Tethered cord syndrome is a progressive disease with a typically insidious onset in infants and children, and which can lead to persistent progress of neurological deficits and a high rate of disability without timely...Tethered cord syndrome is a progressive disease with a typically insidious onset in infants and children, and which can lead to persistent progress of neurological deficits and a high rate of disability without timely intervention. The purpose of this study was to investigate the curative effect of microsurgery in children with different types of tethered cord syndrome. In this study, we analyzed 326 patients with tethered cord syndrome, aged from 2 months to 14 years old, who were followed for 3–36 months after microscopic surgery. Based on clinical manifestations and imaging findings, these patients were classified into five types: tight filum terminale(53 cases), lipomyelomeningocele(55 cases), lipomatous malformation(124 cases), postoperative adhesions(56 cases), and split cord malformation(38 cases). All patients underwent microsurgery. Curative effects were measured before and 3 months after surgery by Spina Bifida Neurological Scale based on sensory and motor functions, reflexes, and bladder and bowel function. The results showed that Spina Bifida Neurological Scale scores improved in all five types after surgery. Overall effective rates in these patients were 75%. Effective rates were 91% in tight filum terminale, 84% in lipomyelomeningocele, 65% in lipomatous malformation, 75% in postoperative adhesion, and 79% in split cord malformation. Binary logistic regression analysis revealed that types of tethered cord syndrome(lipoma-type or not) and symptom duration before surgery were independent influencing factors of surgical outcome. These results show that therapeutic effect is markedly different in patients with different types of tethered cord syndrome. Suitable clinical classification for tethered cord syndrome will be helpful in predicting prognosis and guiding treatment.展开更多
Background: Non-Hodgkin’s lymphoma is an aggressive malignant disease in children and adolescents. Although it is the fourth most common malignancy in Saudi children as reported in Saudi cancer registry, less informa...Background: Non-Hodgkin’s lymphoma is an aggressive malignant disease in children and adolescents. Although it is the fourth most common malignancy in Saudi children as reported in Saudi cancer registry, less information is available about pediatric Non-Hodgkin lymphoma and its outcome in Saudi Arabia. Study Objectives: To provide demographic data, disease characteristics, treatment protocol, toxicity and outcome of treatment in children & adolescents with Non-Hodgkin’s lymphoma treated at KFMC. This study will form base line for future studies about pediatric Non-Hodgkin’s lymphoma in KFMC, which may help to improve outcome for children with cancer in Saudi Arabia. Study Patients and Method: We retrospectively analyzed 28 children and adolescents diagnosed to have Non-Hodgkin’s lymphoma at KFMC between December 2006 and December 2013, followed-up through June 2014. Results: Of the 28 patients, 10 (35.7%) girls and 18 (64.3%) boys, the male-to-female ratio was 1.8;1. The median age at time of diagnosis was 6.4 years old (range 2.0 to 13.0 years old). The majority of patients (64.3%) were aged between 5 and 12 years old. Burkitt’s lymphoma BL/BLL was the most common pathological subtype (60.7%), and DLBCL was the second most common subtype (21.4%). Abdominal and Retroperitoneal involvement was the most common primary site (78.6%) including the ileocaecal region. Most of the children presented with advanced Stage III and IV (75%), Cytogenetic study which screens specifically for the t (8;14) (q24;q32) a characteristic genetic feature of Burkitt’s Lymphoma was obtained from 21 patients, variant rearrangement was observed in 3/21 samples and complex chromosomes karyotype in addition to IGH/MYC rearrangement was observed in 2/21 samples. Those patients presented with very aggressive lymphoma and combined BM and CNS involvement. We use the French-American-British Mature B-Cell Lymphoma 96 Protocol (FAB LMB 96) for treatment fornewly diagnosed Mature B-Cell type NHL and high risk ALL CCG 1961 Protocol for lymphoblastic lymphoma and international Anaplastic Large Cell Lymphoma 99 Study Protocol for ALCL. The median follow-up in patients not experiencing an adverse event was 53.1 months. The estimated 3-year EFE and OS rates in the entire cohort of patients with newly diagnosed NHL treated in the KFMC were 85.2% and 89.2% respectively;Overall survival (OS) rate of patients with mature B-cell-NHL was 88.9%. Conclusion: The outcomes and survival in our small series appeared to be excellent compared with those reported in other international trials even though most of our patients presented in advanced stage of the disease. We feel that the importance of the current study is to document the relative distribution of various types of pediatric non-Hodgkin’s lymphomas and age-specific distribution in different Histological subtypes.展开更多
Background and Objectives: Cancer treatments leading to increased survival rates are reported to participate in the creation of debilitating physical and psychosocial deficits for cancer survivors. Measures of health-...Background and Objectives: Cancer treatments leading to increased survival rates are reported to participate in the creation of debilitating physical and psychosocial deficits for cancer survivors. Measures of health-related quality of life (HRQOL) are designed to tap such consequences of cancer treatment together with the impact of the disease itself. Methods: Parents of 67 included patients aged 8 - 12 years, were asked to complete the parent proxy report of PedsQLTM 3.0 Cancer Module (Arabic version), as well as a separate sheet for socio-demographic data. Results: The ratio of Males to females was 1.8:1 among study patients with a median age of 8 years at diagnosis. Hematological malignancies represented 70.1% of the sample, with the highest proportion for ALL (52.2%). Total QOL showed to be relatively low with mean value of 62.29 for the whole group. Subscales with least scores were for;worry (44.11), perceived physical appearance (50.6), and procedural anxiety (55.34). On the other hand, the best score was 75.98 for communication, followed by 72.63 for cognitive problems. The impacts of some medical and socio-demographic variables on QOL and its subscales were elicited in our results. Conclusion: Increased treatment intensity, long duration of hospital admission, higher frequency of hospital visits, female sex, younger age at diagnosis, and large family size were all associated with a poorer total QOL and/or its subscales among Egyptian pediatric cancer patients.展开更多
The debut, progression and maintenance of skin disease are related to stress(acne, alopecia areata, atopic dermatitis, lichen planus, psoriasis, urticaria, vitiligo, herpes, hyperhidrosis, pemphigus, rosacea or seborr...The debut, progression and maintenance of skin disease are related to stress(acne, alopecia areata, atopic dermatitis, lichen planus, psoriasis, urticaria, vitiligo, herpes, hyperhidrosis, pemphigus, rosacea or seborrheic dermatitis). Environmental, socio-professional, life events are representing external factors. Personality, previous experiences, traits of anxiety are individual factors influencing the state of stress. Perceived stress could be more harmful especially in "high reactors" to stress. Coping abilities to stress could be increased in social programs. There was a recent interest in measuring the quality of life in the last years. There are dermatology and disease specific questionnaires that could help. Out-patients have less time to wait for very sophisticated procedures. They expect faster results. For simple, acute diseases it is important to have a good communication and good understanding of the instructions to get results as soon as possible. For chronic diseases a strong long-term alliance is needed, so the patients should revisit for his benefit and not for giving up. Small questions regarding potential stressful events, impact on the quality of life, stigmatization, the level of symptoms(pruritus), psychiatric comorbidities(anxiety, depression), short questionnaires for quality of life give us a better picture, personalize the doctorpatient relationship and could influence the choice of treatment. Many skin disorders could be seen from a psychosomatic point of view and the final goal, especially for the chronic diseases, is to improve through our treatments the impact on the quality of patient's life.展开更多
文摘目的 对重症患儿在院期间进行的基于患者报告结局的健康测量的应用相关文献进行范围审查,剖析该领域目前的研究特点和进展。方法 以Arksey范围综述方法学为框架,系统检索包括PubMed、The Cochrane Library、CINAHL、Embase、中国知网、万方数据库、维普中文科技期刊数据库和中国生物医学文献数据库,对各数据库建库至2023年1月25日的中英文原始研究文献进行检索和筛选,汇总纳入文献信息并分析。结果 最终纳入文献19篇。基于患者报告结局的重症患儿院内健康测量主要应用于以疼痛和心理健康为主的症状功能评估、健康相关生活质量评估,以及临床干预效果评价。重症监护(intensive care unit ICU)期间的自我报告主要是单维疼痛强度评估,其他更多基于自我报告的测量评价集中在ICU转出前后至出院前。临床以联合使用多种或多维测量工具为主,工具多为普适性,多数工具存在显著的年龄覆盖范围问题。结论 在重症患儿院内照护过程中对其自我报告的健康结局进行标准化测量是提高医疗照护质量、促进患儿院外康复和健康成长的重要保障。但目前重症患儿院内患者报告结局测量的研究与实践均处于较初级阶段,有必要扩大重症患儿院内自我报告健康结局的应用领域、时间范围和形式等,谨慎选择科学全面的患者报告结局测量工具,强化院内基线测量并开展高质量纵向追踪研究,以全面描绘重症患儿的全程健康,提高患儿长期生存质量。
基金supported by the Science Foundation of Military Medical Research and Clinical Research Foundation of PLA General Hospital in China,No.2016FC-CXYY-1006(to AJS)a grant from the Application of Clinical Features of Capital City of Science and Technology Commission in China,No.Z171100001017140(to AJS)
文摘Tethered cord syndrome is a progressive disease with a typically insidious onset in infants and children, and which can lead to persistent progress of neurological deficits and a high rate of disability without timely intervention. The purpose of this study was to investigate the curative effect of microsurgery in children with different types of tethered cord syndrome. In this study, we analyzed 326 patients with tethered cord syndrome, aged from 2 months to 14 years old, who were followed for 3–36 months after microscopic surgery. Based on clinical manifestations and imaging findings, these patients were classified into five types: tight filum terminale(53 cases), lipomyelomeningocele(55 cases), lipomatous malformation(124 cases), postoperative adhesions(56 cases), and split cord malformation(38 cases). All patients underwent microsurgery. Curative effects were measured before and 3 months after surgery by Spina Bifida Neurological Scale based on sensory and motor functions, reflexes, and bladder and bowel function. The results showed that Spina Bifida Neurological Scale scores improved in all five types after surgery. Overall effective rates in these patients were 75%. Effective rates were 91% in tight filum terminale, 84% in lipomyelomeningocele, 65% in lipomatous malformation, 75% in postoperative adhesion, and 79% in split cord malformation. Binary logistic regression analysis revealed that types of tethered cord syndrome(lipoma-type or not) and symptom duration before surgery were independent influencing factors of surgical outcome. These results show that therapeutic effect is markedly different in patients with different types of tethered cord syndrome. Suitable clinical classification for tethered cord syndrome will be helpful in predicting prognosis and guiding treatment.
文摘Background: Non-Hodgkin’s lymphoma is an aggressive malignant disease in children and adolescents. Although it is the fourth most common malignancy in Saudi children as reported in Saudi cancer registry, less information is available about pediatric Non-Hodgkin lymphoma and its outcome in Saudi Arabia. Study Objectives: To provide demographic data, disease characteristics, treatment protocol, toxicity and outcome of treatment in children & adolescents with Non-Hodgkin’s lymphoma treated at KFMC. This study will form base line for future studies about pediatric Non-Hodgkin’s lymphoma in KFMC, which may help to improve outcome for children with cancer in Saudi Arabia. Study Patients and Method: We retrospectively analyzed 28 children and adolescents diagnosed to have Non-Hodgkin’s lymphoma at KFMC between December 2006 and December 2013, followed-up through June 2014. Results: Of the 28 patients, 10 (35.7%) girls and 18 (64.3%) boys, the male-to-female ratio was 1.8;1. The median age at time of diagnosis was 6.4 years old (range 2.0 to 13.0 years old). The majority of patients (64.3%) were aged between 5 and 12 years old. Burkitt’s lymphoma BL/BLL was the most common pathological subtype (60.7%), and DLBCL was the second most common subtype (21.4%). Abdominal and Retroperitoneal involvement was the most common primary site (78.6%) including the ileocaecal region. Most of the children presented with advanced Stage III and IV (75%), Cytogenetic study which screens specifically for the t (8;14) (q24;q32) a characteristic genetic feature of Burkitt’s Lymphoma was obtained from 21 patients, variant rearrangement was observed in 3/21 samples and complex chromosomes karyotype in addition to IGH/MYC rearrangement was observed in 2/21 samples. Those patients presented with very aggressive lymphoma and combined BM and CNS involvement. We use the French-American-British Mature B-Cell Lymphoma 96 Protocol (FAB LMB 96) for treatment fornewly diagnosed Mature B-Cell type NHL and high risk ALL CCG 1961 Protocol for lymphoblastic lymphoma and international Anaplastic Large Cell Lymphoma 99 Study Protocol for ALCL. The median follow-up in patients not experiencing an adverse event was 53.1 months. The estimated 3-year EFE and OS rates in the entire cohort of patients with newly diagnosed NHL treated in the KFMC were 85.2% and 89.2% respectively;Overall survival (OS) rate of patients with mature B-cell-NHL was 88.9%. Conclusion: The outcomes and survival in our small series appeared to be excellent compared with those reported in other international trials even though most of our patients presented in advanced stage of the disease. We feel that the importance of the current study is to document the relative distribution of various types of pediatric non-Hodgkin’s lymphomas and age-specific distribution in different Histological subtypes.
文摘Background and Objectives: Cancer treatments leading to increased survival rates are reported to participate in the creation of debilitating physical and psychosocial deficits for cancer survivors. Measures of health-related quality of life (HRQOL) are designed to tap such consequences of cancer treatment together with the impact of the disease itself. Methods: Parents of 67 included patients aged 8 - 12 years, were asked to complete the parent proxy report of PedsQLTM 3.0 Cancer Module (Arabic version), as well as a separate sheet for socio-demographic data. Results: The ratio of Males to females was 1.8:1 among study patients with a median age of 8 years at diagnosis. Hematological malignancies represented 70.1% of the sample, with the highest proportion for ALL (52.2%). Total QOL showed to be relatively low with mean value of 62.29 for the whole group. Subscales with least scores were for;worry (44.11), perceived physical appearance (50.6), and procedural anxiety (55.34). On the other hand, the best score was 75.98 for communication, followed by 72.63 for cognitive problems. The impacts of some medical and socio-demographic variables on QOL and its subscales were elicited in our results. Conclusion: Increased treatment intensity, long duration of hospital admission, higher frequency of hospital visits, female sex, younger age at diagnosis, and large family size were all associated with a poorer total QOL and/or its subscales among Egyptian pediatric cancer patients.
文摘The debut, progression and maintenance of skin disease are related to stress(acne, alopecia areata, atopic dermatitis, lichen planus, psoriasis, urticaria, vitiligo, herpes, hyperhidrosis, pemphigus, rosacea or seborrheic dermatitis). Environmental, socio-professional, life events are representing external factors. Personality, previous experiences, traits of anxiety are individual factors influencing the state of stress. Perceived stress could be more harmful especially in "high reactors" to stress. Coping abilities to stress could be increased in social programs. There was a recent interest in measuring the quality of life in the last years. There are dermatology and disease specific questionnaires that could help. Out-patients have less time to wait for very sophisticated procedures. They expect faster results. For simple, acute diseases it is important to have a good communication and good understanding of the instructions to get results as soon as possible. For chronic diseases a strong long-term alliance is needed, so the patients should revisit for his benefit and not for giving up. Small questions regarding potential stressful events, impact on the quality of life, stigmatization, the level of symptoms(pruritus), psychiatric comorbidities(anxiety, depression), short questionnaires for quality of life give us a better picture, personalize the doctorpatient relationship and could influence the choice of treatment. Many skin disorders could be seen from a psychosomatic point of view and the final goal, especially for the chronic diseases, is to improve through our treatments the impact on the quality of patient's life.
