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To assess the risk of developing thoracogenic scoliosis (THS) in paediatric patients, depending on the side of lateral thoracotomy (LT) and of spine deviation in the coronal plane by means of logistic regression and scoliosis-free survival analyses.A total of 307 consecutive patients undergoing LT were retrospectively reviewed; 32 patients met the inclusion criteria: 1) underwent LT and developed THS; 2) age 15 years at LT; 3) clinical and radiographic follow-up ≥ 5 years. Patients were divided into ipsilateral group (convexity ipsilateral to LT) and contralateral group (convexity contralateral to LT).The mean follow-up was 10 ± 4.7 in the ipsilateral group (n = 13) and 12 ± 4.8 years in the contralateral group (n = 19). The contralateral group underwent LT at a younger age (4.4 vs 6.4 years, p = 0.55), developed more severe coronal deformity (27.8° vs 18.9°, p = 0.15), had higher rate of THS 20° (47.5% vs 38.4%; p = 0.34) and 45° (21.1% vs 0%; p = 0.99). The mean time from LT to THS diagnosis was 4.2 ± 2.9 in ipsilateral group and 5.5 ± 4.2 years in contralateral group. Left-side LT (p = 0.03) and age 5 years (p = 0.01) showed a lower risk of THS diagnosis. The group variable had a statistically significant effect on the risk of developing THS 45° (p = 0.03).In this series, children that developed THS with a convexity contralateral to the side of LT had more severe and progressive coronal spine deformity.III.

Purpose To validate a simplified RNA isolation method from biofabricating hydroxyapatite (HAp) scaffolds seeded with mesenchymal stem cells (MSCs) and to identify the appropriate reference gene. Methods Ten MSCs-HAp composites were used for RNA isolation by methods based on simplified homogenization steps and column-based purification procedures, while the remaining RNA (n = 13) was extracted by traditional single-step isolation methods. The differences between the two procedures regarding the operation time, RNA quantity and quality were evaluated. Quantitative real-time PCR (qRT-PCR) analysis was performed to identify the appropriate reference gene. Results The simplified method showed significant superiority in operation time (P Conclusion The simplified method could extract intact RNA from biofabricating MSCs-HAp scaffolds and was superior to the traditional single-step procedure in operation time, RNA quantity and quality. GAPDH was identified as the most appropriate reference gene in MSCs-HAp scaffold composites due to its high quantity and good stability.

The management of type 3 lateral condyle fractures (LCFs) remains controversial. The main goal of this study was to evaluate the feasibility of closed reduction and percutaneous pinning (CRPP) in patients with type 3 LCFs and to assess the outcome of such injuries according to the type of treatment, CRPP, or open reduction and internal fixation (ORIF).This is a retrospective review of prospectively enrolled children with type 3 LCF managed by CRPP or ORIF between 2018 and 2021. All patients were followed for at least 12 months. Patients were divided into two groups according to the type of treatment, CRPP or ORIF. Demographic characteristics were recorded for all patients. Standard radiographs were used to identify, evaluate, and classify each fracture and to detect the presence of other concomitant bone lesions. The clinical outcome was assessed according to the Hardacre et al. criteria.Seventy-eight children with type 3 LCF were included; 42 were treated by CRPP (53.8%) and 36 by ORIF (46.2%); the mean follow-up time was 17.7 months (range, 12.3-40.9). The baseline characteristics did not differ between the two groups of patients. Overall, successful CRPP could be achieved in 39 out of 42 patients (92.9%). The mean surgical time was 63.4 and 84.5 min in patients treated by CRPP and ORIF, respectively (p = 0.01). Fluoroscopy time was significantly shorter in patients managed by ORIF than in those treated by CRPP (12 versus 40 s, respectively; p 0.001). Clinical outcome according to the Hardacre et al. criteria was excellent in 37 out of 39 (94.4%) and in 35 out of 36 patients (97.2%) treated by CRPP and ORIF, respectively (p = 0.09).CRPP management of paediatric type 3 LCF has clinical and radiographic outcomes similar to ORIF; if satisfactory reduction cannot be achieved by CRPP, conversion to ORIF should be considered.

Fabry disease is an X-linked lysosomal storage disorder caused by loss of alpha-galactosidase A (α-Gal A) activity and is characterized by progressive accumulation of glycosphingolipids in multiple cells and tissues. FLT190, an investigational gene therapy, is currently being evaluated in a Phase 1/2 clinical trial in patients with Fabry disease (NCT04040049). FLT190 consists of a potent, synthetic capsid (AAVS3) containing an expression cassette with a codon-optimized human GLA cDNA under the control of a liver-specific promoter FRE1 (AAV2/S3-FRE1-GLAco). For mouse studies FLT190 genome was pseudotyped with AAV8 for efficient transduction. Preclinical studies in a murine model of Fabry disease (Gla-deficient mice), and non-human primates (NHPs) showed dose-dependent increases in plasma α-Gal A with steady-state observed 2 weeks following a single intravenous dose. In Fabry mice, AAV8-FLT190 treatment resulted in clearance of globotriaosylceramide (Gb3) and globotriaosylsphingosine (lyso-Gb3) in plasma, urine, kidney, and heart; electron microscopy analyses confirmed reductions in storage inclusion bodies in kidney and heart. In NHPs, α-Gal A expression was consistent with the levels of hGLA mRNA in liver, and no FLT190-related toxicities or adverse events were observed. Taken together, these studies demonstrate preclinical proof-of-concept of liver-directed gene therapy with FLT190 for the treatment of Fabry disease.

Familial periodic paralyses (PPs) are inherited disorders of skeletal muscle characterized by recurrent episodes of flaccid muscle weakness. PPs are classified as hypokalemic (HypoPP), normokalemic (NormoPP), or hyperkalemic (HyperPP) according to the potassium level during the paralytic attacks. HypoPP is an autosomal dominant disease caused by mutations in the CACNA1S gene, encoding for Cav1.1 channel (HypoPP-1), or SCN4A gene, encoding for Nav1.4 channel (HypoPP-2). In the present study, we included 60 patients with a clinical diagnosis of HypoPP. Fifty-one (85%) patients were tested using the direct sequencing (Sanger method) of all reported HypoPP mutations in CACNA1S and SCN4A genes; the remaining 9 (15%) patients were analyzed through a next-generation sequencing (NGS) panel, including the whole CACNA1S and SCN4A genes, plus other genes rarely associated to PPs. Fifty patients resulted mutated: 38 (76%) cases showed p.R528H and p.R1239G/H CACNA1S mutations and 12 (24%) displayed p.R669H, p.R672C/H, p.R1132G/Q, and p.R1135H SCN4A mutations. Forty-one mutated cases were identified among the 51 patients managed with Sanger sequencing, while all the 9 cases directly analyzed with the NGS panel showed mutations in the hotspot regions of SCN4A and CACNA1S. Ten out of the 51 patients unresolved through the Sanger sequencing were further analyzed with the NGS panel, without the detection of any mutation. Hence, our data suggest that in HypoPP patients, the extension of genetic analysis from the hotspot regions using the Sanger method to the NGS sequencing of the entire CACNA1S and SCN4A genes does not lead to the identification of new pathological mutations.

Background and purpose Initial cardiovascular fingolimod effects might compromise baroreflex responses to rapid blood pressure (BP) changes during common Valsalva-like maneuvers. This study evaluated cardiovascular responses to Valsalva maneuver (VM)-induced baroreceptor unloading and loading upon fingolimod initiation. Patients and methods Twenty-one patients with relapsing-remitting multiple sclerosis performed VMs before and 0.5, 1, 2, 3, 4, 5, and 6 hours after fingolimod initiation. We recorded heart rate (HR) as RR intervals (RRI), systolic and diastolic BP (BPsys, BPdia) during VM phase 1, VM phase 2 early, VM phase 2 late, and VM phase 4. Using linear regression analysis between decreasing BPsys and RRI values during VM phase 2 early, we determined baroreflex gain (BRG) reflecting vagal withdrawal and sympathetic activation upon baroreceptor unloading. To assess cardiovagal activation upon baroreceptor loading, we calculated Valsalva ratios (VR) between maximal and minimal RRIs after strain release. Analysis of variance or Friedman tests with post hoc analysis compared corresponding parameters at the eight time points (significance: p Results RRIs at VM phase 1, VM phase 2 early, and VM phase 2 late were higher after than before fingolimod initiation, and maximal after 4 hours. Fingolimod did not affect the longest RRIs upon strain release, but after 3, 5, and 6 hours lowered the highest BPsys values during overshoot and all BPdia values, and thus reduced VRs. BRG was slightly higher after 3 and 5 hours, and significantly higher after 4 hours than before fingolimod initiation. Conclusions VR-decreases 3–6 hours after fingolimod initiation are physiologic results of fingolimod-associated attenuations of BP and HR increases at the end of strain and do not suggest impaired cardiovagal activation upon baroreceptor loading. Stable and at the time of HR nadir significantly increased BRGs indicate improved responses to baroreceptor unloading. Thus, cardiovascular fingolimod effects do not impair autonomic responses to sudden baroreceptor loading or unloading but seem to be mitigated by baroreflex resetting.

To assess skull bone thickness from birth to skeletal maturity at different sites to provide a reference for the correct selection of pin type and pin placement according to age. 270 children and adolescents (age: 0–17 years) with a normal CT scan obtained at Emergency Department for other medical reasons were included. Skull thickness was measured on the axial plane CT scans at eight different sites of the vault: midline anterior (A) and posterior (P), right and left lateral (L), antero-lateral (AL), postero-lateral (PL). From birth to skeletal maturity, L thickness was increased significantly less (+ 58%) compared with AL (+ 205%), P (+ 233%), PL (+ 247%), and A (+ 269%) thickness (P

This study aims to evaluate (1) the probability to achieve normal pelvic radiographs in children with developmental dysplasia of the hip (DDH) treated by closed reduction and (2) the amount of time needed to achieve normal pelvic radiographs and to assess what factors influence both probability and time to achieve normal radiographic parameters following CR and spica cast immobilization for DDH. We retrospectively reviewed 436 patients (393 girls, 43 boys; 507 hips) with DDH treated by closed reduction (CR). Tonnis grade, AVN, acetabular index (AI), centre-edge angle (CEA), and Severin radiographic grade were evaluated on plain radiographs. Criteria to rate pelvis radiographs as normal were established. Cox regression was used to evaluate the factors influencing the probability and the time to achieve normal radiographs. According to our criteria, 167 hips (32.9%) achieved normal radiographic parameters during follow-up. The overall amount of time to achieve normal pelvis radiographs was 36.1 ± 15.5 months. Patients older than 24 months of age at the time of CR needed longer time to achieve normal radiographic parameters (55.2 ± 28 months) compared with other age groups. Cox regression analysis suggested the overall cumulative probability of recovery increased by 46% at five years following CR, then it tended to plateau with an annual increase less than 5%. Age older than 24 months, bilateral dislocation, pre-operative AI greater than 40°, and AVN were risk factors for reduced probability of achieving normal radiographic parameters. The cumulative probability of achieving normal pelvis radiographs increases linearly during the first five years following CR, then it tends to plateau. Age older than 24 months and Tonnis grade III and IV are associated with longer time to achieve normal radiographic parameters. Age older than 24 months, bilateral dislocation, pre-operative AI greater than 40°, and AVN are risk factors for reduced probability of achieving normal radiographic parameters in children with DDH treated by closed means.

To evaluate the correlation between avascular necrosis (AVN) and the amount (severity) and direction (translation and angulation) of initial displacement of pediatric femoral neck fractures. We retrospectively reviewed 108 pediatric patients (mean age 10.3 ± 4.1 years) with femoral neck fractures. The amount of initial translation (T) and angulation (A) was measured on anteroposterior (AP; TAP% and AAP) and lateral (TL% and AL) radiographs. The direction of translation was determined on AP (medial or lateral) and lateral radiographs (anterior or posterior). Furthermore, the presence of a comminuted medial cortex on the AP pelvis radiograph was also recorded. Logistic regression analysis, receiver operating characteristic (ROC) curve analysis, student’s t tests, and chi-square tests were used to evaluate the correlation between AVN and the severity and direction of displacement. Twenty-eight out of 108 hips (25.9%) developed AVN of the femoral head. Logistical regression analysis indicated that TAP%, TL%, AAP, and AL were risk factors for AVN (P < 0.05). The analysis of ROC curves found that TAP% over 37.4% and TL% over 29% were the cut-off values for an increased incidence of AVN; similarly, AAP over 8° and AL over 18.6° were the cut-off values for an increased incidence of AVN. The amount of initial translation is a better predictor of AVN than angulation is; fractures with posterior translation (P = 0.002) and/or medial comminution had a significantly higher incidence of AVN (P = 0.005). The mean diagnostic accuracy of translation (74–75%) was significantly higher than that of angulation (65–66%). Displacement severity and direction are important radiological parameters to be assessed in children with femoral neck fractures. Initial translation better predicts AVN than angulation does. Posterior translation and medial comminution are associated with an increased risk of AVN.

Extra-articular proximal femur fractures (EPFF) remain challenging for their intrinsic instability. The aim of this study is to evaluate the results of elastic stable intramedullary nailing (ESIN) of extra-articular proximal femur fractures in children and adolescents. A retrospective monocentric study of children treated by ESIN for EPFF between 2012 and 2018 was conducted. We included all patients sustaining a fracture within 10% of the femur length below the lesser trochanter. Studied data were age, sex, femur length, fracture distance below the lesser trochanter, number of days of hospitalization, time to nail removal, and complications. Beaty’s criteria and the titanium elastic nailing (TEN) outcome measure scale were used to evaluate radiologic outcome and assess clinical recovery, respectively. A total of 24 cases were reviewed (18 males, 6 females). Mean age was 8.23 years (range 5–13). Mean duration of hospitalization was 3.7 days (range 2–12). Mean time to nail removal was 28 weeks (range 12–53). Malalignment was observed in five patients, but in all cases, angulation did not exceed 10°. No limb length discrepancy was observed. Twenty out of 24 patients had excellent Beaty’s radiological and TEN clinical outcome scores. No poor results were observed. The results of our study show that good outcomes following surgical treatment by ESIN should be expected in children younger than 14 years of age with displaced EPFF. Excellent radiological and clinical outcomes were observed in 83.7% of the cases, with a low rate of complications and short hospital stay.

This study aimed to investigate the radiographic outcomes, rate of redislocation, and avascular necrosis of proximal femoral epiphysis (AVN) in patients aged 24 to 36 months with developmental dysplasia of the hip (DDH) treated by closed reduction (CR) and spica cast immobilization in human position. We reviewed the medical records of 39 patients (51 hips) aged 24 to 36 months with DDH treated by CR and spica cast immobilization in human position. The Tonnis grade, rate of redislocation and AVN, acetabular index (AI), centre-edge angle (CEA), and Severin radiographic grade were evaluated on plain radiographs. Among the included 39 patients (51 hips), 15 hips (29.4%) were Tonnis grade II, 24 hips (47.1%) were grade III, and 12 hips (23.5%) were grade IV. In 47 hips (92.2%), the ossific nucleus was present at the time of CR. Stable reduction was achieved by CR in 39/51 hips (76.5%) and redislocation occurred in 12/51 hips (23.5%). Among the 12 hips that redislocated, 11 underwent open reduction and one repeated CR. Two out of 40 hips (5%) treated by CR developed AVN. Overall, 54.6% of the hips had satisfactory outcomes (39.2% Severin type I and 17.6% type II), while 45.4% had unsatisfactory outcomes (39.2% Severin type III and 3.9% type IV). Of the 40 hips treated by CR, 57.5% and 42.5% of cases had satisfactory outcomes and residual acetabular dysplasia, respectively. Six out of 11 hips (54.6%) treated by open reduction and pelvic osteotomy had satisfactory outcomes. Our study showed that stable CR could be achieved in 76.5% of patients aged 24 to 36 months with DDH at the time of index procedure. Satisfactory outcomes can be expected in 56.4% of the cases (5.0% AVN rate), although late acetabular dysplasia may develop in 43.6% of the hips.

The thoracic spine, the chondral and osseous ribs, and the sternum together make up the thoracic cage. These elements are strictly correlated, although their growth is not synchronous. The purpose of this study is to provide a comprehensive data set of thoracic dimensions and non-invasive volumetric assessment in a large cohort of males and females from early childhood to young adult age.In all, 622 healthy individuals (406 girls, 216 boys) aged 6-18 years were consecutively enrolled between 2006 and 2016. All had to be healthy with no history of spinal deformity, or any lung, cardiovascular, systemic or neuromuscular disease. The optical ORTEN system for trunk surface data acquisition was used to calculate thoracic cage volume (V) and perimeter (Pe), anterior-posterior depth (AP) and transverse diameter (TD), AP/TD ratio, sternal length (St), and T1-T12 distance (Tle) in all patients.The overall average age was 11.1 ± 2.5 years (4-18) for girls and 11.0 ± 3.1 years (4-18) for boys. Average growth parameters were: standing height 146.2 ± 14.6 cm (103-172) for girls and 146.4 ± 20.0 cm (94-192) for boys, sitting height 75.4 ± 8.6 cm (61-91) for girls and 75.5 ± 10.3 cm (60-99) for boys, weight 37.6 ± 10.4 kg (16-65) for girls and 38.3 ± 14.3 kg (13.7-104) for boys, BMI 16.7 ± 3.7 (18.5-26) for girls and 17.0 ± 3.3 (18.7-34.3) for boys. At age 6-8 years: V was 52.5% of its final size in girls and 44.9% in boys; Pe was 80.2% its final length in girls and 76.8% in boys; St reached 68% of its final size in girls and 66.9% in boys; Tle reached 73.3% of its final length in girls and 71.2% in boys. At skeletal maturity, thoracic cage volume in boys was 19.4% greater than in girls (p 0.05). AP/TD ratio remained 1 in all age groups and did not differ between genders (p 0.05).Growth of the thoracic cage is shown to be a gradual process that is more linear than previously reported. Only small increases in annual growth rates were observed during the pubertal growth spurt. The most important events characterizing thoracic cage development occurred during the first few years of postnatal growth. The circular cross-section of the very young child's thorax reached adult-like proportions together with its ovoid shape before age 6 years.

Acoustophoretic microfluidic devices are promising non-contact and high-throughput tools for particle manipulation. Although the effectiveness of this technique has been widely demonstrated for applications based on micrometer-sized particles, the manipulation and focusing of sub-micrometer ones is challenging due to the presence of acoustic streaming. In this article, our study has the aim to investigate and understand which geometrical parameters could be changed to limit the acoustic streaming effect. We numerically study the well-known rectangular cross section of a microfluidic channel and perform a parametric study of the aspect ratio for several particle sizes. The efficiency of the focusing, is explored for different sized particles in order to identify a trend for which the acoustic streaming does not drastically influence the focusing motion of the particles. The possibility to efficiently separate different solid components in liquid suspensions, i.e. the whole blood, is crucial for all applications that require a purified medium such as plasmapheresis or an increase of the concentration of specific subpopulation as the outcome, such as proteomics, cancer biomarker detections and extracellular vesicles separation.

Background Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is a clinical-radiological syndrome that can be related to infectious and non-infectious conditions. The most prominent neurological symptoms are disturbance of consciousness, abnormal speech, delirious behavior, seizures, muscle weakness, ophthalmoplegia, facial nerve paralysis and headache. Here we report the case of a child with MERS presenting with the unusual symptom of bilateral transient blindness. Case presentation A 4-year-old female patient, with a history of fever, abdominal pain, loss of appetite and cough lasted for a few days, experienced 3 episodes of transient bilateral loss of vision with difficulty in walking. Her physical examination showed absence of focal neurological and meningeal irritation signs, although responsiveness was slightly impaired. The ophthalmologic evaluation, including a fundus oculi examination, was negative. The electroencephalogram showed slow activity in the temporo-occipital regions, more evident in the right hemisphere. A lumbar puncture was performed and cerebrospinal fluid analysis revealed normal glycorrhachia, cell counts, protein levels and IgG index. Magnetic resonance imaging of the brain showed a signal alteration in the splenium of the corpus callosum, without contrast enhancement. This finding was suggestive of a reversible cytotoxic lesion. Empiric antiviral treatment with acyclovir and intravenous dexamethasone was initiated. Polymerase chain reaction search for neurotropic viral nucleic acid sequences in the cerebrospinal fluid was negative, while a low number of HHV-6 DNA copies was detected in the blood. Electroencephalograms were repeated in the following days, showing a progressive normalization of the pattern. The child was discharged without symptoms after 10 days of treatment with oral corticosteroids. After 40 days, brain magnetic resonance imaging showed a complete normalization of the signal alteration in the splenium of the corpus callosum. Conclusion Transient blindness was reported as an initial symptom of MERS in a few children. To date, there is no evidence of effective treatment methods. Nonetheless, MERS diagnosis provides pediatricians with valuable prognostic information in order to reassure patients and their families about the good outcome of this disease.

ICD in primary prevention reduced mortality in patients with heart failure (HF); however, in about 80% of the ICD recipients an event requiring a device intervention will never occur. Thus, a reliable screening test included in a multiparametric approach to appropriately select patients to ICD implantation is increasingly required. Aim of the work was to assess if the Iodine-123 Meta-Iodobenzylguanidine scintigraphy (123I-mIBG) could be useful to identify patients with HF who would not benefit from the ICD implantation because at low risk of arrhythmias. This is a retrospective multicentre study on patients undergoing 123I-mIBG from February 2012 to December 2015. Inclusion criteria where: age ≥ 18 years old, LVEF ≤ 35% with idiopathic or ischemic heart disease, no previous malignant ventricular arrhythmias. Patients were divided in two groups based on of late H/M < or ≥ 1.60 on 123I-mIBG. Primary end-point was occurrence of malignant arrhythmias. Secondary end-point was occurrence of cardiac death and hospitalization for worsening HF. MACE were mortality and malignant arrhythmias. Eighty-one patients were enrolled (mean age: 69 years). On 123I-mIBG, 54 patients had late H/M

Background: It is uncertain whether single bone fixation is comparable to both bone fixation in the treatment of unstable both bone forearm fractures in children. Materials and Methods: A systematic review using PubMed, Embase, and Cochrane Library database searches was performed on October 1, 2015 on English language scientific literature only. Clinical study designs comparing single bone fixation with both bone fixation of pediatric both bone forearm fractures were included. Studies of only one treatment modality were excluded from the study. Studies eligible for inclusion were assessed using the risk of bias tool for nonrandomized studies. Results: Metaanalysis points to no significant differences in re-angulation, loss of rotation, union time and complications between single bone and both bone fixation. However, the published research lacks quality. Conclusions: Despite scattered evidence and small sample sizes, the metaanalysis suggests single bone fixation can be considered a suitable alternative for both bone forearm fractures in children, as it carries less time in surgery and less cost without compromise in final functional outcome compared to double-bone fixation.

Increased femoral anteversion can be associated with hip instability, redislocation after closed reduction, and subsequent early degenerative arthritis. Our study compared proximal femoral anteversion of affected and unaffected sides of patients with unilateral developmental dysplasia of the hip (DDH) on two-dimensional computed tomography. The primary aim was to evaluate whether femoral anteversion at the time of treatment affected the outcome of patients with unilateral DDH treated by closed reduction.A retrospective review of 89 patients (82 females; 53 left; mean age: 26.6 months) with unilateral DDH was performed. Anteversion angle (AA) of the femur and acetabular index (AI) of both affected (AAa; AIa) and unaffected (AAu; AIu) hips were measured on two-dimensional CT scan performed no more than seven days prior to the index surgical procedure.Among the 89 patients, 50 underwent closed reduction (56.2%), 38 underwent open reduction with or without pelvic osteotomy (42.7%), and one patient refused treatment (1.1%). Overall, the mean AAa was 28.1° ± 10.2° (range: 6.3°-54°) and mean AAu was 25.2° ± 9.9° (range: 1.9°-52.5°) (t = 3.2, p = 0.002). Tönnis type 2 hips did not show any statistically significant difference between AAa and AAu (p = 0.386), while Tönnis types 3 and 4 hips had significantly higher AAa than did AAu (t = 3.7, p = 0.001). There were significant correlations between age and AAa (coefficient = 0.4; p 0.001) and AAu (coefficient = 0.304; p = 0.004). Correlation analysis showed that AIa did not improve with age in any Tönnis group (r: - 0.24, p = 0.823; F = 0.039, p = 0.962). AAa, AIa, AAD, AID, and Tönnis grade distribution were similar in patients with good (no redislocation) and poor outcomes (redislocation) (p 0.05).In patients with unilateral DDH, anteversion angle (AA) was found to be significantly different between affected and unaffected sides. However, the difference had very limited or no clinical significance, as redislocation/sub-luxation was not influenced by AA values.

In children older than 5 years with a mild form of Legg–Calve–Perthes disease, the outcome is difficult to predict. In this study, we retrospectively correlated gadolinium-enhanced subtracted (DGS) and diffusion (DWI) MRI findings to the radiographic assessment according to the Catterall and Herring et al. classifications and to the final score according to Stulberg et al.: the aim was to identify a precocious, simple, and objective criterion to differentiate between forms evolving favourably and forms requiring an early surgical treatment in order to avoid femoral head deformity and subsequent osteoarthritis. Twelve boys with unilateral mild femoral head involvement (Catterall grade 2 or grade 3) underwent DSG and DWI MR during the early phase of the disease. The absence of enhancement of the external pillar on DSG MRI and the presence of metaphyseal hyperintensity on DWI were considered to be the signs of poor outcome. These findings were correlated with the Catterall and Herring et al. classifications at the initial sclerotic stage and early fragmentation phase and with the Stulberg et al. classifications at least 5 years after the onset of the disease. DSG MRI findings correctly discriminated three out of four patients with a good outcome but underestimated two out of eight patients with a poor outcome. DWI findings correlated with the Catterall and Herring et al. classifications in 12 out of 12 cases. In only one case, DWI findings did not correlate with the Stulberg et al. classification. DWI MR provides an objective and accurate prognostic criterion that is relatively easy to recognise. DGS MR findings are less accurate, thus underestimating the gravity of the disease in one-fourth of the patients with a poor outcome.

Our objective was to find the best predictor of late residual acetabular dysplasia in developmental dysplasia of the hip (DDH) after closed reduction (CR) and discuss the indications for secondary surgery.We retrospectively reviewed the records of 89 patients with DDH (mean age 16.1 ± 4.6 months; 99 hips) who were treated by CR. Hips were divided into three groups according to final outcomes: satisfactory, unsatisfactory and operation. The changes in the acetabular index (AI), centre-edge angle of Wiberg (CEA), Reimer's index (RI) and centre-head distance discrepancy (CHDD) over time among groups were compared. The power of predictors for late residual acetabular dysplasia of AI, CEA, RI and CHDD at different time points was analysed by logistic regression analysis. Receiver operating characteristics (ROC) curve analysis was used to determine cutoff values and corresponding sensitivity, specificity and diagnostic accuracy for these parameters.Both AI and CEA improved in all groups of patients following CR. In the satisfactory group, AI progressively decreased until seven to eight years, while CEA increased until nine to ten years (P 0.05). In the unsatisfactory group, AI and CEA ceased to improve three and two years after CR, respectively (P 0.05). CEA and RI were significantly better in the satisfactory group compared with the unsatisfactory group at all time points (P 0.05). Following CR, both RI and CHDD remained stable over time in all groups. Final outcome following CR could be predicted by AI, CEA and RI at all time points (P 0.01). Cutoff values of AI, CEA and RI were 28.4°, 13.9° and 34.5%, respectively, at one year and 25°, 20° and 27%, respectively, at two to four years post-CR. A total of 80-88% of hips had an unsatisfactory outcome if AI 28.4° and25 at one and two to four years following CR, respectively. However, if CEA was less than or RI was larger than the cutoff values at each time point, only 40-60% of hips had an unsatisfactory outcome. Mean sensitivity (0.889), specificity (0.933) and diagnostic accuracy (92.1%) of AI to predict an unsatisfactory outcome were significantly better compared with CEA (0.731; 0.904; 78.2%) and RI (0.8; 0.655; 70.8%) (P 0.05).Satisfactory and unsatisfactory hips show different patterns of acetabular development after reduction. AI, CEA and RI are all predictors of final radiographic outcomes in DDH treated by CR, although AI showed the best results. AI continues to improve until seven years after CR in hips with satisfactory outcomes, while it ceases to improve three to four years after CR in hips with unsatisfactory outcomes. According to our results, surgery is indicated if AI28° 1 year following CR or AI25° two to four years after CR. CEA and RI should be used as a secondary index to aid in the selection of patients requiring surgery.

Hemiplegic cerebral palsy patient may present a shorten leg on the hemiplegic side that afflicts negatively the kinematic of the uninvolved limb. Thus, the aim of this study was to investigate the modification of gait kinematic after epiphysiodesis for limb equalization and secondary to verify the prediction of correction. Skeletally immature hemiplegic patients with a minimum limb leg discrepancy (LLD) of 2.5 cm were treated with epiphysiodesis of the unaffected knee and clinically evaluated with Edinburgh visual gait score (EVGS). Green–Anderson curve was used to predict time decision for correction. Ten LLD patients were evaluated with the Edinburgh visual gait score (EVGS) before and after surgery. Mean age was 12.7 years, mean follow-up was 6.7 years, and mean LLD was 3.4 cm before surgery and 1.2 cm at final follow-up. After lower limb equalization surgery, improvement in gait kinematics was observed on both the uninvolved and hemiplegic limb of hemiplegic cerebral palsy patients (p