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关键词： airborne contact dermatitis   case report   isothiazolinones   methylisothiazolinone   water-based poster paints   children  

关键词： Antenatal hydronephrosis   disorders of sex development   foreskin   hypospadias   paediatric urology   posterior urethral valves   undescended testis   urinary tract infection   vesicoureteric reflux  

摘要： Paediatric urology is a subject that covers the urological aspects of care in children, some of which are seen also in adults, but may have specific diagnostic methods and treatments that are quite different. Additionally, it covers a range of congenital anomalies either on their own or in combination with a spectrum of disorders that need more complex management available at only specialized centres. For the purposes of a broad and basic understanding of the subject, this article will cover relevant topics and up-to-date guidelines. © 2020

关键词： Paediatric cancer care   governance   financing   health workforce   infrastructure   access to medicines   service delivery   Mexico  

摘要： In Mexico, paediatric cancer is the leading cause of death for children aged 0-18 years. This study analyses the main challenges for paediatric cancer care from the perspective of three key health systems functions: stewardship, financing and service delivery. The study used a mixed methods approach comprised of: (1) a scoping literature review, (2) an analysis of 2008-18 expenditures on paediatric cancer by the Fund for Protection against Catastrophic Expenditures (FPGC) of Seguro Popular and (3) a nation-wide survey of the supply capacity of 59 Ministry of Health (MoH) and 39 Mexican Institute of Social Security (IMSS) hospitals engaged in paediatric cancer care. The study found that while Mexico has made substantial progress towards universal health coverage (UHC) for paediatric cancer treatment, serious gaps persist. FPGC funds for paediatric cancer increased from 2008 to 2011 to reach US$36 million and then declined to US$13.6 million in 2018, along with the number of covered cases. The distribution of health professionals and paediatric oncology infrastructure is uneven between MoH and IMSS hospitals and across Mexican regions. Both institutions share common barriers for continuous and co-ordinated health care and lack monitoring activities that cripple their capacity to apply uniform standards for high-quality cancer care. In conclusion, achieving universal and effective coverage of paediatric cancer treatment is a critical component of UHC for Mexico. This requires periodic and ongoing assessment of health system performance specific to paediatric cancer to identify gaps and propose strategies for continued investment and improvement of access to care and health outcomes for this important cause of premature mortality.

关键词： (3-10) qualitative   Randomised controlled trials   Communication   Appendicitis   Appendicectomy   Pediatric   Surgery   Urgent care   Emergency   Interviews  

摘要： Background Recruiting patients to paediatric trials can be challenging, especially in trials that compare markedly different management pathways and are conducted in acute settings. We aimed to enhance informed consent and recruitment in the CONTRACT trial (CONservative TReatment of Appendicitis in Children a randomised controlled Trial;ISRCTN15830435) - a feasibility trial that compared non-operative treatment (antibiotics) versus appendicectomy for uncomplicated acute appendicitis. Methods Qualitative study embedded within CONTRACT and conducted across three UK children's hospitals. Data were transcribed audio-recordings of 85 CONTRACT recruitment consultations with 58 families;and semi-structured interviews with 35 health professionals and 28 families (34 parents, 14 children) invited to participate in CONTRACT. Data analysis drew on thematic approaches. Throughout CONTRACT, we used findings from the ongoing qualitative analysis to inform bespoke communication training for health professionals recruiting to CONTRACT. Before and after training we also examined qualitative changes in communication during consultations and quantitative changes in recruitment rates. Results Bespoke communication training focussed on presenting the trial arms in a balanced way, emphasising clinical equipoise, exploring family treatment preferences and managing families' expectations about the trial's treatment pathways. Analysis of recruitment consultations indicated that health professionals' presentation of treatment arms became increasingly balanced following training, (e.g. avoiding imbalanced terminology) and recruitment rose from 38 to 62%. However, they remained reluctant to explore families' treatment preferences and respond with further information to balance these preferences. Analyses of interviews identified the time constraints of the urgent care setting, concerns about coercion, and reservations about exposing children to conversations about treatment risks as reasons fo

关键词： Cell differentiation   Epithelial cells   DAPI staining   Pediatrics   Cell cultures   Cell staining   Respiratory infections   Epithelium  

摘要： The culture of differentiated human airway epithelial cells allows the study of pathogen-host interactions and innate immune responses in a physiologically relevant in vitro model. As the use of primary cell culture has gained popularity the availability of the reagents needed to generate these cultures has increased. In this study we assessed two different media, Promocell and PneumaCult, during the differentiation and maintenance of well-differentiated primary nasal epithelial cell cultures (WD-PNECs). We compared and contrasted the consequences of these media on WD-PNEC morphological and physiological characteristics and their responses to respiratory syncytial virus (RSV) infection. We found that cultures generated using PneumaCult resulted in greater total numbers of smaller, tightly packed, pseudostratified cells. However, cultures from both media resulted in similar proportions of ciliated and goblet cells. There were no differences in RSV growth kinetics, although more ciliated cells were infected in the PneumaCult cultures. There was also significantly more IL-29/IFN lambda 1 secreted from PneumaCult compared to Promocell cultures following infection. In conclusion, the type of medium used for the differentiation of primary human airway epithelial cells may impact experimental results.

关键词： Radiology   Paediatric   Teaching   Escape room   Gamification   Education  

摘要： Objectives To develop a paediatric radiology themed escape room session for undergraduate education and secondly, to determine participant satisfaction and improvement in knowledge. Methods A paediatric radiology escape room with accompanying tutorial was developed around key learning objectives set within the RCR and ESR undergraduate curriculum. Students were recruited from two different universities and undertook the escape room themed teaching. An 8-question single best answer (SBA) test was completed before, immediately after and at 2 weeks post-teaching to determine participant improvement and retention of knowledge. The general feedback was also collected. Results The escape room sessions were held three times, for 19 students (6-7 students per session). All groups completed the escape room in <= 20 min. Students enjoyed the experience, assigning an average satisfaction score of 9.4/10 (range 7-10). The majority (17/19, 89.5%) preferred this method of teaching to a lecture-based tutorial alone, although all said they found the tutorial component useful. For the SBA test, there was an average increase in 3.6 marks (range 1-6 marks) per participant between before and after the escape room. This improved knowledge was mostly sustained after 2 weeks, with an average increase of 3.4 marks difference (range 1 to 6) per participant compared to before the teaching. Conclusions A paediatric radiology themed escape room is a feasible teaching method, enjoyed by participants and associated with an increase in radiological knowledge. Further work with larger sample size and direct comparison with other traditional teaching methods is required.

关键词： PANS   PANDAS   NOX2   NADPH oxidase   Oxidative stress   LPS  

摘要： Background Paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections syndrome (PANDAS) identifies patients with acute onset of obsessive-compulsive and tic disorders. The objective of this study was to evaluate serum NOX2 levels, as well as 8-iso-prostaglandin F2 alpha (8-iso-PGF2 alpha) and lipopolysaccharide (LPS) of PANDAS patients. Methods In this study we wanted to compare serum levels of soluble NOX2-dp (sNOX-2-dp), iso-PGF2 alpha and LPS in 60 consecutive subjects, including 30 children affected by PANDAS and 30 controls (CT) matched for age and gender. Serum zonulin was used as intestinal permeability assay. Results Compared with CT, PANDAS children had increased serum levels of sNOX-2-dp, 8-iso-PGF2 alpha and LPS. Bivariate analysis showed that serum sNOX2-dp was significantly correlated with LPS (Rs = 0.359;p = 0.005), zonulin (Rs = 0.444;p < 0.001) and 8-iso-PGF2 alpha (Rs = 0.704;p < 0.001). Serum LPS significantly correlated with zonulin (Rs = 0.610;p < 0.001), and 8-iso-PGF2 alpha (Rs = 0.591;p = 0.001). Finally, a multiple linear regression analysis showed that serum 8-iso-PGF2 alpha and zonulin were the only independent variables associated with sNOX2-dp (R-2 = 68%). Conclusion This study shows that children affected by PANDAS have high circulating levels of sNOX2-dp, isoprostanes and of LPS that could be involved in the process of neuroinflammation.

关键词： Endomyocardial biopsy   Paediatric   Immunohistochemistry   Inflammation   Myocarditis  

摘要： Background: Endomyocardial biopsies (EMB) are the gold standard for the diagnosis of myocarditis in children and adults. The existing WHO/ISFC criteria for lymphocytic cell infiltrates by are based on the myocardium of adults. The aim of this study was to present a paediatric control cohort for the evaluation of inflammation in EMB of children. Methods: In this study endomyocardial tissue from 62 children under 4 years of age was investigated, being collected during a planned open heart surgery with routine resection from ventricular site. Patients had no history of infection or myocardial inflammation. The heart tissue was formalin fixed and embedded in paraffin. Four mm thick tissue sections were stained with haematoxylin and eosin, Masson's trichrome, and Giemsa. Immunohistochemical stainings included quantitative evaluation of CD3(+) T cells, CD20 + B cells, CD68(+) macrophages and MHCII expression. Results: The myocardium was obtained in 96.8% (n = 60) of the cases from the right and in 3.2% (n = 2) from the left ventricle. The median age (interquartile range) at biopsy was 0.5 years (0.3-0.9), 66.1% male. Within this cohort, a median of 2.5/mm(2) (1.0-4.0) CD3(+) T cells, 0.5/mm(2) (0.0-0.6) CD20(+) B cells and 4.0/mm(2) (2.5-6.0) CD68(+) macrophages were detected. The MHC II grade was 0 in 71.0% (n = 44) and 1 in 29.0% (n = 18). Conclusion: This is the first paediatric control cohort being relevant for the correct interpretation of inflammatory heart diseases in EMB. The lymphocytic cell numbers in children needing congenital heart surgery without myocardial inflammation are below the existing values in adults. (C) 2019 Elsevier B.V. All rights reserved.

关键词： Tinnitus   Child   Audiology   Care provision   Clinical management   Healthcare quality   Service evaluation  

摘要： Background Whilst evidence indicates many children experience troublesome tinnitus, specialist services for children are far less established than those available for adults. To date, there is limited understanding of how paediatric tinnitus is managed in the UK, and to what extent current practice reflects what is recommended. This service evaluation aimed to 1) profile how tinnitus in children is managed in UK clinical practice, and assess to what extent care provided by services reflects advice included in the British Society of Audiology (BSA) Tinnitus in Children Practice Guidance, 2) collate clinician opinions on how services may be optimised, and 3) identify common problems experienced by children who present with bothersome tinnitus in clinic. Methods As part of a larger survey, eight questions regarding services for paediatric tinnitus were distributed to UK NHS audiology services via email and social media. Representatives from eighty-seven services responded between July and September 2017. Results Fifty-three percent of respondents reported that their department provided a paediatric tinnitus service. Among these services, there was widespread use of most BSA recommended assessments and treatments. Less widely used practices were the assessment of mental health (42%), and the use of psychological treatment approaches;cognitive behavioural therapy (CBT) (28%), mindfulness (28%), and narrative therapy (14%). There was varied use of measurement tools to assess tinnitus in children, and a minority of respondents reported using adult tinnitus questionnaires with children. Frequently reported tinnitus-related problems presented by children were sleep difficulties, concentration difficulties at school, situation-specific concentration difficulties, and emotional distress. Conclusions Approaches used to manage children with troublesome tinnitus in UK NHS services are largely consistent and reflective of the current practice guidance. However, findings from this

摘要： Luregn J Schlapbach1,2,3, Warwick Butt4, Graeme MacLaren4,5 on behalf of the Australian & New Zealand Intensive Care Society (ANZICS) Paediatric Study Group 1Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Australia 2Paediatric Intensive Care Unit, Queensland Children’s Hospital, Brisbane, Australia 3Department of Intensive Care Medicine and Neonatology, and Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland. 4Paediatric Intensive Care Unit, The Royal Children’s Hospital, Melbourne, Australia 5Cardiothoracic Intensive Care Unit, National University Health System, Singapore, Singapore We thank Beretta-Piccoli and colleagues for their comment regarding our study defining benefit thresholds for ECMO in children with septic shock [1]. The 2020 Pediatric Surviving Sepsis Campaign [6] guidelines issued a recommendation based on low-quality evidence for venoarterial ECMO as rescue therapy for septic shock “refractory to all other treatments”. The problem is when to consider shock “refractory” [7]. The mortality in refractory shock even without ECMO is not 100%, and clinicians have to weigh risk versus benefit of ECMO. While every day clinical decision-making embraces implicit or explicit benefit threshold estimates, our study provides one of the first objective approaches to this scenario. The first point raised by Beretta-Piccoli et al. relates to the generalizability of the findings, given that central cannulation was the predominant access used in our study. Central cannulation provides higher flows and maintains bilateral carotid perfusion with potentially lower cerebral stroke incidence at the expense of higher overall bleeding and infection risk. While central ECMO currently is limited to cardiosurgical centres, these complications are manageable, and timely referral to such high-volume centres should be emphasized. The second point makes refere