Preoperative hematocrit and platelet count are associated with blood loss during spinal fusion for children with neuromuscular scoliosis.

AIM: To assess the relationship of preoperative hematology laboratory results with intraoperative estimated blood loss and transfusion volumes during posterior spinal fusion for pediatric neuromuscular scoliosis. METHODS: Retrospective chart review of 179 children with neuromuscular scoliosis undergoing spinal fusion at a tertiary children's hospital between 2012 and 2017. The main outcome measure was estimated blood loss. Secondary outcomes were volumes of packed red blood cells, fresh frozen plasma, and platelets transfused intraoperatively. Independent variables were preoperative blood counts, coagulation studies, and demographic and surgical characteristics. Relationships between estimated blood loss, transfusion volumes, and independent variables were assessed using bivariable analyses. Classification and Regression Trees were used to identify variables most strongly correlated with outcomes. RESULTS: In bivariable analyses, increased estimated blood loss was significantly associated with higher preoperative hematocrit and lower preoperative platelet count but not with abnormal coagulation studies. Preoperative laboratory results were not associated with intraoperative transfusion volumes. In Classification and Regression Trees analysis, binary splits associated with the largest increase in estimated blood loss were hematocrit ≥44% vs. <44% and platelets ≥308 vs. <308 × 109/L. CONCLUSIONS: Preoperative blood counts may identify patients at risk of increased bleeding, though do not predict intraoperative transfusion requirements. Abnormal coagulation studies often prompted preoperative intervention but were not associated with increased intraoperative bleeding or transfusion needs.

Structure of the bacteriophage PhiKZ non-virion RNA polymerase.

Bacteriophage ΦKZ (PhiKZ) is the archetype of a family of massive bacterial viruses. It is considered to have therapeutic potential as its host, Pseudomonas aeruginosa, is an opportunistic, intrinsically antibiotic resistant, pathogen that kills tens of thousands worldwide each year. ΦKZ is an incredibly interesting virus, expressing many systems that the host already possesses. On infection, it forms a 'nucleus', erecting a barrier around its genome to exclude host endonucleases and CRISPR-Cas systems. ΦKZ infection is independent of the host transcriptional apparatus. It expresses two different multi-subunit RNA polymerases (RNAPs): the virion RNAP (vRNAP) is injected with the viral DNA during infection to transcribe early genes, including those encoding the non-virion RNAP (nvRNAP), which transcribes all further genes. ΦKZ nvRNAP is formed by four polypeptides thought to represent homologues of the eubacterial ß/ß' subunits, and a fifth with unclear homology, but essential for transcription. We have resolved the structure of ΦKZ nvRNAP to better than 3.0 Å, shedding light on its assembly, homology, and the biological role of the fifth subunit: it is an embedded, integral member of the complex, the position, structural homology and biochemical role of which imply that it has evolved from an ancestral homologue to σ-factor.

Procrastination as a Threat to the Psychological Security of the Educational Environment.

The present study provides an analysis of the concept of procrastination and its features, together with a discussion of the fundamental approaches to its investigation. It examines procrastination as a threat to the psychological security of the educational environment. The author presents the results of an empirical investigation of the characteristics of interpersonal relations in the educational environment, academic motivation, and general motivation of students with various degrees of procrastination. The subjects of the investigation were 95 students, of the average age of 18.2 years, in an institution of higher education dedicated to the humanities. The subjects were evaluated using the procrastination scale for student populations developed by C. Lay, the academic motivation scale of R.J. Vallerand, the self-evaluation survey of motivation of academic, intellectual, and professional activity developed by N.A. Bakshaeva and A.A. Verbitsky, and the "Survey of Interpersonal Relations in an Educational Environment" developed by G.S. Kozhukhar and V.V. Kovrov. The primary hypothesis of the study, that the interconnections of interpersonal relations in an educational environment with academic and general motivation would differ in the groups of students with different levels of procrastination, was confirmed. The differences in the evaluations of the quality of interpersonal relations, and indicators of academic and intellectual motivation of students with different levels of procrastination were of special particular significance. It was shown that, the higher the level of students' procrastination, the greater the interaction between the negative aspects of interpersonal relations in the educational environment and the external academic motivation.

The effect of pediatric patient temperament on postoperative outcomes.

BACKGROUND: Research has improved practitioner awareness of the impact of individual characteristics on responses to painful procedures. However, there is little data relating preexisting temperament profiles and postsurgical/anesthesia outcomes in pediatric patients. In particular, it is not clear how best to identify which patients are at risk of poor postsurgical outcomes. AIM: In this prospective study, we examined relationships between preoperative measures of child temperament and postoperative pain/behavioral outcomes of children undergoing tonsillectomy/adenoidectomy surgeries. We sought to determine which temperament profiles were predictive of poor outcomes. METHODS: After IRB approval and informed consent, validated temperament surveys were administered to the parents of a cohort of children undergoing tonsillectomy/adenoidectomy surgery. These data were combined with preoperative, intraoperative, and postoperative outcome measures collected from the electronic medical record utilizing a large integrated anesthesia outcome database. The dataset was further augmented with surveys addressing remote postoperative behaviors. Analysis of the temperament data yielded four groups (positive, negative, excitable, and inhibitory). The probability of high perioperative pain, agitation, emesis, and postoperative behavior changes based on cluster membership was then assessed. RESULTS: A total of 260 patients undergoing tonsillectomy and/or adenoidectomy surgeries were enrolled in the study. ANOVA and chi-squared analyses indicated no statistically significant age, gender, or anesthesia technique differences across the four temperament clusters. Temperament cluster membership was not related to emesis, agitation, or behavioral changes. However, it was found to be predictive of high postoperative pain. Members of the excitable cluster (high positive and negative emotionality) were more likely to report high pain than those in positive cluster (high positive, low negative emotionality) (OR 7.97, 95% CI: 1.62-39.26; P < 0.05). Comparisons among other clusters were not significant. CONCLUSION: Our data indicate that preoperative temperament characteristics may differentially influence pediatric postoperative pain experience in children. Specifically, children with high levels of positive and negative emotionality may exhibit more postsurgical pain behaviors.

The association between high-volume intraoperative fluid administration and outcomes among pediatric patients undergoing large bowel resection.

BACKGROUND: Traditional intraoperative fluid administration practices have been challenged this century with data suggesting improved outcomes with restrictive or goal-directed fluid administration during adult bowel surgery. Minimal data on outcomes associated with differing intraoperative fluid administration practice exists for pediatric patients. AIMS: We assessed factors and outcomes associated with high-volume fluid administration in pediatric patients undergoing colectomy. We hypothesized that high-volume fluid administration is associated with impaired recovery and, thus, increased length of stay. METHODS: A database of perioperative practice and postoperative outcomes at a tertiary pediatric hospital was queried for colectomy encounters between July 2012 and March 2017. Data extracted included patient characteristics, perioperative clinical data, and postoperative outcomes. Encounters were stratified into two groups: greater than 90th percentile fluids administered (high-volume fluid administration group) vs less than 90th percentile fluids administered. Univariable tests, multivariable logistic regression, and propensity score matched group comparisons were used to asses outcomes associated with high-volume fluid administration. RESULTS: A total of 209 colectomy encounters were identified from which 12 were excluded based on predetermined criteria. High-volume fluid administration was associated with length of stay >6 days (AOR 8.14, CI 1.75-37.8, P = 0.007), time to first meal >4 days (AOR of 5.91, CI 1.30-27.17, P = 0.02), and supplemental oxygen requirement >24 hours (AOR 3.60, CI 1.25-10.39, P = 0.02) after adjusting for ASA status, blood loss, transfusion, and open surgery. Similarly, propensity score matched patients with high-volume fluid administration vs controls were more likely to have length of stay >6 days (93% vs 54%, P = 0.007), time to first meal >4 days (93% vs 57%, P = 0.009), and supplemental oxygen requirement >24 hours (36% vs 12%, P = 0.033). CONCLUSION: High-volume fluid administration during colectomy for pediatric patients is associated with worsened postoperative outcomes suggestive of impaired recovery.