Incidences and characteristics of primary lung malignancies in childhood i

alexandrossfakianakis shared this article with you from Inoreader Incidences and characteristics of primary lung malignancies in childhood in Germany: An analysis of population‐based data from German cancer registries Via Pediatric Blood & Cancer Abstract Background: Primary lung malignancies are a heterogeneous group of cancers that occur very rarely in childhood. Due to limited knowledge of their epidemiologic and clinical features, these tumors present a challenge to the treating physicians. This study aimed to increase the knowledge about the occurrence of primary lung malignancies in childhood in Germany. Materials and methods: Pseudonymized data of cases recorded at the German Center for Cancer Registry Data (ZfKD) between 1990 and 2017 were retrieved. Primary lung malignancies were identified using the ICD- and ICD-O classification. Numbers were compared to those reported to the German Childhood Cancer Registry (GCCR). Crude incidence rates were calculated using the ZfKD database. Results: A total of 168 patients diagnosed with primary lung malignancies in the age below 19 years were identified from the ZfKD. The median age at diagnosis was 13 years. The most common tumor entities were lung carcinoids (n = 49), lung carcinoma (n = 36), and pleuropulmonary blastoma (n = 14). An unexpected accumulation of lung cancer cases was noted in the first year of life without a clearly specified histopathological diagnosis. A substantial discrepancy in the numbers of primary lung malignancies between ZfKD and GCCR was found. Conclusions: We present population-based data on the occurrence of primary childhood lung malignancies in Germany, which were more frequent than previously anticipated but likely remained underreported. For better understanding and optimal treatment of these entities, cancer registration needs to be improved through mandatory reporting to the GCCR and regular data sharing between GCCR, population-based and clinical cancer registries. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Emergence of dalbavancin, vancomycin, and daptomycin non-susceptible Staphylococcus aureus in a patient treated with dalbavancin: Case report and isolate characterization

alexandrossfakianakis shared this article with you from Inoreader Emergence of dalbavancin, vancomycin, and daptomycin non-susceptible Staphylococcus aureus in a patient treated with dalbavancin: Case report and isolate characterization Via Clinical Infectious Diseases Advance Access Abstract A patient with end-stage renal disease received 2 doses of dalbavancin for methicillin-resistant Staphylococcus aureus arteriovenous fistula infection and presented 5-weeks later with infective endocarditis secondary to vancomycin, daptomycin, and dalbavancin non-susceptible MRSA. Resistance was associated with walK and scrA mutations, reduced long-chain lipid content, and reduced membrane fluidity. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Unsuspected clonal spread of Methicillin-resistant Staphylococcus aureus causing bloodstream infections in hospitalized adults detected using whole genome sequencing

alexandrossfakianakis shared this article with you from Inoreader Unsuspected clonal spread of Methicillin-resistant Staphylococcus aureus causing bloodstream infections in hospitalized adults detected using whole genome sequencing Via Clinical Infectious Diseases Advance Access Abstract Background Though detection of transmission clusters of methicillin-resistant Staphylococcus aureus (MRSA) infections is a priority for infection control personnel in hospitals, the transmission dynamics of MRSA among hospitalized patients with bloodstream infections (BSIs) has not been thoroughly studied. Whole genome sequencing (WGS) of MRSA isolates for surveillance is valuable for detecting outbreaks in hospitals, but the bioinformatic approaches used are diverse and difficult to compare. Methods We combined short-read WGS with genotypic, phenotypic, and epidemiological characteristics of 106 MRSA BSI isolates collected for routine microbiological diagnosis from inpatients in two hospitals over 12 months. Clinical data and hospitalization history were abstracted from electronic medical records. We compared three genome sequence alignment strategies to assess similarity in cluster asce rtainment. We conducted logistic regression to measure the probability of predicting prior hospital overlap between clustered patient isolates by the genetic distance of their isolates. Results While the three alignment approaches detected similar results, they showed some variation. A Gene-family-based alignment pipeline was most consistent across MRSA clonal complexes. We identified nine unique clusters of closely related BSI isolates. Most BSI were healthcare-associated and community-onset. Our logistic model showed that with 13 single nucleotide polymorphisms the likelihood that any two patients in a cluster had overlapped in a hospital was 50 percent. Conclusions Multiple clusters of closely related MRSA isolates can be identified using WGS among strains cultured from BSI in two hospitals. Genomic clustering of these infections suggest that transmission resulted from a mix of community spread and healthcare exposures long before BSI diagnosis. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Screening auf Mangelernährung bei Kopf-Hals-Tumor-Patienten vor onkologischer Therapie

alexandrossfakianakis shared this article with you from Inoreader Screening auf Mangelernährung bei Kopf-Hals-Tumor-Patienten vor onkologischer Therapie Via Laryngo-Rhino-Otologie Laryngorhinootologie DOI: 10.1055/a-1823-1143 Hintergrund Patienten mit einem Kopf-Hals-Tumor besitzen ein hohes Risiko, peri- bzw. posttherapeutisch eine Mangelernährung zu entwickeln, die den onkologischen Therapieerfolg entscheidend beeinflussen kann. Prätherapeutisch ist hierüber wenig bekannt. Daher ist das Ziel der vorliegenden Studie die prätherapeutische systematische Erfassung des Ernährungszustandes und des Risikos für das Auftreten einer Mangelernährung. Material und Methoden Bei 102 Kopf-Hals-Tumor-Patienten erfolgte die prätherapeutische Untersuchung des Ernährungszustandes via Body-Mass-Index (BMI) sowie des Risikos für Mangelernährung via „Nutritional Risk Screening" (NRS). An möglichen Einflussfaktoren wurden Tumorstadium, -lokalisation, Patientenalter, -geschlecht und das Bestehen einer oropharyngealen Dysphagie, identifiziert über Flexible Endoskopische Evaluation des Schluckvorgangs (FEES), analysiert. Ergebnisse Eine Mangel- bzw. Unterernährung, bemessen am BMI, bestand prätherapeutisch bei bereits 6% der Patienten, ein Risiko für Mangelernährung laut NRS bei 27%, eine oropharyngeale Dysphagie bei 15%. Nur das Vorliegen einer oropharyngealen Dysphagie erwies sich in der linearen Regression als signifikanter Einflussfaktor auf das Risiko einer Mangelernährung (β = 0,380/3,776; p < 0,001). Schlussfolgerungen Bereits prätherapeutisch besteht ein Risiko einer Mangelernährung bei einem Viertel der Kopf-Hals-Tumor-Patienten. Um dieses frühzeitig zu erkennen und um bereits zu Beginn der onkologischen Therapie Maßnahmen zur ihrer Vermeidung einzuleiten, empfiehlt sich daher bereits prätherapeutisch die Untersuchung des Schluckvermögens sowie das systematische Screening auf Mangelernährung via NRS. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The tight rope act: A multicenter regional experience of tourniquets in acute trauma resuscitation

alexandrossfakianakis shared this article with you from Inoreader The tight rope act: A multicenter regional experience of tourniquets in acute trauma resuscitation Via Journal of Trauma and Acute Care Surgery - Current Issue BACKGROUND As tourniquets have become more prevalent, device use has been questioned. This study sought to characterize the incidence, indication, and efficacy of tourniquet placement in acute trauma resuscitation. METHODS Nine regional level 1 trauma centers prospectively enrolled for 12 months adult patients (18 years or older) who had a tourniquet placed. Age, sex, mechanism, tourniquet type, indication, applying personnel, location placed, level of occlusion, and degree of hemostasis were collected. Major vascular injury, imaging and operations performed, and outcomes were assessed. Analyses were performed with significance at p View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Extravasation and outcomes in computed tomography and angiography in patients with pelvic fractures requiring transcatheter arterial embolization: A single-center observational study

alexandrossfakianakis shared this article with you from Inoreader Extravasation and outcomes in computed tomography and angiography in patients with pelvic fractures requiring transcatheter arterial embolization: A single-center observational study Via Journal of Trauma and Acute Care Surgery - Current Issue BACKGROUND Extravasation on contrast-enhanced computed tomography (CECT) is a helpful indicator of the need for transcatheter arterial embolization (TAE) for pelvic fractures. However, previous reports were inconsistent on cases in which angiography is necessary, even though there is no extravasation on computed tomography. This study aimed to describe and analyze the contradictory findings in cases where extravasation is observed on angiography but not on CECT, to contribute to improved management of patients with pelvic fractures. METHODS This was a retrospective single-center study. Patients with pelvic fractures who underwent CECT and TAE between 2014 and 2020 were included. We classified the patients into three groups: CECT and angiography with extravasation (CT+Angio+), CECT with no extravasation and angiography with extravasation (CT−Angio+), and CECT with extravasation and angiography without extravasation (CT+Angio−). RESULTS A total of 113 patients were included in the study: the CT+Angio+ group had 54 patients, CT−Angio+ group, 47; and CT+Angio− group, 12. The CT−Angio+ group had a significantly longer time from arrival to CECT than the CT+Angio+ group (27 minutes vs. 23 minutes, p View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Evaluating the complex association between Social Vulnerability Index and trauma mortality

alexandrossfakianakis shared this article with you from Inoreader Evaluating the complex association between Social Vulnerability Index and trauma mortality Via Journal of Trauma and Acute Care Surgery - Current Issue INTRODUCTION Social determinants of health are known to impact patient-level outcomes, but they are often difficult to measure. The Social Vulnerability Index was created by the Centers for Disease Control to identify vulnerable communities using population-based measures. However, the relationship between SVI and trauma outcomes is poorly understood. METHODS In this retrospective study, we merged SVI data with a statewide trauma registry and used three analytic models to evaluate the association between SVI quartile and inpatient trauma mortality: (1) an unadjusted model, (2) a claims-based model using only covariates available to claims datasets, and (3) a registry-based model incorporating robust clinical variables collected in accordance with the National Trauma Data Standard. RESULTS We identified 83,607 adult trauma admissions from January 1, 2017, to September 30, 2020. Higher SVI was associated with worse mortality in the unadjusted model (odds ratio, 1.72 [95% confidence interval, 1.30–2.29] for highest vs. lowest SVI quintile). A weaker association between SVI and mortality was identified after adjusting for covariates common to claims data. Finally, there was no significant association between SVI and inpatient mortality after adjusting for covariates common to robust trauma registries (adjusted odds ratio, 1.10 [95% confidence interval, 0.80–1.53] for highest vs. lowest SVI quintile). Higher SVI was also associated with a higher likelihood of presenting with penetrating injuries, a shock index of >0.9, any Abbreviated Injury Scale score of >5, or in need of a blood transfusion (p View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Prehospital low titer group O whole blood is feasible and safe: Results of a prospective randomized pilot trial

alexandrossfakianakis shared this article with you from Inoreader Prehospital low titer group O whole blood is feasible and safe: Results of a prospective randomized pilot trial Via Journal of Trauma and Acute Care Surgery - Current Issue INTRODUCTION Low titer group O whole blood (LTOWB) resuscitation is increasingly common in both military and civilian settings. Data regarding the safety and efficacy of prehospital LTOWB remain limited. METHODS We performed a single-center, prospective, cluster randomized, prehospital through in-hospital whole blood pilot trial for injured air medical patients. We compared standard prehospital air medical care including red cell transfusion and crystalloids followed by in-hospital component transfusion to prehospital and in-hospital LTOWB resuscitation. Prehospital vital signs were used as inclusion criteria (systolic blood pressure ≤90 mm Hg and heart rate ≥108 beats per minute or systolic blood pressure ≤70 mm Hg for patients at risk of hemorrhage). Primary outcome was feasibility. Secondary outcomes included 28-day and 24-hour mortality, multiple organ failure, nosocomial infection, 24-hour transfusion requirements, and arrival coagulation parameters. RESULTS Between November 2018 and October 2020, 86 injured patients were cluster randomized by helicopter base. The trial has halted early at 77% enrollment. Overall, 28-day mortality for the cohort was 26%. Injured patients randomized to prehospital LTOWB (n = 40) relative to standard care (n = 46) were similar in demographics and injury characteristics. Intent-to-treat Kaplan-Meier survival analysis demonstrated no statistical mortality benefit at 28 days (25.0% vs. 26.1%, p = 0.85). Patients randomized to prehospital LTOWB relative to standard care had lower red cell transfusion requirements at 24 hours (p View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The effect of tranexamic acid dosing regimen on trauma/hemorrhagic shock-related glycocalyx degradation and endothelial barrier permeability: An in vitro model

alexandrossfakianakis shared this article with you from Inoreader The effect of tranexamic acid dosing regimen on trauma/hemorrhagic shock-related glycocalyx degradation and endothelial barrier permeability: An in vitro model Via Journal of Trauma and Acute Care Surgery - Current Issue BACKGROUND Improved outcomes with early tranexamic acid (TXA) following trauma hemorrhagic shock (T/HS) may be related to its antifibrinolytic, as well as anti-inflammatory properties. Previous in vitro studies have shown that early TXA administration protects against T/HS endothelial barrier dysfunction and associated glycocalyx degradation. An intact endothelial glycocalyx may protect against subsequent neutrophil mediated tissue injury. We postulated that early TXA administration would mitigate against glycocalyx damage and resultant neutrophil adherence and transmigration through the endothelial barrier. This was studied in vitro using a microfluidic flow platform. METHODS Human umbilical vein endothelial cell monolayers were subjected to control or shock conditions (hypoxia + epinephrine) followed by administration of TXA 90 minutes or 180 minutes later. RESULTS "Early" TXA administration protected against glycocalyx degradation, biomarkers of increased permeability and the development of a fibrinolytic phenotype. This was associated with decreased neutrophil endothelial adherence and transmigration. There were no differences in low versus high TXA concentrations. The protective effects were only significant with "early" TXA administration. CONCLUSION There was a concentration and temporal effect of TXA administration on endothelial glycocalyx degradation. This was associated with "vascular leakiness" as indexed by the relative ratio of Ang-2/1 and polymorphonuclear neutrophil transmigration. Tranexamic acid if administered in patients with T/HS should be administered "early"; this includes in the prehospital setting. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Direct to OR resuscitation of abdominal trauma: An NTDB propensity matched outcomes study

alexandrossfakianakis shared this article with you from Inoreader Direct to OR resuscitation of abdominal trauma: An NTDB propensity matched outcomes study Via Journal of Trauma and Acute Care Surgery - Current Issue BACKGROUND Direct to operating room resuscitation (DOR) is used by some trauma centers for severely injured trauma patients as an approach to minimize time to hemorrhage control. It is unknown whether this strategy results in favorable outcomes. We hypothesized that utilization of an emergency department operating room (EDOR) for resuscitation of patients with abdominal trauma at an urban Level I trauma center would be associated with decreased time to laparotomy and improved outcomes. METHODS We included patients 15 years or older with abdominal trauma who underwent emergent laparotomy within 120 minutes of arrival both at our institution and within a National Trauma Data Bank sample between 2007 to 2019 and 2013 to 2016, respectively. Our institutional sample was matched 1:1 to an American College of Surgeons National Trauma Databank sample using propensity score matching based on age, sex, mechanism of injury, and abdominal Abbreviated Injury Scale score. The primary outcome was time to laparotomy incision. Secondary outcomes included blood transfusion requirement, intensive care unit (ICU) length of stay (LOS), ventilator days, hospital LOS, and in-hospital mortality. RESULTS Two hundred forty patients were included (120 institutional, 120 national). Both samples were well balanced, and 83.3% sustained penetrating trauma. There were 84.2% young adults between the ages of 15 and 47, 91.7% were male, 47.5% Black/African American, with a median Injury Severity Score of 14 (interquartile range [IQR], 8–29), Glasgow Coma Scale score of 15 (IQR, 13–15), 71.7% had an systolic blood pressure of >90 mm Hg, and had a shock index of 0.9 (IQR, 0.7–1.1) which did not differ between groups (p > 0.05). Treatment in the EDOR was associated with decreased time to incision (25.5 minutes vs. 40 minutes; p ≤ 0.001), ICU LOS (1 vs. 3.1 days; p View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Beta blockade in TBI: Dose-dependent reductions in BBB leukocyte mobilization and permeability in vivo

alexandrossfakianakis shared this article with you from Inoreader Beta blockade in TBI: Dose-dependent reductions in BBB leukocyte mobilization and permeability in vivo Via Journal of Trauma and Acute Care Surgery - Current Issue BACKGROUND Traumatic brain injury (TBI) is accompanied by a hyperadrenergic catecholamine state that can cause penumbral neuroinflammation. Prospective human studies demonstrate improved TBI survival with beta blockade (bb), although mechanisms remain unclear. We hypothesized that deranged post-TBI penumbral blood brain barrier (BBB) leukocyte mobilization and permeability are improved by bb. METHODS CD1 male mice (n = 64) were randomly assigned to severe TBI—controlled cortical impact: 6 m/s velocity, 1 mm depth, 3 mm diameter—or sham craniotomy, and IP injection of either saline or propranolol (1, 2, or 4 mg/kg) every 12 hours for 2 days. At 48 hours, in vivo pial intravital microscopy visualized live endothelial-leukocyte (LEU) interactions and BBB microvascular leakage. Twice daily clinical recovery was assessed by regaining of lost body weight and the Garcia Neurological Test (motor, sensory, reflex, balance assessments). Brain edema was determined by hemispheric wet-to-dry ratios. RESULTS Propranolol after TBI reduced both in vivo LEU rolling and BBB permeability in a dose-dependent fashion compared with no treatment (p View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.