The Effect of Chronic Preoperative Opioid Use on Surgical Site Infections, Length of Stay, and Readmissions.

BACKGROUND: Chronic opioid use in the United States is a well-recognized public health concern with many negative downstream consequences. Few data exist regarding the use of preoperative opioids in relation to outcomes after elective colorectal surgery. OBJECTIVE: The purpose of this study was to determine if chronic opioid use before colorectal surgery is associated with a detriment in postoperative outcomes. DESIGN: This is a retrospective review of administrative data supplemented by individual chart review. SETTING: This study was conducted in a single-institution, multisurgeon, community colorectal training practice. PATIENTS: All patients undergoing elective colorectal surgery over a 3-year time frame (2011-2014) were selected. MAIN OUTCOME MEASURES: Opioid use was stratified based on total dose of morphine milligram equivalents (naive, sporadic use (>0-15 mg/day), regular use (>15-45 mg/day), and frequent use (>45 mg/day)). Primary outcomes were surgical site infections, length of hospital stay, and readmissions. RESULTS: Of the 923 patients, 23% (n = 213) were using opioids preoperatively. The preoperative opioid group contained more women (p = 0.047), underwent more open surgery (p = 0.003), had more nonmalignant indications (p = 0.013), and had a higher ASA classification (p = 0.003). Although median hospital stay was longer (4.7 days vs 4.0, p < 0.001), there was no difference in any surgical site infections (10.3% vs 7.1%, p = 0.123) or readmissions (14.2% vs 14.1%, p=0.954). Multivariable analysis identified preoperative opioid use (17.0% longer length of stay; 95% CI, 6.8%-28.2%) and ASA 3 or 4 (27.2% longer length of stay; 95% CI, 17.1-38.3) to be associated with an increase in length of stay. LIMITATIONS: Retrospectively abstracted opioid use and small numbers limit the conclusions regarding any dose-related responses on outcomes. CONCLUSIONS: Although preoperative opioid use was not associated with an increased rate of surgical site infections or readmissions, it was independently associated with an increased hospital length of stay. Innovative perioperative strategies will be necessary to eliminate these differences for patients on chronic opioids. See Video Abstract at http://links.lww.com/DCR/B280. EFECTOS DEL CONSUMO CRÓNICO DE OPIOIDES EN EL PREOPERATORIO CON RELACIÓN A LAS INFECCIONES DE LA HERIDA QUIRÚRGICA, LA DURACIÓN DE LA ESTADÍA Y LA READMISIÓN: El consumo crónico de opioides en los Estados Unidos es un problema de salud pública bien reconocido a causa de sus multiples consecuencias negativas ulteriores. Existen pocos datos sobre el consumo de opioides en el preoperatorio relacionado con los resultados consecuentes a una cirugía colorrectal electiva.El propósito es determinar si el consumo crónico de opioides antes de la cirugía colorrectal se asocia con un detrimento en los resultados postoperatorios.Revisión retrospectiva de datos administrativos complementada por la revisión de un gráfico individual.Ejercicio durante la formación de multiples residentes en cirugía colorrectal enTodos los pacientes de cirugía colorrectal electiva durante un período de 3 años (2011-2014).El uso de opioides se estratificó en función de la dosis total de equivalentes de miligramos de morfínicos (uso previo, uso esporádico [> 0-15 mg / día], uso regular (> 15-45 mg / día) y uso frecuente (> 45 mg / día)). Los resultados primarios fueron las infecciones de la herida quirúrgica, la duración de la estadía hospitalaria y la readmisión.De los 923 pacientes, el 23% (n = 213) consumían opioides antes de la operación. El grupo con opioides preoperatorios tenía más mujeres (p = 0.047), se sometió a una cirugía abierta (p = 0.003), tenía mas indicaciones no malignas (p = 0.013) y tenía una clasificación ASA más alta (p = 0.003). Aunque la mediana de la estadía hospitalaria fue más larga (4,7 días frente a 4,0; p <0,001), no hubo diferencia en ninguna infección de la herida quirúrgica (10,3% frente a 7,1%, p = 0,123) o las readmisiones (14,2% frente a 14,1%, p = 0,954). El análisis multivariable identificó que el uso de opioides preoperatorios (17.0% más larga LOS; IC 95%: 6.8%, 28.2%) y ASA 3 o 4 (27.2% más larga LOS; IC 95%: 17.1, 38.3) se asocia con un aumento en LOS.La evaluación retrospectiva poco precisa del consumo de opioides y el pequeño número de casos limitan las conclusiones sobre cualquier respuesta relacionada con la dosis - resultado.Si bien el consumo de opioides preoperatorios no se asoció con un aumento en la tasa de infecciones de la herida quirúrgica o las readmisiones, ella se asoció de forma independiente con un aumento de la LOS hospitalaria. Serán necesarias estrategias perioperatorias innovadoras para eliminar estas diferencias en los pacientes consumidores cronicos de opioides. Consulte Video Resumen en http://links.lww.com/DCR/B280.

Release of calcium ions from particulate monosodium titanates for dental mineralization applications.

PURPOSE: The calcium ion [Ca(II)] release from monosodium titanates (MST) complexed to calcium ions [Ca(II)], referred to as MST-Ca(II), was examined under varying incubation times, pH conditions, and ion equilibrium disruptions. METHODS: Sample supernatants were analyzed for Ca(II) using the QuantiChrom Calcium Assay Kit. RESULTS: No Ca(II) was detected in native MST (control) supernatants but was detected in MST-Ca(II) supernatants. At pH 7, Ca(II) release increased from 0 to 2.5 mg/dL over 3 days (P< 0.05 compared to MST control), remaining constant over the completed incubation times. At pH 5, 15 mg/dL of Ca(II) was immediately released with no further release. When the pH was modulated pH 4 to pH 9, Ca(II) concentration dropped from 25 mg/dL to ~0 mg/dL. Finally, when equilibrium was disrupted by partial replacement of the supernatant with sterile water, Ca(II) release was ongoing, reaching a cumulative total of 20 mg/dL over 35 days. CLINICAL SIGNIFICANCE: The current results suggest that particulate MST-Ca(II) complexes exhibit sustained release of calcium, and that release might be customized by conditions of pH and ionic strength. Thus, these complexes appear promising for biological applications where calcium-mediated mineralization or re-mineralization are desired.

The effects of ecology and evolutionary history on robust capuchin morphological diversity.

Recent molecular work has confirmed the long-standing morphological hypothesis that capuchins are comprised of two distinct clades, the gracile (untufted) capuchins (genus Cebus, Erxleben, 1777) and the robust (tufted) capuchins (genus Sapajus Kerr, 1792). In the past, the robust group was treated as a single, undifferentiated and cosmopolitan species, with data from all populations lumped together in morphological and ecological studies, obscuring morphological differences that might exist across this radiation. Genetic evidence suggests that the modern radiation of robust capuchins began diversifying ∼2.5 Ma, with significant subsequent geographic expansion into new habitat types. In this study we use a morphological sample of gracile and robust capuchin craniofacial and postcranial characters to examine how ecology and evolutionary history have contributed to morphological diversity within the robust capuchins. We predicted that if ecology is driving robust capuchin variation, three distinct robust morphotypes would be identified: (1) the Atlantic Forest species (Sapajus xanthosternos, S. robustus, and S. nigritus), (2) the Amazonian rainforest species (S. apella, S. cay and S. macrocephalus), and (3) the Cerrado-Caatinga species (S. libidinosus). Alternatively, if diversification time between species pairs predicts degree of morphological difference, we predicted that the recently diverged S. apella, S. macrocephalus, S. libidinosus, and S. cay would be morphologically comparable, with greater variation among the more ancient lineages of S. nigritus, S. xanthosternos, and S. robustus. Our analyses suggest that S. libidinosus has the most derived craniofacial and postcranial features, indicative of inhabiting a more terrestrial niche that includes a dependence on tool use for the extraction of imbedded foods. We also suggest that the cranial robusticity of S. macrocephalus and S. apella are indicative of recent competition with sympatric gracile capuchin species, resulting in character displacement.

Evaluation of tertiary pyridine resin for the separation of lanthanides by simulated moving-bed chromatography.

Lanthanide separation by simulated moving-bed chromatography was studied as a model system for separating lanthanide fission products and minor actinides from used nuclear fuels. The simulated moving-bed system was modeled for a tertiary pyridine anion-exchange resin supported on silica particles as the stationary phase and a mixture of methanol and 1 M nitric acid as the mobile phase. Pulse injection tests using a single packed column were used to obtain chromatographic parameters for mathematical modeling of the simulated moving-bed system. Higher concentrations of methanol improved the separation, but the chromatograms showed evidence of nonlinearity of the isotherms. The mathematical model of the simulated moving-bed process predicted a production rate of purified samarium and neodymium at 118 g solute/L resin/day and a purity of 99.5%. The optimal methanol ratio for the production rate for various product purities was determined from the model. The excellent separation of Nd and Sm suggests that the simulated moving-bed system could be applied to the separation of minor actinides such as americium and curium.

Evaluating the influence of feedback on motor skill learning and motor performance for children with developmental coordination disorder: a systematic review.

Introduction: Children with developmental coordination disorder (DCD) have difficulties with learning and performing physical tasks. It is well known that task-specific practice is effective in improving motor skills. Additional feedback during practice may function as a quality improvement mechanism and therefore enhance motor skill outcomes. Aims: To investigate the effect of different forms of feedback on motor learning and motor performance in children with DCD. Methods: A systematic review was conducted (registration CRD42020175118) to investigate the effectiveness of different types of feedback, compared to other forms of feedback, or no additional feedback, on motor learning and motor performance outcomes in children with DCD. The search was run across six electronic databases (last search January 2024). Two reviewers independently screened studies for inclusion, assessed the quality of included studies, and extracted relevant data. A narrative synthesis was performed and included studies that assessed motor learning and/or performance outcomes following an intervention that delivered a specific form of feedback in comparison to another form of feedback or no specific feedback. Results: 14 articles from 13 trials were included in this review. Feedback was delivered by providing various forms of feedback, including: knowledge of results, focus of attention and augmented feedback delivered via technology. No significant differences were found between different forms of feedback for motor learning or performance outcomes for children with DCD. Interventions that used technology (with augmented feedback) to deliver the intervention were found to be as effective as traditional therapy. All groups who participated in therapy, regardless of the presence or type of feedback received, improved in overall scores on a motor performance outcome assessment. Conclusion: Despite the clear rationale for using feedback-oriented interventions for children with DCD, there is surprisingly limited and low-quality research. There is no clear evidence that one form of feedback is more effective than another, although it appears that feedback delivered via technology may be as effective as feedback delivered in traditional therapy interventions for children with DCD. Further exploration is required from appropriately powered and well-designed trials. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=175118, identifier (CRD42020175118).

The impact of location and number of cores on the diagnostic accuracy of renal mass biopsy: an ex vivo study.

OBJECTIVE: To evaluate whether renal mass biopsy (RMB) biopsy location or number affected diagnostic accuracy in a prospective ex vivo study. METHODS: Three cores (1 central and 2 peripheral) were obtained for histologic processing from each of 48 renal masses after nephrectomy. Individual biopsy cores were evaluated independently for tumor subtype and grade by a single, blinded GU pathologist. RESULTS: Although individual biopsy cores were informative and confirmed accurate in only 59 % of samples, accuracy increased to 85 % with three-core biopsy (p < 0.01). Cancer identification with a single peripheral core increased to 77 % by adding a central core (p = 0.005), to 80 % with a second peripheral core (p = 0.008), and to 85 % with three cores (p = 0.001). Similarly, diagnostic yield for histologic subtyping increased from 44 % for 1-core biopsy to 59-63 % with 2-core biopsy (p = 0.03) and to 67 % with 3-core biopsy (p = 0.02). The correct subtype was confirmed at nephrectomy for 63 % of clear cell RCC, 60 % of papillary RCC, 100 % of chromophobe RCC and 75 % of oncocytomas. When recorded, nuclear grade corresponded to final grade assignment in 56 % and was within 1 grade in an additional 37 %. CONCLUSIONS: RMB has not been used routinely in the evaluation of renal cortical neoplasms because of reportedly high rates of indeterminate or inaccurate diagnoses. In this prospective, ex vivo study, single-core RMB results in a low diagnostic yield. Obtaining multiple cores significantly improved diagnostic yield, with similar results with two-core and three-core RMB. We therefore recommend that RMB for suspicion of cancer include at least two peripheral cores.

Separation of americium from curium by oxidation and ion exchange.

Nuclear energy has the potential to be a clean alternative to fossil fuels, but in order for it to play a major role in the US, many questions about the back end of the fuel cycle must be addressed. One of these questions is the difficult separation of americium from curium. Here, we report the oxidation of Am in two systems, perchloric acid and nitric acid and the affect of changing the acid has on the oxidation. K(d) values were observed and a direct separation factor was calculated and was seen to be as high as 20 for four metal(IV) pillared phosphate phosphonate inorganic organic hybrid ion exchange materials. These ion exchangers are characterized by very low selectivity for cations with low charge but extremely high uptake of ions of high charge.

Investigating the effects of varying the angle of application and increasing the ignition source flow rate during ISO ignitability testing on foam and vinyl.

To investigate how, and to what extent, the following factors influence burn damage: (1) the angle of application of the ignition source to the sample surface, and (2) the flow rate for the ignition source, when assessing samples in accordance with ISO 8191-2:1988. Varying the ignition source flow rate and the angle of application of the ignition source to the sample undergoing testing, which are both variations on the existing procedure outlined in the Standard ISO 8191-2:1988. Burn damage as measured by the depth (if applicable) and greatest horizontal and vertical dimensions. Increasing the ignition source gas flow rate (from 45 ml/min to 240 ml/min) increased the measured burn damage for both foam and vinyl samples. The increased damage factor was at least two-fold (and up to five-fold). Changing the angle of application of the ignition source (45 degrees compared to 0 degrees) did not significantly affect the measured burn damage for either sample. These findings indicate that the direction of application of a match-flame equivalent ignition source has no significant affect on the resulting burn damage, but that increasing the ignition source flow rate increases the burn damage for both foam and vinyl samples.

Development and Co-design of NeuroOrb: A Novel "Serious Gaming" System Targeting Cognitive Impairment in Parkinson's Disease.

Whilst Parkinson's disease (PD) is typically thought of as a motor disease, a significant number of individuals also experience cognitive impairment (CI), ranging from mild-CI to dementia. One technique that may prove effective in delaying the onset of CI in PD is cognitive training (CT); however, evidence to date is variable. This may be due to the implementation of CT in this population, with the motor impairments of PD potentially hampering the ability to use standard equipment, such as pen-and-paper or a computer mouse. This may, in turn, promote negative attitudes toward the CT paradigm, which may correlate with poorer outcomes. Consequently, optimizing a system for the delivery of CT in the PD population may improve the accessibility of and engagement with the CT paradigm, subsequently leading to better outcomes. To achieve this, the NeuroOrb Gaming System was designed, coupling a novel accessible controller, specifically developed for use with people with motor impairments, with a "Serious Games" software suite, custom-designed to target the cognitive domains typically affected in PD. The aim of the current study was to evaluate the usability of the NeuroOrb through a reiterative co-design process, in order to optimize the system for future use in clinical trials of CT in individuals with PD. Individuals with PD (n = 13; mean age = 68.15 years; mean disease duration = 8 years) were recruited from the community and participated in three co-design loops. After implementation of key stakeholder feedback to make significant modifications to the system, system usability was improved and participant attitudes toward the NeuroOrb were very positive. Taken together, this provides rationale for moving forward with a future clinical trial investigating the utility of the NeuroOrb as a tool to deliver CT in PD.

Optimizing Cognitive Training for the Treatment of Cognitive Dysfunction in Parkinson's Disease: Current Limitations and Future Directions.

Cognitive dysfunction, primarily involving impairments in executive function, visuospatial function and memory, is one of the most common non-motor symptoms of Parkinson's disease (PD). Currently, the only pharmacological treatments available for the treatment of cognitive dysfunction in PD provide variable benefit, making the search for potential non-pharmacological therapies to improve cognitive function of significant interest. One such therapeutic strategy may be cognitive training (CT), which involves the repetition of standardized tasks with the aim of improving specific aspects of cognition. Several studies have examined the effects of CT in individuals with PD and have shown benefits in a variety of cognitive domains, but the widespread use of CT in these individuals may be limited by motor impairments and other concerns in study design. Here, we discuss the current state of the literature on the use of CT for PD and propose recommendations for future implementation. We also explore the potential use of more recent integrative, adaptive and assistive technologies, such as virtual reality, which may optimize the delivery of CT in PD.

Preliminary Analysis of a Wireless and Wearable Electronic-Textile EASI-Based Electrocardiogram.

Background: With cardiovascular disease continuing to be the leading cause of death and the primary reason for hospitalization worldwide, there is an increased burden on healthcare facilities. Electronic-textile (e-textile)-based cardiac monitoring offers a viable option to allow cardiac rehabilitation programs to be conducted outside of the hospital. Objectives: This study aimed to determine whether signals produced by an e-textile ECG monitor with textile electrodes in an EASI configuration are of sufficient quality to be used for cardiac monitoring. Specific objectives were to investigate the effect of the textile electrode characteristics, placement, and condition on signal quality, and finally to compare results to a reference ECG obtained from a current clinical standard the Holter monitor. Methods: ECGs during different body movements (yawning, deep-breathing, coughing, sideways, and up movement) and activities of daily living (sitting, sitting/standing from a chair, and climbing stairs) were collected from a baseline standard of normal healthy adult male using a novel e-textile ECG and a reference Holter monitor. Each movement or activity was recorded for 5 min with 2-min intervals between each recording. Three different textile area electrodes (40, 60, and 70 mm2) and electrode thicknesses (3, 5, and 10 mm) were considered in the experiment. The effect of electrode placement within the EASI configuration was also studied. Different signal quality parameters, including signal to noise ratio, approximate entropy, baseline power signal quality index, and QRS duration and QT intervals, were used to evaluate the accuracy and reliability of the textile-based ECG monitor. Results: The overall signal quality from the 70 mm2 textile electrodes was higher compared to the smaller area electrodes. Results showed that the ECGs from 3 and 5 mm textile electrodes showed good quality. Regarding location, placing the "A" and "I" electrodes on the left and right anterior axillary points, respectively, showed higher signal quality compared to the standard EASI electrode placement. Wet textile electrodes showed better signal quality compared to their dry counterparts. When compared to the traditional Holter monitor, there was no significant difference in signal quality, which indicated textile monitoring was as good as current clinical standards (non-inferior). Conclusion: The e-textile EASI ECG monitor could be a viable option for real-time monitoring of cardiac activities. A clinical trial in a larger sample is recommended to validate the results in a clinical population.

Severe paediatric systemic lupus erythematosus nephritis--a single-centre experience.

BACKGROUND: Paediatric patients with systemic lupus erythematosus (SLE) often have severe presentations including lupus nephritis (LN). Few paediatric studies have evaluated the anticardiolipin antibody (aCL) and renal histology. The purpose of this study was to evaluate clinicopathologic features, including aCL, short-term clinical and renal histologic outcomes of paediatric patients with new-onset SLE nephritis. METHODS: We conducted a single centre, retrospective inception cohort study. Charts were reviewed at presentation (initial renal biopsy), 6-month (follow-up biopsy) and 12-month follow-up. RESULTS: The population consisted of 21 patients (median age, 14.5 years): 19/21 were female, 6/21 African American, 3/21 Asian, 9/21 Caucasian and 3/21 Hispanic. At presentation, 19/21 had elevated aCL, 15/21 hypertensive, 12/21 nephrotic and 7/21 required haemodialysis (HD)-2/7 HD patients had thrombotic microangiopathy, 1/7 crescentic glomerulonephritis. Two patients had thromboembolism: both had aCL, were taking oral contraceptives and required HD, one was nephrotic and the other had elevated lupus anticoagulant. Initial biopsies revealed 6/21 ISN/RPS class II nephritis, 3/21 class III, 7/21 class IV and 5/21 class V. Treatment consisted of methylprednisolone, corticosteroids, cyclophosphamide or mycophenolate mofetil. Follow-up biopsies revealed 12/13 to have improved histology. Indication for a follow-up biopsy was severe illness at presentation. At 12-month follow-up, no patients were nephrotic (P < 0.001) or required HD (P < 0.001), and 3/14 had elevated aCL (P < 0.001). CONCLUSION: Elevated aCL, hypertension, nephrotic syndrome and need for HD were common presentations among our paediatric SLE nephritis population. Renal histology and aCL were helpful in the therapeutic management.

Rasburicase improves hyperuricemia in infants with acute kidney injury.

Recent data suggest that elevated levels of uric acid (UA) might contribute to the progression of renal disease. Rasburicase, recombinant urate oxidase, is a highly safe and efficacious hypo-uricosuric agent for treatment of elevated UA levels from tumor lysis. We adopted the use of rasburicase for management of hyperuricemia in infants with acute kidney injury (AKI) and, herein, report our experience. We conducted a retrospective chart review of infants with hyperuricemia (UA > 8 mg/dl) secondary to AKI (serum creatinine > 1.5 mg/dl) treated with rasburicase. Seven infants (mean age 34 +/- 55 days, six male), with a mean weight of 3.2 +/- 1.2 kg, were identified. Rasburicase was administered intravenously as a single, onetime, bolus of 0.17 +/- 0.04 mg/kg body weight. Within 24 h, serum UA had decreased from 13.6 +/- 4.5 mg/dl to 0.9 +/- 0.6 mg/dl (P < 0.05), creatinine had decreased from 3.2 +/- 2.0 mg/dl to 2.0 +/- 1.2 mg/dl (P < 0.05), and urinary output had increased from 2.4 +/- 1.2 ml/kg per hour to 5.9 +/- 1.8 ml/kg per hour (P < 0.05). Continued improvements in UA, creatinine, and urinary output were observed in the week following administration of rasburicase, without rebound of the UA. We observed no treatment-related side effects. All patients demonstrated a normalization of uric acid level without need of renal replacement therapy. In conclusion, a single intravenously administered bolus of rasburicase appears to be a novel treatment for hyperuricemia in infants with AKI.

Megestrol acetate improves weight gain in pediatric patients with chronic kidney disease.

OBJECTIVE: Megestrol acetate (MA) has been used to treat weight loss in pediatric patients with malignancies, cystic fibrosis and HIV/AIDS. We herein report our experience with MA in pediatric patients with chronic kidney disease (CKD). DESIGN: We conducted a retrospective cohort study. Charts were evaluated for clinical, treatment, and laboratory data at six time points: approximately 6 months prior to initiation of MA, at initiation and cessation of MA, and at 2-, 4-, and 8-month follow-up. Anthropometric measurements were corrected for age and sex by conversion to z scores. SETTING: Division of Pediatric Nephrology, Helen DeVos Children's Hospital, Grand Rapids, MI. PATIENTS: Pediatric patients (n = 25) with CKD and poor weight gain. INTERVENTION: Patients were administered MA at initial and tapered doses of 14.4 ± 8.1 mg/kg/d and 10.1 ± 6.5 mg/kg/d, respectively, for 5.4 ± 6.3 months. RESULTS: The study population (n = 25) was 60% male, 16% African American, 72% white, and 12% Hispanic with a mean ± SD age of 8.9 ± 5.4 years. Prior to MA therapy, patients demonstrated a decrease in BMI and poor weight gain. The treatment phase was associated with significant increases in BMI (P < .0001) and weight (P < .0001), which were well sustained at 8-month follow-up (P < 0.01 and P < 0.001, respectively). Patients demonstrated continued increases in height. A single patient exhibited physical adverse side effects (cushingoid features) associated with MA; otherwise, MA was well tolerated. CONCLUSIONS: MA appears to effectively improve weight gain in pediatric CKD patients with minimal adverse side effects and may therefore serve as a safe, short-term, nutritional strategy.

Nutritional management of hyperkalemic infants with chronic kidney disease, using adult renal formulas.

OBJECTIVE: This study sought to evaluate the use of adult renal formulas in hyperkalemic infants with chronic kidney disease (CKD). DESIGN: This was a retrospective, single-center cohort study. SETTING: This study took place at the Department of Pediatric Nephrology, Dialysis, and Transplantation at Helen DeVos Children's Hospital (Grand Rapids, MI). PATIENTS: Seven hyperkalemic infants (mean age, 6.9 months) comprised the study population: 29% with stage 3 CKD, 29% with stage 4 CKD, and 42% with stage 5 CKD. INTERVENTION: Infants were empirically treated with adult renal formulas for an average duration of 9.6 months. Six of seven infants were started on breast milk or infant formula (Similac PM 60/40, Abbott Laboratories, Columbus, OH), but because of inadequate growth and hyperkalemia, were transitioned to adult renal formulas (Suplena, Abbott Laboratories, Columbus, OH; Nepro, Abbott Laboratories, Columbus, OH; and/or Renalcal, Nestle Nutrition, Minnetonka, MN). One infant received adult renal formula at birth. MAIN OUTCOME MEASURES: The outcome measures included amount of potassium delivered by infant and adult renal formulas, level of serum potassium, and anthropometric measurements adjusted for age and gender (z-scores). RESULTS: The transition from infant to adult renal formula resulted in a decrease in mean amount of potassium delivered by formula (from 2.6 to 1.0 mEq/kg/day, P < .001) and a decrease in mean serum potassium (from 5.1 to 4.0 mmol/L, P < .01). During treatment with adult renal formula, the infants demonstrated a significant increase in mean weight z-score (from -1.0 to 0.5, P < .01), height z-score (from -1.9 to -0.5, P < .01), and head-circumference z-score (from -1.5 to -1.0, P=.03). Adult renal formulas were well-tolerated. CONCLUSIONS: Hyperkalemic infants with CKD can be nutritionally managed on adult renal formula.

Titanates deliver metal ions to human monocytes.

Amorphous peroxotitantes (APT) are insoluble titanium-based particles that bind a variety of metal compounds with high affinity; these particles could be sequestered locally in a solid phase to deliver metal-based drugs. Previous studies have confirmed the 'biodelivery' of metals from metal-APT complexes to fibroblasts, but not monocytes. Our goal in the current study was to use monocytic cytokine secretion to assess delivery of gold or platinum-based compounds from APT to human THP1 monocytes. Cytokine secretion was not triggered by APT alone or metal-APT complexes. In monocytes activated by lipopolysaccharide (LPS), APT alone enhanced or suppressed IL1beta or IL6 secretion, yet TNFalpha secretion was unaffected. Complexes of APT and Au(III) or cis-platin altered LPS-activated IL6 or IL1beta secretion most, TNFalpha least. Our results suggest that the APT deliver metals to monocytes.

Volatility of elevated serum ferritin in anemic hemodialysis patients.

BACKGROUND: Value of serum ferritin (SF) as an iron store index in hemodialysis (HD) patients has been questioned, especially at ranges >or=200. The objective of this study was to determine the variability of SF in patients with high SF (500-1,200.) and low TSAT (or=18 years, HD >or=90 days, SF 500-1,200., TSAT or=22,500 IU/week or >or=225 IU/kg/week and or=100., >or=200. and >or=300. were 61.0%, 29.3% and 12.2%, respectively, and 27% exhibited positive changes in SF. CONCLUSIONS: SF is a volatile and imprecise indicator of tissue iron stores in anemic HD patients with high SF and low TSAT. This volatility limits clinical utility of SF in this population.

Renovascular hypertension and intrarenal artery aneurysms in a preschool child.

Renovascular hypertension from renal artery aneurysmal formation is a rare complication of fibromuscular dysplasia. Few data exist to direct the management of intrarenal artery aneurysms in pediatric patients. We report the presentation, diagnosis and management of renovascular hypertension and intrarenal aneurysmal disease in a preschool child.

Developing a national research and development centre in assistive technologies for independent living.

Assistive technology (AT) plays a pivotal role in the lives of people who require assistance with one or more aspects of daily living. Ranging from simple devices such as an augmented fork to complex devices like a power wheelchair with integrated environmental control, AT is a broad term to describe a range of products and services that provide assistance. Historically used in the "disability sector", in recent years AT devices have merged into the ageing sector as more Australians develop an impairment through "age-related disability", creating a larger market for equipment that provides independence or restores lost/reduced functionality. Despite the national focus on ageing, Australia lacks a nationally coordinated and cohesive AT sector - most AT equipment and devices are imported and the sector struggles for local research, development, and commercialisation funding. In an attempt to address this issue, a network of rehabilitation engineering and AT centres, universities, and industry players formed a collaboration to submit a Cooperative Research Centre (CRC) proposal to drive Australian AT products and services. The main focus was on developing Australian capacity within the sector and creating innovative products that met Australian needs, leading to import replacement. A secondary focus was on providing a national education program to provide ongoing AT training and development across multiple disciplines associated with both disability and ageing.

Electronic textile-based electrocardiogram monitoring in cardiac patients: a scoping review.

OBJECTIVE: The objectives of this scoping review were to explore, organize and present the existing research literature on the use of electronic textile (e-textile)-based resting, signal-averaged, ambulatory or exercise electrocardiogram (ECG) monitoring to evaluate the application of e-textile technologies for ECG cardiac monitoring. INTRODUCTION: E-textile-based ECG monitoring of cardiac patients offers a possible new alternative for in-hospital monitoring and post-discharge monitoring during cardiac rehabilitation. INCLUSION CRITERIA: Studies that included patients (inpatients or outpatients) who qualified for cardiac rehabilitation programs or continuous ambulatory ECG monitoring were considered. The key concepts that were addressed included resting, signal-averaged, ambulatory or exercise ECG monitoring based on e-textile technologies or e-textile-based cardiac rehabilitation. Studies were excluded if they focused only on specific aspects of the e-textile ECG system rather than a complete ECG system. METHODS: Research reports, dissertations or books that evaluated e-textile-based ECG monitoring of cardiac patients in a hospital or at home, written in English, and published between January 2000 and March 2018 were considered for inclusion. Published and unpublished literature was located through databases including Ovid Medical Literature Analysis and Retrieval System Online (MEDLINE), PubMed Central (PMC), Institute of Electrical and Electronics Engineers (IEEE Xplore), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Database of Systematic Reviews, Web of Science, Scopus, Expanded Academic ASAP, ProQuest Dissertations and Theses Global, SPORTDiscus, and ENGINE-Australian Engineering Database (Informit). Two independent reviewers screened citations for inclusion while the third reviewer resolved any discrepancies. Meta-data from each study were extracted, and a narrative summary was used to present the results. Furthermore, 38 study authors were contacted to request missing or additional data as required, with 16 responding within eight weeks. RESULTS: Of the 207 studies that were eligible for full-text review, only 8% (n = 17) were included in the final study. Eighty-eight percent (n = 15) of included studies were conducted with an adult population, and 11 studies reported an in-hospital application. Only three groups of researchers reported e-textile integration beyond the textile electrodes, mostly in the form of wiring and custom-made printed circuit boards. Eight studies utilized two ECG sensors, while single-lead ECG was the most common configuration, used in 10 studies. ECG result was the primary parameter reported across the included studies. Resting ECG was the most common form of ECG acquired (n = 10), followed by exercise ECG (n = 6) and ambulatory ECG (n = 5). Eight studies addressed the issue of power requirements, and seven studies used Bluetooth for wireless communication. The primary problem reported across all studies was noise from motion artifact. CONCLUSIONS: The recent advances in signal quality and noise reduction for e-textile-based ECG applications are promising. However, the use of a 12-lead, personalized, home-based cardiac rehabilitation monitor system containing fully textile-integrated electronics with diagnostic capability is yet to be reported. Therefore, there is potential for future research in this area. Additionally, motion artifact continues to be a challenge.