Sleep-Disordered Breathing and Cerebral Oxygenation During Sleep in Adults With Mild Cognitive Impairment.

The current study examined relationships between laterality in cerebral oxygenation (L-COX), sleep-disordered breathing (SDB), and daytime function in 16 adults with mild cognitive impairment (MCI). All participants underwent two nights of diagnostic polysomnography. Using dual-cerebral oximetry, L-COX was defined by differences ≥4% in right- versus left-sided percent cerebral oxyhemoglobin saturation. Eight patients had SDB. L-COX was found in five patients, but only on nights with SDB. Greater L-COX was associated more severe SDB: higher frequency of apneas + hypopneas per hour (r = 0.66, p < 0.01), desaturations per hour (r = 0.73, p < 0.01), and percent time with oxygen saturation <88% (r = 0.65, p < 0.01). Greater laterality, but not severity of SDB, was associated with poorer functional ability (Lawton Instrumental Activities of Daily Living Scale: r = -0.83, p = 0.02), lower cognitive function (Mini-Mental State Examination: r = -0.76, p = 0.03), and greater daytime sleepiness (Epworth Sleepiness Scale: r = 0.85, p < 0.001). L-COX associated with SDB suggests disruptions in cerebral autoregulation and need for aggressive treatment of SDB in individuals with MCI. [Res Gerontol Nurs. 2018; 11(6):282-292.].

Sequencing the Vine of the Soul: Full Chloroplast Genome Sequence of Banisteriopsis caapi.

Banisteriopsis caapi is a native South American vine that has been used for centuries by certain tribes along the Amazon basin to treat illnesses. In this study, we present the fully annotated chloroplast genome of Banisteriopsis caapi.

Development of a Reference Standard Library of Chloroplast Genome Sequences, GenomeTrakrCP.

Precise, species-level identification of plants in foods and dietary supplements is difficult. While the use of DNA barcoding regions (short regions of DNA with diagnostic utility) has been effective for many inquiries, it is not always a robust approach for closely related species, especially in highly processed products. The use of fully sequenced chloroplast genomes, as an alternative to short diagnostic barcoding regions, has demonstrated utility for closely related species. The U. S. Food and Drug Administration (FDA) has also developed species-specific DNA-based assays targeting plant species of interest by utilizing chloroplast genome sequences. Here, we introduce a repository of complete chloroplast genome sequences called GenomeTrakrCP, which will be publicly available at the National Center for Biotechnology Information (NCBI). Target species for inclusion are plants found in foods and dietary supplements, toxin producers, common contaminants and adulterants, and their close relatives. Publicly available data will include annotated assemblies, raw sequencing data, and voucher information with each NCBI accession associated with an authenticated reference herbarium specimen. To date, 40 complete chloroplast genomes have been deposited in GenomeTrakrCP (https://www.ncbi.nlm.nih.gov/bioproject/PRJNA325670/), and this will be expanded in the future.

A medical history of Governor John B. Connally and his gunshot wounds.

: On November 22, 1963, the Governor of Texas, John Connally, was injured during the assassination of President John F. Kennedy. Multiple authors have documented President Kennedy's injuries, the attempted resuscitation, and the controversies surrounding these events. However, the injuries sustained by Governor Connally have been overlooked by historians predominantly because of the extraordinary importance of the presidential assassination and its impact on the national consciousness. This review discusses the governor's political life, the mechanism of injury, his medical care, and the role the injuries had on his subsequent public life.

Prehospital Transfusion of Plasma and Red Blood Cells in Trauma Patients.

Abstract Objective. Earlier use of plasma and red blood cells (RBCs) has been associated with improved survival in trauma patients with substantial hemorrhage. We hypothesized that prehospital transfusion (PHT) of thawed plasma and/or RBCs would result in improved patient coagulation status on admission and survival. Methods. Adult trauma patient records were reviewed for patient demographics, shock, coagulopathy, outcomes, and blood product utilization from September 2011 to April 2013. Patients arrived by either ground or two different helicopter companies. All patients transfused with blood products (either pre- or in-hospital) were included in the study. One helicopter system (LifeFlight, LF) had thawed plasma and RBCs while the other air (OA) and ground transport systems used only crystalloid resuscitation. Patients receiving PHT were compared with all other patients meeting entry criteria to the study cohort. All comparisons were adjusted in multilevel regression models. Results. A total of 8,536 adult trauma patients were admitted during the 20-month study period, of which 1,677 met inclusion criteria. They represented the most severely injured patients (ISS = 24 and mortality = 26%). There were 792 patients transported by ground, 716 by LF, and 169 on OA. Of the LF patients, 137 (19%) received prehospital transfusion. There were 942 units (244 RBCs and 698 plasma) placed on LF helicopters, with 1.9% wastage. PHT was associated with improved acid-base status on hospital admission, decreased use of blood products over 24 hours, a reduction in the risk of death in the sickest patients over the first 6 hours after admission, and negligible blood products wastage. In this small single-center pilot study, there were no differences in 24-hour (odds ratio 0.57, p = 0.117) or 30-day mortality (odds ratio 0.71, p = 0.441) between LF and OA. Conclusions. Prehospital plasma and RBC transfusion was associated with improved early outcomes, negligible blood products wastage, but not an overall survival advantage. Similar to the data published from the ongoing war, improved early outcomes are associated with placing blood products prehospital, allowing earlier infusion of life-saving products to critically injured patients.

Do not resuscitate status, not age, affects outcomes after injury: an evaluation of 15,227 consecutive trauma patients.

BACKGROUND: Despite a well-described association of age and injury with mortality and decreased functional status, inpatient mortality studies have traditionally not included analysis of do not resuscitate (DNR) status. We hypothesized that the increased likelihood of DNR status in older patients alters age-adjusted mortality rates in trauma. METHODS: The trauma registry was queried for adult patients admitted to our Level I trauma center (January 2005-December 2008) and divided into eight age groups by decade. Ages 15-44 years were collapsed because of the lack of variation. We compared age, case fatality rate, and DNR status by univariate analysis and trends by χ (p < 0.05). RESULTS: Of the 15,227 adult patients admitted, 13% were elderly (≥65) and 7% died. DNR status was known in 75% of deaths, and 42% of those had active DNR orders on the chart at time of death. DNR likelihood increased with age (p < 0.05), from 5% to 18%. With DNRs excluded, mortality variability across all ages was markedly diminished (4-7%). CONCLUSION: DNR status among trauma patients varies significantly because of inconsistent implementation and meaning between hospitals, and successive decades are more likely to have an active DNR order at time of death. When DNR patients were excluded from mortality analysis, age was minimally associated with an increased risk of death. The inclusion of DNR patients within mortality studies likely skews those analyses, falsely indicating failed resuscitative efforts rather than humane decisions to limit care after injury.

Unique pattern of complications in elderly trauma patients at a Level I trauma center.

BACKGROUND: Trauma centers are caring for increased proportions of elderly patients. Although age and Injury Severity Score are independently associated with mortality, trauma centers were originally designed to care for seriously injured patients without age-specific guidelines. We hypothesized that elderly patients would have different complication patterns than their younger counterparts. METHODS: The trauma registry of an American College of Surgeons -verified Level I trauma center was queried for all patients older than 14 years admitted between January 2005 and December 2008. Mechanism, mortality, and complications were evaluated after dividing patients into eight age groups. RESULTS: Of the 15,223 patients, 13% were elderly (≥65), and 86% were injured via a blunt mechanism. Increasing age correlated with fatality (all Injury Severity Scores), end-organ failure, and thromboembolic complications (deep venous thrombosis and coagulopathy). Analysis revealed a significant breakpoint at 45 years of age for mortality, decubitus ulcer, and renal failure (all p values <0.05). Infectious complications (sepsis, wound infection, and abscess) all peaked between 45 years and 65 years and then declined with increasing age. CONCLUSIONS: We document that elderly trauma patients suffer the same complications as their younger counterparts, albeit at a different rate. More importantly, we identified a "breakpoint" of increased risk of complications and mortality at greater than 45 years. Although the mechanisms behind these observations remain unknown, understanding their unique patterns may allow appropriate allocation of resources and focus research efforts on interventions that should improve outcomes.

Heart rate variability and its association with mortality in prehospital trauma patients.

BACKGROUND: Accurate prehospital triage of trauma patients is difficult, especially in mass casualty situations. Accordingly, the U.S. Military has initiated a program directed toward improving noninvasive prehospital triage algorithms based on available physiologic data. The purpose of this study was to assess heart rate variability and its association with mortality in prehospital trauma patients. METHODS: Trauma patients without significant head injury requiring helicopter transport were identified from a retrospective research database. An equal number, unmatched sample of patients who lived were compared with those who died (n = 15 per group). All patients were transported to a single Level I urban trauma center. The primary independent variable was mortality. Patients with Abbreviated Injury Scale head scores >2 were excluded from the analysis, so that the effects seen were based on hemorrhagic shock. Age, sex, Glasgow Coma Scale score (GCS), blood pressure, pulse pressure, pulse, intubation rate, SpO2, mechanism of injury, transport time, and time of death after admission were recorded. R-waves from the first available 120 seconds of usable data were detected from normal electrocardiograms and heart rate variability was assessed. RESULTS: Patients who died demonstrated a lower GCS (7.9 +/- 1.4 versus 14.4 +/- 0.2; p = 0.0001) and higher intubation rate (53% of patients who died versus 0% patients who lived). Pulse rate, arterial pressure, and SpO2 were not distinguishable statistically between groups (p = 0.08), but pulse pressure was lower in patients who died (39 +/- 3 versus 50 +/- 2 mm Hg; p = 0.01). Compared with patients who lived, those who died had lower normalized low-frequency (LF) power (42 +/- 6 versus 62 +/- 4 LFnu; p = 0.009), higher high-frequency (HF) power (42 +/- 3 versus 32 +/- 3 HFnu; p = 0.04) and higher HF-to-LF ratio (144 +/- 30 versus 62 +/- 11nu; p = 0.01). With absolute HF/LF adjusted for GCS, the intergroup variance accounted for by HF/LF was reduced to 6% (p = 0.16). CONCLUSIONS: Analysis of heart rate variability provides insight into adequacy of autonomic compensation to severe trauma. In our cohort of trauma patients, low pulse pressures coupled with relatively higher parasympathetic than sympathetic modulation characterized and separated patients who died versus patients who survived traumatic injuries when standard physiologic measurements are not different. These data do not suggest advantages of heart rate variability analysis over GCS scores, but suggest future possibilities for remote noninvasive triage of casualties when GCS scores are unattainable.

Isoflavone levels in five soybean (Glycine max) genotypes are altered by phytochrome-mediated light treatments.

The objective of the present study was to determine whether concentrations of different isoflavones (puerarin, genistein, genistin, daidzein, and daidzin) in shoots and roots of five selected soybean genotypes would respond the same or differently to red (650 nm peak transmittance) and far-red (750 nm peak transmittance) light treatments given under controlled environments. Levels of isoflavones (mg g(-1) dry weight biomass) present in seeds, control roots, and shoots and 10 day light-treated seedlings (light, dark, red, and far-red wavelengths) of soybean (Glycine max) were determined by high-performance liquid chromatography analysis in comparison with known isoflavone standards. Seeds of the five soybean genotypes studied consistently stored most of their isoflavones as glucosyl conjugates (e.g., daidzin, genistin, and puerarin). For the five soybean genotypes, isoflavone levels were lower in the seeds as compared with roots plus shoots of control, time zero (first true leaf stage) seedlings. Following 10 days of the respective light treatments, we found that (i) isoflavone levels were enhanced in dark-grown plants over light-grown plants for three of the five genotypes (a new finding) and the reverse occurred for a single genotype (a typical response of legumes) and (ii) generally, far-red end of day (EOD) light treatment enhanced total isoflavone levels in roots plus shoots over red EOD light treatment. Results from the present study show that phytochrome does appear to play a role in regulating isoflavone levels in developing soybean seedlings and that this influence by red/far-red-mediated phytochrome reactions is strongly dependent on the genotypes selected for study.

Radial pulse character relationships to systolic blood pressure and trauma outcomes.

BACKGROUND: Patient measurements that do not require monitoring equipment may be the only way to evaluate casualties in austere conditions to determine treatment and transport priority. Objective. To test the hypothesis that palpable pulse characteristics in the radial artery would estimate systolic blood pressure (SBP) and predict outcome in trauma patients. METHODS: Data were analyzed from the medical records of 342 trauma patients ranging from 18 to 50 years of age. Prehospital data were collected by helicopter emergency medical personnel at the scene of the injury. Based on radial pulse character, patients were divided into normal (n = 313) and weak (n = 29) groups. Those whose medical records did not describe pulse characters were not considered. Differences in SBP, mortality, and medical interventions between the radial-pulse-character groups were evaluated. RESULTS: The SBP taken at the scene was a mean of 26 mm Hg lower in those patients with weak radial pulse characters (102 mm Hg versus 128 mm Hg). Similarly, the lowest mean SBPs recorded in the field between the normal- and weak-pulse-character groups were 112 mm Hg and 99 mm Hg, respectively. Patient mortality increased with weak pulse character such that the mortality rats were 3% for the normal-pulse-character group and 29% for the weak-pulse-character-group (odds ratio = 15.2). CONCLUSIONS: These preliminary data suggest that a weak radial pulse may be an acceptable method for initial rapid evaluation of trauma patients. This simple and rapid method of pulse evaluation should be considered for the triage of trauma patients in field conditions with limited instrumentation.

Prehospital physiologic data and lifesaving interventions in trauma patients.

BACKGROUND: The ability to accurately triage trauma patients can be difficult in the prehospital environment. Prehospital trauma scoring systems have been developed with a goal of determining which patients should be transported immediately to a trauma center, thus benefiting from critical personnel and resource-intensive lifesaving interventions (LSIs). A resource-based endpoint, LSIs, therefore might be the optimal endpoint of prehospital triage scoring and could be used to determine where patients are transported. We hypothesized that simple physiologic data available immediately upon scene arrival would prove predictive of the need for a LSI. METHODS: Trauma patients transported from the injury scene by helicopter were eligible for entry into the study. Prehospital physiologic data and interventions were timed and recorded by flight medical personnel, whereas hospital vital signs, injuries, and interventions were prospectively recorded from the inpatient records. The motor component of the Glasgow Coma Scale was used as an indicator of neurologic function. LSIs were procedures deemed lifesaving by a multidisciplinary panel of trauma experts. RESULTS: Physiologic data were collected from August 2001 to February 2002. Data were collected for 216 random patients transported by the Life Flight helicopter service. There were no differences between LSI and non-LSI patients in age, gender, or transport time, and 80 patients underwent 197 LSIs. The mean age was 33 +/- 17 years, 73% of patients were male, 90% suffered blunt injury, the injury severity score was 14 +/- 9, hypotension (systolic blood pressure of < 90 mm Hg) was present in 14% of cases, and the mortality rate was 6%. Penetrating injury and increasing injury severity score were associated with LSI. Univariate analysis of the physiologic data immediately available in the field revealed that SBP of < 90 mm Hg, motor score of < 6, delayed capillary refill, and increasing pulse were significantly associated with a LSI. However, multivariate analysis revealed that only SBP of < 90 mm Hg and motor score of < 6 were associated with a LSI. When both variables were abnormal, 95% of patients required a LSI; when both variables were normal, 21% of patients required a LSI. CONCLUSIONS: The presence of hypotension or decreased motor score was correlated with the need for LSIs. However, normotensive patients with normal motor scores still frequently required LSIs. Optimal discrimination of this group of patients will require new analytic approaches.

Isolation and structure of gustastatin from the Brazilian nut tree Gustavia hexapetala.

A bioassay-guided investigation of Gustavia hexapetala led to the isolation of a new cancer cell growth inhibitor designated gustastatin (1) and four previously known cancer cell growth inhibitors that included betulinic acid (2). The structures were assigned on the basis of analyses of HRMS combined with 1D and 2D NMR data. The structure of portentol (5) was confirmed by an X-ray crystal structure determination.

Upregulation of isoflavonoids and soluble proteins in edible legumes by light and fungal elicitor treatments.

OBJECTIVE: In this study, our working hypothesis was that continuous light and fungal elicitation treatment of legume seedlings would lead to enhanced levels of isoflavonoids and soluble proteins. RESULTS: Based on short-term light and dark treatments, isoflavonoid (genistein, genistin, daidzein, and daidzin) and soluble protein concentrations were significantly upregulated in the "light" environment compared to the "dark" environment for all edible legume species (kudzu vine, soybean, garbanzo bean, fava bean, mung bean, adzuki bean) that were tested. Kudzu seedlings showed the highest levels of both isoflavonoids and soluble proteins after light-elicited upregulation compared to the other legumes analyzed. All legumes showed less up-regulation of isoflavonoid synthesis when treated with Phytophtora sojae fungal elicitor. Oligosaccharide fungal elicitor caused no such upregulation. CONCLUSIONS: The findings in this study show that edible legume seedlings have enhanced levels of isoflavonoids and soluble proteins when they are grown in the light compared to the conventional practice of growing such seedlings in the dark. This will clearly result in significant improvement in their nutritive and medicinal value.

Jamaica's ethnomedicine: its potential in the healthcare system

Herbal remedies have always been used by Jamaicans for treating a variety of illnesses. However, although many of these medicinal herbs contain beneficial bioactive ingredients, not all of them are safe! Some have toxic components while others, if taken inappropriately, can harm the body's organs and even mask the symptoms of more serious conditions. The authors propose integrating these "alternative" medicinal practices into the healthcare delivery system, beginning with a systematic testing of the remedies used, so that their bioactive ingredients can be identified and dosages standardized

Jamaica's ethnomedicine: its potential in the healthcare system

Herbal remedies have always been used by Jamaicans for treating a variety of illnesses. However, although many of these medicinal herbs contain beneficial bioactive ingredients, not all of them are safe! Some have toxic components while others, if taken inappropriately, can harm the body's organs and even mask the symptoms of more serious conditions. The authors propose integrating these "alternative" medicinal practices into the healthcare delivery system, beginning with a systematic testing of the remedies used, so that their bioactive ingredients can be identified and dosages standardized