Cyclic Vomiting Syndrome in the Emergency Department: A 10-Year Review of Clinical Presentation and Management.

OBJECTIVES: The aims of the study were (1) to determine how frequently patients with cyclic vomiting syndrome (CVS) present to the pediatric emergency department (ED) with CVS-related symptoms, (2) to identify variables in clinical presentation that occur frequently in patients with multiple ED visits, and (3) to compare ED management of CVS with recommended guidelines. METHODS: This study is a retrospective chart review of all ED visits for CVS between April 1, 2008, and April 1, 2018, at a single center. Patients were identified from a master list of patients diagnosed with CVS in a pediatric gastroenterology clinic at the same center between June 1, 2004, and June 19, 2018. RESULTS: Of the 181 CVS clinic patients identified, 65 had visited to the ED (35.9%). Two hundred twenty-eight visits met inclusion criteria. A total of 42.5% of these visits were made by a small number of high-intensity patients (n = 6) who had an average of 16.1 visits each. These patients represented less than 10% of the total patient group. Patients with frequent visits had longer visits (536.52 vs 380.55 minutes), more frequent hospital admissions (57.73% vs 29.01%), and more visits to the ED before a formal diagnosis of CVS was made (5.83 vs 1.22), but few other distinguishing characteristics. Only 27% of eligible visits were managed with an available order set, and management varied from recommended guidelines. CONCLUSIONS: An ambiguous presentation makes the identification and consistent management of CVS in the ED difficult. Physicians should consider CVS for patients who present multiple times with unremitting vomiting to ensure appropriate referral for diagnosis and prophylactic treatment. Future studies are warranted to evaluate anticipatory processing and treatment of the "high-intensity patients" who account for much of the clinical morbidity and resource utilization.

Supramolecular Nanofibrillar Thermoreversible Hydrogel for Growth and Release of Cancer Spheroids.

Growth of three-dimensional cancer spheroids (CSs) in man-made hydrogels mimicking natural extracellular matrix is an important and challenging task. Herein, we report on a supramolecular temperature-responsive hydrogel designed for the growth and subsequent release of CSs. A filamentous hydrogel was formed at 37 °C from an aqueous suspension of cellulose nanocrystals surface-functionalized with temperature-responsive polymer molecules. The encapsulation of cells in the hydrogel enabled effective growth of CSs with dimensions determined by the concentration of cellulose nanocrystals in the hydrogel. On demand release of CSs without loss of cell viability and spheroid integrity was achieved upon hydrogel cooling. The tumorigenic properties of the released CSs were examined by encapsulating and re-growing them in fibrin hydrogel. The results in this work can be used in fundamental cancer research and in cancer drug screening.

Polyelectrolyte vs Polyampholyte Behavior of Composite Chitosan/Gelatin Films.

Composite films of proteins and polysaccharides have a broad range of biomedical and food packaging applications, in which they are frequently exposed to fluid environments with varying ionic strengths. In the present work, we report the behavior of biopolymer films derived from chitosan (Ch), gelatin (GEL), and Ch/GEL mixture in salt solutions with varying concentrations and ion charges. The swelling and dissolution of the Ch films reduced with increasing salt concentration due to the polyelectrolyte behavior of this biopolymer, while the GEL films displayed a polyampholyte behavior, in which film swelling and dissolution were enhanced in salt solutions. Composite Ch/GEL films followed the behavior of GEL. The release of small ionic and zwitter-ionic molecules from the films was enhanced in ionic solutions due to the screened attraction between these molecules and the polymer matrix. These results provide insight into the behavior of protein/polysaccharide films in varying ionic environments, thus enabling enhanced design of biomaterials for a broad range of applications.