bluuebunny/crossref_metadata_2025 huggingface dataset:
Association Between Resilience and Family Member Psychologic Symptoms in Critical Illness
Authors: Sottile Peter D. , Lynch Ylinne , Mealer Meredith , Moss Marc
Published: April 2016

Objectives:

There are increased rates of depression, anxiety, and stress disorders in families of critically ill patients. Interventions directed at family members may help their ability to cope with this stress. Specifically, resilience is a teachable psychologic construct describing a person’s ability to adapt to traumatic situations. Resilience can inherently assist individuals to diminish adverse psychologic outcomes. Consequently, we determined the relationship between resilience and symptoms of depression, anxiety, and acute stress in family members of critically ill patients.

Design:

This is a cross-sectional study.

Setting:

Three medical ICUs were screened by study staff.

Patients:

Family members of ICU patients admitted for greater than 48 hours were approached for enrollment.

Interventions:

The Connor-Davidson Resilience Scale was used to stratify family members as resilient or nonresilient.

Measurements and Main Results:

The Hospital Anxiety and Depression Scale, Impact of Event Scale-Revised, and Family Satisfaction in the ICU were collected prior to ICU discharge to measure symptoms of depression, anxiety, and acute stress, as well as satisfaction with care. One-hundred and seventy family members were enrolled. Seventy-eight family members were resilient. Resilient family members had fewer symptoms of anxiety (14.2% vs 43.6%; p < 0.001), depression (14.1% vs 44.9%; p < 0.001), and acute stress (12.7% vs 36.3%; p = 0.001). Resilient family members were more satisfied with care in the ICU (76.7 vs 70.8; p = 0.008). Resilience remained independently associated with these outcomes after adjusting for family member age and gender, as well as the patient’s need for mechanical ventilation.

Conclusions:

When caring for the critically ill, resilient family members have fewer symptoms of depression, anxiety, and acute stress. Resilient families were generally better satisfied with the care delivered. These data suggest that interventions aimed at increasing resilience may improve a family member’s experience in the ICU.
Role of Strain Rate in the Pathogenesis of Ventilator-Induced Lung Edema*
Authors: Protti Alessandro , Maraffi Tommaso , Milesi Marta , Votta Emiliano , Santini Alessandro , Pugni Paola , Andreis Davide T. , Nicosia Francesco , Zannin Emanuela , Gatti Stefano , Vaira Valentina , Ferrero Stefano , Gattinoni Luciano
Published: April 2016

Objective:

Lungs behave as viscoelastic polymers. Harms of mechanical ventilation could then depend on not only amplitude (strain) but also velocity (strain rate) of lung deformation. Herein, we tested this hypothesis.

Design:

Laboratory investigation.

Setting:

Animal unit.

Subjects:

Thirty healthy piglets.

Interventions:

Two groups of animals were ventilated for 54 hours with matched lung strains (ratio between tidal volume and functional residual capacity) but different lung strain rates (ratio between strain and inspiratory time). Individual strains ranged between 0.6 and 3.5 in both groups. Piglets ventilated with low strain rates had an inspiratory-to-expiratory time ratio of 1:2–1:3. Those ventilated with high strain rates had much lower inspiratory-to-expiratory time ratios (down to 1:9). Respiratory rate was always 15 breaths/min. Lung viscoelastic behavior, with ventilator setting required per protocol, was “quantified” as dynamic respiratory system hysteresis (pressure-volume loop [in Joules]) and stress relaxation (airway pressure drop during an end-inspiratory pause [in cm H2O]). Primary outcome was the occurrence of pulmonary edema within 54 hours.

Measurements and Main Results:

On average, the two study groups were ventilated with well-matched strains (2.1 ± 0.9 vs 2.1 ± 0.9; p = 0.864) but different strain rates (1.8 ± 0.8 vs 4.6 ± 1.5 s–1; p < 0.001), dynamic respiratory system hysteresis (0.6 ± 0.3 vs 1.4 ± 0.8 J; p = 0.001), and stress relaxation (3.1 ± 0.9 vs 5.0 ± 2.3 cm H2O; p = 0.008). The prevalence of pulmonary edema was 20% among piglets ventilated with low strain rates and 73% among those ventilated with high strain rates (p = 0.010).

Conclusions:

High strain rate is a risk factor for ventilator-induced pulmonary edema, possibly because it amplifies lung viscoelastic behavior.
No association between global DNA methylation in peripheral blood and lung cancer risk in nonsmoking women: results from a multicenter study in Eastern and Central Europe
Authors: Davis Ann , Tao Meng-Hua , Chen Jia , Scelo Ghislaine , Bencko Vladimir , Fabianova Eleonora , Foretova Lenka , Janout Vladimir , Lissowska Jolanta , Mates Dana , Mates Ioan N. , Rudnai Peter , Zaridze David , Boffetta Paolo
Published: April 2016

Alterations in global DNA methylation have been suggested to play an important role in cancer development. We evaluated the association of global DNA methylation in peripheral blood with the risk of lung cancer in nonsmoking women from six countries in Central and Eastern Europe. This multicenter case–control study included primary, incident lung cancer cases diagnosed from 1998 to 2001 and controls frequency-matched for geographic area, sex, and age. Global methylation was assessed in peripheral blood DNA from 83 nonsmoking female cases and 181 nonsmoking female controls using the luminometric methylation assay (LUMA). Unconditional logistic regression models were used to estimate associations between DNA methylation in the blood and the risk of lung cancer. LUMA methylation level was not associated with the risk of lung cancer in nonsmoking women. Associations were not significantly different according to different strata of age, BMI, alcohol drinking, or second-hand tobacco smoke exposure status. In our study of nonsmoking women, the LUMA methylation level in peripheral blood was not associated with the risk of lung cancer. Our findings do not support an association of global blood DNA methylation with the risk of lung cancer in nonsmoking women.
Targeting PD-1 and Tim-3 Pathways to Reverse CD8 T-Cell Exhaustion and Enhance Ex Vivo T-Cell Responses to Autologous Dendritic/Tumor Vaccines
Authors: Liu Jingwei , Zhang Shurong , Hu Yuefeng , Yang Zhaomin , Li Jingpo , Liu Xuesong , Deng Lijuan , Wang Yue , Zhang Xiaoyan , Jiang Ting , Lu Xu
Published: April 2016

The paradoxical coexistence of spontaneous tumor antigen-specific immune response with progressive disease in cancer patients need to dissect the molecular pathways involved in tumor-induced T-cell dysfunction or exhaustion. Programmed cell death 1 (PD-1) has been identified as a marker of exhausted T cells in chronic disease states, and blockade of PD-1-PD-L1 interactions has been shown to partially restore T-cell function. We have found that T-cell immunoglobulin mucin (Tim) 3 is expressed on CD8+ tumor-infiltrating lymphocytes (TILs) isolated from patients with colorectal cancer. All T-cell immunoglobulin mucin 3 (Tim-3+) TILs coexpress PD-1, and Tim-3+PD-1+CD8+TILs represent the predominant fraction of Tcells infiltrating tumors. Tim-3+PD-1+CD8+TILs exhibit the most severe exhausted phenotype as defined by failure to produce cytokines, such as interferon-γ, tumor necrosis factor-α, and interleukin-2. We further find that combined targeting of the Tim-3 and PD-1 pathways increased the frequencies of not only interferon-γ and tumor necrosis factor-α but also frequencies of proliferating tumor antigen-specific CD8+ T cells than targeting either pathway alone. A concomitant decrease in regulatory T cells and enhanced killing in a cytotoxicity assay was observed. Collectively, our findings support the use of Tim-3-Tim-3L blockade together with PD-1-PD-L1 blockade to reverse tumor-induced T-cell exhaustion/dysfunction in patients with colorectal cancer.
The Curse of the Dolphins: Cognitive Decline and Psychosis
Authors: Phelps Randall , Tsai Anne , Hagen Arlene , Pinter Joseph , Smith Raegan , Stein Martin T.
Published: April 2016

CASE: Isela is an 11-year-old Mexican-American girl with mild intellectual disability. During a vacation with her family, she went swimming with dolphins. A few days later, Isela awoke at night with laughing spells; during the day, she was pacing, aggressive, and had a decline in self-care and communication skills. Her parents attributed the symptoms to the dolphins. She was evaluated by a pediatric neurologist. The sleep-deprived electroencephalogram, brain magnetic resonance imaging, lumbar puncture, and thyroid function tests were normal. A genomic microarray was sent. The neurologist initiated empirical therapy for seizures with lamotrigine, which caused a rash. It was discontinued. She was then treated with oxcarbazepine followed by topiramate for several months without any change in symptoms. Comparative genomic hybridization revealed a small deletion at 14q13.1, which includes the NPAS3 gene. Psychiatry was consulted after several months of persistent symptoms. Isela seemed to be laughing in response to internal stimuli. Owing to the decline in communication and her apparent preoccupation with visual and auditory internal stimuli, Isela could not be interviewed adequately to confirm that she was experiencing hallucinations, but her laughter seemed to be in response to hallucinations. Isela was diagnosed with disorganized schizophrenia with psychosis. Risperidone was prescribed.

A psychology evaluation was completed a few months later. Parents noted significant improvement after starting risperidone with reduced inappropriate laughing spells, reduced pacing, as well as improved eating, sleeping, communication, and self-care. Cognitive assessment with the Wechsler Abbreviated Scale of Intelligence-II indicated the following: verbal estimated intelligence quotient (IQ) = 70, perceptual estimated IQ = 71, and full-scale estimated IQ = 68. There was no cognitive decline compared with testing at school 4 years previously. Although psychotic symptoms were significantly improved on antipsychotic medication and function appeared to have been restored to her previous level, her parents continued to perceive a significant decline of functioning, and they continued to attribute the psychosis to swimming with the dolphins.
Readmissions After Colectomy: The Upstate New York Surgical Quality Initiative Experience
Authors: Hensley Bradley J. , Cooney Robert N. , Hellenthal Nicholas J. , Aquina Christopher T. , Noyes Katia , Monson John R. , Kelly Kristin N. , Fleming Fergal J.
Published: April 2016

BACKGROUND:

Hospital readmissions remain a major medical and financial concern to the healthcare system and have become an area of interest in health outcomes performance metrics. There is a pressing need to identify process measures that may help reduce readmissions.

OBJECTIVE:

Our aim was to assess the patient characteristics and surgical factors associated with 30-day readmissions for colorectal surgery in Upstate New York.

DESIGN:

This was a retrospective cohort study.

SETTINGS:

The study included colectomy cases abstracted for the National Surgical Quality Improvement Program in the Upstate New York Surgical Quality Initiative from June 2013 to June 2014.

PATIENTS:

The study consists of 630 colectomies. Patients with a length of stay >30 days or who died during the index admission were excluded.

MAIN OUTCOME MEASURES:

Readmission within 30 days of surgery was the main outcome measure.

RESULTS:

Of 630 colectomy patients, 76 patients (12%) were readmitted within 30 days of surgery. Major and minor complications were associated with 30-day postoperative readmission (OR = 2.99 (95% CI, 1.70–5.28) and OR = 2.19 (95% CI, 1.09–4.43)) but excluded from final analysis because they included both predischarge and postdischarge complications. Risk factors independently associated with 30-day postoperative readmission included diabetes mellitus (OR = 1.94 (95% CI, 1.02–3.67)), smoker within the past year (OR = 2.01 (95% CI, 1.12–3.60)), no scheduled follow-up (OR = 2.20 (95% CI, 1.25–3.86)), and ileostomy formation (OR = 1.97 (95% CI, 1.03–3.77)).

LIMITATIONS:

Limitations include the retrospective design and only 30 days of postoperative follow-up.

CONCLUSIONS:

Consistent with national trends, 1 in 8 patients in the Upstate New York Surgical Quality Initiative program was readmitted within 30 days after colorectal surgery. This study identified several risk factors that may act as tangible targets for intervention, including preoperative smoking cessation programs, optimization of diabetic management, mandatory scheduled follow-up appointments on discharge, and ostomy care pathways.
Orthognathic Consequences of Sphincter Pharyngoplasty in Cleft Patients: A 2-Institutional Study
Authors: Yoshikane Frances , Lai Li Han , Hui Brian K. , Martins Deborah B. , Farias-Eisner Gina , Mandelbaum Rachel S. , Hoang Han , Bradley James P. , Wilson Libby , Lee Justine C.
Published: April 2016

Background:

Understanding long-term sequelae of cleft treatment is paramount in the refinement of treatment algorithms to accomplish optimized immediate and long-term outcomes. In this study, we reviewed sphincter pharyngoplasties as a method of velopharyngeal insufficiency (VPI) treatment in relationship to orthognathic surgery.

Methods:

Cleft lip/palate and cleft palate patients, 15 years of age and older, were reviewed for demographics, VPI surgery, revisions, and subsequent orthognathic surgery at 2 institutions. Chi-square test, Student’s t test, and logistic regression analyses were performed.

Results:

In 214 patients reviewed (mean age, 19.5 years), 61.7% were male, 18.2% had isolated cleft palate, 61.2% had unilateral cleft lip and palate, and 20.6% had bilateral cleft lip and palate. A total of 33.6% were diagnosed with VPI and received a sphincter pharyngoplasty (mean age, 11.9 years). When subsequent orthognathic surgery was examined, sphincter pharyngoplasty was not associated with maxillary advancement (P = 0.59) but did correlate with an increase in mandibular surgery from 2.8% to 11.1% (P = 0.02). The indications for mandibular surgery in the pharyngoplasty population were related to congenital micrognathia. When cephalometric analyses were evaluated, sphincter pharyngoplasty resulted in a decreased sella-to-nasion-to-B point angle (mean, 79.0–76.3 degrees, P = 0.02) and a higher incidence of normal to class II maxillomandibular relationships as defined by A point-to-nasion-to-B point angles >0.5 (P = 0.02).

Conclusions:

Sphincter pharyngoplasty decreases anterior mandibular growth and the discrepancy between maxillomandibular skeletal relationships because of the frequent predisposition of cleft patients to maxillary hypoplasia. In patients with congenital mandibular micrognathia, a small increase in mandibular surgeries may occur.
Vascular Regression After Pinguecula Excision and Conjunctival Autograft Using Fibrin Glue
Authors: Jung Seungil , Kwon Ji-Won , Hwang Ho Sik , Chuck Roy S.
Published: April 2016

Objectives:

To determine the change in local vascularization after pinguecula excision and conjunctival autograft secured with fibrin glue at 12 months.

Methods:

Thirty-one eyes of 31 patients which underwent excision and conjunctival autografting with fibrin glue were retrospectively reviewed. Anterior segment photography was obtained before and after the surgery. Cosmetic outcome was evaluated by patient self-grading (five-point scale; excellent (5), good (4), acceptable (3), poor (2), and very poor (1)), and medical evaluation of treatment outcome was based on subjective evaluation of vascularization on anterior segment photography (four-point severity scale; 0 [low] to 3 [high]). Clinical outcome and complications are reported at 12 months.

Results:

Overall cosmetic results were excellent or good in 93.5% (29 of 31) (score 4.68±0.60). Anterior segment photography showed that most cases demonstrated complete removal of pinguecula and regression of surrounding vascularization with mean change in score from 2.13±0.34 preoperatively to 0.09±0.30 postoperatively.

Conclusions:

Pinguecula excision and conjunctival autograft using fibrin glue is an effective and safe method to remove pinguecula for cosmetic purposes. The method presented facilitated regression of vascularization.
Medium-term Outcomes of Unsutured Scleral Flap Trabeculectomies
Authors: Wang Bob Z. , Ang Ghee Soon , Meagher Peter
Published: April 2016

Purpose:

To examine the clinical characteristics and medium-term outcomes of unsutured scleral flap trabeculectomies.

Patient and Methods:

A retrospective review of 45 patients who underwent 50 unsutured scleral flap trabeculectomies by a single ophthalmic surgeon. Information pertaining to each patient’s demographic details, preoperative assessment, surgical procedure, and 2 years of postoperative management were obtained.

Results:

The average age of patients was 72.4±12.5 (range, 30 to 97) years. The diagnosis was primary open-angle glaucoma in 38 (76.0%) cases. The average preoperative, 1 year postoperative and 2-year postoperative intraocular pressure (with number of topical antiglaucoma medications) were 20.8 (2.5), 13.2 (0.4), and 12.6 mm Hg (0.7), respectively. The procedure performed was a trabeculectomy alone in 32 (64.0%) cases, and combined trabeculectomy and phacoemulsification in 18 (36.0%) cases. Four were performed with mitomycin C. Three procedures (6%) had intraoperative complications (2 iris prolapses, 1 subconjunctival hemorrhage). Seven procedures were complicated by a postoperative choroidal detachment, which were managed conservatively and resolved spontaneously over time. There was 1 case (2%) of postoperative hypotony, which failed to resolve (intraocular pressure of <6 mm Hg for >3 months).

Conclusions:

The majority of unsutured scleral flap trabeculectomies had an acceptable risk profile and resulted in a decrease in the intraocular pressure at 2 years postoperatively.
Disseminated Tuberculosis With a Periprostatic Abscess in a Patient With Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome
Authors: Nambiar Puja H. , Short William R.
Published: April 2016

Disseminated tuberculosis (TB) is defined as the spread of Mycobacterium tuberculosis to 1 or more organs via hematogenous or lymphatic spread. Genitourinary TB is rare in developed nations, representing between 2% and 10% of extrapulmonary TB cases. Prostate involvement is uncommon; we present a case of disseminated TB resulting in a periprostatic abscess in a patient with advanced human immunodeficiency virus infection.
Altered pressure pain thresholds and increased wind-up in adult patients with chronic back pain with a history of childhood maltreatment: a quantitative sensory testing study
Authors: Tesarz Jonas , Eich Wolfgang , Treede Rolf-Detlef , Gerhardt Andreas
Published: April 2016

Childhood maltreatment (CM) has been associated with an increased risk of nonspecific chronic low back pain (nsCLBP). However, the mechanisms underlying this association are unclear. Therefore, this study considered whether distinct types of CM are accompanied by specific alterations in somatosensory function. A total of 176 subjects with nsCLBP and 27 pain-free controls (PCs) were included. The Childhood Trauma Questionnaire (CTQ) was used to categorize patients into 2 groups (abused/neglected vs nonabused/nonneglected) for 5 types of CM (emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect). The standardized quantitative sensory testing protocol of the “German Research Network on Neuropathic Pain” was performed to obtain comprehensive profiles on somatosensory function, including detection and pain thresholds, pain sensitivity, and assessments of temporal summation (wind-up). Between 17.7% and 51.4% of subjects with nsCLBP reported CM, depending on the type of CM. Childhood Trauma Questionnaire subscores for emotional and sexual abuse were significantly higher in subjects with nsCLBP than in PCs. Compared with PCs, subjects with CM showed reduced pressure pain thresholds (PPTs), irrespective of the type of CM. Regarding distinct types of CM, subjects with nsCLBP with emotional abuse reported significantly higher wind-up than those without, and sexual abuse was accompanied by enhanced touch sensitivity. Our findings suggest that CM is nonspecifically associated with a decreased PPT in nsCLBP. Emotional abuse apparently leads to enhanced spinal pain summation, and sexual abuse leads to enhanced touch sensitivity. These results emphasize the importance of emotional abuse in nsCLBP and suggest that CM can induce long-term changes in adult somatosensory function.
Symptom profiles in the painDETECT Questionnaire in patients with peripheral neuropathic pain stratified according to sensory loss in quantitative sensory testing
Authors: Vollert Jan , Kramer Martin , Barroso Alejandro , Freynhagen Rainer , Haanpää Maija , Hansson Per , Jensen Troels S. , Kuehler Bianca M. , Maier Christoph , Mainka Tina , Reimer Maren , Segerdahl Märta , Serra Jordi , Solà Romà , Tölle Thomas R. , Treede Rolf-Detlef , Baron Ralf
Published: April 2016

The painDETECT Questionnaire (PDQ) is commonly used as a screening tool to discriminate between neuropathic pain (NP) and nociceptive pain, based on the self-report of symptoms, including pain qualities, numbness, and pain to touch, cold, or heat. However, there are minimal data about whether the PDQ is differentially sensitive to different sensory phenotypes in NP. The aim of the study was to analyze whether the overall PDQ score or its items reflect phenotypes of sensory loss in NP as determined by quantitative sensory testing. An exploratory analysis in the Innovative Medicines Initiative Europain and Neuropain database was performed. Data records of 336 patients identified with NP were grouped into sensory profiles characterized by (1) no loss of sensation, (2) loss of thermal sensation, (3) loss of mechanical sensation, and (4) loss of thermal and mechanical sensation. painDETECT Questionnaire profiles were analyzed in a 2-factor analysis of variance. Patients with loss of thermal sensation (2 and 4) significantly more often reported pain evoked by light touch, and patients with loss of mechanical sensation (3 and 4) significantly more often reported numbness and significantly less often burning sensations and pain evoked by light touch. Although the PDQ was not designed to assess sensory loss, single items reflect thermal and/or mechanical sensory loss at group level, but because of substantial variability, the PDQ does not allow for individual allocation of patients into sensory profiles. It will be useful to develop screening tools according to the current definition of NP.
Digital Chromoendoscopy With i-Scan for In Vivo Prediction of Advanced Colorectal Neoplasia
Authors: Albrecht Heinz , Nägel Andreas , Tasdelen Hüseyin , Rath Timo , Grauer Martin , Vieth Michael , Neurath Markus F. , Neumann Helmut
Published: April 2016

Background:

Recent studies have analyzed the potential of advanced endoscopic imaging techniques for differentiating hyperplastic and adenomatous colorectal lesions. Latest endoscopic resection techniques now also allow for treatment of more advanced staged lesions including treatment of early cancerous lesions.

Aims:

To assess the potential of the i-scan technology to differentiate between adenomatous polyps and advanced staged neoplasia.

Methods:

Consecutive patients undergoing colonoscopy at a tertiary referral center were included. After a dedicated training, participating endoscopists underwent a review of 298 unknown images of colonic lesions to assess colorectal lesion histology.

Results:

Overall accuracy for prediction of advanced staged neoplasia was 92.2% (sensitivity: 94.2%, specificity 90.9%). The positive and negative predictive values were calculated as 87.5% and 95.9%, respectively. The κ-value for differentiating adenomatous polyps and advanced staged neoplasia was 0.8193 (0.7894 to 0.8492). Intraobserver agreement was calculated with a κ-value of 0.9301 (0.8875 to 0.9727).

Conclusions:

Accurate interpretation of i-scan images for prediction of advanced colorectal neoplasia can successfully be performed even by nonexpert endoscopists with a high overall accuracy and excellent interobserver agreements.
Identifying familial hypercholesterolemia in acute coronary syndrome
Authors: Gencer Baris , Nanchen David
Published: April 2016

Purpose of review

Familial hypercholesterolemia is a frequent genetic disorder characterized by elevated LDL-cholestrol and premature coronary heart disease. Familial hypercholesterolemia remains largely underdiagnosed in the general population and for many patients the initial clinical manifestation is acute coronary syndromes (ACS). Furthermore, many missed diagnosis of familial hypercholesterolemia can also occur during hospitalization for ACS. In this review, we aim to discuss the identification and prognosis of familial hypercholesterolemia after hospitalization for ACS.

Recent findings

The prevalence of familial hypercholesterolemia was about 10 times higher among patients hospitalized for ACS compared with the general population. Although 70% of patients with familial hypercholesterolemia were discharged with high-intensity statins, and 65% attended cardiac rehabilitation, less than 5% reached the recommended LDL-cholesterol target less than 1.8 mmol/l 1 year after ACS. Furthermore, patients with familial hypercholesterolemia and ACS were at high-risk of recurrence of cardiovascular events after discharge.

A systematic screening strategy to identify patients with familial hypercholesterolemia at the time ACS is required to maximize secondary prevention and improve lipid management. It is expected that a substantial number of familial hypercholesterolemia patients would benefit from more effective lipid-lowering drugs after ACS, in addition to statins.
Doxorubicin‐Induced Gut Toxicity in Piglets Fed Bovine Milk and Colostrum
Authors: Shen René L. , Rathe Mathias , Jiang Pingping , Pontoppidan Peter E.L. , Heegaard Peter M.H. , Müller Klaus , Sangild Per T.
Published: April 2016

Objective:

Chemotherapy‐induced intestinal toxicity is a common adverse effect of cancer treatment. We hypothesized that a milk diet containing bovine colostrum (BC) would reduce intestinal toxicity in doxorubicin‐treated piglets.

Methods:

“Study 1” investigated intestinal parameters 9 days after a single dose of doxorubicin (1 × 75 mg/m2) in piglets fed bovine milk enriched with whey protein (BM). In “study 2,” responses to doxorubicin treatment were investigated in piglets receiving either 7 BC feedings per day (Only‐BC, n = 13), 4 BC feedings (High‐BC, n = 13), 2 BC feedings (Low‐BC, n = 14), or no BC (only BM, n = 13).

Results:

Doxorubicin treatment induced clinical signs of intestinal toxicity with diarrhea and weight loss, relative to controls (P < 0.05). White blood cells, hexose absorptive function, plasma citrulline, weights of intestine, colon, and spleen were reduced, whereas gut permeability and plasma C‐reactive protein levels were increased (all P < 0.05). Limited or no effects were observed for digestive enzymes, proinflammatory cytokines, or tight‐junction proteins in the intestine. Increasing BC supplementation to doxorubicin‐treated piglets (study 2) had no consistent effects on plasma C‐reactive protein and citrulline levels, intestinal morphology, digestive enzymes, permeability, or proinflammatory cytokines. Only‐BC pigs, however, had lower diarrhea severity toward the end of the experiment (P < 0.05 vs BM) and across the BC groups, intestinal toxicity was reduced (P < 0.01).

Conclusions:

Doxorubicin‐treated piglets are relevant for studying chemotherapy‐induced gut toxicity. Colostrum supplementation had limited effects on doxorubicin‐induced toxicity in milk‐fed piglets suggesting that colostrum and a bovine milk diet enriched with whey protein provided similar protection of the developing intestine from chemotherapy‐induced toxicity.
Accuracy of Prediction Formulae for the Assessment of Resting Energy Expenditure in Hospitalized Children
Authors: Agostoni Carlo , Edefonti Alberto , Calderini Edoardo , Fossali Emilio , Colombo Carla , Battezzati Alberto , Bertoli Simona , Milani Gregorio , Bisogno Arianna , Perrone Michela , Bettocchi Silvia , De Cosmi Valentina , Mazzocchi Alessandra , Bedogni Giorgio
Published: April 2016

Background and Aim:

The resting energy expenditure (REE) of ill children is commonly estimated from prediction formulae developed in healthy children. The aim of the present study was to evaluate the accuracy of commonly employed REE prediction formulae versus indirect calorimetry in hospitalized children.

Methods:

We performed a cross‐sectional study of 236 infants, children, and adolescents consecutively admitted to the Intermediate Care, Nephrology, Intensive Care, Emergency, and Cystic Fibrosis Units of the De Marchi Pediatric Hospital (Milan, Italy) between September 2013 and March 2015. REE was measured by indirect calorimetry and estimated using the World Health Organization (WHO), Harris‐Benedict, Schofield, and Oxford formulae.

Results:

The mean (standard deviation) difference between the estimated and measured REE was: −1 (234) kcal/day for the WHO formula; 82 (286) kcal/day for the Harris‐Benedict formula; 2 (215) kcal/day for the Schofield‐weight formula; −2 (214) kcal/day for the Schofield‐weight and height formula; and −5 (221) kcal/day for the Oxford formula. Even though the WHO, Schofield, and Oxford formulae gave accurate estimates of REE at the population level (small mean bias), all the formulae were not accurate enough to be employed at the individual level (large SD of bias).

Conclusions:

The WHO, Harris‐Benedict, Schofield, and Oxford formulae should not be used to estimate REE in hospitalized children.
Directional Optical Coherence Tomography Reveals Reliable Outer Nuclear Layer Measurements
Authors: Tong Kevin K. , Lujan Brandon J. , Zhou Yixiu , Lin Meng C.
Published: April 2016

Purpose

Directional Optical Coherence Tomography (D-OCT) is a method used to optically segment and identify the outer nuclear layer (ONL) in vivo. The purpose of this study was to determine the repeatability and reproducibility of D-OCT ONL thickness measurements in healthy eyes.

Methods

Sixteen healthy eyes of sixteen subjects were imaged using the Cirrus SD-OCT. The OCT beam entry position was varied horizontally and vertically through the pupil, and cross-sectional images were obtained at baseline and 1-month follow-up by two observers. Detailed segmentation was performed to quantify the thickness of ONL without the inclusion of overlying Henle Fiber Layer. Inter-observer, intra-observer, and inter-visit variability was evaluated using Bland-Altman and coefficient of variation analysis for each category.

Results

All 16 eyes were successfully imaged, registered, and segmented. The maximum mean (SD) inter-operator difference was 2.6 (4.8) μm. The maximum mean (SD) intra-operator difference was 2.4 (5.3) μm. There was no statistically significant difference in ONL measurements detected between baseline and follow-up (p > 0.05). The mean (SD) differences measured across visits by one operator varied from −1.6 (3.1) to 1.1 (6.1) μm. The mean (SD) coefficient of variance (CV%) for all sectors with horizontal orientation was 9.1% (2.3%), 10.1% (2.5%), and 8.6% (2.3%) for inter-observer, intra-observer, and inter-visit, respectively. The mean (SD) coefficient of variance (CV%) for all sectors with vertical orientation was 8.3% (1.8%), 6.9% (1.4%), and 8.3% (2.1%) for inter-observer, intra-observer, and inter-visit, respectively. The majority of the variation of paired repeated measurements originated from between-subject variance. The within-subject variance accounted for less than 1% of the total variability.

Conclusions

ONL thickness measurements can be quantified with good repeatability and reproducibility using D-OCT. Identifying the magnitude of D-OCT variability among normal subjects will allow for improved development of future clinical studies that quantitatively track the progression of macular pathology.
Predicting Accommodative Response Using Paraxial Schematic Eye Models
Authors: Ramasubramanian Viswanathan , Glasser Adrian
Published: April 2016

Purpose

Previous ultrasound biomicroscopy (UBM) studies showed that accommodative optical response (AOR) can be predicted from accommodative biometric changes in a young and a pre-presbyopic population from linear relationships between accommodative optical and biometric changes, with a standard deviation of less than 0.55D. Here, paraxial schematic eyes (SE) were constructed from measured accommodative ocular biometry parameters to see if predictions are improved.

Methods

Measured ocular biometry (OCT, A-scan, and UBM) parameters from 24 young and 24 pre-presbyopic subjects were used to construct paraxial SEs for each individual subject (individual SEs) for three different lens equivalent refractive index methods. Refraction and AOR calculated from the individual SEs were compared with Grand Seiko (GS) autorefractor measured refraction and AOR. Refraction and AOR were also calculated from individual SEs constructed using the average population accommodative change in UBM measured parameters (average SEs).

Results

Schematic eye calculated and GS measured AOR were linearly related (young subjects: slope = 0.77, r2 = 0.86; pre-presbyopic subjects: slope = 0.64, r2 = 0.55). The mean difference in AOR (GS − individual SEs) for the young subjects was −0.27D and for the pre-presbyopic subjects was 0.33D. For individual SEs, the mean ± SD of the absolute differences in AOR between the GS and SEs was 0.50 ± 0.39D for the young subjects and 0.50 ± 0.37D for the pre-presbyopic subjects. For average SEs, the mean ± SD of the absolute differences in AOR between the GS and the SEs was 0.77 ± 0.88D for the young subjects and 0.51 ± 0.49D for the pre-presbyopic subjects.

Conclusions

Individual paraxial SEs predict AOR, on average, with a standard deviation of 0.50D in young and pre-presbyopic subject populations. Although this prediction is only marginally better than from individual linear regressions, it does consider all the ocular biometric parameters.
Using Nurse Practitioners to Optimize Patient Flow in a Pediatric Emergency Department
Authors: Muller Karen , Chee Zoe , Doan Quynh
Published: April 2016

Objectives

Using nurse practitioners (NPs) in pediatric emergency departments (PEDs) is commonplace in the United States, yet little is known on the impact of NPs on patient flow measures in these environments. This study quantifies the impact of NPs on 2 common measures of patient flow.

Methods

We conducted a retrospective cohort study using administrative data from an academic tertiary care PED. Mean shift length of stay (LOS) and the daily proportion of patients leaving without being seen (LWBS) by a clinician were compared between shifts with and without NPs on duty, matched for external variables affecting the level of activity in the department. Multivariate regression analyses were also conducted to further adjust for covariates such as the total number of PED care providers, patient acuity distribution, and total volume seen in the ED.

Results

Despite a slightly reduced total number of providers present on shifts with NPs on duty, a modest but statistically significant reduction in mean shift LOS (−19.11 minutes [95% confidence interval (CI), −31.01 to −7.22]) and daily proportion of LWBS (−1.11% [95% CI, −1.97% to −0.26%]) was observed for shifts with NPs compared with shifts without NPs on duty. Regression analyses showed that incremental NPs on shift were associated with a decreased LOS (−18.76 minutes [95% CI, −24.51 to −13.02]) as well as a reduced odds of LWBS (odds ratio, 0.56; 95% CI, 0.37–0.87).

Conclusions

Nurse practitioners have a modest impact on patient flow measures in a PED and are a valuable resource to optimize patient flow.
Pediatric Disaster Triage System Utilization Across the United States
Authors: Nadeau Nicole L. , Cicero Mark X.
Published: April 2016

Objectives

The study goal was to determine which pediatric disaster triage (PDT) systems are used in US states/territories and whether there is standardization to their use. Secondary goals were to understand user satisfaction with each system, user preferences, and the nature and magnitude of incidents for which the systems are activated.

Methods

A survey was developed regarding PDT systems used in each state/territory, satisfaction with those used, preference for specific systems, and type and magnitude of incidents prompting system activation. The survey was distributed to emergency medical services for children leads in each state/territory.

Results

Eighty-six percent of states/territories responded. Eighty-eight percent of respondents used some formal PDT system, 50% of whom reported utilization of multiple systems. JumpSTART was most commonly used, most often in conjunction with other systems. Of formal systems, JumpSTART has been in use the longest. JumpSTART was also preferred by 71% of those stating a preference; it tied with Smart for median satisfaction level. Although types of incidents prompting system activation was similar across responding states/territories, number of patients prompting activation varied from 1 to 3 to greater than 20, median range of 4 to 7.

Conclusions

Most states/territories use some formal PDT system; few have 1 standardized approach. JumpSTART is predominantly used and is preferred by most respondents. With all systems, there is marked variation in number of patients prompting activation although the reported nature of incidents prompting activation is similar.
Imaging for Suspected Appendicitis
Authors: Menoch Margaret , Simon Harold K. , Hirsh Daniel , Shim Young , Baxter Amy L. , Clifton Matthew , Kim Daniel , Sturm Jesse J.
Published: April 2016

Background

Little is known regarding the effect of different emergency department (ED) practice models on computed tomography (CT) and ultrasound (US) utilization for suspected appendicitis in the ED and through the potential inpatient hospital stay.

Objectives

Examination rates of CT and US for suspected appendicitis at 2 different pediatric EDs (PEDs) through hospital admission: an academic affiliated tertiary PED (site A) compared with a private practice tertiary care PED (site B).

Methods

All visits with the ICD-9 (International Classification of Diseases, Ninth Revision) chief complaint of abdominal pain were retrospectively examined from May 1, 2009, to February 21, 2012. Suspected appendicitis visits were defined as any visit with the chief complaint of abdominal pain where a complete blood cell count was obtained. Abdominal CT and US in the PED and during hospital admission were compared across the 2 sites. Return visits within 72 hours were evaluated for any missed appendicitis.

Results

Overall appendicitis rates were similar at both sites: site A, 4.7%; site B, 4.0%. The odds of having a CT scan performed during visits to the PED for abdominal pain were significantly higher at site B (odds ratio [OR], 3.19; 95% confidence interval [95% CI], 2.74–3.71), whereas the odds of having an US at site B were the opposite (OR, 0.34; 95% CI, 0.28–0.40). When evaluating only the admitted visits, the odds of having a CT were also greater at site B (OR, 2.32; 95% CI, 1.86–2.94) and having an US were less (OR, 0.57; 95% CI, 0.44–0.73).

Conclusions

In this study of 2 PEDs with differing practice models, we identified a dramatic difference in imaging utilization among patients with suspected appendicitis.
Comparison of Image Processing Techniques for Nonviable Tissue Quantification in Late Gadolinium Enhancement Cardiac Magnetic Resonance Images
Authors: Carminati M. Chiara , Boniotti Cinzia , Fusini Laura , Andreini Daniele , Pontone Gianluca , Pepi Mauro , Caiani Enrico G.
Published: April 2016

Purpose:

The aim of this study was to compare the performance of quantitative methods, either semiautomated or automated, for left ventricular (LV) nonviable tissue analysis from cardiac magnetic resonance late gadolinium enhancement (CMR-LGE) images.

Materials and Methods:

The investigated segmentation techniques were: (i) n-standard deviations thresholding; (ii) full width at half maximum thresholding; (iii) Gaussian mixture model classification; and (iv) fuzzy c-means clustering. These algorithms were applied either in each short axis slice (single-slice approach) or globally considering the entire short-axis stack covering the LV (global approach). CMR-LGE images from 20 patients with ischemic cardiomyopathy were retrospectively selected, and results from each technique were assessed against manual tracing.

Results:

All methods provided comparable performance in terms of accuracy in scar detection, computation of local transmurality, and high correlation in scar mass compared with the manual technique. In general, no significant difference between single-slice and global approach was noted. The reproducibility of manual and investigated techniques was confirmed in all cases with slightly lower results for the nSD approach.

Conclusions:

Automated techniques resulted in accurate and reproducible evaluation of LV scars from CMR-LGE in ischemic patients with performance similar to the manual technique. Their application could minimize user interaction and computational time, even when compared with semiautomated approaches.
Augmentation Phalloplasty With Autologous Dermal Fat Graft in the Treatment of “Small Penis”
Authors: Xu Lisi , Zhao Muxin , Chen Wen , Li Yangqun , Yang Zhe , Ma Ning , Wang Weixin , Feng Jun , Liu Qiyu , Ma Tong
Published: April 2016

Background

Our objective is to report on the efficacy and safety of dermal fat graft in augmentation phalloplasty performed on patients who presented complaining of “small penis,” and evaluate the cosmetic and psychological outcomes of it.

Methods

From April 2010 and January 2015, 23 Chinese adult patients aged 18 to 33 years (average, 23 years) with subjective perception of small penis were included; all who requested an increase in the penile dimension underwent penile elongation (suprapubic skin advancement—ligamentolysis) and girth enhancement by dermal fat graft. Besides objective measurement, Male Genital Image Scale was used to facilitate selection of patients and evaluate the outcome, respectively. The change and shrinkage of the dermal fat strips was evaluated by ultrasound examination and computed tomography.

Results

No major complications or erection deficiencies occurred during the postoperative follow-up period. After 6 months, the mean flaccid length was increased by 2.27 ± 0.54 cm, whereas the mean flaccid circumference gain was 1.67 ± 0.46 cm. Significant improvement of genital satisfaction was reported during the follow-up. The shrinkage of dermal fat strips was inconspicuous, and no curvature was observed due to fibrosis.

Conclusions

With strict patient selection, this procedure is proved to be a plausible and reasonable option for patients with penile dysmorphophobia. Also, it provides a potential alternative procedure to current dominant methods and promotes the aesthetic results with penile lengthening.
Tumor Localization for Laparoscopic Colorectal Resection Without Endoscopic Tattooing
Authors: Cai Zhenghao , Pan Ruijun , Ma Junjun , Zheng Minhua
Published: April 2016

Introduction:

Tumor localization is a key step in laparoscopic colorectal surgery. Endoscopic tattooing is widely practiced with a satisfactory accuracy, whereas few studies have investigated its shortcomings. The aim of our study is to assess the accuracy and efficiency of a tumor localization protocol without endoscopic tattooing.

Methods:

The tumor localization protocol was performed for 788 colorectal cancer/polyp patients undergoing laparoscopic colorectal resection. The localization accuracy was evaluated by the intraoperative exploration and the anatomopathologic results.

Results:

The localization accuracy was 100% in our study. The drawbacks of endoscopic tattooing were overcome. Only 16.6% of the patients underwent preoperative endoscopic clip placement. Intraoperative colonoscopy was performed as a planned and purposive procedure instead of a remedial measurement. The misplacement of the camera port for laparoscopy was avoided in 18 cases (2.3%) guided by this protocol.

Conclusions:

Colorectal tumor localization could be improved by this tumor localization protocol without endoscopic tattooing.
DABAM: an open-source database of X-ray mirrors metrology
Authors: Sanchez del Rio Manuel , Bianchi Davide , Cocco Daniele , Glass Mark , Idir Mourad , Metz Jim , Raimondi Lorenzo , Rebuffi Luca , Reininger Ruben , Shi Xianbo , Siewert Frank , Spielmann-Jaeggi Sibylle , Takacs Peter , Tomasset Muriel , Tonnessen Tom , Vivo Amparo , Yashchuk Valeriy
Published: April 2016

An open-source database containing metrology data for X-ray mirrors is presented. It makes available metrology data (mirror heights and slopes profiles) that can be used with simulation tools for calculating the effects of optical surface errors in the performances of an optical instrument, such as a synchrotron beamline. A typical case is the degradation of the intensity profile at the focal position in a beamline due to mirror surface errors. This database for metrology (DABAM) aims to provide to the users of simulation tools the data of real mirrors. The data included in the database are described in this paper, with details of how the mirror parameters are stored. An accompanying software is provided to allow simple access and processing of these data, calculate the most usual statistical parameters, and also include the option of creating input files for most used simulation codes. Some optics simulations are presented and discussed to illustrate the real use of the profiles from the database.
A sample cell forin situelectric-field-dependent structural characterization and macroscopic strain measurements
Authors: Hossain Mohammad J. , Wang Lijun , Wang Zhiyang , Khansur Neamul H. , Hinterstein Manuel , Kimpton Justin A. , Daniels John E.
Published: April 2016

When studying electro-mechanical materials, observing the structural changes during the actuation process is necessary for gaining a complete picture of the structure–property relationship as certain mechanisms may be meta-stable during actuation.In situdiffraction methods offer a powerful and direct means of quantifying the structural contributions to the macroscopic strain of these materials. Here, a sample cell is demonstrated capable of measuring the structural variations of electro-mechanical materials under applied electric potentials up to 10 kV. The cell is designed for use with X-ray scattering techniques in reflection geometry, while simultaneously collecting macroscopic strain data using a linear displacement sensor. The results show that the macroscopic strain measured using the cell can be directly correlated with the microscopic response of the material obtained from diffraction data. The capabilities of the cell have been successfully demonstrated at the Powder Diffraction beamline of the Australian Synchrotron and the potential implementation of this cell with laboratory X-ray diffraction instrumentation is also discussed.
1,2,3,3-Tetramethyl-7-nitro-3,4-dihydroisoquinolinium tetrafluoroborate
Authors: Bouzid Mouna , Hrizi Chakib , Kammoun Majed
Published: April 2016

The title salt, C13H17N2O2+·BF4−, was prepared by the methylation of the imine with Meerwein salt in dichloromethane. The asymmetric unit comprises a 1,3,3-trimethyl-7-nitro-3,4-dihydroisoquinolinium cation and a tetrafluoroborate anion. The coordination around the boron atom in the tetrafluoroborate anion is tetrahedral. The heterocyclic ring adopts a half-chair conformation. The crystal packing is governed by means of C—H...F contacts, which lead to the formation of a three-dimensional network.