Background Two decades ago, hypotensive trauma patients requiring emergent laparotomy had a 40% mortality. In the interim, multiple interventions to decrease hemorrhage-related mortality have been implemented but few have any documented evidence of change in outcomes for patients requiring emergent laparotomy. The purpose of this study was to determine current mortality rates for patients undergoing emergent trauma laparotomy. Methods A retrospective cohort of all adult, emergent trauma laparotomies performed in 2012–2013 at 12 Level I trauma centers was reviewed. Emergent trauma laparotomy was defined as emergency department (ED) admission to surgical start time in ≤90 minutes. Hypotension was defined as arrival ED systolic blood pressure (SBP) ≤90 mmHg. Cause and time to death was also determined. Continuous data are presented as median [IQR]. Results 1,706 patients underwent emergent trauma laparotomy. The cohort was predominately young (31 years [24, 45]), male (84%), sustained blunt trauma (67%), and with moderate injuries (ISS 19 [10, 33]). The time in ED was 24 minutes [14, 39] and time from ED admission to surgical start was 42 minutes [30, 61]. The most common procedures were enterectomy (23%), hepatorrhaphy (20%), enterorrhaphy (16%), and splenectomy (16%). Damage control laparotomy was utilized in 38% of all patients and 62% of hypotensive patients. The Injury Severity Score for the entire cohort was 19 (IQR 10, 33) and 29 (IQR 18, 41) for the hypotensive group. Mortality for the entire cohort was 21% with 60% of deaths due to hemorrhage. Mortality in the hypotensive group was 46%, with 65% of deaths due to hemorrhage. Conclusion Overall mortality rate of a trauma laparotomy is substantial (21%) with hemorrhage accounting for 60% of the deaths. The mortality rate for hypotensive patients (46%) appears unchanged over the last two decades and is even more concerning, with almost half of patients presenting with a SBP ≤ 90 mmHg dying. Level of Evidence Level III (retrospective epidemiologcal study with up to two negative criteria)

Summary In laboratory animals, calorie restriction (CR) protects against aging, oxidative stress, and neurodegenerative pathologies. Reduced levels of growth hormone and IGF-1, which mediate some of the protective effects of CR, can also extend longevity and/or protect against age-related diseases in rodents and humans. However, severely restricted diets are difficult to maintain and are associated with chronically low weight and other major side effects. Here we show that 4 months of periodic protein restriction cycles (PRCs) with supplementation of nonessential amino acids in mice already displaying significant cognitive impairment and Alzheimer’s disease (AD)-like pathology reduced circulating IGF-1 levels by 30–70% and caused an 8-fold increase in IGFBP-1. Whereas PRCs did not affect the levels of β amyloid (Aβ), they decreased tau phosphorylation in the hippocampus and alleviated the age-dependent impairment in cognitive performance. These results indicate that periodic protein restriction cycles without CR can promote changes in circulating growth factors and tau phosphorylation associated with protection against age-related neuropathologies.

BackgroundA growing body of research has explored patient satisfaction as one of the healthcare quality measures. To date, scarce data are available regarding family experience in the trauma and surgical intensive care unit (TSICU). The purpose of this study was to describe and analyze the results of a family satisfaction survey in the TSICU.MethodsFamily members of patients at a level 1 trauma center were invited to participate in this study after 72 hours of intensive care unit stay. Participants completed a modified version of the Family Satisfaction in the Intensive Care Unit questionnaire, a validated survey measuring family satisfaction with care and decision-making. Data collection spanned from April 2016 to July 2017. Patient characteristics were compiled from the medical record. Quantitative analysis was performed using a 5-point Likert score, converted to a scale of 0 (poor) to 100 (excellent).ResultsThe overall response rate was 78.6%. Of the 103 family members for 88 patients, most were young (median age: 41 years) and female (75%). Language fluency was 44.6% English-only, 31.7% Spanish-only, and 23.8% bilingual. Mean summary family satisfaction scores (±SD) were 80.6±26.4 for satisfaction with care, 79.3±27.1 for satisfaction with decision-making, and 80.1±26.7 for total satisfaction. Respondents were less satisfied with the frequency of communication with physicians (70.7±27.4) and language translation (73.2±31.2).DiscussionOverall family satisfaction with the care provided to patients in the TSICU is high, although opportunities for improvement were noted in the frequency of communication between physicians and family and language translation services. Further quality improvement projects are warranted.Level of evidenceCare management study: level V.

Objective: The stimuli used to evoke otoacoustic emissions (OAEs) are typically calibrated based on the total SPL measured at the probe microphone. However, due to the acoustics of the ear-canal space (i.e., standing-wave interference), this method can underestimate the stimulus pressure reaching the tympanic membrane at certain frequencies. To mitigate this effect, stimulus calibrations based on forward pressure level (FPL) can be applied. Furthermore, the influence of ear-canal acoustics on measured OAE levels can be compensated by expressing them in emitted pressure level (EPL). To date, studies have used artificial shallow versus deep probe fits to assess the effects of calibration method on changes in probe insertion. In an attempt to better simulate a clinical setting, the combined effects of FPL calibration of stimulus level and EPL compensation of OAE level on response variability during routine (noncontrived) probe fittings were examined. Design: The distortion component of the distortion-product OAE (DPOAE) and the stimulus-frequency OAE (SFOAE) were recorded at low and moderate stimulus levels in 20 normal-hearing young-adult subjects across a five-octave range. In each subject, three different calibration approaches were compared: (1) the conventional SPL-based stimulus calibration with OAE levels expressed in SPL; (2) FPL stimulus calibration with OAEs expressed in SPL; and (3) FPL stimulus calibration with OAEs expressed in EPL. Test and retest measurements were obtained during the same session and, in a subset of subjects, several months after the initial test. The effects of these different procedures on the inter- and intra-subject variability of OAE levels were assessed across frequency and level. Results: There were no significant differences in the inter-subject variability of OAE levels across the three calibration approaches. However, there was a significant effect on OAE intra-subject variability. The FPL/EPL approach resulted in the overall lowest test-rest differences in DPOAE level for frequencies above 4 kHz, where standing-wave interference is strongest. The benefit was modest, ranging on average from 0.5 to 2 dB and was strongest at the lower stimulus level. SFOAE level variability did not show significant differences among the three procedures, perhaps due to insufficient signal-to-noise ratio and nonoptimized stimulus levels. Correlations were found between the short-term replicability of DPOAEs and the benefit derived from the FPL/EPL procedure: the more variable the DPOAE, the stronger the benefit conferred by the advanced calibration methods. Conclusions: Stimulus and response calibration procedures designed to mitigate the effects of standing-wave interference on both the stimulus and the OAE enhance the repeatability of OAE measurements and reduce their dependence on probe position, even when probe shifts are small. Modest but significant improvements in short-term test-retest repeatability were observed in the mid- to high-frequency region when using combined FPL/EPL procedures. The authors posit that the benefit will be greater in a more heterogeneous group of subjects and when different testers participate in the fitting and refitting of subjects, which is a common practice in the audiology clinic. The impact of calibration approach on OAE inter-subject variability was not significant, possibly due to a homogeneous subject population and because factors other than probe position are at play.

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Obstructive sleep apnea (OSA) is a common sleep disorder. Positive airway pressure (PAP) therapy is the first-line treatment, while its effectiveness is significantly limited by incomplete adherence in many patients. This work aims to find a predictive association between data from in-laboratory sleep studies during treatment (PAP titration polysomnogram, or PSG) and PAP adherence. Based on a PAP titration PSG database, we present a pipeline to develop a wavelet-based deep learning model and address two challenges. First, to tackle the problem of extremely long overnight PSG signals, it randomly draws segments and extracts features locally. The global representation for the entire signal is achieved by local feature P-norm pooling. Second, to tackle the problem of limited dataset size, the pre-trained EfficienNet-B7 is used as an unsupervised feature extractor to transfer ImageNet knowledge to PSG signals in the wavelet domain. The trained pipeline achieves 78% balanced accuracy and 83% AUC on the test set using airflow and frontal EEG signals, which, we believe, is a compelling result as a pilot study. Clinical relevance-Polysomnogram signals may improve clinical treatment of OSA by identifying patients with low likelihood of PAP adherence, enabling intensive efforts to improve adherence or consider alternative therapies.