Fragmentation In Children Research Articles

Prevalence and determinants of low QRS voltages and QRS fragmentation in children and adolescents undergoing sports pre-participation screening.

Low QRS voltages (LQRSV) in limb leads and QRS fragmentation (FQRS) are possible electrocardiographic signs of myocardial fibrosis and cardiomyopathy, but they are not listed in current criteria for interpreting athlete's electrocardiogram (ECG). We investigated the prevalence and determinants of LQRSV and FQRS in a cohort of young apparently healthy athletes undergoing pre-participation screening (PPS). We analysed a consecutive series of 2140 ECG obtained during PPS of young athletes (mean age 12.5 ± 2.6 years, 7-18-year-old, 49% males). The peak-to-peak QRS voltage was measured in all limb leads, and LQRSV were defined when maximum value was <0.5 mV. Fragmented QRS morphologies were grouped into five patterns. Lead aVR was not considered. Maximum peak-to-peak QRS voltage in limb leads was 1.4 ± 0.4 mV, similar between younger and older athletes, but significantly lower in females than males (1.35 ± 0.38 mV vs. 1.45 ± 0.42 mV; P < 0.001). There was a weak correlation between maximal QRS voltages and body mass index (BMI), but not with type of sport or training load. Only five (0.2%) individuals showed LQRSV. At least one fragmented QRS complex was identified in 831 (39%) individuals but excluding the rSr' pattern in V1-V2, only 10 (0.5%) showed FQRS in ≥2 contiguous leads. They were older than those without FQRS, but did not differ in terms of gender, BMI, type of sport, or training load. Low QRS voltages in limb leads and FQRS in ≥2 contiguous leads excluding V1-V2 are rare in young apparently healthy athletes and are not related to the type and intensity of sport activity. Therefore, they may require additional testing to rule out an underlying disease particularly when other abnormalities are present.

QRS fragmentation in children with suspected myocarditis: a possible additional diagnostic sign.

We aim to assess the diagnostic role of QRS fragmentation in children with suspected acute myocarditis. Diagnosis of myocarditis in the paediatric population is challenging. Clinical suspicion, electrocardiogram, and laboratory tests are the main diagnostic features at presentation. However, electrocardiogram in patients with myocarditis is usually considered aspecific. We have previously described QRS fragmentation in adult patients with acute myocarditis. Patients aged less than 18 years, admitted between 2003 and 2019, and discharged with a diagnosis of acute myocarditis were included. Standard electrocardiogram, laboratory, and echocardiographic findings at admission and follow-up were reviewed. QRS fragmentation was defined by the presence of multiphasic R' spikes. Cardiac magnetic resonance and biopsy were performed in selected patients. Twenty-one patients were analysed, 16 males (76%), median age 9.5 (2.5-16) years. At presentation, 12 patients (57%) displayed QRS fragmentation. Median ejection fraction was 40% (27-60). Nine patients (43%) underwent cardiac magnetic resonance and displayed late gadolinium enhancement. One patient underwent biopsy that showed borderline findings. Electrocardiogram leads showing QRS fragmentation correlated with distribution of late gadolinium enhancement. Median follow-up was 600 (190-2343) days. All patients were alive at last follow-up. Six patients (33%) patients displayed persistence of QRS fragmentation. Median ejection fraction was 60% (60-65%). In three patients (14%), ejection fraction remained depressed, two of which showed persistence of QRS fragmentation. In this cohort of children with suspected myocarditis, QRS fragmentation was confirmed as a new additional diagnostic finding to look for at admission and during follow-up.

Study the Relationship between Chronic Inflammation and DNA Changes in Children on Regular Hemodialysis

Background and Aim of the Work: Inflammation is a common feature in chronic kidney disease (CKD), especially enhanced in end stage renal disease patients on hemodialysis (HD).Under inflammatory conditions, reactive oxygen species (ROS) and reactive nitrogen species (RNS) are generated from inflammatory and epithelial cells and result in DNA damage. In this study we assess DNA fragmentation in children with chronic kidney disease on regular hemodialysis sand detect its relation with some of the inflammatory markers. Material and Methods: The study included 40 children with CKD on regular hemodialysis (HD), and they were selected from the hemodialysis unit of Al-Zahraa hospital, Al-Azhar University, during the period from April 2016 to January 2018. Another group of 40 apparently healthy children, matches age and sex with patients group as a controls. Serum level of C-reactive protein (CRP), tumor necrosis factor (TNF-α) and DNA fragmentation assay in the same line with routine investigations were assessed for both groups Results: Children on regular hemodialysis have significantly higher CRP and TNF-α serum levels compared to their controls, it was (27.25±4.64 mg/L),(10.04±1.90 ng/ml) and (1.86±0.59 mg/L) (2.75±0.56 ng/ml) respectively, (P<0.001). There was a significant increase in DNA fragmentation in patients group (1.51±0.31) compared to the controls (0.54±0.21) with (P<0.001). DNA damage was present in (92%) of the study patients. There were significant positive correlations between DNA fragmentation and serum level of CRP, TNF-α, body mass index and dialysis duration. Conclusion: Almost children on hemodialysis are exposed to DNA damage with significant association with inflammatory markers, duration of hemodialysis and BMI.

Inferior patellar pole fragmentation in children: just a normal variant?

Fragmentary ossification of the inferior patella is often dismissed as a normal variant in children younger than 10years of age. The purpose of this study was to determine whether fragmentary inferior patellar pole ossification is a normal variant or is associated with symptoms or signs of pathology using MRI and clinical exam findings as reference. A retrospective review was performed on 150 patients ages 5-10years who underwent 164 knee radiography and MRI exams (45.1% male, mean age: 7.8years). The presence or absence of inferior patellar pole fragmentation on radiography was correlated with the presence or absence of edema-like signal on MR images. Clinical notes were reviewed for the presence of symptoms or signs referable to the inferior patellar pole. These data were compared with a 1:1 age- and sex-matched control group without inferior pole fragmentation. Statistical analysis was performed using two-tailed t-tests. Forty of 164 (24.4%) knee radiographs showed fragmentary ossification of the inferior patella. Of these 40 knees, 62.5% (25/40) had edema-like signal of the inferior patellar bone marrow compared with 7.5% (3/40) of controls (P = 0.035). Patients with fragmentary ossification at the inferior patella had a significantly higher incidence of documented focal inferior patellar pain compared with controls (20% vs. 2.5%, P = 0.015). Inferior patellar pole fragmentation in children 5 to 10years of age may be associated with localized symptoms and bone marrow edema-like signal and should not be routinely dismissed as a normal variant of ossification.

Movement distribution: a new measure of sleep fragmentation in children with upper airway obstruction.

To develop a measure of sleep fragmentation in children with upper airway obstruction based on survival curve analysis of sleep continuity. Prospective repeated measures. Hospital sleep laboratory. 92 children aged 3.0 to 12.9 years undergoing 2 overnight polysomnographic (PSG) sleep studies, 6 months apart. Subjects were divided into 3 groups based on their obstructive apnea and hypopnea index (OAHI) and other upper airway obstruction (UAO) symptoms: primary snorers (PS; n = 24, OAHI <1), those with obstructive sleep apnea syndrome (OSAS; n = 20, OAHI ≥1) and non-snoring controls (C; n = 48, OAHI <1). Subjects in the PS and OSAS groups underwent tonsillectomy and adenoidectomy between PSG assessments. Post hoc measures of movement and contiguous sleep epochs were exported and analyzed using Kaplan-Meier estimates of survival to generate survival curves for the 3 groups. Statistically significant differences were found between these group curves for sleep continuity (P < 0.05) when using movement events as the sleep fragmenting event, but not if stage 1 NREM sleep or awakenings were used. Using conventional indices of sleep fragmentation in survival curve analysis of sleep continuity does not provide a useful measure of sleep fragmentation in children with upper airway obstruction. However, when sleep continuity is defined as the time between gross body movements, a potentially useful clinical measure is produced.

Sleep fragmentation and increased periodic limb movements are more common in children with nocturnal enuresis

To determine sleep fragmentation in children with nocturnal enuresis (NE). Paediatricians assessed NE parameters in children referred to an enuresis clinic. Control subjects, matched by age and gender and without incontinence or (un)treated NE, were recruited from the paediatric sleep clinic regardless of their sleep problem. Sleep was investigated by one overnight video-polysomnography in both groups. The study group comprised 67 children with proven NE (50 boys and 17 girls between six and 16years: 11.1±2.8 SD). They were matched with 67 control subjects (47 boys and 20 girls aged between six and 16years: 11.0±2.9 SD). Children with NE had a higher incidence of periodic limb movements associated with cortical arousals in their sleep. They displayed significant higher periodic limb movement index, arousal index and awakening index than the control group. Children with NE displayed higher sleep fragmentation and periodic limb movements in sleep than the control children with a possible sleep disorder without NE. The findings emphasise the central involvement of the pathophysiology of NE and the multifactorial nature of the condition.

Development of mechanisms of recognition of fragmented images differing in the degree of fragmentation in children of preschool and primary school ages

Recognition of fragmented images with an increasing number of fragments was studied in children of three age groups (five to six, seven to eight, and nine to ten years of age) to compare the behavioral and neurophysiological parameters of recognition in these groups. The most pronounced changes in effectiveness of recognition were observed when the five- to six-year-old and seven- to eight-year-old children were compared. In the former, recognition was not accompanied by any significant changes in the event-related potentials of the prefrontal cortex or by an increase in N250–400 (Ncl) in the extrastriate cortex (though it is an important characteristic of the process). However, the amplitude of the N170–200 component, which reflects analysis and encoding of sensory features, did increase at the age of five to six years. Immaturity of the prefrontal cortex is manifested in a deficiency of the control: these children respond hastily and make numerous mistakes. In seven- to eight-year-old children, recognition is accompanied by an increase in the amplitude of the N100 and N250 components in the prefrontal cortex, whereas the amplitude of the Ncl component increases in the extrastriate cortex. The error rate and recognition threshold are significantly lower in these children than at the age of five to six years. The role of prefrontal cortex is the most pronounced at the age of nine to ten years, which is manifested in the Ncl amplitude and the later phases corresponding to the cognitive recognition. Our results demonstrate qualitative differences in the mechanisms of recognition in children of the preschool and primary school age. At the age of five to six years, recognition is a result of integration of the sensory signs. Beginning from the age of seven to eight years, the prefrontal cortex plays an important role in recognition of the fragmentary images; this brain region is responsible for a search of possible analogues in memory and identification of an object.

Visual scoring of sleep: A comparison between the Rechtschaffen and Kales criteria and the American Academy of Sleep Medicine criteria in a pediatric population with obstructive sleep apnea syndrome

To compare the new American Academy of Sleep Medicine (AASM) criteria for scoring sleep with the previous Rechtschaffen and Kales (R&K) criteria in a cohort of children with primary snoring, obstructive sleep apnea syndrome (OSAS) and normal controls. Polysomnography was performed in 26 consecutive children with primary snoring (13 males, mean age 6.2 years, SD 3.2), in 39 with OSAS (24 males, mean age 6.1 years, SD 3.0), and in 10 age-matched normal controls. Compared to the other groups, OSAS children showed a lower percentage of slow-wave sleep, using both R&K and AASM criteria; they also showed a higher percentage of stage shifts, and N1, using the AASM criteria. Children with primary snoring showed a higher percentage of N1, compared to controls. These results indicate that the use of the new AASM criteria seem to disclose more differences in sleep parameters than the R&K rules in children with OSAS. The AASM criteria seem to disclose a high degree of sleep fragmentation in children with OSAS, mostly related to the repeated occurrence of N1.

Can actigraphy measure sleep fragmentation in children?

ObjectiveThe gold standard assessment for sleep quality is polysomnography (PSG). However, actigraphy has gained popularity as an ambulatory monitor. We aimed to assess the value of actigraphy in measuring sleep...

Culture and children's cosmology

In this investigation, we examined children's knowledge of cosmology in relation to the shape of the earth and the day-night cycle. Using explicit questioning involving a choice of alternative answers and 3D models, we carried out a comparison of children aged 4-9 years living in Australia and England Though Australia and England have a close cultural affinity, there are differences in children's early exposure to cosmological concepts. Australian children who have early instruction in this domain were nearly always significantly in advance of their English counterparts. In general, they most often produced responses compatible with a conception of a round earth on which people can live all over without falling off. We consider coherence and fragmentation in children's knowledge in terms of the timing of culturally transmitted information, and in relation to questioning methods used in previous research that may have underestimated children's competence.

Dynamic changes in EEG spectra during obstructive apnea in children.

Children are less likely to demonstrate EEG arousal during obstructive sleep apnea (OSA) than adults. We hypothesized that changes in spectral EEG characteristics occur during REM-associated OSA in the absence of arousal. Eight snoring children underwent overnight polysomnography. OSA events during REM periods not associated with EEG or behavioral arousal were identified. EEG signals from C3A2 and C4A1 leads corresponding to 1) < or =10-sec epochs preceding OSA (PRE), 2) the obstructed period (OSA), and 3) < or =10-sec epochs following airflow resumption (POST) were subjected to fast Fourier transform (FFT) routines. Seventy-two isolated OSA, and 14 clusters of > 4 OSA events were analyzed. In single OSA, delta OSA amplitude was lower than in PRE (P < 0.01) and in POST (P < 0.001). Furthermore, POST delta amplitude was higher than PRE (P < 0.01). In contrast, in OSA clusters, the dynamic differences in delta amplitude disappeared after the second OSA. Reciprocal increases and decreases occurred for the theta frequency domain during OSA and post-OSA, while sigma and beta frequency power did not change. We conclude that during isolated OSA episodes without arousal, significant decreases in power selectively occur for delta frequency, and are followed by a rebound increase upon termination of apnea. The delta changes are progressively attenuated during repeated OSA. We postulate that delta changes may reflect ongoing adaptations in sleep pressure which are necessary to relieve the respiratory compromise, and may represent subtle evidence for arousal and consequent sleep fragmentation in children with OSAS.

Balancing the Educational Needs of Students with School-Based or School-Linked Services

Since their inception, public schools have striven to prepare the next generation for higher education and adulthood. Curricula reflect the academic challenges and social problems of the times. Many have been developed in schools to address the social-emotional needs of students. This growth in programming has been evidence of a desire to develop links between the public schools and social services and mental health and public health agencies. Even when these links are possible, there are many questions that need to be asked: Does this marriage of services with schools retain the primary role of education? Does the inclusion of such programming take away from funding for schools? How does the concept of school-based or school-linked services balance with the mission of education? In the November 1995 issue of Work, Cynthia Franklin and Calvin L. Streeter in their article entitled School Reform: Linking Public Schools with Human Services (pp. 773-782) painted a compelling picture of linking public schools with human services as a part of school reform. Their continuum of approaches to linking schools and human services illustrates well the depth and breadth of programming and interventions that could and do exist throughout public schools in the United States. The article attempted to present a model that balances the educational needs of students with their social - emotional needs in a school setting. A review of the journal Work in Education for the past five years provides examples of school-based and school-linked to assist students and (health clinics, alcohol and other drug use prevention programs, and so forth). This continuum of services reflects the wide range of social and emotional needs of students in public schools. What troubles me about this article is that, with such an emphasis on social-health services in schools, society may lose sight of the mission of educating students. What drew me to this conclusion was the authors' comment that many proponents of school reform see schools as a natural place for human services activities because they provide maximum access to the majority of children and families (Franklin & Streeter, 1995, p. 773). Even though the model Franklin and Streeter (1995) present is supposed to balance the educational and emotional-social needs of students, it does not in fact discuss their educational needs. The authors point out that benefits will be maximized as integrated services systems reduce the fragmentation in children and family services and accomplish comprehensive school programs (p. 779). This approach may greatly affect the social and emotional needs of students but at what cost to their educational needs? This area is where I feel the authors have failed to clearly explain how in education we can balance the social and emotional needs of students with their academic needs. The article goes on to say, Social workers must demonstrate to educators their expertise in providing creative and effective leadership in six core areas of school reform efforts: environmental assessment, mediation, goal attainment, resource assessment, political action, and needs assessment and intervention planning (Franklin & Streeter, 1995, p. …