Decision-making and paediatric pain: a review

The aim of this paper is to present an overview of the literature on the factors influencing decision-making the nursing care of children in pain. To that effect published and unpublished references werr reviewed. The most frequently cited factors influencing the assessment and management of pain in children are summarized and discussed. Finally recommendations are made where further research is warranted.     

Autonomy in the Rehabilitation of Stroke Patients in Nursing Homes. A Concept Analysis

This article presents a concept analysis of autonomy in relation to the rehabilitation of stroke patients. Analysis of the results of a literature survey provided three important concepts of autonomy in the field of biomedical ethics: self-governance, self-realization and actual autonomy. These concepts are compared with concepts from caring sciences and summarized in a table. The results indicate the importance of the social environment (formal and informal caregivers) for the restoration of autonomy. Because of the patient's condition and context, a social concept of autonomy makes more sense in the rehabilitation of stroke patients in nursing homes than does an individual concept. The concept analysis sheds light on the fact that the majority of studies regarding patient autonomy are primarily based on theoretical reflections, not on empirical studies. More research is warranted to gather information on how patients themselves consider and appreciate autonomy during rehabilitation, to explore the views of stroke patients' formal and informal caregivers and to investigate whether a social concept of autonomy is suitable for all phases of rehabilitation. Concerning the practice of rehabilitation, no definite conclusion can be given as yet.     

Irradiation of volunteers in nuclear medicine

The preliminary assessment of many radiopharmaceuticals is often carried out with the help of "normal volunteers". These volunteers are drawn from the general public, are fully informed of the procedure to be performed and its attendant risks, and in many cases are compensated financially for their trouble. The cooperation of such people is of vital importance to the full understanding of the normal kinetics and metabolism of many new radiopharmaceuticals. The restrictions on the choice of normal volunteers, and the radiation dose limits which must be observed are not explicitly defined in any of the current guidelines, and in this paper we propose a rationale, based upon available information, which sets acceptable limits for volunteers, and provides a framework within which scientists and physicians can work.     

View box luminance measurements and their effect on reader performance

RATIONALE AND OBJECTIVES: The purpose of this study was to investigate the importance of view box luminance and viewing conditions on low-contrast detection by readers. MATERIALS AND METHODS: Radiographs of a mammographic contrast-detail phantom were examined on 632 view box panels. The luminance of these panels was obtained by using a calibrated meter and ranged from 860 to 3,300 nit. Twelve radiologists reported the number of contrast-detail disks for each size (diameter, 0.3-7.0 mm) deemed to be visible on films with optical densities of 1.00-2.60. Radiologist performance in reading low-contrast phantom images was also studied as a function of room illuminance and image masking. RESULTS: Median luminance was 1,700 nit, with 25- and 75-percentile values of 1,450 and 2,150 nit, respectively. Low-contrast visibility generally was independent of view box luminance, regardless of film density or disk diameter. Low-contrast visibility deteriorated when masking around the image was removed and at normal room illuminance. The greatest deterioration in performance occurred at the highest film densities and with the smallest size disks. CONCLUSION: Detection of low-contrast features on radiographs is relatively independent of view box luminance, but it is degraded by the presence of stray light and by increased room illuminance.     

Gender-specific gene expression in post-mortem human brain: localization to sex chromosomes.

Gender differences in brain development and in the prevalence of neuropsychiatric disorders such as depression have been reported. Gender differences in human brain might be related to patterns of gene expression. Microarray technology is one useful method for investigation of gene expression in brain. We investigated gene expression, cell types, and regional expression patterns of differentially expressed sex chromosome genes in brain. We profiled gene expression in male and female dorsolateral prefrontal cortex, anterior cingulate cortex, and cerebellum using the Affymetrix oligonucleotide microarray platform. Differentially expressed genes between males and females on the Y chromosome (DBY, SMCY, UTY, RPS4Y, and USP9Y) and X chromosome (XIST) were confirmed using real-time PCR measurements. In situ hybridization confirmed the differential expression of gender-specific genes and neuronal expression of XIST, RPS4Y, SMCY, and UTY in three brain regions examined. The XIST gene, which silences gene expression on regions of the X chromosome, is expressed in a subset of neurons. Since a subset of neurons express gender-specific genes, neural subpopulations may exhibit a subtle sexual dimorphism at the level of differences in gene regulation and function. The distinctive pattern of neuronal expression of XIST, RPS4Y, SMCY, and UTY and other sex chromosome genes in neuronal subpopulations may possibly contribute to gender differences in prevalence noted for some neuropsychiatric disorders. Studies of the protein expression of these sex-chromosome-linked genes in brain tissue are required to address the functional consequences of the observed gene expression differences.     

Distinct histopathological phenotypes of severe alcoholic hepatitis suggest different mechanisms driving liver injury and failure

Intrahepatic neutrophil infiltration has been implicated in severe alcoholic hepatitis (SAH) pathogenesis; however, the mechanism underlying neutrophil-induced injury in SAH remains obscure. This translational study aims to describe the patterns of intrahepatic neutrophil infiltration and its involvement in SAH pathogenesis. Immunohistochemistry analyses of explanted livers identified two SAH phenotypes despite a similar clinical presentation, one with high intrahepatic neutrophils (Neu^hi), but low levels of CD8⁺ T cells, and vice versa. RNA-Seq analyses demonstrated that neutrophil cytosolic factor 1 (NCF1), a key factor in controlling neutrophilic ROS production, was upregulated and correlated with hepatic inflammation and disease progression. To study specifically the mechanisms related to Neu^hi in AH patients and liver injury, we used the mouse model of chronic-plus-binge ethanol feeding and found that myeloid-specific deletion of the Ncf1 gene abolished ethanol-induced hepatic inflammation and steatosis. RNA-Seq analysis and the data from experimental models revealed that neutrophilic NCF1-dependent ROS promoted alcoholic hepatitis (AH) by inhibiting AMP-activated protein kinase (a key regulator of lipid metabolism) and microRNA-223 (a key antiinflammatory and antifibrotic microRNA). In conclusion, two distinct histopathological phenotypes based on liver immune phenotyping are observed in SAH patients, suggesting a separate mechanism driving liver injury and/or failure in these patients.