BACKGROUND & AIMS: :As the conventional histopathologic examination of thymic carcinoma (TC) is nonspecific, immunohistochemical studies along with correlative radiographic investigations are needed for its correct diagnosis. TC commonly occurs in the late 5th to early 6th decades of life but is extremely rare in childhood. It may be incidentally detected from chest radiographs taken as routine or for other reasons. However, most patients present with symptoms such as chest pain, cough, shortness of breath, dysphagia and hoarseness, which are directly attributable to the mediastinal mass. Although TC frequently invades the neighboring organs, pleura and pericardium and metastasizes to the lymph nodes, liver and lung at the time of the first diagnosis, initial or late metastasis to the bone has been seldom reported in adults. Indeed, the English literature revealed no earlier report on initial bony metastasis in a child to date. We report a case of TC in a 12-year-old boy who initially presented with scapular osteolysis masquerading as a primary bone tumor to emphasize the usefulness of combined imaging for staging and histologic studies, particularly for such an unexpected case.

背景与目标： : 由于胸腺癌 (TC) 的常规组织病理学检查是非特异性的，因此需要进行免疫组织化学研究以及相关的影像学检查才能正确诊断。TC通常发生在生命的第5至第6年初，但在儿童时期极为罕见。可能会从常规或其他原因的胸部x光片中偶然发现。然而，大多数患者出现胸痛，咳嗽，呼吸急促，吞咽困难和声音嘶哑等症状，这些症状直接归因于纵隔肿块。尽管TC在首次诊断时经常侵入邻近的器官，胸膜和心包，并转移到淋巴结，肝脏和肺，但在成年人中很少报道初次或晚期骨转移。事实上，英国文献显示，迄今为止，没有关于儿童最初骨转移的早期报道。我们报告了一个12岁男孩的TC病例，该男孩最初表现为肩胛骨骨溶解，伪装成原发性骨肿瘤，以强调联合成像对分期和组织学研究的有用性，尤其是对于这种意外情况。

BACKGROUND & AIMS: -2

背景与目标： -2

BACKGROUND & AIMS: :The World Health Organization European Region has one of the highest rates of multidrug-resistant tuberculosis (MDR-TB) in the world, resulting in many vulnerable children being exposed each year. Evidence for preventive therapy following MDR-TB exposure is limited and current guidance is conflicting. An internet-based survey was performed to determine clinical practice in this region. Seventy-two clinicians from 25 countries participated. Practices related to screening and decision-making were highly variable. Just over half provided preventive therapy for children exposed to MDR-TB; the only characteristic associated with provision was practice within the European Union (adjusted OR 4.07, 95%CI 1.33-12.5).

背景与目标： : 世界卫生组织欧洲地区是世界上耐多药结核病 (mdr-tb) 发病率最高的地区之一，每年都有许多易受感染的儿童。耐多药结核病暴露后预防性治疗的证据有限，目前的指导意见存在矛盾。进行了基于互联网的调查，以确定该地区的临床实践。来自25个国家的72名临床医生参加了会议。与筛选和决策相关的实践变化很大。刚刚超过一半的人为暴露于耐多药结核病的儿童提供了预防性治疗; 与提供相关的唯一特征是欧盟内部的实践 (调整或4.07，95% CI 1.33-12.5)。

BACKGROUND & AIMS: :We report the fourth observation of Hb Sallanches [alpha104(G11)Cys-->Tyr, TGC-->TAC (alpha2)], an unstable alpha chain variant of intermediate severity in the homozygous state. Heterozygosity occasionally produces mild hypochromia and microcytosis in some patients. A balanced beta/alpha ratio, found in previously reported cases, points to unstable alphabeta dimers formed as a result of the Cys-->Tyr substitution at the alpha1beta1 contact site in this hemoglobin (Hb) variant. Our patient, and the previous two of the three cases reported in patients of Pakistani origin, points to a common population stock, separated by the mass population migration which occurred during the partition of Pakistan and India in 1947.

背景与目标： : 我们报告了Hb Sallanches [alpha104(G11)Cys->Tyr，TGC->TAC (alpha2)] 的第四个观察结果，这是纯合状态中中等严重程度的不稳定 α 链变体。在某些患者中，杂合性偶尔会产生轻度的低色和微囊症。在先前报道的病例中发现的平衡的 β/α 比指出，由于该血红蛋白 (Hb) 变体中alpha1beta1接触位点处的Cys->Tyr取代，形成了不稳定的alphabeta二聚体。我们的患者，以及巴基斯坦裔患者报告的三例病例中的前两例，都指出了一个共同的人口存量，被巴基斯坦和印度1947年分治期间发生的大规模人口迁移所分隔。

BACKGROUND & AIMS: :Heparin-induced thrombocytopenia (HIT) is a potentially life-threatening, adverse effect of heparin therapy. Patients with this complication require an alternative approach to anticoagulation. Bivalirudin is a direct thrombin inhibitor with an efficacy comparable to that of heparin, a short half-life, and reduced bleeding complications in adults. We present the case of a 2-year-old boy with HIT Type II who underwent recanalization of an occluded superior vena cava and stent placement, utilizing bivalirudin as anticoagulant.

背景与目标： 肝素诱导的血小板减少症 (HIT) 是肝素治疗的潜在威胁生命的不良反应。患有这种并发症的患者需要另一种抗凝方法。比伐卢定是一种直接凝血酶抑制剂，其疗效与肝素相当，半衰期短，并减少了成人的出血并发症。我们介绍了一个2岁的II型HIT男孩的病例，该男孩利用比伐卢定作为抗凝剂进行了闭塞的上腔静脉再通和支架置入。

BACKGROUND & AIMS: :Our institution has used the DeBakey VAD Child as a bridge to heart transplantation in select pediatric patients. Pump thrombus is a potentially serious complication with few available treatment options. Only surgical device exchange or the use of tissue plasminogen activator are reported in the literature. We report the use of clopidogrel as an alternative thrombolytic agent in the presence of pump thrombus in an adolescent patient with a DeBakey VAD Child heart pump.

背景与目标： : 我们的机构已将DeBakey VAD儿童用作某些儿科患者进行心脏移植的桥梁。泵血栓是一种潜在的严重并发症，几乎没有可用的治疗选择。文献中仅报道了手术设备交换或组织纤溶酶原激活剂的使用。我们报告了在患有DeBakey VAD儿童心脏泵的青少年患者中，在存在泵血栓的情况下使用氯吡格雷作为替代溶栓剂。

BACKGROUND & AIMS: :We encountered an extremely unusual presentation of proptosis in a 7-yr-old boy due to psammomatoid juvenile ossifying fibroma of frontoethmoidal region. The tumor also led to development of mucocele in the frontal sinus not yet fully developed as on opposite side.

背景与目标： : 我们在一个7岁男孩中遇到了极不寻常的眼球突出现象，这是由于额筛区的类膜样少年骨化纤维瘤所致。肿瘤还导致额窦粘膜囊肿的发展，而另一侧尚未完全发展。

BACKGROUND & AIMS: :Vaccination against hepatitis B virus has rarely been associated with lichen planus. We report a case of this kind in a child from Nepal. A 12-year-old boy had developed generalized itchy violaceous papules and plaques six weeks after the second dose of hepatitis B virus vaccine. Serum HBsAg and HBeAb were negative, but HBsAb was positive. New crops of generalized, similar eruptions developed after the booster dose of vaccine. All the lesions resolved within three months of systemic steroid therapy. There was no recurrence after one year of follow up. Awareness of such an association is necessary, especially in children, because vaccination campaigns are increasing.

背景与目标： : 针对乙型肝炎病毒的疫苗接种很少与扁平苔藓有关。我们报告了一名来自尼泊尔的儿童的此类案件。一名12岁男孩在第二剂乙型肝炎病毒疫苗接种六周后出现了全身发痒的紫红色丘疹和斑块。血清HBsAg和HBeAb均为阴性，但HBsAb为阳性。在加强剂量的疫苗之后，出现了普遍的，类似的爆发的新作物。所有病变在全身类固醇治疗后三个月内消失。随访1年后无复发。对这种关联的认识是必要的，尤其是在儿童中，因为疫苗接种运动正在增加。

BACKGROUND & AIMS: :This investigation examined differences in symptom patterns of two different trauma samples using the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). MMPI-2s of 122 male combat veterans seeking outpatient treatment for combat-related PTSD were compared with those of 64 PTSD-diagnosed adults seeking outpatient treatment for the effects of child sexual abuse (CSA). We examined variables related to degree of health concerns, depression, somatization, anger and hostility, masculine-feminine traits, paranoid ideation, anxiety, difficulties thinking and concentrating, elevated mood, and social introversion, as well as test-taking attitude. MANOVAs revealed between-group differences on several variables. However, when analyses controlled for the effect of age, nearly all differences disappeared; the only remaining difference was in a scale measuring anger. Thus, it appears CSA survivors and combat veterans are much more similar than different in their clinical presentation on the MMPI-2. Conceptual issues in the assessment of PTSD are discussed.

背景与目标： : 这项调查使用明尼苏达州多相人格量表-2 (MMPI-2) 检查了两种不同创伤样本的症状模式差异。将122名寻求与战斗相关的PTSD进行门诊治疗的男性战斗退伍军人的MMPI-2s与64名经PTSD诊断为儿童性虐待 (CSA) 的门诊治疗的成年人进行了比较。我们研究了与健康问题程度，抑郁，躯体化，愤怒和敌意，男性女性特征，偏执观念，焦虑，思考和集中注意力的困难，情绪低落，社交内向以及应试态度有关的变量。MANOVAs揭示了几个变量的组间差异。但是，当分析控制了年龄的影响时，几乎所有差异都消失了。唯一剩下的差异是衡量愤怒的量表。因此，看来CSA幸存者和战斗退伍军人在MMPI-2上的临床表现要相似得多。讨论了PTSD评估中的概念问题。

BACKGROUND & AIMS: :Since Amato and Gilbreth's (1999) meta-analysis of nonresident father involvement and child well-being, nonmarital childbirths and nonresident father involvement both have increased. The unknown implications of such changes motivated the present study, a meta-analytic review of 52 studies of nonresident father involvement and child well-being. Consistent with Amato and Gilbreth, we found that positive forms of involvement were associated with benefits for children, with a small but statistically significant effect size. Amounts of father-child contact and financial provision, however, were not associated with child well-being. Going beyond Amato and Gilbreth, we analyzed the associations between different types of fathering and overall child well-being, and between overall father involvement and different types of child well-being. We found that nonresident father involvement was most strongly associated with children's social well-being and also was associated with children's emotional well-being, academic achievement, and behavioral adjustment. The forms of father involvement most strongly associated with child well-being were involvement in child-related activities, having positive father-child relationships, and engaging in multiple forms of involvement. Moderator analyses demonstrated variation in effect sizes based on both study characteristics and demographic variables. We discuss the implications of these findings for policy and practice.

背景与目标： : 自从Amato和Gilbreth (1999) 对非居民父亲参与和儿童福祉的荟萃分析以来，非婚姻分娩和非居民父亲参与均有所增加。这种变化的未知含义促使本研究进行，该研究是对52项非居民父亲参与和儿童福祉研究的荟萃分析综述。与Amato和Gilbreth一致，我们发现积极的参与形式与儿童的益处相关，但影响大小很小，但具有统计学意义。然而，父子之间的接触和财政供应与儿童福祉无关。除了Amato和Gilbreth之外，我们还分析了不同类型的父亲与整体儿童福祉之间的关联，以及父亲的整体参与与不同类型的儿童福祉之间的关联。我们发现，非居民父亲的参与与孩子的社会福祉最密切相关，也与孩子的情感福祉，学业成就和行为适应有关。与儿童福祉最密切相关的父亲参与形式是参与与儿童有关的活动，建立积极的父子关系以及参与多种形式的参与。主持人分析表明，基于研究特征和人口统计学变量，效应大小存在差异。我们讨论了这些发现对政策和实践的影响。

BACKGROUND & AIMS: OBJECTIVES:To determine the association between opioid prescribing rates and substantiated abuse and neglect across Tennessee counties during an 11-year period. METHODS:We adopted a Bayesian spatiotemporal approach to determine the association between opioid prescribing and rates of substantiated child abuse and neglect over and above environmental and population-level covariates. Annual county-level data for Tennessee (2006-2016) included rates of substantiated child abuse and neglect, rates of drug and non-drug crime incidents, racial and Hispanic composition, per capita income, child poverty and teen birth rates, and vacant housing. RESULTS:Higher opioid prescribing rates were associated with greater risk for substantiated child abuse and neglect across Tennessee counties. Risk for substantiated child abuse and neglect was positively associated with vacant housing, child poverty, teen birth rates, and rates of both drug and non-drug criminal incidents - including stimulant arrests. Risk for substantiated child abuse and neglect was negatively associated with percentages of African Americans. CONCLUSIONS:Results underscore the importance of opioid prescribing and crime rates as independent determinants of spatial and temporal variation in risk for substantiated child abuse and neglect. Policies that regulate and reduce opioid prescribing have the potential to reduce risk for child abuse and neglect.

背景与目标：

BACKGROUND & AIMS: :Background: Children with intellectual disability are at risk for anxiety disorders involving intense physiological reactions and risky behavioral responses. Interventions have been identified in this field; however, assessment of underlying anxiety is limited and flawed.Method: We implemented a single-subject case study using differential reinforcement to treat dog phobia in a boy with intellectual disability. We recorded elopement and compliance with goals and measured physiological expressions of stress: galvanic skin response, heart rate variability, temperature, and latency to calm down.Results: After fifteen therapy sessions, the boy decreased elopement and noncompliance considerably and showed dramatic improvements in emotional self-regulation.Conclusions: Future research should examine the utility of including biosensing measures in clinical applications and the relationship between physiological measures of anxiety and traditional questionnaires. Children with intellectual disability at risk for anxiety disorders should be tracked longitudinally to examine the effect of interventions on social-emotional well-being and self-regulation.

背景与目标： 背景: 智力残疾儿童有患焦虑症的风险，包括强烈的生理反应和危险的行为反应。在这一领域已经确定了干预措施; 然而，对潜在焦虑的评估是有限的和有缺陷的。方法: 我们实施了一个单主题案例研究，使用差异强化来治疗智力残疾男孩的狗恐惧症。我们记录了对目标的私奔和依从性，并测量了压力的生理表达: 皮肤电反应，心率变异性，温度和平静的潜伏期。结果: 经过15次治疗后，男孩大大减少了私奔和不依从性，并表现出情绪self-regulation.Conclusions的显着改善: 未来的研究应检查在临床应用中包括生物传感措施的效用，以及焦虑的生理措施与传统问卷之间的关系。应纵向追踪有焦虑症风险的智力残疾儿童，以检查干预措施对社会情感福祉和自我调节的影响。

BACKGROUND & AIMS: BACKGROUND:Preschool child anthropometric status has been assessed nationally in Nepal since 1975, with semi-decadal surveys since 1996, plus several recent, short-interval surveys to track progress toward achieving a World Health Assembly (WHA) goal to reduce stunting to 24% by 2025. OBJECTIVE:We report prevalence of preschool child stunting and wasting from a national survey in 2016 and place findings into the context of national trends and alignment for Nepal to attain its WHA 2025 goal. METHODS:A representative, midyear Policy and Science for Health, Agriculture and Nutrition (PoSHAN) survey was conducted in 2016 on 5479 children <60 months in 4051 households in 21 village development committees. Child weight and height were measured, and sociodemographic factors were assessed. Data from previous surveys (Nepal Demographic Health Surveys, PoSHAN) were also acquired, and rates of stunting (<-2 height-for-age z score) and wasting (<-2 weight-for-height z score) were compared to current World Health Organization standards. Trends were expressed as average annual rates of reduction (AARR). RESULTS:Nationally, in 2016, 34.1% of preschoolers were stunted and 13.7% wasted. Stunting was highest in the Mountains (40.6%) and wasting highest in the Tarai (18.9%). Trend analysis revealed a steady decline (3.8% AARR) in stunting from 2001 to 2013, with virtually no decline from 2013 to 2016. Wasting has been continually high and variable, at ≥8%, since 1975. CONCLUSIONS:Following a steady decline in prevalence, preschool child stunting has plateaued at ∼35% in Nepal, while wasting has changed little over time, offering the opportunity to inform, reassess, and adjust, as needed, efforts to reach WHA 2025 goals.

背景与目标：

BACKGROUND & AIMS: INTRODUCTION:Urachal cyst is an exceptionally rare disease in children caused by the incomplete obliteration of the urachal remnant. Urachal cysts seldom cause symptoms unless a secondary infection occurs. The symptoms of an infected urachal cyst are nonspecific and may be similar to acute appendicitis or other acute abdominal conditions. However, complications attributable to a delayed diagnosis can endanger the life of a patient. PATIENT CONCERNS:A 5-year-old boy presented with a 3-day history of severe intermittent lower abdominal pain. DIAGNOSIS:Infected urachal cyst. INTERVENTIONS:The patient was treated with surgical resection of the urachus, followed by intravenous antibiotics during the hospitalization. OUTCOMES:The patient was discharged without incident 7 days after the operation. With his follow-up in our out-patient department, he recovered well without any sequelae in the 6 months post-surgery. CONCLUSION:We suggested using the abdominal echo scan to differentiate the urachal cyst because of its high sensitivity and nonradioactive characteristic, and computed tomography is a typical diagnostic tool for urachal cysts. The mainstream management of an infected urachal cyst remains surgical excision. Complete excision of urachal cysts is relatively easy in a pediatric patient and the risk of subsequent infection is low; however, patients tend to have a low, although possible, risk of potential malignant transformation over their lifetimes.

背景与目标：

BACKGROUND & AIMS: :Is it necessary--and possible--to discuss death with a terminally ill child? How should one approach the subject? A recent Swedish study demonstrates the benefits for parents who discuss with their child his or her imminent death, and examines the ways in which caregivers can help such parents. The mother of one child treated in our unit recently wrote a story 48 hours before her child's death. The story served to broach a number of questions often raised by dying children and their families: fear of the unknown, of being replaced, the inevitability of death, grief and fear of being forgotten... Since 2004, the story has been given to several families with dying children in our unit. In order to evaluate the story's impact on families and to determine whether a document which stimulates dialogue should continue to be given to parents, we asked the first thirteen to fill out a questionnaire. The results confirmed that the story was experienced as something positive and that it helped parents to talk with their children. The results of our study lead us to conclude that the medical profession should lend its full support to families who wish to engage in this dialogue with their children. This study also raises many questions and should be part of a global accompaniment strategy. With our support, an illustrated story book called Falikou was published in October 2006.

背景与目标： : 是否有必要 -- 也有可能 -- 与一个身患绝症的孩子讨论死亡问题？一个人应该如何处理这个问题？瑞典最近的一项研究证明了与孩子讨论即将死亡的父母的好处，并研究了照顾者可以帮助这些父母的方式。在我们单位接受治疗的一个孩子的母亲最近在孩子去世前48小时写了一个故事。这个故事提出了垂死的孩子及其家人经常提出的许多问题: 对未知的恐惧，被取代，死亡的必然性，悲伤和被遗忘的恐惧...从2004开始，这个故事已经给了我们单位几个有垂死孩子的家庭。为了评估故事对家庭的影响并确定是否应继续向父母提供激发对话的文件，我们请前十三位填写问卷。结果证实，这个故事被认为是积极的，它帮助父母与孩子交谈。我们的研究结果使我们得出结论，医学界应全力支持希望与子女进行对话的家庭。这项研究也提出了许多问题，应该成为全球伴奏策略的一部分。在我们的支持下，一本名为Falikou的插图故事书在2006年10月出版。