Explore the vast range of titles available.

Midkine (MDK), one of the heparin-binding growth factors, is highly expressed in multiple organs during embryogenesis. Plasma concentrations have been reported to be elevated in patients with a variety of malignancies, in adults with obesity, and in children with short stature, diabetes, and obesity. However, the concentrations in healthy children and their relationships to age, nutrition, and linear growth have not been well studied. Plasma MDK was measured by immunoassay in 222 healthy, normal-weight children (age 0-18 yrs, 101 boys), 206 healthy adults (age 18-91 yrs, 60 males), 61 children with BMI ≥ 95th percentile (age 4-18 yrs, 20 boys), 20 girls and young women with anorexia nervosa (age 14-23 yrs), and 75 children with idiopathic short stature (age 3-18 yrs, 42 boys). Body fat was evaluated by dual-energy X-ray absorptiometry (DXA) in a subset of subjects. The associations of MDK with age, sex, adiposity, race/ethnicity and stature were evaluated. In healthy children, plasma MDK concentrations declined with age (r = -0.54, P < 0.001) with values highest in infants. The decline occurred primarily during the first year of life. Plasma MDK did not significantly differ between males and females or between race/ethnic groups. MDK concentrations were not correlated with BMI SDS, fat mass (kg) or percent total body fat, and no difference in MDK was found between children with anorexia nervosa, healthy weight and obesity. For children with idiopathic short stature, MDK concentrations did not differ significantly from normal height subjects, or according to height SDS or IGF-1 SDS. In healthy children, plasma MDK concentrations declined with age and were not significantly associated with sex, adiposity, or stature-for-age. These findings provide useful reference data for studies of plasma MDK in children with malignancies and other pathological conditions.

Purpose The purpose of this paper is to describe a successful model of shared medical leadership within an academic division of an urban children’s hospital. Design/methodology/approach Experience and outcomes were tracked over a three-year period during which two physicians shared the role of interim division chief of pediatric endocrinology and diabetes, resulting in a working model of shared leadership. Findings An evolutionary trajectory occurred over three years in which the strengths of the leaders were combined to optimize decision making in a complex medical division. Improvements in team satisfaction and additional positive outcomes were achieved. Practical implications Benefits of and challenges tackled by the strategic approach to shared leadership are identified to inform other medical institutions, particularly those with many team members or combined programs that include strong clinical and research components. Originality/value Little has been written within medical literature regarding shared leadership. The shared leadership model described in this paper can be implemented by others in a complex academic setting and will hopefully lead to more robust divisions.

Hyperthyroidism is much less common in children <7 years vs. older children and less well studied. It was our impression that the youngest patients needed a higher weight-based dose of methimazole (MMI) to achieve euthyroidism. To compare the mean MMI dose needed to normalize free T4 in younger (<7 years) vs. older children and the time taken to normalize free T4. Based on chart review (2004–2012), patients were divided into groups based on age at diagnosis: <7 years (n=13), 7–12 years (n=30) and >12 years (n=40). Follow-up visits were reviewed until free T4 normalized. The mean dose of MMI (mg/kg/day) needed to normalize free T4 was 0.71 (±0.29) in the <7 group, significantly higher vs. the two older groups: 0.50 (±0.22) and 0.44 (±0.24). Months taken to achieve a euthyroid state was significantly longer in children <7 (6.23±3.91) vs. the older groups (3.10±2.12 and 3.18±2.86 months). Hyperthyroid children diagnosed before age 7 required higher initial doses of MMI and took a longer time to become euthyroid than older patients. Clinicians should consider starting with higher weight-based MMI doses when treating younger patients to more rapidly normalize free T4.

Midkine (MDK), one of the heparin-binding growth factors, is highly expressed in multiple organs during embryogenesis. Plasma concentrations have been reported to be elevated in patients with a variety of malignancies, in adults with obesity, and in children with short stature, diabetes, and obesity. However, the concentrations in healthy children and their relationships to age, nutrition, and linear growth have not been well studied. Plasma MDK was measured by immunoassay in 222 healthy, normal-weight children (age 0-18 yrs, 101 boys), 206 healthy adults (age 18-91 yrs, 60 males), 61 children with BMI [greater than or equal to] 95.sup.th percentile (age 4-18 yrs, 20 boys), 20 girls and young women with anorexia nervosa (age 14-23 yrs), and 75 children with idiopathic short stature (age 3-18 yrs, 42 boys). Body fat was evaluated by dual-energy X-ray absorptiometry (DXA) in a subset of subjects. The associations of MDK with age, sex, adiposity, race/ethnicity and stature were evaluated. In healthy children, plasma MDK concentrations declined with age (r = -0.54, P < 0.001) with values highest in infants. The decline occurred primarily during the first year of life. Plasma MDK did not significantly differ between males and females or between race/ethnic groups. MDK concentrations were not correlated with BMI SDS, fat mass (kg) or percent total body fat, and no difference in MDK was found between children with anorexia nervosa, healthy weight and obesity. For children with idiopathic short stature, MDK concentrations did not differ significantly from normal height subjects, or according to height SDS or IGF-1 SDS. In healthy children, plasma MDK concentrations declined with age and were not significantly associated with sex, adiposity, or stature-for-age. These findings provide useful reference data for studies of plasma MDK in children with malignancies and other pathological conditions.

Midkine (MDK), one of the heparin-binding growth factors, is highly expressed in multiple organs during embryogenesis. Plasma concentrations have been reported to be elevated in patients with a variety of malignancies, in adults with obesity, and in children with short stature, diabetes, and obesity. However, the concentrations in healthy children and their relationships to age, nutrition, and linear growth have not been well studied. Plasma MDK was measured by immunoassay in 222 healthy, normal-weight children (age 0-18 yrs, 101 boys), 206 healthy adults (age 18-91 yrs, 60 males), 61 children with BMI [greater than or equal to] 95.sup.th percentile (age 4-18 yrs, 20 boys), 20 girls and young women with anorexia nervosa (age 14-23 yrs), and 75 children with idiopathic short stature (age 3-18 yrs, 42 boys). Body fat was evaluated by dual-energy X-ray absorptiometry (DXA) in a subset of subjects. The associations of MDK with age, sex, adiposity, race/ethnicity and stature were evaluated. In healthy children, plasma MDK concentrations declined with age (r = -0.54, P < 0.001) with values highest in infants. The decline occurred primarily during the first year of life. Plasma MDK did not significantly differ between males and females or between race/ethnic groups. MDK concentrations were not correlated with BMI SDS, fat mass (kg) or percent total body fat, and no difference in MDK was found between children with anorexia nervosa, healthy weight and obesity. For children with idiopathic short stature, MDK concentrations did not differ significantly from normal height subjects, or according to height SDS or IGF-1 SDS. In healthy children, plasma MDK concentrations declined with age and were not significantly associated with sex, adiposity, or stature-for-age. These findings provide useful reference data for studies of plasma MDK in children with malignancies and other pathological conditions.

Despite U.S. Food & Drug Administration (FDA) approval of growth hormone (GH) for idiopathic short stature (ISS), many providers face challenges obtaining insurance coverage. We reviewed the insurance coverage experience for ISS at our hospital to identify factors predictive of approval or denial. We reviewed charts of patients who underwent GH stimulation testing from July 1, 2009, to April 30, 2017, to identify ISS patients (height <-2.25 SD, subnormal predicted adult height (PAH) and peak GH >10 ng/mL). Eighty-seven patients met ISS criteria, of whom 47 (29 male/18 female) had a GH request submitted to insurance. Mean age, height, and growth velocity were 8.6 ± 2.7 years, 2.83 ± 0.4 SD, and 4.4 ± 1.7 cm/year, respectively. Mean PAH based on bone age was -2.50 ± 0.9 SD, equaling 62 inches for males and 58 inches for females. Most had private managed care insurance (74%). Overall, 17/47 (36%) received treatment approval, 7 immediately and 10 more on appeal. There were no differences in age, height SD, growth rate, insurance type, or PAH between the 17 who were approved and the 30 denied. For 21 patients who were treated, a mean increase in 0.6 SD in height was seen after 1 year. At our institution, GH coverage requests for ISS included very short children mostly ages 6 to 11, with heights well below -2.25 SD and poor PAH. Only 36% were approved even after appeal. This highlights the challenge in our area to secure GH treatment for a FDA-approved indication. Collaboration between pediatric endocrinologists and insurers focusing on height SD and PAH, may improve cost-effective coverage to deserving short children who meet FDA guidelines for ISS treatment. FDA = Food and Drug Administration; GH = growth hormone; IGF-1 = insulin-like growth factor 1; ISS = idiopathic short stature; PAH = predicted adult height.

A 13-year-old girl with type 1 diabetes presented to the emergency department (ED) after being found unresponsive at home by her mother with a capillary blood glucose (CBG) of 1.488 mmol/L (26.8 mg/dL). She was given intramuscular (IM) glucagon and intravenous (IV) dextrose by emergency medical services, and her CBG increased to 4.628 mmol/L (83.4 mg/dL) by the time of her ED arrival. In the ICU, she received intermittent doses of IM glucagon (1 mg each) because of continued hypoglycemia even on continuous dextrose infusion with a GIR of 10 mg/kg/min.

The study of cellular response to dynamic mechanical loading is an important component of biological research into cellular function at the single-cell level. Understanding the range of cellular changes that can occur as a result of applied forces might be useful in applications such as cell repair and tissue generation. Micromanipulation techniques have been used to study the adaptation of cells to their environment in the past experiments However, accurate imaging and force response measurements as a function of position on the cell makes the use of force probes with nanometer scale dimensions very desirable, since they provide dramatically better spatial resolution and can detect very small changes in forces occurring dynamically in a cell.The main objective of this thesis is to establish protocols to study and analyze the mechanical response of single cells under mechanical loading. In order to accomplish this goal, Atomic Force Microscopy was used because this technique provides the ability to image cells in their native physiological environment, and to apply and measure response to forces in the nano-newton range at selected positions. Atomic Force Microscopy allows comparisons of the mechanical response in different regions of a cell and the observation of possible morphological changes before and after loading.Two different cell lines were studied. Mouse hybridoma and bovine aortic endothelial (BAE) cells were chosen because they have similar dimensions but different biological characteristics. The study of different cell lines also provides insight into the general response of cells to mechanical loading and the difference in responses among individual cells and cell lines. Force response measurements were carried out in a sequence of loading/unloading cycles. For each cycle, the AFM probe was moved 1 μm both towards and away from the cell. The next loading/unloading cycle would then begin after the probe had been moved to a position 0.5 μm closer to the substrate. This methodology was designed to observe changes in the force response over a small range of cell deformation. Figure a shows a typical sequence of force response curve(s) that proceed from right to left. Figure b isolates on one load-unload cycle that clearly exhibits hysteretic behavior related to the viscoelastic nature of the cell. In this case, some elastic energy stored during cell loading is being dissipated. To investigate these effects, experiments were performed to study the impact of variations in cantilever spring constants and AFM tip approach velocities. A mechanical model representing the cell / cantilever system as a one dimensional, non-linear oscillator with viscoelastic terms was developed to compare with the experimental results and good qualitative agreement was found.