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Background: Questions persist about the safety of switching non‐group O recipients of group O uncrossmatched red blood cells (RBC) or low titer group O whole blood (LTOWB) to ABO‐identical RBCs during their resuscitation. Methods: The database of an earlier nine‐center study of transfusing incompatible plasma to trauma patients was reanalyzed. The patients were divided into three groups based on 24‐h RBC transfusion: (1) group O patients who received group O RBC/LTOWB units (control group, n = 1203), (2) non‐group O recipients who received only group O units (n = 646), (3) non‐group O recipients who received at least one unit of group O and non‐group O units (n = 562). Fixed marginal effect of receipt of non‐O RBC units on 6‐ and 24‐h and 30‐day mortality was calculated. Results: The non‐O patients who received only group O RBCs received fewer RBC/LTOWB units and had slightly but significantly lower injury severity score compared to control group; non‐group O patients who received both group O and non‐O units received significantly more RBC/LTOWB units and had a slightly but significantly higher injury severity score compared to control group. In the multivariate analysis, the non‐O patients who received only group O RBCs had significantly higher mortality at 6‐h compared to the controls; the non‐group O recipients of O and non‐O RBCs did not demonstrate higher mortality. At 24‐h and 30‐days, there were no differences in survival between the groups. Conclusion: Providing non‐group O RBCs to non‐group O trauma patients who also received group O RBC units is not associated with higher mortality. [ABSTRACT FROM AUTHOR]

Objective: It has been known that West syndrome (WS) patients with an unknown etiology have better clinical outcomes than patients with an identified etiology of any kind. However, after the exponential discovery of genes with mutations responsible for developmental and epileptic encephalopathy (DEE), a significant proportion of patients with a previously unknown etiology have been reclassified as having a genetic etiology, requiring reinvestigation of this concept. Therefore, this study investigated clinical outcomes of WS patients with genetic and unknown etiologies. Methods: Patients diagnosed with WS without structural or metabolic abnormalities were included in this study. The DEE gene panel, comprising 172 genes, was performed for all patients. All patients were treated using the same treatment protocol for vigabatrin and high‐dose prednisolone add‐on therapy. Favorable responders were defined as patients who were seizure‐free and whose electroencephalogram showed Burden of Amplitudes and Epileptiform Discharges scores of 2 or less. Results: Of the 58 patients included in the study, 17 (29.3%) patients had an identified genetic etiology. There was no significant difference in rates of favorable response at 1 and 3 months after treatment, but significantly higher proportions of patients exhibited favorable responses among those with an unknown etiology at long‐term follow‐up (41.2% vs. 78.0%, p =.006 at 6 months; 29.4% vs. 65.9%, p =.011 at 1 year; 23.5 vs. 65.9%, p =.003 at 2 years). Moreover, the mental, psychomotor, and social age quotients of the patients with an identified genetic etiology were reduced to a significantly greater degree since diagnosis compared with those of the patients with an unknown etiology. Significance: WS patients with genetic and unknown etiologies did not initially exhibit significantly different response rates to the vigabatrin and high‐dose prednisolone add‐on treatment. However, patients with a genetic etiology exhibited significantly higher relapse rates and significantly poorer long‐term responses. [ABSTRACT FROM AUTHOR]

Background: This study investigated the effect on mortality of transfusing ABO‐incompatible plasma from all sources during trauma resuscitation. Methods: Demographic, transfusion, and survival data were retrospectively extracted on civilian trauma patients. Patients were divided by receipt of any quantity of ABO‐incompatible plasma from any blood product (incompatible group) or receipt of solely ABO‐compatible plasma (compatible group). The primary outcome was 30‐day mortality, while other outcomes included 6‐ and 24‐hour mortality. Mixed‐effects logistic regression was used to model the effect of various predictor variables, including receipt of incompatible plasma, on mortality outcomes. Results: Nine hospitals contributed data on a total of 2618 trauma patients. There were 1282 patients in the incompatible group and 1336 patients in the compatible group. In both the unadjusted and adjusted models, the 6‐hour, 24‐hour, and 30‐day mortality rates were not significantly different between these groups. The patients in the incompatible group were then divided into high volume (>342 mL) and low volume (≤342 mL) incompatible plasma recipients. In the adjusted model, the high‐volume group had higher 24‐hour mortality when the Trauma Injury Severity Score survival prediction was >50%. Mortality at 6 hours and 30 days was not higher in this model. The low‐volume group did not have increased mortality at any of the time points in this adjusted model. Conclusion: The transfusion of incompatible plasma in civilian trauma resuscitation does not lead to higher 30‐day mortality. The finding of higher mortality in a select group of recipients in the secondary analysis warrants further study. [ABSTRACT FROM AUTHOR]

The application of physics‐based distributed hydrologic models (DHMs) at hyperresolutions (~100 m) is expected to support several water‐related applications but is still prevented by critical data, model validation, and computational challenges. In this study, we address some of these challenges by applying the TIN‐based Real‐time Integrated Basin Simulator DHM at a nominal resolution of ~88 m in the Río Sonora basin, a regional watershed of ~21,000 km2 in northwest Mexico. First, we generate reliable high‐resolution (1‐km) hydrometeorological forcings by bias correcting reanalysis products with ground observations and applying downscaling routines that use terrain information at high resolution, which is available globally. Second, we develop a strategy to obtain high‐resolution (250‐m) grids of soil parameters by integrating a coarse‐resolution soil map based on the Food and Agriculture Organization classification with recently released high‐resolution global data sets. Third, we apply the model over a decadal period (2004–2013) and use a set of complementary tools, including Taylor diagrams, connectivity analysis, and empirical orthogonal function analysis, to assess its ability to simulate spatial patterns of land surface temperature through comparison with daily remotely sensed products. We find that (i) the hyperresolution‐simulated patterns capture the spatial variability of land surface temperature quite well and (ii) vegetation properties are the major physical factors controlling the discrepancies between simulated and remotely sensed products. The strategies presented here are based on global data sets and robust statistical techniques that can be utilized in different settings with other DHMs, and thus, they provide valuable support for the scientific community focused on hyperresolution hydrologic modeling. Key Points: Long‐term (10 years) hyperresolution (88 m) hydrologic simulations are performed in a regional watershed (21,000 km2)Global and local data sets are integrated to generate high‐resolution hydrometeorological forcings and soil propertiesSimulated and remotely sensed spatial patterns of land surface temperature are compared to validate the model and diagnose its deficiencies [ABSTRACT FROM AUTHOR]

Summary: Objective: With the recognition of epilepsy as a network disease that disrupts the organizing ability of resting‐state brain networks, vagus nerve stimulation (VNS) may control epileptic seizures through modulation of functional connectivity. We evaluated preoperative 2‐deoxy‐2[18F]fluoro‐D‐glucose (FDG) positron emission tomography (PET) in VNS‐implanted pediatric patients with refractory epilepsy to analyze the metabolic connectivity of patients and its prognostic role in seizure control. Methods: Preoperative PET data of 66 VNS pediatric patients who were followed up for a minimum of 1 year after the procedure were collected for the study. Retrospective review of the patients' charts was performed, and five patients with inappropriate PET data or major health issues were excluded. We conducted an independent component analysis of FDG‐PET to extract spatial metabolic components and their activities, which were used to perform cross‐sectional metabolic network analysis. We divided the patients into VNS‐effective and VNS‐ineffective groups (VNS‐effective group, ≥50% seizure reduction; VNS‐ineffective group, <50% reduction) and compared metabolic connectivity differences between groups using a permutation test. Results: Thirty‐four (55.7%) patients showed >50% seizure reduction from baseline frequency 1 year after VNS. A significant difference in metabolic connectivity evaluated by preoperative FDG‐PET was noted between groups. Relative changes in glucose metabolism were strongly connected among the areas of brainstem, cingulate gyrus, cerebellum, bilateral insula, and putamen in patients with <50% seizure control after VNS. Significance: This study shows that seizure outcome of VNS may be influenced by metabolic connectivity, which can be obtained from preoperative PET imaging. This study of metabolic connectivity analysis may contribute in further understanding of the mechanism of VNS in intractable seizures. [ABSTRACT FROM AUTHOR]

Abstract: Background: Lack of cerebrospinal fluid (CSF) pleocytosis has been reported in some children with enteroviral meningitis (EVM). The aim of this paper was to investigate the clinical spectrum and related factors in EVM with CSF non‐pleocytosis. Methods: The databases of children diagnosed with EVM on CSF polymerase chain reaction between 2011 and 2014 were retrospectively reviewed. CSF pleocytosis was defined at each age using the criteria. Clinical and laboratory variables were compared between patients with CSF pleocytosis and non‐pleocytosis. Results: Of the 802 children of EVM, 25.4% (204/802) had CSF non‐pleocytosis. In particular, CSF non‐pleocytosis was found in 63.3% of the neonates versus in 22.2% of the children aged ≥1 year old, indicating that the ratio of CSF non‐pleocytosis had a negative correlation with age (P < 0.001). As the main symptoms, fever (91.8% vs 86.8%, P = 0.038), headache (80.3% vs 63.7%, P < 0.001), and vomiting (75.9% vs 61.8%, P < 0.001) were significantly more frequent in CSF pleocytosis than in CSF non‐pleocytosis. Patients with CSF non‐pleocytosis had much lower peripheral leukocytosis (10 656 ± 3,662 vs 12 403 ± 4,207/mm3, P = 0.014) and C‐reactive protein (0.7±0.8 vs 1.2±1.5 mg/dL, P < 0.001), and earlier lumbar puncture <24 h after onset (42.6% vs 21.4%, p<0.001). No significant difference during the summer and autumn months was seen between the two groups (76.9% vs 81.9%, P = 0.169). Conclusion: CSF non‐pleocytosis in childhood EVM was frequently observed, especially in young infants, regardless of season. We propose that CSF PCR testing for enterovirus can be helpful to recognize EVM in children with CSF non‐pleocytosis. [ABSTRACT FROM AUTHOR]

Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke‐like episodes (MELAS) is a type of mitochondrial disorder and stroke‐like lesions are observed prominently in the brain magnetic resonance imaging. Those stroke‐like lesions of MELAS patients are usually located in the posterior quadrants and do not correspond to typical vascular territories. This case illustrates that focal cerebellar infarction can be the sole initial sign of MELAS. [ABSTRACT FROM AUTHOR]