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The article presents summaries of studies from various pediatric and sport medicine journals. M. Tertti and colleagues researched the degree of degenerative disc disease in young gymnasts. E. Hata and K. Aoki examined the effects of physical training and competitive sports on the age of menarche in young girls. Other studies looked at the anaerobic threshold in boys, body composition in adolescent boys, exercise tests to detect the release of growth hormones, and the effects of medication on exercise in children with asthma.

An unresponsive patient in the postoperative period is a serious complication that can be caused by anesthetics. However, nonanesthetic causes should also be considered. In this case report, we present an unresponsive postoperative patient diagnosed with possible psychosomatic catatonia. We further describe a systematic approach to the unresponsive patient in the postanesthesia care unit (PACU). While not an uncommon occurrence, catatonia is a complex psychomotor syndrome that can be difficult to diagnose; however, catatonia should be considered in unresponsive postoperative patients.

Background: Second-line therapy is frequently utilized for metastatic urothelial carcinoma, but there are limited data to guide this approach. While an assessment of overall survival based on registry data may not capture the impact of second- and third-line therapies on clinical outcome, this may be reflected in relative conditional survival (RCS)., Methods: Patients with stage IV urothelial carcinoma diagnosed from 1990-2010 were identified from the Surveillance, Epidemiology and End Results (SEER) dataset. The association of clinicopathologic variables with disease specific survival (DSS) was explored through univariate and multivariate analyses. DSS in subgroups divided by time period (1990-2000 v 2001-2010) was compared using the Kaplan-Meier method and log-rank test. One-year RCS at annual landmarks up to 5 years was compared in subgroups divided by time period., Results: Of 261,987 patients diagnosed with urothelial carcinoma from 1990-2010, 3,110 patients met criteria for the current analysis. Characteristics of patients diagnosed between 1990 and 2000 (n = 810) and 2001 to 2010 (n = 2,300) were similar and there was no significant difference in DSS between the two groups. On multivariate analysis, older age (age ≥ 80) was associated with shorter DSS (HR 1.79, 95%CI 1.48-2.15), but no association was found between time period of diagnosis and outcome. One-year RCS improved substantially through successive annual landmarks up to 5 years, but no differences were seen in subgroups divided by time of diagnosis., Conclusions: No difference in RCS was observed amongst patients with stage IV urothelial carcinoma diagnosed from 1990-2000 and 2001-2010. A lack of difference in RCS (more so than cumulative DSS) may reflect a lack of progress in salvage therapies for the disease.

Clinical guidelines suggest neoadjuvant cisplatin-based chemotherapy prior to cystectomy in the setting of muscle-invasive bladder cancer (MIBC). A creatinine clearance (CrCl) >60 mL/min is frequently used to characterize cisplatin-eligible patients, and use of the CKD-EPI equation to estimate CrCl has been advocated. From a prospectively maintained institutional database, patients with MIBC who received cystectomy were identified and clinicopathologic information was ascertained. CrCl prior to surgery was computed using three equations: (1) Cockcroft-Gault (CG), (2) CKD-EPI, and (3) MDRD. The primary objective was to determine if the CG and CKD-EPI equations identified a different proportion of patients who were cisplatin-eligible, based on an estimated CrCl of >60 mL/min. Cisplatin-eligibility was also assessed in subsets based on age, CCI score and race. Actuarial rates of neoadjuvant cisplatin-based chemotherapy use were also reported. Of 126 patients, 70% and 71% of patients were found to be cisplatin-eligible by the CKD-EPI and CG equations, respectively (P = 0.9). The MDRD did not result in significantly different characterization of cisplatin-eligibility as compared to the CKD-EPI and CG equations. In the subset of patients age >80, the CKD-EPI equation identified a much smaller proportion of cisplatin-eligible patients (25%) as compared to the CG equation (50%) or the MDRD equation (63%). Only 34 patients (27%) received neoadjuvant cisplatin-based chemotherapy. Of the 92 patients who did not receive neoadjuvant chemotherapy, 64% had a CrCl >60 mL/min by CG. In contrast to previous reports, the CKD-EPI equation does not appear to characterize a broader span of patients as cisplatin-eligible. Older patients (age >80) may less frequently be characterized as cisplatin-eligible by CKD-EPI. The discordance between actual rates of neoadjuvant chemotherapy use and rates of cisplatin eligibility suggest that other factors (e.g., patient and physician preference) may guide clinical decision-making.

Background: Because of limited genetic tools for use in Helicobacter pylori, tests routinely applied in other bacteria for demonstrating a gene's role in viability and other phenotypes have not been applied to this organism. In a mutational study of putative response regulator genes, we aimed to develop such tools for H. pylori., Materials and Methods: We attempted to mutate five response regulator genes by allelic exchange insertional mutagenesis. For genes that yielded no viable mutants, a second copy of the gene was inserted into the chromosome via a suicide vector, and it was seen if providing the second copy would permit the gene's disruption. For genes that yielded mutants with selectable phenotypes, a strategy was developed for reversion whereby an intact copy of the gene is introduced to the organism by transformation with PCR products. Following this procedure, revertants were selected by phenotypic tests then tested for genetic reversion., Results: After failure to attain transformants upon attempted mutation of genes HP0166 and HP1365, we inserted a second copy of each gene within the H. pylori chromosome. In each case the second copy relieved the block of transformation. Mutation of genes HP0703 and HP1021 gave non-motile and small-colony phenotypes, respectively. Following transformation with PCR products containing intact copies of the genes, both phenotype and genotype had reverted following phenotypic selections., Conclusions: The methods used in this study provide new approaches for confirming suspected genotype/phenotype associations and should be widely applicable in the study of H. pylori.

This study examines patterns of growth in height and weight among children (< 60 months) of highland and coastal agricultural communities of Ecuador. Highland children are significantly shorter, but not significantly lighter than their coastal peers. Linear growth rates (cm/6 months) are comparable between the two samples. Growth rates for body weight (kg/6 m) are similar in highland and coastal boys, whereas highland girls display larger weight gains than their coastal counterparts. In both regions, linear growth is compromised to a much greater extent than growth in body weight, and growth faltering for both height and weight is most pronounced between birth and 24 months of age. The similarity in growth rates between the highland and coastal samples suggests that high altitude hypoxia plays a relatively small role in shaping growth during the first five years after birth. Rather, it appears that most of the disparity in height between the two samples can be attributed to differences established by 6 months of age. The pattern of growth retardation seen in both regions during the first 24 postnatal months is similar to that observed among impoverished populations throughout the world and is likely associated with the influence of nutritional and disease stressors. After 2 years of age, little or no "catch up" growth is seen in height, whereas improvements in weight gain are more pronounced, especially among highland girls. Ongoing research is investigating the nutritional and socio-economic correlates of growth within each region.

This paper reviews the results of studies examining the impacts of agricultural commercialization on food consumption and nutritional status carried out over the last 10 years. Several conclusions can be drawn. First, the income effects of shifts to cash cropping are highly dependent on pricing policy for cash crops. Short term gains seen in some schemes are often highly dependent on the maintenance of high prices for commercial crops. Second, those schemes in which subsistence production is protected or stabilized are more likely to show positive results with an increase in income generated from cash cropping. Third, increased income does not translate directly into increased food consumption at either the household or individual (child) level. Shifts in control of income from women to men are important. Fourth, morbidity, especially from diarrheal disease is an important predictor of child growth. A failure to improve morbidity of children may offset gains in food consumption and in some instances a decrease in the time women have to care for their children as a result of commercialization has resulted in greater morbidity among children. Finally, the question "Who benefits and who loses?" is rarely addressed in these studies. The impacts of commercialization are mixed. They are highly dependent on the nature of the crop, the control of production and income, the allocation of household labor, the maintenance of subsistence production, land tenure, and pricing policies for both cash crops and food stuffs. It is these 'intervening' factors, not crop choice, that appear to be the most crucial in the nutritional status of rural people. Economic, food and agricultural policies and programs that advantage the most vulnerable population groups are the most likely to provide positive benefits in terms of food security and nutritional status. To place the emphasis on commercialization per se is to misplace it.

This study examined the validity of the Caltrac motion sensor for measuring physical activity in young children and described change over time in physical activity among 47 preschool children from obese and nonobese families. Children were videotaped in a controlled setting while wearing Caltrac motion sensors and also wore Caltracs at home. Caltrac readings and an observational measure of physical activity were significantly related in both Year 1 ( r = .86) and Year 2 ( r = .83), and outside play was associated with higher Caltrac scores ( r =.43). In addition, physical activity among young girls with obese parents decreased significantly from Year 1 to Year 2.

Two studies were conducted to determine the validity of various measures of physical activity in young children. In Study 1, 21 preschool children were utilized to explore how well measures of children's activity obtained from parents, teachers, and the children predicted observed behavior at school and in the home. Study 2 (n = 51 preschool children) focused on the predictive validity of the Caltrac motion sensor. In both studies, detailed minute-by-minute ratings of children's activity in Study 1 were generally ineffective in predicting observed physical activity. Children's activity preferences, however, were significantly related to the proportion of high intensity physical activity performed. In Study 2, there was a significant relationship (r = .86, p less than .0001) between Caltrac readings and observed physical activity. This correlation was similar for boys and girls, normal and overweight children, and younger and older children. These findings suggest that the Caltrac monitor may provide a valid index of individual differences in physical activity in young children.

This article describes a method of collecting and analyzing itemized grocery receipts for use in epidemiological studies. As part of a larger study of children's food acquisition and exercise habits related to cardiovascular disease, a sample of 50 families was asked to keep itemized grocery receipts for a 2-week period. To control for bias as a result of differences in food consumption and food acquisition, mothers were asked to log meals eaten away from home, food used from home production, and gifts of foods. Items on the receipts were coded according to food groups and whether they represented child-prompted purchases. The items were expressed in terms of the percentage of the food dollar each category represented. Data from the survey were compared with data collected in national surveys. The method was found to be relatively non-intrusive, easily carried out, and eliminated many of the problems associated with non-response, respondent burden, and recall characteristic of other food account methods. It is suggested as a feasible way of characterizing the family food environment in epidemiological studies.

This paper addresses two important methodological problems in the study of diet and nutrition. These are 1) the problems of looking at individual variations in diet within a system of shared dietary norms, and 2) the difficulties in organizing the collection and analysis of data on the circumstances that account for individual differences in diet. It is suggested that an environment provides several alternatives for meeting nutrient requirements, corresponding to alternative methods of food getting. These alternatives are called "nutritional strategies." The environment, including both its physical and social aspects, also imposes constraints on the ability of families to follow particular nutritional strategies. a family's strategy depends on its ability and desire to exploit particular methods of food getting. Data from a small agricultural community in Mexico are used to illustrate this approach. Several alternative strategies are outlined and are seen to be based on differential use of food potentially available to families from 1) subsistence agriculture; 2) purchase; and 3) gathering of wild foods. A focus on alternative nutritional strategies emphasizes the importance of dietary variation, which, at the same time, allows for an understanding of the effects of different variables on food choice.

Although many studies as well as conventional wisdom suggest that increases in income result in improved diet and nutritional status in rural areas of developing countries, several recent studies have failed to demonstrate such a relationship. In this paper the relationships between material wealth and income and dietary strategies are examined for an agricultural community in rural Mexico. A superficial examination focusing on summary indices of dietary adequacy frequently cited in the literature and indices of wealth and income demonstrates a positive relationship between them in this community. However, an examination of the same data emphasizing alternative dietary strategies to achieve nutritional adequacy shows a more complex picture. Increasing income is associated with consumption of purchased foods especially foods of animal origin, and is not associated with the consumption of staple foods produced within the household. Diets dependent on purchased foods do not necessarily meet nutritional needs more adequately than diets which rely on agricultural products and gathered foods. Among the implications of this research are a need for a method of analysis which focuses on alternative nutritional strategies available in particular settings, and a need to reassess the relative importance of income generating activities and subsistence agriculture in areas undergoing agricultural change.