Multidimensional biomarker predicts disease control in response to immunotherapy in recurrent or metastatic head and neck squamous-cell carcinoma.

Purpose: Anti-PD-1 therapy provides clinical benefit in 40-50% of patients with relapsed and/or metastatic head and neck squamous cell carcinoma (RM-HNSCC). Selection of anti- PD-1 therapy is typically based on patient PD-L1 immunohistochemistry (IHC) which has low specificity for predicting disease control. Therefore, there is a critical need for a clinical biomarker that will predict clinical benefit to anti-PD-1 treatment with high specificity.

The clinical and economic impact of cytomegalovirus infection in recipients of hematopoietic stem cell transplantation.

Background: CMV infection (CMV-I) remains an important complication of hematopoietic stem cell transplantation (HSCT).

Methods: This was a retrospective, single-center cohort study in HSCT recipients. Primary outcomes were adjusted cost and all-cause mortality.

Evidence of increased bone resorption in neurofibromatosis type 1 using urinary pyridinium crosslink analysis.

Although neurofibromatosis type 1 (NF1) is a neurocutaneous disorder, skeletal abnormalities such as long-bone dysplasia, scoliosis, sphenoid wing dysplasia, and osteopenia are observed. To investigate the role of bone resorption as a mechanism for the bony abnormalities, we selected urinary pyridinium crosslinks (collagen degradation products excreted in urine) as a measure of bone resorption in NF1. Bone resorption was evaluated by quantitative assessment of the urinary excretion of pyridinium crosslinks [pyridinoline (Pyd) and deoxypyridinoline (Dpd)].

Somnolence effects of antipsychotic medications and the risk of unintentional injury.

Purpose: This study examined the relationship between antipsychotic medications, categorized by published somnolence effects, and unintentional injury (UI).

Methods: The study population included patients of 18-64 years of age in a healthcare insurance database with claims from 2001 to 2004 and diagnoses of schizophrenia or affective disorder. A nested case-control design was used with cases defined by an E-code claim (a specified external cause of injury) for selected UIs.

Evaluation of an innovative pediatric clerkship structure using multiple outcome variables including career choice.

Background: Few studies have examined alternative structures for inpatient clerkships.

Objective: Compare 2 inpatient clerkship structures using multiple outcome variables.

Design: Prospective, randomized controlled trial.

Rheumatic chorea: relationship to systemic manifestations and response to corticosteroids.

Objective: To describe Sydenham chorea among children in a cohort of patients with rheumatic fever (RF).

Study Design: An existing database was used to identify demographic characteristics, clinical manifestations, and therapy in persons with RF identified in Salt Lake City, Utah, from 1985 through January 2002.

Results: Of 584 cases in the database, 537 (91%) were new-onset RF (median age of 10 years) and 177 (33%) had chorea.

Unanswered questions prompted during pediatric primary care visits.

Objectives: To identify the frequency, types, and perceived importance of questions prompted during primary care visits for which pediatricians have no ready answer; to characterize pediatricians' responses to them; and to determine how questions prompted while caring for children with special health care needs (CSHCN) and children without special needs (Cw/oSN) differ.

Methods: Patient visits with 35 general pediatricians were observed. Parents completed a CSHCN screener.

Correlation of duodenal histology with tissue transglutaminase and endomysial antibody levels in pediatric celiac disease.

Background & Aims: IgA antibodies against tissue transglutaminase (TTGA) and endomysium (EMA) are sensitive and specific markers for celiac disease (CD). Data correlating TTGA and EMA levels with degree of villous atrophy are limited. We compared duodenal histopathology in pediatric CD patients with TTGA and EMA serologies, symptoms, height, and weight.

Prehospital intranasal midazolam for the treatment of pediatric seizures.

Background: The local emergency medical services (EMS) council implemented a new pediatric treatment protocol using a Mucosal Atomization Device (MAD) to deliver intranasal (IN) midazolam for seizure activity.

Methods: We sought to compare outcomes in seizing pediatric patients treated with IN midazolam using a MAD (IN-MAD midazolam) to those treated with rectal (PR) diazepam, 18 months before and after the implementation of the protocol.

Results: Of 857 seizure patients brought by EMS to our emergency department (ED), 124 patients (14%) had seizure activity in the presence of EMS and were eligible for inclusion in this study.

The prevalence of driveway back-over injuries in the era of sports utility vehicles.

Background: Small children are vulnerable to serious accidents when a motor vehicle is placed in motion in a driveway. We describe a series of such accidents, consider the predisposing factors, and analyze the outcomes.

Methods: We conducted a retrospective review of the trauma database of a large, level I, freestanding children's hospital with specific attention to driveway auto-pedestrian accidents.

Children with asthma admitted to a pediatric observation unit.

Objective: Observation units (OUs) serve patients who require more evaluation or treatment than possible during an emergency department visit and who are anticipated to stay in the hospital for a short defined period. Asthma is a common admission diagnosis in a pediatric OU. Our main objective was to identify clinical factors associated with failure to discharge a child with asthma from our OU within 24 hours.

Pediatric closed head injuries treated in an observation unit.

Background: Closed head injury (CHI) is common in childhood and frequently results in hospital admission for observation and treatment. Observation units (OUs) have shown significant benefits for patients and physicians. At our institution, a level 1 pediatric trauma center, patients with CHI are often admitted to an OU for up to 24 hours of observation and treatment.

CT scan and the pediatric trauma patient--are we overdoing it?

Background: Recent literature expresses concern for an increased risk of cancer in children exposed to low-dose radiation during computed tomography (CT). In response, children's hospitals have implemented the ALARA (as low as reasonably achievable) concept, but this is not true at most adult referring institutions. The purpose of this study was to assess the diagnostic necessity of CT in the evaluation of pediatric trauma patients.

Molecular characterization of Streptococcus pyogenes isolates collected during periods of increased acute rheumatic fever activity in Utah.

Background: Salt Lake City, Utah has seen a continuing resurgence of rheumatic fever (RF) since 1985.

Methods: emm genotyping and multilocus sequence typing of streptococcal isolates from periods of increased RF activity were performed.

Results: Multiple genotypes were present during 1985 and 1998, two peak years of RF activity, and in 1992, a year with reduced RF activity.