Development of low-dose protocols for thin-section CT assessment of cystic fibrosis in pediatric patients.

Purpose: To develop low-dose thin-section computed tomographic (CT) protocols for assessment of cystic fibrosis (CF) in pediatric patients and determine the clinical usefulness thereof compared with chest radiography. Materials and Methods: After institutional review board approval and informed consent from patients or guardians were obtained, 14 patients with CF and 11 patients without CF (16 male, nine female; mean age, 12.6 years ± 5.4 [standard deviation]; range, 3.5–25 years) who underwent imaging for clinical reasons underwent low-dose thin-section CT. Sections 1 mm thick (protocol A) were used in 10 patients, and sections 0.5 mm thick (protocol B) were used in 15 patients at six levels at 120 kVp and 30–50 mA. Image quality and diagnostic acceptability were scored qualitatively and quantitatively by two radiologists who also quantified disease severity at thin-section CT and chest radiography. Effective doses were calculated by using a CT dosimetry calculator. Results: Low-dose thin-section CT was performed with mean effective doses of 0.19 mSv ± 0.03 for protocol A and 0.14 mSv ± 0.04 for protocol B (P < .005). Diagnostic acceptability and depiction of bronchovascular structures at lung window settings were graded as almost excellent for both protocols, but protocol B was inferior to protocol A for mediastinal assessment (P < .02). Patients with CF had moderate lung disease with a mean Bhalla score of 9.2 ± 5.3 (range, 0–19), compared with that of patients without CF (1.1 ± 1.4; P < .001). There was excellent correlation between thin-section CT and chest radiography (r = 0.88–0.92; P < .001). Conclusion: Low-dose thin-section CT can be performed at lower effective doses than can standard CT, approaching those of chest radiography. Low-dose thin-section CT could be appropriate for evaluating bronchiectasis in pediatric patients, yielding appropriate information about lung parenchyma and bronchovascular structures

Demonstration of Accuracy and Feasibility of Remotely Delivered Oximetry: A Blinded, Controlled, Real-World Study of Regional/Rural Children with Obstructive Sleep Apnoea

Objectives: Evaluate diagnostic accuracy and feasibility of a mail-out home oximetry kit. Design: Patients were referred for both the tertiary/quaternary-centre hospital-delivered oximetry (HDO) and for the mail-out remotely-delivered oximetry (RDO). Quantitative and qualitative data were collected. The COVID-19 pandemic began during this study; therefore, necessary methodological adjustments were implemented. Setting: Patients were first evaluated in Swan Hill, Victoria. RDO kits were sent to home addresses. For the HDO, patients travelled to the Melbourne city area, received the kit, stayed overnight, and returned the kit the following morning. Participants: All consecutive paediatric patients (aged 2–18), diagnosed by a specialist in Swan Hill with obstructive sleep apnoea (OSA) on history/examination, and booked for tonsillectomy +/− adenoidectomy, were recruited. Main outcome measures: Diagnostic accuracy (i.e., comparison of RDO to HDO results) and test delivery time (i.e., days from consent signature to oximetry delivery) were recorded. Patient travel distances for HDO collection were calculated using home/delivery address postcodes and Google® Maps data. Qualitative data were collected with two digital follow-up surveys. Results: All 32 patients that had both the HDO and RDO had identical oximetry results. The HDO mean delivery time was 87.7 days, while the RDO mean delivery time was 23.6 days (p value: n = 28). Conclusions: The remote option is as accurate as the hospital option, strongly preferred by patients, more rapidly completed, and also an ideal investigation delivery method during certain emergencies, such as the COVID-19 pandemic

Perioperative Care of Children with Severe Neurological Impairment and Neuromuscular Scoliosis&mdash;A Practical Pathway to Optimize Peri-Operative Health and Guide Decision Making

Neuromuscular scoliosis is a common feature in children with severe neurological impairment (SNI), including those with severe cerebral palsy. Surgical correction of scoliosis is the mainstay of treatment. This group of patients also have associated medical complexity. The complication rates post-surgery are high, although, for many, they are worth the risk. There are currently no published practice guidelines or care pathways for children with SNI who are undergoing scoliosis corrective surgery. In response to the high uptake of this surgery, coupled with the expected complication rates, our hospital established a perioperative clinic. The purpose of this paper is to describe our perioperative approach. This clinic has developed into a service beyond perioperative care and, with the collaborative meeting, enables shared decision-making to identify the right candidate for surgery. The process involves surgical expertise, understanding the family and child at the centre, and optimisation of medical care pre- and post-surgery. In this paper, we describe the process in a step-by-step manner. We provide clinical vignettes, as well as the proformas that we use, and we highlight the benefits of the team-based process

Mechanisms of Cl(-) transport contributing to salt tolerance

Mechanisms of Cl(-) transport in plants are poorly understood, despite the importance of minimizing Cl(-) toxicity for salt tolerance. This review summarizes Cl(-) transport processes in plants that contribute to genotypic differences in salt tolerance, identifying key traits from the cellular to whole-plant level. Key aspects of Cl(-) transport that contribute to salt tolerance in some species include reduced net xylem loading, intracellular compartmentation and greater efflux of Cl(-) from roots. We also provide an update on the biophysics of anion transport in plant cells and address issues of charge balance, selectivity and energy expenditure relevant to Cl(-) transport mechanisms. Examples are given of anion transport systems where electrophysiology has revealed possible interactions with salinity. Finally, candidate genes for anion transporters are identified that may be contributing to Cl(-) movement within plants during salinity. This review integrates current knowledge of Cl(-) transport mechanisms to identify future pathways for improving salt tolerance.Natasha L. Teakle & Stephen D. Tyerma