Innate Immune Activation After Transfusion of Stored Red Blood Cells

The transfusion of red blood cells (RBCs), although necessary for treatment of anemia and blood loss, has also been linked to increased morbidity and mortality. RBCs stored for longer durations and transfused in larger volumes are often cited as contributory to adverse outcomes. The potential mechanisms underlying deleterious effects of RBC transfusion are just beginning to be elucidated. In this narrative review, we explore the hypothesis that prolonged RBC storage results in elaboration of substances which may function as danger associated molecular pattern molecules that activate the innate immune system with consequences unfavorable to healthy homeostasis. The nature of these chemical mediators and the biological responses to them offers insight into the mechanisms of these pathological responses. Three major areas of activation of the innate immune apparatus by stored RBCs have been tentatively identified: RBC hemolysis, recipient neutrophil priming, and reactive oxygen species production. The possible mechanisms by which each might perturb the innate immune response are reviewed in a search for potential novel pathways through which transfusion can lead to an altered inflammatory response.     

Using handheld computers for daily alcohol assessment: Results from a pilot study

Aims: The purpose of this pilot study was to determine the feasibility and usability of daily retrospective assessments of alcohol use using handheld computers and to explore their comparability to Timeline Followback (TLFB) assessments.

Methods: College student participants received a Handheld Assessment Tool (HAT) at enrolment, which surveyed alcohol consumption and contextual factors for the previous day. After 1 week of daily monitoring, participants completed a paper‐and‐pencil TLFB assessment and HAT usability scale.

Results: Of the 1,800 matched data points on the HAT and TLFB, the overall level of agreement was very good (kappa = 0.80, p<0.001). The mean difference between the number of drinks per drinking days recorded using both methods was 0.19 (SD = 0.56). Participants completed HAT surveys on 87 out of 91 total possible survey days (95.6%). The HAT recorded 34 drinking days and the TLFB recorded 37 out the 91 possible days; the HAT was reported to be highly usable by all participants.

Conclusion: Overall, the HAT was found to be usable and feasible and produced high adherence. Further research should validate this alcohol assessment approach and apply it to representative populations.     

Automated generation of curved planar reformations from volume data: method and evaluation

The authors developed and evaluated a method to automatically create interactive vascular curved planar reformations with computed tomographic (CT) angiographic data. The method decreased user interaction time by 86%, from 15 to 2 minutes. Expert reviewers were asked to indicate their confidence in differentiating automatically created images from clinical-quality manually produced images. The area under the receiver operating characteristic curve was 0.45 (95% CI: 0.39, 0.51), and a test of equivalency indicated that reviewers could not distinguish between images. They also graded image quality as equivalent to that with manual methods and found fewer artifacts on automatically created images. Automatic methods rapidly produce curved planar reformations of equivalent quality with reduced time and effort.     

Effect of Posterior Tracheopexy on Risk of Recurrence in Children after Recurrent Tracheo-Esophageal Fistula Repair

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Patterns of Use of Induction Therapy for T2N0 Esophageal Cancer

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The Impact of Comprehensive Care for Joint Replacement Bundled Payment Program on Care Delivery

Background

Comprehensive Care for Joint Replacement (CJR) is a Medicare initiative to test the impact of holding a hospital accountable for services provided during an episode of care for a lower extremity joint arthroplasty on costs and quality. This study examines whether hospital participation in CJR is associated with having programs focused on improving posthospitalization care or reducing costs using a survey of orthopedic surgeons.