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Acute lymphoblastic leukemia (ALL) with hyperleukocytosis at diagnosis is associated with early morbidity and mortality due to complications of leukostasis. Of 535 pediatric ALL patients (January 2004 to December 2016 from the Yeungnam region of Korea), 72 (13.5%) patients with an initial white blood cell (WBC) count of ≥100×10/L were included in this study, of whom 38 patients had extreme hyperleukocytosis (WBC>200×10/L) at diagnosis. Fourteen patients (19.4%) had ≥1 early respiratory and neurological complications during induction therapy. Relapse occurred in 8 patients (24.2%) with extreme hyperleukocytosis and in 1 patient (3.0%) with an initial WBC count of 100 to 200×10/L (P=0.012). Estimated 10-year event-free survival rate (EFS) and overall survival rate were 78.3%±8.4% and 82.6%±7.7%, respectively. The 10-year EFS was significantly lower in patients with an initial WBC count of >200×10/L than in those with an initial WBC count of 100 to 200×10/L (65.7%±13.4% vs. 91.2%±7.9%; P=0.011). The 10-year EFS and overall survival rate did not differ significantly between patients with extreme hyperleukocytosis who received hematopoietic stem cell transplantation and those who received chemotherapy. In conclusion, pediatric ALL with hyperleukocytosis can lead to early complications and mortality. Patients with initial extreme hyperleukocytosis showed significantly poorer prognosis than those with WBC counts of 100 to 200×10/L.BACKGROUND Almost all pediatric patients with renal tumors are diagnosed with nephroblastoma (Wilms tumor), clear cell sarcoma, or malignant rhabdoid tumor. The choice of treatment is important for relapsed and refractory patients with nephroblastoma. Furthermore, clear cell sarcoma of the kidney (CCSK) and malignant rhabdoid tumor of the kidney (MRTK) have a poor prognosis compared with nephroblastoma. Thus, stem cell transplantation (SCT) is sometimes selected to treat these tumors. PATIENTS AND METHODS The authors targeted a total of 84 patients with nephroblastoma, CCSK, and MRTK who underwent a first autologous SCT between 1992 and 2014, and were registered in the Japanese Transplant Registry Unified Management Program system. The authors retrospectively analyzed the SCT data for survival rate. RESULTS Five-year overall survival rates for nephroblastoma, CCSK, and MRTK were 72.4%±6.3%, 46.8%±13.8%, and 36.4%±14.5%, respectively. The event-free survival rates at 5 years were 64.9%±6.7%, 35.7%±12.8%, and 27.3%±13.4%, respectively. The relapse rates at 5 years were 25.3%±11.4%, 46.2%±28.4%, and 60.0%±43.1%, respectively. CONCLUSION Although the survival rate for nephroblastoma was relatively high, those of CCSK and MRTK were poor.A 9-year-old child with sickle cell disease (sickle beta zero thalassemia) was diagnosed to have acute appendicitis during a hospitalization for pain, acute chest syndrome, and exacerbation of asthma. Because of his high surgical risk, his appendicitis was treated nonsurgically, successfully deferring his appendectomy. He remains well after 1 year. This approach should be considered at least in other sickle cell patients with appendicitis, and perhaps other high-risk populations, if not all children with appendicitis.KMT2A gene rearrangements represent the most frequent group of abnormalities in childhood leukemia (~70% of cases), with over 120 rearrangements described. The investigation of KMT2A rearrangements is still a vast field to be explored. Several studies have been characterizing different outcomes and leukemogenic mechanisms, depending on the translocation partner gene involved in childhood KMT2A-r leukemias. Therefore, the detection of the translocation partner gene, including in the context of complex rearrangements, may help to better delineate the disease. Here, we describe clinical and molecular cytogenetic data of a new complex variant translocation, involving chromosomes 9, 11, and 14, presenting a KMT2A gene extra copy and rearrangements, in an infant with de novo mixed-phenotype acute leukemia.Outcomes of patients with Shwachman-Diamond syndrome (SDS) who developed myeloid malignancies are poor because of refractory disease and high hematopoietic stem cell transplantation-related mortality. We herein report a case of a 7-year-old girl with SDS who developed acute myeloid leukemia with monosomy 7. She was successfully treated with chemotherapy followed by unrelated cord blood transplantation with reduced-intensity conditioning consisting of fludarabine, melphalan, and high-dose cytarabine without significant toxicity. Reduced-intensity conditioning presented in this report might be a preferable option for SDS patients with acute myeloid leukemia, although further evaluation in a larger number of similar cases is necessary.For decades, national paid maternity leave policies of 12 weeks or more have been established in every industrialized country except the United States. Despite women representing 47% of the current U.S. labor force, only 16% of all employed American workers have access to paid parental leave through their workplace. As many as 23% of employed mothers return to work within ten days of giving birth, because of their inability to pay living expenses without income. We reviewed recent studies on the possible effects of paid maternity leave on the mental and physical health of mothers and children. We found that paid maternity leave is associated with beneficial effects on (1) the mental health of mothers and children, including a decrease in postpartum maternal depression and intimate partner violence, and improved infant attachment and child development, (2) the physical health of mothers and children, including a decrease in infant mortality and in mother and infant rehospitalizations, and an increase in pediatric visit attendance and timely administration of infant immunizations, and (3) breastfeeding, with an increase in its initiation and duration. Given the substantial mental and physical health benefits associated with paid leave, as well as favorable results from studies on its economic impact, the United States is facing a clear, evidence-based mandate to create a national paid maternity leave policy. We recommend a national paid maternity leave policy of at least 12 weeks.The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders defines internet gaming disorder without differentiating games from their respective genres, such as first-person shooter versus real-time strategy versus online gaming. Our review of the literature on massively multiplayer online role-playing games (MMORPGs) suggests that MMORPGs are different from other games because they are the most addictive, and therefore deserve to be looked at separately. MMORPGs are internet platforms for online users to interact with each other in a virtual story line. The overview of the existing literature delineates the positive and negative aspects of MMORPGs and also the available evidence on neuroscientific and neuroanatomical correlates between internet gaming disorder and other addictions. Evidence shows that a player's characteristics and motivations can determine his or her risk of developing problematic play. Problematic MMORPG use may lead to mental disorders such as depression and addiction, and can negatively affect quality of life, and vice versa. Conversely, some players may benefit from being part of a social community and from using it as a learning platform or as a safe space to explore gender-identity issues. Brain circuitry and metabolism are changed through problematic MMORPG use, with the affected areas including the ventral striatum and left angular gyrus.Requests for the evaluation of potential adult attention-deficit/hyperactivity disorder (ADHD) is on the rise across primary care clinics. Many health care providers, however, may feel ill equipped to diagnose and manage adults presenting with inattention and impulsivity. The diagnosis of ADHD is often complicated by medical and psychiatric conditions that can contribute to inattention symptoms. In this article, the authors provide a pragmatic clinical approach for evaluating and managing adult ADHD in the primary care setting.OBJECTIVE To describe reoperations in the operating room for complications encountered within 90 days following glaucoma surgery at a single institution over a two-year period. DESIGN Retrospective case series. SUBJECTS Adult patients who have undergone glaucoma surgery including a tube shunt, trabeculectomy with mitomycin C, trabectome or transcleral cyclophotocoagulation from June 1, 2015 to August 30, 2017 at a single institution. METHODS These patients were then examined for postoperative complications that required reoperations within the first 90 days including revision of the tube shunt, revision of the trabeculectomy, drainage of the choroidals or placement of a tube shunt. MAIN OUTCOME MEASURES Percentage of reoperations for complications within the first 90 days following glaucoma surgery and surgical indications for these reoperations. RESULTS 622 glaucoma procedures were performed on 600 eyes in 525 patients over a two-year period from June 1, 2015 to June 30, 2017 by four glaucoma surgeons at a sgery was low and comparable to previous studies. Common indications for reoperation within 90 days include wound leak and tube shunt-related issues.PRECIS Corvis ST Tonometry and Ocular Response Analyzer measurements were conducted in primary open-angle glaucoma and normative subjects. Many parameters were significantly correlated, however, the strengths were weak to moderate. PURPOSE Reichert Ocular Response Analyzer (ORA) parameters are derived from pressure information following the application of air-jet, whereas detailed structural observation can be made using the Corneal Visualization Scheimpflug Technology instrument (CST). The purpose of the study was to investigate the association between CST measurements and ORA measured corneal hysteresis (CH). METHODS 104 eyes of 104 patients with primary open-angle glaucoma and 35 eyes from normative subjects. Measurements of CST, ORA, axial length (AL), average corneal curvature (CC), central corneal thickness (CCT) and intraocular pressure (IOP) with Goldmann applanation tonometry (GAT) were carried out. The association between CST and ORA parameters was assessed using linear regression analysis, with model selection based on the second order bias corrected Akaike Information Criterion index. RESULTS DA ratio (corneal softness, R=-0.51), SP A1 (corneal stiffness, R=0.41), and Inverse Radius (integrated area under the curve of the inverse concave radius, R=-0.44) were significantly correlated with CH (P less then 0.05). The optimal model to explain CH using CST measurements was given by CH=-76.3 + 4.6*A1 time (applanation time in the corneal inward movement) + 1.9*A2 time (second applanation time in the corneal outward movement) + 3.1 * highest concavity deformation amplitude (magnitude of movement of the corneal apex from before deformation to its highest concavity) + 0.016*CCT (R=0.67, P less then 0.001). CONCLUSION CST parameters are significant, but weakly or moderately, related to ORA measured CH.PRéCIS This study found an association between thinner superotemporal retinal nerve fiber layer and obstructive sleep apnoea. However, the lack of association of sleep apnoea with other disc measures does not support a link with glaucoma. AIM Previous findings on the link between obstructive sleep apnoea (OSA) and increased glaucoma risk have been inconsistent. In a community-based study of middle-aged and older adults, we explored for differences in optic disc measures that may resemble preclinical glaucomatous changes in relation to OSA status and severity. METHODS A total of 865 participants (46-67▒y; 45% male) underwent an at-home sleep study during which their apnoea-hypopnoea index (AHI) and sleep oxygen saturation level were measured. Participants were determined to have no OSA (AHI30). At a six-year follow-up visit, the optic discs of both eyes were imaged using spectral domain optic coherence tomography to measure the Bruch's membrane opening minimum rim widths (BMO-MRW) and retinal nerve fiber layer (RNFL) thicknesses.