Agricultural Youth Injuries: A Review of 2015-2017 Cases from U.S. News Media Reports

Background: The hazardous nature of the agricultural environment, reflected in the numerous injuries and deaths to children who live, work and play on farms, coupled with the lack of a comprehensive national surveillance system in the United States, highlights the need for making the best use of publicly available youth agricultural injury data.

Objective: The purpose of this study was to describe a 3-year collection of youth agricultural injuries using the publicly available injury and fatality data from AgInjuryNews.org and present recommendations for future injury prevention strategies.

Methods: Data were obtained from AgInjuryNews.org, a web-based collection of U.S. news reports of agricultural injuries. We analyzed cases from 2015 to 2017 for youth aged 0–17. We classified injuries as occupational and non-occupational related, based on the Farm and Agricultural Injury Classification (FAIC) code. Each case was also coded for source and event using the Occupational Injury and Illness Classification System (OIICS).

Results: Of the 348 injury reports reviewed, 51% were fatal, and about one-third of the victims were 6 years old or younger. Most injuries were non-occupational, and the most frequent injury sources were vehicles (includes tractors and all-terrain vehicles) and machinery. Youth operators, extra riders, roadway operations, and unsupervised youth playing near or in a worksite were four key contributing factors associated with vehicle and machinery related injuries.

Conclusions: This study reaffirms that youth agricultural-related injuries and fatalities are still a persistent problem in the United States. The hypothesis generating AgInjuryNews system can provide more current data than traditional surveillance datasets as a tool for understanding the sources of youth agricultural injuries, monitoring injury trends, and informing policy efforts and prevention strategies. Future studies should continue to explore and evaluate the comprehensiveness of this system’s data and the impact of its dissemination, as well as similar rural health informatics solutions for integration into sustainable interventions that can be customized and delivered domestically and abroad.     

Videoassistierte Patientenaufklärung in der Anästhesiologie

In video-assisted patient education (ViPa), patients watch an educational video about the process and the risks of anaesthesia in addition to the preanaesthetic interview with the anaesthesiologist. Used as a supplement to the preanaesthetic visit, the videos can increase patients' knowledge and satisfaction without having any negative effect on perioperative anxiety. Because the video graphically depicts the basic information, the preanaesthetic visit can then focus on specific aspects of the individual patient, i.e. high anxiety or specific questions. The redundant and monotonous explanations about the procedures and risks of anaesthesia by the interviewing anaesthesiologist are partly replaced by the video, but for medico-legal reasons the ViPa cannot totally replace the preanesthetic interview. It can be used in pediatric anaesthesia and reduces parental anxiety. Because of the lack of studies, the effects of the ViPa on perioperative patient compliance, especially for outpatient surgery, and on the economics of anaesthesia clinics are unclear.     

First screening of Aedes albopictus immunogenic salivary proteins

Study of the human antibody (Ab) response to Aedes salivary proteins can provide new biomarkers to evaluate human exposure to vector bites. The identification of genus‐ and/or species‐specific proteins is necessary to improve the accuracy of biomarkers. We analysed Aedes albopictus immunogenic salivary proteins by 2D immunoproteomic technology and compared the profiles according to human individual exposure to Ae. albopictus or Ae. aegypti bites. Strong antigenicity to Ae. albopictus salivary proteins was detected in all individuals whatever the nature of Aedes exposure. Amongst these antigenic proteins, 68% are involved in blood feeding, including D7 protein family, adenosine deaminase, serpin and apyrase. This study provides an insight into the repertoire of Ae. albopictus immunogenic salivary proteins for the first time.     

Resting-State Functional Connectivity in Patients with Long-Term Remission of Cushing's Disease

Glucocorticoid disturbance can be a cause of psychiatric symptoms. Cushing''s disease represents a unique model for examining the effects of prolonged exposure to high levels of endogenous cortisol on the human brain as well as for examining the relation between these effects and psychiatric symptomatology. This study aimed to investigate resting-state functional connectivity (RSFC) of the limbic network, the default mode network (DMN), and the executive control network in patients with long-term remission of Cushing''s disease. RSFC of these three networks of interest was compared between patients in remission of Cushing''s disease (n=24; 4 male, mean age=44.96 years) and matched healthy controls (n=24; 4 male, mean age=46.5 years), using probabilistic independent component analysis to extract the networks and a dual regression method to compare both groups. Psychological and cognitive functioning was assessed with validated questionnaires and interviews. In comparison with controls, patients with remission of Cushing''s disease showed an increased RSFC between the limbic network and the subgenual subregion of the anterior cingulate cortex (ACC) as well as an increased RSFC of the DMN in the left lateral occipital cortex. However, these findings were not associated with psychiatric symptoms in the patient group. Our data indicate that previous exposure to hypercortisolism is related to persisting changes in brain function.     

Cooperative subunit interactions within the oligomeric envelope glycoprotein of HIV-1: functional complementation of specific defects in gp120 and gp41

The envelope glycoprotein (Env) of HIV-1 is displayed on the surface of the virion or infected cell as an oligomer of multiple gp120/gp41 complexes. We sought to unravel the relationships between this oligomeric structure and the requirements for sequential interactions with CD4 and coreceptor (CCR5 or CXCR4). We used a quantitative cell fusion assay to examine the effects of coexpressing pairs of Envs, each nonfunctional because of a specific defect in one of the essential properties. We observed efficient fusion activity upon coexpression of two Env variants, one containing a gp41 subunit with a mutated fusion peptide and the other containing a gp120 subunit with a mutated CD4 binding site or a mismatched coreceptor specificity. We also observed fusion upon coexpression of two Env variants with distinct gp120 defects, i.e., a CD4 binding site mutation and the incorrect coreceptor specificity determinants. Coimmunoprecipitation experiments verified the efficient formation of mixed oligomers, suggesting that the observed fusion reflected subunit complementation within the oligomeric complex. These results support a model in which cooperative subunit interactions within the Env oligomer result in concerted conformational changes upon receptor binding, resulting in activation for fusion. The implications of these findings for Env function and virus neutralization are discussed.     

Perioperative goal-directed hemodynamic therapy based on radial arterial pulse pressure variation and continuous cardiac index trending reduces postoperative complications after major abdominal surgery: a multi-center,prospective, randomized study

Introduction

Several single-center studies and meta-analyses have shown that perioperative goal-directed therapy may significantly improve outcomes in general surgical patients. We hypothesized that using a treatment algorithm based on pulse pressure variation, cardiac index trending by radial artery pulse contour analysis, and mean arterial pressure in a study group (SG), would result in reduced complications, reduced length of hospital stay and quicker return of bowel movement postoperatively in abdominal surgical patients, when compared to a control group (CG).

Methods

160 patients undergoing elective major abdominal surgery were randomized to the SG (79 patients) or to the CG (81 patients). In the SG hemodynamic therapy was guided by pulse pressure variation, cardiac index trending and mean arterial pressure. In the CG hemodynamic therapy was performed at the discretion of the treating anesthesiologist. Outcome data were recorded up to 28 days postoperatively.

Results

The total number of complications was significantly lower in the SG (72 vs. 52 complications, p = 0.038). In particular, infection complications were significantly reduced (SG: 13 vs. CG: 26 complications, p = 0.023). There were no significant differences between the two groups for return of bowel movement (SG: 3 vs. CG: 2 days postoperatively, p = 0.316), duration of post anesthesia care unit stay (SG: 180 vs. CG: 180 minutes, p = 0.516) or length of hospital stay (SG: 11 vs. CG: 10 days, p = 0.929).

Conclusions

This multi-center study demonstrates that hemodynamic goal-directed therapy using pulse pressure variation, cardiac index trending and mean arterial pressure as the key parameters leads to a decrease in postoperative complications in patients undergoing major abdominal surgery.

Trial registration

ClinicalTrial.gov, {"type":"clinical-trial","attrs":{"text":"NCT01401283","term_id":"NCT01401283"}}NCT01401283.     

Prospective multicenter phase II study of irinotecan as third-line therapy in metastatic colorectal cancer and progression after bolus and infusional 5-fluorouracil

Irinotecan has proven anti-tumor activity as induction treatment in combination with 5-fluorouracil (5-FU) or as second-line treatment after 5-FU in patients with metastatic colorectal cancer. The aim of the present phase II study was to evaluate irinotecan as third-line chemotherapy in patients with colorectal cancer after sequential treatment with bolus 5-FU followed by an infusional 5-FU regimen. Patients pretreated with bolus 5-FU/folinic acid and the infusional 5-FU/folinic acid regimen were treated with 350 mg/m irinotecan i.v. once every 3 weeks in a multicenter phase II study. Tumor size was measured every cycle and treatment with irinotecan was continued until the occurrence of progressive disease or unacceptable toxicity. A total of 50 pretreated patients were included. Of the 45 evaluable patients, 13.3% [n=6, 95% confidence interval (CI) 5.1-26.8] attained a response (complete/partial response) to treatment lasting 5.6 months (95% CI 4.2-6.3) and in four patients response has been confirmed (8.9%, 95% CI 2.5-21.2). Disease stabilization was noted in 51.1% of the patients (n=23, 95% CI 35.8-66.3). The median duration of response/disease stabilization was 4.2 months (95% CI 3.2-6.0). Median overall survival was 7.9 months (95% CI 6.1-11.1), corresponding to a calculated 1-year survival of 28.3% (95% CI 15.2-41.3). Severe neutropenia occurred in 14% (n=7) and anemia grade III in 6% of the patients (n=3). The most frequent non-hematological toxicity grade III/IV related to treatment was diarrhea in 24% of the patients (n=12), followed by vomiting in 8% (n=4) and constipation as well as infection in two patients each (4%) (evaluable n=50). We conclude single-agent irinotecan is an effective and well-tolerable treatment in pretreated patients with metastatic colorectal cancer after failure of bolus and infusional 5-FU/folinic acid regimens. Elderly patients had the same probability to respond.