Propranolol therapy for infantile hemangioma is less toxic but longer in duration than corticosteroid therapy

BACKGROUND: Infantile hemangioma is the most common benign, self-limiting tumour of childhood. Treatment is reserved for hemangiomas that obstruct vital structures or cause significant disfigurement. Traditionally, corticosteroids have been the medical treatment of choice. Since 2008, however, propranolol has been rapidly adopted as an effective pharmacological treatment for infantile hemangioma. Published data regarding the long-term side effects of propranolol are currently lacking. OBJECTIVE: To describe the long-term effects of propranolol and corticosteroids on anthropometric measurements (height, body mass index [BMI]) and blood pressure in children. METHODS: A prospective database analysis of all infantile hemangioma patient visits to the pediatric vascular abnormality clinic at the authors\u27 institution between October 2007 and February 2012 was performed. Anthropometric measures (height and BMI) and blood pressure were analyzed. RESULTS: A total of 290 visits (119 patients) to the pediatric vascular abnormality clinic were reviewed. Of these, 18 patients received medical treatment and their anthropometry was analyzed. BMI percentile increased significantly in patients treated with corticosteroids (P=0.0039). Corticosteroid treatment also resulted in a significant decrease in height percentile (P=0.0078). Anthropometric measures did not cross percentiles in children treated with propranolol. A significant decrease in systolic blood pressure was noted in the propranolol group (P=0.03), but no hypotensive values were recorded. Median treatment duration was significantly longer when patients received propranolol (372 versus 133 days; P=0.0033). CONCLUSION: Propranolol for the treatment of infantile vascular abnormalities does not share the unfavourable effects on patient anthropometry that corticosteroids exhibit; however, a longer duration of therapy is required

LRE re-examined: misinterpretations and unintended consequences

The least restrictive environment (LRE) requirement has been one of the major pillars of special education law in the USA since its enactment in 1975 and has proven to be one of the most contentious principles. Absent a decision by the US Supreme Court or further clarification in the wording of the law itself, it is likely that the debate will continue. This discussion is particularly important because misapplication of the LRE principle can result in a violation of civil rights and deprive children of a free appropriate public education. A review of the historical background of LRE, the Individuals with Disabilities Education Act and relevant court cases supports the contention that the general education setting is the LRE for every child but not necessarily the appropriate placement for all children

Successful use of axonal transport for drug delivery by synthetic molecular vehicles

We report the use of axonal transport to achieve intraneural drug delivery. We constructed a novel tripartite complex of an axonal transport facilitator conjugated to a linker molecule bearing up to a hundred reversibly attached drug molecules. The complex efficiently enters nerve terminals after intramuscular or intradermal administration and travels within axonal processes to neuron cell bodies. The tripartite agent provided 100-fold amplification of saturable neural uptake events, delivering multiple drug molecules per complex. _In vivo_, analgesic drug delivery to systemic and to non-targeted neural tissues was greatly reduced compared to existing routes of administration, thus exemplifying the possibility of specific nerve root targeting and effectively increasing the potency of the candidate drug gabapentin 300-fold relative to oral administration

Effect of ultrafiltration during hemodialysis on hepatic and total-body water: an observational study.

Background The hepatic circulation is involved in adaptive systemic responses to circulatory stress. However, it is vulnerable to both chronic hypervolemia and cardiac dysfunction. The influence of hemodialysis (HD) and ultrafiltration (UF) upon liver water content has been understudied. We conducted a detailed pilot study to characterize the effects of HD upon liver water content and stiffness, referenced to peripheral fluid mobilization and total body water. Methods We studied 14 established HD patients without liver disease. Magnetic resonance imaging (MRI) together with ultrasound-based elastography and bioimpedance assessment were employed to measure hepatic water content and stiffness, body composition, and water content in the calf pre- and post-HD. Results Mean UF volume was 8.13 ± 4.4 mL/kg/hr. Fluid removal was accompanied with effective mobilization of peripheral water (measured with MRI within the thigh) from 0.85 ± 0.21 g/mL to 0.83 ± 0.18 g/mL, and reduction in total body water (38.9 ± 9.4 L to 37.4 ± 8.6 L). However, directly-measured liver water content did not decrease (0.57 ± 0.1 mL/g to 0.79 ± 0.3 m L/g). Liver water content and IVC diameter were inversely proportional (r = - 0.57, p = 0.03), a relationship which persisted after dialysis. Conclusions In contrast to the reduced total body water content, liver water content did not decrease post-HD, consistent with a diversion of blood to the hepatic circulation, in those with signs of greater circulatory stress. This novel observation suggests that there is a unique hepatic response to HD with UF and that the liver may play a more important role in intradialytic hypotension and fluid shifts than currently appreciated

Hubble Space Telescope Near-Ultraviolet Spectroscopy of Bright CEMP-s Stars

We present an elemental-abundance analysis, in the near-ultraviolet (NUV) spectral range, for the bright carbon-enhanced metal-poor (CEMP) stars HD196944 (V = 8.40, [Fe/H] = -2.41) and HD201626 (V = 8.16, [Fe/H] = -1.51), based on data acquired with the Space Telescope Imaging Spectrograph (STIS) on the Hubble Space Telescope. Both of these stars belong to the sub-class CEMP-s, and exhibit clear over-abundances of heavy elements associated with production by the slow neutron-capture process. HD196944 has been well-studied in the optical region, but we are able to add abundance results for six species (Ge, Nb, Mo, Lu, Pt, and Au) that are only accessible in the NUV. In addition, we provide the first determination of its orbital period, P=1325 days. HD201626 has only a limited number of abundance results based on previous optical work -- here we add five new species from the NUV, including Pb. We compare these results with models of binary-system evolution and s-process element production in stars on the asymptotic giant branch, aiming to explain their origin and evolution. Our best-fitting models for HD 196944 (M1,i = 0.9Mo, M2,i = 0.86Mo, for [Fe/H]=-2.2), and HD 201626 (M1,i = 0.9Mo , M2,i = 0.76Mo , for [Fe/H]=-2.2; M1,i = 1.6Mo , M2,i = 0.59Mo, for [Fe/H]=-1.5) are consistent with the current accepted scenario for the formation of CEMP-s stars.Comment: 25 pages, 13 figures; accepted for publication in Ap