Recurrent pain in a child with cerebral palsy: Answers

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Recurrent abdominal pain in a 7-year-old girl

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Recurrent pain in a child with cerebral palsy: Questions

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A Pragmatic Approach to Assessment of Chronic and Recurrent Pain in Children with Severe Neurologic Impairment

The term "severe neurologic impairment" (SNI) is used to describe a group of disorders of the central nervous system which arise in childhood, resulting in motor impairment, cognitive impairment and medical complexity. As a result, much assistance is required with activities of daily living. Since these patients are often unable to self-report pain, or they may exhibit uncommon behaviors when suffering, pain manifestations may go unrecognized. In this article, the basic principles of how to approach pain in children with SNI are discussed

Engineering muscle networks in 3D gelatin methacryloyl hydrogels: influence of mechanical stiffness and geometrical confinement

In this work, the influence of mechanical stiffness and geometrical confinement on the 3D culture of myoblast-laden gelatin methacryloyl (GelMA) photo-crosslinkable hydrogels was evaluated in terms of in vitro myogenesis. We formulated a set of cell-laden GelMA hydrogels with a compressive modulus in the range 1÷17 kPa, obtained by varying GelMA concentration and degree of cross-linking. C2C12 myoblasts were chosen as the cell model, to investigate the supportiveness of different GelMA hydrogels on myotube formation up to 2 weeks. Results showed that the hydrogels with a stiffness in the range 1÷3 kPa provided enhanced support to C2C12 differentiation in terms of myotube number, rate of formation and space distribution. Finally, we studied the influence of geometrical confinement on myotube orientation by confining cells within thin hydrogel slabs having different cross-sections: i) 2000×2000 m, ii) 1000×1000 m and iii) 500×500 m. The obtained results showed that by reducing the cross-section—i.e., by increasing the level of confinement—myotubes were more likely restrained and formed aligned myostructures that better mimicked the native morphology of skeletal muscle

Calibration of the AquaCrop model for winter wheat using MODIS LAI images

In semi-arid environments vegetation density and distribution is of considerable importance for the hydrological water balance. A number of hydrological models exploit Leaf Area Index (LAI) maps retrievedby remote sensing as a measure of the vegetation cover, in order to enhance the evaluation of evapotran-spiration and interception losses. On the other hand, actual evapotranspiration and vegetation development can be derived through crop growth models, such as AquaCrop, developed by FAO (Food and Agricultural Organization), which allows the simulation of the canopy development of the main field crops. We used MODIS LAI images to calibrate AquaCrop according to the canopy cover development of winter wheat. With this aim we exploited an empirical relationship between LAI and canopy cover. In detail Aquacrop was calibrated with MODIS LAI maps collected between 2008 and 2011, and validated with reference to MODIS LAI maps of 2013-2014 in Rocchetta Sant'Antonio and Sant'Agata, two test sites in the Carapelle watershed, Southern Italy. Results, in terms of evaluation of canopy cover, provided improvements. For example, for Rocchetta Sant'Antonio, the statistical indexes vary from r = 0.40, ER = 0.22, RMSE = 17.28 and KGE = 0.31 (using the model without calibration), to r = 0.86, ER = 0.08, RMSE = 6.01 and KGE 0.85 (after calibration). © 2015 Elsevier B.V

Could cooked eggs provide a quantifiable immunologic stimulus that could accelerate allergy resolution?

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Syphilitic Balanitis of Follmann: Can Dermoscopy Be Useful Tool in the Differential Diagnosis?

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Intranasal dexmedetomidine and intranasal ketamine association allows shorter induction time for pediatric sedation compared to intranasal dexmedetomidine and oral midazolam

Background: Non-painful diagnostic procedures require an inactive state for a prolonged time, so that sedation is often needed in younger children to perform the procedures. Our standard of care in this setting consists of the association between oral midazolam (0.5 mg/kg) and intranasal dexmedetomidine (4 mcg/kg). One of the limits of this approach is that the onset of action is quite delayed (up to 55 min) and poorly predictable. We chose to compare this association with intranasal-ketamine and intranasal-dexmedetomidine.Methods: This is a "pre-post" study. The study population included the first forty children receiving sedation with the "new" combination intranasal ketamine (3 mg/kg) and intranasal dexmedetomidine (4 mcg/kg) compared to a historical cohort including the last forty children receiving sedation with our standard of care combination of intranasal dexmedetomidine (4mcg/kg) and oral midazolam (0,5 mg/kg).Results: The association intranasal dexmedetomidine and intranasal ketamine allowed for a significantly shorter sedation induction time than the combination intranasal dexmedetomidine and oral midazolam (13,5 min versus 35 min). Both group's cumulative data showed a correlation between age and sedation effectiveness, with younger children presenting a higher success rate and shorter induction time (p 0,001).Conclusions: This study suggests that the ketamine and dexmedetomidine intranasal association may have a shorter onset of action when compared to intranasal dexmedetomidine and oral midazolam

Impact of the first COVID-19 lockdown on the relationship with parents and peers in a cohort of adolescents with somatic symptom disorder

To investigate the coping strategies of a group of adolescents with somatic symptom disorder compared to non-somatic symptom disorder peers during the COVID-19 related lockdown.This cross-sectional study is the second part of a previously published study showing an improved trend in depression and anxiety in a group of patients with somatic symptom disorder compared to non-somatic symptom disorder peers. An anonymous semi-structured survey was distributed to two groups of Italian adolescents to measure the impact of quarantine on their daily life and coping strategies.We recruited 115 adolescents, 58 (50.4%) mean age 15.3, with a recent diagnosis of somatic symptom disorder and 57 (49.6%) mean age 15.8, control peers.The aim of this study was to detect differences in coping strategies and relationships with parents and peers, during the lockdown period in a group of adolescents with somatic symptom disorder and low disease burden when compared with a non-somatic symptom disorder group.The relationship with parents significantly worsened in 4 (6.9%) of adolescents with somatic symptom disorder compared to 12 (21.1%) adolescents in the non-somatic symptom disorder group (p = 0.048). The relationship with peers significantly improved in 13 (22.4%) of adolescents with symptom disorder versus 3 (5.3%) of peers of the non- somatic symptom disorder group (p = 0.013).Adolescents with somatic symptom disorder with a low burden of physical symptoms experienced less deterioration in their relationships with parents and peers than the non-somatic symptom disorder group