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关键词： Children   hydrocele   laparoscopy   tissue-sealing device  

摘要： Introduction: Laparoscopic herniotomy (LH) for hydrocele is an accepted procedure and provides advantages of contralateral diagnosis and repair with the same incisions. The suturing of patent processus vaginalis is associated with various complications. We describe suture-less herniotomy using tissue-sealing device for LH of hydrocele in children. Materials and Methods: The study was carried out on a prospective group of 21 children presenting with hydrocele after 1 year age over a period of 2 years. All infants with hydrocele and complicated hydroceles were excluded. The technique involved peritoneal incision and sealing of hydrocele sac with tissue-sealing device. Results: A total of 21 patients (28 hydroceles) were operated. The age ranged from 1 year to 14 years (mean age, 4 years). Ten right, 4 left and 7 bilateral hydroceles (2 diagnosed on laparoscopy) were operated. Operative time ranged from 15 to 32 min, with a mean time of 18 min. All patients were discharged after a hospital stay of 12 h. No recurrences were observed during the follow-up period. One patient had persistent hydrocele for 4 months which resolved spontaneously. Conclusion: The laparoscopic suture-less herniotomy for paediatric hydrocele is a safe, secure and easy procedure which can reduce suture and suturing-related complications following LH in hydroceles.

关键词： paediatric cataract   intraocular lens power calculation   formulas  

摘要： Importance There is no clear consensus on which intraocular lens (IOL) power calculation formula provides the best refractive prediction in the paediatric population. Background To evaluate the predictability of desired postoperative refractive outcomes by using six IOL formulas in paediatric cataract cases. Design Retrospective case series. Participants A total of 377 eyes in 377 paediatric patients (<13 years of age) who received primary IOL implants in the capsular bag. Methods This study utilized formulas, namely, SRK II, SRK/T, Hoffer Q, Holladay 1, T2 and Super formula. Prediction errors were calculated based on the difference between the postoperative refraction and the refraction predicted by each formula. Main Outcome Measures The mean prediction error, mean absolute error, median absolute error, percentages of eyes within the prediction errors of +/- 0.50 D, +/- 1.00 D and +/- 2.00 D. Results The mean axial length was 22.48 +/- 1.91 mm (<22.0 mm for 161 eyes). The average age at surgery was 55.21 +/- 28.01 months (<24 months for 37 eyes). The mean prediction error was positive (hyperopic error) with all formulas. Compared to the other IOL power formulas, SRK II showed significantly higher absolute errors (P < .001). Hoffer Q and Holladay 1 generated the least absolute error, followed closely by Super formula. Multiple logistic analyses indicated that age at time of surgery was an independent factor significantly contributing to the refractive surprise using all formulas. Conclusions and Relevance SRK II was the least predictable formula in this study. HofferQ and Holladay 1 yielded the best predictive values.

关键词： Complications   Diabetes   Insulin   Metformin   Paediatrics   Review   Type 1 diabetes   Type 2 diabetes  

摘要： The purpose of this review is to provide an update on the changing face of paediatric type 1 diabetes and type 2 diabetes. Paediatric diabetes is on the rise, with extensive research dedicated to understanding its pathophysiology, comorbidities and complications. As obesity continues to increase among all youth, differentiating between type 1 diabetes and type 2 diabetes has become increasingly difficult but remains important for optimising treatment, anticipating complications and predicting disease risk. Novel treatments are emerging, with the ultimate goal being to achieve glycaemic control, limit weight gain, improve quality of life and reduce comorbidities. In this review, we focus on updates regarding the epidemiology, clinical presentation, comorbidities and complications of paediatric type 1 diabetes and type 2 diabetes and conclude with current and emerging treatments.

关键词： child   craniocerebral trauma   emergency service   hospital   tomography   X-ray computed  

摘要： Objectives Variation in the management of paediatric head injury has been identified worldwide. This prospective study describes imaging and admission practices of children presenting with head injury across 10 hospital EDs in Australia and New Zealand. Methods Prospective observational multicentre study of 20 137 children (under 18 years) as a planned secondary analysis of the Australasian Paediatric Head Injury Rules Study. All presentations with head injury without prior imaging were eligible for inclusion. Variations in rates of computed tomography of the brain (CTB) and admission practices between sites, ED type and country were investigated, as were clinically important traumatic brain injuries (ciTBIs) and abnormal CTBs within CTBs. Results Among the 20 137 enrolled patients, the site adjusted CTB rate was 11.2% (95% confidence interval [CI] 7.8-14.6);individual sites ranged from 2.6 to 18.6%. ciTBI was found in 0.4-2.2%, with abnormal scans documented in 0.7-6.5%. As a percentage of CTBs undertaken, ciTBIs were found in 12.8% (95% CI 10.8-14.7) with individual site variation of 8.8-16.9%, and no statistically significant difference noted, and traumatic abnormalities in 29.3% (95% CI 26.2-32.3) with individual site variation between 19.4 and 35.6%. Among those under 2 years,traumatic abnormalities were found in greater than 50% of CTBs at 90% of sites. Admission rate overall was 24.0% (site adjusted) with wide variation between sites (5.0-48.9%). Conclusion Across the 10 largely tertiary EDs included in this study, the overall CTB rate was low with no significant variation between sites when adjusted for ciTBIs.

摘要： Paediatric malignancies can be broadly defined as those occurring as a consequence of the complex process of physiological growth, arising from embryonic stem cells and their milieu.1 A general feature for paediatric malignancies is an extremely low rate of mutation, even for metastatic, deadly tumours in which a single gene aberration might be the sole recurrent event.2 High mutation rates are therefore dispensable for the genesis of paediatric cancers, which are driven mostly by epigenetic dysregulation. Mutational burden was already known to be low even for patients who had relapsed after treatment, and PD-L1 expression is also low, making it highly unlikely that nivolumab would be active. [...]the negative results are not surprising. Anti-GD2 monoclonal antibodies such as dinutuximab have resulted in long-term overall survival of more than 50%.7 Radioimmunotherapy with 131I-omburtamab has contributed to substantial survival improvements in patients with CNS relapsed neuroblastoma.8 Finally, the success of tisagenlecleucel, an anti-CD19 chimeric antigen receptor T-cell therapy approved for patients with relapsed or refractory B-cell cancers, including B-cell acute lymphoblastic leukaemia, is a remarkable achievement.9 Of note, is that all these successful examples do not rely on host antitumour responses.

摘要： In 2017, about 250,000 adolescents aged 15-19 years acquired a new HIV infection (UNICEF 2018). Of the approximately 1.8 million adolescents (10-19 years old) living with HIV/AIDS, 1.5 million (85%) are in sub-Saharan Africa (UNAIDS 2017, 2018; UNICEF 2018). High HIV prevalence and incidence in sub-Saharan Africa exposes increasing numbers of adolescents and young adults to HIV through both perinatal infection and risky behaviours (UNICEF 2018). Before the early 2000s, when antiretroviral treatment (ART) came into common use in Africa, only about half of HIV-infected infants reached their second birthday (Newell et al. 2004). ART reduced the number of deaths caused by AIDS-related illnesses by about 42% between 2010 and 2017 (UNAIDS 2017, 2018). Increasing ART coverage in Africa has made it more likely that perinatally and behaviourally HIV-infected children will reach adulthood, but it has not eliminated the burden; instead, the burden has shifted to adolescents. Now, more than ever, public health must focus on transferring adolescents from paediatric to adult-centred care (Lowenthal et al. 2014), also called health care transition (Gilliam et al. 2011). HIV-infected adolescents are accountable for their disease progression and are left alone with the responsibility for managing their disease and their health (Dahourou et al. 2017). This is an especially vulnerable period because only 50% of HIV-infected adolescents transferred to adult-centred health care settings remain in care a year after transition (Ryscavage et al. 2016).

关键词： Lean body mass   obesity   echocardiography  

摘要： Background: Indexing left ventricular mass to body surface area or height(2.7)leads to inaccuracies in diagnosing left ventricular hypertrophy in obese children. Lean body mass predictive equations provide the opportunity to determine the utility of lean body mass in indexing left ventricular mass. Our objectives were to compare the diagnostic accuracy of predicted lean body mass, body surface area, and height in detecting abnormal left ventricle mass in obese children. Methods: Obese non-hypertensive patients aged 4-21 years were recruited prospectively. Dual-energy X-ray absorptiometry was used to measure lean body mass. Height, weight, sex, race, and body mass index z-score were used to calculate predicted lean body mass. Results: We enrolled 328 patients. Average age was 12.6 +/- 3.8 years. Measured lean body mass had the strongest relationship with left ventricular mass (R-2= 0.84, p < 0.01) compared to predicted lean body mass (R-2= 0.82, p < 0.01), body surface area (R-2= 0.80, p < 0.01), and height(2.7)(R-2= 0.65, p < 0.01). Of the clinically derived variables, predicted lean body mass was the only measure to have an independent association with left ventricular mass (beta = 0.90, p < 0.01). Predicted lean body mass was the most accurate scaling variable in detecting left ventricular hypertrophy (positive predictive value = 88%, negative predictive value = 99%). Conclusions: Lean body mass is the strongest predictor of left ventricular mass in obese children. Predicted lean body mass is the most accurate anthropometric scaling variable for left ventricular mass in left ventricular hypertrophy detection. Predicted lean body mass should be considered for clinical use as the body size correcting variable for left ventricular mass in obese children.

摘要： [...]it is not only the first peer-reviewed publication evaluating the efficacy of venetoclax in a paediatric population, but also the first evaluation of the combination of venetoclax with intensive acute myeloid leukaemia chemotherapy. [...]in addition to their implications for children, these results are also relevant for the much larger group of adults with acute myeloid leukaemia who are fit for intensive therapy. [...]this additional data will allow inferences to be made about the effect of venetoclax on survival outcomes. To date, these efforts in the paediatric oncology community have been limited to trial-level comparisons of results and a descriptive summary of response rates in a relatively small and heterogeneous group of patients.9 International efforts are ongoing to address these issues, and comparative effectiveness studies using real-world data might complement these efforts.10 Comparative studies have many well known challenges but will provide crucial data to guide the design of trials in both newly diagnosed and relapsed paediatric acute myeloid leukaemia settings.

关键词： ankyloglossia   breastfeeding   frenotomy   lingual frenulum   neonatology  

摘要： Aim To investigate the incidence and characteristics of complications arising from frenotomy for ankyloglossia (tongue-tie) in New Zealand. Methods Prospective surveillance among hospital-based paediatricians of complications arising from frenotomy for ankyloglossia to children <1 year old was conducted by the New Zealand Paediatric Surveillance Unit for 24 months, from August 2016 to July 2018, inclusive. Results A total of 16 cases of complications arising from frenotomy were reported. The overall average annual incidence rate was 13.9/100 000. Geographic variation was noted with a peak of 85.6/100 000 in one region. Complications reported: poor feeding (44%), respiratory events (25%), pain (19%), bleeding (19%) and weight loss (19%). Three children (19%) also had delayed diagnosis of an underlying medical condition initially overlooked in favour of treating their ankyloglossia, this has not previously been reported. The majority (75%) of cases required admission to hospital. Treatments given included supplementary feeds (44%), surgical intervention (25%), breastfeeding support (19%), analgesia (13%) and blood products (13%). A total of 25% of children had one or more frenotomies;50% were treated for two or more of: 'anterior' ankyloglossia, 'posterior' ankyloglossia or 'lip tie';50% had their frenotomies performed out of the hospital. Dentists were the most common performing practitioner (31%). Conclusions Frenotomy rates in New Zealand are unknown. Poor feeding, pain, bleeding, weight loss and delayed diagnosis of an alternative underlying medical condition are important complications that require hospital assessment and admission. Practitioners and parents/families need to be aware of these possibilities. Centralised guidelines with access to specialist second opinions should be developed.

关键词： Paediatrics   Interventional radiology   Diagnostic reference levels   Radiation protection  

摘要： Purpose: To establish local diagnostic reference levels (DRLs) for non-cardiac interventional procedures in paediatrics. Methods: The type of procedure, the patient's weight and age and dose-related data from 279 interventions was recorded in a database completed by interventional radiologists, radiographers and technicians of the Medical Physics department. These procedures were classified into 14 categories and 6 weight ranges. Local DRLs were proposed for those ranges in which a sample of at least 15 patients could be gathered and were calculated as the third quartile (Q3) of the air kerma-area product (P-KA) values. The Q3 of the fluoroscopy time (FT) and number of digital subtraction angiography (DSA) images were also obtained. Finally, the correlation between P-KA and weight was analysed. Results: Local DRLs are proposed for three types of procedures: hepatic/biliary interventions (5-15 kg, 1304 ***(2);15-30 kg, 2121 ***(2)), sclerotherapy procedures (15-30 kg, 704 ***(2);30-50 kg, 4049 ***(2);50-80 kg, 3734 ***(2)) and central venous catheter (CVC) procedures (5-15 kg, 84 ***(2)). Hepatic/biliary interventions showed a moderate correlation (r = 0.61), while sclerotherapy procedures presented a poor correlation (r = 0.34) between P-KA and weight, possibly due to the P-KA dependence on the complexity level. Regarding CVC procedures, a clearly higher correlation was found when the fluoroscopy P-KA value was normalised to the FT (r = 0.85 vs r = 0.35). Conclusions: The results support the feasibility of establishing DRLs for the most common procedures (sclerotherapy, hepatic/biliary and CVC interventions) despite the small number of paediatric interventions.