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Song ontogeny in Nuttall's white-crowned sparrows tutored with individual phrases.
Behav Processes. 2018 Feb 17;:
Authors: Soha JA
Behavioral ontogeny involves the interaction of innate predispositions and experience. In bird song learning, one approach to exploring this interaction is to examine the songs rehearsed by young birds whose exposure to tutor models has been carefully controlled. Here, I analyzed the rehearsed repertoire in Nuttall's white-crowned sparrows (Zonotrichia leucophrys nuttalli) tutored with individual phrases of conspecific and heterospecific songs. The proportions of phrase types rehearsed indicate that the learning biases evident in crystallized song are manifest early on, suggesting preferential memorization rather than preferential retention during attrition. The proportion of songs beginning with whistles increased during song rehearsal and phrase sequence variability decreased, consistent with the idea that innate syntax specifications guide song rehearsal. Single-phrase tutored birds overproduced phrases to the same extent previously observed in birds tutored with full, normal song but retained fewer phrase types in their crystallized repertoires. This suggests that in this subspecies, acquired syntax information does not affect the number of phrase types memorized and rehearsed but does affect repertoire attrition at the end of the sensorimotor phase. I discuss these results with a focus on the action of innate templates in song development and subspecies differences in this process.
PMID: 29462650 [PubMed - as supplied by publisher]
Secundum Atrial Septal Defect.
QJM. 2018 Feb 15;:
Authors: Chia RC, Salazar P, Al-Yafi M, Romano S, Farzaneh-Far A
PMID: 29462467 [PubMed - as supplied by publisher]
Determining Brain Mechanisms that Underpin Analgesia Induced by the Use of Pain Coping Skills.
Pain Med. 2018 Feb 16;:
Authors: Cole LJ, Bennell KL, Ahamed Y, Bryant C, Keefe F, Moseley GL, Hodges P, Farrell MJ
Objective: Cognitive behavioral therapies decrease pain and improve mood and function in people with osteoarthritis. This study assessed the effects of coping strategies on the central processing of knee pain in people with osteoarthritis of the knees.
Methods: Mechanical pressure was applied to exacerbate knee pain in 28 people with osteoarthritis of the knee. Reports of pain intensity and functional magnetic resonance imaging measures of pain-related brain activity were recorded with and without the concurrent use of pain coping skills.
Results: Coping skills led to a significant reduction in pain report (Coping = 2.64 ± 0.17, Not Coping = 3.28 ± 0.15, P < 0.001). These strategies were associated with increased activation in pain modulatory regions of the brain (medial prefrontal and rostral anterior cingulate cortices, Pcorrected < 0.05) and decreased pain-related activation in regions that process noxious input (midcingulate cortex, supplementary motor area, secondary somatosensory cortex, and anterior parietal lobule, Pcorrected < 0.05). The magnitude of the decrease in pain report during the use of pain coping strategies was found to be proportional to the decrease in pain-related activation in brain regions that code the aversive/emotional dimension of pain (anterior insula, inferior frontal gyrus, orbitofrontal cortex, Pcorrected < 0.05) but did not differ between groups with and without training in coping skills. However, training in coping skills reduced the extent to which brain responses to noxious input were influenced by anxiety.
Conclusions: The results of this study support previous reports of pain modulation by cognitive pain coping strategies and contribute to the current understanding of how analgesia associated with the use of pain coping strategies is represented in the brain.
PMID: 29462464 [PubMed - as supplied by publisher]
Rhesus macaques form preferences for brand logos through sex and social status based advertising.
PLoS One. 2018;13(2):e0193055
Authors: Acikalin MY, Watson KK, Fitzsimons GJ, Platt ML
Like humans, monkeys value information about sex and status, inviting the hypothesis that our susceptibility to these factors in advertising arises from shared, ancestral biological mechanisms that prioritize social information. To test this idea, we asked whether rhesus macaques (Macaca mulatta) show choice behavior that is similar to humans in response to sex and social status in advertising. Our results show that monkeys form preferences for brand logos repeatedly paired with images of macaque genitals and high status monkeys. Moreover, monkeys sustain preferences for these brand logos even though choosing them provided no tangible rewards, a finding that cannot be explained by a decision mechanism operating solely on material outcomes. Together, our results endorse the hypothesis that the power of sex and status in advertising emerges from the spontaneous engagement of shared, ancestral neural circuits that prioritize information useful for navigating the social environment. Finally, our results show that simple associative conditioning is sufficient to explain the formation of preferences for brand logos paired with sexual or status-based images.
PMID: 29462189 [PubMed - in process]
Not Using a Tourniquet During Anterior Ankle Arthroscopy Did Not Affect Postoperative Intra-Articular Bleeding or Function at Six Months.
J Bone Joint Surg Am. 2018 Feb 21;100(4):344
Authors: Amendola N
PMID: 29462039 [PubMed - in process]
Neuroinflammation and Central Sensitization in Chronic and Widespread Pain.
Anesthesiology. 2018 Feb 19;:
Authors: Ji RR, Nackley A, Huh Y, Terrando N, Maixner W
Chronic pain is maintained in part by central sensitization, a phenomenon of synaptic plasticity, and increased neuronal responsiveness in central pain pathways after painful insults. Accumulating evidence suggests that central sensitization is also driven by neuroinflammation in the peripheral and central nervous system. A characteristic feature of neuroinflammation is the activation of glial cells, such as microglia and astrocytes, in the spinal cord and brain, leading to the release of proinflammatory cytokines and chemokines. Recent studies suggest that central cytokines and chemokines are powerful neuromodulators and play a sufficient role in inducing hyperalgesia and allodynia after central nervous system administration. Sustained increase of cytokines and chemokines in the central nervous system also promotes chronic widespread pain that affects multiple body sites. Thus, neuroinflammation drives widespread chronic pain via central sensitization. We also discuss sex-dependent glial/immune signaling in chronic pain and new therapeutic approaches that control neuroinflammation for the resolution of chronic pain.
PMID: 29462012 [PubMed - as supplied by publisher]
How Surrogate Decision-Makers for Patients With Chronic Critical Illness Perceive and Carry Out Their Role.
Crit Care Med. 2018 Feb 16;:
Authors: Li L, Nelson JE, Hanson LC, Cox CE, Carson SS, Chai EJ, Keller KL, Tulsky JA, Danis M
OBJECTIVES: Family members commonly make medical decision for patients with chronic critical illness. This study examines how family members approach this decision-making role in real time.
DESIGN: Qualitative analysis of interviews with family members in the intervention arm of a randomized controlled communication trial.
SETTINGS: Medical ICUs at four U.S. hospitals.
PARTICIPANTS: Family members of patients with chronic critical illness (adults mechanically ventilated for ≥ 7 d and expected to remain ventilated and survive for ≥ 72 hr) who participated in the active arm of a communication intervention study.
INTERVENTIONS: Family members participated in at least two content-guided, informational, and emotional support meetings led by a palliative care physician and nurse practitioner.
MEASUREMENTS AND MAIN RESULTS: Grounded theory was used for qualitative analysis of 66 audio recordings of meetings with 51 family members. Family members perceived their role in four main ways: voice of the patient, advocate for the patient, advocate for others, and advocate for oneself. Their decision-making was characterized by balancing goals, sharing their role, keeping perspective, remembering previous experiences, finding sources of strength, and coping with various burdens.
CONCLUSIONS: Family members take a multifaceted approach as they participate in decision-making. Understanding how surrogates perceive and act in their roles may facilitate shared decision-making among clinicians and families during critical care.
PMID: 29462004 [PubMed - as supplied by publisher]
Leveraging E-Learning for Pedagogical Innovation in PA Education.
J Physician Assist Educ. 2018 Mar;29(1):62-66
Authors: Straker HO, McDonald PL, Barnett JS, Collins A
PMID: 29461458 [PubMed - in process]
A Program's Analysis of Communication Methods With Clinical Preceptors.
J Physician Assist Educ. 2018 Mar;29(1):39-42
Authors: Hudak NM, Stouder A, Everett CM
PURPOSE: Preceptors value communication with physician assistant (PA) educational programs. This study describes preceptors' perspectives about one PA program's established and new communication strategies to promote preceptor development and retention.
METHODS: An electronic survey of preceptors was conducted in December 2014. Quantitative and qualitative data were analyzed using descriptive statistics.
RESULTS: Eighty-eight of 209 preceptors completed the survey (42% response rate). Preceptors reported satisfaction with communication frequency and quality. The most preferred topics were preceptor benefits, teaching strategies, feedback about students' performance, and program policy updates. Many preceptors reported not receiving communications sent by mail. A majority of preceptors preferred site visits at least once per year and in person.
CONCLUSIONS: Understanding preceptors' preferred topics helped the study program increase its emphasis on those topics. Knowledge that many preceptors do not receive mailed communications has prompted the program to use electronic communication for all communication types. The results reinforced the program's approach to site visits.
PMID: 29461454 [PubMed - in process]
Use of Patient-Related Outcomes After Orthopaedic Trauma: Helpful or Not So Much?
J Orthop Trauma. 2018 Mar;32 Suppl 1:S48-S51
Authors: Obremskey WT, Higgins TF, Bettger JP, Vrahas MS, Lundy DW
Over 100 years ago, the orthopaedic surgeon, Ernest Codman, recommended that surgeons and hospitals be paid by the "end result." Healthcare Reform is moving to value over volume, and patient-reported outcomes (PROs) are 1 measure of quality and outcomes that are becoming pervasive. In this study, the current status of patient-reported outcomes and their use in orthopaedic trauma was reviewed. The contributors presented the state of PRO measurements at the Basic Science Focus Forum at the OTA Annual Meeting in 2016. Information on the currently available PROs was presented and analyzed to determine whether they were adequate for research in orthopaedic trauma. PROs were then discussed in the context of which were the most appropriate for determining outcomes in trauma surgery. The concept of mobility as a validated PRO for an assessment of general health was then presented. The final topic was a summary of how PROs will be used by insurers and governmental agencies. These topics provide a comprehensive overview of the current state of PROs in the context of orthopaedic trauma.
PMID: 29461404 [PubMed - in process]
Metabolomic responses to lumacaftor/ivacaftor in cystic fibrosis.
Pediatr Pulmonol. 2018 Feb 20;:
Authors: Kopp BT, McCulloch S, Shrestha CL, Zhang S, Sarzynski L, Woodley FW, Hayes D
BACKGROUND: Cystic fibrosis (CF) is a life-limiting disease caused by a defect in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Lumacaftor/Ivacaftor is a novel CFTR modulator approved for patients that are homozygous for Phe508del CFTR, but its clinical effectiveness varies amongst patients, making it difficult to determine clinical responders. Therefore, identifying biochemical biomarkers associated with drug response are clinically important for follow-up studies.
METHODS: Serum metabolomics was performed on twenty patients with CF pre- and 6-month post-Lumacaftor/Ivacaftor response via Ultrahigh Performance Liquid Chromatography-Tandem Mass Spectroscopy (UPLC-MS/MS). Correlation with clinical variables was performed.
RESULTS: Metabolomics analysis demonstrated 188 differentially regulated metabolites between patients pre- and post-Lumacaftor/Ivacaftor initiation, with a predominance of lipid and amino acid alterations. The top 30 metabolites were able to differentiate pre- and post-Lumacaftor/Ivacaftor status in greater than 90% of patients via a random-forest confusion matrix. Alterations in bile acids, phospholipids, and bacteria-associated metabolites were the predominant changes associated with drug response. Importantly, changes in metabolic patterns were associated with clinical responders.
CONCLUSIONS: Selected key lipid and amino acid metabolic pathways were significantly affected by Lumacaftor/Ivacaftor initiation and similar pathways were affected in clinical responders. Targeted metabolomics may provide useful and relevant biomarkers of CFTR modulator responses.
PMID: 29461009 [PubMed - as supplied by publisher]
Variability of sun-induced chlorophyll fluorescence according to stand age-related processes in a managed loblolly pine forest.
Glob Chang Biol. 2018 Feb 20;:
Authors: Colombo R, Celesti M, Bianchi R, Campbell PKE, Cogliati S, Cook BD, Corp LA, Damm A, Domec JC, Guanter L, Julitta T, Middleton EM, Noormets A, Panigada C, Pinto F, Rascher U, Rossini M, Schickling A
Leaf fluorescence can be used to track plant development and stress, and is considered the most direct measurement of photosynthetic activity available from remote sensing techniques. Red and far-red Sun Induced chlorophyll Fluorescence (SIF) maps were generated from high spatial resolution images collected with the HyPlant airborne spectrometer over even-aged loblolly pine plantations in North Carolina (USA). Canopy fluorescence yield (i.e., the fluorescence flux normalized by the light absorbed) in the red and far-red peaks was computed. This quantifies the fluorescence emission efficiencies that is more directly linked to canopy function compared to SIF radiances. Fluorescence fluxes and yields were investigated in relation to tree age to infer new insights on the potential of those measurements in better describing ecosystem processes. The results showed that red fluorescence yield varies with stand age. Young stands exhibited a nearly 2-fold higher red fluorescence yield than mature forest plantations, while the far-red fluorescence yield remained constant. We interpreted this finding in a context of photosynthetic stomatal limitation in aging loblolly pine stands. Current and future satellite missions provide global datasets of SIF at coarse spatial resolution, resulting in intra-pixel mixture effects, which could be a confounding factor for fluorescence signal interpretation. To mitigate this effect, we propose a surrogate of the fluorescence yield, namely the Canopy Cover Fluorescence Index (CCFI) that accounts for the spatial variability in canopy structure by exploiting the vegetation fractional cover. It was found that spatial aggregation tended to mask the effective relationships, while the CCFI was still able to maintain this link. This study is a first attempt in interpreting the fluorescence variability in aging forest stands and it may open new perspectives in understanding long-term forest dynamics in response to future climatic conditions from remote sensing of SIF. This article is protected by copyright. All rights reserved.
PMID: 29460467 [PubMed - as supplied by publisher]
Effect of sucralfate on gastric permeability in an ex vivo model of stress-related mucosal disease in dogs.
J Vet Intern Med. 2018 Feb 20;:
Authors: Hill TL, Lascelles BDX, Blikslager AT
BACKGROUND: Sucralfate is a gastroprotectant with no known systemic effects. The efficacy of sucralfate for prevention and treatment of stress-related mucosal diseases (SRMD) in dogs is unknown.
HYPOTHESIS/OBJECTIVES: To develop a canine ex vivo model of SRMD and to determine the effect of sucralfate on mucosal barrier function in this model.
ANIMALS: Gastric antral mucosa was collected immediately postmortem from 29 random-source apparently healthy dogs euthanized at a local animal control facility.
METHODS: Randomized experimental trial. Sucralfate (100 mg/mL) was applied to ex vivo canine gastric mucosa concurrent with and after acid injury. Barrier function was assessed by measurement of transepithelial electrical resistance (TER) and radiolabeled mannitol flux.
RESULTS: Application of acidified Ringers solution to the mucosal side of gastric antrum caused a reduction in gastric barrier function, and washout of acidified Ringers solution allowed recovery of barrier function (TER: 34.0 ± 2.8% of control at maximum injury, 71.3 ± 5.5% at recovery, P < .001). Sucralfate application at the time of injury or after injury significantly hastened recovery of barrier function (TER: 118.0 ± 15.2% of control at maximum injury, P < .001 and 111.0 ± 15.5% at recovery, P = .35).
CONCLUSIONS AND CLINICAL IMPORTANCE: Sucralfate appeared effective at restoring defects in gastric barrier function induced by acid and accelerating repair of tissues subjected to acid in this model, suggesting that sucralfate could have utility for the treatment and prevention of SRMD in dogs.
PMID: 29460464 [PubMed - as supplied by publisher]
Research directions in the clinical implementation of pharmacogenomics - An Overview of US programs and projects.
Clin Pharmacol Ther. 2018 Feb 20;:
Authors: Volpi S, Bult C, Chisholm RL, Deverka PA, Ginsburg GS, Jacob HJ, Kasapi M, McLeod HL, Roden DM, Williams MS, Green ED, Lyman Rodriguez L, Aronson S, Cavallari LH, Denny JC, Dressler L, Johnson JA, Klein TE, Steven Leeder J, Piquette-Miller M, Perera M, Rasmussen-Torvik LJ, Rehm HL, Ritchie MD, Skaar TC, Wagle N, Weinshilboum R, Weitzel KW, Wildin R, Wilson J, Manolio TA, Relling MV
Response to a drug often differs widely among individual patients. This variability is frequently observed not only with respect to effective responses but also with adverse drug reactions. Matching patients to the drugs that are most likely to be effective and least likely to cause harm is the goal of effective therapeutics. Pharmacogenomics (PGx) holds the promise of precision medicine through elucidating the genetic determinants responsible for pharmacological outcomes and using them to guide drug selection and dosing. Here, we survey the US landscape of research programs in PGx implementation, review current advances and clinical applications of PGx, summarize the obstacles that have hindered PGx implementation, and identify the critical knowledge gaps and possible studies needed to help to address them. This article is protected by copyright. All rights reserved.
PMID: 29460415 [PubMed - as supplied by publisher]
Efficacy, safety and pharmacokinetics of a new high-purity factor X concentrate in women and girls with hereditary factor X deficiency.
J Thromb Haemost. 2018 Feb 20;:
Authors: Kulkarni R, James AH, Norton M, Shapiro A
BACKGROUND: A high-purity, plasma-derived factor X concentrate (pdFX) is approved to treat hereditary factor X deficiency, an autosomal recessive disorder.
OBJECTIVE: Post hoc assessment of pdFX pharmacokinetics, safety, and efficacy in women and girls with hereditary factor X deficiency.
PATIENTS/METHODS: Subjects aged ≥12 years with moderate/severe factor X deficiency (plasma factor X activity <5 IU/dL) received on-demand or preventive pdFX (25 IU/kg) for ≤2 years.
RESULTS: Of 16 enrolled subjects, 10 women and girls (aged 14-58 years [median, 25.5 years]) received 267 pdFX infusions. Mean monthly infusions per subject were higher among women and girls (2.48) than men and boys (1.62). In women and girls, 132 assessable bleeding episodes (61 heavy menstrual bleeding, 47 joint, 15 muscle, 9 other) were treated with pdFX, with a 98% treatment success rate versus 100% in men and boys. Mean pdFX incremental recovery was similar in the 2 groups (2.05 vs 1.91 IU/dL per IU/kg), as was mean half-life (29.3 vs 29.5 hours). Of 142 adverse events in women and girls, headache was the most common (12 events in 6 subjects). Six events (2 infusion-site erythema, 2 fatigue, 1 back pain, 1 infusion-site pain) in 2 subjects were considered possibly pdFX related. Following the trial, pdFX was used to successfully maintain hemostasis in 2 subjects undergoing obstetric delivery.
CONCLUSIONS: pdFX was well tolerated and effective in women and girls with factor X deficiency. Although women and girls had different bleeding symptoms and sites than men and boys, their pdFX pharmacokinetic profile was comparable. This article is protected by copyright. All rights reserved.
PMID: 29460388 [PubMed - as supplied by publisher]
Comparison of emerging contaminants in receiving waters downstream of a conventional wastewater treatment plant and a forest-water reuse system.
Environ Sci Pollut Res Int. 2018 Feb 19;:
Authors: McEachran AD, Hedgespeth ML, Newton SR, McMahen R, Strynar M, Shea D, Nichols EG
Forest-water reuse (FWR) systems treat municipal, industrial, and agricultural wastewaters via land application to forest soils. Previous studies have shown that both large-scale conventional wastewater treatment plants (WWTPs) and FWR systems do not completely remove many contaminants of emerging concern (CECs) before release of treated wastewater. To better characterize CECs and potential for increased implementation of FWR systems, FWR systems need to be directly compared to conventional WWTPs. In this study, both a quantitative, targeted analysis and a nontargeted analysis were utilized to better understand how CECs release to waterways from an FWR system compared to a conventional treatment system. Quantitatively, greater concentrations and total mass load of CECs was exhibited downstream of the conventional WWTP compared to the FWR. Average summed concentrations of 33 targeted CECs downstream of the conventional system were ~ 1000 ng/L and downstream of the FWR were ~ 30 ng/L. From a nontargeted chemical standpoint, more tentatively identified chemicals were present, and at a greater relative abundance, downstream of the conventional system as well. Frequently occurring contaminants included phthalates, pharmaceuticals, and industrial chemicals. These data indicate that FWR systems represent a sustainable wastewater treatment alternative and that emerging contaminant release to waterways was lower at a FWR system than a conventional WWTP.
PMID: 29460251 [PubMed - as supplied by publisher]
Warning SINEs: Alu elements, evolution of the human brain, and the spectrum of neurological disease.
Chromosome Res. 2018 Feb 19;:
Authors: Larsen PA, Hunnicutt KE, Larsen RJ, Yoder AD, Saunders AM
Alu elements are a highly successful family of primate-specific retrotransposons that have fundamentally shaped primate evolution, including the evolution of our own species. Alus play critical roles in the formation of neurological networks and the epigenetic regulation of biochemical processes throughout the central nervous system (CNS), and thus are hypothesized to have contributed to the origin of human cognition. Despite the benefits that Alus provide, deleterious Alu activity is associated with a number of neurological and neurodegenerative disorders. In particular, neurological networks are potentially vulnerable to the epigenetic dysregulation of Alu elements operating across the suite of nuclear-encoded mitochondrial genes that are critical for both mitochondrial and CNS function. Here, we highlight the beneficial neurological aspects of Alu elements as well as their potential to cause disease by disrupting key cellular processes across the CNS. We identify at least 37 neurological and neurodegenerative disorders wherein deleterious Alu activity has been implicated as a contributing factor for the manifestation of disease, and for many of these disorders, this activity is operating on genes that are essential for proper mitochondrial function. We conclude that the epigenetic dysregulation of Alu elements can ultimately disrupt mitochondrial homeostasis within the CNS. This mechanism is a plausible source for the incipient neuronal stress that is consistently observed across a spectrum of sporadic neurological and neurodegenerative disorders.
PMID: 29460123 [PubMed - as supplied by publisher]
Introduction to mammalian genome special issue: the combined role of genetics and environment relevant to human disease outcomes.
Mamm Genome. 2018 Feb 19;:
Authors: Rusyn I, Kleeberger SR, McAllister KA, French JE, Svenson KL
PMID: 29460122 [PubMed - as supplied by publisher]
Comparison of image quality and radiation dose between split-filter dual-energy images and single-energy images in single-source abdominal CT.
Eur Radiol. 2018 Feb 19;:
Authors: Euler A, Obmann MM, Szucs-Farkas Z, Mileto A, Zaehringer C, Falkowski AL, Winkel DJ, Marin D, Stieltjes B, Krauss B, Schindera ST
OBJECTIVES: To compare image quality and radiation dose of abdominal split-filter dual-energy CT (SF-DECT) combined with monoenergetic imaging to single-energy CT (SECT) with automatic tube voltage selection (ATVS).
METHODS: Two-hundred single-source abdominal CT scans were performed as SECT with ATVS (n = 100) and SF-DECT (n = 100). SF-DECT scans were reconstructed and subdivided into composed images (SF-CI) and monoenergetic images at 55 keV (SF-MI). Objective and subjective image quality were compared among single-energy images (SEI), SF-CI and SF-MI. CNR and FOM were separately calculated for the liver (e.g. CNRliv) and the portal vein (CNRpv). Radiation dose was compared using size-specific dose estimate (SSDE). Results of the three groups were compared using non-parametric tests.
RESULTS: Image noise of SF-CI was 18% lower compared to SEI and 48% lower compared to SF-MI (p < 0.001). Composed images yielded higher CNRliv over single-energy images (23.4 vs. 20.9; p < 0.001), whereas CNRpv was significantly lower (3.5 vs. 5.2; p < 0.001). Monoenergetic images overcame this inferiority in CNRpv and achieved similar results compared to single-energy images (5.1 vs. 5.2; p > 0.628). Subjective sharpness was equal between single-energy and monoenergetic images and diagnostic confidence was equal between single-energy and composed images. FOMliv was highest for SF-CI. FOMpv was equal for SEI and SF-MI (p = 0.78). SSDE was significant lower for SF-DECT compared to SECT (p < 0.022).
CONCLUSIONS: The combined use of split-filter dual-energy CT images provides comparable objective and subjective image quality at lower radiation dose compared to single-energy CT with ATVS.
KEY POINTS: • Split-filter dual-energy results in 18% lower noise compared to single-energy with ATVS. • Split-filter dual-energy results in 11% lower SSDE compared to single-energy with ATVS. • Spectral shaping of split-filter dual-energy leads to an increased dose-efficiency.
PMID: 29460070 [PubMed - as supplied by publisher]
Splenic contraction: a new member of the hypovolemic shock complex.
Abdom Radiol (NY). 2018 Feb 19;:
Authors: Enslow MS, Preece SR, Wildman-Tobriner B, Enslow RA, Mazurowski M, Nelson RC
OBJECTIVE: The objective of the article is to assess changes in splenic volume in the setting of hypovolemic shock; splenic enhancement in hypovolemic shock is also assessed.
MATERIALS/METHODS: 71 consecutive adult patients with the hypovolemic shock complex on computed tomography (CT) were identified. Spleen volume and enhancement were compared to a baseline CT scan (without shock) or to height- and sex-corrected normal values and a control population when a comparison CT was unavailable.
RESULTS: Splenic volume was significantly lower in the setting of shock. Average splenic volume in adult patients with shock was 107 ± 63 cm3 compared to 220 ± 164 cm3 in the control population (P < 0.001). All shock patients with a comparison CT (n = 35) had decreased splenic volume in the setting of shock. The area under the receiver operating characteristic (ROC) curve for spleen volume predicting shock was 0.83. Splenic enhancement was also significantly lower in the setting of shock. Mean splenic attenuation value in our shock population was 105 ± 34 HU compared to 134 ± 25 HU in the control population (P < 0.001). Decreased splenic enhancement was present in 25 of 71 shock patients and in none of the control patients (P < 0.001).
CONCLUSION: Decreased splenic volume is a ubiquitous and reliable sign of hypovolemic shock and should be considered a member of the hypovolemic shock complex. It is of particular utility when a prior study is available. Splenic hypoenhancement has high specificity and a high positive predictive value for hypovolemic shock in the correct patient population.
PMID: 29460045 [PubMed - as supplied by publisher]