Predictors of disease severity and outcomes in pediatric patients with croup and COVID-19 in the pediatric emergency department.

BACKGROUND: Croup caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an emerging disease, and data on the risk factors associated with disease severity are still limited. The Westley croup score (WS) is widely used to assess croup severity. The current study aimed to analyze biomarkers associated with the WS and clinical outcomes in patients with croup and coronavirus disease 2019 in the pediatric emergency department (PED). POPULATION AND METHOD: Patients diagnosed with croup caused by SARS-CoV-2 were admitted at two PEDs. Clinical data including age, WS, length of hospital stay, initial laboratory data, and treatment were analyzed. Clinical parameters were evaluated via multivariate logistic regression analysis. The best cutoff values for predicting croup severity and outcomes were identified using the receiver operating characteristic curve. RESULT: In total, 250 patients were assessed. Moreover, 128 (51.2%) patients were discharged from the PED, and 122 (48.8%) were admitted to the hospital. Mild, moderate, and severe croup accounted for 63.6% (n = 159), 32% (n = 80), and 4.4% (n = 11) of all cases, respectively. A high mean age (years), neutrophil count (%), neutrophil-to-lymphocyte ratio (NLR), ALT (U/L), procalcitonin (ng/mL), and hemoglobin (g/dL) level, and length of hospital stay (days), and a low lymphocyte count (%) and blood pH were associated with croup severity and need for intensive care. Based on the multivariate logistic regression model, the NLR remained independent factors associated with croup severity and prognosis. Further, NLR was significantly correlated with WS. The area under the receiver operating characteristic curve of NLR for predicting a WS of ≥3 was 0.895 (0.842-0.948, p < 0.001), and that for predicting ICU admission was 0.795 (0.711-0.879, p < 0.001). The best cutoff values for a WS of ≥3 and ICU admission were 1.65 and 2.06, respectively. CONCLUSION: NLR is correlated with WS and is a reliable, easy-to-use, and cheap biomarker for the early screening and prognosis of croup severity in the PED. A higher NLR may indicate severe croup and the need for further treatment. And the WS score remains reliable for estimating the severity of croup caused by SARS-CoV-2 and the risk of intensive care.

Immediate Effects of Clock-Turn Strategy on the Pattern and Performance of Narrow Turning in Persons With Parkinson Disease.

BACKGROUND AND PURPOSE: Turning difficulty is common in people with Parkinson disease (PD). The clock-turn strategy is a cognitive movement strategy to improve turning performance in people with PD despite its effects are unverified. Therefore, this study aimed to investigate the effects of the clock-turn strategy on the pattern of turning steps, turning performance, and freezing of gait during a narrow turning, and how these effects were influenced by concurrent performance of a cognitive task (dual task). METHODS: Twenty-five people with PD were randomly assigned to the clock-turn or usual-turn group. Participants performed the Timed Up and Go test with and without concurrent cognitive task during the medication OFF period. The clock-turn group performed the Timed Up and Go test using the clock-turn strategy, whereas participants in the usual-turn group performed in their usual manner. Measurements were taken during the 180° turn of the Timed Up and Go test. The pattern of turning steps was evaluated by step time variability and step time asymmetry. Turning performance was evaluated by turning time and number of turning steps. The number and duration of freezing of gait were calculated by video review. RESULTS: The clock-turn group had lower step time variability and step time asymmetry than the usual-turn group. Furthermore, the clock-turn group turned faster with fewer freezing of gait episodes than the usual-turn group. Dual task increased the step time variability and step time asymmetry in both groups but did not affect turning performance and freezing severity. DISCUSSION AND CONCLUSIONS: The clock-turn strategy reduces turning time and freezing of gait during turning, probably by lowering step time variability and asymmetry. Dual task compromises the effects of the clock-turn strategy, suggesting a competition for attentional resources.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A141).

Clinical assessment of children with renal abscesses presenting to the pediatric emergency department.

BACKGROUND: Renal abscesses are relatively uncommon in children but may result in prolonged hospital stays and life-threatening events. We undertook this study to analyze the clinical spectrum of renal abscesses in children admitted to the pediatric emergency department (ED) and to find helpful clinical characteristics that can potentially aid emergency physicians for detecting renal abscesses in children earlier. METHODS: From 2004 to 2011, we retrospectively analyzed 17 patients, aged 18 years or younger, with a definite diagnosis of renal abscess admitted to the ED. The following clinical information was studied: demographics, clinical presentation, laboratory testing, microbiology, imaging studies, treatment modalities, complications, and long-term outcomes. We analyzed these variables among other potential predisposing factors. RESULTS: During the 8-year study period, 17 patients (7 males and 10 females; mean age, 6.1 ± 4.5 years) were diagnosed with renal abscesses on the basis of ultrasonography and computed tomography findings. The 2 most common presenting symptoms were fever and flank pain (100% and 70.6%, respectively). All of the patients presented with leukocytosis and elevated C-reactive protein (CRP) levels. Organisms cultured from urine or from the abscess were identified in 11 (64.7%) patients, and Escherichia coli was the most common organism cultured. All patients were treated with broad-spectrum intravenous antibiotics with the exception of 4 children who also required additional percutaneous drainage of the abscess. CONCLUSIONS: Renal abscesses are relatively rare in children. We suggest that primary care physicians should keep this disease in mind especially when children present with triad symptoms (fever, nausea/vomiting, and flank pain), pyuria, significant leukocytosis, and elevated CRP levels. However, aggressive percutaneous drainage may not need to be routinely performed in children with renal abscesses.

Home-based virtual reality balance training and conventional balance training in Parkinson's disease: A randomized controlled trial.

BACKGROUND/PURPOSE: Virtual reality has the advantage to provide rich sensory feedbacks for training balance function. This study tested if the home-based virtual reality balance training is more effective than the conventional home balance training in improving balance, walking, and quality of life in patients with Parkinson's disease (PD). METHODS: Twenty-three patients with idiopathic PD were recruited and underwent twelve 50-minute training sessions during the 6-week training period. The experimental group (n = 11) was trained with a custom-made virtual reality balance training system, and the control group (n = 12) was trained by a licensed physical therapist. Outcomes were measured at Week 0 (pretest), Week 6 (posttest), and Week 8 (follow-up). The primary outcome was the Berg Balance Scale. The secondary outcomes included the Dynamic Gait Index, timed Up-and-Go test, Parkinson's Disease Questionnaire, and the motor score of the Unified Parkinson's Disease Rating Scale. RESULTS: The experimental and control groups were comparable at pretest. After training, both groups performed better in the Berg Balance Scale, Dynamic Gait Index, timed Up-and-Go test, and Parkinson's Disease Questionnaire at posttest and follow-up than at pretest. However, no significant differences were found between these two groups at posttest and follow-up. CONCLUSION: This study did not find any difference between the effects of the home-based virtual reality balance training and conventional home balance training. The two training options were equally effective in improving balance, walking, and quality of life among community-dwelling patients with PD.

Vanadyl species-catalyzed complementary ß-oxidative carbonylation of styrene derivatives with aldehydes.

A series of oxometallic species and metal acetylacetonates (acac) was examined as catalysts for oxidative carbonylation of styrene with benzaldehyde using t-butylhydroperoxide as the co-oxidant in warm acetonitrile. Among them, VO((acac)2 and vanadyl(IV) chloride were found to be the only catalyst class to achieve cross-coupling processes by judiciously tuning the ligand electronic attributes, leading to ß-hydroxylation- and ß-peroxidation-carbonylation of styrene, respectively, in a complementary manner. Mechanistic studies indicated that vanadyl-associated acyl radicals generated by t-butoxy radical-assisted, homolytic cleavage of the aldehyde C-H bond were involved in tandem processes with an exclusive syn diastereoselectivity in the case of ß-methylstyrene.

Multi-muscle coordination during a challenging stance.

PURPOSE: This study aimed to identify the muscle synergies during standing under various sensory contexts in healthy young adults. METHODS: Sixteen healthy young adults participated in this study. The 4-min stance task was conducted under vision (eyes open or eyes closed) and proprioception (standing on ground or narrowed blocks) manipulated contexts. Electromyography (EMG) of 8 muscles around the right side of the trunk and leg were recorded and submitted to principal component analysis (PCA) to extract the muscle synergies. Two-way ANOVA with repeated measures was employed to test the effect of sensory contexts on the muscle synergies. RESULTS: PCA extracted three muscle synergies that accounted for the variance of standing EMG, including the push-back (composed of medial gastrocnemius, vastus medialis and biceps femoris), push-forward (composed of tibialis anterior and rectus femoris) and proximal mixed (composed of rectus abdominis, rector spinae, rectus femoris and biceps femoris) synergies. Block-standing increased the contribution of the push-back synergy while decreased the contribution of the push-forward synergy. In addition, contribution of the proximal mixed synergy was higher under ground-standing with eyes open than under block-standing with eyes open. CONCLUSION: Three muscle synergies were identified during standing in healthy young adults, and the synergies were affected by proprioception but not visual disturbance. The push-back and push-forward synergies showed the opposite response to proprioceptive disturbance, which may result from their antagonism role. Whether this control regime is used for elderly adults or patient populations with movement disorder needs to be further investigated.

Roles of different forms of lipopolysaccharides in Ralstonia solanacearum pathogenesis.

Lipopolysaccharides (LPS) are critical components for the fitness of most gram-negative bacteria. Ralstonia solanacearum causes a deadly wilting disease in many crops; however, the pathogenic roles of different forms of LPS and their pathways of biogenesis remain unknown. By screening for phage-resistant mutants of R. solanacearum Pss4, whose genome sequence is unavailable, mutants with various types of structural defects in LPS were isolated. Pathogenesis assays of the mutants revealed that production of rough LPS (R-LPS), which does not contain O-polysaccharides, was sufficient to cause necrosis on Nicotiana benthamiana and induce the hypersensitive response on N. tabacum. However, biosynthesis of smooth LPS (S-LPS), which contains O-polysaccharides, was required for bacterial proliferation at infection sites on N. benthamiana leaves and for proliferation and causing wilt on tomato. Complementation tests confirmed the involvement of the previously unidentified cluster RSc2201 to RSc2204 in the formation of R. solanacearum S-LPS. With these data and the availability of the annotated genomic sequence of strain GMI1000, certain loci involved in key steps of R. solanacearum LPS biosynthesis were identified. The strategy of this work could be useful for similar studies in other bacteria without available genome sequences.

Expedient Azide-Alkyne Huisgen Cycloaddition Catalyzed by a Combination of VOSO4 with Cu(0) in Aqueous Media.

A series of vanadium(III), vanadyl(IV/V) species, inorganic metal oxides, and transition-metal oxides was examined as cocatalysts with Cu(0) powder for copper(I)-catalyzed azide-alkyne cycloaddition. Among them, vanadyl(IV) species bearing acetylacetonate, acetate, and sulfate, vanadyl(V) isopropoxide, and vanadate were suitable for the click reactions of per-acetyl and per-benzyl ß-azido glycosides with three different terminal alkynes in CH3CN. Water-soluble vanadyl(IV) sulfate was further selected for efficient click reactions for unprotected ß-glycosyl azides and even compatible with a thiol-containing substrate in aqueous media at ambient temperature.

Ralstonia solanacearum RSc0411 (lptC) is a determinant for full virulence and has a strain-specific novel function in the T3SS activity.

Previously, we have identified an avirulent Ralstonia solanacearum mutant carrying a transposon insertion in RSc0411, a gene homologous to the Escherichia coli LPS-transporting protein LptC. However, how the disruption of RSc0411 affects the bacterium-plant interactions and leads to decreased pathogenicity was not known. Here we show that the disruption of RSc0411 leads to pleiotropic defects, including reducing bacterial motility, biofilm formation, root attachment, rough-form LPS production and virulence in tomato and increasing membrane permeability. Disruption of the orthologous RSc0411 present in other R. solanacearum strains proves that most of these functions are conserved in the species. In contrast, trans-complementation analyses show that only RSc0411 orthologues from closely related bacteria can rescue the defects of the disruption mutant. These results enable us to propose a function for RSc0411, and for the clustered genes, in LPS biogenesis, and for the first time, to our knowledge, also a role of a gene from the DUF1239 gene family in bacterial pathogenicity. In addition and notably, the RSc0411 mutant displays a strain-specific phenotype for hypersensitive response (HR), in which the RSc0411 disruption impairs the HR caused by strain Pss190 but not that by strain Pss1308. Consistent with this strain-specific defect, the mutation clearly affects expression of the type III secretion system (T3SS) in Pss190 but not in other strains, suggesting that the HR-deficient phenotype of the RSc0411 mutant in Pss190 is due to impairment of the T3SS and thus RSc0411 has a strain-specific role in the T3SS activity of R. solanacearum.

Clinical factors in predicting acute renal failure caused by rhabdomyolysis in the ED.

PURPOSE: This study aimed to determine the clinical factors in predicting acute renal failure (ARF) in rhabdomyolysis and investigate the potential risk of renal replacement therapy (RRT). BASIC PROCEDURES: From 2006 to 2011, we retrospectively analyzed 202 patients 65 years or younger with a definite diagnosis of rhabdomyolysis and serum creatinine phosphokinase levels greater than 1000 IU/L. The related clinical factors were analyzed in the patients with ARF caused by rhabdomyolysis. In addition, receiver operating characteristic curves were used to establish the appropriate cutoff values of serum biomarkers in predicting ARF. MAIN FINDINGS: The most common causes of rhabdomyolysis were trauma (n = 54; 26.7%) and infections (n = 37; 18.3%). Of the 202 patients, 29 (14.4%) developed ARF, and RRT was indicated for 5 of these 29 patients. Predictive factors for ARF were dark urine, initial and peak serum myoglobin level, rhabdomyolysis caused by body temperature change, and an elevated serum potassium level. Receiver operating characteristic analysis showed that the best cutoff value of initial serum myoglobin level for predicting ARF was 597.5 ng/mL. Risk factors for RRT in patients with ARF were etiologies of rhabdomyolysis, peak blood urea nitrogen and creatinine levels, and the creatinine phosphokinase level on the third day as rhabdomyolysis developed. PRINCIPAL CONCLUSIONS: Age, dark urine, etiologies, serum levels of blood urea nitrogen, creatinine and potassium, and initial and peak serum myoglobin levels may serve as important factors in predicting ARF in patients with rhabdomyolysis. We suggest that the appropriate cutoff value of initial serum myoglobin for predicting ARF is 600 ng/mL.

Bodyweight loss in predicting neonatal hyperbilirubinemia 72 hours after birth in term newborn infants.

BACKGROUND: Severe dehydration is generally believed to be a cause of significant hyperbilirubinemia in newborn babies. This study aimed to analyze the weight loss of healthy term newborn infants at 24, 48 and 72 hours after birth to predict significant hyperbilirubinemia at 72 hours. METHODS: From January 2007 to December 2008, we conducted this retrospective chart review by measuring total bilirubin (transcutaneous and serum) in 343 healthy, term newborns with a birth body weight of more than 2500 g. We then analyzed the association between body weight loss (BWL) and significant hyperbilirubinemia (total bilirubin more than 15 mg/dL) 72 hours after birth. Receiver operating characteristic curves were used to evaluate the appropriate cutoff BWL percentages on the first three days after birth for the prediction of neonatal hyperbilirubinemia 72 hours after birth. RESULTS: A total of 115 (33.5%) neonates presented with significant hyperbilirubinemia 72 hours after birth, and the percentages of BWL on the first three days were all higher than those in the non-significant hyperbilirubinemia group (all p < 0.05). Breastfeeding was not statistically correlated with significant hyperbilirubinemia (p=0.86). To predict significant hyperbilirubinemia 72 hours after birth, receiver operating characteristic curve analysis showed that the optimum cutoff BWL percentages were 4.48% on the first day of life (sensitivity: 43%, specificity: 70%, positive likelihood ratio [LR+]: 1.43, and negative likelihood ratio [LR-]: 0.82), 7.60% on day 2 (sensitivity: 47%, specificity: 74%, LR+: 1.81, LR-: 0.72), and 8.15% on day 3 (sensitivity: 57%, specificity: 70%, LR+: 1.92, LR-: 0.61) (all p < 0.05). CONCLUSIONS: BWL on the first three days after birth may be a predisposing factor for neonatal hyperbilirubinemia, and may also serve as a helpful clinical factor to prevent significant hyperbilirubinemia 72 hours after birth. The optimal BWL cutoff percentages on the first three days after birth presented in this study may predict hyperbilirubinemia and indicate the need for supplementary feeding.

Clinical spectrum of rhabdomyolysis presented to pediatric emergency department.

BACKGROUND: Rhabdomyolysis is a potentially life-threatening syndrome that can develop from a variety of causes. The aim of the work is to analyze the clinical spectrum and to evaluate the prevalence of various etiologies in children, who present to the emergency department (ED) with rhabdomyolysis. METHODS: During a 6-year study period, we retrospectively analyzed the medical charts of patients, aged 18 years or younger, with a definite diagnosis of rhabdomyolysis and serum creatinine phosphokinase (CK) levels greater than 1000IU/L. We analyzed the clinical spectrum and evaluated the potential risk factors of acute renal failure (ARF). RESULTS: Thirty-seven patients (mean age = 10.2 ± 5.5 years), including 26 males and 11 females, were enrolled in the study. Two of the most common presented symptoms in these 37 patients were muscle pain and muscle weakness (83.8% and 73%, respectively). Dark urine was reported in only 5.4% of the patients. The leading cause of rhabdomyolysis in the 0- to 9-year age group was presumed infection, and the leading cause in the 10- to 18-year age group was trauma and exercise. The incidence of ARF associated with rhabdomyolysis was 8.1 % and no child needed for renal replacement therapy (RRT). We did not identify any reliable predictors of ARF or need for RRT. CONCLUSIONS: The classic triad of symptoms of rhabdomyolysis includes myalgia, weakness and dark urine are not always presented in children. The cause of rhabdomyolysis in younger age is different from that of teenager group. However, the prognosis of rhabdomyolysis was good with appropriate management.

Epidemiology and outcome analysis of children with traumatic out-of-hospital cardiac arrest compared to nontraumatic cardiac arrest.

PURPOSE: This study aimed to determine predictive factors for sustained return of spontaneous circulation (ROSC) in pediatric patients with traumatic out-of-hospital cardiac arrest (OHCA) and compared to those with nontraumatic OHCA. METHODS: This was a retrospective prognostic study of children with OHCA presenting to the emergency department (ED) was conducted from 2005 to 2010. Related clinical factors that influenced sustained ROSC in traumatic OHCA patients were identified and compared to nontraumatic cases. Significant parameters in predicting sustained ROSC in traumatic OHCA children were also determined using multivariate logistic regression analysis, and etiologies of the ICU admissions were analyzed in patients with sustained ROSC. RESULTS: Among 2,978 critically ill children admitted to the ED, 150 were pediatric OHCA patients, including 76 traumatic cases and 74 nontraumatic cases. Of children with OHCA, initial sustained ROSC was achieved in 51 cases (34.0 %), including 31 traumatic cases and 20 of nontraumatic cases. Head and neck injuries were the majority of traumatic cases in the traumatic OHCA children, followed by abdominal injuries and chest injuries. However, abdominal injuries accounted for the highest rate to gain sustained ROSC, while chest injuries had the lowest rate for successful sustained ROSC. Significant factors associated with sustained ROSC in traumatic OHCA included initial cardiac rhythm (P < 0.05), the period from scene to hospital (P < 0.05), and the duration of in-hospital cardiopulmonary resuscitation (CPR) (P < 0.05). CONCLUSIONS: Significant factors related to sustained ROSC have been identified as initial cardiac rhythm, duration of in-hospital CPR, and the period from scene to hospital. Head and neck injuries were the majority of traumatic cases and the prevention in head and neck trauma may play an important part in public health aspects.

Diagnosing appendicitis at different time points in children with right lower quadrant pain: comparison between Pediatric Appendicitis Score and the Alvarado score.

BACKGROUND: Acute appendicitis is the most common abdominal emergency in clinical surgery. This study was designed to compare the diagnostic value of the Pediatric Appendicitis Score (PAS) with that of the Alvarado score based on different time points in children with right lower quadrant (RLQ) abdominal pain. METHODS: This prospective cohort study comprised 1,395 children (aged 3-18 years) with RLQ abdominal pain between 2005 and 2009. The patients were scored by the pediatric emergency physicians. Receiver operating characteristic (ROC) curves were used to determine the appropriate cutoff scores of the Alvarado and PAS systems. The sensitivity and specificity, and area under ROC curve were calculated for both systems. RESULTS: The AUCs of the Alvarado system were all higher than those of the PAS system (day 1: 0.09 vs. 0.87; day 2: 0.87 vs. 0.84; day 3: 0.88 vs. 0.82). The best appropriate cutoff scores were seven (days 1 and 2) and six (day 3) on the PAS and six (days 1 and 2) and seven (day 3) on the Alvarado system. CONCLUSIONS: The preliminary data show that the best cutoff score of Alvarado and PAS systems vary with the different time points of RLQ pain presentation. It may provide helpful information for primary or emergency physicians to determine whether the patient should undergo surgical consultation.

Clinical assessment of children with first-attack seizures admitted to the ED.

PURPOSE: This study aims to evaluate clinical values and determine the function of a pediatric observation unit (POU) as an alternative to inpatient unit admission for children with newly onset seizures. BASIC PROCEDURES: Pediatric patients who were sent to the emergency department (ED) with new-onset seizure were retrospectively analyzed in a 6-year study period. All patients were divided into 3 groups: POU-discharged, unplanned inpatient admission, and required admission. Basic demographics, clinical course, biologic data, and radiologic findings were analyzed among the 3 groups. MAIN FINDINGS: From the 910 children admitted to the ED with first attack of seizure, 405 (44.5%; mean age, 2.86 ± 2.64 years) were admitted to the POU. Of them, 184 (45.4%) were later discharged. Using multivariate logistic regression analysis, patients with febrile seizure, those without elevated serum C-reactive protein level, and those who did not require first-line anticonvulsants in the ED were associated with an increased trend of POU discharge. PRINCIPAL CONCLUSIONS: The POU may be an alternative to immediate admission in selected cases of first seizures. Related information such as age, use of anticonvulsants in the ED, serum C-reactive protein value, and clinical diagnosis of febrile seizure are important factors for determining whether pediatric patients with first seizure attack should be admitted or discharged.

First-attack pediatric hypertensive crisis presenting to the pediatric emergency department.

BACKGROUND: Hypertensive crisis in children is a relatively rare condition presenting with elevated blood pressure (BP) and related symptoms, and it is potentially life-threatening. The aim of this study was to survey children with first attacks of hypertensive crisis arriving at the emergency department (ED), and to determine the related parameters that predicted the severity of hypertensive crisis in children by age group. METHODS: This was a retrospective study conducted from 2000 to 2007 in pediatric patients aged 18 years and younger with a diagnosis of hypertensive crisis at the ED. All patients were divided into four age groups (infants, preschool age, elementary school age, and adolescents), and two severity groups (hypertensive urgency and hypertensive emergency). BP levels, etiology, severity, and clinical manifestations were analyzed by age group and compared between the hypertensive emergency and hypertensive urgency groups. RESULTS: The mean systolic/diastolic BP in the hypertensive crisis patients was 161/102 mmHg. The major causes of hypertensive crisis were essential hypertension, renal disorders and endocrine/metabolic disorders. Half of all patients had a single underlying cause, and 8 had a combination of underlying causes. Headache was the most common symptom (54.5%), followed by dizziness (45.5%), nausea/vomiting (36.4%) and chest pain (29.1%). A family history of hypertension was a significant predictive factor for the older patients with hypertensive crisis. Clinical manifestations and severity showed a positive correlation with age. In contrast to diastolic BP, systolic BP showed a significant trend in the older children. CONCLUSIONS: Primary clinicians should pay attention to the pediatric patients who present with elevated blood pressure and related clinical hypertensive symptoms, especially headache, nausea/vomiting, and altered consciousness which may indicate that appropriate and immediate antihypertensive medications are necessary to prevent further damage.

Impact of Coronavirus Disease 2019 Pandemic on Pediatric Out-of-Hospital Cardiac Arrest in the Emergency Department.

Background: Out-of-hospital cardiac arrest (OHCA) in children is a critical condition with a poor prognosis. After the coronavirus disease 2019 (COVID-19) pandemic developed, the epidemiology and clinical characteristics of the pediatric emergency department (PED) visits have changed. This study aimed to analyze the impact of the COVID-19 pandemic on pediatric OHCA in the PED. Methods: From January 2018 to September 2021, we retrospectively collected data of children (18 years or younger) with a definite diagnosis of OHCA admitted to the PED. Patient data studied included demographics, pre-/in-hospital information, treatment modalities; and outcomes of interest included sustained return of spontaneous circulation (SROSC) and survival to hospital-discharge (STHD). These were analyzed and compared between the periods before and after the COVID-19 pandemic. Results: A total of 97 patients with OHCA (68 boys and 29 girls) sent to the PED were enrolled in our study. Sixty cases (61.9%) occurred in the pre-pandemic period and 37 during the pandemic. The most common age group was infants (40.2%) (p = 0.018). Asystole was the most predominant cardiac rhythm (72.2%, P = 0.048). Eighty patients (82.5%) were transferred by the emergency medical services, 62 (63.9%) gained SROSC, and 25 (25.8%) were STHD. During the COVID-19 pandemic, children with non-trauma OHCA had significantly shorter survival duration and prolonged EMS scene intervals (both p < 0.05). Conclusion: During the COVID-19 pandemic, children with OHCA had a significantly lower rate of SROSC and STHD than that in the pre-pandemic period. The COVID-19 pandemic has changed the nature of PED visits and has affected factors related to ROSC and STHD in pediatric OHCA.

Acute Effects of Static Stretching Combined with Vibration and Nonvibration Foam Rolling on the Cardiovascular Responses and Functional Fitness of Older Women with Prehypertension.

We compared the effects of three warm-up protocols (static stretching (SS), static stretching with vibration foam rolling (SS + VFR), and static stretching with nonvibration foam rolling (SS + FR) on the blood pressure and functional fitness performance in older women with prehypertension. Thirteen older women went through different protocols in separate visits, and their systolic (SBP) and diastolic (DBP) blood pressure, heart rate, mean arterial pressure, brachial pulse pressure (BPP), functional fitness test (back scratch (BS), chair-sit-and-reach, 30 s arm curl (AC), 30 s chair stand, 2 min step, 8-foot up and go), and single-leg standing balance (SLB) were recorded. The SBP and BPP were significantly higher after SS and SS + VFR than after SS + FR. Both SS + FR and SS + VFR significantly improved the 2 min step, when compared with SS. Additionally, SS + VFR significantly improved the BS and AC performance. However, compared with SS and SS + FR, SS + VFR significantly reduced the SLB performance. Therefore, SS + FR may be a better warm-up protocol for older women in maintaining blood pressure. On the other hand, even though SS + VFR induced superior shoulder flexibility, aerobic endurance, and arm strength, it could impair balance.

Acute Effects of Vibration Foam Rolling with Light and Moderate Pressure on Blood Pressure and Senior Fitness Test in Older Women.

Vibration foam rolling (VR) can improve flexibility and sports performance. However, blood pressure (BP), heart rate (HR) and senior fitness test (SFT) responses induced by an acute VR session in older women are currently unknown. Fifteen healthy women (72.90 ± 4.32 years) completed three separated randomly sequenced experimental visits. During each visit, they started with a warm-up protocol (general warm up (GW): walking + static stretching (SS), SS + VR with light pressure (VRL), or SS + VR with moderate pressure (VRM)), and completed BP, HR, SFT measurements. The systolic BP increased significantly after all three warm up protocols (p < 0.05). Both VRL and VRM protocols induced statistically significant improvements (effect size range: 0.3-1.04, p < 0.05) in the senior fitness test (back scratch, 30 s chair stand, 30 s arm curl, and 8 foot up and go), as compared to the GW. In addition, the VRM showed greater improvement for the 2 min step test when comparing with the VRL. Therefore, including VR in a warm-up protocol can result in superior SFT performance enhancement than the GW does in healthy older women.

Clinical spectrum of intra-abdominal abscesses in children admitted to the pediatric emergency department.

BACKGROUND: To analyze clinical spectrum of intra-abdominal abscesses in children and find helpful clinical parameters could aid physicians in earlier detection and differential diagnosis. METHODS: From 2004 to 2011, we retrospectively analyzed 66 pediatric patients, aged 18 years or younger with intra-abdominal abscesses. The data were obtained and studied: demographics, clinical presentations, etiologies, laboratory tests, microbiology, imaging studies, treatment modalities, complications and long-term outcomes. RESULTS: There were 66 patients (mean age, 9.27 ± 4.16 years) diagnosed as intra-abdominal abscesses. The two most common presented symptoms were fever and abdominal pain (90.9%; 78.8%, respectively). Most patients presented with leukocytosis (81.8%) and elevated C-reactive protein (CRP) levels (95.5%). In patients with abscesses in solid organs, urine white blood cell counts, nitrate and leukocyte esterase were all significant parameters (all P < 0.05), and urine pH and specific gravity were both lower than those in non-solid organs (P = 0.026; P = 0.043, respectively). Escherichia coli (E. coli) was the most common organism cultured from renal abscess. Streptococcus viridans was the most common organism cultured from liver abscess. Moreover, the two most predominant bacteria in periappendical and intraperitoneal abscesses were E. coli and Bacteroides fragilis. CONCLUSIONS: We suggest that primary physicians should keep this disease in mind when children present with predisposing risk factors, fever, abdominal pain, leukocytosis and elevated CRP level. Besides, we recommend the urinary analysis or ultrasonography (US) is valuable in patients with fever and abdominal pain.