Case report: Slipped capital femoral epiphysis: a rare adverse event associated with FGFR tyrosine kinase inhibitor therapy in a child.

We report a case of slipped capital femoral epiphysis (SCFE), an on target skeletal toxicity of a pan-FGFR TKI inhibitor, erdafitinib. A 13-year-old boy was diagnosed to have an optic pathway/hypothalamic glioma with signs of increased intracranial pressure and obstructive hydrocephalus requiring placement of ventriculo-peritoneal (VP) shunt. Sequencing of the tumor showed FGFR1-tyrosine kinase domain internal tandem duplication (FGFR1-KD-ITD). He developed hypothalamic obesity with rapid weight gain and BMI >30. At 12 weeks of treatment with erdafitinib, he developed persistent knee pain. X-ray of the right hip showed SCFE. Erdafitinib was discontinued, and he underwent surgical pinning of the right hip. MRI at discontinuation of erdafitinib showed a 30% decrease in the size of the tumor, which has remained stable at 6 months follow-up. Our experience and literature review suggest that pediatric patients who are treated with pan-FGFR TKIs should be regularly monitored for skeletal side effects.

Evaluating a Dual-Ion Battery with an Antimony-Carbon Composite Anode.

Dual-ion batteries (DIBs) are attracting attention due to their high operating voltage and promise in stationary energy storage applications. Among various anode materials, elements that alloy and dealloy with lithium are assumed to be prospective in bringing higher capacities and increasing the energy density of DIBs. In this work, antimony in the form of a composite with carbon (Sb-C) is evaluated as an anode material for DIB full cells for the first time. The behaviour of graphite||Sb-C cells is assessed in highly concentrated electrolytes in the absence and presence of an electrolyte additive (1 % vinylene carbonate) and in two cell voltage windows (2-4.5 V and 2-4.8 V). Sb-C full cells possess maximum estimated specific energies of 290 Wh/kg (based on electrode masses) and 154 Wh/kg (based on the combined mass of electrodes and active salt). The work expands the knowledge on the operation of DIBs with non-graphitic anodes.

Overcoming Diffusion Limitation of Faradaic Processes: Property-Performance Relationships of 2D Conductive Metal-Organic Framework Cu3 (HHTP)2 for Reversible Lithium-Ion Storage.

Faradaic reactions including charge transfer are often accompanied with diffusion limitation inside the bulk. Conductive two-dimensional frameworks (2D MOFs) with a fast ion transport can combine both-charge transfer and fast diffusion inside their porous structure. To study remaining diffusion limitations caused by particle morphology, different synthesis routes of Cu-2,3,6,7,10,11-hexahydroxytriphenylene (Cu3 (HHTP)2 ), a copper-based 2D MOF, are used to obtain flake- and rod-like MOF particles. Both morphologies are systematically characterized and evaluated for redox-active Li+ ion storage. The redox mechanism is investigated by means of X-ray absorption spectroscopy, FTIR spectroscopy and in situ XRD. Both types are compared regarding kinetic properties for Li+ ion storage via cyclic voltammetry and impedance spectroscopy. A significant influence of particle morphology for 2D MOFs on kinetic aspects of electrochemical Li+ ion storage can be observed. This study opens the path for optimization of redox active porous structures to overcome diffusion limitations of Faradaic processes.

Insights into Electrolytic Pre-Lithiation: A Thorough Analysis Using Silicon Thin Film Anodes.

Pre-lithiation via electrolysis, herein defined as electrolytic pre-lithiation, using cost-efficient electrolytes based on lithium chloride (LiCl), is successfully demonstrated as a proof-of-concept for enabling lithium-ion battery full-cells with high silicon content negative electrodes. An electrolyte for pre-lithiation based on γ-butyrolactone and LiCl is optimized using boron-containing additives (lithium bis(oxalato)borate, lithium difluoro(oxalate)borate) and CO2 with respect to the formation of a protective solid electrolyte interphase (SEI) on silicon thin films as model electrodes. Reversible lithiation in Si||Li metal cells is demonstrated with Coulombic efficiencies (CEff ) of 95-96% for optimized electrolytes comparable to 1 m LiPF6 /EC:EMC 3:7. Formation of an effective SEI is shown by cyclic voltammetry and X-ray photoelectron spectroscopy (XPS). electrolytic pre-lithiation experiments show that notable amounts of the gaseous product Cl2 dissolve in the electrolyte leading to a self-discharge Cl2 /Cl- shuttle mechanism between the electrodes lowering pre-lithiation efficiency and causing current collector corrosion. However, no significant degradation of the Si active material and the SEI due to contact with elemental chlorine is found by SEM, impedance, and XPS. In NCM111||Si full-cells, the capacity retention in the 100th cycle can be significantly increased from 54% to 78% by electrolytic pre-lithiation, compared to reference cells without pre-lithiation of Si.

Advanced Dual-Ion Batteries with High-Capacity Negative Electrodes Incorporating Black Phosphorus.

Dual-graphite batteries (DGBs), being an all-graphite-electrode variation of dual-ion batteries (DIBs), have attracted great attention in recent years as a possible low-cost technology for stationary energy storage due to the utilization of inexpensive graphite as a positive electrode (cathode) material. However, DGBs suffer from a low specific energy limited by the capacity of both electrode materials. In this work, a composite of black phosphorus with carbon (BP-C) is introduced as negative electrode (anode) material for DIB full-cells for the first time. The electrochemical behavior of the graphite || BP-C DIB cells is then discussed in the context of DGBs and DIBs using alloying anodes. Mechanistic studies confirm the staging behavior for anion storage in the graphite positive electrode and the formation of lithiated phosphorus alloys in the negative electrode. BP-C containing full-cells demonstrate promising electrochemical performance with specific energies of up to 319 Wh kg-1 (related to masses of both electrode active materials) or 155 Wh kg-1 (related to masses of electrode active materials and active salt), and high Coulombic efficiency. This work provides highly relevant insights for the development of advanced high-energy and safe DIBs incorporating BP-C and other high-capacity alloying materials in their anodes.

Scalable Synthesis of MAX Phase Precursors toward Titanium-Based MXenes for Lithium-Ion Batteries.

MXenes have emerged as one of the most interesting material classes, owing to their outstanding physical and chemical properties enabling the application in vastly different fields such as electrochemical energy storage (EES). MXenes are commonly synthesized by the use of their parent phase, i.e., MAX phases, where "M" corresponds to a transition metal, "A" to a group IV element, and "X" to carbon and/or nitrogen. As MXenes display characteristic pseudocapacitive behaviors in EES technologies, their use as a high-power material can be useful for many battery-like applications. Here, a comprehensive study on the synthesis and characterization of morphologically different titanium-based MXenes, i.e., Ti3C2 and Ti2C, and their use for lithium-ion batteries is presented. First, the successful synthesis of large batches (≈1 kg) of the MAX phases Ti3AlC2 and Ti2AlC is shown, and the underlying materials are characterized mainly by focusing on their structural properties and phase purity. Second, multi- and few-layered MXenes are successfully synthesized and characterized, especially toward their ever-present surface groups, influencing the electrochemical behavior to a large extent. Especially multi- and few-layered Ti3C2 are achieved, exhibiting almost no oxidation and similar content of surface groups. These attributes enable the precise comparison of the electrochemical behavior between morphologically different MXenes. Since the preparation method for few-layered MXenes is adapted to process both active materials in a "classical" electrode paste processing method, a better comparison between both materials is possible by avoiding macroscopic differences. Therefore, in a final step, the aforementioned electrochemical performance is evaluated to decipher the impact of the morphology difference of the titanium-based MXenes. Most importantly, the delamination leads to an increased non-diffusion-limited contribution to the overall pseudocapacity by enhancing the electrolyte access to the redox-active sites.

Congenital Cranial Dysinnervation Disorder: An Unusual Phenotype With Multiple Cranial Neuropathies and Novel Neuroimaging Findings.

Congenital cranial dysinnervation disorders result from a maldevelopment of brainstem nuclei and/or cranial nerves. In some cases, specific genetic abnormalities have been identified. We expand the clinical phenotype of these disorders with the report of a 28-month-old girl who was initially evaluated for seizures and was found to have right sixth nerve palsy, small optic discs with reduced vision in her right eye. Her development was delayed. Brain MRI showed multiple abnormalities involving other cranial nerves, the optic chiasm and brainstem. Her developmental delay and seizure disorder suggest additional cortical involvement.

Epidemiology, Clinical Presentation, and Prognosis of Posterior Circulation Ischemic Stroke in Children.

BACKGROUND: Anterior and posterior circulation strokes are often different in terms of presentation and recurrence risk, but there are few studies that focused on posterior circulation stroke. METHODS: We performed a longitudinal retrospective study of children, birth to 18 years, with posterior circulation ischemic stroke at the Children's Hospital Winnipeg from January 1992 to December 2012. Clinical and radiological features and outcomes were collected using standardized tools. RESULTS: Of the 158 children with arterial ischemic stroke, 23 (14.5%) children, 21 non-neonates, and 11 males were identified. For posterior circulation ischemic stroke, mean crude incidence of 0.38 and crude mortality rate of 0.11 per 100,000 person-years was estimated. The crude total period prevalence rate for the study period was estimated as 8.1 per 100,000 children. Nonspecific symptoms before stroke presentation were present in 38% and impaired consciousness in 71%. Identifiable risk factors were present in two thirds: vasculopathy 24%, infection 19%, trauma 14%, and congenital heart disease 9.5%. Average Pediatric National Institutes of Health Stroke Scale score at presentation was 11. Poor outcome was noted in 45%. Outcome did not change significantly between 12 and 24 months. Aboriginal ethnicity (P = 0.01), high Pediatric National Institutes of Health Stroke Scale score (P = 0.001), bilateral infarction (P = 0.001), and large caliber artery territory infarction (P = 0.02) predicted poor outcome. CONCLUSIONS: Our hospital-based incidence and outcome data provide valuable information to help direct treatment strategies and prognosticate children with posterior circulation ischemic stroke. Our study calls for close observation and early management of children with posterior circulation stroke, in particular with aboriginal ancestry and bilateral and large artery territory infarction.

Lissencephaly with brainstem and cerebellar hypoplasia and congenital cataracts.

Classical lissencephaly may be associated with cerebellar hypoplasia and when significant cerebellar abnormalities occur, defects in proteins encoded by TUBA1A, RELN, and very-low-density lipoprotein receptor (VLDLR) genes have been reported. We present a neonate with a severe neurologic phenotype associated with hypotonia, oropharyngeal incoordination that required a gastric tube for feeding, intractable epilepsy, and congenital cataracts. Her brain magnetic resonance imaging (MRI) showed classical lissencephaly, ventriculomegaly, absent corpus callosum, globular and vertical hippocampi, and severe cerebellar and brainstem hypoplasia. She died at 6 weeks of age. No specific molecular diagnosis was made. This likely represents a previously undescribed genetic lissencephaly syndrome.

Arterial ischemic stroke in an adolescent with presumed perinatal ischemic stroke.

The risk of recurrent ischemic stroke after presumed perinatal stroke and the risk factors for such recurrence are rarely reported. Here, we present an adolescent with a history of presumed perinatal stroke who presented with arterial ischemic stroke recurrence at the age of 15 years. Hereditary thrombophilia screening performed at the time of his stroke recurrence demonstrated protein S deficiency. No evidence-based consensus guidelines on thrombophilia screening in children with presumed perinatal stroke exist, nor has the role of secondary prophylaxis been addressed. There is a risk of stroke recurrence after presumed perinatal stroke, and routine thrombophilia screening may identify those children who are at higher risk for recurrence and who might therefore benefit from secondary prophylaxis. Clear guidelines should be developed to standardize investigations and management of children with presumed perinatal ischemic stroke.

Ataxia-telangiectasia: atypical presentation and toxicity of cancer treatment.

BACKGROUND: The onset of progressive cerebellar ataxia in early childhood is considered a key feature of ataxia-telangiectasia (A-T), accompanied by ocular apraxia, telangiectasias, immunodeficiency, cancer susceptibility and hypersensitivity to ionizing radiation. METHODS: We describe the clinical features and course of three Mennonite children who were diagnosed with A-T following the completion of therapy for lymphoid malignancies. RESULTS: Prior to cancer therapy, all had non-progressive atypical neurological abnormalities, with onset by age 30 months, including dysarthria, dyskinesia, hypotonia and/or dystonia, without telangiectasias. Cerebellar ataxia was noted in only one of the children and was mild until his death at age eight years. None had severe infections. All three children were "cured" of their lymphoid malignancies, but experienced severe adverse effects from the treatments administered. The two children who received cranial irradiation developed supratentorial primitive neuroectodermal tumors of the brain, an association not previously described, with fatal outcomes. CONCLUSIONS: The range of neurological presentations of A-T is broad. Ataxia and telangiectasias may be minimal or absent and the course seemingly non-progressive. The diagnosis of A-T should be considered in all children with neuromotor dysfunction or peripheral neuropathy, particularly those who develop lymphoid malignancies. The consequences of missing the diagnosis may be dire. Radiation therapy and radiomimetic drugs should be avoided in individuals with A-T.

Recurrent posterior circulation stroke in an infant with basilar artery aneurysm.

Arterial ischemic stroke involving the posterior circulation is uncommon in children. The underlying etiologies and risk factors predisposing to posterior circulation stroke include vasculopathies, intracranial trauma, cardiac disease, infection, and hematologic disorders. However, in many children with posterior circulation stroke, the underlying mechanisms are poorly understood. We describe a 14-month-old infant with recurrent arterial ischemic stroke involving the posterior circulation secondary to an aneurysm of the basilar artery.