OBJECTIVES:To identify predictors of chronic ITP (cITP) and to develop a model based on several machine learning (ML) methods to estimate the individual risk of chronicity at the timepoint of diagnosis. METHODS:We analyzed a longitudinal cohort of 944 children enrolled in the Intercontinental Cooperative immune thrombocytopenia (ITP) Study Group (ICIS) Children's Initiative. cITP was defined as a platelet count <100 × 109/L at 12 months post diagnosis. Thirty-six clinical and laboratory variables collected at diagnosis were evaluated, and key predictors were selected using ML approaches. Model performance was assessed by the area under the receiver operating characteristic (ROC) curve. RESULTS:cITP developed in 28.7% of patients. Six variables were identified as the most informative predictors of chronicity. The ML model achieved an area under the ROC curve of 73.7% for predicting cITP at diagnosis. CONCLUSIONS:ML-based prediction models can identify children at increased risk for cITP at the time of diagnosis. Integration of such tools into prospective registries may enhance prognostic accuracy and support individualized clinical decision-making.
Background/Objectives: Uremic pruritus is a common complication in patients with end-stage kidney disease undergoing maintenance hemodialysis. Despite its high prevalence and substantial impact on sleep, psychological well-being, and overall quality of life, its pathophysiology remains multifactorial and incompletely understood. This narrative review summarizes contemporary evidence (2015-2025) on therapeutic strategies for uremic pruritus, with an emphasis on emerging treatments and evolving mechanistic insights. Methods: A PubMed search was conducted for original clinical studies published between 1 January 2015, and 31 October 2025, evaluating treatments for uremic pruritus in adult hemodialysis patients. Eligible study designs included randomized controlled trials and observational interventional studies. Non-English articles, pediatric studies, peritoneal dialysis studies, reviews, case reports, and studies of mixed-etiology pruritus were excluded. Earlier literature was reviewed to contextualize epidemiology and pathophysiology. Results: The review identifies multiple interacting mechanisms-including uremic toxins, immune dysregulation, mineral abnormalities, xerosis, neuropathic changes, and dysregulated opioid signaling-contributing to itch generation. Topical therapies, especially emollients and humectants, consistently improved symptoms with excellent safety profiles. Optimization of dialysis adequacy and membrane selection showed benefit in selected patients. Among systemic therapies, gabapentinoids demonstrated the most robust efficacy but required cautious dosing. Sertraline, nalbuphine, and difelikefalin showed significant antipruritic effects in controlled trials. Emerging therapies, including AST-120, omega-3 fatty acids, and the biologic dupilumab, demonstrated promising but preliminary results. Conclusions: Management of uremic pruritus requires a multifaceted, individualized approach integrating skin-directed therapies, dialysis optimization, and targeted systemic treatments. Ongoing research is needed to identify reliable biomarkers and to develop safer, more effective, mechanism-based therapies.
Background/Objectives: Wilms' tumor (WT) is the most common malignant renal tumor in childhood, and although survival rates are high, a subset of patients with high-risk disease remain prone to treatment resistance and relapse. Increasing evidence suggests that the tumor microenvironment, particularly tumor-associated macrophages (TAMs), may influence tumor behavior and therapeutic response. This study aimed to characterize M1 and M2 macrophage infiltration in WT treated with neoadjuvant chemotherapy according to the International Society of Pediatric Oncology (SIOP) protocol and to evaluate their association with clinicopathological features. Methods: Tumor tissue samples from 46 pediatric patients were analyzed using double immunohistochemical staining for CD80 (M1) and CD163 (M2) macrophages. TAM density and M1/M2 ratios were quantified in viable tumor areas and correlated with clinical, laboratory, and pathohistological parameters. Results: Total TAM counts were significantly higher in tumors with a volume ≥ 500 mL and in unifocal tumors. Both M1 and M2 macrophages were more abundant in larger tumors; however, M2 macrophages predominated overall. The M1/M2 ratio was positively associated with total TAM counts and was significantly higher in tumors with larger volume, elevated serum neuron-specific enolase, and increased creatinine levels. Regressive histological subtypes exhibited a higher M1/M2 ratio compared with other subtypes. No significant associations were observed between macrophage infiltration and tumor stage or risk group. Conclusions: WT treated with neoadjuvant chemotherapy demonstrates low overall macrophage infiltration with a predominance of M2 macrophages. TAM polarization appears to be associated with tumor burden and selected biochemical parameters, highlighting the potential relevance of macrophages as biomarkers and therapeutic targets in WT.
The article by Jiang et al.,presents a comprehensive approach to improve the early diagnosis of biliary atresia(BA),a critical pediatric liver disease[1].
