Multicenter retrospective evaluation of magnetic resonance imaging in pediatric and congenital heart disease patients with cardiac implantable electronic devices.

BACKGROUND: Guidelines addressing magnetic resonance imaging (MRI) in patients with cardiac implantable electronic devices (CIEDs) provide algorithms for imaging pediatric and congenital heart disease (CHD) patients. Guideline acceptance varies by institution. Guidelines also do not support routine MRI scans in patients with epicardial or abandoned leads, common in pediatric and CHD patients. OBJECTIVE: The purpose of this study was to determine the incidence of MRI-related complications in pediatric and CHD patients with CIEDs, including epicardial and/or abandoned leads. METHODS: A multicenter retrospective review included patients with CIEDs who underwent any MRI between 2007 and 2022 at congenital cardiac centers. The primary outcome was any patient adverse event or clinically significant CIED change after MRI, defined as pacing lead capture threshold increase >0.5 V with output change, P- or R- wave amplitude decrease >50% with sensitivity change, or impedance change >50%. RESULTS: Across 14 institutions, 314 patients (median age 18.8 [1.3; 31.4] years) underwent 389 MRIs. There were 288 pacemakers (74%) and 87 implantable cardioverter-defibrillators (22%); 52% contained epicardial leads, and 14 (4%) were abandoned leads only. Symptoms or CIED changes occurred in 4.9% of MRI scans (6.1% of patients). On 9 occasions (2%), warmth or pain occurred. Pacing capture threshold or lead impedance changes occurred in 1.4% and 2.0% of CIEDs post-MRI and at follow-up. CONCLUSION: Our data provide evidence that MRIs can be performed in pediatric and CHD patients with CIEDs, including non-MRI-conditional CIEDs and epicardial and/or abandoned leads, with rare minor symptoms or CIED changes but no other complications.

What the Evidence Does (and Does Not) Show for the Centers for Disease Control and Prevention Child Development Milestones: An Illustrative Example Using Expressive Vocabulary.

PURPOSE: Child development milestones are a critical tool for pediatricians and caregivers to use for developmental surveillance. Following review and selection by a panel of subject matter experts, the Centers for Disease Control and Prevention (CDC) published a revised list of milestones across multiple domains of development. Using expressive vocabulary, a key indicator of language development, as an illustrative example, the purpose of this brief review is to evaluate the evidence used to establish the CDC developmental milestones and determine whether the samples used to establish these milestones are representative of U.S. children. METHOD: Authors reviewed the methods and evidence cited to determine the CDC milestones. First, authors identified each language/communication milestone that measured expressive vocabulary as number of words, followed by review of the sources cited in support of each extracted milestone. Then, data related to both milestones and sample characteristics were extracted and compiled as well as compared with data from a validated parent report measure of expressive vocabulary, the MacArthur-Bates Communication Development Inventories. RESULTS: Results indicated that evidence was conflicting, misaligned, or missing for the selected CDC expressive vocabulary milestones. This review also indicated that the samples used to determine the selected CDC expressive vocabulary milestones are not representative of U.S. children. CONCLUSION: The striking paucity of evidence supporting the new CDC milestones for expressive vocabulary illustrates the critical need for future research in this area to establish more accurate milestones for U.S. children, with a focus on culturally inclusive large-scale data.

Removing obstacles for African American English-speaking children through greater understanding of language difference.

Language difference among speakers of African American English (AAE) has often been considered language deficit, based on a lack of understanding about the AAE variety. Following Labov (1972), Wolfram (1969), Green (2002, 2011), and others, we define AAE as a complex rule-governed linguistic system and briefly discuss language structures that it shares with general American English (GAE) and others that are unique to AAE. We suggest ways in which mistaken ideas about the language variety add to children's difficulties in learning the mainstream dialect and, in effect, deny them the benefits of their educational programs. We propose that a linguistically informed approach that highlights correspondences between AAE and the mainstream dialect and trains students and teachers to understand language varieties at a metalinguistic level creates environments that support the academic achievement of AAE-speaking students. Finally, we present 3 program types that are recommended for helping students achieve the skills they need to be successful in multiple linguistic environments.

Angioleiomyomas of the dura: rare entities that lack KRIT1 mutations.

Angioleiomyomas (ALMs) are cutaneous and soft tissue lesions usually seen in the lower extremities of middle-aged women. The lesions are nodular, mulberry like, and composed of vessels of varying size with abundant intervening smooth muscle; an arterial component is absent. Intracranial examples are exceedingly rare, with <10 cases reported to date, and are usually dural in location. We report the case of 2 young men with dural ALMs: one infratentorial and located near the incisura and the second falcine, posterior to the splenium. Both patients came from the same medium-size community in southern Colorado with a known high incidence of a Hispanic population at risk for familial cavernous cerebral hemangiomas (fCCMs). Both presented within a month of each other with greater than 8-year histories of headaches; preoperative and intraoperative diagnoses were cerebral cavernous malformation (CCM) or vascular meningioma. Histologically, both had discrete lesions composed of large cavernous channels lined by a single layer of cytologically bland endothelium and surrounded by mature, smooth muscle of varying thickness that was orderly near the lumen, more disorganized in intervening areas, and immunoreactive for smooth muscle actin (SMA), muscle-specific actin, and vimentin but not for desmin. Concentric whorls of SMA/CD34 cells were a distinctive feature. We posited that there might be a relationship between dural ALMs and CCMs and undertook polymerase chain reaction-based mutational analysis for the single common mutation seen in Hispanics with familial cavernous cerebral hemangiomas, that is, c.1363C>T KRIT1. Testing proved negative, despite the fact that 1 patient was of strong Hispanic heritage. We concluded that dural ALMs are easily clinically mistaken for CCMs or meningiomas but are not of similar histopathogenesis.