Joints In Children Research Articles

Uncemented Customized Hollow Stems in Tumor Endoprosthetic Replacement-A Good Opportunity to Protect the Adjacent Joint in Children?

This study aimed to retrospectively analyze the follow-up results of cases in which the adjacent joint was preserved using a custom-made uncemented short-stem design (hollow stem) with optional external flanches in tumor endoprosthetic replacement due to bone sarcomas in 13 patients (with an average age of 9.6 years) between 2017 and 2023. Reconstructions were proximal femur (n = 6), intercalary femur (n = 4), intercalary tibia (n = 2), and proximal humerus (n = 1) tumor prostheses. The hollow body was used distally in 10 of the megaprotheses, proximally in 1, and both proximally and distally in 2 of them. The average distance from the joints was 6 cm in stems with flanches and 11.8 cm in stems without flanches. No aseptic loosening or deep infection was observed during an average follow-up of 34 months. Except for one case with a tibial intercalary prosthesis that needed a revision, all cases were well osteointegrated and all lower extremity cases could bear full weight without pain. In cases where the remaining bone stock after bone resection is insufficient for a standard stem implantation, reconstruction with a patient-specific short hollow-stem design appears to be a good alternative to protect healthy joints with high prosthesis survival and low revision rates in the short-term follow-up.

Diagnosis and Treatment of Varus Posteromedial Rotational Instability of the Elbow Joint in Children: Re-Understanding of the Injury Mechanism Associated With Coronoid Process Fractures.

To investigate the injury mechanism, diagnosis, and treatment of varus-posteromedial rotational instability of the elbow joint in children. According to the diagnostic criteria of varus posteromedial rotational instability of elbow joint, 16 children with coronoid process fractures treated in our department from July 2013 to July 2017 were re-evaluated. There were 14 males and 2 females, aged 7 to 14 years, with an average age of 11.6 years. Eight cases on left and 8 cases on right side. An associated elbow dislocation occurred in 8 of 16 cases. Nine patients were treated with a lateral soft tissue repair only. In 7 other patients in addition to the lateral soft tissue repair, the coronoid process fractures were treated with open reduction and fixation. At the last clinical follow-up, each elbow joint range of motion was recorded, radiographs were obtained, and functional performance was evaluated by the Mayo elbow performance score (MEPS). The average follow-up time was 81.9 months for the 9 patients treated with lateral elbow soft tissue repair. At the last follow-up, 2 of the patients had MEPS scores as excellent, 1 was good, and 6 were rated as moderate or poor. Four patients had a cubitus varus deformity. The average follow-up time was 30.3 months for the 7 patients treated with both soft tissue repair and coronoid fracture stabilization. The elbow joint MEPS scores for each of these 7 patients was excellent at the last follow-up, and no complications such as cubitus varus occurred. The results of the study suggest that children could also develop elbow varus-posterior medial rotational instability injuries under the same mechanism. Although the morbidity rate is low, due to insufficient understanding of the injury mechanism, it is prone to missed diagnosis, misdiagnosis, and delayed treatment, resulting in severe complications such as elbow instability, dislocation, traumatic arthritis, and elbow stiffness. On the contrary, according to the treatment principle of the posterior medial rotational instability of the elbow joint in adult, while the lateral repair is carried out, strong and effective reduction and fixation of the coronoid process fractures are adopted, it is expected that such children with rare elbow injuries can obtain excellent treatment outcomes.

Caregiver strategies before intervention moderate caregiver fidelity and maintenance in RCT of JASPER intervention with autistic toddlers

AbstractBackgroundInterventions facilitated by caregivers have gained popularity among those caring for young children with autism. Instructing caregivers on specific techniques to foster social communication skills in their at‐risk or diagnosed autistic children has the potential to alleviate concerns about their children's development. Moreover, it can offer a more intensive early intervention compared to what community providers alone can deliver. This study seeks to explore the correlation between caregiver strategies employed prior to participating in a caregiver‐mediated intervention and the caregiver's fidelity to the intervention, as well as its sustainability during the follow‐up period and child outcomes. This study constitutes a secondary analysis of a randomized controlled trial that compared the joint attention, symbolic play, engagement, and regulation (JASPER) and Psychoeducational Education Intervention (PEI), revealing significant advancements in children's social communication skills with the JASPER intervention.MethodsEighty‐six children (average age 31.5 months) with ASD and their primary caregivers enrolled in the two armed randomized trial evaluating the effect of JASPER versus PEI. Generalized linear mixed models were used to model the longitudinal trajectories of the outcomes.ResultsResults indicated that caregivers in the JASPER intervention made more gains in overall JASPER strategies and individual domain strategies (environment, prompt, communication, mirrored pacing) compared to the caregivers in PEI (p's < 0.01) from baseline to exit. While both groups regressed some in overall and subdomain strategies at follow‐up, caregivers in the JASPER intervention maintained more overall, and specifically in communication, and mirrored pacing strategies compared to PEI group (p's < 0.05). Further, baseline caregiver strategies moderated the treatment effect of child's joint attention skills from exit to follow‐up (p = 0.002), where JASPER dyads with high caregiver strategy use at baseline continued to improve in JA skills post exit, whereas all other children did not.ConclusionIn summary, understanding caregiver style of interaction before intervention on caregiver fidelity and maintenance from exit to follow up and child progress is important to improving intervention uptake and child outcomes.

The Influence of Temporary Epiphysiodesis of the Proximal End of the Tibia on the Shape of the Knee Joint in Children Treated for Leg Length Discrepancy.

Background: Leg length discrepancy (LLD) is a common problem in the daily clinical practice of pediatric orthopedists. Surgical treatment using LLD temporary epiphysiodesis with eight-plate implants is a minimally invasive, safe, and well-tolerated procedure that provides good treatment effects with a relatively low percentage of complications. The main aim of this retrospective study was to determine the effect of epiphysiodesis on the shape of the proximal tibia. Methods: The retrospective study was based on medical records from 2010 to 2019. Radiographs taken before the epiphysiodesis and at 6-month intervals until the end of the treatment were investigated. A total of 60 patients treated for LLD were included in the study (24 girls, 36 boys). They were divided into three groups depending on the duration of the LLD treatment: group I (18 months), group II (30 months), and group III (42 months of treatment). Radiological parameters were assessed, including the roof angle (D), the slope angles (α and β), and the specific parameters of the tibial epiphysis, namely LTH (lateral tubercle height), MTH (medial tubercle height), and TW (tibial width). Results: The roof angle decreased in all the groups, which was accompanied by an increase in the β or α angle. LTH, MTH and TW also increased, and the differences before and after the treatment for the treated legs were statistically significant in all the studied groups. The greatest change in the shape of the articular surface of the proximal tibia occurred after 42 months of treatment. Conclusions: The study showed that epiphysiodesis affects the proximal tibial articular surface over prolonged treatment. Thus, there is a need for future long-term follow-up studies to elucidate the potential effects of LLD egalization.

Etiology and Nursing Care of Children's Knee Joint Sports Injury Diseases

The objective is to explore the etiology, diagnosis, treatment, and prevention of children's knee joint sports injury. The medical records of hospitalized children with sports injuries from 2019 to 2021 were retrospectively analyzed. The total number of hospitalized children with knee joint sports injury increased from 27 in 2019 to 46 in 2021. The main diseases are meniscus injury, dislocation of patella, avulsion fracture of tibial intercondylar crest, ligament injury, articular cartilage injury, and other diseases. Children's sports injuries occur in different ages groups, with the highest incidence in the age group of 7-14, and the incidence rate of boys is about 1.5 times that of girls. Moreover, the number of knee joint sports injury diseases in children is increasing, especially for school-age children. Low energy injury is the most common cause of injury, but high energy injury may lead to serious knee joint function damage, which should be paid great attention.

Role of Magnetic Resonance Imaging in Concomitant Periarticular Infections in Septic Arthritis of Large Joints in Children: A Systematic Review.

Septic arthritis associated with adjacent infections, presents a diagnostic challenge as the clinical presentation is similar to that of isolated septic arthritis, additional diagnostic tools are needed to detect these infections. The purpose of this study was to examine the effectiveness of magnetic resonance imaging (MRI) for diagnosis of concomitant infection in children with septic arthritis of large joints and its effect on patient outcome and treatment. Electronic literature research of PubMed, Cochrane and Scopus, was conducted in January 2022 using a combination of MeSH, search terms and keywords. The data extracted included the study details, demographic data, the proportion of patients having a concomitant periarticular infection, clinical presentation, blood parameters and culture findings and outcomes. This review included seven studies with 499 patients. The mean age was 7.08 ± 2.38 years in the study. There was a male predominance, with 174 being males (62.36%). The most common joint involved was the hip joint (44.47%). 42.48% had concomitant periarticular infections detected by MRI. Osteomyelitis was the most common infection seen in 209 patients (41.84%). The mean duration of antibiotics given and hospital stay was significantly more in periarticular infections (P > 0.05). 32.5% of the patients with septic arthritis underwent a second surgical procedure whereas 61.11% of patients with periarticular infections underwent second procedure in this review (P > 0.05). The use of MRI to diagnose these complicated infections appears to be beneficial. Multi-centric randomised control trials are needed to investigate the efficacy of MRI and its impact on patient care and outcome.

Diagnostic Accuracy Study of the Pediatric-Specific Ultrasound Scoring System for the Knee Joint in Children With Juvenile Idiopathic Arthritis.

We undertook this study to validate the Pediatric Arthritis Ultrasound Scoring System for the knee joint (PAUSS-knee) in children with juvenile idiopathic arthritis (JIA). Children with JIA were enrolled to prospectively receive a musculoskeletal ultrasound (MSUS) examination of the knee and a physical examination to determine presence/absence of clinical arthritis. MSUS images were scored using the PAUSS-knee, a semiquantitative MSUS scoring system (0-3, normal to severe) for B-mode and power Doppler mode. In addition to MSUS, a subset of participants also received magnetic resonance imaging (MRI) of the knee, which was scored according to the combined Juvenile Arthritis MRI Scoring (JAMRIS) system. Spearman's correlations (rs ) were used to calculate associations between variables. Test characteristics of the PAUSS-knee were calculated with MRI as the reference standard. Inflammatory biomarkers were assessed in synovial fluid from involved knees. Eighty children with JIA contributed 112 MSUSs and 25 MRIs of the knee. Of the knees, 41% (n=46) had clinical evidence of arthritis. The B-mode PAUSS-knee score moderately correlated with clinically determined arthritis (rs = 0.54, P < 0.001) and strongly correlated with the JAMRIS score (rs = 0.75, P < 0.001). Compared with MRI, the area under the curve for the B-mode PAUSS-knee was 0.92. For a cutoff of >1, the B-mode PAUSS-knee had a sensitivity of 83% and specificity of 82%. Biomarker analysis indicates that interleukin-2R levels correlate with PAUSS score. Our data indicate that the PAUSS-knee has excellent accuracy for the diagnosis of arthritis when compared with MRI. The PAUSS-knee has the potential to effectively inform JIA medical decision-making in real time.

Prospective evaluation of ultrasound features of magnesium-based bioabsorbable screw resorption in pediatric fractures.

Bioabsorbable magnesium-based alloy screws release gas upon resorption. The resulting findings in the adjacent soft tissues and joints may mimic infection. The aim of the study was to evaluate the ultrasound (US) findings in soft tissues and joints during screw resorption. Prospectively acquired US studies from pediatric patients treated with magnesium screws were evaluated for screw head visibility, posterior acoustic shadowing, twinkling artifact, foreign body granuloma, gas (soft tissue, intra-articular), alterations of the skin and subcutaneous fat, perifascial fluid, localized fluid collections, hypervascularization, and joint effusion. Sixty-six US studies of 28 pediatric patients (nfemale = 9, nmale = 19) were included. The mean age of the patients at the time of surgery was 10.84years; the mean time between surgery and ultrasound was 128.3days (range = 6-468days). The screw head and posterior acoustic shadowing were visible in 100% of the studies, twinkling artifact in 6.1%, foreign body granuloma in 92.4%, gas locules in soft tissue in 100% and intra-articular in 18.2%, hyperechogenicity of the subcutaneous fat in 90.9%, cobblestoning of the subcutaneous fat in 24.2%, loss of normal differentiation between the epidermis/dermis and the subcutaneous fat in 57.6%, localized fluid collection in 9.9%, perifascial fluid in 12.1%, hypervascularization in 27.3%, and joint effusion in 18.2%. US findings in pediatric patients treated with magnesium screws strongly resemble infection, but are normal findings in the setting of screw resorption. Bioabsorbable magnesium-based alloy screws release gas during resorption. The resulting US findings in the adjacent soft tissues and joints in pediatric patients may mimic infection, but are normal findings. • Bioabsorbable magnesium-based alloy screws release gas upon resorption. • The resulting ultrasound findings in children's soft tissues and joints closely resemble those of soft tissue infection or osteosynthesis-associated infection. • Be familiar with these ultrasound findings in order to avoid inadvertently misdiagnosing a soft tissue infection or osteosynthesis-associated infection.

How Does Joint Media Engagement Affect the Development of Executive Functions in 5- to-7 year-old Children?

Executive functions are actively developing in children of preschool age. Executive functions' development is also influenced by the way children are using digital devices. Joint media engagement is one of the parameters of digital device usage that has been poorly studied so far, although this is of great importance from the point of view of cultural-historical psychology. Our research aimed to explore the association between young children's development of executive functions over a year, and their joint media engagement with parents and siblings in preschool children. Four hundred ninety (490) typically developing children (52% of them were boys) participated in the study. It was a longitudinal study: during the first stage, the children were 5-6 years old; the second stage followed one year later. The NEPSY-II subtests (Inhibition, Statue, Memory for Designs, Sentences Repetition) and the Dimensional Change Card Sort were used to assess executive functions. A questionnaire for mothers was used to get information about the children's joint media engagement and screen time. Children who watched video content and played video games together with their siblings developed more inhibitory control over the year than those children who did it alone. Co-viewing of video content with parents was associated with a decrease in cognitive flexibility over the year, as opposed to watching it alone. The obtained data allows us to conclude that joint media engagement is important for executive functions development, and that there are optimal formats of joint media engagement. Based on the limitations of this study, recommendations for future research were suggested.

THE KNEE JOINT IS THE ACHILLES' HEEL OF A CHILD'S BODY

The study objective was to draw practicing physicians’ attention to the risk of knee joint disorders in children during intensive growth to ensure timely detection and treatment. Materials and Methods. We analyzed the results of studies on the diseases of the knee joint carried out by modern scientists over the past ten years. We also took into account the clinical observations of children receiving inpatient treatment at the regional children's hospital. The examination methods were radiography, computer tomography, magnetic resonance imaging, and ultrasound. Results and Discussion. During growth, a child's knee joint is subjected to enormous loads and is sensitive to external and internal factors. The knee joint plays a dominant role in the limb’s longitudinal growth; the growth zones grow so intensively that they can be compared to the work of a "bone nuclear reactor." The bones of the skeleton grow unevenly and intermittently. The peak height velocity is observed at 10–14 years in girls and at 13–18 years in boys; then, height velocity slows down, and after 19 years, height growth almost stops. During the period of intensive growth, bones are very sensitive to internal and external factors of shape formation (growth hormones, physiological loads, radiation, vibration, injuries, hypothermia, metabolic disorders, etc. Therefore, this part is most sensitive to various endogenous and exogenous factors, which is manifested by various dysplastic changes and diseases. Conclusions. During the intensive growth of the child, the knee joint is most vulnerable to various endogenous and exogenous negative factors, which is manifested by various diseases. Osteogenic sarcoma, fibrous cortical defect, and juvenile osteocartilaginous exostoses most often affect the weakest place of the knee joint – the metaphyses of the femur and tibia (Achilles’ heel).

Behavioral Training of High-Functioning Autistic Children by Music Education of Occupational Therapy.

Autistic children, also known as “children from the stars”, have been discovered for more than half a century, but there is still no unified conclusion on the diagnosis, causes, manifestations, and education of autism. The current theory and practice suggest that there is a need to improve the treatment and education of these children. According to existing theories and practices, most autistic children show a special interest in music, and music is very effective in the treatment of autistic children, and through musical activities, children with autism can improve their language, social and emotional, cognitive, and sensorimotor development. In this paper, we record and observe the music classes of children with autism. We select two classes with a total of seven children with autism as the observation subjects in the music classes, record the changes in various aspects and behavioral performance of these seven children with autism in the music activities, and analyze and summarize them. The main purpose of this study is to analyze and summarize how the three major music teaching methods are implemented in the music classroom for autistic children and how they can help autistic children with different characteristics. In the end, we summarize the main problems of music teaching for autistic children found in practice and try to make some suggestions, hoping to provide reference for scholars who study music education for autistic children. The music teaching activities were effective in improving the children's joint attention, movement imitation, rhythm imitation, and cooperation ability, and all three children improved to varying degrees, fulfilling the goals of the teaching activities. The behavioral analysis of the three children during the teaching activities showed that the three children improved their ability to sit comfortably, awareness, musical ability, and rule awareness and reduced inappropriate behaviors and bad emotions, which proved that music education could improve the social and cognitive skills of the children.

Ultrasonography-Guided Combination with Elbow Arthrography-Assisted Minimally Invasive Treatment of Radial Neck Fractures in Young Children.

Background A radius neck fracture in children is a common fracture that not only affects the growth and development of children but also has a certain impact on the function of children's elbow joints. Objective To probe into the application value of ultrasonography- (US-) guided combination with elbow arthrography in the minimally invasive treatment of radial neck fractures in young children, summarize its clinical effect and provide a minimally invasive, safe, effective, and reliable method for treating radial neck fractures in young children. Methods Seventy-three patients with type III or IV radial neck fractures were treated from June 2013 to December 2020 and were divided into the Métaizeau group (n = 31, treatment group) and Kirschner wire (k-wire) k-wire group (n = 42, control group). The Métaizeau group was given US-guided combination with elbow arthrography-assisted modified Métaizeau technique, the k-wire group received open reduction and internal fixation with k-wire and compared the surgical effect of the two groups. Results In comparison with the k-wire group, time of operation, intraoperative bleeding volume, and hospital stay were signally junior to those in the Métaizeau group (P < 0.05). After surgery, in comparison with the k-wire group, the number of degrees to contralateral flexion or forearm rotation was visually lower in the Métaizeau group (P < 0.05), and postoperative complication incidence in the Métaizeau group was visually lower than that in k-wire group (P < 0.05). Conclusion In the minimally invasive treatment of radial neck fractures, US-guided combination with elbow arthrography in young children has better efficacy and high safety. It can be widely promoted and applied clinically.

Radiometric Parameters of the Forearm in Traumatic Instability of the Distal Radioulnar Joint in Children

Background. At present, the literature describes in sufficient detail the use of various methods of X-ray examination of the bones of the forearm in the diagnosis of distal radioulnar joint instability (DRUJI), but there are no data on radiometric parameters for DRUJI of traumatic origin in children. Quantitative diagnostics becomes mandatory for determining the tactics of treating DRUJI of traumatic origin in children.&#x0D; The purpose of study to analyze the radiometric parameters of the distal forearm in case of DRUJI of traumatic origin in children to plan the method of surgical treatment.&#x0D; Мethods. The paper presents an analysis of the results of X-ray examination of 23 children with instability of the distal radioulnar joint of traumatic origin aged 9 to 17 years (mean age 14.212.5 years) the main group. For comparison, radiographs of the contralateral forearms of the same patients were analyzed the comparison group (23 children), and radiographs of the forearm of 69 pediatric patients without signs of DRUJI (control group). On radiographs in the anteroposterior and lateral projections, the following radiometric parameters were evaluated: radioulnar and volar angles, radioulnar index, radioulnar distance, and the difference between the radioulnar distances of both forearms.&#x0D; Results. In 19 patients of the main group, a positive variant of the radioulnar index with dislocation of the head of the ulna was revealed, while the indicators of the radioulnar and volar angle were characterized by variability in values. The average values of radiometric parameters of DRUJI in children without bone-traumatic changes of the forearm are comparable to normal values in adults.&#x0D; Conclusions. In children with DRUJI of traumatic origin, various changes were revealed radiometric indicators of the distal parts of the bones of the forearm, which depend on the type of forearm fracture. In a particular pediatric patient with DRUJI of traumatic origin, these indicators reflect the biomechanical features of the wrist joint, which must be taken into account when planning surgical intervention and predicting the recovery of the anatomy and function of the forearm.

Arthroscopic retrieval of knee foreign bodies in pediatric: a single-centre experience.

The present study was to investigate the clinical features of foreign body (FB) residues in children's knee joints, surgical retrieval, and postoperative function of knee joints. This retrospective study included a total of 13 children (8 boys and 5 girls; the mean age is 6.69years old, range from 2 to 16years old) who underwent retrieval surgery of knee FBs in our hospital. Related clinical factors were recorded and analyzed to find the influence factors of surgical methods and FBs' location change. The FBs in 11 cases were removed completely by arthroscopy, two cases by open surgery changed from arthroscopy. Besides glass pieces (n = 4, 31%) and wooden splinter (n = 1, 7%), sewing needle fragments were the most common type of knee foreign body (n = 8, 62%). There were two patients with FBs whom open surgery changed from arthroscopy was performed. The FBs of patients with open surgery changed from arthroscopy were more likely to locate in the posterior compartment (p = 0.04), and had a higher interval between injury and surgery than that in patients with arthroscopy (p = 0.01). The location of FBs (all were needle fragments) had changed intra-operatively in three patients, whose mean weight was lower than patients with fixed FBs (p = 0.04). The FB (small glass piece) of one patient was flushed out of the joint during arthroscopy. Arthroscopic retrieval surgery was an effective procedure to remove the FBs of the children's knee joint. The earlier it is detected, the easier it is to be treated. The location change of FBs should be cautioned in arthroscopic surgery and they are more likely to migrate into the posterior compartment of the knee joint.

Effects of Soccer Exercise on Balance Ability and Kinesthesia of the Lower Limb Joints in Children Aged 5-6 Years.

Age-, height- and weight-matched children were recruited to the experimental group (EG; n = 31) and control group (n = 32). Following a 16-week soccer training program, balance ability and dominant-side lateral knee and ankle kinesthesia changes were tested. Regarding balance ability, the Sway Index, when children stood on a firm or foam surface with their eyes closed in the static balance test, and the dynamic balance test time were 13.5%, 11.6%, and 14.3% lower in the EG than in the control group, respectively. The scores in the left and right directions were 23.7% and 24.2% higher in the EG, respectively. Regarding kinesthesia, the angle of knee extension and ankle metatarsal flexion and dorsiflexion were 13.4%, 20.0%, and 16.8% lower in the EG than in the control group. These results indicate children in the EG had a better performance. After soccer exercise, children aged 5-6 years displayed improved balance in the left and right directions and improved knee extension, ankle plantarflexion, and dorsiflexion kinesthesia.

Relationship of Malocclusions with Disorders of the Temporomandibular Joint in Children of CALI-Colombia.

The aim of this study was to determine the relationship of malocclusion with the presence and severity of temporomandibular disorders (TMDs) in children. A clinical examination was performed in 87 patients (from 4 to 14 years of age) who attended the dentistry clinics of Universidad del Valle. The 77 patients studied had malocclusions; 55 patients had TMD and 67.3% were female. The most frequent symptom of TMD was articular unilateral noise with 33.8%, followed by pain in at least one masticatory muscle with 26%. TMJ pain was observed in 24.7% of the patients. There was a statistically significant relationship between the presence and severity of TMD with type of dentition and transverse malocclusion, respectively. The presence of TMD in children with malocclusion presented in a high frequency. TMD depends on the type of dentition and its severity is dependent on transverse malocclusion.

The Hidden Joint in Children with Haemophilia on Prophylaxis

The Hidden Joint in Children with Haemophilia on Prophylaxis

СПЕЦИФИКА ПРОФЕССИОНАЛЬНОЙ ПОДГОТОВКИ СТУДЕНТОВ К ПЕДАГОГИЧЕСКОМУ РЕГУЛИРОВАНИЮ СОВМЕСТНОЙ ИЗОБРАЗИТЕЛЬНОЙ ДЕЯТЕЛЬНОСТИ ДЕТЕЙ

The article discusses the features of the professional training of a preschool teacher to regulate the interaction of children with their peers. The basic theoretical idea is presented when developing a model of training students in the field of pedagogical regulation of joint pictorial activity of preschool children, which is a competence-based approach. The specifics of the training of teachers of preschool education are determined, based on two positions: the characteristics of modern childhood and the requirements of the professional standard of a teacher at different educational levels. The key principles of the development of a modern preschool child are highlighted. At the same time, emphasis is placed on changes in the modern space, the system of relations, changes in the child himself. The complexity of the pedagogical participation of the teacher is to preserve the children's individuality, while regulating the communication of children and their joint activities, carrying out pedagogical interaction with the child. The article presents an analysis of approaches to understanding the terms «interaction», «pedagogical interaction», «social interaction» in the scientific literature. The article highlights the main patterns underlying professional work with a child in a children's group. At the same time, the distinctive features of children's interaction with peers, the stages of development of children's communication, the features of children's joint visual activity, the typology of the teacher's participation in this process are considered. Considering the interaction of children in a group of peers, the article presents the author's understanding of the terms «joint productive activity», «interaction of children in conditions of productive activity».

Normal Magnetic Resonance Imaging Appearance of Marrow Adjacent to the Sacroiliac Joints in Children During Development.

On magnetic resonance imaging (MRI) for sacroiliitis, increased T2 marrow signal can be misinterpreted as marrow edema. We hypothesize that a changing but predictable pattern for marrow signal intensity adjacent to the sacroiliac joints is present from infancy through skeletal maturity. The purpose of our study is to characterize the distribution of increased T2 signal intensity within the marrow adjacent to the sacroiliac joints in healthy children. A retrospective review of the electronic health record identified 345 children who underwent MRI examination of the sacrum, sacroiliac joints, or pelvis. Those with underlying disease that may potentially alter sacroiliac marrow signal were excluded. Sixty children, 30 girls and 30 boys, were assessed for T2 marrow signal intensity greater than the interforaminal sacrum and less than or equivalent to the primary spongiosa of the posterior iliac crests at the S1, S2, and S3 levels. The width of increased T2 signal intensity at each sacral level, right and left sides, ilium, and sacrum was measured (mm). The Mann-Whitney U test was used to determine if there were differences between skeletally immature and skeletally mature subjects; defined as aged 15 years for girls and 17 years for boys. When 30 girls and 30 boys are assessed, the width of increased T2 marrow signal adjacent to the sacroiliac joints is significantly greater in skeletally immature than in skeletal mature female subjects for right S1 sacral side (P = 0.0100), left S1 sacral side (P = 0.0119), right S2 sacral side (P = 0.037), left S2 sacral side (P = 0.0020), and in male subjects for the right S2 sacral side (P = 0.0178), right S2 iliac side (P = 0.0415), right S3 sacral side (P = 0.0024), and left S3 sacral side (P = 0.0037). There were insufficient subjects for whom the ilii extended beyond the S2 sacral segments to assess for the S3 iliac sides. Healthy children and adolescents have increased T2 signal intensity within the sacral marrow adjacent to the sacroiliac joints, likely the vascular primary spongiosum, which is greater in adolescence compared with skeletal maturity. Knowledge of this normal pattern is beneficial in interpreting MRI examinations for the presence of sacroiliitis.

Correlation of Age, Sex, and Symptoms to Number of Problematic Joints in Children with Idiopathic Juvenile Arthritis

Background: Juvenile Idiopathic Arthritis (JIA) is a rare case in Asia, including Indonesia. Objective:Analyze the correlation between age, sex, and symptoms on the number of joint problems in children withJIA symptoms. Methods: This study used a retrospective design from January 2016 to December 2019.The data collecting in this study was included age, sex, symptoms, and the number of joint problems. Theanalysis used was multiple linear regression with p &lt;0.05. Results: The correlation between sex (? = 0.015;95% CI -0.002 – 0.002; p = 0.916), age (? = 0.015; 95% CI -0.197 – 0.291; p = 0.916) to the number ofjoint problems was not significant. While, the correlation between symptoms and the number of joints withproblems was significant, which included swelling (? = 1.012; 95% CI 0.243 – 1.782; p = 0.011), fever(? = 1.000; 95% CI 0.082 – 1.918; p = 0.034), and pain. (? = 0.931; 95% CI 0.082 – 1.918; p = 0.007).Conclusion: There is a significant relationship between symptoms and the number of problem joints whileage and sex are not significant