Five days of fever and myocardial inflammation.

Multisystem inflammatory syndrome in children is an emerging pediatric illness associated with severe acute respiratory syndrome coronavirus 2 infection. The syndrome is rare, and evidence-based guidelines are lacking. This report reviews a patient who presented for medical care multiple times early in the course of his illness, thus offering near-daily documentation of symptoms and laboratory abnormalities. The patient did not have thrombocytopenia, anemia, or myocardial inflammation until the fifth day of fever. These laboratory abnormalities coincided with the onset of rash, conjunctival injection, vomiting, and diarrhea: clinical signs that could serve as indicators for when to obtain blood tests. The timing of this patient's onset of multisystem involvement suggests that testing for multisystem inflammatory syndrome in children after only 24 h of fever, as the Centers for Disease Control and Prevention recommends, may yield false-negative results. Testing for multisystem inflammatory syndrome in children after 4 days of fever may be more reliable.

Administration of Dexrazoxane Improves Cardiac Indices in Children and Young Adults With Acute Myeloid Leukemia (AML) While Maintaining Survival Outcomes.

Anthracycline-induced cardiotoxicity remains a significant contributor to late morbidity/mortality in children and young adults with acute myeloid leukemia (AML). The cardioprotectant dexrazoxane can be used as prophylaxis to diminish risk for cardiomyopathy but whether it affects risk of relapse in pediatric AML is unclear. Our institution adopted the use of dexrazoxane before anthracyclines administration for all oncology patients in 2011. We compared patients with AML (ages, 0 to 21 y) who received or did not receive dexrazoxane during the years 2008 to 2013. In total, 44 patients with AML (ages, 4.5 mo to 21.7 y) were included. We identified no statistical difference in 2-year event rate (62% vs. 50%, P=0.41) or 2-year overall survival (69% vs. 69%, P=0.53) between patients receiving (n=28) or not receiving (n=16) dexrazoxane. Ejection fraction (P=0.0262) and shortening fraction (P=0.0381) trended significantly higher in patients that received dexrazoxane compared with those that did not receive dexrazoxane. Utilization of the cardioprotectant dexrazoxane before anthracycline chemotherapy in pediatric patients with AML demonstrated no significant difference in either event rate or overall survival relative to institutional controls and seems to improve cardiac function indices. Further studies in this patient population are needed to confirm these findings.

Subpial and stellate cells: two populations of interneurons in turtle visual cortex.

Turtle visual cortex has three layers and receives direct input from the dorsolateral geniculate complex of the thalamus. The outer layer 1 contains several populations of interneurons, but their physiological properties have not been characterized. This study used intracellular recording methods followed by filling with Neurobiotin to characterize the morphology and physiology of two populations of layer 1 interneurons. Subpial cells have somata positioned in the outer third of layer 1 and dendrites confined within the band of geniculate afferents that runs from lateral to medial across visual cortex. Their dendrites are composed of a sequence of many beads or varicosities separated by intervaricose segments. They have membrane time constants of tau(o) = 45.5 +/- 5.2 ms and electrotonic lengths of 1.1 +/- 0.2. Subpial cells show spike rate adaptation in response to intracellular current pulses. Stellate cells have somata located in the inner two-thirds of layer 1 and, less frequently, in layers 2 and 3. Their dendrites extend in a stellate configuration across the cortex. They are smooth or sparsely spiny, but never bear distinct varicosities. They have membrane time constants of tau(o) = 155.1 +/- 12 ms and electrotonic lengths of 3.8 +/- 0.5. They show little spike rate adaptation in response to intracellular current pulses. The positions of the two populations of cells in visual cortex and their physiological properties suggest that subpial cells may participate in a feedforward inhibitory pathway to pyramidal cells, whereas stellate cells are involved in feedback inhibition to pyramidal cells.