Predictors of in-hospital surgical site infections in surgically managed acetabular fractures: A nationwide analysis.

Background: A surgical site infection (SSI) rate of 4%-8% has been reported in patients who undergo open reduction and internal fixation (ORIF) for acetabular fractures. Studies have identified risk factors for SSI, but none have performed a nationwide analysis of SSI in surgically managed acetabular fracture patients. Methods: The National Inpatient Sample (NIS) database was queried for patients who underwent ORIF for acetabular fractures from 2016 to 2019. Analysis was performed on all patients who underwent ORIF for acetabular fractures, as well as those who only underwent ORIF for isolated acetabular fractures. Clinical characteristics, hospital course, discharge disposition, and hospitalization costs were compared between groups. Multivariate regression analysis was conducted to assess predictors of SSI. Results: 41,725 patients undergoing acetabular fracture repair were identified, of which 490 (1.2%) developed SSI during hospitalization. Age (45.90 vs 49.90, p < 0.001) and Injury Severity Scale (5.99 vs 8.30, p < 0.001) were increased in patients who developed SSI. History of hypertension (HTN) (OR = 2.343, 95% CI 1.96-2.80, p < 0.001), longer hospital length of stay (30.27 days vs 10.00 days, p < 0.001) and total charges ($469,005 vs $193,032, p < 0.001) were associated with SSI. Lower rates of routine discharge were seen in SSI patients (OR = 0.333, 95% CI 0.260-0.426, p < 0.001). Higher rates of inpatient death were associated with SSI (OR = 2.210, 95% CI 1.172-4.17, p = 0.019). Multiple procedures in addition to acetabular fracture repair, iliac artery embolization, substance abuse, later time to internal fixation and HTN were predictive of SSI (p < 0.001). Conclusions: Severity of injury, time to fixation, and factors associated with compromised cardiovascular integrity were predictors of SSI. Identifying patients at risk for SSI should lead to clinical maneuvers that may optimize outcome.

Longer Hospital Length of Stay and Emergency Surgical Intervention are Associated with Lower Rates of Mortality In Elderly Patients with Ruptured Abdominal Aortic Aneurysm: An Analysis of 7,214 Patients.

INTRODUCTION: We aimed to determine predictors for in-hospital mortality for elderly patients with ruptured abdominal aortic aneurysms (AAA) undergoing emergency admission. MATERIALS AND METHODS: This was a retrospective cohort study utilizing the National Inpatient Sample (NIS) Database, 2005-2014, on elderly patients with ruptured AAA undergoing emergency admission. ICD-9 code 441.3 was used to identify patients with ruptured AAA. Male versus female sex, survived versus deceased patients, and operated versus not-operated ones were compared for various patient characteristics. A multivariable logistic regression with backward elimination and a generalized additive model (GAM) were implemented to evaluate the associations between potential risk factors and mortality. RESULTS: A total of 7,214 patients aged 65 and older with ruptured AAA were included. About 31% of total sample, 26% of survived, and 36% of deceased were female. Mortality rate was higher in older patients, females, and those who were not operated on (40.6%) versus those that were (74.5%). Age, sex, healthcare insurance, severity of illness subclass, hospital length of stay, total charges, and several comorbidities had significant association with mortality in univariable models. Multivariable logistic regression with backward elimination confirmed age (odds ratio[OR]=1.04; 95% confidence interval [CI]=1.03-1.05; p<0.001), sex (OR=1.23; 95%CI=1.07-1.41; p=0.004), hospital length of stay (OR=0.87; 95%CI=0.86-0.88; p<0.001), bacterial infection (OR=3.79; 95%CI=3.07-4.68; p<0.001), cardiac disease (OR=1.97; 95%CI=1.71-2.28; p<0.001), liver disease (OR=2.90; 95%CI=2.22-3.77; p<0.001), fluid and electrolyte disorders (OR=1.34; 95%CI=1.18-1.52; p<0.001), and coagulopathy (OR=1.96; 95%CI=1.04-1.37; p=0.01) to be the independent predictors of mortality. Age showed a linear association with mortality; whereas, hospital length of stay had a significant L-shaped association. Elderly patients emergently admitted for ruptured AAA had the lowest risk of mortality with hospital stays greater than seven days (EDF=13.91, p<0.0001). CONCLUSION: Longer hospital length of stay (>7 days) of emergently admitted elderly patients with ruptured abdominal aortic aneurysm was associated with better outcomes and lower risk of mortality. Surgical intervention was also associated with much lower rate of mortality, while increasing age was associated with higher rate of mortality. In elderly patients admitted for ruptured abdominal aortic aneurysm, every one year older than 65, increased the odds of mortality by 4% and female sex increased the odds of mortality by 23%.

Murine macrophages or their secretome delivered in alginate dressings enhance impaired wound healing in diabetic mice.

Diabetic foot ulceration is a devastating diabetic complication with unmet needs. We explored the efficacy of calcium-crosslinked alginate dressings in topically delivering primary macrophages and their secretome to diabetic wounds. The alginate bandages had a microporous structure that enabled even cell loading with prolonged cell survival and egress following wound placement. In vitro experiments showed that we could successfully differentiate and polarize primary murine bone marrow derived monocytes into M0, M1, M2a and M2c defined states with distinct gene expression, surface protein and secretome profiles. The primary macrophages were delivered in the bandages, migrated within the wounds and were still present for as long as 16 days post-injury. In wounds of db/db mice, treatment with all macrophage subtypes and their secretome, when compared to control, accelerated wound healing. Bulk RNA sequencing analysis and multiplex protein quantification of wound lysates revealed that M2c macrophages conditioned media had the most impact in wound healing affecting processes like neurogenesis, while M1 conditioned media promoted keratinization and epidermal differentiation. Collectively, our results indicate that alginate dressings can serve as a delivery platform for topical treatment of diabetic wounds and that conditioned media from distinctly polarized macrophages is equally or more effective than their parental cells in advancing wound healing and could therefore be a promising and technically advantageous alternative to cell therapy.

Exosomes Derived from Epidermal Stem Cells Improve Diabetic Wound Healing.

Diabetic foot ulceration is a major diabetic complication with unmet needs. We investigated the efficacy of epidermal stem cells and epidermal stem cells-derived exosomes (ESCs-Exo) in improving impaired diabetic wound healing and their mechanisms of action. In vitro experiments showed that ESCs-Exo enhanced the proliferation and migration of diabetic fibroblasts and macrophages and promoted alternative or M2 macrophage polarization. In wounds of db/db mice, treatment with both epidermal stem cells and ESCs-Exo, when compared with fibroblast exosomes and PBS control, accelerated wound healing by decreasing inflammation, augmenting wound cell proliferation, stimulating angiogenesis, and inducing M2 macrophage polarization. Multiplex protein quantification of wound lysates revealed TGFß signaling influenced by ESCs-Exo. High-throughput sequencing of small RNAs contained in the ESCs-Exo showed higher proportions of microRNAs than those contained in fibroblast exosomes. In silico functional analysis showed that the ESCs-Exo microRNAs‒target genes were primarily involved in homeostatic processes and cell differentiation and highlighted regulatory control of phosphatidylinositol-3 kinase/protein kinase B and TGFß signaling pathways. This was also validated in vitro. Collectively, our results indicate that epidermal stem cells and ESCs-Exo are equally effective in promoting impaired diabetic wound healing and that ESCs-Exo treatment may be a promising and technically advantageous alternative to stem cell therapies.

Single cell transcriptomic landscape of diabetic foot ulcers.

Diabetic foot ulceration (DFU) is a devastating complication of diabetes whose pathogenesis remains incompletely understood. Here, we profile 174,962 single cells from the foot, forearm, and peripheral blood mononuclear cells using single-cell RNA sequencing. Our analysis shows enrichment of a unique population of fibroblasts overexpressing MMP1, MMP3, MMP11, HIF1A, CHI3L1, and TNFAIP6 and increased M1 macrophage polarization in the DFU patients with healing wounds. Further, analysis of spatially separated samples from the same patient and spatial transcriptomics reveal preferential localization of these healing associated fibroblasts toward the wound bed as compared to the wound edge or unwounded skin. Spatial transcriptomics also validates our findings of higher abundance of M1 macrophages in healers and M2 macrophages in non-healers. Our analysis provides deep insights into the wound healing microenvironment, identifying cell types that could be critical in promoting DFU healing, and may inform novel therapeutic approaches for DFU treatment.

Adesão ao tratamento da urticária crônica / Chronic urticaria treatment adherence

Este trabalho apresenta o estudo de caso de uma mulher encaminhada ao serviço de psicologia de um hospital universitário com diagnóstico de urticária crônica. A queixa principal foi de que, apesar da adesão ao tratamento, os sintomas permaneciam. O objetivo foi auxiliar a cliente na instalação de novos repertórios e na generalização de padrões adequados já instalados, buscando melhor controle da urticária. Realizaram-se dez sessões de atendimento ambulatorial utilizando-se o modelo construcional, da abordagem analítico-comportamental, por meio de análises funcionais de episódios relatados pela cliente. Resultados indica-ram multicausalidade no desencadeamento e manutenção dos sintomas. O treino em análise de contingências favoreceu melhor controle dos fatores ambientais. A cliente aderiu adequadamente ao uso do medicamento após estabelecer relações funcionais entre sintomas e estressores ambientais, promovendo redução dos sintomas e melhor controle da doença. Concluiu-se que o atendimento auxiliou na melhora da qualidade de vida da cliente, destacando-se a relevância da adesão ao tratamento.(AU)

This work presents a case study of a woman who had been addressed to the psychology service, diagnosed with chronic urticaria. This woman's main complaint was that the symptoms were still present even though she was complying the treatment. The purpose was to assist the client to promote the installation of new behaviors and to generalize appropriate behavior patterns, looking for a better urticaria control. Ten sessions were carried out in the hospital, by using the Constructional approach from Behavior Analysis, through the related episode's functional analysis. Results indicated that the triggering and maintenance of the crises had multiple reasons. The contingency-analysis training accomplished during the sessions had promoted a better control of environmental factors. The patient came to comply appropriately with medication use after establishing functional relations between symptoms and environmental stressors. There was a reduction of symptoms and improvement in controlling the disease. This conclusion suggests a better understanding about the relevance of psychotherapeutic accompaniment to the adherence of medical treatment. Patient's reported an improvement in her quality of life.(AU)

Adesão ao tratamento da urticária crônica / Chronic urticaria treatment adherence

Este trabalho apresenta o estudo de caso de uma mulher encaminhada ao serviço de psicologia de um hospital universitário com diagnóstico de urticária crônica. A queixa principal foi de que, apesar da adesão ao tratamento, os sintomas permaneciam. O objetivo foi auxiliar a cliente na instalação de novos repertórios e na generalização de padrões adequados já instalados, buscando melhor controle da urticária. Realizaram-se dez sessões de atendimento ambulatorial utilizando-se o modelo construcional, da abordagem analítico-comportamental, por meio de análises funcionais de episódios relatados pela cliente. Resultados indica-ram multicausalidade no desencadeamento e manutenção dos sintomas. O treino em análise de contingências favoreceu melhor controle dos fatores ambientais. A cliente aderiu adequadamente ao uso do medicamento após estabelecer relações funcionais entre sintomas e estressores ambientais, promovendo redução dos sintomas e melhor controle da doença. Concluiu-se que o atendimento auxiliou na melhora da qualidade de vida da cliente, destacando-se a relevância da adesão ao tratamento.

This work presents a case study of a woman who had been addressed to the psychology service, diagnosed with chronic urticaria. This woman's main complaint was that the symptoms were still present even though she was complying the treatment. The purpose was to assist the client to promote the installation of new behaviors and to generalize appropriate behavior patterns, looking for a better urticaria control. Ten sessions were carried out in the hospital, by using the Constructional approach from Behavior Analysis, through the related episode's functional analysis. Results indicated that the triggering and maintenance of the crises had multiple reasons. The contingency-analysis training accomplished during the sessions had promoted a better control of environmental factors. The patient came to comply appropriately with medication use after establishing functional relations between symptoms and environmental stressors. There was a reduction of symptoms and improvement in controlling the disease. This conclusion suggests a better understanding about the relevance of psychotherapeutic accompaniment to the adherence of medical treatment. Patient's reported an improvement in her quality of life.