To review the emerging role of transcranial MR-guided focused ultrasound as a treatment and research modality for functional neurological disorders, we summarize recent clinical and preclinical studies. Clinical trials have investigated the safety and efficacy of thermal lesions created by transcranial, high-intensity focused ultrasound. Preclinical work has additionally investigated the ability to disrupt the blood-brain barrier and to produce reversible neuromodulation with focused ultrasound utilizing lower intensities. We discuss ongoing trials and future avenues of investigation. © 2016 International Parkinson and Movement Disorder Society.

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Object While some low-grade pediatric gliomas may be cured with resection, many patients harbor tumors that cannot be completely resected safely, are difficult to access via an open surgical approach, or recur. Gamma Knife surgery may be beneficial in the treatment of these tumors. Methods The authors reviewed a consecutive series of 24 pediatric patients treated at the authors' institution between 1989 and 2011. All patients harbored tumors that were either surgically inaccessible or had evidence of residual or recurrent growth after resection. Progression-free survival was evaluated and correlated with clinical variables. Additional outcomes evaluated were clinical outcome, imaging response, and overall survival. Results Between 1989 and 2011, 13 male and 11 female patients (median age 11 years, range 4–18 years) with gliomas were treated. Tumor pathology was pilocytic astrocytoma (WHO Grade I) in 15 patients (63%), WHO Grade II in 4 (17%), and WHO Grade III in 1 (4%). The tumor pathology was not confirmed in 4 patients (17%). The mean tumor volume at the time of treatment was 2.4 cm3. Lesions were treated with a median maximum dose of 36 Gy, median of 3 isocenters, and median marginal dose of 15 Gy. The median duration of imaging follow-up was 74 months, and the median duration of clinical follow-up was 144 months. The tumors responded with a median decrease in volume of 71%. At last follow up, a decrease in tumor size of at least 50% was demonstrated in 18 patients (75%) and complete tumor resolution was achieved in 5 (21%). Progression-free survival at last follow-up was achieved in 20 patients (83%). Progression was documented in 4 patients (17%), with 3 patients requiring repeat resection and 1 patient dying. The initial tumor volume was significantly greater in patients with disease progression (mean volume 4.25 vs 2.0 cm3, p < 0.001). Age, tumor pathology, tumor location, previous radiation, Karnofsky Performance Scale score, symptom duration, and target dosage did not differ significantly between the 2 groups. Conclusions Gamma Knife surgery can provide good clinical control of residual or recurrent gliomas in pediatric patients. Worse outcomes in the present series were associated with larger tumor volumes at the time of treatment.

A group of formula-fed infants were administered a single feed of poliovirus IgA antibody-rich human colostrum 18 to 72 hr after birth. Subsequently, the presence of IgG, IgA, and IgM immunoglobulin and poliovirus antibody activity was determined in serial serum and fecal samples of the neonates. Absorption of IgA immunoglobulin from the colostrum to the circulation was observed in three infants who were fed with colostrum between 18 and 24 hr after birth. Another group of infants of tuberculin-positive mothers who were being breast fed by their own mothers were followed for the development of in vitro correlates of cell-mediated immunity against tuberculin after prolonged breast feeding. Tuberculin-specific proliferative response was observed in the peripheral blood lymphocytes of two neonates after 5 weeks of breast feeding. The responses were undetectable after 12 weeks, although the infants continued to breast feed. No tuberculin reactivity was observed in the cord lymphocytes. These observations suggest uptake of IgA immunoglobulin and components of cellular immunity in the intestine during the immediate neonatal period.

It is known that young premature infants are unable to concentrate urine to the same degree as adults. The following hypotheses have been advanced to explain this difference: (a) A lowered production of antidiuretic hormone (1); (b) a re-,duced response of the distal renal tubule (endorgan) to antidiuretic hormone (2); (c) a decreased rate of solute excretion secondary to a lower rate of glomerular filtration (3).Heller and Zaimis found that there is a lower concentration of antidiuretic hormone in the pituitary body of newborn infants than in adults, when compared on a body weight basis (1). Yet these authors believe that in spite of this smaller amount of hormone in the pituitary of the newborn infant, there is still a sufficient quantity of the hormone to produce a maximally concentrated urine, if the hormone is released and if the renal tubule of the newborn infant is responsive. Heller (2) also showed that amounts of pituitary extract, which produced a pronounced inhibition of water diuresis in adults, had only a slight and fleeting effect on the kidney of newborn infants. In comparing the response of three premature infants with that of two adults to intravenously administered pitressin during water diuresis, it was found (4) that the extent and duration of the antidiuretic response was less in the premature infant. The third hypothesis, the effect of solute excretion, can be tested by noting the changes in urine osmolarity in response to solute loading. If the lower concentrating capacity during hydropenia were solely a reflection of the lower solute load in the premature infant, then a rise in the osmolar concentration should occur with loading. On the 'Read in part before the 23rd Annual Meeting of the Society for Pediatric Research, Atlantic City, New Jersey, May, 1953. 2Aided by grants from the Mead Johnson Company, Evansville, Indiana, and the U. S. Public Health Service.other hand, if the response to loading were similar to the adult but of lesser magnitude, it would suggest that the lower concentrating capacity was due to a deficient tubular response. The experiments reported here were planned to test this hypothesis. METHODSThe subjects of these studies were four premature infants weighing approximately 1500 grams but varying in ages from 5 to 23 days. To induce hydropenia they were deprived of water and formula for 12 to 18 hours. Urine aliquots were obtained to determine the maximum urine osmolarity during water deprivation.Mannitol was used as the loading substance and was given in a 25 per cent solution intravenously. During the first 10 minutes, 180 to 200 milliosmoles per 1.73 M' were given and this was followed by a maintenance infusion of 1 per cent of the total priming dose per minute. Fifteen to 20 minutes were allowed for equilibration of mannitol; urine was collected under oil for three or more 10-minute periods. Blood samples were drawn before loading, after equilibration, and after the experiments were completed. The osmotic pressure, sodium, chloride and potassium of the urine and...

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