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In children, acute liver failure (ALF) is a severe condition associated with high mortality if an emergency liver transplantation (LT) is impossible. Clinical laboratory parameters and different scores or criteria are used to predict ALF evolution in children. We aimed to assess the role of coagulation factors as predictive markers of poor outcomes in children with ALF.The prospective study included 40 children with ALF, diagnosed based on the Pediatric ALF study group criteria. Patients with emergency LT or deceased were considered with poor outcomes. For all patients, we analyzed clinical and laboratory parameters (including plasma level of factor V (FV), factor VII (FVII), and INR). We calculated the PELD (Pediatric End-stage Liver Disease) and MELD (Model for End-stage Liver Disease) scores, King's College Hospital (KCH), and Clichy criteria. We analyzed their performance in predicting a poor outcome.FV and FVII levels were significantly lower in children with poor outcomes than survivors (18.92 ± 19.95% vs. 10.72 ± 10.21%, p = 0.00139, respectively 46.51 ± 26.05% vs. 10.72 ± 10.21%, p = 0.00014). These parameters varied with ALF etiology, being the lowest in metabolic and infectious causes. The maximum value of INR (INR-max) was higher in children with poor outcomes than survivors (7.05 ± 3.20 vs. 2.96 ± 1.82, p = 0.000007), as it also was for the PELD/MELD score (30.06 ± 15.55 vs. 15.77 ± 9.64, p = 0.00092). FVII, FV, and INR-max had an excellent performance in predicting the poor outcome with an area under the ROC curve of 0.894, 0.816, and 0.861, respectively. KCH criteria had a higher sensitivity than Clichy criteria (92.86% vs. 50%) but lower specificity (53.85% vs. 95%).Our results support the role of coagulation factors (INR, FV, and FVII) as predictive markers for the fatal evolution of children with ALF and underlined the need for monitoring along with the usual liver function tests in children with ALF.

In the last 3 years we have conducted a preliminary study into the use of extracorporeal shock wave therapy (ESWT) in patients with variety of soft tissue disorders. It is a form of treatment that ...

Forty-two patients with subtrochanteric fractures were treated from 1987 through 1990. Of these, 31 patients above 70 years of age (average, 81.9) had nonpathologic low-energy fractures that were internally fixed with a sliding screw-plate device. Subtrochanteric fractures with an associated intertrochanteric component were the most common type. Interfragmentary compression was used in long oblique and spiral fractures and those with large butterfly fragments. Patients were mobilized early and allowed partial weightbearing for 6-8 weeks. There was a 29% mortality rate within 3 months of injury. Of the remaining cases, followed for a minimum of 6 months (average, 11.8 months), 20 (91%) united satisfactorily. There was loss of fixation in one case and one instance of plate fracture. We found, given the special circumstances in elderly patients, that the device was suitable not only for subtrochanteric fractures with an intertrochanteric element but also for four-part fractures and two-part spiral fractures. The sliding screw-plate permitted passage of interfragmentary screws and facilitated medial displacement and collapse, which are valuable in cases with medial comminution in reducing the bending moment on the plate. These factors may help reduce the incidence of plate failure and, coupled with familiarity with its use, make it a reliable implant for such difficult fractures in elderly patients. Language: en

Ninety-three patients who presented at a district general hospital in one year with a suspected or actual scaphoid fracture were studied. Certain changes in the accepted management of scaphoid fractures, particularly the radiology of these fractures, are suggested. These changes could result in significant savings of time and money. A new investigation is described which may prove helpful in the long-term prognostic assessment of patients who have suffered a scaphoid fracture.

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The ferrisilicate molecular sieve analogues of zeolite ZSM-5 can be prepared from ferrisilicate gels containing low-molecular-weight silica species. Precipitation of rust-red iron hydroxide at the high pH necessary for crystallization and complex formation of the iron with the amine impurities present in the crystal-directing agent are avoided by titrating the basic silica solution into the acidic iron-containing solution followed by introduction of the template. Pure white crystalline materials have been prepared in this manner over an SiO2/Fe2O3 range of 15 to 200. The presence of homogeneously dispersed iron(III) in the framework of the crystals has been confirmed. The stability of the framework iron under thermal and hydrothermal conditions is lower than the corresponding aluminosilicate.

The basic knowledge necessary for a European pediatric gastroenterologist/hepatologist/nutritionist is set-out in the training syllabus (TS) of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). We retrospectively compared the topics covered in ESPGHAN's training events between 2013 and 2016 with the basic knowledge TS items. Thirty-six initiatives including e-learning were identified. Twelve (33%) courses focused on gastroenterology, 9 (25%) on hepatology, and 10 (28%) on nutrition. Five (14%) courses covered >1 field and were classified "General." The initiatives covered 12 of 57 (21%) TS items; 31 of 57 items (54%) were partially covered; and 14 of 57 (25%) not covered. Five of 9 e-learning courses covered gastroenterology topics, whereas none covered hepatology topics. ESPGHAN's 3-year educational offer partially met the training needs listed in the TS. A coordinated educational program covering all TS items would harmonize training within Europe and would provide trainees with a professional portfolio for employment purposes.