Comparison of laparoscopic cholecystectomy in children at paediatric centres and adult centres: a systematic review and meta-analysis.

INTRODUCTION: Paediatric laparoscopic cholecystectomy (LC) is performed by both paediatric and adult surgeons. The aim of this review was to compare outcomes at paediatric centres (PCs) and adult centres (ACs). METHODS: A literature search was conducted, in accordance with PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines, for papers published between January 2000 and December 2020. Statistical analysis was performed using Stata® version 16 (StataCorp, College Station, TX, US). RESULTS: A total of 92 studies involving 74,852 paediatric LCs met the inclusion criteria. Over half (59%) of the LCs were performed at ACs. No significant differences were noted in the male-to-female ratio, mean age or mean body mass index between PCs and ACs. The main indications were cholelithiasis (34.1% vs 34.4% respectively, p=0.83) and biliary dyskinesia (17.0% vs 23.5% respectively, p<0.01). There was no significant difference in the median inpatient stay (2.52 vs 2.44 days respectively, p=0.89). Bile duct injury was a major complication (0.80% vs 0.37% respectively, p<0.01). Reoperation rates (2.37% vs 0.74% respectively, p<0.01) and conversion to open surgery (1.97% vs 4.74% respectively, p<0.01) were also significantly different. Meta-analysis showed no significant difference in overall complications (p=0.92). CONCLUSIONS: The number of LCs performed, intraoperative cholangiography use and conversion rates were higher at ACs whereas bile duct injury and reoperation rates were higher at PCs. Despite a higher incidence of bile duct injury at PCs, the incidence at both PCs and ACs was <1%. In complex cases, a joint operation by both paediatric and adult surgeons might be a better approach to further improve outcomes. Overall, LC was found to be a safe operation with comparable outcomes at PCs and ACs.

The effect of the transition to Electronic Patient Records on adherence to venous thromboembolism prophylaxis guidelines in general surgical patients.

INTRODUCTION AND OBJECTIVES: Surgical patients are at risk of hospital-acquired venous thromboembolisms (VTEs), and preventative measures such as thromboembolism deterrent stockings (TEDs) and low molecular weight heparin (LMWH) are proven to be beneficial. The National Quality Requirement in the NHS Standard Contract 2017/19 in England mandates that 95% of inpatients undergo VTE risk assessments. As hospitals transition to Electronic Patient Records (EPR), it is important to observe the impact on vital safety indicators such as VTE risk. The aim of this study is to observe the effect of implementing EPR in a tertiary centre on adherence to national guidelines, including VTE assessment rates and prophylaxis administration in surgical patients. MATERIALS AND METHODS: Using consecutive sampling, all acute surgical admissions at the hospital from 26/02/2018 to 18/03/2018 (n=154) pre-EPR and 31/10/2018 to 25/11/2018 (n=151) post-EPR were observed for VTE risk assessment, 24-h re-assessment, prophylaxis prescriptions, administration, and patient compliance. Data was compared using a two-tailed Z-test. RESULTS: Pre-EPR, 96% of patients had completed VTE assessments, which increased after EPR implementation to 97% (p=0.39). LWMH prescription rates decreased from 82% to 77% following EPR (p=0.14). Moreover, TED prescriptions decreased from 84% to 64% post-EPR (p<0.01). Administration rates of prophylaxis generally improved post-EPR. The 24-h re-assessment rate decreased from 62% to 54% of patients (p=0.08). CONCLUSION: The study demonstrated that EPR is non-inferior to paper records. Transitioning to an EPR system did not interfere with the completion of VTE risk assessments, hence did not negatively impact the ability to achieve national targets.

Inactivation of bacterial opportunistic skin pathogens by nonthermal DC-operated afterglow atmospheric plasma.

AIMS: Multidrug-resistant opportunistic pathogens are clinically significant and require the development of new antimicrobial methods. In this study, Acinetobacter baumannii, Pseudomonas aeruginosa and Staphylococcus aureus cells were exposed to atmospheric plasma on agar plates and in vitro on porcine skin for the purpose of testing bacterial inactivation. METHODS AND RESULTS: Microbial inactivation at varying exposure durations was tested using a nonthermal plasma jet generated with a DC voltage from ambient air. The observed reduction in colony forming units was quantified as log(10) reductions. CONCLUSIONS: Direct plasma exposure significantly inactivated seeded bacterial cells by approx. 6 log(10) on agar plates and 2-3 log(10) on porcine skin. On agar plates, an indirect 'bystander' inactivation outside the plasma delivery area was also observed. The reduced inactivation observed on the skin surface was most likely due to cell protection by the variable surface architecture. SIGNIFICANCE AND IMPACT OF STUDY: Atmospheric plasma has potential for clinical application as a disinfectant of patient skin and medically relevant surfaces.

A case of prosopagnosia following moderate closed head injury with left hemisphere focal lesion.

This study describes a left handed woman with prosopagnosia following traumatic brain injury with a focal lesion confined to the left-posterior hemisphere. Few cases of prosopagnosia following unilateral left hemisphere lesions have previously been reported in the literature. Corrected visual acuity was 20/70 (binocular), color vision was intact on screening, and shape detection was borderline. Impairments in higher order visual perception were evident to varying degrees on nonfacial tasks. Matching of unfamiliar faces was very slow but accurate. A marked impairment in the ability to recognize familiar faces and learn new face-name associations was evident on experimental tasks relative to the performance of healthy control subjects. In contrast, identification of characteristics of faces (gender, age) and identification and matching of facial expressions were relatively preserved. We discuss the cognitive processing stages that appear to be disrupted using Bruce and Young's (1986) model of facial recognition and perception as a framework.

Pharyngeal disorders.

Pharyngeal disorders are diverse and can include developmental, traumatic, immune-mediated, infectious, metabolic, endocrine, neurologic, neoplastic, and inflammatory etiologies. Although the clinical history and signalment frequently can localize a disease process to the pharynx, only a careful examination, usually in conjunction with diagnostic tests, can identify the problem. Pharyngeal disorders are of important diagnostic significance. If left untreated, life-threatening respiratory impairment or debilitation and malnutrition may result. For effective treatment, therapy must be aimed at the primary disease process.

Visual information processing after severe closed head injury: effects of forward and backward masking.

Three tachistoscopic tasks were employed to assess whether survivors of severe closed head injury (CHI) exhibit a disturbance of information processing within peripheral and/or central visual pathways. Twelve survivors of severe CHI and 12 individually matched control subjects completed a recognition threshold (no mask) task, a monoptic, forward masking by visual noise task (to assess processing within relatively peripheral pathways), and a dichoptic, backward masking by pattern task (to assess processing within central pathways). For each experimental procedure, the minimum exposure durations required by subjects to identify correctly single consonants and triple consonants were determined. Survivors of severe CHI showed deficits on all three visual tasks. Both groups also had higher threshold durations for the more complex stimuli (triple v single consonants), but differences in threshold were greater in the patients with CHI. The degree of perceptual impairment exhibited by patients with CHI was highly variable and not consistently related to injury characteristics or residual motor or speech and language impairment.

Enhanced stereoselectivity in pig liver esterase catalysed diester hydrolysis. The role of a competitive nucleophile.

The enantioselectivity of pig liver esterase catalysed hydrolysis of cis-N-benzyl-2,5-bis(methoxy-carbonyl)pyrrolidine (1) has previously been shown to be very dependent on the reaction conditions. Hydrolysis performed in media buffered with tris(hydroxymethyl)aminomethane (Tris) afforded a monoester with much higher optical purity than hydrolysis in media without Tris. Detailed product studies in a Tris-buffered medium have been performed using NMR-techniques and a 13C-labelled ester. The NMR-studies revealed the presence of (2S,5R)-N-benzyl-2-methoxycarbonyl-5-[[[2-hydroxy-1,1- bis(hydroxymethyl)ethyl]amino]carbonyl]pyrrolidine (4) as an intermediate, which together with the isolated product (2S,5R)-N-benzyl-2-carboxy-5-[[[2-hydroxy-1,1-bis(hydroxymethyl) ethyl]amino]carbonyl]pyrrolidine (3) suggested Tris as a competitive nucleophile to water. The increased enantioselectivity seen in the produced (2R,5S)-N-benzyl-2-methoxy-carbonyl-5-carboxypyrrolidine (2) was explained by the preference of Tris to react faster with one of the diastereomeric acyl enzymes over the other.

Effects of transcallosal surgery on interhemispheric transfer of information.

The effects of transcallosal surgery on interhemispheric transfer of information were investigated in five patients who underwent partial section of the corpus callosum for evacuation of a brain tumor. In comparison with normal controls, postoperative findings indicated subtle motor and/or sensory manifestations of hemispheric disconnection which tended to resolve overtime. However, in no case were the disconnection effects disabling in the performance of daily activities.

Electrophysiological evidence of lateralized disturbances in children with learning disabilities.

This study used an electrophysiological measurement operation to investigate lateralized processing deficits associated with academic learning-disability subtypes. Fast frequency EEG activity in the 36-44 hertz (Hz) band was recorded from reading-disabled (RLD), arithmetic-disabled (ALD), and nondisabled control children engaged in verbal and nonverbal cognitive tasks. The control group, but neither LD group, exhibited a task-dependent shift in lateralization of 40 Hz EEG; the RLD subjects generated proportionately less left-hemisphere 40 Hz activity than control or ALD subjects during the verbal task; and the ALD subjects generated proportionately less right-hemisphere activity than control or RLD subjects during the nonverbal task. These results indicate that lateralized processing deficits are associated with different types of disabilities, and provide external validation of learning-disability classifications based on academic performance patterns.

Acadesine (AICA-riboside) improves postischemic cardiac recovery.

To test if acadesine (5-aminoimidazole-4-carboxamide riboside), a purine precursor, has cardioprotective effects, 16 dogs were placed on total cardiopulmonary bypass and subjected to global myocardial ischemia. Hemodynamic recovery was compared between a control (n = 8) group receiving standard cardioplegia and an acadesine (n = 8) group pretreated with intravenous acadesine (2.5 mg.kg-1.min-1 for 5 minutes, then 0.5 mg.kg-1.min-1) before ischemia, during ischemia, and until 10 minutes after removal of the aortic cross-clamp. Additionally, in the acadesine group the cardioplegia also contained 20 mumol/L acadesine. While the dogs were on cardiopulmonary bypass, global warm myocardial ischemia was induced by aortic cross-clamping for 5 minutes under normothermic conditions to simulate an angioplasty accident. Five minutes after aortic cross-clamping, hypothermic cardioplegia (30 mL/kg) was administered. The left anterior descending coronary artery was occluded before the first infusion of cardioplegia to simulate poor cardioplegia delivery that can occur during an emergency coronary artery bypass procedure after an angioplasty accident. The left anterior descending artery occlusion was released, and additional cardioplegia (15 mL/kg) infusions were made every 30 minutes thereafter during 120 minutes of cardioplegic ischemia. Thirty minutes after reperfusion, all animals in both groups were weaned from bypass and recovery data were obtained to compare with baseline preischemic values. There were no significant differences in heart rate, left atrial pressure, or systemic vascular resistance between groups after weaning from bypass. Peak developed pressure recovered to 79% +/- 19% (mean +/- standard deviation) of baseline in the acadesine group compared with 56% +/- 22% in the control group (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

A community health nursing curriculum and Healthy People 2000.

The School of Nursing at the University of Alabama at Birmingham recently revised its graduate level community health nursing curriculum based on the priority areas and health objectives in Healthy People 2000. Health priority areas are presented as class topics and provide direction for the students' fieldwork. This paper provides background on the national strategy used to develop the national health objectives, suggestions on how nursing can be at the forefront of influencing the health of the nation, and specifics involved in implementing a community health nursing curriculum using the year 2000 health objectives.

Frontal lobe dysfunction following closed head injury. A review of the literature.

This review of the relationship between frontal lobe pathology and sequelae of closed head injury (CHI) emphasizes the variety of neuropsychological disturbances that may be present and factors that influence symptom presentation. First, the mechanisms of injury in CHI are briefly summarized with an emphasis on frontal involvement. This summary is followed by an overview of frontal lobe structure and function including behavioral and cognitive sequelae associated with frontal damage in other patient populations. Next, findings specifically related to frontal dysfunction in CHI patients are presented. These studies, although few in number, indicate that CHI patients frequently exhibit deficits indicative of frontal damage. The clinical implications of frontal dysfunction following CHI and potential avenues for future research are discussed.

Time course of electrophysiologic effects induced by di-n-butyl-2,2-dichlorovinyl phosphate (DBCV) in the adult hen.

Previous work in our laboratory indicated that di-n-butyl-2,2-dichlorovinyl phosphate (DBCV) produced electrophysiologic changes in hen peripheral nerve that coincided with the development of histopathologic changes and neurologic signs of peripheral neuropathy. The purpose of the present study was to follow the time course for the development of the electrophysiologic changes and to determine whether pretreatment with the phosphinate analog of DBCV (DBCV-P), a nonageable organophosphorus compound, prevented these effects. Although significant electrophysiologic deficits occurred in the tibial and sciatic nerve 24 h after DBCV treatment, the most marked changes coincided with the onset of clinical signs of organophosphorus-induced delayed neuropathy (14-21 d). The sciatic and tibial nerves were equally susceptible to DBCV in producing deficits characterized by changes in the relative refractory period and an increased strength-duration threshold. Pretreatment with DBCV-P prevented the clinical signs and also attenuated the electrophysiologic deficits induced by DBCV treatment. These data suggest that electrophysiologic deficits occur before clinical signs of organophosphorus-induced delayed neuropathy (OPIDN) and may be indicative of a link between neurotoxic esterase (NTE) inhibition and onset of overt clinical toxicity.

The psychiatrist's role in behavioral pediatrics training programs.

Behavioral pediatric fellowships are available in 15 major medical institutions in the United States. In general, these programs focus on the psychologic, social, and biologic determinants of behavior and learning disabilities in children. Child psychiatry's participation in the formulative stages of these programs is considered vital. The authors caution psychiatry to avoid concentrating its energies upon these socially and developmentally inclined behavioral pediatricians to the detriment of all pediatric house staff.