Ecological momentary assessment of eating episodes in obese adults.

OBJECTIVE: The context of eating episodes in obesity is poorly understood. This study examined emotional, physiological, and environmental correlates of pathological and nonpathological eating episodes in a heterogeneous sample of obese adults. METHODS: Community-based participants (n = 50; 84% female [n = 42]; mean [standard deviation] body mass index = 40.3 [8.5]; mean [standard deviation] age = 43.0 [11.9]) recorded all eating episodes and their emotional, physiological, and environmental correlates via ecological momentary assessment for 2 weeks. Generalized estimating equations examined relations between these variables and eating episodes characterized by both self-identified loss of control (LOC) while eating and overeating (binge eating; BE), LOC only, overeating only (OE), and neither LOC nor OE (nonpathological eating). RESULTS: Episodes involving loss of control (BE and LOC) were associated with heightened preepisode and postepisode negative effects (Wald χ range, 15.67-24.39; p values < .001), whereas those involving overeating (BE and OE) were associated with the lowest preepisode and postepisode hunger (Wald χ range, 18.14-39.75; p values <.001). LOC episodes were followed by heightened postepisode cravings (Wald χ = 25.87; p < .001) and were most likely to occur when participants were alone (Wald χ = 13.20; p = .004). CONCLUSION: BE and LOC eating were more consistently associated with emotional and physiological cues than OE and nonpathological eating, whereas most environmental variables did not differ among eating episode types. Results support distinctions among the different constructs characterizing aberrant eating and may be used to inform interventions for obesity and related eating pathology.

Sterile cerebrospinal fluid pleocytosis in young febrile infants with urinary tract infections.

OBJECTIVES: To determine the prevalence of and to identify risk factors for sterile cerebrospinal fluid (CSF) pleocytosis in a large sample of febrile young infants with urinary tract infections (UTIs) and to describe the clinical courses of those patients. DESIGN: Secondary analysis of a multicenter retrospective review. SETTING: Emergency departments of 20 North American hospitals. Patients Infants aged 29 to 60 days with temperatures of 38.0°C or higher and culture-proven UTIs who underwent a nontraumatic lumbar puncture from January 1, 1995, through May 31, 2006. MAIN EXPOSURE: Febrile UTI. OUTCOME MEASURES: Presence of sterile CSF pleocytosis defined as CSF white blood cell count of 10/µL or higher in the absence of bacterial meningitis and clinical course and treatment (ie, presence of adverse events, time to defervescence, duration of parenteral antibiotic treatment, and length of hospitalization). RESULTS: A total of 214 of 1190 infants had sterile CSF pleocytosis (18.0%; 95% confidence interval, 15.9%-20.3%). Only the peripheral white blood cell count was independently associated with sterile CSF pleocytosis, and patients with a peripheral white blood cell count of 15/µL or higher had twice the odds of having sterile CSF pleocytosis (odds ratio, 1.97; 95% confidence interval, 1.32-2.94; P = .001). In the subset of patients at very low risk for adverse events (ie, not clinically ill in the emergency department and without a high-risk medical history), patients with and without sterile CSF pleocytosis had similar clinical courses; however, patients with CSF pleocytosis had longer parenteral antibiotics courses (median length, 4 days [interquartile range, 3-6 days] vs 3 days [interquartile range, 3-5 days]) (P = .04). CONCLUSION: Sterile CSF pleocytosis occurs in 18% of young infants with UTIs. Patients with CSF pleocytosis at very low risk for adverse events may not require longer treatment with antibiotics.

Febrile infants with urinary tract infections at very low risk for adverse events and bacteremia.

BACKGROUND: There is limited evidence from which to derive guidelines for the management of febrile infants aged 29 to 60 days with urinary tract infections (UTIs). Most such infants are hospitalized for ≥48 hours. Our objective was to derive clinical prediction models to identify febrile infants with UTIs at very low risk of adverse events and bacteremia in a large sample of patients. METHODS: This study was a 20-center retrospective review of infants aged 29 to 60 days with temperatures of ≥38°C and culture-proven UTIs. We defined UTI by growth of ≥50,000 colony-forming units (CFU)/mL of a single pathogen or ≥10,000 CFU/mL in association with positive urinalyses. We defined adverse events as death, shock, bacterial meningitis, ICU admission need for ventilator support, or other substantial complications. We performed binary recursive partitioning analyses to derive prediction models. RESULTS: We analyzed 1895 patients. Adverse events occurred in 51 of 1842 (2.8% [95% confidence interval (CI): 2.1%-3.6%)] and bacteremia in 123 of 1877 (6.5% [95% CI: 5.5%-7.7%]). Patients were at very low risk for adverse events if not clinically ill on emergency department (ED) examination and did not have a high-risk past medical history (prediction model sensitivity: 98.0% [95% CI: 88.2%-99.9%]). Patients were at lower risk for bacteremia if they were not clinically ill on ED examination, did not have a high-risk past medical history, had a peripheral band count of <1250 cells per µL, and had a peripheral absolute neutrophil count of ≥1500 cells per µL (sensitivity 77.2% [95% CI: 68.6%-84.1%]). CONCLUSION: Brief hospitalization or outpatient management with close follow-up may be considered for infants with UTIs at very low risk of adverse events.

Twenty-month-old patient with distal humerus fracture and concomitant septic arthritis.

Septic arthritis is an infection of the joint space that requires prompt recognition by physicians. In children, the diagnosis of septic arthritis can often be challenging and delayed diagnosis can produce long-term morbidity. Posttraumatic septic arthritis is rarely reported and can be an equally challenging diagnosis. We present a case of a fully immunized 20-month-old boy with Streptococcus pneumoniae posttraumatic septic arthritis without evidence of an open fracture.

Heelys injuries: a review of the National Electronic Injury Surveillance System data.

OBJECTIVE: The purpose of this study was to describe the types and severity of Heelys-related injuries reported to the National Electronic Injury Surveillance System (NEISS). Strategies for prevention of these injuries may be developed using this information. METHODS: We performed a retrospective analysis of the NEISS data of the US Consumer Safety Product Commission between 2002 and 2006. RESULTS: The NEISS had 131 reported Heelys injuries in children. The mean age was 10.02 years. The upper extremity was most commonly injured, accounting for 75 (57.3%) of the 131 injuries. Fractures were the most common injuries, accounting for 66 (50.4%) of the 131 injuries. Children younger than 12 years were more likely to sustain fractures than their older counterparts (P = 0.001). Children 12 years or older were more likely to sustain sprains than the younger children (P ≤ 0.001). There was no difference in injury patterns between the sexes (P = not significant). Six children required hospital admission. There was 1 reported death. CONCLUSIONS: Most injuries sustained from Heelys use are orthopedic injuries. However, a wide variety of other injuries occur with Heelys use. Children can sustain injuries serious enough to require hospital admission. Parents and children should be educated about the importance of protective gear use while "heeling."

Conservation of mus-ms enzyme motions in the apo- and substrate-mimicked state.

Solution NMR spin-relaxation experiments were used to compare mus-ms dynamics in RNase A in the apo form and as complexed to the substrate-mimic, pTppAp. The crystal structure of the RNase A/pTppAp complex was determined and demonstrates that this ligand binds at the active site and utilizes established substrate binding sites in its interaction with RNase A. Relaxation-compensated CPMG experiments identify flexible residues in and around the active site in both the apo and pTppAp-bound enzyme. Quantitative analysis of the NMR spin-relaxation dispersion curves show that the time scale of motion in RNase A is unchanged when pTppAp binds and is similar to the time scale for the rate-determining step of the catalytic reaction. Temperature-dependent measurements provide an activation barrier for motion of 5.2 +/- 1.0 kcal/mol and 4.5 +/- 1.2 kcal/mol for the apo and pTppAp forms of RNase A, respectively. These data indicate very similar motion exists in the free and bound enzyme. Additionally, chemical shift data suggests that the magnitude of motion is also similar for these two forms and that it is likely that apo enzyme interconverts to a structure that resembles a ligand-bound form. Likewise, it appears that the bound conformation samples the apo enzyme form even when ligand is present. Taken together the data imply that RNase A is in a preexisting dynamic equilibrium between two conformations that represent the open and closed enzyme forms. These data suggest that ligand binding stabilizes the bound conformer but does not induce it.

Optimal surgical cytoreduction in patients with Stage III and Stage IV endometrial carcinoma: a study of morbidity and survival.

OBJECTIVE: To evaluate the survival impact of residual disease at the time of primary surgery for patients with Stage III and IV endometrial carcinoma; to assess morbidity associated with surgical cytoreduction. METHOD: All patients with endometrial carcinoma who underwent primary surgical therapy at the University of Miami between January 1, 1990 and June 1, 2002 were identified. Patients meeting FIGO criteria for Stage III or IV disease were selected. Papillary serous and clear cell histology was excluded. RESULTS: Eighty-five patients were identified: 66 Stage III and 19 Stage IV. Only Stage IIIC and Stage IV were included in survival analysis: 72% (33 Stage IIIC, 9 Stage IV) had optimal cytoreduction and 28% (6 Stage IIIC, 10 Stage IV) had suboptimal cytoreduction. The median survival for Stage IIIC and IV disease was 6.7 months for patients with suboptimal cytoreduction and 17.8 months for patients with optimal cytoreduction (P = 0.001). The proportion of patients with major postoperative complications (37.50% vs. 7.25%, P = 0.005), unplanned postoperative SICU admissions (31.25% vs. 7.25%, P = 0.018), and length of hospital stay exceeding 15 days (31.25% vs. 4.35%, P = 0.005) was greater in patients with suboptimal cytoreductive surgery. CONCLUSIONS: Overall survival is lower and morbidity is higher in patients with advanced endometrial carcinoma having suboptimal cytoreduction at the time of primary surgery. Patients with suspected advanced stage endometrial carcinoma should be counseled on the potential benefits of optimal cytoreductive surgery. Alternative treatment options should be considered in those patients with surgically unresectable disease.