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关键词： Anthropocene Epoch   Anthropedology   Dan Yaalon   Vasily Dokuschaev  

摘要： The venerable science of pedology, initiated in the 19(th) century as the study of the natural factors of soil formation, is adapting to the demands of the Anthropocene, the geologic time during which planet Earth and its soils are transitioning from natural to human-natural systems. With vast areas of soils intensively managed, the future of pedology lies with a renewed science that can be called anthropedology that builds on the pedology of the past but proceeds from "human as outsider" to "human as insider." In other words, the human in pedology must shift from being a soil-disturbing to soil-forming agent. Pedology is well prepared to respond to the challenges of the Anthropocene, given the decades of research on human-soil relations throughout human history and throughout the period of the Great Acceleration (Steffen et al., [76]). However, quantitative understanding of soil responses to the diversity of human forcings remains elementary and needs remedy.

关键词： children   consent   critical care   deferred consent   emergency medicine   paediatrics   research without prior consent  

摘要： Children and young peoples' healthcare should be evidence-based yet many treatments are unlicensed or prescribed off-label. Research is needed, but prospective informed consent for many emergency and critical care trials is neither feasible nor ethical – treatments are time critical, and delays for research discussions may cause harm. Research without prior consent (RWPC) is a practical approach which facilitates such research. Trial interventions are administered immediately to eligible patients, and consent for ongoing study involvement is sought after the emergency situation has passed. This has been permitted in the United Kingdom since an amendment to legislation in 2008, and subsequently employed by several trials. Studies demonstrate that most parents are supportive of this approach provided their child's safety is not compromised, and research discussions are appropriately timed. Practitioners with no experience of RWPC often initially report anxiety about taking this approach, but study experience and training helps change perspectives. Sadly, some children enrolled into such studies will die. Approaching bereaved families for consent requires a bespoke approach, conducted with care and sensitivity. Future research should explore the acceptability of higher risk trials, the viewpoints of children with first-hand experience of this method, and international perspectives. © 2019 Elsevier Ltd

摘要： Paediatric melanoma, usually defined as melanoma occurring in patients younger than 20 years, represents approximately only 1-4 per cent of all melanomas, with an estimated annual incidence rate of nine per million with respect to those aged 15-19 years.[1] The presence of longitudinal melanonychia in a single nail of a child represents a diagnostic challenge for clinicians because worrisome dermatoscopic features of nail matrix melanoma are commonly found in childhood naevi. Previous reported cases of paediatric nail unit melanoma[2] have been considered by some authors as atypical but probably representing benign lentiginous melanocytic hyperplasia or highly active junctional naevi rather than melanoma.[3] Subsequently, other reports described acral melanomas in children after supportive evidence by immunohistochemical staining (p16, S-100, HMB-45). [Extracted from the article]

关键词： Children   Contrast-enhanced ultrasound   Diffusion-weighted imaging   Kidney   Magnetic resonance imaging   Recommendations   Tumour   Ultrasound  

摘要： Contrast-enhanced ultrasound (CEUS) and diffusion-weighted imaging (DWI) are safe, repeatable imaging techniques. The aim of this paper is to discuss the advantages, technical factors and possible clinical applications of these imaging tools in focal renal lesions in children.

关键词： children   diagnostics   management   mycoses   transplantation  

摘要： Background Epidemiology and management practices of invasive fungal diseases (IFD) after allogeneic haematopoietic stem cell transplantation (HSCT) are a subject of constant change. We investigated the contemporary incidence, diagnostics, antifungal management and outcome at a major paediatric transplant centre in Germany. Methods The single-centre retrospective observational study included all paediatric allogeneic HSCT patients (pts) transplanted between 2005 and 2015. Patient-related data were assessed up to 365 days post-transplant. The primary endpoint was the incidence of possible, probable and proven IFDs. Secondary endpoints included diagnostics and antifungal treatment;analysis of risk factors;and overall survival with the last follow-up in January 2017. Results A total of 221 first (196), second (21) or third (4) procedures were performed in 200 pts (median age: 9 years, range, 0.5-22) for leukaemia/lymphoma (149) and non-malignant disorders (72). Prophylaxis was administered in 208 HSCT procedures (94%;fluconazole, 116, mould-active agents, 92). At least one computed tomography scan of the chest was performed in 146, and at least one galactomannan antigen assay in 60 procedures. There were 15 cases of proven (candidemia, 4;aspergillosis, 4) or probable (aspergillosis, 7) IFDs, accounting for an incidence rate of 6.8%. Overall mortality at last follow-up was 30%;the occurrence of proven/probable IFDs was associated with a reduced survival probability (P < .001). Conclusion Morbidity and mortality from IFDs at our institution were consistent with data reported from other centres. Utilisation of healthcare resources for prevention, diagnosis and management of IFDs was considerable.

关键词： Paediatric burns   Mortality   Fabric flammability   History  

摘要： Background: Burn injuries are the third leading cause of preventable death in children worldwide, resulting in over 100 000 annual hospitalisations. In the paediatric population, scalds are the commonest mechanism and burn injuries of greater than 40% total burn surface area (TBSA) are associated with a high mortality and morbidity rate. Aims: The aim of this study was to review mortality in paediatric burns in a tertiary burns centre over a 60-year period, providing an understanding of local causes of mortality and directing future clinical research. Methods: We reviewed data collected prospectively from patients treated for burn injuries at the WCH from 1960 to 2017. Data of age, gender, mechanism of injury and TBSA were collected. TBSA of 40% and greater were included in the study. Results: All patients with total burn surface area (TBSA) less than 40% survived. There were a total of 75 patients who sustained burns of or greater than 40% TBSA. Overall mortality was 34% (26 of 75) of which 24 occurred in the 1960s. Of the 21 patients who died of flame burn injuries, 12 of them were described as clothes catching alight from being in close proximity to the source of flame. Average length of stay for patients who did not survive was 7 days (1-26). Conclusion: Mortality has since declined and the prognosis for survival good, even in TBSA of greater than 90%. The investigations in fabric flammability led by Dr Thomas Pressley and Mr Murray Clarke prompted the rewriting of Australian standards for production of children's clothing. This, in combination with advances in paediatric resuscitation, surgical techniques as well as wound care has improved survival rates and outcomes in extensive burn injuries. Future studies focus to see not only better survival rates, but also better aesthetic and functional outcomes in burn survivors. Crown Copyright (C) 2019 Published by Elsevier Ltd. All rights reserved.

关键词： bronchiolitis   electronic medical record   low-value care  

摘要： Aim Low-value care (LVC) is common. We aimed, using infants presenting to a major tertiary paediatric hospital with bronchiolitis between April 2016 and July 2018, to: (i) assess rates of chest X-ray (CXR) and medication use;(ii) identify associated factors;and (iii) measure the harm of not performing these practices. Methods We extracted data from the electronic medical record for all children aged 1-12 months given a diagnosis of bronchiolitis in the emergency department. Factors potentially associated with LVC practices were extracted, including patient demographics, ordering physician characteristics, order indication, medications prescribed and admission ward. To assess for harm, a radiologist, blinded to CXR indication, reviewed all CXRs ordered over the winter of 2017 for infants with bronchiolitis. Results A CXR was ordered for 439 (11.2%) infants, most commonly to rule out consolidation and collapse (65%). CXRs were more likely to be ordered for admitted infants (40.9% admitted to the general medical ward), and 62% were ordered by emergency department staff. Salbutamol was prescribed for 9.3% (n = 199). Amongst those who had a CXR, 28% were prescribed an antibiotic compared to 2.1% for those who did not. In an audit of 98 CXRs ordered over the winter of 2017, there were no CXR findings that meaningfully affected patient outcomes. Conclusion Using electronic medical record data, we found that CXR and medication use in bronchiolitis were higher than expected given our hospital guideline advice. Future research needs to understand why and develop interventions to reduce LVC.

关键词： Blood culture   Blood volume   Bloodstream infection   Diagnostics   Neonate   Paediatric   Sepsis  

摘要： Background: Bloodstream infections (BSIs) are a major cause of morbidity and mortality in paediatric patients. For fast and accurate diagnosis, blood culture (BC) is the reference standard. However, the procedure for blood sampling in paediatric patients, particularly the optimal blood volume, is the subject of controversy stemming from a lack of knowledge of the bacterial load and because of several obstacles such as low intravascular volume and the risk of causing anaemia. Aims: The aim of this narrative review is to summarize current knowledge on blood sampling in paediatric patients for BC purposes, in particular blood volume and number and type of BC bottles needed for reasonable future guidelines/recommendations. Sources: A comprehensive literature search of PubMed, including all publications in English, was performed in June 2019 using the search terms 'blood culture', 'blood volume', 'bloodstream infection', 'diagnostic', 'paediatric' and/or 'sepsis'. Content: The amount of inoculated blood determines the sensitivity, specificity and time to positivity of a BC, and low-level bacteraemia (<= 10 cfu/mL) in paediatric patients is presumed to be more common than reported. Current approaches for 'adequate' blood volume for paediatric BC are mainly weight- or age-dependent. Of these recommendations, the scheme devised by Gaur and colleagues seems most appropriate and calls for a sample of 1-1.5 mL for children weighing <11 kg and 7.5 mL for a patient weight of 11-17 kg to be drawn into one BC bottle. Inclusion of a more detailed grading in the weight range 4-14 kg, as published by Gonsalves and colleagues, might be useful. (C) 2019 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.