Improved survival from congenital heart disease has led to an increasing need for complex reoperation by reentrant sternotomy. Peripheral cannulation and initiation of cardiopulmonary bypass prior to ...sternotomy to avoid the risk of cardiac injury and massive hemorrhage is an option in adults and larger children, but femoral vessel size precludes this strategy in infants. We describe the management of a high-risk reentry sternotomy in an infant for repair of a giant pseudoaneurysm after prior homograft repair of tetralogy of Fallot, using surgical dissection for suprasternal cannulation of the innominate artery and subxyphoid cannulation of the inferior vena cava.
Anesthetic neurotoxicity has been a hot topic in anesthesia for the past decade. It is of special interest to pediatric anesthesiologists. A subgroup of children potentially at greater risk for ...anesthetic neurotoxicity, based on a prolonged anesthetic exposure early in development, are those children receiving anesthesia for surgical repair of congenital heart disease. These children have a known risk of neurologic deficit after cardiopulmonary bypass for surgical repair of congenital heart disease. Yet, the type of anesthesia used has not been considered as a potential etiology for their neurologic deficits. These children not only receive prolonged anesthetic exposure during surgical repair, but also receive repeated anesthetic exposures during a critical period of brain development. Their propensity to abnormal brain development, as a result of congenital heart disease, may modify their risk of anesthetic neurotoxicity. This review article provides an overview of anesthetic neurotoxicity from the perspective of a pediatric cardiac anesthesiologist and provides insight into basic science and clinical investigations as it relates to this unique group of children who have been studied over several decades for their risk of neurologic injury.
Purpose:
Multimodal microimaging in preclinical models is used to examine the effect of spinal metastases on bony structure; however, the evaluation of tumor burden and its effect on microstructure ...has thus far been mainly qualitative or semiquantitative. Quantitative analysis of multimodality imaging is a time consuming task, motivating automated methods. As such, this study aimed to develop a low complexity semiautomated multimodal μCT/μMR based approach to segment rat vertebral structure affected by mixed osteolytic/osteoblastic destruction.
Methods:
Mixed vertebral metastases were developed via intracardiac injection of Ace-1 canine prostate cancer cells in three 4-week-old rnu/rnu rats. μCT imaging (for high resolution bone visualization), T1-weighted μMR imaging (for bone registration), and T2-weighted μMR imaging (for osteolytic tumor visualization) were conducted on one L1, three L2, and one L3 vertebrae (excised). One sample (L1–L3) was processed for undecalcified histology and stained with Goldner’s trichome. The μCT and μMR images were registered using a 3D rigid registration algorithm with a mutual information metric. The vertebral microarchitecture was segmented from the μCT images using atlas-based demons deformable registration, levelset curvature evolution, and intensity-based thresholding techniques. The μCT based segmentation contours of the whole vertebrae were used to mask the T2-weighted μMR images, from which the osteolytic tumor tissue was segmented (intensity-based thresholding).
Results:
Accurate registration of μCT and μMRI modalities yielded precise segmentation of whole vertebrae, trabecular centrums, individual trabeculae, and osteolytic tumor tissue. While the algorithm identified the osteoblastic tumor attached to the vertebral pereosteal surfaces, it was limited in segmenting osteoblastic tissue located within the trabecular centrums.
Conclusions:
This semiautomated segmentation method yielded accurate registration of μCT and μMRI modalities with application to the development of mathematical models analyzing the mechanical stability of metastatically involved vertebrae and in preclinical applications evaluating new and existing treatment effects on tumor burden and skeletal microstructure.
Background
Older adults with mild cognitive impairment (MCI) and Alzheimer’s disease (AD) often exhibit memory and executive deficits on objective cognitive tests. Meanwhile, significant others often ...report observing symptoms of a dysexecutive nature while labeling them as “memory” difficulties. Our study examined whether objective test performances were predictive of informant‐rated executive symptoms in healthy aging, MCI, and AD.
Method
Participants included healthy older controls (n=71), individuals with MCI n=98 (amnestic MCI n=52; non‐amnestic MCI n=43), and persons with AD (n=40). Objective cognitive performances were measured using a standardized executive composite (Trail Making Test B and Stroop Color‐Word Interference) and a standardized memory composite (delayed recall scores from the California Verbal Learning Test‐II and Visual Reproduction‐II). Study partners completed the Dysexecutive Questionnaire (DEX), which assesses executive behaviors and symptoms.
Result
Multiple regression analyses revealed that objective memory performance predicted informant‐rated dysexecutive symptoms in the AD group and in the MCI group as a whole. In contrast, objective executive performance did not predict DEX scores in any of the groups. As expected, objective cognitive performance and DEX scores were not significantly associated in the control group.
Conclusion
Interestingly, we found that objective memory performance predicted informant‐rated dysexecutive symptoms in MCI and AD, while objective executive performance did not. This finding suggests that in everyday life, patient behaviors labeled as “dysexecutive” may be driven by memory deficits. For example, the DEX reviews behaviors that involve attentional difficulties and perseverative thinking, which can be assessed in both memory and executive tests. Overall, these findings underline the importance of integrating objective test performance with reports of patient symptoms in the real world.
This scoping review aimed to investigate whether the construct of mental health used in research in global construction industry workers utilized a dual-continuum model of mental health that ...incorporates both wellbeing and mental illness dimensions.
A search was conducted in SCOPUS, ERIC, PubMed/MEDLINE, PsychINFO, Web of Science, and VOCED between July 2020 and August 2020. Google was searched for additional records between September 2019 to May 2021.
Five focus areas emerged within the 74 articles identified: Mental Health, Mental Illness, Substance Use, Suicide, and Wellbeing. Findings revealed ambiguity in how mental illness and wellbeing were conceptualized and operationalized. No study utilized a dual-continuum model of mental health that incorporated both wellbeing and mental illness dimensions.
Mental health in the construction industry is poorly understood. Construction workers, researchers, and clinicians would benefit from a reliable and valid evidence base to support mental health literacy initiatives and mental health treatments.
Happenings series. An evaluation of the Nursing Research Fund (NRF) in order to assess whether its objectives have been met, and whether continued targeted investment in Canadian nursing research is ...required. The output of the 5 programmes that the NRF was initially set up to support in 1999 are summarised, and recommendations are made regarding a 2nd phase of funding. (BNI unique abstract) 11 references
The aim of this qualitative study was to address the lack of consensus on the current cyberbullying definition and the limited research on definitions of cyberbullying made by emerging adults in ...Australia. Six focus groups were conducted with a total of 39 participants aged 18 to 25 years. The focus groups used a semi-structured question protocol to gain a deeper understanding of emerging adults’ perceptions, observations, and opinions related to cyberbullying. A thematic analysis revealed that participants perceive cyberbullying to be an extension of traditional bullying comprising similar key components (i.e., intent to harm, repetition, and power imbalance). However, despite a consensus on the components involved, the operationalization of these key components differed among participants depending on whether they adopted a perpetrator, target, or bystander perspective. The current study extends on previous research by focusing on the different perspectives of cyberbullying (i.e., perpetrators, targets, and bystanders) rather than assuming a single perspective, and in turn integrating these perspectives to propose a multifaceted definition of cyberbullying.
Skeletal metastases most frequently affect the vertebral column and may lead to severe consequences including fracture. Clinical management of skeletal metastases often utilizes a multimodal ...treatment approach, including bisphosphonates (BPs). Previous work has demonstrated the synergistic potential of photodynamic therapy (PDT) in combination with BP in treating osteolytic disease through structural, histologic, and destructive mechanical testing analyses. Recent work has developed and validated image-based methods that may be used to non-destructively determine mechanical stability in whole bones, and enable their use for additional (i.e. histologic) analysis. In this work we use an intensity-based 3D image registration technique to compare the strain patterns throughout untreated control and BP + PDT treated rnu/rnu rat spinal motion segments with osteolytic metastases. It was hypothesized that the combination treatment will reduce average and maximum strain values and restore the pattern of strain to that of healthy vertebrae. Mean, median, and 90th percentile strains in the control group were significantly higher than the treatment group. High strain areas in both groups were observed around the endplates; in the control group, large areas of high strains were also observed around the lesions and adjacent to the dorsal wall. Absence of high strains adjacent to the dorsal wall (similar to healthy vertebrae) may correspond to a reduced risk of burst fracture following BP + PDT therapy. This study demonstrates the application of non-destructive image analysis to quantify the positive mechanical effects of combined BP + PDT treatment in the metastatic spine.
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