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1.
The FilmArray Blood Culture Identification Panel was validated for nonblood sterile site specimens with clinical impact of rapid identification compared to conventional diagnostics. The panel accurately identified target organisms from 98% of positive broth cultures a median 1.1?day faster than conventional techniques (P?<?0.0001) with potential clinical impact in 22% of cases.  相似文献   
2.
Pierre Robin sequence (PRS) describes a small mandible with retrognathia, an elevated and posteriorly positioned tongue, and an associated U-shaped cleft palate. The retracted tongue may obstruct the airway leading to respiratory failure, with failure to thrive and adverse neurodevelopmental outcomes if not addressed. If the airway obstruction cannot be overcome with conservative measures, there are non-surgical and surgical options. A nasopharyngeal prong (NPP) is a non-surgical, temporary treatment that avoids the complications inherent in an operation, especially given the natural history of mandibular growth and improved airway obstruction in PRS. Although the use of a prong requires training, support, and follow up, it effectively bypasses the obstruction in the majority of children with PRS, and allows the child to outgrow the airway obstruction until the prong is no longer required. On average, the prong can be removed between 6 and 12 months of age.  相似文献   
3.

Purpose

To identify factors associated with advanced inferior vena cava filter (IVCF) retrieval to raise awareness on technical considerations, retrieval efficiency, and patient safety.

Materials and Methods

A single-center retrospective review was performed of 203 consecutive retrievable IVC filters placed between 2007 and 2014. Attempted retrievals were classified as advanced if the routine “snare and sheath” technique was initially unsuccessful after multiple attempts, or an alternate endovascular maneuver or access site was utilized. Patient and filter characteristics were recorded.

Results

203 attempted retrievals were reviewed (48.7 % male, 51.2 % female, mean age 52.7 years, mean dwell time 109 days). Advanced retrievals were observed in 20 patients (9.8 %) (15 females, 5 males). Fluoroscopy time (p ≤ 0.01, 34.3 ± 21.1 and 5.3 ± 4.5 min for advanced retrievals and routine retrievals respectively, same below), gender (p = 0.031), and retrieval tilt angle (p ≤ 0.01, 5.7 ± 5.10° vs. 11.9 ± 11.03°) were associated with advanced retrievals. Females were 3.16 times more likely to have an advanced retrieval performed than males with a significantly higher tilt angle in those with advanced retrieval. History of cancer (p = 0.502), dwell time (p = 0.916), retrieval caval diameter (p = 0.053), placement caval diameter (p = 0.365), filter type (p = 0.710), strut perforation (p = 0.506), placement tilt angle (p = 0.311), and age (p = 0.558) were not found significantly associated with advanced retrievals.

Conclusions

Women are at increased risk for advanced filter retrieval secondary to a significant change in filter tilt over time compared to men, independent of filter type or competing demographic or filter risks, likely placing them at increased risk for higher procedural fluoroscopy times.
  相似文献   
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Small instestinal submucosa (SIS) is an easily produced material that has been used experimentally for tissue engineering. To evaluate the ability of SIS to facilitate bone growth within a long-bone defect, a segment of the radius was surgically removed in adult, female Sprague-Dawley rats. The defect was either left unfilled or implanted with SIS, demineralized cortical bone (DMCB), or ovalbumin. The defect was evaluated radiographically and histologically after 3, 6, 12, and 24 weeks. Tissue remodeling within the defect was evident by week 3 in SIS- and DMCB-treated rats. Filling was characterized initially by infiltration of mononuclear cells and extracellular material in SIS-implanted rats and multifocal remodeling bone particles and cartilage formation in DMCB implanted rats. Cartilage was observed as early as 3 weeks and bone as early as 6 weeks in SIS-implanted rats. Filling of the defect arose from multiple foci in DMCB-implanted rats, but was contiguous with and parallel to the ulnar shaft in SIS-implanted rats, suggesting that defect repair by SIS may be conductive rather than inductive. Rats in which the defect was left unfilled demonstrated slow but progressive filling of the defect, characterized by mononuclear cell infiltrates and fibrous extracellular material. In summary, SIS facilitated rapid filling of a longbone defect. These results suggest that SIS may be useful as a bone repair material.  相似文献   
7.
Objectives. We determined the impact of Breakfast in the Classroom (BIC) on the percentage of children going without morning food, number of locations where food was consumed, and estimated calories consumed per child.Methods. We used a cross-sectional survey of morning food consumed among elementary school students offered BIC and not offered BIC in geographically matched high-poverty-neighborhood elementary schools.Results. Students offered BIC (n = 1044) were less likely to report not eating in the morning (8.7%) than were students not offered BIC (n = 1245; 15.0%) and were more likely to report eating in 2 or more locations during the morning (51.1% vs 30%). Overall, students offered BIC reported consuming an estimated 95 more calories per morning than did students not offered BIC.Conclusions. For every student for whom BIC resolved the problem of starting school with nothing to eat, more than 3 students ate in more than 1 location. Offering BIC reduced the percentage of students not eating in the morning but may contribute to excess calorie intake. More evaluation of BIC’s impact on overweight and obesity is needed before more widespread implementation.Food insecurity and obesity are both serious concerns in urban, low-income communities,1 particularly for children. Food insecurity occurs “whenever the availability of nutritionally adequate and safe foods or the ability to acquire acceptable foods in socially acceptable ways is limited or uncertain.”2 According to the US Department of Agriculture, in 2010, 11.3% of US children lived in households with food insecurity (reporting mainly reductions in quality and variety of children’s meals), and 1.3% were affected by very low food security (termed “food security with hunger” before 2006).3Obesity is a major public health problem among children nationally4,5 and in New York City (NYC).6 Nearly 21% of public school students aged 5 to 14 years are obese.6 Obesity levels are higher among low-income children who qualify for free school meals (23.4%) than among those who do not (18.9%).7 Paradoxically, obesity often occurs among children with food insecurity. Therefore, any effort to address food insecurity should also address obesity.On any given day, between 12% and 34% of children and adolescents report skipping breakfast.8 Eating breakfast may improve short-term memory and academic performance, particularly in undernourished children.8 The national school breakfast program was established in 1966 and permanently authorized in 1975 to provide for students in need of adequate nutrition in the morning.9 Through local departments of education, the school breakfast program provides meals to youths living below 130% of the federal poverty level.9 However, breakfast consumption among youths has declined since 1965.10 In NYC, more than 70% of public school students qualify for free or reduced-price meals. The NYC Department of Education serves more than 800 000 meals each day, using rigorous guidelines initiated in 2005,11 and has introduced initiatives to increase participation in school meals, such as providing universal free breakfast in the cafeteria to all students, regardless of family income and, more recently, providing breakfast in the classroom (BIC) in some schools.BIC is a program intended to serve those who do not or are unable to take advantage of before-school breakfast in the cafeteria. BIC was piloted in selected public school classrooms in NYC at the discretion of school principals starting in January 2008. In the 2009–2010 school year, a number of elementary schools in low-income NYC neighborhoods initiated BIC, consisting of 4-item breakfasts delivered to classrooms and offered to students by their teacher. Breakfast items included milk, cereal, fruit or 100% fruit juice, and 1 additional item, such as carrot bread or string cheese. By January 2010, approximately 19% of approximately 1500 NYC schools served BIC in some or all classrooms.Given the coexisting problems of food insecurity and obesity, our goal was to determine the impact of BIC on the potential to both reduce breakfast skipping and increase calorie consumption. Specifically, we evaluated whether BIC was associated with any of the following changes in children’s morning food consumption: percentage who did not eat, eating locations, and estimated calories consumed.  相似文献   
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Introduction

We hypothesized that an elevated preoperative alkaline phosphatase (AP) predicted worse outcomes for patients undergoing transarterial chemoembolization (TACE) for neuroendocrine tumor (NET) liver metastases.

Methods

We reviewed all patients who underwent TACE for metastatic NET between 2009 and 2013. Survival was evaluated using preprocedure variables.

Results

One hundred and nine patients underwent 210 TACE procedures. The average age was 57.7 years (range 20–78). Primary sites included pancreas (N?=?20), other gastrointestinal (N?=?52), lung (N?=?9), and unknown (N?=?28). The tumor was grade 1 in 68 (62 %), grade 2 in 21 (19 %), and grade 3 in 3 (3 %). Extrahepatic disease was present in 54 (50 %) and greater than 50 % hepatic tumor burden by imaging in 63 (58 %). Elevated bilirubin occurred in 8 (7 %), elevated AP in 22 (20 %), elevated ALT in 21 (19 %), and elevated AST in 41 (38 %). Univariate predictors included tumor grade (43 vs 27 vs 21 months, p?=?0.015), hepatic tumor burden (59 vs 37 months, p?=?0.009), and elevated AP (59 vs 23 months, p?<?0.001). On multivariate analysis, only elevated AP (p?=?0.001) predicted worse survival.

Conclusions

Elevated AP prior to TACE for metastatic NET portends a worse survival outcome, even more so than tumor grade or extent of hepatic disease.
  相似文献   
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