Prevalence of Eosinophilic Esophagitis in Adolescents with Esophageal Atresia

Background and objective: Eosinophilic esophagitis (EoE) is an increasingly recognized childhood disease. Esophageal atresia (EA) is the most frequent congenital malformation of the esophagus. Recently, cases of EoE occurring in patients with EA have been reported, although the exact prevalence of EoE in EA remains unknown. The aim is to investigate the prevalence of EoE among EA in adolescents and to describe these patients' characteristics. Methods: Systematic upper gastrointestinal endoscopies with multistage esophageal biopsies were prospectively performed in 63 adolescents with EA. A standardized form was used to collect clinical and endoscopic data. Diagnosis of EoE was made as ≥ 15 intraepithelial eosinophils/high power field (HPF), whatever the response on proton pump inhibitors (PPI) therapy. Results: Six patients (9.5%) presented an EoE (17 to 100 eosinophils/HPF). An atopic condition was reported more frequently in the Eo ≥ 15 group than in patients with no EoE (66% vs 16%; P = 0.014). Except for chest pain, symptoms and endoscopic features were similar in patients with EoE and patients with no EoE. Conclusion: In our series of 63 patients born with EA, mainly distal tracheoeosophageal fistula, the prevalence of EoE is increased and therefore should be considered in adolescents with EA. Address correspondence and reprint requests to Emilie Lardenois, MD, CHU de Nancy, service d'anatomopathologie, Hôpital central, 29 avenue du maréchal de Lattre de Tassigny, 54000 Nancy, France (E-mail: E.LARDENOIS@chru-nancy.fr). Received 12 July, 2018 Accepted 1 December, 2018 Funding Source: No funding was secured for this study. Financial Disclosure: The authors have no financial relationships relevant to this article to disclose. The authors have no conflicts of interest relevant to this article to disclose. © 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Endoscopic Pancreatic Function Test (ePFT) and Its Indications

This paper will review briefly the physiology of pancreatic enzyme secretion and the role of stimulated endoscopic testing for assessing exocrine pancreatic function. Published studies in both the pediatric and adult literature are reviewed. The technique and utility of endoscopic pancreatic function testing (ePFT) as the method of choice in the differential diagnosis of pancreatic disorders in childhood is described. Finally, emerging, clinically useful markers that can be measured in the pancreatic fluid will be described. Address correspondence and reprint requests to Karoly Horvath, MD, PhD, Center for Digestive Health and Nutrition, Arnold Palmer Hospital for Children, 60 W Gore Street, Orlando, FL 32806 (e-mail: Karoly.Horvath@orlandohealth.com). Received 22 August, 2018 Accepted 13 November, 2018 The authors report no conflicts of interest. © 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Pyoderma Gangrenosum of the Finger associated with Pediatric Ulcerative Colitis

No abstract available

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2018 Harry Shwachman Award

No abstract available

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Autologous Intestinal Reconstructive Surgery in the Management of Total Intestinal Aganglionosis

Objectives: Total/Near Total intestinal aganglionosis (TIA/NTIA) is the most uncommon and life-threatening form of Hirschsprung disease (HD). The management of TIA/NTIA is challenging and the role of autologous intestinal reconstructive (AIR) surgery is controversial. The objective is to evaluate the effectiveness of AIR in patients with TIA/NTIA. Methods: Records from children affected by total intestinal aganglionosis and enrolled in the multicenter international Pediatric Intestinal Rehabilitation and Transplantation Registry (PIRAT) were retrospectively reviewed. Results: Fourteen patients with TIA were identified. TIA diagnosis was confirmed histologically at the median age of 14 days of life. All received a proximal decompressive jejunostomy. Two patients died, four patients had satisfactory stoma output with enteral tolerance without additional procedures, eight underwent ten AIR procedures (4 Ziegler myotomy-myectomy, 3 transposition of aganglionic ileum with or without myotomy, 2 simple tapering, 1 longitudinal lengthening and tailoring procedure with associated myotomy). AIR significantly reduced median stoma output, from 197 to 31 ml/kg/day (p = 0.0001). The reduction was seen in all patients. In addition, AIR improved enteral tolerance in the long-term in five of eight patients (63%), and temporarily in one, leading to a reduction of PN requirement from 100% to 70% (p = 0.0231). Conclusion: AIR surgery in carefully selected patients may be useful and effective way to enhance residual bowel absorptive function and to reduce PN requirements. AIR and Intestinal transplantation (ITx) are complementary surgical tools in the complex treatment algorithm of TIA/NTIA. Address correspondence and reprint requests to Fabio Fusaro, Department of Medical and Surgical Neonatology, Newborn Surgery Unit, Bambino Gesù Children's Hospital Research Institute, Piazza S. Onofrio 4, 00165 Rome - Italy (. e-mail: fabio.fusaro@opbg.net). Received 28 October, 2018 Revised 23 December, 2018 Accepted 25 December, 2018 Conflicts of interest and source of funding: The Authors declare that there is no conflict of interest or funding source to declare regarding the publication of this article. © 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Is there evidence of gender bias in the oral examination for initial certification by the American Board of Physical Medicine & Rehabilitation?

Objective Unconscious bias (UB) may result in a prejudicial evaluation of another person and lead to unfair treatment. Potential gender bias risk exists in the scoring process on the American Board of Physical Medicine and Rehabilitation (ABPMR) oral examination (Part II) because of the face-to-face interactions between candidates and examiners. This study was undertaken to determine whether performance on the ABPMR Part II Examination differed based on candidate gender or configuration of examiner/candidate gender pairings. The impact of examiner UB training on candidate performance was also assessed. Design Retrospective observational study of first time Part II PM&R Certification Examination test takers between 2013-2018 Results There were significant differences in pass rates (men 84%, women 89%) and mean scaled scores (men 6.56, women 6.81) between men and women (p

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Functional capacity change impacts the quality of life of hospitalized patients undergoing hematopoietic stem cell transplantation

Objective To compare the quality of life of patients undergoing hematopoietic stem cell transplantation (HSCT) who improved their functional capacity during hospitalization (IFC group) with that of patients who maintained or decreased functional capacity during hospitalization (DFC group). Design This observational, longitudinal study included 27 hospitalized patients undergoing HSCT. Patients were divided into IFC (16 patients) and DFC (11 patients). Functional capacity (6-minute Step Test), peripheral muscle strength (Sit-to-Stand Test and Handgrip Strength), and quality of life (EORTC-QLQ-C30) were assessed at admission and at hospital discharge. Results IFC patients had increased functional capacity and peripheral muscle strength of the lower and upper limbs at hospital discharge (P

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Identification and expression pattern of a new digestive invertebrate-type lysozyme from the earthworm

Abstract

Background

The invertebrate type (i-type) lysozyme not showing a clear homology with the known types of lysozyme was first demonstrated from a marine bivalve, conch and earthworm by N-terminal sequence. An i-type lysozyme isolated from the earthworm found to be up-regulated upon bacterial challenge, suggesting this lysozyme to function as an inducible immune factor. However, information on the i-type lysozyme related with digestive function is very limited in the earthworm.

Objective

The objective of this study is to investigate the molecular characteristics and function of the new i-type lysozyme from the earthworm.

Methods

To identify a new i-type lysozyme, multiple amino acid sequence alignment and phylogenetic analyses were employed. Its mRNA expression pattern was observed by fluorescent in situ hybridization (FISH).

Results

A new i-type lysozyme (Ea-iLys) from an earthworm, Eisenia andrei with the open reading frame of 678 bp (226 amino acid residues) appeared to comprise conserved 14 cysteine residues for disulfide bridges and amino acid residues for the enzyme activities of lysozyme and isopeptidase, of which mRNA expression is mainly localized in the lining of midgut epithelium. No significant expression signal was detected in immune competent sites such as chloragogue tissue, typhlosole region, body coelom and muscle layers.

Conclusion

Our results suggest that this enzyme primarily acts as a digestive enzyme rather than an innate immune factor.

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Different divergence events for three pairs of PEBPs in Gossypium as implied by evolutionary analysis

Abstract

Introduction

The phosphatidylethanolamine-binding protein (PEBP) gene family plays a crucial role in seed germination, reproductive transformation, and other important developmental processes in plants, but its distribution in Gossypium genomes or species, evolutionary properties, and the fates of multiple duplicated genes remain unclear.

Objectives

The primary objectives of this study were to elucidate the distribution and characteristics of PEBP genes in Gossypium, as well as the evolutionary pattern of duplication and deletion, and functional differentiation of PEBPs in plants.

Methods

Using the PEBP protein sequences in Arabidopsis thaliana as queries, blast alignment was carried out for the identification of PEBP genes in four sequenced cotton species. Using the primers designed according to the PEBP genome sequences, PEBP genes were cloned from 15 representative genomes of Gossypium genus, and the gene structure, CDS sequence, protein sequence and properties were predicted and phylogenetic analysis was performed. Taking PEBP proteins of grape as reference, grouping of orthologous gene, analysis of phylogeny and divergence of PEBPs in nine species were conducted to reconstruct the evolutionary pattern of PEBP genes in plants.

Results

We identified and cloned 160 PEBPs from 15 cotton species, and the phylogenetic analysis showed that the genes could be classified into the following three subfamilies: MFT-like, FT-like and TFL1-like. There were eight single orthologous group (OG) members in each diploid and 16 double OG members in each tetraploid. An analysis of the expression and selective pressure indicated that expression divergence and strong purification selection within the same OG presented in the PEBP gene family.

Conclusion

An evolutionary pattern of duplication and deletion of the PEBP family in the evolutionary history of Gossypium was suggested, and three pairs of genes resulted from different whole-genome duplication events.

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Native low density lipoprotein increases the production of both nitric oxide and reactive oxygen species in the human umbilical vein endothelial cells

Abstract

Background

Nitric oxide synthases (NOSs) are a unique family of enzymes that catalyze the production of nitric oxide (NO) from l-arginine. Atherogenic action of oxidized low-density lipoproteins (oxLDL) may be mediated partly by the formation of NO in endothelial cells.

Objective

The objective of this study was to identify sources of reactive oxygen species (ROS) causing native LDL (nLDL)-induced senescence of cultured human umbilical vein endothelial cells (HUVECs).

Methods

HUVECs were treated with nLDL and NO production was assessed using Griess reagent as substrate and spectrophotometry in the absence or presence of specific inhibitors of endothelial NOS (eNOS) and inducible NOS (iNOS). In addition, expression levels of eNOS and iNOS were measured with ELISA and western blotting, and ROS was evaluated using 2′,7′-dichlorofluorescin diacetate (DCF-DA) and a fluorescence microplate reader.

Results

NO formation in nLDL-treated HUVECs was significantly increased. Long-term treatment with nLDL up-regulated both eNOS and iNOS proteins. Such increase of NO production in HUVECs induced by nLDL was significantly suppressed by treatment with iNOS-selective inhibitor 1400 W, but not by the eNOS-selective inhibitor L-NIO. Native LDL treatment uncoupled Hsp90, the regulatory binding protein of eNOS, from the enzyme in HUVECs. Native LDL also significantly increased ROS production in HUVECs.

Conclusion

These findings suggest that oxidative stress originated from induction of iNOS and eNOS could be a causative factor for nLDL-induced senescence of HUVECs.

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Expression analysis of miR-221-3p and its target genes in horses

Abstract

Background

A microRNA (miRNA) is a small non-coding RNA (ncRNA) approximately 20 nucleotides long and it affects gene expression through mRNA cleavage or translational repression. Horses (Equus caballus) have been domesticated and bred to enhance their speed for racing. It has been studied extensively with genetic diversity, origins and evolution.

Objectives

We examined expression patterns of miR-221-3p and its target gene CDKN1C in various horse tissues.

Methods

We used bioinformatic tools to examine target gene, seed region and evolutionary conservation of miR-221-3p. The expression patterns of miR-221-3p and its target gene CDKN1C were analyzed by quantitative polymerase chain reaction (qPCR).

Results

Among eight tissues of horse, miR-221-3p was highly expressed in cerebellum and spleen. On the other hand, only medulla was highly expressed in CDKN1C gene.

Conclusion

Our study provides expression data of miR-221-3p and CDKN1C gene in horse and suggests the fundamental information for future studies in relation to functional importance.

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Roles of paxillin phosphorylation in IL-3 withdrawal-induced Ba/F3 cell apoptosis

Abstract

Background

Ba/F3, a mouse pro-B cell line, is dependent on IL-3 for its survival and proliferation. IL-3 withdrawal causes cells to round, stop in G1 phase, then undergo apoptosis. Additionally, IL-3 is known to induce tyrosine phosphorylation of paxillin, a scaffold and signaling protein. We previously determined that overexpression of paxillin prohibited Ba/F3 cell apoptosis induced by IL-3 withdrawal.

Objective

Address whether phosphorylation is essential for the anti-apoptotic effect of overexpressed paxillin.

Methods

Mutations were introduced into paxillin cDNA at five phosphorylation sites—Y31F, Y40F, Y118F, Y181F, S273A, or S273D. After overexpression of paxillin mutants in Ba/F3 cells, the apoptotic proportions of cell populations were measured by an annexin V conjugation assay while cells were undergoing IL-3 withdrawal.

Results

The anti-apoptotic effect of paxillin overexpression was abolished by site-directed mutagenesis replacing Y31, Y40, Y118, and Y181 with phenylalanine, and S273 with aspartic acid. In contrast, the mutation replacing S273 with alanine had no effect on the anti-apoptotic effect.

Conclusion

The above results suggest that paxillin-mediated phosphorylation at Y31, Y40, Y118, and Y181 is essential for the anti-apoptotic effect of paxillin overexpression in Ba/F3 cells and contributes to the cell survival signaling pathway triggered by IL-3. Conversely, phosphorylation at S273 is involved in the negative regulation of the anti-apoptotic action of overexpressed paxillin.

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SPANZA endorses one‐hour clear fluid fasting consensus statement

Abstract

The Society for Paediatric Anaesthesia of New Zealand and Australia (SPANZA) has examined the APA‐ESPA‐ADARPEF joint consensus statement on clear fluid fasting in children, and associated special interest article: Thomas M, Morrison C, Newton R, Schindler E. Consensus statement on clear fluids fasting for elective pediatric general anesthesia. Pediatr Anesth. 2018;28:411–414. SPANZA adds its endorsement to this joint consensus statement agreeing that "based on the current convincing evidence, unless there is a clear contra‐indication, it is safe and recommended for all children able to take clear fluids, to be allowed and encouraged to have these fluids up to one hour before elective general anaesthesia "

This article is protected by copyright. All rights reserved.

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Current perspectives on treatment of perioperative hemodynamic instability and hypotension

Abstract

Children with congenital heart disease are prone to perioperative hypotension and low cardiac output during cardiac surgery. In order to optimize treatment, it is important to understand the myriad of congenital heart lesions as well as the complexity of the pathophysiology and details of the surgical repair. This paper will review common causes of hypotension and treatment in patients with congenital heart disease.

This article is protected by copyright. All rights reserved.

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Correspondence to: ‘Diagnosis and perioperative management in pediatric sleep‐disordered breathing’

Abstract

We read with interest the article recently published by Scalzitti et al. (1) discussing the diagnosis and perioperative management for children with sleep disordered breathing. The author proposes a modified analgesic regime for children with severe sleep disordered breathing. We suggest the authors should make note of the role surgical technique plays in the intraoperative and postoperative analgesic management of these children. They do not differentiate between surgical technique – coblation that uses lower temperatures and radiofrequency to dissect the tissues versus electrocautery that uses high temperatures to abolish the tissues. Some studies have demonstrated less early postoperative pain with coblation.

This article is protected by copyright. All rights reserved.

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Prophylactic sivelestat for esophagectomy and in-hospital mortality: a propensity score-matched analysis of claims database

Abstract

Purpose

Transthoracic esophagectomy is an invasive surgery, and the excessive surgical stress produces inflammatory cytokines, which provoke acute respiratory distress syndrome (ARDS). Sivelestat sodium hydrate—a selective neutrophil elastase inhibitor—is used to treat or prevent ARDS in patients undergoing esophagectomy, although clear evidence is lacking. We investigated the benefits and risk of prophylactic sivelestat.

Methods

This retrospective study used an administrative claims database in Japan. Adult patients who underwent transthoracic esophagectomy from 2010 to 2016 were identified and divided into a prophylactic sivelestat use group and a non-prophylactic use group that included both non-users and therapeutic users. The primary outcome was all-cause in-hospital mortality, and a secondary outcome included the proportion of ARDS. We used 1:1 propensity score matching. For sensitivity analyses, we conducted a 1:2 propensity score matching analysis and several analyses with various patient inclusion criteria.

Results

Of the 3391 patients with esophagectomy, 621 received prophylactic sivelestat. On unadjusted analysis, the sivelestat group had a higher proportion of in-hospital mortality (5.3% vs. 2.9%) compared with the control group. We created a matched cohort of 615 pairs, whose baseline characteristics were well balanced. On adjusted analysis using propensity score matching, prophylactic sivelestat administration was not associated with decreased in-hospital mortality [adjusted odds ratio (aOR) 1.65; 95% confidence interval (CI) 0.95–2.88], ARDS rate (aOR 1.25; 95% CI 0.49–3.17). The findings were also consistent with other sensitivity analyses.

Conclusion

Because mortality and postoperative complications were similar, our findings do not support prophylactic sivelestat administration for patients undergoing esophagectomy.

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Prevalence of Tuberculosis Disease Among Adult US-Bound Refugees with Chronic Kidney Disease

Abstract

The association between chronic kidney disease (CKD) and tuberculosis disease (TB) has been recognized for decades. Recently CKD prevalence is increasing in low- to middle-income countries with high TB burden. Using data from the required overseas medical exam and the recommended US follow-up exam for 444,356 US-bound refugees aged ≥ 18 during 2009–2017, we ran Poisson regression to assess the prevalence of TB among refugees with and without CKD, controlling for sex, age, diabetes, tobacco use, body mass index ( kg/m²), prior residence in camp or non-camp setting, and region of birth country. Of the 1117 (0.3%) with CKD, 21 (1.9%) had TB disease; of the 443,239 who did not have CKD, 3380 (0.8%) had TB. In adjusted analyses, TB was significantly higher among those with than without CKD (prevalence ratio 1.93, 95% CI: 1.26, 2.98, p < 0.01). Healthcare providers attending to refugees need to be aware of this association.

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Association of patterns of moderate-to-vigorous physical activity bouts with pain, physical fatigue and disease severity in women with fibromyalgia: the al-Ándalus project

Publication date: Available online 5 January 2019

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Víctor Segura-Jiménez, Fernando Estévez-López, José Castro-Piñero, Inmaculada C. Álvarez-Gallardo, Alberto Soriano-Maldonado, Milkana Borges-Cosic, Manuel Delgado-Fernández

Abstract

Objectives

i) To examine the associations of non-bouted moderate-to-vigorous physical activity (MVPA) and patterns of MVPA in bouts ≥ 10 min with pain, physical fatigue and disease severity in women with fibromyalgia, and test whether these associations are independent of sedentary time (ST) and physical fitness (PF).

Design

Cross-sectional study carried out from November 2011 to January 2013

Setting

University facilities and fibromyalgia associations.

Participants

439 (51.3±7.6 years old) women with fibromyalgia.

Interventions

Not applicable.

Main outcome measures

ST and MVPA were measured with triaxial accelerometry, and PF with the Senior Fitness test battery. We assessed pain, physical fatigue and disease severity with diverse questionnaires.

Results

Total time in non-bouted MVPA only was independently associated with lower physical fatigue (B=-0.012; P=0.010) and disease severity (B=-0.068; P=0.007) in women with fibromyalgia, regardless of PF but not of ST. Patterns of bouted MVPA were overall associated with symptoms independently of ST or PF. The strongest regressor was the maximum time in MVPA bout (min/bout), which was consistently and independently associated with pain, physical fatigue and disease severity after controlling for ST or PF (all, P≤0.002). Patients meeting bouted physical activity guidelines displayed lower disease severity than those not meeting guidelines (bouted or non-bouted) and those meeting non-bouted physical activity guidelines (all, P≤0.008).

Conclusions

Patterns of MVPA performed in bouts ≥ 10 min were overall consistently and independently associated with core symptoms (pain and fatigue) in fibromyalgia and the overall disease severity, regardless of ST or PF. The results suggest that longer bouts of continuous MVPA are associated with better symptoms profile in this population, which needs to be corroborated in longitudinal research.

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Accumulation and effects of uranium on aquatic macrophyte Nymphaea tetragona Georgi: Potential application to phytoremediation and environmental monitoring

Publication date: March 2019

Source: Journal of Environmental Radioactivity, Volume 198

Author(s): Chen Li, Maolin Wang, Xuegang Luo, Lili Liang, Xu Han, Xiaoyan Lin

Abstract

This study analyzed the ability of Nymphaea tetragona Georgi (N. tetragona) to accumulate water-borne uranium and any effects this could exert on this plant species. In accumulation experiments, N. tetragona was exposed (21 d) to different concentrations of uranium (0–55 mg L⁻¹) and the content of uranium was determined in water and plant tissues (leaves, submerged position and plant) to determine the translocation factor (TF) and bioconcentration factor (BCF). The content of uranium in the plant and plant tissues showed concentration-dependent uptake, leaves were the predominant tissue for uranium accumulation, and TF and BCF values were both affected by the concentration of uranium in the water. In this research, the uranium content and BCF value in the leaves of N. tetragona were upto 3446 ± 155 mg kg⁻¹ and 73 ± 3, respectively. In physiological experiments, uranium treatment boosted the activity of peroxidase (POD), superoxide dismutase (SOD), catalase (CAT) and malondialdehyde (MDA) in the leaves, and increasing uranium concentrations aggravated damage to the cell membrane system. Uranium contamination significantly inhibited the content of soluble protein, as well as chlorophyll-a, chlorophyll-b and carotene in the leaves, indicating the structure and function of chloroplast were destroyed, reducing the photosynthetic performance of plants. These results indicate that the macrophyte N. tetragona can accumulate uranium while showing a stress response via metabolic mechanisms under uranium exposure, and it may be a suitable bioremediation candidate for aquatic marine contamination.

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Human and environmental factors affecting the activity of 131I and 137Cs in urban wastewater: A case study

Publication date: March 2019

Source: Journal of Environmental Radioactivity, Volume 198

Author(s): Daniele Zannoni, Chiara Cantaluppi, Federica Ceccotto, Walter Giacetti, Barbara Lovisetto

Abstract

The analysis of radionuclides content in the waste product of urban wastewater treatment (i.e. sewage sludges) is of great concern for both the safety of workers and in a re-use perspective of the final product. The study of the behavior and the partitioning of radionuclides into sewage sludge samples can be useful not only to determine engineering issues in removal efficiency of radioactive pollutants, but also to determine the factors affecting the content and trends of radionuclides (natural and artificial) in urban wastewater systems. In this study we determine people-related and environmental factors that affect the activity of ¹³¹I (nuclear medicine) and ¹³⁷Cs (fallout) in urban wastewater in a large area of northern Italy. 624 sewage sludge samples coming from 17 wastewater treatment plants were collected between 2012 and 2017 and analyzed with high resolution gamma-spectrometry. In addition to ¹³¹I and ¹³⁷Cs, also the following radionuclides were analyzed for the periodic monitoring: ⁷Be, ⁴⁰K, ⁶⁰Co, ⁶⁷Ga, ¹¹¹In, ¹²⁵I, ¹³⁴Cs, ¹⁹²Ir, ²⁰¹Tl. ¹³¹I is the most frequently detected artificial radionuclide in sewage sludge samples (56%), showing a large variability (mean activity ± standard deviation 93 ± 184 Bq kg⁻¹). The detection frequency of this radionuclide is significantly correlated to population density (R = 0.75, p-value<0.01) and its activity concentration is significantly correlated to wastewater treatment plant size, expressed in population equivalents (R = −0.56, p-value<0.05). The detection frequency of ¹³¹I in sewage sludge samples is modeled as a function of population density, sewer length, inflow rates and population equivalents, accounting for 83% of the variability of observations. Despite the frequency of detection, the activity of ¹³¹I was relevant for workers safety only in less than 0.5% of the cases. On the other hand, ¹³⁷Cs is detected in 36% of samples and its activity shows high correlation with mean annual precipitation (R = 0.67, p-value<0.01) and the activity of natural radionuclides (R = 0.58 and 0.63, for ⁷Be and ⁴⁰K, respectively, p-values <0.05). With a hybrid geostatistical model, we demonstrate that the spatial pattern of ¹³⁷Cs activity in wastewater estimated from sewage sludge samples is consistent with soil contamination from Chernobyl fallout. Moreover, we hypothesize a possible horizontal transport of ¹³⁷Cs in the study area highlighted by different trends of ¹³⁷Cs activity concentration in sludges. The results of this study depict the sensitivity of sewage sludges to the persistent contamination of ¹³⁷Cs, after 30 years from Chernobyl accident, and can be used as a database for future monitoring activities after any accident that includes the spreading of radioactive materials into the environment.

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Background correction method for improving the automated detection of radioisotopes from airborne gamma-ray surveys

Publication date: March 2019

Source: Journal of Environmental Radioactivity, Volume 198

Author(s): Brian W. Dess, Robert T. Kroutil, Gary W. Small

Abstract

An altitude-based background correction strategy was developed for use in the application of pattern recognition methods to the classification of gamma-ray spectra collected during airborne surveys. Application of this methodology helped to suppress the background spectral variation that serves to obscure the photopeaks associated with low levels of gamma-ray emission. The correction method was implemented by optimizing a database of background gamma-ray spectra collected at various locations and altitudes. Given this background database, a field-collected spectrum was corrected by performing linear regression onto a background spectrum from the database at a matching altitude. The residuals about the regression fit were then digitally filtered and submitted to nonparametric linear discriminant analysis for the purpose of computing classification models for targeted radioisotopes. The resulting classifiers were applied to predict the presence or absence of specific radioisotope signatures in data acquired during airborne surveys. Employing data provided by the U.S Environmental Protection Agency Airborne Spectral Photometric Environmental Collection Technology (ASPECT) program, classification models were computed to detect the presence of cesium-137 (¹³⁷Cs) and cobalt-60 (⁶⁰Co). The optimized classifiers were tested over 12 diverse locations, with nine of these data sets containing the target radioisotopes. Correct classification percentages of 99.4% and 99.8% were obtained for the ¹³⁷Cs and ⁶⁰Co classifiers, respectively, on the basis of comparisons to visual inspections of the corresponding spectra.

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Long-term distribution and migration of 137Cs in a small lake ecosystem with organic-rich catchment: A case study of Lake Vorsee (Southern Germany)

Publication date: March 2019

Source: Journal of Environmental Radioactivity, Volume 198

Author(s): T. Ries, V. Putyrskaya, E. Klemt

Abstract

In the shallow eutrophic Lake Vorsee with an organic-rich catchment the ¹³⁷Cs activity concentration in water samples (n = 250) and different fish species (n = 631) was determined for a period of 30 years starting soon after the Chernobyl fallout. To understand the distribution and migration of ¹³⁷Cs in the ecosystem of Lake Vorsee, also the ¹³⁷Cs inventory in soils of the catchment area, in sediments, in suspended matter, in water plants, as well as its vertical distribution in soils and sediments were studied.

The time dependency of the ¹³⁷Cs activity concentration in water and fish was modelled with a compartment model (AQUASCOPE) as well as with the sum of two exponential functions. Results for effective half-lives of ¹³⁷Cs in water are Teff1  = 1.2 a and Teff2  = 7.2 a; for small cyprinidae Teff1  = 0.6 a and Teff2  = 8.9 a; and for pike Teff1  = 1.4 a and Teff2  = 12.1 a. The vertical distribution of ¹³⁷Cs activity concentration in soils was described by a partial differential equation (diffusion constant D = (1.05 ± 1.16) cm²⋅a⁻¹ and convection speed v = (0.14 ± 0.07) cm⋅a⁻¹) and its distribution in sediments by a system of two coupled partial differential equations (fixation rate f = 2.0 d⁻¹; distribution coefficient Kdex = (543 ± 140) L⋅kg⁻¹; sedimentation rate RS = (0.030 ± 0.010) g⋅(cm²⋅a)⁻¹; bioturbation constant Dbio, decreasing linearly with depth with Dbioabs = (3.3 ± 1.0) cm²⋅a⁻¹ at the surface).

According to the extended AQUASCOPE model, the following fractions of the total ¹³⁷Cs inventory were found in the different compartments of the lake ecosystem in 2016: 9.0⋅10⁻¹ in soils of the catchment area, 1.0⋅10⁻¹ in sediments, 5.5⋅10⁻⁵ in water, 1.5⋅10⁻⁵ in suspended matter, 1.3⋅10⁻⁵ in watermilfoil, and 1.6⋅10⁻⁶ in fish.

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Radiocesium in North Pacific coastal and offshore areas of Japan within several months after the Fukushima accident

Publication date: March 2019

Source: Journal of Environmental Radioactivity, Volume 198

Author(s): Yuichiro Kumamoto, Masatoshi Yamada, Michio Aoyama, Yasunori Hamajima, Hideki Kaeriyama, Hisao Nagai, Takeyasu Yamagata, Akihiko Murata, Yukio Masumoto

Abstract

We measured activity concentrations of radiocesium (¹³⁴Cs and ¹³⁷Cs) in seawater samples collected in North Pacific coastal and offshore areas of Japan within several months after the Fukushima Dai-ichi Nuclear Power Plant (FNPP1) accident in March 2011, including archived seawater samples whose radiocesium concentrations were previously reported to be below detection limits. By merging 329 new data with published results, we succeeded in reconstructing the temporal changes in activity concentrations and inventories of FNPP1-derived radiocesium in the coastal and offshore areas within several months after the accident for the first time. ¹³⁷Cs directly-discharged from the FNPP1 was transported eastward within the coastal area about 250 km from the FNPP1 during two months after the accident due to complex movements of coastal surface currents. The eastward speed was calculated to be about 5 cm s⁻¹. Eastward transport of ¹³⁷Cs to the offshore area more than 600 km away from the FNPP1 along the north flank of the Kuroshio Extension Current was faster (about 9 cm s⁻¹) and probably more dominant in the eastward transport. The total inventory of directly-discharged ¹³⁷Cs in early April 2011 was estimated to be 3–6 PBq approximately, which agrees with the smaller estimates in previous studies (2–6 PBq).

Graphical abstract

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Distribution of radionuclides in moss-lichen cover and needles on the same grounds of landscape-climatic zones of Siberia

Publication date: March 2019

Source: Journal of Environmental Radioactivity, Volume 198

Author(s): I.N. Malikova, V.D. Strakhovenko, B.L. Shcherbov

Abstract

The radiation status of the landscape and climatic zones of Siberia at the turn of the 20th and 21st centuries is characterized using bioindicators/biomonitors: lichens, mosses, and needles, according to the results obtained at the sites of their joint growth. The maximal activity of ¹³⁷Cs in these components is observed in the forest-tundra landscaped zone, polluted during the period of nuclear tests from the nuclear test site "Novaya Zemlya" and also due to slow migration of these elements to the soil under the arctic conditions. In the southern territories the specific activity of radiocesium in the moss-lichen cover and needles of conifers corresponds to the regional background, in the forest-tundra zone it sometimes exceeds it, but in general does not pose a threat to human health.

Determined differences in the contents of radioactive elements in lichens and mosses that grow together on sites in different landscape zones of Siberia statistically not significant within one or two standard deviations, and recorded only in the range of 3ϭ at the level of significance 0.05. Specificity of radionuclide distribution in lichens, mosses and needles (differences for epigeals and epiphytic lichens; different species selected at one site, annual and perennial needles, etc.) made it possible to identify the causes of variations in their activities in different zones, along with landscape features of these zones. In the needles of conifers potassium concentration exceeds the content in lichens, at lower levels of thorium and ¹³⁷Cs.

The contents of uranium and thorium in the studied components in all landscape-climatic zones correspond to the natural ones, except for the single local territories, because of the possible anthropogenic influence.

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Fukushima 137Cs releases dispersion modelling over the Pacific Ocean. Comparisons of models with water, sediment and biota data

Publication date: March 2019

Source: Journal of Environmental Radioactivity, Volume 198

Author(s): R. Periáñez, R. Bezhenar, I. Brovchenko, K.T. Jung, Y. Kamidara, K.O. Kim, T. Kobayashi, L. Liptak, V. Maderich, B.I. Min, K.S. Suh

Abstract

A number of marine radionuclide dispersion models (both Eulerian and Lagrangian) were applied to simulate ¹³⁷Cs releases from Fukushima Daiichi nuclear power plant accident in 2011 over the Pacific at oceanic scale. Simulations extended over two years and both direct releases into the ocean and deposition of atmospheric releases on the ocean surface were considered. Dispersion models included an embedded biological uptake model (BUM). Three types of BUMs were used: equilibrium, dynamic and allometric. Model results were compared with ¹³⁷Cs measurements in water (surface, intermediate and deep layers), sediment and biota (zooplankton, non-piscivorous and piscivorous fish). A reasonable agreement in model/model and model/data comparisons was obtained.

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Phytoavailability of 137Cs and stable Cs in soils from different parent materials in Fukushima, Japan

Publication date: March 2019

Source: Journal of Environmental Radioactivity, Volume 198

Author(s): Sho Ogasawara, Tetsuya Eguchi, Atsushi Nakao, Shigeto Fujimura, Yoshihiko Takahashi, Hisaya Matsunami, Hirofumi Tsukada, Junta Yanai, Takuro Shinano

Abstract

Weathered micaceous minerals (micas) are able to release potassium ion (K⁺) and fix caesium-137 (¹³⁷Cs), both of which reduce soil-to-plant transfer of ¹³⁷Cs. Among micas, trioctahedral micas such as biotite is expected to have a stronger ability to supply nonexchangeable K⁺ and a higher amount of Cs fixation sites than dioctahedral micas such as illite. Although biotite is predominant in granitic soils (G soils), illite is mainly dominant in sedimentary rock soils (S soils). Therefore, we hypothesized that G soils have a lower ¹³⁷Cs transfer risk than S soils because of this difference in mineralogy. The objective of the present study was to determine the transfer factor (TF) of ¹³⁷Cs and stable Cs (SCs) and to elucidate the determinant factors of TFs for G and S soils in Fukushima, Japan. Pot experiments were carried out with rice (Oryza sativa L. cv. Hokuriku 193) in G and S soils to determine the TF of ¹³⁷Cs (TF-¹³⁷Cs) and stable Cs (TF-SCs) under K-deficient conditions. TF-¹³⁷Cs and TF-SCs were highly correlated, and both were significantly lower for G soils than for S soils. Higher TF values were shown for soils with lower amounts of exchangeable and nonexchangeable K or with higher percentages of exchangeable ¹³⁷Cs (ex¹³⁷Cs). The percentage of ex¹³⁷Cs was negatively correlated with the amount of Cs fixation sites, represented by the radiocaesium interception potential. Thus, we concluded that smaller TF values for G soils were caused by a stronger ability to supply nonexchangeable K⁺ and a higher amount of Cs fixation sites. These findings will contribute to the establishment of soil screening techniques based on ¹³⁷Cs transfer risk in Fukushima prefecture.

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Radiocesium accumulation in aquatic organisms: A global synthesis from an experimentalist's perspective

Publication date: March 2019

Source: Journal of Environmental Radioactivity, Volume 198

Author(s): Marc Metian, Simon Pouil, Scott W. Fowler

Abstract

A better understanding of the fate of radiocesium in aquatic organisms is essential for making accurate assessments of potential impacts of radiocesium contamination on ecosystems and human health. Studies of the accumulation of ¹³⁴Cs, ¹³⁶Cs and ¹³⁷Cs in diverse biota have been the subject of many field investigations; however, it may often be difficult to understand all the mechanisms underlying the observations reported. To complement field investigations, laboratory experiments allow better understanding the observations and predicting dynamics of Cs within aquatic ecosystems by accurately assessing bioaccumulation of Cs in living organisms. The present review summarizes selected relevant laboratory studies carried out on Cs bioaccumulation in aquatic organisms over a period of more than 60 years. To date, 125 experimental studies have been carried out on 227 species of aquatic organisms since 1957. The present review provides a synthesis of the existing literature by highlighting major findings and identifying gaps of key information that need to be further addressed in future works on this topic. Thus, influences of some environmental parameters such as water chemistry both for marine and freshwater ecosystems, and biotic factors such as the life-stages and size of the organisms on radiocesium bioaccumulation should be examined and become priority topics for future research on Cs accumulation in aquatic organisms.

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Effects of radiocesium fixation potentials on 137Cs retention in volcanic soil profiles of Fukushima forests

Publication date: March 2019

Source: Journal of Environmental Radioactivity, Volume 198

Author(s): Kazumichi Fujii, Noriko Yamaguchi, Naohiro Imamura, Masahiro Kobayashi, Shinji Kaneko, Masamichi Takahashi

Abstract

Radiocesium is well-known to be stabilized by clay minerals in soils, while volcanic soils could typically be poor in micaceous clays that fix ¹³⁷Cs effectively. We investigated ¹³⁷Cs fixation potentials [radiocesium interception potential (RIP)] and depth distribution of ¹³⁷Cs stocks in volcanic soils to analyze effects of clay content and mineralogy on soil retention and migration of ¹³⁷Cs after the Fukushima nuclear accident. Clay minerals of the volcanic soils were dominated by hydroxy-interlayered vermiculite (HIV) and short-range-order minerals, irrespective of bedrocks. The soil RIPs were positively correlated with mass of clay fraction among the HIV-dominated volcanic soils, but RIP per clay content in the HIV-dominated volcanic soils were lower than in the soils rich in illite or vermiculitic clays. The small RIPs in the organic horizons resulted in rapid ¹³⁷Cs migration from the organic horizons and their accumulation in the upper 0–5 cm mineral soil. Although RIPs of the studied volcanic soils fall within the lower class among major soil types, vertical ¹³⁷Cs migration in the mineral soil is small unless RIP is less than 300–400 mmol kg⁻¹ due to the low clay contents and shortage of illite or vermiculite.

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Application of a RE-AIM Evaluation Framework to Test Integration of a Mindfulness Based Parenting Intervention into a Drug Treatment Program

Abstract

Background The RE-AIM framework was applied to the Mindfulness Based Parenting (MBP) intervention to evaluate the feasibility and effectiveness of this innovative trauma informed model in a drug treatment program. The MBP intervention is aimed at mitigating the stress experienced by women in treatment for substance use disorders, and thereby improving parenting and dyadic attachment between mother and child. Methods This was a single arm pre-test post-test design using repeated measure data collected between 2013 and 2016. The design also includes comprehensive process and impact evaluation data. Participants were 120 parenting women enrolled in an opioid treatment program between 2013 and 2016 in Philadelphia, PA. The MBP intervention included weekly 2-h MBP group sessions over 12 weeks, including three dyadic sessions with their child. The main outcomes of this study include the five facets of RE-AIM: Reach, Effectiveness, Adoption, Implementation, and Maintenance. Results The MBP intervention was associated with improvements in parenting across participants. Data showed implementation and sustainability are contingent upon a strong multidisciplinary team and clinical staff support and "buy-in". Iterative adaptations of interventions used in the general population may be necessary when working with a traumatized population burdened by low literacy levels, trauma history and co-occurring disorders. Conclusions MBP is a feasible and effective intervention for improving parenting and dyadic attachment between women with opioid use disorder and their children, and may be useful for other programs that serve parenting women with substance use disorders.

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Educational Attainment and Pregnancy Outcomes: A Danish Register-Based Study of the Influence of Childhood Social Disadvantage on Later Socioeconomic Disparities in Induced Abortion, Spontaneous Abortion, Stillbirth and Preterm Delivery

Abstract

Objectives Socioeconomic disparities in pregnancy outcomes have been found across times and places, but there is a lack of studies investigating the underlying causes. The present study investigated the influence of child protective services in the pregnant woman's family of origin as a proxy of childhood social disadvantage. Methods The study population comprised all registered pregnancies in Denmark during the period from 2000 to 2009 that resulted in an induced abortion, spontaneous abortion, stillbirth or live birth (N = 786,054). Linear regression was used to analyze the associations between educational attainment and pregnancy outcomes in models with and without adjustment for age, parental educational attainment and child protective services in the family of origin. Further, it was tested whether child protective services in the pregnant woman's family of origin modified the associations between educational attainment and pregnancy outcomes. Results Women with low educational attainment had a higher risk of induced abortion, stillbirth and preterm delivery and a lower risk of spontaneous abortion. These associations were to some extent explained by child protective services in the family of origin. Further, child protective services in the pregnant woman's family of origin modified the association between educational attainment and risk of preterm delivery. Thus, women with high educational attainment were not found to differ in risk of preterm delivery according to child protective services in the family of origin Conclusions for Practice Information on childhood social disadvantage may enrich our understanding of the socioeconomic disparities in pregnancy outcomes

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Exploring the Risks of Repeated Pregnancy Among Adolescents and Young Women in the Philippines

Abstract

Objective Knowledge of the factors which influence repeat pregnancy can inform much needed evidence-based prevention programs. This study aims to identify correlates of repeat pregnancy in the Philippines. Methods We used data from five Philippine Demographic and Health Surveys (1993–2013). A total of 4757 women 15–24 years old who had experienced ≥ 1 pregnancy were included. Individual and partner-related factors were fitted into a series of logistic regression stepwise models with deformalized survey weights. Stratified analyses using two age groups (15–19, 20–24) were also conducted. Interaction terms were included to test for statistical differences between the groups. Results Lower wealth quintiles [odds ratio (OR) 1.71, 95% confidence interval (CI) 1.17–2.49] and partner characteristics such as age of ≥ 30 years (OR = 1.99, CI = 1.41–2.82), multiple partners (OR = 4.19, CI = 1.57–11.19) and live-in status (OR = 1.38, CI = 1.02–1.87) were found to be highly correlated with repeat pregnancy in fully adjusted analysis. Receiving prenatal care from traditional healers (OR = 1.93, CI = 1.02–3.63) during the first pregnancy and giving birth for the first time before 18 years of age (OR = 1.12, CI = 1.04–1.20) showed increased risks among 15–19 years old compared to 20–24 years old in stratified analysis. Conclusions for practice In general, partner characteristics were associated with repeat pregnancy among young women suggesting male involvement, especially older partners, in family planning. High risks for repeat pregnancy were observed among adolescent women who reported younger age at first birth and received prenatal care from a traditional healer which entail promotion of trained prenatal care. Further analysis is needed to validate these findings in other developing countries.

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Overprotective/authoritarian maternal parenting is associated with an enhanced error-related negativity (ERN) in emerging adult females

Publication date: Available online 4 January 2019

Source: International Journal of Psychophysiology

Author(s): Iulia Banica, Aislinn Sandre, Anna Weinberg

Abstract

Error monitoring is crucial for survival and adaptation, and can be indexed by the error-related negativity (ERN), a fronto-centrally located negative deflection in the event-related potential (ERP) waveform that differentiates erroneous from correct responses within 100 ms of a response. The ERN is seen as an early neural signal indicating the need to adjust performance and increase executive control. Previous findings indicate that punishing errors increases ERN magnitude, and that punitive parenting predicts an enhanced ERN in children. If punitive parenting can in fact sensitize children to error commission over the long term, an enhanced ERN should be seen in adults who experienced harsh parenting as children. The present study thus sought to establish whether the punitive parenting is associated with an enhanced ERN in emerging adulthood. A sample of 70 emerging adult females reported on their mothers' and fathers' parenting styles separately and performed a flanker task to elicit the ERN. Higher reported overprotective/authoritarian maternal behavior was associated with an enhanced ERN. These results provide further support for the hypothesis that punitive parenting may lead to long-term sensitization of neural networks involved in performance monitoring.

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Comparison of low‐fresh gas flow technique to standard technique of sevoflurane induction in children – a randomized controlled trial

Abstract

Background

Although sevoflurane is preferred for inhalational induction in children, financial and environmental costs remain major limitations. The aim of this study was to determine if the use of low‐fresh gas flow during inhalational induction with sevoflurane could significantly reduce agent consumption, without adversely affecting induction conditions.

Methods

After institutional ethical committee approval, 50 children, aged 1–5 years, undergoing ophthalmic procedures under general anesthesia, were randomized into 2 groups – standard induction (Group S) and low‐flow induction (Group L). A pediatric circle system with 1 L reservoir bag was primed with 8% sevoflurane in oxygen at 6 L.min⁻¹ for 30 seconds before beginning induction. In Group S, FGF was maintained at 6 L.min⁻¹ until the end of induction. In Group L, FGF was reduced to 1 L.min⁻¹ after applying facemask (time = T0). In both groups, sevoflurane was reduced to 5% after loss of eyelash reflex (T1). Once adequate depth of anesthesia was achieved (regular respiration, loss of muscle tone and absence of movement to trapezius squeeze), intravenous access was secured (T2), followed by insertion of an appropriately sized LMA‐Classic^™ (T3). Heart rate and end‐tidal sevoflurane concentration were measured at each of the above time points, and at 15 seconds following laryngeal mask airway insertion (T4). The total amount of sevoflurane consumed during induction was recorded.

Results

Sevoflurane consumption was significantly lower in Group L (4.17 ± 0.70 ml) compared to Group S (8.96 ± 1.11 ml) [mean difference 4.79 (95% CI = 4.25 – 5.33) ml; P < 0.001]. Time to successful laryngeal mask airway insertion was similar in both groups. There were no significant differences in heart rate, incidence of reflex tachycardia or need for rescue propofol.

Conclusion

Induction of anesthesia with sevoflurane using low‐fresh gas flow is effective in reducing sevoflurane consumption, without compromising induction time and conditions.

This article is protected by copyright. All rights reserved.

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The Association Between High Volume Intraoperative Fluid administration and Outcomes Among Pediatric Patients Undergoing Large Bowel Resection

Abstract

Background

Traditional intraoperative fluid administration practices have been challenged this century with data suggesting improved outcomes with restrictive or goal‐directed fluid administration during adult bowel surgery. Minimal data on outcomes associated with differing intraoperative fluid administration practice exists for pediatric patients.

Aims

We assessed factors and outcomes associated with high volume fluid administration in pediatric patients undergoing colectomy. We hypothesized that high volume fluid administration is associated with impaired recovery and, thus, increased length of stay.

Methods

A database of perioperative practice and postoperative outcomes at a tertiary pediatric hospital was queried for colectomy encounters between July 2012 and March 2017. Data extracted included patient characteristics, perioperative clinical data, and postoperative outcomes. Encounters were stratified into two groups: greater than 90^th percentile fluids administered (high volume fluid administration group) versus less than 90^th percentile fluids administered. Univariable tests, multivariable logistic regression, and propensity score matched group comparisons were used to asses outcomes associated with high volume fluid administration.

Results

A total of 209 colectomy encounters were identified from which 12 were excluded based on predetermined criteria. High volume fluid administration was associated with length of stay >6 days (AOR 8.14, CI 1.75‐37.8, P=0.007), time to first meal >4 days (AOR of 5.91, CI 1.30‐27.17, P=0.02) and supplemental oxygen requirement >24 hours (AOR 3.60, CI 1.25‐10.39, P=0.02) after adjusting for ASA status, blood loss, transfusion, and open surgery. Similarly, propensity score matched patients with high volume fluid administration vs controls were more likely to have length of stay >6days (93% vs 54%, P=0.007), time to first meal >4 days (93% vs 57%, P=0.009), and supplemental oxygen requirement >24 hours (36% vs 12%, P=0.033).

Conclusion

High volume fluid administration during colectomy for pediatric patients is associated with worsened postoperative outcomes suggestive of impaired recovery.

This article is protected by copyright. All rights reserved.

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EEG profiles during general anesthesia in children: A comparative study between sevoflurane and propofol

Abstract

Background

In this prospective randomized study we describe the electroencephalographic profiles in children anesthetized with sevoflurane or propofol: Bispectral Index (BIS)‐Concentration relationship and raw electroencephalogram were analyzed.

Methods

Seventy‐three subjects (11 years, range 5‐18) were included and randomly assigned to two groups according to the anesthetic agent. Anesthesia was performed by Target Controlled Infusion of propofol (group P) or by sevoflurane inhalation (group S). Steady state periods were performed at a fixed randomized concentration between 2, 3, 4, 5 and 6 μg.ml⁻¹ of propofol in group P and between 1, 2, 3, 4, 5% of sevoflurane in group S. Remifentanil was continuously administered throughout the study. Clinical data, BIS and raw EEG were continuously recorded. Relationship between BIS and anesthetic concentrations was studied using non‐linear regression. For all steady state periods, EEG traces were reviewed to assess the presence of epileptoid signs, and spectral analysis of raw EEG was performed.

Results

Under propofol, BIS decreased monotonically and EEG slowed down as concentrations increased from 2 to 6 μg.ml⁻¹. Under sevoflurane, BIS decreased from 0 to 4% and paradoxically rose from 4 to 5% of expired concentration: this increase in BIS was associated with the occurrence of fast oscillations and epileptoid signs on the EEG trace. Propofol was associated with more delta waves and burst suppression periods compared to sevoflurane.

Conclusion

Under deep anesthesia, the Bispectral Index and electroencephalographic profiles differ between propofol and sevoflurane. For high concentrations of sevoflurane, an elevated BIS value may be interpreted as a sign of epileptoid patterns or EEG fast oscillations rather than an insufficient depth of hypnosis.

This article is protected by copyright. All rights reserved.

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ESPA Pain Management Ladder: Caudal Clonidine and Cost/Benefit Considerations

Abstract

We read with interest the work by Vittinghoff and colleagues(1) on the creation of guidelines for postoperative pain management in children which aims to "guide best practice" through expert consensus. The creation of a framework for improvement is laudable and may prove useful to lower‐resource institutions as they seek to maximize the patient benefit obtained from any increase in funding. Improving patient outcomes is the essence of medicine.

This article is protected by copyright. All rights reserved.

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Using principal components analysis to examine resting state EEG in relation to task performance

Abstract

Brain dynamics research has highlighted the significance of the ongoing EEG in ERP genesis and cognitive functioning. Few studies, however, have assessed the contributions of the intrinsic resting state EEG to these stimulus‐response processes and behavioral outcomes. Principal components analysis (PCA) has increasingly been used to obtain more objective, data‐driven estimates of the EEG and ERPs. PCA was used here to reassess resting state EEG and go/no‐go task ERP data from a previous study (Karamacoska et al., 2017) and the relationships between these measures. Twenty adults had EEG recorded with eyes closed (EC) and eyes open (EO), and as they completed an auditory go/no‐go task. Separate EEG and ERP PCAs were conducted on each resting condition and stimulus type. For each state, seven EEG components were identified within the delta‐beta frequency range, and six ERP components were obtained for go and no‐go stimuli. Within the task, mean reaction time (RT) correlated positively with go P2 amplitude and negatively with P3b positivity. Regressions revealed that greater EC delta‐1 amplitude predicted shorter mean RT, and larger alpha‐3 amplitude predicted go P3b enhancement. These findings demonstrate the immediate P2 and P3b involvement in decision making and response control and the intrinsic EC delta‐1 and alpha‐3 amplitudes that underpin these processes.

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The impact of physical proximity and attachment working models on cardiovascular reactivity: Comparing mental activation and romantic partner presence

Abstract

Close relationships, especially high‐quality romantic relationships, are consistently associated with positive physical health outcomes. Attenuated cardiovascular reactivity is one physiological mechanism implicated in explaining these effects. Drawing on attachment and social baseline theories, this experimental study evaluated two potential affiliative cues as mechanisms through which romantic relationships may attenuate cardiovascular reactivity to a laboratory‐based stressor. Prior to a cold pressor task, 102 participants were randomly assigned to either have their partner physically present, call upon a mental representation of their partner, or think about their day during the stressor. Consistent with our preregistered hypotheses, participants in both the partner present and mental activation conditions had significantly lower blood pressure (BP) reactivity during the cold pressor task compared to control participants for both systolic (d = −0.54) and diastolic BP (d = −0.53), but no significant differences emerged for heart rate or heart rate variability. Although participants in the partner present and mental activation conditions had similar BP reactivity to the cold pressor task, those in the partner present condition reported significantly less pain as a result of the task. The difference in BP reactivity by condition was moderated—BP reactivity was greater for people with lower self‐reported relationship satisfaction. The results suggest that accessing the mental representation of a romantic partner and a partner's presence each buffer against exaggerated acute stress responses to a similar degree.

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Fear‐potentiated startle response as an endophenotype: Evaluating metrics and methods for genetic applications

Abstract

The modulation of the startle response (SR) by threatening stimuli (fear‐potentiated startle; FPS) is a proposed endophenotype for disorders of the fearful‐fearlessness spectrum. FPS has failed to show evidence of heritability, raising concerns. However, metrics used to index FPS—and, importantly, other conditional phenotypes that are dependent on a baseline—may not be suitable for the approaches used in genetic epidemiology studies. Here, we evaluated multiple metrics of FPS in a population‐based sample of preadolescent twins (N = 569 from 320 twin pairs, M _age = 11.4) who completed a fear‐conditioning paradigm with airpuff‐elicited SR on two occasions (~1 month apart). We applied univariate and multivariate biometric modeling to estimate the heritability of FPS using several proposed standardization procedures. This was extended with data simulations to evaluate biases in heritability estimates of FPS (and similar metrics) under various scenarios. Consistent with previous studies, results indicated moderate test‐retest reliability (r = 0.59) and heritability of the overall SR (h² = 34%) but poor reliability and virtually no unique genetic influences on FPS when considering a raw or standardized differential score that removes baseline SR. Simulations demonstrated that the use of differential scores introduces bias in heritability estimates relative to jointly analyzing baseline SR and FPS in a multivariate model. However, strong dependency of FPS on baseline levels makes unique genetic influences virtually impossible to detect regardless of methodology. These findings indicate that FPS and other conditional phenotypes may not be well suited to serve as endophenotypes unless such codependency can be disentangled.

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The sympathetic role of glutamatergic paraventricular nucleus neurons in blood pressure regulation

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Corrigendum

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Family and Community Medicine

A profile of physical activity, sedentary behaviors, sleep, and dietary habits of Saudi college female students Hana A Alzamil, Manan A Alhakbany, Nora A Alfadda, Sarah M Almusallam, Hazzaa M Al-Hazzaa Journal of Family and Community Medicine 2019 26(1):1-8 BACKGROUND: Few studies have reported valid comprehensive data on lifestyle habits of Saudi college females. In addition, studies on sedentary behaviors (SBs) and the duration of sleep of Saudi college students are rare. Saudi females appear to be less physically active and therefore, at a higher risk of noncommunicable diseases (NCDs). Therefore, the purpose of this study was to investigate lifestyle patterns of Saudi college females, including physical activity (PA), SBs, duration of sleep, and dietary habits. MATERIALS AND METHODS: A cross-sectional study was conducted among females attending health science colleges of King Saud University, using multistage stratified cluster sample (n = 456). Weight, height, PA, SB, sleep, and dietary habits were all assessed using a previously validated questionnaire. RESULTS: Nearly half of the college females were physically inactive. Females exercised mostly at home or alone at no specific time of day. Their activity was for health reasons (43.4%) for weight loss (28.7%); lack of time (71.2%) was the primary reason for inactivity. The majority (>85%) of females spent more time in sedentary activity (>3 h/day) while 95% of females had insufficient sleep (<8 h/night). Over 40% of the participants consumed breakfast or vegetables 5 days or more per week, whereas the corresponding proportions for fruit and milk/dairy products intake were 19.4% and 58.4%, respectively. The proportions of college females who consumed less healthy foods for 3+ days/week were fairly variable, ranging from 21.1% for French fries to 60.4% for chocolates/candy. The predictors of total PA time were increased the duration of sleep and reduced intake of French fries/potato chips. CONCLUSIONS: Unhealthy lifestyle habit appears prevalent among Saudi college females. Efforts toward promoting PA, decreasing SB, and insufficient sleep and improving dietary habits in Saudi females are needed to reduce future risks of NCDs.

Consistency of child self-reports with parent proxy reports on the quality of life of children with attention-deficit/hyperactivity disorder in Riyadh, 2016 Dina M Al-Habib, Fatima A Alhaidar, Ibrahem M Alzayed, Randa M Youssef Journal of Family and Community Medicine 2019 26(1):9-16 BACKGROUND: The quality of life (QoL) of children with attention-deficit/hyperactivity disorder (ADHD) has not been addressed in Saudi Arabia despite the considerable attention it has on account of its prevalence, duration of illness, and sociopsychological effects. The aim of this study was to report on the QoL of children with ADHD and test the concord between children's and parents' reports. MATERIALS AND METHODS: Using the generic PedsQL™ (version 4.0) from both children's and parents' perspectives, a cross-sectional study of 112 children was conducted on children aged 5–18 years with an established diagnosis of ADHD attending child psychiatry clinics of three referral hospitals in Riyadh between December 2015 and May 2016. RESULTS: A total of 112 children with an established diagnosis of ADHD were recruited from the Child Psychiatry Clinic of Al Amal Mental Health Complex (41.1%), Prince Sultan Military Medical City (PSMMC), (33%), and King Khalid University Hospital (KKUH), (25.9%). The majority were boys (74.1%) and Saudi nationals (93.8%). The mean age of children with ADHD was 10.45 ± 3.06 years (Range 5 - 18 years). One-fourth of the mothers of children with ADHD had completed high school and 41.1% had a diploma, university, or postgraduate degree. One-third of the fathers of these children had completed high school (34%) and 38.4% had a diploma, university, or postgraduate degree. The intra-class correlation coefficients between the scores of children and parents were good for physical functioning, fair for social functioning, but moderate for school, emotional, and psychosocial functioning. Children rated themselves significantly better than their parents for emotional, social, school, and psychosocial functioning. The standardized response means indicated a small difference for social functioning and medium differences for the other three domains. The only significant discrepancy was observed in social functioning in relation to the child's age. CONCLUSION: Parents mirrored adequately the observable physical component of the QoL of their children. The QoL report of children with ADHD with respect to communications and intellectual abilities should be taken into account whenever possible and their parents' report also should be sought to provide a more comprehensive view of the child's status.

The association between waiting time and patient satisfaction in outpatient clinics: Findings from a tertiary care hospital in Saudi Arabia Rasmah S Al-Harajin, Sara A Al-Subaie, Ahmed G Elzubair Journal of Family and Community Medicine 2019 26(1):17-22 BACKGROUND: Patient satisfaction is an important indicator for assessing the quality of health care because it affects the timely, efficient, and patient-centered delivery of quality health care, and patient satisfaction is associated with the clinical outcomes. This study aimed to examine the relationship between waiting time and patient satisfaction in a tertiary hospital in Saudi Arabia. MATERIALS AND METHODS: A cross-sectional study was conducted at family medicine and other specialized clinics. Data were collected through a structured, self-administered questionnaire distributed to patients seen at the outpatient clinics. Variables collected were sociodemographic information and patient satisfaction scores to evaluate the association between waiting time and satisfaction. RESULTS: A total of 406 patients participated in the study. Half of the patients reported being satisfied with the waiting time, while the remaining were dissatisfied (mean satisfaction score 38.4 ± 6.63). Family medicine clinic scored better in waiting time than other specialized clinics; between arrival and registration (P < 0.01), between registration and consultation (P < 0.01), consultation time (P < 0.01), and overall waiting time (P < 0.01). Patients treated at the family medicine clinic were more likely to be satisfied than those seen in other specialized clinics (61.2% vs. 40%, P < 0.01). CONCLUSION: Overall satisfaction was lower than shown in previous literature. Gender and clinic type were significantly associated with satisfaction score; those who attended the family medicine clinics were more satisfied than those attending other specialized clinics. Findings may be used to inform researchers, clinicians, and policy-makers' decisions on quality improvement programs.

The impact of using the term "Diabetic Ear" for the patients with skull base osteomyelitis Abdulaziz S AlEnazi, Salma S Al Sharhan, Laila M Telmesani, Nasser A Aljazan, Bander M Al Qahtani, Mohamed A Lotfy Journal of Family and Community Medicine 2019 26(1):23-29 BACKGROUND: Diabetes and ear disease are some of the most widespread health concerns. The focus here is on the impact of using the term “Diabetic Ear” for patients with skull base osteomyelitis (SBM) in the context of malignant otitis externa (MOE). The aim of this study was to discover the awareness of general practitioners (GPs), residents, specialists, and consultants at Primary Health Care Centers about necrotizing otitis externa (NOE), also known previously as malignant external otitis (MOE), assess their deficiencies and provide solutions; also assist them for the early detection and possible prevention of diabetes- related ear diseases and their complications. MATERIALS AND METHODS: A cross-sectional study was conducted among a random sample of physicians (residents, specialists, and consultants) working at the Primary Health Care Centers in Al-Khobar and Dammam cities of the Eastern Province, Saudi Arabia. Data was collected using a standardized questionnaire. SPSS was used for data entry and analysis. RESULTS: The total number of medical practitioners was 84. Their mean age was 33.97 (±9.55). The proportion of females was higher than males, only 28.3% of the participants responded correctly when asked about MOE. Similarly, very few were aware of the risks of MOE (2.5%), complications associated with it (17.3%) and the necessary procedures for managing patients (24.2%). The awareness of doctors in the primary health clinics about MOE was significantly better than those in hospitals (P = 0.002). CONCLUSION: There was a significant deficiency in the knowledge of GPs on MOE. Therefore, health education and awareness programs on MOE are recommended. Furthermore, we recommend that it is necessary to encourage the use of the term “Diabetic EAR “to increase the level of awareness of physicians about MOE.

Effect of Zamzam water on blood methemoglobin level in young rats Ahmed Badar, Abdullah O Bamosa, Mohammed Salahuddin, Abdullah Al Meheithif Journal of Family and Community Medicine 2019 26(1):30-35 BACKGROUND: Methemoglobin (MetHb) level in blood indicates exposure to nitrogenous compounds. Acquired methemoglobinemia as a result of exposure to nitrates in drinking water is primarily an issue for infants. The amount of nitrates in Zamzam water is said to be on the high side. This study was designed to determine the effect of prolonged use of Zamzam water on MetHb in rat pups. MATERIALS AND METHODS: Wistar rat pups (n = 52, 3 weeks old) were divided into four equal groups. All of them were given normal laboratory chow. The groups differed only in the exclusive source of water, that is ordinary bottled water, standardized mineral water, old Zamzam water (stored since 2008) or fresh Zamzam water. MetHb level was checked (using Avoximeter 4000) at the baseline, and then every week for 4 weeks from blood obtained from retro-orbital sinus. Other parameters tested were total haemoglobin, oxyhemoglobin and carboxyhemoglobin. ANOVA was used to compare the means between the groups. RESULTS: None of the rats in any of the four groups showed any sign of methemoglobinemia or toxicity. Both groups on Zamzam water showed higher increments in their total hemoglobin by the end of the study compared to their baseline (22%) than the ordinary water (9%) and the mineral water (5%) groups. None of the groups showed any significant difference in MetHb levels on intergroup comparison at any of the weekly readings and at the end of the study. CONCLUSION: Prolonged use of Zamzam water did not induce any significant difference in MetHb concentration in rat pups, which might indicate that it is safe for infants.

Determinants of energy drinks consumption among the students of a Saudi University Mahmoud H Alabbad, Mohammed Z AlMussalam, Ahmed M AlMusalmi, Mohammad M Alealiwi, Ali I Alresasy, Haidar N Alyaseen, Ahmed Badar Journal of Family and Community Medicine 2019 26(1):36-44 BACKGROUND: Energy drinks contain stimulants mainly caffeine. The use of these drinks by university students is on the rise despite concerns about their safety. This study identified the determinants of the consumption of energy drinks in a cohort of Saudi university students. MATERIALS AND METHODS: This cross-sectional study was carried out at Imam Abdulrahman Bin Faisal University in Saudi Arabia. The students who volunteered to participate (n = 1255) were asked to complete a pretested questionnaire soliciting information on gender, marital status, class and college of study, pattern of energy drinks use, reasons for use, any benefits as well as any untoward effects experienced. Data was analysed using IBM-SPSS (version 21) to determine frequencies and compare various categories of the energy drink users. Logistic regression analysis were performed to identify determinants of energy drinks consumption. RESULTS: Out of 1255 participants, 245 reported using energy drinks. Out of a total 1255 students, 903 (72%) were from medical and 352 (28%) from nonmedical colleges of the university. There were 890 junior and 365 senior students. The female participants were significantly more among both senior and junior medical students. The age of the participants (mean ± SD) was 20.2 ± 1.9 years. The frequency of energy drinks users was higher in the male nonmedical students (both senior and junior) compared to the medical students. The most significant determinants identified were male gender (odds ratio [OR] 4.2, 95% confidence interval [CI] =3.34, 6.12), and being single (OR = 2.8, CI = 1.98, 4.24). In addition, being in non-medical field of study (OR = 1.3, 95% CI=0.61-2.13) was also found to have a reasonable association with energy drink consumption. CONCLUSION: We report male gender, unmarried status, and studying in nonmedical colleges of the university as the main determinants of the consumption of energy drinks by university students. Scrutiny of the patterns and reasons for the consumption of energy drinks might help in developing educational interventions to ensure the appropriate use of energy drinks by young adults.

Medical students' perception of their educational environment at Imam Abdulrahman Bin Faisal University, Kingdom of Saudi Arabia Soban Q Khan, Mohammad Al-Shahrani, Abdul Khabeer, Faraz A Farooqi, Abdullah Alshamrani, Abdulrahman M Alabduljabbar, Ahmed S Bahamdan, Mohammad A Alqathani Journal of Family and Community Medicine 2019 26(1):45-50 OBJECTIVE: The purpose of this study was to investigate students' perception of the educational climate in a medical school in Dammam, Kingdom of Saudi Arabia (KSA). The difference in the perception of preclinical year students and clinical year students was also evaluated. MATERIALS AND METHODS: This cross-sectional study was conducted among 2nd to 6th year students at the medical college of Imam Abdulrahman Bin Faisal University. “Dundee Ready Educational Environment Measure” (DREEM) was used to evaluate the educational environment. RESULTS: Out of 518, 238 students participated in the study; participation rate of 45.9%. The average DREEM score was 112.38 with a SD of 22.4. Students' perception of atmosphere got the highest score (27.1 ± 6.7) of the five DREEM subscales. The 3rd year had the highest DREEM score compared to students of other levels, while the DREEM score of preclinical students was significantly higher than that of the clinical year students. CONCLUSION: Perception of medical students about the educational climate was more positive than negative. Although the DREEM score and its subdomains showed a positive educational environment, students still mentioned some problematic areas that need to be addressed. Findings of this study could encourage other medical colleges in the KSA to focus on weak areas and address the issues raised by students, especially clinical year students.

Prevalence of patients with epilepsy unfit to drive Esra' H Al Zaid Journal of Family and Community Medicine 2019 26(1):51-56 BACKGROUND: There is no consensus among medical experts as to whether patients with epilepsy (PWEs) should be permitted to drive. PWEs who have had uncontrolled seizures in the past year are at an increased risk of road traffic accidents, often leading to the destruction of property, injury, or death. Currently, there is no clear policy on whether PWEs can drive in Saudi Arabia. Existing policies attempt to balance the potentially harmful and beneficial aspects of the issue. The purpose of this study was to measure the prevalence of PWEs who are unfit to drive. MATERIALS AND METHODS: Data were collected by interviews, a structured validated questionnaire, and a review of the medical records of 140 PWEs, with a response rate of 84%. RESULTS: Fifty four percent of PWEs were found unfit to drive. Of the 118 participants, 17.7% did not drive and 97 (82.3%) drove. Of the 21 patients who did not drive, 14 (11.8% of the total sample) never drove and 7 (5.9% of the total sample) stopped driving because of epilepsy. Of the 104 patients who drove, 45 (43.2% of the total sample) had a history of seizures while they drove. These incidents had resulted in the involvement of 28 patients (26.9% of the total sample) in motor vehicle accidents and 17 (16.3% of the total sample) patients being admitted to the emergency room. CONCLUSION: Structured regulation and licensing procedures are necessary for PWEs to drive safely. Regulations in other countries demand that seizures be controlled for 1 year before epileptic patients are allowed unrestricted driving. Such regulations would improve road safety in Saudi Arabia.

Immune's-boosting agent: Immunomodulation potentials of propolis Mohammed Al-Hariri Journal of Family and Community Medicine 2019 26(1):57-60 With a concomitant increase in immune-related diseases such as allergic diseases, Type 1 diabetes mellitus, rheumatoid arthritis, multiple sclerosis, psoriasis, inflammatory bowel disease and other immune-related responses such as immunodeficiency, various infectious, diseases, vaccines, and malignancies, it has become very important to have a well-balanced and properly functioning immune system for the maintenance of human health. Recent scientific research has strongly suggested propolis as one of the most promising immunomodulation agents. This review describes recent findings with respect to propolis and its ingredients that show potential in this respect and evaluate their potential mechanisms. The author believes that propolis or/and its ingredients alone and in combination could be promising in manipulating the immune response and inducing immunomodulation. Further exploratory studies are needed to support large clinical trials toward further development of propolis.

Chest pain as a possible side effect of pitavastatin (Livalo) Nada R AlZahrani, Amna F Yassin Journal of Family and Community Medicine 2019 26(1):61-63 Coronary heart disease is a serious complication of dyslipidemia. Pitavastatin is a more commonly prescribed medication for the treatment of dyslipidemia. Here, we report the case of a 37-year-old female, a known patient with well-controlled bronchial asthma. She was recently found to be dyslipidemic and started on pitavastatin calcium 4 mg once a day (OD). On the 10th day of treatment, she began to have crushing chest pain and was admitted to the hospital. All investigations for coronary heart disease came out negative. Her symptoms improved dramatically when pitavastatin was stopped. Pitavastatin is reported to cause myalgia and muscle spasm, especially at higher doses. There is evidence in literature that this medication might cause chest pain in old obese ladies if taken at high doses. We report this case as a possibility of chest pain even in younger females.

No Thermoregulatory Impairment in Skin Graft Donor Sites during Exercise-Heat Stress

The U.S. Army's Standards of Medical Fitness, AR 40-501, state that "Prior burn injury (to include donor sites) involving a total body surface area of 40 percent or more does not meet the standard". Inclusion of donor sites (sites harvested for skin grafts) in this Standard implies that thermoregulatory function is impaired within donor sites during exercise-heat stress; however, supporting evidence is currently lacking. Purpose To test the hypothesis that well-healed donor and non-injured sites demonstrate similar elevations in skin blood flow and sweating during exercise-induced hyperthermia. Methods Twenty burn survivors (>1 year post-injury; four females) cycled for 60 min in a 39.7 ± 0.3°C and 21.1 ± 3.3% relative humidity environment at ~50% of maximal aerobic capacity. Core and mean skin temperatures were recorded throughout exercise. Skin blood flow (laser-Doppler imaging) was measured at baseline and after exercise within donor (LDFDON) and adjacent non-injured control (LDFCON) sites. At 45 min of exercise, local sweat rates (Technical Absorbents) were measured within the same donor (LSRDON) and non-injured (LSRCON) areas. Results After 60 min of exercise, core and skin temperatures reached 38.2 ± 0.4°C and 35.5 ± 1.2°C, respectively. The increase in skin blood flow from baseline to end-exercise (LDFDON: 91.6 ± 44.5 AU; LDFCON: 106.0 ± 61.6 AU; P = 0.17) and local sweat rates (LSRDON: 0.46 ± 0.26 mg·cm−2·min−1; LSRCON: 0.53 ± 0.25 mg·cm−2·min−1; P = 0.14) were not different between donor and non-injured control sites. Conclusion Well-healed donor sites retain the ability to increase skin blood flow and sweating during exercise-heat stress, providing evidence against the inclusion of donor sites when determining whether a burn injury meets the Army's Standards of Medical Fitness. Address for Correspondence: Dr. Craig Crandall, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 7232 Greenville Avenue, Dallas, Texas, USA, 75231. Tel: 214-345-4623. E-mail: craigcrandall@texashealth.org This work was supported by the Department of Defense (W81XWH-15-1-0647 to CGC), a Natural Sciences and Engineering Research Council of Canada Postdoctoral Fellowship (to MNC), and the National Institutes of Health (R01GM068865-11S1 to CGC and GM). CONFLICT OF INTEREST: The authors have no conflicts of interest to disclose. The results of the present study do not constitute endorsement by ACSM. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for publication: 31 December 2018. © 2019 American College of Sports Medicine

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