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There are no standardized pediatric treatment protocols for monomorphic post-transplant lymphoproliferative disorder (PTLD). We reviewed data from Canadian pediatric centers to determine patient characteristics, treatment approaches and outcomes. There were 55 eligible children diagnosed with monomorphic PTLD between January 2001-December 2021. Forty-nine (89%) underwent reduction of immunosuppression. The majority, 44 (80%), received rituximab, 40/44 (91%) with concurrent chemotherapy. A total of 46 (84%) children received chemotherapy: LMB-96 (48%) and low-dose cyclophosphamide with prednisone (30%) being the favored regimens. Projected 3-year event-free survival and overall survival was 62% and 77%, respectively. Approach to monomorphic PTLD treatment was relatively consistent across Canada.

Candida auris can persist for long periods on hospital surfaces and on the skin. C. auris has the ability to form drug-resistant biofilms, which can substantially impact on patient outcome. In comparison to Candida albicans, C. auris has a lower capacity to form biofilms in in vitro models and a higher capacity when tested on animal skin models. Intraspecies variation is shown to exist, with some clinical isolates having greater biofilm capabilities than others. There is a need for models that closely mimic the real niches where infection occurs on human patients. This protocol describes, in detail, a human skin model to study C. auris biofilm formation using catheterized and non-catheterized skin.

To provide an overview of the diagnostic tests available to identify invasive fungal disease (IFD) in children with a primary immunodeficiency and to evaluate the relative strengths and weaknesses of those tests. Novel tools to aid the diagnosis of IFD, such as fungal PCRs and lateral flow devices (for Aspergillus spp.), are emerging. However, the paucity of high-quality, multicentre clinical trials evaluating the performance of these diagnostic tools, particularly in the paediatric cohort of interest, remains a challenge. Children with primary immunodeficiencies are seldom referenced in existing studies. It is difficult to provide recommendations for the majority of fungal diagnostic tests, with the exception of histopathology, microscopy, culture, and imaging modalities, due to their poorly studied and largely unvalidated nature. Moving forward, multicentre trials considering the role of these tools in the investigation of children with probable IFD and a primary immunodeficiency are strongly encouraged.

Vaccinationis a critical tool in the prevention of COVID‐19 infection for individuals and for communities. The mRNA vaccines contain polyethylene glycol (PEG) as a stabilizer. Currently, in North America, only the BNT162b2 (Pfizer‐BioNTech) mRNA vaccine is approved for individuals aged 12–17. Most patients treated with contemporary regimens for acute lymphoblastic leukemia receive PEG‐asparaginase (PEG‐ASNase) and 10%–30% will develop allergic reactions. Optimizing access and safety for vaccine administration for these patients is critical. This report describes a process developed to support COVID vaccination in a cohort of adolescents and young adults with a history of PEG‐ASNase allergy.

Background There is significant evidence for cognitive decline following deep brain stimulation (DBS). Current stimulation paradigms utilize gamma frequency stimulation for optimal motor benefits; however, little has been done to optimize stimulation parameters for cognition. Recent evidence implicates subthalamic nucleus (STN) theta oscillations in executive function, and theta oscillations are well-known to relate to episodic memory, suggesting that theta frequency stimulation could potentially improve cognition in Parkinson’s disease (PD). Objective To evaluate the acute effects of theta frequency bilateral STN stimulation on executive function in PD versus gamma frequency and off, as well as investigate the differential effects on episodic versus nonepisodic verbal fluency. Methods Twelve patients (all males, mean age 60.8) with bilateral STN DBS for PD underwent a double-blinded, randomized cognitive testing during stimulation at (1) 130–135 Hz (gamma), (2) 10 Hz (theta) and (3) off. Executive functions and processing speed were evaluated using verbal fluency tasks (letter, episodic category, nonepisodic category, and category switching), color-word interference task, and random number generation task. Performance at each stimulation frequency was compared within subjects. Results Theta frequency significantly improved episodic category fluency compared to gamma, but not compared to off. There were no significant differences between stimulation frequencies in other tests. Conclusion In this pilot trial, our results corroborate the role of theta oscillations in episodic retrieval, although it is unclear whether this reflects direct modulation of the medial temporal lobe and whether similar effects can be found with more canonical memory paradigms. Further work is necessary to corroborate our findings and investigate the possibility of interleaving theta and gamma frequency stimulation for concomitant motor and cognitive effects.

This article aims to provide a structured and concise guide for the general paediatrician managing a child with hemihypertrophy. Hemihypertrophy is a relatively uncommon condition. The significance is that a proportion of those affected are at risk of developing malignancies in childhood. For these children regular surveillance is required. We have outlined how one might assess and investigate a child presenting with hemihypertrophy. We have also formulated a practicable surveillance strategy which is in line with the current Royal College of Paediatrics and Child Health (RCPCH) guideline ‘Wilms’ tumour surveillance in at-risk children’.

Smallpox produced the death of up to thirty percent of those infected, so Jenner's preventive method spread quickly. The Spanish government designed and supported a ten-year effort to carry smallpox vaccine to its American and Asian territories in a chain of arm-to-arm vaccination of children. An expedition directed by Doctor Francisco Xavier de Balmis sailed from Corunna in November 1803, stopping in the Canary Islands, Puerto Rico, and Venezuela. Balmis led a subexpedition to Cuba, Mexico, and the Philippines; his assistants returned to Mexico in 1807, while Balmis took vaccine to China and returned to Spain (and again to Mexico, 1810-13). Vice-director José Salvany and his staff took vaccine to present-day Colombia, Ecuador, Peru, Bolivia, and Chilean Patagonia. The Spanish Royal Philanthropic Vaccine Expedition shows the first attempts to solve questions still important for the introduction of new immunizations--professionalization in public health, technology transfer, protection of research subjects, and evaluation of vaccine efficacy, safety, and cost.

To the Editor: We write to extend the support of the Council of the association Mediterranean Editors and Translators to the Croatian Medical Journal (CMJ) at this difficult time in which the journal’s editorial independence is under attack (1). The situation takes us very much by surprise because the CMJ is held in high esteem in our region and around the world as an exemplary journal publishing research from the “scientific periphery.” Many of our editors are copyeditors or board editors for similar journals and we consider the CMJ’s innovation of a novel “author-helpful” policy (involving instructive interventions) to be the gold standard for small journals published in English from non-Anglophone settings. We are sorry to see that colleagues on the editors’ home turf do not seem to be aware of the positive impact the CMJ has had on the editorial world. The CMJ is synonymous with integrity and editorial quality, in spite of the grave difficulties faced by such journals. We particularly admire the CMJ’s handling of the case of duplicate publication. Many of our members report that their work (whether in journal copyediting, author’s editing, or university education) involves a persistent struggle with various types of plagiarism and we applaud when a clear stand is made. Unethical publication practices are a harmful reflection on all the individuals and institutions involved, and can only be controlled through responsible collaboration by authors and their supervisors, institutional authorities, translators and editors who aid with manuscript preparation, and the journals themselves. Each must take suitable action to curb inappropriate practices and encourage authors to achieve high editorial standards. We consider that the CMJ’s approach to the investigation and resolution of the Kurjak case is an example of responsible management that honors its reputation for editorial honesty. On behalf of the governing Council of Mediterranean Editors and Translators

Based on a collection of monoclonal antibodies (mAb) against insulin-like growth factor I (IGF-I), we have defined the IGF-I epitopes involved in the interaction with IGF-binding proteins (IGFBP) and IGF-I receptors. We have also characterized the ability of these antibodies to block IGF-I-induced survival of the IL-3-dependent Ba/F3 cell line. More than 140 hybridomas secreting IGF-I-specific mAb were characterized, of which 28 were studied in detail. They display apparent affinity constants ranging from less than 10(6) to 10(10) M-1 and varying crossreactivity with IGF-II, including 2 mAb with higher affinity for IGF-II than for IGF-I. None crossreact with insulin or any other growth factor tested. Using both enzyme immunoassays and real-time biospecific interaction analysis, we have identified 8 epitopic clusters related to the primary structure of IGF-I, according to mAb reactivity to synthetic peptides, proteolytic fragments of IGF-I, and various IGF-I mutants. The mAb panel also was used to map the IGF domains implicated in the interaction with IGFBP and IGF-I receptors. An IGF-I domain has been identified that remains exposed after IGF-I binding to IGFBP-1 or to IGFBP-3, which is recognized by 6 different mAb. The mAb in this group also bind IGF-I, when complexed to the type-1 IGF receptor on the murine pro-B cell line Ba/F3, and BALB/c 3T3 fibroblasts overexpressing the human receptor. Finally, IGF-I-promoted survival can be blocked with mAb specific for target epitopes, and their potential use in tumor cell growth control is discussed.