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"Latar Belakang. Tatalaksana optimal diperlukan pada kasus instabilitas patella karena puncak insidensinya terjadi pada remaja usia 11 hingga 14 tahun dengan angka rekurensi yang tinggi, serta risiko instabilitas dan deformitas yang menetap. Terdapat perbedaan tatalaksana antara dislokasi patella rekuren dengan habitualis sehubungan dengan etiologi multipel yang mendasari, namun hingga saat ini belum ditemukan adanya rekomendasi tatalaksana yang memberikan luaran terbaik.Metode. Studi ini menggunakan desain systematic review berdasarkan metode Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) yang dilakukan pada bulan Agustus - September 2023. Penelusuran literatur dilakukan menggunakan sumber yang dipublikasi melalui online journal dan online database (PubMed, EMBASE, Scopus, Ebsco, dan Proquest) dengan tidak membatasi waktu, namun terbatas pada artikel berbahasa Inggris.Hasil. Pencarian literatur menghasilkan 385 artikel, dengan 5 artikel memenuhi kriteria inklusi penelitian. Sebanyak 44 pasien anak (50 lutut) yang dilakukan operasi diikutsertakan dalam penelitian ini. Hampir seluruh studi yang di inklusi melaporkan tercapainya ROM lutut yang normal pasca operasi. Secara keseluruhan, ditunjukkan adanya perbaikan dari rerata skor fungsional lutut (Skor Kujala dan Lysholm) pasca operasi pada seluruh subjek studi. Dalam hal rekurensi, salah satu studi melaporkan kejadian rekurensi pada 1 (2%) pasien, sedangkan dalam hal komplikasi, nyeri pasca operasi menjadi komplikasi yang paling banyak ditemukan, yakni pada 10 (20%) lutut. Analisis statistik kemudian dilakukan pada luaran studi luaran klinis, rekurensi, dan komplikasi dimana hasil menunjukkan perbedaan yang signifikan antar studi (p <0.001) pada luaran klinis dan komplikasi. Analisis kemudian dilanjutkan dengan analisis post- hoc untuk mencari perbedaan paling signifikan antar studi. Secara keseluruhan, didapatkan perbaikan pada hasil luaran fungsional pasca operasi. Hasil analisis statistik pada luaran fungsional dan komplikasi menunjukkan perbedaan yang signifikan antar studi. Hal ini dapat diakibatkan perbedaan komorbiditas pada populasi antar studi.Kesimpulan. Studi-studi yang diinklusi merupakan studi kohort dan bersifat tidak homogen sehingga belum bisa disimpulkan teknik mana yang paling baik. Metode paling efektif masih terus dikembangkan dengan melakukan modifikasi serta kombinasi dari teknik-teknik yang sudah ada.

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Introduction. Optimal management is needed in cases of patellar instability because the peak incidence occurs in adolescents aged 11 to 14 years with a high recurrence rate, as well as a risk of persistent instability and deformity. There are differences in management between recurrent and habitual patellar dislocations due to the multiple underlying etiologies, but to date there has been no recommendation for treatment that provides the best outcomes.

Method. This was a systematic review conducted based on the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) method and carried out from August to September 2023. The literature search was carried out using sources published through online journals and databases (PubMed, EMBASE, Scopus, Ebsco, and Proquest) with no time limits, but limited to English language articles.

Result. The literature search yielded 385 articles, with 5 articles meeting the study inclusion criteria. A total of 44 pediatric patients (50 knees) who underwent surgery were included in this study. Almost all of the included studies reported achieving normal knee ROM after surgery. Overall, there was an improvement in the mean knee functional scores (Kujala and Lysholm Scores) after surgery in all study subjects. In terms of recurrence, one study reported recurrence in 1 (2%) patients, while in terms of complications, postoperative pain was the most commoncomplication,namelyin10 (20%) knees. Statistical analysis was then performed on the study outcomes of functional outcomes, recurrence, and complications where the results showed significant differences between studies (p < 0.001) on functional outcomes and complications. The analysis was then continued with post-hoc analysis to determine the most significant differences between studies. Overall, there was an improvement in postoperative functional outcomes. The results of statistical analysis on functional outcomes, and complications showed significant differences between studies. This result could be caused by the differences in comorbidities in the population between studies.

Conclusion. The included studies were cohort studies and not homogeneous so it could not be concluded which technique was best. The most effective methods are still being developed by modifying and combining existing techniques."

"Perkembangan teknologi memainkan peranan penting dalam ketersediaan parameter pencitraan pada prosedur kateterisasi jantung, yang berdampak pada perlunya dilakukan optimasi pada kualitas citra dan tingkat dosis radiasi guna menentukan kombinasi parameter optimasi yang optimal. Pada kasus pasien anak (pediatrik), keperluan optimasi menjadi sangat penting sebab waktu hidup pasien yang lebih panjang dan sel yang lebih rentan terhadap radiasi. Tujuan dari penelitian ini adalah menentukan parameter pencitraan yang optimal di antara variasi yang diberikan, yakni mode pencitraan, diameter pembuluh darah (8, 6, 4, 2, dan 1 mm), dan konsentrasi media kontras berbasis Iodin (16%, 14%, 12%, dan 10% pada larutan plasma darah), dengan Figure of Merit (FOM) sebagai parameter. Fantom dibuat sebagai pengganti pasien pediatrik. Pengukuran Entrance Surface Air Kerma (ESAK) dan dosis keluaran dilakukan bersamaan dengan kalkulasi Signal-to-Noise Ratio (SNR) dari masing-masing variasi. Dari kalkulasi dosis dan kualitas citra, FOM untuk semua variasi dapat dikalkulasi dan kondisi optimum dapat ditentukan. Sebagai hasil, mode low dose pada fluoroskopi dan mode 15 fps low contrast mode ditentukan sebagai mode paling optimum untuk pasien berketebalan 10 cm. Ditemukan pula bahwa material timah tidak cocok digunakan dalam studi karena nilai SNR yang terlalu jauh jika dibandingkan dengan larutan Iodin.

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Technological development plays an essential role in expanding the breadth of imaging parameters in cardiac catheterization procedure, consequencing on the need of optimization involving image quality and dose level to consider the most favorable parameter combination. In the case of paediatric patients, the awareness is greater owing to the longer life expectancy as well as higher vulnerability against radiation effects in younger cells. The purpose of this study is to assess the most favorable imaging parameters among varied factors, i.e. the available imaging modes, vessel diameter (8, 6, 4, 2, and 1 mm), and iodine-based contrast agent’s concentration (16%, 14%, 12%, and 10% in a blood plasma solution), employing Figure of Merit (FOM) as optimization parameter. In house phantom was constructed to accommodate all variations within the dimensional constrain of a paediatric patient. Measurements of Entrance Surface Air Kerma (ESAK) and exit dose were performed along with calculations of Signal-to-Noise Ratio (SNR) of each varied objects. From the measured dose and image quality, calculation of FOM was done resulting that of all modes, it was favorable to employ low dose fluoroscopy mode and lower frame/s mode in cine acquisition due to low delivered dose and insignificant image quality change among the modes. Higher frame/s cine modes were, however, usable when clinical situation dictates with the expense of the dose level being twice as much as the lower frame rate cine modes. This work also found that the use of Tin as Iodine replacement for research purposes is inadvisable."

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