Adolescence and the journey to adulthood involves exciting opportunities as well as psychosocial stress for young people growing up.These normal experiences are potentially magnified for teenagers living with chronic ...Adolescence and the journey to adulthood involves exciting opportunities as well as psychosocial stress for young people growing up.These normal experiences are potentially magnified for teenagers living with chronic illness or disability and their families.Advances in care have improved survival for children with a variety of serious chronic medical conditions such that many who may once have died in childhood now survive well into adulthood with ongoing morbidity.For those with highly complex needs,care is often provided at major paediatric hospitals with expertise,specially trained personnel,and resources to support young people and their families for the first decades of life.At the end of adolescence,however,it is generally appropriate and necessary for young adults and their caregivers to transition to the care of clinicians trained in the care of adults at general hospitals.While there are some well-managed models to support this journey of transition,these are often specific to certain conditions and usually do not involve intensive care.Many patients may encounter considerable challenges during this period.Difficulties may include the loss of established therapeutic relationships,a perception of austerity and reduced amenity in facilities oriented to caring for adult patients,and care by clinicians with less experience with more common paediatric conditions.In addition,there is a risk of potential conflict between clinicians and families regarding goals of care in the event of a critical illness when it occurs in a young adult with major disability and long-term health issues.These challenges present genuine opportunities to better understand the transition from paediatric to adult-based care and to improve processes that assist clinicians who support patients and families as they shift between healthcare settings.展开更多
Paediatric renal tumors are rare and accounts for about 7%of all paediatric malignant tumors.The spectrum of paediatric renal tumors ranges from benign to malignant.Benign tumors include cystic nephroma,metanephric tu...Paediatric renal tumors are rare and accounts for about 7%of all paediatric malignant tumors.The spectrum of paediatric renal tumors ranges from benign to malignant.Benign tumors include cystic nephroma,metanephric tumors and ossifying renal tumor of infancy.Tumor with low grade malignancy includes mesoblastic nephroma.Malignant tumors are nephroblastoma,clear cell sarcoma,malignant rhabdoid tumor,anaplastic sarcoma and Ewing sarcoma.Additionally,there are molecularly defined renal tumors,which includes renal cell carcinoma(RCC)with MiT translocations,ALK-rearranged RCC,eosinophilic solid and cystic RCC and SMARCB1-deficient renal medullary carcinoma.These tumors apart from having characteristic clinical presentation and histomorphology,also carry typical molecular mutations and translocations.Certain renal tumors have association with various genetic syndromes such as Beckwith-Weidmann syndrome,Wilm’s tumor,aniridia,genitourinary anomalies and mental retardation syndrome,Denys-Drash syndrome,rhabdoid tumor predisposition syndrome and DICER syndrome.This review article focusses on molecular characteristics,histomorphology and syndromic association of pediatric renal tumors,their immunohistochemical approach to diagnosis with recent updates in molecularly defined renal tumors.展开更多
Paediatric liver transplantation(PLT)is a life-saving procedure for children with advanced liver disease or hepatoblastoma.The number of available grafts is limited in relation to the number of children on PLT waiting...Paediatric liver transplantation(PLT)is a life-saving procedure for children with advanced liver disease or hepatoblastoma.The number of available grafts is limited in relation to the number of children on PLT waiting list.This graft shortage has led transplant societies and healthcare organizations to explore ways to investigate possible options and expand the donor pool.The safe use of grafts from obese donors has always been a subject of debate among PLT specialists.Donors’obesity is strongly associated with hepatic steatosis which can affect graft function by impairing microcirculation and maximizing the potential of ischemiareperfusion injury.Donor body mass index consideration should go hand in hand with the workup for hepatic steatosis which is an independent predictor for early graft dysfunction.New strategies to optimize the grafts before PLT such as normothermic regional perfusion and ex vivo liver perfusion can potentially mitigate the risk of using grafts from obese donors.This review summarizes the available evidence about the impact of donor obesity on PLT and highlights the current policies to widen the graft pool and suggest future research directions to improve donor selection and patient outcomes.展开更多
OBJECTIVE:To establish a standardized framework encompassing the precise locations,manipulations,functions and indications of specific acupoints in the field of paediatric Tuina.METHODS:The development of consensus in...OBJECTIVE:To establish a standardized framework encompassing the precise locations,manipulations,functions and indications of specific acupoints in the field of paediatric Tuina.METHODS:The development of consensus involved three distinct stages.Initially,a list of paediatric Tuina specific acupoints was compiled based on an extensive literature review,which was subsequently supplemented through expert interviews.In the second stage,the Delphi method was employed to assess the significance of acupoint locations,manipulations,functions,and indications.In situations where the questionnaire survey failed to yield agreement or when the experts held reservations,the nominal group approach was utilized during the expert consensus meeting.The final version of the technical standardized material was ultimately determined during an expert consensus conference.After undergoing external peer review and evaluation,the completed draft was prepared for public dissemination RESULTS:The comprehensive list identified a total of 66 specific acupoints.The location and manipulation questionnaire consisted of 156 items based on the literature database,while the function and indication questionnaire contained 116 items.Two rounds of Delphi surveys were conducted for the location and manipulation category,and another two rounds of Delphi surveys were conducted for the function and indication category.During the experts consensus meeting The panel of experts conducted in-depth discussions on 61 questions,resulting in the formulation of technical guidelines for the locations,manipulations,functions,and indications of 64 paediatric Tuina acupoints.Subsequently,the research team compiled and edited the draft of the technical guidelines for acupoints of paediatric Tuina,which was finalized after external review and feedback.CONCLUSION:This study successfully established the recognized technical standards for practitioners of paediatric Tuina,thereby standardizing clinical practices and providing a foundation setting the framework for future research.The guidelines offer theoretical insights and recommendations for conducting clinical studies comparing different acupoint sites,as well as modifying or enhancing treatment regimens.展开更多
This article illustrates the clinical practice of psycho-oncology in a paediatric onco-haematology department by young psychologists.To begin with,we look at the role of the psychologist in a somatic department.Creati...This article illustrates the clinical practice of psycho-oncology in a paediatric onco-haematology department by young psychologists.To begin with,we look at the role of the psychologist in a somatic department.Creativity in clinical work and the modulation of medical temporality.The aim here is to discuss the construction of the professional identity in relation to the construction of the therapeutic alliance with patients.Specifically,we will look at the relationship with creativity,which is necessary to support children and adolescents in their existential questioning.This work of creativity in the therapeutic alliance will be illustrated using two clinical cases that are particularly representative of clinical work centred on the relationship with finitude.展开更多
BACKGROUND Coronavirus disease 2019(COVID-19)has a major influence on all parts of society.AIM To examine the consequences of the national lockdown and political initiatives during the first surge of the COVID-19 pand...BACKGROUND Coronavirus disease 2019(COVID-19)has a major influence on all parts of society.AIM To examine the consequences of the national lockdown and political initiatives during the first surge of the COVID-19 pandemic expressed by changes in incidences of musculoskeletal paediatric injuries.METHODS Study design was a retrospective multicenter cohort study.A‘pandemic’cohort was established from 16 March 2020 to 21 April 2020,where all institutions including day care and schools were closed.A‘pre-pandemic’cohort was established from the same period in 2019 for comparison.Included were all patients admitted at the emergency departments with paediatric musculoskeletal injuries(aged 0-15 years)identified by a relevant musculoskeletal ICD-10 diagnosis(DSxxx),concussions(DZ033D),or burns(DT2xx).RESULTS The‘pre-pandemic’cohort consisted of 2101 patients,and the‘pandemic’cohort consisted of 1070 patients,indicating a decrease of paediatric musculoskeletal injuries of 51%.The incidence of paediatric injury in the‘pre-pandemic’cohort was 10460/100000/year.In the‘pandemic’cohort,the incidence was 5344/100000/year.CONCLUSION A resource re-allocation to help serve the COVID-19 patients might be possible without reducing the level of care for injury-related paediatric patients.展开更多
Paediatric retinal detachment（PRD）is an uncommon and challenging disease;it differs from adult detachments in etiology,anatomical characteristics,management and prognosis.PRDs can be particularly challenging,even fo...Paediatric retinal detachment（PRD）is an uncommon and challenging disease;it differs from adult detachments in etiology,anatomical characteristics,management and prognosis.PRDs can be particularly challenging,even for the most expert paediatric surgeons due to the higher prevalence of total retinal detachments,late diagnosis and bilateral involvement with respect to those which occur in adulthood.Moreover,the anatomical success,when achieved,is frequently not related to a functional recover.Postsurgical adverse events,refractive errors and amblyopia may additionally undermine the final outcome.Up to date there are few reviews regarding the approach of retinal detachment in children,mainly dealing with rhegmatogenous retinal detachment.In this review,rhegmatogenous,retinopathy of prematurityrelated and Coats’-related PRDs were considered.The available literature from the last decades were reviewed and summarized.Epidemiology,etiology and clinical presentation,together with therapeutic approaches and outcomes have been reviewed and discussed.展开更多
The Paediatric Observation Priority Score (POPS) is a bespoke assessment tool for use in Paediatric Emergency Departments incorporating traditional physiological parameters alongside more subjective observational crit...The Paediatric Observation Priority Score (POPS) is a bespoke assessment tool for use in Paediatric Emergency Departments incorporating traditional physiological parameters alongside more subjective observational criteria. Initial performance characteristics of POPS were analysed in a convenience sample of 936 presentations to ED. Triage on the basis of gut instinct parameters identified an additional 261 patients deemed of lowest acuity compared to analysis by physiology scores. Resource consumption increased with increasing acuity on presentation. POPS shows promise in assisting in the assessment process of children presenting to Emergency Departments. Inclusion of subjective triage criteria helps contextualise the physiological parameter scoring by using the experience of staff conducting triage. Initial interpretation of presenting physiology gives a more informed assessment of initial acuity, and thus is better able to identify a child who can be safely managed in the community. The system also allows for rapid detection of those most unwell.展开更多
Hepatocellular adenomas(HCAs)represent rare,benign liver tumours occurring predominantly in females taking oral contraceptives.In children,HCAs comprise less than 5%of hepatic tumours and demonstrate association with ...Hepatocellular adenomas(HCAs)represent rare,benign liver tumours occurring predominantly in females taking oral contraceptives.In children,HCAs comprise less than 5%of hepatic tumours and demonstrate association with various conditions.The contemporary classification of HCAs,based on their distinctive genotypes and clinical phenotypes,includes hepatocyte nuclear factor 1 homeobox alpha-inactivated HCAs,beta-catenin-mutated HCAs,inflammatory HCAs,combined beta-catenin-mutated and inflammatory HCAs,sonic hedgehogactivated HCAs,and unclassified HCAs.In children,there is a lack of literature on the characteristics and distribution of HCA subtypes.In this review,we summarized different HCA subtypes and the clinicopathologic spectrum of HCAs in the paediatric population.展开更多
There has been a rapid expansion in the knowledge of paediatric gastroenterology over the recent decade,with a fast-growing repertoire of diagnostic techniques and management strategies for a wide spectrum of childhoo...There has been a rapid expansion in the knowledge of paediatric gastroenterology over the recent decade,with a fast-growing repertoire of diagnostic techniques and management strategies for a wide spectrum of childhood gastrointestinal(GI)diseases.Paediatric GI endoscopy is a core competency every paediatric gastroenterologist should possess,and represents one of the most common procedures performed in children for both diagnostic and therapeutic purposes.Yet there remains a dearth of literature on the utility and outcomes of paediatric GI endoscopy in the Asia-Pacific region.Data on the diagnostic value of paediatric GI endoscopy would be an important aspect of discussion,with the emergence of inflammatory bowel disease(IBD)and eosinophilic GI disease as increasingly common endoscopic diagnoses.Time-based trends in paediatric GI endoscopy do point towards more IBD and gastroesophageal reflux disease-related complications being diagnosed,with a declining incidence of GI bleeding.However,the real-world diagnostic value of endoscopy in Asia must be contextualised to the region-specific prevalence of paediatric GI diseases.Helicobacter pylori infection,particularly that of multidrug-resistant strains,remains a highly prevalent problem in specific regions.Paediatric functional GI disorders still account for the majority of childhood GI complaints in most centres,hence the diagnostic yield of endoscopy should be critically evaluated in the absence of alarm symptoms.GI therapeutic endoscopy is also occasionally required for children with ingested foreign bodies,intestinal polyposis or oesophageal strictures requiring dilation.Endoscopic haemostasis is a potentially life-saving skill in cases of massive GI bleeding typically from varices or peptic ulcers.Advanced endoscopic techniques such as capsule endoscopy and balloon-assisted enteroscopy have found traction,particularly in East Asian centres,as invaluable diagnostic and therapeutic tools in the management of IBD,obscure GI bleeding and intestinal polyposis.State of the art endoscopic diagnostics and therapeutics,including the use of artificial intelligence-aided endoscopy algorithms,real-time confocal laser endomicroscopy and peroral endoscopic myotomy,are expected to gain more utility in paediatrics.As paediatric gastroenterology matures as a subspecialty in Asia,it is essential current paediatric endoscopists and future trainees adhere to minimum practice standards,and keep abreast of the evolving trends in the diagnostic and therapeutic value of endoscopy.This review discusses the available published literature on the utility of paediatric GI endoscopy in Asia Pacific,with the relevant clinical outcomes.展开更多
The incidence of paediatric inflammatory bowel disease(PIBD) has dramatically increased in the last 20 years. Although first reported in mid 1970s',diagnostic laparoscopy has started to be routinely adopted in pae...The incidence of paediatric inflammatory bowel disease(PIBD) has dramatically increased in the last 20 years. Although first reported in mid 1970s',diagnostic laparoscopy has started to be routinely adopted in paediatric surgical practice since late 1990s'. Minimally invasive surgery was first limited to diagnostic purposes. After 2002 it was also applied to the radical treatment of PIBD,either Crohn's disease(CD) or Ulcerative colitis. During the last decade minimally invasive approaches to PIBD have gained popularity and have recently became the "gold standard" for the treatment of such invalidating and troublesome chronic diseases. The authors describe and track the historical evolution of minimally invasive surgery for PIBD and address all available opportunities,including most recent advancements such as robotic surgery,single port approaches and minimally invasive treatment of perianal fistulising CD. A systematic review of all series of PIBD treated with minimally invasive approaches published so far is provided in order to determine the incidence and type of patients' complications reported up to present days. The authors also describe their experience with minimally invasive surgery for PIBD and will report the results of 104 laparoscopic procedures performed in a series of 61 patients between January 2006 and December 2014.展开更多
Acute septic arthritis in children is an orthopaedic emergency.A delay in diagnosis and inappropriate treatment can result in devastating damage to the joint with lifelong disability as a consequence.The clinical pres...Acute septic arthritis in children is an orthopaedic emergency.A delay in diagnosis and inappropriate treatment can result in devastating damage to the joint with lifelong disability as a consequence.The clinical presentation can be a diagnostic challenge,especially in young children.A recent systematic review showed that joint tenderness and fever are important signals of septic arthritis.Ultrasound is helpful in detecting the presence of a joint effusion.Plain radiographs may show bone changes but magnetic resonance imaging is the most reliable imaging study for detecting concomitant osteomyelitis.The diagnosis of acute septic arthritis is highly suggestive when pus is aspirated from the joint,in case of a positive culture or a positive gram stain of the joint fluid,or if there is a white blood-cell count in the joint fluid of more than 50000/mm3.Staphylococcus aureus is the most commonly cultured organism.Recent systematic reviews have identified the most effective drainage techniques,including needle aspiration,arthroscopy and arthrotomy,depending on the affected joint.After the drainage procedure it is important to monitor the clinical and laboratory outcomes.Additional drainage procedures may be necessary in select cases.展开更多
Gliosarcoma is rare central nervous system tumour and a variant of glioblastoma multiforme with bimorphic histological pattern of glial and sarcomatous differentiation. It occurs in elderly between 5^(th) and 6^(th) d...Gliosarcoma is rare central nervous system tumour and a variant of glioblastoma multiforme with bimorphic histological pattern of glial and sarcomatous differentiation. It occurs in elderly between 5^(th) and 6^(th) decades of life and extremely rare in children. It is highly aggressive tumour and managed like glioblastoma multiforme. A 12-year-old female child presented with complaints of headache and vomiting from 15d and blurring of vision from 3d. Magnetic resonance imaging of brain shows heterogeneous mass in right parieto-occipital cortex. A right parieto-occipito-temporal craniotomy with complete excision of mass revealed a primary glioblastoma on histopathological investigation. Treatment consists of maximum surgical excision followed by adjuvant radiotherapy. The etiopathogenesis, treatment modalities and prognosis is discussed. The available literature is also reviewed.展开更多
Computed tomography(CT)has earned a well-deserved role in diagnostic radiology,producing crosssectional and three-dimensional images which permit enhanced diagnosis of many pathogenic processes.The speed,versatility,a...Computed tomography(CT)has earned a well-deserved role in diagnostic radiology,producing crosssectional and three-dimensional images which permit enhanced diagnosis of many pathogenic processes.The speed,versatility,accuracy,and non-invasiveness of this procedure have resulted in a rapid increase in its use.CT imaging,however,delivers a substantially higher radiation dose than alternative imaging methodologies,particularly in children due to their smaller body dimensions.In addition,CT use in children produces an increased lifetime risk of cancer,as children’s developing organs and tissues are inherently more vulnerable to cellular damage than those of adults.Though individual risks are small,the increasing use of CT scans in children make this an important public health problem.Various organizations have recommended measures to minimize unnecessary exposures to radiation through CT scanning.These include elimination of multiple or medically unnecessary scans,development of patientspecific dosing guidelines,and use of alternative radiographic methodology wherever possible.Another important factor in excessive CT exposures,however,is a documented lack of awareness among medical practitioners of the doses involved in CT usage as well as itssignificant potential dangers.This review examines the effects of paediatric CT radiation,discusses the level of medical practitioner awareness of these effects,and offers recommendations on alternative diagnostic methods and practitioner education.展开更多
3D printing is a promising technology used in the fabrication of complex oral dosage delivery pharmaceuticals.This study first reports an innovative color jet 3D printing(CJ-3DP)technology to produce colorful cartoon ...3D printing is a promising technology used in the fabrication of complex oral dosage delivery pharmaceuticals.This study first reports an innovative color jet 3D printing(CJ-3DP)technology to produce colorful cartoon levetiracetam pediatric preparations with high accuracy and reproducibility.For this study,the ideal printing ink consisted of 40%(v/v)isopropanol aqueous solution containing 0.05%(w/w)polyvinylpyrrolidone and 4%(w/w)glycerin,which was satisfied with scale-up of the production.The external and internal spatial structures of the tablets were designed to control the appearance and release,and cartoon tablets with admirable appearances and immediate release characteristics were printed.The dosage model showed a good linear relationship between the model volume and the tablet strength(r>0.999),which proved the potential of personalized administration.The surface roughness indicated that the appearance of the CJ-3DP tablets was significantly better than the first listed 3D printed drug(Spritam R).Moreover,the scanning electron microscopy and porosity results further showed that the tablets have a structure of loose interior and tight exterior,which could ensure good mechanical properties and rapid dispersion characteristics simultaneously.In conclusion,the innovative CJ-3DP technology can be used to fabricate personalized pediatric preparations for improved compliance.Due to the stable formulation and fabrication process,this technology has the potential in scale-up production.展开更多
AIM To determine if ketamine sedation is a safe and cost effective way of treating displaced paediatric radial and ulna fractures in the emergency department. METHODS Following an agreed interdepartmental protocol, fr...AIM To determine if ketamine sedation is a safe and cost effective way of treating displaced paediatric radial and ulna fractures in the emergency department. METHODS Following an agreed interdepartmental protocol, fractures of the radius and ulna(moderately to severely displaced) in children between the age of 2 and 16 years old, presenting within a specified 4 mo period, were manipulated in our paediatric emergency department. Verbal and written consent was obtained prior to procedural sedation to ensure parents were informed and satisfied to have ketamine. A single attempt at manipulation was performed. Pre and postmanipulation radiographs were requested and assessed to ensure adequacy of reduction. Parental satisfaction surveys were collected after the procedure to assess the perceived quality of treatment. After closed reduction and cast immobilisation, patients were then followed-up in the paediatric outpatient fracture clinic and functional outcomes measured prospectively. A cost analysis compared to more formal manipulation under a general anaesthetic was also undertaken.RESULTS During the 4 mo period of study, 10 closed, moderate to severely displaced fractures were identified and treated in the paediatric emergency department using our ketamine sedation protocol. These included fractures of the growth plate(3), fractures of both radius and ulna(6) and a single isolated proximal radius fracture. The mean time from administration of ketamine until completion of the moulded plaster was 20 min. The mean time interval from sedation to full recovery was 74 min. We had no cases of unacceptable fracture reduction and no patients required any further manipulation, either in fracture clinic or under a more formal general anaesthetic. There were no serious adverse events in relation to the use of ketamine. Parents, patients and clinicians reported extremely favourable outcomes using this technique. Furthermore, compared to using a manipulation under general anaesthesia, each case performed under ketamine sedation was associated with a saving of ￡1470, the overall study saving being ￡14700. CONCLUSION Ketamine procedural sedation in the paediatric population is a safe and cost effective method for the treatment of displaced fractures of the radius and ulna, with high parent satisfaction rates.展开更多
Inflammatory bowel disease(IBD) comprises two distinct but related chronic relapsing inflammatory conditions affecting different parts of the gastrointestinal tract. Crohn's disease is characterised by a patchy tr...Inflammatory bowel disease(IBD) comprises two distinct but related chronic relapsing inflammatory conditions affecting different parts of the gastrointestinal tract. Crohn's disease is characterised by a patchy transmural inflammation affecting both small and large bowel segments with several distinct phenotypic presentations. Ulcerative colitis classically presents as mucosal inflammation of the rectosigmoid(distal colitis), variably extending in a contiguous manner more proximally through the colon but not beyond the caecum(pancolitis). This article highlights aspects of the presentation, diagnosis, and management of IBD that have relevance for paediatric practice with particular emphasis on surgical considerations. Since 25% of IBD cases present in childhood or teenage years, the unique considerations and challenges of paediatric management should be widely appreciated. Conversely, we argue that the organizational separation of the paediatric and adult healthcare worlds has often resulted in late adoption of new approaches particularly in paediatric surgical practice.展开更多
Colonic motility subserves large bowel functions, including absorption, storage, propulsion and defaecation. Co-lonic motor dysfunction remains the leading hypothesis to explain symptom generation in chronic constipat...Colonic motility subserves large bowel functions, including absorption, storage, propulsion and defaecation. Co-lonic motor dysfunction remains the leading hypothesis to explain symptom generation in chronic constipation, a heterogeneous condition which is extremely prevalent in the general population, and has huge socioeconomic impact and individual suffering. Physiological testing plays a crucial role in patient management, as it is now accepted that symptom-based assessment, although im-portant, is unsatisfactory as the sole means of directing therapy. Colonic manometry provides a direct method for studying motor activities of the large bowel, and this review provides a contemporary understanding of how this technique has enhanced our knowledge of normalcolonic motor physiology, as well as helping to elucidate pathophysiological mechanisms underlying constipation. Methodological approaches, including available catheter types, placement technique and recording protocols, are covered, along with a detailed description of re-corded colonic motor activities. This review also criti-cally examines the role of colonic manometry in current clinical practice, and how manometric assessment may aid diagnosis, classification and guide therapeutic inter-vention in the constipated individual. Most importantly, this review considers both adult and paediatric patients. Limitations of the procedure and a look to the future are also addressed.展开更多
AIM:To study whether adalimumab(ADA) was associated with improvement in growth,bone mineraldensity(BMD) and bone metabolism.METHODS:In children with Crohn's disease(CD) there is a high prevalence of growth failure...AIM:To study whether adalimumab(ADA) was associated with improvement in growth,bone mineraldensity(BMD) and bone metabolism.METHODS:In children with Crohn's disease(CD) there is a high prevalence of growth failure and reduced BMD.Treatment with infliximab is associated with an improvement in growth.Anthropometry,paediatric CD activity index(PCDAI),bone markers and BMD was measured in 18 patients(72% females) one year before and after start of ADA with a median age of 14.4 years(range:5-19 years) at treatment start.Outcomes were indicators of growth with treatment as well as interval growth.RESULTS:Eleven(61%) children experienced catchup growth after ADA.PCDAI significantly decreased from 52.1 ± 16 to 30.4 ± 23(P ≤ 0.001).Post ADA,body mass index(BMI) standard deviation score(SDS) 0.1[range:2.7-(-0.8)] vs-1 [range:0.1-(-3.6)],P = 0.04 and △BMI SDS in children 0.3 [range:0.7-(-0.2)] vs-1.1 [range:1.2-(-2.3)],P = 0.01 in remission were significantly higher compared to those with moderate to severe inflammation.The main predictors for growth were 25-hydroxycholecalciferol and for bone mineralisation weight and height SDS.ADA had no significant influence on bone markers and BMD.CONCLUSION:Next to improvement of PCDAI,half of the children achieved a positive catch-up growth.A better nutritional status with improvement in BMI and weight is positive predictor for improved growth and bone mineralisation.展开更多
The following is a continued analysis about some terms related to paediatrics in traditional Chinese medicine （TCM） included in the WHO International Standard Termi- nologies on Traditional Medicine in the Western P...The following is a continued analysis about some terms related to paediatrics in traditional Chinese medicine （TCM） included in the WHO International Standard Termi- nologies on Traditional Medicine in the Western Pacific Region （abbreviated as the WPRO Standard）[1] and the International Standard Chinese-English Basic Nomenclature of Chinese Medicine compiled by World Federation of Chinese Medicine Societies （abbreviated as the WFCMS Standard）[2], according to explanations made in the book entitled A Great Dictionary of Traditional Chinese Medicine[3], Chinese-English Dictionary of Traditional Chinese Medicine[4] and the studies made in the book entitled International Standardization of English Translation of Traditional Chinese Medicine： Study of Theory, Summarization of Practice and Exploration of Methods[5].展开更多
文摘Adolescence and the journey to adulthood involves exciting opportunities as well as psychosocial stress for young people growing up.These normal experiences are potentially magnified for teenagers living with chronic illness or disability and their families.Advances in care have improved survival for children with a variety of serious chronic medical conditions such that many who may once have died in childhood now survive well into adulthood with ongoing morbidity.For those with highly complex needs,care is often provided at major paediatric hospitals with expertise,specially trained personnel,and resources to support young people and their families for the first decades of life.At the end of adolescence,however,it is generally appropriate and necessary for young adults and their caregivers to transition to the care of clinicians trained in the care of adults at general hospitals.While there are some well-managed models to support this journey of transition,these are often specific to certain conditions and usually do not involve intensive care.Many patients may encounter considerable challenges during this period.Difficulties may include the loss of established therapeutic relationships,a perception of austerity and reduced amenity in facilities oriented to caring for adult patients,and care by clinicians with less experience with more common paediatric conditions.In addition,there is a risk of potential conflict between clinicians and families regarding goals of care in the event of a critical illness when it occurs in a young adult with major disability and long-term health issues.These challenges present genuine opportunities to better understand the transition from paediatric to adult-based care and to improve processes that assist clinicians who support patients and families as they shift between healthcare settings.
文摘Paediatric renal tumors are rare and accounts for about 7%of all paediatric malignant tumors.The spectrum of paediatric renal tumors ranges from benign to malignant.Benign tumors include cystic nephroma,metanephric tumors and ossifying renal tumor of infancy.Tumor with low grade malignancy includes mesoblastic nephroma.Malignant tumors are nephroblastoma,clear cell sarcoma,malignant rhabdoid tumor,anaplastic sarcoma and Ewing sarcoma.Additionally,there are molecularly defined renal tumors,which includes renal cell carcinoma(RCC)with MiT translocations,ALK-rearranged RCC,eosinophilic solid and cystic RCC and SMARCB1-deficient renal medullary carcinoma.These tumors apart from having characteristic clinical presentation and histomorphology,also carry typical molecular mutations and translocations.Certain renal tumors have association with various genetic syndromes such as Beckwith-Weidmann syndrome,Wilm’s tumor,aniridia,genitourinary anomalies and mental retardation syndrome,Denys-Drash syndrome,rhabdoid tumor predisposition syndrome and DICER syndrome.This review article focusses on molecular characteristics,histomorphology and syndromic association of pediatric renal tumors,their immunohistochemical approach to diagnosis with recent updates in molecularly defined renal tumors.
文摘Paediatric liver transplantation(PLT)is a life-saving procedure for children with advanced liver disease or hepatoblastoma.The number of available grafts is limited in relation to the number of children on PLT waiting list.This graft shortage has led transplant societies and healthcare organizations to explore ways to investigate possible options and expand the donor pool.The safe use of grafts from obese donors has always been a subject of debate among PLT specialists.Donors’obesity is strongly associated with hepatic steatosis which can affect graft function by impairing microcirculation and maximizing the potential of ischemiareperfusion injury.Donor body mass index consideration should go hand in hand with the workup for hepatic steatosis which is an independent predictor for early graft dysfunction.New strategies to optimize the grafts before PLT such as normothermic regional perfusion and ex vivo liver perfusion can potentially mitigate the risk of using grafts from obese donors.This review summarizes the available evidence about the impact of donor obesity on PLT and highlights the current policies to widen the graft pool and suggest future research directions to improve donor selection and patient outcomes.
基金Grants from Key Research and Development Projects of the Ministry of Science and Technology Funding Support:Standards for Traditional Chinese Medicine Technology(No.2019YFC1712003)2023 First-class Discipline Construction Project of Beijing University of Chinese Medicine:Tuina。
文摘OBJECTIVE:To establish a standardized framework encompassing the precise locations,manipulations,functions and indications of specific acupoints in the field of paediatric Tuina.METHODS:The development of consensus involved three distinct stages.Initially,a list of paediatric Tuina specific acupoints was compiled based on an extensive literature review,which was subsequently supplemented through expert interviews.In the second stage,the Delphi method was employed to assess the significance of acupoint locations,manipulations,functions,and indications.In situations where the questionnaire survey failed to yield agreement or when the experts held reservations,the nominal group approach was utilized during the expert consensus meeting.The final version of the technical standardized material was ultimately determined during an expert consensus conference.After undergoing external peer review and evaluation,the completed draft was prepared for public dissemination RESULTS:The comprehensive list identified a total of 66 specific acupoints.The location and manipulation questionnaire consisted of 156 items based on the literature database,while the function and indication questionnaire contained 116 items.Two rounds of Delphi surveys were conducted for the location and manipulation category,and another two rounds of Delphi surveys were conducted for the function and indication category.During the experts consensus meeting The panel of experts conducted in-depth discussions on 61 questions,resulting in the formulation of technical guidelines for the locations,manipulations,functions,and indications of 64 paediatric Tuina acupoints.Subsequently,the research team compiled and edited the draft of the technical guidelines for acupoints of paediatric Tuina,which was finalized after external review and feedback.CONCLUSION:This study successfully established the recognized technical standards for practitioners of paediatric Tuina,thereby standardizing clinical practices and providing a foundation setting the framework for future research.The guidelines offer theoretical insights and recommendations for conducting clinical studies comparing different acupoint sites,as well as modifying or enhancing treatment regimens.
文摘This article illustrates the clinical practice of psycho-oncology in a paediatric onco-haematology department by young psychologists.To begin with,we look at the role of the psychologist in a somatic department.Creativity in clinical work and the modulation of medical temporality.The aim here is to discuss the construction of the professional identity in relation to the construction of the therapeutic alliance with patients.Specifically,we will look at the relationship with creativity,which is necessary to support children and adolescents in their existential questioning.This work of creativity in the therapeutic alliance will be illustrated using two clinical cases that are particularly representative of clinical work centred on the relationship with finitude.
文摘BACKGROUND Coronavirus disease 2019(COVID-19)has a major influence on all parts of society.AIM To examine the consequences of the national lockdown and political initiatives during the first surge of the COVID-19 pandemic expressed by changes in incidences of musculoskeletal paediatric injuries.METHODS Study design was a retrospective multicenter cohort study.A‘pandemic’cohort was established from 16 March 2020 to 21 April 2020,where all institutions including day care and schools were closed.A‘pre-pandemic’cohort was established from the same period in 2019 for comparison.Included were all patients admitted at the emergency departments with paediatric musculoskeletal injuries(aged 0-15 years)identified by a relevant musculoskeletal ICD-10 diagnosis(DSxxx),concussions(DZ033D),or burns(DT2xx).RESULTS The‘pre-pandemic’cohort consisted of 2101 patients,and the‘pandemic’cohort consisted of 1070 patients,indicating a decrease of paediatric musculoskeletal injuries of 51%.The incidence of paediatric injury in the‘pre-pandemic’cohort was 10460/100000/year.In the‘pandemic’cohort,the incidence was 5344/100000/year.CONCLUSION A resource re-allocation to help serve the COVID-19 patients might be possible without reducing the level of care for injury-related paediatric patients.
文摘Paediatric retinal detachment（PRD）is an uncommon and challenging disease;it differs from adult detachments in etiology,anatomical characteristics,management and prognosis.PRDs can be particularly challenging,even for the most expert paediatric surgeons due to the higher prevalence of total retinal detachments,late diagnosis and bilateral involvement with respect to those which occur in adulthood.Moreover,the anatomical success,when achieved,is frequently not related to a functional recover.Postsurgical adverse events,refractive errors and amblyopia may additionally undermine the final outcome.Up to date there are few reviews regarding the approach of retinal detachment in children,mainly dealing with rhegmatogenous retinal detachment.In this review,rhegmatogenous,retinopathy of prematurityrelated and Coats’-related PRDs were considered.The available literature from the last decades were reviewed and summarized.Epidemiology,etiology and clinical presentation,together with therapeutic approaches and outcomes have been reviewed and discussed.
文摘The Paediatric Observation Priority Score (POPS) is a bespoke assessment tool for use in Paediatric Emergency Departments incorporating traditional physiological parameters alongside more subjective observational criteria. Initial performance characteristics of POPS were analysed in a convenience sample of 936 presentations to ED. Triage on the basis of gut instinct parameters identified an additional 261 patients deemed of lowest acuity compared to analysis by physiology scores. Resource consumption increased with increasing acuity on presentation. POPS shows promise in assisting in the assessment process of children presenting to Emergency Departments. Inclusion of subjective triage criteria helps contextualise the physiological parameter scoring by using the experience of staff conducting triage. Initial interpretation of presenting physiology gives a more informed assessment of initial acuity, and thus is better able to identify a child who can be safely managed in the community. The system also allows for rapid detection of those most unwell.
文摘Hepatocellular adenomas(HCAs)represent rare,benign liver tumours occurring predominantly in females taking oral contraceptives.In children,HCAs comprise less than 5%of hepatic tumours and demonstrate association with various conditions.The contemporary classification of HCAs,based on their distinctive genotypes and clinical phenotypes,includes hepatocyte nuclear factor 1 homeobox alpha-inactivated HCAs,beta-catenin-mutated HCAs,inflammatory HCAs,combined beta-catenin-mutated and inflammatory HCAs,sonic hedgehogactivated HCAs,and unclassified HCAs.In children,there is a lack of literature on the characteristics and distribution of HCA subtypes.In this review,we summarized different HCA subtypes and the clinicopathologic spectrum of HCAs in the paediatric population.
文摘There has been a rapid expansion in the knowledge of paediatric gastroenterology over the recent decade,with a fast-growing repertoire of diagnostic techniques and management strategies for a wide spectrum of childhood gastrointestinal(GI)diseases.Paediatric GI endoscopy is a core competency every paediatric gastroenterologist should possess,and represents one of the most common procedures performed in children for both diagnostic and therapeutic purposes.Yet there remains a dearth of literature on the utility and outcomes of paediatric GI endoscopy in the Asia-Pacific region.Data on the diagnostic value of paediatric GI endoscopy would be an important aspect of discussion,with the emergence of inflammatory bowel disease(IBD)and eosinophilic GI disease as increasingly common endoscopic diagnoses.Time-based trends in paediatric GI endoscopy do point towards more IBD and gastroesophageal reflux disease-related complications being diagnosed,with a declining incidence of GI bleeding.However,the real-world diagnostic value of endoscopy in Asia must be contextualised to the region-specific prevalence of paediatric GI diseases.Helicobacter pylori infection,particularly that of multidrug-resistant strains,remains a highly prevalent problem in specific regions.Paediatric functional GI disorders still account for the majority of childhood GI complaints in most centres,hence the diagnostic yield of endoscopy should be critically evaluated in the absence of alarm symptoms.GI therapeutic endoscopy is also occasionally required for children with ingested foreign bodies,intestinal polyposis or oesophageal strictures requiring dilation.Endoscopic haemostasis is a potentially life-saving skill in cases of massive GI bleeding typically from varices or peptic ulcers.Advanced endoscopic techniques such as capsule endoscopy and balloon-assisted enteroscopy have found traction,particularly in East Asian centres,as invaluable diagnostic and therapeutic tools in the management of IBD,obscure GI bleeding and intestinal polyposis.State of the art endoscopic diagnostics and therapeutics,including the use of artificial intelligence-aided endoscopy algorithms,real-time confocal laser endomicroscopy and peroral endoscopic myotomy,are expected to gain more utility in paediatrics.As paediatric gastroenterology matures as a subspecialty in Asia,it is essential current paediatric endoscopists and future trainees adhere to minimum practice standards,and keep abreast of the evolving trends in the diagnostic and therapeutic value of endoscopy.This review discusses the available published literature on the utility of paediatric GI endoscopy in Asia Pacific,with the relevant clinical outcomes.
基金Supported by Italian Ministry of Health Ricerca Corrente
文摘The incidence of paediatric inflammatory bowel disease(PIBD) has dramatically increased in the last 20 years. Although first reported in mid 1970s',diagnostic laparoscopy has started to be routinely adopted in paediatric surgical practice since late 1990s'. Minimally invasive surgery was first limited to diagnostic purposes. After 2002 it was also applied to the radical treatment of PIBD,either Crohn's disease(CD) or Ulcerative colitis. During the last decade minimally invasive approaches to PIBD have gained popularity and have recently became the "gold standard" for the treatment of such invalidating and troublesome chronic diseases. The authors describe and track the historical evolution of minimally invasive surgery for PIBD and address all available opportunities,including most recent advancements such as robotic surgery,single port approaches and minimally invasive treatment of perianal fistulising CD. A systematic review of all series of PIBD treated with minimally invasive approaches published so far is provided in order to determine the incidence and type of patients' complications reported up to present days. The authors also describe their experience with minimally invasive surgery for PIBD and will report the results of 104 laparoscopic procedures performed in a series of 61 patients between January 2006 and December 2014.
文摘Acute septic arthritis in children is an orthopaedic emergency.A delay in diagnosis and inappropriate treatment can result in devastating damage to the joint with lifelong disability as a consequence.The clinical presentation can be a diagnostic challenge,especially in young children.A recent systematic review showed that joint tenderness and fever are important signals of septic arthritis.Ultrasound is helpful in detecting the presence of a joint effusion.Plain radiographs may show bone changes but magnetic resonance imaging is the most reliable imaging study for detecting concomitant osteomyelitis.The diagnosis of acute septic arthritis is highly suggestive when pus is aspirated from the joint,in case of a positive culture or a positive gram stain of the joint fluid,or if there is a white blood-cell count in the joint fluid of more than 50000/mm3.Staphylococcus aureus is the most commonly cultured organism.Recent systematic reviews have identified the most effective drainage techniques,including needle aspiration,arthroscopy and arthrotomy,depending on the affected joint.After the drainage procedure it is important to monitor the clinical and laboratory outcomes.Additional drainage procedures may be necessary in select cases.
文摘Gliosarcoma is rare central nervous system tumour and a variant of glioblastoma multiforme with bimorphic histological pattern of glial and sarcomatous differentiation. It occurs in elderly between 5^(th) and 6^(th) decades of life and extremely rare in children. It is highly aggressive tumour and managed like glioblastoma multiforme. A 12-year-old female child presented with complaints of headache and vomiting from 15d and blurring of vision from 3d. Magnetic resonance imaging of brain shows heterogeneous mass in right parieto-occipital cortex. A right parieto-occipito-temporal craniotomy with complete excision of mass revealed a primary glioblastoma on histopathological investigation. Treatment consists of maximum surgical excision followed by adjuvant radiotherapy. The etiopathogenesis, treatment modalities and prognosis is discussed. The available literature is also reviewed.
文摘Computed tomography(CT)has earned a well-deserved role in diagnostic radiology,producing crosssectional and three-dimensional images which permit enhanced diagnosis of many pathogenic processes.The speed,versatility,accuracy,and non-invasiveness of this procedure have resulted in a rapid increase in its use.CT imaging,however,delivers a substantially higher radiation dose than alternative imaging methodologies,particularly in children due to their smaller body dimensions.In addition,CT use in children produces an increased lifetime risk of cancer,as children’s developing organs and tissues are inherently more vulnerable to cellular damage than those of adults.Though individual risks are small,the increasing use of CT scans in children make this an important public health problem.Various organizations have recommended measures to minimize unnecessary exposures to radiation through CT scanning.These include elimination of multiple or medically unnecessary scans,development of patientspecific dosing guidelines,and use of alternative radiographic methodology wherever possible.Another important factor in excessive CT exposures,however,is a documented lack of awareness among medical practitioners of the doses involved in CT usage as well as itssignificant potential dangers.This review examines the effects of paediatric CT radiation,discusses the level of medical practitioner awareness of these effects,and offers recommendations on alternative diagnostic methods and practitioner education.
基金This work was supported by the National Natural Science Foundation of China(No.82073793)the National Major Science and Technology Projects of China(No.2018ZX09721003-007/No.2018ZX09J18107).
文摘3D printing is a promising technology used in the fabrication of complex oral dosage delivery pharmaceuticals.This study first reports an innovative color jet 3D printing(CJ-3DP)technology to produce colorful cartoon levetiracetam pediatric preparations with high accuracy and reproducibility.For this study,the ideal printing ink consisted of 40%(v/v)isopropanol aqueous solution containing 0.05%(w/w)polyvinylpyrrolidone and 4%(w/w)glycerin,which was satisfied with scale-up of the production.The external and internal spatial structures of the tablets were designed to control the appearance and release,and cartoon tablets with admirable appearances and immediate release characteristics were printed.The dosage model showed a good linear relationship between the model volume and the tablet strength(r>0.999),which proved the potential of personalized administration.The surface roughness indicated that the appearance of the CJ-3DP tablets was significantly better than the first listed 3D printed drug(Spritam R).Moreover,the scanning electron microscopy and porosity results further showed that the tablets have a structure of loose interior and tight exterior,which could ensure good mechanical properties and rapid dispersion characteristics simultaneously.In conclusion,the innovative CJ-3DP technology can be used to fabricate personalized pediatric preparations for improved compliance.Due to the stable formulation and fabrication process,this technology has the potential in scale-up production.
文摘AIM To determine if ketamine sedation is a safe and cost effective way of treating displaced paediatric radial and ulna fractures in the emergency department. METHODS Following an agreed interdepartmental protocol, fractures of the radius and ulna(moderately to severely displaced) in children between the age of 2 and 16 years old, presenting within a specified 4 mo period, were manipulated in our paediatric emergency department. Verbal and written consent was obtained prior to procedural sedation to ensure parents were informed and satisfied to have ketamine. A single attempt at manipulation was performed. Pre and postmanipulation radiographs were requested and assessed to ensure adequacy of reduction. Parental satisfaction surveys were collected after the procedure to assess the perceived quality of treatment. After closed reduction and cast immobilisation, patients were then followed-up in the paediatric outpatient fracture clinic and functional outcomes measured prospectively. A cost analysis compared to more formal manipulation under a general anaesthetic was also undertaken.RESULTS During the 4 mo period of study, 10 closed, moderate to severely displaced fractures were identified and treated in the paediatric emergency department using our ketamine sedation protocol. These included fractures of the growth plate(3), fractures of both radius and ulna(6) and a single isolated proximal radius fracture. The mean time from administration of ketamine until completion of the moulded plaster was 20 min. The mean time interval from sedation to full recovery was 74 min. We had no cases of unacceptable fracture reduction and no patients required any further manipulation, either in fracture clinic or under a more formal general anaesthetic. There were no serious adverse events in relation to the use of ketamine. Parents, patients and clinicians reported extremely favourable outcomes using this technique. Furthermore, compared to using a manipulation under general anaesthesia, each case performed under ketamine sedation was associated with a saving of ￡1470, the overall study saving being ￡14700. CONCLUSION Ketamine procedural sedation in the paediatric population is a safe and cost effective method for the treatment of displaced fractures of the radius and ulna, with high parent satisfaction rates.
文摘Inflammatory bowel disease(IBD) comprises two distinct but related chronic relapsing inflammatory conditions affecting different parts of the gastrointestinal tract. Crohn's disease is characterised by a patchy transmural inflammation affecting both small and large bowel segments with several distinct phenotypic presentations. Ulcerative colitis classically presents as mucosal inflammation of the rectosigmoid(distal colitis), variably extending in a contiguous manner more proximally through the colon but not beyond the caecum(pancolitis). This article highlights aspects of the presentation, diagnosis, and management of IBD that have relevance for paediatric practice with particular emphasis on surgical considerations. Since 25% of IBD cases present in childhood or teenage years, the unique considerations and challenges of paediatric management should be widely appreciated. Conversely, we argue that the organizational separation of the paediatric and adult healthcare worlds has often resulted in late adoption of new approaches particularly in paediatric surgical practice.
基金Supported by NH&MRC Australia (ID 630502) (to Dinning PG)
文摘Colonic motility subserves large bowel functions, including absorption, storage, propulsion and defaecation. Co-lonic motor dysfunction remains the leading hypothesis to explain symptom generation in chronic constipation, a heterogeneous condition which is extremely prevalent in the general population, and has huge socioeconomic impact and individual suffering. Physiological testing plays a crucial role in patient management, as it is now accepted that symptom-based assessment, although im-portant, is unsatisfactory as the sole means of directing therapy. Colonic manometry provides a direct method for studying motor activities of the large bowel, and this review provides a contemporary understanding of how this technique has enhanced our knowledge of normalcolonic motor physiology, as well as helping to elucidate pathophysiological mechanisms underlying constipation. Methodological approaches, including available catheter types, placement technique and recording protocols, are covered, along with a detailed description of re-corded colonic motor activities. This review also criti-cally examines the role of colonic manometry in current clinical practice, and how manometric assessment may aid diagnosis, classification and guide therapeutic inter-vention in the constipated individual. Most importantly, this review considers both adult and paediatric patients. Limitations of the procedure and a look to the future are also addressed.
文摘AIM:To study whether adalimumab(ADA) was associated with improvement in growth,bone mineraldensity(BMD) and bone metabolism.METHODS:In children with Crohn's disease(CD) there is a high prevalence of growth failure and reduced BMD.Treatment with infliximab is associated with an improvement in growth.Anthropometry,paediatric CD activity index(PCDAI),bone markers and BMD was measured in 18 patients(72% females) one year before and after start of ADA with a median age of 14.4 years(range:5-19 years) at treatment start.Outcomes were indicators of growth with treatment as well as interval growth.RESULTS:Eleven(61%) children experienced catchup growth after ADA.PCDAI significantly decreased from 52.1 ± 16 to 30.4 ± 23(P ≤ 0.001).Post ADA,body mass index(BMI) standard deviation score(SDS) 0.1[range:2.7-(-0.8)] vs-1 [range:0.1-(-3.6)],P = 0.04 and △BMI SDS in children 0.3 [range:0.7-(-0.2)] vs-1.1 [range:1.2-(-2.3)],P = 0.01 in remission were significantly higher compared to those with moderate to severe inflammation.The main predictors for growth were 25-hydroxycholecalciferol and for bone mineralisation weight and height SDS.ADA had no significant influence on bone markers and BMD.CONCLUSION:Next to improvement of PCDAI,half of the children achieved a positive catch-up growth.A better nutritional status with improvement in BMI and weight is positive predictor for improved growth and bone mineralisation.
文摘The following is a continued analysis about some terms related to paediatrics in traditional Chinese medicine （TCM） included in the WHO International Standard Termi- nologies on Traditional Medicine in the Western Pacific Region （abbreviated as the WPRO Standard）[1] and the International Standard Chinese-English Basic Nomenclature of Chinese Medicine compiled by World Federation of Chinese Medicine Societies （abbreviated as the WFCMS Standard）[2], according to explanations made in the book entitled A Great Dictionary of Traditional Chinese Medicine[3], Chinese-English Dictionary of Traditional Chinese Medicine[4] and the studies made in the book entitled International Standardization of English Translation of Traditional Chinese Medicine： Study of Theory, Summarization of Practice and Exploration of Methods[5].
