Static Plantar Pressure under Different Conditions in Children with Surgically Treated Unilateral Slipped Capital Femoral Epiphysis.

BACKGROUND: Slipped capital femoral epiphysis (SCFE) is the most common hip disease during infancy and adolescence. Our study aimed to analyze static plantar pressure in children with surgically treated unilateral SCFE. METHODS: Twenty-two children with right SCFE with in situ fixation with one percutaneous screw were assessed by PoData plantar pressure analysis under three different conditions (open eyes, eyes closed, and head retroflexed). RESULTS: The total foot loading was significantly higher on the unaffected limb compared with the affected one for all the three testing conditions (p < 0.05). When assessing the differences between testing conditions, there were no significant differences for the right and left foot loadings, or for the three sites of weight distribution, except for the right fifth metatarsal head (lower loading in eyes-closed condition in comparison to eyes open, p = 0.0068), left fifth metatarsal head (increased loading in head-retroflexed condition in comparison to eyes open, p = 0.0209), and left heel (lower loading in head-retroflexed condition in comparison to eyes open, p = 0.0293). CONCLUSION: Even after a successful surgical procedure, differences in foot loading can impact the postural static activities in different conditions (natural eyes-open, eyes-closed, or head-retroflexed posture).

Small Scale, High Precision: Robotic Surgery in Neonatal and Pediatric Patients-A Narrative Review.

This narrative review explores the evolution and implications of robotic-assisted surgery in pediatric and neonatal cases, focusing on its advantages, drawbacks, and the specific diseases amenable to this innovative technology. Following PRISMA guidelines, 56 relevant articles from the past five years were selected, emphasizing advancements in precision, reduced trauma, and expedited recovery times for pediatric patients. Despite challenges like cost and training, ongoing research shapes pediatric robotic-assisted surgery, promising improved outcomes. The technology's benefits include enhanced precision, minimized scarring, and faster recovery, addressing the challenges in delicate pediatric procedures. Challenges encompass cost, training, and instrument design, but ongoing refinements aim to overcome these. This review underscores psychological and musculoskeletal considerations for patients and surgeons. While acknowledging limitations and preferred pathologies, this review outlines the transformative potential of robotic-assisted surgery in reshaping pediatric surgical care. This comprehensive assessment concludes that, despite challenges, ongoing advancements promise a future of enhanced precision and tailored care in pediatric surgery.

Cystic Echinococcosis in Hospitalized Children from Western Romania: A 25-Year Retrospective Study.

Cystic echinococcosis (CE) is a cosmopolitan parasitic disease caused by Echinococcus granulosus. We aimed to assess the epidemiological aspects of the disease in hospitalized children from Western Romania, a well-known endemic area for CE. We retrospectively investigated the medical records of children hospitalized between 1998 and 2022. A total of 144 patients were included, and 58.3% were from rural areas. The number of cases increased with age, from 9% in the age group 3-5 years to 59.7% in the age group 11-17 years. The liver was more frequently affected (65.3%), and a significant association between gender and the affected organ was noted; liver cysts were more frequently diagnosed in girls, while lung cysts were recorded mostly in boys. Complications were more frequently reported in patients with pulmonary CE compared to hepatic CE (p = 0.04). Boys had more complications (16/23, 69.6%) compared to girls (7/23, 30.4%) (p = 0.03). A third of the children were hospitalized for more than 14 days, and multiple hospitalizations were recorded in 31.3% of the patients. This paper provides new insights into the epidemiologic features of cystic echinococcosis in children from Western Romania. Our findings indicate that exposure to the parasite starts in childhood, and the rate of hospitalization increases with age. Public health strategies should be implemented and permanently improved in order to lower the prevalence of CE in children.

Case Report of a Unique Intra-Operative Finding in a Pediatric Distal Radius Non-Union: Does This Shed Light on Other Non-Unions or Malunions in Children?

Non-unions are quite rare in closed fractures in children. Most distal radius fractures require orthopedic reduction and conservative treatment with very good radiological and clinical/functional results. In case of unsatisfactory reduction, surgical treatment is necessary to correct significant displacement. Surgical treatment consists of closed reduction and percutaneous fixation using K-wires. If closed reduction is not possible, open reduction and fixation is mandatory. Generally, fixation is obtained using K-wires, in most cases, even if open reduction is necessary, rarely locking plates, especially in adolescents. The present paper presents a case of non-union that eventually required open reduction and plating. During surgery, however, it became evident that the cause for non-union was the traumatic transposition of the long extensor radialis tendon, through the fracture site to the volar side of the distal forearm. The movement of the carpus translated to constant mobility in the fracture site, leading to non-union and a continuous tendency towards anterior angulation of the distal fragment. The tendon was reduced to its anatomical position, the fracture was reduced, and fixed using a locking plate, and union was achieved with no complications. Traumatic transpositions of tendons should be considered in pediatric non-unions, and restoring anatomy is essential.

Does COVID-19 Infection during Pregnancy Increase the Appearance of Congenital Gastrointestinal Malformations in Neonates?

BACKGROUND: COVID-19 was an infection that was capable of bringing the entire world to a standstill position within a period of days to months. Despite the advancements in the medical sector, the contagion was difficult to control and costed the lives of millions of people worldwide. Many short- and long-term effects are witnessed even to date in people that contracted the disease. Pregnant females had to suffer not only the devastating effects of the virus, but also the psycho-social impact of the lockdown. The impact of COVID-19 infection during pregnancy causing decreased antenatal care or hypoxemic episodes due to severe respiratory distress and whether it could lead to the appearance of congenital gastrointestinal malformation in neonates is still unclear. The aim of our study was to analyze if COVID-19 infection during pregnancy could increase the incidence of gastric malformations in neonates born from these women. MATERIALS AND METHODS: We sifted the files of all neonates admitted into our hospital between January 2022 and December 2022, and based on inclusion and exclusion criteria, we included the cases having gastrointestinal congenital malformations during the COVID-19 pandemic. We performed a single-center, retrospective, observational descriptive study. We further divided the patients based on the anatomical location of the malformation. We also took down details of the evolution of pregnancy and whether the mother had contracted a SARS-CoV-2 infection during the pregnancy. Details regarding the Apgar score, days of intensive care admission, sex, and nutrition were the key findings studied. RESULTS: A total of 47 neonates were found to have digestive anomalies, among which, based on the anatomical locations, the number of malformation cases found at the level of the esophagus were 15, while 16 occurred at the level of the pylorus; we found 12 cases of malformation of the duodenum, and four cases had malformation of the rectum. Out of these 47 neonates, 38.3% were females and 61.7% were males. A total of 58% were preemies, among which 9% had intra-uterine growth retardation (IUGR), and 42% were full-term newborns, among which 4% had intra-uterine growth retardation (IUGR). A total of 45% of the births were primiparous pregnancies and 55% were from multiparous females. A total of 14 mothers were found to have tested positive for COVID-19 during the course of pregnancy (p-value = 0.23); many had mild symptoms but were not tested. CONCLUSIONS: COVID-19 can affect the wellbeing of the pregnant female and their fetus. Larger studies can help gain extensive knowledge as to whether COVID-19 also has the potential to result in congenital gastrointestinal anomalies in children born from COVID-19 positive mothers. In our study, only a few infants born with this pathology were found to be born from COVID-19 positive mothers. Hence, it is difficult to conclude or exclude a direct correlation between the infection and the congenital malformations.

Pulse Wave Velocity, a Predictor of Major Adverse Cardiovascular Events, and Its Correlation with the General Stress Level of Health Care Workers during the COVID-19 Pandemic.

Background and Objectives: In the COVID-19 epidemiological context, the health care workers who were treating patients with COVID-19 were exposed daily to additional stress. Pulse wave velocity (PWV) is a predictive parameter for possible major adverse cardiovascular events. The present study aimed to evaluate the correlation between the general stress levels and PWVs of medical workers during the COVID-19 pandemic. Materials and Methods: The study group was heterogeneous in terms of the medical profession. PWV was measured using a TendioMed arteriograph. Assessment of stress level was performed using a general stress questionnaire with questions grouped on the areas that contribute to stress: lifestyle, environment, symptoms, job, relationships and personality. PWV measurements and stress assessment were performed both during the period with many patients with COVID-19 and during the period with few patients with COVID-19. Results: The stress levels and PWVs of subjects were higher in the period when they cared for patients with COVID-19 than in the period when they did not have patients with COVID-19. Conclusions: The study shows a positive correlation between the PWV of each subject and his/her stress score (the higher the stress score, the higher the PWV).

VEGF Pathway Gene Expression Profile of Proliferating versus Involuting Infantile Hemangiomas: Preliminary Evidence and Review of the Literature.

Background. Infantile hemangiomas may have unexpected behavior. Initial regression (spontaneously or drug-induced) may be followed by unexplained recurrences. At this moment, there are no well-established criteria to predict infantile hemangioma reccurrences. Methods. We compared the VEGF pathway gene expression profile for one case of involuting infantile hemangioma versus one case of recurrent proliferative infantile hemangioma using TaqMan Array. Results. We found ten genes upregulated for both involuting and recurrent proliferative hemangiomas: ACTB, KRAS, MAP2K1, HRAS, NOS3, BAD, HSPB1, HPRT1, GUSB, and CASP9. Thirteen genes were downregulated for both involuting and proliferative hemangiomas: FIGF, ACTG1, GRB2, MAPKAPK2, ACTG2, MAP2K2, MAPK3, HSP90AA1, MAP2K6, NRAS, ACTA1, KDR, and MAPK1. Three genes showed divergent expression between proliferating and involuting hemangiomas. Proliferating hemangioma had MAPK14 and AKT1 gene upregulation and ACTA2 downregulation. Involuting infantile hemangioma was characterized by ACTA2 upregulation and AKT1 and MAPK14 downregulation. Conclusions. Three genes, AKT1, p38/MAPK14, and ACTA2, were found to have divergent expression in proliferating and involuting infantile hemangiomas. Excepting AKT1, which was mentioned in the last ISSVA classification (strictly related to Proteus Syndrome), none of the other genes were reported. An accurate gene expression profile mapping of infantile hemangiomas together with a gene expression-based hemangioma classification is stringently needed.

Ultrasonographic findings of child acute appendicitis incorporated into a scoring system.

INTRODUCTION: This study aimed to investigate the ultrasonographic features of paediatric acute appendicitis and incorporate them into a scoring algorithm that will quantify the risk of complications and the strength of recommendation for surgical intervention. METHODS: 179 patients with suspected appendicitis who had undergone ultrasonographic examination were included in this study. Based on their medical evaluation and post-surgical histopathological results, patients were categorised into confirmed appendicitis (n = 101) and non-appendicitis (n = 78) groups. RESULTS: In the appendicitis group, the appendix was visualised in 66 (65.3%) patients. In cases where the appendix was not visualised, we looked out for secondary inflammatory signs, which were present in 32 (31.7%) patients. Using stepwise logistic regression, Blumberg's sign, free fluid or collection, hyperaemia, non-compressible appendix and an appendix diameter > 7 mm were found to be significant predictive factors for appendicitis. A new scoring system called POPs was developed, combining inflammatory predictors and ultrasonography findings, with an area under the receiver operating characteristic curve of 0.958 (95% confidence interval 0.929-0.986). CONCLUSION: The newly developed POPs-based diagnosis scheme proved a promising alternative to existing scoring systems such as the Alvarado score. Although further calibration would be beneficial, the proposed scoring scheme is simple and easy to understand, memorise and apply in the emergency room.

Combined Staged Surgery and Negative-Pressure Wound Therapy for Closure of a Giant Omphalocele.

The management of giant omphaloceles had always been a point of interest for the pediatric surgeons. Many surgical techniques were proposed, but none of them succeeded to become the standard procedure in closing the congenital abdominal defect. We present a case of giant omphalocele in which we used staged surgical closure combined with a prosthetic patch, with negative-pressure therapy and, finally, definitive surgical closure. Even though a major complication occurred during the treatment, we were able to close the defect without any prosthetic material left in place.

The Impact of Overweight and Obesity on Plantar Pressure in Children and Adolescents: A Systematic Review.

We aimed to synthesise the results of previous studies addressing the impact of overweight and obesity on plantar pressure in children and adolescents. An electronic search of scientific literature was conducted using PubMed, Cochrane and Scopus database, with keywords: "plantar pressure" AND "children" AND "obesity"; "plantar pressure" AND "adolescents" AND "obesity", "plantar pressure" AND "children" AND "overweight", "plantar pressure" AND "adolescents" AND "overweight". Twenty-two articles were included in the review and the following data were recorded: authors, publication year, type of technology (systems, software) for the determination of plantar pressure, study characteristics. Most of the articles used dynamic plantar pressure determination with only four using static plantar pressure measurement. Using ultrasonography with static plantar pressure determination, the correlation between structural and functional changes in the feet of obese children. In overweight and obese children and adolescents, important findings were recorded: higher contact area, increased maximum force beneath the lateral and medial forefoot, increased pressure-time integral beneath the midfoot and 2nd-5th metatarsal regions. Significantly increased foot axis angle and significantly flatter feet were observed in obese subjects in comparison to their normal-weight counterparts. The obese children presented increased midfoot fat pad thickness, with decreased sensitivity of the whole foot and midfoot.

Assessment of Static Plantar Pressure, Stabilometry, Vitamin D and Bone Mineral Density in Female Adolescents with Moderate Idiopathic Scoliosis.

(1) Background: Adolescent idiopathic scoliosis (AIS) can be associated with vitamin D deficiency and osteopenia. Plantar pressure and stabilometry offer important information about posture. The objectives of our study were to compare static plantar pressure and stabilometric parameters, serum 25-OH-vitamin D3 and calcium levels, and bone mineral densitometry expressed as z-score in patients with moderate AIS and healthy subjects. (2) Methods: 32 female adolescents (idiopathic S shaped moderate scoliosis, main lumbar curve) and 32 gender and age-matched controls performed: static plantar pressure, stabilometry, serum 25-OH-vitamin D3 and calcium levels, and dual X-ray absorptiometry scans of the spine. (3) Results: In scoliosis patients, significant differences were recorded between right and left foot for total foot, first and fifth metatarsal, and heel loadings. Stabilometry showed a poorer postural control when compared to healthy subjects (p < 0.001). Patients had significantly lower vitamin D, calcium levels, and z-scores. Lumbar Cobb angle was significantly correlated with the z-score (r = -0.39, p = 0.02), with right foot fifth metatarsal load (r = -0.35, p = 0.04), center of pressure CoPx (r = -0.42, p = 0.01), CoP displacement (r = 0.35, p = 0.04) and 90% confidence ellipse area (r = -0.38, p = 0.03). (4) Conclusions: In our study including female adolescents with idiopathic S shaped moderate scoliosis, plantar pressure and stabilometric parameters were influenced by the main scoliotic curve.

Respiratory function, functional capacity, and physical activity behaviours in children and adolescents with scoliosis.

OBJECTIVES: To assess pulmonary function and functional capacity in children and adolescents with mild or moderate idiopathic scoliosis who were included in a rehabilitation programme, and to observe some of their physical activity behaviours. METHODS: Forty children (aged 9-17 years) with mild or moderate idiopathic scoliosis (patients) and 40 sex- and age-matched healthy controls were included in the study. Physical activity behaviours (hours of time spent at a desk and at a computer, hours of competitive and non-competitive practice of exercise per week) were recorded. Patients were assessed before beginning rehabilitation and 12 weeks after an exercised-based programme by spirometry and functional capacity testing (6-minute walk test). RESULTS: All respiratory and functional capacity parameters were significantly increased after physical therapy compared with before beginning physical therapy in patients. However, there were still differences between patients and controls in all assessed parameters after therapy. Children and adolescents who were diagnosed with scoliosis spent a longer time at a computer, and had reduced regular and competitive physical exercise compared with controls. CONCLUSIONS: In children and adolescents with mild/moderate idiopathic scoliosis, pulmonary parameters and functional capacity are improved after 12 weeks of supervised physical therapy.

Static plantar pressure and functional capacity in children with femoral shaft fractures treated by titanium elastic nailing.

BACKGROUND: Femoral shaft fractures represent common fractures of the lower limb in the paediatric population. The objectives of our study were to analyse the static plantar pressure and functional capacity in children with surgically treated unilateral femoral shaft fractures, 1 month after the metallic implant removal. METHODS: Our study included 24 children with unilateral femoral shaft fracture (fracture site contralateral to the dominant leg) treated by titanium elastic nailing (TEN) implants, with the removal of the implant 6 months after initial surgery. The patients were divided into two groups: Group 1 (12 patients without inpatient rehabilitation) and Group 2 (12 patients who attended inpatient rehabilitation). The patients and 12 gender and age-matched healthy controls performed plantar pressure analysis and functional capacity testing (6-min walk test: 6MWT). For patients in Group 1 and 2 the assessments were performed 1 month after the TEN implant removal. Paired t-tests were used to compare the intragroup data. A one-way ANOVA test for independent measures was performed to assess the differences for plantar pressure, and 6MWT among study groups and controls. RESULTS: All study patients had left femoral shaft fractures (affected limb). The patients and controls were all right leg dominant. In both Group 1 and Group 2 total foot loading was significantly higher on the non-affected limb compared with the affected limb. When compared to the non-affected limb, the loadings on the affected limb were significantly increased on the first and fifth metatarsal in Group 1, and on the fifth metatarsal in Group 2, with a significantly smaller heel loading. When compared with the controls we found significant differences for all pressure parameters, except for the right foot load for the rehabilitation group. Although the functional capacity values were higher in the rehabilitation group the two patients groups had significantly lower 6MWT values. CONCLUSIONS: When compared to healthy controls children with surgically treated unilateral femoral shaft fractures, although assessed after 7 months, had a different weight distribution on the feet and a decreased functional capacity. A rehabilitation programme included in the management of these patients is important for regaining their functional level.

Assessment of children with pectus excavatum without surgical correction.

OBJECTIVE: To assess respiratory function and functional capacity in children with pectus excavatum who followed a physical therapy program, to compare these parameters to healthy controls and to evaluate adherence of this category of patients (pectus excavatum without surgical indications) to a supervised exercise program. METHODS: This study included 14 children with pectus excavatum and 14 gender and age-matched healthy controls. The study patients performed a 12-week exercise program. They were assessed at the beginning and at the end of rehabilitation by spirometry and functional capacity testing (6-min walk test). Parents of children with pectus excavatum completed a 10-item adherence questionnaire. RESULTS: In the study patients all respiratory parameters increased after rehabilitation. After 12 weeks there were no differences between study patients and controls, except for functional capacity that still had lower values in children with pectus excavatum. The parents of all patients agreed about fitting of the training program with their child's daily routine, low difficulty of the exercises, the child following the physiotherapist's instructions and confidence in the results of rehabilitation. CONCLUSIONS: In children with pectus excavatum without surgical indications, forced vital capacity, forced expiratory volume in 1 s and functional capacity assessed by the 6­min walk test improved significantly after a 12-week supervised exercise program. The study showed that adherence to the exercise-based program was good for all patients.

Type II pleuropulmonary blastoma in a 2-year-old girl: a case report.

Pleuropulmonary blastoma (PPB) is a very rare, malignant aggressive primary lung tumor, which occurs mainly in children less than 5 years old. Due to its poor prognosis, it is aggressively treated with multimodal therapy including surgery and chemotherapy. We present a case of PPB in a 2-year-old girl who was brought to the pediatric clinic for fever, cough and respiratory distress. Imaging studies showed a heterogeneous solid-cystic mass (12∕9∕11 cm) in the upper right pulmonary lobe. Through right thoracotomy, a specimen was obtained, the histopathological and immunohistochemical features of the specimen being suggestive for type II PPB. Aggressive chemotherapy and right pneumonectomy resulted in control of disease, the patient being currently in complete remission four years after the diagnosis.

MicroRNA Expression is Associated with Sepsis Disorders in Critically Ill Polytrauma Patients.

A critically ill polytrauma patient is one of the most complex cases to be admitted to the intensive care unit, due to both the primary traumatic complications and the secondary post-traumatic interactions. From a molecular, genetic, and epigenetic point of view, numerous biochemical interactions are responsible for the deterioration of the clinical status of a patient, and increased mortality rates. From a molecular viewpoint, microRNAs are one of the most complex macromolecular systems due to the numerous modular reactions and interactions that they are involved in. Regarding the expression and activity of microRNAs in sepsis, their usefulness has reached new levels of significance. MicroRNAs can be used both as an early biomarker for sepsis, and as a therapeutic target because of their ability to block the complex reactions involved in the initiation, maintenance, and augmentation of the clinical status.

Mesenchymal hamartoma of the left liver lobe in an 18-month-old female patient.

Mesenchymal hamartoma of the liver (MHL) is a benign and rare hepatic lesion, with an uncertain etiology and a potential for developing into an undifferentiated distant embryonal sarcoma after an incomplete resection. It mainly presents as progressive abdominal distension with normal blood works. Most cases are diagnosed in the first two years of life, with a higher frequency in boys and on the right liver. We report the case of a mesenchymal hamartoma of the left liver in an 18-month-old girl, with a rough evolution and a literature review. There were performed an abdominal computed tomography (CT) scan and resection of the lesion. The macroscopic and histological examination described a 16.5×17.9×10.5 cm multicystic mass as a MHL lesion. MHLs may have a malignant potential and in the clinical presence of a "neoplastic" syndrome there requires a good diagnosis and drastic surgical treatment.

Development of a high-performance anesthesia ventilator for research in small animals.

INTRODUCTION: Small animal models are used extensively in basic research because of their low cost and possibility to mimic several human pathologies. These models are used to either analyze the underlying mechanisms and/or assess therapeutic approaches. In this respect, gentle and safe artificial ventilation is mandatory, especially for prolonged experimental procedures that require the survival of the animals. The aim of the present paper was to develop and validate a high-performance anesthesia ventilator for small animals. METHODS: A pressure-controlled ventilator with assisted ventilation and deep breath modulated on a scheduled basis and a PEEP facility for an improved anesthetic management was developed. Parameters of acid-base balance and arterial blood gases were measured initially at the end of arterial catheterization and monitored throughout the experiment. RESULTS: Our data show the following average values (mmHg) for pO2: 440 +/- 45 (initial), 378 +/- 24 (2 h), 373 +/- 22 (4 h), and 375 +/- 28 (6 h) and for pCO2: 35 +/- 3 (initial), 34 +/- 5 (2 h), 38 +/- 5 (4 h), and 40 +/- 6 (6 h), respectively. CONCLUSIONS: We describe the procedure for the manufacture of a reliable, high-performance anesthesia ventilator that facilitates recovery of spontaneous respiration at animal arousal with preservation of normal blood gases values and no damage to the lungs.

Determination of the mechanical requirements for a progressive correction system of pectus excavatum in children.

Pectus excavatum is the most frequent deformity of the thorax. Many surgical procedures have been used for correcting this chest wall deformity. The Nuss procedure is an instant full correction using a rigid stainless steel bar, but some patients experience acute pain. We propose a new progressive correction technique for the chest deformity using an elastic rod. This method requires the specification of mechanical properties correlated with thorax anthropometric characteristics. We determined the force-displacement correlation for anterior-posterior compression of the thorax for 40 normal male and female subjects between 4 and 16 years of age. The measurement data offer the following conclusions: displacements<3.1-4 cm in pectus excavatum can be corrected with the Nuss method because the pain level is not acute. Younger children can tolerate an average displacement of 3.22 cm, while older children can tolerate only a shorter displacement, of 2.62 cm. The average required force in order to obtain a displacement of up to 4 cm varies with age between 10.28 kilgram-force (kgf) at a younger age to 13.61 kgf in older children. At a younger age one can achieve larger displacements with a smaller force, but the force required for the same correction grows linearly with age. Displacements>4 cm must be corrected progressively. The correction of pectus excavatum should be achieved with a progressive correction system (PCS) that must take into account these mechanical parameters.