Role of a point-of-care protease activity diagnostic test in Canadian clinical practice: a Canadian expert consensus ©

Nonhealing wounds (stalled, healable) challenge affected individuals, wound clinicians, and society. Nonhealing may result despite local factors being corrected. The interplay between tissue degradation, increased inflammatory response, and abundant protease activity is a challenging quandary. A modified Delphi process was utilized to investigate a protease activity test and practice implications.     

Widespread cortical morphologic changes in juvenile myoclonic epilepsy: evidence from structural MRI

Purpose: Atypical morphology of the surface of the cerebral cortex may be related to abnormal cortical folding (gyrification) and therefore may indicate underlying malformations of cortical development (MCDs). Using magnetic resonance imaging (MRI)–based analysis, we examined cortical morphology in patients with juvenile myoclonic epilepsy (JME). Methods: MRI data was collected for 24 patients with JME and 40 demographically matched healthy controls. FreeSurfer, an automated cortical surface reconstruction method, was applied to compare cortical morphology between patients and controls. Areas of anomalous cortical morphology were defined as regions of interest (ROIs) to contrast regional cortical parameters, such as surface area, average thickness, and mean curvature between patients and controls. Key Findings: In patients with JME, changes to cortical morphology were detected in several regions. In the left hemisphere, these were in insular and cingulate cortices, occipital pole, and middle temporal and fusiform gyri. In the right hemisphere, changes were detected in insular cortex, inferior temporal gyrus, and precuneus. Further analysis of ROIs revealed that these changes are related to differences in surface area rather than average cortical thickness. In addition, mean curvature abnormalities were detected in the insula bilaterally, the left cingulate cortex, and right inferior temporal gyrus. Significance: The morphologic findings in this study suggest that structural abnormalities in JME extend beyond mesial frontal lobe regions of the brain. These may be indicative of areas of subtle cortical folding abnormality related to early disruption of cortical development.     

Annual research review: conceptualising functional impairment in children and adolescents

Functional impairment is a key factor in the clinical importance of mental health problems in children. Yet, the nature of impairment and criteria for defining and assessing impairment in childhood disorders has been surprisingly overlooked in much of the literature. The current article examines the extant literature on the conceptualisation, nature and assessment of impairment in childhood disorders. Relations between diagnostic symptoms and functional impairment are discussed together with the influence of impairment on diagnostic decisions and prevalence rates. Several factors influencing impairment in childhood such as culture, development and gender are considered. This article concludes with a discussion of the utility of separating judgements of impairment from specific diagnoses, which is proposed for consideration in the forthcoming DSM-5.     

The epidemiology of paediatric head injuries: Data from a referral centre in Victoria, Australia

Aim:   Currently, there are no population-based or hospital-based studies on the full spectrum of paediatric head injuries (HIs) in Australia. We set out to provide detailed information on the incidence rates, causes and clinical management of all severities of HI in children and adolescents at an Australian tertiary referral centre using emergency department (ED) and admission data as a basis for further investigations and prevention efforts.
Methods:   A retrospective chart review of all children aged 0–16 years who attended the Royal Childrens Hospital (RCH), Melbourne, following a HI in 2004 was used. The cases were identified using the International Classification of Diseases 10th revision codes, and all medical records were reviewed based on a piloted data form. Information was collected on demographics, injury factors and clinical management of HIs in the hospital setting.
Results:   Over the 12-month period, there were 1115 children with an HI who attended the RCH ED, or were admitted. Ninety per cent were classified as mild, 8% as moderate and 3% as severe. Males and children under 3 years had the higher attendance rates. Falls, sports and motor vehicle accidents were the main HI causes. The main sport played (30%) when sustaining an HI was Australian rules football. Thirty-two per cent of children were admitted, 67% of these with mild HI. Twenty-one per cent had a radiology imaging study, most (67%) with a normal result.
Conclusions:   Many HI causes appear preventable, in particular, falls from heights in infants and sports safety. High rates of admission and radiology imaging of mild HI warrant further investigation.     

High‐Resolution Sonography of the Normal Extrapelvic Vas Deferens

Objective. The purpose of this study was to determine the reliability of sonographic visualization of the normal extrapelvic vas deferens and to analyze its appearance and dimensions. Methods. Scans of the scrotum and spermatic cords were obtained in 25 fertile volunteers. Identification of the vas deferens was attempted bilaterally in the scrotal, suprascrotal, and prepubic segments in all volunteers. When possible, the total thickness and the diameter of the lumen were measured. Visualization and dimensions were correlated with the body mass index (BMI) and abstinence interval. Results. All segments of the vas deferens were identified bilaterally in all volunteers. In all cases, it appeared as an anechoic or very hypoechoic tubular structure that was noncompressible and contained no detectable blood flow. It was convoluted inferiorly and became straight as it progressed from the scrotum to the suprascrotal and prepubic segments. The lumen was seen in the suprascrotal segment in all of the volunteers except the one with the highest BMI. The total thickness of the vas ranged from 1.5 to 2.7 mm (mean, 1.89 mm). The lumen of the vas ranged from 0.2 to 0.7 mm (mean, 0.43 mm). There was no correlation between the luminal diameter and the abstinence interval. Conclusions. The extrapelvic portion of the vas deferens is reliably visualized sonographically. Its appearance is characteristic and reproducible. The lumen can be measured in almost all cases.