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Objective To investigate the clinical features and diagnosis and treatment methods of nasal glial ectopia in children. Methods The clinical data of 8 cases of nasal glial ectopia admitted to Henan Children’s Hospital from August 2014 to October 2022 were retrospectively analyzed. Nasal CT and fiber electronic nasopharyngoscopy were performed before surgery. All children underwent surgery under general anesthesia, including intranasal type and mixed type through nasal endoscopic approach, and the nasal dorsal longitudinal and fusiform incisions were performed for the extranasal type. Regular follow-up was performed after surgery. Results All the 8 cases were congenital, including 7 male children and 1 female child, 19 days to 48 months old. There were 4 cases of intranasal type, 3 cases of extranasal type and 1 case of mixed type. Children with intranasal type and mixed type were mainly characterized by nasal congestion, while children with extranasal type showed nasal and back mass. All the operations were successful and no recurrence occurred during the follow-up period of 4-102 months. one child with intranasal type developed right nasal stenosis more than 40 days after surgery, and the remaining children did not have nasal deformity or dysfunction. Conclusions Nasal glial ectopia is rare, and preoperative imaging can help to clarify the location and extent of lesions. Surgical resection is currently the main treatment method, and the surgical approach can be selected according to the lesion site. Nasal endoscopic surgery can be performed for intranasal type and mixed type, while extranasal incision can be made for the extranasal type. Additionally, nasal skull base surgery can be performed if necessary. [ABSTRACT FROM AUTHOR]

目的 探讨艾司氯胺酮减轻学龄期患儿丙泊酚中/长链脂肪乳注射痛的半数有效剂量 (median effective dose, ED50) 。 方法 本研究为前瞻性研究, 选取2023年5月至2023年7月在湖南省儿童医院行全身麻醉手术的学龄期患儿 26 例作为研究对象, 年龄 6～13 岁, 美国麻醉医师协会分级Ⅰ～Ⅱ级。麻醉过程由2名麻醉医师完成, 第一名麻醉医师负责给药, 为每例患儿注射丙泊酚中/长链脂肪乳前预先注射艾司氯胺酮, 同时由另一名不知药物剂量的麻醉医师记录相关不良反应; 根据Ambesh评分评估丙泊酚中/长链脂肪乳注射后患儿注射疼痛程度。根据改良序贯法对艾司氯胺酮剂量进行调整, 艾司氯胺酮初始剂量为 0.2 mg/kg, 若Ambesh评分≤1分, 纳入有效组, 则下一例患儿艾司氯胺酮剂量减少 0.02 mg/kg; 若Ambesh评分>1分, 纳入无效组, 则下一例患儿艾司氯胺酮剂量增加 0.02 mg/kg。当出现7个交叉点 (有效转为无效) 时终止研究。采用Probit回归分析法计算艾司氯胺酮减轻学龄期患儿丙泊酚中/长链脂肪乳注射痛的ED50、95%有效剂量 (95% effective dose, ED95) 、99%有效剂量 (99% effective dose, ED99) 及各自的95%置信区间 (confidence interval, CI) 。 结果 共 26 例患儿完成试验, 其中有效组14例, 无效组 12 例。艾司氯胺酮减轻学龄期患儿丙泊酚中/长链脂肪乳注射痛 ED50 为 0.14 mg/kg, 95% CI (0.07～0.18 mg/kg) ; ED95 为 0.22 mg/kg, 95% CI (0.18～0.90 mg/kg) ; ED99为0.25 mg/kg, 95% CI (0.20～1.20 mg/kg) 。 结论 本研究初步证明预先注射艾司氯胺酮减轻学龄期儿童丙泊酚中/长链脂肪乳注射痛的ED50为0.14 mg/kg。 [ABSTRACT FROM AUTHOR]

Objective To explore the application of pedicled prepuce island flap vaginoplasty for feminized children with masculinized 46, XX sexual dysplasia and high vaginal confluence and evaluate its efficacy. Methods From January 1, 2017 to December 1, 2020, 9 children with masculine 46, XX differences of sex development/disorders of sex development (46, XX DSD) underwent pedicled prepuce island flap vaginoplasty plus clitoris shortening and Y-V labioplasty. All of them belonged to salt loss type congenital adrenal hyperplasia (CAH) due to 21 hydroxylase deficiency. Prader type was Ⅲ-Ⅴ with high vaginal confluence. The average age was 20.2(10-62) month. Dressing was removed at Day 3-4 post-operation and discharge occurred at Day 5-7 post-operation. Urinary catheter and vaginal stent were removed at Week 2 post-operation. Results Among them, 8 cases were followed up for (12-60) month. The postoperative appearance of external genitalia was recognized by family members. One case of vaginal stenosis was improved through vaginal dilation. There were no onsets of such lower urinary tract symptoms as urinary incontinence, frequent urination and dysuria or urethrovaginal fistula. Both postoperative appearance and early function were satisfactory. Conclusions As an effective treatment for high vaginal confluence of masculine 46, XX DSD, vaginoplasty with pedicled prepuce island flap may be applied alone or in combination with total urogenital mobilization (TUM).After operation, a narrow vagina forms with an opening in vestibule, decent urinary control and satisfactory appearance of external genitalia. It is suitable for all kinds of vulva feminization surgery. [ABSTRACT FROM AUTHOR]

Objective To compare the efficacy of Da Vinci robot-assisted and laparoscopic-assisted modified Soave with short muscular cuff anastomosis procedures for classical Hirschsprung disease (HSCR). Methods From January 2021 to December 2023, 60 HSCR children undergoing operations were retrospectively reviewed. According to operative techniques, they were assigned into two groups of robot ( n=25) and laparoscopy ( n=35). Operative age, body weight, operative duration, anal dissection time, intraoperative volume of blood loss, hospitalization stay length and hospitalization expense were recorded. Incidence of postoperative enterocolitis and anastomotic complications (anastomotic obstruction, anastomotic leakage & rectovaginal fistula) were compared between two groups. Postoperative defecation control status was tracked through defecation scoring system. Results Between robot and laparoscopic groups, dissection duration (20.2±3.3 vs.33.1±5.6 min), intraoperative volume of blood loss (11.0±6.0 vs.16.9±13.2 ml), hospitalization expense [(46±3) vs.(38±6) thousand yuan)], incidence of anastomotic complications [(0%, 0/25) vs.(17.1%, 6/35)], defecation frequency [(2.4±0.8) vs.(3.4±1.2)], soiling frequency [(0.72±0.73) vs.(1.4±0.9)]and postoperative defecation function score [(7.7±0.9) vs.(6.8±0.9)]. The differences were statistically significant (P<0.05). However, operative duration, hospitalization stay length and incidence of enterocolitis were not statistically significant ( P>0.05). Conclusions As compared with laparoscopic-assisted approach, Da Vinci robot-assisted modified Soave with short muscular cuff anastomosis can shorten operative duration of anal dissection, lower the incidence of anastomotic complications and improve defecation function in HSCR children. [ABSTRACT FROM AUTHOR]

Day surgery was initially pioneered by pediatric surgeons and has a history of over a century in foreign countries. In the past decade or so, driven by policy initiatives, more than 2000 hospitals in China have implemented day surgery. As a new surgical management model distinct from traditional inpatient and outpatient surgeries, various medical institutions have different understandings, management philosophies, and development directions for day surgery, leading to inconsistent concepts, standards, and recommended surgical procedures across regions. The expansion of medical resources in recent years has also encountered some obstacles in the implementation of day surgery. Given the shorter hospital stay and higher quality requirements of day surgery, traditional medical quality management systems are not fully adapted to the fast-paced day surgery model. Therefore, strict admission and evaluation systems need to be established. The practice of day surgery must focus on the three original intents of alleviating difficulties in accessing medical care, improving the medical experience, and enhancing hospital performance management. It is crucial to accurately understand the spirit of relevant government documents and consistently apply the patient-centered approach to ensure that more patients can benefit from safe, efficient, convenient, and comfortable day surgery services. [ABSTRACT FROM AUTHOR]

Day surgery model is a rapidly developing healthcare system in China that emphasizes the concept of enhanced recovery after surgery and is widely used in simple, minimally invasive procedures such as pediatric adenoidectomy. Based on this model, Shenzhen Children's Hospital has developed the "shuttle day management model", which combines centralized management with a blend of centralized and decentralized patient care, enhancing the efficiency of pediatric day surgeries. Quality management is essential for the safety of day surgery, and this paper elaborates on the full-process quality management of pediatric adenoidectomy day surgeries. It discussed the application of the "shuttle day management model" in pediatric specialized hospitals, covering areas such as physician and patient admission criteria, clinical pathway management, preoperative evaluation, intraoperative surgery and anaesthesia management, postoperative medication and complication management, strict discharge standards, and post-discharge follow-up. The aim is to provide new insights into the management of pediatric day surgeries, ensuring efficient, standardized, flexible, and safe management, thus contributing to the high-quality and rapid development of day surgery. [ABSTRACT FROM AUTHOR]

目的 探讨小儿腹股沟斜疝和鞘膜积液日间手术的疗效及卫生经济学价值。 方法 本研究为回顾性研究, 收集昆明市儿童医院泌尿外科自2018年1月至2022年12月收治的小儿腹股沟斜疝及鞘膜积液4 094例作为研究对象。根据患儿在日间诊疗中心或泌尿外科病房手术治疗情况, 分为日间组 ( n＝2 327) 和住院组 ( n＝1 767) ; 根据病种将日间组分为腹股沟斜疝日间组 (A组, n＝870) 和鞘膜积液日间组 (C组, n＝1 457), 将住院组分为腹股沟斜疝住院组 (B组, n＝777) 和鞘膜积液住院组 (D组, n＝990) 。将4个亚组配为2对 (A组&B组、C组&D组), 比较两种手术模式下患儿一般资料、住院时间、住院费用、院内感染、满意度和术后并发症的差异, 并分析两种手术模式的成本、治疗效果指数 (effect index, EI) 和成本效果比 (cost-effectiveness ratio, CER) 。 结果 以上2对进行组内比较显示, 术后发生发热或呕吐、需医疗机构处理的切口渗血或感染、复发和对侧新发情况差异无统计学意义 ( P>0.05) ; A、B组年龄分别为 (4.43±2.85) 岁和 (3.58±2.82) 岁, C、D组的年龄分别为 (3.84±1.96) 岁和 (3.48±2.03) 岁, 差异均有统计学意义 ( P<0.05) 。A、B组住院时间分别为 (10.30±3.35) h和 (62.80±23.97) h, C、D组住院时间分别为 (10.12±4.53) h和 (62.06±25.96) h, 差异均有统计学意义 ( P<0.05) 。A、B组住院费用分别为 (3 602.10±431.48) 元和 (5 226.22±585.93) 元; C、D组住院费用分别 (3 592.67±387.67) 元和 (5 234.48±666.73) 元, 差异均有统计学意义 ( P<0.05) 。A、B组的满意度评分分别为 (89.50±4.95) 分和 (83.38±6.02) 分, C、D组的满意度评分分别为 (88.83±4.56) 分和 (84.26±5.77) 分, 差异均有统计学意义 ( P<0.05) 。A、B组直接医疗成本分别为 (3 534.28±520.93) 元和 (5 372.72±785.06) 元, C、D组直接医疗成本分别为 (3 468.71±519.03) 元和 (5 299.55±795.16) 元, 差异均有统计学意义 ( P<0.05) 。A、B组间接成本分别为 (63.99±20.09) 元和 (368.25±136.11) 元, C、D组间接成本分别为 (62.18±25.38) 元和 (368.91±149.21) 元, 差异均有统计学意义 ( P<0.05) 。A、B组总成本分别为 (3 598.27±522.57) 元和 (5 740.97±866.26) 元, C、D组总成本分别为 (3 530.90±523.26) 元和 (5 668.46±894.14) 元, 差异均有统计学意义 ( P<0.05) 。A、B组的少数民族人数占比分别为20.9%和21.0%, 差异无统计学意义 ( P>0.05) ; 而C、D组少数民族人数占比分别为18.1%和28.8%, 差异有统计学意义 ( P<0.05) 。A、B组本市患儿占比分别为67.0%和53.5%, C、D组本市患儿占比分别为69.3%和52.4%, 差异有统计学意义 ( P<0.05) 。A、B组麻醉评估分级 (American Society of Anesthesiologists, ASA) 为Ⅰ级人数比例分别为87.4%和83.7%; C、D组的ASA分级为Ⅰ级人数占比分别为88.8%和83.7%; 差异均有统计学意义 ( P<0.05) 。A、B组医保支付比例分别为80.1%和68.2%; C、D组医保支付比例分别为79.4%和68.6%, 差异均有统计学意义 ( P<0.05) 。A、B组院内感染发生率分别为0.5%和3.9%, C、D组的院内感染发生率分别为0.3%和3.7%; 差异均有统计学意义 ( P<0.05) 。A、B组EI分别为0.98、1.03, CER分别为3 671.70、5 573.75; C、D组EI分别为0.99、1.02, CER分别为3 566.56、5 557.31。 结论 日间手术在同样治疗效果的情况下, 可以明显减少住院时间、住院费用、院内感染的发生和医疗成本, 并提高患儿家属满意度, 有更高的卫生经济学效益。 [ABSTRACT FROM AUTHOR]

Objective To investigate the feasibility and clinical efficacy of a day surgery management model in pediatric patients undergoing robot-assisted patent ductus arteriosus(PDA) ligation as a day surgery. Methods This retrospective study included 275 PDA children undergoing Da Vinci robot assisted endoscopy at the Children's Hospital, Zhejiang University School of Medicine, from August 2020 to October 2023. Patients were divided into two groups: the day surgery group ( n=120) managed with a day surgery approach under ERAS protocol, and the control group ( n=155) managed with conventional inpatient surgery approach under ERAS protocol . The two groups were compared for differences in surgery duration, preoperative fasting time, time to first postoperative fluid intake, postoperative pain scores, incidence of postoperative complications, surgery cancellation rate on the day of surgery, parental satisfaction, length of hospital stay, and total hospitalization costs. Results The day surgery group had a significantly shorter preoperative fasting duration (136.18±23.05 min vs.339.28±111.274 min), time to first postoperative fluid intake (63.14±12.841 min vs.168.33±59.516 min), length of hospital stay (1.00±0.00 days vs.2.72±2.25 days), and total hospitalization costs (51 760±1 350 RMB vs.53 330±1 870 RMB) compared to the control group ( P<0.05).The surgery cancellation rate on the day of surgery was significantly lower in the day surgery group [1.64% (2/120) vs.9.88%(17/155), P<0.05]. The incidence of postoperative fever [7.50%(9/120) vs.38.06% (59/155)]and residual leakage [0.83% (1/120) vs.7.10% (11/155)]was significantly lower in the day surgery group ( P<0.05), but there was no statistically significant difference in postoperative hoarseness. Postoperative pain scores were similar between the two groups (0.83±1.23 vs.0.78±1.10, P>0.05). Conclusions The application of the day surgery management model under ERAS protocol in pediatric robot-assisted PDA ligation significantly reduces the length of hospital stay and total hospitalization costs, optimizes the healthcare experience for children and their parents and does not increase the incidence of postoperative complications, making it a safe and feasible approach in clinical practice. [ABSTRACT FROM AUTHOR]

Objective To explore the impact of manual stretching on the size changes of sternomastoid (SCM) tumor in congenital muscular torticollis (CMT). Methods Between May 2017 and May 2019, retrospective review was conducted for 209 CMT children with SCM tumor. There were 132 males and 77 females, respectively. The side of involvement, the first visiting age and the initial long diameter, short diameter and cross section area of the SCM tumor were compared between sexes. Three visits were recorded in 209 patients, of whom 71 had four visits. The long diameter, short diameter and cross section area of the SCM tumor were compared between different visits. According to the age at visiting, 141 cases were 1 month old, 67 cases were 2 months old, 91 cases were 3 months old, 51 cases were 4 months old, 49 cases were 5 months old, 58 cases were 6 months old, 32 cases were 7 months old, 39 cases were 8 months old, 22 cases were 9 months old, 16 cases were 10 months old, 11 cases were 11 months old, 118 cases were 12 months old, and 15 cases were older than 12 months old. The long diameter, short diameter and cross section area of the SCM tumor were compared between different age. The patients were divided into three groups according to the age when ultrasound demonstrated the tumor disappeared. Group Ⅰ: ≤ 6 months; Group Ⅱ: >6 months; Group Ⅲ: Still not disappeared at the final follow up. The demographic information, the initial long diameter, short diameter and cross section area of the SCM tumor and the total follow up time were compared within three groups. Results Initial long diameter, short diameter and cross-section area were (28.8±5.6)mm, (12.5±2.4)mm and (288.5±94.9)mm² respectively. No gender differences existed in initial visiting age [ (37.2±19.1) vs. (37.7±20.2) day, P=0.669], initial long diameter [ (29.0±5.6) vs. (28.6±5.6)mm, P=0.818], short diameter [ (12.6±2.4) vs. (12.2±2.3)mm, P=0.640]or cross-section area [ (293.5±96.8) vs. (280.0±91.0) mm², P=0.458].Long diameter [first time (28.9±5.6), second time (17.1±14.0), third time (5.9±11.4), fourth time (1.0±5.2)mm, P<0.001], short diameter[first time (12.4±2.4) second time (7.1±5.8), third time (2.4±4.7), fourth time (0.4±2.3)mm, P<0.001] and cross section area[first time (288.1±94.4), second time (157.6±146.4), third time (52.1±109.1), fourth time (9.4±53.7)mm², P<0.001]decreased gradually with elapsing visiting time and age. And 40.3% of tumors disappeared until an age of 6 months and this ratio spiked to 94.3% at Month 12.No differences existed in initial visiting age [ ( (36.0±18.9) vs. (38.4±20.6) vs. (37.1±14.0)day, P=0.701], left/right involved side[36∶46, 49∶56, 10∶11, P=0.918]or initial long diameter [ (28.5±5.4) vs. (28.7±5.8) vs. (30.7±5.0)mm, P=0.286]among three groups. Meanwhile, short diameter[ (11.9±2.3) vs. (12.6±2.3) vs. (13.6±2.4)mm, P=0.007]and cross-section area [ (273.5±90.6) vs. (291.3±94.4) vs. (335.0±98.5)mm², P=0.027]differed statistically among three groups. Gender ratio (male: female) increased from group Ⅰ to group Ⅲ (48∶35, 68∶37, 16∶5).However, the difference was insignificant ( P=0.277).Group Ⅲ had greater initial short diameter [ (13.6±2.4) vs. (11.9±2.3)mm, P<0.05]and cross section area[ (335.0±98.5) vs. (273.5±90.6)mm², P<0.05]than Group Ⅰand yet shorter follow-up time [ (6.9±2.3) vs. (10.7±3.1)m, P<0.05]than Group Ⅱ. Average age of disappearing tumor was greater in boys and that in girls [ (8.7±4.4) vs. (7.5±3.3)m, P<0.05]. Conclusions More than 90% of SCM tumors in CMT children may disappear within an age of 1 year if manual stretching is initiated within 3 months. Tumors disappear later in boys than girls. The dynamic process of SCM tumor may be evaluated more accurately after improving health tutoring and boosting follow-up compliance. [ABSTRACT FROM AUTHOR]

Congenital macrodactyly is a rare non-hereditary congenital malformation characterized by varying degrees of enlargement of all fundamental structures (bones, tendons, nerves, blood vessels, adipose tissue, nails, and skin) of the affected toes or fingers. Due to its low incidence, the pathogenesis remains unclear, and the clinical manifestations vary. There is significant individual variation in the location and degree of enlargement of the affected toes (fingers), so there is no unified standard for the treatment selection Currently, there are few documented cases of congenital macrodactyly, and there is a lack of systematic understanding and treatment guidelines for the disease. This paper reviews the advances in research on the pathogenesis and treatment methods of congenital macrodactyly. [ABSTRACT FROM AUTHOR]

Objective To summarize the experience in diagnosing and treating pediatric liver trauma and to explore treatment strategies for pediatric abdominal closed liver trauma. Methods A retrospective analysis was conducted on the clinical data of 150 children with liver trauma treated at the Department of General Surgery, Hunan Children's Hospital, from January 2013 to December 2022. The study included 85 males and 65 females, aged 4. 66±2. 91 years. Treatment approaches were selected based on indicators such as hemoglobin (HB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), prothrombin time (PT), activated partial thromboplastin time (APTT), the World Society of Emergency Surgery (WSES) liver trauma grading, and the American Association for the Surgery of Trauma (AAST) liver trauma grading. Patients were divided into a conservative treatment group and a surgical treatment group. Observation indicators include HB, ALT, AST, TBIL, PT, APTT, AAST, and WSES grading, length of hospital stay (d), cure rate, and complications. Results Among the 150 cases, 131 were treated conservatively, and 19 underwent surgery (14 cases of liver resection and 5 cases of liver repair surgery). Except for one death due to severe hemorrhagic shock, the remaining 149 cases were successfully treated. In the conservative treatment group, there were significant differences in HB [(106. 71±15. 41) vs. (116. 17±12. 76)], AST [(544. 12±225. 05) vs. (33. 11±7. 86)], ALT [(513. 23±207. 58) vs. (43. 60±19. 00)], and TBIL [(10. 42±3. 38) vs. (8. 24±2. 75)]before and after treatment ( P<0. 05). In the surgical treatment group, there were significant differences in HB [(93. 33±15. 42) vs. (120. 67±14. 14)], AST [(547. 71±230. 83) vs. (30. 34±6. 21)], ALT [(523. 22±240. 98) vs. (31. 57±15. 90)], and TBIL [(10. 53±3. 65) vs. (7. 86±2. 28)]before and after treatment ( P<0. 05). However, there were no significant differences in PT or APTT before and after treatment in either group ( P>0. 05). Additionally, there were no statistically significant differences between the two groups in terms of these indicators before and after treatment ( P>0. 05). Conclusions Regardless of the grading standards used (AAST or WSES), the vast majority of children with Ⅰ, Ⅱ, and Ⅲ degree liver trauma, as well as some with AAST-IV liver trauma, can be successfully treated with non-surgical approaches. However, for children with WSES-Ⅳ liver trauma, surgical intervention should be promptly considered if hemodynamic instability occurs, irrespective of AAST grading. [ABSTRACT FROM AUTHOR]

Objective To develop a discharge scoring scale for pediatric day surgery, assess its reliability and validity, and implement it in clinical practice, providing an effective tool for assessing the safe discharge of pediatric day surgery patients. Methods This retrospective study was based on the indicators of the Post Anesthetic Discharge Scoring System (PADSS), incorporating the unique physiological and psychological characteristics of pediatric patients. A discharge scoring scale tailored for pediatric day surgery was developed, tested for reliability and validity, and applied in the Day Surgery Center at Kunming Children's Hospital, Yunnan Province. A total of 5, 843 children who underwent day surgery between January 2023 and December 2023 were selected as study subjects. The newly developed pediatric day surgery discharge scoring scale was used to evaluate the patients' readiness of discharge, and the results were compared with the quality control indicators for day surgery from 2022. Results The pediatric day surgery discharge scoring scale included 5 dimensions and 15 items. The overall Cronbach's alpha coefficient for the scale was 0. 809, with a test-retest reliability coefficient of 0. 916. The content validity index at the scale level was 0. 930, while the item-level content validity index ranged from 0. 900 to 1. 000. Exploratory factor analysis showed that the factor loadings for each item on the corresponding factors ranged from 0. 748 to 0. 891. Confirmatory factor analysis revealed a chi-square/degrees of freedom ratio of 1. 490, a root mean square error of approximation of 0. 050, and all fit indices were greater than 0. 8. Comparing the 2023 data with the 2022 day surgery quality control indicators, there were statistically significant differences in the incidence of postoperative adverse reactions or complications [1. 33%(78/5 843) vs. 2. 46%(127/5 171)], unplanned re-admission rates [0. 10%(6/5 843) vs. 0. 27%(14/5 171)], unplanned delayed discharge rates[0. 09%(5/5 843) vs. 0. 37%(19/5 171)], and unplanned transfer rates[0. 39%(23/5 843) vs. 0. 68% (35/5 171)]( P<0. 05). Conclusions The pediatric day surgery discharge scoring scale is well-designed, reliable, and valid, with high practicality and safety. It can serve as a standard for evaluating the safe discharge of pediatric day surgery patients. [ABSTRACT FROM AUTHOR]

Minimally invasive day surgery is a category of day surgery, and preoperative anesthesia evaluation is a critical step in ensuring the smooth conduct of pediatric minimally invasive day surgery. The preoperative anesthesia evaluation for such surgeries should neither completely deviate from the standard evaluation protocols for day surgeries nor be considered entirely equivalent to them. Proper understanding of the specific requirements for preoperative anesthesia evaluation in this context ensures that inclusion and exclusion criteria are neither too lenient nor too strict, thereby fully leveraging the benefits of "daytime" and "minimally invasive" aspects of these surgeries. Pediatric minimally invasive day surgeries offer advantages such as minimal trauma and rapid recovery. However, the anesthetic management of these surgeries presents higher risks due to factors such as the young age of the patients, the significant physiological impact of pneumoperitoneum, and the brief postoperative observation period. This article discusses the current status and developments in preoperative anesthesia evaluation for pediatric minimally invasive day surgeries, issues regarding the timeliness of evaluations, and provides medical recommendations for the content of these evaluations. [ABSTRACT FROM AUTHOR]

Objective To explore the effects of catheters of different sizes on uroflowmetry after Snodgrass surgery in children. Methods From July 2017 to June 2020, retrospective study was performed for 266 children with hypospadias undergoing initial Snodgrass surgery. According to the postoperative size of catheter, they were divided into 3 groups of Fr 6 ( n=89), Fr 8 ( n=85) and Fr 10 ( n=92). All catheters were removed at Week 2 post-operation. Uroflowmetry was examined at Month 1 post-operation (T1), Month 3 post-operation (T2), Month 6 post-operation (T3), Year 1 post-operation (T4) and Year 2 post-operation (T5). And urine flow curve, Q max (maximum flow rate) and Q ave (average flow rate) were recorded. ResultsQ max and Q ave were both the lowest among three groups at T1 and increased over time. Intragroup comparison showed Q max{Fr 6[(6. 90±2. 73), (7. 27±2. 40), (8. 62±3. 03), (9. 98±3. 08), (11. 3±3. 42) mL/s] vs. Fr 8 [(7. 19±3. 14), (7. 50±2. 88), (8. 41±2. 96), (8. 97±2. 83), (10. 82±4. 45) mL/s] vs. Fr 10 [(6. 72±2. 84), (6. 87±2. 71), (8. 28±2. 91), (9. 48±2. 83), (10. 95±3. 15) mL/s]} and Q ave{Fr 6 [(3. 99±1. 57), (4. 46±1. 67), (5. 15±1. 88), (5. 86±1. 78), (6. 47±2. 22) mL/s] vs. Fr 8 [(4. 04±1. 78), (4. 14±1. 76), (4. 96±1. 78), (5. 45±1. 91), (6. 28±2. 89) mL/s] vs. Fr 10 [(4. 04±1. 57), (4. 29±1. 70), (5. 02±1. 80), (5. 64±1. 99), (6. 84±2. 37) mL/s]} differed greatly at 5 timepoints ( P<0. 01), Multiple comparisons revealed that Q max and Q ave were significantly different between T2 and T3 ( P<0. 01), T3 and T4 ( P<0. 01) and T4 and T5 ( P<0. 01). Urine flow curve type indicated that platform curve dominated for 60%(160/266) and 55%(145/266) at T1/2 while bell curve accounted for 52%(138/266), 57%(152/266) and 64%(172/266) at T3/4/5. Ratio of urine flow curve type differed markedly at 5 timepoints ( P<0. 001), especially between T2 and T3 ( P<0. 05). Conclusions In children of hypospadias after Snodgrass surgery, postoperative uroflowmetry is not affected by catheters of different sizes. [ABSTRACT FROM AUTHOR]

In recent years, the rapid development of endoscopic technology has allowed pediatric surgeons to apply this technique to the neonatal population. During laparoscopic and thoracoscopic surgeries in neonates, surgeons insufflate carbon dioxide into the abdominal and thoracic cavities to create pneumoperitoneum and pneumothorax, respectively, to achieve a satisfactory surgical view. However, the establishment of pneumoperitoneum and pneumothorax increases intra-abdominal and intrathoracic pressures, leading to carbon dioxide retention and potentially hypercapnia, which affects physiological functions. This article reviews the physiological effects of carbon dioxide pneumoperitoneum and pneumothorax on neonates. [ABSTRACT FROM AUTHOR]

Objective To explore the feasibility of using magnetic resonance imaging (MRI) to measure the teardrop and sourcil line (TSL) for predicting the occurrence of residual acetabular dysplasia (RAD) after closed reduction (CR) in children with developmental dysplasia of the hip (DDH). Methods This study measured and recorded the continuity of the bony TSL and the maximum acetabular distance (AD) on MRI in 54 children, totaling 68 hips (40 unilateral cases and 14 bilateral cases) clinically diagnosed with DHH and who underwent CR. X-ray images were used to observe and record the acetabular index (AI) at the time of CR, as well as the International Hip Dysplasia Institute (IHDI) classification. According to the modified Severin classification, the affected hips were divided into RAD and non-RAD groups, and differences between the two groups were compared. Additionally, patients were categorized into MRI-bony TSL continuous and non-continuous groups to compare differences in indicators between these groups. The receiver operating characteristic curve (ROC) was used to evaluate the effectiveness of the AD difference in predicting the occurrence of RAD. ResultsAmong the 68 hips, 2 were classified as Severin type Ⅰ, 15 as type Ⅱ, 46 as type Ⅲ, and 5 as type Ⅳ; 51 hips in the RAD group, and 17 in the non-RAD group. Univariate analysis showed that IHDI classification, the continuity of the bony TSL, and the AD difference between the normal and affected sides were related factors for the occurrence of RAD after CR in DHH children. Multivariate logistic regression analysis revealed that IHDI classification ( OR=0. 090, 95% CI: 0. 010-0. 794), MRI-bony TSL continuity ( OR=0. 015, 95% CI: 0. 002-0. 128), and AD difference between the normal and affected sides ( OR=7. 1×108, 95% CI: 370. 6-1. 4×1015) were independent factors influencing the occurrence of RAD after CR in DHH children ( P<0. 05). ROC curve analysis showed that the difference between normal side and affected side AD predicted the onset of RAD by 0. 31cm, corresponding sensitivity and specificity were 0. 900 and 0. 833, respectively, and AUC was 0. 917. Conclusions IHDI classification, MRI-bony TSL continuity, and the AD difference between the normal and affected sides can serve as indicators for predicting RAD occurrence after CR in DDH children. Compared to X-ray TSL, MRI-bony TSL can predict the occurrence of RAD earlier and more accurately. [ABSTRACT FROM AUTHOR]

Currently, congenital ureteropelvic junction obstruction (UPJO) is primarily treated with laparoscopic pyeloplasty (LP) in clinical practice. However, the hospital stay is relatively long. The enhanced recovery after surgery (ERAS) protocol management results in a shorter hospital stay and, as verified by day surgery, does not increase the risk of postoperative adverse events. This article reviews the latest progress of ERAS protocols for pediatric LP both domestically and internationally. It recommends relatively important ERAS elements and major outcome indicators in preoperative, intraoperative, and postoperative stages, promoting the application of ERAS protocols in LP. [ABSTRACT FROM AUTHOR]

Objective To investigate the characteristics of pulmonary function changes in older children with pertussis. Methods Clinical data and pulmonary function date of older children diagnosed with pertussis in outpatient clinics from April 2021 to December 2023 were collected. The clinical data of the case group were collected. A group of healthy older children were included as the control group. Pulmonary function parameters included peak expiratory flow (PEF), forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), FEV1/FVC, expiratory flow at 50% of vital capacity (FEF50), maximum mid-expiratory flow (MMEF) and expiratory flow rate with 75% vigorous exhalation (FEF75). Results Seventy children (36 boys and 34 girls) with pertussis were recruited in the case group, including 54 children with pertussis only and 16 children with pertussis and asthma together. The incidence of paroxysmal cough was 40.0% (28/70) and inspiratory croup 8.5% (6/70) in the case group. Sixty healthy children (28 boys and 32 girls) were included in the control group. There were no significant differences in gender, age, height and body weight between children with pertussis alone group and the control group (P＞0.05). The pulmonary function parameters were significantly lower in the children with pertussis alone group than those in the control group, and PEF had the most obvious decline: PEF%pred [80.5 (62.6, 85.9) vs. 109.8 (103.2, 118.7)]. Compared with the pertussis alone group, pulmonary function was not decrease further in the pertussis combined with asthma group. After the improvement of clinical symptoms of children in the pertussis alone group, the level of pulmonary function (PEF and FEF50) increased significantly, but they were still lower than those of the control group. Conclusion The pulmonary function declines slightly in loder children with pertussis. The decreased PEF is most significant. [ABSTRACT FROM AUTHOR]

Objective To compare and analyze the effectiveness of sequential nutritional support and parenteral nutrition support in clinical intervention of pediatric acute pancreatitis. Methods Data of 102 children with acute pancreatitis were retrospectively collected and divided into the parenteral nutrition group (n=51) and the sequential nutrition group (n=51) based on the type of parenteral nutrition support. Changes in nutritional status, immune function indicators and body rehabilitation indicators were compared before and after intervention between two groups. The humoral immune indexes (IgA, IgG and IgM) were detected by immunonephelometry. The body recovery indexes (abdominal distension relief time, oral feeding recovery time, body temperature recovery time, blood and urine amylase recovery time and hospital stay) were compared between the two groups. Results After intervention, levels of serum albumin, total protein and prealbumin were higher in the study group than those in the control group, while levels of blood amylase and urine amylase were lower than those in the control group (P＜0.05). After intervention, the CD3+, CD4+ and CD4+/CD8+ indicators were higher in the study group than those in the control group (P＜0.05). After intervention, IgA, IgG and IgM indicators were higher in the study group than those in the control group (P＜0.05). The relief time of abdominal distension, recovery time of oral feeding, recovery time of body temperature, recovery time of blood and urine amylase and hospitalization time were all shorter in the study group than those in the control group (P＜0.05). Conclusion Sequential nutritional support can effectively improve the nutritional status of children with acute pancreatitis, enhance immune function and promote physical recovery compared to parenteral nutrition support. [ABSTRACT FROM AUTHOR]

Objective To investigate clinical features and risk factors of childhood diabetes mellitus (DM) complicated with urinary tract infection (UTI). Methods The data of 160 children with DM in our hospital in the past 2 years were collected as the research object, and they were divided into the UTI group and the non-UTI group UTI, with 80 cases in each group. The clinical data of children with DM and UTI were collected and analyzed, including DM type, sex, age, body mass index (BMI), living environment, duration of disease, length of hospital stay, indwelling catheter, ketoacidosis, antibiotic and insulin use, the types of bacteria isolated from urine samples and various laboratory indicators on admission. Results Pathogen bacteria mainly included Escherichia coli (n=37, 46.2%), Enterococci (n=21, 26.2%) and Klebsiella pneumoniae (n= 9, 11.2%) in the UTI group. Univariate analysis showed that there were significant differences in obesity, duration of disease, length of hospital stay, indwelling catheter, ketoacidosis, antibiotic use, glycosylated hemoglobin (HbA1c), albumin (ALB) and serum creatinine (Cr) between the two groups (P＜0.05). Multivariate regression analysis showed that risk factors for DM complicating UTI included prolonged hospitalization (OR=2.087, 95%CI: 1.562-2.789), indwelling urinary catheter (OR= 15.886, 95%CI: 2.336-108.007), ketoacidosis (OR=9.300, 95%CI: 1.169-73.992), duration of disease ≥36 months (OR= 20.548, 95%CI: 2.425-174.119), increased HbA1c (OR=16.686, 95%CI: 3.666-75.955) and serum Cr (OR=1.010, 95%CI: 1.002-1.019), while the increased serum ALB (OR=0.799, 95%CI: 0.702-0.910) was its protective factor. Conclusion Pathogenic bacteria in the UTI group are mainly Escherichia coli. Children with DM and UTI are closely related to the length of hospitalization, indwelling catheter, ketoacidosis, duration of disease, HbA1c, serum Cr and ALB levels. [ABSTRACT FROM AUTHOR]

Objective To review the effect of resection of pediaric craniopharyngioma and the long- term quality of life. Methods The clinical datas before, during and after operation of 30 pediatric craniopharyngioma patients who were operated in Xuanwu Hospital, Capital Medical University from March 2014 to June 2024 were collected for retrospective analysis. The Katz index, body mass index (BMI), as well as one's ability to paparticipate in normal school life and physical exercise at last follow - up were recorded as key factors of long - term quality of life assesement. Results There were 7 (23.33%) of pediatric craniopharyngioma patients were identified as obese, 19 (63.33%) patients had endocrine dysfunction and 30 (100%) were identified as Katz index grade A before operation. Total resection of the tumor was achieved in 29 cases, while one case had subtotal resection. Median follow-up time was 38.00 (17.25, 53.00) months. The number of obese children increased to 9 (30%) during the last follow-up, but showed no statistic significance (-2 = 0.125, P = 0.727). The number of patients with endocrine dysfunction increased to 27 (90%), and showed statistic significance (-2 = 4.083, P = 0.039). All 30 cases remained Katz index grade A during the last follow-up. During the last follow-up, only one patient hadn't return to normal school life and 2 patients couldn't join physical exercise in school after total resection of craniopharyngioma. Conclusions Total resection in pediatric craniopharyngioma patients can still achieve good prognosis, and should be the target of surgical treatment. [ABSTRACT FROM AUTHOR]

Pediatric drug-resistant epilepsy (DRE) significantly affects children's neurodevelopment and quality of life, often accompanied by cognitive dysfunction and behavioral abnormalities, imposing a heavy economic and psychological burden on families and society. Surgery is an effective treatment for DRE, especially for children who do not respond to medication. This article reviews the current status of surgical treatment for pediatric DRE, discussing the necessity and timing of surgery, surgical indications, and preoperative evaluation. It introduces the applications of resective and palliative surgeries and explores the development of new technologies such as laser interstitial thermotherapy (LITT) and high - intensity focused ultrasound (HIFU). This review provides a theoretical foundatio [ABSTRACT FROM AUTHOR]

Spinal and spinal cord tumors in children are rare and often present with non-specific symptoms, leading to delayed diagnosis and potentially catastrophic consequences. Most pediatric spinal tumors in children are benign tumors, primarily including osteoid osteomas, osteoblastomas and aneurysmal bone cysts. Malignant spinal tumors are extremely rare, mainly including osteosarcoma, Ewing's sarcoma, lymphoma and metastatic neuroblastoma. Pediatric spinal cord tumors mostly include astrocytomas, ependymomas and schwannomas. There are also congenital benign tumors, such as lipomas and teratomas, which are relatively not uncommon. This article provides a review of the clinical characteristics of spinal and spinal cord tumors in children, with the aim of improving clinical understanding of pediatric spinal and spinal cord tumors, and guiding diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Pediatric intracranial germ cell tumors (GCT) are clinically rare but highly heterogeneous tumors, primarily occurring in children and adolescents. The treatment method depends on the tumor type. Pure germinoma can be cured with radiotherapy and chemotherapy, while mature teratomas can be cured with surgical resection. Non-germinomatous germ cell tumors (NGGCT) require comprehensive treatment. Current domestic and international guidelines or expert consensus recommend initial chemotherapy, followed by surgical resection for those not achieving complete remission. However, clinical practice has found that surgery risks increase after chemotherapy, leading some experts to advocate for direct surgery. Beijing Tiantan Hospital, Capital Medical University proposed a clinical diagnosis and treatment strategy for pediatric intracranial NGGCT (2023 Tiantan version), recommending joint evaluation by neurosurgeons and oncologists for individualized treatment to provide better treatment plans for children. [ABSTRACT FROM AUTHOR]

Since the first Chinese pediatric neurosurgery meeting was convenced in 2002, the pediatric neurosurgery discipline in China has undergone remarkable transformation and growth. Throughout this period, both general and pediatric hospitals have progressively established dedicated Pediatric Neurosurgery Departments. Additionally, the methodology for training medical professionals in this field has undergone a substantial evolution, shifting from the conventional pediatric surgery training paradigm to a comprehensive system tailored for neurosurgical specialists and postgraduate students. Consequently, there has been a consistent increase in the number of physicians specializing in pediatric neurosurgery nationwide. In relation to surgical instruments and equipment, significant advancements have been achieved in pediatric neurosurgery. Notably, the neurosurgical operating microscope has emerged as a vital tool, significantly enhancing the therapeutic outcomes for a wide range of pediatric neurosurgical conditions. Furthermore, both the Chinese Medical Doctor Association and the Chinese Medical Association have established specialized pediatric neurosurgery subgroups, providing robust support for the continuous development and advancement of this field in China. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Journal of Contemporary Pediatrics is the property of Xiangya Medical Periodical Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Chinese Journal of Contemporary Pediatrics is the property of Xiangya Medical Periodical Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Chinese Journal of Contemporary Pediatrics is the property of Xiangya Medical Periodical Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Chinese Journal of Contemporary Pediatrics is the property of Xiangya Medical Periodical Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Chinese Journal of Contemporary Pediatrics is the property of Xiangya Medical Periodical Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Chinese Journal of Contemporary Pediatrics is the property of Xiangya Medical Periodical Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Chinese Journal of Contemporary Pediatrics is the property of Xiangya Medical Periodical Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Chinese Journal of Contemporary Pediatrics is the property of Xiangya Medical Periodical Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective To explore the effects of tonsillectomy under general anesthesia on articulatory characteristics and blood levels of procalcitonin (PCT), platelet membrane protein-140 (GMP-140), and T lymphocyte subsets in children with obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods Forty-three children with OSAHS who underwent tonsillectomy under general anesthesia in the Department of Otorhinolaryngology Head and Neck Surgery of Xi’an Children’s Hospital, Shaanxi Province from June 2020 to March 2022 were randomly selected for the study. The children were evaluated for articulatory characteristics, blood levels of PCT, GMP-140, and T lymphocyte subsets, as well as sleep status before surgery and at 1 and 3 months after surgery. Results The longest duration of articulating /a/ was significantly prolonged and the second formant was significantly enhanced at 1 and 3 months after surgery (F=43.07,39.65,P

Objective To explore the activity of ANCA positive disease in children with lupus nephritis （LN） and examine its impact on the severity of disease to provide evidence-based rationales for rapid diagnosis, reasonable clinical decision-making and standardized management and offer new ideas for managing systemic lupus erythematosus （SLE）. Methods From January 2014 to April 2022, retrospective review was conducted for the relevant clinical data of 170 hospitalized LN children. Experimental group had 93 children with ANCA testing and 33 were positive for ANCA. Clinical manifestations, laboratory tests, SLE Disease Activity Index （SLEDAI） score, treatments and prognoses of this group were compared with other 60 ANCA-negative children （control group）. SPSS22.0 software was utilized for performing statistical analysis. Results The most common manifestations in LN children were proteinuria （59.13%）, fever （48.38%）, edema （39.78%） and hematuria （34.4%）. The degree of renal damage was significantly greater in ANCA-positive group than that in ANCA-negative group. And 24-hour urinary protein quantity of ANCA positive group was higher than that of ANCA negative group. No significant differences existed between ANCA-positive and ANCA-negative SLE children in blood routine, liver/kidney function, lipids, immunoglobulins, complement or inflammatory parameters. SLEDAI scores were significantly higher in ANCA-positive group than those in ANCA-negative group （mean SLEDAI scores were 15.62 and 11.78, P = 0.033）. The survival rate of ANCA positive group was lower than that of ANCA negative group. Conclusions ANCA-positive LN children have greater disease activity, worse basic renal function and a higher probability of poor clinical prognosis.

Background With the improvement of economic level and changes in lifestyle of residents, the obesity among children and adolescents has become increasingly severe, threatening the healthy growth of children and adolescents. BMI was used as an evaluation index of obesity in most previous studies, which may underestimate the prevalence of central obesity. Therefore, it is urgent to evaluate the waist circumference (WC) and trend of the prevalence of central obesity among children and adolescents in Putuo District, in order to provide scientific basis for targeted proposed intervention. Objective To analyze WC and the trend in the prevalence of central obesity among children and adolescents aged 7-18 years in Putuo District, Shanghai, from 2018 to 2023. Methods Data on medical examinations of primary and secondary school students in Putuo District in 2018 and 2020 to 2023 were used to analyze the WC, the prevalence of central obesity and the trends. The 90th percentile (P90) age-specific children and adolescents of different genders was used as the cut-off point of high WC, and WC exceeding the P90 value was defined as central obesity. SPSS 22.0 and SAS 13.1 were used for statistical analysis and Excel 2021 was used for graphic plotting. Results A total of 280 648 primary and secondary school students participated in the medical examination in Putuo District, Shanghai, from 2018 to 2023, of which 146 334 (52.1%) were male students and 134 314 (47.9%) were female students, with an median age of 10.5 (8.7, 12.6) years. WC of male and female students from 2018 to 2023 showed fluctuating downward trends with a statistically significant difference (Hmale=209.785, Hfemale=373.076; P

Objective To discuss the classification and surgical treatment strategies of complex spinal lipoma in children. Methods A total of 68 children with complex spinal lipoma were selected for treatment at Beijing Tsinghua Changgung Hospital, Affiliated Hospital of Tsinghua University from January 2015 to January 2023. They were divided into dorsal type (n = 42), transitional type (n = 15) and chaotic type (n = 11) based on XIU - SUN classification. All patients underwent microsurgical treatment under neurophysiological monitoring. The early (within one month after surgery) and long-term (over one year after surgery) efficacy and safety of all patients were evaluated. Results Early efficacy: according to the Kirollos grading method for intraoperative decompression, 61 cases (89.71%) reached level Ⅰ , 5 cases (7.35%) reached level Ⅱ , and 2 cases (2.94%) reached level Ⅲ ; according to the degree of resection, complete resection was achieved in 7 cases (10.29%), subtotal resection in 16 cases (23.53%), and partial resection in 45 cases (66.18%). Long-term efficacy: all patients were followed up for (5.00 ± 0.20) years. According to the McCormick spinal cord injury grading system, there was no statistically significant difference in the preoperative and postoperative neurological scores of the dorsal type (χ2 = 0.364, P = 0.549), transitional type (χ2 = 0.125, P = 1.000) and chaotic type (χ2 = 1.500, P = 0.219). MRI examination revealed recurrence of lipoma in 6 cases (8.82%). The postoperative symptoms improved to different degrees, and the progression free survivial rate was 91.18% (62/68). Postoperative complications: 25 cases (36.76%) of postoperative complications were observed, including urinary and fecal dysfunction in 13 cases (19.12%), decreased muscle strength in 9 cases (13.24%), cerebrospinal fluid leakage in 3 cases (4.41%), central nervous system infection leading to acute hydrocephalus in 2 cases (2.94%), with 2 cases presenting with both decreased muscle strength and urinary and fecal dysfunction. Conclusions XIU - SUN classification has a guiding role in surgical strategy. In cases of dorsal type and most of transitional types, a subtotal or complete resection can be chosen. For chaotic type and medullary type, a reduction - based approach is recommended. All types of spinal lipoma should undergo detachment release.

Objective To research new methods and materials for cranioplasty in children with various types of skull defects. Methods and Results A total of 40 childrens with different locations, sizes and reasons of skull defects underwent surgery using 3 classes of homogeneous yet heterogeneous biomimetic hydroxyapatite collagen bone materials developed by Tsinghua University. These include porous mineralized collagen scaffolds (pMC), compact mineralized collagen scaffolds (cMC), and biphasic mineralized collagen composite scaffolds (bMC). Cranioplasty was successful in all cases, with no serious postoperative complications and good recovery outcomes. After 3 months to one year of follow-up, there was no displacement of the implants, the shape of the head was normal, the incisions healed well. Reexamination CT showed that the biomimetic hydroxyapatite collagen bone material implants were not shifted, and imaging fusion was partially achieved. The pMC CT HU-value was 300-400 HU, and the cMC CT HU - value was 700-900 HU, and the CT HU - value was close to normal bone tissue over time. Conclusions The use of different types of biomimetic hydroxyapatite collagen composites allows for personalized cranial reconstruction based on individual needs, and has been proven to possess good bio- compatibility and osteoinductive capacity. This approach is thus promising for research and clinical applications, with significant value.

Pediatric drug-resistant epilepsy (DRE) significantly affects children's neurodevelopment and quality of life, often accompanied by cognitive dysfunction and behavioral abnormalities, imposing a heavy economic and psychological burden on families and society. Surgery is an effective treatment for DRE, especially for children who do not respond to medication. This article reviews the current status of surgical treatment for pediatric DRE, discussing the necessity and timing of surgery, surgical indications, and preoperative evaluation. It introduces the applications of resective and palliative surgeries and explores the development of new technologies such as laser interstitial thermotherapy (LITT) and high - intensity focused ultrasound (HIFU). This review provides a theoretical foundation for the advancement of pediatric epilepsy surgery toward more minimally invasive and precise approaches.

Objective To review the effect of resection of pediaric craniopharyngioma and the long-term quality of life. Methods The clinical datas before, during and after operation of 30 pediatric craniopharyngioma patients who were operated in Xuanwu Hospital, Capital Medical University from March 2014 to June 2024 were collected for retrospective analysis. The Katz index, body mass index (BMI), as well as one's ability to paparticipate in normal school life and physical exercise at last follow - up were recorded as key factors of long - term quality of life assesement. Results There were 7 (23.33%) of pediatric craniopharyngioma patients were identified as obese, 19 (63.33%) patients had endocrine dysfunction and 30 (100%) were identified as Katz index grade A before operation. Total resection of the tumor was achieved in 29 cases, while one case had subtotal resection. Median follow-up time was 38.00 (17.25, 53.00) months. The number of obese children increased to 9 (30%) during the last follow-up, but showed no statistic significance (χ2 = 0.125, P = 0.727). The number of patients with endocrine dysfunction increased to 27 (90%), and showed statistic significance (χ2 = 4.083, P = 0.039). All 30 cases remained Katz index grade A during the last follow-up. During the last follow-up, only one patient hadn't return to normal school life and 2 patients couldn't join physical exercise in school after total resection of craniopharyngioma. Conclusions Total resection in pediatric craniopharyngioma patients can still achieve good prognosis, and should be the target of surgical treatment.

Idiopathic nephrotic syndrome （INS） is the most common and challenging glomerular disease in childhood and most children respond favorably to glucocorticoid therapy. However， up to half of INS patients present with steroid-dependent or frequently-relapsing nephrotic syndrome so that selecting proper treatment regimens has remained one great clinical challenge. Rituximab （RTX） for nephrotic syndrome is generally efficacious. However， clinical outcomes vary greatly at different centers. This review summarized the effectiveness and risk of different RTX protocols for children with steroid-dependent or frequently-relapsing nephrotic syndrome.

Background Henoch-Schonlein purpura is a vascular inflammatory illness that develops in childhood and in some children involves the kidneys, clinically known as Henoch-Schonlein purpura nephritis. Different studies have suggested different interventions, and there is a wide variation in the outcome indicators used for the intervention approaches. Objective To investigate and analyze the current status of clinical research outcome indicators for Henoch-Schonlein purpura nephritis in China, so as to provide a reference basis for the establishment of a core set of outcome indicators in this field. Methods CNKI, CBM, VIP, Wanfang Data, PubMed, Cochrane Library, Embase and Web of Science were systematically searched to collect publicly available Henoch-Schonlein purpura nephritis studies from January 2010 to June 2021. The Chinese databases were searched using the search strategy of title or keywords combined with subject terms, and the English databases were searched using subject terms combined with free words. Two investigators independently screened the literature and extracted information according to the inclusion and exclusion criteria, processed and analyzed the data on outcome indicators. Results A total of 148 randomized controlled trials of Henoch-Schonlein purpura nephritis were included, and the outcome indicators of Henoch-Schonlein purpura nephritis studies were mainly physical and chemical indicators, with fewer symptomatic indicators. The highest frequency of outcome indicators were clinical efficacy (121 times, 81.76%), adverse reactions (74 times, 50.00%), 24-hour urine protein (68 times, 45.95%), urinary red blood cells (43 times, 29.05%), and recurrence rate (20 times, 13.51%). The division between primary and secondary outcome indicators was clearly distinguished in only two articles. Conclusion There are several indicators for the research outcomes of Henoch-Schonlein purpura nephritis in China, primarily physical and chemical variables, with significant variation. The research focuses on efficacy measures but ignores adverse reactions. As a result, it is necessary to establish a set of outcome indicators for clinical intervention studies on Henoch-Schonlein purpura nephritis in order to provide a reference basis for selecting outcome indicators and guiding clinical decision-making in future similar studies.

Background Studies have confirmed that executive function in overweight and obese children is closely related to obesity and may have a bidirectional association. Aerobic exercise, as an effective intervention, can effectively promote their brain development and cognitive function, especially executive function, but the quantitative relationship of the improvement effect still needs to be further explored. Objective To systematically evaluate the intervention effect of aerobic exercise on executive function-related indexes in overweight and obese children. Methods Randomized controlled trials of aerobic exercise interventions for executive function in overweight and obese children were searched in CNKI, Wanfang Data, CBM, Cochrane Library, PubMed, Embase, and Web of Science databases, and the timeframe for searching was from the establishment of each database to July 2023. The quality of the included literature was assessed according to the Cochrane Risk of Bias Assessment Tool, and Meta-analysis of outcome indicators was performed using RevMan 5.3 and Stata 15.0 software. Results Nine randomized controlled trials, including 940 overweight and obese children, were finally included. The results of Meta-analysis showed that a single session of aerobic exercise intervention was effective in improving the executive function of overweight and obese children (WMD=-6.98, 95%CI=-11.89 to -2.07, P=0.005). Subgroup analyses showed no significant differences in the improvement of any of the executive function subcomponents in overweight and obese children with a single intervention duration of less than 30 minutes of aerobic exercise (WMD=-0.84, 95%CI=-9.37 to 7.68, P=0.85) ; aerobic exercise with a single intervention duration longer than 30 minutes improved inhibitory function in overweight and obese children (WMD=-10.50, 95%CI=-19.15 to -1.85, P=0.02). When a long-term exercise intervention was carried out (the intervention period was 8 weeks), in contrast to the control group, the aerobic exercise improved interference control in overweight and obese children (WMD=-0.16, 95%CI=-0.18 to -0.14, P

Background The incidence of delay language development in early childhood is high, and the early recognition rate is low, which has a significant negative impact on the early childhood development of other dimensions. The family cognitive environment is a key factor affecting early childhood language development. Objective This study aimed to explore the influence of family cognitive environment on early childhood language development, and provide theoretical basis for promoting early childhood language development from the perspective of community intervention on family cognitive environment. Methods A retrospective case-control study was conducted on 4 307 children who were admitted to a community child healthcare department in Shanghai from 2018 to 2020. The Shanghai Pediatric Development Screening Scale Ⅱ (DenverⅡ) was used for developmental screening, which was conducted at the child's age of 1, 2, and 3 years old. A total of 172 children with delay language development were selected as the case group, and 516 children with normal language development were included in the control group, which was determined by the matching factor of age, with a ratio of the number of children in the case and control groups being 1∶3. The following information of children in both groups were collected, including children's basic birth characteristics, parental demographic characteristics, maternal pregnancy and childbirth characteristics, and family cognitive environment characteristics. The Logistic regression analysis was used to explore the influencing factors of delay early childhood language development. Results A total of 172 children with delayed early language development had an incidence rate of 3.99%, among them ,1-year-old, 2-year-old, and 3-year old children accounted for 33.14% (57 cases), 53.49% (92 cases), and 13.37% (23 cases), respectively. The proportions of male children, children with premature birth, and children with maternal education of high school and below were higher in the case group than those in the control group (P

Background Currently, the treatment of refractory epilepsy (RE) in children is still a difficult point in epilepsy treatment. In China, pirenzapine (PER) is still a new drug for treating RE in children, and there is currently a lack of recommendations for adding PER to the treatment of RE in children. And in Chinese reports, the sample size of RE patients treated with PER is relatively small. Therefore, the efficacy of PER for pediatric RE, especially for young children with RE, still needs to be further studied with a large sample size. Objective To explore the efficacy, possible indications, adverse reactions, and tolerability of PER addition therapy for RE in children. Methods A self-control and retrospective analysis was conducted on children with RE aged 0-18 who were treated at the Women and Children's Hospital, Qingdao University from January 2022 to January 2023. The frequency of seizures at different observation points before and after the addition of PER treatment was compared, and the effective rate of PER was evaluated. Adverse drug reactions and drug retention rates were recorded, and the clinical characteristics of the effective and ineffective groups of PER were analyzed. Results A total of 192 study subjects were included. After adding PER treatment, the effective rates at 12, 24, and 36 weeks were 56.3% (108/192), 62.1% (113/182), and 69.7% (122/175), respectively, and the seizure free rates were 19.3% (37/192), 21.4% (39/182), and 24.6% (43/175). The incidence of adverse reactions was 16.1% (31/192), mainly including dizziness, irritability, weakness, and drowsiness. The last follow-up drug retention rate was 91.1% (175/192). There was a statistically significant difference in the onset age, duration of anti-epileptic treatment, type of origin, seizure form, frequency of seizures before the addition of PER, number of combined anti-epileptic drugs (ASMs), and ketogenic diet/surgical treatment between patients with RE who received continuous medication for 12 weeks (P

To summarize the nursing experience of a 4-month-old critical ill child with perianal necrotizing fasciitis complicated with severe sepsis, refractory septic shock and respiratory failure. The key points of nursing include: Timely assessment of wounds and wound conditions; Strengthening wound care and promote wound healing; Strengthening perianal and perineal nursing to prevent infection; ensuring the safety of the child and avoiding the pressure of the stoma and the wound; Attention should be paid to the use of sedative and analgesic drugs in children, and analgesic evaluation should be strengthened to reduce pain in children. After 24 days of careful care, the child's condition was stable. The wound had healed well, and the child had been transferred to the general ward for continued treatment. (本文总结1例肛周坏死性筋膜炎(NF)危重症患儿的护理经验。护理要点包括: 及时评估伤口和创面的情况, 调整伤口护理措施; 加强伤口护理, 促进伤口愈合; 加强肛周、会阴护理预防感染; 积极变换体位, 避免造口及创面受压; 科学使用儿童镇静镇痛药物, 加强镇痛评估, 减轻患儿疼痛。经过24 d的精心治疗和护理, 患儿病情稳定, 伤口愈合良好, 转往普通病房继续治疗。)

Objective To investigate the imaging diagnosis and differential diagnosis methods for common tumors in the posterior fossa of children, and to propose a flow chart for the diagnosis of common tumors in the posterior fossa of children based on the limited diffusion of DWI according to the idea of localization diagnosis followed by qualitative diagnosis. Methods A total of 118 pediatric patients with posterior fossa tumors who underwent surgical resection in Huashan Hospital, Fudan University from January 2021 to January 2024 were enrolled, and all of them underwent head CT and MRI examinations, and preoperative localization diagnosis and qualitative diagnosis were carried out accordingly. Then, based on whether DWI was diffusion limited, a flow chart for the diagnosis of common tumors in the posterior fossa of children was proposed. Results A total of 118 children with posterior fossa tumors were localization and qualitatively diagnosed, including 41 cases of fourth ventricular tumors, including medulloblastoma (27 cases), pilocytic astrocytoma (7 cases), ependymoma (5 cases), choroid plexus papilloma (one case), and rosette-forming glioneuronal tumor (RGNT, one case). There were 38 cases of brainstem tumors, including 24 cases of diffuse midline glioma, H3 K27 - altered, 5 cases of pilocytic astrocytoma, 3 cases of cavernous hemangioma, 2 cases of pediatric-type diffuse high-grade glioma (prone to diffuse midline glioma, H3 wild type), 2 cases of ganglio glioma, one case of atypical teratoid/rhabdoid tumor (AT/RT), and one case of pediatric - type diffuse low - grade glioma. There were 9 cases of cerebellopontine angle (CPA) tumors, including 3 cases of pilocytic astrocytoma, 2 cases of cholesteatoma, one case of medulloblastoma, one case of diffuse midline glioma, H3 K27-altered, one case of pilomyxoid astrocytoma, and one case of Ewing sarcoma. There were 30 cases of cerebellar tumors, including 15 cases of pilocytic astrocytoma, 7 cases of medulloblastoma, 2 cases of cavernous hemangioma, one case of ependymoma, one case of pediatric-type diffuse low-grade glioma, one case of pediatric-type diffuse high- grade glioma (prone to diffuse midline glioma, H3 wild type), one case of dysembryoplastic neuroepithelial tumor (DNT), one case of hamartoma, and one case of extrarenal rhabdomyomatoid tumor cerebellar metastases. Localization diagnosis, the accuracy of preoperative CT was 93.22% (110/118), while the accuracy of preoperative MRI was 100% (118/118). Qualitative diagnosis, 74 cases (62.71%) had accurate qualitative diagnosis, 23 cases (19.49%) had general diagnosis, and 21 cases (17.80%) had wrong diagnosis. The imaging differential diagnosis of posterior fossa tumors in children focuses on medulloblastoma, pilocytic astrocytoma, ependymoma, and diffuse midline glioma, H3 K27-altered. The incidence of limited diffusion of DWI in medulloblastoma, pilocytic astrocytoma and ependymoma outside the brainstem was 100% (35/35), 4% (1/25) and 5/6, and the difference among the three tumors was statistically significant (Z = - 5.601, P = 0.000). The incidence of limited diffusion of DWI in diffuse midline glioma, H3 K27- altered and pilocytic astrocytoma in the brainstem was 79.17% (19/24) and 1/5, and the difference between the two tumors was also statistically significant (Fisher's exact possibility: P = 0.038). Conclusions The early diagnosis of posterior fossa tumors in children is difficult, and DWI is an important basis for differential diagnosis.

Cerebellar mutism syndrome (CMS) is a prevalent postoperative complication in children following posterior fossa tumor surgery, with a significantly variable incidence rate across different pathological types of tumors, being highest in medulloblastoma (24%-30%). The pathogenesis of CMS remains to be elucidated, but it is believed to be associated with damage to the cerebellocerebral circuits, harm to the fastigial nuclei of cerebellum and periaqueductal gray matter of the midbrain, and alterations in brain networks. Predictive models constructed based on the risk factors of CMS have not yet demonstrated the anticipated stability and have not been widely adopted in clinical settings. Pharmacological treatments are primarily based on clinical experience, yet their efficacy requires further validation, hence there is currently a lack of a clearly effective treatment method; non-pharmacological treatments, such as physical therapy, occupational therapy, and speech therapy, have shown some effect on improving the long - term quality of life. This review summarizes the pathogenesis and therapeutic advances of CMS, and future research should be dedicated to exploring the pathophysiological mechanisms of CMS, constructing more accurate predictive models, devising personalized treatment plans, and enhancing the long-term prognosis for children.

Objective To compare the detection rates of epileptogenic foci in drug - refractory epilepsy children using video electroencephalography (VEEG), MRI and PET. Methods The 24 h and 2 h VEEG, MRI and PET/CT or PET/MRI were conducted for 70 children with drug - refractory epilepsy in Children's Hospital of Nanjing Medical University from January 2020 to April 2022, and Raven's Standard Progressive Matrices (SPM) or Developmental Screening Test for Child under six (DST) based on their age (< 5 or ≥ 5 years old) were assessed for intelligence. Results Among 70 children, 44 seizures were detected during 24 h VEEG, while 31 seizures were detected during 2 h VEEG, and there was statistically significant difference between the two methods (χ2 = 5.760, P = 0.015). The consistency of diagnosing single location/ unilateral abnormalities, bilateral abnormalities, or normal results was poor among VEEG, MRI and PET/CT or PET/MRI (κ = 0.194, P = 0.000), and the difference among the three methods was statistically significant (χ2 = 33.068, P = 0.001). The VEEG (χ2 = 25.000, P = 0.000) and PET/CT or PET/MRI (χ2 = 11.764, P = 0.002) had higher diagnostic capabilities than MRI, and PET/CT or PET/MRI had higher diagnostic capability than VEEG (χ2 = 8.048, P = 0.014). There were 41 children (58.57%) showed mental retardation, among them children with onset age ≤ 2 years had a higher rate compared to those with onset age > 2 years (χ2 = 6.193, P = 0.013), and children with abnormal VEEG background had a higher rate compared to those with normal VEEG background (χ2 = 4.868, P = 0.027). Conclusions The detection rate of epileptiform discharges and clinical seizures can be increased by lengthening VEEG time at each time and increasing the number of times of VEEG. PET/CT or PET/MRI and VEEG can provide localization information of epileptic foci of children whose MRI results are negative. The mental retardation rate of children who have onset age ≤ 2 years and of abnormal VEEG background is higher.