ABSTRACT
Introduction: Dual diagnosis (DD) with traumatic brain injury (TBI) and spinal cord injury (SCI) poses clinical and rehabilitation challenges. While comorbid TBI is common among adults with SCI, little is known about the epidemiology in the pediatric population. The primary objective of this study was to evaluate the prevalence of TBI among children in the United States hospitalized with SCI. Secondary objectives were to compare children hospitalized with DD with those with isolated SCI with regards to age, gender, race, hospital length of stay, and hospital charges. Methods: A retrospective analysis of hospital discharges among children aged 0-18 years occurring between 2016-2018 from U.S. hospitals participating in the Kids' Inpatient Database. ICD-10 codes were used to identify cases of SCI, which were then categorized by the presence or absence of comorbid TBI. Results: 38.8% of children hospitalized with SCI had a co-occurring TBI. While DD disproportionately occurred among male children (67% of cases), when compared with children with isolated SCI, those with DD were not significantly more likely to be male. They were more likely to be Caucasian. The mean age of children with DD (13.2 ± 5.6 years) was significantly less than that of children with isolated SCI (14.4 ± 4.3 years). DD was associated with longer average lengths of stay (6 versus 4 days) and increased mean total hospital charges ($124,198 versus $98,089) when compared to isolated SCI. Conclusion: Comorbid TBI is prevalent among U.S. children hospitalized with SCI. Future research is needed to better delineate the impact of DD on mortality, quality of life, and functional outcomes.
ABSTRACT
A re-immunization programme has been tested to improve the protective response elicited in sole by a previously developed BEI-inactivated betanodavirus vaccine. The vaccine was prepared using a reassortant RGNNV/SJNNV strain which is highly pathogenic for sole, and vaccination assays were performed by intraperitoneal injection. Experimental design included a prime- and a booster-vaccination group, which consisted of individuals that received a second vaccine injection at 30 days post vaccination), and their respective controls. A month after prime/booster vaccination, fish were challenged by intramuscular injection with the homologous NNV strain. Samples were collected at different times post vaccination and post challenge to assess the immune response and viral replication. Booster dose enhanced the protection against NNV infection because a significant increase in survival was recorded when compared with prime-vaccinated individuals (relative percent survival 77 vs. 55). In addition, a clear decrease in viral replication in the brain of challenged sole was observed. During the immune induction period, no differences in IgM production were observed between prime- and booster-vaccinated fish, and the expression of the antigen presenting cells (APC)-related molecule MHC class II antigen was the only differential stimulation recorded in the re-immunized individuals. However, a significant upregulation of mhcII and the lymphocytes T helper (Th) marker cd4 was observed after the challenge in the booster-vaccinated group, suggesting these cells play a role in the protection conferred by the booster injection. In addition, after viral infection, re-immunized fish showed specific and neutralizing antibody production and overexpression of other immune-related genes putatively involved in the control of NNV replication.
ABSTRACT
Management of clavicle fractures depends in part on the magnitude of shortening compared with the contralateral, intact clavicle. However, estimating prefracture length may be complicated by side-to-side asymmetry. The authors retrospectively reviewed chest radiographs using a ruler tool to measure clavicle length in 696 patients 12 to 25 years old. Absolute and relative least significant change values that represented statistically significant true biological differences were 3.54 mm and 2.44%, respectively. Length differences in which the left was greater than the right or the right was greater than the left exceeding the absolute least significant change were found in 35.2% of males and 39.8% of females. Length differences exceeding 5 mm and 10 mm were 19% and 2.6% in males and 22.6% and 0.9% in females, respectively. There was a statistically significant left bias in length difference, with a 2.1-fold and a 1.6-fold greater chance of the left being longer than the right (although usually <5 mm in actual length) in males and females, respectively. The authors concluded that small but significant left-biased length asymmetry prevailed in both sexes. Differences exceeding 10 mm were rare. Contralateral clavicles can be used to estimate prefracture length of presenting fractures with the understanding that small left-right length discrepancy is common. [Orthopedics. 2018; 41(1):e104-e109.].
