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BACKGROUND: There is a large body of literature examining factors associated with children’s pre-operative anxiety; however, cultural variables such as ethnicity and language have not been included. AIM: The purpose of this investigation was to examine the role of Latino ethnicity and Spanish-speaking families in pediatric pre-operative anxiety. METHODS: Participants were 294 children aged 2–15 years of age undergoing outpatient, elective tonsillectomy and/or adenoidectomy surgery and general anesthesia. Participants were recruited and categorized into three groups: English-speaking non-Latino White (n = 139), English-speaking Latino (n = 88), and Spanish-speaking Latino (n = 67). Children’s anxiety was rated at two time points before surgery: the time the child entered the threshold of the operating room (Induction 1) and the time when the anesthesia mask was placed (Induction 2). RESULTS: Results from separate linear regression models at Induction 1 and Induction 2 respectively showed that being from a Spanish-speaking Latino family was associated with higher levels of pre-operative anxiety compared with being from an English-speaking family. In addition, young age and low sociability was associated with higher pre-operative anxiety in children. CONCLUSIONS: Clinicians should be aware that younger, less sociable children of Spanish-speaking Latino parents are at higher risk of developing pre-operative anxiety and manage these children based on this increased risk.

Objectives/Hypothesis To evaluate the effect of intraoperative acupuncture on posttonsillectomy pain in the pediatric population. Study Design Prospective, double-blind, randomized, placebo-controlled trial. Methods Patients aged 3 to 12 years undergoing tonsillectomy were recruited at a tertiary children's hospital between February 2011 and May 2012. Participants were block-randomized to receive acupuncture or sham acupuncture during anesthesia for tonsillectomy. Surgeons, staff, and parents were blinded from treatment. Tonsillectomy was performed by one of two surgeons using a standard technique (monopolar cautery), and a single anesthetic protocol was followed. Study endpoints included time spent in the postanesthesia care unit, the amount of opioids administered in the perioperative period, and pain measures and presence of nausea/vomiting from postoperative home surveys. Results Fifty-nine children aged 3 to 12 years were randomized to receive acupuncture (n = 30) or sham acupuncture (n = 29). No significant demographic differences were noted between the two cohorts. Perioperative data were recorded for all patients; 73% of patients later returned home surveys. There were no significant differences in the amount of opioid medications administered or total postanesthesia care unit time between the two cohorts. Home surveys of patients but not of parents revealed significant improvements in pain control in the acupuncture treatment-group postoperatively (P = 0.0065 and 0.051, respectively), and oral intake improved significantly earlier in the acupuncture treatment group (P = 0.01). No adverse effects of acupuncture were reported. Conclusions This study demonstrates that intraoperative acupuncture is feasible, well tolerated, and results in improved pain and earlier return of diet postoperatively. Level of Evidence 1b. Laryngoscope, 125:1972–1978, 2015

Cognitive dysfunction and aberrant behaviors are the hallmarks of childhood neurodevelopmental disorders. Though current diagnostic constructs for these disorders are useful for professional communication and obtaining therapeutic services, the current taxonomic categories are likely to be too heterogeneous to support scientific investigation.1 More homogeneous models are needed to overcome the problem of heterogeneity in our current taxonomy of neurodevelopmental disorders, so that genetic and neural mechanisms underlying the development and course of maladaptive cognition and behavior can be determined.2 Fragile X syndrome (FraX) is caused by a mutation in the FMR1 gene on chromosome Xq27.3; it is the most common known cause of inherited neurodevelopmental disability. The FMR1 gene codes for the fragile X mental retardation protein (FMRP) that regulates the translation of numerous proteins critical for brain maturation and function.3 Lack of FMRP leads to dendritic spine dysmorphogenesis and impaired synaptic plasticity.3 Both male and female individuals with the FMR1 full mutation show intellectual deficits, with typical cognitive level in the moderate-to-severe range of mental retardation in male individuals, and low average intelligence quotient (IQ) in female individuals.4 The most prominent neurobehavioral phenotype associated with FraX is autistic-spectrum behaviors seen in 60 of 90% of male individuals and 25 to 80% of female individuals.5 Autistic behaviors include impairments in social interaction and communication, and repetitive/stereotypic behaviors.4 Previous structural brain imaging studies indicate that abnormalities of brain morphology occur in FraX (see Hessl and colleagues6 for review). In brief, in the context of overall normal brain size, individuals with FraX have excessive caudate nucleus (CN) size and small superior temporal gyrus (STG) and posterior (cerebellar) vermis (PV). Abnormalities in size of both the CN and PV correlate with IQ and FMRP levels.7,8 Furthermore, results from diffusion tensor and functional imaging studies indicate that there is abnormal anterior cerebral-caudate connectivity and function in FraX.9–11 FMRP levels also correlate with anterior cerebral and CN activation during specific functional magnetic resonance imaging tasks in individuals with FraX.11 As a causatively homogeneous disorder where affected children share a common genetic risk factor, FraX is a valuable model from which to learn about pathways leading from specific gene mutation to aberrant brain development and cognitive-behavioral symptoms.2 Accordingly, the aim of this study was to determine the associations among levels of FMRP, neuroanatomic variation, and aberrant cognition and behavior in FraX using multiple complementary image processing and statistical approaches. Based on previous imaging and behavioral findings in FraX6–8 and autism,12 we hypothesized that abnormal morphology of the CN, PV, amygdala, and STG would most strongly distinguish between FraX and control subjects. We further predicted that abnormal morphology would be associated with FMRP levels, IQ, and aberrant behaviors. Though previous studies have identified some neuroanatomic abnormalities in FraX and their association with FMRP levels and IQ,7,8,13,14 this study is novel in several aspects: (1) it uses three-dimensional high-resolution image datasets; (2) new image processing techniques are employed (ie, voxel brain morphometry [VBM] and surface-based modeling); (3) we utilize a novel statistical approach to image analysis (the Quality Receiver Operating Characteristic Curve [QROC]); and (4) it is the largest sample of FraX subjects published to date.