Emergency Abdominal Surgery in the Elderly: Can We Predict Mortality?

Emergency Abdominal Surgery in the Elderly: Can We Predict Mortality?

World J Surg. 2016 Oct 25;

Authors: Sharrock AE, McLachlan J, Chambers R, Bailey IS, Kirkby-Bott J

Abstract
BACKGROUND: The United Kingdom population is ageing. Half of patients requiring an emergency laparotomy are aged over 70, 20 % die within 30 days, and less than half receive good care. Frailty and delay in management are associated with poor surgical outcomes. P-POSSUM risk scoring is widely accepted, but its validity in patients aged over 70 undergoing emergency laparotomy is unclear.
AIMS: To assess if P-POSSUM risk stratification reliably predicts inpatient mortality in this group and establish whether those who died within 30 days received delayed care.
METHODS: Observational study of consecutive patients aged 70 and over fulfilling the National Emergency Laparotomy Audit criteria from a tertiary hospital. The predictive value of pre-operative P-POSSUM, ASA, lactate and other routine variables was assessed. Surgical review, decision to operate, consultant surgical review, antibiotic prescription, laparotomy and discharge or death time points were assessed by 30-day survival.
RESULTS: One hundred and ninety-three patients were included. This represented 46.28 % of those undergoing an emergency laparotomy in our centre. Pre-operative P-POSSUM scoring, ASA grade and lactate were moderate predictors of mortality (AUC 0.784 and 0.771, respectively, lactate AUC 0.705, all p ≤ 0.001). No correlation existed between pre-operative P-POSSUM and days to death (p = 0.209), nor were there delays in key management timings in those who died in 30 days.
CONCLUSIONS: P-POSSUM scoring may predict inpatient mortality with moderate discrimination. Addition of frailty scoring in this high-risk group might better identify those with a high risk of mortality after emergency laparotomy and would be a fertile area for further research.

PMID: 27783141 [PubMed - as supplied by publisher]

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Predicting feeding tube and tracheotomy dependence in laryngeal cancer patients.

Related Articles

Predicting feeding tube and tracheotomy dependence in laryngeal cancer patients.

Acta Otolaryngol. 2016 Oct 26;:1-5

Authors: Lavo JP, Ludlow D, Morgan M, Caldito G, Nathan CA

Abstract
CONCLUSIONS: The two scales reliably measure laryngeal edema and dysfunction in laryngeal cancer patients. The eight categories from these scales, and abnormal pharyngeal squeeze, can be used to form a new rating scale intended to help clinicians identify and circumvent swallowing complications after chemo-irradiation.
OBJECTIVES: The objectives were to compare two laryngeal edema rating scales in laryngeal cancer patients and determine if post-radiation +/- chemotherapy edema predicts dependence on a feeding tube and/or tracheostomy.
METHODS: A retrospective chart review between 2005-2008 revealed 28 laryngeal cancer patients status post-radiation +/- chemotherapy, with video laryngoscopies performed within 6 months after treatment. Four raters evaluated videos based on the Laryngopharyngeal Edema Scale (LES) and the Reflux Finding Score (RFS). Tracheostomy and feeding tube outcomes were then correlated with the two scales.
RESULTS: Feeding tube and tracheostomy dependence were associated with pre-treatment vocal cord paralysis, advanced T stage, and chemoradiation. Eight categories from the LES and RFS scales were significantly associated with the need for a feeding tube.

PMID: 27780384 [PubMed - as supplied by publisher]

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American health care paradox - high spending on health care and poor health.

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American health care paradox - high spending on health care and poor health.

QJM. 2016 Oct 24;:

Authors: Bradley EH, Sipsma H, Taylor LA

Abstract
BACKGROUND: for decades, U.S. taxpayers have been lamenting the high cost of health care. Since the mid-1980s, Americans have had double-digit spending on health care. Despite this investment, Americans are less healthy than their European and Scandinavian counterparts across an array of health measures.
AIM: We sought to explore how inadequate attention to the social, behavioral, and environmental determinants of health may contribute to the American health care paradox of high health care spending and poor health outcomes.
DESIGN: Mixed methodsMethods: We report previous findings related from a 10-year analysis of national-level health and social service spending and health outcome data from the Organisation of Economic and Cooperation and Development (OECD). We also put forth case studies representing different socioeconomic strata to illustrate the relationship between health care and social service spending and health.
RESULTS: Although the U.S. spending more of its GDP on health care than any other country, it is not a high spender when one sums spending on both health care and social services. The U.S. however has the lowest ratio of our social service spending to health care spending in the OECD, and countries with lower ratios on average have worse health outcomes. Cases from diverse socioeconomic strata demonstrate how limited attention to the social determinants of health can result in extremely high health care costs and poor health outcomes.
CONCLUSIONS: Greater investment in addressing the social, behavioral, and environmental determinants of health may foster better health without accelerating health care costs in America.

PMID: 27780898 [PubMed - as supplied by publisher]

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Multi-parameter vital sign database to assist in alarm optimization for general care units

Abstract

Continual vital sign assessment on the general care, medical-surgical floor is expected to provide early indication of patient deterioration and increase the effectiveness of rapid response teams. However, there is concern that continual, multi-parameter vital sign monitoring will produce alarm fatigue. The objective of this study was the development of a methodology to help care teams optimize alarm settings. An on-body wireless monitoring system was used to continually assess heart rate, respiratory rate, SpO₂ and noninvasive blood pressure in the general ward of ten hospitals between April 1, 2014 and January 19, 2015. These data, 94,575 h for 3430 patients are contained in a large database, accessible with cloud computing tools. Simulation scenarios assessed the total alarm rate as a function of threshold and annunciation delay (s). The total alarm rate of ten alarms/patient/day predicted from the cloud-hosted database was the same as the total alarm rate for a 10 day evaluation (1550 h for 36 patients) in an independent hospital. Plots of vital sign distributions in the cloud-hosted database were similar to other large databases published by different authors. The cloud-hosted database can be used to run simulations for various alarm thresholds and annunciation delays to predict the total alarm burden experienced by nursing staff. This methodology might, in the future, be used to help reduce alarm fatigue without sacrificing the ability to continually monitor all vital signs.

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Low intraoperative heart rate volatility is associated with early postoperative mortality in general surgical patients: a retrospective case–control study

Abstract

Heart rate volatility (HRVO) is hypothesized to be a physiological measure of sympathetic activity and is defined by the standard deviation (SD) of the heart rate (HR) in beats per minutes (BPM) over fixed time intervals. To investigate the relationship between low HRVO (SD < 0.5 BPM) during surgical procedures and mortality within 48 h post-procedure. We retrospectively reviewed all adult general surgical procedures performed at our center from January 1, 2003 through July 1, 2013 to identify patients who died within 48 h post-procedure. Demographic, heart rate, and mortality data were extracted from the electronic anesthesia record. Propensity score analysis was used to find matching controls based on age, gender, ASA score, anesthesia type, Charlson index, procedure type, emergency status, year, use of preoperative beta blocker, hypertension, diabetes, atrial fibrillation and heart failure. HRVO was calculated for each 5 min interval as the SD of all HR's within that interval. Negative binomial regression was then used to model the count of intervals with HRVO < 0.5 BPM for the duration of the surgery. During the 10 year study period, 283 patients died within 48 h of procedure finish. These patients were matched to 566 patients who did not die within 48 h after procedure. Patients who died had a 39 % increase in frequency of low HRVO episodes compared to patients who survived (RR 1.39, 95 % CI 1.13–1.72; p = 0.003). Low HRVO during surgical procedure is associated with increased mortality risk within 48 h after procedure. Strategies to identify HRVO early and modify it may lead to improvement in outcomes.

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Changes in intraocular pressure during surgery in the lateral decubitus position under sevoflurane and propofol anesthesia

Abstract

Intraocular pressure (IOP) has been shown to change with body position. Several studies have shown that the lateral decubitus position (LDP) is associated with a significant increase in IOP in the dependent eye. However, whether anesthetic agents alter IOP in the LDP remains unclear. This study investigated the effect of sevoflurane and propofol anesthesia on IOP in the LDP. A total of 28 patients undergoing surgery in the LDP were included. Patients were randomly allocated to sevoflurane or propofol groups. IOP in both eyes was recorded and compared between groups at five time points: after anesthesia induction, after endotracheal intubation, at 5 min and 1 h after a positional change to the LDP, and 5 min after returning to the supine position. In the sevoflurane group, IOP was significantly increased in both dependent and non-dependent eyes 1 h after changing to the LDP. In the propofol group, IOP decreased in both dependent and non-dependent eyes after tracheal intubation, but did not increase after changing to the LDP. The number of patients in whom IOP increased to ≥28 mmHg was greater in the sevoflurane group than in the propofol group. Propofol may be better than sevoflurane for the maintenance of anesthesia in the LDP. Monitoring of IOP in the LDP might help avoid ophthalmic complications.

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Effect of using a Planecta™ port with a three-way stopcock on the natural frequency of blood pressure transducer kits

Abstract

Blood pressure transducer kits are equipped with two types of Planecta™ ports—the flat-type Planecta™ port (FTP) and the Planecta™ port with a three-way stopcock (PTS). We reported that FTP application decreased the natural frequency of the kits. However, Planecta™ is an invaluable tool as it prevents infection, ensures technical simplicity, and excludes air. Hence, an ideal Planecta™ port that does not decrease the frequency characteristics is required. As a first step in this direction, we aimed to assess the influence of PTSs on the natural frequency of blood transducer kits. A DTXplus transducer kit (DT4812J; Argon Medical Devices, TX, USA) was used along with ≥1 PTSs (JMS, Hiroshima, Japan), and the frequency characteristics were assessed. The natural frequency and damping coefficient of each kit were obtained by using frequency characteristics analysis software, and these parameters were evaluated by plotting them on Gardner's chart. Regardless of whether one or two PTSs were inserted, the natural frequency of the kits only slightly decreased (from 42.5 to 41.1 Hz, when 2 PTSs were used). Thus, the frequency characteristics of the kits with PTSs were adequate for pressure monitoring. The insertion of ≥2 FTPs in pressure transducer kits should be avoided, as they markedly decrease the natural frequency and lead to underdamping. However, the effect of PTS insertion in pressure transducer kits on the frequency characteristics is minimal. Thus, we found that the use of PTS markedly improved the frequency characteristics as compared to the use of FTP.

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Effect-site concentrations of remifentanil causing bradycardia in hypnotic and non-hypnotic patients

Abstract

Although the induction of anaesthesia with remifentanil often causes bradycardia, the relationship between the effect-site concentration (Ce) of remifentanil and instantaneous heart rate (HR) has remained unclear. The present study examined the relationship between instantaneous HR and remifentanil Ce at the induction of anaesthesia with and without propofol hypnosis, to facilitate safe management of anaesthesia induction with remifentanil. Instantaneous HR was calculated every 5 s using an electrocardiographic real-time analysis system (MemCalc/Makin2; GMS, Tokyo, Japan). At the beginning of anaesthesia induction, continuous infusion of remifentanil (1 μg min⁻¹ kg⁻¹) preceded hypnosis with propofol in 13 patients [non-hypnosis group; mean age, 67.8 (17.5) years], while propofol bolus (30–50 mg) was injected together with continuous remifentanil medication in 18 patients [hypnosis group; mean age, 62.9 (16.5) years]. Remifentanil Ce was estimated every 5 s using the three-compartment model proposed by Minto et al. and the relationship between estimated remifentanil Ce and instantaneous HR was examined. In the hypnosis group, HR was significantly lower than basal HR when remifentanil Ce was increased to 3.5 ng ml⁻¹ (p < 0.05), whereas no significant HR reduction was found in the non-hypnosis group until remifentanil Ce reached >5 ng ml⁻¹ (p < 0.05). The induction of anaesthesia using remifentanil with propofol hypnotics significantly reduces HR even in a low remifentanil Ce insufficient to suppress the cardiovascular response at tracheal intubation. Preparations to treat bradycardia are recommended for the safe management of anaesthesia induction when remifentanil is combined with hypnotics.

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Capnodynamic assessment of effective lung volume during cardiac output manipulations in a porcine model

Abstract

A capnodynamic calculation of effective pulmonary blood flow includes a lung volume factor (ELV) that has to be estimated to solve the mathematical equation. In previous studies ELV correlated to reference methods for functional residual capacity (FRC). The aim was to evaluate the stability of ELV during significant manipulations of cardiac output (CO) and assess the agreement for absolute values and trending capacity during PEEP changes at different lung conditions. Ten pigs were included. Alterations of alveolar carbon dioxide were induced by cyclic reoccurring inspiratory holds. The Sulphur hexafluoride technique for FRC measurements was used as reference. Cardiac output was altered by preload reduction and inotropic stimulation at PEEP 5 and 12 cmH₂O both in normal lung conditions and after repeated lung lavages. ELV at baseline PEEP 5 was [mean (SD)], 810 (163) mL and decreased to 400 (42) mL after lavage. ELV was not significantly affected by CO alterations within the same PEEP level. In relation to FRC the overall bias (limits of agreement) was −35 (−271 to 201) mL, and percentage error 36 %. A small difference between ELV and FRC was seen at PEEP 5 cmH₂O before lavage and at PEEP 12 cmH₂O after lavage. ELV trending capability between PEEP steps, showed a concordance rate of 100 %. ELV was closely related to FRC and remained stable during significant changes in CO. The trending capability was excellent both before and after surfactant depletion.

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Comparison of the accuracy of hemoglobin point of care testing using HemoCue and GEM Premier 3000 with automated hematology analyzer in emergency room

Abstract

The laboratory analysis provides accurate, but time consuming hemoglobin level estimation especially in the emergency setting. The reliability of time-sparing point of care devices (POCT) remains uncertain. We tested two POCT devices accuracy (HemoCue^®201⁺ and Gem^®Premier™3000) in routine emergency department workflow. Blood samples taken from patients admitted to the emergency department were analyzed for hemoglobin concentration using a laboratory reference Beckman Coulter LH 750 (HB_LAB), the HemoCue (HB_HC) and the Gem Premier 3000 (HB_GEM). Pairwise comparison for each device and Hb_LAB was performed using correlation and the Bland–Altman methods. The reliability of transfusion decision was assessed using three-zone error grid. A total of 292 measurements were performed in 99 patients. Mean hemoglobin level were 115 ± 33, 110 ± 28 and 111 ± 30 g/l for Hb_HC, Hb_GEM and Hb_LAB respectively. A significant correlation was observed for both devices: Hb_HC versus Hb_LAB (r² = 0.93, p < 0.001) and HB_GEM versus HB_LAB (r² = 0.86, p < 0.001). The Bland–Altman method revealed bias of −3.7 g/l (limits of agreement −20.9 to 13.5) for HB_HC and HB_LAB and 2.5 g/l (−18.6 to 23.5) for HB_GEM and HB_LAB, which significantly differed between POCT devices (p < 0.001). Using the error grid methodology: 94 or 91 % of values (Hb_HC and Hb_GEM) fell in the zone of acceptable difference (A), whereas 0 and 1 % (Hb_HC and Hb_GEM) were unacceptable (zone C). The absolute accuracy of tested POCT devices was low though reaching a high level of correlation with laboratory measurement. The results of the Morey´s error grid were unfavorable for both POCT devices.

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Cerebral near-infrared spectroscopy in the care of patients during cardiological procedures: a summary of the clinical evidence

Abstract

Patients undergoing cardiological procedures generally have significant cardiovascular morbidity, and therefore these patients might be at risk for major periprocedural complications. The ability to closely monitor the hemodynamic status would present a major advantage to optimize patient care in this setting. The aim of this review is to assess the available evidence for the use of near-infrared spectroscopy (NIRS) in the care of patients during cardiological procedures. A systematic literature search was conducted using electronic bibliographic databases (MEDLINE, PubMed, EMBASE) from their first available date using the following search strategy: (spectroscopy, near-infrared OR infrared spectroscopy OR NIRS OR cerebral oxygen*) AND (interventional OR electrophysiological OR catheterization OR ablation OR ICD OR defibrillator). Inclusion criteria were limited to human studies, English language and cardiac patients. All manuscripts concerning the use of NIRS in every area of catheterization and electrophysiology were included. The literature search yielded eleven observational studies and five case reports concerning the research question. No randomized trials could be retrieved. Six studies evaluated NIRS during supraventricular and ventricular arrhythmias, one during transcatheter aortic valve implantations, and four studies assessed the use of NIRS in pediatric catheterization procedures. Overall, the studies demonstrated that NIRS provides a very quick representation of cerebral oxygen saturation and that it might identify changes that could not be predicted from standard hemodynamic monitoring. However, the evidence is currently too low to conclude that NIRS can optimize patient care during cardiological procedures.

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Accuracy and precision of transcardiopulmonary thermodilution in patients with cardiogenic shock

Abstract

Hemodynamic monitoring plays a crucial role in the supportive treatment of critically ill patients. In this setting, the use of the pulmonary artery catheter (PAC) is a standard procedure. In this study we prospectively compare the accuracy and precision of pulmonary thermodilution (PTD) by PAC and transcardiopulmonary thermodilution (TC-PTD) in patients with cardiogenic shock following an acute cardiac event. In this prospective study 77 hemodynamic measurements were taken in 11 patients presenting cardiogenic shock (CS) treated at the medical intensive care unit of our university hospital. Hemodynamic parameters were measured simultaneously by PTD and by TC-PTD. Both techniques assessed showed a strong correlation in the obtained hemodynamic parameters. The mean bias of cardiac index between measured by PTD (CIpa) and by TC-PTD (CIpi) was 0.04 ± 0.35 L/min/m². During intra-aortic balloon pump (IABP) counterpulsation and therapeutic hypothermia (TH) in post-resuscitation care, mean bias between CIpa and CIpi was 0.04 ± 0.36 and 0.04 ± 0.34 L/min/m², respectively. Similarly, patients presenting mitral or tricuspid regurgitation showed interchangeable parameters. Preload parameters obtained by TC-PTD showed significant differences in patients with left ventricular ejection fraction (LVEF) <35 %, compared to patients with LVEF ≥35 %. In contrast, pulmonary arterial occlusion pressure showed no significant difference. Hemodynamic measurements by PTD and TC-PTD are interchangeable during therapy of CS, including patients IABP, TH, mitral or tricuspid regurgitation. Preload parameters measured by TC-PTD seem to be more accurate in these patients than pressure parameters of PTD to gather the acute hemodynamic situation.

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Performance of computer simulated inhalational anesthetic uptake model in comparison with real time isoflurane concentration

Abstract

Gas Man software was developed to enhance our understanding of the pharmacokinetics of inhalational anaesthetics. To date the Gas Man software has not been validated in humans. In this study we compared the Gas Man software with real time measured end tidal isoflurane concentrations while using a semi closed circle system in anesthetised patients. Thirty-four ASA I and II patients 18–60 years of age were selected for the study. After a standardized induction anesthesia was maintained with N₂O + O₂ mixture and isoflurane using the circle system. The fresh gas flow or dial setting of Isoflurane vaporizer were changed at random. The inspired and end-tidal concentration values of isoflurane measured at 1 min intervals were retrieved from the patient monitor. Real time anesthetic settings for the patient were simultaneously simulated in the Gas Man software to generate the inspired and end-tidal concentration of isoflurane values at every minute for comparison. Varvel's criteria have been used to assess this model. The median absolute performance error was 9.39 %, median performance error was −5.30 %, wobble was 5.16 %, and divergence was −1.82 %. All criteria were within limits of the acceptable performance of the model. The end-tidal concentration values of isoflurane in real patients are very close to those predicted by Gas Man software. The pharmocokinetics of inhalational anesthetic administration in patients can be taught accurately using Gas Man technology. This technology may also help in developing different kinetic models of inhalational agents in the body.

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Prediction of hemodynamic reactivity using dynamic variations of Analgesia/Nociception Index (∆ANI)

Abstract

The Analgesia/Nociception Index (ANI), a 0–100 non-invasive index calculated from heart rate variability, reflects the analgesia/nociception balance during general anesthesia. We hypothesized that dynamic variations of ANI (∆ANI) would provide better performance than static values to predict hemodynamic reactivity during desflurane/remifentanil general anesthesia. One hundred and twenty-eight patients undergoing ear–nose–throat or lower limb orthopedic surgery were analyzed in this prospective observational study. The ANI, heart rate and systolic blood pressure were recorded before induction, at skin incision, during procedure and at emergence from general anesthesia. Changes in these variables were recorded after 1 min for ANI (ANI_1min) and 5 min for heart rate and systolic blood pressure. The dynamic variation of ANI at the different time points was defined as: ∆ANI = (ANI_1min − ANI)/([ANI + ANI_1min]/2). Receiver-operating characteristic (ROC) curves were built to evaluate the performance of ANI, ANI1 min and ∆ANI to predict hemodynamic reactivity (increase by more than 20 % in heart rate and/or systolic blood pressure within 5 min). For the prediction of hemodynamic reactivity, better performance was observed with ∆ANI (area under ROC curve (AUC ROC) = 0.90) in comparison to ANI (ROC AUC = 0.50) and ANI_1min (ROC AUC = 0.77). A ∆ANI threshold of −19 % predicts hemodynamic reactivity with 85 % [95 % CI 77–91] sensitivity and 85 % [95 % CI 81–89] specificity. Dynamic variations of ANI provide better performance than static values to predict hemodynamic reactivity during desflurane/remifentanil general anesthesia. These findings may be of interest for the individual adaptation of remifentanil doses guided by ∆ANI during general anesthesia, although this remains to be demonstrated.

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Ambient temperature effect on pulse rate variability as an alternative to heart rate variability in young adult

Abstract

Pulse rate variability (PRV) is a promising physiological and analytic technique used as a substitute for heart rate variability (HRV). PRV is measured by pulse wave from various devices including mobile and wearable devices but HRV is only measured by an electrocardiogram (ECG). The purpose of this study was to evaluate PRV and HRV at various ambient temperatures and elaborate on the interchangeability of PRV and HRV. Twenty-eight healthy young subjects were enrolled in the experiment. We prepared temperature-controlled rooms and recorded the ECG and photoplethysmography (PPG) under temperature-controlled, constant humidity conditions. The rooms were kept at 17, 25, and 38 °C as low, moderate, and high ambient temperature environments, respectively. HRV and PRV were derived from the synchronized ECG and PPG measures and they were studied in time and frequency domain analysis for PRV/HRV ratio and pulse transit time (PTT). Similarity and differences between HRV and PRV were determined by a statistical analysis. PRV/HRV ratio analysis revealed that there was a significant difference between HRV and PRV for a given ambient temperature; this was with short-term variability measures such as SDNN SDSD or RMSSD, and HF-based variables including HF, LF/HF and normalized HF. In our analysis the absolute value of PTT was not significantly influenced by temperature. Standard deviation of PTT, however, showed significant difference not only between low and moderate temperatures but also between low and high temperatures. Our results suggest that ambient temperature induces a significant difference in PRV compared to HRV and that the difference becomes greater at a higher ambient temperature.

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Ultrasound-guided spinal anesthesia for cesarean section in a parturient with spinal metastases

Abstract

Preprocedural spinal ultrasound appears to decrease the failure rate and complications of neuraxial anesthesia compared to the conventional landmark technique. It is especially beneficial in difficult cases where conventional palpation technique may fail. We recently encountered a parturient with multiple lumbar and cervical spinal metastatic lesions presenting for cesarean section in the third trimester. We used spinal ultrasound to define the appropriate intervertebral space and measure the distance to the ligamentum flavum-dura mater complex. This greatly helped in administering a safe spinal anesthetic and avoiding general anesthesia which might have been hazardous in this patient.

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Sensor fusion methods for reducing false alarms in heart rate monitoring

Abstract

Automatic patient monitoring is an essential resource in hospitals for good health care management. While alarms caused by abnormal physiological conditions are important for the delivery of fast treatment, they can be also a source of unnecessary noise because of false alarms caused by electromagnetic interference or motion artifacts. One significant source of false alarms is related to heart rate, which is triggered when the heart rhythm of the patient is too fast or too slow. In this work, the fusion of different physiological sensors is explored in order to create a robust heart rate estimation. A set of algorithms using heart rate variability index, Bayesian inference, neural networks, fuzzy logic and majority voting is proposed to fuse the information from the electrocardiogram, arterial blood pressure and photoplethysmogram. Three kinds of information are extracted from each source, namely, heart rate variability, the heart rate difference between sensors and the spectral analysis of low and high noise of each sensor. This information is used as input to the algorithms. Twenty recordings selected from the MIMIC database were used to validate the system. The results showed that neural networks fusion had the best false alarm reduction of 92.5 %, while the Bayesian technique had a reduction of 84.3 %, fuzzy logic 80.6 %, majority voter 72.5 % and the heart rate variability index 67.5 %. Therefore, the proposed algorithms showed good performance and could be useful in bedside monitors.

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Electroencephalographic evoked pain response is suppressed by spinal cord stimulation in complex regional pain syndrome: a case report

Abstract

Pain is a subjective response that limits assessment. The purpose of this case report was to explore how the objectivity of the electroencephalographic response to thermal stimuli would be affected by concurrent spinal cord stimulation. A patient had been implanted with a spinal cord stimulator for the management of complex regional pain syndrome of both hands for 8 years. Following ethical approval and written informed consent we induced thermal stimuli using the Medoc PATHWAY Pain & Sensory Evaluation System on the right hand of the patient with the spinal cord stimulator switched off and with the spinal cord stimulator switched on. The patient reported a clinically significant reduction in thermal induced pain using the numerical rating scale (71.4 % reduction) with spinal cord stimulator switched on. Analysis of electroencephalogram recordings indicated the occurrence of contact heat evoked potentials (N2–P2) with spinal cord stimulator off, but not with spinal cord stimulator on. This case report suggests that thermal pain can be reduced in complex regional pain syndrome patients with the use of spinal cord stimulation and offers objective validation of the reported outcomes with this treatment.

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Thermosensitive bioadhesive gels for the vaginal delivery of sildenafil citrate: In vitro characterization and clinical evaluation in women using clomiphene citrate for induction of ovulation.

Thermosensitive bioadhesive gels for the vaginal delivery of sildenafil citrate: In vitro characterization and clinical evaluation in women using clomiphene citrate for induction of ovulation.

Drug Dev Ind Pharm. 2016 Oct 26;:1-32

Authors: Soliman GM, Fetih G, Abbas AM

Abstract
OBJECTIVE: To develop and characterize in situ thermosensitive gels for the vaginal administration of sildenafil as a potential treatment of endometrial thinning occurring as a result of using clomiphene citrate for ovulation induction in women with type II eugonadotrophic anovulation. While sildenafil has shown promising results in the treatment of infertility in women, the lack of vaginal pharmaceutical preparation and the side effects associated with oral sildenafil limit its clinical effectiveness.
METHODS: Sildenafil citrate in situ forming gels were prepared using different grades of Pluronic® (PF-68 and PF-127). Mucoadhesive polymers as sodium alginate and hydroxyethyl cellulose were added to the gels in different concentrations and the effect on gel properties was studied. The formulations were evaluated in terms of viscosity, gelation temperature (Tsol-gel), mucoadhesion properties and in vitro drug release characteristics. Selected formulations were evaluated in women with clomiphene citrate failure due to thin endometrium (Clinicaltrial.gov identifier NCT02766725).
RESULTS: The Tsol-gel decreased with increasing PF-127 concentration and it was modulated by addition of PF-68 to be within the acceptable range of 28-37°C. Increasing Pluronic® concentration increased gel viscosity and mucoadhesive force but decreased drug release rate. Clinical results showed that the in situ sildenafil vaginal gel significantly increased endometrial thickness and uterine blood flow with no reported side effects. Further, these results were achieved at lower frequency and duration of drug administration.
CONCLUSION: Sildenafil thermosensitive vaginal gels might result in improved potential of pregnancy in anovulatory patients with clomiphene citrate failure due to thin endometrium.

PMID: 27783532 [PubMed - as supplied by publisher]

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Solvents effects on crystallinity and dissolution of β-artemether.

Solvents effects on crystallinity and dissolution of β-artemether.

Drug Dev Ind Pharm. 2016 Oct 26;:1-20

Authors: Xu J, Singh V, Yin X, Singh P, Wu L, Xu X, Guo T, Sun L, Gui S, Zhang J

Abstract
β-artemether (ARM) is a widely used anti-malarial drug isolated from the Chinese antimalarial plant, Artemisia annua. The solvent effects on crystal habits and dissolution of ARM were thoroughly investigated and discussed herein. The ARM was recrystallized in 9 different solvents of varied polarity, namely, methanol, ethanol, isopropanol, tetrahydrofuran, dichloromethane, trichloromethane, ethyl acetate, acetone and hexane by solvent evaporation method. The obtained crystals were morphologically characterized using scanning electron microscope (SEM). The average sizes of crystals were 1.80 to 2.64 µm calculated from microscopic images using Image-Pro software. No significant change in chemical structure was noticed after recrystallization and the specific band at 875 cm(-1) wavenumber (C-O-O-C) confirmed the presence of most sensitive functional group in ARM chemical structure. The existence and production of two polymorphic forms, polymorph A and polymorph B, was confirmed by differential scanning calorimetry (DSC) and powder X-ray diffraction (PXRD). The data suggested that the fabrication of polymorph B can be simply obtained from the recrystallization of ARM in specific solvent. Significant effects of solvent polarity, crystals shapes and sizes on drug dissolution were noticed during in vitro dissolution test. The release kinetics were calculated and well fitted by Higuchi and Hixon-Crowell models. The ARM-Methanol and ARM-Hexane showed highest and slowest dissolution respectively, due to the effects of solvent polarity and crystal morphologies. Overall, proper selection of the solvents for the final crystallization of ARM helps to optimize dissolution and bioavailability for a better delivery of anti-malarial drug.

PMID: 27781497 [PubMed - as supplied by publisher]

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Systematic literature review on effectiveness of self-management support interventions in patients with chronic conditions and low socio-economic status

Aim. To assess the quality of evidence and determine the effect of patient-related and economic outcomes of self-management support interventions in chronically ill patients with a low socio-economic status. Background. Integrated evidence on self-management support interventions in chronically ill people with low socio-economic status is lacking. Design. Systematic literature review. Data sources. Cochrane database of trials, PubMed, CINAHL, Web of Science, PsycINFO and Joanna Briggs Institute Library were searched (2000–2013). Randomized controlled trials addressing self-management support interventions for patients with cardiovascular disease, stroke, cancer, diabetes and/or chronic respiratory disease were included. Review methods. Data extraction and quality assessment were performed by independent researchers using a data extraction form. Results. Studies (n = 27) focused mainly on diabetes. Fourteen studies cited an underlying theoretical basis. Most frequently used self-management support components were lifestyle advice, information provision and symptom management. Problem-solving and goal-setting strategies were frequently integrated. Eleven studies adapted interventions to the needs of patients with a low socio-economic status. No differences were found for interventions developed based on health behaviour theoretical models. Conclusion. Limited evidence was found for self-management support interventions in chronically ill patients with low socio-economic status. Essential characteristics and component(s) of effective self-management support interventions for these patients could not be detected. Rigorous reporting on development and underlying theories in the intervention is recommended.

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Intermittent axillary temperature measurement fails to detect fever in critically ill patients

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2 cases of eye asymmetry

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Duration of urethral catheterization after urethroplasty: how long is enough?

Background: To report the impact of duration of urethral catheterization (DUC) on the rate of extravasation on voiding cysto-urethrography (VCUG) and the subsequent need of catheter replacement in urethroplasty. Methods: Two hundred nineteen consecutive patients undergoing urethroplasty between October 2010 and November 2014 were evaluated for the impact of DUC. Patients were divided into 2 groups, based on the scheduled DUC ≤10 days (Group 1, n=86) or >10 days (Group 2, n=133). Results: Fourteen patients (6.4%) had extravasation on VCUG with an additional period of catheter usage. In 10 of the 14 patients (71.4%) clinical signs of impaired wound healing were present. In group 1 (median DUC 8 days) 3 patients (3.5%) needed an additional period of urethral catheterization, compared to 11 patients (8.3%) in group 2 (median DUC 14 days). Strictures in group 2 were longer (4 vs 2 cm, p<0.001) and more complex. Redo urethroplasty was needed in 9 of the 14 patients with extravasation. Conclusion: In uncomplicated cases of urethroplasty, the urethral catheter can be safely removed after 8 to 10 days postoperatively. Extravasation on VCUG occurs in around 6% of urethroplasties and is a prognostic factor for stricture recurrence and reoperation.

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Otoscopic examinations reveal high prevalence of outer and middle ear pathologies in paediatrics in Limpopo, South Africa.

Otoscopic examinations reveal high prevalence of outer and middle ear pathologies in paediatrics in Limpopo, South Africa.

Int J Audiol. 2016 Oct 26;:1-4

Authors: Phanguphangu MC

Abstract
OBJECTIVE: To determine the prevalence of outer and middle ear pathologies in paediatrics in Limpopo, South Africa.
DESIGN: Cross-sectional retrospective review of otoscopy results obtained during a school health screening campaign conducted between March and June 2015. Descriptive statistics through percentages and frequency tables were used to analyse the data. Logistic regression was used to determine associations between age, gender and pathologies observed.
STUDY SAMPLE: Medical folders of 1089 pupils.
RESULTS: Forty-nine percent had normal otoscopy results. A significant 36% (n = 392) had impacted cerumen. Furthermore, 45% of those with impacted cerumen were bilaterally impacted. Additionally, 4% presented with foreign bodies and a further 8% had otitis externa and otitis media. The remaining 3% had tympanic membrane perforations. The odds of developing outer and middle ear pathologies were higher in pupils below 6 years of age (p = 0.046).
CONCLUSION: This study highlights a high prevalence of outer and middle ear pathologies in paediatrics in Limpopo and therefore recommends comprehensive baseline and periodic screenings; to identify children with outer and middle ear pathologies and need further management, and consequently prevent the complications of these pathologies. Additionally, this report highlights a rising need for large-scale research to provide comprehensive analysis of these pathologies.

PMID: 27783901 [PubMed - as supplied by publisher]

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Parent perceptions of their child's communication and academic experiences with cochlear implants.

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Parent perceptions of their child's communication and academic experiences with cochlear implants.

Int J Audiol. 2016 Oct 26;:1-10

Authors: Nelson LH, Herde L, Munoz K, White KR, Page MD

Abstract
OBJECTIVE: To explore parent perceptions of communication and academic experiences of cochlear implant (CI) recipients under the age of 18.
DESIGN: Cross-sectional survey design. Two surveys (K-12, birth-5) queried parent perceptions of the impact of CI on communication, listening in various environments and academic achievement. Surveys contained 16-23 multiple choice and/or Likert ratings, plus four open-ended questions to assess reasons for obtaining a CI, satisfaction with CI and suggestions for professionals.
STUDY SAMPLE: Surveys were sent to 156 parents of CI recipients; 81 surveys returned; response rate 52%.
RESULTS: According to parent report, 95% of K-12 children and 100% of preschool children used spoken language as their primary mode of communication; majority of K-12 children performed same as or better than peers across academic subjects; 99% of respondents were pleased with their decision to obtain a CI. The most important reasons reported for choosing CIs were for their child to use the same language as their families and to effectively communicate in hearing society. Satisfaction with CI was better in quiet than in noise. Respondents stressed the importance of audiologists having excellent skills in CI management and programming.
CONCLUSIONS: Respondents were positive about the benefits of obtaining CI for their child.

PMID: 27780377 [PubMed - as supplied by publisher]

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Sweep frequency impedance measures in young infants: developmental characteristics from birth to 6 months.

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Sweep frequency impedance measures in young infants: developmental characteristics from birth to 6 months.

Int J Audiol. 2016 Oct 26;:1-10

Authors: Aithal V, Kei J, Driscoll C, Murakoshi M, Wada H

Abstract
OBJECTIVE: International Journal of Audiology To study the developmental characteristics of sweep frequency impedance (SFI) measures in healthy infants from birth to 6 months.
DESIGN: All infants were assessed using high-frequency tympanometry (HFT), distortion product otoacoustic emission (DPOAE) and SFI tests. SFI measures consisted of measurement of resonance frequency (RF) and mobility (ΔSPL) of the outer and middle ear. A mixed model analysis of variance was applied to the SFI data to examine the effect of age on RF and ΔSPL.
STUDY SAMPLE: Study included 117 ears from 83 infants of different age groups from birth to 6 months.
RESULTS: The mean RF of the outer ear increased from 279 Hz at birth to 545 Hz at 4 months, whereas mean ΔSPL of the outer ear decreased from 7.9 dB at birth to 3.7 dB at 4 months of age. In contrast, the mean RF and ΔSPL of the middle ear did not change significantly with age up to 6 months.
CONCLUSIONS: Developmental characteristics should be considered when evaluating the function of the outer and middle ear of young infants (≤6 months) using the SFI. The preliminary normative SFI data established in this study may be used to assist with the evaluation.

PMID: 27780372 [PubMed - as supplied by publisher]

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[Tinnitus in patients with hemifacial spasm: a treatable combination?]

[Tinnitus in patients with hemifacial spasm: a treatable combination?]

Ned Tijdschr Geneeskd. 2016;160(0):D208

Authors: Verhagen CV, Meulstee J, Boogaarts HD, Verhagen WI

Abstract
BACKGROUND: About 5-15% of people in the Western world will suffer from an extended period of tinnitus during their lifetime. This is often a non-treatable, disabling disorder. Tinnitus can be classified as pulsatile or non-pulsatile. Pulsatile tinnitus can be caused by a treatable neurovascular compression.
CASE DESCRIPTION: Here we describe two patients, a 68-year old woman and 40-year old man suffering from pulsatile tinnitus and hemifacial spams due to neurovascular compression of the facial and acoustic nerve in the anterior cranial fossa. After microvascular decompression using the Jannetta procedure, in which a sponge was placed between the blood vessel and the nerve, the tinnitus and hemifacial spasm disappeared.
CONCLUSION: Recognition of hemifacial spasm in patients with tinnitus is important because the symptoms are treatable when it is due to neurovascular compression. Because hemifacial spasm can manifest in subtle forms - for instance unilateral blinking - this important symptom can easily be overlooked.

PMID: 27781964 [PubMed - in process]

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Pulmonary metastases from benign calvarial meningioma: a case report.

Pulmonary metastases from benign calvarial meningioma: a case report.

Br J Neurosurg. 2016 Oct 26;:1-3

Authors: Cho BR, Yoon WS

Abstract
The most common intracranial tumour is meningioma, which rarely presents with extracranial metastasis, especially in benign cases. We report a case of meningioma recurrence with multiple pulmonary metastases in a patient who had a benign meningioma removed 12 years prior.

PMID: 27782754 [PubMed - as supplied by publisher]

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Osteocutaneous bone flap - a useful variant of the osteoplastic flap in pediatric patients.

Osteocutaneous bone flap - a useful variant of the osteoplastic flap in pediatric patients.

Br J Neurosurg. 2016 Oct 26;:1-3

Authors: Krishnan P, Sridhar K

Abstract
Traditional teaching describes two types of bone flaps in craniotomies - 'free bone flap' and osteoplastic craniotomies. While in the former, the entire bone flap devoid of soft tissue attachments is removed, in the latter the bone flap that is turned is hinged on a pedicle of temporalis muscle with the aim of retaining its vascular supply. We describe a variant of the latter in 13 pediatric patients in whom the lower margin of the craniotomy was above the attachment of the temporalis muscle and where the bone flap was lifted with all the layers of the scalp including the skin and galea, highlighting the thought process behind its performance and the advantages of the same.

PMID: 27782751 [PubMed - as supplied by publisher]

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Kernohan-Woltman notch phenomenon: a review article.

Kernohan-Woltman notch phenomenon: a review article.

Br J Neurosurg. 2016 Oct 26;:1-8

Authors: Zhang CH, DeSouza RM, Kho JS, Vundavalli S, Critchley G

Abstract
Kernohan-Woltman notch phenomenon (KWNP) is a false localising sign which may still cause diagnostic confusion. It was first described by Kernohan and Woltman in 1929, through post-mortem studies on 297 patients following cases of false localisation. They proposed that raised intracranial pressure causes uncal herniation, which can compress the contralateral cerebral peduncle against the tough tentorium, manifesting as hemiparesis ipsilateral to the primary brain lesion. A number of case reports have been written since the original description of this phenomenon, primarily secondary to intracranial bleeds, and little has been written about long-term outcome of patients who develop KNWP. We performed a literature search of all published cases of KWNP, and reviewed its clinical, pathophysiological, imaging and neurophysiological characteristics. Furthermore, we summarise the long-term outcomes of these patients as described by case reports, with the aim to improve understanding of rehabilitation potential. Thirty-eight cases were found through a PubMed search. We also included a case from our own Trust, making the total number of cases in the analysis 39. Thirty-six cases were secondary to intracranial bleeds (22 of which were traumatic), the remainder were due to an arachnoid cyst, high grade glioma, and reabsorption bone syndrome. Additional clinical manifestations to hemibrachiocrural syndrome included third nerve palsy, mydriasis of the contralateral and ipsilateral pupils, facial nerve palsies, and parkinsonism. Twenty-six (67%) patients had improvement in motor function of varying degrees, with twelve (31%) patients attaining complete motor recovery or independence. More studies on long-term outcome of patients who develop KWNP are needed to understand rehabilitation potential.

PMID: 27781487 [PubMed - as supplied by publisher]

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A Case of Birt-Hogg-Dubé (BHD) Syndrome Harboring a Novel Folliculin (FLCN) Gene Mutation.

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A Case of Birt-Hogg-Dubé (BHD) Syndrome Harboring a Novel Folliculin (FLCN) Gene Mutation.

Am J Case Rep. 2016 Oct 26;17:788-792

Authors: Yukawa T, Fukazawa T, Yoshida M, Morita I, Kato K, Monobe Y, Furuya M, Naomoto Y

Abstract
BACKGROUND Birt-Hogg-Dubé (BHD) syndrome is an autosomal dominant disorder clinically characterized by pulmonary cysts, spontaneous pneumothorax, renal cell cancer, and skin fibrofolliculomas. The disorder is caused by germline mutations in the FLCN gene. CASE REPORT A 56-year-old female was admitted to our hospital with a diagnosis of bilateral spontaneous pneumothorax. A computed tomography (CT) scan of the chest revealed bilateral multiple bullae predominantly located in the subpleural and mediastinal areas in the bilateral upper and lower lobes. Although she was cured by thoracic cavity drainage, she underwent resection of bilateral lung bullae because she had a prior history of right pneumothorax at 37- and 45-years of age. She had no signs of renal tumor but had fibrofolliculoma in her face and a family history of pneumothorax, we therefore suspected BHD syndrome. DNA sequence analyses determined that there was a two base pair deletion in exon 4 of the FLCN gene, confirming the diagnosis of BHD syndrome. CONCLUSIONS Here we report a case of BHD syndrome with a previously unreported FLCN mutation.

PMID: 27780965 [PubMed - in process]

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Post-therapeutic dosimetry of 177Lu-DKFZ-PSMA-617 in the treatment of patients with metastatic castration-resistant prostate cancer.

Post-therapeutic dosimetry of 177Lu-DKFZ-PSMA-617 in the treatment of patients with metastatic castration-resistant prostate cancer.

Nucl Med Commun. 2016 Oct 25;

Authors: Yadav MP, Ballal S, Tripathi M, Damle NA, Sahoo RK, Seth A, Bal C

Abstract
OBJECTIVE: Lu-DKFZ-PSMA-617, a urea-based compound, binds to the extracellular domain of prostate-specific membrane antigen, thus providing an effective target for the treatment of metastatic castration-resistant prostate cancer (mCRPC). Before its therapeutic use, it is necessary that the radiation dosimetry of this radiopharmaceutical be studied to determine the safe activity that can be administered in patients to prevent haematological, renal and liver toxicity. The present study thus aimed to assess the pharmacokinetics and dosimetry of Lu-DKFZ-PSMA-617 in CRPC patients.
MATERIALS AND METHODS: After obtaining ethical clearance from the institute ethics review board, we enrolled mCRPC patients who were positive on a Glu-NH-CO-NH-Lys-(Ahx)-[Ga(HBED-CC)] PET/CT scan. For kidney protection, a cocktail of lysine and arginine diluted in 2 litres of normal saline was infused, starting from 30 to 60 min before Lu-DKFZ-PSMA-617 infusion. The mean administered activity in the overall population was 2.52±1.3 GBq. For the purpose of dosimetry, each patient underwent nine planar whole-body scans along with blood and urine sample collection at 0.5, 3.5, 24, 48, 72, 96, 120, 144 and 168 h, respectively. SPECT/CT was performed to derive the volume of salivary glands (parotid and submandibular glands) and tumour. Dosimetric evaluation was carried out using the OLINDA/EXM 1.0 software.
RESULTS: A total of 26 mCRPC patients with a mean age of 66.30±9.95 years (range: 38-81 years) were recruited. Normal physiological uptake was observed in all the patients in the lacrimal glands, salivary glands (parotid glands and submandibular glands), liver, spleen, kidneys, intestines and urinary bladder. Organs with the highest absorbed doses were the salivary glands, followed by the kidneys, receiving 1.24±0.26 and 0.99±0.31 mGy/MBq, respectively. The mean absorbed doses to the liver, urinary bladder and red marrow were 0.36±0.10, 0.243±0.09 and 0.048±0.05 mGy/MBq, respectively. The mean whole-body dose was 0.016±0.003 mGy/MBq.
CONCLUSION: Lu-DKFZ-PSMA-617 therapy is a safe option in the treatment of mCRPC patients.

PMID: 27782913 [PubMed - as supplied by publisher]

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Perioperative Complications of Cervical Spine Surgery: Analysis of a Prospectively Gathered Database through the Association for Collaborative Spinal Research.

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Perioperative Complications of Cervical Spine Surgery: Analysis of a Prospectively Gathered Database through the Association for Collaborative Spinal Research.

Global Spine J. 2016 Nov;6(7):640-649

Authors: Leckie S, Yoon ST, Isaacs R, Radcliff K, Fessler R, Haid R, Traynelis V

Abstract
Study Design Retrospective review of prospectively gathered data. Objective To report the rate and impact of perioperative complications in cervical spine surgery. To our knowledge, no prior study of the cervical spine has analyzed a large prospectively gathered data set for adverse events, based on surgical subgroup. Methods The ProSTOS database features prospectively documented perioperative adverse events for 1,269 patients who had cervical spine surgery at multiple centers in North America between 2008 and 2011. We subgrouped patients by approach, whether surgery was a primary or revision operation, and by the number of levels involved. Multivariate analysis with stepwise logistic regression was used to relate complication rates to gender, age, smoking status, body mass index, approach, revision status, and number of levels involved. Follow-up was 41%. Results Adverse events occurred significantly more frequently in posterior and combined procedures than in anterior procedures. Revision surgery had significantly more complications than primary surgery. For patients who had anterior surgery, those who had one, two, and three or more levels operated had no significant difference in complication rates. Patients who had posterior surgery had significantly more complications if they had two or more levels operated compared with one level. The lowest rates of complications were for one-level primary surgery (<5%), and multilevel posterior, revision posterior, and revision combined surgery had complication rates over 6 times higher (>28%). Patients who had complications were significantly older than patients who did not. The most common adverse events were dysphagia and cardiac complications. The most severe morbid complications, in terms of increased treatment needs and hospital stay, were paraparesis and seizure. Conclusions Perioperative complication rates in cervical spine surgery are significantly lower in younger patients, surgery performed through an anterior approach (compared with a posterior or combined approach), with fewer levels involved (particularly in posterior surgery), and in primary (compared with revision) procedures.

PMID: 27781183 [PubMed - in process]

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Endoscopic Resection of a Giant Esophageal Lipoma Causing Sudden Choking.

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Endoscopic Resection of a Giant Esophageal Lipoma Causing Sudden Choking.

Korean J Gastroenterol. 2016 Oct 25;68(4):210-213

Authors: Jo DH, Chon HK, Woo SH, Kim TH

Abstract
Most esophageal lipomas are discovered incidentally and are small and asymptomatic. However, large (>4 cm) lipomas may cause various symptoms, including dysphagia, regurgitation, or epigastric discomfort. We present a 45-year-old woman with intermittent sudden choking and globus pharyngeus. Upper gastrointestinal endoscopy and endoscopic ultrasound revealed an approximately 10.0×1.5 cm pedunculated subepithelial tumor in the upper esophagus, identified as the cause of her symptoms. A thoracic computed tomography scan revealed a fat attenuated longitudinal mass along the upper esophagus, suggestive of a lipoma. Endoscopic resection of the lesion was performed with a detachable snare to relieve her symptoms, and the pathologic findings were consistent with a lipoma.

PMID: 27780945 [PubMed - in process]

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Afferent nerve ending density in the human laryngeal mucosa: potential implications on endoscopic evaluation of laryngeal sensitivity.

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Afferent nerve ending density in the human laryngeal mucosa: potential implications on endoscopic evaluation of laryngeal sensitivity.

Dysphagia. 2015 Apr;30(2):139-44

Authors: Ruoppolo G, Schettino I, Biasiotta A, Roma R, Greco A, Soldo P, Marcotullio D, Patella A, Onesti E, Ceccanti M, Albino F, Giordano C, Truini A, De Vincentiis M, Inghilleri M

Abstract
Laryngeal sensitivity is crucial for maintaining safe swallowing, thus avoiding silent aspiration. The sensitivity test, carried out by fiberoptic endoscopic examination of swallowing, plays an important role in the assessment of dysphagic patients. The ventricular folds appear to be more sensitive than the epiglottis during the sensitivity test. Therefore, this study aimed to investigate the mechanical sensitivity of the supraglottic larynx. In seven healthy adults undergoing microlaryngoscopy to remove vocal cord polyps, we excised mucosal samples from the epiglottis and ventricular folds. We measured afferent nerve fiber density by immunoelectron microscopy. All of the subjects underwent an endoscopic sensitivity test based on lightly touching the laryngeal surface of the epiglottis and ventricular folds. The discomfort level was self-rated by the subjects on the visual analog scale. Samples were fixed and stored in cryoprotectant solution at 4 °C. Sections were stained with the protein gene product 9.5, a pan-neuronal selective marker. Nerve fiber density was calculated as the number of fibers per millimeter length of section. The mean nerve fiber density was higher in ventricular samples than in epiglottis samples (2.96 ± 2.05 vs 0.83 ± 0.51; two-sided p = 0.018). The mean visual analog scale scores were significantly higher for touching the ventricular folds than for touching the epiglottis (8.28 ± 1.11 vs 4.14 ± 1.21; two-sided p = 0.017). The higher sensitivity of the ventricular region should be considered for further refining clinical endoscopic evaluation of laryngeal sensitivity.

PMID: 25519304 [PubMed - indexed for MEDLINE]

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Safety and Efficacy of Oral Feeding in Infants with BPD on Nasal CPAP.

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Safety and Efficacy of Oral Feeding in Infants with BPD on Nasal CPAP.

Dysphagia. 2015 Apr;30(2):121-7

Authors: Hanin M, Nuthakki S, Malkar MB, Jadcherla SR

Abstract
Safety and efficacy of oral feeding was examined in infants with bronchopulmonary dysplasia (BPD) on nasal continuous positive airway pressure (NCPAP). We hypothesized that repetitive oral feeding enhances aero-digestive outcomes and reduces resource utilization. Data from infants with BPD (37-42 weeks post menstrual age) that were orally fed while on NCPAP (n = 26) were compared with those that were exclusively gavage fed on NCPAP (n = 27). Subject assignment was random and physician practice based. Specifically, we compared the differences in aero-digestive milestones, resource utilization, and safety metrics. Demographic characteristics such as gender distribution, gestational age, and birth weight, clinical characteristics such as frequency of intraventricular hemorrhage and patent ductus arteriosus needing surgical ligation were similar in both groups (p > 0.05). Characteristics of respiratory support and airway milestones were similar in both groups (p > 0.05). However, infants in NCPAP-oral fed group had earlier acquisition of full oral feeding milestone by 17 days (median) versus infants who were not orally fed during NCPAP (p < 0.05). Discharge weights and the frequency of gastrostomy tube placement were also similar in both groups (p > 0.05). There were no tracheostomies in either group. There was no incidence of clinically significant aspiration pneumonia in infants during the period of the oral feeding while on NCPAP. Controlled introduction of oral feedings in infants with BPD during NCPAP is safe and may accelerate the acquisition of oral feeding milestones.

PMID: 25380678 [PubMed - indexed for MEDLINE]

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Physical properties of root crops treated with novel softening technology capable of retaining the shape, color, and nutritional value of foods.

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Physical properties of root crops treated with novel softening technology capable of retaining the shape, color, and nutritional value of foods.

Dysphagia. 2015 Apr;30(2):105-13

Authors: Umene S, Hayashi M, Kato K, Masunaga H

Abstract
Hard, difficult-to-eat root crops (carrots and burdock roots) were homogeneously softened by an enzyme permeation method so that they could be mashed easily by the tongue while retaining appearance, flavor, and nutrients. The appearance, color, and nutritional value of these foods were equivalent to those of normally cooked root crops of the same type. The firmness of the softened root crops was at least 100 times as low as normally cooked root crops and lower than some care food products for patients with swallowing disorders. Compared with control root crops, which were treated with a freeze-thaw infusion method, the treated foods were 10 to 25 times as soft, with significantly lower rates of foodstuff syneresis and better preservation of color and nutritional value. Furthermore, the cell walls of the treated burdock roots resembled those of normally cooked ones, while the cells of freeze-thaw infusion burdock roots were destroyed and few cell walls remained. It was expected that these root crops softened by the enzymatic processing could be one of the best model foods for patients with masticatory disturbance or swallowing disorders or both.

PMID: 25343879 [PubMed - indexed for MEDLINE]

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Detecting failure of climate predictions

Runge, MC; Stroeve, JC; Barrett, AP; McDonald-Madden, E; (2016) Detecting failure of climate predictions. Nature Climate Change , 6 (9) pp. 861-864. 10.1038/NCLIMATE3041 .

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Modelling and monitoring tools to evaluate the Urban Heat Island's contribution to the risk of indoor overheating

Schneider dos Santos, R; Taylor, JG; Davies, M; Mavrogianni, A; Symonds, P; (2017) Modelling and monitoring tools to evaluate the Urban Heat Island's contribution to the risk of indoor overheating. In: Proceedings of the Building Performance and Optimization conference, BSO16. by Hamza, N. and Underwood, C (Ed),. Newcastle University: Newcastle, UK,. (In press).

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Detecting failure of climate predictions

Runge, MC; Stroeve, JC; Barrett, AP; McDonald-Madden, E; (2016) Detecting failure of climate predictions. Nature Climate Change , 6 (9) pp. 861-864. 10.1038/NCLIMATE3041 .

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Modelling and monitoring tools to evaluate the Urban Heat Island's contribution to the risk of indoor overheating

Schneider dos Santos, R; Taylor, JG; Davies, M; Mavrogianni, A; Symonds, P; (2017) Modelling and monitoring tools to evaluate the Urban Heat Island's contribution to the risk of indoor overheating. In: Proceedings of the Building Performance and Optimization conference, BSO16. by Hamza, N. and Underwood, C (Ed),. Newcastle University: Newcastle, UK,. (In press).

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Lagrangian coherent structures in the wake of a streamwise cylinder

Cagney, N; Balabani, S; (2016) Lagrangian coherent structures in the wake of a streamwise cylinder. In: Proceedings of the 68th APS-DFD Meeting. American Physical Society (In press).

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Keynote: Blurred boundaries: capturing and managing personal information in archival records in the digital era

Lomas, EJ; (2016) Keynote: Blurred boundaries: capturing and managing personal information in archival records in the digital era. In: (Proceedings) International private archives and culture conference - the Right to Memory and to Privacy: Visibility and the Internet. Fundação Casa de Rui Barbosa (In press).

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Telling Stories: A Process of Identification - An analysis of the Professional Life Histories of six neophyte teacher educators

Amott, PM; (2016) Telling Stories: A Process of Identification - An analysis of the Professional Life Histories of six neophyte teacher educators. Presented at: British Educational Research Association Annual Conference 2016 (BERA Annual Conference 2016), Leeds. (In press). Green open access

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Different mucosal expression of Th17 related genes in the small and large bowel of IBD patients

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In vivo vascular hyporeactivity in the mesenteric artery of rats with cirrhosis: reversed by chronic octreotide LAR administration

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Evaluatie van vaste fase cytometrie voor de detectie en de leefbaarheidsbepaling van fungi

http://ift.tt/2eyE3XS

Decreased leukocyte recruitment in the peritoneal microcirculation of rats with portal hypertension: role of L-selectin?

http://ift.tt/2eUKv8m

Increased angiogenesis and permeabiliy in the peritoneal microcirculation of rats with portal hypertension and cirrhosis

http://ift.tt/2eyG6Ls