bluuebunny/crossref_metadata_2025_split huggingface dataset:
Emergence delirium, pain or both? a challenge for clinicians
Authors: Somaini Marta , Sahillioğlu Emre , Marzorati Chiara , Lovisari Federica , Engelhardt Thomas , Ingelmo Pablo M. 
Published: January 2015

SummaryBackgroundChildren commonly display early postoperative negative behavior (e‐PONB) after general anesthesia, which includes emergence delirium (ED), discomfort, temperament, and pain. However, it is often difficult for the caregiver to discriminate between various aspects of e‐PONB.ObjectiveThis prospective observational study evaluates the possibility to distinguish between ED and pain in young children using validated pediatric observational scales in the early postoperative phase.MethodsFollowing institutional approval and written consent, children undergoing elective adenoidectomy and/or tonsillectomy were enrolled. Following standardized anesthesia, two trained observers simultaneously evaluated children's behavior with the Paediatric Anaesthesia Emergence Delirium Scale (PAED) and with the Face, Legs, Activity, Cry, Consolability scale (FLACC) at extubation, and at 5, 10, and 15 min.ResultsOf 150 children that completed the study, 32 (21%) had ED, 7 (5%) had pain, and 98 (65%) had simultaneously both ED and pain. The association of ‘No eye contact’, ‘No purposeful action’ and ‘No awareness of surroundings’ (ED1) had a sensitivity of 0.96 and a specificity of 0.80 (PPV 0.97, NPV 0.78) to identify ED. ‘Inconsolability’ and ‘Restlessness’ (ED2) had a sensitivity of 0.69 and a specificity of 0.88 (PPV 0.83 and NPV 0.78) to identify pain.ConclusionIt is difficult to differentiate between ED and pain using FLACC and PAED scores. ‘No eye contact’, ‘No purposeful action’, and ‘No awareness of surroundings’ significantly correlated with ED. ‘Inconsolability’ and ‘Restlessness’ are not reliable enough to identify pain or ED in the first 15 min after awakening.
Dexmedetomidine vs midazolam as preanesthetic medication in children: a meta‐analysis of randomized controlled trials
Authors: Pasin Laura , Febres Daniela , Testa Valentina , Frati Elena , Borghi Giovanni , Landoni Giovanni , Zangrillo Alberto 
Published: January 2015

SummaryIntroductionThe preoperative period is a stressing occurrence for most people undergoing surgery, in particular children. Approximately 50–75% of children undergoing surgery develop anxiety which is associated with distress on emergence from anesthesia and with later postoperative behavioral problems. Premedication, commonly performed with benzodiazepines, reduces preoperative anxiety, facilitates separation from parents, and promotes acceptance of mask induction. Dexmedetomidine is a highly selective α2‐agonist with sedative and analgesic properties. A meta‐analysis of all randomized controlled trials (RCTs) on dexmedetomidine versus midazolam was performed to evaluate its efficacy in improving perioperative sedation and analgesia, and in reducing postoperative agitation when used as a preanesthetic medication in children.MethodsStudies were independently searched in PubMed, BioMedCentral, Embase, and the Cochrane Central Register of clinical trials and updated on August 15th, 2014.Primary outcomes were represented by improved sedation at separation from parents, at induction of anesthesia, and reduction in postoperative agitation. Secondary outcomes were reduction in rescue analgesic drugs, and duration of surgery and anesthesia. Inclusion criteria were random allocation to treatment and comparison between dexmedetomidine and midazolam. Exclusion criteria were adult studies, duplicate publications, intravenous administration, and no data on main outcomes.ResultsData from 1033 children in 13 randomized trials were analyzed. Overall, in the dexmedetomidine group there was a higher incidence of satisfactory sedation at separation from parents (314 of 424 [74%] in the dexmedetomidine group vs 196 of 391 [50%] in the midazolam group, RR = 1.30 [1.05–1.62], P = 0.02), a reduced incidence of postoperative agitation (14 of 140 [10%] vs 56 of 141 [40%], RR = 0.31 [0.13–0.73], P = 0.008), and a significant reduction in the rescue doses of analgesic drugs (49 of 241 [20%] vs 95 of 243 [39%], RR = 0.52 [0.39–0.70], P < 0.001). There was no evidence of a higher incidence of satisfactory sedation at anesthesia induction or any reduction of duration of surgery and anesthesia.ConclusionsDexmedetomidine is effective in decreasing anxiety upon separation from parents, decreasing postoperative agitation, and providing more effective postoperative analgesia when compared with midazolam.
A randomized comparison of the i‐gel™ with the self‐pressurized air‐Q™ intubating laryngeal airway in children
Authors: Kim Min‐Soo , Lee Jae Hoon , Han Sang Won , Im Young Jae , Kang Hyo Jong , Lee Jeong‐Rim 
Published: January 2015

SummaryBackgroundSupraglottic airway devices with noninflatable cuff have advantages in omitting the cuff pressure monitoring and reducing potential pharyngolaryngeal complications. Typical devices without cuff inflation available in children are the i‐gel™ and the self‐pressurized air‐Q™ intubating laryngeal airway (air‐Q SP). To date, there is no comparative study between these devices in pediatric patients.AimThe purpose of this randomized study was to compare the i‐gel™ and the self‐pressurized air‐Q™ intubating laryngeal airway (air‐Q SP) in children undergoing general anesthesia.MethodsEighty children, 1–108 months of age, 7–30 kg of weight, and scheduled for elective surgery in which supraglottic airway devices would be suitable for airway management, were randomly assigned to either the i‐gel or the air‐Q SP. Oropharyngeal leak pressure and fiberoptic view were assessed three times as follows: after insertion and fixation of the device, 10 min after initial assessment, and after completion of surgery. We also assessed insertion parameters and complications.ResultsInsertion of the i‐gel was regarded as significantly easier compared to the air‐Q SP (P = 0.04). Compared to the air‐Q SP group, the i‐gel group had significantly higher oropharyngeal leak pressures at all measurement points and significantly lower frequencies of gastric insufflation at 10 min after initial assessment and completion of surgery. The air‐Q SP group had better fiberoptic views than the i‐gel group at all measurement points.ConclusionOur results showed that the i‐gel had easier insertion and better sealing function, and the air‐Q SP provided improved fiberoptic views in children requiring general anesthesia.
Determination of the 95% effective dose of remifentanil for the prevention of coughing during extubation in children undergoing tonsillectomy (with or without adenoidectomy)
Authors: Park Yong‐Hee , Chung Eun‐Jin , Lee Ji‐Hyun , Kim Jin‐Tae , Kim Chong‐Sung , Kim Hee‐Soo 
Published: January 2015

SummaryBackgroundLimited data are available regarding the 95% effective dose (ED95) of remifentanil to prevent the cough response during emergence from general anesthesia in children.MethodsThis study included 40 patients aged 3–12 years who underwent elective tonsillectomy with or without adenoidectomy. A predetermined remifentanil dose was infused continuously with desflurane during surgery and was continued until extubation. In the emergence period, the cough response during awake extubation was assessed to determine the remifentanil dose for the next patient. The first patient received remifentanil at the rate of 0.01 μg·kg−1·min−1, and subsequent patients received a 0.01 μg·kg−1·min−1 higher dose than the previous patient if there was more than moderate coughing detected, and the patient after those with less than mild coughing received either the same dose (95% probability) or a 0.01 μg·kg−1·min−1 lower dose (5% probability) using the biased coin design. Times to extubation and adverse events were recorded. The ED95 was calculated using the maximum‐likelihood estimation.ResultsThe ED95 of remifentanil for preventing coughing during extubation was 0.060 μg·kg−1·min−1 (95% confidence interval, 0.037–0.068). There was moderate coughing in all groups receiving 0.01–0.06 μg·kg−1·min−1 of remifentanil, but no cough response occurred in the group receiving remifentanil 0.07 μg·kg−1·min−1. Time to extubation was weakly correlated with remifentanil infusion rate (r = 0.331). One patient who received remifentanil 0.07 μg·kg−1·min−1 showed desaturation over 5 s immediately after extubation, but recovered after receiving 100% oxygen.ConclusionThe ED95 of the continuous remifentanil infusion rate was 0.060 μg·kg−1·min−1 to prevent the cough response during extubation in children after tonsillectomy.
Efficacy of the Japanese herbal medicine rikkunshito in infants with gastroesophageal reflux disease
Authors: Otake Kohei , Uchida Keiichi , Mori Koichiro , Ide Shozo , Koike Yuhki , Takamura Mitsuyuki , Inoue Mikihiro , Kusunoki Masato 
Published: January 2015

AbstractBackgroundGastroesophageal reflux disease (GERD) in infants is among the most common reason for physician consultation worldwide. A traditional Japanese medicine, rikkunshito (RKT), is effective for GERD in adult and pediatric patients. The aim of this study was to evaluate the efficacy and safety of RKT in infants with GERD.MethodsFifty‐four infants were referred to between July 2004 and December 2012 for evaluation and treatment of GERD. All infants had failure to thrive. We excluded nine patients with cow's milk protein allergy, neurological impairment or surgical indications. We retrospectively reviewed the clinical records of 45 infants with GERD. Twenty‐nine infants were treated with RKT (TJ‐43; 0.3 g/kg/day; RKT group), and 16 infants were treated with mosapride citrate at 0.5 mg/kg/day (mosapride group). The primary endpoint was RKT‐induced relief of clinical symptoms and bodyweight gain in infants with GERD.ResultsAfter 3 months of treatment, the frequency of vomiting per day was significantly lower in the RKT group than in the mosapride group (P = 0.0146) and the weight Z‐score was significantly higher in the RKT group than in the mosapride group (RKT group, −2.5 ± 1.5 vs mosapride group, −5.0 ± 2.0; P = 0.0386). No adverse effects were noted in either group.ConclusionsRKT may be safe and effective for relief of GER symptoms and for bodyweight gain in infants with GERD.
Dyadic Effects of Individual and Friend on Physical Activity in College Students
Authors: Kim Gwang Suk , Lee Chung Yul , Kim In Sook , Lee Tae Hwa , Cho Eunhee , Lee Hyeonkyeong , McCreary Linda L. , Kim Su Hee 
Published: January 2015

AbstractObjectivePhysical activity (PA) tends to decline throughout the college years, and close friends’ influence is known to be an important factor in maintaining PA. This study examined the actor effect and partner effect between an individual and his/her friend regarding the influence of self‐efficacy and social support on PA among Korean college students.Design and SampleCross‐sectional survey data from 108 pairs of individual students and friends were analyzed.MeasuresThe survey questionnaire measured PA, self‐efficacy toward exercise, social support for PA, anxiety and depression, community environments, and perceived health status. Structural equation modeling with path analysis was conducted to test Actor‐Partner Interdependence Model (APIM) explaining close relationships on PA.ResultsOne‐sided partner effect that friends' perceived friend support was directly related to individual's PA (β = 0.20, p < .05) was revealed. Regarding actor effects, self‐efficacy was directly related to higher levels of PA for individual and friend. Perceived health status was related to higher level of individuals’ PA.ConclusionsThese results suggest a role for public health nurses in developing interventions for college‐aged young adults that promotes friend support for PA as well as individual self‐efficacy toward PA, to engage young adults in establishing lifelong health‐promoting PA.
Movement and Agreement in Right‐Node‐Raising Constructions
Authors: Grosz Patrick Georg 
Published: January 2015

AbstractThis paper discusses the following type of right‐node‐raising construction (Ross): Coordinate structures in which elements that are interpreted in only one conjunct have moved across material that is interpreted as part of both conjuncts. I show that there are constructions of this type that simultaneously exhibit noncanonical plural agreement with two singularDPs and a ban on collective predicates in the same environment, which suggests contradictory conclusions. I argue that these properties follow from an approach to right‐node raising that allows multiple instances of sharing within the same tree (see Gračanin‐Yuksek,; de Vries). I propose an analysis of such plural agreement that treats it on analogy with agreement with conjoined singularDPs. I argue that, for the constructions with noncanonical plural agreement that I discuss, the present analysis is superior over a backward‐deletion analysis and a (non‐multidominance‐based) across‐the‐board movement analysis.
Comparative Proteomic Analysis Reveals Activation of Mucosal Innate Immune Signaling Pathways during Cholera
Authors: Ellis Crystal N. , LaRocque Regina C. , Uddin Taher , Krastins Bryan , Mayo-Smith Leslie M. , Sarracino David , Karlsson Elinor K. , Rahman Atiqur , Shirin Tahmina , Bhuiyan Taufiqur R. , Chowdhury Fahima , Khan Ashraful Islam , Ryan Edward T. , Calderwood Stephen B. , Qadri Firdausi , Harris Jason B. 
Published: January 2015

ABSTRACTVibrio choleraeO1 is a major cause of acute watery diarrhea in over 50 countries. Evidence suggests thatV. choleraeO1 may activate inflammatory pathways, and a recent study of a Bangladeshi population showed that variants in innate immune genes play a role in mediating susceptibility to cholera. We analyzed human proteins present in the small intestine of patients infected withV. choleraeO1 to characterize the host response to this pathogen. We collected duodenal biopsy specimens from patients with acute cholera after stabilization and again 30 days after initial presentation. Peptides extracted from biopsy specimens were sequenced and quantified using label-free mass spectrometry and SEQUEST. Twenty-seven host proteins were differentially abundant between the acute and convalescent stages of infection; the majority of these have known roles in innate defense, cytokine production, and apoptosis. Immunostaining confirmed that two proteins, WARS and S100A8, were more abundant in lamina propria cells during the acute stage of cholera. Analysis of the differentially abundant proteins revealed the activation of key regulators of inflammation by the innate immune system, including Toll-like receptor 4, nuclear factor kappa-light-chain-enhancer of activated B cells, mitogen-activated protein kinases, and caspase-dependent inflammasomes. Interleukin-12β (IL-12β) was a regulator of several proteins that were activated during cholera, and we confirmed that IL-12β was produced by lymphocytes recovered from duodenal biopsy specimens of cholera patients. Our study shows that a broad inflammatory response is generated in the gut early after onset of cholera, which may be critical in the development of long-term mucosal immunity againstV. choleraeO1.
Natural Variant of Collagen-Like Protein A in Serotype M3 Group A Streptococcus Increases Adherence and Decreases Invasive Potential
Authors: Flores Anthony R. , Jewell Brittany E. , Versalovic Erika M. , Olsen Randall J. , Bachert Beth A. , Lukomski Slawomir , Musser James M. 
Published: January 2015

ABSTRACT

Group A
Streptococcus
(GAS) predominantly exists as a colonizer of the human oropharynx that occasionally breaches epithelial barriers to cause invasive diseases. Despite the frequency of GAS carriage, few investigations into the contributory molecular mechanisms exist. To this end, we identified a naturally occurring polymorphism in the gene encoding the streptococcal collagen-like protein A (SclA) in GAS carrier strains. All previously sequenced invasive serotype M3 GAS possess a premature stop codon in the
sclA
gene truncating the protein. The carrier polymorphism is predicted to restore SclA function and was infrequently identified by targeted DNA sequencing in invasive strains of the same serotype. We demonstrate that a strain with the carrier
sclA
allele expressed a full-length SclA protein, while the strain with the invasive
sclA
allele expressed a truncated variant. An isoallelic mutant invasive strain with the carrier
sclA
allele exhibited decreased virulence in a mouse model of invasive disease and decreased multiplication in human blood. Further, the isoallelic invasive strain with the carrier
sclA
allele persisted in the mouse nasopharynx and had increased adherence to cultured epithelial cells. Repair of the premature stop codon in the invasive
sclA
allele restored the ability to bind the extracellular matrix proteins laminin and cellular fibronectin. These data demonstrate that a mutation in GAS carrier strains increases adherence and decreases virulence and suggest selection against increased adherence in GAS invasive isolates.
The Secreted Effector Protein EspZ Is Essential for Virulence of Rabbit Enteropathogenic Escherichia coli
Authors: Wilbur John Scott , Byrd Wyatt , Ramamurthy Shylaja , Ledvina Hannah E. , Khirfan Khaldoon , Riggs Michael W. , Boedeker Edgar C. , Vedantam Gayatri , Viswanathan V. K. 
Published: January 2015

ABSTRACT

Attaching and effacing (A/E) pathogens adhere intimately to intestinal enterocytes and efface brush border microvilli. A key virulence strategy of A/E pathogens is the type III secretion system (T3SS)-mediated delivery of effector proteins into host cells. The secreted protein EspZ is postulated to promote enterocyte survival by regulating the T3SS and/or by modulating epithelial signaling pathways. To explore the role of EspZ in A/E pathogen virulence, we generated an isogenic
espZ
deletion strain (Δ
espZ
) and corresponding
cis
-complemented derivatives of rabbit enteropathogenic
Escherichia coli
and compared their abilities to regulate the T3SS and influence host cell survival
in vitro
. For virulence studies, rabbits infected with these strains were monitored for bacterial colonization, clinical signs, and intestinal tissue alterations. Consistent with data from previous reports,
espZ
-transfected epithelial cells were refractory to infection-dependent effector translocation. Also, the Δ
espZ
strain induced greater host cell death than did the parent and complemented strains. In rabbit infections, fecal Δ
espZ
strain levels were 10-fold lower than those of the parent strain at 1 day postinfection, while the complemented strain was recovered at intermediate levels. In contrast to the parent and complemented mutants, Δ
espZ
mutant fecal carriage progressively decreased on subsequent days. Δ
espZ
mutant-infected animals gained weight steadily over the infection period, failed to show characteristic disease symptoms, and displayed minimal infection-induced histological alterations. Terminal deoxynucleotidyltransferase-mediated dUTP-biotin nick end labeling (TUNEL) staining of intestinal sections revealed increased epithelial cell apoptosis on day 1 after infection with the Δ
espZ
strain compared to animals infected with the parent or complemented strains. Thus, EspZ-dependent host cell cytoprotection likely prevents epithelial cell death and sloughing and thereby promotes bacterial colonization.
Cyclo(Phe-Pro) Produced by the Human Pathogen Vibrio vulnificus Inhibits Host Innate Immune Responses through the NF-κB Pathway
Authors: Kim Kiwan , Kim Na-Jeong , Kim So Young , Kim In Hwang , Kim Kun-Soo , Lee Gap Ryol 
Published: January 2015

ABSTRACT

Cyclo(Phe-Pro) (cFP) is a secondary metabolite produced by certain bacteria and fungi. Although recent studies highlight the role of cFP in cell-to-cell communication by bacteria, its role in the context of the host immune response is poorly understood. In this study, we investigated the role of cFP produced by the human pathogen
Vibrio vulnificus
in the modulation of innate immune responses toward the pathogen. cFP suppressed the production of proinflammatory cytokines, nitric oxide, and reactive oxygen species in a lipopolysaccharide (LPS)-stimulated monocyte/macrophage cell line and in bone marrow-derived macrophages. Specifically, cFP inhibited inhibitory κB (IκB) kinase (IKK) phosphorylation, IκBα degradation, and nuclear factor κB (NF-κB) translocation to the cell nucleus, indicating that cFP affects the NF-κB pathway. We searched for genes that are responsible for cFP production in
V. vulnificus
and identified VVMO6_03017 as a causative gene. A deletion of VVMO6_03017 diminished cFP production and decreased virulence in subcutaneously inoculated mice. In summary, cFP produced by
V. vulnificus
actively suppresses the innate immune responses of the host, thereby facilitating its survival and propagation in the host environment.
A Metalloprotease Secreted by the Type II Secretion System Links Vibrio cholerae with Collagen
Authors: Park Bo R. , Zielke Ryszard A. , Wierzbicki Igor H. , Mitchell Kristie C. , Withey Jeffrey H. , Sikora Aleksandra E. 
Published: January 2015

ABSTRACT

Vibrio cholerae
is autochthonous to various aquatic niches and is the etiological agent of the life-threatening diarrheal disease cholera. The persistence of
V. cholerae
in natural habitats is a crucial factor in the epidemiology of cholera. In contrast to the well-studied
V. cholerae
-chitin connection, scarce information is available about the factors employed by the bacteria for the interaction with collagens. Collagens might serve as biologically relevant substrates, because they are the most abundant protein constituents of metazoan tissues and
V. cholerae
has been identified in association with invertebrate and vertebrate marine animals, as well as in a benthic zone of the ocean where organic matter, including collagens, accumulates. Here, we describe the characterization of the
V. cholerae
putative collagenase, VchC, encoded by open reading frame VC1650 and belonging to the subfamily M9A peptidases. Our studies demonstrate that VchC is an extracellular collagenase degrading native type I collagen of fish and mammalian origin. Alteration of the predicted catalytic residues coordinating zinc ions completely abolished the protein enzymatic activity but did not affect the translocation of the protease by the type II secretion pathway into the extracellular milieu. We also show that the protease undergoes a maturation process with the aid of a secreted factor(s). Finally, we propose that
V. cholerae
is a collagenovorous bacterium, as it is able to utilize collagen as a sole nutrient source. This study initiates new lines of investigations aiming to uncover the structural and functional components of the
V. cholerae
collagen utilization program.