The Sensitivity of Limited-Sequence MRI in Identifying Pediatric Cervical Spine Injury: A Western Pediatric Surgery Research Consortium Multicenter Retrospective Cohort Study.

INTRODUCTION: Clinical clearance of a child's cervical spine after trauma is often challenging due to impaired mental status or an unreliable neurologic examination. Magnetic resonance imaging (MRI) is the gold standard for excluding ligamentous injury in children but is constrained by long image acquisition times and frequent need for anesthesia. Limited-sequence MRI (LSMRI) is used in evaluating the evolution of traumatic brain injury and may also be useful for cervical spine clearance while potentially avoiding the need for anesthesia. The purpose of this study was to assess the sensitivity and negative predictive value of LSMRI as compared to gold standard full-sequence MRI as a screening tool to rule out clinically significant ligamentous cervical spine injury. METHODS: We conducted a ten-center, five-year retrospective cohort study (2017-2021) of all children (0-18y) with a cervical spine MRI after blunt trauma. MRI images were re-reviewed by a study pediatric radiologist at each site to determine if the presence of an injury could be identified on limited sequences alone. Unstable cervical spine injury was determined by study neurosurgeon review at each site. RESULTS: We identified 2,663 children less than 18 years of age who underwent an MRI of the cervical spine with 1,008 injuries detected on full-sequence studies. The sensitivity and negative predictive value of LSMRI were both >99% for detecting any injury and 100% for detecting any unstable injury. Young children (age < 5 years) were more likely to be electively intubated or sedated for cervical spine MRI. CONCLUSION: LSMRI is reliably detects clinically significant ligamentous injury in children after blunt trauma. To decrease anesthesia use and minimize MRI time, trauma centers should develop LSMRI screening protocols for children without a reliable neurologic exam. LEVEL OF EVIDENCE: 2 (Diagnostic Tests or Criteria).

Chronic Myeloid Leukemia, Version 2.2024, NCCN Clinical Practice Guidelines in Oncology.

Chronic myeloid leukemia (CML) is defined by the presence of Philadelphia chromosome resulting from a reciprocal translocation between chromosomes 9 and 22 [t9;22] that gives rise to a BCR::ABL1 fusion gene. CML occurs in 3 different phases (chronic, accelerated, and blast phase) and is usually diagnosed in the chronic phase in developed countries. Tyrosine kinase inhibitor (TKI) therapy is a highly effective treatment option for patients with chronic phase-CML. The primary goal of TKI therapy in patients with chronic phase-CML is to prevent disease progression to accelerated phase-CML or blast phase-CML. Discontinuation of TKI therapy with careful monitoring is feasible in selected patients. This manuscript discusses the recommendations outlined in the NCCN Guidelines for the diagnosis and management of patients with chronic phase-CML.

Imaging of Pediatric Cervical Lymphadenopathy.

There is a wide variety of disease entities in children, which can present with cervical adenopathy. The spectrum of pathology and imaging appearance differs in many cases from that seen in adults. This review aims to compare the strengths and limitations of the various imaging modalities available to image pediatric patients presenting with cervical adenopathy, provide guidance on when to image, and highlight the imaging appearance of both common and uncommon disorders affecting the cervical nodes in children to aid the radiologist in their clinical practice.

Epithelioid neoplasm of the spinal cord in a child with spinal muscular atrophy treated with onasemnogene abeparvovec.

Spinal muscular atrophy is an autosomal recessive disease resulting in motor neuron degeneration and progressive life-limiting motor deficits when untreated. Onasemnogene abeparvovec is an adeno-associated virus serotype 9-based gene therapy that improves survival, motor function, and motor milestone achievement in symptomatic and presymptomatic patients. Although the adeno-associated virus genome is maintained as an episome, theoretical risk of tumorigenicity persists should genomic insertion occur. We present the case of a 16-month-old male with spinal muscular atrophy who was diagnosed with an epithelioid neoplasm of the spinal cord approximately 14 months after receiving onasemnogene abeparvovec. In situ hybridization analysis detected an onasemnogene abeparvovec nucleic acid signal broadly distributed in many but not all tumor cells. Integration site analysis on patient formalin-fixed, paraffin-embedded tumor samples failed to detect high-confidence integration sites of onasemnogene abeparvovec. The finding was considered inconclusive because of limited remaining tissue/DNA input. The improved life expectancy resulting from innovative spinal muscular atrophy therapies, including onasemnogene abeparvovec, has created an opportunity to analyze the long-term adverse events and durability of these therapies as well as identify potential disease associations that were previously unrecognized because of the premature death of these patients.

Prenatal diagnosis of Poland-Möbius syndrome by multimodality fetal imaging.

We describe prenatal diagnosis of Poland-Möbius syndrome using a combination of ultrasound and MRI. Poland syndrome was diagnosed based on absence of the pectoralis muscles associated with dextroposition of the fetal heart and elevation of the left diaphragm. Associated brain anomalies that led to the diagnosis of Poland-Möbius syndrome, included ventriculomegaly, hypoplastic cerebellum, tectal beaking, and a peculiar flattening of the posterior aspect of the pons and medulla oblongata, which has been reported by postnatal diffusion tensor imaging studies as a reliable neuroimaging marker for Möbius syndrome. Since abnormalities of cranial nerves VI and VII may be difficult to detect prenatally, careful attention to the appearance of the brain stem as illustrated in the current report may aid in the prenatal diagnosis of Möbius syndrome.

Intrauterine and Perinatal Infections.

Imaging plays an important role in evaluating patients with suspected intrauterine and perinatal infections. Advances in fetal imaging including both ultrasound and MRI allow for increasingly more specific diagnosis if the radiologist is familiar with specific imaging features and patterns. Early imaging of neonates with suspected central nervous system infection is valuable to enable prompt treatment and differentiate infection from other conditions which can clinically present similarly. Ultrasound is a useful initial modality to screen for abnormalities however MRI with and without contrast remains the optimal examination to characterize infection, evaluate for potential surgical targets, and provide prognostic information.

Delay Discounting as a Potential Therapeutic Target for Weight Loss in Breast Cancer Survivors.

Obesity in breast cancer (BC) survivors is associated with increased mortality. Delay discounting (DD) is a behavioral economic measure of how individuals value future outcomes. Higher DD correlates with obesity in the general population. Valuation of the future may be associated with obesity differently in cancer survivors. This study evaluated the relationship between DD and obesity in BC survivors. We report an exploratory analysis assessing cross-sectional associations between DD, BMI, and lifestyle behaviors (vegetable and fruit consumption, exercise) related to obesity in 89 women with hormone receptor positive non-metastatic BC. Multivariate linear regression analysis examined demographic and lifestyle behavior variables associated with both BMI and DD. Greater willingness to wait for larger, delayed rewards (lower DD) was significantly associated with lower BMI (standardized beta = −0.32; p < 0.01), independent of age, race, income, time since diagnosis, and menopausal status. There was no significant association between DD and fruit consumption or exercise frequency. Vegetable consumption was significantly associated with lower DD (standardized beta = 0.24; p < 0.05). Higher DD is associated with obesity and decreased frequency of vegetable consumption in BC survivors. Future studies should investigate DD as a therapeutic target for behavioral interventions to facilitate weight loss and promote longevity in this population.

Multidisciplinary Approach to Older Adults with Hematologic Malignancies-a Paradigm Shift.

Hematologic malignancies are most likely to present in the seventh and eighth decades of life. Continued population growth will lead to increasing numbers of older adults with hematologic malignancies. Oncology care for older adults is complex and must account for the effect of aging on disease biology and treatment tolerance. Multidisciplinary oncology care has been utilized in solid tumor oncology for decades, initially driven by the need for multi-modality treatment. In this review, we make the case for multidisciplinary oncogeriatric care for older adults with hematologic malignancies in order to best navigate the intersection of aging and blood cancer.

Stronger Together: The Student Experience During the Onset of COVID-19.

BACKGROUND: This study examined the effects of the coronavirus disease 2019 pandemic on nursing students. The Interpretive Phenomenological Analysis qualitative approach was used to analyze alternative assignments added during the Spring and Summer 2020 courses. Participants included nursing students at the baccalaureate, master, and doctoral levels. RESULTS: Stress and anxiety emerged as the prevalent theme. Fear was the second most prevalent theme; however, no doctoral students cited fear as a concern. All three cohorts cited a sense of duty and dedication to patient care. CONCLUSIONS: All of the participants reported similar concerns and emotions that influenced them at the onset of the pandemic. Baccalaureate students' emotions were associated with concerns about working conditions and the safety of themselves and loved ones. The master of nursing students' emotions were reflective of the moral and ethical components of patient care. The doctoral students embodied the transition to advanced nursing practice and implications for future practice. [J Nurs Educ. 2021;60(9):517-521.].

Delay discounting and adjuvant endocrine therapy adherence in hormone receptor-positive breast cancer.

OBJECTIVES: Oral endocrine therapy improves survival among hormone responsive breast cancer (HRBC) survivors; however, 30-70% of patients are nonadherent. One patient-centered factor that may impact adherence is delay discounting (DD), or the degree to which patients value future outcomes. In prior research, DD is robustly associated with maladaptive health behavior; but no work to our knowledge has examined delay discounting and medication nonadherence in breast cancer patients. Study 1 examined cross-sectional associations between DD and endocrine therapy nonadherence. Study 2 examined whether DD in the HRBC population is amenable to a brief intervention-episodic future thinking (EFT), in which participants preexperience future events. METHOD: In Study 1, HRBC survivors completed assessments of DD and endocrine therapy adherence (pill count and self-report). In Study 2, participants were randomized to engage in a brief behavioral intervention (EFT) or a control condition, and again completed assessments of DD. RESULTS: Eighty nine female HRBC survivors completed Studies 1 and 2. Controlling for other known risk factors, greater DD was significantly associated with poorer pill-count but not self-report adherence. In Study 2, the EFT intervention significantly reduced DD when compared to control episodic thinking. CONCLUSIONS: DD is associated with direct-observation (pill count) measures of endocrine therapy adherence in HRBC survivors, suggesting it is a potential therapeutic target for improving adherence. This target is also amenable to intervention with EFT. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Magnetic Resonance Imaging Features and Clinical Findings in Pediatric Idiopathic Intracranial Hypertension: A Case-Control Study.

The purpose of this study is to identify salient magnetic resonance imaging (MRI) findings of pediatric IIH, to determine the relevance of these findings with regard to disease pathogenesis, and to relate these findings to the clinical presentation towards identification of risk factors of disease. A retrospective, a case-control study of 38 pediatric patients with and 24 pediatric patients without IIH from the ophthalmology department at a tertiary care center was performed. Clinical data, including ophthalmic findings and lumbar puncture results, were recorded. Neuroimaging, including both MRI and magnetic resonance venography (MRV), was evaluated for perioptic subarachnoid space diameter enlargement, posterior globe flattening, optic nerve head protrusion, empty or partially empty sella turcica, dural venous sinus abnormalities, skull base crowding, and prominent arachnoid granulations. Compared with controls, IIH patients had larger perioptic subarachnoid space diameters, higher incidences of posterior globe flattening, protrusion of the optic nerve heads, an empty sella turcica, and dural venous sinus abnormalities. A perioptic subarachnoid space diameter of ≥5.2 mm was identified as an independent predictor of IIH (p < 0.001) with sensitivity of 87% and specificity of 67%. Several significant MRI findings in pediatric IIH were identified. Using a model that uniquely incorporated clinical and MRI findings at presentation, we provide a framework for risk stratification for the diagnosis of pediatric IIH which may be utilized to facilitate diagnosis. Future prospective work is needed to further validate the model developed in this study.

Data Quality Assessment for Super-Resolution Fetal Brain MR Imaging: A Retrospective 1.5 T Study.

BACKGROUND: Super-resolution is a promising technique to create isotropic image volumes from stacks of two-dimensional (2D) motion-corrupted images in fetal magnetic resonance imaging (MRI). PURPOSE: To determine an acquisition quality metric and correlate that metric with radiologist perception of three-dimensional (3D) image quality. STUDY TYPE: Retrospective. SUBJECTS: Eighty-seven patients, mean gestational age 29 ± 6 weeks. FIELD STRENGTH/SEQUENCE: 1.5 T/2D fast spin-echo. ASSESSMENT: Four radiologists (L.G., D.M.E.B., P.C., and J.V.; 31, 21, 7, and 7 years' experience, respectively) graded reconstructions on a 0 to 4 scale for overall appearance and visibility of specific anatomy. During reconstruction, slices were labeled as inliers based on correlation between a simulated vs. actual acquisition. The fraction of brain voxels in inlier slicers vs. total brain voxels was measured for each acquisition. STATISTICAL TESTS: Paired sample t test, Pearson's correlation, intra-class correlation. RESULTS: The average brain mask inlier fraction for all acquisitions was 0.8. There was a statistically significant correlation (0.71) between overall reconstruction appearance and number of acquisitions with inlier fraction above 0.73. There was low correlation (0.21, P = 0.05) between the number of acquisitions used in the reconstruction and overall score when no data quality measure was considered. Similar results were found for ratings of specific anatomy. Statistically significant differences in overall perception of image quality were found when using three vs. four, four vs. five, and three vs. five high-quality acquisitions in the reconstruction. Five high-quality acquisitions were sufficient to yield an average radiologist rating of 3.59 out of 4.0 for overall image quality. DATA CONCLUSION: Reconstruction quality can be reliably predicted using the brain mask inlier fraction. Real-time super-resolution protocols could exploit this to terminate acquisition when enough high-quality acquisitions have been collected. To achieve consistent 3D image quality it may be necessary to acquire more than five scans to compensate for severely motion-corrupted acquisitions. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY: 1.

Data on combustion, performance and emissions of a 6.8 L, 6-cylinder, Tier II diesel engine.

A diesel engine has been a desirable machine due to its better fuel efficiency, reliability, and higher power output. It is widely used in transportations, locomotives, power generation, and industrial applications. The combustion of diesel fuel emits harmful emissions such as unburned hydrocarbons (HC), particulate matter (PM), nitrogen oxides (NOx), and carbon monoxides (CO). This article presents data on the efficiency, combustion, and emission of a 4-stroke diesel engine. The engine is a 6.8 L turbocharged 6-cylinder Tier II diesel engine fitted with a common rail injection system. The test was carried out at the Powerhouse Energy Campus, Colorado State University Engines and Energy Conversion facility. The ISO Standard 8178:4 Cycle D2 cycle was adopted for this study consists of five test runs at 1800 rpm. During the testing, CO, carbon dioxide (CO2), oxygen (O2), NOx, PM, unburned HC as a total HC (THC), methane (CH4), formaldehyde (CH2O), and volatile organic compound (VOC) emissions were measured. At the same time, the data acquisition system recorded the combustion data. The engine's performance is characterized by the brake specific fuel combustion (BSFC) and thermal efficiency. A dataset of correlations among the parameters was also presented in this article.

Imaging of fetal brain tumors.

Congenital brain tumors, defined as those diagnosed prenatally or within the first 2 months of age, represent less than 2% of pediatric brain tumors. Their location, prevalence and pathophysiology differ from those of tumors that develop later in life. Imaging plays a crucial role in diagnosis, tumor characterization and treatment planning. The most common lesions diagnosed in utero are teratomas, followed by gliomas, choroid plexus papillomas and craniopharyngiomas. In this review, we summarize the pathogenesis, diagnosis, management and prognosis of the most frequent fetal brain tumors.

Relating anthropometric indicators to brain structure in 2-month-old Bangladeshi infants growing up in poverty: A pilot study.

Anthropometric indicators, including stunting, underweight, and wasting, have previously been associated with poor neurocognitive outcomes. This link may exist because malnutrition and infection, which are known to affect height and weight, also impact brain structure according to animal models. However, a relationship between anthropometric indicators and brain structural measures has not been tested yet, perhaps because stunting, underweight, and wasting are uncommon in higher-resource settings. Further, with diminished anthropometric growth prevalent in low-resource settings, where biological and psychosocial hazards are most severe, one might expect additional links between measures of poverty, anthropometry, and brain structure. To begin to examine these relationships, we conducted an MRI study in 2-3-month-old infants growing up in the extremely impoverished urban setting of Dhaka, Bangladesh. The sample size was relatively small because the challenges of investigating infant brain structure in a low-resource setting needed to be realized and resolved before introducing a larger cohort. Initially, fifty-four infants underwent T1 sequences using 3T MRI, and resulting structural images were segmented into gray and white matter maps, which were carefully evaluated for accurate tissue labeling by a pediatric neuroradiologist. Gray and white matter volumes from 29 infants (79 â€‹± â€‹10 days-of-age; F/M â€‹= â€‹12/17), whose segmentations were of relatively high quality, were submitted to semi-partial correlation analyses with stunting, underweight, and wasting, which were measured using height-for-age (HAZ), weight-for-age (WAZ), and weight-for-height (WHZ) scores. Positive semi-partial correlations (after adjusting for chronological age and sex and correcting for multiple comparisons) were observed between white matter volume and HAZ and WAZ; however, WHZ was not correlated with any measure of brain volume. No associations were observed between income-to-needs or maternal education and brain volumetric measures, suggesting that measures of poverty were not associated with total brain tissue volume in this sample. Overall, these results provide the first link between diminished anthropometric growth and white matter volume in infancy. Challenges of conducting a developmental neuroimaging study in a low-resource country are also described.