Although acute kidney injury (AKI) is a frequent postoperative complication after liver transplantation, renal function following living-related liver transplantation (LRLT) in infants remains understudied. The aim of this study was to identify the prevalence of AKI and the impact of AKI on outcomes in infant recipients with biliary atresia. We retrospectively reviewed infants who underwent LRLT surgery between January 2018 and January 2021. The primary outcome was the risk of postoperative AKI occurrence in the first 7 postoperative days. A multivariate regression analysis model was used to investigate risk factors for AKI, and the incidence and impacts of AKI on outcomes were analyzed. A total of 98 patients were included in the analysis. AKI occurred in 59 patients (60.2%) within 7 days after surgery. Logistic regression analysis revealed that preoperative transfusion (p < 0.05) and lower serum creatinine (SCr) (p < 0.05) were independent risk factors for AKI. The incidence of serious complications was significantly higher in the AKI group than in the non-AKI group (p < 0.05). The postoperative mechanical ventilation time (p < 0.05) and hospital stay (p = 0.019) were significantly longer in the AKI group. There was no evidence of chronic kidney disease (CKD) in any surviving infants within 1 year after surgery. In conclusion, AKI is common in infant LRLT (60.2%), and preoperative transfusion and lower SCr levels were independently associated with AKI. AKI may be associated with the incidence of serious complications, prolonged use of ventilators, and hospital stays. No CKD occurred within 1 year.
This research meticulously explores the diverse factors influencing the occurrence of Hirschsprung-associated enterocolitis (HAEC) subsequent to surgical interventions for congenital megacolon. Considering that Hirschsprung's Disease (HSCR) management predominantly necessitates excision of the aganglionic intestinal segment, the study specifically delineates the correlation between the extent of the excised intestinal segment and the HAEC risk post-surgery. An analysis of clinical data from 505 patients spanning 2012–2022 enabled a comparison of clinical attributes between patients with and without postoperative HAEC, the application of statistical analyses to identify factors significantly correlating with HAEC, and the determination of independent risk factors via a Logistic regression model. Findings indicate a significant association between preoperative conditions, HSCR variants, and the excised intestinal segment's length with HAEC risk, identifying resection length and albumin levels as independent risk factors. Notably, an increase in resection length by 1 cm correlates with a 9.8% rise in postoperative HAEC risk, whereas a 1 g/L elevation in albumin levels corresponds to a 5.6% risk reduction. Subgroup analyses reaffirm that, across all HSCR variants, an extended resection length significantly elevates HAEC risk. This study underscores the critical roles of albumin levels and the length of the resected intestinal segment as independent risk factors for HAEC post-congenital megacolon surgery, providing essential insights for clinical strategies aimed at mitigating HAEC risk and enhancing patient care outcomes.
Benign convulsions with mild gastroenteritis (CwG) characterized by afebrile seizures that occurred in the acute period of mild gastroenteritis often occur in infancy and toddlers. Until now, it has not been well acknowledged and thereby classified by the International League against Epilepsy (ILAE) as epilepsy syndrome or acute symptomatic seizures (ASS). Thus far, accumulating data suggest that CwG could fit all the mandatory criteria of ASS from the aspects of pathogenesis, clinical manifestations, and outcomes, rather than epilepsy in spite of the rare cases developing epilepsy over time. This review provides a comprehensive picture of this entity aiming to facilitate the pediatricians, particularly for general practitioners, to better recognize this unique entity and, ultimately, to minimize unnecessary evaluation and treatment.
Early postnatal alcohol exposure can have negative impacts on neonatal rat brain development and function. Our research explored the impacts of alcohol exposure from postnatal day 4 to PD9 on Sprague‒Dawley rat pups. Pups were intragastrically administered with either an alcohol milk solution or a pure milk solution twice daily. On PD10, brains were analyzed via histological and biochemical methods. Alcohol exposure led to growth impairment, behavioral abnormalities, and cognitive deficits. It also reduced microglial numbers in the hippocampus while activating the remaining microglia to secrete IL-6. In addition, alcohol induced the upregulation of pro-apoptotic factors and downregulation of the anti-apoptotic protein BCL-2 in the hippocampus by activating the JAK/STAT/SOCS3 signaling pathway. Similar effects were observed in vitro when BV-2 cells were exposed to ethanol and HT-22 cells were exposed to IL-6. The drug AG490, a STAT3 inhibitor, mitigated IL-6-induced JAK/STAT activation and neuronal apoptosis in HT-22 cells. Overall, these findings demonstrate that early-life alcohol exposure triggers an inflammatory microglial response involving the release of IL-6, which activates JAK/STAT signaling, leading to hippocampal neuronal apoptosis and developmental/cognitive impairments. AG490 may disrupt this inflammatory signaling cascade and cause neuronal damage.
The aim of this study is to research the expression of the transient receptor potential canonical channel 3 (TRPC3) in a neonatal hyperoxic lung injury model of bronchopulmonary dysplasia (BPD), and to further investigate the role of the TRPC3/nuclear factor-κB (NF-κB) signaling pathway in hyperoxia-induced BPD by a TRPC3 agonist (GSK1702934A). The hyperoxic lung injury model of BPD was established in Sprague–Dawley neonatal rats. Hematoxylin and eosin (HE) staining and radial alveolar count (RAC) values showed that the hyperoxic lung injury model of BPD was successfully established in the neonatal rats, and pulmonary edema was found in the neonatal rats with BPD. The results of reference transcriptome sequencing, Quantitative real-time PCR (qPCR), and western blot showed lower pulmonary expression of TRPC3 in the BPD group than in the control group. Immunofluorescence showed predominant expression of TRPC3 in airways and pulmonary vessels, and the fluorescence intensity of the BPD group was lower than that of the control group. Lung dry-to-wet weight ratio, HE staining, and RAC value showed that the lung histomorphology significantly improved in the BPD + TRPC3 agonist group compared with the BPD group on day 14 but did not revert to the level of the control group. According to qPCR results, compared with the control group, the expression of NF-κB1 decreased and the expression of NF-κBiz increased in the BPD group, whereas the expression of NF-κBiz decreased in the BPD + TRPC3 agonist group. Therefore, we draw the conclusion that TRPC3 may activate NF-κB by inhibiting NF-κBiz to promote cell proliferation and lung growth and development.
Ultrasonography has begun to be applied to the examination of fractures in recent years owing to its safety, noninvasiveness, portability, and high sensitivity. The subcutaneous soft tissue of children is thinner than that of adults, children's bones have a high level of elasticity and a low level of brittleness, and the pediatric fractures heal quickly and produce more callus, therefore ultrasonography is a more suitable examination in pediatric bone fractures. In this paper, we intend to review the mechanism, performance, and examination effect of ultrasound examination in bone fractures, analyze the advantages and disadvantages between ultrasound imaging and X-ray imaging, and further propose an outlook for the application of ultrasound technology in pediatric bone fractures.
The clinical appearances of Pyogenic granuloma (PG) in children are not as typical as in adults. Meanwhile, skin biopsy is hard to accept for parents in most of time. Therefore, data of PG in children has been deprived. To analyze the dermoscopic features of PG in children in order to improve the efficiency of diagnosis and treatment and to reduce the probability of invasive examination. A single-center retrospective study conducted from 1 January 2022 to 30 August 2022 summarized and analyzed the clinical data and dermoscopic features of patients clinically diagnosed with PG. A total of 36 patients were involved, 61.11% were males, 72.22% occurred in the face. Over 50% patients had the following dermoscopic patterns: reddish homogeneous area (100%), white collarette (91.7%), yellow-white scales (69.4%), vascular structures (52.8%), and white rail lines (55.6%). Regression analysis found that gender and courses of disease had a statistically significant impact on part of the dermoscopic patterns. The proportions of dermoscopic features with yellow-white scales (69.4%), dark red scabs (27.8%), and bleeding (27.8%) in this study were higher than in previous studies (26.7%, 10%, and 10%, respectively). Dermoscope is a practical diagnostic tool for PG in children. It is necessary to consider gender, disease course and lesion locations when PG is diagnosed using dermoscope. The characteristics of yellow-white scales, dark red scabs, and bleeding are the microscopic features that distinguish pediatric patients with PG from adult patients, which should be given special attention to in pediatric patients.
Sleep-related disorders in children can significantly impact children's physical, emotional, and cognitive development and constitute a major source of parental concern. This comprehensive review aims to describe sleep-related disorders commonly encountered in pediatric practice, their etiology, diagnosis, and management strategies. The review explores various disorders prevalent in different age groups, including insomnia, sleep apnea, parasomnias, and circadian rhythm disorders, highlighting the importance of early identification and intervention for optimal child health and well-being.
To investigate the clinical characteristics of febrile infection-related epilepsy syndrome (FIRES). We used trajectory analysis and logistic regression analysis to investigate the clinical characteristics and prognostic risk factors respectively. Twenty-seven patients (16 males) were included. The median age of onset was 7 (IQR: 4–9) years. Routine cerebrospinal fluid (CSF) examination was normal. Electroencephalogram (EEG) showed frequent microseizures and electroseizures in all patients. Eight patients had claustrum signs in the acute phase. Anesthetics and anti-seizure medications (ASM) were used in all patients. All patients received immunotherapy, including plasma exchange (n = 4), immunoglobulin (n = 26), and corticosteroids (n = 19). Trajectory diagrams of seizure showed 6 patients had bimodal disease course. Besides, we found there may be a linear relationship between body temperature and convulsion frequency (R2 = 0.25). The median Glasgow outcome scale (GOS) was 3 (IQR: 1–4). Nine deaths occurred, including abandonment of treatment (n = 3), hemodynamic instability (n = 3), brain hernia (n = 2), and brain hernia with hemodynamic instability (n = 1). Seizure onset combined with fever (p = 0.003), periodic discharge (p = 0.002), and non-ketogenic diet (non-KD) (p = 0.005) were independent risk factors for death. The KD group (n = 10) had lower mortality (p = 0.009), lower convulsion frequency at latest follow-up (p < 0.001), less ASM (p = 0.002), and higher GOS (p < 0.001) than non-KD group (n = 17). Therefore, some FIRES patients may have bimodal disease course. There may be a linear relationship between body temperature and convulsion frequency. Seizure onset combined with fever, periodic discharge and KD may affect the prognosis.
Neuroblastoma (NB) is a common extracranial solid tumor in children, and currently our understanding of the molecular mechanisms underlying tumor progression is not very thorough. In clinical practice, although the prognosis and survival rates of NB patients in the low-risk and medium-risk groups are still acceptable, the prognosis and survival rates of NB patients in the high-risk group are extremely poor. Therefore, improving awareness of NB tumors is crucial for improving the treatment status of NB patients in clinical practice. So we collected common tumor exposure factors and performed multiple Mendelian randomization (MR) analysis on NB, and ultimately determined that the increase in Resting CD4 regulatory T cell was positively correlated with the occurrence and development of NB. In addition, we also used the network pharmacology algorithm proximity to screen the NB chemotherapy drug papain and reasonably speculated that there is an interaction between papain and CD4 regulatory T cell in the chemotherapy of NB patients.