The effect of medical clowning on reducing pain, crying, and anxiety in children aged 2-10 years old undergoing venous blood drawing--a randomized controlled study.

UNLABELLED: Recently, the utilization of medical clowns to reduce anxiety, stress, and even pain associated with hospitalization has become popular. However, the scientific basis of this benefit and outcome is scant. Venipuncture and IV cannulation are very common sources of pain in ill children. To reduce pain, one common approach is to apply a local anesthetic prior to the procedure. In the current study, we sought to compare the utilization of medical clowning in this process with two control groups: (1) local anesthetic cream (EMLA®, Astrazeneca, London, UK) applied prior to the procedure (active control) and (2) the procedure performed with neither clown nor EMLA (control group). We hypothesized that a medical clown will reduce pain, crying, and anxiety in children undergoing this procedure.Children aged 2-10 years who required either venous blood sampling or intravenous cannulation were recruited and randomly assigned to one of the three groups. Outcome measures consisted of the duration of the whole procedure (measured objectively by an independent observer), the duration of crying (measured objectively by an independent observer), subjective assessment of pain level (a commonly used validated scale), and anxiety level regarding future blood exams (by questionnaire). Analysis of variance (ANOVA) was used to compare between the groups. p < 0.05 was considered statistically significant.One hundred children participated. Mean age was 5.3 ± 2.5 years (range 2-10 years). The duration of crying was significantly lower with clown than in the control group (1.3 ± 2.0 vs 3.8 ± 5.4 min, p = 0.01). With EMLA, this duration was 2.4 ± 2.9 min. The pain magnitude as assessed by the child was significantly lower with EMLA than in the control group (2.9 ± 3.3 vs 5.3 ± 3.8, p = 0.04), while with clown it was 4.1 ± 3.5, not significant when compared with the other two modalities. Hence, duration of crying was shortest with clown while pain assessment was lowest with EMLA. Furthermore, with clown duration of cry was significantly shorter than in controls, but pain perception did not significantly differ between these groups. As expected, the duration of the entire process was shortest in the control group (5.0 ± 3.8 min), moderate with clown (19.3 ± 5.8 min), and longest with EMLA (63.2 ± 11.4 min, p < 0.0001 between all). Parental reporting of a beneficial effect was greater with clown than with EMLA (3.6 ± 0.8 vs 3.0 ± 1.1, p = 0.02). Parental assessment of child's anxiety related to future blood tests as evaluated by telephone the following day revealed that it was significantly lower with clown than in the control group or EMLA (2.6 ± 1.2 vs 3.7 ± 1.3 or 3.8 ± 1.6, p < 0.01 for both). CONCLUSIONS: Distraction by a medical clown is helpful in children undergoing blood tests or line insertion. Although pain reduction was better with EMLA, both duration of cry and anxiety were lower with a medical clown. These results strongly encourage and support the utilization of medical clowns while drawing blood in children.

Heat stress attenuates new cell generation in the hypothalamus: a role for miR-138.

The anterior hypothalamus (Ant Hyp) of the brain serves as the main regulator of numerous homeostatic functions, among them body temperature. Fine-tuning of the thermal-response set point during the critical postnatal sensory-developmental period involves neuronal network remodeling which might also be accompanied by alterations in hypothalamic cell populations. Here we demonstrate that heat stress during the critical period of thermal-control establishment interferes with generation of new cells in the chick hypothalamus. Whereas conditioning of the 3-day-old chicks under high ambient temperatures for 24h diminished the number of newborn cells in anterior hypothalamic structures 1 week after the treatment, mild heat stress did not influence the amount of new cells. Phenotypic analysis of these newborn cells indicated a predominant decrease in non-neuronal cell precursors, i.e. cells that do not express doublecortin (DCX). Furthermore, heat challenge of 10-day-old previously high-temperature-conditioned chicks abolished hypothalamic neurogenesis and significantly decreased the number of cells of non-neural origin. As a potential regulatory mechanism for the underlying generation of new cells in the hypothalamus, we investigated the role of the microRNA (miRNA) miR-138, previously reported by us to promote hypothalamic cell migration in vitro and whose levels are reduced during heat stress. Intracranial injection into the third ventricle of miR-138 led to an increase in the number of newborn cells in the Ant Hyp, an effect which might be partially mediated by inhibition of its direct target reelin. These data demonstrate the role of ambient temperature on the generation of new cells in the hypothalamus during the critical period of thermal-control establishment and highlight the long-term effect of severe heat stress on hypothalamic cell population. Moreover, miRNAs, miR-138 in particular, can regulate new cell generation in the hypothalamus.

MiR-138 promotes the migration of cultured chicken embryonic hypothalamic cells by targeting reelin.

Neuronal network remodeling during critical periods of sensory development might be accompanied by alterations in hypothalamic cell populations. MicroRNAs play a central role in regulating neuronal function, including neural stem cell proliferation, and neuronal migration, maturation and integration into viable circuits by modulating different mRNA targets. Here we investigated the role of miR-138 in cell proliferation and migration in a neuron-enriched hypothalamic cell culture prepared from chicks on embryonic day 16. Ectopic expression of miR-138 enhanced hypothalamic cell migration, but did not affect cell proliferation. As a potential mechanism for miR-138's effect on cell migration, we investigated reelin (Reln) as a direct target of miR-138. Luciferase reporter assay and Ago2-immunoprecipitation experiments confirmed direct binding of miR-138 to the Reln 3'-untranslated region. Ectopic miR-138 abolished Reln levels in hypothalamic cells and enhanced their migration, similar to Reln-antisense DNA. Furthermore, inhibition of Reln expression by miR-138 led to decreased phosphorylation level of the key component of Reln-regulated signaling cascades, Disabled 1. These findings describe miR-138 as a novel regulator of hypothalamic cell migration, acting at least in part via inhibition of Reln expression and leading to the inactivation of Reln signals.

CT colonography: data acquisition and patient preparation techniques.

The success of a virtual endoscopy is essentially dependent on the image quality of the corresponding 3-dimensional reconstructions. Before loading image data on a post-processing computer, certain prerequisites concerning the source data must be met. To carry out a CT colonography, the source data must be of good quality. High spatial resolution in all geometrical directions, continuous data acquisition without gaps, and artefact-free images are pivotal factors influencing source data. A generally applicable rule is that the size of the smallest detectable polyp is limited by the nominal slice thickness, emphasizing the ultimate importance of the initially chosen primary slice collimation. Furthermore, calculation of an endoluminal view is impossible without sufficient distension of the bowels. Thorough patient preparation that accommodates the technical circumstances for post-processing is also required for attaining a high sensitivity in polyp detection.