Contribution of caregiver and child anxiety and depressive symptoms to child asthma-related quality of life.

BACKGROUND: Depression and anxiety negatively affect asthma-related quality of life (QoL). Yet, little is known regarding mood and asthma-related factors that best uniquely explain asthma-related QoL in children. OBJECTIVE: This cross-sectional study evaluated the unique variance explained by caregiver and child depressive and anxiety symptom severity in child asthma-related QoL, apart from that explained by demographics and asthma control. METHODS: Children aged 7 to 17 years with asthma (n = 205) and their caregivers with major depressive disorder were included. A 3-stage hierarchical linear regression analysis was conducted with the Pediatric Asthma Quality of Life Questionnaire total scores considered as the outcome. Predictors included demographic characteristics (stage 1); asthma control assessed by the Asthma Control Test (stage 2); and caregiver depression and anxiety (Hamilton Rating Scale for Depression and the Spielberger State/Trait Anxiety Scale) and child depression and anxiety (Children's Depression Inventory and the Screen for Child Anxiety-Related Disorders) (stage 3). RESULTS: Demographic characteristics accounted for only 5.5% of the Pediatric Asthma Quality of Life Questionnaire scores. Asthma control significantly increased variance explained in QoL to 32.6%, whereas caregiver and child depression and anxiety symptoms significantly increased variance explained to 42.6%. Child anxiety was found to uniquely explain the largest proportion of variance in QoL (rs2 = 0.584). CONCLUSION: After adjusting variance in QoL for demographic characteristics and asthma control, caregiver and child depression and anxiety measures significantly increased the proportion of variance explained in a child's asthma-related QoL. In addition to better asthma control, child and caregiver depression and anxiety should be addressed to increase child asthma-related QoL. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02809677.

Sensitivity and Specificity of the ImPACT Neurocognitive Test in Collegiate Athletes and US Military Service Academy Cadets with ADHD and/or LD: Findings from the NCAA-DoD CARE Consortium.

BACKGROUND AND OBJECTIVE: Computer-based neurocognitive tests are widely used in sport-related concussion management, but the performance of these tests is not well understood in the participant population with attention-deficit/hyperactivity disorder (ADHD) and/or learning disorder (LD). This research estimates the sensitivity and specificity performance of the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) computer-based neurocognitive test in identifying concussion in this population. METHODS: Study participants consisted of collegiate university athletes and military service academy cadets from the National Collegiate Athletic Association-Department of Defense CARE Consortium who completed the ImPACT test between 2014 and 2021. Participants who self-identified as belonging to one of the subgroups of interest (ADHD with or without LD [ADHD:LD+/-], LD with or without ADHD [LD:ADHD+/-], ADHD and/or LD [ADHD a/o LD]) and completed a baseline (1874 ADHD:LD+/-, 779 LD:ADHD+/-, 2338 ADHD a/o LD) or 24-48 h post-concussion (175 ADHD:LD+/-, 77 LD:ADHD+/-, 216 ADHD a/o LD) ImPACT assessment were included. Sensitivity and specificity were calculated using a normative data method and three machine learning classification methods: logistic regression, classification and regression tree, and random forest. RESULTS: Using the four methods, participants with ADHD:LD+/- had sensitivities that ranged from 0.474 to 0.697, and specificities that ranged from 0.538 to 0.686. Participants with LD:ADHD+/- had sensitivities that ranged from 0.455 to 0.688, and specificities that ranged from 0.456 to 0.588. For participants with ADHD a/o LD, sensitivities ranged from 0.542 to 0.755, and specificities ranged from 0.451 to 0.724. CONCLUSIONS: For all subgroups and analytical methods, the results illustrate sensitivity and specificity values below typically accepted levels indicative of clinical utility. These findings support that using ImPACT alone may be insufficient to inform concussion diagnoses and encourages the use of a multi-dimensional concussion assessment.

Inadvertent parathyroidectomy: incidence, risk factors, and outcomes.

BACKGROUND: Parathyroid glands are ≤5 mm, often subcapsular or intrathyroidal, and obscured by lymph nodes, making preservation a challenge. The purpose of this study was to determine the incidence of inadvertent parathyroidectomy (IP) and whether it contributes to hypoparathyroidism after thyroidectomy. MATERIALS AND METHODS: A retrospective review of all thyroidectomies by a single surgeon from January 2010 to August 2014 was completed to determine the rate of IP and permanent hypoparathyroidism. Medical records were assessed for demographics, extent of thyroidectomy, central compartment neck dissection, thyroid gland weight, parathyroid autotransplantation, reoperation, pathology, postoperative calcium levels, and number of parathyroid glands removed. RESULTS: A total of 386 patients underwent thyroidectomy. Mean age was 52 y, and 327 (85%) patients were women. There were 25 (7%) patients who underwent reoperation, 40 (10%) who underwent central compartment neck dissection, and 128 (33%) who underwent parathyroid autotransplantation. IP occurred in 78 (20%) patients. Permanent hypoparathyroidism occurred in 7 (2.7%) of 258 patients after total or completion thyroidectomy, four (6.7%) with IP compared with three (1.5%) without IP (P = 0.033). Logistic regression analysis revealed that female gender (odds ratio = 2.768, P = 0.040), central compartment neck dissection (odds ratio = 9.584, P = 0.001), and thyroid gland weight (odds ratio = 0.994, P = 0.022) were independent factors associated with IP. CONCLUSIONS: IP, which occurred in 20% of patients undergoing thyroidectomy, is a potentially remediable factor associated with a higher rate of hypoparathyroidism. Central compartment neck dissection is an independent risk factor for IP.

Choriocarcinoma of the adrenal gland: A case report.

INTRODUCTION: Non-gestational, extragonadal choriocarcinoma is a rare clinical entity. PRESENTATION OF CASE: Herein, we report a 56 year old woman who presented with an incidental adrenal mass and was diagnosed with a non-gestational choriocarcinoma of the adrenal gland as the sole site of disease. DISCUSSION: To our knowledge, this is the first case of an ectopic primary adrenal choriocarcinoma. A metastasis from a primary tumor that completely regressed or that could not be identified is an alternate explanation. CONCLUSION: It should be recognized that choriocarcinoma can affect the adrenal gland and it should be considered as a rare cause for an adrenal incidentaloma.

Diagnosis of infection after splenectomy for trauma should be based on lack of platelets rather than white blood cell count.

BACKGROUND: There is a lack of evidence-based criteria to assist the diagnosis of infection following trauma splenectomy (TS). However, the literature suggests that white blood cell count (WBC) is associated with infection in patients who undergo TS. We sought to find whether there exist key differences in laboratory and clinical parameters that can assist the diagnosis of infection after TS. METHODS: We evaluated all consecutive trauma patients who had undergone TS at a Level 1 trauma center from 2005 to 2011 for the development of infection. To do this, we compared the values of demographic, laboratory, and clinical variables of infected and non-infected patients on odd post-operative days (POD) in the period from 1-15 days after TS. RESULTS: Of 127 patients who underwent TS, 25 died within 48 h after the procedure and were excluded from our analysis, leaving, 102 patients for investigation. In the 41 (40%) patients who developed an infection, the mean day for the first infectious episode was POD 7 (range, POD 4-14). The three most common infections were pneumonia (51%), urinary tract infection (24%), and bacteremia (20%). An evaluation of laboratory and clinical parameters showed no differences in the WBC of the patients who did and did not develop infections at any time in the 15 d after TS. However, the platelet count was statistically significantly higher in non-infected patients on POD 3-9 and on POD 13, and maximal body temperature was statistically significantly higher in the infected group of patients during the first week after TS. Differences in laboratory and clinical values of the infected and non-infected patients were greatest on POD 5. CONCLUSIONS: Patients who undergo TS have high rates of infectious complications. The WBC is not a reliable predictor of infection in these patients in the 2 wks following TS. However, patients who do not develop infection after TS have statistically significantly higher absolute platelet counts and rates of change in their daily platelet counts than those who develop infection.

The Lgr5 transgene is expressed specifically in glycinergic amacrine cells in the mouse retina.

Retinal amacrine cells are a diverse set of interneurons within the inner nuclear layer. The canonical Wnt pathway is highly active within mature amacrine cells, but its role remains unclear. Leucine-rich repeat containing G-protein receptor 5 (Lgr5) is a newly identified component of the Wnt receptor complex that potentiates beta-catenin signaling. In multiple epithelial organs Lgr5 marks adult tissue stem cells. We investigated the expression of this gene using Lgr5-eGFP-IRES-CreER transgenic reporter mice. In the eye, Lgr5 was exclusively expressed in glycinergic amacrine cells in adult mice. Amacrine cells are post-mitotic and represent the first neuronal and non-stem cell lineage to express Lgr5. We further interrogated the spatiotemporal labeling of individual amacrine cells with controlled fluorophore expression. This "fluorofilling" technique provides a tool to study amacrine morphology and dissect neural networks.

Anterior abdominal stab injury: a comparison of self-inflicted and intentional third-party stabbings.

BACKGROUND: There is minimal literature comparing self-inflicted (SI) with non-self-inflicted (NSI) anterior abdominal stab wounds (AASW). METHODS: Adult patients treated at a level 1 trauma center from 2006 through 2011 with an AASW were reviewed. RESULTS: There were 215 patients with an AASW; 20% were SI. NSI patients had more nonabdominal injuries (47% vs 16%, P < .01) and disposition directly to the operating room (45% vs 26%, P = .02). Intra-abdominal injury rates were similar. One hundred twenty-eight patients had isolated AASWs; 28% were SI. SI patients had higher admission rates (86% vs 63%, P = .01). One hundred three patients had isolated stable/asymptomatic AASWs; 31% were SI. SI patients had more admissions (84% vs 52%, P < .01), had higher intensive care unit admission rates (23% vs 5%, P = .01), longer LOS (3.2 vs 1.4, P < .01), and higher hospital charges ($18,000 vs $11,000, P < .01). The rates of intra-abdominal injury were again similar. CONCLUSIONS: Controlling for extra-abdominal injuries, SI AASW patients have similar rates of intra-abdominal injury but use more resources.