Translational pediatrics最新文献

{"title":"Predictors of using biologics within one year after EEN therapy in pediatric Crohn's disease.","authors":"Xiaoxi Wang, Yudie Hu, Jingan Lou, Youyou Luo, Jindan Yu, Youhong Fang, Lujing Tang, Hong Zhao, Luojia Xu, Kerong Peng, Yao Lv, Jie Chen","doi":"10.21037/tp-2026-0515","DOIUrl":"https://doi.org/10.21037/tp-2026-0515","url":null,"abstract":"<p><strong>Background: </strong>Biologics are commonly used as the second-line medication for maintenance of remission after exclusive enteral nutrition (EEN) induction in pediatric Crohn's disease (CD). However, predictors of using biologics after EEN therapy in CD are yet to be elucidated. This study explores the predictive factors for the application of biologics in children with CD who had finished 8 weeks of EEN induction.</p><p><strong>Methods: </strong>Seventy-five patients were divided into derivation group (n=54) and validation group (n=21). Baseline characteristics were compared between biological group and non-biological group. Univariate and multivariate analyses were performed to correlate 102 laboratory indicators. Finally, binary stepwise logistic regression was used to construct a prediction model.</p><p><strong>Results: </strong>The predictor identified for biologic use in the prediction model was complement C4 and red blood cell distribution width (RDW). Complement C4 [odds ratio (OR) =1.04, 95% confidence interval (CI): 1.01-1.07] and RDW (OR =1.41, 95% CI: 1.05-1.91) were identified as significant independent predictors (P<0.05). Patients with baseline complement C4 levels >0.415 g/L and RDW >13.5% were more likely to use biologics within 1 year after EEN.</p><p><strong>Conclusions: </strong>Complement C4 and RDW are predictors of biologic use within 1 year after EEN-induced clinical remission. Elevated complement C4 and RDW are associated with the use of biologics after induction of remission. However, extensive experimental validation is still required to confirm the above findings.</p>","PeriodicalId":23294,"journal":{"name":"Translational pediatrics","volume":"15 9","pages":"381"},"PeriodicalIF":2.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acyclovir and ganciclovir exposure and short-term outcomes in hospitalized children with EBV-associated mononucleosis-like illness: a retrospective cohort study using inverse probability of treatment weighting.","authors":"Ying Ding, Qinghui Chen, Ruyue Chen, Xiaozhong Li","doi":"10.21037/tp-2026-0517","DOIUrl":"https://doi.org/10.21037/tp-2026-0517","url":null,"abstract":"<p><strong>Background: </strong>Epstein-Barr virus (EBV)-associated mononucleosis-like illness in children involves marked immune activation and variable clinical severity. Although supportive care remains standard for immunocompetent children, acyclovir and ganciclovir are frequently used in hospitalized patients with severe manifestations. However, their real-world effectiveness remains uncertain. This study aimed to characterize real-world antiviral treatment patterns and evaluate the associations of acyclovir and ganciclovir exposure with short-term clinical outcomes in hospitalized children with EBV-associated mononucleosis-like illness.</p><p><strong>Methods: </strong>This single-center retrospective cohort study included 1,059 hospitalized children with EBV-associated mononucleosis-like illness at the Children's Hospital of Soochow University from January 2019 to December 2023. Patients were categorized into no antiviral therapy (n=371), acyclovir (n=526), and ganciclovir (n=162) groups. Eligibility required compatible symptoms, EBV serologic evidence, detectable EBV DNA, atypical lymphocytosis, and acute-phase immunophenotyping. Antiviral exposure was analyzed as a time-varying variable, and stabilized inverse probability of treatment weighting (IPTW) was applied using baseline clinical, laboratory, virological, and immunological variables.</p><p><strong>Results: </strong>Before weighting, antiviral-treated children had greater disease severity, including higher alanine aminotransferase (ALT), aspartate aminotransferase (AST), EBV DNA levels, and CD4/CD8 ratio inversion. After IPTW, covariate balance was achieved [all standardized mean difference (SMD) <0.10]. Median time to defervescence was 5.2, 6.1, and 5.6 days in the no-antiviral, acyclovir, and ganciclovir groups, respectively. IPTW-weighted Cox analysis showed lower fever-resolution hazard with acyclovir [hazard ratio (HR) 0.78, 95% confidence interval (CI): 0.69-0.89], whereas ganciclovir showed no significant association (HR 0.91, 95% CI: 0.76-1.09). The prediction model integrating clinical and immune indicators achieved an area under the curve (AUC) of 0.69.</p><p><strong>Conclusions: </strong>Antiviral use mainly reflected disease severity and was not associated with improved short-term outcomes after adjustment. Supportive care and individualized risk stratification remain important.</p>","PeriodicalId":23294,"journal":{"name":"Translational pediatrics","volume":"15 9","pages":"384"},"PeriodicalIF":2.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655820/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bone marrow kinase X-linked in pulmonary diseases: pathogenic gene, diagnostic biomarker, and treatment target-a narrative review.","authors":"Xiaoxue Gao, Zhixian Gou, Liqun Lu","doi":"10.21037/tp-2026-0648","DOIUrl":"https://doi.org/10.21037/tp-2026-0648","url":null,"abstract":"<p><strong>Background and objective: </strong>Lung-related diseases impose a substantial global health burden, yet effective diagnostic and therapeutic strategies remain limited. Bone marrow kinase X-linked (BMX), a Tec family non-receptor tyrosine kinase, is increasingly recognized as a critical player in pulmonary pathophysiology. This review aims to systematically evaluate BMX's roles in major lung diseases, clarify its mechanisms, assess its biomarker and therapeutic potential, and identify key knowledge gaps.</p><p><strong>Methods: </strong>We searched PubMed, Web of Science, and Scopus up to December 2025 using keywords related to BMX and pulmonary diseases, with additional references identified from article bibliographies.</p><p><strong>Key content and findings: </strong>BMX is implicated in pneumonia, asthma, chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, and lung cancer via PI3K/AKT, MAPK/ERK, NF‑κB, and TGF‑β/Smad pathways, regulating inflammation, fibrosis, cell survival, and metastasis. BMX expression correlates with disease severity and prognosis, supporting its biomarker potential. Preclinical studies show that BMX inhibitors reduce disease severity in animal models, but clinical translation is hampered by lack of specific biomarkers, limited trials, and challenges in selectivity and resistance.</p><p><strong>Conclusions: </strong>This review synthesizes current knowledge on BMX in pulmonary diseases, highlighting its pathogenic, diagnostic, and therapeutic significance. By outlining current gaps and future directions, it provides a foundation for developing BMX‑targeted precision medicine to ultimately improve patient outcomes.</p>","PeriodicalId":23294,"journal":{"name":"Translational pediatrics","volume":"15 9","pages":"390"},"PeriodicalIF":2.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nasal intermittent positive pressure ventilation versus nasal continuous positive airway pressure as initial respiratory support during minimally invasive surfactant therapy in preterm infants with respiratory distress syndrome: a retrospective real-world cohort study.","authors":"Jinzhen Su, Minyi Ruan, Yan Wang, Yao Zhu, Lan Zhang, Minxu Li","doi":"10.21037/tp-2026-0716","DOIUrl":"https://doi.org/10.21037/tp-2026-0716","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Nasal continuous positive airway pressure (NCPAP) and nasal intermittent positive pressure ventilation (NIPPV) are commonly used as initial non-invasive respiratory support in preterm infants with respiratory distress syndrome (RDS). Minimally invasive surfactant therapy (MIST) is increasingly used to reduce exposure to endotracheal intubation, but data on NIPPV compared to NCPAP during MIST remain limited. This study aimed to compare NIPPV and NCPAP as initial respiratory support during MIST in preterm infants with RDS, with the primary outcome of invasive mechanical ventilation within the first 72 h of life.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This single-center, retrospective, real-world cohort study included preterm infants (&lt;37 weeks of gestation) with RDS who received MIST within 6 h after birth between January 2021 and January 2025. Infants were grouped according to the initial mode of non-invasive respiratory support: NIPPV (n=170) or NCPAP (n=130). The primary outcome measure was invasive mechanical ventilation (IMV) within the first 72 h of life. Between-group comparisons, multivariable logistic regression adjusted for gestational age and birth weight, inverse probability of treatment weighting, and gestational-age subgroup analyses were performed. Secondary outcome measures included neonatal morbidities, respiratory-support duration, length of hospital stay, surfactant use, and blood gas changes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Infants in the NIPPV group had lower gestational age (31.37±2.09 &lt;i&gt;vs.&lt;/i&gt; 33.51±1.73 weeks, P&lt;0.001) and birth weight (1.60±0.45 &lt;i&gt;vs.&lt;/i&gt; 1.99±0.47 kg, P&lt;0.001) than those in the NCPAP group. IMV within 72 h occurred in 46/170 infants (27.1%) in the NIPPV group and 24/130 infants (18.5%) in the NCPAP group [unadjusted risk ratio, 1.47; 95% confidence interval (CI): 0.95-2.27; P=0.08]. After adjustment for gestational age and birth weight, the association was not statistically significant (adjusted odds ratio, 0.605; 95% CI: 0.32-1.14; P=0.12), and the inverse-probability-weighted analysis yielded similar results (P=0.10). No gestational-age subgroup showed a significant difference in the primary outcome. Unadjusted rates of BPD and ROP, as well as non-invasive ventilation duration and length of hospital stay, were higher in the NIPPV group, consistent with greater baseline immaturity. Moderate or severe BPD, ROP requiring surgery, NEC, IVH, hsPDA, sepsis, pneumothorax, and repeat surfactant treatment did not differ significantly between groups. Blood gas profiles improved after surfactant treatment in both groups, with no significant post-treatment between-group differences.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In preterm infants with RDS receiving MIST, initial NIPPV and NCPAP were associated with no statistically significant difference in IMV requirement within 72 h after accounting for major baseline imbalances. NIPPV appears to be a feasible alternative to NCPAP in this setting","PeriodicalId":23294,"journal":{"name":"Translational pediatrics","volume":"15 9","pages":"387"},"PeriodicalIF":2.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can we predict who hurts most after pediatric adenotonsillectomy?","authors":"Farrukh R Virani, Adam C Adler","doi":"10.21037/tp-2026-0709","DOIUrl":"10.21037/tp-2026-0709","url":null,"abstract":"","PeriodicalId":23294,"journal":{"name":"Translational pediatrics","volume":"15 9","pages":"396"},"PeriodicalIF":2.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral rehydration salts utilization in pediatric diarrhea management among Chinese pediatricians: a national survey.","authors":"Xinyi Jia, Xiaoyu Chen, Xiaorui He, Zhenya Zhu, Ziyu Liu, Diya Ye, Fei Gao, Qiancheng Xu, Wei Zheng, Sitang Gong, Baoxi Wang, Jie Wu, Xiwei Xu, Lanlan Geng, Mizu Jiang","doi":"10.21037/tp-2026-0477","DOIUrl":"https://doi.org/10.21037/tp-2026-0477","url":null,"abstract":"<p><strong>Background: </strong>Oral rehydration salts (ORS) are essential for pediatric diarrhea management. However, not all children with diarrhea receive standardized ORS therapy. This study aimed to assess ORS utilization in the management of pediatric diarrhea among pediatricians in China and to identify factors associated with their ORS prescribing practices.</p><p><strong>Methods: </strong>A nationwide cross-sectional survey was conducted among 1,788 pediatricians participating in diarrhea training programs across China between August 2021 and April 2023. Data on demographics, professional characteristics, and ORS practices were collected. Chi-squared tests and logistic regression were used.</p><p><strong>Results: </strong>The overall ORS recommendation rate was 85.96%, with significant regional variation (highest: Central South China, 90.22%; lowest: Northeast China, 77.55%). Only 60.57% of pediatricians preferred reduced osmolarity ORS, with the lowest usage in Northwest China (41.73%). Furthermore, 36.81% used ORS only when the child was already dehydrated, 18.12% mistakenly believed that ORS was restricted to oral administration (rising to 25.52% in North China), and 42.51% incorrectly believed that ORS was exclusively for treating diarrhea (reaching 55.65% in North China). Although 98.61% provided guidance to parents, 21.87% incorrectly supported adding fruit juice or milk to ORS. Multiple logistic regression identified higher professional titles and specialization in pediatric gastroenterology as significant predictors of appropriate ORS prescribing practices.</p><p><strong>Conclusions: </strong>Deficits exist in the knowledge and practice of ORS in China, especially in specific regions and among certain pediatricians. Future targeted and specific pediatric diarrhea training programs may contribute to more standardized treatment of pediatric diarrhea.</p>","PeriodicalId":23294,"journal":{"name":"Translational pediatrics","volume":"15 9","pages":"380"},"PeriodicalIF":2.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for plastic bronchitis complicating severe <i>Mycoplasma pneumoniae</i> pneumonia in children and development of a machine learning-based predictive model.","authors":"Kun Jiang, Silei Yan, Haoxiang Gu, Liling Qian","doi":"10.21037/tp-2026-0579","DOIUrl":"https://doi.org/10.21037/tp-2026-0579","url":null,"abstract":"<p><strong>Background: </strong>Plastic bronchitis (PB) is a rare but life-threatening complication of severe <i>Mycoplasma pneumoniae</i> pneumonia (SMPP) in children, and effective tools for its early prediction remain limited. This study aimed to identify risk factors for PB complicating SMPP and develop a machine learning-based predictive model.</p><p><strong>Methods: </strong>This retrospective cohort study included 166 children (aged 1-14 years) with SMPP admitted between January 2022 and December 2024. Patients were classified into PB (n=51) and non-PB (n=115) groups based on bronchoscopy and randomly split into training and validation sets (7:3 ratio). Eight machine learning algorithms were developed and evaluated based on the area under the receiver operating characteristic curve (AUC), precision-recall curve (PRC), decision curve analysis (DCA), accuracy, and F1-score. The optimal model was selected and interpreted using SHapley Additive exPlanations (SHAP). Candidate risk factors were identified and further analyzed using multivariable logistic regression to develop a nomogram. The predictive model was assessed using both sets and further validated by bootstrap resampling.</p><p><strong>Results: </strong>Generalized linear model (GLM) achieved the highest performance [AUC: 0.951, cross-validation AUC: 0.915, accuracy 0.880, F1-score: 0.825, area under the precision-recall curve (AUPRC): 0.856] in the training set, representing the optimal model. Fever duration, serum prealbumin, and D-dimer were the most influential features in SHAP analysis. Multivariable analysis confirmed these as independent risk factors: fever duration [odds ratio (OR): 1.550, 95% confidence interval (CI): 1.297-1.908, P<0.001], prealbumin (OR: 0.959, 95% CI: 0.939-0.976, P<0.001), and D-dimer (OR: 1.723, 95% CI: 1.157-2.627, P=0.009). The nomogram exhibited acceptable discriminative ability [C-index: 0.933 (95% CI: 0.887-0.980) in the training set; 0.831 (95% CI: 0.717-0.946) in the validation set; 0.913 (95% CI: 0.869-0.957) in bootstrap validation] and calibration (Brier score: 0.106, 0.142, and 0.103, respectively). The Hosmer-Lemeshow goodness-of-fit test yielded χ²=5.983 for internal validation [P=0.649 (>0.05)], suggesting acceptable model fit, with DCA confirming clinical utility across 0-90% threshold probabilities.</p><p><strong>Conclusions: </strong>Fever duration, serum prealbumin, and D-dimer are independent risk factors for PB in children with SMPP. This internally derived nomogram achieved moderate discrimination and acceptable calibration in our limited single-center cohort. Further external validation in independent patient cohorts is therefore necessary to verify its generalizability and clinical utility.</p>","PeriodicalId":23294,"journal":{"name":"Translational pediatrics","volume":"15 9","pages":"365"},"PeriodicalIF":2.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age-related clinical characteristics of respiratory syncytial virus infection in hospitalized children: a retrospective study.","authors":"Shuying Wang, Bing Huang, Yingxue Ding","doi":"10.21037/tp-2026-0691","DOIUrl":"https://doi.org/10.21037/tp-2026-0691","url":null,"abstract":"<p><strong>Background: </strong>Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory tract infections in children, yet age-stratified clinical characteristics of hospitalized children with RSV infection remain incompletely defined. This study aimed to compare the clinical manifestations, laboratory parameters, co-infections, and disease severity between hospitalized children with RSV infection aged ≤3 years and those aged >3 years, so as to provide evidence for age-stratified diagnosis, treatment, and prevention of RSV infection.</p><p><strong>Methods: </strong>A total of 624 hospitalized children with RSV infection admitted to Beijing Friendship Hospital, Capital Medical University, from 2023 to 2025 were retrospectively enrolled. Based on age at admission, patients were stratified into two groups: ≤3 years (n=434) and >3 years (n=190). Demographic characteristics, clinical manifestations, laboratory parameters, etiological findings, and treatment data were collected. Intergroup comparisons were performed using the χ² test, Fisher's exact test, Mann-Whitney U test, or independent samples t-test, as appropriate.</p><p><strong>Results: </strong>Compared with the ≤3 years group, the >3 years group had higher rates of fever (92.6% <i>vs.</i> 79.5%), longer fever duration (6 <i>vs.</i> 5 days), severe pneumonia (13.7% <i>vs.</i> 6.7%), co-infection (47.4% <i>vs.</i> 26.0%), and longer disease course (10 <i>vs.</i> 8 days) (all P<0.001, except severe pneumonia P=0.005). Co-infection with <i>Mycoplasma pneumoniae</i> (33.7% <i>vs.</i> 10.1%) and other viruses (20.0% <i>vs.</i> 12.7%) was also more frequent in the >3 years group (all P<0.05). The ≤3 years group showed higher wheezing rates (22.6% <i>vs.</i> 6.3%, P<0.001). Laboratory findings revealed higher neutrophil counts (3.16×10⁹/L <i>vs.</i> 2.44×10⁹/L) and C-reactive protein (CRP) levels (3.5 <i>vs.</i> 1.3 mg/L) but lower white blood cell (WBC) count and lymphocyte counts in the >3 years group (all P<0.001). Glucocorticoid (11.6% <i>vs.</i> 7.8%) and intravenous immunoglobulin (IVIG) use (1.1% <i>vs.</i> 1.2%) were comparable between groups (P>0.05).</p><p><strong>Conclusions: </strong>Compared with children aged ≤3 years, hospitalized children aged >3 years with RSV infection had higher proportions of fever, prolonged disease course, co-infection, and severe pneumonia. Early recognition and dynamic assessment should be emphasized in this age group to avoid underestimating disease severity based on age alone.</p>","PeriodicalId":23294,"journal":{"name":"Translational pediatrics","volume":"15 9","pages":"379"},"PeriodicalIF":2.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655870/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of a 'three meals and sleep routine' lifestyle intervention with weight and metabolic health in children with obesity: a prospective, single-arm pilot study.","authors":"Qi Long, Ming Ma, Dan Wang, Fei Chen, Xuelian Zhou, Wei Wu, Guanping Dong, Junfen Fu","doi":"10.21037/tp-2026-0402","DOIUrl":"https://doi.org/10.21037/tp-2026-0402","url":null,"abstract":"<p><strong>Background: </strong>Intensive health behavior and lifestyle treatment is the foundation of pediatric obesity care, but sustained adherence and weight-loss maintenance remain difficult. Regular meal and sleep timing may complement standard care, although pediatric interventional evidence is limited. This prospective, single-arm pilot study aimed to evaluate longitudinal changes in weight, body composition, and metabolic markers during a 'three meals and sleep routine' (TMSR) intervention.</p><p><strong>Methods: </strong>This prospective, single-center, single-arm pilot study consecutively included 119 children with obesity aged 5-18 years [body mass index (BMI)-for-age Z-score (BAZ) >2] from January 2022 to December 2023. Families received nutritionist-led written guidance for three structured meals per day, no caloric intake between meals, age-based energy targets of 1,500-2,300 kcal/day, a protocol-defined minimum of 7.5 hours of nighttime sleep with lights off by 22:30, and maintenance of habitual physical activity. Follow-up was planned at approximately 2-month intervals but occurred according to clinical availability. Anthropometry, bioelectrical-impedance body composition, and fasting metabolic markers were assessed. Adherence, dietary intake, sleep, and physical activity were not objectively monitored. Generalized linear mixed models used available repeated measurements to estimate average within-cohort change over time.</p><p><strong>Results: </strong>The cohort had a mean age of 10.24±2.33 years; 82 participants (68.9%) were male and 37 (31.1%) were female. The fitted BMI trajectory decreased from approximately 26.0 kg/m² at baseline to 24.5 kg/m² at month 4, then increased to 25.4 kg/m² by month 12. BAZ followed the same pattern, decreasing from 2.9 to 2.3 before increasing to 2.4. Visceral fat area and percentage body fat also declined through month 4 and subsequently rebounded. Fasting insulin and glucose showed early declines followed by partial rebound, whereas triglycerides and serum uric acid declined across follow-up. In linear-time models, average monthly coefficients were negative for BMI, BAZ, visceral fat area, percentage body fat, fasting insulin, glucose, triglycerides, and serum uric acid. These coefficients summarize within-cohort associations and do not capture the observed nonlinear trajectories.</p><p><strong>Conclusions: </strong>In this uncontrolled cohort, several anthropometric and metabolic measures improved during the first 4-6 months, but BMI, BAZ, adiposity measures, insulin, and glucose later showed partial rebound. The findings are preliminary and hypothesis-generating; the absence of a comparator and objective adherence data precludes causal attribution to TMSR and limits assessment of durability and safety. Controlled, multicenter studies with age-appropriate sleep targets and objective behavioral monitoring are needed.</p>","PeriodicalId":23294,"journal":{"name":"Translational pediatrics","volume":"15 9","pages":"369"},"PeriodicalIF":2.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical characteristics and treatment analysis of children with glucose transporter type 1 deficiency syndrome: a report of two cases.","authors":"Menglu Cao, Bingbing Zhang, Xiao Xiao, Fangfang Cheng, Jianmei Tian","doi":"10.21037/tp-2026-1-0159","DOIUrl":"https://doi.org/10.21037/tp-2026-1-0159","url":null,"abstract":"<p><strong>Background: </strong>Glucose transporter type 1 deficiency syndrome (GLUT1-DS) is a rare neurometabolic disorder caused by mutations in the <i>SLC2A1</i> gene, leading to glucose transporter type 1 (GLUT1) dysfunction and cerebral energy failure. Clinically, it presents with intractable epilepsy, movement disorders, and developmental delay. Timely diagnosis remains challenging due to clinical heterogeneity.</p><p><strong>Case description: </strong>We report two pediatric cases that presented with early-onset drug-resistant epilepsy, ataxia, and developmental delay. Case 1 presented with refractory epilepsy that was poorly responsive to antiseizure medications. Cerebrospinal fluid (CSF) analysis revealed hypoglycorrhachia (CSF glucose: 2.17 mmol/L; CSF-to-blood glucose ratio: 0.388). Genetic testing identified a heterozygous <i>SLC2A1</i> variant (c.1198C>A, p.Arg400Ser), confirming GLUT1-DS. A ketogenic diet (KD) was initiated, leading to a significant reduction in seizure frequency. Case 2 presented with paroxysmal movement disorders and drug-resistant seizures. CSF analysis showed a glucose level of 2.27 mmol/L with a CSF-to-blood ratio of 0.315. <i>SLC2A1</i> sequencing identified a mutation (c.988C>T, p.Arg330Ter). Following KD initiation, both patients showed significant clinical improvement (complete seizure freedom in Case 2 and marked reduction in Case 1), although long-term efficacy requires further monitoring.</p><p><strong>Conclusions: </strong>A decreased CSF glucose level and a low CSF-to-blood glucose ratio are key diagnostic clues for GLUT1-DS. Early initiation of a KD yielded favorable short-term clinical outcomes in both cases, highlighting the importance of prompt metabolic and genetic screening.</p>","PeriodicalId":23294,"journal":{"name":"Translational pediatrics","volume":"15 9","pages":"394"},"PeriodicalIF":2.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}