bluuebunny/crossref_metadata_2025 huggingface dataset:
Regional brain signal variability: a novel indicator of pain sensitivity and coping
Authors: Rogachov Anton , Cheng Joshua C. , Erpelding Nathalie , Hemington Kasey S. , Crawley Adrian P. , Davis Karen D.
Published: July 2016

Variability in blood oxygen level–dependent (BOLD) functional magnetic resonance imaging (fMRI) signals reflects the moment-by-moment fluctuations in resting-state fMRI (rs-fMRI) activity within specific areas of the brain. Regional BOLD signal variability was recently proposed to serve an important functional role in the efficacy of neural systems because of its relationship to behavioural performance in aging and cognition studies. We previously showed that individuals who better cope with pain have greater fluctuations in interregional functional connectivity, but it is not known whether regional brain signal variability is a mechanism underlying pain coping. We tested the hypothesis that individual pain sensitivity and coping is reflected by regional fMRI BOLD signal variability within dynamic pain connectome–brain systems implicated in the pain experience. We acquired resting-state fMRI and assessed pain threshold, suprathreshold temporal summation of pain, and the impact of pain on cognition in 80 healthy right-handed individuals. We found that regional BOLD signal variability: (1) inversely correlated with an individual's temporal summation of pain within the ascending nociceptive pathway (primary and secondary somatosensory cortex), default mode network, and salience network; (2) was correlated with an individual's ability to cope with pain during a cognitive interference task within the periaqueductal gray, a key opiate-rich brainstem structure for descending pain modulation; and (3) provided information not captured from interregional functional connectivity. Therefore, regional BOLD variability represents a pain metric with potential implications for prediction of chronic pain resilience vs vulnerability.
Increased cutaneous miR-let-7d expression correlates with small nerve fiber pathology in patients with fibromyalgia syndrome
Authors: Leinders Mathias , Doppler Kathrin , Klein Thomas , Deckart Maximiliane , Rittner Heike , Sommer Claudia , Üçeyler Nurcan
Published: July 2016

Fibromyalgia syndrome (FMS) is a chronic widespread pain condition probably comprising subgroups with different underlying pathomechanisms. There is increasing evidence for small nerve fiber impairment in subgroups of patients with FMS. MicroRNAs (miRNAs) regulate molecular factors determining nerve de- and re-generation. We investigated whether systemic and cutaneous miRNA expression in patients with FMS is related to small nerve fiber pathology. We confirmed previous findings of disturbed small fiber function and reduced intraepidermal nerve fiber density in subgroups of patients with FMS. We found 51 aberrantly expressed miRNAs in white blood cells of patients with FMS, of which miR-let-7d correlated with reduced small nerve fiber density in patients with FMS. Furthermore, we demonstrated miR-let-7d and its downstream target insulin-like growth factor-1 receptor as being aberrantly expressed in skin of patients with FMS with small nerve fiber impairment. Our study gives further evidence of small nerve fiber pathology in FMS subgroups and provides a missing link in the pathomechanism that may lead to small fiber loss in subgroups of patients with FMS.
A Quality Improvement Project to Increase Breast Milk Expression
Authors: Connolly Mary Ellen , Buckley Kathleen M.
Published: July 2016

Breast milk is recognized as the ideal nutrition for all infants especially for infants in the neonatal intensive care unit (NICU). Breast milk diet for critically ill infants is associated with decreased septic events and length of stay and reduced risk of surgical necrotizing enterocolitis.

Purpose

This quality improvement project focused on the development of a breast pumping program for mothers with infants in the NICU.

Methods

NICU nurse breast milk champions received education on benefits of breast milk and key factors in maintaining adequate milk supply. Champions engaged mothers in conversations to provide support and used a “Coming to Volume Assessment” tool as a guide to assess pumping effectiveness. Champions were interviewed about the benefits, ease of use of assessment tool, and future directions for the pumping program.

Results

Daily contact with the bedside nurse had a positive effect on breast milk expression rates. Six of 14 mothers, who met with a champion greater than three times in a 2-week period, reached goal volumes. Average maximum milk produced was 836.6 ml ( SD = 228.5 ml, 95% confidence interval [596, 1076]) on infants’ eighth day of life. Champions described the program as a positive experience for the mothers and themselves and the tool as easy to use. They also endorsed continued implementation of the pumping program.

Conclusions

A pumping program in the NICU that incorporates staff education and use of the “Coming to Volume Assessment” tool with frequent dialogue with mothers to evaluate effectiveness of breast milk expression can aide in the promotion of breast milk expression.
Evaluating the Efficacy and Safety of Epidural Analgesia for Postoperative Pain Management in Neonates/Infants Undergoing Abdominal or Thoracic Surgery
Authors: Duran Melissa S. , Meeker Tamara M. , Rintoul Natalie E. , Maxwell Lynne G.
Published: July 2016

Introduction

The purpose of this study was to evaluate the efficacy and safety of epidural analgesia in neonates/infants after open abdominal or thoracic surgery. Efficacy was measured by recorded pain score and need for additional continuous opioid. Safety was measured by length of time infusion was administered, complications, and adverse events.

Methods

This study was a nonexperimental, descriptive, retrospective design conducted in the newborn/infant intensive care unit at an urban quaternary care pediatric hospital. Subjects were neonates/infants 0–12 months admitted after abdominal or thoracic surgery with an epidural for postoperative pain management.

Results

Ninety-four neonates/infants were identified. Patients received a continuous intravenous opioid, in addition to the epidural, 45% of the time. There was no statistically significant correlation of the addition of a continuous opioid infusion with gender ( p = .83), gestational age ( p = .59), or race ( p = .98). The surgical site was statistically significant, with infants who had a thoracotomy requiring a continuous opioid infusion 24% of the time versus 67% of the time in those who had a laparotomy ( p = .0003). There were minor complications related to epidurals 21% of the time and no adverse events. Regardless of the need for a continuous opioid infusion, pain scores were greater for all patients between 8 and 16 hours postoperatively.

Discussion

Epidural analgesia was shown to be safe and effective in surgical neonates/infants. Epidurals were most effective as monotherapy in neonates/infants after thoracotomies. The addition of a continuous opioid should be considered in all neonates/infants after laparotomies. The results of this study will help guide practice in the future, increase patient safety, and improve postoperative outcomes.
Combination Therapy of All-Trans Retinoic Acid With Ursodeoxycholic Acid in Patients With Primary Sclerosing Cholangitis
Authors: Assis David N. , Abdelghany Osama , Cai Shi-Ying , Gossard Andrea A. , Eaton John E. , Keach Jill C. , Deng Yanhong , Setchell Kenneth D.R. , Ciarleglio Maria , Lindor Keith D. , Boyer James L.
Published: July 2016

Goals:

To perform an exploratory pilot study of all-trans retinoic acid (ATRA) combined with ursodeoxycholic acid (UDCA) in patients with primary sclerosing cholangitis (PSC).

Background:

PSC is a progressive disorder for which there is no accepted therapy. Studies in human hepatocyte cultures and in animal models of cholestasis indicate that ATRA might have beneficial effects in cholestatic disorders.

Study:

ATRA (45 mg/m2/d, divided and given twice daily) was combined with moderate-dose UDCA in patients with PSC who had incomplete response to UDCA monotherapy. The combination was administered for 12 weeks, followed by a 12-week washout in which patients returned to UDCA monotherapy. We measured alkaline phosphatase (ALP), alanine aminotransferase (ALT), bilirubin, cholesterol, bile acids, and the bile acid intermediate 7α-hydroxy-4-cholesten-3-one (C4) at baseline, week 12, and after washout.

Results:

Fifteen patients completed 12 weeks of therapy. The addition of ATRA to UDCA reduced the median serum ALP levels (277±211 to 243±225 U/L, P=0.09) although this, the primary endpoint, did not reach significance. In contrast, median serum ALT (76±55 to 46±32 U/L, P=0.001) and C4 (9.8±19 to 7.9±11 ng/mL, P=0.03) levels significantly decreased. After washout, ALP and C4 levels nonsignificantly increased, whereas ALT levels significantly increased (46±32 to 74±74, P=0.0006), returning to baseline.

Conclusions:

In this human pilot study, the combination of ATRA and UDCA did not achieve the primary endpoint (ALP); however, it significantly reduced ALT and the bile acid intermediate C4. ATRA appears to inhibit bile acid synthesis and reduce markers of inflammation, making it a potential candidate for further study in PSC (NCT 01456468).
Upper Versus Lower Endoscopy in the Diagnosis of Graft-Versus-Host Disease
Authors: Cloutier Justin , Wall Donna A. , Paulsen Kristjen , Bernstein Charles N.
Published: July 2016

Background and Aim:

The optimal endoscopic approach to patients with suspected gut graft-versus-host disease (GVHD) after hematopoietic stem cell transplantation (HSCT) is uncertain. We aimed to assess the diagnostic yield of upper and lower endoscopies performed in patients post-HSCT.

Methods:

We identified a cohort post-HSCT with acute and chronic GVHD who underwent gastrointestinal endoscopies for GVHD diagnosis. Hospital charts were reviewed and results were stratified according to patients’ symptoms.

Results:

From 1990 to 2013 433 HSCTs were performed. Fifty-six patients underwent 141 endoscopies, of which 117 were done to evaluate for GVHD or an alternative diagnosis. A total of 28/43 (65%) of the lower endoscopies and 41/74 (55%) of the upper endoscopies diagnosed GVHD or an alternative disease process on pathology. A total of 15/43 (35%) of lower endoscopies were flexible sigmoidoscopies, and 11/15 (73%) of these diagnosed GVHD or an alternative diagnosis. Upper endoscopy performed in patients with diarrhea as their only symptom diagnosed GVHD in 44% and an alternative diagnosis in 11%. In comparison, lower endoscopy in patients with only diarrhea diagnosed GVHD in 50%, and 18% offered an alternative diagnosis. Upper endoscopy provided a diagnosis of opportunistic viral and fungal infections of the upper gastrointestinal tract in 7 patients, while lower endoscopy diagnosed pseudomembranous colitis in 2.

Conclusions:

Upper and lower endoscopy had a similar diagnostic yield in patients with known or suspected GVHD involving the gut, even for patients presenting only with diarrhea. Because of its ease and safety upper endoscopy is the preferred initial endoscopic approach in patients with suspected gut GVHD, however flexible sigmoidoscopy is a reasonable other option.
On-treatment and off-treatment efficacy of entecavir in a real-life cohort of chronic hepatitis B patients
Authors: Park Chung-Hwa , Kim Hee Yeon , Lee Sung Won , Song Do Seon , Song Myeong Jun , Kwon Jung Hyun , You Chan Ran , Jang Jeong Won , Kim Chang Wook , Choi Sang Wook , Bae Si Hyun , Choi Jong Young , Yoon Seung Kew
Published: July 2016

Background and aims

Entecavir (ETV) is a potent nucleoside analogue with high genetic barrier to resistance. In this study, real-life clinical experiences in the long-term use of ETV and the durability of its off-treatment effectiveness were analyzed.

Materials and methods

This study was based on a large real-life cohort of 2240 chronic hepatitis B patients treated with ETV between January 2006 and December 2012 using a centralized electronic data repository.

Results

Among 2240 patients, 804 patients were treatment naive and underwent ETV monotherapy. Their mean treatment duration was 712±493 days, with a cumulative proportion of patients achieving HBV DNA less than 300 copies/ml in 85.8, 95.7, and 97.6% at years 1, 2, and 3, respectively. Predictors for earlier virologic response were female sex, lower HBV DNA, higher alanine transaminase, lower platelet count, and HBeAg negativity at baseline. In patients who achieved virologic response and HBeAg loss, the cumulative relapse rate was 91.3% in 2 years after the cessation of treatment. During the treatment, 34 patients developed hepatocellular carcinoma, among whom 30 patients had cirrhosis before treatment initiation. ETV treatment showed efficient virologic response as the treatment duration was extended, but off-treatment efficacy was not durable, and the antiviral treatment showed some limitation in preventing hepatocellular carcinoma among liver cirrhosis patients, implying that treatment cessation should be taken into consideration more carefully.

Conclusion

This study from a real-life cohort may provide data on treating chronic hepatitis B patients more close to everyday clinical practice.
Advances in pediatric cardiac MRI
Authors: Banka Puja , Geva Tal
Published: July 2016

Purpose of review

Spurred by numerous recent technological advances, cardiac MRI (CMR) is now the gold standard for anatomic evaluation, quantitative assessment of chamber size and function, flow quantification, and tissue characterization. This review focuses on recent advances in pediatric and congenital CMR, highlighting recent safety data, and discussing future directions.

Recent findings

CMR has become an important component of risk stratification and procedural planning in numerous congenital and pediatric heart diseases. Innovative approaches to image acquisition and reconstruction are leading the way toward fast, high-resolution, three- and four-dimensional datasets for delineation of cardiac anatomy, function, and flow. In addition, techniques for assessing the composition of the myocardium may help elucidate the pathophysiology of late complications, identify patients at risk for heart failure, and assist in the evaluation of therapeutic strategies.

CMR provides invaluable morphologic, hemodynamic, and functional data that help guide diagnosis, assessment, and management of pediatric and adult congenital heart disease. As imaging techniques advance and data accumulate on the relative and additive value of CMR in patient care, its role in a multimodality approach to the care of this population of patients is becoming clear and is likely to continue to evolve.
Making a heart: advances in understanding the mechanisms of cardiac development
Authors: Dees Ellen , Baldwin H. Scott
Published: July 2016

Purpose of review

The study of cardiac development is critical to inform management strategies for congenital and acquired heart disease. This review serves to highlight some of the advances in this field over the past year.

Recent findings

Three main areas of study are included that have been particularly innovative and progressive. These include more precise gene targeting in animal models of disease and in moving from animal models to human disease, more precise in-vitro models including three-dimensional structuring and inclusion of hemodynamic components, and expanding the concepts of genetic regulation of heart development and disease.

Targeted genetics in animal models are able to make use of tissue and time-specific promotors that drive gene expression or knockout with high specificity. In-vitro models can recreate flow patterns in blood vessels and across cardiac valves. Noncoding RNAs, once thought to be of no consequence to gene transcription and translation, prove to be key regulators of genetic function in health and disease.
Early Posthepatoportoenterostomy Predictors of Native Liver Survival in Biliary Atresia
Authors: Nightingale Scott , Stormon Michael O. , O'Loughlin Edward V. , Shun Albert , Thomas Gordon , Benchimol Eric I. , Day Andrew S. , Adams Susan , Shi Edward , Ooi Chee Y. , Kamath Binita M. , Fecteau Annie , Langer Jacob C. , Roberts Eve A. , Ling Simon C. , Ng Vicky L.
Published: July 2016

Objectives:

Most infants with biliary atresia (BA) require liver transplantation (LT) after hepatoportoenterostomy (HPE), including those who initially clear jaundice. The aim of the present study was to identify clinical and routine laboratory factors in infants with BA post‐HPE that predict native liver survival at 2 years.

Methods:

A retrospective cohort study was conducted in 217 patients with BA undergoing HPE in Sydney, Australia and Toronto, Canada between January 1986 and July 2009. Univariate and multivariate logistic regression using backwards‐stepwise elimination identified variables at 3 months after HPE most associated with 2‐year native liver survival.

Results:

Significant variables (P < 0.05) on univariate analysis included serum total bilirubin (TB) and albumin at 3 months post‐HPE, bridging fibrosis or cirrhosis on initial liver biopsy, ascites of <3 months post‐HPE, type 3 BA anatomy, age at HPE of >45 days, change in length z scores within 3 months of HPE, and center. On multivariate analysis, TB (P < 0.0001) and albumin (P = 0.02) at 3 months post‐HPE, and center (P = 0.0003) were independently associated with native liver survival. Receiver operating characteristic analysis revealed an optimal cut‐off value of TB <74 μmol/L (4.3 mg/dL; area under the receiver operating characteristic curve 0.8990) and serum albumin level >35 g/L (3.5 mg/dL; area under the receiver operating characteristic curve 0.7633) to predict 2‐year native liver survival. TB and albumin levels 3 months post‐HPE defined 3 groups (1: TB ⩽74 μmol/L, albumin >35 g/L; 2: TB ⩽74 μmol/L, albumin ⩽35 g/L; 3: TB >74 μmol/L) with distinct short‐ and long‐term native liver survival rates (log‐rank P < 0.001). Length z scores 3 months post‐HPE were poorer for group 2 than group 1 (−0.91 vs −0.30, P = 0.0217) with similar rates of coagulopathy.

Conclusions:

Serum TB and albumin levels 3 months post‐HPE independently predicted native liver survival in BA when controlling for center. Serum albumin level <35 g/L in infants with BA who were no longer jaundiced at 3 months post‐HPE was a poor prognostic indicator. Poorer linear growth and absence of significant coagulopathy suggest a role for early aggressive nutritional therapy in this group.
Oral Tocofersolan Corrects or Prevents Vitamin E Deficiency in Children With Chronic Cholestasis
Authors: Thébaut Alice , Nemeth Antal , Le Mouhaër Jeannie , Scheenstra René , Baumann Ulrich , Koot Bart , Gottrand Fredéric , Houwen Roderick , Monard Laure , de Micheaux Sylvie Lafaye , Habes Dalila , Jacquemin Emmanuel
Published: July 2016

Objectives:

D‐Alpha‐tocopheryl polyethylene glycol 1000 succinate (Tocofersolan, Vedrop), has been developed in Europe to provide an orally bioavailable source of vitamin E in children with cholestasis. The aim was to analyze the safety/efficacy of Vedrop in a large group of children with chronic cholestasis.

Methods:

Two hundred seventy‐four children receiving Vedrop for vitamin E deficiency or for its prophylaxis were included from 7 European centers. Median age at treatment onset was 2 months and median follow‐up was 11 months. Vedrop was prescribed at a daily dose of 0.34 mL/kg (25 IU/kg) of body weight. Three methods were used to determine a sufficient serum vitamin E status: vitamin E, vitamin E/(total cholesterol), vitamin E/(total cholesterol + triglycerides).

Results:

Before Vedrop therapy, 51% of children had proven vitamin E deficiency, 30% had normal vitamin E status and 19% had an unknown vitamin E status. During the first months of treatment, vitamin E status was restored in the majority of children with insufficient levels at baseline (89% had a normal status at 6 months). All children with a normal baseline vitamin E status had a normal vitamin E status at 6 months. Among children with an unknown vitamin E status at baseline, 93% had a normal vitamin E status at 6 months. A sufficient vitamin E status was observed in 80% of children with significant cholestasis (serum total bilirubin >34.2 μmol/L). No serious adverse reaction was reported.

Conclusions:

Vedrop seems a safe and effective oral formulation of vitamin E that restores and/or maintains sufficient serum vitamin E level in the majority of children with cholestasis, avoiding the need for intramuscular vitamin E injections.
Guideline for the Evaluation of Cholestatic Jaundice in Infants
Authors: Fawaz Rima , Baumann Ulrich , Ekong Udeme , Fischler Björn , Hadzic Nedim , Mack Cara L. , McLin Valérie A. , Molleston Jean P. , Neimark Ezequiel , Ng Vicky L. , Karpen Saul J.
Published: July 2016

Cholestatic jaundice in infancy affects approximately 1 in every 2500 term infants and is infrequently recognized by primary providers in the setting of physiologic jaundice. Cholestatic jaundice is always pathologic and indicates hepatobiliary dysfunction. Early detection by the primary care physician and timely referrals to the pediatric gastroenterologist/hepatologist are important contributors to optimal treatment and prognosis. The most common causes of cholestatic jaundice in the first months of life are biliary atresia (25%–40%) followed by an expanding list of monogenic disorders (25%), along with many unknown or multifactorial (eg, parenteral nutrition‐related) causes, each of which may have time‐sensitive and distinct treatment plans. Thus, these guidelines can have an essential role for the evaluation of neonatal cholestasis to optimize care. The recommendations from this clinical practice guideline are based upon review and analysis of published literature and the combined experience of the authors. The committee recommends that any infant noted to be jaundiced after 2 weeks of age be evaluated for cholestasis with measurement of total and direct serum bilirubin, and that an elevated serum direct bilirubin level (direct bilirubin levels >1.0 mg/dL or >17 μmol/L) warrants timely consideration for evaluation and referral to a pediatric gastroenterologist or hepatologist. Of note, current differential diagnostic plans now incorporate consideration of modern broad‐based next‐generation DNA sequencing technologies in the proper clinical context. These recommendations are a general guideline and are not intended as a substitute for clinical judgment or as a protocol for the care of all infants with cholestasis. Broad implementation of these recommendations is expected to reduce the time to the diagnosis of pediatric liver diseases, including biliary atresia, leading to improved outcomes.
Maternal Infections, Antibiotics, and Paracetamol in Pregnancy and Offspring Celiac Disease
Authors: Mårild Karl , Kahrs Christian R. , Tapia German , Stene Lars C. , Størdal Ketil
Published: July 2016

Objectives:

Infections in pregnancy are common, may affect fetal development, and have been linked to offspring autoimmunity. We aimed to determine whether maternal infections, the use of antibiotics, and use of paracetamol in pregnancy are associated with the risk of offspring celiac disease (CD).

Methods:

The nationwide Norwegian Mother and Child Cohort Study includes 84,274 children born in the period from 2000 to 2009 with prospectively collected questionnaire data on maternal infections and medication use in pregnancy. CD was identified through questionnaires and the Norwegian Patient Register. Logistic regression yielded odds ratios adjusted for age and sex (aORs).

Results:

During a median follow‐up of 8.5 years, 617 children (0.7%) were diagnosed with CD. The aOR for offspring CD per increase in number of maternal infections was 1.07 (95% confidence interval [CI] = 1.01–1.13), but not significantly increased for categories 1 infection (1.01 [95% CI = 0.82–1.25]) and ≥2 infections (1.22 [95% CI = 1.00–1.49]) versus no infection. We found the same pattern for respiratory tract infections, but not for gastrointestinal infections. The aORs were broadly consistent across pregnancy periods of exposure. The use of antibiotics and paracetamol was, compared with no use, not associated with offspring CD (aOR = 1.16 [95% CI = 0.94–1.43] and aOR = 1.13 [95% CI = 0.96–1.33], respectively; P values for trend >0.2).

Conclusions:

In this large pregnancy cohort we found no clear association between maternal infections in pregnancy and offspring CD, but considering the marginal significance in some of our results maternal infections cannot be ruled out as a risk factor. Reassuringly for both parents‐to‐be and clinicians, the use of antibiotics and paracetamol in pregnancy was not a significant risk factor.
Anoxic Brain Injury Secondary to Metabolic Encephalopathy
Authors: Ferris Lyndsey M. , Engelke Carla
Published: July 2016

Purpose

To discuss the clinical case of a patient suffering visual dysfunction secondary to a metabolic brain injury, the patient’s visual rehabilitative treatment, and outcomes.

Case Report

A 24-year-old Caucasian male presented to the Southern Arizona Veteran’s Affairs Healthcare System’s Traumatic Brain Injury (TBI) eye clinic for evaluation and treatment of visual dysfunction secondary to an anoxic brain injury suffered 4 months before. Symptoms included persistent right homonymous hemianopia, oculomotor dysfunction, and a visual information processing deficit. After 5 weeks of vision rehabilitation, the patient was reassessed and displayed significant improvement in both signs and symptoms.

Conclusions

The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is a metabolic syndrome that causes hyponatremia and, in severe cases, encephalopathy and anoxic brain injury. Damage to the visual pathways can produce visual field, ocular motility, and binocular vision deficits. Comprehensive treatment including rehabilitative vision therapy bolstering the natural neuroplasticity process can provide improvements in patients’ quality of life.
Global Trends in Extracorporeal Membranous Oxygenation Use and Survival of Patients With Influenza-Associated Illness
Authors: de St. Maurice Annabelle M. , Bridges Brian C. , Rycus Peter T. , Fonnesbeck Christopher J. , Fleming Geoffrey M. , Halasa Natasha B.
Published: July 2016

Objectives:

To determine the overall use of extracorporeal membranous oxygenation for influenza-associated illness and describe risk factors associated with mortality in these patients.

Design:

Retrospective multicenter cohort analysis.

Setting:

The international Extracorporeal Life Support Organization database was queried for patients with influenza-associated illness on extracorporeal membranous oxygenation from 1992 to 2014.

Patients:

In total, 1,654 patients with influenza-associated illness on extracorporeal membranous oxygenation.

Interventions:

None.

Measurements and Main Results:

Demographic and clinical data collected included age, type of support, duration of support, type of microbial codetection, complications, and survival status at discharge. The primary outcome of interest was survival to hospital discharge. From 1992 to 2014, 1,688 (3%) of the 61,336 extracorporeal membranous oxygenation runs were due to influenza-associated illness reflecting 1,654 unique patients: 30 (2%) were neonates, 521 (31%) were pediatric patients, and 1,103 (67%) were adults. Extracorporeal membranous oxygenation use for influenza-associated illness increased from 1992 to 2014, with a marked increase in use after the 2009 H1N1 pandemic. Survival to hospital discharge of patients with influenza-associated illness on extracorporeal membranous oxygenation was 63% and was not affected by bacterial codetection. However, when patients with Staphylococcus aureus codetection were compared with those with another bacterial codetection, their survival to hospital discharge was significantly lower (52% vs 67%; p < 0.01). In a logistic regression model, the effect of S. aureus on in-hospital mortality varied by age group, with younger patients with S. aureus having increased in-hospital mortality.

Conclusions:

Extracorporeal membranous oxygenation use for individuals with influenza increased over time, particularly after the 2009 H1N1 pandemic, most notably among older adults. Survival to hospital discharge for patients with influenza on extracorporeal membranous oxygenation was slightly higher than survival to hospital discharge for respiratory illness due to any cause. Bacterial codetection was common among patients with influenza on extracorporeal membranous oxygenation and was associated with increased days on extracorporeal membranous oxygenation but not increased mortality. Only S. aureus codetection in children was associated with increased in-hospital mortality.
Circuit Lifetime With Citrate Versus Heparin in Pediatric Continuous Venovenous Hemodialysis*
Authors: Zaoral Tomáš , Hladík Michal , Zapletalová Jana , Trávníček Bořek , Gelnarová Eliška
Published: July 2016

Objectives:

To determine if there is a difference between regional citrate and global heparinized anticoagulation on circuit lifetimes during continuous venovenous hemodialysis in children.

Design:

Prospective “cross-over” trial.

Setting:

PICU, Department of Pediatrics, University Hospital Ostrava.

Patients:

Children 0–18 years old.

Interventions:

From 2009 to 2014, 63 eligible children (age, 89.24 ± 62.9 mo; weight, 30.37 ± 20.62 kg) received at least 24 hours of continuous venovenous hemodialysis. Each child received four continuous venovenous hemodialysis circuits with anticoagulants in the following order: heparin, citrate, heparin, citrate. Circuit life ended when transmembrane pressure was greater than or equal to 250 mm Hg for more than 60 minutes.

Measurements and Main results:

The total mean circuit lifetime was 39.75 ± 10.73 hours. Citrate had a significantly longer median circuit lifetime (41.0 hr; CI, 37.6–44.4) than heparin (36.0 hr; CI, 35.4–36.6; p = 0.0001). Mortality was 33.33%. Circuit lifetime was significantly correlated to patient age (r = 0.606), weight (r = 0.763), and blood flow rate (r = 0.697). Transfusion rates (units of red cells per circuit of continuous venovenous hemodialysis) were 0.17 (0.0–1.0) with citrate and 0.36 (0.0–2.0) with heparin (p = 0.002).

Conclusions:

We showed in our study that citrate provided significantly longer circuit lifetimes than heparin for continuous venovenous hemodialysis in children. Citrate was superior to heparin for the transfusion requirements. Citrate was feasible and safe in children and infants.
Development and Initial Validation of the Pediatric Neuromuscular Recovery Scale
Authors: Ardolino Elizabeth M. , Mulcahey Mary Jane , Trimble Shelley , Argetsinger Laura , Bienkowski Marci , Mullen Courtney , Behrman Andrea L.
Published: July 2016

Purpose:

The Neuromuscular Recovery Scale (NRS) was developed to assess the capacity of adults' post-spinal cord injury (SCI) to perform functional tasks without compensation. Application of the NRS to children has been challenging. The purpose of this study was to develop and complete the initial validation of a pediatric version of the NRS.

Methods:

First, the investigative team developed a draft Pediatric NRS. Next, a Delphi method was used to amend the draft by 12 pediatric experts. Finally, the revised Pediatric NRS was field-tested on a sample of children with SCI (n = 5) and without (n = 7).

Results:

After the Delphi process and field testing, the Pediatric NRS consists of 13 items scored on a 12-point scale. All items, except 1, achieved 80% agreement by experts.

Conclusions:

This is the first step in development and validation of a pediatric SCI scale that evaluates neuromuscular capacity, in the context of pediatric function, without compensation.
Caring for Patients With Severe and Enduring Eating Disorders (SEED): Certification, Harm Reduction, Palliative Care, and the Question of Futility
Authors: WESTMORELAND PATRICIA , MEHLER PHILLIP S.
Published: July 2016

Anorexia nervosa is a serious mental illness with a high mortality rate. The body image distortion inherent to this disorder and the impaired judgment and cognition due to malnutrition frequently result in patients refusing treatment. Treatment is most effective if patients are treated early in the course of their illness and undergo a full course of treatment. Involuntary treatment may therefore be both life-saving and critical to recovery. Between April 2012 and March 2016, 109 patients (5.2% of patients admitted to the Eating Recovery Center in Denver, CO) were certified, 39% of whom were transferred from the ACUTE Center for Eating Disorders at Denver Health Medical Center. Of these 109 certified patients, 31% successfully completed treatment, and 42% returned for a further episode of care; 24% of the certifications were terminated as involuntary treatment was not found to be helpful. Conclusions supported by these data are that patients with anorexia nervosa who are the most medically ill often require involuntary treatment. In addition, although many patients who are certified successfully complete treatment, involuntary treatment is not helpful approximately 25% of the time. Many of the patients for whom certification is ineffective are those who suffer from a lifetime of illness that is severe and enduring. Patients with severe and enduring eating disorders (SEED) typically undergo cyclical weight restoration and weight loss. Many of these patients question the value of serial treatments, especially when they have few (if any) illness-free intervals. Patients, families, and treating physicians often wish to explore other models of care, including harm reduction and palliative care. In addition, patients with SEED may also contemplate whether a compassionate death would be better than an ongoing lifetime of suffering. In this review, we outline arguments for and against the concept of futility in SEED, and explore whether (or when) patients are competent to make the decision to die.
Antipsychotic Medication Prescribing Practices Among Adult Patients Discharged From State Psychiatric Inpatient Hospitals
Authors: ORTIZ GLORIMAR , HOLLEN VERA , SCHACHT LUCILLE
Published: July 2016

Objectives:

The goal of this study was to explore antipsychotic medication prescribing practices in a sample of 86,034 patients discharged from state psychiatric inpatient hospitals and to find the prevalence of patients discharged with no antipsychotic medications, on antipsychotic monotherapy, and on antipsychotic polypharmacy. For patients discharged on antipsychotic polypharmacy, the study explored the adjusted rates of antipsychotic polypharmacy, the reasons patients were discharged on antipsychotic polypharmacy, the proportion of antipsychotic polypharmacy by mental health disorder, and the characteristics associated with being discharged on antipsychotic polypharmacy.

Methods:

This cross-sectional study analyzed all discharges for adult patients (18 to 64 y of age) from state psychiatric inpatient hospitals between January 1 and December 31, 2011. The relationship among variables was explored using χ2, t test, and analysis of variance. Logistic regression was used to determine predictors of antipsychotic polypharmacy.

Results:

The prevalence of antipsychotic polypharmacy was 12%. Of the discharged patients receiving at least 1 antipsychotic medication (adjusted rate), 18% were on antipsychotic polypharmacy. The strongest predictors of antipsychotic polypharmacy being prescribed were having a diagnosis of schizophrenia and a length of stay of 90 days or more. Patients were prescribed antipsychotic polypharmacy primarily to reduce their symptoms.

Conclusions:

Antipsychotic polypharmacy continues at a high enough rate to affect nearly 10,000 patients with a diagnosis of schizophrenia each year in state psychiatric inpatient hospitals. Further analysis of the clinical presentation of these patients may highlight particular aspects of the illness and its previous treatment that are contributing to practices outside the best-practice guideline. An increased understanding of trend data, patient characteristics, and national benchmarks provides an opportunity for decision-making that is sensitive to the patient’s needs and cognizant of the hospital’s accomplishments in adopting best practices.
New Laboratory Tests in Psychiatry: What Should Mental Health Practitioners Know?
Authors: PRESKORN SHELDON H.
Published: July 2016

In recent years, a significant upsurge in the development of new laboratory tests for use in psychiatric practice has occurred. This column discusses salient questions about those tests to help mental health practitioners better understand the potential role of such tests in their clinical practices. These issues are particularly relevant for mental health professionals who prescribe psychotropic medications. The column does not provide an exhaustive list of tests nor does it review the pros and cons of any specific company’s tests.
Selective Serotonin Reuptake Inhibitor/Serotonin-Norepinephrine Reuptake Inhibitor Use as a Predictor of a Diagnosis of Restless Legs Syndrome
Authors: BAILEY ANNE L. , MAKELA EUGENE H. , ASBERG KIA
Published: July 2016

Objective/Background:

Because restless legs syndrome (RLS) is a problematic syndrome, demonstrating an association between use of selective serotonin reuptake inhibitors (SSRIs)/serotonin-norepinephrine reuptake inhibitors (SNRIs) and RLS may help direct patient care. The goals of this study were (1) to establish the incidence of RLS in mental health patients being treated with SSRIs or SNRIs in a local Veterans Affairs medical center and (2) to evaluate the frequency with which certain SSRIs or SNRIs are associated with RLS and the trend in frequency of the diagnosis since the revision of the criteria for RLS offered by the International Restless Leg Syndrome Study Group (IRLSSG), the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and the International Classification of Sleep Disorders, Revised (ICSD-3).

Methods:

A retrospective chart review was used to evaluate the number of patients receiving SSRI/SNRI therapy with and without a diagnosis of RLS, with the date of the RLS diagnosis and initiation of SSRI/SNRI therapy noted. The frequency with which certain SSRIs/SNRIs were associated with RLS, and the frequency of RLS diagnoses since January 2012 were also noted. Descriptive statistics and logistic regression were used for data analysis.

Results:

A total of 254 charts were reviewed. A majority of the patients (89.8%) were male, and 14 (5.5%) were diagnosed with RLS. A logistic regression equation approached significance in predicting RLS (P=0.053). Age and sex emerged as significant predictors of RLS. The prevalence of any individual SSRI or SNRI being associated with RLS was indeterminable. No difference was seen in the number of RLS diagnoses since the refining of the IRLSSG, DSM-5, and ICSD-3 criteria.

Conclusions:

The use of SSRIs/SNRIs does not seem to be associated with a diagnosis of RLS. In addition, the diagnosis of RLS does not seem to have become more common since the revision of the diagnostic criteria for the disorder.
The Effect of Borderline Personality Pathology on Outcome of Cognitive Behavior Therapy
Authors: LIS ERIC , MYHR GAIL
Published: July 2016

Cognitive behavioral therapy (CBT) is an evidence-based psychotherapeutic approach which has been shown to be an effective intervention for most psychiatric disorders. There are conflicting data in the literature regarding whether a comorbid personality disorder worsens the prognosis of CBT for depression, anxiety, and other complaints. This study examined data collected before and after courses of CBT for patients with significant borderline (n=39, 11.5%) or obsessive-compulsive (n=66, 19.4%) personality pathology or no personality disorder (n=235, 69.1%). A diagnosis of personality pathology was not a significant predictor of outcome in CBT as measured by the reliable change index. However, patients with borderline personality pathology did demonstrate a greater response to CBT than other patients in terms of improvement on several measures of symptoms. Patients with borderline personality pathology appear to enter therapy with greater subjective depression and interpersonal difficulty than other patients but achieve larger gains during therapy. Implications and directions for future research are discussed.
Assessment of Response to Providing Health-related Information in a Community Psychiatry Outpatient Setting
Authors: PAWAR DEEPA , MOJTABAI RAMIN , GOLDMAN AVIVA , BATKIS DONNA , MALLOY KATHLEEN , CULLEN BERNADETTE
Published: July 2016

The objective of this study was to assess the subjective responses of patient and staff to the provision of health-related information in an outpatient psychiatric clinic. Simple educational information on healthy eating, exercising, and smoking cessation was provided in the waiting area of a clinic over the course of a year. This information took the form of educational handouts, educational DVDs, and monthly “special events” such as a poster competition for smoking cessation. In addition, patients were given an opportunity to attend free nutritional counseling sessions. Also, when needed, staff assisted patients in making appointments with primary care physicians. At the end of the year, a survey was distributed to patients and staff to assess the perceived benefits of the initiative. The majority of the 79 patients who completed the survey (n=60, 76%) had used the information provided, 95% of whom (n=57) had made some behavioral change, with 13% of the total survey respondents indicating that they had quit smoking. Ninety percent of the surveyed providers (18/20) felt that the initiative had had a positive impact on their patients. These results suggest that simple, low cost health and wellness initiatives in conjunction with an enthusiastic expenditure of a relatively small amount of staff time have the potential to have a positive impact on individuals attending an outpatient psychiatric clinic.
Childhood Exposure to Violence and Chronic Physical Conditions in a National Sample of US Adolescents
Authors: McLaughlin Katie A. , Basu Archana , Walsh Kate , Slopen Natalie , Sumner Jennifer A. , Koenen Karestan C. , Keyes Katherine M.
Published: July 2016

Objectives

Exposure to violence is associated with chronic physical conditions in adults. Although violence exposure is common among youths, it is unknown whether violence is associated with chronic physical conditions in childhood and adolescence. We examined the associations of violence exposure with chronic physical conditions in a population-representative sample of US adolescents and determined whether associations were explained by co-occurring mental disorders.

Methods

Data were drawn from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A), a national cross-sectional survey of 6,483 adolescents (ages 13–17). Lifetime exposure to violence; Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition mood, anxiety, and substance disorders; and self-reported arthritis, frequent headaches, back or neck problems, other chronic pain, asthma, and allergies were assessed.

Results

One in 4 (24.99%) adolescents reported exposure to violence. Violence exposure was associated with elevated odds of back/neck pain, headaches, chronic pain, allergies, and asthma (odds ratio [OR], 1.5–2.1; 95% confidence interval [CI], 1.1–3.5) after adjustment for sociodemographics, socioeconomic status, and lifetime mental disorders. Regarding new onsets, violence exposure was associated with greater hazard for subsequent first-onset only of back/neck pain (hazard ratio, 1.9; 95% CI, 1.2–3.0) and headaches (hazard ratio, 1.4; 95% CI, 1.1–1.8), and these associations were explained by early-onset mental disorders.

Conclusions

Childhood violence exposure is associated with chronic physical conditions that emerge early in the life course, although associations are stronger for prevalent than incident conditions. Violence exposure predicts incident pain conditions only, and these associations are explained by mental disorders that begin after violence exposure. Interventions and policies aimed at preventing violence and detecting and treating early-onset mental disorders have the potential to reduce morbidity, mortality, and health disparities beginning early in development.
Effects of Noninvasive Brain Stimulation on Food Cravings and Consumption: A Meta-Analytic Review
Authors: Lowe Cassandra J. , Vincent Corita , Hall Peter A.
Published: July 2016

Objective

The primary aim of this review was to evaluate the effectiveness of noninvasive brain stimulation to the dorsolateral prefrontal cortex (dlPFC) for modulating appetitive food cravings and consumption in laboratory (via meta-analysis) and therapeutic (via systematic review) contexts.

Methods

Keyword searches of electronic databases (PubMed, Scopus, Web of Science, PsychoInfo, and EMBASE) and searches of previous quantitative reviews were used to identify studies (experimental [single-session] or randomized trials [multi-session]) that examined the effects of neuromodulation to the dlPFC on food cravings (n = 9) and/or consumption (n = 7). Random-effects models were employed to estimate the overall and method-specific (repetitive transcranial magnetic stimulation [rTMS] and transcranial direct current stimulation [tDCS]) effect sizes. Age and body mass index were examined as potential moderators. Two studies involving multisession therapeutic stimulation were considered in a separate systematic review.

Results

Findings revealed a moderate-sized effect of modulation on cravings across studies (g, −0.516; p = .037); this effect was subject to significant heterogeneity (Q, 33.086; p < .001). Although no statistically significant moderators were identified, the stimulation effect on cravings was statistically significant for rTMS (g, −0.834; p = .008) but not tDCS (g, −0.252; p = .37). There was not sufficient evidence to support a causal effect of neuromodulation and consumption in experimental studies; therapeutic studies reported mixed findings.

Conclusions

Stimulation of the dlPFC modulates cravings for appetitive foods in single-session laboratory paradigms; when estimated separately, the effect size is only significant for rTMS protocols. Effects on consumption in laboratory contexts were not reliable across studies, but this may reflect methodological variability in delivery of stimulation and assessment of eating behavior. Additional single- and multi-session studies assessing eating behavior outcomes are needed.