Reliability of Center of Pressure Measures for Assessing the Development of Sitting Postural Control in Infants With or at Risk of Cerebral Palsy

Objective To establish the test-retest reliability of linear and nonlinear measures, including intra- and intersession reliability, when used to analyze the center of pressure (COP) time series during the development of infant sitting postural control in infants with or at risk for cerebral palsy (CP). Design Longitudinal study. Setting University hospital laboratory. Participants Infants with or at risk for CP (N=18; mean age ± SD at entry into the study, 13.7±3.6mo). Interventions Not applicable. Main Outcome Measures Infant sitting COP data were recorded for 3 trials at each session (2 sessions for each month within 1 week) for 4 consecutive months. The linear COP parameters of the root mean square, the range of sway for both the anterior-posterior and the medial-lateral directions, and the sway path were calculated. In addition, the nonlinear parameters of approximate entropy, Lyapunov exponent (LyE), and the correlation dimension for both directions were also calculated. Intra- and intersession reliability was computed by the intraclass correlation coefficient (ICC). Results Regarding nonlinear measures, LyE showed high intra- and intersession ICC values in comparison with all other parameters evaluated. Intrasession and intersession reliability increased overall in the last 2 months of data collection and as sitting posture improved. Conclusions Our results suggested that the methodology presented is a reliable way of examining the development of sitting postural control in infants with or at risk for CP, and the reliability results generally parallel values found in sitting postural behavior in typical infants. Therefore, this methodology may be helpful in examining efficacy of therapy protocols directed at advancing sitting postural control in infants with motor developmental delays

Comprehensive Chronic Pain Treatment: Does Smoking Affect Outcomes?

Abstract Objective: To determine whether smoking status effects pain and functional outcomes in a chronic pain program. Methods: A retrospective cohort study of 178 patients treated at the Nebraska Medicine comprehensive Pain Management Program over a five year period was completed. Outcomes measures were the Visual Analog Scale Past Month Average Pain score (VAS-PMA), Multidimensional Pain Inventory pain and interference scales (MPI-P and MPI-I), and the Pain and Impairment Relationship Scale (PAIRS). Patients were categorized by smoking status into non-smoker or current smoker groups. Wilcoxon tests were used to compare the pre scores, post scores, and post-minus-pre scores between smoking status groups. Results: The pre-treatment VAS-PMA and MPI-P median scores were significantly higher in the current smoker group (81.5 and 5.0, respectively) compared to the non-smoker group (76.5 and 4.3, respectively), whereas post-treatment median scores did not differ. Furthermore, the current smoker group had a significantly greater decrease on the MPI-P from pre- to post-treatment (median=-2.0) than the non-smoker group (median=-1.6). In addition, smokers had a significantly higher pre-treatment PAIRS score (73.5) than nonsmokers (70), whereas post-treatment scores did not differ. Conclusion: Smokers and non-smokers both benefit from the program, but smokers, who report greater initial pain and stronger beliefs about the association between pain and functional impairment, may benefit more than non-smokers

Establishing an Institution-Wide Graduate Medical Education Research Collaborative to Promote Scholarly Activities among House Officers

Background: House officers’ ability to participate in research and quality improvement projects can be hindered by barriers, including lack of time, mentoring, and resources. Objective: Create a collaborative for house officers that provides readily accessible resources in study design as well as data collection, analysis, interpretation, and presentation. Methods: In 2017, we established a collaborative comprised of biostatisticians and an Associate Dean for Graduate Medical Research, providing a trove of experience in research and quality improvement. We worked closely with the Institutional Review Board and Electronic Health Records Core to simplify the process for house officers to utilize these research resources. The collaborative has weekly small group meetings to discuss new projects/updates and monthly large group meetings where house officers can present their ideas for additional feedback from peers and additional faculty. These formats are flexible, which allows us to tailor our assistance to the needs of each individual project. Results: In the first year since establishing the collaborative, we have received 51 project concepts from 44 house officers. Of the projects needing assistance (n=44), 100% were discussed in one of our weekly meetings and received assistance from the collaborative, and 34% presented at our large monthly meeting. A year into the collaborative, 20% of projects are either in the data analysis phase or have already been presented. Conclusion: As evidenced by the number of projects we received in our first year, there is a significant benefit for this type of collaborative resource to support and stimulate successful scholarly activity in house officers

Biologic variability of human foreskin fibroblasts in 2D and 3D culture: implications for a wound healing model

<p>Abstract</p> <p>Background</p> <p>The fibroblast-populated 3D collagen matrix is a model of tissue and healing which has been used since the 1980's. It was hypothesized that anchorage disruption of the collagen matrix would produce p53-dependent apoptosis in the embedded fibroblasts, but results of hypothesis testing were variant.</p> <p>Findings</p> <p>The response of p53 to anchorage disruption in 3D culture or to UV irradiation in 2D culture was influenced both by fibroblast strain and culture conditions. It also was determined that data scatter in a collagen matrix contraction assay was related to fibroblast strain and possibly to technical factors, such as cell culture technician and/or number of matrices utilized. Subsequent analysis suggested that phenotypic drift and/or inter-strain genetic variability may have been responsible for the data scatter. In addition, several technical factors were identified that may have contributed to the scatter.</p> <p>Conclusion</p> <p>Experimentation with human foreskin fibroblasts in both 2D and 3D culture can produce variant data. The underlying cause of the data scatter appears to be partially due to the biologic variability of the fibroblast.</p

Induction of Colonic Aberrant Crypts in Mice by Feeding Apparent N-Nitroso Compounds Derived From Hot Dogs

Nitrite-preserved meats (e.g., hot dogs) may help cause colon cancer because they contain N-nitroso compounds. We tested whether purified hot-dog-derived total apparent N-nitroso compounds (ANC) could induce colonic aberrant crypts, which are putative precursors of colon cancer. We purified ANC precursors in hot dogs and nitrosated them to produce ANC. In preliminary tests, CF1 mice received 1 or 3 i.p. injections of 5mg azoxymethane (AOM)/kg. In Experiments 1 and 2, female A/J mice received ANC in diet. In Experiment 1, ANC dose initially dropped sharply because the ANC precursors had mostly decomposed but, later in Experiment 1 and throughout Experiment 2, ANC remained at 85 nmol/g diet. Mice were killed after 8 (AOM tests) or 17–34 (ANC tests) wk.Median numbers of aberrant crypts in the distal 2 cm of the colon for 1 and 3 AOMinjections, CF1 controls, ANC (Experiment 1), ANC (Experiment 2),and untreated A/J mice were 31, 74, 12, 20, 12, and 5–6, with P < 0.01 for both ANC tests. Experiment 2 showed somewhat increased numbers of colonic mucin-depleted foci in the ANC-treated group. We conclude that hot-dog-derived ANC induced significant numbers of aberrant crypts in the mouse colon

Influence of Intraoperative Fluid Volume on Cardiopulmonary Bypass Hematocrit and Blood Transfusions in Coronary Artery Bypass Surgery

A hematocrit (Hct) of less than 25% during cardiopulmonary bypass (CPB) and transfusion of homologous packed red blood cells (PRBC) are each associated with an increased probability of adverse events in cardiac surgery. Although the CPB circuit is a major contributor to hemodilution intravenous (IV) fluid volume may also significantly influence the level of hemodilution. The objective of this study was to explore the influence of asanguinous IV fluid volume on CPB Hct and intraoperative PRBC transfusion. After Institutional Review Board approval, a retrospective chart review of 90 adult patients that had undergone an elective, isolated CABG with CPB was conducted. Regression analysis was used to determine if pre-CPB fluid volume was associated with the lowest CPB Hct and the incidence of an intraoperative PRBC transfusion. In separate multivariate analyses, higher pre-CPB fluid volume was associated with lower minimum CPB Hct (p 1600 mL (n = 35) had a decreased mean low CPB Hct (22.4% vs 25.6%, p < .0001), an increased incidence of a CPB Hct <25% (74% vs. 38%, p = .0008) and PRBC transfusion (60% vs. 16%, p < .0001), and increased median PRBC units transfused (2.0 vs 1.0, p = .1446) despite no significant difference in gender, age, patient size, baseline Hct, or CPB prime volume. Patients that received a PRBC transfusion (n = 30) received a significantly higher volume of pre-CPB fluid than nontransfused patients (1800 vs. 1350 mL, p = .0039). These findings suggest that pre-CPB fluid volume can significantly contribute to hemodilutional anemia in cardiac surgery. Optimizing pre-CPB volume may preserve baseline Hct and help limit intraoperative hemodilution

Autologous Platelet Gel and Platelet-Poor Plasma Reduce Pain With Total Shoulder Arthroplasty

The recovery of patients undergoing total shoulder arthroplasty (TSA) can be adversely affected by a number of complications. Autologous platelet gel (APG), produced by activating platelet-rich plasma (PRP), has been shown to improve hemostasis and wound healing and reduce infections in some surgical procedures. Activated platelet-poor plasma (PPP) has also been used as a hemostatic agent. This study examines the effects of APG and PPP treatment on TSA patients postoperatively. After Institutional Review Board (IRB) approval, 40 patients undergoing TSA at our institution were prospectively enrolled in our study. They were randomized into either a control (n = 20) or study (n = 20) group, with the study group receiving APG and PPP treatment. Preoperative demographic data, pre- and postoperative laboratory data, pain scores, pain medication, complications, pre- and postoperative range of motion measurements, and postoperative lengths of stay were recorded for each group. The preoperative internal rotation index was significantly higher in the control group compared with treatment patients (4.64 ± 4.46 vs. 1.88 ± 2.44, p < .05). The percent hemoglobin retained postoperatively was higher in the treatment group at 24 (84.54 ± 5.32 vs. 79.87 ± 8.73) and 72 hours (87.46 ± 16.03 vs. 76.70 vs. 5.96), but neither difference reached statistical significance. The treatment group had significantly lower pain scores (p = .007) and total fentanyl requirements (p < .05) compared with control patients. The internal rotation index improvement factor (postoperative internal rotation index/preoperative internal rotation index) was significantly higher in the treatment group vs. the control group (p < .05). Although it did not reach statistical significance, the treatment group was discharged almost 9 hours earlier than the control group (64.44 ± 15.23 vs. 73.39 ± 15.37). APG and PPP treatment decreased pain and provided a greater increase in internal rotation measurements postoperatively

Associations of Budd-Chiari Syndrome and Factors Predicting Need for TIPS and Liver Transplantation: Long-Term Single-Center Experience

Background: Budd-Chiari Syndrome (BCS) is a rare thrombotic disorder that involves obstruction of hepatic venous outflow. It can result in increased sinusoidal pressure and portal hypertension. Patients may develop cirrhosis and liver failure from chronic injury, along with other complications such as ascites and varices. BCS is associated with thrombophilia and hematological disorders such as myeloproliferative neoplasms (MPNs) and other auto-immune diseases. Patients typically receive long-term anticoagulation to decrease the risk of recurrence of thrombosis along with supportive measures such as trans-jugular intrahepatic portosystemic shunt (TIPS) and liver transplant. Methods: We performed a retrospective study to describe the patient population with BCS at UNMC. We evaluated 23 patient medical records and collected data on demographics, risk factors, health history, BCS presentation, associated diseases, any acquired/inherited thrombophilia, laboratory results at the earliest available date from diagnosis, and treatments/procedures received. Model of End-Stage Liver Disease (MELD) and Child-Pugh scores were calculated and reported. Descriptive Findings: The median age for the 23 patients in our study was 36 years (range: 11-59 years). The percentage of females was 60.87%. The overall survival rate was 91.3%. Median follow-up duration was 89 months (range: 3-330 months). Of the total, 57% of the patients had myeloproliferative neoplasms (MPNs). Cirrhosis of liver was observed in 74% of the patients. 8.7% of patients developed BCS after receiving the COVID-19 vaccine (Ad26.COV2.S). 91.3% of patients received long-term anticoagulation. 65% of patients received TIPS and/or liver transplant. Conclusion: The most common primary cause of BCS in our study was MPNs (57%). Vaccine-induced thrombotic thrombocytopenia (VITT) after COVID-19 vaccine was found to be a newly described primary cause of BCS.https://digitalcommons.unmc.edu/surp2021/1046/thumbnail.jp