range (IQR): 26-53] vs. 40 years [IQR: 28-55]), gender (males; 81.9 vs. 79.5%), median ISS (29 [25.5-34] vs. 27 [25-33]), GCS score (3 [3-4] vs. 3 [3-3], presence of significant midline shift (75.9 vs. 79.5%), and comorbidities. The patients who presented with ABPR had a significantly higher mortality (34.9 vs. 10.8%; p = 0.002). A higher number of patients were discharged to skilled nursing and rehabilitation facilities (16.7 vs. 10.8% and 46.3 vs. 41.9%, respectively; p = 0.045). CONCLUSION: Approximately 65% of severe TBI patients survived after the evacuation of the EDH despite the absence of pupillary reaction.

Factors associated with pediatric trauma patients leaving against medical advice.

BACKGROUND: Discharge against medical advice (AMA) leads to worse patient outcomes, increased readmission rates, and higher cost. However, AMA discharge has received limited study, particularly in pediatric trauma patients. Our objective was to explore the risk factors associated with leaving AMA in pediatric trauma patients. METHODS: We performed a retrospective analysis on pediatric trauma patients from 2017 to 2019 using the National Trauma Data Bank. We examined patient characteristics including age (<18 years), race, sex, Glasgow Coma Scale, trauma type, primary payment methods, and Abbreviated Injury Scale. Multiple Logistic Regression models were utilized to determine characteristics associated with leaving AMA. RESULTS: Of the 224,196 pediatric patients included in the study, 238 left AMA (0.1%). Our study showed black pediatric trauma patients were more likely to leave AMA compared to nonblack patients (OR 1.987, 95% CI 1.501 to 2.631). Patients with self-pay coverage were more likely to leave AMA than those with other insurance coverages (OR 1.759, 95% CI 1.183 to 2.614). Blunt trauma patients were more likely to leave AMA than those with penetrating trauma (OR 1.683, 95% CI 1.216 to 2.330). Every one-year increase in age led to 15% increase in odds of AMA discharge (OR 1.150, 95% CI 1.115 to 1.186). Pediatric patients with severe abdominal injuries were less likely to leave AMA compared to those with mild abdominal injuries (OR 0.271, 95% CI 0.111 to 0.657). Patients with severe lower extremity injury were less likely to leave AMA compared to those with mild lower extremity injuries (OR 0.258, 95% CI 0.127 to 0.522). CONCLUSION: Race, insurance, injury type, and age play a role in AMA discharge of pediatric trauma patients. Black pediatric trauma patients have ∼ double the AMA discharge rate of nonblack patients. AMA discharge remains relevant, and addressing racial and socioeconomic factors provide opportunities for future interventions in pediatric trauma care. LEVEL OF EVIDENCE: III, retrospective study.

Association of Designated Pediatric Trauma Center and Outcomes of Severely Injured Children Who Were Mechanically Ventilated and Underwent Tracheostomy: A Propensity-Matched Analysis.

OBJECTIVES: The purpose of the study is to examine the outcomes of care delivered at the pediatric trauma center (PTC) in severely injured children who were intubated, mechanically ventilated, and underwent tracheostomy. METHODS: The study data were obtained from the Trauma Quality Improvement Program database for the calendar years 2017 to 2019. All children aged ≤17 years who sustained severe injury, required intubation and mechanical ventilation for more than 96 hours, and underwent tracheostomy were included in the study. Patients' characteristics, injury severity, and outcomes were compared between the care provided at the PTCs (level I or level II) and nonpediatric trauma centers (NPTCs). The propensity score matching methodology was used to perform the analysis. All P values are 2-sided, and a P value of <0.0.5 is considered statistically significant. RESULTS: Of 2164 patients who were qualified for the study, 1288 (59%) of the patients were treated at PTCs, and 876 (40.5%) of the patients were treated at NPTCs. Propensity matching created 876 pairs of patients. There were no significant differences found between the 2 groups on patients' characteristics except for age. Patients who were treated at PTCs had a median age of 14 (10-16) versus 15 (11-17) years ( P < 0.001) when compared with care provided at NPTCs. A longer hospital stay was found in the PTC group when compared with the NPTC group (24 [23, 25] vs 22 [21, 24], P = 0.008). Patients who were treated at PTC were found to have significantly less sepsis occurrence (0.9% vs 2.2%), and a higher proportion of patients were discharged home without needing additional support (26.2% vs 18.5%). CONCLUSIONS: Care at the PTC was associated with a lower occurrence of sepsis complications. A higher number of patients were discharged home without additional services when the care was provided at PTC.

Outcomes of Repeat Surgery in Pediatric Severe Traumatic Brain Injury: An Analysis from Approaches and Decisions in Acute Pediatric Traumatic Brain Injury Trial.

BACKGROUND: Early operative intervention, craniotomy, and/or craniectomy are occasionally warranted in severe traumatic brain injury (TBI). Persistent increased intracranial pressure or accumulation of intracranial hematoma postsurgery can result in higher mortality and morbidity. There is a gap in information regarding the outcome of repeat surgery (RS) in pediatric patients with severe TBI. METHODS: An observational cohort study titled Approaches and Decisions in Acute Pediatric TBI Trial data was obtained from the Federal Interagency Traumatic Brain Injury Research Informatics System. All pediatric patients who underwent craniotomy or decompressive craniectomy, survived more than 44 hours and were found to have persistent elevated intracranial pressure >20 mmHg for 2 consecutive hours were included in the study. The purpose of the study was to find the outcomes of RS in pediatric severe TBI. Propensity based matching was used to find the outcomes. The primary outcome was 60-day mortality. RESULTS: Out of 1000 total patients enrolled in the Approaches and Decisions in Acute Pediatric Trial, 160 patients qualified for this study. Propensity score matching created 13 pairs of patients. There were no significant differences found between the groups who had RS versus those who did not have repeat surgery on baseline characteristics. There were no significant differences found between the groups regarding 60-day mortality, median hospital days, median intensive care unit days, and 6-month favorable outcome on Glasgow Outcome Scale Extended score. CONCLUSIONS: There was no difference in mortality between patients who underwent a second surgery and patients who did not have to undergo a second surgery.

Esculetin unveiled: Decoding its anti-tumor potential through molecular mechanisms-A comprehensive review.

BACKGROUND: The growing complexity of cancer has made it a significant concern in the medical community. Although cancer research has advanced, it is still challenging to create new effective medications due to the limitations and side effects of existing treatment strategies. These are enforcing the development of some alternative drugs from natural compounds with fewer drawbacks and side effects. AIM: Therefore, this review aims to provide up-to-date, crucial, and all-encompassing data on esculetin's anticancer activity, including all relevant molecular and cellular processes based on in vivo and in vitro investigations. RESULTS: According to the literature review, esculetin is available in nature and is effective against 16 different types of cancer. The general mechanism shown by esculetin is modulating signaling cascades and its related pathways, like cell proliferation, cell growth, autophagy, apoptosis, necrosis, inflammation, angiogenesis, metastasis, invasion, and DNA damage. Nanoformulation of esculetin improves this natural product's efficacy by improving water solubility. Esculetin's synergistic effects with both natural substances and conventional treatments have been shown, and this method aids in reversing resistance mechanisms by modulating resistance-related proteins. In addition, it has fewer side effects on humans than other phytochemicals and standard drugs with some good pharmacokinetic features. CONCLUSION: Therefore, until standard chemotherapeutics are available in pharmaceutical markets, esculetin should be used as a therapeutic drug against various cancer types.

Factors Associated With Tracheostomy in Ventilated Pediatric Trauma Patients. A National Trauma Database Study.

PURPOSE: The purpose of the study was to find the factors that were associated with tracheostomy procedures in ventilated pediatric trauma patients. METHODS: The Trauma Quality Improvement Program (TQIP) database of the calendar year 2017 through 2019 was accessed for the study. All patients <18 years old and who were on mechanical ventilation for more than 96 hours were included in the study. Multiple logistic regression analysis was performed to find the factors that were associated with a tracheostomy. RESULTS: Out of 2653 patients, 1907 (71.88%) patients underwent tracheostomy. The patients who underwent tracheostomy had a lower median [IQR] of Glasgow Coma Scale (GCS) (3 [3-8] vs 5 [3-10], P < .001) and had a higher proportion of severe spine injury (On Abbreviated Injury Scale [AIS]≥3) (11.6% vs 8.8%, P = .044) when compared with patients who did not have tracheostomy. Lower GCS scores and severe spine injury were associated with higher odds of tracheostomy, with all P values <.05. Higher proportion of tracheostomy procedures were performed at level I pediatric trauma centers as compared to non-designated pediatric centers (odds ratio [95% CI]: 1.848 [1.524-2.242], P < .001). CONCLUSION: A lower GCS score, severe spine injury and highest level trauma centers were associated with a tracheostomy.

Outcomes of Elevated Blood Alcohol Concentrations in Elderly Patients Following a Ground Level Fall: A Matched Analysis from the National Trauma Quality Program.

BACKGROUND: The rising elderly population and the concomitant increase in alcohol consumption can result in a ground level fall (GLF). The purpose of this study is to evaluate the in-hospital mortality, hospital length of stay, and discharge disposition of elderly patients who sustained a ground level fall (GLF) and tested positive for an elevated blood alcohol concentration (BAC). METHODS: The data of patients who were 65 years and older, had an injury after a GLF, and tested for BAC were accessed from the American College of Surgeon -Trauma Quality improvement Program (ACS-TQIP) from the calendar year of 2011-2016. Patients' demography, injury, comorbidities, and outcomes were compared between the groups who tested positive (>0.08g/dl) and negative (0 mg/dl) for BAC. Univariate, followed by matched analyses were performed. All p values are two sided, and a p value <0.05 is considered statistically significant. RESULTS: Out of 20,163 patients who satisfied the inclusion criteria, 2,398 (∼12%) patients tested positive for an elevated BAC. There were significant differences found between the two groups, BAC positive vs. BAC negative, in univariate analysis for age and sex with P values <0.001. Propensity score matching balanced demographic characteristics; however, differences remained in certain comorbidities. Exact matching balanced patient demography, injury, and comorbidities. The paired matched analysis showed no significant differences between the two groups for in-hospital mortality (2.1% vs. 2.1%, P=1) and median hospital length of stay (5[4-5] vs. 5[5-5], P=0.307). A higher proportion of patients in BAC group suffered from alcohol withdrawal syndrome (AWS) and deep vein thrombosis (DVT) complications (9.5% vs. 1.4%, P<0.001 and 1.5% vs. 0.5%, P=0.018) compared to BAC negative patients. A slightly higher percentage of patients in the BAC positive group were discharged home without any additional services (39.6% vs. 36.9%, P<0.001). CONCLUSION: Of the elderly patients who sustained a GLF and tested for BAC, approximately 12% tested positive for BAC. The overall in-hospital mortality was 2.1%. The BAC-positive group suffered from higher complications of AWS and DVT, and more than 60% of patients required additional services at the time of discharge.

Factors associated with compartment syndrome after a tibial fracture in children.

Objectives: Compartment syndrome (CS) after a tibial fracture in children is one of the orthopedic emergencies. Identifying high-risk patients in a timely fashion minimizes morbidities. This study aimed to find the risk factors of CS after a tibial fracture. Methods: The study data was retrieved from the Trauma Quality Improvement Program database of the calendar year 2017-2019. All patients aged <18 years old who were admitted to the hospital with tibial fractures were included in the study. Patients' characteristics, including demography, injury, injury severity, and associated crushed and vascular injuries were analyzed between the groups who developed CS versus those who did not develop CS after a tibial fracture. Multiple logistic regression analyses were performed to find the association of CS. All p values are two-sided and a p value<0.05 is considered statistically significant. Results: Of 4492 patients who qualified for the study, 49 (1.1%) patients developed CS. The patients who developed CS sustained more crush injuries and were associated with a higher rate of vascular injury (2% vs 0.1%, p=0.043% & 10.2% vs 2.2%, p=0.005). Multivariable analysis showed that for every increase in 1 year of age, the odds of occurrence of CS increased by 15.7% (adjusted OR (AOR)=1.157, 95% CI: 1.032 to 1.297, p=0.013). Non-African American race was associated with more than double the risk of developing CS when compared with the African American race, AOR was 2.238, (95% CI: (1.08 to 4.638)). The associated crush injury had an approximately 19-fold higher risk of CS when compared with patients presented with no crush injury, AOR was 18.812, (95% CI: (1.513 to 233.931)). Associated vascular injury was found to have significantly higher AOR, 3.509, 95% CI: (1.287 to 9.563) of CS. Conclusion: Increased age, non-African American race, vascular injury, and crushed injury were associated with a risk of developing CS after a tibial fracture. Level of evidence IV: Study type: Observational cohort study.

pH regulated lactose inspired fabrication of zinc oxide nanoparticles for insulin sensing by LSPR absorption.

Nanostructured metal oxide particles with diversified morphologies are in high demand in nanotechnology. The particle size, shape, and overall geometry mainly depend on the fabrication method. This study reports synthesis of zinc oxide nanoparticles (ZnO NPs) from zinc nitrate hexahydrate [Zn(NO3)2.6H2O] precursor in aqueous media at 65 °C by using lactose from cow milk as a reducing agent and regulating pH from 6 to 10. UV-visible absorption gave maximum absorbance (λmax) at 371-375 nm in ethanol for localized surface plasmon resonance (LSPR), FTIR exhibited bands at ca. 439-481 cm-1 for stretching mode Zn-O bonds, and XRD peaks at 2 θ values at 31.8, 34.45, and 36.28° confirmed the fabricated ZnO NPs. The XRD spectra also indicated that the ZnO crystallite (20-30 nm) has a hexagonal wurtzite structure. The average particle sizes measured by DLS were ca. 50-837 nm, and SEM microphotographs demonstrated the morphology of ZnO NPs with a hexagonal, rod-shaped, or spike-like structure. The ZnO NPs were used to investigate the LSPR absorption at various concentrations of insulin, ranging from 2.5 µM to 50 µM. The ZnO NPs fabricated at pH 7 and 10 showed better insulin sensing performance with high precision. The synthesis approach of ZnO NPs with variable morphologies would play a significant function in biomedical science especially real time monitoring of glucose for efficient management of diabetes.

Impact of cannabis on outcome in patients following traumatic injury.

INTRODUCTION: Outcomes of trauma patients who tested positive for cannabis at the time of admission showed variable results. Sample size and research methodology that was used in prior studies may have resulted in the conflict. The purpose of the study was to evaluate the impact of cannabis use on outcomes in trauma patients using national data. Our hypothesis was that the use of cannabis will impact outcomes. METHODS: The trauma quality improvement program (TQIP) Participant Use File (PUF) database of the calendar years 2017 and 2018 were accessed for the study. All trauma patients aged 12 years old and above who were tested for cannabis at the time of initial evaluation were included in the study. Variables included in the study were: race, sex, injury severity score (ISS), Glasgow Coma Scale (GCS) Score, Abbreviated Injury Scale (AIS) score of different body regions and comorbidities. Excluded from the study were all patients who were not tested for cannabis or tested for cannabis but were also tested positive for alcohol and other drugs and those suffering from mental conditions. Propensity matched analysis was performed. The outcome of interest was overall in-hospital mortality and complications. RESULTS: Propensity matched analysis created 28,028 pairs. The analysis showed no significant difference in-hospital mortality between cannabis positive and cannabis negative groups (3.2% vs. 3.2%). The median length of hospital stay in both groups was not significantly different (4 [IQR: 3-8] vs. 4 [IQR: 2-8] days). No significant difference was found between the two groups regarding hospital complications except in pulmonary embolism (PE) with 0.1% less incidence of PE in the cannabis positive group compared to the cannabis negative group (0.4 vs. 0.5%). The incidence of DVT was identical in both groups (0.9% vs. 0.9%). CONCLUSION: Cannabis was not associated with overall in-hospital mortality or morbidity. There was a slight decrease in the incidence of PE in the cannabis positive group.

Outcomes of Severe Acute Kidney Injury in Pediatric Trauma Patients; The Trauma Quality Improvement Program Database Study.

INTRODUCTION: Acute kidney injury (AKI) has been associated with higher mortality and morbidity in trauma victims. There is a paucity of information regarding the outcomes of severe AKI (sAKI) in pediatric trauma patients. Therefore, the trauma quality improvement program database (TQIP) was used to assess that hypothesis sAKI will be associated with higher mortality among pediatric trauma patients. METHODS: The TQIP database was accessed for the study. Patients aged <18 years old admitted to the hospital after sustaining injury were included in the study. Demographics, injury severity score (ISS) and Glasgow coma scale (GCS) score, other body regions injuries, and available comorbidities were included in the study. Propensity score matching analysis was performed to compare the two groups, sAKI vs. no sAKI on patients' characteristics and outcomes. All p values are two-sided. A p-value <0.05 is considered statistically significant. RESULTS: Out of 139,832 patients who qualified for the study, 106 (0.1%) patients suffered from sAKI. Pair-matched analysis showed no significant difference between the groups, sAKI, and no sAKI, regarding the in-hospital mortality (14.3% vs. 12.4%, P = 0.838). There was a prolonged hospital length of stay in the sAKI group when compared to the no sAKI group, (27 days [21-33] vs. 10 [9-14], P < 0.001). There was a higher incidence of deep vein thrombosis (DVT) (12.4% vs. 2.9%, P = 0.024) in the sAKI group as well. CONCLUSION: The sAKI patients stayed in the hospital approximately three times longer and had a 4-fold increase in the occurrence of DVT. No significant difference was found between the groups in in-hospital mortality. TYPE OF STUDY: Retrospective cohort study.

Exploring the anti-cancer potential of dietary phytochemicals for the patients with breast cancer: A comprehensive review.

BACKGROUND: The most common and deadly cancer in female is breast cancer (BC) and new incidence and deaths related to this cancer are rising. AIMS: Several issues, that is, high cost, toxicity, allergic reactions, less efficacy, multidrug resistance, and the economic cost of conventional anti-cancer therapies, has prompted scientists to discover innovative approaches and new chemo-preventive agents. MATERIALS: Numerous studies are being conducted on plant-based and dietary phytochemicals to discover new-fangled and more advanced therapeutic approaches for BC management. RESULT: We have identified that natural compounds modulated many molecular mechanisms and cellular phenomena, including apoptosis, cell cycle progression, cell proliferation, angiogenesis and metastasis, up-regulation of tumor-suppressive genes, and down-regulation of oncogenes, modulation of hypoxia, mammosphere formation, onco-inflammation, enzymatic regulation, and epigenetic modifications in BC. We found that a number of signaling networks and their components such as PI3K/Akt/mTOR, MMP-2 and 9, Wnt/-catenin, PARP, MAPK, NF-κB, Caspase-3/8/9, Bax, Bcl2, Smad4, Notch1, STAT3, Nrf2, and ROS signaling can be regulated in cancer cells by phytochemicals. They induce up-regulation of tumor inhibitor microRNAs, which have been highlighted as a key player for ani-BC treatments followed by phytochemical supplementation. CONCLUSION: Therefore, this collection offers a sound foundation for further investigation into phytochemicals as a potential route for the development of anti-cancer drugs in treating patients with BC.

Outcomes of care at higher-level trauma centers in octogenarians with a history of anticoagulant use who fall from ground level.

BACKGROUND: The appropriate care of octogenarian trauma patients after a fall from ground level (FFGL) is a key factor for better outcomes. The purpose of this study is to use data from a national database to evaluate the outcomes of patients who are 80-89 years old with a history of anticoagulant use, sustained a FFGL, and were treated at a higher-level care institution. METHODS: The Trauma Quality Improvement Program (TQIP) database of the calendar year 2017-2018 was accessed for the study. All hospitalized trauma patients between the ages of 80-89 years old with a history of anticoagulant use and sustaining an injury after FFGL were included in the study. Other variables included in the study are sex [male], race [white], initial systolic blood pressure (SBP mmHg), Injury Severity Score (ISS), Glasgow Coma Scale (GCS), hypotension with an SBP<110 mmHg and other comorbidities. The outcomes of the patients were compared with the care at higher-level trauma centers (Level I & Level II) and lower-level trauma centers (Level III) using propensity matched analysis. RESULTS: After propensity matching, 2348 patients were identified in each group. There was no clinically significant difference between the patients' characteristics who were treated at higher-level and lower-level care centers. A paired matched analysis showed greater mortality in patients who were treated at higher-level care centers compared to lower-level care centers (3.7% vs 2.6%, P = 0.03). The absolute difference in mortality was 1.1%[95% CI: 0.001, 0.022] which may not have any clinical relevance. A greater number of patients were discharged to home and a lesser number of patients were discharged to a skilled nursing facility (SNF) when they were treated at higher-level trauma centers. CONCLUSION & RELEVANCE: The care at higher-level trauma centers did not show any benefit in-hospital mortality in the short term. A higher number of patients was discharged to home without assistance.

Minor injury turns into major problem in severe acute kidney injury: a propensity matched analysis.

Objective: Severe acute kidney injury (sAKI) has been associated with a higher mortality in trauma patients, and severity of trauma often correlates with risk of sAKI. Whether minor to moderate trauma is associated with sAKI is less clear. The purpose of the study was to examine the outcomes of minor to moderate trauma patients who developed sAKI. Methods: The National Trauma Database participant use files of 2017 and 2018 were accessed for the study. All patients aged 18 years old and above who sustained an Injury Severity Score (ISS) of <16 and who were brought to a level I or level II trauma center were included in the study. sAKI was defined as an abrupt decrease in kidney function either three times increase in serum creatinine (SCr) level from the baseline or increase in SCr to ≥4.0 mg/dL (≥353.6 µmol/L), initiation of renal replacement therapy, or anuria for ≥12 hours. Propensity matching analysis was performed between the groups who developed sAKI and without sAKI. Outcome of interest was in-hospital mortality. Results: A total of 655 872 patients fulfilled the inclusion criteria with complete information, of which 1896 patients were found to have sAKI. There were significant differences between the two groups on baseline characteristics. The propensity score matching eliminated all the differences and created 1896 pairs of patients. The median hospital length of stay was longer in patients with sAKI when compared with patients who did not develop sAKI (14 (13 to 15) vs. 5 (5 to 5), days p<0.001). The overall in-hospital mortality was 20.6% in patients with sAKI compared with 2.1% without sAKI (p<0.001). Conclusion: The occurrence of sAKI in minor to moderate trauma patients was less than 0.5%. There was a three times longer hospital stay in patients with sAKI and 10-fold increase in mortality when compared with patients who did not develop sAKI. Level of evidence: IV. Study type: Observational cohort study.