Ultrasound Accuracy in Diagnosing Appendicitis in Obese Pediatric Patients.

The use of ultrasound to diagnose appendicitis in pediatric patients has been growing with the improvement of ultrasound technology and operator skills, but its utility in the increasingly obese pediatric population has not been thoroughly investigated. A retrospective review of all pediatric (≤18 years old) patients with appendicitis who were admitted at a single hospital from 2014 to 2016 was conducted. Patients were stratified into body mass index (BMI) percentile categories based on the centers for disease control guidelines. Comparisons were then made. There were 231 patients with an average BMI percentile of 72.6; 99 (42.9%) who had an ultrasound, of which 54 (54.5%) were positive for acute appendicitis, whereas 43 (43.4%) were nondiagnostic. In patients who had a nondiagnostic ultrasound, 37 had a CT demonstrating acute appendicitis. These were compared with 123 patients who had CT alone demonstrating acute appendicitis. The CT-only group was older (12 vs 9, P < 0.005), tended to be male (78 (63%) vs 15 (41%), P = 0.019), had fewer operations performed (81 (66%) vs 30 (81%), P = 0.048) but had no significant difference in BMI percentile (75.8 vs 71.7, P = 0.465). Ultrasound had a 100 per cent positive predictive value in obese and overweight children. Ultrasound is a reliable study in obese and overweight pediatric patients with acute appendicitis.

Anatomy and physiology predict response to motor cortex stimulation after stroke.

OBJECTIVES: Preclinical studies found that epidural motor cortex stimulation improved motor deficits after stroke, but a phase III trial in humans did not corroborate these results. The current retrospective analysis examined subjects randomized to stimulation in order to identify features distinguishing responders from nonresponders. METHODS: Anatomic (MRI measures of gray matter thickness and of white matter tract injury) and physiologic methods (motor evoked responses) were examined as predictors of treatment response. RESULTS: Among 60 subjects randomized to cortical stimulation, both anatomic and physiologic measures at baseline predicted behavioral response to therapy. Anatomically, those achieving the primary efficacy endpoint had a smaller fraction of the corticospinal tract injured by stroke compared to those who did not (44% vs 72%, p < 0.04), and rarely had severe tract injury. Physiologically, the primary efficacy endpoint was reached more often (67%) by those with preserved motor evoked responses (MER) upon cortical stimulation compared to those lacking MER (27%, p < 0.05). Those with an elicitable MER also had a lower rate of precentral gyrus injury (0% vs 33%, p < 0.05) by stroke, as compared to those lacking MER, and had higher gray matter volume compared to those lacking MER in regions including ipsilesional precentral gyrus. CONCLUSIONS: In this clinical stroke trial, the more that the physiologic integrity of the motor system was preserved, the more likely that a patient was to derive gains from subsequent therapy, consistent with preclinical models. Functional and structural preservation of key brain substrates are important to deriving gain from a restorative therapy.

A system for addressing incidental findings in neuroimaging research.

When healthy subjects undergo brain imaging, incidental findings are not rare. The optimal response to such findings has been the focus of considerable discussion. The current report describes the operations and results of a system that provides a review of incidental findings by an appropriate medical professional. A web-based system was created whereby investigators performing brain MRI scans on healthy subjects could refer images with suspected concerns to a board certified radiologist who had a Certificate of Added Qualification in Neuroradiology. The specific details of this system are described. Among 27 scans suspected by an investigator of having a significant finding, all but one were referred by a researcher with a PhD. The most common concerns described by these investigators were for the possible presence of a cyst or of enlarged ventricles. The most common findings reported by the radiologist were Virchow-Robin spaces and cysts. Findings were generally of low clinical significance, with 1 major exception. Identifying the optimal response to incidental findings in neuroimaging research remains a challenge. The current report describes a system for providing expert assistance and so addresses these issues in the setting of suspected incidental findings. To our knowledge the current system is the first to provide a specific means for evaluation of incidental findings in neuroimaging research.