Akron Children's Hospital (ACH) is a pediatric acute care hospital in Northeast Ohio that provides care to infants, children, adolescents, young adults, aged 0–21 and even some older adults.
Stimulus size and cognitive demand have previously been used to elicit changes in accommodation and pupil size, but their separate effects remain unclear. This study assessed how target size (6/15, 6/30) and cognitive demand (passive or active viewing) impact accommodation and pupil size. Twenty-three children (mean age = 8.3±3.1 years) and 21 adults (mean age = 22.2±3.9 years) with age-normal visual acuity viewed 6/15 or 6/30 sized numbers monocularly. In passive conditions, participants were asked to simply look at the numbers, whereas in active conditions, participants silently added sets of numbers. Children who were too young to add answered questions about the numbers. Accommodation and pupil size were measured continuously at 50 Hz using the PowerRef 3. A repeated-measures analysis of variance with factors of age group (children, adults), cognition (passive, active) and stimulus size (6/15, 6/30) was performed on accommodative measurements and pupil size. Accommodative measurements were significantly greater in active than passive conditions (p = 0.005), but this effect was only observed in children (p < 0.001). Pupil size was significantly larger during active than passive viewing conditions across both age groups (p < 0.001). Stimulus size did not modulate accommodation or pupil size significantly (p > 0.05). Cognitive demand, but not stimulus size, increased accommodation in children in the present study. These findings suggest that task instruction can significantly impact accommodation, but, relative to larger targets, smaller targets may not be associated with greater accommodative measurements in clinical or research settings.
Prospective, multi-institutional surgical data collection in pediatric neuro-oncology remains limited despite substantial variation in operative and perioperative management across institutions. To address this, we are developing the NeuroPoint Alliance (NPA) Quality Outcomes Database (QOD) Pediatric Tumor Surgery Registry. Here, we used a modified Delphi process to define a core outcome set for the registry. A modified Delphi study was conducted among pediatric neurosurgeons serving as site principal investigators for the proposed registry. Candidate data elements were rated on a 9-point Likert scale. Consensus for inclusion was predefined as ≥70
To compare the outcomes of three sequential surgical techniques used over time for posterior spinal fusion (PSF) in adolescent idiopathic scoliosis (AIS) patients with Lenke 1 2 curves. Three sequential cohorts of Lenke 1 2 AIS patients who underwent PSF between 2008 and 2021 were retrospectively identified. Surgical technique, including concave rod derotation (T1), concave en bloc reduction (T2), or convex-first differential rod contouring technique (T3), was recorded. Preoperative, intraoperative, and minimum 2-year postoperative variables were compared. Ninety-three Lenke 1 2 AIS patients were evaluated: 30 T1, 25 T2, and 38 T3. No significant differences were noted in demographics or preoperative radiographic measurements. The T3 group utilized higher implant density and more posterior column osteotomies (PCOs). Postoperatively, there was equivalent coronal correction index in all three cohorts. T3 resulted in significantly improved sagittal plane parameters, including final T5-T12 kyphosis (16.8° vs. 13.3° vs. 20.8° p = 0.011), final T2-T12 kyphosis (19.9° vs. 18.8°, 27.0° p = 0.033), delta T2-T12 kyphosis (-1.0° vs. -6.7° vs.1.5° p = 0.005), and delta 3D kyphosis (14.1° vs. 10.5° vs. 15.8° p = 0.034). Significant covariates of postoperative T5-T12 kyphosis included preoperative 3D kyphosis (p = < 0.001) and number of PCOs (p = 0.002). There were no differences in complications, readmissions, or unplanned reoperations. Practice evolution using a recent technique, specifically the convex-first differential rod reduction technique (T3), results in superior restoration of thoracic kyphosis compared to older concave rod derotation (T1) or concave en bloc reduction (T2) techniques for Lenke 1 2 AIS patients.
OBJECTIVE:To assess the 2022 American College of Rheumatology (ACR)/EULAR classification criteria for antineutrophil cytoplasmic antibody-associated vasculitis (AAV) in children with chronic small-to-medium vessel vasculitis. METHODS:A cohort of 574 patients, identified by physician's diagnosis (MD-diagnosis) in A Registry of Childhood Vasculitis, was classified by computation of registry data as having granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), or eosinophilic GPA after applying (1) ACR/EULAR AAV criteria and (2) pediatric-adapted European Medicines Agency (Ped-EMA) classification algorithm (incorporating Ankara GPA criteria). Venn diagrams compared the resulting GPA and MPA cohorts with MD-diagnosis. Sensitivity and specificity of criteria for GPA were evaluated against MD-diagnosis. Fisher exact test evaluated differences in the frequencies of individual clinical features in GPA versus MPA. RESULTS:Comparing ACR/EULAR criteria against the Ped-EMA algorithm for classifying AAV, more patients were classified as GPA or MPA (n = 396 vs 360, respectively), fewer had GPA (n = 261 vs 288, respectively), more had MPA (n = 135 vs 72, respectively), and fewer GPA cases coclassified as MPA (12% vs 28%, respectively); there were more differences between GPA and MPA in Pediatric Vasculitis Activity Score-defined clinical features (n = 14 vs 10, respectively). When classifying GPA by ACR/EULAR or Ankara criteria, sensitivity (74.5% vs 72.1%, respectively) was comparable, and specificity for ACR/EULAR criteria (93.9% vs 79.9%, respectively) was improved. CONCLUSION:The 2022 ACR/EULAR classification criteria for AAV perform at least as well as previous pediatric criteria and provide categorical MPA criteria where none existed previously; the criteria for GPA and MPA now specifically differentiate each other, with more differences between them in the frequencies of clinical features. Our findings support the preferential use of ACR/EULAR over Ankara criteria for GPA in pediatrics.
Previous studies have demonstrated poor outcomes in pediatric patients with H3 G34-mutant diffuse hemispheric glioma (DHG). However, the biological basis for this therapeutic resistance remains poorly understood. Furthermore, the effectiveness of temozolomide (TMZ) and the role of surgery in pediatric patients remain uncertain. Therefore, we performed a multi-institutional retrospective analysis of the clinical, imaging, and molecular characteristics of 36 pediatric (≤ 18 years) patients with newly diagnosed H3 G34-mutant DHG. The median age of the cohort was 14 years (8–18 years). The median progression-free survival (PFS) was 0.7 years (95
