Unsafe at any speed--kids riding all-terrain vehicles

Background

All-terrain vehicle (ATV) sales have climbed 89% in the last 5 years. We sought to determine if pediatric ATV accidents have increased in frequency and morbidity.

Methods

Medical records of children treated in our emergency unit for ATV accidents from 1993 to 2003 were reviewed. The 11 years were divided into 2 periods, January 1993 to June 1998 and July 1998 to December 2003, to allow comparisons and analysis of trends over time.

Results

We treated 184 children, with 90% requiring admission. Comparing the first and second halves of the study, patients treated increased from 8.7 ± 4.8 (mean ± SD) to 24.5 ± 11.1 per year (P < .01), patients requiring immediate operation increased from 4 (9%) of 44 to 24 (17%) of 140, and patients with serious injuries (resulting in direct intensive care unit admission, immediate operation, or death) rose from 12 (27%) of 44 to 51 (36%) of 140. Patient age was 11.5 ± 3.9 years. Sixty-eight percent of the children sustained multiple injuries and 50% required surgery. Only 35% of the children wore helmets.

Conclusion

Over the 2 periods, there was a significant increase in number of patients treated, and considerable increases in serious injuries, and need for immediate operation. Despite inherent risks with riding ATVs, helmet use and patient age were remarkably low.     

Update in the management of patients with hormone-refractory prostate cancer

PURPOSE OF REVIEW: 2004 was a critical year for advances in prostate cancer treatment. The results from two pivotal multicenter phase III randomized studies are the first to demonstrate a survival benefit associated with chemotherapeutic treatment interventions in patients with hormone-refractory prostate cancer. This review will focus on an interpretation of the data from these two studies, the emerging role for chemotherapy in 2005 and beyond, and ongoing areas of clinical research. RECENT FINDINGS: Phase I and II studies have demonstrated biochemical and objective responses achieved with docetaxel-based chemotherapy in men with hormone-refractory prostate cancer. Two pivotal phase III clinical trials, TAX 327 and SWOG 9916 have demonstrated a survival advantage of docetaxel-based chemotherapy over mitoxantrone. Novel targeted therapies under investigation include calcitriol, growth factor-targeted agents, epothilones and others. SUMMARY: We now have a new standard of care for men with metastatic hormone-refractory prostate cancer. Further investigation of docetaxel-based regimens in earlier clinical states of disease is warranted and may demonstrate greater clinical benefit. Additional chemotherapy agents are being studied, and may also add to the future armamentarium available for prostate cancer. The enrolment of patients into these studies is critical to the ongoing evolution of prostate cancer management.     

Measurement of vasoactive intestinal peptide using a competitive fluorescent microsphere immunoassay or ELISA in human blood samples

The concentration of Vasoactive Intestinal Peptide (VIP) as measured by recycling immunoaffinity chromatography (RIC) has been reported to be elevated in the blood of patients with autism as compared with normal subjects. In this study, we have developed a “Competitive Fluorescent Microsphere Immunoassay” (cFMI) in which VIP competes with biotinylated VIP in binding to polyclonal antibodies on microspheres. The results were obtained using the Luminex¹⁰⁰ system. We measured VIP in serum, plasma, and material eluted from dried blood spots on filter paper with both the cFMI and an ELISA procedure. We found that a purification procedure was necessary for obtaining useful results from plasma and serum, however, a preincubation step was required with the blood eluates. This newly developed cFMI was more sensitive (2.5 vs. 20.0 pg/ml), and more reproducible than the ELISA. To get accurate measurements of VIP in eluted material high sensitivity is especially important. Thus, the cFMI using the Luminex system has definite advantages over a conventional ELISA including the possibility that samples can be assayed at higher dilutions. We have determined that the VIP concentrations of serum, plasma, and dried blood spot eluate specimens as measured with the cFMI assay system were similar to those measured with ELISA. Thus, the new cFMI using Luminex system may be useful for detection of VIP in human blood samples.     

Exposure to violence and parenting as mediators between poverty and psychological symptoms in urban African American adolescents

The present study builds on past research that has found support for a conceptual model in which poverty is linked with adolescent psychological symptoms through economic stressors and impaired parenting. The present study examined this model in a sample of urban African American mothers and their adolescent children. In addition, an alternative hypothesis was examined: that exposure to community violence mediates the relation between poverty and psychological symptoms in urban youth. Limited support was found for a model in which poverty is linked with internalizing symptoms through exposure to community violence and with externalizing symptoms through economic stressors and inconsistent discipline. Interpretations, limitations, and directions for future research are outlined.     

Video Analysis of Sensory-Motor Features in Infants with Fragile X Syndrome at 9–12 Months of Age

This study utilized retrospective video analysis to distinguish sensory-motor patterns in infants with fragile X syndrome (FXS) (n=11) from other infants [i.e., autism (n=11), other developmental delay (n=10), typical (n=11)] at 9–12 months of age. Measures of development, autistic features, and FMRP were assessed at the time of entry into the study. Home videos collected from families were edited and coded with previously validated procedures. Findings revealed a pattern of sensory-motor features (e.g., repetitive leg movements, posturing, less sophistication/repetitive use of objects) associated with FXS, and suggest these infants were most similar to the group of infants with other developmental delays, irrespective of co-existing autistic symptoms later in life. Infant sensory-motor features in the FXS group were more predictive of an early developmental milestone (i.e., age walking) than later, more broad, developmental outcomes, or FMRP. Implications for early identification and differential diagnosis are discussed. An erratum to this article can be found at     

Tuberous sclerosis complex in a young woman diagnosed incidentally on the basis of pregnancy ultrasonography

Tuberous sclerosis complex (TSC) is more prevalent than previously believed and most cases result from new mutations and, hence, do not have affected relatives. Many patients who meet the new diagnostic criteria have unrecognized skin lesions and/or occult lesions in internal organs. As early diagnosis and appropriate intervention can reduce morbidity and mortality from the neurologic. renal, and pulmonary complications of TSC, physicians should be alert for the dermatological signs of the condition and for the incidental finding of TSC lesions during diagnostic testing. Patients with TSC may be asymptomatic and of normal intelligence. We report a case of TSC diagnosed by the incidental finding of renal lesions in a young woman during pregnancy ultrasonic examination.     

Folk pharmaceutical knowledge in the territory of the Dolomiti Lucane, inland southern Italy

An ethnopharmacognostic survey on the traditional pharmaceutical knowledge (TPhK) of old and newly introduced natural remedies used for healing humans in a small mountainous area in Central Lucania, inland southern Italy, was carried out using classical ethnographical and ethnobiological methods. Approximately 110 remedies of plant origin (belonging to 103 botanical taxa), 30 of animal origin and 20 mineral or industrial (non-pharmaceutical) products were recorded. Among these remedies, the common use of the aerial parts of Hypericum hircinum and the leaves of Morus alba against cough, and the uncommon uses of Salvia argentea leaves as a haemostatic, of Erigeron acer roots to relieve tooth-aches and arthritic pains, and Elaphe quatuorlineata snake fat for rheumatism are reported for first time in Italy. Moreover, diverse medicinal plants used for uncommon medical purposes and a few biological ingredients used in food preparations with the aim to improve human health were identified. Pharmacological and toxicological considerations relating to possible applications of the recorded traditional knowledge in modern evidence-based medicine are discussed as well. The data that we present here could suggest new inputs for further phytochemical and pharmacological studies among Mediterranean folk pharmacopoeias, and also for sustaining environmentally integrated projects focused on of the maintenance of TPhK via breeding or controlled gathering activities of local medicinal species.