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Krzysztof Czyzewski,1 Magdalena Dziedzic,1 Malgorzata Salamonowicz,2 Jowita Fraczkiewicz,2 Olga Zajac-Spychala,3 Agnieszka Zaucha-Prazmo,4 Jolanta Gozdzik,5 Przemyslaw Galazka,6 Natalia Bartoszewicz,1 Ewa Demidowicz,1 Jan Styczynski1 1Department of Pediatric Hematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland; 2Department of Pediatric Transplantation, Oncology and Hematology, Medical University, Wroclaw, Poland; 3Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland; 4Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Medical University, Lublin, Poland; 5Stem Cell Transplant Center, University Children’s Hospital, Department of Clinical Immunology and Transplantology, Jagiellonian University Collegium Medicum, Krakow, Poland; 6Department of General and Oncological Surgery for Children and Adolescents, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, PolandCorrespondence: Krzysztof CzyzewskiDepartment of Pediatric Hematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Ul. Sklodowskiej-Curie 9, Bydgoszcz 85-094, PolandTel +48 52 585 48 60Fax +48 52-585 4087Email k.czyzewski@cm.umk.plObjective: The analysis of epidemiology, risk factors and outcome of viral infections in children and adolescents after hematopoietic cell transplantation (HCT).Methods: In this multicenter nationwide study a total of 971 HCT procedures (741 allo-HCT; 230 auto-HCT) over a period of 6 years were analyzed.Results: During this period 801 episodes of viral infections were diagnosed in 442 patients. The incidence of viral infections was 57.9% in allo-HCT and 4.8% in auto-HCT patients. The most frequent infections after allo-HCT were caused by cytomegalovirus (CMV), polyoma BK virus (BKV) and Epstein–Barr virus (EBV). The majority of infections occurred within the first 4 months after allo-HCT and over 80% required pharmacotherapy or symptomatic therapy. The median time of treatment of specific viral infection ranged from 7 (for EBV) to 24 (for CMV) days. The highest mortality was observed in case of CMV infection. The risk factors for viral infections were allo-HCT, acute leukemia, acute and chronic graft versus host disease (a/cGVHD), and matched unrelated donor (MUD)/mismatched unrelated donor (MMUD)-HCT. The risk factor for death from viral infection were CMV-IgG seropositivity in acute lymphoblastic leukemia recipient, and MUD/MMUD-HCT. The incidence of EBV infection requiring pre-emptive treatment with rituximab in allo-HCT children was 19.3%. In 30.8% cases of EBV infection, these episodes were preceded by other viral infection and treated with antivirals, which did not prevent development of EBV-DNA-emia with need of rituximab treatment in 81.5% cases. In 47.7% of these cases, GVHD was a factor enabling development of significant EBV-DNA-emia during antiviral therapy of other infection.Conclusion: We have shown that antiviral drugs do not prevent EBV reactivation in allo-HCT pediatric patients.Keywords: children, EBV, HCT, infectious complications, risk factors analysis, viral infections

Background: The first dorsal compartment of the wrist includes tendons of abductor pollicis longus (APL) and extensor pollicis brevis (EPB). However, many studies have showed multiple anatomical variations including anomalies in the number of both APL and EPB tendons and presence of intercompartmental fibro-osseous septum. Unfortunately, studies describing those variations are not consistent, hence, the aim of this study was to provide most accurate data about these anatomical variations in the population, using systematic review and meta-analysis. Materials and methods: For this purpose, PubMed, Scopus, Web of Science, Embase and a number of minor online libraries were searched. Articles which included exact data about the number of APL or EPB tendons or a presence of intercompartmental septum were qualified for a more precise evaluation. Therefore, out of 1629 studies initially evaluated, 68 were finally included in this meta-analysis. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: A total of 5229 studied wrists have been included in this study. Double APL and single EPB are the most common variations of tendons in the first dorsal compartment, both in cadavers and patients with de Quervain’s disease, with no statistically significant differences between those two groups. Presence of intercompartmental fibro-osseus septum is much more common in patients with de Quervain’s disease than in cadavers. Conclusions: Our results should improve the awareness of anatomical variations in the first dorsal compartment, which in turn should have impact on treatment of de Quervain’s disease in clinical practice. [ABSTRACT FROM AUTHOR]

Background: The goal of the present study was to provide accurate data on the prevalence and morphometrical aspects of the cranio-orbital foramen (COF), which can surely be of use by surgeons performing procedures on the lateral orbit. Furthermore, the embryology and the clinical significance of this osseous structure were thoroughly discussed. Materials and methods: Major online medical databases such as PubMed, Scopus, Embase, Web of Science, and Google Scholar were searched to find all relevant studies regarding COF. Results: Eventually, a total of 25 studies that matched the required criteria and contained complete and relevant data were included in this meta-analysis. The pooled prevalence of COF was found to be 48.37% (95% confidence interval [CI]: 41.67–55.10%). The occurrence of the COF unilaterally was set to be 71.92% (95% CI: 41.87–96.97%). The occurrence of the COF bilaterally was set at 26.08% (95% CI: 3.03–58.13%). Conclusions: In conclusion, we believe that this is the most accurate and up-to- -date study regarding the anatomy of the COF. The COF is prevalent in 48.37% of the cases, and it is most frequently unilateral (73.92%). Furthermore, the prevalence of accessory COFs was found to be 16.72%. The presence of these foramina may represent a source of haemorrhage that ophthalmic surgeons should be aware of when performing procedures in the lateral part of the orbit. [ABSTRACT FROM AUTHOR]

Background: Divided zygoma (DZ) is an important structure in the midfacial region. The anatomy of DZ is poorly researched, but knowledge about this entity could be useful during posttraumatic facial reconstructions. The aim of this study was to estimate the prevalence and anatomy of DZ in different regions around the world. Therefore, the authors performed a meta-analysis, including all studies that report extractable data on the DZ. Materials and methods: The main online medical databases such as PubMed, EBSCO, ScienceDirect, Web of Science, SciELO, BIOSIS, Current Content Connect, Korean Journal Database and Russian Citation Index, were utilised to gather all studies on anatomical characteristics, prevalence, symmetry, and a number of divisions of zygomatic bone. Results: A total of 20 studies were included in this meta-analysis. Data were grouped and analysed in five categories: (1) prevalence of DZ bone, (2) prevalence of DZ skulls, (3) gender prevalence of DZ with sides, (4) divisions of zygomatic bone, (5) symmetry of DZ. Conclusions: In conclusion, the authors of the present study believe that this study can be considered an up-to-date meta-analysis regarding the prevalence, divisions, and symmetricity of the DZ. The data provided by the present study may be useful information for physicians in recognizing the DZ of the fracture and may be important information during zygomatic bone osteotomy. Detailed anatomical knowledge of the midfacial region can prevent surgical complications when operating in this area. [ABSTRACT FROM AUTHOR]

The aim was to evaluate the incidence, clinical course, and outcome of adenoviral infection (AdVI) in pediatric patients diagnosed and treated due to cancer and in pediatric recipients of hematopoietic stem cell. Over a 72‐month period, all‐in 5599 children with cancer: 2441 patients with hematological malignancy (HM) and 3158 with solid tumors (ST), and 971 patients after transplantation: 741 after allogeneic (allo‐HSCT) and 230 after autologous (auto‐HSCT) were enrolled into the study. Among cancer patients, 67 episodes of AdVI appeared in 63 (1.1%) children, including 45 (1.8%) with HM and 18 (0.6%; P <.001) with ST. Within transplanted patients, AdVIs were responsible for 88 episodes in 81 (8.3%) children (P <.001), including 78 (10.5%) patients after allo‐HSCT and 3 (1.3%) after auto‐HSCT. Time to develop AdVI was short, especially after allo‐HSCT. The most common clinical manifestation in cancer patients was enteritis diagnosed in 63 (94.0%) cases, while among HSCT recipient asymptomatic adenoviremia was found in 36 (40.9%) cases and the most common clinical manifestation was urinary tract infection. Cancer patients with disseminated disease, as well as HSCT recipients with either asymptomatic viremia or disseminated disease, received antiviral treatment. The most commonly used first‐line therapy was cidofovir. None of the cancer patients died due to AdVI, while within HSCT recipients three patients developed disseminated adenoviral disease and died despite antiviral treatment. In cancer patients, AdVIs are rare and associated with very good prognosis even without specific treatment. However, in allo‐HSCT recipients, disseminated disease with fatal outcome is more likely to occur. Highlights: Low incidence of HAdV causing less severe infections not requiring antiviral therapy but with satisfactory outcome within cancer patients.In allo‐HSCT recipients disseminated disease requiring antiviral drugs and at risk of fatal outcome is more likely to occur.Monitoring for HAdV in all patients, and especially in those who underwent AdVI prior to HSCT or had MD or MMUD‐HSCT, at early posttransplantation period should be recommended. [ABSTRACT FROM AUTHOR]

Background: Hodgkin (HL) and non‐Hodgkin lymphoma (NHL) represent a spectrum of lymphoid malignancies that are often curable with currently applied treatment regimens; however, 15%‐30% of lymphoma patients still suffer from relapsed or refractory (rel/ref) disease. Although hematopoietic stem cell transplantation (HSCT) improves outcomes of second‐line therapy for lymphoma in childhood, the complication rates in this group of patients, especially infectious complications (IC), remain unclear. Objective: The aim of this population‐based cohort study was a retrospective analysis of incidence, epidemiology and profile of bacterial infections (BI), invasive fungal disease (IFD), and viral infections (VI) in primary or rel/ref lymphoma patients, both HL and NHL. Patients and methods: We subdivided lymphoma patients into three groups: patients with primary conventional chemotherapy/radiotherapy regimens (group A), patients with rel/ref lymphoma treated with second‐line chemotherapy (group B), and rel/ref lymphoma patients who underwent HSCT (group C). The medical records of the patients were biannually reported by each pediatric oncology center, and the data were analyzed centrally. Results: Within 637 patients with primary lymphoma, at least one IC was diagnosed in 255 (40.0%), among 52 patients with rel/ref lymphoma 24 (46.2%) ICs were observed, and in transplanted group, 28 (57.1%) out of 49 children were diagnosed with IC (P =.151). The distribution of etiology of IC differed between the patient groups (A, B, C), with a predominance of BI in group A (85.6% vs 72.0% and 47.9%, respectively), VI in group C (9% and 16.0% vs 46.6%, respectively), and IFD in group B (5.4% vs 12.0% vs 5.5%, respectively). Overall, 500 (68.0%) episodes of bacterial IC were diagnosed in the entire group. Apart from HL patients treated with chemotherapy, in all the other subgroups of patients Gram‐positives were predominant. The rate of multidrug‐resistant bacteria was high, especially for Gram‐negatives (41.1% in group A, 62.5% in group B, and 84.6% in group C). The infection‐related mortality was comparable for each group. Conclusions: The incidence of IC was comparable during first‐ and second‐line chemotherapy and after HSCT, but their profile was different for primary or re/ref lymphoma and depended on the type of therapy. [ABSTRACT FROM AUTHOR]

Aims: Multidrug‐resistant (MDR) bacteria are an emerging cause of morbidity and mortality after haematopoietic stem cell transplantation (HSCT). The aim of the study was to analyse the incidence, clinical characteristics and survival from bacterial infections (BI) caused by MDR pathogens in paediatric HSCT recipients. Methods and Results: Among 971 transplanted patients, BI were found in 416 children between the years 2012 and 2017. Overall, there were 883 bacterial episodes, which includes 85·8% after allo‐HSCT and 14·2% after auto‐HSCT. MDR strains were responsible for half of the total number of bacterial episodes. Over 50% of MDR pathogens were Enterobacteriaceae causing mainly gut infections or urinary tract infections. Conclusions: Regarding HSCT type, we did not find differences in the profile of MDR BI between allo‐ and auto‐HSCT recipients. However, survival in MDR and non‐MDR infections was comparable. Significance and Impact of the Study: The large sample size enables unique analysis and makes our data more applicable to other paediatric HSCT centres. In the absence of local epidemiological data, presented clinical characteristics of MDR‐caused infections may be used to optimize the prophylactic strategies, early identification of infectious complications of MDR aetiology and thus promptly initiate adequate antibiotic therapy and further improve patients' outcome. [ABSTRACT FROM AUTHOR]

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INTRODUCTION: Paramedics often encounter patients with difficult airways requiring emergent airway management. OBJECTIVE: The purpose of this study was to compare intubation utilizing the Airtraq with direct laryngoscopy (DL) in the manikin model. We evaluated the number of attempts, the time to successful intubation, and the Airtraq's learning curve. METHODS: This was a randomized, crossover study involving paramedics. Each participant was given a standardized lecture and a demonstration of the Airtraq device. After a 5-minute practice session on a Laerdal Airway Management Trainer with the Airtraq and DL, participants managed the following four scenarios on a Laerdal SimMan manikin: 1) normal airway; 2) tongue edema; 3) cervical spine immobilization; and 4) repeated normal airway. Results were analyzed using the Wilcoxon signed rank test. RESULTS: Thirty paramedics participated in this study. For scenario 1, there were no significant differences in either the number of attempts or the time to ventilation between the devices. For scenario 2, the mean time to ventilation was significantly faster, and fewer intubation attempts were observed with the Airtraq when compared with DL. For scenario 3, there were no significant differences in number of attempts and time to ventilation. Scenario 4 demonstrated significantly less time to ventilation and fewer intubation attempts with the Airtraq. A significant decrease in time to ventilation was observed with the Airtraq when comparing scenarios 1 and 4. CONCLUSIONS: The Airtraq was shown to be equal to or faster than DL. The Airtraq has a rapid learning curve demonstrated by a significantly decreased time to ventilation between scenarios 1 and 4. [ABSTRACT FROM AUTHOR]

Accelerated atherosclerosis and increased cardiovascular events have been extensively documented in patients with end stage chronic kidney disease.

Adipose tissue is at a point of high interest in medical research, not only as an energy depot, but also because it secretes nearly more than 600 cytokines. These are termed‚ adipokines’. Human adipokines are involved in numerous metabolic processes, including the regulation of appetite, energy expenditure, insulin sensitivity, inflammation and cardiovascular activity. Thus, these could be clinically important as a markers of adipose tissue function and increased metabolic risk. The search for novel adipokines linking obesity to related co-morbidities has become a major topic in obesity research. In such work, there is an increasing need to define their function, their molecular targets and their potential clinical relevance as biomarkers or in the treatment of obesity and other metabolic diseases.

The aim of the study was to assess plasma concentration of catecholamines and asymmetric dimethyl arginine levels and a possible relationship to predict the mortality rates among hemodialysis patients. The study population comprised 27 subjects, aged 65-70 years. Each patient underwent dialysis thrice a week. Furthermore, the median duration of hemodialysis was 3.5 years. Based on the conducted research, it can be concluded that the concentrations of adrenaline and the level of asymmetric dimethylarginine have predictive value of mortality among hemodialysis patients. Of note, lowering plasma asymmetric dimethylarginine concentration may represent therapeutic target for prevention of progressive renal damage.