With the increasing use of magnetic resonance imaging (MRI) in the evaluation of children with endocrine disorders, pituitary stalk thickening (PST) poses a clinical conundrum due to the potential ...for underlying neoplasms and challenges in obtaining a tissue biopsy. The existing literature suggests Langerhans cell histiocytosis (LCH) to be the commonest (16%) oncologic cause for PST, followed by germ cell tumors (GCTs, 13%) (CCLG 2021). As the cancer epidemiology varies according to ethnicity, we present herein the incidence and predictors for oncologic etiologies in Hong Kong Chinese children with PST.
Based on a territory-wide electronic database, we reviewed patients aged < 19 years who presented to three referral centers with endocrinopathies between 2010 and 2022. Records for patients who underwent at least one MRI brain/pituitary were examined (
= 1670): those with PST (stalk thickness ≥ 3 mm) were included, while patients with pre-existing cancer, other CNS and extra-CNS disease foci that were diagnostic of the underlying condition were excluded.
Twenty-eight patients (M:F = 10:18) were identified. The median age at diagnosis of PST was 10.9 years (range: 3.8-16.5), with central diabetes insipidus (CDI) and growth hormone deficiency (GHD) being the most frequent presenting endocrine disorders. At a median follow-up of 4.8 years, oncologic diagnoses were made in 14 patients (50%), including 13 GCTs (46%; germinoma = 11, non-germinoma = 2) and one LCH (4%). Among patients with GCTs, 10 were diagnosed based on histology, two by abnormal tumor markers and one by a combination of histology and tumor markers. Three patients with germinoma were initially misdiagnosed as hypophysitis/LCH. The cumulative incidence of oncologic diagnoses was significantly higher in boys and patients with PST at presentation ≥6.5 mm, CDI or ≥2 pituitary hormone deficiencies at presentation and evolving hypopituitarism (all
< 0.05 by log-rank).
A higher rate of GCTs was observed in Chinese children with endocrinopathy and isolated PST. The predictors identified in this study may guide healthcare providers in Asia in clinical decision making. Serial measurement of tumor markers is essential in management.
Fecal microbiota transplant (FMT) has emerged as a potential treatment for severe colitis associated with graft-versus-host disease (GvHD) following hematopoietic stem cell transplant. Bacterial ...engraftment from FMT donor to recipient has been reported, however the fate of fungi and viruses after FMT remains unclear. Here we report longitudinal dynamics of the gut bacteriome, mycobiome and virome in a teenager with GvHD after receiving four doses of FMT at weekly interval. After serial FMTs, the gut bacteriome, mycobiome and virome of the patient differ from compositions before FMT with variable temporal dynamics. Diversity of the gut bacterial community increases after each FMT. Gut fungal community initially shows expansion of several species followed by a decrease in diversity after multiple FMTs. In contrast, gut virome community varies substantially over time with a stable rise in diversity. The bacterium, Corynebacterium jeikeium, and Torque teno viruses, decrease after FMTs in parallel with an increase in the relative abundance of Caudovirales bacteriophages. Collectively, FMT may simultaneously impact on the various components of the gut microbiome with distinct effects.
Daily concentrations of lead (Pb) were determined for PM
2.5 samples collected from an urban location in Xi’an, China from 2007 to 2009 to assess the effects of the phasing out of leaded gasoline in ...2000. The Pb concentrations (annual average: 0.306 μg m
−3, range: below detection limit to 2.631 μg m
−3) have declined after the phasing out of leaded gasoline, but the concentrations were still higher than those reported in many other cities. Seasonal variations of Pb were significant, with high concentrations in winter, presumably due to the burning of coal, and low concentrations in summer, due to a deep mixed layer and scavenging of aerosols by precipitation. Correlation analyses and enrichment factor calculations both indicated that anthropogenic sources had a large influence on atmospheric Pb. The lead isotope ratios were low in winter (the average
207Pb/
206Pb ratio was 0.843 ± 0.032;
208Pb/
206Pb was 1.908 ± 0.058) and high in summer (
207Pb/
206Pb was 0.860 ± 0.032;
208Pb/
206Pb was 2.039 ± 0.057), suggesting that coal combustion was the major Pb source in winter and vehicular emission was the major Pb source in summer. Positive Matrix Factorization receptor model indicated that there were five major sources for Pb in PM
2.5. Coal combustion was the major contributor, accounting for 39.0% PM
2.5 mass, followed by vehicular emissions (30.4%). Other contributors included 17.8% from industrial emissions, 11.6% from biomass burning, and 1.2% from fugitive dust.
► Pb concentrations (average: 0.306 μg m
−3 during 2007–2009) have declined after the phasing out of leaded gasoline. ► Pb concentrations in Xi’an are still higher than those reported in many other cities. ► Coal combustion was the strongest source for PM
2.5 Mass (39.0%).
Objectives
Tube feeding is prevalent among patients with advanced dementia despite empirical data that suggest its lack of benefit. To provide an alternative to tube feeding for end-of-life patients, ...a careful hand feeding program was launched in a Hong Kong geriatric convalescent hospital in February 2017. We aim to compare the rates of feeding tube insertion before and after program implementation and determine risk factors for feeding tube insertion. For patients on careful hand feeding, we evaluated their sustainability on oral feeding and the rates of hospital readmissions compared with tube feeding patients over the next 12 months.
Design
Retrospective cohort study.
Setting and Participants
Advanced dementia patients ≥60 years with indication for tube feeding due to feeding problems admitted from January 2015–June 2019.
Methods
Data was collected on demographic and clinical variables, initial feeding mode (careful hand feeding vs. tube feeding), subsequent feeding mode changes, and hospital admissions over the next 12 months. Rates of feeding tube insertion, sustainability on oral feeding, and hospital readmissions were compared using Chi-square test. Risk factors for feeding tube insertion were assessed using logistic regression models.
Results
Among 616 advanced dementia patients admitted with feeding problems, feeding tube insertion rate declined significantly after careful hand feeding program implementation (72% vs 51% p<.001). Independent risk factors for feeding tube insertion were admission prior to program implementation, presence of dysphagia alone, dysphagia combined with poor intake, and lack of advance care planning. Among patients on careful hand feeding, 91% were sustained on oral feeding over the next twelve months and did not differ significantly before or after careful hand feeding program implementation (p=.67). There was no significant difference in hospital readmission rates between careful hand feeding patients and tube feeding patients before (83% vs 86%, p=.55) and after careful hand feeding program implementation (87% vs 85%, p=.63).
Conclusions and Implications
A hospital careful hand feeding program significantly reduced the feeding tube insertion rate among advanced dementia patients with feeding problems. The vast majority of patients on careful hand feeding were sustained on oral feeding over the next 12 months but their rate of hospital readmissions remained similarly high after program implementation.
UCBT recipients with TM are at high risk of EF related to low number of stem cells and prior alloimmunization after multiple blood transfusions. Here, we evaluated the safety and efficacy of ...double‐unit UCBT using TT‐containing conditioning regimens in TM. Retrospective analysis of children who underwent double‐unit UCBT for TM in the Prince of Wales Hospital between August 2007 and January 2017, and outcome of double‐unit UCBT for TM was compared with outcome of HLA‐matched sibling BMT. Ten patients, median age 4.2 years, received double‐unit UCBT. All patients except one engrafted at a median of 19 days. None of the patients with successful engraftment had grade III or IV aGVHD. Among nine patients with successful engraftment, six of nine patients evaluable after day 100 developed cGVHD. All patients with cGVHD were well controlled after treatment with steroids and/or supportive care and maintained good quality of life. In comparison with patients receiving BMT, those given UCBT had slower platelet recovery, and more cGVHD. With a median follow‐up of 272 months after BMT and 84 months after UCBT, the 8‐year OS after BMT and UCBT was 92% and 90% (P = .84), whereas 8‐year DFS after BMT and UCBT was 87% and 80% (P = .54). UCB could be an acceptable source of stem cells for transplantation of TM patients when HLA‐matched family bone marrow donors are NA.
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