Algorithmic Prediction of Restraint and Seclusion in an Inpatient Child and Adolescent Psychiatric Population.

BACKGROUND: Restraint and seclusion in an inpatient child and adolescent psychiatric population adversely affects the overall value and safety of care. Due to adverse events, negative outcomes, and associated costs, inpatient psychiatric hospitals must strive to reduce and ultimately eliminate restraint and seclusion with innovative, data-driven approaches. AIM: To identify patterns of client characteristics that are associated with restraint and seclusion in an inpatient child and adolescent psychiatric population. METHOD: A machine learning application of fast-and-frugal tree modeling was used to analyze the sample. RESULTS: The need for restraint and seclusion were correctly predicted for 73% of clients at risk (sensitivity), and 76% of clients were correctly predicted as negative or low risk (specificity), for needing restraint and seclusion based on the following characteristics: having a disruptive mood dysregulation disorder and/or attention-deficit hyperactivity disorder diagnosis, being 12 years old or younger, and not having a depressive and/or bipolar disorder diagnosis. CONCLUSIONS: The client characteristics identified in the predictive algorithm should be reviewed on admission to recognize clients at risk for restraint and seclusion. For those at risk, interventions should be developed into an individualized client treatment plan to facilitate a proactive approach in preventing behavioral emergencies requiring restraint and seclusion.

Prospective longitudinal decline in cognitive-communication skills following treatment for childhood brain tumor.

BACKGROUND: The effect of childhood brain tumor and its treatments on the developing brain are recognized to cause late-occurring structural and functional changes, inclusive of neurocognitive and communication disturbances. AIMS: The aim of the present study was to investigate changes in function in the prospective cognitive-communication and language abilities of two children surviving childhood brain tumor (CBT) over a 12-month period post-treatment. METHODS: The comprehensive language and cognitive-communication abilities of two cases (male aged 7;8-8;8, female aged 10;9-11;9) were assessed at two timepoints over a 12-month period: six months and 18 months following completion of CBT cancer treatment. RESULTS: Findings revealed a sharp decline in problem solving abilities over a 12-month period in the early stages of recovery from CBT in both cases examined, despite no or mild-moderate deficits in cognitive-communication or language function at initial assessment. Pre-literacy skills were noted to deteriorate on one task for one child, despite intact abilities at first assessment. CONCLUSIONS: The findings of progressive deterioration of cognitive-communication skills in both children treated for CBT highlights a clear need for ongoing surveillance and full comprehensive assessment across development. The critical need for ongoing management after discharge and implementation of early intervention throughout development is highlighted.

Toward understanding the role of cartilage particulates in synovial inflammation.

OBJECTIVE: Arthroscopy with lavage and synovectomy can remove tissue debris from the joint space and the synovial lining to provide pain relief to patients with osteoarthritis (OA). Here, we developed an in vitro model to study the interaction of cartilage wear particles with fibroblast-like synoviocytes (FLS) to better understand the interplay of cartilage particulates with cytokines on cells of the synovium. METHOD: In this study sub-10 µm cartilage particles or 1 µm latex particles were co-cultured with FLS ±10 ng/mL interleukin-1α (IL-1α) or tumor necrosis factor-α (TNF-α). Samples were analyzed for DNA, glycosaminoglycan (GAG), and collagen, and media samples were analyzed for media GAG, nitric oxide (NO) and prostaglandin-E2 (PGE2). The nature of the physical interaction between the particles and FLS was determined by microscopy. RESULTS: Both latex and cartilage particles could be phagocytosed by FLS. Cartilage particles were internalized and attached to the surface of both dense monolayers and individual cells. Co-culture of FLS with cartilage particulates resulted in a significant increase in cell sheet DNA and collagen content as well as NO and PGE2 synthesis compared to control and latex treated groups. CONCLUSION: The proliferative response of FLS to cartilage wear particles resulted in an overall increase in extracellular matrix (ECM) content, analogous to the thickening of the synovial lining observed in OA patients. Understanding how cartilage particles interface with the synovium may provide insight into how this interaction contributes to OA progression and may guide the role of lavage and synovectomy for degenerative disease.

Dermatology Medical Education: A Multicenter Survey Study of the Undergraduate Perspective of the Dermatology Clinical Clerkship.

BACKGROUND/AIMS: Limited data are available regarding the undergraduate dermatology clinical clerkship curriculum in the United States. Our primaryaim is to assess medical students' perspectives of the dermatology clinical clerkship. METHODS: A multicenter survey study was conducted, which included four California dermatology academic programs. A 17-item questionnaire was designed to investigate medical student perception with regard tothe overall educational value of the various teaching aspects of the dermatology clinical clerkship. RESULTS: A total of 152 medical student surveys were completed. Over half of the medical students felt proficient in diagnosing the most commondermatologic conditions. Eighty-seven percent of medical students were very satisfied with the dermatology clerkship. Ninety-one percent of students felt the length of the clerkship was appropriate. CONCLUSIONS: The vast majority of medical students reported a high level of proficiency in the treatment and diagnosis of common skin disorders. In contrast, our findings suggest that medical students may not begaining sufficient hands-on experience in conducting certain dermatologic procedures following the dermatology clerkship. Overall, medical studentperception of the dermatology clinical clerkship was mostly positive.

Language and executive function skills as predictors of semantic fluency performance in pre-school children.

Purpose: To explore how language and executive function skills of pre-school-aged children contribute to semantic fluency (a form of verbal fluency) performance. This study investigated effect of age and contribution of vocabulary and executive function on qualitative aspects of the semantic fluency task.Method: Forty typically developing Australian-English-speaking pre-school children, aged 4;0-5;11 (mean age = 55.5 months, SD = 5.21) participated. Eight assessment tasks were presented in random order examining semantic fluency, vocabulary knowledge and executive function. Hierarchical multiple regression analyses determined the extent to which measures of executive function and vocabulary accounted for fluency (number of words correctly produced) and qualitative aspects of the semantic fluency task (number of clusters, number of clustered words, number of switches).Result: While executive function and vocabulary were positively correlated with fluency and all qualitative measures of semantic fluency performance, they were not significant predictors of any aspect of task performance. Age and vocabulary were the only significant predictors of fluency, number of words clustered, and number of switches. Performance on these tasks was strongly related to vocabulary and automated retrieval processes.Conclusion: Pre-school children do not predominantly rely on executive function during semantic fluency. The influence that vocabulary has on semantic fluency task performance outweighs that accounted for by age.

Communication and swallowing management in childhood brain tumour or leukaemia: A survey of health professionals and consumers.

Purpose: Brain tumour and leukaemia represent the most common childhood cancers and can result in communication and swallowing difficulties. The purpose of this study was to survey health professionals and consumers regarding the management of communication and swallowing difficulties in children with brain tumour or leukaemia (CBTL).Method: In this study participants completed a survey focussing on (1) communication and swallowing assessment and intervention, (2) multidisciplinary team (MDT) practices and (3) risk factors. Quantitative data were reported using descriptive statistics. Qualitative data were analysed using NVivo12 Qualitative Data Analysis Software.Result: Twenty-four participants were included (22 health professionals; two consumers). Most participants (≥80%) agreed that comprehensive and regular communication and swallowing assessments improved outcomes. Communication and swallowing interventions were reported to improve outcomes by 96% of participants. MDT care was considered essential in improving outcomes. Speech-language pathologists were the primary health professional identified in communication management; additional multidisciplinary health professionals were highlighted in swallowing management. Risk factors were identified across three categories: cancer-related, treatment-related and child-factors.Conclusion: This study collates the expertise and experience of multidisciplinary health professionals and consumers which can be used to guide assessment and intervention for communication and swallowing in CBTL. It also provides perspectives on MDT care and consideration of patient values and risk factors.

Poloxamer 407 as a solubilising agent for tolfenamic acid and as a base for a gel formulation.

A solubility phase study was carried out to investigate the ability of Poloxamer 407 (P407) to solubilise tolfenamic acid. P407 considerably enhanced the solubility of this anti-inflammatory agent, by increasing its concentration in aqueous solution at least 2000-fold (up to C=4mM), when present at 12% (w/w) at 25 degrees C. The solubilisation process was spontaneous and exothermic, as indicated by thermodynamic parameters. A mixture experimental design was used to investigate the physical and release properties of P407-based gel formulations. The experimental design allowed verifying that drug release, occurring through a Fickian diffusion mechanism, was independent of the bulk viscosity of the system. The sustained release of tolfenamic acid towards the receptor phase constituted by isopropyl myristate was accompanied, in its early stage, by the concomitant release of ethanol and tetrahydrofurfuryl alcohol (THFA) used as cosolvents to obtain a drug loading of 0.6% (w/w). The poloxamer micellar phase was directly involved in the late stage of drug release, thus indicating that a strong interaction occurred in the gel between the poloxamer and tolfenamic acid. Results point out the possibility of both the systemic and topical administration of tolfenamic acid by means of aqueous solutions or gels containing P407 at an adequate concentration.

A unique intron-containing hsp70 gene induced by heat shock and during sporulation in the aquatic fungus Blastocladiella emersonii.

We have isolated and characterized cDNA and genomic DNA clones encoding the 70-kDa heat-shock protein (Hsp70) from the aquatic fungus Blastocladiella emersonii (Be). Nucleotide (nt) sequence analysis predicts an acidic protein containing 650 amino acids, with a calculated molecular mass of 70.8 kDa. The Be hsp70 gene is induced by heat shock (HS), as well as during sporulation of the fungus, and its coding region is interrupted by a single intron. All the evidence seems to indicate that this is the only hsp70 in Be. S1 nuclease protection assays revealed that splicing of the hsp70 intron is highly thermoresistant; at the lethal temperature of 42 degrees C, only 30% of the hsp70 mRNAs have not been processed. A single transcription start point (tsp), localized about 30 nt downstream from a putative TATA box, was determined both during HS and at normal temperatures. The promoter region presented several NGAAN repeats (where N is any nucleotide) characteristic of HS elements, as well as putative binding sites for ATF, Sp1 and two metal-responsive elements.

Mass spectrometric characterization and HPLC determination of the main urinary metabolites of nimesulide in man.

A study was undertaken for the characterization and quantitative determination of the main urinary metabolites of the non-steroidal anti-inflammatory drug (NSAID) nimesulide (4-nitro-2-phenoxy-methanesulfonanilide) in man following single oral administration (200 mg). Urines were collected from six healthy volunteers at 12, 24, 48, 72 and 96 h post-administration and submitted to liquid liquid extraction before (free metabolites) and after enzymatic hydrolysis (conjugated metabolites). The structure of the metabolites, isolated by TLC separation, was elucidated by mass spectrometry (electron impact ionization) and confirmed by synthesis. Five metabolites were identified: they arise from hydroxylation to the phenoxy nucleus (M1 = hydroxynimesulide); reduction of the nitro group to an amino derivative (M2); concomitant hydroxylation and reduction (M3); N-acetylation of the M2 (M4) and of the M3 (M5) metabolites. Quantitation was by reverse phase high performance liquid chromatography (Supelcosil LC-18 DB column; mobile phase: sodium phosphate buffer (pH 3.0, 50 mM)-acetonitrile (gradient elution); flow rate: 1 ml min(-1); UV detection, 230 nm), procedure which allows in a single chromatographic run the simultaneous determination of the unchanged drug and of its metabolites. The urinary excretion of the drug and metabolites (free + conjugated) in the overall 96 h-interval accounts for approximately 40% of the administered dose: 17.55 +/- 3.6% M1; 0.72 +/- 0.43% M2; 2.45 +/- 1.22% M3; 19.07 +/- 4.3% M5. The bulk of the metabolites was in conjugated form. Percentages excretion of the unchanged drug and of M4 metabolite were below 0.5%. The described method is suited to specifically and quantitatively measure nimesulide and metabolites in human urine with acceptable precision and accuracy.

LC coupled to ion-trap MS for the rapid screening and detection of polyphenol antioxidants from Helichrysum stoechas.

Liquid Chromatography-Ion Trap Mass Spectrometry with an atmospheric pressure chemical ionization (APCI) interface in the negative and positive-ion modes in parallel to UV-diode-array detection (DAD), was applied for the rapid detection/characterization in crude extracts of the water-soluble antioxidant phenolics from Helichrysum stoechas. APCI-MS provides unequivocal molecular weight data of these compounds and useful information about their structures (diagnostic fragments ions), which were confirmed by the UV-DAD fingerprints. This combined approach allows the identification of ten constituents, including the three naturally occurring isomers of caffeoylquinic acid (CGAs), namely neo-chlorogenic acid, chlorogenic acid and crypto-chlorogenic acid, 2 isomeric dicaffeoyl quinic acids, 2 isomeric naringenin glucosides, quercetin, kaempferol and apigenin glucosides and a tetrahydroxychalcone-glucoside. The water-soluble extract from H. stoechas, standardized in both total polyphenol and kaempferol-3-glucoside content, exhibits strong antioxidant activity in vitro when tested in both artificial membrane systems (phosphatidylcholine liposomes) and in a cell model (rat erythrocytes).

Nitrosylhemoglobin, an unequivocal index of nitric oxide release from nitroaspirin: in vitro and in vivo studies in the rat by ESR spectroscopy.

Electron spin resonance (ESR) spectroscopy was applied for the unequivocal detection/quantitation of nitric oxide (NO) as nitrosylhemoglobin (HbFe(II)NO) released from nitroaspirin, benzoic acid,2-(acetyloxy)-3-[(nitrooxy)methyl]phenyl ester (NCX-4016; NO-ASA), the lead of a new class of nonsteroidal anti-inflammatory drugs. In both in vitro and in vivo experiments, the paramagnetic complex was detected at 100 K in the venous blood of the rat (microwave power, 20 mW) and characterized by a three-line hyperfine structure with coupling constants (A(x) and A(z)) of 17 G at g(x)=2.066 and g(z)=2.009. The kinetics of NO release from the drug were first determined in vitro by incubating rat blood with 1 mM NO-ASA and confirmed by the two-line hyperfine structure obtained with the labeled compound ((15)N-NO-ASA). In in vivo studies, the hematic levels of HbFe(II)NO were determined after oral (p.o.) and intraperitoneal (i.p.) administration of the drug (100 and 200 mg kg(-1)). In p.o. treated animals, the complex was detectable at 1 h post-dosing and its formation was maximal at 4-6 h, where the antithrombotic activity peaks. In i.p. treated animals, HbFe(II)NO complex peaks at the second hour to decline thereafter: in these animals, the ESR technique was applied to also detect nitrosylmyoglobin as an index of NO diffusion/compartmentalization in myocardial tissue. The results of this study emphasize the great potentiality of ESR spectroscopy for the study of the release, the metabolic fate and distribution of NO from nitrovasodilators.

[The epithelial bell]. / La campana epiteliale.

The epithelial bell which surrounds the clitoris in most mammals arises by fusion of visceral and parietal layers of the prepuce. Adhesion of the epithelia occurs between the squamous cells and a normal connection is formed by desmosomes and other junctions. There is total absence of cornifications. The squamous epithelial double lamina splits occasionally in some patches where the free surfaces are getting back to a normal process of keratinization as in the wall of the vestibule. In the closed pits the keratin scales form squamous granules without sebaceous secretion. Sometimes a similar process occurs in the human prepuce with the same results as described in cat and rabbit. The granules of keratin are different from the smegmaliths as they do not contain sebaceous secretion.

[Modified radical mastectomy in local anesthesia]. / Mastectomia radicale modificata in anestesia locale.

The authors report their experience on the use of local anesthesia for modified radical mastectomy. They have used this modality in five patients who could not undergo general anesthesia because of underlying severe medical illness and in a sixth one who adamantly refused general anesthesia. They describe in detail the technique used, stressing the importance of a thorough knowledge of regional neuroanatomy. There were no complications in their small series. The authors conclude by stating that the use of local anesthesia may expand the indications for "toilet mastectomy" to include patients in poor medical condition, unsuitable for general anesthesia.

[A case of intestinal obstruction after migration of esophageal endoprosthesis]. / Su di un caso di ostruzione intestinale da migrazione di endoprotesi esofagea.

Endoscopic dilatation and stenting are the procedures of choice in the treatment of oesophago-gastric anastomotic stricture following oesophagectomy, leading to immediate relief of dysphagia with a low procedure-related risk. Prosthesis displacement is a described late complication, easy detected and sorted out whenever possible with endoscopic retrieval. A case in which stent migration ended at the terminal part of the small intestine, presenting with the clinical features of mechanical ileum, is described.

[Kimura disease]. / Morbo di Kimura.

Kimura's disease is a chronic inflammatory pathology belonging to the angio-lymphatic proliferative disorders. The clinical features are a tumour-like swelling usually in the head and neck, with or without lymphadenopathy, often accompanied by eosinophilia and elevated serum IgE. It could be confused with angiolymphoid hyperplasia with eosinophilia. Other clinical differential diagnosis to Kimura's disease are reactive lymphadenopathy, lymphoma, parotid tumor with nodal metastasis and Mikulicz disease. The diagnosis is achieved by excisional biopsy which is also the therapy of choice. The prognosis is excellent. A case of Kimura's disease in an Italian female is presented together with a review of the literature.

[Rectal foreign bodies. Principles of therapy]. / Corpi estranei endorettali. Principi di terapia.

The authors report their experience with the treatment of endorectal foreign bodies (EFB). They review the literature on the subject and examine the various therapeutic options. Considering the possible complications of leaving an EFG in place for prolonged period of times in the hope of spontaneous delivery, they suggest that immediate removal is always indicated. They describe various technical modalities for endoscopic removal, that can avoid laparotomy in the majority of cases.

[Inguinal hernia surgery under local anesthesia. Technical note and immediate results]. / Plastica per ernia inguinale in anestesia locale. Note tecniche e risultati immediati.

The authors report their experience on local anesthesia for inguinal hernia repair in 164 patients. They describe the neuroanatomy of the inguinal region as well as the technique of loco-regional anesthesia. The Shouldice repair was most frequently employed, followed by the Bassini repair. Local anesthesia was very well tolerated by the patients, sometimes with the addition of mild sedation. The postoperative course was definitely shortened by the use of local anesthesia, and all patients were able to take a regular diet and to walk few hours after surgery.

[Acute intestinal infarction. Diagnostic and therapeutic problems]. / Infarto intestinale acuto. Problemi diagnostici e terapeutici.

The authors report their experience in thirteen cases of mesenteric infarction. They emphasize the difficulty in diagnosing and treating this entity, considering also the impossibility in most centers of performing emergency selective angiography of the superior mesenteric artery (SMA) When feasible, mesenteric rivascularization should always be attempted, followed 24 hours later by a "second look" procedure.

[The conservative treatment of infected vascular prostheses in surgery to revascularize the lower limbs]. / Trattamento conservativo delle protesi vascolari infette nella chirurgia di rivascolarizzazione degli arti inferiori.

Infected vascular grafts are associated with very high rates of limb loss and mortality. "Classic" treatment has invariably included graft excision. Recent reports have suggested that a more conservative approach may be indicated in selected cases, leaving the graft in place and using an aggressive local treatment associated with appropriate intravenous antibiotics. The authors report their experience with two patients with infected prosthetic vascular grafts in the groin. They both had purulent drainage from the groin wound, with the graft exposed close to the femoral anastomosis. They were both treated successfully without graft removal, and both graft maintained patency, with a follow-up of 22 and 19 months.

[The Knight-Griffen technique in colorectal surgery]. / La tecnica di Knight-Griffen nella chirurgia colorettale.

The use of stapling devices has changed the practice of colorectal surgery. The authors report their experience with the "double stapling" technique introduced by Knight and Griffen in 1980 for the performance of low colorectal anastomosis. They treated 42 patients, with a mean age of 63.2 years. In 34 surgery was performed for rectal adenocarcinoma, while 8 patients were being reoperated on for closure of a colostomy after Hartmann's operation. In one patient a diverting colostomy was fashioned because of poor bowel cleansing, secondary to a stenosing rectal carcinoma. Mortality was nil. There were no clinical anastomotic leaks. There were 2 cases of late postoperative anastomotic stenosis that responded to endoscopic pneumatic dilatation.