Pragmatic Early Predictors of Survival After Trauma.

Introduction: Accurately predicting the risk of early mortality after trauma can guide appropriate use of resources. This study aims to create a pragmatic mortality prediction from prehospital data.

Methods: The Linking Investigators in Trauma and Emergency Service Task Order One (LITES TO1) database was used to identify predictors of mortality at hour 3, hour 24, and day 30 after trauma.

Association between coagulation biomarkers, intracranial hemorrhage types, and tranexamic acid treatments in early traumatic brain injury.

Background: Although a prehospital 2 g bolus of tranexamic acid (TXA) has been associated with decreased mortality in patients with traumatic intracranial hemorrhage (ICH), the underlying mechanism remains controversial. We investigated whether early coagulation biomarkers are associated with ICH type, prehospital TXA treatment, and outcomes in patients with early traumatic brain injury (TBI).

Methods: We conducted a secondary analysis of the Prehospital TXA for TBI trial (Glasgow Coma Scale score of <13 and systolic blood pressure of ≥90 mm Hg in patients blindly randomized prehospital to either a 2 g TXA bolus, 1 g TXA bolus plus 1 g TXA infusion, or placebo bolus plus infusion).

x-ABC versus ABC: shifting paradigms in early trauma resuscitation.

Exsanguinating hemorrhage is the most common cause of preventable death after trauma. Since the development of cardiopulmonary resuscitation, the airway, breathing and circulation (ABCs) have been applied to early resuscitation in different contexts including trauma. The ABCs have been a pivotal paradigm in the Advanced Trauma Life Support course since its development, but recent data have indicated that prioritizing the management of eXsanguinating hemorrhage (x-ABC) improves outcomes.

Evolution of whole blood trauma resuscitation in childbearing age females: practice patterns and trends.

Background: The use of low titer group O whole blood (LTOWB) for resuscitation of patients with traumatic hemorrhage is becoming increasingly common. Practices regarding the administration of RhD-positive LTOWB to childbearing age females (CBAFs) vary between institutions due to concerns about RhD alloimmunization. This study examined practices related to LTOWB transfusion as they pertain to age and sex.

Diagnostic Performance of GFAP, UCH-L1, and MAP-2 Within 30 and 60 Minutes of Traumatic Brain Injury.

Importance: Data on the performance of traumatic brain injury (TBI) biomarkers within minutes of injury are lacking.

Objectives: To examine the performance of glial fibrillary acidic protein (GFAP), ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), and microtubule-associated protein 2 (MAP-2) within 30 and 60 minutes of TBI in identifying intracranial lesions on computed tomography (CT) scan, need for neurosurgical intervention (NSI), and clinically important early outcomes (CIEO).

Design, Setting, And Participants: This cohort study is a biomarker analysis of a multicenter prehospital TBI cohort from the Prehospital Tranexamic Acid Use for TBI clinical trial conducted across 20 centers and 39 emergency medical systems in North America from May 2015 to March 2017.

Cooling rate uncovers epimer-dependent supramolecular organization of carbohydrate amphiphiles.

We show distinct CH-π interactions and assembly pathways for the amphiphile -(fluorenylmethoxycarbonyl)-galactosamine and its epimer -(fluorenylmethoxycarbonyl)-glucosamine. These differences result in the formation of supramolecular nanofibrous systems with opposite chirality. Our results showcase the importance of the carbohydrates structural diversity for their specific biointeractions and the opportunity that their ample interactome offers for synthesis of versatile and tunable supramolecular (bio) materials.

Multifunctional calcium-based nanocarriers for synergistic treatment of triple-negative breast cancer.

Targeted breast cancer therapies hold the potential to improve the efficiency of drug delivery to the pathology site without impacting the viability and function of healthy cells. Herein, we developed multifunctional nanocarriers that target simultaneously several downstream signaling processes in triple negative breast cancer cells. The system comprises pH sensitive CaCO nanoparticles (NPs) as carriers of the anticancer drug doxorubicin (DOX).

Research priorities in tranexamic acid after trauma: Secondary analysis of the National Trauma Research Action Plan.

Introduction: Tranexamic acid (TXA) is an antifibrinolytic drug that is used in traumatic hemorrhage and traumatic brain injury. Although TXA is considered relatively safe and inexpensive and is widely available, data regarding its mechanisms, optimal dosing, and timing, as well as relative risks and benefits for different patient populations, are inconsistent. In this study, we aim to identify and summarize consensus research questions related to TXA across all National Trauma Research Action Plan (NTRAP) Delphi expert panels to identify priorities for future research on TXA in trauma.

study of the blood-brain barrier transport of bioactives from Mediterranean foods.

The Mediterranean diet (MD), characterized by olive oil, olives, fruits, vegetables, and wine intake, is associated with a reduced risk of dementia. These foods are rich in bioactives with neuroprotective and antioxidant properties, including hydroxytyrosol (HT), tyrosol (TYRS), serotonin (SER) and protocatechuic acid (PCA), a phenolic acid metabolite of anthocyanins. It remains to be established if these molecules cross the blood-brain barrier (BBB), a complex interface that strictly controls the entrance of molecules into the brain.

Leukoaraiosis Is Not Associated With Recovery From Aphasia in the First Year After Stroke.

After a stroke, individuals with aphasia often recover to a certain extent over time. This recovery process may be dependent on the health of surviving brain regions. Leukoaraiosis (white matter hyperintensities on MRI reflecting cerebral small vessel disease) is one indication of compromised brain health and is associated with cognitive and motor impairment.

Are Data Driving Our Ambulances? Liberal Use of Tranexamic Acid in the Prehospital Setting.

Background: Current data on tranexamic acid (TXA) supports early administration for severe hemorrhagic shock. Administration by EMS has been facilitated by developing protocols and standing orders informed by these data. In this study, patterns of TXA use by EMS agencies serving a large level 1 trauma center were examined.

Association of fibrinolysis phenotype with patient outcomes following traumatic brain injury.

Background: Impaired coagulation is associated with elevated risk of mortality in trauma patients. Prior studies have demonstrated increased mortality in patients with hyperfibrinolysis (HF) and fibrinolysis shutdown (SD). In addition, prior studies have demonstrated no effect of tranexamic acid (TXA) on fibrinolysis phenotypes.

Efficacy of molecular and nano-therapies on brain tumor models in microfluidic devices.

The three-dimensional (3D) organization of cells affects their mobility, proliferation, and overall response to treatment. Spheroids, organoids, and microfluidic chips are used in cancer research to reproduce in vitro the complex and dynamic malignant microenvironment. Herein, single- and double-channel microfluidic devices are used to mimic the spatial organization of brain tumors and investigate the therapeutic efficacy of molecular and nano anti-cancer agents.

Recovery from aphasia in the first year after stroke.

Most individuals who experience aphasia after a stroke recover to some extent, with the majority of gains taking place in the first year. The nature and time course of this recovery process is only partially understood, especially its dependence on lesion location and extent, which are the most important determinants of outcome. The aim of this study was to provide a comprehensive description of patterns of recovery from aphasia in the first year after stroke.

A Model for Sleep Apnea Management in Underserved Patient Populations.

Introduction: Obstructive sleep apnea (OSA) is a common condition in the United States that is strongly linked to metabolic disease, cardiovascular disease, and increased mortality. Uninsured populations experience sleep health disparities, including delayed recognition, diagnosis, and treatment of OSA due to barriers accessing and affording care. Partnerships between primary care clinics and sleep medicine specialists for sleep apnea management have the potential to increase screening, testing, and treatment among underserved populations.

Expanding the Conformational Landscape of Minimalistic Tripeptides by Their -Glycosylation.

We report on the supramolecular self-assembly of tripeptides and their -glycosylated analogues, in which the carbohydrate moiety is coupled to a central serine or threonine flanked by phenylalanine residues. The substitution of serine with threonine introduces differential side-chain interactions, which results in the formation of aggregates with different morphology. -glycosylation decreases the aggregation propensity because of rebalancing of the π interactions.

Prehospital resuscitation.

Traumatic injury is the leading cause of death in young people in the USA. Our knowledge of prehospital resuscitation is constantly evolving and is often informed by research based on military experience. A move toward balanced blood product resuscitation and away from excessive crystalloid use has led to improvements in outcomes for trauma patients.

Aromatic carbohydrate amphiphile disrupts cancer spheroids and prevents relapse.

Spheroids recapitulate the organization, heterogeneity and microenvironment of solid tumors. Herein, we targeted spatiotemporally the accelerated metabolism of proliferative cells located on the spheroid surface that ensure structure maintenance and/or growth. We demonstrate that phosphorylated carbohydrate amphiphile acts as a potent antimetabolite due to glycolysis inhibition and to in situ formation of supramolecular net around spheroid surface where alkaline phosphatase is overexpressed.

Intensity- and timing-dependent modulation of motion perception with transcranial magnetic stimulation of visual cortex.

Despite the widespread use of transcranial magnetic stimulation (TMS) in research and clinical care, the dose-response relations and neurophysiological correlates of modulatory effects remain relatively unexplored. To fill this gap, we studied modulation of visual processing as a function of TMS parameters. Our approach combined electroencephalography (EEG) with application of single pulse TMS to visual cortex as participants performed a motion perception task.

Application of long-interval paired-pulse transcranial magnetic stimulation to motion-sensitive visual cortex does not lead to changes in motion discrimination.

The perception of visual motion is dependent on a set of occipitotemporal regions that are readily accessible to neuromodulation. The current study tested if paired-pulse Transcranial Magnetic Stimulation (ppTMS) could modulate motion perception by stimulating the occipital cortex as participants viewed near-threshold motion dot stimuli. In this sham-controlled study, fifteen subjects completed two sessions.

Site-Specific Effects of Online rTMS during a Working Memory Task in Healthy Older Adults.

The process of manipulating information within working memory is central to many cognitive functions, but also declines rapidly in old age. Improving this process could markedly enhance the health-span in older adults. The current pre-registered, randomized and placebo-controlled study tested the potential of online repetitive transcranial magnetic stimulation (rTMS) applied at 5 Hz over the left lateral parietal cortex to enhance working memory manipulation in healthy elderly adults.

Inhibiting cancer metabolism by aromatic carbohydrate amphiphiles that act as antagonists of the glucose transporter GLUT1.

We report on aromatic -glucosides that inhibit selectively the cancer metabolism two coexistent mechanisms: by initial deprivation of the glucose uptake through competitive binding in the glucose binding pocket of GLUT1 and by formation of a sequestering nanoscale supramolecular network at the cell surface through localized (biocatalytic) self-assembly. We demonstrate that the expression of the cancer associated GLUT1 and alkaline phosphatase are crucial for the effectiveness of this combined approach: cancer cells that overexpress both proteins are prompter to cell death when compared to GLUT1 overexpressing cells. Overall, we showcase that the synergism between physical and biochemical deprivation of cancer metabolism is a powerful approach for development of effective anticancer therapies.