Experience In Treatment Research Articles

Clinical Insights Into Pediatric Solid Pseudopapillary Neoplasms of the Pancreas.

Solid pseudopapillary neoplasms(SPNs) of the pancreas are rare tumors with low malignant potential that usually occur in young girls and women. This study investigated the treatment experiences and outcomes after surgery for pediatric SPNs in our institutions as pediatric case series ofsolid SPNs are few, and long-term follow-up is also limited. We retrospectively reviewed the outcomes of nine patients diagnosed with SPNs who underwent surgery in our three hospitals (The Jikei University Hospital, The Jikei University Kashiwa Hospital, and Kawaguchi Municipal Medical Center)between 2001 and 2023. All nine patients who underwent surgery were girls. Their ages ranged from 8 to 15 years (median: 10years). The location of the tumor was at the pancreatic head, body, and tail in five, one, and three patients, respectively. Enucleation, pancreaticoduodenectomy, and laparoscopic distal pancreatectomy (LDP) were performed in four, two, and three patients, respectively. Regarding postoperative complications, a pancreatic fistula was detected in six patients, with three and three patients having grades A and B fistulas, respectively; two patients required percutaneous drainage, and one patient required endoscopic ultrasonography (EUS)-guided transgastric drainage. The follow-up period rangedfrom six to 261 months (median: 97 months). At the final follow-up, all nine patients were alive without recurrence. SPNs of the pancreas are incidentally diagnosed by diagnostic workups following trauma in children more frequently compared to adults. Additionally, the tumor resection by minimally invasive approaches, such as enucleation, or laparoscopic procedures results in a good prognosis in some cases.

The association between experiences of unfair treatment in school and adolescent adjustment over 5 years.

This study investigates how high-school experiences of unfair treatment connect to adolescents' higher education enrollment and life satisfaction 5 years later. We utilized four waves of data at ages 14 years (T1), 16 (T2), 18 (T3) and 19 (T4) in the UK (N = 13,065; 51% Male, 49% Female, 70% White, 11% Black, 19% South-Asian). Perceived teacher unfairness at T1 predicted lower university aspirations (T2) and subsequently lower enrollment in higher education (at T3 and T4) and life satisfaction (T4). Experiences with T1 teacher ethnic discrimination also predicted lower life satisfaction. The effects were similar across historically minoritized and majority-background pupils, but historically minoritized adolescents experienced more ethnic discrimination in school. Our findings highlight the importance of fair treatment for all pupils.

Management of Compound Depressed Fractures over Venous Sinuses

Abstract Objective The aim of this study was to report our experience in the surgical treatment of compound depressed fractures over the venous sinuses with special highlights on the prediction and dealing with intraoperative sinus injury. Materials and Methods We conducted a retrospective review of all patients who underwent surgery for compound depressed fractures overlying the dural venous sinuses in our hospital between January 2019 and December 2021. Results A total of 34 patients were included in our study. The mean age of the patients was 19.85 years, most of our patients were males 27 (79.4%), and isolated head trauma was the most common mode of trauma (76.5%). The superior sagittal sinus (SSS) was distinguished as the most commonly involved venous sinus below the fractures in 28 patients (82.4%). An intraoperative tear in the sinus was found in 17 patients (50%), which was easily controlled with different methods. In two patients who had a severe head injury with a Glasgow Coma Scale (GCS) score of ≤8 associated with a fissure fracture crossing the sinus, there was a complete tear of the sinus followed by massive bleeding, which required sinus ligation. We lost both of them in following days. Conclusion In experienced tertiary neurotrauma centers, compound depressed fractures over the venous sinuses should be surgically elevated in most cases, taking into consideration that bleeding from the sinus can be controlled in most cases, and complete tear of the sinus with massive bleeding is the least scenario faced in reality and is usually associated with a severe head injury. If expert opinion favors the conservative approach, then close follow-up for months is recommended due to the high possibility of sinus thrombosis and intracranial hypertension, especially in children.

Factors Affecting Health Seeking Behavior of Elderly People in a Community of Pokhara, Nepal

Introduction: Individuals have different opinion regarding willingness to seek help from health care services. Thus, a study aimed to find out the health care seeking behaviour, factors affecting health care seeking behaviour and association between health seeking and those factors among elderly people. Methods: Cross-sectional analytical study was conducted among 197 elderly people of 65 years and above in Pokhara Metropolitan City Ward No.28. Non probability purposive sampling technique was used. Data was collected by face to face interview technique using self-developed structured interview schedule. SPSS 16 was used for data analysis. Descriptive statistics frequency, percentage, mean and standard deviation were used for data analysis. Inferential statistics (Chi-square test) was used to reveal the association between the selected factors and health seeking behaviour.. Results: Finding showed 77.66% of respondents sought appropriate health care where as only 22.34 % of respondents sought inappropriate health care. Among those who sought care from appropriate health care, 65.48% of respondents sought care from governmental hospital. Among those who sought inappropriate health care still 22.72 % of respondents had belief in traditional healer. Accompany for the treatment of elderly was found statistically significant and other factors was not found statistically significant Conclusion: Based on the findings more than two third of the respondents reported that they seek appropriate health care. Among those respondents nearly half of respondents’ reason for seeking appropriate health care was good experience of medical treatment in the past. Among those whose health seeking behaviour is inappropriate, still one fourth of respondents had belief on traditional healer. Key words: Health seeking behavior; Elderly people; Nepal

Androgen-mediated maternal effects and trade-offs: postnatal hormone development, growth, and survivorship in wild meerkats.

Mammalian reproductive and somatic development is regulated by steroid hormones, growth hormone (GH), and insulin-like growth factor-1 (IGF-1). Based largely on information from humans, model organisms, and domesticated animals, testosterone (T) and the GH/IGF-1 system activate sexually differentiated development, promoting male-biased growth, often at a cost to health and survivorship. To test if augmented prenatal androgen exposure in females produces similar developmental patterns and trade-offs, we examine maternal effects in wild meerkats (Suricata suricatta), a non-model species in which adult females naturally, albeit differentially by status, express exceptionally high androgen concentrations, particularly during pregnancy. In this cooperative breeder, the early growth of daughters predicts future breeding status and reproductive success. We examine effects of normative and experimentally induced variation in maternal androgens on the ontogenetic patterns in offspring reproductive hormones (androstenedione, A4; T; estradiol, E2), IGF-1, growth from pup emergence at 1 month to puberty at 1 year, and survivorship. Specifically, we compare the male and female offspring of dominant control (DC or high-T), subordinate control (SC or lower-T), and dominant treated (DT or blocked-T) dams, the latter having experienced antiandrogen treatment in late gestation. Meerkat offspring showed sex differences in absolute T and IGF-1 concentrations, developmental rates of A4 and E2 expression, and survivorship - effects that were sometimes socially or environmentally modulated. Atypical for mammals were the early male bias in T that disappeared by puberty, the absence of sex differences in A4 and E2, and the female bias in IGF-1. Food availability was linked to steroid concentrations in females and to IGF-1, potentially growth, and survival in both sexes. Maternal treatment significantly affected rates of T, E2, and IGF-1 expression, and weight, with marginal effects on survivorship; offspring of DT dams showed peak IGF-1 concentrations and the best survivorship. Maternal effects thus impact offspring development in meerkats, with associated trade-offs: Whereas prenatal androgens modify postnatal reproductive and somatic physiology, benefits associated with enhanced competitiveness in DC lineages may have initial costs of reduced IGF-1, delay in weight gain, and decreased survivorship. These novel data further confirm the different evolutionary and mechanistic pathways to cooperative breeding and call for greater consideration of natural endocrine variation in both sexes.

Benefit and Safety of Sodium-Glucose Co-Transporter 2 Inhibitors in Older Patients with Type 2 Diabetes Mellitus.

People with type 2 diabetes mellitus (T2DM) are at higher risk of developing cardiovascular disease, heart failure, chronic kidney disease, and premature death than people without diabetes. Therefore, treatment of diabetes aims to reduce these complications. Sodium-glucose co-transporter 2 (SGLT2) inhibitors have shown beneficial effects on cardiorenal and metabolic health beyond glucose control, making them a promising class of drugs for achieving the ultimate goals of diabetes treatment. However, despite their proven benefits, the use of SGLT2 inhibitors in eligible patients with T2DM remains suboptimal due to reports of adverse events. The use of SGLT2 inhibitors is particularly limited in older patients with T2DM because of the lack of treatment experience and insufficient long-term safety data. This article comprehensively reviews the risk-benefit profile of SGLT2 inhibitors in older patients with T2DM, drawing on data from prospective randomized controlled trials of cardiorenal outcomes, original studies, subgroup analyses across different age groups, and observational cohort studies.

Hope experiences in pregnant women after artificial reproduction technology: Becoming a mother.

Hope is a common phenomenon in human life. The process of infertile women being treated with assisted reproductive technology is difficult. The concept of hope can be applied in the nursing practice to help patients have a positive treatment experience, reduce feelings of despair, and find significance in difficult treatments. This study used phenomenological approach to understand the essential structure of the hope experiences of infertile women after successful artificial reproduction. A total of 10 infertile women who were successfully pregnant for more than 8 weeks and less than 24 weeks participated in this study. The essence of the hope experiences of infertile women after successful artificial reproduction was the process of "becoming a mother" which included four themes: (1) try hard to get pregnant; (2) outline a blueprint for the future of motherhood; (3) protect the fetus; and (4) integrate the fetus into the family. This study enabled medical teams to play the role of caregivers, intervened in hope care, and strengthened evidence-based practice to improve the quality of care by focusing on feelings of hope.

A VERY RARE CASE: THE DEVELOPMENT OF TUBA-OVARİAN TORSİON İN ENDOMETRİOMA

Endometriosis is increasingly diagnosed in women of reproductive age and is estimated to affect up to 10% of women. Endometriomas are a common antithesis in patients of reproductive age and require special planning and experience for optimal treatment. Endometroma in rare cases occurs with an acute abdominal picture. However, adnexal torsion is very rare in these patients. Because endometriomas are often tightly adherent to neighboring structures, and therefore they seem less likely to cause adnexal torsion, although there is insufficient data on the torsion rate in these cysts. With this case report, we thought to contribute to the literature with the case of torsion in endometrioma.

Urologist communication is a primary factor leading to erectile dysfunction treatment postprostatectomy.

Studies have shown insufficient utilization of care for patients with erectile dysfunction (ED) after radical prostatectomy (RP). The aim of this study was to evaluate variables associated with barriers to seeking and receiving ED treatment. In this multicenter prospective cross-sectional study, the functional outcomes of 936 patients were assessed 10 to 15years after RP. A total of 525 patients with ED or incontinence were asked about their treatment experiences or lack thereof. The data were analyzed using the chi-square test, t test, and multivariate logistic analyses. Patients answered validated questionnaires regarding information sources, communication with their partner and urologist, and barriers to ED treatment. Of the 525 patients, 80 were not available to survey. A total of 304 patients answered the survey (response: 68.0%). A total of 246 patients had ED and were included in this study. The mean age at surgery was 64.4 ± 6.1years, and the mean age at the time of this survey was 77.1 ± 6.2years. The mean follow-up duration was 12.7 ± 1.5years. Forty-six percent (n = 114 of 246) of the patients had never received ED treatment. The most important conversation partners regarding the ED were the partner (69% [n = 169 of 246]) and the urologist (48% [n = 118 of 246]). Patients who never received ED treatment were less likely to have conversations with their urologist (34% vs 60%; P < .001), had less support (51% vs 68%; P = .01), and had less interest in sex from their partner (20% vs 40%; P = .001). Communication with other groups (general practitioners, other physicians, family, friends, and the Internet) had no influence on ED treatment utilization. The most relevant barrier to receiving ED treatment was the belief that treatment would not help (65%). No interest in sex from their partner (odds ratio, 3.9) and no conversation with their urologist about ED (odds ratio, 2.9) were found to be independent predictors of not receiving ED treatment. Urologists should have enhanced awareness of how to approach patients directly about their ED and actively offer them treatment options. These results should be further validated in a multicenter, prospective study. Response bias may have affected the results. Furthermore, the current cohort was relatively old. This study revealed that no interest in sex from one's partner and insufficient communication with a urologist were relevant barriers to insufficient utilization of ED treatment after RP.

Living with Pompe disease: results from a qualitative interview study with children and adolescents and their caregivers

BackgroundChildren and adolescents with Pompe disease (PD) face chronic and progressive myopathy requiring time-intensive enzyme replacement therapy (ERT). Little is known about their perspectives on the disease and its treatment. This study explored their perceptions of disease symptoms and functioning status, and more subjective feelings about the impacts on their lives as part of developing a disease-specific questionnaire.MethodsEleven pediatric patients aged 8–18 years and 26 caregivers from six children’s hospitals in Germany, Austria, and Switzerland underwent semi-structured interviews. Data were recorded, transcribed using MAXQDA software, and analyzed using qualitative content analysis. A system of meaningful categories was developed.ResultsSixteen main categories were derived across four major thematic areas: perceptions of symptoms and limitations, experiences to do with the biopsychosocial impact of PD, treatment experiences, and general emotional well-being/burden. Participants demonstrated broad heterogeneity in symptom perceptions such as muscle weakness, breathing difficulties, pain, and fatigue. Emotional appraisals of limitations were not directly proportional to their severity, and even comparatively minor impairments were often experienced as highly frustrating, particularly for social reasons. The main psychosocial topics were social exclusion vs. inclusion and experiences to do with having a disease. The main finding regarding treatment was that switching ERT from hospital to home was widely viewed as a huge relief, reducing the impact on daily life and the burden of infusions. Emotional well-being ranged from not burdened to very happy in most children and adolescents, including the most severely affected.ConclusionThis study provided qualitative insights into the perceptions and experiences of pediatric PD patients. Interestingly, biopsychosocial burden was not directly related to disease severity, and tailored psychosocial support could improve health-related quality of life. The present findings ensure the content validity of a novel questionnaire to be tested as a screening tool to identify patients in need of such support.

Unfair Racial Treatment in Healthcare, Healthcare Utilization, and Health Status Among Black, Indigenous, Women of Color

Black, Indigenous, Women of Color (BIWOC) face well-documented health disparities in the United States. However, the extent to which recent experiences of unfair racial treatment in medical settings contribute to health disparities is not well understood. The objective of this study was to examine associations of experiencing unfair racial treatment by a provider during the most recent medical encounter with healthcare utilization and health status in BIWOC. We utilized multivariate logistic regression models to examine data from the Association of American Medical Colleges’ biannual Survey of Healthcare Access collected between 2012 and 2019. Data were extracted for 5,549 participants who identified both as a woman and a Black, Indigenous, Person of Color to generate our BIWOC sample of interest. Among BIWOC, experiencing unfair racial treatment during their most recent healthcare visit in the past year was associated with higher odds of delaying healthcare ( OR = 3.50, p &lt; .001) and using the emergency department as their usual source of care ( OR = 1.54, p &lt; .001). Experiencing unfair racial treatment was also associated with having chronic physical conditions ( OR = 1.31, p = .002), chronic depression ( OR = 1.56, p &lt; .001), and activity limitations due to both emotional ( OR = 2.98, p &lt; .001) and physical ( OR = 2.47, p &lt; .001) impairment. Recent experience of racial discrimination by a healthcare provider was associated with lower healthcare utilization and poorer health status in a national sample of BIWOC. Reducing unfair treatment in healthcare settings is critical for improving BIWOC health.

Standardized treatment of infection after anterior cruciate ligament reconstruction

Infection after anterior cruciate ligament reconstruction (ACLR) is a rare and catastrophic postoperative complication. The aims of this study were to investigate the diagnostic, treatment and rehabilitation measures for postoperative infection following after ACLR. A retrospective study was conducted on 1500 patients who underwent ACLR between January 2011 and January 2022. Twenty patients who met the criteria for summarizing the incidence patterns and treatment experiences were selected for a complete investigation of their diagnostic, therapeutic, and rehabilitation processes, as well as outpatient follow-up results. Among the 20 patients who developed postoperative infections, Staphylococcus aureus was the main pathogen (80%). The clinical manifestations mainly included fever (80%) and knee joint pain (100%). Laboratory tests demonstrated that C-reactive protein (CRP) levels were greater than 50 mmol/L in fifteen patients (75%). All of the patients received intravenous antibiotic therapy. Five patients (25%) of tendon socket infection were treated with continuous negative pressure suction irrigation, whereas the other fifteen patients with intra-articular infection were treated with arthroscopic debridement and continuous flushing. The Lysholm score of the affected knee was compared before treatment and 6 months after treatment, and the difference was statistically significant (t = 20.78, P < 0.001). The success rate of treatment was 100%, and there were no significant differences between patients who received secondary treatment and functional exercise and those who underwent ACLR in terms of knee joint function or range of motion during the same time period. Infection was rare after ACLR, however it was fatal, and the main pathogen was Staphylococcus aureus. Early diagnosis and a comprehensive treatment approach are pivotal for the successful management of postoperative infections following ACLR. The results of this study contribute valuable clinical insights for further refining surgical procedures, enhancing infection prevention measures, and optimizing rehabilitation protocols.

Miotomía endoscópica por vía oral (POEM) como tratamiento para la acalasia pediátrica: estudio multicéntrico y primeros resultados

IntroductionLaparoscopic Heller miotomy of achalasia has been classically recognized as the gold standard management in children. There is increasing experience with the peroral endoscopic miotomy (POEM) approach in pediatrics, although the series published are scarce. The objective of this study was to present our experience in primary or secondary treatment of pediatric achalasia by POEM and its clinical success rate. MethodsWe performed a retrospective review of pediatric patients with achalasia who underwent POEM in some national centers from October 2016 to January 2023. We evaluated clinical efficacy (Eckardt score ≤3), demographic characteristics, intraoperative, preoperative and postoperative, complications, and follow-up. ResultsFifteen POEM were performed in fourteen pediatric patients (aged 12 to 18 years) with achalasia. POEM was the first line treatment in 11 patients, but 4 (21.3%) had previous treatment: 1 (7,1%) pneumatic balloon dilation and 2 (14,2%) laparoscopic Heller myotomy and 1 (7,1%) previous POEM. The average age was 15 years (SD±1,9). The baseline Eckardt score was 7,5 (SD:±1,8), with the baseline GERD score being 6 (SD:±2,9). There was a Clavien-Dindo grade 2 postoperative adverse event corresponding to mild pneumonia (7,1%). The postoperative Eckardt and GERD score after 12 months of follow-up were 0.7 (SD±1,2) and 0,5 (SD±0,7). The study has a success rate greater than 93%. ConclusionsPOEM seems a safe and effective procedure, with a short postoperative period for treatment of pediatric achalasia.

The experience of chronic protracted mandibular dislocation treatment: manual vs. surgical reduction

Temporomandibular joint dislocation is a common challenge in dental care, but it can be promptly addressed through manual realignment, making it standard procedure in the realm of oral health. Nonetheless, effectively preventing and treating chronic protracted mandibular dislocation (CPMD), characterized by prolonged dislocation, remains a significant challenge. Hence, a retrospective analysis was conducted on the clinical data of 10 patients diagnosed with chronic protracted mandibular dislocation (CPMD), encompassing diagnosis, treatment, and prognosis details. CPMD tends to be more prevalent among the elderly population, with an average age of 67.2±11.9 years and a male-to-female ratio of 1:9. All diagnosed patients presented with bilateral anterior dislocation, each requiring diverse pre-treatment approaches. The most significant risk factor contributing to CPMD was unconsciousness resulting from nervous system injury, which delayed the perception of symptoms associated with temporomandibular joint dislocation. 90% of CPMD patients experienced successful treatment through manual reduction, while a refractory CPMD cohort, resistant to manual reduction, necessitated surgical intervention for resolution. All patients underwent treatment involving elastic intermaxillary traction, which served as the primary means of achieving reduction. Subsequent analysis of CT data revealed that condylar displacement beyond the zygomatic arch served as an indication for surgical reduction. Consequently, manual reduction under general anesthesia combined with elastic intermaxillary traction proved effective for managing CPMD cases. However, cases displaying excessive vertical displacement beyond the zygomatic arch should be considered for surgical intervention based on CT findings.

Experience in the Treatment of Male Prolactinomas: A Single-Center, 10-Year Retrospective Study

Introduction: Male prolactinomas are uncommon and typically macroadenomas with difficult treatment and management. The purpose of this study was to summarize the treatment and management experiences of 254 male prolactinoma patients at a single center. Methods: This was a 10-year retrospective study conducted at a single center. A total of 254 male prolactinoma patients were included. Clinical data for all subjects were collected using an electronic medical record system. Results: A total of 254 male patients with prolactinoma were studied. Their median age at onset was 28.8 years, and median disease duration was 28.5 months. The median PRL levels were 582.0 ng/mL at diagnosis. Their median maximum tumor diameter was 23.0 mm, with macroadenoma accounting for the majority (76.7%). After treatment, the biochemical remission rate with monotherapy was 36.6%, but significantly increased to 60.6% with multidisciplinary treatment (p < 0.001). Knosp 0–2 patients had significantly higher rates of biochemical remission compared to Knosp 3–4 (all p < 0.05). In addition, the maximum diameter of adenoma (B = −0.110, p = 0.008) and cavernous sinus invasion (B = −1.741, p = 0.023) were negatively correlated with postoperative biochemical remission. The maximum diameter of the adenoma (B = − 0.131, p < 0.001) was a negative correlation factor, while treatment duration (B = 0.034, p = 0.002) was a positive correlation factor for biochemical response to medication. Conclusion: Male prolactinoma has a low biochemical remission rate when treated alone, but multitherapy can improve it even more. Surgery may also be considered for male prolactinoma with a micro, and noninvasive tumor after a thorough evaluation.

Research on the comprehensive child life intervention program (CCLIP) for adjusting medical fear in children with central nervous system (CNS) cancers: a randomized controlled trial study protocol

BackgroundMedical fear is a common psychological reaction in hospitalized children, especially during radiotherapy for central nervous system (CNS) cancers. This fear not only causes negative emotions such as anxiety and depression but also affects children’s quality of life and treatment outcomes. It is exacerbated by factors such as unfamiliar environments during radiation therapy and separation from parents. Child Life, as a professional service, offers physical and mental support to children through medical understanding and psychological preparation, addressing their social and psychological needs, among other things. This study aims to construct a comprehensive Child Life intervention program (CCLIP), consisting of four key components: psychological adjustment and preparation, therapeutic play, pain management and coping strategies, and family support. The integration of effective intervention methods aims to reduce medical fear in children undergoing radiotherapy, promote psychological well-being, improve treatment compliance, and enhance quality of life.MethodsThis study is a protocol for a randomized controlled trial. Using a random number table method, we plan to recruit 38 eligible children who meet the inclusion criteria and then randomize them into two distinct groups: the intervention group and the control group. The intervention group will receive the CCLIP, and the control group will receive standardized care. Data will be collected through questionnaires and on-site assessments during the one-month intervention period at four distinct time points: the day of admission (T0), the first radiotherapy positioning (T1), mid-radiotherapy (T2), and postradiotherapy (T3). The primary outcome measure is the effectiveness of the CCLIP in reducing medical fear among children receiving radiation treatment for CNS cancers. Secondary outcomes include anxiety, depression, radiation adherence, quality of life among children, and parental satisfaction.DiscussionThis study aims to alleviate medical fear among children with CNS tumors undergoing radiotherapy through the implementation of the CCLIP while enhancing their mental health and quality of life. The expected outcomes of this research include providing effective intervention strategies for clinical practice, improving the treatment experience and long-term prognosis of children, and having positive impacts on children and their families.Trial registrationThis study is registered at the Chinese Clinical Trial Registry, ChiCTR2400082622. Registered 2 April, 2024.

Clinical features and treatment of 70 children with lupus anticoagulant-hypoprothrombinemia syndrome: a retrospective study from a single center in China

BackgroundLupus anticoagulant-hypoprothrombinemia syndrome (LAHPS) is a rare acquired bleeding disorder characterized by the presence of lupus anticoagulant (LA) and acquired hypoprothrombinemia. ObjectivesTo summarize the experience of diagnosis, clinical features, and treatment of lupus anticoagulant-hypoprothrombinemia syndrome (LAHPS). MethodsA retrospective study of 70 children diagnosed with LAHPS from January 2019 to February 2024 at a single center was conducted. ResultsA total of 70 subjects (32 boys and 38 girls), with a mean age of 5.58 years, were included in the study. Among these subjects, 15 had autoimmune diseases (AIDs), 51 had infections, and 4 had unknown causes. Fifty-six of 70 (80%) subjects experienced bleeding with the median bleeding score of 4, 1 of 70 (1.4%) presented with thrombosis, and 13 of 70 (18.6%) were asymptomatic. All patients exhibited prolonged prothrombin time, significantly prolonged activated partial thromboplastin time, decreased factor (F)II activity (FII:C), and positive lupus anticoagulant. There was a weak negative correlation between the severity of bleeding and FII:C level (rs = −0.4283; P < .001). Patients with infection-associated LAHPS were younger than those with AIDs-associated LAHPS (P < .0001). In the study, LAHPS subjects are treated with corticosteroids as the first-line therapy, or in combination with immunosuppressants. Coagulation factor replacement therapy can effectively prevent and control bleeding events. After follow-up, lupus anticoagulant of all patients had turned negative within 12 weeks. And, prothrombin time and FII:C were completely normalized of all patients without recurrence of bleeding and without thrombosis. ConclusionChildren develop LAHPS most commonly after AIDs and infection. Most patients presented with mild to moderate bleeding. The severity of bleeding symptoms was not exactly parallel to the decreased FII:C level.

Understanding the importance of therapeutic alliance during physiotherapy treatment for musculoskeletal pain in children: a scoping review.

Musculoskeletal pain affecting children is common. Rehabilitation and treatment effectiveness can be influenced by multiple individual and contextual factors. The need for more rigorous evaluation of physiotherapy treatment for children's pain, identification of the role of specific techniques, and exploration of the influence of the therapeutic alliance is needed. This scoping review of research aimed to examine: (1) What are the perceptions of children, parents, and physiotherapists about the importance of therapeutic alliance during musculoskeletal pain treatment? (2) What are the key characteristics of therapeutic alliance during a child's musculoskeletal pain treatment from the perspectives of children, parents, and physiotherapists? and (3) What are the perceived impacts of therapeutic alliance (positive and negative) during a child's physiotherapy treatment for musculoskeletal pain? The scoping review, based on Arksey and O'Malley's framework and reporting was guided by PRISMA-ScR. The search strategy was based on three concept blocks: (1) Study population: Children (<18 years); (2) Medical condition: Any musculoskeletal pain (acute, chronic primary, chronic secondary); (3) Intervention: Qualitative exploration of experience of physiotherapy treatment delivered by a physiotherapist from the perspective of a child, parent, or physiotherapist. The search (no date limit) was conducted in February 2024 across Medline, AMED and CINAHL. Following duplicate removal and assessment of eligibility of the initial 236 articles, nine articles were included; of these, only one specifically aimed to explore therapeutic alliance and it was the only paper to directly mention therapeutic alliance. All nine articles presented the child's experience. One overarching theme "Finding resilience within me through therapeutic alliance" and three main themes: "A trusted guide through the ups and the downs of rehabilitation"; "Having a route map"; and "Take me seriously but make it fun" were identified. Therapeutic alliance was considered important by children, parents and physiotherapist and it influenced child and parent perceptions of physiotherapy and overall treatment outcomes. Physiotherapists can foster the children's resilience when experiencing musculoskeletal pain by providing disciplinary expertise, connecting and collaborating with the child by becoming their trusted guide, and co-creating a route map for rehabilitation by helping them to learn about their body, pain and recovery timeline.

Experience of treatment of newborns with gastroschisis in the conditions of the national center for maternal and child health care

Experience of treatment of newborns with gastroschisis in the conditions of the national center for maternal and child health care

Strategies for Managing Pediatric Fracture Pain: Assessment, Pharmacological, and Non-Pharmacological Interventions.

Fractures are prevalent among the pediatric population, with approximately 1 in 3 children experiencing at least 1 fracture during childhood. Children are not just little adults; they have unique needs in pain management. With a lack of knowledge in pediatric pain management, medical staff primarily focus on the fractures, often overlooking and inadequately addressing pain. There is a scarcity of literature on acute fracture pain for children, while a wealth of literature summarizes chronic and tumor-related pain in children, which is not suitable for addressing pain caused by fractures. Therefore, a pain management literature review grounded in clinical experience is essential to provide guidance to doctors and parents on safely and effectively reducing the pain associated with children's fractures. We conducted a thorough review of existing literature and summarized treatment experiences into the 3 areas of pain assessment, non-pharmacological treatments, and pharmacological treatments. First, we evaluated and analyzed existing pain assessment methods, identifying the most suitable tools for different age groups. Second, we explored non-pharmacological treatments suitable for children with fractures to alleviate mild to moderate pain and reduce the need for analgesics. Lastly, we reviewed pharmacological treatments. For moderate pain, we recommend administering non-steroidal anti-inflammatory drugs. For severe pain, we suggest opioid medications, providing detailed information on usage and contraindications for different age groups. Therefore, this article aimed to review the evaluation and management of pain in children with bone fracture, and covers aspects of pediatric pain characteristics, pain assessment tools, pharmacological therapy, and non-pharmacologic therapy.