Food reinforcement, energy intake, and macronutrient choice.

Background: Food is a powerful reinforcer that motivates people to eat. The relative reinforcing value of food (RRV(food)) is associated with obesity and energy intake and interacts with impulsivity to predict energy intake.

Objective: How RRV(food) is related to macronutrient choice in ad libitum eating tasks in humans has not been studied; however, animal research suggests that sugar or simple carbohydrates may be a determinant of reward value in food.

Does linezolid modulate lung innate immunity in a murine model of methicillin-resistant Staphylococcus aureus pneumonia?

Objectives: Methicillin-resistant Staphylococcus aureus is an important cause of mortality among nosocomial infections. Recent investigations suggest that linezolid is superior to vancomycin in achieving clinical cure in patients with nosocomial pneumonia. We hypothesized that linezolid may exhibit anti-inflammatory properties in vivo model of pneumonia.

Pneumothorax and subcutaneous emphysema secondary to blunt chest injury.

This is the case of a patient with a history of blunt chest trauma associated with subcutaneous emphysema and pneumothorax. The patient complained of inspiratory stridor on presentation. Anatomical relationships can explain the pathophysiological process.

Relationship between food habituation and reinforcing efficacy of food.

Reinforcing value and habituation are two processes that have been used to study eating behaviors, but no research has examined their relationship, how they relate to energy intake, and whether they respond in a similar manner to food deprivation. Twenty-two female subjects were randomized to food deprived or non-deprived conditions, and assessed for food reinforcement, habituation to food and ad libitum eating. Results showed food reinforcement and habituation are correlated (r = 0.

Anesthetic management of aortocaval fistula repair associated with aortic valve replacement, severe aortic regurgitation, and bacterial endocarditis.

We report a case of an adult male who had received a gunshot to the abdomen 12 years earlier. He presented with manifestations of high-output congestive heart failure (CHF), aortic regurgitation (AR), and pulmonary septic embolism. Further investigation revealed an aortocaval fistula (ACF).

Virtual socialization in adults with spina bifida.

Objective: To use spina bifida (SB) as a model of chronic physical disability to study the associations of virtual socialization, friendships, and quality of life (QOL) in adults.

Design: Cross-sectional survey.

Setting: Subjects were recruited from residential living facilities, outpatient clinics, and the University of Pittsburgh Medical Center (UPMC) research registry.

Nursing home acquired pneumonia: approach to management.

Purpose Of Review: Pneumonia is among the leading causes of mortality in nursing home residents and a primary reason for transfer to acute care facilities. Compared with community-dwelling individuals, residents of long-term care facilities have extensive underlying medical illnesses and more functional disabilities and are at increased risk of acquiring drug-resistant pathogens. This review focuses on recent recommendations for diagnostic work up, validity of prognostic models, and current approach to treatment of nursing home acquired pneumonia (NHAP).

Isolated interrupted aortic arch: unexpected diagnosis in a 63-year-old male.

A 63-year-old male with history of hypertension, dyspnea on exertion, and chronic chest pain was admitted for elective cardiac angiography. Arterial blood pressure was 160/90 mmHg in both arms. Femoral and popliteal pulses were extremely weak, and third (S3) and fourth (S4) heart sounds were audible.

Alteration in respiratory physiology in obesity for anesthesia-critical care physician.

Obesity is known to be a major risk factor of a whole range of cardiovascular, metabolic and respiratory disorders. The pattern of regional fat distribution plays an important role in the pre-disposition of obese subjects to respiratory complications. Obesity is responsible for important changes in respiratory function both during spontaneous breathing as well as during general anesthesia and mechanical ventilation.

Late administration of antenatal vitamin A promotes pulmonary structural maturation and improves ventilation in the lamb model of congenital diaphragmatic hernia.

Purpose: The lungs in congenital diaphragmatic hernia (CDH) are hypoplastic and immature making respiratory support one of the most challenging aspects of caring for these neonates. Vitamin A is essential for normal lung growth and development. It also promotes alveolarization.

Influence of obesity on mortality of drivers in severe motor vehicle crashes.

Purpose: The purpose of the study was to investigate the relationship between obesity and mortality of drivers in severe motor vehicle crashes involving at least one fatality.

Basic Procedures: Fatalities were selected from 155,584 drivers included in the 2000-2005 Fatality Analysis Reporting System. Drivers were stratified by body mass index, confounders were adjusted for, and multiple logistic regression was used to determine the odds ratio (OR) of death in each body mass index class compared with normal weight.

Improving quality of NSAID prescribing by internal medicine trainees with an educational intervention.

Background: Prescribing nonsteroidal anti-inflammatory drugs (NSAIDs) for older adults is a safety concern. Education innovations in postgraduate training designed to improve patient safety should comply with the Accreditation Council for Graduate Medical Education (ACGME).

Purpose: The objective is to evaluate a seven-component education program for internal medicine trainees designed to change prescribing practices while addressing ACGME competencies.

Nodular lymphangitis: Report of a case with presentation of a diagnostic paradigm.

A 54-year-old man with asthma, mitral valve prolapse, and a back injury developed erythematous nodules that progressed along the lymphatic drainage of his right arm. Skin biopsy revealed granulomatous inflammation with microabscess formation. Culture confirmed Mycobacterium marinum infection.

Comparison of midturbinate flocked-swab specimens with nasopharyngeal aspirates for detection of respiratory viruses in children by the direct fluorescent antibody technique.

Paired nasopharyngeal aspirate (NPA) and midturbinate flocked-swab specimens from 153 children with respiratory symptoms were examined by the direct fluorescent antibody (DFA) technique. Seventy-four infants (49%) had a viral infection documented by DFA. The flocked-swab specimens had 93% sensitivity and 96.

National survey to assess the content and availability of difficult-airway carts in critical-care units in the United States.

We have surveyed the availability of equipment, content of difficult-airway carts (DAC), and training in the use of such equipment in intensive-care units (ICU). We devised a set of proposals regarding what constitutes the ideal DAC. We surveyed 300 ICU in the United States.

Effects of medial meniscal posterior horn avulsion and repair on meniscal displacement.

Medial meniscal posterior root avulsion (MMRA) leads to deleterious alteration of medial joint compartment loading profiles and increased risk of medial degenerative changes. Surgical repair restores more normal biomechanics to the knee. Our hypothesis is that MMRA will cause medial meniscal (MM) extrusion and gap formation between the root attachment site and MM.

Community-acquired methicillin-resistant Staphylococcus aureus pericarditis presenting as cardiac tamponade.

Chest computed tomography showed pericardial effusion and bilateral small pleural effusion in a 19-year-old patient. Nine hundred mL of yellow purulent fluid was drained by pericardiocentesis. Culture of the fluid grew methicillin resistant Staphylococcus aureus (MRSA).

Cognitive reserve moderates decline in information processing speed in multiple sclerosis patients.

Cognitive reserve is widely recognized as a moderator of cognitive decline in patients with senile dementias such as Alzheimer's disease. The same effect may occur in multiple sclerosis (MS), an immunologic disorder affecting the central nervous system. While MS is traditionally considered an inflammatory, white matter disease, degeneration of gray matter is increasingly recognized as the primary contributor to progressive cognitive decline.

Role of dual antiplatelet therapy in symptomatic patients with established vascular disease: putting the CHARISMA trial into therapeutic perspective.

Introduction: The CHARISMA (Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance) trial has spurred debate over subgroup analysis interpretation and prompted renewed consideration of the long-term role of dual aspirin and clopidogrel therapy (DAPT) in patients with established vascular disease.

Discussion: Previous DAPT studies consistently demonstrated greater efficacy but an increased risk of bleeding compared with aspirin alone in patients with acute coronary syndromes or undergoing percutaneous coronary intervention. However, CHARISMA data were inconclusive and difficult to interpret.

A phase I, pharmacokinetic, and pharmacodynamic study of two schedules of vorinostat in combination with 5-fluorouracil and leucovorin in patients with refractory solid tumors.

Purpose: We conducted a phase I clinical trial to determine the maximum tolerated dose (MTD) of daily or twice daily vorinostat x 3 days when combined with fixed doses of 5-fluorouracil (FU) and leucovorin every 2 weeks.

Experimental Design: Vorinostat doses were escalated in a standard 3 x 3 phase I design. FU/leucovorin was started on day 2 of vorinostat and consisted of leucovorin 400 mg/m(2) i.

Food reinforcement, delay discounting and obesity.

Choice is a central construct in behavioral economics, with choice research divided into choice of concurrent alternative reinforcers, which is conceptualized as relative reinforcing value, or choice of small immediate versus larger delayed rewards, usually of the same commodity, which is conceptualized as delay of gratification and delay discounting. Relative reinforcing value, delay of gratification and delay discounting paradigms can be used to study obesity, which involves strong motivation to obtain and consume food reinforcers. Strong food reinforcement and difficulties in delay of gratification are risk factors for child weight gain, and both are related to individual differences in overweight/obesity.

Can computed tomography angiography of the brain replace lumbar puncture in the evaluation of acute-onset headache after a negative noncontrast cranial computed tomography scan?

Objectives: The primary goal of evaluation for acute-onset headache is to exclude aneurysmal subarachnoid hemorrhage (SAH). Noncontrast cranial computed tomography (CT), followed by lumbar puncture (LP) if the CT is negative, is the current standard of care. Computed tomography angiography (CTA) of the brain has become more available and more sensitive for the detection of cerebral aneurysms.

Electrical foot stimulation: a potential new method of deep venous thrombosis prophylaxis.

The purpose of this study was to compare venous blood flow velocity of intermittent pneumatic compression to electrical stimulation of the foot. A prospective randomized controlled study of 40 healthy volunteers was conducted. Subjects were seated for 4 hours during which they received electrical stimulation of the sole of the foot or intermittent pneumatic compression of the foot.