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Purpose: To report the functional results of our experience and to describe intraoperative findings and complications due to the techniques used in our service. Methods: From January 2018 to December 2022, 27 Pediatric patients aged from 8 to 16 years underwent surgery to treat proximal humerus fractures. Their demographic characteristics were evaluated, as well as their clinical characteristics on admission, type of reduction (closed/open), presence of interposition in open reductions, type of implant, complications, and functional range of movement according to two shoulder functional scores. Results: Mean age was 11.2 years (8–15), there was a predominance of males, who accounted for 70% of the cases, and sports accidents were the cause of injury in 44% of the cases. Anatomical location was balanced between patients, including 55% of physeal fractures and 45% of metaphyseal ones. Overall, 81.5% of patients required open reduction to achieve axis correction, and that 55.5% of fractures were fixed with Kirschner wires, and 44, 4% with elastic titanium nails. Mean QuickDASH score was 0.58 (0–1.7), and Constant score was 9 (3–24). There were no major complications, but 27% of cases subjected to open reduction presented a hypertrophic scar. Conclusion: Surgical treatment of severely displaced proximal humerus fractures is successful, both with closed and open reduction; type of implant does not play a key role and should be selected based on the characteristics of each case. Surgical training should prevail at the time of decision-making. When these recommendations are followed, results can be excellent and sequelae are infrequent. [ABSTRACT FROM AUTHOR]

Background. Whole-body computed tomography (WBCT) is commonly employed for primary screening in pediatric patients experiencing out-of-hospital cardiac arrest (OHCA) without prehospital return of spontaneous circulation (ROSC). This study aimed to evaluate the cause of OHCA on WBCT and compare WBCT findings between ROSC and non-ROSC groups in non-traumatic pediatric OHCA cases in an emergency department setting. Methods. A retrospective analysis was conducted on 27 pediatric patients (mean age: 32.4 months; median age: 10 months) who experienced non-traumatic OHCA without prehospital ROSC and were transported to our tertiary care hospital between January 2013 and December 2023. WBCT scans were performed to investigate the cause of OHCA, with recorded findings in the head, chest, abdomen, and subcutaneous tissues. Results. In all cases, the direct causes of OHCA were undetermined, and WBCT identified no fatal findings. Statistical comparisons of CT findings between the ROSC and non-ROSC groups revealed significant differences. The non-ROSC group had a higher incidence of brain swelling, loss of cerebral gray-white matter differentiation, symmetrical lung consolidation/ground-glass opacity, cardiomegaly, hyperdense aortic walls, narrowed aorta, gas in the mediastinum, and hepatomegaly compared to the ROSC group. Conclusions. Although WBCT did not reveal the direct cause of OHCA, several CT findings were significantly more frequent in the non-ROSC group, including brain swelling, loss of cerebral gray-white matter differentiation, symmetrical lung consolidation/ground-glass opacity, cardiomegaly, hyperdense aortic wall, narrowed aorta, gas in the mediastinum, and hepatomegaly. These findings, resembling postmortem changes, may aid in clinical decision making regarding the continuation or cessation of resuscitation efforts in pediatric OHCA cases. [ABSTRACT FROM AUTHOR]

Copyright of Mersin University School of Medicine Lokman Hekim Journal of History of Medicine & Folk Medicine is the property of Mersin University School of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

We aimed to explore simple and effective clinical parameters or combinations to predict coronary artery dilation and aneurysm formation in pediatric patients with Kawasaki disease (KD). This retrospective cohort study included pediatric patients with KD from January, 2013 to December, 2022. Multiple demographic and clinical data were collected, collated, and calculated from the medical records. Then they were divided into the coronary artery dilation and aneurysm formation group or the non-coronary artery dilation and aneurysm formation group. Lymphocyte-C-reactive protein ratio (LCR) was transformed into its natural logarithm and expressed as lnLCR. A total of 64 pediatric patients with KD were enrolled in this cohort study after 1:3 propensity score matching (PSM). For each unit increase in lnLCR, the possibility of coronary artery dilation and aneurysm formation decreased to 0.419 times the original value. The areas under the receiver operating characteristic (ROC) curves of lnLCR combined with albumin (ALB), ALB, and lnLCR to classify pediatric patients with KD into the coronary artery dilation and aneurysm formation group were 0.781, 0.692, and 0.743, respectively. LCR combined with ALB upon admission is a promising predictor of coronary artery dilation and aneurysm formation in pediatric patients with KD. [ABSTRACT FROM AUTHOR]

This study investigated the occurrence and dynamics of oral Staphylococcus species in patients with orofacial clefts undergoing surgical rehabilitation treatment. Patients (n = 59) were statistically stratified and analyzed (age, gender, types of orofacial clefts, surgical history, and types of previous surgical rehabilitation). Salivary samples were obtained between hospitalization and the return to the specialized medical center. Microbiological diagnosis was performed by classical methods, and MALDI-TOF MS. MRSA strains (SCCmec type II, III, and IV) were characterized by the Decision Tree method. A total of 33 (55.9%) patients showed oral staphylococcal colonization in one, two, or three sampling steps. A high prevalence has been reported for S. aureus (including HA-, MRSA and CA-MRSA), followed by S. saprophyticus, S. epidermidis, S. sciuri, S. haemolyticus, S. lentus, S. arlettae, and S. warneri. The dynamics of oral colonization throughout surgical treatment and medical follow-up may be influenced by (i) imbalances in staphylococcal maintenance, (ii) efficiency of surgical asepsis or break of the aseptic chain, (iii) staphylococcal neocolonization in newly rehabilitated anatomical oral sites, and (iv) total or partial maintenance of staphylococcal species. The highly frequent clinical periodicity in specialized medical and dental centers may contribute to the acquisition of MRSA in these patients. [ABSTRACT FROM AUTHOR]

This study aims to explore the diagnostic potential of blood lipid profiles in suspected ventilator-associated pneumonia (VAP). Early detection of VAP remains challenging for clinicians due to subjective clinical criteria and the limited effectiveness of current diagnostic tests. Blood samples from 20 patients, with ages between 6 months and 15 years, were collected at days 1, 3, 6, and 12, and an untargeted lipidomics analysis was performed using a Ultra high Pressure Liquid Chromatography hyphenated with High Resolution Mass Spectrometry UPLC-HRMS (TIMS-TOF/MS) platform. Patients were stratified based on modified pediatric clinical pulmonary index score (mCPIS) into high (mCPIS ≥ 6, n = 12) and low (mCPIS < 6, n = 8) VAP suspicion groups. With the untargeted lipid profiling, we were able to identify 144 lipid species from different lipid groups such as glycerophospholipids, glycerolipids, and sphingolipids, in the blood of children with VAP. Multivariate and univariate statistical analyses revealed a distinct distribution of blood lipid profiles between the studied groups, indicating the potential utility of lipid biomarkers in discriminating VAP presence. Additionally, specific lipids were associated with pharyngeal culture results, notably the presence of Klebsiella pneumoniae and Staphylococcus aureus, underscoring the importance of lipid profiling in identifying the microbial etiology of VAP. [ABSTRACT FROM AUTHOR]

Background: Virtual reality (VR) refers to a computer-generated simulation or environment that can be experienced and interacted with by a person through special electronic equipment, such as a headset with a screen and motion-tracking sensors. VR has been used as a distraction technique to alleviate pain and discomfort during medical procedures or as an alternative to traditional pain medication. This article explores VR’s effectiveness in reducing pain in pediatric patients undergoing painful clinical procedures. Methodology: This systematic review and meta-analysis was performed as per the preferred reporting item for systematic review and meta-analysis guidelines. A systematic literature search was conducted for all articles published till December 2022 in four different databases: PubMed, Scopus, Embase, and LILACS, which yielded 6886 studies. Studies showing the effect of VR on pediatric patients undergoing clinical procedures were included in the study. Risk of bias (ROB) 2.0 was used to assess the ROB. Outcome data were pooled using a random-effects model and reported as standardized mean difference (SMD) with a 95% confidence interval (CI). The meta-analysis was performed on RevMan5.4. Subgroup analysis was done for the different clinical procedures. Results: A total of 2477 participants from 34 studies were included in the meta-analysis. Children in whom VR was used had a significantly lower pain score as compared to the control group with an SMD of 0.87 (CI 95% −1.20, −0.53; (P < 0.00001). Subgroup analysis based on the type of intervention did not reveal any significant difference (P = 0.19). Heterogeneity for overall pain using a random effect model with I2 was significant (P < 0.00001). Conclusion: This systematic review suggests that the use of VR distraction in children undergoing painful procedures is associated with significantly lower pain scores. Hence, VR can be a promising intervention for reducing pain experienced by pediatric patients during medical procedures.

Nonoperating room regional anesthesia (NORRA) involves providing regional anesthesia in environments other than the standard operating rooms, such as in intensive care units, emergency departments, or interventional radiology suites. Although regional anesthesia is well-documented for its benefits in perioperative care, its application in nonoperating room environments remains limited. We conducted a narrative literature review using various databases such as PubMed, Embase, Medline, Ovid, PMC, and Google Scholar. Our search strategy involved using different combinations of terms associated with regional anesthesia, nonoperating room anesthesia, intensive care units, and pediatric patients. Regional anesthesia offers significant benefits for pediatric patients, such as reducing the need for opioids and enhancing autonomic, metabolic, and immunological responses. Techniques used in NORRA include central neuraxial blocks, peripheral nerve blocks, and topical anesthesia, with common anesthetic agents being lidocaine, bupivacaine, and eutectic mixture of local anesthetic cream. This review investigates the applications, indications, challenges, and future prospects of NORRA in pediatric patients.

Background: Severe aplastic anemia (SAA) associated with Down syndrome (DS) is a rare hematological disease with only a few cases reported in the literature. The efficacy of standard therapy with either allogeneic hematopoietic stem cell transplantation or immunosuppressive therapy (IST) has not been well studied in patients with DS and AA. Romiplostim, a thrombopoietin receptor agonist, has shown promising results in the treatment of SAA refractory to IST. Case report: We describe a 7-year-old child with DS with severe transfusion-dependent thrombocytopenia. She was diagnosed with SAA based on bone marrow biopsy findings of low cellularity (10 %). As a matched sibling donor was not available, she was started on romiplostim, on which she had a trilineage hematopoietic response. By seven days after the first dose of romiplostim, she became transfusion independent. Conclusion: Our case is the first reported case on the successful treatment of AA with romiplostim in a child with DS. The report supports that romiplostim could be considered for patients lacking a matched sibling donor. Further studies are needed to provide more understanding of long-term remission and the optimal duration of treatment.

Although rarely diagnosed in the pediatric population, deep vein thrombosis (DVT) is experiencing a growing incidence, while continuously acquiring different nuances due to the widening range of risk factors and lifestyle changes in children and adolescents.

Abstract Background Diagnosing non-gestational uterine choriocarcinoma in children is challenging because of its rarity and nonspecific imaging findings. Herein, we report a case of non-gestational uterine choriocarcinoma in a child, which was unexpectedly found during exploratory laparotomy and confirmed by histopathological findings. However, the tumor did not respond to chemotherapy. Case presentation A 4-year-old Indonesian female patient was brought into the emergency unit with chief complaint of vaginal bleeding. She had suffered from vaginal spotting 4 months before being admitted to the hospital. Physical examination revealed a distended abdomen in the left lumbar region and a palpable fixed mass with a smooth surface. Abdominal computed tomography scans revealed a large mass (10 × 6 × 12 cm) with fluid density and calcification. Thus, we suspected left ovarian teratoma. The patient’s luteinizing hormone, follicle-stimulating hormone, and lactate dehydrogenase levels were 25.2 mIU/ml, 0.1 mIU/ml, and 406 U/l, respectively. According to the clinical and radiological findings, we decided to perform an exploratory laparotomy and found a tumor originating from the uterus, not the ovarium. We did not observe liver nodules and any enlargement of abdominal lymph nodes. Subsequently, we performed hysterectomy. The histopathological findings supported the diagnosis of choriocarcinoma. The patient was discharged uneventfully on postoperative day 5. Thereafter, the patient underwent nine cycles of chemotherapy, including carboplatin (600 mg/m2 IV), etoposide (120 mg/m2 IV), and bleomycin (15 mg/m2 IV). However, on the basis of the clinical findings of a palpable mass and partial intestinal obstruction, the tumor relapsed soon after the ninth cycle of chemotherapy. Currently, the patient is undergoing chemotherapy again. Conclusions Although pure non-gestational uterine choriocarcinoma is rare, it should be considered as one of the differential diagnoses for intraabdominal tumors in a child, so as to better guide and counsel families regarding the surgical plan and prognosis, respectively. In the present case, the patient’s response to chemotherapy was poor, implying that the treatment of non-gestational choriocarcinoma is still challenging, particularly in the pediatric population.

Objective: Trauma is a leading cause of morbidity and mortality in children. One in every four patients with trauma has abdominal trauma. Abdominal trauma is the third leading cause of death associated with trauma. Mortality increases in patients with inflammation because of the body's reaction to trauma. The systemic immune-inflammation index (SIII) is a test indicative of body inflammation based on complete blood count alone. Index value may indicate prognosis of pediatric patients with blunt abdominal trauma. Materials and Methods: The present study was designed as a retrospective, single-center research. The study included pediatric patients with isolated blunt abdominal trauma who were admitted to the emergency department between June 01, 2021 and June 01, 2022 and met the inclusion criteria. Patient demographic data; medical history; leukocytes, platelet, and neutrophil count; SIII; and outcome status were captured in the case form. Results: The study included 103 patients, of whom 64.1% were male and the mean age was 7.32±5.12 years. Mortality was noted in 6.8% of the patients included in the study. The sensitivity and specificity for a cut-off value of 890.47×103/L SIII were 95.7% and 62.5%, respectively (area under the curve: 0.832; 95% confidence interval: 0.820-0.944, p<0.003), in pediatric patients with blunt abdominal trauma. Conclusion: High SIII scores, a rapid, inexpensive, reliable, and radiation-free test, could be used as a predictor of mortality in pediatric patients admitted to the emergency department with blunt abdominal trauma. [ABSTRACT FROM AUTHOR]

Background: Diagnosing non-gestational uterine choriocarcinoma in children is challenging because of its rarity and nonspecific imaging findings. Herein, we report a case of non-gestational uterine choriocarcinoma in a child, which was unexpectedly found during exploratory laparotomy and confirmed by histopathological findings. However, the tumor did not respond to chemotherapy. Case presentation: A 4-year-old Indonesian female patient was brought into the emergency unit with chief complaint of vaginal bleeding. She had suffered from vaginal spotting 4 months before being admitted to the hospital. Physical examination revealed a distended abdomen in the left lumbar region and a palpable fixed mass with a smooth surface. Abdominal computed tomography scans revealed a large mass (10 × 6 × 12 cm) with fluid density and calcification. Thus, we suspected left ovarian teratoma. The patient's luteinizing hormone, follicle-stimulating hormone, and lactate dehydrogenase levels were 25.2 mIU/ml, 0.1 mIU/ml, and 406 U/l, respectively. According to the clinical and radiological findings, we decided to perform an exploratory laparotomy and found a tumor originating from the uterus, not the ovarium. We did not observe liver nodules and any enlargement of abdominal lymph nodes. Subsequently, we performed hysterectomy. The histopathological findings supported the diagnosis of choriocarcinoma. The patient was discharged uneventfully on postoperative day 5. Thereafter, the patient underwent nine cycles of chemotherapy, including carboplatin (600 mg/m2 IV), etoposide (120 mg/m2 IV), and bleomycin (15 mg/m2 IV). However, on the basis of the clinical findings of a palpable mass and partial intestinal obstruction, the tumor relapsed soon after the ninth cycle of chemotherapy. Currently, the patient is undergoing chemotherapy again. Conclusions: Although pure non-gestational uterine choriocarcinoma is rare, it should be considered as one of the differential diagnoses for intraabdominal tumors in a child, so as to better guide and counsel families regarding the surgical plan and prognosis, respectively. In the present case, the patient's response to chemotherapy was poor, implying that the treatment of non-gestational choriocarcinoma is still challenging, particularly in the pediatric population. [ABSTRACT FROM AUTHOR]

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background/Objectives: The tongue harbors about two-thirds of the microorganisms present in the mouth; the stable bacterial population consists mainly of aerobic and facultative anaerobic streptococci. These bacterial colonies, found more frequently on the tongue than on the outside of the hard part of the dental enamel in children younger than 18 months, suggest that the tongue is a potential bacterial reservoir. The aim of this review is to examine the scientific literature to clarify whether the mechanical removal of bacterial biofilm on the tongue can have a positive effect on caries prevention, with the reduction in colony-forming unit (CFU) of salivary streptococcus and the whole-mouth plaque index (FMPS). Methods: An open literature search was conducted by using PubMed (MEDLINE), Cochrane Library and Google Scholar. The most studied age range was 9 to 12 years, with groups of children with no caries and groups with a minimum number of two teeth that were reconstructed, decayed and/or missing (DMFS/dmfs > 2) who experienced different tongue hygiene methods for the first time. Results: Four randomized trials met the search criteria and were included in this review. Conclusions: The results obtained suggest that specific tongue hygiene protocols, combined with a healthy diet and lifestyle, could be considered the gold standard to enable more effective primary prevention and improve the health of pediatric patients. This review improves the understanding of the impact of tongue hygiene in controlling the bacteria responsible for the onset of carious disease and its systemic correlates; however, further research with more data is needed to further confirm the findings of this research. [ABSTRACT FROM AUTHOR]

Chen Bai, Mingcan Xu, Yan Guo, Yanwu Jin, Xin Zhao Department of Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of ChinaCorrespondence: Yanwu Jin; Xin Zhao, Department of Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, No. 247, Beiyuan Road, Jinan, Shandong, 250033, People’s Republic of China, Email jinyanwu_aa@163.com; lujnzx@sohu.comAbstract: Remimazolam is a novel ultrashort-acting benzodiazepine that allosterically modulates γ-aminobutyric acid type A (GABAA) receptors to exert sedative effects. Remimazolam has the properties of controllable sedation, rapid onset, and a short duration of action, along with minor depression of circulation and respiration. Remimazolam has been approved for clinical use since 2020 in Japan, and it has been applied for procedural sedation, general anesthesia induction and maintenance, and sedation in ICU patients, and has been proven to be safe and effective. Currently, no consensus has been reached on the clinical application of remimazolam in pediatric patients. This review introduces the clinical research progress and limitations of remimazolam in recent years, aiming to supply scientific guidance and a theoretical reference for the application of remimazolam in pediatric anaesthesia.Keywords: remimazolam, sedation, pediatric patient, clinical anesthesia

Purpose: This study aims to underscore the rarity of intraorbital hydatid disease caused by Echinococcus granulosus, emphasizing the importance of comprehensive exploration and documentation for effective management. Observations: Clinical presentations include proptosis, visual deterioration, ocular motility disruptions, and chemosis. A case study of an 8-year-old boy with a retroorbital hydatid cyst successfully resected through a right transcaruncular orbitotomy approach is presented, highlighting surgical complexities and the efficacy of pre and post-operative albendazole therapy. Conclusion and Importance: The successful excision and management of the intraorbital hydatid cyst underscore the significance of accurate diagnosis and precise surgical intervention. This case emphasizes the importance of expanding knowledge about this rare manifestation, contributing to enhanced diagnostic and treatment strategies for optimal outcomes in managing global health concerns.

Background: The most common cause of obstructive sleep apnea syndrome (OSAS) in the pediatric age group is adenotonsillar hypertrophy. In our study, we aimed to investigate inflammatory changes in blood parameters in patients who underwent adenotonsillectomy due to upper respiratory tract obstruction. Materials and Methods: 50 patients who were operated on due to adenotonsillar hypertrophy, who applied to the outpatient clinic with a complaint of witnessed apnea, were retrospectively examined. Complete blood count (CBC) parameters of the patients before surgery and at the 6th month postoperative follow-up were evaluated. In our study, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), mean platelet volume (MPV), the ratio of WBC to MPV (WMR), red blood cell distribution width (RDW), platelet distribution width (PDW). The changes in ) values after surgery were examined. Results: The study was conducted with a total of 50 cases, 36% (n=18) of which were girls and 64% (n=32) were boys. The ages of the cases ranged between 5 and 13, and the average age was 9.28±2.53. In our study, the decrease in WMR, MPV, and NLR measurements after surgery was found to be statistically significant (p<0.01). Additionally, the decrease in PDW measurements was found to be statistically significant (p<0.05). RDW and PLR measurement changes in our study do not show a statistically significant difference (p>0.05). Conclusions: This study showed that prothrombotic values improved after adenotonsillectomy in patients with upper airway obstruction due to adenotonsillar hypertrophy. Our results demonstrate the effectiveness and necessity of surgery in patients with upper airway obstruction. [ABSTRACT FROM AUTHOR]

The Apple Watch™ (AW) offers heart rate (HR) tracking by photoplethysmography (PPG) and single-lead electrocardiographic (ECG) recordings. The accuracy of AW-HR and diagnostic performance of AW-ECGs among children during both sinus rhythm and arrhythmias have not been explored. The purposes of this study were to assess the accuracy of AW-HR measurements compared to gold standard modalities in children during sinus rhythm and arrhythmias and to identify non–sinus rhythms using AW-ECGs. Subjects ≤18 years wore an AW during (1) telemetry admission, (2) electrophysiological study (EPS), or (3) exercise stress test (EST). AW-HRs were compared to gold standard modality values. Recorded AW-ECGs were reviewed by 3 blinded pediatric electrophysiologists. Eighty subjects (median age 13 years; interquartile range 1.0–16.0 years; 50% female) wore AW (telemetry 41% [n = 33]; EPS 34% [n = 27]; EST 25% [n = 20]). A total of 1090 AW-HR measurements were compared to time-synchronized gold standard modality HR values. Intraclass correlation coefficient (ICC) was high 0.99 (0.98–0.99) for AW-HR during sinus rhythm compared to gold standard modalities. ICC was poor comparing AW-HR to gold standard modality HR in tachyarrhythmias (ICC 0.24–0.27) due to systematic undercounting of AW-HR values. A total of 126 AW-ECGs were reviewed. Identification of non–sinus rhythm by AW-ECG showed sensitivity of 89%–96% and specificity of 78%–87%. We found high levels of agreement for AW-HR values with gold standard modalities during sinus rhythm and poor agreement during tachyarrhythmias, likely due to hemodynamic effects of tachyarrhythmias on PPG-based measurements. AW-ECGs had good sensitivity and moderate specificity in identification of non–sinus rhythm in children. [ABSTRACT FROM AUTHOR]

Background and Objectives: Assess the quality of life of children aged 2–10 with mild to moderate bronchial asthma. To evaluate the general health condition of children with mild and moderate severity bronchial asthma. To determine health changes in children with mild- and moderate-severity bronchial asthma as they grow older. To evaluate the impact of mild- and moderate-severity bronchial asthma on children's daily and social activities, physical health, emotional state, and general well-being. Materials and Methods: A comparative cross-sectional study was conducted in March–June 2020. Parents or guardians of 2–10-year-old children without bronchial asthma and children with mild to moderate bronchial asthma were interviewed after receiving their written informed consent. The questionnaire was based on the standardized quality-of-life quiz SF-36. A total of 248 questionnaires were collected—106 from the parents or guardians of children with bronchial asthma and 142 from parents/guardians of children without bronchial asthma. For further analysis, 106 children without bronchial asthma and with no chronic conditions were selected. Quantitative variables were compared using the Mann–Whitney U test and qualitative data using the chi-square (χ2) criteria. Quantitative data were described by giving means, medians, and standard deviations (SD); qualitative features by giving relative frequencies. Statistical data were analyzed using SPSS and Excel 2020. Results: Children with mild and moderate asthma exhibit poorer health compared to their healthy counterparts. Only 20.7% of respondents with asthma reported excellent or very good health, contrasting with 64.1% of healthy children (p < 0.001). As children with asthma age, their general condition improves, with 46.2% showing improvement in the past year, while 42.5% of healthy children had a stable condition (p < 0.05). In various activities, children with asthma face more constraints than healthy children (p < 0.05), including energetic activities (sick—59.5%; healthy—10.3%), moderate activities (sick—24.5%; healthy—4.7%), climbing stairs (sick—22.7%; healthy—3.8%), and walking over 100 m (sick—9.4%; healthy—0%). Children with asthma are more likely to experience exhaustion, anxiety, tiredness, lack of energy, and restraint in public activities (p < 0.05). Conclusions: Parents/caregivers of children with mild to moderate bronchial asthma rate their health worse than those of healthy children do. As children with mild to moderate bronchial asthma grow, the disease impact on their overall well-being decreases. Children with mild to moderate bronchial asthma, compared to healthy children, experience more limitations in vigorous or moderate activities; face more difficulties climbing stairs or walking more than 100 m; frequently feel exhaustion, anxiety, fatigue, or lack of energy; and encounter restrictions in social activities. [ABSTRACT FROM AUTHOR]

Background: Carbapenem-resistant Klebsiella pneumoniae (CRKP) clinical isolations have rapidly increased in pediatric patients. To investigate a possible health care-associated infections of CRKP in a tertiary pediatric hospital, the circulating clones and carbapenem-resistant pattern between CRKP and carbapenem-resistant Acinetobacter baumannii (CRAB) isolates were compared to classify their epidemiological characteristics. The results will help to identify the epidemic pattern of the CRKP transmission in the hospital. Methods: Ninety-six CRKP and forty-eight CRAB isolates were collected in Kunming Children's Hospital from 2019 through 2022. These isolates were genotyped using repetitive extragenic palindromic-PCR (REP-PCR). Carbapenemase phenotypic and genetic characterization were investigated using a disk diffusion test and singleplex PCR, respectively. In addition, these characteristics of the two pathogens were compared. Conclusions: These CRKP isolates exhibited different biological and genetic characteristics with dynamic changes, suggesting widespread communities. Continuous epidemiological surveillance and multicenter research should be carried out to strengthen the prevention and control of infections. [ABSTRACT FROM AUTHOR]

Purpose: Interleukin-10 receptor (IL-10R) deficiency can result in life-threatening very early-onset inflammatory bowel disease (VEO-IBD). Umbilical cord blood transplantation (UCBT) is a curative therapy for patients with IL-10R deficiency. This study aimed to investigate the efficacy of UCBT in treating IL-10R deficiency and develop a predictive model based on pre-transplant factors. Methods: Eighty patients with IL-10R deficiency who underwent UCBT between July 2015 and April 2023 were retrospectively analyzed. Cox proportional hazards regression and random survival forest were used to develop a predictive model. Results: Median age at transplant was 13.0 months (interquartile range [IQR], 8.8–25.3 months). With a median follow-up time of 29.4 months (IQR, 3.2–57.1 months), the overall survival (OS) rate was 65.0% (95% confidence interval [CI], 55.3%–76.3%). The engraftment rate was 85% (95% CI, 77%–93%). The cumulative incidences of acute and chronic graft-versus-host disease were 48.2% (95% CI, 37.1%–59.4%) and 12.2% (95% CI, 4.7%–19.8%), respectively. VEO-IBD-associated clinical symptoms were resolved in all survivors. The multivariate analysis showed that IL-6 and stool occult blood were independent prognostic risk factors. The multivariate Cox proportional hazards regression model with stool occult blood, length- or height-for-age Z-score, medical history of sepsis, and cord blood total nucleated cells showed good discrimination ability, with a bootstrap concordance index of 0.767–0.775 in predicting OS. Conclusion: Better inflammation control before transplantation and higher cord blood total nucleated cell levels can improve patient prognosis. The nomogram can successfully predict OS in patients with IL-10R deficiency undergoing UCBT. [ABSTRACT FROM AUTHOR]

Copyright of Selcuk Dental Journal is the property of Selcuk Dental Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background. Whole-body computed tomography (WBCT) is commonly employed for primary screening in pediatric patients experiencing out-of-hospital cardiac arrest (OHCA) without prehospital return of spontaneous circulation (ROSC). This study aimed to evaluate the cause of OHCA on WBCT and compare WBCT findings between ROSC and non-ROSC groups in non-traumatic pediatric OHCA cases in an emergency department setting. Methods. A retrospective analysis was conducted on 27 pediatric patients (mean age: 32.4 months; median age: 10 months) who experienced non-traumatic OHCA without prehospital ROSC and were transported to our tertiary care hospital between January 2013 and December 2023. WBCT scans were performed to investigate the cause of OHCA, with recorded findings in the head, chest, abdomen, and subcutaneous tissues. Results. In all cases, the direct causes of OHCA were undetermined, and WBCT identified no fatal findings. Statistical comparisons of CT findings between the ROSC and non-ROSC groups revealed significant differences. The non-ROSC group had a higher incidence of brain swelling, loss of cerebral gray-white matter differentiation, symmetrical lung consolidation/ground-glass opacity, cardiomegaly, hyperdense aortic walls, narrowed aorta, gas in the mediastinum, and hepatomegaly compared to the ROSC group. Conclusions. Although WBCT did not reveal the direct cause of OHCA, several CT findings were significantly more frequent in the non-ROSC group, including brain swelling, loss of cerebral gray-white matter differentiation, symmetrical lung consolidation/ground-glass opacity, cardiomegaly, hyperdense aortic wall, narrowed aorta, gas in the mediastinum, and hepatomegaly. These findings, resembling postmortem changes, may aid in clinical decision making regarding the continuation or cessation of resuscitation efforts in pediatric OHCA cases.

This study investigated the occurrence and dynamics of oral Staphylococcus species in patients with orofacial clefts undergoing surgical rehabilitation treatment. Patients (n = 59) were statistically stratified and analyzed (age, gender, types of orofacial clefts, surgical history, and types of previous surgical rehabilitation). Salivary samples were obtained between hospitalization and the return to the specialized medical center. Microbiological diagnosis was performed by classical methods, and MALDI-TOF MS. MRSA strains (SCCmec type II, III, and IV) were characterized by the Decision Tree method. A total of 33 (55.9%) patients showed oral staphylococcal colonization in one, two, or three sampling steps. A high prevalence has been reported for S. aureus (including HA-, MRSA and CA-MRSA), followed by S. saprophyticus, S. epidermidis, S. sciuri, S. haemolyticus, S. lentus, S. arlettae, and S. warneri. The dynamics of oral colonization throughout surgical treatment and medical follow-up may be influenced by (i) imbalances in staphylococcal maintenance, (ii) efficiency of surgical asepsis or break of the aseptic chain, (iii) staphylococcal neocolonization in newly rehabilitated anatomical oral sites, and (iv) total or partial maintenance of staphylococcal species. The highly frequent clinical periodicity in specialized medical and dental centers may contribute to the acquisition of MRSA in these patients.

We present a low-cost and easily accessible adaptation system to perform stereotactic procedures in infants. We used an adaptive device consisting of a headband with a plaster bandage, cotton bandage roll, and gauze bandages. Prior to its clinical application, the device was tested in our neuroscience laboratory using a simulation model of a size similar to that of a 5-month-old infant, during which no complications arose. The headband cast technique was subsequently reproduced in a 5-month-old patient, serving as a fixation point for the placement of a Micromar frame for biopsy of a thalamic lesion. A stereotactic biopsy was successfully performed in a 5-month-old patient using a headband cast to secure the stereotactic frame. This method enabled precise targeting of the selected site, resulting in a histopathological diagnosis without any associated complications. The adaptive device is safe, easily accessible, and reproducible, facilitating the performance of stereotactic diagnostic procedures in infants, accurately reaching the planned objective without causing injuries or additional complications. [ABSTRACT FROM AUTHOR]

Methemoglobinemia occasionally causes cyanosis particularly in congenital methemoglobinemia. Avoidance of exposure to oxidizing agents is important for patients with congenital methemoglobinemia because of their deficient enzymatic pathways and decreased oxygen-carrying capacity. Here, we present a pediatric patient with preoperatively undiagnosed congenital methemoglobinemia who underwent catheterization with probably diagnosis of pulmonar hypertension under general anesthesia. The pediatric patient was a 10-year-old who displayed a low pulse oximetry reading of 92% prior to induction of anesthesia. Methemoglobinemia was first suspected intraoperatively because of a mismatch of SpO2 of finger pulse oximetry and SaO2 of arterial blood, and was later confirmed by multiplewavelength CO-oximetry. The pathophysiology, etiology, clinical manifestations, anesthetic considerations, and treatment options of methemoglobinemia are discussed. [ABSTRACT FROM AUTHOR]

Background: Upper cervical chordoma (UCC) is a rare disease, and although transoral approaches are the methods of choice, minimally invasive techniques have not been established. Method: We report the successful use of endoscopic transoral surgery for upper cervical chordoma at the C1–3 levels in the midline epidural space in an 8-year-old girl who presented with neck pain and quadriplegia. Three months after occipitocervical posterior fixation, endoscopic transoral surgery was performed and the tumor was nearly totally removed. Conclusion: Endoscopic transoral surgery in pediatric patients with UCCs is a minimally invasive and safe technique. [ABSTRACT FROM AUTHOR]

Granular cell tumor (GCT) is an uncommon benign neoplasm derived from Schwann cells, frequently affecting the oral cavity, skin, and gastrointestinal tract. On microscopy, pseudocarcinomatous squamous hyperplasia (PSH) and perineural involvement are potential diagnostic pitfalls. GCT should be differentiated from non-neural GCT (NN-GCT). A 13-year-old male patient was referred presenting a nodular lesion on the upper lip several months ago. After excisional biopsy, microscopy revealed GCT without PSH but presenting multifocal perineural involvement. By immunohistochemistry, ALK was negative, whereas Rb and INI1 expression was intact. Moreover, with few intraoral NN-GCTs being assessed, recent studies suggest that acquired dermal NN-GCT subgroup seems to correspond to ALK-rearranged variants of epithelioid fibrous histiocytoma. Accordingly, further research on this topic is strongly encouraged. [ABSTRACT FROM AUTHOR]

Multiple endocrine neoplasia 2B (MEN2B) is a rare syndrome with prevalence estimated at approximately 0.2 per 100,000; it is caused by mutation of the RET proto-oncogene. MEN2B is characterized by early-onset medullary thyroid carcinoma (MTC), ganglioneuromatosis of the aerodigestive tract, marfanoid habitus, ophthalmologic abnormalities, and pheochromocytoma in adulthood. Mutations in the RyR1 gene manifest clinically in congenital myopathies and/or malignant hyperthermia susceptibility. We present a case of a 4-year-old boy with an accidentally detected RET and RyR1 mutations in the course of diagnostic approach of short stature and delayed motor development. Due to a poor and blurred clinical picture of MEN2B syndrome, accompanied by RyR1 mutation symptoms, the diagnostic path was extended. Our patient had no family history of MTC. In the imaging studies of the thyroid gland, no abnormalities were found, whereas the serum level of calcitonin was elevated to 34 pg/mL (N < 5.0). The patient qualified for total thyroidectomy, and the histopathological examination confirmed the diagnosis of MTC. The postoperative serum calcitonin level dropped to normal ranges. This case shows how new genetic diagnostic procedures could be crucial in accidentally diagnosing rare endocrine disease with atypical symptoms, giving an opportunity for relatively early intervention. [ABSTRACT FROM AUTHOR]

Introduction: Ovarian torsion is a rare gynecological surgical emergency. It typically occurs with a sudden onset of unilateral lower abdominal pain. However, ovarian torsion with epigastric or periumbilical pain in pediatric patients has not been thoroughly reported. Case presentation: A 7-year-old girl presented with a 2-day history of frequent vomiting and acute abdominal pain. The abdominal pain was mild, intermittent, and extended from the epigastric to the umbilical region. Physical examination revealed localized tenderness in the epigastric to the umbilical region. No abnormal findings were observed on abdominal or pelvic ultrasonography. Contrast-enhanced computed tomography (CT) of the abdomen revealed no bowel obstruction, free air, appendicitis, pancreatitis, urinary tract stones, large cysts, masses in the uterus, uterine adnexa, or aorta or mesenteric artery abnormalities. Frequent vomiting and mild epigastric pain improved gradually from day 5 of hospitalization. However, on day 7, the abdominal pain and vomiting recurred and moved from the epigastric region to the middle of the lower abdomen and persisted. Finally, the abdominal pain moved to the right lower quadrant and worsened. Abdominal and pelvic ultrasound and Magnetic Resonance Imaging (MRI) performed on day 11 revealed right ovarian torsion. An elective oophorectomy was performed to remove the right ovary. Her postoperative period was good. Conclusion: This case highlights the need to consider ovarian torsion as a differential diagnosis of epigastric pain in pediatric patients.

Coronavirus disease-2019-associated pediatric multisystem inflammatory disease has been defined as a severe disease that causes fever, abdominal pain, hypotension, and myocardial dysfunction in children with severe acute respiratory syndrome-coronavirus-2 infection. However, some multiple systemic inflammatory syndrome (MIS-C) cases progress to multi-organ failure requiring intensive care follow-up. In the patient who had severe abdominal pain, vomiting and high fever and was diagnosed with acute appendicitis in the emergency room, the diagnosis of MIS-C was considered during the follow-up, and parasitic infestation, which is one of the rare etiological causes of acute appendicitis, was detected.

Portal hypertension is a frequent syndrome characterized by an increased portal pressure gradient. The relevance of portal hypertension derives from the frequency and severity of its complications. Rectal varicose is relatively common in portal hypertension patients with meager bleeding rates; However, rectal variceal bleeding is a complicated and sometimes life-threatening condition. The management of rectal variceal bleeding has yet to be adequately established. Endoscopy, surgery, or transjugular intrahepatic portosystemic shunt placement (TIPS) can be performed in patients with gastrointestinal bleeding secondary to portal hypertension due to different etiologies.We present a successful case of direct abdominal percutaneous embolization of multiple and tortuous superior rectal varicose via the inferior mesenteric vein in a 7-year-old female patient with refractory rectal variceal bleeding, not susceptible to endoscopic, surgical, or TIPS management.

Vascular injuries in paediatric patients, though infrequent, pose significant risks and challenges due to the scarcity of literature and the unique characteristics of the paediatric vascular tree. Trauma and iatrogenic causes, such as the inadvertent radial artery injury detailed in this case, are identified as primary culprits. The small calibre of paediatric vessels complicates diagnosis, and distinguishing true injuries from vasospasm is challenging, with potential consequences like thrombosis and limb-length discrepancies. This case underscores the importance of heightened awareness during routine procedures, especially in immunocompromised children or those on steroids, as even seemingly simple actions like surgical dressing can lead to catastrophic complications. The discussion emphasizes the lack of consensus in managing paediatric vascular injuries and explores repair techniques, postoperative care considerations, and the role of heparin therapy in preventing thrombosis. The presented case aims to raise awareness about the gravity of such complications and the need for vigilant care in paediatric patients with underlying health issues. [ABSTRACT FROM AUTHOR]

This study aims to explore the diagnostic potential of blood lipid profiles in suspected ventilator-associated pneumonia (VAP). Early detection of VAP remains challenging for clinicians due to subjective clinical criteria and the limited effectiveness of current diagnostic tests. Blood samples from 20 patients, with ages between 6 months and 15 years, were collected at days 1, 3, 6, and 12, and an untargeted lipidomics analysis was performed using a Ultra high Pressure Liquid Chromatography hyphenated with High Resolution Mass Spectrometry UPLC-HRMS (TIMS-TOF/MS) platform. Patients were stratified based on modified pediatric clinical pulmonary index score (mCPIS) into high (mCPIS ≥ 6, n = 12) and low (mCPIS < 6, n = 8) VAP suspicion groups. With the untargeted lipid profiling, we were able to identify 144 lipid species from different lipid groups such as glycerophospholipids, glycerolipids, and sphingolipids, in the blood of children with VAP. Multivariate and univariate statistical analyses revealed a distinct distribution of blood lipid profiles between the studied groups, indicating the potential utility of lipid biomarkers in discriminating VAP presence. Additionally, specific lipids were associated with pharyngeal culture results, notably the presence of Klebsiella pneumoniae and Staphylococcus aureus, underscoring the importance of lipid profiling in identifying the microbial etiology of VAP.

Background/Objectives: The tongue harbors about two-thirds of the microorganisms present in the mouth; the stable bacterial population consists mainly of aerobic and facultative anaerobic streptococci. These bacterial colonies, found more frequently on the tongue than on the outside of the hard part of the dental enamel in children younger than 18 months, suggest that the tongue is a potential bacterial reservoir. The aim of this review is to examine the scientific literature to clarify whether the mechanical removal of bacterial biofilm on the tongue can have a positive effect on caries prevention, with the reduction in colony-forming unit (CFU) of salivary streptococcus and the whole-mouth plaque index (FMPS). Methods: An open literature search was conducted by using PubMed (MEDLINE), Cochrane Library and Google Scholar. The most studied age range was 9 to 12 years, with groups of children with no caries and groups with a minimum number of two teeth that were reconstructed, decayed and/or missing (DMFS/dmfs > 2) who experienced different tongue hygiene methods for the first time. Results: Four randomized trials met the search criteria and were included in this review. Conclusions: The results obtained suggest that specific tongue hygiene protocols, combined with a healthy diet and lifestyle, could be considered the gold standard to enable more effective primary prevention and improve the health of pediatric patients. This review improves the understanding of the impact of tongue hygiene in controlling the bacteria responsible for the onset of carious disease and its systemic correlates; however, further research with more data is needed to further confirm the findings of this research.

Abstract Background Angioimmunoblastic T-cell lymphoma is an uncommon subtype of peripheral T-cell lymphoma in children with fewer than 20 cases reported in literature. Case presentation A 3-year-old Omani boy was diagnosed with ataxia–talengectasia presenting with fever and generalized lymphadenopathy. His biopsy revealed atypical lymphocytic infiltrate consistent with the diagnosis of angioimmunoblastic T-cell lymphoma. Within 3 weeks from the initial presentation and without any neoadjuvant therapy, he showed complete recovery of symptoms with absence of fever and regression of all previously affected lymph nodes. He has remained in remission ever since. Conclusion This is the first report of spontaneous improvement of angioimmunoblastic T-cell lymphoma in a patient with ataxia–telangiectasia who was 3 years old at presentation. Owing to the paucity of similar cases, this report adds valuable diagnostic, therapeutic, and monitoring data.

Backgroud/purpose: The prevalence of carious lesions and traumatic injury in individuals between ages 6 and 12 is high. This study aimed to characterize pediatric patients aged 6–12 treated in the endodontic clinic and investigate the prevalence and patterns of their provided endodontic treatments. Materials and methods: Clinical and radiographic records of patients (ages 6–12) referred to the postgraduate Endodontics clinic from June 2017 to June 2020 were reviewed. Demographics, pre-and post-operative conditions, type of endodontic treatment, and behavioral management were collected. Results: A total of 6350 teeth from 6089 patients were treated in this period, and 425 teeth (6.7%) from 405 patients were included. Ages 9–11 were the most commonly treated age group. Significantly more lower molars (41.9%) and upper anterior teeth (36.7%) were treated (P

To evaluate the efficacy of incisional ropivacaine infiltration by presternal multi-orifice catheter to manage poststernotomy pain in pediatric cardiac surgery. A prospective, randomized, and double-blind comparative study. At a single-institution tertiary referral cardiac center. The study comprised 200 children undergoing cardiac surgeries through a midline sternotomy. Children were allocated randomly to 1 of 3 groups. Group A (n = 65) and group B (n = 64) received 0.375% ropivacaine infusion and intermittent bolus, respectively, by presternal multi-orifice catheter, whereas Group C (n = 64) did not receive any local anesthetic (LA) drug. Postoperatively, intravenous paracetamol was used for multimodal analgesia, and fentanyl was given as rescue analgesia, respectively. Pain was assessed by a Modified Objective Pain Score (MOPS) for 48 hours postextubation. Group B had significantly lower early MOPS at the first hour, but in the later period, the mean MOPS was lower in group A. The requirement of the first rescue analgesia was 3 ± 1.51, 6.1 ± 2.26, and 2.6 ± 0.87 hours for groups A (n = 60), B (n = 60), and C (n = 60), respectively. The 48-hour fentanyl consumption was significantly lower (p < 0.001) in group A (0.5 ± 0.68 µg/kg) and group B (0.7 ± 0.86 µg/kg) than the control group (3.4 ± 0.68 µg/kg). The length of intensive care unit stay was lower (p < 0.001) in groups A and B than in group C; however, the length of hospital stay was comparable (p = 0.07). LA bolus and infusion through presternal multi-orifice catheter provided effective analgesia postoperatively. However, the bolus was more efficacious in the early phase but equivalent in later periods. Therefore, bolus and LA infusion can be used for steady poststernotomy pain relief in children undergoing cardiac surgeries. [ABSTRACT FROM AUTHOR]

Objectives: To develop a scoring system based on independent predictors of the need for ventriculoperitoneal (VP) shunt after brain tumor resection in pediatric patients. Methods: A total of 416 pediatric patients (≤ 14 years old) with brain tumors who underwent surgery were randomly assigned to the training (n = 333) and validation cohorts (n = 83). Based on the implementation of VP shunt, the training cohort was divided into the VP shunt group (n = 35) and the non-VP shunt group (n = 298). Univariate and multivariate logistic analyses were performed. A scoring system was developed based on clinical characteristics and operative data, and scores and corresponding risks were calculated. Results: Age < 3 (p = 0.010, odds ratio [OR] = 3.162), blood loss (BL) (p = 0.005, OR = 1.300), midline tumor location (p < 0.001, OR = 5.750), preoperative hydrocephalus (p = 0.001, OR = 7.044), and total resection (p = 0.025, OR = 0.284) were identified as independent predictors. The area under the curve (AUC) of the scoring system was higher than those of age < 3, BL, midline tumor location, preoperative hydrocephalus, and total resection (0.859 vs. 0.598, 0.717, 0.725, 0.705, and 0.555, respectively; p < 0.001). Furthermore, the scoring system showed good performance in the validation cohort (AUC = 0.971). The cutoff value for predictive scores was 5.5 points, which categorized patients into low risk (0-5 points) and high risk (6-14 points) groups. Conclusions: Our scoring system, integrating age < 3, BL, midline tumor location, preoperative hydrocephalus, and total resection, provides a practical evaluation. Scores ranging from 6 to 14 points indicate high risk. [ABSTRACT FROM AUTHOR]

Buccal foams containing omeprazole (OME) have been developed as potential drug delivery systems for individuals encountering swallowing difficulties, particularly pediatric and geriatric patients. The buccal foams were formulated from lyophilized aqueous gels of maltodextrin, used as a sweetener, combined with various polymers (alginate, chitosan, gelatin, tragacanth) to fine tune their structural, mechanical, and physicochemical properties. Consistent with the requirements for efficient drug delivery across buccal epithelium, the foam comprised of hydroxypropyl methylcellulose and alginate (HPMC-Alg-OME), exhibited moderate hardness and high mucoadhesion resulting to prolonged residence and increased transport of the active across porcine epithelium. The HPMC-Alg-OME foam induced a 30-fold increase in the drug's apparent permeability across porcine buccal tissue, compared to the drug suspension. The developed buccal foams exhibited excellent stability, as evidenced by the unchanged omeprazole content even after six months of storage under ambient conditions (20 °C and 45% RH). Results indicate that buccal foams of omeprazole may address the stability and ease of administration issues related to oral administration of the drug, particularly for children and elderly patients who have difficulty swallowing solid dosage forms. [Display omitted] • Development of an easy-to-administer buccal foam of omeprazole for patients with swallowing difficulties. • The foam significantly increased omeprazole's permeability across buccal tissue compared to the drug suspension. • Buccal foams of omeprazole address stability and administration challenges for children and elderly patients. [ABSTRACT FROM AUTHOR]

Background: The coagulation system is more complicated in younger infants because the hemostatic system is not completely mature before 6 months. There is confusion among pediatricians to choose conventional coagulation tests and thromboelastography (TEG) to evaluate coagulation function for infants in major surgery. This study was undertaken to perform a comparison between the two methods for pediatric patients who underwent cardiopulmonary bypass (CPB) surgery. Methods: Infant patients who underwent CPB surgery were divided into two groups - younger group (age < 6 months old, n = 72) and older group (age from 6 months old to 12 years old, n = 76). Prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), and fibrinogen (Fib) of conventional coagulation tests and reaction time (R-time), speed of fibrin building up (ɑ-Angle), clot conformation time (K-time), maximum colt amplitude (MA) of TEG results before and after CPB, as well as increasing or decreasing rate of all the values after CPB, were compared between the two groups. Postoperative transfusion details were summarized. Results: PT, APTT, R-time, and K-time markedly increased (p < 0.05) and Fib, ɑ-Angle, and MA decreased (p < 0.05) after CPB in both groups. The younger group had a much higher rate of postoperative transfusion with suspended red cells (54.17% vs. 17.11%), fresh frozen plasma (29.17% vs. 9.21%), cryoprecipitate (9.72% vs. 1.32%), and apheresis platelet (5.56% vs. 0) than the older group. Increasing rate of R-time and K-time and decreasing rate of ɑ-Angle and MA after CPB in the younger group were significantly higher than that in the older group (p < 0.01), whereas no significant differences were observed in conventional coagulation tests (p > 0.2). Conclusions: TEG was more sensitive than conventional coagulation tests in response to variation of coagulation function for younger infants after major surgery. [ABSTRACT FROM AUTHOR]

Introduction: Microtia reconstruction with autologous costal cartilage framework grafting is challenging because the three-dimensional structure of the ear is highly complex, and meeting the high aesthetic demands of patients can be difficult. If the skin flap overlying the framework is thinned to achieve a smooth and accentuated outline, a poor blood supply in the thin skin flap may lead to skin necrosis, exposure of the framework, and poor surgical results. Hyperbaric oxygen (HBO2 ) therapy can promote the healing of complex wounds and flaps. This study sought to determine the effectiveness of HBO2 therapy for the prevention of postoperative complications after framework grafting in microtia reconstruction. Methods: We retrospectively evaluated postoperative complications and compared outcomes in pediatric patients who underwent costal cartilage grafting for microtia reconstruction at our institution between 2011 and 2015, according to whether or not they received postoperative HBO2 therapy. HBO2 therapy was applied once daily for a total of 10 sessions starting on the first postoperative day. Results: During the study period, eight patients received HBO2 therapy after costal cartilage grafting, and 12 did not. There was no significant difference in the incidence of postoperative ulcers. However, the incidence of framework exposure was lower, and the healing time was shorter in patients who received HBO2 therapy than in those who did not. Discussion: HBO2 therapy can be used safely in pediatric patients to reduce postoperative complications and improve the aesthetic outcome of microtia reconstruction. After costal cartilage grafting, HBO2 therapy should be considered as adjuvant therapy. [ABSTRACT FROM AUTHOR]

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