Interest of the MGAP score on in-hospital trauma patients: Comparison with TRISS, ISS and NISS scores

Trauma scoring systems were created to predict mortality and enhance triage capabilities. However, efficacy of scoring systems to predict mortality and accuracy of originally reported severity thresholds remains uncertain. A single-center, retrospective study was conducted at University of Virginia (UVA), an American College of Surgeons verified Level I trauma center. We compared four scoring systems: MGAP (Mechanism, Glasgow Coma Scale, Age, and arterial pressure), Injury Severity Score (ISS), New Injury Severity Score (NISS), and Trauma Related Injury Severity Score (TRISS) to predict in-hospital mortality and disposition from the emergency department to higher acuity level of care including mortality (i.e. operating room, intensive care unit, morgue) versus standard floor admission using area under the curve (AUC) for receiver operating characteristic analysis. Second, we examined sensitivity of these scores at standard thresholds to determine if adjustments were needed to minimize under-triage (sensitivity ≥95%). TRISS was the best predictor of mortality in a cohort of n = 16,265 with AUC of 0.920 (95% CI: 0.911-0.929, p<0.0001), followed by MGAP with AUC of 0.900 (95% CI: 0.889-0.911, p<0.0001), and finally ISS and NISS (0.830 (95% CI: 0.814-0.847) and 0.827 (95% CI: 0.809-0.844) respectively). NISS was the best predictor of high acuity disposition with an AUC of 0.729 (95% CI: 0.721-0.736, p<0.0001), followed by ISS with AUC of 0.714 (95% CI: 0.707-0.722, p<0.0001), and finally TRISS and MGAP (0.673 (95% CI: 0.665-0.682) and 0.613 (95% CI: 0.604-0.621) respectively (p<0.0001). At historic thresholds, no scoring system displayed adequate sensitivity to predict mortality, with values ranging from 73% for ISS to 80% for NISS. In conclusion, in the reported study cohort, TRISS was the best predictor of mortality while NISS was the best predictor of high acuity disposition. We also stress updating scoring system thresholds to achieve ideal sensitivity, and investigating how scoring systems derived to predict mortality perform when predicting indicators of morbidity such as disposition from the emergency department.

Autoantibodies to red blood cell surface Glycophorin A impact the activation poise of circulating leukocytes

BACKGROUND

Both M and N alleles encode antigens on Glycophorin A (GPA), a red blood cell (RBC) surface sialoglycoprotein. Interaction between RBC GPA and leukocyte surface lectins may downregulate their activation. The current study investigates if RBC autoantibodies against GPA, such as auto-anti-M/N, prime an activated phenotype in peripheral blood leukocytes.

METHODS

Leukocyte activation was assessed in whole blood from patients with auto-anti-GPA (anti-M/N) and compared to those with allo-anti-M/N and healthy subjects. Control samples from healthy subjects with no antibodies incubated in vitro with either anti-GPA or anti-Rh were analyzed for neutrophil and monocyte surface activation marker expression, reactive oxygen species (ROS) content, and formation of aggregates with RBCs. Samples incubated with an IgG₁ isotype antibody served as controls.

RESULTS

Ex vivo, neutrophil CD66b and monocyte CD63 surface expression was increased in patients with auto-anti-M/N compared to those with allo anti-M/N (p = .1757; p = .0698) and to healthy subjects (p = .0186; p = .013). In vitro, neutrophil CD66b and monocyte CD63 surface expression was increased following incubation with anti-GPA compared to anti-Rh (p = .0003; p = .0328) and isotype control (p = .000; p = .0062). Intracellular ROS content increased in both neutrophils and monocytes incubated with anti-GPA compared to anti-Rh (p = .0012; p = .0693) and isotype control (p = .001; p = .0021). Percentage of neutrophil-RBC aggregates was decreased when incubated with anti-GPA compared to isotype control (p < .01).

CONCLUSIONS

Neutrophils and monocytes in peripheral blood exposed to an antibody directed against GPA on RBC surfaces, such as M or N antigens, may be primed towards an activated phenotype.

Fabrication of Tobacco Mosaic Virus-Like Nanorods for Peptide Display

Virus-like particles (VLPs) are genome-free protein shells assembled from virus coat proteins (CPs). The uniform and nanoscale structure of VLPs combined with their noninfectious nature have made them ideal candidates for the display of functional peptides. While the vast majority of VLPs are derived from spherical viruses, tobacco mosaic virus (TMV) produces a rod-shaped particle with a hollow central channel. However, under physiological conditions the TMV CP forms only disk-shaped macromolecules. Here, we describe the design, construction, purification, and processing of rod-shaped TMV-VLPs using a simple bacterial expression system. The robust nature of this system allows for the display of functional peptides and molecules on the outer surface of this novel VLP.

Diagnosing comorbidity in substance abusers: a comparison of the test-retest reliability of two interviews

This study examines the test-retest reliability of two interview schedules (computer- and clinician-administered) in diagnosing lifetime comorbidity in treated substance abusers. The Computerized Diagnostic Interview Schedule (C-DIS) and the Structured Clinical Interview for DSM-III-R (SCID) were both administered to 173 substance abusers after random assignment to one of two groups. Within 1 to 2 weeks, subjects in the first group repeated the C-DIS and subjects in the second group were reinterviewed by a different clinician, blind to the results of the initial SCID. Both instruments showed good to excellent reliability for DSM-III-R psychoactive substance use disorders with kappas ranging from .50 to .89 for individual disorders. However, the reliability of comorbid other mental disorders was substantially poorer on both instruments, particularly the SCID. C-DIS kappas ranged from -.05 for generalized anxiety to .70 for simple phobia. SCID kappas ranged from .31 for panic disorder to .83 for antisocial personality disorder. Anxiety disorders as a category, some phobic disorders, and antisocial personality disorder showed acceptable levels of test-retest reliability on both instruments. There was a trend for borderline or threshold cases to account for some of the disagreement on the C-DIS. Differences of opinion between clinicians on organicity accounted for some of the disagreements on panic disorder and major depression. The C-DIS, unlike the SCID, tended to diagnose more disorders at initial interview, perhaps a result of its tedious probe structure. Neither instrument should be administered only once to provide a reliable lifetime diagnostic profile of comorbidity in substance abusers.

Diagnosing comorbidity in substance abusers. Computer assessment and clinical validation

This study compares DSM-III-R lifetime diagnoses assigned to a sample of substance abusers in treatment made by the Computerized Diagnostic Interview Schedule (C-DIS) with those made by clinicians on the basis of the Structured Clinical Interview for DSM-III-R (SCID) and patient chart information. A sample of 173 subjects were interviewed with the C-DIS and then by a clinician using the SCID. A second SCID was administered by a different clinician to 80 of the subjects 1 to 2 weeks later and consensus diagnoses were then made using all available information. With the exception of antisocial personality disorder and most psychoactive substance use disorders, the initial C-DIS showed poor diagnostic agreement with the initial SCID. As a potential screening instrument, the C-DIS did identify 30 of the 32 subjects with a consensus axis I (nondrug) disorder, but diagnosed twice as many positives as were confirmed by the consensus diagnoses. A negative C-DIS for comorbid disorders was confirmed in 9 out of 10 cases by clinicians.

Controlled drinking--disease concept controversy: suggestions for synthesis

The disease concept of alcoholism is presented as a variant of the personality model of behaviour, while the controlled drinking studies are manifestations of the situational approach to the study of behaviour. It is suggested that the current controversy concerning the feasibility and advisability of using controlled drinking as a treatment goal and as an alternative to abstinence is the result of limitations of the two theoretical models. An interactional model of behaviour which could encompass both positions and provide direction for future effort is outlined.