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Will artificial intelligence widen the therapeutic gap between children and adults?

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pediatric Investigation 2024年第1期8卷 1-6页

作者： Matthew Nagy Bryan Sisk Albert Lai Eric Kodish Cleveland clinic Lerner College of Medicine Case Western Reserve UniversityClevelandOhioUSA Department of pediatrics Division of Hematology/OncologyWashington University School of MedicineSt.LouisMissouriUSA Department of Medicine Bioethics Research CenterWashington University School of MedicineSt.LouisMissouriUSA Institute for Informatics Washington University School of MedicineSt.LouisMissouriUSA Department of pediatric Hematology Oncology and Blood and Marrow Transplantation Cleveland Clinic Children’sClevelandOhioUSA

The impending rise of artificial intelligence(AI)-powered healthcare offers exciting hope for improved care and outcomes in children with serious illnesses.1 The historical precedent in healthcare,however,suggests that advancements in adult care do not necessarily result in proportional progress in *** disparity was first noted in the mid-20th century when tragedies that involved drugs with well-studied and known adult safety profiles,such as sulfonamide elixir and thalidomide,resulted in harm to children due to limited pediatric clinical trial inclusion.2 As a result,legislation in 1962 required drug companies to include package labels that restricted or dissuaded the use of medications in children that were not properly studied in this population.2 Subsequently,physicians became reluctant to prescribe many medications,and pharmaceutical companies had little incentive to enroll children in trials as an unfavorable result could negatively impact sales in the adult market,and a successful outcome would only marginally increase the market pool.3 This lack of access led *** Shirkey to describe children as"therapeutic orphans"in 1968.2 After more than half a century of legislation aimed at increasing pediatric representation in research and drug development(Figure 1),enrollment of children in clinical trials remains disproportionately low,4 with children included in as few as 12%of trials for diseases with a burden equal to,or greater in,the pediatric versus adult population.

关键词： companies Figure properly

Esophageal inserted subclavian catheter:a rare complication

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World Journal of Emergency Medicine 2024年第3期15卷 243-245页

作者： DilberÜçöz Kocaşaban SertaçGüler Emergency Medicine clinic Health Sciences University Ankara Training and Research HospitalAnkara 06930Turkey

Central venous catheterization(CVC) is an invasive procedure for administering fluids,nutrients,and drugs;monitoring central venous pressure;performing pulmonary artery catheterization;and placing transvenous pacemakers in intensive care units and all specialties,from anesthesia to emergency medicine,for the treatment of trauma and hemodynamically unstable pediatric and adult patients.[1,2]Complications have been observed in more than 15% of patients who underwent ***,infectious,and thrombotic complications have been reported in 5%–19%,5%–26%,and 2%–26% of patients,respectively.[3] Malposition,on the other hand,is common in subclavian catheter insertion and is usually associated with an initially misplaced guidewire.[4]

关键词： unstable insertion initially

Outcomes of long-acting injectable antipsychotics use in pregnancy:A literature review

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World Journal of Psychiatry 2024年第4期14卷 582-599页

作者： Ana V Pejčić Srdjan M Stefanović MilošN Milosavljević Vladimir S Janjić Marko M Folić Nevena D Folić Jovana Z Milosavljević Department of Pharmacology and Toxicology Faculty of Medical SciencesUniversity of KragujevacKragujevac 34000Serbia Department of Pharmacy Faculty of Medical SciencesUniversity of KragujevacKragujevac 34000Serbia Department of clinical Pharmacology University Clinical Center KragujevacKragujevac 34000Serbia Department of Psychiatry Faculty of Medical SciencesUniversity of KragujevacKragujevac 34000Serbia clinic for Psychiatry University Clinical Center KragujevacKragujevac 34000Serbia Center for Pharmaceutical and Pharmacological Research Faculty of Medical SciencesUniversity of KragujevacKragujevac 34000Serbia Department of pediatrics Faculty of Medical SciencesUniversity of KragujevacKragujevac 34000Serbia pediatric clinic University Clinical Center KragujevacKragujevac 34000Serbia Department of Anatomy Faculty of Medical SciencesUniversity of KragujevacKragujevac 34000Serbia

BACKGROUND Women with a history of serious psychotic disorders are at increased risk of disease relapse during ***-acting injectable(LAI)antipsychotics have been widely used to improve adherence and prevent relapse in patients with various severe psychotic disorders,but there is a lack of high-quality data from previous research on the safety of LAI antipsychotics during *** To summarize relevant data on maternal,pregnancy,neonatal,and developmental outcomes from published cases of LAI antipsychotic use in *** A literature search was performed through November 11,2023,using three online databases:PubMed/MEDLINE,Scopus,and Web of *** reports or case series that reported information about the outcomes of pregnancy in women who used LAI antipsychotics at any point in pregnancy,with available full texts,were *** statistics,narrative summation,and tabulation of the extracted data were *** A total of 19 publications satisfied the inclusion criteria:3 case series,15 case reports,and 1 conference *** reported the outcomes of LAI antipsychotic use in 74 women and 77 *** use of secondgeneration LAI antipsychotics was reported in the majority(n=47;61.0%)of ***-generation LAI antipsychotics were administered during 30 pregnancies(39.0%).Most of the women(approximately 64%)had either satisfactory control of symptoms or no information about relapse,while approximately 12%of them had developed gestational diabetes mellitus.A minority of cases reported adverse outcomes such as stillbirth,spontaneous abortion,preterm birth,low birth weight,congenital anomalies,and neurological manifestations in ***,there were no reports of negative long-term developmental *** Currently available data seem reassuring,but further well-designed studies are required to properly evaluate the risks and benefits of LAI antipsychotic use during pregnancy.

关键词： Antipsychotic agents Long-acting injectable Pregnancy Outcome Review

Autoantibodies related to ataxia and other central nervous system manifestations of gluten enteropathy

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World Journal of clinical Cases 2024年第12期12卷 2031-2039页

作者： Tsvetelina Velikova Georgi Vasilev Russka Shumnalieva Lyubomir Chervenkov Dimitrina Georgieva Miteva Milena Gulinac Stamatios Priftis Snezhina Lazova Medical Faculty Sofia University"St.Kliment Ohridski"Sofia 1407Bulgaria clinic of Neurology and Department of Emergency Medicine UMHAT"Sv.Georgi"Plovdiv 4000Bulgaria Department of Rheumatology Clinic of RheumatologyUniversity Hospital"St.Ivan Rilski"Medical University-SofiaSofia 1612Bulgaria Department of Diagnostic Imaging Medical University PlovdivPlovdiv 4000Bulgaria Department of Genetics Faculty of BiologySofia University"St.Kliment Ohridski"Sofia 1164Bulgaria Department of General and clinical Pathology Medical University of PlovdivPlovdiv 4002Bulgaria Department of Healthcare Faculty of Public Health“Prof.Tsekomir VodenicharovMDDSc”Medical University of SofiaSofia 1407Bulgaria Department of pediatric University Hospital"N.I.Pirogov"Sofia 1606Bulgaria

Gluten ataxia and other central nervous system disorders could be linked to gluten enteropathy and related *** this narrative review,we focus on the various neuro-logical manifestations in patients with gluten sensitivity/celiac disease,immunological and autoimmune mechanisms of ataxia in connection to gluten sensitivity and the autoantibodies that could be used as a biomarker for diagnosing and *** focused on the anti-gliadin antibodies,antibodies to different isoforms of tissue transglutaminase(TG)(anti-TG2,3,and 6 antibodies),anti-glycine receptor antibodies,anti-glutamine acid decarboxylase antibodies,anti-deamidated gliadin peptides antibodies,*** studies found a higher prevalence of these antibodies in patients with gluten sensitivity and neurological dysfunction,presented as different neurological *** also discuss the role of a gluten-free diet on the clinical improvement of patients and also on imaging of these disorders.

关键词： Gluten ataxia Celiac disease Gluten enteropathy Autoantibodies Anti-gliadin antibodies Anti-bodies to tissue transglutaminase Anti-tissue transglutaminase antibodies Anti-transglutaminase 6 antibodies Anti-glycine receptor antibodies Anti-glutamine acid decarboxylase antibodies

A rare case of cardiac and ophthalmic manifestations of meningococcal septicemia

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World Journal of Emergency Medicine 2024年第4期15卷 328-330页

作者： Svetlana Rachina Anastasia Shchendrygina Heshan Radeesha de Silva Svetlana Tarasenko Nadezhda Mukhina Irina Komarova Ludmila Fedina Elena Burmistrova Elvira Martens Sergey Sidorenko Vladimir Gostev Dmitry Polev Alina Saitova Lyudmila Kraeva Nikita Goncharov Irina Zvetkova Department of Hospital Therapy I M Sechenov First Moscow State Medical UniversityMoscow 119048Russia Outpatient clinic#64 Moscow 119048Russia Department of Cardiology City Clinical Hospital n.a.S.S.YudinMoscow 119048Russia Department of Medical Microbiology and Molecular Epidemiology Pediatric Research and Clinical Center for InfectiousDiseasesSaint Petersburg 197022Russia Department of Medical Microbiology North-Western State Medical University Named After I.I.MechnikovSaintPetersburg 191015Russia Department of Epidemiology Saint-Petersburg Pasteur InstituteSaint Petersburg 197101Russia

Acute pericarditis is usually a self-limiting disorder that commonly occurs due to viral etiology or unexplained *** pericarditis(MP)is a remarkably uncommon clinical entity that manifests as a complication during the acute or convalescent phase of meningococcal ***,its occurrence within the context of meningococcal septicemia has also been *** report a rare case of a previously healthy male patient who developed both acute pericarditis and uveitis as a presentation of meningococcal septicemia,with no characteristic skin rashes or meningeal signs.

关键词： acute Acute rare

Congenital Cervico-Mandibular Cystic Lymphangioma in pediatric Surgical Setting in Guinea

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Open Journal of pediatrics 2024年第1期14卷 164-173页

作者： Thierno Saïdou Barry Mohamed Lamine Sadou Sacko Balla Keita Aissatou Bailo Balde Mamadou Alpha Diallo Moussa Conde Ibrahima Kalil Dioubate Mory Sangare Salamata Sall Mariama Dalanda Diallo Daniel Agbo-Panzo pediatric Surgery Department Donka National Hospital (HND) of Conakry University Hospital (Gamal Abdel Nasser University of Conakry (UGANC) of Guinea) Conakry Guinea Hadja Bilguissou BARRY Medical-Surgical clinic (HBB) Conakry Guinea Albert Royer Children’s Service Cheikh Anta DIOP University (UCAD) Dakar Senegal Surgery Department of the Regional Hospital Center of Ziguinchor (CHRZ) Ziguinchor Senegal

Introduction: Cystic lymphangiomas are rare benign malformative tumors of the lymphatic system of obscure etiopathogenesis. The cervico-facial location remains the most common (75%). Although benign, these tumors remain potentially fatal, due to possible compression of the upper aero-digestive tract. The aim of this work is to study the epidemiological, diagnostic and therapeutic characteristics of cervico-mandibular congenital cystic lymphangiomas in the pediatric surgery department of the Donka National Hospital (HND) Conakry. Patients and methods: This is a retrospective and descriptive study of 13 files lasting 7 years from January 2015 to December 31, 2021. The files of children whose age is less than or equal to 15 years operated on cervical tumor with histological evidence of cystic lymphangioma were retained. The data were analyzed using SPSS statistical software 21 and anonymously. Results: The incidence of this study was 1.86 cases per year and a sex ratio of 0.62 in favor of girls. The average age was 8 months 19 days. In the antecedents, we only find poorly monitored pregnancies. The average size of the tumors was 11.85 cm. Cervical ultrasound and standard x-ray of the cervical mass were the only examinations performed. Total surgical excision of the cervical tumor was performed in all patients. The mass was polycystic on exploration. The histological examination of the surgical specimens was in favor of a cystic lymphangioma. The surgical consequences were simple in 11 patients (84.62%) and complicated by parietal suppuration in 2 cases (15.38%). There were no cases of recurrence after one year of follow-up. Conclusion: Cervico-mandibular cystic lymphangiomas are the most frequent locations of congenital lymphangiomas in children. Their severity is linked to the risk of compression of the aero-digestive tracts. Their diagnosis must be confirmed by the histology of the surgical specimen. Despite the therapeutic arsenal, excision of the cystic mass remain

关键词： Congenital Cystic Lymphangioma (LKC) Child pediatric Surgery Guinea

Exercise Catheterization for Hemodynamic Evaluation of Adults with Coarctation of the Aorta

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Congenital Heart Disease 2022年第6期17卷 605-615页

作者： Irene Martin de Miguel C.Charles Jain Alexander C.Egbe Jason H.Anderson Heidi M.Connolly William R.Miranda Department of Cardiovascular Medicine Mayo ClinicRochesterMinnesotaUSA Department of pediatric and Adolescent Medicine Division of Pediatric CardiologyMayo ClinicRochesterMinnesotaUSA

Background: Coarctation of the aorta (CoA) is associated with a generalized arteriopathy and long-term complicationsdespite repair. Data on invasive exercise hemodynamics in this population are lacking. Accordingly, wereviewed adults with CoA undergoing exercise catheterization to assess 1. hemodynamic profile;2. feasibilityfor assessment of CoA severity. Methods: Twenty patients undergoing exercise cardiac catheterization (12 armadduction and 8 supine cycle ergometry) at a quaternary care center between 2004 and 2021 were identified. Restingand exercise hemodynamic data were abstracted from the procedure logs. Results: Mean age was 43.6 ±12.0 years. Eleven patients (55%) had resting pulmonary arterial wedge pressure (PAWP) >15 mmHg;amongthose undergoing arterial catheterization, left ventricular end-diastolic pressure was >15 mmHg in 63%. Elevenpatients (55%) had pulmonary hypertension: 7 (35%) combined and 4 (20%) isolated post-capillary. At peak exercise,ΔPAWP/Δcardiac output (CO) ≥2 and Δmean pulmonary artery pressure/ΔCO ≥3 mmHg/l/min were foundin 7 (78%) and 6 (67%) patients, respectively;the composite of exercise PAWP ≥25 mmHg or ΔPAWP/ΔCO>2 was seen in 12 (86%). CoA peak-to-peak gradients at baseline (n = 14) and during exercise (n = 9) were 12(3–16) and 16 mmHg (9–28), respectively. Only 2 patients had an increase in CoA gradient to >20 mmHg withexercise. Conclusions: Diastolic dysfunction and pulmonary hypertension were highly prevalent, with exerciseunmasking abnormal diastolic and pulmonary vascular reserve in some individuals. Most patients failed to showsignificant increases in CoA peak-to-peak gradients with exercise. Further studies are warranted to establish thebest diagnostic method for CoA severity assessment.

关键词： Coarctation of the aorta exercise heart catheterization diastolic dysfunction hypertension

Characteristics and trends of pediatric firepit burns: insights for prevention and safety

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World Journal of pediatric Surgery 2024年第1期7卷 54-58页

作者： Maria Fazal Charbel Chidiac Raheel Ahmad Oussama Issa Erica Hodgman Alejandro V Garcia Johns Hopkins School of Medicine BaltimoreMarylandUSA Department of Surgery Division of Pediatric SurgeryJohns Hopkins School of MedicineBaltimoreMarylandUSA Division of the Biological Sciences University of ChicagoChicagoIllinoisUSA School of Medicine American University of BeirutBeirutLebanon

Introduction As fire pits grow in popularity,so do the associated burn *** study examines pediatric fire pit burns characteristics to raise awareness and promote safety *** We conducted a retrospective review of pediatric patients(clinic *** median length of stay was 2 days(IQR=1.0-3.5).The peak months for burns were from August through October(n=40,46.0%),with an increase observed from 10 cases in 2016to 20 cases in *** Given the significant proportion of firepit burns resulting from unsafe fire behaviors,it is crucial that caretakers are aware of proper firepit safety *** ofevidence Il.

关键词： burns admitted prevention

Des-Arg(9)bradykinin as a causal metabolite for autism spectrum disorder

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World Journal of Psychiatry 2024年第1期14卷 88-101页

作者： Zhong-Yu Huang Zi-Pan Lyu Hong-Gui Li Hua-Zhi You Xiang-Na Yang Cai-Hui Cha Center for Medical Research on Innovation and Translation Institute of Clinical MedicineGuangzhou First People’s HospitalSchool of MedicineSouth China University of TechnologyGuangzhou 510000Guangdong ProvinceChina School of Biological Sciences Nanyang Technological UniversityNanyang Ave 639798Singapore Department of pediatrics First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhou 510405Guangdong ProvinceChina Department of Nutrition First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhou 510405Guangdong ProvinceChina Department of pediatric Traditional Chinese Medicine clinic Guangzhou Women and Children's Medical CenterGuangzhou 510632Guangdong ProvinceChina Department of Psychology Guangzhou Women and Children's Medical CenterGuangzhou 510632Guangdong ProvinceChina

BACKGROUND Early diagnosis and therapeutic interventions can greatly enhance the developmental trajectory of children with autism spectrum disorder(ASD).However,the etiology of ASD is not completely *** presence of confounding factors from environment and genetics has increased the difficulty of the identification of diagnostic biomarkers for *** To estimate and interpret the causal relationship between ASD and metabolite profile,taking into consideration both genetic and environmental *** A two-sample Mendelian randomization(MR)analysis was conducted using summarized data from large-scale genome-wide association studies(GWAS)including a metabolite GWAS dataset covering 453 metabolites from 7824 European and an ASD GWAS dataset comprising 18381 ASD cases and 27969 healthy *** in plasma were set as exposures with ASD as the main *** causal relationships were estimated using the inverse variant weight(IVW)*** also performed leave-one-out sensitivity tests to validate the robustness of the *** on the drafted metabolites,enrichment analysis was conducted to interpret the association via constructing a protein-protein interaction network with multi-scale evidence from databases including Infinome,SwissTargetPrediction,STRING,and *** Des-Arg(9)-bradykinin was identified as a causal metabolite that increases the risk of ASD(β=0.262,SE=0.064,P_(IVW)=4.64×10^(-5)).The association was robust,with no significant heterogeneity among instrument variables(P_(MR Egger)=0.663,P_(IVW)=0.906)and no evidence of pleiotropy(P=0.949).Neuroinflammation and the response to stimulus were suggested as potential biological processes mediating the association between Des-Arg(9)bradykinin and *** Through the application of MR,this study provides practical insights into the potential causal association between plasma metabolites and *** findings offer perspectives for the discovery of diagnos

关键词： Des-Arg(9)bradykinin Autism spectrum disorder Mendelian randomization Metabolite Enrichment analysis