Pediatric cancers are particularly significant due to their uncommon occurrence in children,driven by a variety of underlying factors.Because of their distinct molecular and genetic makeup,which makes early detection ...Pediatric cancers are particularly significant due to their uncommon occurrence in children,driven by a variety of underlying factors.Because of their distinct molecular and genetic makeup,which makes early detection challenging,they are linked to problems.Diagnostic methods like imaging and tissue biopsy are only effective when the tumor has reached a size that can be identified.The liquid biopsy technique,the least intrusive and most convenient diagnostic method,is the subject of this review.It focuses on the significance of single cell analysis in examining uncommon cancer types.The many biomarkers found in bodily fluids and the cancer types they are linked to in children have been assessed,as has the potential route towards early detection and cancer recurrence forecasting.Combining the single cell liquid biopsy with the newest technologies,such as computational and multi-omics approaches,which have improved the efficiency of processing massive and unique genetic data,appears promising.This article discusses on a number of case reports for uncommon pediatric malignancies,such as Neuroblastoma,Medulloblastoma,Wilms Tumor,Rhabdomyosarcoma,Ewing Sarcoma,and Retinoblastoma,as well as their liquid biopsy profiles.Furthermore,the findings raise ethical questions regarding the therapeutic application of the technology as well as possible difficulties related to clinical translation.The likelihood that this single cell liquid biopsy will be clinically validated and eventually used as a routine diagnostic tool for uncommon pediatric cancers will rise with the realistic approach to sensitivity monitoring,specificity upgrading,and optimization.展开更多
A recently published prospective study marks a breakthrough for congenital olfactory disorders in children.The study provides the first long-term,three-year follow-up data,robustly demonstrating the durable efficacy a...A recently published prospective study marks a breakthrough for congenital olfactory disorders in children.The study provides the first long-term,three-year follow-up data,robustly demonstrating the durable efficacy and safety of autologous nasal epithelial stem cell transplantation.This work reveals immense therapeutic potential for a condition traditionally considered untreatable.However,this milestone achievement also presents new challenges.To translate this pioneering therapy from a single-center success to a global standard,multicenter,controlled clinical trials must be initiated immediately.Only through rigorous validation can we ensure its widespread adoption and ultimately bring hope to millions of children worldwide.展开更多
Urinary tract infections(UTIs)are among the most prevalent pediatric bacterial infections,and undertreated episodes may lead to renal scarring,hypertension,or chronic kidney disease.Multidrug-resistant(MDR)Enterobacte...Urinary tract infections(UTIs)are among the most prevalent pediatric bacterial infections,and undertreated episodes may lead to renal scarring,hypertension,or chronic kidney disease.Multidrug-resistant(MDR)Enterobacterales have been increasingly reported in children,with higher rates in Asian and Middle Eastern settings than in high-income countries[1,2].展开更多
The international scientific literature presents still incipient results regarding the management of cancer symptom clusters by oncology nursing,especially in pediatric oncology.This is a promising field of investigat...The international scientific literature presents still incipient results regarding the management of cancer symptom clusters by oncology nursing,especially in pediatric oncology.This is a promising field of investigation for clinical nurses and researchers,and when it is subsidized by medium-range theories,they co-rroborate the diagnoses and interventions of nursing in oncology,enhancing the science of nursing care.This minireview article aims to discuss the utilizing the hospital clowns as a complementary therapy,to enhance quality of life and reduce stress and fatigue in pediatric cancer patients.Overall,the evidence presented so far pointed out that complementary therapy might help improve the quality of life of pediatric cancer patients,and that complementary therapy usage should be part of a health comprehensive care model,delivering therapeutic approaches that might enhance the mind-body during a pediatric cancer patients’life span.The results of scientific investigations by nurses,particularly those linked to the basic sciences,play a critical role in advancing personalized care in pediatric integrative oncology.展开更多
Nanomedicine has evolved significantly over the last decades and expanded its applications in pediatric oncology,which represents a special domain with unique patients and distinct requirements.The need for early canc...Nanomedicine has evolved significantly over the last decades and expanded its applications in pediatric oncology,which represents a special domain with unique patients and distinct requirements.The need for early cancer diagnosis andmore effective and targeted therapies aiming to increase the pediatric patients’survival rates andminimize the treatment-related side effects to survivors is profound.Nanoparticles(NPs)come as a beacon of hope to provide sensitive cancer diagnostic tools and assist contrast agents’transport to the malignant tumors.Besides,NPs could be designed to deliver targeted drugs and genes to tumors,minimizing the medicine-related toxicities.Metal and metal oxide NPs could be exploited as sensitizers to enhance chemotherapy and radiotherapy effects.Future research should emphasize pediatric models to gain secure results about NPs’safety and efficiency for pediatric cancer patients.This review presents the recent studies on the use of NPs in pediatric cancer management and highlights their impact on diagnosis,treatment outcomes,and the quality of life of the survivors.The purpose of this study is to investigate the benefits that may arise from the use of NPs in pediatric oncology,address the potential limitations and challenges,and discuss the needs for future research efforts.展开更多
Objective:This article employs a scoping review methodology,integrates knowledge and information about current pediatric nurses'practices and perceptions regarding family-centered care in pediatric settings.Method...Objective:This article employs a scoping review methodology,integrates knowledge and information about current pediatric nurses'practices and perceptions regarding family-centered care in pediatric settings.Methods:Published articles were retrieved from databases including EBSCO host,PubMed,Springer,Science Direct,Ovid,and CINAHL between 2013 and 2023.Results:The finding shows a better understanding of pediatric nurses'perceptions of family-centered care in association with their clinical settings.However,the evidence indicates that integrating family-centered care components into health care services is difficult and confusing to nurses and is often not implemented in a clinical setting.As evidenced by this review,studies have consistently reported similar results;family-centered care was a good perception and understood by pediatric nurses as a concept but inconsistently used in a daily practice setting.Conclusions:This scoping review is the first phase in promoting a strategic plan to provide educational interventions for pediatric nurses to implement family-centered care in their daily practice settings.It's necessary to recognize pediatric nurses'perceptions and practices concerning family-centered care to provide optimal healthcare services in pediatric settings.展开更多
Upper gastrointestinal(GI)endoscopy is considered an essential procedure in pediatric gastroenterology.It has evolved over many decades into a state where it plays a crucial role in providing diagnostic and therapeuti...Upper gastrointestinal(GI)endoscopy is considered an essential procedure in pediatric gastroenterology.It has evolved over many decades into a state where it plays a crucial role in providing diagnostic and therapeutic advantages across a broad spectrum of diseases.This review examines its role in diagnosing and managing common pediatric GI conditions,emphasizing notable advancements in techniques,clinical use,and future directions.We conducted a detailed literature survey using PubMed,Scopus,and Google Scholar,and English-language articles were reviewed.This review process included the latest articles,guidelines,and conference papers on pediatric and adult upper GI endoscopy.An upper GI endoscopy is imperative in diagnosing many pediatric GI diseases as it enables visualization of the gut mucosa,obtaining mucosal biopsies from suspicious areas or lesions for histological assessment,and selecting an effective management and follow-up plan.New advancements,including high-resolution endoscopy,narrow-band imaging,and confocal laser endomicroscopy,have revolutionized pediatric endoscopy by improving precision and reducing the need for invasive interventions.Furthermore,recent therapeutic developments in the field,such as endoscopic submucosal dissection and endoscopic mucosal resection,are now being utilized to treat preneoplastic lesions or refractory esophageal strictures.However,despite its usefulness,performing this procedure in children is challenging for various reasons,including the need for sedation,anesthesia,and smaller instrument sizes,the unavailability of trained staff,lack of training facilities,and the absence of dedicated endoscopy suites for children.In conclusion,pediatric upper GI endoscopy plays a pivotal role in pediatric gastroenterology,offering both therapeutic and diagnostic benefits.Progress in the field leads to the development of novel techniques that improve overall patient care,such as artificial intelligence in pattern recognition,which enhances lesion detection,predicts premalignant or pre-inflammatory areas,and minimizes investigator-related errors.Additionally,refining protocols and guidelines is essential to improve the safety,efficacy,and precision of upper GI endoscopy,ensuring the best possible care for children.展开更多
The surgical treatment of severe scoliosis and kyphoscoliosis in the pediatric population is complicated and has high morbidity and mortality risks.Severe scoliosis has traditionally been defined by a coronal Cobb ang...The surgical treatment of severe scoliosis and kyphoscoliosis in the pediatric population is complicated and has high morbidity and mortality risks.Severe scoliosis has traditionally been defined by a coronal Cobb angle of greater than 90°or 100°.The usual corrective methods for these patients have been anterior or posterior release and osteotomies using a combined anterior-posterior or posterior-only approach.Many of these patients have pre-existing pulmonary compromise;therefore,an anterior approach is often not reasonable or possible.Acute correction of a deformity may also cause neurologic injury.Halo gravity traction(HGT)allows for progressive,gradual,and sustained correction of the spinal deformity in the coronal,sagittal,and axial planes,leading to a decrease in the amount of correction needed at definitive posterior fusion.This relates to decreased postoperative neurologic deficit and improved pulmonary function.Preoperative HGT has evolved to be the surgical adjunct in the treatment of severe spinal deformity.Indications for HGT,best protocols of application,and optimal duration of traction still lack uniformity;thus,a review of the literature remains relevant and necessary.This review summarizes the existing literature on HGT,including its indications,applications,duration of traction,and associated complications.展开更多
BACKGROUND Although critically ill pediatric patients can benefit from the use of sedation,it can cause side effects and even iatrogenic complications.Since pediatric patients cannot adequately express the intensity o...BACKGROUND Although critically ill pediatric patients can benefit from the use of sedation,it can cause side effects and even iatrogenic complications.Since pediatric patients cannot adequately express the intensity or location of the pain,discriminating the cause of their irritability and agitation can be more complicated than in adults.Thus,sedation therapy for children requires more careful attention.AIM To evaluate the association of the internal parental care protocol and the reduction in pediatric intensive care unit(PICU)postoperatively.METHODS This retrospective cohort study was carried out in the PICU of the tertiary medical center in Kazakhstan.The internal parental care protocol was developed and implemented by critical care team.During the pandemic,restrictions were also placed on parental presence in the PICU.We compare two groups:During restriction and after return to normal.The level of agitation was evaluated using the Richmond Agitation-Sedation Scale.Univariate and multivariate logistic regression analyses were performed to examine associations of parental care with sedation therapy.RESULTS A total of 289 patients were included in the study.Of them,167 patients were hospitalized during and 122 after the restrictions of parental care.In multivariate analysis,parental care was associated with lower odds of prescribing diazepam(odds ratio=0.11,95%confidence interval:0.05-0.25),controlling for age,sex,cerebral palsy,and type of surgery.CONCLUSION The results of this study show that parental care was associated only with decreased odds of prescribing sedative drugs,while no differences were observed for analgesics.展开更多
BACKGROUND The management of pediatric choledocholithiasis is complicated by anatomical constraints and the subsequent risks of conventional therapies requiring external drainage.This case report introduces a novel la...BACKGROUND The management of pediatric choledocholithiasis is complicated by anatomical constraints and the subsequent risks of conventional therapies requiring external drainage.This case report introduces a novel laparoscopic microincision tech-nique at the cystic duct confluence,designed to eliminate T-tube dependence,minimize ductal trauma,and expedite recovery,which are critical priorities for active children.We present this innovation to address unmet pediatric-specific surgical needs and demonstrate its feasibility as a tailored,minimally invasive solution for choledocholithiasis in children.A 12-year-old girl with a 5-year history of recurrent upper abdominal pain was diagnosed with choledocholithiasis,cholelithiasis,and biliary pancreatitis based on imaging and laboratory tests.After failed conservative management,laparo-scopic cholecystectomy with a microincision at the cystic duct confluence enabled choledochoscopic extraction of seven stones without T-tube placement.Primary closure using absorbable sutures with cystic duct confluence preserved biliary integrity.Postoperatively,liver function and amylase levels normalized by day 3,and abdominal ultrasonography confirmed no complications.The patient promptly resumed normal activity with no recurrence observed at the 16-month follow-up visit.This approach avoids external drainage,minimizes ductal manipulation,and optimizes recovery,which are key advantages for pediatric patients.CONCLUSION Microincision at the cystic duct confluence safely eliminates T-tubes,ensures stone clearance,and accelerates pediatric recovery.展开更多
Pediatric liver masses encompass a diverse spectrum of benign and malignant lesions,with distinct patterns based on patient age.Optimal imaging is critical for timely diagnosis,management,and prognosis.This pictorial ...Pediatric liver masses encompass a diverse spectrum of benign and malignant lesions,with distinct patterns based on patient age.Optimal imaging is critical for timely diagnosis,management,and prognosis.This pictorial minireview cate-gorizes pediatric liver masses by age group to guide hepatology and radiology practice,with an emphasis on imaging characteristics.In children from birth to six years of age,the most common liver masses include hepatoblastoma,the most common primary hepatic malignancy in this age group;infantile hemangioma,a benign vascular tumor with a characteristic appearance on imaging;and mesen-chymal hamartoma,a rare developmental lesion.For children older than six years,liver masses are distinct,with hepatocellular carcinoma being the predo-minant malignant lesion.Benign masses such as focal nodular hyperplasia and hepatocellular adenoma also emerge in this age range,often linked to hormonal influences or metabolic disorders.The masses observed across all pediatric age groups include hepatic cysts,choledochal cysts,hydatid cysts,pyogenic and amebic abscesses,tuberculosis,lymphoma,and metastases,each presenting with unique imaging features essential for differential diagnosis.This minireview provides a comprehensive,age-based overview of pediatric liver masses,focusing on clinical presentation and key imaging findings to support accurate diagnosis and optimize management strategies in clinical hepatology,particularly in low resource settings.展开更多
Background of the Study: Femoral shaft fracture is the most common pediatric injury requiring hospitalization. For children less than 5 years old, non-surgical approach is recommended. For pediatric patients 5 - 14 ye...Background of the Study: Femoral shaft fracture is the most common pediatric injury requiring hospitalization. For children less than 5 years old, non-surgical approach is recommended. For pediatric patients 5 - 14 years old, the most common mode of treatment is flexible intramedullary nailing with a known complication of pain at post-op site, inflammatory reaction/bursitis at the entry site, superficial and deep infection, knee synovitis, knee stiffness, leg length discrepancy, proximal nail migration, angulation or malunion, delayed and non-union, implant breakage. This study aims to present a rare complication of a femoral fracture fixed with flexible intramedullary nail. Methodology: We report the outcome of a 12-year-old male with peri implant fracture of the left femur. He underwent removal of plates and screws and subsequently fixed with flexible intramedullary nails. Patient was followed up at 1, 3, 7, and 10 months post-operatively. Varus-valgus, sagittal angulation, and limb shortening were measured pre- and post-operatively. Complications were recorded on each visit. Results: Pre-operative varus angulation was 10˚, pro-curvatum of 55˚ with limb shortening of 4 cm. Postoperatively, varus was maintained to 10˚ but pro-curvatum was corrected to 4˚ and limb shortening was reduced to 1 cm. However, after 1 month the varus angulation increased to 30˚ while maintaining sagittal pro-curvatum. Limb shortening also increased to 2 cm. New bone formation started to appear along the mechanical axis of the left femur which is apparent at 3 months post-op and pro-curvatum increased to 20˚. At 7 and 10 months post-op no signs of union was noted at the fracture site but the callus formation along the mechanical axis gradually matured and appeared as a new femoral shaft. Conclusion: Formation of new bone in response to unstable flexible intramedullary fixation in pediatric femoral shaft fracture is a very rare complication.展开更多
BACKGROUND Knowledge-based systems(KBS)are software applications based on a knowledge database and an inference engine.Various experimental KBS for computerassisted medical diagnosis and treatment were started to be u...BACKGROUND Knowledge-based systems(KBS)are software applications based on a knowledge database and an inference engine.Various experimental KBS for computerassisted medical diagnosis and treatment were started to be used since 70s(VisualDx,GIDEON,DXPlain,CADUCEUS,Internist-I,Mycin etc.).AIM To present in detail the“Electronic Pediatrician(EPed)”,a medical non-machine learning artificial intelligence(nml-AI)KBS in its prototype version created by the corresponding author(with database written in Romanian)that offers a physiopathology-based differential and positive diagnosis and treatment of ill children.METHODS EPed specifically focuses on the physiopathological reasoning of pediatric clinical cases.EPed has currently reached its prototype version 2.0,being able to diagnose 302 physiopathological macro-links(briefly named“clusters”)and 269 pediatric diseases:Some examples of diagnosis and a previous testing of EPed on a group of 34 patients are also presented in this paper.RESULTS The prototype EPed can currently diagnose 269 pediatric infectious and noninfectious diseases(based on 302 clusters),including the most frequent respiratory/digestive/renal/central nervous system infections,but also many other noninfectious pediatric diseases like autoimmune,oncological,genetical diseases and even intoxications,plus some important surgical pathologies.CONCLUSION EPed is the first and only physiopathology-based nml-AI KBS focused on general pediatrics and is the first and only pediatric Romanian KBS addressed to medical professionals.Furthermore,EPed is the first and only nml-AI KBS that offers not only both a physiopathology-based differential and positive disease diagnosis,but also identifies possible physiopathological“clusters”that may explain the signs and symptoms of any child-patient and may help treating that patient physiopathologically(until a final diagnosis is found),thus encouraging and developing the physiopathological reasoning of any clinician.展开更多
Photon-counting computed tomography(PCCT)represents a significant advancement in pediatric cardiovascular imaging.Traditional CT systems employ energy-integrating detectors that convert X-ray photons into visible ligh...Photon-counting computed tomography(PCCT)represents a significant advancement in pediatric cardiovascular imaging.Traditional CT systems employ energy-integrating detectors that convert X-ray photons into visible light,whereas PCCT utilizes photon-counting detectors that directly transform X-ray photons into electric signals.This direct conversion allows photon-counting detectors to sort photons into discrete energy levels,thereby enhancing image quality through superior noise reduction,improved spatial and contrast resolution,and reduced artifacts.In pediatric applications,PCCT offers substantial benefits,including lower radiation doses,which may help reduce the risk of malignancy in pediatric patients,with perhaps greater potential to benefit those with repeated exposure from a young age.Enhanced spatial resolution facilitates better visualization of small structures,vital for diagnosing congenital heart defects.Additionally,PCCT’s spectral capabilities improve tissue characterization and enable the creation of virtual monoenergetic images,which enhance soft-tissue contrast and potentially reduce contrast media doses.Initial clinical results indicate that PCCT provides superior image quality and diagnostic accuracy compared to conven-tional CT,particularly in challenging pediatric cardiovascular cases.As PCCT technology matures,further research and standardized protocols will be essential to fully integrate it into pediatric imaging practices,ensuring optimized diagnostic outcomes and patient safety.展开更多
In China pediatric liver transplantation(PLT)has become a safe and standardized procedure.Innovations and measures to further improve long-term survival and quality of life for children should be the next focus.In par...In China pediatric liver transplantation(PLT)has become a safe and standardized procedure.Innovations and measures to further improve long-term survival and quality of life for children should be the next focus.In particular better strategies related to the surgical treatment of high-risk recipients as well as the long-term follow-up of pediatric liver recipients have to be addressed.A particular attention should be given to children presenting significant co-morbidities and those needing retransplantation.A tight mul-tidisciplinary follow-up system addressing both short-and long-term issues of pediatric liver recipients is still a challenge for the Chinese pediatric transplant community.展开更多
BACKGROUND Childhood obesity is a significant public health concern,particularly amongst children with chronic kidney disease requiring kidney transplant(KT).Obesity,defined as a body mass index(BMI)of 30 kg/m^(2) or ...BACKGROUND Childhood obesity is a significant public health concern,particularly amongst children with chronic kidney disease requiring kidney transplant(KT).Obesity,defined as a body mass index(BMI)of 30 kg/m^(2) or greater,is prevalent in this population and is associated with disease progression.While BMI in-fluences adult KT eligibility,its impact on pediatric transplant outcomes remains unclear.This study investigates the effect of BMI on graft survival and patient outcomes,addressing gaps in the literature and examining disparities across BMI classifications.AIM To assess the impact of BMI classifications on graft and patient survival following KT.METHODS A retrospective cohort study analyzed 23081 pediatric transplant recipients from the Standard Transplant Analysis and Research database(1987-2022).Patients were grouped into six BMI categories:Underweight,healthy weight,overweight,and Class 1,2,and 3 obesity.Data were analyzed using one-way way analysis of variance,Kruskal-Wallis tests,Chi-squared tests,Kaplan-Meier survival analysis with log-rank tests,and Cox proportional hazard regressions.Statistical significance was set at P<0.05.RESULTS Class 3 obese recipients had lower 1-year graft survival(88.7%)compared to healthy-weight recipients(93.1%,P=0.012).Underweight recipients had lower 10-year patient survival(81.3%,P<0.05)than healthy-weight recipients.Class 2 and 3 obese recipients had the lowest 5-year graft survival(67.8%and 68.3%,P=0.013)and Class 2 obesity had the lowest 10-year graft survival(40.7%).Cox regression identified increases in BMI category as an independent predictor of graft failure[hazard ratio(HR)=1.091,P<0.001]and mortality(HR=1.079,P=0.008).Obese patients experienced longer cold ischemia times(11.6 and 13.1 hours vs 10.2 hours,P<0.001).Class 3 obesity had the highest proportion of Black recipients(26.2%vs 17.9%,P<0.001).CONCLUSION Severe obesity and underweight status are associated with poorer long-term outcomes in pediatric KT recipients,emphasizing the need for nuanced transplant eligibility criteria addressing obesity-related risks and socioeconomic disparities.展开更多
BACKGROUND Functional gastrointestinal disorders(FGIDs)in children present with chronic symptoms like abdominal pain,diarrhea,and constipation without identifiable structural abnormalities.These disorders are closely ...BACKGROUND Functional gastrointestinal disorders(FGIDs)in children present with chronic symptoms like abdominal pain,diarrhea,and constipation without identifiable structural abnormalities.These disorders are closely linked to gut-brain axis dysfunction,altered gut microbiota,and psychosocial stress,leading to psychia-tric comorbidities such as anxiety,depression,and behavioral issues.Under-standing this bidirectional relationship is crucial for developing effective,holistic management strategies that address physical and mental health.AIM To examine the psychiatric impacts of FGIDs in children,focusing on anxiety and depression and their association with other neurodevelopmental disorders of childhood,such as attention-deficit/hyperactivity disorder,emphasizing the role of the gut-brain axis,emotional dysregulation,and psychosocial stress.Key mechanisms explored include neurotransmitter dysregulation,microbiota imbalance,central sensitization,heightening stress reactivity,emotional dysregulation,and symptom perception.The review also evaluates the role of family dynamics and coping strategies in exacerbating FGID symptoms and contributing to psychiatric conditions.METHODS A narrative review was conducted using 328 studies sourced from PubMed,Scopus,and Google Scholar,covering research published over the past 20 years.Inclusion criteria focused on studies examining FGID diagnosis,gut-brain mechanisms,psychiatric comorbidities,and psychosocial factors in pediatric populations.FGIDs commonly affecting children,including functional constipation,abdominal pain,irritable bowel syndrome,gastroesophageal reflux,and cyclic vomiting syndrome,were analyzed concerning their psychological impacts.RESULTS The review highlights a strong connection between FGIDs and psychiatric symptoms,mediated by gut-brain axis dysfunction,dysregulated microbiota,and central sensitization.These physiological disruptions increase children’s vulnerability to anxiety and depression,while psychosocial factors-such as chronic stress,early-life trauma,maladaptive family dynamics,and ineffective coping strategies-intensify the cycle of gastrointestinal and emotional distress.CONCLUSION Effective management of FGIDs requires a biopsychosocial approach integrating medical,psychological,and dietary interventions.Parental education,early intervention,and multidisciplinary care coordination are critical in mitigating long-term psychological impacts and improving both gastrointestinal and mental health outcomes in children with FGIDs.展开更多
BACKGROUND In pediatric age group patients(<18 years old)treated operatively for distal radius/both bone fractures extending imaging beyond the initial postoperative period-particularly in uncomplicated cases-appea...BACKGROUND In pediatric age group patients(<18 years old)treated operatively for distal radius/both bone fractures extending imaging beyond the initial postoperative period-particularly in uncomplicated cases-appears to provide limited additional benefit.AIM To determine the necessary number of follow-up X-rays to use resources efficiently.METHODS Participants included in this study are pediatric age group patients who were treated operatively for distal radius/both bone fractures and were identified from a prospected collected data from the operating room database between the years 2009 and 2017.The data in the study included patients who had distal radius fractures and underwent fixation surgery(n=88).RESULTS When assessing the difference in the odds of conducting 1 or less X-ray compared to 2 or more X-rays in regard to the type of fixation,the only significant difference is the closed reduction fixation method.Patients who underwent closed reduction method procedure have significantly lower odds of having 2 more X-rays compared to those who didn’t have closed reduction method.Open reduction,internal fixation,and other fixation methods(close reduction and internal fixation,debridement,or epiphysiodesis)have higher odds of having two or more X-rays compared to patients who did not receive these methods;however,these odds are not statistically significant.CONCLUSION The findings of this study reveal notable absence of a statistically significant association between the frequency of postoperative X-rays and the outcome of children with distal radius fractures.展开更多
Pediatric pancreatic tumors,though rare,pose significant diagnostic and manage-ment challenges.The recent,22-year nationwide survey on pediatric pancreatic tumors in Japan by Makita et al offers valuable insights into...Pediatric pancreatic tumors,though rare,pose significant diagnostic and manage-ment challenges.The recent,22-year nationwide survey on pediatric pancreatic tumors in Japan by Makita et al offers valuable insights into this uncommon enti-ty,revealing striking geographical variations and questioning current treatment paradigms.This editorial commentary analyzes the study's key findings,inclu-ding the predominance of solid pseudopapillary neoplasms and their younger age of onset,which contrast sharply with Western data.It explores the implications for clinical practice and research,emphasizing the need for population-specific approaches to diagnosis and treatment.The revealed limited institutional expe-rience and surgical management patterns prompt a reevaluation of optimal care delivery for these complex cases,suggesting benefits of centralizing healthcare services.Furthermore,the commentary advocates for international collaborative studies to elucidate the genetic,environmental,and lifestyle factors influencing the development and progression of pediatric pancreatic tumors across diverse populations.It also outlines future directions,calling for advancements in precision medicine and innovative care delivery models to improve global patient outcomes.Unraveling Makita et al's findings within the broader landscape of pediatric oncology can stimulate further research and clinical advancements in managing pancreatic and other rare tumors in children.展开更多
This editorial discusses the findings of Elbarky et al on the role of selenoprotein P1(SEPP1)in pediatric obesity and insulin resistance.Their study uncovered si-gnificantly lower SEPP1 Levels in children who were obe...This editorial discusses the findings of Elbarky et al on the role of selenoprotein P1(SEPP1)in pediatric obesity and insulin resistance.Their study uncovered si-gnificantly lower SEPP1 Levels in children who were obese compared with hea-lthy peers,demonstrating a negative correlation between SEPP1 levels and mea-sures of adiposity and insulin resistance.These findings suggest that SEPP1 is a biomarker useful in the early identification of insulin resistance in pediatric populations.This editorial emphasizes the clinical implications of the study and calls for further research to validate and explore the role of SEPP1 in metabolic health.展开更多
文摘Pediatric cancers are particularly significant due to their uncommon occurrence in children,driven by a variety of underlying factors.Because of their distinct molecular and genetic makeup,which makes early detection challenging,they are linked to problems.Diagnostic methods like imaging and tissue biopsy are only effective when the tumor has reached a size that can be identified.The liquid biopsy technique,the least intrusive and most convenient diagnostic method,is the subject of this review.It focuses on the significance of single cell analysis in examining uncommon cancer types.The many biomarkers found in bodily fluids and the cancer types they are linked to in children have been assessed,as has the potential route towards early detection and cancer recurrence forecasting.Combining the single cell liquid biopsy with the newest technologies,such as computational and multi-omics approaches,which have improved the efficiency of processing massive and unique genetic data,appears promising.This article discusses on a number of case reports for uncommon pediatric malignancies,such as Neuroblastoma,Medulloblastoma,Wilms Tumor,Rhabdomyosarcoma,Ewing Sarcoma,and Retinoblastoma,as well as their liquid biopsy profiles.Furthermore,the findings raise ethical questions regarding the therapeutic application of the technology as well as possible difficulties related to clinical translation.The likelihood that this single cell liquid biopsy will be clinically validated and eventually used as a routine diagnostic tool for uncommon pediatric cancers will rise with the realistic approach to sensitivity monitoring,specificity upgrading,and optimization.
文摘A recently published prospective study marks a breakthrough for congenital olfactory disorders in children.The study provides the first long-term,three-year follow-up data,robustly demonstrating the durable efficacy and safety of autologous nasal epithelial stem cell transplantation.This work reveals immense therapeutic potential for a condition traditionally considered untreatable.However,this milestone achievement also presents new challenges.To translate this pioneering therapy from a single-center success to a global standard,multicenter,controlled clinical trials must be initiated immediately.Only through rigorous validation can we ensure its widespread adoption and ultimately bring hope to millions of children worldwide.
文摘Urinary tract infections(UTIs)are among the most prevalent pediatric bacterial infections,and undertreated episodes may lead to renal scarring,hypertension,or chronic kidney disease.Multidrug-resistant(MDR)Enterobacterales have been increasingly reported in children,with higher rates in Asian and Middle Eastern settings than in high-income countries[1,2].
基金Supported by the Coordination of Improvement of Higher Education Personnel(CAPES)and National Council for Scientific and Technological Development(CNPq),No.311427/2023-5.
文摘The international scientific literature presents still incipient results regarding the management of cancer symptom clusters by oncology nursing,especially in pediatric oncology.This is a promising field of investigation for clinical nurses and researchers,and when it is subsidized by medium-range theories,they co-rroborate the diagnoses and interventions of nursing in oncology,enhancing the science of nursing care.This minireview article aims to discuss the utilizing the hospital clowns as a complementary therapy,to enhance quality of life and reduce stress and fatigue in pediatric cancer patients.Overall,the evidence presented so far pointed out that complementary therapy might help improve the quality of life of pediatric cancer patients,and that complementary therapy usage should be part of a health comprehensive care model,delivering therapeutic approaches that might enhance the mind-body during a pediatric cancer patients’life span.The results of scientific investigations by nurses,particularly those linked to the basic sciences,play a critical role in advancing personalized care in pediatric integrative oncology.
文摘Nanomedicine has evolved significantly over the last decades and expanded its applications in pediatric oncology,which represents a special domain with unique patients and distinct requirements.The need for early cancer diagnosis andmore effective and targeted therapies aiming to increase the pediatric patients’survival rates andminimize the treatment-related side effects to survivors is profound.Nanoparticles(NPs)come as a beacon of hope to provide sensitive cancer diagnostic tools and assist contrast agents’transport to the malignant tumors.Besides,NPs could be designed to deliver targeted drugs and genes to tumors,minimizing the medicine-related toxicities.Metal and metal oxide NPs could be exploited as sensitizers to enhance chemotherapy and radiotherapy effects.Future research should emphasize pediatric models to gain secure results about NPs’safety and efficiency for pediatric cancer patients.This review presents the recent studies on the use of NPs in pediatric cancer management and highlights their impact on diagnosis,treatment outcomes,and the quality of life of the survivors.The purpose of this study is to investigate the benefits that may arise from the use of NPs in pediatric oncology,address the potential limitations and challenges,and discuss the needs for future research efforts.
文摘Objective:This article employs a scoping review methodology,integrates knowledge and information about current pediatric nurses'practices and perceptions regarding family-centered care in pediatric settings.Methods:Published articles were retrieved from databases including EBSCO host,PubMed,Springer,Science Direct,Ovid,and CINAHL between 2013 and 2023.Results:The finding shows a better understanding of pediatric nurses'perceptions of family-centered care in association with their clinical settings.However,the evidence indicates that integrating family-centered care components into health care services is difficult and confusing to nurses and is often not implemented in a clinical setting.As evidenced by this review,studies have consistently reported similar results;family-centered care was a good perception and understood by pediatric nurses as a concept but inconsistently used in a daily practice setting.Conclusions:This scoping review is the first phase in promoting a strategic plan to provide educational interventions for pediatric nurses to implement family-centered care in their daily practice settings.It's necessary to recognize pediatric nurses'perceptions and practices concerning family-centered care to provide optimal healthcare services in pediatric settings.
文摘Upper gastrointestinal(GI)endoscopy is considered an essential procedure in pediatric gastroenterology.It has evolved over many decades into a state where it plays a crucial role in providing diagnostic and therapeutic advantages across a broad spectrum of diseases.This review examines its role in diagnosing and managing common pediatric GI conditions,emphasizing notable advancements in techniques,clinical use,and future directions.We conducted a detailed literature survey using PubMed,Scopus,and Google Scholar,and English-language articles were reviewed.This review process included the latest articles,guidelines,and conference papers on pediatric and adult upper GI endoscopy.An upper GI endoscopy is imperative in diagnosing many pediatric GI diseases as it enables visualization of the gut mucosa,obtaining mucosal biopsies from suspicious areas or lesions for histological assessment,and selecting an effective management and follow-up plan.New advancements,including high-resolution endoscopy,narrow-band imaging,and confocal laser endomicroscopy,have revolutionized pediatric endoscopy by improving precision and reducing the need for invasive interventions.Furthermore,recent therapeutic developments in the field,such as endoscopic submucosal dissection and endoscopic mucosal resection,are now being utilized to treat preneoplastic lesions or refractory esophageal strictures.However,despite its usefulness,performing this procedure in children is challenging for various reasons,including the need for sedation,anesthesia,and smaller instrument sizes,the unavailability of trained staff,lack of training facilities,and the absence of dedicated endoscopy suites for children.In conclusion,pediatric upper GI endoscopy plays a pivotal role in pediatric gastroenterology,offering both therapeutic and diagnostic benefits.Progress in the field leads to the development of novel techniques that improve overall patient care,such as artificial intelligence in pattern recognition,which enhances lesion detection,predicts premalignant or pre-inflammatory areas,and minimizes investigator-related errors.Additionally,refining protocols and guidelines is essential to improve the safety,efficacy,and precision of upper GI endoscopy,ensuring the best possible care for children.
文摘The surgical treatment of severe scoliosis and kyphoscoliosis in the pediatric population is complicated and has high morbidity and mortality risks.Severe scoliosis has traditionally been defined by a coronal Cobb angle of greater than 90°or 100°.The usual corrective methods for these patients have been anterior or posterior release and osteotomies using a combined anterior-posterior or posterior-only approach.Many of these patients have pre-existing pulmonary compromise;therefore,an anterior approach is often not reasonable or possible.Acute correction of a deformity may also cause neurologic injury.Halo gravity traction(HGT)allows for progressive,gradual,and sustained correction of the spinal deformity in the coronal,sagittal,and axial planes,leading to a decrease in the amount of correction needed at definitive posterior fusion.This relates to decreased postoperative neurologic deficit and improved pulmonary function.Preoperative HGT has evolved to be the surgical adjunct in the treatment of severe spinal deformity.Indications for HGT,best protocols of application,and optimal duration of traction still lack uniformity;thus,a review of the literature remains relevant and necessary.This review summarizes the existing literature on HGT,including its indications,applications,duration of traction,and associated complications.
文摘BACKGROUND Although critically ill pediatric patients can benefit from the use of sedation,it can cause side effects and even iatrogenic complications.Since pediatric patients cannot adequately express the intensity or location of the pain,discriminating the cause of their irritability and agitation can be more complicated than in adults.Thus,sedation therapy for children requires more careful attention.AIM To evaluate the association of the internal parental care protocol and the reduction in pediatric intensive care unit(PICU)postoperatively.METHODS This retrospective cohort study was carried out in the PICU of the tertiary medical center in Kazakhstan.The internal parental care protocol was developed and implemented by critical care team.During the pandemic,restrictions were also placed on parental presence in the PICU.We compare two groups:During restriction and after return to normal.The level of agitation was evaluated using the Richmond Agitation-Sedation Scale.Univariate and multivariate logistic regression analyses were performed to examine associations of parental care with sedation therapy.RESULTS A total of 289 patients were included in the study.Of them,167 patients were hospitalized during and 122 after the restrictions of parental care.In multivariate analysis,parental care was associated with lower odds of prescribing diazepam(odds ratio=0.11,95%confidence interval:0.05-0.25),controlling for age,sex,cerebral palsy,and type of surgery.CONCLUSION The results of this study show that parental care was associated only with decreased odds of prescribing sedative drugs,while no differences were observed for analgesics.
文摘BACKGROUND The management of pediatric choledocholithiasis is complicated by anatomical constraints and the subsequent risks of conventional therapies requiring external drainage.This case report introduces a novel laparoscopic microincision tech-nique at the cystic duct confluence,designed to eliminate T-tube dependence,minimize ductal trauma,and expedite recovery,which are critical priorities for active children.We present this innovation to address unmet pediatric-specific surgical needs and demonstrate its feasibility as a tailored,minimally invasive solution for choledocholithiasis in children.A 12-year-old girl with a 5-year history of recurrent upper abdominal pain was diagnosed with choledocholithiasis,cholelithiasis,and biliary pancreatitis based on imaging and laboratory tests.After failed conservative management,laparo-scopic cholecystectomy with a microincision at the cystic duct confluence enabled choledochoscopic extraction of seven stones without T-tube placement.Primary closure using absorbable sutures with cystic duct confluence preserved biliary integrity.Postoperatively,liver function and amylase levels normalized by day 3,and abdominal ultrasonography confirmed no complications.The patient promptly resumed normal activity with no recurrence observed at the 16-month follow-up visit.This approach avoids external drainage,minimizes ductal manipulation,and optimizes recovery,which are key advantages for pediatric patients.CONCLUSION Microincision at the cystic duct confluence safely eliminates T-tubes,ensures stone clearance,and accelerates pediatric recovery.
文摘Pediatric liver masses encompass a diverse spectrum of benign and malignant lesions,with distinct patterns based on patient age.Optimal imaging is critical for timely diagnosis,management,and prognosis.This pictorial minireview cate-gorizes pediatric liver masses by age group to guide hepatology and radiology practice,with an emphasis on imaging characteristics.In children from birth to six years of age,the most common liver masses include hepatoblastoma,the most common primary hepatic malignancy in this age group;infantile hemangioma,a benign vascular tumor with a characteristic appearance on imaging;and mesen-chymal hamartoma,a rare developmental lesion.For children older than six years,liver masses are distinct,with hepatocellular carcinoma being the predo-minant malignant lesion.Benign masses such as focal nodular hyperplasia and hepatocellular adenoma also emerge in this age range,often linked to hormonal influences or metabolic disorders.The masses observed across all pediatric age groups include hepatic cysts,choledochal cysts,hydatid cysts,pyogenic and amebic abscesses,tuberculosis,lymphoma,and metastases,each presenting with unique imaging features essential for differential diagnosis.This minireview provides a comprehensive,age-based overview of pediatric liver masses,focusing on clinical presentation and key imaging findings to support accurate diagnosis and optimize management strategies in clinical hepatology,particularly in low resource settings.
文摘Background of the Study: Femoral shaft fracture is the most common pediatric injury requiring hospitalization. For children less than 5 years old, non-surgical approach is recommended. For pediatric patients 5 - 14 years old, the most common mode of treatment is flexible intramedullary nailing with a known complication of pain at post-op site, inflammatory reaction/bursitis at the entry site, superficial and deep infection, knee synovitis, knee stiffness, leg length discrepancy, proximal nail migration, angulation or malunion, delayed and non-union, implant breakage. This study aims to present a rare complication of a femoral fracture fixed with flexible intramedullary nail. Methodology: We report the outcome of a 12-year-old male with peri implant fracture of the left femur. He underwent removal of plates and screws and subsequently fixed with flexible intramedullary nails. Patient was followed up at 1, 3, 7, and 10 months post-operatively. Varus-valgus, sagittal angulation, and limb shortening were measured pre- and post-operatively. Complications were recorded on each visit. Results: Pre-operative varus angulation was 10˚, pro-curvatum of 55˚ with limb shortening of 4 cm. Postoperatively, varus was maintained to 10˚ but pro-curvatum was corrected to 4˚ and limb shortening was reduced to 1 cm. However, after 1 month the varus angulation increased to 30˚ while maintaining sagittal pro-curvatum. Limb shortening also increased to 2 cm. New bone formation started to appear along the mechanical axis of the left femur which is apparent at 3 months post-op and pro-curvatum increased to 20˚. At 7 and 10 months post-op no signs of union was noted at the fracture site but the callus formation along the mechanical axis gradually matured and appeared as a new femoral shaft. Conclusion: Formation of new bone in response to unstable flexible intramedullary fixation in pediatric femoral shaft fracture is a very rare complication.
文摘BACKGROUND Knowledge-based systems(KBS)are software applications based on a knowledge database and an inference engine.Various experimental KBS for computerassisted medical diagnosis and treatment were started to be used since 70s(VisualDx,GIDEON,DXPlain,CADUCEUS,Internist-I,Mycin etc.).AIM To present in detail the“Electronic Pediatrician(EPed)”,a medical non-machine learning artificial intelligence(nml-AI)KBS in its prototype version created by the corresponding author(with database written in Romanian)that offers a physiopathology-based differential and positive diagnosis and treatment of ill children.METHODS EPed specifically focuses on the physiopathological reasoning of pediatric clinical cases.EPed has currently reached its prototype version 2.0,being able to diagnose 302 physiopathological macro-links(briefly named“clusters”)and 269 pediatric diseases:Some examples of diagnosis and a previous testing of EPed on a group of 34 patients are also presented in this paper.RESULTS The prototype EPed can currently diagnose 269 pediatric infectious and noninfectious diseases(based on 302 clusters),including the most frequent respiratory/digestive/renal/central nervous system infections,but also many other noninfectious pediatric diseases like autoimmune,oncological,genetical diseases and even intoxications,plus some important surgical pathologies.CONCLUSION EPed is the first and only physiopathology-based nml-AI KBS focused on general pediatrics and is the first and only pediatric Romanian KBS addressed to medical professionals.Furthermore,EPed is the first and only nml-AI KBS that offers not only both a physiopathology-based differential and positive disease diagnosis,but also identifies possible physiopathological“clusters”that may explain the signs and symptoms of any child-patient and may help treating that patient physiopathologically(until a final diagnosis is found),thus encouraging and developing the physiopathological reasoning of any clinician.
文摘Photon-counting computed tomography(PCCT)represents a significant advancement in pediatric cardiovascular imaging.Traditional CT systems employ energy-integrating detectors that convert X-ray photons into visible light,whereas PCCT utilizes photon-counting detectors that directly transform X-ray photons into electric signals.This direct conversion allows photon-counting detectors to sort photons into discrete energy levels,thereby enhancing image quality through superior noise reduction,improved spatial and contrast resolution,and reduced artifacts.In pediatric applications,PCCT offers substantial benefits,including lower radiation doses,which may help reduce the risk of malignancy in pediatric patients,with perhaps greater potential to benefit those with repeated exposure from a young age.Enhanced spatial resolution facilitates better visualization of small structures,vital for diagnosing congenital heart defects.Additionally,PCCT’s spectral capabilities improve tissue characterization and enable the creation of virtual monoenergetic images,which enhance soft-tissue contrast and potentially reduce contrast media doses.Initial clinical results indicate that PCCT provides superior image quality and diagnostic accuracy compared to conven-tional CT,particularly in challenging pediatric cardiovascular cases.As PCCT technology matures,further research and standardized protocols will be essential to fully integrate it into pediatric imaging practices,ensuring optimized diagnostic outcomes and patient safety.
文摘In China pediatric liver transplantation(PLT)has become a safe and standardized procedure.Innovations and measures to further improve long-term survival and quality of life for children should be the next focus.In particular better strategies related to the surgical treatment of high-risk recipients as well as the long-term follow-up of pediatric liver recipients have to be addressed.A particular attention should be given to children presenting significant co-morbidities and those needing retransplantation.A tight mul-tidisciplinary follow-up system addressing both short-and long-term issues of pediatric liver recipients is still a challenge for the Chinese pediatric transplant community.
文摘BACKGROUND Childhood obesity is a significant public health concern,particularly amongst children with chronic kidney disease requiring kidney transplant(KT).Obesity,defined as a body mass index(BMI)of 30 kg/m^(2) or greater,is prevalent in this population and is associated with disease progression.While BMI in-fluences adult KT eligibility,its impact on pediatric transplant outcomes remains unclear.This study investigates the effect of BMI on graft survival and patient outcomes,addressing gaps in the literature and examining disparities across BMI classifications.AIM To assess the impact of BMI classifications on graft and patient survival following KT.METHODS A retrospective cohort study analyzed 23081 pediatric transplant recipients from the Standard Transplant Analysis and Research database(1987-2022).Patients were grouped into six BMI categories:Underweight,healthy weight,overweight,and Class 1,2,and 3 obesity.Data were analyzed using one-way way analysis of variance,Kruskal-Wallis tests,Chi-squared tests,Kaplan-Meier survival analysis with log-rank tests,and Cox proportional hazard regressions.Statistical significance was set at P<0.05.RESULTS Class 3 obese recipients had lower 1-year graft survival(88.7%)compared to healthy-weight recipients(93.1%,P=0.012).Underweight recipients had lower 10-year patient survival(81.3%,P<0.05)than healthy-weight recipients.Class 2 and 3 obese recipients had the lowest 5-year graft survival(67.8%and 68.3%,P=0.013)and Class 2 obesity had the lowest 10-year graft survival(40.7%).Cox regression identified increases in BMI category as an independent predictor of graft failure[hazard ratio(HR)=1.091,P<0.001]and mortality(HR=1.079,P=0.008).Obese patients experienced longer cold ischemia times(11.6 and 13.1 hours vs 10.2 hours,P<0.001).Class 3 obesity had the highest proportion of Black recipients(26.2%vs 17.9%,P<0.001).CONCLUSION Severe obesity and underweight status are associated with poorer long-term outcomes in pediatric KT recipients,emphasizing the need for nuanced transplant eligibility criteria addressing obesity-related risks and socioeconomic disparities.
文摘BACKGROUND Functional gastrointestinal disorders(FGIDs)in children present with chronic symptoms like abdominal pain,diarrhea,and constipation without identifiable structural abnormalities.These disorders are closely linked to gut-brain axis dysfunction,altered gut microbiota,and psychosocial stress,leading to psychia-tric comorbidities such as anxiety,depression,and behavioral issues.Under-standing this bidirectional relationship is crucial for developing effective,holistic management strategies that address physical and mental health.AIM To examine the psychiatric impacts of FGIDs in children,focusing on anxiety and depression and their association with other neurodevelopmental disorders of childhood,such as attention-deficit/hyperactivity disorder,emphasizing the role of the gut-brain axis,emotional dysregulation,and psychosocial stress.Key mechanisms explored include neurotransmitter dysregulation,microbiota imbalance,central sensitization,heightening stress reactivity,emotional dysregulation,and symptom perception.The review also evaluates the role of family dynamics and coping strategies in exacerbating FGID symptoms and contributing to psychiatric conditions.METHODS A narrative review was conducted using 328 studies sourced from PubMed,Scopus,and Google Scholar,covering research published over the past 20 years.Inclusion criteria focused on studies examining FGID diagnosis,gut-brain mechanisms,psychiatric comorbidities,and psychosocial factors in pediatric populations.FGIDs commonly affecting children,including functional constipation,abdominal pain,irritable bowel syndrome,gastroesophageal reflux,and cyclic vomiting syndrome,were analyzed concerning their psychological impacts.RESULTS The review highlights a strong connection between FGIDs and psychiatric symptoms,mediated by gut-brain axis dysfunction,dysregulated microbiota,and central sensitization.These physiological disruptions increase children’s vulnerability to anxiety and depression,while psychosocial factors-such as chronic stress,early-life trauma,maladaptive family dynamics,and ineffective coping strategies-intensify the cycle of gastrointestinal and emotional distress.CONCLUSION Effective management of FGIDs requires a biopsychosocial approach integrating medical,psychological,and dietary interventions.Parental education,early intervention,and multidisciplinary care coordination are critical in mitigating long-term psychological impacts and improving both gastrointestinal and mental health outcomes in children with FGIDs.
文摘BACKGROUND In pediatric age group patients(<18 years old)treated operatively for distal radius/both bone fractures extending imaging beyond the initial postoperative period-particularly in uncomplicated cases-appears to provide limited additional benefit.AIM To determine the necessary number of follow-up X-rays to use resources efficiently.METHODS Participants included in this study are pediatric age group patients who were treated operatively for distal radius/both bone fractures and were identified from a prospected collected data from the operating room database between the years 2009 and 2017.The data in the study included patients who had distal radius fractures and underwent fixation surgery(n=88).RESULTS When assessing the difference in the odds of conducting 1 or less X-ray compared to 2 or more X-rays in regard to the type of fixation,the only significant difference is the closed reduction fixation method.Patients who underwent closed reduction method procedure have significantly lower odds of having 2 more X-rays compared to those who didn’t have closed reduction method.Open reduction,internal fixation,and other fixation methods(close reduction and internal fixation,debridement,or epiphysiodesis)have higher odds of having two or more X-rays compared to patients who did not receive these methods;however,these odds are not statistically significant.CONCLUSION The findings of this study reveal notable absence of a statistically significant association between the frequency of postoperative X-rays and the outcome of children with distal radius fractures.
文摘Pediatric pancreatic tumors,though rare,pose significant diagnostic and manage-ment challenges.The recent,22-year nationwide survey on pediatric pancreatic tumors in Japan by Makita et al offers valuable insights into this uncommon enti-ty,revealing striking geographical variations and questioning current treatment paradigms.This editorial commentary analyzes the study's key findings,inclu-ding the predominance of solid pseudopapillary neoplasms and their younger age of onset,which contrast sharply with Western data.It explores the implications for clinical practice and research,emphasizing the need for population-specific approaches to diagnosis and treatment.The revealed limited institutional expe-rience and surgical management patterns prompt a reevaluation of optimal care delivery for these complex cases,suggesting benefits of centralizing healthcare services.Furthermore,the commentary advocates for international collaborative studies to elucidate the genetic,environmental,and lifestyle factors influencing the development and progression of pediatric pancreatic tumors across diverse populations.It also outlines future directions,calling for advancements in precision medicine and innovative care delivery models to improve global patient outcomes.Unraveling Makita et al's findings within the broader landscape of pediatric oncology can stimulate further research and clinical advancements in managing pancreatic and other rare tumors in children.
文摘This editorial discusses the findings of Elbarky et al on the role of selenoprotein P1(SEPP1)in pediatric obesity and insulin resistance.Their study uncovered si-gnificantly lower SEPP1 Levels in children who were obese compared with hea-lthy peers,demonstrating a negative correlation between SEPP1 levels and mea-sures of adiposity and insulin resistance.These findings suggest that SEPP1 is a biomarker useful in the early identification of insulin resistance in pediatric populations.This editorial emphasizes the clinical implications of the study and calls for further research to validate and explore the role of SEPP1 in metabolic health.
