Subclassification of Bethesda Atypical and Follicular Neoplasm Categories According to Nuclear and Architectural Atypia Improves Discrimination of Thyroid Malignancy Risk

Thyroid, Ahead of Print.


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Getting Your Toddler to Eat

Parenting is hard work. One of the most common challenges we face is teaching our kids to be healthy eaters. As obesity rates in children and adolescents rise, we've seen a large focus on the importance of teaching healthy eating with lots of "dos" and "don'ts." Quite frankly it can be overwhelming. 

In my psychology practice, I treat children and adolescents with feeding difficulties ranging from your typical picky eating to more extreme restrictive eating that leads to medical concerns.

I hear parents share their challenges, frustrations, and sometimes feelings of defeat. Parents come to me for help with feeding difficulties, and as a new mom embarking on my own journey of teaching my daughter to eat well, I never fathomed I would face some of these same challenges and frustrations. I figured I know how to shape a health eater, right? Well, what I forgot is that my 18-month old daughter is no different than any other kid!

My title at home is Mom, not Dr. Shelton, and I find myself veering from the very advice I provide every day to my patients and families. One of the most important we talk about, and what I must remind myself of, is what Ellyn Satter, a dietitian and feeding expert, coined as the division of responsibility in feeding – Parents are responsible for what is presented to eat and the manner in which it is presented.  Kids are responsible for how much and even whether they eat. As a parent, this is sometimes a hard rule to follow because of our own parenting worries about our children's growth and nutrition. However, this rule truly helps avoid unnecessary food battles with your toddler. Here are some other important mealtime strategies to keep in mind if you have a picky eater.

1. Have scheduled meals and snacks. Typically we recommend 3 meals and 2-3 snacks throughout the day so your toddler has an opportunity to eat every 2 or 3 hours. Keeping a consistent daily schedule is important, too. Scheduled meals and snacks help avoid grazing throughout the day. You want your toddler to come to the table hungry and ready to eat. Otherwise, they won't be motivated to eat much or try new foods.
2. Plan ahead. You're in charge of choosing the food for meals and snacks. Provide a variety of foods during the meal/snack so your toddler can pick and choose what she wants to eat.
3. Don't short-order cook. If you child refuses a meal or snack, don't get up and make them something else. That gives your kiddo the message that they are not expected to eat what the family eats. It may seem like you're wasting food if your toddler doesn't eat very much, but in the long run you will teach you little one to eat what the rest of the family eats.
4. Limit mealtimes to 20-30 minutes and snacks to 15 minutes. Keeping a kiddo at the table until they have finished their plate can lead to more food battles. Many parents worry that their kids will starve if they don't eat their meal. But rest assured that your little one has 5-6 chances to each throughout the day. If they don't eat much at one meal/snack, they'll probably be hungrier for the next meal/ snack.
5. Be realistic about portions. Toddlers don't need to eat very much to meet their nutritional needs. If you're worried about whether he's eating enough, talk with your pediatrician.
6. Expose, expose, expose. Toddlers can take a long time to warm up to new foods. If you don't expose them to foods, they'll never have the opportunity to warm up to it. Continuing to offer a new food leaves it as an option. One of those times, she might take you up on it! Consider it a success if she tastes the food but then takes it back out of her mouth. The more she does this, the more likely it is she might eat the food.
7. Tolerate some mess. This is a hard one for parents, my husband included. Toddlers use their fingers and tend to be messy. Or if your toddler is like my daughter, she spends more time smashing her food between her fingers or tossing it around on her tray than actually eating. She tells us she does not like a food or is all done by dropping food on the floor. I have to remember that she is not trying to annoy us. She's simply learning about her food and how to communicate with us. We have to teach our kids expectations for mealtime. It's okay to set limits and say "no" to teach your kiddos to keep their food on their plate. Model other ways your kiddo can tell you she's all done with mealtime. If they continue to misbehave, you can end mealtime.
8. Don't let your kiddo fill up on juice or milk. Many toddler love to drink juice and milk. If they fill up on those, they will be less interested in eating at meals because they've already gotten enough calories from their drinks. Limit juice and milk to meals/ snacks and offer water between meals/ snacks. Talk with your pediatrician about how much juice or milk to offer each day.
9. Make mealtimes pleasant. Most importantly, take the focus off of eating. Meals are a time to spend with your family and to enjoy each other. Talk about your day, something fun ahead, anything! Leave electronics somewhere else and turn off the TV!

The post Getting Your Toddler to Eat appeared first on ChildrensMD.

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Butterfly cartilage tympanoplasty outcomes: A single-institution experience and literature review

Publication date: Available online 29 March 2018
Source:American Journal of Otolaryngology
Author(s): Mejd Jumaily, Joel Franco, Jim Gallogly, Joshua L. Hentzelman, Dary J. Costa, Alan P.K. Wild, Anthony A. Mikulec
PurposeIn 1998, Dr. Eavey described the trans-canal inlay butterfly cartilage tympanoplasty technique, also known as cartilage button tympanoplasty. Many retrospective studies have since demonstrated its efficacy and decreased operative time when compared to underlay and overlay tympanoplasty techniques. The butterfly cartilage tympanoplasty approach uses only a cartilage graft to repair tympanic membrane perforations. The aim of this study was to review the literature for studies that examined butterfly cartilage tympanoplasty success rates and outcomes and compare them to outcomes from our cohort.Materials and methodsButterfly cartilage tympanoplasties were performed in 23 pediatric patients and 7 adult patients. We evaluated the tympanic membrane perforation closure rate and hearing results measured by closure of the air-bone gap.ResultsThe reviewed studies evaluating butterfly cartilage tympanoplasties demonstrated perforation closure rates between 71%–100%. The hearing outcomes in the reviewed literature varied, although the majority reported improved hearing. In our cohort, 21 of the 32 repaired tympanic membrane perforations demonstrated complete perforation closure. The mean follow-up length was 13.4 months. The mean air-bone gap decreased from 13.4 dB to 6.9 dB.ConclusionsThe butterfly cartilage/cartilage button technique is effective in closing tympanic membrane perforations and decreasing the air-bone gap in both adults and children.



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Tube patency: Is there a difference following otic drop administration?

Publication date: Available online 29 March 2018
Source:American Journal of Otolaryngology
Author(s): Joseph E. Dohar, Chung H. Lu
PurposeMany surgeons instill peri-operative otic drops to maintain tube patency. A post-hoc analysis of three randomized, controlled studies involving a one-time administration of ciprofloxacin (OTO-201) given instead of otic drops perioperatively was conducted to evaluate tube patency in patients who did and did not receive otic drops as defined within the study protocol.Materials and methodsPost-hoc, retrospective analysis from three prospective, randomized, double-blind trials, (Phase 1b study [n = 83] and two Phase 3 studies [n = 532]) which enrolled children with confirmed middle ear effusion on the day of tympanostomy tube surgery and then randomized to placebo/sham (tubes alone) or OTO-201 and studied over a 28-day observation period. Patients with observed otorrhea post-tube were provided otic drops in the studies. An analysis was performed on the combined studies to evaluate tube patency, determined by pneumatic otoscopy and tympanometry, at four defined study visits over 28 days after the initial tube placement.ResultsThe analysis included 591 total patients with similar baseline demographics across groups. Tube patency ranged from 87 to 95% for patients who received otic drops, and from 96 to 99% for patients who did not receive otic drops.ConclusionBased on a retrospective post-hoc analysis from three randomized controlled trials in nearly 600 patients, tympanostomy tube occlusion rates was not increased in patients who did not receive otic drops. From this analysis, occlusion is likely caused primarily by peri-operative otorrhea since patency rates approached 99% in the absence of this complication.



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Editorial Board

Publication date: April 2018
Source:Autoimmunity Reviews, Volume 17, Issue 4





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The Impact of Postreperfusion Syndrome on Acute Kidney Injury in Living Donor Liver Transplantation: A Propensity Score Analysis

BACKGROUND: Postreperfusion syndrome (PRS) has been shown to be related to postoperative morbidity and graft failure in orthotopic liver transplantation. To date, little is known about the impact of PRS on the prevalence of postoperative acute kidney injury (AKI) and the postoperative outcomes after living donor liver transplantation (LDLT). The purpose of our study was to determine the impact of PRS on AKI and postoperative outcomes after LDLT surgery. METHODS: Between January 2008 and October 2015, we retrospectively collected and evaluated the records of 1865 patients who underwent LDLT surgery. We divided the patients into 2 groups according to the development of PRS: PRS group (n = 715) versus no PRS group (n = 1150). Risk factors for AKI and mortality were investigated by multivariable logistic and Cox proportional hazards regression model analysis. Propensity score (PS) analysis (PS matching and inverse probability of treatment weighting analysis) was designed to compare the outcomes between the 2 groups. RESULTS: The prevalence of PRS and the mortality rate were 38% and 7%, respectively. In unadjusted analyses, the PRS group showed more frequent development of AKI (P

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Anesthetics Influence Mortality in a Drosophila Model of Blunt Trauma With Traumatic Brain Injury

Background: Exposure to anesthetics is common in the majority of early survivors of life-threatening injuries. Whether and to what degree general anesthetics influence outcomes from major trauma is unknown. Potential confounding effects of general anesthetics on outcome measures are usually disregarded. We hypothesized that exposure to isoflurane or sevoflurane modulates the outcome from blunt trauma with traumatic brain injury (bTBI). Methods: We tested the hypothesis in a novel model of bTBI implemented in Drosophila melanogaster. Fruit flies of the standard laboratory strain w1118 were cultured under standard conditions. We titrated the severity of bTBI to a mortality index at 24 hours (MI24) of approximately 20% under control conditions. We administered standard doses of isoflurane and sevoflurane before, before and during, or after bTBI and measured the resulting MI24. We report the MI24 as mean ± standard deviation. Results: Isoflurane or sevoflurane administered for 2 hours before bTBI reduced the MI24 from 22.3 ± 2.6 to 10.4 ± 1.8 (P

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