bluuebunny/crossref_metadata_2025 huggingface dataset:
Is a Single Low Dose of Intrathecal Morphine a Useful Adjunct to Patient‐Controlled Analgesia for Postoperative Pain Control Following Lumbar Spine Surgery? A Preliminary Report
Authors: Yen David , Turner Kim , Mark David
Published: March 2016

BACKGROUND: Several studies addressing intrathecal morphine (ITM) use following spine surgery have been published either involving the pediatric population, using mid‐ to high‐dose ITM, or not in conjunction with morphine patient‐controlled analgesia (PCA).

OBJECTIVES: To determine whether low‐dose ITM is a useful adjunct to PCA for postoperative pain control following elective lumbar spine surgery in adults.

METHODS: Thirty‐two patients were enrolled in a double‐blinded randomized controlled trial, and received either ITM or intrathecal placebo. Postoperatively, all patients were given a PCA pump and observed for the first 24 h in a step‐down unit. Measurements of: total PCA morphine consumed in the first 24 h; intensity of pain; pruritus; nausea at 4 h, 8 h and 24 h; time to first ambulation; length of hospital stay; and occurrences of respiratory depression were recorded.

RESULTS: The total PCA use was significantly lower in the ITM group. There were lower average pain scores in the ITM group, which increased to that of the intrathecal placebo group over 24 h; however, this failed to attain statistical significance. There were no differences in nausea, pruritus, time to first ambulation or hospital length stay. There were no cases of respiratory depression in either group.

CONCLUSIONS: ITM may be a useful adjunct to PCA, but did not decrease time to ambulation or length of stay.
Characteristics and Associations of Pain Intensity in Patients Referred to a Specialist Cancer Pain Clinic
Authors: Pina Paulo , Sabri Elham , Lawlor Peter G
Published: March 2016

BACKGROUND: Uncontrolled cancer pain (CP) may impair quality of life. Given the multidimensional nature of CP, its poor control is often attributed to poor assessment and classification.

OBJECTIVES: To determine the characteristics and associations of pain intensity in a specialist CP clinic.

METHODS: Consecutive patients referred to the CP clinic of the Portuguese Cancer Institute (Lisbon, Portugal) had standardized initial assessments and status documentation of the following: Brief Pain Inventory ratings for ‘pain now’ as the outcome variable; initial pain intensity (iPI) on a 0 to 10 scale; pain mechanism (using the Douleur Neuropathique 4 tool to assess neuropathic pain); episodic pain; Eastern Cooperative Oncology Group rating; oral morphine equivalent daily dose (MEDD); Hospital Anxiety Depression Scale and Emotional Thermometer scores; and cancer diagnosis, metastases, treatment and pain duration. Univariable analyses were conducted to test the association of independent variables with iPI. Variables with P<0.1 were entered into a multivariable regression model, using backward elimination and a cut‐point of P=0.2 for final model selection.

RESULTS: Of 371 participants, 285 (77%) had moderate (4 to 6) or severe (7 to 10) iPI. The initial median MEDD was relatively low (30 mg [range 20 mg to 60 mg]). In the multivariable model, higher income, Eastern Cooperative Oncology Group rating 3 to 4, cancer diagnosis (head and neck, genitourinary and gastrointestinal), adjuvant use and initial MEDD were associated with iPI (P<0.05). The model’s R2 was 18.6, which explained only 19% of iPI variance.

CONCLUSIONS: The diversity of factors associated with pain intensity and their limited explanation of its variance underscore the biopsychosocial complexity of CP. Adequacy of CP management warrants further exploration.
Nitrous Oxide Persistently Alleviates Pain Hypersensitivity in Neuropathic Rats: A Dose‐Dependent Effect
Authors: Ben Boujema Meric , Laboureyras Emilie , Pype Jan , Bessière Baptiste , Simonnet Guy
Published: March 2016

BACKGROUND: Despite numerous pharmacological approaches, there are no common analgesic drugs that produce meaningful relief for the majority of patients with neuropathic pain. Although nitrous oxide (N2O) is a weak analgesic that acts via opioid‐dependent mechanisms, it is also an antagonist of the N‐methyl‐D‐aspartate receptor (NMDAR). The NMDAR plays a critical role in the development of pain sensitization induced by nerve injury.

OBJECTIVE: Using the chronic constriction injury of the sciatic nerve in male rats as a preclinical model of neuropathic pain, the first aim of the present study was to evaluate the lowest N2O concentration and the shortest time of N2O postinjury exposure that would produce persistent relief of neuropathic pain. The second aim was to compare the effects of N2O with gabapentin, a reference drug used in human neuropathic pain relief.

METHODS: Changes in the nociceptive threshold were evaluated using the paw pressure vocalization test in rats.

RESULTS: Among the various N2O concentrations tested, which ranged from 25% to 50%, only 50% N2O single exposure for 1 h 15 min induced a persistent (minimum of three weeks) and significant (60%) reduction in pain hypersensitivity. A single gabapentin dose (75 mg/kg to 300 mg/kg, intraperitoneally) induced an acute (1 h to 1 h 30 min) dose‐dependent effect, but not a persistent effect such as that observed with N2O.

CONCLUSIONS: These preclinical results suggest that N2O is advantageous for long‐lasting neuropathic pain relief after sciatic nerve injury compared with other drugs used in humans such as gabapentinoids or NMDAR antagonists. The present preclinical study provides a rationale for developing comparative clinical studies.
Making a Timely Diagnosis of Pulmonary Tuberculosis
Authors: Long Richard
Published: March 2016

Making a timely diagnosis of adult‐type pulmonary tuberculosis (TB) is critical to interrupting transmission and optimizing treatment outcomes. A hypothesis based on clinical experience is that a timely diagnosis may be made by addressing seven clinical rubrics: six related to history, one to the laboratory. Responses may be considered to be part of a clinical heuristic for making a timely diagnosis of pulmonary TB. The larger the number of affirmative responses, the more likely the diagnosis, although it is probable some questions carry more weight than others. The radiograph is key and may almost be considered to be confirmatory of the history. Collectively, the responses should prompt suspicion of pulmonary TB – submission of sputum for acid‐fast bacilli smear and culture, and respiratory isolation.
The Association between Sleep‐Disordered Breathing and Magnetic Resonance Imaging Findings in a Pediatric Cohort with Chiari 1 Malformation
Authors: Amin Reshma , Sayal Priya , Sayal Aarti , Massicote Colin , Pham Robin , Al-Saleh Suhail , Drake James , Narang Indra
Published: March 2016

BACKGROUND: The prevalence of sleep‐disordered breathing (SDB) reported in the literature for Chiari malformation type 1 (CM1) is uniformly high (24% to 70%). In Canada, there is limited access to pediatric polysomnography (PSG). Therefore, the identification of clinical features would be invaluable for triaging these children.

OBJECTIVE: To identify demographic features, clinical symptoms/signs and radiological findings associated with SDB in a large pediatric cohort with CM1.

METHODS: A retrospective review was conducted on children with CM1 who underwent baseline PSG. Data were collected on patient demographics (age, sex, weight, height, body mass index), clinical symptoms (chart review and clinical questionnaires), diagnostic imaging of the brain and cervicothoracic spine, and medical history at the time of referral.

RESULTS: A total of 68 children were included in the review. The mean (± SD) age of the children at the time of PSG was 7.33±4.01 years; 56% (n=38) were male. There was a 49% prevalence of SDB in this cohort based on the overall apnea‐hypopnea index. Obstructive sleep apnea was the predominant type of SDB. Tonsillar herniation was significantly correlated with obstructive apnea‐hypopnea index (r=0.24; P=0.036).

CONCLUSIONS: A direct relationship between the degree of cerebellar tonsillar herniation and obstructive sleep apnea was demonstrated. However, further prospective studies that include neurophysiological assessment are needed to further translate the central nervous system imaging findings to predict the presence of SDB.
The Medical Life of Henry Norman Bethune
Authors: Deslauriers Jean , Goulet Denis
Published: March 2016

BACKGROUND: Henry Norman Bethune is one of the most exciting and incredible surgeons that Canada has ever produced. Indeed, he is often characterized as one of the world’s best‐known surgeons. He was an innovator and his scientific contributions have stood the test of time. In Canada, he will forever be remembered as a social activist committed to the welfare of the poor and to the reform of the health care system. In the People’s Republic of China, he is idolized and remains the only foreigner to ever become a national hero.

OBJECTIVE: To detail the numerous and significant achievements of Henry Norman Bethune in the field of thoracic surgery and as a social activist and describe his heroic war‐time actions on the battlefields of both Spain and China.

METHOD: Information was gathered through the reading of the numerous publications written about the life and work of Bethune, interviews with knowledgeable people from Canadian and Chinese universities, analysis of Bethune’s own publications, and extensive experience of one of the authors in China.

RESULTS: In the social sense, Henry Norman Bethune had a difficult personality, but he was deeply caring about the plight of his patients, especially the poor. As a thoracic surgeon, he could be ingenious, thoughtful and effective but he could also be abrasive, restless and temperamental. His scientific contributions were sound and, at the time, gained worldwide attention. As an activist, he led a crusade to reform the Canadian health care system, demanding free health care for all. His outstanding work during the Spanish Civil War, where he organized the first ever mobile blood transfusion unit, and during the Sino‐Japanese war, where he was totally committed to the welfare of both soldiers and civilian population, were deliberate acts of resistance against Fascist onslaught and enthusiasm for the Communist cause.

CONCLUSIONS: Henry Norman Bethune was unconventional and a revolutionary, but he was brilliant. He will forever be remembered as an innovative thoracic surgeon and outstanding humanitarian.
Application of a Cold Patch for Relieving Pain after Transepithelial Photorefractive Keratectomy
Authors: Zeng Yuan , Li Yi , Gao Jian-Hua
Published: March 2016

Although photorefractive keratectomy often results in better corneal stability and fewer corneal flap complications than LASIK, pain remains a major drawback of the procedure. The authors compared the safety and efficacy of a postoperative cold patch versus intraoperative application of a chilled balanced salt solution on transepithelial photorefractive keratectomy‐related postoperative pain.

BACKGROUND: A return toward toward photorefractive keratectomy has occurred due to better corneal stability and fewer corneal flap complications; however, pain remains a major drawback of the procedure. Currently, clinical pain control measures focus on the administration of pain medications, which may delay corneal epithelial healing and has, occasionally, led to serious corneal toxicity.

OBJECTIVES: To investigate the safety and efficacy of a cold patch on postoperative pain and other relevant consequences of transepithelial photorefractive keratectomy.

METHODS: A prospective, randomized controlled study was conducted. Forty patients (80 eyes) scheduled to undergo transepithelial photorefractive keratectomy for myopia or myopic astigmatism were randomly and equally assigned to be treated with ice‐cold balanced salt solution during surgery (wash group) or to wear a postoperative cold patch on the eye for 24 h. The main outcomes were pain score on a visual analogue scale, postoperative eyelid edema, conjunctival hyperemia, epithelial healing time, haze and postoperative best‐corrected visual acuity.

RESULTS: All patients completed the final tests. Demographic characteristics and pain scores during surgery were similar between the two groups. The mean postoperative pain scores of patients in the cold patch group at 8 h, 16 h and 24 h were significantly lower than those of patients in the wash group. Scores for postoperative eyelid edema and conjunctival hyperemia in the cold patch group were also lower than in the wash group. Patients in the cold patch group used fewer painkillers. Epithelial healing time, haze and early recovery of visual acuity were similar between the two groups. No eyelid frostbite was observed.

CONCLUSION: Wearing a cold patch on the eye after transepithelial photorefractive keratectomy effectively relieved pain and inflammation, and reduced the use of painkillers without any side effects.
Effects of Continuous Fascia Iliaca Compartment Blocks for Postoperative Analgesia in Patients with Hip Fracture
Authors: Nie Hongling , Yang Ya-Xiong , Wang Yang , Liu Yong , Zhao Bin , Luan Bo
Published: March 2016

BACKGROUND: Effective analgesia is essential for the postoperative care of orthopedic patients.

OBJECTIVES: To evaluate the efficacy of continuous fascia iliaca compartment block (FIB) as postoperative analgesia after hip fracture surgery, and to compare FIB with patient‐controlled intravenous analgesia (PCIA) using fentanyl for 48 h postoperatively.

METHODS: Patients with hip fractures who were scheduled for open reduction and internal fixation surgery using the antirotation proximal femoral nail technique were randomly assigned to the FIB or PCIA groups. Postoperative pain was assessed using a numeral rating scale at 2 h, 4 h, 6 h, 12 h, 24 h and 48 h after analgesia was started. Delirium, postoperative nausea and vomiting (PONV), and pruritus were also monitored.

RESULTS: Patients in the FIB group reported less pain than those in the PCIA group (P=0.039, d=−0.3). The change in pain scores over time was similar between the two groups. There were six patients with PONV and five patients with pruritus in the PCIA group, while no PONV or pruritus was noticed in the FIB group (P=0.013). Ten (19.6%) patients in the FIB group and three (5.7%) patients in the PCIA group developed postoperative delirium (P=0.032, d=0.77).

CONCLUSION: Continuous FIB is a safe and effective technique for postoperative analgesia after hip fracture surgery, making it an option for pain management in elderly patients with hip fractures.
Analysis of Radiofrequency Lesions in Egg Whites in Vitro Produced by Application of the Tew Electrode for Different Temperatures and Times
Authors: Kwon Young Suk , Lim So Young , Kim Jong Ho , Jang Ji Su , Kim Chul Ho , Kwon Kwang Jun , Yon Jun Heum
Published: March 2016

BACKGROUND: Understanding the size and shape of radiofrequency lesions is important to reduce side effects when applied to patients.

OBJECTIVES: To investigate the radiofrequency lesions produced by the application of the Tew electrode for different temperatures and times.

METHODS: The white from a fresh hen’s egg was placed in a rectangular glass container and warmed to 37°C. After immersion of the Tew electrode in the egg white, radiofrequency lesions were produced at 65°C, 70°C, 75°C, 80°C, 85°C and 90°C. For each temperature, photographs were taken at 10 s, 20 s, 30 s, 40 s, 50 s, 60 s, 70 s, 80 s, 90 s, 100 s, 110 s and 120 s. The size of the lesion was measured at each temperature and time. A mixed model was used to analyze the data.

RESULTS: The size of the lesion increased with increasing temperature and time. There were statistically significant differences in the size of the internal radius between the 65°C and 70°C groups and the 70°C and 75°C groups, as well as in the 70°C and 75°C groups in the size of the external radius and the 60°C to 80°C groups in the size of the distal radius. The maximum lesion size was produced at 90°C and 120 s, and was 1.06±0.16 mm in internal radius, 0.37±0.15 mm in external radius, 0.39±0.04 mm in distal radius.

CONCLUSION: The Tew electrode produces lesions following the contour of the tip, and the internal radius is larger than the external and distal radius. The best combination of temperature and time for lesioning using the Tew electrode is 80°C, for 60 s to 90 s.
Patients’ Recall of Diagnostic and Treatment Information Improves with Use of the Pain Explanation and Treatment Diagram in an Outpatient Chronic Pain Clinic
Authors: Finestone Hillel M , Yanni Matthew M , Dalzell Catherine J
Published: March 2016

Educating patients about their condition and treatment plan is an essential component of successful treatment. Patients need to understand their condition, recall treatment suggestions and comply with the treatment protocol. Unfortunately, the method of patient education most commonly used by physicians is verbal teaching and discussion, which leads to poor patient recall. The authors of this article developed the Pain Explanation and Treatment Diagram, a worksheet that the clinician completes with the patient during their first consultation to function as a record of their diagnosis, pain risk factors and an action plan for when pain occurs. In this study, patient recall, among other variables, was assessed as a function of time since first appointment.

BACKGROUND: To maximize the benefit of therapies, patients must understand their condition, recall treatment suggestions and comply with treatments. The Pain Explanation and Treatment Diagram (PETD) is a one‐page worksheet that identifies risk factors (health‐related habits, sleep, exercise, ergonomics and psychosocial factors) involved in chronic pain. Clinician and patient complete the PETD together, and the clinician notes recommended treatments and lifestyle changes.

OBJECTIVES: To examine the effect of use of the PETD on patient recall of diagnostic and treatment information on the sheet.

METHODS: The present study was a cross‐sectional analysis. Patients with chronic musculoskeletal pain seen by one physiatrist at an outpatient pain clinic in a university‐affiliated hospital between 2009 and 2012 (all of whom received the PETD) were eligible. A structured telephone interview lasting approximately 1 h was used to determine recall of PETD diagnostic and treatment information.

RESULTS: Of the 84 eligible patients, 46 were contacted and 29 completed the telephone interview. Participants recalled an average of 12.2% (95% CI 7.8% to 17.4%) of items without prompting and 48.5% (95% CI 42.0% to 53.5%) when prompted. Participants who referred to the PETD at home (n=13) recalled significantly more items than those who did not (n=15) (17.6% [95% CI 11.1% to 23.9%] versus 5.2% [95% CI 3.0% to 14.5%], P=0.004); when prompted, the rates increased to 54.3% (95% CI 48.3% to 61.2%) and 41.2% (95% CI 34.7% to 50.7%), respectively (P=0.032).

CONCLUSIONS: The PETD is a promising, feasible and inexpensive tool that can improve patients’ recall of diagnostic‐ and treatment‐related information.
Spinal Antinociceptive Action of Amiloride and Its Interaction with Tizanidine in the Rat Formalin Test
Authors: Ouyang Handong , Wang Peizong , Huang Wan , Li Qiang , Nie Bilin , Zeng Weian
Published: March 2016

BACKGROUND: Amiloride has been reported to produce a wide variety of actions, thereby affecting several ionic channels and a multitude of receptors and enzymes. Intrathecal α2‐adrenergic receptor agonists produce pronounced analgesia, and amiloride modulates α2‐adrenergic receptor agonist binding and function, acting via the allosteric site on the α2A‐adrenergic receptor.

OBJECTIVES: To investigate the antinociceptive interaction of intrathecal amiloride and the α2‐adrenoceptor agonist tizanidine using a rat formalin test.

METHODS: Sprague‐Dawley rats were chronically implanted with lumbar intrathecal catheters and were tested for paw flinching using formalin injection. Biphasic painful behaviour was recorded. Amiloride, tizanidine or an amiloride‐tizanidine mixture was administered 10 min before formalin injection. To characterize any interactions, isobolographic analysis was performed. The effects of a pretreatment using intrathecally administered yohimbine was also tested.

RESULTS: Intrathecally administered amiloride (12.5 μg to 100 μg) and tizanidine (0.5 μg to 5 μg), given separately, produced a significant dose‐related suppression of the biphasic responses in the formalin test. Isobolographic analysis revealed that the combination of intrathecal amiloride and tizanidine synergistically reduced phase I and II activities. Intrathecally administered yohimbine antagonized or attenuated the antinociceptive effect of amiloride, tizanidine and the amiloride‐tizanidine mixture. Intrathecally administered amiloride synergistically interacts with tizanidine to reduce the nociceptive response in the formalin test, most likely by activating α2‐adrenoceptors in the spinal cord.

CONCLUSIONS: Although intrathecal tizanidine produced pronounced analgesia, antinociceptive doses of intrathecal tizanidine also produced several side effects, including bradycardia and sedation. Amiloride produced antinociceptive action against the thermal nociceptive test without side effects in rats.
Fidaxomicin: A Novel Agent for the Treatment of Clostridium difficile Infection
Authors: Zhanel George G , Walkty Andrew J , Karlowsky James A
Published: March 2016

BACKGROUND: Due to the limitations of existing treatment options for Clostridium difficile infection (CDI), new therapies are needed.

OBJECTIVE: To review the available data on fidaxomicin regarding chemistry, mechanisms of action and resistance, in vitro activity, pharmacokinetic and pharmacodynamic properties, efficacy and safety in clinical trials, and place in therapy.

METHODS: A search of PubMed using the terms “fidaxomicin”, “OPT‐80”, “PAR‐101”, “OP‐1118”, “difimicin”, “tiacumicin” and “lipiarmycin” was performed. All English‐language articles from January 1983 to November 2014 were reviewed, as well as bibliographies of all articles.

RESULTS: Fidaxomicin is the first macrocyclic lactone antibiotic with activity versus C difficile. It inhibits RNA polymerase, therefore, preventing transcription. Fidaxomicin (and its active metabolite OP‐1118) is bactericidal against C difficile and exhibits a prolonged postantibiotic effect (approximately 10 h). Other than for C difficile, fidaxomicin demonstrated only moderate inhibitory activity against Gram‐positive bacteria and was a poor inhibitor of normal colonic flora, including anaerobes and enteric Gram‐negative bacilli. After oral administration (200 mg two times per day for 10 days), fidaxomicin achieved low serum concentration levels but high fecal concentration levels (mean approximately 1400 μg/g stool). Phase 3 clinical trials involving adults with CDI demonstrated that 200 mg fidaxomicin twice daily for 10 days was noninferior to 125 mg oral vancomycin four times daily for 10 days in regard to clinical response at the end of therapy. Fidaxomicin was, however, reported to be superior to oral vancomycin in reducing recurrent CDI and achieving a sustained clinical response (assessed at day 28) for patients infected with non‐BI/NAP1/027 strains.

CONCLUSION: Fidaxomicin was noninferior to oral vancomycin with regard to clinical response at the end of CDI therapy. Fidaxomicin has been demonstated to be as safe as oral vancomycin, but superior to vancomycin in achieving a sustained clinical response for CDI in patients infected with non‐BI/NAP1/027 strains. Caution should be exercised in using fidaxomicin monotherapy for treatment of severe complicated CDI because limited data are available. Whether fidaxomicin is cost effective (due to its significantly higher acquisition cost versus oral vancomycin) depends on the acceptable willingness to pay threshold per quality‐adjusted life year as a measure of assessing cost effectiveness.
Postoperative Resource Utilization and Survival among Liver Transplant Recipients with Model for End-Stage Liver Disease Score ≥40: A Retrospective Cohort Study
Authors: Cardoso Filipe S , Karvellas Constantine J , Kneteman Norman M , Meeberg Glenda , Fidalgo Pedro , Bagshaw Sean M
Published: March 2016

BACKGROUND: Cirrhotic patients with Model for End-stage Liver Disease (MELD) score ≥40 have high risk for death without liver transplant (LT).

OBJECTIVE: To evaluate these patients’ outcomes after LT.

METHODS: The present study analyzed a retrospective cohort of 519 cirrhotic adult patients who underwent LT at a single Canadian centre between 2002 and 2012. Primary exposure was severity of liver disease measured by MELD score at LT (≥40 versus <40). Primary outcome was duration of first intensive care unit (ICU) stay after LT. Secondary outcomes were duration of first hospital stay after LT, rate of ICU readmission, re-LT and survival rates.

RESULTS: On the day of LT, 5% (28 of 519) of patients had a MELD score ≥40. These patients had longer first ICU stays after LT (14 versus two days; P<0.001). MELD score ≥40 at LT was independently associated with first ICU stay after LT ≥10 days (OR 3.21). These patients had longer first hospital stays after LT (45 versus 18 days; P<0.001); however, there was no significant difference in the rate of ICU readmission (18% versus 22%; P=0.58) or re-LT rate (4% versus 4%; P=1.00). Cumulative survival at one month, three months, one year, three years and five years was 98%, 96%, 90%, 79% and 72%, respectively. There was no significant difference in cumulative survival stratified according to MELD score ≥40 versus <40 at LT (P=0.59).

CONCLUSIONS: Cirrhotic patients with MELD score ≥40 at LT utilize greater postoperative health resources; however, they derive similar long-term survival benefit from LT.
Pasteurella multocida Non‐Native Joint Infection after a Dog Lick: A Case Report Describing a Complicated Two‐Stage Revision and a Comprehensive Review of the Literature
Authors: Philip W Lam , Page Andrea V
Published: March 2016

Prosthetic joint infections (PJIs) are commonly caused by pathogens such as Staphylococcus aureus and coagulase‐negative staphylococci; however, other microbial etiologies and specific risk factors are increasingly recognized. Pasteurella multocida is a Gram‐negative coccobacillus that is part of the normal oral flora in many animals, and is particularly common in dogs and cats. PJIs caused by P multocida have been reported only rarely in the literature and typically occur in the context of an animal bite or scratch. The present article describes a P multocida joint infection that occurred after a dog lick and complicated a two‐stage revision arthroplasty. A comprehensive review of the literature regarding P multocida PJIs follows.
Noninvasive Ventilation Practice Patterns for Acute Respiratory Failure in Canadian Tertiary Care Centres: A Descriptive Analysis
Authors: Digby Geneviève C , Keenan Sean P , Parker Christopher M , Sinuff Tasnim , Burns Karen E , Mehta Sangeeta , Ronco Juan J , Kutsogiannis Demetrios J , Rose Louise , Ayas Najib T , Berthiaume Luc R , D’Arsigny Christine L , Stollery Daniel E , Muscedere John
Published: March 2016

BACKGROUND: The extent of noninvasive ventilation (NIV) use for patients with acute respiratory failure in Canadian hospitals, indications for use and associated outcomes are unknown.

OBJECTIVE: To describe NIV practice variation in the acute setting.

METHODS: A prospective observational study involving 11 Canadian tertiary care centres was performed. Data regarding NIV indication, mode and outcomes were collected for all adults (>16 years of age) treated with NIV for acute respiratory failure during a four‐week period (between February and August 2011). Logistic regression with site as a random effect was used to examine the association between preselected predictors and mortality or intubation.

RESULTS: A total of 330 patients (mean [± SD] 30±12 per centre) were included. The most common indications for NIV initiation were pulmonary edema (104 [31.5%]) and chronic obstructive pulmonary disease (99 [30.0%]). Significant differences in indications for NIV use across sites, specialty of ordering physician and location of NIV initiation were noted. Although intubation rates were not statistically different among sites (range 10.3% to 45.4%), mortality varied significantly (range 6.7% to 54.5%; P=0.006). In multivariate analysis, the most significant independent predictor of avoiding intubation was do‐not‐resuscitate status (OR 0.11 [95% CI 0.03 to 0.37]).

CONCLUSION: Significant variability existed in NIV use and associated outcomes among Canadian tertiary care centres. Assignment of do‐not‐resuscitate status prevented intubation.
Physiological Evaluation of Childcare-Associated Muscle Load on the Neck and Shoulder Region in Japanese Women
Authors: Yoshinaga Saori , Kiyokawa Takuma , Kuramoto Eriko , Kinoshita Hiroe , Nemoto Seiji
Published: March 2016

The awkward movements and postures associated with childcare activities can lead to musculoskeletal symptoms in the neck and shoulders. “Dakko” is a method for carrying a child in Japan, and recently it has been reported to cause shoulder stiffness. To our knowledge, the relationship between childcare activities and the physical load on the neck and shoulders is poorly understood. The present study aims to clarify the muscle load on the neck and shoulder region through dakko simulations. First, the association between dakko movements and trapezius muscle activity is clarified by image and electromyogram analyses. Based on this clarification, the distributions and intensity of the muscle load from repetitive dakko movements are clarified using myogenic potential topography. During dakko movements, trapezius muscle activity was observed when lifting up and setting down the child, but not when holding the child. For the repetitive movements, myogenic electrical potentials were observed in the trapezius region after movement load, and individual characteristics of participants were revealed in both the load distributions and the recovery process. Repetitive dakko movements likely induced sustained muscle tonus in the trapezius, which may be a factor related to shoulder stiffness.
A Modeling Method for Small Packing Particles in Electromagnetic Simulation
Authors: Zhong Yi Cheng , Cheng Yu Jian , Fan Yong
Published: March 2016

A modeling method for small packing particles is proposed in this paper, especially for the application of the electromagnetic simulation. This method is able to model random distributed and mutual-contacted packing particles efficiently and accurately. This modeling method is faster than a commonly used software, especially for large number of particles. The accuracy of this modeling method is validated by experiments of packing density and effective permittivity. The established model can be easily imported into commercial electromagnetic simulation software.
Celiac Disease and Gluten-Free Oats: A Canadian Position Based on a Literature Review
Authors: La Vieille Sébastien , Pulido Olga M. , Abbott Michael , Koerner Terence B. , Godefroy Samuel
Published: March 2016

This paper provides an overview of the latest scientific data related to the safety of uncontaminated oats (<20 ppm of gluten) in the diet of individuals with celiac disease (CD). It updates the previous Health Canada position posted on the Health Canada website in 2007 and a related paper published in 2009. It considers a number of recent studies published between January 2008 and January 2015. While recognizing that a few people with celiac disease seem to be clinically intolerant to oats, this review concludes that oats uncontaminated by gluten-containing cereals (wheat, rye, and barley) can be safely ingested by most patients with celiac disease and that there is no conclusive evidence that the consumption of uncontaminated or specially produced oats containing no greater than 20 ppm gluten by patients with celiac disease should be limited to a specific daily amount. However, individuals with CD should observe a stabilization phase before introducing uncontaminated oats to the gluten-free diet (GFD). Oats uncontaminated with gluten should only be introduced after all symptoms of celiac disease have resolved and the individual has been on a GFD for a minimum of 6 months. Long-term regular medical follow-up of these patients is recommended but this is no different recommendation to celiac individuals on a GFD without oats.
Evaluation of High-Resolution Satellite-Based Real-Time and Post-Real-Time Precipitation Estimates during 2010 Extreme Flood Event in Swat River Basin, Hindukush Region
Authors: Anjum Muhammad Naveed , Ding Yongjian , Shangguan Donghui , Ijaz Muhammad Wajid , Zhang Shiqiang
Published: March 2016

Satellite-based real-time and post-real-time precipitation estimates of Tropical Rainfall Measuring Mission (TRMM) Multisatellite Precipitation Analysis (TMPA-3B42) were evaluated during an extreme heavy precipitation event (on 28–30 July 2010) over Swat River Basin and adjacent areas in Hindukush Region. Observations of 15 rain gauging stations were used for the evaluation of TMPA products. Results showed that the spatial pattern of precipitation in the event was generally captured by post-real-time product (3B42V7) but misplaced by real-time product (3B42RT), witnessed by a high spatial correlation coefficient for 3B42V7 (CC = 0.87) and low spatial correlation coefficient for 3B42RT (CC = 0.20). The temporal variation of the storm precipitation was not well captured by both TMPA products. 3B42V7 product underestimated the storm accumulated precipitation by 32.15%, while underestimation by 3B42RT was 66.73%. Based on the findings of this study, we suggest that the latest TMPA-based precipitation products, 3B42RT and 3B42V7, might not be able to perform well during extreme precipitation events, particularly in complex terrain regions like Hindukush Mountains. Therefore, cautions should be considered while using 3B42RT and 3B42V7 as input data source for the modelling, forecasting, and monitoring of floods and potential landslides in Hindukush Region.
Diagnostic Role of Colon Capsule Endoscopy in Patients with Optimal Colon Cleaning
Authors: Akyüz Ümit , Yılmaz Yusuf , İnce Ali Tüzün , Kaya Bülent , Pata Cengiz
Published: March 2016

Background. Colon capsule endoscopy (CCE) is a diagnostic test with relatively rare usage. In this study, we aimed to evaluate both the optimal cleaning regimen for CCE and the diagnostic value of test in the study group.Methods. A total of 62 patients were enrolled in this study. In the first step, 3 different colon preparing regimens were given to 30 patients [Group A: 3 days of liquid diet, sodium phosphate (NaP) (90 mL), and NaP enema;Group B: 3 days of liquid diet, 4 L of polyethylene glycol (PEG), and metoclopramide;Group C: 3 days of liquid diet, 4 L of PEG, NaP (45 mL), and bisacodyl after capsule ingestion] (10 patients in each group). The other consecutive 32 patients were cleaned with the best regimen which was NaP + PEG and CCE was performed. The results of CCE were controlled with colonoscopy in 28 patients.Results. Group C had the highest cleaning score, compared with the other groups (2.2±0.4versus2.7±0.4versus3.7±0.4,pvalue=0.000). The CCE findings were as follows in 28 patients who were also examined with colonoscopy: polyp (range: 5–10 mm) in 6 patients, internal hemorrhoids in 3 patients, angiodysplasia in 1 patient, diverticula in 1 patient, and ulcerative colitis in 1 patient. The sensitivity, specificity, PPV, and NPV of CCE were 100%, 92%, 93%, and 100%, respectively.Conclusions. Low dosage NaP combined with PEG provides optimal bowel preparation for CCE. CCE appears to be a highly sensitive diagnostic modality for detecting colonic pathologies.
Domperidone Prescribing Practices Exposed Patients to Cardiac Risk despite a “Black Box” Warning: A Canadian Tertiary Care Center Study
Authors: Forbes Nauzer , Cooray Mohan , Al-Dabbagh Raed , Yuan Yuhong , Tse Frances , Liu Louis W. C. , Xenodemetropoulos Ted
Published: March 2016

Background.In 2012, Health Canada released a warning regarding domperidone use, based on associations with life-threatening arrhythmias and death.Objective.This study aimed to compare the appropriateness of domperidone prescribing patterns before the advisory to those afterward.Methods.Two retrospective reviews were conducted for patients prescribed domperidone during quarters in 2005 and 2012. Outcomes included appropriateness of indication, dosing regimens, monitoring of electrolytes, baseline electrocardiogram performance and characteristics, presence of left ventricular dysfunction, and coprescription of QT-prolonging medications. Univariable and multivariable logistic regression analyses were performed.pvalues < 0.05 were considered significant.Results.290 and 287 patients were analyzed in 2005 and 2012, respectively. Domperidone initiation in hospital decreased from 2005 to 2012 (71.4% versus 39.4%,p<0.0001) as did prescriptions for nonapproved indications (84.8% versus 58.2%,p<0.0001). In-hospital initiation predicted prescription for nonapproved indications (OR = 7.01, 95% CI 4.52–10.87,p<0.0001). Use of domperidone as the sole GI drug predicted nonapproved indications (OR = 2.51, 95% CI 1.38–4.55,p=0.002).Conclusions.The advisory was associated with more appropriate domperidone initiation and compliance with recommended dosages. Our study suggests the need for increased awareness of the dosing and monitoring of domperidone to ensure patient safety.
Sleep Control Game for Wireless Sensor Networks
Authors: Lee Sang Hoon , Kim Hyeokman , Choi Lynn
Published: March 2016

In wireless sensor networks (WSNs), each node controls its sleep to reduce energy consumption without sacrificing message latency. In this paper we apply the game theory, which is a powerful tool that explains how each individual acts for his or her own economic benefit, to analyze the optimal sleep schedule for sensor nodes. We redefine this sleep control game as a modified version of the Prisoner’s Dilemma. In the sleep control game, each node decides whether or not it wakes up for the cycle. Payoff functions of the sleep control game consider the expected traffic volume, network conditions, and the expected packet delay. According to the payoff function, each node selects the best wake-up strategy that may minimize the energy consumption and maintain the latency performance. To investigate the performance of our algorithm, we apply the sleep control game to X-MAC, which is one of the recent WSN MAC protocols. Our detailed packet level simulations confirm that the proposed algorithm can effectively reduce the energy consumption by removing unnecessary wake-up operations without loss of the latency performance.
OpenFlow-Based Mobility Management Scheme and Data Structure for the Mobility Service at Software Defined Networking
Authors: Park Pill-Won , Kim Seong-Mun , Min Sung-Gi
Published: March 2016

The network-based mobility management is adapted to the OpenFlow architecture for mobility service at Software Defined Networking (SDN), and data structure for mobility service is proposed. SDN is a newly proposed Internet architecture which decouples the data and control planes, and mobility management is one of the most important issues in SDN. In order to provide mobility management service by utilizing the mobility scheme proposed earlier in a new network environment, the existing mobility schemes need to be modified. Particularly, the characters of the network environment need to be considered when designing the function of the network entities and data structure. Our proposed mobility management scheme is focused on the centralized control mechanism of SDN. We referred to Proxy Mobile IPv6 (PMIPv6) and OpenFlow-based PMIPv6 with a centralized mobility management controller (OPMIPv6-C). It has a merged data structure for the mobility service on SDN controller and minimizes the number of switches which need flow table modification at handover. At the performance analysis chapter, we compare the signaling cost at the registration and handover phase, packet delivery cost, and handover latency between the proposed scheme and OPMIPv6-C.
Recent Intensified Winter Coldness in the Mid-High Latitudes of Eurasia and Its Relationship with Daily Extreme Low Temperature Variability
Authors: Lu Chuhan , Xie Shaoqing , Qin Yujing , Zhou Jiewen
Published: March 2016

Observational records in recent decades show a large-scale decrease in the cold-season temperature variance in the Northern Hemisphere midlatitudes under continuous global warming. However, severe low temperature events in winter frequently occurred in midlatitude Eurasia (MEA) in the last decade. Here, we define a new coldness intensity (CI) index for the near-surface based on the amplitude of daily anomalously cold temperatures in winter to demonstrate the CI of the variability of low temperature extremes. The results show that a sign-consistent mode dominates the CI variation in MEA, with a marked intensification during the last decade via empirical orthogonal function (EOF) analysis. This leading mode is significantly related to the frequency of winter extreme events. The associated circulations are characterized by a remarkable anomalous anticyclone in Northwest Eurasia, which induced substantial cold advection in MEA. The widespread intensified CI in MEA is closely linked with strong surface anticyclones and synoptic blocking in the mid-high latitudes (25°E–85°E). Coincidently, positive phase shifts of the first two leading modes of the extratropical circulation, which feature similar blocking-like anomalies in the northwestern Eurasian subarctic, jointly play an important role in the recent frequency of severe winters.
High-Performance Wireless Piezoelectric Sensor Network for Distributed Structural Health Monitoring
Authors: Gao Shang , Dai Xuewu , Liu Zheng , Tian Guiyun
Published: March 2016

This paper presents the development of a newly designed wireless piezoelectric (PZT) sensor platform for distributed large-scale structure health monitoring, where real-time data acquisition with high sampling rate up to 12.5 Msps (sample per second) and distributed lamb-wave data processing are implemented. In the proposed wireless PZT network, a set of PZT transducers are deployed at the surface of the structure, a lamb-wave is excited, and its propagation characteristics within the structure are inspected to identify damages. The developed wireless node platform features a digital signal processor (DSP) of TMS320F28335 and an improved IEEE 802.15.4 wireless data transducer RF233 with up to 2 Mbps data rate. Each node supports up to 8 PZT transducers, one of which works as the actuator generating the lamb-wave at an arbitrary frequency, while the responding vibrations at other PZT sensors are sensed simultaneously. In addition to hardware, embedded signal processing and distributed data processing algorithm are designed as the intelligent “brain” of the proposed wireless monitoring network to extract features of the PZT signals, so that the data transmitted over the wireless link can be reduced significantly.
Phase-Type Arrivals and Impatient Customers in Multiserver Queue with Multiple Working Vacations
Authors: Goswami Cosmika , Selvaraju N.
Published: March 2016

We consider a PH/M/c queue with multiple working vacations where the customers waiting in queue for service are impatient. The working vacation policy is the one in which the servers serve at a lower rate during the vacation period rather than completely ceasing the service. Customer’s impatience is due to its arrival during the period where all the servers are in working vacations and the arriving customer has to join the queue. We formulate the system as a nonhomogeneous quasi-birth-death process and use finite truncation method to find the stationary probability vector. Various performance measures like the average number of busy servers in the system during a vacation as well as during a nonvacation period, server availability, blocking probability, and average number of lost customers are given. Numerical examples are provided to illustrate the effects of various parameters and interarrival distributions on system performance.
Defect Detection in Tire X-Ray Images Using Weighted Texture Dissimilarity
Authors: Guo Qiang , Zhang Caiming , Liu Hui , Zhang Xiaofeng
Published: March 2016

Automatic defect detection is an important and challenging problem in industrial quality inspection. This paper proposes an efficient defect detection method for tire quality assurance, which takes advantage of the feature similarity of tire images to capture the anomalies. The proposed detection algorithm mainly consists of three steps. Firstly, the local kernel regression descriptor is exploited to derive a set of feature vectors of an inspected tire image. These feature vectors are used to evaluate the feature dissimilarity of pixels. Next, the texture distortion degree of each pixel is estimated by weighted averaging of the dissimilarity between one pixel and its neighbors, which results in an anomaly map of the inspected image. Finally, the defects are located by segmenting this anomaly map with a simple thresholding process. Different from some existing detection algorithms that fail to work for tire tread images, the proposed detection algorithm works well not only for sidewall images but also for tread images. Experimental results demonstrate that the proposed algorithm can accurately locate the defects of tire images and outperforms the traditional defect detection algorithms in terms of various quantitative metrics.
Differences betweenMycobacterium-Host Cell Relationships in Latent Tuberculous Infection of MiceEx Vivoand Mycobacterial Infection of Mouse CellsIn Vitro
Authors: Ufimtseva Elena
Published: March 2016

The search for factors that account for the reproduction and survival of mycobacteria, including vaccine strains, in host cells is the priority for studies on tuberculosis. A comparison of BCG-mycobacterial loads in granuloma cells obtained from bone marrow and spleens of mice with latent tuberculous infection and cells from mouse bone marrow and peritoneal macrophage cultures infected with the BCG vaccinein vitrohas demonstrated that granuloma macrophages each normally contained a single BCG-Mycobacterium, while those acutely infectedin vitrohad increased mycobacterial loads and death rates. Mouse granuloma cells were observed to produce the IFNγ, IL-1α, GM-CSF, CD1d, CD25, CD31, СD35, and S100 proteins. None of these activation markers were found in mouse cell cultures infectedin vitroor in intact macrophages. Lack of colocalization of lipoarabinomannan-labeled BCG-mycobacteria with the lysosomotropic LysoTracker dye in activated granuloma macrophages suggests that these macrophages were unable to destroy BCG-mycobacteria. However, activated mouse granuloma macrophages could control mycobacterial reproduction in cells bothin vivoand inex vivoculture. By contrast, a considerable increase in the number of BCG-mycobacteria was observed in mouse bone marrow and peritoneal macrophages after BCG infectionin vitro, when no expression of the activation-related molecules was detected in these cells.