bluuebunny/crossref_metadata_2025_split huggingface dataset:
C Histomorphology of neuromuscular junction in Duchenne muscular dystrophy
Authors: THEROUX MARY C , OLIVANT ALICIA , AKINS ROBERT E 
Published: August 2010

SummaryBackground:  Our objective was to better understand neuromuscular junction (NMJ) morphology in children with Duchenne muscular dystrophy (DMD).Methods:  We examined the NMJs of four children, age 6–13 years, who were diagnosed with DMD. Using our previously established staining technique, we examined the gross appearance of the NMJs in patients with DMD and evaluated the spread of acetylcholine receptors (AChRs) in relationship to the NMJs. We used a computerized algorithm to measure the area of staining corresponding to AChRs and NMJ.Results:  Abnormal shape and morphological appearance of some of the NMJs was clearly evident. The spread of AChRs in DMD patients is comparable with the spread of AChRs in nonDMD patients.Conclusions:  The distribution of AChRs in relationship to the boundaries of NMJs in DMD children is similar to the distribution of NMJs in the erector spinae muscles of idiopathic scoliosis patients.
Tumor lysis associated with dexamethasone use in a child with leukemia
Authors: OSTHAUS WILHELM ALEXANDER , LINDERKAMP CHRISTIN , BÜNTE CHRISTOPH , JÜTTNER BJORN , SÜMPELMANN ROBERT 
Published: August 2010

SummaryPostoperative nausea and vomiting (PONV) occurs in every third patient undergoing general anesthesia without PONV prophylaxis. Antiemetic prophylaxis with dexamethasone is commonly used in patients at moderate risk. We present a case in which PONV prophylaxis with a single dose of dexamethasone led to tumor lysis in a patient with acute leukemia. In case of a cancer patient at moderate risk for PONV, the anesthesiologist should contact the oncologist first, or use other antiemetic drugs such as antiserotoninergic agents for PONV prophylaxis.
Intravenous clonidine infusion in infants after cardiovascular surgery
Authors: POHL‐SCHICKINGER ANJA , LEMMER JULIA , HÜBLER MICHAEL , ALEXI‐MESKISHVILI VLADIMIR , REDLIN MATTHIAS , BERGER FELIX , STILLER BRIGITTE 
Published: August 2010

SummaryBackground:  The aim of this study was to investigate the hemodynamic profile and heart rhythm in infants who were given intravenous clonidine infusion after prolonged analgesia/sedation following cardiac surgery.Methods:  This is a single center retrospective review. A total of 542 cardiovascular surgical procedures in infants aged 0–24 months with congenital heart disease were performed between 01/2003 and 12/2005 at the Deutsches Herzzentrum in Berlin. The majority received no long‐term analgesia/sedation, but 50 (9%) of these infants received clonidine (dosed at 0.18–3.6 μg·kg−1·h−1) for sedation and to reduce withdrawal symptoms such as CNS hyperactivation, hypertension, tachycardia, and fever. The hospital records of these infants were studied.Results:  Fifty infants (median age 5.0 months, median body weight 5.3 kg, 32 males/18 females) received prolonged analgesia/sedation to ensure hemodynamic stability. Clonidine infusion started on day 5 (median) after surgery. During clonidine treatment we found an age‐related normalized profile of hemodynamic parameters with a reduction of heart rate and mean arterial pressure from the upper norm to the mean within 24 h (P < 0.001). In no case did clonidine cause low blood pressure resulting in additional therapy to reach the target blood pressure. There were no adverse effects on cardiac rhythm, especially no onset of atrioventricular block. Midazolam, fentanyl, and other opioids could be ended on day 4 of clonidine treatment.Conclusions:  Although off‐label, it is feasible to use clonidine infusions in infants in the PICU setting after cardiac surgery without hemodynamic problems arising.
Incidence of postdural puncture headache and backache following diagnostic/therapeutic lumbar puncture using a 22G cutting spinal needle, and after introduction of a 25G pencil point spinal needle
Authors: LOWERY SUSAN , OLIVER ALEXANDER 
Published: August 2010

SummaryBackground:  Postdural puncture headache (PDPH) after lumbar puncture (LP) is as common in children as adults. 22G needles are routinely used in adults and children for diagnostic/therapeutic LP, in contrast to 25G or less as standard for spinal anesthesia. We sought to identify incidence of PDPH and backache in oncology children undergoing LP at Royal Marsden Hospital, and whether this could be reduced by a change from 22G to 25G pencil point needle.Methods:  Symptom questionnaires were given to parents for completion 7 days following LP, and incidence of side effects ascertained. The standard needle was a 22G Quincke. A 25G pencil point spinal needle was subsequently introduced and incidence of side effects reaudited. Number of attempts with the pencil point needle was documented.Results:  Fifty‐six of 83 questionnaires were completed for the 22G Quincke (67%). Incidence of headache was 33%, with 11% classified as PDPH (6 children, 2 > 7 days). Nausea/vomiting occurred in 25% and backache in 11%; 43 of 79 questionnaires were completed for the 25G pencil point needle (54%). Incidence of headache was 30% with 7% classified as PDPH (3 children, none >7 days). Nausea/vomiting occurred in 23%, and backache in none. Seventy percentage of needle insertions by pediatricians were successful on first attempt, 89% on second, and 100% on third.Conclusions:  We have confirmed a significant incidence of PDPH in oncology patients and suggest that a 25G pencil point needle can be used successfully for diagnostic/therapeutic LP, with significantly reduced incidence of back pain, and a small tendency towards a shorter duration of PDPH symptoms.
Anesthetic management of children with pulmonary arterial hypertension
Authors: FRIESEN ROBERT H. , WILLIAMS GLYN D. 
Published: August 2010

SummaryPulmonary arterial hypertension (PAH) is associated with significant perioperative risk for major complications, including pulmonary hypertensive crisis and cardiac arrest. Several mechanisms of hemodynamic deterioration, including acute increases in pulmonary vascular resistance (PVR), alterations of ventricular contractility and function and coronary hypoperfusion can contribute to morbidity. Anesthetic drugs exert a variety of effects on PVR, some of which are beneficial and some undesirable. The goals of balanced and cautious anesthetic management are to provide adequate anesthesia and analgesia for the surgical procedure while minimizing increases in PVR and depression of myocardial function. The development of specific pulmonary vasodilators has led to significant advances in medical therapy of PAH that can be incorporated in anesthetic management. It is important that anesthesiologists caring for children with PAH be aware of the increased risk, understand the pathophysiology of PAH, form an appropriate anesthetic management plan and be prepared to treat a pulmonary hypertensive crisis.
Propofol vs pentobarbital for sedation of children undergoing magnetic resonance imaging: results from the Pediatric Sedation Research Consortium
Authors: MALLORY MICHAEL D. , BAXTER AMY L. , KOST SUSANNE I. ,   THE PEDIATRIC SEDATION RESEARCH CONSORTIUM
Published: August 2010

SummaryBackground:  Pentobarbital and propofol are commonly used to sedate children undergoing magnetic resonance imaging (MRI). The Pediatric Sedation Research Consortium (PSRC) was created in 2003 to improve pediatric sedation process and outcomes.Objective:  To use PSRC records to compare the effectiveness, efficiency and adverse events of propofol vs pentobarbital for sedation of children undergoing MRI.Methods:  Pediatric Sedation Research Consortium records of children aged 6 months to 6 years who were primarily sedated with either i.v. pentobarbital or propofol were included. Participating PSRC investigators obtained institutional review board approval before data collection.Results:  Of 11 846 sedations for MRI, 7079 met inclusion criteria (propofol: n = 5072; pentobarbital: n = 2007). Demographic details were similar between the two groups. Ideal sedation was produced in 96.45% of the pentobarbital group and in 96.8% of the propofol group (P = 0.478), but pentobarbital was more likely to result in poor sedation canceling the procedure (OR 5.88; CI 2.24, 15.40). Propofol resulted in physiologic changes more frequently than did pentobarbital (OR 5.69; CI 1.35, 23.97). Pentobarbital was associated with prolonged recovery (OR 16.82; CI 4.98, 56.8), unplanned admission (OR 5.60; CI 1.02, 30.82), vomiting (OR 36.76; CI 4.84, 279.2) and allergic complication (OR 9.15; CI 1.02, 82.34). The incidence of airway complications was not significantly different between the two. The median recovery time for patients receiving propofol was 30 min, whereas for pentobarbital it was 75 min (P < 0.001).Conclusion:  Among institutions contributing data to the PSRC, it is found that propofol provides more efficient and effective sedation than pentobarbital for children undergoing MRI. Although apnea occurred with a greater frequency in patients who received propofol, the rate of apnea and airway complications for propofol was not statistically different from that seen in patients who received pentobarbital.
The addition of ketamine to a morphine nurse‐ or patient‐controlled analgesia infusion (PCA/NCA) increases analgesic efficacy in children with mucositis pain
Authors: JAMES PAUL J. , HOWARD RICHARD F. , WILLIAMS DAVID GLYN 
Published: August 2010

SummaryAim:  To assess the efficacy of adding ketamine to morphine nurse‐ or patient‐controlled analgesia (NCA/PCA) infusions in treating mucositis pain in children.Background:  Mucositis pain can be very difficult to control in some patients despite the use of parenteral opioids. In our institution, we have started adding low‐dose ketamine to the morphine NCA/PCA in these children in an effort to improve analgesic efficacy.Methods/materials:  The records of all children receiving a morphine/ketamine PCA or NCA for mucositis pain in our institution from 1999 to 2007 were reviewed. At the time of treatment, details of the analgesic management and consumption, pain scores and side effects were prospectively recorded and then entered on to an electronic database. Ketamine was added at a concentration of 20 or 40 μg·kg−1 per ml with our standard morphine NCA/PCA infusions and protocols being used.Results:  In 28 patients, there was no difference between average morphine consumption in the 24 h pre and post the addition of ketamine (33.1 (±10.7) vs 35.2 (±14.3) μg·kg−1 per hour, P = 0.45) but in those with recorded pain scores (n = 16), the median percentage of pain scores ≥4 was 48% (13–100%) preketamine versus 33% (0–82%) postketamine (P = 0.01). In all patients, there was no change in the rates of nausea and vomiting and pruritis pre and post the addition of ketamine and no other significant side effects were reported. No difference was seen between those who had 20 or 40 μg·kg−1 per ml of ketamine added.Conclusion:  The addition of ketamine to a morphine NCA/PCA improves analgesic efficacy in children with mucositis pain with no increase in the incidence of side effects.
A prospective randomized trial comparing supraglottic airways for flexible bronchoscopy in children
Authors: BAKER PAUL A. , BRUNETTE KATHARINE E.J. , BYRNES CATHERINE A. , THOMPSON JOHN M.D. 
Published: August 2010

SummaryObjective:  A prospective randomized, controlled trial was conducted comparing supraglottic airways (SGA) for flexible bronchoscopy in 100 children.Background:  Pediatric flexible bronchoscopy is commonly performed using a SGA as both a ventilation device and a conduit for flexible bronchoscopy. We observed that some disposable SGAs were associated with increased resistance to bronchoscope manipulation compared to the LMA Classic™ (cLMA™).Methods:  We compared the cLMA™ to the Ambu® Aura Once™, Portex® Soft Seal™, Boss Systems disposable silicone laryngeal mask, and LMA Unique™. We recorded the subjective resistance of the bronchoscope manipulation within the SGA by linear analog score and measured the time to insert the bronchoscope from the proximal end of the SGA to the right upper lobe. We also scored the view of the larynx through the bronchoscope and measured SGA cuff pressures.Results:  Resistance to bronchoscope manipulation during pediatric flexible bronchoscopy was higher using polyvinyl chloride (PVC) disposable SGAs (Ambu®, Unique™, and Portex®) than the silicone re‐usable cLMA™ (P < 0.0001). The Unique™ and Ambu® laryngeal masks were clinically inferior to the cLMA™ at all levels of the airway (P < 0.0001). The Portex® Soft Seal™ was not different above the larynx but was significantly statistically inferior at (P < 0.04) and below the larynx (P < 0.006) and inferior overall (P < 0.007). Boss Systems single‐use laryngeal mask was as effective as the cLMA™.Conclusion:  In this trial, PVC single‐use laryngeal masks were inferior to the silicone cLMA™ and Boss Systems laryngeal masks for flexible bronchoscopy in children.
Incidence of self‐limiting back pain in children following caudal blockade: an exploratory study
Authors: VALOIS TERESA , OTIS ANNIK , RANGER MANON , MUIR JOHN G. 
Published: August 2010

SummaryBackground:  Currently, in pediatric anesthesia, there is no evidence‐based information available to pediatric patients and their parents regarding the incidence of back pain after neuraxial injections performed for postoperative analgesia. Back pain postepidural blockade has been reported in numerous studies with adult patients; however, it has not been investigated in children. The main objective of this study is to examine the incidence of back pain symptoms after caudal blockade (early and late onset) in children.Methods:  Patients under the age of 18 years, who received caudal blockade at the Montreal Children’s Hospital between July 2006 and December 2008 were recruited in this prospective observational study. Back pain was measured prospectively by patient self‐report and parental observation during the 15‐day postoperative period. Patients, or their parents, were contacted by phone on postoperative day 2 (POD2) and postoperative day 15 (POD15) to answer a seven‐item symptom questionnaire.Results:  In a sample of 135 children, the incidence of back pain symptoms was 4.7% and 1.1% on POD2 and POD15, respectively.Conclusions:  The results of this study provide support that transient self‐limiting back pain after caudal blockade does occur in pediatric patients. Clinically, this is useful information for physicians to provide to their patients. An exploration of factors that may be associated with back pain following caudal blockade in children is an interesting area of future research.
Incidence of sore throat in children following use of flexible laryngeal mask airways – impact of an introducer device
Authors: WILLIAM ANTHEA , CHAMBERS NEIL A. , ERB THOMAS O. , Von UNGERN‐STERNBERG BRITTA S. 
Published: August 2010

SummaryBackground:  Insertion of a flexible laryngeal mask airway (FLMA) is more difficult and therefore might result in a higher risk for trauma to the upper airway. To facilitate the insertion of FLMA, the use of an introducer device (Portex Limited, Hythe, Kent, UK) was promoted. However, the impact of the use of this device on the occurrence of postoperative sore throat is unknown.Methods:  Four hundred children (3–21 years) undergoing elective ambulatory surgery were consecutively included in this study. In 196 cases, the FLMA was inserted using an introducer device. The FLMA cuff was then inflated and the pressure adjusted to below 60 cmH2O (according to manufacturers guidelines) using a calibrated cuff manometer (Portex Limited). Three types of FLMA were available: FLMA classic, FLMA unique (both FLMA PacMed, Richmond, Victoria, Australia) and FLMA ProBreathe (Well Lead Medical Co Ltd., Hualong, Guangzhou, China). Prior to discharge, patients’ pain was assessed using an age appropriate scale.Results:  Thirteen children (3.3%) developed sore throat, two (0.5%) sore neck and three (0.75%) sore jaw. Of those that developed sore throat, seven had a FLMA inserted with an introducer, six without an introducer. Using a laryngeal mask airways (LMA) with a polyvinyl chloride (PVC), surface was associated with a higher risk for sore throat compared with an LMA with a silicone surface (P = 0.0002).Conclusion:  In this study with controlled low cuff pressures, the incidence of sore throat was low. The use of an introducer device did not affect the rate of sore throat.
Emergence agitation after cataract surgery in children: a comparison of midazolam, propofol and ketamine
Authors: CHEN JIAYAO , LI WENXIAN , HU XIAO , WANG DINGDING 
Published: August 2010

SummaryObjectives:  The aim of this study was to determine whether the concurrent use of either of a subhypnotic dose of midazolam, propofol or ketamine with fentanyl just before discontinuing the sevoflurane anesthesia would effectively sedate the children as they recovered and significantly decrease the incidence and severity of emergence agitation and would not delay patient awakening and discharge.Background:  Postoperative emergence agitation may occur in children after general anesthesia with volatile anesthetics. Children who undergo cataract surgery after sevoflurane induction and sevoflurane–remifentanil maintenance may experience this type of agitation.Methods/Materials:  In 120 un‐premedicated children aged 1–7 years, mask induction with sevoflurane was performed and they were then randomly assigned to one of the three antiagitation postoperative groups (n = 40). We studied the postoperative antiagitation effects of subhypnotic doses of midazolam combined with fentanyl, propofol with fentanyl or ketamine with fentanyl administered just before discontinuing the sevoflurane anesthesia. A score for the level of agitation can be assigned based on the recovery mental state (RMS) scale and the recently published pediatric anesthesia emergence delirium scale (PAED). Postoperative factors assessed included emergence behaviors, the time to eye opening, the time to discharge from the postanesthesia care unit (PACU) to the ward.Results:  There were significantly more agitated children in the ketamine‐group when compared to the midazolam‐group or to the propofol‐group at all time P < 0.05), especially at 10 and 15 min. The PAED scale showed a significant advantage for midazolam–fentanyl [5 (2–15)] and propofol–fentanyl [6 (3–15)] versus ketamine–fentanyl [10 (3–20)] (P < 0.05). The time to discharge from the PACU to the ward was not significantly different among the groups.Conclusions:  Intravenous administration of a subhypnotic dose of midazolam or propofol in addition to a low dose of fentanyl just before discontinuing the sevoflurane anesthesia was both effective on decreasing the incidence and severity of emergence agitation in children undergoing cataract extraction without significant delaying recovery time and discharge. The effect of midazolam was clearer than that seen with propofol.
Trade‐offs and the evolution of life‐histories during range expansion
Authors: Burton Olivia J. , Phillips Ben L. , Travis Justin M. J. 
Published: August 2010

Ecology Letters(2010)AbstractDuring range‐advance, individuals on the expanding edge of the population face a unique selective environment. In this study, we use a three‐trait trade‐off model to explore the evolution of dispersal, reproduction and competitive ability during range expansion. We show that range expansion greatly affects the evolution of life‐history traits due to differing selection pressures at the front of the range compared with those found in stationary and core populations. During range expansion, dispersal and reproduction are selected for on the expanding population front, whereas traits associated with fitness at equilibrium density (competitive ability) show dramatic declines. Additionally, we demonstrate that the presence of a competing species can considerably reduce the extent to which dispersal is selected upwards at an expanding front. These findings have important implications for understanding both the rate of spread of invasive species and the range‐shifting dynamics of native species in response to climate change.
Meta‐analysis reveals negative yet variable effects of ocean acidification on marine organisms
Authors: Kroeker Kristy J. , Kordas Rebecca L. , Crim Ryan N. , Singh Gerald G. 
Published: August 2010

Ecology Letters (2010) 13: 1419–1434AbstractOcean acidification is a pervasive stressor that could affect many marine organisms and cause profound ecological shifts. A variety of biological responses to ocean acidification have been measured across a range of taxa, but this information exists as case studies and has not been synthesized into meaningful comparisons amongst response variables and functional groups. We used meta‐analytic techniques to explore the biological responses to ocean acidification, and found negative effects on survival, calcification, growth and reproduction. However, there was significant variation in the sensitivity of marine organisms. Calcifying organisms generally exhibited larger negative responses than non‐calcifying organisms across numerous response variables, with the exception of crustaceans, which calcify but were not negatively affected. Calcification responses varied significantly amongst organisms using different mineral forms of calcium carbonate. Organisms using one of the more soluble forms of calcium carbonate (high‐magnesium calcite) can be more resilient to ocean acidification than less soluble forms (calcite and aragonite). Additionally, there was variation in the sensitivities of different developmental stages, but this variation was dependent on the taxonomic group. Our analyses suggest that the biological effects of ocean acidification are generally large and negative, but the variation in sensitivity amongst organisms has important implications for ecosystem responses.
Key innovations within a geographical context in flowering plants: towards resolving Darwin’s abominable mystery
Authors: Vamosi Jana C. , Vamosi Steven M. 
Published: August 2010

Ecology Letters (2010)AbstractElucidating factors associated with diversification have been attempted in lineages as diverse as birds, mammals and angiosperms, yet has met with limited success. In flowering plants, the ambiguity of associations between traits and diversification has sparked debate since Darwin’s description of angiosperm diversification as an ‘abominable mystery’. Recent work has found that diversification is often diversity‐dependent, suggesting that species richness depends on geographical area available more than on traits or the time available to accumulate species. Here, we undertake phylogenetic generalized least squares analyses that jointly examine the effects of age, ecoregion area and four ecological traits on diversification in 409 angiosperm families. Area explained the most variation, dwarfing the effect of traits and age, suggesting that diversity‐dependent diversification is controlled by ecological limits. Within the context of area, however, traits associated with biotic pollination (zygomorphy) exhibited the greatest effect, possibly through the evolution of specialization.