bluuebunny/crossref_metadata_2025 huggingface dataset:
Low-energy shock waves enhance the susceptibility of staphylococcal biofilms to antimicrobial agents in vitro
Authors: Wanner S. , Gstöttner M. , Meirer R. , Hausdorfer J. , Fille M. , Stöckl B.
Published: May 2011

Biofilm-associated infections in wounds or on implants are difficult to treat. Eradication of the bacteria is nearly always impossible, despite the use of specific antibiotics. The bactericidal effects of high-energy extracorporeal shock waves on Staphylococcus aureus have been reported, but the effect of low-energy shock waves on staphylococci and staphylococcal biofilms has not been investigated. In this study, biofilms grown on stainless steel washers were examined by electron microscopy. We tested ten experimental groups with Staph. aureus-coated washers and eight groups with Staph. epidermidis.

The biofilm-cultured washers were exposed to low-energy shock waves at 0.16 mJ/mm2 for 500 impulses. The washers were then treated with cefuroxime, rifampicin and fosfomycin, both alone and in combination. All tests were carried out in triplicate. Viable cells were counted to determine the bactericidal effect.

The control groups of Staph. aureus and Staph. epidermidis revealed a cell count of 6 × 108 colony-forming units/ml. Complete eradication was achieved using the combination of antibiotic therapy (single antibiotic in Staph. aureus, a combination in Staph. epidermidis) and shock wave application (p < 0.01).

We conclude that shock waves combined with antibiotics could be tested in an in vitro model of infection.
The influence of socioeconomic status on the incidence, outcome and mortality of fractures of the hip
Authors: Quah C. , Boulton C. , Moran C.
Published: May 2011

This is the first study to use the English Indices of Multiple Deprivation 2007, the Government’s official measure of multiple deprivation, to analyse the effect of socioeconomic status on the incidence of fractures of the hip and their outcome and mortality. Our sample consisted of all patients admitted to hospital with a fracture of the hip (n = 7511) in Nottingham between 1999 and 2009.

The incidence was 1.3 times higher (p = 0.038) in the most deprived populations than in the least deprived; the most deprived suffered a fracture, on average, 1.1 years earlier (82.0 years versus 83.1 years, p < 0.001). The mortality rate proved to be significantly higher in the most deprived population (log-rank test, p = 0.033), who also had a higher number of comorbidities (p = 0.001).

This study has shown an increase in the incidence of fracture of the hip in the most deprived population, but no association between socioeconomic status and mortality at 30 days. Preventative programmes aimed at reducing the risk of hip fracture should be targeted towards the more deprived if they are to make a substantial impact.
Human hip impingement morphology
Authors: Hogervorst T. , Bouma H. , de Boer S. F. , de Vos J.
Published: May 2011

We examined the morphology of mammalian hips asking whether evolution can explain the morphology of impingement in human hips. We describe two stereotypical mammalian hips, coxa recta and coxa rotunda. Coxa recta is characterised by a straight or aspherical section on the femoral head or head-neck junction. It is a sturdy hip seen mostly in runners and jumpers. Coxa rotunda has a round femoral head with ample head-neck offset, and is seen mostly in climbers and swimmers.

Hominid evolution offers an explanation for the variants in hip morphology associated with impingement. The evolutionary conflict between upright gait and the birth of a large-brained fetus is expressed in the female pelvis and hip, and can explain pincer impingement in a coxa profunda. In the male hip, evolution can explain cam impingement in coxa recta as an adaptation for running.
Complications and outcome of tibial lengthening using the Ilizarov method with or without a supplementary intramedullary nail
Authors: Sun X.-T. , Easwar T. R. , Manesh S. , Ryu J.-H. , Song S.-H. , Kim S.-J. , Song H.-R.
Published: May 2011

We compared the complications and outcome of tibial lengthening using the Ilizarov method with and without the use of a supplementary intramedullary nail. In a retrospective case-matched series assembled from 176 patients with tibial lengthening, we matched 52 patients (26 pairs, group A with nail and group B without) according to the following criteria in order of importance: 1) difference in amount of lengthening (± 2 cm); 2) percentage difference in lengthening (± 5%); 3) difference in patient’s age (± seven years); 4) aetiology of the shortening, and 5) level of difficulty in obtaining the correction. The outcome was evaluated using the external fixator index, the healing index and an outcome score according to the criteria of Paley. It was found that some complications were specific to group A or B respectively, but others were common to both groups.

The outcome was generally better in lengthenings with a nail, although there was a higher incidence of rectifiable equinus deformity in these patients.
An analysis of metal ion levels in the joint fluid of symptomatic patients with metal-on-metal hip replacements
Authors: Davda K. , Lali F. V. , Sampson B. , Skinner J. A. , Hart A. J.
Published: May 2011

We retrospectively analysed concentrations of chromium and cobalt ions in samples of synovial fluid and whole blood taken from a group of 92 patients with failed current-generation metal-on-metal hip replacements. We applied acid oxidative digestion to our trace metal analysis protocol, which found significantly higher levels of metal ion concentrations in blood and synovial fluid than a non-digestive method. Patients were subcategorised by mode of failure as either ‘unexplained pain’ or ‘defined causes’. Using this classification, chromium and cobalt ion levels were present over a wider range in synovial fluid and not as strongly correlated with blood ion levels as previously reported. There was no significant difference between metal ion concentrations and manufacturer of the implant, nor femoral head size below or above 50 mm. There was a moderately positive correlation between metal ion levels and acetabular component inclination angle as measured on three-dimensional CT imaging.

Our results suggest that acid digestion of samples of synovial fluid samples is necessary to determine metal ion concentrations accurately so that meaningful comparisons can be made between studies.
Adolescent slipped capital femoral epiphysis treated by a modified Dunn osteotomy with surgical hip dislocation
Authors: Huber H. , Dora C. , Ramseier L. E. , Buck F. , Dierauer S.
Published: May 2011

Between June 2001 and November 2008 a modified Dunn osteotomy with a surgical hip dislocation was performed in 30 hips in 28 patients with slipped capital femoral epiphysis. Complications and clinical and radiological outcomes after a mean follow-up of 3.8 years (1.0 to 8.5) were documented. Subjective outcome was assessed using the Harris hip score and the Western Ontario and McMaster Universities osteoarthritis index questionnaire.

Anatomical or near-anatomical reduction was achieved in all cases. The epiphysis in one hip showed no perfusion intra-operatively and developed avascular necrosis. There was an excellent outcome in 28 hips. Failure of the implants with a need for revision surgery occurred in four hips.

Anatomical reduction can be achieved by this technique, with a low risk of avascular necrosis. Cautious follow-up is necessary in order to avoid implant failure.
Acute haematogenous upper cervical osteomyelitis in neonates
Authors: Tomaszewski R. , Bijata W.
Published: May 2011

Haematogenous osteomyelitis in newborns and infants usually occurs in the long bones and is rare in the short or flat bones. We present two neonates with osteomyelitis of the upper cervical spine affecting the second to fourth cervical vertebrae and the first and second cervical vertebrae, respectively. Despite some delay in diagnosis, both responded successfully to conservative treatment with antibiotics, a cervical collar and needle puncture. The latest follow-up at six and seven years, respectively, showed no persistent neurological deficit and a normal diameter of the cervical spinal canal on MRI.
First-time revision using impacted morsellised allograft bone with a cemented Exeter stem
Authors: Zampelis V. , Ornstein E. , Franzén H. , Atroshi I.
Published: May 2011

Previously, radiostereometric analysis following hip revision performed using impacted morsellised allograft bone and a cemented Exeter stem has shown continuous subsidence of the stem for up to five years. It is not known whether the subsidence continues thereafter. In our study, 17 of 25 consecutive osteo-arthritic patients with aseptically loose stems who underwent first-time revision using impacted morsellised allograft bone and a cemented Exeter stem were followed by yearly radiostereometric examinations for nine years. The mean subsidence at six weeks was 1.1 mm (0.1 to 2.3), from six weeks to one year 1.3 mm (0 to 2.6), from one to five years 0.7 mm (0 to 2.0), and from five to nine years 0.7 mm (0.1 to 3.1). That from six weeks to nine years was 2.7 mm (0 to 6.4) (95% confidence interval 2.0 to 3.5). The Charnley pain score significantly improved after revision, and was maintained at nine years, but walking ability deteriorated slightly as follow-up extended. Of the eight patients who were not followed for nine years, two had early subsidence exceeding 11 mm.

Our findings show that in osteo-arthritic patients who undergo revision for aseptic loosening of the stem using impacted morsellised allograft bone and a cemented Exeter stem, migration of the stem continues over nine years at a slower rate after the first year, but without clinical deterioration or radiological loosening.
Multicentre randomised clinical trials in trauma care
Authors: Rangan A. , Maffulli N.
Published: May 2011

Multicentre clinical trials in trauma care are gaining prominence as a means of generating good-quality evidence to inform and influence clinical practice. We believe multicentre trials have an important role to play in supporting evidence-based practice, and further investment in such trials is justified.
Assessment of radiolucent lines around the Oxford unicompartmental knee replacement
Authors: Kalra S. , Smith T. O. , Berko B. , Walton N. P.
Published: May 2011

The Oxford unicompartmental knee replacement gives good results in patients with symptomatic osteoarthritis of the medial compartment. Previous studies have suggested that the presence of radiolucent lines (RLLs) does not reflect a poor outcome in such patients. However, the reliability and validity of this assessment have not been determined. Our aim was to assess the intra- and interobserver reliability and the sensitivity and specificity of the assessment of RLLs around both tibial and femoral components using standard radiographs.

Two reviewers assessed the radiographs of 45 patients who had loosening of the tibial or femoral component confirmed at revision surgery and compared them with those of a series of 45 asymptomatic patients matched for age and gender.

The results suggested that, using standard radiographs, tibial RLLs were 63.6% sensitive and 94.4% specific and femoral RLLs 63.9% sensitive and 72.7% specific for loosening. Overall intra- and interobserver reliability was highly variable, but zonal analysis showed that lucency at the tip of the femoral peg was significantly associated with loosening of the femoral component.

Fluoroscopically guided radiographs may improve the zonal reliability of the assessment of RLLs, but further independent and comparative studies are required. In the meantime, the innocence of the physiological RLLs detected by standard radiographs should be viewed with caution.
The Canadian Orthopaedic Trauma Society
Authors: Buckley R. , Leighton R. , Trask K.
Published: May 2011

The Canadian Orthopaedic Trauma Society was started in an endeavour to answer the difficult problem of obtaining enough patients to perform top-quality research into fractures. By maintaining a high standard, including randomised study design, inclusivity, open discussion among surgeons and excellent long-term follow-up, this group has become a leader in the orthopaedic research community. This annotation describes the short history, important components and spirit necessary to build a research community or team which will function well despite the difficult research environment facing individual surgeons.
Fixation of intracapsular fractures of the femoral neck in young patients
Authors: Duckworth A. D. , Bennet S. J. , Aderinto J. , Keating J. F.
Published: May 2011

The aim of this study was to determine the comorbid risk factors for failure in young patients who undergo fixation of a displaced fracture of the femoral neck. We identified from a prospective database all such patients ≤ 60 years of age treated with reduction and internal fixation. The main outcome measures were union, failure of fixation, nonunion and the development of avascular necrosis.

There were 122 patients in the study. Union occurred in 83 patients (68%) at a mean follow-up of 58 months (18 to 155). Complications occurred in 39 patients (32%) at a mean of 11 months (0.5 to 39). The rate of nonunion was 7.4% (n = 9) and of avascular necrosis was 11.5% (n = 14). Failures were more common in patients over 40 years of age (p = 0.03). Univariate analysis identified that delay in time to fixation (> 24 hours), alcohol excess and pre-existing renal, liver or respiratory disease were all predictive of failure (all p < 0.05). Of these, alcohol excess, renal disease and respiratory disease were most predictive of failure on multivariate analysis.

Younger patients with fractures of the femoral neck should be carefully evaluated for comorbidities that increase the risk of failure after reduction and fixation. In patients with a history of alcohol abuse, renal or respiratory disease, arthroplasty should be considered as an alternative treatment.
Relationship Characteristics and Contraceptive Use Among Young Adults
Authors: Manlove Jennifer , Welti Kate , Barry Megan , Peterson Kristen , Schelar Erin , Wildsmith Elizabeth
Published: May 2011

CONTEXT: Young adults have high rates of unintended childbearing and STDs, yet little research has examined the role of relationship characteristics in their contraceptive use.

METHODS: Data collected from the 2002–2005 rounds of the National Longitudinal Survey of Youth yielded a sample of 4,014 dating relationships among sexually active 18–26‐year‐olds. Bivariate analysis and multivariate logistic and multinomial logistic regressions assessed associations between relationship characteristics and contraceptive use at last sex.

RESULTS: In three‐quarters of the relationships, respondents had used some method at last intercourse; respondents in 26% of the relationships had used a condom only, in 26% a hormonal method only and in 23% dual methods. Compared with respondents in relationships in which first sex occurred within two months of starting to date, those who first had sex before dating were more likely to have used any method at last sex (odds ratio, 1.4), particularly condoms or dual methods (relative risk ratio, 1.5 for each). The relative risk of using a hormonal method only, rather than no method or condoms only, increased with relationship duration (1.01) and level of intimacy (1.1–1.2). Discussing marriage or cohabitation was associated with reduced odds of having used any method (0.7) and a reduced relative risk of having used condoms alone or dual methods (0.6 for each). Increasing levels of partner conflict and asymmetry were also linked to reduced odds of any method use (0.97 and 0.90, respectively).

CONCLUSIONS: Prevention programs should address relationship context in contraceptive decision making, perhaps by combining relationship and sex education curricula to foster communication and negotiation skills.
Analysis of Glycosaminoglycans in Cerebrospinal Fluid from Patients with Mucopolysaccharidoses by Isotope-Dilution Ultra-Performance Liquid Chromatography–Tandem Mass Spectrometry
Authors: Zhang Haoyue , Young Sarah P , Auray-Blais Christiane , Orchard Paul J , Tolar Jakub , Millington David S
Published: May 2011

BACKGROUND

New therapies for the treatment of mucopolysaccharidoses that target the brain, including intrathecal enzyme replacement, are being explored. Quantitative analysis of the glycosaminoglycans (GAGs) that accumulate in these disorders is required to assess the disease burden and monitor the effect of therapy in affected patients. Because current methods lack the required limit of quantification and specificity to analyze GAGs in small volumes of cerebrospinal fluid (CSF), we developed a method based on ultra-performance liquid chromatography–tandem mass spectrometry (UPLC-MS/MS).

METHODS

Samples of CSF (25 μL) were evaporated to dryness and subjected to methanolysis. The GAGs were degraded to uronic acid-N-acetylhexosamine dimers and mixed with internal standards derived from deuteriomethanolysis of GAG standards. Specific dimers derived from heparan, dermatan and chondroitin sulfates (HS, DS and CS) were separated by UPLC and analyzed by electrospray ionization MS/MS using selected reaction monitoring for each targeted GAG product and its corresponding internal standard.

RESULTS

CSF from control pediatric subjects (n = 22) contained <0.38 mg/L HS, 0.26 mg/L DS, and 2.8 mg/L CS, whereas CSF from patients with Hurler syndrome (n = 7) contained concentrations of DS and HS that were at least 6-fold greater than the upper control limits. These concentrations were reduced by 17.5% to 82.5% after allogeneic transplantation and treatment with intrathecal and intravenous enzyme replacement therapy.

CONCLUSIONS

The method described here has potential value in monitoring patients with mucopolysaccharidoses receiving treatment targeted to the brain.
First-Trimester Risk Calculation for Trisomy 13, 18, and 21: Comparison of the Screening Efficiency between 2 Locally Developed Programs and Commercial Software
Authors: Sørensen Steen , Momsen Günther , Sundberg Karin , Friis-Hansen Lennart , Jørgensen Finn Stener
Published: May 2011

BACKGROUND

Reliable individual risk calculation for trisomy (T) 13, 18, and 21 in first-trimester screening depends on good estimates of the medians for fetal nuchal translucency thickness (NT), free β-subunit of human chorionic gonadotropin (hCGβ), and pregnancy-associated plasma protein-A (PAPP-A) in maternal plasma from unaffected pregnancies. Means and SDs of these parameters in unaffected and affected pregnancies are used in the risk calculation program. Unfortunately, our commercial program for risk calculation (Astraia) did not allow use of local medians. We developed 2 alternative risk calculation programs to assess whether the screening efficacies for T13, T18, and T21 could be improved by using our locally estimated medians.

METHODS

We established these estimates from 19 594 women with singleton pregnancies and from 100 pregnant women carrying a fetus affected with trisomy (11 with T13, 23 with T18, and 66 with T21). All measured values were recalculated to a multiple of the median (MoM) and log10 transformed; the mean and SD were calculated for each group.

RESULTS

At a given risk cutoff value, we observed a slight improvement in detection rate (DR) for T13, T18, and T21 for a slightly higher false-positive rate (FPR) compared with the commercial program. The lower FPR in the commercial program was caused mainly by an inaccuracy in the PAPP-A median.

CONCLUSIONS

Center-specific medians for NT, hCGβ, and PAPP-A should be used in risk calculation programs to ensure high DRs and low FPRs for all 3 trisomies at a given risk cutoff.
Comparative Analysis of PCR–Electrospray Ionization/Mass Spectrometry (MS) and MALDI-TOF/MS for the Identification of Bacteria and Yeast from Positive Blood Culture Bottles
Authors: Kaleta Erin J , Clark Andrew E , Cherkaoui Abdessalam , Wysocki Vicki H , Ingram Elizabeth L , Schrenzel Jacques , Wolk Donna M
Published: May 2011

BACKGROUND

Emerging technologies for rapid identification of microbes demonstrate a shift from traditional biochemical and molecular testing algorithms toward methods using mass spectrometry (MS) for the semiquantitative analysis of microbial proteins and genetic elements. This study was performed to assess the diagnostic accuracy of 2 such technologies, PCR–electrospray ionization (ESI)/MS and MALDI-TOF/MS, with respect to phenotypic and biochemical profiling as a reference standard method. A positive challenge set of blood culture bottles was used to compare PCR-ESI/MS and MALDI-TOF/MS performance on a matched set of samples.

METHODS

We performed characterization of bloodstream infections from blood cultures using the Ibis T5000 PCR-ESI/MS and the Bruker MALDI Biotyper 2.0 (MALDI-TOF/MS) platforms for microbial identification. Diagnostic accuracy was determined by independent comparison of each method to phenotypic and biochemical characterization with Vitek2 analysis as the reference standard identification.

RESULTS

The diagnostic accuracy, represented as positive agreement, at the genus level was 0.965 (0.930–0.984) for PCR-ESI/MS and 0.969 (0.935–0.987) for MALDI-TOF/MS, and at the species level was 0.952 (0.912–0.974) with PCR-ESI/MS and 0.943 (0.902–0.968) for MALDI-TOF/MS. No statistically significant difference was found between PCR-ESI/MS and MALDI-TOF/MS in the ability to rapidly identify microorganisms isolated from blood culture.

CONCLUSIONS

Our results demonstrate that PCR-ESI/MS and MALDI-TOF/MS are equivalent in their ability to characterize bloodstream infections with respect to the reference standard, and highlight key differences in the methods that allow for each method to have a unique niche as a tool for rapid identification of microbes in blood cultures.
Effect of sample collection, temperature and time of storage on β-galactosidase and total hexosaminidase activities in dried blood collected on filter paper
Authors: de Castilhos Cristina D. , Mezzalira Jamila , Goldim Mariana P.S. , Werlang Frederico G. , Coelho Janice C.
Published: May 2011

Background: Dried blood spots (DBS) on filter paper is a valuable sampling technique in clinical chemistry, but the stability of enzymes used in the diagnosis of lysosomal storage diseases (LSDs) needs to be evaluated.

Methods: In a first experiment, blood from 20 subjects was collected using a syringe without additives and distributed into EDTA tubes, heparin tubes, and spotted on filter paper for the comparison of sampling effects. In a second experiment, blood from 30 healthy subjects was spotted on filter paper and analyzed for β-galactosidase and total hexosaminidase activities after storage of the samples at different temperatures for up to 180 days.

Results: Initially, we observed that enzyme activities were the same, independent of the collection method. When DBS was stored at 37°C the activity of β-galactosidase dropped to 85% of the initial value after 180 days (p<0.05). At all other temperatures (–20°C, 4°C and 25°C), the results were within the methodological error. Total hexosaminidase activity did not change significantly during the entire study period and at different storage temperatures.

Conclusions: The two enzymes investigated in the present study may be stored for up to 17 days (β-galactosidase) or 180 days (total hexosaminidase) until analysis without loss of activity.
Corpus evidence of the viability of statistical preemption
Authors: Goldberg Adele E.
Published: May 2011

The present paper argues that there is ample corpus evidence of statistical preemption for learners to make use of. In the case of argument structure constructions, a verbi is preempted from appearing in a construction A, CxA, if and only if the following probability is high: P(CxB|context that would be suitable for CxA and verbi). For example, the probability of hearing a preemptive construction, given a context that would otherwise be well-suited for the ditransitive is high for verbs like explain that overwhelmingly appear in the dative, and low for verbs like tell that readily appear in the ditransitive. Strength of statistical preemption is determined both by this probability, and by the frequency (ln (F)) of a verb in a preemptive construction when the context is at least as well suited to the preempted construction. The critiques of preemption by Stefanowitsch (Cognitive Linguistics 19: 513–531, 2008, this volume) are countered by arguing that the relevant probabilities were not considered. Moreover, we find evidence that constructions are somewhat less constrained when yoked to non-alternating verbs, as Stefanowitsch (cf. this volume) suggests should be the case.
Treatment with tetrahydrocannabinol (THC) prevents infertility in male cystic fibrosis mice
Authors: Bregman Tatiana , Fride Ester
Published: May 2011

Background: Cystic fibrosis (CF) is a hereditary disease caused by mutations of the gene encoding a channel protein CFTR, conducting Cl– and HCO3
– ions. The disease is characterized by disturbances in most physiological systems, and more than 95% of men are infertile. The mechanism underlying the etiology of CF is associated with an imbalance of fatty acids. It has been suggested that the function of the endocannabinoid system is also disturbed in CF, because endocannabinoids are derivatives of fatty acids. We assumed, therefore, that endocannabinoid activity, which plays an important role in fertility, is disrupted in CF and could be one of the causes of infertility. The aim of the present study was to test the hypothesis that stimulation of endocannabinoid receptors in infancy would normalize their function and prevent infertility in adulthood.

Methods: Knockout male mice (cftr–/–) were treated with tetrahydrocannabinol (THC), endocannabinoid receptors agonist, in infancy from days 7 until 28, daily.

Results: CF males treated with THC were fully fertile, producing offspring comparable by the number of litters and the number of pups with wild-type mice. CF males that were not treated with THC were completely infertile.

Conclusions: The present study shows that (i) endocannabinoid function is impaired in CF mice, as evidenced by the regenerating effect of its stimulation on the fertility of otherwise infertile males, (ii) endocannabinoid system dysfunction is apparently the determining factor causing infertility in CF, and (iii) mild stimulation of the endocannabinoid system in infancy and adolescence appears to normalize many reproductive processes and thereby prevent infertility in CF males.
A New Framework for Quality Partnerships in Children's Hospitals
Authors: Levy Fiona Howard , Brilli Richard J. , First Lewis R. , Hyman Daniel , Kohrt Alan E. , Ludwig Stephen , Miles Paul V. , Saffer Marian
Published: May 2011

Children's hospitals and their affiliated departments of pediatrics often pursue separate programs in quality and safety; by integrating these programs, they can accelerate progress. Hospital executives and pediatric department chairs from 14 children's hospitals have been exploring practical approaches for integrating quality programs. Three components provide focus: (1) alignment of quality priorities and resources across the organizations; (2) education and training for physicians in the science of improvement; and (3) professional development and career progression for physicians in recognition of quality-improvement activities. Process and resource requirements are identified for each component, and specific, actionable steps are identified. The action steps are arrayed on a continuum from basic to advanced integration. The resulting matrix serves as an “integration framework,” useful to a hospital and its pediatric academic department at any stage of integration for assessing its current state, plotting a path toward further integration, tracking its progress, and identifying potential collaborators and models of advanced integration. The framework contributes to health care's quality-improvement movement in multiple ways: it addresses a basic impediment to quality and safety improvement; it is an implementable model for integrating quality programs; it offers career-advancement potential for physicians interested in quality; it helps optimize investments in quality and safety; and it can be applied both within a single children's hospital and across multiple children's hospitals. Widespread adoption of the integration framework could have a transformative effect on the children's hospital sector, not the least of which is improved quality and safety on a large scale.
Risk of Later Seizure After Perinatal Arterial Ischemic Stroke: A Prospective Cohort Study
Authors: Wusthoff Courtney J. , Kessler Sudha Kilaru , Vossough Arastoo , Ichord Rebecca , Zelonis Sarah , Halperin Aviva , Gordon Danielle , Vargas Gray , Licht Daniel J. , Smith Sabrina E.
Published: May 2011

OBJECTIVE:

Although acute seizures are common among neonates with arterial ischemic stroke (AIS), the incidence of subsequent seizures is unknown. The goals of this study were to determine the incidence of seizures following hospital discharge after perinatal acute AIS, and to assess lesion characteristics associated with later seizure occurrence.

METHODS:

Neonates with confirmed acute AIS on MRI were identified through a prospective stroke registry. Clinic visits and telephone follow-up identified occurrence of seizures after hospital discharge. MRI scans were graded for size and characteristics of infarct, and associations with seizures after stroke were analyzed.

RESULTS:

At a mean (SD) follow-up of 31.3 (16.1) months, 11 of 46 (23.9%) patients with perinatal AIS had at least 1 seizure. Five patients had a single episode of seizure, and 6 developed epilepsy. The Kaplan-Meier probability of remaining seizure-free at 3 years was 73%. Stroke size on MRI was significantly associated with development of later seizures, with an incidence rate of later seizures 6.2 times higher among those with larger stroke size.

CONCLUSIONS:

Seizures occurred in <25% of patients during initial follow-up after perinatal AIS. Of those with seizures, nearly half had a single episode of seizure and not early epilepsy. Larger stroke size was associated with higher risk of seizure. These data suggest that prolonged treatment with anticonvulsant agents may not be indicated for seizure prophylaxis after perinatal AIS. These findings may help guide clinicians in counseling families and could form the basis for much-needed future research in this area.
Inpatient Health Care Utilization for Children Dependent on Long-term Mechanical Ventilation
Authors: Benneyworth Brian D. , Gebremariam Achamyeleh , Clark Sarah J. , Shanley Thomas P. , Davis Matthew M.
Published: May 2011

OBJECTIVE:

The objective was to describe the characteristics of pediatric discharges associated with long-term mechanical ventilation (LTMV) compared with those with complex chronic conditions (CCCs), and evaluate trends over time in health care utilization for the discharges associated with LTMV.

METHODS:

The Kids' Inpatient Database, compiled by the Agency for Healthcare Research and Quality, was used. Routine newborn care was excluded. Discharges associated with LTMV were identified by using the International Classification of Diseases, Ninth Revision, code v46.1x and compared with discharges associated with CCCs in 2006 using simple regression and χ2 analyses. Trends in LTMV-associated discharges from 2000 to 2006 were assessed using variance-weighted least squares regression.

RESULTS:

In 2006, there were an estimated 7812 discharges associated with LTMV. Compared with discharges for children with CCCs, LTMV discharges had significantly higher mortality, longer lengths of stay, higher mean charges, more emergency department admissions, and more discharges to long-term care. From 2000 to 2006, there was a 55% increase in the number of LTMV discharges and a concurrent 70% increase in aggregate hospital charges. The majority of LTMV discharges occurred in children 4 years old and younger, and ∼50% of the aggregate charges were for children younger than 1 year.

CONCLUSIONS:

Discharges for children associated with LTMV require substantively greater inpatient resource use than other children with CCCs. As the number of discharges and associated aggregate charges increase over time, additional research must examine patterns of care for specific clinical subgroups of LTMV, especially children aged 4 years and younger.
Care Models and Associated Outcomes in Congenital Heart Surgery
Authors: Burstein Danielle S. , Jacobs Jeffrey P. , Li Jennifer S. , Sheng Shubin , O'Brien Sean M. , Rossi Anthony F. , Checchia Paul A. , Wernovsky Gil , Welke Karl F. , Peterson Eric D. , Jacobs Marshall L. , Pasquali Sara K.
Published: May 2011

OBJECTIVE:

Recently, there has been a shift toward care of children undergoing heart surgery in dedicated pediatric cardiac intensive care units (CICU). The impact of this trend on patient outcomes is unclear. We evaluated postoperative outcomes associated with a CICU versus other ICU models.

PATIENTS AND METHODS:

Society of Thoracic Surgeons Congenital Heart Surgery Database participants (2007–2009) who completed an ICU survey were included. In multivariable analysis, we evaluated outcomes associated with a CICU versus other ICUs, adjusting for center volume, patient factors, and Society of Thoracic Surgeons–European Association for Cardiothoracic Surgery surgical risk category.

RESULTS:

A total of 20 922 patients (47 centers; 25 with a CICU) were included. Overall unadjusted mortality was 3.8%, median length of stay was 6 days (interquartile range: 4–13), and 21% had 1 or more complications. In multivariable analysis, there was no difference in mortality comparing CICUs versus other ICUs (odds ratio: 0.88 [95% confidence interval: 0.65–1.19]). In stratified analysis, CICUs were associated with lower mortality only among those in Society of Thoracic Surgeons–European Association for Cardiothoracic Surgery category 3 (odds ratio: 0.47 [95% confidence interval: 0.25–0.86]), primarily related to atrioventricular canal repair and arterial switch operation. There was no difference in length of stay or complications overall or in stratified analysis.

CONCLUSIONS:

We were not able to detect a difference in postoperative morbidity or mortality associated with the presence of a dedicated CICU for children undergoing heart surgery. There may be a survival benefit in certain subgroups .
Cardiovascular Events and Death in Children Exposed and Unexposed to ADHD Agents
Authors: Schelleman Hedi , Bilker Warren B. , Strom Brian L. , Kimmel Stephen E. , Newcomb Craig , Guevara James P. , Daniel Gregory W. , Cziraky Mark J. , Hennessy Sean
Published: May 2011

OBJECTIVE:

The objective of this study was to compare the rate of severe cardiovascular events and death in children who use attention-deficit/hyperactivity disorder (ADHD) medications versus nonusers.

PATIENTS AND METHODS:

We performed a large cohort study using data from 2 administrative databases. All children aged 3 to 17 years with a prescription for an amphetamine, atomoxetine, or methylphenidate were included and matched with up to 4 nonusers on the basis of data source, gender, state, and age. Cardiovascular events were validated using medical records. Proportional hazards regression was used to calculated hazard ratios.

RESULTS:

We identified 241 417 incident users (primary cohort). No statistically significant difference between incident users and nonusers was observed in the rate of validated sudden death or ventricular arrhythmia (hazard ratio: 1.60 [95% confidence interval (CI): 0.19–13.60]) or all-cause death (hazard ratio: 0.76 [95% CI: 0.52–1.12]). None of the strokes identified during exposed time to ADHD medications were validated. No myocardial infarctions were identified in ADHD medication users. No statistically significant difference between prevalent users and nonusers (secondary cohort) was observed (hazard ratios for validated sudden death or ventricular arrhythmia: 1.43 [95% CI: 0.31–6.61]; stroke: 0.89 [95% CI: 0.11–7.11]; stroke/myocardial infarction: 0.72 [95% CI: 0.09–5.57]; and all-cause death: 0.77 [95% CI: 0.56–1.07).

CONCLUSIONS:

The rate of cardiovascular events in exposed children was very low and in general no higher than that in unexposed control subjects. Because of the low number of events, we have limited ability to rule out relative increases in rate.
An Emergency Department Septic Shock Protocol and Care Guideline for Children Initiated at Triage
Authors: Larsen Gitte Y. , Mecham Nancy , Greenberg Richard
Published: May 2011

BACKGROUND:

Unrecognized and undertreated septic shock increases morbidity and mortality. Septic shock in children is defined as sepsis and cardiovascular organ dysfunction, not necessarily with hypotension.

OBJECTIVE:

Cases of unrecognized and undertreated septic shock in our emergency department (ED) were reviewed with a focus on (1) increased recognition at triage and (2) more aggressive treatment once recognized. We hypothesized that septic shock protocol and care guideline would expedite identification of septic shock, increase compliance with recommended therapy, and improve outcomes.

METHODS:

We developed an ED septic shock protocol and care guideline to improve recognition beginning at triage and evaluated all eligible ED patients from January 2005 to December 2009.

RESULTS:

We identified 345 pediatric ED patients (49% male, median age: 5.6 years), and 297 (86.1%) met septic shock criteria at triage. One hundred ninety-six (56.8%) had ≥1 chronic complex condition. Hypotension was present in 34% (n = 120); the most common findings were tachycardia (n = 251 [73%]) and skin-color changes (n = 269 [78%]). The median hospital length of stay declined over the study period (median: 181–140 hours; P < .05); there was no change in mortality rate, which averaged 6.3% (22 of 345). The greatest gains in care included more complete recording of triage vital signs, timely fluid resuscitation and antibiotic administration, and serum lactate determination.

CONCLUSIONS:

Implementation of an ED septic shock protocol and care guideline improved compliance in delivery of rapid, aggressive fluid resuscitation and early antibiotic and oxygen administration and was associated with decreased length of stay.
Dramatic Response to Panitumumab and Bevacizumab in Metastatic Gallbladder Carcinoma
Authors: Riley Elizabeth , Carloss Harry
Published: May 2011

This letter reports on a dramatic response to panitumumab and bevacizumab in a patient with widespread metastatic gall bladder carcinoma.
Short-Course Versus Standard Chemoradiation in T3 Rectal Cancer
Authors: Hong Theodore S. , Mamon Harvey
Published: May 2011

Presentation of the Case

A 68-year-old woman with no past medical history presents with rectal bleeding. Colonoscopy reveals a mass in the midrectum at approximately 8 cm. Biopsy shows adenocarcinoma. On physical exam, the tip of the mass is barely palpable. A magnetic resonance imaging (MRI) scan of the pelvis demonstrates a tumor with invasion through the muscularis in the midrectum (Fig. 1). There is at least 2 cm between the tip of the mass and the mesorectum. A single 8-mm lymph node is seen in the perirectal space. A medical oncologist, surgical oncologist, and radiation oncologist see the patient and they recommend that the patient receive 6 weeks of infusional 5-fluorouracil (5-FU) and external beam radiation to a dose of 50.4 Gy. After chemoradiation, the oncologists expect the patient to undergo a low anterior resection and, upon recovery, 4 months of 5-FU–based adjuvant chemotherapy. The oncology fellow asks the attending physicians whether short-course radiation therapy is appropriate for this patient.
All Nodes Lead to Chemo…
Authors: Schapira Lidia , Higgins Michaela J.
Published: May 2011

Presentation of the Case

A 51-year-old woman presents with an abnormal screening mammogram. Core biopsy shows an invasive ductal cancer that stains strongly for estrogen receptor (ER) and progesterone receptor (PR) and does not overexpress human epidermal growth factor receptor 2. She underwent a partial mastectomy and sentinel node biopsy. The invasive tumor measured 2.1 cm in greatest diameter and was grade 1. There was a 0.4 cm metastatic deposit in one of two sentinel lymph nodes (pT1cN1/stage IIA). There was no tumor within 0.2 cm of all margins and no lymphatic or vascular invasion noted. She was evaluated in the breast multidisciplinary clinic by a medical, surgical, and radiation oncologist. The question for our colleagues is what is the optimal adjuvant therapy for this woman and, more specifically, is chemotherapy necessary?
Household Feeding Patterns and Feeding Habits: Effects on the Health of Ibibio Households in Uyo Urban, Akwa Ibom State, Nigeria
Authors: Ikoh Moses Udo , Emmanuel Agness Unwana , Charles Arit O. , Charles J. O.
Published: May 2011

Food is one of the basic needs of man, and has a strong positive relationship with health. This article examines the impact of food consumption patterns and habits on the health of Ibibio households in Uyo, the capital of Akwa Ibom State of Nigeria. Employing a stratified random sampling framework, the study administered 368 questionnaires to respondents from both low-income and high-income households on equal proportion, and was complimented with four Focus Group Discussions (FGDs). Results indicate that the majority of households consumed foods classified under condiments/spices, stem/roots, vegetables, fat/oil, seafood, and poultry/meat on daily basis. Foods such as cereals, fruits, and bulbs were not common in their daily menu. Some respondents, especially from the low-income households, had to skip and/or forego meals for the benefit of the younger ones. The Linear Estimation System (LES) revealed deficiency in the Recommended Dietary Allowance (RDA) and blamed this on income poverty and lack of knowledge on the nutritional values of food. To obtain good health, there are prescribed food items that must be eaten in a scientifically required mix. The study therefore recommends nutritional and health education and the creation of awareness on the nutritional values of locally produced food items that would enhance nutritional and health status of the citizenry and food security.
Using a Symbolic Interactionist Approach to Role and Identity to Illuminate Medical Student Avoidance of Primary Care
Authors: Waller Kimberly A.
Published: May 2011

A symbolic interactionist approach is presented and analyzed in reference to helping solve the problem of medical students not choosing primary care practice for a career. The concepts of “Role” and “Identity” are examined in the social interaction context of pre-med and med students and the larger environment in the United States. Recommendations for application of these findings in selection of students and their training are included.
A deliberative solution to the social choice problem
Authors: Mladenovic Ivan
Published: May 2011

Is there a sense in which society makes rational decision in a democratic way
that is similar to individual rational decision-making? Social choice theory
claims that rational social choice is not possible. Or, at least, that if
possible, then the social choice must be dictatorial. I shall present a
deliberative solution to the social choice problem. This solution is called
deliberative, because it is based on the assumptions of deliberative
democracy.
The light of freedom in the age of enlightenment - part 1: The Netherlands
Authors: Molnar Aleksandar
Published: May 2011

The central topic of the article is the importance of the freedom for the Age
of Enlightenment, as well as ties connecting philosophy of Enlightenment and
political liberalism. Furthermore, the author?s central thesis is that the
light that began to enlightened the reason in the Age of Enlightenment had
nothing to do with God or nature, but solely with human freedom. As Anthony
Ashley Cooper, third Earl of Shaftsbury, noted in one of his letters, freedom
shed the light on two countries at first: the Netherlands and England. The
author is also disputing the thesis developed by Jonathan Irving Israel in
his recent books Radical Enlightenment and Enlightenment Contested that the
movement of radical Enlightenment in 18. century was almost exclusevly
inspired by the political and religious philosophy of the Dutch Baruch de
Spinoza. Although Spinoza?s contribution to the radical Enlightenment is
clear and evident, he could be also perceived as a thinker who inspired some
currents of moderate Enlightenment and counter-Enlightenment as well.
Zorba, Socrates, and the good life
Authors: Kovacevic Filip
Published: May 2011

How should one live in order to live well? What are the defining
characteristics of the good life? These questions - the perennial concern of
classical scholars - have in the last 25 years become the subject of debates
in contemporary social and political theory as well. Foucault (1986), Taylor
(1989), Kekes (1995), Cottingham (1998) and Nehamas (1998) have all stressed
the importance of the ?art of living? or ?caring for the self? in light of
contemporary political and economic developments. This article, as my
contribution to the debate, offers the analysis of two models of the ?good
life?: the one as presented by Plato and embodied in the literary character
of Socrates, and the other as presented by Nikos Kazantzakis and embodied in
the literary figure of Zorba. In general terms, Socrates advocates the rule
of reason and the denigration and submission of the bodily Eros, while Zorba
remains suspicious of the mind - ?a careful little shopkeeper? - and stresses
the significance of bodily experiences as ways of linking oneself with the
rest of the universe. Hence in the article I formulate an ethic of sensual
Eros by focusing on Zorba?s way of life and contrast it to the Socratic
ethics. I conclude that the concern and respect for the body, for the house
in which Eros dwells, is the necessary a priori for the living of the good
life. This way of life is not one that rejects reason altogether, but what it
does reject is the desire of reason to monopolize the individual?s life
processes.
Mussels as a bio-indicator of the environmental quality of the coastal water of the Boka Kotorska bay (Montenegro)
Authors: Jovic Mihajlo , Stankovic Ana , Slavkovic-Beskoski Latinka , Tomic Ilija , Degetto Sandro , Stankovic Slavka
Published: May 2011

The Mediterranean blue mussel Mytilus galloprovincialis was used as a
pollution level indicator in the Boka Kotorska Bay of the southeastern
Adriatic on the Montenegrin coast. The ever-increasing urbanization and
industrialization, combined with a poor sewage system, an increase in both
marine and inland traffic, as well as insufficient water circulation in the
Bay itself have resulted in some level of pollution. Since heavy metals are
extremely toxic and do not easily undergo biodecomposition, the results of
this study supply valuable information concerning the metal pollution of the
marine environment in Boka Kotorska Bay. The concentrations of the
investigated metals and nonmetals accumulated in the mussels were determined
during the fall of 2007 using Atomic Absorption Spectroscopy (AAS) for Cr,
Mn, Co, Ni, Cu, Cd, Hg, Pb, Sn and V, and Energy Dispersive X-ray
Fluorescence (ED-XRF) to determine the concentrations of Fe, Zn, Si, P, S,
Cl, K and Ca. ED-XRF was also used to determine the levels of non-metals and
elements present in high concentrations. Comparing the data from this study
in relation to data from other regions for Mytilus galloprovincialis, the
mussel sampled from the Boka Kotorska Bay showed a moderate level of
pollution.