Notes

By way of Their particular Eye: Healthcare Staff member Complying With Personal Protective clothing Throughout the COVID-19 Crisis.
sociated with a 25.1% increase (95% CI, 10.2%-40.1%; p = 0.001) in DF/CFICU-30. Increasing Abbreviated Injury Scale for the head was associated with decreased DF/CF-ICU-30 by analysis of variance (p < 0.001).

Nontrauma patients had higher incidence of postoperative abdominal sepsis and need for dialysis, while T was independently associated with increased delirium, perhaps because of traumatic brain injury.

Therapeutic study, level IV.
Therapeutic study, level IV.
Appropriate interfacility transfers are a key component of highly functioning trauma systems but transfer of unsalvageable patients can overburden the resources of higher-level centers. We sought to identify the occurrence and associated reasons for futile transfers within our trauma system.

Using prospectively collected data from our system database, a retrospective cohort study was conducted to identify patients who underwent interfacility transfer to our American College of Surgeons level I center. Adult patients from June 2017 to June 2019 who died, had comfort measures implemented, were discharged, or went to hospice care within 48 hours of admission without significant operation, procedure, or radiologic intervention were examined. Futility was defined as resulting in death or hospice discharge within 48 hours of transfer without major operative, endoscopic, or radiologic intervention.

A total of 1,241 patients transferred to our facility during the study period. Four hundred seven patients had a port for referral will significantly improve appropriate allocation of health care resources.

Economic; Care management, level IV.
Economic; Care management, level IV.
Despite the widespread institution of modern massive transfusion protocols with balanced blood product ratios, survival for patients with traumatic hemorrhage receiving ultramassive transfusion (UMT) (defined as ≥20 U of packed red blood cells [RBCs]) in 24 hours) remains low and resource consumption remains high. Therefore, we aimed to identify factors associated with mortality in trauma patients receiving UMT in the modern resuscitation era.

An Eastern Association for the Surgery of Trauma multicenter retrospective study of 461 trauma patients from 17 trauma centers who received ≥20 U of RBCs in 24 hours was performed (2014-2019). Multivariable logistic regression and Classification and Regression Tree analysis were used to identify clinical characteristics associated with mortality.

The 461 patients were young (median age, 35 years), male (82%), severely injured (median Injury Severity Score, 33), in shock (median shock index, 1.2; base excess, -9), and transfused a median of 29 U of RBCs, 22 U of frhoracotomy can aid in prognostication.

Prognostic, level III.
Prognostic, level III.
Normothermic machine perfusion (NMP) has become a clinically established tool to preserve livers in a near-physiological environment. However, little is known about the predictive value of perfusate parameters towards the outcomes after transplantation.

Fifty-five consecutive NMP-livers between 2018-2019 were included. All of the livers were perfused on the OrganOx metra® device according to an institutional protocol. Transplant and perfusion data were collected prospectively.

Forty-five livers were transplanted after NMP. Five livers stem from donors after circulatory death and 31 (68.9%) from extended criteria donors (ECD). Mean (SD) cold ischemia time (CIT) was 6.4 (2.3) hours; mean (SD) total preservation time 21.4 (7.1) hours. Early allograft dysfunction (EAD) occurred in 13/45 (28.9%) patients. Perfusate aspartate-aminotransferase (p=0.008), alanine-aminotransferase (p=0.006), lactate-dehydrogenase (p=0.007) and their development over time, alkaline phosphatase (p=0.013) and sodium (p=0.016) correlated with EAD. Number of perfusate platelets correlated with CIT-duration and were indicative for the occurrence of EAD. Moreover, vWF antigen was significantly higher in perfusates of EAD-livers (p<0.001) and ΔvWF antigen correlated with EAD. mTOR inhibitor While perfusate lactate and glucose had no predictive value, EAD was more likely to occur in livers with lower perfusate pH (p=0.008). ΔPerfusate AP, Δperfusate AST, Δperfusate ALT and Δperfusate LDH correlated closely with MEAF but not L-GrAFT. Bile parameters correlated with ECD and donor risk index.

Biomarker assessment during NMP may help to predict EAD after liver transplantation. The increase of transaminases and LDH over time as well as platelets and vWF antigen are important factors indicative for EAD.
Biomarker assessment during NMP may help to predict EAD after liver transplantation. The increase of transaminases and LDH over time as well as platelets and vWF antigen are important factors indicative for EAD.A significant proportion of patients with COVID-19 develop acute respiratory distress syndrome (ARDS) with high risk of death. The efficacy of veno-venous extra-corporeal membrane oxygenation (VV-ECMO) for COVID-19 on longer term outcomes, unlike in other viral pneumonias, is unknown. In this study we aimed to compare the 6-month mortality of patients receiving VV-ECMO support for COVID-19 with a historical viral ARDS cohort. Fifty-three consecutive patients with COVID-19 ARDS admitted for VV-ECMO to the Royal Brompton Hospital between 17/03/2020 and 30/05/2020 were identified. Mortality, patient characteristics, complications and ECMO parameters were then compared to a historical cohort of patients with non-COVID-19 viral pneumonia. At 6 months survival was significantly higher in the COVID-19 than in the non-COVID-19 viral pneumonia cohort (84.9% vs. 66.0%, p=0.040). Patients with COVID-19 had an increased Murray score (3.50 vs. 3.25, p=0.005), a decreased burden of organ dysfunction (SOFA score (8.76 vs. 10.42, p=0.004), an increased incidence of pulmonary embolism (69.8% vs. 24.5%, p less then 0.001) and in those who survived to decannulation longer ECMO runs (19 vs. 11 days, p=0.001). Our results suggest that survival in patients supported with EMCO for COVID-19 are at least as good as those treated for non-COVID-19 viral ARDS.Ionic polymer metal composite (IPMC) always takes big risks of electrode cracking and peeling, which lead to energy wasting, waterloss, and uneven electric field distribution, thus hamper its commercial applications. To address this issue, we propose a facile and effective technique to repair the electrode fatigue by coating polyvinylpyrrolidone (PVP) encapsulated Ag nanoparticles (PVP@AgNPs) on the long-term used IPMC surface. To improve the electrochemical stability, the silver nanoparticles (Ag NPs) with a diameter of ∼34 nm are encapsulated by a 1.3 nm thick PVP film, thus forming a shell-core structure to resist corrosion from the electrolyte solution. Physiochemical investigations reveal that, PVP@AgNPs closely attach to the interior and exterior surfaces of the original Pt nanograin electrode, thus refreshing its electronic conductivity; the repaired IPMC actuator exhibits better electromechanical properties compared to its precursor actuator 7.62 folds in displacement output, 9.38 folds in force output, and 9.
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