教学课程资源库 更多>>

关键词： Epilepsy surgery   Depth electrode   Stereotactic implantation   Invasive diagnostic   Robot  

摘要： Objective: The number of patients requiring depth electrode implantation for invasive video EEG diagnostics increases in most epilepsy centres. Here we report on our institutional experience with frameless robot-assisted stereotactic placement of intracerebral depth electrodes using the Neuromate? stereotactic robot-system. Methods: We identified all patients who had undergone robot-assisted stereotactic placement of intracerebral depth electrodes for invasive extra-operative epilepsy monitoring between September 2013 and March 2020. We studied technical (placement) and diagnostic accuracy of the robot-assisted procedure, associated surgical complications and procedural time requirements. Results: We evaluated a total of 464 depth electrodes implanted in 74 patients (mean 6 per patient, range 1?12). There were 27 children and 47 adults (age range: 3.6?64.6 yrs.). The mean entry and target point errors were 1.82?1.15 and 1.98?1.05 mm. Target and entry point errors were significantly higher in paediatric vs. adult patients and for electrodes targeting the temporo-mesial region. There were no clinically relevant haemorrhages and no infectious complications. Mean time for the placement of one electrode was 37?14 min and surgery time per electrode decreased with the number of electrodes placed. 55 patients (74.3%) underwent definitive surgical treatment. 36/51 (70.1%) patients followed for >12 months or until seizure recurrence became seizure-free (ILAE I). Conclusion: Frameless robot-guided stereotactic placement of depth electrodes with the Neuromate? stereotactic robot-system is safe and feasible even in very young children, with good in vivo accuracy and high diagnostic precision. The surgical workflow is time-efficient and further improves with increasing numbers of implanted electrodes.

关键词： carbohydrate counting   diabetes technology   dietitian   education   multidisciplinary team   nutritional management   paediatric diabetes   physical activity  

摘要： The provision of optimal care for children and young people with diabetes requires a multidisciplinary approach and a great team understands the skills and expertise of each member. Specialist paediatric diabetes dietitians offer evidence-based dietary advice to optimise blood glucose management. Education on the adjustment of insulin for food intake, including advanced techniques made possible with newer insulin delivery technologies (insulin pumps and automated insulin delivery systems) are an example of the essential dietetic role in the team. They also have expertise in behaviour change which enables them to counsel children and young people, and their families about lifestyle choices;encouraging a healthy diet and adequate physical activity. A dietitian will rely on coordinated and fully integrated working with all other members of the MDT to best fulfil their role. Optimal outcomes from dietary management can only be achieved alongside specialist nurses, psychologists and clinicians. This article seeks to outline how dietitians contribute to the specialist paediatric diabetes MDT, and the importance of their role in achieving excellent patient care. It mainly focusses on the management of children and young people with Type 1 diabetes. © 2021

关键词： Chondrosarcoma   Neoplasms   Connective and soft tissue   Musculoskeletal diseases   Children   MRI  

摘要： Objective To describe the MRI features of paediatric conventional central chondrosarcoma (CC-CS) and correlate with histological grade. Materials and methods A retrospective review of children/adolescents with histologically confirmed CC-CS. Data collected included age, sex, skeletal location, and histology from needle biopsy or resection, which was classified as atypical cartilaginous tumours/grade 1 CS (ACT/Gd 1 CS), high-grade chondrosarcoma (HGCS), and dedifferentiated chondrosarcoma (DD-CS). MRI studies were reviewed independently by 2 radiologists blinded to the histology grade, who graded the tumours as ACT/Gd 1 CS, HGCS, and DD-CS based on MRI features. Results The study included 7 males and 10 females with mean age 13.9 years (range 6-18 years). Tumours were located in the femur (n = 6), humerus (n = 3), tibia, ilium, scapula, and ulna (n = 1 each), and the small bones of the hands or feet (n = 4). Final histology grade was ACT/Gd 1 CS in 15 cases and HGCS in 2 (both grade 1 CS with focal transition to grade 2), 15 based on surgical specimens, 1 based on open biopsy, and 1 on needle biopsy alone. Predicted MRI grade for the 2 readers was ACT/Gd 1 CS in 11 cases each and HGCS in 6 cases each, indicating a mismatch between predicted MRI grade and histological grade in 8 (47%) cases (4 cases with one reader mismatch and 4 cases with both). Conclusions MRI findings in paediatric CC-CS may be misleading, showing features suggestive of HGCS 7 of 17 (41.2%) of cases. This should be taken into consideration when planning surgical treatment.

关键词： Nasal strip   Deep throat saliva   SARS-CoV-2 surveillance   Viral RNA detection   Sampling methods   Paediatrics surveillance  

摘要： Assessing hearing loss predictors like extended high frequency and distortion product otoacoustic emission (DPOAE) growth can indicate early subtle cochlear changes, but does not alter the chemotherapy dose or administration method. [...]changing chemotherapy based on predictive measures is inappropriate and poses a major risk. Furthermore, radiation might potentiate the toxicity of several chemotherapy agents. [...]this important aspect of ototoxicity monitoring following radiation must be considered by all paediatric oncology and audiology units.

关键词： Bayesian forecasting   mycophenolate   nonlinear mixed‐   effects modelling   paediatrics   population pharmacokinetics  

摘要： Mycophenolic acid (MPA) is widely used in paediatric kidney transplant patients and sometimes prescribed for additional indications. Population pharmacokinetic or pharmacodynamic modelling has been frequently used to characterize the fixed, random and covariate effects of MPA in adult patients. However, MPA population pharmacokinetic data in the paediatric population have not been systematically summarized. The objective of this narrative review was to provide an up-to-date critique of currently available paediatric MPA population pharmacokinetic models, with emphases on modelling techniques, pharmacological findings and clinical relevance. PubMed and EMBASE were searched from inception of database to May 2020, where a total of 11 studies have been identified representing kidney transplant (n = 4), liver transplant (n = 1), haematopoietic stem cell transplant (n = 1), idiopathic nephrotic syndrome (n = 2), systemic lupus erythematosus (n = 2), and a combined population consisted of kidney, liver and haematopoietic stem cell transplant patients (n = 1). Critical analyses were provided in the context of MPA absorption, distribution, metabolism, excretion and bioavailability in this paediatric database. Comparisons to adult patients were also provided. With respect to clinical utility, Bayesian estimation models (n = 6) with acceptable accuracy and precision for MPA exposure determination have also been identified and systematically evaluated. Overall, our analyses have identified unique features of MPA clinical pharmacology in the paediatric population, while recognizing several gaps that still warrant further investigations. This review can be used by pharmacologists and clinicians for improving MPA pharmacokinetic-pharmacodynamic modelling and patient care.

关键词： Micturition syncope   children   asystole  

摘要： Syncope occurs frequently in children, and the differential includes situational syncope, specifically micturition syncope. We report the youngest child to our knowledge to have micturition syncope associated with a prolonged asystolic pause. He underwent a neurological and cardiovascular evaluation without additional findings. Behavioural modifications were instituted with no recurrent syncope.

关键词： Antibiotics   Infectious diseases   Paediatrics  

关键词： Echocardiography   education   variation   skills   training   transfer  

摘要： Background: Factors that facilitate transfer of training in paediatric echocardiography remain poorly understood. This study assessed whether high-variation training facilitated successful transfer in paediatric echocardiography. Methods: A mixed-methods study of transfer of technical and interpretive skill application amongst postgraduate trainees. Trainees were randomised to a low or high-variation training group. After a period of 8 weeks intensive echocardiography training, we video-recorded how trainees completed an echocardiogram in a complex cardiac lesion not previously encountered. Blinded quantitative analysis and scoring of trainee performance (echocardiogram performance, report, and technical proficiency) were performed using a validated assessment tool by a blinded cardiologist and senior cardiac physiologist. Qualitative interviews of the trainees were recorded to ascertain trainee experiences during the training and transfer process. Results: Sixteen trainees were enrolled in the study. For the cumulative score for all three components tested (echocardiogram performance, report, and technical proficiency), chi(2) = 8.223, p = .016, which showed the high-variation group outperformed the low-variation group. Two common themes which assisted in the transfer emerged from interviews are as follows: (1) use of strategies described in variation theory to describe abnormal hearts, (2) the use of formative live feedback from trainers during hands-on training. Conclusion: Training strategies exposing trainees to high-variation training may aid transfer of paediatric echocardiography skills.