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Pyogenic sacroiliitis (PS) is rare with less than 100 pediatric cases reported in the medical literature. To better characterize PS in the pediatric population, we investigated a series of children presenting with PS. Retrospective data analysis was done at an academic tertiary center between the years of 2000 and 2017. All hospitalized children ≤ 16 years of age with PS were evaluated. Of the 894 children hospitalized with osteoarticular infections, 18 were diagnosed with PS (2%) and are included in the review. Two clinically distinct groups were identified. PS in infants (n = 13, 72.2%, mean age 1.1 years) had an indolent course and a faster recovery without any bacterial source identified. In contrast, the group of older children (n = 5, 27.8%, mean age 11.6 years) had a more complicated course and a higher rate of identified bacterial infections.Conclusion: We describe an under-recognized entity of PS in infants with a mild clinical course and fast recovery that differ from the "classical" septic sacroiliitis. Infants with PS did not suffer from invasive complications, and pathogen characteristics of older children were not identified. Infants with fever, irritability, decreased range of motion in the pelvic area, and pain during diapering should alert the clinician to this diagnosis. What is Known: • Pediatric pyogenic sacroiliitis is an extremely rare condition usually caused by Staphylococcus aureus with highest incidence in adolescents. • The diagnosis of PS is challenging due to its rarity and difficulty in assessing the sacroiliac joint. What is New: • We describe an under-recognized entity of PS in infants with a mild clinical course, without invasive complications and with fast recovery that differ from "classical" septic sacroiliitis. • Infants with fever, irritability, decreased range of motion in the pelvic area and pain during diapering should raise clinical suspicion of this diagnosis.

Trans-coronal radio observations were taken during the 2011 observing campaign of the Akatsuki spacecraft through superior conjunction. The observed X-band (8.4 GHz) signals exhibit frequency fluctuations (FF) that are produced by temporal variations in electron density along the radio ray path. A two-component model for interpretation of the FF is proposed: FF scales largely with acoustic wave amplitude through the inner coronal regions where the sound speed dwarfs the solar wind outflow speed, while FF in the region of solar wind acceleration is dominated by the increased density oscillation frequency on the sensing path that results from bulk advection of the plasma inhomogeneities. An estimate of fractional electron density fluctuation is obtained from the mid-corona. A radial profile of slow solar wind speed is determined in the extended corona using mass-flux continuity principles. The coronal sonic point for slow solar wind is estimated to range from 4 to 5 solar radii from the heliocenter.

Here, we report on the feasibility and use of magnetic resonance imaging-based methods to the study of electrohydrodynamic (EHD) liquid bridges. High-speed tomographic recordings through the longitudinal axis of water bridges were used to characterize the mass transfer dynamics, mixing, and flow structure. By filling one beaker with heavy water and the other with light water, it was possible to track the spread of the proton signal throughout the total liquid volume. The mixing kinetics are different depending on where the light nuclei are located and proceeds faster when the anolyte is light water. Distinct flow and mixing regions are identified in the fluid volumes, and it is shown that the EHD flow at the electrodes can be counteracted by the density difference between water isotopes. MR phase contrast imaging reveals that within the bridge section, two separate counter-propagating flows pass one above the other in the bridge.

The use of cannabis as both a therapeutic agent and recreational drug is common, and its availability is increasing as a result of legalization in many countries. Among older children, the manifestations of cannabis intoxication are numerous and include both neurological and systemic manifestations that are frequently non-specific. There have been only a few reports detailing cannabis intoxication in infants and toddlers. We describe three infants who presented to the emergency department with encephalopathic signs without prominent systemic manifestations. During the initial interview of caregivers, no history of exposure to neurotoxic agents was obtained. All three patients were subsequently diagnosed with cannabis intoxication based on urine toxic screens for delta-9-tetrahydrocannabinol (THC). The infants recovered with supportive care that included fluids and monitoring. The non-specific symptomatology of cannabis intoxication in infants together with the wide differential for unexplained acute onset encephalopathy may delay diagnosis and lead to inappropriate procedures and interventions such as antimicrobial treatments and imaging studies.Healthcare personnel of emergency rooms, urgent care centers, and general clinics should be aware of the potential risk of cannabis ingestion in young infants. A thorough medical history and toxic screen are warranted in all infants with unexplained decreased sensorium.

When a high-voltage direct-current is applied to two beakers filled with water or polar liquid dielectrica, a horizontal bridge forms between the two beakers. This experiment was first carried out by Lord Armstrong in 1893 and then forgotten until recently. Such bridges are stable by the action of electrohydrodynamic (EHD) forces caused by electric field gradients counteracting gravity. Due to these gradients a permanent pumping of liquid from one beaker into the other is observed. At macroscopic scale several of the properties of a horizontal water bridge can be explained by modern electrohydrodynamics, analyzing the motion of fluids in electric fields. Whereas on the molecular scale water can be described by quantum mechanics, there is a conceptual gap at mesoscopic scale which is bridged by a number of theories including quantum mechanical entanglement and coherent structures in water – theories that we discuss here. Much of the phenomenon is already understood, but even more can still be learned from it, since such “floating” liquid bridges resemble a small high voltage laboratory of their own: The physics of liquids in electric fields of some kV/cm can be studied, even long time experiments like neutron or light scattering are feasible since the bridge is in a steady-state equilibrium and can be kept stable for hours. It is also an electro-chemical reactor where compounds are transported through by the EHD flow, enabling the study of electrochemical reactions under potentials which are otherwise not easily accessible. Last but not least the bridge provides the experimental biologist with the opportunity to expose living organisms such as bacteria to electric fields without killing them, but with a significant influence on their behavior, and possibly, even on their genome.

When a high-voltage direct-current is applied to two beakers filled with polar liquid dielectrica like water or methanol, a horizontal bridge forms between the two beakers. By repeating a version of Pellat’s experiment, it is shown that a horizontal bridge is stable by the action of electrohydrodynamic pressure. Thus, the static and dynamic properties of the phenomenon called a ‘floating water bridge’ can be explained by the gradient of Maxwell pressure, replenishing the liquid within the bridge against any drainage mechanism. It is also shown that a number of liquids can form stable and long horizontal bridges. The stability of such a connection, and the asymmetry in mass flow through such bridges caused by the formation of ion clouds in the vicinity of the electrodes, is also discussed by two further experiments.

Pyruvate carboxylase (PC) is a biotinylated mitochondrial enzyme that catalyzes the conversion of pyruvate to oxaloacetate. Children with inborn errors of PC metabolism have lactic acidosis, hypoglycemia, and mental retardation. The variable severity of the clinical phenotype is dependent on both genetic and environmental factors. Two consanguineous families with moderate forms of PC deficiency were characterized at the biochemical and molecular levels. In both families, the probands were found to have low PC activity (range, 2-25% of control) in blood lymphocytes and skin fibroblasts associated with either diminished or normal protein levels. In the first case, sequencing of patient-specific PC cDNA demonstrated a T to C substitution at nucleotide 434, which causes a valine to alanine change at amino acid residue 145. Direct sequencing of the parents showed that they are heterozygous for this mutation. In the second family, a brother and sister had mental retardation and episodes of severe lactic/ketoacidosis in early childhood. In these cases, a C to T substitution at nucleotide 1351 results in a cysteine for arginine substitution at amino acid residue 451; the parents were also found to be heterozygous for this mutation. In both families, no other mutations were found, and both substitutions occurred in relatively conserved amino acid residues. These mutations, located in the biotin carboxylase domain, provide a unique opportunity to analyze how natural occurring mutations affect PC function.

Central diabetes insipidus: a previously unreported side effect of temozolomide La temozolomide (TMZ) e un agente alchilante impiegato soprattutto per il trattamento dei tumori del sistema nervoso centrale. Questo articolo descrive 2 pazienti con diabete insipido (DI) apparentemente indotto dalla TMZ. Partendo da questa osservazione, sono stati identificati nel Registro di Ricerca del Massachusetts General Hospital 3 altri potenziali casi di DI causato dalla TMZ tra 1.545 pazienti trattati con questo farmaco (prevalenza stimata 0,3%). Un uomo di 53 anni affetto da oligoastrocitoma e uno di 38 anni affetto da oligodendroglioma svilupparono polidipsia e poliuria circa 2 mesi dopo l’inizio della TMZ. Gli esami di laboratorio dimostrarono ipersodiemia e deficit di concentrazione urinaria, compatibili con la diagnosi di DI. I pazienti furono trattati con successo con desmopressina acetato. La desmopressina fu sospesa dopo la sospensione della TMZ, e il DI non si ripresento. La risonanza magnetica sellare mostro unicamente l’assenza della tipica iperintensita posteriore della neuroipofisi in entrambi i casi, ma non la presenza di lesioni metastatiche a livello ipotalamico. I test di funzione ipofisaria anteriore rimasero normali in entrambi i pazienti. Il meccanismo con cui la TMZ induce DI non e chiaro. La TMZ potrebbe interferire con la produzione di ADH; in alternativa potrebbe interferire con l’accumulo di ADH e/o la sua secrezione direttamente dalla neuroipofisi. Sebbene il regime terapeutico standard di somministrazione della TMZ sia un ciclo di 5 giorni ogni 28, 4 di questi 5 pazienti ricevettero il farmaco quotidianamente e il quinto fu trattato quotidianamente a settimane alterne. Non e chiaro se il DI si manifesti anche nei pazienti trattati con la TMZ a dosi standard. Anche se tutti i 5 pazienti erano di sesso maschile, non e possibile affermare che si tratti di un effetto sesso-specifico. La prevalenza dello 0,3% in tutti i 1.545 pazienti trattati sembra bassa, pero questo valore potrebbe sottostimare la reale prevalenza di DI in quanto incontinenza urinaria e minzione frequente sono state riportate, rispettivamente, nell’8 e nel 5% dei pazienti con astrocitoma anaplastico di questa serie trattati con la TMZ. E possibile che una porzione di pazienti con questi sintomi fosse in realta affetta da DI parziale. In tutti i pazienti trattati con la TMZ e stata fatta una ricerca a posteriori sulla presenza di sintomi quali incontinenza urinaria, frequenza nella minzione, polidipsia, poliuria: 208 pazienti riferirono questi sintomi; 164 di questi non ricevettero alcuna prescrizione di desmopressina o ebbero solo la diagnosi di ipersodiemia o di DI. Si puo immaginare che una parte di questi pazienti abbia avuto un DI lieve e non diagnosticato. In conclusione questa e la prima osservazione di DI durante trattamento con TMZ. In questi pazienti il DI e reversibile e risponde rapidamente al trattamento con desmopressina. La prevalenza di DI iatrogeno sembra rara, ma non si puo escludere che questa complicazione sia stata finora sottodiagnosticata. Il riconoscimento e il trattamento di questa condizione potrebbe migliorare la qualita di vita e la capacita funzionale dei pazienti.

It is shown that some general boundary value problems for an ordinary linear differential system are normally solvable.