Impact of persistent antiphospholipid antibodies on risk of incident symptomatic thromboembolism in children: a systematic review and meta-analysis

The aim of this study was to estimate the impact of antiphospholipid (aPL) antibodies on the risk of incident thromboembolism (TE; arterial and venous) in children via meta-analysis of published observational studies. A systematic search of electronic databases (Medline, EMBASE, OVID, Web of Science, The Cochrane Library) for studies published from 1966 to 2010 was conducted using keywords in combination both as MeSH terms and text words. Two authors independently screened citations and those meeting the a priori defined inclusion criteria were retained. Data on year of publication, study design, country of origin, number of patients/controls, ethnicity, TE type, and frequency of recurrence were abstracted. Heterogeneity across studies was evaluated, and summary odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using either fixed-effects or random-effects models. Of 504, 16 pediatric studies met the inclusion criteria. In total 1403 patients and 1667 population-based controls ≤18 years were enrolled. No significant heterogeneity was discerned across studies, and no publication bias was detected. Thus, data from arterial and venous TE were analyzed together. In addition, meta-regression analysis did not reveal statistically significant differences between site of TE, age at first TE, country, or publication year. A statistically significant association with a first TE was demonstrated for persistent aPL antibodies, with an overall summary ORs/CI of 5.9/3.6-9.7 (arterial 6.6/3.5-12.4; deep vein thrombosis 4.9/2.2-10.9). The present meta-analysis indicates that detection of persistent aPL is clinically meaningful in children with, or at risk for, TE and underscores the importance of pediatric thrombophilia screening programs.     

Becoming normal: a grounded theory study on the emotional process of stroke recovery

The purpose of this grounded theory study was to examine the emotional process of stroke recovery, personally experienced by stroke survivors. Nine stroke survivors living in Atlantic Canada participated in this study. Data collection came from formal unstructured interviews and one group interview. The central problem experienced by these stroke survivors was being less than 100%. The basic social process used to address this problem was becoming normal, which is composed of three stages: recognizing stroke will not go away, choosing to work on recovery, and working on being normal. Each stage has several phases. Being less than 100% is the emotional result of being unable to do certain things that serve to form individuals' identities. A critical finding was that physical and emotional recovery is inseparable, and recovery is directed towards regaining the ability to perform these certain things. Becoming normal was influenced both positively and negatively by the following conditions: personal strengths and attributes, past history, family support, professional support, faith and comparing self to peers. The results of this study have implications for nursing practice, nursing education and nursing research. It adds to nursing knowledge by illuminating the close relationship between physical and emotional recovery, the duration of the stroke recovery process, and the necessity for survivors to make a deliberate choice to recover.     

Reductions in caloric intake and early postnatal growth prevent glucose intolerance and obesity associated with low birthweight

Aims/hypothesis Low birthweight (LBW) and rapid postnatal weight gain, or catch-up growth, are independent risk factors for the development of obesity and diabetes during adult life. Individuals who are both small at birth and have postnatal catch-up growth are at the highest risk. We hypothesised that dietary interventions designed to attenuate catch-up growth in LBW subjects may have long-term beneficial consequences.Materials and methods We used our previously described mouse model of LBW-associated diabetes, created by restricting maternal food intake to 50% during the last week of gestation. Control (C) dams and dams that had been subjected to undernutrition (U) were then provided either chow ad libitum after delivery or 50% food restriction on a per-day basis from delivery until weaning. We designated the resulting four groups control-control (CC), undernutrition-control (UC), control-undernutriton (CU) and undernutrition-undernutrition (UU), indicating the prenatal and postnatal experimental conditions, respectively. Carbohydrate metabolism and adiposity were assessed prospectively in offspring until age 6 months.Results Males that were small at birth and exhibited early postnatal catch-up growth developed glucose intolerance and obesity by age 6 months. In contrast, LBW mice without catch-up growth (UU) remained smaller than controls (CC), and glucose intolerance and obesity was prevented. Similarly, mice with normal birthweight that had blunted catch-up growth (CU) were leaner and had better tolerance test than CC mice. Catch-up growth during the first week of life correlated better than birthweight with glucose, fat mass and glucose tolerance up to 6 months of age.Conclusions/interpretation Prevention of early catch-up growth reversed the development of glucose intolerance and obesity in our mouse model of LBW-associated diabetes.     

Botulinum Toxin vs. Topical Glyceryl Trinitrate Ointment for Pain Control in Patients Undergoing Hemorrhoidectomy: A Randomized Trial

Purpose The maximum resting pressure in the anal canal is greatly raised after hemorrhoidectomy. This increase is likely to be the cause of postoperative pain, which is still the most troublesome early problem after hemorrhoidectomy. This study was designed to compare, after hemorrhoidectomy, the effects of intrasphincter injection of botulinum toxin vs. application of glyceryl trinitrate ointment in improving wound healing and reducing postoperative pain at rest or during defecation. Methods Thirty patients with hemorrhoids of third and fourth degree were included in the study and randomized in two groups. Anorectal manometry was performed preoperatively and 5 and 40 days after hemorrhoidectomy. One group received one injection containing 20 IU of botulinum toxin, whereas the other an application of 300 mg of 0.2 percent glyceryl trinitrate ointment three times daily for 30 days. Results Five days after hemorrhoidectomy, maximum resting pressure was significantly reduced compared with baseline values in both groups (85 ± 15 vs. 68 ± 11 mmHg for the group treated with botulinum toxin, 87 ± 11 vs. 78 ± 11 mmHg for the group treated with glyceryl trinitrate ointment). Overall analysis of postoperative pain at rest showed a significant reduction in the botulinum toxin group vs. glyceryl trinitrate group, whereas pain during defecation and time of healing were similar. Adverse effects, such as headaches, were observed only in the glyceryl trinitrate group. Forty days after hemorrhoidectomy in the glyceryl trinitrate group, maximum resting pressure values were similar to preoperative ones, whereas the values were still reduced in the botulinum toxin group. Conclusions A single intrasphincter injection of botulinum toxin was more effective and safer than repeated applications of glyceryl trinitrate in reducing early postoperative pain at rest but not during defecation. Supported by Ministero dell’Università e della Ricerca Scientifica e Tecnologica (MURST), grants 2003–04. An erratum to this article is available at .     

Granular cell tumor of stomach： A case report and review of literature

Granular cell tumor (GCT) was described for the first time by Abrikosoff in 1926. It is a relatively rare neoplasm that may occur at many sites, but most commonly in the skin or soft tissues. The occurrence of GCT in the gastrointestinal tract is rare, accounting approximately for 8% of all tumors, among which the most common site is the esophagus, whereas gastric localization is very rare. Gastric GCTs can be solitary or, more frequently, associated with other gastrointestinal localization. Although GCTs are usually clinically and histologically benign, some malignant cases have been reported. Histologically, these tumors consist of polygonal and fusiform cells disposed in compact "nests" and immunohistochemical staining for S-100 protein supports the proposed derivation from Schwann cells. A correct preoperative diagnosis of this tumor can only be made in 50% of all patients and it is always based on endoscopic biopsy. Laparoscopic or conventional wedge resection represents the treatment of choice. In this study, the authors reported a case of a 49-year-old woman with a solitary granular cell tumor of the stomach with infiltrative pattern, successfully treated with surgical resection. A review of literature is also presented with emphasis on diagnostic criteria concerning the malignant form.     

Sociodemographic factors associated with weekend birth and increased risk of neonatal mortality

OBJECTIVE: To learn whether weekend risk of neonatal mortality is related to selected sociodemographic factors. DESIGN: A retrospective cohort design. Logistic regression was used to obtain odds ratios, and analysis of variance and chi-square to identify differences in values and incidence of key variables. SAMPLES: The data were derived from matched Texas birth and infant death certificates from 1999 through 2001. MAIN OUTCOME MEASURES: A subset of deaths up to 28 days of life attributable to conditions originating in the perinatal period. These deaths were called neonatal mortality-p. RESULTS: Women who were White, married, had Medicaid assistance, and had private prenatal care were less likely to deliver on weekends. Odds of neonatal mortality-p increased 36.5% when a birth took place on the weekend. The weekend crude odds of neonatal mortality-p increased for all racial/ethnic groups, but the differences were not statistically significant. CONCLUSIONS: The likelihood of delivering on the weekend increases with certain sociodemographic factors. This fact is important because the risk of neonatal mortality is higher among weekend births.     

Influence of registered nurses' attitudes toward bariatric patients on educational programming effectiveness

BACKGROUND AND OBJECTIVE: This study describes registered nurses' (RNs') attitudes toward obese adult patients using the Attitudes Toward Obese Adult Patients Instrument. METHODS: Full-time RNs (N = 119) employed in a medical center, acute rehabilitation institution, and skilled nursing facility participated in the study. RESULTS: Findings revealed that RNs have positive attitudes toward obese adults. RNs were concerned about personal and patient safety. Respondents recognized the complex care needs of bariatric patients and the increased workload associated with meeting these demands. There were differences in attitudes between medical center RNs and acute rehabilitation RNs, possibly related to differences in workload and length of stay. CONCLUSIONS: The effectiveness of bariatric educational programming may be improved if RN attitudes and concerns are measured and addressed.