Σάββατο, 24 Σεπτεμβρίου 2016

Poster 399 The Bubble Technique: A Novel Use of Sterile Water to Facilitate Lead Placement

Devang Padalia: I Have No Relevant Financial Relationships To Disclose

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Poster 392 Neurotoxic Manifestations After Intrathecal Gadobutrol Injection: A Case Report

Devang Padalia: I Have No Relevant Financial Relationships To Disclose

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Poster 391 Prospective, Double-blind, Randomized Clinical Trial to Compare Single Shot Adductor Canal Nerve Block Versus Femoral Nerve Block Combined with Local Infiltration Analgesia: Postoperative Functional Outcomes After Total Knee Arthroplasty

George Macrinici: I Have No Relevant Financial Relationships To Disclose

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Poster 437 Pain in Spinal Cord Injury - An Unusual Presentation of Complex Regional Pain Syndrome: A Case Report

Siddarth Thakur: I Have No Relevant Financial Relationships To Disclose

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Participation in Daily Life: Influence on Quality of Life in Ambulatory Children with Cerebral Palsy

Jaclyn Russell: I Have No Relevant Financial Relationships To Disclose

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Poster 508 A Pilot Patient Safety Simulation Station for Physical Medicine and Rehabilitation Residents: A Case Report

Cynthia Pineda: I Have No Relevant Financial Relationships To Disclose

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Controversies of Scoliosis Management in Duchenne Muscular Dystrophy

David Berbrayer: I Have No Relevant Financial Relationships To Disclose

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Poster 284 The Effect Playing Electronic Musical Instruments has on the Functional Improvement of the Hemiplegic Upper Limbs and Its Psychological Effect

Fumihito Kasai: I Have No Relevant Financial Relationships To Disclose

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Incidence of Tethered Cord in Toe Walking: Single Center Experience at Gillette Children's Specialty Healthcare

Kelly Cho: I Have No Relevant Financial Relationships To Disclose

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Poster 474 A Male with Rett Syndrome: Broadening the Differential Diagnosis: A Case Report

Gary Panagiotakis: I Have No Relevant Financial Relationships To Disclose

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Impact of Selective Percutaneous Myofascial Lengthening (SPML) on Quality of Life in Children with Cerebral Palsy

Tracey Isidro: I Have No Relevant Financial Relationships To Disclose

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Poster 402 An Acute Presentation of Spinal Epidural Lipomatosis

Juewon Khwarg: I Have No Relevant Financial Relationships To Disclose

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Treatment with Botulinum Toxin Type A in Infants with Refractory Congenital Muscular Torticollis: A 10-Year Retrospective Study.

Clarice Sinn: I Have No Relevant Financial Relationships To Disclose

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Poster 268 Dextromethorphan and Quinidine for Treating Post-Traumatic Brain Injury Agitation: A Case Series

Gilbert Siu: I Have No Relevant Financial Relationships To Disclose

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The Effect of Vitamin D Supplementation on Pain, Mood, Depression, and Strength in Patients with Spinal Cord Injury

Thornton Williams: I Have No Relevant Financial Relationships To Disclose

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Poster 491 Mirror Therapy in Improving Hand Function of a Hemiparetic Child with Brain Abscess and Tetralogy of Fallot: A Case Report

Angelita Roma Hebreo: I Have No Relevant Financial Relationships To Disclose

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Stimulation Across the Transverse Carpal Ligament in Carpal Tunnel Syndrome

Stephen Kishner: I Have No Relevant Financial Relationships To Disclose

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Poster 454 Improving Urine Drug Testing in New Patients at a University-Affiliated Pain Clinic and Analysis of Gender Differences in Urine Drug Testing

Jack Smith: I Have No Relevant Financial Relationships To Disclose

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A Randomized Comparison of Locomotor Therapy Interventions: Partial Body Weight Supported Treadmill, Lokomat® and G-Eo® Training in Traumatic Brain Injury

Alberto Esquenazi: Research Grants - Allergan, Research Grants - Ipsen

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Poster 420 Pharmacodynamic Effects from a Category 3 Oral Human Abuse Potential Study of an Abuse-Deterrent, Extended-Release Morphine Product Candidate in Nondependent, Recreational Opioid Users

Michael Smith: I Have No Relevant Financial Relationships To Disclose

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Strategy-Based Reasoning Training Changes Cingulo-opercular Network Connectivity in Chronic Traumatic Brain Injury

Publication date: October 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 10
Author(s): Kihwan Han, Sandra B. Chapman, Daniel C. Krawczyk




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Editorial Board

Publication date: October 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 10





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Constraint Induced Movement Therapy for Children with Brain Tumors

Publication date: October 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 10
Author(s): Jessica Sparrow, Liang Zhu, Amar Gajjar, Belinda N. Mandrell, Kirsten K. Ness




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Table of Contents

Publication date: October 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 10





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Editors' Selections From This Issue: Volume 97 / Number 10 / October 2016

Publication date: October 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 10





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Annual Raking and Weighting of the Traumatic Brain Injury Model Systems National Database for Enhanced Population Estimation and Inference

Publication date: October 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 10
Author(s): Jessica Ketchum, Jeffrey P. Cuthbert, C.B. Eagye, Gale G. Whiteneck, Cynthia Harrison-Felix




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Current Research Outcomes From the Spinal Cord Injury Model Systems

Publication date: October 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 10
Author(s): Yuying Chen, Allen W. Heinemann




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Interim results of the RAPPER II Trial: Functional Physiotherapy in the REX Robotic Powered Walking Aid

Publication date: October 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 10
Author(s): Jon Graham, Nick Birch, Tom Priestley




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Masthead

Publication date: October 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 10





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2016 ACRM Annual Conference Abstracts

Publication date: October 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 10





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Altered Functional Connectivity and Motor Control One Year after Pediatric TBI

Publication date: October 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 10
Author(s): Jaclyn Stephens, Anita Barber, Stewart Mostofsky, Stacy Suskauer




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Establishing a Framework for Driving Rehabilitation in Multiple Sclerosis

Publication date: October 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 10
Author(s): Hannes Devos, Maud Ranchet, Deborah Backus, Abiodun Emmanuel Akinwuntan




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Gender Disparities in Stress from Providing Care to Older Mexican Americans: A Descriptive Study of the HEPESE

Publication date: October 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 10
Author(s): Diane Collins, Amit Kumar, Brian Downer, Amol M. Karmarkar, Kyriakos S. Markides




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Center for Large Data Research and Data Sharing in Rehabilitation

Publication date: October 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 10
Author(s): Kenneth Ottenbacher




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Developing Artificial Neural Network Models to Predict Functioning One Year After Traumatic Spinal Cord Injury

Publication date: October 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 10
Author(s): Timothy Belliveau, Alan M. Jette, Subramani Seetharama, Jeffrey Axt, David Rosenblum, Daniel Larose, Bethlyn Houlihan, Mary Slavin, Chantal Larose
ObjectiveTo develop mathematical models for predicting level of independence with specific functional outcomes 1 year after discharge from inpatient rehabilitation for spinal cord injury.DesignStatistical analyses using artificial neural networks and logistic regression.SettingRetrospective analysis of data from the national, multicenter Spinal Cord Injury Model Systems (SCIMS) Database.ParticipantsSubjects (N=3142; mean age, 41.5y) with traumatic spinal cord injury who contributed data for the National SCIMS Database longitudinal outcomes studies.InterventionsNot applicable.Main Outcome MeasuresSelf-reported ambulation ability and FIM-derived indices of level of assistance required for self-care activities (ie, bed-chair transfers, bladder and bowel management, eating, toileting).ResultsModels for predicting ambulation status were highly accurate (>85% case classification accuracy; areas under the receiver operating characteristic curve between .86 and .90). Models for predicting nonambulation outcomes were moderately accurate (76%–86% case classification accuracy; areas under the receiver operating characteristic curve between .70 and .82). The performance of models generated by artificial neural networks closely paralleled the performance of models analyzed using logistic regression constrained by the same independent variables.ConclusionsAfter further prospective validation, such predictive models may allow clinicians to use data available at the time of admission to inpatient spinal cord injury rehabilitation to accurately predict longer-term ambulation status, and whether individual patients are likely to perform various self-care activities with or without assistance from another person.



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Spinal Cord Injury Model Systems: Review of Program and National Database From 1970 to 2015

Publication date: October 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 10
Author(s): Yuying Chen, Michael J. DeVivo, J. Scott Richards, Theresa B. SanAgustin
The Spinal Cord Injury Model Systems (SCIMS) centers have provided continuous, comprehensive multidisciplinary care for persons with spinal cord injury (SCI) in the United States since their inception in 1970. In addition, the research conducted and the analysis of data collected at these centers facilitate advances in the care and the overall quality of life for people with SCI. Over the past 45 years, the SCIMS program and National Spinal Cord Injury Database (NSCID) have undergone major revisions, which must be recognized in the planning, conduct, and interpretation of SCIMS research to prevent misinterpretation of findings. Therefore, we provide herein a brief review of the SCIMS program and the associated NSCID throughout its history, emphasizing changes and accomplishments within the past 15 years, to facilitate a better understanding and interpretation of the data presented in SCIMS research publications, including the articles published in this special issue of the Archives.



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Request for Proposals

Publication date: October 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 10





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Navigation Services for Stroke Survivors and Caregivers Post-Discharge

Publication date: October 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 10
Author(s): Julia Richards




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Trajectories of Life Satisfaction After Spinal Cord Injury

Publication date: October 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 10
Author(s): Christopher R. Pretz, Allan J. Kozlowski, Yuying Chen, Susan Charlifue, Allen W. Heinemann
ObjectiveTo describe individual-level temporal change in life satisfaction after spinal cord injury.DesignIndividual growth curve (IGC) analysis of prospectively collected data from the National Institute on Disability, Independent Living, and Rehabilitation Research National Spinal Cord Injury Database (NSCID).SettingMulticenter, longitudinal database study.ParticipantsParticipants (N=4846) in the NSCID.InterventionsNot applicable.Main Outcome MeasureRasch-transformed Satisfaction With Life Scale scores.ResultsIndividual-level trajectories reflecting life satisfaction vary extensively and are associated with demographic and injury-related characteristics. Demographic characteristics include race, sex, pre-employment and discharge marital status, and level of education; injury-related factors include days in rehabilitation, neurologic level, age at injury, and injury etiology. Results are displayed graphically by way of a computer-generated interactive tool and represent different trajectories of individual-level changes in life satisfaction.ConclusionsIGC methodology allows researchers and clinicians to anticipate patient-specific trajectories through use of an automated interactive tool. Projected trajectories hold promise in facilitating planning for inpatient and outpatient services, which could enhance long-term outcomes.



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Mild Traumatic Brain Injury and Chronic Pain: Using Mixed Methods to Explore Unique and Overlapping Phenomenology

Publication date: October 2016
Source:Archives of Physical Medicine and Rehabilitation, Volume 97, Issue 10
Author(s): Deborah Snell, Rachelle Martin, Lois Surgenor, Jean Hay-Smith, Gary Hooper, Tracy Melzer, Richard Siegert, Tim Anderson




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ECMO Transport with a twist. Jet-Pack: THX.RNoAF!

As it stood about minutes to save the dying patient's life,his doctor called the Airforce and asked for F-16.-The patient was so ill that he could not have been saved otherwise,said Dr.Anders Wetting Carlsen at St. Olav's Hospital.-I've flown fighters since 1993,and have never heard of anything like this.But we try to be solution-oriented,says sq.leader Børge"Gaff"Kleppe at the Armed Forces 338 Sq.-Chance would have it that we had two flights bound for an exercise.One of them had even a cargo tank where there might be room,says sq.commander.It is not often F-16 aircraft flying with a so-called cargo tank.While the fighters got ready for departure, a helicopter from AirAmbulance on the way from Trondheim to Orland with the machine.Less than ten min.after they landed at the fighter base,the plane was heading north.(40Min.from 1.st call)(Both ECMO`s att local hospital in use)Usually we spend 35 min.pilot was there in less then 25.Local AirAmbulance waiting,Landing at Hosp.minutes later.

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ECMO Transport with a twist. Jet-Pack: THX.RNoAF!

As it stood about minutes to save the dying patient's life,his doctor called the Airforce and asked for F-16.-The patient was so ill that he could not have been saved otherwise,said Dr.Anders Wetting Carlsen at St. Olav's Hospital.-I've flown fighters since 1993,and have never heard of anything like this.But we try to be solution-oriented,says sq.leader Børge"Gaff"Kleppe at the Armed Forces 338 Sq.-Chance would have it that we had two flights bound for an exercise.One of them had even a cargo tank where there might be room,says sq.commander.It is not often F-16 aircraft flying with a so-called cargo tank.While the fighters got ready for departure, a helicopter from AirAmbulance on the way from Trondheim to Orland with the machine.Less than ten min.after they landed at the fighter base,the plane was heading north.(40Min.from 1.st call)(Both ECMO`s att local hospital in use)Usually we spend 35 min.pilot was there in less then 25.Local AirAmbulance waiting,Landing at Hosp.minutes later.

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ECMO Transport with a twist. Jet-Pack: THX.RNoAF!

As it stood about minutes to save the dying patient's life,his doctor called the Airforce and asked for F-16.-The patient was so ill that he could not have been saved otherwise,said Dr.Anders Wetting Carlsen at St. Olav's Hospital.-I've flown fighters since 1993,and have never heard of anything like this.But we try to be solution-oriented,says sq.leader Børge"Gaff"Kleppe at the Armed Forces 338 Sq.-Chance would have it that we had two flights bound for an exercise.One of them had even a cargo tank where there might be room,says sq.commander.It is not often F-16 aircraft flying with a so-called cargo tank.While the fighters got ready for departure, a helicopter from AirAmbulance on the way from Trondheim to Orland with the machine.Less than ten min.after they landed at the fighter base,the plane was heading north.(40Min.from 1.st call)(Both ECMO`s att local hospital in use)Usually we spend 35 min.pilot was there in less then 25.Local AirAmbulance waiting,Landing at Hosp.minutes later.

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Association between physical activity and inflammatory bowel disease risk: A meta-analysis

Previous studies of an association between physical activity and inflammatory bowel disease have yielded conflicting results.

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Association between physical activity and inflammatory bowel disease risk: A meta-analysis

Previous studies of an association between physical activity and inflammatory bowel disease have yielded conflicting results.

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ECMO Transport with a twist. Jet-Pack: THX.RNoAF!

As it stood about minutes to save the dying patient's life,his doctor called the Airforce and asked for F-16.-The patient was so ill that he could not have been saved otherwise,said Dr.Anders Wetting Carlsen at St. Olav's Hospital.-I've flown fighters since 1993,and have never heard of anything like this.But we try to be solution-oriented,says sq.leader Børge"Gaff"Kleppe at the Armed Forces 338 Sq.-Chance would have it that we had two flights bound for an exercise.One of them had even a cargo tank where there might be room,says sq.commander.It is not often F-16 aircraft flying with a so-called cargo tank.While the fighters got ready for departure, a helicopter from AirAmbulance on the way from Trondheim to Orland with the machine.Less than ten min.after they landed at the fighter base,the plane was heading north.(40Min.from 1.st call)(Both ECMO`s att local hospital in use)Usually we spend 35 min.pilot was there in less then 25.Local AirAmbulance waiting,Landing at Hosp.minutes later.

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Laparoscopic cholecystectomy in an adult moyamoya disease case

Moyamoya disease (MMD) is a progressive disorder caused by blocked arteries or spontaneous occlusion of the blood vessels of the circle of Willis with compensatory collateral vasculature; it is an increasingly recognized cause of stroke [1,2]. Anesthetic management of patients with MMD is challenging because appropriate control of hemodynamic state and ventilation is required to prevent neurologic adverse events. We previously reported the perioperative management of video-assisted thoracoscopic surgery in an adult patient with MMD [3].

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Atypical dicrotic notch in arterial blood pressure waveform morphology

Invasive arterial blood pressure (ABP) monitoring is an effective tool to monitor a patient's hemodynamic status and may sometimes provide valuable information about their fluid status. In the cardiac cycle, the dicrotic notch of the ABP waveform indicates closure of the aortic valve, and its location varies according to the timing of aortic closure. In normal ABP waveforms, the dicrotic notch is positioned above the morphologic level, which marks diastolic pressure (Fig. 1A). In an atypical waveform morphology occasionally discovered, the dicrotic notch is in a different position (Fig.

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Are Y o u Ready For The STORM ? Head Over (the) Water ...

"" We offer training in water rescue , river rescue and water safety , as well as a dealer rescue equipment and safety equipment. We also offer water activities,rafting&consulting -water safety and rescue. "" River rescue, water rescue, surface rescue , rescuer, Head Above Water: Lars Fossum - Tlf: +4792261844 Mail: lars@hodeovervann.no

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Are Y o u Ready For The STORM ? Head Over (the) Water ...

"" We offer training in water rescue , river rescue and water safety , as well as a dealer rescue equipment and safety equipment. We also offer water activities,rafting&consulting -water safety and rescue. "" River rescue, water rescue, surface rescue , rescuer, Head Above Water: Lars Fossum - Tlf: +4792261844 Mail: lars@hodeovervann.no

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Are Y o u Ready For The STORM ? Head Over (the) Water ...

"" We offer training in water rescue , river rescue and water safety , as well as a dealer rescue equipment and safety equipment. We also offer water activities,rafting&consulting -water safety and rescue. "" River rescue, water rescue, surface rescue , rescuer, Head Above Water: Lars Fossum - Tlf: +4792261844 Mail: lars@hodeovervann.no

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Are Y o u Ready For The STORM ? Head Over (the) Water ...

"" We offer training in water rescue , river rescue and water safety , as well as a dealer rescue equipment and safety equipment. We also offer water activities,rafting&consulting -water safety and rescue. "" River rescue, water rescue, surface rescue , rescuer, Head Above Water: Lars Fossum - Tlf: +4792261844 Mail: lars@hodeovervann.no

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Hepatitis B core-related antigen: a strong indicator for cessation of nucleos(t)ide analog therapy in patients with chronic hepatitis B



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Cost-effectiveness of drug monitoring of anti-TNF therapy in inflammatory bowel disease and rheumatoid arthritis: a systematic review

Abstract

Background

Therapeutic drug monitoring (TDM) of anti-TNF is increasingly used to manage inflammatory bowel diseases (IBD) and rheumatoid arthritis (RA). The cost-effectiveness of this strategy is debated.

Methods

All studies comparing the cost-effectiveness of a TDM-based strategy and an empirical dose management of anti-TNF in IBD or RA were screened. Studies were identified through the MEDLINE electronic database (up to July 2016), and annual international meeting abstracts were also manually reviewed.

Results

Seven studies were included: two randomized controlled trials (RCTs) enrolling 332 patients [247 Crohn's disease (CD) and 85 ulcerative colitis (UC)] and five modeling approaches. Four studies included only CD patients, one included both CD and UC patients, and two included only RA patients. Three studies compared the cost-effectiveness of the two strategies in patients with secondary infliximab (IFX) failure (dose-escalation strategy), one in patients in remission on optimized IFX (de-escalation strategy), one in patients starting adalimumab, and two in patients with clinical response to maintenance anti-TNF therapy. The two RCTs demonstrated that a TDM strategy led to major cost savings, ranging from 28 to 34 %. The three modeling approaches with regard to CD patients demonstrated cost savings ranging from $5396 over a 1-year period to €13,130 per patient at 5 years of follow-up. A TDM strategy also led to major cost savings in the two modeling approaches in RA patients.

Conclusions

Available evidence indicates that a TDM strategy leads to major cost savings related to anti-TNF therapy in both IBD and RA patients, with no negative impact on efficacy.



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ECMO Transport with a twist. Jet-Pack:

As it stood about minutes to save the dying patient's life,his doctor called the Airforce and asked for F-16.-The patient was so ill that he could not have been saved otherwise,said Dr.Anders Wetting Carlsen at St. Olav's Hospital.-I've flown fighters since 1993,and have never heard of anything like this.But we try to be solution-oriented,says squadron leader Børge"Gaff"Kleppe at the Armed Forces 338 Sq. -Chance would have it that we had two flights bound for Moss on an exercise. One of them had even a cargo tank where there might be room,says sq. commander. It is not often F-16 aircraft flying with a so-called cargo tank -a small external tank with room for minimal load. While the fighters got ready for departure, a helicopter from Air ambulance on the way from Trondheim to Orland with the machine. Less than ten minutes after they landed at the fighter base,the plane was heading north.(Both ECMO`s att local hospital in use)Usually we spend 35 min.pilot was there in less then 25. ...

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Repetitive transcranial magnetic stimulation for treatment resistant depression: Re-establishing connections

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Publication date: November 2016
Source:Clinical Neurophysiology, Volume 127, Issue 11
Author(s): Rodney J. Anderson, Kate E. Hoy, Zafiris J. Daskalakis, Paul B. Fitzgerald
Repetitive transcranial magnetic stimulation (rTMS) is a relatively recent addition to the neurostimulation armamentarium for treating individuals suffering from treatment refractory depression and has demonstrated efficacy in clinical trials. One of the proposed mechanisms of action underlying the therapeutic effects of rTMS for depression involves the modulation of depression-associated dysfunctional activity in distributed brain networks involving frontal cortical and subcortical limbic regions, via changes to aberrant functional and structural connectivity. Although there is currently a paucity of published data, we review changes to functional and structural connectivity following rTMS for depression. Current evidence suggests an rTMS-induced normalisation of depression-associated dysfunction within and between large scale functional networks, including the default mode, central executive and salience networks, associated with an amelioration of depressive symptoms. Additionally, changes to measures of white matter microstructure, primarily in the dorsolateral prefrontal cortex, have also been reported following rTMS for depression, possibly reversing depression-associated abnormalities. We argue that measures of functional and structural connectivity can be used to optimise rTMS targeting within the dorsolateral prefrontal cortex and also to explore novel rTMS targets for depression. Finally, we discuss the utility of measures of brain connectivity as predictive biomarkers of rTMS treatment response in guiding therapeutic decisions.



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ECMO Transport with a twist. Jet-Pack:

As it stood about minutes to save the dying patient's life,his doctor called the Airforce and asked for F-16.-The patient was so ill that he could not have been saved otherwise,said Dr.Anders Wetting Carlsen at St. Olav's Hospital.-I've flown fighters since 1993,and have never heard of anything like this.But we try to be solution-oriented,says squadron leader Børge"Gaff"Kleppe at the Armed Forces 338 Sq. -Chance would have it that we had two flights bound for Moss on an exercise. One of them had even a cargo tank where there might be room,says sq. commander. It is not often F-16 aircraft flying with a so-called cargo tank -a small external tank with room for minimal load. While the fighters got ready for departure, a helicopter from Air ambulance on the way from Trondheim to Orland with the machine. Less than ten minutes after they landed at the fighter base,the plane was heading north.(Both ECMO`s att local hospital in use)Usually we spend 35 min.pilot was there in less then 25. ...

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ECMO Transport with a twist. Jet-Pack:

As it stood about minutes to save the dying patient's life,his doctor called the Airforce and asked for F-16.-The patient was so ill that he could not have been saved otherwise,said Dr.Anders Wetting Carlsen at St. Olav's Hospital.-I've flown fighters since 1993,and have never heard of anything like this.But we try to be solution-oriented,says squadron leader Børge"Gaff"Kleppe at the Armed Forces 338 Sq. -Chance would have it that we had two flights bound for Moss on an exercise. One of them had even a cargo tank where there might be room,says sq. commander. It is not often F-16 aircraft flying with a so-called cargo tank -a small external tank with room for minimal load. While the fighters got ready for departure, a helicopter from Air ambulance on the way from Trondheim to Orland with the machine. Less than ten minutes after they landed at the fighter base,the plane was heading north.(Both ECMO`s att local hospital in use)Usually we spend 35 min.pilot was there in less then 25. ...

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ECMO Transport with a twist. Jet-Pack:

As it stood about minutes to save the dying patient's life,his doctor called the Airforce and asked for F-16.-The patient was so ill that he could not have been saved otherwise,said Dr.Anders Wetting Carlsen at St. Olav's Hospital.-I've flown fighters since 1993,and have never heard of anything like this.But we try to be solution-oriented,says squadron leader Børge"Gaff"Kleppe at the Armed Forces 338 Sq. -Chance would have it that we had two flights bound for Moss on an exercise. One of them had even a cargo tank where there might be room,says sq. commander. It is not often F-16 aircraft flying with a so-called cargo tank -a small external tank with room for minimal load. While the fighters got ready for departure, a helicopter from Air ambulance on the way from Trondheim to Orland with the machine. Less than ten minutes after they landed at the fighter base,the plane was heading north.(Both ECMO`s att local hospital in use)Usually we spend 35 min.pilot was there in less then 25. ...

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Expression of the insulinoma-associated 1 (insm1) gene in Xenopus laevis tadpole retina and brain

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Publication date: Available online 23 September 2016
Source:Gene Expression Patterns
Author(s): Jennifer L. Bosse, Heithem M. El-Hodiri
The insulinoma-associated 1 (insm1) gene is involved in the differentiation of several neuronal and endoderm derived cell types. insm1 is expressed in the retina and brain of several vertebrates including Xenopus laevis. We report the detailed expression pattern of insm1 in the X. laevis tadpole retina and brain. X. laevis insm1 is expressed in most of the ciliary marginal zone of the mature retina and the optic tectum, dorsal pallium, hypothalamus and preoptic areas of the developing tadpole brain. Overall, insm1 is expressed in regions of the tadpole brain and retina harboring populations of progenitor cells.



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SEO exicutive - seo

we need a seo exicutive.

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Unusual Endoscopic Features in a Child With Drug Reaction With Eosinophilia and Systemic Symptoms

imageNo abstract available

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Ultrasound Elastography Is Useful for Evaluation of Liver Fibrosis in Children—A Systematic Review

imageObjectives: Adult studies have proven ultrasound elastography as a validated measure of liver fibrosis. The present study aimed to review the available literature on ultrasound elastography in children to evaluate the ability of the method to distinguish healthy from fibrotic liver tissue and investigate whether cutoff values for liver fibrosis in children have been established. Methods: A literature search was performed in MEDLINE, EMBASE, the Cochrane Library, and Web of Science to identify studies on ultrasound elastography of the liver in children. Only original research articles in English concerning ultrasound elastography in children with and without liver disease, younger than 18 years, were included. All reference lists of the included articles were hand-searched for further references. Results: Twenty-seven articles were included. Elastography in children without liver disease was investigated in 14 studies and were comparable to those existing for adults. Twelve studies compared elastography with liver biopsy in children with liver disease and found that cirrhosis was correctly diagnosed, whereas it was more difficult to assess severe fibrosis correctly. For the distinction between no, mild, and moderate fibrosis in children with liver disease the method was less accurate. Ultrasound elastography was able to differentiate between children with and without liver fibrosis. In children without liver disease ultrasound, elastography showed consistent liver stiffness values comparable to those found in adults. No fibrosis-specific cutoffs were proposed. Conclusions: Ultrasound elastography was able to diagnose cirrhosis, distinguish healthy from fibrotic liver tissue, and showed consistent liver stiffness values in children without liver disease.

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Treatment of Pulmonary Exacerbations Improves Short But Not Long-Term Growth Trajectory in Children With Cystic Fibrosis

imageObjectives: The present study sought to determine the long-term growth consequences after a pulmonary exacerbation in children with cystic fibrosis (CF). Methods: Retrospective cohort study of pediatric patients with CF with a hospital admission for a pulmonary exacerbation. Logistic regression used to determine risk factors for failure to recover baseline body mass index (BMI) percentile. Results: Of 72 patients, 43% failed to recover their baseline BMI percentile 12 months after discharge and these patients also had a lower forced expiratory volume in 1 second at follow-up. A greater decrease in weight percentile from baseline to admission was the only risk factor identified (odds ratio 0.83, P = 0.0015). Conclusions: Greater decrease in weight percentile from baseline to admission predicts failure to recover BMI percentile 1 year after a pulmonary exacerbation. Children with CF with poor growth preceding a pulmonary exacerbation continue to be at risk for long-term nutritional failure despite treatment for pulmonary exacerbation.

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Pediatric Acute-on-Chronic Liver Failure in a Specialized Liver Unit: Prevalence, Profile, Outcome, and Predictive Factors

imageObjectives: The aim of the study was to assess the prevalence, profile, outcome, and predictive factors of pediatric acute-on-chronic liver failure (ACLF). Methods: All children 3 months to 18 years satisfying the Asia Pacific Association for the Study of Liver Diseases definition of ACLF were included. Data were both extracted from records (January 2011 to December 2014) and prospectively collected (January to October 2015). Successful outcome was defined as survival with native liver at 90 days, whereas poor outcome included those who died or received liver transplantation. Results: Of the 499 children with chronic liver disease (CLD), 56 (11.2%) presented as ACLF, with a mean age of 9.35 (±4.39) years. Wilson disease and autoimmune hepatitis were the commonest underlying CLDs accounting for 24 (42.8%) and 18 (32.1%) cases, respectively. The most frequent events precipitating ACLF were a flare up of the underlying disease in 27 (48.2%) and acute viral hepatitis in 17 (30%). Poor outcome occurred in 22 (39.3%) children: 17 (30.4%) died and 5 (8.9%) received liver transplantation. Poor outcome was associated with grades 3 to 4 hepatic encephalopathy, bilirubin ≥17.5, international normalized ratio ≥3.5, and presence of 2 or more organ failures. On multivariate analysis, a Chronic Liver Failure-Sequential Organ Failure Assessment score ≥10 best predicted mortality (odds ratio 20.45, 95% confidence interval 3.9–106.7). Conclusions: ACLF is present in 11.2% of childhood CLD, with a 90-day native liver survival of 61%. A Chronic Liver Failure-Sequential Organ Failure Assessment score of ≥10 best predicts mortality at day 90.

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Use of Indirect Calorimetry to Detect Overfeeding in Critically Ill Children: Finding the Appropriate Definition

imageObjectives: Overfeeding during critical illness is associated with adverse effects such as metabolic disturbances and increased risk of infection. Because of the lack of sound studies with clinical endpoints, overfeeding is arbitrarily defined as the ratio caloric intake/measured resting energy expenditure (mREE) or alternatively as a comparison of measured respiratory quotient (RQ) to the predicted RQ based on the macronutrient intake (RQmacr). We aimed to compare definitions of overfeeding in critically ill mechanically ventilated children based on mREE, RQ, and caloric intake to find an appropriate definition. Methods: Indirect calorimetry measurements were performed in 78 mechanically ventilated children, median age 6.3 months. Enteral and/or parenteral nutrition was provided according to the local guidelines. Definitions used to indicate overfeeding were the ratio caloric intake/mREE of >110% and >120% and by the measured RQ > RQmacr + 0.05. Results: The proportion of patients identified as overfed varied widely depending on the definition used, ranging from 22% (RQ > RQmacr + 0.05), to 40% and 50% (caloric intake/mREE of >120% and >110%, respectively). Linear regression analysis showed that all patients would be identified as overfed with the definition RQ > RQmacr + 0.05 when the ratio caloric intake/mREE exceeded 165%. Caloric intake was higher in children with a standard deviation-score weight for age

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Role of Procalcitonin and C-Reactive Protein As Biomarkers of Infection in Children With Liver Disease

imageObjectives: Early and accurate identification of infection in patients with liver disease is challenging. The present study evaluated the role of procalcitonin (PCT) and C-reactive protein (CRP) as biomarkers of bacterial infection in children with liver disease. Methods: Demographic and clinical data of consecutive children admitted with acute liver failure (ALF) or decompensated chronic liver disease (DCLD) were collected. PCT and CRP were measured within 24 hours of admission. Blood and urine culture, chest x-ray, and ascitic fluid analysis were done. Results: One hundred sixty-four children (113 boys, age 76 [0.5–204] months, ALF 69, DCLD 95) were enrolled. Seventy-seven (47%) had infection. Most common site was ascitic fluid (n = 35), followed by urinary tract (n = 26), pneumonia (n = 22), and blood stream infection (n = 16). Twenty-one children had multiple-site infections, 18 had severe sepsis, and 36 had systemic inflammatory response syndrome. PCT and CRP correlated with infection severity, higher in severe sepsis (8.3 [3.5–38] ng/mL and 4.1 [0.3–13.8] mg/dL) than only infection (0.89 [0.1–8] ng/mL and 1.7 [0.32–24] mg/dL) and no infection (0.3 [0.1–6.75] ng/mL and 0.3 [0.1–4.16 mg/dL]). Systemic inflammatory response syndrome was more common in patients with infection (31/77 vs 5/87, P = 0.00). PCT (>0.5 ng/mL) and CRP (>0.6 mg/dL) performed better in DCLD (AUC of 0.90 and 0.83) compared with patients with ALF (AUC of 0.73 and 0.69). Conclusions: : PCT and CRP are reliable markers of infection and correlate with infection severity in children with liver disease. Their diagnostic accuracy is better in DCLD than ALF cases.

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Associated Factors for Antegrade Continence Enemas for Refractory Constipation and Fecal Incontinence

imageObjective: Determine clinical and manometric parameters associated with success of antegrade continence enemas (ACEs) administered via cecostomy in the treatment of constipation and fecal overflow incontinence. Methods: We performed a retrospective review of clinical symptoms and manometry (colonic and anorectal) before cecostomy in 40 pediatric patients (20 males, 20 females). The mean age at time of follow-up was 9.5 ± 4.4 years with a mean follow-up time of 12.2 ± 10.9 months. Clinical outcomes were defined as good, if subjects had >3 bowel movements per week,

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Exposure-Response of Palonosetron for Prevention of Chemotherapy-Induced Nausea and Vomiting in Pediatric Patients

imageObjectives: Extrapolation of efficacy from adult populations to pediatrics may be appropriate if it is reasonable to assume that the 2 populations have similar disease progression and response to intervention. When full extrapolation of efficacy is deemed appropriate, the pediatric dose can be determined by "matching" exposure to a drug with that observed in adult patients. This approach has been used in certain therapeutic areas to alleviate the burden of pediatric clinical trials. We present here a case in which exposure matching is not appropriate. Methods: Data analyses including pharmacokinetics and exposure-response were performed using data obtained from 2 pediatric chemotherapy-induced nausea and vomiting trials for intravenously administered palonosetron (Aloxi; a 5-HT3 receptor antagonist) injection and the results were compared with adult findings. Results: At the approved doses for adults (0.25 mg) and pediatric patients (20 μg/kg), mean systemic exposure (area under the curve) of palonosetron in pediatric patients was approximately 3-fold higher than that in adults, whereas the response rate was similar between the 2 populations. Across pediatric patients, those younger than 6 years of age appeared to have a higher response than those ages 6 years or older, even though estimated systemic exposure was comparable between these age groups. Conclusions: Overall, these analyses provide an example in which pediatric and adult exposure data alone are insufficient to adequately identify effective pediatric doses and raise questions about the appropriateness of exposure matching for other drugs in the same therapeutic class. In such cases, pediatric dose-ranging and efficacy studies are needed.

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Acute-on-Chronic Liver Failure in Children: A Separate Clinical Entity

No abstract available

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Effects of an Off-Axis Pivoting Elliptical Training Program on Gait Function in Persons With Spastic Cerebral Palsy: A Preliminary Study.

This preliminary study examined the effects of off-axis elliptical training on reducing transverse-plane gait deviations and improving gait function in 8 individuals with cerebral palsy (CP) (15.5 +/- 4.1 years) who completed an training program using a custom-made elliptical trainer that allows transverse-plane pivoting of the footplates during exercise. Lower-extremity off-axis control during elliptical exercise was evaluated by quantifying the root-mean-square and maximal angular displacement of the footplate pivoting angle. Lower-extremity pivoting strength was assessed. Gait function and balance were evaluated using 10-m walk test, 6-minute-walk test, and Pediatric Balance Scale. Toe-in angles during gait were quantified. Participants with CP demonstrated a significant decrease in the pivoting angle (root mean square and maximal angular displacement; effect size, 1.00-2.00) and increase in the lower-extremity pivoting strength (effect size = 0.91-1.09) after training. Reduced 10-m walk test time (11.9 +/- 3.7 seconds vs. 10.8 +/- 3.0 seconds; P = 0.004; effect size = 1.46), increased Pediatric Balance Scale score (43.6 +/- 12.9 vs. 45.6 +/- 10.8; P = 0.042; effect size = 0.79), and decreased toe-in angle (3.7 +/- 10.5 degrees vs. 0.7 +/- 11.7 degrees; P = 0.011; effect size = 1.22) were observed after training. We present an intervention to challenge lower-extremity off-axis control during a weight-bearing and functional activity for individuals with CP. Our preliminary findings suggest that this intervention was effective in enhancing off-axis control, gait function, and balance and reducing in-toeing gait in persons with CP. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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Apathy Due to Injury of the Prefrontocaudate Tract Following Mild Traumatic Brain Injury.

In this study, we report on a patient who developed apathy resulting from injury to the prefrontocaudate tract following mild traumatic brain injury (TBI), which was observed on diffusion tensor tractography (DTT). A 46-year-old female patient was involved in a bus accident. Her history included intracerebral hemorrhage (ICH) in the left putamen 4 years ago before the head trauma, and her family reported that she had fully recovered. She developed apathy after the TBI, worsening over time. Decreased neural connectivity of the left caudate nucleus (CN) to the left upper medial prefrontal cortex (PFC) resulting from the ICH was observed on the pre-TBI-DTT, whereas on the post-TBI-DTT (28 months after TBI), the neural connectivity of the left CN to the left upper medial PFC was increased, whereas that to the left lower medial PFC and orbitofrontal cortex was decreased. In the right hemisphere, decreased neural connectivity of the CN to the medial PFC and orbitofrontal cortex was observed on the post-TBI-DTT compared with the pre-TBI-DTT. Injury of the prefrontocaudate tract was observed in a patient with old ICH who developed apathy following mild TBI, using DTT. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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The Sunken Skull.

No abstract available

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Evaluation of the Cost of Comprehensive Outpatient Therapies in Patients with Malignant Brain Tumors.

Objective: The aim of this study was to compare the cost of comprehensive outpatient therapy (day rehabilitation) in individuals with malignant brain tumors to those with stroke and traumatic brain injury. Design: This was a prospective, nonrandomized, longitudinal study of 49 consecutive adults with malignant brain tumors enrolled in the 6 day rehabilitation sites of 1 institution over 35 months. The control group was composed of 50 patients with brain injury and 50 patients with stroke, who were also enrolled in the day rehabilitation program during the same period. A comparison was made of the total Medicare cost and the cost per day of day rehabilitation in patients with malignant brain tumors compared with the control group. Results: The patients with malignant brain tumors had lower total cost and cost per day than did the combined traumatic brain injury and stroke group during day rehabilitation (F2,143 = 3.056 [P = 0.05] and F2,142 = 5.046 [P = 0.008], respectively). Conclusions: The cost of comprehensive outpatient rehabilitation in patients with malignant brain tumors is less expensive than that of patients with traumatic brain injury or stroke, which are neurological diagnoses commonly seen in day rehabilitation. This study shows that cost should not be a barrier to providing outpatient therapies to this patient population. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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Mainstream capnography system for nonintubated children in the postanesthesia care unit: Performance with changing flow rates, and a comparison to side stream capnography

Abstract

Introduction

Monitoring of exhaled carbon dioxide (CO2) in nonintubated patients is challenging. We compared the precision of a mainstream mask capnography to side stream sampling nasal cannula capnography. In addition, we compared the effect of gas flow rates on the measured exhaled CO2 between mainstream mask and side stream nasal cannula capnography.

Methods

A mainstream mask capnography system (cap-ONE) was tested. Children (weight of 7–40 kg, ASA 1–2) following anesthesia for minor procedures were assigned randomly to side stream or mainstream sampling groups. The side stream group wore a nasal cannula with CO2 side port (NC). In the postanesthesia care unit, O2 flow was started at 5 l·min−1, reduced to 2 and then 0.25 l·min−1 every 3 min. Capnogram analysis measuring heights of all the waveforms was performed for continuous 120 s from the end of recording at each O2 flow rate for each group.

Results

Fifty-eight children were enrolled and 39 were analyzed (18 side stream NC and 21 mainstream mask). There were two mouth breathing children excluded from study in side stream NC group due to failure to capture measurable CO2 waveforms. Peak CO2 values measured by mainstream mask system were normally (Gaussian) distributed with smaller standard deviation (sd) at each O2 flow than were those measured by side stream NC system which demonstrated irregular distributions with larger sd. Peak CO2 values measurement was less affected by a change in flow rate in mainstream mask group than in side stream NC group (P = 0.04 in 5–0.25 l·min−1 O2 flow change).

Conclusion

A new mainstream mask system (cap-ONE) performed with greater precision than side stream NC monitoring regardless of mouth breathing. Measurement of peak CO2 values by mainstream mask system showed normal distribution with smaller standard deviation (sd) and was less affected by O2 flow change in predictable fashion.

Thumbnail image of graphical abstract

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Can transcutaneous near infrared spectroscopy detect severe hepatic ischemia: a juvenile porcine model

Summary

Background

Vascular complications following pediatric liver transplantation occur in 8–10% of cases, and no continuous, non-invasive monitoring for this problem exists. Near infrared spectroscopy (NIRS) allows non-invasive, continuous, transcutaneous assessment of hemoglobin oxygenation (StO2) 1–4 cm below the skin surface.

Aims

We hypothesized that transcutaneous NIRS would be able to detect severe hepatic ischemia, and tested this in an animal model using 15–20 kg and 5–7 kg juvenile pigs.

Materials and Methods

Direct liver surface and transcutaneous hepatic tissue hemoglobin oxygen saturation (StO2) were measured during occlusions of the hepatic artery and portal vein. Changes in hepatic delivery of oxygen (HepDO2) were calculated for each ischemic challenge and compared to changes in direct liver surface (DirHepStO2) and transcutaneous liver StO2 measurements (CutHepStO2).

Results

In the 15–20 kg animals during complete occlusion, CutHepStO2 decreased by 6.0(±4.9)%, whilst DirHepStO2 decreased by 83.7(±7.2)%. In the 5–7 kg animals during complete occlusion, CutHepStO2 decreased by 27.4(±8.5)%, whilst DirHepStO2 decreased by 82.8(±4.6)%.

Conclusion

Transcutaneous hepatic StO2 monitoring cannot reliably detect severe hepatic ischemia in a juvenile porcine model, although a stronger and potentially useful signal is seen in 5–7 kg pigs. Trials of this technology should be currently restricted to situations where the organ is less than 1 cm from the skin surface, corresponding to infants of <10 kg.

Thumbnail image of graphical abstract

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High-flow nasal cannula therapy and apnea time in laryngeal surgery

Summary

In small children, high-flow nasal cannula therapy may prolong apnea time even when an inspiratory oxygen fraction below 100% is used. This will be beneficial in prolonged intubation attempts, but especially during procedures requiring prolonged apnea time, leading to fewer airway manipulations and markedly enhanced surgical conditions.



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