Intraoperative Arthroscopic Cold Irrigation Solution Does Not Affect Postoperative Pain and Swelling

OBJECTIVE: To determine what effect using a cold irrigating solution during arthroscopic knee surgery would have on postoperative pain intensity, pain-medicine consumption, and knee joint swelling. DESIGN AND SETTING: We employed a randomized, controlled trial design. Subjects were randomly assigned to either the cold (4 degrees C) irrigating saline group or room-temperature (18 degrees C) irrigating saline (control) group. Subjects were blinded to group assignment. All surgeries were performed at the same hospital by the same surgeon. SUBJECTS: The sample was 93 physically active patients (32 women, 61 men, mean age = 47.4 +/- 15.1 years) who had knee injuries requiring surgery. Those with cold sensitivities or contraindications to the use of cold were excluded. MEASUREMENTS: A 10-cm horizontal visual analog scale was used to measure postoperative pain intensity. Postoperative pain-medicine consumption was recorded using a daily log. Knee joint swelling (girth) was measured at midpatella and 2 in (5.08 cm) above midpatella. Pain and swelling measures were collected before and after surgery. RESULTS: No statistical or clinical differences were found between the cold-saline and control groups for pain, pain-medicine consumption, and postoperative swelling across the first 4 postoperative days. CONCLUSIONS: Our results suggest that using intra-articular cold saline to irrigate the knee joint during arthroscopic surgery had no statistically or clinically significant effect on postoperative pain, medication usage, or swelling in the first 4 postoperative days.     

Monitoring prenatal alcohol exposure

Alcohol use during pregnancy is a leading, preventable cause of birth defects and developmental disabilities in the United States, with fetal alcohol syndrome (FAS) being one of the most severe outcomes. Current survey statistics find that approximately one in eight pregnant women (500,000 per year) report alcohol use, with approximately 80,000 reporting binge drinking. While annual rates have fluctuated, trends analysis finds that there has been no significant change in rates of prenatal alcohol exposure over the past 10-year period. Development of effective programs to prevent FAS and to monitor the success of prevention efforts requires epidemiological data systems to inform these activities. This article describes alcohol use patterns among childbearing-age women and data sources that can be used in monitoring this behavior.     

Snoring and sleep-disordered breathing in young children: subjective and objective correlates

STUDY OBJECTIVES: We sought to assess the predictive validity of parental report of snoring and other behaviors by comparing such reports with objective findings from overnight polysomnography for the evaluation of sleep-disordered breathing in 2 nonclinical samples, namely, at-risk preschoolers and an older group reflective of the general community. Predictive validity of snoring alone and a score based on multiple child behaviors were compared to outcome at different levels of severity of sleep-disordered breathing. DESIGN: Retrospective observational study. SETTING: Questionnaires were distributed through school programs; polysomnography was performed at Kosair Children's Hospital in Louisville, Kentucky. PARTICIPANTS: One hundred twenty-two preschoolers and 172 5- to 7-year-olds, and their parents, participated in both subjective-report and objective-recording portions of the study. MEASUREMENTS AND RESULTS: Compared to the presence of snoring on polysomnography, parental report of frequent snoring was highly sensitive and specific for both age groups. At all but the lowest level of severity of sleep-disordered breathing, predictive ability was higher for both groups when a parental-report score based on multiple measures of child behavior was applied, compared to parental report of snoring alone. The profiles of these predictive child behaviors differed between the 2 groups, as did their sensitivity and specificity, at their high ranges of parental report. CONCLUSIONS: Scores derived from parental-report questionnaires of children's snoring and other sleep and wake behaviors can be used as surrogate predictors of snoring or sleep-disordered breathing in children. However, design and interpretation should consider age, risk status, and the purpose of the screening assessment.     

Peripheral arterial tonometry events and electroencephalographic arousals in children

STUDY OBJECTIVES: Peripheral arterial tonometry (PAT) is a sensitive measure of moment-to-moment changes in sympathetic activity and reliably identifies arousals in adult subjects. We investigated whether PAT events during sleep are associated with visually recognizable electroencephalographic arousals in healthy children and in children with sleep-disordered breathing. DESIGN: Prospective cohort. SETTING: Pediatric Sleep Research Laboratory. PARTICIPANTS: Twenty children with obstructive sleep apnea syndrome, 20 children with mild sleep-disordered breathing, and 20 control children with a mean age of 7.6 +/- 2.6 years (range: 5.7-16.5 years); 53% of children were boys. INTERVENTIONS AND MEASUREMENTS: Polysomnographic evaluation in the sleep laboratory with concomitant recording of PAT. PAT events were defined as attenuations from immediately preceding baseline of 20% to 50% (PAT20) and > 50% (PAT50) for at least 5 seconds and the indexes calculated per hour of sleep time that included good-quality PAT signals. Total PAT index (the sum of PAT20 index and PAT50 index) was also calculated. RESULTS: Total PAT index correlated with total arousal index and spontaneous arousal index (r = 0.55, P < .0001, r = 0.64, P < .001, respectively), especially in the group with obstructive sleep apnea syndrome (r = 0.71, P < .0001). The sensitivity and specificity of PAT for identifying electroencephalographic arousals were 95% and 35%, respectively. The PAT device identified pathologic arousals indexes (> or = 16 per hour) (area under the curve 0.79, P = .002). Thirty-five percent of respiratory events (eg, obstructive apnea or hypopnea) were associated with a visual electroencephalographic arousal, compared to 92% being associated with PAT attenuation events. CONCLUSIONS: Arousals in sleeping children are associated with increased sympathetic discharge, as evidenced by attenuations in PAT signal. However, a significant proportion of PAT attenuations were not accompanied by visual electroencephalographic arousals. Thus, the importance of these autonomic arousals has yet to be explored in association with morbidities related to sleep-disordered breathing and, therefore, PAT technology cannot be recommended as an alternative tool for measuring arousals in children. Nevertheless, these data further support the contention that adult criteria for the measurement for arousals may not be adequate in children.     

Sleep pressure correlates of cognitive and behavioral morbidity in snoring children

STUDY OBJECTIVES: Sleep architecture is not preserved in children with sleep-disordered breathing but, rather, undergoes dynamic changes that exhibit significant correlation with severity of sleep-disordered breathing. A sleep pressure score (SPS) with a cutoff value of 0.25 was derived from analysis of a large cohort of snoring and control children. Neurocognitive batteries were applied to examine the potential effect of SPS. DESIGN: Prospective study. PARTICIPANTS: 199 children who underwent a battery of neurobehavioral tests following an overnight sleep study were assigned to SPSHigh (> or = 0.25) or SPSLow (< 0.25) groups, and their neurocognitive performances were compared. RESULTS: Children in the SPSHigh group were significantly more likely to have deficits in memory, language abilities, verbal abilities, and some visuospatial functions than were children in the SPSLow group. These effects remained highly significant after adjusting for confounding variables and exhibited small to moderate effect sizes. CONCLUSIONS: We conclude that a sleep-pressure numerical factor derived from the overnight polysomnogram in snoring children is associated with deficits in neurobehavioral daytime functions that is independent of respiratory disturbance and hypoxemia and suggests a significant role for disturbed sleep homeostasis in pediatric sleep-disordered breathing.     

CD45 isoforms in T cell signalling and development

The CD45 phosphotyrosine phosphatase is expressed on T cells as multiple isoforms due to alternative splicing. The panoply of isoforms expressed is tightly regulated during T cell development and on mature peripheral T cell subsets following activation. We describe the analysis of comparative CD45 isoform expression levels on thymic and T cell subsets from the C57BL/6 mouse. Only four isoforms were expressed at significant protein levels: CD45R0, CD45RB, CD45RBC and CD45RABC, although trace amounts of others may be present. The expression of CD45RBC was about nine-fold higher on CD8(+) than on CD4(+) peripheral T cells, whereas CD45R0 expression was higher on CD4(+) T cells. We provide a general overview of the current models that have been proposed to explain the molecular actions of the different CD45 isoforms. Achieving a thorough understanding of the biological reasons for the existence and tight regulation of CD45 isoform expression in immune cells remains one of the outstanding challenges in the CD45 research field.     

Diffuse colonic ganglioneuromatous polyposis

Ganglioneuromatous polyposis is a very rare intestinal disease which differs from isolated polypoid ganglioneuroma and from diffuse ganglioneuromatosis. Its clinical, endoscopic, microscopic and evolutive features are poorly known. We report three cases of colonic ganglioneuromatous polyposis that illustrated an uncommon diffusion pattern in two men and one woman aged 63-72 who presented with chronic diarrhea. Endoscopic features suggesting the diagnosis were diffuse polyposis predominating in the cecum and right colon, with hyperhemic flat lesions enhanced after indigocarmin instillation. Histological study of the biopsies, and of colectomy specimens, showed a diffuse mucosal ganglioneuromatous proliferation with a few adenomatous polyps. Search for multiple endocrine neoplasia (MEN) type 2b was negative. In conclusion, this polypoid type of diffuse ganglioneuromatosis can be suspected in patients with chronic diarrhea by the special endoscopic aspect of the colonic polyposis. Pathologists should be aware of the distinctive features; diagnosis requires search for adenomas and/or neoplasia by total colopsy in addition to search for MEN 2b.     

Analysis of a staging assessment system for prediction of surgical interval in recurrent respiratory papillomatosis

INTRODUCTION: A staging system for assessment of recurrent respiratory papillomatosis (RRP) has been in use over the last 3 years for 17 patients at our children's hospital. OBJECTIVE: To evaluate a staging system for assessment of RRP on the basis of the predictive value on the surgical interval of: anatomic staging system score, urgency of intervention, voice quality, and stridor. To assess effect on surgical interval of the age of patient at time of surgery and use of adjuvant therapy. To develop a model based on the staging criteria to predict need for adjuvant therapy. DESIGN: Validation cohort. SETTING: Academic children's hospital. RESULTS: Estimated time to surgery decreased by "x days": "independent variable" "(95% CI)" as follows. Four days: each 1 point in total anatomical score (0.2, 8); 120 days: total anatomical score >20 (37,203); 143 days: urgent versus scheduled surgery (42, 243); 100 days: aphonic versus normal voice (-211, 343); 31 days: abnormal versus normal voice (-281, 343); 125 days: stridor at rest versus no stridor (-31, 281); 109 days: stridor with activity versus no stridor (19, 198); 26 days: each 1 year decrease in age (22, 30). Adjuvant therapy delays next surgery by 32 days (-4, 69) and average scores decreased while on adjuvant therapy. CONCLUSIONS: Elements of our proposed staging system are effective in prediction of surgical interval with statistical significance achieved for total anatomical scores, urgency of intervention and stridor with activity versus no stridor. This study is pilot in nature and provides a framework upon which future studies can be based. The analysis of a larger, more severity diverse population could yield results which lead to a model capable of effectively predicting future surgical interval based on a weighted prediction score calculated from age, comorbidities, anatomic staging score, and clinical staging score.     

Rapid and simple quantitative measurement of alpha-fetoprotein by combining immunochromatographic strip test and artificial neural network image analysis system

BACKGROUND: Quantitative immunochromatographic strip (ICS) assay can facilitate clinical diagnosis by providing more information than traditional qualitative or semiquantitative strip assay. METHODS: We constructed a human serum alpha-fetoprotein (AFP) measurement system by combining semiquantitative ICS tests and artificial neural network (ANN) image analysis system [immunochromatographic strip analyzed by artificial neural network image analysis system (IAIS)]. After ICS tests completed, the AFP concentration can be obtained from analysis of IAIS software. The equipment required are commercial semiquantitative AFP dipstick, optical scanner, centrifuge (option), personal computer, and software of IAIS. RESULTS: The serum AFP concentrations measured by IAIS were strongly correlated (r = 0.9971) with that by RIA. Using Bland-Altman analysis, the IAIS achieved clinical acceptable limits of agreement in comparison with RIA. The within-run precision of IAIS, expressed as coefficients of variation (CV), at 81.7 ng/ml was 1.50% and, at 244.4 ng/ml, was 1.09%. The measurement of serum AFP by IAIS can be completed in 20 min. CONCLUSIONS: The newly constructed quantitative immunochromatographic strip assay (IAIS) is a simple, rapid, and reliable method for serum AFP measurement. With the simple equipment required, the IAIS can be performed outside the laboratory and is ideal for outpatient or point-of-care AFP testing.