Silver trauma: a study of pre- and post-COVID-19 pandemic pan-CT scanning in elderly trauma patients in a large teaching hospital.

AIM: The challenges posed by the assessment of elderly trauma patients increase the reliance on emergency CT scanning to diagnose an injury. The COVID-19 pandemic posed challenges to image service delivery. We sought to assess the effect of the COVID-19 pandemic on the imaging of elderly trauma. MATERIALS AND METHODS: All trauma patients aged 65 and over who underwent whole-body CT scanning in the same 3-month period (April-June) in 2019 and 2022 were included in our study. Data was collected on demographics, time of scanning, clinical request details and positive report findings. Anatomical injury distribution, abbreviated injury scale (AIS) and injury severity scores (ISS) were calculated. Consensus judgment was obtained on scan justification and significance of findings. Chi-squared test of association was applied to the categorical outcomes of interest. Associations were considered significant if p<0.05. RESULTS: 79 patients were scanned in the pre-pandemic assessment period versus 217 post-pandemic, an increase of 175%, including a 248% rise in fall-from-standing requests. There was a statistically significant reduction of trauma CT requests meeting fulfilment criteria post-pandemic (95% vs 83%) (p=0.008), with significantly fewer positive findings (45.6% vs 29%) (p=0.024). There was a decrease in median ISS score in the post-pandemic group (p=0.062). CONCLUSION: Despite increased scanning, there was a reduction in both the number and severity of positive traumatic imaging findings. The pandemic has increased reliance on CT without a concomitant increase in the detection of positive findings nor clinically significant findings. This single-centre study demonstrates the need to further evaluate pan-CT trauma scanning in silver trauma patients.

Do we know how scabies outbreaks in residential and nursing care homes for the elderly should be managed? A systematic review of interventions using a novel approach to assess evidence quality.

Currently no national guidelines exist for the management of scabies outbreaks in residential or nursing care homes for the elderly in the United Kingdom. In this setting, diagnosis and treatment of scabies outbreaks is often delayed and optimal drug treatment, environmental control measures and even outcome measures are unclear. We undertook a systematic review to establish the efficacy of outbreak management interventions and determine evidence-based recommendations. Four electronic databases were searched for relevant studies, which were assessed using a quality assessment tool drawing on STROBE guidelines to describe the quality of observational data. Nineteen outbreak reports were identified, describing both drug treatment and environmental management measures. The quality of data was poor; none reported all outcome measures and only four described symptom relief measures. We were unable to make definitive evidence-based recommendations. We draw on the results to propose a framework for data collection in future observational studies of scabies outbreaks. While high-quality randomised controlled trials are needed to determine optimal drug treatment, evidence on environmental measures will need augmentation through other literature studies. The quality assessment tool designed is a useful resource for reporting of outcome measures including patient-reported measures in future outbreaks.

Distinct iron architecture in SF3B1-mutant myelodysplastic syndrome patients is linked to an SLC25A37 splice variant with a retained intron.

Perturbation in iron homeostasis is a hallmark of some hematologic diseases. Abnormal sideroblasts with accumulation of iron in the mitochondria are named ring sideroblasts (RS). RS is a cardinal feature of refractory anemia with RS (RARS) and RARS with marked thrombocytosis (RARS/-T). Mutations in SF3B1, a member of the RNA splicing machinery are frequent in RARS/-T and defects of this gene were linked to RS formation. Here we showcase the differences in iron architecture of SF3B1-mutant and wild-type (WT) RARS/-T and provide new mechanistic insights by which SF3B1 mutations lead to differences in iron. We found higher iron levels in SF3B1 mutant vs WT RARS/-T by transmission electron microscopy/spectroscopy/flow cytometry. SF3B1 mutations led to increased iron without changing the valence as shown by the presence of Fe(2+) in mutant and WT. Reactive oxygen species and DNA damage were not increased in SF3B1-mutant patients. RNA-sequencing and Reverse transcriptase PCR showed higher expression of a specific isoform of SLC25A37 in SF3B1-mutant patients, a crucial importer of Fe(2+) into the mitochondria. Our studies suggest that SF3B1 mutations contribute to cellular iron overload in RARS/-T by deregulating SLC25A37.

Neurokinin-1 receptor antagonists as novel antidepressants: trials and tribulations.

Based upon animal experiments and early clinical trials, neurokinin-1 receptor antagonists showed promise as novel antidepressants. Subsequently, however, more extensive clinical trials did not reveal evidence of efficacy in depression. The development of novel antidepressants will require a better understanding of the neural basis of antidepressant action in humans.

A sea-floor spreading event captured by seismometers.

Two-thirds of Earth's surface is formed at mid-ocean ridges, yet sea-floor spreading events are poorly understood because they occur far beneath the ocean surface. At 9 degrees 50'N on the East Pacific Rise, ocean-bottom seismometers recently recorded the microearthquake character of a mid-ocean ridge eruption, including precursory activity. A gradual ramp-up in activity rates since seismic monitoring began at this site in October 2003 suggests that eruptions may be forecast in the fast-spreading environment. The pattern culminates in an intense but brief (approximately 6-hour) inferred diking event on 22 January 2006, followed by rapid tapering to markedly decreased levels of seismicity.

Cubic aluminum silicides RE8Ru12Al49Si9(Al(x)Si12-x) (RE = Pr, Sm) from liquid aluminum. Empty (Si,Al)12 cuboctahedral clusters and assignment of the Al/Si distribution with neutron diffraction.

Two new quaternary aluminum silicides, RE8Ru12Al49Si9(Al(x)Si12-x) (x approximately 4; RE = Pr, Sm), have been synthesized from Sm (or Sm2O3), Pr, Ru, and Si in molten aluminum between 800 and 1000 degrees C in sealed fused silica tubes. Both compounds form black shiny crystals that are stable in air and NaOH. The Nd analog is also stable. The compounds crystallize in a new structural type. The structure, determined by single-crystal X-ray diffraction, is cubic, space group Pm3m with Z = 1, and has lattice parameters of a = 11.510(1) A for Sm8Ru12Al49Si9(Al(x)Si12-x) and a = 11.553(2) A for Pr8Ru12Al49Si9(Al(x)Si12-x) (x approximately 4). The structure consists of octahedral units of AlSi6, at the cell center, Si2Ru4Al8 clusters, at each face center, SiAl8 cubes, at the middle of the cell edges, and unique (Al,Si)12 cuboctohedral clusters, at the cell corners. These different structural units are connected to each other either by shared atoms, Al-Al bonds, or Al-Ru bonds. The rare earth metal atoms fill the space between various structural units. The Al/Si distribution was verified by single-crystal neutron diffraction studies conducted on Pr8Ru12Al49Si9(Al(x)Si12-x). Sm8Ru12Al49Si9(Al(x)Si12-x) and Pr8Ru12Al49Si9(Al(x)Si12-x) show ferromagnetic ordering at Tc approximately 10 and approximately 20 K, respectively. A charge of 3+ can be assigned to the rare earth atoms while the Ru atoms are diamagnetic.

Probing the influence of local coordination environment on the properties of Fe-type nitrile hydratase model complexes.

A series of four structurally related cis-dithiolate-ligated Fe(III) complexes, [Fe(III)(DITpy)2]Cl (1), [Fe(III)(DITIm)2]Cl (2), [Fe(III)(ADIT)2]Cl (3), and [Fe(III)(AMIT)2]Cl (4), are described. The structural characterization of 3 as well as the spectroscopic properties of 3 and 4 has been previously reported. Crystal data for 1, 2, and 4 are as follows: 1.3H2O crystallizes in the orthorhombic space group Pca2(1) with a = 19.800(4) A, b = 18.450(4) A, c = 14.800(3) A, and Z = 8. 2.(1/2)EtOH.1/2H2O crystallizes in the monoclinic space group Cc with a = 24.792(4) A, b = 14.364(3) A, c = 17.527(3) A, beta = 124.91(2) degrees, and Z = 8. 4 crystallizes in the triclinic space group P1 with a = 8.0152(6) A, b = 10.0221(8) A, c = 11.8384(10) A, alpha = 73.460(3) degrees, beta = 71.451(5) degrees, gamma = 72.856(4) degrees, and Z = 2. Complexes 1-4 share a common S2N4 coordination environment that consists of two cis-thiolates, two trans-imines, and two cis-terminal nitrogen donors: Nterm = pyridine (1), imidazole (2), and primary amine (3 and 4). The crystallographically determined mean Fe-S bond distances in 1-4 range from 2.196 to 2.232 A and are characteristic of low-spin Fe(III)-thiolate complexes. The low-spin S = 1/2 ground state was confirmed by both EPR and magnetic susceptibility measurements. The electronic spectra of these complexes are characterized by broad absorption bands centered near approximately 700 nm that are consistent with ligand-to-metal charge-transfer (CT) bands. The complexes were further characterized by cyclic voltammetry measurements, and all possess highly negative Fe(III)/Fe(II) redox couples ( approximately -1 V vs SCE, saturated calomel electrode) indicating that alkyl thiolate donors are effective at stabilizing Fe(III) centers. Both the redox couple and the 700 nm band in the visible spectra show solvent-dependent shifts that are dependent upon the H-bonding ability of the solvent. The implications of these results with respect to the active site of the iron-containing nitrile hydratases are also discussed.

The clinical management database.

The clinical management database utilizes ICU patient data in aggregate to examine quality of care and resource utilization at the population level. As clinicians become accountable for efficiency and quality, this type of database is essential to understand the results of care. This article reviews the challenges of evaluating cost and quality including the potential for bias and measurement error. A practical approach to starting a database is outlined with examples and suggestions.

A reversible cause of hypercapnic respiratory failure: lower motor neuronopathy associated with renal cell carcinoma.

We describe a unique case of a patient with a reversible paraneoplastic motor neuronopathy who presented with hypercapnic respiratory failure. The patient developed progressive respiratory and limb muscle weakness until treated with removal of a renal cell carcinoma, which was followed by a complete resolution of neuromuscular symptoms. The literature of paraneoplastic motor neuronopathies is reviewed, specifically in reference to respiratory failure.

Recognition, assessment, and treatment of anxiety in the critical care patient.

A multidisciplinary group of experts involved in the treatment of critically ill patients participated in a workshop conference designed to develop practice recommendations for the recognition, assessment, and treatment of anxiety in the critical care environment. Anxiety was identified as a ubiquitous problem in critical care that may interfere with healing and recovery. The faculty agreed that clinicians should be familiar with the signs and symptoms of anxiety and should be able to determine when interventions are necessary. Whenever possible, nonpharmacologic methods for anxiolysis should be incorporated into intensive care protocols. Intensive care personnel should be trained in those interventions that require specialized expertise, and they should become familiar with the drugs available for the treatment of anxiety. Protocols for determining the best agents to be used in a given setting and their most appropriate method of administration should be established. Pharmacologic and nonpharmacologic treatments are not mutually exclusive but should be complementary. Finally, procedures for obtaining psychiatric consultation, when necessary, should be in place.

Pulmonary embolism in the critically ill: strategies for prevention and treatment.

Most ICU patients are at high risk for developing deep venous thrombosis; thus, they should be considered candidates for prophylaxis against pulmonary emboli (PE). If early ambulation is not an option, give low-dose heparin or apply lower extremity pneumatic compression. When PE cannot be prevented, rapid treatment is mandatory. Inotropic agents can be used to improve right ventricular contractility; however, the role of volume loading for augmenting preload is controversial. Heparin is the first-line therapy for halting ongoing thrombosis; administer a 5,000- to 10,000-U bolus, followed by a continuous infusion of about 35,000 U/d. Thrombolysis, embolectomy, and occlusive devices are other therapeutic options.

Errors and bias in using predictive scoring systems.

Scoring systems used to predict clinical outcomes for critically ill patients have been refined in the past decade, yet even the most recently developed systems contain flaws that limit their application. In general, prediction rules are derived by defining an association between a number of clinical variables and a particular outcome in a reference patient population. By systematically examining the qualities of the independent variables and the size and scope of the derivation data set, potential sources of error and bias can be identified. Existing and future predictive systems must be validated on large groups of patients and continuously updated to keep pace with new approaches to the practice of critical care medicine.

Metaphase chromosome and nucleoid differences between CHO-K1 and its radiosensitive derivative xrs-5.

The Chinese hamster ovary (CHO) cell line xrs-5 is a radiation-sensitive mutant isolated from CHO-K1 cells. The radiation sensitivity is associated with a defect in DNA double-strand break rejoining. Chromatin structure also appears altered in xrs-5 cells compared with the parental CHO-K1 cells. Metaphase chromosomes from xrs-5 are more condensed in appearance than CHO-K1 chromosomes. The overcondensed look is not the result of colcemid sensitivity. Electron microscopy studies suggest that xrs-5 metaphase chromosomes have larger loops of chromatin extending out from the chromosome core. There are also differences between CHO-K1 and xrs-5 cells in the size and fluorescence pattern of ethidium bromide-stained nucleoid preparations. These results suggest that there is a fundamental difference between CHO-K1 and xrs-5 in either the organization of the supercoiled loops of DNA attached to the nuclear matrix or in the nature of the proteins that attach the DNA to the matrix. These alterations in chromosome structure may underlie, in part, the radiation sensitivity of xrs-5 cells.