Pediatric Volunteers Research Articles

IGHG4: innovative diagnostic biomarkers for iron overload in β-thalassemia patients

ABSTRACT Objectives This study aims to investigate the serotransferrin (TF), complement C1s subcomponent (C1S), immunoglobulin heavy constant gamma 4 (IGHG4), hemoglobin subunit alpha (HBA1), and clusterin (CLU) contents in β-thalassemia patients, and explores their physiological role as potential non-invasive bioindicators for disease diagnosis and iron overload. Methods A total of 62 children with β-thalassemia were recruited and categorized by genotype, along with 17 healthy pediatric volunteers for analysis. The circulating ferritin content was evaluated, and plasma levels of TF, C1S, IGHG4, HBA1, and CLU were assessed using ELISA. The primary outcome of this study was the correlation between the five protein marker levels and iron overload. Continuous variables were analyzed using the Student's t-test or the Mann–Whitney U test. A binary logistic regression model identified independent predictors of iron overload in patients with β-thalassemia. Receiver operating characteristics (ROC) were employed to evaluate the model's performance. Results The IGHG4 protein content was significantly lower in β-thalassemia patients compared to healthy controls. The IGHG4 protein content was reduced in the β+/β0 and β0/β0 patient populations compared to controls, with no significant difference observed between the β+/β0 group and healthy controls. A strong inverse relationship was identified between the IGHG4 protein content and SF concentration (r = −0.322, p = 0.004). Finally, plasma IGHG4 levels demonstrated adequate diagnostic capability, as indicated by our ROC curve analysis. Conclusion In conclusion, decreased IGHG4 protein levels are significantly associated with the degree of iron overload in β-thalassemia patients and may serve as a possible biomarker for evaluating iron overload.

Aortic velocity measurements derived from phase-contrast MRI are influenced by a cardiac implantable electronic device in both adult and pediatric human subjects.

Overall there is a lack of evidence on the accuracy and precision of phase-contrast (PC) MRI in patients with cardiac implantable electronic devices (CIEDs). The purpose of this study is to determine whether aortic velocity measurements are influenced by a CIED. We scanned 21 adult patients and 8 pediatric volunteers using clinical standard PC and real-time PC (rt-PC) sequences with and without a CIED generator taped on human subjects (below the left clavicle for adults and children; also on the abdomen for children) to mimic image artifacts. Peak and mean velocities above the aortic valve were calculated. The Bland-Altman analyses on peak velocity measurements in pediatric subjects showed that both the accuracy and precision worsen as the distance between the CIED and aortic valve decreases (i.e., from abdomen to below the left clavicle). Specifically, both the bias and the coefficient of variation (CV) for both clinical PC and rt-PC increased from the abdominal position (clinical: bias = -1.1%, CV = 4.3%; rt-PC: bias = -0.3%, CV = 3.4%) to the clavicle position (clinical: bias = -4.0%, CV = 8.1%; rt-PC: bias = 8.2%, CV = 7.3%). A similar trend was observed for mean velocity. The mean difference in peak and mean velocity measurements between rt-PC with CIED (either position) and clinical standard PC with no CIED was within 7.5%. In adult patients, the mean difference between rt-PC with CIED and clinical standard PC with CIED in peak velocity was 6.9%, and the CV was 7.9%. This study demonstrates that aortic velocity measurements are influenced by CIED in both adult and pediatric subjects.

Evaluation of the effect of obesity, dietary glycemic index and metabolic profiles on the cardiovascular risk in children with classical phenylketonuria

ObjectivesTo compare the glycemic index(GI),obesity,echocardiographic,and arterial stiffness measurements with the healthy control group to evaluate the cardiovascular risk of pediatric classical phenylketonuria(PKU). MethodsThe study was a prospective observational,involving 104 pediatric volunteers between 2019 and 2020.Two groups were formed:the PKU patient group and the healthy control group.These two groups were further divided into three subgroups:obese,overweight,and normal weight.The patients' anthropometric measurements,body fat analysis,biochemical analysis, GI and glycemic load(GL),arterial stiffness measurements,and echocardiographic findings were recorded. ResultsThe PKU patient group's glucose,total cholesterol,LDL,and HDL values were significantly lower than the healthy control group(p = 0.010 for glucose and p = 0.001 for total cholesterol,LDL and HDL).Triglyceride levels were higher in the PKU patient group than in the healthy controls(109.6 vs. 76.7 mg/dl,p = 0.001). GI and GL were significantly lower in the PKU patient group than in the healthy control group(GI 453 vs. 392.9,p = 0.017 and GL 101.1 vs. 85.5,p = 0.036).Left ventricular mass(LVM)-z-score and LVM index were significantly higher in the PKU group than in the healthy control group(LVM z-score 0.9 vs. 0.5,p = 0.014 and LVM index 38.9 vs. 32.7 g/m2.7,p = 0.001). A moderately statistically significant positive correlation was found between the mean phenylalanine(phe) value and pulse wave velocity(PWV) among the PKU patient groups(R: 0.477,p < 0.001).A moderately statistically significant positive correlation was also found between waist circumference and PWV in the PKU patient group(R:0.541, p < 0.001). ConclusionsOur study found that close follow-up of phe levels and PWV is more critical than obesity, GI, and GL in the cardiovascular evaluation of classical PKU patients.A large number of multicenter pediatric studies are needed in this area.

Assessment of pediatric shoulder range of motion and loading response to evaluate the biofidelity of the Large Omni-directional Child (LODC) anthropomorphic test device (ATD) shoulder design

The shoulder girdle complex, through engagement with the seat belt, influences motor vehicle occupant upper body movement during frontal impacts, affecting the movement of the head and spine. The recently developed Large Omni-directional Child (LODC) anthropomorphic test device (ATD) was designed with flexible shoulder girdle structures that capture the unique kinematics in pediatric occupants. However, the LODC shoulder has not been evaluated for biofidelity due to the lack of biomechanical data available on pediatric shoulder responses. This study evaluated quasi-static pediatric shoulder girdle complex responses through non-invasive displacement measurements. These data were obtained to evaluate, and, if necessary, improve the biofidelity of the LODC ATD. Shoulder range of motion and anthropometric measurements were obtained from 25 pediatric volunteers, ages 8–12 years old. Loads were applied bilaterally exclusively to the shoulder complexes in increments of 25 N up to 150 N per shoulder at 90 and 135 degrees of shoulder flexion. Still photos were used to determine shoulder displacement in the sagittal plane from images captured prior to and following the load applications. Data analysis consisted of motion tracking to evaluate the absolute and relative displacement of the right acromion and T1. The displacements for each volunteer were normalized based on the volunteer’s shoulder width compared to the shoulder width of the LODC ATD. For the 90° load, the acromion moved relative to T1 an average of 28.1 mm forward and 3.1 mm downward at maximum displacement. For the 135° load, the acromion moved relative to T1 an average of 15.5 mm forward and 42.7 mm upward at maximum displacement. Similar displacements at higher loads indicated that the volunteers achieved their maximum range of motion. The results of this study will be compared to the LODC ATD, assessing the biofidelity of the shoulder complex.

Application of amide proton transfer imaging to pretreatment risk stratification of childhood neuroblastoma: comparison with neuron-specific enolase.

The diagnosis and treatment of childhood neuroblastoma (NB) varies with different risk groups, thus requiring accurate preoperative risk assessment. This study aimed to verify the feasibility of amide proton transfer (APT) imaging in risk stratification of abdominal NB in children, and compare it with the serum neuron-specific enolase (NSE). This prospective study enrolled 86 consecutive pediatric volunteers with suspected NB, and all subjects underwent abdominal APT imaging on a 3T magnetic resonance imaging scanner. A 4-pool Lorentzian fitting model was used to mitigate motion artifacts and separate the APT signal from the contaminating ones. The APT values were measured from tumor regions delineated by two experienced radiologists. The one-way analysis of variance, independent-sample t-test, Mann-Whitney U-test, and receiver operating characteristic analysis were performed to evaluate and compare the risk stratification performance of the APT value and serum NSE index-a routine biomarker of NB in clinics. Thirty-four cases (mean age, 38.6±32.4 months; 5 very-low-risk, 5 low-risk, 8 intermediate-risk and 16 high-risk ones) were included in the final analysis. The APT values were significantly higher in high-risk NB (5.80%±1.27%) than in the non-high-risk group (3.88%±1.01%) composed of the other three risk groups (P<0.001). However, there was no significant difference (P=0.18) in NSE levels between the high-risk (93.05±97.14 ng/mL) and non-high-risk groups (41.45±30.99 ng/mL). The associated area under the curve (AUC) of the APT parameter (AUC =0.89) in differentiating high-risk NB from non-high-risk NB was significantly higher (P=0.03) than that of NSE (AUC =0.64). As an emerging non-invasive magnetic resonance imaging technique, APT imaging has a promising prospect for distinguishing high-risk NB from non-high-risk NB in routine clinical applications.

A Full-Scale Exercise for Preparedness for Uncertain and Novel Chemical Hazards with Pediatric Casualties: Project PUNCH

Introduction:In 2022, the Harvard/Beth Israel Deaconess Disaster Medicine Fellowship conducted a full-scale exercise (FSX) with the dual mission of 1) training Disaster Medicine Fellows (DMFs) in exercise design, planning, and execution, and 2) expanding local first responder experience with pediatric casualties in a mixed-method terrorist attack.Method:Project PUNCH (Preparedness for Uncertain and Novel Chemical Hazards) was planned in two stages. A tabletop exercise in the form of a facilitated discussion was conducted in March 2022 with stakeholders from Fire, Emergency Medical Services (EMS), and the Massachusetts HazMat Team. A FSX simulating a combined blast and chemical attack on a family gathering was held in June 2022 at Anna Maria College in Paxton, MA.Results:Fire, EMS, HazMat, LifeFlight, local Police, MA State Police, a local Medical Reserve Corps, and over 40 volunteer victims including 16 pediatric volunteers participated in the FSX. The FSX was a two-hour exercise with a simulated explosion and a secondary drone-deployed dummy-opioid aerosol release. This was the first FSX for the Paxton Region since the coronavirus pandemic began. Planning was conducted by the DMFs between January and June 2022 with the aid of Fellowship faculty and local stakeholders following Homeland Security Exercise and Evaluation Program guidelines. Local and Fellowship leadership with Pediatric expertise were engaged to plan pediatric specific considerations, precautions and safety measures. COVID precaution guidelines were followed. These efforts are detailed in the forthcoming field report. Educational guides for toxidromes and triage and resuscitation of pediatric victims were distributed to first responders.Conclusion:The end outcome was a FSX that trained DMFs in exercise design, planning, and execution, and increased experience of local first responders with the concepts of asymmetric terrorist attacks and comfort with pediatric disaster victims. Multi-agency disaster drills remain an important training tool for preparedness and response to mass casualty events.

Prospective quantitative gene expression analysis of kallikrein-related peptidase KLK10 as a diagnostic biomarker for childhood acute lymphoblastic leukemia.

BackgroundThe most common malignancy in children is acute lymphoblastic leukemia (ALL). This study aimed to explore KLK10 mRNA expression as a potential diagnostic biomarker for ALL in children and to examine the effect of chemotherapy on KLK10 mRNA expression following the induction and after three months of receiving chemotherapy.MethodsIn this prospective study, total RNA was extracted from blood samples of 23 pediatric ALL patients on diagnosis, after one month and three months of receiving chemotherapy. Healthy pediatric volunteers (n = 12) were selected as control individuals. After cDNA synthesis, KLK10 mRNA gene expression levels were quantified using quantitative real-time PCR (qRT-PCR).ResultsKLK10 mRNA expression levels were significantly decreased in leukemic cells compared to their levels in cells of normal blood samples (p = 0.0001). KLK10 expression levels in ALL patients after one month and three months of receiving chemotherapy decreased compared to normal blood samples (p < 0.0001 and p = 0.0175 respectively). The expression level of KLK10 mRNA in ALL patients after one month of chemotherapy was decreased compared to their level on diagnosis (p = 0.4413). KLK10 mRNA expression levels in ALL patients after three months of chemotherapy were increased compared to their level on diagnosis (p = 0.0602). The ROC curve illustrated that KLK10 mRNA expression could very efficiently discriminate ALL patients from normal counterparts (AUC=0.886, 95% CI [0.7720–1.000], SE = 0.0582, p = 0.0004).ConclusionKLK10 mRNA expression could serve as a potential diagnostic molecular biomarker for ALL in children.

Following drug degradation and consequent taste deterioration of an oral reconstituted paediatric suspension during dosing interval via electronic tongue

BackgroundThe taste of oral liquid dosage forms is a crucial factor that impacts pediatric patient compliance. Taste of suspensions can be typically evaluated by human volunteers. Recently, the electronic tongue (ET) has been proven as an emerging tool that could be useful to follow up various formulations’ properties like taste and composition. This study aimed to evaluate the potential use of ET in assessing the taste deterioration of reconstituted oral suspensions and compare the results obtained with the typical in vivo panel taste method. MethodsFour commercially available brands of amoxicillin/ clavulanic acid suspensions (one brand and three generic formulations) were reconstituted and stored in refrigerator to assess their taste on a daily basis. The taste of these products was assessed using Alpha-Astree ET and the obtained results were compared with those obtained from an in vivo panel taste assessment using a hedonic panel test (the 5-point hedonic scale). ResultsAll evaluated suspensions exhibited similar trends. ET and in vivo analysis indicated low taste scores for all evaluated suspensions immediately after reconstitution, possibly due to the incomplete dissolution of sucrose. The scores for all formulations were higher on day 2, followed by a steady state for the next two days. After that, a significant decay in the scores was observed in the fifth day for all evaluated suspensions. ET results were in excellent agreement with the results obtained via in vivo panel test method. ConclusionThe ET seems to be promising for testing the taste of pharmaceutical liquid preparations and evaluate possible deterioration upon storage or after reconstitution. It may provide a platform to avoid the involvement of pediatric volunteers in clinical evaluation and can be employed as a quality control tool during manufacturing.

Urinary Monocyte Chemoattractant Protein-1 in Patients With Alport Syndrome

In patients with Alport syndrome, the rate of kidney function decline varies with genotype, chromosomal sex, and possibly other factors.1 We hypothesized that certain urinary biomarkers can predict the rate of kidney function decline in patients with Alport syndrome. We collected urine samples from 76 patients with Alport syndrome (39 male, 37 female) recruited through the Alport Syndrome Treatments and Outcomes Registry (ClinicalTrials.gov identifiers NCT00481130 and NCT01602835) and from 40 healthy adult and 11 healthy pediatric volunteers.

Improving hyperpolarized 129 Xe ADC mapping in pediatric and adult lungs with uncertainty propagation.

Hyperpolarized (HP) 129 Xe-MRI provides non-invasive methods to quantify lung function and structure, with the 129 Xe apparent diffusion coefficient (ADC) being a well validated measure of alveolar airspace size. However, the experimental factors that impact the precision and accuracy of HP 129 Xe ADC measurements have not been rigorously investigated. Here, we introduce an analytical model to predict the experimental uncertainty of 129 Xe ADC estimates. Additionally, we report ADC dependence on age in healthy pediatric volunteers. An analytical expression for ADC uncertainty was derived from the Stejskal-Tanner equation and simplified Bloch equations appropriate for HP media. Parameters in the model were maximum b-value (bmax ), number of b-values (Nb ), number of phase encoding lines (Nph ), flip angle and the ADC itself. This model was validated by simulations and phantom experiments, and five fitting methods for calculating ADC were investigated. To examine the lower range for 129 Xe ADC, 32 healthy subjects (age 6-40 years) underwent diffusion-weighted 129 Xe MRI. The analytical model provides a lower bound on ADC uncertainty and predicts that decreased signal-to-noise ratio yields increases in relative uncertainty . As such, experimental parameters that impact non-equilibrium 129 Xe magnetization necessarily impact the resulting . The values of diffusion encoding parameters (Nb and bmax ) that minimize strongly depend on the underlying ADC value, resulting in a global minimum for . Bayesian fitting outperformed other methods (error < 5%) for estimating ADC. The whole-lung mean 129 Xe ADC of healthy subjects increased with age at a rate of 1.75 × 10-4 cm2 /s/yr (p= 0.001). HP 129 Xe diffusion MRI can be improved by minimizing the uncertainty of ADC measurements via uncertainty propagation. Doing so will improve experimental accuracy when measuring lung microstructure in vivo and should allow improved monitoring of regional disease progression and assessment of therapy response in a range of lung diseases.

503 Burn Camp Volunteer Engagement

Abstract Introduction Much has been published in burn literature regarding the positive impact of camp participation on burn survivors. Less has been said about the positive benefits reaped by the volunteers who freely give their time to support burn camp initiatives. Often these volunteers are fire fighters, members of the hospital’s burn team, family members or burn survivors or adult burn survivors. Occasionally, volunteers have no prior ties to the burn injury community. These individuals donate their time to attending burn camp as a counselor or camp volunteer and many serve through the year on planning and organization committees. Prior studies have reported a positive professional benefit from camp participation including improved job effectiveness and motivation. Counselors also reported personal benefits including personal growth and socialization. The same benefits may be present for non-counselor volunteers. Methods This survey-based project explored the attitudes of burn camp volunteers. Surveys were sent to current and past volunteers of one facility’s Pediatric Burn Camp. These include but are not limited to community members, firefighters, medical staff and Burn Team members. Surveys were sent via mail with a follow-up email sent one month later to encourage survey completion. Results Surveys were sent to 40 pediatric burn camp volunteers. 28 respondents reported between 1 and 27 years of camp participation. 75% report no regular contact with burn survivors related to their occupation. 29% of respondents were firefighters, 18% were burn team members and 32% were burn survivors. Respondents answered write in questions related to what they love about camp and how their camp experience could be made better. Nine topics related to attitudes were addressed in a Likert scale format. Statistical analysis will be performed to evaluate trends in volunteer attitudes and to compare attitudes to longevity of camp participation, volunteer age and occupation. Trends in recommended camp improvements will be addressed. Conclusions Longevity of camp participation is directly related to volunteer believes and attitudes. Whether because of other responsibilities, changing vocations or a loss of interest in the cause, often volunteers fail to return year to year. Volunteer engagement is an essential part of keeping burn camp a viable resource for pediatric burn survivors. By assessing volunteer perceptions, camp directors can discover areas for improvement and camp attributes that draw volunteers to burn camp. Volunteer recruit strategies developed with these trends in mind may be more successful in attainment and retention of dedicated volunteers.

Associated parallels of the initial potential mineralization value of oral fluid and intensity of dental caries in children with cleft lip and palate

BACKGROUND: Cleft upper lip and palate is the most common malformation of the maxillofacial region. Despite the huge successes that have been achieved by dental surgeons in eliminating such defects, the issues of studying the initial indicators of the cariesological status in children with congenital cleft lip and palate are still not fully resolved. The study of the above issues will allow us to correct the plan of therapeutic and preventive action, which will lead to effective rehabilitation of children with cleft lip and palate.&#x0D; AIM: This study aimed to conduct a clinical assessment of the initial mineralizing ability of oral fluids in children with congenital cleft lip and palate depending on the cariology status.&#x0D; MATERIAL AND METHODS: This study presented the results of the clinical assessment of the initial value of the mineralizing ability of oral fluid depending on the intensity of dental caries in children with congenital cleft lip and palate. To determine the mineralizing ability of mixed saliva, 76 teeth of pediatric volunteers with congenital cleft lip and palate with a high level of mineralization potential of oral fluid, with medium, low, and very low levels of the studied indicator, were examined. The level of the mineralizing ability of mixed saliva was determined by visualization depending on the involvement of functionally oriented groups of teeth with caries.&#x0D; RESULTS: The general characteristics of the mineralization potential of oral fluids, depending on the intensity of dental caries, help determine that with mild caries, the average value of the studied indicator was 21.9%, at an average intensity level of 31.0%, at a high intensity level of 47.1%.&#x0D; CONCLUSIONS: An inverse-diameter dependence was found in the intensity level of caries on the mineralizing ability of oral fluids.

Biofidelic Evaluation of the Large Omni-Directional Child Anthropomorphic Test Device in Low Speed Loading Conditions.

Motor vehicle crashes remain the leading cause of death for children. Traditionally, restraint design has focused on the crash phase of the impact with an optimally seated occupant. In order to optimize restrain design for real-world scenarios, research has recently expanded its focus to non-traditional loading conditions including pre-crash positioning and lower speed impacts. The goal of this study was to evaluate the biofidelity of the large omni-directional child (LODC) ATD in non-traditional loading conditions by comparing its response to pediatric volunteer data in low-speed sled tests. Low-speed (2-4 g, 1.9-3.0 m/s) frontal (0°), far-side oblique (60°), and far-side lateral (90º) sled tests, as well as lateral swerving (0.72 g, 0.5 Hz) tests, were conducted using the LODC. The LODC was restrained using a 3-point-belt with an electromechanical motorized seat belt retractor, or pre-pretensioner. Motion capture markers were placed on the head, torso, and belt. The LODC was compared to previously collected pediatric volunteer data as well as the HIII 10 and Q10. Significant difference between the pediatric volunteers and ATDs were identified by comparing the mean ATD response to the pediatric volunteer 95% CI. The LODC exhibited lower forward head excursion (262 mm) compared to pediatric volunteers (263 - 333 mm) in low-speed frontal sled tests (p<0.05), but was closer to the pediatric volunteers than the HIII 10 (179 mm) and Q10 (171 mm). In lateral swerving, the LODC (429 mm) exhibited greater lateral head excursion (p<0.05) compared to pediatric volunteers (115 - 171 mm). The LODC exhibited a greater reduction in kinematics compared to the pediatric volunteers in all loading conditions with a pre-pretensioner. These data provide valuable insight into the biofidelity of the LODC in non-traditional loading conditions, such as evaluating pre-crash maneuvers on occupant response.

Response Ratio Development for Lateral Pendulum Impact with Porcine Thorax and Abdomen Surrogate Equivalents.

There has been recent progress over the past 10 years in research comparing 6-year-old thoracic and abdominal response of pediatric volunteers, pediatric post mortem human subjects (PMHS), animal surrogates, and 6-year-old ATDs. Although progress has been made to guide scaling laws of adult to pediatric thorax and abdomen data for use in ATD design and development of finite element models, further effort is needed, particularly with respect to lateral impacts. The objective of the current study was to use the impact response data of age equivalent swine from Yaek et al. (2018) to assess the validity of scaling laws used to develop lateral impact response corridors from adult porcine surrogate equivalents (PSE) to the 3-year-old, 6-year-old, and 10-year-old for the thorax and abdominal body regions. Lateral impact response corridors were created from 50th adult male PSE pendulum lateral impact T1, T14, and L6 accelerations and pendulum impact force time histories for the thorax and abdomen testing performed. The ISO 9790 scaling technique using length, mass, and elastic modulus scale factor formulas were used in conjunction with measured swine parameters to calculate scale factors for the PSE. In addition to calculation of pertinent test scale factors, response ratios for the pendulum impact tests were calculated. The scaling factors and response ratios determined for the porcine surrogates were compared to the already established ISO human lateral pendulum impact response ratios to determine whether a consistent pattern over the age levels described for the two sets of data (human and swine) exists. The actual lateral impact pendulum data, for both thoracic and abdominal regions, increases in magnitude and time duration from the 3-year-old PSE up to the 50th male PSE. This increase in magnitude and time duration is comparable to the human response corridors developed based on an impulse-momentum analysis and the elastic bending modulus derived from human skull bone. This pattern in the human impact response corridors was observed in the response ratio values and the swine response data. Based on the current study's findings, when utilizing the elastic modulus of human skull bone presented previously in research, thoracic and abdominal lateral pendulum impact response of PSE follows the general scaling laws, based on the impulse-momentum spring-mass model. The thoracic and abdominal lateral pendulum force impact response of PSE also follows the human scaled impact response corridors for lateral pendulum impact testing presented in previous research. The overall findings of the current study confirm, through actual swine testing of appropriate weight porcine surrogates, that scaling laws are applicable from the midsized-male adult down to the 3-year-old age level using human skull elastic modulus values established in previous research.

Evaluation of Periarticular Soft Tissues in Patients With Juvenile Idiopathic Arthritis by Superb Microvascular Imaging and Shear Wave Elastography.

This study aims to compare the vascularity and elasticity of periarticular soft tissues by superb microvascular imaging (SMI) and power Doppler (PD) ultrasound along with shear wave elastography (SWE) between children with juvenile idiopathic arthritis (JIA) and healthy children. This prospective single center study, conducted between March 2018 and May 2018, included 22 children with JIA (14 males, 8 females; mean age 11.27±5 years; range, 5 to 17 years) and 24 healthy pediatric volunteers (12 males, 12 females; mean age 13±5.5 years; range, 7 to 17 years). Quadriceps tendon (QT), patellar tendon (PT), infraarticular and supraarticular soft tissue elasticities were calculated via SWE. Supraarticular and infraarticular soft tissue vascularity index (VI) were evaluated via SMI and PD. No significant difference was found among the mean ages of the participants in study and control groups. Mean VI of both supraarticular (8.15%) and infraarticular soft tissues (7.9%) by SMI were significantly higher in study group compared to control group (2.88% vs. 2.57%, respectively). Mean VI of both supraarticular (9.1%) and infraarticular soft tissues (8.12%) by PD were significantly higher in study group compared to control group (3.4% vs. 3.1%, respectively). Highly significant good positive correlation was found between VI values obtained with PD and SMI (r=0.9, p=0.001). There was a significant moderate positive correlation between the mean elasticity of the QT with VI of the supraarticular soft tissues by SMI (r=0.4, p=0.003). There was a significant moderate positive correlation of VI of infraarticular soft tissues by SMI with mean elasiticity of PT (r=0.42, p=0.002). Vascularity index by SMI and PD could differentiate patients with JIA from healthy subjects. The SWE examination of tendons and soft tissues did not show any significant difference among patients with JIA and healthy subjects.

Oral health and plaque microbial profile in juvenile idiopathic arthritis

BackgroundThe oral microbiota has been implicated in the pathogenesis of rheumatoid arthritis through activation of mucosal immunity. This study tested for associations between oral health, microbial communities and juvenile idiopathic arthritis (JIA).MethodsA cross-sectional exploratory study of subjects aged 10–18 years with oligoarticular, extended oligoarticular and polyarticular JIA was conducted. Control groups included pediatric dental clinic patients and healthy volunteers. The primary aim was to test for an association between dental health indices and JIA; the secondary aim was to characterize the microbial profile of supragingival plaque using 16S rRNA gene sequencing.ResultsThe study included 85 patients with JIA, 62 dental patients and 11 healthy child controls. JIA patients overall had significantly more gingival inflammation compared to dental patients, as evidenced by bleeding on probing of the gingiva, the most specific sign of active inflammation (p = 0.02). Overall, however, there was a trend towards better dental hygiene in the JIA patients compared to dental patients, based on indices for plaque, decay, and periodontitis. In the JIA patients, plaque microbiota analysis revealed bacteria belonging to genera Haemophilus or Kingella elevated, and Corynebacterium underrepresented. In poly JIA, bacteria belonging to the genus Porphyromonas was overrepresented and Prevotella was underrepresented.ConclusionIncreased gingival inflammation in JIA was independent of general oral health, and thus cannot be attributed to poor dental hygiene secondary to disability. The variation of microbial profile in JIA patients could indicate a possible link between gingivitis and synovial inflammation.

Kinematic Analysis of Smiles in the Healthy Pediatric Population Using 3-Dimensional Motion Capture.

Facial normalcy, as measured with 2-dimensional or 3-dimensional photographs, has been documented in the healthy pediatric population. However, static images convey far from a complete representation of an individual's daily interactions with peers. Craniofacial surgery induces changes to soft or osseous tissues and thereby affects dynamic facial expression. To-date, there has not been rigorous, dynamic quantification of normal facial expression. In this study, we used 4-dimensional (4D) imaging to assess the facial expression of healthy children to provide a normative reference point for craniofacial surgeons. A total of 36 healthy pediatric volunteers underwent 4D video recordings while performing a maximal voluntary smile. A face template containing 884 landmarks was registered and tracked throughout the videos using Dimensional Imaging software. Participants were divided into 2 smile groups: open-lip smile and closed-lip smile. Kinematic analysis of smiles was calculated for every landmark from its position in the resting frame to its terminal displacement. Composite smiles and Euclidean distance maps were generated displaying areas of greatest displacement near the oral commissures. There was significant difference between closed-lip and open-lip groups in regions of eyes and cheeks. In addition, the open-lip smile group demonstrated significantly greater displacement in the oral commissure on the left side compared to the right (P < .05); whereas, in the closed-lip group, the eyes and cheeks moved significantly more on the right side. This study presents an innovative method that can be used to evaluate facial expressions to help craniofacial surgeons restore functional movement in patients with facial anomalies.

Multi-parametric Ultrasound Evaluation of Pediatric Thyroid Dyshormonogenesis

The aim of this study was to assess the diagnostic contribution of gray-scale ultrasonography, color Doppler, superb microvascular imaging and shear wave elastography in thyroid dyshormonogenesis (TD). From October 2017 to February 2018, the prospective study included 31 patients (13.6 y; 11–14 y) diagnosed with TD based on thyroid scintigraphy and perchlorate discharge tests and 40 healthy pediatric volunteers (12.8 y; 10–16 y). Median resistive indices (RIs), peak systolic and end-diastolic velocities, vascularity indices (VIs) via superb microvascular imaging and shear wave elastography parameters were evaluated. Median VI values were significantly higher and median RI values were significantly lower in the study group than the control group. No significant difference was found between shear wave elastography parameters of the TD and control group. VI was significantly correlated with median total thyroid gland volumes (p = 0.002, r = 0.28), medication dosage (p = 0.03, r = 0.48) and 2-h radioactive iodine uptake values (p = 0.008, r = 0.57). VI is a clinically significant and novel parameter useful for diagnosing TD.

Different habitus but similar electrocardiogram: Cardiac repolarization parameters in children – Comparison of elite athletes to obese children

Introduction:The standard 12-lead electrocardiogram (ECG) remains a widely used tool in the basic cardiac evaluation of children and adolescents. With the emergence of inherited arrhythmia syndromes, the period of cardiac repolarization has been the focus of attention. So far, data on cardiac repolarization and its normal variants in healthy children are scarce. This may cause uncertainties in the differentiation between pathologies and normal variants. As abnormal autonomic regulation seems to be a major influencing factor on cardiac repolarization, this study aimed to evaluate the parameters of cardiac repolarization of children in extremely good physical shape to obese children to improve knowledge about cardiac repolarization in these subgroups of pediatric patients that are vastly affected by the alterations of autonomic regulation.Methods:A total of 426 pediatric volunteers (84 lean, healthy controls; 130 obese healthy pediatric volunteers; and 212 elite athletes) were enrolled in the study, and the parameters of cardiac repolarization were determined in 12-lead ECG.Results:Most importantly, there were no pathological findings, neither in the healthy controls nor in the obese or athletes. Athletes showed overall shorter corrected QT intervals than children from the other groups. This is also true if a correction of the QT interval is performed using the Hodges formula to avoid bias due to a tendency to lower heart rates in athletes. Athletes showed the shortest Tpeak-to-end ratios between the groups. The comparison of athletes from primarily strength and power sports versus those from endurance sports showed endurance-trained athletes to have significantly longer QT intervals.Conclusions:This study suggests that neither obesity nor extensive sports seems to result in pathological cardiac repolarization parameters in healthy children. Therefore, pathology has to be assumed if abnormal repolarization parameters are seen and might not be simply attributed to the child's habitus or an excellent level of fitness.

Prevalence of Arnold nerve reflex in subjects with and without chronic cough: Relevance to Cough Hypersensitivity Syndrome

IntroductionCough is induced by stimulation of structures innervated by the vagus nerve, including the upper and lower airways and distal esophagus. The Arnold nerve reflex describes cough resulting from stimulation of the external auditory canal, which is innervated by the auricular branch of the vagus. We have recently reported the increased prevalence of this reflex in adults, but not children, with chronic cough, relative to healthy adult and pediatric subjects. The prevalence of the Arnold nerve reflex in patients with pulmonary disease but without chronic cough has not been investigated previously. MethodsThree hundred adults and 100 children with chronic cough, 50 adults with stable pulmonary disease but without chronic cough, as well as 100 adult and 100 pediatric volunteers, underwent evaluation consisting of stimulation of the external auditory canal of each ear with a cotton-tipped applicator. Cough occurring within 10 s of stimulation was considered induced by the intervention. ResultsArnold's nerve reflex was present in 23.3% of adults and 3% of children with chronic cough. The prevalence of the reflex was 2% among healthy adults and children. In adults with chronic cough, Arnold's nerve reflex was observed more commonly in women (29.3%) than men (10.5%), and was unilateral in the majority of patients (88.6%). In patients with respiratory disease but without chronic cough, Arnold nerve reflex was present in 2%. ConclusionsThe greater than 11-fold prevalence of the Arnold nerve reflex in adults with chronic cough compared with healthy volunteers and adults with respiratory disease but without chronic cough, supports the concept of the Cough Hypersensitivity Syndrome (CHS), in which vagal hypersensitivity is proposed to underlie chronic refractory cough. The absence of increased prevalence among children with chronic cough suggests that CHS is an acquired condition, perhaps triggered by viral respiratory infection or other environmental factor.