Sleep-disordered breathing and verbal skills in school-aged community children.

Sleep-disordered breathing (SDB) has been repeatedly associated with neurocognitive deficits in children. However, impairments in verbal skills have been inconsistently reported. The effects of SDB on verbal skills of 76 age-, gender, ethnicity, and maternal education matched groups of children with habitual snoring, but normal overnight sleep studies (HS), and children with significant SDB were compared to non-snoring healthy controls.

A 19-month-old boy with recurrent respiratory distress.

We present a 19-month-old boy with a history of asthma who presented to the pediatric emergency department with noisy breathing and tachypnea partially responsive to albuterol. He was discharged to routine care at home. His parents brought him back the next day for persistent respiratory distress despite routine home albuterol.

Dietary and physical activity patterns in children with obstructive sleep apnea.

Objective: To assess dietary and physical activity patterns and morning circulating blood levels of the orexigenic hormones ghrelin and visfatin in children with either obesity, obstructive sleep apnea (OSA), or both conditions.

Study Design: In this cross-sectional design, 5- to 9-year-old participants (n = 245) from the community were identified. After overnight polysomnography, caregivers filled out a food and physical activity questionnaire, and the child underwent a fasting blood draw for ghrelin and visfatin plasma levels.

Laboratory and clinical predictors of thrombosis and hemorrhage in 29 pediatric extracorporeal membrane oxygenation nonsurvivors.

Extracorporeal membrane oxygenation (ECMO) is a life-saving therapy for infants and children with cardiac and respiratory failure. However, thrombosis and hemorrhage are common complications. To determine clinical and laboratory predictors of thrombosis and hemorrhage resulting from ECMO, records and slides were reviewed from 29 consecutive autopsies from 2004 through 2008 of pediatric patients who received ECMO at our institution.

Obstructive sleep apnoea is associated with impaired pictorial memory task acquisition and retention in children.

The aim of our study was to evaluate whether obstructive sleep apnoea (OSA) is associated with impaired acquisition and recall of a pictorial-based memory tasks in children. 54 children with OSA and 17 controls matched for age, sex and ethnicity underwent a sleep study (overnight polysomnogram). Before the sleep study subjects completed a 15-min pictorial memory task acquisition consisting of four trials, followed by a free-recall period to assess retention after 10 min and the following morning upon awakening.

Pediatric obstructive sleep apnea: a potential late consequence of respiratory syncitial virus bronchiolitis.

Study Objectives: To examine the hypothesis that children who suffered from severe respiratory syncitial virus (RSV) bronchiolitis during infancy may be at higher risk for obstructive sleep apnea (OSA) later in childhood.

Methods: Survey of Kosair Children's Hospital medical records allowed for identification of potential candidates for the study. Twenty-one randomly selected children (mean age +/- SD: 5.

Stillborn infant with calcified chorionic epithelium, corneal scarring, and pericarditis.

This autopsy of a stillborn term infant revealed a constellation of unusual features including calcification of the chorion membrane and portions of the umbilical vascular media, extensive white matter gliosis, arthrogryposis multiplex congenita, adhesions of one eyelid to the globe, pericarditis, a miniature left foot, and a cleft palate. We hypothesized that the membrane and umbilical cord lesions resulted from an episode of resolved chorioamnionitis earlier in the pregnancy. Mare reproductive loss syndrome (MRLS) demonstrates a bacteremic infection of the amniotic cavity, pericarditis, and uniocular endophthalmitis in the mare.

Metachronous mediastinal seminoma occurring after intracranial germinoma in an adolescent.

We report a case of a mediastinal seminoma occurring 19 months after the resolution of a pineal germinoma. A 15-year-old boy with headaches and visual changes was diagnosed with a pineal germinoma by biopsy and mildly elevated beta-human chorionic gonadatropin (beta-HCG) in serum and cerebral spinal fluid. Radiation therapy leads to the resolution of his pineal germinoma and normalization of the beta-HCG.

The anatomic relationship between the common femoral artery and common femoral vein in frog leg position versus straight leg position in pediatric patients.

Background: Overlap of the femoral artery (FA) on the femoral vein (FV) has been shown to occur in pediatric patients. This overlap may increase complications such as arterial puncture and failed insertions of central venous lines (CVLs). Knowledge of the anatomic relationship between the FV and FA may be important in avoiding these complications.

Comparison of Web-based and face-to-face training concerning patient education within a hospital system.

The authors examined education records of 1,661 registered nurses from four affiliated hospitals who attended either a 1-hr face-to-face instructor-led training program, an instructor-facilitated Web-based training program, or an independent Web-based training program to fulfill a training requirement concerning patient education. The authors compared post-test results, course evaluation results, and costs and also developed a demographic profile of nurses' preferences for Web-based and face-to-face learning options. There was no significant difference in course effectiveness or satisfaction between the training methods studied; however, because of the large number of nurses who selected Web-based training, it was the most cost-effective alternative.

Catecholamine alterations in pediatric obstructive sleep apnea: effect of obesity.

Study Objectives: Obstructive sleep apnea (OSA) elicits increased sympathetic activity in adults and increased urinary catecholamines. Moreover, urinary catecholamine excretion is altered in obese patients. We hypothesized that morning urine catecholamine levels would be correlated with the severity of obstructive sleep apnea and degree of obesity in children.

Semi-automated region of interest generation for the analysis of optically recorded neuronal activity.

Bath-applied membrane-permeant Ca(2+) indicators offer access to network function with single-cell resolution. A barrier to wider and more efficient use of this technique is the difficulty of extracting fluorescence signals from the active constituents of the network under study. Here we present a method for semi-automatic region of interest (ROI) detection that exploits the spatially compact, slowly time-varying character of the somatic signals that these indicators typically produce.

A mixed cell culture model for assessment of proliferation in tonsillar tissues from children with obstructive sleep apnea or recurrent tonsillitis.

Background: Recurrent infective tonsillitis (RI) and obstructive sleep apnea (OSA) are the major indications for adenotonsillectomy (T&A) in children. However, little is known on the determinants of lymphadenoid tissue proliferation in the pediatric upper airway.

Objectives: To develop an in vitro culture system allowing for assessment of tonsillar or adenoidal proliferation under basal or stimulated conditions.

Cardiovascular complications of obstructive sleep apnea syndrome: evidence from children.

Obstructive Sleep Apnea Syndrome (OSAS) is a common condition in children, and is characterized by intermittent partial or complete occlusion of the upper airway during sleep, leading to profound disturbances in homeostatic gas exchange, frequent arousals and disturbed sleep architecture. Pediatric OSAS is associated with a multitude of end-organ morbidities, most of which have been uncovered in the last decade. Of particular interest are the cardiovascular complications that may develop in children with OSAS, since they are posited to have not only an immediately significant impact on cardiovascular health during childhood, but may also affect cardiovascular outcomes later during adult life.

Beta-cell death and proliferation after intermittent hypoxia: role of oxidative stress.

Intermittent hypoxia (IH), such as occurs in sleep apnea, induces increased oxidative stress and is associated with altered glucose homeostasis. Because pancreatic beta cells are very sensitive to oxidative stress we tested whether they could be affected by IH. The effects of IH exposure (24 h/day, 5.

Leukotriene pathways and in vitro adenotonsillar cell proliferation in children with obstructive sleep apnea.

Introduction: The abundant expression of leukotrienes (LTs) and their receptors in adenotonsillar tissues of children with obstructive sleep apnea (OSA) suggest that LT antagonists could be useful in treating OSA.

Methods: The effects of LTD4 and of LT receptor antagonists zileuton, montelukast, and BAY u9773 were examined on mixed cell cultures prepared from dissociated tonsils or adenoids harvested intraoperatively from children with polysomnographically diagnosed OSA. Proliferation was assessed by (3)[H]-thymidine incorporation, and inflammatory cytokine production (tumor necrosis factor [TNF]-alpha, interleukin [IL]-6, IL-8, IL-10, and IL-12) was assessed in supernatants using enzyme-linked immunosorbent assay.

Obesity and excessive daytime sleepiness in prepubertal children with obstructive sleep apnea.

Introduction: The epidemic of childhood obesity has prompted remarkable changes in the relative proportions of symptomatic overweight or obese children being referred for evaluation of habitual snoring. However, it remains unclear whether obesity modifies the relative frequency of daytime symptoms such as excessive daytime sleepiness.

Methods: Fifty consecutive, nonobese, habitually snoring, otherwise-healthy children (age range: 6-9 years) and 50 age-, gender-, and ethnicity-matched obese children (BMI z score: >1.

Corticosteroids suppress in vitro tonsillar proliferation in children with obstructive sleep apnoea.

Intranasal corticosteroids (CS) are potentially useful interventions for children with obstructive sleep apnoea (OSA), and may reduce lymphadenoid tissue size in the upper airway. The present authors hypothesised that CS would reduce cellular proliferation and the production of pro-inflammatory cytokines in a tonsil/adenoid mixed-cell culture system. Dissociated tonsils or adenoids harvested intra-operatively from children with polysomnographically diagnosed OSA were cultured in control medium (CO) or after stimulation with lipopolysaccharide and concanavalin A (STIM), and incubated with dexamethasone (DEX; 10(-5)-10(-7) M), fluticasone (FLU; 10(-5)-10(-14) M) and budesonide (BUD; 10(-4)-10(-14) M).

The multiple challenges of obstructive sleep apnea in children: morbidity and treatment.

Purpose Of Review: To delineate some of the major morbid phenotypes that have emerged in pediatric obstructive sleep apnea (OSA), address new concepts in our understanding of OSA-associated morbidities, and elaborate on innovative therapeutic schemes that may improve outcomes for this condition. In addition, the conceptual framework whereby a childhood condition such as OSA can be linked to specific adult diseases will be presented.

Recent Findings: OSA in children is a frequent condition that affects up to 3% of nonobese, otherwise healthy children.

Malic enzyme is present in mouse islets and modulates insulin secretion.

Aims/hypothesis: The pyruvate-malate shuttle is a metabolic cycle in pancreatic beta cells and is important for beta cell function. Cytosolic malic enzyme (ME) carries out an essential step in the shuttle by converting malate to pyruvate and generating NADPH. In rat islets the pyruvate-malate shuttle may regulate insulin secretion and it has been shown to play a critical role in adaptation to obesity and insulin resistance.

Pilomatrixoma in an infant: diagnostic challenges of fine-needle aspiration.

Fine-needle aspiration biopsy (FNAB) is a well-recognized minimally invasive tool in the diagnosis of neoplasia of various organ systems. Several reports in the literature suggest that FNAB can be an accurate method for the preoperative diagnosis and treatment planning. We describe a case to caution the interpretation from a FNAB that contains suboptimal contents (basaloid cells only) and highlight a clinical-pathologic-based algorithm that can provide the appropriate management for the patient when the cytopathologic diagnosis does not fit the clinical impression.

The role of nitric oxide in the neural control of breathing.

The control of breathing has been a long examined enigma. Despite the critical biological significance of respiratory control, the framework of the molecular interactions which generate and regulate these incredible phenomena are only beginning to be delineated. Recent advances in the understanding the role of nitric oxide (NO) as a signaling molecule have facilitated our understanding of the high level complexities and multiple interacting pathways in many biological systems including those underlying neural control of ventilation.

Restrictive tunnel patent foramen ovale and left atrial hypertension in single-ventricle physiology: implications for stent placement across the atrial septum.

Our objective is to describe our approach to the management of patients with single-ventricle physiology and restrictive tunnel patent foramen ovale (TPFO) with unfavorable atrial septal morphology. We describe a series of five patients with single-ventricle physiology and restrictive TPFO and our experience with radiofrequency perforation (RFP), static balloon atrial septostomy (BAS), and stent implantation to create an alternative pathway for left atrial decompression. Between July 4, 2006, and July 10, 2007, five patients with single-ventricle physiology and restrictive TPFO were brought to the cardiac catheterization laboratory for decompression of a hypertensive left atrium.