Translational pediatrics最新文献

{"title":"Outcomes after surgical management of anomalous aortic origin of a coronary artery (AAOCA): an up-to-date systematic review and meta-analysis.","authors":"Giuseppe Imperatore, Mauro Lo Rito, Giuseppe Scrascia, Lorenzo Giovannico, Luca Savino, Giuseppe Fischetti, Giovanni Meliota, Danila Azzolina, Christoph Gräni, Tomaso Bottio, Massimo A Padalino","doi":"10.21037/tp-2026-0455","DOIUrl":"10.21037/tp-2026-0455","url":null,"abstract":"<p><strong>Background: </strong>Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital anomaly that represents a leading cause of sudden cardiac death (SCD) in children and young athletes. Risk is concentrated in specific anatomical phenotypes, particularly anomalous aortic origin of the left coronary artery from the right sinus (L-AAOCA), variants with interarterial and/or intramural proximal course, and anomalous coronary orifice (slit-like) and acute take-off angle. Despite advances in multimodal imaging, optimal risk stratification and management remain controversial, and no randomized trials comparing surgical and conservative strategies exist. This study aims to systematically evaluate contemporary evidence and quantitatively estimate pooled clinical outcomes to define procedural safety and durability.</p><p><strong>Methods: </strong>A systematic search of PubMed/MEDLINE, Embase, Scopus, and the Cochrane Library was performed from database inception to March 2026. Eligible studies enrolled patients with AAOCA and reported management strategies and clinical outcomes. Original surgical series with fewer than 10 operated patients were excluded from the quantitative synthesis. A qualitative synthesis and random-effects meta-analysis of proportions were conducted to estimate pooled surgical incidence outcomes. Subjective postoperative symptoms and objectively documented residual ischemia were analysed as separate endpoints. For each outcome, study-specific evaluable denominators were used when follow-up populations differed from the baseline surgical cohort.</p><p><strong>Results: </strong>Twenty studies were included in the updated synthesis, substantially expanding the contemporary surgical evidence base. Pooled perioperative mortality was 0.85% [95% confidence interval (CI): 0.46-1.37%; I<sup>2</sup>=0%], and pooled coronary-related reintervention was 4.06% (95% CI: 3.07-5.36%; I<sup>2</sup>=0%). New or worsened postoperative aortic regurgitation (AR) occurred in 6.65% (95% CI: 3.75-11.53%; I<sup>2</sup>=67.7%), with higher rates in unroofing-dominant cohorts. When analysed as distinct endpoints, persistent postoperative symptoms remained relatively common (12.41%, 95% CI: 7.44-20.00%; I<sup>2</sup>=84.5%), whereas objective residual ischemia after repair was uncommon (3.86%, 95% CI: 1.80-8.07%; I<sup>2</sup>=68.7%). Conservative management, predominantly applied to lower-risk R-AAOCA phenotypes, showed low annualized mortality in selected series but non-negligible cumulative risk in registry data.</p><p><strong>Conclusions: </strong>This up-to-date systematic review and meta-analysis found low perioperative mortality and favorable mid-term outcomes after AAOCA repair, although reintervention and postoperative AR remain relevant and vary by surgical technique. Persistent symptoms exceeded objective residual ischemia, indicating that symptoms are not a direct surrogate of residual ischemic risk. Conservative management showe","PeriodicalId":23294,"journal":{"name":"Translational pediatrics","volume":"15 8","pages":"300"},"PeriodicalIF":2.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13559088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931250","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":"Plasma polyunsaturated fatty acids and amino acids in children with attention-deficit hyperactivity disorder: correlations with clinical and cognitive features.","authors":"Liuyan Zhu, Lei Wang, Tianmiao Gu, Weijun Chen","doi":"10.21037/tp-2026-0590","DOIUrl":"10.21037/tp-2026-0590","url":null,"abstract":"<p><strong>Background: </strong>Attention-deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children, characterized by inattention, hyperactivity and impulsivity. Metabolic profiles of polyunsaturated fatty acids (PUFAs) and amino acids have been linked to neurodevelopmental processes associated with ADHD. This cross-sectional study aimed to compare plasma levels of PUFAs and amino acids between medication-naive children with ADHD and typically developing (TD) children, after adjusting for multiple confounding factors, and explore their correlations with clinical symptoms and cognitive function.</p><p><strong>Methods: </strong>A total of 102 medication-naive children with ADHD and 91 TD children were enrolled. Plasma concentrations of four PUFAs and seven neuroactive amino acids were measured using liquid chromatography-tandem mass spectrometry. Group comparisons were performed using analysis of covariance adjusted for age, gender, body mass index (BMI), paternal education level, maternal education level, family annual income, only child status, and main caregiver of children. Correlation analyses and multiple testing corrections were also conducted.</p><p><strong>Results: </strong>After adjustment for confounding factors, ADHD group had higher plasma glutamate (Glu) (median: 103.08 <i>vs.</i> 102.25 µmol/L, P=0.043). Tryptophan (Try) was positively correlated with the Swanson, Nolan, and Pelham rating scale version IV (SNAP-IV) inattention scores (r=0.209, P=0.03). γ-aminobutyric acid (GABA) was negatively correlated with full scale intelligence quotient (IQ) (r=-0.198, P=0.04), and eicosapentaenoic acid (EPA) was negatively correlated with Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV) processing speed (r=-0.212, P<0.05). Glu and arachidonic acid (ARA) levels differed significantly across groups defined by hyperactivity-impulsivity severity (H=6.695, P=0.04; H=8.616, P=0.01). Boys had higher WISC-IV verbal comprehension (P=0.04).</p><p><strong>Conclusions: </strong>This study provides exploratory evidence of weak but significant correlations among plasma PUFAs, amino acids, clinical symptoms, and cognitive function in medication-naive children with ADHD. These preliminary findings support further investigation of peripheral metabolic profiles as potential phenotypic correlations rather than established biomarkers for ADHD.</p>","PeriodicalId":23294,"journal":{"name":"Translational pediatrics","volume":"15 8","pages":"344"},"PeriodicalIF":2.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13559132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931271","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":"Retrospective analysis of platelet to high-density lipoprotein cholesterol ratio in obese children with metabolic dysfunction-associated fatty liver disease.","authors":"Gang Li, Chen Wang, Weixia Yang","doi":"10.21037/tp-2026-0416","DOIUrl":"10.21037/tp-2026-0416","url":null,"abstract":"<p><strong>Background: </strong>The platelet-to-high-density lipoprotein cholesterol ratio (PHR) is an emerging biomarker for identifying systemic inflammation and a hypercoagulable state. Non-alcoholic fatty liver disease (NAFLD) encompasses a spectrum of liver conditions closely associated with metabolic dysfunction and is recognised as the hepatic manifestation of metabolic syndrome. In 2020, an international consensus panel proposed \"metabolic dysfunction-associated fatty liver disease\" (MAFLD) as an alternative nomenclature for NAFLD, better reflecting the disease's pathophysiology. MAFLD development is closely linked to inflammation and hypercoagulability, and this study aimed to investigate the association between PHR levels and MAFLD in children with obesity.</p><p><strong>Methods: </strong>A total of 209 obese children aged 6 to 14 years who visited the Children's Medical Center of the Affiliated Hospital of Nantong University were enrolled in this study. Obesity was defined as a body mass index (BMI) ≥95th percentile (P95) for the same age and sex. All participants underwent ultrasound to determine the presence of hepatic steatosis, and data on physical examination and biochemical parameters were collected. The platelet-to-HDL cholesterol ratio (PHR) was calculated based on platelet (PLT) count and high-density lipoprotein cholesterol (HDL-C) using the following formula: PHR = PLT (1,000 cells/µL)/HDL-C (mmol/L). Multivariable logistic regression analysis was applied to evaluate the association between PHR and MAFLD. Restricted cubic spline (RCS) analysis was performed to characterize the dose-response relationship.</p><p><strong>Results: </strong>Children with MAFLD had significantly higher PHR levels than obese children without MAFLD (289.48±81.15 vs. 233.86±60.57, t=-5.67, P<0.001). Multivariable regression analysis demonstrated that the highest quartile of PHR (Q4) was significantly associated with an increased risk of MAFLD after adjustment for gender, age, BMI-standard deviation score (BMI-SDS) and multiple metabolic indices [odds ratio (OR) = 6.28, 95% confidence interval (CI): 2.14-18.45, P<0.001]. The dose-response curve indicated a linear positive association between PHR and the risk of MAFLD (overall P<0.001, non-linearity P=0.77).</p><p><strong>Conclusions: </strong>Elevated PHR level is an independent risk factor for MAFLD in obese children and may serve as a potential biomarker for the early screening of pediatric MAFLD.</p>","PeriodicalId":23294,"journal":{"name":"Translational pediatrics","volume":"15 8","pages":"334"},"PeriodicalIF":2.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13559099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931276","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":"The dose-effect relationship between red blood cell transfusion volume and adverse events in pediatric cardiac surgery.","authors":"Wenting Wang, Qindong Liu, Tianyu Gao, Yu Jin, He Wang, Jia Liu, Bingyang Ji, Jinping Liu","doi":"10.21037/tp-2026-0369","DOIUrl":"10.21037/tp-2026-0369","url":null,"abstract":"<p><strong>Background: </strong>Pediatric cardiac surgery requiring cardiopulmonary bypass (CPB) is associated with high transfusion rates. While transfusions increase risks of adverse events, existing evidence cannot differentiate whether risks arise from transfusion itself or cumulative volumes. This study aims to explore the relationship between intra-operative transfusion volume and adverse outcomes, exploring whether transfusion volume has a linear or threshold effect on adverse outcomes.</p><p><strong>Methods: </strong>This retrospective cohort study included pediatric patients (≤14 years old) undergoing cardiac surgery with CPB, categorized by intra-operative red blood cell (RBC) volume transfused: 0, 0.1-22.2 mL/kg, 22.3-27.0 mL/kg, 27.1-34.5 mL/kg and >34.5 mL/kg. Outcomes included prolonged mechanical ventilation (MV), acute kidney injury (AKI), severe AKI and composite complications (chest drainage >10 mL/kg/d, culture-confirmed pulmonary infection, extracorporeal membrane oxygenation (ECMO) implantation, and in-hospital mortality). Multivariable logistic regression was used to analyze the relationship between intra-operative RBC transfusion volume and outcomes.</p><p><strong>Results: </strong>A total of 19,081 children were included, of whom 44.5% received RBC transfusion during surgery. Among these, 10.7% received 0.1-22.2 mL/kg, 11.3% received 22.3-27.0 mL/kg, 11.3% received 27.1-34.5 mL/kg and 11.0% received >34.5 mL/kg RBC transfusion. Higher RBC transfusion volumes correlated with certain adverse events. However, after adjustment for potential confounders, no consistent linear dose-effect relationship was observed. Instead, a threshold-effect association was identified. Compared with no transfusion, RBC transfusion >34.5 mL/kg was associated with increased risks of prolonged MV [odds ratio (OR): 3.45, 95% confidence interval (CI): 2.78-4.28; P<0.001], AKI (OR: 1.21, 95% CI: 1.01-1.44; P=0.04), and composite complications (OR: 2.30, 95% CI: 1.54-3.43; P<0.001), whereas low-volume transfusion was inversely associated with composite complications (0.1-22.2 mL/kg: OR, 0.36; 95% CI: 0.17-0.76; P=0.007), prolonged MV (0.1-22.2 mL/kg: OR, 0.55; 95% CI: 0.40-0.77; P=0.001; 22.3-27.0 mL/kg: OR, 0.64; 95% CI: 0.48-0.85; P=0.002), and AKI (0.1-22.2 mL/kg: OR, 0.81; 95% CI: 0.68-0.95; P=0.01).</p><p><strong>Conclusions: </strong>In this large cohort of pediatric patients undergoing surgery for congenital heart disease (CHD), there was a threshold effect between intraoperative RBC transfusion volume and adverse outcomes. Besides, low-volume transfusion was inversely associated with these outcomes. These findings highlight the importance of evaluating RBC transfusion using weight-adjusted volume and suggest that an optimal transfusion range may exist in pediatric cardiac surgery.</p>","PeriodicalId":23294,"journal":{"name":"Translational pediatrics","volume":"15 8","pages":"327"},"PeriodicalIF":2.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13559129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931248","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":"Development of a machine learning-based assistive diagnostic model for Epstein‑Barr virus‑associated hemophagocytic lymphohistiocytosis in pediatric patients.","authors":"Sheng-Quan Guo, Ying Tian, Yu-Feng Zhang, Hui-Ling Deng, Xi-Ru Yang, Min Han, Lu Cao, Peng-Fei Xu, Xiao-Yan Wang","doi":"10.21037/tp-2026-0406","DOIUrl":"10.21037/tp-2026-0406","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Children with evolving Epstein‑Barr virus‑associated hemophagocytic lymphohistiocytosis (EBV-HLH) often do not fully meet the established HLH‑2004 diagnostic criteria at admission, making timely identification of progressors challenging and increasing the risk of poor outcomes. We aimed to develop an internally evaluated, interpretable assistive diagnostic model using routine admission parameters to differentiate EBV-HLH from uncomplicated EBV infection early. The model was compared against multiple machine learning classifiers, interpreted via SHapley Additive exPlanations (SHAP) analysis, and deployed as a web‑based research prototype to support clinical reasoning before full diagnostic criteria are formally met.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective case-control study collected clinical and laboratory data from 244 pediatric inpatients with active EBV infection (Xi'an Children's Hospital, 2021-2025). HLH was diagnosed according to the HLH-2004 criteria (fulfilling ≥5 of 8 criteria). This study employed a time-matched case-control design, in which children with EBV-HLH were matched 1:3 with children with uncomplicated EBV infection based on the diagnosis date ±3 calendar days, then randomly split into training (171 cases) and validation (73 cases) sets at a 7:3 ratio. Significant univariate variables underwent least absolute shrinkage and selection operator (LASSO) regression analysis and Boruta feature selection. The final set of variables was analyzed using six machine learning classifiers-logistic regression (LR), support vector machine (SVM), random forest (RF), naive Bayes (NB), gradient boosting machine (GBM), and LASSO-with hyperparameters optimized for each. The best model was visualized via SHAP and deployed as a Shiny web calculator for individual use.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The study population had a median age of 6.4 years (interquartile range: 4.8-9.6) and 48.3% were male. Triglyceride (TG), interferon-γ (IFN-γ), serum ferritin (FE), platelet count (PLT), and the CD4&lt;sup&gt;+&lt;/sup&gt;/CD8&lt;sup&gt;+&lt;/sup&gt; ratio are the five statistically significant features that have been validated and were retained for subsequent modeling. The RF model demonstrated excellent discriminative performance, yielding an area under the curve (AUC) of 0.895 [95% confidence interval (CI): 0.824-0.966] on the validation set, with a sensitivity of 0.735 and a specificity of 0.846. The SHAP ranked these features in descending importance: TG levels, IFN-γ levels, FE levels, PLT levels, and the CD4&lt;sup&gt;+&lt;/sup&gt;/CD8&lt;sup&gt;+&lt;/sup&gt; ratio. A web calculator based on SHAP was deployed for individualized risk estimation for clinicians.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This work identified five key biomarkers for early differential identification of EBV-HLH in pediatric patients. The RF model showed promising internal discriminative ability, and SHAP confirmed its interpretability via individual‑level feature visualization. Due ","PeriodicalId":23294,"journal":{"name":"Translational pediatrics","volume":"15 8","pages":"320"},"PeriodicalIF":2.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13559095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931223","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":"Diagnostic and therapeutic value of double-balloon enteroscopy in pediatric patients with Peutz-Jeghers syndrome.","authors":"Wei-Chen Shen, Zhu-Bin Pan, Shi-Qin Qi, Jun-Jun Ju, Yu-Liang Zhou, Tao Zhang, Zhen-Qiang Zhang","doi":"10.21037/tp-2026-1-0039","DOIUrl":"10.21037/tp-2026-1-0039","url":null,"abstract":"<p><strong>Background: </strong>Peutz-Jeghers syndrome (PJS) is a rare autosomal dominant disorder characterized by mucocutaneous pigmentation and gastrointestinal hamartomatous polyposis, with a particularly high predilection for the small intestine. These polyps carry significant risks of intussusception, bleeding, and malignant transformation, making effective surveillance and intervention essential in affected children. This study aimed to evaluate the diagnostic and therapeutic value of double-balloon enteroscopy (DBE) in children with PJS.</p><p><strong>Methods: </strong>Clinical data were retrospectively collected from 22 children diagnosed with PJS who underwent DBE at Anhui Provincial Children's Hospital between March 2024 and October 2025. The analyzed parameters included sex, age, duration of enteroscopy, examination approach, depth of insertion, number of polyps resected intraoperatively, intraoperative blood loss, postoperative complications, and length of hospital stay. Statistical analyses were performed for all variables.</p><p><strong>Results: </strong>Among the 22 pediatric patients, 16 were male and 6 were female, with a mean age of 11.35±3.96 years. The median duration of enteroscopy was 157.0 (90.75-253.5) minutes. An oral-only approach was performed in 7 patients, an anal-only approach in 5 patients, and combined oral and anal approaches in 10 patients. The mean insertion depth via the oral approach was 202.5±30.66 cm distal to the ligament of Treitz, whereas the mean insertion depth via the anal approach was 173.33±26.37 cm proximal to the ileocecal junction. A total of 76 polyps were resected using the oral approach and 135 polyps using the anal approach. One patient presented with a broad-based polyp located in the descending portion of the duodenum, which necessitated conversion to open laparotomy for polypectomy. Overall, 211 polyps were resected across all pediatric patients. The median intraoperative blood loss was 2.0 (1.0-2.0) mL per patient, and the mean postoperative hospital stay was 7.50±2.67 days. No postoperative gastrointestinal bleeding, intestinal perforation, or severe infectious complications were observed.</p><p><strong>Conclusions: </strong>DBE is a safe and feasible technique for the resection of multiple intestinal polyps in children with PJS. Compared with traditional open laparotomy, DBE offers advantages including scar-free healing, reduced surgical trauma, and improved postoperative recovery. These findings indicate that DBE has substantial clinical value and supports its broader application in pediatric clinical practice.</p>","PeriodicalId":23294,"journal":{"name":"Translational pediatrics","volume":"15 8","pages":"340"},"PeriodicalIF":2.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13559138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931290","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":"Influenza vaccination in children with underlying conditions: affirming effectiveness and confronting gaps.","authors":"Kimberley H Geissler, Elizabeth Peacock-Chambers","doi":"10.21037/tp-2026-0545","DOIUrl":"10.21037/tp-2026-0545","url":null,"abstract":"","PeriodicalId":23294,"journal":{"name":"Translational pediatrics","volume":"15 8","pages":"296"},"PeriodicalIF":2.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13559140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931117","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":"Predictive value of the prognostic nutritional index and aggregate index of systemic inflammation for pulmonary complications in children with influenza.","authors":"Yuanyuan Wu, Jianjian Zhang, Xuejia Ke, Junping Pan, Yuping Hu","doi":"10.21037/tp-2026-0567","DOIUrl":"10.21037/tp-2026-0567","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary complications drive morbidity in pediatric influenza, but early risk stratification remains challenging. This study evaluated the predictive utility of the prognostic nutritional index (PNI) and the aggregate index of systemic inflammation (AISI)-accessible biomarkers of immune-nutritional and inflammatory status-for pulmonary complications in pediatric influenza.</p><p><strong>Methods: </strong>This retrospective study analyzed 248 pediatric patients with influenza admitted between January 2022 and December 2024. PNI and AISI were calculated from admission laboratory data. Multivariable logistic regression and receiver operating characteristic (ROC) curves were utilized to evaluate the independent and combined predictive performance of PNI and AISI for the development of pulmonary complications.</p><p><strong>Results: </strong>Pulmonary complications developed in 86 patients (34.7%). These patients exhibited significantly lower PNI and higher AISI than those without complications (both P<0.001). Furthermore, PNI correlated inversely, and AISI positively, with disease severity markers including C-reactive protein (CRP), procalcitonin, fever duration, and hospital length of stay (all P<0.001). Multivariable analysis identified prolonged fever, decreased PNI, and elevated AISI as independent predictors of pulmonary complications. The combined PNI-AISI model showed higher apparent discriminatory performance than PNI or AISI alone [the area under the receiver operating characteristic curve (AUC): 0.913, sensitivity: 87.2%, specificity: 85.2%]; however, further validation is required to confirm its generalizability.</p><p><strong>Conclusions: </strong>Decreased PNI and elevated AISI independently predict pulmonary complications and disease severity in pediatric influenza. Integrating these indices provides a highly accurate, accessible, and physiologically grounded tool for early risk stratification, optimizing clinical decision-making.</p>","PeriodicalId":23294,"journal":{"name":"Translational pediatrics","volume":"15 8","pages":"343"},"PeriodicalIF":2.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13559136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931243","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":"Obesity-related palmitic acid exacerbates IL-13-induced mucus phenotype in 16HBE airway epithelial cells via AMPK suppression.","authors":"Qingbin Liu, Xiaoyi Chang, Wei Jing, Siyu Liu","doi":"10.21037/tp-2026-0547","DOIUrl":"10.21037/tp-2026-0547","url":null,"abstract":"<p><strong>Background: </strong>Mucus hypersecretion and obesity are two prevalent comorbidities that independently worsen childhood asthma outcomes. However, the metabolic mechanisms by which obesity-related factors interact with type 2 (T2) inflammatory signals to exacerbate airway epithelial mucus phenotype remain poorly understood. This study aimed to investigate whether palmitic acid (PA), a representative obesity-related saturated fatty acid, amplifies interleukin-13 (IL-13)-induced mucus phenotype in human bronchial epithelial cells and to determine whether the AMP-activated protein kinase (AMPK) axis mediates this interaction.</p><p><strong>Methods: </strong>We stimulated 16HBE human bronchial epithelial cells with IL-13 (10 ng/mL, 72 h), PA (100 µM, 48 h), or combined IL-13 and PA exposure, in which PA was added during the final 48 h of IL-13 treatment. We activated AMPK pharmacologically with AICAR (1 mM) and suppressed AMPK genetically through small interfering RNA (siRNA)-mediated PRKAA1 knockdown. We quantified <i>MUC5AC</i>, <i>MUC5B</i>, <i>CLCA1</i>, and <i>PRKAA1</i> messenger RNA (mRNA) transcripts by reverse transcription-quantitative polymerase chain reaction (RT-qPCR), measured IL-8 secretion by enzyme-linked immunosorbent assay (ELISA), assessed AMPKα, phosphorylated acetyl-CoA carboxylase (p-ACC), and acetyl-CoA carboxylase (ACC) by Western blot, and evaluated MUC5AC and zonula occludens-1 (ZO-1) localization by immunofluorescence.</p><p><strong>Results: </strong>Combined IL-13 and PA stimulation markedly elevated MUC5AC and CLCA1 mRNA and protein expression beyond IL-13 alone (P<0.001). In addition, combined stimulation further increased IL-8 secretion (P<0.001), indicating a stronger pro-inflammatory epithelial response after combining inflammatory and metabolic stimuli. In parallel, the p-ACC/ACC ratio, an indicator of AMPK activity, was lowest after combined IL-13 and PA exposure (P<0.001). AMPK activation with AICAR partially reversed MUC5AC, CLCA1, and IL-8 upregulation and restored ZO-1 continuity (P<0.001), whereas PRKAA1 knockdown further aggravated MUC5AC expression (P<0.01) and reduced p-ACC levels (P<0.05).</p><p><strong>Conclusions: </strong>PA amplifies IL-13-induced airway epithelial mucus phenotype through suppression of the AMPK axis. AMPK may represent a potential therapeutic target for mucus hypersecretion in obesity-related childhood asthma.</p>","PeriodicalId":23294,"journal":{"name":"Translational pediatrics","volume":"15 8","pages":"342"},"PeriodicalIF":2.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13559131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931259","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":"Stage-associated differences in injury and stress responses of hiPSC-derived cardiomyocytes under macrophage-derived inflammatory stimulation.","authors":"Wei Jing, Qingbin Liu, Xiaoyi Chang, Yuna Zhang, Jing Li","doi":"10.21037/tp-2026-0505","DOIUrl":"10.21037/tp-2026-0505","url":null,"abstract":"<p><strong>Background: </strong>Macrophage-driven inflammation contributes to myocardial injury in pediatric myocarditis, but the extent to which cardiomyocyte maturation status influences responses to inflammatory stimulation remains unclear. This study aimed to investigate stage-associated differences in human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) exposed to THP-1 macrophage-derived conditioned media and to explore the involvement of stress-response pathways.</p><p><strong>Methods: </strong>A macrophage-derived inflammatory microenvironment was modeled using THP-1-derived macrophage conditioned media (M0-CM and M1-CM). hiPSC-CMs at day 7 (D7) and day 21 (D21) were used as early-stage and relatively more mature in vitro stages, respectively. Cell viability was assessed using Cell Counting Kit-8 (CCK-8), and lactate dehydrogenase (LDH) release and cardiac troponin I (cTnI) levels were measured to evaluate injury. C/EBP homologous protein (CHOP) expression was analyzed by Western blot, and mitochondrial membrane potential (ΔΨm) was determined using tetraethylbenzimidazolylcarbocyanine iodide (JC-1) staining following small interfering RNA (siRNA)-mediated CHOP knockdown.</p><p><strong>Results: </strong>M1-CM significantly increased tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) levels compared with M0 and control groups (P<0.001), along with upregulation of inducible nitric oxide synthase (iNOS) (P<0.001). Under inflammatory stimulation, D7 hiPSC-CMs showed greater decreases in viability and greater LDH and cTnI release than D21 hiPSC-CMs in the stage-stratified analyses. CHOP expression was induced by M1-CM (P<0.001), and CHOP knockdown decreased LDH release (P<0.001) and partially restored ΔΨm (P<0.05).</p><p><strong>Conclusions: </strong>Early-stage hiPSC-CMs showed greater vulnerability to THP-1 macrophage-derived inflammatory stimulation than relatively more mature D21 cells in this <i>in vitro</i> model. CHOP-associated endoplasmic reticulum (ER) stress contributed partly to mitochondrial dysfunction, but this system does not fully recapitulate pediatric myocarditis and requires validation in more physiologically complex models.</p>","PeriodicalId":23294,"journal":{"name":"Translational pediatrics","volume":"15 8","pages":"301"},"PeriodicalIF":2.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13559075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931295","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}