Tracking rivalry with neural rhythms: multivariate SSVEPs reveal perception during binocular rivalry.

The contents of awareness can substantially change without any modification to the external world. Such effects are exemplified in binocular rivalry, where a different stimulus is presented to each eye causing instability in perception. This phenomenon has made binocular rivalry a quintessential method for studying consciousness and the necessary neural correlates for awareness. However, to conduct research on binocular rivalry usually requires self-reports of changes in percept, which can produce confounds and exclude states and contexts where self-reports are undesirable or unreliable. Here, we use a novel multivariate spatial filter dubbed 'Rhythmic Entrainment Source Separation' to extract steady state visual evoked potentials from electroencephalography data. We show that this method can be used to quantify the perceptual switch-rate of participants during binocular rivalry and therefore may be valuable in experimental contexts where self-reports are methodologically problematic or impossible, particularly as an adjunct. Our analyses also reveal that 'no-report' conditions may affect the deployment of attention and thereby neural correlates, another important consideration for consciousness research.

Gallbladder remnant: A potential source for biliary stones postcholecystectomy; a case report in a child with sickle cell disease.

Stone formation in a gallbladder remnant is a rare postcholecystectomy complication. This report describes the case of gallstones in a gallbladder remnant of an adolescent with sickle cell disease (SCD) years after laparoscopic cholecystectomy. A 15-year-old female with SCD presented to our gastroenterology clinic with concerns of recurrent choledocholithiasis despite cholecystectomy 2 years before presentation. About 4 months before presentation to our clinic, she was evaluated at the referring physician's emergency department for recurrent severe abdominal pain of 1 month duration. After admission to the hospital, common bile duct stones were seen on magnetic resonance cholangiopancreatography (MCRP) imaging and subsequently removed via endoscopic retrograde cholangiopancreatography (ERCP). On review of her MRCP and ERCP at our hospital, a remnant of gallbladder containing multiple stones was identified. She subsequently underwent a laparoscopic resection of the gallbladder remnant. Clinicians should consider biliary duct imaging in children with biliary colic following cholecystectomy, especially those with history of chronic hemolysis.

Association between BMI Change, Transaminases, and Other Metabolic Parameters in Children with Nonalcoholic Fatty Liver Disease.

Background: Weight loss and lifestyle interventions are the mainstay of treatment in pediatric NAFLD. There are gaps in the literature on the objective improvement in BMI to meaningfully impact NAFLD in children. Aim: To determine the decrease in BMI associated with a significant decline in ALT and other metabolic parameters. Methods: Retrospective chart review of pediatric patients with the diagnosis of NAFLD. Data were collected at the baseline and 6 and 12 months. A linear regression model was used to assess the percent change in BMI predictive of change in ALT and other metabolic parameters. Results: 281 charts were included. 71% of patients who had up to a 2.5% loss in BMI at 6 months had a decrease in ALT of up to 10 U/L compared to 43% patients who did not have a decrease in BMI up to 2.5% loss at the same time period (P=0.01). The linear regression model showed that 6-month and 12-month percent changes in BMI are predictive of 6-month and 12-month ALT changes (P=0.01 and 0.02), respectively. ALT normalization was achieved on 12% of patients with a ≥2.5% decrease in BMI at 6 months compared to 1% of patients that had no decrease of ≥2.5% decrease in BMI at 6 months (P=0.01). The mean BMI Z-score decline was 0.18 (P=0.001) in the group with a ≥2.5% decrease in BMI at 6 months. Conclusions: BMI loss of up to 2.5% and the mean BMI Z-score 0.18 are associated with a significant decrease in ALT of up to 10 U/L. BMI percent change at 6 months and 12 months is predictive of changes in ALT. These results should help guide providers in clinical practice set objective goals for the management of children with NAFLD resulting from obesity.

Event-free survival of maralixibat-treated patients with Alagille syndrome compared to a real-world cohort from GALA.

BACKGROUND AND AIMS: Alagille syndrome (ALGS) is characterized by chronic cholestasis with associated pruritus and extrahepatic anomalies. Maralixibat, an ileal bile acid transporter inhibitor, is an approved pharmacologic therapy for cholestatic pruritus in ALGS. Since long-term placebo-controlled studies are not feasible or ethical in children with rare diseases, a novel approach was taken comparing 6-year outcomes from maralixibat trials with an aligned and harmonized natural history cohort from the G lobal AL agille A lliance (GALA) study. APPROACH AND RESULTS: Maralixibat trials comprise 84 patients with ALGS with up to 6 years of treatment. GALA contains retrospective data from 1438 participants. GALA was filtered to align with key maralixibat eligibility criteria, yielding 469 participants. Serum bile acids could not be included in the GALA filtering criteria as these are not routinely performed in clinical practice. Index time was determined through maximum likelihood estimation in an effort to align the disease severity between the two cohorts with the initiation of maralixibat. Event-free survival, defined as the time to first event of manifestations of portal hypertension (variceal bleeding, ascites requiring therapy), surgical biliary diversion, liver transplant, or death, was analyzed by Cox proportional hazards methods. Sensitivity analyses and adjustments for covariates were applied. Age, total bilirubin, gamma-glutamyl transferase, and alanine aminotransferase were balanced between groups with no statistical differences. Event-free survival in the maralixibat cohort was significantly better than the GALA cohort (HR, 0.305; 95% CI, 0.189-0.491; p <0.0001). Multiple sensitivity and subgroup analyses (including serum bile acid availability) showed similar findings. CONCLUSIONS: This study demonstrates a novel application of a robust statistical method to evaluate outcomes in long-term intervention studies where placebo comparisons are not feasible, providing wide application for rare diseases. This comparison with real-world natural history data suggests that maralixibat improves event-free survival in patients with ALGS.

Plant traits and associated data from a warming experiment, a seabird colony, and along elevation in Svalbard.

The Arctic is warming at a rate four times the global average, while also being exposed to other global environmental changes, resulting in widespread vegetation and ecosystem change. Integrating functional trait-based approaches with multi-level vegetation, ecosystem, and landscape data enables a holistic understanding of the drivers and consequences of these changes. In two High Arctic study systems near Longyearbyen, Svalbard, a 20-year ITEX warming experiment and elevational gradients with and without nutrient input from nesting seabirds, we collected data on vegetation composition and structure, plant functional traits, ecosystem fluxes, multispectral remote sensing, and microclimate. The dataset contains 1,962 plant records and 16,160 trait measurements from 34 vascular plant taxa, for 9 of which these are the first published trait data. By integrating these comprehensive data, we bridge knowledge gaps and expand trait data coverage, including on intraspecific trait variation. These data can offer insights into ecosystem functioning and provide baselines to assess climate and environmental change impacts. Such knowledge is crucial for effective conservation and management in these vulnerable regions.

Cessations of consciousness in meditation: Advancing a scientific understanding of nirodha samapatti.

Absence of consciousness can occur due to a concussion, anesthetization, intoxication, epileptic seizure, or other fainting/syncope episode caused by lack of blood flow to the brain. However, some meditation practitioners also report that it is possible to undergo a total absence of consciousness during meditation, lasting up to 7 days, and that these "cessations" can be consistently induced. One form of extended cessation (i.e., nirodha samapatti) is thought to be different from sleep because practitioners are said to be completely impervious to external stimulation. That is, they cannot be 'woken up' from the cessation state as one might be from a dream. Cessations are also associated with the absence of any time experience or tiredness, and are said to involve a stiff rather than a relaxed body. Emergence from meditation-induced cessations is said to have profound effects on subsequent cognition and experience (e.g., resulting in a sudden sense of clarity, openness, and possibly insights). In this paper, we briefly outline the historical context for cessation events, present preliminary data from two labs, set a research agenda for their study, and provide an initial framework for understanding what meditation induced cessation may reveal about the mind and brain. We conclude by integrating these so-called nirodha and nirodha samapatti experiences-as they are known in classical Buddhism-into current cognitive-neurocomputational and active inference frameworks of meditation.

Investigation of advanced mindfulness meditation "cessation" experiences using EEG spectral analysis in an intensively sampled case study.

Mindfulness meditation is a contemplative practice informed by Buddhism that targets the development of present-focused awareness and non-judgment of experience. Interest in mindfulness is burgeoning, and it has been shown to be effective in improving mental and physical health in clinical and non-clinical contexts. In this report, for the first time, we used electroencephalography (EEG) combined with a neurophenomenological approach to examine the neural signature of "cessation" events, which are dramatic experiences of complete discontinuation in awareness similar to the loss of consciousness, which are reported to be experienced by very experienced meditators, and are proposed to be evidence of mastery of mindfulness meditation. We intensively sampled these cessations as experienced by a single advanced meditator (with over 23,000 h of meditation training) and analyzed 37 cessation events collected in 29 EEG sessions between November 12, 2019, and March 11, 2020. Spectral analyses of the EEG data surrounding cessations showed that these events were marked by a large-scale alpha-power decrease starting around 40 s before their onset, and that this alpha-power was lowest immediately following a cessation. Region-of-interest (ROI) based examination of this finding revealed that this alpha-suppression showed a linear decrease in the occipital and parietal regions of the brain during the pre-cessation time period. Additionally, there were modest increases in theta power for the central, parietal, and right temporal ROIs during the pre-cessation timeframe, whereas power in the Delta and Beta frequency bands were not significantly different surrounding cessations. By relating cessations to objective and intrinsic measures of brain activity (i.e., EEG power) that are related to consciousness and high-level psychological functioning, these results provide evidence for the ability of experienced meditators to voluntarily modulate their state of consciousness and lay the foundation for studying these unique states using a neuroscientific approach.

Descelularización y regeneración de tráquea porcina: un acercamiento a la ingeniería tisular / Decellularization and Regeneration of Porcine Trachea: an Approach to Tissue Engineering

Resumen Antecedentes: la ingeniería tisular permite obtener órganos como injertos a partir de tejidos descelularizados, regenerados con células autólogas. Objetivo: descelularizar y regenerar tráqueas porcinas. Material y métodos: se descelularizaron tráqueas porcinas colocándolas cada una en el epiplón de cuatro cerdos Yorkshire para su regeneración in vivo. Una tráquea desce-lularizada con tritón (DT), descelularizada con desoxicolato (DD), descelularizada con desoxicolato y reforzada con un polímero y células epiteliales (DDR), y una nativa crio-preservada (NC). Después de 8 días se obtuvieron la DD, NC y DDR; y al día 15, la DT. Se las evaluó mecánica e histológicamente, se realizó el análisis casuístico. Resultados: las tráqueas descelularizadas conservaron la integridad del cartílago, sin diferencias mecánicas, excepto la DDR con mayor rigidez. Las tráqueas regeneradas presentaron menor rigidez, excepto la DDR que además perdió el epitelio y la vascula-ridad. Las DT, DD mostraron epitelio no respiratorio, fibrosis y vasculogénesis con in-flamación. Conclusiones: las matrices conservaron sus características mecánicas. La regenera-ción in vivo ofrece ventajas como la esterilidad, interacción celular, nutrientes; es senci-llo, factible y económico, pero no hay control del crecimiento celular y vascularización, y los tejidos presentaron alteraciones mecánicas e histológicas. El polímero impidió la re-epitelialización y revascularización. Este estudio abre la posibilidad de mejorar las me-todologías de ingeniería tisular aplicadas al tejido traqueal.

Abstract Introduction: tissue engineering makes it possible to obtain organs as grafts from de-cellularized tissues, regenerated with autologous cells.Objective: decellularize and regenerate porcine tracheas.ARTÍCULO ORIGINAL | Respirar, 2023; 15(3): 188-199 | ISSN 2953-3414 | https://doi.org/10.55720/respirar.15.3.5RECIBIDO: 9 agosto 2023ACEP TADO: 31 agosto 2023 Elisa Barrera-Ramírezhttps://orcid.org/0000-0002-2778-0882Rubén Efraín Garrido-Cardonahttps://orcid.org/0000-0001-6083-5403Alejandro Martínez-Martínezhttps://orcid.org/0000-0003-3448-910XLuis Fernando Plenge-Tellecheahttps://orcid.org/0000-0002-1619-5004Edna Rico-Escobarhttps://orcid.org/0000-0002-0933-0220Esta revista está bajo una licencia de Creative Commons Reconocimiento 4.0 Internacional. Respirar 2023; 15 (3): 189ARTÍCULO ORIGINAL / E. Barrera-Ramírez, R.E. Garrido-Cardona, A. Martínez-Martínez, L.F. Plenge-Tellechea, E. Rico-EscobarDescelularización y regeneración de tráqueaISSN 2953-3414Materials and Methods: Porcine tracheas were decellularized by placing each one in the omentum of four Yorkshire pigs for regeneration in vivo. A trachea decellularized with triton (DT), decellularized with deoxycholate (DD), decellularized with deoxycho-late and reinforced with a polymer, and epithelial cells (DDR), and a cryopreserved na-tive (NC). After 8 days, the DD, NC and DDR were obtained; and on day 15, the DT. The evaluation was mechanically and histologically, performing the case analysis.Results: the decellularized tracheas preserved the integrity of the cartilage, with no me-chanical differences, except for the DDR with greater rigidity. The regenerated trache-as presented less rigidity, except the DDR, which also lost the epithelium and vascular-ity. The DT, DD showed non-respiratory epithelium, fibrosis and vasculogenesis with inflammation.Conclusions: the matrices retained their mechanical characteristics, in vivo regenera-tion offers advantages such as sterility, cell interaction, nutrients; it is simple, feasible and economical, but there is no control of cell growth and vascularization, and the tis-sues presented mechanical and histological alterations. The polymer prevented re-epi-thelialization and revascularization. This study opens the possibility of improving tissue engineering methodologies applied to tracheal tissue.

Insight and the selection of ideas.

Perhaps it is no accident that insight moments accompany some of humanity's most important discoveries in science, medicine, and art. Here we propose that feelings of insight play a central role in (heuristically) selecting an idea from the stream of consciousness by capturing attention and eliciting a sense of intuitive confidence permitting fast action under uncertainty. The mechanisms underlying this Eureka heuristic are explained within an active inference framework. First, implicit restructuring via Bayesian reduction leads to a higher-order prediction error (i.e., the content of insight). Second, dopaminergic precision-weighting of the prediction error accounts for the intuitive confidence, pleasure, and attentional capture (i.e., the feeling of insight). This insight as precision account is consistent with the phenomenology, accuracy, and neural unfolding of insight, as well as its effects on belief and decision-making. We conclude by reflecting on dangers of the Eureka Heuristic, including the arising and entrenchment of false beliefs and the vulnerability of insights under psychoactive substances and misinformation.

Lesion detection in digital breast tomosynthesis: human reader experiments indicate no benefit from the integration of information from multiple planes.

Purpose: In digital breast tomosynthesis (DBT), radiologists need to review a stack of 20 to 80 tomosynthesis images, depending upon breast size. This causes a significant increase in reading time. However, it is currently unknown whether there is a perceptual benefit to viewing a mass in the 3D tomosynthesis volume. To answer this question, this study investigated whether adjacent lesion-containing planes provide additional information that aids lesion detection for DBT-like and breast CT-like (bCT) images. Method: Human reader detection performance was determined for low-contrast targets shown in a single tomosynthesis image at the center of the target (2D) or shown in the entire tomosynthesis image stack (3D). Using simulations, targets embedded in simulated breast backgrounds, and images were generated using a DBT-like (50 deg angular range) and a bCT-like (180 deg angular range) imaging geometry. Experiments were conducted with spherical and capsule-shaped targets. Eleven readers reviewed 1600 images in two-alternative forced-choice experiments. The area under the receiver operating characteristic curve (AUC) and reading time were computed for the 2D and 3D reading modes for the DBT and bCT imaging geometries and for both target shapes. Results: Spherical lesion detection was higher in 2D mode than in 3D, for both DBT- and bCT-like images (DBT: AUC2D=0.790, AUC3D=0.735, P=0.03; bCT: AUC2D=0.869, AUC3D=0.716, P<0.05), but equivalent for capsule-shaped signals (DBT: AUC2D=0.891, AUC3D=0.915, P=0.19; bCT: AUC2D=0.854, AUC3D=0.847, P=0.88). Average reading time was up to 134% higher for 3D viewing (P<0.05). Conclusions: For the detection of low-contrast lesions, there is no inherent visual perception benefit to reviewing the entire DBT or bCT stack. The findings of this study could have implications for the development of 2D synthetic mammograms: a single synthesized 2D image designed to include all lesions present in the volume might allow readers to maintain detection performance at a significantly reduced reading time.

The illusion of insight: detailed warnings reduce but do not prevent false "Aha!" moments.

False "Aha!" moments can be elicited experimentally using the False Insight Anagram Task (FIAT), which combines semantic priming and visual similarity manipulations to lead participants into having "Aha!" moments for incorrect anagram solutions. In a preregistered experiment (N = 255), we tested whether warning participants and explaining to them exactly how they were being deceived, would reduce their susceptibility to false insights. We found that simple warnings did not reduce the incidence of false insights. On the other hand, participants who were given a detailed explanation of the methods used to deceive them experienced a small reduction in false insights compared to participants given no warning at all. Our findings suggest that the FIAT elicits a robust false insight effect that is hard to overcome, demonstrating the persuasive nature of false insights when the conditions are ripe for them.

Development of White Matter Fiber Covariance Networks Supports Executive Function in Youth.

The white matter architecture of the human brain undergoes substantial development throughout childhood and adolescence, allowing for more efficient signaling between brain regions that support executive function. Increasingly, the field understands grey matter development as a spatially and temporally coordinated mechanism that follows hierarchically organized gradients of change. While white matter development also appears asynchronous, previous studies have largely relied on anatomical atlases to characterize white matter tracts, precluding a direct assessment of how white matter structure is spatially and temporally coordinated. Here, we leveraged advances in diffusion modeling and unsupervised machine learning to delineate white matter fiber covariance networks comprised of structurally similar areas of white matter in a cross-sectional sample of 939 youth aged 8-22 years. We then evaluated associations between fiber covariance network structural properties with both age and executive function using generalized additive models. The identified fiber covariance networks aligned with the known architecture of white matter while simultaneously capturing novel spatial patterns of coordinated maturation. Fiber covariance networks showed heterochronous increases in fiber density and cross section that generally followed hierarchically organized temporal patterns of cortical development, with the greatest increases in unimodal sensorimotor networks and the most prolonged increases in superior and anterior transmodal networks. Notably, we found that executive function was associated with structural features of limbic and association networks. Taken together, this study delineates data-driven patterns of white matter network development that support cognition and align with major axes of brain maturation.

Validation of spot urine in estimating 24-h urinary sodium, potassium and sodium-to-potassium ratio during three different sodium diets in healthy adults.

PURPOSE: To evaluate the validity of spot urine assay methods in estimating the 24-h urinary sodium, potassium and sodium-to-potassium ratio during three different sodium diets. MATERIALS AND METHODS: Twelve healthy volunteers were asked to adhere to 3 dietary sodium targets (3.3-5.0g/day,<3.3 g/day and >5.0 g/day) for three consecutive weeks and to measure salt excretion daily in spot urine samples using a self-monitoring device. On day 7 of each week, 24-h urine was collected to compare measured with estimated 24-h salt excretion (by the Kawasaki, Tanaka and INTERSALT equations). RESULTS: Correlation coefficients relating measured and estimated 24-h sodium excretion were low and not significant for Kawasaki and INTERSALT and moderate for the Tanaka equation (τ 0.56-0.64,p<.05). Bland-Altman plots showed considerable differences between estimated and measured sodium excretion across all salt diets. Over 40% of the participants showed an absolute difference between measured and estimated 24-h sodium of more than 1000 mg/day. The correlation coefficients between 24-h and spot Na/K ratio were 0.67, 0.94 and 0.85(p<.05), and mean differences were 0.59, 0.06 and 0.48 for the intermediate, low and high sodium diets, respectively. CONCLUSION: These findings do not support estimation of individual 24-h salt excretion from spot urine by the Kawasaki, Tanaka, or INTERSALT formula. Plain language summaryAccurate monitoring of salt intake is essential to improve BP control. At present, measurement of sodium and potassium excretion in multiple non-consecutive 24-h urinary collections is considered the gold standard for measuring dietary sodium intake. However, this method is burdensome, time-consuming and error prone.Therefore, we assessed and compared the validity of three formula-based approaches to estimate 24-h urinary sodium and potassium excretion and the Na/K ratio from spot urine samples measured by a self-monitoring device under three different sodium diets using 24-h urine collections as the reference.We conclude that use of three commonly used equations that estimate 24-h urinary sodium and potassium excretion result in substantial bias, poor precision and poor accuracy and are therefore not recommended. The Na/K ratio based on multiple casual urine samples may be a useful, low-burden, low-cost alternative method to 24-h urine collection for monitoring daily salt intake.

Emotion regulation difficulties in the relation between stress-related insomnia symptoms and brain response to emotional faces: An fMRI study.

The aim of the current study was to investigate whether the experience of insomnia symptoms per se and symptoms of insomnia due to stress are associated with an increased brain response to the presentation of emotional faces. In addition, we also examined whether the effect of these sleep difficulties on emotional reactivity at the brain level depends on the experience of emotion regulation (ER) difficulties. The current sample consisted of 37 individuals (20 females, 17 males) selected from a larger group of 120 respondents who completed a survey about sleep problems and ER difficulties. Our results indicate that the tendency to experience stress-related insomnia symptoms but not insomnia symptoms per se modulates brain responses to emotional facial expressions, especially in areas of the parietal cortex, insula, and surrounding opercular voxels. Furthermore, difficulties in ER might play an important role, as the effect of stress-related insomnia symptoms on most of these brain regions disappears when controlling for difficulties in ER. However, an effect in the insula was maintained during the presentation of angry faces, suggesting that stress-related insomnia symptoms may increase the brain response to anger in the insula relatively independent from difficulties in ER. These findings suggest that individuals affected by stress-related insomnia symptoms show an enhanced brain response when presented with emotional stimuli (either positive or negative) in brain areas associated with hyperarousal, which could represent a possible ER deficit in these individuals. Thus, interventions that focus on targeting ER difficulties might be effective in reducing the hyperarousal state in individuals affected by stress-related insomnia symptoms.

Procalcitonina y proteína C reactiva séricas como biomarcadores predictivos de dehiscencia de anastomosis intestinal en cirugía colorrectal.

BACKGROUND: There has been recent interest in the seric levels of procalcitonin (PCT) and C reactive protein (PCR) as a marker of intraabdominal infection after a colorrectal surgery, however, the actual literature remains inconclusive. OBJECTIVE: To test if C-Reactive Protein (PCR) and procalcitonin (PCT) as predictive factors of anastomotic leak after colorectal surgery. METHOD: Retrospective cohort, of patients with ileostomy or colostomy who had intestinal transit restitution by general surgeons in our center, from march 2018 to march 2020. RESULTS: We registered 4 (36.4%) anastomotic leaks. We compared median PCR and PCT between group 1 (without anastomotic leak) and group 2 (with anastomotic leak). Median PCT3PO was 4.86 ng/ml in group 1 vs 13.7 ng/ml in group 2, and PCT5PO was 1.3071 ng/ml vs 6.74 ng/ml (DS: 5.04 vs. 11.53 and 0.779 vs. 10.44). Median PCR3PO and PCR5PO was 194.7 mg/l in group 1 vs 100.97 mg/l in group 2, and 159.8 mg/l vs 65.67 mg/l, (DS: 88.78 vs. 82.01 and 94.77 vs. 58.009). CONCLUSIONS: Persistent higher levels of seric PCR and PCT at 3rd and 5th postoperative day could be an anastomotic leackage. This biomarkers might be added as additional criteria of discharge.

ANTECEDENTES: La medición sérica de procalcitonina (PCT) y proteína C reactiva (PCR) como marcadores de infección intraabdominal posterior a la cirugía colorrectal ha tomado interés en los recientes años, sin embargo, la literatura que existe en la actualidad no es concluyente. OBJETIVO: Evaluar los biomarcadores séricos de inflamación procalcitonina (PCT) y proteína C reactiva (PCR) como factores predictores para dehiscencia de anastomosis (DA) en cirugía colorrectal. MÉTODO: Cohorte retrospectiva de pacientes con cirugía abdominal, con ileostomía o colostomía, que fueron protocolizados para restitución del tránsito intestinal por el departamento de cirugía general en un hospital de tercer nivel, de marzo de 2018 a marzo de 2020. RESULTADOS: La DA ocurrió en 4 (36.4%) de 11 pacientes. Se comparó la media de dos grupos: el grupo 1 sin DA frente al grupo 2 que presentaron DA. Las concentraciones séricas de PCT3PO fueron de 4.86 ng/ml en el grupo 1 y 13.7 ng/ml en el grupo 2, y las de PCT5PO fueron de 1.3071 ng/ml y 6.74 ng/ml, respectivamente (desviación estándar [DE]: 5.04 vs. 11.53 y 0.779 vs. 10.44). Las concentraciones séricas de PCR3PO fueron de 194.7 mg/l en el grupo 1 y 100.97 mg/l en el grupo 2, y las de PCR5PO fueron de 159.8 mg/l y 65.67 mg/l, respectivamente (DE: 88.78 vs. 82.01 y 94.77 vs. 58.009). CONCLUSIONES: La persistencia de valores elevados den PCR y PCT séricas al tercer y quinto día posoperatorios pudieran demostrar DA. Estos marcadores podrían agregarse como criterio de egreso.

A Wolf in Sheep's Clothing: Reuse of Routinely Obtained Laboratory Data in Research.

Electronic health records (EHRs) contain valuable data for reuse in science, quality evaluations, and clinical decision support. Because routinely obtained laboratory data are abundantly present, often numeric, generated by certified laboratories, and stored in a structured way, one may assume that they are immediately fit for (re)use in research. However, behind each test result lies an extensive context of choices and considerations, made by both humans and machines, that introduces hidden patterns in the data. If they are unaware, researchers reusing routine laboratory data may eventually draw incorrect conclusions. In this paper, after discussing health care system characteristics on both the macro and micro level, we introduce the reader to hidden aspects of generating structured routine laboratory data in 4 steps (ordering, preanalysis, analysis, and postanalysis) and explain how each of these steps may interfere with the reuse of routine laboratory data. As researchers reusing these data, we underline the importance of domain knowledge of the health care professional, laboratory specialist, data manager, and patient to turn routine laboratory data into meaningful data sets to help obtain relevant insights that create value for clinical care.

Racial/Ethnic Disparities in the Management of Pediatric Acute Pancreatitis Across Children's Hospitals.

OBJECTIVES: Racial or ethnic disparities in health care delivery and resource utilization have been reported in a variety of pediatric diseases. In acute pancreatitis (AP), there is an association between Black race and increased inpatient mortality. Data on the association of race and ethnicity and resource use for managing pediatric AP are lacking. The aim of this study is to investigate this potential association in pediatric AP. METHODS: Retrospective study of children 0-18 years diagnosed with AP in the Pediatric Health Information System (PHIS) database from 2012 to 2018. Descriptive statistics were used to summarize cohort characteristics. Race/ethnicity classifications included non-Hispanic Black (NHB), non-Hispanic White (NHW, used as reference), Hispanic, and "Other." Associations between patient characteristics and race/ethnicity were determined using χ2 tests. Generalized linear mixed regression model was used to determine the association of race/ethnicity with odds of resource utilization, costs, and length of hospital stay after adjusting for covariates with a random intercept for site. RESULTS: Five thousand nine hundred sixty-three patients from 50 hospitals were included. Adjusted analysis showed that NHB children hospitalized with AP were at lower odds of receiving opioids in the first 24 hours [adjusted odds ratio (aOR) = 0.82, 95% confidence interval (CI) = 0.70-0.98] and receiving intravenous fluids during the hospitalization (aOR = 0.64, 95% CI = 0.43-0.96) when compared with NHW children. Additionally, NHB and Hispanic children had a prolonged adjusted mean length of hospital stay and higher hospital costs when compared with NHW children. Although there was no significant association between race/ethnicity and diagnosis of pancreatic necrosis or sepsis, Hispanic and "Other" children were at higher odds of receiving antibiotics during hospitalization for AP (aOR = 1.33, 95% CI = 1.13-1.57 and aOR = 1.37, 95% CI = 1.09-1.73, respectively) than NHW children. CONCLUSIONS: Disparities exist in utilization of health care interventions for pediatric AP patients by race/ethnicity. Future studies should investigate why these disparities exist and if these disparities affect outcomes.

Thinking style and psychosis proneness do not predict false insights.

The FIAT paradigm (Grimmer et al., 2021) is a novel method of eliciting 'Aha' moments for incorrect solutions to anagrams in the laboratory, i.e. false insights. There exist many documented reports of psychotic symptoms accompanying strong feelings of 'Aha!' (Feyaerts, Henriksen, Vanheule, Myin-Germeys, & Sass, 2021; Mishara, 2010; Tulver, Kaup, Laukkonen, & Aru, 2021), suggesting that the newly developed FIAT could reveal whether people who have more false insights are more prone to psychosis and delusional belief. To test this possibility, we recruited 200 participants to take an adapted version of the FIAT and complete measures of thinking style and psychosis proneness. We found no association between experimentally induced false insights and measures of Schizotypy, Need for Cognition, Jumping to Conclusions, Aberrant Salience, Faith in Intuition, or the Cognitive Reflection Task. We conclude that experiencing false insights might not be constrained to any particular type of person, but rather, may arise for anyone under the right circumstances.