Tumor surveillance tests are used to detect relapse and to guide the clinician in making therapeutic changes. Identification of relapse early in the course of disease may improve long-term survival. For patients with neuroblastoma, current conventional surveillance methods include radiologic testing, bone marrow analysis, physical examination, and measurement of urinary catecholamine metabolites. Immunocytologic analysis of blood for the detection of circulating tumor cells is a highly specific and sensitive method, which may prove useful in monitoring patients with neuroblastoma. In our study, circulating tumor cells were detected in seven of 10 patients with known disseminated disease at diagnosis and in six of 13 patients during therapy. In some patients, as few as two tumor cells were identified among 100,000 normal hematopoietic cells. The presence or absence of circulating neuroblasts in the 13 patients evaluated during therapy was significantly correlated with tumor relapse (P = .002). We conclude that immunocytologic analysis of blood is a sensitive method for the detection of circulating neuroblasts. We recommend that this technique be used in conjunction with other conventional methods for improved tumor detection and subsequent monitoring of neuroblastoma patients.

Peripheral blood stem cells (PBSC) are being used as one alternative to autologous marrow rescue for patients with neuroblastoma and other solid malignancies. Some physicians prefer use of PBSC because less risk of tumor contamination is believed to exist. This hypothesis was evaluated by immunocytologic analysis of blood samples and concurrently drawn bone marrow (BM) samples and of PBSC harvests obtained from 31 patients with disseminated neuroblastoma. We found circulating neoplastic cells in 75% of specimens analyzed at diagnosis, in 36% during therapy, and in 14% of PBSC harvests. Tumor cells in blood obtained during therapy did not appear until 3 months after the time of diagnosis. Clearance of circulating neuroblastoma cells was documented after two courses of induction chemotherapy. Six of 13 patients with minimal or no BM disease had positive blood specimens. We conclude that substantial risk of tumor contamination of PB harvests exists and recommend that induction chemotherapy be administered before hematopoietic progenitor cells are collected from blood.

A B S T RA C TThis paper reviews interventions for preventing the occurrence and recurrence of major types of child maltreatment. We begin with an overview of the challenges of establishing evidence-based interventions to prevent child abuse and neglect in many countries, and underscore the importance of this need with child maltreatment incidence rates in the USA, and how much each type and subtype contribute to child out-of-home placement. Next, we identify the well-supported, supported and promising interventions for each child maltreatment type and subtype, according to their level of research evidence using an evidence-based clearing house. The paper closes with a discussion of the implications for practice, evaluation, policy and agency management, including intervention knowledge gaps that showcase areas that need additional practice research.

Tumor surveillance tests are used to determine whether malignant cells are responsive or resistant to therapeutic regimens. For patients with neuroblastoma, conventional methods of surveillance are not sensitive enough. Because tumor cells are shed into the circulation, immunocytologic analysis of blood may function as a sensitive monitoring system. In this study, five blood samples were obtained from two patients with disseminated neuroblastoma at diagnosis and during therapy. These samples were analyzed with monoclonal antibodies and immunoperoxidase staining to determine whether circulating neuroblasts were present. In both patients, the presence or absence of circulating neuroblasts yielded information that was more sensitive than that from conventional tests. The authors conclude that immunocytologic analysis of blood should be included with conventional monitoring methods for surveillance of patients with disseminated neuroblastoma.

The death of any child is a tragedy. When that death is caused by abuse or neglect, sorrow is often coupled with anger: How could this have happened? More importantly, was this preventable? A federal commission, the Commission to Eliminate Child Abuse and Neglect Fatalities (CECANF), is working to turn anger into action to stop these tragedies. 1 At least 1500 children die every year at the hands of those who are supposed to care for and protect them. We say "at least" because we do not have reliable data about the number of deaths from child maltreatment. There is no national standard for counting these deaths, and the data about child fatalities come from multiple sources that do not coordinate or share data. Most experts, including the US Government Accountability Office, believe that child abuse and neglect (CAN) fatalities are significantly undercounted. 2,3 Recognizing that even 1 death from CAN is 1 too many, Congress passed the Protect Our Kids Act that created CECANF in 2012. 4 CECANF, a 12-member panel appointed by the president and Congress, began its work in February 2014. Commissioners have 2 years to study the extent and causes of CAN fatalities and to submit a report to Congress that includes concrete recommendations for a national strategy to eliminate CAN fatalities. In June 2014, CECANF began a series of public hearings across the country. Commissioners reached out to experts from a broad range of disciplines. Local legislators, child welfare leaders, law enforcement officials, federal policy experts, data experts, community leaders, tribal representatives, child and parent advocates, former foster children, and pediatricians have been among those who have testified and offered recommendations to the commission. Their testimony is available on the CECANF Web site. 1 CAN FATALITIES AS A PUBLIC HEALTH CRISIS After a child dies or almost dies from abuse or neglect, the lay press and others often focus on what child protective services (CPS) should have done or not done. The reality is that a significant proportion of children are known to CPS before the incident that led to their death or near-death. Part of the reason is that child maltreatment fatalities occur