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Objective: To determine the nature and extent of minor neuropsychological deficits in patients with subjective cognitive decline (SCD) and their association with CSF biomarkers of Alzheimer disease (AD)., Method: We analyzed data from n = 449 cognitively normal participants (n = 209 healthy controls, n = 240 patients with SCD) from an interim data release of the German Center for Neurodegenerative Diseases Longitudinal Cognitive Impairment and Dementia Study (DELCODE). An extensive neuropsychological test battery was applied at baseline for which we established a latent, 5 cognitive domain factor structure comprising learning and memory, executive functions, language abilities, working memory, and visuospatial functions. We compared groups in terms of global and domain-specific performance and correlated performance with different CSF markers of AD pathology., Results: We observed worse performance (Cohen d = ≈0.25-0.5, adjusted for age, sex differences with analysis of covariance) in global performance, memory, executive functions, and language abilities for the SCD group compared to healthy controls. In addition, worse performance in these domains was moderately ( r = ≈0.3) associated with lower CSF β-amyloid 42/40 and CSF β-amyloid 42 /phosphorylated tau181 in the whole sample and specifically in the SCD subgroup., Conclusions: Within the spectrum of clinically unimpaired (i.e., before mild cognitive impairment) cognitive performance, SCD is associated with minor deficits in memory, executive function, and language abilities. The association of these subtle cognitive deficits with AD CSF biomarkers speaks to their validity and potential use for the early detection of underlying preclinical AD., (© 2020 American Academy of Neurology.)

We present the case of a 3-year-old boy who was diagnosed with cerebral abscesses due to Aspergillus nidulans infection on day 28 of induction chemotherapy for acute lymphoblastic leukemia. He responded well to treatment with voriconazole and caspofungin, making a full recovery. There are very few cases of invasive aspergillosis reported in children during induction chemotherapy for acute leukemia and A. nidulans is rare in the absence of chronic granulomatous disease.

Objective: Despite recent advances in the outcome of children with cancer, the demands on medical professionals caring for these patients can be intense. Our qualitative study explored the work-related demands and rewards experienced by Canadian pediatric oncology staff., Study Design: Interviews were conducted with 33 staff members (10 oncologists, 3 subspecialty residents, 9 nurses, 5 social workers, and 6 child life specialists) from 4 hospitals. Participants were asked to describe work-related rewards and demands. Interviews were recorded and transcribed verbatim. Interview transcripts were analyzed to identify all sources of demands and rewards., Results: Pediatric oncology staff described work-related rewards and demands related to the following areas: (1) working with children; (2) working with families; (3) working within a multidisciplinary health care team; (4) working in a pediatric oncology unit; and (5) working within a hospital or academic health center. Overall, health care providers described their job as fulfilling and meaningful. For most health care providers, many work-related issues were described as both rewarding and demanding., Conclusions: Our study identifies important demands and rewards associated with working in pediatric oncology. Future research could explore the relationship between work-related stress and job satisfaction and how these factors either cause or prevent burnout syndrome.

A 10-year-old girl with multiple persistent ganglioneuromas originating from the spontaneous maturation of a metastatic neuroblastoma is described. Multiple biopsies confirm progressive maturation and urine catecholamines, which were initially elevated, have normalized over time. The management and risk of malignant transformation of ganglioneuromas is discussed.

Cisplatin is an important chemotherapeutic agent in the treatment of many pediatric malignancies, but its use is limited in part by ototoxicity. The authors' institution has been administering standard-dose cisplatin by continuous infusion rather than bolus administration in germ cell tumors. The authors retrospectively reviewed 39 patients with germ cell tumors requiring chemotherapy over the past 20 years and recorded data including demographics, cumulative cisplatin dose, degree of ototoxicity (by the Brock grading system), and disease outcome. The median age was 9.4 years and the majority of children (48.7%) had endodermal sinus tumor. Twenty-one children received 400 mg/m of cisplatin or more. One child had evidence of significant ototoxicity at last follow-up (6.64 years after diagnosis). This patient received a total cumulative dose of 500 mg/m of cisplatin. Eighty-two percent of children achieved clinical remission of their disease. The authors conclude that continuous administration of cisplatin is associated with minimal ototoxicity while maintaining good tumoricidal efficacy, and further studies using this regimen are warranted.

Purpose: This report describes an isolated pleural relapse during hematopoietic remission in a child previously treated for acute lymphoblastic leukemia (ALL)., Patient and Methods: An 11-year-old boy had a cough and exertional dyspnea 34 months after an initial diagnosis of ALL and 10 months after completion of therapy. Imaging studies revealed a large left pleural effusion. Bone marrow and cerebrospinal fluid studies were negative for disease at this time., Results: Histopathologic examination of biopsy samples revealed cells with morphologic features of acute lymphoblastic leukemia blasts. Immunophenotyping, cytogenetic, and gene rearrangement studies confirmed the presence of a leukemic blast cell population similar to that detected at initial diagnosis. An isolated extramedullary relapse in the pleura was diagnosed. The patient underwent successful reinduction therapy and subsequently a matched unrelated donor bone marrow transplant; he died of disseminated infection in the posttransplant period., Conclusions: Unusual extramedullary sites of relapse are recognized with increasing frequency as long-term survival in childhood ALL improves. The length of the disease-free interval before relapse is felt to be of prognostic significance. Isolated relapse to the pleural space has not previously been described. The mechanism for persistence of leukemic clones in patients who appear to be in hematopoietic remission is unknown.

We review cellular and molecular processes involved in injury and repair of skeletal muscle with regard to the amount and location of damage produced. Discussion is based on advances made by use of newer techniques, including immunochemistry, in situ hybridization, molecular biology, ultrastructural analysis, and cell culture. Damage and repair processes after eccentric work, stretch, overload, chronic stimulation, cold injury, and other models are discussed for cellular and molecular components. Hypertrophy or hyperplasia can occur under certain conditions. After injury, satellite cells are activated by growth factors. These cells can also be activated during fiber-type transformation, probably to provide necessary DNA content rather than to supply cells of a new lineage. Emphasis is given to myosin mRNA studied by in situ hybridization to localize subcellular distribution. Increases in mRNA concentration are found near nuclei in damaged regions and at the subcellular sites being repaired in the middle of skeletal muscle fibers or near the myotendon junction. The activation of genes for muscle regulatory factors during development is compared with their activation in regeneration and response to injury.