Discoid meniscus is the most common congenital meniscal abnormality encountered in pediatric patients and frequently involves the lateral meniscus. While some discoid menisci remain asymptomatic, many children and adolescents develop pain, mechanical symptoms, or instability requiring surgical treatment. Historically, subtotal or total meniscectomy was commonly performed to address pain, mechanical symptoms, and functional limitation associated with symptomatic discoid meniscus. However, growing evidence regarding the biomechanical and long-term consequences of meniscal loss has led to a significant shift in treatment philosophy. Contemporary surgical management therefore emphasizes preservation of meniscal tissue whenever possible. Arthroscopic reshaping of the discoid meniscus combined with repair of associated tears or peripheral instability allows restoration of meniscal morphology while maintaining its biomechanical function. Given the long life expectancy and activity demands of pediatric patients, meniscal preservation should be considered the primary objective when surgically treating symptomatic discoid meniscus in children.
Prepectoral total breast reconstruction (PPTBR) has become a popular technique due to the many benefits observed in properly selected patients. Compared with the retropectoral implant position, PPTBR has the advantage of maintaining the pectoral major muscle in its anatomic original position, avoiding acute and chronic pain, maintaining better extremity strength and motion, and avoiding animation deformity and post-radiotherapy pectoral fibrosis. The basic principles of the technique can be used with a tissue expander or permanent implants. We present the preliminary report of 46 patients (51 breasts). In all, 20 out of the 46 patients had an association with radiotherapy; 18 of them received post-mastectomy radiotherapy and 2 received total breast irradiation on previous conservative treatment. The period of follow-up was 2–32 months, beginning in July 2019. The main surgical approach was using a lateral aspect of the inframammary fold incision. Depending on the new subdermal implant pocket width, in 20 patients, a synthetic mesh was placed. We only had two major complications: one who required reintervention due to radionecrosis and conversion to a dorsal flap plus a permanent implant, and the other who required a change into a retropectoral plane reconstruction due to wound dehiscence. No implant infection of grade 3–4 capsular contraction has been reported so far. The aesthetic result was excellent for most patients and the surgeon’s opinion, according to the Harris scale.
Introduction and Objectives Liver elastography provides a noninvasive assessment of fibrosis in autoimmune hepatitis (AIH); however, its value for predicting biochemical response to treatment remains uncertain, especially in the presence of active inflammation.The aims were to evaluate whether baseline liver stiffness is associated with complete biochemical response and to assess its diagnostic accuracy for histological fibrosis in treatment-naive AIH patients. Materials and Methods Retrospective cohort of 42 patients managed between 2017 and 2025 at a tertiary center, with baseline elastography and biochemical follow-up. Complete response was defined as normalization of AST, ALT, and immunoglobulin G at six months. Liver stiffness was compared according to measurement method and predefined fibrosis cutoffs. Results Eighteen patients (43%) achieved complete biochemical response, whereas twenty-four (57%) did not. Baseline liver stiffness did not differ between groups: ARFI 10.65 versus 11.57 kPa (p=0.625) and FibroScan 13.5 versus 19.3 kPa (p=0.565). Baseline advanced fibrosis was also similar: 14/18 (78%) versus 19/24 (79%) (p=0.914). Elastography was associated with histologic F3–F4 fibrosis (OR 9.3; IC95% 1.62-53.6, p=0.012), with sensitivity 92.3%, specificity 43.8%, PPV 73%, and NPV 78%. False-positive cases showed higher inflammatory activity than true positives: AST 581 versus 79 U/L (p=0.006), ALT 703 versus 66 U/L (p=0.002), and IgG 2440 versus 1975 mg/dL (p=0.055). Conclusions Baseline elastography did not predict complete biochemical response, but it identified advanced fibrosis with high sensitivity, although it tended to overestimate fibrosis in patients with greater baseline inflammatory activity.
Abstract Background Invasive bacterial infections are a leading cause of mortality in children with cancer and febrile neutropenia (FN). Clinical tools have been developed to predict sepsis in this population but the added value of comprehensive biomarkers such as RNA expression profiling remains unclear. This study aimed to determine the utility of transcriptome profiling for early sepsis identification in children with cancer and FN. Methods Prospective, multicenter study conducted over three years in 6 hospitals in Chile in which children ≤ 18 years with cancer and FN were enrolled within 2 hours of fever onset, and blood samples obtained for blood culture and RNA expression profile analyses. Healthy age-matched controls (HC) were enrolled in parallel. A validated clinical scoring system was used to classify children in low and high-risk. Gene expression data was analyzed using linear regression and differential expressed genes were obtained with adjusted p-value < 0.05 and fold change > 2 in R environment. Modular analysis and quantitative gene set enrichment were used to identify pathways and network differences between groups. Results Data from 137 episodes of FN and in 34 healthy controls were analyzed. Median age was 8 (IQR: 6-12) years and 68 (50%) were male. The underlying diseases included hematological malignancies in 99 (72.3%) and solid tumor in 38 (27.7%) children. Of the137 episodes, 43 were classified as low risk -- and most (n=39; 91%) had a respiratory virus identified--, and 94 episodes were classified as high-risk. Of the high-risk episodes 22 developed sepsis, 20 of which had a positive blood culture. Pairwise comparisons identified 791significantly expressed genes between low-risk children and HC, while 991 genes were identified between children with sepsis and HC (Fig 1 A-B). The proportion of underexpressed genes was higher in children with sepsis (~70%) than in the low-risk group (~50%). Further, modular pathway analysis showed underexpression of inflammation, T and B-cell genes irrespective of the clinical classification, while interferon, monocyte, and neutrophil genes were overexpressed in the low-risk group but underexpressed in children with sepsis (Fig 1C). Conclusion This study highlights the potential value of blood gene expression profiling for classifying children with cancer and FN according to their clinical risk classification. It also provides a deeper understanding of the pathways that are activated or suppressed in sepsis in this population.
