http://yael-nissan.weebly.com/uploads/5/2/9/2/5292348/the_introduction_to_pain_an_integrative_review_-_millan.pdf

The induction of pain: an integrative review

Adenosine 5'-triphosphate and adenosine as endogenous signaling molecules in immunity and inflammation

Hemoglobin concentrations were maintained at a mean (±SD) level that was 2.1±0.2 g per deciliter lower in the restrictive-strategy group than in the liberal-strategy group (lowest average levels, 8.7±0.4 and 10.8±0.5 g per deciliter, respectively; P<0.001). Patients in the restrictive-strategy group received 44% fewer transfusions; 174 patients (54%) in that group did not receive any transfusions, as compared with 7 patients (2%) in the liberal-strategy group (P<0.001). New or progressive multiple-organ dysfunction syndrome (the primary outcome) developed in 38 patients in the restrictive-strategy group, as compared with 39 in the liberal-strategy group (12% in both groups) (absolute risk reduction with the restrictive strategy, 0.4%; 95% confidence interval, –4.6 to 5.4). There were 14 deaths in each group within 28 days after randomization. No significant differences were found in other outcomes, including adverse events. Conclusions In stable, critically ill children a hemoglobin threshold of 7 g per deciliter for red-cell transfusion can decrease transfusion requirements without increasing adverse outcomes. (Controlled-trials.com number, ISRCTN37246456.)

/pdf/transfusion-strategies-for-patients-in-pediatric-intensive-3d34vkvpll.pdf

Transfusion Strategies for Patients in Pediatric Intensive Care Units

Objective:Our objective was to quantify incremental risk associated with transfusion of packed red blood cells and other blood components on morbidity after coronary artery bypass graftingDesign:The study design was an observational cohort studySetting:This investigation took place at a large tert

Morbidity and mortality risk associated with red blood cell and blood-component transfusion in isolated coronary artery bypass grafting.

Delis‐Kaplan Executive Function System

A retrospective study of the prevalence of child neuropsychiatric disorders was done involving pervasive developmental disorder (PDD), attention-deficit/hyperactivity disorder (ADHD), and Tourette syndrome in young offenders (15-22 years, n = 126) consecutively referred for presentencing forensic psychiatric investigation (FPI) in Stockholm, Sweden. Most offenders were referred for FPI because of serious offenses. Case report sheets were prepared, and retrospective neuropsychiatric DSM IV diagnoses were made by the first two authors. For best-estimated diagnoses, the case report sheets were then submitted to the fifth author, a child neuropsychiatrist with expertise in this area. Fifteen percent of the subjects had a definite diagnosis of ADHD, and another 15 percent had PDD, including 12 percent PDD not otherwise specified (NOS) and 3 percent Asperger syndrome. Autistic disorder was not found in any case. Tourette syndrome occurred in two percent of the cases. The rate of PDD is particularly striking. Neuropsychiatric diagnoses had been determined in the FPI in only a few cases. The contribution of constitutional problems to later criminal development may have been underestimated.

Juvenile and young adult mentally disordered offenders: the role of child neuropsychiatric disorders

Researchers and clinicians have devoted increasing attention to Asperger's syndrome during the past two decades. Although Asperger's syndrome is a developmental disorder, professionals in a variety of settings have begun to consider the diagnosis among adults who manifest social and communication abnormalities. Case studies (e.g., Baron-Cohen, 1988; Kohn et al., 1998) and prevalence research (Scragg & Shah, 1994) from forensic settings indicate that a small subset of Asperger's syndrome patients come into contact with the legal system due to their social impairments and idiosyncratic interests. We provide case histories of individuals with Asperger's syndrome encountered in forensic contexts and discuss the implications of this disorder for forensic clinicians. Our six cases were notable for certain commonalties, including deficient empathy. The cases also revealed ways in which Asperger's patients tend to differ from most individuals in forensic settings.

Asperger's Syndrome in Forensic Settings

Generation of cytokines in red cell concentrates during storage is prevented by prestorage white cell reduction

Background:

The aim of this study was to investigate the occurrence of postoperative delirium (POD) in elderly patients undergoing major abdominal surgery and to identify factors associated with delirium in this population.



Methods:

Data were collected prospectively from 51 patients aged 65 years or more. Delirium was diagnosed by the Confusion Assessment Method and from the medical records. The Mini Mental State Examination (MMSE) was used to identify cognitive impairment.



Results:

POD occurred in 26 of 51 patients. Delirium lasted for 1–2 days in 14 patients (short POD group) and 3 days or more in 12 patients (long POD group). The latter patients had significantly greater intraoperative blood loss and intravenous fluid infusion, a higher rate of postoperative complications, a lower MMSE score on postoperative day 4 and a longer hospital stay than patients without POD. Patients in the short POD group were significantly older than those in the long POD group and those who did not develop delirium.



Conclusion:

Approximately half of the elderly patients in this study developed POD. Bleeding was found to be an important risk factor for delirium. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Postoperative delirium in elderly patients after major abdominal surgery

Background: The cytokine network has important implications for the systemic inflammatory and metabolic response in trauma and infection. Cytokines exogenously administered to traumatized and infected patients may have implications for the trauma response in these patients. The main objective of this study was to characterize red blood cell concentrates (RBCs) with regard to cytokine content.



Methods: We investigated the concentrations of tumor necrosis factor α (TNF), interleukin-1 β (IL-1), interleukin-6 (IL-6) and interleukin-8 (IL-8) in sixteen units of RBCs stored at +4° C during 40 days. Samples from RBCs were taken every tenth day. Healthy volunteers were used as controls.



Results: IL-1 and IL-8 in RBCs were increased compared to controls, P< 0.01 - P < 0.001 and TNF in RBCs were increased on days 1 and 40 compared to controls, P < 0.05. During storage TNF was highest on day 1, 69 (< 3 - 1060) pg/ml, median (range). IL-1 concentrations increased during the period of storage from 5 (< 2 - 205) pg/ml to 174 (< 2 - 2180) pg/ml, P < 0.01. IL-6 was 6 (< 2 - 210) pg/ml on day 1 and did not change over the period of storage. IL-8 was highest on day 40,164 (15 - 790) pg/ml and compared to day 1 the concentrations were increased on day 10 and day 40, P < 0.05 for both comparisons.



Conclusions: The results indicate the presence of TNF, IL-1, IL-6 and IL-8 in stored RBCs, though there was a great variability over the period of storage and between units of RBCs. In some samples of RBCs the content of cytokines reached levels that may be anticipated to contribute to systemic inflammation and the symptomatology of acute transfusion reactions.

Marianne Kristiansson

Papers

Juvenile and young adult mentally disordered offenders: the role of child neuropsychiatric disorders

Asperger's Syndrome in Forensic Settings

Generation of cytokines in red cell concentrates during storage is prevented by prestorage white cell reduction

Postoperative delirium in elderly patients after major abdominal surgery

Cytokines in stored red blood cell concentrates: promoters of systemic inflammation and simulators of acute transfusion reactions?