bluuebunny/crossref_metadata_2025_split huggingface dataset:
Volatile Anesthetic Action in a Computational Model of the Thalamic Reticular Nucleus
Authors: Gottschalk Allan , Miotke Sam A. 
Published: May 2009

Background
Although volatile anesthetics (VAs) modulate the activity of multiple ion channels, the process whereby one or more of these effects are integrated to produce components of the general anesthetic state remains enigmatic. Computer models offer the opportunity to examine systems level effects of VA action at one or more sites. Motivated by the role of the thalamus in consciousness and sensory processing, a computational model of the thalamic reticular nucleus was used to determine the collective impact on model behavior of VA action at multiple sites.

Methods
A computational model of the thalamic reticular nucleus was modified to permit VA modulation of its ion channels. Isobolographic analysis was used to determine how multiple sites interact.

Results
VA modulation of either T-type Ca(2+) channels or gamma-aminobutyric acid type A receptors led to increased network synchrony. VA modulation of both further increased network synchronization. VA-induced decrements in Ca(2+) current permitted greater impact of inhibitory currents on membrane potential, but at higher VA concentrations the decrease in Ca(2+) current led to a decreased number of spikes in the burst generating the inhibitory signal. MAC-awake (the minimum alveolar concentration at which 50% of subjects will recover consciousness) concentrations of both isoflurane and halothane led to similar levels of network synchrony in the model.

Conclusions
Relatively modest VA effects at both T-type Ca(2+) channels and gamma-aminobutyric acid type A receptors can substantially alter network behavior in a computational model of a thalamic nucleus. The similarity of network behavior at MAC-awake concentrations of different VAs is consistent with a contribution of the thalamus to VA-induced unconsciousness through action at these channels.
Approach Combining the Airway Scope and the Bougie for Minimizing Movement of the Cervical Spine during Endotracheal Intubation
Authors: Takenaka Ichiro , Aoyama Kazuyoshi , Iwagaki Tamao , Ishimura Hiroshi , Takenaka Yukari , Kadoya Tatsuo 
Published: May 2009

Background
The Airway Scope (AWS, AWS-S100; Hoya-Pentax, Tokyo, Japan), a recently introduced video laryngoscope, has been reported to reduce movement of the cervical spine during intubation attempts in comparison with conventional laryngoscopes. Use of the bougie as an aid for the AWS may cause further reduction. The authors compared cervical spine movement during intubation with the AWS with and without a bougie.

Methods
Thirty patients without cervical spine abnormality were randomized into two groups: intubation with AWS only and intubation with the AWS and the bougie. The cervical spine motion between the occiput (C0) and the fourth cervical vertebra (C4) was observed fluoroscopically, and change in movement between adjacent vertebrae created by each intubation method was compared. Time to intubation was also measured.

Results
Laryngoscopy with the AWS produced extension of the cervical spine segments assessed (C0-4). Median extension angle of the C0-4 during intubation using the AWS was reduced from 16.0 degrees without the bougie to 6.5 degrees with the bougie (P < 0.01). There was no significant difference in time to intubation between them.

Conclusions
Use of the bougie resulted in significantly reduced extension of the cervical spine during intubation attempt with the AWS in patients with a normal cervical spine.
Morphine-6β-glucuronide Rapidly Increases Pain Sensitivity Independently of Opioid Receptor Activity in Mice and Humans
Authors: van Dorp Eveline L. A. , Kest Benjamin , Kowalczyk William J. , Morariu Aurora M. , Waxman Amanda R. , Arout Caroline A. , Dahan Albert , Sarton Elise Y. 
Published: May 2009

Background
Previous data indicate that morphine-6beta-glucuronide (M6G), a morphine metabolite with analgesic properties, can paradoxically increase pain sensitivity in mice and humans. The authors tested mice and humans for M6G hyperalgesia and assessed the contribution of N-methyl-D-aspartate receptor activity in mice.

Methods
Nociception after acute injection (10 mg/kg) and chronic infusion (1.6 mg/kg per 24 h) of M6G or saline was assayed using the tail-withdrawal test in CD-1 mice implanted with pellets containing the opioid antagonist naltrexone or placebo and in knockout mice lacking mu-, kappa-, and delta-opioid receptors and their B6129F(1) controls. In volunteers, responses to heat pain were tested after a M6G (0.4 mg/kg) injection in the presence of a continuous high naloxone (0.04-mg/kg bolus followed by 0.04 mg/kg per hour) or saline background infusion.

Results
Acute M6G injection evoked analgesia in CD-1 mice implanted with placebo pellets and B6129F(1) control mice, whereas it caused hyperalgesia in CD-1 mice treated concurrently with naltrexone and in knockout mice. Continuous M6G infusion produced hyperalgesia within 24 h, lasting for a minimum of 6 days, in both placebo- and naltrexone-pelleted mice. The N-methyl-D-aspartate receptor antagonist MK-801 (0.05 mg/kg) blocked and reversed hyperalgesia after the acute injection and continuous infusion of M6G, respectively. In humans, M6G increased heat pain sensitivity for at least 6 h independently of simultaneous naloxone infusion.

Conclusions
These data indicate that M6G causes hyperalgesia independent of previous or concurrent opioid receptor activity or analgesia. In mice, a causal role for the N-methyl-D-aspartate receptor is also indicated.
Anesthetic-induced Improvement of the Inflammatory Response to One-lung Ventilation
Authors: De Conno Elisena , Steurer Marc P. , Wittlinger Moritz , Zalunardo Marco P. , Weder Walter , Schneiter Didier , Schimmer Ralph C. , Klaghofer Richard , Neff Thomas A. , Schmid Edith R. , Spahn Donat R. , Z’graggen Birgit Roth , Urner Martin , Beck-Schimmer Beatrice 
Published: May 2009

Background
Although one-lung ventilation (OLV) has become an established procedure during thoracic surgery, sparse data exist about inflammatory alterations in the deflated, reventilated lung. The aim of this study was to prospectively investigate the effect of OLV on the pulmonary inflammatory response and to assess possible immunomodulatory effects of the anesthetics propofol and sevoflurane.

Methods
Fifty-four adults undergoing thoracic surgery with OLV were randomly assigned to receive either anesthesia with intravenously applied propofol or the volatile anesthetic sevoflurane. A bronchoalveolar lavage was performed before and after OLV on the lung side undergoing surgery. Inflammatory mediators (tumor necrosis factor alpha, interleukin 1beta, interleukin 6, interleukin 8, monocyte chemoattractant protein 1) and cells were analyzed in lavage fluid as the primary endpoint. The clinical outcome determined by postoperative adverse events was assessed as the secondary endpoint.

Results
The increase of inflammatory mediators on OLV was significantly less pronounced in the sevoflurane group. No difference in neutrophil recruitment was found between the groups. A positive correlation between neutrophils and mediators was demonstrated in the propofol group, whereas this correlation was missing in the sevoflurane group. The number of composite adverse events was significantly lower in the sevoflurane group.

Conclusions
This prospective, randomized clinical study suggests an immunomodulatory role for the volatile anesthetic sevoflurane in patients undergoing OLV for thoracic surgery with significant reduction of inflammatory mediators and a significantly better clinical outcome (defined by postoperative adverse events) during sevoflurane anesthesia.
Is the Performance of Acceleromyography Improved with Preload and Normalization?
Authors: Claudius Casper , Skovgaard Lene Theil , Viby-Mogensen Jørgen 
Published: May 2009

Background
Many studies have indicated that acceleromyography and mechanomyography cannot be used interchangeably. To improve the agreement between the two methods, it has been suggested to use a preload and to refer all train-of-four (TOF) ratios to the control TOF (normalization) when using acceleromyography. The first purpose of this study was to test whether a preload applied to acceleromyography would increase the precision and the agreement with mechanomyography. The second purpose was to evaluate whether normalization would improve the agreement with mechanomyography.

Methods
Sixty patients were randomized to acceleromyography with or without a preload (Hand Adapter; Organon, Oss, the Netherlands). On the contralateral arm, mechanomyography was used. Anesthesia was induced with propofol and an opioid, and neuromuscular block with 0.6 mg/kg rocuronium. The precision and the bias and limits of agreement (with or without normalization) between the methods were evaluated using TOF stimulation.

Results
Preload improved the precision of acceleromyography by 21%, but it also increased the mean control TOF ratio from 1.07 to 1.13. Normalization of the acceleromyographic TOF ratios diminished the bias to mechanomyography during recovery (e.g., from 0.15 to 0.05 at TOF 0.90); when the mechanomyographic TOF values were normalized as well, the bias was eliminated. However, normalization did not exclude wide individual differences between acceleromyography and mechanomyography (+/- 0.10-0.20 at TOF 0.90).

Conclusion
Preload increases the precision of acceleromyography, and normalization of the TOF ratios decreases bias in relation to mechanomyography. When both acceleromyography and mechanomyography are normalized, there is no significant bias between the two methods.
Extraneural versus Intraneural Stimulation Thresholds during Ultrasound-guided Supraclavicular Block
Authors: Bigeleisen Paul E. , Moayeri Nizar , Groen Gerbrand J. 
Published: May 2009

Background
A stimulation current of no more than 0.5 mA is regarded as safe in avoiding nerve injury and delivering adequate stimulus to provoke a motor response. However, there is no consistent level of stimulating threshold that reliably indicates intraneural placement of the needle. The authors determined the minimally required stimulation threshold to elicit a motor response outside and inside the most superficial part of the brachial plexus during high-resolution, ultrasound-guided, supraclavicular block.

Methods
After institutional review board approval, ultrasound-guided, supraclavicular block was performed on 55 patients. Patients with neurologic dysfunction were excluded. Criteria for extraneural and intraneural stimulation were defined and assessed by independent experts. To determine success rate and any residual neurologic deficit, qualitative sensory and motor examinations were performed before and after block placement. At 6 month follow-up, the patients were examined for any neurologic deficit.

Results
Thirty-nine patients met all set stimulation criteria. Median +/- SD (interquartile range) minimum stimulation threshold outside was 0.60 +/- 0.37 mA (0.40, 1.0) and inside 0.30 +/- 0.19 mA (0.20, 0.40). The difference of 0.30 mA was statistically significant (P < 0.0001). Stimulation currents of 0.2 mA or less were not observed outside the trunk in any patient. Significantly higher thresholds were observed in diabetic patients. Success rate was 100% after 20 min. Thirty-four patients had normal sensory and motor examination at 6 months. Five patients were lost to follow-up.

Conclusion
Within the limitations of this study and the use of ultrasound, a stimulation current of 0.2 mA or less is reliable to detect intraneural placement of the needle. Furthermore, stimulation currents of more than 0.2 and no more than 0.5 mA could not rule out intraneural position.
Survival Probabilities of Patients With Childhood Spinal Muscle Atrophy
Authors: Mannaa Mohannad M , Kalra Maninder , Wong Brenda , Cohen Aliza P , Amin Raouf S 
Published: May 2009

Objective:
Medical and technological advances over the past 2 decades have resulted in improved patient care for children with spinal muscular atrophy (SMA). The objective of the present study was to describe changes in the life expectancy of pediatric patients with SMA over time and to compare these findings with previously reported survival patterns.

Methods:
Medical records of all patients diagnosed with SMA over a 16-year period (1989-2005) at Cincinnati Children's Hospital Medical Center were reviewed. Data pertaining to date of birth, type of SMA, medical and surgical interventions, pulmonary complications, and date of death were obtained.

Results:
Kaplan-Meier survival analyses showed a significant improvement in survival probabilities in the severest form of SMA.

Conclusions:
We found a positive trend in the survival of patients with severe SMA. Although we cannot attribute this trend to any single factor, it is likely that advances in pulmonary care and aggressive nutritional support have played a significant role.
Unilateral Myokymia of the Tongue After Radiation Therapy for Cervical Nodal Melanoma
Authors: Richardson Randal C , Weiss Michael D 
Published: May 2009

Abstract

Hypoglossal neuropathy with associated myokymia as a delayed effect of radiation is a rare occurrence, presumably due to the relative resistance of cranial nerves to injury from irradiation. The authors describe the first case of myokymia of the unilateral tongue with myokymic discharges on needle electromyography after hypofractionated radiation therapy for an extracranial melanoma of the neck. The earlier onset of myokymia than previous cases may represent more direct radiation exposure due to radiation site or the higher radiation dosage administered for treatment of melanomas.
13C‐Breath Tests for Sucrose Digestion in Congenital Sucrase Isomaltase–deficient and Sacrosidase‐supplemented Patients
Authors: Robayo‐Torres Claudia C , Opekun Antone R , Quezada‐Calvillo Roberto , Villa Xavier , Smith EO , Navarrete Marilyn , Baker Susan S , Nichols Buford L 
Published: May 2009

ABSTRACTBackground:Congenital sucrase‐isomaltase deficiency (CSID) is characterized by absence or deficiency of the mucosal sucrase‐isomaltase enzyme. Specific diagnosis requires upper gastrointestinal biopsy with evidence of low to absent sucrase enzyme activity and normal histology. The hydrogen breath test (BT) is useful, but is not specific for confirmation of CSID. We investigated a more specific 13C‐sucrose labeled BT.Objectives:Determine whether CSID can be detected with the 13C‐sucrose BT without duodenal biopsy sucrase assay, and if the 13C‐sucrose BT can document restoration of sucrose digestion by CSID patients after oral supplementation with sacrosidase (Sucraid).Methods:Ten CSID patients were diagnosed by low biopsy sucrase activity. Ten controls were children who underwent endoscopy and biopsy because of dyspepsia or chronic diarrhea with normal mucosal enzymes activity and histology. Uniformly labeled 13C‐glucose and 13C‐sucrose loads were orally administered. 13CO2 breath enrichments were assayed using an infrared spectrophotometer. In CSID patients, the 13C‐sucrose load was repeated adding Sucraid. Sucrose digestion and oxidation were calculated as a mean percent coefficient of glucose oxidation averaged between 30 and 90 minutes.Results:Classification of patients by 13C‐sucrose BT percent coefficient of glucose oxidation agreed with biopsy sucrase activity. The breath test also documented the return to normal of sucrose digestion and oxidation after supplementation of CSID patients with Sucraid.Conclusions:13C‐sucrose BT is an accurate and specific noninvasive confirmatory test for CSID and for enzyme replacement management.
Polymorphisms in the IBD5 Locus Are Associated With Crohn Disease in Pediatric Ashkenazi Jewish Patients
Authors: Tomer Gitit , Wetzler Graciela , Keddache Mehdi , Denson Lee A 
Published: May 2009

ABSTRACTObjectives:To analyze the IBD5 locus in a homogenous cohort of Ashkenazi Jewish (AJ) children with Crohn disease (CD).Patients and Methods:A total of 83 AJ children with CD and 73 AJ healthy controls were studied. Genotyping for single nucleotide polymorphisms (SNPs) including OCTN1 (SLC22A4; 1672C→T), OCTN2 (SLC22A5; 207G→C), IGR2096, IGR2198, and IGR2230 genes was performed using the TaqMan system. NOD2/CARD15 variants also were typed using established methods.Results:All IBD5 SNPs tested were in linkage disequilibrium (D′>0.8), and showed significant association with CD in our cohort of AJ children. The IGR2096 SNP, which is not located within the same linkage disequilibrium block as the OCTN1 and 2 SNPs, showed an even stronger association with CD (P = 0.017; odds ratio = 1.7). Patients with CD who had the OCTN1 susceptibility allele were more likely to carry 1 of the 3 NOD2/CARD15 SNPs tested (P = 0.01; odds ratio = 4.8).Conclusions:We have demonstrated a significant association between the IBD5 locus and CD in a homogenous cohort of pediatric AJ patients. Due to the tight linkage disequilibrium in the region, it is not possible to identify the causative IBD5 variant. Future functional studies will ultimately reveal the causative gene variant at this locus.
Circulating Adiponectin as a Marker for Glucocorticoid‐related Side Effects in Children and Adolescents With Inflammatory Bowel Disease
Authors: Vihinen Marianne K , Kolho Kaija‐Leena , Jänne Olli A , Andersson Sture , Raivio Taneli 
Published: May 2009

ABSTRACTGlucocorticoid therapy is widely used in clinical practice. However, treatment with steroids carries the risk of side effects. We investigated changes in serum adiponectin and leptin in response to systemic glucocorticoid treatment in 18 pediatric patients with inflammatory bowel disease and contrasted these findings to circulating glucocorticoid bioactivity measured with a mammalian cell bioassay. Interestingly, serum adiponectin levels at 2 to 4 weeks of therapy were significantly higher in patients who experienced acute glucocorticoid‐related side effects (22.9 ± 2.6 μg/mL, n = 7) than in those who did not (16.0 ± 2.1 μg/mL, n = 11, P < 0.05). Serum leptin was not associated with side effects. Circulating adiponectin may serve as an early and readily available endogenous biomarker for acute glucocorticoid‐related side effects in pediatric patients.
Prenatal Lipopolysaccharide Increases Postnatal Intestinal Injury in a Rat Model of Necrotizing Enterocolitis
Authors: Giannone Peter J , Nankervis Craig A , Richter Juli M , Schanbacher Brandon L , Reber Kristina M 
Published: May 2009

ABSTRACTBackground:An increased incidence of necrotizing enterocolitis (NEC) has been noted in infants who are born to mothers with chorioamnionitis.Hypothesis:Our objective was to test the hypothesis that newborn rat pups born to mothers exposed to prenatal lipopolysaccharide during pregnancy would be more susceptible to intestinal injury in a rat model of NEC and that the increased intestinal injury is mediated by dysregulation of inducible nitric oxide synthase.Methods:Time‐dated pregnant Sprague‐Dawley dams were given an intraperitoneal injection of either 2 mg/kg of lipopolysaccharide or vehicle. Rat pups from each group of dams were delivered at term and placed in a rat NEC model. A subset of pups was given either vehicle or aminoguanidine. Intestines were harvested and graded for degree of intestinal injury.Results:Maternal prenatal lipopolysaccharide exposure increased the frequency and severity of intestinal injury in the neonatal rat NEC model. Treatment with aminoguanidine significantly decreased plasma nitric oxide levels. Additionally, aminoguanidine significantly decreased intestinal injury.Conclusions:Intestinal injury observed may be mediated via nitric oxide synthase dysregulation.
Capsule Endoscopy in the Evaluation of Patients With Unexplained Growth Failure
Authors: Moy Libia , Levine Jeremiah 
Published: May 2009

ABSTRACTBackground:Poor weight gain and growth can be caused by many medical, nutritional, behavioral, and psychological factors. Crohn disease is one of the more common gastrointestinal etiologies associated with growth failure. The aim of this study is to determine the role of capsule endoscopy (CE) in the evaluation of older children and adolescents who were referred to a pediatric gastroenterology service for a chief complaint of unexplained growth failure.Patients and Methods:We retrospectively reviewed the records of children with growth failure undergoing CE between August 2002 and November 2005. Height and weight (expressed as z scores) were recorded at least 6 months before study, at the time of the study, and at least 6 months poststudy. All of the patients had celiac disease and Crohn disease excluded using standard biochemical, radiologic, endoscopic, and histologic assessment.Results:Seven children (4 males and 3 females) were included in the study—mean age 11.7 ± 3.6 years. Indications for CE were growth failure associated with abdominal pain (3 patients), diarrhea and apthous ulcers (2 patients), delayed puberty (1 patient), or a family history of Crohn disease (1 patient). The mean z score for weight at the time of the study was −2.10 ± 1.0 and for height was −1.50 ± 0.7 All 7 children had normal small bowel series performed before the CE. All had both endoscopically and histologically normal esophagogastroduodenoscopy and colonoscopy. In 4 of 7 patients, multiple small bowel apthous ulcerations consistent with Crohn disease were identified by CE. All 4 patients who had abnormal CE were treated and started gaining weight. The mean z score for weight after 6 months of treatment was −1.35 ± 1.2 and for height was −0.50 ± 1.7. The mean z score for weight after treatment was significantly improved compared with the mean z score at diagnosis (P < 0.05).Conclusions:In our study, 4 of the 7 older children and adolescents with unexplained growth failure and normal small bowel series were found to have Crohn disease involving the small intestine. In addition, we were able to show the improvement on the mean z score for weight after treatment of small bowel Crohn disease was instituted.
Malposition of Feeding Tubes in Neonates: Is It an Issue?
Authors: Quandt Daniel , Schraner Thomas , Ulrich Bucher Hans , Arlettaz Mieth Romaine 
Published: May 2009

ABSTRACTObjectives:Accurate tube placement of orogastric and nasogastric feeding tubes in neonates is important to ensure safe and effective enteral feeding. Errors in placement and position of feeding tubes are described in literature, but there is little evidence of the exact prevalence of improperly placed tubes, especially in neonates.Materials and Methods:To evaluate the prevalence of improperly placed feeding tubes, we reviewed 381 consecutive radiographs and defined the position of the feeding tubes.Results:We found that in 41% of the placements, the optimal position of the feeding tubes was achieved, whereas overall 59% of the feeding tubes had been placed incorrectly.Conclusions:There is a need for both better rules to measure the distance between nose (lips) and the body of the stomach and improved methods to confirm correct tube position in neonates.