Translational pediatrics最新文献

Background: Currently, the exploration of amblyopia treatment methods is gradually shifting to the restoration of binocular visual perceptual function. Binocular fusion function, as an important component of binocular visual function, mainly reflects the patient's ability to integrate the signals received from both eyes. In this study, we investigated the relationship between binocular fusion function and improvement in visual acuity during amblyopia treatment.

Methods: A retrospective analysis was conducted on a cohort of patients with amblyopia, aged 3-14 years old, who visited an outpatient clinic in Shenzhen Eye Hospital between May 2021 and January 2023. The investigation included 105 patients (210 eyes) with isometropic or anisometropic amblyopia. All participants underwent cycloplegic refraction examination and binocular fusion function measurement. All patients underwent standard amblyopia treatment, and those with the best-corrected visual acuity (BCVA) of 0.6 or higher in the amblyopic eye of both eyes received binocular fusion training using a computer platform.

Results: A statistically significant negative correlation (-0.263, P=0.007) was observed between the absolute difference in binocular BCVA and binocular fusion function at the start of treatment (baseline). Linear regression analysis revealed that the improvement in BCVA in the amblyopic eye exhibited correlations with several factors, including the baseline binocular BCVA difference, baseline BCVA of the amblyopic eye, improvement in binocular fusion function, and the number of fusion training sessions (regression coefficients: -0.463, -0.771, 0.007, and 0.063, respectively; all P<0.05). Two patterns of binocular fusion function development during treatment were identified using group-based trajectory modeling (GBTM): the slow growth pattern and the rapid growth pattern. The results of a multivariate logistic regression model indicated a statistically significant link between fusion training and the development pattern of binocular fusion function [odds ratio (OR): 5.219, 95% confidence interval (CI): 2.045-13.323].

Conclusions: Enhancing binocular fusion function may result in an improvement of BCVA in the amblyopic eye of patients with amblyopia. The frequency of binocular fusion training is crucial for rapid improvement in binocular fusion function.

Pediatric and congenital cardiac surgery, characterized by its complexity and high-stakes nature, demands superior technical expertise and multidisciplinary teamwork. With limited surgeons worldwide, the role of continuous skill refinement and collaborative practice is crucial for patient safety and successful outcomes. A literature search was performed using the PubMed, Cochrane, SCOPUS and Web of Science databases for studies published until September 2024. Articles were analysed to summarize findings on the impact of mentorship and teamwork within pediatric and congenital cardiac surgery. This article explores the dual importance of teamwork and mentorship in shaping the next generation of pediatric and congenital cardiac surgeons. The study examines the impact of mentorship on reducing learning curves and improving surgical outcomes whilst highlight the unique challenges faced by surgeons in low-income countries (LICs). Effective mentorship can serve as a bridge between knowledge and practice, ensuring that surgeons in resource-constrained environments can confidently adapt to challenges and improve patient outcomes despite the limited resources. By emphasizing a culture of innovation and collaborative teamwork, pediatric and congenital cardiac surgery continues to achieve increasingly better patient outcomes on a global scale. This study highlights how continuous mentorship and teamwork not only enhance technical proficiency but also drive advancements in surgical techniques and overall care, contributing to the ongoing global progress in pediatric and congenital cardiac surgery.

Background: Leg length discrepancy is a common complication following flexible intramedullary nail (FIN) fixation for femoral shaft fractures in adolescents. This retrospective study was designed to evaluate the possible cause of femoral overlengthening in children with femoral shaft fracture.

Methods: We retrospectively included 138 patients diagnosed with femoral shaft fractures between June 2012 and December 2022 and reported the clinical/radiological outcomes after at least half a year of surgery. We have introduced a new parameter, distal physis growth proportion (DPGP), which can be used to predict the origin of femoral growth.

Results: The mean DPGP value of 138 samples was 50.9%, of which 24 (17.4%) were greater than 70% and 114 (82.6%) were less than 70%. In the group with nail-canal diameter ratio (NCD) values greater than 60%, the proportion of patients with DPGP values exceeding 70% was significantly higher compared to the group with NCD values less than 60%. However, there was no significant difference between gender, fracture side, fracture type, mode of reduction, associated craniocerebral injury or the distance from fracture site to distal articular surface of femur.

Conclusions: In children with femoral shaft fractures treated with FIN fixation, the number of patients with DPGP lesser than 70% far exceeded the number of patients with DPGP greater than 70%, indicating the significant role of fracture end stimulation in femoral lengthening.

Background: Quercetin (QCT) is a bioflavonoid derived from vegetables and fruits that has anti-inflammatory and anti-ferroptosis effects against various diseases. Previous studies have shown that QCT modulates the production of cellular inflammatory factors in asthma models and delays the development of chronic airway inflammation. However, the regulatory mechanism of QCT, a traditional Chinese medicine, in the treatment of asthma has not been elucidated. The aim of the present study is to investigate whether QCT can inhibit ferroptosis via the SIRT1/Nrf2 pathway and play a therapeutic role in asthma.

Methods: An ovalbumin-induced mouse asthma model was established, and its function was verified by hematoxylin eosin staining, enzyme linked immunosorbent assay, ferric ion assay, malondialdehyde and superoxide dismutase assays, dihydroethidium staining, immunohistochemical staining, western blotting, and quantitative real-time polymerase chain reaction.

Results: Our results indicated that an ovalbumin-induced asthma mouse model had been successfully established and that QCT inhibited inflammation, reduced serum levels of inflammatory factors IL-4, IL-5 and IL-13, increased superoxide dismutase levels in lung tissue homogenates, and reduced malondialdehyde and ferric ion production in asthmatic mice. In addition, we found that QCT was able to reverse the expression of SIRT1, Nrf2 and HO-1 in an in vivo asthma mouse model.

Conclusions: The data from this study indicate that QCT can alleviate asthma, and its mechanism is related to the regulation of ferroptosis, oxidative stress, and the expression of SIRT1 protein.

Background: As the incidence of childhood obesity has risen significantly and it can result in many complications in adulthood, this study aimed to provide a new view for early prevention of childhood obesity by detecting the levels of interleukin-6 (IL-6) and chemerin in children and studying the clinical significance.

Methods: We used a case-control design. Serum chemerin and IL-6 levels were measured among 101 participants, including 50 children with obesity and 51 healthy children. Chemerin and IL-6 were correlated with metabolic parameters, and the independent determinants of chemerin and IL-6 were studied by using multivariate linear regression analysis.

Results: The levels of chemerin, IL-6, body mass index (BMI), blood pressure, triglyceride (TG), low-density lipoprotein (LDL), hemoglobin A1c (HbA1c), Fins, C-peptide, homeostasis model assessment of insulin resistance (HOMA-IR), aspartate aminotransferase (AST), alanine aminotransferase (ALT), uric acid and creatinine were significantly increased in children with obesity (P<0.05). While, the levels of high-density lipoprotein (HDL) in the obese group were remarkably lower (P<0.05). The correlative analysis showed that serum chemerin and IL-6 were positively correlated with BMI, Fins, C-peptide, HOMA-IR, and AST, and chemerin was also positively correlated with systolic blood pressure, ALT, and IL-6 (P<0.05). Multivariate linear regression analysis showed that IL-6 was the independent determinant of chemerin.

Conclusions: The elevated levels of serum chemerin and IL-6 in children with obesity were positively correlated with multiple metabolic indicators, suggesting that chemerin and IL-6 may be involved in the occurrence of childhood obesity and its complications, and were expected to become early warning metabolic risk predictors.

Background: Pectus excavatum (PE) is the most common chest wall deformity, characterized by an insidious onset, gradual progression, and challenges in early diagnosis. It is often accompanied by emaciation and distinctive metabolic traits, which may provide valuable insights into its internal physiological and biochemical mechanisms. Our study attempted to screen out biomarkers by identifying the metabolic characteristics of PE, and the results provide a scientific basis for the early diagnosis of PE.

Methods: Untargeted metabolomic and lipidomic analyses using liquid chromatography-mass spectrometry was conducted on serum samples obtained from 20 patients diagnosed with PE and 30 healthy case-controls. Principal component analysis and partial least squares discriminant analysis were employed to assess the quality of the metabolic profiling and delineate the metabolic differences between the PE and healthy cohorts. Receiver operating characteristic analysis was conducted to evaluate the predictive accuracy of the selected biomarkers. Pathway analysis of the dysregulated metabolites was utilized to elucidate the underlying pathological pathways.

Results: Fourteen metabolites and seven lipids were found to be differentially expressed between patients with PE and healthy controls. Indole-3-acetaldehyde showed potential as a biomarker for PE, with an area under the curve value of 0.94, making it effective in distinguishing patients with PE. Pathway analysis revealed enrichment of several pathological pathways, such as valine, leucine, and isoleucine biosynthesis; sphingolipid metabolism; glycine, serine, and threonine metabolism; and glycerophospholipid metabolism.

Conclusions: In our study, we employed a multiomics approach to comprehensively examine dysregulated serological molecules in PE patients, and the analyses revealed potential biomarkers for early diagnosis and provided information for pathological studies.

The placement of totally implantable venous access ports (TIVAPs) is a critical step in the overall care of pediatric oncohematologic patients. These devices constitute a significant technical challenge and are not free of complications during their placement and use. There is extensive literature concerning placement techniques, including venous cut-down (mainly from the external jugular vein) and venous access through ultrasound-guided puncture (Seldinger technique), usually performed in jugular or subclavian veins. Considering that in chronic patients, especially oncology patients, the preservation of quality central venous accesses is essential, alternatives for peripherally inserted central venous catheters have been proposed. The cephalic vein is a peripheral accessory vein located at the deltopectoral groove and characterized by well-defined surgical landmarks. Although scarce and focused on adult populations, the preceding literature concerning using the cephalic vein for TIVAP placement shows promising results. In this manuscript, I present my experience using this technique in pediatric populations, detailing the necessary preoperative preparation to perform the procedure safely, the technical aspects of its implantation, and the most relevant postoperative considerations. Critical knowledge gaps concerning this technique that warrant further study, such as the role of ultrasound as a predictor of success for cephalic vein cut-down TIVAP placement in pediatric populations, are also discussed.

Background: Segmental chromosome aberrations, defined as presence of aberrations, deletion, or imbalance in the chromosomal arms, have long been considered as a predictor of poor prognosis of patients with neuroblastoma. The objective of this meta-analysis is to quantitively analyze the hazard ratios (HRs) of different whole or segmental chromosome aberrations for overall survival (OS) rate or event-free survival (EFS) rate of patients with neuroblastoma.

Methods: Relevant studies about chromosome, neuroblastoma, predictor, prognosis, and survival published from the inception to April 2023 in the databases of PubMed, Embase, and Web of Science were searched, screened, and reviewed. The risk of bias of included articles was assessed using the Quality In Prognosis Studies tool. Basic characteristics, HRs of long term (>3 years) EFS and OS with 95% confidence intervals (CIs) of included articles were extracted. A random effects model of DerSimonian-Laird was used to analyze the extracted HRs. For studies that did not report HRs, narrative synthesis was used for summarization.

Results: There were 34 (including 14,356 patients) in 844 searched studies finally included for narrative and quantitative analysis. There were 24 articles rated as low risk of bias and 10 articles rated as moderate. Although the results were inconsistent, the pooled effect of HR for 1p loss was 4.46 (1.88-10.59) for EFS and 2.29 (1.26-4.15) for OS; the pooled effect of HR for 17q gain was 4.81 (3.29-7.04) for EFS and 3.98 (2.11-7.54) for OS; the pooled effect of HR for 11q loss was 2.54 (2.32-3.73) for OS. Results of 1p36 loss, 1p22 loss, 11q23 loss, 11q13-q14 gain, 1q gain, 1q22 gain, 2p gain, 3p loss, 4p loss, 14q loss, 14q32 loss, and other segmental chromosome aberrations were also summarized.

Conclusions: 1p loss, 11q loss, and 17q gain were identified as significant independent predictors for long-term OS and EFS of patients with neuroblastoma.

Growth hormone (GH) plays a key role in human growth and development. In addition to promoting height growth, GH affects bone metabolism, bone size, and bone mineral density (BMD) in children and adolescents by affecting bone formation and resorption. Among them, the effect of GH on spinal growth has been widely concerned. Scoliosis is a three-dimensional structural spinal deformity characterized by lateral curvature of one or more segments of the spine accompanied by vertebral rotation and sagittal imbalance. For children with growth hormone deficiency (GHD), whether GH supplementation leads to scoliosis is still controversial. In recent years, numerous scholars have conducted extensive research to investigate the correlation between recombinant human GH replacement therapy and scoliosis, yielding divergent findings with some even presenting contradictory results. This study aims to investigate the impact of GH on spinal growth and explore the association between recombinant human GH replacement therapy and scoliosis by comprehensively reviewing the effects of GH and insulin-like growth factors 1 (IGF-1) on bone metabolism, bone mass, as well as examining the consequences of GHD on bone health. Additionally, we aim to access the influence of recombinant human GH replacement therapy on adolescent idiopathic scoliosis (AIS).