罗玛琳达大学

Learning ObjectivesAfter studying this article, the participant should be able to (1) understand the incidence and trends of pediatric head and neck cancer; (2) identify the common tumors that present in the head and neck region; (3) describe the risk factors and pathogenesis associated with these malignancies, to identify children at risk; and (4) describe and understand the common presentations of these tumors to gain confidence in diagnosing these patients early in practice.SummaryPediatric head and neck malignancies are rare; however, their incidence is rising rapidly, with an incidence of 3.29 diagnoses per 100,000 person-years. These malignancies often present with nonspecific symptoms distinct from adults, making early diagnosis more challenging. Recognizing early symptoms in children is essential to improve treatment and long-term outcomes. This review discusses the incidence, pathogenesis, classification, and presentation of the common pediatric head and neck malignancies, including lymphoma, soft tissue sarcoma, thyroid carcinoma, salivary gland malignancies, bone malignancies, nasopharyngeal carcinoma, and melanoma.

This review synthesizes the key scientific discussions and clinical insights presented at the Core Conference of GlomCon Hawaii 2025, held in Oahu, Hawaii, from September 23–25, 2025.

BackgroundThe Lynch syndrome INtegrative Epidemiology And GEnetics (LINEAGE) consortium was established to address gaps in understanding genotype-specific cancer risks and risk-modifiers in contemporary North American Lynch syndrome (LS) populations. LINEAGE is a multi-center, longitudinal cohort to systematically collect data on risk factors, adherence to care, quality of surveillance, and patient-, provider-, and system-level factors associated with incident LS-associated cancers.MethodsLINEAGE recruits individuals with confirmed pathogenic or likely pathogenic variants in LS-associated genes from participating institutions. Data includes retrospective and prospective collection, encompassing clinical abstraction (demographics, surgical history, endoscopic data, treatments), patient-reported surveys (behavioral/lifestyle factors, quality of life, procedures), endoscopist-level data, and biosample metadata. A standardized REDCap database, data harmonization protocols, and a virtual biobank support reproducibility and linkage of clinical data and biosamples. Rigorous quality assurance/quality control processes are embedded for data integrity.ResultsParticipating centers will contribute data to determine gene-specific risks, and gene-environment interactions for Lynch-associated, and other cancers. We will evaluate associations with exposure to, and quality of cancer risk-reduction care, including endoscopic surveillance, risk-reduction surgery, and chemoprevention. The inclusion of provider-level variables, such as endoscopist training and experience, enables unique research into modifiers of post-endoscopy cancer risk. The linked biosample resources will further facilitate mechanistic studies and biomarker discovery.ConclusionsLINEAGE provides a robust platform for advancing LS research by integration of clinical, pathological, epidemiological and genetic data across institutions. Its standardized, collaborative framework enhances the validity and generalizability of risk estimates that will guide decision-making and policy for surveillance to ultimately reduce morbidity and mortality for individuals with Lynch syndrome.

QuestionIn preterm neonates supported with continuous positive airway pressure (CPAP), is early caffeine administration and less invasive surfactant administration (LISA) associated with a lower frequency of death or moderate to severe neurodevelopmental impairment (NDI) at 2 years compared with CPAP support alone?FindingsIn this secondary analysis of a randomized clinical trial of 180 infants born at a gestational age of 24 to 29 weeks 6 days, 82% had follow-up data, and death or NDI occurred in 23% receiving LISA compared with 33% receiving CPAP alone. This difference was not statistically significant.MeaningThese findings suggest that among preterm infants supported with CPAP, LISA was not associated with a reduction in death or NDI at 2 years. This secondary analysis of a randomized clinical trial of preterm infants examines whether early caffeine and less invasive surfactant administration are associated with reduced mortality or improvements in neurodevelopmental impairment at 2-year follow-up. ImportanceIn preterm neonates supported with continuous positive airway pressure (CPAP), early caffeine administration and less invasive surfactant administration (LISA) results in a lower frequency of endotracheal intubation. It is unknown whether this regimen improves outcomes at a corrected age of 2 years in this population.ObjectiveTo determine whether LISA improves neurodevelopmental impairment (NDI) and pulmonary outcomes at a corrected age of 2 years.Design, Setting, and ParticipantsThis prespecified secondary analysis and follow-up of a randomized clinical trial was performed at 3 academic medical centers in California. Participants included infants born at gestational ages ranging from 24 weeks 0 days to 29 weeks 6 days with follow-up assessments available. Follow-up visits occurred from May 2, 2022, to April 3, 2025.InterventionsInfants received intravenous caffeine by 2 hours of life followed by either less invasive surfactant administration (intervention group) or CPAP without initial surfactant administration (control group).Main Outcomes and MeasuresThe primary outcome was the composite of death or moderate to severe NDI at a corrected age of 2 years, as measured by the Bayley Scales of Infant Development (BSID). Secondary outcomes included components of the BSID composite; the third edition of the Ages and Stages Questionnaire (ASQ-3); developmental screening; pulmonary outcomes of bronchodilator use, oral and/or inhaled corticosteroid use, or hospitalizations with respiratory diagnoses after discharge; and results of an autism screen.ResultsOf 180 randomized infants, 147 (81.7%) had follow-up assessments available (74 in the LISA group and 73 in the CPAP group); 75 infants (51.0%) were male. The mean (SD) gestational age at the time of the Bayley assessment was 24.6 (1.5) months corrected age for the LISA group and 24.7 (2.2) months corrected age for the CPAP group. The mean (SD) chronological age for the ASQ-3 was 28.1 (2.4) months for both groups. Death or moderate to severe NDI occurred in 17 of 74 children (23.0%) in the LISA group and 23 of 70 (32.9%) in the control group (odds ratio [OR], 1.56 [95% CI, 0.77-3.17]; P = .22). On the screening ASQ-3, infants in the LISA group had no statistically significant differences in rates of typical development (22 of 69 [31.9%] vs 12 of 67 [17.9%]; OR, 0.47 [95% CI, 0.21-1.04]; P = .06) and scores indicating possible delay (43 of 69 [62.3%] vs 47 of 67 [70.1%]; OR, 1.42 [95% CI, 0.70-2.90]; P = .34) compared with the control group. Children in the LISA group were more likely to have a mean (SD) fine motor z score in the reference range (-0.59 [1.10] vs -1.00 [1.01]; P = .03). There were no differences between the LISA and CPAP groups in bronchodilator use, oral and/or inhaled corticosteroid use, or postdischarge hospitalizations with respiratory diagnoses.Conclusions and RelevanceIn this secondary analysis of a randomized clinical trial of preterm infants supported with CPAP, early caffeine administration plus LISA did not reduce the incidence of death or moderate to severe NDI noted on the BSID. Infants who received LISA were more likely to have a fine motor domain score in the reference range on ASQ-3 developmental screen.Trial RegistrationClinicalTrials.gov Identifier: NCT04209946

PurposeAutologous fat transfer is widely used in reconstructive and aesthetic surgery; however, its efficacy is often limited by suboptimal fat graft survival. Various pharmacological adjuncts have been proposed to enhance fat graft viability. This study aims to assess and rank potential adjuvant agents based on their effectiveness, safety, Food and Drug Administration (FDA) approval for human use, and clinical applicability to identify the most promising candidate for future clinical trials.MethodsIn this targeted literature review, a weighted scoring analysis was conducted to evaluate several adjuncts proposed to improve fat graft viability. The scoring framework incorporated 6 key domains: FDA approval for human use, effectiveness in animal models, dosing optimization, safety in humans, mechanistic rationale, and cost-effectiveness. Each of the first 5 domains was scored on a 1-to-5 scale based on strength of supporting evidence, whereas cost-effectiveness was scored on a 1-to-3 scale. Total scores were calculated by summing all 6 domain scores, allowing a comparative ranking of adjuncts with the highest translational potential. The agents evaluated included deferoxamine, insulin with beta-fibroblast growth factor, poloxamers, ADE4+ endothelial cells, hyaluronan hydrogel, botulinum toxin A, and a combination of prostaglandin E2 with polydeoxyribonucleotide.ResultsDeferoxamine received the highest total score (22/28) and demonstrated robust preclinical evidence supporting its ability to promote angiogenesis, reduce oxidative stress, and enhance fat graft retention by up to 50%. Insulin combined with beta-fibroblast growth factor scored 18, showing promising effectiveness but limited by lack of FDA approval. Hyaluronan hydrogel and poloxamers followed with scores of 17 and 16, respectively. Botulinum toxin A scored 15, limited by inconsistencies in efficacy data in fat grafting. Prostaglandin E2 with polydeoxyribonucleotide scored 15, and ADE4+ endothelial cells scored 14 because of limited approval and less compelling results in improving fat graft viability.ConclusionDeferoxamine emerged as the top translational candidate due to its dual role as an iron chelator and hypoxia-mimetic, reducing oxidative injury and promoting vascular regeneration. Our team is currently conducting ex vivo studies exposing human adipose grafts to deferoxamine and assessing viability with confocal microscopy. These results will inform optimal delivery and design of future clinical trials.