Factor VIIa administration in traumatic brain injury: an AAST-MITC propensity score analysis.

Background:Recombinant factor VIIa (rFVIIa) has been used off-label as an adjunct in the reversal of warfarin therapy and management of hemorrhage after trauma. Only a handful of these reports are rigorous studies, from which results regarding safety and effectiveness have been mixed. There remains no clear consensus as to the role of rFVIIa in traumatic brain injury (TBI). Methods:Eleven level 1 trauma centers provided clinical data and head CT scans of patients with a Glasgow Coma Scale (GCS) score of ≤13 and radiographic evidence of TBI. A propensity score (PS) to receive rFVIIa in those surviving ≥2 days was calculated for each patient based on patient demographics, comorbidities, physiology, Injury Severity Score, admission GCS score, and treatment center. Patients receiving rFVIIa within 24 hours of admission were matched to patients who did not receive rFVIIa for outcomes assessment. Subgroup analysis evaluated patients with primary head injury with PS matching. Results:There were 4284 patient observations; 129 received rFVIIa. Groups were comparable after matching. No differences in mortality or morbidity were found. Improvement in GCS score from admission to discharge was less among those receiving rFVIIa (5.5 vs. 2.4; P value 0.001); however, there was no difference in average GCS score at discharge. No significant differences in outcomes were identified in patients with isolated TBI receiving rFVIIa. Discussion:rFVIIa in early management of TBI is not associated with a decreased risk of mortality or morbidity, and may negatively impact recovery and functional status at discharge in the severely injured patient with polytrauma. Level of evidence:Level III. Study type:Therapeutic/care management

The American Association for the Surgery of Trauma renal injury grading scale: Implications of the 2018 revisions for injury reclassification and predicting bleeding interventions.

BackgroundIn 2018, the American Association for the Surgery of Trauma (AAST) published revisions to the renal injury grading system to reflect the increased reliance on computed tomography scans and non-operative management of high-grade renal trauma (HGRT). We aimed to evaluate how these revisions will change the grading of HGRT and if it outperforms the original 1989 grading in predicting bleeding control interventions.MethodsData on HGRT were collected from 14 Level-1 trauma centers from 2014 to 2017. Patients with initial computed tomography scans were included. Two radiologists reviewed the scans to regrade the injuries according to the 1989 and 2018 AAST grading systems. Descriptive statistics were used to assess grade reclassifications. Mixed-effect multivariable logistic regression was used to measure the predictive ability of each grading system. The areas under the curves were compared.ResultsOf the 322 injuries included, 27.0% were upgraded, 3.4% were downgraded, and 69.5% remained unchanged. Of the injuries graded as III or lower using the 1989 AAST, 33.5% were upgraded to grade IV using the 2018 AAST. Of the grade V injuries, 58.8% were downgraded using the 2018 AAST. There was no statistically significant difference in the overall areas under the curves between the 2018 and 1989 AAST grading system for predicting bleeding interventions (0.72 vs. 0.68, p = 0.34).ConclusionAbout one third of the injuries previously classified as grade III will be upgraded to grade IV using the 2018 AAST, which adds to the heterogeneity of grade IV injuries. Although the 2018 AAST grading provides more anatomic details on injury patterns and includes important radiologic findings, it did not outperform the 1989 AAST grading in predicting bleeding interventions.Level of evidencePrognostic and Epidemiological Study, level III

Phosphoinositide-dependent kinase 1 targets protein kinase A in a pathway that regulates interleukin 4

CD28 plays a critical role in T cell immune responses. Although the kinase Akt has been shown to act downstream of CD28 in T helper (Th)1 cytokine induction, it does not induce Th2 cytokines such as interleukin 4 (IL-4). We recently reported that phosphoinositide-dependent kinase 1 (PDK1) partially corrects the defect in IL-4 production present in CD28-deficient T cells, suggesting that PDK1 regulates IL-4 independently of Akt. We now describe a signaling pathway in which PDK1 targets IL-4 in the murine Th2 cell line D10. PDK1-mediated activation of this pathway is dependent on protein kinase A (PKA) and the nuclear factor of activated T cells (NFAT) P1 transcriptional element in the IL-4 promoter. PDK1 localizes to the immune synapse in a phosphatidylinositol 3-kinase–dependent manner, partially colocalizes with PKA at the synapse, and physically interacts with PKA. In RNA interference knockdown experiments, PDK1 is necessary for phosphorylation of PKA in T cells, as well as for activation of the IL-4 NFAT P1 element by the T cell receptor (TCR) and CD28. Phosphorylation of the critical PKA threonine residue is stimulated by engagement of TCR/CD28 via a PDK1-dependent mechanism. These findings together define a pathway linking the kinases PDK1 and PKA in the induction of the Th2 cytokine IL-4

Trauma ICU Prevalence Project: the diversity of surgical critical care.

Background:Surgical critical care is crucial to the care of trauma and surgical patients. This study was designed to provide a contemporary assessment of patient types, injuries, and conditions in intensive care units (ICU) caring for trauma patients. Methods:This was a multicenter prevalence study of the American Association for the Surgery of Trauma; data were collected on all patients present in participating centers' trauma ICU (TICU) on November 2, 2017 and April 10, 2018. Results:Forty-nine centers submitted data on 1416 patients. Median age was 58 years (IQR 41-70). Patient types included trauma (n=665, 46.9%), non-trauma surgical (n=536, 37.8%), medical (n=204, 14.4% overall), or unspecified (n=11). Surgical intensivists managed 73.1% of patients. Of ICU-specific diagnoses, 57% were pulmonary related. Multiple high-intensity diagnoses were represented (septic shock, 10.2%; multiple organ failure, 5.58%; adult respiratory distress syndrome, 4.38%). Hemorrhagic shock was seen in 11.6% of trauma patients and 6.55% of all patients. The most common traumatic injuries were rib fractures (41.6%), brain (38.8%), hemothorax/pneumothorax (30.8%), and facial fractures (23.7%). Forty-four percent were on mechanical ventilation, and 17.6% had a tracheostomy. One-third (33%) had an infection, and over half (54.3%) were on antibiotics. Operations were performed in 70.2%, with 23.7% having abdominal surgery. At 30 days, 5.4% were still in the ICU. Median ICU length of stay was 9 days (IQR 4-20). 30-day mortality was 11.2%. Conclusions:Patient acuity in TICUs in the USA is very high, as is the breadth of pathology and the interventions provided. Non-trauma patients constitute a significant proportion of TICU care. Further assessment of the global predictors of outcome is needed to inform the education, research, clinical practice, and staffing of surgical critical care providers. Level of evidence:IV, prospective observational study

Safety and Efficacy of Erythropoietin in Traumatic Brain Injury Patients: A Pilot Randomized Trial

Background. Erythropoietin (EPO) is a neuroprotective agent utilized in stroke patients. This pilot study represents the first randomized trial of EPO in traumatic brain injury (TBI) patients. Methods. Adult, blunt trauma patients with evidence of TBI were randomized to EPO or placebo within 6 hours of injury. Baseline and daily serum S-100B and Neuron Specific Enolase (NSE) levels were measured. Results. TBI was worse in the EPO (n = 11) group compared to placebo patients (n = 5). The use of EPO did not impact NSE (P = .89) or S100 B (P = .53) levels compared to placebo. Conclusions. At the dose used, EPO did not reduce neuronal cell death compared to placebo; however, TBI severity was worse in the EPO group while levels of NSE and S100-B were similar to the less injured placebo group making it difficult to rule out a treatment effect. A larger, balanced study is necessary to confirm a potential treatment effect

Cal Poly Battle Bot

This senior project endeavored to design, construct, and optimize a 120lb robot combatant tailored for the competitive arena of combat robotics. The project is a collaborative effort between mechanical, computer, and electrical engineering students at Cal Poly, combining diverse expertise to achieve a unified goal. Our competition, RoboGames, was in April of this year in Northern California. The mechanical engineering team assumed primary responsibility for the physical components of the battle bot, focusing on three pivotal components: a robust drivetrain, armor, and a highperformance vertical spinner. These elements constitute the foundation of the battle bot\u27s offensive and defensive capabilities, crucial for success in the competition arena. This Final Design Review brings the results of our design and testing. All four subsystems have been engineered to meet the requirements of our sponsor as will be shown in our supporting documentation. This document includes theoretical calculations used to conduct comprehensive stress analyses, affording invaluable insights into the expected behavior of our robot at the competition. These analyses will serve as a benchmark for real-world testing, allowing for iterative refinement and optimization. The convergence of theoretical simulations and empirical data will drive the project towards an optimized and battle-ready configuration. Our project meets the criteria of being a functional prototype by serving as a foundation for the Cal Poly Battlebots team as something that next year’s team can build upon. The current robot can drive and only needs a few machining improvements to be mechanically battle ready for the competition next year. By synergizing the diverse expertise of mechanical, computer, and electrical engineering disciplines, this project aims to culminate in a battle bot that not only excels in the rigors of competition but also showcases the ingenuity and collaboration of our interdisciplinary team

A Guide for the Import and Export of Seeds of ICRISAT Mandate Crops

This revised summary of plant quarantine import and export instruction for seeds of ICRISAT mandate crops: sorghum, pearl millet, pigeonpea, chickpea and groundnut has been prepared as a guide for safe, smooth and speedy exchange of seeds. Assembly of germplasm from all over the world and distribution of cultivars to scientists and cooperators for testing in the semi-arid tropics are essential to the success of ICRISAT's crop improvement programs. The Government of India wishes to encourage the unrestricted movement of seed and genetic material into and out of India, subject to quarantine regulations which aim at preventing the accidental transport of exotic insect pests and diseases across international borders, ICRISAT respects the plant qurantine rules and regulations of different countries and wishes to ensure that all seed exchanges conform with these regulation and meet the approval of the National Plant Quarantine Services. The Indian Government has established rules and procedures for clearance of seed materials and so have most of the other countries, and these have been kept in mind while writing this brochure. It is hoped cooperators and scientists involved in the collection, despatch and exchange of seed and plant materials of our crops will follow these procedures carefully, so as to ensure effective plant protection through safe prompt movement of seed to and from cooperators working in various countrie

Quarantine Important Diseases of Sorghum, Pearl Millet, Chickpea, Pigeonpea and Groununut

Quarantine important diseases of sorghum, pearl millet, chickpea, pigeonpea and groundnut are described. In case of sorghum no report appears to be available on the occurrence of milo, bacterial leaf streak, bacterial leaf blight and bacterial leaf spot in India. Downy mildew, head smut and sugarcane mosaic virus, though found in the country, have quarantine restrictions owing to the fear of their new races being introduced. Downy mildew and ergot, the two serious diseases of pearl millet, are present in India but the entry of seed from the areas where these diseases occur is restricted. Bean yellow mosaic virus of chickpea has not been recorded in India; cucumber mosaic virus, pea leaf roll virus, blight, wilt and alfalfa mosaic virus are present in the country but import of seed from countries where these diseases occur is restricted under quarantine rules. In the case of pigeonpea, anthracnose, bacterial leaf spot and stem canker, sterility mosaic virus and yellow mosaic virus do occur in the country but they too have quarantine restrictions. The exotic diseases of groundnut — scab, Texas root rot, rosette virus, peanut stunt virus, peanut mottle virus and peanut marginal chlorosis virus — and already occurring rust and bacterial wilt, have quarantine importance