Solution Blow-Spun Poly (Ethylene Oxide)-Polysulfone Bicomponent Fibers-Characterization of Morphology, Structure, and Properties.

Solution blow spinning was used to prepare nonwoven bicomponent fibers constituted by poly (ethylene oxide)-Polysulfone (PEO-PSF). As a new material, deep characterization was carried out to have a database to understand final performance regarding its multiple functions as a potential material for biomedical applications. The morphology was studied by field emission scanning electron and transmission electron microscopy and optical profilometry. Structural characterization was carried out by Fourier transform infrared spectroscopy and thermal degradation by thermogravimetric analysis. Additionally, wettability and mechanical behavior were studied by contact angle measurements and tensile tests, respectively. The bicomponent material was constituted of fibers with a structure mainly described by a core-shell structure, where the PSF phase is located at the center of the fibers, and the PEO phase is mainly located at the outer parts of the fibers, leading to a kind of shell wall. The study of possible interactions between different phases revealed them to be lacking, pointing to the presence of an interface core/shell more than an interphase. The morphology and roughness of the bicomponent material improved its wettability when glycerol was tested. Indeed, its mechanical properties were enhanced due to the PSF core provided as reinforcement material.

Semantic Priming and Its Link to Verbal Comprehension and Working Memory in Children with Learning Disorders.

Children with learning disorders (LD children) often have heterogeneous cognitive impairments that affect their ability to learn and use basic academic skills. A proposed cause for this variability has been working memory (WM) capacity. Altered patterns of event-related potentials (ERPs) in these children have also been found in the N400 component associated with semantic priming. However, regarding the semantic priming effect in LD children, no distinction has been made for children with varying WM abilities. This study aims to explore the relationship of WM with the brain's electrophysiological response that underlies semantic priming in LD children that performed a lexical decision task. A total of 40 children (8-10 years old) participated: 28 children with LD and 12 age-matched controls. The ERPs were recorded for each group and analyzed with permutation-based t-tests. The N400 effect was observed only in the control group, and both groups showed a late positive complex (LPC). Permutation-based regression analyses were performed for the results from the LD group using the WISC-IV indices (e.g., Verbal Comprehension and WM) as independent predictors of the ERPs. The Verbal Comprehension Index, but not the WM index, was a significant predictor of the N400 and LPC effects in LD children.

Effects of neurofeedback on the self-concept of children with learning disorders.

Children with learning disorders (LDs) often have a lower self-concept than their typically developing peers. Neurofeedback (NFB) treatments seem to improve the cognitive and academic performance of these children, but the effects on self-concept have not been studied. In this exploratory study, 34 right-handed children (8-11 y.o.) with LD and delayed electroencephalographic maturation responded to the Piers-Harris Children's Self-Concept Scale. One group received NFB (n = 20), and another group (n = 14) served as control, which included 9 children treated with sham-NFB and 5 on a waiting-list. A nonparametric permutation approach was used to compare the academic performance and self-concept difference (postscores - prescores) between the NFB and control groups. Given the smaller size of the control subgroups, a comparison of the percent changes between sham-NFB and the waiting-list was performed with the non-overlap of all pairs (NAP) technique. In the NFB group, the scores of reading, math, and global self-concept increased significantly, highlighting the self-concept subdomains of physical appearance, nonanxiety, popularity, and happiness. Additionally, the sham-NFB subgroup showed better outcomes than the waiting-list subgroup, perhaps due to noncontrolled factors. We found improved academic performance and self-concept in children with LDs who received NFB treatment. This study is an important exploratory step in studying a relevant treatment that seems to ameliorate symptoms of LDs such as anxiety and low self-concept.

Risk Factors for Severe Anaphylaxis in Children.

OBJECTIVE: To identify risk factors associated with severe anaphylaxis in children. STUDY DESIGN: We carried out a multicenter prospective observational study including children less than 18 years old diagnosed with anaphylaxis in 7 Spanish pediatric emergency departments (EDs) between May 2016 and April 2018. Children were considered to have severe anaphylaxis if they met one or more of the following criteria: requirement for 2 or more doses of epinephrine, clinically important biphasic reaction, endotracheal intubation, intensive care unit admission, and/or death. RESULTS: We included 453 episodes of anaphylaxis. Of these, 61 were classified as severe anaphylaxis (13.5%, 95% CI [10.6-16.9]): 53 (11.7%) required more than 1 dose of epinephrine, and there were 14 (3.1%) cases of clinically important biphasic reactions, 2 (0.4%) intubations in the ED, and 6 (1.3%) admissions to the intensive care unit. No patients died. In the multivariable regression, we identified 5 independent risk factors for severe anaphylaxis: history of asthma (P = .002; OR 2.705, 95% CI [1.431-5.113]), onset of the symptoms less than 5 minutes after the allergen exposure (P = .002; OR 2.619, 95% CI [1.410-4.866]), non-well appearance (P = .005; OR 2.973, 95% CI [1.380-6.405]), tachycardia (P = .014; OR 2.339, 95% CI [1.191-4.959]), and hypotension (P = .036; OR 3.725, 95% CI [1.087-12.762]). CONCLUSIONS: Childhood anaphylaxis is usually well controlled in the ED. Children with a history of asthma, rapid onset of the symptoms, who are non-well appearing, or have tachycardia or hypotension upon arrival to the ED are more likely to have severe episodes.

Pilot Clinical Trial of High-Flow Oxygen Therapy in Children with Asthma in the Emergency Service.

OBJECTIVES: To assess the efficacy of high-flow nasal cannula (HFNC) oxygen therapy and safety in children with asthma and moderate respiratory failure in the emergency department (ED). STUDY DESIGN: This was a prospective randomized pilot trial of children (aged 1-14 years) presenting to a tertiary academic pediatric ED with moderate-to-severe asthma exacerbations between September 2012 and December 2015. Patients with a pulmonary score (PS) ≥6 or oxygen saturation <94% with a face mask despite initial treatment (salbutamol/ipratropium bromide and corticosteroids) were randomized to HFNC or to conventional oxygen therapy. Pharmacologic treatment was at the discretion of attending physicians. The primary outcome was a decrease in PS ≥2 in the first 2 hours. Secondary outcomes included disposition, length of stay, and need for additional therapies. RESULTS: We randomly allocated 62 children to receive either HFNC (n = 30) or standard oxygen therapy (n = 32). Baseline patient characteristics were similar in the 2 groups. At 2 hours after the start of therapy, PS had decreased by ≥2 points in 16 patients in the HFNC group (53%) compared with 9 controls (28%) (P = .01). Between-group differences in disposition, length of stay, and need for additional therapies were not significant. No side effects were reported. CONCLUSION: HFNC appears to be superior to conventional oxygen therapy for reducing respiratory distress within the first 2 hours of treatment in children with moderate-to-severe asthma exacerbation refractory to first-line treatment. Further studies are needed to demonstrate its overall efficacy in the management of asthma and respiratory failure in the ED. TRIAL REGISTRATION: EudraCT: 2012-001771-36.

Preparation and Characterization of Polymer Composite Materials Based on PLA/TiO2 for Antibacterial Packaging.

Polymer composite materials based on polylactic acid (PLA) filled with titanium dioxide (TiO2) nanoparticles were prepared. The aim of this work was to investigate the antibacterial action of TiO2 against a strain of E. coli (DH5α) to obtain information on their potential uses in food and agro-alimentary industry. PLA/TiO2 systems were prepared by a two-step process: Solvent casting followed by a hot-pressing step. Characterization was done as a function of particle size (21 nm and <100 nm) and particle content (0%, 1%, 5%, 10%, and 20%, wt %). Structural characterization carried out by X-ray diffraction (XRD) and Fourier Transformed Infrared spectroscopy (FTIR) did not reveal significant changes in polymer structure due to the presence of TiO2 nanoparticles. Thermal characterization indicated that thermal transitions, measured by differential scanning calorimetry (DSC), did not vary, irrespective of size or content, whereas thermogravimetric analysis (TGA) revealed a slight increase in the temperature of degradation with particle content. Bacterial growth and biofilm formation on the surface of the composites against DH5α Escherichia coli was studied. Results suggested that the presence of TiO2 nanoparticles decreases the amount of extracellular polymeric substance (EPS) and limits bacterial growth. The inhibition distances estimated with the Kirby-Bauer were doubled when 1% TiO2 nanoparticles were introduced in PLA, though no significant differences were obtained for higher contents in TiO2 NPs.

Randomized Trial of Dexamethasone Versus Prednisone for Children with Acute Asthma Exacerbations.

OBJECTIVE: To determine whether 2 doses of dexamethasone is as effective as 5 days of prednisolone/prednisone therapy in improving symptoms and quality of life of children with asthma exacerbations admitted to the emergency department (ED). STUDY DESIGN: We conducted a randomized, noninferiority trial including patients aged 1-14 years who presented to the ED with acute asthma to compare the efficacy of 2 doses of dexamethasone (0.6 mg/kg/dose, experimental treatment) vs a 5-day course of prednisolone/prednisone (1.5 mg/kg/d, followed by 1 mg/kg/d on days 2-5, conventional treatment). Two follow-up telephone interviews were completed at 7 and 15 days. The primary outcome measures were the percentage of patients with asthma symptoms and quality of life at day 7. Secondary outcomes were unscheduled returns, admissions, adherence, and vomiting. RESULTS: During the study period, 710 children who met the inclusion criteria were invited to participate and 590 agreed. Primary outcome data were available in 557 patients. At day 7, experimental and conventional groups did not show differences related to persistence of symptoms (56.6%, 95% CI 50.6-62.6 vs 58.3%, 95% CI 52.3-64.2, respectively), quality of life score (80.0 vs 77.7, not significant [ns]), admission rate (23.9% vs 21.7%, ns), unscheduled ED return visits (4.6% vs 3.3%, ns), and vomiting (2.1% vs 4.4%, ns). Adherence was greater in the dexamethasone group (99.3% vs 96.0%, P < .05). CONCLUSION: Two doses of dexamethasone may be an effective alternative to a 5-day course of prednisone/prednisolone for asthma exacerbations, as measured by persistence of symptoms and quality of life at day 7. CLINICAL TRIAL REGISTRATION: clinicaltrialsregister.eu: 2013-003145-42.

Is this child sick? Usefulness of the Pediatric Assessment Triangle in emergency settings.

OBJECTIVE: The Pediatric Assessment Triangle is a rapid assessment tool that uses only visual and auditory clues, requires no equipment, and takes 30-60s to perform. It's being used internationally in different emergency settings, but few studies have assessed its performance. The aim of this narrative biomedical review is to summarize the literature available regarding the usefulness of the Pediatric Assessment Triangle in clinical practice. SOURCES: The authors carried out a non-systematic review in the PubMed®, MEDLINE®, and EMBASE® databases, searching for articles published between 1999-2016 using the keywords "pediatric assessment triangle," "pediatric triage," "pediatric assessment tools," and "pediatric emergency department." SUMMARY OF THE FINDINGS: The Pediatric Assessment Triangle has demonstrated itself to be useful to assess sick children in the prehospital setting and make transport decisions. It has been incorporated, as an essential instrument for assessing sick children, into different life support courses, although little has been written about the effectiveness of teaching it. Little has been published about the performance of this tool in the initial evaluation in the emergency department. In the emergency department, the Pediatric Assessment Triangle is useful to identify the children at triage who require more urgent care. Recent studies have assessed and proved its efficacy to also identify those patients having more serious health conditions who are eventually admitted to the hospital. CONCLUSIONS: The Pediatric Assessment Triangle is quickly spreading internationally and its clinical applicability is very promising. Nevertheless, it is imperative to promote research for clinical validation, especially for clinical use by emergency pediatricians and physicians.

Is this child sick? Usefulness of the Pediatric Assessment Triangle in emergency settings / Esta criança está doente? Utilidade do Triângulo de Avaliação Pediátrica nas configurações de emergência

Abstract Objective: The Pediatric Assessment Triangle is a rapid assessment tool that uses only visual and auditory clues, requires no equipment, and takes 30-60 s to perform. It's being used internationally in different emergency settings, but few studies have assessed its performance. The aim of this narrative biomedical review is to summarize the literature available regarding the usefulness of the Pediatric Assessment Triangle in clinical practice. Sources: The authors carried out a non-systematic review in the PubMed®, MEDLINE®, and EMBASE® databases, searching for articles published between 1999-2016 using the keywords "pediatric assessment triangle," "pediatric triage," "pediatric assessment tools," and "pediatric emergency department." Summary of the findings: The Pediatric Assessment Triangle has demonstrated itself to be useful to assess sick children in the prehospital setting and make transport decisions. It has been incorporated, as an essential instrument for assessing sick children, into different life support courses, although little has been written about the effectiveness of teaching it. Little has been published about the performance of this tool in the initial evaluation in the emergency department. In the emergency department, the Pediatric Assessment Triangle is useful to identify the children at triage who require more urgent care. Recent studies have assessed and proved its efficacy to also identify those patients having more serious health conditions who are eventually admitted to the hospital. Conclusions: The Pediatric Assessment Triangle is quickly spreading internationally and its clinical applicability is very promising. Nevertheless, it is imperative to promote research for clinical validation, especially for clinical use by emergency pediatricians and physicians.

Resumo Objetivo: O Triângulo de Avaliação Pediátrica é uma ferramenta de avaliação rápida que usa apenas pistas visuais e auditivas, não necessita de equipamentos e leva de 30-60 segundos. Tem sido usado internacionalmente em diferentes configurações de emergência, porém poucos estudos avaliaram seu desempenho. O objetivo desta análise biomédica narrativa é resumir a literatura disponível com relação à utilidade do Triângulo de Avaliação Pediátrica na prática clínica. Fontes: Fizemos uma análise não sistemática nas bases de dados do PubMed®, Medline® e Embase® em busca de artigos publicados entre 1999-2016 com as palavras-chave "triângulo de avaliação pediátrica", "triângulo pediátrico", "ferramentas de avaliação pediátrica" e "departamento de emergência pediátrica". Resumo dos achados: O Triângulo de Avaliação Pediátrica demonstrou ser útil na avaliação de crianças doentes na configuração pré-hospitalar e na tomada de decisões de transporte. Ele foi incorporado, como um instrumento essencial na avaliação de crianças doentes, em diferentes cursos de apoio de vida, apesar de pouco ter sido escrito sobre a eficácia de ensino do Triângulo de Avaliação Pediátrica. Pouco foi publicado sobre o desempenho do Triângulo de Avaliação Pediátrica na avaliação inicial no departamento de emergência (DE). No DE, o Triângulo de Avaliação Pediátrica é útil para identificar, na triagem, crianças que exigem cuidado mais urgente. Estudos recentes avaliaram e provaram a eficácia do Triângulo de Avaliação Pediátrica também na identificação dos pacientes com doenças de saúde mais graves e, eventualmente, são internados no hospital. Conclusões: O Triângulo de Avaliação Pediátrica se difunde rapidamente de forma internacional e sua aplicabilidade clínica é muito promissora. Contudo, é essencial promover pesquisa para validação clínica, principalmente para o uso clínico por pediatras e médicos de emergência.

Tratamento cirúrgico da região cervical associado a suturas de suspensão platismal com fios de politetrafluoroetileno / Surgical treatment of cervical region associated with polytetrafluoroetilene platysmal susénsion sutures

Introdução: A partir da década de 70, grande importância tem sido atribuída ao sistema músculo-aponeurótico superficial (SMAS) e ao platisma, sendo o manejo adequado destas estruturas considerado ponto-chave na obtenção de melhores resultados nas cirurgias de rejuvenescimento facial. Consideram-se casos de difícil resolução, atribuídos por McKinney como grau IV, cientes com significativa flacidez de pele e músculos, bandas platismais pronunciadas e separadas, protrusão das glândulas submandibulares, baixa posição do osso hióide, grande quantidade de gordura e uma linha mandibular pouco definida. Método: Um grupo de 89 pacientes com estas características e submetido a tratamento cirúrgico foi avaliado, retrospectivamente. O tratamento cirúrgico constou de ritidoplastias cérvico-faciais associadas a dissecção e tração do complexo SMAS-platisma, platismoplastia medial segundo Feldman e sutura entrecruzada com fio de politetrafluoroetileno (PTFE), realizada nos bordos platismais e fixa à mastóide. Preconiza-se que a sutura de suspensão do complexo SMAS-platisma seja efetuada somente após a conclusão da região cervical, caso contrário, o avanço do platisma à linha média promoveria tração inferior e novo acúmulo tecidual na margem mandibular. Resultados: Os resultados apurados demonstram baixos índices de complicações relevantes 3,2 por cento, associados a maior satisfação pós-operatória. Conclusão: Conclui-se pela eficácia da rotina cirúrgica adotada e pela segurança da sutura de PTFE, possibilitando resultados favoráveis nesta difícil condição.

Introduction: Since the 1970s, great importance has beenatributed to superficial musculoaponeurotic system (SMAS)and platysma dissection, considering the proper approachof these structures the key point in order to achieve better results in facial rejuvenation...

Fixação com parafusos absorvíveis no tratamento da região frontal com videoendoscopia / Biodegradable screw fixation in the treatment of the frontal area with videoendoscopy

São utilizados muitos métodos para obter a fixação dos tecidos moles no tratamento da região frontal com videoendoscopia (EAFL). Porém, nenhum deles pode ser considerado como sendo o melhor. Desde quando iniciamos a fazer EAFL, utilizamos a fixação com parafusos. Depois de notar que a fixação externa temporária com parafuso metálico apresentava alguns efeitos negativos, começamos a usar a fixação interna com parafusos absorvíveis (biodegradáveis). O propósito deste estudo é transmitir nossa experiência e comentar alguns pontos importantes relativos a este método. Nós avaliamos os casos submetidos a cirurgia endoscópica da face nos últimos quatro anos. Foram operados noventa e nove pacientes. Em trinta e oito utilizou-se a fixação externa com parafusos metálicos, e em sessenta e um, a fixação interna com parafusos absorvíveis. Nesse grupo, constatou-se significativa redução nas complicações inerentes ao método, com a mesma qualidade no resultado. Evidencia-se que, mesmo ainda demandando um custo considerável, o emprego de parafusos internos absorvíveis constitui-se numa opção prática, efetiva e segura para a fixação da região frontal na cirurgia endoscópica.

Many methods are used to obtain the fixation of the soft tissues in the treatment of the front area with videoendoscopia (EAFL). However none of them can be considered as the best. From when we began to pratice EAFL, we used the fixation with screws. After noticing that the fixation temporary with metallic screw it presented some negative effects, we start using the fixation interns with absorbable screw (biodegradable). The purpose of this study is to transmit our experience and to comment on some relative important points to this method. We evaluated the submitted cases the surgery endoscopic asssisted frontal lifting in the last four years. Ninety nine patients were operated. In thirty eight the fixation was used with metallic screws and in sixty one a the fixation interns with absorbable screw. In that group, significant reduction was verified in the inherent complications to the method, with the same quality in the result. It is evidenced that, still demanding a considerable cost, the job of internal screws is constituted in a practical option, it executes and it holds for the fixation of the front area after endoscopic surgery.

Complicaciones pre y pos operatorias inmediatas de la cirugía de tiroides en el hipertiroidismo / Complication pre and pos inmediate operating of surgery of thyroid

Hace una revisión sobre las complicaciones de la cirugía de la glándula tirides iperfuncionantes, no se incluye los casos de hipertiroidismo uninodulares pero se revisa todos los casos de bocio y multinodulares iperfuncionantes. Establece que la cirugía es una alternativa de tratamiento definitivo