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ated and practical.OBJECTIVE To assess the progress of the Healthy People 2020 (HP2020) objective to increase the proportion of children with autism spectrum disorder (ASD) who receive treatment by 48 months old and to examine the relationship between predisposing, enabling, and need factors and age of initial treatment receipt. METHOD We used data from the National Survey of Children's Health, 2016 to 2017, a nationally representative study of US children. Our sample included children aged 3 to 17 years old with ASD who received treatment (N = 1333). We conducted χ goodness of fit tests and logistic regression. RESULTS The HP2020 objective to enroll 57.6% of 8-year-old children with ASD in treatment by 48 months old was not met (40.9%). Among 3- to 5-year-old children with ASD, the proportion who received treatment by 48 months old was more than double that of 8-year-old children (88.3%). We detected social inequities and significant differences by provider type and state mandate. CONCLUSION Research with larger samples is needed to continue tracking progress. If the goal continues not to be met, work will be required to explain stagnation and to inform additional targeted efforts to reduce the age of initial treatment.OBJECTIVE Alcohol use can worsen attention-deficit/hyperactivity disorder (ADHD) symptoms, interfere with treatment, and worsen outcomes. Our objective was to describe parental perceptions of alcohol use for their adolescents with ADHD. learn more METHODS Parents of adolescents with ADHD completed an online survey about perceptions of adolescent alcohol use for adolescents with ADHD. learn more We described the level of parental concern about the impacts of alcohol use on their adolescent's functioning. We assessed whether specific covariates were associated with the level of parental concern. RESULTS Of 290 parents who completed the survey, 96.5% were women, and 66.1% had an educational attainment of college degree or higher. Most adolescents (75.4%) took ADHD medication, and 59.9% had comorbid anxiety or depression. Almost one-third (30.3%) of parents perceived that their adolescent was more likely to use alcohol because of ADHD, whereas 34.8% of parents disagreed with this and 34.8% of parents were neutral. Parents who suspected their adolescent regularly used alcohol were less likely to report concern about the impact of alcohol on their adolescent's school performance or ADHD medication effectiveness compared with parents who did not suspect regular adolescent alcohol use. Almost half of the parents (48.5%) did not report discussing the impact of alcohol use on ADHD with their adolescent. CONCLUSION Many parents of adolescents with ADHD do not understand the unique risks of alcohol use for their adolescents. link2 In addition, if alcohol use harm is not obvious, parents may not perceive there to be concerns about alcohol use on functioning. Parental education about alcohol use and ADHD is needed.Malakoplakia is a rare, granulomatous disorder that is typically triggered by infections in immunocompromised patients. Although it most commonly affects the urinary tract, cases may occasionally occur in the gastrointestinal tract. There are case reports of malakoplakia of the pancreas with associated pathologic description, but none with detailed imaging and endoscopic findings. In addition, description of magnetic resonance imaging characteristics of mass-forming malakoplakia in the literature is sparse. We present a case of pancreaticoduodenal malakoplakia in an immunocompromised patient, including detailed description of magnetic resonance imaging, computed tomography, and endoscopic findings with radiology-pathology correlation. link2 Classic pathologic features of malakoplakia (eg, hypercellularity, inflammation, and mineralization of Michaelis-Gutmann bodies) lead to specific features on imaging, such as marked diffusion restriction, heterogeneous enhancement, calcification, and increased attenuation on nonenhanced computed tomography. These features may help differentiate malakoplakia from other more common lesions that occur in this location, especially if present in an immunocompromised patient.OBJECTIVES Hypertriglyceridemia-induced pancreatitis is an important cause of acute pancreatitis (AP) in children, which lacks established guidelines. The aim of this study was to review management approaches at a single pediatric center. link3 METHODS This retrospective study included all inpatients younger than 21 years with AP and triglycerides (TG) of 1000 mg/dL or greater. A linear mixed effect model was used to calculate drop in TGs. The patient's diet, intravenous fluid (IVF) rate, insulin, and plasmapheresis were included in the model. RESULTS Seventeen admissions were identified among 8 patients, average age 15 years (range, 6-19 years). Fifty percent had recurrent AP and 29% of admissions had complications including 1 death. The population was primarily female (75%), white (75%), and overweight, and 63% had diabetes. The median stay was 5.4 days. There were 14 approaches used with variations in IVF rates, insulin, plasmapheresis, and nill per os (NPO) versus feeds. Variables that reduced TG's were NPO, higher IVF rates, plasmapheresis, and insulin (P less then 0.05). Importantly, NPO reduced TGs faster than those who started early nutrition. CONCLUSIONS Hypertriglyceridemia is an important cause of pancreatitis in children. This study shares a management algorithm from a single institution. Larger studies are needed for more evidence-based guidelines.Pancreatic ductal adenocarcinoma (PDAC) treatments have historically focused on targeting tumor cells directly. However, in pancreatic masses, the stroma encasing the malignant epithelial cells constitutes up to 80% to 90% of the tumor bulk. This extracellular matrix, which was previously neglected when designing cancer therapies, is now considered fundamental for tumor progression and drug delivery. Desmoplastic tissue is extensively cross-linked, resulting in tremendous tensile strength. This key pathological feature is procarcinogenic, linking PDAC and breast cancer (BC). Physical forces exerted onto cellular surfaces are detected intracellularly and transduced via biochemical messengers in a process called mechanotransduction. learn more Mechanotransduction and tensional homeostasis are linked, with an integral role in influencing tumor growth, metastasis, and interactions with the immune system. It is essential to enhance our knowledge of these integral elements of parenchymal tumors. We aim to review the topic, with a special emphasis on desmoplastic processes and their importance in pancreatic and BC development and treatments, mindful that innovative diagnostic and therapeutic strategies cannot focus on biochemical pathways alone. We then focus on common therapeutic targets identified in both PDAC and BC models and/or patients, aiming to understand these treatments and draw similarities between the two tumors.Radiologic characterization of pancreatic lesions is currently limited. Computed tomography is insensitive in detecting and characterizing small pancreatic lesions. link2 Moreover, heterogeneity of many pancreatic lesions makes determination of malignancy challenging. As a result, invasive diagnostic testing is frequently used to characterize pancreatic lesions but often yields indeterminate results. Computed tomography texture analysis (CTTA) is an emerging noninvasive computational tool that quantifies gray-scale pixels/voxels and their spatial relationships within a region of interest. link3 In nonpancreatic lesions, CTTA has shown promise in diagnosis, lesion characterization, and risk stratification, and more recently, pancreatic applications of CTTA have been explored. This review outlines the emerging role of CTTA in identifying, characterizing, and risk stratifying pancreatic lesions. Although recent studies show the clinical potential of CTTA of the pancreas, a clear understanding of which specific texture features correlate with high-grade dysplasia and predict survival has not yet been achieved. Further multidisciplinary investigations using strong radiologic-pathologic correlation are needed to establish a role for this noninvasive diagnostic tool.BACKGROUND Cerebral malaria (CM) remains a leading cause of mortality and morbidity in children in sub-Saharan Africa. Recent studies using brain magnetic resonance imaging have revealed increased brain volume as a major predictor of death. Similar morphometric predictors of morbidity at discharge are lacking. The aim of this study was to investigate the utility of serial cranial cisternal cerebrospinal fluid (CSF) volume measurements in predicting morbidity at discharge in pediatric CM survivors. link3 METHODS In this case-control study, 54 Malawian pediatric CM survivors with neurologic sequelae evident at discharge who underwent serial magnetic resonance imaging scans while comatose were matched to concurrently admitted children with serial imaging who made full recoveries. Serial cranial cisternal CSF volume quantified by radiologists blinded to outcome was evaluated as a predictor of neurologic deficits at discharge. The probability of neurologic sequelae was determined using a model that included coma duration and changes in cisternal CSF volume over time. RESULTS Coma duration before admission was similar between cases and controls (16.1 vs. 15.3; P = 0.81), but overall coma was longer among children with sequelae (60 vs. 38 hours; P less then 0.01). Lower initial CSF volumes and decreased volumes over time were both associated with a higher probability of neurologic sequelae at discharge. CONCLUSIONS Among pediatric CM survivors with prolonged coma, lower initial CSF volume and decreasing volume during coma is associated with neurologic sequelae at discharge. These findings suggest that cerebral edema is an underlying contributor to both morbidity and mortality in pediatric CM.SIGNIFICANCE Prism-induced convergence and vertical vergence for maintaining binocular fusion induced postural instability to a greater extent than diplopic conditions. This finding has important implication in relation to postural control of patients with large exophoria or vertical phoria in optometric clinic. PURPOSE The purpose of this study was to examine whether binocular single vision with prism-induced horizontal and vertical vergence and diplopia might affect the static postural stability. METHODS Forty-two subjects with a mean ± standard deviation age of 23.79 ± 2.81 years were enrolled in this study. To simulate convergence and divergence, base-in and base-out (BO) prisms of 4 and 8 Δ were added, respectively. To simulate vertical vergence, vertical prism of 2 Δ was added in a trial frame that corrected for the subject's refractive error during far distance (6 m) gaze. The prism power necessary to break fusion in each subject was detected and applied to induce diplopia in horizontal and vertical directions. Indices of general instability and sway power were measured under visual conditions using Tetrax and compared with normal viewing without the prism. Correlations between general instability indices and the ranges of break point in convergence and divergence were analyzed. RESULTS Postural instability was increased significantly when convergence induced by BO 4 and 8 Δ and vertical vergence induced by 2 Δ were stimulated. The correlation coefficient between ranges of BO break point and indices of general instability was -0.308 in the BO 4 Δ and -0.306 in the BO 8 Δ condition. CONCLUSIONS Although binocular input is recognized as an important factor in postural stability, binocular input with excessively stimulated convergence and vertical vergence during a far distance gaze is a latent factor affecting postural stability. On the other hand, diplopia did not influence postural stability.
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