Streptococcus anginosus group infections in hospitalised children and young people.

AIM: The Streptococcus anginosus group (SAG) comprises three bacterial species colonising the mouth and gastrointestinal and genitourinary tracts and capable of serious pyogenic infections. Although well-described in adults, studies in children are limited. Here, we characterise paediatric SAG infections from a single Australian centre. METHODS: Hospitalised patients aged ≤18 years with positive SAG cultures from January 2009 to December 2019 were identified from Pathology Queensland's Gold Coast Laboratory database and their medical records were reviewed. RESULTS: Two-hundred children (62% male), median age 12 years (interquartile range 6-16), with positive SAG cultures were identified. Overall, 90% received intravenous antibiotics, 89% underwent surgical drainage, 23% were readmitted and 15% required additional surgery. The most common sites were the abdomen (39%), soft tissues (36%) and head and neck regions (21%). Since 2011, Pathology Queensland reported SAG at the species level (n = 133). Of these, S. anginosus was the most prevalent (39%), then S. constellatus (34%) and S. intermedius (27%). Compared with the other two species, S. intermedius was most commonly associated with head and neck infections (relative risk (RR) = 2.2, 95% confidence interval (CI) 1.4-3.5), while S. constellatus (RR = 1.7, 95% CI 1.2-2.4) and S. anginosus (RR = 1.5, 95% CI 1.0-2.0) were each associated with a higher risk of intra-abdominal infection than S. intermedius. Since February 2015, the number of children admitted with SAG-associated intra-abdominal infection per 1000 hospitalisations increased by 29% annually compared with an annual decline of 8% in previous years. CONCLUSIONS: SAG infections occur at various anatomical sites. Despite antibiotics and surgical management, almost one-quarter are re-hospitalised for further treatment.

Thyroid function testing in an inpatient mental health unit.

OBJECTIVE: Thyroid function tests are a common screening investigation for patients admitted to a psychiatric inpatient unit. METHOD: This study aimed to retrospectively assess the clinical utility of routine thyroid function testing performed on newly admitted psychiatric patients over a 4-year period in Victoria, Australia via chart review of all abnormal results identified. RESULTS: Our retrospective audit revealed only two cases where identification of thyroid dysfunction informed patient management. In each case, the patient had a known history of thyroid disease. In this audit period, 893 patients required screening to yield one clinically relevant abnormal result, costing AU$24,975.57. CONCLUSION: Such low clinical utility does not support routine admission thyroid function tests for psychiatric inpatients. We conclude that thyroid function tests should only be performed where the history and clinical signs suggest a likely contribution of thyroid dysfunction to the psychiatric presentation.

Optimization of NaOH Molarity, LUSI Mud/Alkaline Activator, and Na2SiO3/NaOH Ratio to Produce Lightweight Aggregate-Based Geopolymer.

This paper presents the mechanical function and characterization of an artificial lightweight geopolymer aggregate (ALGA) using LUSI (Sidoarjo mud) and alkaline activator as source materials. LUSI stands for LU-Lumpur and SI-Sidoarjo, meaning mud from Sidoarjo which erupted near the Banjarpanji-1 exploration well in Sidoarjo, East Java, Indonesia on 27 May 2006. The effect of NaOH molarity, LUSI mud/Alkaline activator (LM/AA) ratio, and Na2SiO3/NaOH ratio to the ALGA are investigated at a sintering temperature of 950 °C. The results show that the optimum NaOH molarity found in this study is 12 M due to the highest strength (lowest AIV value) of 15.79% with lower water absorption and specific gravity. The optimum LUSI mud/Alkaline activator (LM/AA) ratio of 1.7 and the Na2SiO3/NaOH ratio of 0.4 gives the highest strength with AIV value of 15.42% with specific gravity of 1.10 g/cm3 and water absorption of 4.7%. The major synthesized crystalline phases were identified as sodalite, quartz and albite. Scanning Electron Microscope (SEM) image showed more complete geopolymer matrix which contributes to highest strength of ALGA produced.

Tensile Properties of In Situ 3D Printed Glass Fiber-Reinforced PLA.

A 3D printed composite via the fused filament fabrication (FFF) technique has potential to enhance the mechanical properties of FFF 3D printed parts. The most commonly employed techniques for 3D composite printing (method 1) utilized premixed composite filaments, where the fibers were integrated into thermoplastic materials prior to printing. In the second method (method 2), short fibers and thermoplastic were mixed together within the extruder of a 3D printer to form a composite part. However, no research has been conducted on method 3, which involves embedding short fibers into the printed object during the actual printing process. A novel approach concerning 3D printing in situ fiber-reinforced polymer (FRP) by embedding glass fibers between deposited layers during printing was proposed recently. An experimental investigation has been undertaken to evaluate the tensile behavior of the composites manufactured by the new manufacturing method. Neat polylactic acid (PLA) and three different glass fiber-reinforced polylactic acid (GFPLA) composites with 1.02%, 2.39%, and 4.98% glass fiber contents, respectively, were 3Dprinted. Tensile tests were conducted with five repetitions for each sample. The fracture surfaces of the samples were then observed under scanning electron microscopy (SEM). In addition, the porosities of the 3D printed samples were measured with a image processing software (ImageJ 1.53t). The result shows that the tensile strengths of GFPLA were higher than the neat PLA. The tensile strength of the composites increased from GFPLA-1 (with a 1.02% glass fiber content) to GFPLA-2.4 (with a 2.39% glass fiber content), but drastically dropped at GFPLA-5 (with a 4.98% glass fiber content). However, the tensile strength of GFPLA-5 is still higher than the neat PLA. The fracture surfaces of tensile samples were observed under scanning electron microscopy (SEM). The SEM images showed the average line width of the deposited material increased as glass fiber content increased, while layer height was maintained. The intralayer bond of the deposited filaments improved via the new fiber embedding method. Hence, the porosity area is reduced as glass fiber content increased.

Fly ash-based geopolymer lightweight concrete using foaming agent.

In this paper, we report the results of our investigation on the possibility of producing foam concrete by using a geopolymer system. Class C fly ash was mixed with an alkaline activator solution (a mixture of sodium silicate and NaOH), and foam was added to the geopolymeric mixture to produce lightweight concrete. The NaOH solution was prepared by dilute NaOH pellets with distilled water. The reactives were mixed to produce a homogeneous mixture, which was placed into a 50 mm mold and cured at two different curing temperatures (60 °C and room temperature), for 24 hours. After the curing process, the strengths of the samples were tested on days 1, 7, and 28. The water absorption, porosity, chemical composition, microstructure, XRD and FTIR analyses were studied. The results showed that the sample which was cured at 60 °C (LW2) produced the maximum compressive strength for all tests, (11.03 MPa, 17.59 MPa, and 18.19 MPa) for days 1, 7, and 28, respectively. Also, the water absorption and porosity of LW2 were reduced by 6.78% and 1.22% after 28 days, respectively. The SEM showed that the LW2 sample had a denser matrix than LW1. This was because LW2 was heat cured, which caused the geopolymerization rate to increase, producing a denser matrix. However for LW1, microcracks were present on the surface, which reduced the compressive strength and increased water absorption and porosity.

3D-Printed Fiber-Reinforced Polymer Composites by Fused Deposition Modelling (FDM): Fiber Length and Fiber Implementation Techniques.

Fused Deposition Modelling (FDM) is an actively growing additive manufacturing (AM) technology due to its ability to produce complex shapes in a short time. AM, also known as 3-dimensional printing (3DP), creates the desired shape by adding material, preferably by layering contoured layers on top of each other. The need for low cost, design flexibility and automated manufacturing processes in industry has triggered the development of FDM. However, the mechanical properties of FDM printed parts are still weaker compared to conventionally manufactured products. Numerous studies and research have already been carried out to improve the mechanical properties of FDM printed parts. Reinforce polymer matrix with fiber is one of the possible solutions. Furthermore, reinforcement can enhance the thermal and electrical properties of FDM printed parts. Various types of fibers and manufacturing methods can be adopted to reinforce the polymer matrix for different desired outcomes. This review emphasizes the fiber types and fiber insertion techniques of FDM 3D printed fiber reinforcement polymer composites. A brief overview of fused deposition modelling, polymer sintering and voids formation during FDM printing is provided, followed by the basis of fiber reinforced polymer composites, type of fibers (synthetic fibers vs. natural fibers, continuous vs. discontinuous fiber) and the composites' performance. In addition, three different manufacturing methods of fiber reinforced thermoplastics based on the timing and location of embedding the fibers, namely 'embedding before the printing process (M1)', 'embedding in the nozzle (M2)', and 'embedding on the component (M3)', are also briefly reviewed. The performance of the composites produced by three different methods were then discussed.

Mechanical and Microstructural Evaluations of Lightweight Aggregate Geopolymer Concrete before and after Exposed to Elevated Temperatures.

This paper presents the mechanical and microstructural characteristics of a lightweight aggregate geopolymer concrete (LWAGC) synthesized by the alkali-activation of a fly ash source (FA) before and after being exposed to elevated temperatures, ranging from 100 to 800 °C. The results show that the LWAGC unexposed to the elevated temperatures possesses a good strength-to-weight ratio compared with other LWAGCs available in the published literature. The unexposed LWAGC also shows an excellent strength development versus aging times, up to 365 days. For the exposed LWAGC to the elevated temperatures of 100 to 800 °C, the results illustrate that the concretes gain compressive strength after being exposed to elevated temperatures of 100, 200 and 300 °C. Afterward, the strength of the LWAGC started to deteriorate and decrease after being exposed to elevated temperatures of 400 °C, and up to 800 °C. Based on the mechanical strength results of the exposed LWAGCs to elevated temperatures of 100 °C to 800 °C, the relationship between the exposure temperature and the obtained residual compressive strength is statistically analyzed and achieved. In addition, the microstructure investigation of the unexposed LWAGC shows a good bonding between aggregate and mortar at the interface transition zone (ITZ). However, this bonding is subjected to deterioration as the LWAGC is exposed to elevated temperatures of 400, 600 and 800 °C by increasing the microcrack content and swelling of the unreacted silicates.

Changes in the length and diameter of the normal appendix throughout childhood.

BACKGROUND/AIM: It has been proposed that the narrow diameter of the appendix is important in providing a 'safe zone' for commensal intestinal flora, while the length of the appendix can be variable. This study aimed to investigate the relationship between appendiceal length, diameter and age, in children under the age of eighteen years, to determine if the appendix changes in size with age. METHODS: The histological records of all cases of children undergoing appendicectomy at the Royal Children's Hospital (Melbourne) between 2009 and 2011 were retrospectively reviewed. Participants were excluded on the basis of histological evidence of acute inflammation, and data on the diameter and length of the appendix were collected from 210 children, aged zero to seventeen years. RESULTS: Data were stratified by age for analysis into ≤ 3 years, >3 and ≤ 9, >9 and ≤ 13 and >13 years. Mean diameters per group were 3.7 (± 1.3), 6.3 (± 1.2), 6.7 (± 1.6) and 6.9 (± 1.6) millimetres respectively. Mean lengths per group were 39.7 (± 16.1), 66.3 (± 15.3), 63.7 (± 21.3) and 68.8 (± 18.2) millimetres. Both diameter and length were higher in the older age groups, compared with the ≤ 3 year olds (p < 0.001). A positive correlation was seen between age and appendix diameter (R = 0.5, p < 0.001) and length (R = 0.3, p=0.03) in the ≤ 3 group only. Mean diameter and length values did not differ significantly between groups aged > 3 years old. CONCLUSION: This study showed that following an initial growth period during early infancy up to about 3 years, the appendix achieves its adult proportions and does not continue to grow throughout childhood.

The regulation of testicular descent and the effects of cryptorchidism.

The first half of this review examines the boundary between endocrinology and embryonic development, with the aim of highlighting the way hormones and signaling systems regulate the complex morphological changes to enable the intra-abdominal fetal testes to reach the scrotum. The genitoinguinal ligament, or gubernaculum, first enlarges to hold the testis near the groin, and then it develops limb-bud-like properties and migrates across the pubic region to reach the scrotum. Recent advances show key roles for insulin-like hormone 3 in the first step, with androgen and the genitofemoral nerve involved in the second step. The mammary line may also be involved in initiating the migration. The key events in early postnatal germ cell development are then reviewed because there is mounting evidence for this to be crucial in preventing infertility and malignancy later in life. We review the recent advances in what is known about the etiology of cryptorchidism and summarize the syndromes where a specific molecular cause has been found. Finally, we cover the recent literature on timing of surgery, the issues around acquired cryptorchidism, and the limited role of hormone therapy. We conclude with some observations about the differences between animal models and baby boys with cryptorchidism.

Home transcutaneous electrical stimulation to treat children with slow-transit constipation.

PURPOSE: This study aimed to test the effectiveness of home transcutaneous electrical stimulation (TES) when patients with slow-transit constipation (STC) were trained by a naive clinician. METHODS: A surgeon was trained to teach the TES method to STC children who then self-administered at home (1 hour a day, 3-6 months) using a battery-powered interferential stimulator. Bowel diaries, PedsQL4.0 questionnaires, and radio-nuclear colonic transit studies were completed before and after treatment. RESULTS: Thirty-two children (16 female; mean age, 8.3 years; range, 3-17 years) self-administered 3 to 6 months of TES. Three did not return diaries. Group 1 (n = 13) started with less than 3 bowel actions per week, and group 2 (n = 16), with more than 3 bowel actions per week. Defecation frequency increased in 69% of group 1 (mean, 1.4-3.0 per week; P = .02). Soiling frequency decreased in 50% of group 2 (5.4-1.9 per week, P = .04). Of 13 patients, 7 improved with development of urge-initiated defecation. Abdominal pain decreased in 48% (1.6 episodes per week to 0.9 per week, P = .06). Stool consistency improved in 56%. There was significant improvement in child-reported and parent-reported PedsQL Scores. Colonic transit improved in 13 of 25 patients. CONCLUSION: Home TES provides a new treatment for STC children, with 50% of treatment-resistant patients benefited. Success requires clinician training and close patient contact. Transcutaneous electrical stimulation increased defecation and reduced soiling.

Daily transabdominal electrical stimulation at home increased defecation in children with slow-transit constipation: a pilot study.

PURPOSE: Transcutaneous electrical stimulation (TES) (3 sessions/wk) over the abdomen stimulated bowel functions in a randomized controlled trial. This pilot study assessed whether daily TES at home with a safe, portable machine would be possible and more efficacious than trial results. METHODS: Eleven patients (6 male/5 female; mean age, 14 years; range, 12-18 years) with slow-transit constipation who relapsed or responded poorly in the trial were recruited (11 +/- 5 months later). An EPM-IF-4160 (Fuji Dynamics, Hong Kong) portable machine (sine waveform, 4 kHz carrier frequency, 80-160 Hz beat frequency, intensity <33 mA) delivering interferential current (2 electrodes over epigastrium + 2 over kidneys) was applied 1 hour daily at home. Continence diaries were kept for 1 month before and 2 months during treatment. RESULTS: All children completed more than 1 month of treatment after baseline recording. Defecation increased in 9 of 11 children, and soiling decreased in 4 of 11 children. There was a significant increase in total episodes of defecation per week (mean +/- SD, 2.5 +/- 2.1 vs 6.7 +/- 4.4; P = .008) and a nonsignificant decrease in soiling (3.8 +/- 1.6 vs 1.1 +/- 0.5 episodes/wk, P = .1). Daily stimulation does not affect abdominal pain. No adverse events occurred. CONCLUSIONS: Daily TES at home is safe and significantly improved bowel function in children who did not respond to 3 times per week of TES. Home TES may be a novel treatment of intractable slow transit constipation, avoiding hospital visits.