Search Results (21,302)

Background: The timing of delivery depends on the condition of the fetus and the mother’s body, which is reflected in both the incretion of enzymes in the pregnant woman’s body and their use by the developing fetus in the anabolic process. The aim: This work was aimed to analyze the activities of transaminases (aspartate aminotransferase (AST) and alanine aminotransferase (ALT)) and alkaline phosphatase (AlPh) in liquid media (blood serum, amniotic fluid, umbilical cord blood, and placental homogenate) in pregnant women in each trimester of pregnancy and in the postpartum period, considering the timing and type of delivery (term, premature or late delivery, or cesarean section). Methods: Data from studies in non-pregnant (n = 45) and pregnant (n = 193) women, including women in labor with different delivery timings (term, premature, and late) and types of delivery (natural birth or cesarean section), were analyzed. Amniotic fluid, umbilical cord blood, and the placental homogenate were collected during labor. The de Ritis coefficient (AST/ALT) was calculated. Alkaline phosphatase activity was determined using the standard constant-time method using Lahema diagnosticum biotests, and transaminase activity was determined using the colorimetric dinitrophenylhydrazine method, according to Reitman and Frenkel. Outcomes: The highest alkaline phosphatase activity was recorded in the placenta homogenate (6906.2 ± 208.1 U/mL) in pregnant women who gave birth at term. The highest transaminase activity was found in umbilical cord blood and, in particular, in the placenta in pregnant women with premature and late births. Conclusions: The significant role of transaminases and alkaline phosphatase in the transport functions of the histohematic barriers of the mother and fetus was established, which provides a mechanism for the constancy of enzyme levels in blood plasma. Full article

Hemophilic arthropathy (HA) is a complication of hemophilia, which is a genetic disorder characterized by a deficiency in blood clotting factors. HA is characterized by joint damage with inflammatory responses, pain, and movement limitations due to recurrent bleeding in the joints. The inflammatory reactions contribute to the activation of coagulation factors, which can exacerbate bleeding and further damage the affected joints. Therefore, the interaction between inflammation and coagulation plays a crucial role in the progression and complications of HA. Management strategies often focus both on inflammation and coagulation to alleviate symptoms and preserve joint function. Temperature can influence the inflammatory response and coagulation. The aim of this work was to understand how temperature management can positively or negatively influence the HA. We have carried out a narrative review of the available literature. This review explores the impacts of temperature on biological processes, and it discusses the possible clinical implications for the HA treatment. Our research shows that cold exposure has anti-inflammatory and analgesic effects, while heat is linked to pro-inflammatory cytokine release. Both hot and cold treatments are ill-advised for hemophilia patients. Heat stimulates neo-angiogenesis, and cold hampers coagulation, posing risks for increased bleeding in individuals with hemophilia. Full article

Introduction: The rise in youth sports participation has led to an increase in pediatric sports-related injuries in the United States, contributing to growing healthcare costs and exacerbating socioeconomic disparities. Insurance payor status is a critical factor influencing access to care, treatment delays, and health outcomes. This study examines the association between insurance payor status and outcomes in pediatric sports-related injuries. Methods: A systematic review of the Medline database was conducted. Included studies reported insurance payor status and pediatric sports orthopedic patient outcomes following surgery. Outcomes included time to be seen by a provider, treatment access, complication and revision rates, postoperative Emergency Department (ED)/Urgent Care utilization, readmission rates, hospital length of stay, pain, functional scores, discharge destinations, return to activity, and follow-up. Results: A total of 35 studies comprising 535,891 pediatric patients were included. Publicly insured or uninsured patients consistently experienced significant delays in accessing care, with average wait times for clinic visits, imaging, and surgery up to six times longer compared to privately insured patients. These delays were associated with worsened injury severity, higher rates of postoperative complications, and poorer functional outcomes. Publicly insured patients were less likely to receive advanced treatments such as bracing or physical therapy, further compounding disparities. Minority groups faced delays even when controlling for insurance status. Conclusions: Public and uninsured pediatric patients face systemic barriers to timely and equitable care, resulting in worse outcomes following sports-related injuries. Future research should explore targeted solutions to ensure equitable care for this vulnerable population. Full article

Background/Objectives: It is increasingly realized that the advances in diagnosis and treatment for those born with congenitally malformed hearts have now resulted in avoidance of morbidity being equally as important as avoiding postoperative mortality. Detailed personalized diagnoses will now be key to achieve such improvements. Methods: We have reviewed our own experience in diagnosing major phenotypic variations on selected congenital cardiac malformations, showing that the ability to personalize the findings is at hand, although not always to date universally employed. Results: We have chosen four categories to illustrate how the definitions now provided by the International Nomenclature Society, and incorporated in the 11th iteration of the International Classification of Disease, make it possible to provide personalized diagnoses. The lesions chosen for review are the arrangement of the atrial appendages, the lesions permitting interatrial shunting, the options in the setting of deficient ventricular septation, and the abnormal morphology of the aortic root. We show that not all centers, as yet, are taking advances of these opportunities at hand to tailor the chosen treatments. Conclusions: Detailed phenotypic definitions have now been provided for all the major congenital cardiac malformations. Use of these definitions should now provide personalized medicine for all those born with malformed hearts. As yet, the definitions are not used to their full effect. Full article

Genetic profiling and molecular biology methods have made it possible to study the etiology of the end-stage organ disease that led to transplantation, the genetic factors of compatibility and tolerance of the transplant, and the pharmacogenetics of immunosuppressive drugs and allowed for the development of monitoring methods for the early assessment of allograft rejection. This study aims to report the design and baseline characteristics of an integrated personalized genetic approach in solid organ transplantation, including whole-exome sequencing (WES) and the monitoring of dd-cfDNA by dPCR. Preliminary results reported female recipients with male donors undergoing two pediatric and five adult kidney and three heart transplantations. WES revealed a pathogenic mutation in RBM20 and VUS in TTN and PKP2 in heart recipients, while kidney donors presented mutations in UMOD and APOL1 associated with autosomal-dominant kidney diseases, highlighting the risks requiring the long-term monitoring of recipients, donors, and their family members. %dd-cfDNA levels were generally stable but elevated in cadaveric kidney recipient and one pediatric patient with infectious complications and genetic variants in the ABCB1 and ABCC2 genes. These findings highlight the potential of combining genetic and molecular biomarker-based approaches to improve donor–recipient matching, predict complications, and personalize post-transplant care, paving the way for precision medicine in transplantation. Full article

Malignant glioma is a highly aggressive, therapeutically non-responsive, and deadly disease with a unique tumor microenvironment (TME). Of the 14 currently recognized and described cancer hallmarks, five are especially implicated in malignant glioma and targetable with repurposed drugs: cancer stem-like cells, in general, and glioma stem-like cells in particular (GSCs), vascularization and hypoxia, metabolic reprogramming, tumor-promoting inflammation and sustained proliferative signaling. Each hallmark drives malignant glioma development, both individually and through interactions with other hallmarks, in which the TME plays a critical role. To combat the aggressive malignant glioma spatio-temporal heterogeneity driven by TME interactions, and to overcome its therapeutic challenges, a combined treatment strategy including anticancer therapies, repurposed drugs and multimodal immunotherapy should be the aim for future treatment approaches. Full article

Glycyrrhiza uralensis Fisch. is a medicinal herb that can be added to food to provide therapeutic effects and reduce the burden of medications. Herein, the immunomodulatory effects of Glycyrrhiza polysaccharides (GPs) were verified and illustrated by intervening immunocompromised rats treated with different doses of GPs, which were reflected for adjusting the composition and structure of the intestinal microbiota and altering the metabolic profile. The immunomodulatory effects of GPs were exerted by regulating the intestinal microenvironment. In particular, GPs could promote the growth of probiotic bacteria Allobaculum, norank__o_Clostridia_UCG-014, Dubosiella, and g__norank_o___RF39 and curb the growth of harmful bacteria Enterococcus. The results showed that GPs had a prebiotic effect, which contributed to improving the intestinal environment and maintaining intestinal health. In addition, the content of beneficial differential metabolites was up-regulated, especially short-chain fatty acids, with alanine, aspartate, and glutamate metabolism; arginine biosynthesis; glyoxylate and dicarboxylate metabolism being the most enriched pathways. These metabolic pathways imply the metabolic process of GPs, and the metabolic pathways and differential effector metabolites of it are focused. Overall, the purpose of this article lies in providing support for the application of GPs for regulating immune function. Full article

Background/Objectives: While there are several debates on en bloc renal transplants and pediatric donors regarding the efficacy and concern for renal mass, multiple studies have supported the notion that transplanting pediatric en bloc kidneys produces comparable results in contrast to single kidneys from living or deceased donors. Methods: This case series included a retrospective analysis of a university medical center, primarily focused on comparing the post-operative outcomes between recipients of pediatric and adult en bloc kidneys, which are horseshoe kidneys, from deceased donors and recipients of single adult kidneys from living or deceased donors. Results: This study demonstrated that the post-operative results in recipients of pediatric en bloc kidneys consisting of serum creatinine and estimated glomerular filtration rate (eGFR) values were lower and higher, respectively, and had a comparable improvement in kidney function at post-transplant, 1-week, 1-month, 3-months, and 1-year post-op marks. Conclusions: Our center data and outcomes indicate that en bloc kidney transplantation from pediatric donors yields comparable results to that of single kidney transplantations from living and deceased donors. Full article

Background: Helicobacter pylori is the most prevalent chronic bacterial infection globally, acquired mostly during childhood. It is associated with chronic gastritis, peptic ulcer disease, and gastric cancer. Due to challenges in culturing H. pylori, diagnostic reference standards often rely on combining ≥2 non-culture, biopsy-based methods. Histology with Giemsa staining is widely used in clinical settings due to its low cost and reliable performance. Methods: This study evaluated the concordance between histology with Giemsa staining as the reference standard and other diagnostic methods, including the rapid urease test (RUT), ureA RT-PCR, 16S sequencing, and anti-H. pylori serum IgG. Positive percent of agreement (PPA), negative percent of agreement (NPA) and concordance kappa index were calculated. Results: A total of 120 patients (41 positive and 79 negative by Giemsa staining) were analyzed. Among the methods tested, RT-PCR for ureA showed the best performance (PPA = 94.7%, NPA = 98.6%, kappa = 0.939), while RUT underperformed compared with expectations (PPA = 65.9%, NPA = 97.5%, kappa = 0.681). Serology had the lowest performance (PPA = 53.7%, NPA = 96.1%, kappa = 0.548). Conclusions: The combination of histology with Giemsa staining and ureA RT-PCR achieved the highest detection rate and strongest agreement. Full article

The accurate detection of Mycobacterium tuberculosis (MTB) is a pressing challenge in the precise prevention and control of tuberculosis. Currently, the efficiency and accuracy of drug resistance detection for MTB are low, and cross-contamination is common, making it inadequate for clinical needs. This study developed a rapid nucleic acid detection method for MTB based on scattering loop-mediated isothermal amplification (LAMP). Specific primers for the MTB-specific gene (Ag85B) were designed, and the LAMP reaction system was optimized using a self-developed scattering LAMP turbidimeter. Experimental results showed that the optimal reaction system included 1.5 µL of 100 mmol/L magnesium ions, 3.5 µL of 10 mmol/L dNTPs, 6 µL of 1.6 mol/L betaine, and a reaction temperature of 65 °C. The minimum detection limit was 12.40 ng/L, with the fastest detection time being approximately 10 min. The reaction exhibited good specificity, with no amplification bands for other pathogens. Twenty culture-positive samples and twenty culture-negative samples were tested in parallel; the accuracy of the positive group was 100%, the detection time was (24.9 ± 13 min), and there was no negative detection. This method features high detection efficiency, low cost, high accuracy, and effectively reduces cross-contamination, providing a new technology for the rapid clinical detection of MTB. Full article

Various prenatal and postnatal factors such as gestational age, mode of delivery, sex, antibiotic exposure, feeding type, duration of feed and other exposures associated with the hospital environment can drive the formation of gut microbiota. In the current study, we examined the role of all these factors in the gut microbiota of healthy Indian preterm infants admitted to NICU in the first four weeks of life. Preterm neonates admitted to the NICU from April 2023 and October 2023 were recruited and fecal samples were collected weekly once beginning from the seventh day till the 30th day of life. 16s rRNA gene sequencing was performed on the NovaSeq 6000 platform. The PICRUSt2 tool was used to predict the functional profiles of the gut microbiome. A total of 61 samples were collected from 16 preterm infants. Alpha and beta diversity showed the administration of probiotics, postnatal age, mode of delivery, and sex of infants as major contributors to altered microbial diversity in preterm infants. The MaAsLin2 analysis showed that the supplementation of probiotics increased Bifidobacterium levels. PICRUSt2 analysis revealed that probiotic supplementation increased the bacterial genes responsible for bile acid metabolism and glycosphingolipid synthesis. Probiotics and postnatal age are responsible for alterations of the gut microbial composition in healthy preterm infants. Full article

Background and Objectives: The COVID-19 pandemic globally has negative effects on mental health. Research from Western countries, such as the US, Canada, Australia, and Europe, shows that the COVID-19 pandemic is associated with an increased trend of anorexia nervosa (AN) among children and adolescents. However, the trend after the pandemic in Eastern countries, including Japan, is not well-understood, and it remains unclear whether the pandemic is associated with the trend in these countries. This study aimed to examine the association between the COVID-19 pandemic and the newly diagnosed AN among children and adolescents in Japan. Materials and Methods: Using the nationwide multi-hospital database in Japan, we analyzed the clinical outpatient data in the departments of pediatrics, psychosomatic medicine, and psychiatry. The participants comprised children and adolescents aged 7–19 years newly diagnosed with AN from January 2017 to January 2022. An interrupted time series analysis was used to compare the trends of newly diagnosed AN before and after the COVID-19 pandemic. Estimating the changes in the trends over the pandemic was performed using a Poisson regression model. Results: The total cases of newly diagnosed AN were 41 cases diagnosed in 38 months (1.08 cases per month) before the pandemic and 34 in 23 months (1.48 cases per month) after the pandemic. Notably, in the 7–14 age group, the cases per month increased from 0.74 to 1.13 cases per month over the period. Before the pandemic, a decrease in cases was observed (Incidence Rate Ratio [IRR] = 0.961; 95% CI = 0.932–0.990). Conversely, the after-pandemic period showed a contrasting trend, with increased cases (IRR = 1.096; 95% CI = 1.032–1.176). Furthermore, the number and cases per month in boys increased over the period, from 1 to 5 cases and from 0.03 to 0.22 cases per month, compared to girls from 28 to 26 cases and from 1.05 to 1.26 cases per month. Conclusions: Our findings suggest that sociocultural differences at a national level may not affect the trend of AN after the pandemic. The pandemic and lifestyle changes after the pandemic occurred in both Western and Eastern countries. Considering that, individual, parental, and peer factors related to the pandemic and the consequent lifestyle changes may be more associated with the development of AN. Further research in different countries is needed to elucidate the mechanisms of AN and the long-term impact of the pandemic. Full article

Background/Objectives: Recombinant growth hormone (rhGH) treatment plays an important role in the transition phase in those subjects diagnosed as having persistent growth hormone deficiency (GHD). We aimed to identify the main predictors of persistent GHD in a large cohort of subjects with childhood-onset GHD who underwent retesting and their correlation with height gain and mid-parental height (MPH). Methods: Anthropometric data, such as growth rate; bone age (BA); IGF-1 SDS at the start, at 1 year, and at the end of rhGH therapy; GH peak at diagnosis and at retesting; brain Magnetic Resonance Imaging (MRI) at diagnosis; and height gain upon reaching final height (FH) and compared to MPH, were obtained from medical records of GHD patients. Results: Persistent GHD was detected in 37 out of 91 (40.7%) GHD subjects. In univariate analysis, persistent GHD was associated with growth rate at 1 year (p = 0.0117) and with the first test GH peak (p = 0.0290). In the regression analysis, persistent GHD was positively associated with growth rate at 1 year (p = 0.0294) and negatively with female gender (p = 0.0424). Height gain was positively associated with growth rate (p = 0.0010) and with age at onset (p = 0.0021), while an inverse association with BA at baseline (p = 0.0002) and IGF-1 SDS (p = 0.0321) was found. Conclusions: Our study confirmed that the most important predictor of persistent GHD is the growth rate in the first year of therapy. Furthermore, growth rate in the first year, female gender, and lower BA at diagnosis are predictors of rhGH efficacy both in terms of height gain and target height achievement. Full article

Background and Objectives: This study aimed to examine the influence of socio-demographic factors (marital status, number of children, and education level) on the knowledge, attitudes, and practices (KAP) concerning Early Childhood Caries (ECC) prevention among parents in Bihor, Romania. This research seeks to address the lack of regional data on the influence of socio-demographic factors, such as marital status, number of children, and education level, on parental knowledge, attitudes, and practices regarding ECC prevention. These insights are essential for developing targeted public health interventions in Romania. Materials and Methods: Conducted from March to September 2024, this cross-sectional study utilized a KAP questionnaire distributed online to parents of children under six. The survey was adapted to local contexts and included sections on demographic data and ECC-specific knowledge, attitudes, and practices. Statistical analyses, including Chi-square tests, were performed to evaluate the relationship between socio-demographic factors and KAP outcomes, ensuring robust data interpretation under ethical standards set by the Declaration of Helsinki. Results: Of the 798 respondents who accessed the questionnaire, 419 completed it, resulting in a completion rate of 52.5%. The participants had a mean age of 33.8 years. In terms of gender distribution, 348 (83.1%) were female and 71 (16.9%) were male. Higher educational levels were strongly correlated with better ECC knowledge and preventive practices; parents with university degrees demonstrated significantly better understanding and engagement in ECC prevention (p < 0.05). Married parents participated more actively in ECC prevention than unmarried ones, with 61.1% adhering to recommended practices compared to significantly lower rates among unmarried parents (p = 0.020). While this difference was statistically significant, the lower representation of unmarried parents in the sample should be considered when interpreting this finding. Families with fewer children showed more effective ECC preventive practices (p = 0.001). Conclusions: The study suggests that higher education and smaller family sizes are associated with better ECC prevention behaviors, emphasizing the need for targeted public health interventions. These could include parental education campaigns on ECC prevention, community-based oral health workshops, subsidized fluoride programs, and increased accessibility to pediatric dental services for underprivileged families. Full article

Background/Objectives: Assessing antibiotic MICs at high bacterial counts is likely to disclose hidden bacterial resistance and the inoculum effect if present and therefore also reveal potential decreased antibiotic effectiveness. In the current study, we evaluated the predictive potential of MICs determined at high bacterial inocula to evaluate meropenem effectiveness and emergence of resistance in Klebsiella pneumoniae. Methods: Nine carbapenemase-free or carbapenemase-producing K. pneumoniae strains were exposed to meropenem in an in vitro hollow-fiber infection model (HFIM). The treatment effects were correlated with simulated antibiotic ratios of the area under the concentration–time curve (AUC) to the MIC (AUC/MIC) and to MICs determined at high inocula (AUC/MIC_HI). Results: Based on MICs determined at standard inocula, meropenem effects at different AUC/MIC ratios for both carbapenemase-free and carbapenemase-producing K. pneumoniae strains were stratified and could not be described by a single relationship. In contrast, when AUC/MIC_HI ratios were used, a single relationship with the antibiotic effect was obtained for all tested strains. Similarly, the emergence of meropenem resistance in HFIM was concordant with AUC/MIC_HI, but not with AUC/MIC ratios. Conclusions: MICs determined at high bacterial inocula enable the prediction of meropenem effects both for carbapenemase-free and for carbapenemase-producing K. pneumoniae strains. Also, MICs at standard and high inocula can identify carbapenemase-producing strains by revealing the inoculum effect. Full article