Who is in Your Waiting Room? Social Determinants of Health and Adverse Childhood Experiences in Pediatric Surgery Clinics.

BACKGROUND: Social determinants of health (SDoH) influence overall health, although little is known about the SDoH for pediatric patients requiring surgical services. This study aims to describe SDoH for pediatric surgical patients attending out-patient, community, and outreach clinics, as well as demonstrate the feasibility of identifying and addressing SDoH and Adverse Childhood Experiences (ACEs) when appropriate. METHODS: A cross-sectional study using surveys evaluating SDoH that were distributed to families attending pediatric surgical clinics over a two-year period. The pilot survey used validated questions and was later refined to a shorter version with questions on: Barriers to care, Economic factors, Adversity, Resiliency and Social capital (BEARS). Data was analyzed with descriptive and inferential statistics. RESULTS: 851 families across 13 clinics participated. One third of families reported not having a primary health care provider or being unable to turn to them for additional support. One in four families were found to have a household income less than the Canadian after-tax low-income threshold (<$40,000 CAD). Two-thirds of families answered questions about ACEs, and those with more ACEs were more likely to report a low income. Forty percent of families rarely or only sometimes had adequate social support. CONCLUSION: This survey tool enabled discussions between families and care providers, which allowed clinicians to appropriately follow-up with families and refer them to social work for further support when indicated. Addressing concerns around SDoH within a busy surgical clinical is feasible and may positively affect long-term health outcomes and equitable resource allocation. LEVEL OF EVIDENCE: IV.

A Review and Quality Assessment of TikTok Videos for Burn Education.

Social media platforms can serve as a readily accessible tool for burn education, potentially reducing the incidence and severity of burn injuries. Previous studies have investigated the quality of online burn education videos on platforms such as YouTube. Here, we review the quality of such videos on TikTok, a newer and rapidly growing platform. TikTok was searched for English videos using 29 keywords (hashtags) such as #burn, #education, #prevention, and #management. The first 30 videos per hashtag were screened. Videos were categorized by content and creator. Two independent reviewers assessed the quality of the included videos using the Global Quality Scale (GQS). Metrics such as views, commentary, and likes were also examined. Of 535 screened videos, 72 met inclusion criteria. 47% (n = 34) were on management, 33% (n = 31) education, and 10% (n = 7) prevention. Only 6% (n = 4) cited sources. The median GQS score was 3.0 (IQR: 2.0-3.0, max 4.0). 50% (n = 36) were made by healthcare professionals with a median GQS score of 3.0 (IQR: 2.0-3.0, max 4.0) compared to 2.0 (IQR: 2.0-3.0, max 4.0) in nonhealthcare professionals (n = 36). Viewership varied from 41 to 4.2 million views. Overall, there is a lack of high-quality educational information on TikTok. This rapidly expanding and dynamic platform may provide an opportunity to direct individuals to higher quality resources.

How Institution of the Sup-ER Protocol in a Clinic Changed Procedure Patterns in Upper Brachial Plexus (Erb's Type) Birth Injuries.

BACKGROUND: For children with upper brachial plexus birth injury (BPBI; C5, C6, ±C7 roots), most clinics first recommend nonsurgical treatment followed by primary and/or secondary surgical interventions in selected patients. Since 2008, we have used an infant shoulder repositioning protocol (supination-external rotation [Sup-ER]) designed to prevent shoulder internal rotation contracture and its potential effects on the shoulder joint. This study characterizes our clinic's current choice, number, and timing of primary and secondary procedural interventions (including Botox) and compares Sup-ER protocol patients with those of our historical controls. METHODS: The records of all patients with upper BPBI who underwent procedures from 2001 to 2018 were retrospectively reviewed and grouped into a historical (2001-2007, n = 20) and recent (2008-2018, n = 23) cohort. Patient demographics, procedure types and timing, and functional outcomes were collected and analyzed. RESULTS: Since the 2008 institution of the Sup-ER protocol, fewer brachial plexus exploration and grafting (BPEG) surgeries were performed and none in later infancy, where nerve transfers were preferred. There were more and earlier Botox injections. There were fewer tendon transfers, and the preoperative indications were from a higher level of function. CONCLUSIONS: We now see fewer indications for BPEG surgeries overall. After the 3-month-age group, more direct nerve transfers are indicated instead of the BPEG surgery if nerve surgery is required at all. Shoulder tendon transfer rates have decreased. Humeral osteotomies are not seen in our recent group. Glenoid osteotomies within tendon transfers are rare in both groups.

Can the Sup-ER Protocol Decrease the Prevalence and Severity of Elbow Flexion Deformity in Brachial Plexus Birth Injuries?

BACKGROUND: Brachial plexus birth injuries (BPBIs) can often result in functional and cosmetic deficits including, according to a recent scoping review, elbow flexion contractures in up to 48%. A treatment algorithm that includes a custom long-arm orthosis to optimize early glenohumeral joint positioning (Sup-ER protocol) has been shown to improve shoulder range of motion. Although the protocol was not intentionally designed to affect the elbow, this study investigates the prevalence and severity of elbow flexion contractures in children treated with that protocol. METHODS: This prospective cross-sectional cohort study examined 16 children aged 4 and older with BPBI severe enough to be treated with the Sup-ER protocol. Passive and active elbow flexion and extension range of motion (ROM) were assessed in both arms. Elbow flexion contractures were defined as > 5o from neutral. RESULTS: Within the cohort of 16 patients (mean age: 7.0 years, range: 4.5-11.6 years), the mean maximal passive elbow extension was -6.2° in the affected arm and + 5.1° (hyperextension) in the unaffected arm. Zero patients had a severe elbow flexion contracture (>30o) and only 6/16 met the lowest threshold definition of elbow flexion contracture (>5o), with a mean onset at 22 months of age. CONCLUSIONS: This study suggests an unintended decreased prevalence and severity of elbow flexion contractures in children with more severe BPBI treated with the Sup-ER protocol, relative to published values.

Something Stinks! Finding Ways to Manage Noxious Odours in the Operating Room and Other Clinical Settings A Randomized Controlled Trial.

Objectives: The hospital can be saturated with noxious smells. Anecdotally, medical staff apply products to surgical masks to lessen the impact of these smells. This study aimed to determine the odour-masking ability of 4 inexpensive and convenient products. Methods: A randomized, single-blinded crossover study was conducted in Vancouver, Canada. Participants, 19 to 30 years old, were invited to participate. Participants with active allergies, upper respiratory tract infection, alteration to sense of smell, or failure of olfactory screen were excluded from the study. An experimental odour was used in lieu of a noxious surgical odour. After smelling the experimental odour without barriers, participants were re-exposed to the odour using 5 surgical masks in randomized order. Each mask was lined with a test product (cherry lip balm, tincture of benzoin, Mastisol, mint toothpaste, and control [plain mask]). Participants rated the effectiveness of products at masking the experimental odour from 0 to 100 (0 = completely ineffective, 100 = completely effective). Participants also rated the pleasantness of the products, recorded if the products made them feel unwell, and identified their preferred product overall. Results: Eighty participants were included in the study (33 male, 47 female), averaging 24.2 years of age. Mean odour-masking effectiveness for cherry lip balm was 66.5 (±24.6), tincture of benzoin: 62.6 (±25.0), Mastisol: 61.3 (±23.9), mint toothpaste: 57.5 (±27.4), and control: 21.9 (±21.8). All products performed better than the control (P < .001), but there was no significant difference in performance between products. Cherry lip balm was the most preferred odour-masking product (29 participants), followed by mint toothpaste (22), Mastisol (14), tincture of benzoin (10), and control (5). Conclusions: All tested products demonstrated equivalent odour-masking abilities. If health care professionals choose to use an odour-masking product, they should consider their own olfactory preferences.

Objectifs: L'hôpital peut être saturé d'odeurs nauséabondes. On rapporte que le personnel médical applique des produits sur leurs masques chirurgicaux pour atténuer l'impact de ces odeurs. Cette étude visait à déterminer l'efficacité de quatre produits masqueurs d'odeurs, et ce de façon pratique et peu couteuse. Méthodes: Une étude croisée a simple insu et a répartition aléatoire a été menée à Vancouver, Canada. Des participants âgés de 19 à 30 ans, ont été invités à participer. Les participants souffrant d'allergies actives, d'une infection des voies respiratoires supérieures, d'une altération olfactive, ou aillant échoué la procédure de sélection ont été exclus de l'étude. Une odeur expérimentale a été utilisée au lieu d'une odeur nauséabonde chirurgicale. Après avoir senti l'odeur expérimentale, les participants ont été réexposés à la même odeur à cinq reprises. A chaque reprise, le participant était muni d'un de 5 masques tapissé d'un agent masquant d'odeur (baume à lèvres aux cerises, teinture de benzoïne, mastisol, dentifrice à la menthe, et contrôle [masque standard]). L'ordre des masques a été déterminé de façon aléatoire. Les participants ont noté sur une échelle de 0 à 100 l'efficacité des produits à masquer l'odeur (0: complètement inefficace, 100: complètement efficace). Les participants ont également évalué la qualité plaisante des agents, si ceux-ci les rendaient nauséeux, et ont ensuite identifié leur produit préféré parmi l'ensemble. Résultats: Quatre-vingts participants ont été inclus dans l'étude (33 hommes, 47 femmes), âgés en moyenne de 24,2 ans. L'efficacité des produits à masquer l'odeur expérimentale étaient d'une moyenne de 66,5 (+24,6) pour le baume à lèvres aux cerises ; 62,6 (+25,0) pour la teinture de benzoine ; 61,3 (+23,9) le mastisol ; 57,5 (+27,4) pour le dentifrice à la menthe, et 21,9 (+21,8) le contrôle. Tous les agents testés ont reçu une note supérieure au contrôle (P < .001). Par-contre, il n'y avait pas de différence significative entre les agents. Le baume à lèvres aux cerises était le produit préféré (29 participants), suivi du dentifrice à la menthe (22), du mastisol (14), de la teinture de benzoine (10), et finalement du contrôle (5). Conclusions: Tous les produits testés ont démontré une efficacité similaire, celle-ci supérieure comparée au contrôle. Si les professionnels de la santé souhaitent d'utiliser un produit qui masque les odeurs, ils devraient tenir compte de leurs propres préférences.

Shoulder Rotation Function Following the Sup-ER Protocol in Children with Brachial Plexus Injuries.

Background: Our group previously developed an upper extremity repositioning (Sup-ER) protocol for brachial plexus birth injuries (BPBIs) that may improve supination and external rotation (ER) at 2 years of age. Questions were raised about the potential for the protocol to cause internal rotation (IR) deficits. The goal of this study was to explore the longer-term outcomes of the Sup-ER protocol and investigate IR/ER function. Methods: This prospective cross-sectional cohort study examined 16 children older than 4 years of age with significant enough BPBI to be treated with the Sup-ER protocol. Total shoulder and elbow function were assessed, including passive and active ranges of motion and strength of IR and ER. Results: Range of motion (ROM) for most active movements was decreased in the affected compared to unaffected arm. Notably, IR passive ROM was similar in the affected (78.7°) and unaffected arm (82.8°). External rotation strength of the affected arm was weaker (42.8 N) compared to the unaffected arm (57.9 N). IR strength had a greater deficit in the affected (43.2 N) arm compared to the unaffected arm (72.2 N), but both ER and IR showed less deficit than described in the literature. Conclusions: Despite differences in ranges of motion between the affected and unaffected arms, ROMs for the affected arm were comparable to the functional limits as reported in the literature. The Sup-ER protocol shows potential to optimize long-term shoulder rotation function in children with BPBI without compromising IR.

Assessing the Social Determinants of Health and Adverse Childhood Experiences in Patients Attending a Children's Hospital Cleft Palate-Craniofacial Program.

This study aimed to describe the social determinants of health (SDoH) for patients receiving multidisciplinary team care in a Cleft Palate-Craniofacial program, develop responsive and consistent processes to include trauma-informed psychosocial histories, promote discussions about additional "non-medical" factors influencing health and surgical outcomes, and demonstrate that these activities are feasible in the context of multidisciplinary patient-provider interactions.Single-site, cross-sectional study using a questionnaire.Participants were recruited from a provincial quaternary care Cleft Palate-Craniofacial program at British Columbia Children's Hospital in Vancouver, BC, Canada.290 families completed the questionnaire.34% of families experience significant barriers to accessing primary health care, 51% struggle financially, and 11% scored four or more on the Adverse Childhood Experiences scale. Furthermore, 47% reported not having adequate social support in their lives, and 5% reported not feeling resilient at the time of the survey.Patients with cleft and craniofacial anomalies have complex needs that extend beyond the surgical and medical care they receive. It is critical that all Cleft and Craniofacial teams incorporate social histories into their clinic workflow and be responsive to these additional needs. Discussions surrounding SDoH and adversity are welcomed by families; being involved in the care and decision-making plans is highly valued. Healthcare providers can and should ask about SDoH and advocate for universal access to responsive, site-based, social work support for their patients.

Online Cleft Educational Videos: Parent Preferences.

OBJECTIVE: Determine what parents of children with cleft lip and palate value in online educational videos and evaluate whether their needs are currently being met. DESIGN: Focus groups and telephone interviews were used to define parent information needs, followed by an evaluation of whether currently available YouTube videos meet these needs. SETTING: British Columbia Children's Hospital multidisciplinary cleft clinic. PARTICIPANTS: Twenty-four parents of children with nonsyndromic cleft lip and palate. RESULTS: Parents desired videos that are accessible, trustworthy, relatable, and positive. Parents preferred a series of short videos addressing relevant topics as their child grows. Currently available YouTube videos only partially met these needs, with underrepresented topics including hearing, dentition, and surgeries for older children. CONCLUSIONS: While access and validity of video resources can be improved by directing patients and families to appropriate videos, some parent needs remain unmet.

Experiences of Canadian Parents of Young Children With Cleft Lip and/or Palate.

PURPOSE: Prior literature has described the perspectives of parents of young children with clip lip and/or palate; however, few studies have described parents' experiences within a Canadian health care system. This study aims to better understand the experiences of parents of young children with cleft lip and/or palate seen at a Canadian tertiary care center and identify their care needs. DESIGN: In-depth semistructured interviews. SETTING: Pediatric tertiary care center. PARTICIPANTS: Parents of children younger than 7 years of age with cleft lip and/or palate. RESULTS: From 14 interviews, 4 themes were identified. The diagnosis theme was associated with reactions, timing, and search for information. Key concerns within the theme of physiology and function were around feeding and speech. The health care experience theme included burden of care, peripheral hospitals and services, the cleft lip and palate clinic, and clinicians. The psychosocial theme included parents' reactions to their child's pain, coping strategies, family interactions, and school/day care experiences. Parents felt care could be improved by having: access to good information and community speech therapists, shorter appointment wait times, a peer support network, and increased cleft knowledge within their child's school and peer groups. CONCLUSIONS: The experience of parents of children with cleft lip and/or palate is complex but can be organized into 4 themes. Clinics may consider suggestions offered by parents to improve care. Future work should address parents' needs and aim to create a parent-reported quality-of-life measure specific to parents of young children with cleft lip and/or palate.

A Cross-Sectional Analysis of the BC Children's Hospital Cleft Palate Program Waitlist.

OBJECTIVE: A 2016 review of the BC Children's Hospital Cleft Palate - Craniofacial Program (CPP) revealed that one-third of patients met the program's care recommendations and half met the American Cleft Palate-Craniofacial Association guidelines. This study reviews patients on the CPP waitlist and determines median wait times and missed clinical assessments as well as identifies how wait times are influenced by medical complexity, specialized speech service needs, vulnerability, and distance from clinic. DESIGN: Cross-sectional. SETTING: BC Children's Hospital Cleft Palate-Craniofacial Program. PATIENTS: Five hundred seventy-six waitlisted patients. MAIN OUTCOME MEASURES: Additional wait time after recommended appointment date. Correlation of additional wait time with diagnosis, number of specialists required, speech services needed, vulnerability, and distance from the clinic. Missed plastic surgery, speech, and orthodontic assessments according to CPP team recommendations and ACPA guidelines. RESULTS: Patients had a median additional wait time of 11 months (interquartile range: 5-27). Longer additional wait times were associated with a craniofacial diagnosis (P = .019), a need for formal speech assessments or evaluations (P < .001), or a requirement to see multiple specialists (P < .001). Vulnerability and distance from clinic did not affect wait times. Plastic surgery assessments were not available at the preschool and preteen time points for 45 (8%) patients, 355 (62%) patients were unable to access speech assessments, and 120 (21%) were unable to complete an orthodontic assessment. CONCLUSION: Patients wait up to an additional year to be seen by the CPP and miss speech, orthodontic, and surgical assessments at key developmental milestones. Additional resources are required to address these concerns.

OBJECTIF: Une analyse du programme de chirurgie labiofaciale et crâniofaciale (PCLC) du BC Children's Hospital réalisée en 2016 a révélé que le tiers des patients respectaient les recommandations du programme et la moitié, les lignes directrices de l'American Cleft Palate-Craniofacial Association (ACPA). La présente étude visait à passer en revue les patients sur la liste d'attente du PCLC, à déterminer la liste d'attende médiane et les évaluations cliniques ratées et à établir l'effet de la complexité médicale, des besoins en orthophonie, de la vulnérabilité et de la distance de la clinique sur les temps d'attente. MÉTHODOLOGIE: Transversale. CONTEXTE: Programme de chirurgie labiofaciale et crâniofaciale du BC Children's Hospital. PATIENTS: 576 sur la liste d'attente. PRINCIPALES MESURES DE RÉSULTATS: Temps d'attente supplémentaire après la date recommandée du rendez-vous. Corrélation du temps d'attente supplémentaire avec le diagnostic, le nombre de spécialistes requis, les besoins en orthophonie, la vulnérabilité et la distance de la clinique. Évaluations ratées en chirurgie plastique, en orthophonie et en orthodontie en fonction des recommandations de l'équipe du PCLC et des lignes directrices de l'ACPA. RÉSULTATS: Les patients devaient subir un temps d'attente supplémentaire médian de 11 mois (plage interquartile de 5 à 27). Des temps d'attente supplémentaires plus longs s'associaient à un diagnostic crâniofacial (P = 0,019), à la nécessité de subir une évaluation officielle en orthophonie (P < 0,001) ou à la nécessité de consulter de multiples spécialistes (P < 0,001). La vulnérabilité et la distance de la clinique n'avaient pas d'incidence sur les temps d'attente. Les évaluations en chirurgie plastique n'étaient pas disponibles pour 45 patients (8 %) pendant la période préscolaire et à la préadolescence, alors que 355 patients (62 %) n'avaient pas eu accès à une évaluation en orthophonie et 120 (21 %), en orthodontie. CONCLUSION: Les patients attendent jusqu'à une année supplémentaire avant d'être vus par le PCLC et ratent des évaluations en orthophonie, en orthodontie et en chirurgie lors d'étapes importantes de leur développement. Des ressources supplémentaires s'imposent pour corriger ces lacunes.

A Review of Validated Quality-of-Life Patient-Reported Outcome Measures in Pediatric Plastic Surgery.

BACKGROUND: There has been an exponential increase in the number of patient-reported outcome measures in plastic surgery. The authors reviewed the reliability, validity, and practicality of the most frequently used patient-reported outcome measures in pediatric plastic surgery research. METHODS: A review of the literature from January of 2010 to June of 2015 was conducted to identify patient-reported outcome measures in pediatric plastic surgery. Patient-reported measures used in five articles with two validation studies were included for analysis and classified as generic, disease-specific, and mental health. The type of validation used and reliability scores were compared across each class of outcome measure. The practicality of each measure was determined by the frequency of use and the number of items and cost. RESULTS: Of the 173 unique patient-reported outcome measures identified, 14 were included for analysis and classified as generic (n = 7), disease-specific (n = 4), and mental health (n = 3). The majority of all measures used construct validity. Disease-specific measures had the highest distribution of domains related to physical functioning, the same domain also found to have the highest reliability scores. A patient-reported outcome measure's frequency of use was not associated with its number of items or cost. CONCLUSIONS: This review found that generic patient-reported outcome measures were used most often, construct validity was used most frequently, physical functioning domains had the highest reliability, and the number of items or cost of a patient-reported outcome measure was not related to its frequency of use. Considered together, this information may inform the future development or selection of patient-reported outcome measures in pediatric plastic surgery.

Multidisciplinary Cleft Palate Program at BC Children's Hospital: Are We Meeting the Standards of Care?

OBJECTIVE: To characterize current Cleft Palate Program (CPP) practices and evaluate the timeliness of appointments with respect to patient age and diagnosis based on American Cleft Palate-Craniofacial Association (ACPA) population guidelines and CPP patient-specific recommendations. DESIGN: A retrospective review of CPP patient appointments from November 6, 2012, to March 31, 2015, was done. Data were analyzed using descriptive and inferential statistics. SETTING: The study was conducted using data from the CPP at BC Children's Hospital. PATIENTS: A total of 1214 appointments were considered in the analysis, including syndromic and nonsyndromic patients of 0 to 27 years of age. MAIN OUTCOME MEASURES: Percentage of patients meeting follow-up targets by ACPA standards and CPP team recommendations. RESULTS: Our results showed patients 5 years and younger or nonsyndromic were more likely to be seen on time (P < .001). No relationship between the timeliness of an appointment and specific patient diagnoses or distance to clinic was found. With the exception of nursing (97% of appointments were on time), all disciplines had less than 45% of appointments on time with 51% of appointments meeting ACPA guidelines for timeliness and 32% of all appointments meeting CPP recommendations. CONCLUSION: Timely care for the cleft/craniofacial patient populations represents a challenge for the CPP. Although half of patients may meet the general ACPA guidelines, only 32% of patients are meeting the CPP patient-specific recommendations. To provide better patient care, future adjustments are needed, which may include improved resource allotment and program support.

OBJECTIF: Caractériser les pratiques du programme sur la fente labiopalatine (PFL) et évaluer la rapidité des rendez-vous compte tenu de l'âge du patient et du diagnostic en fonction des lignes directrices en population de l'American Cleft Palate-Craniofacial Association (ACPA) et des recommandations aux patients du PFL. MÉTHODOLOGIE: Les chercheurs ont procédé à une analyse rétrospective des rendez-vous des patients du PFL entre le 6 novembre 2012 et le 31 mars 2015. Ils ont analysé les données au moyen de statistiques descriptives et inférentielles. LIEU: L'étude a été réalisée à l'aide des données du PFL du BC Children's Hospital. PATIENTS: Les chercheurs ont évalué 1 214 rendez-vous dans l'analyse, incluant les patients syndromiques et non syndromiques de 0 à 27 ans. PRINCIPALES MESURES: Pourcentage de patients qui respectaient les cibles de suivi fixées par les normes de l'ACPA et les recommandations du PFL. RÉSULTATS: Les résultats ont démontré que les patients de cinq ans et moins et les patients non syndromiques étaient plus susceptibles d'être vus dans les délais fixés (P < .001). Il n'y avait pas de lien entre le moment d'un rendez-vous et le diagnostic exact du patient ou la distance de la clinique. À l'exception des soins infirmiers (où 97 % des rendez-vous avaient lieu dans les délais fixés), toutes les disciplines tenaient moins de 45 % de leurs rendez-vous dans les délais fixés. Ainsi, 51% de ces rendez-vous respectaient les lignes directrices de l'ACPA en matière de rapidité et 32 % de tous les rendez-vous, les recommandations du PFL. CONCLUSIONS: Au sein du PFL, il était difficile d'offrir des soins rapides à la population de patients ayant une fente labiopalatine ou craniofaciale. Même si la moitié des patients peut respecter les directives générales de l'ACPA, seulement 32 % d'entre eux respectent les recommandations du PFL. Pour mieux soigner les patients, il faudra apporter des correctifs, qui pourraient inclure une meilleure répartition des ressources et un meilleur soutien du programme.

Image guided sclerotherapy for the treatment of venous malformations.

BACKGROUND: Percutaneous sclerotherapy is the preferred method of treatment for VMs (venous malformations). However, treatment protocols vary, and research on the most effective sclerosant is conflicting. Additionally, there is limited knowledge on the effect of sclerosant volume on treatment outcome. This study aims to determine the outcomes and complications of image-guided sclerotherapy for VMs with respect to sclerosant and sclerosant volume. Towards this, a 10-year retrospective chart review was conducted of patients with VMs treated with sclerotherapy at the Vascular Anomalies Clinic at British Columbia Children's Hospital. RESULTS: Thirty-four patients with VMs were treated of which 15 had a successful outcome, 13 had a failed outcome, and 6 had additional planned treatments after the study time period. Lesions on the head and neck or classified as type I or II had the highest success rates. Combination therapy with both ethanol and 3% STS (sodium tetradecyl sulphate), and ethanol alone had a higher success rate (64% and 60%) compared to 3% STS (11%). Major complications were most associated with 3% STS (17%) followed by ethanol (9%), and no major complications were found with combination. No relationship between the volume of sclerosant per lesion volume and outcome was found. CONCLUSIONS: Combination and ethanol were the most effective sclerosants in terms of highest success rates and lowest complication rates, and sclerosant volume per lesion volume had no effect on outcomes. Future work should aim at studying larger sample sizes to account for the multiple factors that may influence the choice of sclerosant and treatment outcomes.

Lymphatic Malformation Architecture: Implications for Treatment With OK-432.

PURPOSE: Herein, the authors aim to describe their findings of novel architectural types of lymphatic malformations (LM) and explain the relationship between these architectures and OK-432 treatment outcomes. METHODS: A retrospective review was conducted of all patients diagnosed with a LM treated with OK-432 at the Vascular Anomalies Clinic at BC Children's Hospital from December 2002 to January 2012. RESULTS: Twenty-seven patients were included in the study. Sixty percent of lesions were present by 2 years of age with the majority located in the head and neck (59%). The average number of sclerotherapy procedures was 1.4 per patient. Treatment under fluoroscopic guidance revealed 3 new LM architectures: open-cell microcystic, closed-cell microcystic, and lymphatic channel. Response to treatment was complete or good for 14/19 macrocystic and for 1/2 mixed lesions. Open-cell microcystic LMs gave a complete or good response for 3/3, which was attributed to OK-432 freely communicating between cysts. Closed-cell microcystic LM had localized cysts that did not allow OK-432 to freely communicate and were associated with partial responses, 2/2. The lymphatic channel had a partial response. There were 2 minor complications and 1 instance of recurrence. CONCLUSIONS: The identification of 3 new LM architectures expands the current accepted classification to include: open-cell microcystic, closed-cell microcystic, and lymphatic channels. The majority of complete responses to OK-432 were found with macrocystic lesions. Open-cell microcystic lesions respond better to OK-432 than closed-cell microcystic lesions, and lymphatic channels may respond to OK-432. These key architecture-response relationships have direct clinical implications for treatment with OK-432 sclerotherapy.

Stereocontrolled disruption of the Ugi reaction toward the production of chiral piperazinones: substrate scope and process development.

The factors determining diastereoselectivity observed in the multicomponent conversion of amino acids, aziridine aldehyde dimers, and isocyanides into chiral piperazinones have been investigated. Amino acid-dependent selectivity for either trans- or cis-substituted piperazinone products has been achieved. An experimentally determined diastereoselectivity model for the three-component reaction driven by aziridine aldehyde dimers has predictive value for different substrate classes. Moreover, this model is useful in reconciling the previously reported observations in multicomponent reactions between isocyanides, α-amino acids, and monofunctional aldehydes.

Just add tetrazole: 5-(2-pyrrolo)tetrazoles are simple, highly potent anion recognition elements.

We report a novel pyrrolo-tetrazole motif that encodes anion binding orders of magnitude stronger than closely related systems and suggests the general utility of amide-tetrazole exchanges for creating simple, high-affinity anion binders.

Recognition properties of carboxylic acid bioisosteres: anion binding by tetrazoles, aryl sulfonamides, and acyl sulfonamides on a calix[4]arene scaffold.

Tetrazoles and acyl sulfonamides are functional groups that are common in medicinal chemistry but virtually unexplored as recognition elements in supramolecular chemistry. We report here on the anion binding properties of these highly acidic N-H functional groups. We have prepared two new calixarene-based tetrazole-containing hosts, as well as new acetyl sulfonamide and benzoyl sulfonamide hosts. We also report on analogous hosts bearing the better-known aryl sulfonamide functional group as a point of comparison. We find that these hosts are competent anion binders and that the recognition of anions by these groups is highly dependent on their conformational preferences. We also report in detail on the preferred molecular shape of each acid bioisostere as determined by calculations and structural database surveys, and discuss how these shapes impact binding in the context of the reported hosts.