Percutaneous electrical nerve field stimulation improves comorbidities in children with cyclic vomiting syndrome.

Introduction: Children with cyclic vomiting syndrome (CVS) frequently suffer from disabling abdominal pain and comorbidities that impair quality of life. A noninvasive, auricular percutaneous electrical nerve field stimulation (PENFS) device is shown to be effective for abdominal pain in children with disorders of gut-brain interaction. We aimed to determine the effects of PENFS on pain, common comorbidities, and quality of life in pediatric CVS. Methods: Children aged 8-18 years with drug-refractory CVS were enrolled in a prospective, open-label study receiving 6 consecutive weeks of PENFS. Subjects completed the following surveys at baseline, during/after therapy (week 6), and at extended follow-up approximately 4-6 months later: Abdominal Pain Index (API), State-Trait Anxiety Inventory for Children (STAI-C), Pittsburgh Sleep Quality Index (PSQI), and Patient Reported Outcome Measurement Information System (PROMIS) Pediatric Profile-37. Results: Thirty subjects were included. Median (interquartile range, IQR) age was 10.5 (8.5-15.5) years; 60% were female. Median API scores decreased from baseline to week 6 (p = 0.003) and to extended follow-up (p < 0.0001). State anxiety scores decreased from baseline to week 6 (p < 0.0001) and to extended follow-up (p < 0.0001). There were short-term improvements in sleep at 6 weeks (p = 0.031) but not at extended follow-up (p = 0.22). Quality of life measures of physical function, anxiety, fatigue, and pain interference improved short-term, while there were long-term benefits for anxiety. No serious side effects were reported. Conclusions: This is the first study to demonstrate the efficacy of auricular neurostimulation using PENFS for pain and several disabling comorbidities in pediatric CVS. PENFS improves anxiety, sleep, and several aspects of quality of life with long-term benefits for anxiety.Clinical trial registration: ClinicalTrials.gov, identifier NCT03434652.

Rhinocerebral Mucormycosis Associated With Anterior Skull Base Actinomyces Osteomyelitis in a Pediatric Patient With Type 1 Diabetes.

Rhino-orbital-cerebral mucormycosis (ROCM) is a fulminant, often fatal, angioinvasive fungal infection commonly transmitted through inhalation of fungal spores and traumatic inoculation. While the literature has documented rare cases of infection in immunocompetent patients, the vast majority of case fatalities are noted in immunosuppressed populations. Common predisposing factors to infection include immunosuppressive therapies, hematologic malignancies, and most notably, uncontrolled diabetes. Actinomycosis is a subacute to chronic bacterial infection stemming from non-spore-forming anaerobic/microaerophilic bacteria of the genus Actinomyces. Infection with Actinomyces species has been documented across numerous anatomical sites; however, literature on concurrent infection with ROCM in pediatric patients is sparse. We document a case of a 17-year-old male with uncontrolled type 1 diabetes who presented to the emergency department with combined ROCM and actinomycotic infection of his anterior skull base.

Reimagining the Introductory Math Curriculum for Life Sciences Students.

Calculus is typically one of the first college courses encountered by science, technology, engineering, and mathematics (STEM) majors. Calculus often presents major challenges affecting STEM student persistence, particularly for students from groups historically underrepresented in STEM. For life sciences majors, calculus courses may not offer content that is relevant to biological systems or connect with students' interests in biology. We developed a transformative approach to teaching college-level math, using a dynamical systems perspective that focuses first on demonstrating why students need math to understand living systems, followed by providing quantitative and computational skills, including concepts from calculus, that students need to build and analyze mathematical models representing these systems. We found that students who complete these new math courses perform better in subsequent science courses than their counterparts who take traditional calculus courses. We also provide evidence that the new math curriculum positively impacts students' academic performance, with data that show narrowing of the achievement gap, based on students' math grades, between student subgroups in the new math courses. Moreover, our results indicate that students' interest in the concepts and skills critical to the quantitative preparation of 21st-century life sciences majors increases after completing the new contextualized math curriculum.

Autonomous cage-side system for remote training of non-human primates.

BACKGROUND: Training non-human primates (NHPs) for translational medical experimentation is an essential yet time consuming process. To increase training efficiency, some training systems have been designed for NHPs to use at their home cages. Several autonomous cage-side tablet-based systems have been proposed, but none of these systems allow for remote monitoring and task modification while also being wireless, low-cost, light weight, and portable. NEW METHOD: Here we present ACTS: an Autonomous Cage-side Training System which meets all these criteria. ACTS consists of 1) a touchscreen tablet and a speaker attached to the subject's home cage, 2) an inexpensive reward system made from a slightly modified fish feeder, and 3), a laptop operating the system wirelessly and remotely via a router. RESULTS: We were able to test the system and wirelessly train two macaques in their home cages. Remote access enabled us to control ACTS from up to 90 m, through up to 3 walls, and through a floor of a building. The device is compatible with different reward pellet sizes and could run about two hours with a ∼4 mm pellet size. The animals were able to generalize the task when transferred to a traditional experimental rig. COMPARISON WITH EXISTING METHODS: The low cost and modest skill required to build and implement ACTS lowers the barrier for NHP researchers and caregivers to deploy autonomous, remotely controlled tablet-based cage-side systems. CONCLUSION: ACTS can be used for low-cost, wireless cage-side training of NHPs being prepared for translational medical experimentation.

Acute Blockade of PACAP-Dependent Activity in the Ventromedial Nucleus of the Hypothalamus Disrupts Leptin-Induced Behavioral and Molecular Changes in Rats.

Leptin signaling pathways, stemming primarily from the hypothalamus, are necessary for maintaining normal energy homeostasis and body weight. In both rodents and humans, dysregulation of leptin signaling leads to morbid obesity and diabetes. Since leptin resistance is considered a primary factor underlying obesity, understanding the regulation of leptin signaling could lead to therapeutic tools and provide insights into the causality of obesity. While leptin actions in some hypothalamic regions such as the arcuate nuclei have been characterized, less is known about leptin activity in the hypothalamic ventromedial nuclei (VMN). Recently, pituitary adenylate cyclase-activating polypeptide (PACAP) has been shown to reduce feeding behavior and alter metabolism when administered into the VMN in a pattern similar to that of leptin. In the current study, we examined whether leptin and PACAP actions in the VMN share overlapping pathways in the regulation of energy balance. Interestingly, PACAP administration into the VMN increased STAT3 phosphorylation and SOCS3 mRNA expression, both of which are hallmarks of leptin receptor activation. In addition, BDNF mRNA expression in the VMN was increased by both leptin and PACAP administration. Moreover, antagonizing PACAP receptors fully reversed the behavioral and cellular effects of leptin injections into the VMN. Electrophysiological studies further illustrated that leptin-induced effects on VMN neurons were blocked by antagonizing PACAP receptors. We conclude that leptin dependency on PACAP signaling in the VMN suggests a potential common signaling cascade, allowing a tonically and systemically secreted neuropeptide to be more precisely regulated by central neuropeptides.

Cognitive pharmacy services at a pediatric nephrology and hypertension clinic.

PURPOSE: Pediatric patients require special attention from pediatric pharmacists. This is particularly true for pediatric patients with chronic kidney disease (CKD) as the number of their medications and the complexity of their treatment increase with disease progression. However, there is paucity of information describing pediatric cognitive pharmacy services in this setting. The objective of this study is to identify the potential roles of a clinical pharmacist as a provider in a pediatric nephrology and hypertension clinic. METHODS: Pediatric patients (≤18 years of age) who chronically took at least one medication were consecutively enrolled at the University of North Carolina (UNC) Pediatric Nephrology and Hypertension Clinic from 1 August 2007 to 15 April 2008. Demographic information and the interventions performed during the clinic visit by a clinical pharmacist were examined. RESULTS: Three hundred and seventy-four visits made in 283 participants were evaluated. The mean (SD) number of cognitive pharmacy interventions per patient was 2.3 (1.0) on the first visit, with medication counseling and verification of current medications comprising the most common activity (85%). The mean (SD) number of medications per patient was 5.7 (4.8) and of medications counseled per visit was 4.0 (3.4). Medication adherence was investigated in 141 (38%) visits. Pretransplant education on medications was performed in 3% of the patients. Discrepancies of medications were discovered in 12 of the 374 visits. CONCLUSION: Pediatric cognitive pharmacy services to patients at the UNC pediatric nephrology clinic were feasible, which improved the quality of services and promoted better outcomes for these complex patients.

Nonlinear and nonplanar dynamics of suspended nanotube and nanowire resonators.

Previous works on suspended carbon nanotube and nanowire resonators assume a priori that they oscillate in a single plane. We explore the nonlinear dynamics of such resonators and demonstrate that they can suddenly transition from a planar motion to a whirling, "jump rope" like motion. We identify nondimensional gate voltage, resonator geometry, quality factor, and flexural and axial elastic stiffnesses for which such motions can arise. The deliberate use of nonlinear and nonplanar motions opens up a variety of new modalities for this class of nanoelectromechanical systems that are not accessible in the linear operating regime.