Diffuse neurofibroma with hypertrichosis in a toddler.

Diffuse neurofibroma is a rare type of neurofibroma uncommonly reported in infancy. It is a slow growing tumor originating in the peripheral nerve sheath. We present the case of a 17-month-old boy with diffuse neurofibroma of the scalp associated with hypertrichosis. His genetic and clinical workup for neurofibromatosis was negative.

Racial and Ethnic Disparities in Allergen Immunotherapy Prescription for Allergic Rhinitis.

BACKGROUND: Racial and ethnic differences exist in the severity of various atopic diseases including allergic rhinitis (AR). Patients of under-represented races and ethnicities may be subjected to disparate subcutaneous allergen immunotherapy (SCIT) prescription practices. OBJECTIVE: To explore the racial and ethnic disparities in the use of SCIT among patients with AR. METHODS: In this retrospective matched cohort study, we used the TriNetX US Collaborative Network, a multicenter electronic health record-based database to identify patients with AR 18 years and older. Patients were grouped according to their racial and ethnic identification. Study groups were matched for baseline demographics, atopic comorbidities, heart diseases and utilization of ß-blockers, and angiotensin-converting enzyme inhibitors. The proportion of patients of under-represented racial and ethnic groups started on SCIT was contrasted to the non-Hispanic White cohort. RESULTS: We identified 1,038,000 patients with AR; the mean age (±standard deviation) at the index was 49.7 (±16.1) years, and 64.6% were female. Ethnicity information was available from 87.3% of patients, and the majority (92.3%) were non-Hispanic. Over a 3-year observation period, fewer Black patients (relative risk [RR], 0.40; 95% confidence interval [CI], 0.33-0.48) and Hispanic patients (RR, 0.80; 95% CI, 0.64-0.99) were started on SCIT compared with non-Hispanic White patients. The proportions of Asian patients who were initiated on SCIT tended to be lower when compared with non-Hispanic White patients (RR, 0.69; 95% CI, 0.47-1.009). CONCLUSIONS: In the United States, differences in SCIT prescription exist between Black and Hispanic patients relative to White patients. Barriers to treatment should be explored and mitigated.

Relationship between vertical stiffness and soft-tissue injuries in professional Australian football.

Soft-tissue injuries are common in Australian football. Recently, literature has identified non-modifiable and modifiable risk factors, including vertical stiffness (Kvert). However, limitations regarding measurement frequency and duration exist; thus, further information is required about the role of Kvert as a modifiable risk factor for injury. This study examined the seasonal variation in Kvert and its relationship to soft-tissue injuries in professional Australian football. The mean Kvert and bilateral asymmetry were assessed and compared between injured and non-injured players. For the seasonal analysis, 56 players were tested across two seasons with no variation in bilateral asymmetry evident (p= 0.33). While there were generally no changes in Kvert, the value from the end of the second pre-season revealed 5% lower values than the mean of two seasons (p= 0.02). Considering the injury analysis, 21 lower-body soft-tissue injuries were recorded from 18 participants. No differences were recorded for mean Kvert between the injured and non-injured groups (p= 0.16-0.76). When assessing Kvert asymmetry, the injured group displayed a 4.5% higher value than the non-injured group at the end of the pre-season test (p= 0.03) but not at other time-points (p= 0.16-0.99). Higher Kvert bilateral asymmetry measures after the pre-season appear to be related to lower-body soft-tissue injury in professional Australian footballers. Medical and conditioning staff should consider this measure when trying to mitigate the onset of injury or identify at-risk players.

Learning styles vary among general surgery residents: analysis of 12 years of data.

PURPOSE: Understanding the learning styles of individuals may assist in the tailoring of an educational program to optimize learning. General surgery faculty and residents have been characterized previously as having a tendency toward particular learning styles. We seek to understand better the learning styles of general surgery residents and differences that may exist within the population. METHODS: The Kolb Learning Style Inventory was administered yearly to general surgery residents at the University of Cincinnati from 1994 to 2006. This tool allows characterization of learning styles into 4 groups: converging, accommodating, assimilating, and diverging. The converging learning style involves education by actively solving problems. The accommodating learning style uses emotion and interpersonal relationships. The assimilating learning style learns by abstract logic. The diverging learning style learns best by observation. Chi-square analysis and analysis of variance were performed to determine significance. RESULTS: Surveys from 1994 to 2006 (91 residents, 325 responses) were analyzed. The prevalent learning style was converging (185, 57%), followed by assimilating (58, 18%), accommodating (44, 14%), and diverging (38, 12%). At the PGY 1 and 2 levels, male and female residents differed in learning style, with the accommodating learning style being relatively more frequent in women and assimilating learning style more frequent in men (Table 1, p < or = 0.001, chi-square test). Interestingly, learning style did not seem to change with advancing PGY level within the program, which suggests that individual learning styles may be constant throughout residency training. If a resident's learning style changed, it tended to be to converging. In addition, no relation exists between learning style and participation in dedicated basic science training or performance on the ABSIT/SBSE. CONCLUSIONS: Our data suggests that learning style differs between male and female general surgery residents but not with PGY level or ABSIT/SBSE performance. A greater understanding of individual learning styles may allow more refinement and tailoring of surgical programs.

Photodynamic therapy using Verteporfin (benzoporphyrin derivative monoacid ring A, BPD-MA) and 630 nm laser light in canine esophagus.

BACKGROUND AND OBJECTIVE: Verteporfin is a new photosensitizer with short-term skin photosensitivity. The objective of this preclinical study was to find the light dose that effectively ablates canine esophageal mucosa when delivered 30 minutes after Verteporfin injection. STUDY DESIGN/MATERIALS AND METHODS: Verteporfin was administered intravenously (0.75 mg/kg). 630 nm light from KTP/Dye laser was delivered using an esophageal Photodynamic therapy (PDT) balloon. In Phase I study, animals were treated 30 minutes after drug injection using 40, 60, and 80 J/cm to find the desired light dose. Using results from phase I and application of reciprocity principle (light dose vs. plasma concentration of drug), additional light doses were calculated for delivery at other times. In phase II, animals were treated at 15, 60, and 120 minutes, using the calculated light doses of 60, 145, and 200 J/cm, respectively. Animals were followed for 2 days to 4 weeks. RESULTS: In Phase I, 80 J/cm at 30 minutes induced total mucosal ablation. In Phase II, light doses of 60, 145, and 200 J/cm induced similar mucosal injuries when delivered at 15, 60, and 120 minutes, respectively. CONCLUSIONS: Effective mucosal ablation in canine esophagus was achieved using Verteporfin and 630 nm light doses of 60, 80, 145, and 200 J/cm when delivered at 15, 30, 60, and 120 minutes after the drug injection, respectively.