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Sample records for progressive pediatric diffuse

  1. Diffuse and uncontrolled vascular smooth muscle cell proliferation in rapidly progressing pediatric moyamoya disease.

    PubMed

    Reid, Amy J; Bhattacharjee, Meenakshi B; Regalado, Ellen S; Milewicz, Allen L; El-Hakam, Lisa M; Dauser, Robert C; Milewicz, Dianna M

    2010-09-01

    Moyamoya disease is a rare stroke syndrome of unknown etiology resulting from stenosis or occlusion of the supraclinoid internal carotid artery (ICA) in association with an abnormal vascular network in the basal ganglia. Although the highest incidence of moyamoya disease is in pediatric patients, pathology reports have been primarily limited to adult samples and describe occlusive fibrocellular lesions in the intimae of affected arteries. We describe the case of a young girl with primary moyamoya disease who presented at 18 months of age with right hemiparesis following an ischemic stroke. Angiography showed stenosis of the distal left ICA, left middle cerebral artery, and right ICA. An emergent left-sided dural inversion was performed. Recurrent strokes and alternating hemiplegia necessitated a right dural inversion 6 months later. Nonetheless, her aggressive disease proved uniquely refractory to surgical revascularization, and she succumbed to recurrent strokes and neurological deterioration at 2.5 years of age. Pathological specimens revealed a striking bilateral occlusion of the anterior carotid circulation resulting from intimal proliferation of smooth muscle cells (SMCs). Most strikingly, the ascending aorta and the superior mesenteric artery demonstrated similar intimal proliferation, along with SMC proliferation in the media. The systemic pathology involving multiple arteries in this extremely young child, the first case of its kind available for autopsy, suggests that globally uncontrolled SMC proliferation, in the absence of environmental risk factors and likely resulting from an underlying genetic alteration, may be a primary etiologic event leading to moyamoya disease. PMID:20809708

  2. Parametric Response Mapping of Apparent Diffusion Coefficient (ADC) as an Imaging Biomarker to Distinguish Pseudoprogression from True Tumor Progression In Peptide-Based Vaccine Therapy for Pediatric Diffuse Instrinsic Pontine Glioma

    PubMed Central

    Ceschin, Rafael; Kurland, Brenda F.; Abberbock, Shira R.; Ellingson, Benjamin M.; Okada, Hideho; Jakacki, Regina I.; Pollack, Ian F.; Panigrahy, Ashok

    2015-01-01

    Background and Purpose Immune response to cancer therapy may result in pseudoprogression, which can only be identified retrospectively and which may disrupt an effective therapy. This study assesses whether serial parametric response mapping (PRM, a voxel-by-voxel method of image analysis also known as functional diffusion mapping) analysis of ADC measurements following peptide-based vaccination may help prospectively distinguish progression from pseudoprogression in pediatric patients with diffuse intrinsic pontine gliomas. Materials and Methods From 2009–2012, 21 children age 4–18 with diffuse intrinsic pontine gliomas were enrolled in a serial peptide-based vaccination protocol following radiotherapy. DWI was acquired before immunotherapy and at six week intervals during vaccine treatment. Pseudoprogression was identified retrospectively based on clinical and radiographic findings, excluding DWI. Parametric response mapping was used to analyze 96 scans, comparing ADC measures at multiple time points (from first vaccine to up to 12 weeks after the vaccine was halted) to pre-vaccine baseline values. Log-transformed fractional increased ADC (fiADC), fractional decreased ADC (fdADC), and parametric response mapping ratio (fiADC/fdADC) were compared between patients with and without pseudoprogression, using generalized estimating equations with inverse weighting by cluster size. Results Median survival was 13.1 months from diagnosis (range 6.4–24.9 months). Four of 21 children (19%) were assessed as experiencing pseudoprogression. Patients with pseudoprogression had higher fitted average log-transformed parametric response mapping ratios (p=0.01) and fiADCs (p=0.0004), compared to patients without pseudoprogression. Conclusion Serial parametric response mapping of ADC, performed at multiple time points of therapy, may distinguish pseudoprogression from true progression in patients with diffuse intrinsic pontine gliomas treated with peptide-based vaccination

  3. Diffusion characteristics of pediatric pineal tumors

    PubMed Central

    Whitehead, Matthew T; Siddiqui, Adeel; Klimo, Paul; Boop, Frederick A

    2015-01-01

    Background Diffusion weighted imaging (DWI) has been shown to be helpful in characterizing tumor cellularity, and predicting histology. Several works have evaluated this technique for pineal tumors; however studies to date have not focused on pediatric pineal tumors. Objective We evaluated the diffusion characteristics of pediatric pineal tumors to confirm if patterns seen in studies using mixed pediatric and adult populations remain valid. Materials and methods This retrospective study was performed after Institutional Review Board approval. We retrospectively evaluated all patients 18 years of age and younger with pineal tumors from a single institution where preoperative diffusion weighted imaging as well as histologic characterization was available. Results Twenty patients (13 male, 7 female) with pineal tumors were identified: seven with pineoblastoma, four with Primitive Neuroectodermal Tumor (PNET), two with other pineal tumors, and seven with germ cell tumors including two germinomas, three teratomas, and one mixed germinoma-teratoma. The mean apparent diffusion coefficient (ADC) values in pineoblastoma (544 ± 65 × 10–6 mm2/s) and pineoblastoma/PNET (595 ± 144 × 10–6 mm2/s) was lower than that of the germ cell tumors (1284 ± 334 × 10–6 mm2/s; p < 0.0001 vs pineoblastoma). One highly cellular germinoma had an ADC value of 694 × 10–6 mm2/s. Conclusion ADC values can aid in differentiation of pineoblastoma/PNET from germ cell tumors in a population of children with pineal masses. PMID:25963154

  4. Progress and Prospects in Pediatric Leukemia.

    PubMed

    Madhusoodhan, P Pallavi; Carroll, William L; Bhatla, Teena

    2016-07-01

    Pediatric leukemia is the single most common malignancy affecting children, representing up to 30% of all pediatric cancers. Dramatic improvements in survival for acute lymphoblastic leukemia (ALL) have taken place over the past 4 decades with outcomes approaching 90% in the latest studies. However, progress has been slower for myeloid leukemia and certain subgroups like infant ALL, adolescent/young adult ALL, and relapsed ALL. Recent advances include recognition of molecularly defined subgroups, which has ushered in precision medicine approaches. We discuss the current understanding of the biology of the various childhood leukemias, recent advances in research, and future challenges in this field. PMID:27283082

  5. Diffusion-weighted imaging in pediatric body magnetic resonance imaging.

    PubMed

    Chavhan, Govind B; Caro-Dominguez, Pablo

    2016-05-01

    Diffusion-weighted MRI is being increasingly used in pediatric body imaging. Its role is still emerging. It is used for detection of tumors and abscesses, differentiation of benign and malignant tumors, and detection of inflamed bowel segments in inflammatory bowel disease in children. It holds great promise in the assessment of therapy response in body tumors, with apparent diffusion coefficient (ADC) value as a potential biomarker. Significant overlap of ADC values of benign and malignant processes and less reproducibility of ADC measurements are hampering its widespread use in clinical practice. With standardization of the technique, diffusion-weighted imaging (DWI) is likely to be used more frequently in clinical practice. We discuss the principles and technique of DWI, selection of b value, qualitative and quantitative assessment, and current status of DWI in evaluation of disease processes in the pediatric body. PMID:27229502

  6. Diffusion tensor imaging suggests extrapontine extension of pediatric diffuse intrinsic pontine gliomas

    PubMed Central

    Wagner, Matthias W.; Bell, W. Robert; Kern, Jason; Bosemani, Thangamadhan; Mhlanga, Joyce; Carson, Kathryn A.; Cohen, Kenneth J.; Raabe, Eric H.; Rodriguez, Fausto; Huisman, Thierry A.G.M.; Poretti, Andrea

    2016-01-01

    Purpose To apply DTI to detect early extrapontine extension of pediatric diffuse intrinsic pontine glioma along the corticospinal tracts. Methods In children with diffuse intrinsic pontine glioma, low-grade brainstem glioma, and age-matched controls, DTI metrics were measured in the posterior limb of the internal capsule and posterior centrum semiovale. Histological examination was available in one patient. Results 6 diffuse intrinsic pontine glioma, 8 low-grade brainstem glioma, and two groups of 25 controls were included. In diffuse intrinsic pontine glioma compared to controls, fractional anisotropy was lower in the bilateral posterior limb of the internal capsule, axial diffusivity was lower in the bilateral posterior centrum semiovale and posterior limb of the internal capsule, while radial diffusivity was higher in the bilateral posterior limb of the internal capsule. No significant differences were found between low-grade brainstem glioma and controls. In diffuse intrinsic pontine glioma compared to low-grade brainstem glioma, axial diffusivity was lower in the bilateral posterior limb of the internal capsule. Histological examination in one child showed tumor cells in the posterior limb of the internal capsule. Conclusion Reduction in fractional anisotropy and axial diffusivity and increase in radial diffusivity in diffuse intrinsic pontine glioma may reflect tumor extension along the corticospinal tracts as shown by histology. DTI may detect early extrapontine tumor extension in diffuse intrinsic pontine glioma before it becomes apparent on conventional MRI sequences. PMID:26971411

  7. Basic Research and Progress against Pediatric Cancer

    Cancer.gov

    An infographic about the importance of basic research for making progress against childhood cancers. The graphic shows the research milestones that led to the development and approval of Unituxin to treat neuroblastoma, a cancer seen mainly in children.

  8. CST recovery in pediatric hemiplegic patients: Diffusion tensor tractography study.

    PubMed

    Baek, Seung Ok; Jang, Sung Ho; Lee, Eusil; Kim, Saeyoon; Hah, Jeong Ok; Park, Yong Hoon; Lee, Jae Min; Son, Su Min

    2013-12-17

    Many diffusion tensor imaging (DTI) studies have reported an association between corticospinal tract (CST) injury and motor dysfunction. In this study, we investigated CST recovery in 29 pediatric patients with clinical hemiplegia using DTI. We measured the fractional anisotropy (FA), apparent diffusion coefficient (ADC), and asymmetric anisotropy (AA) of both CSTs. The patients were classified into three groups according to severity of CST disruption of the more affected hemisphere. DTI was followed up for 9.34 ± 2.07 months after initial evaluation. The FA value of the more affected CST showed a significant decrease compared to the opposite side at initial and follow up evaluation, respectively (p<0.05). The FA value of both CSTs showed a significant increase at follow up compared to the initial evaluation, while more changes were observed on the more affected side, compared with the less affected side (p<0.05). AA showed a significant decrease at follow up, and showed significant correlation with interval change of FA value of the more affected side, not with that of the less affected side (r=0.543, p<0.05). 19 patients showed change of CST integrity. In the current study, the results of DTI showed recovery of the CST and provided radiologic evidence for a scientific basis of brain plasticity in pediatric patients. PMID:24176879

  9. Predictors of Disease Progression in Pediatric Dilated Cardiomyopathy

    PubMed Central

    Molina, Kimberly M.; Shrader, Peter; Colan, Steven D.; Mital, Seema; Margossian, Renee; Sleeper, Lynn A.; Shirali, Girish; Barker, Piers; Canter, Charles E.; Altmann, Karen; Radojewski, Elizabeth; Selamet Tierney, Elif Seda; Rychik, Jack; Tani, Lloyd Y.

    2014-01-01

    Background Despite medical advances, children with dilated cardiomyopathy (DCM) remain at high risk of death or need for cardiac transplantation. We sought to identify predictors of disease progression in pediatric DCM. Methods and Results The Pediatric Heart Network evaluated chronic DCM patients with prospective echocardiographic and clinical data collection during an 18-month follow-up. Inclusion criteria were age <22 years and DCM disease duration >2 months. Patients requiring intravenous inotropic/mechanical support or listed status 1A/1B for transplant were excluded. Disease progression was defined as an increase in transplant listing status, hospitalization for heart failure, intravenous inotropes, mechanical support, or death. Predictors of disease progression were identified using Cox proportional hazards modeling and classification and regression tree analysis. Of the 127 patients, 28 (22%) had disease progression during the 18-month follow-up. Multivariable analysis identified older age at diagnosis (hazard ratio=1.14 per year; P<0.001), larger left ventricular (LV) end-diastolic M-mode dimension z-score (hazard ratio=1.49; P<0.001), and lower septal peak systolic tissue Doppler velocity z-score (hazard ratio=0.81; P=0.01) as independent predictors of disease progression. Classification and regression tree analysis stratified patients at risk of disease progression with 89% sensitivity and 94% specificity based on LV end-diastolic M-mode dimension z-score ≥7.7, LV ejection fraction <39%, LV inflow propagation velocity (color M-mode) z-score <-0.28, and age at diagnosis ≥8.5 months. Conclusions In children with chronic stable DCM, a combination of diagnosis after late infancy and echocardiographic parameters of larger LV size and systolic and diastolic function predicted disease progression. PMID:24132734

  10. Collaborative Efforts Driving Progress in Pediatric Acute Myeloid Leukemia.

    PubMed

    Zwaan, C Michel; Kolb, Edward A; Reinhardt, Dirk; Abrahamsson, Jonas; Adachi, Souichi; Aplenc, Richard; De Bont, Eveline S J M; De Moerloose, Barbara; Dworzak, Michael; Gibson, Brenda E S; Hasle, Henrik; Leverger, Guy; Locatelli, Franco; Ragu, Christine; Ribeiro, Raul C; Rizzari, Carmelo; Rubnitz, Jeffrey E; Smith, Owen P; Sung, Lillian; Tomizawa, Daisuke; van den Heuvel-Eibrink, Marry M; Creutzig, Ursula; Kaspers, Gertjan J L

    2015-09-20

    Diagnosis, treatment, response monitoring, and outcome of pediatric acute myeloid leukemia (AML) have made enormous progress during the past decades. Because AML is a rare type of childhood cancer, with an incidence of approximately seven occurrences per 1 million children annually, national and international collaborative efforts have evolved. This overview describes these efforts and includes a summary of the history and contributions of each of the main collaborative pediatric AML groups worldwide. The focus is on translational and clinical research, which includes past, current, and future clinical trials. Separate sections concern acute promyelocytic leukemia, myeloid leukemia of Down syndrome, and relapsed AML. A plethora of novel antileukemic agents that have emerged, including new classes of drugs, are summarized as well. Finally, an important aspect of the treatment of pediatric AML--supportive care--and late effects are discussed. The future is bright, with a wide range of emerging innovative therapies and with more and more international collaboration that ultimately aim to cure all children with AML, with fewer adverse effects and without late effects. PMID:26304895

  11. Diffusion-weighted MRI derived apparent diffusion coefficient identifies prognostically distinct subgroups of pediatric diffuse intrinsic pontine glioma.

    PubMed

    Lober, Robert M; Cho, Yoon-Jae; Tang, Yujie; Barnes, Patrick D; Edwards, Michael S; Vogel, Hannes; Fisher, Paul G; Monje, Michelle; Yeom, Kristen W

    2014-03-01

    While pediatric diffuse intrinsic pontine gliomas (DIPG) remain fatal, recent data have shown subgroups with distinct molecular biology and clinical behavior. We hypothesized that diffusion-weighted MRI can be used as a prognostic marker to stratify DIPG subsets with distinct clinical behavior. Apparent diffusion coefficient (ADC) values derived from diffusion-weighted MRI were computed in 20 consecutive children with treatment-naïve DIPG tumors. The median ADC for the cohort was used to stratify the tumors into low and high ADC groups. Survival, gender, therapy, and potential steroid effects were compared between the ADC groups. Median age at diagnosis was 6.6 (range 2.3-13.2) years, with median follow-up seven (range 1-36) months. There were 14 boys and six girls. Seventeen patients received radiotherapy, five received chemotherapy, and six underwent cerebrospinal fluid diversion. The median ADC of 1,295 × 10(-6) mm(2)/s for the cohort partitioned tumors into low or high diffusion groups, which had distinct median survivals of 3 and 13 months, respectively (log-rank p < 0.001). Low ADC tumors were found only in boys, whereas high ADC tumors were found in both boys and girls. Available tissue specimens in three low ADC tumors demonstrated high-grade histology, whereas one high ADC tumor demonstrated low-grade histology with a histone H3.1 K27M mutation and high-grade metastatic lesion at autopsy. ADC derived from diffusion-weighted MRI may identify prognostically distinct subgroups of pediatric DIPG. PMID:24522717

  12. [Progress and problems in pediatric surgery--the Association of Pediatric Anesthesiologists].

    PubMed

    Tamiya, K

    1984-09-01

    From the first meeting of the Japanese Society of Pediatric Surgeons in 1964 a small group discussion on anesthetic problems and patient care was held by some anesthesiologists at night. The Association of Pediatric Anesthesiologists (started in 1971) has undertaken the night meeting ever since the twelfth Annual Meeting of the Society of Pediatric Surgeons in 1975. The problems about pediatric respiratory management, neonatal emergency surgery and pediatric anesthesia were discussed frequently by doctors in different specialties. The recent decrease of mortality in neonatal surgery is thought to have come from the improvement of pediatric respiratory management. This night meeting of anesthesiologists has had a major role in the resolution of problems in pediatric respiratory impairment. The problems to be resolved in an emergency--persistent fetal circulation, barotrauma, nutritional problems in long term ventilatory support and so on--, will be discussed in the future. The purpose of this association is to elevate the quality of pediatric anesthesiologists by discussion with the other specialists of medicine and to make clear their responsibility in Children's Hospitals or Centers. PMID:6503982

  13. Pediatric lymphedema caused by diffuse cervical lymphadenopathy: A case report and review of the literature.

    PubMed

    Gitomer, Sarah A; Giannoni, Carla M; Cañadas, Karina T

    2016-08-01

    Pediatric head and neck lymphedema is rare and there have not been any reported cases in children. Here we discuss severe, diffuse head and neck lymphedema in a child caused by compression of the internal jugular veins by lymphadenopathy from Kawasaki's disease. With steroid and intravenous immunoglobulin treatment, the lymphadenopathy improved and facial edema slowly resolved. In review of the literature, complications of head and neck lymphedema including airway obstruction and blindness are discussed. This case highlights the importance of the pediatric otolaryngologist considering lymphedema as a cause for facial swelling and monitoring for complications of lymphedema. PMID:27368445

  14. Diffuse alveolar hemorrhage and recombinant factor VIIa treatment in pediatric patients

    PubMed Central

    2016-01-01

    Diffuse alveolar hemorrhage (DAH) is a life-threatening pulmonary complication in patients with hematologic malignancies or autoimmune disorders. The current treatment options, which include corticosteroids, transfusions, extracorporeal membrane oxygenation (ECMO), and immunosuppressants, have been limited and largely unsuccessful. Recombinant activated factor VII (rFVIIa) has been successfully administered, either systemically or bronchoscopically, to adults for the treatment of DAH, but there are few data on its use in pediatric patients. The current literature in the PubMed database was reviewed to evaluate the efficacy and risk of rFVIIa treatment for DAH in pediatric patients. This review discusses the diagnosis and treatment of DAH, as well as a new treatment paradigm that includes rFVIIa. Additionally, the risks and benefits of off-label use of rFVIIa in pediatric patients are discussed. PMID:27186216

  15. Evidence-Based Interventions in Pediatric Psychology: Progress Over the Decades

    PubMed Central

    2014-01-01

    This introduction to the special issue on Evidence-Based Interventions in Pediatric Psychology provides background on the process used to develop the special issue, a summary of the key findings from the series of reviews, and discussion of the implications for evidence-based practice. Authors followed a three-phase approach to develop their systematic reviews using rigorous systematic review methodology drawn heavily from the Cochrane Collaboration. The strength of the evidence for each pediatric psychology intervention was evaluated using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The introduction discusses the progress that has been made in the evidence base for pediatric psychology interventions since the first special series published in 1999. Recommendations to stimulate further research and expand and strengthen the quality of the evidence base are described. The introduction concludes with implications from the special issue for pediatric psychology training in evidence-based practice. PMID:24996921

  16. Progress and perspectives in pediatric acute respiratory distress syndrome.

    PubMed

    Rotta, Alexandre Tellechea; Piva, Jefferson Pedro; Andreolio, Cinara; de Carvalho, Werther Brunow; Garcia, Pedro Celiny Ramos

    2015-01-01

    Acute respiratory distress syndrome is a disease of acute onset characterized by hypoxemia and infiltrates on chest radiographs that affects both adults and children of all ages. It is an important cause of respiratory failure in pediatric intensive care units and is associated with significant morbidity and mortality. Nevertheless, until recently, the definitions and diagnostic criteria for acute respiratory distress syndrome have focused on the adult population. In this article, we review the evolution of the definition of acute respiratory distress syndrome over nearly five decades, with a special focus on the new pediatric definition. We also discuss recommendations for the implementation of mechanical ventilation strategies in the treatment of acute respiratory distress syndrome in children and the use of adjuvant therapies. PMID:26331971

  17. Progress and perspectives in pediatric acute respiratory distress syndrome

    PubMed Central

    Rotta, Alexandre Tellechea; Piva, Jefferson Pedro; Andreolio, Cinara; de Carvalho, Werther Brunow; Garcia, Pedro Celiny Ramos

    2015-01-01

    Acute respiratory distress syndrome is a disease of acute onset characterized by hypoxemia and infiltrates on chest radiographs that affects both adults and children of all ages. It is an important cause of respiratory failure in pediatric intensive care units and is associated with significant morbidity and mortality. Nevertheless, until recently, the definitions and diagnostic criteria for acute respiratory distress syndrome have focused on the adult population. In this article, we review the evolution of the definition of acute respiratory distress syndrome over nearly five decades, with a special focus on the new pediatric definition. We also discuss recommendations for the implementation of mechanical ventilation strategies in the treatment of acute respiratory distress syndrome in children and the use of adjuvant therapies. PMID:26331971

  18. Pediatrics

    NASA Technical Reports Server (NTRS)

    Spackman, T. J.

    1978-01-01

    The utilization of the Lixiscope in pediatrics was investigated. The types of images that can presently be obtained are discussed along with the problems encountered. Speculative applications for the Lixiscope are also presented.

  19. Predictive classification of pediatric bipolar disorder using atlas-based diffusion weighted imaging and support vector machines.

    PubMed

    Mwangi, Benson; Wu, Mon-Ju; Bauer, Isabelle E; Modi, Haina; Zeni, Cristian P; Zunta-Soares, Giovana B; Hasan, Khader M; Soares, Jair C

    2015-11-30

    Previous studies have reported abnormalities of white-matter diffusivity in pediatric bipolar disorder. However, it has not been established whether these abnormalities are able to distinguish individual subjects with pediatric bipolar disorder from healthy controls with a high specificity and sensitivity. Diffusion-weighted imaging scans were acquired from 16 youths diagnosed with DSM-IV bipolar disorder and 16 demographically matched healthy controls. Regional white matter tissue microstructural measurements such as fractional anisotropy, axial diffusivity and radial diffusivity were computed using an atlas-based approach. These measurements were used to 'train' a support vector machine (SVM) algorithm to predict new or 'unseen' subjects' diagnostic labels. The SVM algorithm predicted individual subjects with specificity=87.5%, sensitivity=68.75%, accuracy=78.12%, positive predictive value=84.62%, negative predictive value=73.68%, area under receiver operating characteristic curve (AUROC)=0.7812 and chi-square p-value=0.0012. A pattern of reduced regional white matter fractional anisotropy was observed in pediatric bipolar disorder patients. These results suggest that atlas-based diffusion weighted imaging measurements can distinguish individual pediatric bipolar disorder patients from healthy controls. Notably, from a clinical perspective these findings will contribute to the pathophysiological understanding of pediatric bipolar disorder. PMID:26459075

  20. Progress in understanding the diffuse UV cosmic background

    NASA Astrophysics Data System (ADS)

    Henry, Richard Conn

    I report on progress in my ongoing work with Professor Jayant Murthy concerning the origin and nature of the diffuse ultraviolet background radiation over the sky. We have obtained and are reducing a vast trove of Voyager ultraviolet spectrometer observations of the diffuse background shortward of Lalpha , including for the first time measurements made from the outermost regions of the solar system, where noise from solar-system scattered (and then grating-scattered) solar Lalpha is lowest. Also, we have obtained and are investigating the complete set of GALEX observations of the diffuse ultraviolet background longward of Lalpha . Preliminary investigation appears to confirm that longward of Lalpha there exists a component of the diffuse ultraviolet background that is not dust-scattered starlight.

  1. Putaminal Diffusivity Correlates With Disease Progression in Parkinson's Disease

    PubMed Central

    Chan, Ling-Ling; Ng, Kia-Min; Yeoh, Chooi-Sum; Rumpel, H.; Li, Hui-Hua; Tan, Eng-King

    2016-01-01

    Abstract Diffusion tensor imaging (DTI) is an increasingly used noninvasive imaging tool. However its long-term clinical utility is unclear. Parkinson's disease (PD) is a common neurodegenerative disease. We prospectively examined a cohort of 46 Parkinson's disease (PD) patients who underwent diffusion tensor imaging (DTI) of the brain at baseline and 6 years later on a 1.5 Tesla scanner using a standardized protocol. DTI parameters of mean diffusivity (MD) and fractional anisotrophy (FA) were extracted using regions-of-interest (ROIs) analysis from various brain regions. Compared to the baseline scan, MD increased in all brain regions (P < 0.0001). FA increased in the substantia nigra and posterior putamen, but decreased in the frontal white matter (P < 0.0001). Linear regression analysis demonstrated that the MD in the anterior putamen increased 11.6 units (95% CI = [4.71, 18.43]) (P = 0.0003) for every unit increase of United PD Rating Scale (UPDRS). Our 6-year prospective longitudinal study demonstrated increased diffusivity in all brain regions and that in the anterior putamen correlated with disease progression. Serial diffusion data may be useful as an additional objective in vivo biomarker for motor progression in PD. PMID:26871779

  2. Progressive Diffuse Osteonecrosis in a Patient with Secondary Hemophagocytic Lymphohistiocytosis

    PubMed Central

    Takahashi, Takashi; Rykken, Jeffrey

    2015-01-01

    This is a case report with serial imaging showing progression of diffuse osteonecrosis in a patient after a diagnosis of secondary hemophagocytic lymphohistiocytosis (HLH). While bone marrow involvement in HLH has been long noted at histological evaluation and is itself one of the diagnosis criteria, to the best of our knowledge, there has been no previous publication addressing osseous image findings in a patient with HLH. PMID:26693376

  3. Diffusion-weighted imaging in pediatric body MR imaging: principles, technique, and emerging applications.

    PubMed

    Chavhan, Govind B; Alsabban, Zehour; Babyn, Paul S

    2014-01-01

    Diffusion-weighted (DW) imaging is an emerging technique in body imaging that provides indirect information about the microenvironment of tissues and lesions and helps detect, characterize, and follow up abnormalities. Two main challenges in the application of DW imaging to body imaging are the decreased signal-to-noise ratio of body tissues compared with neuronal tissues due to their shorter T2 relaxation time, and image degradation related to physiologic motion (eg, respiratory motion). Use of smaller b values and newer motion compensation techniques allow the evaluation of anatomic structures with DW imaging. DW imaging can be performed as a breath-hold sequence or a free-breathing sequence with or without respiratory triggering. Depending on the mobility of water molecules in their microenvironment, different normal tissues have different signals at DW imaging. Some normal tissues (eg, lymph nodes, spleen, ovarian and testicular parenchyma) are diffusion restricted, whereas others (eg, gallbladder, corpora cavernosa, endometrium, cartilage) show T2 shine-through. Epiphyses that contain fatty marrow and bone cortex appear dark on both DW images and apparent diffusion coefficient maps. Current and emerging applications of DW imaging in pediatric body imaging include tumor detection and characterization, assessment of therapy response and monitoring of tumors, noninvasive detection and grading of liver fibrosis and cirrhosis, detection of abscesses, and evaluation of inflammatory bowel disease. PMID:24819803

  4. Variations in apparent diffusion coefficient values following chemotherapy in pediatric neuroblastoma

    PubMed Central

    Demir, Senay; Altinkaya, Naime; Kocer, Nazim Emrah; Erbay, Ayse; Oguzkurt, Pelin

    2015-01-01

    PURPOSE In children the assessment of solid tumors’ response to chemotherapy is based primarily on size reduction, which can be unreliable and a late marker, in the presence of necrosis. We aimed to establish whether apparent diffusion coefficient (ADC) values of childhood neuroblastomas show proportional changes in relation to chemotherapy response. METHODS We evaluated 15 pediatric patients with abdominopelvic neuroblastomas, who had undergone MRI before and after chemotherapy. Two radiologists retrospectively analyzed all images by drawing a round uniform region-of-interest in the solid/contrast-enhancing portion of the lesions in consensus. The ADC values from pre- and postchemotherapy images were compared. RESULTS Postchemotherapy ADC values were significantly higher than those obtained before treatment (P < 0.05, for minimum, maximum, and median ADC values). CONCLUSION Our results support diffusion-weighted MRI as a promising noninvasive biomarker of therapeutic responses. To the best of our knowledge, this is the first report to compare diffusion-weighted imaging findings before and after chemotherapy in childhood neuroblastic tumors. PMID:25519453

  5. The role of diffusion tensor tractography in the surgical treatment of pediatric optic chiasmatic gliomas.

    PubMed

    Ge, Ming; Li, ShaoWu; Wang, Liang; Li, ChunDe; Zhang, Junting

    2015-04-01

    Diffusion tensor tractography(DTT) can theoretically be used in assessing the optic chiasmatic glioma(OCGs),which are still in debate about optimal treatment. The purpose of this study was to investigate the role of this technology in offering more information about the tumor, assisting the debulking surgery, and helping to anticipate visual outcomes. As a prospective cohort study, the enrolled patients received routine pre- and postoperative neuro-ophthalmology, neuroimaging, and endocrine examinations. Fiber tractography was meanwhile performed based on diffusion tensor imaging examination. Identification of the position relationship between the lesions and residual optic path, and morphology analysis of them was done based on their DTT features. All the information was used for confirmation by the intraoperative findings. 11 pediatric patients were enrolled in this study. Most of them got subtotal resection of the tumors and stable postoperative visual outcomes. On the DTT imagings, the tumors were divided into infiltrative endophytic ones (TypeI) and inflated ones (TypeII), which can be subclassified as inferior and superior chiasmatic ones based on the positional relationships between the optic chiasm fibers and the tumors. These positional relationships were confirmed intraoperatively. The postoperative DTT images were quite different from preoperative ones. The application of DTT to children with OCGs is feasible, and valuable for getting more information about the disease, improving surgical techniques, and helping predict the overall and visual prognosis of the patients. The exact correlations of DTT features and visual outcomes need to be further verified. PMID:25617076

  6. Discordant Impact of HLA on Viral Replicative Capacity and Disease Progression in Pediatric and Adult HIV Infection

    PubMed Central

    Adland, Emily; Paioni, Paolo; Thobakgale, Christina; Laker, Leana; Mori, Luisa; Muenchhoff, Maximilian; Csala, Anna; Clapson, Margaret; Flynn, Jacquie; Novelli, Vas; Hurst, Jacob; Naidoo, Vanessa; Shapiro, Roger; Huang, Kuan-Hsiang Gary; Frater, John; Prendergast, Andrew; Prado, Julia G.; Ndung’u, Thumbi; Walker, Bruce D.; Carrington, Mary; Jooste, Pieter; Goulder, Philip J. R.

    2015-01-01

    HLA class I polymorphism has a major influence on adult HIV disease progression. An important mechanism mediating this effect is the impact on viral replicative capacity (VRC) of the escape mutations selected in response to HLA-restricted CD8+ T-cell responses. Factors that contribute to slow progression in pediatric HIV infection are less well understood. We here investigate the relationship between VRC and disease progression in pediatric infection, and the effect of HLA on VRC and on disease outcome in adult and pediatric infection. Studying a South African cohort of >350 ART-naïve, HIV-infected children and their mothers, we first observed that pediatric disease progression is significantly correlated with VRC. As expected, VRCs in mother-child pairs were strongly correlated (p = 0.004). The impact of the protective HLA alleles, HLA-B*57, HLA-B*58:01 and HLA-B*81:01, resulted in significantly lower VRCs in adults (p<0.0001), but not in children. Similarly, in adults, but not in children, VRCs were significantly higher in subjects expressing the disease-susceptible alleles HLA-B*18:01/45:01/58:02 (p = 0.007). Irrespective of the subject, VRCs were strongly correlated with the number of Gag CD8+ T-cell escape mutants driven by HLA-B*57/58:01/81:01 present in each virus (p = 0.0002). In contrast to the impact of VRC common to progression in adults and children, the HLA effects on disease outcome, that are substantial in adults, are small and statistically insignificant in infected children. These data further highlight the important role that VRC plays both in adult and pediatric progression, and demonstrate that HLA-independent factors, yet to be fully defined, are predominantly responsible for pediatric non-progression. PMID:26076345

  7. Discordant Impact of HLA on Viral Replicative Capacity and Disease Progression in Pediatric and Adult HIV Infection.

    PubMed

    Adland, Emily; Paioni, Paolo; Thobakgale, Christina; Laker, Leana; Mori, Luisa; Muenchhoff, Maximilian; Csala, Anna; Clapson, Margaret; Flynn, Jacquie; Novelli, Vas; Hurst, Jacob; Naidoo, Vanessa; Shapiro, Roger; Huang, Kuan-Hsiang Gary; Frater, John; Prendergast, Andrew; Prado, Julia G; Ndung'u, Thumbi; Walker, Bruce D; Carrington, Mary; Jooste, Pieter; Goulder, Philip J R

    2015-06-01

    HLA class I polymorphism has a major influence on adult HIV disease progression. An important mechanism mediating this effect is the impact on viral replicative capacity (VRC) of the escape mutations selected in response to HLA-restricted CD8+ T-cell responses. Factors that contribute to slow progression in pediatric HIV infection are less well understood. We here investigate the relationship between VRC and disease progression in pediatric infection, and the effect of HLA on VRC and on disease outcome in adult and pediatric infection. Studying a South African cohort of >350 ART-naïve, HIV-infected children and their mothers, we first observed that pediatric disease progression is significantly correlated with VRC. As expected, VRCs in mother-child pairs were strongly correlated (p = 0.004). The impact of the protective HLA alleles, HLA-B*57, HLA-B*58:01 and HLA-B*81:01, resulted in significantly lower VRCs in adults (p<0.0001), but not in children. Similarly, in adults, but not in children, VRCs were significantly higher in subjects expressing the disease-susceptible alleles HLA-B*18:01/45:01/58:02 (p = 0.007). Irrespective of the subject, VRCs were strongly correlated with the number of Gag CD8+ T-cell escape mutants driven by HLA-B*57/58:01/81:01 present in each virus (p = 0.0002). In contrast to the impact of VRC common to progression in adults and children, the HLA effects on disease outcome, that are substantial in adults, are small and statistically insignificant in infected children. These data further highlight the important role that VRC plays both in adult and pediatric progression, and demonstrate that HLA-independent factors, yet to be fully defined, are predominantly responsible for pediatric non-progression. PMID:26076345

  8. Silent cerebral emboli following percutaneous closure of atrial septal defect in pediatric patients: a diffusion-weighted MRI study

    PubMed Central

    Koç, Gonca; Özyurt, Abdullah; Doğanay, Selim; Baykan, Ali; Görkem, S. Burcu; Doğan, M. Sait; Pamukçu, Özge; Üzüm, Kazım; Coşkun, Abdulhakim; Narin, Nazmi

    2016-01-01

    PURPOSE The aim of this prospective study was to investigate the incidence of silent cerebrovascular embolic events associated with percutaneous closure of atrial septal defect (ASD) in pediatric patients. METHODS A total of 23 consecutive pediatric patients (mean age, 10.4±3.8 years; range, 4–17 years) admitted for transcatheter closure of ASD were recruited in the study. The patients were scanned with a 1.5 Tesla clinical scanner. Two cranial magnetic resonance imaging (MRI) examinations were acquired before the procedure and within 24 hours following the catheterization. MRI included turbo spin-echo fluid-attenuated inversion recovery (FLAIR) sequence and diffusion-weighted imaging technique with single-shot echo-planar spin-echo sequence. The transcatheter closure of ASD was performed by three expert interventional cardiologists. Amplatzer septal occluder device was implemented for the closure of the defect. No contrast medium was administered in the course of the procedure. RESULTS None of the patients had diffusion restricted cerebral lesions resembling microembolic infarctions on postprocedural MRI. Preprocedural MRI of two patients revealed nonspecific hyperintense white matter lesions on FLAIR images with increased diffusion, which were considered to be older ischemic lesions associated with previously occurred paradoxical embolism. CONCLUSION The current study suggests that percutaneous closure of the ASD, when performed by experienced hands, may be free of cerebral microembolization in pediatric patients. However, due to the relatively small sample size, further studies with larger patient groups are needed for the validation of our preliminary results. PMID:26394443

  9. Prognostic role for diffusion-weighted imaging of pediatric optic pathway glioma.

    PubMed

    Yeom, K W; Lober, R M; Andre, J B; Fisher, P G; Barnes, P D; Edwards, M S B; Partap, S

    2013-07-01

    Optic pathway glioma (OPG) has an unpredictable course, with poor correlation between conventional imaging features and tumor progression. We investigated whether diffusion-weighted MRI (DWI) predicts the clinical behavior of these tumors. Twelve children with OPG (median age 2.7 years; range 0.4-6.2 years) were followed for a median 4.4 years with DWI. Progression-free survival (time to requiring therapy) was compared between tumors stratified by apparent diffusion coefficient (ADC) from initial pre-treatment scans. Tumors with baseline ADC greater than 1,400 × 10(-6) mm(2)/s required treatment earlier than those with lower ADC (log-rank p = 0.002). In some cases, ADC increased leading up to treatment, and declined following treatment with surgery, chemotherapy, or radiation. Baseline ADC was higher in tumors that eventually required treatment (1,562 ± 192 × 10(-6) mm(2)/s), compared with those conservatively managed (1,123 ± 114 × 10(-6) mm(2)/s) (Kruskal-Wallis test p = 0.013). Higher ADC predicted earlier tumor progression in this cohort and in some cases declined after therapy. Evaluation of OPG with DWI may therefore be useful for predicting tumor behavior and assessing treatment response. PMID:23673514

  10. Investigation of vibration-induced artifact in clinical diffusion-weighted imaging of pediatric subjects.

    PubMed

    Berl, Madison M; Walker, Lindsay; Modi, Pooja; Irfanoglu, M Okan; Sarlls, Joelle E; Nayak, Amritha; Pierpaoli, Carlo

    2015-12-01

    It has been reported that mechanical vibrations of the magnetic resonance imaging scanner could produce spurious signal dropouts in diffusion-weighted images resulting in artifactual anisotropy in certain regions of the brain with red appearance in the Directionally Encoded Color maps. We performed a review of the frequency of this artifact across pediatric studies, noting differences by scanner manufacturer, acquisition protocol, as well as weight and position of the subject. We also evaluated the ability of automated and quantitative methods to detect this artifact. We found that the artifact may be present in over 50% of data in certain protocols and is not limited to one scanner manufacturer. While a specific scanner had the highest incidence, low body weight and positioning were also associated with appearance of the artifact for both scanner types evaluated, making children potentially more susceptible than adults. Visual inspection remains the best method for artifact identification. Software for automated detection showed very low sensitivity (10%). The artifact may present inconsistently in longitudinal studies. We discuss a published case report that has been widely cited and used as evidence to set policy about diagnostic criteria for determining vegetative state. That report attributed longitudinal changes in anisotropy to white matter plasticity without considering the possibility that the changes were caused by this artifact. Our study underscores the need to check for the presence of this artifact in clinical studies, analyzes circumstances for when it may be more likely to occur, and suggests simple strategies to identify and potentially avoid its effects. PMID:26350492

  11. Presentation and progression of a disc cyst in a pediatric patient.

    PubMed

    Lin, Ning; Schirmer, Clemens M; Proctor, Mark R

    2011-02-01

    Disc cysts are rare intraspinal extradural lesions that communicate with the intervertebral disc and can mimic the symptoms of acute lumbar disc herniation. Initially reported in the Japanese-language literature as a new entity (discal cyst), there are few documented cases in North America, and only 1 prior case in the pediatric population. The authors present the case of a 16-year-old girl with an intervertebral disc cyst causing lumbar radiculopathy that progressed despite conservative treatment. All medical records, imaging studies, intraoperative findings, and pertinent literature were reviewed. Serial preoperative MR imaging revealed enlargement of the intraspinal cyst at the L4-5 level, resulting in compression of the right L-5 nerve root. Enlargement of the cyst occurred over a 4-month period despite conservative treatment with physical therapy and corticosteroid injections. Microsurgical discectomy and excision of the cyst resulted in complete resolution of the preoperative radiculopathy. An intervertebral disc cyst is a rare entity in the adult population and exceedingly rare in the pediatric population but should remain in the differential diagnosis of any intraspinal extradural mass. The authors hypothesize that there exists a spectrum of this entity that may not be responsive to conservative therapy. Cyst excision alone or in conjunction with microsurgical discectomy is safe and effective in treating radiculopathy caused by disc cysts. PMID:21284469

  12. Epstein-Barr virus presence in pediatric diffuse large B-cell lymphoma reveals a particular association and latency patterns: analysis of viral role in tumor microenvironment.

    PubMed

    Cohen, Melina; De Matteo, Elena; Narbaitz, Marina; Carreño, Fernanda Agost; Preciado, Maria V; Chabay, Paola A

    2013-04-01

    Non-Hodgkin's lymphoma represents 6-10% of pediatric malignancies, and diffuse large B-cell lymphoma (DLBCL) is one of the three major subtypes. The 2008 WHO classification included a new entity, Epstein-Barr virus (EBV)-positive DLBCL of the elderly, affecting patients >50 years. It has been demonstrated that EBV may play a role in tumor microenvironment composition, disturbing antitumor immune response and disease progression. As most studies were performed in adults, our aim was to assess EBV presence and latency pattern, as well as T-cell microenvironment in a pediatric DLBCL series of Argentina. The study was conducted on formalin-fixed paraffin-embedded biopsies from 25 DLBCL patients. EBV-encoded small nuclear early regions (EBERs) expression was performed by in situ hybridization, whereas EBV gene expression was analyzed using real-time PCR. Epstein-Barr virus latent membrane proteins (LMP)1, LMP2A, CD3, CD4, CD8 and Foxp3 expression were assessed by immunohistochemistry (IHC). Forty percent of cases showed EBV expression, with a significantly higher incidence among patients <10 years (p = 0.018), and with immunosuppressed (p = 0.023). T-cell subsets were not altered by EBV presence. Full EBV latency antigen expression (latency type III) was the most frequently pattern observed, together with BZLF1 lytic gene expression. One patient showed II-like pattern (LMP1 without LMP2A expression). Based exclusively on IHC, some patients showed latency II/III (EBERs and LMP1 expression) or I (EBERs only). These findings suggest that EBV association in our series was higher than the previously demonstrated for elderly DLBCL and that EBV latency pattern could be more complex from those previously observed. Therefore, EBV could be an important cofactor in pediatric DLBCL lymphomagenesis. PMID:22987474

  13. Single- and Multivoxel Proton Spectroscopy in Pediatric Patients With Diffuse Intrinsic Pontine Glioma

    SciTech Connect

    Steffen-Smith, Emilie A.; Venzon, David J.; Bent, Robyn S.; Hipp, Sean J.; Warren, Katherine E.

    2012-11-01

    Purpose: To determine the feasibility of two magnetic resonance spectroscopy (MRS) techniques for treating pediatric patients with diffuse intrinsic pontine gliomas (DIPGs) and to evaluate the relationship of metabolic profiles determined by each technique. Utility of each technique for improving patient management is also discussed. Methods and Materials: Children with DIPG (n = 36) were evaluated using single-voxel spectroscopy (SVS) and magnetic resonance spectroscopic imaging (MRSI) during the same imaging session. Patients were followed longitudinally (n = 150 total studies). Technical feasibility was defined by sufficient water and lipid suppression for detection of metabolites. Correlation of metabolic data obtained by SVS and MRSI was determined using the Spearman rank method. Metabolite ratios, including choline:N-acetyl-aspartate (Cho:NAA) and Cho:creatine (Cho:Cr), were obtained from SVS and MRSI. Results: SVS and MRSI acquisitions were feasible in >90% of studies. Maximum Cho:NAA and Cho:Cr from MRSI analysis were strongly associated with Cho:NAA and Cho:Cr obtained by SVS (r = 0.67 and 0.76, respectively). MRSI Cho:NAA values were more heterogeneous than Cho:Cr values within the same lesion, and a strong linear relationship between the range and maximum Cho:NAA values was observed. Conclusions: SVS and MRSI acquisitions were feasible, with a strong correlation in metabolic data. Both techniques may improve diagnostic evaluation and management of DIPG. SVS is recommended for global assessment of tumor metabolism before and after therapy. MRSI showed heterogeneous patterns of metabolic activity within these tumors and is recommended for planning and monitoring targeted therapies and evaluating nearby tissue for tumor invasion.

  14. White matter and reading deficits after pediatric traumatic brain injury: A diffusion tensor imaging study

    PubMed Central

    Johnson, Chad Parker; Juranek, Jenifer; Swank, Paul R.; Kramer, Larry; Cox, Charles S.; Ewing-Cobbs, Linda

    2015-01-01

    Pediatric traumatic brain injury often results in significant long-term deficits in mastery of reading ability. This study aimed to identify white matter pathways that, when damaged, predicted reading deficits in children. Based on the dual-route model of word reading, we predicted that integrity of the inferior fronto-occipital fasciculus would be related to performance in sight word identification while integrity of the superior longitudinal fasciculus would be related to performance in phonemic decoding. Reading fluency and comprehension were hypothesized to relate to the superior longitudinal fasciculus, inferior fronto-occipital fasciculus, and cingulum bundle. The connectivity of white matter pathways was used to predict reading deficits in children aged 6 to 16 years with traumatic brain injury (n = 29) and those with orthopedic injury (n = 27) using tract-based spatial statistics. Results showed that children with traumatic brain injury and reduced microstructural integrity of the superior longitudinal fasciculus demonstrated reduced word-reading ability on sight word and phonemic decoding tasks. Additionally, children with traumatic brain injury and microstructural changes involving the cingulum bundle demonstrated reduced reading fluency. Results support the association of a dorsal pathway via the superior longitudinal fasciculus with both sight word reading and phonemic decoding. No association was identified between the inferior fronto-occipital fasciculus and sight word reading or phonemic decoding. Reading fluency was associated with the integrity of the cingulum bundle. These findings support dissociable pathways predicting word reading and fluency using Diffusion Tensor Imaging and provide additional information for developing models of acquired reading deficits by specifying areas of brain damage which may predict reading deficits following recovery from the acute phase of TBI. PMID:26740920

  15. Relationship Between Diffusion Tensor Imaging (DTI) Findings and Cognition Following Pediatric TBI: A Meta-Analytic Review

    PubMed Central

    Roberts, Rachel M.; Mathias, Jane L.; Rose, Stephen E.

    2016-01-01

    ABSTRACT This study meta-analyzed research examining relationships between diffusion tensor imaging and cognition following pediatric traumatic brain injury (TBI). Data from 14 studies that correlated fractional anisotropy (FA) or apparent diffusion coefficient/mean diffusivity with cognition were analyzed. Short-term (<4 weeks post-TBI) findings were inconsistent, but, in the medium to long term, FA values for numerous large white matter tracts and the whole brain were related to cognition. However, the analyses were limited by the diversity of brain regions and cognitive outcomes that have been examined; all in relatively small samples. Moreover, additional data are needed to investigate the impact of age and injury severity on these findings. PMID:27232263

  16. H3F3A K27M mutation in pediatric CNS tumors: a marker for diffuse high-grade astrocytomas.

    PubMed

    Gielen, Gerrit H; Gessi, Marco; Hammes, Jennifer; Kramm, Christof M; Waha, Andreas; Pietsch, Torsten

    2013-03-01

    Brain tumors are one of the most common childhood malignancies. Diffuse high-grade gliomas represent approximately 10% of pediatric brain tumors. Exon sequencing has identified a mutation in K27M of the histone H3.3 gene (H3F3A K27M and G34R/V) in about 20% of pediatric glioblastomas, but it remains to be seen whether these mutations can be considered specific for pediatric diffuse high-grade astrocytomas or also occur in other pediatric brain tumors. We performed a pyrosequencing-based analysis for the identification of H3F3A codon 27 and codon 34 mutations in 338 pediatric brain tumors. The K27M mutation occurred in 35 of 129 glioblastomas (27.1%) and in 5 of 28 (17.9%) anaplastic astrocytomas. None of the other tumor entities showed H3F3A K27M mutation. Because H3F3A K27M mutations occur exclusively in pediatric diffuse high-grade astrocytomas, analysis of codon 27 mutational status could be useful in the differential diagnosis of these neoplasms. PMID:23429371

  17. Single agent vinorelbine in pediatric patients with progressive optic pathway glioma.

    PubMed

    Cappellano, Andrea Maria; Petrilli, Antonio Sergio; da Silva, Nasjla Saba; Silva, Frederico Adolfo; Paiva, Priscila Mendes; Cavalheiro, Sergio; Bouffet, Eric

    2015-01-01

    The management of progressive unresectable low-grade glioma remains controversial. Treatment options have included radiotherapy, and more recently chemotherapy, usually following an initial period of observation. Within this context, we evaluated vinorelbine, a semi-synthetic vinca alkaloid that has shown evidence of activity against glioma. From July 2007 an institutional protocol with vinorelbine (30 mg/m(2) days 0, 8, 22) for a total of 18 cycles, has been conducted at IOP/GRAACC/UNIFESP for children with optic pathway glioma (OPG). The main objectives were clinical and radiological response, as well as toxicity profile. Twenty-three patients with progressive OPG with a mean age of 69 months (4-179) were enrolled. Three patients had a diagnosis of neurofibromatosis type 1. Twenty-two patients were assessable for response with an overall objective response rate of 63 %, with eight patients showing stable disease. The most important toxicity was hematologic (grade III/IV neutropenia) observed in four patients. Gastrointestinal toxicity (grade I/II vomiting) was observed in seven patients and only 1 patient showed grade I peripheral neuropathy. The median progression-free survival (PFS) was 33 months (6.9-69) with a 3 and 5 year PFS of 64 ± 19 and 37 ± 20 %, respectively, for an overall 3 and 5 year-survival of 95 ± 10 %. This study suggests that vinorelbine may be an interesting option for pediatric low-grade gliomas, showing low toxicity profile and providing a good quality of life for patients with such chronic disease. PMID:25366366

  18. Activation of less affected corticospinal tract and poor motor outcome in hemiplegic pediatric patients: a diffusion tensor tractography imaging study

    PubMed Central

    Kim, Jin Hyun; Son, Su Min

    2015-01-01

    The less affected hemisphere is important in motor recovery in mature brains. However, in terms of motor outcome in immature brains, no study has been reported on the less affected corticospinal tract in hemiplegic pediatric patients. Therefore, we examined the relationship between the condition of the less affected corticospinal tract and motor function in hemiplegic pediatric patients. Forty patients with hemiplegia due to perinatal or prenatal injury (13.7 ± 3.0 months) and 40 age-matched typically developing controls were recruited. These patients were divided into two age-matched groups, the high functioning group (20 patients) and the low functioning group (20 patients) using functional level of hemiplegia scale. Diffusion tensor tractography images showed that compared with the control group, the patient group of the less affected corticospinal tract showed significantly increased fiber number and significantly decreased fractional anisotropy value. Significantly increased fiber number and significantly decreased fractional anisotropy value in the low functioning group were observed than in the high functioning group. These findings suggest that activation of the less affected hemisphere presenting as increased fiber number and decreased fractional anisotropy value is related to poor motor function in pediatric hemiplegic patients. PMID:26889198

  19. Locoregional Tumor Progression After Radiation Therapy Influences Overall Survival in Pediatric Patients With Neuroblastoma

    SciTech Connect

    Pai Panandiker, Atmaram S.; McGregor, Lisa; Krasin, Matthew J.; Wu Shengjie; Xiong Xiaoping; Merchant, Thomas E.

    2010-03-15

    Purpose: There is renewed attention to primary site irradiation and local control for patients with high-risk neuroblastoma (NB). We conducted a retrospective review to identify factors that might predict for locoregional tumor control and its impact on overall survival. Methods and Materials: Between July 2000 through August 2006, a total of 44 pediatric patients with NB received radiation therapy (RT) with curative intent using computed tomography (CT)-based treatment planning. The median age was 3.4 years and the median cumulative dose was 23.4 Gy. Overall survival and locoregional tumor control were measured from the start of RT to the date of death or event as determined by CT/magnetic resonance imaging/meta-iodobenzylguanidine. The influence of age at irradiation, gender, race, cumulative radiation dose, International Neuroblastoma Staging System stage, treatment protocol and resection status was determined with respect to locoregional tumor control. Results: With a median follow-up of 34 months +- 21 months, locoregional tumor progression was observed in 11 (25%) and was evenly divided between primary site and adjacent nodal/visceral site failure. The influence of locoregional control reached borderline statistical significance (p = 0.06). Age (p = 0.5), dose (p = 0.6), resection status (p = 0.7), and International Neuroblastoma Staging System stage (p = 0.08) did not influence overall survival. Conclusions: Overall survival in high-risk neuroblastoma is influenced by locoregional tumor control. Despite CT-based planning, progression in adjacent nodal/visceral sites appears to be common; this requires further investigation regarding target volume definitions, dose, and the effects of systemic therapy.

  20. Intensity-Corrected Dual-Echo Echo-Planar Imaging (DE-EPI) for Improved Pediatric Brain Diffusion Imaging

    PubMed Central

    Straka, Matus; Iv, Michael; Moseley, Michael E.; Barnes, Patrick D.; Skare, Stefan

    2015-01-01

    Here we investigate the utility of a dual-echo Echo-Planar Imaging (DE-EPI) Diffusion Weighted Imaging (DWI) approach to improve lesion conspicuity in pediatric imaging. This method delivers two ‘echo images’ for one diffusion-preparation period. We also demonstrate how the echoes can be utilized to remove transmit/receive coil-induced and static magnetic field intensity modulations on both echo images, which often mimic pathology and thereby pose diagnostic challenges. DE-EPI DWI data were acquired in 18 pediatric patients with abnormal diffusion lesions, and 46 pediatric patient controls at 3T. Echo1 [TE = 45ms] and Echo2 [TE = 86ms] were corrected for signal intensity variation across the images by exploiting the images equivalent coil-sensitivity and susceptibility-induced modulations. Two neuroradiologists independently reviewed Echo1 and Echo2 and their intensity-corrected variants (cEcho1 and cEcho2) on a 7-point Likert scale, with grading on lesion conspicuity diagnostic confidence. The apparent diffusion coefficient (ADC) map from Echo1 was used to validate presence of true pathology. Echo2 was unanimously favored over Echo1 for its sensitivity for detecting acute brain injury, with a mean respective lesion conspicuity of 5.7/4.4 (p < 0.005) and diagnostic confidence of 5.1/4.3 (p = 0.025). cEcho2 was rated higher than cEcho1, with a mean respective lesion conspicuity of 5.5/4.3 (p < 0.005) and diagnostic confidence of 5.4/4.4 (p < 0.005). cEcho2 was favored over all echoes for its diagnostic reliability, particularly in regions close to the head coil. This work concludes that DE-EPI DWI is a useful alternative to conventional single-echo EPI DWI, whereby Echo2 and cEcho2 allows for improved lesion detection and overall higher diagnostic confidence. PMID:26069959

  1. Progress of the National Pediatric Free Antiretroviral Therapy program in China.

    PubMed

    Zhao, Yan; Sun, Xin; He, Yun; Tang, Zhirong; Peng, Guoping; Liu, Aiwen; Qiao, Xiaochun; Li, Huiqin; Chen, Zhiqiang; Dou, Zhihui; Ma, Ye; Liu, Zhongfu; Zhang, Fujie

    2010-10-01

    In 2003, the Chinese Government initiated a free antiretroviral therapy (ART) program focusing on adult AIDS patients. Pediatric antiretroviral (ARV) formulations were yet unavailable. It was not until July 2005, with the initiation of a two-stage program implemented by the Chinese Ministry of Health, that pediatric formulations became accessible in China. Initially, the pediatric ART program was piloted in six provinces with the highest incidences of pediatric HIV/AIDS. The pilot stage allowed the Chinese Center for Disease Control and Prevention (CCDC) to finalize entry criteria, treatment regimen, and patient monitoring and follow-up procedures. The second stage commenced at the end of 2006 when the program was scaled-up nationally. In order to guarantee treatment of pediatric patients, extensive training in the selection of appropriate ARV drug regimen and dosage was provided to doctors, often through on-site collaboration with domestic and international experts. The CCDC simultaneously established a pediatric ARV management system and a pediatric ART information system. CD4 count and other laboratory tests are being routinely performed on these pediatric patients. By the end of June 2009, 1529 pediatric patients had received ARV under the national program. However, challenges remain. Firstly, many children infected with HIV/AIDS live in rural areas where the treatment quality is hindered by the limited number of medical facilities and skilled medical workers. Secondly, much of the pediatric ARV drug supply depends on donation. An effort needs to be made by the Chinese Government to establish China's own drug procurement and supply system. PMID:20665285

  2. Commentary: Progress and Challenges in Evidence-based Family Assessment in Pediatric Psychology

    PubMed Central

    2008-01-01

    It is widely accepted that families are integral to biopsychosocial, social ecological, and other systemic approaches for understanding families and pediatric health. Pediatric psychologists are among the strongest advocates for families. At the same time, families pose challenges that we (pediatric psychology as a field) struggle with in terms of theoretical conceptualizations, assessment and intervention approaches, and training. We primarily use individual frameworks in our practice and research. In this brief commentary, prompted by the report of accomplishments in evidence-based family assessment in pediatric psychology (Alderfer et al., 2007), I outline some of the background for an implicit “challenge” to our field to advance our family orientation and provide some concrete ideas about next steps.

  3. Progression of Microstructural Degeneration in Progressive Supranuclear Palsy and Corticobasal Syndrome: A Longitudinal Diffusion Tensor Imaging Study

    PubMed Central

    Walter, Rudolph; Ng, Peter; Luong, Phi N.; Dutt, Shubir; Heuer, Hilary; Rojas-Rodriguez, Julio C.; Tsai, Richard; Litvan, Irene; Dickerson, Bradford C.; Tartaglia, Maria Carmela; Rabinovici, Gil; Miller, Bruce L.; Rosen, Howard J.

    2016-01-01

    Progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS) are both 4 microtubule binding repeat tauopathy related disorders. Clinical trials need new biomarkers to assess the effectiveness of tau-directed therapies. This study investigated the regional distribution of longitudinal diffusion tensor imaging changes, measured by fractional anisotropy, radial and axial diffusivity over 6 months median interval, in 23 normal control subjects, 35 patients with PSP, and 25 patients with CBS. A mixed-effects framework was used to test longitudinal changes within and between groups. Correlations between changes in diffusion variables and clinical progression were also tested. The study found that over a 6 month period and compared to controls, the most prominent changes in PSP were up to 3±1% higher rates of FA reduction predominantly in superior cerebellar peduncles, and up to 18±6% higher rates of diffusivity increases in caudate nuclei. The most prominent changes in CBS compared to controls were up to 4±1% higher rates of anisotropy reduction and 18±6% higher rates of diffusivity increase in basal ganglia and widespread white matter regions. Compared to PSP, CBS was mainly associated with up to 3±1% greater rates of anisotropy reduction around the central sulci, and 11±3% greater rates of diffusivity increase in superior fronto-occipital fascicules. Rates of diffusivity increases in the superior cerebellar peduncle correlated with rates of ocular motor decline in PSP patients. This study demonstrated that longitudinal diffusion tensor imaging measurement is a promising surrogate marker of disease progression in PSP and CBS over a relatively short period. PMID:27310132

  4. Perfusion and diffusion MRI of glioblastoma progression in a four-year prospective temozolomide clinical trial

    SciTech Connect

    Leimgruber, Antoine; Ostermann, Sandrine; Yeon, Eun Jo; Buff, Evelyn; Maeder, Philippe P.; Stupp, Roger; Meuli, Reto A. . E-mail: Reto.Meuli@chuv.ch

    2006-03-01

    Purpose: This study was performed to determine the impact of perfusion and diffusion magnetic resonance imaging (MRI) sequences on patients during treatment of newly diagnosed glioblastoma. Special emphasis has been given to these imaging technologies as tools to potentially anticipate disease progression, as progression-free survival is frequently used as a surrogate endpoint. Methods and Materials: Forty-one patients from a phase II temolozomide clinical trial were included. During follow-up, images were integrated 21 to 28 days after radiochemotherapy and every 2 months thereafter. Assessment of scans included measurement of size of lesion on T1 contrast-enhanced, T2, diffusion, and perfusion images, as well as mass effect. Classical criteria on tumor size variation and clinical parameters were used to set disease progression date. Results: A total of 311 MRI examinations were reviewed. At disease progression (32 patients), a multivariate Cox regression determined 2 significant survival parameters: T1 largest diameter (p < 0.02) and T2 size variation (p < 0.05), whereas perfusion and diffusion were not significant. Conclusion: Perfusion and diffusion techniques cannot be used to anticipate tumor progression. Decision making at disease progression is critical, and classical T1 and T2 imaging remain the gold standard. Specifically, a T1 contrast enhancement over 3 cm in largest diameter together with an increased T2 hypersignal is a marker of inferior prognosis.

  5. Reaction and diffusion in turbulent combustion. Progress report

    SciTech Connect

    Pope, S.B.

    1992-10-02

    Progress was made on the following: Development of two-variable ({xi} - y) thermochemistry suitable for DNS (direct numerical simulation) studies; determination of laminar flame properties based on this thermochemistry; determination of the parameter range that can be accessed by DNS with good resolution; implementation of the thermochemistry in the DNS code; performance of exploratory simulations, and the development of techniques of relating Eulerian DNS data to turbulent combustion theories; implementation of the DNS code on parallel and distributed computers, and the study of relative molecular motion in turbulence.

  6. Pediatric Burkitt's lymphoma and diffuse B-cell lymphoma: are surveillance scans required?

    PubMed

    Eissa, H M; Allen, C E; Kamdar, K; Simko, S; Goradia, P; Dreyer, Z; Steuber, P; McClain, K L; Guillerman, R P; Bollard, Catherine M

    2014-04-01

    Outcomes in pediatric B-Non-Hodgkin Lymphoma (B NHL) have improved with intensive chemotherapy protocols, with long-term survival now over 80%. However, long-term adverse effects of therapy and poor outcomes for patients who relapse remain challenges. In this study, we aimed to evaluate the potential risks and benefits of routine relapse surveillance imaging after the completion of therapy. We reviewed 44 B NHL patients diagnosed and treated at Texas Children's Cancer Center in the period between 2000 to 2011. All cross-sectional diagnostic imaging examinations performed for disease assessment after completion of chemotherapy were reviewed and cumulative radiation dosage from these examinations and the frequency of relapse detection by these examinations were recorded. Only 3 patients of the 44 relapsed (6.8%), though none of the relapses were initially diagnosed by computed tomography (CT) or fludeoxyglucose positron emission tomography (FDG-PET) scans. Median effective dose of ionizing radiation per patient was 40.3 mSv with an average of 49.1 mSv (range 0-276 mSv). This single-institution study highlights the low relapse rate in pediatric B-NHL with complete response at the end of therapy, the low sensitivity of early detection of relapse with surveillance CT or FDG-PET imaging, and the costs and potential increased risk of secondary malignancies from cumulative radiation exposure from surveillance imaging. We propose that routine surveillance CT or FDG-PET scans for these patients may not be necessary. PMID:24087880

  7. PL-03FEASIBILITY OF GENOMICS-ENABLED THERAPY FOR PEDIATRIC HIGH-GRADE GLIOMAS AND DIFFUSE PONTINE GLIOMAS

    PubMed Central

    Mueller, Sabine; Liang, Winnie; Byron, Sara; Nazemi, Kellie; Leary, Sarah; Kilburn, Lindsay; Prados, Michael; Gupta, Nalin; Craig, David; Carpten, John; Berens, Michael

    2014-01-01

    Children with pediatric high-grade gliomas (pHGG) including diffuse intrinsic pontine gliomas (DIPG) continue to have a dismal prognosis and, as a result, novel therapeutic approaches are needed. We evaluated whether genomic profiling, defined as sequencing of tumor and germline exomes and tumor RNA, can be used to identify distinct, actionable events that may guide treatment of children with pHGG. Tumor from eight archival cases were assessed to confirm high tumor cellularity of samples (>60%) and were evaluated by genomic profiling. Successfully sequenced tumor specimens originated from DIPG (n = 2), astrocytoma grade II (n = 1), astrocytoma grade III (n = 1), glioblastoma (n = 4). We generated average mapped coverages of >145X across all exomes and generated >190M reads for each tumor RNA. Identified alterations were matched to potential therapeutic options using a custom drug-matching pipeline utilizing a pharmacopeia that includes FDA-approved drugs, potential repositioned agents, and investigational compounds. Alterations in genes previously implicated in pediatric glioma were identified, including mutations in histone H3 (H3F3A), PDGFRA, TP53, and ATRX and copy number loss of CDKN2A. Alterations associated with potential sensitivity to FDA-approved oncology agents included frameshift and splice-site mutations in TSC2 and extracellular mutations in PDGFRA (E229K, C235Y mutations; previously reported in pHGG), with predicted sensitivity to mTOR inhibitors and PDGFRA inhibitors, respectively. Inclusion of repositioned therapies and agents in clinical development expanded the actionable roster to include: CDKN2A deletion, BRD4 gain, PRKCI gain, ATM mutation, and overexpression of EZH2, KIF11, MELK, PLK4, and WEE1, several of which are direct targets of investigational agents currently in clinical trials. In conclusion, potentially actionable alterations were uncovered by applying integrative sequencing strategies to pHGG patients. Future efforts will apply this

  8. Diffuse gastrointestinal bleeding and BK polyomavirus replication in a pediatric allogeneic haematopoietic stem cell transplant patient.

    PubMed

    Koskenvuo, M; Lautenschlager, I; Kardas, P; Auvinen, E; Mannonen, L; Huttunen, P; Taskinen, M; Vettenranta, K; Hirsch, H H

    2015-01-01

    Patients undergoing haematopoietic stem cell transplantation (HSCT) are at high risk of severe gastrointestinal bleeding caused by infections, graft versus host disease, and disturbances in haemostasis. BK polyomavirus (BKPyV) is known to cause hemorrhagic cystitis, but there is also evidence of BKV shedding in stool and its association with gastrointestinal disease. We report putative association of BKPyV replication with high plasma viral loads in a pediatric HSCT patient developing hemorrhagic cystitis and severe gastrointestinal bleeding necessitating intensive care. The observation was based on chart review and analysis of BKPyV DNA loads in plasma and urine as well as retrospective BKPyV-specific IgM and IgG measurements in weekly samples until three months post-transplant. The gastrointestinal bleeding was observed after a >100-fold increase in the plasma BKPyV loads and the start of hemorrhagic cystitis. The BKPyV-specific antibody response indicated past infection prior to transplantation, but increasing IgG titers were seen following BKPyV replication. The gastrointestinal biopsies were taken at a late stage of the episode and were no longer informative of BK polyomavirus involvement. In conclusion, gastrointestinal complications with bleeding are a significant problem after allogeneic HSCT to which viral infections including BKPyV may contribute. PMID:25542476

  9. Diffusion Tensor Imaging of Incentive Effects in Prospective Memory after Pediatric Traumatic Brain Injury

    PubMed Central

    Wilde, Elisabeth A.; Bigler, Erin D.; Chu, Zili; Yallampalli, Ragini; Oni, Margaret B.; Wu, Trevor C.; Ramos, Marco A.; Pedroza, Claudia; Vásquez, Ana C.; Hunter, Jill V.; Levin, Harvey S.

    2011-01-01

    Abstract Few studies exist investigating the brain-behavior relations of event-based prospective memory (EB-PM) impairments following traumatic brain injury (TBI). To address this, children with moderate-to-severe TBI performed an EB-PM test with two motivational enhancement conditions and underwent concurrent diffusion tensor imaging (DTI) at 3 months post-injury. Children with orthopedic injuries (OI; n = 37) or moderate-to-severe TBI (n = 40) were contrasted. Significant group differences were found for fractional anisotropy (FA) and apparent diffusion coefficient for orbitofrontal white matter (WM), cingulum bundles, and uncinate fasciculi. The FA of these WM structures in children with TBI significantly correlated with EB-PM performance in the high, but not the low motivation condition. Regression analyses within the TBI group indicated that the FA of the left cingulum bundle (p = 0.003), left orbitofrontal WM (p < 0.02), and left (p < 0.02) and right (p < 0.008) uncinate fasciculi significantly predicted EB-PM performance in the high motivation condition. We infer that the cingulum bundles, orbitofrontal WM, and uncinate fasciculi are important WM structures mediating motivation-based EB-PM responses following moderate-to-severe TBI in children. PMID:21250917

  10. The Progression and Natural History of Pediatric Nonalcoholic Fatty Liver Disease.

    PubMed

    Goyal, Nidhi P; Schwimmer, Jeffrey B

    2016-05-01

    Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the United States. Childhood NAFLD is associated with hepatic and nonhepatic morbidity and mortality. Nonhepatic associations include cardiovascular, metabolic, pulmonary, and psychological disorders. Cardiovascular conditions observed in childhood include left ventricular dysfunction. Furthermore, childhood obesity is associated with greater odds of having hepatocellular carcinoma as an adult. Evidence suggests that NAFLD may begin in utero in children of diabetic mothers. Thus rigorous efforts for structured diagnosis and follow-up are a priority to better develop the understanding of outcomes in pediatric NAFLD. PMID:27063272

  11. Study of mechanisms of hydrogen diffusion in separation devices. Annual progress report, 1980-1981

    SciTech Connect

    Lee, M.H.

    1981-04-20

    The main results are in the following 3 areas: (1) static and dynamic properties of the hydrogen diffusion model; (2) exact asymptotic solutions of the model; (3) new physics of the lattice hydrogen. The progress made during this period has been particularly significant. The hydrogen diffusion model has brought to light a number of puzzling features of hydrogen metal systems. These advances have made it possible now to begin to study some of the long-range objectives put forth in the initial proposal.

  12. Spatially selective 2D RF inner field of view (iFOV) diffusion kurtosis imaging (DKI) of the pediatric spinal cord

    PubMed Central

    Conklin, Chris J.; Middleton, Devon M.; Alizadeh, Mahdi; Finsterbusch, Jürgen; Raunig, David L.; Faro, Scott H.; Shah, Pallav; Krisa, Laura; Sinko, Rebecca; Delalic, Joan Z.; Mulcahey, M.J.; Mohamed, Feroze B.

    2016-01-01

    Magnetic resonance based diffusion imaging has been gaining more utility and clinical relevance over the past decade. Using conventional echo planar techniques, it is possible to acquire and characterize water diffusion within the central nervous system (CNS); namely in the form of Diffusion Weighted Imaging (DWI) and Diffusion Tensor Imaging (DTI). While each modality provides valuable clinical information in terms of the presence of diffusion and its directionality, both techniques are limited to assuming an ideal Gaussian distribution for water displacement with no intermolecular interactions. This assumption neglects pathological processes that are not Gaussian therefore reducing the amount of potentially clinically relevant information. Additions to the Gaussian distribution measured by the excess kurtosis, or peakedness, of the probabilistic model provide a better understanding of the underlying cellular structure. The objective of this work is to provide mathematical and experimental evidence that Diffusion Kurtosis Imaging (DKI) can offer additional information about the micromolecular environment of the pediatric spinal cord. This is accomplished by a more thorough characterization of the nature of random water displacement within the cord. A novel DKI imaging sequence based on a tilted 2D spatially selective radio frequency pulse providing reduced field of view (FOV) imaging was developed, implemented, and optimized on a 3 Tesla MRI scanner, and tested on pediatric subjects (healthy subjects: 15; patients with spinal cord injury (SCI):5). Software was developed and validated for post processing of the DKI images and estimation of the tensor parameters. The results show statistically significant differences in mean kurtosis (p < 0.01) and radial kurtosis (p < 0.01) between healthy subjects and subjects with SCI. DKI provides incremental and novel information over conventional diffusion acquisitions when coupled with higher order estimation algorithms

  13. Spatially selective 2D RF inner field of view (iFOV) diffusion kurtosis imaging (DKI) of the pediatric spinal cord.

    PubMed

    Conklin, Chris J; Middleton, Devon M; Alizadeh, Mahdi; Finsterbusch, Jürgen; Raunig, David L; Faro, Scott H; Shah, Pallav; Krisa, Laura; Sinko, Rebecca; Delalic, Joan Z; Mulcahey, M J; Mohamed, Feroze B

    2016-01-01

    Magnetic resonance based diffusion imaging has been gaining more utility and clinical relevance over the past decade. Using conventional echo planar techniques, it is possible to acquire and characterize water diffusion within the central nervous system (CNS); namely in the form of Diffusion Weighted Imaging (DWI) and Diffusion Tensor Imaging (DTI). While each modality provides valuable clinical information in terms of the presence of diffusion and its directionality, both techniques are limited to assuming an ideal Gaussian distribution for water displacement with no intermolecular interactions. This assumption neglects pathological processes that are not Gaussian therefore reducing the amount of potentially clinically relevant information. Additions to the Gaussian distribution measured by the excess kurtosis, or peakedness, of the probabilistic model provide a better understanding of the underlying cellular structure. The objective of this work is to provide mathematical and experimental evidence that Diffusion Kurtosis Imaging (DKI) can offer additional information about the micromolecular environment of the pediatric spinal cord. This is accomplished by a more thorough characterization of the nature of random water displacement within the cord. A novel DKI imaging sequence based on a tilted 2D spatially selective radio frequency pulse providing reduced field of view (FOV) imaging was developed, implemented, and optimized on a 3 Tesla MRI scanner, and tested on pediatric subjects (healthy subjects: 15; patients with spinal cord injury (SCI):5). Software was developed and validated for post processing of the DKI images and estimation of the tensor parameters. The results show statistically significant differences in mean kurtosis (p < 0.01) and radial kurtosis (p < 0.01) between healthy subjects and subjects with SCI. DKI provides incremental and novel information over conventional diffusion acquisitions when coupled with higher order estimation algorithms

  14. The emerging role of NG2 in pediatric diffuse intrinsic pontine glioma

    PubMed Central

    Yadavilli, Sridevi; Scafidi, Joseph; Becher, Oren J.; Saratsis, Amanda M.; Hiner, Rebecca L.; Kambhampati, Madhuri; Mariarita, Santi; MacDonald, Tobey J.; Codispoti, Kari-Elise; Magge, Suresh N.; Jaiswal, Jyoti K.; Packer, Roger J.; Nazarian, Javad

    2015-01-01

    Diffuse intrinsic pontine gliomas (DIPGs) have a dismal prognosis and are poorly understood brain cancers. Receptor tyrosine kinases stabilized by neuron-glial antigen 2 (NG2) protein are known to induce gliomagenesis. Here, we investigated NG2 expression in a cohort of DIPG specimens (n= 50). We demonstrate NG2 expression in the majority of DIPG specimens tested and determine that tumors harboring histone 3.3 mutation express the highest NG2 levels. We further demonstrate that microRNA 129-2 (miR129-2) is downregulated and hypermethylated in human DIPGs, resulting in the increased expression of NG2. Treatment with 5-Azacytidine, a methyltransferase inhibitor, results in NG2 downregulation in DIPG primary tumor cells in vitro. NG2 expression is altered (symmetric segregation) in mitotic human DIPG and mouse tumor cells. These mitotic cells co-express oligodendrocyte (Olig2) and astrocyte (glial fibrillary acidic protein, GFAP) markers, indicating lack of terminal differentiation. NG2 knockdown retards cellular migration in vitro, while NG2 expressing neurospheres are highly tumorigenic in vivo, resulting in rapid growth of pontine tumors. NG2 expression is targetable in vivo using miR129-2 indicating a potential avenue for therapeutic interventions. This data implicates NG2 as a molecule of interest in DIPGs especially those with H3.3 mutation. PMID:25987129

  15. Mesenchymal transition and PDGFRA amplification/mutation are key distinct oncogenic events in pediatric diffuse intrinsic pontine gliomas.

    PubMed

    Puget, Stephanie; Philippe, Cathy; Bax, Dorine A; Job, Bastien; Varlet, Pascale; Junier, Marie-Pierre; Andreiuolo, Felipe; Carvalho, Dina; Reis, Ricardo; Guerrini-Rousseau, Lea; Roujeau, Thomas; Dessen, Philippe; Richon, Catherine; Lazar, Vladimir; Le Teuff, Gwenael; Sainte-Rose, Christian; Geoerger, Birgit; Vassal, Gilles; Jones, Chris; Grill, Jacques

    2012-01-01

    Diffuse intrinsic pontine glioma (DIPG) is one of the most frequent malignant pediatric brain tumor and its prognosis is universaly fatal. No significant improvement has been made in last thirty years over the standard treatment with radiotherapy. To address the paucity of understanding of DIPGs, we have carried out integrated molecular profiling of a large series of samples obtained with stereotactic biopsy at diagnosis. While chromosomal imbalances did not distinguish DIPG and supratentorial tumors on CGHarrays, gene expression profiling revealed clear differences between them, with brainstem gliomas resembling midline/thalamic tumours, indicating a closely-related origin. Two distinct subgroups of DIPG were identified. The first subgroup displayed mesenchymal and pro-angiogenic characteristics, with stem cell markers enrichment consistent with the possibility to grow tumor stem cells from these biopsies. The other subgroup displayed oligodendroglial features, and appeared largely driven by PDGFRA, in particular through amplification and/or novel missense mutations in the extracellular domain. Patients in this later group had a significantly worse outcome with an hazard ratio for early deaths, ie before 10 months, 8 fold greater that the ones in the other subgroup (p = 0.041, Cox regression model). The worse outcome of patients with the oligodendroglial type of tumors was confirmed on a series of 55 paraffin-embedded biopsy samples at diagnosis (median OS of 7.73 versus 12.37 months, p = 0.045, log-rank test). Two distinct transcriptional subclasses of DIPG with specific genomic alterations can be defined at diagnosis by oligodendroglial differentiation or mesenchymal transition, respectively. Classifying these tumors by signal transduction pathway activation and by mutation in pathway member genes may be particularily valuable for the development of targeted therapies. PMID:22389665

  16. Mesenchymal Transition and PDGFRA Amplification/Mutation Are Key Distinct Oncogenic Events in Pediatric Diffuse Intrinsic Pontine Gliomas

    PubMed Central

    Bax, Dorine A.; Job, Bastien; Varlet, Pascale; Junier, Marie-Pierre; Andreiuolo, Felipe; Carvalho, Dina; Reis, Ricardo; Guerrini-Rousseau, Lea; Roujeau, Thomas; Dessen, Philippe; Richon, Catherine; Lazar, Vladimir; Le Teuff, Gwenael; Sainte-Rose, Christian; Geoerger, Birgit; Vassal, Gilles; Jones, Chris; Grill, Jacques

    2012-01-01

    Diffuse intrinsic pontine glioma (DIPG) is one of the most frequent malignant pediatric brain tumor and its prognosis is universaly fatal. No significant improvement has been made in last thirty years over the standard treatment with radiotherapy. To address the paucity of understanding of DIPGs, we have carried out integrated molecular profiling of a large series of samples obtained with stereotactic biopsy at diagnosis. While chromosomal imbalances did not distinguish DIPG and supratentorial tumors on CGHarrays, gene expression profiling revealed clear differences between them, with brainstem gliomas resembling midline/thalamic tumours, indicating a closely-related origin. Two distinct subgroups of DIPG were identified. The first subgroup displayed mesenchymal and pro-angiogenic characteristics, with stem cell markers enrichment consistent with the possibility to grow tumor stem cells from these biopsies. The other subgroup displayed oligodendroglial features, and appeared largely driven by PDGFRA, in particular through amplification and/or novel missense mutations in the extracellular domain. Patients in this later group had a significantly worse outcome with an hazard ratio for early deaths, ie before 10 months, 8 fold greater that the ones in the other subgroup (p = 0.041, Cox regression model). The worse outcome of patients with the oligodendroglial type of tumors was confirmed on a series of 55 paraffin-embedded biopsy samples at diagnosis (median OS of 7.73 versus 12.37 months, p = 0.045, log-rank test). Two distinct transcriptional subclasses of DIPG with specific genomic alterations can be defined at diagnosis by oligodendroglial differentiation or mesenchymal transition, respectively. Classifying these tumors by signal transduction pathway activation and by mutation in pathway member genes may be particularily valuable for the development of targeted therapies. PMID:22389665

  17. Insights into pediatric diffuse intrinsic pontine glioma through proteomic analysis of cerebrospinal fluid.

    PubMed

    Saratsis, Amanda M; Yadavilli, Sridevi; Magge, Suresh; Rood, Brian R; Perez, Jennifer; Hill, D Ashley; Hwang, Eugene; Kilburn, Lindsay; Packer, Roger J; Nazarian, Javad

    2012-05-01

    Diffuse intrinsic pontine glioma (DIPG) is a leading cause of brain tumor-related death in children. DIPG is not surgically resectable, resulting in a paucity of tissue available for molecular studies. As such, tumor biology is poorly understood, and, currently, there are no effective treatments. In the absence of frozen tumor specimens, body fluids--such as cerebrospinal fluid (CSF), serum, and urine--can serve as more readily accessible vehicles for detecting tumor-secreted proteins. We analyzed a total of 76 specimens, including CSF, serum, urine, and normal and tumor brainstem tissue. Protein profiling of CSF from patients with DIPG was generated by mass spectrometry using an LTQ-Orbitrap-XL and database search using the Sequest algorithm. Quantitative and statistical analyses were performed with ProteoIQ and Partek Genomics Suite. A total of 528 unique proteins were identified, 71% of which are known secreted proteins. CSF proteomic analysis revealed selective upregulation of Cyclophillin A (CypA) and dimethylarginase 1 (DDAH1) in DIPG (n = 10), compared with controls (n = 4). Protein expression was further validated with Western blot analysis and immunohistochemical assays using CSF, brain tissue, serum, and urine from DIPG and control specimens. Immunohistochemical staining showed selective upregulation of secreted but not cytosolic CypA and DDAH1 in patients with DIPG. In this study, we present the first comprehensive protein profile of CSF specimens from patients with DIPG to demonstrate selective expression of tumor proteins potentially involved in brainstem gliomagenesis. Detection of secreted CypA and DDAH1 in serum and urine has potential clinical application, with implications for assessing treatment response and detecting tumor recurrence in patients with DIPG. PMID:22492959

  18. The Digital Road to Scientific Knowledge Diffusion; A Faster, Better Way to Scientific Progress?

    SciTech Connect

    Wojick, D E; Warnick, W L; Carroll, B C; Crowe, J

    2006-06-01

    With the United States federal government spending billions annually for research and development, ways to increase the productivity of that research can have a significant return on investment. The process by which science knowledge is spread is called diffusion. It is therefore important to better understand and measure the benefits of this diffusion of knowledge. In particular, it is important to understand whether advances in Internet searching can speed up the diffusion of scientific knowledge and accelerate scientific progress despite the fact that the vast majority of scientific information resources continue to be held in deep web databases that many search engines cannot fully access. To address the complexity of the search issue, the term global discovery is used for the act of searching across heterogeneous environments and distant communities. This article discusses these issues and describes research being conducted by the Office of Scientific and Technical Information (OSTI).

  19. Progress Report for Diffusion Welding of the NGNP Process Application Heat Exchangers

    SciTech Connect

    R.E. Mizia; D.E. Clark; M.V. Glazoff; T.E. Lister; T.L. Trowbridge

    2011-12-01

    The U.S. Department of Energy selected the high temperature gas-cooled reactor as the basis for the Next Generation Nuclear Plant (NGNP). The NGNP will demonstrate the use of nuclear power for electricity, hydrogen production, and process heat applications. The NGNP Project is currently investigating the use of metallic, diffusion welded, compact heat exchangers to transfer heat from the primary (reactor side) heat transport system to the secondary heat transport system. An intermediate heat exchanger will transfer this heat to downstream applications such as hydrogen production, process heat, and electricity generation. The channeled plates that make up the heat transfer surfaces of the intermediate heat exchanger will have to be assembled into an array by diffusion welding. This report describes the preliminary results of a scoping study that evaluated the diffusion welding process parameters and the resultant mechanical properties of diffusion welded joints using Alloy 800H. The long-term goal of the program is to progress towards demonstration of small heat exchanger unit cells fabricated with diffusion welds. Demonstration through mechanical testing of the unit cells will support American Society of Mechanical Engineers rules and standards development, reduce technical risk, and provide proof of concept for heat exchanger fabrication methods needed to deploy heat exchangers in several potential NGNP configurations.1 Researchers also evaluated the usefulness of modern thermodynamic and diffusion computational tools (Thermo-Calc and Dictra) in optimizing the parameters for diffusion welding of Alloy 800H. The modeling efforts suggested a temperature of 1150 C for 1 hour with an applied pressure of 5 MPa using 15 {micro}m nickel foil as joint filler to reduce chromium oxidation on the welded surfaces. Good agreement between modeled and experimentally determined concentration gradients was achieved

  20. Twenty-five years of progress in the medical treatment of pediatric and congenital heart disease.

    PubMed

    McNamara, D G

    1983-01-01

    In the past 25 years there has been a many-fold increase in the prospect that with early recognition and modern treatment the newborn with critical congenital heart disease will reach adult life in a healthy condition, prepared to earn a living and to function as a spouse and as a parent. Advancements in the medical treatment of congenital heart disease may create less public acclaim than may surgical treatment but many purely medical developments provide the basis for achieving ultimate surgical success and, by judicious use of some forms of medical treatment, operation can be avoided altogether. The eight major contributions to patient care that are discussed in this review and the 35 that are simply listed are merely examples of the many developments that have occurred in the past 25 years. These include: 1) the organization of pediatric cardiology and the contribution of volunteer health organizations, 2) continuing medical education aimed at promoting early diagnosis of congenital heart disease and prompt referral to a cardiac center, 3) advances in the technology of cardiac catheterization, 4) Rashkind's balloon atrial septostomy and other catheter manipulative procedures, 5) pharmacologic manipulation of the ductus, 6) beta-adrenergic blockade for control of a variety of problems, including paroxysmal hypoxemic attacks, certain arrhythmias and relief of symptoms in hypertrophic cardiomyopathy, 7) echocardiography, and 8) advances in arrhythmias, electrophysiologic studies and use of pacemakers. PMID:6131085

  1. Preradiation chemotherapy may improve survival in pediatric diffuse intrinsic brainstem gliomas: Final results of BSG 98 prospective trial

    PubMed Central

    Frappaz, Didier; Schell, Matthias; Thiesse, Philippe; Marec-Bérard, Perrine; Mottolese, Carmine; Perol, David; Bergeron, Christophe; Philip, Thierry; Ricci, Anne Claire; Galand-Desme, Sophie; Szathmari, Alexandru; Carrie, Christian

    2008-01-01

    Radiation therapy remains the only treatment that provides clinical benefit to children with diffuse brainstem tumors. Their median survival, however, rarely exceeds 9 months. The authors report a prospective trial of front-line chemotherapy aimed at delaying radiation until time of clinical progression. The aim was to investigate the possibility that radiotherapy would maintain its activity in children whose disease progressed after chemotherapy. Twenty-three patients took part in this protocol, the BSG 98 protocol, which consisted of frontline chemotherapy alternating hematotoxic and nonhematotoxic schedules. Each cycle included three courses delivered monthly; the first course was 1,3-bis(2-chloroethyl)-1-nitrosourea– cisplatin, and the second and third were high-dose methotrexate. Three patients underwent one cycle; 5 patients each, two and three cycles; and 10 patients, four cycles. Twenty of the 23 patients eventually received local radiation therapy. A historical cohort of 14 patients who received at least local radiation therapy served as controls. Four patients experienced severe iatrogenic infections, and 11 patients required platelet transfusions. Median survival increased significantly in patients participating in the protocol compared to that in the historical controls (17 months, 95% confidence interval [CI], 10–23 months, vs. 9 months, 95% CI, 8–10 months; p = 0.022), though hospitalization was prolonged (57 vs. 25 days, p = 0.001). Although frontline chemotherapy alternating hematotoxic and nonhematotoxic schedules significantly increases overall median survival, its cost from infection and hospitalization deserves honest discussion with the children and their parents. PMID:18577561

  2. Pediatric non alcoholic fatty liver disease: old and new concepts on development, progression, metabolic insight and potential treatment targets

    PubMed Central

    2013-01-01

    Nonalcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease in children. NAFLD has emerged to be extremely prevalent, and predicted by obesity and male gender. It is defined by hepatic fat infiltration >5% hepatocytes, in the absence of other causes of liver pathology. It includes a spectrum of disease ranging from intrahepatic fat accumulation (steatosis) to various degrees of necrotic inflammation and fibrosis (non-alcoholic steatohepatatis [NASH]). NAFLD is associated, in children as in adults, with severe metabolic impairments, determining an increased risk of developing the metabolic syndrome. It can evolve to cirrhosis and hepatocellular carcinoma, with the consequent need for liver transplantation. Both genetic and environmental factors seem to be involved in the development and progression of the disease, but its physiopathology is not yet entirely clear. In view of this mounting epidemic phenomenon involving the youth, the study of NAFLD should be a priority for all health care systems. This review provides an overview of current and new clinical-histological concepts of pediatric NAFLD, going through possible implications into patho-physiolocical and therapeutic perspectives. PMID:23530957

  3. Is seborrhoeic dermatitis associated with a diffuse, low-grade folliculitis and progressive cicatricial alopecia?

    PubMed

    Pitney, Lucy; Weedon, David; Pitney, Michael

    2016-08-01

    An association between adult scalp seborrhoeic dermatitis and cicatricial hair loss has not previously been convincingly established. This study seeks to demonstrate a unique relationship between a clinically identifiable chronic scalp dermatitis-folliculitis with the characteristic histological features of low-grade inflammatory fibrosing alopecia, resulting in a distinctive progressive cicatricial alopecia which we believe is prevalent and hitherto unrecognised, and befits the description of seborrhoeic folliculitis. The clinical, epidemiological and histopathological features of seborrhoeic folliculitis are demonstrated to establish its unique status among the disorders of adult diffuse cicatricial alopecia. PMID:25753934

  4. Pharmacological or genetic inhibition of LDHA reverses tumor progression of pediatric osteosarcoma.

    PubMed

    Gao, Shan; Tu, Dan-Na; Li, Heng; Jiang, Jian-Xin; Cao, Xin; You, Jin-Bin; Zhou, Xiao-Qin

    2016-07-01

    Reprogrammed energy metabolism is an emerging hallmark of cancer. Lactate dehydrogenase A (LDHA), a key enzyme involved in anaerobic glycolysis, is frequently deregulated in human malignancies. However, limited knowledge is known about its roles in the progression of osteosarcoma (OS). In this study, we found that LDHA is commonly upregulated in four OS cell lines compared with the normal osteoblast cells (hFOB1.19). Treatment with FX11, a specific inhibitor of LDHA, significantly reduced LDHA activity, and inhibited cell proliferation and invasive potential in a dose dependent manner. Genetic silencing of LDHA resulted in a decreased lactate level in the culture medium, reduced cell viability and decreased cell invasion ability. Meanwhile, silencing of LDHA also compromised tumorigenesis in vivo. Furthermore, knockdown of LDHA remarkably reduced extracellular acidification rate (ECAR) as well as glucose consumption. In the presence of 2-DG, a glycolysis inhibitor, LDHA-mediated cell proliferation and invasion were completely blocked, indicating the oncogenic activities of LDHA may dependent on Warburg effect. Finally, pharmacological inhibition of c-Myc or HIF1α significantly attenuated LDHA expression. Taken together, upregulated LDHA facilitates tumor progression of OS and might be a potential target for OS treatment. PMID:27261617

  5. Physiologic abnormalities of cardiac function in progressive systemic sclerosis with diffuse scleroderma

    SciTech Connect

    Follansbee, W.P.; Curtiss, E.I.; Medsger, T.A. Jr.; Steen, V.D.; Uretsky, B.F.; Owens, G.R.; Rodnan, G.P.

    1984-01-19

    To investigate cardiopulmonary function in progressive systemic sclerosis with diffuse scleroderma, we studied 26 patients with maximal exercise and redistribution thallium scans, rest and exercise radionuclide ventriculography, pulmonary-function testing, and chest roentgenography. Although only 6 patients had clinical evidence of cardiac involvement, 20 had abnormal thallium scans, including 10 with reversible exercise-induced defects and 18 with fixed defects (8 had both). Seven of the 10 patients who had exercise-induced defects and underwent cardiac catheterization had normal coronary angiograms. Mean resting left ventricular ejection fraction and mean resting right ventricular ejection fraction were lower in patients with post-exercise left ventricular thallium defect scores above the median (59 +/- 13 per cent vs. 69 +/- 6 per cent, and 36 +/- 12 per cent vs. 47 +/- 7 per cent, respectively). The authors conclude that in progressive systemic sclerosis with diffuse scleroderma, abnormalities of myocardial perfusion are common and appear to be due to a disturbance of the myocardial microcirculation. Both right and left ventricular dysfunction appear to be related to this circulatory disturbance, suggesting ischemically mediated injury.

  6. Methylene blue treatment delays progression of perfusion-diffusion mismatch to infarct in permanent ischemic stroke

    PubMed Central

    Rodriguez, Pavel; Jiang, Zhao; Huang, Shiliang; Shen, Qiang; Duong, Timothy Q

    2016-01-01

    Stroke is a leading cause of morbidity and mortality in the world. Low-dose methylene blue (MB), which has been used safely to treat methemoglobinemia and cyanide poisoning in humans, has energy enhancing and antioxidant properties. We tested the hypothesis that methylene blue treatment delays progression of at-risk tissue (ca. perfusion-diffusion mismatch) to infarct in permanent middle cerebral artery occlusion in rats at two MB treatment doses. Serial MRI was used to evaluate MB treatment efficacy. The major findings were: (i) MB significantly prolonged the perfusion-diffusion mismatch, (ii) MB mildly increased the CBF in the hypoperfused tissue, (iii) MB did not change the final infarct volume in permanent ischemic stroke, and (iv) there were no dose-dependent effects on mismatch progression for the 1 and 3mg/kg doses studied. This neuroprotective effect is likely the result of sustained ATP production and increased CBF to tissue at risk. This work has the potential to readily lead to clinical stroke trials given MB's excellent safety profile. PMID:25218555

  7. Molecular Profiling Reveals Biologically Discrete Subsets and Pathways of Progression in Diffuse Glioma.

    PubMed

    Ceccarelli, Michele; Barthel, Floris P; Malta, Tathiane M; Sabedot, Thais S; Salama, Sofie R; Murray, Bradley A; Morozova, Olena; Newton, Yulia; Radenbaugh, Amie; Pagnotta, Stefano M; Anjum, Samreen; Wang, Jiguang; Manyam, Ganiraju; Zoppoli, Pietro; Ling, Shiyun; Rao, Arjun A; Grifford, Mia; Cherniack, Andrew D; Zhang, Hailei; Poisson, Laila; Carlotti, Carlos Gilberto; Tirapelli, Daniela Pretti da Cunha; Rao, Arvind; Mikkelsen, Tom; Lau, Ching C; Yung, W K Alfred; Rabadan, Raul; Huse, Jason; Brat, Daniel J; Lehman, Norman L; Barnholtz-Sloan, Jill S; Zheng, Siyuan; Hess, Kenneth; Rao, Ganesh; Meyerson, Matthew; Beroukhim, Rameen; Cooper, Lee; Akbani, Rehan; Wrensch, Margaret; Haussler, David; Aldape, Kenneth D; Laird, Peter W; Gutmann, David H; Noushmehr, Houtan; Iavarone, Antonio; Verhaak, Roel G W

    2016-01-28

    Therapy development for adult diffuse glioma is hindered by incomplete knowledge of somatic glioma driving alterations and suboptimal disease classification. We defined the complete set of genes associated with 1,122 diffuse grade II-III-IV gliomas from The Cancer Genome Atlas and used molecular profiles to improve disease classification, identify molecular correlations, and provide insights into the progression from low- to high-grade disease. Whole-genome sequencing data analysis determined that ATRX but not TERT promoter mutations are associated with increased telomere length. Recent advances in glioma classification based on IDH mutation and 1p/19q co-deletion status were recapitulated through analysis of DNA methylation profiles, which identified clinically relevant molecular subsets. A subtype of IDH mutant glioma was associated with DNA demethylation and poor outcome; a group of IDH-wild-type diffuse glioma showed molecular similarity to pilocytic astrocytoma and relatively favorable survival. Understanding of cohesive disease groups may aid improved clinical outcomes. PMID:26824661

  8. Ursodeoxycholic acid therapy in pediatric patients with progressive familial intrahepatic cholestasis.

    PubMed

    Jacquemin, E; Hermans, D; Myara, A; Habes, D; Debray, D; Hadchouel, M; Sokal, E M; Bernard, O

    1997-03-01

    Progressive familial intrahepatic cholestasis (PFIC) is a lethal inherited childhood cholestasis of hepatocellular origin. Different subtypes of PFIC have been described according to serum gamma-glutamyl transpeptidase (GGT) activity. There is currently no effective medical therapy available for children with PFIC. We report on 39 patients with PFIC who received ursodeoxycholic acid (UDCA) orally (20-30 mg/kg b.w./day) for a period of 2 to 4 years. Group 1 (n = 26) consisted of children with normal GGT activity, and group 2 (n = 13) of children with high GGT activity. Within group 1, liver tests normalized in 11 children, improved in 5, and stabilized or worsened in 10. Within group 2, liver tests normalized in six children, improved in four, and stabilized or worsened in three. Improvement of parameters was associated with an enrichment of the circulating pool of bile acids with UDCA. Hepatosplenomegaly and pruritus disappeared or diminished in children in whom liver tests normalized. In nine of these children, liver tests worsened and normalized again after stopping and restarting UDCA. Liver histology assessed in four children after normalization of liver tests and 2 years of treatment showed a decrease in fibrosis. We conclude that UDCA should be considered in the initial therapeutic management of children with PFIC, because it appears effective in resolving or improving the liver function and the clinical status of a fair proportion of children. Chronic UDCA therapy might thus avoid the need for liver transplantation in some children with PFIC. PMID:9049190

  9. Pediatric Brain Tumor Foundation

    MedlinePlus

    ... you insights into your child's treatment. LEARN MORE Brain tumors and their treatment can be deadly so ... to make progress in “immunogenomics” Read more >> Pediatric Brain Tumor Foundation 302 Ridgefield Court, Asheville, NC 28806 ...

  10. Differences in Supratentorial Damage of White Matter in Pediatric Survivors of Posterior Fossa Tumors With and Without Adjuvant Treatment as Detected by Magnetic Resonance Diffusion Tensor Imaging

    SciTech Connect

    Rueckriegel, Stefan Mark; Driever, Pablo Hernaiz; Blankenburg, Friederike; Luedemann, Lutz; Henze, Guenter; Bruhn, Harald

    2010-03-01

    Purpose: To elucidate morphologic correlates of brain dysfunction in pediatric survivors of posterior fossa tumors by using magnetic resonance diffusion tensor imaging (DTI) to examine neuroaxonal integrity in white matter. Patients and Methods: Seventeen medulloblastoma (MB) patients who had received surgery and adjuvant treatment, 13 pilocytic astrocytoma (PA) patients who had been treated only with surgery, and age-matched healthy control subjects underwent magnetic resonance imaging on a 3-Tesla system. High-resolution conventional T1- and T2-weighted magnetic resonance imaging and DTI data sets were obtained. Fractional anisotropy (FA) maps were analyzed using tract-based spatial statistics, a part of the Functional MRI of the Brain Software Library. Results: Compared with control subjects, FA values of MB patients were significantly decreased in the cerebellar midline structures, in the frontal lobes, and in the callosal body. Fractional anisotropy values of the PA patients were not only decreased in cerebellar hemispheric structures as expected, but also in supratentorial parts of the brain, with a distribution similar to that in MB patients. However, the amount of significantly decreased FA was greater in MB than in PA patients, underscoring the aggravating neurotoxic effect of the adjuvant treatment. Conclusions: Neurotoxic mechanisms that are present in PA patients (e.g., internal hydrocephalus and damaged cerebellar structures affecting neuronal circuits) contribute significantly to the alteration of supratentorial white matter in pediatric posterior fossa tumor patients.

  11. Recent progress of MODIS solar diffuser on-orbit degradation characterization

    NASA Astrophysics Data System (ADS)

    Chen, H.; Wang, Z.; Sun, J.; Angal, A.; Xiong, X.

    2012-09-01

    An on-board Solar Diffuser (SD) is used for the MODIS reflective solar bands (RSB) calibration. Its on-orbit bidirectional reflectance factor (BRF) degradation is tracked using an on-board Solar Diffuser Stability Monitor (SDSM). The SDSM is a ratioing radiometer with nine detectors, covering wavelengths from 412 nm to 936 nm. During each scheduled SD calibration event, the SDSM makes alternate observations of the Sun and the sunlight reflected by the SD. To best match the SDSM detector signals from its Sun view and SD view, a fix attenuation screen is placed in its Sun view path. This paper provides a brief description of MODIS RSB on-orbit calibration and the use of its on-board SD and SDSM subsystem, including different approaches developed and used to track MODIS SD on-orbit degradation. It reports recent progress made to better characterize MODIS SD on-orbit degradation and to support MODIS Level 1B (L1B) calibration look-up table (LUT) updates for the upcoming collection 6 (C6) reprocessing. Results of both Terra and Aqua SD on-orbit degradation derived from newly improved SDSM Sun view screen vignetting function and response fitting strategy, and their impact on RSB calibration uncertainties are also presented.

  12. Hereditary Diffuse Leukoencephalopathy with Spheroids with Phenotype of Primary Progressive MS

    PubMed Central

    Karrenbauer, Virginija; Gustavsen, Marte; Bedri, Sahl; Glaser, Anna; Myhr, Kjell-Morten; Haugarvoll, Kristoffer; Zetterberg, Henrik; Harbo, Hanne; Kockum, Ingrid; Hillert, Jan; Wszolek, Zbigniew

    2014-01-01

    BACKGROUND Hereditary diffuse leukoencephalopathy with spheroids (HDLS) is a devastating, hereditary white matter (WM) disorder with heterogenous neuropsychiatric features. We looked for CSF1R mutations in primary progressive multiple sclerosis (PPMS) patients and report the clinical features of a family with a novel CSF1R mutation. METHODS We sequenced CSF1R exons 12-22 in a cohort of 220 PPMS patients from the Swedish and Norwegian national MS registries. RESULTS One patient had a novel mutation, c.2562T>A; p.Asn854Lys, in the CSF1R gene. Her symptoms started at the age of 29 years with insidious onset of pyramidal weakness in the left leg. The cerebrospinal fluid (CSF) examination showed four IgG bands. An MRI performed 4 years after symptom onset demonstrated patchy deep WM lesions. She was diagnosed as having PPMS and treated with intramuscular interferon beta 1a. Due to slow disease progression, the development of memory decline, and cerebellar signs, she was given subcutaneous interferon beta 1a without any benefit. The updated pedigree indicated that 5 siblings also had the CSF1R gene mutation; one was diagnosed with PPMS. Six more distant relatives also had a neurological disorder; four were clinically diagnosed with PPMS. CONCLUSIONS Our study indicates that a chronic course of HDLS may mimic PPMS. Genetic testing for CSF1R mutations in PPMS cases with a positive family history of neurological disorders may establish the diagnosis of HDLS. PMID:25311247

  13. Progress in Pediatrics in 2012: choices in allergy, endocrinology, gastroenterology, hematology, infectious diseases, neurology, nutrition and respiratory tract illnesses.

    PubMed

    Caffarelli, Carlo; Santamaria, Francesca; Vottero, Alessandra; Bernasconi, Sergio

    2013-01-01

    In this review, we summarize the progresses in allergy, endocrinology, gastroenterology, hematology, infectious diseases, neurology, nutrition and respiratory tract illnesses that have been published in The Italian Journal of Pediatrics in 2012. The induction of Treg activity by probiotics might be effective for promoting tolerance towards food allergens. Nasal cytology is useful in patients with rhinitis for diagnosing chronic non-allergic non-infectious diseases. Atopic eczema is associated both with an aberrant skin matrix and impaired systemic immune response. Therefore, isolated topical treatment may have suboptimal effect. Diagnostic work-up of exercise-induced anaphylaxis, including exercise challenge test, is necessary to reach a diagnosis. Studies may support a role for nutrition on prevention of asthma and cardiovascular diseases. Clinicians need to early identify adolescent menstrual abnormalities to minimize sequelae, and to promote health information. In Multiple Endocrine Neoplasia type 2B investigations include acetylcholinesterase study of rectal mucosa followed by the molecular analysis of RET mutation. Low adherence to gluten-free diet and osteopenia are common problems in children with diabetes mellitus type 1 and celiac disease. In infantile colic, laboratory tests are usually unnecessary and the treatment is based on reassurance. Prevalence of obesity and stunting is elucidated by several studies. Evidences are growing that dietetic measures are needed to prevent obesity in children with acute leukemia. Treatment studies for infectious diseases show promise for probiotics along with standard triple therapy in children with Helicobacter pilori infection, while zinc has no effect on pneumonia. Educational programs about the proper management of the febrile child are warranted. A new hour-specific total serum bilirubin nomogram has been shown to be able to predict newborns without hyperbilirubinemia after 48 to 72 hours of life. Newborns with

  14. Pediatric MS

    MedlinePlus

    ... of the oral medications in the pediatric population. Network of Pediatric MS Centers The National MS Society ... MS Study Group (2004) and established a nationwide network of six Pediatric MS Centers of Excellence (2006) ...

  15. Pediatric Injury

    MedlinePlus

    ... common causes, which are 1 , 2 , 3 : Motor vehicle accidents Suffocation (being unable to breathe) Drowning Poisoning ... gov/safechild [top] American Academy of Pediatrics. (2008). Management of pediatric trauma. Pediatrics, 121 , 849–854. [top] ...

  16. Energetics of silicate melts from thermal diffusion studies. Annual progress report

    SciTech Connect

    Walker, D.

    1992-07-01

    Efforts are reported in the following areas: laboratory equipment (multianvils for high P/T work, pressure media, SERC/DL sychrotron), liquid-state thermal diffusion (silicate liquids, O isotopic fractionation, volatiles, tektites, polymetallic sulfide liquids, carbonate liquids, aqueous sulfate solutions), and liquid-state isothermal diffusion (self-diffusion, basalt-rhyolite interdiffusion, selective contamination, chemical diffusion).

  17. Progression of striatal and extrastriatal degeneration in multiple system atrophy: a longitudinal diffusion-weighted MR study.

    PubMed

    Pellecchia, Maria Teresa; Barone, Paolo; Vicidomini, Caterina; Mollica, Carmine; Salvatore, Elena; Ianniciello, Marta; Liuzzi, Raffaele; Longo, Katia; Picillo, Marina; De Michele, Giuseppe; Filla, Alessandro; Brunetti, Arturo; Salvatore, Marco; Pappatà, Sabina

    2011-06-01

    Diffusion-weighted imaging has been largely used to detect and quantify early degenerative changes in patients with multiple system atrophy, but progression of neurodegeneration has been poorly investigated. We performed a serial diffusion-weighted imaging study in a population of multiple system atrophy patients and analyzed the evolution of diffusion properties in striatal and extrastriatal brain regions. Diffusion-weighted imaging was obtained in 11 multiple system atrophy patients at baseline and after a follow-up of 11.7 ± 1.2 months, and Trace (D) changes in different brain regions were correlated with disease duration and severity. A significant increase in Trace (D) was observed at follow-up in the putamen (P < .001), pons (P = .003), cerebellar white matter (P = .03), thalamus (P = .013), and frontal white matter (P = .021). Both Unified Multiple System Atrophy Rating Scale Part II and Unified Parkinson's Disease Rating Scale Part III scores significantly increased at follow-up (P = .003), but percent changes of Unified Parkinson's Disease Rating Scale Part III and Unified Multiple System Atrophy Rating Scale Part II did not correlate with percent changes of Trace (D) values in any brain region. This longitudinal study provides new insights into the progression of neurodegeneration in different brain regions in multiple system atrophy. Our results confirm that abnormal diffusivity in the putamen is sensitive to change over time in multiple system atrophy patients and show for the first time a progression of Trace (D) alterations in specific extrastriatal regions. Diffusivity changes in these regions may be useful for monitoring disease progression even after a short follow-up period. © 2011 Movement Disorder Society. PMID:21469200

  18. K27M mutation in histone H3.3 defines clinically and biologically distinct subgroups of pediatric diffuse intrinsic pontine gliomas.

    PubMed

    Khuong-Quang, Dong-Anh; Buczkowicz, Pawel; Rakopoulos, Patricia; Liu, Xiao-Yang; Fontebasso, Adam M; Bouffet, Eric; Bartels, Ute; Albrecht, Steffen; Schwartzentruber, Jeremy; Letourneau, Louis; Bourgey, Mathieu; Bourque, Guillaume; Montpetit, Alexandre; Bourret, Genevieve; Lepage, Pierre; Fleming, Adam; Lichter, Peter; Kool, Marcel; von Deimling, Andreas; Sturm, Dominik; Korshunov, Andrey; Faury, Damien; Jones, David T; Majewski, Jacek; Pfister, Stefan M; Jabado, Nada; Hawkins, Cynthia

    2012-09-01

    Pediatric glioblastomas (GBM) including diffuse intrinsic pontine gliomas (DIPG) are devastating brain tumors with no effective therapy. Here, we investigated clinical and biological impacts of histone H3.3 mutations. Forty-two DIPGs were tested for H3.3 mutations. Wild-type versus mutated (K27M-H3.3) subgroups were compared for HIST1H3B, IDH, ATRX and TP53 mutations, copy number alterations and clinical outcome. K27M-H3.3 occurred in 71 %, TP53 mutations in 77 % and ATRX mutations in 9 % of DIPGs. ATRX mutations were more frequent in older children (p < 0.0001). No G34V/R-H3.3, IDH1/2 or H3.1 mutations were identified. K27M-H3.3 DIPGs showed specific copy number changes, including all gains/amplifications of PDGFRA and MYC/PVT1 loci. Notably, all long-term survivors were H3.3 wild type and this group of patients had better overall survival. K27M-H3.3 mutation defines clinically and biologically distinct subgroups and is prevalent in DIPG, which will impact future therapeutic trial design. K27M- and G34V-H3.3 have location-based incidence (brainstem/cortex) and potentially play distinct roles in pediatric GBM pathogenesis. K27M-H3.3 is universally associated with short survival in DIPG, while patients wild-type for H3.3 show improved survival. Based on prognostic and therapeutic implications, our findings argue for H3.3-mutation testing at diagnosis, which should be rapidly integrated into the clinical decision-making algorithm, particularly in atypical DIPG. PMID:22661320

  19. PIM kinases are progression markers and emerging therapeutic targets in diffuse large B-cell lymphoma

    PubMed Central

    Brault, L; Menter, T; Obermann, E C; Knapp, S; Thommen, S; Schwaller, J; Tzankov, A

    2012-01-01

    Background: PIM serine/threonine kinases are often highly expressed in haematological malignancies. We have shown that PIM inhibitors reduced the survival and migration of leukaemic cells. Here, we investigated PIM kinases in diffuse large B-cell lymphoma (DLBCL) biopsy samples and DLBCL cell lines. Methods: Immunohistochemical staining for PIM kinases and CXCR4 was performed on tissue microarrays from a cohort of 101 DLBCL cases, and the effects of PIM inhibitors on the survival and migration of DLBCL cell lines were determined. Results: PIM1 expression significantly correlated with the activation of signal transducer and activator of transcription (STAT) 3 and 5, P-glycoprotein expression, CXCR4-S339 phosphorylation, and cell proliferation. Whereas most cases exhibited cytoplasmic or cytoplasmic and nuclear PIM1 and PIM2 expression, 12 cases (10 of the non-germinal centre DLBCL type) expressed PIM1 predominately in the nucleus. Interestingly, nuclear expression of PIM1 significantly correlated with disease stage. Exposure of DLBCL cell lines to PIM inhibitors modestly impaired cellular proliferation and CXCR4-mediated migration. Conclusion: This work demonstrates that PIM expression in DLBCL is associated with activation of the JAK/STAT signalling pathway and with the proliferative activity. The correlation of nuclear PIM1 expression with disease stage and the modest response to small-molecule inhibitors suggests that PIM kinases are progression markers rather than primary therapeutic targets in DLBCL. PMID:22722314

  20. Assessment of health-related quality of life in pediatric hematopoietic stem cell transplant recipients: progress, challenges and future directions

    PubMed Central

    Parsons, Susan K; Tighiouart, Hocine; Terrin, Norma

    2014-01-01

    This article provides an overview of health-related quality of life (HRQoL) assessments in pediatric hematopoietic stem cell transplants, focusing on the relationship between child and parent proxy ratings of the child’s HRQoL and how measurement of HRQoL may be incorporated into clinical decision-making. Parent and child ratings of the child’s health may be affected differently by unequal access to and incongruent understanding of available information, as well as the effect of age difference on interpretation. In particular, parents and children may experience the impact of clinical events on HRQoL very differently. The recent US Federal emphasis on ‘patient-centeredness’ has helped fuel the development and application of more clinically functional and low-burden HRQoL measures. Future work in pediatric hematopoietic stem cell transplants must seek to capture the experiences and perceptions of all those involved. PMID:23570432

  1. Diffuse myogenin expression by immunohistochemistry is an independent marker of poor survival in pediatric rhabdomyosarcoma: a tissue microarray study of 71 primary tumors including correlation with molecular phenotype.

    PubMed

    Heerema-McKenney, Amy; Wijnaendts, Liliane C D; Pulliam, Joseph F; Lopez-Terrada, Dolores; McKenney, Jesse K; Zhu, Shirley; Montgomery, Kelli; Mitchell, Janet; Marinelli, Robert J; Hart, Augustinus A M; van de Rijn, Matt; Linn, Sabine C

    2008-10-01

    The pathologic classification of rhabdomyosarcoma (RMS) into embryonal or alveolar subtype is an important prognostic factor guiding the therapeutic protocol chosen for an individual patient. Unfortunately, this classification is not always straightforward, and the diagnostic criteria are controversial in a subset of cases. Ancillary studies are used to aid in the classification, but their potential use as independent prognostic factors is rarely studied. The aim of this study is to identify immunohistochemical markers of potential prognostic significance in pediatric RMS and to correlate their expression with PAX-3/FKHR and PAX-7/FKHR fusion status. A single tissue microarray containing 71 paraffin-embedded pediatric RMSs was immunostained with antibodies against p53, bcl-2, Ki-67, CD44, myogenin, and MyoD1. The tissue microarray and whole paraffin blocks were studied for PAX-3/FKHR and PAX-7/FKHR gene fusions by fluorescence in situ hybridization and reverse transcription-polymerase chain reaction. Clinical follow-up data were available for each patient. Immunohistochemical staining results and translocation status were correlated with recurrence-free interval (RFI) and overall survival (OS) using the Kaplan-Meier method, the log-rank test, and Cox proportional hazard regression. The minimum clinical follow-up interval was 24 months (median follow-up=57 mo). On univariable analysis, immunohistochemical expression of myogenin, bcl-2, and identification of a gene fusion were associated with decreased 5-year RFI and 10-year OS (myogenin RFI P=0.0028, OS P=0.0021; bcl-2 RFI P=0.037, OS P=0.032; gene fusion RFI P=0.0001, OS P=0.0058). After adjustment for Intergroup Rhabdomyosarcoma Study-TNM stage, tumor site, age, tumor histology, and translocation status by multivariable analysis, only myogenin retained an independent association with RFI (P=0.034) and OS (P=0.0069). In this retrospective analysis, diffuse immunohistochemical reactivity for myogenin in RMS

  2. High-Resolution Diffusion Tensor Spinal Cord MRI Measures as Biomarkers of Disability Progression in a Rodent Model of Progressive Multiple Sclerosis

    PubMed Central

    Gilli, Francesca; Chen, Xi; Pachner, Andrew R.; Gimi, Barjor

    2016-01-01

    Disease in the spinal cord is a major component of disability in multiple sclerosis, yet current techniques of imaging spinal cord injury are insensitive and nonspecific. This study seeks to remove this major impediment to research in multiple sclerosis and other spinal cord diseases by identifying reliable biomarkers of disability progression using diffusion tensor imaging (DTI), a magnetic resonance imaging technique, to evaluate the spinal cord in a model of multiple sclerosis, i.e. the Theiler’s Murine Encephalitis Virus-Induced Demyelinating Disease (TMEV-IDD). Mice with TMEV-IDD with varying levels of clinical disease were imaged using a 9.4T small animal MRI scanner. Axial diffusivity, radial diffusivity, and fractional anisotropy were calculated. Disability was assessed periodically using Rotarod assay and data were expressed as a neurological function index. Correlation was performed between DTI measurements and disability scores. TMEV-IDD mice displayed significant increased neurological deficits over time when compared with controls (p<0.0001). Concurrently, the values of fractional anisotropy and axial diffusivity were both decreased compared to controls (both p<0.0001), while radial diffusivity was increased (p<0.0001). Overall, fractional anisotropy changes were larger in white matter than in grey matter and differences were more pronounced in the ventral region. Lower disability scores were associated with decreased fractional anisotropy values measured in the ventral (r = 0.68; p<0.0001) and ventral-lateral (r = 0.70; p<0.0001) regions of the white matter. These data demonstrate that DTI measures of the spinal cord contribute to strengthening the association between neuroradiological markers and clinical disability, and support the use of DTI measures in spinal cord imaging in MS patients. PMID:27467829

  3. Pediatric Cardiomyopathies

    MedlinePlus

    ... Pressure High Blood Pressure Tools & Resources Stroke More Pediatric Cardiomyopathies Updated:Oct 22,2015 Patient education material ... oxygen or high blood pressure. According to the Pediatric Cardiomyopathy Registry, one in every 100,000 children ...

  4. Myocarditis - pediatric

    MedlinePlus

    Pediatric myocarditis is inflammation of the heart muscle in an infant or young child. ... infections such as Lyme disease. Other causes of pediatric myocarditis include: Allergic reactions to certain medicines Exposure ...

  5. Energetics of melts from thermal diffusion studies. FY 1995 progress report

    SciTech Connect

    Lesher, C.E.

    1996-12-31

    This research program characterizes mass transport by diffusion in geological fluids in response to thermal, solubility, and/or chemical gradients to obtain quantitative information on the thermodynamic and kinetic properties of multicomponent systems. Silicate liquids undergo substantial thermal diffusion (Soret) differentiation, while the response in sulfide, carbonate, and aqueous fluids to an imposed temperature gradient is varied. The experimental observations of this differentiation are used to evaluate the form and quantitative values of solution parameters, and to quantify ordinary diffusion coefficients, heats of transport, and activation energies of multicomponent liquids. The diffusion, solution, and element partition coefficients determined for these geological fluids form a data base for understanding magmatic crystallization behavior and for evaluating geothermal, ore deposit, and nuclear waste isolation potentials.

  6. Energetics of melts from thermal diffusion studies. FY 1996 progress report

    SciTech Connect

    Lesher, C.E.

    1997-12-31

    This research program characterizes mass transport by diffusion in geological fluids in response to thermal, solubility, and/or chemical gradients to obtain quantitative information on the thermodynamic and kinetic properties of multicomponent systems. Silicate liquids undergo substantial thermal diffusion (Soret) differentiation, while the response in sulfide, carbonate, and aqueous fluids to an imposed temperature gradient is varied. The experimental observations of this differentiation are used to evaluate the form and quantitative values of solution parameters, and to quantify ordinary diffusion coefficients, heats of transport, and activation energies of multicomponent liquids. The diffusion, solution, and element partition coefficients determined for these geological fluids form a data base for understanding magmatic crystallization behavior and for evaluating geothermal, ore deposit, and nuclear waste isolation potentials.

  7. Pediatric Stroke

    PubMed Central

    Jeong, Goun; Lim, Byung Chan

    2015-01-01

    Pediatric stroke is relatively rare but may lead to significant morbidity and mortality. Along with the advance of brain imaging technology and clinical awareness, diagnosis of pediatric stroke is increasing wordwide. Pediatric stroke differs from adults in variable risk factor/etiologies, diverse and nonspecific clinical presentation depending on ages. This review will be discussed pediatric stroke focusing on their clinical presentations, diagnosis and etiologies/risk factors. PMID:26180605

  8. Progress Report for Diffusion Welding of the NGNP Process Application Heat Exchangers

    SciTech Connect

    R.E. Mizia; D.E. Clark; M.V. Glazoff; T.E. Lister; T.L. Trowbridge

    2011-04-01

    The NGNP Project is currently investigating the use of metallic, diffusion welded, compact heat exchangers to transfer heat from the primary (reactor side) heat transport system to the secondary heat transport system. The intermediate heat exchanger will transfer this heat to downstream applications such as hydrogen production, process heat, and electricity generation. The channeled plates that make up the heat transfer surfaces of the intermediate heat exchanger will have to be assembled into an array by diffusion welding.

  9. Pediatric Extranodal Lymphoma.

    PubMed

    Chung, Ellen M; Pavio, Michael

    2016-07-01

    Lymphoma is the third most common pediatric neoplasm. Non-Hodgkin lymphoma (NHL) accounts for nearly half of cases and commonly involves extranodal sites. Compared with adults, this histologic spectrum of pediatric NHL is very narrow and consists of aggressive tumors. Patients typically present with widespread disease. Generally, NHL occurring in children includes Burkitt lymphoma, lymphoblastic lymphoma, diffuse large B-cell lymphoma, and anaplastic large cell lymphoma. Staging and assessment of therapeutic response are usually based on FDG-PET/CT. Due to the increased susceptibility of young patients to the effects of ionizing radiation, alternative methods of imaging are being explored. PMID:27265605

  10. Energetics of melts from thermal diffusion studies. FY 1993 progress report

    SciTech Connect

    Lesher, C.E.

    1994-12-31

    This research program characterizes diffusional mass transport in geological fluids in response to thermal, solubility and chemical gradients using tools of experimental petrology. Quantitative information is obtained on the thermodynamic and kinetic properties of multicomponent systems that are the basis for predictive models of chemical diffusion, mineral dissolution, and complexing in synthetic and natural silicate systems. Among the technical accomplishments related to establishing the UCD experimental petrology laboratory in the last year has been the design and construction of two compact piston-cylinder devices capable of achieving 40 kb using 1/2-in. pressure vessels (also capable of accommodating 3/4-in. vessels). These machines are now on-line and performing thermal diffusion experiments. In addition to establishing the new laboratory at UCD, the PI began studies of molecular diffusion in the absence of a thermal gradient with results published on the chemical and self diffusion of Sr and Nd in naturally-occurring silicate liquids, and self diffusivities of Si and O in basaltic liquid.

  11. Pediatric sialadenitis.

    PubMed

    Francis, Carrie L; Larsen, Christopher G

    2014-10-01

    Sialadenitis in the pediatric population accounts for up to 10% of all salivary gland disease. Viral parotitis and juvenile recurrent parotitis are the two most common causes. Multiple factors, independently or in combination, can result in acute, chronic, or recurrent acute salivary gland inflammation. Sialendoscopy has emerged as the leading diagnostic technique and intervention for pediatric sialadenitis. Sialendoscopy is a safe and effective gland-preserving treatment of pediatric sialadenitis. Investigational studies are needed to address the impact of steroid instillation, postoperative stenting, and long-term outcomes of pediatric sialendoscopy. This article presents a comprehensive review of pathophysiology, clinical presentation, diagnosis, and treatment of pediatric sialadenitis. PMID:25128215

  12. Progressive Volume Loss and White Matter Degeneration in Cstb-Deficient Mice: A Diffusion Tensor and Longitudinal Volumetry MRI Study

    PubMed Central

    Manninen, Otto; Laitinen, Teemu; Lehtimäki, Kimmo K.; Tegelberg, Saara; Lehesjoki, Anna-Elina; Gröhn, Olli; Kopra, Outi

    2014-01-01

    Unverricht-Lundborg type progressive myoclonus epilepsy (EPM1, OMIM 254800) is an autosomal recessive disorder characterized by onset at the age of 6 to 16 years, incapacitating stimulus-sensitive myoclonus and tonic-clonic epileptic seizures. It is caused by mutations in the gene encoding cystatin B. Previously, widespread white matter changes and atrophy has been detected both in adult EPM1 patients and in 6-month-old cystatin B–deficient mice, a mouse model for the EPM1 disease. In order to elucidate the spatiotemporal dynamics of the brain atrophy and white matter changes in EPM1, we conducted longitudinal in vivo magnetic resonance imaging and ex vivo diffusion tensor imaging accompanied with tract-based spatial statistics analysis to compare volumetric changes and fractional anisotropy in the brains of 1 to 6 months of age cystatin B–deficient and control mice. The results reveal progressive but non-uniform volume loss of the cystatin B–deficient mouse brains, indicating that different neuronal populations possess distinct sensitivity to the damage caused by cystatin B deficiency. The diffusion tensor imaging data reveal early and progressive white matter alterations in cystatin B–deficient mice affecting all major tracts. The results also indicate that the white matter damage in the cystatin B–deficient brain is most likely secondary to glial activation and neurodegenerative events rather than a primary result of CSTB deficiency. The data also show that diffusion tensor imaging combined with TBSS analysis provides a feasible approach not only to follow white matter damage in neurodegenerative mouse models but also to detect fractional anisotropy changes related to normal white matter maturation and reorganisation. PMID:24603771

  13. Progress in pediatrics in 2013: choices in allergology, endocrinology, gastroenterology, hypertension, infectious diseases, neonatology, neurology, nutrition and respiratory tract illnesses.

    PubMed

    Caffarelli, Carlo; Santamaria, Francesca; Vottero, Alessandra; Dascola, Carlotta Povesi; Mirra, Virginia; Sperli, Francesco; Bernasconi, Sergio

    2014-01-01

    This review will provide new information related to pathophysiology and management of specific diseases that have been addressed by selected articles published in the Italian Journal of Pediatrics in 2013, focusing on allergology, endocrinology, gastroenterology, hypertension, infectious diseases, neonatology, neurology, nutrition and respiratory tract illnesses in children. Recommendations for interpretation of skin prick test to foods in atopic eczema, management of allergic conjunctivitis, hypertension and breastfeeding in women treated with antiepileptic drugs and healthy breakfast have been reported. Epidemiological studies have given emphasis to high incidence of autoimmune disorders in patients with Turner syndrome, increasing prevalence of celiac disease, frequency of hypertension in adolescents, incidence and risk factor for retinopathy of prematurity. Advances in prevention include elucidation of the role of probiotics in reducing occurrence of allergies and feeding intolerance, and events of foetal life that influence later onset of diseases. Mechanistic studies suggested a role for vitamin D deficiency in asthma and type 1 diabetes and for reactivation of Varicella-Zoster virus in aseptic meningitis. Regarding diagnosis, a new mean for the diagnosis of hyperbilirubinaemia in newborns, a score for recognition of impaired nutritional status and growth and criteria for early Dyke-Davidoff-Masson Syndrome have been suggested. New therapeutic approaches consist of use of etanercept for reducing insulin dose in type 1 diabetes, probiotics in atopic eczema, and melatonin in viral infections. PMID:25015124

  14. Central Nervous System Lymphoma in a 3-Year-Old Male Suffering from a Severe Juvenile Xanthogranuloma – the Usefulness of Perfusion Weighted Imaging and Diffusion Weighted Imaging in the Diagnostics of Pediatric Brain Tumors

    PubMed Central

    Neska-Matuszewska, Małgorzata; Zimny, Anna; Kałwak, Krzysztof; Sąsiadek, Marek J.

    2015-01-01

    Summary Background Primary Central Nervous System Lymphomas (PCNSLs) are rare, malignant brain tumors derived from lymphocytes B. Juvenile xanthogranuloma (JXG) is a non-Langerhans histiocytic cell disorder in children which mostly affects the skin. Rare fatalities have been reported in extracutaneous manifestation. Brain magnetic resonance imaging (MRI) is a method of choice in the diagnostics of all neoplastic CNS lesions. Perfusion weighted imaging (PWI) and diffusion weighted imaging (DWI) allow for more detailed analysis of brain tumors including the rate of neoangiogenesis and cellularity. We presented a pediatric patient suffering from JXG with CNS involvement and the role of brain MRI including DWI and PWI in the evaluation of brain focal lesions. Case Report A 3-year-old male with severe JXG underwent two stem cell transplantations with a development of neurological complications. The patient underwent emergency CT and MRI which revealed a non-specific enhancing focal brain lesion. In DWI it showed restricted diffusion while PWI revealed low values of rCBV and the signal intensity curve returning above the baseline level. Advanced MRI techniques such as DWI and PWI suggested PCNSL. Stereotactic biopsy confirmed PCNSL due to Ebstein-Barr virus reactivation. Conclusions The use of advanced MRI sequences is important to differentiate brain lesions in pediatric patients. The use of PWI and DWI facilitated the diagnosis of PCNSL. It is important to remember that PCNSLs show a very typical pattern of changes visualized with MRI such as: usually strong homogenous enhancement, restricted diffusion and low perfusion. PMID:25624957

  15. Progress in pediatrics in 2015: choices in allergy, endocrinology, gastroenterology, genetics, haematology, infectious diseases, neonatology, nephrology, neurology, nutrition, oncology and pulmonology.

    PubMed

    Caffarelli, Carlo; Santamaria, Francesca; Di Mauro, Dora; Mastrorilli, Carla; Mirra, Virginia; Bernasconi, Sergio

    2016-01-01

    This review focuses key advances in different pediatric fields that were published in Italian Journal of Pediatrics and in international journals in 2015. Weaning studies continue to show promise for preventing food allergy. New diagnostic tools are available for identifying the allergic origin of allergic-like symptoms. Advances have been reported in obesity, short stature and autoimmune endocrine disorders. New molecules are offered to reduce weight gain and insulin-resistance in obese children. Regional investigations may provide suggestions for preventing short stature. Epidemiological studies have evidenced the high incidence of Graves' disease and Hashimoto's thyroiditis in patients with Down syndrome. Documentation of novel risk factors for celiac disease are of use to develop strategies for prevention in the population at-risk. Diagnostic criteria for non-celiac gluten sensitivity have been reported. Negative effect on nervous system development of the supernumerary X chromosome in Klinefelter syndrome has emerged. Improvements have been made in understanding rare diseases such as Rubinstein-Taybi syndrome. Eltrombopag is an effective therapy for immune trombocytopenia. Children with sickle-cell anemia are at risk for nocturnal enuresis. Invasive diseases caused by Streptococcus pyogenes are still common despite of vaccination. No difference in frequency of antibiotic prescriptions for acute otitis media between before the publication of the national guideline and after has been found. The importance of timing of iron administration in low birth weight infants, the effect of probiotics for preventing necrotising enterocolitis and perspectives for managing jaundice and cholestasis in neonates have been highlighted. New strategies have been developed to reduce the risk for relapse in nephrotic syndrome including prednisolone during upper respiratory infection. Insights into the pathophysiology of cerebral palsy, arterial ischemic stroke and acute encephalitis

  16. FINAL RESULTS OF A PROSPECTIVE MULTI-INSTITUTIONAL PHASE II STUDY OF EVEROLIMUS (RAD001), AN MTOR INHIBITOR, IN PEDIATRIC PATIENTS WITH RECURRENT OR PROGRESSIVE LOW-GRADE GLIOMA. A POETIC CONSORTIUM TRIAL

    PubMed Central

    Kieran, Mark W.; Yao, X.; Macy, M.; Leary, S.; Cohen, K.; MacDonald, T.; Allen, J.; Boklan, J.; Smith, A.; Nazemi, K.; Gore, L.; Trippett, T.; DiRenzo, J.; Narendran, A.; Perentesis, J.; Prabhu, S.; Pinches, N.; Robison, N.; Manley, P.; Chi, S.

    2014-01-01

    BACKGROUND: Purpose: The ras/raf signaling pathway is crucial in the development of pediatric low-grade gliomas (LGGs). Aberrant ras/raf signaling is involved in tumorigenesis through promotion of cell proliferation, survival, and differentiation in sporadic LGG. Everolimus (RAD001) is a potent and selective inhibitor of mTOR, a downstream element of the ras/raf pathway. The activity, safety and pharmacokinetics of everolimus in pediatric patients with radiographic recurrent/progressive LGG are presented. METHODS: Pediatric patients with radiographic progressive or recurrent LGGs without neurofibromatosis type I were treated with oral everolimus 5mg/m2/dose once daily. Therapy was provided for 28 days (one cycle) and could be repeated for a total of 12 cycles. Response, as determined by standard 2-D MRI criteria, was assessed for all patients. Pharmacokinetics, pharmacogenetics, pharmacodynamic parameters including inhibition of p70s6 kinase activity, 4E-BP1 phosphorylation inhibition and suppression of cMyc expression, as well as the toxicity profile of everolimus were evaluated. RESULTS: Twenty-three patients with a median age of 9 years (range, 3–17 years) were enrolled, all of whom had received prior chemotherapy (average # regimens = 2.7) including progression after a carboplatin-containing regimen. Median number of cycles of therapy was 10 (range, 1-12). Responses were determined by blinded central review and included 4 patients with PR (>50% decrease) and 13 with stable disease. Six patients had progressive disease by one year. Overall therapy was well tolerated; two patients discontinued therapy due to mouth sores (n = 1) and withdrawal of consent (n = 1). Everolimus PK parameters were similar to those previously reported in both adult and pediatric patients and drug trough levels were maintained above 5ng/ml. Pharmacodynamic analysis demonstrated inhibition of downstream targets of mTOR including phospho-S6 kinase, 4E-BP1 phosphorylation and c

  17. Pediatric palliative care.

    PubMed

    Moody, Karen; Siegel, Linda; Scharbach, Kathryn; Cunningham, Leslie; Cantor, Rabbi Mollie

    2011-06-01

    Progress in pediatric palliative care has gained momentum, but there remain significant barriers to the appropriate provision of palliative care to ill and dying children, including the lack of properly trained health care professionals, resources to finance such care, and scientific research, as well as a continued cultural denial of death in children. This article reviews the epidemiology of pediatric palliative care, special communication concerns, decision making, ethical and legal considerations, symptom assessment and management, psychosocial issues, provision of care across settings, end-of-life care, and bereavement. Educational and supportive resources for health care practitioners and families, respectively, are included. PMID:21628042

  18. Homozygous loss of ADAM3A revealed by genome-wide analysis of pediatric high-grade glioma and diffuse intrinsic pontine gliomas

    PubMed Central

    Barrow, Jennifer; Adamowicz-Brice, Martyna; Cartmill, Maria; MacArthur, Donald; Lowe, James; Robson, Keith; Brundler, Marie-Anne; Walker, David A.; Coyle, Beth; Grundy, Richard

    2011-01-01

    Overall, pediatric high-grade glioma (pHGG) has a poor prognosis, in part due to the lack of understanding of the underlying biology. High-resolution 244 K oligo array comparative genomic hybridization (CGH) was used to analyze DNA from 38 formalin-fixed paraffin-embedded predominantly pretreatment pHGG samples, including 13 diffuse intrinsic pontine gliomas (DIPGs). The patterns of gains and losses were distinct from those seen in HGG arising in adults. In particular, we found 1q gain in up to 27% of our cohort compared with 9% reported in adults. A total of 13% had a balanced genetic profile with no large-scale copy number alterations. Homozygous loss at 8p12 was seen in 6 of 38 (16%) cases of pHGG. This novel deletion, which includes the ADAM3A gene, was confirmed by quantitative real-time PCR (qPCR). Loss of CDKN2A/CDKN2B in 4 of 38 (10%) samples by oligo array CGH was confirmed by fluorescent in situ hybridization on tissue microarrays and was restricted to supratentorial tumors. Only ∼50% of supratentorial tumors were positive for CDKN2B expression by immunohistochemistry (IHC), while ∼75% of infratentorial tumors were positive for CDKN2B expression (P = 0.03). Amplification of the 4q11–13 region was detected in 8% of cases and included PDGFRA and KIT, and subsequent qPCR analysis was consistent with the amplification of PDGFRA. MYCN amplification was seen in 5% of samples being significantly associated with anaplastic astrocytomas (P= 0.03). Overall, DIPG shared similar spectrum of changes to supratentorial HGG with some notable differences, including high-frequency loss of 17p and 14q and lack of CDKN2A/CDKN2B deletion. Informative genetic data providing insight into the underlying biology and potential therapeutic possibilities can be generated from archival tissue and typically small biopsies from DIPG. Our findings highlight the importance of obtaining pretreatment samples. PMID:21138945

  19. [Diffusion/dispersion transport of chemically reacting species]. Progress report, FY 1992--1993

    SciTech Connect

    Helgeson, H.C.

    1993-07-01

    Progress is reported on the following: calculation of activity coefficients for aqueous silica in alkali metal chloride solutions; calculation of degrees of formation of polyatomic clusters of Al in alkali chloride solutions; bulk composition-pH diagrams for arkosic sediments; and chemical interaction of petroleum, oil field brines, and authigenic mineral assemblages. Plans for future research are given.

  20. The Role of Genetic Variants of Stromal Cell-Derived Factor 1 in Pediatric HIV-1 Infection and Disease Progression

    PubMed Central

    Gianesin, Ketty; Freguja, Riccardo; Carmona, Francesco; Zanchetta, Marisa; Del Bianco, Paola; Malacrida, Sandro; Montagna, Marco; Rampon, Osvalda; Giaquinto, Carlo; De Rossi, Anita

    2012-01-01

    Stromal cell-Derived Factor 1 (SDF1) is the natural ligand of CXCR4, the coreceptor of HIV-1 X4 viruses. This study investigated the role of the single nucleotide polymorphism (SNP) rs1801157 (NM_000609.5:c.*519G>A) of the SDF1 gene in the natural history of mother-to-child transmission of HIV-1 and disease progression of HIV-1-infected children. The study was conducted in 428 children born to HIV-1-seropositive mothers, who had not undergone antiretroviral therapy (ART) during pregnancy, and in 120 HIV-1-infected children for whom the end-point was the onset of AIDS or the initiation of ART; 16 children developed early AIDS (<24 months of life), 13 from 24 to 84 months of age, and 14 had late AIDS (>84 months). The rs1801157 SNP was not associated with risk of perinatal infection in any genetic models tested. By contrast, this SNP influenced disease progression in a time-dependent manner. rs1801157 GA heterozygous children had a higher risk of late AIDS (HR = 6.3, 95%CI 1.9–20.7, p = 0.002) than children with the rs1801157 GG genotype. Children were studied for viral coreceptor usage at birth, after 84 months of age and/or at AIDS onset. While R5 viruses using CCR5 coreceptor were predominant at birth (94%) and at early AIDS (85%), viruses using CXCR4 coreceptor emerged during the course of infection and were detected in 49% of children older than 84 months and in 62% of late AIDS. The rs1801157 SNP did not influence the emergence of R5X4 viruses, but children with the rs1801157 GA genotype and R5X4 viruses were at significantly higher risk of late AIDS than children with rs1801157 GG genotype (OR = 8.0, 95% CI 1.2–52.2, p = 0.029). Our results indicate that the rs1801157 SNP does not influence perinatal infection, but impacts disease progression. This effect is time-dependent and linked to the coreceptor-usage of viral variants that undergo evolution during the course of HIV-1 infection. PMID:22962615

  1. Progress in the Large-Eddy Simulation of an Asymmetric Plane Diffuser

    NASA Technical Reports Server (NTRS)

    Fatica, Massimiliano; Mittal, Rajat

    1996-01-01

    The flow through a plane asymmetric diffuser is a good test case for assessing the capability of LES since it contains features such as large scale unsteady separation and strong intermittency which are difficult to capture using conventional modeling approaches. Previous attempts to simulate this flow (Kaltenbach, 1994) have significantly underpredicted the extent of separation. The objective of the present research is to understand why the previous simulations did not predict the flow separation correctly. This study focuses on mesh refinement and matching of the inlet velocity profile. In order to perform this study, the flow solver of Kaltenbach (1994) was modified to increase its accuracy and efficiency. The improved algorithm allows for better resolution at affordable CPU cost.

  2. Progress in p(+)n InP solar cells fabricated by thermal diffusion

    NASA Technical Reports Server (NTRS)

    Faur, Mircea; Faur, Maria; Flood, D. J.; Brinker, D. J.; Weinberg, I.; Fatemi, N. S.; Vargas-Aburto, Carlos; Goradia, C.; Goradia, Manju

    1992-01-01

    In SPRAT XI, we proposed that p(sup +)n diffused junction InP solar cells should exhibit a higher conversion efficiency than their n(sup +)p counterparts. This was mainly due to the fact that our p(sup +)n (Cd,S) cell structures consistently showed higher V (sub OC) values than our n(sup +)p (S,Cd) structures. The highest V(sub OC) obtained with the p(sup +)n (Cd,S) cell configuration was 860 mV, as compared to the highest V(sub OC) 840 mV obtained with the n(sup +)p (S,Cd) configuration (AMO, 25 C). In this work, we present the performance results of our most recent thermally diffused cells using the p(sup +)n (Cd,S) structure. We have been able to fabricate cells with V(sub OC) values approaching 880 mV. Our best cell with an unoptimized front contact grid design (GS greater than or equal to 10%) showed a conversion efficiency of 13.4% (AMO, 25 C) without an AR coating layer. The emitter surface was passivated by a -50A P rich oxide. Achievement of such high V(sub OC) values was primarily due to the fabrication of emitter surfaces, having EPD densities as low as 2E2 cm(sup -2) and N(sub a)N(sub d) of about 3E18 cm (sup -3). In addition, our preliminary investigation of p(sup +)n structures seem to suggest that Cd-doped emitter cells are more radiation resistant than Zn-doped emitter cells against both high energy electron and proton irradiation.

  3. Characterization of Degradation Progressive in Composite Laminates Subjected to Thermal Fatigue and Moisture Diffusion by Lamb Waves.

    PubMed

    Li, Weibin; Xu, Chunguang; Cho, Younho

    2016-01-01

    Laminate composites which are widely used in the aeronautical industry, are usually subjected to frequency variation of environmental temperature and excessive humidity in the in-service environment. The thermal fatigue and moisture absorption in composites may induce material degradation. There is a demand to investigate the coupling damages mechanism and characterize the degradation evolution of composite laminates for the particular application. In this paper, the degradation evolution in unidirectional carbon/epoxy composite laminates subjected to thermal fatigue and moisture absorption is characterized by Lamb waves. The decrease rate of Lamb wave velocity is used to track the degradation evolution in the specimens. The results show that there are two stages for the progressive degradation of composites under the coupling effect of thermal cyclic loading and moisture diffusion. The present work provides an alternative to monitoring the degradation evolution of in-service aircraft composite Laminates. PMID:26907283

  4. Characterization of Degradation Progressive in Composite Laminates Subjected to Thermal Fatigue and Moisture Diffusion by Lamb Waves

    PubMed Central

    Li, Weibin; Xu, Chunguang; Cho, Younho

    2016-01-01

    Laminate composites which are widely used in the aeronautical industry, are usually subjected to frequency variation of environmental temperature and excessive humidity in the in-service environment. The thermal fatigue and moisture absorption in composites may induce material degradation. There is a demand to investigate the coupling damages mechanism and characterize the degradation evolution of composite laminates for the particular application. In this paper, the degradation evolution in unidirectional carbon/epoxy composite laminates subjected to thermal fatigue and moisture absorption is characterized by Lamb waves. The decrease rate of Lamb wave velocity is used to track the degradation evolution in the specimens. The results show that there are two stages for the progressive degradation of composites under the coupling effect of thermal cyclic loading and moisture diffusion. The present work provides an alternative to monitoring the degradation evolution of in-service aircraft composite Laminates. PMID:26907283

  5. Diffusion MR Characteristics Following Concurrent Radiochemotherapy Predicts Progression-Free and Overall Survival in Newly Diagnosed Glioblastoma

    PubMed Central

    Chang, Warren; Pope, Whitney B.; Harris, Robert J.; Hardy, Anthony J.; Leu, Kevin; Mody, Reema R.; Nghiemphu, Phioanh L.; Lai, Albert; Cloughesy, Timothy F.; Ellingson, Benjamin M.

    2015-01-01

    The standard of care for newly diagnosed glioblastoma (GBM) is surgery, then radiotherapy (RT) with concurrent temozolomide (TMZ), followed by adjuvant TMZ. We hypothesized patients with low diffusivity measured using apparent diffusion coefficient (ADC) histogram analysis evaluated after RT+TMZ, prior to adjuvant TMZ, would have a significantly shorter progression-free (PFS) and overall survival (OS). To test this hypothesis we evaluated 120 patients with newly diagnosed GBM receiving RT+TMZ followed by adjuvant TMZ. MRI was performed after completion of RT+TMZ, prior to initiation of adjuvant TMZ. A double Gaussian mixed model was used to describe the ADC histograms within the enhancing tumor, where ADCL and ADCH were defined as the mean ADC value of the lower and higher Gaussian distribution, respectively. An ADCL value of 1.0 um2/ms and ADCH value of 1.6 um2/ms were used to stratify patients into high and low risk categories. Results suggest patients with low ADCL had significantly shorter PFS (Cox Hazard Ratio = 0.12, P = 0.0006). OS was significantly shorter with low ADCL tumors, showing a median OS of 407 vs. 644 days (Cox Hazard Ratio = 0.31, P = 0.047). ADCH was not predictive of PFS or OS when accounting for age and ADCL. In summary, newly diagnosed glioblastoma patients with low ADCL after completion of RT+TMZ are likely to progress and die earlier than patients with higher ADCL. Results suggest ADC histogram analysis may be useful for patient risk stratification following completion of RT+TMZ. PMID:26740971

  6. Year in Review 2015: Pediatric ARDS.

    PubMed

    Cheifetz, Ira M

    2016-07-01

    Led by the work of the Pediatric Acute Lung Injury Consensus Conference, much was published on the topic of pediatric ARDS in 2015. Although the availability of definitive data to the pediatric practitioner for the management of infants and children with pediatric ARDS continues to lag behind that for the adult clinician, 2015 augmented the available medical literature with more information than had been seen for years. This article will review key pediatric ARDS publications with a focus on the Pediatric Acute Lung Injury Consensus Conference consensus definition, sedation management, use of high-frequency oscillatory ventilation, diagnosis of delirium, noninvasive respiratory support, lung-protective ventilation, and adjunct management therapies. Despite the recent progress, additional investigation in each of these areas is essential to the continued advancement of our knowledge and, more importantly, improvements in the outcome for pediatric patients with ARDS. PMID:27381701

  7. Low rates of recurrence and slow progression of pediatric pilocytic astrocytoma after gross-total resection: justification for reducing surveillance imaging.

    PubMed

    Dodgshun, Andrew J; Maixner, Wirginia J; Hansford, Jordan R; Sullivan, Michael J

    2016-05-01

    OBJECTIVE Pilocytic astrocytomas (PAs) are common brain tumors in children. Optimal management of PA is gross-total resection (GTR), after which event-free survival (EFS) is excellent. The tempo of recurrences, when they do occur, is relatively sparsely reported, and there is no agreed upon surveillance recommendation for patients in this category. It has been suggested that surveillance MRI is performed too frequently and could be safely reduced in both frequency and duration. The authors conducted a retrospective review of pediatric patients with PA who underwent GTR at a single institution over an 18-year period and who had documented recurrences. METHODS All patients under 18 years of age who had undergone GTR of a PA between 1996 and 2013 were included in the study. Clinical, radiological, and tumor characteristics were recorded. RESULTS Sixty-seven patients met the criteria for GTR over the period studied. The 5-year EFS rate was 95% (95% CI 89%-100%) and overall survival was 100%. Recurrences showed a nonsignificant trend of occurring more commonly in patients with persistent nonenhancing FLAIR abnormalities after surgery, but there was no difference with regard to tumor location. All recurrences occurred before 3 years postresection, all were asymptomatic, and all patients were observed for at least one additional scan after the initial detection during routine surveillance MRI before further therapy was undertaken. CONCLUSIONS EFS and overall survival are excellent after GTR in this population with PAs. Progression after recurrence occurs slowly and is asymptomatic. A less intensive schedule of MRI surveillance in this group of patients would result in time and cost savings, without compromising safety. The authors suggest a schedule of 6 MRI scans to be obtained postoperatively, at 3-6 months, then at 1, 2, 3.5, and 5 years. PMID:26722760

  8. Invasive tracheobronchial aspergillosis progressing from bronchial to diffuse lung parenchymal lesions.

    PubMed

    Ohta, Hiromitsu; Yamazaki, Susumu; Miura, You; Kanazawa, Minoru; Sakai, Fumikazu; Nagata, Makoto

    2016-03-01

    Invasive tracheobronchial aspergillosis that is entirely limited or predominantly confined to tracheobronchial lesions is a relatively rare form of invasive pulmonary aspergillosis. Extended parenchymal opacities that are radiological manifestations of invasive aspergillosis sometimes occur following invasive tracheobronchial aspergillosis. However, it remains unclear whether or not invasive tracheobronchial aspergillosis is the initial stage of invasive pulmonary aspergillosis. A 61-year-old woman was admitted because of severe diarrhea and dehydration. Three days after admission, she complained of dyspnea. A computed tomography (CT) scan of the chest showed bronchial wall thickening. She developed respiratory failure despite antibiotic therapy. A CT scan showed obstructions of bronchial lumens and bronchiectasis in the right upper lobe. A spergillus fumigatus was identified from samples obtained in bronchoscopic examination. Bronchial lesions rapidly progressed to be extended. A spergillus infection with multiple parenchymal opacities was observed on CT scan. She responded to treatment with antifungal drugs. PMID:26839700

  9. Recent progress in noninvasive diabetes screening by diffuse reflectance near-infrared skin spectroscopy

    NASA Astrophysics Data System (ADS)

    Heise, H. M.; Haiber, S.; Licht, M.; Ihrig, D. F.; Moll, C.; Stuecker, M.

    2006-02-01

    Near infrared spectroscopy exhibits a tremendous potential for clinical chemistry and tissue pathology. Owing to its penetration depth into human skin, near infrared radiation can probe chemical and structural information non-invasively. Metabolic diseases such as diabetes mellitus increase nonenzymatic glycation with the effect of glucose molecules bonding chemically to proteins. In addition, glycation accumulates on tissue proteins with the clearest evidence found in extracellular skin collagen, affecting also covalent crosslinking between adjacent protein strands, which reduces their flexibility, elasticity, and functionality. Non-enzymatically glycated proteins in human skin and following chemical and structural skin changes were our spectroscopic target. We carried out measurements on 109 subjects using two different NIR-spectrometers equipped with diffuse reflection accessories. Spectra of different skin regions (finger and hand/forearm skin) were recorded for comparison with clinical blood analysis data and further patient information allowing classification into diabetics and non-diabetics. Multivariate analysis techniques for supervised classification such as linear discriminant analysis (LDA) were applied using broad spectral interval data or a number of optimally selected wavelengths. Based on fingertip skin spectra recorded by fiber-optics, it was possible to classify diabetics and non-diabetics with a maximum accuracy of 87.8 % using leave-5-out cross-validation (sensitivity of 87.5. %, specificity of 88.2 %). With the results of this study, it can be concluded that ageing and glycation at elevated levels cannot always be separated from each other.

  10. Myocardial function and perfusion in the CREST syndrome variant of progressive systemic sclerosis. Exercise radionuclide evaluation and comparison with diffuse scleroderma

    SciTech Connect

    Follansbee, W.P.; Curtiss, E.I.; Medsger, T.A. Jr.; Owens, G.R.; Steen, V.D.; Rodnan, G.P.

    1984-09-01

    Myocardial function and perfusion were evaluated in 22 patients with progressive systemic sclerosis with the CREST syndrome using exercise and radionuclide techniques, pulmonary function testing, and chest roentgenography. The results were compared with a similar study of 26 patients with progressive systemic sclerosis with diffuse scleroderma. The prevalence of thallium perfusion abnormalities was similar in the groups with CREST syndrome and diffuse scleroderma, (64 percent versus 77 percent), but the defects were significantly smaller in the CREST syndrome (p less than 0.01). Reperfusion thallium defects in the absence of extramural coronary artery disease were seen in 38 percent of patients with diffuse scleroderma. This finding was not seen in any of the patients with the CREST syndrome. In diffuse scleroderma, abnormalities of both right and left ventricular function were related to larger thallium perfusion defects. In the CREST syndrome, abnormalities of left ventricular function were minor, were seen only during exercise, and were unrelated to thallium perfusion defects. Abnormal resting right ventricular function was seen in 36 percent of the patients with the CREST syndrome and was associated with an isolated decrease in diffusing capacity of carbon monoxide. It is concluded that the cardiac manifestations of the CREST syndrome are distinct from those found in diffuse scleroderma. Unlike diffuse scleroderma, abnormalities of left ventricular function in the CREST syndrome are minor and are unrelated to abnormalities of coronary perfusion. Right ventricular dysfunction in the CREST syndrome appears to be primarily related to pulmonary vascular disease.

  11. Progress in p(+)n InP solar cells fabricated by thermal diffusion

    NASA Technical Reports Server (NTRS)

    Flood, D. J.; Brinker, D. J.; Weinberg, I.; Vargas, C.; Faur, Mircea; Faur, Maria; Goradia, C.; Goradia, M.; Fatemi, N. S.

    1993-01-01

    The performance results of our most recently thermally diffused InP solar cells using the p(+)n (Cd,S) structures are presented. We have succeeded in fabricating cells with measured AMO, 25 C V(sub oc) exceeding 880 mV (bare cells) which to the best of our knowledge is higher than previously reported V(sub oc) values for any InP homojunction solar cells. The cells were fabricated by thinning the emitter, after Au-Zn front contacting, from its initial thickness of about 4.5 microns to about 0.6 microns. After thinning, the exposed surface of the emitter was passivated by a thin (approximately 50A) P-rich oxide. Based on the measured EQY and J(sub sc)-V(sub oc) characteristics of our experimental high V(sub oc) p(+)n InP solar cells, we project that reducing the emitter thickness to 0.3 microns, using an optimized AR coating, maintaining the surface hole concentration of 3 x 10(exp 18)cm(sup -3), reducing the grid shadowing from actual 10.55 percent to 6 percent and reducing the contact resistance will increase the actual measured 12.57 percent AMO 25 C efficiency to about 20.1 percent. By using our state-of-the-art p(+)n structures which have a surface hole concentration of 4 x 10(exp 18)cm(sup -3) and slightly improving the front surface passivation, an even higher practically achievable AMO, 25 C efficiency of 21.3 percent is projected.

  12. Pediatric Specialists

    MedlinePlus

    ... Life Family Life Family Life Medical Home Family Dynamics Media Work & Play Getting Involved in Your Community ... Life Medical Home Health Insurance Pediatric Specialists Family Dynamics Media Work & Play Getting Involved in Your Community ...

  13. Pediatric Terminology

    Cancer.gov

    The National Institute of Child Health and Human Development (NICHD) is working with NCI Enterprise Vocabulary Services (EVS) to provide standardized terminology for coding pediatric clinical trials and other resea

  14. Pediatric sleep apnea

    MedlinePlus

    Sleep apnea - pediatric; Apnea - pediatric sleep apnea syndrome; Sleep-disordered breathing - pediatric ... Untreated pediatric sleep apnea may lead to: High blood pressure Heart or lung problems Slow growth and development

  15. Virtual Pediatric Hospital

    MedlinePlus

    ... Last revised on February 12, 2016 Related Digital Libraries Pediatric GeneralPediatrics.com - the general pediatrician's view of the Internet PediatricEducation.org - a pediatric digital library and learning collaboratory intended to serve as a ...

  16. Pediatric Anthropometry

    NASA Astrophysics Data System (ADS)

    Klinich, Kathleen D.; Reed, Matthew P.

    Anthropometry is the measurement of human size, shape, and physical capabilities. Most pediatric anthropometry data are gathered to describe child growth patterns, but data on body size, mass distribution, range of motion, and posture are used to develop crash test dummies and computational models of child occupants. Pediatric anthropometry data are also used to determine child restraint dimensions, so they will accommodate the applicable population of child occupants.

  17. q-Space diffusion MRI (QSI) of the disease progression in the spinal cords of the Long Evans shaker: diffusion time and apparent anisotropy

    PubMed Central

    Anaby, Debbie; Duncan, Ian D.; Smith, Chelsey M.; Cohen, Yoram

    2014-01-01

    q-Space diffusion MRI (QSI) was used to study the spinal cords of Long Evans shaker (les) rats, a model of dysmyelination, and their age-matched controls at different maturation stages. Diffusion was measured parallel and perpendicular to the fibers of the spinal cords of the two groups and at different diffusion times. The results showed that QSI is able to detect the dysmyelination process that occurs in this model in the different stages of the disease. The differences in the diffusion characteristics of the spinal cords of the two groups were found to be larger when the diffusion time was increased from 22 to 100 ms. We found that the radial mean displacement is a much better parameter than the QSI fractional anisotropy (FA) to document the differences between the two groups. We observed that the degree of myelination affects the diffusion characteristics of the tissues, but has a smaller effect on FA. All of the extracted diffusion parameters that are affected by the degree of myelination are affected in a diffusion time-dependent fashion, suggesting that the terms apparent anisotropy, apparent fractional anisotropy and even apparent root-mean-square displacement (rmsD) are more appropriate. PMID:24123305

  18. Disease progression in systemic sclerosis-overlap syndrome is significantly different from limited and diffuse cutaneous systemic sclerosis

    PubMed Central

    Moinzadeh, Pia; Aberer, Elisabeth; Ahmadi-Simab, Keihan; Blank, Norbert; Distler, Joerg H W; Fierlbeck, Gerhard; Genth, Ekkehard; Guenther, Claudia; Hein, Ruediger; Henes, Joerg; Herich, Lena; Herrgott, Ilka; Koetter, Ina; Kreuter, Alexander; Krieg, Thomas; Kuhr, Kathrin; Lorenz, Hanns-Martin; Meier, Florian; Melchers, Inga; Mensing, Hartwig; Mueller-Ladner, Ulf; Pfeiffer, Christiane; Riemekasten, Gabriela; Sárdy, Miklós; Schmalzing, Marc; Sunderkoetter, Cord; Susok, Laura; Tarner, Ingo H; Vaith, Peter; Worm, Margitta; Wozel, Gottfried; Zeidler, Gabriele; Hunzelmann, Nicolas; Ahrazoglu, Nil Mona

    2015-01-01

    Background Systemic sclerosis (SSc)-overlap syndromes are a very heterogeneous and remarkable subgroup of SSc-patients, who present at least two connective tissue diseases (CTD) at the same time, usually with a specific autoantibody status. Objectives To determine whether patients, classified as overlap syndromes, show a disease course different from patients with limited SSc (lcSSc) or diffuse cutaneous SSc (dcSSc). Methods The data of 3240 prospectively included patients, registered in the database of the German Network for Systemic Scleroderma and followed between 2003 and 2013, were analysed. Results Among 3240 registered patients, 10% were diagnosed as SSc-overlap syndrome. Of these, 82.5% were female. SSc-overlap patients had a mean age of 48±1.2 years and carried significantly more often ‘other antibodies’ (68.0%; p<0.0001), including anti-U1RNP, -PmScl, -Ro, -La, as well as anti-Jo-1 and -Ku antibodies. These patients developed musculoskeletal involvement earlier and more frequently (62.5%) than patients diagnosed as lcSSc (32.2%) or dcSSc (43.3%) (p<0.0001). The onset of lung fibrosis and heart involvement in SSc-overlap patients was significantly earlier than in patients with lcSSc and occurred later than in patients with dcSSc. Oesophagus, kidney and PH progression was similar to lcSSc patients, whereas dcSSc patients had a significantly earlier onset. Conclusions These data support the concept that SSc-overlap syndromes should be regarded as a separate SSc subset, distinct from lcSSc and dcSSc, due to a different progression of the disease, different proportional distribution of specific autoantibodies, and of different organ involvement. PMID:24389298

  19. Clinicopathologic Features of Pediatric Oligodendrogliomas

    PubMed Central

    Rodriguez, Fausto J.; Tihan, Tarik; Lin, Doris; McDonald, William; Nigro, Janice; Feuerstein, Burt; Jackson, Sadhana; Cohen, Kenneth; Burger, Peter C.

    2015-01-01

    Oligodendrogliomas are an important adult form of diffuse gliomas with a distinctive clinical and genetic profile. Histologically similar tumors occurring rarely in children are incompletely characterized. We studied 50 patients with oligodendrogliomas (median age at diagnosis 8 y, range 7mo to 20 y). Tumors resembling dysembryoplastic neuroepithelial tumors or pilocytic astrocytomas or those having a “mixed” histology were excluded. Tumors at first diagnosis were low grade (n=38) or anaplastic (n=12). Histologic features included uniform round cells with perinuclear halos (100%), secondary structures (predominantly perineuronal satellitosis) (90%), calcifications (46%), and microcysts (44%). Sequential surgical specimens were obtained in 8 low-grade oligodendroglioma patients, with only 1 progressing to anaplasia. Studies for 1p19q performed in 40 cases demonstrated intact 1p19q loci in 29 (73%), 1p19q codeletion in 10 (25%), and 1p deletion with intact 19q in 1 (2%). Except for 2 young patients (3 and 11 y of age), patients with 1p19q codeletion were older than 16 years at diagnosis. Mutant IDH1 (R132H) protein immunohistochemistry was positive in 4 (of 22) (18%) cases, 3 of which also had 1p19q codeletion, whereas 1p19q status was not available on the fourth case. There was a nonsignificant trend for worse overall survival in grade III tumors, but no significant association with age, extent of resection, or 1p19q status. In summary, oligodendrogliomas with classic histology occur in the pediatric population but lack 1p19q codeletion and IDH1 (R132H) mutations in most instances. They are predominantly low grade, recur/clinically progress in a subset, but demonstrate a relatively low frequency of histologic progression. PMID:24805856

  20. Update on Pediatric Perfusion Practice in North America: 2005 Survey

    PubMed Central

    Groom, Robert C.; Froebe, Shane; Martin, Janine; Manfra, Michael J.; Cormack, John E.; Morse, Catherine; Taenzer, Andreas H.; Quinn, Reed D.

    2005-01-01

    %). This survey provides an overview of clinical practice in 2004. The series of surveys document the historical progression of clinical practice over the past 16 years. Practice surveys may also be useful for identifying gaps between evidence-based knowledge and clinical practice. These surveys document the diffusion of innovation related to CPB during the past 16 years and areas of variation in practice that need further study. PMID:16524149

  1. Update on pediatric perfusion practice in North America: 2005 survey.

    PubMed

    Groom, Robert C; Froebe, Shane; Martin, Janine; Manfra, Michael J; Cormack, John E; Morse, Catherine; Taenzer, Andreas H; Quinn, Reed D

    2005-12-01

    provides an overview of clinical practice in 2004. The series of surveys document the historical progression of clinical practice over the past 16 years. Practice surveys may also be useful for identifying gaps between evidence-based knowledge and clinical practice. These surveys document the diffusion of innovation related to CPB during the past 16 years and areas of variation in practice that need further study. PMID:16524149

  2. The progressive and diffuse nature of neuroblastoma: Treatment with I-131 metaiodobenzylguanidine (I-131 MIBG). S-W

    SciTech Connect

    Shen; Sisson, J.C.; Hutchinson, R.; Shapiro, B.; Shulkin, B.; Geatti, O.; Mallett, S.; Eyre, P.; Mangner, T.; Beierwaltes, W.H.

    1985-05-01

    Neuroblastoma is a lethal and not uncommon cancer. In advanced disease, external beam radiation and chemotherapy bring no more than temporary remissions. Most neuroblastomas concentrate I-131 MIBG which then has therapeutic potential for these tumors. The authors treated the neuroblastomas of 7 patients, 20 mos-24 yrs of age, with I-131 MIBG. Factors were examined to explain the results. All but the oldest patient had extensive disease. Scintigraphy portrayed tumor infiltrations of the skeleton not otherwise detectable; in long bones, and, for 2 patients, in hands or feet. Hematopoiesis was precarious from the effects of both tumor and prior chemotherapy. Some tumors produce dopamine, but blockade of receptors was not required prior to I-131 MIBG. I-131 MIBG doses, 60-200 mCi, were scaled for body size. Because of the infiltrative nature of the tumor, rad doses could not be measured. Three had subjective (less pain, more ambulatory) improvement but 1 had enlarging tumors and 1 died; the oldest has not been reevaluated. Four patients died, all of progressive disease. No harmful effects of I-131 MIBG were seen but 1 patient had leukopenia. This paper concludes; I-131 MIBG has the potential to produce benefits in patients with neuroblastoma. But certain factors must be taken into account. Diffuse involvement of marrow will require new approaches to dosimetry, for tumor and for marrow; and the cancer is usually rapidly lethal, and early treatment is necessary.

  3. Configurational diffusion of asphaltenes in fresh and aged catalyst extrudates. Quarterly progress report, March 20, 1995--June 20, 1995

    SciTech Connect

    Guin, J.A.

    1995-09-01

    The objective of this research is to determine the relationship between the size and shape of coal and petroleum macromolecules and their diffusion rates i.e., effective diffusivities, in catalyst pore structures. That is, how do the effective intrapore diffusivities depend on molecule configuration and pore geometry.

  4. Immunotherapy for Pediatric Leukemia

    PubMed Central

    Shah, Nirali N.; Dave, Hema; Wayne, Alan S.

    2013-01-01

    Substantial progress has been made in the treatment of leukemia in childhood. Despite this, leukemia remains a leading cause of pediatric cancer-related mortality and the prognosis is guarded for individuals with relapsed or refractory disease. Standard therapies are associated with a wide array of acute and long-term toxicities and further treatment intensification may not be tolerable or beneficial. The curative potential of allogeneic stem cell transplantation is due in part to the graft-versus-leukemia effect, which provides evidence for the therapeutic capacity of immune-based therapies. In recent years there have been significant advances in the development and application of immunotherapy in the treatment of leukemias, including the demonstration of activity in chemotherapy-resistant cases. This review summarizes immunotherapeutic approaches in the treatment of pediatric leukemia including current results and future directions. PMID:23847759

  5. Pediatric sepsis

    PubMed Central

    Randolph, Adrienne G; McCulloh, Russell J

    2014-01-01

    Sepsis is the leading cause of death in children worldwide. Although the diagnosis and management of sepsis in infants and children is largely influenced by studies done in adults, there are important considerations relevant for pediatrics. This article highlights pediatric-specific issues related to the definition of sepsis and its epidemiology and management. We review how the capacity of the immune system to respond to infection develops over early life. We also bring attention to primary immune deficiencies that should be considered in children recurrently infected with specific types of organisms. The management of pediatric sepsis must be tailored to the child’s age and immune capacity, and to the site, severity, and source of the infection. It is important for clinicians to be aware of infection-related syndromes that primarily affect children. Although children in developed countries are more likely to survive severe infections than adults, many survivors have chronic health impairments. PMID:24225404

  6. History of German pediatric cardiology.

    PubMed

    Heintzen, P

    2002-01-01

    Due to the isolation of German medicine in World War II accompanied by the destruction of many hospitals, German pediatricians did not show any serious interest in the treatment of children with congenital heart diseases, nor did they take notice of the progress achieved by Helen Taussig, Alfred Blalock and other cardiologists and surgeons in the western world. This problem was even worse in East Germany. Only a few German internists and forward-looking surgeons were able and ready to take care of this group of principally operable children in places like Bonn/Düsseldorf, Marburg/Munich, Berlin, and Hamburg. However, in the early 1950s some directors of pediatrics at university hospitals--largely motivated by the cardiac surgeons--allowed or even encouraged younger colleagues to concentrate on pediatric cardiology and to begin application of heart catheterization and angiocardiography. In 1960 a group of colleagues interested in pediatric cardiology met for the first time in Frankfurt and became the nucleus of the future "working group" (1969) and finally the "German Society of Pediatric Cardiology" (1974). By 1972 pediatric cardiology had been approved as an independent (sub)specialty. Colleagues and friends from surrounding countries (Austria, Great Britain, Sweden, Switzerland, and the Netherlands) and also from the US and some eastern countries were either members or regular guests during or between the meetings. Pediatric cardiology is now represented in Germany by specialized practitioners, trainees and assistants who work in both community and university hospitals, and in specialized departments. Due to the foresightedness of the Chief of Pediatrics, Prof. G. Joppich, the first Chair of Pediatric Cardiology was founded in Göttingen in 1960 under the direction of A. Beuren. Another model of interdisciplinary cooperation between pediatric cardiologists, bioengineers, mathematicians and computer scientists was established in Kiel in 1966. In other places

  7. Pediatric rosacea.

    PubMed

    Kellen, Roselyn; Silverberg, Nanette B

    2016-07-01

    Because rosacea is uncommon in the pediatric population, care must be taken to exclude other papulopustular disorders. Children can present with vascular, papulopustular, and/or ocular findings. Importantly, ocular symptoms can appear before the cutaneous symptoms of rosacea, leading to misdiagnosis. Rosacea is a clinical diagnosis, but histopathologic examination typically reveals dilated vessels, perivascular lymphohistiocytic infiltrates in the upper dermis, elastosis, and disorganization of the upper dermal connective tissue. Treatment involves avoiding known triggers and utilizing topical and/or systemic therapies. Although treatment can control flares, pediatric rosacea often persists into adulthood. PMID:27529708

  8. Pediatric Sarcomas.

    PubMed

    Williams, Regan F; Fernandez-Pineda, Israel; Gosain, Ankush

    2016-10-01

    Pediatric sarcomas are a heterogeneous group of tumors accounting for approximately 10% of childhood solid tumors. Treatment is focused on multimodality therapy, which has improved the prognosis over the past two decades. Current regimens focus on decreasing treatment for low-risk patients to decrease the long-term side effects while maximizing therapy for patients with metastatic disease to improve survival. Pediatric sarcomas can be divided into soft tissue sarcomas and osseous tumors. Soft tissue sarcomas are further delineated into rhabdomyosarcomas, which affect young children and nonrhabdomyosarcomas, which are most common in adolescents. The most common bone sarcomas are osteosarcomas and Ewing's sarcoma. PMID:27542645

  9. Pediatric ultrasonography

    SciTech Connect

    Hayden, C.K. Jr.; Swischuk, L.E.

    1987-01-01

    Two leading experts explore the benefits and limitations of pediatric ultrasonography, explaining the latest techniques for optimal imaging of specific body regions: the head, chest, abdomen, pelvis, extremities, and soft tissues. Numerous illustrations emphasize significant points and combine with the text to show specifically what to look for when imaging children.

  10. Pediatric Trichotillomania

    PubMed Central

    Harrison, Julie P.; Franklin, Martin E.

    2012-01-01

    Trichotillomania (TTM) is an impulse control disorder characterized by chronic hair-pulling, distress, and impairment. Although the negative effects of TTM are documented and often readily evident, there remains a paucity of psychopathology and treatment research on this disorder, particularly in pediatric populations. In an effort to improve assessment of pediatric TTM, several TTM-specific instruments for youth have now been developed to reliably identify symptoms and examine related phenomenology. Instrument development has now yielded instruments to evaluate TTM and related symptoms in the context of clinical trials of youth, and the first randomized controlled trial of any treatment for pediatric TTM was recently published. Using the initial pediatric TTM studies as building blocks, future research is now needed to create a stronger body of knowledge about the relative and combined efficacy of potential interventions for TTM in youth, as well as to examine the effects of TTM phenomenology and comorbidity on treatment outcome. Dissemination efforts must also be heightened for this knowledge to best reach these vulnerable populations. PMID:22437627

  11. Configurational diffusion of asphaltenes in fresh and aged catalyst extrudates. Quarterly progress report, December 20, 1995--March 20, 1996

    SciTech Connect

    Guin, J.A.

    1996-07-01

    The objective of this research is to determine the relationship between the size and shape of coal and petroleum macromolecules and their diffusion rates i.e., effective diffusivities, in catalyst pore structures. That is, how do the effective intrapore diffusivities depend on molecule configuration and pore geometry? This quarter, adsorptive diffusion of both coal and petroleum asphaltenes in THF into porous catalysts were performed. A mathematical model with linear adsorption isotherm for asphaltene diffusion was developed. The molecular weight distribution of both asphaltenes were ascertained by GPC using polystyrene standards. The asphaltene diffusion data were simulated fairly well by the mathematical model, and linear adsorption constants were obtained for asphaltene fractions with different equivalent polystyrene molecular weights.

  12. Configurational diffusion of asphaltenes in fresh and aged catalysts extrudates. Quarterly progress report, September 20, 1992--December 20, 1992

    SciTech Connect

    Guin, J.A.; Tarrer, A.R.

    1992-12-31

    Objective is to determine the relation between the size and shape of coal and petroleum micromolecules and their diffusion rates in catalyst pore structures. Diffusivity measurements will be performed with aged catalysts from coal liquefaction pilot plants. During this period, equilibrium adsorption experiments were carried out to determine the adsorption isotherm needed in the data analysis. The equilibrium isotherm for quinoline in cyclohexane with fresh Shell 324 (Ni-Mo/Al{sub 2}O{sub 3}) catalyst was found to be nonlinear and well represented by the Freundlich adsorption isotherm. The effective diffusivity was found to be less than the estimated pore diffusivity for nonrestrictive diffusion, indicating pore restriction for quinoline diffusion in cyclohexane with Shell 324 catalyst.

  13. Configurational diffusion of asphaltenes in fresh and aged catalyst extrudates. Quarterly progress report, December 20, 1991--March 20, 1992

    SciTech Connect

    Guin, J.A.; Tarrer, A.R.

    1992-07-01

    This quarter we performed some initial scoping experiments dealing with the diffusive adsorption of petroleum/asphalt and coal molecules on alumina catalysts. In this experiments, the concentration of solute molecules in a bath exposed to the adsorbing solid (alumina) was monitored as a function of time. Because these are only preliminary scoping experiments, no quantitative calculations of diffusivity or adsorption equilibria were made; however, these experiments do demonstrate the feasibility of the finite bath technique for diffusivity determination.

  14. Combined Secretomics and Transcriptomics Revealed Cancer-Derived GDF15 is Involved in Diffuse-Type Gastric Cancer Progression and Fibroblast Activation

    PubMed Central

    Ishige, Takayuki; Nishimura, Motoi; Satoh, Mamoru; Fujimoto, Mai; Fukuyo, Masaki; Semba, Toshihisa; Kado, Sayaka; Tsuchida, Sachio; Sawai, Setsu; Matsushita, Kazuyuki; Togawa, Akira; Matsubara, Hisahiro; Kaneda, Atsushi; Nomura, Fumio

    2016-01-01

    Gastric cancer is classified into two subtypes, diffuse and intestinal. The diffuse-type gastric cancer (DGC) has poorer prognosis, and the molecular pathology is not yet fully understood. The purpose of this study was to identify functional secreted molecules involved in DGC progression. We integrated the secretomics of six gastric cancer cell lines and gene expression analysis of gastric cancer tissues with publicly available microarray data. Hierarchical clustering revealed characteristic gene expression differences between diffuse- and intestinal-types. GDF15 was selected as a functional secreted molecule owing to high expression only in fetal tissues. Protein expression of GDF15 was higher in DGC cell lines and tissues. Serum levels of GDF15 were significant higher in DGC patients as compared with healthy individuals and chronic gastritis patients, and positively correlated with wall invasion and lymph node metastasis. In addition, the stimulation of GDF15 on NIH3T3 fibroblast enhanced proliferation and up-regulated expression of extracellular matrix genes, which were similar to TGF-β stimulation. These results indicate that GDF15 contributes to fibroblast activation. In conclusion, this study revealed that GDF15 may be a novel functional secreted molecule for DGC progression, possibly having important roles for cancer progression via the affecting fibroblast function, as well as TGF-β. PMID:26892343

  15. Vitamin D status is a determinant of atorvastatin effect on carotid intima medial thickening progression rate in children with lupus: an Atherosclerosis Prevention in Pediatric Lupus Erythematosus (APPLE) substudy

    PubMed Central

    Robinson, Angela Byun; Tangpricha, Vin; Yow, Eric; Gurion, Reut; Schanberg, Laura E; McComsey, Grace A

    2014-01-01

    Objective Epidemiological associations suggest that vitamin D status may play a role in inflammation and progression of atherosclerosis. Using frozen serum, carotid intima medial thickness (CIMT) measurements and other existing data from the Atherosclerosis Prevention in Pediatric Lupus Erythematosus (APPLE) trial, we assessed interactions between serum 25-hydroxyvitamin D (25(OH)D), atorvastatin randomisation and CIMT progression rate. Methods Participants in the 3-year APPLE trial were randomised to placebo or atorvastatin and CIMT progression rate was measured. Baseline frozen serum was used to measure 25(OH)D concentrations. Mixed effect longitudinal models for CIMT progression at 3 years were used to evaluate interaction between vitamin D deficiency (serum 25(OH)D <20 ng/mL) at baseline and atorvastatin or placebo treatment, adjusting for key systemic lupus erythematosus disease variables and cardiovascular risk factors. Results 201/221 APPLE participants had available samples and were included in this analysis; 61/201 (30%) had vitamin D deficiency at baseline. In adjusted longitudinal modelling, there was significant interaction between baseline vitamin D deficiency and atorvastatin randomisation in 3-year progression of mean-max CIMT. In four out of six carotid segments, there was a greater decrease in mean-max CIMT progression rate in subjects who were treated with atorvastatin compared with placebo if they had baseline serum 25(OH)D levels ≥20 ng/mL. Conclusions Subjects with serum 25(OH)D ≥20 ng/mL had less mean-max CIMT progression following 3 years of atorvastatin treatment. Results from secondary analyses must be interpreted cautiously, but findings suggest that underlying vitamin D deficiency may be involved in response to atorvastatin in atherosclerosis prevention. Trial registration number NCT00065806. PMID:25396067

  16. Configurational diffusion of asphaltenes in fresh and aged catalyst extrudates. Quarterly progress report, June 20, 1995--September 20, 1995

    SciTech Connect

    Guin, J.A.

    1996-01-01

    The objective of this research is to determine the relationship between the size and shape of coal and petroleum macromolecules and their diffusion rates i.e., effective diffusivities, in catalyst pore structures. This quarter, three petroleum and two coal asphaltenes were prepared from petroleum asphalts and coal derived solids separately by solvent extraction.

  17. Pediatric heart surgery - discharge

    MedlinePlus

    ... discharge; Heart valve surgery - children - discharge; Heart surgery - pediatric - discharge; Heart transplant - pediatric - discharge ... Keane JF, Lock JE, Fyler DC, eds. Nadas' Pediatric Cardiology . 2nd ed. St. Louis, MO; WB Saunders; ...

  18. Pediatric sleep apnea

    MedlinePlus

    Sleep apnea - pediatric; Apnea - pediatric sleep apnea syndrome; Sleep-disordered breathing - pediatric ... During sleep, all of the muscles in the body become more relaxed. This includes the muscles that help keep ...

  19. Quarterly progress report on configurational diffusion of asphaltenes in fresh and aged catalyst extrudates, September 20, 1995--December 20, 1995

    SciTech Connect

    Guin, J.A.

    1995-12-31

    The objective of this research is to determine the relationship between the size and shape of coal and petroleum macromolecules and their diffusion rates i.e., effective diffusivities, in catalyst pore structures. That is, how do the effective intrapore diffusivities depend on molecule configuration and pore geometry. The research is divided into the following tasks: (1) relationship between effective intrapore diffusion coefficients, molecular size and pore geometry; (2) effects of solvent composition, solute concentration, and temperature on the molecular configuration and diffusion rate of coal and petroleum asphaltenes in catalysts pore; and (3) assessment of diffusional limitations in aged catalysts. This quarter, the GPC column efficiency was rechecked by using acetone injection. The calibration curve for the GPC was rechecked through polystyrene standards with narrow molecular weight distributions. Some experiments on adsorption and diffusion of coal asphaltenes through porous catalysts were performed. The asphaltenes were grouped into nine fractions with the concentration being determined via GPC. It was found that the uptake rate for one asphaltene fraction is different from those for other fractions. Comparison of experimental uptake data shows a difference in hindered diffusion behavior between petroleum asphaltenes and coal asphaltenes.

  20. Configurational diffusion of asphaltenes in fresh and aged catalysts extrudates. Quarterly progress report, [March--June 1993

    SciTech Connect

    Guin, J.A.; Tarrer, A.R.

    1993-09-01

    The objective of this research is to determine the relationship between the size and shape of coal and petroleum macromolecules and their diffusion rates i.e., effective diffusivities, in catalyst pore structures. Finite bath-type diffusion experiments will be performed using both coal and petroleum-derived macromolecular species, e.g. asphaltenes, as well as model compounds, e.g. porphyrins, polymers, of known molecular size. By monitoring the concentration of solute macromolecules in the bath, the effective intrapore diffusion coefficients will be determined through application of the appropriate diffusion equations. Macromolecular species concentrations will be monitored by size exclusion chromatography (SEC). Relationships will be sought between the size, and shape, e.g. planar, coil, of the diffusing solutes and the pore geometry (pore size distribution) of the catalyst support The effects of molecule configuration and catalyst pore size distribution on the effective intrapore diffusivity will be examined. Specially prepared laboratory catalysts with very narrow pore size distributions and other model porous media, eg. porous Vycor glass, will be utilized in the experiments. Pore structures of all catalysts and other porous media will be characterized by mercury porosimetry and surface area (BET) analysis.

  1. Pediatric Neurotrauma

    PubMed Central

    Kannan, Nithya; Ramaiah, Ramesh; Vavilala, Monica S.

    2014-01-01

    Traumatic brain injury (TBI) is the leading cause of death and disability in children over 1 year of age. Knowledge about the age-specific types of injury and how to manage children with neurotrauma is essential to understanding and recognizing the extent and degree of injury and to optimize outcomes. In this article, we review the epidemiology, pathophysiology, and clinical management of pediatric neurotrauma. PMID:25024940

  2. Pediatric Virology

    PubMed Central

    Portnoy, Bernard

    1965-01-01

    Pediatric virology is not an isolàted discipline. Rather, the syndromes associated with viral infection are modified by the unique characteristics of infancy and childhood. Fortunately for the pediatrician, and certainly for children, viral infections in childhood are rarely fatal, and are almost never serious. Future efforts of the pediatrician and virologist should be directed toward increased fetal salvage as with rubella and the prevention of severe, viral lower respiratory tract disease. PMID:14298871

  3. Pediatric nutrition.

    PubMed

    Greco, Deborah S

    2014-03-01

    This article discusses pediatric nutrition in puppies and kittens. Supplementation of basic nutrients such as fat, protein, minerals, vitamins, and essential fatty acids of the bitch is essential for the proper growth and development of puppies during the lactation period. Milk replacers are compared for use in puppies and kittens. Supplements such as colostrum and probiotics for promotion of a healthy immune system and prevention or treatment of stress-induced and weaning diarrhea are also discussed. PMID:24580990

  4. [Isotope tracer studies of diffusion in silicates and of geological transport processes using actinide elements]. Progress report

    SciTech Connect

    Wasserburg, G.J.

    1991-12-31

    This report consists of sections entitled resonance ionization mass spectrometry of Os, Mg self-diffusion in spinel and silicate melts, neotectonics: U-Th ages of solitary corals from the California coast, uranium-series evidence on diagenesis and hydrology of carbonates of Barbados, diffusion of H{sub 2}O molecules in silicate glasses, and development of an extremely high abundance sensitivity mass spectrometer.

  5. Configurational diffusion of asphaltenes in fresh and aged catalyst extrudates. Quarterly progress report, June 20--September 30, 1996

    SciTech Connect

    Guin, J.A.

    1996-12-31

    The objective of this research is to determine the relationship between the size and shape of coal and petroleum macromolecules and their diffusion rates i.e., effective diffusivities, in catalyst pore structures. That is, how do the effective intrapore diffusivities depend on molecule configuration and pore geometry. The study involves three tasks: Relationship between effective intrapore diffusion coefficients, molecular size, and pore geometry; Effects of solvent composition, solute concentration, and temperature on the molecular configuration and diffusion rate of coal and petroleum asphaltenes in catalyst pores; and Assessment of diffusional limitations in aged catalysts. This quarter, uptake experiments of coal and petroleum asphaltenes into porous catalyst were performed using different initial concentrations, temperatures, and solvents. The adsorption-diffusion parameters were obtained by simulating the experimental data with the mathematical model. The results showed that the adsorption constants for coal asphaltene fractions at 0.5 mg/cm{sup 3} initial concentration are less than those at 0.05 mg/cm{sup 3}, indicating the non-linearity of coal asphaltene adsorption on porous catalyst. Comparison of uptake results using different solvents showed that the adsorption constants with solvent toluene are much larger than those with THF solvent. The effect of temperature on the adsorptive uptake was complex, with the adsorptivity for coal asphaltenes at 35 C exceeding that at 25 C in the lower (< 10{sup 3}) molecular weight region; while the adsorptivities for petroleum asphaltenes are about the same at 20, 35, and 50 C.

  6. Advanced computational methods for nodal diffusion, Monte Carlo, and S{sub N} problems. Progress report, January 1, 1992--March 31, 1993

    SciTech Connect

    Martin, W.R.

    1993-01-01

    This document describes progress on five efforts for improving effectiveness of computational methods for particle diffusion and transport problems in nuclear engineering: (1) Multigrid methods for obtaining rapidly converging solutions of nodal diffusion problems. A alternative line relaxation scheme is being implemented into a nodal diffusion code. Simplified P2 has been implemented into this code. (2) Local Exponential Transform method for variance reduction in Monte Carlo neutron transport calculations. This work yielded predictions for both 1-D and 2-D x-y geometry better than conventional Monte Carlo with splitting and Russian Roulette. (3) Asymptotic Diffusion Synthetic Acceleration methods for obtaining accurate, rapidly converging solutions of multidimensional SN problems. New transport differencing schemes have been obtained that allow solution by the conjugate gradient method, and the convergence of this approach is rapid. (4) Quasidiffusion (QD) methods for obtaining accurate, rapidly converging solutions of multidimensional SN Problems on irregular spatial grids. A symmetrized QD method has been developed in a form that results in a system of two self-adjoint equations that are readily discretized and efficiently solved. (5) Response history method for speeding up the Monte Carlo calculation of electron transport problems. This method was implemented into the MCNP Monte Carlo code. In addition, we have developed and implemented a parallel time-dependent Monte Carlo code on two massively parallel processors.

  7. Trends in pediatric rehabilitation.

    PubMed

    Burkett, K W

    1989-03-01

    The 1980s have been declared the decade of the disabled. Surgeon General Koop has stated that "it is profoundly important for our own society that we tend to these issues of disabled children, that these children not be forgotten or pushed aside, and that we retain our belief in the strength of the American family". The field of pediatric rehabilitation, unheard of as recently as the late 1970s, has become a recognized specialty. The definition of pediatric rehabilitation has expanded to include the care and treatment of children with congenital and acquired disabilities. The pediatric rehabilitation nurse is challenged to keep abreast of new developments in the field while seeking and implementing innovative ways to assist the child and family in their adjustment to the child's disability. A knowledge base of normal growth and development is essential when assessing abnormal patterns in the child with a disability. Complete assessment of the child with a disability includes a parent-child interview and physical assessment, with particular focus on the child's developmental age, movement patterns, and functional activities of daily living. The reaction of the child and family to the disability is all too often viewed as lack of "acceptance" of the child's disability. A continuum of "adjustment" to the disability for both family and child describes normal coping mechanisms for living with and managing the needs of a disabled child. It is important for the pediatric rehabilitation nurse to develop a partnership with parents in which they serve as consultants to families, not as directors of the child's care. Cerebral palsy and spina bifida are the two most common childhood disabilities. With advanced technologic equipment and refined surgical procedures, the child's potential for independence is reaching new heights. Computerized technology has aided the motor-impaired child to progress through normal developmental processes of exploration and discovery. Specialized

  8. Pediatric Insomnia.

    PubMed

    Brown, Kelly M; Malow, Beth A

    2016-05-01

    Insomnia in children is complex and frequently multifactorial. This review discusses the major categories of insomnia as well as common causes. The consequences of insomnia, including issues with mood, behavior, and cognition, are discussed. Sleep disorders are much more prevalent in certain pediatric populations, such as children with autism spectrum disorders. The evaluation of insomnia in children includes a focused history and examination and occasionally actigraphy or polysomnography. Behavioral and pharmacological therapies are discussed, as are future directions for research and clinical practice. PMID:26378738

  9. Pediatric radiology

    SciTech Connect

    Silverman, F.N.

    1982-01-01

    A literature review with 186 references of diagnostic pediatric radiology, a speciality restricted to an age group rather than to an organ system or technique of examination, is presented. In the present chapter topics follow the basic organ system divisions with discussions of special techniques within these divisions. The diagnosis of congenital malformations, infectious diseases and neoplasms are a few of the topics discussed for the head and neck region, the vertebrae, the cardiovascular system, the respiratory system, the gastrointestinal tract, the urinary tract, and the skeleton. (KRM)

  10. Pediatric lymphomas in Brazil

    PubMed Central

    Gualco, Gabriela; Klumb, Claudete E; Barber, Glen N; Weiss, Lawrence M; Bacchi, Carlos E

    2010-01-01

    OBJECTIVE: This study provides the clinical pathological characteristics of 1301 cases of pediatric/adolescent lymphomas in patients from different geographic regions of Brazil. METHODS: A retrospective analyses of diagnosed pediatric lymphoma cases in a 10‐year period was performed. We believe that it represents the largest series of pediatric lymphomas presented from Brazil. RESULTS: Non‐Hodgkin lymphomas represented 68% of the cases, including those of precursor (36%) and mature (64%) cell origin. Mature cell lymphomas comprised 81% of the B‐cell phenotype and 19% of the T‐cell phenotype. Hodgkin lymphomas represented 32% of all cases, including 87% of the classical type and 13% of nodular lymphocyte predominant type. The geographic distribution showed 38.4% of the cases in the Southeast region, 28.7% in the Northeast, 16.1% in the South, 8.8% in the North, and 8% in the Central‐west region. The distribution by age groups was 15–18 years old, 33%; 11–14 years old, 26%; 6–10 years old, 24%; and 6 years old or younger, 17%. Among mature B‐cell lymphomas, most of the cases were Burkitt lymphomas (65%), followed by diffuse large B‐cell lymphomas (24%). In the mature T‐cell group, anaplastic large cell lymphoma, ALK‐positive was the most prevalent (57%), followed by peripheral T‐cell lymphoma, then not otherwise specified (25%). In the group of classic Hodgkin lymphomas, the main histological subtype was nodular sclerosis (76%). Nodular lymphocyte predominance occurred more frequently than in other series. CONCLUSION: Some of the results found in this study may reflect the heterogeneous socioeconomical status and environmental factors of the Brazilian population in different regions. PMID:21340214

  11. Configurational diffusion of asphaltenes in fresh and aged catalyst extrudates. Quarterly progress report, June 20, 1993--September 20, 1993

    SciTech Connect

    Guin, J.A.; Tarrer, A.R.

    1993-12-01

    This quarter, we measured the surface areas and effective diffusivities for fresh, spent and regenerated unimodal Criterion 324 and bimodal EXP-AO-60 catalysts. The results showed that the surface areas for spent catalysts decreased greatly due to coke formation and metal deposition during coal liquefaction process. After regeneration, the catalyst surface areas were partially or completely restored. Adsorption equilibrium experiments showed that the adsorption isotherms for quinoline in cyclohexane with these six sample of catalysts could be well represented by Freundlich isotherms. The effective diffusivities with these catalysts were obtained by fitting experimental data with the diffusional model. The results indicated that the effective diffusivity for fresh bimodal catalyst with larger pore size was greater than that for fresh unimodal catalyst with a smaller pore size. After the catalysts were used in a coal liquefaction process, the effective diffusivities decreased to less than 1% of those for fresh catalysts. When the spent catalysts were regenerated in air, the effective diffusivites were recovered to 35--50% of those for fresh catalysts.

  12. Isotope tracer studies of diffusion in silicates and of geological transport processes using actinide elements. Progress report

    SciTech Connect

    Wasserburg, G.J.

    1992-12-31

    The following are reported: high abundance sensitivity mass spectrometer for U-Th studies; {sup 238}U-{sup 230}Th disequilibrium in recent lavas from Iceland; water-rock interaction from U-Th studies; resonance ionization mass spectrometry of Os and Ti isotopes; and self-diffusion of Mg.

  13. Serial Lung Magnetic Resonance Imaging to Monitor Disease Progression in a Child With a Diffuse Alveolar Hemorrhage Syndrome

    PubMed Central

    Kaleel, Mohammed; Schramm, Craig; Pascal, Melanie; O’Louglin, Michael; Collins, Melanie Sue

    2015-01-01

    Serial lung magnetic resonance imaging (MRI) was performed in a child with diffuse alveolar hemorrhage (DAH). To minimize radiation exposure with conventional serial chest computerized tomography (CT), serial MRIs of the lungs were used. This effectively monitored her disease process as well as detected acute hemorrhage after 5 years remission. PMID:25699125

  14. Microbiome and pediatric atopic dermatitis.

    PubMed

    Powers, Claire E; McShane, Diana B; Gilligan, Peter H; Burkhart, Craig N; Morrell, Dean S

    2015-12-01

    Atopic dermatitis is a chronic inflammatory skin condition with drastic impacts on pediatric health. The pathogenesis of this common disease is not well understood, and the complex role of the skin microbiome in the pathogenesis and progression of atopic dermatitis is being elucidated. Skin commensal organisms promote normal immune system functions and prevent the colonization of pathogens. Alterations in the skin microbiome may lead to increased Staphylococcus aureus colonization and atopic dermatitis progression. Despite the evidence for their important role, probiotics have not been deemed efficacious for the treatment of atopic dermatitis, although studies suggest that probiotics may be effective at preventing the development of atopic dermatitis when given to young infants. This review will cover the most recent published work on the microbiome and pediatric atopic dermatitis. PMID:26388516

  15. Incidental Diagnosis of Diffuse Intrinsic Pontine Glioma in Children

    PubMed Central

    Wright, K. D.; Sabin, N. D.; Cheuk, D.; McNall-Knapp, R. Y.; Shurtleff, S. A.; Gajjar, A.; Broniscer, A.

    2014-01-01

    Children with diffuse intrinsic pontine glioma (DIPG) have a short onset, rapidly progressive neurologic decline before diagnosis. Therefore, incidental diagnosis of such an aggressive cancer is counterintuitive, yet our experience shows DIPG may occur as part of a spectrum of incidentally diagnosed pediatric brain cancers. Although children with incidentally diagnosed DIPG may experience a longer survival, it remains a potentially deadly cancer despite treatment with radiotherapy. Histologic confirmation is warranted when feasible in such patients to confirm diagnosis. Moreover, recent advances in genome-wide analyses may suggest incidentally diagnosed DIPGs are biologically distinct from the majority of these cancers. PMID:25598012

  16. Improved spatial regression analysis of diffusion tensor imaging for lesion detection during longitudinal progression of multiple sclerosis in individual subjects

    NASA Astrophysics Data System (ADS)

    Liu, Bilan; Qiu, Xing; Zhu, Tong; Tian, Wei; Hu, Rui; Ekholm, Sven; Schifitto, Giovanni; Zhong, Jianhui

    2016-03-01

    Subject-specific longitudinal DTI study is vital for investigation of pathological changes of lesions and disease evolution. Spatial Regression Analysis of Diffusion tensor imaging (SPREAD) is a non-parametric permutation-based statistical framework that combines spatial regression and resampling techniques to achieve effective detection of localized longitudinal diffusion changes within the whole brain at individual level without a priori hypotheses. However, boundary blurring and dislocation limit its sensitivity, especially towards detecting lesions of irregular shapes. In the present study, we propose an improved SPREAD (dubbed improved SPREAD, or iSPREAD) method by incorporating a three-dimensional (3D) nonlinear anisotropic diffusion filtering method, which provides edge-preserving image smoothing through a nonlinear scale space approach. The statistical inference based on iSPREAD was evaluated and compared with the original SPREAD method using both simulated and in vivo human brain data. Results demonstrated that the sensitivity and accuracy of the SPREAD method has been improved substantially by adapting nonlinear anisotropic filtering. iSPREAD identifies subject-specific longitudinal changes in the brain with improved sensitivity, accuracy, and enhanced statistical power, especially when the spatial correlation is heterogeneous among neighboring image pixels in DTI.

  17. Configurational diffusion of asphaltenes in fresh and aged catalyst extrudates. Quarterly progress report, March 20, 1996--June 20, 1996

    SciTech Connect

    Guin, J.A.

    1996-10-01

    This quarter, hindered diffusion of one coal and two petroleum asphaltenes was studied by adsorptive uptake in THF from a bath surrounding a commercial NiMo/Al{sub 2}O{sub 3} catalyst. Several asphaltene fractions were defined via SEC (size exclusion chromatography), with the molecular weight of each fraction being determined by its elution characteristics using polystyrene standards. It was found that both the coal and petroleum asphaltenes have very broad molecular weight distributions; however, the molecular weights of the coal asphaltenes (50--1000) were much smaller than those of the two petroleum asphaltenes (300--10000 and 300--20000 respectively). Simulation results showed that even though the properties of coal and petroleum asphaltenes were quite different, the values of model parameters for the fractions of the three asphaltenes had the same trend; with increasing molecular weight of the fraction, the adsorption constant monotonically increases, and the effective diffusivity decreases. The experimental diffusion data of the three asphaltenes were well represented by similar mathematical models.

  18. Improved spatial regression analysis of diffusion tensor imaging for lesion detection during longitudinal progression of multiple sclerosis in individual subjects.

    PubMed

    Liu, Bilan; Qiu, Xing; Zhu, Tong; Tian, Wei; Hu, Rui; Ekholm, Sven; Schifitto, Giovanni; Zhong, Jianhui

    2016-03-21

    Subject-specific longitudinal DTI study is vital for investigation of pathological changes of lesions and disease evolution. Spatial Regression Analysis of Diffusion tensor imaging (SPREAD) is a non-parametric permutation-based statistical framework that combines spatial regression and resampling techniques to achieve effective detection of localized longitudinal diffusion changes within the whole brain at individual level without a priori hypotheses. However, boundary blurring and dislocation limit its sensitivity, especially towards detecting lesions of irregular shapes. In the present study, we propose an improved SPREAD (dubbed improved SPREAD, or iSPREAD) method by incorporating a three-dimensional (3D) nonlinear anisotropic diffusion filtering method, which provides edge-preserving image smoothing through a nonlinear scale space approach. The statistical inference based on iSPREAD was evaluated and compared with the original SPREAD method using both simulated and in vivo human brain data. Results demonstrated that the sensitivity and accuracy of the SPREAD method has been improved substantially by adapting nonlinear anisotropic filtering. iSPREAD identifies subject-specific longitudinal changes in the brain with improved sensitivity, accuracy, and enhanced statistical power, especially when the spatial correlation is heterogeneous among neighboring image pixels in DTI. PMID:26948513

  19. The 16-year incidence, progression and regression of diabetic retinopathy in a young population-based Danish cohort with type 1 diabetes mellitus: The Danish cohort of pediatric diabetes 1987 (DCPD1987).

    PubMed

    Broe, Rebecca; Rasmussen, Malin Lundberg; Frydkjaer-Olsen, Ulrik; Olsen, Birthe Susanne; Mortensen, Henrik Bindesboel; Peto, Tunde; Grauslund, Jakob

    2014-01-01

    The aim was to investigate the long-term incidence of proliferative diabetic retinopathy (PDR), and progression and regression of diabetic retinopathy (DR) and associated risk factors in young Danish patients with Type 1 diabetes mellitus. In 1987-89, a pediatric cohort involving approximately 75 % of all children with Type 1 diabetes in Denmark <19 years of age was identified (n = 720). In 1995, 339 (47.1 %) were re-studied with retinopathy graded and all relevant diabetic parameters assessed. Of those, 185 (54.6 %) were evaluated again in 2011 for the same clinical parameters. All retinal images were graded using modified early treatment of DR study for 1995 and 2011. In 1995, mean age was 21.0 years and mean diabetes duration 13.5 years. The 16-year incidence of proliferative retinopathy, 2-step progression and 2-step regression of DR was 31.0, 64.4 and 0.0 %, respectively, while the incidence of DR was 95.1 %. In a multivariate logistic regression model, progression to PDR was significantly associated with 1995 HbA1c (OR 2.61 per 1 % increase, 95 % CI 1.85-3.68) and 1995 diastolic blood pressure (OR 1.79 per 10 mmHg increase, 95 % CI 1.04-3.07). Two-step progression of DR was associated with male gender (OR 2.37 vs. female, 95 % CI 1.07-5.27), 1995 HbA1c (OR 3.02 per 1 % increase, 95 % CI 2.04-4.48) and 1995 vibration perception threshold (OR 1.19 per 1 Volt increase, 95 % CI 1.02-1.40). In conclusion, one in three progressed to PDR and two in three had 2-step progression despite young age and increased awareness of the importance of metabolic control. After 30 years duration of diabetes, the presence of DR is almost universal. PMID:24193810

  20. Pediatric tracheomalacia.

    PubMed

    Fraga, Jose Carlos; Jennings, Russell W; Kim, Peter C W

    2016-06-01

    Tracheomalacia (TM) is defined as an increased collapsibility of the trachea due to structural anomalies of the tracheal cartilage and/or posterior membrane. Tracheomalacia has a wide range of etiologies but is most commonly present in children born with esophageal atresia and tracheal esophageal fistula. Clinical symptoms can range from minor expiratory stridor with typical barking cough to severe respiratory distress episodes to acute life-threatening events (ALTE). Although the majority of children have mild-to-moderate symptoms and will not need surgical intervention, some will need life-changing surgical treatment. This article examines the published pediatric literature on TM, discusses the details of clinical presentation, evaluation, diagnosis, and a variety of treatments. PMID:27301602

  1. Adolescent and Pediatric Brain Tumors

    MedlinePlus

    ... abta.org Donate Now Menu Adolescent & Pediatric Brain Tumors Brain Tumors In Children Pediatric Brain Tumor Diagnosis Family ... or Complete our contact form Adolescent & Pediatric Brain Tumors Brain Tumors In Children Pediatric Brain Tumor Diagnosis Family ...

  2. Pediatric Antifungal Agents

    PubMed Central

    Cohen-Wolkowiez, Michael; Moran, Cassandra; Benjamin, Daniel K.; Smith, P Brian

    2009-01-01

    Purpose of review In immunocompromised hosts, invasive fungal infections are common and fatal. In the past decade, the antifungal armamentarium against invasive mycoses has expanded greatly. The purpose of this report is to review the most recent literature addressing the use of antifungal agents in children. Recent findings Most studies evaluating the safety and efficacy of antifungal agents are limited to adults. However, important progress has been made in describing the pharmacokinetics and safety of newer antifungal agents in children, including the echinocandins. Summary Dosage guidelines for newer antifungal agents are currently based on adult and limited pediatric data. Because important developmental pharmacology changes occur throughout childhood impacting the pharmacokinetics of these agents, antifungal studies specifically designed for children are necessary. PMID:19741525

  3. Lagrangian and Eulerian diffusion study in the coastal surface layers. Progress report, July 1, 1979-June 30, 1980

    SciTech Connect

    Carter, H H; Okubo, A; Wilson, R E; Sanderson, B; Pritchard, D W

    1980-07-01

    This research project addresses a fundamental problem in turbulence theory, the relation between Lagrangian and Eulerian statistics, by carrying out, analyzing, and interpreting a set of field experiments in the coastal waters off the south shore of Long Island. The study will not only provide information on the relation between the Lagrangian and Eulerian autocorrelations but also between the various experimental methods for quantitatively estimating turbulent diffusion. Two experiments, one in summer and one in winter, consisting of simultaneous measurements of dye diffusion, drogue dispersion, and Eulerian current velocities in a typical coastal locale were planned. In order to ensure a match between the Lagrangian (drogues, dye) scales of motion and the Eulerian (current meters) scales, however, a preliminary experiment, consisting of a 6 mooring current meter array and a short (approx. 3 hours) drogue experiment, was conducted during March 1980. Results of this preliminary experiment and their implications to the experimental program are discussed. The principal results were an improved design of our current meter array, and a wider variety of drogue experiments, i.e., multi-level, multi-scale, and continuous source simulation.

  4. (Energetics of silicate melts from thermal diffusion studies): Progress report for the second year's activities, January--December 1988

    SciTech Connect

    Lesher, C.; Walker, D.

    1988-01-01

    The second year of this three year renewal has been used to continue data collection and analysis of thermal (Soret) diffusion in silicate liquid and explore the related process of thermal migration in subliquidus magmas. During the past year we have expanded our experimental capabilities for thermal gradient work by the construction of two new miniaturized piston-cylinder devices capable of 20kb. This has greatly alleviated the bottleneck on our existing facilities and has permitted us to undertake long term thermal diffusion experiments which have been prohibitive in the past. Data collection efforts have also been materially aided by advances in thermal insulation in the pressure media outside our pressurized cylindrical heaters. BaCO/sub 3/ + 10%Cr/sub 2/O/sub 3/ is very effective in protecting the pressure vessel core from thermal deterioration with the result that the heater inside and outside diameters can be substantially increased. This permits several charges to be run simultaneously in an axisymmetric cluster around a double or triple junction thermocouple which can measure axial thermal gradients in situ. These thermal insulation and charge volume increase innovations also have been adapted in our on going studies of mineral-liquid element partitioning, silicate mineral dissolution and silicate liquid interdiffusion and should prove to be wide applicability and utility in other piston-cylinder laboratories, as well. 13 refs.

  5. Pediatric diagnostic imaging

    SciTech Connect

    Gyll, C.; Blake, N.S.

    1986-01-01

    This book treats the practical problems of pediatric radiography and radiological procedures. Written jointly by a radiographer and a radiologist, it covers pediatric positioning and procedures. An extended chapter covers neonatal radiography and radiology.

  6. Pediatric Endocrinology Nurses Society

    MedlinePlus

    ... International Welcome to PENS The Pediatric Endocrinology Nursing Society (PENS) is committed to the development and advancement ... PENS@kellencompany.com • Copyright © 2016 Pediatric Endocrinology Nursing Society • ALL RIGHTS RESERVED • Privacy Policy • Admin

  7. Diffusion of gases in coals and chars: Quarterly technical progress report No. 8, June 15, 1987-September 14, 1987

    SciTech Connect

    Smith, D.M.

    1987-01-01

    As a result of the complex nature of coal, it is difficult to probe its pore structure over the entire pore size range of interest. Multiple techniques such as gas adsorption (nitrogen and carbon dioxide), mercury porosimetry, small angle x-ray scattering (SAXS) and density measurements are required. These techniques suffer from inherent problems such as a limited pore size range, errors due to network/percolation effects, the necessity of pore shape assumptions, and/or sample changes during analysis. In this work, the use of low-field NMR spin-lattice relaxation measurements as a pore structure analysis technique for coal is demonstrated. In principle, NMR pore structure analysis does not suffer from the problems of the other methods. Other measuring techniques investigated during the report period are: Surface area determination via nitrogen and carbon dioxide adsorption for raw coals; mercury porosimetry; and diffusion measurements.

  8. Nuclear imaging in pediatrics

    SciTech Connect

    Siddiqui, A.R.

    1985-01-01

    The author's intent is to familiarize practicing radiologists with the technical aspects and interpretation of nuclear medicine procedures in children and to illustrate the indications for nuclear medicine procedures in pediatric problems. Pediatric doses, dosimetry, sedation, and injection techniques, organ systems, oncology and infection, testicular scanning and nuclear crystography, pediatric endocrine and skeletal systems, ventilation and perfusion imaging of both congenital and acquired pediatric disorders, cardiovascular problems, gastrointestinal, hepatobiliary, reticuloendothelial studies, and central nervous system are all topics which are included and discussed.

  9. Evolution of a symptomatic diffuse developmental venous anomaly with progressive cerebral atrophy in an atypical case of Sturge-Weber syndrome.

    PubMed

    Ohno, Koyo; Saito, Yoshiaki; Togawa, Masami; Shinohara, Yuki; Ito, Takamichi; Sugano, Hidenori; Itamura, Shinji; Nishimura, Yoko; Tamasaki, Akiko; Maegaki, Yoshihiro

    2015-09-01

    A 2-year-old boy had glaucoma, bilateral facial haemangioma and widespread blue nevi on the trunk and extremities since birth. Dilated medullary veins were detected in the left cerebral periventricular white matter on magnetic resonance imaging (MRI). Macrocephaly and delayed psychomotor development were observed during late infancy, and susceptibility-weighted angiography revealed an extensive developmental venous anomaly with multiple caput medusae throughout bilateral hemispheres, accompanied by periventricular hyperintense alterations on MRI and progressive diffuse atrophy of the cerebral mantle with left-sided predominance. Hypoperfusion in the left cerebral and cerebellar hemisphere was also uncovered. No meningeal haemangioma was observed. This patient may represent a novel subgroup of phakomatosis cases that can be regarded as a variant of Sturge-Weber syndrome. PMID:25547041

  10. NOTCH1, TP53, and MAP2K1 Mutations in Splenic Diffuse Red Pulp Small B-cell Lymphoma Are Associated With Progressive Disease.

    PubMed

    Martinez, Daniel; Navarro, Alba; Martinez-Trillos, Alejandra; Molina-Urra, Ricardo; Gonzalez-Farre, Blanca; Salaverria, Itziar; Nadeu, Ferran; Enjuanes, Anna; Clot, Guillem; Costa, Dolors; Carrio, Ana; Villamor, Neus; Colomer, Dolors; Martinez, Antonio; Bens, Susanne; Siebert, Reiner; Wotherspoon, Andrew; Beà, Sílvia; Matutes, Estella; Campo, Elias

    2016-02-01

    Splenic diffuse red pulp small B-cell lymphoma (SDRPL) is considered an indolent neoplasm and its pathogenesis is not well known. We investigated the molecular characteristics of 19 SDRPL patients, 5 of them with progressive disease. IGHV genes were mutated in 9/13 (69%). Cytogenetic and molecular studies identified complex karyotypes in 2 cases, and IGH rearrangements in 3, with PAX5 and potentially TCL1 as partners in each one of them. Copy number arrays showed aberrations in 69% of the tumors, including recurrent losses of 10q23, 14q31-q32, and 17p13 in 3, and 9p21 in 2 cases. Deletion of 7q31.3-q32.3 was present in only 1 case and no trisomies 3 or 18 were detected. NOTCH1 and MAP2K1 were mutated in 2 cases each, whereas BRAF, TP53, and SF3B1 were mutated each in single cases. No mutations were found in NOTCH2 or MYD88. Four of the 5 patients with aggressive disease had mutations in NOTCH1 (2 cases), TP53 (1 case), and MAP2K1 (1 case). The progression-free survival of patients with mutated genes was significantly shorter than in the unmutated (P=0.011). These findings show that SDRPL share some mutated genes but not chromosomal alterations, with other splenic lymphomas, that may confer a more aggressive behavior. PMID:26426381

  11. Genetic analysis of a case of glioblastoma with oligodendroglial component arising during the progression of diffuse astrocytoma.

    PubMed

    Hata, Nobuhiro; Suzuki, Satoshi O; Murata, Hideki; Hatae, Ryusuke; Akagi, Yojiro; Sangatsuda, Yuhei; Amano, Toshiyuki; Yoshimoto, Koji; Tahira, Tomoko; Mizoguchi, Masahiro

    2015-07-01

    The most recent definition of glioblastoma with oligodendroglioma component (GBMO) assigned clinical significance to the observation of oligodendroglial foci within glioblastomas. However, the pathological mechanism of its histogenesis has not yet been determined. We report the genetic analysis of a GBMO case that evolved from an astrocyte lineage. A 37-year-old male underwent a third craniotomy for the removal of recurrent lesions of a secondary glioblastoma originating from a previous diffuse astrocytoma. The lesion in the right frontal lobe contained oligodendroglial foci within a glioblastoma background, while the remaining lesions showed only classic glioblastoma histology. Genetic analyses revealed distal 10q loss of heterozygosity (LOH) occurring de novo in the oligodendroglial tissue, as well as 10p, 17p LOH, and isocitrate dehydrogenase-1 gene (IDH1) mutations inherited from the previous lesions. The final recurrent glioblastoma underwent LOH on almost the entire of chromosome 10. Based on these results, the importance of an oligodendroglial component in glioblastomas may be limited. PMID:25354913

  12. Weight as predictors of clinical progression and treatment failure: Results from the TREAT Asia Pediatric HIV Observational Database (TApHOD)

    PubMed Central

    Kariminia, Azar; Durier, Nicolas; Jourdain, Gonzague; Saghayam, Suneeta; Do, Chau V.; Van Nguyên, Lam; Hansudewechakul, Rawiwan; Lumbiganon, Pagakrong; Chokephaibulkit, Kulkanya; Truong, Khanh Huu; Sirisanthana, Virat; Ung, Vibol; Vonthanak, Saphonn; Ananworanich, Jintanat; Yusoff, Nik Khairulddin N.; Kurniati, Nia; Razali, Kamarul Azahar; Fong, Moy Siew; Nallusamy, Revathy; Wati, Dewi Kumara

    2014-01-01

    Objective To evaluate the value of time-updated weight and height in predicting clinical progression, immunological and virological failure in children receiving combination antiretroviral therapy (cART). Methods We used Cox regression to analyse data of a cohort of Asian children. Results 2608 children were included; median age at cART was 5.7 years. Time-updated weight for age Z score <−3 was associated with mortality (P < 0.001) independent of CD4%; and <−2 was associated with immunological failure (P ≤ 0.03) independent of age at cART. Conclusion Weight monitoring provides useful data to inform clinical management of children on cART in resource-limited settings. PMID:24872132

  13. Priorities in pediatric epilepsy research

    PubMed Central

    Baca, Christine B.; Loddenkemper, Tobias; Vickrey, Barbara G.; Dlugos, Dennis

    2013-01-01

    The Priorities in Pediatric Epilepsy Research workshop was held in the spirit of patient-centered and patient-driven mandates for developing best practices in care, particularly for epilepsy beginning under age 3 years. The workshop brought together parents, representatives of voluntary advocacy organizations, physicians, allied health professionals, researchers, and administrators to identify priority areas for pediatric epilepsy care and research including implementation and testing of interventions designed to improve care processes and outcomes. Priorities highlighted were 1) patient outcomes, especially seizure control but also behavioral, academic, and social functioning; 2) early and accurate diagnosis and optimal treatment; 3) role and involvement of parents (communication and shared decision-making); and 4) integration of school and community organizations with epilepsy care delivery. Key factors influencing pediatric epilepsy care included the child's impairments and seizure presentation, parents, providers, the health care system, and community systems. Care was represented as a sequential process from initial onset of seizures to referral for comprehensive evaluation when needed. We considered an alternative model in which comprehensive care would be utilized from onset, proactively, rather than reactively after pharmacoresistance became obvious. Barriers, including limited levels of evidence about many aspects of diagnosis and management, access to care—particularly epilepsy specialty and behavioral health care—and implementation, were identified. Progress hinges on coordinated research efforts that systematically address gaps in knowledge and overcoming barriers to access and implementation. The stakes are considerable, and the potential benefits for reduced burden of refractory epilepsy and lifelong disabilities may be enormous. PMID:23966254

  14. Pediatric Hand Injuries.

    PubMed

    Sullivan, Matthew A; Cogan, Charles J; Adkinson, Joshua M

    2016-01-01

    Pediatric hand injuries are extremely common. Although many hand injuries are adequately managed in the emergency department, some may need evaluation and treatment by a pediatric hand surgeon to ensure a good functional outcome. This article discusses the diagnosis and management of the most common pediatric hand maladies: fingertip injuries/amputation, tendon injuries, and phalangeal and metacarpal fractures. The plastic surgery nurse should be familiar with hand injuries that require intervention to facilitate efficient management and optimal postoperative care. PMID:27606586

  15. M2 tumour-associated macrophages contribute to tumour progression via legumain remodelling the extracellular matrix in diffuse large B cell lymphoma

    PubMed Central

    Shen, Long; Li, Honghao; Shi, Yuzhi; Wang, Dekun; Gong, Junbo; Xun, Jing; Zhou, Sifan; Xiang, Rong; Tan, Xiaoyue

    2016-01-01

    Effects of M2 tumour-associated macrophages on the pathogenesis of diffuse large B cell lymphoma (DLBCL) are still controversial. Our data showed that the number of CD163-positive M2 macrophages correlated negatively with DLBCL prognosis. Macrophage depletion by clodronate liposomes significantly suppressed tumour growth in a xenograft mouse model of DLBCL using OCI-Ly3 cells. Moreover, M2 polarization of macrophages induced legumain expression in U937 cells. Exogenous legumain promoted degradation of fibronectin and collagen I, which was abolished by administration of a legumain inhibitor RR-11a. Overexpression of legumain in Raw 264.7 cells also induced tube formation of endothelial cells in matrigel. In the xenograft mouse model of DLBCL, decreased fibronectin and collagen I, as well as increased legumain expression and angiogenesis were found at the late stage tumours compared with early stage tumours. Co-localization of legumain and fibronectin was observed in the extracellular matrix of tumour tissues. Administration of the legumain inhibitor to the xenograft DLBCL model suppressed tumour growth, angiogenesis and collagen deposition compared with the control. Taken together, our results suggest that M2 tumour-associated macrophages affect degradation of the extracellular matrix and angiogenesis via overexpression of legumain, and therefore play an active role in the progression of DLBCL. PMID:27464733

  16. M2 tumour-associated macrophages contribute to tumour progression via legumain remodelling the extracellular matrix in diffuse large B cell lymphoma.

    PubMed

    Shen, Long; Li, Honghao; Shi, Yuzhi; Wang, Dekun; Gong, Junbo; Xun, Jing; Zhou, Sifan; Xiang, Rong; Tan, Xiaoyue

    2016-01-01

    Effects of M2 tumour-associated macrophages on the pathogenesis of diffuse large B cell lymphoma (DLBCL) are still controversial. Our data showed that the number of CD163-positive M2 macrophages correlated negatively with DLBCL prognosis. Macrophage depletion by clodronate liposomes significantly suppressed tumour growth in a xenograft mouse model of DLBCL using OCI-Ly3 cells. Moreover, M2 polarization of macrophages induced legumain expression in U937 cells. Exogenous legumain promoted degradation of fibronectin and collagen I, which was abolished by administration of a legumain inhibitor RR-11a. Overexpression of legumain in Raw 264.7 cells also induced tube formation of endothelial cells in matrigel. In the xenograft mouse model of DLBCL, decreased fibronectin and collagen I, as well as increased legumain expression and angiogenesis were found at the late stage tumours compared with early stage tumours. Co-localization of legumain and fibronectin was observed in the extracellular matrix of tumour tissues. Administration of the legumain inhibitor to the xenograft DLBCL model suppressed tumour growth, angiogenesis and collagen deposition compared with the control. Taken together, our results suggest that M2 tumour-associated macrophages affect degradation of the extracellular matrix and angiogenesis via overexpression of legumain, and therefore play an active role in the progression of DLBCL. PMID:27464733

  17. White Paper on P4 Concepts for Pediatric Imaging.

    PubMed

    Daldrup-Link, Heike E; Sammet, Christina; Hernanz-Schulman, Marta; Barsness, Katherine A; Cahill, Anne Marie; Chung, Ellen; Doria, Andrea S; Darge, Kassa; Krishnamurthy, Rajesh; Lungren, Matthew P; Moore, Sheila; Olivieri, Laura; Panigrahy, Ashok; Towbin, Alexander J; Trout, Andrew; Voss, Stephan

    2016-05-01

    Over the past decade, innovations in the field of pediatric imaging have been based largely on single-center and retrospective studies, which provided limited advances for the benefit of pediatric patients. To identify opportunities for potential "quantum-leap" progress in the field of pediatric imaging, the ACR-Pediatric Imaging Research (PIR) Committee has identified high-impact research directions related to the P4 concept of predictive, preventive, personalized, and participatory diagnosis and intervention. Input from 237 members of the Society for Pediatric Radiology was clustered around 10 priority areas, which are discussed in this article. Needs within each priority area have been analyzed in detail by ACR-PIR experts on these topics. By facilitating work in these priority areas, we hope to revolutionize the care of children by shifting our efforts from unilateral reaction to clinical symptoms, to interactive maintenance of child health. PMID:26850380

  18. Health Informatics for Pediatric Disaster Preparedness Planning

    PubMed Central

    Burke, R.V.; Ryutov, T.; Neches, R.; Upperman, J.S.

    2010-01-01

    Objective 1. To conduct a review of the role of informatics in pediatric disaster preparedness using all medical databases. 2. To provide recommendations to improve pediatric disaster preparedness by the application of informatics. Methods A literature search was conducted using MEDLINE, CINHL and the Cochrane Library using the key words “children” AND “disaster preparedness and disaster” AND “informatics”. Results A total of 314 papers were initially produced by the search and eight that met the selection criteria were included in the review. Four themes emerged: tools for disaster preparedness, education, reunification and planning and response. Conclusion The literature pertaining to informatics and pediatric disaster preparedness is sparse and many gaps still persist. Current disaster preparedness tools focus on the general population and do not specifically address children. The most progress has been achieved in family reunification; however, the recommendations delineated are yet to be completed. PMID:23616840

  19. Gray zone lymphomas in pediatric patients.

    PubMed

    Liang, Xiayuan; Greffe, Brian; Cook, Bruce; Giller, Roger; Graham, Douglas K; McGranahan, Amy N; Wang, Michael

    2011-01-01

    Gray zone lymphomas are defined as lymphoid malignancies that cannot be reliably classified into a single distinct disease entity after all available morphologic, immunophenotypic, and molecular investigations have been performed. The 2008 World Health Organization Classification proposed 2 gray zone lesions: (1) B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma and (2) B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and classical Hodgkin lymphoma. These gray zone lesions are rare, especially in pediatric patients, and create a great challenge to both pathologists and oncologists because this differential diagnosis has direct implications for management strategies. In this manuscript, we report 2 cases of pediatric patients with gray zone lymphoma and review clinicopathologic features, treatment options, and outcomes of this uncommon tumor. PMID:20331368

  20. Pediatric sciatic neuropathies

    PubMed Central

    Ryan, M.M.; Escolar, D.M.; Darras, B.; Jones, H.R.

    2011-01-01

    Objective: The incidence, cause, and prognosis of sciatic neuropathy in children is not well understood. We report our 30-year experience of 53 patients with pediatric sciatic neuropathies (SN). Methods: Prospective review of the history, physical examination, electrophysiologic findings, and clinical course of children with SN. Results: The etiology of SN injury was varied and included trauma (13), iatrogenic causes (13) (8 orthopedic surgeries and 5 miscellaneous surgeries), prolonged extrinsic compression and immobilization (6), tumors (7), vascular (5), idiopathic and progressive (4), infantile and nonprogressive (2), and unknown, presumed postviral (3). Electrophysiologic studies demonstrated abnormalities in motor conduction studies of the peroneal nerve in 44/53 (83%) or tibial nerve in 35/51 (67%). Sensory conduction studies were abnormal in sural nerve in 34 of 43 cases (79%), and superficial peroneal nerves in 15/25 (60%). Needle EMG was abnormal in peroneal innervated muscles in all subjects, in tibial nerve innervated muscles in 43/51 (84%), and in the hamstrings in 18/29 (62%). Prognosis for recovery was variable and depended on the etiology and the severity of the nerve injury. Conclusions: SN is an uncommon mononeuropathy in children. The causes of SN are varied in children compared to adults. Electrophysiologic studies in children may be limited by poor tolerance but play an important role in establishing the diagnosis. PMID:21403109

  1. Teaching Prevention in Pediatrics.

    ERIC Educational Resources Information Center

    Cheng, Tina L.; Greenberg, Larrie; Loeser, Helen; Keller, David

    2000-01-01

    Reviews methods of teaching preventive medicine in pediatrics and highlights innovative programs. Methods of teaching prevention in pediatrics include patient interactions, self-directed learning, case-based learning, small-group learning, standardized patients, computer-assisted instruction, the Internet, student-centered learning, and lectures.…

  2. Economics of pediatric burns.

    PubMed

    Bass, Michael J; Phillips, Linda G

    2008-07-01

    Sustaining a burn injury sets in motion a cycle of pain, disfigurement, and a search for survival. In pediatric burns, the injury extends to the parents where fear, ignorance, and helplessness forever change their lives. Pediatric burn injuries are caused by fire, hot liquids, clothing irons, hair curlers, caustic substances like drain cleaner, the grounding of an electrical source, and exposure to radiation. Efficiency in the delivery of pediatric burn care is critical. Maximizing resource utilization means continual self-evaluation and economic analysis of therapeutic modalities. Griffiths et al found that most childhood burns are due to scalds, which can be treated for $1061 per percent burn. Paddock et al reduced the cost of treating superficial pediatric burns and reduced the length of stay in hospital using silver-impregnated gauze over traditional methods. Barrett et al found improved cosmesis of skin grafts using cultured epithelial autografts but at a substantially increased cost. Corpron et al showed that pediatric burn units that treat burns >10% total body surface area and operative treatment of pediatric burns regardless of size generate positive revenue. There is a paucity of evidentiary pediatric burn economic data. More research is needed to address areas of pediatric burn care inefficiency. Improving knowledge of cost in all health care endeavors will create competition and drive down expenditures. PMID:18650705

  3. Musculoskeletal Ultrasound in Pediatrics.

    PubMed

    Harcke, H. Theodore

    1998-01-01

    Ultrasound is ideally suited to the evaluation of the pediatric musculoskeletal system because of the increased ratio of cartilage to bone in the immature skeleton. The purpose of this article is to review the current uses of musculoskeletal ultrasound in pediatric patients. Hip sonography is widely accepted; other applications are increasing in popularity. PMID:11387111

  4. Pediatric Odontogenic Tumors.

    PubMed

    Abrahams, Joshua M; McClure, Shawn A

    2016-02-01

    Pediatric odontogenic tumors are rare, and are often associated with impacted teeth. Although they can develop anywhere in the jaws, odontogenic tumors mainly occur in the posterior mandible. This article discusses the diagnosis and treatment of the most common pediatric odontogenic tumors, such as ameloblastoma, keratocystic odontogenic tumor, odontoma, and cementoblastoma. PMID:26614700

  5. Pediatric Salivary Gland Malignancies.

    PubMed

    Ord, Robert A; Carlson, Eric R

    2016-02-01

    Pediatric malignant salivary gland tumors are extremely rare. The percentage of malignant tumors is higher than that seen in adults, although the outcomes in terms of survival are better in pediatric patients. The mainstay of treatment is surgical excision with negative margins. This article reviews current concepts in demographics, etiology, management, and outcomes of malignant salivary tumors in children. PMID:26614703

  6. Physical activity and pediatric multiple sclerosis: Developing a research agenda.

    PubMed

    Yeh, E Ann; Kinnett-Hopkins, Dominique; Grover, Stephanie A; Motl, Robert W

    2015-11-01

    Three-quarters of children with multiple sclerosis (MS) experience fatigue or depression, and progressive neurocognitive decline may be seen as early as two years after MS diagnosis. Furthermore, a higher magnetic resonance imaging disease burden is seen in pediatric-onset MS compared with adult-onset MS. To date, limited knowledge exists regarding behavioral methods for managing symptoms and disease progression in pediatric MS. To that end, this paper builds an evidence-based argument for the possible symptomatic and disease-modifying effects of exercise and physical activity in pediatric MS. This will be accomplished through: (a) a review of pediatric MS and its consequences; (b) a brief overview of physical activity and its consequences in children and adults with MS; and (c) a selective review of research on the neurological benefits of physical activity in pediatric populations. This topical review concludes with a list of 10 questions to guide future research on physical activity and pediatric MS. The objective of this paper is the provision of a research interest, focus and agenda involving pediatric MS and its lifelong management though exercise and physical activity behavior. Such an agenda is critical as the effects and maintenance of physical activity and exercise track across the lifespan, particularly when developed in the early stages of life. PMID:26447061

  7. Pediatric Care Online: A Pediatric Point-of-Care Tool.

    PubMed

    Vardell, Emily

    2016-01-01

    Pediatric Care Online is the American Academy of Pediatrics' point-of-care tool designed for health care providers. Pediatric Care Online builds on content from Red Book Online and Pediatric Patient Education and features Quick Reference topic pages for more than 250 pediatric health care topics. The multitude of resources available within Pediatric Care Online will be reviewed in this column, and a sample search will be used to illustrate the type of information available within this point-of-care pediatric resource. PMID:27054536

  8. Advances in Imaging of the Pediatric Pituitary Gland.

    PubMed

    Bou-Ayache, Jad M; Delman, Bradley N

    2016-06-01

    High-resolution MRI of the pediatric sella can help identity or confirm clinical abnormalities, assess pituitary gland size and structure, and reveal acquired lesions. This article reviews contemporary techniques for imaging of the sella and associated structures in this population. Strengths and weaknesses of conventional imaging are discussed, as are techniques that can enhance yield. Some new and emerging technologies are discussed, including MR elastography, perfusion imaging, spectroscopy, and diffusion-weighted and diffusion-tensor imaging. It is expected that this overview will provide insight as to where pediatric sella imaging is currently and where it may head in the future. PMID:27241974

  9. Possible Role of GADD45γ Methylation in Diffuse Large B-Cell Lymphoma: Does It Affect the Progression and Tissue Involvement?

    PubMed Central

    Barış, İkbal Cansu; Caner, Vildan; Şen Türk, Nilay; Sarı, İsmail; Hacıoğlu, Sibel; Doğu, Mehmet Hilmi; Çetin, Ozan; Tepeli, Emre; Can, Özge; Bağcı, Gülseren; Keskin, Ali

    2015-01-01

    Objective: Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma among adults and is characterized by heterogeneous clinical, immunophenotypic, and genetic features. Different mechanisms deregulating cell cycle and apoptosis play a role in the pathogenesis of DLBCL. Growth arrest DNA damage-inducible 45 (GADD45γ) is an important gene family involved in these mechanisms. The aims of this study are to determine the frequency of GADD45γ methylation, to evaluate the correlation between GADD45γ methylation and protein expression, and to investigate the relation between methylation status and clinicopathologic parameters in DLBCL tissues and reactive lymphoid node tissues from patients with reactive lymphoid hyperplasia. Materials and Methods: Thirty-six tissue samples of DLBCL and 40 nonmalignant reactive lymphoid node tissues were analyzed in this study. Methylation-sensitive high-resolution melting analysis was used for the determination of GADD45γ methylation status. The GADD45γ protein expression was determined by immunohistochemistry. Results: GADD45γ methylation was frequent (50.0%) in DLBCL. It was also significantly higher in advanced-stage tumors compared with early-stage (p=0.041). In contrast, unmethylated GADD45γ was associated with nodal involvement as the primary anatomical site (p=0.040). Conclusion: The results of this study show that, in contrast to solid tumors, the frequency of GADD45γ methylation is higher and this epigenetic alteration of GADD45γ may be associated with progression in DLBCL. In addition, nodal involvement is more likely to be present in patients with unmethylated GADD45γ. PMID:25912017

  10. Recent progress in understanding pediatric bipolar disorder.

    PubMed

    Goldstein, Benjamin I

    2012-04-01

    Bipolar disorder is one of the most severe psychiatric illnesses, particularly when onset occurs during childhood or adolescence. With recent empirical evidence, questions regarding the existence of bipolar disorder among children and adolescents have given way to questions regarding prevalence. There are substantial risks inherent in misapplying diagnoses and treatments of bipolar disorder when not warranted and in withholding these diagnoses and treatments when they are warranted. As with adults, the course of bipolar disorder among children and adolescents diagnosed using unmodified diagnostic criteria is characterized by recovery and recurrence, functional impairment, suicidality, and high rates of comorbid psychiatric and medical problems. Discrepancies between increasing billing diagnoses and a stable epidemiologic prevalence of bipolar disorder suggest the possibility that diagnostic criteria are not being systematically applied in some clinical settings. Introducing new diagnoses may exacerbate rather than mitigate concerns regarding misdiagnosis and excessive use of mood-stabilizing medications. Several medications, particularly second-generation antipsychotics, are efficacious for treating acute manic episodes of bipolar I disorder. However, less is known regarding the treatment of other mood states and subtypes of bipolar disorder. Psychosocial treatments provide a forum in which to educate children and families regarding bipolar disorder and its treatment, and may be especially beneficial for reducing depressive symptoms. Offspring of parents with bipolar disorder are at increased risk of developing the illness, as are youth with major depressive disorder and certain psychiatric comorbidities. Preliminary findings regarding biomarkers offer hope that, in the future, these biomarkers may inform diagnostic and treatment decisions. PMID:22213607

  11. Pediatric Multiple Sclerosis.

    PubMed

    Lee, Ji Y; Chitnis, Tanuja

    2016-04-01

    Pediatric multiple sclerosis (MS) is a chronic inflammatory neurologic disease that is challenging to diagnose and treat. Although there are many clinical parallels between pediatric-onset MS and adult-onset MS, there is also accumulating evidence of distinguishing clinical features that may, in part, arise from development-specific, neuroimmune processes governing MS pathogenesis in children. Here the authors describe the clinical features, diagnosis, and treatment of pediatric MS, with a particular focus on describing clinical features and highlighting new developments that promise a better understanding of pediatric MS pathogenesis. An important task that lies ahead for pediatric neurologists is better understanding the early gene-environment interaction that precipitates the first demyelinating event in pediatric MS. This area is of particular importance for understanding the MS etiology and the natural history of pediatric MS. Such understanding should in turn inform new developments in diagnostic tools, long-term therapies, and much-needed biomarkers. Such biomarkers are not only valuable for defining the disease onset, but also for monitoring both the treatment response and a disease evolution that spans multiple decades in children with MS. PMID:27116721

  12. Pediatric ventricular assist devices.

    PubMed

    Adachi, Iki; Burki, Sarah; Zafar, Farhan; Morales, David Luis Simon

    2015-12-01

    The domain of pediatric ventricular assist device (VAD) has recently gained considerable attention. Despite the fact that, historically, the practice of pediatric mechanical circulatory support (MCS) has lagged behind that of adult patients, this gap between the two groups is narrowing. Currently, the Berlin EXCOR VAD is the only pediatric-specific durable VAD approved by the U.S Food and Drug Administration (FDA). The prospective Berlin Heart trial demonstrated a successful outcome, either bridge to transplantation (BTT), or in rare instances, bridge to recovery, in approximately 90% of children. Also noted during the trial was, however, a high incidence of adverse events such as embolic stroke, bleeding and infection. This has incentivized some pediatric centers to utilize adult implantable continuous-flow devices, for instance the HeartMate II and HeartWare HVAD, in children. As a result of this paradigm shift, the outlook of pediatric VAD support has dramatically changed: Treatment options previously unavailable to children, including outpatient management and even destination therapy, have now been becoming a reality. The sustained demand for continued device miniaturization and technological refinements is anticipated to extend the range of options available to children-HeartMate 3 and HeartWare MVAD are two examples of next generation VADs with potential pediatric application, both of which are presently undergoing clinical trials. A pediatric-specific continuous-flow device is also on the horizon: the redesigned Infant Jarvik VAD (Jarvik 2015) is undergoing pre-clinical testing, with a randomized clinical trial anticipated to follow thereafter. The era of pediatric VADs has begun. In this article, we discuss several important aspects of contemporary VAD therapy, with a particular focus on challenges unique to the pediatric population. PMID:26793341

  13. Pediatric ventricular assist devices

    PubMed Central

    Burki, Sarah; Zafar, Farhan; Morales, David Luis Simon

    2015-01-01

    The domain of pediatric ventricular assist device (VAD) has recently gained considerable attention. Despite the fact that, historically, the practice of pediatric mechanical circulatory support (MCS) has lagged behind that of adult patients, this gap between the two groups is narrowing. Currently, the Berlin EXCOR VAD is the only pediatric-specific durable VAD approved by the U.S Food and Drug Administration (FDA). The prospective Berlin Heart trial demonstrated a successful outcome, either bridge to transplantation (BTT), or in rare instances, bridge to recovery, in approximately 90% of children. Also noted during the trial was, however, a high incidence of adverse events such as embolic stroke, bleeding and infection. This has incentivized some pediatric centers to utilize adult implantable continuous-flow devices, for instance the HeartMate II and HeartWare HVAD, in children. As a result of this paradigm shift, the outlook of pediatric VAD support has dramatically changed: Treatment options previously unavailable to children, including outpatient management and even destination therapy, have now been becoming a reality. The sustained demand for continued device miniaturization and technological refinements is anticipated to extend the range of options available to children—HeartMate 3 and HeartWare MVAD are two examples of next generation VADs with potential pediatric application, both of which are presently undergoing clinical trials. A pediatric-specific continuous-flow device is also on the horizon: the redesigned Infant Jarvik VAD (Jarvik 2015) is undergoing pre-clinical testing, with a randomized clinical trial anticipated to follow thereafter. The era of pediatric VADs has begun. In this article, we discuss several important aspects of contemporary VAD therapy, with a particular focus on challenges unique to the pediatric population. PMID:26793341

  14. Pediatric Body Magnetic Resonance Imaging.

    PubMed

    Kandasamy, Devasenathipathy; Goyal, Ankur; Sharma, Raju; Gupta, Arun Kumar

    2016-09-01

    Magnetic resonance imaging (MRI) is a radiation-free imaging modality with excellent contrast resolution and multiplanar capabilities. Since ionizing radiation is an important concern in the pediatric population, MRI serves as a useful alternative to computed tomography (CT) and also provides additional clues to diagnosis, not discernible on other investigations. Magnetic resonance cholangiopancreatography (MRCP), urography, angiography, enterography, dynamic multiphasic imaging and diffusion-weighted imaging provide wealth of information. The main limitations include, long scan time, need for sedation/anesthesia, cost and lack of widespread availability. With the emergence of newer sequences and variety of contrast agents, MRI has become a robust modality and may serve as a one-stop shop for both anatomical and functional information. PMID:26916887

  15. Pediatric autonomic disorders.

    PubMed

    Axelrod, Felicia B; Chelimsky, Gisela G; Weese-Mayer, Debra E

    2006-07-01

    The scope of pediatric autonomic disorders is not well recognized. The goal of this review is to increase awareness of the expanding spectrum of pediatric autonomic disorders by providing an overview of the autonomic nervous system, including the roles of its various components and its pervasive influence, as well as its intimate relationship with sensory function. To illustrate further the breadth and complexities of autonomic dysfunction, some pediatric disorders are described, concentrating on those that present at birth or appear in early childhood. PMID:16818580

  16. Genetic pediatric retinal diseases

    PubMed Central

    Say, Emil Anthony T.

    2014-01-01

    Hereditary pediatric retinal diseases are a diverse group of disorders with pathologies affecting different cellular structures or retinal development. Many can mimic typical pediatric retinal disease such as retinopathy of prematurity, vitreous hemorrhage, retinal detachment and cystoid macular edema. Multisystem involvement is frequently seen in hereditary pediatric retinal disease. A thorough history coupled with a good physical examination can oftentimes lead the ophthalmologist or pediatrician to the correct genetic test and correct diagnosis. In some instances, evaluation of parents or siblings may be required to determine familial involvement when the history is inconclusive or insufficient and clinical suspicion is high.

  17. Pediatric heart surgery - discharge

    MedlinePlus

    ... reduced appetite Alternate Names Congenital heart surgery - discharge; Patent ductus arteriosus ligation - discharge; Hypoplastic left heart repair - ... of the aorta Congenital heart defect - corrective surgery Patent ductus arteriosus Pediatric heart surgery Tetralogy of Fallot ...

  18. American Academy of Pediatrics

    MedlinePlus

    ... Bright Futures Medical Home Clinical Support Pediatric Care Online Patient Education Online Bright Futures Medical Home Connected Kids Red Book ... Finding a Job Career Support Professional Education PediaLink/Online Education Maintenance of Certification Professional Education Publications MOC | ...

  19. Imaging Pediatric Vascular Lesions.

    PubMed

    Nguyen, Tuyet A; Krakowski, Andrew C; Naheedy, John H; Kruk, Peter G; Friedlander, Sheila Fallon

    2015-12-01

    Vascular anomalies are commonly encountered in pediatric and dermatology practices. Most of these lesions are benign and easy to diagnose based on history and clinical exam alone. However, in some cases the diagnosis may not be clear. This may be of particular concern given that vascular anomalies may occasionally be associated with an underlying syndrome, congenital disease, or serious, life-threatening condition. Defining the type of vascular lesion early and correctly is particularly important to determine the optimal approach to management and treatment of each patient. The care of pediatric patients often requires collaboration from a multitude of specialties including pediatrics, dermatology, plastic surgery, radiology, ophthalmology, and neurology. Although early characterization of vascular lesions is important, consensus guidelines regarding the evaluation and imaging of vascular anomalies does not exist to date. Here, the authors provide an overview of pediatric vascular lesions, current classification systems for characterizing these lesions, the various imaging modalities available, and recommendations for appropriate imaging evaluation. PMID:26705446

  20. Pediatric oncology in Pakistan.

    PubMed

    Ashraf, Muhammad Shamvil

    2012-03-01

    Pediatric oncology in Pakistan has developed over last decade with substantial increase in the facility for treatment and number of expertise. Though large numbers of children still do not reach treatment center more children have now access to quality cancer treatment. There has been gradual improvement in Pediatric oncology nursing and allied services. Pediatric Palliative care in Pakistan is in initial phase of development. Pediatric Oncology services are largely supported by philanthropists. Children Cancer Hospital a project of Children Cancer Foundation Pakistan Trust is not only providing quality treatment to every child regardless of paying ability but also playing a pivotal role in capacity building and creating awareness about childhood cancer in Pakistan. PMID:22357147

  1. Imaging Pediatric Vascular Lesions

    PubMed Central

    Nguyen, Tuyet A.; Krakowski, Andrew C.; Naheedy, John H.; Kruk, Peter G.

    2015-01-01

    Vascular anomalies are commonly encountered in pediatric and dermatology practices. Most of these lesions are benign and easy to diagnose based on history and clinical exam alone. However, in some cases the diagnosis may not be clear. This may be of particular concern given that vascular anomalies may occasionally be associated with an underlying syndrome, congenital disease, or serious, life-threatening condition. Defining the type of vascular lesion early and correctly is particularly important to determine the optimal approach to management and treatment of each patient. The care of pediatric patients often requires collaboration from a multitude of specialties including pediatrics, dermatology, plastic surgery, radiology, ophthalmology, and neurology. Although early characterization of vascular lesions is important, consensus guidelines regarding the evaluation and imaging of vascular anomalies does not exist to date. Here, the authors provide an overview of pediatric vascular lesions, current classification systems for characterizing these lesions, the various imaging modalities available, and recommendations for appropriate imaging evaluation. PMID:26705446

  2. Pediatric liver transplantation

    PubMed Central

    Spada, Marco; Riva, Silvia; Maggiore, Giuseppe; Cintorino, Davide; Gridelli, Bruno

    2009-01-01

    In previous decades, pediatric liver transplantation has become a state-of-the-art operation with excellent success and limited mortality. Graft and patient survival have continued to improve as a result of improvements in medical, surgical and anesthetic management, organ availability, immunosuppression, and identification and treatment of postoperative complications. The utilization of split-liver grafts and living-related donors has provided more organs for pediatric patients. Newer immunosuppression regimens, including induction therapy, have had a significant impact on graft and patient survival. Future developments of pediatric liver transplantation will deal with long-term follow-up, with prevention of immunosuppression-related complications and promotion of as normal growth as possible. This review describes the state-of-the-art in pediatric liver transplantation. PMID:19222089

  3. Pediatric Celiac Disease

    MedlinePlus

    ... Sprue Association/USA Gluten Intoloerance Group of North America NASPGHAN Foundation Supporters Educational support for the NASPGHAN ... NASPGHAN) Celiac Disease Eosinophilic Esophagitis Pediatric IBD Nutrition & Obesity Reflux & GERD Research & Grants Our Supporters Site Map © ...

  4. Pediatric heart surgery

    MedlinePlus

    Heart surgery - pediatric; Heart surgery for children; Acquired heart disease; Heart valve surgery - children ... after the baby is born. For others, your child may be able to safely wait for months ...

  5. NIH Pediatric Rheumatology Clinic

    MedlinePlus

    ... patients without discrimination on the basis of race, religion, ethnic group, citizenship, or residence. We can provide ... studies to help understand pediatric rheumatic diseases. Natural history studies, for example, are designed to study how ...

  6. Immunotherapy Targets in Pediatric Cancer

    PubMed Central

    Orentas, Rimas J.; Lee, Daniel W.; Mackall, Crystal

    2011-01-01

    Immunotherapy for cancer has shown increasing success and there is ample evidence to expect that progress gleaned in immune targeting of adult cancers can be translated to pediatric oncology. This manuscript reviews principles that guide selection of targets for immunotherapy of cancer, emphasizing the similarities and distinctions between oncogene-inhibition targets and immune targets. It follows with a detailed review of molecules expressed by pediatric tumors that are already under study as immune targets or are good candidates for future studies of immune targeting. Distinctions are made between cell surface antigens that can be targeted in an MHC independent manner using antibodies, antibody derivatives, or chimeric antigen receptors versus intracellular antigens which must be targeted with MHC restricted T cell therapies. Among the most advanced immune targets for childhood cancer are CD19 and CD22 on hematologic malignancies, GD2 on solid tumors, and NY-ESO-1 expressed by a majority of synovial sarcomas, but several other molecules reviewed here also have properties which suggest that they too could serve as effective targets for immunotherapy of childhood cancer. PMID:22645714

  7. Integrative Nutrition for Pediatrics.

    PubMed

    Erlichman, Jessi; Hall, Amanda; Dean, Amy; Godwin, Bridget; Mascarenhas, Maria

    2016-06-01

    Food is essential for life. Yet, poor food choices may cause poor health. Dietary manipulation is frequently integrated into the management of common chronic pediatric conditions. Parents seek dietary information to have more control over child's condition and to avoid side effects of medicine. This article reviews selected diets for a few common pediatric disorders including eczema, attention deficit hyperactivity disorder, headache and migraine, non-celiac gluten sensitivity, and irritable bowel syndrome. PMID:26832886

  8. Pediatric nuclear medicine

    SciTech Connect

    Treves, S.T.

    1985-01-01

    This book discusses the diagnostic techniques of nuclear medicine as applied in pediatric patients. Particular emphasis is placed on the subject of scintigraphy of organ systems for diagnostic purposes. The topics covered are: scintigraphy of skeleton, bone marrow spleen, liver, thyroid, lungs, urinary tract, brain, heart and cerebrospinal fluid. The pathology and scintigraphy of lacrimal glands is also covered. Other diagnostic techniques of radiology in pediatrics are also briefly discussed for comparative evaluation.

  9. Correlative pediatric imaging

    SciTech Connect

    Garty, I.; Delbeke, D.; Sandler, M.P.

    1989-01-01

    Nuclear medicine, ultrasound, and magnetic resonance imaging (MRI) are considered ideal imaging modalities for pediatric patients. The future is even more promising for pediatric imaging with the development of newer and improved radiopharmaceuticals, instrumentation and diagnostic modalities such as positron emission tomography, labeled monoclonal antibodies, and faster dynamic and contrast enhanced MRI methods. However, correlation of more conventional imaging modalities with nuclear medicine, ultrasound and MRI remain essential for optimal patient care. 43 references.

  10. Pediatric Open Fractures.

    PubMed

    Trionfo, Arianna; Cavanaugh, Priscilla K; Herman, Martin J

    2016-07-01

    Open fractures in children are rare and are typically associated with better prognoses compared with their adult equivalents. Regardless, open fractures pose a challenge because of the risk of healing complications and infection, leading to significant morbidity even in the pediatric population. Therefore, the management of pediatric open fractures requires special consideration. This article comprehensively reviews the initial evaluation, classification, treatment, outcomes, and controversies of open fractures in children. PMID:27241379

  11. Pediatric upper gastrointestinal studies.

    PubMed

    Odgren, Mike

    2014-01-01

    Upper gastrointestinal examinations are common procedures in many radiology departments. Performing this examination on pediatric patients requires understanding the formation of the gastrointestinal tract and the various disease processes and anatomical variances that can occur. The examination also requires a thorough patient history. This article discusses embryologic development and anatomy of the small bowel and colon, disease processes and conditions of the upper gastrointestinal tract, and fluoroscopic upper gastrointestinal tract examinations performed on the pediatric and neonatal patient. PMID:24806054

  12. Clinicopathologic features of pediatric oligodendrogliomas: a series of 50 patients.

    PubMed

    Rodriguez, Fausto J; Tihan, Tarik; Lin, Doris; McDonald, William; Nigro, Janice; Feuerstein, Burt; Jackson, Sadhana; Cohen, Kenneth; Burger, Peter C

    2014-08-01

    Oligodendrogliomas are an important adult form of diffuse gliomas with a distinctive clinical and genetic profile. Histologically similar tumors occurring rarely in children are incompletely characterized. We studied 50 patients with oligodendrogliomas (median age at diagnosis 8 y, range 7 mo to 20 y). Tumors resembling dysembryoplastic neuroepithelial tumors or pilocytic astrocytomas or those having a "mixed" histology were excluded. Tumors at first diagnosis were low grade (n=38) or anaplastic (n=12). Histologic features included uniform round cells with perinuclear halos (100%), secondary structures (predominantly perineuronal satellitosis) (90%), calcifications (46%), and microcysts (44%). Sequential surgical specimens were obtained in 8 low-grade oligodendroglioma patients, with only 1 progressing to anaplasia. Studies for 1p19q performed in 40 cases demonstrated intact 1p19q loci in 29 (73%), 1p19q codeletion in 10 (25%), and 1p deletion with intact 19q in 1 (2%). Except for 2 young patients (3 and 11 y of age), patients with 1p19q codeletion were older than 16 years at diagnosis. Mutant IDH1 (R132H) protein immunohistochemistry was positive in 4 (of 22) (18%) cases, 3 of which also had 1p19q codeletion, whereas 1p19q status was not available on the fourth case. There was a nonsignificant trend for worse overall survival in grade III tumors, but no significant association with age, extent of resection, or 1p19q status. In summary, oligodendrogliomas with classic histology occur in the pediatric population but lack 1p19q codeletion and IDH1 (R132H) mutations in most instances. They are predominantly low grade, recur/clinically progress in a subset, but demonstrate a relatively low frequency of histologic progression. PMID:24805856

  13. Pediatric integrative medicine: pediatrics' newest subspecialty?

    PubMed Central

    2012-01-01

    Background Integrative medicine is defined as relationship-centered care that focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing, including evidence-based complementary and alternative medicine. Pediatric integrative medicine (PIM) develops and promotes this approach within the field of pediatrics. We conducted a survey to identify and describe PIM programs within academic children’s hospitals across North America. Key barriers and opportunities were identified for the growth and development of academic PIM initiatives in the US and Canada. Methods Academic PIM programs were identified by email and eligible for inclusion if they had each of educational, clinical, and research activities. Program directors were interviewed by telephone regarding their clinical, research, educational, and operational aspects. Results Sixteen programs were included. Most (75%) programs provided both inpatient and outpatient services. Seven programs operated with less than 1 FTE clinical personnel. Credentialing of complementary and alternative medicine (CAM) providers varied substantially across the programs and between inpatient and outpatient services. Almost all (94%) programs offered educational opportunities for residents in pediatrics and/or family medicine. One fifth (20%) of the educational programs were mandatory for medical students. Research was conducted in a range of topics, but half of the programs reported lack of research funding and/or time. Thirty-one percent of the programs relied on fee-for-service income. Conclusions Pediatric integrative medicine is emerging as a new subspecialty to better help address 21st century patient concerns. PMID:22894682

  14. A clinicopathologic study of diencephalic pediatric low-grade gliomas with BRAF V600 mutation.

    PubMed

    Ho, Cheng-Ying; Mobley, Bret C; Gordish-Dressman, Heather; VandenBussche, Christopher J; Mason, Gary E; Bornhorst, Miriam; Esbenshade, Adam J; Tehrani, Mahtab; Orr, Brent A; LaFrance, Delecia R; Devaney, Joseph M; Meltzer, Beatrix W; Hofherr, Sean E; Burger, Peter C; Packer, Roger J; Rodriguez, Fausto J

    2015-10-01

    Among brain tumors, the BRAF (V600E) mutation is frequently associated with pleomorphic xanthoastrocytomas (PXAs) and gangliogliomas (GGs). This oncogenic mutation is also detected in ~5 % of other pediatric low-grade gliomas (LGGs) including pilocytic astrocytomas (PAs) and diffuse astrocytomas. In the current multi-institutional study of 56 non-PXA/non-GG diencephalic pediatric LGGs, the BRAF (V600) mutation rate is 36 %. V600-mutant tumors demonstrate a predilection for infants and young children (diffuse astrocytomas, 75 % of the BRAF (V600)-mutant tumors could not be definitively classified on initial histopathologic evaluation. At a median follow-up of 55 months, the 5-year progression-free survival (PFS) rate for BRAF (V600)-mutant diencephalic low-grade astrocytomas (LGAs) was 22 ± 12 %, shorter than BRAF (V600)-WT PAs (52 ± 13 %) but higher than PMAs (10 ± 6 %). Of note, long-term PFS was observed in several adolescent patients with BRAF (V600)-mutant tumors. In children aged 0-12 years, 5-year PFS rate and median PFS in BRAF (V600)-mutant LGAs are 9 ± 9 % and 19 months (95 % CI 3-37 months), respectively. The PFS is comparable to that in BRAF (V600)-WT PMAs (5-year PFS rate: 10 ± 9 %; median PFS: 15 months, 95 % CI 3-32 months; p = 0.96) and significantly shorter than BRAF (V600)-WT PAs (5-year PFS rate: 46 ± 13 %; median PFS: 51 months, 95 % CI 20-∞ months; p < 0.05). In summary, diencephalic BRAF (V600)-mutant pediatric LGAs are associated with unique clinicopathologic features and have a more aggressive clinical course, especially in children

  15. Pediatric Electrocardiographic Imaging (ECGI) Applications

    PubMed Central

    Silva, Jennifer N. A.

    2014-01-01

    Summary Noninvasive electrocardiographic imaging (ECGI) has been used in pediatric and congenital heart patients to better understand their electrophysiologic substrates. In this article we focus on the 4 subjects related to pediatric ECGI: 1) ECGI in patients with congenital heart disease and Wolff-Parkinson-White syndrome, 2) ECGI in patients with hypertrophic cardiomyopathy and pre-excitation, 3) ECGI in pediatric patients with Wolff-Parkinson-White syndrome, and 4) ECGI for pediatric cardiac resynchronization therapy. PMID:25722754

  16. What Is a Pediatric Endocrinologist?

    MedlinePlus

    ... dealing with children and in treating children with endocrine disorders and hormonal problems. If your pediatrician suggests that your child see a pediatric endocrinologist, you can be assured that your child will receive the best possible care. To find a pediatrician or pediatric specialist in ... © Copyright 2016 American Academy of Pediatrics. All rights reserved.

  17. [Tracheostomy in pediatrics patients].

    PubMed

    Fantoni, A; Ripamonti, D

    2002-05-01

    This is a case study of 79 children who under-went a tracheostomy with three different techniques, used in succession on three different groups of patients: surgical, percutaneous with progressive probes and translaryngeal technique. The pediatric patient, only under the age of 10, starts showing clear-cut anatomical differences compared to an adult, which gradually become more marked the younger the patient is. The causes of increased difficulties that can normally be found in these patients are obviously due to the reduced diameter of the airway and, above all, the high degree of pliability of the cartilaginous frame. After the discovery that even minimal external pressure can cause the collapse of the tracheal walls, it was decided to adopt the systematic use of a rigid bronchoscope, in order to be able to offer internal support to the anterior wall. The following advantages were obtained in the various techniques: In surgery it permitted the reduction, through the protrusion of the trachea, of the size of the operatory field, of the tracheal opening and consequently of the local trauma. It also caused less bleeding and reduced the risk of lesion to the pleural dome which are very frequent when a bronchoscope is not used. In the percutaneous method the bronchoscope allowed the application of the technique without complications, even in infants of only a few months' old, because it eliminated tracheal squashing, caused by the introduction of the needle, dilators and especially cannula, and the relative danger of lesion to the posterior wall of the trachea. This complication which was always impending in the original technique, which does not involve the use of a rigid bronchoscope, is the main reason which lead to the ban on PDT for patients younger than 16-18. In the translaryngeal method the advantages are of minor importance because they are limited to the initial stage of the procedure, the introduction of the needle and guide wire which are quicker and more

  18. Pediatric nuclear medicine

    SciTech Connect

    Not Available

    1986-01-01

    This symposium presented the latest techniques and approaches to the proper medical application of radionuclides in pediatrics. An expert faculty, comprised of specialists in the field of pediatric nuclear medicine, discussed the major indications as well as the advantages and potential hazards of nuclear medicine procedures compared to other diagnostic modalities. In recent years, newer radiopharmaceuticals labeled with technetium-99m and other short-lived radionuclides with relatively favorable radiation characteristics have permitted a variety of diagnostic studies that are very useful clinically and carry a substantially lower radiation burden then many comparable X-ray studies. This new battery of nuclear medicine procedures is now widely available for diagnosis and management of pediatric patients. Many recent research studies in children have yielded data concerning the effacacy of these procedures, and current recommendations will be presented by those involved in conducting such studies. Individual papers are processed separately for the Energy Data Base.

  19. Integrative Pediatrics: Looking Forward

    PubMed Central

    McClafferty, Hilary

    2015-01-01

    Increase in the prevalence of disease and illness has dramatically altered the landscape of pediatrics. As a result, there is a demand for pediatricians with new skills and a sharper focus on preventative health. Patient demand and shifting pediatric illness patterns have accelerated research in the field of pediatric integrative medicine. This emerging field can be defined as healing-oriented medicine that considers the whole child, including all elements of lifestyle and family health. It is informed by evidence and carefully weighs all appropriate treatment options. This Special Issue of Children, containing a collection of articles written by expert clinicians, represents an important educational contribution to the field. The goal of the edition is to raise awareness about integrative topics with robust supporting evidence, and to identify areas where more research is needed.

  20. Ethics in pediatric dermatology.

    PubMed

    Kelly, John B; Makkar, Hanspaul S

    2012-01-01

    The patient-parent-physician relationship is central to studying medical ethics in pediatric dermatology. The rights of children in medical decision making are ambiguous, and parents and physicians will often override the autonomy of a child when a particular treatment is deemed to be in the child's best interest. The use of physical restraint to enforce a treatment should be justified, and a reasonable attempt should be made to ensure the cooperation of the child, if possible. Medical photography is central to the practice of pediatric dermatology in that it allows for serial observation of cutaneous lesions over time. Established guidelines and standards should be followed. Pediatric dermatologists frequently prescribe medications off-label; if following established professional standards, and prescribing with good intention, off-label prescribing can be appropriate and rational. PMID:22902215

  1. Pediatric intestinal motility disorders

    PubMed Central

    Gfroerer, Stefan; Rolle, Udo

    2015-01-01

    Pediatric intestinal motility disorders affect many children and thus not only impose a significant impact on pediatric health care in general but also on the quality of life of the affected patient. Furthermore, some of these conditions might also have implications for adulthood. Pediatric intestinal motility disorders frequently present as chronic constipation in toddler age children. Most of these conditions are functional, meaning that constipation does not have an organic etiology, but in 5% of the cases, an underlying, clearly organic disorder can be identified. Patients with organic causes for intestinal motility disorders usually present in early infancy or even right after birth. The most striking clinical feature of children with severe intestinal motility disorders is the delayed passage of meconium in the newborn period. This sign is highly indicative of the presence of Hirschsprung disease (HD), which is the most frequent congenital disorder of intestinal motility. HD is a rare but important congenital disease and the most significant entity of pediatric intestinal motility disorders. The etiology and pathogenesis of HD have been extensively studied over the last several decades. A defect in neural crest derived cell migration has been proven as an underlying cause of HD, leading to an aganglionic distal end of the gut. Numerous basic science and clinical research related studies have been conducted to better diagnose and treat HD. Resection of the aganglionic bowel remains the gold standard for treatment of HD. Most recent studies show, at least experimentally, the possibility of a stem cell based therapy for HD. This editorial also includes rare causes of pediatric intestinal motility disorders such as hypoganglionosis, dysganglionosis, chronic intestinal pseudo-obstruction and ganglioneuromatosis in multiple endocrine metaplasia. Underlying organic pathologies are rare in pediatric intestinal motility disorders but must be recognized as early as

  2. Pediatric intestinal motility disorders.

    PubMed

    Gfroerer, Stefan; Rolle, Udo

    2015-09-01

    Pediatric intestinal motility disorders affect many children and thus not only impose a significant impact on pediatric health care in general but also on the quality of life of the affected patient. Furthermore, some of these conditions might also have implications for adulthood. Pediatric intestinal motility disorders frequently present as chronic constipation in toddler age children. Most of these conditions are functional, meaning that constipation does not have an organic etiology, but in 5% of the cases, an underlying, clearly organic disorder can be identified. Patients with organic causes for intestinal motility disorders usually present in early infancy or even right after birth. The most striking clinical feature of children with severe intestinal motility disorders is the delayed passage of meconium in the newborn period. This sign is highly indicative of the presence of Hirschsprung disease (HD), which is the most frequent congenital disorder of intestinal motility. HD is a rare but important congenital disease and the most significant entity of pediatric intestinal motility disorders. The etiology and pathogenesis of HD have been extensively studied over the last several decades. A defect in neural crest derived cell migration has been proven as an underlying cause of HD, leading to an aganglionic distal end of the gut. Numerous basic science and clinical research related studies have been conducted to better diagnose and treat HD. Resection of the aganglionic bowel remains the gold standard for treatment of HD. Most recent studies show, at least experimentally, the possibility of a stem cell based therapy for HD. This editorial also includes rare causes of pediatric intestinal motility disorders such as hypoganglionosis, dysganglionosis, chronic intestinal pseudo-obstruction and ganglioneuromatosis in multiple endocrine metaplasia. Underlying organic pathologies are rare in pediatric intestinal motility disorders but must be recognized as early as

  3. Diffusion of gases in coals and chars: Technical progress report, quarterly report No. 5, 9/15/86-12/14/86

    SciTech Connect

    Smith, D.M.

    1986-01-01

    Work during the past quarter involved: (1) surface area measurement; (2) mercury porosimetry; (3) NMR pore structure analysis; and (4) diffusion measurements. Surface area measurements via both nitrogen and carbon dioxide adsorption were completed for all group A coals. Four particle sizes of three coals were studied with mercury porosimetry. NMR relaxation experiments were used to determine continuous pore size distributions. Activity concerning diffusion measurements has been in the area of improving experimental design for both the pellet string reactor and batch desorption experiments. 1 ref.

  4. Psychological issues in pediatric obesity

    PubMed Central

    Kalra, Gurvinder; De Sousa, Avinash; Sonavane, Sushma; Shah, Nilesh

    2012-01-01

    Pediatric obesity is a major health problem and has reached epidemiological proportions today. The present paper reviews major psychological issues in pediatric obesity from a developmental perspective. Research and literature has shown that a number of developmental, family, maternal and child factors are responsible in the genesis of pediatric obesity. Family food habits, early developmental lifestyle of the child, parenting, early family relationships and harmony all contribute towards the growth and development of a child. The present review focuses on the role of developmental psychological factors in the pathogenesis of pediatric obesity and highlights the developmental factors that must be kept in mind when evaluating a case of pediatric obesity. PMID:23766572

  5. Utility of late gadolinium enhancement in pediatric cardiac MRI.

    PubMed

    Etesami, Maryam; Gilkeson, Robert C; Rajiah, Prabhakar

    2016-07-01

    Late gadolinium enhancement (LGE) cardiac magnetic resonance (MR) imaging sequence is increasingly used in the evaluation of pediatric cardiovascular disorders, and although LGE might be a normal feature at the sites of previous surgeries, it is pathologically seen as a result of extracellular space expansion, either from acute cell damage or chronic scarring or fibrosis. LGE is broadly divided into ischemic and non-ischemic patterns. LGE caused by myocardial infarction occurs in a vascular distribution and always involves the subendocardial portion, progressively involving the outer regions in a waveform pattern. Non-ischemic cardiomyopathies can have a mid-myocardial (either linear or patchy), subepicardial or diffuse subendocardial distribution. Idiopathic dilated cardiomyopathy can have a linear mid-myocardial pattern, while hypertrophic cardiomyopathy can have fine, patchy enhancement in hypertrophied and non-hypertrophied segments as well as right ventricular insertion points. Myocarditis and sarcoidosis have a mid-myocardial or subepicardial pattern of LGE. Fabry disease typically affects the basal inferolateral segment while Danon disease typically spares the septum. Pericarditis is characterized by diffuse or focal pericardial thickening and enhancement. Thrombus, the most common non-neoplastic cardiac mass, is characterized by absence of enhancement in all sequences, while neoplastic masses show at least some contrast enhancement, depending on the pathology. Regardless of the etiology, presence of LGE is associated with a poor prognosis. In this review, we describe the technical modifications required for performing LGE cardiac MR sequence in children, review and illustrate the patterns of LGE in children, and discuss their clinical significance. PMID:26718199

  6. Development of a Pediatric Fall Risk And Injury Reduction Program.

    PubMed

    Kramlich, Debra L; Dende, Denise

    2016-01-01

    Fall prevention programs that include reliable, valid, and clinically tested screening tools have demonstrated more positive effects for adult and geriatric populations than those not including such assessment. In contrast, because falling is a natural part of growth and development for pediatric patients, progression toward effective prevention programs for this population has proven to be a challenge; a significant impediment is the lack of definition regarding what constitutes a reportable fall. This project explored pediatric health care providers' perceptions of patient falls in order to define a reportable pediatric fall and inform development of a prevention program. A concept analysis of defining attributes, antecedents, and consequences of pediatric falls from literature formed the basis for a set of questions; a convenience sample of 28 pediatric health care providers in an acute care hospital in New England participated in six moderated focus groups. Constant comparison method was used to code the qualitative data and develop themes. Participants unanimously agreed on several points; as expected, their years of experience in pediatric practice provided valuable insight. Three major themes emerged: patient characteristics, caregiver characteristics, and environmental characteristics. Based on factors identified by staff, a screening tool was adopted and integrated into the electronic medical record. Staff were actively engaged in developing definitions, selecting tools, and identifying next steps toward a comprehensive fall reduction program for their patients. As a result, they have embraced changes and advocated successfully for endorsement by the organization. PMID:27254976

  7. The future of pediatric research.

    PubMed

    Boat, Thomas F

    2007-11-01

    The future of pediatric research will be enhanced by strengthening traditional biomedical approaches and embracing emerging opportunities. Biomedical discovery and translation of new knowledge, concepts, and devices into better diagnostic and therapeutic options will require more pediatric physician-scientists, rapid adoption of enabling technologies, increased funding for research and research training (including the creation of federally funded pediatric translational research centers), and a broader distribution of research activities across the academic pediatric community. Rapid improvement of child health outcomes also will be realized through robust health services research in pediatrics, including the application of rigorous quality improvement science that documents and disseminates successful interventions, leading to better access and effectiveness of care. Improving the value of pediatric care is a realistic goal. Achieving better outcomes through individually tailored (personalized) care for children should be tested experimentally. The future of pediatrics is bright, but will depend on the recognition of and response to a growing array of exciting opportunities. PMID:17950318

  8. Pediatric Low Vision

    MedlinePlus

    ... Asked Questions Español Condiciones Chinese Conditions Pediatric Low Vision What is Low Vision? Partial vision loss that cannot be corrected causes ... and play. What are the signs of Low Vision? Some signs of low vision include difficulty recognizing ...

  9. Pediatric Urinary Tract Infection

    MedlinePlus

    SBA National Resource Center: 800-621-3141 Pediatric Urinary Tract Infections and Catheterization in Children with Neurogenic Bladder and ... To protect the kidneys from damage – By preventing urinary tract infections (UTI) – By identifying and treating vesicoureteral remux (VUR). ...

  10. Pediatric functional gastrointestinal disorders

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Functional gastrointestinal disorders continue to be a prevalent set of conditions faced by the healthcare team and have a significant emotional and economic impact. In this review, the authors highlight some of the common functional disorders seen in pediatric patients (functional dyspepsia, irrita...

  11. Pediatric heart surgery

    MedlinePlus

    Heart surgery - pediatric; Heart surgery for children; Acquired heart disease; Heart valve surgery - children ... There are many kinds of heart defects. Some are minor, and others are more serious. Defects can occur inside the heart or in the large blood vessels ...

  12. Pediatric Traumatic Brain Injury.

    PubMed

    Schaller, Alexandra L; Lakhani, Saquib A; Hsu, Benson S

    2015-10-01

    The purpose of this article is to provide a better understanding of pediatric traumatic brain injury and its management. Within the pediatric age group, ages 1 to 19, injuries are the number one cause of death with traumatic brain injury being involved in almost 50 percent of these cases. This, along with the fact that the medical system spends over $1 billion annually on pediatric traumatic brain injury, makes this issue both timely and relevant to health care providers. Over the course of this article the epidemiology, physiology, pathophysiology, and treatment of pediatric traumatic brain injury will be explored. Emphasis will be placed on the role of the early responder and the immediate interventions that should be considered and/or performed. The management discussed in this article follows the most recent recommendations from the 2012 edition of the Guidelines for the Acute Medical Management of Severe Traumatic Brain Injury in Infants, Children, and Adolescents. Despite the focus of this article, it is important not to lose sight of the fact that an ounce of prevention is worth a pound--or, to be more precise and use the average human's brain measurements, just above three pounds--of cure. PMID:26630835

  13. Pharmacotherapy of Pediatric Insomnia

    ERIC Educational Resources Information Center

    Owens, Judith A.

    2009-01-01

    General guidelines for the use of medication to treat pediatric insomnia are presented. It should be noted that medication is not the first treatment choice and should be viewed within the context of a more comprehensive treatment plan. The pharmacological and clinical properties of over the counter medications and FDA-approved insomnia drugs are…

  14. Pediatric head trauma

    PubMed Central

    Alexiou, George A; Sfakianos, George; Prodromou, Neofytos

    2011-01-01

    Head injury in children accounts for a large number of emergency department visits and hospital admissions. Falls are the most common type of injury, followed by motor-vehicle-related accidents. In the present study, we discuss the evaluation, neuroimaging and management of children with head trauma. Furthermore, we present the specific characteristics of each type of pediatric head injury. PMID:21887034

  15. Pediatric Glaucoma: Pharmacotherapeutic Options.

    PubMed

    Samant, Monica; Medsinge, Anagha; Nischal, Ken K

    2016-06-01

    Childhood glaucoma is a major therapeutic challenge for pediatric ophthalmologists and glaucoma specialists worldwide. Management depends on the etiology and age at presentation. A variety of drugs are available for the control of intraocular pressure in children; however, none of these drugs have been licensed by the regulatory agencies for use in children. Furthermore, evidence gained from randomized controlled trials in the pediatric population is sparse, and little is known regarding the use of newer anti-glaucoma preparations. This evidence-based review aims to discuss the available pharmacotherapeutic options for glaucoma in children. Topical adrenoceptor blockers, topical and systemic carbonic anhydrase inhibitors, prostaglandin (PG) analogs, adrenoceptor agonists, parasympathomimetics, and combined preparations are available for use in children, but usually as an off-label indication. Therefore, it is important to recognize that serious side effects have been reported, even with topical drops, and measures to reduce systemic absorption should be taken. Most drugs have been shown to have comparable ocular hypotensive effects, with the lowest occurrence of systemic side effects with PG analogs. Whereas a newly introduced prostaglandin analog, tafluprost, and some other preservative-free preparations have shown promising results in adult glaucoma patients, no pediatric reports are available as yet. Future studies may describe their role in treating pediatric glaucoma. This review also shares some suggested treatment pathways for primary congenital glaucoma (PCG), juvenile open angle glaucoma (JOAG), developmental glaucoma, aphakic/pseudophakic glaucoma, and uveitic glaucoma. PMID:27093864

  16. Pediatric psoriasis: an update

    PubMed Central

    Silverberg, Nanette B

    2009-01-01

    Pediatric psoriasis consists broadly of 3 age groups of psoriatic patients: infantile psoriasis, a self-limited disease of infancy, psoriasis with early onset, and pediatric psoriasis with psoriatic arthritis. About one-quarter of psoriasis cases begin before the age of 18 years. A variety of clinical psoriasis types are seen in childhood, including plaque-type, guttate, erythrodermic, napkin, and nail-based disease. Like all forms of auto-immunity, susceptibility is likely genetic, but environmental triggers are required to initiate disease activity. The most common trigger of childhood is an upper respiratory tract infection. Once disease has occurred, treatment is determined based on severity and presence of joint involvement. Topical therapies, including corticosteroids and calcipotriene, are the therapies of choice in the initial care of pediatric patients. Ultraviolet light, acitretin and cyclosporine can clear skin symptoms, while methotrexate and etanercept can clear both cutaneous and joint disease. Concern for psychological development is required when choosing psoriatic therapies. This article reviews current concepts in pediatric psoriasis and a rational approach to therapeutics. PMID:19898649

  17. Pediatric Short Bowel Syndrome

    PubMed Central

    Spencer, Ariel U.; Neaga, Andreea; West, Brady; Safran, Jared; Brown, Pamela; Btaiche, Imad; Kuzma-O'Reilly, Barbara; Teitelbaum, Daniel H.

    2005-01-01

    Objective: To determine predictors of survival and of weaning off parenteral nutrition (PN) in pediatric short bowel syndrome (SBS) patients. Summary Background Data: Pediatric SBS carries extensive morbidity and high mortality, but factors believed to predict survival or weaning from PN have been based on limited studies. This study reviews outcomes of a large number of SBS infants and identifies predictors of success. Methods: Multivariate Cox proportional hazards analysis was conducted on 80 pediatric SBS patients. Primary outcome was survival; secondary outcome was ability to wean off PN. Nonsignificant covariates were eliminated. P < 0.05 was considered significant. Results: Over a mean of 5.1 years of follow-up, survival was 58 of 80 (72.5%) and 51 weaned off PN (63.8%). Cholestasis (conjugated bilirubin ≥2.5 mg/dL) was the strongest predictor of mortality (relative risk [RR] 22.7, P = 0.005). Although absolute small bowel length was only slightly predictive, percentage of normal bowel length (for a given infant's gestational age) was strongly predictive of mortality (if <10% of normal length, RR of death was 5.7, P = 0.003) and of weaning PN (if ≥10% of normal, RR of weaning PN was 11.8, P = 0.001). Presence of the ileocecal valve (ICV) also strongly predicted weaning PN (RR 3.9, P < 0.0005); however, ICV was not predictive of survival. Conclusions: Cholestasis and age-adjusted small bowel length are the major predictors of mortality in pediatric SBS. Age-adjusted small bowel length and ICV are the major predictors of weaning from PN. These data permit better prediction of outcomes of pediatric SBS, which may help to direct future management of these challenging patients. PMID:16135926

  18. Combustor diffuser interaction program

    NASA Technical Reports Server (NTRS)

    Srinivasan, Ram; Thorp, Daniel

    1986-01-01

    Advances in gas turbine engine performance are achieved by using compressor systems with high stage loading and low part count, which result in high exit Mach numbers. The diffuser and combustor systems in such engines should be optimized to reduce system pressure loss and to maximize the engine thrust-to-weight ratio and minimize length. The state-of-the-art combustor-diffuser systems do not meet these requirements. Detailed understanding of the combustor-diffuser flow field interaction is required for designing advanced gas turbine engines. An experimental study of the combustor-diffuser interaction (CDI) is being conducted to obtain data for the evaluation and improvement of analytical models applicable to a wide variety of diffuser designs. The CDI program consists of four technical phases: Literature Search; Baseline Configuration; Parametric Configurations; and Performance Configurations. Phase 2 of the program is in progress.

  19. Cellular immunotherapy for pediatric solid tumors

    PubMed Central

    HEGDE, MEENAKSHI; MOLL, ALEXANDER; BYRD, TIARA T.; LOUIS, CHRYSTAL U.; AHMED, NABIL

    2015-01-01

    Substantial progress has been made in the treatment of pediatric solid tumors over the past 4 decades. However, children with metastatic and or recurrent disease continue to do poorly despite the aggressive multi-modality conventional therapies. The increasing understanding of the tumor biology and the interaction between the tumor and the immune system over the recent years have led to the development of novel immune-based therapies as alternative options for some of these high-risk malignancies. The safety and anti-tumor efficacy of various tumor vaccines and tumor-antigen specific immune cells are currently being investigated for various solid tumors. In early clinical trials, most of these cellular therapies have been well tolerated and have shown promising clinical responses. Although substantial work is being done in this field, the available knowledge for pediatric tumors remains limited. We review the contemporary early phase cell-based immunotherapy efforts for pediatric solid tumors and discuss the rationale and the challenges thereof. PMID:25082406

  20. Hidradenitis suppurativa in the pediatric population.

    PubMed

    Liy-Wong, Carmen; Pope, Elena; Lara-Corrales, Irene

    2015-11-01

    Hidradenitis suppurativa (HS) generally appears after puberty, is infrequently seen in younger children, and early onset, which is associated with more widespread disease, is more common in children with a positive family history of HS. When compared with adults with HS, children with HS are more likely to have hormonal imbalances, making hormonal investigations integral to disease management in pediatric patients. HS affects intertriginous areas, presenting with double-ended comedones, tender subcutaneous nodules, purulent discharge, and the formation of sinus tracts, hypertrophic fibrotic scars, and dermal contractures. Treatment of HS in children has not been well studied. The goals of therapy in the pediatric setting are to alleviate pain, minimize inflammation and scarring, prevent disease progression, and postpone the need for surgery. Mild cases can be treated with topical antibiotics, while topical and oral antibiotics are the primary therapies for moderate forms of HS. Modalities like biologic agents, laser therapy, or surgery have been reserved for severe pediatric cases of HS. Early recognition and treatment are critical to minimize the effects of the disease on the life course. Given the significant impact of the condition on quality of life and self-esteem, there is a clear role for psychological support. PMID:26470613

  1. Pediatric stress fractures: a pictorial essay

    PubMed Central

    Shelat, Nirav H.; El-Khoury, Georges Y.

    2016-01-01

    More children are participating in organized and recreational athletics at a younger age. It has been well documented that increased athletic specialization and year-round activities have resulted in higher incidences of overuse injuries, including stress fractures and stress reactions. Initially, stress fractures can be radiographically occult. Continued stress on the injured bone or cartilage can lead to progressive radiographic changes. Because of the prevalence of these injuries, both orthopedic surgeons and radiologists should be aware of the radiographic and magnetic resonance imaging (MRI) features of common stress fractures in children. This article reviews frequently encountered stress fractures involving various bones in the pediatric population. PMID:27528851

  2. Chronic kidney disease - pediatric risk factors.

    PubMed

    Tasic, Velibor; Janchevska, Aleksandra; Emini, Nora; Sahpazova, Emilija; Gucev, Zoran; Polenakovic, Momir

    2016-01-01

    The knowledge about the progression of chronic kidney disease is an important issue for every pediatric nephrologist and pediatrician in order to implement appropriate measures to prevent wasting of renal function and the final consequence - end stage renal disease with the need for the dialysis and transplantation. Therefore it is important to know, treat or ameliorate the standard risk factors such as hypertension, proteinuria, anemia, hyperparathyroidism etc. In this review devoted to the World Kidney Day 2016 we will pay attention to the low birth parameters, obesity, hyperuricemia and smoking which emerged as particularly important risk factors for children and adolescent with chronic kidney disease. PMID:27442412

  3. Pediatric Brain Tumors: Current Knowledge and Therapeutic Opportunities.

    PubMed

    Glod, John; Rahme, Gilbert J; Kaur, Harpreet; H Raabe, Eric; Hwang, Eugene I; Israel, Mark A

    2016-05-01

    Great progress has been made in many areas of pediatric oncology. However, tumors of the central nervous system (CNS) remain a significant challenge. A recent explosion of data has led to an opportunity to understand better the molecular basis of these diseases and is already providing a foundation for the pursuit of rationally chosen therapeutics targeting relevant molecular pathways. The molecular biology of pediatric brain tumors is shifting from a singular focus on basic scientific discovery to a platform upon which insights are being translated into therapies. PMID:26989915

  4. What Is a Pediatric Infectious Diseases Specialist?

    MedlinePlus

    ... Size Email Print Share What is a Pediatric Infectious Diseases Specialist? Page Content Article Body If your child ... teen years. What Kind of Training Do Pediatric Infectious Diseases Specialists Have? Pediatric infectious diseases specialists are medical ...

  5. What Is a Pediatric Sports Medicine Specialist?

    MedlinePlus

    ... Email Print Share What is a Pediatric Sports Medicine Specialist? Page Content Article Body If your child ... teens. What Kind of Training Do Pediatric Sports Medicine Specialists Have? Pediatric sports medicine specialists are medical ...

  6. What Is a Pediatric Critical Care Specialist?

    MedlinePlus

    ... Email Print Share What is a Pediatric Critical Care Specialist? Page Content Article Body If your child ... PICU. What Kind of Training Do Pediatric Critical Care Specialists Have? Pediatric critical care specialists are medical ...

  7. Restricted Diffusion of Pus in the Subarachnoid Space: MRSA Meningo-Vasculitis and Progressive Brainstem Ischemic Strokes – A Case Report

    PubMed Central

    Rose, David Z.; Parra-Herran, Carlos; Petito, Carol K.; Post, M. Judith D.

    2010-01-01

    Extra-axial restriction on diffusion weighted imaging (DWI) is an unusual finding on brain magnetic resonance imaging (MRI). Intra-axial restriction on DWI, however, is common, and can represent brain parenchymal infarction, tumor, abscess, or toxic-metabolic process. The infrequency of extra-axial DWI restriction and the paucity of clinico-pathological correlation in the literature limit its differential diagnosis. Scant case reports suggest that extra-axial DWI restriction could be a lymphoma, neurenteric cyst, or, in one patient, subdural empyema [1,2,3]. We postulate that pus formation must be excluded first, because it can provoke an aggressive meningo-vasculitis with rapidly fatal, intra-axial infarctions. Our patient was a 45-year-old man, presenting to our hospital with left facial droop and right (contralateral) arm and leg weakness. Initial MRI revealed DWI restriction in the left lateral pons, consistent with a classic Millard-Gubler stroke. Also noted was a subtle, extra-axial area of curvilinear diffusion restriction in the left cerebellar-pontine angle's subarachnoid space. Days later, the patient had a headache, and repeat MRI revealed extension of the two DWI lesions – both the intra-axial pontine infarction and the extra-axial area of restricted diffusion in the subarachnoid space. The patient became comatose, a third MRI revealed more extensive DWI restrictions, and he expired despite aggressive care. Autopsy revealed massive brainstem infarcts, a thick lymphoplasmacytic infiltrate, copious Gram-Positive cocci (likely MRSA) and arteries partially occluded with fibrointimal proliferation. This emphasizes the concept that extra-axial DWI restriction can represent pus development in the subarachnoid space – a radiographic marker to identify a patient at risk for demise due to septic, meningo-vasculitic infarctions. PMID:21045937

  8. Progressive paralysis associated with diffuse astrocyte anaplasia in delta 202 mice homozygous for a transgene encoding the SV40 T antigen.

    PubMed

    López-Revilla, Rubén; Soto-Zárate, Carlos; Ridaura, Cecilia; Chávez-Dueñas, Lucía; Paul, Dieter

    2004-03-01

    A convenient transgenic astrocytoma model in delta202 mice, homozygous for a construct encoding the early region of the SV40 virus genome, is described. In the offspring of crosses between delta202 mice heterozygous for the transgene nearly 60% were transgenic; one third of these developed progressive paralysis starting in the hindlimbs at approximately 35 days of age and died at 90 +/- 30 days of age. In affected mice proliferating-non-neuronal cells immunostained with antibodies to the GFAP, an astrocyte marker, whose number increased with age were found in the white matter of the brain, cerebellum and spinal cord, and progressive degeneration and necrosis of spinal motoneurons was observed that-may explain the paralysis. The early onset and reproducible time course of the neurological disease suggest that homozygous delta202 mice, whose proliferating astrocytes appear to damage spinal motoneurons, are a useful model to study astrocyte differentiation, function and tumorigenesis. PMID:15068170

  9. Benign Pediatric Salivary Gland Lesions.

    PubMed

    Carlson, Eric R; Ord, Robert A

    2016-02-01

    Salivary gland lesions are rare in pediatric patients. In addition, the types of salivary gland tumors are different in their distribution in specific sites in the major and minor salivary glands in children compared with adults. This article reviews benign neoplastic and nonneoplastic salivary gland disorders in pediatric patients to help clinicians to develop an orderly differential diagnosis that will lead to expedient treatment of pediatric patients with salivary gland lesions. PMID:26614702

  10. Sonography of the Pediatric Chest.

    PubMed

    Goh, Yonggeng; Kapur, Jeevesh

    2016-05-01

    Traditionally, pediatric chest diseases are evaluated with chest radiography. Due to advancements in technology, the use of sonography has broadened. It has now become an established radiation-free imaging tool that may supplement plain-film findings and, in certain cases, the first-line modality for evaluation of the pediatric chest. This pictorial essay will demonstrate the diagnostic potential of sonography, review a spectrum of pediatric chest conditions, and discuss their imaging features and clinical importance. PMID:27009313

  11. Medical Comorbidities in Pediatric Headache.

    PubMed

    Jacobs, Howard; Singhi, Samata; Gladstein, Jack

    2016-02-01

    Comorbid conditions frequently occur in pediatric headaches and may significantly affect their management. Comorbidities that have been associated with pediatric headaches include attention-deficit or hyperactivity disorder, autism, developmental disabilities, depression, anxiety, epilepsy, obesity, infantile colic, atopic disorders, inflammatory bowel disease, and irritable bowel syndrome. The goal of this article is to review these comorbidities associated with pediatric headache, thereby empowering child neurologists to identify common triggers and tailor management strategies that address headache and its comorbidities. PMID:27017024

  12. Pediatric genetic ocular tumors

    PubMed Central

    Rouhani, Behnaz; Ramasubramanian, Aparna

    2014-01-01

    Pediatric genetic ocular tumors include malignancies like retinoblastoma and phakomatosis like neurofibromatosis, tuberous sclerosis, von Hippel-Lindau syndrome, and nevoid basal cell carcinoma syndrome. It is important to screen for ocular tumors both for visual prognosis and also for systemic implications. The phakomatosis comprise of multitude of benign tumors that are aysmptomatic but their detection can aid in the diagnosis of the syndrome. Retinoblastoma is the most common malignant intraocular tumor in childhood and with current treatment modalities, the survival is more than 95%. It is transmitted as an autosomal dominant fashion and hence the offsprings of all patients with the germline retinoblastoma need to be screened from birth. This review discusses the various pediatric genetic ocular tumors discussing the clinical manifestation, diagnosis and treatment.

  13. Pediatric digital chest imaging

    SciTech Connect

    Tarver, R.D.; Cohen, M.; Broderick, N.J.; Conces, D.J. Jr. )

    1990-01-01

    The Philips Computed Radiography system performs well with pediatric portable chest radiographs, handling the throughout of a busy intensive care service 24 hours a day. Images are excellent and routinely provide a conventional (unenhanced) image and an edge-enhanced image. Radiation dose is decreased by the lowered frequency of repeat examinations and the ability of the plates to respond to a much lower dose and still provide an adequate image. The high quality and uniform density of serial PCR portable radiographs greatly enhances diagnostic content of the films. Decreased resolution has not been a problem clinically. Image manipulation and electronic transfer to remote viewing stations appear to be helpful and are currently being evaluated further. The PCR system provides a marked improvement in pediatric portable chest radiology.

  14. Hippocrates on Pediatric Dermatology.

    PubMed

    Sgantzos, Markos; Tsoucalas, Gregory; Karamanou, Marianna; Giatsiou, Styliani; Tsoukalas, Ioannis; Androutsos, George

    2015-01-01

    Hippocrates of Kos is well known in medicine, but his contributions to pediatric dermatology have not previously been examined. A systematic study of Corpus Hippocraticum was undertaken to document references of clinical and historical importance of pediatric dermatology. In Corpus Hippocraticum, a variety of skin diseases are described, along with proposed treatments. Hippocrates rejected the theory of the punishment of the Greek gods and supported the concept that dermatologic diseases resulted from a loss of balance in the body humors. Many of the terms that Hippocrates and his pupils used are still being used today. Moreover, he probably provided one of the first descriptions of skin findings in smallpox, Henoch-Schönlein purpura (also known as anaphylactoid purpura, purpura rheumatica, allergic purpura), and meningococcal septicemia. PMID:26058689

  15. Acupuncture for Pediatric Pain

    PubMed Central

    Golianu, Brenda; Yeh, Ann Ming; Brooks, Meredith

    2014-01-01

    Chronic pain is a growing problem in children, with prevalence as high as 30.8%. Acupuncture has been found to be useful in many chronic pain conditions, and may be of clinical value in a multidisciplinary treatment program. The basic principles of acupuncture are reviewed, as well as studies exploring basic mechanisms of acupuncture and clinical efficacy. Conditions commonly treated in the pediatric pain clinic, including headache, abdominal pain, fibromyalgia, juvenile arthritis, complex regional pain syndrome, cancer pain, as well as perioperative pain studies are reviewed and discussed. Areas in need of further research are identified, and procedural aspects of acupuncture practice and safety studies are reviewed. Acupuncture can be an effective adjuvant in the care of pediatric patients with painful conditions, both in a chronic and an acute setting. Further studies, including randomized controlled trials, as well as trials of comparative effectiveness are needed. PMID:27417472

  16. Pediatric Biliary Interventions.

    PubMed

    Atchie, Benjamin; Kalva, Sanjeeva; Josephs, Shellie

    2015-12-01

    An interventional radiologist is frequently called to evaluate and treat biliary diseases in children; a tailored approach specific to this population is required. Imaging with an emphasis on minimizing ionizing radiation is used not only in the initial workup but also to guide interventions. The most common form of intervention generally consists of transhepatic biliary drainage to treat either biliary obstruction or bile leakage, a scenario frequently encountered after pediatric liver transplantation. Other pathologies referred for evaluation and management include biliary atresia and, rarely, symptomatic choledochal cysts. Biliary complications caused by an underlying malignancy are not a frequently encountered problem in the pediatric population. The initial evaluation, role of preprocedural imaging, and interventional management with an emphasis on technique are discussed regarding these common biliary pathologies in children. PMID:26615168

  17. Pediatric obesity. An introduction.

    PubMed

    Yanovski, Jack A

    2015-10-01

    The prevalence of child and adolescent obesity in the United States increased dramatically between 1970 and 2000, and there are few indications that the rates of childhood obesity are decreasing. Obesity is associated with myriad medical, psychological, and neurocognitive abnormalities that impact children's health and quality of life. Genotypic variation is important in determining the susceptibility of individual children to undue gains in adiposity; however, the rapid increase in pediatric obesity prevalence suggests that changes to children's environments and/or to their learned behaviors may dramatically affect body weight regulation. This paper presents an overview of the epidemiology, consequences, and etiopathogenesis of pediatric obesity, serving as a general introduction to the subsequent papers in this Special Issue that address aspects of childhood obesity and cognition in detail. PMID:25836737

  18. Pediatric parafalcine empyemas

    PubMed Central

    Niklewski, Franziska; Petridis, Athanasios K.; Al Hourani, Jasmin; Blaeser, Klaus; Ntoulias, Georgios; Bitter, Andrej; Rosenbaum, Thorsten; Scholz, Martin

    2013-01-01

    Subdural intracranial empyemas and brain abscesses are a rare complication of bacterial sinusitis. Pediatric parafalcine abscesses are a rare entity with different treatment compared with other brain abscesses. We present two pediatric cases with falcine abscess as a sinusitis complication and introduce our department’s treatment management. In addition a review of literature is performed. Surgical cases of our department and their management are compared with the current literature. In our cases, both of the children showed a recurrent empyema after the first surgical treatment and antibiotic therapy. A second surgical evacuation was necessary. The antibiotic therapy was given for 3 months. Short-time follow-up imaging is necessary irrespective of infection parameters in blood and patient's clinical condition. Especially in parafalcine abscesses a second look may be an option and surgical treatment with evacuation of pus is the treatment of choice if abscess remnants are visualized. PMID:24964473

  19. Pediatric parafalcine empyemas.

    PubMed

    Niklewski, Franziska; Petridis, Athanasios K; Al Hourani, Jasmin; Blaeser, Klaus; Ntoulias, Georgios; Bitter, Andrej; Rosenbaum, Thorsten; Scholz, Martin

    2013-01-01

    Subdural intracranial empyemas and brain abscesses are a rare complication of bacterial sinusitis. Pediatric parafalcine abscesses are a rare entity with different treatment compared with other brain abscesses. We present two pediatric cases with falcine abscess as a sinusitis complication and introduce our department's treatment management. In addition a review of literature is performed. Surgical cases of our department and their management are compared with the current literature. In our cases, both of the children showed a recurrent empyema after the first surgical treatment and antibiotic therapy. A second surgical evacuation was necessary. The antibiotic therapy was given for 3 months. Short-time follow-up imaging is necessary irrespective of infection parameters in blood and patient's clinical condition. Especially in parafalcine abscesses a second look may be an option and surgical treatment with evacuation of pus is the treatment of choice if abscess remnants are visualized. PMID:24964473

  20. Pediatric epilepsy syndromes.

    PubMed

    Wirrell, Elaine; Nickels, Katherine C

    2010-06-01

    Epilepsy syndromes denote specific constellations of clinical seizure type(s), EEG findings, and other characteristic clinical features. Most syndromes recognized in epilepsy are genetic and developmental disorders that begin in the pediatric years. Epilepsy syndromes are divided into idiopathic (primary) types, in which the presumed etiology is genetic, versus symptomatic (secondary) types, in which there is either an underlying etiology that is known or presumed based on other evidence of brain dysfunction. Epilepsies are also classified by those with generalized seizures and those with localization-related seizures. Identification of a specific syndrome is important to define the best treatment and accurately prognosticate long-term outcome for children with epilepsy. In this chapter, clinical and electrographic features as well as inheritance patterns of common pediatric epilepsy syndromes are discussed. PMID:22810315

  1. MR in pediatric neuroimaging

    SciTech Connect

    Wolpert, S.M. ); Barnes, P.; Strand, R. )

    1990-01-01

    The multitude of modern imaging techniques has made pediatric neuroradiology increasingly complex. The practitioner must have a thorough understanding of each possible diagnostic study in order to achieve the best results at the least expense and with minimal risk. In this book, MRI is emphasized; correlative CT, ultrasound, angiographic, and conventional x-ray studies assist in establishing effective diagnostic protocols and reaching accurate diagnoses.

  2. Modelling Pediatric Kinematics

    PubMed Central

    van Ratingen, M.R.; Wismans, J.

    1998-01-01

    In the field of pediatric biomechanics, crash dummy and numerical model development suffers from too limited human subject data to directly establish response and injury values. In order to create child crash dummies and numerical models it is necessary to combine the results from real world accident and reconstruction data, scaled adult data and data from animal testing with limited child volunteer data. This paper presents the functional and biomechanical targets for child crash dummies and numerical models.

  3. Common Pediatric Urological Disorders

    PubMed Central

    Robson, Wm. Lane M.; Leung, Alexander K.C.; Boag, Graham S.

    1991-01-01

    The clinical and radiological presentations of 12 pediatric urological disorders are described. The described disorders include pyelonephritis, vesicoureteral reflux, ureteropelvic obstruction, ureterovesical obstruction, ectopic ureterocele, posterior urethral valves, multicystic dysplastic kidney, polycystic kidney disease, ectopic kidney, staghorn calculi, urethral diverticulum, and urethral meatal stenosis. ImagesFigure 1-2Figure 3Figure 3Figure 4Figure 5Figure 6-7Figure 8-9Figure 10Figure 11-12 PMID:21229068

  4. Psittacine incubation and pediatrics.

    PubMed

    Romagnano, April

    2012-05-01

    Psittacine pediatric medicine and surgery can only continue to be practiced by avian veterinarians if psittacine aviculture (the successful captive breeding of parrot species) is active and thriving. Although beautiful, intelligent parrots are popular as beloved pets and reside in zoo and private collections around the world, private psittacine aviculture is in a transition period recovering from difficult economic times. Many of the larger aviculturists have left and the rise of the small aviculturist has significantly changed the industry. PMID:22640534

  5. Pediatric palliative care

    PubMed Central

    Benini, Franca; Spizzichino, Marco; Trapanotto, Manuela; Ferrante, Anna

    2008-01-01

    The WHO defines pediatric palliative care as the active total care of the child's body, mind and spirit, which also involves giving support to the family. Its purpose is to improve the quality of life of young patients and their families, and in the vast majority of cases the home is the best place to provide such care, but for cultural, affective, educational and organizational reasons, pediatric patients rarely benefit from such an approach. In daily practice, it is clear that pediatric patients experience all the clinical, psychological, ethical and spiritual problems that severe, irreversible disease and death entail. The international literature indicates a prevalence of incurable disease annually affecting 10/10,000 young people from 0 to 19 years old, with an annual mortality rate of 1/10,000 young people from birth to 17 years old. The needs of this category of patients, recorded in investigations conducted in various parts of the world, reveal much the same picture despite geographical, cultural, organizational and social differences, particularly as concerns their wish to be treated at home and the demand for better communications between the professionals involved in their care and a greater availability of support services. Different patient care models have been tested in Italy and abroad, two of institutional type (with children staying in hospitals for treating acute disease or in pediatric hospices) and two based at home (the so-called home-based hospitalization and integrated home-based care programs). Professional expertise, training, research and organization provide the essential foundations for coping with a situation that is all too often underestimated and neglected. PMID:19490656

  6. Introduction to pediatric oncology

    SciTech Connect

    McWhirter, W.R.; Masel, J.P.

    1987-01-01

    This book covers the varied and complex aspects of management in pediatric oncology. Emphasis is placed on a team approach and on establishing and maintaining an individualized, humanistic relationships with the patient. Numerous illustrations show modern imaging techniques that are proving most valuable in the investigation of suspected or confirmed childhood cancer. Physical and psychological side effects of short-term and long-term treatment are also discussed.

  7. [Opportunistic mycoses in pediatrics].

    PubMed

    Dupont, B

    1985-12-01

    The two most important pathologic conditions leading to mycotic opportunistic infections in children are impairment of mechanisms of defense due to immunosuppressive drugs and congenital defects of immunity. Other circumstances belong to pediatrics such as prematurity or cystic fibrosis. A few examples are chosen to illustrate these situations: congenital candidiasis, chronic mucocutaneous candidiasis, chronic dermatophytic disease, neonatal candidemia, mycotic infections in chronic granulomatous disease and aspergillosis in cystic fibrosis. PMID:3833106

  8. Acupuncture in Pediatrics.

    PubMed

    Brittner, Mindy; Le Pertel, Noemie; Gold, Melanie A

    2016-06-01

    There has been extensive research on the use of acupuncture in adults with a wide array of conditions. Much less research has been conducted on the use of acupuncture in children. In this article, we review the history and philosophy of acupuncture, and the literature on its effectiveness and safety in children and adolescents, giving special attention to the pediatric and adolescent conditions that have been most studied in high-quality randomized controlled trials (RCTs). PMID:26867822

  9. Moral Dilemmas in Pediatric Orthopedics.

    PubMed

    Mercuri, John J; Vigdorchik, Jonathan M; Otsuka, Norman Y

    2015-12-01

    All orthopedic surgeons face moral dilemmas on a regular basis; however, little has been written about the moral dilemmas that are encountered when providing orthopedic care to pediatric patients and their families. This article aims to provide surgeons with a better understanding of how bioethics and professionalism apply to the care of their pediatric patients. First, several foundational concepts of both bioethics and professionalism are summarized, and definitions are offered for 16 important terms within the disciplines. Next, some of the unique aspects of pediatric orthopedics as a subspecialty are reviewed before engaging in a discussion of 5 common moral dilemmas within the field. Those dilemmas include the following: (1) obtaining informed consent and assent for either surgery or research from pediatric patients and their families; (2) performing cosmetic surgery on pediatric patients; (3) caring for pediatric patients with cognitive or physical impairments; (4) caring for injured pediatric athletes; and (5) meeting the demand for pediatric orthopedic care in the United States. Pertinent considerations are reviewed for each of these 5 moral dilemmas, thereby better preparing surgeons for principled moral decision making in their own practices. Each of these dilemmas is inherently complex with few straightforward answers; however, orthopedic surgeons have an obligation to take the lead and better define these kinds of difficult issues within their field. The lives of pediatric patients and their families will be immeasurably improved as a result. PMID:26652336

  10. Imaging of Pediatric Stroke.

    PubMed

    Bhatia, Aashim; Pruthi, Sumit

    2016-09-01

    Despite being as common as brain tumors in children, lack of awareness of pediatric stroke presents unique challenges, both in terms of diagnosis and management. Due to diverse and overlapping risk factors, as well as variable clinical presentations, the diagnosis can be either missed or frequently delayed. Early recognition and treatment of pediatric stroke is however critical in optimizing long-term functional outcomes, reducing morbidity and mortality, and preventing recurrent stroke. Neuroimaging plays a vital role in achieving this goal. The advancements in imaging over the last two decades have allowed for multiple modality options for suspected stroke with more accurate diagnosis, as well as quicker turnaround time in imaging diagnosis, especially at primary stroke centers. However, with the multiple imaging possibilities, referring physicians can be overwhelmed with the best option for each clinical situation and what the literature recommends. Here the authors review the etiology of pediatric stroke in the settings of arterial ischemia, hemorrhage, and cerebral sinovenous thrombosis (CSVT), with emphasis on the best diagnostic tools available, including advanced imaging techniques. PMID:26920396

  11. Nutrition in Pediatric Cardiomyopathy

    PubMed Central

    Miller, Tracie L.; Neri, Daniela; Extein, Jason; Somarriba, Gabriel; Strickman-Stein, Nancy

    2007-01-01

    Pediatric cardiomyopathies are heterogeneous groups of serious disorders of the heart muscle and are responsible for significant morbidity and mortality among children who have the disease. While enormous improvements have been made in the treatment and survival of children with congenital heart disease, parallel strides have not been made in the outcomes for cardiomyopathies. Thus, ancillary therapies, such as nutrition and nutritional interventions, that may not cure but may potentially improve cardiac function and quality of life, are imperative to consider in children with all types of cardiomyopathy. Growth failure is one of the most significant clinical problems of children with cardiomyopathy with nearly one-third of children with this disorder manifesting some degree of growth failure during the course of their illness. Optimal intake of macronutrients can help improve cardiac function. In addition, several specific nutrients have been shown to correct myocardial abnormalities that often occur with cardiomyopathy and heart failure. In particular, antioxidants that can protect against free radical damage that often occurs in heart failure and nutrients that augment myocardial energy production are important therapies that have been explored more in adults with cardiomyopathy than in the pediatric population. Future research directions should pay particular attention to the effect of overall nutrition and specific nutritional therapies on clinical outcomes and quality of life in children with pediatric cardiomyopathy. PMID:18159216

  12. Pediatric suprasellar lesions

    PubMed Central

    Deopujari, C. E.; Kumar, Ashish; Karmarkar, V. S.; Biyani, N. K.; Mhatre, M.; Shah, N. J.

    2011-01-01

    Pediatric brain tumors have always been challenging as well as intriguing in their anatomical, surgical, and postsurgical management-related issues. They are a heterogeneous set of pathologies involving different age groups in childhood and also differ widely from their adult counterparts as far as adjuvant therapies are concerned. Though neurosurgeons across the world are radical in surgery for most of the pediatric tumors, it can often be at the cost of future quality of life in suprasellar tumors. As the time has gone by, the pendulum has swung toward rather conservative and maximal safe surgical resections with adjuvant therapies coming to the forefront. Hence, the aim is to achieve a good quality of life for these children along with a control of tumor growth (rather than cure) and to again tackle the tumors, if required, once these children reach adolescence or adulthood. We have reviewed the literature for different pediatric suprasellar tumors and discussed their current management giving our perspective with illustrative cases. PMID:22069431

  13. Pharmacogenomic information in FDA-approved drug labels: Application to pediatric patients.

    PubMed

    Green, D J; Mummaneni, P; Kim, I W; Oh, J M; Pacanowski, M; Burckart, G J

    2016-06-01

    Pharmacogenomic (PGx) information is increasingly being incorporated into US Food and Drug Administration-approved drug labels. We reviewed the data source (adults vs. pediatrics) of PGx information in approved drug labels and assessed the suitability of applying adult-derived PGx information and related prescribing recommendations to the care of pediatric patients. We identified 65 drugs with labels containing PGx information and that have also been evaluated in children and found that in the majority of cases (56/65, 86%), the PGx information described was derived from adult studies. The application of PGx information from adults to pediatrics was deemed suitable for 71.4% (n = 40) of the drugs and unclear for 28.6% (n = 16). An ontogeny effect, limited or conflicting data regarding ontogeny of the genetic biomarker, or a difference in the pathophysiology or progression of the adult vs. pediatric disease were the primary reasons for deeming direct application from adults to pediatrics unclear. PMID:26693845

  14. Pediatric Nurse Practitioner Program: Theories for Extended Pediatric Nursing Practice.

    ERIC Educational Resources Information Center

    Brady, Margaret A.

    A description is provided of "Theories for Extended Pediatric Nursing Practice," a required course for pediatric and family nurse practitioner students in a California state university program. The course description presents information on the curricular placement of the course, prerequisites, in-class time allotments, and the focus of the course…

  15. Immunology of Pediatric HIV Infection

    PubMed Central

    Tobin, Nicole H.; Aldrovandi, Grace M.

    2013-01-01

    Summary Most infants born to human immunodeficiency virus (HIV)-infected women escape HIV infection. Infants evade infection despite an immature immune system and, in the case of breastfeeding, prolonged repetitive, exposure. If infants become infected, the course of their infection and response to treatment differs dramatically depending upon the timing (in utero, intrapartum, or during breastfeeding) and potentially the route of their infection. Perinatally acquired HIV infection occurs during a critical window of immune development. HIV’s perturbation of this dynamic process may account for the striking age-dependent differences in HIV disease progression. HIV infection also profoundly disrupts the maternal immune system upon which infants rely for protection and immune instruction. Therefore, it is not surprising that infants who escape HIV infection still suffer adverse effects. In this review, we highlight the unique aspects of pediatric HIV transmission and pathogenesis with a focus on mechanisms by which HIV infection during immune ontogeny may allow discovery of key elements for protection and control from HIV. PMID:23772619

  16. Educational Preparation of Pediatric Audiologists

    ERIC Educational Resources Information Center

    Roush, Jackson

    2010-01-01

    Pediatric audiologists play a vital role in detection, diagnosis, and intervention for young children with hearing loss and their families. Preparing the next generation of pediatric audiologists necessitates a creative approach that balances the requirements of a broad curriculum with the special skills needed to serve a unique and varied…

  17. Pediatric imaging for the technologist

    SciTech Connect

    Wilmot, D.M.; Sharko, G.A.

    1987-01-01

    This manual provides an accessible store of information on pediatric imaging procedures, with clearly described techniques and instructions. The aim is to simplify the pediatric examination. Extensively illustrated, this work describes in detail correct positioning, radiation protection, and methods of immobilization. The concluding chapters clarify what is required in the final image for accurate diagnosis.

  18. Intravenous acetaminophen use in pediatrics.

    PubMed

    Shastri, Nirav

    2015-06-01

    Acetaminophen is a commonly used pediatric medication that has recently been approved for intravenous use in the United States. The purpose of this article was to review the pharmacodynamics, indications, contraindications, and precautions for the use of intravenous acetaminophen in pediatrics. PMID:26035501

  19. Pediatric maxillary and mandibular tumors.

    PubMed

    Trosman, Samuel J; Krakovitz, Paul R

    2015-02-01

    Pediatric maxillary and mandibular tumors offer considerable challenges to otolaryngologists, oral surgeons, pathologists, and radiologists alike. Because of the close proximity to vital structures, appropriate steps toward a definitive diagnosis and treatment plan are of paramount importance. This article reviews the most common causes of pediatric jaw masses and discusses diagnostic and therapeutic considerations and recommendations. PMID:25442129

  20. Group Intervention in Pediatric Rehabilitation

    ERIC Educational Resources Information Center

    LaForme Fiss, Alyssa

    2012-01-01

    Group intervention in pediatric physical and occupational therapy is an alternative to individual intervention allowing the therapist to meet the needs of multiple children at one time. Survey research indicates that approximately 40% to 60% of pediatric physical and occupational therapists use group intervention at least occasionally in practice,…

  1. Holographic diffusers

    NASA Astrophysics Data System (ADS)

    Wadle, Stephen; Wuest, Daniel; Cantalupo, John; Lakes, Roderic S.

    1994-01-01

    Holographic diffusers are prepared using silver halide (Agfa 8E75 and Kodak 649F) and photopolymer (Polaroid DMP 128 and DuPont 600, 705, and 150 series) media. It is possible to control the diffusion angle in three ways: by selection of the properties of the source diffuser, by control of its subtended angle, and by selection of the holographic medium. Several conventional diffusers based on refraction or scattering of light are examined for comparison.

  2. Controversies in Pediatric Perioperative Airways

    PubMed Central

    Klučka, Jozef; Štourač, Petr; Štoudek, Roman; Ťoukálková, Michaela; Harazim, Hana; Kosinová, Martina

    2015-01-01

    Pediatric airway management is a challenge in routine anesthesia practice. Any airway-related complication due to improper procedure can have catastrophic consequences in pediatric patients. The authors reviewed the current relevant literature using the following data bases: Google Scholar, PubMed, Medline (OVID SP), and Dynamed, and the following keywords: Airway/s, Children, Pediatric, Difficult Airways, and Controversies. From a summary of the data, we identified several controversies: difficult airway prediction, difficult airway management, cuffed versus uncuffed endotracheal tubes for securing pediatric airways, rapid sequence induction (RSI), laryngeal mask versus endotracheal tube, and extubation timing. The data show that pediatric anesthesia practice in perioperative airway management is currently lacking the strong evidence-based medicine (EBM) data that is available for adult subpopulations. A number of procedural steps in airway management are derived only from adult populations. However, the objective is the same irrespective of patient age: proper securing of the airway and oxygenation of the patient. PMID:26759809

  3. 78 FR 48438 - Pediatric Ethics Subcommittee of the Pediatric Advisory Committee; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-08

    ... HUMAN SERVICES Food and Drug Administration Pediatric Ethics Subcommittee of the Pediatric Advisory... Administration (FDA). The meeting will be open to the public. Name of Subcommittee: Pediatric Ethics Subcommittee... recommendations to the Pediatric Advisory Committee on pediatric ethical issues. Date and Time: The meeting...

  4. Pediatric nonalcoholic fatty liver disease: A clinical and laboratory challenge

    PubMed Central

    Pacifico, Lucia; Poggiogalle, Eleonora; Cantisani, Vito; Menichini, Guendalina; Ricci, Paolo; Ferraro, Flavia; Chiesa, Claudio

    2010-01-01

    The true prevalence of pediatric nonalcoholic fatty liver disease (NAFLD) is unknown. Challenges in determining the population prevalence of NAFLD include the type of test (and the reference intervals used to define normal and abnormal), the type of population (general population, hospital series), the demographic characteristics of the population sampled, and the nature of the study design. The natural history of pediatric NAFLD remains uncertain. The issue of when to perform a liver biopsy in children with suspected NAFLD remains controversial. Children with NAFLD but normal alanine aminotransferase are rarely investigated. However, evidence of alterations in glucose metabolism parameters should prompt a better understanding of the natural history of pediatric NAFLD not only in terms of the progression of liver disease but also regarding its potential relationship with other health outcomes such as type 2 diabetes mellitus and cardiovascular disease. This evidence could make liver biopsy mandatory in the majority of cases at risk of progressive and severe hepatic and extrahepatic disease. This conclusion, however, raises the question of the feasibility of liver biopsy assessment in an extremely large at risk population, and of the cost/effectiveness of this policy. There is a considerable, continuous interest in reliable, noninvasive alternatives that will allow the prognosis of pediatric NAFLD to be followed in large community or population-based studies. PMID:21161009

  5. Pediatric myocarditis: A sentinel of non-cardiac chronic diseases?

    PubMed Central

    Felszeghy, Enikő; Kovács, Tamás; Berkes, Andrea; Tóth, László; Balla, György; Korponay-Szabó, Ilma

    2014-01-01

    Introduction Although long-term outcome studies in large pediatric myocarditis/cardiomyopathy populations have been reported in literature, none of them focused on comorbidities. Methods All children and adolescents (age <18 years) treated with myocarditis at the Department of Pediatrics, University of Debrecen, Hungary were followed. Patients suffering from myocarditis during the period 1996–2011 were enrolled. Results Over the 16-year period, a diagnosis of myocarditis was established in nine children. Their median age was 1.11 (0.03–8.71) years. Three of the nine patients died. Left ventricular dilatation and ejection fraction normalized within 1–21 months in the survivors. None of the cases progressed to dilated cardiomyopathy. Regarding non-cardiac comorbidities, myocarditis or recurrent peri-myocarditis preceded the manifestation of celiac disease in two patients, while cystic fibrosis was diagnosed after the improvement of cardiac function in another, and Alström syndrome was diagnosed several years after complete recovery from myocarditis in yet another patient. Conclusion These results suggest that manifestations of other chronic pediatric diseases may be more frequent among survivors of pediatric myocarditis. Prolonged follow-up of patients who survive myocarditis is therefore recommended not only to detect possible progression to cardiomyopathy but also to identify non-cardiac comorbidities. PMID:25598988

  6. Diffusion MRI

    NASA Astrophysics Data System (ADS)

    Fukuyama, Hidenao

    Recent advances of magnetic resonance imaging have been described, especially stressed on the diffusion sequences. We have recently applied the diffusion sequence to functional brain imaging, and found the appropriate results. In addition to the neurosciences fields, diffusion weighted images have improved the accuracies of clinical diagnosis depending upon magnetic resonance images in stroke as well as inflammations.

  7. Neuroprognostication After Pediatric Cardiac Arrest

    PubMed Central

    Kirschen, Matthew P.; Topjian, Alexis A.; Hammond, Rachel; Illes, Judy; Abend, Nicholas S.

    2014-01-01

    BACKGROUND Management decisions and parental counseling after pediatric cardiac arrest depend on the ability of physicians to make accurate and timely predictions regarding neurological recovery. We evaluated neurologists and intensivists performing neuroprognostication after cardiac arrest to determine prediction agreement, accuracy, and confidence. METHODS Pediatric neurologists (n = 10) and intensivists (n = 9) reviewed 18 cases of children successfully resuscitated from a cardiac arrest and managed in the pediatric intensive care unit. Cases were sequentially presented (after arrest day 1, days 2–4, and days 5–7), with updated examinations, neurophysiologic data, and neuroimaging data. At each time period, physicians predicted outcome by Pediatric Cerebral Performance Category and specified prediction confidence. RESULTS Predicted discharge Pediatric Cerebral Performance Category versus actual hospital discharge Pediatric Cerebral Performance Category outcomes were compared. Exact (Predicted Pediatric Cerebral Performance Category – Actual Pediatric Cerebral Performance Category = 0) and close (Predicted Pediatric Cerebral Performance Category – Actual Pediatric Cerebral Performance Category = ±1) outcome prediction accuracies for all physicians improved over successive periods (P < 0.05). Prediction accuracy did not differ significantly between physician groups at any period or overall. Agreement improved over time among neurologists (day 1 Kappa [κ], 0.28; days 2–4 κ, 0.43; days 5–7 κ, 0.68) and among intensivists (day 1 κ, 0.30; days 2–4 κ, 0.44; days 5–7 κ, 0.57). Prediction confidence increased over time (P < 0.001) and did not differ between physician groups. CONCLUSIONS Inter-rater agreement among neurologists and among intensivists improved over time and reached moderate levels. For all physicians, prediction accuracy and confidence improved over time. Further prospective research is needed to better characterize how physicians

  8. Social pediatric emergencies.

    PubMed

    Jacobs, J

    1978-01-01

    A social pediatric emergency invokes the concept of a crisis situation, which often reflects an acute temporary state, the culmination of problems of long duration. The needs demonstrated in child abuse, neglect and deprivation, sexual abuse, the handling of the crisis of birth, pregnancy and abnormality, death and dying, adoption and learning disabilities are related to the family psychodynamic relationships and the doctor team approach. The social pediatrician can play his role as the physician, advocate, activist and educationalist in the many complex situations revealed within family, community and society. PMID:569270

  9. Pediatric Respiratory Emergencies.

    PubMed

    Richards, Amber M

    2016-02-01

    Respiratory emergencies are 1 of the most common reasons parents seek evaluation for the their children in the emergency department (ED) each year, and respiratory failure is the most common cause of cardiopulmonary arrest in pediatric patients. Whereas many respiratory illnesses are mild and self-limiting, others are life threatening and require prompt diagnosis and management. Therefore, it is imperative that emergency clinicians be able to promptly recognize and manage these illnesses. This article reviews ED diagnosis and management of foreign body aspiration, asthma exacerbation, epiglottitis, bronchiolitis, community-acquired pneumonia, and pertussis. PMID:26614243

  10. Pediatric environmental health.

    PubMed Central

    Walker, Bailus

    2005-01-01

    The links between environmental agents, environmental conditions, and disease and disability among children are receiving increasing attention. Evidence abounds that children are more susceptible than adults to the damaging effects of environmental agents and conditions. This evidence is illuminated by the much-publicized and expanding research agenda on the prevention, recognition, diagnosis and treatment of environmentally related disease in the pediatric population. Encouragingly, advances in molecular biology and other sciences are providing important tools to aid pediatricians and other healthcare professionals in meeting the environmental health needs of children. PMID:15712790

  11. Pediatric Genitourinary Oncology

    PubMed Central

    Dénes, Francisco Tibor; Duarte, Ricardo Jordão; Cristófani, Lílian Maria; Lopes, Roberto Iglesias

    2013-01-01

    Tumors of the kidney, bladder, prostate, testis, and adrenal represent a large part of the adult urologic practice, but are relatively infrequent in children. The natural history and management of these tumors in the pediatric age is different from that of the adults. As result of the successful work of several clinical trial groups in recent decades, there has been a significant improvement in their cure rates. The aim of this article is to review their most significant clinical aspects, as well as to present an update in their management. PMID:24400293

  12. Epigenetics in pediatrics.

    PubMed

    Puumala, Susan E; Hoyme, H Eugene

    2015-01-01

    Epigenetic mechanisms are external modifications of DNA that cause changes in gene function and are involved in many diseases. Specific examples of pediatric diseases with a known or suspected epigenetic component include Beckwith-Wiedemann syndrome, childhood leukemia, allergies, asthma, fetal alcohol spectrum disorders, childhood obesity, and type 2 diabetes mellitus. Currently, epigenetically active treatments are being used to treat childhood leukemia. Potential epigenetically active treatments and preventive regimens are under study for other diseases. Pediatricians need to be aware of the epigenetic basis of disease to help inform clinical decision making in the future. PMID:25554107

  13. 21 CFR 601.27 - Pediatric studies.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 7 2014-04-01 2014-04-01 false Pediatric studies. 601.27 Section 601.27 Food and... LICENSING Biologics Licensing § 601.27 Pediatric studies. (a) Required assessment. Except as provided in... pediatric subpopulations, and to support dosing and administration for each pediatric subpopulation...

  14. 21 CFR 601.27 - Pediatric studies.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 7 2012-04-01 2012-04-01 false Pediatric studies. 601.27 Section 601.27 Food and... LICENSING Biologics Licensing § 601.27 Pediatric studies. (a) Required assessment. Except as provided in... pediatric subpopulations, and to support dosing and administration for each pediatric subpopulation...

  15. 21 CFR 601.27 - Pediatric studies.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 7 2013-04-01 2013-04-01 false Pediatric studies. 601.27 Section 601.27 Food and... LICENSING Biologics Licensing § 601.27 Pediatric studies. (a) Required assessment. Except as provided in... pediatric subpopulations, and to support dosing and administration for each pediatric subpopulation...

  16. Correlating tumor metabolic progression index measured by serial FDG PET-CT, apparent diffusion coefficient measured by magnetic resonance imaging (MRI) and blood genomics to patient’s outcome in advanced colorectal cancer: the CORIOLAN study

    PubMed Central

    2014-01-01

    Background Metastatic colorectal cancer (mCRC) may present various behaviours that define different courses of tumor evolution. There is presently no available tool designed to assess tumor aggressiveness, despite the fact that this is considered to have a major impact on patient outcome. Methods/Design CORIOLAN is a single-arm prospective interventional non-therapeutic study aiming mainly to assess the natural tumor metabolic progression index (TMPI) measured by serial FDG PET-CT without any intercurrent antitumor therapy as a prognostic factor for overall survival (OS) in patients with mCRC. Secondary objectives of the study aim to test the TMPI as a prognostic marker for progression-free survival (PFS), to assess the prognostic value of baseline tumor FDG uptake on PFS and OS, to compare TMPI to classical clinico-biological assessment of prognosis, and to test the prognostic value on OS and PFS of MRI-based apparent diffusion coefficient (ADC) and variation of vADC using voxel-based diffusion maps. Additionally, this study intends to identify genomic and epigenetic factors that correlate with progression of tumors and the OS of patients with mCRC. Consequently, this analysis will provide information about the signaling pathways that determine the natural and therapy-free course of the disease. Finally, it would be of great interest to investigate whether in a population of patients with mCRC, for which at present no known effective therapy is available, tumor aggressiveness is related to elevated levels of circulating tumor cells (CTCs) and to patient outcome. Discussion Tumor aggressiveness is one of the major determinants of patient outcome in advanced disease. Despite its importance, supported by findings reported in the literature of extreme outcomes for patients with mCRC treated with chemotherapy, no objective tool allows clinicians to base treatment decisions on this factor. The CORIOLAN study will characterize TMPI using FDG-PET-based metabolic imaging

  17. Vitritis in Pediatric Genetic Retinal Disorders

    PubMed Central

    Stunkel, Maria; Bhattarai, Sajag; Kemerley, Andrew; Stone, Edwin M.; Wang, Kai; Mullins, Robert F.; Drack, Arlene V.

    2014-01-01

    Structured Abstract Purpose To determine which types of pediatric retinal degeneration are associated with inflammatory cells in the anterior vitreous (AV). Design Retrospective, observational study in humans. Methods Retrospective chart review was performed for pediatric patients with suspected retinal degeneration presenting to a single examiner from 2008–2013. Age, visual acuity (VA), slit lamp examination of AV (SLAV), clinical and molecular genetic diagnoses were documented. Anterior vitreous cells were graded clinically with SLAV from rare cells (1–4) to 1+ (5–9), 2+ (10–30), or 3+ (more than 30). Cells were also counted in magnified slit beam photographs masked to molecular diagnosis when obtainable. Main outcome measures Cell counts in SLAV, best corrected VA, molecular and clinical diagnoses. Results One hundred and five charts were evaluated, 68 of which (64.8%) included SLAV data. Numerous (1+ or greater) cells were present in 22/68 (32.4%) patients, whereas 4/68 (5.9%) had rare cells and 42/68 (61.8%) had no cells. The average age between patients with cells, no-cells, and rare cells did not differ significantly (p=0.25). VA averaged 20/124 in patients with cells, 20/143 in patients with no-cells, and 20/68 in patients with rare cells (p= 0.70). The most frequent diagnoses with cells included Bardet Biedl syndrome, Leber congenital amaurosis (LCA), and retinitis pigmentosa. The most frequent diagnoses without cells included congenital stationary night blindness, LCA, Stargardt disease, and blue cone monochromacy. Discussion A non-random subset of pediatric retinal degenerations exhibit vitritis. Cells were present in 5/5 BBS patients (a progressive degeneration) whereas cells were not detected in any of the 12 patients with CSNB (a stable dysfunction). Conclusion Studying vitritis in pediatric retinal degenerations may reveal whether inflammation accompanies progressive vision loss in certain sub-types. Potentially, inflammation could be treated

  18. Pediatric optic neuritis.

    PubMed

    Yeh, E Ann; Graves, Jennifer S; Benson, Leslie A; Wassmer, Evangeline; Waldman, Amy

    2016-08-30

    Optic neuritis (ON) is a common presenting symptom in pediatric CNS demyelinating disorders and may be associated with dramatic visual loss. Knowledge regarding clinical presentation, associated diseases, therapy, and outcomes in ON in children has grown over the past decade. These studies have shown that younger children (<10 years of age) are more likely to present with bilateral ON and older children with unilateral ON. Furthermore, studies focusing on visual recovery have shown excellent recovery of high-contrast visual acuity in the majority of children, but functional and structural studies have shown evidence of irreversible injury and functional decline after ON in children. Although randomized controlled treatment trials have not been performed in children and adolescents with ON, standard of care suggests that the use of high-dose pulse steroids is safe and likely effective. This article reviews current knowledge about the clinical presentation and management of pediatric ON, with attention to associated syndromes and evaluative tools that may inform diagnosis and interventions. PMID:27572862

  19. Pediatric DXA: clinical applications

    PubMed Central

    Sparke, Paul; Henwood, Maria J.

    2007-01-01

    Normal bone mineral accrual requires adequate dietary intake of calcium, vitamin D and other nutrients; hepatic and renal activation of vitamin D; normal hormone levels (thyroid, parathyroid, reproductive and growth hormones); and neuromuscular functioning with sufficient stress upon the skeleton to induce bone deposition. The presence of genetic or acquired diseases and the therapies that are used to treat them can also impact bone health. Since the introduction of clinical DXA in pediatrics in the early 1990s, there has been considerable investigation into the causes of low bone mineral density (BMD) in children. Pediatricians have also become aware of the role adequate bone mass accrual in childhood has in preventing osteoporotic fractures in late adulthood. Additionally, the availability of medications to improve BMD has increased with the development of bisphosphonates. These factors have led to the increased utilization of DXA in pediatrics. This review summarizes much of the previous research regarding BMD in children and is meant to assist radiologists and clinicians with DXA utilization and interpretation. PMID:17431606

  20. Immunotherapy for pediatric cancer.

    PubMed

    Grupp, Stephan A; Verneris, Michael; Sondel, Paul M; Cooper, Laurence J N

    2008-01-01

    Improvements in adult cancer survivorship can be achieved from behavioral changes and adopting screening programs. Yet, these approaches cannot be readily applied to lower the morbidity and mortality from childhood cancers. Rather, pediatric oncologists must rely on procedures and therapies to treat, rather than prevent malignancies. The systematic application of chemotherapy, radiation therapy, and surgery has led to remarkable advances in survival but these improvements have come at a cost. Children routinely receive chemotherapy agents that were designed decades ago, and these drugs have predictable side effects that result in the loss of potential for long-term survivors. The advent of targeted applications of immune-based therapies offers children with cancer a new class of oncolytic therapies that may be used to treat disease refractory to conventional approaches and lessen the toxicity of current treatment regimens without compromising remission. This review explores how 3 components of the immune system--T cells, natural killer (NK) cells, and antibodies--can be used for therapy of pediatric malignancies. PMID:18162219

  1. Updates in pediatric nutrition.

    PubMed

    Oken, E; Lightdale, J R

    2001-06-01

    Ongoing research in several areas of pediatric nutrition has new practical applications for community-based pediatricians. For example, a fresh understanding of risk factors for rickets persuades pediatricians to recognize and treat this disease, which was thought to be nearly extinct in the modern industrialized world. Similarly, an expanded awareness of the antibacterial components of breast milk encourages a more complete dialogue between pediatricians and new mothers about the potential benefits of breast-feeding. For those infants with feeding intolerance, new data help to refine the indications for hypoallergenic formulas, which are increasingly recommended for children with a variety of symptoms. The past year also has seen breakthroughs in our understanding of supplemental nutrition for children. Vitamin A may provide direct benefits for the most vulnerable of children, namely premature infants at high risk for lung disease. At the other end of the pediatric spectrum, adolescent athletes seeking to enhance their performance are consuming poorly studied sports supplements that may not be beneficial and may even be toxic. Finally, a greater appreciation for the epidemic of obesity that is sweeping the United States and other countries suggests that children at high risk may represent a far more diverse population than had been recognized previously. PMID:11389365

  2. Pediatric contact dermatitis.

    PubMed

    Sharma, Vinod K; Asati, Dinesh P

    2010-01-01

    Allergic contact dermatitis (ACD) in children, until recently, was considered rare. ACD was considered as a disorder of the adult population and children were thought to be spared due to a lack of exposure to potential allergens and an immature immune system. Prevalence of ACD to even the most common allergens in children, like poison ivy and parthenium, is relatively rare as compared to adults. However, there is now growing evidence of contact sensitization of the pediatric population, and it begins right from early childhood, including 1-week-old neonates. Vaccinations, piercing, topical medicaments and cosmetics in younger patients are potential exposures for sensitization. Nickel is the most common sensitizer in almost all studies pertaining to pediatric contact dermatitis. Other common allergens reported are cobalt, fragrance mix, rubber, lanolin, thiomersol, neomycin, gold, mercapto mix, balsum of Peru and colophony. Different factors like age, sex, atopy, social and cultural practices, habit of parents and caregivers and geographic changes affect the patterns of ACD and their variable clinical presentation. Patch testing should be considered not only in children with lesions of a morphology suggestive of ACD, but in any child with dermatitis that is difficult to control. PMID:20826990

  3. Pediatric heart transplantation

    PubMed Central

    Stiasny, Brian; Dave, Hitendu; Cavigelli-Brunner, Anna; Balmer, Christian; Kretschmar, Oliver; Bürki, Christoph; Klauwer, Dietrich; Hübler, Michael

    2015-01-01

    Pediatric heart transplantation (pHTx) represents a small (14%) but very important and particular part in the field of cardiac transplantation. This treatment has lifelong impact on children. To achieve the best short and especially long-term survival with adequate quality of life, which is of crucial importance for this young patient population, one has to realize and understand the differences with adult HTx. Indication for transplantation, waitlist management including ABO incompatible (ABOi) transplantation and immunosuppression differ. Although young transplant recipients are ultimately likely to be considered for re-transplantation. One has to distinguish between myopathy and complex congenital heart disease (CHD). The differences in anatomy and physiology make the surgical procedure much more complex and create unique challenges. These recipients need a well-organized and educated team with pediatric cardiologists and intensivists, including a high skilled surgeon, which is dedicated to pHTx. Therefore, these types of transplants are best concentrated in specialized centers to achieve promising outcome. PMID:25922739

  4. Pediatric facial burns.

    PubMed

    Kung, Theodore A; Gosain, Arun K

    2008-07-01

    Despite major advances in the area of burn management, burn injury continues to be a leading cause of pediatric mortality and morbidity. Facial burns in particular are devastating to the affected child and result in numerous physical and psychosocial sequelae. Although many of the principles of adult burn management can be applied to a pediatric patient with facial burns, the surgeon must be cognizant of several important differences. Facial burns and subsequent scar formation can drastically affect the growth potential of a child's face. Structures such as the nose and teeth may become deformed due to abnormal external forces caused by contractures. Serious complications such as occlusion amblyopia and microstomia must be anticipated and urgently addressed to avert permanent consequences, whereas other reconstructive procedures can be delayed until scar maturation occurs. Furthermore, because young children are actively developing the concept of self, severe facial burns can alter a child's sense of identity and place the child at high risk for future emotional and psychologic disturbances. Surgical reconstruction of burn wounds should proceed only after thorough planning and may involve a variety of skin graft, flap, and tissue expansion techniques. The most favorable outcome is achieved when facial resurfacing is performed with respect to the aesthetic units of the face. Children with facial burns remain a considerable challenge to their caregivers, and these patients require long-term care by a multidisciplinary team of physicians and therapists to optimize functional, cosmetic, and psychosocial outcomes. PMID:18650717

  5. [New horizons in pediatrics].

    PubMed

    Grossman, Zachi

    2012-06-01

    The profession of pediatrics is constantLy changing. New morbidities are replacing old ones, as a reflection of the changes in society. Even today, old and rare morbidities, like scurvy or acute urinary retention, can be encountered in special settings and populations such as handicapped and developmentally delayed children. The availability of ever newer genetic tests highlights the duty of pediatricians to constantly update families for carrier detection, but also raises questions on the cLinical significance of asymptomatic mutations. Vaccination is one of the most effective pubLic health measures, but failure of medical staff to follow self vaccination recommendations might jeopardize protecting the children. Anti vaccination movement is rapidly growing due to the Internet. However, we must acknowledge the benefits inherent in Internet forums, for example, adolescents consulting anonymously regarding pubertal issues. A new and most needed aspect of care is treatment of pain in children. Increased staff awareness concerning anaLgesia is needed as well as promoting the use of medical clowns for anxiety and pain provoking procedures. Delivering appropriate healthcare to different societal demographic sectors is a challenge for pediatricians. The approach to fever phobia among ultra orthodox parents and advocacy for safety recommendations in the Arab population are two such exampLes. Finally, we shouLd always strive for innovative approaches in pediatric diseases affecting quality of life, and celiac disease is certainly promising in this direction. PMID:22991856

  6. The Diffuse Sclerosing Variant of Papillary Thyroid Cancer Presenting as Innumerable Diffuse Microcalcifications in Underlying Adolescent Hashimoto's Thyroiditis: A Case Report.

    PubMed

    Jeong, Sun Hye; Hong, Hyun Sook; Lee, Eun Hye; Kwak, Jeong Ja

    2016-03-01

    Hashimoto's thyroiditis is the most common diffuse thyroid disease and is characterized by diffuse lymphocytic infiltration. However, the ultrasonographic findings of papillary thyroid carcinomas that arise from Hashimoto's thyroiditis in the pediatric and adolescent population are not well known.We report a rare ultrasonographic finding in a 22-year-old woman diagnosed with the diffuse sclerosing variant of papillary thyroid carcinoma that arose from underlying Hashimoto's thyroiditis: innumerable diffuse microcalcifications instead of a typical malignant-appearing nodule. PMID:27015194

  7. CHIEF PEDIATRIC RESIDENTS TRAINING - A TRAINING PROGRAM OF THE AMERICAN ACADEMY OF PEDIATRICS

    EPA Science Inventory

    The American Academy of Pediatrics will convene workshops at four meetings of the Pediatric Academic Societies for incoming pediatric chief residents. The residents receive an overview of childen's environmental health issues, will create a powerpoint presentation on a specific ...

  8. Imaging in pediatric liver transplantation.

    PubMed

    Monti, L; Soglia, G; Tomà, P

    2016-05-01

    Liver transplantation has become an established curative treatment in adult patients with acute or chronic end-stage liver diseases. In pediatric cases the number of cadaveric donor livers is not sufficient and to overcome the shortage of appropriate-sized whole liver grafts, technical variants of liver transplantation have been practiced. Reduced-size cadaveric and split cadaveric allografts have become an important therapeutic option, expanding the availability of size-appropriate organs for pediatric recipients with terminal liver disease. The number of pediatric deaths awaiting liver transplantation has been reduced by the introduction of living-related liver transplantation, developed to overcome the shortage of suitable grafts for children. It is important for radiologists to know that children have distinct imaging of liver transplantation that distinguish them from adults. A multidisciplinary pediatric liver transplantation team should be skilled in pediatric conditions and in associated processes, risks and complications. Radiologists should know the common pediatric liver diseases that lead to liver transplantation, the anastomotic techniques and the expected postoperative imaging findings. The aim of this study is to illustrate the role of non-invasive imaging such us ultrasonography, color Doppler ultrasonography, multidetector computed tomography and magnetic resonance imaging in the evaluation of pediatric liver transplantation and in potential liver donors. PMID:26909515

  9. Pediatric drug development: formulation considerations.

    PubMed

    Ali, Areeg Anwer; Charoo, Naseem Ahmad; Abdallah, Daud Baraka

    2014-10-01

    Absence of safe, effective and appropriate treatment is one of the main causes of high mortality and morbidity rates among the pediatric group. This review provides an overview of pharmacokinetic differences between pediatric and adult population and their implications in pharmaceutical development. Different pediatric dosage forms, their merits and demerits are discussed. Food and Drug Administration Act of 1997 and the Best Pharmaceuticals for Children Act 2002 added 6 months patent extension and exclusivity incentives to pharmaceutical companies for evaluation of medicinal products in children. Prescription Drug User Fee Act and Food and Drug Administration Amendments Act of 2007 made it mandatory for pharmaceutical companies to perform pediatric clinical studies on new drug products. Drug development program should include additional clinical bridge studies to evaluate differences in pharmacokinetics and pharmacodynamics of drugs in adult and child populations. Additionally, pharmaceutical development should consider ease of administration, palatability, appropriate excipients, stability and therapeutic equivalency of pediatric dosage forms. Pediatric population is diverse with individual preferences and demand for custom made dosage formulations. Practically it is not feasible to have different pharmaceutical dosage forms for each group. Hence, an appropriate dosage form that can be administered across pediatric population is warranted. PMID:24483293

  10. Genome-wide association studies in pediatric chronic kidney disease.

    PubMed

    Gupta, Jayanta; Kanetsky, Peter A; Wuttke, Matthias; Köttgen, Anna; Schaefer, Franz; Wong, Craig S

    2016-08-01

    The genome-wide association study (GWAS) has become an established scientific method that provides an unbiased screen for genetic loci potentially associated with phenotypes of clinical interest, such as chronic kidney disease (CKD). Thus, GWAS provides opportunities to gain new perspectives regarding the genetic architecture of CKD progression by identifying new candidate genes and targets for intervention. As such, it has become an important arm of translational science providing a complementary line of investigation to identify novel therapeutics to treat CKD. In this review, we describe the method and the challenges of performing GWAS in the pediatric CKD population. We also provide an overview of successful GWAS for kidney disease, and we discuss the established pediatric CKD cohorts in North America and Europe that are poised to identify genetic risk variants associated with CKD progression. PMID:26490952

  11. Pediatric Brain Tumors: Innovative Genomic Information Is Transforming the Diagnostic and Clinical Landscape.

    PubMed

    Gajjar, Amar; Bowers, Daniel C; Karajannis, Matthias A; Leary, Sarah; Witt, Hendrik; Gottardo, Nicholas G

    2015-09-20

    Pediatric neuro-oncology has undergone an exciting and dramatic transformation during the past 5 years. This article summarizes data from collaborative group and institutional trials that have advanced the science of pediatric brain tumors and survival of patients with these tumors. Advanced genomic analysis of the entire spectrum of pediatric brain tumors has heralded an era in which stakeholders in the pediatric neuro-oncology community are being challenged to reconsider their current research and diagnostic and treatment strategies. The incorporation of this new information into the next-generation treatment protocols will unleash new challenges. This review succinctly summarizes the key advances in our understanding of the common pediatric brain tumors (ie, medulloblastoma, low- and high-grade gliomas, diffuse intrinsic pontine glioma, and ependymoma) and some selected rare tumors (ie, atypical teratoid/rhabdoid tumor and CNS primitive neuroectodermal tumor). The potential impact of this new information on future clinical protocols also is discussed. Cutting-edge genomics technologies and the information gained from such studies are facilitating the identification of molecularly defined subgroups within patients with particular pediatric brain tumors. The number of evaluable patients in each subgroup is small, particularly in the subgroups of rare diseases. Therefore, international collaboration will be crucial to draw meaningful conclusions about novel approaches to treating pediatric brain tumors. PMID:26304884

  12. Assessment of the contralesional corticospinal tract in early-onset pediatric hemiplegia: Preliminary findings.

    PubMed

    Hawe, Rachel L; Dewald, Jules P A

    2014-01-01

    While pediatric hemiplegia results from a unilateral lesion, the immature state of the brain at the time of injury increases the likelihood of observing changes in the non-lesioned hemisphere as well. The purpose of this preliminary study was to use diffusion tensor imaging to evaluate the contralesional corticospinal tracts in individuals with early-onset pediatric hemiplegia. Twelve individuals with pediatric hemiplegia and ten age-matched controls underwent diffusion tensor imaging (DTI). Corticospinal projections were reconstructed using probabilistic tractography for both the lesioned and contralesional side in pediatric hemiplegia as well as the dominant and non-dominant sides in control subjects. The contralesional tract was found to have decreased white matter integrity relative to control subjects. Compared to controls, the contralesional tract also showed increased tract volume. The increase in volume suggests the presence of ipsilateral corticospinal projections from the contralesional hemisphere that are maintained during development to control the paretic extremities. Decreases in integrity may be explained by diffuse damage or incomplete maturation. The findings of this study support the notion of bilateral motor involvement in pediatric hemiplegia, and the need to address bilateral neural changes as well as motor deficits in this population. PMID:25571199

  13. Local delivery methods of therapeutic agents in the treatment of diffuse intrinsic brainstem gliomas.

    PubMed

    Goodwin, C Rory; Xu, Risheng; Iyer, Rajiv; Sankey, Eric W; Liu, Ann; Abu-Bonsrah, Nancy; Sarabia-Estrada, Rachel; Frazier, James L; Sciubba, Daniel M; Jallo, George I

    2016-03-01

    Brainstem gliomas comprise 10-20% of all pediatric central nervous system (CNS) tumors and diffuse intrinsic pontine gliomas (DIPGs) account for the majority of these lesions. DIPG is a rapidly progressive disease with almost universally fatal outcomes and a median survival less than 12 months. Current standard-of-care treatment for DIPG includes radiation therapy, but its long-term survival effects are still under debate. Clinical trials investigating the efficacy of systemic administration of various therapeutic agents have been associated with disappointing outcomes. Recent efforts have focused on improvements in chemotherapeutic agents employed and in methods of localized and targeted drug delivery. This review provides an update on current preclinical and clinical studies investigating treatment options for brainstem gliomas. PMID:26849840

  14. [What is new in pediatric oncology?].

    PubMed

    Oberlin, O; Brugières, L; Patte, C; Kalifa, C; Vassal, G; Valteau-Couanet, D; Hartmann, O

    2000-08-01

    The significant progress made in pediatric oncology during recent years has been due to a major breakthrough in the field of molecular biology and the introduction of new therapeutic strategies that take into account both the quality and the duration of life. Molecular biology has already been instrumental in more fully categorizing the 'small round-cell tumor' group, and in reclassifying the 'Ewing family' tumors. It also provides a valuable tool for the prognostic evaluation of neuroblastomas through the analysis of the N-myc oncogene. In addition, it has permitted the identification of the Li-Fraumeni syndrome of predisposition to cancer in the child, thereby raising the problematical ethical issue of communicating relevant information to subjects at risk. Two examples illustrate innovative strategic concepts: 1) Burkitt's lymphoma, or an example of the successful de-intensification of treatment; and 2) brain tumors in young children, regarding which the desire to improve the quality of life has led to innovative attempts to replace radiotherapy by chemotherapy. Considerable progress has been made in the field of neuropsychology, thereby permitting an improved assessment of disorders and a better management of rehabilitation programs. New anti-cancer agents and also chemo- and radiotherapy that spare healthy tissue are also being developed. Gene therapy and molecular biology will play a major role in future therapeutic strategies; and are now at the preclinical trial stage. This significant overall progress leads to a reconsideration of the organizational approach toward treatment of the pediatric patient population suffering from cancer, and a critical assessment of disease management, which should take into account not only the technical aspects of the disease but also familial and social considerations. PMID:10985189

  15. Septorhinoplasty in the Pediatric Patient.

    PubMed

    Bhuskute, Aditi; Sumiyoshi, Mika; Senders, Craig

    2016-08-01

    Pediatric septorhinoplasty has been an area of controversy because early surgical intervention can prevent normal growth. There are certain conditions where early correction of the nose is indicated, such as in cleft lip nasal deformities, severe traumatic deformities, and congenital nasal lesions. Animal and clinical studies have been helpful in elucidating certain areas of the nose that are potential growth zones that should be left undisturbed when performing nasal surgeries on pediatric patients. We discuss the timing, indications, and surgical technique in pediatric septorhinoplasty. PMID:27400839

  16. Radiation Safety in Pediatric Orthopaedics.

    PubMed

    Caird, Michelle S

    2015-01-01

    Patients, surgeons, and staff are exposed to ionizing radiation in pediatric orthopaedic surgery from diagnostic studies and imaging associated with procedures. Estimating radiation dose to pediatric patients is based on complex algorithms and dose to surgeons and staff is based on dosimeter monitoring. Surgeons can decrease radiation exposure to patients with careful and thoughtful ordering of diagnostic studies and by minimizing exposure intraoperatively. Surgeon and staff radiation exposure can be minimized with educational programs, proper shielding and positioning intraoperatively, and prudent use of intraoperative imaging. Overall, better awareness among pediatric orthopaedic surgeons of our role in radiation exposure can lead to improvements in radiation safety. PMID:26049299

  17. Pediatric facial transplantation: Ethical considerations

    PubMed Central

    Flynn, Jennifer; Shaul, Randi Zlotnik; Hanson, Mark D; Borschel, Gregory H; Zuker, Ronald

    2014-01-01

    Facial transplantation is becoming increasingly accepted as a method of reconstructing otherwise unreconstructable adult faces. As this modality is made more available, we must turn our attention to pediatric patients who may benefit from facial transplantation. In the current article, the authors present and briefly examine the most pressing ethical challenges posed by the possibility of performing facial transplantation on pediatric patients. Furthermore, they issue a call for a policy statement on pediatric facial transplantation. The present article may serve as a first step in that direction, highlighting ethical issues that would need to be considered in the creation of such a statement. PMID:25114614

  18. Advanced manufacturing: Technology diffusion

    SciTech Connect

    Tesar, A.

    1995-12-01

    In this paper we examine how manufacturing technology diffuses rom the developers of technology across national borders to those who do not have the capability or resources to develop advanced technology on their own. None of the wide variety of technology diffusion mechanisms discussed in this paper are new, yet the opportunities to apply these mechanisms are growing. A dramatic increase in technology diffusion occurred over the last decade. The two major trends which probably drive this increase are a worldwide inclination towards ``freer`` markets and diminishing isolation. Technology is most rapidly diffusing from the US In fact, the US is supplying technology for the rest of the world. The value of the technology supplied by the US more than doubled from 1985 to 1992 (see the Introduction for details). History shows us that technology diffusion is inevitable. It is the rates at which technologies diffuse to other countries which can vary considerably. Manufacturers in these countries are increasingly able to absorb technology. Their manufacturing efficiency is expected to progress as technology becomes increasingly available and utilized.

  19. Moral Hazard in Pediatrics.

    PubMed

    Brunnquell, Donald; Michaelson, Christopher M

    2016-07-01

    "Moral hazard" is a term familiar in economics and business ethics that illuminates why rational parties sometimes choose decisions with bad moral outcomes without necessarily intending to behave selfishly or immorally. The term is not generally used in medical ethics. Decision makers such as parents and physicians generally do not use the concept or the word in evaluating ethical dilemmas. They may not even be aware of the precise nature of the moral hazard problem they are experiencing, beyond a general concern for the patient's seemingly excessive burden. This article brings the language and logic of moral hazard to pediatrics. The concept reminds us that decision makers in this context are often not the primary party affected by their decisions. It appraises the full scope of risk at issue when decision makers decide on behalf of others and leads us to separate, respect, and prioritize the interests of affected parties. PMID:27292845

  20. Pediatric radiation oncology

    SciTech Connect

    Halperin, E.C.; Kun, L.E.; Constine, L.S.; Tarbell, N.J.

    1989-01-01

    This text covers all aspects of radiation therapy for treatment of pediatric cancer. The book describes the proper use of irradiation in each of the malignancies of childhood, including tumors that are rarely encountered in adult practice. These include acute leukemia; supratentorial brain tumors; tumors of the posterior fossa of the brain and spinal canal; retinoblastoma and optic nerve glioma; neuroblastoma; Hodgkin's disease; malignant lymphoma; Ewing's sarcoma; osteosarcoma; rhabdomyosarcoma; Desmoid tumor; Wilms' tumor; liver and biliary tumors; germ cell and stromal cell tumors of the gonads; endocrine, aerodigestive tract, and breast tumors; Langerhans' cell histiocytosis; and skin cancer and hemangiomas. For each type of malignancy, the authors describe the epidemiology, common presenting signs and symptoms, staging, and proper diagnostic workup. Particular attention is given to the indications for radiation therapy and the planning of a course of radiotherapy, including the optimal radiation dose, field size, and technique.

  1. Advances in pediatrics. Volume 32

    SciTech Connect

    Barness, L.A.

    1985-01-01

    These proceedings collect papers on pediatrics. Topics include: the biological role and clinical implications of taurine; human milk nonprotein nitrogen; monoclonal antibodies in the diagnosis and treatment of childhood diseases; and human immune responses to polysaccharide antigens.

  2. What Is a Pediatric Gastroenterologist?

    MedlinePlus

    ... Life Family Life Family Life Medical Home Family Dynamics Media Work & Play Getting Involved in Your Community ... Life Medical Home Health Insurance Pediatric Specialists Family Dynamics Media Work & Play Getting Involved in Your Community ...

  3. What Is a Pediatric Rheumatologist?

    MedlinePlus

    ... Life Family Life Family Life Medical Home Family Dynamics Media Work & Play Getting Involved in Your Community ... Life Medical Home Health Insurance Pediatric Specialists Family Dynamics Media Work & Play Getting Involved in Your Community ...

  4. What Is a Pediatric Geneticist?

    MedlinePlus

    ... Life Family Life Family Life Medical Home Family Dynamics Media Work & Play Getting Involved in Your Community ... Life Medical Home Health Insurance Pediatric Specialists Family Dynamics Media Work & Play Getting Involved in Your Community ...

  5. What Is a Pediatric Urologist?

    MedlinePlus

    ... Life Family Life Family Life Medical Home Family Dynamics Media Work & Play Getting Involved in Your Community ... Life Medical Home Health Insurance Pediatric Specialists Family Dynamics Media Work & Play Getting Involved in Your Community ...

  6. Childhood Obesity for Pediatric Gastroenterologists

    PubMed Central

    Huang, Jeannie S.; Barlow, Sarah E.; Quiros-Tejeira, Ruben E.; Scheimann, Ann; Skelton, Joseph; Suskind, David; Tsai, Patrika; Uko, Victor; Warolin, Joshua P.; Xanthakos, Stavra A.

    2014-01-01

    Obesity in childhood is one of the major health issues in pediatric health care today. As expected, the prevalence of obesity-related comorbidities has risen in parallel with that of obesity. Consultation regarding these concomitant diseases and subsequent management by subspecialists, including pediatric gastroenterologists, is now common and has resulted in obesity being recognized as a chronic disease requiring coordination of care. Although medications and even surgery may provide effective, though often temporary, treatments for obesity and its comorbidities, behavioral interventions addressing healthy dietary and physical activity habits remain a mainstay in the obesity treatment paradigm. Therefore, the issue of weight management must be addressed by both general practitioner and subspecialist alike. In this report, we review select aspects of pediatric obesity and obesity-related management issues because it relates in particular to the field of pediatric gastroenterology and hepatology. PMID:23282941

  7. Neonatal and pediatric respiratory care

    SciTech Connect

    Koff, P.B. ); Eitzman, D.V.; Nev, J. )

    1988-01-01

    This book contains 23 chapters. Some of the titles are: Radiographic evaluations; Neonatal parenchymal diseases: physiologic development; Oxygen therapy; Pediatric parenchymal diseases; and Care of the neurologically injured child.

  8. Pediatric Ingestions: Emergency Department Management.

    PubMed

    Tarango Md, Stacy M; Liu Md, Deborah R

    2016-04-01

    Pediatric ingestions present a common challenge for emergency clinicians. Each year, more than 50,000 children aged less than 5 years present to emergency departments with concern for unintentional medication exposure, and nearly half of all calls to poison centers are for children aged less than 6 years. Ingestion of magnetic objects and button batteries has also become an increasing source of morbidity and mortality. Although fatal pediatric ingestions are rare, the prescription medications most responsible for injury and fatality in children include opioids, sedative/hypnotics, and cardiovascular drugs. Evidence regarding the evaluation and management of common pediatric ingestions is comprised largely of case reports and retrospective studies. This issue provides a review of these studies as well as consensus guidelines addressing the initial resuscitation, diagnosis, and treatment of common pediatric ingestions. Also discussed are current recommendations for decontamination, administration of antidotes for specific toxins, and management of ingested foreign bodies. PMID:27104813

  9. Genetic predisposition to pediatric myeloid malignancies.

    PubMed

    Muramatsu, Hideki

    2016-06-01

    Various genetic disorders are known to be associated with cancer predisposition. For example, children with Down syndrome are predisposed to developing acute myeloid leukemia, and those with RASopathies, such as Noonan syndrome, are predisposed to juvenile myelomonocytic leukemia. To date, more than 250 diseases or syndromes have been reported to be associated with the development of pediatric cancers. Recently, the advent of the massive parallel sequencing technique revealed several germline mutations, including RUNX1, CEBPA, GATA2, SRP72, ETV6, and DDX41, which are associated with familial myeloid malignancies. A significant number of children with myeloid malignancies may harbor pathognomonic germline variants. It is strongly recommended that precise diagnosis, genetic counseling, familial screening, and follow-up programs be provided for patients with such a predisposition to cancer. To identify genetic disorders associated with predispositions to pediatric myeloid malignancies, the development of an efficient screening system with the massive parallel sequencer for germline and somatic mutations, which would also be useful for familial genetic studies and prediction of tumor progression, is needed. PMID:27384852

  10. Innovation in pediatric surgical education.

    PubMed

    Clifton, Matthew S; Wulkan, Mark L

    2015-06-01

    Pediatric surgical training in the United States remained basically unchanged from the model developed by Ladd and Gross in the 1930s until recently. Standardized curriculum and novel evaluation methods are now being implemented. Pediatric Surgical education is currently undergoing a transition to competency-based evaluation and promotion. Unfortunately, there is little data on the efficacy of these changes. This presents an opportunity for further study of how we conduct training, and how we evaluate and promote our trainees. PMID:25976147

  11. Mass transport by diffusion

    NASA Technical Reports Server (NTRS)

    Baird, James K.

    1987-01-01

    For the purpose of determining diffusion coefficients as required for electrodeposition studies and other applications, a diaphragm cell and an isothermal water bath were constructed. the calibration of the system is discussed. On the basis of three calibration runs on the diaphram cell, researchers concluded that the cell constant beta equals 0.12 cm -2 . Other calibration runs in progress should permit the cell constant to be determined with an accuracy of one percent.

  12. Competencies in Training at the Graduate Student Level: Example of a Pediatric Psychology Seminar Course

    PubMed Central

    Ievers-Landis, Carolyn E.; Hazen, Rebecca A.; Fehr, Karla K.

    2015-01-01

    The recently developed competencies in pediatric psychology from the Society of Pediatric Psychology (SPP) Task Force on Competencies and Best Training Practices in Pediatric Psychology provide a benchmark to evaluate training program practices and student progress toward training in level-specific competency goals. Graduate-level training presents a unique challenge for addressing the breadth of competencies required in pediatric psychology while maintaining development of broader clinical psychology training goals. We describe a recurring graduate-level pediatric psychology seminar course that addresses training in a number of the competency cluster areas. The structure of the seminar, examples of classroom topics that correspond with competency cluster areas as well as benchmarks used to evaluate each student’s development in the competency area are provided. Specific challenges in developing and maintaining the seminar in this format are identified, and possible solutions are offered. This training format could serve as a model for established pediatric psychology programs to expand their didactic training goals or for programs without formal pediatric psychology training to address competencies outside of clinical placements. PMID:26900536

  13. The global pediatric antiretroviral market: analyses of product availability and utilization reveal challenges for development of pediatric formulations and HIV/AIDS treatment in children

    PubMed Central

    2010-01-01

    Background Important advances in the development and production of quality-certified pediatric antiretroviral (ARV) formulations have recently been made despite significant market disincentives for manufacturers. This progress resulted from lobbying and innovative interventions from HIV/AIDS activists, civil society organizations, and international organizations. Research on uptake and dispersion of these improved products across countries and international organizations has not been conducted but is needed to inform next steps towards improving child health. Methods We used information from the World Health Organization Prequalification Programme and the United States Food and Drug Administration to describe trends in quality-certification of pediatric formulations and used 7,989 donor-funded, pediatric ARV purchase transactions from 2002-2009 to measure uptake and dispersion of new pediatric ARV formulations across countries and programs. Prices for new pediatric ARV formulations were compared to alternative dosage forms. Results Fewer ARV options exist for HIV/AIDS treatment in children than adults. Before 2005, most pediatric ARVs were produced by innovator companies in single-component solid and liquid forms. Five 2-in1 and four 3-in-1 generic pediatric fixed-dose combinations (FDCs) in solid and dispersible forms have been quality-certified since 2005. Most (67%) of these were produced by one quality-certified manufacturer. Uptake of new pediatric FDCs outside of UNITAID is low. UNITAID accounted for 97-100% of 2008-2009 market volume. In total, 33 and 34 countries reported solid or dispersible FDC purchases in 2008 and 2009, respectively, but most purchases were made through UNITAID. Only three Global Fund country recipients reported purchase of these FDCs in 2008. Prices for pediatric FDCs were considerably lower than liquids but typically higher than half of an adult FDC. Conclusion Pediatric ARV markets are more fragile than adult markets. Ensuring a long

  14. Neuroimaging in Pediatric Traumatic Brain Injury: Current and Future Predictors of Functional Outcome

    ERIC Educational Resources Information Center

    Suskauer, Stacy J.; Huisman, Thierry A. G. M.

    2009-01-01

    Although neuroimaging has long played a role in the acute management of pediatric traumatic brain injury (TBI), until recently, its use as a tool for understanding and predicting long-term brain-behavior relationships after TBI has been limited by the relatively poor sensitivity of routine clinical imaging for detecting diffuse axonal injury…

  15. Epilepsy Surgery for Pediatric Epilepsy: Optimal Timing of Surgical Intervention

    PubMed Central

    SUGANO, Hidenori; ARAI, Hajime

    2015-01-01

    Pediatric epilepsy has a wide variety of etiology and severity. A recent epidemiological study suggested that surgery might be indicated in as many as 5% of the pediatric epilepsy population. Now, we know that effective epilepsy surgery can result in seizure freedom and improvement of psychomotor development. Seizure control is the most effective way to improve patients neurologically and psychologically. In this review, we look over the recent evidence related to pediatric epilepsy surgery, and try to establish the optimal surgical timing for patients with intractable epilepsy. Appropriate surgical timing depends on the etiology and natural history of the epilepsy to be treated. The most common etiology of pediatric intractable epilepsy patients is malformation of cortical development (MCD) and early surgery is recommended for them. Patients operated on earlier than 12 months of age tended to improve their psychomotor development compared to those operated on later. Recent progress in neuroimaging and electrophysiological studies provide the possibility of very early diagnosis and comprehensive surgical management even at an age before 12 months. Epilepsy surgery is the only solution for patients with MCD or other congenital diseases associated with intractable epilepsy, therefore physicians should aim at an early and precise diagnosis and predicting the future damage, consider a surgical solution within an optimal timing. PMID:25925754

  16. Mifepristone Treatment of Cushing's Syndrome in a Pediatric Patient.

    PubMed

    Banerjee, Ronadip R; Marina, Neyssa; Katznelson, Laurence; Feldman, Brian J

    2015-11-01

    Cushing's syndrome (CS) in the pediatric population is challenging to diagnose and treat. Although next-generation medical therapies are emerging for adults with CS, none are currently approved or used in children. Here we describe the first use of mifepristone, a glucocorticoid receptor antagonist, to treat CS in a pediatric subject. The patient, a 14-year-old girl with an 18-month history of metastatic neuroendocrine carcinoma, suffered from fatigue, profound myopathy, irritability, and depression. She was found to have hypertension, hypokalemia, and worsening control of her preexisting type 1 diabetes. In this report, we detail our clinical evaluation that confirmed CS caused by an ectopic adrenocorticotropic hormone secreting tumor. Surgical and radiation therapies were not pursued because of her poor functional status and limited life expectancy, and medical treatment of CS was indicated for symptom relief. Mifepristone treatment provided rapid improvement in glycemic control, insulin resistance, and hypertension as well as significant diminishment of her myopathy and fatigue. Hypokalemia was managed with an oral potassium replacement and dose escalation of spironolactone; no other significant adverse effects were observed. Despite successful palliation of Cushing's signs and symptoms, the patient died of progression of her cancer. This case demonstrates the safety and efficacy of mifepristone treatment in a pediatric patient with symptomatic, ectopic CS. We conclude that, in appropriate pediatric patients with CS, glucocorticoid receptor antagonism with mifepristone should be considered to control the effects of hypercortisolism and to improve quality of life. PMID:26459648

  17. Giovanni Battista Morgagni and his contribution to pediatric surgery.

    PubMed

    Zani, Augusto; Cozzi, Denis A

    2008-04-01

    Pediatric surgery is a less than a century old surgical specialty. However, early knowledge of human malformations and pediatric surgical conditions dates back to centuries before. One of the main contributors to progress in these fields was Giovanni Battista Morgagni (1682-1771), who also had a substantial weight in the development of future pediatric surgery. With his masterpiece De Sedibus et Causis Morborum per Anatomen Indagatis (On the Seats and Causes of Diseases Investigated by Anatomy) (1761), he set the basis for modern pathology. In this textbook, Morgagni was the first to describe anatomical elements like the trigonum sternocostale dextrum (the Morgagni's foramen), the appendix testis (the Morgagni's hydatid), and the vertical folds of distal rectum (the Morgagni's columns). He was also the first to describe pediatric pathological conditions like epispadia, meconium peritonitis, Crohn's disease, and coarctation of the aorta. Finally, he substantially contributed to the understanding of the pathophysiology of conditions like the vesico-ureteral reflux, the anterior wall defects (gastroschisis/omphalocele), and the spina bifida. For this, it was said of him: "If all the anatomical findings made by Morgagni should bear his name, probably one third of human body would be called Morgagni's." PMID:18405723

  18. Rituximab plus a CHOP-like regimen, central nervous system prophylaxis, and contralateral testicular irradiation for localized primary testicular diffuse large B-cell lymphoma lead to prolonged progression-free survival.

    PubMed

    Ichikawa, Kunimoto; Noguchi, Masaaki; Koike, Michiaki; Aritaka, Nanae; Sekiguchi, Yasunobu; Sunami, Yoshitaka; Tsutsui, Miyuki; Hosone, Masaru; Hirano, Takao; Gotoh, Akihiko; Komatsu, Norio

    2014-10-01

    We retrospectively evaluated the clinical features, management, and survival of 12 patients (age 51-84 years) with localized primary testicular diffuse large B-cell lymphoma (PTL). All 12 PTL patients underwent orchiectomy. Seven of the 12 patients were treated with strategy A, which consisted of at least six cycles of rituximab (R) plus a CHOP-like regimen, central nervous system (CNS) prophylaxis involving intrathecal chemotherapy (IT) and/or high-dose intravenous methotrexate, and contralateral scrotal irradiation (cRT). The other five patients were treated with strategy B, which included three regimens: orchiectomy alone, orchiectomy plus cRT and IT, and orchiectomy plus 3-4 cycles of R-CHOP plus cRT with or without IT. The median follow-up period was 48 months (range 19-123 months). The 4-year progression-free survival (PFS) rate for the seven patients treated with strategy A was 85.7 %, whereas that for the five patients treated with strategy B was 20 %. The patients treated with strategy A exhibited a significantly higher 4-year PFS rate than those treated with strategy B (P = 0.017). These results confirmed that the administration of a sufficient number of cycles of an R-containing chemotherapy regimen plus cRT plus CNS prophylaxis should be considered as a treatment for localized PTL. PMID:25085255

  19. Central nervous system infection in the pediatric population

    PubMed Central

    Sahu, Rabi Narayan; Kumar, Raj; Mahapatra, A. K.

    2009-01-01

    Infection of the central nervous system is a life-threatening condition in the pediatric population. Almost all agents can cause infection within the central nervous system and the extent of infection ranges from diffuse involvement of the meninges, brain, or the spinal cord to localized involvement presenting as a space-occupying lesion. Modern imaging techniques define the anatomic region infected, the evolution of the disease, and help in better management of these patients. Acute bacterial meningitis remains a major cause of mortality and long-term neurological disability. Fortunately, the incidence of infection after clean craniotomy is < 5%, but it leads to significant morbidity as well as fiscal loss. The most significant causative factor in postcraniotomy infections is postoperative CSF leak. Cerebral abscess related to organic congenital heart disease is one of the leading causes of morbidity and mortality in the pediatric population. The administration of prophylactic antibiotics is indicated for contaminated and clean-contaminated wounds. PMID:21887170

  20. Better outcome after pediatric resuscitation is still a dilemma

    PubMed Central

    Sahu, Sandeep; Kishore, Kamal; Lata, Indu

    2010-01-01

    Pediatric cardiac arrest is not a single problem. Although most episodes of pediatric cardiac arrest occur as complications and progression of respiratory failure and shock. Sudden cardiac arrest may result from abrupt and unexpected arrhythmias. With a better-tailored therapy, we can optimize the outcome. In the hospital, cardiac arrest often develops as a progression of respiratory failure and shock. Typically half or more of pediatric victims of in-hospital arrest have pre-existing respiratory failure and one-third or more have shock, although these figures vary somewhat among reporting hospitals. When in-hospital respiratory arrest or failure is treated before the development of cardiac arrest, survival ranges from 60% to 97%. Bradyarrthmia, asystole or pulseless electric activity (PEA) were recorded as an initial rhythm in half or more of the recent reports of in-hospital cardiac arrest, with survival to hospital discharge ranging from 22% to 40%. Data allowing characterization of out of hospital pediatric arrest are limited, although existing data support the long-held belief that as with hospitalized children, cardiac arrest most often occurs as a progression of respiratory failure or shock to cardiac arrest with bradyasystole rhythm. Although VF (Ventricular fibrillation, is a very rapid, uncoordinated, ineffective series of contractions throughout the lower chambers of the heart. Unless stopped, these chaotic impulses are fatal) and VT (Ventricular tachycardia is a rapid heartbeat that originates in one of the ventricles of the heart. To be classified as tachycardia, the heart rate is usually at least 100 beats per minute) are not common out-of-cardiac arrest in children, they are more likely to be present with sudden, witnessed collapse, particularly among adolescents. Pre-hospital care till the late 1980s was mainly concerned with adult care, and the initial focus for pediatric resuscitation was provision of oxygen and ventilation, with initial rhythm at

  1. Vaneless diffusers

    NASA Astrophysics Data System (ADS)

    Senoo, Y.

    The influence of vaneless diffusers on flow in centrifugal compressors, particularly on surge, is discussed. A vaneless diffuser can demonstrate stable operation in a wide flow range only if it is installed with a backward leaning blade impeller. The circumferential distortion of flow in the impeller disappears quickly in the vaneless diffuser. The axial distortion of flow at the diffuser inlet does not decay easily. In large specific speed compressors, flow out of the impeller is distorted axially. Pressure recovery of diffusers at distorted inlet flow is considerably improved by half guide vanes. The best height of the vanes is a little 1/2 diffuser width. In small specific speed compressors, flow out of the impeller is not much distorted and pressure recovery can be predicted with one-dimensional flow analysis. Wall friction loss is significant in narrow diffusers. The large pressure drop at a small flow rate can cause the positive gradient of the pressure-flow rate characteristic curve, which may cause surging.

  2. Burden of pediatric hepatitis C.

    PubMed

    El-Shabrawi, Mortada Hassan; Kamal, Naglaa Mohamed

    2013-11-28

    Hepatitis C virus (HCV) is a major health burden infecting 170-210 million people worldwide. Additional 3-4 millions are newly-infected annually. Prevalence of pediatric infection varies from 0.05%-0.36% in the United States and Europe; up to 1.8%-5.8% in some developing countries. The highest prevalence occurs in Egypt, sub-Saharan Africa, Amazon basin and Mongolia. HCV has been present in some populations for several centuries, notably genotypes 1 and 2 in West Africa. Parenteral anti-schistosomal therapy practiced in the 1960s until the early 1980s had spread HCV infection throughout Egypt. Parenteral acquisition of HCV remains a major route for infection among Egyptian children. Insufficient screening of transfusions, unsterilized injection equipment and re-used needles and syringes continue to be major routes of HCV transmission in developing countries, whereas vertical transmission and adolescent high-risk behaviors (e.g., injection drug abuse) are the major routes in developed countries. The risk of vertical transmission from an infected mother to her unborn/newborn infant is approximately 5%. Early stages of HCV infection in children do not lead to marked impairment in the quality of life nor to cognitive, behavioral or emotional dysfunction; however, caregiver stress and family system strain may occur. HCV slowly progresses to serious complications as cirrhosis (1%-2%) and hepatocellular carcinoma (HCC) especially in the presence of risk factors as hemolytic anemias, obesity, treated malignancy, and concomitant human immune deficiency and/or hepatitis B virus co-infection. HCV vaccine remains elusive to date. Understanding the immune mechanisms in patients who successfully cleared the infection is essential for vaccine development. The pediatric standard of care treatment consists of pegylated interferon-α 2a or b plus ribavirin for 24-48 wk. The new oral direct acting antivirals, approved for adults, need further evaluation in children. Sustained

  3. Comprehensive training for the future pediatric cardiologist

    PubMed Central

    Subramanyan, Raghavan

    2016-01-01

    India faces a huge burden of pediatric and adult congenital heart diseases (CHDs). Many acquired valvar, myocardial, and vascular diseases also need treatment in childhood and adolescence. The emergence of pediatric cardiology as an independent specialty has been a relatively recent development. A few centers of excellence in pediatric cardiology have developed. However, the requirement of pediatric cardiac care and pediatric cardiologists is far in excess of what is available. There are no guidelines at present in India for uniform training in pediatric cardiology. Many training programs are nonstructured and do not focus on the regional needs. Both core training and advanced training programs are essential to provide adequate numbers of community-level pediatric cardiologists and academic leaders respectively. This article proposes a detailed plan and curriculum for comprehensive training of future pediatric cardiologists in India. PMID:27011684

  4. Diffusion barriers

    NASA Technical Reports Server (NTRS)

    Nicolet, M. A.

    1983-01-01

    The choice of the metallic film for the contact to a semiconductor device is discussed. One way to try to stabilize a contact is by interposing a thin film of a material that has low diffusivity for the atoms in question. This thin film application is known as a diffusion barrier. Three types of barriers can be distinguished. The stuffed barrier derives its low atomic diffusivity to impurities that concentrate along the extended defects of a polycrystalline layer. Sacrificial barriers exploit the fact that some (elemental) thin films react in a laterally uniform and reproducible fashion. Sacrificial barriers have the advantage that the point of their failure is predictable. Passive barriers are those most closely approximating an ideal barrier. The most-studied case is that of sputtered TiN films. Stuffed barriers may be viewed as passive barriers whose low diffusivity material extends along the defects of the polycrystalline host.

  5. Diffuse radiation

    NASA Technical Reports Server (NTRS)

    1981-01-01

    A diffuse celestial radiation which is isotropic at least on a course scale were measured from the soft X-ray region to about 150 MeV, at which energy the intensity falls below that of the galactic emission for most galactic latitudes. The spectral shape, the intensity, and the established degree of isotropy of this diffuse radiation already place severe constraints on the possible explanations for this radiation. Among the extragalactic theories, the more promising explanations of the isotropic diffuse emission appear to be radiation from exceptional galaxies from matter antimatter annihilation at the boundaries of superclusters of galaxies of matter and antimatter in baryon symmetric big bang models. Other possible sources for extragalactic diffuse gamma radiation are discussed and include normal galaxies, clusters of galaxies, primordial cosmic rays interacting with intergalactic matter, primordial black holes, and cosmic ray leakage from galaxies.

  6. Magnetoencephalography in pediatric epilepsy

    PubMed Central

    Kim, Hunmin; Chung, Chun Kee

    2013-01-01

    Magnetoencephalography (MEG) records the magnetic field generated by electrical activity of cortical neurons. The signal is not distorted or attenuated, and it is contactless recording that can be performed comfortably even for longer than an hour. It has excellent and decent temporal resolution, especially when it is combined with the patient's own brain magnetic resonance imaging (magnetic source imaging). Data of MEG and electroencephalography are not mutually exclusive and it is recorded simultaneously and interpreted together. MEG has been shown to be useful in detecting the irritative zone in both lesional and nonlesional epilepsy surgery. It has provided valuable and additive information regarding the lesion that should be resected in epilepsy surgery. Better outcomes in epilepsy surgery were related to the localization of the irritative zone with MEG. The value of MEG in epilepsy surgery is recruiting more patients to epilepsy surgery and providing critical information for surgical planning. MEG cortical mapping is helpful in younger pediatric patients, especially when the epileptogenic zone is close to the eloquent cortex. MEG is also used in both basic and clinical research of epilepsy other than surgery. MEG is a valuable diagnostic modality for diagnosis and treatment, as well as research in epilepsy. PMID:24244211

  7. Pharmacogenomics in pediatric leukemia

    PubMed Central

    Paugh, Steven W.; Stocco, Gabriele; Evans, William E.

    2013-01-01

    Purpose of review The therapeutic index of many medications, especially in children, is very narrow with substantial risk for toxicity at doses required for therapeutic effects. This is particularly relevant to cancer chemotherapy, where the risk of toxicity must be balanced against potential suboptimal (low) systemic exposure that can be less effective in patients with the higher rates of drug clearance. The purpose of this review is to discuss genetic factors that lead to interpatient differences in the pharmacokinetics and pharmacodynamics of these medications. Recent findings Genome wide agonistic studies of pediatric patient populations are revealing genome variations that may affect susceptibility to specific diseases and that influence the pharmacokinetic and pharmacodynamic characteristics of medications. Several genetic factors with relatively small effect may be combined in the determination of a pharmacogenomic phenotype and considering these polygenic models may be mandatory in order to predict the related drug response phenotypes. These findings have potential to yield new insights into disease pathogenesis, and lead to molecular diagnostics that can be used to optimize the treatment of childhood cancers Summary Advances in genome technology and their comprehensive and systematic deployment to elucidate the genomic basis of inter-patient differences in drug response and disease risk, hold great promise to ultimately enhance the efficacy and reduce the toxicity of drug therapy in children. PMID:20861736

  8. Common pediatric epilepsy syndromes.

    PubMed

    Park, Jun T; Shahid, Asim M; Jammoul, Adham

    2015-02-01

    Benign rolandic epilepsy (BRE), childhood idiopathic occipital epilepsy (CIOE), childhood absence epilepsy (CAE), and juvenile myoclonic epilepsy (JME) are some of the common epilepsy syndromes in the pediatric age group. Among the four, BRE is the most commonly encountered. BRE remits by age 16 years with many children requiring no treatment. Seizures in CAE also remit at the rate of approximately 80%; whereas, JME is considered a lifelong condition even with the use of antiepileptic drugs (AEDs). Neonates and infants may also present with seizures that are self-limited with no associated psychomotor disturbances. Benign familial neonatal convulsions caused by a channelopathy, and inherited in an autosomal dominant manner, have a favorable outcome with spontaneous resolution. Benign idiopathic neonatal seizures, also referred to as "fifth-day fits," are an example of another epilepsy syndrome in infants that carries a good prognosis. BRE, CIOE, benign familial neonatal convulsions, benign idiopathic neonatal seizures, and benign myoclonic epilepsy in infancy are characterized as "benign" idiopathic age-related epilepsies as they have favorable implications, no structural brain abnormality, are sensitive to AEDs, have a high remission rate, and have no associated psychomotor disturbances. However, sometimes selected patients may have associated comorbidities such as cognitive and language delay for which the term "benign" may not be appropriate. PMID:25658216

  9. Pediatric Medullary Thyroid Carcinoma

    PubMed Central

    Starenki, Dmytro; Park, Jong-In

    2016-01-01

    Medullary thyroid carcinoma (MTC), which originates from thyroid parafollicular C cells, accounts for 3 to 5% of thyroid malignancies. MTC occurs either sporadically or in an inherited autosomal dominant manner. Hereditary MTC occurs as a familial MTC or as a part of multiple endocrine neoplasia (MEN) type 2A and B syndromes. A strong genotype-phenotype correlation has been observed between hereditary MTC and germ-line “gain of function” mutations of the RET proto-oncogene. Most cases of pediatric MTC are hereditary whereas sporadic MTC is rare in children and is usually diagnosed in adults. Therefore, MTC in children is most often diagnosed in the course of a familial genetic investigation. The standard treatment of MTC mainly requires surgery involving total thyroidectomy and central neck node dissection before extrathyroidal extension occurs. To prevent MTC development in hereditary syndromes, prophylactic thyroidectomy is performed in presymptomatic patients. An appropriate age at which the surgery should take place is determined based upon the data from genotyping, serum calcitonin measurements, and ultrasonography. For the treatment of advanced MTC cases, the broad spectrum receptor tyrosine kinase inhibitors vandetanib and cabozantinib, which also inhibit RET, are used although they are not always effective. PMID:27014708

  10. Pediatric otitis media.

    PubMed

    Julien, D K; Gricar, J A; Cave, D G

    1998-12-01

    The pediatric patients with routine, easiest-to-treat otitis media utilize 2.1 office visits during the course of a PTE. This patient group also received 0.13 tests, 0.14 laboratory and pathology services, and 0.05 medical/surgical procedures during the course of a PTE. Though 29.2% of these patients did not produce a claim for prescription drug therapy, this patient group received at least 1.53 prescriptions per PTEs. One prescription drug group was used in 39.8% of all PTEs. Of the PTEs treated with a single drug group, at least 56.4% were treated with amoxicillin. Two prescription drug groups were used in 18.1% of the PTEs. The prescribing patterns of physicians using two drug groups demonstrate a wide variety of switching patterns, some of which may have cost-of-care implications. Though surgical procedures are seldom utilized in SOI-1, approximately one-half of SOI-2 PTEs undergo some type of surgical procedure. The most common surgical procedure was myringotomy with the PE-TM tubes, which represents 82% of procedures performed on SOI-2 patients. The major cost drivers in the treatment of otitis media are clinical visits and antimicrobial drugs. PMID:10338744

  11. Pediatric Arm Function Test

    PubMed Central

    Uswatte, Gitendra; Taub, Edward; Griffin, Angi; Rowe, Jan; Vogtle, Laura; Barman, Joydip

    2012-01-01

    Objective Although there are several validated upper-extremity measures in young children with cerebral palsy (CP), none primarily assess capacity to carry out actions and tasks with the more-affected arm. To address this need, we developed the Pediatric Arm Function Test (PAFT), which involves behavioral observation of how children use their more-affected arm during structured play in the laboratory or clinic. This paper evaluates the reliability and validity of the PAFT Functional Ability scale. Design In Study 1, 20 children between 2–8 years with a wide range of upper-extremity hemiparesis due to CP completed the PAFT on two occasions separated by three weeks. In Study 2, 41 children between 2–6 years with similar characteristics completed the PAFT and received a grade reflecting severity of more-affected arm motor impairment. Results In Study 1, the PAFT test-retest reliability correlation coefficient was 0.74. In Study 2, convergent validity was supported by a strong, inverse correlation (r = −0.6, p < .001) between PAFT scores and grade of impairment. Conclusions The PAFT Functional Ability scale is a reliable and valid measure of more-affected arm motor capacity in children with CP between 2–6 years. It can be employed to measure upper-extremity neurorehabilitation outcome. PMID:23103486

  12. Pediatric Mechanical Circulatory Support

    PubMed Central

    Lorts, Angela; Morales, David

    2013-01-01

    Mechanical circulatory support (MCS) in the pediatric heart failure population has a limited history especially for infants, and neonates. It has been increasingly recognized that there is a rapidly expanding population of children diagnosed and living with heart failure. This expanding population has resulted in increasing numbers of children with medically resistant end-stage heart failure. The traditional therapy for these children has been heart transplantation. However, children with heart failure unlike adults do not have symptoms until they present with end-stage heart failure and therefore, cannot safely wait for transplantation. Many of these children were bridged to heart transplantation utilizing extracorporeal membranous oxygenation as a bridge to transplant which has yielded poor results. As such, industry, clinicians, and the government have refocused interest in developing increasing numbers of MCS options for children living with heart failure as a bridge to transplantation and as a chronic therapy. In this review, we discuss MCS options for short and long-term support that are currently available for infants and children with end-stage heart failure. PMID:24368965

  13. Debriefing in pediatrics

    PubMed Central

    2015-01-01

    Debriefing is a conversational session that revolves around the sharing and examining of information after a specific event has taken place. Debriefing may follow a simulated or actual experience and provides a forum for the learners to reflect on the experience and learn from their mistakes. Originating from the military and aviation industry, it is used on a daily basis to reflect and improve the performance in other high-risk industries. Expert debriefers may facilitate the reflection by asking open-ended questions to probe into the framework of the learners and apply lessons learned to future situations. Debriefing has been proven to improve clinical outcomes such as the return of spontaneous circulation after cardiac arrest and the teaching of teamwork and communication in pediatrics. Incorporating debriefing into clinical practice would facilitate the cultural change necessary to talk more openly about team performance and learn from near misses, errors, and successes that will improve not only clinical outcome but also patient safety. PMID:25774195

  14. Allergen-specific immunotherapy in pediatric allergic asthma

    PubMed Central

    2016-01-01

    Allergen-specific immunotherapy (AIT) is the only curative way that can change the immunologic response to allergens and thus can modify the natural progression of allergic diseases. There are some important criteria which contributes significantly on efficacy of AIT, such as the allergen extract used for treatment, the dose and protocol, patient selection in addition to the severity and control of asthma. The initiation of AIT in allergic asthma should be considered in intermittent, mild and moderate cases which coexisting with other allergic diseases such as allergic rhinitis, and in case of unacceptable adverse effects of medications. Two important impact of AIT; steroid sparing effect and preventing from progression to asthma should be taken into account in pediatric asthma when making a decision on starting of AIT. Uncontrolled asthma remains a significant risk factor for adverse events and asthma should be controlled both before and during administration of AIT. The evidence concerning the efficacy of subcutaneous (SCIT) and sublingual immunotherapy (SLIT) for treatment of pediatric asthma suggested that SCIT decreases asthma symptoms and medication scores, whereas SLIT can ameliorate asthma symptoms. Although the effectiveness of SCIT has been shown for both seasonal and perennial allergens, the data for SLIT is less convincing for perennial allergies in pediatric asthma. PMID:27489785

  15. Allergen-specific immunotherapy in pediatric allergic asthma.

    PubMed

    Yukselen, Ayfer

    2016-07-01

    Allergen-specific immunotherapy (AIT) is the only curative way that can change the immunologic response to allergens and thus can modify the natural progression of allergic diseases. There are some important criteria which contributes significantly on efficacy of AIT, such as the allergen extract used for treatment, the dose and protocol, patient selection in addition to the severity and control of asthma. The initiation of AIT in allergic asthma should be considered in intermittent, mild and moderate cases which coexisting with other allergic diseases such as allergic rhinitis, and in case of unacceptable adverse effects of medications. Two important impact of AIT; steroid sparing effect and preventing from progression to asthma should be taken into account in pediatric asthma when making a decision on starting of AIT. Uncontrolled asthma remains a significant risk factor for adverse events and asthma should be controlled both before and during administration of AIT. The evidence concerning the efficacy of subcutaneous (SCIT) and sublingual immunotherapy (SLIT) for treatment of pediatric asthma suggested that SCIT decreases asthma symptoms and medication scores, whereas SLIT can ameliorate asthma symptoms. Although the effectiveness of SCIT has been shown for both seasonal and perennial allergens, the data for SLIT is less convincing for perennial allergies in pediatric asthma. PMID:27489785

  16. Plasmaphresis therapy for pulmonary hemorrhage in a pediatric patient with IgA nephropathy

    PubMed Central

    Yim, Dae-Kyoon; Lee, Sang-Taek

    2015-01-01

    IgA nephropathy usually presents as asymptomatic microscopic hematuria or proteinuria or episodic gross hematuria after upper respiratory infection. It is an uncommon cause of end-stage renal failure in childhood. Pulmonary hemorrhage associated with IgA nephropathy is an unusual life-threatening manifestation in pediatric patients and is usually treated with aggressive immunosuppression. Pulmonary hemorrhage and renal failure usually occur concurrently, and the pulmonary manifestation is believed to be caused by the same immune process. We present the case of a 14-year-old patient with IgA nephropathy who had already progressed to end-stage renal failure in spite of immunosuppression and presented with pulmonary hemorrhage during oral prednisone treatment. His lung disease was comparable to diffuse alveolar hemorrhage and was successfully treated with plasmapheresis followed by oral prednisone. This case suggests that pulmonary hemorrhage may develop independently of renal manifestation, and that plasmapheresis should be considered as adjunctive therapy to immunosuppressive medication for treating IgA nephropathy with pulmonary hemorrhage. PMID:26576186

  17. Pediatric Interventional Radiology: Vascular Interventions.

    PubMed

    Kandasamy, Devasenathipathy; Gamanagatti, Shivanand; Gupta, Arun Kumar

    2016-07-01

    Pediatric interventional radiology (PIR) comprises a range of minimally invasive diagnostic and therapeutic procedures that are performed using image guidance. PIR has emerged as an essential adjunct to various surgical and medical conditions. Over the years, technology has undergone dramatic and continuous evolution, making this speciality grow. In this review, the authors will discuss various vascular interventional procedures undertaken in pediatric patients. It is challenging for the interventional radiologist to accomplish a successful interventional procedure. There are many vascular interventional radiology procedures which are being performed and have changed the way the diseases are managed. Some of the procedures are life saving and have become the treatment of choice in those patients. The future is indeed bright for the practice and practitioners of pediatric vascular and non-vascular interventions. As more and more of the procedures that are currently being performed in adults get gradually adapted for use in the pediatric population, it may be possible to perform safe and successful interventions in many of the pediatric vascular lesions that are otherwise being referred for surgery. PMID:26964551

  18. Integrated Molecular Genetic Profiling of Pediatric High-Grade Gliomas Reveals Key Differences With the Adult Disease

    PubMed Central

    Paugh, Barbara S.; Qu, Chunxu; Jones, Chris; Liu, Zhaoli; Adamowicz-Brice, Martyna; Zhang, Junyuan; Bax, Dorine A.; Coyle, Beth; Barrow, Jennifer; Hargrave, Darren; Lowe, James; Gajjar, Amar; Zhao, Wei; Broniscer, Alberto; Ellison, David W.; Grundy, Richard G.; Baker, Suzanne J.

    2010-01-01

    Purpose To define copy number alterations and gene expression signatures underlying pediatric high-grade glioma (HGG). Patients and Methods We conducted a high-resolution analysis of genomic imbalances in 78 de novo pediatric HGGs, including seven diffuse intrinsic pontine gliomas, and 10 HGGs arising in children who received cranial irradiation for a previous cancer using single nucleotide polymorphism microarray analysis. Gene expression was analyzed with gene expression microarrays for 53 tumors. Results were compared with publicly available data from adult tumors. Results Significant differences in copy number alterations distinguish childhood and adult glioblastoma. PDGFRA was the predominant target of focal amplification in childhood HGG, including diffuse intrinsic pontine gliomas, and gene expression analyses supported an important role for deregulated PDGFRα signaling in pediatric HGG. No IDH1 hotspot mutations were found in pediatric tumors, highlighting molecular differences with adult secondary glioblastoma. Pediatric and adult glioblastomas were clearly distinguished by frequent gain of chromosome 1q (30% v 9%, respectively) and lower frequency of chromosome 7 gain (13% v 74%, respectively) and 10q loss (35% v 80%, respectively). PDGFRA amplification and 1q gain occurred at significantly higher frequency in irradiation-induced tumors, suggesting that these are initiating events in childhood gliomagenesis. A subset of pediatric HGGs showed minimal copy number changes. Conclusion Integrated molecular profiling showed substantial differences in the molecular features underlying pediatric and adult HGG, indicating that findings in adult tumors cannot be simply extrapolated to younger patients. PDGFRα may be a useful target for pediatric HGG, including diffuse pontine gliomas. PMID:20479398

  19. Japanese consensus guidelines for pediatric nuclear medicine. Part 1: Pediatric radiopharmaceutical administered doses (JSNM pediatric dosage card). Part 2: Technical considerations for pediatric nuclear medicine imaging procedures.

    PubMed

    Koizumi, Kiyoshi; Masaki, Hidekazu; Matsuda, Hiroshi; Uchiyama, Mayuki; Okuno, Mitsuo; Oguma, Eiji; Onuma, Hiroshi; Kanegawa, Kimio; Kanaya, Shinichi; Kamiyama, Hiroshi; Karasawa, Kensuke; Kitamura, Masayuki; Kida, Tetsuo; Kono, Tatsuo; Kondo, Chisato; Sasaki, Masayuki; Terada, Hitoshi; Nakanishi, Atsushi; Hashimoto, Teisuke; Hataya, Hiroshi; Hamano, Shin-ichiro; Hirono, Keishi; Fujita, Yukihiko; Hoshino, Ken; Yano, Masayuki; Watanabe, Seiichi

    2014-06-01

    The Japanese Society of Nuclear Medicine has recently published the consensus guidelines for pediatric nuclear medicine. This article is the English version of the guidelines. Part 1 proposes the dose optimization in pediatric nuclear medicine studies. Part 2 comprehensively discusses imaging techniques for the appropriate conduct of pediatric nuclear medicine procedures, considering the characteristics of imaging in children. PMID:24647992

  20. Pediatric cochlear implantation: an update.

    PubMed

    Vincenti, Vincenzo; Bacciu, Andrea; Guida, Maurizio; Marra, Francesca; Bertoldi, Barbara; Bacciu, Salvatore; Pasanisi, Enrico

    2014-01-01

    Deafness in pediatric age can adversely impact language acquisition as well as educational and social-emotional development. Once diagnosed, hearing loss should be rehabilitated early; the goal is to provide the child with maximum access to the acoustic features of speech within a listening range that is safe and comfortable. In presence of severe to profound deafness, benefit from auditory amplification cannot be enough to allow a proper language development. Cochlear implants are partially implantable electronic devices designed to provide profoundly deafened patients with hearing sensitivity within the speech range. Since their introduction more than 30 years ago, cochlear implants have improved their performance to the extent that are now considered to be standard of care in the treatment of children with severe to profound deafness. Over the years patient candidacy has been expanded and the criteria for implantation continue to evolve within the paediatric population. The minimum age for implantation has progressively reduced; it has been recognized that implantation at a very early age (12-18 months) provides children with the best outcomes, taking advantage of sensitive periods of auditory development. Bilateral implantation offers a better sound localization, as well as a superior ability to understand speech in noisy environments than unilateral cochlear implant. Deafened children with special clinical situations, including inner ear malformation, cochlear nerve deficiency, cochlear ossification, and additional disabilities can be successfully treated, even thogh they require an individualized candidacy evaluation and a complex post-implantation rehabilitation. Benefits from cochlear implantation include not only better abilities to hear and to develop speech and language skills, but also improved academic attainment, improved quality of life, and better employment status. Cochlear implants permit deaf people to hear, but they have a long way to go before

  1. [Notes for the history of pediatric gastroenterology in Peru].

    PubMed

    Álvarez Carrasco, Ricardo Iván

    2015-01-01

    The Pediatric Gastroenterology and Nutrition in Peru, is one of the subspecialties of Pediatrics that has experienced one of the most significant growth in recent decades, however, to achieve this seat it should have passed a long way built through the efforts and talent hundreds of doctors for several generations. Its modern history began in 1981 with the creation of the first unit of the specialty in the National Institute of Child Health (INSN), followed by the establishment of the second specialization that contributed to its spread and progress of several hospitals in the country, and many of them now have a doctor of this specialty. Our purpose is to plant the foundations of that story, whose extension go beyond the space that allows us an article. PMID:26397286

  2. Cellular and Antibody Based Approaches for Pediatric Cancer Immunotherapy

    PubMed Central

    Huang, Michael A.; Krishnadas, Deepa K.; Lucas, Kenneth G.

    2015-01-01

    Progress in the use of traditional chemotherapy and radiation-based strategies for the treatment of pediatric malignancies has plateaued in the past decade, particularly for patients with relapsing or therapy refractory disease. As a result, cellular and humoral immunotherapy approaches have been investigated for several childhood cancers. Several monoclonal antibodies are now FDA approved and commercially available, some of which are currently considered standard of practice. There are also several new cellular immunotherapy approaches under investigation, including chimeric antigen receptor (CAR) modified T cells, cancer vaccines and adjuvants, and natural killer (NK) cell therapies. In this review, we will discuss previous studies on pediatric cancer immunotherapy and new approaches that are currently being investigated in clinical trials. PMID:26587548

  3. Vismodegib Exerts Targeted Efficacy Against Recurrent Sonic Hedgehog–Subgroup Medulloblastoma: Results From Phase II Pediatric Brain Tumor Consortium Studies PBTC-025B and PBTC-032

    PubMed Central

    Robinson, Giles W.; Orr, Brent A.; Wu, Gang; Gururangan, Sridharan; Lin, Tong; Qaddoumi, Ibrahim; Packer, Roger J.; Goldman, Stewart; Prados, Michael D.; Desjardins, Annick; Chintagumpala, Murali; Takebe, Naoko; Kaste, Sue C.; Rusch, Michael; Allen, Sariah J.; Onar-Thomas, Arzu; Stewart, Clinton F.; Fouladi, Maryam; Boyett, James M.; Gilbertson, Richard J.; Curran, Tom; Ellison, David W.; Gajjar, Amar

    2015-01-01

    Purpose Two phase II studies assessed the efficacy of vismodegib, a sonic hedgehog (SHH) pathway inhibitor that binds smoothened (SMO), in pediatric and adult recurrent medulloblastoma (MB). Patients and Methods Adult patients enrolled onto PBTC-025B and pediatric patients enrolled onto PBTC-032 were treated with vismodegib (150 to 300 mg/d). Protocol-defined response, which had to be sustained for 8 weeks, was confirmed by central neuroimaging review. Molecular tests to identify patterns of response and insensitivity were performed when tissue was available. Results A total of 31 patients were enrolled onto PBTC-025B, and 12 were enrolled onto PBTC-032. Three patients in PBTC-025B and one in PBTC-032, all with SHH-subgroup MB (SHH-MB), exhibited protocol-defined responses. Progression-free survival (PFS) was longer in those with SHH-MB than in those with non-SHH–MB, and prolonged disease stabilization occurred in 41% of patient cases of SHH-MB. Among those with SHH-MB, loss of heterozygosity of PTCH1 was associated with prolonged PFS, and diffuse staining of P53 was associated with reduced PFS. Whole-exome sequencing identified mutations in SHH genes downstream from SMO in four of four tissue samples from nonresponders and upstream of SMO in two of four patients with favorable responses. Conclusion Vismodegib exhibits activity against adult recurrent SHH-MB but not against recurrent non-SHH–MB. Inadequate accrual of pediatric patients precluded conclusions in this population. Molecular analyses support the hypothesis that SMO inhibitor activity depends on the genomic aberrations within the tumor. Such inhibitors should be advanced in SHH-MB studies; however, molecular and genomic work remains imperative to identify target populations that will truly benefit. PMID:26169613

  4. Pharmacologic treatment of pediatric insomnia.

    PubMed

    Owens, Judith A; Moturi, Sricharan

    2009-10-01

    Pediatric insomnia is common in children and adolescents, particularly in children who have comorbid medical, psychiatric, and neurodevelopmental disorders, and may be associated with cognitive, emotional, and psychosocial impairments that often result in significant caregiver burden. Although several behavioral interventions for pediatric insomnia are effective, there is a relative paucity of empiric evidence supporting the use of pharmacologic treatment. Sedative/hypnotic drugs are frequently used in clinical practice to treat pediatric insomnia, and guidelines for the use of these medications in general as well as for specific medications have been developed. This review presents expert consensus guidelines for the use of these medications in clinical practice, with a focus on the different classes of pharmacologic agents that are most commonly prescribed. PMID:19836701

  5. Antibiotic resistance in pediatric urology

    PubMed Central

    Copp, Hillary L.

    2014-01-01

    Antibiotics are a mainstay in the treatment of bacterial infections, though their use is a primary risk factor for the development of antibiotic resistance. Antibiotic resistance is a growing problem in pediatric urology as demonstrated by increased uropathogen resistance. Lack of urine testing, nonselective use of prophylaxis, and poor empiric prescribing practices exacerbate this problem. This article reviews antibiotic utilization in pediatric urology with emphasis on modifiable practice patterns to potentially help mitigate the growing rates of antibiotic resistance. This includes urine testing to only treat when indicated and tailor broad-spectrum therapy as able; selective application of antibiotic prophylaxis to patients with high-grade vesicoureteral reflux and hydronephrosis with counseling regarding the importance of compliance; and using local antiobiograms, particularly pediatric-specific antiobiograms, with inpatient versus outpatient data. PMID:24688601

  6. Pediatric Obesity: Etiology and Treatment

    PubMed Central

    Crocker, Melissa K.; Yanovski, Jack A.

    2009-01-01

    Synopsis This paper reviews factors that contribute to excessive weight gain in children and outlines current knowledge regarding approaches for treating pediatric obesity. Virtually all of the known genetic causes of obesity primarily increase energy intake. Genes regulating the leptin signaling pathway are particularly important for human energy homeostasis. Obesity is a chronic disorder that requires long-term strategies for management. The foundation for all treatments for pediatric obesity remains restriction of energy intake with lifestyle modification. There are few long-term studies of pharmacotherapeutic interventions for pediatric obesity. Bariatric surgical approaches are the most efficacious obesity treatments but, because of their potential risks, are reserved for those with the most significant complications of obesity. PMID:19717003

  7. The Genetics of Pediatric Obesity.

    PubMed

    Chesi, Alessandra; Grant, Struan F A

    2015-12-01

    Obesity among children and adults has notably escalated over recent decades and represents a global major health problem. We now know that both genetic and environmental factors contribute to its complex etiology. Genome-wide association studies (GWAS) have revealed compelling genetic signals influencing obesity risk in adults. Recent reports for childhood obesity revealed that many adult loci also play a role in the pediatric setting. Childhood GWAS have uncovered novel loci below the detection range in adult studies, suggesting that obesity genes may be more easily uncovered in the pediatric setting. Shedding light on the genetic architecture of childhood obesity will facilitate the prevention and treatment of pediatric cases, and will have fundamental implications for diseases that present later in life. PMID:26439977

  8. Sudden Cardiac Arrest in Pediatrics.

    PubMed

    Scheller, RoseAnn L; Johnson, Laurie; Lorts, Angela; Ryan, Thomas D

    2016-09-01

    Sudden cardiac arrest (SCA) in the pediatric population is a rare and potentially devastating occurrence. An understanding of the differential diagnosis for the etiology of the cardiac arrest allows for the most effective emergency care and provides the patient with the best possible outcome. Pediatric SCA can occur with or without prodromal symptoms and may occur during exercise or rest. The most common cause is arrhythmia secondary to an underlying channelopathy, cardiomyopathy, or myocarditis. After stabilization, evaluation should include electrocardiogram, chest radiograph, and echocardiogram. Management should focus on decreasing the potential for recurring arrhythmia, maintaining cardiac preload, and thoughtful medication use to prevent exacerbation of the underlying condition. The purpose of this review was to provide the emergency physician with a concise and current review of the incidence, differential diagnosis, and management of pediatric patients presenting with SCA. PMID:27585126

  9. Pediatric transverse myelitis.

    PubMed

    Absoud, Michael; Greenberg, Benjamin M; Lim, Ming; Lotze, Tim; Thomas, Terrence; Deiva, Kumaran

    2016-08-30

    Pediatric acute transverse myelitis (ATM) is an immune-mediated CNS disorder and contributes to 20% of children experiencing a first acquired demyelinating syndrome (ADS). ATM must be differentiated from other presentations of myelopathy and may be the first presentation of relapsing ADS such as neuromyelitis optica (NMO) or multiple sclerosis (MS). The tenets of the diagnostic criteria for ATM established by the Transverse Myelitis Consortium Working Group can generally be applied in children; however, a clear sensory level may not be evident in some. MRI lesions are often centrally located with high T2 signal intensity involving gray and neighboring white matter. Longitudinally extensive ATM occurs in the majority. Asymptomatic lesions on brain MRI are seen in more than one-third and predict MS or NMO. The role of antibodies such as myelin oligodendrocyte glycoprotein in monophasic and relapsing ATM and their significance in therapeutic approaches remain unclear. ATM is a potentially devastating condition with variable outcome and presents significant cumulative demands on health and social care resources. Children generally have a better outcome than adults, with one-half making a complete recovery by 2 years. There is need for standardization of clinical assessment and investigation protocols to enable international collaborative studies to delineate prognostic factors for disability and relapse. There are no robust controlled trials in children or adults to inform optimal treatment of ATM, with one study currently open to recruitment. This review provides an overview of current knowledge of clinical features, investigative workup, pathogenesis, and management of ATM and suggests future directions. PMID:27572861

  10. Neuroimaging of pediatric intracranial infection--part 1: techniques and bacterial infections.

    PubMed

    Nickerson, Joshua P; Richner, Beat; Santy, Ky; Lequin, Maarten H; Poretti, Andrea; Filippi, Christopher G; Huisman, Thierry A G M

    2012-04-01

    Conventional and advanced neuroimaging have become central to the diagnosis of infectious diseases of the pediatric central nervous system. Imaging modalities used by (pediatric) neuroradiologists include cranial ultrasound, computed tomography, and magnetic resonance imaging, including advanced techniques such as diffusion weighted or tensor imaging, perfusion weighted imaging, susceptibility weighted imaging, and (1) H magnetic resonance spectroscopy. In this first of a two part review, imaging techniques in general and the imaging findings of bacterial infections of the intracranial compartment including epidural empyema, subdural empyema, meningitis, cerebritis, cerebral abscess, and pyogenic intraventricular empyema (ventriculitis) are discussed. PMID:22304299

  11. Pharmacologic Treatment of Pediatric Hypertension.

    PubMed

    Dhull, Rachita S; Baracco, Rossana; Jain, Amrish; Mattoo, Tej K

    2016-04-01

    Prevalence of hypertension is increasing in children and adolescents. Uncontrolled hypertension in children not only causes end organ damage but also increases the risk of adult hypertension and cardiovascular disease. Clinical trials have proven efficacy of antihypertensive medications in children. These medications are well tolerated by children with acceptable safety profile. The choice of agent is usually driven by underlying etiology of hypertension, profile of its side effects, and clinician's preference. This article will review currently available pediatric data on mechanism of action, common adverse effects, pediatric indication, recent clinical trial, and newer drugs in the common classes of antihypertensive medications. PMID:27048353

  12. Diagnostic imaging in pediatric emergencies

    SciTech Connect

    Heller, R.M.; Coulam, C.M.; Allen, J.H.; Fleischer, A.; Lee, G.S.; Kirchner, S.G.; James A.E. Jr.

    1980-07-01

    Evaluation of pediatric emergencies by diagnostic imaging technics can involve both invasive and noninvasive procedures. Nuclear medicine, conventional radiography, ultrasound, computerized axial tomography, and xeroradiography are the major nonangiographic diagnostic technics available for patient evaluation. We will emphasize the use of computerized axial tomography, nuclear medicine, xeroradiography, and ultrasound in the evaluation of emergencies in the pediatric age group. Since the radiologist is the primary consultant with regard to diagnostic imaging, his knowledge of these modulities can greatly influence patient care and clinical results.

  13. Medication Errors in Outpatient Pediatrics.

    PubMed

    Berrier, Kyla

    2016-01-01

    Medication errors may occur during parental administration of prescription and over-the-counter medications in the outpatient pediatric setting. Misinterpretation of medication labels and dosing errors are two types of errors in medication administration. Health literacy may play an important role in parents' ability to safely manage their child's medication regimen. There are several proposed strategies for decreasing these medication administration errors, including using standardized dosing instruments, using strictly metric units for medication dosing, and providing parents and caregivers with picture-based dosing instructions. Pediatric healthcare providers should be aware of these strategies and seek to implement many of them into their practices. PMID:27537086

  14. Reslizumab for pediatric eosinophilic esophagitis.

    PubMed

    Walsh, Garry M

    2010-07-01

    Pediatric eosinophilic esophagitis is an inflammatory condition associated with marked eosinophil accumulation in the mucosal tissues of the esophagus. Eosinophils are major proinflammatory cells thought to make a major contribution to allergic diseases that affect the upper and lower airways, skin and GI tract. IL-5 is central to eosinophil maturation and release from the bone marrow, and their subsequent accumulation, activation and persistence in the tissues. Reslizumab (Cinquil, Ception Therapeutics Inc., PA, USA) is a humanized monoclonal antibody with potent IL-5 neutralizing effects that represents a potential treatment for eosinophilic diseases. This article considers the current status of the clinical development of reslizumab for pediatric eosinophilic esophagitis. PMID:20636000

  15. Multidisciplinary care in pediatric oncology

    PubMed Central

    Cantrell, Mary Ann; Ruble, Kathy

    2011-01-01

    This paper describes the significant advances in the treatment of childhood cancer and supportive care that have occurred over the last several decades and details how these advances have led to improved survival and quality of life (QOL) for children with cancer through a multidisciplinary approach to care. Advances in the basic sciences, general medicine, cooperative research protocols, and policy guidelines have influenced and guided the multidisciplinary approach in pediatric oncology care across the spectrum from diagnosis through long-term survival. Two case studies are provided to highlight the nature and scope of multidisciplinary care in pediatric oncology care. PMID:21811384

  16. Psychoneuroimmunology and the pediatric surgeon.

    PubMed

    Tagge, Edward P; Natali, Elizabeth Lee; Lima, Evan; Leek, Dustin; Neece, Cameron L; Randall, Kiti Freier

    2013-08-01

    The mind-body connection is receiving increasing scrutiny in a large number of clinical settings, although research has lagged in the pediatric specialties. Psychoneuroimmunology (PNI) is a novel interdisciplinary scientific field that examines the relationship of the mind to the patient's neurologic, endocrine, and immune systems by examining critical parameters such as the effects of mental stress on wound healing and infection rates. Techniques that modify a patient's emotional and mental responses to illness and surgery have positive effects on their physiology resulting in improved recoveries and higher patient satisfaction rates. In the appropriate clinical settings, an awareness of PNI can enhance outcomes for pediatric surgical patients. PMID:23870208

  17. Pediatric Urology for the General Surgeon.

    PubMed

    Chalmers, David J; Vemulakonda, Vijaya M

    2016-06-01

    Pediatric urology spans the neonatal period through the transition into early adulthood. There are a variety of common pediatric urologic conditions that overlap significantly with pediatric surgery. This article reviews the pertinent pathophysiology of a few key disease processes, including the pediatric inguinal hernia and/or hydrocele, cryptorchidism, and circumcision. General surgeons may find themselves in the position of managing these problems primarily, particularly in rural areas that may lack pediatric subspecialization. An understanding of the fundamentals can guide appropriate initial management. Additional focus is devoted to the management of genitourinary trauma to guide the general surgeon in more acute, emergent settings. PMID:27261794

  18. Setting up the Pediatric Endoscopy Unit.

    PubMed

    Lerner, Diana G; Pall, Harpreet

    2016-01-01

    As pediatric gastrointestinal endoscopy continues to develop and evolve, pediatric gastroenterologists are more frequently called on to develop and direct a pediatric endoscopy unit. Lack of published literature and focused training in fellowship can render decision making about design, capacity, operation, equipment purchasing, and staffing challenging. To help guide management decisions, we distributed a short survey to 18 pediatric gastroenterology centers throughout the United States and Canada. This article provides practical guidance by summarizing available expert opinions on the topic of setting up a pediatric endoscopy unit. PMID:26616893

  19. Recent Developments in the Assessment and Treatment of Pediatric Obsessive-Compulsive Disorder

    ERIC Educational Resources Information Center

    Berman, Noah C.; Abramowitz, Jonathan S.

    2010-01-01

    Although tremendous strides have recently been made in the development of assessment and treatment methods for pediatric obsessive-compulsive disorder (OCD), more accurate methods for diagnosis, more effective treatments, and more refined instruments for monitoring progress during therapy are still needed. The present commentary highlights the…

  20. Pediatric cancer gone viral. Part I: strategies for utilizing oncolytic herpes simplex virus-1 in children

    PubMed Central

    Cripe, Timothy P; Chen, Chun-Yu; Denton, Nicholas L; Haworth, Kellie B; Hutzen, Brian; Leddon, Jennifer L; Streby, Keri A; Wang, Pin-Yi; Markert, James M; Waters, Alicia M; Gillespie, George Yancey; Beierle, Elizabeth A; Friedman, Gregory K

    2015-01-01

    Progress for improving outcomes in pediatric patients with solid tumors remains slow. In addition, currently available therapies are fraught with numerous side effects, often causing significant life-long morbidity for long-term survivors. The use of viruses to kill tumor cells based on their increased vulnerability to infection is gaining traction, with several viruses moving through early and advanced phase clinical testing. The prospect of increased efficacy and decreased toxicity with these agents is thus attractive for pediatric cancer. In part I of this two-part review, we focus on strategies for utilizing oncolytic engineered herpes simplex virus (HSV) to target pediatric malignancies. We discuss mechanisms of action, routes of delivery, and the role of preexisting immunity on antitumor efficacy. Challenges to maximizing oncolytic HSV in children are examined, and we highlight how these may be overcome through various arming strategies. We review the preclinical and clinical evidence demonstrating safety of a variety of oncolytic HSVs. In Part II, we focus on the antitumor efficacy of oncolytic HSV in pediatric tumor types, pediatric clinical advances made to date, and future prospects for utilizing HSV in pediatric patients with solid tumors. PMID:26436135

  1. Preliminary report on the diffusion of solids

    USGS Publications Warehouse

    Van Orstrand, C. E.; Dewey, F.P.

    1916-01-01

    Although 19 years has elapsed since Roberts-Austen published his classical paper on the diffusion of solid metals, no attempt seems to have been made to verify his important results and conclusions or to extend the investigations to minerals and to the great number of solids in which diffusion may be expected to occur. Progress has been made by means of chemical and electrical methods in the detection of diffusion in a number of metals in the solid state, some progress has been made in explaining the phenomena of diffusion on the basis of osmotic pressure and the kinetic theory, and recent measurements of the vapor pressures of solids have contributed indirectly to the progress of the science, but investigators have not undertaken the difficult and essential task of making definitive determinations of the coefficients of diffusivity at various pressures and temperatures.

  2. Galactic Diffuse Polarized Emission

    NASA Astrophysics Data System (ADS)

    Carretti, Ettore

    2011-12-01

    Diffuse polarized emission by synchrotron is a key tool to investigate magnetic fields in the Milky Way, particularly the ordered component of the large scale structure. Key observables are the synchrotron emission itself and the RM is by Faraday rotation. In this paper the main properties of the radio polarized diffuse emission and its use to investigate magnetic fields will be reviewed along with our current understanding of the galactic magnetic field and the data sets available. We will then focus on the future perspective discussing RM-synthesis - the new powerful instrument devised to unlock the information encoded in such an emission - and the surveys currently in progress like S-PASS and GMIMS.

  3. [Cerebrolysin in pediatric neurology practice].

    PubMed

    Petrukhin, A S; Pylaeva, O A

    2014-01-01

    Мany aspects of сerebrolysin treatment in a wide range of nervous system disorders in children are described. High efficacy and well tolerated therapy are revealed. These findings expand the perspectives of using сerebrolysin in pediatric neurology. PMID:24637827

  4. Pediatric imaging for the technologist

    SciTech Connect

    Sharko, G.; Wilmont, D.

    1987-01-01

    This book discusses the diagnostic techniques of radiology in pediatric patients. The topics discussed are: Computed tomography; radiography of skull, face, abdomen, skeleton; nuclear medicine; quality control of image processing and radiation doses of patients and standards of radiation protection of patients.

  5. Current concepts in pediatric endocrinology

    SciTech Connect

    Styne, D.M.; Brook, C.G.D.

    1987-01-01

    This book contains seven chapters. They are: Recombinant DNA Technology; The HLA System in Congenital Adrenal Hyperplasia; Neuroendocrinology; Circadian Rhythms; Basic Aspects and Pediatric Implications; New Treatment Methods in Diabetes Mellitus; The Insulin-Like Growth Factors; and Hypopituitarism: Review of Behavioral Data.

  6. Antibody Therapy for Pediatric Leukemia

    PubMed Central

    Vedi, Aditi; Ziegler, David S.

    2014-01-01

    Despite increasing cure rates for pediatric leukemia, relapsed disease still carries a poor prognosis with significant morbidity and mortality. Novel targeted therapies are currently being investigated in an attempt to reduce adverse events and improve survival outcomes. Antibody therapies represent a form of targeted therapy that offers a new treatment paradigm. Monoclonal antibodies are active in pediatric acute lymphoblastic leukemia (ALL) and are currently in Phase III trials. Antibody-drug conjugates (ADCs) are the next generation of antibodies where a highly potent cytotoxic agent is bound to an antibody by a linker, resulting in selective targeting of leukemia cells. ADCs are currently being tested in clinical trials for pediatric acute myeloid leukemia and ALL. Bispecific T cell engager (BiTE) antibodies are a construct whereby each antibody contains two binding sites, with one designed to engage the patient’s own immune system and the other to target malignant cells. BiTE antibodies show great promise as a novel and effective therapy for childhood leukemia. This review will outline recent developments in targeted agents for pediatric leukemia including monoclonal antibodies, ADCs, and BiTE antibodies. PMID:24795859

  7. PEDIATRIC NUTRITION SURVEILLANCE SYSTEM (PEDNSS)

    EPA Science Inventory

    The Pediatric Nutrition Surveillance System (PedNSS) is a program-based surveillance system designed to monitor the growth, anemia, and breast-feeding status of low-income U.S. children who participate in federally funded maternal and child health nutritional programs. The system...

  8. Percutaneous nephrolithotomy for pediatric urolithiasis

    PubMed Central

    Ganpule, Arvind P.; Mishra, Shashikant; Desai, Mahesh R.

    2010-01-01

    Pediatric urolithiasis is a management dilemma as a number of treatment options are available such as shock wave lithotripsy (SWL), percutaneous nephrolithotomy (PCNL), and retrograde intrarenal surgery (RIRS). PCNL offers good clearance rates in a single hospital stay. The concerns with PCNL include the use of large instrument in pediatric kidneys, parenchymal damage and the associated effects on renal function, radiation exposure with fluoroscopy, and the risk of major complications including sepsis and bleeding. Evolution of pediatric PCNL technique such as miniaturization of instruments, limitation of tract size and advanced intracorporeal lithotripters have resulted in this technique being widely utilized for achieving stone-free status in appropriate patients. Many of the patients in our country come from remote areas thereby requiring special considerations during treatment. This also necessitates complete clearance in a single shorter hospital stay. PCNL appears to be the optimal option available in this scenario. The literature suggests that even complex and staghorn calculi can be tackled with this approach. The choice of the method to gain access is a matter of experience and personal preference. Ultrasound offers the advantage of visualization of spleen, liver and avoids injury. Miniaturization of instruments, particularly smaller nephroscopes and the potential to use lasers will decrease the morbidity and improve the clearance rates further. In this article, we analyze the management of pediatric urolithiasis with PCNL. We discuss our technique and analyze the results, complications and technique mentioned in the contemporary literature. PMID:21369389

  9. Pulse oximetry in pediatric practice.

    PubMed

    Fouzas, Sotirios; Priftis, Kostas N; Anthracopoulos, Michael B

    2011-10-01

    The introduction of pulse oximetry in clinical practice has allowed for simple, noninvasive, and reasonably accurate estimation of arterial oxygen saturation. Pulse oximetry is routinely used in the emergency department, the pediatric ward, and in pediatric intensive and perioperative care. However, clinically relevant principles and inherent limitations of the method are not always well understood by health care professionals caring for children. The calculation of the percentage of arterial oxyhemoglobin is based on the distinct characteristics of light absorption in the red and infrared spectra by oxygenated versus deoxygenated hemoglobin and takes advantage of the variation in light absorption caused by the pulsatility of arterial blood. Computation of oxygen saturation is achieved with the use of calibration algorithms. Safe use of pulse oximetry requires knowledge of its limitations, which include motion artifacts, poor perfusion at the site of measurement, irregular rhythms, ambient light or electromagnetic interference, skin pigmentation, nail polish, calibration assumptions, probe positioning, time lag in detecting hypoxic events, venous pulsation, intravenous dyes, and presence of abnormal hemoglobin molecules. In this review we describe the physiologic principles and limitations of pulse oximetry, discuss normal values, and highlight its importance in common pediatric diseases, in which the principle mechanism of hypoxemia is ventilation/perfusion mismatch (eg, asthma exacerbation, acute bronchiolitis, pneumonia) versus hypoventilation (eg, laryngotracheitis, vocal cord dysfunction, foreign-body aspiration in the larynx or trachea). Additional technologic advancements in pulse oximetry and its incorporation into evidence-based clinical algorithms will improve the efficiency of the method in daily pediatric practice. PMID:21930554

  10. Ultrasonography: Applications in Pediatric Abdomen.

    PubMed

    Saxena, Akshay Kumar; Gupta, Pankaj; Sodhi, Kushaljit Singh

    2016-06-01

    Ultrasonography (US) is a valuable imaging tool for evaluation of different clinical conditions in children, in general and abdominal conditions, in particular. The interest in US derives primarily from the lack of ionizing radiation exposure, low cost, portability, real-time imaging and Doppler capabilities. In addition, US application requires no preparation or sedation, making it particularly attractive in the pediatric population. Because of these advantages, US has been adopted as the primary imaging tool for evaluation of a number of pediatric abdominal conditions that would have involved the use of ionising radiation in the past, e.g., pyloric stenosis, intussusception and various renal and bladder abnormalities, to name a few. Certain limitations, however, are inherent to US including large body habitus, excessive bowel gas, postoperative state and the learning curve. In addition, pediatric US is particularly challenging as the children are frequently unable to co-operate for breath holding and many of them are crying during the scanning. In the present review, the authors discuss the various applications of US in the evaluation of pediatric abdomen. PMID:26973334

  11. Approach to Pediatric Chest Radiograph.

    PubMed

    Jana, Manisha; Bhalla, Ashu Seith; Gupta, Arun Kumar

    2016-06-01

    Chest radiograph remains the first line imaging modality even today, especially in ICU settings. Hence proper interpretation of chest radiographs is crucial, which can be achieved by adopting a systematic approach and proper description and identification of abnormalities. In this review, the authors describe a short and comprehensive way of interpreting the pediatric chest radiograph. PMID:26983619

  12. Pediatric melioidosis in Southern India.

    PubMed

    Mukhopadhyay, Chiranjay; Eshwara, Vandana K; Kini, Pushpa; Bhat, Vinod

    2015-08-01

    Melioidosis in children is increasingly detected from the coastal region of Southern India during monsoon. We present 11 cases of melioidosis, ranging from localized to disseminated, treated successfully, barring one death. It calls for awareness and upgrading laboratory facilities for better diagnosis and management of pediatric melioidosis. PMID:26388638

  13. Advances in pediatrics. Volume 31

    SciTech Connect

    Barness, L.A.

    1984-01-01

    This book discusses the advances made in pediatrics. The topics discussed are--Molecular biology of thalassemia; genetic mapping of humans; technology of recombinant-DNA; DNA-sequencing and human chromosomes and etiology of hereditary diseases; acne; and T-cell abnormalities.

  14. Standards for Pediatric Immunization Practices.

    ERIC Educational Resources Information Center

    Centers for Disease Control (DHHS/PHS), Atlanta, GA.

    This booklet outlines 18 national standards for pediatric immunizations. The standards were developed by a 35-member working group drawn from 24 different public and private sector organizations and from numerous state and local health departments and approved by the U.S. Public Health Service. The first three standards state that: immunization…

  15. Coagulopathy after severe pediatric trauma.

    PubMed

    Christiaans, Sarah C; Duhachek-Stapelman, Amy L; Russell, Robert T; Lisco, Steven J; Kerby, Jeffrey D; Pittet, Jean-François

    2014-06-01

    Trauma remains the leading cause of morbidity and mortality in the United States among children aged 1 to 21 years. The most common cause of lethality in pediatric trauma is traumatic brain injury. Early coagulopathy has been commonly observed after severe trauma and is usually associated with severe hemorrhage and/or traumatic brain injury. In contrast to adult patients, massive bleeding is less common after pediatric trauma. The classical drivers of trauma-induced coagulopathy include hypothermia, acidosis, hemodilution, and consumption of coagulation factors secondary to local activation of the coagulation system after severe traumatic injury. Furthermore, there is also recent evidence for a distinct mechanism of trauma-induced coagulopathy that involves the activation of the anticoagulant protein C pathway. Whether this new mechanism of posttraumatic coagulopathy plays a role in children is still unknown. The goal of this review is to summarize the current knowledge on the incidence and potential mechanisms of coagulopathy after pediatric trauma and the role of rapid diagnostic tests for early identification of coagulopathy. Finally, we discuss different options for treating coagulopathy after severe pediatric trauma. PMID:24569507

  16. Assessing Competence in Pediatric Cardiology

    ERIC Educational Resources Information Center

    Johnson, Apul E.; And Others

    1976-01-01

    In response to the need to assure physician competence, a rating scale was developed at the University of Minnesota Medical School for use in evaluating clinical competence in pediatric cardiology. It was tested on first- and second-year specialists. Development and testing procedures are described. (JT)

  17. Patient education and pediatric oncology.

    PubMed

    Kramer, R F; Perin, G

    1985-03-01

    An overview is provided of important principles and content useful in planning educational programs for pediatric oncology patients and their families. Implementation considerations, such as assessment of the learner, selection of appropriate teaching methods, and problems with the selection process are addressed. PMID:2579366

  18. Family Functioning in Pediatric Trichotillomania

    ERIC Educational Resources Information Center

    Moore, Phoebe S.; Franklin, Martin E.; Keuthen, Nancy J.; Flessner, Christopher A.; Woods, Douglas W.; Piacentini, John A.; Stein, Dan J.; Loew, Benjamin

    2009-01-01

    Little is known about how pediatric trichotillomania (TTM), a clinically significant and functionally impairing disorder, is impacted by, and impacts, family functioning. We explored dimensions of family functioning and parental attitudes in a sample of children and adolescents who participated in an Internet-based survey and satisfied…

  19. Defusing Diffusion

    ERIC Educational Resources Information Center

    Dou, Remy; Hogan, DaNel; Kossover, Mark; Spuck, Timothy; Young, Sarah

    2013-01-01

    Diffusion has often been taught in science courses as one of the primary ways by which molecules travel, particularly within organisms. For years, classroom teachers have used the same common demonstrations to illustrate this concept (e.g., placing drops of food coloring in a beaker of water). Most of the time, the main contributor to the motion…

  20. Relativistic diffusion

    NASA Astrophysics Data System (ADS)

    Haba, Z.

    2009-02-01

    We discuss relativistic diffusion in proper time in the approach of Schay (Ph.D. thesis, Princeton University, Princeton, NJ, 1961) and Dudley [Ark. Mat. 6, 241 (1965)]. We derive (Langevin) stochastic differential equations in various coordinates. We show that in some coordinates the stochastic differential equations become linear. We obtain momentum probability distribution in an explicit form. We discuss a relativistic particle diffusing in an external electromagnetic field. We solve the Langevin equations in the case of parallel electric and magnetic fields. We derive a kinetic equation for the evolution of the probability distribution. We discuss drag terms leading to an equilibrium distribution. The relativistic analog of the Ornstein-Uhlenbeck process is not unique. We show that if the drag comes from a diffusion approximation to the master equation then its form is strongly restricted. The drag leading to the Tsallis equilibrium distribution satisfies this restriction whereas the one of the Jüttner distribution does not. We show that any function of the relativistic energy can be the equilibrium distribution for a particle in a static electric field. A preliminary study of the time evolution with friction is presented. It is shown that the problem is equivalent to quantum mechanics of a particle moving on a hyperboloid with a potential determined by the drag. A relation to diffusions appearing in heavy ion collisions is briefly discussed.

  1. Demonstrating Diffusion

    ERIC Educational Resources Information Center

    Foy, Barry G.

    1977-01-01

    Two demonstrations are described. Materials and instructions for demonstrating movement of molecules into cytoplasm using agar blocks, phenolphthalein, and sodium hydroxide are given. A simple method for demonstrating that the rate of diffusion of a gas is inversely proportional to its molecular weight is also presented. (AJ)

  2. Relativistic diffusion.

    PubMed

    Haba, Z

    2009-02-01

    We discuss relativistic diffusion in proper time in the approach of Schay (Ph.D. thesis, Princeton University, Princeton, NJ, 1961) and Dudley [Ark. Mat. 6, 241 (1965)]. We derive (Langevin) stochastic differential equations in various coordinates. We show that in some coordinates the stochastic differential equations become linear. We obtain momentum probability distribution in an explicit form. We discuss a relativistic particle diffusing in an external electromagnetic field. We solve the Langevin equations in the case of parallel electric and magnetic fields. We derive a kinetic equation for the evolution of the probability distribution. We discuss drag terms leading to an equilibrium distribution. The relativistic analog of the Ornstein-Uhlenbeck process is not unique. We show that if the drag comes from a diffusion approximation to the master equation then its form is strongly restricted. The drag leading to the Tsallis equilibrium distribution satisfies this restriction whereas the one of the Jüttner distribution does not. We show that any function of the relativistic energy can be the equilibrium distribution for a particle in a static electric field. A preliminary study of the time evolution with friction is presented. It is shown that the problem is equivalent to quantum mechanics of a particle moving on a hyperboloid with a potential determined by the drag. A relation to diffusions appearing in heavy ion collisions is briefly discussed. PMID:19391727

  3. Psychopharmacology in pediatric critical care.

    PubMed

    Stoddard, Frederick J; Usher, Craigan T; Abrams, Annah N

    2006-07-01

    Psychopharmacologic treatment in pediatric critical care requires a careful child or adolescent psychiatric evaluation, including a thorough review of the history of present illness or injury, any current or pre-existing psychiatric disorder, past history, and laboratory studies. Although there is limited evidence to guide psychopharmacologic practice in this setting, psychopharmacologic treatment is increasing in critical care, with known indications for treatment, benefits, and risks; initial dosing guidelines; and best practices. Treatment is guided by the knowledge bases in pediatric physiology, psycho-pharmacology, and treatment of critically ill adults. Pharmacologic considerations include pharmacokinetic and pharmcodynamic aspects of specific drugs and drug classes, in particular elimination half-life, developmental considerations, drug interactions, and adverse effects. Evaluation and management of pain is a key initial step, as pain may mimic psychiatric symptoms and its effective treatment can ameliorate them. Patient comfort and safety are primary objectives for children who are acutely ill and who will survive and for those who will not. Judicious use of psychopharmacolgic agents in pediatric critical care using the limited but growing evidence base and a clinical best practices collaborative approach can reduce anxiety,sadness, disorientation, and agitation; improve analgesia; and save lives of children who are suicidal or delirious. In addition to pain, other disorders or indications for psychopharmacologic treatment are affective disorders;PTSD; post-suicide attempt patients; disruptive behavior disorders (especially ADHD); and adjustment, developmental, and substance use disorders. Treating children who are critically ill with psychotropic drugs is an integral component of comprehensive pediatric critical care in relieving pain and delirium; reducing inattention or agitation or aggressive behavior;relieving acute stress, anxiety, or depression; and

  4. Pediatric Acute Respiratory Distress Syndrome: Fibrosis versus Repair

    PubMed Central

    Im, Daniel; Shi, Wei; Driscoll, Barbara

    2016-01-01

    Clinical and basic experimental approaches to pediatric acute lung injury (ALI), including acute respiratory distress syndrome (ARDS), have historically focused on acute care and management of the patient. Additional efforts have focused on the etiology of pediatric ALI and ARDS, clinically defined as diffuse, bilateral diseases of the lung that compromise function leading to severe hypoxemia within 7 days of defined insult. Insults can include ancillary events related to prematurity, can follow trauma and/or transfusion, or can present as sequelae of pulmonary infections and cardiovascular disease and/or injury. Pediatric ALI/ARDS remains one of the leading causes of infant and childhood morbidity and mortality, particularly in the developing world. Though incidence is relatively low, ranging from 2.9 to 9.5 cases/100,000 patients/year, mortality remains high, approaching 35% in some studies. However, this is a significant decrease from the historical mortality rate of over 50%. Several decades of advances in acute management and treatment, as well as better understanding of approaches to ventilation, oxygenation, and surfactant regulation have contributed to improvements in patient recovery. As such, there is a burgeoning interest in the long-term impact of pediatric ALI/ARDS. Chronic pulmonary deficiencies in survivors appear to be caused by inappropriate injury repair, with fibrosis and predisposition to emphysema arising as irreversible secondary events that can severely compromise pulmonary development and function, as well as the overall health of the patient. In this chapter, the long-term effectiveness of current treatments will be examined, as will the potential efficacy of novel, acute, and long-term therapies that support repair and delay or even impede the onset of secondary events, including fibrosis. PMID:27066462

  5. Modeling of hydrogen-air diffusion flame

    NASA Technical Reports Server (NTRS)

    Isaac, K. M.

    1988-01-01

    Work performed during the first six months of the project duration for NASA Grant (NAG-1-861) is reported. An analytical and computational study of opposed jet diffusion flame for the purpose of understanding the effects of contaminants in the reactants and thermal diffusion of light species on extinction and reignition of diffusion flames is in progress. The methodologies attempted so far are described.

  6. Simulation-based medical education in pediatrics.

    PubMed

    Lopreiato, Joseph O; Sawyer, Taylor

    2015-01-01

    The use of simulation-based medical education (SBME) in pediatrics has grown rapidly over the past 2 decades and is expected to continue to grow. Similar to other instructional formats used in medical education, SBME is an instructional methodology that facilitates learning. Successful use of SBME in pediatrics requires attention to basic educational principles, including the incorporation of clear learning objectives. To facilitate learning during simulation the psychological safety of the participants must be ensured, and when done correctly, SBME is a powerful tool to enhance patient safety in pediatrics. Here we provide an overview of SBME in pediatrics and review key topics in the field. We first review the tools of the trade and examine various types of simulators used in pediatric SBME, including human patient simulators, task trainers, standardized patients, and virtual reality simulation. Then we explore several uses of simulation that have been shown to lead to effective learning, including curriculum integration, feedback and debriefing, deliberate practice, mastery learning, and range of difficulty and clinical variation. Examples of how these practices have been successfully used in pediatrics are provided. Finally, we discuss the future of pediatric SBME. As a community, pediatric simulation educators and researchers have been a leading force in the advancement of simulation in medicine. As the use of SBME in pediatrics expands, we hope this perspective will serve as a guide for those interested in improving the state of pediatric SBME. PMID:25748973

  7. Interim fluorine-18 fluorodeoxyglucose PET-computed tomography and cell of origin by immunohistochemistry predicts progression-free and overall survival in diffuse large B-cell lymphoma patients in the rituximab era

    PubMed Central

    Hallack Neto, Abrahão; Siqueira, Sheila; Lage, Luis Alberto de Padua Covas; de Paula, Henrique M.; Coutinho, Arthur M.; Pereira, Juliana

    2016-01-01

    Objective The aim of this study was to analyze the prognostic value of the interim PET (iPET)-computed tomography (CT) (iPET-CT) after two cycles of immunochemotherapy with the R-CHOP protocol in patients with diffuse large B-cell non-Hodgkin lymphoma (DLBCL) treated with a curative intent in combination with the neoplastic cell origin defined by Hans’s immunohistochemstry algorithm followed in a reference center for cancer treatment in Brazil. Materials and methods We prospectively evaluated 147 DLBCL patients treated with R-CHOP-21 to assess the value of the International Prognostic Index, iPET-CT, and cell of origin by immunohistochemistry as prognostic markers in the rituximab era. Fluorine-18 fluorodeoxyglucose PET-CT was performed after two cycles (iPET-CT) and at the end of treatment in 111 patients. Lymphoma cases were categorized into germinal center (GC) and nongerminal center subtypes by immunohistochemistry according to Hans’s algorithm. Results The median age of GC-DLBCL patients (52.7 years) was lower than that of nongerminal center-DLBCL patients (59.4 years) (P=0.021); in addition, it was lower in patients with negative iPET-CT findings (52.7 years) versus positive findings (59.4 years) (P=0.031). The overall survival at 48 months was 100% for iPET-CT-negative GC-DLBCL patients and 61.2% for iPET-CT-positive GC-DLBCL patients (P=0.002). Progression-free survival at 30 months was 100% for iPET-CT-negative GC-DLBCL patients and 60.3% for iPET-CT-positive GC-DLBCL patients (P=0.001). Conclusion We conclude that iPET-CT associated with cell origin identified a very good prognostic group in DLBCL patients treated with R-CHOP. Video Abstract: http://links.lww.com/NMC/A59 PMID:27281359

  8. Priorities in pediatric epilepsy research: improving children's futures today.

    PubMed

    Berg, Anne T; Baca, Christine B; Loddenkemper, Tobias; Vickrey, Barbara G; Dlugos, Dennis

    2013-09-24

    The Priorities in Pediatric Epilepsy Research workshop was held in the spirit of patient-centered and patient-driven mandates for developing best practices in care, particularly for epilepsy beginning under age 3 years. The workshop brought together parents, representatives of voluntary advocacy organizations, physicians, allied health professionals, researchers, and administrators to identify priority areas for pediatric epilepsy care and research including implementation and testing of interventions designed to improve care processes and outcomes. Priorities highlighted were 1) patient outcomes, especially seizure control but also behavioral, academic, and social functioning; 2) early and accurate diagnosis and optimal treatment; 3) role and involvement of parents (communication and shared decision-making); and 4) integration of school and community organizations with epilepsy care delivery. Key factors influencing pediatric epilepsy care included the child's impairments and seizure presentation, parents, providers, the health care system, and community systems. Care was represented as a sequential process from initial onset of seizures to referral for comprehensive evaluation when needed. We considered an alternative model in which comprehensive care would be utilized from onset, proactively, rather than reactively after pharmacoresistance became obvious. Barriers, including limited levels of evidence about many aspects of diagnosis and management, access to care--particularly epilepsy specialty and behavioral health care--and implementation, were identified. Progress hinges on coordinated research efforts that systematically address gaps in knowledge and overcoming barriers to access and implementation. The stakes are considerable, and the potential benefits for reduced burden of refractory epilepsy and lifelong disabilities may be enormous. PMID:23966254

  9. Simulation based planning of surgical interventions in pediatric cardiology

    NASA Astrophysics Data System (ADS)

    Marsden, Alison L.

    2013-10-01

    Hemodynamics plays an essential role in the progression and treatment of cardiovascular disease. However, while medical imaging provides increasingly detailed anatomical information, clinicians often have limited access to hemodynamic data that may be crucial to patient risk assessment and treatment planning. Computational simulations can now provide detailed hemodynamic data to augment clinical knowledge in both adult and pediatric applications. There is a particular need for simulation tools in pediatric cardiology, due to the wide variation in anatomy and physiology in congenital heart disease patients, necessitating individualized treatment plans. Despite great strides in medical imaging, enabling extraction of flow information from magnetic resonance and ultrasound imaging, simulations offer predictive capabilities that imaging alone cannot provide. Patient specific simulations can be used for in silico testing of new surgical designs, treatment planning, device testing, and patient risk stratification. Furthermore, simulations can be performed at no direct risk to the patient. In this paper, we outline the current state of the art in methods for cardiovascular blood flow simulation and virtual surgery. We then step through pressing challenges in the field, including multiscale modeling, boundary condition selection, optimization, and uncertainty quantification. Finally, we summarize simulation results of two representative examples from pediatric cardiology: single ventricle physiology, and coronary aneurysms caused by Kawasaki disease. These examples illustrate the potential impact of computational modeling tools in the clinical setting.

  10. Simulation based planning of surgical interventions in pediatric cardiology

    PubMed Central

    Marsden, Alison L.

    2013-01-01

    Hemodynamics plays an essential role in the progression and treatment of cardiovascular disease. However, while medical imaging provides increasingly detailed anatomical information, clinicians often have limited access to hemodynamic data that may be crucial to patient risk assessment and treatment planning. Computational simulations can now provide detailed hemodynamic data to augment clinical knowledge in both adult and pediatric applications. There is a particular need for simulation tools in pediatric cardiology, due to the wide variation in anatomy and physiology in congenital heart disease patients, necessitating individualized treatment plans. Despite great strides in medical imaging, enabling extraction of flow information from magnetic resonance and ultrasound imaging, simulations offer predictive capabilities that imaging alone cannot provide. Patient specific simulations can be used for in silico testing of new surgical designs, treatment planning, device testing, and patient risk stratification. Furthermore, simulations can be performed at no direct risk to the patient. In this paper, we outline the current state of the art in methods for cardiovascular blood flow simulation and virtual surgery. We then step through pressing challenges in the field, including multiscale modeling, boundary condition selection, optimization, and uncertainty quantification. Finally, we summarize simulation results of two representative examples from pediatric cardiology: single ventricle physiology, and coronary aneurysms caused by Kawasaki disease. These examples illustrate the potential impact of computational modeling tools in the clinical setting. PMID:24255590

  11. Diffusion bonding

    DOEpatents

    Anderson, Robert C.

    1976-06-22

    1. A method for joining beryllium to beryllium by diffusion bonding, comprising the steps of coating at least one surface portion of at least two beryllium pieces with nickel, positioning a coated surface portion in a contiguous relationship with an other surface portion, subjecting the contiguously disposed surface portions to an environment having an atmosphere at a pressure lower than ambient pressure, applying a force upon the beryllium pieces for causing the contiguous surface portions to abut against each other, heating the contiguous surface portions to a maximum temperature less than the melting temperature of the beryllium, substantially uniformly decreasing the applied force while increasing the temperature after attaining a temperature substantially above room temperature, and maintaining a portion of the applied force at a temperature corresponding to about maximum temperature for a duration sufficient to effect the diffusion bond between the contiguous surface portions.

  12. Role of modeling and simulation in pediatric investigation plans.

    PubMed

    Manolis, Efthymios; Osman, Tariq Eldirdiry; Herold, Ralf; Koenig, Franz; Tomasi, Paolo; Vamvakas, Spiros; Saint Raymond, Agnes

    2011-03-01

    Ethical and practical constraints encourage the optimal use of resources in pediatric drug development. Modeling and simulation has emerged as a promising methodology acknowledged by industry, academia, and regulators. We previously proposed a paradigm in pediatric drug development, whereby modeling and simulation is used as a decision tool, for study optimization and/or as a data analysis tool. Three and a half years since the Paediatric Regulation came into force in 2007, the European Medicines Agency has gained substantial experience in the use of modeling and simulation in pediatric drug development. In this review, we present examples on how the proposed paradigm applies in real case scenarios of planned pharmaceutical developments. We also report the results of a pediatric database search to further 'validate' the paradigm. There were 47 of 210 positive pediatric investigation plan (PIP) opinions that made reference to modeling and simulation (data included all positive opinions issued up to January 2010). This reflects a major shift in regulatory thinking. The ratio of PIPs with modeling and simulation rose to two in five based on the summary reports. Population pharmacokinetic (POP-PK) and pharmacodynamics (POP-PD) and physiologically based pharmacokinetic models are widely used by industry and endorsed or even imposed by regulators as a way to circumvent some difficulties in developing medicinal products in children. The knowledge of the effects of age and size on PK is improving, and models are widely employed to make optimal use of this knowledge but less is known about the effects of size and maturation on PD, disease progression, and safety. Extrapolation of efficacy from different age groups is often used in pediatric medicinal development as another means to alleviate the burden of clinical trials in children, and this can be aided by modeling and simulation to supplement clinical data. The regulatory assessment is finally judged on clinical grounds

  13. PLANNING FOR PEDIATRIC ENVIRONMENTAL HEALTH FELLOWSHIP PROGRAM SPONSORED BY THE AMBULATORY PEDIATRIC ASSOCIATION

    EPA Science Inventory

    The Pediatric Environmental Health Fellowship program is a three year fellowship which will emphasize teaching, research and mastery of scientific and grant writing skills, the development of advocacy skills, and the the ability to review pediatric environmental health literature...

  14. Latent Progression Pediatric Scrotal Schwannoma. A Case Report

    PubMed Central

    Gkikas, Christos; Ram, Manisha; Tsafrakidis, Petros

    2016-01-01

    We report the case of a 24 year old patient being diagnosed with scrotal schwannoma initially presenting at age 9. To our knowledge, this is the first case with such an early onset. The patient underwent an uncomplicated surgical excision. We are also reviewing the literature on scrotal schwannoma. PMID:27169021

  15. 75 FR 67378 - Pediatric Advisory Committee; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-02

    ... HUMAN SERVICES Food and Drug Administration Pediatric Advisory Committee; Notice of Meeting AGENCY: Food... of Committee: Pediatric Advisory Committee. General Function of the Committee: To provide advice and.... Contact Person: Walter Ellenberg, Office of Pediatric Therapeutics, Office of Special Medical...

  16. 75 FR 7281 - Pediatric Advisory Committee; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-02-18

    ... HUMAN SERVICES Food and Drug Administration Pediatric Advisory Committee; Notice of Meeting AGENCY: Food... of Committee: Pediatric Advisory Committee. General Function of the Committee: To provide advice and... learn about possible modifications before coming to the meeting. Agenda: The Pediatric...

  17. Pediatric Anthrax Clinical Management

    PubMed Central

    Bradley, John S.; Peacock, Georgina; Krug, Steven E.; Bower, William A.; Cohn, Amanda C.; Meaney-Delman, Dana; Pavia, Andrew T.

    2015-01-01

    Anthrax is a zoonotic disease caused by Bacillus anthracis, which has multiple routes of infection in humans, manifesting in different initial presentations of disease. Because B anthracis has the potential to be used as a biological weapon and can rapidly progress to systemic anthrax with high mortality in those who are exposed and untreated, clinical guidance that can be quickly implemented must be in place before any intentional release of the agent. This document provides clinical guidance for the prophylaxis and treatment of neonates, infants, children, adolescents, and young adults up to the age of 21 (referred to as “children”) in the event of a deliberate B anthracis release and offers guidance in areas where the unique characteristics of children dictate a different clinical recommendation from adults. PMID:24777226

  18. Thyroid Cancer in Pediatrics.

    PubMed

    Machac, Josef

    2016-06-01

    Well differentiated thyroid cancer (DTC) in children is characterized by a high rate of response to treatment and low disease-specific mortality. Treatment of children with DTC has evolved toward a greater reliance on evaluation and monitoring with serial serum thyroglobulin measurements and ultrasound examinations. Radioiodine therapy is recommended for thyroid remnant ablation in high-risk patients, treatment of demonstrated radioiodine-avid local-regional disease not amenable to surgical resection, or distant radioiodine-avid metastatic disease. Sufficient time should be given for benefits of radioiodine therapy to be realized, with follow-up monitoring. Re-treatment with radioiodine can be deferred until progression of significant disease manifests. PMID:27241970

  19. Advances in Pediatric Pharmacology, Therapeutics, and Toxicology

    PubMed Central

    Gonzalez, Daniel; Paul, Ian M.; Benjamin, Daniel K.; Cohen-Wolkowiez, Michael

    2014-01-01

    Significant advancements have been made in pediatric therapeutics and pharmacology over the last two years. In the United States, passage of the Food and Drug Administration Safety and Innovation Act has made the Best Pharmaceuticals for Children Act and Pediatric Research Equity Act permanent, and ensured that studies will be conducted in neonates. In Europe, the Pediatric Regulation, which went into effect in early 2007, has also provided a framework encouraging an expansion of pediatric research. Because of such regulatory involvement, a greater number of studies are being performed, and more pediatric dosing, efficacy, and safety information is being incorporated into product labels. The goal of this publication is to highlight important advancements made in the field of pediatric pharmacology, toxicology, and therapeutics from January 2012 to December 2013. PMID:25037123

  20. Gender Distribution of Pediatric Stone Formers

    NASA Astrophysics Data System (ADS)

    Novak, Thomas E.; Trock, Bruce J.; Lakshmanan, Yegappan; Gearhart, John P.; Matlaga, Brian R.

    2008-09-01

    Recent epidemiologic evidence suggests that the gender prevalence among adult stone-formers is changing, with an increasing incidence of stone disease among women. No similar data have ever been reported for the pediatric stone-forming population. We performed a study to define the gender distribution among pediatric stone-formers using a large-scale national pediatric database. Our findings suggest that gender distribution among stone formers varies by age with male predominance in the first decade of life shifting to female predominance in the second decade. In contrast to adults, females in the pediatric population are more commonly affected by stones than are males. The incidence of pediatric stone disease appears to be increasing at a great rate in both sexes. Further studies should build on this hypothesis-generating work and define the effects of metabolic and environmental risk factors that may influence stone risk in the pediatric patient population

  1. Pharmacogenetics in clinical pediatrics: challenges and strategies

    PubMed Central

    Van Driest, Sara L; McGregor, Tracy L

    2013-01-01

    The use of genetic information to guide medication decisions holds great promise to improve therapeutic outcomes through increased efficacy and reduced adverse events. As in many areas of medicine, pediatric research and clinical implementation in pharmacogenetics lag behind corresponding adult discovery and clinical applications. In adults, genotype-guided clinical decision support for medications such as clopidogrel, warfarin and simvastatin are in use in some medical centers. However, research conducted in pediatric populations demonstrates that the models and practices developed in adults may be inaccurate in children, and some applications lack any pediatric research to guide clinical decisions. To account for additional factors introduced by developmental considerations in pediatric populations and provide pediatric patients with maximal benefit from genotype-guided therapy, the field will need to develop and employ creative solutions. In this article, we detail some concerns about research and clinical implementation of pharmacogenetics in pediatrics, and present potential mechanisms for addressing them. PMID:24363766

  2. The neurocognitive impact of Fabry disease on pediatric patients.

    PubMed

    Bugescu, Nicolle; Alioto, Andrea; Segal, Summer; Cordova, Matthew; Packman, Wendy

    2015-04-01

    Fabry disease (FD) is an X-linked lysosomal storage disorder that results in progressive multisystemic organ complications. Several studies have examined neurocognitive impairments in adults; however, there is a paucity of research examining neurocognitive functioning in children with FD. This is the first exploratory study to examine the neurocognitive functioning of pediatric patients with FD and to evaluate the effects of enzyme replacement therapy (ERT) on neurocognitive functioning within this population. Families attending a national conference with at least one child with FD and one parent affected by FD comprised the sample (n = 48; 24 pediatric patients, 24 parents). Pediatric participants (10 males, 14 females) between the ages of 6 and 18 years and their parent(s) were involved in the study. Data from a demographic questionnaire and two neurocognitive self-report and parent-report measures were analyzed. Parent reports of neurocognitive functioning were also compared to a sample of children with and without head injury and to a sample of children who had undergone liver transplant (LT). Children with FD had poorer cognitive and executive functioning than healthy peers, and were comparable to children with head injury and LT. In addition, children using ERT had higher scores on measures of overall cognitive functioning, as well as fewer problems with attention/working memory and executive functioning. Results of this study suggest that children with FD may exhibit poorer cognitive and executive functioning relative to healthy peers. The use of ERT may mitigate the negative impact of FD on neurocognitive functioning in pediatric patients. PMID:25739920

  3. Molecular Insights into Pediatric Brain Tumors Have the Potential to Transform Therapy

    PubMed Central

    Gajjar, Amar; Pfister, Stefan M.; Taylor, Michael D.; Gilbertson, Richard J.

    2014-01-01

    High-throughput genomic technologies have shed light on the biologic heterogeneity of several pediatric brain tumors. The biology of the four common pediatric brain tumors—namely medulloblastoma, ependymoma, high-grade glioma including diffuse intrinsic pontine glioma and low-grade glioma are highlighted in this CCR Focus article. The discovery that medulloblastoma consists of 4 different subgroups namely WNT, SHH, Group 3 and Group 4, each with distinct clinical and molecular features, has impacted the treatment of children with medulloblastoma. Prospective studies have documented the efficacy of SMO inhibitors in a subgroup of patients with SHH medulloblastoma. Efforts are ongoing to develop specific therapies for each of the subgroups of medulloblastoma. Similar efforts are being pursued for ependymoma, high grade glioma and diffuse intrinsic pontine glioma where the disease outcome for the latter two tumors has not changed over the past 3 decades despite several prospective clinical trials. Developing and testing targeted therapies based on this new understanding remains a major challenge to the pediatric neuro-oncology community. The focus of this review is to summarize the rapidly evolving understanding of the common pediatric brain tumors based on genome wide analysis. These novel insights will add impetus to translating these laboratory based discoveries to newer therapies for children diagnosed with these tumors. PMID:25398846

  4. A Pediatric Case of Thelaziasis in Korea

    PubMed Central

    Yim, Chung Hyuk; Ko, Jeong Hee; Lee, Jung Hyun; Choi, Yu Mi; Lee, Won Wook; Ahn, Sang Ki; Ahn, Myoung Hee; Choi, Kyong Eun

    2016-01-01

    In the present study, we intended to report a clinical pediatric case of thelaziasis in Korea. In addition, we briefly reviewed the literature on pediatric cases of thelaziasis in Korea. In the present case, 3 whitish, thread-like eye-worms were detected in a 6-year-old-boy living in an urban area and contracted an ocular infection known as thelaziasis incidentally during ecological agritainment. This is the first report of pediatric thelaziasis in Seoul after 1995. PMID:27417087

  5. Pediatric Mixed Connective Tissue Disease.

    PubMed

    Berard, Roberta A; Laxer, Ronald M

    2016-05-01

    Pediatric-onset mixed connective tissue disease is among the rare disease entities in pediatric rheumatology and includes features of arthritis, polymyositis/dermatomyositis, systemic lupus erythematosus, and systemic sclerosis. Accurate recognition and diagnosis of the disease is paramount to prevent long-term morbidity. Advances in the genetic and immunologic understanding of the factors involved in the etiopathogenesis provide an opportunity for improvements in prognostication and targeted therapy. The development of a multinational cohort of patients with mixed connective tissue disease would be invaluable to provide more updated data regarding the clinical presentation, to develop a standardized treatment approach, disease activity and outcome tools, and to provide data on long-term outcomes and comorbidities. PMID:27032791

  6. Pediatric Brain Tumors: An Update.

    PubMed

    Segal, Devorah; Karajannis, Matthias A

    2016-07-01

    Brain tumors collectively represent the most common solid tumors in childhood and account for significant morbidity and mortality. Until recently, pediatric brain tumors were diagnosed and classified solely based on histologic criteria, and treatments were chosen empirically. Recent research has greatly enhanced our understanding of the diverse biology of pediatric brain tumors, their molecular and genetic underpinnings, leading to improved diagnostic accuracy and risk stratification, as well as the development of novel biomarkers and molecular targeted therapies. For subsets of patients, these new treatment options have already resulted in improved survival and decreased treatment toxicity. In this article, we provide an overview of the most common childhood brain tumors, describe recent key advances in the field, and discuss the therapeutic challenges that remain. PMID:27230809

  7. The Virtual Pediatric Airways Workbench.

    PubMed

    Quammen, Cory W; Taylor Ii, Russell M; Krajcevski, Pavel; Mitran, Sorin; Enquobahrie, Andinet; Superfine, Richard; Davis, Brad; Davis, Stephanie; Zdanski, Carlton

    2016-01-01

    The Virtual Pediatric Airways Workbench (VPAW) is a patient-centered surgical planning software system targeted to pediatric patients with airway obstruction. VPAW provides an intuitive surgical planning interface for clinicians and supports quantitative analysis regarding prospective surgeries to aid clinicians deciding on potential surgical intervention. VPAW enables a full surgical planning pipeline, including importing DICOM images, segmenting the airway, interactive 3D editing of airway geometries to express potential surgical treatment planning options, and creating input files for offline geometric analysis and computational fluid dynamics simulations for evaluation of surgical outcomes. In this paper, we describe the VPAW system and its use in one case study with a clinician to successfully describe an intended surgery outcome. PMID:27046595

  8. Gender and Sexuality in Pediatrics.

    PubMed

    Merens, Teri A

    2016-05-01

    The terms gender and sexuality, once rarely discussed in a public forum, are now dominant topics of conversation on social media, in all forms of entertainment, politics, law, and medicine. The pediatric primary care physician, like all people and institutions involved in the delivery of health care, must be diligent about providing compassionate and competent care to patients and families contending with gender issues. The complex variety of obstacles these patients may face require a well-informed, sensitive clinician who can offer sound medical advice and appropriate referral. This article guides pediatricians through some of the challenges related to gender identity so they can assist their patients in navigating through any difficulties. [Pediatr Ann. 2016;45(5):e158-e161.]. PMID:27171801

  9. Sleep in the Pediatric Population.

    PubMed

    Hintze, Jonathan P; Paruthi, Shalini

    2016-03-01

    This article provides an overview of common pediatric sleep disorders encountered in the neurology clinic, including restless legs syndrome, narcolepsy, parasomnias, sleep-related epilepsy, and sleep and headaches. An overview of each is provided, with an emphasis on accurate diagnosis and treatment. It is important in comprehensive neurologic care to also obtain a sleep history, because treating the underlying sleep condition may improve the neurologic disorder. PMID:26972036

  10. Differential diagnosis in pediatric radiology

    SciTech Connect

    Grunebaum, M.

    1986-01-01

    This work presents 415 tables of differential diagnosis applicable to pediatric radiology, emphasizing clinical presentation and the findings of conventional radiographs. The six chapters cover the respiratory, cardiovascular, urinary, gastrointestinal, and skeletal systems, and the head. The first few tables in each chapter cover major clinical signs, the next few deal with the newborn period only, and the remainder deal with radiographic differential diagnoses seen in children. An index and brief reference list complete the book.

  11. In vivo diagnostic nuclear medicine. Pediatric experience

    SciTech Connect

    Goetz, W.A.; Hendee, W.R.; Gilday, D.L.

    1983-09-01

    The use of radiopharmaceuticals for diagnostic tests in children is increasing and interest in these is evidenced by the addition of scientific sessions devoted to pediatric medicine at annual meetings of The Society of Nuclear Medicine and by the increase in the literature on pediatric dosimetry. Data presented in this paper describe the actual pediatric nuclear medicine experience from 26 nationally representative U.S. hospitals and provide an overview of the pediatric procedures being performed the types of radiopharmaceuticals being used, and the activity levels being administered.

  12. MRI findings in pediatric patients with scurvy.

    PubMed

    Gulko, Edwin; Collins, Lee K; Murphy, Robyn C; Thornhill, Beverly A; Taragin, Benjamin H

    2015-02-01

    In modern times scurvy is a rarely encountered disease caused by ascorbic acid (vitamin C) deficiency. However, sporadic cases of scurvy persist, particularly within the pediatric population. Recent individual case reports highlight an increased incidence of scurvy among patients with autism or developmental delay, with isolated case reports detailing the magnetic resonance imaging (MRI) findings of scurvy in these pediatric populations. We present the MRI findings of scurvy in four patients with autism or developmental delay, and review the literature on MRI findings in pediatric patients with scurvy. Despite its rarity, the radiologist must consider scurvy in a pediatric patient with a restricted diet presenting with arthralgia or myalgia. PMID:25109378

  13. Special article: 2014 Pediatric Clinical Trials Forum.

    PubMed

    Bogue, Clifford; DiMeglio, Linda A; Maldonado, Samuel; Portman, Ronald J; Smith, P Brian; Sullivan, Janice E; Thompson, Charles; Woo, Heide; Flinn, Susan

    2016-04-01

    In November 2014, the American Academy of Pediatrics convened key stakeholders to discuss the feasibility of accelerating children's medical advances by creating an independent global Pediatric Clinical Trials Network. The Forum identified challenges posed by the US and global clinical trial systems regarding testing and disseminating drugs and devices for pediatric patients. Stakeholders mapped a vision to improve the safety and efficacy of pediatric drugs, biological products, and medical devices by creating a global Pediatric Clinical Trials Network. Such a Network would act as a central infrastructure for pediatric subspecialties and enable dedicated staff to provide clinical research sites with scientific, medical, and operational support. A Network would facilitate development and availability of innovative, high-quality therapies to extend and enhance the lives of neonates, infants, children, adolescents, and young adults. Participants expressed strong interest in forming such a Network, since drugs and devices still come to market without adequate pediatric indications-particularly in neonatology and rare diseases. Participants developed a Consensus Statement expressing their shared vision for a Network: Attendees of the Pediatric Clinical Trials Stakeholder Forum resolved to establish a Global Pediatric Clinical Trials Network and are committed to engage in the work to create and sustain it. PMID:26650344

  14. Progressive External Ophthalmoplegia.

    PubMed

    McClelland, Collin; Manousakis, Georgios; Lee, Michael S

    2016-06-01

    Progressive external ophthalmoplegia (PEO), marked by progressive bilateral ptosis and diffuse reduction in ocular motility, represents a finding of mitochondrial myopathy rather than a true diagnosis. PEO often occurs with other systemic features of mitochondrial dysfunction that can cause significant morbidity and mortality. Accurate and early recognition of PEO is paramount for the optimal care of these patients. We present an evidence-based review of the presenting neuro-ophthalmic features, differential diagnosis, diagnostic tools, systemic implications, and treatment options for isolated PEO and other PEO-associated mitochondrial syndromes. PMID:27072953

  15. Preventing and managing pediatric obesity

    PubMed Central

    Plourde, Gilles

    2006-01-01

    OBJECTIVE To review the evidence on prevention and management of childhood obesity and to offer suggestions for family physicians. QUALITY OF EVIDENCE Articles were obtained from a PubMed search. Most studies on pediatric obesity provide level II evidence. There are some level I studies on management. MAIN MESSAGE Pediatric obesity is underdiagnosed and undertreated. Prevention should be initiated as early as pregnancy. Prevention and treatment approaches should include patient and family interventions focusing on nutrition, physical activity, reduced television viewing, and behaviour modification. The effectiveness of such interventions by primary care physicians has not been totally demonstrated, but incorporating them into clinical practice routines is likely to be beneficial. CONCLUSION Family physicians have a role in promoting preventive measures and identifying and treating obesity-related comorbidity. Pediatric obesity is not an individual child’s problem, but a problem that involves the whole family and the community. Recommending a healthy diet and increased physical activity and counseling families on behaviour change is the best approach to preventing and managing childhood obesity. PMID:16572577

  16. Novel Therapies for Pediatric Cancers

    PubMed Central

    Macy, Margaret E.; Sawczyn, Kelly K.; Garrington, Timothy P.; Graham, Douglas K.; Gore, Lia

    2011-01-01

    The current high cure rates for children diagnosed with cancer can in part be attributed to emphasis on large cooperative group clinical trials. The significant improvement in pediatric cancer survival over the last few decades is the result of optimized chemotherapy drug dosing, timing, and intensity; however, further alterations in traditional chemotherapy agents are unlikely to produce substantially better outcomes. Furthermore, there remains a subset of patients who have a very poor prognosis due to tumor type or stage at presentation, or who have a dismal prognosis with relapse or recurrence. As such, innovative approaches to therapy and new drugs are clearly needed for introduction into the current pediatric oncology arsenal. A variety of biologically targeted therapies which have shown promise in preclinical studies and early phase adult clinical trials are now being explored in pediatric clinical trials. These novel agents hold the promise for continuing to drive forward improvements in patient survival with potentially less toxicity than exists with traditional chemotherapy drugs. PMID:18928662

  17. Plasma substitutes therapy in pediatrics.

    PubMed

    Pietrini, Domenico; De Luca, Daniele; Tosi, Federica; Luca, Ersilia; Cavaliere, Franco; Conti, Giorgio; Piastra, Marco

    2012-06-01

    Hypovolemia is the most common cause of circulatory failure in children and may lead to critical tissue perfusion and eventually multiple-organ failure. Administration of fluids to maintain or restore intravascular volume represents a common intervention after hemorrhagic shock occurring during surgical procedures or in patients with trauma. Notwithstanding, there is uncertainty whether the type of fluid may significantly influence the outcome, especially in pediatrics. Both human albumin and crystalloids are usually administered: the advantages of crystalloids include low cost, lack of effect on coagulation, no risk of anaphylactic reaction or transmission of infectious agents. However, large amount of crystalloid infusion has been correlated with pulmonary oedema, bilateral pleural effusions, intestinal intussusception, excessive bowel edema, impairing closure of surgical wounds and peripheral edema. Moreover, intravascular volume expansion obtained by crystalloids is known to be significantly shorter and less efficacious than colloids. Among synthetic colloids, gelatins have been used for many years in children, also in early infancy, to treat intravascular fluid deficits. Hydroxyethylstarch (HES) preparations have been introduced recently, becoming very popular for vascular loading both in adults and children. However, the number of pediatric studies aimed at evaluating HES efficacy and tolerance is limited. Given the ongoing controversies on the use of colloids in childhood, this review will focus on the pharmacodynamics of synthetic and non synthetic colloids for the treatment of critical blood loss in pediatrics. PMID:22512388

  18. Biomarkers and pediatric environmental health.

    PubMed

    Lubin, B; Lewis, R

    1995-09-01

    It is now possible to identify biochemical and/or cellular changes in humans due to exposure to an environmental toxin. These changes are called biomarkers and are currently used in research studies to identify individuals exposed to specific toxic substances. Advances in the field of biomarker technology may have important implications for the detection, prevention, and treatment of certain diseases in children. This technology may enable physicians to screen children who have no clinically detectable illness for evidence of exposure to specific toxins. Such information could lead to implementation of preventive measures and development of new therapeutic strategies. However, several important issues, including potential adverse consequences resulting from the widespread use of this technology, must be considered prior to its utilization within a clinical setting. Leaders of the pediatric and public health communities should recognize the paucity of scientific data in the pediatric environmental health area, and new approaches to this important aspect of child health should be developed. This article will address several of the issues involved in pediatric environmental health and consider questions that should be answered as the potential for technology transfer becomes a reality. PMID:8549501

  19. Odontogenic lesions in pediatric patients.

    PubMed

    Fang, Qi-Gen; Shi, Shuang; Sun, Chang-Fu

    2014-05-01

    The purpose was to evaluate our 20-year experience of pediatric odontogenic lesions. Pediatric patients with a diagnosis of odontogenic lesion were identified. Three hundred ten patients were odontogenic; dentigerous cyst was seen in 62.0% of the cases. Most (70.2%) of them occurred in mixed dentition period, and it had a male preponderance. Odontogenic keratocystic tumor occurred in the permanent dentition period. It had an equal site distribution. Odontoma was seen in 20.0% of the cases. Its site of predilection was the mandible. Ameloblastoma was the most common odontogenic tumor. Most of the cases occurred in the permanent dentition period. It affected the male and female equally. Calcifying epithelioma odontogenic tumor was seen in 11.8% of the cases. All the lesions occurred in the primary dentition period. It had no sex or site preponderance. Myxoma was seen in 3.6% of the cases. It was most common in the permanent dentition period, and it was more frequent in the male. Iliac crest bone graft was successfully performed in 28 patients, postoperative infection occurred in 2 patients, and no donor-site dysfunctions were reported. The observed differences in lesion type and distribution in this study compared with previous researches may be attributable to genetic and geographic variation in the populations studied. Iliac crest bone graft was suggested for pediatric mandible reconstruction. PMID:24785745

  20. Patterns of Pediatric Maxillofacial Injuries.

    PubMed

    Bede, Salwan Yousif Hanna; Ismael, Waleed Khaleel; Al-Assaf, Dhuha

    2016-05-01

    Facial trauma in children and adolescents is reported to range from 1% to 30%. Because of many anatomical, physiological, and psychological characteristics of the pediatric population, maxillofacial injuries in children should be treated with special consideration that is attributable to certain features inherent in facial growth patterns of children. This study evaluated maxillofacial injuries in 726 children in terms of incidence, patterns of injury, causes, and treatment modalities and compared these parameters among 3 pediatric age groups. Intergroup differences were analyzed using Z test for 2 populations' proportion. The results showed that the incidence of pediatric maxillofacial injuries and fractures is higher than that reported elsewhere with male predominance. Soft tissue injuries are more frequently encountered in younger individuals, whereas the incidence of skeletal injuries increases with age. This study also revealed that certain etiologies, namely road traffic accidents, violence, bicycle, missiles, and industrial injures, increase with age; on the other hand, falls and puncture wounds are more common in younger children. PMID:27100637

  1. Pediatric multiple sclerosis: Conventional first-line treatment and general management.

    PubMed

    Ghezzi, Angelo; Amato, Maria Pia; Makhani, Naila; Shreiner, Teri; Gärtner, Jutta; Tenembaum, Silvia

    2016-08-30

    Many disease-modifying therapies are currently available for adults with relapsing-remitting multiple sclerosis (MS) but none of them has been tested in pediatric MS in randomized placebo-controlled trials. At present, as suggested by observational studies and experts' guidelines, interferon-β and glatiramer acetate continue to be the standard first-line treatments for pediatric MS. Observational studies and some controlled unblinded trials have shown a positive effect of these meditations in reducing relapse rate and delaying disease progression, with an acceptable safety profile. The goal of this article is to provide an overview of current knowledge with regard to safety, tolerability, and efficacy of first-line treatment options for MS in the pediatric age group, with the aim of providing guidance for planning first-line treatment of MS in children and adolescents. PMID:27572869

  2. Propofol-Related Infusion Syndrome in Critically Ill Pediatric Patients: Coincidence, Association, or Causation?

    PubMed Central

    Timpe, Erin M.; Eichner, Samantha F.; Phelps, Stephanie J.

    2006-01-01

    Over the past two decades numerous reports have described the development of a propofol-related infusion syndrome (PRIS) in critically ill adult and pediatric patients who received continuous infusion propofol for anesthesia or sedation. The syndrome is generally characterized by progressive metabolic acidosis, hemodynamic instability and bradyarrhythmias that are refractory to aggressive pharmacological treatments. PRIS may occur with or without the presence of hepatomegaly, rhabdomyolysis or lipemia. To date, the medical literature contains accounts of 20 deaths in critically ill pediatric patients who developed features consistent with PRIS. These reports have generated considerable discussion and debate regarding the relationship, if any, between propofol and a constellation of clinical symptoms and features that have been attributed to its use in critically ill pediatric patients. This paper reviews the literature concerning PRIS, its clinical presentation, proposed mechanisms for the syndrome, and potential management should the syndrome occur. PMID:23118644

  3. Quantum diffusion

    SciTech Connect

    Habib, S.

    1994-10-01

    We consider a simple quantum system subjected to a classical random force. Under certain conditions it is shown that the noise-averaged Wigner function of the system follows an integro-differential stochastic Liouville equation. In the simple case of polynomial noise-couplings this equation reduces to a generalized Fokker-Planck form. With nonlinear noise injection new ``quantum diffusion`` terms rise that have no counterpart in the classical case. Two special examples that are not of a Fokker-Planck form are discussed: the first with a localized noise source and the other with a spatially modulated noise source.

  4. DIFFUSION PUMP

    DOEpatents

    Levenson, L.

    1963-09-01

    A high-vacuum diffusion pump is described, featuring a novel housing geometry for enhancing pumping speed. An upright, cylindrical lower housing portion is surmounted by a concentric, upright, cylindrical upper housing portion of substantially larger diameter; an uppermost nozzle, disposed concentrically within the upper portion, is adapted to eject downwardly a conical sheet of liquid outwardly to impinge upon the uppermost extremity of the interior wall of the lower portion. Preferably this nozzle is mounted upon a pedestal rising coaxially from within the lower portion and projecting up into said upper portion. (AEC)

  5. [INTESTINAL TRANSPLANTATION IN PEDIATRICS

    PubMed

    Alarcón M, Pedro; Alarcón M, Jorge

    1997-01-01

    Intestinal Transplantation used to be an utopia in Medicine, and this was mainly due to the factor that the surgical technique was not the best at the beginning. When this was perfectioned, the next obstacle for the adequate progress of this surgery was the limited availability of anti-rejection drugs due to the fact that Ciclosporine has been and still is a drug of relative effectiveness. With the discovery of new anti-rejection drugs and with a best knowledge of the concomitant liver transplantation roll on the prognosis of these patients, it was possible to get in this decade, specifically in the last 2 years, extraordinary results; for example, from 170 pacients who underwent intestinal transplantation around the world, more than half were done by the University of Pittsburg. This university reported a survival of 62%. But, this percentage has been improved even more, the University of Miami reported a survival of 70% through the use of corticoides and two powerful anti-rejection drugs: FK-506 and Mycophelate. PMID:12219105

  6. Configurational diffusion of coal macromolecules

    SciTech Connect

    Guin, J.A.; Curtis, C.W.; Tarrer, A.R.

    1989-01-01

    During this quarter, progress has been made in two areas: (1) preparation of the calibration curve for gel permeation chromatography analysis of coal asphaltene; (2) preliminary measurements of the effective diffusion coefficients of coal asphaltene fractions. A calibration curve was prepared with standard compounds including polystyrenes, polynuclear aromatic hydrocarbons and tetraphenylporphine in GPC analysis. A correlation equation was obtained from the calibration curve to estimate the molecular weights of coal asphaltene fractions. Based on this GPC analysis, effective diffusion coefficients of coal asphaltene fractions were measured.

  7. Natural compounds for pediatric cancer treatment.

    PubMed

    Ferrucci, Veronica; Boffa, Iolanda; De Masi, Gina; Zollo, Massimo

    2016-02-01

    There is a tremendous need in clinics to impair cancer progression through noninvasive therapeutic approaches. The use of natural compounds to achieve this is of importance to improve the quality of life of young patients during their treatments. This review will address the "status of the art" related to the potential of natural compounds that are undergoing investigation in combination with standard therapeutic protocols in preclinical and clinical studies and their importance for pediatric cancer treatment. The early studies of drug discovery of these natural compounds discussed here include the main targets, the cellular signaling pathways involved, and the potential modes of action. We also focus on some promising natural compounds that have shown excellent results in vitro and in vivo: Chebulagic acid, Apigenin, Norcantharidin, Saffron/Crocin, Parthenolide, Longikaurin E, Lupeol, Spongistatin 1, and Deoxy-variolin B. Additionally, we introduce the effects of several compounds from nutraceutical and functional foods, to underline their potential use as adjuvant therapies to improve therapeutic benefits. For this purpose, we have selected several compounds: Agaritine, Ganoderma and GL6 peptide, Diallyl trisulfide and Ajoene from garlic, Epigallocatechin gallate from green tea, Curcumin, Resveratrol, and Quercetin. PMID:26650503

  8. Community pediatrics from the federal government's perspective.

    PubMed

    Hutchins, V L

    1994-12-01

    Community pediatrics has enjoyed remarkable success in recent years. While I have touched on some of that progress and some of the current issues in child health care, it is apparent that many challenges continue to face the field. In the coming months, one can expect many of these issues to enter the health-care reform discussions. The questions that will arise are not unlike those about mental health care: how large will the benefits package be, what kind of reimbursement system will be used, and who will be the provider? Optimism about the answers doesn't reign every day. In the chairman's preface to Beyond Rhetoric, the final report of the National Commission on Children, Senator John D. Rockefeller IV wrote: It is time for our country to recognize the pressing need to ensure accessible, affordable health care, and take the necessary steps to enable children to be born and grow up healthy and to become able, productive adults...(H)istory will judge this generation of Americans harshly if we allow futile debate to take the place of action. For millions of children and families, the hour already is late. One can look at numerous reports on child health over the past 30 years and find similar impassioned calls to action--with little subsequent action. I hope it will be different this time. PMID:7892066

  9. Impact of minimally invasive surgery on the pediatric surgical profession.

    PubMed

    Jones, Vinci S; Biesheuvel, Cornelis J; Cohen, Ralph C

    2008-12-01

    We conducted a survey among pediatric surgeons to examine the impact of the advent of minimally invasive surgery (MIS) on the pediatric surgical profession with respect to job satisfaction and training challenges. An invitation to participate in a web-based questionnaire was sent out to 306 pediatric surgeons. Apart from demographic details and training recommendations, parameters relevant to job satisfaction, including patient interaction, peer pressure, ethical considerations, academic progress, ability to train residents, and financial remuneration, were studied. The response rate was 38.2%. Working in a unit performing MIS was identified by 71% of respondents as the most effective and feasible modality of training in MIS. Inability to get away from a busy practice was the most common reason cited for inability to acquire MIS training. The overall responses to the job satisfaction parameters showed a positive trend in the current MIS era for patient interaction, ethical considerations, academic progress, and training residents, with a negative trend for peer pressure and financial remuneration. The enthusiastic minimally invasive surgeons (EMIS) were defined as those having more than 5 years of MIS experience and also performing more than 10% of their work using MIS. Of the 113 responses analyzed, 67 belonged to the EMIS category. Those belonging to the EMIS group were less likely to feel inadequate in training their residents, in meeting the felt needs of the patients, or to complain about peer pressure. They were more likely to consider MIS to be as relevant and beneficial in children as in adults. Embracing MIS, as represented by the EMIS group, correlated with an overall greater job satisfaction. PMID:19105675

  10. Conventional and advanced MRI features of pediatric intracranial tumors: supratentorial tumors.

    PubMed

    Borja, Maria J; Plaza, Michael J; Altman, Nolan; Saigal, Gaurav

    2013-05-01

    OBJECTIVE. Our objective is to review the imaging characteristics and applications of conventional and advanced neuroimaging techniques of supratentorial intracranial masses in the pediatric population. Specifically, we review astrocytomas, oligodendrogliomas, primary neuroectodermal tumors, dysembryoplastic neuroepithelial tumors, gangliogliomas, arachnoid cysts, and choroid plexus and pineal region masses. CONCLUSION. Advanced imaging methods, such as MR spectroscopy, perfusion MRI, functional MRI, diffusion-tensor imaging, and tractography, help develop a more accurate differential diagnosis and aid in planning tumor treatment. PMID:23617516

  11. A unique CD8(+) T lymphocyte signature in pediatric type 1 diabetes.

    PubMed

    Hamel, Yamina; Mauvais, François-Xavier; Pham, Hang-Phuong; Kratzer, Roland; Marchi, Christophe; Barilleau, Émilie; Waeckel-Enée, Emmanuelle; Arnoux, Jean-Baptiste; Hartemann, Agnès; Cordier, Corinne; Mégret, Jerome; Rocha, Benedita; de Lonlay, Pascale; Beltrand, Jacques; Six, Adrien; Robert, Jean-Jacques; van Endert, Peter

    2016-09-01

    Human type 1 diabetes results from a destructive auto-reactive immune response in which CD8(+) T lymphocytes play a critical role. Given the intense ongoing efforts to develop immune intervention to prevent and/or cure the disease, biomarkers suitable for prediction of disease risk and progress, as well as for monitoring of immunotherapy are required. We undertook separate multi-parameter analyses of single naïve and activated/memory CD8(+) T lymphocytes from pediatric and adult patients, with the objective of identifying cellular profiles associated with onset of type 1 diabetes. We observe global perturbations in gene and protein expression and in the abundance of T cell populations characterizing pediatric but not adult patients, relative to age-matched healthy individuals. Pediatric diabetes is associated with a unique population of CD8(+) T lymphocytes co-expressing effector (perforin, granzyme B) and regulatory (transforming growth factor β, interleukin-10 receptor) molecules. This population persists after metabolic normalization and is especially abundant in children with high titers of auto-antibodies to glutamic acid decarboxylase and with elevated HbA1c values. These findings highlight striking differences between pediatric and adult type 1 diabetes, indicate prolonged large-scale perturbations in the CD8(+) T cell compartment in the former, and suggest that CD8(+)CD45RA(-) T cells co-expressing effector and regulatory factors are of interest as biomarkers in pediatric type 1 diabetes. PMID:27318739

  12. A framework of pediatric hospital discharge care informed by legislation, research, and practice.

    PubMed

    Berry, Jay G; Blaine, Kevin; Rogers, Jayne; McBride, Sarah; Schor, Edward; Birmingham, Jackie; Schuster, Mark A; Feudtner, Chris

    2014-10-01

    To our knowledge, no widely used pediatric standards for hospital discharge care exist, despite nearly 10 000 pediatric discharges per day in the United States. This lack of standards undermines the quality of pediatric hospital discharge, hinders quality-improvement efforts, and adversely affects the health and well-being of children and their families after they leave the hospital. In this article, we first review guidance regarding the discharge process for adult patients, including federal law within the Social Security Act that outlines standards for hospital discharge; a variety of toolkits that aim to improve discharge care; and the research evidence that supports the discharge process. We then outline a framework within which to organize the diverse activities that constitute discharge care to be executed throughout the hospitalization of a child from admission to the actual discharge. In the framework, we describe processes to (1) initiate pediatric discharge care, (2) develop discharge care plans, (3) monitor discharge progress, and (4) finalize discharge. We contextualize these processes with a clinical case of a child undergoing hospital discharge. Use of this narrative review will help pediatric health care professionals (eg, nurses, social workers, and physicians) move forward to better understand what works and what does not during hospital discharge for children, while steadily improving their quality of care and health outcomes. PMID:25155156

  13. The utility of IgM, CD21, HGAL and LMO2 in the diagnosis of pediatric follicular lymphoma.

    PubMed

    Karnik, Tejashree; Ozawa, Michael G; Lefterova, Martina; Luna-Fineman, Sandra; Alvarez, Elysia; Link, Michael; Zehnder, James L; Arber, Daniel A; Ohgami, Robert S

    2015-04-01

    Pediatric follicular lymphoma (pFL) is a rare neoplasm with features differing from follicular lymphoma arising in adults. Here, we describe a rare case of pFL that showed morphologic features partially overlapping with progressive transformation of germinal centers and reactive follicular hyperplasia. As typical of pFL, neoplastic B cells within follicles did not express B-cell leukemia/lymphoma 2 (BCL2). However, this case showed additional distinctive abnormal findings, which contributed to the diagnosis: (1) diffuse and uniform staining of immunoglobulin M (IgM) on cells within and outside of follicles, (2) abnormally dim expression of CD21 on follicular dendritic cells, and (3) expression of human germinal center-associated lymphoma (HGAL) and LIM domain only 2 (LMO2) on B cells in interfollicular and follicular areas. This case demonstrates the utility of these abnormal features, which can be seen in adult- or usual-type follicular lymphoma, in the diagnosis of pFL. Further studies are necessary to evaluate the significance of these findings in other cases of pFL. PMID:25701230

  14. Simulation-based planning of surgical interventions in pediatric cardiology

    NASA Astrophysics Data System (ADS)

    Marsden, Alison

    2012-11-01

    Hemodynamics plays an essential role in the progression and treatment of cardiovascular disease. This is particularly true in pediatric cardiology, due to the wide variation in anatomy observed in congenital heart disease patients. While medical imaging provides increasingly detailed anatomical information, clinicians currently have limited knowledge of important fluid mechanical parameters. Treatment decisions are therefore often made using anatomical information alone, despite the known links between fluid mechanics and disease progression. Patient-specific simulations now offer the means to provide this missing information, and, more importantly, to perform in-silico testing of new surgical designs at no risk to the patient. In this talk, we will outline the current state of the art in methods for cardiovascular blood flow simulation and virtual surgery. We will then present new methodology for coupling optimization with simulation and uncertainty quantification to customize treatments for individual patients. Finally, we will present examples in pediatric cardiology that illustrate the potential impact of these tools in the clinical setting.

  15. An Introduction to Fractional Diffusion

    NASA Astrophysics Data System (ADS)

    Henry, B. I.; Langlands, T. A. M.; Straka, P.

    The mathematical description of diffusion has a long history with many different formulations including phenomenological models based on conservation of mass and constitutive laws; probabilistic models based on random walks and central limit theorems; microscopic stochastic models based on Brownian motion and Langevin equations; and mesoscopic stochastic models based on master equations and Fokker-Planck equations. A fundamental result common to the different approaches is that the mean square displacement of a diffusing particle scales linearly with time. However there have been numerous experimental measurements in which the mean square displacement of diffusing particles scales as a fractional order power law in time. In recent years a great deal of progress has been made in extending the different models for diffusion to incorporate this fractional diffusion. The tools of fractional calculus have proven very useful in these developments, linking together fractional constitutive laws, continuous time random walks, fractional Langevin equations and fractional Brownian motions. These notes provide a tutorial style overview of standard and fractional diffusion processes.

  16. Screening and Identification in Pediatric Primary Care

    ERIC Educational Resources Information Center

    Simonian, Susan J.

    2006-01-01

    This article reviews issues related to behavioral screening in pediatric primary care settings. Structural-organizational issues affecting the use of pediatric primary care screening are discussed. This study also reviewed selected screening instruments that have utility for use in the primary care setting. Clinical and research issues related to…

  17. Nursing 436A: Pediatric Oncology for Nurses.

    ERIC Educational Resources Information Center

    Jackman, Cynthia L.

    A description is provided of "Pediatric Oncology for Nurses," the first in a series of three courses offered to fourth-year nursing students in pediatric oncology. The first section provides a course overview, discusses time assignments, and describes the target student population. Next, a glossary of terms, and lists of course goals, long-range…

  18. Teaching Pediatric Psychology Concepts to Medical Students.

    ERIC Educational Resources Information Center

    Rae, William A.

    The psychiatric/behavioral science component of the medical school curriculum at Texas A&M University, which involves a pediatric psychology rotation, is described. The content areas of pediatric psychology includes the basic curriculum areas of child/adolescent psychodiagnostic categories, behavioral/developmental disorders, and knowledge of…

  19. Pandemic Influenza Pediatric Office Plan Template

    SciTech Connect

    HCTT CHE

    2010-01-01

    This is a planning tool developed by pediatric stakeholders that is intended to assist pediatric medical offices that have no pandemic influenza plan in place, but may experience an increase in patient calls/visits or workload due to pandemic influenza.

  20. A Method for Defining Competency in Pediatrics

    ERIC Educational Resources Information Center

    Burg, Fredric D.; And Others

    1976-01-01

    In 1972 the American Board of Pediatrics (ABP) initiated studies leading to a report that identifies the important components of competency needed in pediatrics. Three dimensions of competence were identified: subject matter, abilities, and tasks. Each of these is discussed. (LBH)

  1. Audiovisual Instruction in Pediatric Pharmacy Practice.

    ERIC Educational Resources Information Center

    Mutchie, Kelly D.; And Others

    1981-01-01

    A pharmacy practice program added to the core baccalaureate curriculum at the University of Utah College of Pharmacy which includes a practice in pediatrics is described. An audiovisual program in pediatric diseases and drug therapy was developed. This program allows the presentation of more material without reducing clerkship time. (Author/MLW)

  2. The proteomics of pediatric brain tumors.

    PubMed

    Anagnostopoulos, Athanasios K; Tsangaris, George T

    2014-10-01

    Pediatric tumors of the CNS are the leading cause of cancer-related mortality in children. In pediatric pathology, brain tumors constitute the most frequent solid malignancy. An unparalleled outburst of information in pediatric neuro-oncology research has been witnessed over the last few years, largely due to increased use of high-throughput technologies such as genomics, proteomics and meta-analysis tools. Input from these technologies gives scientists the advantage of early prognosis assessment, more accurate diagnosis and prospective curative intent in the pediatric brain tumor clinical setting. The present review aims to summarize current knowledge on research applying proteomics techniques or proteomics-based approaches performed on pediatric brain tumors. Proteins that can be used as potential disease markers or molecular targets, and their biological significance, are herein listed and discussed. Furthermore, future perspectives that proteomics technologies may offer regarding this devastating disorder are presented. PMID:25059388

  3. Pediatric Cancer Recognition Training in Botswana.

    PubMed

    Slone, Jeremy S; Ishigami, Elise; Mehta, Parth S

    2016-01-01

    Delayed presentation of children with cancer is a significant barrier to improving the survival from children's cancer in low- and middle-income countries (LMICs). Botswana, a country of approximately 2 million people in southern Africa, has only 1 pediatric cancer treatment program, based at Princess Marina Hospital (PMH) in the capital of Gaborone. A pediatric cancer recognition training program was developed that reached 50% of the government hospitals in Botswana teaching 362 health care workers how to recognize and refer children with cancer to PMH. Through evaluation of attendees, limitations in pediatric cancer training and general knowledge of pediatric cancer were identified. Attendees demonstrated improvement in their understanding of pediatric cancer and the referral process to PMH following the workshop. PMID:27336006

  4. PEDSnet: a National Pediatric Learning Health System.

    PubMed

    Forrest, Christopher B; Margolis, Peter A; Bailey, L Charles; Marsolo, Keith; Del Beccaro, Mark A; Finkelstein, Jonathan A; Milov, David E; Vieland, Veronica J; Wolf, Bryan A; Yu, Feliciano B; Kahn, Michael G

    2014-01-01

    A learning health system (LHS) integrates research done in routine care settings, structured data capture during every encounter, and quality improvement processes to rapidly implement advances in new knowledge, all with active and meaningful patient participation. While disease-specific pediatric LHSs have shown tremendous impact on improved clinical outcomes, a national digital architecture to rapidly implement LHSs across multiple pediatric conditions does not exist. PEDSnet is a clinical data research network that provides the infrastructure to support a national pediatric LHS. A consortium consisting of PEDSnet, which includes eight academic medical centers, two existing disease-specific pediatric networks, and two national data partners form the initial partners in the National Pediatric Learning Health System (NPLHS). PEDSnet is implementing a flexible dual data architecture that incorporates two widely used data models and national terminology standards to support multi-institutional data integration, cohort discovery, and advanced analytics that enable rapid learning. PMID:24821737

  5. PEDSnet: a National Pediatric Learning Health System

    PubMed Central

    Forrest, Christopher B; Margolis, Peter A; Bailey, L Charles; Marsolo, Keith; Del Beccaro, Mark A; Finkelstein, Jonathan A; Milov, David E; Vieland, Veronica J; Wolf, Bryan A; Yu, Feliciano B; Kahn, Michael G

    2014-01-01

    A learning health system (LHS) integrates research done in routine care settings, structured data capture during every encounter, and quality improvement processes to rapidly implement advances in new knowledge, all with active and meaningful patient participation. While disease-specific pediatric LHSs have shown tremendous impact on improved clinical outcomes, a national digital architecture to rapidly implement LHSs across multiple pediatric conditions does not exist. PEDSnet is a clinical data research network that provides the infrastructure to support a national pediatric LHS. A consortium consisting of PEDSnet, which includes eight academic medical centers, two existing disease-specific pediatric networks, and two national data partners form the initial partners in the National Pediatric Learning Health System (NPLHS). PEDSnet is implementing a flexible dual data architecture that incorporates two widely used data models and national terminology standards to support multi-institutional data integration, cohort discovery, and advanced analytics that enable rapid learning. PMID:24821737

  6. Pediatric Cancer Recognition Training in Botswana

    PubMed Central

    Slone, Jeremy S.; Ishigami, Elise; Mehta, Parth S.

    2016-01-01

    Delayed presentation of children with cancer is a significant barrier to improving the survival from children’s cancer in low- and middle-income countries (LMICs). Botswana, a country of approximately 2 million people in southern Africa, has only 1 pediatric cancer treatment program, based at Princess Marina Hospital (PMH) in the capital of Gaborone. A pediatric cancer recognition training program was developed that reached 50% of the government hospitals in Botswana teaching 362 health care workers how to recognize and refer children with cancer to PMH. Through evaluation of attendees, limitations in pediatric cancer training and general knowledge of pediatric cancer were identified. Attendees demonstrated improvement in their understanding of pediatric cancer and the referral process to PMH following the workshop. PMID:27336006

  7. Highlights of the second international conference on "Immunotherapy in Pediatric Oncology".

    PubMed

    Capitini, Christian M; Gottschalk, Stephen; Brenner, Malcolm; Cooper, Laurence J N; Handgretinger, Rupert; Mackall, Crystal L

    2011-09-01

    The Second International Conference on Immunotherapy in Pediatric Oncology was held in Houston, Texas, USA, October 11-12, 2010, to discuss the progress and challenges that have occurred in cutting edge immunotherapeutic strategies currently being developed for pediatric oncology. Major topics included immune targeting of acute lymphoblastic leukemia and pediatric solid tumors, chimeric antigen receptors (CARs) for hematologic malignancies and solid tumors, enhancing graft-versus-leukemia for pediatric cancers, overcoming hurdles of immunotherapy, strategies to active the innate immune system, and moving immunotherapy beyond phase I studies. Significant progress has been made in the last 2 years both in the development of novel immunobiologics such as CARs, and in establishing survival benefits of an anti-GD2 monoclonal antibody in randomized studies. Although there is much excitement going forward, a great deal of laboratory and regulatory challenges lie ahead in improving the efficacy of each of these modalities as well as getting them to patients in a timely and cost-effective fashion. The resulting discussions will hopefully lead to new collaborations and insight for further translational and clinical studies. PMID:21854215

  8. Peripheral doses from pediatric IMRT

    SciTech Connect

    Klein, Eric E.; Maserang, Beth; Wood, Roy; Mansur, David

    2006-07-15

    Peripheral dose (PD) data exist for conventional fields ({>=}10 cm) and intensity-modulated radiotherapy (IMRT) delivery to standard adult-sized phantoms. Pediatric peripheral dose reports are limited to conventional therapy and are model based. Our goal was to ascertain whether data acquired from full phantom studies and/or pediatric models, with IMRT treatment times, could predict Organ at Risk (OAR) dose for pediatric IMRT. As monitor units (MUs) are greater for IMRT, it is expected IMRT PD will be higher; potentially compounded by decreased patient size (absorption). Baseline slab phantom peripheral dose measurements were conducted for very small field sizes (from 2 to 10 cm). Data were collected at distances ranging from 5 to 72 cm away from the field edges. Collimation was either with the collimating jaws or the multileaf collimator (MLC) oriented either perpendicular or along the peripheral dose measurement plane. For the clinical tests, five patients with intracranial or base of skull lesions were chosen. IMRT and conventional three-dimensional (3D) plans for the same patient/target/dose (180 cGy), were optimized without limitation to the number of fields or wedge use. Six MV, 120-leaf MLC Varian axial beams were used. A phantom mimicking a 3-year-old was configured per Center for Disease Control data. Micro (0.125 cc) and cylindrical (0.6 cc) ionization chambers were appropriated for the thyroid, breast, ovaries, and testes. The PD was recorded by electrometers set to the 10{sup -10} scale. Each system set was uniquely calibrated. For the slab phantom studies, close peripheral points were found to have a higher dose for low energy and larger field size and when MLC was not deployed. For points more distant from the field edge, the PD was higher for high-energy beams. MLC orientation was found to be inconsequential for the small fields tested. The thyroid dose was lower for IMRT delivery than that predicted for conventional (ratio of IMRT/cnventional ranged

  9. [Radiological diagnostics of pediatric lungs].

    PubMed

    Beer, M; Ammann, B

    2015-07-01

    Pediatric lung diseases are a common clinical problem. Besides the clinical examination and laboratory tests, imaging studies are the mainstay in the diagnostics of pediatric lung diseases. Thorough consideration of radiation protection based on optimized equipment also includes the protection of relatives and medical staff. The high impact of radiation protection in children necessitates a different choice of imaging modalities compared to adults. Ultrasound and magnetic resonance imaging (MRI) as adjunct or complementary imaging methods are of greater value than computed tomography (CT). The suspicion of pneumonia is the most common reason for chest imaging examinations in children. An anteroposterior or posteroanterior view chest X-ray is sufficient in most cases and sometimes in combination with ultrasound. The latter can also be used alone for follow-up examinations if the clinical presentation does not change. Additionally, ultrasound is applied to examine unclear structures seen on chest X-rays, such as the thymus or pulmonary sequestration in adjunct with color-coded duplex sonography. A chest X-ray is also the method of choice to examine the various forms of respiratory distress syndrome, such as wet lung disease or surfactant deficiency syndrome in newborns. Fluoroscopy is used in older children with suspected ingestion and/or aspiration of foreign bodies and CT is mostly used for staging and follow-up of thoracic and pulmonary structures in pediatric oncology. Recent technical advances, e.g. iterative reconstruction, have dramatically reduced the CT dosage. Apart from some indications (e.g. tumors and sequestration) MRI is rarely used in children; however, its potential for functional analyses (e.g. perfusion and ventilation) may increase the application in the near future. PMID:26152499

  10. Pediatric palliative care and pediatric medical ethics: opportunities and challenges.

    PubMed

    Feudtner, Chris; Nathanson, Pamela G

    2014-02-01

    The fields of pediatric palliative care (PPC) and pediatric medical ethics (PME) overlap substantially, owing to a variety of historical, cultural, and social factors. This entwined relationship provides opportunities for leveraging the strong communication skills of both sets of providers, as well as the potential for resource sharing and research collaboration. At the same time, the personal and professional relationships between PPC and PME present challenges, including potential conflict with colleagues, perceived or actual bias toward a palliative care perspective in resolving ethical problems, potential delay or underuse of PME services, and a potential undervaluing of the medical expertise required for PPC consultation. We recommend that these challenges be managed by: (1) clearly defining and communicating clinical roles of PPC and PME staff, (2) developing questions that may prompt PPC and PME teams to request consultation from the other service, (3) developing explicit recusal criteria for PPC providers who also provide PME consultation, (4) ensuring that PPC and PME services remain organizationally distinct, and (5) developing well-defined and broad scopes of practice. Overall, the rich relationship between PPC and PME offers substantial opportunities to better serve patients and families facing difficult decisions. PMID:24488535

  11. Pediatric gliomas as neurodevelopmental disorders.

    PubMed

    Baker, Suzanne J; Ellison, David W; Gutmann, David H

    2016-06-01

    Brain tumors represent the most common solid tumor of childhood, with gliomas comprising the largest fraction of these cancers. Several features distinguish them from their adult counterparts, including their natural history, causative genetic mutations, and brain locations. These unique properties suggest that the cellular and molecular etiologies that underlie their development and maintenance might be different from those that govern adult gliomagenesis and growth. In this review, we discuss the genetic basis for pediatric low-grade and high-grade glioma in the context of developmental neurobiology, and highlight the differences between histologically-similar tumors arising in children and adults. GLIA 2016;64:879-895. PMID:26638183

  12. Radiosurgery for Pediatric Brain Tumors.

    PubMed

    Murphy, Erin S; Chao, Samuel T; Angelov, Lilyana; Vogelbaum, Michael A; Barnett, Gene; Jung, Edward; Recinos, Violette R; Mohammadi, Alireza; Suh, John H

    2016-03-01

    The utility of radiosurgery for pediatric brain tumors is not well known. For children, radiosurgery may have an important role for treating unresectable tumors, residual disease, or tumors in the recurrent setting that have received prior radiotherapy. The available evidence demonstrates utility for some children with primary brain tumors resulting in good local control. Radiosurgery can be considered for limited residual disease or focal recurrences. However, the potential toxicities are unique and not insignificant. Therefore, prospective studies need to be performed to develop guidelines for indications and treatment for children and reduce toxicity in this population. PMID:26536284

  13. Radiation protection in pediatric radiology

    SciTech Connect

    Not Available

    1981-01-01

    The purpose of this report is to make available a source of practical information regarding the manner in which radiologic examinations in children should be conducted to reduce the radiation dose to these patients and those responsible for thier care. The report is mainly for the use of pediatricians, radiologists, radiologic technicians, and other personnel who order or use radiological methods in examining children, Appendices contain methods for estimating doses to various organs, and doses from various examinations in pediatric radiology. The Council has adopted some units of the SI system of nomenclature. A glossary of terms is included. (KRM)

  14. Pediatric surgical pathology. Second edition

    SciTech Connect

    Dehner, L.P.

    1987-01-01

    The edition provides view of congenital, hereditary, infectious, and inflammatory neoplastic diseases occurring during the first two decades of life, with special reference to clinical, laboratory, and roentgenographic features. Material includes observations from some of the major national studies on Wilms' tumor and rhabdomyosarcomas, the new classification of pediatric malignant lymphomas, a discussion of the role of immunocytochemistry as it applies to the diagnosis of childhood infections and neoplasms, an examination of graft-versus-host disease in the liver and intestinal tract and more.

  15. Pediatric genetic disorders of lens

    PubMed Central

    Nihalani, Bharti R.

    2014-01-01

    Pediatric genetic disorders of lens include various cataractous and non-cataractous anomalies. The purpose of this review is to help determine the genetic cause based on the lens appearance, ocular and systemic associations. Children with bilateral cataracts require a comprehensive history, ophthalmic and systemic examination to guide further genetic evaluation. With advancements in genetics, it is possible to determine the genetic mutations and assess phenotype genotype correlation in different lens disorders. The genetic diagnosis helps the families to better understand the disorder and develop realistic expectations as to the course of their child's disorder.

  16. Clinical recommendation: pediatric lichen sclerosus.

    PubMed

    Bercaw-Pratt, Jennifer L; Boardman, Lori A; Simms-Cendan, Judith S

    2014-04-01

    Lichen sclerosus is a chronic inflammatory condition affecting the anogenital region that may present in the prepubertal or adolescent patient. Clinical presentations include significant pruritus, labial adhesions, and loss of pigmentation. Treatment includes topical anti-inflammatory agents and long-term follow-up as there is a high risk of recurrence and an increased risk of vulvar cancer in adult women with history of lichen sclerosus. These recommendations are intended for pediatricians, gynecologists, nurse practitioners and others who care for pediatric/adolescent girls in order to facilitate diagnosis and treatment. PMID:24602304

  17. Compassion Fatigue in Pediatric Nurses.

    PubMed

    Berger, Jill; Polivka, Barbara; Smoot, Elizabeth Ann; Owens, Heather

    2015-01-01

    Compassion fatigue in nursing has been shown to impact the quality of patient care and employee satisfaction and engagement. The aims of this study were to determine the prevalence and severity of compassion fatigue among pediatric nurses and variations in prevalence based on respondent demographics using a cross-sectional survey design. Nurses under 40 years of age, with 6-10 years of experience and/or working in a medical-surgical unit had significantly lower compassion satisfaction and higher levels of burnout. Secondary traumatic stress from caring for children with severe illness or injury or end of life was a key contributor to compassion fatigue. PMID:25800590

  18. Prognostic Significance of Telomere Maintenance Mechanisms in Pediatric High-Grade Gliomas

    PubMed Central

    Dorris, Kathleen; Sobo, Matthew; Onar-Thomas, Arzu; Panditharatna, Eshini; Stevenson, Charles B.; Gardner, Sharon L.; DeWire, Mariko D.; Pierson, Christopher R.; Olshefski, Randal; Rempel, Sandra A.; Goldman, Stewart; Miles, Lili; Fouladi, Maryam; Drissi, Rachid

    2014-01-01

    Background Children with high-grade glioma, including diffuse intrinsic pontine glioma (DIPG), have a poor prognosis despite multimodal therapy. Identifying novel therapeutic targets is critical to improve their outcome. We evaluated prognostic roles of telomere maintenance mechanisms in children with HGG, including DIPG. Methods A multi-institutional retrospective study was conducted involving 50 flash-frozen HGG (35 non-brainstem; 15 DIPG) tumors from 45 children (30 non-brainstem; 15 DIPG). Telomerase activity, expression of hTERT mRNA (encoding telomerase catalytic component) and TERC (telomerase RNA template) and alternative lengthening of telomeres (ALT) mechanism were assayed. Cox Proportional Hazard regression analyses assessed association of clinical and pathological variables, TERC and hTERT levels, telomerase activity, and ALT use with progression-free or overall survival (OS). Results High TERC and hTERT expression was detected in 13/28 non-brainstem HGG samples as compared to non-neoplastic controls. High TERC and hTERT expression was identified in 13/15 and 11/15 DIPG samples, respectively, compared to controls. Evidence of ALT was noted in 3/11 DIPG and 10/19 non-brainstem HGG specimens. ALT and telomerase use were identified in 4/19 non-brainstem HGG and 2/11 DIPG specimens. In multivariable analyses, increased TERC and hTERT levels were associated with worse OS in patients with non-brainstem HGG, after controlling for tumor grade or resection extent. Conclusions Children with HGG and DIPG, have increased hTERT and TERC expression. In children with non-brainstem HGG, increased TERC and hTERT expression levels are associated with a worse OS, making telomerase a promising potential therapeutic target in pediatric HGG. PMID:24477622

  19. 21 CFR 880.5140 - Pediatric hospital bed.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Pediatric hospital bed. 880.5140 Section 880.5140... Devices § 880.5140 Pediatric hospital bed. (a) Identification. A pediatric hospital bed is a device intended for medical purposes that consists of a bed or crib designed for the use of a pediatric...

  20. 21 CFR 880.5140 - Pediatric hospital bed.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Pediatric hospital bed. 880.5140 Section 880.5140... Devices § 880.5140 Pediatric hospital bed. (a) Identification. A pediatric hospital bed is a device intended for medical purposes that consists of a bed or crib designed for the use of a pediatric...

  1. 21 CFR 880.5140 - Pediatric hospital bed.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Pediatric hospital bed. 880.5140 Section 880.5140... Devices § 880.5140 Pediatric hospital bed. (a) Identification. A pediatric hospital bed is a device intended for medical purposes that consists of a bed or crib designed for the use of a pediatric...

  2. 21 CFR 880.5140 - Pediatric hospital bed.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Pediatric hospital bed. 880.5140 Section 880.5140... Devices § 880.5140 Pediatric hospital bed. (a) Identification. A pediatric hospital bed is a device intended for medical purposes that consists of a bed or crib designed for the use of a pediatric...

  3. 76 FR 46304 - Pediatric Advisory Committee; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-02

    ... HUMAN SERVICES Food and Drug Administration Pediatric Advisory Committee; Notice of Meeting AGENCY: Food... of Committee: Pediatric Advisory Committee. General Function of the Committee: To provide advice and..., September 22, 2011, the Pediatric Advisory Committee will meet to discuss pediatric-focused safety...

  4. 21 CFR 880.5140 - Pediatric hospital bed.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Pediatric hospital bed. 880.5140 Section 880.5140... Devices § 880.5140 Pediatric hospital bed. (a) Identification. A pediatric hospital bed is a device intended for medical purposes that consists of a bed or crib designed for the use of a pediatric...

  5. 78 FR 12763 - Pediatric Advisory Committee; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-25

    ... HUMAN SERVICES Food and Drug Administration Pediatric Advisory Committee; Notice of Meeting AGENCY: Food... of Committee: Pediatric Advisory Committee. General Function of the Committee: To provide advice and... Thursday, March 14, 2013, the Pediatric Advisory Committee will meet to discuss pediatric-focused...

  6. The School Psychologist in a Department of Pediatrics.

    ERIC Educational Resources Information Center

    Pfeiffer, Steven I.

    The field of pediatric psychology is a relatively new and emerging specialty, with medical center departments of pediatrics increasingly employing child-oriented psychologists. Since there are no doctoral programs in pediatric psychology, school psychologists with specialized internship training in pediatric psychology are well qualified for these…

  7. Diffusion in solid-Earth systems

    NASA Astrophysics Data System (ADS)

    Watson, E. Bruce; Baxter, Ethan F.

    2007-01-01

    Recent years have seen a rapid expansion in the acquisition and use of information on diffusive transport in phases relevant to the solid Earth (crystals, melts and fluids). Although far from complete, the data base on diffusion coefficients is now sufficiently large that broad constraints can be placed upon the length- and time scales of many natural transport phenomena in which diffusion plays a role. Conversely, observations of diffusion progress in specific natural samples can be used to extract time-temperature information for a variety of geologic and geochemical processes, ranging from sediment burial and crustal erosion to fluid-mediated reactions and biosignature retention. Despite this undeniable progress, several major challenges remain that largely define the frontiers of research in solid-Earth diffusion. Perhaps foremost among these is the need to address and understand the multi-scale, multi-path aspects of diffusion in many systems—a complication that is not limited to polyphase materials (individual mineral grains can exhibit clear indications of multi-path behavior even when visible evidence of such paths is lacking). Many other diffusion frontiers are linked in one way or another to this multi-scale issue; they include: diffusion of molecular H 2O and the effect of H species on diffusion in minerals and rocks; diffusive fractionation of multiple isotopes of a single element; diffusion at the extreme conditions of the deep Earth; reconciliation of observations from natural samples and laboratory studies; and development of theoretical approaches to 'predict' diffusion behavior in regions inaccessible to observation.

  8. The Multicenter Pediatric and Adult Congenital EP Quality (MAP-IT) Initiative-rationale and design: report from the pediatric and congenital electrophysiology society's MAP-IT taskforce.

    PubMed

    Seslar, Stephen P; Kugler, John; Batra, Anjan S; Collins, Kathryn K; Crosson, Jane; Dubin, Anne M; Etheridge, Susan; Kanter, Ronald; Papez, Andrew; Radbill, Andrew E; Serwer, Gerald A; Tanel, Ronn E; Tsao, Sabrina; Webster, Gregory; Saarel, Elizabeth V

    2013-01-01

    Multicenter clinical registries are increasingly recognized as valuable tools for establishing benchmarks, facilitating patient-centered quality improvement and research. In 2010, the Pediatric and Congenital Electrophysiology Society convened a taskforce of its members to design, construct, and implement a clinical registry known as the Multicenter Pediatric and Adult Congenital EP Quality (MAP-IT) Initiative. The present aim of the MAP-IT Initiative is to create an infrastructure by which we can measurably improve patient-centered outcomes and reduce complications associated with electrophysiology studies and catheter ablation in pediatric and congenital heart disease patients. The purpose of this writing is to report the progress to date from three of the four subcommittees of the MAP-IT taskforce. Specifically, we present our initial set of key data elements and definitions, recommended database table structure, and considerations regarding wide-scale implementation of the registry. Development of a risk/complexity score for use in the MAP-IT registry is presented in a separate companion manuscript. It is our intent that these manuscripts will serve to introduce the electrophysiology and pediatric cardiology community to the MAP-IT initiative and provide a rationale for its design and recommended implementation strategy. PMID:23663492

  9. Histologically Benign, Clinically Aggressive: Progressive Non-Optic Pathway Pilocytic Astrocytomas in Adults with NF1

    PubMed Central

    Strowd, Roy E.; Rodriguez, Fausto J.; McLendon, Roger E.; Vredenburgh, James J.; Chance, Aaron B.; Jallo, George; Olivi, Alessandro; Ahn, Edward S.; Blakeley, Jaishri O.

    2016-01-01

    Although optic pathway gliomas are the most common brain tumors associated with neurofibromatosis type 1 (NF1), extra-optic gliomas occur and may behave more aggressively with outcomes that differ by age. A retrospective case-control study was designed to describe the clinical course of adult NF1 patients with progressive extra-optic pilocytic astrocytomas (PAs) and compare to a pediatric cohort. Data for patients treated at the Johns Hopkins Comprehensive Neurofibromatosis Center from 2003 to 2013 were reviewed to identify cases (adults, age >18) and controls (pediatric, age <18) with clinically or radiographically progressive extra-optic PAs. Demographic, clinical, histologic, and radiographic data were collected. Three adult NF1 cases and four pediatric NF1 controls were identified. Mean age was 32.3 ± 9.5 years, 66% male (cases); 12.8±4.2 years, 100% male (controls). Symptomatic progression occurred in two-of-three adults (67%) while the majority of pediatric patients presented with isolated radiographic progression (n=3, 75%). Onset tended to be more rapid in adults (4±1 vs. 14±8.3 months, P=0.10). Subtotal resection was the treatment for all pediatric patients. Radiotherapy (n=2), chemotherapy (n=2), and targeted, biologic agents (n=2) were administered in adults. Although all pediatric patients are living, outcomes were universally poor in adults with progression to death in all (median survival 17.1 months, range 6.6–30.3). In conclusion, despite grade I histology, all three adult NF1 patients with progressive extra-optic PAs suffered an aggressive clinical course which was not seen in pediatric patients. Clinicians should be aware of this clinico-histologic discrepancy when counseling and managing adult NF1 patients with progressive extra-optic PAs. PMID:26992069

  10. Histologically benign, clinically aggressive: Progressive non-optic pathway pilocytic astrocytomas in adults with NF1.

    PubMed

    Strowd, Roy E; Rodriguez, Fausto J; McLendon, Roger E; Vredenburgh, James J; Chance, Aaron B; Jallo, George; Olivi, Alessandro; Ahn, Edward S; Blakeley, Jaishri O

    2016-06-01

    Although optic pathway gliomas are the most common brain tumors associated with neurofibromatosis type 1 (NF1), extra-optic gliomas occur and may behave more aggressively with outcomes that differ by age. A retrospective case-control study was designed to describe the clinical course of adult NF1 patients with progressive extra-optic pilocytic astrocytomas (PAs) and compare to a pediatric cohort. Data for patients treated at the Johns Hopkins Comprehensive Neurofibromatosis Center from 2003 to 2013 were reviewed to identify cases (adults, age >18) and controls (pediatric, age <18) with clinically or radiographically progressive extra-optic PAs. Demographic, clinical, histologic, and radiographic data were collected. Three adult NF1 cases and four pediatric NF1 controls were identified. Mean age was 32.3 ± 9.5 years, 66% male (cases); 12.8 ± 4.2 years, 100% male (controls). Symptomatic progression occurred in two-of-three adults (67%) while the majority of pediatric patients presented with isolated radiographic progression (n = 3, 75%). Onset tended to be more rapid in adults (4 ± 1 vs. 14 ± 8.3 months, P = 0.10). Subtotal resection was the treatment for all pediatric patients. Radiotherapy (n = 2), chemotherapy (n = 2), and targeted, biologic agents (n = 2) were administered in adults. Although all pediatric patients are living, outcomes were universally poor in adults with progression to death in all (median survival 17.1 months, range 6.6-30.3). In conclusion, despite grade I histology, all three adult NF1 patients with progressive extra-optic PAs suffered an aggressive clinical course which was not seen in pediatric patients. Clinicians should be aware of this clinico-histologic discrepancy when counseling and managing adult NF1 patients with progressive extra-optic PAs. © 2016 Wiley Periodicals, Inc. PMID:26992069

  11. Rise and fall of subclones from diagnosis to relapse in pediatric B-acute lymphoblastic leukaemia | Office of Cancer Genomics

    Cancer.gov

    There is incomplete understanding of genetic heterogeneity and clonal evolution during cancer progression. Here we use deep whole-exome sequencing to describe the clonal architecture and evolution of 20 pediatric B-acute lymphoblastic leukaemias from diagnosis to relapse. We show that clonal diversity is comparable at diagnosis and relapse and clonal survival from diagnosis to relapse is not associated with mutation burden.

  12. Neurocognitive Function in Pediatric Bipolar Disorder: 3-Year Follow-Up Shows Cognitive Development Lagging behind Healthy Youths

    ERIC Educational Resources Information Center

    Pavuluri, Mani N.; West, Amy; Hill, Kristian; Jindal, Kittu; Sweeney, John A.

    2009-01-01

    The comparison of the neurocognitive functioning of people with pediatric bipolar disorder (PBD) with a control group shows that the developmental progress in executive functions and verbal memory of those with PBD was significantly less than those in the control group. The results were seen after comparing data from baseline cognitive tests and a…

  13. Radiologic evaluation of the ear anatomy in pediatric cholesteatoma.

    PubMed

    Manolis, Evangelos N; Filippou, Dimitrios K; Tsoumakas, Constantinos; Diomidous, Marianna; Cunningham, Michael J; Katostaras, Theophanis; Weber, Alfred L; Eavey, Roland D

    2009-05-01

    The aim of the study was to describe computed tomography (CT) findings in middle ear cholesteatoma in pediatric patients. A cohort of 32 children with cholesteatoma (3-14 years old) entered the study. From them, 30 presented acquired cholesteatoma (AC), and 2 presented congenital cholesteatoma. All of the children were investigated using CT before surgery of the middle ear and mastoid. Computed tomography was performed with 1- or 2-mm axial and coronal sections of both temporal bones. Nineteen children with AC (63.3%) revealed a diffuse soft-tissue density isodense with muscle, whereas in 6 of them, the mass mimicked inflammation. The remaining revealed localized soft-tissue mass with partially lobulated contour. In AC, ossicular erosion was detected in 23 cases (76.7%), abnormal pneumatization in 19 cases (63.3%), and erosion-blunting of spur and enlargement of middle ear or mastoid in 8 cases (26.7%). The 2 congenital cholesteatomas revealed soft-tissue mass with polypoid densities, while a semicircular canal fistula was detected in one of them. High-resolution CT facilitates early diagnosis and appropriate treatment of pediatric cholesteatoma by assessing the anatomic abnormalities and the extent of disease, which are crucial in middle ear and mastoid surgery. PMID:19390457

  14. Recommendations in pediatric antiretroviral therapy.

    PubMed

    Ikeda, Takehisa; Ch'ng, Tong Wei; Oleske, James M

    2007-02-01

    The pathogenesis of HIV infection and the general principles of therapy are the same for HIV-infected adults, adolescents, children and infants. However, antiretroviral treatment of HIV infection in pediatrics requires the consideration of a number of factors specific to its population, including differences in drug pharmacokinetics and the use of virologic and immunologic markers, as well as age-related adherence issues. This review summarizes the text of the Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection, which was updated in October 2006. The guidelines are the work of the Working Group on Antiretroviral Therapy and Medical Management of HIV-Infected Children, a group of the Office of AIDS Research Advisory Council of the National Institutes of Health, which reviews new data on an ongoing basis and provides regular updates to the guidelines. As these guidelines were developed for the US, they may not be applicable in other countries. This summary does not attempt to place the Working Group guidelines in the context of international guidelines, nor does it attempt to detail the use of antiretroviral medication in the prevention of perinatal transmission of HIV, such as addressing the use of zidovudine versus single-dose nevirapine. PMID:17257086

  15. The pediatric vaccine stockpiling problem.

    PubMed

    Truong, Van-Anh

    2012-09-21

    The U.S. has experienced many major interruptions of its pediatric vaccine production in the past decade. The Centers for Disease Control and Prevention (CDC) copes with these shortages by building a national stockpile of pediatric vaccines, which it makes accessible to the public in the event of a shortage. The management of this stockpile is difficult due to limited production capacity and long and unpredictable production interruptions. In this paper, we address policies for managing the stockpile. We provide sufficient conditions for the optimal policy to be a modified state-dependent base-stock policy, with the base-stock level decreasing in the pipeline inventory. Since the optimal policy is in general difficult to evaluate, we derive bounds on the optimal decision in each period. We develop an efficient policy that performs on average within 1% of optimality in simulations. We show that stocking the same supply of vaccine of every type can be over-conservative in some cases, and inadequate in others by large factors. We also quantify the substantial reduction in inventory level that can be achieved when there are multiple suppliers in the market. PMID:22874852

  16. The treatment of pediatric migraine.

    PubMed

    Lewis, Donald W; Yonker, Marcy; Winner, Paul; Sowell, Michael

    2005-06-01

    The management of pediatric migraine requires a balance of biobehavioral measures coupled with agents for acute treatment and, if needed, daily preventive medicines. A recent American Academy of Neurology practice parameter has critically reviewed the limited data regarding the efficacy and safety of medicines for the acute and preventive therapy of pediatric migraine. The first step is to establish the headache frequency and degree to which the migraines impact upon lifestyle and performance. The next step is to institute nonpharmacologic measures such as regulation of sleep (improved sleep hygiene), moderation of caffeine, regular exercise, and identification of provocative influences (eg, stress, foods, social pressures). A wide variety of therapeutic options exist for patients whose migraine headaches occur with sufficient frequency and severity to produce functional impairment. The most rigorously studied agents for the acute treatment of migraine are ibuprofen, acetaminophen, and sumatriptan nasal spray, all of which have shown safety and efficacy in controlled trials. Daily preventive drug therapies are warranted in about 20% to 30% of young migraine sufferers. The particular drug selected for the individual patient requires an appreciation of comorbidities such as affective or anxiety disorders, co-existent medical conditions such as asthma or diabetes, and acceptability of potential toxicities such as weight gain, sedation, or tremor. PMID:16018227

  17. Pediatric Sudden Sensorineural Hearing Loss.

    PubMed

    Kizilay, Ahmet; Koca, Çiğdem Firat

    2016-06-01

    Sudden sensorineural hearing loss is defined as sudden unilateral or bilateral sensorineural hearing loss with at least 30 dB decrease in threshold in 3 contiguous test frequencies occurring over 72 hours or less. It is rare among children. The mechanism of the process and prognosis of the disorder remains unclear. The current incidence of sudden sensorineural hearing loss among pediatric population is unknown. The authors carried out a retrospective chart analysis of patients under 15 years of age from 2004 to 2015, who consulted to the Otolaryngology Head and Neck Surgery Department of Inonu University Medical Faculty. Age, sex, number of affected ear and side, audiometric evaluations, medical follow-up, treatment method, duration of treatment recovery, associated complaints; tinnitus and/or vertigo, presence of mumps disease were recorded for each patient. A 4-frequency pure-tone average (500, 1000, 2000, and 4000 Hz) was calculated for each ear. Complete recovery, defined as some hearing level compared with the nonaffected ear, was observed in 3 patients (21.4 %) and there was no partial hearing recovery. The hearing loss of 11 patient remained unchanged after prednisolone treatment. Two of the 11 patients had bilaterally total sensorineural hearing loss and evaluated as appropriate for cochlear implantation. Sex of patient and laterality of hearing loss were not correlated with hearing recovery. Sensorineural hearing loss among pediatrics has been the issue of otolaryngologists. The incidence, etiology, and treatment methods should be more studied. PMID:27171971

  18. Ventricular assist devices in pediatrics

    PubMed Central

    Fuchs, A; Netz, H

    2001-01-01

    The implantation of a mechanical circulatory device for end-stage ventricular failure is a possible therapeutic approach in adult and pediatric cardiac surgery and cardiology. The aim of this article is to present mechanical circulatory assist devices used in infants and children with special emphasis on extracorporeal membrane oxygenation, Berlin Heart assist device, centrifugal pump and Medos assist device. The success of long-term support with implantable ventricular assist devices in adults and children has led to their increasing use as a bridge to transplantation in patients with otherwise non-treatable left ventricular failure, by transforming a terminal phase heart condition into a treatable cardiopathy. Such therapy allows rehabilitation of patients before elective cardiac transplantation (by removing contraindications to transplantation mainly represented by organ impairment) or acting as a bridge to recovery of the native left ventricular function (depending on underlying cardiac disease). Treatment may also involve permanent device implantation when cardiac transplantation is contraindicated. Indications for the implantation of assisted circulation include all states of cardiac failure that are reversible within a variable period of time or that require heart transplantation. This article will address the current status of ventricular assist devices by examining historical aspects of its development, current technical issues and clinical features of pediatric ventricular assist devices, including indications and contraindications for support. PMID:22368605

  19. Meeting the Growing Need for Pediatric Rehabilitation Medicine Physicians.

    PubMed

    Houtrow, Amy J; Pruitt, David W

    2016-04-01

    Disability in childhood is on the rise. In light of the national shortage of pediatric rehabilitation medicine physicians to provide care for the growing population of children with disabilities, the field of pediatric rehabilitation medicine should consider allowing pediatric trainees into pediatric rehabilitation medicine fellowships. There are concerns about how best to train these fellows. This commentary discusses the issues and concludes that training opportunities should be developed to allow pediatricians to become pediatric rehabilitation medicine physicians. PMID:26772528

  20. Re-envisioning pediatric nursing education.

    PubMed

    Carlson, Karen L

    2012-01-01

    A majority of children are healthy and never hospitalized in acute care settings. With the challenges faced in the delivery of pediatric nursing education, is it reasonable to continue to insist that all nursing students have an acute care pediatric nursing experience? This article presents arguments for the need to re-envision pediatric nursing education to use limited pediatric nursing faculty and pediatric clinical sites in innovative ways to maintain high-quality outcomes for undergraduate nursing students. The article outlines issues, provides ideas, and advocates for increased use of available innovations. Virtual learning communities and a wealth of other new technologies provide new and inventive ways to deliver essential content. Pediatric nursing leaders need to demonstrate new pedagogies and discourage teaching specialty content in the same manner it has been taught for more than 40 years. The challenges are important to practicing nurses as well as academic faculty because of the implications for the future nursing workforce in pediatric settings and healthcare of children. PMID:23073251