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
The following is a brief analysis about some terms related to paediatrics in traditional Chinese medicine （TCM） included in the WHO International Standard Terminologies on Traditional Medicine in the Western Pacific...The following is a brief analysis about some terms related to paediatrics in traditional Chinese medicine （TCM） included in the WHO International Standard Terminologies on Traditional Medicine in the Western Pacific Region （abbreviated as the WPRO Standard）EI~ and the Interna- tional Standard Chinese-English Basic Nomenclature of Chinese Medicine compiled by the World Federation of Chinese Medicine Societies （abbreviated as the WFCMS Standard）, according to explanations made in the book entitled A Concise Dictionary of Traditional Chinese Medicinet,展开更多
The following is a continued analysis about the third group of terms related to paediatrics in TCM included in the WHO International Standard Terminologies on Traditional Medicine in the Western Pacific Region （abbre...The following is a continued analysis about the third group of terms related to paediatrics in TCM included in the WHO International Standard Terminologies on Traditional Medicine in the Western Pacific Region （abbreviated as the WPRO Standard） and the International Standard Chinese- English Basic Nomenclature of Chinese Medicine compiled by World Federation of Chinese Medicine Societies （abbreviated as the WFCMS Standard）,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
1 DBP as a Subspecialty under Paediatrics and Child Health Developmental Paediatrics was established first in the United Kingdomin 1950’s at the Newcomen Clinic at
Inborn errors of metabolism(IEM)are rare disorders,most are liver-based with liver transplantation(LT)emerging as an effective cure in the pediatric population.LT has been shown to offer a cure or deter disease progre...Inborn errors of metabolism(IEM)are rare disorders,most are liver-based with liver transplantation(LT)emerging as an effective cure in the pediatric population.LT has been shown to offer a cure or deter disease progression and provide symptomatic improvement in patients with IEM.Each metabolic disorder is unique,with the missing enzyme or transporter protein causing substrate deficiency or toxic byproduct production.Knowledge about the distribution of deficient enzymes,the percentage of enzymes replaced by LT,and the extent of extrahepatic involvement helps anticipate and manage complications in the perioperative period.Most patients have multisystem involvement and can be on complex dietary regimens.Metabolic decompensation can be triggered due to the stress response to surgery,fasting and other unanticipated complications perioperatively.Thus,a multidisciplinary team’s input including those from metabolic specialists is essential to develop disease and patient-specific strategies for the perioperative management of these patients during LT.In this review,we outline the classification of IEM,indications for LT along with potential benefits,basic metabolic defects and their implications,details of extrahepatic involvement and perioperative management strategies for LT in children with some of the commonly presenting IEM,to assist anesthesiologists handling this cohort of patients.展开更多
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
BACKGROUND Supracondylar humeral fractures are among the most common paediatric injuries.Displacement and consequent need for reduction impose operative treatment.Restoration of the anatomy of the distal part of the h...BACKGROUND Supracondylar humeral fractures are among the most common paediatric injuries.Displacement and consequent need for reduction impose operative treatment.Restoration of the anatomy of the distal part of the humerus prevents deformities and functional disorders of the elbow and upper limb.Stable K-wire fixation can be succeeded either by closed or open reduction method.AIM To investigate the safety and efficacy of open reduction method in the operative treatment of Gartland type III and IV supracondylar humeral fractures in children.METHODS We retrospectively studied 131 cases of paediatric supracondylar humerus fractures of Gartland type III-IV treated operatively by open reduction and pinning between 2001 and 2023 in our department.All patients underwent clinical and radiological examination recording elbow range of motion,function and deformity.RESULTS The standard lateral approach was carried out in all patients while in 47 cases(35.9%)additional medial approach was used.Average follow-up time was 5.4 years(1-14 years).Fracture healing was completed at 4-6 weeks.The average operative time was 50 min(range:37-75 minutes,SD:11.307)and the average duration of radiation exposure based on image intensifier usage time was 20 seconds(range:7-45 seconds,SD:9.864).No infections or iatrogenic neurovascular complications were recorded and the functional outcome regarding range of motion,Patient-Reported Outcome Measures(Disabilities of the Arm,Shoulder,and Hand questionnaire,Mayo Elbow Performance Scores)at 2-year follow-up was satisfying.CONCLUSION Open reduction and K-wire fixation provide very satisfactory outcome in supracondylar fractures of the humerus in children with reduced radiation burden.Moreover,the risk of neurovascular injuries due to manipulations of closed reduction,is minimized while complications related to surgical approaches are insignificant provided there is expertise.展开更多
Traumatic brain injury(TBI) is a major cause of death and disability in children. Severe TBI is a leading cause of death and often leads to life changing disabilities in survivors. The modern management of severe TBI ...Traumatic brain injury(TBI) is a major cause of death and disability in children. Severe TBI is a leading cause of death and often leads to life changing disabilities in survivors. The modern management of severe TBI in children on intensivecare unit focuses on preventing secondary brain injury to improve outcome. Standard neuroprotective measures are based on management of intracranial pressure(ICP) and cerebral perfusion pressure(CPP) to optimize the cerebral blood flow and oxygenation, with the intention to avoid and minimise secondary brain injury. In this article, we review the current trends in management of severe TBI in children, detailing the general and specific measures followed to achieve the desired ICP and CPP goals. We discuss the often limited evidence for these therapeutic interventions in children, extrapolation of data from adults, and current recommendation from paediatric guidelines. We also review the recent advances in understanding the intracranial physiology and neuroprotective therapies, the current research focus on advanced and multi-modal neuromonitoring, and potential new therapeutic and prognostic targets.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
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
Positron emission tomography(PET) is a minimally in-vasive technique which has been well validated for the diagnosis, staging, monitoring of response to therapy, and disease surveillance of adult oncology patients. Tr...Positron emission tomography(PET) is a minimally in-vasive technique which has been well validated for the diagnosis, staging, monitoring of response to therapy, and disease surveillance of adult oncology patients. Tra-ditionally the value of PET and PET/computed tomogra-phy(CT) hybrid imaging has been less clearly defined for paediatric oncology. However recent evidence has emerged regarding the diagnostic utility of these mo-dalities, and they are becoming increasingly important tools in the evaluation and monitoring of children with known or suspected malignant disease. Important indi-cations for 2-deoxy-2-(18F)fluoro-D-glucose(FDG) PET in paediatric oncology include lymphoma, brain tumours, sarcoma, neuroblastoma, Langerhans cell histiocytosis, urogenital tumours and neurofibromatosis type Ⅰ. This article aims to review current evidence for the use of FDG PET and PET/CT in these indications. Attention will also be given to technical and logistical issues, the description of common imaging pitfalls, and dosimetric concerns as they relate to paediatric oncology.展开更多
BACKGROUND There remains a dearth of Asian epidemiological literature for paediatric inflammatory bowel disease(PIBD).AIM To describe the presenting features of PIBD from 7 Asia-Pacific pediatric gastroenterology cent...BACKGROUND There remains a dearth of Asian epidemiological literature for paediatric inflammatory bowel disease(PIBD).AIM To describe the presenting features of PIBD from 7 Asia-Pacific pediatric gastroenterology centers via a central standardised electronic data platform.METHODS Clinical,endoscopic and radiologic data at diagnosis from the registry were extracted between 1^(st) January 1995 to 31^(st) December 2019.Disease phenotypic characteristics were classified as per the Paris classification system.RESULTS There was a distinct rise in new PIBD cases:Nearly half(48.6%)of the cohort was diagnosed in the most recent 5 years(2015-2019).The ratio of Crohn’s disease(CD):Ulcerative colitis(UC):IBDUnclassified was 55.9%:38.3%:5.8%.The mean age was 9.07 years with a high proportion of very early onset IBD(VEO-IBD)(29.3%)and EO-IBD(52.7%).An over-representation of the Indian/South Asian ethnic group was observed which accounted for 37.0% of the overall Singapore/Malaysia subcohort(6.8%-9.0%Indians in census).Indian/South Asian CD patients were also most likely to present with symptomatic perianal disease(P=0.003).CD patients presented with significantly more constitutional symptoms(fever,anorexia,malaise/fatigue and muscle-wasting)than UC and higher inflammatory indices(higher C-reactive protein and lower albumin levels).CONCLUSION We observed a high incidence of VEO-IBD and an over-representation of the Indian ethnicity.South Asian CD patients were more likely to have symptomatic perianal disease.展开更多
Ependymomas are a somewhat diverse category of glial tumors that often develop from the lining of the brain’s ventricles, or the spinal cord’s central canal. They make up 5% of all neuroepithelial tumors, 10% of pae...Ependymomas are a somewhat diverse category of glial tumors that often develop from the lining of the brain’s ventricles, or the spinal cord’s central canal. They make up 5% of all neuroepithelial tumors, 10% of paediatric brain tumors, and up to 33% of brain tumors in children under the age of three. Hydrocephalus is one of the complications, and it can be identified as progressive macrocephaly or increasing head circumference crossing percentiles, nausea, vomiting, poor appetite, irritability, and regression of developmental milestones.展开更多
Despite the acceptance of physical activity （PA） being integral to a young person＇s health, children with disability often exhibit low levels of PA. In young people with cystic fibrosis （CF） the importance of exe...Despite the acceptance of physical activity （PA） being integral to a young person＇s health, children with disability often exhibit low levels of PA. In young people with cystic fibrosis （CF） the importance of exercise and daily PA is acknowledged by clinicians and their support teams, however, there is a lack of knowledge related to its prescription. CF is a recessive genetic disorder affecting the lung, pancreas and sweat glands. CF is the most common life shortening genetic disease in the Caucasian population for which there is no cure. In the UK, CF affects over 9000 people, with 4000 under 16 years of age. Only about half of the CF population can expect to live beyond 40 years of age. Besides drug therapies, rehabilitative exercise programmes form an important component of treatment and long term exercise programmes are considered positive treatment strategies, but all lack any detailed prescriptive information. Several reviews and editorials have highlighted the lack of evidence based research in PA and exercise training in young people with CF; but advocate a greater need for understanding the role of exercise in therapeutic interventions. The purpose of this review is to update the reader on the current recommendations and evidence in PA and exercise training for young people with CE These developments have extended our understanding of PA and exercise training in children and adolescents with CF, and its implementation in the management of this chronic disease.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
Introduction: Gall stones disease is a rare oc-currence in paediatric patients and the diagno-sis is often overlooked. Patients often present with non-specific symptoms of abdominal pain and the classic features of ga...Introduction: Gall stones disease is a rare oc-currence in paediatric patients and the diagno-sis is often overlooked. Patients often present with non-specific symptoms of abdominal pain and the classic features of gallstones are some-times absent [1]. The aim of our study is to in-crease the awareness of cholecystitis and acute pancreatitis being a possible occurrence in the paediatric age group and should therefore be in the differential diagnosis of acute abdominal pain in children. We undertook a retrospective analy- sis of all the paediatric patients recorded as hav- ing had a laparoscopic Cholecystectomy per-formed at Prince Charles Hospital. 8 paediatric patients underwent Laparoscopic cholecysteco- my between 2000 and 2008 consisting of 5 fe-male patients and 3 male patients. The average age of the cohort was 14.1 years [12-16]. Pre- morbid obesity was a feature in 4 patients and all patients reported high fat diet. Abdominal Ul- trasound used to assess all 8 patients who pre- sented with acute abdomen showed gallstones to be present in all. 7 patients underwent an ele- ctive procedure 3-6 months after the initial di-agnosis was made and 1 patient had laparosco- pic Cholecystectomy within 72 hours of initial presentation. 1 patient was found to have an in- herited haematological disorder and 2 of the pa- tients were sisters with a family history of gall- stone disease. 2 patients presented with acute pancreatitis. Gallstone related cholecystitis is a rare occurrence amongst paediatric patients and is often overlooked as a differential diagnosis. We report 8 patients over an 8 year period. Con- clusion: It is important that clinicians include cholecystitis and biliary colic in the differential diagnosis of patients presenting with acute ab-domen in childhood not explained by other di-agnoses. Laparoscopic Cholecystectomy is the treatment of choice and has minimal complica-tions.展开更多
Coronary allograft vasculopathy remains one of the leading causes of death beyond the first year post transplant. As a result of denervation following transplantation, patients lack ischaemic symptoms and presentation...Coronary allograft vasculopathy remains one of the leading causes of death beyond the first year post transplant. As a result of denervation following transplantation, patients lack ischaemic symptoms and presentation is often late when the graft is already compromised. Current diagnostic tools are rather invasive, or in case of angiography, significantly lack sensitivity. Therefore a non-invasive tool that could al ow early diagnosis would be invaluable.This paper review the disease form its different diagnosis techniques,including new and less invasive diagnostic tools to its pharmacological management and possible treatments.展开更多
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].
文摘The following is a brief analysis about some terms related to paediatrics in traditional Chinese medicine （TCM） included in the WHO International Standard Terminologies on Traditional Medicine in the Western Pacific Region （abbreviated as the WPRO Standard）EI~ and the Interna- tional Standard Chinese-English Basic Nomenclature of Chinese Medicine compiled by the World Federation of Chinese Medicine Societies （abbreviated as the WFCMS Standard）, according to explanations made in the book entitled A Concise Dictionary of Traditional Chinese Medicinet,
文摘The following is a continued analysis about the third group of terms related to paediatrics in TCM included in the WHO International Standard Terminologies on Traditional Medicine in the Western Pacific Region （abbreviated as the WPRO Standard） and the International Standard Chinese- English Basic Nomenclature of Chinese Medicine compiled by World Federation of Chinese Medicine Societies （abbreviated as the WFCMS Standard）,
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1 DBP as a Subspecialty under Paediatrics and Child Health Developmental Paediatrics was established first in the United Kingdomin 1950’s at the Newcomen Clinic at
文摘Inborn errors of metabolism(IEM)are rare disorders,most are liver-based with liver transplantation(LT)emerging as an effective cure in the pediatric population.LT has been shown to offer a cure or deter disease progression and provide symptomatic improvement in patients with IEM.Each metabolic disorder is unique,with the missing enzyme or transporter protein causing substrate deficiency or toxic byproduct production.Knowledge about the distribution of deficient enzymes,the percentage of enzymes replaced by LT,and the extent of extrahepatic involvement helps anticipate and manage complications in the perioperative period.Most patients have multisystem involvement and can be on complex dietary regimens.Metabolic decompensation can be triggered due to the stress response to surgery,fasting and other unanticipated complications perioperatively.Thus,a multidisciplinary team’s input including those from metabolic specialists is essential to develop disease and patient-specific strategies for the perioperative management of these patients during LT.In this review,we outline the classification of IEM,indications for LT along with potential benefits,basic metabolic defects and their implications,details of extrahepatic involvement and perioperative management strategies for LT in children with some of the commonly presenting IEM,to assist anesthesiologists handling this cohort of patients.
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.
文摘BACKGROUND Supracondylar humeral fractures are among the most common paediatric injuries.Displacement and consequent need for reduction impose operative treatment.Restoration of the anatomy of the distal part of the humerus prevents deformities and functional disorders of the elbow and upper limb.Stable K-wire fixation can be succeeded either by closed or open reduction method.AIM To investigate the safety and efficacy of open reduction method in the operative treatment of Gartland type III and IV supracondylar humeral fractures in children.METHODS We retrospectively studied 131 cases of paediatric supracondylar humerus fractures of Gartland type III-IV treated operatively by open reduction and pinning between 2001 and 2023 in our department.All patients underwent clinical and radiological examination recording elbow range of motion,function and deformity.RESULTS The standard lateral approach was carried out in all patients while in 47 cases(35.9%)additional medial approach was used.Average follow-up time was 5.4 years(1-14 years).Fracture healing was completed at 4-6 weeks.The average operative time was 50 min(range:37-75 minutes,SD:11.307)and the average duration of radiation exposure based on image intensifier usage time was 20 seconds(range:7-45 seconds,SD:9.864).No infections or iatrogenic neurovascular complications were recorded and the functional outcome regarding range of motion,Patient-Reported Outcome Measures(Disabilities of the Arm,Shoulder,and Hand questionnaire,Mayo Elbow Performance Scores)at 2-year follow-up was satisfying.CONCLUSION Open reduction and K-wire fixation provide very satisfactory outcome in supracondylar fractures of the humerus in children with reduced radiation burden.Moreover,the risk of neurovascular injuries due to manipulations of closed reduction,is minimized while complications related to surgical approaches are insignificant provided there is expertise.
文摘Traumatic brain injury(TBI) is a major cause of death and disability in children. Severe TBI is a leading cause of death and often leads to life changing disabilities in survivors. The modern management of severe TBI in children on intensivecare unit focuses on preventing secondary brain injury to improve outcome. Standard neuroprotective measures are based on management of intracranial pressure(ICP) and cerebral perfusion pressure(CPP) to optimize the cerebral blood flow and oxygenation, with the intention to avoid and minimise secondary brain injury. In this article, we review the current trends in management of severe TBI in children, detailing the general and specific measures followed to achieve the desired ICP and CPP goals. We discuss the often limited evidence for these therapeutic interventions in children, extrapolation of data from adults, and current recommendation from paediatric guidelines. We also review the recent advances in understanding the intracranial physiology and neuroprotective therapies, the current research focus on advanced and multi-modal neuromonitoring, and potential new therapeutic and prognostic targets.
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Positron emission tomography(PET) is a minimally in-vasive technique which has been well validated for the diagnosis, staging, monitoring of response to therapy, and disease surveillance of adult oncology patients. Tra-ditionally the value of PET and PET/computed tomogra-phy(CT) hybrid imaging has been less clearly defined for paediatric oncology. However recent evidence has emerged regarding the diagnostic utility of these mo-dalities, and they are becoming increasingly important tools in the evaluation and monitoring of children with known or suspected malignant disease. Important indi-cations for 2-deoxy-2-(18F)fluoro-D-glucose(FDG) PET in paediatric oncology include lymphoma, brain tumours, sarcoma, neuroblastoma, Langerhans cell histiocytosis, urogenital tumours and neurofibromatosis type Ⅰ. This article aims to review current evidence for the use of FDG PET and PET/CT in these indications. Attention will also be given to technical and logistical issues, the description of common imaging pitfalls, and dosimetric concerns as they relate to paediatric oncology.
文摘BACKGROUND There remains a dearth of Asian epidemiological literature for paediatric inflammatory bowel disease(PIBD).AIM To describe the presenting features of PIBD from 7 Asia-Pacific pediatric gastroenterology centers via a central standardised electronic data platform.METHODS Clinical,endoscopic and radiologic data at diagnosis from the registry were extracted between 1^(st) January 1995 to 31^(st) December 2019.Disease phenotypic characteristics were classified as per the Paris classification system.RESULTS There was a distinct rise in new PIBD cases:Nearly half(48.6%)of the cohort was diagnosed in the most recent 5 years(2015-2019).The ratio of Crohn’s disease(CD):Ulcerative colitis(UC):IBDUnclassified was 55.9%:38.3%:5.8%.The mean age was 9.07 years with a high proportion of very early onset IBD(VEO-IBD)(29.3%)and EO-IBD(52.7%).An over-representation of the Indian/South Asian ethnic group was observed which accounted for 37.0% of the overall Singapore/Malaysia subcohort(6.8%-9.0%Indians in census).Indian/South Asian CD patients were also most likely to present with symptomatic perianal disease(P=0.003).CD patients presented with significantly more constitutional symptoms(fever,anorexia,malaise/fatigue and muscle-wasting)than UC and higher inflammatory indices(higher C-reactive protein and lower albumin levels).CONCLUSION We observed a high incidence of VEO-IBD and an over-representation of the Indian ethnicity.South Asian CD patients were more likely to have symptomatic perianal disease.
文摘Ependymomas are a somewhat diverse category of glial tumors that often develop from the lining of the brain’s ventricles, or the spinal cord’s central canal. They make up 5% of all neuroepithelial tumors, 10% of paediatric brain tumors, and up to 33% of brain tumors in children under the age of three. Hydrocephalus is one of the complications, and it can be identified as progressive macrocephaly or increasing head circumference crossing percentiles, nausea, vomiting, poor appetite, irritability, and regression of developmental milestones.
文摘Despite the acceptance of physical activity （PA） being integral to a young person＇s health, children with disability often exhibit low levels of PA. In young people with cystic fibrosis （CF） the importance of exercise and daily PA is acknowledged by clinicians and their support teams, however, there is a lack of knowledge related to its prescription. CF is a recessive genetic disorder affecting the lung, pancreas and sweat glands. CF is the most common life shortening genetic disease in the Caucasian population for which there is no cure. In the UK, CF affects over 9000 people, with 4000 under 16 years of age. Only about half of the CF population can expect to live beyond 40 years of age. Besides drug therapies, rehabilitative exercise programmes form an important component of treatment and long term exercise programmes are considered positive treatment strategies, but all lack any detailed prescriptive information. Several reviews and editorials have highlighted the lack of evidence based research in PA and exercise training in young people with CF; but advocate a greater need for understanding the role of exercise in therapeutic interventions. The purpose of this review is to update the reader on the current recommendations and evidence in PA and exercise training for young people with CE These developments have extended our understanding of PA and exercise training in children and adolescents with CF, and its implementation in the management of this chronic disease.
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Introduction: Gall stones disease is a rare oc-currence in paediatric patients and the diagno-sis is often overlooked. Patients often present with non-specific symptoms of abdominal pain and the classic features of gallstones are some-times absent [1]. The aim of our study is to in-crease the awareness of cholecystitis and acute pancreatitis being a possible occurrence in the paediatric age group and should therefore be in the differential diagnosis of acute abdominal pain in children. We undertook a retrospective analy- sis of all the paediatric patients recorded as hav- ing had a laparoscopic Cholecystectomy per-formed at Prince Charles Hospital. 8 paediatric patients underwent Laparoscopic cholecysteco- my between 2000 and 2008 consisting of 5 fe-male patients and 3 male patients. The average age of the cohort was 14.1 years [12-16]. Pre- morbid obesity was a feature in 4 patients and all patients reported high fat diet. Abdominal Ul- trasound used to assess all 8 patients who pre- sented with acute abdomen showed gallstones to be present in all. 7 patients underwent an ele- ctive procedure 3-6 months after the initial di-agnosis was made and 1 patient had laparosco- pic Cholecystectomy within 72 hours of initial presentation. 1 patient was found to have an in- herited haematological disorder and 2 of the pa- tients were sisters with a family history of gall- stone disease. 2 patients presented with acute pancreatitis. Gallstone related cholecystitis is a rare occurrence amongst paediatric patients and is often overlooked as a differential diagnosis. We report 8 patients over an 8 year period. Con- clusion: It is important that clinicians include cholecystitis and biliary colic in the differential diagnosis of patients presenting with acute ab-domen in childhood not explained by other di-agnoses. Laparoscopic Cholecystectomy is the treatment of choice and has minimal complica-tions.
文摘Coronary allograft vasculopathy remains one of the leading causes of death beyond the first year post transplant. As a result of denervation following transplantation, patients lack ischaemic symptoms and presentation is often late when the graft is already compromised. Current diagnostic tools are rather invasive, or in case of angiography, significantly lack sensitivity. Therefore a non-invasive tool that could al ow early diagnosis would be invaluable.This paper review the disease form its different diagnosis techniques,including new and less invasive diagnostic tools to its pharmacological management and possible treatments.
