Selective Skeletal Surveys for Infants With Skull Fractures: Examining the Rates of Return to Medical Care for Concern of Physical Abuse.

OBJECTIVES: This study aimed to describe which infants with a skull fracture (1) receive a child abuse pediatrician (CAP) consultation, (2) receive a skeletal survey, and (3) re-present to medical care before age 3 years with concerns for physical abuse. METHODS: We conducted a retrospective chart review of infants younger than 12 months who presented to the emergency department between January 1, 2005, and December 30, 2015, with a skull fracture. Medical records were reviewed for the skull fracture presentation and for all future medical evaluations at the same institution with concerns for physical abuse until 3 years of age. RESULTS: Of 366 infants with a skull fracture, a CAP was contacted for 272 (74%) and 76 (20.8%) infants who received a skeletal survey. Factors associated with skeletal survey acquisition included younger age (<6 months), no history to explain the skull fracture, other injuries on examination, and social risk factors. Six children (1.6%) re-presented to medical care with concerns of physical abuse before age 3 years. Five of these infants did not have a skeletal survey at the time of their skull fracture, and 1 was likely a case of missed physical abuse at the time of the skull fracture. DISCUSSION: Most skull fractures in infancy occur accidentally, and a skeletal survey may not be necessary for every infant. Obtaining a thorough history including social risk factors, performing a complete physical examination, and consulting with a CAP is an effective first step in the evaluation of physical abuse in infants with skull fractures.

A versatile Agrobacterium-based plant transformation system for genetic engineering of diverse citrus cultivars.

Developing an efficient transformation system is vital in genetically engineering recalcitrant crops, particularly trees. Here, we outline an Agrobacterium tumefaciens-based stable plant transformation methodology for citrus genetic engineering. The process was optimized to suit the requirements of fourteen citrus varieties by establishing appropriate infection, co-cultivation, selection, and culture media conditions. The procedure includes transforming seedling-derived epicotyl segments with an A. tumefaciens strain, then selecting and regenerating transformed tissues. Transgenic shoots were further identified by a visual reporter (e.g., ß-glucuronidase) and confirmed by Northern and Southern blot analysis. Transgene integrations among the transgenic lines ranged between one to four. The methodology can yield transformation efficiencies of up to 11%, and transgenic plants can be recovered as early as six months, depending on the variety. In addition, we show that incorporating A. tumefaciens helper virulence genes (virG and virE), spermidine, and lipoic acid in the resuspension buffer before transformation improved the transformation efficiency of specific recalcitrant cultivars, presumably by enhancing T-DNA integration and alleviating oxidative stress on the explant tissues. In conclusion, the optimized methodology can be utilized to engineer diverse recalcitrant citrus varieties towards trait improvement or functional genetics applications.

Cachexia and Invisible Stomach on Endoscopy: An Endoscopist's Enigma and a Surgeon's Axiom.

Gastroduodenal intussusception (GDI) is a very rare clinical entity in adults. GDI can present acutely or chronically in adults with varying spectrum of symptoms and signs. GDI can present acutely with abdominal pain, vomiting and palpable mass. In rare instances it can lead to anemia and cachexia. Computed tomography (CT) of the abdomen can demonstrate GDI in majority of cases. However, endoscopy findings could lead to identifying etiological factor and tissue diagnosis. In majority of the cases endoscopy may show mucosal or submucosal lesion leading to GDI. We bring forward a case of GDI wherein patient presented with cachexia, intermittent vomiting along with anemia. Further workup including imaging has resulted in the rare diagnosis of GDI. Interestingly we encountered a rare of its kind, endoscopic presentation where there was total absence of stomach due to its complete invagination through the pylorus into the duodenum arising from a giant gastric hyperplastic polyp. We have successfully managed this patient with surgical intervention leading to positive clinical outcomes. On review of literature, we found that it is extremely rare to have a completely absent stomach on endoscopy in a patient with no previous surgical intervention. We would like to share our experience so that endoscopists are aware of such uncommon and interesting presentations. To the best of our knowledge, such a case has not been reported so far in literature.

Poststroke exercise is as effective as skilled rehabilitation: Effects in young and aged mice.

Stroke is a leading cause of long-term disability, though current rehabilitative strategies fail to yield complete recovery. Focused training of the impaired limb improves functional outcome in rodents, but these strategies require intensive training that is difficult to practice in humans. Because aerobic exercise has been found to induce beneficial changes in the brain, it is a promising rehabilitative strategy after stroke. The current study investigated the effect of voluntary poststroke aerobic exercise on functional outcome in young and aged mice. Mice were trained on a skilled reaching task before receiving focal ischemic stroke and being subdivided into 3 different groups for rehabilitative training: traditional skilled reach rehabilitation, aerobic exercise, and control procedures. Both young and aged mice benefited from aerobic exercise after stroke, though the behavioral profile somewhat differed. Aerobic exercise in young mice yielded poststroke performance levels that were equivalent to preinjury levels. In aged mice, aerobic exercise accelerated improvement in motor performance without an effect on the absolute level of performance compared with controls. Our results suggest that aerobic exercise may be an effective alternative or adjunctive rehabilitative strategy after stroke. Potential mechanisms of this effect need to be further investigated. (PsycINFO Database Record (c) 2018 APA, all rights reserved).