scholarly journals Comparison of the TOFscan and the TOF-Watch SX during pediatric neuromuscular function recovery: a prospective observational study

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Hyung-Been Yhim ◽  
Young-Eun Jang ◽  
Ji-Hyun Lee ◽  
Eun-Hee Kim ◽  
Jin-Tae Kim ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Muscle Relaxant ◽  
Prospective Observational Study ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Three Dimensional ◽  
Limits Of Agreement ◽  
Function Recovery ◽  
Train Of Four ◽  
Good Concordance

Abstract Background TOFscan is a three-dimensional acceleromyography neuromuscular monitoring device that does not require initial calibration before muscle relaxant injection. This study aimed to compare TOFscan with TOF-Watch SX, the currently widely accepted uni-dimensional acceleromyography, for use among the pediatric population. We aimed to assess the agreement between TOFscan with TOF-Watch SX in the pediatric population’s neuromuscular recovery. Methods A total of 35 children aged 6–12 years were enrolled. Prior to any muscle relaxant injection, TOFscan and TOF-Watch SX were applied at each opposite arm and monitoring began concurrently throughout neuromuscular recovery. Calibration was performed for TOF-Watch SX, and train-of-four values were recorded every 15 s. Agreement between the two devices was evaluated with Modified Bland-Altman analysis. Results The bias between TOF-Watch SX and TOFscan were all within the 95% limits of agreement. The bias and standard deviation were smaller and the limit of agreement was narrower in the normalized group than in the non-normalized group [normalized bias −0.002 (95% CI, −0.013 to 0.010), standard deviation (SD) 0.111 vs non-normalized bias 0.010 (95% CI, −0.003 to 0.0236), SD 0.127]. Conclusions TOFscan reliably demonstrated lack of bias and good concordance with TOF-Watch SX throughout the neuromuscular recovery, especially when normalized. Despite technical limitations, the two devices were unbiased along the path of spontaneous and pharmacological reversal in pediatric patients. Trial registration ClinicalTrials.gov NCT03775603. Registered on 13 March 2018

Comparison of the TOFscan and the TOF-Watch SX during Recovery of Neuromuscular Function

2018 ◽  
Vol 129 (5) ◽  
pp. 880-888 ◽  
Author(s):  
Glenn S. Murphy ◽  
Joseph W. Szokol ◽  
Michael J. Avram ◽  
Steven B. Greenberg ◽  
Torin D. Shear ◽  
...  
Keyword(s):  
Neuromuscular Blockade ◽  
Spontaneous Recovery ◽  
Three Dimensional ◽  
Tracheal Extubation ◽  
Neuromuscular Function ◽  
Neuromuscular Monitoring ◽  
Limits Of Agreement ◽  
Train Of Four ◽  
Good Agreement

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Quantitative neuromuscular monitoring is required to ensure neuromuscular function has recovered completely at the time of tracheal extubation. The TOFscan (Drager Technologies, Canada) is a new three-dimensional acceleromyography device that measures movement of the thumb in multiple planes. The aim of this observational investigation was to assess the agreement between nonnormalized and normalized train-of-four values obtained with the TOF-Watch SX (Organon, Ireland) and those obtained with the TOFscan during recovery from neuromuscular blockade. Methods Twenty-five patients were administered rocuronium, and spontaneous recovery of neuromuscular blockade was allowed to occur. The TOFscan and TOF-Watch SX devices were applied to opposite arms. A preload was applied to the TOF-Watch SX, and calibration was performed before rocuronium administration. Both devices were activated, and train-of-four values were obtained every 15 s. Modified Bland–Altman analyses were conducted to compare train-of-four ratios measured with the TOFscan to those measured with the TOF-Watch SX (when train-of-four thresholds of 0.2 to 1.0 were achieved). Results Bias and 95% limits of agreement between the TOF-Watch SX and the TOFscan at nonnormalized train-of-four ratios between 0.2 and 1.0 were 0.021 and −0.100 to 0.141, respectively. When train-of-four measures with the TOF-Watch SX were normalized, bias and 95% limits of agreement between the TOF-Watch SX and the TOFscan at ratios between 0.2 and 1.0 were 0.015 and −0.097 to 0.126, respectively. Conclusions Good agreement between the TOF-Watch SX with calibration and preload application and the uncalibrated TOFscan was observed throughout all stages of neuromuscular recovery.

scholarly journals Hypocalcemia following Neridronate Administration in Pediatric Patients with Osteogenesis Imperfecta: A Prospective Observational Study

2020 ◽  
Vol 09 (02) ◽  
pp. 093-100 ◽  
Author(s):  
Evelina Maines ◽  
Elisa Tadiotto ◽  
Grazia Morandi ◽  
Michela Fedrizzi ◽  
Rossella Gaudino ◽  
...  
Keyword(s):  
Vitamin D ◽  
Observational Study ◽  
Osteogenesis Imperfecta ◽  
Prospective Observational Study ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Vitamin D Levels ◽  
D Values

AbstractThe use of intravenous bisphosphonates has been linked to hypocalcemia both in children and adults with osteogenesis imperfecta (OI). The aims of this study were: (1) to investigate the incidence of hypocalcemia in the first 48 hours (T48) after neridronate infusion in a pediatric population with OI and (2) to assess any correlation between the baseline values of calcium, vitamin D (25-hydroxyvitamin D) and bone turnover markers, and the postinfusion calcium values. We conducted a prospective observational study on 37 pediatric patients. All patients were treated with a single infusion of neridronate at a dose of 1 to 2 mg/kg. The study provided two postinfusion reassessments: 24 hours (T24) and T48 after neridronate administration. Hypocalcemia was observed in 11% of patients at T24 and in 50% of patients at T48 from neridronate infusion. We observed a positive linear correlation between the baseline vitamin D values and postinfusion calcium values, both at baseline and at T24 and T48. Hypocalcemia was mild and asymptomatic in all cases. Postinfusion calcium levels were related to baseline vitamin D levels. Consequently, low vitamin D levels should be considered a significant risk factor for hypocalcemia and should be carefully investigated and treated before neridronate infusion.

scholarly journals A PROSPECTIVE OBSERVATIONAL STUDY ON PATTERN OF ADVERSE DRUG REACTION TO ANTIBIOTICS COMMONLY PRESCRIBED IN THE HOSPITALIZED PEDIATRIC PATIENTS

2018 ◽  
Vol 11 ◽  
Author(s):  
Malarkodi Velraj,
Keyword(s):  
Prospective Observational Study ◽  
Pediatric Patients ◽  
Early Recognition ◽  
Pediatric Population ◽  
Onset Time ◽  
World Health ◽  
Beta Lactams ◽  
Medication Information ◽  
Set Up ◽  
Health Organization

Objective: Antibiotics are the almost usually specified or authorized medication in hospitals, and antibiotics were found to be the almost bothersome classes of drugs providing or endowing to adverse drug reactions (ADRs). Therefore, the present study was conducted to check or regulate the precautions (ADRs) of antibiotics usually specified or authorized in the pediatrics unit. Methods: A potential, experimental, non-interventionist study was conducted or executed in the Department of Pediatrics for a time of 6 months to analyze the ADRs reported spontaneously from the hospital using patient statistics, objective and medication information, data of ADRs, onset time, causal drug details, outcome, and severity. Results: Among 72 ADRs observed, beta-lactams and quinolones were set up to be contributing the highest number of ADRs. The duct or abdominal system was the almost commonly affected organ, followed by respiratory system and the cardiovascular system. The assessment by the World Health Organization causation estimation scale demonstrated that 5.56% ADRs were certain, 55.56% were possible, 30.56% were probable, and 8.33% were unlikely. Conclusion: Thus, the pattern of ADRs occurring in the pediatric population was observed and assessed. Early recognition and management of ADRs are essential to reduce the burden of ADRs

scholarly journals Paranasal Mass in a Healthy Male Toddler

2021 ◽  
pp. 014556132110079
Author(s):  
Melonie Anne Phillips ◽  
Meredith Lind ◽  
Gerd McGwire ◽  
Diana Rodriguez ◽  
Suzanna Logan
Keyword(s):  
Differential Diagnosis ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Age Group ◽  
Significant Morbidity ◽  
Healthy Male ◽  
Neck Tumors ◽  
Complete Surgical Resection ◽  
Maxilla And Mandible ◽  
Benign Mass

Head and neck tumors are rare in pediatric patients but should be kept in the differential when a patient presents with a new swelling or mass. One of these tumors is a myxoma, which is an insidiously growing, benign mass originating from the mesenchyme. They most commonly arise in the myocardium but can also develop in facial structures, particularly in the maxilla and mandible. When arising in facial structures, ocular, respiratory, and digestive systems can be affected based on local invasion. Complete surgical resection is curative but can lead to significant morbidity as well. Here, we present a case of a 15-month-old toddler presenting with a paranasal mass, which was ultimately diagnosed as a maxillary myxoma. This tumor is very rare in the pediatric population, especially in the toddler age-group, reminding clinicians to broaden the differential diagnosis when a patient’s course is atypical.

scholarly journals All-case Japanese post-marketing surveillance of the real-world safety and efficacy of rituximab treatment in patients with refractory nephrotic syndrome

2021 ◽  
Author(s):  
Mana Kobayashi ◽  
Yutaro Kageyama ◽  
Takashi Ando ◽  
Junko Sakamoto ◽  
Shohji Kimura
Keyword(s):  
Nephrotic Syndrome ◽  
Standard Deviation ◽  
Real World ◽  
Pediatric Patients ◽  
Safety And Efficacy ◽  
The Real ◽  
Post Marketing Surveillance ◽  
Post Marketing ◽  
Refractory Nephrotic Syndrome ◽  
Observation Period

Abstract Background Rituximab is conditionally approved in Japan for use in patients with refractory nephrotic syndrome. To meet the conditions of approval, an all-case post-marketing surveillance study was conducted to confirm the real-world safety and efficacy of rituximab in patients of all ages with refractory nephrotic syndrome. Methods All patients scheduled to receive rituximab treatment for refractory nephrotic syndrome were eligible to register (registration: August 29, 2014 through April 15, 2016); the planned observation period was 2 years from the initiation of rituximab treatment (intravenous infusion, 375 mg/m2 once weekly for four doses). The study was conducted at 227 hospitals throughout Japan. Adverse drug reactions (ADRs) were collected for safety outcomes. The efficacy outcomes were relapse-free period and the degree of growth in pediatric (< 15 years) patients. Results In total, 997 (447 pediatric) patients were registered; 981 (445) were included in the safety analysis set; 852 (402) completed the 2-year observation period; and 810 (429) were included in the efficacy analysis set. Refractory nephrotic syndrome had developed in childhood for 85.0% of patients, and 54.6% were aged ≥15 years. ADRs were observed in 527 (53.7%) patients, treatment-related infection/infestation in 235 (24.0%) patients, and infusion reactions in 313 (31.9%) patients. The relapse-free period was 580 days (95% confidence interval, 511–664). There was a significant change in height standard deviation score (pediatric patients; mean change, 0.093; standard deviation, 0.637; P = 0.009). Conclusion The safety and efficacy of rituximab treatment in patients with refractory nephrotic syndrome were confirmed in the real-world setting. Clinical trial registration UMIN000014997.

scholarly journals The follow-up of the robotic-assisted Soave procedure for Hirschsprung’s disease in children

2021 ◽  
Author(s):  
Tran Anh Quynh ◽  
Pham Duy Hien ◽  
Le Quang Du ◽  
Le Hoang Long ◽  
Nguyen Thi Ngoc Tran ◽  
...  
Keyword(s):  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Pediatric Patients ◽  
Three Dimensional ◽  
Dentate Line ◽  
Robotic Arms ◽  
Robotic Assisted ◽  
The Mean ◽  
Pull Through

AbstractRobotic surgery offers three-dimensional visualization and precision of movement that could be of great value to gastrointestinal surgeons. There were many previous reports on robotic technology in performing Soave colonic resection and pull-through for Hirschsprung’s disease in children. This study described the follow-up of the Robotic-assisted Soave procedure for Hirschsprung’s disease in children. Robotic-assisted endorectal pull-through was performed using three robotic arms and an additional 5-mm trocar. The ganglionic and aganglionic segments were initially identified by seromuscular biopsies. The rest of the procedure was carried out according to the Soave procedure. We left a short rectal seromuscular sleeve of 1.5–2 cm above the dentate line. From December 2014 to December 2017, 55 pediatric patients were operated on. Age ranged from 6 months to 10 years old (median = 24.5 months). The aganglionic segment was located in the rectum (n = 38), the sigmoid colon (n = 13), and the left colon (n = 4). The mean total operative time was 93.2 ± 35 min (ranging from 80 to 180 min). Minimal blood was lost during the surgery. During the follow-up period, 41 patients (74.6%) had 1–2 defecations per day, 12 patients (21.8%) had 3–4 defecations per day, and 2 patients (3.6%) had more than 4 defecations per day. Fecal incontinence, enterocolitis, and mild soiling occurred in three (5.4%), four (7.3%), and two pediatric patients, respectively. Robotic-assisted Soave procedure for Hirschsprung’s disease in children is a safe and effective technique. However, a skilled robotic surgical team and procedural modifications are needed.

scholarly journals Quantification of Measurement and Model Effects in Monopile Foundation Scour Protection Experiments

2021 ◽  
Vol 9 (6) ◽  
pp. 585
Author(s):  
Minghao Wu ◽  
Leen De Vos ◽  
Carlos Emilio Arboleda Chavez ◽  
Vasiliki Stratigaki ◽  
Maximilian Streicher ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Flow Field ◽  
Three Dimensional ◽  
Small Scale ◽  
Maximum Wave Height ◽  
Chaotic Flow ◽  
The Mean ◽  
Scour Protection ◽  
Damage Number ◽  
Measurement Effects

The present work introduces an analysis of the measurement and model effects that exist in monopile scour protection experiments with repeated small scale tests. The damage erosion is calculated using the three dimensional global damage number S3D and subarea damage number S3D,i. Results show that the standard deviation of the global damage number σ(S3D)=0.257 and is approximately 20% of the mean S3D, and the standard deviation of the subarea damage number σ(S3D,i)=0.42 which can be up to 33% of the mean S3D. The irreproducible maximum wave height, chaotic flow field and non-repeatable armour layer construction are regarded as the main reasons for the occurrence of strong model effects. The measurement effects are limited to σ(S3D)=0.039 and σ(S3D,i)=0.083, which are minor compared to the model effects.

scholarly journals 1346. Implementation of a Multidisciplinary 48 Hour Antibiotic Timeout in a Pediatric Population

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S684-S684
Author(s):  
Victoria Konold ◽  
Palak Bhagat ◽  
Jennifer Pisano ◽  
Natasha N Pettit ◽  
Anish Choksi ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Pediatric Population ◽  
Intervention Group ◽  
Post Intervention ◽  
Days Of Therapy ◽  
New Antibiotics ◽  
Core Elements ◽  
Quasi Experimental ◽  
Empirical Antibiotics ◽  
The Impact

Abstract Background To meet the core elements required for antimicrobial stewardship programs, our institution implemented a pharmacy-led antibiotic timeout (ATO) process in 2017 and a multidisciplinary ATO process in 2019. An antibiotic timeout is a discussion and review of the need for ongoing empirical antibiotics 2-4 days after initiation. This study sought to evaluate both the multidisciplinary ATO and the pharmacy-led ATO in a pediatric population, compare the impact of each intervention on antibiotic days of therapy (DOT) to a pre-intervention group without an ATO, and to then compare the impact of the pharmacy-led ATO versus multidisciplinary ATO on antibiotic days of therapy (DOT). Methods This was a retrospective, pre-post, quasi-experimental study of pediatric patients comparing antibiotic DOT prior to ATO implementation (pre-ATO), during the pharmacy-led ATO (pharm-ATO), and during the multidisciplinary ATO (multi-ATO). The pre-ATO group was a patient sample from February-September 2016, prior to the initiation of a formal ATO. The pharmacy-led ATO was implemented from February-September 2018. This was followed by a multidisciplinary ATO led by pediatric residents and nurses from February-September 2019. Both the pharm-ATO and the multi-ATO were implemented as an active non-interruptive alert added to the electronic health record patient list. This alert triggered when new antibiotics had been administered to the patient for 48 hours, at which time, the responsible clinician would discuss the antibiotic and document their decision via the alert workspace. Pediatric patients receiving IV or PO antibiotics administered for at least 48 hours were included. The primary outcome was DOT. Secondary outcomes included length of stay (LOS) and mortality. Results 1284 unique antibiotic orders (n= 572 patients) were reviewed in the pre-ATO group, 868 (n= 323 patients) in the pharm-ATO and 949 (n= 305 patients) in the multi-ATO groups. Average DOT was not significantly different pre vs post intervention for either methodology (Table 1). Mortality was similar between groups, but LOS was longer for both intervention groups (Table 1). Impact of an ATO on DOT, Mortality and LOS Conclusion An ATO had no impact on average antibiotic DOT in a pediatric population, regardless of the ATO methodology. Disclosures All Authors: No reported disclosures

scholarly journals Forest Height Estimation Based on P-Band Pol-InSAR Modeling and Multi-Baseline Inversion

2020 ◽  
Vol 12 (8) ◽  
pp. 1319
Author(s):  
Xiaofan Sun ◽  
Bingnan Wang ◽  
Maosheng Xiang ◽  
Liangjiang Zhou ◽  
Shuai Jiang
Keyword(s):  
Standard Deviation ◽  
Vertical Structure ◽  
Incidence Angle ◽  
Three Dimensional ◽  
Solution Space ◽  
Model Complexity ◽  
Two Dimensional ◽  
Dimensional Parameter ◽  
Model Inversion ◽  
Forest Height

The Gaussian vertical backscatter (GVB) model has a pivotal role in describing the forest vertical structure more accurately, which is reflected by P-band polarimetric interferometric synthetic aperture radar (Pol-InSAR) with strong penetrability. The model uses a three-dimensional parameter space (forest height, Gaussian mean representing the strongest backscattered power elevation, and the corresponding standard deviation) to interpret the forest vertical structure. This paper establishes a two-dimensional GVB model by simplifying the three-dimensional one. Specifically, the two-dimensional GVB model includes the following three cases: the Gaussian mean is located at the bottom of the canopy, the Gaussian mean is located at the top of the canopy, as well as a constant volume profile. In the first two cases, only the forest height and the Gaussian standard deviation are variable. The above approximation operation generates a two-dimensional volume only coherence solution space on the complex plane. Based on the established two-dimensional GVB model, the three-baseline inversion is achieved without the null ground-to-volume ratio assumption. The proposed method improves the performance by 18.62% compared to the three-baseline Random Volume over Ground (RVoG) model inversion. In particular, in the area where the radar incidence angle is less than 0.6 rad, the proposed method improves the inversion accuracy by 34.71%. It suggests that the two-dimensional GVB model reduces the GVB model complexity while maintaining a strong description ability.

Three-Dimensional Computerized Anthropometry of the Nose: Landmark Representation Compared to Surface Analysis

2007 ◽  
Vol 44 (3) ◽  
pp. 278-285 ◽  
Author(s):  
Virgilio F. Ferrario ◽  
Fabrizio Mian ◽  
Redento Peretta ◽  
Riccardo Rosati ◽  
Chiarella Sforza
Keyword(s):  
Three Dimensional ◽  
Digital Data ◽  
Limits Of Agreement ◽  
B Splines ◽  
Surface Areas ◽  
Using Data ◽  
Difference Volume ◽  
T Values ◽  
Plaster Models ◽  
Plaster Casts

Objective: To compare three-dimensional nasal measurements directly made on subjects to those made on plaster casts, and nasal dimensions obtained with a surface-based approach to values obtained with a landmark representation. Methods: Soft-tissue nasal landmarks were directly digitized on 20 healthy adults. Stone casts of their noses were digitized and mathematically reconstructed using nonuniform rational B-splines (NURBS) curves. Linear distances, angles, volumes and surface areas were computed using facial landmarks and NURBS-reconstructed models (surface-based approach). Results: Measurements on the stone casts were somewhat smaller than values obtained directly from subjects (differences between −0.05 and −1.58 mm). Dahlberg's statistic ranged between 0.73 and 1.47 mm. Significant (p < .05) t values were found for 4 of 15 measurements. The surface-based approach gave values 3.5 (volumes) and 2.1 (surface area) times larger than those computed with the landmark-based method. The two values were significantly related (volume, r = 0.881; surface, r = 0.924; p < .001), the resulting equations estimated actual values well (mean difference, volume −0.01 mm3, SD 1.47, area 0.05 cm2, SD 1.44); limits of agreement between −2.89 and 2.87 mm3 (volume); −2.88 and 2.78 cm2 (area). Conclusions: Considering the characteristics of the two methods, and for practical purposes, nasal distances and angles obtained on plaster models were comparable to digital data obtained directly from subjects. Surface areas and volumes were best obtained using a surface-based approach, but could be estimated using data provided by the landmark representation.

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