Translational pediatrics最新文献

{"title":"Is blood benign?-current evidence on perioperative pediatric transfusion.","authors":"Whitman B Wiggins, Heather Liebe, Ana R Do, Janice A Taylor, Shawn D Larson, Izabela Oluwole, Reema Kashif, Steven L Raymond","doi":"10.21037/tp-2026-0563","DOIUrl":"10.21037/tp-2026-0563","url":null,"abstract":"","PeriodicalId":23294,"journal":{"name":"Translational pediatrics","volume":"15 8","pages":"297"},"PeriodicalIF":2.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13559070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931110","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 between 24-hour urine output during early non-invasive ventilation and short-term adverse outcomes in late preterm infants: a retrospective cohort study.","authors":"Ling Lu, Xiuxia Zhang","doi":"10.21037/tp-2026-0489","DOIUrl":"10.21037/tp-2026-0489","url":null,"abstract":"<p><strong>Background: </strong>Despite advances in respiratory management, late preterm infants with severe pneumonia requiring non-invasive ventilation (NIV) remain at risk of short-term adverse outcomes, and early identification of at-risk infants remains challenging. Current clinical assessment during NIV largely relies on respiratory severity and inflammatory parameters, which may not fully capture evolving systemic physiological changes related to circulatory adaptation and organ perfusion. Urine output during the first 24 hours of NIV support is a routinely monitored bedside parameter that may reflect renal perfusion and hemodynamic status and may provide complementary prognostic information beyond conventional indicators. However, whether early urine output is independently associated with short-term adverse outcomes in this population remains unclear. This study aimed to investigate the association between early 24-hour urine output and short-term adverse outcomes in late preterm infants with severe pneumonia receiving NIV support.</p><p><strong>Methods: </strong>This retrospective cohort study included 240 late preterm infants with severe pneumonia admitted to the neonatal intensive care unit (NICU) between June 2023 and December 2025. Short-term adverse outcomes were defined as a composite endpoint including NIV failure, persistent severe hypoxemia, respiratory deterioration, and multiple organ dysfunction syndrome (MODS) within 7 days after NIV initiation. Perinatal characteristics, admission data, and dynamic clinical parameters during the early NIV period were collected. Multivariable logistic regression analysis was performed to identify factors associated with adverse outcomes. Receiver operating characteristic (ROC) analysis was performed as an exploratory analysis to assess the discriminatory performance of 24-hour urine output for short-term adverse outcomes.</p><p><strong>Results: </strong>Among the 240 enrolled infants, 41 (17.1%) developed short-term adverse outcomes. Multivariable logistic regression analysis demonstrated that lower 5-minute Apgar score, higher procalcitonin (PCT) level, and 24-hour urine output were independently associated with short-term adverse outcomes. Lower 24-hour urine output was significantly associated with increased risk of adverse outcomes [adjusted odds ratio (OR) =0.208, 95% confidence interval (CI): 0.107-0.404, P<0.001]. Sensitivity analyses yielded generally consistent findings.</p><p><strong>Conclusions: </strong>Among late preterm infants with severe pneumonia receiving NIV support, lower early 24-hour urine output was associated with a higher risk of short-term adverse outcomes. As a routinely available parameter, 24-hour urine output may provide complementary prognostic information alongside conventional clinical indicators. Further prospective validation is required before its potential clinical application can be determined.</p>","PeriodicalId":23294,"journal":{"name":"Translational pediatrics","volume":"15 8","pages":"302"},"PeriodicalIF":2.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13559087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931220","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":"Metabolic reprogramming rewires aberrant immune responses to drive endothelial dysfunction in Kawasaki disease: a narrative review.","authors":"Zixuan Zhao, Shuhui Wang, Xuan Li, Liyan Zhu, Haitao Lv, Guanghui Qian","doi":"10.21037/tp-2026-0494","DOIUrl":"10.21037/tp-2026-0494","url":null,"abstract":"<p><strong>Background and objective: </strong>Kawasaki disease (KD) is a systemic pediatric vasculitis characterized by dysregulated immune activation and substantial risk of coronary artery lesions. Emerging evidence suggests metabolic reprogramming is a critical link between immune responses and endothelial dysfunction during KD progression. This review aims to provide an integrated overview of metabolic alterations in KD pathogenesis, focusing on clinical observations, mechanistic insights, and experimental evidence.</p><p><strong>Methods: </strong>A literature search was conducted using PubMed and Web of Science to identify studies published up to July 2026, combining \"Kawasaki disease\" with terms related to metabolism and metabolic pathways, including metabolites, glucose, glycolysis, amino acids, lipids, fatty acid oxidation, succinic acid, the tricarboxylic acid (TCA) cycle, nitric oxide, urine, gut microbiota, mouse models, and therapeutic strategies. Relevant clinical, experimental, and mechanistic studies were reviewed and synthesized.</p><p><strong>Key content and findings: </strong>Accumulating evidence indicates extensive metabolic remodeling in KD, including enhanced glycolysis, disrupted lipid metabolism and fatty acid oxidation, altered amino acid metabolism, and TCA cycle perturbations. These abnormalities are closely linked to immune activation, mitochondrial dysfunction, oxidative stress, and vascular inflammation. KD mouse models further support metabolic reprogramming, marked by altered tryptophan and amino acid metabolism, lipid metabolism, and lactate production. Notably, kynurenine pathway activation with reduced tryptophan availability is associated with inflammatory amplification and mitochondrial impairment. Beyond host-derived changes, gut microbiota dysbiosis and its metabolites appear to correlate with immune responses and disease severity. However, clinical translation of these metabolic signatures into reliable biomarkers or therapeutic targets remains limited.</p><p><strong>Conclusions: </strong>This review highlights metabolic reprogramming as a key interface linking immune dysregulation, endothelial injury, and vascular complications in KD. Metabolic abnormalities may act not merely as consequences of inflammation but as active regulators of vascular dysfunction and disease progression. Significant gaps remain in establishing causal relationships between specific metabolic alterations and KD pathogenesis. Future studies integrating multicenter cohorts with cellular, multi-omics, and animal model approaches, particularly centered on the metabolic-immune-vascular injury axis, will be essential for identifying novel biomarkers and therapeutic strategies.</p>","PeriodicalId":23294,"journal":{"name":"Translational pediatrics","volume":"15 8","pages":"348"},"PeriodicalIF":2.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13559126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931279","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":"Early-onset type 1 diabetes mellitus in a child with a pathogenic <i>CTLA4</i> variant complicated by generalized lipodystrophy and severe insulin resistance: a case report and literature review.","authors":"Yu Ding, Qun Li, Qianwen Zhang, Shiyang Gao, Juan Li, Lingwen Ying, Ru-En Yao, Tingting Yu, Xiumin Wang","doi":"10.21037/tp-2026-0532","DOIUrl":"10.21037/tp-2026-0532","url":null,"abstract":"<p><strong>Background: </strong>The co-occurrence of early-onset type 1 diabetes mellitus (T1DM), acquired generalized lipodystrophy (AGL), and severe insulin resistance (SIR) is extremely rare, poses significant therapeutic challenges and no cases associated with pathogenic Cytotoxic T-lymphocyte-associated 4 (<i>CTLA4</i>) variants have been previously documented.</p><p><strong>Case description: </strong>We performed genetic testing, flow cytometric immunophenotyping, leptin measurement and a 4.5-year clinical follow-up in a 3-year-3-month-old boy with early-onset T1DM, insulin allergy following initial insulin therapy, progressive lipodystrophy, SIR and mild hepatic dysfunction. We additionally conducted a systematic literature review to summarize <i>CTLA4</i> variant-related autoimmune endocrine disorders and fat metabolism abnormalities. Pathological biopsy of subcutaneous adipose tissue revealed scattered lymphocytes and histiocytes infiltrating the fat septa and perivascular areas. A heterozygous pathogenic c.151C>T (p.Arg51*) variant in the <i>CTLA4</i> gene was identified by whole-exome sequencing (WES) analysis. His father and sister carried the same variant with incomplete penetrance. The patient showed markedly reduced <i>CTLA4</i> expression on regulatory T cells and undetectable serum leptin. Treatment with abatacept normalized liver function but did not improve glycemic control or insulin resistance. During the follow-up, the patient's growth consistently exceeded the 97th percentile for age and gender.</p><p><strong>Conclusions: </strong>This report established the first association between a pathogenic <i>CTLA4</i> variant and AGL, which expands the known clinical phenotypic spectrum of <i>CTLA4</i>-related immune dysregulation disorders. <i>CTLA4</i> genetic testing should be considered in patients presenting with early-onset T1DM and unexplained lipodystrophy to enable early diagnosis and guide personalized management.</p>","PeriodicalId":23294,"journal":{"name":"Translational pediatrics","volume":"15 8","pages":"353"},"PeriodicalIF":2.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13559137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931262","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":"Endoplasmic reticulum stress-mediated disruption of mitochondrial homeostasis drives airway epithelial barrier fragility and enhances susceptibility to recurrent respiratory tract infections in children.","authors":"Xiaoyi Chang, Wei Jing, Qingbin Liu, Xueli Wu","doi":"10.21037/tp-2026-0508","DOIUrl":"10.21037/tp-2026-0508","url":null,"abstract":"<p><strong>Background: </strong>Recurrent respiratory tract infections (RRTIs) are among the most common pediatric health problems and impose substantial healthcare burden. Airway epithelial fragility is increasingly recognized as an important contributor to RRTIs in children, although the upstream molecular mechanisms remain incompletely understood. Endoplasmic reticulum (ER) stress and mitochondrial dysfunction have been implicated in epithelial injury in chronic airway diseases, yet their interplay in pediatric RRTIs is unclear. This study aimed to investigate whether ER stress-mediated disruption of mitochondrial homeostasis drives airway epithelial barrier fragility and enhances inflammatory susceptibility in children with RRTIs.</p><p><strong>Methods: </strong>Nasal swab samples from healthy children and RRTI patients were analyzed for ER stress-, barrier-, and mitochondrial-related markers. Tunicamycin-induced ER stress and polyinosinic-polycytidylic acid [Poly(I:C)]-stimulated inflammatory amplification models were established in 16HBE cells, followed by rescue treatment with 4-phenylbutyric acid (4-PBA) or MitoTEMPO.</p><p><strong>Results: </strong>Compared with healthy controls, RRTI children exhibited significantly increased HSPA5 and DDIT3 mRNA expression and elevated IL-6, IL-8, and CXCL10 protein levels (all P<0.001), whereas TJP1, OCLN, and TFAM expression was markedly reduced (all P<0.001). In 16HBE cells, tunicamycin induced ER stress activation, mitochondrial dysfunction, transepithelial electrical resistance (TEER) reduction, and epithelial permeability elevation. Under ER stress preconditioning, Poly(I:C)-induced inflammatory responses, mitochondrial reactive oxygen species (mtROS) accumulation, mitochondrial membrane potential collapse, and barrier leakage were further aggravated (all P<0.001). Both 4-PBA and MitoTEMPO partially reversed these pathological alterations.</p><p><strong>Conclusions: </strong>ER stress-mediated mitochondrial homeostasis disruption promotes airway epithelial barrier fragility and enhances inflammatory susceptibility in pediatric RRTIs.</p>","PeriodicalId":23294,"journal":{"name":"Translational pediatrics","volume":"15 8","pages":"306"},"PeriodicalIF":2.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13559128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931268","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":"Radiofrequency ablation for severe hemangiomas with thrombocytopenia and coagulation abnormalities (Kasabach-Merritt phenomenon).","authors":"Junjie Lin, Bin Fang, Wenting Jiao, Changkuan Chen, Yaqing Ding, Gaozan Zhu, Wenqiu Wang, Wenbo Liu, Hua Xiang, Junbo Qiao","doi":"10.21037/tp-2026-1-0054","DOIUrl":"10.21037/tp-2026-1-0054","url":null,"abstract":"<p><strong>Background: </strong>Kasabach-Merritt phenomenon (KMP), a potentially fatal complication of hemangiomas, necessitates effective therapeutic interventions. This study aimed to evaluate the efficacy of radiofrequency ablation (RFA) in managing severe hemangiomas with KMP, characterized by thrombocytopenia and coagulation abnormalities. While RFA emerges as a promising therapeutic option, its efficacy in pediatric KMP patients warrants further investigation.</p><p><strong>Methods: </strong>This retrospective analysis included 35 pediatric patients diagnosed with KMP who were treated at the Department of Hemangioma Surgery, The Third Affiliated Hospital of Zhengzhou University between March 2018 and September 2024. All patients underwent RFA under general anesthesia, with color Doppler ultrasound continuously monitoring the precise, multi-layer, multi-point ablation procedure.</p><p><strong>Results: </strong>In all 35 patients (15 males, 20 females; age range: 1 day-6 months; median age: 8 days), postoperative normalization of platelet counts was observed. Lesions exhibited initial hardening within 7 days but subsequently returned to normal after 2 weeks of dressing changes. During the follow-up period ranging from 6 to 24 months, complete ablation of all lesions was achieved, tumors resolved entirely, no recurrence was detected, and local function, anatomy, and aesthetics were well preserved.</p><p><strong>Conclusions: </strong>RFA demonstrates as a minimally invasive, safe, and effective therapeutic approach for KMP, associated with a low complication rate. It significantly improves survival rates and quality of life in pediatric patients, positioning itself as a highly promising therapeutic option for broader clinical application.</p>","PeriodicalId":23294,"journal":{"name":"Translational pediatrics","volume":"15 8","pages":"324"},"PeriodicalIF":2.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13559082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931201","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":"Evaluating the risk of elevated IL-6 levels in pediatric patients: a stratified approach and evidence of interaction effects.","authors":"Xun Li, Haipeng Yan, Xiao Li, Enmin Li, Ting Luo, Xiangyu Wang, Longlong Xie, Yufan Yang, Xinping Zhang, Jiaotian Huang, Zhenghui Xiao","doi":"10.21037/tp-2026-0470","DOIUrl":"10.21037/tp-2026-0470","url":null,"abstract":"<p><strong>Background: </strong>Distinguishing between an appropriate and a pathologically dysregulated elevation of interleukin-6 (IL-6) is challenging. This study aimed to explore how physiological function abnormalities could help identify subpopulations in whom IL-6 levels were associated with disease severity.</p><p><strong>Methods: </strong>This retrospective study included pediatric patients with serum IL-6 test results. After selecting laboratory parameters that effectively identify a subpopulation in which IL-6 levels can predict adverse clinical outcomes, the chosen parameters were categorized into function groups. Using IL-6 levels and the number of impaired functions as stratifying parameters, the risk of adverse outcomes for each stratum was calculated. To assess the interaction effect between functional impairment and IL-6 elevation on adverse outcomes, the relative excess risk due to interaction (RERI) was calculated.</p><p><strong>Results: </strong>A total of 56,170 pediatric patients were included. Fourteen laboratory parameters in pediatric patients could be used as stratifying parameters, where abnormal values suggest that IL-6 levels could be used as a prognostic marker [area under the receiver operating characteristic curves (AUCs) >0.7]. These parameters were categorized into five functional groups: immunological [white blood cell (WBC), neutrophils, monocytes], hepatic [aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bile acids], renal (creatinine, uric acid), coagulation [platelets, activated partial thromboplastin time (APTT), thrombin time], and myocardial enzymes [myoglobin, creatine kinase (CK), CK-MB]. For the rate of adverse outcomes, the rate difference (RD) between the IL-6 >85^th and ≤85^th percentile groups ranged from 0.7% [95% confidence interval (CI): 0.2%, 1.2%] in the stratum with 1 impaired function to 16.9% (95% CI: 12.5%, 21.3%) in the stratum with ≥4 impaired functions. Similar trends were observed for the rate of pediatric intensive care unit (PICU) admission and the length of hospital stays. For adverse outcomes, the RERI between the increased number of impaired functions and IL-6 levels increased from 1.06 (1 impaired function + IL-6 >85^th percentile; 95% CI: 0.73, 1.38) to 42.79 (4 impaired functions + IL-6 >85^th percentile; 95% CI: 34.49, 51.09). Consistent results were observed in the validation cohort and in disease-specific subpopulations.</p><p><strong>Conclusions: </strong>The risk associated with elevated IL-6 levels increases as the number of impaired functions grows, with an intensified interaction effect between IL-6 elevation and functional impairment on clinical outcomes, offering a simple method for clinical risk stratification.</p>","PeriodicalId":23294,"journal":{"name":"Translational pediatrics","volume":"15 8","pages":"323"},"PeriodicalIF":2.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13559113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148930334","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":"Traditional Chinese medicine combined with conventional Western medicine for chronic cough following respiratory infection in children: a systematic review and meta-analysis.","authors":"Shengtao Cui, Xiaofei Xie, Jingjing Yang, Yao Xiao, Wei Wang","doi":"10.21037/tp-2026-0205","DOIUrl":"10.21037/tp-2026-0205","url":null,"abstract":"<p><strong>Background: </strong>Chronic cough following respiratory infection in children is often refractory to conventional therapies. However, the current clinical evidence regarding the efficacy of traditional Chinese medicine (TCM) remains inconclusive and lacks systematic synthesis, leaving clinicians without clear guidance. This study systematically evaluated the efficacy and safety of TCM for chronic cough following respiratory infection in children to support clinical decision-making.</p><p><strong>Methods: </strong>A systematic search was conducted in the Cochrane Library, PubMed, Embase, Web of Science, Wiley Online Library, China National Knowledge Infrastructure (CNKI), and Wanfang databases. Randomized controlled trials (RCTs) of TCM for chronic cough following respiratory infection in children were included. Meta-analyses were performed using RevMan 5.4 and Stata 16.0.</p><p><strong>Results: </strong>A total of 23 RCTs involving 2,126 children were included. Meta-analysis demonstrated that, compared with conventional Western medical treatment alone, TCM combined with conventional treatment significantly improved the overall clinical effectiveness rate [risk ratio (RR) =1.19, 95% confidence interval (CI) (1.15, 1.24), P<0.001], shortened the time to cough resolution [mean difference (MD) =-3.19, 95% CI (-4.42, -1.97), P<0.001] and the time to disappearance of pulmonary rales [MD =-2.00, 95% CI (-2.47, -1.54), P<0.001], and significantly reduced cough symptom scores [MD =-1.32, 95% CI (-1.69, -0.95), P<0.001]. For secondary outcomes, combined TCM therapy significantly reduced TCM syndrome scores, improved immune function indicators [immunoglobulin A (IgA), immunoglobulin M (IgM), and immunoglobulin G (IgG)], and decreased levels of inflammatory biomarkers [C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and monocyte chemoattractant protein-4 (MCP-4)]. No statistically significant difference was observed between groups in the incidence of adverse events.</p><p><strong>Conclusions: </strong>TCM used as an adjunct to conventional Western medical treatment may provide additional benefits in improving clinical outcomes and alleviating symptoms in children with post-infectious chronic cough. However, due to limitations in study quality and heterogeneity, further high-quality, well-designed studies are warranted to strengthen the evidence base.</p>","PeriodicalId":23294,"journal":{"name":"Translational pediatrics","volume":"15 8","pages":"337"},"PeriodicalIF":2.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13559104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931197","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":"Ultrasound-based nomogram for predicting high-risk hepatic portal venous gas in children: a retrospective cohort study.","authors":"Chao Ma, Pengling Huang, Guanghua Pei, Zhaowei Meng","doi":"10.21037/tp-2026-0541","DOIUrl":"10.21037/tp-2026-0541","url":null,"abstract":"<p><strong>Background: </strong>Hepatic portal venous gas (HPVG) is an uncommon but potentially life-threatening ultrasonographic finding in the pediatric population. Early identification of high-risk HPVG cases requiring urgent surgical intervention remains a clinical challenge. This study aimed to develop and validate an ultrasound-based nomogram for predicting high-risk HPVG in children.</p><p><strong>Methods: </strong>A retrospective cohort of 107 pediatric patients with ultrasound-confirmed HPVG was analyzed. Participants were divided into high-risk group (n=20) and benign group (n=87) based on whether they underwent abdominal surgery or died. Clinical characteristics and ultrasound features were compared between groups. Univariate and multivariate logistic regression analyses were performed to identify independent predictors. A nomogram was subsequently constructed, with model performance assessed via receiver operating characteristic (ROC) curves, calibration curves, the Hosmer-Lemeshow goodness-of-fit test, bootstrap internal validation, and decision curve analysis (DCA).</p><p><strong>Results: </strong>Multivariate logistic regression identified bowel wall layer [unclear vs. clear: odds ratio (OR) =25.171, 95% confidence interval (CI): 4.249-227.708, P=0.001] and intestinal gas distribution (localized <i>vs.</i> none: OR =6.978, 95% CI: 1.515-51.211, P=0.02; diffuse <i>vs.</i> none: OR =65.077, 95% CI: 10.107-663.804, P<0.001) as independent predictors of high-risk HPVG. The model demonstrated good discriminative capability [area under curve (AUC) =0.899, 95% CI: 0.843-0.956]. The Hosmer-Lemeshow test confirmed adequate model fit (P=0.051). Bootstrap internal validation with 500 resamples yielded an optimism-corrected AUC of 0.879 (95% CI: 0.755-0.965), with minimal optimism of 0.020. DCA confirmed meaningful clinical net benefit across a wide range of threshold probabilities.</p><p><strong>Conclusions: </strong>This study developed and validated an ultrasound-based prediction model for identifying high-risk HPVG in children. Loss of bowel wall stratification and abnormal intestinal gas distribution were identified as independent predictors of adverse outcomes. This model provides a practical, point-of-care risk stratification tool that can assist physicians in distinguishing children with HPVG who may benefit from urgent surgical intervention from those who can be managed conservatively.</p>","PeriodicalId":23294,"journal":{"name":"Translational pediatrics","volume":"15 8","pages":"313"},"PeriodicalIF":2.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13559130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931241","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":"Efficacy and safety of application of Sivelestat in pediatric intensive care unit: a systematic review and meta‑analysis.","authors":"Cai-Xia Tu, Jian-Ling Shen, Dan-Yang Ren, Yun-Wei Li, Qiong Zou, Yan-Ming Yang, Hui-Ying Li","doi":"10.21037/tp-2026-1-0119","DOIUrl":"10.21037/tp-2026-1-0119","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The use of Sivelestat in pediatrics remains controversial. Given the limited available evidence, drug labeling does not recommend its administration in children, yet it is increasingly used off-label for pediatric patients with cardiopulmonary bypass (CPB)-related injury or acute respiratory distress syndrome (ARDS). This meta-analysis synthesized the existing data to evaluate the efficacy and safety of Sivelestat in pediatric populations, aiming to provide evidence for rational clinical medication.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A computerized search was conducted to identify reports on the application of Sivelestat in critically ill pediatric patients in databases PubMed, Embase, Cochrane Library, Web of Science, China national knowledge infrastructure (CNKI), Wanfang Data and VIP from inception to May 2026. The meta-analysis was performed using Review Manager 5.3 version. The risk of bias was assessed using the Cochrane Handbook Risk of Bias Assessment tool.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Finally, 8 controlled studies and 5 case reports were included, involving a total of 608 and 10 children respectively. The results of the meta-analysis showed that the overall P/F ratio was significantly higher in the SE group than in the control group [mean difference (MD) =27.17, 95% confidence interval (CI): 11.84, 42.50, P&lt;0.001]. However, subgroup analysis revealed no significant difference in P/F ratio between the two groups among children with CPB. In children with ARDS, a marked increase in the P/F ratio was observed in the SE group [MD =24.65, 95% CI: 18.12, 31.19, P&lt;0.001). A low risk of bias was identified for this outcome, and further research is warranted to confirm the results. The overall ICU stay time was significantly shorter in the SE group [MD =-2.57, 95% CI: -4.26, -0.87, P=0.003). Similarly, subgroup analysis showed no significant difference in children with CPB, while a marked reduction in ICU stay was observed in the SE group among children with ARDS [MD =-4.03, 95% CI: -7.12, -0.94, P=0.01). The hospital stay time was significantly shorter in the SE group [MD =-2.96, 95% CI: -3.68, -2.24, P&lt;0.001). The overall levels of inflammatory factors were significantly lower in the SE group, including WBC count, CRP, IL-6, IL-8, and TNF-α. Among them, the subgroup findings for WBC and TNF-α were inconsistent. Only a marked reduction was found in children with ARDS. Furthermore, its incidence of complications and adverse events was significantly lower [OR =0.38, 95% CI: 0.22, 0.65, P&lt;0.001). However, existing data are insufficient for a full safety assessment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In pediatric patients with severe conditions such as ALI/ARDS, Sivelestat may improve the oxygenation index and inhibit the release of inflammatory mediators, but safety assessment remains limited. However, given the limited number of included studies and inter-study heterogeneity, large-scale trials are still needed to v","PeriodicalId":23294,"journal":{"name":"Translational pediatrics","volume":"15 8","pages":"335"},"PeriodicalIF":2.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13559072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931287","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}