LA phonospirometry technique compared to pediatric respiratory assessment measure and peak expiratory flow measurement as a novel technique to assess the severity of an asthma exacerbation.

Objective: Asthma is a common chronic disease treated in emergency departments. The measurements of Peak Expiratory Flow (PEF) and Pediatric Respiratory Assessment Measure (PRAM) scores have been recommended as objective techniques in the assessment of acute asthma exacerbations, but have multiple barriers limiting their use. The Los Angeles phonospirometry technique is an easier, trans-cultural technique. The technique assesses dyspnea by measuring how many seconds a child is able to chant "LA LA LA" in a single breath. The objective of this study is to determine the correlation of this technique with PEF measurements and PRAM scores in children with acute asthma exacerbations, both before and after nebulized bronchodilator treatment. Methods: A convenient sample of children aged 5-17 years being treated for asthma in the ED was enrolled. Phonospirometry, PRAM, and PEF measurements were obtained through pre and post inhaled bronchodilator treatments. The highest values from each measurement were correlated using Spearman's correlation coefficient. Results: A total of 91 children were enrolled. The correlations at pre-treatment, after first, second, and third treatments between phonospirometry and PEF were 0.38 (p < 0.001), 0.60 (p < 0.001), 0.54 (p < 0.001), 0.52 (p < 0.01), respectively; between phonospirometry and PRAM were -0.37 (p < 0.001), -0.42 (p < 0.001), -0.26 (p < 0.05), and -0.06 (p > 0.05), respectively; and between PEF and PRAM were -0.6 (p < 0.01), -0.54 (p < 0.001), -0.38 (p < 0.01), and -0.36 (p - 0.05), respectively. Conclusions: This novel technique correlates mild to moderately with PEF, and shows promising aide in the assessment of children with acute asthma exacerbations.

Potencial de reminerialización en premolares expuestos a dos barnices fluorados, estudio in vitro / Remineralization potencial in premolars exposed to two types of fluoride varnishes. In vitro study

Objetivo: Comparar el potencial de remineralización a través de la microdureza del esmalte de premolares con desmineralización artificial, expuestos a dos barnices fluorados: NaF al 5% (Duraphat) y NaF al 5% con TCP (Clinpro™ White Varnish). Metodología: El estudio in vitro incluyó 45 bloques de esmalte que fueron divididos al azar en tres grupos: Grupo 1 (grupo control), Grupo 2 (NaF al 5%) y Grupo 3 (NaF al 5% con TCP). Se crearon lesiones artificiales de caries en el esmalte y luego se aplicó a cada grupo el barniz correspondiente. La muestra fue sometida a pH cíclico por cinco días consecutivos y luego la microdureza superficial fue medida usando la prueba de dureza Vickers. Resultados: La microdureza superficial obtenida después del régimen de tratamiento en cada grupo fue mayor que los valores de microdureza superficial post desmineralización artificial, en donde el Grupo 1 (149,17) presentó la menor microdureza superficial post remineralización, seguida del Grupo 2 (175,85) y el Grupo 3 (182,66). Se observó diferencia significativa cuando se comparó el Grupo 1 con el Grupo 2 y el Grupo 3; sin embargo, entre el Grupo 2 y Grupo 3 no se observó diferencia significativa. Conclusiones: El uso del barniz fluorado en la remineralización de lesiones cariosas incipientes en ambos casos fue efectivo. La adición del TCP en estos compuestos fluorados mostró un mayor valor de microdureza del esmalte dental en comparación con el barniz fluorado con NaF al 5%, pero esta diferencia no fue significativa. (AU)

Objective:The aim of the study was to compare the potential of remineralization through the enamel microhardness of premolars with artificial demineralization, exposed to two fluoride varnishes: 5% NaF (Duraphat) and 5% NaF with TCP (Clinpro ™ White Varnish).Material and Methods:The in vitro study included 45 enamel blocks were randomly divided into three groups: Group 1 (control group), Group 2 (5% NaF) and Group 3 (5% NaF with TCP). Artificial carious lesions in enamel were created and then applied the corresponding varnish to each group. The sample was submitted to cyclic pH for five consecutive days and then the superficial microhardness of the enamel was measured using the Vickers hardness test.Results:The superficial microhardness obtained after treatment regimen in each study group was higher than the values of microhardness post artificial demineralization, where Group 1 (149.17) showed the lowest microhardness post remineralization, followed by Group 2 (175.85) and Group 3 (182.66). Significant difference was observed when compared Group 1 with Group 2 and Group 3; however, between Group 2 and Group 3, no significant difference was observed.Conclusions:The use of fluoride varnish on remineralization of incipient carious lesions in both cases was effective. Addition of TCP in these fluorinated compounds showed a higher microhardness of dental enamel compared with fluoride varnish NaF5%, but this difference was not significant. (AU)

Laparoscopic Reoperative Antireflux Surgery Is More Cost-Effective than Open Approach.

BACKGROUND: We previously reported on the outcomes of laparoscopic and open reoperative antireflux surgery. The aim of this study was to compare the costs of these procedures. STUDY DESIGN: We performed a retrospective review. Financial and procedure coding data were obtained using a cost accounting system. There were 49 procedures in 46 patients (36 female and 10 male). There were 38 laparoscopic (including 4 conversions) and 11 open procedures (7 transabdominal repairs and 4 gastric-preserving Roux-en-Y esophagojejunostomy). Values are median and interquartile range (IQR) and mean costs. RESULTS: Median age was 54 years (IQR 49 to 67 years) for the laparoscopic group vs 56 years (IQR 50 to 65 years) for the open group (p = 0.675). Mean direct costs per case for the laparoscopic group vs open group were $12,655 vs $24,636 (p < 0.002); operating room costs: $3,788 vs $5,547 (p = 0.011); hospital room costs: $1,948 vs $6,438 (p < 0.005); and supply costs: $4,386 vs $5,386 (p = 0.077). Median duration of the operation for the laparoscopic group was 185 minutes (IQR 147 to 254 minutes) vs 308 minutes (IQR 259 to 416 minutes) for the open group (p < 0.002). Median length of stay for the laparoscopic group was 3 days (IQR 2 to 4 days) vs 9 days (IQR 8 to 14 days) for the open group (p < 0.001). There was no 30-day or in-hospital mortality. Excluding the 4 Roux-en-Y procedures, direct costs for the laparoscopic group (n = 38) were $12,655 vs $23,678 for the transabdominal group (n = 7) (p = 0.035); duration of operation: 185 minutes (IQR 147 to 254 minutes) vs 292 minutes (IQR 218 to 309 minutes) (p = 0.003); and length of stay: 3 days (IQR 2 to 4 days) vs 9 days (IQR 7 to 15 days) (p = 0.017). There were 3 recurrences in the laparoscopic group. Two were repaired laparoscopically and 1 required a gastric-preserving Roux-en-Y esophagojejunostomy because the patient had undergone 2 earlier failed repairs. Including the cumulative costs of 3 recurrent hiatal hernia repairs, the driving force to reduce costs remained length of stay, manifested by the costs of the hospital rooms. CONCLUSIONS: Laparoscopic reoperative antireflux surgery is more cost-effective than open repair. The laparoscopic approach, when feasible, should be considered the surgical option for treatment of recurrent hiatal hernia in specialized esophageal centers with highly experienced surgical teams.

Los Angeles phonospirometry technique: creating a normogram that correlates with peak expiratory flow measurements in children.

OBJECTIVE: Measurement of peak expiratory flow (PEF) is recommended in the assessment of patients with asthma. However, the use of PEF involves multiple barriers, which have limited its use. Phonospirometry, as assessed by a novel Los Angeles phonospirometry technique, has shown good correlation to standard PEF measurements in a pilot study on symptomatic patients with asthma. We sought to develop a normogram for phonospirometry, and to validate the PEF normogram. METHODS: A convenience sample of asymptomatic children ages 3-17 years old was approached for participation in the Emergency Department. Sample size calculations determined that at least 30 children per age group (n = 450) were needed. Children were asked to perform PEF measurements and phonospirometry, measured as the length of time (in s) the child was able to chant "lalala" in a single breath. RESULTS: 510 children were enrolled. Spearman's rho between PEF and phonospirometry was 0.722. Phonospirometry correlated with both age and height, with a Spearman rho of 0.697 and 0.696, respectively. This was slightly lower than the correlation of PEF with age and height with Spearman rhos of 0.877 and 0.902, respectively. A normogram was developed for phonospirometry based on age and height. CONCLUSIONS: This study determined normal value ranges for the Los Angeles phonospirometry technique for age and height, and also showed that the technique has good correlation with PEF. This technique may be used to assess a pediatric patient with an acute asthma exacerbation.

A surgical team with focus on staff education in a community hospital improves outcomes, costs and patient satisfaction.

BACKGROUND: Outcomes, decreased costs, and patient satisfaction are the driving forces of a successful surgical practice. METHODS: A surgical team was assembled on October 1, 2010, and educational sessions were implemented. The outcomes and costs for patients who underwent laparoscopic fundoplication and Heller myotomy before and after October 1, 2010, were compared. A Press Ganey patient satisfaction survey was mailed to all patients. RESULTS: There were 268 procedures (103 before and 165 after October 1, 2010): 64 laparoscopic fundoplications and Heller myotomies (23 before and 41 after). There were significant reductions in median operating time (185 minutes [interquartile range {IQR}, 155 to 257 minutes] vs 126 minutes [IQR, 113 to 147 minutes]; P = .001), length of stay (2.0 days [IQR, 2.0 to 4.0 days] vs 1.0 day [IQR, 1.0 to 2.5 days]; P = .05), operating room costs ($2,407 [IQR, $2,171 to $2,893] vs $2,147 [IQR, $1,942 to $2,345]; P = .004), and hospital room costs ($937 [IQR, $799 to $2,159] vs $556 [IQR, $484 to $937]; P = .044). The survey showed significant improvements in patients' experiences in communication with nurses (P = .025), pain management (P = .000), communication about medications (P = .037), and discharge instructions (P = .024). CONCLUSIONS: Assembling a surgical team with focus on staff education has a significant impact on outcomes, costs, and patient satisfaction.

Absorption, distribution, and biotransformation of hexahydro-1,3,5-trinitro-1,3,5-triazine in B6C3F1 mice (Mus musculus).

Absorption, distribution, and biotransformation are 3 critical aspects affecting toxicant action in animals. In the present study, B6C3F1 mice (Mus musculus) were exposed for 28 d to contaminated feed that contained 1 of 5 different hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX) concentrations: 0 mg/kg, 0.5 mg/kg, 5 mg/kg, 50 mg/kg, and 500 mg/kg. The authors quantified RDX and its reductive transformation products hexahydro-1-nitroso-3,5-dinitro-1,3,5-triazine (MNX), hexahydro-1,3-dinitroso-5-nitro-1,3,5-triazine (DNX), and hexahydro-1,3,5-trinitroso-1,3,5-triazine (TNX) in the stomach, intestine, plasma, liver, and brain of these mice. Average RDX concentrations followed a dose-dependent pattern for all matrices tested. No controls had concentrations above limits of detection. Average RDX concentrations in tissues of exposed mice ranged from 11.1 ng/mL to 182 ng/mL, 25.6 ng/g to 3319 ng/g, 123 ng/g to 233 ng/g, 144 ng/g to 35 900 ng/g, and 51.1 ng/g to 2697 ng/g in the plasma, brain, liver, stomach, and intestine, respectively. A considerable amount of RDX was present in the brain, especially in the highest-exposure group. This is consistent with the widely observed central nervous system effects caused by γ-aminobutyric acid inhibition associated with RDX exposure. N-nitroso metabolites of RDX were also present in tested tissues in a dose-dependent pattern. Average MNX concentrations in the stomachs of mice exposed to RDX ranged from nondetectable in control exposures to 490 ng/g in the highest-exposure groups. In the brain, MNX accumulated at a maximum average concentration of 165.1 ng/g, suggesting the potential formation of MNX from RDX within the brain. At higher exposures, DNX and TNX were present in the stomach, plasma, and brain of mice. The presence of RDX metabolites at notable amounts in different tissues suggests that RDX can transform into its N-nitroso metabolites in vivo by an undefined mechanism.

Examination of the mutagenicity of RDX and its N-nitroso metabolites using the Salmonella reverse mutation assay.

The mutagenicity of hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX) and its N-nitroso derivatives hexahydro-1-nitroso-3,5-dinitro-1,3,5-triazine (MNX) and hexahydro-1,3,5-trinitroso-1,3,5-triazine (TNX) were evaluated using the Salmonella tryphimurium reverse mutation assay (Ames assay) with strains TA97a, TA98, TA100, and TA102. Using a preincubation procedure and high S9 activation (9%), RDX was observed to induce weak mutagenesis to strain TA97a with a mutagenicity index (MI) of 1.5-2.0 at a dose range of 32.7-1090microg/plate. MNX induced moderate mutagenesis to strain TA97a with an MI of 1.6-2.8 at a dose range of 21.7-878microg/plate. TNX also induced moderate mutagenesis in strain TA97a with an MI of 2.0-3.5 to TA97a at a dose range of 22.7-1120microg/plate. TNX also caused weak mutagenesis to strain TA100 with S9 activation at the dose of 1200microg/plate. MNX and TNX induced weak to moderate mutagenesis to strain TA102. Strain TA97a was found to be the most sensitive strain among these four strains. No cytotoxicity of RDX, MNX, and TNX was observed at the concentrations used in this study. Doses were verified by HPLC.