Rationale:Rabies is a zoonotic disease with a high mortality,primarily transmitted through the bite of infected mammals,particularly dogs and cats.Despite being a well-known disease since ancient times,it continues to...Rationale:Rabies is a zoonotic disease with a high mortality,primarily transmitted through the bite of infected mammals,particularly dogs and cats.Despite being a well-known disease since ancient times,it continues to cause a significant number of human deaths worldwide,with approximately 65000 fatalities reported annually.Patient concerns:We present two fatal cases of rabies in a 12-year-old immigrant boy and a 7-year-old boy.The first case was subject to a 24-hour delay in receiving appropriate medical attention and rabies preventive measures due to the lack of awareness among emergency hospital staff,leading to the administration of wound dressing only.The second case received timely rabies immunoglobulin administration;however,there was a 4-day delay in administering the fourth dose of the rabies vaccine,despite presenting evident symptoms of rabies.Diagnosis:Postmortem examination of brain samples from both patients confirmed the presence of rabies virus.Interventions:Post-exposure prophylaxis for rabies.Outcomes:Both patients were admitted to the hospital after the manifestation of rabies-related symptoms,with the 12-year-old child seeking medical care 47 days after the animal bite and the 7-year-old child seeking medical care 58 days after the exposure.Finally,the first patient died after 27 days and the second patient died after 40 days of hospitalization.Lessons:There is an urgent need for heightened awareness and education among both healthcare professionals and the public regarding the urgency of seeking immediate medical attention after potential rabies exposure.Timely recognition and initiation of post-exposure prophylaxis are pivotal in preventing the progression of the disease.Strengthening surveillance and reporting systems,coupled with continuous training for healthcare professionals,can contribute to early detection and management of rabies cases.展开更多
There are few pharmacologic options for the treatment of cognitive deficits associated with traumatic brain injury in pediatric patients.Acetylcholinesterase inhibitors such as donepezil have been evaluated in adult p...There are few pharmacologic options for the treatment of cognitive deficits associated with traumatic brain injury in pediatric patients.Acetylcholinesterase inhibitors such as donepezil have been evaluated in adult patients after traumatic brain injury,but relatively less is known about the effect in pediatric populations.The goal of this review is to identify knowledge gaps in the efficacy and safety of acetylcholinesterase inhibito rs as a potential a djuvant treatment fo r neurocognitive decline in pediatric patients with traumatic brain injury.Investigators queried PubMed to identify literature published from database inception thro ugh June 2023 desc ribing the use of donepezil in young adult traumatic brain injury and pediatric patients with predefined conditions.Based on preselected search criteria,340 unique papers we re selected for title and abstra ct screening.Thirty-two reco rds were reviewed in full after eliminating preclinical studies and pape rs outside the scope of the project.In adult traumatic brain injury,we review results from 14 papers detailing 227 subjects where evidence suggests donepezil is well tole rated and shows both objective and patient-reported efficacy for reducing cognitive impairment.In children,3 pape rs report on 5 children recovering from traumatic brain injury,showing limited efficacy.An additional 15 pediatric studies conducted in populations at risk for cognitive dysfunction provide a broader look at safety and efficacy in 210 patients in the pediatric age group.Given its promise for efficacy in adults with traumatic brain injury and tole rability in pediatric patients,we believe further study of donepezil for children and adolescents with traumatic brain injury is warranted.展开更多
BACKGROUND Distal humerus elbow fractures are one of the most common traumatic fractures seen in pediatric patients and present as three main types:Supracondylar(SC),lateral condyle(LC),and medial epicondyle(ME)fractu...BACKGROUND Distal humerus elbow fractures are one of the most common traumatic fractures seen in pediatric patients and present as three main types:Supracondylar(SC),lateral condyle(LC),and medial epicondyle(ME)fractures.AIM To evaluate the epidemiology of pediatric distal humerus fractures(SC,LC,and ME)from an American insurance claims database.METHODS A retrospective review was performed on patients 17 years and younger with the ICD 9 and 10 codes for SC,LC and ME fractures based on the IBM Truven MarketScan®Commercial and IBM Truven MarketScan Medicare Supplemental databases.Patients from 2015 to 2020 were queried for treatments,patient age,sex,length of hospitalization,and comorbidities.RESULTS A total of 1133 SC,154 LC,and 124 ME fractures were identified.SC fractures had the highest percentage of operation at 83%,followed by LC(78%)and ME fractures(41%).Male patients were,on average,older than female patients for both SC and ME fractures.CONCLUSION In the insurance claims databases used,SC fractures were the most reported,followed by LC fractures,and finally ME fractures.Age was identified to be a factor for how a pediatric distal humerus fractures,with patients with SC and LC fractures being younger than those with ME fractures.The peak age per injury per sex was similar to reported historic central tendencies,despite reported trends for younger physiologic development.展开更多
In the field of pediatric nursing, in the perinatal period, numerous ethical issues arise alongside the advancement of medical technology. However, sufficient education on bioethics is not provided in the pediatric nu...In the field of pediatric nursing, in the perinatal period, numerous ethical issues arise alongside the advancement of medical technology. However, sufficient education on bioethics is not provided in the pediatric nursing domain of basic nursing education. The purpose of this research is to examine the current status of bioethics education in the pediatric nursing domain of basic nursing education and explore the challenges perceived by the pediatric nursing faculty regarding bioethics education. The research method was a questionnaire survey on 100 randomly selected pediatric nursing faculty members from nursing universities across Japan. The results revealed that although bioethics issues were considered important, the emphasis remained primarily on addressing bioethics as part of nursing that respects children’s rights. Furthermore, respondents expressed difficulties regarding teaching methods and content related to bioethics.展开更多
BACKGROUND Screening for iron deficiency anemia(IDA)is important in managing pediatric patients with inflammatory bowel disease(IBD).Concerns related to adverse reactions may contribute to a reluctance to prescribe in...BACKGROUND Screening for iron deficiency anemia(IDA)is important in managing pediatric patients with inflammatory bowel disease(IBD).Concerns related to adverse reactions may contribute to a reluctance to prescribe intravenous(IV)iron to treat IDA in this population.AIM To track the efficacy and safety of IV iron therapy in treating IDA in pediatric IBD patients admitted to our center.METHODS A longitudinal observational cohort study was performed on 236 consecutive pediatric patients admitted to our tertiary IBD care center between September 2017 and December 2019.92 patients met study criteria for IDA,of which 57 received IV iron,17 received oral iron,and 18 were discharged prior to receiving iron therapy.RESULTS Patients treated with IV iron during their hospitalization experienced a significant increase of 1.9(±0.2)g/dL in mean(±SE)hemoglobin(Hb)concentration by the first ambulatory follow-up,compared to patients who received oral iron 0.8(±0.3)g/dL or no iron 0.8(±0.3)g/dL(P=0.03).One out of 57(1.8%)patients that received IV iron therapy experienced an adverse reaction.CONCLUSION Our findings demonstrate that treatment with IV iron therapy is safe and efficacious in improving Hb and iron levels in pediatric patients with IDA and active IBD.展开更多
Pediatric inflammatory bowel disease(IBD)is a chronic inflammatory disorder,with increasing incidence and prevalence worldwide.There have been recent advances in imaging and endoscopic technology for disease diagnosis...Pediatric inflammatory bowel disease(IBD)is a chronic inflammatory disorder,with increasing incidence and prevalence worldwide.There have been recent advances in imaging and endoscopic technology for disease diagnosis,treatment,and monitoring.Intestinal ultrasound,including transabdominal,transperineal,and endoscopic,has been emerging for the assessment of transmural bowel inflammation and disease complications(e.g.,fistula,abscess).Aside from surgery,IBD-related intestinal strictures now have endoscopic treatment options including through-the-scope balloon dilatation,injection,and needle knife stricturotomy and new evaluation tools such as endoscopic functional lumen imaging probe.Unsedated transnasal endoscopy may have a role in patients with upper gastrointestinal Crohn’s disease or those with IBD with new upper gastrointestinal symptoms.Improvements to dysplasia screening in pediatric patients with longstanding colonic disease or primary sclerosing cholangitis hold promise with the addition of virtual chromoendoscopy and ongoing research in the field of artificial intelligence-assisted endoscopic detection.Artificial intelligence and machine learning is a rapidly evolving field,with goals of further personalizing IBD diagnosis and treatment selection as well as prognostication.This review summarized these advancements,focusing on pediatric patients with IBD.展开更多
Introduction: Cystic lymphangiomas are rare benign malformative tumors of the lymphatic system of obscure etiopathogenesis. The cervico-facial location remains the most common (75%). Although benign, these tumors rema...Introduction: Cystic lymphangiomas are rare benign malformative tumors of the lymphatic system of obscure etiopathogenesis. The cervico-facial location remains the most common (75%). Although benign, these tumors remain potentially fatal, due to possible compression of the upper aero-digestive tract. The aim of this work is to study the epidemiological, diagnostic and therapeutic characteristics of cervico-mandibular congenital cystic lymphangiomas in the pediatric surgery department of the Donka National Hospital (HND) Conakry. Patients and methods: This is a retrospective and descriptive study of 13 files lasting 7 years from January 2015 to December 31, 2021. The files of children whose age is less than or equal to 15 years operated on cervical tumor with histological evidence of cystic lymphangioma were retained. The data were analyzed using SPSS statistical software 21 and anonymously. Results: The incidence of this study was 1.86 cases per year and a sex ratio of 0.62 in favor of girls. The average age was 8 months 19 days. In the antecedents, we only find poorly monitored pregnancies. The average size of the tumors was 11.85 cm. Cervical ultrasound and standard x-ray of the cervical mass were the only examinations performed. Total surgical excision of the cervical tumor was performed in all patients. The mass was polycystic on exploration. The histological examination of the surgical specimens was in favor of a cystic lymphangioma. The surgical consequences were simple in 11 patients (84.62%) and complicated by parietal suppuration in 2 cases (15.38%). There were no cases of recurrence after one year of follow-up. Conclusion: Cervico-mandibular cystic lymphangiomas are the most frequent locations of congenital lymphangiomas in children. Their severity is linked to the risk of compression of the aero-digestive tracts. Their diagnosis must be confirmed by the histology of the surgical specimen. Despite the therapeutic arsenal, excision of the cystic mass remains the only effective alternative in our socio-economic conditions to avoid recurrences and loss of follow-up of patients.展开更多
Objective:To observe and explore the value of the combined application of red blood cell distribution width(RDW),platelet distribution width(PDW),and immunoglobulin E(IgE)in the process of clinical diagnosis of childr...Objective:To observe and explore the value of the combined application of red blood cell distribution width(RDW),platelet distribution width(PDW),and immunoglobulin E(IgE)in the process of clinical diagnosis of children with asthma.Methods:Fifty-five children with suspected asthma were admitted to the hospital from July 2021 to July 2023.They underwent a bronchodilator test upon admission and their RDW,PDW,and IgE were detected.The efficacy of diagnosis with a single indicator(RDW/PDW/IgE)and combined parameters(PDW+PDW+IgE)were compared with the results of the bronchodilator test.Results:49 cases of pediatric asthma were diagnosed by the bronchodilator test.RDW and PDW of asthmatic children were lower than those of non-asthmatic children,while the IgE of asthmatic children was higher than that of non-asthmatic children,and there was a significant difference in the RDW,PDW,and IgE among children with different degrees of asthma severity(P<0.05).The positive rate of the three combined diagnostic tests of RDW,PDW,and IgE was significantly higher than the positive rate of a single-parameter diagnosis(P<0.05).Conclusion:The combination of RDW,PDW,and IgE plays a crucial role in the clinical diagnosis of asthmatic children.These tests further improve the efficiency of clinical diagnosis and help identify the severity of the disease.展开更多
Pneumonia ranks as a leading cause of mortality, particularly in children aged five and under. Detecting this disease typically requires radiologists to examine chest X-rays and report their findings to physicians, a ...Pneumonia ranks as a leading cause of mortality, particularly in children aged five and under. Detecting this disease typically requires radiologists to examine chest X-rays and report their findings to physicians, a task susceptible to human error. The application of Deep Transfer Learning (DTL) for the identification of pneumonia through chest X-rays is hindered by a shortage of available images, which has led to less than optimal DTL performance and issues with overfitting. Overfitting is characterized by a model’s learning that is too closely fitted to the training data, reducing its effectiveness on unseen data. The problem of overfitting is especially prevalent in medical image processing due to the high costs and extensive time required for image annotation, as well as the challenge of collecting substantial datasets that also respect patient privacy concerning infectious diseases such as pneumonia. To mitigate these challenges, this paper introduces the use of conditional generative adversarial networks (CGAN) to enrich the pneumonia dataset with 2690 synthesized X-ray images of the minority class, aiming to even out the dataset distribution for improved diagnostic performance. Subsequently, we applied four modified lightweight deep transfer learning models such as Xception, MobileNetV2, MobileNet, and EfficientNetB0. These models have been fine-tuned and evaluated, demonstrating remarkable detection accuracies of 99.26%, 98.23%, 97.06%, and 94.55%, respectively, across fifty epochs. The experimental results validate that the models we have proposed achieve high detection accuracy rates, with the best model reaching up to 99.26% effectiveness, outperforming other models in the diagnosis of pneumonia from X-ray images.展开更多
Objective:To analyze the effectiveness of modified non-traumatic filling technology in the treatment of pediatric dental caries.Methods:Ninety-seven children with dental caries who were treated in our hospital(Panyu M...Objective:To analyze the effectiveness of modified non-traumatic filling technology in the treatment of pediatric dental caries.Methods:Ninety-seven children with dental caries who were treated in our hospital(Panyu Maternal and Child Care Service Center of Guangzhou)from January 2022 to December 2023 were selected and randomly divided into two groups,with 48 cases in the experimental group and 49 in the control group.The experimental group was treated with modified non-traumatic filling techniques,while the control group was treated with conventional filling techniques.Observation indicators such as the total effectiveness of the treatment,incidence of adverse events,treatment compliance,and pain scores were analyzed after the intervention.Result:After intervention,the total effectiveness of the treatment in the experimental group was higher than that in the control group(P<0.05).The incidence of adverse events in the experimental group was lower than that of the control group(P<0.05).The treatment compliance of patients in the experimental group was higher than that in the control group(P<0.05).The pain score of the experimental group was lower than that of the control group(P<0.05).Conclusion:The application of modified non-traumatic filling technology in the treatment of pediatric dental caries showed good therapeutic outcomes.After the intervention,the child’s symptoms were significantly alleviated,the incidence of adverse events such as filling material falling off was reduced,their compliance was improved,and the pain was relieved.This procedure is worth to be promoted for clinical application.展开更多
BACKGROUND: Despite the rapid development of pediatric intensive care medicine, there are still limited data in the literature regarding the follow-up of pediatric trauma patients in pediatric intensive care units(PIC...BACKGROUND: Despite the rapid development of pediatric intensive care medicine, there are still limited data in the literature regarding the follow-up of pediatric trauma patients in pediatric intensive care units(PICUs). In this study, we aim to evaluate our experience with children admitted and followed up with the diagnosis of trauma at our PICU.METHODS: We evaluated the retrospective data of 77 pediatric trauma patients who were admitted to the PICU at Sancaktepe Sehit Prof. Dr. IlhanVarank Training and Research Hospital from August 2020 to December 2022. The demographic data, clinical parameters and laboratory results were recorded. The primary outcome was the mortality in PICU. The performances of markers in predicting mortality were evaluated with receiver operating characteristic(ROC) curves.RESULTS: The median age of the patients was 70(33–157) months, and the median duration of hospitalization in the PICU was 6(2–11) d. Of the 77 patients, 9 died due to trauma(11,1%). Among the clinical parameters, Pediatric Risk of Mortality III(PRISM III) Score, inotrope requirement, extracorporeal treatment requirement, and mechanical ventilator requirement were significantly higher in non-survivors than in survivors. Among the laboratory parameters, procalcitonin(PCT), lactate/albumin ratio(LAR), neutrophil/lymphocyte ratio(NLR), and transfusion requirement were significantly higher in non-survivors than in survivors.CONCLUSION: In pediatric trauma patients, baseline PCT, LAR, and NLR values can be used to identify patients at risk for mortality.展开更多
BACKGROUND:To promote the shared decision-making(SDM)between patients and doctors in pediatric outpatient departments,this study was designed to validate artificial intelligence(AI)-initiated medical tests for childre...BACKGROUND:To promote the shared decision-making(SDM)between patients and doctors in pediatric outpatient departments,this study was designed to validate artificial intelligence(AI)-initiated medical tests for children with fever.METHODS:We designed an AI model,named Xiaoyi,to suggest necessary tests for a febrile child before visiting a pediatric outpatient clinic.We calculated the sensitivity,specificity,and F1 score to evaluate the efficacy of Xiaoyi’s recommendations.The patients were divided into the rejection and acceptance groups.Then we analyzed the rejected examination items in order to obtain the corresponding reasons.RESULTS:We recruited a total of 11,867 children with fever who had used Xiaoyi in outpatient clinics.The recommended examinations given by Xiaoyi for 10,636(89.6%)patients were qualified.The average F1 score reached 0.94.A total of 58.4%of the patients accepted Xiaoyi’s suggestions(acceptance group),and 41.6%refused(rejection group).Imaging examinations were rejected by most patients(46.7%).The tests being time-consuming were rejected by 2,133 patients(43.2%),including rejecting pathogen studies in 1,347 patients(68.5%)and image studies in 732 patients(31.8%).The difficulty of sampling was the main reason for rejecting routine tests(41.9%).CONCLUSION:Our model has high accuracy and acceptability in recommending medical tests to febrile pediatric patients,and is worth promoting in facilitating SDM.展开更多
BACKGROUND Children with acute liver failure(ALF)who meet the criteria are eligible for super-urgent transplantation,whereas children with end-stage chronic liver disease(ESCLD)are usually transplanted electively.Pedi...BACKGROUND Children with acute liver failure(ALF)who meet the criteria are eligible for super-urgent transplantation,whereas children with end-stage chronic liver disease(ESCLD)are usually transplanted electively.Pediatric liver transplantation(PLT)in ALF and ESCLD settings has been well described in the literature,but there are no studies comparing the outcomes in these two groups.AIM To determine if there is a difference in post-operative complications and survival outcomes between ALF and ESCLD in PLT.METHODS This was a retrospective observational study of all primary PLTs performed at a single center between 2000 and 2019.ALF and ESCLD groups were compared for pretransplant recipient,donor and operative parameters,and post-operative outcomes including graft and patient survival.RESULTS Over a 20-year study period,232 primary PLTs were performed at our center;195 were transplanted for ESCLD and 37 were transplanted for ALF.The ALF recipients were significantly older(median 8 years vs 5.4 years;P=0.031)and heavier(31 kg vs 21 kg;P=0.011).Living donor grafts were used more in the ESCLD group(34 vs 0;P=0.006).There was no difference between the two groups concerning vascular complications and rejection,but there were more bile leaks in the ESCLD group.Post-transplant patient survival was significantly higher in the ESCLD group:1-,5-,and 10-year survival rates were 97.9%,93.9%,and 89.4%,respectively,compared to 78.3%,78.3%,and 78.3%in the ALF group(P=0.007).However,there was no difference in 1-,5-,and 10-year graft survival between the ESCLD and ALF groups(90.7%,82.9%,77.3%vs 75.6%,72.4%,and 66.9%;P=0.119).CONCLUSION Patient survival is inferior in ALF compared to ESCLD recipients;the main reason is death in the 1st year post-PLT in ALF group.Once the ALF children overcome the 1st year after transplant,their survival stabilizes,and they have good long-term outcomes.展开更多
The clinical scenario of pediatric liver disease is becoming more intricate due to changes in the disease spectrum,in which an increasing number of inherited/metabolic liver diseases are reported,while infectious dise...The clinical scenario of pediatric liver disease is becoming more intricate due to changes in the disease spectrum,in which an increasing number of inherited/metabolic liver diseases are reported,while infectious diseases show a decreasing trend.The similar clinical manifestations caused by inherited/metabolic diseases might be under-recognized or misdiagnosed due to nonspecific characteristics.A delayed visit to a doctor due to a lack of symptoms or mild symptoms at an early stage will result in late diagnosis and treatment.Moreover,limited diagnostic approaches,especially liver biopsy,are not easily accepted by pediatric patients,leading to challenges in etiological diagnosis.Liver dysfunction due to inherited/metabolic diseases is often caused by a variety of metabolites,so precision treatment is difficult;symptomatic treatment is a compelling option for inherited disorders.展开更多
Biologic agents with various mechanisms against Crohn’s disease(CD)have been released and are widely used in clinical practice.However,two anti-tumor necrosis factor(TNF)agents,infliximab(IFX)and adalimumab(ADL),are ...Biologic agents with various mechanisms against Crohn’s disease(CD)have been released and are widely used in clinical practice.However,two anti-tumor necrosis factor(TNF)agents,infliximab(IFX)and adalimumab(ADL),are the only biologic agents approved by the Food and Drug Administration for pediatric CD currently.Therefore,in pediatric CD,the choice of biologic agents should be made more carefully to achieve the therapeutic goal.There are currently no headto-head trials of biologic agents in pediatric or adult CD.There is a lack of accumulated data for pediatric CD,which requires the extrapolation of adult data for the positioning of biologics in pediatric CD.From a pharmacokinetic point of view,IFX is more advantageous than ADL when the inflammatory burden is high,and ADL is expected to be advantageous over IFX in sustaining remission in the maintenance phase.Additionally,we reviewed the safety profile,immunogenicity,preference,and compliance between IFX and ADL and provide practical insights into the choice of anti-TNF therapy in pediatric CD.Careful evaluation of clinical indications and disease behavior is essential when prescribing anti-TNF agents.In addition,factors such as the efficacy of induction and maintenance of remission,safety profile,immunogenicity,patient preference,and compliance play an important role in evaluating and selecting treatment options.展开更多
BACKGROUND Per-oral endoscopic myotomy(POEM)is emerging as a prefer treatment option for pediatric achalasia.However,data are limited on the long-term efficacy of POEM in children and adolescents with achalasia.AIM To...BACKGROUND Per-oral endoscopic myotomy(POEM)is emerging as a prefer treatment option for pediatric achalasia.However,data are limited on the long-term efficacy of POEM in children and adolescents with achalasia.AIM To evaluate the safety and long-term efficacy of POEM for pediatric patients with achalasia and compare those outcomes with adult patients.METHODS This retrospective cohort study was conducted in patients with achalasia who underwent POEM.Patients aged under 18 years were included in the pediatric group;patients aged between 18 to 65 years who underwent POEM in the same period were assigned to the control group.For investigation of long-term followup,the pediatric group were matched with patients from the control group in a 1:1 ratio.The procedure-related parameters,adverse events,clinical success,gastroesophageal reflux disease(GERD)after POEM,and quality of life(QoL)were evaluated.RESULTS From January 2012 to March 2020,POEM was performed in 1025 patients aged under 65 years old(48 in the pediatric group,1025 in the control group).No significant differences were observed in the occurrence of POEM complications between the two groups(14.6%vs 14.6%;P=0.99).Among the 34 pediatric patients(70.8%)who underwent follow-up for 5.7 years(range 2.6-10.6 years),clinical success was achieved in 35 patients(35/36;97.2%).No differences were observed in post-POEM GERD occurrence(17.6%vs 35.3%;P=0.10).QoL was significantly improved in both groups after POEM.CONCLUSION POEM is safe and effective for pediatric patients with achalasia.It can achieve significant symptoms relief and improve QoL.展开更多
To the Editor:Pediatric liver transplantation is the only treatment option for end-stage liver disease in children,and the 5-year and 20-year survival rates after living donor liver transplantation(LDLT)can reach 91.5...To the Editor:Pediatric liver transplantation is the only treatment option for end-stage liver disease in children,and the 5-year and 20-year survival rates after living donor liver transplantation(LDLT)can reach 91.5% and 84.2%[1].Many Asian countries,including China,have begun to develop LDLT and achieved good progress.However,the shortage of donor livers in children remains a serious problem.展开更多
AIM:To study and compare the predisposing factors and clinical features of pediatric,adult,and elderly rhegmatogenous retinal detachment(RRD).METHODS:This is an observational analytic crosssectional study in which pat...AIM:To study and compare the predisposing factors and clinical features of pediatric,adult,and elderly rhegmatogenous retinal detachment(RRD).METHODS:This is an observational analytic crosssectional study in which patients with RRD admitted for surgery during 6mo period were divided into 3 age groups:pediatric(<18y),adult(18-60y),and elderly(>60y).Patients’demographic data,clinical features,RRD predisposing factors/features including myopia(axial length≥26.5 mm),aphakia/pseudophakia,blunt trauma,peripheral retinal degenerations,history of RRD in the fellow eye,and surgical interventions/findings were recorded and analyzed.RESULTS:Totally 142 patients(142 eyes)were studied:26(18.31%)pediatrics,86(60.56%)adults,and 30(21.13%)elderly.Elderly patients had a significantly higher intraocular pressures and cataracts compared to the other 2 groups(P=0.04).The RRD extent was larger in pediatric group(mostly 4 quadrants)compared to adults and elderly(mostly 2 quadrants),but it was not statistically insignificant(P=0.242).There were not statistically significantly differences in proliferative vitreoretinopathy(PVR)rate,posterior vitreous detachment(PVD)rate,number,site,shape,and size of breaks in three groups.All three groups had macular detachment in all eyes.Myopia and peripheral retinal degenerations were found to be more significant in adults(P=0.049,P=0.035,respectively),while blunt trauma was higher but insignificant in pediatric eyes(P=0.052).Pars plana vitrectomy(PPV)with silicone oil as a tamponade was the most used surgery in all groups.CONCLUSION:There are no significant difference in PVR rate in pediatric eyes but a significant higher rate of total RRD.Blunt trauma is more frequent in pediatrics eyes while myopia and/or peripheral retinal degenerations are more frequent in older ages.The rate of PPV as a choice for surgery is similar among all age groups.展开更多
BACKGROUND Endocardial fibroelastosis(EFE)is a diffuse endocardial collagen and elastin hyperplasia disease of unknown etiology,which may be accompanied by myocardial degenerative changes leading to acute or chronic h...BACKGROUND Endocardial fibroelastosis(EFE)is a diffuse endocardial collagen and elastin hyperplasia disease of unknown etiology,which may be accompanied by myocardial degenerative changes leading to acute or chronic heart failure.However,acute heart failure(AHF)without obvious associated triggers is rare.Prior to the report of endomyocardial biopsy,the diagnosis and treatment of EFE are highly susceptible to being confounded with other primary cardiomyopathies.Here,we report a case of pediatric AHF caused by EFE mimicking dilated cardiomyopathy(DCM),with the aim of providing a valuable reference for clinicians to early identify and diagnose EFE-induced AHF.CASE SUMMARY A 13-mo-old female child was admitted to hospital with retching.Chest X-ray demonstrated enhanced texture in both lungs and an enlarged heart shadow.Color doppler echocardiography showed an enlarged left heart with ventricular wall hypokinesis and decreased left heart function.Abdominal color ultrasonography revealed a markedly enlarged liver.Pending the result of the endomyocardial biopsy report,the child was treated with a variety of resuscitative measures including nasal cannula for oxygen,intramuscular sedation with chlorpromazine and promethazine,cedilanid for cardiac contractility enhancement,and diuretic treatment with furosemide.Subsequently,the child’s endomyocardial biopsy report result was confirmed as EFE.After the above early interventions,the child’s condition gradually stabilized and improved.One week later,the child was discharged.During a 9-mo follow-up period,the child took intermittent low-dose oral digoxin with no signs of recurrence or exacerbation of the heart failure.CONCLUSION Our report suggests that EFE-induced pediatric AHF may present in children over 1 year of age without any apparent precipitants,and that the associated clinical presentations are grossly similar to that of pediatric DCM.Nonetheless,it is still possible to be diagnosed effectively on the basis of the comprehensive analysis of auxiliary inspection findings before the result of the endomyocardial biopsy is reported.展开更多
AIM:To explore the hotspots and frontiers of genetic research on pediatric cataracts.METHODS:Global publications from 2013 to 2022 related to genes in pediatric cataracts were extracted from the Web of Science Core Co...AIM:To explore the hotspots and frontiers of genetic research on pediatric cataracts.METHODS:Global publications from 2013 to 2022 related to genes in pediatric cataracts were extracted from the Web of Science Core Collection,and were analyzed in terms of the publication counts,countries,journals,authors,keywords,cited references,subject categories,and the underlying hotspots and frontiers.RESULTS:Totally 699 publications were included in the final analysis.The predominant actors were identified,with China(n=240)and PLoS One(n=33)being the most productive country and journal respectively.The research hotspots extracted from keywords were crystallin gene mutations,pathogenicity evaluation,phenotypes of ocular and neurodevelopmental abnormalities,genes encoding membrane proteins,and diagnosis of multisystemic disorders.The co-cited articles formed 10 clusters of research topics,including FYCO1(56 items),mutation screening(43 items),gap junction(29 items),the Warburg Micro syndrome(29 items),ephrin-A5(28 items),novel mutation(24 items),eye development and function(22 items),cholestanol(7 items),OCRL(6 items),and pathogenicity prediction(3 items).The research frontiers were FYCO1,ephrin-A5,and cholestanol.Cell biology showed the strongest bridging effects among different disciplines in the field(betweenness centrality=0.44).CONCLUSION:With the progress in next-generation sequencing and multidisciplinary collaboration,genetic research on pediatric cataracts broadens the knowledge scope of the crystalline lens,as well as other organs and systems,shedding light on the molecular mechanisms of systemic diseases.Cell biology may integrate multidisciplinary content to address cutting-edge issues in the field.展开更多
文摘Rationale:Rabies is a zoonotic disease with a high mortality,primarily transmitted through the bite of infected mammals,particularly dogs and cats.Despite being a well-known disease since ancient times,it continues to cause a significant number of human deaths worldwide,with approximately 65000 fatalities reported annually.Patient concerns:We present two fatal cases of rabies in a 12-year-old immigrant boy and a 7-year-old boy.The first case was subject to a 24-hour delay in receiving appropriate medical attention and rabies preventive measures due to the lack of awareness among emergency hospital staff,leading to the administration of wound dressing only.The second case received timely rabies immunoglobulin administration;however,there was a 4-day delay in administering the fourth dose of the rabies vaccine,despite presenting evident symptoms of rabies.Diagnosis:Postmortem examination of brain samples from both patients confirmed the presence of rabies virus.Interventions:Post-exposure prophylaxis for rabies.Outcomes:Both patients were admitted to the hospital after the manifestation of rabies-related symptoms,with the 12-year-old child seeking medical care 47 days after the animal bite and the 7-year-old child seeking medical care 58 days after the exposure.Finally,the first patient died after 27 days and the second patient died after 40 days of hospitalization.Lessons:There is an urgent need for heightened awareness and education among both healthcare professionals and the public regarding the urgency of seeking immediate medical attention after potential rabies exposure.Timely recognition and initiation of post-exposure prophylaxis are pivotal in preventing the progression of the disease.Strengthening surveillance and reporting systems,coupled with continuous training for healthcare professionals,can contribute to early detection and management of rabies cases.
基金Division of Neurology,Cincinnati Children’s Hospital Medical Center(as a Medical Student Scholars Program award to ALM)。
文摘There are few pharmacologic options for the treatment of cognitive deficits associated with traumatic brain injury in pediatric patients.Acetylcholinesterase inhibitors such as donepezil have been evaluated in adult patients after traumatic brain injury,but relatively less is known about the effect in pediatric populations.The goal of this review is to identify knowledge gaps in the efficacy and safety of acetylcholinesterase inhibito rs as a potential a djuvant treatment fo r neurocognitive decline in pediatric patients with traumatic brain injury.Investigators queried PubMed to identify literature published from database inception thro ugh June 2023 desc ribing the use of donepezil in young adult traumatic brain injury and pediatric patients with predefined conditions.Based on preselected search criteria,340 unique papers we re selected for title and abstra ct screening.Thirty-two reco rds were reviewed in full after eliminating preclinical studies and pape rs outside the scope of the project.In adult traumatic brain injury,we review results from 14 papers detailing 227 subjects where evidence suggests donepezil is well tole rated and shows both objective and patient-reported efficacy for reducing cognitive impairment.In children,3 pape rs report on 5 children recovering from traumatic brain injury,showing limited efficacy.An additional 15 pediatric studies conducted in populations at risk for cognitive dysfunction provide a broader look at safety and efficacy in 210 patients in the pediatric age group.Given its promise for efficacy in adults with traumatic brain injury and tole rability in pediatric patients,we believe further study of donepezil for children and adolescents with traumatic brain injury is warranted.
文摘BACKGROUND Distal humerus elbow fractures are one of the most common traumatic fractures seen in pediatric patients and present as three main types:Supracondylar(SC),lateral condyle(LC),and medial epicondyle(ME)fractures.AIM To evaluate the epidemiology of pediatric distal humerus fractures(SC,LC,and ME)from an American insurance claims database.METHODS A retrospective review was performed on patients 17 years and younger with the ICD 9 and 10 codes for SC,LC and ME fractures based on the IBM Truven MarketScan®Commercial and IBM Truven MarketScan Medicare Supplemental databases.Patients from 2015 to 2020 were queried for treatments,patient age,sex,length of hospitalization,and comorbidities.RESULTS A total of 1133 SC,154 LC,and 124 ME fractures were identified.SC fractures had the highest percentage of operation at 83%,followed by LC(78%)and ME fractures(41%).Male patients were,on average,older than female patients for both SC and ME fractures.CONCLUSION In the insurance claims databases used,SC fractures were the most reported,followed by LC fractures,and finally ME fractures.Age was identified to be a factor for how a pediatric distal humerus fractures,with patients with SC and LC fractures being younger than those with ME fractures.The peak age per injury per sex was similar to reported historic central tendencies,despite reported trends for younger physiologic development.
文摘In the field of pediatric nursing, in the perinatal period, numerous ethical issues arise alongside the advancement of medical technology. However, sufficient education on bioethics is not provided in the pediatric nursing domain of basic nursing education. The purpose of this research is to examine the current status of bioethics education in the pediatric nursing domain of basic nursing education and explore the challenges perceived by the pediatric nursing faculty regarding bioethics education. The research method was a questionnaire survey on 100 randomly selected pediatric nursing faculty members from nursing universities across Japan. The results revealed that although bioethics issues were considered important, the emphasis remained primarily on addressing bioethics as part of nursing that respects children’s rights. Furthermore, respondents expressed difficulties regarding teaching methods and content related to bioethics.
文摘BACKGROUND Screening for iron deficiency anemia(IDA)is important in managing pediatric patients with inflammatory bowel disease(IBD).Concerns related to adverse reactions may contribute to a reluctance to prescribe intravenous(IV)iron to treat IDA in this population.AIM To track the efficacy and safety of IV iron therapy in treating IDA in pediatric IBD patients admitted to our center.METHODS A longitudinal observational cohort study was performed on 236 consecutive pediatric patients admitted to our tertiary IBD care center between September 2017 and December 2019.92 patients met study criteria for IDA,of which 57 received IV iron,17 received oral iron,and 18 were discharged prior to receiving iron therapy.RESULTS Patients treated with IV iron during their hospitalization experienced a significant increase of 1.9(±0.2)g/dL in mean(±SE)hemoglobin(Hb)concentration by the first ambulatory follow-up,compared to patients who received oral iron 0.8(±0.3)g/dL or no iron 0.8(±0.3)g/dL(P=0.03).One out of 57(1.8%)patients that received IV iron therapy experienced an adverse reaction.CONCLUSION Our findings demonstrate that treatment with IV iron therapy is safe and efficacious in improving Hb and iron levels in pediatric patients with IDA and active IBD.
文摘Pediatric inflammatory bowel disease(IBD)is a chronic inflammatory disorder,with increasing incidence and prevalence worldwide.There have been recent advances in imaging and endoscopic technology for disease diagnosis,treatment,and monitoring.Intestinal ultrasound,including transabdominal,transperineal,and endoscopic,has been emerging for the assessment of transmural bowel inflammation and disease complications(e.g.,fistula,abscess).Aside from surgery,IBD-related intestinal strictures now have endoscopic treatment options including through-the-scope balloon dilatation,injection,and needle knife stricturotomy and new evaluation tools such as endoscopic functional lumen imaging probe.Unsedated transnasal endoscopy may have a role in patients with upper gastrointestinal Crohn’s disease or those with IBD with new upper gastrointestinal symptoms.Improvements to dysplasia screening in pediatric patients with longstanding colonic disease or primary sclerosing cholangitis hold promise with the addition of virtual chromoendoscopy and ongoing research in the field of artificial intelligence-assisted endoscopic detection.Artificial intelligence and machine learning is a rapidly evolving field,with goals of further personalizing IBD diagnosis and treatment selection as well as prognostication.This review summarized these advancements,focusing on pediatric patients with IBD.
文摘Introduction: Cystic lymphangiomas are rare benign malformative tumors of the lymphatic system of obscure etiopathogenesis. The cervico-facial location remains the most common (75%). Although benign, these tumors remain potentially fatal, due to possible compression of the upper aero-digestive tract. The aim of this work is to study the epidemiological, diagnostic and therapeutic characteristics of cervico-mandibular congenital cystic lymphangiomas in the pediatric surgery department of the Donka National Hospital (HND) Conakry. Patients and methods: This is a retrospective and descriptive study of 13 files lasting 7 years from January 2015 to December 31, 2021. The files of children whose age is less than or equal to 15 years operated on cervical tumor with histological evidence of cystic lymphangioma were retained. The data were analyzed using SPSS statistical software 21 and anonymously. Results: The incidence of this study was 1.86 cases per year and a sex ratio of 0.62 in favor of girls. The average age was 8 months 19 days. In the antecedents, we only find poorly monitored pregnancies. The average size of the tumors was 11.85 cm. Cervical ultrasound and standard x-ray of the cervical mass were the only examinations performed. Total surgical excision of the cervical tumor was performed in all patients. The mass was polycystic on exploration. The histological examination of the surgical specimens was in favor of a cystic lymphangioma. The surgical consequences were simple in 11 patients (84.62%) and complicated by parietal suppuration in 2 cases (15.38%). There were no cases of recurrence after one year of follow-up. Conclusion: Cervico-mandibular cystic lymphangiomas are the most frequent locations of congenital lymphangiomas in children. Their severity is linked to the risk of compression of the aero-digestive tracts. Their diagnosis must be confirmed by the histology of the surgical specimen. Despite the therapeutic arsenal, excision of the cystic mass remains the only effective alternative in our socio-economic conditions to avoid recurrences and loss of follow-up of patients.
文摘Objective:To observe and explore the value of the combined application of red blood cell distribution width(RDW),platelet distribution width(PDW),and immunoglobulin E(IgE)in the process of clinical diagnosis of children with asthma.Methods:Fifty-five children with suspected asthma were admitted to the hospital from July 2021 to July 2023.They underwent a bronchodilator test upon admission and their RDW,PDW,and IgE were detected.The efficacy of diagnosis with a single indicator(RDW/PDW/IgE)and combined parameters(PDW+PDW+IgE)were compared with the results of the bronchodilator test.Results:49 cases of pediatric asthma were diagnosed by the bronchodilator test.RDW and PDW of asthmatic children were lower than those of non-asthmatic children,while the IgE of asthmatic children was higher than that of non-asthmatic children,and there was a significant difference in the RDW,PDW,and IgE among children with different degrees of asthma severity(P<0.05).The positive rate of the three combined diagnostic tests of RDW,PDW,and IgE was significantly higher than the positive rate of a single-parameter diagnosis(P<0.05).Conclusion:The combination of RDW,PDW,and IgE plays a crucial role in the clinical diagnosis of asthmatic children.These tests further improve the efficiency of clinical diagnosis and help identify the severity of the disease.
文摘Pneumonia ranks as a leading cause of mortality, particularly in children aged five and under. Detecting this disease typically requires radiologists to examine chest X-rays and report their findings to physicians, a task susceptible to human error. The application of Deep Transfer Learning (DTL) for the identification of pneumonia through chest X-rays is hindered by a shortage of available images, which has led to less than optimal DTL performance and issues with overfitting. Overfitting is characterized by a model’s learning that is too closely fitted to the training data, reducing its effectiveness on unseen data. The problem of overfitting is especially prevalent in medical image processing due to the high costs and extensive time required for image annotation, as well as the challenge of collecting substantial datasets that also respect patient privacy concerning infectious diseases such as pneumonia. To mitigate these challenges, this paper introduces the use of conditional generative adversarial networks (CGAN) to enrich the pneumonia dataset with 2690 synthesized X-ray images of the minority class, aiming to even out the dataset distribution for improved diagnostic performance. Subsequently, we applied four modified lightweight deep transfer learning models such as Xception, MobileNetV2, MobileNet, and EfficientNetB0. These models have been fine-tuned and evaluated, demonstrating remarkable detection accuracies of 99.26%, 98.23%, 97.06%, and 94.55%, respectively, across fifty epochs. The experimental results validate that the models we have proposed achieve high detection accuracy rates, with the best model reaching up to 99.26% effectiveness, outperforming other models in the diagnosis of pneumonia from X-ray images.
文摘Objective:To analyze the effectiveness of modified non-traumatic filling technology in the treatment of pediatric dental caries.Methods:Ninety-seven children with dental caries who were treated in our hospital(Panyu Maternal and Child Care Service Center of Guangzhou)from January 2022 to December 2023 were selected and randomly divided into two groups,with 48 cases in the experimental group and 49 in the control group.The experimental group was treated with modified non-traumatic filling techniques,while the control group was treated with conventional filling techniques.Observation indicators such as the total effectiveness of the treatment,incidence of adverse events,treatment compliance,and pain scores were analyzed after the intervention.Result:After intervention,the total effectiveness of the treatment in the experimental group was higher than that in the control group(P<0.05).The incidence of adverse events in the experimental group was lower than that of the control group(P<0.05).The treatment compliance of patients in the experimental group was higher than that in the control group(P<0.05).The pain score of the experimental group was lower than that of the control group(P<0.05).Conclusion:The application of modified non-traumatic filling technology in the treatment of pediatric dental caries showed good therapeutic outcomes.After the intervention,the child’s symptoms were significantly alleviated,the incidence of adverse events such as filling material falling off was reduced,their compliance was improved,and the pain was relieved.This procedure is worth to be promoted for clinical application.
文摘BACKGROUND: Despite the rapid development of pediatric intensive care medicine, there are still limited data in the literature regarding the follow-up of pediatric trauma patients in pediatric intensive care units(PICUs). In this study, we aim to evaluate our experience with children admitted and followed up with the diagnosis of trauma at our PICU.METHODS: We evaluated the retrospective data of 77 pediatric trauma patients who were admitted to the PICU at Sancaktepe Sehit Prof. Dr. IlhanVarank Training and Research Hospital from August 2020 to December 2022. The demographic data, clinical parameters and laboratory results were recorded. The primary outcome was the mortality in PICU. The performances of markers in predicting mortality were evaluated with receiver operating characteristic(ROC) curves.RESULTS: The median age of the patients was 70(33–157) months, and the median duration of hospitalization in the PICU was 6(2–11) d. Of the 77 patients, 9 died due to trauma(11,1%). Among the clinical parameters, Pediatric Risk of Mortality III(PRISM III) Score, inotrope requirement, extracorporeal treatment requirement, and mechanical ventilator requirement were significantly higher in non-survivors than in survivors. Among the laboratory parameters, procalcitonin(PCT), lactate/albumin ratio(LAR), neutrophil/lymphocyte ratio(NLR), and transfusion requirement were significantly higher in non-survivors than in survivors.CONCLUSION: In pediatric trauma patients, baseline PCT, LAR, and NLR values can be used to identify patients at risk for mortality.
基金This study was supported by the Science and Technology Innovation-Biomedical Supporting Program of Shanghai Science and Technology Committee(19441904400)Program for artificial intelligence innovation and development of Shanghai Municipal Commission of Economy and Informatization(2020-RGZN-02048).
文摘BACKGROUND:To promote the shared decision-making(SDM)between patients and doctors in pediatric outpatient departments,this study was designed to validate artificial intelligence(AI)-initiated medical tests for children with fever.METHODS:We designed an AI model,named Xiaoyi,to suggest necessary tests for a febrile child before visiting a pediatric outpatient clinic.We calculated the sensitivity,specificity,and F1 score to evaluate the efficacy of Xiaoyi’s recommendations.The patients were divided into the rejection and acceptance groups.Then we analyzed the rejected examination items in order to obtain the corresponding reasons.RESULTS:We recruited a total of 11,867 children with fever who had used Xiaoyi in outpatient clinics.The recommended examinations given by Xiaoyi for 10,636(89.6%)patients were qualified.The average F1 score reached 0.94.A total of 58.4%of the patients accepted Xiaoyi’s suggestions(acceptance group),and 41.6%refused(rejection group).Imaging examinations were rejected by most patients(46.7%).The tests being time-consuming were rejected by 2,133 patients(43.2%),including rejecting pathogen studies in 1,347 patients(68.5%)and image studies in 732 patients(31.8%).The difficulty of sampling was the main reason for rejecting routine tests(41.9%).CONCLUSION:Our model has high accuracy and acceptability in recommending medical tests to febrile pediatric patients,and is worth promoting in facilitating SDM.
文摘BACKGROUND Children with acute liver failure(ALF)who meet the criteria are eligible for super-urgent transplantation,whereas children with end-stage chronic liver disease(ESCLD)are usually transplanted electively.Pediatric liver transplantation(PLT)in ALF and ESCLD settings has been well described in the literature,but there are no studies comparing the outcomes in these two groups.AIM To determine if there is a difference in post-operative complications and survival outcomes between ALF and ESCLD in PLT.METHODS This was a retrospective observational study of all primary PLTs performed at a single center between 2000 and 2019.ALF and ESCLD groups were compared for pretransplant recipient,donor and operative parameters,and post-operative outcomes including graft and patient survival.RESULTS Over a 20-year study period,232 primary PLTs were performed at our center;195 were transplanted for ESCLD and 37 were transplanted for ALF.The ALF recipients were significantly older(median 8 years vs 5.4 years;P=0.031)and heavier(31 kg vs 21 kg;P=0.011).Living donor grafts were used more in the ESCLD group(34 vs 0;P=0.006).There was no difference between the two groups concerning vascular complications and rejection,but there were more bile leaks in the ESCLD group.Post-transplant patient survival was significantly higher in the ESCLD group:1-,5-,and 10-year survival rates were 97.9%,93.9%,and 89.4%,respectively,compared to 78.3%,78.3%,and 78.3%in the ALF group(P=0.007).However,there was no difference in 1-,5-,and 10-year graft survival between the ESCLD and ALF groups(90.7%,82.9%,77.3%vs 75.6%,72.4%,and 66.9%;P=0.119).CONCLUSION Patient survival is inferior in ALF compared to ESCLD recipients;the main reason is death in the 1st year post-PLT in ALF group.Once the ALF children overcome the 1st year after transplant,their survival stabilizes,and they have good long-term outcomes.
基金Supported by the Shenzhen Science and Technology Innovation Program,No.JCYJ20220818102801004(to Dai DL).
文摘The clinical scenario of pediatric liver disease is becoming more intricate due to changes in the disease spectrum,in which an increasing number of inherited/metabolic liver diseases are reported,while infectious diseases show a decreasing trend.The similar clinical manifestations caused by inherited/metabolic diseases might be under-recognized or misdiagnosed due to nonspecific characteristics.A delayed visit to a doctor due to a lack of symptoms or mild symptoms at an early stage will result in late diagnosis and treatment.Moreover,limited diagnostic approaches,especially liver biopsy,are not easily accepted by pediatric patients,leading to challenges in etiological diagnosis.Liver dysfunction due to inherited/metabolic diseases is often caused by a variety of metabolites,so precision treatment is difficult;symptomatic treatment is a compelling option for inherited disorders.
文摘Biologic agents with various mechanisms against Crohn’s disease(CD)have been released and are widely used in clinical practice.However,two anti-tumor necrosis factor(TNF)agents,infliximab(IFX)and adalimumab(ADL),are the only biologic agents approved by the Food and Drug Administration for pediatric CD currently.Therefore,in pediatric CD,the choice of biologic agents should be made more carefully to achieve the therapeutic goal.There are currently no headto-head trials of biologic agents in pediatric or adult CD.There is a lack of accumulated data for pediatric CD,which requires the extrapolation of adult data for the positioning of biologics in pediatric CD.From a pharmacokinetic point of view,IFX is more advantageous than ADL when the inflammatory burden is high,and ADL is expected to be advantageous over IFX in sustaining remission in the maintenance phase.Additionally,we reviewed the safety profile,immunogenicity,preference,and compliance between IFX and ADL and provide practical insights into the choice of anti-TNF therapy in pediatric CD.Careful evaluation of clinical indications and disease behavior is essential when prescribing anti-TNF agents.In addition,factors such as the efficacy of induction and maintenance of remission,safety profile,immunogenicity,patient preference,and compliance play an important role in evaluating and selecting treatment options.
基金Supported by National Natural Science Foundation of China,No.82070682。
文摘BACKGROUND Per-oral endoscopic myotomy(POEM)is emerging as a prefer treatment option for pediatric achalasia.However,data are limited on the long-term efficacy of POEM in children and adolescents with achalasia.AIM To evaluate the safety and long-term efficacy of POEM for pediatric patients with achalasia and compare those outcomes with adult patients.METHODS This retrospective cohort study was conducted in patients with achalasia who underwent POEM.Patients aged under 18 years were included in the pediatric group;patients aged between 18 to 65 years who underwent POEM in the same period were assigned to the control group.For investigation of long-term followup,the pediatric group were matched with patients from the control group in a 1:1 ratio.The procedure-related parameters,adverse events,clinical success,gastroesophageal reflux disease(GERD)after POEM,and quality of life(QoL)were evaluated.RESULTS From January 2012 to March 2020,POEM was performed in 1025 patients aged under 65 years old(48 in the pediatric group,1025 in the control group).No significant differences were observed in the occurrence of POEM complications between the two groups(14.6%vs 14.6%;P=0.99).Among the 34 pediatric patients(70.8%)who underwent follow-up for 5.7 years(range 2.6-10.6 years),clinical success was achieved in 35 patients(35/36;97.2%).No differences were observed in post-POEM GERD occurrence(17.6%vs 35.3%;P=0.10).QoL was significantly improved in both groups after POEM.CONCLUSION POEM is safe and effective for pediatric patients with achalasia.It can achieve significant symptoms relief and improve QoL.
基金supported by grants from the National Natural Science Foundation of China(82071797 and 81873874)Clinical Research Plan of SHDC(SHDC2020CR2021B and SHDC2020CR5012)。
文摘To the Editor:Pediatric liver transplantation is the only treatment option for end-stage liver disease in children,and the 5-year and 20-year survival rates after living donor liver transplantation(LDLT)can reach 91.5% and 84.2%[1].Many Asian countries,including China,have begun to develop LDLT and achieved good progress.However,the shortage of donor livers in children remains a serious problem.
文摘AIM:To study and compare the predisposing factors and clinical features of pediatric,adult,and elderly rhegmatogenous retinal detachment(RRD).METHODS:This is an observational analytic crosssectional study in which patients with RRD admitted for surgery during 6mo period were divided into 3 age groups:pediatric(<18y),adult(18-60y),and elderly(>60y).Patients’demographic data,clinical features,RRD predisposing factors/features including myopia(axial length≥26.5 mm),aphakia/pseudophakia,blunt trauma,peripheral retinal degenerations,history of RRD in the fellow eye,and surgical interventions/findings were recorded and analyzed.RESULTS:Totally 142 patients(142 eyes)were studied:26(18.31%)pediatrics,86(60.56%)adults,and 30(21.13%)elderly.Elderly patients had a significantly higher intraocular pressures and cataracts compared to the other 2 groups(P=0.04).The RRD extent was larger in pediatric group(mostly 4 quadrants)compared to adults and elderly(mostly 2 quadrants),but it was not statistically insignificant(P=0.242).There were not statistically significantly differences in proliferative vitreoretinopathy(PVR)rate,posterior vitreous detachment(PVD)rate,number,site,shape,and size of breaks in three groups.All three groups had macular detachment in all eyes.Myopia and peripheral retinal degenerations were found to be more significant in adults(P=0.049,P=0.035,respectively),while blunt trauma was higher but insignificant in pediatric eyes(P=0.052).Pars plana vitrectomy(PPV)with silicone oil as a tamponade was the most used surgery in all groups.CONCLUSION:There are no significant difference in PVR rate in pediatric eyes but a significant higher rate of total RRD.Blunt trauma is more frequent in pediatrics eyes while myopia and/or peripheral retinal degenerations are more frequent in older ages.The rate of PPV as a choice for surgery is similar among all age groups.
文摘BACKGROUND Endocardial fibroelastosis(EFE)is a diffuse endocardial collagen and elastin hyperplasia disease of unknown etiology,which may be accompanied by myocardial degenerative changes leading to acute or chronic heart failure.However,acute heart failure(AHF)without obvious associated triggers is rare.Prior to the report of endomyocardial biopsy,the diagnosis and treatment of EFE are highly susceptible to being confounded with other primary cardiomyopathies.Here,we report a case of pediatric AHF caused by EFE mimicking dilated cardiomyopathy(DCM),with the aim of providing a valuable reference for clinicians to early identify and diagnose EFE-induced AHF.CASE SUMMARY A 13-mo-old female child was admitted to hospital with retching.Chest X-ray demonstrated enhanced texture in both lungs and an enlarged heart shadow.Color doppler echocardiography showed an enlarged left heart with ventricular wall hypokinesis and decreased left heart function.Abdominal color ultrasonography revealed a markedly enlarged liver.Pending the result of the endomyocardial biopsy report,the child was treated with a variety of resuscitative measures including nasal cannula for oxygen,intramuscular sedation with chlorpromazine and promethazine,cedilanid for cardiac contractility enhancement,and diuretic treatment with furosemide.Subsequently,the child’s endomyocardial biopsy report result was confirmed as EFE.After the above early interventions,the child’s condition gradually stabilized and improved.One week later,the child was discharged.During a 9-mo follow-up period,the child took intermittent low-dose oral digoxin with no signs of recurrence or exacerbation of the heart failure.CONCLUSION Our report suggests that EFE-induced pediatric AHF may present in children over 1 year of age without any apparent precipitants,and that the associated clinical presentations are grossly similar to that of pediatric DCM.Nonetheless,it is still possible to be diagnosed effectively on the basis of the comprehensive analysis of auxiliary inspection findings before the result of the endomyocardial biopsy is reported.
基金Supported by the National Natural Science Foundation of China(No.81900841)the Science and Technology Program of Guangzhou,China(No.202201011815)+3 种基金the Guangdong Basic and Applied Basic Research Foundation(No.2022A1515011181)the Teaching Reform Research Program of Sun Yat-sen University(No.JX3030604024)the Youth Project of State Key Laboratory of Ophthalmology(No.2021QN02)the Construction Project of High-Level Hospitals in Guangdong Province(No.303020102).
文摘AIM:To explore the hotspots and frontiers of genetic research on pediatric cataracts.METHODS:Global publications from 2013 to 2022 related to genes in pediatric cataracts were extracted from the Web of Science Core Collection,and were analyzed in terms of the publication counts,countries,journals,authors,keywords,cited references,subject categories,and the underlying hotspots and frontiers.RESULTS:Totally 699 publications were included in the final analysis.The predominant actors were identified,with China(n=240)and PLoS One(n=33)being the most productive country and journal respectively.The research hotspots extracted from keywords were crystallin gene mutations,pathogenicity evaluation,phenotypes of ocular and neurodevelopmental abnormalities,genes encoding membrane proteins,and diagnosis of multisystemic disorders.The co-cited articles formed 10 clusters of research topics,including FYCO1(56 items),mutation screening(43 items),gap junction(29 items),the Warburg Micro syndrome(29 items),ephrin-A5(28 items),novel mutation(24 items),eye development and function(22 items),cholestanol(7 items),OCRL(6 items),and pathogenicity prediction(3 items).The research frontiers were FYCO1,ephrin-A5,and cholestanol.Cell biology showed the strongest bridging effects among different disciplines in the field(betweenness centrality=0.44).CONCLUSION:With the progress in next-generation sequencing and multidisciplinary collaboration,genetic research on pediatric cataracts broadens the knowledge scope of the crystalline lens,as well as other organs and systems,shedding light on the molecular mechanisms of systemic diseases.Cell biology may integrate multidisciplinary content to address cutting-edge issues in the field.
