Purpose Most children today with bone sarcomas undergo limb-sparing surgery. When treating children younger than 12 years of age, the result is significant limb length discrepancy (LLD). One of the solutions is the use of an expandable endoprosthesis. Methods A retrospective analysis of 38 skeletally immature patients with bone sarcoma of the lower limb in whom different types of expandable endoprostheses were used from January 1988 to December 2005 were included. All patients were under the age of 14 years. There were 26 osteosarcoma and 12 Ewing's sarcomas. The data collected included the tumor characteristics, the surgical and other treatment modalities, complications and their treatment, and the final LLD and functional results.Results Fifty-five percent of the patients survived and had a mean follow-up of 113 months. All survivors reached skeletal maturity at the time of last follow-up. Seventy-one percent of the survivors had satisfactory function and 29% had a poor result. There were three secondary amputations due to local recurrence. Complications were documented in 58% of patients; the most common was infection that was diagnosed 56 times (primary 16% and secondary 84%). A significant correlation was found between function and final LLD (greater than 5 cm = inferior function), the number of complications, and the number of surgical procedures performed other than prosthesis elongation. The younger the patient was at definitive surgery, the shorter the time it took for the prosthesis to fail. Conclusion In order to improve results, the number of operations must be reduced. This can be achieved by the use of novel non-invasive expandable endoprostheses or biological reconstruction.

Febrile hospitalized pediatric oncology patients, with and without pandemic influenza A/H1N1, had a similar demographic and clinical presentation with a relatively good outcome. This was probably because of early antiviral treatment and possibly because of the relatively low virulence of the virus. Immunization should be encouraged in these patients.

Background: Human resources are essential to the sustainability and scalability of health interventions. A barrier to global cancer efforts has been the scarcity of trained pediatric hematology/oncology (PHO) professionals in low- and middle-income countries (LMIC). Studies highlight this inequity and the need to develop a global PHO workforce through allocation of financial resources, strengthening of healthcare infrastructure, and development of innovative training programs. Ethiopia is the second most populous country in Africa. Because of recent reduction in infant mortality and improved treatment of Malaria and HIV in Ethiopia, non-communicable diseases contribute an increasing proportion of childhood mortality. The annual incidence of pediatric cancer in Ethiopia is estimated to be 6000-8000 cases. Prior to 2013, no dedicated PHO programs existed in Ethiopia, and there was no formal process for training local physicians in PHO. The following intervention aimed to increase local capacity for treating childhood cancer through the creation of a formal two-year PHO fellowship. Strategy: The PHO fellowship program was created by The Aslan Project, a US non-profit led by a group of experts in PHO, pediatric oncology nursing, and pathology with experience practicing in LMIC, in collaboration with Addis Ababa University (AAU). The goal was to provide a robust educational experience for fellows within the existing resource-constrained clinical environment. Tikur Anbessa Specialized Hospital (TASH) was the initial clinical site (in 2013) for the training program with a second at Jimma University Medical Center (JUMC) in 2016. An Aslan clinical director was present throughout the first year at each location. Visiting faculty from the US and Canada provided clinical supervision, on-site didactics, and professional mentorship. The second year of training included a six-month rotation at a high-functioning cancer institution in India. Fellows were expected to complete a scholarly activity, pass a certification exam, and serve as pediatric hematologist-oncologists in Ethiopia for a minimum of two years following training. Outcomes: Since 2013, four physicians completed PHO fellowship based in Ethiopia, with extensive support of local healthcare leadership and visiting faculty. One additional fellow left training prior to completion and one fellow currently is in training. Twenty-three faculty members from 18 Universities made 51 trips to Ethiopia for onsite training of fellows from 2013-2019. Each fellow completed a rotation in India in his/her second year (Tata Memorial Hospital, Mumbai, or TMC Kolkata). Fellowship projects included a comprehensive pediatric cancer unit assessment, safe chemotherapy practices, and the role of diagnostic pathology. The four subspecialty-trained physicians have remained local, two at TASH, one at JUMC, and one returned to Gertrude's Children's Hospital in Nairobi, Kenya. JUMC now supports a 22 bed PHO unit running at 90% capacity with over 300 new diagnoses since August 2016. TASH supports a 26 bed inpatient unit and 16 additional inpatient beds at a nearby oncology center, treating over 600 new patients annually. The fellowship structure has succeeded in training subspecialty physicians to establish PHO care in Ethiopia. Discussion: Developing specialized care in LMIC requires a multifaceted approach, including nursing training, social support, health system buy-in, diagnostic expertise and facility, pharmacy services, and subspecialty physicians. Focusing on physician training for PHO in Ethiopia, we designed a training structure and curriculum to 1) teach resource appropriate medical care, 2) provide sustained clinical mentorship, 3) develop health system leadership skills, and 4) retain physicians to support local pediatric oncology units. Onsite training by visiting faculty was augmented by sending fellows to a mature, middle-income country program and the support of full-time clinical faculty/mentorship for a large portion of the program. Challenges included fellow recruitment, pathologic accuracy, chemotherapy access, nutritional support, and treatment retention. Formal subspecialty PHO training can be implemented in LMIC without established subspecialty physicians, but requires ongoing commitment of administrators, visiting faculty, local universities, and a multidisciplinary team of health professionals. Disclosures Alexander: AbbVie: Other: travel funding.

Purpose: A considerable barrier to global pediatric oncology efforts has been the scarcity and even absence of trained professionals in many low-and middle-income countries, where the majority of children with cancer reside. In 2013, no dedicated pediatric hematology-oncology (PHO) programs existed in Ethiopia despite the estimated annual incidence of 6000-12000 cases. The Aslan Project initiative was established to fill this gap in order to improve pediatric cancer care in Ethiopia. A major objective was to increase subspecialty PHO-trained physicians who were committed to practicing locally and empowered to lead programmatic development.

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