Participation outcomes for children with acquired brain injury: a narrative review.

AIM: To review the literature on participation outcomes used in children and adolescents with acquired brain injury (ABI) and to synthesize the available evidence on recovery trajectories in participation after ABI. METHOD: This study searched electronic databases (Medline, Cinahl, Embase and PsychInfo) from March 2011 back to the earliest available time (1966) using the following terms with brain injury (brain tumours excluded) and children: social or community or school and outcome assessment or participation. Retrieved articles were rated for methodological quality using Oxford Centre for Evidence Based Medicine criteria (CEBM). RESULTS: Sixteen articles were included for analysis. The methodological characteristics and quality of these studies varied considerably. Three studies used an explicit participation measure, nine studies featured an implicit participation measure and four used tailored participation measures. There is level 1c evidence that children and adolescents with ABI have participation restrictions at home, at school and in the community 18 months (SD = 14) after discharge. CONCLUSIONS: The available literature indicates that children and adolescents with ABI are at risk for participation restrictions. Research on recovery trajectories in participation after ABI in children is lacking. Longitudinal studies using explicit participation measures and higher quality research methodologies (quantitative, qualitative and mixed methods) are recommended.

Clostridial Gas Gangrene of the Abdominal Wall After Laparoscopic Cholecystectomy: A Case Report and Review.

Clostridial gas gangrene is a rare, yet severe, complication after laparoscopic cholecystectomy. We present a case report of a 48-year-old man with obesity, coronary artery disease, and diabetes, who developed clostridial gas gangrene of the abdominal wall after an uncomplicated laparoscopic cholecystectomy. Although the diagnosis was missed initially, successful radical surgical debridement was performed and the patient survived. Pathogenesis, symptoms, prognostic factors, and the best treatment are discussed.

Lactobacillus rhamnosus induces peripheral hyporesponsiveness in stimulated CD4+ T cells via modulation of dendritic cell function.

BACKGROUND: Although it is widely recognized that the intake of so-called probiotic microorganisms is beneficial in chronic mucosal inflammation and topical allergic disease, the immunologic details explaining how such bacteria can exert these effects remain obscure. OBJECTIVE: We determined whether Lactobacillus rhamnosus can modulate T cell responses in vitro and in vivo. DESIGN: In vitro, human monocyte-derived dendritic cells (DCs) matured in the presence of L. rhamnosus were used to instruct naive CD4+ T cells; subsequently, the T cell response was assessed with the use of CD3/CD28 and interleukin (IL) 2. Cytokine production by ex vivo-stimulated naive cells and memory T cells was measured before and after oral supplementation with L. rhamnosus in 6 healthy volunteers and 6 patients with Crohn disease. RESULTS: A decreased T cell proliferation and cytokine production, especially of IL-2, IL-4, and IL-10, was observed in CD3/CD28-stimulated T cells derived from L. rhamnosus-matured DCs. This T cell hyporesponsiveness was associated with enhanced DC-T cell interaction and normal responsiveness of T cells for IL-2. In vivo oral supplementation of L. rhamnosus for 2 wk induced a similar T cell hyporesponsiveness, including impaired ex vivo T helper subsets 1 and 2 responses without up-regulation of immunoregulatory cytokines in cohorts of both healthy volunteers and patients with Crohn disease. CONCLUSIONS: We propose that L. rhamnosus modulates DC function to induce a novel form of T cell hyporesponsiveness; this mechanism might be an explanation for the observed beneficial effects of probiotic treatment in clinical disease.

[Treatment of abdominal aortic aneurysm: is there still a place for open repair?]. / Behandeling van abdominaal aorta-aneurysma: is er nog plaats voor open herstel?

Due to lower peri-operative mortality, lower risk of complications and shorter duration of hospital stay, endovascular aneurysm repair has become preferential treatment for an infrarenal aortic aneurysm. Three randomised studies that compared endovascular repair with open repair now report follow-up data of an average of six years. The data shows a loss of peri-operative mortality advantage after two to three years. More re-interventions are performed following endovascular treatment. The predominant cause of death is due to cardiovascular events, for which optimal medical therapy is crucial. The initial mortality advantage of endovascular aneurysm repair compared to open repair is lost sooner in elderly and high-risk patients than in those patients who are relatively young and low-risk.