Pharmacologic Restraint Use During Mental Health Admissions to Children's Hospitals.

OBJECTIVES: Primary mental health admissions are increasing across US children's hospitals. These patients may experience agitation requiring pharmacologic restraint. This study characterized pharmacologic restraint use in medical inpatient units by primary mental health diagnosis. METHODS: This retrospective, cross-sectional study used the Pediatric Health Information System database. The study included children aged 5 to 17 years admitted with a primary mental health diagnosis between 2016 and 2021. Rates of pharmacologic restraint use per 1000 patient days were determined for 13 mental health diagnoses and trended over time with Poisson regression. RESULTS: Of 91 898 hospitalizations across 43 hospitals, 3% of admissions and 1.3% of patient days involved pharmacologic restraint. Trends in the rate of pharmacologic restraint use remained stable (95% confidence interval [CI], 0.7-2.1), whereas the incidence increased by 141%. Diagnoses with the highest rates of pharmacologic restraint days per 1000 patient days included autism (79.4; 95% CI, 56.2-112.3), substance-related disorders (45.0; 95% CI, 35.9-56.4), and disruptive disorders (44.8; 95% CI, 25.1-79.8). The restraint rate significantly increased in disruptive disorders (rate ratio [RR], 1.4; 95% CI, 1.1-1.6), bipolar disorders (RR, 2.0; 95% CI, 1.4-3.0), eating disorders (RR, 2.4; 95% CI, 1.5-3.9), and somatic disorders (RR, 4.2; 95% CI, 1.9-9.1). The rate significantly decreased for autism (RR, 0.8; 95% CI, 0.6-1.0) and anxiety disorders (RR, 0.3; 95% CI, 0.2-0.6). CONCLUSIONS: Pharmacologic restraint use among children hospitalized with a primary mental health diagnosis increased in incidence and varied by diagnosis. Characterizing restraint rates and trends by diagnosis may help identify at-risk patients and guide targeted interventions to improve pharmacologic restraint utilization.

The Temporal Region in Unilateral Coronal Craniosynostosis: Fronto-orbital Advancement Versus Endoscopy-Assisted Strip Craniectomy.

OBJECTIVE: To compare postoperative temporal expansion in patients treated with fronto-orbital advancement or endoscopy-assisted craniectomy with cranial orthotic therapy. DESIGN: This is a retrospective, multicenter cohort study of patients with unilateral coronal craniosynostosis (UCS). SETTING: Computed tomographic (CT) scans were drawn from UCS patients treated at Boston Children's Hospital or St Louis Children's Hospital. PATIENTS: The study included 56 patients with UCS after fronto-orbital advancement (n = 32) or endoscopic repair (n = 24) and 10 age-matched controls. INTERVENTION: Fronto-orbital advancement entails a craniotomy of the frontal bone and superior orbital rim followed by reshaping and forward advancement. Endoscopic repair is the release of the synostotic suture and guidance of further growth of the cranium using a molding orthotic. MAIN OUTCOME MEASURES: Measures included posterior temporal width, anterior temporal width, orbital width, and anterior cranial fossa area taken preoperatively and 1 year postoperatively. Linear regression was performed to assess 1 year postoperative improvement in symmetry; covariates included preoperative symmetry and type of surgery. RESULTS: Both treatments showed improvement in orbital width and anterior cranial fossa area symmetry 1 year postoperatively ( P < .001), but no significant improvement in posterior or anterior temporal width symmetry. Linear regression revealed no difference between the 2 procedures in any of the 4 measurements (.096 ≤ P ≤ .898). CONCLUSIONS: Fronto-orbital advancement and endoscopic repair show equivalent outcomes 1 year postoperatively in all 3 width measurements and anterior cranial fossa area. Neither procedure produced significant improvement in temporal width.

Engineered nanoparticles induced brush border disruption in a human model of the intestinal epithelium.

Nanoparticles hold great promise in cell biology and medicine due to the inherent physico-chemical properties when these materials are synthesized on the nanoscale. Moreover, their small size, and the ability to functionalize the outer nanoparticle surface makes them an ideal vector suited to traverse a number of physical barriers in the human body. While nanoparticles hold great promise for applications in cell biology and medicine, their downfall is the toxicity that accompanies exposure to biological systems. This chapter focuses on exposure via the oral route since nanomaterials are being engineered to act as carriers for drugs, contrast agents for specialized imaging techniques, as well as ingested pigments approved by regulatory agencies for human food products. After these nanomaterials are ingested they have the potential to interact with a number of biologically significant tissues, one of which is the epithelium of the small intestine. Within the small intestine exists enterocytes whose principal function is nutrient absorption. The absorptive process is aided by microvilli that act to increase the surface area of the epithelium. Dense arrays of microvilli, referred to as the brush border, have recently been shown to undergo disruption as a consequence of exposure to nanomaterials. This chapter aims to set the stage for detailed mechanistic studies at the cell biology level concerning this newly emerging nanotoxicity research paradigm, as the underlying structural characterization responsible for the existence of microvilli have been elucidated.