Impact on Child Psychiatry.

The American pediatric mental health system is in crisis; the COVID-19 pandemic highlighted and exacerbated existing gaps. All youth were affected by the pandemic, an impact medicated by mental illness, the closing of schools, reduced access to mental health services, loss and bereavement, and financial and emotional stress on families. The pandemic's fallout is likely to be felt for years to come as today's youth move through successive developmental stages. Improvements in health care systems for youth, innovations in how care is delivered, and ongoing community support for recovery and resilience are needed moving forward.

Nonsuicidal Self-Injury in Youth: A Primer for Pediatricians.

Nonsuicidal self-injury (NSSI) is a relatively common occurrence in youth, and pediatricians must be prepared to address this behavior in their patients in an open and nonjudgmental way. Although NSSI is done without suicidal intent, its occurrence does increase the risk for suicide and is often found with other diagnosable psychiatric conditions. Screening for NSSI should be accompanied by screening for suicidal ideation and comorbid psychiatric disorders to ensure that the patient's current risk is properly assessed and that they have access to the right resources and treatments. This article is a primer for primary care pediatricians for how to talk about and address NSSI in their patients. [Pediatr Ann. 2021;50(2):e72-e76.].

Impact of apical extent of root canal filling on vertical root fracture: a case-control study.

AIM: To investigate the impact of apical extent of root filling on vertical root fracture (VRF) in a case-control study. METHODOLOGY: Eighty-six patients (119 roots) diagnosed with VRF in crowned root filled anterior and posterior teeth were selected. The cases were matched individually with control teeth in a ratio of 1:1 for age (±5 years), gender, tooth type, canal instrumentation method, master apical file (MAF) size and taper, technique of canal filling and time period after root filling. All root canals had been prepared using nickel-titanium (NiTi) rotary instruments and filled using the lateral compaction technique. The apical extent of root filling (overfilled to or beyond the radiographic apex or not overfilled and short of the radiographic apex) was recorded as the dependent variable by two individual examiners. Inter-examiner agreement was obtained using Kappa statistics. Recorded numbers of overfilled and not overfilled canals in cases and controls were analysed using chi-square tests and conditional logistic regression, and odds ratio was calculated. In addition, the frequency distribution of vertical and cross-sectional extensions and the course of VRFs were evaluated. RESULTS: The mean age of patients with VRFs was 50 ± 10 years with 27 (31%) males and 59 (69%) females. The Kappa score for inter-observer agreement was 0.832 (P < 0.001). There was a significant difference between cases and controls with respect to apical extent of root filling (P < 0.0001). When compared to roots not overfilled, overfilled roots had 11.5 times higher odds for occurrence of VRF (OR = 11.5; CI: 4.99 - 26.48). Most VRFs had a complete corono-apical longitudinal extension and were present bucco-lingually/palatally. CONCLUSION: After matching for age, gender, tooth type, MAF size and taper, canal filling technique and time period after root filling, root canals filled to or beyond the radiographic apex following lateral compaction had a greater association with VRF than canals filled short of the radiographic apex.

Anesthetic Considerations for Patients With Congenital Central Hypoventilation Syndrome: A Systematic Review of the Literature.

Congenital central hypoventilation syndrome (CCHS) is a form of sleep-disordered breathing characterized by a diminished drive to breathe during sleep, despite progressive hypercapnia and hypoxia. The condition results from mutations in the paired-like homeobox 2B (PHOX2B) gene. The aim of this review was to conduct a systematic search of the current data on CCHS as it relates to perioperative considerations and to discuss the classification, prevalence, pathophysiology, presentation, genetics, and management of the condition. A systematic search of Medline, EMBASE, Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials was done up to October 2015. The results were limited to human studies published in the English language. Study titles and abstracts were screened to identify studies relating to CCHS relevant to anesthetic care. All study designs including randomized controlled trials, observational studies, case reports, or case series were included. The searches yielded 165 articles, of which 45 were relevant to perioperative considerations. There were 15 relevant case reports categorized as pertaining to the following: (1) novel presentations of the condition after sedation/anesthesia; (2) anesthetic techniques used in patients with established CCHS; and (3) patients with CCHS who experienced anesthetic complications. Review of the case reports showed that patients ranged from neonates up to 59 years of age. Novel presentations of the disease after sedation or anesthesia for minor procedures often led to diagnosis. The sequelae of undiagnosed CCHS led to complications, such as hypoxia, desaturations, apneas, seizures, unplanned intensive care admissions, prolonged hospital stays, and long-term tracheostomies. There appeared to be few postoperative complications in patients with known CCHS. Anesthesiologists need to be aware of undiagnosed late-onset CCHS and include this condition in the differential diagnosis of patients with unexplained postoperative respiratory depression. Anesthetic techniques should minimize the use of agents that further depress respiration postprocedure and ensure adequate monitoring to detect postoperative apneas.

The hyaluronan receptors CD44 and Rhamm (CD168) form complexes with ERK1,2 that sustain high basal motility in breast cancer cells.

CD44 is an integral hyaluronan receptor that can promote or inhibit motogenic signaling in tumor cells. Rhamm is a nonintegral cell surface hyaluronan receptor (CD168) and intracellular protein that promotes cell motility in culture. Here we describe an autocrine mechanism utilizing cell surface Rhamm-CD44 interactions to sustain rapid basal motility in invasive breast cancer cell lines that requires endogenous hyaluronan synthesis and the formation of Rhamm-CD44-ERK1,2 complexes. Motile/invasive MDA-MB-231 and Ras-MCF10A cells produce more endogenous hyaluronan, cell surface CD44 and Rhamm, an oncogenic Rhamm isoform, and exhibit more elevated basal activation of ERK1,2 than less invasive MCF7 and MCF10A breast cancer cells. Furthermore, CD44, Rhamm, and ERK1,2 uniquely co-immunoprecipitate and co-localize in MDA-MB-231 and Ras-MCF10A cells. Combinations of anti-CD44, anti-Rhamm antibodies, and a MEK1 inhibitor (PD098059) had less-than-additive blocking effects, suggesting the action of all three proteins on a common motogenic signaling pathway. Collectively, these results show that cell surface Rhamm and CD44 act together in a hyaluronan-dependent autocrine mechanism to coordinate sustained signaling through ERK1,2, leading to high basal motility of invasive breast cancer cells. Therefore, an effect of CD44 on tumor cell motility may depend in part on its ability to partner with additional proteins, such as cell surface Rhamm.

Molecular characterization and chromosome-specific TRAP-marker development for Langdon durum D-genome disomic substitution lines.

The aneuploid stocks of durum wheat (Triticum turgidum L. subsp. durum (Desf.) Husnot) and common wheat (T. aestivum L.) have been developed mainly in 'Langdon' (LDN) and 'Chinese Spring' (CS) cultivars, respectively. The LDN-CS D-genome chromosome disomic substitution (LDN-DS) lines, where a pair of CS D-genome chromosomes substitute for a corresponding homoeologous A- or B-genome chromosome pair of LDN, have been widely used to determine the chromosomal locations of genes in tetraploid wheat. The LDN-DS lines were originally developed by crossing CS nulli-tetrasomics with LDN, followed by 6 backcrosses with LDN. They have subsequently been improved with 5 additional backcrosses with LDN. The objectives of this study were to characterize a set of the 14 most recent LDN-DS lines and to develop chromosome-specific markers, using the newly developed TRAP (target region amplification polymorphism)-marker technique. A total of 307 polymorphic DNA fragments were amplified from LDN and CS, and 302 of them were assigned to individual chromosomes. Most of the markers (95.5%) were present on a single chromosome as chromosome-specific markers, but 4.5% of the markers mapped to 2 or more chromosomes. The number of markers per chromosome varied, from a low of 10 (chromosomes 1A and 6D) to a high of 24 (chromosome 3A). There was an average of 16.6, 16.6, and 15.9 markers per chromosome assigned to the A-, B-, and D-genome chromosomes, respectively, suggesting that TRAP markers were detected at a nearly equal frequency on the 3 genomes. A comparison of the source of the expressed sequence tags (ESTs), used to derive the fixed primers, with the chromosomal location of markers revealed that 15.5% of the TRAP markers were located on the same chromosomes as the ESTs used to generate the fixed primers. A fixed primer designed from an EST mapped on a chromosome or a homoeologous group amplified at least 1 fragment specific to that chromosome or group, suggesting that the fixed primers might generate markers from target regions. TRAP-marker analysis verified the retention of at least 13 pairs of A- or B-genome chromosomes from LDN and 1 pair of D-genome chromosomes from CS in each of the LDN-DS lines. The chromosome-specific markers developed in this study provide an identity for each of the chromosomes, and they will facilitate molecular and genetic characterization of the individual chromosomes, including genetic mapping and gene identification.