Exposure to statin therapy decreases the incidence of venous thromboembolism after trauma.

INTRODUCTION: Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in trauma patients, despite chemoprophylaxis. Statins have been shown capable of acting upon the endothelium. We hypothesized that statin therapy in the pre- or in-hospital settings leads to a decreased incidence of VTE. METHODS: We conducted a retrospective cohort study of injured patients who received statin therapy pre- or in-hospital. Adult, highest-level trauma activation patients admitted January 2018 - June 2022 were included. Patients on prehospital anticoagulants, history of inherited bleeding disorder, and who died within the first 24 hours were excluded. Statin users were matched to non-users by statin use indications including age, current heart and cardiovascular conditions and history, hyperlipidemia, injury severity, and body mass index. Time to in-hospital statin initiation and occurrence of VTE and other complications within 60 days were collected. Differences between groups were determined by univariate, multivariable logistic regression, and Cox proportional hazard analyses. RESULTS: Of 3,062 eligible patients, 79 were statin users that were matched to 79 non-users. There were no differences in admissions demographics, vital signs, injury pattern, transfusion volumes, lengths of stay, or mortality between groups. The overall VTE incidence was 10.8% (17/158). Incidence of VTE in statin users was significantly lower (3%) than non-users (19%; P = 0.003). Differences between statin users and non-users were observed for rates of DVT (0% vs 9%), PE (3% vs 15%), and sepsis (0% vs 5%). Exposure to statins was associated with an 82% decreased risk of developing VTE (hazard ratio = 0.18, 95% CI 0.04 - 0.86; P = 0.033). CONCLUSIONS: Statin exposure was associated with decline in VTE and lower individual rates of DVT, PE, and sepsis. Our findings indicate that statins should be evaluated further as a possible adjunctive therapy for VTE chemoprophylaxis after traumatic injury. LEVEL OF EVIDENCE AND STUDY TYPE: Level III, Retrospective Cohort Study.

Competitive release during fire succession influences ecological turnover in a small mammal community.

Ecologists have long debated the relative importance of biotic interactions versus species-specific habitat preferences in shaping patterns of ecological dominance. In western North America, cycles of fire disturbance are marked by transitions between North American deermice (Peromyscus maniculatus), which predominate after wildfires, and southern red-backed voles (Myodes gapperi), which gradually replace deermice 3-4 years postfire and maintain dominance as forests mature. While this shift has been frequently documented, the processes that mediate this turnover are debated. One possibility is competitive release, which predicts a reduction in vole competition may contribute to niche expansion and population growth in deermice. Alternatively, turnover in both species may be shaped by differences in their preferred habitat and resource base, as predicted by optimum foraging theory. We evaluate these hypotheses using stable isotopes and spatial mark-recapture of deermouse and vole populations sampled prior to and following a fire as part of a longitudinal study in the Greater Yellowstone Ecosystem. Fire disturbance was associated with a 94% decrease in vole abundance but a 102% increase in deermice. Even after accounting for microhabitat, vole and deermouse populations were negatively correlated spatially and temporally (R = -0.45), and competitor abundance was more important prefire than postfire. When vole abundance was high (prefire), vole dietary niche space was seven times broader than that of deermice. Postfire, deermouse dietary niche nearly tripled and was enriched in 13 C (i.e., more C4 plants), while voles occupied a slightly reduced dietary niche (79% of prefire breadth). Our results suggest deermice are experiencing ecological release due to a reduction in vole competition but vole shifts are largely driven by habitat preferences.

Randomized Controlled Trial Comparing the Bulb Aspirator With a Nasal-Oral Aspirator in the Treatment of Bronchiolitis.

OBJECTIVE: This study aimed to compare the traditional bulb aspirator with a nasal-oral aspirator in the treatment of bronchiolitis. METHODS: This was a single-center, single-blind, randomized controlled trial. Patients with bronchiolitis discharged from the emergency department were randomized to receive a bulb or nasal-oral aspirator for home use.Data regarding return visits, hydration, respiratory relief, parental satisfaction, device preference, and adverse events were gathered using a predistribution questionnaire, diary, poststudy questionnaire, and chart review. RESULTS: There was not a statistically significant difference in the rate of unscheduled return visits (bulb vs nasal-oral, 28.2% vs 20.7%; P = 0.26). No difference was seen in hydration or respiratory relief in either the diary or poststudy questionnaire. The nasal-oral aspirator had higher satisfaction rates (bulb vs nasal-oral, 68.8% vs 93.9%; P < 0.01). When asked which device was preferred with regard to all devices ever tried, 57.2% of respondents reported the nasal-oral aspirator. More adverse events were seen with the bulb compared with the nasal-oral aspirator (bulb vs nasal-oral, 50.0% vs 17.5%; P < 0.01). CONCLUSIONS: No difference was appreciated between the bulb and nasal-oral aspirators in unscheduled return rates. The nasal-oral aspirator demonstrated higher parental satisfaction and preference rates, and fewer adverse effects compared with the bulb aspirator. Medical providers should have a cost-benefit discussion with caregivers when recommending home aspirators for the treatment of bronchiolitis.Registry ClinicalTrials.gov Identifier: NCT03288857. Comparison of the Bulb Aspirator With a Nasal-Oral Aspirator in the Treatment of Bronchiolitis.