Imatinib and Trigger Avoidance for Mast Cell Activation Syndrome Presenting With Attacks of Abdominal Pain, Nausea, Vomiting, and Diarrhea.

The etiology for concurrent attacks of abdominal pain, nausea, vomiting, and diarrhea can be obscure. Mast cell activation syndrome is not usually considered in this differential diagnosis. A 53-year-old paint salesman suffered severe attacks of these symptoms for the 3 decades of his career. Nortriptyline, loperamide, hyoscyamine, and ondansetron failed to address his symptoms. Mast cell activation syndrome was ultimately diagnosed. Intravenous mast cell-targeted therapy reduced severity of attacks. Multiple oral mast cell-targeted treatments were ineffective, but addition of low-dose imatinib resulted in dramatic improvement. Recognition that paint-fume exposure-triggered attacks led to behavioral modifications which further reduced symptoms.

Predictors of radiation oncology resident research productivity.

PURPOSE: Academic research is an essential part of residency training, yet resident productivity in research seems to be highly variable. The aim of this study was to determine the factors, both individual and institutional, that contribute to research output among radiation oncology residents. METHODS: Newly practicing radiation oncologists and current senior residents were identified and invited via e-mail to complete a web-based survey. The survey addressed demographic factors, previous academic accomplishments, and residency program structure. The end point, research productivity, was defined as the number of first-author papers produced or research grants awarded on the basis of work initiated during residency. RESULTS: Ninety-seven of the 232 senior residents and recently graduated radiation oncologists surveyed responded (a 42% response rate). The median number of publications produced on the basis of work during residency was 3 (range, 0-7). Twenty-one respondents indicated that they had received 1 or more grants. Forty-four respondents completed <6 months of research, while 53 completed ≥6 months of research. Univariate analysis revealed that a scientific college major and the amount of designated research time were positively correlated (P < .05) with first-author publications. Entering with a PhD, presenting research at an international meeting before residency, participation in the Holman Research Pathway, female gender, publications before residency, and the amount of designated research time were positively correlated (P < .05) with receiving a research grant. On multivariate regression analysis, the amount of designated research time was the sole determinant of first-author papers (P < .007), while participation in the Holman Pathway was the only surveyed factor that was correlated with research grants awarded (P < .001). CONCLUSIONS: The amount of designated research time during residency training is the sole independent predictor of research productivity as measured by publications. Participation in the Holman Pathway is the sole detected item shown to be an independent predictor of achieving a peer-reviewed grant. Residency program structure has a major impact on the productivity of residents.

Neonatal intensive care unit stress is associated with brain development in preterm infants.

OBJECTIVE: Although many perinatal factors have been linked to adverse neurodevelopmental outcomes in very premature infants, much of the variation in outcome remains unexplained. The impact on brain development of 1 potential factor, exposure to stressors in the neonatal intensive care unit, has not yet been studied in a systematic, prospective manner. METHODS: In this prospective cohort study of infants born at <30 weeks gestation, nurses were trained in recording procedures and cares. These recordings were used to derive Neonatal Infant Stressor Scale scores, which were employed to measure exposure to stressors. Magnetic resonance imaging (brain metrics, diffusion, and functional magnetic resonance imaging) and neurobehavioral examinations at term equivalent postmenstrual age were used to assess cerebral structure and function. Simple and partial correlations corrected for confounders, including immaturity and severity of illness, were used to explore these relations. RESULTS: Exposure to stressors was highly variable, both between infants and throughout a single infant's hospital course. Exposure to a greater number of stressors was associated with decreased frontal and parietal brain width, altered diffusion measures and functional connectivity in the temporal lobes, and abnormalities in motor behavior on neurobehavioral examination. INTERPRETATION: Exposure to stressors in the Neonatal Intensive Care Unit is associated with regional alterations in brain structure and function. Further research into interventions that may decrease or mitigate exposure to stressors in the neonatal intensive care unit is warranted.