Background Trauma centers are receiving increasing numbers of older trauma patients. There is a lack of literature on the outcomes for elderly trauma patients who undergo damage control laparotomy (DCL). We hypothesized that trauma centers with geriatric protocols would have better outcomes in elderly patients after DCL. Methods A retrospective chart review of consecutive adult trauma patients with DCL at 8 level 1 trauma centers was conducted from 2012 to 2018. Patients aged 40 or older were included. Age ≥ 55 years was defined as elderly. Demographics, injury information, clinical outcomes, including mortality, and complications were recorded. Univariate and multivariate analyses were performed. Results A total of 379 patients with DCLs were identified with an average age of 54.8 ± 0.4 years with 39.3% (n = 149/379) of patients aged ≥ 55. Geriatric protocols or a consulting geriatric service was present at 37.5% (n = 3/8) of institutions. Age ≥ 55 was a significant risk factor for in-hospital mortality (OR 2, 95% CI 1.0-4.0, P = .04). Institutions without dedicated geriatric trauma protocols/services had higher overall in-hospital mortality on both univariate (57.9% vs 34.3%, P = .02) and multivariate analyses (OR 2.1, 95% CI 1.3-3.4, P < .001). Conclusions Surgical management of older trauma patients remains a challenge. Geriatric protocols or dedicated services were found to be associated with improved outcomes. Future efforts should focus on standardizing the availability of these resources at trauma centers.

BACKGROUND AND OBJECTIVES: To describe differences in practice patterns and outcomes of young preterm versus age-matched term infants evaluated for sepsis, because evaluation and management of this group are not well defined. METHODS: We conducted a retrospective single-center study at an academic, freestanding children’s hospital of previously healthy preterm and term infants aged 0 to 60 days, who presented for initial evaluation of fever and/or hypothermia from 2014 to 2019. We classified infants by gestational age as preterm (32–36 6/7 weeks) and term (37–42 weeks) and compared diagnostic evaluation, management, and clinical outcomes. RESULTS: Out of 363 preterm infants evaluated for sepsis, 336 met inclusion criteria; within the same study period, 2331 term infants were evaluated for sepsis, of which 600 were randomly selected and 554 were included. Clinicians performed inflammatory marker testing and chest x-rays more frequently in preterm infants 31% vs 25% (P = .034) and 50% vs 32% (P &lt; .001), respectively. Preterm infants had a higher rate of bacteremia 5.9% vs 2.5% (P = .035), were hospitalized more frequently 72% vs 63% (P = .006), and required ICU level of care more often 32% vs 5% (P &lt; .001) than term infants. They had lower rates of viral infections 33% vs 42% (P = .015) and no significant increased return visits. Febrile preterm and term infants, and older hypothermic preterm infants had relatively higher rates of serious bacterial infections. Hypothermic preterm infants had the longest hospitalizations. CONCLUSIONS: Preterm infants had increased rates of bacteremia and required higher level of care compared with age-matched term infants, likely reflecting their increased risk for sepsis and other concomitant morbidities associated with preterm birth.

Background: Hyperlipidemia plays a pivotal role in the pathogenesis of diabetes, atherosclerosis, and cardiovascular diseases. Specific lipids of atherosclerotic plaques are potentially one of the local factors which render them susceptible to rupture. Their underlying unresolved inflammation and oxidative stress contribute to the transition from stable to unstable plaques. Therefore, we aimed to identify, characterize, and compare the intraplaque lipids composition among diabetic and non-diabetic patients and to ascertain their role in inflammation, and atherosclerotic plaque destabilization and rupture. Methods: Approved by the IRB, University of Arizona, Tucson Lipids were analyzed by liquid chromatography-mass spectrometry (LC-MS) from 40 surgically removed endarterectomy specimens that include Asymptomatic & Non-diabetic (n=13), Symptomatic & Non-diabetic (n=17), Asymptomatic & Diabetic (n=5) iv. Symptomatic & Diabetic (n=5) patients. Seventy nine lipid species from the main lipid classes phosphatidylcholine (PC), phosphatidylserine (PS), phosphatidylethanolamine (PE), phosphatidylinositol (PI), cholesteryl ester (CE) phosphatidylglycerol (PG), sphingomyelin (SM), and ceramide (Cer) were included in this lipidomic profiling. Results: LC-MS data analysis identified a significant difference (p<0.05) in 2 individual lipid species – a long chain polyunsaturated PC(40:7) and SM(18:1) between diabetic and non-diabetic (Table:1). A total of 23 lipid species were significantly (p<0.05 to p<0.005) differentially present between symptomatic and asymptomatic samples. Symptomatic diabetic and nondiabetic samples showed a significant (p<0.05 to p<0.005) difference in 13 lipids belonging to PC, SM and PE. Our studies also showed a higher peroxidation of intraplaque lipid from diabetic patients compared to non-diabetics, and a significant increase in reactive oxygen species (ROS) production in human coronary artery smooth muscle cells treated with lipids from diabetic plaques. Conclusions: This exploratory analysis showed distinct patterns of intraplaque lipid composition. Identification of these high-risk plaque lipid biomarkers will help to delineate the cellular and molecular mechanism responsible for stable to vulnerable plaques transition.

High resolution spectroscopy of stars has been rarely used because at visible wavelengths, the atmosphere produces a star image typically 10-20 times the diffraction limit of the telescope. Either the grating must be used at a far poorer resolution than its diffraction limit, or much light must be lost at the slit.