Pediatric Spine Trauma in the United States--Analysis of the HCUP Kid'S Inpatient Database (KID) 1997-2009

BACKGROUND

Few references are available describing the epidemiology of pediatric spine injuries. The purpose of this study is to examine the prevalence, risk factors and trends during the period from 1997 to 2009 of pediatric spine injuries in the United States using a large national database.

METHODS

Data was obtained from the Kid's Inpatient Database (KID) developed by the Healthcare Cost and Utilization Project (HCUP), for the years 1997-2009. This data includes >3 million discharges from 44 states and 4121 hospitals on children younger than 20 years. Weighted variables are provided which allow for the calculation of national prevalence rates. The Nationwide Emergency Department Sample (NEDS), HCUP. net, and National Highway Traffic Safety Administration (NHTSA) data were used for verification and comparison.

RESULTS

A prevalence of 107.96 pmp (per million population) spine injuries in children and adolescents was found in 2009, which is increased from the 77.07 pmp observed in 1997. The group 15 to 19 years old had the highest prevalence of all age groups in (345.44 pmp). Neurological injury was present in 14.6% of the cases, for a prevalence of 15.82 pmp. The majority (86.7%) of these injuries occurred in children >15 years. Motor vehicle collisions accounted for 52.9% of all spine injuries, particularly in children >15 years. Between 1997 and 2009 the hospital length of stay decreased, but hospital charges demonstrated a significant increase.

CONCLUSIONS

Pediatric Spine Injuries continue to be a relevant problem, with rates exceeding those of other industrialized nations. Teenagers >15 years of age were at greatest risk, and motor vehicle collisions accounted for the most common mechanism. An increase in prevalence was observed between 1997 and 2009, and this was matched by a similar increase in hospital charges.

LEVEL OF EVIDENCE

III.

Aurora kinase A is superior to Ki67 as a prognostic indicator of survival in neuroblastoma

AIMS

To compare the expression and prognostic value of the cell cycle markers Aurora kinase A (AURKA) and Ki67 in neuroblastoma, because AURKA expression levels have greater prognostic significance than those of Ki67 in some cancers.

METHODS AND RESULTS

Eighty-eight neuroblastomas were immunostained with anti-AURKA and Ki67 antibodies. Digitally scanned slides were scored using imaging analysis software. Median AURKA and Ki67 proliferation indices (PIs) were 1.5% and 26%, respectively. Higher than median AURKA and Ki67 levels were detected in the neuroblastomas from patients belonging to the high-risk group, those with MYCN amplification, and those with unfavourable pathology, including a high mitosis-karyorrhexis index (MKI). High AURKA and Ki67 levels were significantly associated with shorter overall survival (OS) and event-free survival (EFS) in univariate analyses. In multivariate analyses, high AURKA level was associated with significantly shorter OS and EFS, independently of risk group, and of MYCN amplification and MKI. High Ki67 level was not associated with shorter OS or EFS after adjustment for risk group or MYCN amplification and MKI.

CONCLUSIONS

High AURKA and Ki67 levels were associated with adverse prognostic factors and shorter survival, but AURKA provides more valuable prognostic information than Ki67 in neuroblastoma.

The impact of national guidance for anomaly screening and invasive testing: unintended consequences

Recent guidance from the UK National Screening Committee (NSC) and the Fetal Anomaly Screening Programme (FASP) has led to important changes in prenatal ultrasound diagnosis and invasive testing. These relate to prenatal ultrasound investigation of what were previously known as 'soft markers' for Down's syndrome at the time of the detailed anomaly scan and as to whether full karyotype or FISH (fluorescent in situ hybridisation)/QFPCR (quantitative fluorescence PCR) testing for trisomies should be carried out when an invasive test is performed. Neither recommendation is directly related to the other but both in combination could have profound implications for the detection of chromosomal abnormalities other than trisomy 21 (Down's syndrome). In the light of two cases recently managed in one regional fetal medicine unit, we retrospectively reviewed cases where, with correct application of the NSC and FASP recommendations, non-lethal and clinically important chromosomal abnormalities would most likely not have been detected.

Pitfalls of operative management of secondary post-tonsillectomy haemorrhage--a case report

INTRODUCTION

The authors present a potential complication associated with the surgical management of post-tonsillectomy haemorrhage using absorbable cellulose haemostatic dressings. The article discusses the deficiencies of our current understanding of how best to manage this common and potentially life-threatening ENT emergency.

CASE REPORT

A 40-year-old man presented to Accident-and-Emergency with a post-tonsillectomy haemorrhage on the 7th postoperative day. The bleeding was managed surgically, with suturing of the faucial pillars incorporating a piece of Surgicel into the closure. Two days later the patient experienced an episode of partial airway obstruction, due to a piece of dislodged haemostatic material, owing to failure of the closure. The techniques used in the operative management of post-tonsillectomy bleeding are not formally evaluated or discussed in the current literature, and in some cases are unreliable or even potentially hazardous. Further discussion, research, and formulation of a more stepwise approach would be of considerable benefit.

VEGF-C, VEGF-D and VEGFR-3 expression in peripheral neuroblastic tumours

AIMS

More than 50% of neuroblastomas (NBs) present with haematogenous and/or lymphatic metastasis; however, little is known about the clinicopathological significance in NBs of the key lymphangiogenesis growth factors vascular endothelial growth factor (VEGF)-C and VEGF-D and the receptor VEGFR-3.

METHODS AND RESULTS

Ninety-three NBs and nine ganglioneuromas (GNs) were immunostained for VEGF-C, VEGF-D and VEGFR-3. VEGF-C and VEGF-D were present in 76% and 82% of the NBs, respectively. There was no significant difference in VEGF-C expression between NBs and GNs. VEGF-D expression was significantly higher in NBs compared with GNs and in MYCN-amplified NBs. VEGFR-3 tumoral cell expression (VEGFR-3c), present in 48% of the NBs, was significantly higher in NBs from children ≥ 18 months at presentation and those belonging to a high-risk group. VEGFR-3 lymphovascular density was increased significantly in NBs compared with GNs and in NBs associated with adverse clinicopathological and biological factors. Lymphovascular invasion, assessed in VEGFR-3-stained vessels, was present in ∼50% of NBs. Cox regression analyses demonstrated that VEGFR-3c expression was associated with a significantly shorter event-free survival and that its effect was independent of the important pathological variable, mitosis-karyorrhexis index.

CONCLUSIONS

VEGF-D and VEGFR-3 up-regulation support tumour progression in NB and VEGFR-3c may provide a useful prognostic marker in NBs.

A prospective, randomized, controlled trial of autologous haematopoietic stem cell transplantation for aggressive multiple sclerosis: a position paper

Background:

Haematopoietic stem cell transplantation (HSCT) has been tried in the last 15 years as a therapeutic option in patients with poor-prognosis autoimmune disease who do not respond to conventional treatments. Worldwide, more than 600 patients with multiple sclerosis (MS) have been treated with HSCT, most of them having been recruited in small, single-centre, phase 1–2 uncontrolled trials. Clinical and magnetic resonance imaging outcomes from case series reports or Registry-based analyses suggest that a major response is achieved in most patients; quality and duration of response are better in patients transplanted during the relapsing–remitting phase than in those in the secondary progressive stage.

Objectives:

An interdisciplinary group of neurologists and haematologists has been formed, following two international meetings supported by the European and American Blood and Marrow Transplantation Societies, for the purpose of discussing a controlled clinical trial, to be designed within the new scenarios of evolving MS treatments.

Conclusions:

Objectives of the trial, patient selection, transplant technology and outcome assessment were extensively discussed. The outcome of this process is summarized in the present paper, with the goal of establishing the background and advancing the development of a prospective, randomized, controlled multicentre trial to assess the clinical efficacy of HSCT for the treatment of highly active MS.

Caregivers' knowledge, behavior, and attitudes regarding healthy sleep in young children

STUDY OBJECTIVES

To examine sleep health knowledge and beliefs and their relationship to sleep practices in a community sample of caregivers of young children.

METHODS

A convenience sample of caregivers visiting a museum on one of 2 consecutive weekend days completed a brief parent-report survey on child sleep habits and parental basic sleep knowledge and beliefs and attitudes regarding sleep as a health behavior.

RESULTS

Of the 253 analyzable surveys (response rate 80%; mean age of index child 3.4 ± 2.0 years), 23% of children did not have a consistent bedtime, 25% had a bedtime later than 9 pm, 23% had at least one electronic device in the bedroom, and 56% frequently fell asleep with an adult present. Both positive and negative sleep habits tended to cluster together. Children who had irregular and late bedtimes were more than twice as likely to obtain insufficient sleep that those with regular and early bedtimes (OR 2.30, 2.45). While 25% of children were getting less than the recommended sleep amount for age, just 13% of parents believed that their child was getting insufficient sleep. Lack of knowledge regarding the potential negative impact of specific sleep practices was associated with an increased likelihood of engaging in those practices.

CONCLUSIONS

The results of this survey study of a generally well-educated sample of caregivers suggest that there are clear parental knowledge gaps regarding healthy sleep in young children and supports the need for increased sleep health education.

Human papillomavirus vaccine intention among college men: what's oral sex got to do with it?

OBJECTIVE

To identify associations between engaging in oral sex and perceived risk of oral cancer among college men. Also, to identify associations, and their moderating factors, between oral sex and human papillomavirus (HPV) vaccine acceptance.

METHODS

Young men were recruited from 2 university campuses in the South (N = 150). Men completed an audio computer-assisted self-administered interview.

RESULTS

With the exception of receiving fellatio, each measure of oral sex behavior was significantly associated with greater perceived risk of oral cancer. Four oral sex behaviors evidenced significant associations with vaccine acceptance. Men engaging in recent oral sex or reporting oral sex behaviors with more than 2 partners were more likely to indicate vaccine intent. African American/black race, communication with parents about sex-related topics, and HPV-related stigma/shame were identified as moderating factors.

CONCLUSION

Young college men giving or receiving oral sex with multiple partners may be predisposed to HPV vaccination.

Is male intent to be vaccinated against HPV a function of the promotion message?

We aimed to determine whether the type of outcome expectation, stemming from HPV vaccination, would have any effect on young men's HPV vaccine intent. We recruited young men (18-24 years of age) from two university campuses (n = 150). After answering a series of questions they were randomly assigned to one of three information conditions (all delivered by computer): (1) how women may benefit from men's HPV vaccination, (2) preventing genital warts and (3) preventing head and neck cancers. Intent to be vaccinated against HPV in the next 12 months was assessed before and after receiving the informational session corresponding to the assigned condition. A repeated-measures t-test indicated that a significant increase in young men's intent to be vaccinated after they received the assigned information (t = 9.48, [147], P = 0.0001). However, the increase in intent to be vaccinated did not vary by group assignment as there were no significant differences in mean intent scores between the three groups (F = 0.59, [2/144], P = 0.56). Information that promotes the outcome expectations of protecting women from cervical cancer, preventing genital warts for men and preventing head and neck cancers for men may be equally effective in promoting increased intent for HPV vaccine acceptance among young university men.

Pseudo-lyre sign

Carotid body tumours cause characteristic splaying of the internal and external carotid arteries, known as ‘Lyre Sign’. Vagal paragangliomas are rare tumours that arise from glomus cells along the length of the vagus nerve. We present a case in which a vagal paraganglioma has arisen from the vagus nerve at the carotid bifurcation, and has mimicked the ‘Lyre Sign’ of a carotid body tumour.

Microliteracy and the Discourse of Canadian Multiculturalism

This article outlines the chaotic proliferation of multicultural micro-literacies over the decades since the Canadian government first brought the concept of multiculturalism to the national stage in the mid-1960s. The authors define multicultural literacy in terms of patterned and sustained orientations to multiculturalism discourse — orientations that manifest themselves by way of recurrent social and textual practices. In the years prior to 1988 and the official enactment of multiculturalism in Canada, the discourse lent itself to naïve and largely optimistic renderings in a phase of literacy development described in the essay as protoliteracy. Subsequent efforts by the Canadian government to mute the discourse, even as it made multiculturalism into official policy, cleared the way for a post-literate multiplication of multicultural literacies in this country, which severely fragmented and undermined the discourse in the process.

Prenatal detection of unbalanced chromosomal rearrangements by array CGH

BACKGROUND

Karyotype analysis has been the standard method for prenatal cytogenetic diagnosis since the 1970s. Although highly reliable, the major limitation remains the requirement for cell culture, resulting in a delay of as much as 14 days to obtaining test results. Fluorescent in situ hybridisation (FISH) and quantitative fluorescent PCR (QF-PCR) rapidly detect common chromosomal abnormalities but do not provide a genome wide screen for unexpected imbalances. Array comparative genomic hybridisation (CGH) has the potential to combine the speed of DNA analysis with a large capacity to scan for genomic abnormalities. We have developed a genomic microarray of approximately 600 large insert clones designed to detect aneuploidy, known microdeletion syndromes, and large unbalanced chromosomal rearrangements.

METHODS

This array was tested alongside an array with an approximate resolution of 1 Mb in a blind study of 30 cultured prenatal and postnatal samples with microscopically confirmed unbalanced rearrangements.

RESULTS

At 1 Mb resolution, 22/30 rearrangements were identified, whereas 29/30 aberrations were detected using the custom designed array, owing to the inclusion of specifically chosen clones to give increased resolution at genomic loci clinically implicated in known microdeletion syndromes. Both arrays failed to identify a triploid karyotype. Thirty normal control samples produced no false positive results.

CONCLUSIONS

Analysis of 30 uncultured prenatal samples showed that array CGH is capable of detecting aneuploidy in DNA isolated from as little as 1 ml of uncultured amniotic fluid; 29/30 samples were correctly diagnosed, the exception being another case of triploidy. These studies demonstrate the potential for array CGH to replace conventional cytogenetics in the great majority of prenatal diagnosis cases.

Impact of a national external quality assessment scheme for breast pathology in the UK

BACKGROUND

This article presents the results and observed effects of the UK National Health Service Breast Screening Programme (NHSBSP) external quality assurance scheme in breast histopathology.

AIMS/METHODS

The major objectives were to monitor and improve the consistency of diagnoses made by pathologists and the quality of prognostic information in pathology reports. The scheme is based on a twice yearly circulation of 12 cases to over 600 registered participants. The level of agreement was generally measured using kappa statistics.

RESULTS

Four main situations were encountered with respect to diagnostic consistency, namely: (1) where consistency is naturally very high-this included diagnosing in situ and invasive carcinomas (and certain distinctive subtypes) and uncomplicated benign lesions; (2) where the level of consistency was low but could be improved by making guidelines more detailed and explicit-this included histological grading; (3) where consistency could be improved but only by changing the system of classification-this included classification of ductal carcinoma in situ; and (4) where no improvement in consistency could be achieved-this included diagnosing atypical hyperplasia and reporting vascular invasion. Size measurements were more consistent for invasive than in situ carcinomas. Even in cases where there is a high level of agreement on tumour size, a few widely outlying measurements were encountered, for which no explanation is readily forthcoming.

CONCLUSIONS

These results broadly confirm the robustness of the systems of breast disease diagnosis and classification adopted by the NHSBSP, and also identify areas where improvement or new approaches are required.