In this population-based cohort study of pediatric OCD of the knee, male patients had a much greater incidence of OCD and almost 4 times the risk of OCD compared with female patients. Also, patients aged 12 to 19 years had 3 times the risk of OCD of the knee as compared with 6- to 11-year-old children.

Frequent exposure of children to general anesthesia is common practice in modern medicine. Although previously unrecognized, recent in vitro and in vivo animal studies suggest that exposure to clinically relevant general anesthetics at the peak of brain development could be detrimental to immature mammalian neurons, as demonstrated by massive and widespread apoptotic neurodegeneration. The survival of the developing neurons presumably depends on proper and timely formation of synapses, for which synaptic proteins (e.g., synaptophysin, synaptobrevin, amphiphysin, synaptosomal-associated protein 25 [SNAP-25], and Ca(2+)/calmodulin-dependent protein kinase II [CaM kinase II]) are crucially important. Overinhibition of developing neurons impairs synaptic protein function and activity-induced synaptic plasticity, which could in turn result in permanent neuronal loss. To examine the effects of general anesthesia, the pharmacological agents known to cause extensive neuronal inhibition, on synaptic proteins, and neuronal survival at the peak of synaptogenesis, we exposed 7-day-old rat pups to general anesthesia (midazolam, 9 mg/kg of body weight, subcutaneously, followed by 6 h of nitrous oxide 75 vol% and isoflurane 0.75 vol%). We found that this general anesthesia causes permanent neuronal deletion in the most vulnerable brain regions-the cerebral cortex and the thalamus-while transiently modulating protein levels of synaptophysin, synaptobrevin, amphiphysin, SNAP-25, and CaM kinase II.

Background:The frequency of osteochondritis dissecans (OCD), a disorder of the subchondral bone and articular cartilage, is not well described.Purpose:To assess the frequency of pediatric OCD lesions that progress to surgery based on sex, joint involvement, and age.Study Design:Descriptive epidemiology study.Methods:A retrospective chart review (2007-2011) was performed on OCD. Inclusion criteria included OCD of any joint and patients aged 2 to 19 years. Exclusion criteria included traumatic osteochondral fractures or coexistence of non-OCD intra-articular lesions. Differences in progression toward surgery were compared between age groups, sex, and joint location. Logistical regression analysis was performed by sex, age, and ethnicity.Results:Overall, 317 patients with a total of 334 OCD lesions were found. The majority of lesions (61.7%) were in the knee, with ankle, elbow, shoulder, and foot lesions representing 25.4%, 12.0%, 0.6%, and 0.3% of all lesions, respectively. The majority of joints needing surgery were in the knee (58.5%), with ankle and elbow lesions representing 22.9% and 18.6% of surgeries performed, respectively. The percentage of all OCD lesions progressing to surgery was 35.3%; surgical progression for knee, ankle, and elbow joints was 33.5%, 31.8%, and 55.0%, respectively. Logistic regression analysis found no statistically significant different risk of progressing to surgery for OCD of the knee, elbow, and ankle between sexes. Patients aged 12 to 19 years had a 7.4-times greater risk of progression to surgery for knee OCD lesions than 6- to 11-year-olds. Patients aged 12 to 19 years were 8.2 times more likely to progress to surgery for all OCD lesions than patients aged 6 to 11 years. Progression to surgery of ankle OCD did not significantly differ based on location. Three of 4 trochlear lesions progressed to surgery, along with 1 of 1 tibial, 1 of 3 patellar, 40.3% of lateral femoral condylar, and 28.2% of medial femoral condylar lesions.Conclusion:In this large cohort study of pediatric OCD patients, 35% progressed to surgery. Progression to surgery did not differ significantly between sexes with OCD of any joint. Progression to surgery for OCD of the knee, elbow, and ankle strongly correlated with patient age at the time of diagnosis.Clinical Relevance:The knowledge of likelihood of progression to surgery of OCD by location, sex, and age is useful in counseling patients and in planning treatment. This study confirms a worse prognosis in the nonoperative treatment of older patients with OCD.

In this population-based cohort study of pediatric ankle OCD, female patients had a greater incidence of OCD and a 1.5 times greater risk for ankle OCD compared with male patients. Teenagers had nearly 7 times the risk for ankle OCD compared with children 6 to 11 years of age.

Studies conducted in animal model of infectious diseases or H-Y antigen model suggest a crucial role for CD4+ T cells in providing help for CD8+ T-cell memory responses. This concept suggests that inclusion of T helper epitopes in vaccine formulation will result in improved CD8+ T-cell responses. Although this concept has been applied to cancer vaccine design, the role of CD4+ T cells in the memory differentiation of CD8+ T cells and retention of their anti-tumor function have never been tested in breast cancer model. Using the FVB mouse model of neu-positive breast carcinoma we report for the first time that helpless T cells showed cytostatic or tumor inhibitory effects during primary tumor challenge whereas, helped T cells showed cytotoxic effects and resulted in complete tumor rejection. Such differential effects, in vivo, were associated with higher frequency of CD8+PD-L1+ and CD8+PD-1+ T cells in animals harboring helpless T cells as well as higher titer of IL-2 in the sera of animals harboring helped T cells. However, depletion of CD4+ T cells did not alter the ability of neu-specific CD8+ T cells to differentiate into memory cells and to retain their effector function against the tumor during recall challenge. These results suggest the inhibitory role of CD4+ T cells on CD8+ T-cell exhaustion without substantial effects on the differentiation of memory T cells during priming phase of the immune responses against breast cancer.

Objectives:To assess the demographics and epidemiology of osteochondritis dissecans (OCD) of the ankle, elbow, foot, and shoulder in patients age 2-19.Methods:A retrospective chart review was done on OCD between 2007 and 2011. Inclusion criteria included OCD of the ankle, elbow, foot, or shoulder, and patients aged 2-19. Exclusion criteria included the co-existence of any other intra-articular lesions. Joint involvement, laterality, and all patient demographics were recorded. The incidence of OCD in 2010 was determined for the ankle, elbow, and foot.Results:125 patients with a total of 128 OCD lesions fit the inclusion criteria. 60.2% of lesions were right sided and 39.8% left sided. Males had 53.9% and females 46.1% of all lesions. Lesions of the ankle, elbow, foot, and shoulder represented 66.4%, 31.3%, 0.8%, and 1.6% of all joints, respectively. No OCD lesions were found in the 2-5 year-olds. The incidence of ankle OCD for patients aged 6-19 was 4.7 per 100,000 for all patients, and 3.5, and 6.0 per 100,000 for males and females, respectively. The incidence of elbow OCD was 2.2 per 100,000 for all patients, and 3.8 and 0.6 per 100,000 for males and females, respectively. The incidence of OCD in the foot was 0.15 per 100,000 for all patients. The male/female ratio for elbow OCD was 6.4/1, and 1/1.6 for ankle OCD. In the ankle joint, the vast majority involved the medial talus (71.8%), with most of the rest involving the lateral talus (22.4%). Females had 28.8% of lesions in the lateral talus while males had only 12.1%. Almost all elbow lesions (97.5%) involved the capitellum. In the shoulder, both lesions involved the glenoid, and in the foot, the single lesion involved the metatarsal head.Conclusion:In this population-based cohort study of pediatric OCD in nearly 1 million children, males had a greater incidence of OCD and most were right sided. Females had nearly twice the incidence of ankle OCD, while males had over 6 times the incidence of elbow OCD. To our knowledge, this is the largest epidemiologic/demographic study of pediatric OCD of the ankle, elbow, foot, and shoulder reported.

Objectives:To assess the demographics and epidemiology of osteochondritis dissecans (OCD) of the knee in patients age 2-19 and the frequency with which these lesions progress to surgery.Methods:A retrospective EMR chart review of an integrated health system was done on OCD between 2007 and 2011. Inclusion criteria included OCD of the knee and patients aged 2-19, with approximately 1 million patients in this cohort. Lesion location, laterality, and all patient demographics were recorded. OCD incidence was determined for the group as a whole and by age group (divided into age 2-5, group A=6-11, group B=12-19). Differences in progression toward surgery were compared between age groups, gender, and joint location.Results:192 patients with a total of 206 OCD lesions fit the inclusion criteria. No OCD lesions were found in 2-5 year olds. 53.4% of lesions were right-sided, 46.6% left-sided. The medial femoral condyle was the most commonly affected location with 63.6% of the knee OCD lesions, followed by the lateral femoral condyle with 32.5%. Lesions of the femoral trochlea, patella, and lateral tibial plateau represented less than 4% of the total combined. No OCD lesions were found in the 2-5 year-olds. The incidence of knee OCD for patients aged 6-19 was 9.6 per 100,000 for all patients, and 15.7 and 3.3 per 100,000 for males and females, respectively. Group B represented the vast majority of OCD, with an incidence of 21.8 per 100,000 in 12-19 year olds versus 8.7 in group A. Females in group A and B had an incidence of 4.6 and 13.3 per 100,00, respectively, while males had an incidence of 12.5 and 30.1 per 100,00 for group A and B, respectively. The overall male/female ratio for knee OCD was 3.7/1. 33.8% of all lesions progressed to surgery. Lesion location did correlate with progression to surgery, with rare trochlear lesions and tibial lesions more likely to undergo surgery (100%, 100%) than lateral and medial femoral condyle lesions (40.3% and 28.7%) and patellar lesions (33.3%).Conclusion:In this population-based cohort study of pediatric OCD in nearly 1 million children, males had a much greater incidence of OCD and the majority were right sided lesions. Teenagers had nearly 3 times the incidence of OCD as compared to the 6-11 year old group. Although most OCD lesions were located on the medial femoral condyle, lateral femoral condyle lesions were also common. The incidence of OCD in this study was similar to a smaller Swedish study by Linden et al 40 years previously. The knowledge of likelihood of progression to surgery of OCD by location, sex, and age is useful in counseling patients and in planning treatment. To our knowledge, this is the largest study of the demographics, epidemiology, and incidence of progression to surgery of OCD of the knee in children ever reported.

BackgroundBlunt traumatic brachial plexus injuries (BTBPI) are severe peripheral nerve injuries which present in a small portion of trauma patients but can result in long-term neurological disability and severe chronic pain.ObjectiveThe goal of this study was to describe the epidemiology of BTBPI in a northern rural setting caused by motor-powered collisions, and to determine the relative risk of these injuries in shielded (cars, trucks, vans, and so on) and unshielded vehicles (snowmobiles, all-terrain vehicles and motorcycles).MethodsThis retrospective study describes the epidemiology of BTBPI caused by motor-powered collisions and treated at two level II trauma centers in northeast Minnesota and determines the relative risk of these injuries in shielded (cars, trucks, vans, and so on) and unshielded vehicles (snowmobiles, all-terrain vehicles and motorcycles). We hypothesized unshielded motor vehicle crashes in rural areas are at an increased risk of incurring BTBPI.ResultsOut of all injuries resulting from motor-powered collisions in a 20-year period (9951), BTBPIs were found in 63 trauma patients, a prevalence of 0.6%. The rate of BTBPI involving unshielded vehicles (1.0%) was significantly higher than those involving a shielded vehicle (0.4%) and primarily occurred in rural areas (70%).ConclusionsUnshielded vehicle crashes, particularly snowmobiles, have the highest risk for BTBPI in our rural region. The overall incidence of these injuries appears to be declining.Level of evidenceLevel III.