简介：AbstractTonsillectomy with and without adenoidectomy is a frequently performed surgical procedure in children. Although a common procedure, it is not without significant risk. It is critical for anesthesiologists to consider preoperative, intraoperative, and postoperative patient factors and events to optimize safety, especially in young children. In the majority of cases, the indication for adenotonsillectomy in young children is obstructive breathing. Preoperative evaluation for patient comorbidities, especially obstructive sleep apnea, risk factors for a difficult airway, and history of recent illness are crucial to prepare the patient for surgery and develop an anesthetic plan. Communication and collaboration with the otolaryngologist is key to prevent and treat intraoperative events such as airway fires or hemorrhage. Postoperative analgesia planning is critical for safe pain control especially for those patients with a history of obstructive sleep apnea and opioid sensitivity. In young children, it is important to also consider the impact of anesthetic medications on the developing brain. This is an area of continuing research but needs to be weighed when planning for surgical treatment and when discussing risks and benefits with patients’ families.

简介：AIM:ToevaluatetheefficacyandsafetyofN-butyl-2-cyanoacrylateintreatingacutebleedingofgastricvaricesinchildren.METHODS:Theretrospectivestudyincluded21childrenwith47episodesofactivegastricvaricealbleedingwhoweretreatedbyendoscopicinjectionofN-butyl-2-cyanoacrylateatAsanMedicalCenterChildren’sHospitalbetweenAugust2004andDecember2011.Toreducetheriskofembolism,eachinjectionconsistedof0.1-0.5mLof0.5mLN-butyl-2-cyanoacrylatedilutedwith0.5or0.8mLLipiodol.Theprimaryoutcomewasincidenceofhemostasisaftervaricealobliterationandthesecondaryoutcomewascomplicationoftheprocedure.RESULTS:The21patientsexperienced47episodesofactivegastricvaricealbleeding,includingrebleeding,forwhichtheyreceivedatotalof52cyanoacrylateinjections.Following42bleedingepisodes,hemostasiswasachievedafteroneinjectionandfollowingfivebleedingepisodesitwasachievedaftertwoinjections.Themeanvolumeofeachsinglealiquotofcyanoacrylateinjectedwas0.3±0.1mL(range:0.1-0.5mL).Injectionachievedhemostasisin45of47(95.7%)episodesofacutegastricvaricealbleeding.Elevenpatients(52.4%)developedrebleedingevents,withthemeandurationofhemostasisbeing11.1±11.6mo(range:1.0-39.2mo).Notreatment-relatedcomplicationssuchasdistalembolismwerenotedwiththeexceptionofabdominalpaininonepatient(4.8%).Amongfourmortalities,onepatientdiedofvaricealrebleeding.CONCLUSION:Endoscopicvaricealobliterationusingasmallvolumeofaliquotswithrepeatedcyanoacrylateinjectionwasaneffectiveandsafeoptionforthetreatmentofgastricvaricesinchildren.

简介：AbstractIntroduction:Congenital analgesia is a rare autosomal recessive hereditary disease. The primary damage of congenital analgesia is central structure damage of comprehensive pain perception.Case presentation:A 1-year-old Han Chinese boy was admitted to hospital because of a tongue bite. He had no response to noxious stimulation of the body surface and was diagnosed with congenital analgesia. A small dose of remifentanil was intravenously injected during anesthetic induction to reduce the stress response caused by endotracheal intubation. A certain depth of anesthesia should be guaranteed during anesthetic induction and surgery to alleviate the stress response induced by endotracheal intubation and the operation.Conclusion:Opioid analgesics are not required for general anesthesia in patient with congenital insensitivity to pain. With a heat dissipation barrier in patients with congenital insensitivity to pain with anhidrosis, body temperature, end-tidal carbon dioxide and bispectral index should be monitored.

简介：Objectives:Thisstudyexaminedthequalityoflife(QoL)oftheparentsandsiblingsofhearing-impairedchildrenwithcochlearimplants(CIs).Design:Thisisacross-sectional,questionnaire-basedstudy.Thequestionnaireconsistsofthreesub-domains-interaction,emotionalwell-beingandsupportforthehearing-impairedchildandtheoverallQoL-andtwoopen-endedquestionsforparticipantstoprovidecommentsandsuggestionstoenhancetheirfamily'sQoL.Atotalof63questionnairesweree-mailedormailedtofamilieswhomettheinclusioncriteria.Setting:ThestudywasconductedundertheCenterforRehabilitation&SpecialNeeds,FacultyofHealthSciences,UniversitiKebangsaanMalaysia,KualaLumpur.Participants:Atotalof79parentsand23siblingsfrom44familiesofchildrenwithCIparticipatedinthisstudy.Mainoutcomemeasures:Themeanscoreforeachofthesub-domainandtheoverallQoLforbothsubjectgroupswerecomputed.Theanswersfortheopen-endedquestionswerelistedandorganizedintothemes.Results:ThereweresignificantcorrelationsbetweentheoverallQoLscoreandeachofthetestdomainsfortheparents'group(p<0.01).Forthesiblings'group,onlytheinteractionandsupportdomainsweresignificant.Interactionwasthemainsub-domainaffectingtheparents'QoLbutforsiblings,thiscouldnotbedetermined.Atotalof60%ofthepooledcommentswereclassifiedas‘concerns’.Asforthesuggestions,38.7%requestedsomeformofsupport,mainlyfinancial(41.7%).Conclusions:FamilieswithhearingimpairedchildrenwithCIhavenumerousconcernsthatneedtobeaddressed,eventhough,onaverage,theyweresatisfiedwiththeiroverallQoL.

简介：AbstractImportance:There is a high incidence of iron deficiency in children worldwide. Notably, however, while iron deficiency is the most common cause of anemia, little is known about the prevalence and different types of iron deficiency in neuroblastoma patients.Objective:The aim of the present study was to investigate the prevalence of iron deficiency in patients newly diagnosed with neuroblastoma.Methods:A total of 195 newly diagnosed neuroblastoma patients from November 2015 to January 2018 were analyzed retrospectively. The survival analysis was estimated by the Kaplan-Meier method.Results:Of the 195 neuroblastoma patients included in the study, 121 (62.1%) had iron deficiency, 55 (28.2%) had absolute iron deficiency, and 66 (33.9%) had functional iron deficiency. Being aged ≥ 18 months, tumor originating in the abdomen, International Neuroblastoma Risk Group Staging System M, high-risk neuroblastoma, lactate dehydrogenase ≥ 1500 U/L, neuron-specific enolase ≥ 100 U/L, unfavorable histologic category, MYCN amplification, chromosome 1p loss, and bone marrow metastasis were associated with significantly higher rates of functional iron deficiency (P < 0.05).Interpretation:Functional iron deficiency at the time of initial neuroblastoma diagnosis predicted lower event-free survival. Long-term effects of iron supplementation in neuroblastoma patients with different types of iron deficiency need to be further studied.

简介：ObjectiveTinnitusandhyperacusisaresubjectivesymptomswhichcanbereportedbypeopleofanyage.Althoughtinnitusandhyperacusiscanhaveanegativeeffectonchilddevelopment,thesesymptomsarecommonlyoverlookedbytheirparentsandclinicians.Inthispaper,wereviewclinicalreportsontinnitusandhyperacusisinchildrenandbasicscientificstudiesonthesedisordersinordertoprovideupdatesofthesedisordersinthepediatricpopulation.Recentstudieshavefoundthattinnitusandhyperacusisarenotuncommoninchildren,especiallyinthosewithconductiveandsensorineuralhearingloss.Theparentsandcliniciansshouldpayattentionwhenchildrenshowabnormalbehaviorsandespeciallywhentheydevelophearingloss.Sincethereisnoobjectivemeasurementfortinnitusandhyperacusis,thediagnosisinchildrencanbechallenging.TinnitusandhyperacusisarealsocommoninWilliamssyndromeandautismbutthemechanismsarestillnotclear.Highdosesofsalicylateandnoiseexposurecaninducetinnitus.Animalstudieshavedeterminedlackofinhibitionintheauditorycortexandtheinferiorcolliculusmaybecriticalfortinnitusandhyperacusisgeneration.Thenon-classicauditorysystemmayalsobeinvolvedintheawarenessandtoleranceoftinnitusandhyperacusis.

简介：AbstractPurpose:Pelvic fracture evaluation with abdominopelvic computed tomography (CT) and formal CT cystography for rule out of urine bladder injury have been commonly employed in pediatric trauma patients. The additional delayed imaging required to obtain optimal CT cystography is, however, associated with increased doses of ionizing radiation to pelvic organs and represent a significant risk in the pediatric population for future carcinogenic risk. We hypothesized that avoidance of routine CT cystography among pediatric pelvic fracture victims would not result in an appreciable rate of missed bladder injuries and would aid in mitigating the radiation exposure risk associated with these additional images.Methods:A retrospective cohort study involving blunt trauma pelvic fractures among pediatric trauma patients (age<14) between the years 1997 and 2016 was conducted utilizing the Israeli National Trauma Registry. Statistical analysis was performed using SAS statistical software version 9.4 via the tests of Chisquare test and two-sided Fisher's exact test. A p value of less than 0.05 was considered statistically significant.Results:A total of 1072 children were identified from the registry for inclusion. Mean age of patients was 7.7 years (range 0-14) and 713 (66.5%) were male. Overall mortality in this population was 4.1% (44/1072). Only 2.1% (23) of pediatric patients with pelvic fractures had bladder injury identified, with just 9 children having intraperitoneal bladder rupture (0.8% of all the patients).Conclusion:The vast majority of blunt pediatric trauma victims with pelvic fractures do not have urine bladder injuries. Based on our study results we do not recommend the routine utilization of CT cystography in this unique population.

简介：AbstractImportance:The prevalence and characteristics of short stature (SS) among children in China should be assessed to provide guidance for planning and implementation of nationwide public health policies. Thus far, there have been no accurate estimates of the prevalence of SS in China.Objective:To analyze the prevalence of SS among children in China and to explore the influences of sex, area, age, study year, and study site on prevalence rates.Methods:Relevant literature was identified by searching the following databases: PubMed, Embase, The Cochrane Library, Chinese Biomedical Literature, China Knowledge Resource Integrated, WeiPu, and WanFang databases. Meta-analysis was carried out using STATA 11.2.Results:This meta-analysis included 39 studies with 348 326 Chinese participants; the studies covered 20 provinces, municipalities, and autonomous regions. The pooled prevalence of SS was 3.2% (95% confidence interval [CI], 2.6%-3.7%; I2 = 99.8%). The prevalence of SS in boys and girls were 3.1% (95% CI, 2.5%-3.7%) and 3.2% (95% CI, 2.6%-3.9%), respectively. The sex difference was not statistically significant (P > 0.05). The prevalence of SS was higher in rural areas than in urban areas (4.7% [95% CI, 3.6%-5.8%] vs. 2.8% [95% CI, 2.2%-3.4%]; P < 0.001). The prevalence of SS was higher in West China (5.2%; 95% CI, 4.4%-6.0%) than in Northeast China (0.6%; 95% CI, 0.3%-0.8%), East China (2.3%; 95% CI, 1.9%-2.8%), or Central China (2.9%; 95% CI, 1.9%-3.9%).Interpretation:The prevalence of SS among children was higher in western and rural areas of China. Close attention to children’s growth and development is needed to prevent the occurrence of SS.

简介：AbstractPediatric and adult spinal cord injuries (SCI) are distinct entities. Children and adolescents with SCI must suffer from lifelong disabilities, which is a heavy burden on patients, their families and the society. There are differences in Chinese and foreign literature reports on the incidence, injury mechanism and prognosis of SCI in children and adolescents. In addition to traumatic injuries such as car accidents and falls, the proportion of sports injuries is increasing. The most common sports injury is the backbend during dance practice. Compared with adults, children and adolescents are considered to have a greater potential for neurological improvement. The pathogenesis and treatment of pediatric SCI remains unclear. The mainstream view is that the mechanism of nerve damage in pediatric SCI include flexion, hyperextension, longitudinal distraction and ischemia. We also discuss the advantages and disadvantages of drugs such as methylprednisolone in the treatment of pediatric SCI and the indications and timing of surgery. In addition, the complications of pediatric SCI are also worthy of attention. New imaging techniques such as diffusion tensor imaging and diffusion tensor tractography may be used for diagnosis and assessment of prognosis. This article reviews the epidemiology, pathogenesis, imaging, clinical characteristics, treatment and complications of SCI in children and adolescents. Although current treatment cannot completely restore neurological function, patient quality of life can be enhanced. Continued developments and advances in the research of SCI may eventually provide a cure for children and adolescents with this kind of injury.

简介：AbstractImportance:Bacteremia tuberculosis (TB) is a severe form of extrapulmonary TB. Studies assessing bacteremia TB in children are limited, especially for HIV-negative children.Objective:To explore the detailed clinical features of the bacteremia TB in children under 18 years of age.Methods:We reviewed the clinical records of the patients retrospectively and collected the strains isolated from their blood cultures. We used mycobacterial interspersed repetitive-unit-variable-number tandem-repeat (MIRU-VNTR) to characterize the bacterial genotypes and alamarBlue to determine their drug susceptibility profiles. Polymerase chain reactions and DNA sequencing were used to identify drug-resistant mutations.Results:There were 13 pediatric bacteremia TB patients, 10 of whom were diagnosed with Bacillus Calmette–Guérin (BCG) bacteremia TB. Thirteen patients aged from 0.30 to 11.58 years were enrolled, of whom 76.92% were boys. All had fevers before hospitalization, and 76.92% had respiratory symptoms. All had received BCG vaccinations, and 46.15% had adverse post-vaccination reactions. Compared with Mycobacterium tuberculosis, BCG bacteremia was more likely to appear in younger children. Patients with BCG bacteremia had primary immunodeficiency diseases, and lower CD4, IgA, and IgE levels.Interpretation:Bacteremia TB was rapidly fatal in a large proportion of the immunodeficient children. Because classic findings may not be diagnostically specific, a high level of clinical suspicion is required, especially for patients with certain types of immunosuppression. Studies are needed to develop rapid diagnostic tests and to determine the value of empirical therapy in childhood bacteremia TB.

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简介：AbstractA large-scale vaccination of coronavirus disease-19 (COVID-19) in adults has been conducted for nearly a year, and there is a growing recognition that immunization for children is also essential. It has been months since emergency use of pediatric COVID-19 vaccine was approved, we reviewed the prevalence and transmission of COVID-19 in children. The prevalence of COVID-19 in children is reduced due to vaccination even in a Delta prevalent period, so an increase in the vaccination rate is needed in children. Although the precise role of children in the transmission requires more research to uncover, they likely played a significant role, according to the available literature. We also described four candidate COVID-19 vaccines for children on their safety and immunogenicity and the impact of severe acute respiratory syndrome coronavirus 2 variants on childhood vaccination. Safety issues on pediatric vaccines post-approval, like adverse events following immunization and adverse events of special interest require studies on long-term and effective regulatory mechanisms.

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简介：AIM:Toexaminefamilialaggregationofirritablebowelsyndrome(IBS)viaparentalreinforcement/modelingofsymptoms,coping,psychologicaldistress,andexposuretostress.METHODS:Mothersofchildrenbetweentheagesof8and15yearswithandwithoutIBSwereidentifiedthroughtheGroupHealthCooperativeofPugetSound.Motherscompletedquestionnaires,includingtheChildBehaviorChecklist(childpsychologicaldistress),theFamilyInventoryofLifeEvents(familyexposuretostress),SCL-90R(mo...

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简介：AbstractBackground:The standard treatment for pediatric differentiated thyroid carcinoma (DTC) still requires consideration because of a lack of clinical evidence. The purpose of this study was to summarize the clinical experiences and explore the risk factors for post-operative recurrence through a retrospective analysis to develop better clinical strategies for pediatric DTC.Methods:This study retrospectively analyzed children and adolescents with DTC who were treated between January 1999 and December 2014 at the Cancer Hospital, Chinese Academy of Medical Sciences. Clinicopathological results and outcomes were collected. A log-rank test of Kaplan-Meier curves and the Cox regression model were used to determine the factors associated with recurrence.Results:Data of 150 patients were collected in this study. During the follow-up, there was only one disease-related death. The recurrence rates at 3, 5, and 10 years were 13.6%, 18.7%, and 28.6%, respectively. There was a significant difference in the rate of recurrence according to age (P < 0.001), extrathyroidal extension (P < 0.001), lymph node metastasis (P = 0.023), and invasion of the trachea and esophageal wall (P = 0.004). Cox regression analysis demonstrated that age (P = 0.006) and extrathyroidal extension (P = 0.013) were significant dependent factors of post-operative recurrence.Conclusions:The prognosis of DTC in children and adolescents is favorable. A close follow-up is recommended because of the high recurrence rate. A comparatively higher recurrence rate was observed in the younger age group, and new age-based divisions may be needed to conveniently evaluate the possibility of recurrence.

简介：ObjectiveTrauma在在沙特阿拉伯的年轻年龄组之中是死亡和病态的领先的原因并且开发国家。这研究试图为临床的严厉作为一个潜在的预言者与创伤的大脑损害(TBI)在孩子评估血小板计数的秋天，outcome.MethodsTotally，有TBI的74个病人从开始2008年1月到目的进入我们的医院的小儿科的特别护理单位(PICU)2010年3月(27个月)。基线注册标准是很长时间12年，在在损伤事件以后的4个小时以内的承认，和缩短的损害规模(AIS)(或)，3.1；相对风险(RR)，2.15。接收装置操作特征(巨鸟)曲线和Youden索引证明PFP的最佳截止点在51.5%.ConclusionPFP与TBI的严厉被增加，它能也为它的结果作为一个重要独立预言因素被拿。

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简介：AIM:Tocomparethecornealparametersofchildrenwithcongenitalisolatedgrowthhormonedeficiencyandhealthysubjects.METHODS:Inthiscross-sectional,prospectivestudy,50caseswithgrowthhormone(GH)deficiencytreatedwithrecombinantGHand71healthychildrenunderwentacompleteophthalmicexamination.Thecornealhysteresis(CH),cornealresistancefactor(CRF),Goldmann-correlatedintraocularpressure(IOPg)andcorneal-compensatedintraocularpressure(IOPcc)weremeasuredwiththeOcularResponseAnalyzer(ORA).Centralcornealthickness(CCT)wasmeasuredbyaultrasonicpachymeter.RESULTS:Themeanagewas13.0±3.0yearsintheGHdeficiencygroupconsistingof21femalesand29malesand13.4±2.4yearsinthehealthychildrengroupconsistingof41femalesand30males.Therewasnostatisticallysignificantdifferencebetweenthegroupsforgenderorage(Chi-squaretest,P=0.09;independentttest,P=0.28,respectively).ThemeandurationofrecombinantGHtherapywas3.8±2.4yinthestudygroup.ThemeanCH,CRF,IOPgandIOPccvalueswere11.0±2.0,10.9±1.9,15.1±3.3,and15.1±3.2mmHgrespectivelyinthestudygroup.Thesamevalueswere10.7±1.7,10.5±1.7,15.2±3.3,and15.3±3.4mmHgrespectivelyinthecontrolgroup.ThemeanCCTvalueswere555.7±40.6,545.1±32.5μminthestudyandcontrolgroupsrespectively.TherewasnostatisticallysignificantdifferencebetweenthetwogroupsforCH,CRF,IOPg,IOPccmeasurementsorCCTvalues(independentt-test,P=0.315,0.286,0.145,0.747,0.13respectively).CONCLUSION:OurstudysuggeststhatGHdeficiencydoesnothaveaneffectonthecornealparametersandCCTvalues.ThisobservationcouldbebecauseofthedurationbetweenthebeginningofdiseaseandthediagnosisandbeginningofGHtherapy.