Food insecurity as a risk factor for obesity: A review

Obesity is considered a 21^st-century epidemic and it is a metabolic risk factor for Non-Communicable Diseases such as cardiovascular diseases, type 2 diabetes, metabolic syndrome, hypertension, some types of cancer, among others. Thus, its prevention and treatment are important public health concerns. Obesity within the context of food insecurity adds an additional layer of complexity to the current obesity epidemic. Efficient policies and interventions ought to take into consideration the effects of food insecurity on the risks of developing obesity among food insecure households. This review aims to analyze the recent available evidence around the obesity – food insecurity paradox. Most of the literature has consistently shown that there is a significant association between food insecurity and obesity, specifically in women of high-income countries. However, mechanisms explaining the paradox are still lacking. Even though researchers have tried to analyze the issue using different individual and societal variables, these studies have failed to explain the mediatory mechanisms of the food insecurity–obesity relationship since the proposed mechanisms usually lack strength or are purely theoretical. The research focus should shift from cross-sectional models to other research designs that allow the exploration of pathways and mechanisms underlying the food insecurity and obesity relationship, such as longitudinal studies, which will hopefully lead to consecutive research testing the effectiveness of different approaches and scale up such interventions into diverse contexts among those affected by obesity and the different degrees of food insecurity.

Limitations of Available Blood Products for Massive Transfusion During Mass Casualty Events at US Level 1 Trauma Centers

INTRODUCTION

Exsanguination remains a leading cause of preventable death in traumatically injured patients. To better treat hemorrhagic shock, hospitals have adopted massive transfusion protocols (MTPs) which accelerate the delivery of blood products to patients. There has been an increase in mass casualty events (MCE) worldwide over the past two decades. These events can overwhelm a responding hospital's supply of blood products. Using a computerized model, this study investigated the ability of US trauma centers (TCs) to meet the blood product requirements of MCEs.

METHODS

Cross-sectional survey data of on-hand blood products were collected from 16 US level-1 TCs. A discrete event simulation model of a TC was developed based on historic data of blood product consumption during MCEs. Each hospital's blood bank was evaluated across increasingly more demanding MCEs using modern MTPs to guide resuscitation efforts in massive transfusion (MT) patients.

RESULTS

A total of 9,000 simulations were performed on each TC's data. Under the least demanding MCE scenario, the median size MCE in which TCs failed to adequately meet blood product demand was 50 patients (IQR 20-90), considering platelets. Ten TCs exhaust their supply of platelets prior to red blood cells (RBCs) or plasma. Disregarding platelets, five TCs exhausted their supply of O- packed RBCs, six exhausted their AB plasma supply, and five had a mixed exhaustion picture.

CONCLUSION

Assuming a TC's ability to treat patients is limited only by their supply of blood products, US level-1 TCs lack the on-hand blood products required to adequately treat patients following a MCE. Use of non-traditional blood products, which have a longer shelf life, may allow TCs to better meet the blood product requirement needs of patients following larger MCEs.

Endovascular Resuscitation and Trauma Management (EVTM)-Practical Aspects and Implementation

ABSTRACT

In recent years there has been a tremendous increase in hemorrhage control by endovascular methods. Traumatic and non-traumatic hemorrhage is being more frequently managed with endografts, embolization agents, and minimal invasive methods. These methods initially were used in hemodynamically stable patients only, whereas now these are being implemented in acute settings and hemodynamically unstable patients. The strategy of using endovascular and combined open-endo methods approach for hemodynamic instability in trauma and non-trauma patients has been named EVTM- EndoVascular resuscitation and Trauma Management. The EVTM concept will be presented in this article, describing how it is developed and used, as well as its limitations and future aspects.

The Role of TEG and ROTEM in Damage Control Resuscitation

ABSTRACT

Trauma-induced coagulopathy is associated with very high mortality, and hemorrhage remains the leading preventable cause of death after injury. Directed methods to combat coagulopathy and attain hemostasis are needed. The available literature regarding viscoelastic testing, including thrombelastography (TEG) and rotational thromboelastometry (ROTEM), was reviewed to provide clinically relevant guidance for emergency resuscitation. These tests predict massive transfusion and developing coagulopathy earlier than conventional coagulation testing, within 15 min using rapid testing. They can guide resuscitation after trauma, as well. TEG and ROTEM direct early transfusion of fresh frozen plasma when clinical gestalt has not activated a massive transfusion protocol. Reaction time and clotting time via these tests can also detect clinically significant levels of direct oral anticoagulants. Slowed clot kinetics suggest the need for transfusion of fibrinogen via concentrates or cryoprecipitate. Lowered clot strength can be corrected with platelets and fibrinogen. Finally, viscoelastic tests identify fibrinolysis, a finding associated with significantly increased mortality yet one that no conventional coagulation test can reliably detect. Using these parameters, guided resuscitation begins within minutes of a patient's arrival. A growing body of evidence suggests this approach may improve survival while reducing volumes of blood products transfused.

Back to the Future: Whole Blood Resuscitation of the Severely Injured Trauma Patient

ABSTRACT

Following advances in blood typing and storage, whole blood transfusion became available for the treatment of casualties during World War I. While substantially utilized during World War II and the Korean War, whole blood transfusion declined during the Vietnam War as civilian centers transitioned to blood component therapies. Little evidence supported this shift, and recent conflicts in Iraq and Afghanistan have renewed interest in military and civilian applications of whole blood transfusion. Within the past two decades, civilian trauma centers have begun to study transfusion protocols based upon cold-stored, low anti-A/B titer type O whole blood for the treatment of severely injured civilian trauma patients. Early data suggests equivalent or improved resuscitation and hemostatic markers with whole blood transfusion when compared to balanced blood component therapy. Additional studies are taking place to define the optimal way to utilize low-titer type O whole blood in both prehospital and trauma center resuscitation of bleeding patients.

Acute abdomen in the immunocompromised patient: WSES, SIS-E, WSIS, AAST, and GAIS guidelines

Immunocompromised patients are a heterogeneous and diffuse category frequently presenting to the emergency department with acute surgical diseases. Diagnosis and treatment in immunocompromised patients are often complex and must be multidisciplinary. Misdiagnosis of an acute surgical disease may be followed by increased morbidity and mortality. Delayed diagnosis and treatment of surgical disease occur; these patients may seek medical assistance late because their symptoms are often ambiguous. Also, they develop unique surgical problems that do not affect the general population. Management of this population must be multidisciplinary.This paper presents the World Society of Emergency Surgery (WSES), Surgical Infection Society Europe (SIS-E), World Surgical Infection Society (WSIS), American Association for the Surgery of Trauma (AAST), and Global Alliance for Infection in Surgery (GAIS) joined guidelines about the management of acute abdomen in immunocompromised patients.

COVID-19 the showdown for mass casualty preparedness and management: the Cassandra Syndrome

Since December 2019, the world is potentially facing one of the most difficult infectious situations of the last decades. COVID-19 epidemic warrants consideration as a mass casualty incident (MCI) of the highest nature. An optimal MCI/disaster management should consider all four phases of the so-called disaster cycle: mitigation, planning, response, and recovery. COVID-19 outbreak has demonstrated the worldwide unpreparedness to face a global MCI.

This present paper thus represents a call for action to solicitate governments and the Global Community to actively start effective plans to promote and improve MCI management preparedness in general, and with an obvious current focus on COVID-19.

Liver trauma: WSES 2020 guidelines

Liver injuries represent one of the most frequent life-threatening injuries in trauma patients. In determining the optimal management strategy, the anatomic injury, the hemodynamic status, and the associated injuries should be taken into consideration. Liver trauma approach may require non-operative or operative management with the intent to restore the homeostasis and the normal physiology. The management of liver trauma should be multidisciplinary including trauma surgeons, interventional radiologists, and emergency and ICU physicians. The aim of this paper is to present the World Society of Emergency Surgery (WSES) liver trauma management guidelines.

Kidney and uro-trauma: WSES-AAST guidelines

Renal and urogenital injuries occur in approximately 10-20% of abdominal trauma in adults and children. Optimal management should take into consideration the anatomic injury, the hemodynamic status, and the associated injuries. The management of urogenital trauma aims to restore homeostasis and normal physiology especially in pediatric patients where non-operative management is considered the gold standard. As with all traumatic conditions, the management of urogenital trauma should be multidisciplinary including urologists, interventional radiologists, and trauma surgeons, as well as emergency and ICU physicians. The aim of this paper is to present the World Society of Emergency Surgery (WSES) and the American Association for the Surgery of Trauma (AAST) kidney and urogenital trauma management guidelines.

Crystal structure of poly[bis-(ammonium) [bis-(μ4-benzene-1,3,5-tri-carboxyl-ato)dizincate] 1-methyl-pyrrolidin-2-one disolvate]

The title three-dimensional metal-organic framework (MOF) compound, {(NH4)2[Zn2(C9H3O6)2]·2C5H9NO} n , features an anionic framework constructed from Zn(2+) cations and benzene-1,3,5-tri-carboxyl-ate (BTC) organic anions. Charge balance is achieved by outer sphere ammonium cations formed by degradation of di-n-butyl-amine in the solvothermal synthesis of the compound. Binuclear {Zn2(COO)2} entities act as the framework's secondary building units. Each Zn(II) atom has a tetrahedral coordination environment with an O4 set of donor atoms. The three-dimensional framework adopts a rutile-type topology and channels are filled in an alternating fashion with ordered and disordered 1-methyl-pyrrolidin-2-one solvent mol-ecules and ammonium cations. The latter are held in the channels via four N-H⋯O hydrogen bonds, including three with the benzene-1,3,5-tri-carboxyl-ate ligands of the anionic framework and one with a 1-methyl-pyrrolidin-2-one solvent mol-ecule.

Crystal structure of a polymeric calcium levulinate dihydrate: catena-poly[[di-aqua-calcium]-bis-(μ2-4-oxo-butano-ato)]

The crystal structure of calcium levulinate dihydrate forms a one-dimensional coordination polymer based on a CaO₈ complex unit which lies on a twofold rotation axis. This unit comprises two monodentate water O-atom donors and six carboxyl­ate O-atom donors, two of which are also bridging, from the two bidentate chelate levulinate ligands. The complex chains are stabilized by intra- and inter­molecular water O—H⋯O hydrogen bonds, forming an overall three-dimensional structure.

In the title calcium levulinate complex, [Ca(C₅H₇O₃)₂(H₂O)₂]_n, the Ca²⁺ ion lies on a twofold rotation axis and is octa­coordinated by two aqua ligands and six O atoms from four symmetry-related carboxyl­ate ligands, giving a distorted square-anti­prismatic coordination stereochemistry [Ca—O bond-length range = 2.355 (1)–2.599 (1) Å]. The levulinate ligands act both in a bidentate carboxyl O,O′-chelate mode and in a bridging mode through one carboxyl O atom with an inversion-related Ca²⁺ atom, giving a Ca⋯Ca separation of 4.0326 (7) Å. A coordination polymeric chain structure is generated, extending along the c-axial direction. The coordinating water mol­ecules act as double donors and participate in intra-chain O—H⋯O hydrogen bonds with carboxyl O atoms, and in inter-chain O—H⋯O hydrogen bonds with carbonyl O atoms, thus forming an overall three-dimensional structure.

Bayesian Variable Selection in Linear Regression in One Pass for Large Data Sets

Bayesian models are generally computed with Markov Chain Monte Carlo (MCMC) methods. The main disadvantage about MCMC methods is the large number of iterations they need to sample the posterior distributions of model parameters, especially for large data sets. On the other hand, variable selection remains a challenging problem due to its combinatorial search space, where Bayesian models are a promising solution. In this work, we study how to accelerate Bayesian model computation for variable selection in linear regression. We propose a fast Gibbs sampler algorithm, a widely used MCMC method, that incorporates several optimizations. We use non-informative and conjugate prior distributions on several model parameters, which enable data set summarization in one pass exploiting an augmented set of sufficient statistics. Thereafter the algorithm can iterate in main memory. Sufficient statistics are indexed with a sparse binary vector to efficiently compute matrix projections based on selected variables. Discovered variable subsets probabilities, selecting and discarding each variable, are stored on a hash table for fast retrieval in future iterations. We study how to integrate our algorithm into a database management system (DBMS), exploiting aggregate User-Defined Functions for parallel data summarization and stored procedures to manipulate matrices with arrays. An experimental evaluation with real data sets evaluates accuracy and time performance, comparing our DBMS-based algorithm, with the R package. Our algorithm is shown to produce accurate results, scale linearly on data set size and run orders of magnitude faster than the R package.

Crystal structure of 1,3-dimethyl-3-phenyl-pyrrolidine-2,5-dione: a clinically used anti-convulsant

In the title compound, C12H13NO2, the five-membered ring has an envelope conformation; the disubstituted C atom lies out of the mean plane through the four other ring atoms (r.m.s. deviation = 0.0038 Å) by 0.1877 (18) Å. The plane of the phenyl substituent is practically perpendicular to that of the planar part of the five-membered ring, with a dihedral angle of 87.01 (5)°. In the crystal, mol-ecules are linked by weak C-H⋯O hydrogen bonds, forming inversion dimers. The dimers are linked by further C-H⋯O hydrogen bonds, as well as carbon-yl-carbonyl attractive inter-actions [O⋯C = 3.2879 (19) Å], forming a three-dimensional framework structure.

Integrating multi-platform genomic data using hierarchical Bayesian relevance vector machines

Background

Recent advances in genome technologies and the subsequent collection of genomic information at various molecular resolutions hold promise to accelerate the discovery of new therapeutic targets. A critical step in achieving these goals is to develop efficient clinical prediction models that integrate these diverse sources of high-throughput data. This step is challenging due to the presence of high-dimensionality and complex interactions in the data. For predicting relevant clinical outcomes, we propose a flexible statistical machine learning approach that acknowledges and models the interaction between platform-specific measurements through nonlinear kernel machines and borrows information within and between platforms through a hierarchical Bayesian framework. Our model has parameters with direct interpretations in terms of the effects of platforms and data interactions within and across platforms. The parameter estimation algorithm in our model uses a computationally efficient variational Bayes approach that scales well to large high-throughput datasets.

Results

We apply our methods of integrating gene/mRNA expression and microRNA profiles for predicting patient survival times to The Cancer Genome Atlas (TCGA) based glioblastoma multiforme (GBM) dataset. In terms of prediction accuracy, we show that our non-linear and interaction-based integrative methods perform better than linear alternatives and non-integrative methods that do not account for interactions between the platforms. We also find several prognostic mRNAs and microRNAs that are related to tumor invasion and are known to drive tumor metastasis and severe inflammatory response in GBM. In addition, our analysis reveals several interesting mRNA and microRNA interactions that have known implications in the etiology of GBM.

Conclusions

Our approach gains its flexibility and power by modeling the non-linear interaction structures between and within the platforms. Our framework is a useful tool for biomedical researchers, since clinical prediction using multi-platform genomic information is an important step towards personalized treatment of many cancers. We have a freely available software at: http://odin.mdacc.tmc.edu/~vbaladan.

2013 WSES guidelines for management of intra-abdominal infections

Despite advances in diagnosis, surgery, and antimicrobial therapy, mortality rates associated with complicated intra-abdominal infections remain exceedingly high.The 2013 update of the World Society of Emergency Surgery (WSES) guidelines for the management of intra-abdominal infections contains evidence-based recommendations for management of patients with intra-abdominal infections.

Complicated intra-abdominal infections in a worldwide context: an observational prospective study (CIAOW Study)

Despite advances in diagnosis, surgery, and antimicrobial therapy, mortality rates associated with complicated intra-abdominal infections remain exceedingly high. The World Society of Emergency Surgery (WSES) has designed the CIAOW study in order to describe the clinical, microbiological, and management-related profiles of both community- and healthcare-acquired complicated intra-abdominal infections in a worldwide context. The CIAOW study (Complicated Intra-Abdominal infection Observational Worldwide Study) is a multicenter observational study currently underway in 57 medical institutions worldwide. The study includes patients undergoing surgery or interventional drainage to address complicated intra-abdominal infections. This preliminary report includes all data from almost the first two months of the six-month study period. Patients who met inclusion criteria with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs) were included in the study. 702 patients with a mean age of 49.2 years (range 18–98) were enrolled in the study. 272 patients (38.7%) were women and 430 (62.3%) were men. Among these patients, 615 (87.6%) were affected by community-acquired IAIs while the remaining 87 (12.4%) suffered from healthcare-associated infections. Generalized peritonitis was observed in 304 patients (43.3%), whereas localized peritonitis or abscesses was registered in 398 (57.7%) patients.

The overall mortality rate was 10.1% (71/702). The final results of the CIAOW Study will be published following the conclusion of the study period in March 2013.

Evaluating statistical tests on OLAP cubes to compare degree of disease

Statistical tests represent an important technique used to formulate and validate hypotheses on a dataset. They are particularly useful in the medical domain, where hypotheses link disease with medical measurements, risk factors, and treatment. In this paper, we propose to compute parametric statistical tests treating patient records as elements in a multidimensional cube. We introduce a technique that combines dimension lattice traversal and statistical tests to discover significant differences in the degree of disease within pairs of patient groups. In order to understand a cause-effect relationship, we focus on patient group pairs differing in one dimension. We introduce several optimizations to prune the search space, to discover significant group pairs, and to summarize results. We present experiments showing important medical findings and evaluating scalability with medical datasets.

Association rule discovery with the train and test approach for heart disease prediction

Association rules represent a promising technique to improve heart disease prediction. Unfortunately, when association rules are applied on a medical data set, they produce an extremely large number of rules. Most of such rules are medically irrelevant and the time required to find them can be impractical. A more important issue is that, in general, association rules are mined on the entire data set without validation on an independent sample. To solve these limitations, we introduce an algorithm that uses search constraints to reduce the number of rules, searches for association rules on a training set, and finally validates them on an independent test set. The medical significance of discovered rules is evaluated with support, confidence, and lift. Association rules are applied on a real data set containing medical records of patients with heart disease. In medical terms, association rules relate heart perfusion measurements and risk factors to the degree of disease in four specific arteries. Search constraints and test set validation significantly reduce the number of association rules and produce a set of rules with high predictive accuracy. We exhibit important rules with high confidence, high lift, or both, that remain valid on the test set on several runs. These rules represent valuable medical knowledge.

Time-correlated soliton tunneling in charge and spin density waves

We consider a model in which an electric field induces quantum nucleation of kink-antikink pairs in a pinned charge or spin density wave. Pair nucleation events, prevented by Coulomb blockade below a pair creation threshold, become correlated in time above threshold. The model provides a natural explanation for the observed (i) small density wave polarization below threshold in NbSe (3), (ii) narrow band noise, (iii) coherent oscillations, and (iv) mode-locking at high drift frequencies.

SIV infection of monkey spleen cells including follicular dendritic cells in different stages of disease

Immunoaffinity enriched spleen follicular dendritic cells (FDCs), lymphocytes, and macrophages from SIVsm-inoculated cynomolgus monkeys (Macaca fascicularis) at different stages of disease were compared for latent and productive SIV infection. Analysis of FDCs by in situ hybridization, electron microscopy, and coculture assays indicated that comparatively high levels of virus were associated with the FDC fraction. Polymerase chain reaction (PCR) and RT-PCR results revealed that the levels for SIVpol DNA did not correlate with the level of env mRNA in the various cell subsets, suggesting differences in latency. Limiting dilution assays for spliced env mRNA showed a 10-100-fold higher amount of env mRNA in FDCs than in other spleen cell subsets early during SIV infection. At late stages of disease, the number of productively infected FDCs significantly decreased in parallel with a marked reduction of the FDC network and follicular involution. Our findings indicate that destruction of FDCs probably reflects a cytopathic effect of SIV and/or the activity of specific antiviral cytotoxic T lymphocytes.

Heterogeneity of spindle cells in Kaposi's sarcoma: comparison of cells in lesions and in culture

The immunophenotype of spindle cells in epidemic, endemic, and classic (sporadic) Kaposi's sarcoma (KS) lesions was defined by the demonstration of various cell markers and compared with that of KS-derived cell lines. No significant histological or immunophenotypic differences were observed between the three clinical types of KS at comparable stages. The spindle-cell compartment of the different KS types was composed predominantly of a mixture of proliferating CD45+/CD68+ bone-marrow-derived monocytes and TE7+/collagen+ fibroblastic cells with varying expression of EN4/PAL-E/CD31/CD34/CD36 endothelial-associated antigens and/or smooth-muscle-specific alpha-actin (alpha-actin). The latter cells appeared to represent transitional forms of fibroendothelial and fibromyocytic cells. The in vitro cultured KS-derived cell lines (KS-3, KS-6, and KS-8) expressed the fibroblastic antigen TE7 and smooth-muscle-specific alpha-actin but not leukocytic or endothelial-associated antigens consistent with the phenotype of fibromyoid spindle cells of primary lesions. Neither HIV antigen nor provirus DNA was demonstrable in the epidemic KS lesions. The observed heterogeneity of the spindle-cell compartment further substantiates the view that Kaposi's sarcoma, irrespective of clinical setting, expresses salient features more compatible with reactive, tumor-like lesion than clonal sarcoma.

Evidence for protein tyrosine kinase involvement in CD6-induced T cell proliferation

Several studies have demonstrated that addition of soluble anti-CD6 mAbs to 12-O-tetradecanoylphorbol 13-acetate (TPA)-treated naive T cells can induce cell proliferation. We showed in the present study that cell proliferation in TPA-treated T cell cultures can be enhanced several fold when the anti-CD6 mAbs are either immobilized or crosslinked with rabbit anti-mouse immunoglobulins (RAM Ig). Using a src family protein tyrosine kinase (PTK) inhibitor, herbimycin A, the cell proliferation induced by the anti-CD6 mAb, IOR-T1, in TPA-treated T cells were effectively abolished. Analysis of the cellular proteins in these cells after crosslinking the CD6 receptor with IOR-T1 (followed by RAM Ig) in the presence of TPA resulted in an increased level of tyrosine phosphorylation. Pretreatment of native T cells with herbimycin A (0.5 and 1 microgram/ml) for 18 hr completely inhibited the tyrosine phosphorylation on cellular substrates in T cell cultures stimulated with IOR-T1/RAM Ig and TPA. Similar concentrations of herbimycin A also inhibited the increase in IL-2 mRNA expression and cell proliferation in T cell cultures after IOR-T1/RAM Ig and TPA treatment. Furthermore, the increase in cytosolic free Ca2+ concentration in naive T cells after crosslinking of the CD6 receptor with IOR-T1/RAM Ig was also inhibited by herbimycin A. Taken together, our results suggest that CD6-mediated T cell proliferation is IL-2 dependent, and involves tyrosine kinase activity which is strictly dependent on protein kinase C activation.