Development of a Pediatric Fertility Preservation Program: A Report From the Pediatric Initiative Network of the Oncofertility Consortium

Infertility is known to decrease quality of life among adults. In some cases, infertility is caused by medical conditions and/or treatments prescribed in childhood, and using methods to protect or preserve fertility may expand future reproductive possibilities. Structured programs to offer counseling about infertility risk and fertility preservation options are essential in the care of pediatric patients facing fertility-threatening conditions or treatments, yet multiple barriers to program development exist. This report was developed from the institutional experiences of members of the Pediatric Initiative Network of the Oncofertility Consortium, with the intent of providing guidance for health care providers aiming to establish programs at institutions lacking pediatric fertility preservation services. The mechanics of building a fertility preservation program are discussed, including essential team members, target populations, fertility preservation options (both established and experimental), survivorship issues, research opportunities, and ethical considerations. Common barriers to program development and utilization, including low referral rates and financial concerns, are also discussed, and recommendations made for overcoming such barriers.     

角膜塑形镜对近视青少年脉络膜厚度的影响研究

目的随访观察配戴角膜塑形镜及框架眼镜1年的青少年低、中度近视患者,探讨戴镜前后及2组间脉络膜厚度的差异。方法选取-1.00~-6.00 D的252例青少年近视患者,随机分为试验组及对照组,试验组配戴角膜塑形镜,对照组配戴框架眼镜。应用重复测量方差分析、独立样本t检验分析患者治疗1年期间的眼轴,黄斑中心凹及鼻侧、颞侧脉络膜厚度(应用EDI-SD OCT)。结果治疗1年后,试验组患者的眼轴增加明显缓于对照组(低度近视组t=19.071,P<0.001;中度近视组t=19.457,P<0.001);试验组戴镜后各时间点的脉络膜厚度与戴镜前相比均有增厚(P<0.001),低度近视组在戴镜1个月内脉络膜增厚最为明显(P<0.05),1个月后基本趋于稳定(P>0.05),而中度近视组在戴镜3个月内脉络膜增厚最为明显(P<0.05),3个月后基本趋于稳定(P>0.05)。颞侧脉络膜厚度厚于鼻侧。1年后试验组与对照组脉络膜厚度比较差异均有统计学意义(P<0.001)。结论青少年近视患者配戴角膜塑形镜后,眼轴增长变慢,早期脉络膜厚度有不同程度增加,1~3个月后基本保持稳定。     

Giant benign cystosarcoma phylloides in the adolescent female

Cystosarcoma phylloides is an uncommon breast tumor in children. About 30 cases have been reported in girls under the age of 20 years. A case of giant benign cystosarcoma phylloides in a 15-year-old girl is reported. Offprint requests to: N. Gürses     

Transverse plane pelvic rotation in adolescent idiopathic scoliosis: primary or compensatory?

Several studies have suggested that the pelvis is involved in the etiology or pathogenesis of adolescent idiopathic scoliosis (AIS). The purpose of this retrospective, cross-sectional radiographic study is to identify any correlation between the transverse plane rotational position of the pelvis in stance and operative-size idiopathic or congenital scoliosis deformities, using Scheuermann’s kyphosis and isthmic spondylolisthesis patients for comparison. The hypothesis tested was that the direction of transverse pelvic rotation is the same as that for a thoracic scoliosis. As a group, AIS patients had a significant transverse plane pelvic rotation in the same direction as the thoracic curve. When subdivided into the six Lenke curve patterns, this was true for the groups with a major thoracic curve: thoracic (1), double thoracic (2) and double curve patterns (3). It was not true for patterns with a major thoracolumbar/lumbar curve: single thoracolumbar/lumbar (5) and double thoracic-thoracolumbar/lumbar (6). Nor was it true for triple (4) curves. The Lenke 1 and 2 major thoracic curves without compensatory thoracolumbar/lumbar curves did not have the predicted pelvic rotation. All congenital scoliosis patients studied had main thoracic curves and significant transverse plane pelvic rotation in the same direction as the thoracic curve. There was no transverse plane pelvic rotation in the Scheuermann’s kyphosis or isthmic spondylolisthesis patients. We interpret these findings as consistent with a compensatory rotation of the pelvis in the same direction as the main thoracic curve in most patients with a compensatory thoracolumbar/lumbar curve as well as in patients with main thoracic congenital scoliosis.     

Height of girls with adolescent idiopathic scoliosis

In a Finnish population, the standing height of 1500 consecutive female patients aged 9-24 years (mean 13.9 years) with untreated idiopathic scoliosis of at least 10 degrees in their lateral curves was compared with the standing height of average girls. The mean magnitude of the major curves was 29.4 degrees (range 10 degrees-80 degrees), and that of the minor curves 20.3 degrees (range 0 degrees-66 degrees). A formula for the height loss caused by the lateral curves, and that caused by thoracic kyphosis, was derived. The corrected height of the girls with idiopathic scoliosis was highly significantly (P<0.001) greater than the height of average girls at the age of 11-15, and this high level of significance was present at the age of 11-13, even without correcting for the height loss caused by scoliosis. After maturation, the girls with idiopathic scoliosis were not significantly taller than average girls. On average, the magnitude of thoracic kyphosis did not affect the height of patients with scoliosis as compared with the height of normal girls of the same age.     

青少年特发性胸椎侧凸后路凸侧胸廓成形术的并发症分析

目的:探讨青少年特发性胸椎侧凸患者后路凸侧胸廓成形术的并发症发生原因及预防措施。方法:自1999年1月～2006年9月,共有410例青少年特发性胸椎侧凸患者在我科施行脊柱侧凸后路矫形内固定术,同时行同一切口下的凸侧胸廓成形术,男86例,女324例。年龄11～18岁,平均14.7岁。术前剃刀背畸形15°～48°,平均32°。统计并发症发生情况。结果:凸侧胸廓成形的肋骨切除数平均4.2根,术后剃刀背畸形0°～14°,平均6°。无手术死亡病例。24例(5.8%)术中发生壁层胸膜穿孔,6例(1.5%)术后胸腔积液,3例(0.7%)术后气胸,1例(0.2%)术后呼吸困难需间歇性吸氧,34例(8.3%)术后有局部反常呼吸,17例(4.1%)术后诉不同程度的胸壁疼痛,9例(2.2%)诉局部皮肤麻木或感觉减退,3例(0.7%)早期手术的患者术后肋骨残端突出明显,1例(0.2%)皮下血肿,1例(0.2%)皮肤压疮。经相应处理后,患者大多恢复满意。319例平均随访28个月,仅4例仍残留有胸壁皮肤感觉减退。结论:凸侧胸廓成形术是一种安全、有效的改善"剃刀背"畸形的手段。提高手术技巧,术后积极处理,可以减少甚至避免相关并发症的发生。     

Low levels of 25-hydroxy vitamin D are associated with elevated parathyroid hormone in healthy adolescent females

This study aimed to investigate the relationship between 25-hydroxyvitamin D [25(OH)D)] and parathyroid hormone (PTH) levels in adolescent females residing in a northern climate. Concern regarding vitamin D status in this population is due to limited sunlight exposure in northern latitudes, decreased outdoor recreational activities, as well as decreased conversion in black girls from increased skin pigmentation. In this cross-sectional analysis, serum samples were assayed for 25(OH)D using competitive protein binding (CPB) assay and PTH with immuno-radiometric (RIA) procedures. Four hundred postmenarcheal females (12–18 years) residing in northeastern Ohio were recruited. Subjects were excluded if they had a history of bone, kidney, or liver disease, or used medications that affect bone. The primary goal was to determine serum 25(OH)D concentrations in relation to circulating PTH levels in a population of adolescent girls. The Spearman correlation test was used to compare PTH and 25(OH)D. Fit multiple split models were run to determine change in slope of the regression line when 25(OH)D and PTH were plotted. Analysis of variance was determined using modeled means with differences by race and season in the final model. Unadjusted mean serum 25(OH)D and PTH levels were 55.0±30.4 nmol/l and 39.4±20.6 ng/l, respectively. Blacks had lower 25(OH)D and higher PTH compared with non-blacks (P<0.0001), especially during the winter months. Decreasing 25(OH)D was inversely correlated with PTH (r=–0.314) (P<0.0001), and at concentrations of 25(OH)D 90 nmol/l, an increase in PTH was observed. Adolescents are at risk for decreased serum 25(OH)D concentrations, especially black girls. We found that the widely used cutoff for vitamin D deficiency is associated with increasing PTH levels and is below the inflection point for a change in the slope of the regression line. Our results support the need for further research to establish optimal vitamin D status in adolescent girls.     

基于微信的积极心理干预对护士工作倦怠及工作绩效的影响

目的探讨基于微信平台的"三件好事"积极心理干预对在职护士工作倦怠及工作绩效的影响。方法将73名存在工作倦怠症状的在职护士随机分为干预组33名和对照组40名。对照组无干预,干预组接受6个月的基于微信平台的"三件好事"积极心理干预。结果两组工作倦怠的干预效应、时间效应及交互效应具有统计学意义,两组工作奉献、任务绩效及人际促进维度的干预效应和交互效应具有统计学意义(P0.05,P0.01)。结论基于微信平台的"三件好事"积极心理干预有利于改善在职护士的工作倦怠,提升其主观感知的工作绩效。