Systematic Review and Meta-analysis of Histological Gastric Biopsy Aspects According to the Updated Sydney System in Children.

OBJECTIVES: A descriptive and comparative study of gastric histological aspects according to the updated Sydney classification (USC), obtained from Helicobacter pylori-positive versus H pylori-negative children referred for upper gastrointestinal endoscopy. METHODS: The Prisma method was used to perform a systematic review and meta-analysis. Selection criteria were based on following key words USC, H pylori, children, endoscopy, or biopsy. Publication biases were assessed according to the Newcastle-Ottawa Scale, and a meta-regression analysis was done. The study was registered on the PROSPERO platform. RESULTS: Between 1994 and 2017, 1238 references were found; 97 studies were retained for the systematic review with a total number of 25,867 children; 75 studies were selected for the meta-analysis concerning 5990 H pylori-infected and 17,782 uninfected children.H pylori-positive versus H pylori-negative children, according to the USC, showed significantly higher relative risk for gastric antral and corpus chronic inflammation, presence of neutrophils, and of lymphoid follicles, and gastric mucosa atrophy, whereas, intestinal metaplasia showed a significantly higher RR only in antral biopsies. The meta-regression analysis showed that H pylori-positive versus H pylori-negative children had significantly higher risk only for corpus activity according to age, recurrent abdominal pain, and geographical area of low H pylori prevalence. CONCLUSIONS: H pylori infection in children was associated with higher relative risk for gastric antral and corpus chronic inflammation, presence of neutrophils, lymphoid follicles, and rare gastric mucosa atrophy, whereas, rare intestinal metaplasia was only significantly higher in the antral area.

Prediction of clinical height gain from surgical posterior correction of idiopathic scoliosis.

OBJECTIVE: The best predictors of height gain due to surgical correction are the number of fused vertebrae and the degrees of the corrected Cobb angle. Existing studies of predictive models measured the radiographic spinal height and did not report the clinical height gain. The aims of this study were to determine the best predictive factors of clinical height gain before surgical correction, construct a predictive model using patient population data for machine learning, and test the performance of this model on a validation population. METHODS: The authors reviewed 145 medical records of consecutive patients who underwent surgery that included placement of posterior spinal instrumentation and fusion for idiopathic scoliosis between 2012 and 2016. Standing and sitting clinical heights were measured before and after surgery in patients who had been surgically treated under similar conditions. Multivariate analysis was then performed and the results were used to develop a predictive model for height gain after surgery. The data from the included patients were randomly assigned to a learning set or a test set. RESULTS: In total, 116 patients were included in the analysis, for whom the average postoperative clinical height gain in a standing position was 4.2 ± 1.8 cm (range 0-11 cm). The best prediction model was calculated as follows: standing clinical height gain (cm) = 1 - 0.023 × sitting clinical height (cm) - 0.19 × Risser stage + 0.058 × Cobb preoperative angle (°) + 0.021 × T5-12 kyphosis (°) + 0.14 × number of levels fused. In the validation cohort, 91% of the predicted values had an error of less than one-half of the actual height gain. CONCLUSIONS: This predictive model formula for calculating the potential postoperative height gain after surgical treatment can be used preoperatively to inform idiopathic scoliosis patients of what outcomes they may expect from posterior spinal instrumentation and fusion (taking into account the model's uncertainty).

Pain coping strategies in children with cerebral palsy.

AIM: To describe coping strategies in children and adolescents with cerebral palsy (CP), relative to age. METHOD: Patients were prospectively recruited from two paediatric rehabilitation centres in France. The Pediatric Pain Coping Inventory - French and Structured Pain Questionnaire were completed by an experienced professional for each child. RESULTS: One hundred and forty-two children with CP were included (80 males, 62 females; median age 12y; IQR=8-15y). They generally used fewer coping strategies than typically developing children ('Seeks social support and action': 12.47 vs 12.85, p=0.477; 'Cognitive self-instruction': 9.28 vs 10.90, p<0.001; 'Distraction': 4.89 vs 7.00, p<0.001; 'Problem solving': 4.43 vs 5.19, p<0.001). In the CP group, 'Seeks social support and action' decreased with age (p=0.021) and 'Cognitive self-instruction' increased with age (p<0.001). 'Problem solving' and 'Distraction' did not change with age. Coping strategies were influenced by Gross Motor Function Classification System level (p=0.022) and history of surgery (p=0.002). INTERPRETATION: Children with CP generally used fewer coping strategies than typically developing children and tended to rely on social support. Use of active strategies increased with age; however, they appeared later than in typically developing children and were used to a lesser extent. WHAT THIS PAPER ADDS: Children with cerebral palsy (CP) use fewer pain-coping strategies than typically developing children. Children with CP tend to use social support to cope with pain. Children with CP learn more appropriate strategies from previous painful experiences. Active coping strategies appear later but remain underused in children with CP.

ESTRATEGIAS DE AFRONTAMIENTO DEL DOLOR EN NIÑOS CON PARÁLISIS CEREBRAL: OBJETIVO: Describir estrategias de afrontamiento en niños y adolescentes con parálisis cerebral (PC), en relación con la edad. MÉTODO: Los pacientes fueron reclutados prospectivamente de dos centros de rehabilitación pediátrica en Francia. El Inventario de Afrontamiento del Dolor Pediátrico - Cuestionario de Dolor Francés y Estructurado fue completado por un profesional con experiencia para cada niño. RESULTADOS: Se incluyeron 142 niños con PC (80 varones, 62 mujeres; mediana de edad de 12 años; IQR = 8-15 años). En general, los niños con PC utilizaron menos estrategias de afrontamiento que los niños con desarrollo típico ("Busca apoyo social y acción": 12,47 vs 12,85, p = 0,477; "Autoinstrucción cognitiva": 9,28 vs 10,90, p <0,001; "Distracción": 4,89 vs 7,00, p <0,001; "Resolución de problemas": 4,43 vs 5,19, p <0,001). En el grupo de PC, la búsqueda de apoyo y acción social disminuyó con la edad (p = 0,021) y la autoinstrucción cognitiva aumentó con la edad (p <0,001). La "resolución de problemas" y la "distracción" no cambiaron con la edad. Las estrategias de afrontamiento se vieron influenciadas por el nivel del Sistema de Clasificación de la Función Motora Gruesa (p = 0,022) y los antecedentes quirúrgicos (p = 0,002). INTERPRETACIÓN: Los niños con PC generalmente usaron menos estrategias de afrontamiento que los niños con un desarrollo típico y tendían a confiar en el apoyo social. El uso de estrategias activas aumenta con la edad; sin embargo, aparecieron más tarde que en los niños con un desarrollo típico y se utilizaron en menor medida.

ESTRATÉGIAS PARA LIDAR COM A DOR EM CRIANÇAS COM PARALISIA CEREBRAL: OBJETIVO: Descrever estratégias para lidar com a dor em crianças e adolescentes com paralisia cerebral (PC), com relação à sua idade. MÉTODO: Pacientes foram prospectivamente recrutados em dois centros de reabilitação pediátrica na França. O Inventário Pediátrico de Manejo da Dor - Francês e o Questionário Estruturado sobre dor foram completados para cada criança por um profissional com experiência. RESULTADOS: Cento e quarenta e duas crianças com PC foram incluídas (80 do sexo masculino, 62 do sexo feminino; idade mediana 12a; IIQ=8-15a). Elas geralmente usaram menos estratégias para lidar com a dor do que crianças com desenvolvimento típico ('Procura suporte e ação social': 12,47 vs 12,85, p=0=,477; 'Auto-instrução cognitiva': 9,28 vs 10,90, p<0,001; 'Distração: 4,89 vs 7,00, p<0,001; 'Resolução do problema': 4,43 vs 5,19, p<0,001). No grupo com PC, 'Procura suporte e ação social' diminuiu com a idade (p=0,021) e Auto-instrução cognitiva' aumentou com a idade (p<0,001). 'Resolução de problemas' e 'Distração' não mudaram com a idade. As estratégias de manejo da dor foram influenciadas pelo nível do Sistema de Classificação da Função Motora Grossa (p=0,022) e histórico de cirurgia (p=0,002). INTERPRETAÇÃO: Crianças com PC geralmente usam menos estratégias para lidar com a dor do que crianças com desenvolvimento típico, e tendem a depender de suporte social. O uso de estratégias efetivas aumentou com a idade; no entanto, elas aparecem mais tarde do que em crianças com desenvolvimento típico, e são utilizadas em menor escala.

Identification of a Circulating MicroRNA Profile as a Biomarker of Metastatic Cutaneous Melanoma.

No specific biomarkers for prognostication or evaluation of tumour load in melanoma have been reported to our knowledge. MicroRNAs (miRNAs) are strongly implicated in oncogenesis and tumour progression, and their circulating forms have been studied as potential biomarkers in oncology. The aim of this prospective study was to identify a melanoma-specific profile of plasma miRNAs. A screening phase, using RNA microarray, was conducted on plasma from 14 patients with metastatic melanoma and 5 healthy subjects. Selected miRNAs were analysed by RTqPCR in 2 independent training and validation cohorts including, respectively, 29 and 31 patients and 16 and 43 control subjects. A profile of 2 miRNAs (miR-1246 and miR-185) significantly associated with metastatic melanoma with a sensitivity of 90.5% and a specificity of 89.1% was identified. This plasma miRNA profile may become an accurate non-invasive biomarker for melanoma.