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Background: Although economic stability, social context, and healthcare access are well-known social determinants of health associated with more challenging recovery after traumatic injury, little is known about how these factors differ by mechanism of injury. Our team sought to use the results of social determinants of health screenings to better understand the population that engaged with psychosocial support services after traumatic musculoskeletal injury and fill a gap in our understanding of patient-reported social health needs.Question/purpose: What is the relationship between social determinants of health and traumatic musculoskeletal injury?Methods: Trauma recovery services is a psychosocial support program at our institution that offers patients and their family members resources such as professional coaching, peer mentorship, post-traumatic stress disorder screening and treatment, educational resources, and more. This team engages with any patient admitted to, treated at, and released from our institution. Their primary engagement population is individuals with traumatic injury, although not exclusively. Between January 2019 and October 2021, the trauma recovery services team interacted with 6036 patients. Of those who engaged with this service, we considered only patients who experienced a traumatic musculoskeletal injury and had a completed social determinants of health screening tool. During the stated timeframe, 13% (814 of 6036) of patients engaged with trauma recovery services and had a complete social determinants of health screening tool. Of these, 53% (428 of 814) had no physical injury. A further 26% (99 of 386) were excluded because they did not have traumatic musculoskeletal injuries, leaving 4.8% (287) for analysis in this cross-sectional study. The study population included patients who interacted with trauma recovery services at our institution after a traumatic orthopaedic injury that occurred between January 2019 and October 2021. Social determinants of health risk screening questionnaires were self-administered prospectively using a screening tool developed by our institution based on Centers for Medicare and Medicaid Services social determinants of health screening questions. Mechanisms of injury were separated into intentional (physical assault, sexual assault, gunshot wound, or stabbing) and unintentional (fall, motor vehicle collision, or motorcycle crash). During the study period, 287 adult patients interacted with trauma recovery services after a traumatic musculoskeletal injury and had complete social determinant of health screening; 123 injuries were unintentional and 164 were intentional. Patients were primarily women (55% [159 of 287]), single (73% [209 of 287]), and insured by Medicaid or Medicare (78% [225 of 287]). Mechanism category was determined after a thorough medical record review to verify the appropriate category. An initial exploratory univariate analysis was completed for the primary outcome variable using the Pearson chi-squared test for categorical variables and a two-tailed independent t-test for continuous variables. All demographic variables and social determinants of health with p < 0.20 in the univariate analysis were included in a multivariate binary regression analysis to determine independent associations with injury mechanism. All variables with p < 0.05 in the multivariate analysis were considered statistically significant.Results: After controlling for potential demographic confounders, younger age (odds ratio [OR] 0.93 [95% confidence interval (CI) 0.90 to 0.96]; p < 0.001), Black race (compared with White race, OR 2.71 [95% CI 1.20 to 6.16]; p = 0.02), Hispanic ethnicity (compared with White race, OR 5.32 [95% CI 1.62 to 17.47]; p = 0.006), and at-risk status for food insecurity (OR 4.27 [95% CI 1.18 to 15.39]; p = 0.03) were independently associated with intentional mechanisms of injury.Conclusion: There is a relationship between the mechanism of traumatic orthopaedic injury and social determinants of health risks. Specifically, data showed a correlation between food insecurity and intentional injury. Healthcare systems and providers should be cognizant of this, as well as the additional challenges patients may face in their recovery journey because of social needs. Screening for needs is only the first step in addressing patient's social health needs. Healthcare systems should also allocate resources for personnel and programs that support patients in meeting their social health needs. Future studies should evaluate the impact of such programming in responding to social needs that impact health outcomes and improve health disparities.Level Of Evidence: Level IV, prognostic study. [ABSTRACT FROM AUTHOR]

Chrysin, a passion flower extract, may be beneficial because of its potential to attenuate surgical suppression of natural killer (NK) cell activity. We divided 37 male Sprague-Dawley rats into 3 treatment groups: (1) rats undergoing abdominal surgery and administered isoflurane and a 5% solution of dimethyl sulfoxide in saline (vehicle), (2) rats undergoing abdominal surgery and administered isoflurane and chrysin solubilized in 5% dimethyl sulfoxide, and (3) rats not undergoing surgery but administered isoflurane and chrysin. Natural killer cell activity was measured before and 24 hours after the experiment. Analysis of covariance, with preoperative NK cell activity as the covariate, was used to corn pare differences in NK cell activity among groups. The Scheffe procedure was used to make post hoc comparisons. Analysis revealed a significant difference (P = .006) such that group 2 had significantly less NK cell suppression compared with groups 1 and 3. These findings suggest that chrysin may attenuate surgical suppression of NK cell activity, thereby minimizing metastatic spread of cancer. [ABSTRACT FROM AUTHOR]

Tooth eruption is defined as the movement of a tooth from its site of development within the jaws to its position of function within the oral cavity. We present a critical review of evidence for the mechanisms and regulation of the intraosseous and supraosseous phases of eruption, with an emphasis upon the canine premolar model studied by the authors. Analyses at different stages of premolar eruption indicate that selective fragmentation of dental follicle protein DF-95 correlates with the presence of elevated levels of follicular collagenase and stromelysin, and with the onset of premolar movement. A dramatic decrease in these metalloproteinases followed initiation of movement. A biochemical and cell biological model for regulation of tooth eruption is proposed based upon these new and existing data. [ABSTRACT FROM AUTHOR]

Glucagon (gcg) regulates hepatic glucose and amino acid (AA) metabolism, and increased gcg levels (hyperglucagonemia) contribute to hyperglycemia in diabetes. We hypothesized that the enzyme neprilysin (NEP) contributes to gcg degradation. We measured plasma gcg levels during a mixed meal in nine healthy men after a single dose of the NEP-inhibitor/angiotensin II receptor blocker (194 mg sacubitril/206 mg valsartan, 30 min prior to meal), a DPP-4 inhibitor (sitagliptin, 2x100mg), these combined, or the meal alone. Postprandial gcg levels were 2.7-fold higher in sacubitril/valsartan treated individuals compared to controls (P=0.005) and this was not significantly altered by the addition of sitagliptin (P=0.28). Sacubitril/valsartan also lowered postprandial plasma AA levels (P=0.01), but glucose levels were unaffected (P=0.76). In obese individuals (n=7), eight weeks sacubitril/valsartan treatment increased fasting gcg levels (P=0.02). To test whether NEP degrades gcg and diminishes its signaling, we performed mass-spectrometry and assessed cells transfected with the gcg receptor (gcgr). We found that NEP cleaves gcg and that the gcg fragments produced were unable to activate the gcgr. In non-sedated C57BL/6JRj female mice (n=8) NEP inhibition (sacubitril, 0.7 nmol/g) increased gcg levels (P=0.02) and tended to increase AA disappearance (P=0.076) and urea formation (P=0.08) during an AA challenge. A gcgr antagonist (Novo Nordisk; 25-2648, 100 mg/kg) abolished the increase in urea formation observed with sacubitril alone. Gcg levels were increased 1.9-fold (P<0.002) with sacubitril compared to without, after a single injection of gcg (96 ng/g). In mice with genetic ablation of NEP (n=10), fasting plasma urea (P=0.003) but surprisingly not gcg levels (P=0.57) were increased compared to controls. NEP degrades gcg and thus inhibitors of NEP may result in hyperglucagonemia with potential metabolic perturbations on hepatic AA metabolism. Disclosure: S. Kjeldsen: None. S. Zraika: Research Support; Self; Novartis Pharmaceuticals Corporation. S.M. Mongovin: None. L.H. Hansen: None. D. Terzic: None. P.D. Mark: None. P. Plomgaard: None. J.P. Gøtze: None. M. Winther-Soerensen: None. J. Hunt: None. K.D. Galsgaard: None. M.M. Rosenkilde: Board Member; Self; Synklino. Consultant; Self; Antag Therapeutics, Bainan Biotech. G.H. Goossens: None. E.E. Blaak: None. J.J. Holst: Advisory Panel; Self; AstraZeneca, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Zealand Pharma A/S. Other Relationship; Spouse/Partner; Antag Therapeutics. N.J. Wewer Albrechtsen: Research Support; Self; Mercodia, Novo Nordisk A/S, Novo Nordisk Foundation. Speaker's Bureau; Self; Merck Sharp & Dohme Corp. Funding: Novo Nordisk Foundation (NNF19OC0055001) [ABSTRACT FROM AUTHOR]

As seen in this CME online activity (available at http://courses.elseviercme.com/spasticity/662e), treatment of patients with spasticity due to upper motor neuron syndromes, including traumatic brain injury, stroke, and cerebral palsy, is multifaceted, involving chemodenervation, systemic medications, surgical therapy, rehabilitation efforts, and home care. Optimal care begins with the recognition that each patient's impairments are unique and must be assessed carefully to determine the impact of muscle overactivity, loss of dexterity, and weakness on passive and active function in the context of the patients' goals. While botulinum toxin plays a major role in providing symptomatic relief and functional improvement from hypertonia, it should rarely be used as a standalone treatment. [ABSTRACT FROM AUTHOR]

Diabetes is an independent risk factor for heart failure. Treatment with a neprilysin inhibitor-angiotensin receptor blocker (sacubitril/valsartan) was demonstrated to improve glycemia and reduce time to initiation of insulin therapy but the underlying mechanism(s) are unknown. We hypothesized that sacubitril/valsartan attenuates neprilysin-dependent degradation of GLP-1, and that combined inhibition of the other enzyme cleaving intact GLP-1, dipeptidyl peptidase 4 (DPP-4), would have synergistic effects on levels of intact GLP-1. In two open-labeled clinical trials, a total of 16 healthy men received a standardized meal (34% carbohydrates, 45% fat, 21% protein) combined with a prior single dose of sacubitril (194mg)/valsartan(206mg), sitagliptin (2x100mg), sacubitril(194mg)/valsartan(206mg) and sitagliptin (2x100mg), or control. Sacubitril/valsartan increased postprandial plasma concentrations of total GLP-1 by 67% and had synergistic effects on intact GLP-1 when combined with sitagliptin. Concentrations of glucose, insulin, and GIP were not significantly changed upon sacubitril/valsartan treatment. Sacubitril/valsartan synergistically protects intact GLP-1 when combined with a DPP-4 inhibitor pointing to a therapeutic potential for the combination in patients with cardiovascular disease and diabetes. Disclosure: N.J. Wewer Albrechtsen: Research Support; Self; Mercodia, Novo Nordisk A/S. Speaker's Bureau; Self; Merck Sharp & Dohme Corp. P.D. Mark: None. L.H. Hansen: None. U.Ø. Andersen: None. B. Hartmann: None. R.D. Carr: Employee; Self; Merck & Co., Inc. Speaker's Bureau; Spouse/Partner; Eli Lilly and Company, Merck & Co., Inc. F. Gustafsson: Advisory Panel; Self; Abbott, Corvia Medical, Inc. Consultant; Self; Bayer AG. Employee; Spouse/Partner; Novo Nordisk A/S. Research Support; Self; Novo Nordisk Foundation. Speaker's Bureau; Self; Novartis AG, Novo Nordisk A/S. C.F. Deacon: Employee; Spouse/Partner; Merck Sharp & Dohme Corp. Stock/Shareholder; Spouse/Partner; Merck & Co., Inc. Other Relationship; Self; Eli Lilly and Company, Merck Sharp & Dohme Corp. J.J. Holst: Advisory Panel; Self; Novo Nordisk A/S. J.P. Gøtze: None. P. Plomgaard: None. Funding: Rigshopitalet [ABSTRACT FROM AUTHOR]

The article presents a case study of the 19-year-old white male with schizoaffective disorder who developed a granulocytosis on three consecutive clozapine trials. He was given clozapine for psychotic symptoms despite multiple antipsychotic trials. However, thereafter achieved long-term stabilization of psychiatric symptoms and absolute neutrophil count (ANC) through concurrent use of clozapine and granulocyte colony-stimulating factor (G-CSF) with clear dosing parameters.

The article presents the case history of a 54-year-old woman presented with a several month history of increasing anorectal pain who was diagnosed with adenosquamous carcinoma of the anus. Adenosquamous carcinoma is characterized by presence of both squamous cell carcinoma and adenocarcinoma within the same tumor.

The enzyme horseradish peroxidase (HRP) has been entrapped in situ by electropolymerization of pyrrole onto a platinum electrode. The latter was previously coated by a polypyrrole layer for better adhesion of the biocatalyst film and in order to avoid the enzyme folding onto the Pt electrode. The biosensor allowed the determination of hydrogen peroxide in the concentration range comprised between 4.9×10−7 and 6.3×10−4 M. The biosensor retained more than 90% of its original activity after 35 days of use. [Copyright &y& Elsevier]

Exploitation of the physical, chemical and electrically conductive properties of poly(3-dodecylthiophene) (P3DDT) for the preconcentration and release in solid phase microextraction (SPME) of organometallic arsenobetaine (AsB) from aqueous media was investigated. Hydrophobic interactions between this neutral arsenic species and an undoped polythiophene (no applied potential) with n-substituted alkyl groups (n=12) in the three position were used for the diffusion-controlled preconcentration. After absorption into the polymer matrix, the chemical properties of this conductive polymer were changed by applying an external potential. This potential provides a sufficient driving force for desorption of the analyte from the extraction phase into an aqueous solution for subsequent analysis. The applied positive potential oxidizes the polymer to its charged hydrophilic state, which releases the neutral analyte. The concentration and speciation of the analyte from the sample matrix was analyzed by HPLC coupled to an ICP-MS. The diffusion-controlled uptake was fast (equilibrium attained within minutes) and did not require pretreatment of the analyte. The electrochemically-controlled release of the analyte is also very rapid (within minutes). This conducting polymer film system, therefore, can offer analytical applications for the convenient preconcentration and subsequent analysis of neutral environmental species. [Copyright &y& Elsevier]