Estimated glomerular filtration rate (eGFR) is preferred, especially in more vulnerable populations, since direct GFR measurement involves an invasive and time-consuming procedure. Routinely, various existing equations are used to calculate eGFR, but there is room for improvement, motivating interest in using machine learning (ML) models for eGFR prediction. Evidence has shown that ML models can outperform equations in younger populations, though performing comparably in general populations. We included seven ML algorithms and three equations and conducted intra-comparisons and inter-comparisons across three variants: serum creatinine- (SCr), cystatin C- (CysC) and SCr/CysC-based models for predicting eGFR in children, adolescents, and young adults. Hyperparameter optimization was performed to support model selection. We compared the selected ML models built either with data from the full age range or between 2 and 25 years. Finally, we investigated including equation-derived estimates as additional features in ML models. Performance was evaluated using Lin’s concordance correlation coefficient (Lin’s CCC), P10, P30, and Passing-Bablok regression. the SCr/CysC-based random forest (RF) appeared as one of the most robust and strong ML models, and showed improved agreement with mGFR when compared to evaluated equations and single biomarker machine learning model and equation variants, with Lin’s CCC values of 0.80 (0.78, 0.82), P10 0.41 (0.38, 0.43) and P30 0.89 (0.87, 0.91). However, no performance difference was detected between RF models trained on different age cohorts. Finally, integrating equation-derived estimates as additional features into the SCr/CysC-based RF model improved the accuracy to P10 0.45 (0.42,0.48). When focusing on children, adolescents, and young adults (2–25 years), RF, irrespective of the training cohort, is one of the most robust ML models and had an improved or comparable performance with the evaluated equations. Using equation-derived estimates as features significantly improved RF performance. The best-performing model combined biomarkers, demographic information, and equation-derived estimates, indicating a complementary role of ML and domain knowledge captured by the evaluated GFR equations.
Dental caries remains a global public health challenge, and dental treatment under general anesthesia (DGA) is often necessary in uncooperative pediatric patients. Although Japan has a well-established universal healthcare system, DGA provision is limited and concentrated in urban areas. Children with neurodevelopmental disorders (NDDs) may need to travel farther to receive DGA for dental caries, particularly in Hokkaido, which is characterized by a vast geographic area and high rurality index. This study aimed to examine whether NDDs were associated with longer travel distance among children receiving DGA for dental caries. We conducted a single-center retrospective cross-sectional study of pediatric participants (age: ≤12 years) who underwent DGA for dental caries between 2015 and 2020. The primary outcome was the distance (km) from their residence to the treatment facility. The secondary outcome was a travel distance of ≥ 16 km, and the sensitivity outcome was crossing the secondary healthcare service area boundaries. Multivariable linear regression was used for the primary outcome, and modified Poisson regression was used for the secondary and sensitivity outcomes. A false discovery rate adjustment was applied to secondary and sensitivity analyses. Among the 398 eligible participants (median age, 4.0 years; 57.5
Pretend play is an important indicator of child development and may provide clinically relevant information about how autistic children organise, sustain, and share play. However, little is known about how pretend play varies across the three autism support levels. To investigate and describe pretend play performance across the three support levels in autistic children. This mixed methods study included 42 autistic children aged 4 to 7 years, evenly distributed across DSM-5-TR Levels 1, 2, and 3 (14 per group). Pretend play was assessed using the Child-Initiated Pretend Play Assessment 2 (ChIPPA2). Quantitative analyses included raw scores for Percentage of Elaborate Play Actions (PEPA), Number of Object Substitutions (NOS), Number of Imitated Actions (NIA), supportive and non-supportive indicators of play, and Enjoyment in Play Scale scores. Group differences were examined using Kruskal-Wallis tests and Quade’s rank analysis of covariance controlling for age and sex. The qualitative component was based on narrative observational records derived from video-recorded sessions and analysed using qualitative content analysis. Findings were integrated during interpretation. Significant differences were found across the three support levels for PEPA scores, NOS symbolic and combined scores, NIA scores, supportive and non-supportive indicators of play, and enjoyment in play. Children in Level 1 showed the most complex pretend play performance, children in Level 3 the least complex, and Level 2 an intermediate profile. Qualitative analysis identified four thematic categories: symbolic elaboration of play, social engagement during play, reduced play engagement and discontinuity, and concrete, repetitive, and sensory-perceptual engagement with materials. Symbolic play was more sustained and elaborated in Level 1, less integrated in Level 2, and brief and circumscribed in Level 3. In contrast, concrete, repetitive, and sensory-perceptual engagement with materials was especially evident in children with higher support needs. Integrated findings showed convergence between lower quantitative performance and less sustained, less socially shared, and less symbolically organised play. Pretend play performance varied across the three support levels in autistic children. The ChIPPA2 provided clinically meaningful information about the organisation, continuity, enjoyment, and social sharing of play, and may support more individualised assessment and intervention planning.
The differential diagnosis and treatment of non-specific neurological manifestations in adolescents (such as headaches and impaired consciousness) remain a significant challenge in clinical practice. Current clinical routine tends to prioritize the investigation of infectious etiologies, yet functional gastrointestinal disorders are frequently overlooked during screening. Furthermore, in cases of suspected increased intracranial pressure, empirical treatment is often initiated without objective measurement of intracranial pressure, which carries underappreciated risks. We report a case of a 14-year-old female patient presenting with sudden bilateral temporal headache, dizziness, and a 21-hour episode of stupor that had spontaneously resolved before hospital arrival. On admission she was alert but lethargic, with normal vital signs, normal neurological examination, and an unremarkable head CT. She was empirically treated with acyclovir and intravenous mannitol for suspected intracranial infection with presumed elevated intracranial pressure. However, subsequent investigations did not support either diagnosis: cerebrospinal fluid analysis was normal with an opening pressure of 70 mmH2O (below the pediatric reference range, measured after mannitol administration), fundoscopic examination revealed no papilledema, and brain MRI showed no infectious or structural abnormalities. Persistent headache and lethargy continued despite mannitol therapy. During hospitalization, the patient developed severe constipation. An upright abdominal radiograph demonstrated extensive fecal retention and gaseous distension throughout the colon, together with an incidental finding of non-fusion of the posterior vertebral arches at S1–S2. Following bowel evacuation and discontinuation of mannitol, the persistent headache and lethargy substantially improved, with no recurrence during 3-month follow-up. This case illustrates that empirical osmotherapy for presumed intracranial hypertension, in the absence of objective evidence from relevant examinations—such as cerebrospinal fluid pressure measurements—may be both ineffective and potentially harmful. Clinicians should base decisions about osmotherapy on objective intracranial pressure assessment rather than presumptive diagnosis, and should include gastrointestinal evaluation in the work-up of adolescents with persistent unexplained neurological symptoms. Incidental anatomical findings such as isolated posterior arch defects should not be over-interpreted in the absence of dedicated MRI evaluation.
To evaluate the predictive value of umbilical cord blood neuron-specific enolase (NSE) and brain-derived neurotrophic factor (BDNF) levels, in combination with Neonatal Behavioral Neurological Assessment (NBNA) scores, for neurodevelopmental outcomes at 6 months in offspring of mothers with gestational diabetes mellitus (GDM). A prospective cohort of 140 term neonates born to mothers with GDM at Suzhou High-tech Zone People’s Hospital from January 2023 to December 2024 was included. Cord blood NSE and BDNF levels were measured at birth, and NBNA was performed on postnatal day 3. At 6 months, neurodevelopment was assessed using the Gesell Developmental Scales. Infants were stratified into an abnormal group (developmental quotient [DQ] < 85) and a normal group (DQ ≥ 85). Between-group differences were analyzed. Receiver operating characteristic (ROC) curves were constructed to assess the predictive performance of individual and combined indicators. Twenty-seven infants (19.3
