Children’s bones are more elastic and have a thicker periosteum than those of adults, resulting in subtle, incomplete fractures. Diagnosis based on plain radiographs alone can be challenging. The shortage of pediatric radiologists compounds this difficulty, leading to a risk of missed fractures. Therefore, we considered that it might be possible to help prevent missed fractures by developing and validating an automated detection model for pediatric forearm fractures on plain radiographs using deep learning techniques (convolutional neural networks [CNNs] and Vision Transformers [ViTs]). To train and validate such a model, this study targeted the frontal and lateral views of plain radiographs from 517 patients aged 1–14 years with forearm fractures. We first performed preprocessing to focus on the forearm region in the images. Thirteen models (visual geometry group [VGG], ResNet, DenseNet, and ViT) were used to classify the presence or absence of fractures and were evaluated and compared using 5-fold cross-validation. Verification of these models showed that VGG16 exhibited the best performance. The overall result, which integrated the predictions from the frontal and lateral views, achieved a sensitivity of 0.872 ± 0.015, a specificity of 0.925 ± 0.016, a balanced accuracy of 0.898 ± 0.003, and an AUC of 0.962 ± 0.002. Furthermore, visualization of saliency maps (using gradient-weighted class activation mapping and an attention map) revealed that the model focused on the bone during prediction. Therefore, if the proposed method is used in hospitals, it could possibly support diagnosis and help reduce missed fractures.
BACKGROUND:Streptococcus agalactiae (Group B Streptococcus, GBS) is a leading cause of invasive neonatal and infant infections, including sepsis and meningitis. This study aimed to estimate the vaccine coverage and characterize the genomic features of pediatric invasive GBS in Japan. METHODS:We conducted a nationwide, multicenter, retrospective genomic surveillance study involving 237 GBS isolates from sterile specimens of children aged ≤15 years across 35 hospitals in Japan between 2004 and 2023. Serotyping, antimicrobial susceptibility testing, and whole-genome sequencing were performed. RESULTS:The estimated vaccine coverage was 98.3% for the hexavalent polysaccharide vaccine and 94.9% for the GBS-NN/NN2 protein vaccine. Erythromycin and clindamycin resistance were observed in 61.2% and 43.5%, respectively. Among the 75 CC17 isolates, 59 (78.7%) contained only PI-2B and harbored both ermB and tetO, indicating the predominance of a multidrug-resistant clone. Single nucleotide polymorphism-based analysis revealed evidence of nosocomial transmission and persistent regional circulation, particularly within the ST17 and ST23 lineages. CONCLUSIONS:This study suggests that current maternal GBS vaccine candidates would provide broad coverage for pediatric invasive infections in Japan. The identification of persistent and regionally disseminated lineages highlights the importance of investigating potential, yet, poorly understood, transmission routes, including environmental reservoirs, to inform future prevention strategies.
Background/Objectives: Although Tumor-Treating Fields (TTFields) therapy is an established treatment modality for adult glioblastoma, clinical data on its efficacy in pediatric brain tumors are extremely scarce. The present study aimed to evaluate the safety of TTFields therapy for pediatric diffuse high-grade glioma (HGG) and to conduct an exploratory analysis of its efficacy. Methods: A prespecified, interim analysis was performed to determine whether the study should be continued on the basis of safety and feasibility data on the first three patients. The target population was children aged 5 to 17 years with newly diagnosed, supratentorial HGG or its first recurrence following frontline therapy. After completion of initial, local treatment for the tumor (surgical removal and/or radiotherapy), all patients received TTFields therapy using OptuneTM for 28 days per course for up to 26 courses until disease progression. Results: The interim analysis, which was completed in October 2022, included three female patients aged 14, 17, and 9 years. All had a histological grade 4 tumor, two of which were radiation-induced, secondary HGG. No serious, treatment-related toxicities or device-related issues were observed. All three patients were able to continue using the device for 75% or more of the time in accordance with the protocol, suggesting that the treatment was feasible. The MRI findings of two patients indicated that the treatment has a potential antitumor effect. Based on these results, the study was resumed and is currently being continued at multiple centers. Conclusions: The initial results of the prespecified, interim analysis demonstrated that TTFields therapy was safe and feasible for children with HGG. This study was funded by the Japan Agency for Medical Research and Development (AMED) and was registered with the Japan Registry of Clinical Trials (jRCTs032200423).
The objective was to prepare guidelines to perform the current optimum treatment by organizing effective and efficient treatments of hemangiomas and vascular malformations, confirming the safety, and systematizing treatment, employing evidence-based medicine techniques and aimed at improvement of the outcomes. Clinical questions (CQs) were decided based on the important clinical issues. For document retrieval, key words for literature searches were set for each CQ and literature published from 1980 to the end of December 2020 was searched in PubMed, and Japana Centra Revuo Medicina (JCRM). The strengths of evidence and recommendations acquired by systematic reviews were determined following the Medical Information Network Distribution Service (Minds) technique. A total of 38 CQs were used to compile recommendations and the subjects included efficacy of resection, sclerotherapy/embolization, drug therapy, laser therapy, radiotherapy, and other conservative treatment, differences in appropriate treatment due to the location of lesions and among symptoms, appropriate timing of treatment and tests, pathological diagnosis deciding the diagnosis, and causal genes of vascular anomalies. Thus, the Japanese clinical practice guidelines for vascular tumors, vascular malformations, lymphatic malformations, and lymphangiomatosis 2022 have been prepared as the evidence-based guidelines for the management of vascular anomalies.
BACKGROUND:Antimicrobial de-escalation (ADE) is recommended within antimicrobial stewardship programs; however, its safety and impact on multidrug-resistant organism (MDRO) emergence in critically ill patients remain uncertain. METHODS:We retrospectively studied adults (aged≥18 years) in a 12-bed intensive care unit (ICU) of a tertiary hospital in Tokyo, Japan, who received empirical antimicrobials for ≥72 h between January 2020 and December 2024. Patients were classified into ADE and No-ADE groups according to the European Society of Intensive Care Medicine/European Society of Clinical Microbiology and Infectious Diseases criteria. The primary outcome was 28-day mortality, whereas secondary outcomes were 90-day mortality and new MDRO detection. Multivariable and propensity score-matched analyses were performed. RESULTS:Among 960 patients, ADE occurred in 330 (34.4%). No significant differences were observed between ADE and No-ADE groups in 28-day mortality (11.8% vs. 10.8%) or 90-day mortality (17.3% vs. 17.5%). The proportion of patients with newly detected MDRO within 90 days was lower in the ADE group (5.5% vs. 9.2%). However, ADE was not independently associated with mortality. Although crude MDRO incidence was lower in the ADE group, multivariable analysis showed a statistically significant association between ADE and MDRO detection. ADE was associated with shorter empirical antimicrobial duration and ICU stay. CONCLUSIONS:ADE was not associated with increased mortality. Reduced empirical antimicrobial exposure and shorter ICU stay likely reflect stewardship-related processes rather than a direct causal effect.
