Remote real-time supervision via tele-ultrasound in focused cardiac ultrasound: A single-blinded cluster randomized controlled trial.

BACKGROUND: Supervision via tele-ultrasound presents a remedy for lacking on-site supervision in focused cardiac ultrasound, but knowledge of its impact is largely absent. We aimed to investigate tele-supervised physicians' cine-loop quality compared to that of non-supervised physicians and compared to that of experts. METHODS: We conducted a single-blinded cluster randomized controlled trial in an emergency department in western Denmark. Physicians with basic ultrasound competence scanned admitted patients twice. The first scan was non-supervised, and the second was non-supervised (control) or tele-supervised (intervention). Finally, experts in focused cardiac ultrasound scanned the same patient. Two blinded observers graded cine-loops recorded from all scans on a 1-5 scale. The outcome was the mean summarized scan gradings compared with a linear mixed-effects model. RESULTS: In each group, 10 physicians scanned 44 patients. From the mean summarized gradings, on a scale from 4 to 20, the second non-supervised scan grading was 10.9 (95% CI 10.2-11.7), whereas the tele-supervised grading was 12.6 (95% CI: 11.8-13.3). From the first to the second scan, tele-supervised physicians moved 9% (1.09; 95% CI: 1.00-1.19; P = 0.041) closer to the experts' quality than the non-supervised physicians. CONCLUSION: Tele-supervised physicians performed scans of better quality than non-supervised physicians. The present study supports the use of tele-supervision for physicians with basic focused ultrasound competence in a setting where on-site supervision is unavailable.

Direct pathway to the brain.

Whole-body autoradiographic stuidies demonstrated that, when isotopically labeled glucose is placed in the ligated oropharynx, there is a rapid movement of the isotope directly to the intracranial cavity. This passage involves nonspecific diflision, bypassing all recognized rouctes to the brain.

Staphylococcal toxic shock syndrome.

A 28 year old male presented with fever, tachycardia, generalized lymphadenopathy and diffuse rash over the body. He failed to respond to intravenous antibiotics and developed cardiogenic shock, multiple organ failure and died within six hours after hospitalization. Staphylococcus aureus colonies were revealed on blood culture.

Rosai Dorfman syndrome with sinonasal mucosa and intraocular involvement.

A 15 year-old-male presented with concurrent sinonasal polyposis and anterior uveitis with cervical lymph node enlargement. Cervical lymph node biopsy confirmed Rosai-Dorfman disease. Though patient's eye symptoms did not respond well to topical corticosteroid treatment but he showed a remarkable regression in the size of nasal polyps and cervical lymph nodes after systemic corticosteroids. Intraocular involvement in such a case is rare.

Assessing clinical probability of pulmonary embolism: prospective validation of the simplified Geneva score.

Essentials The simplified Geneva score allows easier pretest probability assessment of pulmonary embolism (PE). We prospectively validated this score in the ADJUST-PE management outcome study. The study shows that it is safe to manage patients with suspected PE according to this score. The simplified Geneva score is now ready for use in routine clinical practice. SUMMARY: Background Pretest probability assessment by a clinical prediction rule (CPR) is an important step in the management of patients with suspected pulmonary embolism (PE). A limitation to the use of CPRs is that their constitutive variables and corresponding number of points are difficult to memorize. A simplified version of the Geneva score (i.e. attributing one point to each variable) has been proposed but never been prospectively validated. Aims Prospective validation of the simplified Geneva score (SGS) and comparison with the previous version of the Geneva score (GS). Methods In the ADJUST-PE study, which had the primary aim of validating the age-adjusted D-dimer cut-off, the SGS was prospectively used to determine the pretest probability in a subsample of 1621 study patients. Results Overall, PE was confirmed in 294 (18.1%) patients. Using the SGS, 608 (37.5%), 980 (60.5%) and 33 (2%) were classified as having a low, intermediate and high clinical probability. Corresponding prevalences of PE were 9.7%, 22.4% and 45.5%; 490 (30.1%) patients with low or intermediate probability had a D-dimer level below 500 µg L-1 and 653 (41.1%) had a negative D-dimer test according to the age-adjusted cut-off. Using the GS, the figures were 491(30.9%) and 650 (40.9%). None of the patients considered as not having PE based on a low or intermediate SGS and negative D-dimer had a recurrent thromboembolic event during the 3-month follow-up. Conclusions The use of SGS has similar efficiency and safety to the GS in excluding PE in association with the D-dimer test.

Dietary evaluation of patients with smell and/or taste disorders.

The impact of smell and taste disorders on dietary habits and nutritional status has received limited research attention. This paper reports findings obtained from questionnaires and diet records completed by 40 healthy subjects and 118 patients with chemosensory dysfunction. Chemosensory disorders were frequently associated with decreases in food acceptability. Although dietary responses to these dysfunctions varied greatly, patients with distorted or phantom smell and/or taste sensations tended to report weight loss whereas those with simple sensory loss were more likely to report weight gain. Indices derived from diet records did not indicate that either group of patients was at substantial nutritional risk, but food frequency responses and estimates of body mass index were consistent with patient reports of changes in dietary patterns and weight. In addition, marked weight change and aberrant dietary practices were noted in individual patients. Thus, there were indications that chemosensory dysfunction may be associated with nutritionally important dietary alterations.

The preference-aversion behavior of rats for nutritionally-controlled diets containing oil or fat.

The preference-aversion behavior of Sprague-Dawley rats for semi-purified diets containing various levels of either corn oil, animal fat (lard) or hydrogenated vegetable oil (Crisco) was determined in brief and long-term, two-choice preference tests. After the first day of exposure, rats selected more calories from the control-unadulterated diet than from experimental diets containing either oil or fat. Only in the first hour of exposure (with diets containing either 5% Crisco, 15 or 25% lard) or in the first day (with diets containing 5% Crisco, 5 or 15% lard) was a preference for experimental diets observed. There were significant effects of oil and fat concentration and of exposure time upon preference for experimental diets, such that preference for the experimental diets was reduced as levels of oil or fat and as the time of experiment increased. Changes in diet selection had no major effect on total caloric intake measured as the sum of both experimental and control dietary choices, although total intake on a daily basis tended to decrease during the middle portion (2-4 days) of the study, then recover by the end of the study. The results suggest that postingestional factors related to the dietary oil and fat (rather than the sensory properties of the diets) directed the long-term preference behavior of rats for semi-purified diets adulterated with various levels of either corn oil, animal fat (lard) or hydrogenated vegetable oil (Crisco).

Interaction of MSG taste with nutrition: perspectives in consummatory behavior and digestion.

Studies in the taste system of mammals indicate that monosodium glutamate (MSG) produces a unique taste sensation termed umami. As a derivative of glutamic acid, MSG is a naturally occurring nutrient in many foods; its commercial use to improve food palatability for humans is well documented. Behavioral studies with experimental animals have revealed that preference for MSG in solutions and selection of MSG-flavored diets can be explained by sensory means with no appreciable effects on preference by postingestive consequences. However, preference for umami-flavored fluids is reduced by feeding rats low-protein diets or low quality protein. MSG-flavored diets, initially unpreferred, were subsequently highly selected. However, the adulteration of diets by MSG either did not or only slightly increased food intake. In light of the significant contribution of MSG to diet taste, apparently as a signal coupled to dietary proteins, physiological studies have been initiated to reveal its role as a stimulator of the cephalic phase of pancreatic exocrine secretion. Modified sham-feeding experiments with dogs have shown that oral stimulation by MSG produced significant stimulation of both pancreatic flow and protein output in conscious dogs.

Preference of rats for food flavors and texture in nutritionally controlled semi-purified diets.

Preference for nutritionally controlled, semi-purified diets modified by the addition of potent food flavors was determined for Sprague Dawley rats using two-choice diet preference tests. Intake of each food cup was monitored after 1 hr and for each 24 hr period thereafter up to 5 days. Preference was also determined for the flavored diets prepared in three forms differing in texture: powdered, and pellets of two sizes. Rats easily detected minor amounts of the food flavors, and the tests provided a catalog of 12 preferred flavors. Exposure time to the diets altered preference for a minority of flavors; diets initially avoided in the first hour test were likely to become less aversive upon continued exposure. Whether or not a specific flavored diet was preferred, total food intake was not affected during the 5 day period monitored. Rats displayed strong preference for diets of a pelleted texture compared to the same diets in a powdered form.

Emesis in birds.

Comparative studies of emesis in the herring gull, pigeon, chicken, and cowbird were conducted, using orally administered copper sulfate and intravenously administered copper sulfate, hydergine, apomorphine, and lanatoside C. A response to every emetic was elicited from some birds. However, the individual and species differences among the birds were as great as those among mammals. Further, the response of the avian species studied did not indicate that any of them could be used to predict how a specific mammal would react. The differences in response to the emetics by the birds do not offer any simple pattern related to feeding behavior.

Gustatory sequelae of alimentary disorders.

Disorders in different regions of the alimentary tract have been associated with alterations in gustatory function. Current understanding of mechanisms underlying the taste disturbances and their impact on the physical and emotional well-being of patients is incomplete. Indeed, in most instances, present knowledge remains at a descriptive level. Accumulating evidence that profound interactions occur between the sense of taste and alimentary function poses a challenge to apply this knowledge in the clinic setting.

Adaptation of canine pancreatic enzymes to diet composition.

1. Lipase, protease and amylase activity in canine pancreatic juice were determined during the feeding of basal, high fat, high protein and high carbohydrate diets for 3-week periods.2. The level of lipase in pancreatic juice was significantly augmented by increasing the dietary intakes of fat (P < 0.05) and carbohydrate (P < 0.05) but was not affected by increasing the protein intake.3. Protease activity was highly augmented by increasing the intake of protein (P < 0.01), was less strongly augmented by increasing carbohydrate (P < 0.10), but was not affected by the level of dietary fat ingested.4. Enzyme activities in canine pancreatic juice were modified by the nature of the diet on which the animals were maintained and the response for a given enzyme may be influenced by more than one dietary constituent.

Effect of vitamin B-6 deficiency on preference for several taste solutions in the rat.

The effect of dietary-induced vitamin B-6 (B-6) deficiency on the intake of the taste solutions, sodium chloride (NaCl), sodium saccharin (NaSacc), quinine sulfate (QS), and hydrochloric acid (HCl) was studied using a 48 hour, two-bottle choice technique. The B-6 deficient group demonstrated increased preference to 1.5 X 10(-1) and 3.0 X 10(-1) M NaCl compared to control ad libitum fed and control pair-fed groups. Total fluid intake on NaCl test days was also elevated in the B-6 deficient rats. There was no significant difference in the mean preference to NaSacc, QS, or HCl among the three groups. Adrenal hypertrophy was observed in the deficient rats. There was no change in the plasma level of Na and Zn but there was a reduction in urinary Na excretion. When the deficient rats were replenished by intraperitoneal injection of pyridoxine.HCl and feeding with the control diet containing adequate B-6, the increased preference for NaCl was extinguished, suggesting that the preference alteration was reversible. Urinary Na excretion also returned to normal.

Effect of unpalatable diets, food restriction and saccharin-adulterated diet on tryptic, chymotryptic, and amylolytic activity in pancreas, intestine and feces of rats.

Growing rats were fed either 10 to 17% protein (casein) diets whose taste was changed daily by addition of aversive stimuli. Under these circumstances food intake and body weight gain were reduced compared with controls fed unadulterated diets. More amylolytic activity per gram pancreas was found in rats fed a 10% protein, aversive diet and in their pair-fed controls fed restricted amounts of an unadulterated diet compared with ad libitum controls. More amylolytic activity per gram chyme of small intestine was also found in rats fed less than ad libitum amounts of a 10% protein diet. The chymotrypsin activity in the pancreas of rats fed a 17% protein, aversive diet was greater than in that of control animals or that of the pair-fed animals. The 2- to 10-fold higher proteolytic activity found in the small intestine and especially in the large intestine and feces of rats fed the aversive diet was specifically related to the adulteration of the diet with sodium saccharin. Feeding a diet containing sodium saccharin led to lower cecal pH. Under conditions of the present experiments, changes in digestive enzyme activity are not directly related to the aversive taste of the diet.