Fetal learning: a prospective randomized controlled study.

OBJECTIVES: To examine whether prenatal exposure to a music stimulus alters fetal behavior and whether this continues into the newborn period. SUBJECTS AND METHODS: A prospective randomized control trial was conducted using an exposure learning model in 20 normal term pregnancies. Music was played to ten fetuses via a headphone on the maternal abdomen. Ten controls had the headphone without sound. All fetal studies took place within 72 h prior to elective delivery. All 20 newborns were exposed to the same music on days 3-5. Computerized assessment of fetal heart rate and activity was documented and neonatal behavioral states were recorded. Nonparametric statistical analysis was used. RESULTS: For the first hour of study, exposed fetuses had higher mean heart rates (FHR) and spent more time exhibiting high FHR variation compared to unexposed fetuses, but neither of these differences was statistically significant. However, by the fourth hour the exposed fetuses not only demonstrated these two features but also exhibited more state transitions (P = 0.01) and higher FHR variation (P = 0.04) compared to unexposed fetuses. These effects were carried over into the neonatal period with prenatally exposed newborns manifesting more state transitions (P = 0.01) and spending a higher proportion of time in awake states (P = 0.05) when exposed to the same music stimulus. CONCLUSION: Prenatal music exposure alters the fetal behavioral state and is carried forward to the newborn period. This suggests that a simple form of fetal programming or learning has occurred.     

Upper-limb function in Australian children with traumatic brain injury: A controlled, prospective study

OBJECTIVE: To describe upper-limb function in children with mild and severe traumatic brain injury (TBI), by using both quantitative and qualitative measures. DESIGN: Controlled, prospective cohort study with assessment points initially, at 6 months, and at 2 years after TBI. SETTING: A tertiary pediatric trauma center in Australia. PATIENTS: Fifty-one children, ranging in age up to 14 years, who were consecutive admissions with TBI. On the basis of initial and persisting abnormal coma score and persistence of posttraumatic amnesia, they were assigned to either a mild (n = 26) or a severely injured (n = 25) group. Thirty children admitted with non-TBI trauma were recruited as a control group. MAIN OUTCOME MEASURES: Quantitative measures included Bruininks-Oseretsky Test of Motor Proficiency and Peabody Developmental Motor Scales. Qualitative measures included Brunnstrom Recovery Stages (adapted), categoric scales of muscle tone, grasp used when handwriting, quality of writing product, bilateral activity, and splint use. RESULTS: There was little difference between the groups on the standardized assessments for subjects who could complete the tests. Qualitative measures showed the severe TBI group to have more difficulties with gross arm control, hand control, and hand function. CONCLUSION: Children with severe TBI experience more and persisting difficulties with upper-limb function. It is essential to include both quantitative and qualitative measures in this type of research.     

Headache and cognitive profile in children: a cross-sectional controlled study

We investigated whether children affected by tension-type headache and migraine without aura, compared with a healthy control group that was matched by age, culturally and socioeconomically display a diverse intellectual functioning and have a separate “cognitive profile”. A cross-sectional study was conducted from January 2006 to November 2008 at “Sapienza University” in Rome. A total of 134 children were diagnosed as being affected by either migraine without aura (93) or tension-type headache (41). On the basis of our exclusion/inclusion criteria, we enrolled 82 of these 134 children, 63 of whom were affected by migraine without aura and 19 by tension-type headache. On entry, cognitive functions were assessed in both the affected subjects and the control group by the Wechsler Intelligence Scale for Children-revised. Significant differences were found between the headache and control groups in the mean total intelligence quotient and verbal intelligence quotient scores (p < 0.001). Significant negative correlations were found between the total intelligence quotient, verbal intelligence quotient, performance intelligence quotient and the frequency of attacks (r = −0.55 and p < 0.001, r = −0.61 and p < 0.001, r = −0.29 and p < 0.01, respectively), as well as between the total intelligence quotient score and the age at headache onset (r = 0.234, p < 0.05). Our results suggest that the cognitive profile of children affected by headache should be assessed at the first child neurology outpatient observation. From a therapeutic point of view, although within a normal range, the abilities most likely to be less brilliant in such children are verbal skills.     

Hypnosis and pain in children.

The development of studies on neuroimaging applied to hypnosis and to the study of pain not only helps to validate the existence of a hypnotic state but also to ratify its therapeutic effects. These studies also enable us to understand how hypnosis is effective on the cortical level. It also helps us see, from another perspective, the mechanisms of pain leading perhaps to a different definition of pain. This article develops the latest knowledge in the domain of hypnosis and pain, and approaches the clinical practices and their applications in the management of pain in children.     

Patient satisfaction with community psychiatric nursing: a prospective controlled study

A sample of patients allocated to receive either community psychiatric nursing or out-patient psychiatrist follow-up was interviewed at 6-month intervals for a total period of 18 months. Two dimensions of patient satisfaction are discussed: a cross-sectional analysis of the quality of the perceived therapeutic relationship and an analysis over time of attitudes to aspects of the mental health care received. The satisfaction expressed with elements of the therapeutic relationship revealed that patients find nurses more approachable and more sympathetic. The satisfaction expressed by patients receiving the nursing mode of follow-up was superior to that expressed by out-patient psychiatrist patients. Particularly positive were responses made by nursing patients to domiciliary visiting. The greater levels of satisfaction with nursing follow-up increased over time.     

Anaphylactoid reactions to intravenous N-acetylcysteine: a prospective case controlled study

INTRODUCTION: Since its introduction in 1977, intravenous N-acetylcysteine has become the treatment of choice for paracetamol overdose. The aim of our study was to investigate the existence of predictive factors in the likelihood of developing anaphylactoid reactions to N-acetylcysteine. METHODS: Prospective case-controlled study of all patients who presented to our emergency department (ED) between January 1997 and June 1999, and who were treated with intravenous N-acetylcysteine on the short stay observation ward. RESULTS: Sixty-four patients received N-acetylcysteine infusions; thirty-one (48.4%) developed an anaphylactoid reaction. Nineteen patients who reacted were commenced on N-acetylcysteine prior to receipt of paracetamol concentrations and fifteen (48.4%) were categorised as high-risk. Seventy-one percent of reactions occurred within the first 15 min. Thirteen patients who developed a reaction, had levels which fell below the treatment lines. The levels of a further nine reactors lay above the high-risk but below the normal-risk lines. Only five patients who reacted had levels above the normal-risk line. Two of the patients who reacted to intravenous N-acetylcysteine presented at a later date with a further paracetamol overdose. Both required treatment with intravenous N-acetylcysteine, the first bag being infused over one hour. Neither developed a reaction. CONCLUSION: We report a substantially higher incidence of anaphylactoid reactions to intravenous N-acetylcysteine than has previously been documented. It appears that these reactions are more likely to occur in high-risk patients, when plasma paracetamol concentrations were found to be below the treatment lines and in late presenters. Perhaps, giving the loading dose of N-acetylcysteine over 60 min could reduce the incidence of adverse reactions.     

Pharmacokinetics of ticarcillin in patients with cystic fibrosis: a controlled prospective study

We compared the pharmacokinetics of ticarcillin at a dose of 120 mg/kg in 11 patients with cystic fibrosis to 11 control subjects matched for age and sex. The mean elimination half-life of ticarcillin in serum was 70.8 minutes in the control subjects and 53.1 minutes in the patients with cystic fibrosis. The total body clearance of ticarcillin was significantly higher in cystic fibrosis patients (65.6 +/- 22.0 versus 46.2 +/- 10.9 ml/min/m2 in control subjects; p = 0.017). The nonrenal clearance of ticarcillin was also significantly higher in patients with cystic fibrosis (24.8 +/- 11.1 versus 13.3 +/- 6.0 ml/min/m2 for the control group; p = 0.006). There was no significant difference in volume of distribution between the two groups. We concluded that the shorter elimination half-life and the higher total body clearance of ticarcillin in patients with cystic fibrosis are a result of an increase in both renal and nonrenal elimination.     

Visual attention in children with migraine: a controlled comparative study

The aim of this study was to evaluate the visual attention of children with migraine and compare it with a control group. Thirty migrainous children and 30 controls without headache were subjected to a visual attention assessment with Trail Making Tests (TMT) A/B, Letter Cancellation Test, and the Brazilian computerized test Visual Attention Test, third edition. The migraine group was evaluated after 2 days without headache. The migraine group had an inferior performance compared with the control group on TMT A ( P  = 0.03) and B ( P  = 0.001), and more errors on tasks 1 ( P  = 0.032) and 2 ( P  = 0.015) of the Visual Attention Test, presenting difficulty with selective and alternate attention. Attention is a neurological function that depends on structures such as the brainstem, cerebral cortex and the limbic system and on neurotransmitters such as dopamine and noradrenaline. The neurochemical aspects involved in the physiopathology of migraine and attention mechanisms probably predispose these children to visual attention deficits.     

Severe electrolyte disorders following cardiac surgery: a prospective controlled observational study

Introduction

Electrolyte disorders are an important cause of ventricular and supraventricular arrhythmias as well as various other complications in the intensive care unit. Patients undergoing cardiac surgery are at risk for development of tachyarrhythmias, especially in the period during and immediately after surgical intervention. Preventing electrolyte disorders is thus an important goal of therapy in such patients. However, although levels of potassium are usually measured regularly in these patients, other electrolytes such as magnesium, phosphate and calcium are measured far less frequently. We hypothesized that patients undergoing cardiac surgical procedures might be at risk for electrolyte depletion, and we therefore conducted the present study to assess electrolyte levels in such patients.

Methods

Levels of magnesium, phosphate, potassium, calcium and sodium were measured in 500 consecutive patients undergoing various cardiac surgical procedures who required extracorporeal circulation (group 1). A total of 250 patients admitted to the intensive care unit following other major surgical procedures served as control individuals (group 2). Urine electrolyte excretion was measured in a subgroup of 50 patients in both groups.

Results

All cardiac patients received 1 l cardioplegia solution containing 16 mmol potassium and 16 mmol magnesium. In addition, intravenous potassium supplementation was greater in cardiac surgery patients (mean ± standard error: 10.2 ± 4.8 mmol/hour in cardiac surgery patients versus 1.3 ± 1.0 in control individuals; P < 0.01), and most (76% versus 2%; P < 0.01) received one or more doses of magnesium (on average 2.1 g) for clinical reasons, mostly intraoperative arrhythmia. Despite these differences in supplementation, electrolyte levels decreased significantly in cardiac surgery patients, most of whom (88% of cardiac surgery patients versus 20% of control individuals; P < 0.001) met criteria for clinical deficiency in one or more electrolytes. Electrolyte levels were as follows (mmol/l [mean ± standard error]; cardiac patients versus control individuals): phosphate 0.43 ± 0.22 versus 0.92 ± 0.32 (P < 0.001); magnesium 0.62 ± 0.24 versus 0.95 ± 0.27 (P < 0.001); calcium 1.96 ± 0.41 versus 2.12 ± 0.33 (P < 0.001); and potassium 3.6 ± 0.70 versus 3.9 ± 0.63 (P < 0.01). Magnesium levels in patients who had not received supplementation were 0.47 ± 0.16 mmol/l in group 1 and 0.95 ± 0.26 mmol/l in group 2 (P < 0.001). Urinary excretion of potassium, magnesium and phosphate was high in group 1 (data not shown), but this alone could not completely account for the observed electrolyte depletion.

Conclusion

Patients undergoing cardiac surgery with extracorporeal circulation are at high risk for electrolyte depletion, despite supplementation of some electrolytes, such as potassium. The probable mechanism is a combination of increased urinary excretion and intracellular shift induced by a combination of extracorporeal circulation and decreased body temperature during surgery (hypothermia induced diuresis). Our findings may partly explain the high risk of tachyarrhythmia in patients who have undergone cardiac surgery. Prophylactic supplementation of potassium, magnesium and phosphate should be seriously considered in all patients undergoing cardiac surgical procedures, both during surgery and in the immediate postoperative period. Levels of these electrolytes should be monitored frequently in such patients.     

Brain MRI in children with migraine: a controlled morphometric study

Sixteen children and adolescents, aged 5–17 years, with migraine and 24 migraine-free age-matched healthy volunteers underwent brain MR1 (1.0 T). Signal intensities of the brain, midsagittal and coronal diameters of the brainstem were quantitatively measured. General signal intensities did not differ between the groups. Compared to controls (17%), more migraine patients (50%) had high-signal foci on T2-weighted images. The diameters of the pons were greater in the migraine group ( p =0.016), although within the normal range. The diameters of the mesencephalon and the medulla oblongata did not differ between the groups, perhaps because they reach the adult size in early, childhood in contrast to the pons, which continues to grow. Childhood migraine may be associated with slightly more than average growth of the ports. As the pathophysiology of migraine is still unclear it might be worth studying with new MR methods.     

Hypnosis with children: Selected readings compiled

It was hypothesized that the ability to selectively concentrate attention on mental images would be greater among high hypnotizable Ss than among low hypnotizable Ss, as indicated by a greater interference with visual signal detection by concurrent visual mental imagery in response to specified nouns. This hypothesis was not supported in the overall results, though the finding of a significant interference effect among the high hypnotizable female Ss, but not among other subgroups, indicates that further research with a more refined procedure might be worthwhile. On the control trials without images, the high hypnotizable Ss made more false alarms than lows, and had a significantly different bias index indicating that high hypnotizable Ss were more likely than lows to respond “yes” when uncertain about whether the signal was present; false alarms can be interpreted as a nonhypnotic measure of suggestibility. The high and low hypnotizable Ss did not differ in their times to generate images in response to the specified nouns.     

青少年错颌畸形患者牙齿美观期待的前瞻性研究

目的 探讨青少年错颌畸形患者在正畸治疗过程中牙齿美观主观感受和牙齿美观期待的动态变化.方法 随机选择30例14～18周岁错颌畸形治疗患者作为治疗组进行长达1.5年的前瞻性随访研究,采用正畸治疗需要指数的美观量表(IOTN-AC)调查患者对自我错颌畸形的评价,用自制的牙齿美观期待量表进行期待值评估;随机选择该年龄段错颌畸形未治疗者21例作为对照组进行随访;随访时间点均为治疗开始前、治疗开始后0.5,1.0,1.5年.结果 随着随访时间的延长,治疗组患者IOTN-AC分值逐渐降低,对照组患者IOTN-AC分值逐渐升高;治疗组和对照组患者牙齿美观期待值均呈现逐渐升高的趋势;2组比较差异显著.结论 针对青少年错颌畸形患者,对于治疗者,在治疗后期应加强沟通,以防患者急于求成、依从性差导致治疗失败;对未治疗者应消除其不愿治疗的顾虑,使其尽快治疗以便改善其牙齿美观性,最终提升其心理健康状况.     

Acupuncture in children and adolescents with bronchial asthma: a randomised controlled study

Objective

This randomised controlled trial evaluates the immediate effects of acupuncture as an add-on therapy in in-patient rehabilitation of children and adolescents with bronchial asthma.

Patients and methods

In a pre–post design, the severity of symptoms, lung function, illness-specific quality of life (Paediatric Asthma Quality of Life Questionnaire – PAQLQ) and general and asthma-specific level of anxiety (State-Trait Anxiety Inventory for Children – STAIC) were investigated in 46 acupuncture and 47 control patients. In addition to asthma sports, climate therapy and behavioural training, the intervention group received acupuncture treatment with a standardised needle pattern (12× 30 min.).

Results

With acupuncture, the peak expiratory flow variability differs significantly (p < 0.01) from that of the control patients’ group. Moreover, the acupuncture group differs significantly in their rehabilitation response at the time of discharge concerning perceived anxiety (STAIC-S). The lung function tests do not present differences between groups.

Conclusion

After additional acupuncture, amelioration of peak expiratory flow variability and anxiety can be shown, without any difference in objective lung function tests and quality of life between study groups. Further studies might evaluate the effects of acupuncture on childhood asthma in an outpatient setting.     

Variation in intraocular pressure caused by repetitive positional changes during laparoscopic colorectal surgery: a prospective,randomized, controlled study comparing propofol and desflurane anesthesia

Laparoscopic surgery is often prolonged and requires positional changes to facilitate surgical access. Previous studies reported intraocular pressure (IOP) changes in one fixed position. This study investigated the effect of desflurane and propofol anesthesia on IOP during repeated positional changes. A total of 46 patients undergoing laparoscopic colorectal surgery were randomized into desflurane or propofol groups. IOP was measured using a handheld tonometer at seven time points: before induction (baseline), after endotracheal intubation, after pneumoperitoneum, after the first Trendelenburg and right tilt position, after reverse Trendelenburg and right tilt position, after the second Trendelenburg and right tilt position and before endotracheal extubation. Trendelenburg positioning raised IOP in both groups. In the desflurane group, IOP at the first Trendelenburg position was 6.27 and 8.48 mmHg higher than baseline IOP in left and right eye, respectively; IOP at the second Trendelenburg position was 7 and 9.44 mmHg higher than baseline in left and right eye, respectively. In the propofol group, IOP at the first Trendelenburg position was 2.04 and 4.04 mmHg higher than baseline in left and right eyes, respectively. It was 3.04 and 4.87 mmHg higher than baseline in left and right eye, respectively, at the second Trendelenburg position. In the desflurane group, 56.52% patients exhibited high IOP (≥?25 mmHg) compared with 13.04% in the propofol group at the second Trendelenburg position in the right eyes (P?=?0.005). There was a positive correlation between IOP and peak inspiratory pressure (P?<?0.001). Propofol anesthesia mitigated wide variations in IOP caused by repetitive positional changes during laparoscopic colorectal surgery.     

Outcomes from homeopathic prescribing in dental practice: a prospective, research-targeted, pilot study

BACKGROUND AND AIMS: A base for targeted research development in dental homeopathy can be founded on systematic collection and analysis of relevant data obtained by dentists in clinical practice. With these longer-term aims in mind, we conducted a pilot data collection study, in which 14 homeopathic dentists collected clinical and outcome data over a 6-month period in their practice setting. METHODS: A specifically designed Excel spreadsheet enabled recording of consecutive dental appointments under the following main headings: date; patient identity (anonymised), age and gender; dental condition/complaint treated; whether chronic or acute, new or follow-up case; patient-assessed outcome (7-point Likert scale: -3 to +3) compared with first appointment; homeopathic medicine/s prescribed; whether any other medication/s being taken for the condition. Spreadsheets were submitted monthly via e-mail to the project co-ordinator for data synthesis and analysis. RESULTS: Practitioners typically submitted data regularly and punctually, and most data cells were completed as required, enabling substantial data analysis. The mean age of patients was 46.2 years. A total of 726 individual patient conditions were treated overall. There was opportunity to follow-up 496 individual cases (positive outcome in 90.1%; negative in 1.8%; no change in 7.9%; outcome not recorded in 0.2%). Sixty-four of these 496 patients reported their outcome assessment before the end of the homeopathic appointment. Strongly positive outcomes (scores of +2 or +3) were achieved most notably in the frequently treated conditions of pericoronitis, periodontal abscess, periodontal infection, reversible pulpitis, sensitive cementum, and toothache with decay. CONCLUSIONS: This multi-practitioner pilot study has indicated that systematic recording of practice data in dental homeopathy is both feasible and capable of informing future research. A refined version of the spreadsheet can be employed in larger-scale research-targeted data collection in the dental practice setting.