ObjectiveTo investigate the effectiveness of rotationplasty in treating osteosarcoma of distal femur in children.MethodsA clinical data of 10 children with osteosarcoma of distal femur treated with rotationplasty between March 2014 and June 2016 was retrospectively analyzed. There were 7 boys and 3 girls with an average age of 6.7 years (range, 4-10 years). There were 4 cases of osteoblastic osteosarcoma, 4 cases of mixed osteosarcoma, and 2 cases of chondroblastic osteosarcoma. All children were staged as Enneking stage ⅡB. The disease duration ranged from 3.5 to 6.0 months (mean, 4.6 months). The lower limb functional scoring system of 1993 Musculoskeletal Tumor Society (MSTS93), Toronto Extremity Salvage Score (TESS), and knee mobility were used to evaluate postoperative function. Tumor recurrence and metastases were monitored by radiograph.ResultsPoor superficial incision healing occurred in 1 patient, and healed after dressing change. The other incisions healed by first intention. All children were followed up 24-72 months (mean, 52.6 months). No local recurrence was observed during follow-up. Three of the ten patients suffered from metastases including 1 dying of multiple organ dysfunction syndrome, 1 alive with tumor, and 1 tumor free survival. Painful callosities and ulcers which related to prosthetic wear occurred in 2 patients and turned up after optimizing prosthetic fit and physiotherapy. The fracture healing time was 2.5-5.0 months (mean, 3.5 months). All children could walk independently at 4 months postoperatively. At last follow-up, the MSTS93 score was 19-25 (mean, 22) and the TESS score was 87-93 (mean, 90). The extension of knee joint mobility with artificial limbs was 0°-10° (mean, 5°), and the flexion of knee joint mobility with artificial limbs was 85°-95° (mean, 90.5°).ConclusionRotationplasty in treating osteosarcoma of distal femur in children with limb salvage difficulties can effectively preserve the limb function and improve the quality of life, and it can be used as an alternative to amputation.
ObjectiveTo observe and analyze the changes of macular choroidal thickness in children with occult high myopia and its influencing factors.MethodsA prospective, non-randomized, contemporaneous controlled trial. From September 2019 to October 2020, 56 children (110 eyes) who first visited the ophthalmic clinic of the Affiliated Hospital of Chengde Medical College without any myopia correction training were enrolled in this study. There were 33 males (64 eyes) and 23 females (46 eyes), with the average age of 8.62±1.87 years old; the age ranged from 6 to 12 years old. According to the clinical manifestations of myopia in children, they were divided into occult high myopia group (27 cases, 52 eyes) and control group (29 cases, 58 eyes). In the 52 eyes of the occult high myopia group, the spherical equivalent refraction (SER) of －0.00 to －1.00 D, ＞－1.00 to －2.00 D, ＞－2.00 to －3.00 D were 15, 16 and 21 eyes. Among 58 eyes in the control group, the SER of －0.00 to －1.00 D, ＞－1.00 to －2.00 D, ＞－2.00 to －3.00 D were 21, 18 and 19 eyes, respectively. The macular fovea within 6 mm was divided into three concentric circles centered on the macular fovea, which included the central area with a diameter of 1 mm, the inner ring area with a diameter of 1-3 mm, and the outer ring area with a diameter of 3-6 mm, totally 9 areas. The inner ring and outer ring were divided into upper, lower, nasal and temporal areas. The changes of choroidal thickness in each macular area of children in occult high myopia group and control group were observed. The choroidal thickness in each macular area was compared between the two groups using independent sample t-test. Pearson correlation analysis was used to analyze the correlation between mean foveal choroidal thickness and gender, age, intraocular pressure, ocular axis, diopter and corneal curvature in occult high myopia group.ResultsChoroidal thickness in macular area of children in occult high myopia group was thinnest in nasal side and thickest in temporal side. Compared with the control group, the mean choroidal thickness in the 9 macular zones of children in the occult high myopia group was significantly thinner than that in the control group, and the difference was statistically significant (P＜0.05). The mean choroidal thickness in each macular region decreased with the increase of diopter in children with occult high myopia. Compared with the control group with the same spherical equivalent, there was no significant difference in the area above the inner ring and the outer ring of the macular fovea in the occult high myopia group of －0.00 to －1.00 D and the temporal side of the inner ring and the outer ring of the macular fovea in the occult high myopia group of ＞－2.00 to －3.00 D (P＞0.05), but there were significant differences among the other regions (P＜0.05). Pearson correlation analysis results showed that the average choroidal thickness of the fovea in children with occult high myopia was negatively correlated with age (r=－3.410, R2=11.630, P=0.010), eye axis (r=1.420, R2=2.016, P=0.030) and diopter (r=－2.680, R2=7.182, P=0.040), but not significantly correlated with gender (r=0.166, R2=0.028, P=0.240), intraocular pressure (r=0.330, R2=0.109, P=0.800) and corneal curvature (r=－0.260, R2=0.068, P=0.850).ConclusionsThe thickness of macular choroidal in children with occult high myopia is the thinnest on the nasal side of the macular fovea and the thickest on the temporal side of the macular fovea. The mean choroidal thickness in each region of the macular is thinner than that in the common myopia children with the same diopter. The mean choroidal thickness of fovea is negatively correlated with age, ocular axis and diopter.
Objective To research whether systemic family therapy is a useful intervention for behavioral problems. Methods Two hundred and seventy six children who were in the fourth grade of elementary school were assessed by family dynamics questionnaires and their parents were tested by Achenbach Child Behavioral Checklist. Fifty-seven children with behavioral problems were divided into two groups: 20 children and their parents agreed to receive systemic therapy for four weeks and 37 children and their parents who refused this therapy formed the control group.All children and their parents were reassessed after four months. Data were analyzed by SPSS 11.5. Results The characteristics of family dymanmic and children’s behavior improved significantly after systemic therapy. The "depressing and hostile family" at mosphere became "harmonious and open" (P=0.000) and this was also significantly better than the control group after therapy(P=0.000). "Self-differentiation of family members" was significantly improved after therapy (P=0.000) and also was significantly better than the control group after therapy (P=0.005). "Patient is helpless victim" changed to "Patient can do something" (P=0.000) and this was significantly better than the control group after therapy (P=0.003) . Total CBCL score decreased in the treatment group after therapy (P=0.003 for father, P=0.000 for mother). Compared with the control group. Total CBCL score also showed decreases (P=0.033 for father, P=0.014 for mother). Conclusions The techniques of systemic family therapy are practical and effective methods to intervene children’s behavioral problems.
PurposeTo analyze the effect of medication withdraw (MW) on long-term electroencephalogram (EEG) monitoring in children who need preoperative assessment for refractory epilepsy.MethodsRetrospective analysis was performed on the data of preoperative long-term EEG monitoring of children with refractory epilepsy who needed preoperative evaluation in the Pediatric Epilepsy Center of Peking University First Hospital from August 2018 to December 2019. Monitoring duration: at least three habitual seizures were detected, or the monitoring duration were as long as 10 days. MW protocol was according to the established plan.ResultsA total of 576 children (median age 4.4 years) required presurgical ictal EEGs, and 75 (75/576, 13.0%) needed MW for ictal EEGs. Among the 75 cases, 38 were male and 37 were female. The age range was from 15 months to 17 years (median age: 7.0 years). EEG and clinical data of with 65 children who strictly obey the MW protocol were analyzed. The total monitoring duration range was from 44.1 h (about 2 days) to 241.8 h (about 10 days)(median: 118.9 h (about 5 days)). Interictal EEG features before MW were including focal interictal epileptiform discharge (IED) in 39 cases (39/65, 60%), focal and generalized IED in 2 cases (2/65, 3.1%), multifocal IED in 20 cases (20/65, 30.7%), multifocal and generalized IED in 2 cases (2/65, 3.1%), and no IED in 2 cases (2/65, 3.1%). After MW, 18 cases (18/65, 27.7%) had no change in IED and the other 47 cases had changes of IED after MW. And IEDs in 46 cases (46/65, 70.8%) were aggravated, and IED was decreased in 1 case. The pattern of aggravated IED was original IED increasement, in 41 cases (41/46, 89.1%), and 5 cases (5 /46, 10.9%) had generalized IED which was not detected before MW. Of the 46 patients with IED exacerbations, 87.3% appeared within 3 days after MW. Habitual seizures were detected in 56 cases (86.2%, 56/65) after MW, and within 3 days of MW in 80.4% cases. Eight patients (14.3%) had secondary bilateral-tonic seizure (BTCS), of which only 1 patient had no BTCS in his habitual seizures. In 56 cases, 94.6% (53/56) had seizures after MW of two kinds of AEDs.Conclusions① In this group, thirteen percent children with intractable epilepsy needed MW to obtain ictal EEG; ② Most of them (86.2%) could obtain ictal EEG by MW. The IED and ictal EEG after MW were still helpful for localization of epileptogenic zone; ③ Most of the patients can obtain ictal EEG within 3 days after MW or after MW of two kinds of AEDs;4. The new secondary generalization was extremely rare.
Objective To assess the methodological quality of pediatric COVID-19 guidelines using the AGREE Ⅱ. Methods Domestic and foreign pediatric COVID-19 guidelines from inception to 1st Oct 2021 were electronically searched in PubMed, CBM, CNKI, VIP, WanFang Data, Medlive, NGC, GIN, and NICE databases and relevant websites. Two researchers independently assessed the methodological quality of the guidelines by using AGREE Ⅱ. Results A total of 21 guidelines were included. The AGREE Ⅱ results revealed that the average scores of included guidelines in 6 domains (scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, and editorial independence) were 62.70%, 36.24%, 20.34%, 50.42%, 22.12% and 53.17%, respectively. ConclusionThe methodological quality of pediatric COVID-19 guidelines is poor. Guideline developers should follow the requirements of AGREE Ⅱ in guideline development.
Objective To formulate an evidence-based treatment plan for a child patient with Asymptomatic Wolff-Parkinson-White (WPW) Syndrome. Methods Based on the clinical problems whether the patients with asymptomatic WPW syndrome need prevent catheter ablation or not, we used “asymptomatic WPW syndrome” as the keywords and searched The Cochrane Library (Issue 3, 2007), MEDLINE (1981 to 2007), ACP Journal Club (1991 to 2007), BMJ Clinical Evidence (1999 to 2007) and NGC (1998 to 2007) for systematic reviews, randomized controlled trials (RCTs), controlled clinical trials and treatment guidelines. The methodological quality of the included studies was assessed to identify the current best evidence. Results Two RCTs were retrieved in MEDLINE. The results showed arrhythmic events increased significantly in the high-risk control group than those in the ablation group, and in the patients with multi-pathways than those with only one pathway. Based on the current evidence, integrated with clinical expertise and the patients’ values, the patients underwent electrophysiologic test and the result showed the dominance pathway in the right side and the concealed accessory pathway in the left side. Then prevent catheter ablation was performed, and no cardiovascular complications occurred in the following 12 months, which confirmed that the plan was proved optimal. Conclusion The findings of this study should reassure physicians and parents alike that in the children with the WPW syndrome who are at high risk for arrhythmias, ablation is an appropriate option.