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•Ultrasound can be used effectively to visualise location of vaccine deposition.•60° or 90° angle of injection resulted in an IM vaccination for most individuals.•Individuals with a BMI>25 were less likely to receive IM vaccinations.•A 25mm needle may not be sufficient for IM vaccination in obese individuals. Globally, recommendations differ on the ideal angle of needle insertion to ensure vaccinate deposition in muscle for optimal safety and immunogenicity. This study aimed to compare the level of vaccinate deposition during vaccination, using two different needle angles (60° and 90°), in young children, adolescents and adults. In this randomized cross-over study, two doses of a licensed hepatitis vaccine, were administered to study participants, at a 60° or 90° angle using a fixed template. Ultrasonography was performed with a Philips iu22 ultrasound system. Real time clips and hard copies of images were recorded showing the injection and level of deposition of the vaccinate. Reactogenicity at the site of administration was assessed by participants/parents. Nineteen participants were enrolled including children, adolescents and adults. Of the total 38 injections performed, 29 (76%) were confirmed by ultrasound as intramuscular (IM), 3 (8%) as not IM, and 6 (16%) unknown. For vaccinations visualised and administered at 60°, 87% (13/15) were intramuscular vs 94.1% (16/17) for those administered at 90°. A body mass index (BMI)≤25 was associated with a higher likelihood of IM injection compared to BMI>25 (p=0.038). There were no differences in reactogenicity for either 60° or 90° angle of administration. For the majority of vaccinees, a 60–90° angle of vaccine administration is appropriate for IM deposition of vaccinate. The likelihood of intramuscular deposition is reduced for individuals with a BMI>25. The increasing rates of obesity globally highlight the importance of tailoring vaccination procedures accordingly.

Objective: Globally, recommendations differ on the ideal angle of needle insertion to ensure vaccinate deposition in muscle for optimal safety and immunogenicity. This study aimed to compare the level of vaccinate deposition during vaccination, using two different needle angles (60 degree and 90 degree ), in young children, adolescents and adults. Methods: In this randomized cross-over study, two doses of a licensed hepatitis vaccine, were administered to study participants, at a 60 degree or 90 degree angle using a fixed template. Ultrasonography was performed with a Philips iu22 ultrasound system. Real time clips and hard copies of images were recorded showing the injection and level of deposition of the vaccinate. Reactogenicity at the site of administration was assessed by participants/parents. Results: Nineteen participants were enrolled including children, adolescents and adults. Of the total 38 injections performed, 29 (76%) were confirmed by ultrasound as intramuscular (IM), 3 (8%) as not IM, and 6 (16%) unknown. For vaccinations visualised and administered at 60 degree , 87% (13/15) were intramuscular vs 94.1% (16/17) for those administered at 90 degree . A body mass index (BMI) less than or equal to 25 was associated with a higher likelihood of IM injection compared to BMI>25 (p = 0.038). There were no differences in reactogenicity for either 60 degree or 90 degree angle of administration. Conclusion: For the majority of vaccinees, a 60-90 degree angle of vaccine administration is appropriate for IM deposition of vaccinate. The likelihood of intramuscular deposition is reduced for individuals with a BMI>25. The increasing rates of obesity globally highlight the importance of tailoring vaccination procedures accordingly.

OBJECTIVE:--Obese children have severe endothelial dysfunction as measured by flow-mediated dilation (FMD). We have shown that folic acid normalizes endothelial function in children with type 1 diabetes who have a similar degree of endothelial dysfunction but lower total plasma homocyst(e)ine (tHcy) and higher folate status. Our aim was to evaluate, for the first time, the effect of folate supplementation on endothelial dysfunction in obese children. RESEARCH DESIGN AND METHODS--A total of 53 obese subjects (26 male, mean ± SD age 13.3 ± 2.2 years, and BMI Z score 2.29 ± 0.25) participated in a randomized, double-blind, placebo-controlled, parallel trial of oral folic acid (5 mg/day) or placebo for 8 weeks. Before and after the intervention, we assessed endothelial function (FMD), smooth muscle function (glyceryl trinitrate-induced dilatation [GTN]), high-sensitivity C-reactive protein (hsCRP), tHcy, serum folate, red cell folate (RCF), and lipids. RESULTS:--There were no group differences at baseline. FMD did not change with the intervention (folic acid group pre- and postintervention: 6.42 ± 5.03 and 6.56 ± 4.79%, respectively, vs. placebo group: 5.17 ± 3.54 and 5.79 ± 4.26%, respectively; P = 0.6). Folate supplementation increased serum folate and RCF by 18.4 nmol/l (P < 0.001) and 240.1 nmol/l (P < 0.001), respectively, and decreased tHcy by 0.95 μmol/l (P = 0.008). The intervention did not change GTN, hsCRP, or lipids. CONCLUSIONS:--Folic acid supplementation does not improve endothelial function in obese children without diabetes despite increasing folate status and reducing tHcy. This is in contrast to the response to folate in children with type 1 diabetes.

We report an unusual cause of intestinal obstruction in a 16-month-old boy who presented with abdominal pain of 6 h duration. The patient was thought to have an intussusception, with plain radiographic evidence of a small-bowel obstruction (SBO). A subsequent US examination showed no evidence of intussusception but resulted in a diagnosis of SBO caused by the ingestion of whole dried apricots. The apricots had been eaten several hours earlier and had swelled in the intestinal lumen. The US imaging findings and experimental correlation are presented.

Have you seen the television show ‘MythBusters’? It was decided to carry out a radiographic version of ‘MythBusters’. The study involved the investigation of the urban myth about a female radiographer who accidentally x‐rayed her hand, only to discover that her diamond engagement ring was a fake. To prove or disprove the legend, a number of natural diamonds and cubic zirconia crystals were radiographed. Sure enough, there was a definite and consistent difference between the resultant images. The study confirmed part of the myth that radiography can differentiate between a diamond and a cubic zirconia fake diamond.

Even with the advent of more specialised imaging modalities such as fluoroscopic contrast examinations, CT and MRI, the plain abdominal radiograph remains the initial imaging modality in investigating the signs and symptoms of suspected gut pathology. However, ultrasound is playing an increasing part in the detection of gut pathology in paediatric patients. At our hospital, when plain abdominal radiography does not provide a diagnosis, ultrasound is commonly requested to rule out conditions that require urgent attention, such as intussusception, appendicitis and midgut malrotation and volvulus. After these conditions have been excluded however, the ultrasound examination can frequently lead to the diagnosis of several other conditions, including gastroenteritis, Crohn's disease, mesenteric lymphadenopathy and less commonly, duplication cysts, bezoas, and haemolytic uraemic syndrome. Although plain radiography of the abdomen may be suggestive of gut pathology, the additional information provided by sonography often provides a specific diagnosis, leading to better patient care. This paper is a presentation of ten case studies demonstrating the use of ultrasound to augment plain X‐ray findings, in order to obtain a final diagnosis.

Cystic dysplasia of the rete testis (the network of straight seminiferous tubules within the mediastinum testis leading to the efferent ductules) is a rare congenital anomaly. There are only 15 cases reported in the literature to date and only one report of the US findings [1-5]. This report highlights the characteristic appearance of the lesion on ultrasound examination and its association with renal abnormalities in two patients.

Host defense and inflammation are regulated by the NF-κB essential modulator (NEMO), a scaffolding protein with a broad immune cell and tissue expression profile. Hypomorphic mutations in inhibitor of NF-κB kinase regulatory subunit gamma (IKBKG) encoding NEMO typically present with immunodeficiency. Here, we characterized a pediatric autoinflammatory syndrome in 3 unrelated male patients with distinct X-linked IKBKG germline mutations that led to overexpression of a NEMO protein isoform lacking the domain encoded by exon 5 (NEMO-Δex5). This isoform failed to associate with TANK binding kinase 1 (TBK1), and dermal fibroblasts from affected patients activated NF-κB in response to TNF but not TLR3 or RIG-I-like receptor (RLR) stimulation when isoform levels were high. By contrast, T cells, monocytes, and macrophages that expressed NEMO-Δex5 exhibited increased NF-κB activation and IFN production, and blood cells from these patients expressed a strong IFN and NF-κB transcriptional signature. Immune cells and TNF-stimulated dermal fibroblasts upregulated the inducible IKK protein (IKKi) that was stabilized by NEMO-Δex5, promoting type I IFN induction and antiviral responses. These data revealed how IKBKG mutations that lead to alternative splicing of skipping exon 5 cause a clinical phenotype we have named NEMO deleted exon 5 autoinflammatory syndrome (NDAS), distinct from the immune deficiency syndrome resulting from loss-of-function IKBKG mutations.

Chronic wounds are a major clinical problem where wound closure is prevented by pathologic factors, including immune dysregulation. To design efficient immunotherapies, an understanding of the key molecular pathways by which immunity impairs wound healing is needed. Interleukin-1 (IL-1) plays a central role in regulating the immune response to tissue injury through IL-1 receptor (IL-1R1). Generating a knockout mouse model, we demonstrate that the IL-1–IL-1R1 axis delays wound closure in diabetic conditions. We used a protein engineering approach to deliver IL-1 receptor antagonist (IL-1Ra) in a localised and sustained manner through binding extracellular matrix components. We demonstrate that matrix-binding IL-1Ra improves wound healing in diabetic mice by re-establishing a pro-healing microenvironment characterised by lower levels of pro-inflammatory cells, cytokines and senescent fibroblasts, and higher levels of anti-inflammatory cytokines and growth factors. Engineered IL-1Ra has translational potential for chronic wounds and other inflammatory conditions where IL-1R1 signalling should be dampened.Tan, Lash et al. show that blocking the Interleukin-1 receptor promotes rapid wound closure in diabetic mice. They engineered a matrix binding form of Interleukin-1 receptor antagonist (IL-1Ra) that has the ability of precise localisation and retention in the tissue. IL-1Ra holds the potential for expediting wound healing in diabetic patients.

Increased agriculture production associated with intense application of herbicides, pesticides, and fungicides leads to soil contamination worldwide. Nickel (Ni), due to its high mobility in soils and groundwater, constitutes one of the greatest problems in terms of environmental pollution. Metals, including Ni, in high concentrations are toxic to cells by imposing a condition of oxidative stress due to the induction of reactive oxygen species (ROS), which damage lipids, proteins, and DNA. This study aimed to characterize the Ni antioxidant response of two tolerant Burkholderia strains (one isolated from noncontaminated soil, SNMS32, and the other from contaminated soil, SCMS54), by measuring superoxide dismutase (SOD), catalase (CAT), glutathione reductase (GR), and glutathione S-transferase (GST) activities. Ni accumulation and bacterial growth in the presence of the metal were also analyzed. The results showed that both strains exhibited different trends of Ni accumulation and distinct antioxidant enzymes responses. The strain from contaminated soil (SCMS54) exhibited a higher Ni biosorption and exhibited an increase in SOD and GST activities after 5 and 12 h of Ni exposure. The analysis of SOD, CAT, and GR by nondenaturing PAGE revealed the appearance of an extra isoenzyme in strain SCMS54 for each enzyme. The results suggest that the strain SCMS54 isolated from contaminated soil present more plasticity with potential to be used in soil and water bioremediation.