Comparison of transcatheter versus surgical closure of perimembranous ventricular septal defect in pediatric patients: A systematic review and meta-analysis

ObjectivePerimembranous ventricular septal defect (pmVSD) is a common congenital heart disease (CHD) usually treated with either catheter or surgical closure. Superiority of one procedure over the other in children is still a matter of debate. We performed this meta-analysis to compare the clinical outcomes and cost of transcatheter and surgical closure of pmVSD in children.Materials and methodsWe searched seven databases (MEDLINE, PubMed, EMBASE, Google Scholar, CENTRAL, CINHAL, and Cochrane library) and literature references for articles published in the past 10 years (between January 2008 and January 2018) comparing closure of pmVSD by both procedures in children. The outcomes of interest were success rate, residual shunt, need for blood transfusion, complications especially complete atrioventricular block, length of hospital stay, and cost.ResultsA total of 1750 articles were identified. However, only five studies fulfilled the inclusion criteria. As regards success rate, no significant difference was found between surgical and catheter closure. Residual shunt was significantly lower in catheter closure than surgical closure [risk ratio (RR) = 0.44; 95% confidence interval (CI), 0.23–0.83, p = 0.01). The need for blood transfusion and the length of hospital stay were significantly lower in the catheter closure compared to surgical closure (RR = 0.02; 95% CI, 0.01–0.08; p < 0.00001), (RR = ?4.81; 95% CI, ?7.76 to ?1.86; p = 0.001), respectively. However, overall complications, complete atrioventricular block, and the cost were comparable in both procedures.ConclusionTranscatheter closure of pmVSD in children was as effective as surgical closure with a lower residual shunt and need for blood transfusion, and shorter hospital stay.     

749例社区获得性肺炎儿童的病原体分布特点

【摘要】目的 探讨南充地区儿童社区获得性肺炎（CAP）的病原学分布特点。方法 选取2017 年 1 月～12 月于南充市中心医院儿科病房住院的749例CAP患儿，根据年龄分为婴儿组(319例)、幼儿组(217例)、学龄前组(154例)、学龄组(59例)，回顾性分析患儿咽深部呼吸道分泌物的细菌培养和呼吸道 11 种病原体IgM抗体血清学检测结果。结果 749例患儿中,310例检出细菌阳性,阳性率41.39%，其中肺炎链球菌82株(26.45%)，大肠埃希菌63株(20.32%)，流感嗜血杆菌39株(12.58%)； 220例检出病毒阳性,阳性率为29.37%，其中IVB208株(65.00%)，IVA41株(12.81%)，PIV39株(12.19%)；102例检出非典型肺炎病原阳性，阳性率13.62%，其中MP74株(62.18%)，CP30株(25.21%)，LP15株(12.60%)；混合病原体检出阳性者有177例，阳性率15.62%，其中细菌、病毒混合感染60例(33.90%)，细菌、非典型肺炎病原体混合感染56例(31.64%)，病毒混合感染30例(16.95%)。结论 肺炎链球菌是南充地区CAP住院患儿的首要细菌病原，IVB是首要病毒病原，MP是首要非典型肺炎病原，混合感染以细菌、病毒混合感染为主。     

Quality of Pulmonary Function Tests in Participants with Down Syndrome

IntroductionPeople with Down syndrome (DS) have high respiratory morbidity, evaluating their respiratory health with standardized, objective tests is desirable. Thus, the objective of this study was to evaluate the technical quality of Pulmonary Function Tests (PFTs) to determine which ones are most suitable for this population.MethodsParticipants included children, teenagers and adults with DS, 5 years of age or older (n = 302). The technical quality of the impulse oscillometry system (IOS), forced spirometry, lung-diffusing capacity for carbon monoxide (DL_CO), and 6-min walk test (6MWT) were analyzed by age group. Capnography and pulse oximetry were included in the study. Technical quality was determined on the basis of current international PFTs standards.ResultsFifty-one percent of participants were males. A total of 184 participants (71%) who completed the IOS fulfilled the quality criteria, while 210 (70%) completed the 6MWT. Performance on forced spirometry and DL_CO was poor. All pulse oximetries and 96% percent heart rates obtained had good quality, but exhaled carbon dioxide (PetCO₂) and respiratory rate (RR) showed deficient repeatability.ConclusionsIOS appears to be the most reliable instrument for evaluating lung mechanics in individuals with DS.     

Short bowel mucosal morphology,proliferation and inflammation at first and repeat STEP procedures

Background

Although serial transverse enteroplasty (STEP) improves function of dilated short bowel, a significant proportion of patients require repeat surgery. To address underlying reasons for unsuccessful STEP, we compared small intestinal mucosal characteristics between initial and repeat STEP procedures in children with short bowel syndrome (SBS).

五岁以下重症肺炎患儿预后的危险因素

目的 探讨五岁以下重症肺炎患儿的临床治疗及影响预后的危险因素，为临床小儿重症肺炎的防治、诊治及预后提供理论依据。方法 收集2016年10月～2018年10月徐州医科大学第二附属医院住院部115例重症肺炎患儿的临床资料，回顾性分析所有患儿的临床资料、并发症及相关治疗，并采用Logistic回归分析其预后的危险因素。 结果 115例重症肺炎患儿中，呼吸性酸中毒42例（36.52%）；低钠血症38例（33.04%）和低钙血症37例（32.17%）；呼吸合胞病毒33例（28.69%）；肺炎克雷伯杆菌11例（9.57%）；胸部X线检查示斑片状阴影105例（91.30%），经治疗无效或加重者，80例行胸部CT检查示肺节段性不张44例（55.00%）。106例患儿出现并发症，其中47.17%患儿出现一种并发症，5283%患儿出现两种及以上并发症，所有患儿均使用抗生素治疗。使用与未使用机械通气患儿的预后比较，差异有统计学意义(P＜0.05)。经单因素分析，入院前病程、转入重症监护室、有基础疾病、有并发症、贫血、电解质酸碱平衡紊乱、低白蛋白的患儿治疗有效率显著降低（P＜0.05）。经多因素Logistic回归分析，入院前病程、转入重症监护室、有基础疾病、有并发症、贫血、电解质酸碱平衡紊乱、低白蛋白均为影响重症肺炎患儿预后的独立危险因素（P＜0.05）。结论 重症肺炎患儿的病情复杂多样，入院前病程、转入重症监护室、基础疾病、并发症、贫血、电解质酸碱平衡紊乱、白蛋白均为影响重症肺炎患儿预后的独立危险因素，应积极治疗，有效给予对症干预，以改善患儿预后，降低患儿病死率。     

The use of augmented toys to facilitate play in school-aged children with visual impairments

BackgroundChildren with visual impairments (VIs) face challenges in social play activities, which limits their opportunities to practice social skills.AimsWe investigated whether augmented toys were effective to facilitate play in 52 children with VIs who attended special schools for students with visual impairments and blindness.Methods and procedures52 children with VIs (mean age: 9.22 years, SD = 2.07) played three times with both an augmented and a non-augmented toy. A Playmobil® knight’s castle was augmented with Radio Frequency Identification (RFID) technology, such that each play figure produced audio feedback during play. The RFID-technology could be activated and deactivated. Social and cognitive aspects of play were coded from video and data were analyzed using multilevel logistics.Outcomes and resultsChildren showed less disengagement and more parallel play, but less cooperative play when they used the augmented versus the non-augmented castle. This pattern persisted after repeated play sessions with both toys.ConclusionsThe addition of sounds to physical toys increased shared attention between children with VIs during the exploration of play materials, yet it interfered with social interaction during peer play.     

Comparison of dynamic occlusal contacts during chewing between children with primary dentition and normal adult females

ObjectiveInvestigation of dynamic occlusal contacts when food particles are being pulverized during chewing is of interest for many researchers and clinicians. However, measurement of dynamic occlusal contacts during chewing is difficult, and differences between children and adults have not been established. The purpose of this study is to test the hypothesis that dynamic occlusal contacts of children differ from those of adult females.Subjectsand methods: Thirteen healthy children (4–6 years of age; mean age 5 years, 7 months) and thirteen adult females (18–26 years of age; mean age 20 years, 7 months) with normal occlusion participated in this study. Occlusal contact area (OCA) was estimated with a developed measurement system combining 3-D digitization of tooth shape with 3-D tracking of mandibular movements (1) during the closing stroke, (2) at the maximum closing position (MCP), and (3) during the opening stroke. OCA at static maximum intercuspation (ICP) was also estimated.ResultsAt the MCP, the children's OCA was less than 76.4% of the contact area seen at the ICP. The timing of maximum OCA in children was shifted more towards the opening stroke compared with adults, and the OCA remained greater during opening in children than adults. The occurrence of the MCP was less stable in children than in adults, both between subjects and within subjects.ConclusionsWe conclude that both the amount of OCA and the pattern of occlusal contacts during the occlusal phase of chewing completely differ between children and adult females.     

单纯性肥胖症学龄儿童肝脏脂肪含量的MRI研究

目的分析学龄儿童单纯性肥胖症的MRI表现及MRS特点,确定其肝脏脂肪的MRI定量评估方法。方法将2015年1月—2016年12月期间临床诊断单纯性肥胖症的学龄儿童52例(男31例,女21例)作为病例组,平均年龄(10.1±1.1)岁。同年龄组[平均年龄(9.8±0.9)岁]的正常健康儿童40例(男22例,女18例)作为对照组。采用SIEMENS 1.5 T Avanto MR设备行MRI和~1H-MRS检查。观察肝实质于同相位、反相位影像上的信号变化;通过~1H-MRS获得肝脏兴趣区的水峰峰值(P_w)、水峰下面积(A_w)、脂峰峰值(P_l)及脂峰下面积(A_l)并计算出脂肪分数(FF)。采用独立样本t检验比较正常儿童和肥胖症患儿间P_w、A_w、P_l、A_l、FF差异;采用单因素方差分析比较轻、中、重度肥胖症患儿间各项指标的差异。并利用受试者操作特征(ROC)曲线评估MRS诊断脂肪肝的敏感度、特异度及准确度。结果肥胖症患儿组于T_1WI反相位影像上信号不同程度减低,而正常组T_1WI同反相位影像信号一致。MRS结果如下:(1)正常组和肥胖症组的P_w、A_w差异无统计学意义(P0.05)。(2)肥胖症患儿P_l、A_l、FF明显高于正常组(均P0.05);其中FF的诊断效能最高,敏感度为100%,特异度为82%,准确度为85%。(3)随着肥胖分级的增加,肥胖患儿的P_l、A_l均增高。结论 T_1WI双回波同反相位技术和MRS是目前定量测量肝脏脂肪含量的有效方法,在前者对脂肪肝做出初步诊断的基础上, MRS可进一步对脂肪肝进行量化分级。