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Purpose: According to the homeostasis model, patellofemoral pain (PFP) arises as a consequence of disturbed homeostasis of anterior structures of the knee due to vascular insufficiency. Near‐infrared spectroscopy (NIRS) allows to measure changes of concentrations (µmol/cm2) of (de)‐oxygenated hemoglobine (HHb and O2Hb). The aim was to study differences in patellar hemodynamics between patients and healthy controls. Methods: Hemodynamics of patients (n = 30 [female = 20, age = 21.5, BMI = 22.9]) and controls (n = 30 (female = 18, age = 21.4, BMI = 22.4]) were evaluated for two activities ('Prolonged Sitting' and 'Stair Descent'). Blinding for health status was implemented. Results: During 'Prolonged Sitting', PFP patients exhibited smaller decreases in mean changes for HHb (PFP [M = −1.5 to −1.9], healthy controls [M = −2.0 to −2.3]) and O2Hb (PFP [M = −2.0 to −3.2], healthy controls [M = −3.4 to −4.1]). However, these differences were statistically non‐significant (p = 0.14–0.82 and p = 0.056–0.18, respectively). Conversely, for 'Stair Descent', PFP patients showed statistically significant smaller decreases in mean changes for HHb (PFP [M = −1.9, SD = 1.8], healthy controls [M = −2.5, SD = 1.7], p = 0.043) and O2Hb (PFP [M = −3.2, SD = 3.2], healthy controls [M = −4.9, SD = 2.7], p = 0.004). Conclusions: The differences suggest potential impairment in patellar hemodynamics in PFP patients, providing support for the homeostasis model. Evidence‐based treatment strategies targeting patellar hemodynamics should be further refined and subjected to evaluation in clinical trials. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

Purpose: According to the homeostasis model, patellofemoral pain (PFP) results from disturbed homeostasis due to vascular insufficiency in the anterior knee. Near-Infrared Spectroscopy (NIRS) measures relative changes in concentrations (in µmol/cm2) of (de-)oxygenated hemoglobine (HHb and O2Hb). The aims were to: 1) investigate the characteristics of the NIRS signal derived from the patella during experiments affecting hemodynamics in healthy controls, and 2) determine the test–retest reliability of NIRS in positions clinically relevant for PFP patients. Methods: Two experiments were conducted on 10 healthy controls and analysed using Student's t-test. Reliability (ICC2,1) was evaluated for two activities ('Prolonged Sitting' and 'Stair Descent') in five PFP patients and 15 healthy controls, performed twice within five days. Results: The NIRS signal (HHb and O2Hb) showed a statistically significant increase (p <.001 –.002) on all optodes (30, 35, 40 mm) during 'Venous Occlusion' (M = 1.0 – 2.0), while it showed no statistically significant change (p =.075 –.61) during 'Skin Compression' (M = -0.9 – 0.9) on the 30 and 35 mm optode. Reliability of NIRS (HHb and O2Hb) ranged from moderate to almost perfect (ICC2,1 =.47 –.95) on the 30 mm optode for 'Prolonged Sitting', and from moderate to substantial (ICC2,1 =.50 –.68) on the 35 mm optode for 'Stair Descent'. Conclusions: Patella NIRS measurements are affected by venous occlusion, but not by skin compression, and are sufficiently reliable as research application to compare real-time patellar bone hemodynamics. These insights may assist to improve effectiveness of evidence-based treatment strategies for PFP. Trial registration: ISRCTN Trial Registration under number: 90377123. [ABSTRACT FROM AUTHOR]

Background: There are limited data on the use of video laryngoscopy for pediatric patients outside of the operating room. Aim: Our primary aim was to evaluate whether implementation of video laryngoscopy‐guided coaching for tracheal intubation is feasible with a high level of compliance and associated with a reduction in adverse tracheal intubation‐associated events. Methods: This is a pre‐post observational study of video laryngoscopy implementation with standardized coaching language for tracheal intubation in a single‐center, pediatric intensive care unit. The use of video laryngoscopy as a coaching device with standardized coaching language was implemented as a part of practice improvement. All patients in the pediatric intensive care unit were included between January 2016 and December 2017 who underwent primary tracheal intubation with either video laryngoscopy or direct laryngoscopy. The uptake of the implementation, sustained compliance, tracheal intubation outcomes including all adverse tracheal intubation‐associated events, oxygen desaturations (<80% SpO2), and first attempt success were measured. Results: Among 580 tracheal intubations, 284 (49%) were performed during the preimplementation phase, and 296 (51%) postimplementation. Compliance for the use of video laryngoscopy with standardized coaching language was high (74% postimplementation) and sustained. There were no statistically significant differences in adverse tracheal intubation‐associated events between the two phases (pre‐ 9% vs. post‐ 5%, absolute difference −3%, CI95: −8% to 1%, p =.11), oxygen desaturations <80% (pre‐ 13% vs. post‐ 13%, absolute difference 1%, CI95: –6% to 5%, p =.75), or first attempt success (pre‐ 73% vs. post‐ 76%, absolute difference 4%, CI95: –3% to 11%, p =.29). Supervisors were more likely to use the standardized coaching language when video laryngoscopy was used for tracheal intubation than with standard direct laryngoscopy (80% vs. 43%, absolute difference 37%, CI95: 23% to 51%, p <.001). Conclusions: Implementation of video laryngoscopy as a supervising device with standardized coaching language was feasible with high level of adherence, yet not associated with an increased occurrence of any adverse tracheal intubation‐associated events and oxygen desaturation. [ABSTRACT FROM AUTHOR]

The importance of preoperative cardiac function in pediatric lung transplantation is unknown. We hypothesized that worse preoperative right ventricular (RV) systolic and worse left ventricular (LV) diastolic function would be associated with a higher risk of primary graft dysfunction grade 3 (PGD 3) between 48 and 72 hours. We performed a single center, retrospective pilot study of children (<18 years) who had echocardiograms <1 year prior to lung transplantation between 2006 and 2019. Conventional and strain echocardiography parameters were measured, and PGD was graded. Area under the receiver operating characteristic (AUROC) curves and logistic regression were performed. Forty‐one patients were included; 14 (34%) developed PGD 3 and were more likely to have pulmonary hypertension (PH) as the indication for transplant (P =.005). PGD 3 patients had worse RV global longitudinal strain (P =.01), RV free wall strain (FWS) (P =.003), RV fractional area change (P =.005), E/e' (P =.01) and lateral e' velocity (P =.004) but not tricuspid annular plane systolic excursion (P =.61). RV FWS (AUROC 0.79, 95% CI 0.62‐0.95) and lateral e' velocity (AUROC 0.87, 95% CI 0.68‐1.00) best discriminated PGD 3 development and showed the strongest association with PGD 3 (RV FWS OR 3.87 [95% CI 1.59‐9.43], P =.003; lateral e' velocity OR 0.10 [95% CI 0.01‐0.70], P =.02). These associations remained when separately adjusting for age, weight, primary PH diagnosis, ischemic time, and bypass time. In this pilot study, worse preoperative RV systolic and worse LV diastolic function were associated with PGD 3 and may be modifiable recipient risk factors in pediatric lung transplantation. [ABSTRACT FROM AUTHOR]

Background and Aims: The pediatric Critical Illness Stress-induced Immune Suppression (CRISIS) trial compared the effectiveness of 2 nutraceutical supplementation strategies and found no difference in the development of nosocomial infection and sepsis in the overall population. We performed an exploratory post hoc analysis of interaction between nutraceutical treatments and host immune status related to the development of nosocomial infection/sepsis.Methods: Children from the CRISIS trial were analyzed according to 3 admission immune status categories marked by decreasing immune competence: immune competent without lymphopenia, immune competent with lymphopenia, and previously immunocompromised. The comparative effectiveness of the 2 treatments was analyzed for interaction with immune status category.Results: There were 134 immune-competent children without lymphopenia, 79 previously immune-competent children with lymphopenia, and 27 immunocompromised children who received 1 of the 2 treatments. A significant interaction was found between treatment arms and immune status on the time to development of nosocomial infection and sepsis ( P < .05) and on the rate of nosocomial infection and sepsis per 100 patient days ( P < .05). Whey protein treatment protected immune-competent patients without lymphopenia from infection and sepsis, both nutraceutical strategies were equivalent in immune-competent patients with lymphopenia, and zinc, selenium, glutamine, and metoclopramide treatment protected immunocompromised patients from infection and sepsis.Conclusions: The science of immune nutrition is more complex than previously thought. Future trial design should consider immune status at the time of trial entry because differential effects of nutraceuticals may be related to this patient characteristic. [ABSTRACT FROM AUTHOR]

Objectives We aimed to determine whether implementation of a structured multidisciplinary electroencephalography ( EEG) monitoring pathway improved the timeliness of administration of antiseizure medication in response to electrographic seizures in encephalopathic critically ill children. Methods A multidisciplinary team developed a pathway to standardize EEG monitoring and seizure management in encephalopathic critically ill children, aiming to decrease the time from electrographic seizure onset to antiseizure medication administration. Data were collected to inform the team of improvement opportunities, which were then provided by an institutional pathway, staff education, and streamlined communication. Measurements were obtained before and after pathway implementation to assess for improvement. Results We collected data on 41 patients before and 21 after pathway implementation. There were no differences between the baseline and pathway groups in demographic characteristics, acute encephalopathy etiologies, or antiseizure medications utilized. The median duration [interquartile range, IQR] from seizure onset to antiseizure medication administration was shorter for patients treated with the pathway (64 min [50, 101]) compared to patients treated prior to pathway implementation (139 min [71, 189]; p = 0.0006). The median [IQR] interval from seizure onset to antiseizure medication order was shorter for the pathway group (31 min [20, 49]) than the baseline group (71 min [33, 131]; p = 0.003). The median [IQR] interval from antiseizure medication order to administration was shorter for the pathway group (30 min [19, 40]) than the baseline group (40 min [17, 68]) (p = 0.047). Seizure termination was more likely to occur following initial antiseizure medication administration in the pathway than baseline group (67% vs. 27%, p = 0.002). Significance Implementation of the pathway resulted in a significant reduction in the duration between electrographic seizure onset and antiseizure medication administration, and a significant increase in the rate of electrographic seizure termination following an initial antiseizure medication. Further study is needed to determine whether these changes are associated with improved outcomes. [ABSTRACT FROM AUTHOR]

Objectives Nitric oxide ( NO) is a critical regulator of vascular tone and signal transduction in the cardiovascular system. NO is synthesized by three unique enzymes (nitric oxide synthases [ NOS]): endothelial and neuronal NOS, both constitutively expressed, and inducible NOS ( iNOS), which is induced by proinflammatory stimuli and subsequently produces a burst of NO. NO has been implicated as both an injurious and a beneficial mediator after cardiac arrest and resuscitation. A previous study in swine found that iNOS expression is absent in the myocardium prior to cardiac arrest and that it increases after 10 minutes of untreated ventricular fibrillation ( VF), decreases somewhat during the early postresuscitation period, and then steadily increases up to 6 hours postresuscitation. Because this time course of iNOS expression mirrors that of postresuscitation myocardial dysfunction, this study was designed to test the hypothesis that selective inhibition of iNOS improves postresuscitation outcomes in swine. Methods Thirty-two domestic swine of either sex were randomly assigned to receive one of the following treatments 15 minutes after return of spontaneous circulation ( ROSC): 1) NG-nitro- l-arginine methyl ester ( l- NAME), a global NO inhibitor; 2) aminoguanidine ( AG), a selective iNOS inhibitor; or 3) saline as control. After 10 minutes of untreated VF, swine received a standard resuscitation protocol. Twenty-four-hour survival, neurological status, left ventricular ( LV) function, and hemodynamic measurements were obtained. Results Return of spontaneous circulation occurred in 28 of 32 animals (88%). Only successfully resuscitated animals were assigned to treatment groups and completed the study. There were no differences in survival or neurological outcomes between groups. There were also no differences in LV function or hemodynamic variables found between the control group and the AG group. Global inhibition of NOS with l- NAME post- ROSC increased aortic pressure and transiently decreased pulse pressure. Treatment with l- NAME also increased LV end diastolic pressure and decreased cardiac output within 30 minutes post- ROSC, which was sustained throughout the 4-hour measurements, compared to both the control and the AG groups. In addition, LV ejection fraction recovered to baseline measurements in both the control and AG groups, but failed to recover in the l- NAME group. Conclusions Global inhibition of NOS after cardiac arrest and resuscitation markedly worsens hemodynamic variables. Selective inhibition of iNOS after cardiac arrest and resuscitation does not prevent postresuscitation myocardial stunning. There were no significant differences in neurological outcome or survival between treatment groups. [ABSTRACT FROM AUTHOR]

Purpose The purpose of the study was to survey program directors of postdoctoral prosthodontic programs in the United States regarding their programs' complete denture impression techniques. The key objectives of the survey were to identify the current trends in complete denture impression making and to determine which techniques and materials are taught in US postdoctoral prosthodontic programs. Materials and Methods An online survey was sent to all program directors of US postdoctoral prosthodontic programs. The survey comprised two sections: preliminary impressions and final impressions. The survey contained 22 questions that would take approximately 5 minutes to complete. All responses remained anonymous throughout the survey. Results The response rate for the survey was 87%. A majority of the programs did not separately border mold the tray prior to making the preliminary impressions (82%). The impression material of choice for the preliminary impression was irreversible hydrocolloid (88%). Selective pressure was the predominantly used impression philosophy (80%). All programs border molded the custom tray, and 95% recorded the borders in sections. The material of choice for border molding the custom tray was modeling plastic impression compound (71%). The most commonly used impression material for the final impressions was polyvinylsiloxane (PVS) (42%), and the second most commonly used impression material was polysulphide (32%). The most common technique for locating the posterior palatal seal was marking intraorally and transferring onto the final impression (65%). Most programs routinely advised their patients not to wear their existing dentures for at least 24 hours before the final impressions were made (83%). Conclusions Based on the results of this study, the following conclusions can be drawn: (1) The most commonly used material for the preliminary impression was irreversible hydrocolloid and for the final impression was PVS. (2) Modeling plastic impression compound was used by most programs to border mold the custom trays. (3) Selective pressure was the predominantly used impression philosophy. (4) A majority of the programs made a special consideration for excessive movable (flabby) tissue. (5) Most programs routinely advised their patients to not wear their existing dentures for at least 24 hours before the final impressions were made. [ABSTRACT FROM AUTHOR]

Objective: Anti-Tr is among the better described autoantibodies in paraneoplastic cerebellar degeneration (PCD) combined with Hodgkin lymphoma (HL); however, the Tr antigen remains unidentified. Methods: We used immunoprecipitation of total rat brain extract followed by mass spectrometry to identify the antigen recognized by anti-Tr-positive sera. By Western blotting and cell-based assays, we tested a total of 12 anti-Tr-positive and 246 control sera and determined the region of the epitope recognized by the anti-Tr antibodies. Deletion and mutant constructs were generated to further map the antigenic region. Results: Mass spectrometry analysis of immunopurified rat brain extract using 4 different anti-Tr-positive sera led to the identification of Delta/Notch-like epidermal growth factor-related receptor (DNER) as the Tr antigen. All but 1 of 246 control samples were negative in the HeLa cell-based screening assay, whereas 12 of the 12 anti-Tr-positive sera stained hemagglutinin-tagged DNER-expressing cells. Only 1 control subject with HL but no ataxia was found to be both DNER and Tr positive. Using deletion constructs, we pinpointed the main epitope to the extracellular domain. Knockdown of endogenous DNER in hippocampal and N-glycosylation mutations abolished the anti-Tr staining, indicating that glycosylation of DNER is required for it to be recognized by anti-Tr antibodies. Interpretation: DNER is the antigen detected by anti-Tr-positive sera. Presence of anti-Tr antibodies in patients with PCD and HL or HL only can now be screened quickly and reliably by using a cell-based screening assay. ANN NEUROL 2012 [ABSTRACT FROM AUTHOR]

This case report presents treatment of two patients with the usual characteristics of Cleidocranial Dysostosis. A multidisciplinary approach using the disciplines of prosthodontics, orthodontics, and oral surgery was effected. Exfoliation of the patient's deciduous teeth and failure of permanent anterior tooth eruption led to emotional, social, and self-esteem issues in both patients. Due to the psychosocial issues confronting these two patients, esthetics was addressed prior to active intervention with orthodontics and after some surgical intervention. The use of two interim overdenture prostheses with magnetic retention is described. [ABSTRACT FROM AUTHOR]

In many areas of science, research questions imply the analysis of a set of coupled data blocks, with, for instance, each block being an experimental unit by variable matrix, and the variables being the same in all matrices. To obtain an overall picture of the mechanisms that play a role in the different data matrices, the information in these matrices needs to be integrated. This may be achieved by applying a data-analytic strategy in which a global model is fitted to all data matrices simultaneously, as in some forms of simultaneous component analysis (SCA). Since such a strategy implies that all data entries, regardless the matrix they belong to, contribute equally to the analysis, it may obfuscate the overall picture of the mechanisms underlying the data when the different data matrices are subject to different amounts of noise. One way out is to downweight entries from noisy data matrices in favour of entries from less noisy matrices. Information regarding the amount of noise that is present in each matrix, however, is, in most cases, not available. To deal with these problems, in this paper a novel maximum-likelihood-based simultaneous component analysis method, referred to as MxLSCA, is proposed. Being a stochastic extension of SCA, in MxLSCA the amount of noise in each data matrix is estimated and entries from noisy data matrices are downweighted. Both in an extensive simulation study and in an application to data stemming from cross-cultural emotion psychology, it is shown that the novel MxLSCA strategy outperforms the SCA strategy with respect to disclosing the mechanisms underlying the coupled data. [ABSTRACT FROM AUTHOR]

The article presents information on the treatment of Discoid lupus erythematosus (DLE). Lupus erythematosus is a disease with a spectrum ranging from cutaneous involvement only to a serious multisystem disorder with significant sequelae and mortality. Discoid changes typically include persistent erythema, telangiectasia, follicular plugging, scarring, and atrophy. The prognosis of DLE is good, but several outcomes are possible. The cutaneous disease may remit spontaneously, remain minimally active, or progress to pigmentary changes, scarring and disfigurement.

In this article, authors review the English language literature and propose criteria for the diagnosis and management of urticarial vasculitis. A review of the literature has revealed that urticarial vasculitis is a spectrum of disease in its clinical aspects, histopathology, and serology; the course of the disease is usually benign, although there may be late-onset complications; the histological diagnosis is based upon the presence of leukocytoclastic vasculitis; and an organized therapeutic regimen may be helpful in the treatment of urticarial vasculitis.

This clinical report describes the management of chronic, proliferative inflammatory epithelial and fibrous hyperplasia following loss of a mandibular implant-retained prosthesis. A classic surgical technique was used. The patient was referred to the oral surgeon for sialodochoplasty and sulcoplasty. With a combination of surgery and prosthodontic management with a conforming surgical stent, a satisfactory denture foundation was created, allowing for fabrication of an implant-retained definitive prosthesis. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including trends in in-hospital cardiopulmonary resuscitation (CPR), impact of training program on pediatric intensive care unit (ICU) and pediatric risk of mortality (PRISM).

The article discusses urticarial vasculitis in adults by citing case studies. Urticarial vasculitis is an immune complex disease with variable clinical and serologic features. Skin lesions of urticarial vasculitis are characteristically erythematous papules or plaques with central clearing; lesions persist for 48-72 hours, produce burning or pain, and may resolve with secondary skin changes such as purpura or hyperpigmentation. Many patients with urticarial vasculitis show evidence of systemic disease; target organs include the kidneys, lungs and joints.