Analysis of Navy Physical Evaluation Board diagnoses (1998-2000)

An analysis is provided from 19,265 Physical Evaluation Board diagnoses from 10,406 Navy personnel from 1998 to 2000. The leading diagnostic categories were musculoskeletal and mental disorders as well as for subgroups of women and officers. Musculoskeletal conditions were 41.6% of the diagnoses and decreased with advancing age (42.9% for <30 years; 41.1% for 30-40 years; 37.6% for >40 years; chi2 for trend [1 df] = 26.4; p = 0.000). Mental disorders were 11.8% of the diagnoses and also decreased with advancing age (14.1% for <30 years; 10.4% for 30-40 years; 8.8% for >40 years; chi2 for trend [1 df] = 84; p = 0.000). Diagnoses for injury and poisoning (8.9%), nervous system (7.6%), and ill-defined conditions (4.7%) completed the top five categories below age 40 years, whereas circulatory disorders were evident after age 40 years. These findings suggest priorities for reducing overall medical disability losses in our active duty Navy forces.     

Thalidomide is anti-angiogenic in a xenograft model of neuroblastoma

Thalidomide has previously been shown to have anti-angiogenic properties. More recently, clinical efficacy of this agent has been demonstrated in multiple myeloma and prostate cancer. Neuroblastoma is the most frequent solid tumor of the abdomen of childhood, yet children with this disease frequently have metastases at presentation. Such patients have a very poor prognosis with current therapies. Thus, new approaches are needed. We have previously shown that VEGF antagonists can inhibit neoangiogenesis and tumor growth in experimental neuroblastoma. In this study, we investigated the anti-angiogenic and anti-tumor properties of thalidomide in a xenograft model of human neuroblastoma. Tumors were induced in athymic mice using the human neuroblastoma cell line NGP. Intraperitoneal thalidomide (100 mg/kg/dose) or vehicle was administered beginning one week after implantation, and animals euthanized at six weeks. Thalidomide treatment did not significantly alter tumor growth as compared with controls. However, thalidomide suppressed angiogenesis, as demonstrated both by fluorescein angiography and immunohistochemical staining, and induced apoptosis of endothelial cells in neuroblastoma xenografts. Quantification of microvessel density demonstrated a significant reduction of vasculature in treated tumors (p<0.004). Thalidomide induced co-option of host vasculature, an effect noted previously after VEGF blockade. This study demonstrates that thalidomide has anti-angiogenic properties in experimental neuroblastoma.     

CD38 expression on CD8(+) T cells as a prognostic marker in vertically HIV-infected pediatric patients

Increased expression of CD38 on CD8(+) T cells is associated with activation of the immune system, progression of HIV disease, and death in adults. The prognostic significance of these cells in HIV-infected children, where the picture is complicated by age-related differences in CD38 expression, remains controversial. Measuring the unimodal expression of CD38 on CD8(+) T cells in adults and children by flow cytometry is best accomplished by quantitating the antigen on the cell surface. To our knowledge, this technique has not previously been reported in a pediatric population. Vertically HIV-infected children were age matched for mild (n = 26) and severe (n = 23) clinical disease. Eleven age-matched HIV-negative controls were included for comparison. Quantitation of CD38 on CD8(+) T cells was performed at baseline and 1 y later. The ages of the children in the three clinical groups did not differ significantly (p = 0.6004). HIV-infected children had significantly increased CD38 measurements in comparison with the HIV-negative controls (p = 0.0131), and the severe disease group tended to have higher measurements than the mild disease group. Increased CD38(+)CD8(+) T cells were significant predictors of death within the first year (p = 0.043). These findings support the view that increased CD38 expression on CD8(+) T cells has the same prognostic significance in pediatric as in adult HIV disease.     

Atypical lipomatous masses of the extremities: outcome of surgical treatment

Atypical lipomatous tumors occur predominantly in middle-aged patients and often present as painless, slow-growing masses in the extremities. The clinical outcomes of surgically treated superficial or deep atypical lipomas of the extremities were reviewed. Thirty-one patients were included in this study. There were 16 men and 15 women, with an average age of 57 years (range, 32-87 years). The mean followup was 7 years (range, 1-28.8 years). Twenty-five tumors occurred in the lower extremity and six in the upper extremity. Sixteen patients (52%) had a recurrence at an average of 4.7 years after resection. Twelve (39%) patients required additional surgical procedures to treat their tumor. Occurrence of a deep lesion and positive margins at the time of the initial surgery correlated closely with the rate of recurrence and need for additional surgical treatment. Dedifferentiation to high-grade liposarcoma developed in four (13%) patients. Atypical lipomas have a high propensity for local recurrence and a potential for malignant dedifferentiation. Patients with atypical lipomas require careful evaluation, complete surgical excision when possible, and close clinical followup extending beyond 5 years.     

Separable effects of priming and imageability on word processing: an ERP study

Concrete, highly imageable words (e.g. banana) are easier to understand than abstract words for which it is difficult to generate an image (e.g. justice). This effect of concreteness or imageability has been taken by some as evidence for the existence of separable verbal- and image-based semantic systems. Instead, however, effects of concreteness may result from better associations to relevant contextual representations for concrete than for abstract words within a single semantic system. In this study, target words of high and low imageability were preceded by supportive (related) or non-supportive (unrelated) context words. The influence of contextual support on the imageability effect was measured by recording event-related brain potentials (ERPs) to the high and low imageable target words in both context conditions. The topographic distributions of the ERPs elicited by the high versus low imageable target words were found to be different, and this effect was independent of contextual support. These data are consistent with the idea that distinct verbal- and image-based semantic codes exist for word representations, and that as a result, concrete words that are highly imageable can be understood more easily.     

Fetal intracranial hemorrhage. Prenatal diagnosis and postnatal outcomes

Objective: To present our experience with 14 cases of fetal intracranial hemorrhage (ICH).

Methods: Cases of fetal ICH detected in our institution between 2005 and 2016 by ultrasonography. Maternal characteristics, ultrasound and MRI findings, and postnatal outcome were noted.

Results: Twelve cases (86.7%) were identified during a third trimester routine scan at a median gestational age of 30.6 weeks. The ICH was classified as Grade 2 in two cases, Grade 3 in three cases, and Grade 4 in nine cases. Nine cases were bilateral and five were unilateral (four left/one right). The 11 MRI available confirmed grade and location and, in six cases (54.5%), added new findings. There were six terminations of pregnancy, one intrauterine fetal death and seven babies born alive. These were followed up for 28 months (range 3–96). Some grade of neurologic impairment was observed in five children (71.4%, one Grade 3/four Grade 4), mainly mild to moderate motor sequelae.

Conclusion: Diagnosis of fetal ICH is amenable to antenatal US. Most of the cases identified are of high grade and usually detected during the third trimester. MRI is a valuable complementary tool in evaluating ICH. Conversely to that previously reported, postnatal survival is high but it entails the risk of adverse neurologic outcome in most neonates.     

Intimate Partner Relationships,Work-Life Factors,and Their Associations With Burnout Among Partnered Pediatric Residents

Background

Burnout is prevalent among pediatric residents, and reducing burnout is a priority for pediatric residency programs. Understanding residents’ personal circumstances, including relationship satisfaction and perceived work-life conflict, may identify novel determinants of burnout.