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Background Hematopoeitic cell transplantation (HCT) in childhood has been associated with late complications including endocrine, neurocognitive, and cardiopulmonary abnormalities. Little is known about the complications of transplantation in infants. Procedure Eligible subjects underwent HCT for acute lymphoblastic leukemia (ALL) or acute myelogenous leukemia (AML) at less than 3 years of age. Seventeen out of 33 eligible patients were evaluated, transplanted between 1981–2000. Eleven patients had AML, 11 were female. Preparative regimen included total body irradiation (TBI) for eleven. Age at HCT ranged from 0.58 to 2.97 years, and survival 3.25 to 22.33 years. Patients underwent physical and laboratory evaluation, dual-energy X-ray absorptiometry (DXA) scan, bone age X-ray, neuropsychological, and quality of life (QOL) evaluation. Results Identified abnormalities included: growth hormone deficiency (59%), hypothyroidism (35%), osteochondromas (24%), decreased bone mineral density (24%), and dyslipidemias (59%). Two patients developed a second malignancy. Neuropsychological testing revealed average intelligence quotient (IQ) with attention deficits and other weaknesses for most patients. There were no overall differences between QOL in these children when compared to population norms. Conclusions Of the survivors evaluated, typical late effects seen after radiation exposure are common, yet most subjects were doing well without major ongoing medical issues. Dyslipidemias affect more than half of patients and may be associated with metabolic syndrome, placing patients at increased risk for early cardiovascular disease. Even in this group of patients where the majority was exposed to TBI at a very young age, most are functioning at an average or above-average level. Pediatr Blood Cancer 2007;49:958–963. © 2007 Wiley-Liss, Inc.

Brief, gentle arm restraint is widely used in experimental studies of children's anger, but the pattern of responses generated by such restraint has been incompletely described. We now describe a hierarchy of responses within trials as well as an escalation across trials that have both methodological and theoretical significance. Mothers of 87 15-month olds prevented them from playing with a toy by restraining their arms on two consecutive 30 sec trials. Physical struggling was the first and most frequent response; children who struggled were significantly more likely to vocalize, and those who vocalized were significantly more likely to show facial expressions of anger. The children's responses became more probable, rapid, and intense during Trial 2 restraint. Overall, the hierarchy was orderly enough to meet criteria for Guttman scalability. The particular sequence observed suggests situational, as opposed to bio-energetic, ordering of responses. Methodologically, the two trial paradigm is a simple, ecologically valid model for studying anger escalation that parallels the “attack priming” of aggression in other species. The magnitude and persistence of anger priming may provide novel measures of anger regulation. Theoretically, the existence of an orderly response hierarchy is consistent with previous observations suggesting that, within a situational context, the sequential appearance of specific behaviors may indicate progressive increases in anger intensity. Aggr. Behav. 33:508–518, 2007. © 2007 Wiley-Liss, Inc.

OBJECTIVE—Long-standing type 1 diabetes is associated with deficits on neurocognitive testing that suggest central white matter dysfunction. This study investigated whether diffusion tensor imaging (DTI), a type of magnetic resonance imaging that measures white matter integrity quantitatively, could identify white matter microstructural deficits in patients with long-standing type 1 diabetes and whether these differences would be associated with deficits found by neurocognitive tests. RESEARCH DESIGN AND METHODS—Twenty-five subjects with type 1 diabetes for at least 15 years and 25 age- and sex-matched control subjects completed DTI on a 3.0 Tesla scanner and a battery of neurocognitive tests. Fractional anisotropy was calculated for the major white matter tracts of the brain. RESULTS—Diabetic subjects had significantly lower mean fractional anisotropy than control subjects in the posterior corona radiata and the optic radiation (P < 0.002). In type 1 diabetic subjects, reduced fractional anisotropy correlated with poorer performance on the copy portion of the Rey-Osterreith Complex Figure Drawing Test and the Grooved Peg Board Test, both of which are believed to assess white matter function. Reduced fractional anisotropy also correlated with duration of diabetes and increased A1C. A history of severe hypoglycemia did not correlate with fractional anisotropy. CONCLUSIONS—DTI can detect white matter microstructural deficits in subjects with long-standing type 1 diabetes. These deficits correlate with poorer performance on selected neurocognitive tests of white matter function.

Advances in the treatment of childhood cancers have greatly improved survivorship. Success has not come without cost, however, as survivors are at risk for late effects of treatment, including neurocognitive late effects (e.g., difficulties with thinking and reasoning). In the advent of chemotherapy-only protocols, researchers are examining neurocognitive sequelae of these agents to understand the specific role of chemotherapy in neurocognitive changes and the mechanism through which these occur. In this review, we examine the state of the literature on neurocognitive late effects after chemotherapy and their proposed neural mechanisms.