The aim of this retrospective study was to investigate the impact of early postoperative enteral nutrition on the short-term prognosis of neonatal gastric perforation. The 63 neonates were divided into two groups based on enteral nutrition timing: the early enteral nutrition (EEN) group (≤15 days) and the late enteral nutrition (LEN) group (>15 days). The EEN group was additionally matched with the LEN1 group based on closely aligned gestational age (difference ≤6 days), birth weight (difference <250 g), and age of onset (<1 day). Data from the EEN, LEN, and LEN1 groups were compared and analyzed. No significant differences were observed among the groups in baseline characteristics such as gestational age, birth weight, age at hospital admission, cesarean section rate, and so on (p > 0.05). Furthermore, preoperative comorbidities, clinical symptoms, and examination results were not significantly different between the three groups (p > 0.05). However, the time required to achieve total enteral nutrition, the length of hospital stay, and fistula retention time were significantly less in the EEN group compared to the LEN groups (p < 0.05). The EEN group also exhibited a shorter gastrointestinal decompression time than the LEN1 group, but other major postoperative outcome measures were not significantly different. In conclusion, our study suggests that early postoperative enteral nutrition (≤15 days) could reduce the time to total enteral nutrition, length of hospital stay, and fistula retention time, without increasing adverse prognosis rates.
The aim is to investigate the possible advantages and disadvantages of contralateral testicular fixation (CTF) for boys with testicular torsion (TT) by long-term clinical follow-up results. A retrospective cohort study was conducted on TT boys at Children’s Hospital of Chongqing Medical University from September 2005 to December 2020. The baseline characteristics, intraoperative findings, and clinical follow-up results were compared between TT patients underwent orchiopexy with or without CTF, and orchiectomy with or without CTF, respectively. The χ2 test and the Fisher’s Exact test were used to compare dichotomous outcomes, and the Mann-Whitney U test was used to compare continuous outcomes without normal distribution. A total of 140 cases were included in this study. The bell clapper deformity was found in 30.4% of all torsed testes underwent orchiopexy, 16.4% during contralateral testicular exploration, and only 10.9% in bilateral sides. Contralateral testicular volume, adverse events, and paternity rates were comparable between patients underwent orchiopexy with or without CTF, and no subsequent contralateral TT observed during follow-up. However, those patients underwent orchiectomy without CTF had more incidence of scrotal discomfort than those had orchiectomy with CTF (P = 0.027). In addition, one boy suffered subsequent contralateral TT after orchiectomy without CTF. The incidence of bell clapper deformity was lower in this research than that of literature reports. CTF would not induce testicular volume loss, atrophy or scrotal pain. Contralateral testicular discomfort and even subsequent TT could be more easily observed during follow-up in patients without CTF. We still recommend routine surgical fixation of contralateral testicle during surgery.
Neonatal hypoxia–ischemia (HI) is one of the main factors that cause neonatal severe neurologic impairment and death. Shown by a large number of studies, caspase-1 plays a significant effect in diseases such as hypoxic–ischemic brain damage (HIBD) and may be a key component of the protein complex that initiates PANoptosis. VX-765, an inhibitor of caspase-1, exerts a potential neuroprotective effect in traumatic brain injury. However, it is unknown whether the administration of VX-765 has neuroprotective effects on neonatal rats that suffered HIBD, and if so, the underlying mechanisms are also still unknown. In the present study, we found that treatment with VX-765 (50 mg/kg, i.p.) significantly ameliorated the impairment of locomotor coordination functions and myodynamia as well as the spatial learning and memory in neonatal rats subjected with HIBD. These behavior improvements were attributed to VX-765 reducing infarct volumes and neuronal loss in the CA1, CA3 region of hippocampus, and deeper layers of the cortex in HIBD rats. Moreover, the enzyme-linked immunosorbent assay showed that VX-765 obviously decreased the production of neuroinflammatory factors including TNF-α, IL-1β, and IL-6. Importantly, we identified HI promoted PANoptosis activation in vivo and in vitro, and VX-765 obviously suppressed PANoptosis activation. Finally, we demonstrated that VX-765 treatment reversed neuronal injury induced by oxygen–glucose deprivation (OGD). Taken together, these results suggest that VX-765 protects the neurons against damage by suppressing neuroinflammation and PANoptosis activation, thereby improving locomotor coordination and cognitive impairments in neonatal HIBD rats, indicating that VX-765 may be an underlying therapeutic drug for the clinical treatment of hypoxic–ischemic encephalopathy (HIE).
Pulmonary embolism (PE) leads to obstruction of pulmonary circulation, resulting in increased pulmonary vascular resistance, elevated pulmonary arterial pressure, and increased right heart load. In severe cases, it can lead to cardiac decompensation and life-threatening conditions. However, clinical studies on PE in children are limited, with many diagnostic and treatment guidelines derived from adult populations. We retrospectively analyzed the clinical manifestations, risk factors, co-morbidity, and outcomes of PE patients admitted to a large children's hospital in southwest China. A total of 24 children with PE participated, 9 boys (37.5%), aged 0.1–14.6, (median: 8.15 years old). Except for two asymptomatic cases, the duration from symptom onset to the diagnosis of PE varied from 2 to 45 days (median: 12 days). Among these children, 13 (54.2%) patients experienced a delayed diagnosis exceeding 10 days. A total of 7 children died from underlying diseases, and no one met the outcome of recurrent PE or PE-related death. Among the 17 survivors, complete resolution of PE was in 11 (64.7%) children, partial resolution who progressed to chronic PE was in 3 (17.7%) children, and no follow-up computed tomography pulmonary angiography was performed in the remaining 3 (17.7%) children. This study revealed that the majority of pediatric PE cases presented with respiratory symptoms, with a considerable proportion initially misdiagnosed as pneumonia, and emphasized the importance of early recognition and appropriate management strategies in improving outcomes for the affected children. Further research is warranted to elucidate the pathophysiology, refine diagnostic algorithms, and establish standardized treatment protocols tailored to the pediatric population.
This study explored the value of routine transthoracic echocardiography (TTE) combined with two-dimensional speckle tracking echocardiography (2D-STE) for the early evaluation of left ventricular remodeling in the hypertensive immature rabbit model. Twenty-seven New Zealand white rabbits were divided into Group A (sham-operated group), Group B (mild group), and Group C (severe group), with 9 rabbits per group. The hypertension model was constructed using the “two kidneys one clip” method. Changes in left ventricular function and the degree of left ventricular wall thickening were observed by TTE at 1, 4, and 8 weeks after modeling. The global longitudinal strain (GLS-AVG, GLS-A4C, GLS-A2C, and GLS-LAX) of the left ventricle (LV) and the longitudinal strain (LS) of the 18 segments of left ventricular myocardium were analyzed using 2D-STE. Concurrently, LV myocardial tissue was sampled for HE staining and Masson staining. Receiver operating characteristic (ROC) curves were plotted to evaluate the accuracy of 2D-STE parameters in predicting myocardial fibrosis. The model group exhibited varying degrees of left ventricular remodeling. GLS-A4C, GLS-A2C, GLS-LAX, and GLS-AVG in the model group increased at 1 week after modeling (P < 0.01), with LS abnormalities concentrated in the apical segments. GLS-AVG showed a significant positive correlation with both IVSd and CVF (P < 0.01). The area under the curve (AUC) values of GLS-AVG, GLS-A4C, GLS-A2C, and GLS-LAX were 0.850, 0.827, 0.839, and 0.800, respectively. This study demonstrates the promise of TTE combined with 2D-STE for the early and comprehensive evaluation of left ventricular myocardial damage in hypertensive children in the clinical setting.
To provide a new minimally invasive treatment for children with benign thyroid nodules, and to provide clinical data for applying microwave ablation (MWA) to children. A retrospective analysis was conducted on the clinical data of 21 pediatric patients with benign thyroid nodules who underwent ultrasound-guided MWA at the Children's Hospital affiliated with Chongqing Medical University from July 2022 to August 2023. The safety, clinical efficacy, volume reduction ratio and prognostic value of the treatment were evaluated. The participants were followed for at least 4 months (median 7 months, range 4–16 months). The average (range) ablation time for the 21 patients was only(233.90 ± 184.97) (40–660)seconds, with intraoperative bleeding less than 0.5 mL. No complications such as hoarseness, seizures or coughing during drinking water were observed after ablation treatment. All the participants' hormone reflecting thyroid function remained in the normal ranges after treatment. Besides, these hormones at 12 h after surgery and 1 month after surgery were not statistically different from those before surgery. Immediate postoperative ultrasound imaging showed a significant decrease in volume of benign thyroid nodules, the volume of nodules at 1 month postoperatively (M, 1.39), and the volume of nodules at 4 months postoperatively (M, 0.40) significantly smaller than that before surgery (M, 4.94). Ultrasound-guided MWA is a new option for the treatment of benign thyroid nodules in children, with advantages such as minimal invasiveness, good clinical effect, high safety, little damage to thyroid function, short operation time, less intraoperative bleeding, low pain sensation and aesthetic appearance.
Undernutrition in children remains a public health concern. Despite the global efforts to address undernutrition, Lesotho continues to bear the highest burden of childhood undernutrition. The study assessed the anthropometric measurements and dietary intake of children aged 6–24 months. A descriptive cross-sectional study was conducted among 113 mother–child dyads attending clinic visits at Makoanyane Military Hospital (Maseru district); n = 50 and Motebang Hospital (Leribe district); n = 63. A structured sociodemographic and feeding practices questionnaires based on adapted World Health Organization (WHO) questionnaires were used. The usual food consumption was collected using an unquantified food frequency questionnaire. Anthropometric measurements and z scores computation were done as per WHO standard guidelines. Statistics included percentages for categorical variables and means for continuous variables. The percentage of continued breastfeeding was 54.0% in Maseru and 28.6% in Leribe districts. Complementary feeds were introduced at the mean age of 5.3 ± 1.0 (Maseru) and 5.2 ± 1.3 months (Leribe). In Leribe, 84.1% of children were consuming maize porridge every day while in Maseru, 68.0% of children were consuming commercial baby cereal every day. The prevalence of wasting was 10.0% (Maseru) and 20.6% with 14.3% of severe wasting (Leribe). A higher percentage of stunting was observed in Leribe (36.5%) than in Maseru (20.0%) (p < 0.001). The prevalence of moderate and severe stunting was 8.0% and 12.0% in Maseru and 20.6% and 15.9% in Leribe, respectively. The prevalence of stunting is alarmingly high in Leribe. The findings suggest an urgent need to strengthen maternal and child health and nutrition programs to ameliorate feeding practices and nutritional status.
Endocardial temporary pacemakers (TP) are widely used in the treatment of cardiovascular diseases in adults, but their application and clinical experience in the treatment of pediatric cardiovascular cases are relatively limited. This study aims to share the experience of using endocardial TP at a pediatric medical center in China. The study included patients who received their first endocardial TP implantation in the Department of Cardiology at Children's Hospital of Chongqing Medical University, China, from 2016 to 2022. A retrospective analysis of their clinical data was conducted. Our study involved 45 children who underwent endocardial TP implantation. Among these, 25 children (55.56%) converted to sinus rhythm after pacemaker parameter adjustment and the pacemaker was successfully removed; 13 children (28.89%) did not recover sinus rhythm and ultimately required a permanent pacemaker; in 4 cases, the family refused permanent pacemaker implantation; in 1 case, the treatment was abandoned by the family; and 2 children died during hospitalization. Notably, among the 20 children with fulminant myocarditis (FM), 16 children (80.00%) converted to sinus rhythm after pacemaker parameter adjustment and the pacemaker was successfully removed; 3 children (15.00%) ultimately received a permanent pacemaker; and 1 child died during hospitalization. Endocardial TP have shown remarkable efficacy in the treatment of critical heart disease, especially FM.
Due to the lack of studies examining suicide trends and its implications on pediatric populations, this study aimed to address the gap in research and to identify the magnitude and the impact of suicide by exploring trends in suicide among Mississippians from 2012 to 2022. The study uses data from the Mississippi Statistically Automated Health Resource System, which is an online database with data collected from vital statistics. Joinpoint regression models were used to calculate annual percentage change (APC) and average annual percentage change (AAPC) as an indicator of trends. The overall age-adjusted suicide rate increased from 9.4 deaths per 100,000 in 2012 to 10.8 deaths per 100,000 in 2022 for pediatric and adolescent patients aged 15–24 years (14.9% increase). There are upward trends for females (AAPC, 6.33%, 95% CI, −0.82%–16.82%), Blacks (AAPC, 7.72%, 95% CI, 2.19%–16.47%), and other races (AAPC, 7.59%, 95% CI, −0.83%–21.47%). Males had a downward trend from 2015 to 2022 (APC, −1.46%, 95 CI, −14.05%–1.35%). Whites also had a downward trend from 2017 to 2022 (APC, 4.74%, 95% CI, −15.42% to −0.96%). This study identified an overall increase in suicide. However, trends varied by gender, race, and age. Based on the findings, Mississippi needs more initiatives aimed toward equitable prevention of suicide among youth and the implementation of gun control policies. By implementing these measures, Mississippi could tremendously benefit and improve mental health outcomes and reduce suicide within the state.
The purpose of this article is to provide an overview of techniques for evaluating patients with adolescent idiopathic scoliosis (AIS). It encompasses the history, clinical examinations, and diagnostic imaging methods for AIS. These methods include digital radiological examination, EOS® imaging, nuclear medicine, ultrasound, body surface topography techniques such as the Moiré pattern technique, raster stereophotography, and DIERS formetric 4D as well as computed tomography and magnetic resonance imaging (MRI). Traditionally, full-spine standing X-rays have been the standard for diagnosing AIS. High-quality clinical assessments may continue as a reference for assessing other spinal deformities. However, the new diagnostic imaging methods aim to reduce radiation exposure while maintaining image quality and practicality. Emerging technologies demonstrate strong reliability and effectiveness in diagnostic imaging of AlS. These techniques may be beneficial for diagnosing and monitoring AIS and its progression without requiring high levels of radiation exposure. The article is a search and summary of the PubMed electronic database to understand the current and future status of AIS imaging technology, which can not only help to introduce other researchers to the field but also serve as a valuable source for healthcare professionals to study existing methods, develop new ones, or select evaluation strategies.
Ventricular septal defect is the most common congenital heart disease in children. Among them, doubly committed ventricular septal defect (dcVSD) can be accompanied by aortic valve lesions in the early stage due to its particular anatomical structure. With its low self-healing, once diagnosed, it needs to be treated timely. Currently, the interventional treatment of proper femoral vein radiation intervention in the department of cardiology is challenging to operate. The scope of application is small, and dcVSD is mainly treated by extracorporeal bypass and transthoracic occlusion. The indications, surgical experience, and prognosis of surgery are summarized.
Tibial tubercle avulsion fractures (TTAFs) are uncommon injuries in the pediatric population, predominantly affecting children and adolescents who are approaching skeletal maturity and frequently engage in high-energy activities. Despite of their rarity, TTAFs can significantly impact the lives of young individuals involved in sports and other strenuous activities. The mechanism of TTAFs occurrence involves forceful quadriceps contraction against resistance or rapid knee flexion with contracted quadriceps. TTAFs may coincide with other related injuries due to their mechanism of occurrence and commonly present with an abrupt onset of pain, focal soft-tissue swelling and tenderness on palpation. Predisposing factors such as a history of Osgood-Schlatter disease and an extreme body mass index (BMI) could contribute to TTAFs susceptibility. Diagnosis of TTAFs typically relies on X-rays, complemented by computed tomography (CT) and magnetic resonance imaging (MRI) for screening associated injuries and preoperative assessment. While a well-established classification system exists, with the Ogden classification being the most commonly employed, intriguingly, a direct correlation between fracture type and treatment method, as well as the choice of surgical fixation modality, remains elusive. The management of TTAFs encompasses both conservative and surgical approaches, with open reduction internal fixation (ORIF) being the predominant surgical method and the prognosis for this condition is generally favorable. By synthesizing existing knowledge and presenting potential areas of uncertainty, this review aims to offer valuable insights to orthopedic practitioners when they are confronted with this infrequent injury.
Septic arthritis is a serious infectious disease in children. In this study, we retrospectively analyzed the relationship between demographics, laboratory values at presentation, reported symptoms at presentation, joint involvement, and distribution characteristics of pathogenic bacteria in 171 patients during the period of 2012–2022. The results showed that a total of 77 pathogen-positive patients were detected in the 171 patients (culture-positive rate of 45.0%), 15 categories of pathogenic bacteria, and the highest detection rates were 52 cases of Staphylococcus aureus (67.5%), Streptococcus pyogenes in 7 cases (9.1%), and Streptococcus pneumoniae in 5 cases (6.5%). Comparison of these three pathogens revealed that the age of the Staphylococcus aureus and Streptococcus pyogenes groups was significantly older than that of the Streptococcus pneumoniae group (p < 0.05), and that the white blood cell count (WBC) of the Streptococcus pyogenes group was significantly higher than that of the Staphylococcus aureus group (p < 0.05), and that the Streptococcus pyogenes group had a significantly higher procalcitonin (PCT), which was significantly higher in the Streptococcus pneumoniae group (p < 0.05). The results suggest that the pathogenic bacteria of septic arthritis in children are mainly Staphylococcus aureus, Streptococcus pneumoniae infection occurred more commonly in the infant stage, and Staphylococcus aureus and Streptococcus pyogenes were detected frequently in school-age children. Streptococcus pyogenes was found to be more pathogenic than Staphylococcus aureus and Streptococcus pneumoniae.
Treating obesity in children is a significant challenge for modern medicine and a delicate matter at the same time. Although obesity treatment typically involves lifestyle modifications; in particular implementation of a detailed menu and calorie restrictions, when it comes to children, imposing a specific menu can be tough and consequently counterproductive. Therefore, it is advisable to introduce some small single steps and simple rules to lower the risk of obesity without causing unnecessary pressure. This article includes practical advice on how to treat and prevent excessive body weight in children. While primarily aimed at professionals working with children and their parents or guardians—such as teachers, dietitians, and pediatricians—these recommendations can also be adapted for parents and caregivers in various formats to effectively reach and benefit this target group.
Clinical Trial Registration: This study is a retrospective clinical trial and therefore not subject to clinical trial registration requirements.