Indiana University-Purdue University Indianapolis (IUPUI) / The need for a safe but effective agent to sedate dental patients who are severe behavior management problems prompted this investigation of ketamine HCl. Ketamine HCl is a general anesthetic agent with the unique property of selectively depressing the higher centers of the brain without adversely affecting respiration or cardiac output. Sixty behavior problem pedodontic patients were selected at random and placed in one of three groups to receive the following treatments: Treatment I - ketamine HCl and scopolamine; Treatment II - ketamine, scopolamine, and droperidol, and Treatment III - ketamine, scopolamine, and nitrous oxide-oxygen analgesia. Each treatment group received ketamine HCl 2 mg/lb and 0.1 - 0.3 mg scopolamine. The second two treatment groups were supplemented with droperidol .025 mg/lb or nitrous oxide-oxygen (20-50%) to maintain anesthesia. The patients were given a series of pre and post-treatment mental and physical tests and were considered completely recovered when they could equal their pre treatment test scores. Routine dental restorative procedures limited to one and one-half hours were carried out with the use of the ruber dam. Onset of anesthesia was five minutes for all three treatment groups. Treatment III showed a significantly longer working time but recovery times were not significantly different between groups. Ketamine HCl was determined to be a safe, effective agent for use in pedodontic outpatients provided prescribed techniques are followed. Complications were infrequent and minor and parental response was considered satisfactory.

Indiana University-Purdue University Indianapolis (IUPUI) / This investigation served as a follow-up of the unilateral and bilateral cleft lip and palate patients who underwent primary alveolar bone grafting at James Whitcomb Riley Hospital of the Indiana University Medical Center. The sample consisted of 18 patients, 15 males and three females, who received primary alveolar grafts between September 7, 1983 and March 5, 1985. Thirteen had complete unilateral clefts, and five had complete bilateral clefts of the lip and palate. The mean age of the group was 8 years, and none had received orthodontic treatment. The statistical analysis of the lateral cephalometric radiographs revealed significant differences in maxillofacial growth between the Riley sample population and the non-cleft, age-matched patients in the University of Michigan Growth Study. The Riley data were, overall, statistically and proportionately smaller than the normal population. These findings are due to the smaller skeletal size of the Riley group. Arch symmetry measurements indicated that at 8 years of age there were significant differences from ideal or perfect symmetry. Due to existent dental development and scarring from the palatal procedure, these findings were expected. Ideal symmetry may not be a realistic achievement for the cleft patients. Palatal surface area values were visually analyzed through graphs. The growth patterns of the Riley population were similar to those of the normal and non-grafted cleft groups in a study from the University of Miami. The data supports the theory that primary alveolar bone grafting, as performed at James Whitcomb Riley Hospital, does not result in growth attenuation.

Natural killer (NK) cells are a type of lymphocyte involved in innate and adaptive immunity. In adults, exercise can increase NK cell cytotoxicity both as a total percent of target cell lysis and an increase in the function of each NK cell. Much less is known about this response in children. Thus, the objectives of this study were to examine: 1) the effects of exercise intensity and structure on NK specific lysis and NKCA per cell in youth, and 2) differences in baseline and post-exercise specific lysis and NKCA per cell by pubertal status and sex. We also examined the NK cell and NK subset response to these exercise protocols by pubertal status and sex to help contextualize the NK functional response. We recruited healthy, recreationally active pre-pubertal (8-11 years, N=5) and late/post-pubertal (15-18 years, N=6) children from the Hamilton community. Participants completed 4 experimental cycling sessions in a randomized order including: high intensity intermittent (HI-INT) or continuous (HI-CONT), and moderate intensity intermittent (MOD-INT) or continuous (MOD-CONT) cycling. Blood was collected at baseline (PRE), immediately post-exercise (POST), and at 30- and 60-minutes recovery (REC1 and REC2, respectively). Peripheral Blood Mononuclear Cells (PBMC) were isolated from each timepoint and used in a cytotoxic assay with K562 targets. Flow cytometry was used to quantify target cell death (reported as specific lysis and NKCA per cell), and to determine NK cells and subsets as a proportion of lymphocytes. Exercise significantly increased specific lysis from PRE (25.1± 6.7%) to POST (30.6±11.0%), while NKCA per cell increased from PRE (0.69±0.76) to REC2 (1.3±1.3); p<0.05 for both. These responses were seen irrespective of exercise intensity and structure, pubertal status, and sex. The % total NK cells increased from PRE to POST (6.8±2.8% vs. 13.6±7.2%), and was greater in post-pubertal children vs. pre-pubertal children (20.9±6.2% vs. 9.1±4.3%), and after HI-INT (15.5±8.1%) and MOD-INT (16.2±9.5%) vs. HI-CONT (12.0 ± 5.0%) and MOD-CONT exercises (10.6 ± 4.5%; p<0.05 for all). Acute exercise can enhance NK cell cytotoxicity in youth regardless of exercise intensity, structure, pubertal status, or sex. NK function and mobilization responses to exercise did not always align, which suggests that unique post-exercise processes contribute to changes in NK cell proportions, specific lysis, and NKCA per cell. Our study has enhanced the understanding of exercise-induced changes NK cell cytotoxicity in the growing years. Future research will focus on explaining these effects, and exploring the clinical application of exercise programs in youth. / Thesis / Master of Science (MSc) / The purpose of this study was to determine if exercise can increase the function of Natural Killer cells (NK cells) in children. These cells are a very important part of our immune system that work to protect us from harmful infections and cancers. We also wanted to see if puberty or sex influence how NK cells respond to exercise. We asked boys and girls who were 8-11 years old or 15-18 years old to visit our lab 5 times. During their first visit, we measured their fitness level. In the next 4 visits, they completed one of four different types of exercise including: 1) 30 minutes of hard cycling, 2) 5 minutes of stop-and-start hard cycling, 3) 30 minutes of less hard cycling, and 4) 5 minutes of stop-and-start less hard cycling. We collected blood at four times during each session, including: 1) before the exercise, 2) immediately after the exercise, 3) 30-minutes after exercise, and 4) 60-minutes after exercise. We took NK cells from this blood and added them to cancer cells. We measured how many cancer cells were killed by the NK cells. We were interested in learning if exercise changed the percent of cancer cells killed by NK cells. We also wanted to know if exercise helped make each NK cell a better killer. We found that immediately after exercise, NK cells were able to kill a greater percent of cancer cells than they could before exercise. We also found that at 60-minutes after exercise, each NK cell killed a greater number of cancer cells than they were able to before exercise. There were no differences in NK cell cancer killing capacity between boys and girls, or between pre-pubertal or post-pubertal children. Our study helps us understand how we can increase important immune functions with exercise in children.

Indiana University-Purdue University Indianapolis (IUPUI) / Malpractice litigation is on the increase and a lack of informed consent is more frequently becoming primary and secondary causes of action. A study was designed to compare and analyze the viewpoints of Indiana pediatric dentists and trial attorneys concerning the doctrine of informed consent. The ultimate goal was to share the information with both groups and raise the level of awareness of the doctrine among pediatric dentists. A three-page questionnaire dealing with the doctrine of informed consent was mailed to 85 pediatric dentists and 350 trial attorneys practicing in Indiana. The response rate for pediatric dentists was 70.6 percent and the response rate for trial attorneys was 61.4 percent. Overall, most pediatric dentists and trial attorneys were moderately familiar with the doctrine of informed consent. However, trial attorneys do not feel that pediatric dentists conform to the doctrine, while pediatric dentists perceive that they do conform. Pediatric dentists and trial attorneys recommend that informed consent be obtained orally and then documented on an informed consent form. Both professional groups agree that obtaining informed consent is necessary in the practice of pediatric dentistry. Unfortunately, pediatric dentists and trial attorneys do not f eel that predoctoral dental school education or specialty training prepares the pediatric dentist to obtain an informed consent. Not surprisingly, both groups feel that pediatric dentists are more concerned with obtaining informed consent today than they were in the past. Most pediatric dentists are obtaining informed consent in less than five minutes. However, pediatric dentists feel that the time spent obtaining informed consent has either remained the same (55.9 percent) or increased (44.1 percent); trial attorneys feel that this trend has increased (81.5 percent). Overall, pediatric dentists and trial attorneys disagree on whether parental consent is required for specific patient types. Moreover, the two groups agree on the type of consent necessary. For 20 dental procedures (54 percent) and disagree on 17 dental procedures (46 percent). Finally, most trial attorneys and pediatric dentists feel that conforming to the doctrine of informed consent reduces or eliminates future malpractice litigation.

No description available.

The benefits of intraoperative transesophageal echocardiography (TEE) during cardiac surgery are well documented. Intraoperative TEE accurately confirms and in many cases refines delineation of congenital heart lesions, can be used as a means for establishing an intraoperative technical surgical score, and offers a low incidence of intraoperative complications. It seemed likely that the rate of perioperative complications in children would be congruent with the current available data in adults. After Institutional Review Board approval, a retrospective chart review of patients at Boston Children's Hospital who underwent the TEE procedure between May 2012 and December 2014 was conducted. The final study sample consisted of 129 patient charts. Adverse events related to TEE were documented and defined as follows: 1) those potentially attributable to TEE and 2) those with a high likelihood of being related to TEE; defined as dysphagia, esophageal perforation, gastrointestinal bleeding, and throat discomfort/pain. Of the 129 total cases, there was only one case reporting an intraoperative adverse event with a high likelihood of being related to TEE. This incidence rate of 0.77% is consistent with the literature existing on adult and pediatric TEE safety studies. Literature on postoperative adverse events related to intraoperative TEE use in pediatric patients was limited to the incidence of dysphagia. The sample included no incidence of dysphagia and the review enumerated six postoperative adverse events (4.65%) of which had a high likelihood of being related to TEE. Three of these events were classified as major and three were classified as minor. Major postoperative events included blood draining from nasogastric/orogastric tubes and blood tinged secretions suctioned from the endotracheal tube. Minor events were patient reported as sore throat and voice hoarseness. It was concluded that TEE use is not associated with an increased risk of adverse events in pediatric patients if performed according to institutional procedure and recommendations. Intraoperative TEE offers immediate assessment of the adequacy of surgical repair and presence of residual lesions. This information can be used to generate a surgical technical performance score. The ability to detect and correct residual lesions with information provided by intraoperative TEE allows the surgeon to improve technical performance thereby reducing postoperative morbidity.

Thesis (M.S.)--Boston University

The aim of this thesis was to determine the synergistic effect of milk and exercise to: promote fat loss while maintaining protein balance and muscle; improve cardiovascular fitness and strength; and to evaluate the short-term adaptations of the inflammatory system and metabolic risk factors in overweight adolescents (boys ages 11-15 years, girls ages 9 to 13 years). A 7-day dietary intervention with 1-h intense exercise was used with randomization to milk (MILK: n=26, 8 male, 18 female) or carbohydrate beverage (CONT; n=29, 12 male, 17 female) post exercise. Both groups received a diet based on their resting energy expenditure. To determine whole body protein balance (WBPB), participants consumed 15N-glycine. Subjects performed a maximal cycling test to determine changes in power and 1-repetition maximum testing to determine changes in strength. Blood was taken to evaluate glucose and insulin; tumour necrosis factor-alpha (TNF-α), interleukin-6 and c-reactive protein ; and blood pressure was measured pre and post intervention. Although body weights did not change, the MILK group maintained more muscle (-0.2 ± 0.6 vs. -0.7 ± 0.8 kg, p<0.01) and had a greater loss in body fat (-0.4 ± 1 vs. 0.5 ± 1.0 %, p<0.006). The changes in body composition were supported by a greater WBPB after training in the MILK group (1.64 ± 1.1 vs. 0.84 ± 0.6, p<0.001). Power increased only in the MILK group with an increase of 0.13 watts/kg (p<0.05) with an increase in V02max that approached significance (p=0.06). Improvements in strength and the blood risk factors were not different between the groups. There was a greater decline in mean arterial pressure in the MILK group (-3 ± 6 mmHg vs. 2 ± 7 mmHg, p< 0.04). The exercise intervention led to an increase in TNF-α in both groups (0.3 ± 0.7 pg/ml vs. 0.5 ± 0.7 pg/ml, p<0.001). These data support the consumption of milk after exercise in the early stages of pediatric obesity treatment. / Thesis / Doctor of Philosophy (PhD) / The aim of this thesis was to determine if milk and exercise work together to: promote body fat loss while maintaining protein balance and muscle in overweight adolescents; increase fitness and strength; and assess changes in inflammatory markers and disease risk factors. A 7-day diet with 1-hour exercise sessions was performed with milk or a carbohydrate drink. Protein balance was measured by a urine marker. Pre and post the following measures were used: cycling test for power; weight lifting test for strength; blood for disease markers; and blood pressure. After the week, the milk group were in a more positive protein balance, maintained more muscle, had a greater loss in body fat, greater increase in power and lower blood pressure compared to the carbohydrate group. Some of the inflammatory markers increased in both groups. Exercise combined with the nutrients from milk can have a positive effect on adolescent health.

The purpose of this study was to investigate the neuropsychological outcomes of pediatric subjects undergoing temporal lobe surgery, and then compare the outcomes between subjects in the iMRI and the standard operating suites. This study involved 77 children ages one to 21 years (M = 11.98) at time of surgery for intractable epilepsy. Forty-seven returned for repeat neuropsychological assessment. At baseline, subjects with early onset of epilepsy (≤ 7 years) scored worse on a measure of attention (p = .02), FSIQ (p < .01), perceptual reasoning (p < .01), and processing speed (p = .06). At one-year follow-up, interactions were observed for the response style domain of the attention measure (p = .03), FSIQ (p = .06) and working memory (p = .08). Follow-up at one year, for the group as a whole, revealed decline in verbal memory (p = .04) and reading comprehension (p = .02); and improvement for word reading (p = .05). No significant differences were observed between the iMRI and standard operating suite. Though, hemisphere, duration of epilepsy, preoperative seizure frequency, lesional disease, seizure type, presence of epileptogenic focus, and number of lobes involved accounted for variance in neuropsychological outcomes. These results provide further support for that certain preoperative individual, disease, and therapeutic variables are predictive of neurocognitive outcome following surgery for temporal lobe epilepsy. Additionally, the results demonstrated that surgery may also impact attention.

Thesis (M.S.)--Boston University