Successful treatment of a solitary skull metastasis in a child with Wilms' Tumor

This report presents the successful treatment of a child with a solitary metastatic lesion to the calvarium following treatment for Stage III anaplastic Wilms’ Tumor

Controlled trial of lovastatin combined with an open-label treatment of a parent-implemented language intervention in youth with fragile X syndrome.

BackgroundThe purpose of this study was to conduct a 20-week controlled trial of lovastatin (10 to 40 mg/day) in youth with fragile X syndrome (FXS) ages 10 to 17 years, combined with an open-label treatment of a parent-implemented language intervention (PILI), delivered via distance video teleconferencing to both treatment groups, lovastatin and placebo.MethodA randomized, double-blind trial was conducted at one site in the Sacramento, California, metropolitan area. Fourteen participants were assigned to the lovastatin group; two participants terminated early from the study. Sixteen participants were assigned to the placebo group. Lovastatin or placebo was administered orally in a capsule form, starting at 10 mg and increasing weekly or as tolerated by 10 mg increments, up to a maximum dose of 40 mg daily. A PILI was delivered to both groups for 12 weeks, with 4 activities per week, through video teleconferencing by an American Speech-Language Association-certified Speech-Language Pathologist, in collaboration with a Board-Certified Behavior Analyst. Parents were taught to use a set of language facilitation strategies while interacting with their children during a shared storytelling activity. The main outcome measures included absolute change from baseline to final visit in the means for youth total number of story-related utterances, youth number of different word roots, and parent total number of story-related utterances.ResultsSignificant increases in all primary outcome measures were observed in both treatment groups. Significant improvements were also observed in parent reports of the severity of spoken language and social impairments in both treatment groups. In all cases, the amount of change observed did not differ across the two treatment groups. Although gains in parental use of the PILI-targeted intervention strategies were observed in both treatment groups, parental use of the PILI strategies was correlated with youth gains in the placebo group and not in the lovastatin group.ConclusionParticipants in both groups demonstrated significant changes in the primary outcome measures. The magnitude of change observed across the two groups was comparable, providing additional support for the efficacy of the use of PILI in youth with FXS.Trial registrationUS National Institutes of Health (ClinicalTrials.gov), NCT02642653. Registered 12/30/2015

Physical Examination is the Best Predictor of the Need for Abdominal Surgery in Children Following Motor Vehicle Collision

BACKGROUND: Exploratory laparotomy in children after motor vehicle collision (MVC) is rare. In the absence of definitive hemorrhage or free abdominal air on radiographic imaging, predictors for operative exploration are conflicting. OBJECTIVE: The purpose of this study was to explore objective findings that may aid in determining which children require operative abdominal exploration after MVC. METHODS: Data from 2010-2014 at an American College of Surgeons-certified level 1 pediatric trauma center were retrospectively reviewed. Demographics, vital signs, laboratory data, radiologic studies, operative records, associated injuries, and outcomes were analyzed and p < 0.05 was considered statistically significant. RESULTS: Eight hundred sixty-two patients 0-18 years of age presented to the hospital after an MVC during the study period. Seventeen patients (2.0%) required abdominal exploration and all were found to have intraabdominal injuries. Respiratory rate was the only vital sign that was significantly altered (p = 0.04) in those who required abdominal surgery compared with those who did not. Physical examination findings, such as the seat belt sign, abdominal bruising, abdominal wound, and abdominal tenderness, were present significantly more frequently in those requiring abdominal surgery (p < 0.0001). Each finding had a negative predictive value for the need for operative exploration of at least 0.98. There were no significant differences in trauma laboratory values or radiographic findings between the 2 groups. CONCLUSION: Data from this study solidify the relationship between specific physical examination findings and the need for abdominal exploration after MVC in children. In addition, these data suggest that a lack of the seat belt sign, abdominal bruising, abdominal wounds, or abdominal tenderness are individually predictive of patients who will not require surgical intervention

Shoulder Arthroscopy After a Proximal Humeral Fracture Malunion: Athlete Care and Clinical Medicine in Middle-Aged Athletes

Malunion of the proximal humerus is operationally defined as healing of the fractured bone in a non-anatomical position, resulting in a painful and disabling deformity (e.g., a bone being shorter than normal, twisted or rotated in a bad position, or bent), which affects the range of motion (ROM) and functional movement. A correction and functional restoration are often needed in athletes, since their profession requires superior physical functioning. Shoulder arthroscopy has evolved dramatically over the past 15 years and has been used in cases of malunion of the humerus in athletes. However, there is a scarcity of evidence concerning middle-aged athletes. PURPOSE: To examine the benefits of shoulder arthroscopy after a proximal humeral fracture unified in malposition in middle-aged athletes. METHODS: Physical examination and imaging evaluation using 3D Computed Tomography(3D-CT), Magnetic Resonance Imaging (MRI), and shoulder radiographs (anteroposterior, internal rotation, and lateral scapular view) were used to evaluate shoulder dysfunction after proximal humeral fracture in malposition. Fourteen athletes (9 males, 5 females; Mage = 43.1, SD = 3.5) were included in this research. According to Neer classification before surgery, 11 (78%) had one part displaced and the rest three (22%) had two parts displaced. Post-operative clinical results were evaluated with self-reported pain score (1-10), UCLA scores, and shoulder abduction ROM measured with a goniometer. RESULTS: There was significant difference in pain scores (Mbefore = 8, Range: 6-9; Mafter = 4, Range: 2-6; p \u3c .001), in UCLA scores (Mbefore = 12, Range: 9-16; Mafter = 28, Range: 20-31; p \u3c .01), and in shoulder abduction ROM (Mbefore = 80, Range: 70-100; Mafter = 135, Range: 120-150; p \u3c .05). CONCLUSION: Our research provides evidence for clinical translation in improving health outcomes in middle-aged athletes with a history of proximal humeral fracture union in malposition: shoulder arthroscopy can be simultaneously beneficial in terms of decreasing pain level, increasing ROM, and restoring limb function

Gender Differences Concerning Physical Activity Beliefs and Practices among Fourth and Fifth Graders in Rural Virginia

Cardiovascular disease is the leading cause of death in the United States. Physical activity (PA) is a known preventative factor. It is recommended that children participate in 60 minutes of PA daily, but most do not meet these guidelines. Further, boys, aged 8-17 years, spend more time in PA than girls of the same age. The purposes of this study were to identify gender differences in PA beliefs and practices among fourth and fifth graders and to determine when gender disparities in self-confidence regarding PA and fitness occur.&nbsp; Subjects were 41 fourth (19 boys; 22 girls) and 33 fifth (16 boys; 17 girls) graders in a public elementary school in the rural northwest. They participated in the FitnessGram, a nationwide assessment of flexibility, aerobic capacity, and muscular strength and endurance, and a proctored survey about their PA beliefs, self-confidence, and participation. There were no differences in FitnessGram data between boys and girls for aerobic capacity or muscular strength and endurance, but girls had increased flexibility when compared to boys in both grades. Importantly, survey results showed fifth grade girls had less confidence they could improve their physical fitness (p = 0.002) or their overall health (p = 0.004) when compared to fourth grade girls. Research is needed to determine how these changes in self-confidence contribute to the gender gap in time spent in PA. We recommend physical education programs throughout all grades teach healthy behaviors, including time spent in PA, and work to build and maintain self-confidence in girls

Tropospheric sources and sinks of gas-phase acids in the Colorado Front Range

We measured organic and inorganic gas-phase acids in the Front Range of Colorado to better understand their tropospheric sources and sinks using a high-resolution time-of-flight chemical ionization mass spectrometer. Measurements were conducted from 4 to 13 August 2014 at the Boulder Atmospheric Observatory during the Front Range Air Pollution and Photochemistry Éxperiment. Diurnal increases in mixing ratios are consistent with photochemical sources of HNO3, HNCO, formic, propionic, butyric, valeric, and pyruvic acid. Vertical profiles taken on the 300&thinsp;m tower demonstrate net surface-level emissions of alkanoic acids, but net surface deposition of HNO3 and pyruvic acid. The surface-level alkanoic acid source persists through both day and night, and is thus not solely photochemical. Reactions between O3 and organic surfaces may contribute to the surface-level alkanoic acid source. Nearby traffic emissions and agricultural activity are a primary source of propionic, butyric, and valeric acids, and likely contribute photochemical precursors to HNO3 and HNCO. The combined diel and vertical profiles of the alkanoic acids and HNCO are inconsistent with dry deposition and photochemical losses being the only sinks, suggesting additional loss mechanisms.</p

Sources and Secondary Production of Organic Aerosols in the Northeastern United States during WINTER

Most intensive field studies investigating aerosols have been conducted in summer, and thus, wintertime aerosol sources and chemistry are comparatively poorly understood. An aerosol mass spectrometer was flown on the National Science Foundation/National Center for Atmospheric Research C‐130 during the Wintertime INvestigation of Transport, Emissions, and Reactivity (WINTER) 2015 campaign in the northeast United States. The fraction of boundary layer submicron aerosol that was organic aerosol (OA) was about a factor of 2 smaller than during a 2011 summertime study in a similar region. However, the OA measured in WINTER was almost as oxidized as OA measured in several other studies in warmer months of the year. Fifty‐eight percent of the OA was oxygenated (secondary), and 42% was primary (POA). Biomass burning OA (likely from residential heating) was ubiquitous and accounted for 33% of the OA mass. Using nonvolatile POA, one of two default secondary OA (SOA) formulations in GEOS‐Chem (v10‐01) shows very large underpredictions of SOA and O/C (5×) and overprediction of POA (2×). We strongly recommend against using that formulation in future studies. Semivolatile POA, an alternative default in GEOS‐Chem, or a simplified parameterization (SIMPLE) were closer to the observations, although still with substantial differences. A case study of urban outflow from metropolitan New York City showed a consistent amount and normalized rate of added OA mass (due to SOA formation) compared to summer studies, although proceeding more slowly due to lower OH concentrations. A box model and SIMPLE perform similarly for WINTER as for Los Angeles, with an underprediction at ages \u3c6 hr, suggesting that fast chemistry might be missing from the models