Differences in degree, differences in kind: characterizing lung injury in trauma.

Background: Acute lung injury following trauma remains a significant source of morbidity and mortality. Although multiple trauma studies have used hypoxemia without radiographic adjudication as a surrogate for identifying adult respiratory distress syndrome (ARDS) cases, the differences between patients with hypoxemia alone and those with radiographically confirmed ARDS are not well described in the literature. We hypothesized that nonhypoxemic, hypoxemic, and ARDS patients represent distinct groups with unique characteristics and predictors.

Ex-PRESS glaucoma filter: an MRI compatible metallic orbital foreign body imaged at 1.5 and 3T.

Aim: To report on the MRI compatibility of the Ex-PRESS glaucoma filtration device, a tiny metallic implant placed into the anterior chamber of the eye that is much smaller than traditional glaucoma shunts, and to educate the radiology community regarding its appearance.

Materials And Methods: Seven patients with Ex-PRESS glaucoma filtration devices were identified that had undergone MRI at San Francisco General Hospital/University of California San Francisco Medical Center by searching and cross-referencing the radiology reporting system and the electronic medical record. MRI images were reviewed for artefact interfering with interpretation.

Evolving beyond the vicious triad: Differential mediation of traumatic coagulopathy by injury, shock, and resuscitation.

Background: A subset of trauma patients with critical injury present with coagulopathy, portending markedly worse outcomes. Clinical practice is evolving to treat the classical risk factors of hypothermia, hemodilution, and acidosis; however, coagulopathy persists even in the absence of these factors. We sought to determine the relative importance of injury- and shock-specific factors compared with resuscitation-associated factors in coagulopathy after trauma.

The impact of trauma-center care on mortality and function following pelvic ring and acetabular injuries.

Background: Lower mortality and improved physical function following major polytrauma have been associated with treatment at level-I trauma centers compared with that at hospitals without a trauma center (nontrauma centers). This study investigated the impact of trauma-center care on outcomes after pelvic and acetabular injuries.

Methods: Mortality and quality-of-life-related scores were compared among patients treated in eighteen level-I trauma centers and fifty-one nontrauma centers in fourteen U.

A comparative study of molecular characteristics of diffuse large B-cell lymphoma from patients with and without human immunodeficiency virus infection.

Purpose: HIV-related diffuse large B-cell lymphoma (DLBCL) may be biologically different from DLBCL in the general population. We compared, by HIV status, the expression and prognostic significance of selected oncogenic markers in DLBCL diagnosed at Kaiser Permanente in California, between 1996 and 2007.

Experimental Design: Eighty HIV-infected DLBCL patients were 1:1 matched to 80 HIV-uninfected DLBCL patients by age, gender, and race.

Recent developments in the assessment of the multiply injured trauma patient.

Purpose Of Review: To provide an update on the recent developments and controversies in the assessment of the traumatically injured patient.

Recent Findings: Recent literature suggests that: whole-body computed tomography (CT) is an effective strategy in more severely injured blunt trauma patients; 64-slice CT scanning now provides an effective noninvasive screening method for blunt cerebrovascular injury; the need for MRI imaging, in addition to CT, for the diagnosis of occult ligamentous injury of the cervical spine remains an unresolved controversy; point-of-care testing has made significant improvements in our ability to predict which patients will need a massive transfusion; and thromboelastography has enhanced our ability to tailor a hemostatic resuscitation more accurately.

Summary: The recent advances in the assessment of the multiply injured patient allow clinicians to more efficiently diagnose a patient's injuries and implement treatment in a more timely manner.

Vascular access type, inflammatory markers, and mortality in incident hemodialysis patients: the Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) Study.

Background: Few reports have shown an association between access type and inflammatory marker levels in a longitudinal cohort. We investigated the role of access type on serial levels of inflammatory markers and the role of inflammatory markers in mediating the association of access type and risk of mortality in a prospective study of incident dialysis patients.

Study Design: Cohort study, post hoc analysis of the CHOICE (Choices for Healthy Outcomes in Caring for ESRD) Study.

Dental pulp stem cell (DPSC) isolation, characterization, and differentiation.

Dental pulp stem cells (DPSC) have been proposed as an alternative to pluripotent stem cells to study multilineage differentiation in vitro and for therapeutic application. Standard culture media for isolation and expansion of stem cells includes animal sera or animal-derived matrix components (e.g.

Race and other risk factors for incident proteinuria in a national cohort of HIV-infected veterans.

Background: Proteinuria in human immunodeficiency virus (HIV)-infected individuals has been associated with poorer outcomes. We examined risk factors associated with the development of proteinuria in a national registry of HIV-infected veterans.

Methods: A total of 21,129 HIV-infected veterans of black and white race without preexisting kidney disease were receiving health care in the Veterans' Health Administration (VHA) medical system between 1997 and 2011.

CROI 2014: Viral hepatitis and complications of HIV disease and antiretroviral therapy.

The remarkable advances in interferon-sparing, all-oral hepatitis C virus (HCV) treatment were a highlight of the 2014 Conference on Retroviruses and Opportunistic Infections (CROI). The backbone of the nucleotide inhibitor sofosbuvir and the nonstructural protein 5A (NS5A) inhibitor ledipasvir with an additional third agent (HCV protease inhibitor or HCV nonnucleoside reverse transcriptase inhibitor) led to a sustained virologic response (SVR) rate 12 weeks after cessation of treatment of 95% to 100% after only 6 weeks of treatment. These results demonstrate the potential of combination directacting antiviral (DAA) therapy for abbreviated, well-tolerated, and highly effective HCV treatment.

Annals of Emergency Medicine Journal Club. Global Emergency Medicine Journal Club: Social media responses to the November 2013 Annals of Emergency Medicine Journal Club.

The Annals November 2013 Journal Club issue marked one of the first collaborations with Academic Life in Emergency Medicine, a medical education blog, in an effort to promote a worldwide, transparent, online effort to perform critical appraisals of journal articles. The Global Emergency Medicine Journal Club was hosted on the blog for 1 week during November 18 to 24, 2013, with comments moderated on the blog and on Twitter. This summary article compiles the discussion and insights.

Impact of partial participation in integrated family planning training on medical knowledge, patient communication and professionalism.

Introduction: Obstetrics and gynecology residency programs are required to provide access to abortion training, but residents can opt out of participating for religious or moral reasons. Quantitative data suggest that most residents who opt out of doing abortions participate and gain skills in other aspects of the family planning training. However, little is known about their experience and perspective.

Descriptive analysis of a novel health care approach: reverse colocation-primary care in a community mental health "home".

Objective: Persons with serious mental illness have increased rates of chronic medical conditions, have limited access to primary care, and incur significant health care expenditures. Few studies have explored providing medical care for these patients in the ambulatory mental health setting. This study describes a real-world population of mental health patients receiving primary care services in a community mental health clinic to better understand how limited primary care resources are being utilized.

Availability and characteristics of abortion training in US ob-gyn residency programs: a national survey.

Objective: To assess the availability and characteristics of abortion training in US ob-gyn residency programs.

Methods: We surveyed fourth-year residents at US residency programs by email regarding availability and type of abortion training, procedural experience and self-assessed competence in abortion skills. We conducted multivariable, ordinal logistic regression with general estimating equations to determine individual-level and resident-reported, program-level correlates of quantity of uterine evacuation procedures done during residency.

Stem cell-derived endochondral cartilage stimulates bone healing by tissue transformation.

Although bone has great capacity for repair, there are a number of clinical situations (fracture non-unions, spinal fusions, revision arthroplasty, segmental defects) in which auto- or allografts attempt to augment bone regeneration by promoting osteogenesis. Critical failures associated with current grafting therapies include osteonecrosis and limited integration between graft and host tissue. We speculated that the underlying problem with current bone grafting techniques is that they promote bone regeneration through direct osteogenesis.

Propensity for hip dislocation in normal gait loading versus sit-to-stand maneuvers in posterior wall acetabular fractures.

Treatment of posterior wall (PW) fractures of the acetabulum is guided by the size of the broken wall fragment and by hip instability. Biomechanical testing of hip instability typically is done by simulating the single-leg-stance (SLS) phase of gait, but this does not represent daily activities, such as sit-to-stand (STS) motion. We conducted a study to examine and compare hip instability after PW fractures in SLS and STS loading.

Combined SCI and TBI: recovery of forelimb function after unilateral cervical spinal cord injury (SCI) is retarded by contralateral traumatic brain injury (TBI), and ipsilateral TBI balances the effects of SCI on paw placement.

A significant proportion (estimates range from 16 to 74%) of patients with spinal cord injury (SCI) have concomitant traumatic brain injury (TBI), and the combination often produces difficulties in planning and implementing rehabilitation strategies and drug therapies. For example, many of the drugs used to treat SCI may interfere with cognitive rehabilitation, and conversely drugs that are used to control seizures in TBI patients may undermine locomotor recovery after SCI. The current paper presents an experimental animal model for combined SCI and TBI to help drive mechanistic studies of dual diagnosis.

U-500R and aspart insulin for the treatment of severe insulin resistance in pregnancy associated with pregestational diabetes.

Severe insulin resistance as a complication of diabetes in pregnancy is seen with increasing frequency. Treatment with large doses of insulin (>300 units perday) can be practically difficult. A woman with preexisting Type 2 diabetes mellitus and poor glycemic control presented in early pregnancy requiring over 1000 units of insulin daily.

Opting out of abortion training: benefits of partial participation in a dedicated family planning rotation for ob-gyn residents.

Background: This study was conducted to describe the experiences of residents who opt out of some components of a dedicated abortion rotation.

Study Design: Eligible residents at programs receiving funding from the Kenneth J. Ryan Residency Training Program in Abortion and Family Planning were invited to complete a cross-sectional, online survey.

Lenalidomide enhancement of human T cell functions in human immunodeficiency virus (HIV)-infected and HIV-negative CD4 T lymphocytopenic patients.

Suppressed T cell functions in human immunodeficiency virus (HIV) infection were identified and corrected by lenalidomide in middle-aged HIV-infected patients. Chemotaxis of T cells from HIV-infected men (n = 6, mean 43 years) to sphingosine 1-phosphate (S1P) and CCL21 was significantly lower than that of HIV-negative men (n = 6, mean 41 years), and was enhanced significantly up to control levels by 100 and 1000 nM lenalidomide. Generation of interleukin (IL)-2, but not interferon (IFN)-γ, by T cells of middle-aged HIV-infected men was significantly lower than that for controls and was increased significantly by 10-1000 nM lenalidomide up to a maximum of more than 300%.

Impact of capacity reductions in acute public-sector inpatient psychiatric services.

Objective: This study tested the hypothesis that reductions in acute public-sector psychiatric inpatient capacity in a major urban area would be associated with negative impacts on patients and the community.

Methods: The impact of two discrete service changes that reduced acute inpatient capacity by 50% in a single public-sector general hospital setting was examined. Indicators of impact were obtained from existing administrative databases for a 33-month period.

Text Messaging as an Adjunct to CBT in Low-Income Populations: A Usability and Feasibility Pilot Study.

This article outlines the development and usability-feasibility testing of an automated text-messaging adjunct to cognitive- behavioral therapy (CBT) for depression in a public sector clinic serving low-income patients. The text-messaging adjunct is aimed at increasing homework adherence, improving self-awareness, and helping track patient progress. Daily text messages were sent to patients, inquiring about their mood.