[This corrects the article DOI: 10.1016/j.apsb.2022.05.019.].

Objective To investigate the the effects of fracture fragment size and fixation method on biomechanical stability of distal tibial epiphyseal injuries in children.Methods A three-dimensional(3D)finite element model of a Salter-Harris Ⅱ(SH-Ⅱ)epiphyseal injury with fracture fragments of varying sizes(Small,Middle,Big)was constructed using computed tomography(CT)data from the lower limb of a 10-year-old volunteer.and bone-internal fixation assemblies were created with 1-3 screws(1 S group,2 S group,3 S group)and Kirschner wire(K group).The model was subjected to gravitational forces,posterior drawer forces,and external rotation.Displacement and stress distributions on fracture fragments and fixation devices were analyzed.Results The maximum displacement for the four groups of models was concentrated at the distal end of the fracture fragment.Under gravity conditions,the maximum displacement of the distal end of the fracture fragment in the 1 S,2 S,3 S and K models in Small group was 5.69,5.57,5.56,0.11 mm,respectively,and the bone stress was 16.95,12.26,8.57 and 5.00 MPa,respectively.A high stress area at the epiphyseal plate and the fracture line was easily formed under screw fixation,while a high stress area at the edge of the epiphyseal plate was formed under Kirschner wire fixation.Conclusions When distal tibial epiphyseal injuries in children are treated by using screws,increasing the number of screws can improve the fixation stability and share local bone stress,but the connection area between the fracture fragment and the epiphyseal plate cannot be too small.Kirschner wire fixation can provide better biomechanical effects than screw fixation.

Objective To investigate the clinical utility of krebs von den lungen-6(KL-6),a sialoglycan antigen,in the auxiliary diagnosis of idiopathic pulmonary hemosiderosis(IPH)in children.Methods A total of 140 children admitted to the First Affiliated Hospital of Guangzhou Medical University from June 2014 to July 2024 were categorized into a case group and a control group.The case group was further subdivided into four subgroups based on disease type:IPH group(n=32),interstitial lung disease(ILD)group(n=22),pneumonia(PN)group(n=60),and non-pulmonary disease(NPD)group(n=26).Serum KL-6 levels were measured for all children across these groups,and the differences in KL-6 expression between children with IPH and those without IPH(including the ILD,PN,and NPD groups)were analyzed.Results The positive rates of KL-6 in each group of children,from highest to lowest,were as follows:IPH(68.75%),ILD(45.45%),PN(1.69%),and NPD(0.00%).The differences in positive rates between groups were statistically significant(χ2=66.10,P<0.001).The mean serum level of KL-6 in the IPH group was significantly higher than that in the PN group(Z=-6.92,P<0.001).Diagnostic test results indicated that the area under the ROC curve was 0.940(95%CI:0.89 to 1.00,P<0.001),with a cut off value of 392.00 U/mL,sensitivity of 81.30%,and specificity of 95.00%.Conclusions KL-6 demonstrates significant diagnostic value in distinguishing IPH children from those with PN and NPD,making it a promising blood biomarker for aiding in the diagnosis of IPH.

Developmental dysplasia of the hip (DDH) is the most common bone developmental disorder in children, emphasizing the need for effective, standardized, and accurate screening and treatment approaches. This paper reviews traditional ultrasound diagnostic methods for DDH in children aged 0-6 months and examines the latest advancements in artificial intelligence (AI)-assisted ultrasound technology. It compares the diagnostic accuracy, efficiency, and limitations of these approaches while addressing controversies surrounding the adoption of AI. Results indicate that AI-assisted ultrasound significantly outperforms traditional methods in both accuracy and efficiency but also raises concerns about over-diagnosis and over-treatment. Despite these challenges, AI-assisted ultrasound holds immense potential, and with technological advancements, it is expected to gain wider acceptance among clinicians, enhancing its application in clinical practice.

Objective:To investigate the clinical characteristics of limb overgrowth following proximal femoral osteotomy (PFO) for unilateral developmental dysplasia of the hip (DDH) in children.Methods:A retrospective analysis was conducted on 36 children with unilateral DDH who underwent PFO at Xi'an Honghui Hospital from June 2017 to June 2021. The cohort included 4 males and 32 females, with a mean age of 4.23±3.15 years (range: 2-12 years), comprising 28 left-sided and 8 right-sided cases. According to the International Hip Dysplasia Institute (IHDI) classification, there were 2 type I, 9 type II, 16 type III, and 9 type IV cases. Radiographic parameters [femoral length, femoral neck anteversion angle, neck-shaft angle, acetabular index (AI), center-edge angle (CEA), center-head distance discrepancy (CHDD)] and PFO parameters (varus angle, shortening length, derotation angle) were measured on X-ray and 3D CT reconstructions. Comparisons were made between the overgrowth ≥1 cm group ( n=14) and <1 cm group ( n=22) to analyze risk factors and patterns. Results:The overgrowth ≥1 cm group had significantly younger patients (2.49±1.03 years vs. 5.13±3.47 years, t=-2.757, P<0.001). Overgrowth magnitude varied significantly across age subgroups: 11.08±6.17 mm in the 2-4 years group, 5.08±0.19 mm in the >4-<6 years group, and 2.44±4.50 mm in the ≥6 years group ( F=5.436, P=0.031). The highest incidence of overgrowth occurred in the 2-4 years subgroup (56%, 20/36). Limb overgrowth initiated at 3 months postoperatively, exhibited a linear correlation with follow-up duration during 6-18 months [ r=0.78, 95% CI(0.62, 0.88), P<0.001)], and plateaued after 18 months [ r=-0.15, 95% CI(-0.75, 0.57), P=0.710]. Postoperative CEA and CHDD showed significant improvements ( P<0.05), while AI remained unchanged ( P>0.05). Conclusions:Children aged 2-4 years exhibit higher incidence and severity of post-PFO limb overgrowth. The rapid progression phase occurs within 6-18 months postoperatively, stabilizing thereafter. CEA and CHDD serve as critical indicators for evaluating intervention efficacy in DDH-related overgrowth.

Objective:To investigate the efficacy and safety of transurethral incision for the treatment of ureterocele in infants.Methods:A retrospective analysis of 28 cases of ureterocele admitted from March 2012 to May 2023 were reviewed, all of which were less than 1 year old, 16 male and 12 female, with an average age of(5.7±3.5)months. The ureterocele was located on the left side in 8 cases, on the right side in 15 cases, and bilaterally in 5 cases. There were 12 cases of single system ureterocele, of which 7 cases were unilateral and 5 cases were bilateral. Duplex system ureterocele was observed in 16 cases, all of which were unilateral. Clinical manifestations: urinary tract infection in 13 cases, 11 cases of ureterocele or hydronephrosis and ureteral dilation were found during antenatal examination, and 4 cases of ureterocele were found after birth. Urological ultrasound, intravenous pyelography(IVP) and voiding cystourethrography(VCUG) were performed in all children, and 17 cases underwent magnetic resonance urolography (MRU), and confirm the diagnosis of ureterocele preoperatively. All of the cases were performed the transurethral incision.The ureterocele was punctured and incised 1-2 mm at the base of the bulge, and 2-4 points were punctured according to the bulge atrophy. Bilateral ureteroceles were punctured and incised simultaneously. Postoperative urine routine test, urinary tract color ultrasound and VCUG were performed to determine if there is urinary tract infection, hydronephrosis, ureteral dilation and bulging, and whether a second surgery is needed.Results:All operations were conducted successfully. The intraoperative bleeding was less than 3 ml and no intraoperative complications. The operative time was (28.4±10.3) min. The median postoperative follow-up was 34 (32, 36) months. Six cases underwent postoperative VCUG examination. Eleven children were recovered well with single systemic ureterocele. One child developed grade Ⅳ vesicoureteral reflux(VUR)and combined with bladder diverticulum, and ureterocele underwent open diverticulotomy and ureteral reimplantation six months after surgery. Nine children were recovered well with duplex systemic ureterocele. Six cases of children developed infection, of which 2 cases had an infection once within one month after TUI, and the other four cases still had intermittent infections after six months and VCUG was performed, and one case showed grade Ⅲ VUR of the lower ureter, which was observed conservatively, while the other three cases had enlarged cysts but no VUR, and upper heminephrectomy was performed, and the patients recovered well after surgery. Except for these 6 exceptions, in another case, after ten years of follow-up, the ureterocele became larger but no VUR, and the results were good after a second transurethral incision. There was no significant difference in the postoperative infections, new VUR cases, and secondary surgeries between the two groups.Conclusions:Transurethral incision has good surgical effect on children with single system ureterocele and duplex system ureterocele, and has advantages of easy operation, less trauma, safety and effectiveness, and few complications. It deserves to be recommended as the treatment of choice, especially for infants and young children.

Developmental dysplasia of the hip (DDH) is the most common bone developmental disorder in children, emphasizing the need for effective, standardized, and accurate screening and treatment approaches. This paper reviews traditional ultrasound diagnostic methods for DDH in children aged 0-6 months and examines the latest advancements in artificial intelligence (AI)-assisted ultrasound technology. It compares the diagnostic accuracy, efficiency, and limitations of these approaches while addressing controversies surrounding the adoption of AI. Results indicate that AI-assisted ultrasound significantly outperforms traditional methods in both accuracy and efficiency but also raises concerns about over-diagnosis and over-treatment. Despite these challenges, AI-assisted ultrasound holds immense potential, and with technological advancements, it is expected to gain wider acceptance among clinicians, enhancing its application in clinical practice.

Objective:To investigate the clinical characteristics of limb overgrowth following proximal femoral osteotomy (PFO) for unilateral developmental dysplasia of the hip (DDH) in children.Methods:A retrospective analysis was conducted on 36 children with unilateral DDH who underwent PFO at Xi'an Honghui Hospital from June 2017 to June 2021. The cohort included 4 males and 32 females, with a mean age of 4.23±3.15 years (range: 2-12 years), comprising 28 left-sided and 8 right-sided cases. According to the International Hip Dysplasia Institute (IHDI) classification, there were 2 type I, 9 type II, 16 type III, and 9 type IV cases. Radiographic parameters [femoral length, femoral neck anteversion angle, neck-shaft angle, acetabular index (AI), center-edge angle (CEA), center-head distance discrepancy (CHDD)] and PFO parameters (varus angle, shortening length, derotation angle) were measured on X-ray and 3D CT reconstructions. Comparisons were made between the overgrowth ≥1 cm group ( n=14) and <1 cm group ( n=22) to analyze risk factors and patterns. Results:The overgrowth ≥1 cm group had significantly younger patients (2.49±1.03 years vs. 5.13±3.47 years, t=-2.757, P<0.001). Overgrowth magnitude varied significantly across age subgroups: 11.08±6.17 mm in the 2-4 years group, 5.08±0.19 mm in the >4-<6 years group, and 2.44±4.50 mm in the ≥6 years group ( F=5.436, P=0.031). The highest incidence of overgrowth occurred in the 2-4 years subgroup (56%, 20/36). Limb overgrowth initiated at 3 months postoperatively, exhibited a linear correlation with follow-up duration during 6-18 months [ r=0.78, 95% CI(0.62, 0.88), P<0.001)], and plateaued after 18 months [ r=-0.15, 95% CI(-0.75, 0.57), P=0.710]. Postoperative CEA and CHDD showed significant improvements ( P<0.05), while AI remained unchanged ( P>0.05). Conclusions:Children aged 2-4 years exhibit higher incidence and severity of post-PFO limb overgrowth. The rapid progression phase occurs within 6-18 months postoperatively, stabilizing thereafter. CEA and CHDD serve as critical indicators for evaluating intervention efficacy in DDH-related overgrowth.

Objective To investigate the the effects of fracture fragment size and fixation method on biomechanical stability of distal tibial epiphyseal injuries in children.Methods A three-dimensional(3D)finite element model of a Salter-Harris Ⅱ(SH-Ⅱ)epiphyseal injury with fracture fragments of varying sizes(Small,Middle,Big)was constructed using computed tomography(CT)data from the lower limb of a 10-year-old volunteer.and bone-internal fixation assemblies were created with 1-3 screws(1 S group,2 S group,3 S group)and Kirschner wire(K group).The model was subjected to gravitational forces,posterior drawer forces,and external rotation.Displacement and stress distributions on fracture fragments and fixation devices were analyzed.Results The maximum displacement for the four groups of models was concentrated at the distal end of the fracture fragment.Under gravity conditions,the maximum displacement of the distal end of the fracture fragment in the 1 S,2 S,3 S and K models in Small group was 5.69,5.57,5.56,0.11 mm,respectively,and the bone stress was 16.95,12.26,8.57 and 5.00 MPa,respectively.A high stress area at the epiphyseal plate and the fracture line was easily formed under screw fixation,while a high stress area at the edge of the epiphyseal plate was formed under Kirschner wire fixation.Conclusions When distal tibial epiphyseal injuries in children are treated by using screws,increasing the number of screws can improve the fixation stability and share local bone stress,but the connection area between the fracture fragment and the epiphyseal plate cannot be too small.Kirschner wire fixation can provide better biomechanical effects than screw fixation.

Objective To investigate the clinical utility of krebs von den lungen-6(KL-6),a sialoglycan antigen,in the auxiliary diagnosis of idiopathic pulmonary hemosiderosis(IPH)in children.Methods A total of 140 children admitted to the First Affiliated Hospital of Guangzhou Medical University from June 2014 to July 2024 were categorized into a case group and a control group.The case group was further subdivided into four subgroups based on disease type:IPH group(n=32),interstitial lung disease(ILD)group(n=22),pneumonia(PN)group(n=60),and non-pulmonary disease(NPD)group(n=26).Serum KL-6 levels were measured for all children across these groups,and the differences in KL-6 expression between children with IPH and those without IPH(including the ILD,PN,and NPD groups)were analyzed.Results The positive rates of KL-6 in each group of children,from highest to lowest,were as follows:IPH(68.75%),ILD(45.45%),PN(1.69%),and NPD(0.00%).The differences in positive rates between groups were statistically significant(χ2=66.10,P<0.001).The mean serum level of KL-6 in the IPH group was significantly higher than that in the PN group(Z=-6.92,P<0.001).Diagnostic test results indicated that the area under the ROC curve was 0.940(95%CI:0.89 to 1.00,P<0.001),with a cut off value of 392.00 U/mL,sensitivity of 81.30%,and specificity of 95.00%.Conclusions KL-6 demonstrates significant diagnostic value in distinguishing IPH children from those with PN and NPD,making it a promising blood biomarker for aiding in the diagnosis of IPH.