Child Temperaments, Differential Parenting, and the Sibling Relationships of Children with Autism Spectrum Disorder

This study examined associations between sibling temperaments, differential parenting, and the quality of the relationships between 50 children with autism spectrum disorder (ASD) and their typically developing siblings. The temperament dimension of persistence, but not activity level or emotional intensity, was found to relate to the quality of the sibling relationship. Effects were stronger for temperaments of the typically developing siblings, but persistence levels of both groups of children interacted to predict sibling relationship quality. Persistence also was the temperament dimension associated with differential parenting, with increased levels of differential parenting occurring when siblings, and to some degree the children with ASD, were low in persistence. When siblings were dissatisfied with differential parenting, quality of the sibling relationship was compromised.     

Clinical significance of skin biopsies in the diagnosis and management of graft-vs-host disease in early postallogeneic bone marrow transplantation

OBJECTIVE: To determine the value of skin biopsies in the management of suspected graft-vs-host disease (GVHD) within 30 days of allogeneic bone marrow transplantation (BMT). DESIGN: Retrospective study based on review of a BMT database. SETTING: Leukemia/BMT ward of a tertiary care, university teaching hospital. PATIENTS: One hundred and eighty-seven consecutive patients who received allogeneic BMT between January 1, 1994, and June 30, 1997, at Vancouver General Hospital, Vancouver, British Columbia. MAIN OUTCOME MEASURES: (1) Skin biopsy frequency for patients with rashes suggestive of acute GVHD; (2) clinical significance of skin biopsy in the management of patients with suspected acute GVHD after BMT; (3) relationship between severity of clinical GVHD and the likelihood to receive GVHD therapy; and (4) relationship between biopsy status or biopsy result and outcome of BMT (acute and chronic GVHD, transplant-related mortality, and overall and event-free survival). RESULTS: During the early post-BMT period (<30 days after BMT), 88 patients had rashes suggestive of acute GVHD; of these, 51 (58%) underwent skin biopsy to confirm the diagnosis. Skin biopsies were performed more often for higher clinical stages of cutaneous GVHD. There was no significant difference between the patients with positive biopsy findings and those with negative findings, either in the clinical severity of acute GVHD or in likelihood to receive treatment for GVHD. Most (85%) of the patients who underwent biopsies and received GVHD therapy had treatment initiated before skin biopsies were performed or before the results were available. The higher the clinical grade of overall acute GVHD, the more likely it was that the patients were treated for GVHD (P<.001). The outcome of BMT was not influenced by the skin biopsy status or biopsy result. CONCLUSIONS: The biopsy findings correlated poorly with the clinical severity of skin rash suggestive of acute GVHD soon after BMT. The decision to treat suspected acute GVHD depended not on skin biopsy findings but rather on clinical severity of acute GVHD. In this regard, skin biopsy has a limited role in the management of patients early after allogeneic BMT.     

Quantification of histologic features of dysplastic nevi

We quantified the histologic features of 100 consecutive dysplastic nevi. Although there is heterogeneity in the microscopic attributes of dysplastic nevi, certain features that are seen repeatedly should enable the histologic identification of these melanocytic neoplasms. These features include a central dermal nevocytic component with a peripheral extension of a junctional component, elongated epidermal rete ridges, bridging of nests of melanocytes at the dermo-epidermal junction, nests of melanocytes at the sides of rete ridges as well as at their bases, and concentric eosinophilic fibrosis. Cytologic features of melanocytes were not as valuable as architectural features of individual nevi in classifying these lesions. We also provide an atlas of selected histologic features that depicts some aspects of this heterogeneity.     

ACCM/PALS haemodynamic support guidelines for paediatric septic shock: an outcomes comparison with and without monitoring central venous oxygen saturation

INTRODUCTION: The ACCM/PALS guidelines address early correction of paediatric septic shock using conventional measures. In the evolution of these recommendations, indirect measures of the balance between systemic oxygen delivery and demands using central venous or superior vena cava oxygen saturation (ScvO(2) > or = 70%) in a goal-directed approach have been added. However, while these additional goal-directed endpoints are based on evidence-based adult studies, the extrapolation to the paediatric patient remains unvalidated. OBJECTIVE: The purpose of this study was to compare treatment according to ACCM/PALS guidelines, performed with and without ScvO(2) goal-directed therapy, on the morbidity and mortality rate of children with severe sepsis and septic shock. DESIGN, PARTICIPANTS AND INTERVENTIONS: Children and adolescents with severe sepsis or fluid-refractory septic shock were randomly assigned to ACCM/PALS with or without ScvO(2) goal-directed resuscitation. MEASUREMENTS: Twenty-eight-day mortality was the primary endpoint. RESULTS: Of the 102 enrolled patients, 51 received ACCM/PALS with ScvO(2) goal-directed therapy and 51 received ACCM/PALS without ScvO(2) goal-directed therapy. ScvO(2) goal-directed therapy resulted in less mortality (28-day mortality 11.8% vs. 39.2%, p=0.002), and fewer new organ dysfunctions (p=0.03). ScvO(2) goal-directed therapy resulted in more crystalloid (28 (20-40) vs. 5 (0-20 ml/kg, p<0.0001), blood transfusion (45.1% vs. 15.7%, p=0.002) and inotropic (29.4% vs. 7.8%, p=0.01) support in the first 6 h. CONCLUSIONS: This study supports the current ACCM/PALS guidelines. Goal-directed therapy using the endpoint of a ScvO(2)> or =70% has a significant and additive impact on the outcome of children and adolescents with septic shock.     

Therapeutic efficacy of different antimalarial regimens in the Costa Rica-Nicaragua border region]

The search for short treatments for malaria is still a goal for many developing countries. The World Health Organization has recommended a three-day treatment with primaquine and quinine, but this treatment is difficult to apply in many rural areas because it requires a malaria technician to stay at least three days in a community. This is very hard when these communities are dispersed and increases the cost of treatment and supplies. This study tested treatments of 1, 5, and 9 days against a treatment of 14 days. Using the Kaplan-Meier method, no statistical difference was found among these four treatment approaches. We strongly recommend using the one-day treatment, in and endemic rural areas where the population is dispersed and has difficulty accessing health care.     

Imaging spin probe distribution in the tumor of a living mouse with 250 MHz EPR: correlation with BOLD MRI.

Electron paramagnetic resonance imaging (EPRI) promises to provide new insights into the physiology of tissues in health and disease. Understanding the in vivo imaging capability of this new modality requires comparison with other physiologically responsive techniques. Here, an initial comparison between 2D EPR spatial imaging of a narrow single line injectable paramagnetic trityl spin probe and 2D slice-selected carbogen subtraction BOLD MRI is presented. The images were obtained from the same FSa fibrosarcoma grown in the leg of a C3H mouse. This tumor was unusual in comparison with others imaged with subtraction BOLD MRI because of its peripheral distribution of intensity. The spatial distribution of the EPR spin probe showed the same peripheral distribution. The pixel resolutions of these images are comparable. These images provide an early in vivo comparison of EPRI with a well-established imaging modality. The comparison validates the in vivo distribution of spin probe as imaged with EPRI, and provides a proof of principle for the comparison of BOLD and EPRI.     

The detection and management of dysplastic nevi and early melanoma

Worldwide, the incidence and mortality rates for melanoma are increasing at an alarming rate. Recently, the recognition of dysplastic nevi as markers and potential precursors for melanoma has identified one group of individuals with an increased risk to develop this disease. Close surveillance of these individuals should improve the ability of clinicians to detect melanoma at an early stage when surgical excision of the primary tumor is curative in the majority of patients.

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Resumen En todo el mundo se informa un incremento alarmante en las tasas de incidencia y de mortalidad por melanoma. Recientemente se ha demostrado que los nevus displásicos son marcadores y precursores potenciales de melanoma, lo cual permite identificar un grupo poblacional con mayor riesgo de desarrollar esta enfermedad. El seguimiento cuidadoso de las personas que conforman este grupo debe mejorar la capacidad de la detección clínica del melanoma en una etapa temprana de su evolución, cuando la resección quirúrgica del neoplasma primario resulta curativa en la mayoría de lo pacientes.

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Résumé Dans le monde entier, l'incidence du mélanome et la mortalité qui en découle augmentent de manière alarmante. Récemment, l'identification de certains naevi comme marqueurs et précurseurs potentiels de mélanome, a permis l'individualisation d'un groupe de sujet à haut risque pour développer un mélanome. Une surveillance étroite de cette population, à un stade où l'excision chirurgicale de la tumeur primitive peut être curative, devrait permettre d'augmenter le nombre de cas détectés par les cliniciens à un stade utile.