Sick from what? Trauma during the SARS-CoV-2 pandemic.

BACKGROUND: We present the case of two brothers with identical mechanisms of injury presenting simultaneously, one with SARS-Cov-2 respiratory failure and the other in hemorrhagic shock. SUMMARY: Healthcare globally and in the United States met novel challenges during the unprecedented severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) health crisis. The effect of SARS-CoV-2 on hospital and health care delivery systems has been widely reported. Elective surgical procedures were suspended; however, trauma and acute care services remained active and faced unique challenges during this pandemic. Trauma patients by their nature of injury require rapid assessment and treatment to include invasive emergency operations. Not only do trauma centers have to adapt to limited resources and new procedures limiting exposure, they are also met with the confounding issue of trauma patients concomitantly presenting with SARS-CoV-2 respiratory illness. CONCLUSION: Trauma care providers must now contend with SARS-CoV-2 on the differential for patients presenting with trauma. This is demonstrated by our case of two brothers with identical mechanisms of injury presenting simultaneously, one in shock from respiratory failure and the other hemorrhagic.

Helicobacter pylori is not the predominant etiology for peptic ulcers requiring operation.

As the number of patients requiring operation for peptic ulcer disease (PUD) declines, presumed contemporary ulcer etiology has largely been derived from medically treated patients not subjected to surgery. The purpose of this study was to examine the specific causes of PUD in patients requiring surgery. Our Acute Care Surgical Service registry was reviewed for patients operated on for complications of PUD from 2004 to 2009. Emphasis was placed on individual etiologic factors for PUD. There were 128 patients (52% male, 81% white) who underwent emergency operation including: simple patch closure (n = 61, 48%); gastric resection (n = 22, 17%); gastric resection with vagotomy (n = 21, 16%); vagotomy and pyloroplasty (n = 18, 14%); or other procedures (n = 6, 5%). Complications necessitating operation were perforation (n = 79, 62%); bleeding (n = 29, 23%); obstruction (n = 12, 9%); and intractability (n = 8, 6%). Perioperative mortality was 12.5 per cent. Risk factors for PUD included tobacco use (50%), alcohol abuse (34%), and steroids (21%). Nonsteroidal anti-inflammatory use was confirmed in 68 (53%) patients. Of the 128 patients, 82 (64%) were tested for Helicobacter pylori, 33 (40%) of which were positive and 49 (60%) negative. Helicobacter pylori, thus, was the confirmed ulcer etiology in only 26 per cent of cases. Unlike contemporary series of medically treated PUD, Helicobacter pylori may not be the predominant etiologic factor in patients who experience complications requiring surgery. A "traditional" surgical approach with liberal use of vagotomy, not antibiotic triple therapy, may well be the preferred treatment consideration in such cases.

The value of a carotid duplex surveillance program for stroke prevention.

BACKGROUND: Although duplex ultrasonography (DU) can readily identify progression of carotid stenosis, controversy regarding the natural history of asymptomatic carotid stenosis as well as the need and appropriate interval for carotid DU surveillance still exists. Furthermore, consensus has not yet been made in the surgical literature regarding the usefulness, cost-effectiveness, or timing of DU surveillance after carotid endarterectomy (CEA). The purpose of this study was to determine how often DU surveillance for asymptomatic carotid disease or postintervention stenosis resulted in any change in the patient's clinical management, how many strokes were prevented by DU surveillance, and the cost of such a DU surveillance program per stroke prevented. METHODS: We reviewed a 9-year vascular surgical database to identify all patients enrolled in a carotid DU surveillance program for asymptomatic carotid stenosis or following CEA between January 1, 2000, and December 31, 2008. The number of duplex scans and CEAs performed in those patients through March 2010 was also determined. The results of the Asymptomatic Carotid Atherosclerosis Study were then used to estimate the number of strokes prevented by CEA in the study population. Reimbursement data were assessed to calculate the average cost of each DU and the cost of the DU surveillance program for each stroke prevented. RESULTS: During the study period, there were 11,531 carotid duplex scans performed on 3,003 patients (mean: 3.84 scans per patient) who had been enrolled in the DU surveillance program. CEA for asymptomatic carotid stenosis was performed on 225 (7.5%) patients. The DU surveillance program prevented approximately 13 strokes (871 carotid duplex scans per stroke prevented). The mean cost of each duplex scan was $332 ± 170. The total cost of the DU surveillance program was approximately $3,830,000 or $290,000 per stroke prevented. CONCLUSIONS: Although a carotid DU surveillance program generates substantial revenue for a vascular surgery practice, it is costly and inefficient. A reappraisal of the "value" of carotid DU surveillance in stroke prevention is warranted. Consideration should be given to eliminating routine surveillance of postendarterectomy carotids in the absence of contralateral disease and limiting the number of DU surveillance studies for asymptomatic carotid disease.

Interfacial assembly of turnip yellow mosaic virus nanoparticles.

An extensive study of the factors that affect the interfacial assembly of bionanoparticles at the oil/water (O/W) interface is reported. Bionanoparticles, such as viruses, have distinctive structural properties due to the unique arrangement of their protein structures. The assembly process of such bionanoparticles at interfaces is governed by factors including the ionic strength and pH of the aqueous layer, concentration of the particles, and nature of the oil phase. This study highlights the impact of these factors on the interfacial assembly of bionanoparticles at the O/W interface using native turnip yellow mosaic virus (TYMV) as the prototype. Robust monolayer assemblies of TYMV were produced by self-assembly at the O/W interface using emulsions and planar interfaces. TYMV maintained its structure and integrity under different assembly conditions. For the emulsion droplets, they were fully covered with TYMV as evidenced by transmission electron microscopy (TEM) and scanning force microscopy (SFM). Tensiometry and small-angle neutron scattering (SANS) further supported this finding. Although the emulsions offered a complete coverage by TYMV particles, they lacked long-range ordering due to rapid exchange at the interface. By altering the assembly process, highly ordered, hexagonal arrays of TYMV were obtained at planar O/W interfaces. The pH, ionic strength, and viscosity of the solution played a crucial role in enhancing the lateral ordering of TYMV assembled at the planar O/W interface. This interfacial ordering of TYMV particles was further stabilized by introduction of a positively charged dehydroabietyl amine (DHAA) in the organic phase which held the assembly together by electrostatic interactions. The long-range array formation was observed using TEM and SFM. The results presented here illustrate that the interfacial assembly at the O/W interface is a versatile approach to achieve highly stable self-assembled structures.