Lurie Childrens Hospital of Chicago

Chicago, IL, United States

Lurie Childrens Hospital of Chicago

Chicago, IL, United States
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Lehman P.J.,Lurie Childrens Hospital Of Chicago | Carl R.L.,Lurie Childrens Hospital Of Chicago
Pediatric Annals | Year: 2017

With rising rates of sports participation among children and adolescents, pediatricians are increasingly being called upon to perform preparticipation physical evaluations (PPEs) for young athletes. The purpose of this review article is to discuss the general structure of a comprehensive PPE and how the PPE differs from a typical health maintenance visit. The PPE focuses attention on screening for cardiac conditions that predispose athletes to sudden cardiac death with exercise. This review also addresses the debate over whether electrocardiogram screening should be a routine required part of the PPE. In addition to cardiac screening, evaluation and management of musculoskeletal injury, concussion, and the female athlete triad will be discussed in greater detail. © SLACK Incorporated.

Xu D.,Northwestern University | Xu D.,Lurie Childrens Hospital of Chicago | Miller S.D.,Northwestern University | Koh S.,Lurie Childrens Hospital of Chicago | Koh S.,Northwestern University
Frontiers in Cellular Neuroscience | Year: 2013

Epilepsy is a chronic brain disorder that affects 1% of the human population worldwide. Immune responses are implicated in seizure induction and the development of epilepsy. Pre-clinical and clinical evidence have accumulated to suggest a positive feedback cycle between brain inflammation and epileptogenesis. Prolonged or recurrent seizures and brain injuries lead to upregulation of proinflammatory cytokines and activated immune responses to further increase seizure susceptibility, promote neuronal excitability, and induce blood-brain barrier breakdown. This review focuses on the potential role of innate and adaptive immune responses in the pathogenesis of epilepsy. Both human studies and animal models that help delineate the contributions of brain inflammation in epileptogenesis will be discussed. We highlight the critical role of brain-resident immune mediators and emphasize the contribution of brain-infiltrating peripheral leukocytes. Additionally, we propose possible immune mechanisms that underlie epileptogenesis. Several proinflammatory pathways are discussed, including the interleukin-1 receptor/toll-like receptor signaling cascade, the pathways activated by damage-associated molecular patterns, and the cyclooxygenase-2/prostaglandin pathway. Finally, development of better therapies that target the key constituents and processes identified in these mechanisms are considered, for instance, engineering antagonizing agents that effectively block these pathways in an antigen-specific manner. © 2013 Xu, Miller and Koh.

Edens B.M.,Northwestern University | Edens B.M.,Lurie Childrens Hospital Of Chicago | Miller N.,Northwestern University | Miller N.,Lurie Childrens Hospital Of Chicago | And 2 more authors.
Frontiers in Cellular Neuroscience | Year: 2016

Selective motor neuron degeneration is a hallmark of amyotrophic lateral sclerosis (ALS). Around 10% of all cases present as familial ALS (FALS), while sporadic ALS (SALS) accounts for the remaining 90%. Diverse genetic mutations leading to FALS have been identified, but the underlying causes of SALS remain largely unknown. Despite the heterogeneous and incompletely understood etiology, different types of ALS exhibit overlapping pathology and common phenotypes, including protein aggregation and mitochondrial deficiencies. Here, we review the current understanding of mechanisms leading to motor neuron degeneration in ALS as they pertain to disrupted cellular clearance pathways, ATP biogenesis, calcium buffering and mitochondrial dynamics. Through focusing on impaired autophagic and mitochondrial functions, we highlight how the convergence of diverse cellular processes and pathways contributes to common pathology in motor neuron degeneration. © 2016 Edens, Miller and Ma.

Meyers R.L.,University of Utah | Tiao G.,Cincinnati Childrens Hospital and Medical Center | De Ville De Goyet J.,University of Rome Tor Vergata | Superina R.,Lurie Childrens Hospital of Chicago | Aronson D.C.,University of Malawi
Current Opinion in Pediatrics | Year: 2014

Purpose of review: This is part two of a two-part state of the art-hepatoblastoma. International hepatoblastoma specialists were brought together to highlight advances, controversies, and future challenges in the treatment of this rare pediatric tumor. Recent findings: Pretreatment extent of disease (PRETEXT) is a grouping system introduced as part of the multicenter international childhood liver tumors strategy group, SIOPEL-1, study in 1990. The system has been refined over the ensuing years and has now come to be adopted for risk stratification by all of the major pediatric liver tumor multicenter trial groups. PRETEXT is being intensively studied in the current ChildrenÊs Oncology Group (COG) AHEP-0731 trial in an attempt to validate interobserver reproducibility and ability to monitor response to neoadjuvant chemotherapy, and determine surgical resectability. PRETEXT is now used to identify those patients who are at risk for having an unresectable tumor and who should be referred to a liver specialty center with transplant capability early in their treatment schema. Summary: International collaborative efforts in hepatoblastoma have led to increased refinements in the use of the PRETEXT and post-treatment extent to define prognosis and surgical resectability. PRETEXT criteria which suggest a possible need for liver transplantation are discussed in detail. © 2014 Wolters Kluwer Health.

Collins Jr. J.W.,Lurie Childrens Hospital of Chicago | Soskolne G.R.,University of California at San Francisco | Rankin K.M.,University of Illinois at Chicago | Bennett A.C.,University of Illinois at Chicago
Maternal and Child Health Journal | Year: 2013

To determine whether maternal nativity (US-born versus foreign-born) is associated with the first year mortality rates of term births. Stratified and multivariable binomial regression analyses were performed on the 2003-2004 National Center for Health Statistics linked live birth-infant death cohort files. Only term (37-42 weeks) infants with non-Latina White, African-American, and Mexican-American mothers were studied. The infant mortality rate (<365 days, IMR) of births to US-born non-Latina White mothers (n = 3,684,569) exceeded that of births to foreignborn White mothers (n = 226,621): 2.4/1,000 versus 1.3/1,000, respectively; relative risk (RR) = 1.8 [95 %confidence interval (CI) 1.6-2.0]. The IMR of births to US-born African-American mothers (n = 787,452) exceeded that of births to foreign-born African-American mothers (n = 118,246): 4.1/1,000 versus 2.2/1,000, respectively; RR = 1.8 (1.6-2.1). The IMR of births to US-born Mexican-American mothers (n = 338,337) exceeded that of births to Mexican-born mothers (n = 719,837): 2.4/1,000 versus 1.8/1,000, respectively; RR = 1.3 (1.2-1.4). These disparities were not limited to a singular cause of death and were widest among deaths due to Sudden Infant Death Syndrome. In multivariable binomial regression models, the adjusted RR of infant mortality for non-LBW, term births to US-born (compared to foreign-born) for White, African-American, and Mexican-American mothers equaled 1.5 (1.3-1.7), 1.7 (1.5-2.1) and 1.6 (1.4-1.8), respectively. The IMR of term births to White, African-American, and Mexican-American mothers exceeds that of their counterparts with foreign-born mothers independent of traditional individual level risk factors. © Springer Science+Business Media New York 2012.

Mistry R.D.,Aurora University | Fischer J.B.,University of Michigan | Prasad P.A.,University of California at San Francisco | Coffin S.E.,Children's Hospital of Philadelphia | And 2 more authors.
Pediatrics | Year: 2014

OBJECTIVE: Data on complications from upper respiratory infection are limited. We examined development of severe complications in children presenting to the emergency department (ED) for moderate to severe influenza-like illness (ILI).RESULTS: There were 241 enrolled subjects with median age of 27.4 months (interquartile range 8.9-68.5); 59.3% were boys and 48.5% were black. High-risk conditions were present in 53.5%. Severe complications developed in 35.3% (95% confidence interval [CI] 29.3-41.3), most frequently pneumonia (26.1%). The risk for severe complications was increased in subjects with neurologic or neuromuscular conditions (relative risk 4.0; 95% CI 1.9-8.2). No specific respiratory virus was associated with development of severe complications. Among patients with influenza, severe complications were greater with subtype H1N1 infection (relative risk 1.45, 95% CI 0.99-2.13, P = .048), and were at highest risk for pneumonia (relative risk 4.2, 95% CI 1.2-15.9).METHODS: Prospective cohort study of children 0 to 19 years presenting to a tertiary care children's hospital ED during peak respiratory viral seasons from 2008 to 2010. Subjects included had moderate to severe ILI, defined by performance of venipuncture and nasopharyngeal multiplex polymerase chain reaction for respiratory viruses. Severe complications (respiratory failure, encephalopathy, seizures, pneumonia, bacteremia, death) were prospectively determined. Risk factors for severe complications were collected, including demographics, comorbidities, and household exposures.CONCLUSION: In children presenting to the ED for moderate to severe ILI, those with neurologic and neuromuscular disease are at increased risk for severe complications. Development of severe complications did not differ by infecting virus; however, risk of severe complications was greater with subtype H1N1 compared with other influenza.

Jain S.,Children's Healthcare Of Atlanta | Cheng J.,Children's Healthcare Of Atlanta | Alpern E.R.,Lurie Childrens Hospital of Chicago | Thurm C.,Childrens Hospital Association | And 5 more authors.
Pediatrics | Year: 2014

BACKGROUND: Blood, urine, and cerebrospinal fluid cultures and admission for antibiotics are considered standard management of febrile neonates (0-28 days). We examined variation in adherence to these recommendations across US pediatric emergency departments (PEDs) and incidence of serious infections (SIs) in febrile neonates. METHODS: Cross-sectional study of neonates with a diagnosis of fever evaluated in 36 PEDs in the 2010 Pediatric Health Information System database. We analyzed performance of recommended management (laboratory testing, antibiotic use, admission to hospital), 48-hour return visits to PED, and diagnoses of SI. RESULTS: Of 2253 neonates meeting study criteria, 369 (16.4%) were evaluated and discharged from the PED; 1884 (83.6%) were admitted. Recommended management occurred in 1497 of 2253 (66.4%; 95% confidence interval, 64.5-68.4) febrile neonates. There was more than twofold variation across the 36 PEDs in adherence to recommended management, recommended testing, and recommended treatment of febrile neonates. There was significant variation in testing and treatment between admitted and discharged neonates (P < .001). A total of 269 in 2253 (11.9%) neonates had SI, of whom 223 (82.9%; 95% confidence interval, 77.9-86.9) received recommended management. CONCLUSIONS: There was wide variation across US PEDs in adherence to recommended management of febrile neonates. One in 6 febrile neonates was discharged from the PED; discharged patients were less likely to receive testing or antibiotic therapy than admitted patients. A majority of neonates with SI received recommended evaluation and management. High rates of SI in admitted patients but low return rates for missed infections in discharged patients suggest a need for additional studies to understand variation from the current recommendations. Copyright © 2014 by the American Academy of Pediatrics.

Mehta H.M.,Northwestern University | Glaubach T.,Lurie Childrens Hospital Of Chicago | Corey S.J.,Northwestern University
Advances in Experimental Medicine and Biology | Year: 2014

Granulocyte differentiation and immune response function is a dynamic process governed by a highly coordinated transcriptional program that regulates cellular fate and function, often in a context-dependent manner. Advances in high-throughput technologies and bioinformatics have allowed us to better understand complex biological processes at the genomic and proteomic levels. Components of the environmental milieu, along with the molecular mechanisms that drive the development, activation, and regulation of granulocytes, have since been elucidated. In this chapter, we present the intricate network in which these elements come together and influence one another. In particular, we describe the critical roles of transcription factors like PU.1, CCAAT/enhancer-binding protein (C/EBPα; alpha), C/EBPε (epsilon), and growth factor independent-1 (Gfi-1). We also review granulocyte colony-stimulating factor (G-CSF) receptor-induced signal transduction pathways, their influence on proliferation and differentiation, and the cooperativity of cytokines and chemokines in this process. © Springer Science+Business Media NewYork 2014.

Sweeney M.,Cincinnati Childrens Hospital Medical Center | Rubin J.,Lurie Childrens Hospital of Chicago | Hopkins S.E.,Children's Hospital of Philadelphia
Pediatric Neurology | Year: 2014

Background Neurogenic pulmonary edema may be a complication of multiple neurological processes. Although there is debate regarding the underlying pathophysiology, the recognition of neurogenic pulmonary edema is vitally important because of the high-potential for mortality and need for treatment of the underlying disorder. Methods We present an example of recurrent neurogenic pulmonary edema in an adolescent boy with multiple sclerosis who was diagnosed with pneumonia at the time of initial presentation. We also review the presenting symptoms, physiologic parameters, and imaging findings from published reports of patients with multiple sclerosis presenting with neurogenic pulmonary edema. Results Although all 11 cases found via literature review presented with respiratory symptoms, cardiac dysfunction was variable, as was the presence of other neurological findings. All but one case had a documented medullary lesion. Corticosteroids were effective in resolving symptoms. Three patients were not treated with corticosteroids, and one of these died (onset of pulmonary edema during sleep). Conclusions Awareness of these patients may expedite recognition and treatment of future patients, thus minimizing time to appropriate treatment and reducing mortality. © 2014 Elsevier Inc. All rights reserved.

Lavigne J.V.,Lurie Childrens Hospital of Chicago | Gouze K.R.,Lurie Childrens Hospital of Chicago | Bryant F.B.,Lurie Childrens Hospital of Chicago | Hopkins J.,Lurie Childrens Hospital of Chicago
Journal of Abnormal Child Psychology | Year: 2014

There are distinct dimensions of Oppositional Defiant Disorder (ODD) that have been associated with symptoms of other disorders (heterotypic continuity). The present study compared the heterotypic continuity of a two-factor (Pitt-2) model and the three-factor model incorporated into DSM-5 with symptoms of anxiety and depression. Participants were a diverse community sample of 796 children (38.8 % minority, 49.1 % boys) assessed at ages 4, 5 and 6 years. Symptoms were assessed with the dimensional scales of the Diagnostic Interview Schedule for Children-Young Child version and the Child Symptom Inventory. Dimensions of both the two- and three-factor DSM-5 models were associated with later symptoms of anxiety and depression. The association, however, was weak when accounting for initial levels of internalizing symptoms: thus there was little evidence for the unique contributions of ODD dimensions to symptoms of subsequent internalizing disorders for either model. © 2014 Springer Science+Business Media New York.

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