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Collective vigilantism, group violence to punish perceived offenses to a community, is both global and common in the contemporary world. It is also crucial for understanding state formation, contestation, crime, law and justice, inequality, and racial and ethnic conflicts. We review existing definitions and explanations for collective vigilantism, present a new typology of collective vigilantism that considers both the aims and level of organization of participating agents, and highlight important patterns that emerge from recent research, including the contributions to this special symposium. We present an argument for what a political science treatment of the topic can offer and introduce an ambitious research agenda that builds on cross-cutting themes and puzzles that emerge from the special symposium.

Image-guided drainage catheter placement is a commonly performed procedure. While the complication rate is low, one potential complication is iatrogenic bowel traversal (IBT). Prior literature reported up to a 3.0% incidence of IBT events. This retrospective review examined image-guided percutaneous abscess catheter placements over 82 months to characterize the incidence, risk factors, and outcomes of IBT. Of 3,507 catheters placed, there were 13 IBT events, conferring a 0.4% incidence. Rates of IBT were similar whether ultrasound and fluoroscopy or computed tomography was utilized for placement. Of these 13 IBT events, 2 were transgastric, 1 was transcolonic, and 10 were through small bowel. Of these events, one patient died of vasopressor refractory septic shock, four underwent operative repair of the enterotomy, and eight were managed with catheter placement and gradual downsizing. The Society of Interventional Radiology Adverse Event Severity Scale was utilized to further categorize IBT events with observed severity ranging from moderate to life threatening. Although overall incidence has decreased since 35 years ago, IBT events are potentially life-threatening adverse events and further study to identify and minimize risk factors is essential.

How can states prevent armed groups from exploiting local governance gaps to (re)establish territorial control during transitions to national peace? We report results from an experimental evaluation of Colombia’s ComunPaz program, a scalable, inexpensive intervention that sought to replace rebel governance by harnessing complementarities between state and communal authorities and by improving security and justice provision in areas once dominated by FARC, the country’s largest rebel group. We find that ComunPaz enhanced the quality of local dispute resolution, increased citizens’ trust in (some) state institutions, and strengthened coordination between state and communal authorities. It also appears to have reduced citizens’ trust in, and reliance on, armed groups. The program did not, however, increase reliance on either state or communal authorities to resolve disputes, nor did it increase citizens’ trust in communal institutions. We discuss the implications of our findings for peace-building and state-building in countries transitioning from civil war.

What are the legacies of armed resistance? Why do some communities engage in armed mobilization in response to violence, disorder, and insecurity, while others under very similar conditions do not? Focusing on mobilization against organized crime in contemporary Mexico, we argue that historical experiences of armed resistance can have lasting effects on local preferences, networks, and capacities, which can facilitate armed collective action under conditions of rampant insecurity in the long run. Empirically, we study the Cristero rebellion in the early 20th century and grassroots anti-crime mobilization in Mexico during recent years. Using an instrumental variables approach, we show that communities that pushed back against state incursions almost a century earlier were more likely to rise up against organized crime in contemporary times.

The phosphoinositide 3-kinase (PI3K) pathway is a common target for oncologic therapies and mediates much of insulin’s action. The PI3Kα inhibitor alpelisib is effective in advanced breast cancer but causes hyperglycemia in up to 80% of patients. The FDA label recommends metformin as first-line treatment of alpelisib-induced hyperglycemia. There is no consensus on other options. This is a single-center, retrospective review of new alpelisib users at a cancer center in 2021. Manual chart review for periods of exposure to alpelisib and antidiabetic drugs identified 67 patients newly started on alpelisib. Average age was 59 years. Median exposure time to alpelisib was 103 days. Antidiabetic drugs were prescribed in 48% (32/67) of patients, with 25% (17/67) using 2 or more. Of patients who stopped alpelisib, 14% (5/35) were primarily due to hyperglycemia. Hyperglycemia was a contributing cause in another 3 cases. The only antidiabetic drugs significantly associated with glucose reduction in multivariable analysis were metformin (26 mg/dL reduction, 95% CI 6.4 - 45.6) and SGLT2 inhibitors (74 mg/dL reduction, 95% CI 42 - 104) . Diabetic ketoacidosis (DKA) occurred in 6% (4/67) of patients. There was a higher rate of DKA among SGLT2 inhibitor users compared to nonusers (p=0.019) . SGLT2 inhibitors are effective as second-line to metformin for alpelisib-induced hyperglycemia but with a higher rate of DKA. Disclosure M. Weintraub: None. D. Liu: Consultant; Invitae Corporation. J. Flory: None. Funding P30 CA008748

Objective To determine the association of anti-obesity medications (FDA-approved and off-label) with weight loss maintenance over 3-5 years. Methods We performed a retrospective observational study of adults 18-75 years treated for overweight/obesity at a tertiary academic weight management center with an initial visit between April 1st, 2014 and April 1st, 2016. We excluded patients who had a period of follow-up less than 2.5 years or a gap in follow-up of greater than 2 years. Patients who had bariatric surgery, pregnancy, or a medical condition predisposing them to weight loss during the study were also excluded. We extracted key demographic data, medical history, and weight at each visit. Anti-obesity medication (AOM) start date and end date was determined through chart review with attention to patient self-reporting of medication adherence to calculate total exposure to each AOM. We used the weight loss maintenance definition of weight regain ≤ 3% of the nadir weight. Results A total of 428 patients met inclusion criteria for the analysis and were followed for a mean of 4.4 years. The mean age was 50.9 years, 73% were female, and median initial BMI was 34.3 kg/m2. Weight categories were as follows: 19% overweight, 35% class 1, 25% class 2, and 20% class 3 obesity. In addition, 16% had diabetes and 36% had prediabetes. The median nadir BMI was 25.6 with a median maximum weight loss of 14.7%. The median time to achieving nadir weight was 1.9 years. Average weight change from the initial to final visit was -10.6% (-10.9 kg), with a final visit median BMI of 27.4. The proportion of patients who achieved ≥5%, ≥10%, ≥15%, and ≥20% total weight loss was 70.8%, 48.1%, 30.1%, and 16.8%, respectively. During the 4.4 years the patients were followed, weight regain following the nadir weight was 6.3%. At the last observation, 40.2% of all patients had maintained their maximum weight loss. The mean number of AOMs trialed throughout the duration of the study was 4.2. At the final visit, a mean of 2.5 AOMs were being taken. The most common medications observed at the final visit alone or in combination were metformin (76.2% of patients), phentermine (31.1%), topiramate (30.8%), bupropion (29.9%), and semaglutide (24.5%). Conclusion Long-term weight loss of 10.6% was observed over 3-5 years in adults with overweight/obesity who were managed with pharmacotherapy. This study demonstrates clinically significant long-term weight loss maintenance can be achieved with pharmacotherapy and lifestyle interventions. Presentation: Sunday, June 12, 2022 11:30 a.m. - 11:45 a.m.

The explosion of cities and megacities has increased scholars’ and policy markers’ attention to the effects such changes might have on conflict: increasingly, urban environments may alter the nature of warfare but not necessarily the incidence of intrastate war. We argue that high levels of urban concentration—the concentration of populations in one or relatively few urban centers—increases both the likelihood of civil wars and their intensity. Urban concentration limits the ability of the state to project power across space, exacerbating grievances in rural areas, easing rebel control of territory, and enhancing their military strength. At the same time, cities become high-value loci of contestation even as urban warfare constrains conventional state military strength. The result is more symmetrical fighting producing more battle deaths. Cross-national regressions show that urban concentration exerts a crucial effect on the likelihood, nature, and intensity of intrastate warfare.

How can states prevent armed groups from exploiting local governance gaps to (re)establish territorial control during transitions to national peace? We report results from an experimental evaluation of the ComunPaz program, a scalable, inexpensive intervention that sought to replace rebel governance by harnessing complementarities between state and communal authorities and improving security and justice provision in areas once dominated by FARC, Colombia’s largest rebel group. We find that ComunPaz enhanced the quality of dispute resolution at the local level, increased citizens’ trust in (some) state institutions, and strengthened coordination between state and communal authorities. It also appears to have reduced citizens’ trust in, and reliance on, armed groups. The program did not, however, increase reliance on either state or communal authorities to resolve disputes, nor did it increase citizens’ trust in communal institutions. We discuss the implications of our findings for peacebuilding and statebuilding in countries transitioning from civil war.

Governments across the developing world deploy their armed forces for domestic policing. Advocates of these policies tout their crime reduction effects, while detractors claim they undermine human rights. We experimentally evaluate a military policing intervention in Cali, Colombia, one of the country’s most violent cities. The intervention involved recurring, intensive military patrols targeting crime hotspots, randomly assigned at the city block level. Using administrative crime and human rights data, surveys of more than 10,000 residents, and firsthand observations from civilian monitors, we find that military policing had weak (if any) effects on crime during the intervention, and adverse effects following its completion. We observe higher rates of crime, crime witnessing, crime reporting, and arrests in the weeks after the intervention. We also find suggestive evidence of increased human rights abuses, committed by police officers rather than soldiers. The benefits of military policing likely are small and not worth the costs.

Approximately one third of the global prison population is in pretrial detention, waiting for trial. Overreliance on pretrial detention exposes defendants to harsh conditions, exacerbates jail overcrowding, increases recidivism, and favors criminal governance. What policies can resource-strapped countries implement to effectively address excessive pretrial detention? Based on a theoretical model focused on institutional-level efforts, we evaluate an experimental intervention implemented in El Salvador intended to increase pretrial release requests and reduce pre-trial detention. The intervention randomly assigned public defenders to receive specialized legal training, an improved interview protocol, material resources, and increased communication channels. We find that this inexpensive, scalable program increased pretrial release requests from public defenders by nearly 10% (0.228 standard deviations) and increased the success in securing pretrial release by 4.4% (0.114 standard deviations). Heterogeneous treatment effect analyses suggest that the program increased strategic litigation among the most experienced public defenders and has distinct effects for those accused of minor and severe crimes. We find no evidence that the mechanism explaining our results involves changes in public defenders’ attitudes or perceptions about their work environments. Criminal justice programs focusing on pretrial detention may help reduce prison overcrowding in high crime countries.

This chapter examines the role of the Colombian military during the Havana peace negotiations in shaping policy decisions regarding demobilization of guerilla forces. It uses semi-structured interviews with individuals involved in the negotiations to provide an important glimpse into the behind-the-scenes policy negotiations that led to specific provisions in the agreement. It also describes the role of the military in the Colombian peace process. The chapter refers to an analytical model for the logistics of demobilization used by negotiators in Havana and the specific tasks undertaken by the military during the negotiations. It seeks to serve as a point of departure for other peace processes as other countries also strive for an end to their own armed conflicts.

RNA polymerase (Pol) III has a noncanonical role of viral DNA sensing in the innate immune system. This polymerase transcribes viral genomes to produce RNAs that lead to induction of type I interferons (IFNs). However, the genetic and functional links of Pol III to innate immunity in humans remain largely unknown. Here, we describe a rare homozygous mutation (D40H) in the POLR3E gene, coding for a protein subunit of Pol III, in a child with recurrent and systemic viral infections and Langerhans cell histiocytosis. Fibroblasts derived from the patient exhibit impaired induction of type I IFN and increased susceptibility to human cytomegalovirus (HCMV) infection. Cultured cell lines infected with HCMV show induction of POLR3E expression. However, induction is not restricted to DNA virus, as sindbis virus, an RNA virus, enhances the expression of this protein. Likewise, foreign nonviral DNA elevates the steady-state level of POLR3E and elicits promoter-dependent and -independent transcription by Pol III. Remarkably, the molecular mechanism underlying the D40H mutation of POLR3E involves the assembly of defective initiation complexes of Pol III. Our study links mutated POLR3E and Pol III to an innate immune deficiency state in humans.

Why is it so hard to get opposing elites to work together rather than to seek partisan gains and/or political survival? While the credible commitment problem is widely known, there are a number of lesser known obstacles to building trust and trustworthiness between opposing elites. This article presents an account of how some of those obstacles interact through time. Common institutional types, particularly winner-takes-all and power-sharing institutions, force trade-offs between agile responses in the short term and medium-term trust between elites, on the one hand, and between trust among elites in the medium term and the adaptability of agreements in the long term, on the other. We call this the ‘time horizon trilemma’. As an alternative approach, we consider a variant on the two-person consulate used by the Roman Republic for more than 400 years as Rome rose to prominence. In our variant, a ‘turn-taking institution’, opposing executives take short alternating turns as the ultimate decisionmaker within one term. We conduct behavioral games in the experimental lab to provide an initial estimate of the impact of these institutional types – winner-takes-all, requiring consensus only, requiring turn-taking only, or requiring both – on overcoming obstacles to agile responses in the short term, trust among elites in the medium term, and adaptability of agreements in the long term. We find that turn-taking is a promising alternative to solving the time horizon trilemma.

Does violent repression strengthen the state? In this article we explore the legacies of repression by the Mexican government on subsequent patterns of state consolidation. We investigate how a particular form of state repression, forced disappearances of alleged leftist dissidents during the ‘Dirty War’, had path-dependent consequences for different dimensions of state capacity nearly 50 years later. To do so, we rely on data gathered from suppressed Mexican human rights reports of forced disappearances which, to our knowledge, have not been analyzed by social scientists before. Controlling for a rich set of pre-disappearances covariates we find that forced disappearances are positively correlated with contemporary measures of fiscal, territorial, and bureaucratic capacity. However, historical forced disappearances do not help the state to provide security, to consolidate its monopoly over the use of force, or to provide welfare-related public goods in the long run. Moreover, disappearances are negatively correlated with various measures of trust in the government. Forced disappearances committed by the state appear to have long-term yet heterogeneous effects on state consolidation.

Data on non-fermentative Gram-negative rods (NFGNR) bacteremia in children with malignancies are limited. The aim of this study was to present clinical picture, antimicrobial susceptibility pattern, risk factors for resistance and outcome in NFGNR bacteremia in children with cancer. All episodes of NFGNR bacteremia occurring during 2001–2014 in children with cancer in a tertiary-care hospital were retrospectively analyzed. Pseudomonas and Acinetobacter spp. resistant to three or more antibiotic classes and all Stenotrophomonas maltophilia (SM) were defined as multidrug-resistant bacteria (MDR). A total of 80 children (44 males, 0.8–18 years, median 5 years) developed 107 episodes (116 pathogens) of NFGNR bacteremia; Pseudomonas aeruginosa (PA) (51; 43.9%), Acinetobacter baumannii (AB) (21, 18.1%), SM (18, 15.5%); and others (27, 25.2%). The rate of NFGNR bacteremia in children with certain solid tumors (e.g. sarcoma, 12/134 (9.0%)) was comparable to that of hematological malignancies (52/429 (12.2%). Focal infection and septic shock occurred in 16 (14.9%) and four (3.7%) episodes, respectively. Thirty (25.8%) of 116 NFGNR were MDR. The most significant predictors of bacteremia with MDR PA or AB were severe neutropenia (

Spanish Abstract: En agosto del 2019 se cumplieron dos anos de la reincorporacion de las Farc-EP. Este proceso es uno de los principales desafios de la implementacion del Acuerdo Final firmado entre el Estado colombiano y la organizacion guerrillera en noviembre de 2016. Los avances en materia de reincorporacion garantizaran su sostenibilidad. En este documento analizamos las actitudes de los exintegrantes frente al proceso en esta primera etapa, tomando los resultados del Registro Nacional de Reincorporacion (RNR), realizado entre la Agencia Nacional de Reincorporacion (ARN) y el componente Farc del Consejo Nacional de Reincorporacion (CNR). Tras mostrar que hay aspectos positivos en las actitudes de las personas en proceso de reincorporacion, y algunos que deben mirarse con preocupacion, estudiamos que caracteristicas de los exintegrantes y su entorno se asocian con mejores actitudes y condiciones para la implementacion del proceso de reincorporacion. Complementamos este analisis contrastando las actitudes de la poblacion en proceso de reincorporacion con las de la poblacion civil, haciendo paralelos, en terminos de los retos de politica publica, para ambos grupos. La evidencia presentada sirve para canalizar esfuerzos en donde mas parecen necesitarse. English Abstract: As of 2019, two years had passed since the demobilization of the Farc-EP. The reincorporation process of former combatants is one of the main challenges of implementating the Final Agreement signed between the Colombian state and the guerrilla organization in November 2016. Progress on reincorporation will ensure its sustainability. In this document we analyze the attitudes of former members of the Farc-EP with respect to this process during its early phases. To do so, we use the results of the National Reincorporation Registry (RNR), carried out between the National Reincorporation Agency (ARN) and the Farc component of the National Reincorporation Council (CNR). After showing that former members display positive attitudes towards their reincorporation process, and noting some others that raise concerns, we explore which characteristics of former members of the Farc-EP and their environment are associated with better attitudes and conditions for the implementation of this point of the peace agreement. We complement this analysis by contrasting activities of the population in the process of reincorporation with those of the civilian population, drawing parallels in terms of public policy challenges for both groups. The evidence presented in this document sheds light on possible future priorities to determine where efforts should be concentrated.

Spanish Abstract: Aunque las restricciones a motocicletas han sido adoptadas en mas de 25 ciudades en Colombia para reducir el crimen, no existe evidencia empirica que demuestre su efectividad. Este documento evalua el impacto de seis de estas medidas. Para identificar el efecto causal de las politicas, estimamos modelos de diferencia-en-diferencias que explotan la variacion espacial y temporal de las restricciones usando datos georeferenciados de crimen. No encontramos grandes efectos de estas medidas, ni efectos duraderos, sobre el delito. Dado los costos de vigilar su cumplimiento y los costos que se imponen sobre la ciudadania, las autoridades locales deberian buscar otras alternativas de politica publica en materia de seguridad. English Abstract: Although motorcycle restrictions have been adopted to reduce crime in more than 25 Colombian cities, no empirical evidence exists to demonstrate their effectiveness. This document evalutes the impact of six of these restrictions. To identify their causal effects, we estimate difference-in-differences models that exploit spatial and temporal variation in their implementation and georeferenced crime data. We find neither large nor lasting effects of these measures on crime. Given the high costs of assuring compliance with these measures and the costs they impose on citizens, local authorities should seek out other public policy alternatives to improve citizen security.

Objective Cross-national replication of the high rates of overweight/obesity among U.S. pediatric cancer survivors (PCS) is limited. Predictors of weight trajectories of Israeli PCS were examined from diagnosis and end of active cancer treatment to 3 years posttreatment. Methods World Health Organization-derived body mass index (z-BMI) values were calculated at each time point from medical records of 135 Israeli PCS (M diagnosis age = 11.4). A three-section piecewise multilevel model including age, ethnicity, gender, treatment length, and diagnosis as predictors was used to estimate z-BMI trajectories. Results Most participants remained at a healthy weight at all time points. Differing weight trajectories emerged for PCS diagnosed with lymphoma/leukemia versus other cancer diagnoses from diagnosis to end of treatment, but similar weight change patterns were observed posttreatment. Conclusion Replication of U.S. PCS weight trajectories was not observed in Israeli PCS, suggesting the importance of exploring environmental risk factors contributing to obesity among PCS.

Adenosine deaminase 2 deficiency is an autoinflammatory disease, characterized by various forms of vasculitis. We describe 5 patients with adenosine deaminase 2 deficiency with various hematologic manifestations, including pure red cell aplasia, with no evidence for vasculitis.

International organizations and national governments deliver billions of dollars in development assistance each year to citizens in ongoing insurgencies. Existing work shows that development assistance shapes insurgent violence, yet underspecified mechanisms and a failure to test all competing explanations have hampered knowledge cumulation. This article proposes a new theory of insurgent territorial loss to argue that development assistance should increase overall violence by insurgents, and indiscriminate violence in particular. Anti-poverty subsidies incentivize information sharing with the government, increasing incumbent territorial control and forcing insurgents to rely on increased and more indiscriminate violence to recapture territory. A difference-in-differences identification strategy combined with matching tests all existing mechanisms against one another in the context of a conditional cash transfer program in Colombia. The empirics provide support for the territorial loss mechanism, while co...

Autosomal recessive malignant infantile osteopetrosis is a congenital disease characterized by pathologically increased bone density. Recently, the use of whole exome sequencing has been utilized as a clinical diagnostic tool in a number of Mendelian disorders. In this study, whole exome sequencing (WES) was successfully used in six patients with malignant infantile osteopetrosis (MIOP) and identified mutations in four MIOP-related genes (CLCN7, TCIRG1, SNX10, and TNFRSF11A). We report these patients, describe the mutations and review the current literature.

Purpose To evaluate radiological findings in a cohort of 22 patients with infantile malignant osteopetrosis in order to establish the correlation between radiological findings and different genetic backgrounds. Materials and Methods Clinical files, genetic analysis results, and radiological examinations of children treated for osteopetrosis with bone marrow transplantation in a referral center in the last 5 years were retrospectively evaluated. The study received institutional review board (IRB) approval. Results Twenty-two patients were included in the study: 18 males, four females, ages 1 month–9 years 10 months, and the median age was 11 months (mean 23 months). There were 12 patients with different mutations in the TCIRG1 gene, five with mutations in the SNX10 gene, four children harbored RANK mutations, and one patient had a CLCN7 mutation. We noted more severe radiological findings in patients with TCIRG1 and RANK mutations, including fractures, osteopetrorickets, hydrocephalus, and hepatomegaly. Varus deformity of the femoral neck was seen exclusively in patients with a TCIRG1 mutation. Conclusions The variable genetic spectrum of osteopetrosis is associated with a variable radiological presentation. These correlations may be helpful for priorities in genetic analysis.

Nasopharyngeal carcinoma (NPC) is a rare and locally aggressive form of childhood cancer. Treatment of NPC includes chemotherapy and radiotherapy. With current treatment protocols, survival rates for patients with nonmetastatic disease is over 80%. Data regarding very late events including long-term treatment-related morbidities and second malignancies are scarce. We present our data on 42 patients with NPC treated in Israel between 1989 and 2014, and followed until 2019. During follow up, five patients had disease recurrence, and four children developed secondary malignancy. Median time to diagnosis of secondary malignancy was 105 months. Eighty-eight percent of patients have long-term treatment-related morbidities.

Langerhans cell histiocytosis (LCH) is a rare disease characterized by abnormal proliferation of bone marrow-derived histiocytes (Langerhans cells). LCH may manifest orally with single or multiple lesions of the alveolar or basal bone. Ulcerated mucosal lesions may be accompanied by periodontal lesions that present with gingival inflammation, bleeding, recession, necrosis, toothache, dental hypermobility, tooth development abnormalities, and premature tooth loss. This paper presents the case of a five-month-old boy with very early oral manifestations of LCH and describes the combined systemic and dental treatment during a 36-month follow-up. A combined local and systemic approach may be necessary to control oral disease manifestations.

Background Monocular vision has been found to have a negative effect on children's motion processing and motor functions. Yet, knowledge of motor function of survivors of retinoblastoma (RB) with monocular vision (due to enucleation, for example) is limited. This study examined motor function and its relationship to visual-related and health-related quality of life (HRQOL) in survivors of RB with monocular vision. Procedure Parents of 27 survivors of RB, who underwent an enucleation of one eye resulting in monocular vision, and of 21 typically developing children between the ages of 6 and 12, were administered questionnaires relating to their children's motor function (DCDQ), as well as vision-related function (CVFQ) and HRQOL (PedsQL). Results Of the 27 survivors of RB, 7 (25.6%) were found to have difficulties in motor functions, compared with 1 (4.8%) child in the control group. The difficulties were faced mainly in daily function requiring control during movement, including jumping, running, and ball playing. Additionally, significant correlations were found between motor functions and children's QOL. Finally, survivors of RB with monocular vision were found to have lower QOL, specifically physical- and school-related QOL. Conclusion Survivors of RB who have monocular vision have a higher rate of decreased motor function and lower QOL. These results point to a need for ongoing assessment of survivors of RB to allow timely detection of motor deficits and to institute appropriate therapeutic interventions.

Retinoblastoma (RB) is a malignant tumor presenting in the eyes of infants and children, which endangers life, the eye and vision. The treatment of RB has undergone marked changes in recent years, and great progress has been made in our ability to preserve eyes. Over the last three decades most Israeli patients with RB have been treated in the National Specialty Ocular Oncology Service at the Hadassah-Hebrew University Medical Center in Jerusalem.To describe advances in the primary treatment of RB with an emphasis on eye-preserving treatments.The study included a retrospective cohort of patients who were diagnosed and treated at our center over the last three decades. Review of patients' records was approved by the Hadassah IRB.From 1988 to 2014 we diagnosed 290 children (138 girls - 47.6%). The mean age at diagnosis (±SE) was 18.1±1.2 months, median 12.5 months. RB was unilateral in 55.6% of the cases, bilateral in 41.3% and unilateral multifocal in 3.1%. There was an even distribution of disease severity (IRB grouping). Since the advent of IV chemotherapy (IVC) there has been a decrease in the rate of eye enucleation from ~90% to ~30% of the children until the year 2000 with a stable rate thereafter. In the years 1990-2000 there was an increase followed by a decrease in the use of primary external beam radiotherapy (EBRT), and a parallel small increase in the use of brachytherapy from the mid '90s until today. The recently introduced novel treatments - intravitreal (IVitC) and intra-arterial chemotherapy (IAC) - were used as a complimentary treatment to IVC, and not yet as a single primary modality until 2014.IVC replaced the need to enucleate in most of the cases, but 30% of children still require a primary enucleation.IVC usually requires additive treatments (thermal-cryotherapy, trans-pupillary thermotherapy - TTT, brachytherapy and/or local chemotherapy - IVitC and IAC) and with the use of multi-modal therapy many eyes can be preserved. In the period reported in the current manuscript, the use of IAC as a primary treatment approach was only used in isolated cases. In Summary, There have been significant advances in our ability to save eyes, and the field continues to progress.