Miracle-dz/UniFAR-FTUs huggingface dataset:
World Federation of Pediatric Intensive and Critical Care Societies—Its global agenda*

The World Federation of Pediatric Intensive and Critical Care Societies (WFPICCS) is an international body that brings together international expertise, experience, and influence to improve the outcomes of children suffering from life-threatening illness and injury. Its mission is educational, scientific, and charitable in nature. WFPICCS is committed to a global environment, in which all children have access to intensive and critical care of the highest standard. It exists to find ways of improving the care of critically ill children throughout the world, and making that knowledge available to those who care for such children. As in an ideal world all children should have access to state of the art critical care services, this is unlikely to happen anytime soon. Faced with this reality, the member societies of the WFPICCS will strive to develop the best model and provide the best care for critically ill and injured children worldwide. The challenge is to find the appropriate role that we need to (and can effectively) play in decreasing both unnecessary death and suffering for children. Clearly, we cannot achieve these goals on our own, hence WFPICCS visualizes close cooperation and collaboration with other agencies offering care to critically ill or injured children such as the World Health Organization, World Federation of Societies of Intensive and Critical Care Medicine, International Pediatric Associations, and regional organizations and programs to achieve our objectives. We feel that this document while imperfect is a good starting point and hope that it will stimulate more discussion to guide the agenda of the federation for years to come.
Osteoporosis in patients over 50 years of age following restorative proctocolectomy for ulcerative colitis: Is DXA screening warranted?

Background: Ulcerative colitis (UC) and increasing age are associated with an increased risk of osteoporosis. Screening of postmenopausal women and men older than 50 years with ulcerative colitis for osteoporosis is recommended. The prevalence of osteoporosis in restorative proctocolectomy (RPC) patients more than 50 years old is not known. Methods: Fifty‐three consecutive patients older than age 50 who had undergone RPC for UC underwent a bone density scan (DXA). Sex, smoking status, age at diagnosis of UC, duration of UC, age at RPC, years since RPC, age at DXA, and pouch histological inflammatory score were recorded. The Kruskal‐Wallis test and Spearman's correlation coefficient were used to analyze the data. Results: Fifty‐three patients were studied; their median age was 58 years, and the median age at RPC was 45. The prevalence of osteopenia and osteoporosis was 43.4% and 13.2%, respectively. Age at RPC was negatively correlated with bone density (P = 0.041, r = 0.281), and there was a negative correlation approaching significance with age at the time of DXA (P = 0.071, r = −0.250). No other factor studied correlated with bone density. Conclusions: The prevalence of osteoporosis and osteopenia found in this study is similar to that reported for UC patients who have not undergone RPC. Patients having RPC should be screened in line with current UC guidelines, targeting those older than 50 years. (Inflamm Bowel Dis 2009)
Ablation of gly96/immediate early gene‐X1 (gly96/iex‐1) aggravates DSS‐induced colitis in mice: Role for gly96/iex‐1 in the regulation of NF‐&kgr;B

Background: Inflammatory bowel diseases (IBDs) result from environmental and genetic factors and are characterized by an imbalanced immune response in the gut and deregulated activation of the transcription factor NF‐&kgr;B. Addressing the potential role of gly96/iex‐1 in the regulation of NF‐&kgr;B in IBD, we used the dextran sodium sulfate (DSS) colitis model in mice in which the gly96/iex‐1 gene had been deleted. Methods: C57BL/6 mice of gly96/iex‐1−/− or gly96/iex‐1+/+ genotype were treated continuously with 4% DSS (5 days) and repeatedly with 2% DSS (28 days) for inducing acute and chronic colitis, respectively. In addition to clinical and histological exploration, colon organ culture and bone marrow‐derived cells (BMCs) were analyzed for chemo/cytokine expression and NF‐&kgr;B activation. Results: Compared to wildtype littermates, gly96/iex‐1−/− mice exhibited an aggravated phenotype of both acute and chronic colitis, along with a greater loss of body weight and colon length. Colonic endoscopy revealed a higher degree of hyperemia, edema, and bleeding in gly96/iex‐1−/− mice, and immunohistochemistry detected massive mucosal infiltration of leukocytes and marked histological changes. The expression of proinflammatory chemo‐ and cytokines was higher in the colon of DSS‐treated gly96/iex‐1−/− mice, and the NF‐&kgr;B activation was enhanced particularly in the distal colon. In cultured BMCs from gly96/iex‐1−/− mice, Pam3Cys4 treatment induced expression of proinflammatory mediators to a higher degree than in gly96/iex‐1+/+ BMCs, along with greater NF‐&kgr;B activation. Conclusions: Based on the observation that genetic ablation of gly96/iex‐1 triggers intestinal inflammation in mice, we demonstrate for the first time that gly96/iex‐1 exerts strong antiinflammatory activity via its NF‐&kgr;B‐counterregulatory effect. (Inflamm Bowel Dis 2009;)
Parents' concern about their children's weight.

OBJECTIVE Firstly, to investigate the degree of concern parents feel about their children's weight (parental concern). Secondly, to identify factors that influence this concern, and to test a model of parental concern using structural equation modeling. SUBJECTS A total of 347 non-overweight, overweight, and obese children (aged 6-13; Mean = 9.5, SD = 1.8) and their parents. METHODS Children and their parents attended an assessment session during which they were weighed and measured. Parents were administered a structured interview, which included the Eating Disorder Examination, and completed the Pediatric Quality of Life Inventory (parent proxy), and the Children's Body Image Scale. RESULTS Eighty-two percent of parents of overweight children, and 18% of parents of obese children reported little parental concern. Higher parental concern was associated with higher child Body Mass Index, less parental underestimation of child body size, and lower child health-related quality of life. CONCLUSIONS Interventions targeting childhood obesity should aim to optimise parental concern by reducing parents' underestimation of child body size and increasing their awareness of the effects of overweight and obesity on children's health and quality of life.
Mapping of inflammatory bowel disease in northern France: Spatial variations and relation to affluence

Background:Geographic variations in the incidence of inflammatory bowel disease (IBD) may reflect variations in the distribution of environmental etiologic factors. We assessed spatial variation in the incidence of IBD in northern France and analyzed its association with a deprivation index. Methods:All cases of IBD included in the EPIMAD registry between 1990 and 2003 were extracted. The standardized incidence ratio (SIR) was calculated for each canton in the region. The association between incidence and deprivation was assessed using the Townsend deprivation index. Results:The mean annual incidence rates of Crohn's disease (CD) and ulcerative colitis (UC) were 6.2 × 10−5 and 3.8 × 10−5, respectively. The mean cumulative numbers of cases by canton were 18.4 (1–183) for CD and 11.3 (0–148) for UC. For both CD and UC, mapping depicted spatial heterogeneity in the SIR with spatial autocorrelation. A high relative risk (RR) of CD was observed in mainly rural and periurban cantons of the region. For UC, a high RR was found in cantons of the south and the center of Pas‐de‐Calais. No significant correlation was observed between spatial variations in IBD and deprivation. Conclusions:The incidence of IBD is associated with spatial heterogeneity in northern France. The noteworthy predominance of CD in agricultural areas warrants further investigations. (Inflamm Bowel Dis 2009;)
Neighborhood characteristics in relation to diet, physical activity and overweight of Canadian children.

BACKGROUND Neighborhood infrastructure may provide an important opportunity to prevent overweight among children. In the present study we investigated whether access to shops for modestly priced fresh produce, access to parks and playgrounds, access to recreational facilities and neighborhood safety are related to children's diet, physical and sedentary activities, and body weights. METHODS Data were obtained from the Children's Lifestyle and School-performance Study, a survey including 5,471 grade five students and their parents in the province of Nova Scotia, Canada. Students completed the Harvard Food Frequency Questionnaire and had their height and weight measured. Parents completed questions on socio-economic background and how they perceived their neighborhood. We applied multilevel regression methods to relate these neighborhood characteristics with children's fruit and vegetable consumption, dietary fat intake, diet quality, frequency of engaging in sports with and without a coach, screen time, overweight and obesity. RESULTS Children in neighborhoods with greater perceived access to shops had healthier diets and were less likely to be overweight or obese. Children in neighborhoods with good access to playgrounds, parks and recreational facilities were reportedly more active and were less likely to be overweight or obese, whereas children in safe neighborhoods engaged more in unsupervised sports. CONCLUSIONS The study demonstrated associations between neighborhood characteristics, health behaviors and childhood overweight. This contributes to the knowledge base that is still too narrow to justify informed preventative public health policy. We advocate the evaluation of natural experiments created by new policy that affect neighborhood infrastructures as the optimal opportunity to enlarge this knowledge base.
Diagnosis of Ventilator‐associated Pneumonia: An Evaluation of Direct Examination and Presence of Intracellular Organisms

Background: Ventilator‐associated pneumonia (VAP) requires early diagnosis and adequate antibiotic therapy. The aim of this prospective postmortem study was to assess the accuracy of direct examination and quantification of intracellular organisms (ICO) for the diagnosis of VAP. Methods: Total and differential cell counts were performed on fluids recovered using nonbronchoscopic sampling techniques (blind bronchial sampling [BBS], mini‐bronchoalveolar lavage [mini‐BAL]) and from bronchoalveolar lavage (BAL) performed during fiberscopy. These 3 sampling techniques were done within 15 min of death without discontinuing mechanical ventilation. Quantification of ICO was performed on each sample recovered from the various sampling procedures. Gram reaction and morphology of bacteria were evaluated on Gram smears. Results: The results of each technique were compared with histology and culture of lung tissue specimens obtained by surgical pneumonectomies in 28 patients who died after at least 72 h of mechanical ventilation. Histology was positive in 13 patients and negative in 15 patients. When only VAP with positive lung culture was considered (histologic signs of bronchopneumonia plus positive lung tissue culture), the sensitivity of Gram staining on BAL, mini‐BAL, and BBS was 56%, 44%, and 56%, respectively. If all samples were considered, the sensitivity and the specificity of the determination of the percentage of ICO were low (less than 70%) whatever the sampling technique. Conclusions: For initial therapeutic guidance, direct examination and presence of ICO do not contribute for establishing the diagnosis of VAP, essentially because of a lack of sensitivity. However, when positive, Gram staining can obviously guide initial antibiotherapy.
Prevalence of adverse events in pediatric intensive care units in the United States*

Objectives: Selection of relevant patient safety interventions for the pediatric intensive care (PICU) requires identification of the types and severity of adverse events (AEs) and adverse drug events (ADEs) that occur in this setting. The study's objectives were to: 1) determine the rates of AEs/ADEs, including types, severity, and preventability, in PICU patients; 2) identify population characteristics associated with increased risk of AEs/ADEs; 3) develop and test a PICU specific trigger tool to facilitate identification of AEs/ADEs. Design, Setting, Patients: Retrospective, cross-sectional, randomized review of 734 patient records who were discharged from 15 U.S. PICUs between September and December 2005. Intervention: A novel PICU-focused trigger tool for AE/ADE detection. Measurements and Results: Sixty-two percent of PICU patients had at least one AE. A total of 1488 AEs, including 256 ADEs, were identified. This translates to a rate of 28.6 AEs and 4.9 ADEs per 100 patient-days. The most common types of AEs were catheter complications, uncontrolled pain, and endotracheal tube malposition. Ten percent of AEs were classified as life-threatening or permanent; 45% were deemed preventable. Higher adjusted rates of AEs were found in surgical patients (p = .02), patients intubated at some point during their PICU stay (p = .002), and patients who died (p < .001). Surgical patients had higher preventable adjusted AE (p = .01) and ADE rates (p = .02). The adjusted cumulative risk of an AE per PICU day was 5.3% and 1.6% for an ADE alone. There was a 4% increase in adjusted ADEs rates for every year increase in age. Conclusions: AEs and ADEs occur frequently in the PICU setting. These data provide areas of focus for evidence-based prevention strategies to decrease the substantial risk to this vulnerable pediatric population.
Acute Heart Failure Syndromes: The Role of Vasopressin Antagonists

Hospitalizations for acute heart failure syndromes (AHFS) are associated with high post-discharge morbidity and mortality. The potential role of vasopressin antagonists (VA) in AHFS was presented at the 2008 European Society of Cardiology Working Group on Acute Cardiac Care Meeting held in Versailles, France from 25–28 October 2008. This report represents a summary of the presentation at this meeting.
Relationship between plasma osteopontin and oxidative stress in patients with coronary artery disease

Background: It is known that oxidative stress plays an important role in the pathogenesis of atherosclerosis and that an association exists between osteopontin (OPN) and atherosclerosis. Objectives: It was proposed that malondialdehyde (MDA), a biomarker of lipid peroxidation and oxidative stress, would be related to plasma OPN levels in patients with coronary artery disease (CAD). Methods/results: Plasma OPN and MDA levels were measured in 71 patients (60 males and 11 females; mean age 61.7 ± 10 years). Fifty-eight patients had significant CAD (group I) and 13 patients were free of CAD as defined angiographically (group II). Plasma OPN was measured by enzyme-linked immunosorbent assay (ELISA), while MDA was determined spectrophotometrically. Multivariate regression analysis revealed that ln-transformed OPN levels were independently associated with MDA after adjustment for age, hypertension and diabetes mellitus (R2 = 0.278, p = 0.0004 and β regression coefficient = 0.252 [standard error = 0.0958], p = 0.011). OPN and MDA levels were higher in patients with diabetes (73.6 ± 36.2 ng/ml versus 56.1 ± 30.9 ng/ml, p = 0.02 and 2.5 ± 0.5 μM versus 2.0 ± 0.5 μM, p = 0.002, respectively). Conclusions: The association between OPN and MDA levels in patients with CAD suggests an interaction between OPN and oxidative stress. This interaction may play a role in the pathogenesis of atherosclerosis.
Inflammatory bowel disease and completed suicide in Danish adults

Background: The risk of suicide is increased among people with inflammatory bowel disease (IBD); however, most of the evidence regarding this association comes from studies of all‐cause mortality, with small numbers of people who have committed suicide, or from clinical case reports. The current study examined the association between the two forms of IBD: Crohn's disease (CD) and ulcerative colitis (UC), and completed suicide in a population‐based sample. Methods: Data for this nested case–control study were obtained from the Danish national healthcare and social registries. We included 27,053 cases who completed suicide between January 1, 1981, and December 31, 2006. Controls were selected from the general population and matched to cases on gender, date of birth, and calendar time (n = 551,060). Results: There was an increased rate of suicide among participants with both CD (odds ratio [OR] = 1.6, 95% confidence interval [CI]: 1.1, 2.3) and UC (OR = 1.9, 95% CI: 1.4, 2.4), when adjusting for the matched factors and identified confounders. Conclusions: The current study suggests that physicians treating IBD patients should be vigilant about expressions of suicidal ideation or signs and symptoms of self‐harm. (Inflamm Bowel Dis 2010)
Homing of immune cells: Role in homeostasis and intestinal inflammation

Abstract: Rather like a satellite navigation system directing a vehicle to a particular destination defined by post‐code, immune cells have homing molecules or “immune post‐codes” enabling them to be recruited to specific organs, such as the intestine or skin. An efficient system would be designed such that the site of entry of an antigen influences the homing of effector T cells back to the appropriate organ. For example, to mount an immune response against an intestinal pathogen, T cells with a propensity to home to the gut to clear the infection would be induced. In health, there is such a sophisticated and finely tuned system in operation, enabling an appropriate balance of immune activity in different anatomical compartments. In disease states such as inflammatory bowel disease (IBD), which is characterized by intestinal inflammation and often an inflammatory process involving other organs such as skin, joints, liver, and eye, there is accumulating evidence that there is malfunction of this immune cell trafficking system. The clinical importance of dysregulated immune cell trafficking in IBD is reflected in recently proven efficacious therapies that target trafficking pathways such as natalizumab, an &agr;4 integrin antibody, and Traficet‐EN, a chemokine receptor‐9 (CCR9) antagonist. Here we review the mechanisms involved in the homing of immune cells to different tissues, in particular the intestine, and focus on alterations in immune cell homing pathways in IBD. Unraveling the mechanisms underlying the immune post‐code system would assist in achieving the goal of tissue‐specific immunotherapy. (Inflamm Bowel Dis 2010)
Social economic costs and health-related quality of life in patients with amyotrophic lateral sclerosis in Spain

Amyotrophic lateral sclerosis (ALS) is a process that leads to the functional disability of the individual in a relatively short period of time, with a very important limitation of autonomy and affecting the quality of life. We wished to determine the economic burden (direct and indirect costs), as well as health-related quality of life (HRQoL) in patients with ALS in Spain. A cross-sectional study was carried out on 63 patients with ALS during 2004. A retrospective assessment of the use of resources was obtained through questionnaires completed by the patients and/or the patients’ caregivers. The approach used was a cost-of-illness study based on a societal perspective. We assessed the HRQoL with the EQ-5D. Mean annual cost per patient with ALS was €36,194. The most important categories of costs were informal care, early retirement, medications, and orthopaedic devices. The mean EQ-5D index score was 0.18 and the mean EQ-5D VAS score was 29. Considerations of the costs related to caregiving to cope with the patients’ disabilities, as well as the high indirect costs resulting from early retirement in patients with ALS, should become a priority for health authorities in Spain. The patients’ HRQoL was very low and substantially influenced by the degree of severity of ALS.
Is there a difference in clinical outcomes, inflammation, and hypermetabolism between scald and flame burn?

Objective: Severe thermal injury induces inflammatory and hypermetabolic responses that are associated with morbidity and mortality. However, it is not well-documented whether the causes of burns affect inflammation, hypermetabolism, and morbidity. The aim of the present study was to determine whether there is a difference in degree of inflammation, hypermetabolism, endocrine and acute-phase response, and clinical outcome between pediatric patients with scald and flame burns. Interventions: None. Measurements and Main Results: Children with burns requiring surgical intervention were enrolled in this cohort study and divided into two groups, scald or flame burn. In a second assignment, we analyzed the study populations in representative subgroups containing individuals with third-degree burns of 40% to 60% total body surface area. We determined clinical outcomes, resting energy expenditures, cytokine profiles, acute-phase proteins, constitutive proteins, and hormone panels. Statistical analysis was evaluated by analysis of variance, Student's t test corrected with the Bonferroni post hoc test, and the propensity score. Statistical significance was set at p < . 05. A total of 912 patients were identified. Six hundred seventy-four had a flame burn and 238 had a scald burn. There was a significant difference (p < .05) in burn size (flame, 48% ± 23%; scald, 40% ± 21%), third-degree burn (flame, 39% ± 27%; scald 22% ± 25%), age (flame, 8 ± 5 yrs; scald, 3 ± 3 yrs), and mortality between groups. Propensity analysis confirmed the type of burn as a significant risk factor for morbidity and mortality. Subanalysis conducted in a representative patient group suffering from 40% to 60% burn total body surface area revealed that flame burns lead to significantly increased hypermetabolic, inflammatory, and acute-phase responses when compared to scald burns (p < .05). The frequency of sepsis was 3% in the scald burn group, while it was 14% in the flame group (p < .001). Multiorgan failure occurred in 14% of the scald patients, while it occurred in 17% of flame patients. The mortality in patients suffering from a scald burn was 3% compared to 6% in the flame-burned group (p < .05). Conclusion: The type of burn affects hypermetabolism, inflammation, acute-phase responses, and mortality postburn.