Flow In Children Research Articles

Study of renal blood flow in children with obstructive uropathies

Aim. To evaluate hemodynamic indicators of the kidneys in children with obstructive uropathies.Materials and Methods. The study was conducted at the Republican Scientific and Clinical Center of Pediatrics and Pediatric Surgery, involving 32 children aged 1 to 14 years, comprising 18 girls (56.3%) and 14 boys (43.7%). The children were divided into 3 groups: Group I with unilateral hydronephrosis - 14 (43.7%) children, Group II with bilateral hydronephrosis - 10 (31.3%) children, and Group III with ureterohydronephrosis - 8 (25%) children.Results and Discussion. Obstructive uropathy resulting from congenital kidney malformations, such as organic obstruction (hydronephrosis), causes dilation of the renal collecting system, increased ureteral pressure, reduced intrarenal blood flow, renal parenchyma atrophy, and progressive chronic renal failure.Conclusion. The above findings demonstrate that ultrasound using pulsed-wave Doppler and color Doppler mapping is an optimal non-invasive method for assessing renal hemodynamics.

Safety and efficacy of L-Glutamine in reducing the frequency of acute complications among patients with sickle cell disease: A randomized controlled study

To evaluate the safety and efficacy of L-glutamine in reducing vaso-occlusive crisis (VOC) and improving cerebral arterial blood flow in children with sickle cell disease (SCD). This is an interventional randomized controlled trial that recruited sixty SCD patients, aged 9.2 ± 3.7 years, who had at least two VOCs during the last 12 months and on a stable dose of hydroxyurea. They were randomly assigned in a 1:1 ratio to receive glutamine (0.3 gm/kg/dose/12h) orally for 24 weeks or the standard of care (SOC). All patients had VOCs in the last year > 3, those on glutamine had a higher number of VOCs and hospitalization for VOC in the last year. There was a decreasing trend in the number, severity, and hospitalization of VOC and a significantly lower cumulative number of VOCs and hospitalizations in the glutamine group than in SOC (p = 0.008, p < 0.001 respectively). Time-averaged mean maximum velocity for the glutamine group had a marginal increase in both middle cerebral arteries, all values remained normal within a normal range, and in both internal carotid arteries, values increased from abnormally low to normal ranges at week 24. Glutamine reduced the number of VOCs and severity and may have a potentially favorable impact on the cerebral arterial flow velocities.

Abnormal cerebral blood flow in children with developmental stuttering.

Stuttering affects approximately 5% of children; however, its neurological basis remains unclear. Identifying imaging biomarkers could aid in early detection. Accordingly, we investigated resting-state cerebral blood flow (CBF) in children with developmental stuttering. Pulsed arterial spin labelling magnetic resonance imaging was utilised to quantify CBF in 35 children with developmental stuttering and 27 healthy controls. We compared normalised CBF between the two groups and evaluated the correlation between abnormal CBF and clinical indicators. Compared with healthy controls, the stuttering group exhibited decreased normalised CBF in the cerebellum lobule VI bilaterally, right cuneus, and left superior occipital gyrus and increased CBF in the right medial superior frontal gyrus, left rectus, and left dorsolateral superior frontal gyrus. Additionally, normalised CBF in the left cerebellum lobule VI and left superior occipital gyrus was positively correlated with stuttering severity. Children who stutter display decreased normalised CBF primarily in the cerebellum and occipital gyrus, with increased normalised CBF in the frontal gyrus. Additionally, the abnormal CBF in the left cerebellum lobule VI and leftsuperior occipital gyrus was associated with more severe symptoms, suggesting that decreased CBF in these areas may serve as a novel neuroimaging clue for stuttering. Stuttering occurs in 5% of children and often extends into adulthood, which may negatively affect quality of life. Early detection and treatment are essential. We used pulsed arterial spin labelling magnetic resonance imaging to visualise the resting-state cerebral blood flow (CBF) in children who stutter and healthy children. Normalised CBF was decreased in stutterers in the cerebellum and occipital gyrus and increased in the frontal gyrus. Stuttering severity was linked to abnormal normalised CBF in the left cerebellum lobule VI and left superior occipital gyrus, suggesting that CBF may serve as a novel neuroimaging clue for stuttering.

The effect of endoscopic renal and ureteral stone surgeries on renal blood flow in children: a prospective trial

Aim: To assess the impact of endoscopic stone surgeries on renal perfusion and blood flow in children. Materials and methods: Children who underwent percutaneous nephrolithotomy (PCNL), retrograde intrarenal surgery (RIRS), ureterorenoscopy (URS), endoscopic combined intrarenal surgery (ECIRS) were included to the study. Renal Doppler ultrasonography (RDUS) was performed one day before the operation, and on the postoperative 1st day and 1st month. Peak systolic velocity (PSV) and end-diastolic velocity (EDV) were measured, and resistive index (RI) was calculated with the (PSV-EDV)/PSV formula. RDUS parameters were compared before and after surgery and between ipsilateral and contralateral kidneys. Results: A total of 45 children with a median age was 8 (2–17) years were included (15 (33.3%) girls, 30 (66.7%) boys). PCNL was performed in 13 children (28.9%), RIRS 11 (24.4%), URS 12 (26.7%), and ECIRS 9 (20%). There was no significant difference in renal and segmental PSV, EDV and RI values of operated kidney in the preoperative, postoperative periods. There was no significant difference between RDUS parameters of the ipsilateral and contralateral kidneys in preoperative or postoperative periods. PSV and EDV values were significantly higher in the 1st postoperative month in the group without preoperative DJ stent than in the group with DJ stent (p = 0,031, p = 0,041, respectively). However, RI values were similar. The mean RI were below the threshold value of 0.7 in each period. Conclusion: RDUS parameters didn’t show a significant difference in children. Endoscopic surgeries can be safely performed in pediatric stone disease.

Thoughts on Children's Education from the Perspective of Ibn Hajar Al-Haitami

According to Ibn Hajar al-Haitami, the purpose of children's education involves efforts to care, develop, and exploit the potential of students so that they are able to understand kitabulloh, have noble morals, and have the skills to lead an independent life. In order to achieve these educational goals, Ibn Hajar al-Haitami wrote a book that specifically discusses various aspects, including educational objectives, educational flow, educator competencies, children's educational techniques, education costs, and characteristics of children's educational institutions. All these components are analyzed and described in his work entitled Tahrīru al-Maqōl Fī Adābi Wa Ahkāmi Wa Fawā'idu Yahtāju Ilaihā Muˋaddibū al-Aṭfāl. The study focused on six aspects of education discussed in the book, using. Descriptive Content Analysis Method, Types of Literature Research, and Descriptive Qualitative Approach. The main data are obtained from Tahrīru al-Maqōl Fī Adābi Wa Ahkāmi Wa Fawā'idu Yahtāju Ilaihā Muˋaddibū al-Aṭfāl, while the secondary data comes from various books discussing the biography of Ibn Hajar al-Haitami. The research process involves three stages: data collection, data processing, and data reporting. The results showed that the focus of children's educational goals emphasizes the development of material and non-material potential of learners. A religious-conservative approach is used in the flow of children's education, with the dominant educational technique being takzir. The competence of educators that is prioritized includes personal and social dimensions, while education financing can be obtained through salaries, endowments, and grants. Ibn Hajar al-Haitami recommended educational institutions in the form of maktab and madrasa.

Echocardiographic Comparison of Left Ventricular Systolic Function and Aortic Blood Flow Velocimetry in Children with Ventricular Septal Defect.

The assessments of left ventricular (LV) longitudinal systolic dynamics in children with ventricular septal defect (VSD) have achieved a major milestone in the evaluation of LV systolic function. This study aims to evaluate the LV function, LV mass (LVM), and the descending aorta blood flow in children with VSD compared to that obtained in age and sex-matched controls. The mean LVM of the control, 113.5 ± 123.9 was higher than that of those who had VSD, 75.8 ± 83.9, and the difference in mean was found to be statistically significant (Mann-Whitney U = 2.322, P = 0.022). The mean EF of the control, 67.9 ± 10.3 was comparable to that of those with VSD, 65.6 ± 13.9, (Student's t = 1.223, P = 0.223). Similarly, the mean descending aorta blood flow of control, 1.6 ± 2.2 was comparable to that of those with VSD, 3.9 ± 16.1, (Mann-Whitney U = 1.002, P = 0.321). There was a very weak positive correlation between LVM and descending aorta blood flow among the subjects (n = 85, r = 0.117, P = 0.425). There was a very weak negative correlation between LVM and descending aorta blood flow among control. (n = 85, r = -0.065, P = 0.609). The LVM among children with VSD is lower than controls but there is no difference between LV function in subjects and controls. There is a linear increase of LVM with descending aorta blood flow.

Pulmonary blood flow in children with univentricular heart and unilateral diaphragmatic paralysis.

Spontaneous breathing has an important effect on pulmonary arterial blood flow in patients with Glenn/Fontan circulation. Unilateral diaphragmatic paralysis (DP) is a frequent complication after heart surgery in congenital heart disease. The aim of this study was to investigate the influence of unilateral DP on blood flow distribution in the pulmonary arteries with Glenn/Fontan circulation. Magnetic resonance phase-contrast imaging was used to evaluate stroke volume index (SVI) in the left and right pulmonary arteries in patients with Glenn/Fontan circulation with unilateral DP. Data for 18 patients with univentricular heart and unilateral DP were analysed, 8 in the Glenn stage and 10 in the Fontan stage. Ten patients had right-sided DP, and 8 had left-sided DP. A diaphragmatic plication was performed in 7 patients. The control group consisted of 36 patients with Glenn (n = 16)/Fontan (n = 20) circulation without DP. In both left- and right-sided DP, the SVI to the ipsilateral side was significantly lower than in controls [2.81 (1.45-4.50) ml/m2 left vs 11.97 (7.36-16.37) ml/m2 in controls, P < 0.0002; 8.2 (4.49-12.64) ml/m2 with right vs 12.64 (9.66-16.61) ml/m2 in controls; P = 0.0284]. The SVI to the contralateral side showed a slight but non-significant increase in the presence of unilateral DP. Unilateral DP in patients with Glenn/Fontan circulation has a negative impact on pulmonary arterial SVI on the side of the paralysis.

Correlations among visual analog scales, total nasal symptom scores, and peak nasal inspiratory flow in children with perennial allergic rhinitis

Correlations among visual analog scales, total nasal symptom scores, and peak nasal inspiratory flow in children with perennial allergic rhinitis

Mechanically assisted cough strategies: user perspectives and cough flows in children with neurodisability.

Mechanical insufflation-exsufflation (MI-E) is used to augment cough in children with neurodisability. We aimed to determine the user comfort and cough flows during three MI-E strategies, and to predict factors associated with improved comfort and cough flows. This multicentre, crossover trial was done at four regional hospitals in Norway. Children with neurodisability using MI-E long term via mask were enrolled. In randomised order, they tested three MI-E setting strategies (in-/exsufflation pressure (cmH2O)/in (In)- versus exsufflation (Ex) time): 1) "A-symmetric" (±50/In=Ex); 2) "B-asymmetric" (+25- +30)/-40, In>Ex); and 3) "C-personalised", as set by their therapist. The primary outcomes were user-reported comfort on a visual analogue scale (VAS) (0=maximum comfort) and peak cough flows (PCF) (L·min-1) measured by a pneumotachograph in the MI-E circuit. We recruited 74 children median (IQR) age 8.1 (4.4-13.8) years, range 0.6-17.9, and analysed 218 MI-E sequences. The mean±sd VAS comfort scores were 4.7±2.96, 2.9±2.44 and 3.2±2.46 for strategies A, B and C, respectively (A versus B and C, p<0.001). The mean±sd PCF registered during strategies A, B and C were 203±46.87, 166±46.05 and 171±49.74 L·min-1, respectively (A versus B and C, p<0.001). Using low inspiratory flow predicted improved comfort. Age and unassisted cough flows increased exsufflation flows. An asymmetric or personalised MI-E strategy resulted in better comfort scores, but lower PCF than a symmetric approach utilising high pressures. All three strategies generated cough flows above therapeutic thresholds and were rated as slightly to moderately uncomfortable.

Superior Vena Cava Flow in Children With Attention Deficit Hyperactivity Disorder.

Attention deficit/hyperactivity disorder (ADHD), whose definition, diagnosis and treatment has been the subject of debate in the scientific community for a long time, is the most common neurobehavioral disorder in childhood. There are many studies on the pathophysiology of attention deficit. However, there is no study in the literature based on direct or indirect measurement of cerebral venous circulation in ADHD, and the effect of methylphenidate (MPH) treatment on cerebral venous circulation. Therefore, it was aimed to noninvasively measure superior vena cava (SVC) flow, which is an indirect indicator of cerebral venous flow, by transthoracic echocardiography in patients with ADHD. In the study, 44 healthy children, and 40 ADHD patients who were planned to start on osmotic-release oral system (OROS)- MPH were included. SVC flows were measured in healthy children and before and after drug therapy of ADHD patients. SVC flow was found to be higher in ADHD patients compared to healthy children. A significant decrease was found in SVC flow of ADHD patients after OROS-MPH treatment. There was no decrease in SVC flow of patients who did not respond adequately to MPH treatment. This first study of SVC flow in children with ADHD showed that ADHD was associated with increased SVC flow and MPH treatment had a reducing effect on this increased SVC flow. We believe that noninvasive, easily measurable, and reproducible SVC flow may be a new focus of interest for future comprehensive studies as a biomarker to support clinical evaluation in the diagnosis and treatment follow-up of ADHD patients.

Comparison of phase contrast magnetic resonance imaging and scintigraphy for determination of split pulmonary blood flow in children and young adults with congenital heart disease.

Measurement of differential blood flow to the lungs is important to understanding flow dynamics in the setting of congenital heart disease. Split blood flow via the pulmonary arteries guides and demonstrates the effect of interventions. Minimally invasive imaging of pulmonary blood flow can be achieved with scintigraphy or magnetic resonance imaging (MRI). To assess agreement of pulmonary blood flow measurements obtained by scintigraphy and MRI in children and young adults. We performed a retrospective review of patients < 21years of age who had undergone both nuclear medicine pulmonary perfusion scans (Tc-99m MAA) and cardiac MRI examinations from January 2012 to August 2021 at our tertiary pediatric hospital. Patient demographics, medical/surgical information, and estimates of split blood flow by both modalities were recorded. Pearson's correlation coefficient was used to determine the relationship between split blood flow measured by the two examinations. Agreement was calculated using interclass correlation coefficient (ICC) for absolute agreement and Bland-Altman difference analysis. Correlation between split blood flow measured by scintigraphy and MRI using net flow was 0.90 (95% CI: 0.83-0.94, P< 0.001) and the ICC for agreement on split blood flow was 0.90 (95% CI: 0.84-0.94). Mean difference in split blood flow by Bland-Altman analysis was 0.79% with 95% limits of agreement (-11.2 to 12.8%). There is excellent agreement between Tc-99m scintigraphy and phase contrast MRI for quantification of split pulmonary blood flow in children and young adults with congenital heart disease.

Evaluation of Portal, Splenic, and Hepatic Vein Flows in Children Undergoing Congenital Heart Surgery

Little is known about changes in portal, splenic, and hepatic vein flow patterns in children undergoing congenital heart surgery. This study aimed to determine the characteristics of portal, splenic, and hepatic vein flow patterns using ultrasonography in children undergoing cardiac surgery. Single-center, prospective observational study. Tertiary children's hospital, operating room. Children undergoing cardiac surgery. The authors obtained ultrasound data from the heart, inferior vena cava, portal, splenic, and hepatic veins before and after surgeries. In the biventricular group, which included children with atrial and ventricular septal defects and pulmonary stenosis (n=246), the portal pulsatility index decreased from 38.7% to 25.6% (p < 0.001) after surgery. The preoperative portal pulsatility index was significantly higher in patients with pulmonary hypertension (43.3% v 27.4%; p < 0.001). In the single-ventricle group (n=77), maximum portal vein flow velocities of Fontan patients were significantly lower (13.5 cm/s) compared with that of patients with modified Blalock-Taussig shunt (19.7 cm/s; p=0.035) or bidirectional cavopulmonary shunt (23.1 cm/s; p < 0.001). The cardiac index was inversely correlated with the portal pulsatility index in the bidirectional cavopulmonary shunt and Fontan circulation. (β=-5.693, r2=0.473; p=0.001) The portal pulsatility index was correlated with splenic venous pulsatility and hepatic venous atrial reverse flow velocity in biventricular and single-ventricle groups. The characteristics of venous Doppler patterns in the portal, splenic, and hepatic veins differed according to congenital heart disease. Further studies are required to determine the association between splanchnic venous Doppler findings and clinical outcomes in this population.

Cerebral blood flow in children with persisting postconcussive symptoms and posttraumatic headache at 2 weeks postconcussion.

Persisting postconcussive symptoms (pPCS), particularly headache, can significantly disrupt children's recovery and functioning. However, the underlying pathophysiology of these symptoms remains unclear. The goal in this study was to determine whether pPCS are related to cerebral blood flow (CBF) at 2 weeks postconcussion. The authors also investigated whether variations in CBF can explain the increased risk of acute posttraumatic headache (PTH) in female children following concussion. As part of a prospective, longitudinal study, the authors recruited children 5-18 years old who were admitted to the emergency department of a tertiary pediatric hospital with a concussion sustained within 48 hours of admission. Participants underwent pseudocontinuous arterial spin labeling MRI at 2 weeks postconcussion to quantify global mean gray and white matter perfusion (in ml/100 g/min). Conventional frequentist analysis and Bayesian analysis were performed. Comparison of recovered (n = 26) and symptomatic (n = 12) groups (mean age 13.15 years, SD 2.69 years; 28 male) found no differences in mean global gray and white matter perfusion at 2 weeks postconcussion (Bayes factors > 3). Although female sex was identified as a risk factor for PTH with migraine features (p = 0.003), there was no difference in CBF between female children with and without PTH. Global CBF was not associated with pPCS and female PTH at 2 weeks after pediatric concussion. These findings provide evidence against the use of CBF measured by arterial spin labeling as an acute biomarker for pediatric concussion recovery.

Peak nasal inspiratory flow in children and adolescents with sickle cell disease: a case-control study.

Sickle cell disease is the most frequent of the hereditary hemoglobinopathies and it presents multisystemic effects. A manifestation that is commonly found in sickle cell disease is upper airway obstruction, particularly adenotonsillar hypertrophy. This study aims to evaluate the peak nasal inspiratory flow measurements of children and adolescents with sickle cell disease. This is a case-control study on children aged between 8 and 15 years who were diagnosed with sickle cell disease. Peak nasal inspiratory flow measurements were obtained from patients. A total of 279 patients were enrolled in this study, with 93 in the case group and 186 in the control group. The case group had an 82.83% chance of having lower peak nasal inspiratory flow values than the control group. In the case group, 75% of the peak nasal inspiratory flow values were in the lower standards, whereas in the control group, only 25% were in the lower standards. This study showed a high prevalence of reduced peak nasal inspiratory flow values in children with sickle cell disease and could certainly be incorporated into the day-to-day clinical evaluation of patients as a screening instrument.

Medical rehabilitation of children with obstructive uropathy

To develop technologies of physiotherapy application (sound stimulation, selective chromotherapy) for inclusion in comprehensive medical rehabilitation of children with megaloureter. Clinical observations and special examinations have been performed in 90 children with megaloureter aged from 1 to 10 years. The patients were divided into 2 groups: 30 children (study group) received sound stimulation combined with selective chromotherapy; 30 children (the 1st comparison group) - sound stimulation; 30 children (the 2nd comparison group) - selective chromotherapy (blue spectrum). General clinical methods, ultrasound of kidneys and bladder with Doppler monitoring of intrarenal blood flow, functional methods of bladder examination were used. The positive effects of separate and combined application of sound stimulation and selective chromotherapy on clinical and laboratory indicators, urodynamics of urinary tract and renal blood flow in children with megaloureter after surgery have been revealed. The efficacy of selective chromotherapy use in children with megaloureter and comorbid neurologic bladder dysfunction has been proven. Modern technologies for the application of physiotherapy, namely selective chromotherapy and sound stimulation, to include them in the comprehensive medical rehabilitation of children with megaloureter, have been developed for the first time and their high efficacy has been proven.

ANÁLISE DOS REGISTROS DE CARDIOPATIAS CONGÊNITAS EM CRIANÇAS MENORES DE UM ANO NO BRASIL

OBJECTIVE: To describe the records of congenital heart diseases in children under one year of age in Brazil, from 1998 to 2018. METHOD: Descriptive, quantitative research that used DATASUS records for diagnoses and deaths due to malformations of the device as a data source. Cardiocirculatory flow in children under one year of age. The data were analyzed until 12/31/2018 and statistically analyzed by the software R. RESULTS: On the basis of SINASC, 26,841 diagnoses of congenital heart diseases were observed, with greater frequency in 2018 (11%), among males (57.3%), white color / race (57.02%) and in the southeast region (66.76%). At the base of the SIM, 60,931 deaths from congenital heart diseases were recorded, with a greater number in 2014 (5.45%), among males (54.01%), aged 28 to 364 days (47.17%), color / white race (51.37%) and southeast region (41.32%). There was significant statistics for the ratio of confirmed cases and deaths at the age of 0 to 6 days with (p = 0.01) and (p = 0.00) and from 28 to 364 days (p = 0.01) and (p = 0.02), respectively. CONCLUSION: The number of malformations found is alarming compared to the number of births. Consolidating such information prepares professionals to face the studied pathology.

Accuracy of pulmonary ultrasound versus chest radiography for detecting pulmonary congestion resulting from increased pulmonary blood flow in children with congenital heart disease and left-to-right shunting

Introduction: Congenital heart diseases are a set of simple or complex dynamic heterogeneous malformations that originate in the embryo, progress through the pregnancy, and considerably change throughout the course of extrauterine life. They are the most common congenital defect, with a global prevalence estimated at 1.8 cases per 100 live births. These diseases can be classified by the cardiovascular segment affected and the impact on blood oxygenation and pulmonary flow. One of their most feared repercussions is pulmonary hypertension, which can result from lung exposure to increased blood flow, which changes vascular tone and causes medial hypertrophy and vascular remodeling. The advent of echocardiography has revolutionized healthcare for these children; however, chest radiography is still the most commonly used method for detecting increased blood flow and pulmonary edema. Objectives: Thus, this study compared the accuracy of ultrasound and chest radiography in detecting congestion resulting from increased pulmonary blood flow in children with congenital heart disease and left-to-right shunting. Methods: This is an observational longitudinal analytical prospective study comparing lung ultrasounds and chest radiographs of patients with congenital heart disease. Results: Our results suggest that ultrasound, which is a noninvasive diagnostic method that emits no radiation, has a discriminatory capacity similar to that of radiography, and has 92.59 % accuracy, 89.47 % sensitivity, and 100 % specificity. Conclusions: Pulmonary ultrasound is highly accurate, sensitive, and specific, and can be used to assess pulmonary congestion and edema resulting from increased blood flow in patients with heart disease.

Short-term effect of orthokeratology lens wear on choroidal blood flow in children with low and moderate myopia

We investigated changes in choroidal vascularity and choriocapillaris blood perfusion during orthokeratology (Ortho-K) lens wear. Sixty-two children with low to moderate myopia were enrolled. The Ortho-K group (n = 42) continuously wore Ortho-K lenses for 3 months, and the controls (n = 20) wore single-vision distance spectacles. All of the patients were instructed to return for follow-up visits after 1 day, 1 week and 1 month and 3 months of treatment. The subfoveal choroidal thickness (SFChT), choroidal vascularity [including the total choroidal area, luminal area, stromal area, and choroidal vascularity index (CVI)] and percentage of choriocapillaris flow voids (FV%) were determined with a Cirrus HD-OCT instrument. Additionally, ocular parameters were measured. In the Ortho-K group, the SFChT significantly increased by 12.61 ± 5.90 μm, the CVI was significantly increased by 2.99 ± 2.07% and 3.01 ± 2.32% on the horizontal and vertical scans respectively, and the FV% was significantly decreased by 0.89 ± 0.34% from baseline at the 1-week visit (all p < 0.001). The choroidal parameters remained unchanged at the 1-month and 3-month follow-ups with respect to the 1-week follow-up. In the control group, the choroidal parameters did not change significantly at 1 month (all p > 0.05). At the 3-month visit, the changes in the axial length (AL) and vitreous chamber depth (VCD) were significantly greater in the control group than in the Ortho-K group (0.14 ± 0.23 and 0.03 ± 0.05 mm in AL, 0.15 ± 0.23 and 0.06 ± 0.03 mm in VCD respectively). Our longitudinal study showed several choroidal parameter changes in the early stage in Ortho-K lens wearers with low to moderate myopia, and these changes persisted over 3 months. We speculate that Ortho-K lenses regulate choroidal thickness and blood perfusion, affecting myopia development.

The longitudinal evolution of cerebral blood flow in children with tuberous sclerosis assessed by arterial spin labeling magnetic resonance imaging may be related to cognitive performance.

To study longitudinal changes in tuber and whole-brain perfusion in children with tuberous sclerosis complex (TSC) using arterial spin labeling (ASL) perfusion MRI and correlate them with pathological EEG slow wave activity and neurodevelopmental outcomes. Retrospective longitudinal cohort study of 13 children with TSC, 3 to 6 serial ASL-MRI scans between 2 months and 7 years of age (53 scans in total), and an EEG examination performed within 2 months of the last MRI. Tuber cerebral blood flow (CBF) values were calculated in tuber segmentation masks, and tuber:cortical CBF ratios were used to study tuber perfusion. Logistic regression analysis was performed to identify which initial tuber characteristics (CBF value, volume, location) in the first MRI predicted tubers subsequently associated with EEG slow waves. Whole-brain and lobar CBF values were extracted for all patient scans and age-matched controls. CBF ratios were compared in patients and controls to study longitudinal changes in whole-brain CBF. Perfusion was reduced in tubers associated with EEG slow waves compared with other tubers. Low tuber CBF values around 6 months of age and large tuber volumes were predictive of tubers subsequently associated with EEG slow waves. Patients with severe developmental delay had more severe whole-brain hypoperfusion than those with no/mild delay, which became apparent after 2 years of age and were not associated with a higher tuber load. Dynamic changes in tuber and brain perfusion occur over time. Perfusion is significantly reduced in tubers associated with EEG slow waves. Whole-brain perfusion is significantly reduced in patients with severe delay. • Tubers associated with EEG slow wave activity were significantly more hypoperfused than other tubers, especially after 1 year of age. • Larger and more hypoperfused tubers at 6 months of age were more likely to subsequently be associated with pathological EEG slow wave activity. • Patients with severe developmental delay had more extensive and severe global hypoperfusion than those without developmental delay.

Ultrasound and laser Doppler flowmetry assessment of jaw muscle hypertonia in children with cerebral palsy

Relevance. Spastic cerebral palsy is one of the most common forms of cerebral palsy, in which muscular hypertonia, including jaw muscles, is present. To date, there is no universal algorithm for muscle hypertonia. The diagnosis is made based on complaints and data from an electromyographic study. This paper describes and proves the rationale for including ultrasound and laser Doppler flowmetry (LDF) in additional diagnostic methods.Material and methods. We examined 84 children with cerebral palsy using ultrasound and LDF to study the state of the mastication muscles. The ultrasound examination determined the structure and thickness of the masseter and temporal muscles and detected trigger points and the infiltration site. LDF was performed both at rest and after an occlusal test, which allows assessing the reserve capacities of the mastication muscles. We compared the received data with a group of healthy subjects of the same age.Results. Ultrasound parameters and LDF data differed from the control group. The ultrasound examination revealed trigger points for the first time without patients’ complaints. Congestion caused by damage to muscle cells is characteristic of the local blood flow in children with cerebral palsy. The results of the occlusal test evidenced the mastication muscle compensation abilities, which clinicians should consider during treatment planning.Conclusion. The received data will help dentists diagnose and treat muscle hypertonia, which will prevent pathology deterioration.