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pediatrics sensitivity and specificity study

Kent P Hymel, Ming Wang, Vernon M Chinchilli, Wouter A Karst, Douglas F Willson, Mark S Dias, Bruce E Herman, Christopher L Carroll, Suzanne B Haney, Reena Isaac
BACKGROUND: Evidence-based, patient-specific estimates of abusive head trauma probability can inform physicians' decisions to evaluate, confirm, exclude, and/or report suspected child abuse. OBJECTIVE: To derive a clinical prediction rule for pediatric abusive head trauma that incorporates the (positive or negative) predictive contributions of patients' completed skeletal surveys and retinal exams. PARTICIPANTS AND SETTING: 500 acutely head-injured children under three years of age hospitalized for intensive care at one of 18 sites between 2010 and 2013...
December 11, 2018: Child Abuse & Neglect
Andrew D Graustein, Elizabeth A Misch, Munyaradzi Musvosvi, Muki Shey, Javeed A Shah, Chetan Seshadri, Augustine Aguoju, Kathryn Bowman, Humphrey Mulenga, Ashley Veldsman, Willem A Hanekom, Mark Hatherill, Thomas J Scriba, Thomas R Hawn
RATIONALE: HSP90B1, also known as gp96, is a chaperone for multiple Toll-like receptors (TLRs) and is necessary for TLR-mediated inflammatory responses in murine myeloid cells. The molecule is also expressed in T-cells though its specific role is unknown. We hypothesized that human HSP90B1 regulates monocyte and T-cell responses to Mycobacterium tuberculosis (Mtb) and bacilli Calmette-Guerin (BCG) and that its variants are associated with susceptibility to TB disease. METHODS: We screened 17 haplotype-tagging SNPs in the HSP90B1 gene region for association with BCG-induced T-cell cytokine responses using both an ex-vivo whole blood assay (N = 295) and an intracellular cytokine staining assay (N = 180) on samples collected 10 weeks after birth...
2018: PloS One
Alejandro Sanchez-Crespo
Single photon emission computed tomography (SPECT) provides high contrast three dimensional images of the regional distribution of a radiotracer. SPECT is a widely used technique in pulmonary investigations of the ventilation (V) and perfusion (Q) in the adult patient, mainly in the diagnosis of pulmonary embolism. However, safety concerns among practitioners due to radiation exposure and the use of macroaggregate albumin for the perfusion scan have historically precluded the use of SPECT in pediatric patients with nonembolic pulmonary disorders...
January 2019: Seminars in Nuclear Medicine
Amanda E Pope, Nicholas Stanzione, Bita V Naini, Maria Garcia-Lloret, Kevin A Ghassemi, Elizabeth A Marcus, Martin G Martin, Laura J Wozniak
OBJECTIVE: Recent studies show increased serum and esophageal IgG4 in patients with eosinophilic esophagitis (EoE), suggesting a possible IgG4-involved process. The role of IgG4 in pediatric EoE has not been extensively investigated. Our aim was to analyze IgG4 in esophageal tissue in children in parallel to that in adults with EoE. METHODS: In a retrospective institutional review board-approved study, we performed immunohistochemical staining of IgG4 in esophageal biopsy specimens from 39 subjects: children with EoE (n = 16), adults with EoE (n = 15), children with reflux esophagitis (n = 4), and pediatric controls (n = 4)...
December 11, 2018: Journal of Pediatric Gastroenterology and Nutrition
Rosemary Thomas-Mohtat, Craig Sable, Kristen Breslin, Jacqueline G Weinberg, Aparna Prasad, Lauren Zinns, Joanna S Cohen
BACKGROUND: Focused cardiac ultrasound (FOCUS) is a core competency for pediatric emergency medicine (PEM) fellows. The objectives of this study were (1) to evaluate test characteristics of PEM-fellow-performed FOCUS for pericardial effusion and diminished cardiac function and (2) to assess image interpretation independent of image acquisition. METHODS: PEM fellows performed and interpreted FOCUS on patients who also received cardiology service echocardiograms, the reference standard...
December 9, 2018: Critical Ultrasound Journal
Margarida Paiva Coelho, Esmeralda Martins, Laura Vilarinho
Primary mitochondrial disorders are highly variable in clinical presentation, biochemistry, and molecular etiology. Mitochondrial disorders can be caused by genetic defects in the mitochondrial, in nuclear genome, or in the interplay between the two genomes. Biochemical screening tests may be inconclusive or misleading since patients, with confirmed mitochondrial disorders specially in pediatric age, may exhibit normal routine biochemistry, muscle histology, or enzymatic analysis of the mitochondrial respiratory chain...
December 7, 2018: European Journal of Pediatrics
Jinqiu Fu, Libo Si, Yong Zhuang, Aijun Zhang, Nianzheng Sun, Dong Li, Bin Hao, Xiuli Ju
Although ~80% of newly diagnosed pediatric patients with acute lymphoblastic leukemia (ALL) become disease‑free following appropriate treatment, relapses frequently occur, with dismal prognosis. Therefore, it is urgent to develop novel therapeutic modalities. Resistance to chemotherapy is a major obstacle for the treatment of relapsed ALL. It has been indicated that Wnt pathway is potentially associated with leukemia recurrence. In the current study, a vincristine (VCR)‑resistant variant of the human ALL cell line BALL‑1 (BALL‑1/VCR) that also had relatively specific resistance to both doxorubicin and etoposide was generated...
December 4, 2018: Oncology Reports
Min Jiang, Xueqin Zou, Lingyun Lu
Acute B‑cell lymphoblastic leukemia (B‑ALL) is a common type of blood cancer, which is associated with aberrant gene expression. Cytokine receptor‑like factor 2 (CRLF2) serves a crucial role in the growth and allergic and inflammatory responses of dendritic cells and T cells. The purpose of the present study was to investigate the potential therapeutic and prognostic effect of silencing the CRLF2‑mediated RAC‑α serine/threonine‑protein kinase (AKT)/serine/threonine‑protein kinase mTOR (mTOR) pathway in B‑ALL...
December 7, 2018: Oncology Reports
Chris A Rees, Andrea T Cruz, Stephen B Freedman, Prashant Mahajan, Neil G Uspal, Pamela Okada, Paul L Aronson, Amy D Thompson, Paul T Ishimine, Suzanne M Schmidt, Nathan Kuppermann, Lise E Nigrovic
In 4292 infants aged ≤60 days with cerebrospinal fluid (CSF) pleocytosis, the bacterial meningitis score had excellent sensitivity (121 of 121 [100.0%] [95% confidence interval, 96.5%-100.0%]) but low specificity (66 of 4171 [1.6%] [95% confidence interval, 1.3%-2.0%]) and therefore should not be applied clinically to infants in this age group.
December 10, 2018: Journal of the Pediatric Infectious Diseases Society
Kelly L Brown, Joanna M Lubieniecka, Giulia Armaroli, Katharina Kessel, Kristen M Gibson, Jinko Graham, Dongmeng Liu, Robert E W Hancock, Colin J Ross, Susanne M Benseler, Raashid A Luqmani, David A Cabral, Dirk Foell, Christoph Kessel
Objectives: Chronic primary systemic vasculitidies (CPV) are a collection of rare diseases involving inflammation in blood vessels, often in multiple organs. CPV can affect adults and children and may be life- or organ-threatening. Treatments for adult CPV, although effective, have known severe potential toxicities; safety and efficacy of these drugs in pediatric patients is not fully understood. There is an unmet need for biologic measures to assess the level of disease activity and, in turn, inform treatment choices for stopping, starting, or modifying therapy...
2018: Frontiers in Pediatrics
Fernando Vaquerizo-Villar, Daniel Álvarez, Leila Kheirandish-Gozal, Gonzalo C Gutiérrez-Tobal, Verónica Barroso-García, Andrea Crespo, Félix Del Campo, David Gozal, Roberto Hornero
BACKGROUND: The gold standard for pediatric sleep apnea hypopnea syndrome (SAHS) is overnight polysomnography, which has several limitations. Thus, simplified diagnosis techniques become necessary. OBJECTIVE: The aim of this study is twofold: (i) to analyze the blood oxygen saturation (SpO2) signal from nocturnal oximetry by means of features from the wavelet transform in order to characterize pediatric SAHS; (ii) to evaluate the usefulness of the extracted features to assist in the detection of pediatric SAHS...
2018: PloS One
Hideki Sudo, Terufumi Kokabu, Yuichiro Abe, Akira Iwata, Katsuhisa Yamada, Yoichi M Ito, Norimasa Iwasaki, Satoshi Kanai
Idiopathic scoliosis is the most common pediatric musculoskeletal disorder that causes a three-dimensional deformity of the spine. Early detection of this progressive aliment is essential. The aim of this study is to determine outcomes using a newly developed automated asymmetry-evaluation system for the surface of the human back using a three-dimensional depth sensor. Seventy-six human subjects suspected to have idiopathic scoliosis were included in this study. Outcome measures include patient demographics, radiographic measurements, and asymmetry indexes defined in the automated asymmetry-recognition system...
December 7, 2018: Scientific Reports
Pedro Bichaff, Karina T Setani, Emiliana H G Motta, Artur F Delgado, Werther B Carvalho, Michele Luglio
OBJECTIVE: Opioid abstinence syndrome is common in the pediatric intensive care environment because sedation is often needed during the children's treatment. There is no specific guideline regarding the management of these patients; and lately, methadone is an important drug for the prevention of abstinence symptoms during the weaning of opioids. This study gathers the available research to establish the initial dose of methadone, the rate of taper and tools to recognize this syndrome and act promptly...
October 2018: Revista da Associação Médica Brasileira
Rebecca Wallihan, Keely G Smith, Mark D Hormann, Rajesh R Donthi, Kimberly Boland, John D Mahan
BACKGROUND: Traditionally, quizzes have been applied as a tool for summative assessment, though literature suggests their use as a formative assessment can improve motivation and content retention. With this premise, we implemented a series of intermittent, online quizzes known as the Board Examination Simulation Exercise (BESE). We sought to demonstrate an association between BESE participation and scores and performance on the American Board of Pediatrics (ABP) Certifying Examination (CE)...
December 4, 2018: BMC Medical Education
Chunyan Tao, Selena Chen, Hongxia Li, Yuanyuan Wang, Yuli Wang, Ping Liu, Ying Liao, Chunyu Zhang, Chaoshu Tang, Hongfang Jin, Junbao Du
Objectives: To explore the predictive value of immediate heart rate alteration from supine to upright in the differential diagnosis between vasovagal syncope (VVS) and postural tachycardia syndrome (POTS) in children. Materials and Methods: A total of 76 pediatric outpatients or inpatients who visited the Peking University First Hospital from July 2016 to November 2017 were recruited in the study. Among them, 52 patients were diagnosed with VVS and 24 patients were diagnosed with POTS. The differential diagnostic value of acceleration index (AI) and 30/15 ratio was evaluated by the receiver operating characteristic (ROC) curve...
2018: Frontiers in Pediatrics
Sara Karjoo
Carotid intima media thickness (cIMT) and brachial flow-mediated dilation (FMD) evaluated by ultrasound are non-invasive markers of atherosclerosis. Increased cIMT in adults has been correlated to early vascular damage. Several studies show similar correlations of elevated cIMT in children with obesity, hyperlipidemia, and metabolic syndrome. Additionally, several articles have correlated non-alcoholic fatty liver disease (NAFLD) with elevated cIMT, indicating early atherosclerosis. It is alarming that these vascular changes may be seen in children as young as 10 years of age...
2018: Frontiers in Pediatrics
Namrata Maity, Chhanda Das, Madhumita Mukhopadhyay, Tamanna Parvin, Ashis Kumar Saha, Biswanath Mukhopadhyay
BACKGROUND: Pediatric renal neoplasms comprise about 7%-8% of all neoplasms in children. Wilms tumour (WT) is the most common among pediatric renal tumours. AIMS AND OBJECTIVES: The study was undertaken to study the epidemiological occurrence of pediatric renal tumours in a tertiary care hospital and to ascertain the validity and reliability of touch smear imprint cytology in intraoperative diagnosis of renal tumours and correlate with subsequent histopathological diagnosis and to assess the expression of proliferation marker Ki-67 in different components and stages of WT...
October 2018: Journal of Laboratory Physicians
Simone Kathemann, Elke Lainka, Johannes M Ludwig, Axel Wetter, Andreas Paul, Peter F Hoyer, Michael Forsting, Thomas Schlosser
PURPOSE: Extrahepatic portal vein thrombosis (EPVT) is one major cause of portal hypertension in children. Surgical reinstallation of portal venous flow can be achieved in patients with patent intrahepatic portal venous system/Rex recess. Our study aimed to compare the ability of magnetic resonance imaging (MRI) and retrograde portography (RP) to assess patency of the intrahepatic portal venous system in children with EPVT. METHODS: All pediatric patients with EPVT who were examined with contrast enhanced MRI (1...
October 30, 2018: Journal of Pediatric Surgery
Peter M Wolfgram, Bhavana Narala, David T Wyatt
BACKGROUND: Variance between current American Diabetes Association (ADA) and International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines and in clinical practice exists for the use of thyroid antibody and thyroid function screening in pediatric patients with new-onset type 1 diabetes (T1D). METHODS: North American Pediatric Endocrine Society (PES) members were surveyed regarding their thyroid screening practices of euthyroid youth with T1D. An institutional analysis of the ability of antithyroid peroxidase (aTPO) and antithyroglobulin antibodies (aTG) to predict the subsequent use of levothyroxine was performed...
November 29, 2018: Hormone Research in Pædiatrics
Todd Karsies, Melissa Moore-Clingenpeel, Mark Hall
Background: Risk-based guidelines aid empiric antibiotic selection for critically ill adults with suspected infection with Gram-negative bacilli with high potential for antibiotic resistance (termed high-risk GNRs). Neither evidence-based guidelines for empiric antibiotic selection nor validated risk factors predicting high-risk GNR growth exist for critically ill children. We developed and validated a model for predicting high-risk GNR growth in critically ill children with suspected infection...
November 2018: Open Forum Infectious Diseases
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