bluuebunny/crossref_metadata_2025 huggingface dataset:
Systematic study of Duadicus Dallas, 1851 (Insecta: Hemiptera: Heteroptera: Acanthosomatidae: Blaudusinae: Blaudusini), including the description of a new species from Western Australia
Authors: Wang Xiao‐Jing , Liu Guo‐Qing , Cassis Gerasimos
Published: October 2013

A new species of the acanthosoamtid genus Duadicus Dallas is described from Australia: D. namyatovae sp. nov., which is endemic to Western Australia. The type species D. pallidus is redescribed including the first detailed description of the male and female genitalia. Digital images, scanning electron micrographs and illustrations of the diagnostic characters are provided for both species. Host plant associations for both species are given, with preferences for species belonging to Melaleuca.
Zambia's input subsidy programs
Authors: Mason Nicole M. , Jayne T.S. , Mofya‐Mukuka Rhoda
Published: October 2013

Over the last decade, subsidies for fertilizer and hybrid maize seed have re‐emerged as a cornerstone of the Government of the Republic of Zambia's (GRZ's) agricultural development and poverty reduction strategies. This article reviews the Farmer Input Support Programme (FISP) and other GRZ input subsidy programs since structural adjustment. It then synthesizes existing and presents new empirical evidence on the programs’ targeting outcomes and effects. Results suggest that although 73% of smallholder households cultivate less than 2 hectares of land, and that these households constitute 78% of the smallholder farms below the US$1.25/capita/day poverty line, the majority (55%) of FISP fertilizer goes to households that cultivate larger areas. Other factors constant, wealthier households receive more subsidized inputs. Subsidized fertilizer promotes maize intensification and extensification (at the expense of fallow land), but an additional kg of subsidized fertilizer only raises maize output by 1.88 kg on average. As a result of low maize–fertilizer response rates, poor targeting, crowding out, and diversion of fertilizer intended for the program, financial benefit–cost ratios for FISP fertilizer are well below one. The article concludes with recommended reforms to FISP, including that it be downsized and the savings invested in known drivers of pro‐poor agricultural growth.
How do fertilizer subsidy programs affect total fertilizer use in sub‐Saharan Africa? Crowding out, diversion, and benefit/cost assessments
Authors: Jayne T.S. , Mather David , Mason Nicole , Ricker‐Gilbert Jacob
Published: October 2013

A major determinant of input subsidy programs’ effects on the achievement of national policy goals is the extent to which they raise total fertilizer use. This study synthesizes recent literature on how the new generation of targeted input subsidy programs has affected national fertilizer use after accounting for crowding effects, and derives benefit–cost (BC) estimates of the fertilizer subsidy programs for Kenya, Malawi, and Zambia after accounting for crowding out and diversion. We highlight two major findings. First, accounting for the illicit diversion of program fertilizer can profoundly influence estimates of how fertilizer subsidy programs affect total fertilizer use and program impacts. Given recent evidence that 33% or more of total program fertilizer may be diverted before being received by intended beneficiary farmers, the failure to account for program diversion is shown to overestimate the contribution of the subsidy programs to national fertilizer use by 67.3% in the case of Malawi, by 61.6% for Zambia, and by 138.0% for Kenya. The second major finding is that the incremental value of maize output produced from these subsidy programs is considerably less than their costs in most years, except under unusually high maize price assumptions. Conventional BC analyses that do not account for crowding out and diversion may seriously overestimate the benefits of input subsidy programs. Greater attention to program design and implementation details to reduce problems of crowding out and diversion can substantially raise the returns to such programs.
Cutting Edge: IL‐10‐Producing Regulatory B Cells in Early Human Pregnancy
Authors: Rolle Luise , Memarzadeh Tehran Maryam , Morell‐García Anselm , Raeva Yanitsa , Schumacher Anne , Hartig Roland , Costa Serban‐Dan , Jensen Federico , Zenclussen Ana Claudia
Published: October 2013

Problem

The function of IL‐10 producing regulatory B cells (Breg) during gestation is unknown. Here, we aimed to understand their participation in early pregnancy.

Method

CD19+CD24hiCD27+B cell frequency, measured by flow cytometry, increased with pregnancy onset but not in the case of spontaneous abortions.

Results

B cells from non‐pregnant women cultured with serum from normal pregnant women produced higher IL‐10 levels than those cultured with serum from spontaneous abortion patients or autologous serum. CD19+‐activated B cells from pregnant women strongly suppressed TNF‐a production by CD4+T cells when cocultured. We identified hCG as an important factor regulating the number and function of Breg during pregnancy.

Conclusions

Breg emerge as important players in pregnancy; they suppress undesired immune responses from maternal T cells and are therefore important for tolerance acquisition.
Postpartum voiding dysfunction: Identifying the risk factors
Authors: Buchanan Julie , Beckmann Michael
Published: October 2013

Background

Postpartum urinary retention (PPUR) (also known as voiding dysfunction) is a common problem, defined as the inability to completely void after giving birth. If voiding dysfunction is not recognised, bladder overdistension can lead to denervation, detrusor atony and prolonged voiding dysfunction.

Aim

To describe the incidence of PPUR amongst postpartum women undergoing routine bladder scanning and to identify the factors that lead to postpartum voiding dysfunction.

Methods

A retrospective analysis of all postpartum women at Mater Health Services, Brisbane between February and December 2012 was undertaken. Routinely collected postvoid residual bladder volumes (PVRBV) were reported using a bladder scanner at four and six hours and two to three days postbirth or following removal of an indwelling catheter (IDC). The characteristics of women with or without increased PVRBV were analysed.

Results

Postvoid residual bladder volumes at four‐hours postbirth/removal of IDC were available for 5558 women of whom 281 (5.1%) had a residual volume measured >150 mL. Obstetric factors explored included mode of birth, method of analgesia or anaesthesia, duration of labour, degree of perineal trauma, birth weight, gestation, parity, maternal age and body mass index. After controlling for confounders, nulliparity (aOR 1.53; 95% CI 1.05–2.26), birth by caesarean section (aOR 2.21; 95% CI 1.10–4.41) and 3rd/4th degree perineal trauma (aOR 2.01; 95% CI 1.09–3.72) were significant independent predictors of PPUR.

Conclusion

Following the introduction of a protocol of timed voiding and routine measurement of PVRBV after birth/removal of IDC, PPUR is uncommon. Adopting a risk‐factor‐based approach to PVRBV screening is not supported by these data.
Staphylococcus aureus enterotoxin‐specific IgE is associated with asthma in the general population: a GA2LEN study
Authors: Tomassen P. , Jarvis D. , Newson R. , Van Ree R. , Forsberg B. , Howarth P. , Janson C. , Kowalski M. L. , Krämer U. , Matricardi P. M. , Middelveld R. J. M. , Todo‐Bom A. , Toskala E. , Thilsing T. , Brożek G. , Van Drunen C. , Burney P. , Bachert C.
Published: October 2013

Background

Specific IgE to Staphylococcus aureus enterotoxins (SE‐IgE) has been associated with asthma. In the general population, we aimed to determine the prevalence of and risk factors for serum SE‐IgE and to examine the association with asthma.

Methods

A postal questionnaire was sent to a random sample of adults in 19 centers across Europe. A random sample of respondents was invited for clinical examination upon which they answered a questionnaire, underwent skin prick tests (SPTs) for common aeroallergens, and provided blood for measurement of total IgE and SE‐IgE. Risks were analyzed within centers using weighted logistic regression, and overall estimates calculated using fixed‐effects meta‐analysis.

Results

2908 subjects were included in this analysis. Prevalence of positive SE‐IgE was 29.3%; no significant geographic variation was observed. In contrast to positive skin prick tests, SE‐IgE was more common in smokers (<15 pack‐year: OR 1.11, P = 0.079, ≥15 pack‐year: OR 1.70, P < 0.001), and prevalence did not decrease in older age‐groups or in those with many siblings. Total IgE concentrations were higher in those with positive SE‐IgE than in those with positive SPT. SE‐IgE was associated with asthma (OR 2.10, 95% confidence interval [1.60–2.76], P = 0.001) in a concentration‐dependent manner. This effect was independent of SPT result and homogeneous across all centers.

Conclusions

We report for the first time that SE‐IgE is common in the general population throughout Europe and that its risk factors differ from those of IgE against aeroallergens. This is the first study to show that SE‐IgE is significantly and independently associated with asthma in the general population.
A randomised prospective trial of intra‐operative oesophageal Doppler‐guided fluid administration in major gynaecological surgery
Authors: McKenny M. , Conroy P. , Wong A. , Farren M. , Gleeson N. , Walsh C. , O'Malley C. , Dowd N.
Published: October 2013

Intra‐operative oesophageal Doppler monitor‐guided fluid management has been associated with improved postoperative length of hospital stay and morbidity in gastrointestinal and orthopaedic surgery. We designed a randomised controlled trial to test the hypothesis that this approach to intra‐operative fluid management in major elective open gynaecological surgery would shorten the length of postoperative stay, defined as time to readiness for hospital discharge. Postoperative morbidity was evaluated as a secondary outcome. The oesophageal Doppler monitor group underwent intra‐operative fluid management using an oesophageal Doppler‐guided stroke volume optimisation algorithm. Control group (conventional fluid therapy) intra‐operative fluid management was based on conventional haemodynamic indices. In a single centre, 102 patients were randomly assigned: 51 to the oesophageal Doppler monitor group (51 analysed) and 51 to the control group (50 analysed). Evaluators who were blinded to patient assignment collected postoperative outcome data. There was no difference in the length of postoperative hospital stay between the groups: median (IQR [range]) number of days until ready for discharge was 6 (5–8 [4–25]) days in the oesophageal Doppler monitor group compared with 7 (5–9 [4–42]) days in the control group, p = 0.5. There was no difference between the groups in postoperative morbidity survey scores on postoperative days 1, 3 or 5. Seven patients in the oesophageal Doppler monitor group and 11 in the control group experienced postoperative complications (p = 0.41). These findings question whether intra‐operative oesophageal Doppler‐guided fluid therapy is of benefit in patients undergoing open gynaecological surgery.
Heart Rate Variability and Procedural Outcome in Catheter Ablation for Atrial Fibrillation
Authors: Seaborn Geoffrey E.J. , Todd Keith , Michael Kevin A. , Baranchuk Adrian , Abdollah Hoshiar , Simpson Christopher S. , Akl Selim G. , Redfearn Damian P.
Published: October 2013

Introduction

In patients with normal hearts, increased vagal tone is associated with onset of paroxysmal atrial fibrillation (AF). Vagal denervation of the atria renders AF less inducible. Circumferential pulmonary vein isolation (CPVI) is effective for treating paroxysmal and persistent AF, and has been shown to impact heart rate variability (HRV) indices, in turn, reflecting vagal denervation. We examined the impact of CPVI on HRV indices, and evaluated the relationship between vagal modification and AF recurrence.

Methods

Electrocardiogram recordings were collected from 83 consecutive patients (63 male, 20 female, age 56.9 ± 9.3 years) undergoing CPVI for paroxysmal (n = 56) or persistent (n = 27) AF. Recordings were obtained over 10 minutes preprocedure, and at intervals up to 12 months. Antiarrhythmic medications were suspended prior to CPVI, and were resumed for 3 months following. Success was defined as no recurrence of atrial arrhythmia lasting longer than 30 seconds.

Results

In patients with successful procedures (n = 56, 42 paroxysmal, 14 persistent), HRV indices were significantly altered, with respect to preprocedure levels, over a sustained period. However, patients with recurrence (n = 27, 14 paroxysmal, 13 persistent) demonstrated similar HRV to their preprocedure levels over the follow‐up period.

Conclusion

Our results suggest that patients experiencing recurrence after a single CPVI have HRV attenuated by the procedure only intermittently, whereas patients with one successful CPVI experience a sustained change. A short‐term HRV recording is a convenient and potentially important marker for recurrence of atrial arrhythmia in a population undergoing CPVI.
Lomitapide at Supratherapeutic Plasma Levels Does Not Prolong the QTc Interval—Results from a TQT Study with Moxifloxacin and Ketoconazole
Authors: Darpo Borje , Ferber Georg , Zhou Meijian , Sumeray Mark , Sager Philip
Published: October 2013

Background

The aim of this study was to assess the effect of high plasma levels of lomitapide and its main metabolite on ECG parameters.

Methods

In this randomized five‐way cross‐over thorough QT study, 56 healthy subjects were enrolled. Study treatments were administered orally for 3 days in five separate periods in which subjects were dosed with (1) a single dose of 75 mg lomitapide on Day 1 followed by a single dose of 200 mg on Day 3; (2) ketoconazole 200 mg BID; (3) ketoconazole with a single dose of 75 mg lomitapide on Day 3; (4) a single dose of 400 mg moxifloxacin on Day 3 and (5) placebo.

Results

Single doses of 75 and 200 mg lomitapide alone or in combination with ketoconazole caused minor changes in the change‐from‐baseline QTcI (ΔQTcI), whereas moxifloxacin and ketoconazole caused an increase of ΔQTcI with a peak effect at 1 and 3 hours postdosing, respectively. The largest mean placebo‐corrected ΔQTcI (ΔΔQTcI) for lomitapide did not exceed 3 ms (upper bound of 90% CI: 4.7 ms) at any time points postdosing. Ketoconazole caused mild QT prolongation with mean ΔΔQTcI of 5.9 and 6.5 ms at 2 and 3 hours postdosing, and exposure‐response analysis demonstrated a significantly positive slope of 1.3 ms per μg/mL (90% CI: 1.0–1.7). Moxifloxacin met the criteria for assay sensitivity.

Conclusions

Lomitapide does not have an effect on cardiac repolarization. The study's ability to detect small QTc changes was demonstrated with both moxifloxacin and ketoconazole.
Diagnostic Accuracy of a New Cardiac Electrical Biomarker for Detection of Electrocardiogram Changes Suggestive of Acute Myocardial Ischemic Injury
Authors: Schreck David M. , Fishberg Robert D.
Published: October 2013

Objective

A new cardiac “electrical” biomarker (CEB) for detection of 12‐lead electrocardiogram (ECG) changes indicative of acute myocardial ischemic injury has been identified. Objective was to test CEB diagnostic accuracy.

Methods

This is a blinded, observational retrospective case‐control, noninferiority study. A total of 508 ECGs obtained from archived digital databases were interpreted by cardiologist and emergency physician (EP) blinded reference standards for presence of acute myocardial ischemic injury. CEB was constructed from three ECG cardiac monitoring leads using nonlinear modeling. Comparative active controls included ST voltage changes (J‐point, ST area under curve) and a computerized ECG interpretive algorithm (ECGI). Training set of 141 ECGs identified CEB cutoffs by receiver‐operating‐characteristic (ROC) analysis. Test set of 367 ECGs was analyzed for validation. Poor‐quality ECGs were excluded. Sensitivity, specificity, and negative and positive predictive values were calculated with 95% confidence intervals. Adjudication was performed by consensus.

Results

CEB demonstrated noninferiority to all active controls by hypothesis testing. CEB adjudication demonstrated 85.3–94.4% sensitivity, 92.5–93.0% specificity, 93.8–98.6% negative predictive value, and 74.6–83.5% positive predictive value. CEB was superior against all active controls in EP analysis, and against ST area under curve and ECGI by cardiologist.

Conclusion

CEB detects acute myocardial ischemic injury with high diagnostic accuracy. CEB is instantly constructed from three ECG leads on the cardiac monitor and displayed instantly allowing immediate cost‐effective identification of patients with acute ischemic injury during cardiac rhythm monitoring.
Sudden Death Due to Nonarrhythmic Cause in a Patient with L‐TGA
Authors: Hayward Robert M. , Ursell Philip C. , Foster Elyse , Tseng Zian H.
Published: October 2013

We report a case of sudden death in a clinically stable adult with l‐transposition of the great arteries (l‐TGA). Sudden death has been reported to be the leading cause of death in l‐TGA and is often attributed to arrhythmias in the absence of another identifiable cause. However, the contribution of nonarrhythmic causes to the burden of sudden death in this population is unknown. Comprehensive postmortem investigation, including autopsy and pacemaker interrogation, demonstrated that the cause of death was massive pulmonary hemorrhage due to stenosis of the patient's mechanical tricuspid (systemic AV) valve. This report highlights the important contribution of nonarrhythmic causes of sudden death in this population and the value of autopsy and device interrogation in determining true cause of death.
Thermal sealing systems with and without tissue divider for total thyroidectomy
Authors: Glover Anthony R. , Gundara Justin S. , Lee James C. , Sywak Mark S. , Delbridge Leigh W. , Sidhu Stan B.
Published: October 2013

Background

Sutureless thyroid surgery utilizing thermal sealing is now well established. However, incremental advances in technology still require formal clinical evaluation in order to ensure that added technology does not compromise safety. In this study, we compared a new thermal sealing device incorporating a tissue divider (LigaSure Small Jaw) with the device we have previously reported for use in total thyroidectomy (LigaSure Precise).

Methods

A cohort study was undertaken of 872 total thyroidectomies over a 2‐year period. Patients were selected for each group on the basis of device availability within four institutions and outcomes were obtained from a prospectively maintained database.

Results

Small Jaw was used in 399 cases and Precise in 473. No significant differences between patient demographics (sex, age), operation indication or pathology were found. Significantly more Small Jaw operations were performed in private versus public hospitals (P < 0.01). Regarding outcomes, there was no significant difference in the incidence of any complication (haematoma, temporary/permanent hypoparathyroidism or temporary/permanent recurrent laryngeal nerve injury). In a subgroup analysis of operations performed in the public hospital system, Small Jaw was found to be significantly faster (mean operative time: 79 versus 103 min) (95% CI 74–84 and 96–110 min) (P < 0.01).

Conclusion

The incorporation of a tissue divider into thermal sealing devices is efficacious and safe, with no compromise in clinical outcome, while providing the added benefit of a significant reduction in operative times.
Predictive value of C‐reactive protein with Alvarado score in acute appendicitis
Authors: Thirumallai Siva , Wijesuriya Suraj Ruwan , Mitchell Andrew , Delriviere Luc
Published: October 2013

Background

The aim of the study was to evaluate whether C‐reactive protein (CRP) level on admission could aid the diagnostic accuracy of Alvarado score in acute appendicitis.

Methods

We retrospectively evaluated hospital records and database of 234 patients (men 116, women 118, median age 28 years, range 15–87 years) who underwent appendicectomy for acute appendicitis. Patients were categorized into three groups retrospectively based on the Alvarado score. Group I: score 7–10 (n = 155), group II: score 4–6 (n = 71), group III: score less than 3 (n = 10). Negative (NPV) and positive predictive values (PPV) of CRP was calculated.

Results

Overall, 169 of 234 (72.2%) had histopathological confirmation of acute appendicitis. The predicted accuracy of Alvarado score was 84.5% in group I, 50.7% in group II and 25% in group III. The PPV of high CRP and NPV of normal CRP for group I was 88% and 36.4%, in group II, 63% and 72%, in group III, 33% and 86%, respectively.

Conclusion

The Alvarado score and CRP taken together improve the predictive value of diagnosing acute appendicitis. Having a normal CRP in the equivocal group of Alvarado 4–6, should be further evaluated by advanced imaging before proceeding to appendicectomy.
Maternal obesity and induction of labor
Authors: O'Dwyer Vicky , O'Kelly Sarah , Monaghan Bernadette , Rowan Ann , Farah Nadine , Turner Michael J.
Published: October 2013

Objective

To review induction of labor analyzed by body mass index (BMI) category in primigravidas and multigravidas.

Design

Prospective observational study.

Population

Women enrolled after sonographic confirmation of singleton pregnancy in the first trimester.

Setting

Large university teaching hospital.

Methods

Maternal height and weight were measured accurately before BMI calculation. Clinical details were recorded after review of individual obstetric records.

Main outcome measures

Emergency cesarean section and obstetric interventions.

Results

Of 2000 women enrolled, 50.4% (n = 1008) were primigravidas and 17.3% (n = 346) were obese. The induction rate was 25.6% and the overall cesarean section rate 22.0%. Primigravidas were more likely to have labor induced than multigravidas (38.1% vs. 23.4%, p < 0.001). Compared with women with a normal BMI, obese primigravidas but not obese multigravidas were more likely to have labor induced. In primigravidas who had labor induced, the cesarean section rate was 20.6% (91/442) compared with 8.3% (17/206) in multigravidas who had labor induced (p < 0.001). In obese primigravidas, induction of labor was also more likely to be associated with other interventions such as epidural analgesia, fetal blood sampling and emergency cesarean section. In contrast, induction of labor in obese multigravidas was not only less common but also not associated with an increase in other interventions compared with multigravidas with a normal BMI.

Conclusions

Due to the short‐term and long‐term implications of an unsuccessful induction in an obese primigravida, we recommend that induction of labor should only be undertaken for strict obstetric indications after careful consideration by an experienced clinician.
Recognition of Objects in Simulated Irregular Phosphene Maps for an Epiretinal Prosthesis
Authors: Lu Yanyu , Wang Jing , Wu Hao , Li Liming , Cao Xun , Chai Xinyu
Published: October 2013

Visual prostheses offer a possibility of restoring vision to the blind. It is necessary to determine minimum requirements for daily visual tasks. To investigate the recognition of common objects in daily life based on the simulated irregular phosphene maps, the effect of four parameters (resolution, distortion, dropout percentage, and gray scale) on object recognition was investigated. The results showed that object recognition accuracy significantly increased with an increase of resolution. Distortion and dropout percentage had significant impact on the object recognition; with the increase of distortion level and dropout percentage, the recognition decreased considerably. The accuracy decreased significantly only at gray level 2, whereas the other three gray levels showed no obvious difference. The two image processing methods (merging pixels to lower the resolution and edge extraction before lowering resolution) showed significant difference on the object recognition when there was a high degree of distortion level or dot dropout.
Reproduction of Continuous Flow Left Ventricular Assist Device Experimental Data by Means of a Hybrid Cardiovascular Model With Baroreflex Control
Authors: Fresiello Libera , Zieliński Krzysztof , Jacobs Steven , Di Molfetta Arianna , Pałko Krzysztof Jakub , Bernini Fabio , Martin Michael , Claus Piet , Ferrari Gianfranco , Trivella Maria Giovanna , Górczyńska Krystyna , Darowski Marek , Meyns Bart , Kozarski Maciej
Published: October 2013

Long‐term mechanical circulatory assistance opened new problems in ventricular assist device—patient interaction, especially in relation to autonomic controls. Modeling studies, based on adequate models, could be a feasible approach of investigation. The aim of this work is the exploitation of a hybrid (hydronumerical) cardiovascular simulator to reproduce and analyze in vivo experimental data acquired during a continuous flow left ventricular assistance. The hybrid cardiovascular simulator embeds three submodels: a computational cardiovascular submodel, a computational baroreflex submodel, and a hydronumerical interface submodel. The last one comprises two impedance transformers playing the role of physical interfaces able to provide a hydraulic connection with specific cardiovascular sites (in this article, the left atrium and the ascending/descending aorta). The impedance transformers are used to connect a continuous flow pump for partial left ventricular support (Synergy Micropump, CircuLite, Inc., Saddlebrooke, NJ, USA) to the hybrid cardiovascular simulator. Data collected from five animals in physiological, pathological, and assisted conditions were reproduced using the hybrid cardiovascular simulator. All parameters useful to characterize and tune the hybrid cardiovascular simulator to a specific hemodynamic condition were extracted from experimental data. Results show that the simulator is able to reproduce animal‐specific hemodynamic status both in physiological and pathological conditions, to reproduce cardiovascular left ventricular assist device (LVAD) interaction and the progressive unloading of the left ventricle for different pump speeds, and to investigate the effects of the LVAD on baroreflex activity. Results in chronic heart failure conditions show that an increment of LVAD speed from 20 000 to 22 000 rpm provokes a decrement of left ventricular flow of 35% (from 2 to 1.3 L/min). Thanks to its flexibility and modular structure, the simulator is a platform potentially useful to test different assist devices, thus providing clinicians additional information about LVAD therapy strategy.
Short‐Term In Vivo Performance of the Cleveland Clinic PediPump Left Ventricular Assist Device
Authors: Fumoto Hideyuki , Shiose Akira , Flick Christine R. , Noble Lawrence D. , Dudzinski David T. , Casas Fernando , Takaseya Tohru , Arakawa Yoko , Fukamachi Kiyotaka , Smith William A. , Duncan Brian W.
Published: October 2013

The PediPump was implanted in six healthy lambs (mean 25.6 ± 1.4 kg) between the left ventricular apex and the descending aorta to evaluate in vivo performance for up to 30 days. Anticoagulation was achieved by continuous heparin infusion. Three animals were euthanized prematurely, two because of respiratory dysfunction and one because of deteriorating pump performance resulting from thrombus formation inside the pump. Three lambs were electively sacrificed 30 days after implantation; all had stable hemodynamics and minimal hemolysis, as indicated by low plasma free hemoglobin (2.5 ± 3.1 mg/dL). Mean 30‐day pump flow was 1.8 ± 0.1 L/min at a pump speed of 12 200 ± 400 rpm. Neither activated clotting time nor activated partial thromboplastin time followed the changes in heparin dose. At necropsy, depositions were observed at the front (n = 1) and rear rotor axial positioning stops (n = 4); improved polishing techniques on the stationary stop surfaces and the addition of a hard‐carbon, thin‐film coating on the rotating stop of the pumps used for the last two experiments addressed the deposition seen earlier. In conclusion, the PediPump showed excellent hydraulic performance and minimal hemolysis during support for up to 30 days. Depositions observed at the axial positioning stops in earlier experiments were addressed by design and material refinements. We continue to focus on developing effective anticoagulation management in the lamb model as well as on further evaluating and demonstrating pump biocompatibility.
Flow Dynamics of Different Adult ECMO Systems: A Clinical Evaluation
Authors: Lehle Karla , Philipp Alois , Müller Thomas , Schettler Frank , Bein Thomas , Schmid Christof , Lubnow Matthias
Published: October 2013

Membrane oxygenator (MO) failure is a known hazard during venovenous extracorporeal membrane oxygenation (v‐v ECMO) therapy. Knowledge about technical and performance details of different ECMO systems (Maquet, Rastatt, Germany; Medos, Stolberg, Germany; Sorin, Modena, Italy) licensed for adults with acute lung failure might improve their handling. This retrospective study comprises 186 adult patients (Regensburg ECMO Registry) treated with v‐v ECMO. Flow dynamic data were used to analyze the performance of different blood pumps, cannula types, and MOs to maintain an adequate blood flow (1–5 L/min). Usage of the Medos ECMO system in critically ill patients required a higher pump speed and generated a higher pressure drop across the MO (dpMO), however, without an increase in free plasma hemoglobin. The dpMO depended on the type of MO and increased with blood flow as expected. Type‐specific normal values are reported. A distinct increase in dpMO above normal values within 1 day required an immediate MO exchange. This was an infrequent technical complication (3%). Finally, pressure‐flow performance of single dual‐lumen cannulas (27 Fr) was comparable with small single‐lumen cannulas (15 Fr), without an increased risk of technical‐induced hemolysis. Despite different performances, all current commercially available adult v‐v ECMO systems produce adequate blood flow without an increased risk in technical‐induced hemolysis. Familiarity with the specific properties of individual systems allows early detection of technical complications. Additionally, the choice of an adequate cannula requires a closer consideration of the individual patient situation.
Glistening in glaucomatous eyes: visual performances and risk factors
Authors: Schweitzer Cedric , Orignac Isabelle , Praud Delphine , Chatoux Olivier , Colin Joseph
Published: October 2013

Purpose

To analyse risk factors and visual performances of glaucomatous eyes with glistening in the intra‐ocular lens (IOL).

Methods

Prospective study performed between November 2010 and April 2011 and involving 67 consecutive glaucomatous eyes (47 patients), who previously had a phacoemulsification with a hydrophobic acrylic IOL implanted in the capsular bag. Glistening was classified in three groups of severity grade: G0 (<50 microvacuoles per mm2), G1 (50–150 microvacuoles per mm2), and G2 (>150 microvacuoles per mm2). All eyes underwent a best‐corrected visual acuity evaluation (BCVA, LogMAR scale), a complete clinical examination, a visual field test, a contrast sensitivity evaluation and a wavefront analysis of high‐order aberrations (HOAs) using a Shack–Hartmann aberrometer. Eyes with a posterior capsular opacification and a BCVA>0.30 LogMAR were excluded.

Results

Twenty six eyes (38.8%) had a grade 0, 12 eyes (17.9%) a grade 1 and 29 eyes (43.3%) a grade 2 of glistening severity grade. The mean follow‐up after cataract surgery was 35.2 ± 24.2 months and was significantly higher for G1 and G2 groups (p < 0.001). A higher number of topical glaucoma medication were associated with a higher glistening severity grade (p < 0.05). G1 and G2 groups had significantly lower mean contrast sensitivity values at high spatial frequencies and significantly higher loss variance (LV) values of the visual field test (p < 0.05). There was no significant difference in mean BCVA between groups (p = 0.455).

Conclusions

In glaucomatous eyes, glistening increased with time was associated with the number of topical glaucoma medications daily instilled and altered visual performances. It should be a consideration for glaucoma patients who are more likely to develop glistening within the IOL optic.
A 10‐year experience of outcome in chemotherapy‐treated hereditary retinoblastoma
Authors: Bartuma Katarina , Pal Niklas , Kosek Sonja , Holm Stefan , All‐Ericsson Charlotta
Published: October 2013

Purpose

The aim is to report the 10‐year retrospective experience of systemic chemotherapy for a population‐based group of patients with hereditary retinoblastoma at a national referral centre. The outcomes include control rates, treatment side‐effects, adjuvant therapy, failure rate, survival, secondary cancers and visual acuity.

Methods

All patients (n = 24, 46 eyes) diagnosed with retinoblastoma and treated with systemic chemotherapy at a national referral centre during 2001–2011 were included. Data were extracted from medical records.

Results

The patients were followed for a mean of 60 months (range 13–144). Four—six cycles of VEC was administered to all newly diagnosed group B/C/D/E eyes with bilateral disease and 83% (38 of 46) responded to the treatment. None of the patients discontinued chemotherapy because of adverse reactions. Altogether 26% (12 of 46) of the eyes received second‐line therapy (other than thermotherapy, cryotherapy and chemotherapy). The failure rate was 35% (16 of 46) and mortality rate 0%. None of the patients developed CNS manifestations (metastases or trilateral retinoblastoma). One of the patients developed a second primary tumour (osteosarcoma) 4 years following retinoblastoma diagnosis. Altogether 17% (4 of 24) patients received radiation therapy, 28% (13 of 46) of the eyes had to be enucleated, and one patient underwent bilateral enucleation. The age‐correlated visual acuity was mean of 73% of expected visual acuity.

Conclusion

Group A/B retinoblastomas have a distinct chemotherapy response, while group C/D/E tumours do not respond as well. The success rate was 65%; while patients have a good prognosis for life, approximately one‐third of all hereditary cases received radiation therapy or underwent enucleation.
Identification of important and potentially avoidable risk factors in a prospective audit study of neonatal deaths in a paediatric hospital in Vietnam
Authors: Kruse Alexandra Y , Phuong Cam N , Ho Binh TT , Stensballe Lone G , Pedersen Freddy K , Greisen Gorm
Published: October 2013

Aim

Neonatal deaths (≤28 days) account for more than half of child mortality in Vietnam. Presumably most die in hospital, but data are scarce. This study aimed to identify risk factors of death among hospitalised neonates.

Methods

We prospectively studied all neonatal deaths and expected deaths (discharged alive after withdrawal of life‐sustaining treatment) in a Vietnamese tertiary paediatric hospital during a 12‐month period in 2009–2010. The medical files were audited classifying admission prognosis, discharge outcome, cause of death/expected death according to two classifications, and important and potentially avoidable risk factors during the hospital stay.

Results

Among 5763 neonates admitted, 235 deaths and 67 expected deaths were included. According to both classifications, major causes were congenital malformations, prematurity and severe infections. Six risk factors were identified in 85% (60/71) of the neonates with a relatively good prognosis: recognition or response to danger signs, internal transfers, nosocomial infections, sepsis management, access to usual equipment/staff, and family perception.

Conclusion

Among 302 neonatal deaths/expected deaths, the major causes were congenital malformations, prematurity and severe infections. Six important and potentially avoidable risk factors could be addressed in the subgroup with relatively good admission prognosis, without implementing new technology or major organisational changes.
Seventeen‐year study shows rise in parapneumonic effusion and empyema with higher treatment failure after chest tube drainage
Authors: Yu Danny , Buchvald Frederik , Brandt Bodil , Nielsen Kim G
Published: October 2013

Aim

To evaluate epidemiology, pre‐admission characteristics and management of paediatric parapneumonic effusions (PPEs) and empyema in a tertiary paediatric pulmonary centre between 1993 and 2010.

Methods

Retrospective chart review study using paediatric and thoracic database searches, with particular emphasis on pre‐admission characteristics, disease stage (simple or complex effusion or empyema), general management and surgical procedures.

Results

One hundred children were eligible, exhibiting a significant increase in incidence from 0.5 to 2.6 per 100 000 across the study period. Baseline characteristics were similar across disease stages. Streptococcus pneumoniae was the most common pathogen. Surgical intervention beyond chest tube drainage (CTD) was required in 50%; this rate showed a particular increase in children aged 0–5 years (OR, 3.1), but was otherwise not influenced by baseline characteristics, disease stage or use of intrapleural fibrinolytics. Length of hospitalisation did not differ across disease stages or primary interventional procedures.

Conclusion

This study confirmed an increasing incidence of PPEs and empyema in a Scandinavian tertiary paediatric pulmonary centre. Young children exhibited higher treatment failure after CTD. Length of hospitalisation was similar across disease stages and was comparable to previous reports according to primary interventional procedure.
Infants with severe respiratory syncytial virus needed less ventilator time with nasal continuous airways pressure then invasive mechanical ventilation
Authors: Borckink Ilse , Essouri Sandrine , Laurent Marie , Albers Marcel JIJ , Burgerhof Johannes GM , Tissières Pierre , Kneyber Martin CJ
Published: October 2013

Aim

Nasal continuous positive airway pressure (NCPAP) has been proposed as an early first‐line support for infants with severe respiratory syncytial virus (RSV) infection. We hypothesised that infants <6 months with severe RSV would require shorter ventilator support on NCPAP than invasive mechanical ventilation (IMV).

Methods

Retrospective cohort analysis of infants admitted to two paediatric intensive care units, one primarily using NCPAP and one exclusively using IMV, between January 2008 and February 2010.

Results

We studied 133 (NCPAP n = 89, IMV n = 46) consecutively admitted infants. On admission, disease severity [i.e. Paediatric RISk of Mortality (PRISM) II score (NCPAP 5.1 ± 2.8 vs. IMV 12.2 ± 6.0, p < 0.001) and SpO2/FiO2 ratio (NCPAP 309 ± 81 vs. IMV 135 ± 98, p < 0.001)] was higher in the IMV group. NCPAP remained independently associated with shorter ventilatory support (hazard ratio 2.3, 95% CI 1.1–4.7, p = 0.022) after adjusting for PRISM II score, PCO2, SpO2/FiO2 ratio, bronchopulmonary dysplasia and occurrence of clinically suspected secondary bacterial pneumonia.

Conclusion

Nasal continuous positive airway pressure was independently associated with a shorter duration of ventilatory support. Differences in baseline disease severity mandate a randomised trial before the routine use of NCPAP can be recommended.
Adolescents and young adults with physical illness: a comparative study of psychological distress
Authors: Ferro Mark A
Published: October 2013

Aim

There is limited research investigating the relationship between physical illness and psychological distress among adolescents during the transition to young adulthood. This study examined risk for clinically relevant psychological distress over a 10‐year period comparing adolescents and young adults with asthma or epilepsy with healthy controls.

Methods

This research used data from the British Household Panel Survey (1991–2009) to compare healthy 16 to 25‐year‐olds (n = 7342) with individuals with asthma (n = 1798) and epilepsy (n = 117). Psychological distress was measured using the 12‐item General Health Questionnaire. Controlling for sociodemographic characteristics, generalised linear modelling was used to examine risk of psychological distress over time.

Results

Using healthy individuals as the reference category, prevalence ratios for psychological distress among individuals with asthma and epilepsy ranged from 1.1 to 2.7 and 2.3 to 7.0, respectively. Controlling for potential confounding factors (sex, marital status, employment status, income), risk for psychological distress was increased among individuals with asthma (OR = 1.94, p < 0.0001) or epilepsy (OR = 3.45, p = 0.0002) compared with healthy controls during the follow‐up.

Conclusion

Recognizing the increased risk among individuals with physical illness, paediatric and adult health professionals are well positioned to facilitate successful transition to adult health services and prevent or reduce psychological distress in this vulnerable population.
Exclusive breastfeeding for 4 versus 6 months and growth in early childhood
Authors: Jonsdottir Olof H , Kleinman Ronald E , Wells Jonathan C , Fewtrell Mary S , Hibberd Patricia L , Gunnlaugsson Geir , Thorsdottir Inga
Published: October 2013

Aim

To investigate the growth and the prevalence of overweight in early childhood among infants exclusively breastfed for 6 months (EBF) compared with those receiving complementary foods from 4 months of age in addition to breast milk (CF).

Methods

A total of 119 mother–infant pairs were randomised either in the CF or in the EBF group. Weight, length and head circumference of the infants were measured at birth, 6 weeks, and 3–6 months of age. In the follow‐up, the children's weight, length and head circumference were measured at 8, 10, 12 and 18 months and weight and height at 29–38 months.

Results

There were no differences between groups in the anthropometric outcome measures of weight‐for‐age (p = 0.78), length‐for‐age (p = 0.59), head‐circumference‐for‐age (p = 0.82) and BMI‐for‐age (p = 0.61), using repeated measurements ANOVA. Furthermore, no difference was seen in the prevalence between groups in risk of being overweight or in those who were overweight at 18 months and 29–38 months of age.

Conclusion

Exclusive breastfeeding for the first 4 or 6 months of life does not seem to affect the risk of being overweight or the prevalence of those who were overweight in early childhood.
Neurological symptoms in hospitalised patients: do we assess hyponatraemia with sufficient care?
Authors: Rodríguez M Jose , Alcaraz Andrés , Solana Maria Jose , García Ana
Published: October 2013

Aim

To review the incidence of hyponatraemic encephalopathy in children treated in a tertiary care centre hospital, together with the clinical setting and clinical management of these cases.

Methods

Retrospective descriptive study by chart review of patients admitted to hospital during 2000–2010. Patients older than 1 month were included who had severe hyponatraemia (sodium concentration <125 mmol/L) on admission or during their hospital stay and co‐incidental neurological symptoms. Epidemiological, clinical, laboratory and therapeutic data were collected.

Results

We analysed 41 cases of severe hypotonic hyponatraemia and neurological symptoms compatible with hyponatraemic encephalopathy. Boys accounted for 56.1% patients, and the median age was 1 year. Hyponatraemia was acquired in hospital by 61% of the patients, and 88% of those patients were receiving intravenous hypotonic fluids. The most frequent neurological symptom was seizures. The most common therapeutic strategy was sodium supplementation and antiepileptic drugs. Hypertonic fluids were only used in the initial treatment of 16 patients. There were two deaths related to hyponatraemic encephalopathy.

Conclusion

Hyponatraemia should always be considered a cause of neurological symptoms in hospitalised patients. Treatment should be prompt to prevent neurological sequelae and death. Current recommendations for fluid management in hospitalised children should be reviewed.
Providing lipid‐based nutrient supplements does not affect developmental milestones amongMalawian children
Authors: Mangani Charles , Cheung Yin Bun , Maleta Kenneth , Phuka John , Thakwalakwa Chrissie , Dewey Kathryn , Manary Mark , Puumalainen Taneli , Ashorn Per
Published: October 2013

Aim

To assess whether using lipid‐based nutrient supplements (LNS) to complement the diets of infants and young children affected when they achieved selected developmental milestones.

Methods

In rural Malawi, 840 6‐month‐old healthy infants were enrolled to a randomised trial. Control participants received no supplements, others were provided with milk‐containingLNS, soy‐containingLNSor corn–soy blend (CSB) for 12 months. Outcomes were the age at which they achieved key milestone: motor (walking with assistance, standing and walking alone, running), social (drinking from a cup and eating by themself) and language (saying single comprehensible words and waving goodbye).

Results

The mean age at which the subjects walked with assistance was 42.5, 42.3, 42.7 and 43.2 weeks in the control, milk‐LNS, soy‐LNSandCSBgroups, respectively (p = 0.748). There were also no significant differences in the mean age at standing alone (45.0, 44.9, 45.1 and 46.3 weeks), walking alone (54.6, 55.1, 55.3, 56.5 weeks), running (64.6, 63.7, 64.8, 65.9 weeks) or any other social or language milestones (each p > 0.10).

Conclusion

The findings do not support a hypothesis that providing tested formulations and doses of micronutrient‐fortifiedLNSorCSBwould have an impact on when young children in rural Malawi achieved selected developmental milestones.
Early lexical development and risk of verbal and nonverbal cognitive delay at school age
Authors: Ghassabian Akhgar , Rescorla Leslie , Henrichs Jens , Jaddoe Vincent W , Verhulst Frank C , Tiemeier Henning
Published: October 2013

Aim

To characterise the relationship between preschool lexical delay and language comprehension and nonverbal intelligence at school age.

Methods

The mothers of 2724 children completed the MacArthur Communicative Development Inventory when their child reached 1.5 years and the Language Development Survey and the Parent Report of Children's Ability at 2.5 years. When the children were 6 years old, we assessed vocabulary comprehension and nonverbal intelligence using Dutch batteries for language and nonverbal intelligence.

Results

Demographic factors explained 9.9% of the variance in vocabulary comprehension and 8.7% of the variance in nonverbal intelligence at 6 years. Male gender, low maternal education and non‐Western ethnic background predicted vocabulary comprehension delay at 6 years. Lexical development at 1.5 and 2.5 years explained only 3.8% of the variance in language comprehension at the age of six. Late onset expressive vocabulary delay increased the risk of language comprehension and nonverbal intelligence delay at 6 years (OR=2.31, 95% CI: 1.62‐3.29 and OR=1.74, 95% CI: 1.17–2.58, respectively).

Conclusion

Sociodemographic factors are important predictors of delays in language and nonverbal abilities as children enter school. In contrast, early expressive lexical delays, in particular before the age of two, have limited predictive power for language delays at the age of six.