Structure In Pediatric Patients Research Articles

The impact of tonsillectomy and/or adenoidectomy on cognitive function and brain structure in pediatric patients with OSAHS

The impact of tonsillectomy and/or adenoidectomy on cognitive function and brain structure in pediatric patients with OSAHS

Alterations in cortical thickness and volumes of subcortical structures in pediatric patients with complete spinal cord injury.

To study the changes in cortical thickness and subcortical gray matter structures in children with complete spinal cord injury (CSCI), reveal the possible causes of dysfunction beyond sensory motor dysfunction after CSCI, and provide a possible neural basis for corresponding functional intervention training. Thirty-seven pediatric CSCI patients and 34 age-, gender-matched healthy children as healthy controls (HCs) were recruited. The 3D high-resolution T1-weighted structural images of all subjects were obtained using a 3.0 Tesla MRI system. Statistical differences between pediatric CSCI patients and HCs in cortical thickness and volumes of subcortical gray matter structures were evaluated. Then, correlation analyses were performed to analyze the correlation between the imaging indicators and clinical characteristics. Compared with HCs, pediatric CSCI patients showed decreased cortical thickness in the right precentral gyrus, superior temporal gyrus, and posterior segment of the lateral sulcus, while increased cortical thickness in the right lingual gyrus and inferior occipital gyrus. The volume of the right thalamus in pediatric CSCI patients was significantly smaller than that in HCs. No significant correlation was found between the imaging indicators and the injury duration, sensory scores, and motor scores of pediatric CSCI patients. These findings demonstrated that the brain structural reorganizations of pediatric CSCI occurred not only in sensory motor areas but also in cognitive and visual related brain regions, which may suggest that the visual processing, cognitive abnormalities, and related early intervention therapy also deserve greater attention beyond sensory motor rehabilitation training in pediatric CSCI patients.

Role of Transabdominal Ultrasonography in the Evaluation of Pediatric Patients With Daytime Wetting: A Single-Center Pilot Study.

Urinary incontinence (UI) is a frequent cause of admission to pediatric nephrology outpatient clinics. The aim of this study was to determine whether anatomical changes in lower urinary tract structures (retrovesical angulation [RVA] and bladder neck position [BNP]) are associated with UI in pediatric patients with daytime-wetting in comparison to healthy children. In this prospective study, patients with daytime UI diagnosed using the Dysfunctional Voiding Symptom Score of the International Children's Continence Society and 3-day-voiding/bowel diary were compared with an age- and sex-matched control group without incontinence. In addition to routine clinical evaluation, RVA and BNP were measured at rest using transabdominal ultrasound (TA-US). Intra-rater agreement was estimated. A total of 88 children were included in the study, with 44 children (22 boys, 22 girls) each in patient and control groups. RVA was significantly greater and BNP was significantly lower in the patient group versus control group (RVA: 134.30 ± 10.05 vs 127.94 ± 13.15, P=.013; BNP: 11.88 ± 4.53 vs 17.20 ± 5.55, P < .001, respectively). Irrespective of the presence of incontinence, girls had a significantly greater RVA than boys (P < .001). However, there was no difference between sexes in BNP values (P=.630). Intra-rater agreement was very strong for RVA (P < .001, r=.897), and strong for BNP (P < .001, r=.774). TA-US imaging is a non-invasive and practical procedure routinely performed in pediatric patients presenting with UI complaints. Our study demonstrated anatomical changes in lower urinary tract structures in pediatric patients with UI. These changes should be considered in the diagnosis, follow-up, and treatment of patients with UI.

Alterations in the structure and function of the brain in adolescents with new daily persistent headache: A pilot MRI study.

The purpose of this study was to explore brain morphological and functional connectivity alterations in adolescents with new daily persistent headache (NDPH) compared to pain-free, healthy controls. NDPH is one of the most disabling and least understood primary headache conditions. To date, no studies have considered the role of brain function and structure in pediatric patients with NDPH. In this cross-sectional study, resting-state functional and structural images were acquired for 13 patients with NDPH (M age=15.9, standard deviation [SD] ± 1.4) and 13 age- and sex-matched controls (M age=16.2, SD ± 1.8) using magnetic resonance imaging. Participants were recruited from the Pediatric Headache Program at Boston Children's Hospital and from the Greater Boston area. In patients, clinical features of NDPH, including disease duration, pain intensity ratings, pain sensitivity, and functional disability were also assessed, and their associations with functional and structural brain alterations were explored. Compared to controls, patients with NDPH demonstrated reduced cortical thickness in the bilateral superior temporal gyrus, left superior, and middle frontal gyrus areas (p < 0.05, Monte Carlo corrected for multiple comparisons). Furthermore, reduced cortical thickness of the left superior frontal gyrus was related to elevated pain sensitivity in NDPH (r=-0.79, p=0.006). Patients showed altered functional connectivity between regions involved in emotional and cognitive networks of pain, including the amygdala, insula, frontal regions, and cerebellar subregions. The present study provides the first preliminary evidence of functional and structural brain differences in pediatric patients with NDPH compared to controls. Identifying alterations in cortical thickness and resting-state connectivity between specific brain regions could provide characteristics of NDPH and probable mechanisms that may guide personalized therapeutic interventions.

Evaluation of the relationship between tooth decay and trabecular bone structure in pediatric patients using fractal analysis: a retrospective study.

The movement of chewing affects the growth and development of the stomatognathic system. Tooth decay, which is known to have effects on chewing, can affect the jaw bone due to its indirect effect on the mechanical forces transmitted to the jaw bone. This study aimed to evaluate the relationship between dental caries and jawbone trabeculation during the growth and development processes in children using fractal dimension (FD) analysis. A total of 120 patients were divided into three groups. The groups were determined as follows: group 1: 40 patients without deep dentin caries/apical rarefying osteitis, group 2: 40 patients with deep dentin caries/apical rarefying osteitis on the right or left sides, and group 3: 40 patients with deep dentin caries/apical rarefying osteitis on both the right and left side. Digital panoramic images of the selected patients were evaluated using FD analysis. There was no statistically significant difference in the FD analysis among the groups. Age and sex factors were not found statistically significant in the in-group evaluation (p>0.05). In group 3, FD values of the right condyle (r= -0.42, p<0.05), right ramus (r= -0.37, p<0.05) and left ramus (r= -0.45, p<0.05) were negatively correlated with age. There is no relationship between tooth decay and trabeculation of the jawbone in children aged 8-13 years.

Higher volumes of hippocampal subfields in pediatric obsessive-compulsive disorder

Differences in hippocampus volume have been identified in adult patients with obsessive-compulsive disorder (OCD). However, the role of this limbic structure in pediatric patients is unclear. This study aimed to investigate the hippocampus and its subregions in a sample of 29 children and adolescents with OCD compared to 28 healthy controls, matched for age, sex, education, and IQ. Volumetric segmentation was performed using the Freesurfer software to calculate the volumes of the subregions that reflect the hippocampal cytoarchitecture. The volumes of three anatomic subregions (tail, body, and head) were also calculated. ANCOVA was performed to investigate differences of these volumes between patients and controls, controlling for total gray matter volume. After Bonferroni correction for multiple comparisons (p-value < 0.00556 for the body and < 0.00625 for the head structures), patients presented statistically significant larger volumes of the following structures: left subiculum body; left CA4 body; left GC-DG body; left molecular layer body; right parasubiculum; left CA4 head; left molecular layer head; right subiculum head and right molecular layer head. These enlarged volumes resulted in larger left and right whole hippocampi in patients, as well as bilateral hippocampal heads and left hippocampal body (all p-values < 0.00625). There were no associations between OCD severity and hippocampal volumes. These findings diverge from previous reports on adults and may indicate that larger hippocampal volumes could reflect an early marker of OCD, not present in adults.

Does the fibula have the potential to remodel into a neocondylar structure in pediatric patients following condylar reconstruction using free fibula flap?

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Our Treatment Approach in Pediatric Maxillofacial Traumas

Maxillofacial injuries in children are rarer in proportion in comparison to adult facial injuries, and they constitute 1% to 15% of all facial bone fractures. The causes and incidence of maxillofacial injuries in children differ based on social, cultural, and environmental factors. The purpose of this study is to investigate the etiology, epidemiology, and type of injury in pediatric facial injuries, as well as analyzing types of fractures, related injuries, and treatment options. The study obtained the approval of the local ethics board to include 55 pediatric patients in the age group of 0 to 18 years who received inpatient treatment or surgical interventions owing to maxillofacial trauma at an Esthetic, Plastic and Reconstructive Surgery Clinic between January 2016 and December 2018. The patients were examined under 5 groups based on their causes of injury: motorized vehicle accidents (MVA); bicycle; falls (from height or ground level); assault; firearm injuries. They were examined under 6 groups based on the location of their fractures: mandibula, maxilla, orbita, frontal bone, zygomatic arch, nasal bone. The study included 55 patients of the ages 0 to 18 with the mean age of 11.6 ± 3.2 years. Thirty-seven of the patients (67.2%) were male, whereas 18 (32.7%) were female. Among the causes of injury, the highest number of patients was 25 (45.4%) with MVA. The most frequent location of the fractures was the mandible. Consequently, experiences regarding pediatric maxillofacial traumas are limited, and there is no complete consensus on treatment. In difference to the interventions in adults, the dental structure in pediatric patients need to be definitely considered, the least invasive intervention form should be preferred, and observation and follow-up should be practiced in minimally displaced fractures rather than surgical interventions.

Genetic biomarkers related to hemarthrosis, inflammation, and cartilage structure in pediatric patients with hemophilic arthropathy.

BackgroundThe pathophysiology of hemophilic arthropathy is complex and not completely understood. In this study, we aimed to identify biomarkers that can affect the hemophilic arthropathy severity.MethodsFifty patients were analyzed for biomarker frequencies; in 37 patients, articular symptoms were evaluated based on the physical joint examination score, and in 18, it was based on magnetic resonance imaging. Eight polymorphisms, namely FV 1691G>A, FII 20210G>A, MTHFR 677C>T and 1298A>C, TNFα‐308G>A and ‐238G>A, ACAN VNTR, and IL1RN*2‐VNTR were identified.ResultsPatients with the MTHFR 677TT genotype showed a higher number of affected joints (1.83 ± 0.9 vs. 0.55 ± 0.7 for CC; p = .023), whereas those with the MTHFR 1298AC genotype exhibited higher effusion according to two radiologists (0.90 ± 0.31/1.20 ± 0.63 vs. 0.38 ± 0.52/0.50 ± 0.53 for AA genotype; p = .043/0.036, respectively). In addition, patients with the TNFα‐308GA genotype had more subchondral cysts (0.75 ± 0.95 vs. 0.07 ± 0.26 for GG genotype; p = .041).ConclusionsThe distribution of risk genotypes for MTHFR and TNFα‐308GA suggests their association with clinical parameters of hemophilic arthropathy. Cohort studies are essential to verify these associations.

Osteochondritis dissecans shows a severe course and poor outcome in patients with juvenile idiopathic arthritis: a matched pair study of 22 cases.

Juvenile osteochondritis dissecans (JOCD) and juvenile idiopathic arthritis (JIA) are both common diseases which may affect joints and bony structures in pediatric patients. In some cases, JOCD and JIA occur at the same time. In this study, the course of JOCD in patients with JIA was therefore evaluated to provide possible recommendations for further treatment opportunities and control examinations. From 06/2012 to 03/2018 55 children with JOCD with or without JIA were examined. Inclusion criteria were: (1) age ≤ 16years, (2) diagnosis of a JOCD with or without JIA and (3) two routine MRI controls. The JOCD evaluation based on the classification according to Bruns and the measurement of the largest extent via MRI. 18 of these 55 children met our criteria: 11 JOCD findings of 7 patients with JIA (group A) were matched according to age and localization of JOCD to 11 patients without JIA (group B). Mean age of disease onset of JIA was 8.2years (oligo JIA) and of JOCD 11.6years. The mean time follow-up was 17.7months. At all observation time points more JOCD findings (with stage III° and IV°, respectively) along with a significant deterioration was seen in group A compared to group B. The comparison of the last MRI control between group A and group B shows a significant smaller defect size (decrease of 54.5%, p = 0.028) in group B (97.9 ± 48.9 mm2) as in group A (185.1 ± 102.9 mm2). In comparison of first (169.7 ± 84.2 mm2) and last MRI (97.9 ± 48.9 mm2) a significant decrease in lesion size of JOCD in group B was seen (decrease of 58.4%, p = 0.048). Patients with JIA show a more progressive and severe course of JOCD. Therefore, we recommend (1) the early use of MRI in patients with JIA and persistent joint pain to detect potential JOCD and (2) in presence of JIA and JOCD regular MRI follow-up controls to identify deteriorating JOCD findings and prevent early joint destruction in pediatric patients.

Size-dependent scanning parameters (kVp and mAs) for photon-counting spectral CT system in pediatric imaging: simulation study

We are developing a photon-counting spectral CT detector with a small pixel size of mm2, offering a potential advantage for better visualization of small structures in pediatric patients. The purpose of this study is to determine the patient size dependent scanning parameters (kVp and mAs) for pediatric CT in two imaging cases: adipose imaging and iodinated blood imaging.Cylindrical soft-tissue phantoms of diameters between 10–25 cm were used to mimic patients of different ages from 0 to 15 y. For adipose imaging, a 5 mm diameter adipose sphere was assumed as an imaging target, while in the case of iodinated imaging, an iodinated blood sphere of 1 mm in diameter was assumed. By applying the geometry of a commercial CT scanner (GE Lightspeed VCT), simulations were carried out to calculate the detectability index, , with tube potentials varying from 40 to 140 kVp. The optimal kVp for each phantom in each imaging case was determined such that the dose-normalized detectability index, dose, is maximized. With the assumption that the detectability index in pediatric imaging is required the same as in typical adult imaging, the value of mAs at optimal kVp for each phantom was selected to achieve a reference detectability index that was obtained by scanning an adult phantom (30 cm in diameter) in a typical adult CT procedure (120 kVp and 200 mAs) using a modeled energy-integrating system.For adipose imaging, the optimal kVps are 50, 60, 80, and 120 kVp, respectively, for phantoms of 10, 15, 20, and 25 cm in diameter. The corresponding mAs values required to achieve the reference detectability index are only 9%, 23%, 24%, and 54% of the mAs that is used for adult patients at 120 kVp, for 10, 15, 20, and 25 cm diameter phantoms, respectively. In the case of iodinated imaging, a tube potential of 60 kVp was found optimal for all phantoms investigated, and the mAs values required to achieve the reference detectability index are 2%, 9%, 37%, and 109% of the adult mAs. The results also indicate that with the use of respective optimal kVps, the photon-counting spectral system offers up to 30% higher dose than the modeled energy-integrating system for adipose imaging, and 70% for iodinated imaging.

Neurocognition and brain structure in pediatric patients with type 1 diabetes

Recent findings suggest that in addition to severe hypoglycemia, chronic hyperglycemia may also hamper the cognitive development of patients with type 1 diabetes. Executive and memory dysfunctions mediated by frontoparietal and temporal brain structures are frequently reported to be associated with type 1 diabetes. However, most studies investigating pediatric patients with diabetes focus on either brain function or brain structure. The current study combines neuropsychological and structural brain imaging methods (i.e., voxel-based-morphometry) to study the neurofunctional integrity of frontoparietal brain areas. We investigated 30 children with type 1 diabetes and 19 healthy controls. Children with diabetes were divided into two groups representing better (HbA1c ≤ 7.9%) and worse (HbA1c ≥ 8.0%) glycemic con- trol. Our findings were threefold: First, results revealed significant group differences with respect to neuropsychological performance (i.e. response accuracies on a marker task tapping frontoparietal brain functions). Second, structural imaging disclosed significant group differences between patients and controls regarding gray matter volume in frontal (anterior cingulate) and occipital (cuneus, bordering precuneus) brain regions and regarding white matter in middle temporal and occipital gyri as well as in the ventromedial temporal lobe (uncus). Third, disease duration, age at diagnosis and white matter volume in a hippocampal region-of-interest (but not HbA1c levels, intelligence, total gray/white matter or other white/gray matter regions-of-interest) explained 56% of neuropsycholo- gical performance variance. Taken together, our findings are among the first to provide evidence of a direct link between brain function and brain structure in pediatric patients with type 1 diabetes.

Involved-nodal radiation therapy leads to lower doses to critical organs-at-risk compared to involved-field radiation therapy

BackgroundInvolved field radiotherapy (IFRT) after cytotoxic chemotherapy has become the standard of care in treating pediatric patients with Hodgkin lymphoma. However, recent interest in shrinking the treatment volume to involved node radiotherapy (INRT) may allow lower doses to critical organ structures. We dosimetrically compared IFRT and INRT treatment approaches. MethodsINRT treatment plans were retrospectively constructed from 17 consecutively treated pediatric patients identified with Hodgkin lymphoma who had been previously treated with conventional IFRT. The radiation doses delivered to organs-at-risk (OARs) with virtual INRT treatment plans based on INRT field design were then compared to the original IFRT treatment plans. Metrics for comparison included mean doses to organs and volumes of organ receiving at least 50% of the original prescription dose (V50%). A one-tailed, paired t-test was then performed to verify statistical significance at an alpha level of 0.05. ResultsAll organs at risk compared in this investigation (kidneys, heart, thyroid, parotids, and lungs) had significantly lower doses of radiation with INRT when compared to IFRT (p<0.05). Furthermore, the volume of the breast receiving at least 50% of the initial prescription dose was statistically lower in the INRT plans. ConclusionsUtilizing the concept of INRT results in a reduction of radiation dose to critical organ structures in pediatric patients with Hodgkin lymphoma when compared to the more traditional method of IFRT.

Brief Report: CANTAB Performance and Brain Structure in Pediatric Patients with Asperger Syndrome

By merging neuropsychological (CANTAB/cambridge neuropsychological test automated battery) and structural brain imaging data (voxel-based-morphometry) the present study sought to identify the neurocognitive correlates of executive functions in individuals with Asperger syndrome (AS) compared to healthy controls. Results disclosed subtle group differences regarding response speed on only one CANTAB subtest that is thought to tap fronto-executive network functions (SWM/spatial working memory). Across all participants, SWM performance was significantly associated with two brain regions (precentral gyrus white matter, precuneus grey matter), thus suggesting a close link between fronto-executive functions (SWM) and circumscribed fronto-parietal brain structures. Finally, symptom severity (ADOS total score) was best predicted by response speed on a set-shifting task (IES) thought to tap fronto-striatal functions (corrected R2 56%).

Brown Adipose Tissue and Its Relationship to Bone Structure in Pediatric Patients

Emerging evidence suggests a possible link between brown adipose tissue (BAT) and bone metabolism. The objective of this study was to examine the relationships between BAT and bone cross-sectional dimensions in children and adolescents. This was a cross-sectional study. The study was conducted at a pediatric referral center. Patients included 40 children and teenagers (21 males and 19 females) successfully treated for pediatric malignancies. There were no interventions. The volume of BAT was determined by fluorodeoxyglucose-positron emission tomography/computed tomography. Measures of the cross-sectional area and cortical bone area and measures of thigh musculature and sc fat were determined at the midshaft of the femur. Regardless of sex, there were significant correlations seen between BAT volume and the cross-sectional dimensions of the bone (r values between 0.68 and 0.77; all P ≤ 0 .001). Multiple regression analyses indicated that the volume of BAT predicted femoral cross-sectional area and cortical bone area, even after accounting for height, weight, and gender. The addition of muscle as an independent variable increased the predictive power of the model but significantly decreased the contribution of BAT. The volume of BAT is positively associated with the amount of bone and the cross-sectional size of the femur in children and adolescents. This relation between BAT and bone structure could, at least in part, be mediated by muscle.

2028 Second Cancer after Total Body Irradiation: a retrospective analysis of 773 patients

Involved field radiotherapy (IFRT) after cytotoxic chemotherapy has become the standard of care in treating pediatric patients with Hodgkin lymphoma. However, recent interest in shrinking the treatment volume to involved node radiotherapy (INRT) may allow lower doses to critical organ structures. We dosimetrically compared IFRT and INRT treatment approaches.INRT treatment plans were retrospectively constructed from 17 consecutively treated pediatric patients identified with Hodgkin lymphoma who had been previously treated with conventional IFRT. The radiation doses delivered to organs-at-risk (OARs) with virtual INRT treatment plans based on INRT field design were then compared to the original IFRT treatment plans. Metrics for comparison included mean doses to organs and volumes of organ receiving at least 50% of the original prescription dose (V50%). A one-tailed, paired t-test was then performed to verify statistical significance at an alpha level of 0.05.All organs at risk compared in this investigation (kidneys, heart, thyroid, parotids, and lungs) had significantly lower doses of radiation with INRT when compared to IFRT (p < 0.05). Furthermore, the volume of the breast receiving at least 50% of the initial prescription dose was statistically lower in the INRT plans.Utilizing the concept of INRT results in a reduction of radiation dose to critical organ structures in pediatric patients with Hodgkin lymphoma when compared to the more traditional method of IFRT.

Diameters of normal thoracic vascular structures in pediatric patients

To determine the normal range of aortic and pulmonary artery diameters on chest CT, and to search a constant ratio when the diameters of thoracic vascular structures are compared with an internal reference. Contrast-enhanced chest CT scans of 133 pediatric patients were retrospectively evaluated. Diameters of ascending and descending aorta, main pulmonary artery, right and left pulmonary arteries and a constant thoracic vertebra were measured. The mean ratios of thoracic vascular diameters to the diameter of the thoracic vertebra were calculated. There was a positive correlation between the age of the patients and vascular diameters. The mean ratios of vascular diameters to the diameter of thoracic vertebra, ranged from 1.1 for the ascending aorta to 0.70 for the right and left pulmonary arteries, were consistent. Diameters of thoracic vascular structures increase with age. The consistent vertebral to vessel ratios can be useful in evaluation of chest CT of pediatric patients.