Fractures are becoming a bigger and bigger global health problem, with an estimated 178 million new cases each year and 455 million people living with disabilities caused by fractures. Donor site morbidity, the risk of immune rejection, and limited functional integration all make current grafting techniques less effective. Biomaterials that come from nature, like collagen, gelatin, chitosan, alginate, hyaluronic acid (HA), and silk fibroin, have become promising scaffolds because they are bioactive, mimic the extracellular matrix (ECM), and can be broken down by enzymes. Crosslinking and composite reinforcement can greatly change how well they work. For example, collagen scaffolds that are highly crosslinked with glutaraldehyde keep up to 51.9% of their tensile strength after being exposed to enzymes, while non-crosslinked scaffolds only keep 12% of their strength. Chitosan–hydroxyapatite matrices, on the other hand, can reach compressive strengths of 2–12 MPa, which is close to the strength of cancellous bone. Additive manufacturing and 4D printing allow for precise control of structures and the ability to change their shape over time, which helps with vascularization and mechanical adaptation. Injectable and in situ-forming hydrogels show clinically important results, such as filling 85% of osteochondral defects in rabbits, improving left ventricular ejection fraction by up to 9% in large-animal cardiac models, and speeding up healing by 25–40% in chronic wounds. Even with these improvements, it is still hard to get batch consistency, a standardized way to test mechanical properties, and production that meets GMP (Good Manufacturing Practices) standards and can be scaled up.

Background: Seasonal influenza viruses are primarily known for causing respiratory illness, but rare hematologic complications can occur, especially in young children. While influenza A is more commonly linked to severe manifestations, influenza B can similarly precipitate life-threatening cytopenias, particularly in toddlers. Case Presentation: We report the case of a previously healthy 1-year-and-8-months-old girl who presented with a high fever, cough, and marked pallor during peak influenza season. Laboratory tests revealed significant microcytic, hypochromic anemia and severe thrombocytopenia. Rapid antigen testing was positive for influenza B. An extensive workup for other causes of bicytopenia, including leukemia, hemolysis, aplastic anemia, and other viral infections, yielded negative results. The child was managed with urgent red blood cell and platelet transfusions, oseltamivir antiviral therapy, broad-spectrum antibiotics, corticosteroids, and supportive care. Bone marrow aspiration was deferred in light of the rapid hematologic recovery. Her hemoglobin greatly improved, and her platelet count reached normal values at discharge. Conclusions: Our case underscores the need to consider influenza in the differential diagnosis of unexplained cytopenias during flu season. This case illustrates that influenza B can mimic hematologic malignancies. Rapid diagnosis and supportive treatment are essential to avoid fatal outcomes. Influenza vaccination plays a significant role in preventing severe complications, such as those we encountered.

Background: Cardiac rhythm disorders in children and adolescents have a high incidence. In certain conditions, sudden death may occur. Materials and Methods: We conducted a prospective study including 199 patients divided into two subgroups: one subgroup of 80 practicing different sports and another one of 119 non-sportive, symptomatic patients. We studied all socio-demographic data, medical histories, and the elements revealed by the clinical and paraclinical examinations. Results: Only 39 (19.60%) participants did not practice any kind of sport; 46 participants had cases of sudden cardiac death in their families; 60.80% of children and adolescents were exposed to smoking; among the symptomatic group, symptoms like vertigo, chest pain, lipothymia, and palpitations predominated. Conclusions: A significant percentage of participants with heart rhythm disorders at risk for sudden death was identified. It is extremely important to identify and restrict them from intense physical exertion and to reassess them periodically in order to reduce the risk of sudden cardiac death.

Background and Objectives: Seizures and epilepsy are common in children with life-limiting illnesses, particularly in the context of severe neurological impairment. However, data on the clinical profile of these patients in paediatric palliative care are limited, and the lack of standardised protocols adapted to this context represents a clinical challenge. To assess the prevalence of epilepsy and associated clinical characteristics in children receiving paediatric palliative care and to develop a clinical protocol for the management of seizures based on expert consensus. Materials and Methods: A retrospective observational study was conducted, based on the analysis of clinical data from children registered in a paediatric palliative care service (Lumina Association, Romania). Demographic, diagnostic, neurological status and anticonvulsant treatment data were collected. Based on the results obtained and the existing literature, a clinical protocol was developed using a modified Delphi method approach, involving a multidisciplinary panel of experts and two rounds of evaluation of clinical statements. Results: A total of 101 patients (54.5% boys and 45.5% girls) were included, with a mean age of 7.2 ± 4.7 years. Epilepsy was documented in 32.7% of patients and was significantly associated with a neurological diagnosis (p = 0.008), severe neurodevelopmental delay (p = 0.032) and severe motor impairment (p = 0.036). The Delphi process led to the validation of 13 clinical recommendations, the majority of which achieved a strong level of consensus (>85%). Conclusions: Epilepsy is common and closely associated with severe neurological impairment in paediatric palliative care. The integration of systematic neurological assessment and the implementation of a consensus-based clinical protocol can support a more structured approach to seizure management in paediatric palliative care.

Background and Objectives: Healthcare-associated infections (HAIs) caused by Pseudomonas aeruginosa represent a challenge for healthcare systems worldwide, with significant incidence, high mortality, and increasing antibiotic resistance. This paper aims to describe and analyze the epidemiology of HAI cases with Pseudomonas aeruginosa in a tertiary neurosurgical hospital in the northeastern region of Romania during 2020–2024. Materials and Methods: Study inclusion criteria were patients of any age (as the hospital also admits pediatric patients from the region) and a diagnosis of P. aeruginosa HAI, with a signed informed consent form by the adult patient or relatives for pediatric patients. Results: During 2020–2024, 163 cases of P. aeruginosa HAIs were identified. The annual incidence decreased from 4.41‰ in 2020 to 2.37‰ in 2024 (p = 0.0038). Most cases occurred in the intensive care unit (ICU) (119/163; 73.0%), followed by neurosurgery wards (37/163; 22.7%). Overall, 110 cases (67.5%) occurred in men and 53 (32.5%) in women. The analysis also showed a predominance of late-onset cases and the presence of antimicrobial-resistant phenotypes among the identified P. aeruginosa isolates. Conclusions: This study provides an integrated epidemiological characterization of P. aeruginosa HAIs in a regional neurosurgical hospital, highlighting the predominance of ICU-associated cases, late-onset infections, and antimicrobial-resistant phenotypes. These findings support the need for continued epidemiological surveillance and antimicrobial resistance monitoring in high-risk neurosurgical settings.

Background: Cardiac arrhythmias in children and adolescents may present with nonspecific symptoms such as precordial pain, palpitations, and syncope. We evaluated the clinical characteristics and rhythm findings of symptomatic pediatric patients and examined cross-sectional associations between reported symptoms and selected rhythm diagnoses, with particular attention to the diagnostic and management yield of ambulatory Holter monitoring. Because symptom timing is not always captured during diagnostic monitoring, associations between reported symptoms and detected rhythm abnormalities must be distinguished from temporal symptom–rhythm correlation and causation. Methods: We conducted an observational study of 119 children and adolescents aged 1–18 years, who were evaluated at a tertiary pediatric hospital for symptoms potentially suggestive of cardiac rhythm abnormalities. Data included demographic characteristics, clinical symptoms, personal and family history, resting electrocardiography, ambulatory Holter monitoring, and exercise testing where clinically indicated. The primary analysis was cross-sectional. Because symptom timing during ambulatory monitoring was not recorded, the study was not designed to establish temporal symptom–rhythm correlation or causality. Descriptive analyses were performed for the final 119-participant cohort. Selected symptom–rhythm associations were evaluated using the contingency table methods with odds ratios (ORs), 95% confidence intervals (CIs), and Fisher’s exact tests where appropriate. Holm’s adjustment was applied to the prespecified family of reconstructed symptom–rhythm comparisons. Results were interpreted according to both statistical evidence and effect-size precision. Results: The cohort comprised 119 participants, including 75 females (63.0%) and 44 males (37.0%). The most frequently reported symptoms were precordial pain (105/119, 88.2%), palpitations (80/119, 67.2%), and syncope or lipothymia (39/119, 32.8%). A family history of sudden cardiac death was reported by 28 participants (23.5%). Forty-two participants (35.3%) had a normal resting ECG, while 77 (64.7%) underwent ambulatory Holter monitoring. Among those undergoing Holter monitoring, 65/77 (84.4%) had rhythm abnormalities detected exclusively by ambulatory monitoring and not identified on the resting ECG. Holter findings resulted in at least one documented management change in 38/77 participants (49.4%). Management categories were not mutually exclusive and included lifestyle or activity adjustment in 21 participants, initiation of antiarrhythmic therapy in 19, medication monitoring in 19, and targeted cardiac imaging, including cardiac magnetic resonance imaging, in 5. In this cross-sectional analysis, reported syncope/lipothymia was strongly associated with the presence of complete atrioventricular block (10/39 [25.6%] versus 1/80 [1.3%]; OR 27.24, 95% CI 3.34–222.29; Fisher’s exact p < 0.001; Holm’s adjusted p approximately 0.0004). The unadjusted association between syncope/lipothymia and the WPW-labelled diagnosis did not remain statistically significant after Holm’s adjustment. No statistically significant associations were identified between syncope/lipothymia and PSVT or VT. Conclusions: In this pediatric cohort, ambulatory Holter monitoring identified rhythm abnormalities not detected on resting ECG in a substantial proportion of monitored participants and resulted in documented changes in clinical management in approximately half of those monitored. Reported syncope/lipothymia was strongly associated with the presence of complete atrioventricular block in the reconstructed cross-sectional analysis. Because symptom timing during monitoring was not recorded, these findings do not establish that the detected rhythm abnormalities caused the reported symptoms or that symptoms predict future rhythm outcomes. Further studies using prospectively defined symptom–rhythm event recording and longitudinal follow-up are needed to evaluate temporal correlation and prognosis.