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Background: After a traumatic intracranial hemorrhage (tICH), patients often receive a platelet transfusion to reverse the effects of antiplatelet medication and to reduce neurologic complications. As platelet transfusions have their own risks, this study evaluated their effects on tICH progression, need for operations and mortality. Methods: In this retrospective study, we identified patients admitted to a level 1 trauma centre with a tICH from 2011 to 2015 who were taking acetylsalicylic acid (ASA) or clopidogrel, or both. We categorized patients into 2 groups: platelet transfusion recipients and nonrecipients. We collected data on demographic characteristics, changes in brain computed tomography findings, neurosurgical interventions, in-hospital death and intensive care unit (ICU) length of stay (LOS). We used multivariable logistic regression to compare outcomes between the 2 groups. Results: We identified 224 patients with tICH, 156 (69.6%) in the platelet transfusion group and 68 (30.4%) in the no transfusion group. There were no between-group differences in progression of bleeds or rates of neurosurgical interventions. In the transfusion recipients, there was a trend toward increased ICU LOS (adjusted odds ratio [OR] 1.59, 95% confidence interval [CI] 0.74-3.40) and in-hospital death (adjusted OR 3.23, 95% CI 0.48-21.74). Conclusion: There were no differences in outcomes between patients who received platelet transfusions and those who did not; however, the results suggest a worse clinical course, as indicated by greater ICU LOS and mortality, in the transfusion recipients. Routine platelet transfusion may not be warranted in patients taking ASA or clopidogrel who experience a tICH, as it may increase ICU LOS and mortality risk. Contexte : Apres une hemorragie intracranienne traumatique, les patients recoivent souvent une transfusion de plaquettes pour inverser les effets des medicaments antiplaquettaires et reduire les complications neurologiques. Les transfusions de plaquettes comportent des risques particuliers; l'etude portait sur leurs effets sur la progression de l'hemorragie intracranienne traumatique, ainsi que sur la necessite d'une operation et la mortalite. Methodes : Dans cette etude retrospective, nous avons cible des patients atteints d'une hemorragie intracranienne traumatique admis dans un centre de traumatologie de niveau 1, de 2011 a 2015, qui prenaient de l'acide acetylsalicylique (AAS) ou du clopidogrel, ou les deux. Ces patients ont ete classes en 2 categories : ceux ayant recu une transfusion de plaquettes et ceux n'ayant pas recu de transfusion. Nous avons recueilli des donnees sur les caracteristiques demographiques, les changements des resultats de la tomodensitometrie cerebrale, les interventions neurochirurgicales, les deces a l'hdpital et la duree de sejour en unite de soins intensifs. Nous avons eu recours a une analyse de regression logistique multivariee pour comparer les resultats entre les 2 groupes. Resultats : Nous avons cible 224 patients atteints d'une hemorragie intracranienne traumatique: 156 (69,6 %) ayant recu une transfusion de plaquettes et 68 (30,4 %) n'ayant pas recu de transfusion. Il n'y avait aucune difference entre les groupes concernant la progression des saignements ou les taux d'interventions neurochirurgicales. Chez les patients ayant recu une transfusion, on a observe une tendance a la hausse de la duree de sejour en unite de soins intensifs (rapport de cotes [RC] ajuste de 1,59; intervalle de confiance [IC] de 95 %, 0,74-3,40) et des deces a l'hdpital (RC ajuste de 3,23; IC de 95 % de 0,48-21,74). Conclusion : On n'a observe aucune difference au chapitre des resultats entre les patients ayant recu une transfusion de plaquettes et les autres. Toutefois, les resultats suggerent une evolution clinique defavorable chez les patients ayant recu une transfusion, se traduisant par une duree de sejour en unite de soins intensifs plus longue et un taux de mortalite plus eleve. La transfusion plaquettaire systematique pourrait ne pas etre avisee chez les patients prenant de l'AAS ou du clopidogrel qui souffrent d'une hemorragie intracranienne traumatique, car elle pourrait faire augmenter la duree de sejour en unite de soins intensifs et exacerber le risque de mortalite., Traumatic brain injury (TBI) is associated with substantial mortality, morbidity and cost. The Centers for Disease Control and Prevention reported that, in 2014, 2.87 million cases of TBI-related presentations were [...]

Thousands of nuclear and cytosolic proteins are modified with a single β-N-acetylglucosamine on serine and threonine residues in mammals, a modification termed O-GlcNAc. This modification is essential for normal development and plays important roles in virtually all intracellular processes. Additionally, O-GlcNAc is involved in many disease states, including cancer, diabetes, and X-linked intellectual disability. Given the myriad of functions of the O-GlcNAc modification, it is therefore somewhat surprising that O-GlcNAc cycling is mediated by only two enzymes: the O-GlcNAc transferase (OGT), which adds O-GlcNAc, and the O-GlcNAcase (OGA), which removes it. A significant outstanding question in the O-GlcNAc field is how do only two enzymes mediate such an abundant and dynamic modification. In this review, we explore the current understanding of mechanisms for substrate selection for the O-GlcNAc cycling enzymes. These mechanisms include direct substrate interaction with specific domains of OGT or OGA, selection of interactors via partner proteins, posttranslational modification of OGT or OGA, nutrient sensing, and localization alteration. Altogether, current research paints a picture of an exquisitely regulated and complex system by which OGT and OGA select substrates. We also make recommendations for future work, toward the goal of identifying interaction mechanisms for specific substrates that may be able to be exploited for various research and medical treatment goals. [ABSTRACT FROM AUTHOR]

Although it has become increasingly common for hospitals to engage in development projects aimed at improving the social determinants of health in surrounding communities, scholarly literature examining the establishment of trust between hospitals and communities is sparse. Because of an extensive and complex history of abuse suffered by marginalized populations at the hands of medical institutions, trust building is critical to the pursuit of equitable health outcomes in these communities. A scoping review was conducted to assess the current base of knowledge for building trust between hospital systems and community members. The review identified only 13 relevant articles addressing this topic, centered on six key themes: with whom to form partnerships; how to form partnerships; conceptualizing and defining trust; questions about investment and hiring; effective communication with communities; and, understanding communities. [ABSTRACT FROM AUTHOR]