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Development of orphan drugs for rare diseases. 开发治疗罕见病的孤儿药。
IF 3.2 Q1 PEDIATRICS Pub Date : 2024-07-01 Epub Date: 2023-06-28 DOI: 10.3345/cep.2023.00535
Han-Wook Yoo

Most rare diseases (orphan diseases) still lack approved treatment options despite major advances in research providing the necessary tools to understand their molecular basis and legislation providing regulatory and economic incentives to expedite the development of specific therapies. Addressing this translational gap is a multifaceted challenge, a key aspect of which is the selection of an optimal therapeutic modality to translate advances in rare disease knowledge to potential medicines known as orphan drugs. There are several strategies for developing orphan drugs for rare genetic disorders, including protein replacement therapies, small-molecule therapies (e.g., substrate reduction, chemical chaperone, cofactor, expression modification, and read-through therapies), monoclonal antibodies, antisense oligonucleotides, small interfering RNA or exon skipping therapies, gene replacement and direct genome-editing therapies, mRNA therapy, cell therapy, and drug repurposing. Each strategy has its own strengths and limitations in orphan drug development. Furthermore, numerous hurdles are present in clinical trials of rare genetic diseases because of difficulty with patient recruitment, unknown molecular physiology, the natural history of the disease, ethical concerns regarding pediatric patients, and regulatory challenges. To address these barriers, the rare genetic diseases community, including academic institutions, industry, patient advocacy groups, foundations, payers, and government regulatory and research organizations, must become engaged in discussions about these issues.

尽管研究取得了重大进展,为了解罕见病(孤儿病)的分子基础提供了必要的工具,立法也为加快开发特定疗法提供了监管和经济激励措施,但大多数罕见病(孤儿病)仍然缺乏经批准的治疗方案。解决这一转化差距是一个多方面的挑战,其中一个关键方面是选择最佳治疗方式,将罕见病知识的进步转化为潜在的药物,即孤儿药。罕见遗传病孤儿药的开发有多种策略,包括蛋白质替代疗法、小分子疗法(如底物还原、化学伴侣、辅助因子、表达修饰和通读疗法)、单克隆抗体、反义寡核苷酸、小干扰 RNA 或外显子跳越疗法、基因替代和直接基因组编辑疗法、mRNA疗法、细胞疗法和药物再利用。在孤儿药开发过程中,每种策略都有其自身的优势和局限性。此外,罕见遗传病的临床试验还存在许多障碍,如患者招募困难、分子生理学未知、疾病的自然史、儿科患者的伦理问题以及监管挑战等。为了解决这些障碍,罕见遗传病社区,包括学术机构、行业、患者权益组织、基金会、付款人以及政府监管和研究组织,必须参与到有关这些问题的讨论中来。
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引用次数: 0
Advancing orphan drug development for rare diseases. 推进罕见病孤儿药开发。
IF 3.2 Q1 PEDIATRICS Pub Date : 2024-07-01 Epub Date: 2023-11-17 DOI: 10.3345/cep.2023.01109
Jung Min Ko
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引用次数: 0
Metabolic complications of obesity in children and adolescents. 儿童和青少年肥胖的代谢并发症。
IF 3.2 Q1 PEDIATRICS Pub Date : 2024-07-01 Epub Date: 2023-11-16 DOI: 10.3345/cep.2023.00892
Hyunjin Park, Jung Eun Choi, Seunghee Jun, Hyelim Lee, Hae Soon Kim, Hye Ah Lee, Hyesook Park

The global prevalence of childhood and adolescent obesity, exacerbated by the coronavirus disease 2019 pandemic, affects school-aged children and preschoolers. Early-onset obesity, which carries a high risk of metabolic complications, may contribute to a lower age at the onset of cardiovascular disease. As metabolic diseases such as diabetes, dyslipidemia, and nonalcoholic fatty liver disease observed in adulthood are increasingly recognized in the pediatric population, there is an emphasis on moving disease susceptibility assessments from adulthood to childhood to enable early detection. However, consensus is lacking regarding the definition of metabolic diseases in children. In response, various indicators such as the pediatric simple metabolic syndrome score, continuous metabolic syndrome score, single-point insulin sensitivity estimator, and fatty liver index have been proposed in several studies. These indicators may aid the early detection of metabolic complications associated with pediatric obesity, although further validation studies are needed. Obesity assessments are shifting in perspective from visual obesity to metabolic health and body composition considerations to fill the gap in health impact assessments. Sarcopenic obesity, defined as the muscle- to-fat ratio, has been proposed in pediatric populations and is associated with metabolic health in children and adolescents. The National Health Screening Program for Children in Korea has expanded but still faces limitations in laboratory testing. These tests facilitate timely intervention by identifying groups at a high risk of metabolic complications. Early detection and intervention through comprehensive health screening are critical for mitigating long-term complications of childhood obesity.

2019冠状病毒病大流行加剧了全球儿童和青少年肥胖的流行,不仅影响到学龄儿童,也影响到学龄前儿童。早发性肥胖,伴随着较高的代谢并发症风险,可能有助于降低心血管疾病(CVD)的发病年龄。随着代谢性疾病如糖尿病、血脂异常和非酒精性脂肪性肝病(NAFLD)越来越多地出现在儿童人群中,人们越来越重视将疾病易感性评估从成年期转移到儿童期,以便早期发现。与成人不同,儿童代谢性疾病的定义缺乏共识。针对此,多项研究提出了儿童单纯代谢综合征评分(PsiMS)、连续代谢综合征评分(cMetS)、单点胰岛素敏感性估计器(SPISE)、脂肪肝指数(FLI)等指标。这些指标可能有助于解释和早期发现与儿童肥胖相关的代谢并发症,尽管还需要更多的有效性研究。与此同时,肥胖评估正从视觉肥胖的角度转向代谢健康和身体成分的考虑,以填补健康影响评估的空白。肌少性肥胖,定义为肌肉与脂肪的比例(MFR),已经提出在儿科人群中,也被发现与儿童和青少年的代谢健康有关。韩国的全国儿童健康检查项目已经扩大,但在实验室检测方面仍面临限制。这些测试通过识别代谢并发症的高危人群,促进及时干预。通过全面健康筛查进行早期发现和干预对于减轻儿童肥胖的长期并发症至关重要。
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引用次数: 0
Use of virtual reality in children in a broad range of medical settings: a systematic narrative review of recent meta-analyses. 在多种医疗环境中对儿童使用虚拟现实技术:对近期荟萃分析的系统性叙述回顾。
IF 4.2 Q1 PEDIATRICS Pub Date : 2024-06-01 Epub Date: 2024-05-21 DOI: 10.3345/cep.2023.00388
Emily Antonovics, Grammatina Boitsios, Thomas Saliba

Virtual reality (VR) is an emerging method that can be used in many scenarios involving children. VR has been increasingly studied as it has become cheaper, more widely available, and of better quality. In this review of current meta-analyses on the use of VR in children in the medical setting, we examined its role in 5 broad settings where it is used to alleviate pain and anxiety as well as in therapeutic scenarios. The study scope was purposefully broad to highlight a wide range of cases. We searched the ScienceDirect, SpringerLink, Cochrane Library, PubMed, and PMC databases for meta-analyses using VR in pediatric populations in medical settings. The National Institutes of Health quality assessment tool and Quality of Reporting of Meta-analyses statement checklist were used to verify study quality. Six hundred fifty-three articles were retrieved; after the application of the inclusion and exclusion criteria, 11 remained. These meta-analyses included cerebral palsy (4 meta-analyses), attention deficit/hyperactivity disorder (2 meta-analyses), burn care (1 meta-analysis), preoperative anxiety (2 meta-analyses), and needle-involving procedures (2 meta-analyses). The meta-analyses showed broadly positive results, with VR being useful in the areas in which it was applied. This study had several limitations. The meta-analyses consistently highlighted a high level of heterogeneity, making it challenging to draw clear conclusions. Most meta-analyses across all fields yielded encouraging results. However, further studies are required to confirm these findings. Guidelines must be established for future experiments to provide a standard and uniform procedure for reducing the heterogeneity of experimental methods.

虚拟现实(VR)是一种新兴的方法,可用于许多涉及儿童的场景。随着虚拟现实技术越来越便宜、越来越普及、质量越来越高,对它的研究也越来越多。在本综述中,我们对目前在医疗环境中儿童使用 VR 的情况进行了荟萃分析,研究了 VR 在 5 种广泛环境中的作用,其中包括用于减轻疼痛和焦虑以及治疗的场景。我们特意扩大了研究范围,以突出广泛的案例。我们在 ScienceDirect、SpringerLink、Cochrane Library、PubMed 和 PMC 数据库中搜索了在医疗环境中对儿科人群使用 VR 的荟萃分析。美国国立卫生研究院质量评估工具和荟萃分析报告质量声明核对表被用来验证研究质量。共检索到 653 篇文章;在应用纳入和排除标准后,还剩下 11 篇。这些荟萃分析包括脑瘫(4 项荟萃分析)、注意力缺陷/多动障碍(2 项荟萃分析)、烧伤护理(1 项荟萃分析)、术前焦虑(2 项荟萃分析)和针刺过程(2 项荟萃分析)。荟萃分析结果显示,VR 在其应用的领域中具有广泛的积极意义。这项研究存在一些局限性。荟萃分析始终强调高度的异质性,因此很难得出明确的结论。所有领域的大多数荟萃分析都得出了令人鼓舞的结果。不过,还需要进一步的研究来证实这些结果。必须为今后的实验制定指导原则,为减少实验方法的异质性提供标准和统一的程序。
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引用次数: 0
Effectiveness of online responsive teaching in young children with developmental disabilities: a pilot study. 在线响应式教学对发育障碍幼儿的有效性:一项试点研究。
IF 4.2 Q1 PEDIATRICS Pub Date : 2024-06-01 Epub Date: 2024-05-21 DOI: 10.3345/cep.2023.01662
Jung Sook Yeom, Jeongmee Kim

Background: Responsive teaching (RT) interventions, which enhance developmental outcomes by improving children's engagement behaviors, are traditionally delivered in person. However, the coronavirus disease 2019 pandemic complicated this approach.

Purpose: This study aimed to evaluate the efficacy and acceptance of online RT in children with developmental disabilities and their parents.

Methods: This pilot study was conducted in Jinju, South Korea, and enrolled parent-child dyads referred to Gyeongsang National University Hospital for developmental concerns between April and September 2022. The children underwent a comprehensive developmental evaluation. The parents received a 5-session RT intervention via ZOOM on a mostly weekly basis. The first 2 sessions involved child development and RT lectures, while the others involved coaching on 3 of the 66 RT strategies. Problem behaviors, parent-child interactions, and parenting stress were assessed pre- versus postintervention using the Korean versions of the Child Behavior Checklist, Maternal/Child Behavior Rating Scale, and Parent Stress Index 4th Edition Short Form, respectively. Acceptability was evaluated using a self-administered questionnaire.

Results: Of the 30 recruited parent-child pairs, 23 (76%) completed the intervention and assessments. The children (mean age, 2.66±0.86 years) included 12 with language delays, 7 with autism spectrum disorder, and 4 with global delays. Predominantly mothers (96%) participated. Online RT significantly improved pivotal behaviors- including joint attention (P=0.04), cooperation (P=0.01), and affect (P=0.01)-and reduced overall problem behaviors (P=0.04). Parents reported less parenting stress (P=0.01), improved interactive behaviors with increased responsiveness (P<0.01), and decreased directiveness (P<0.01). High satisfaction with online RT interventions was also previously reported.

Conclusion: These findings suggest that online RT can improve children's emotional and behavioral outcomes and maternal interaction styles and reduce parenting stress, offering accessible interventions amid challenges such as limited access and pandemics.

背景:回应式教学(RT)干预措施通过改善儿童的参与行为来提高发展成果,传统上都是亲自进行。目的:本研究旨在评估在线回应式教学干预对发育障碍儿童及其父母的有效性和接受度:这项试点研究在韩国晋州进行,招募了2022年4月至9月期间因发育问题转诊至庆尚大学医院的亲子二人组。孩子们接受了全面的发育评估。父母通过 ZOOM 接受了为期 5 次的 RT 干预,大部分时间为每周一次。前两节课涉及儿童发展和 RT 讲座,其他两节课涉及 66 种 RT 策略中 3 种策略的辅导。问题行为、亲子互动和养育压力分别在干预前和干预后使用韩文版儿童行为检查表、母子行为评定量表和第四版家长压力指数简表进行评估。采用自填式问卷对接受度进行评估:在招募的 30 对亲子中,有 23 对(76%)完成了干预和评估。这些儿童(平均年龄(2.66±0.86)岁)中有 12 名语言发育迟缓儿童、7 名自闭症谱系障碍儿童和 4 名全面发育迟缓儿童。主要由母亲(96%)参与。在线 RT 明显改善了关键行为,包括共同注意(P=0.04)、合作(P=0.01)和情感(P=0.01),并减少了整体问题行为(P=0.04)。家长们报告说,他们的养育压力减少了(P=0.01),互动行为得到了改善,反应能力提高了(P=0.01):这些研究结果表明,在线 RT 可以改善儿童的情绪和行为结果,改善母亲的互动方式,减轻养育压力,从而在交通不便和大流行病等挑战中提供方便的干预措施。
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引用次数: 0
Kisspeptin and DLK1 levels for monitoring treatment of girls with central precocious puberty. 用于监测中枢性性早熟女孩治疗的 Kisspeptin 和 DLK1 水平。
IF 4.2 Q1 PEDIATRICS Pub Date : 2024-06-01 Epub Date: 2024-05-21 DOI: 10.3345/cep.2023.01361
Witchuwan Onsoi, Nattakarn Numsriskulrat, Suphab Aroonparkmongkol, Vichit Supornsilchai, Khomsak Srilanchakon

Background: Kisspeptin and delta-like 1 homolog (DLK1) are neuropeptides that reportedly play an important role in pubertal timing by activating and inhibiting the hypothalamic-pituitary-gonadal axis, respectively. Consequently, serum kisspeptin and DLK1 levels may be novel biomarkers for differentiating between central precocious puberty (CPP) and premature thelarche (PT) in girls and used to monitor CPP treatment.

Purpose: To compare baseline serum kisspeptin and DLK1 levels in girls with CPP at diagnosis and after treatment to age-matched girls with PT.

Methods: This prospective longitudinal study included girls with precocious puberty and girls with PT who experienced breast development before 8 years of age and peak luteinizing hormone levels of ≥6 versus <6 IU/L after a gonadotropin-releasing hormone (GnRH) stimulation test. Serum kisspeptin and DLK1 levels were determined in both groups at baseline and after 6 months of GnRH analog treatment in the CPP group and analyzed by enzyme-linked immunosorbent assay.

Results: The study divided a total of 48 girls into CPP (n=24; mean age, 7.7±0.7 years) and PT (n=24; mean age, 7.4±0.8 years) groups. The baseline median serum kisspeptin levels were 50.5 pg/mL (range, 38.2-77 pg/mL) and 49.5 pg/mL (range, 39.7-67.6 pg/mL), respectively (P=0.89), while the baseline median serum DLK1 levels were 6.5 ng/mL (range, 5.9-7.5 ng/mL) and 6 ng/mL (4.4-14.4 ng/mL), respectively (P=0.68). After 6 months of GnRH analog treatment in the CPP group, the median serum kisspeptin level was lower (46.4 ng/mL; range, 37.1-60 ng/mL) than that at baseline (P=0.002), while the median serum DLK1 level was higher (7 ng/mL; range, 6.7-8.9) than that at baseline (P=0.002).

Conclusion: Our findings suggest that baseline serum kisspeptin and DLK1 levels are not reliable biomarkers for differentiating between CPP and PT. However, significant changes in serum kisspeptin and DLK1 levels may be used to monitor CPP treatment.

背景:据报道,Kisspeptin和delta-like 1同源物(DLK1)分别通过激活和抑制下丘脑-垂体-性腺轴,在青春期时间上发挥重要作用。因此,血清中的吻肽(kisspeptin)和DLK1水平可能是区分女孩中枢性性早熟(CPP)和早熟(PT)的新型生物标志物,并可用于监测CPP的治疗情况。目的:比较CPP女孩在诊断时和治疗后的血清吻肽(kisspeptin)和DLK1基线水平,以及PT女孩与年龄匹配者的血清吻肽(kisspeptin)和DLK1水平:这项前瞻性纵向研究纳入了8岁前乳房发育且黄体生成素峰值水平≥6的性早熟女孩和PT女孩:研究将 48 名女孩分为 CPP 组(24 人;平均年龄为 7.7±0.7 岁)和 PT 组(24 人;平均年龄为 7.4±0.8 岁)。基线中位血清Kisspeptin水平分别为50.5 pg/mL(范围:38.2-77 pg/mL)和49.5 pg/mL(范围:39.7-67.6 pg/mL)(P=0.89),而基线中位血清DLK1水平分别为6.5 ng/mL(范围:5.9-7.5 ng/mL)和6 ng/mL(4.4-14.4 ng/mL)(P=0.68)。CPP组患者在接受6个月的GnRH类似物治疗后,血清kisspeptin的中位水平(46.4 ng/mL;范围:37.1-60 ng/mL)低于基线水平(P=0.002),而血清DLK1的中位水平(7 ng/mL;范围:6.7-8.9)高于基线水平(P=0.002):我们的研究结果表明,基线血清kisspeptin和DLK1水平并不是区分CPP和PT的可靠生物标志物。然而,血清吻肽和DLK1水平的明显变化可用于监测CPP的治疗。
{"title":"Kisspeptin and DLK1 levels for monitoring treatment of girls with central precocious puberty.","authors":"Witchuwan Onsoi, Nattakarn Numsriskulrat, Suphab Aroonparkmongkol, Vichit Supornsilchai, Khomsak Srilanchakon","doi":"10.3345/cep.2023.01361","DOIUrl":"10.3345/cep.2023.01361","url":null,"abstract":"<p><strong>Background: </strong>Kisspeptin and delta-like 1 homolog (DLK1) are neuropeptides that reportedly play an important role in pubertal timing by activating and inhibiting the hypothalamic-pituitary-gonadal axis, respectively. Consequently, serum kisspeptin and DLK1 levels may be novel biomarkers for differentiating between central precocious puberty (CPP) and premature thelarche (PT) in girls and used to monitor CPP treatment.</p><p><strong>Purpose: </strong>To compare baseline serum kisspeptin and DLK1 levels in girls with CPP at diagnosis and after treatment to age-matched girls with PT.</p><p><strong>Methods: </strong>This prospective longitudinal study included girls with precocious puberty and girls with PT who experienced breast development before 8 years of age and peak luteinizing hormone levels of ≥6 versus <6 IU/L after a gonadotropin-releasing hormone (GnRH) stimulation test. Serum kisspeptin and DLK1 levels were determined in both groups at baseline and after 6 months of GnRH analog treatment in the CPP group and analyzed by enzyme-linked immunosorbent assay.</p><p><strong>Results: </strong>The study divided a total of 48 girls into CPP (n=24; mean age, 7.7±0.7 years) and PT (n=24; mean age, 7.4±0.8 years) groups. The baseline median serum kisspeptin levels were 50.5 pg/mL (range, 38.2-77 pg/mL) and 49.5 pg/mL (range, 39.7-67.6 pg/mL), respectively (P=0.89), while the baseline median serum DLK1 levels were 6.5 ng/mL (range, 5.9-7.5 ng/mL) and 6 ng/mL (4.4-14.4 ng/mL), respectively (P=0.68). After 6 months of GnRH analog treatment in the CPP group, the median serum kisspeptin level was lower (46.4 ng/mL; range, 37.1-60 ng/mL) than that at baseline (P=0.002), while the median serum DLK1 level was higher (7 ng/mL; range, 6.7-8.9) than that at baseline (P=0.002).</p><p><strong>Conclusion: </strong>Our findings suggest that baseline serum kisspeptin and DLK1 levels are not reliable biomarkers for differentiating between CPP and PT. However, significant changes in serum kisspeptin and DLK1 levels may be used to monitor CPP treatment.</p>","PeriodicalId":36018,"journal":{"name":"Clinical and Experimental Pediatrics","volume":" ","pages":"296-302"},"PeriodicalIF":4.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11150982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141076863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Importance of pediatrician's role in preventing positional plagiocephaly. 儿科医生在预防位置性头畸形中的重要作用。
IF 4.2 Q1 PEDIATRICS Pub Date : 2024-06-01 Epub Date: 2024-05-21 DOI: 10.3345/cep.2023.01025
Hee-Jeong Kang
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引用次数: 0
Pentraxin 3 as a marker of early-onset neonatal sepsis. 五肽 3 是新生儿早期败血症的标志物。
IF 4.2 Q1 PEDIATRICS Pub Date : 2024-06-01 Epub Date: 2024-05-23 DOI: 10.3345/cep.2024.00409
Safaa ELMeneza, Iman El-Bagoury, Hind Rayes, Amira Hassan
{"title":"Pentraxin 3 as a marker of early-onset neonatal sepsis.","authors":"Safaa ELMeneza, Iman El-Bagoury, Hind Rayes, Amira Hassan","doi":"10.3345/cep.2024.00409","DOIUrl":"10.3345/cep.2024.00409","url":null,"abstract":"","PeriodicalId":36018,"journal":{"name":"Clinical and Experimental Pediatrics","volume":" ","pages":"312-314"},"PeriodicalIF":4.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11150985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141082595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Action-plan and as-needed therapy in allergic rhinitis. 过敏性鼻炎的行动计划和按需治疗。
IF 4.2 Q1 PEDIATRICS Pub Date : 2024-06-01 Epub Date: 2024-05-21 DOI: 10.3345/cep.2023.00654
Hyeon-Jong Yang

Action-plan is a written set of instructions that helps patient manage their symptoms and respond to worsening of their condition. The action-plan usually includes information on how to recognize, treat, and prevent worsening of symptoms. The plan also helps patient understand when to use their medications, how much to use, and how often to use them as-needed. An action-plan should be developed through a discussion between the patient and the physician, reflecting the patient's severity, preferences, and values and should be regularly updated to reflect changes in the person's condition. In asthma, action-plans and as-needed therapy are already well utilized. Unlike asthma, the importance of an action-plan has been overlooked in allergic rhinitis (AR), but its importance has recently been recognized. AR is a chronic condition that affects people differently, and can cause a range of symptoms, including nasal congestion, runny nose, sneezing, itching, and watery eyes. Therefore, an action-plan and as-needed therapy can help patients manage these symptoms more effectively, reducing the impact on their daily activities and quality of life. Furthermore, it can be tailored to meet the personal needs of each patient, based on the severity of their symptoms, their triggers, and their overall health. Because action-plan can help patients adhere to their treatment regimen by providing clear instructions on when and how to take medication, it can help patients stay on track with their treatment, reducing the likelihood of missed doses and treatment failures. Overall, an action-plan and as-needed therapy are important components of a comprehensive treatment plan for patients with AR. They can help to improve symptom control, prevent complications, and promote adherence to treatment, leading to better outcomes and a higher quality of life.

行动计划是一套书面说明,用于帮助患者控制症状和应对病情恶化。行动计划通常包括如何识别、治疗和预防症状恶化的信息。该计划还能帮助患者了解何时用药、用药量以及按需用药的频率。行动计划应通过患者与医生之间的讨论制定,反映患者的严重程度、偏好和价值观,并应定期更新,以反映患者病情的变化。在哮喘病中,行动计划和按需治疗已经得到了很好的应用。与哮喘不同,行动计划在过敏性鼻炎(AR)中的重要性一直被忽视,但最近其重要性已得到认可。过敏性鼻炎是一种慢性疾病,对人的影响各不相同,可引起一系列症状,包括鼻塞、流鼻涕、打喷嚏、瘙痒和流眼泪。因此,行动计划和按需治疗可以帮助患者更有效地控制这些症状,减少对日常活动和生活质量的影响。此外,还可以根据每位患者的症状严重程度、诱发因素和整体健康状况,为其量身定制个性化的治疗方案。由于行动计划可以通过提供明确的服药时间和方法指导来帮助患者坚持治疗,因此可以帮助患者坚持治疗,减少漏服药物和治疗失败的可能性。总之,行动计划和按需治疗是 AR 患者综合治疗计划的重要组成部分。它们有助于改善症状控制、预防并发症和促进坚持治疗,从而获得更好的治疗效果和更高的生活质量。
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引用次数: 0
Iron deficiency in children with a focus on inflammatory conditions. 以炎症为重点的儿童铁缺乏症。
IF 4.2 Q1 PEDIATRICS Pub Date : 2024-06-01 Epub Date: 2024-05-21 DOI: 10.3345/cep.2023.00521
Na Hee Lee

Iron deficiency (ID) tends to be overlooked compared with anemia. However, its prevalence is estimated to be twice as high as that of ID anemia, and ID without anemia can be accompanied by clinical and functional impairments. The symptoms of ID are nonspecific, such as fatigue and lethargy, but can lead to neurodevelopmental disorders in children, restless legs syndrome, and recurrent infections due to immune system dysregulation. In particular, the risk of ID is high in the context of chronic inflammatory diseases (CIDs) due to the reaction of various cytokines and the resulting increase in hepcidin levels; ID further exacerbates these diseases and increases mortality. Therefore, the diagnosis of ID should not be overlooked through ID screening especially in high-risk groups. Ferritin and transferrin saturation levels are the primary laboratory parameters used to diagnose ID. However, as ferritin levels respond to inflammation, the diagnostic criteria differ among guidelines. Therefore, new tools and criteria for accurately diagnosing ID should be developed. Treatment can be initiated only with an accurate diagnosis. Oral iron is typically the first-line treatment for ID; however, the efficacy and safety of intravenous iron have recently been recognized. Symptoms improve quickly after treatment, and the prognosis of accompanying diseases can also be improved. This review highlights the need to improve global awareness of ID diagnosis and treatment, even in the absence of anemia, to improve the quality of life of affected children, especially those with CIDs.

与贫血相比,铁缺乏症(ID)往往被忽视。然而,据估计,缺铁性贫血的发病率是缺铁性贫血的两倍,而且不伴有贫血的缺铁性贫血还可能伴有临床和功能障碍。ID 的症状无特异性,如疲倦和嗜睡,但可导致儿童神经发育障碍、不安腿综合征,以及因免疫系统失调而引起的反复感染。特别是在慢性炎症性疾病(CIDs)的情况下,由于各种细胞因子的反应以及由此导致的血磷脂水平升高,ID 的风险很高;ID 会进一步加重这些疾病,并增加死亡率。因此,通过 ID 筛查不应忽视 ID 的诊断,尤其是在高危人群中。铁蛋白和转铁蛋白饱和度是诊断 ID 的主要实验室指标。然而,由于铁蛋白水平会对炎症做出反应,不同指南的诊断标准也不尽相同。因此,应开发新的工具和标准来准确诊断 ID。只有在得到准确诊断后才能开始治疗。口服铁剂通常是治疗 ID 的一线疗法;然而,静脉注射铁剂的有效性和安全性最近已得到认可。治疗后症状会很快改善,伴随疾病的预后也会得到改善。本综述强调,即使在没有贫血的情况下,也有必要提高全球对 ID 诊断和治疗的认识,以改善患儿的生活质量,尤其是 CID 患儿的生活质量。
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引用次数: 0
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Clinical and Experimental Pediatrics
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