Meyer Children's Hospital

Bronchopulmonary dysplasia (BPD) affects premature newborns, particularly those receiving supplemental oxygen therapy. Exposure of underdeveloped lungs to oxygen levels higher than the intrauterine environment causes oxidative stress, impairing alveolarisation, vascularisation and causing fibrosis. The β3-adrenoceptor could represent a promising target for BPD treatment because of its oxygen-dependent regulation, ability to reduce oxidative stress and protection against intestinal hyperoxia-induced damage. In this study, neonatal rat pups were reared under hyperoxia for 2 weeks to induce a BPD-like disease and treated with the β3-adrenoceptor agonist BRL37344 (1, 3 or 6 mg kg-1). Through oxidative stress, hyperoxia decreases pulmonary volume, impairs alveolarisation and vascularisation, and causes fibrosis and type II pneumocyte hyperplasia, thereby reducing survival rates. BRL37344 at 3 mg kg-1 counteracted these alterations, doubling survival rates. Our findings demonstrate a new role for β3-adrenoceptors in protecting the lungs from hyperoxic injury, suggesting its pharmacological activation as a strategy for treating Bronchopulmonary dysplasia of prematurity and, possibly, other lung fibrosis-related disorders.

Introduction. Pediatric burns are a frequent cause of emergency department attendance and hospitalization and may result in acute pain, infection, delayed healing, and long-term sequelae such as hypertrophic scarring and functional impairment. Early management aims to limit burn progression, optimize the wound microenvironment, and reduce the burden of painful dressing changes for children and families. First aid behaviors and the choice of first-line topical agents and dressings vary widely, and traditional treatments such as silver sulfadiazine have been challenged by newer dressings designed to improve comfort and support outpatient care. Methods. We conducted a scoping review in accordance with PRISMA-ScR guidance to map evidence on conservative, non-surgical topical agents and dressings used as first-line treatment for minor-to-moderate pediatric burns (age <18 years). We searched PubMed/MEDLINE, Embase, CINAHL, and the Cochrane Library and screened titles/abstracts and full texts in duplicate. We included comparative and non-comparative studies reporting outcomes related to healing, infection, pain, dressing burden, resource use, and scar endpoints. Findings were synthesized descriptively without meta-analysis or risk-of-bias appraisal. Results. From 2,397 records, 38 studies met eligibility criteria. Designs were heterogeneous (randomized trials, prospective/retrospective cohorts, pilots, observational analyses, and case-based reports) and were conducted across multiple countries. Interventions included first aid and analgesic adjuncts; silver sulfadiazine compared with alternative topical agents and dressings; advanced silver-impregnated systems (eg, hydrofiber/foam dressings); biosynthetic or synthetic membranes and biomaterials (eg, Suprathel®, Biobrane®); hyaluronic acid–based protocols; nanocellulose dressings; gel-based or bioactive treatments; and other innovative dressings. Across comparative studies in superficial-to-partial thickness burns, several advanced dressings were associated with fewer dressing changes and lower procedural pain while achieving comparable or faster re-epithelialization than silver sulfadiazine. Effects on infection, length of stay, and scar outcomes were variable and often limited by inconsistent definitions and follow-up. Discussion. The mapped literature indicates that selected advanced dressings may provide clinically meaningful advantages by reducing dressing-change frequency and procedural pain, potentially facilitating outpatient management in appropriate cases. However, certainty is constrained by heterogeneity in burn depth assessment, variation in debridement and analgesia pathways, and inconsistent outcome reporting, with limited long-term scar and functional data. Future studies should adopt standardized, patient-centered pediatric outcomes (healing, infection definitions, validated pain/itch measures, and scar assessments) and pragmatic comparative designs to inform internationally applicable care pathways.

Abstract Tribology is the science and engineering dealing with friction wear and lubrication, it was practiced already in the ancient time, but the term tribology was only coined in 1966 after the Greek word Tribos which means rubbing. Although at its beginning tribology was exclusively used for mechanical elements soon after 1966 the term was broadened to several other applications and various branches and subfields of tribology emerged. This opened the gate to fruitful interdisciplinary collaboration between tribology researchers and colleagues from different science fields. In the present paper we briefly describe the already well-established branches of tribology and then describe the story of a new branch, termed Psycho-tribology, which is still in its infantly stage but enthusiastically accepted by several researchers in social sciences who are eager to collaborate with colleagues from the tribology community. Hence, the main purpose of the present paper is to expose this new branch to the tribology community and encourage tribology scholars around the world to become active in Psycho-tribology for the benefit of global humanity.

Purpose: The purpose of this study was to evaluate the feasibility of magnetic resonance imaging (MRI)-based radiomics derived from routine T2-weighted imaging for initial risk stratification in pediatric neuroblastoma (NB) and to explore its potential role as a noninvasive adjunct to established clinical and molecular classification systems. Methods: In this retrospective, single-center pilot study, 45 children with newly diagnosed NB (2015-2024) were analyzed. Primary tumors were manually segmented on baseline axial T2-weighted MRI. A total of 107 Image Biomarker Standardization Initiative (IBSI)-compliant radiomic features were extracted. Supervised machine learning classifiers (Random Forest, XGBoost) and dimensionality reduction approaches (principal component analysis [PCA], linear discriminant analysis [LDA]) combined with K-means clustering were evaluated. Model performance was assessed using stratified cross-validation and an independent test set. Reporting adhered to the Checklist for Evaluation of Radiomics Research (CLEAR). Results: Fifteen patients (33%) were classified as high-risk (HR) and 30 (67%) as non-high-risk (NHR) according to International Neuroblastoma Risk Group (INRG) criteria. The highest classification performance was achieved using LDA followed by K-means clustering, with a test accuracy of 77.8%, sensitivity of 64.7%, and specificity of 85.7%. Radiomic classification agreed with conventional risk stratification in 77.8% of cases. The analysis relied exclusively on T2-weighted imaging, supporting workflow feasibility without requiring contrast administration or advanced MRI sequences. Conclusions: In this single-center pilot study, T2-weighted MRI radiomics demonstrated feasibility for noninvasive initial risk stratification in pediatric NB. Although limited by sample size and the lack of external validation, these findings support further multicenter investigations of radiomics as an adjunctive imaging biomarker during early diagnostic evaluation.

Airway management remains a critical aspect of anesthesia, intensive care and emergency medicine, particularly when facing difficult airways. Traditional methods, such as endotracheal intubation via direct laryngoscopy, have evolved with the introduction of advanced tools designed to enhance oxygenation and facilitate airway control. This narrative review presents 10 essential tips for safe up-to-date airway management, emphasizing the importance of a patient-centered, oxygen-focused and strategic approach rather than a purely device-oriented one. By incorporating strategies for assessment, prediction and timely interventions and transition, healthcare professionals can improve patient outcomes and minimize complications during airway management.

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Post-infectious bronchiolitis obliterans (PIBO) is a rare chronic obstructive pulmonary disease affecting children after a severe respiratory infection. The primary goal of this narrative review is to synthesize evidence on pulmonary function in children with PIBO, with a focus on spirometric indices, and to evaluate the efficacy of therapies reported in the literature. It also provides an overview of the disease’s epidemiology, risk factors, clinical presentation and diagnostic methods. Studies reported various spirometric parameters including forced expiratory volume in one second, forced vital capacity, the ratio between these two parameters, and forced expiratory flow at 25%-75%. A narrative synthesis described therapies including bronchodilators, corticosteroids, macrolides, combination regimens, novel therapies and non-pharmacological interventions. Most studies were small, but data showed moderate to severe impairments in pulmonary function in pediatric PIBO, with mild heterogeneity. Corticosteroids and combined therapies offered short-term relief, but long-term benefits were limited by adverse effects. Pulmonary rehabilitation may preserve lung function and quality of life, although evidence remains scarce. Given the limited research on therapy and pulmonary outcomes, further studies are necessary to understand the long-term effects of treatments. This review underscores the urgent need for multicenter studies and evidence-based guidelines to improve care for children with PIBO.

ABSTRACT BACKGROUND Peak oxygen uptake (pVO 2 ) is a strong, independent predictor of adverse cardiovascular outcomes, supporting cardiopulmonary exercise testing as a primary end point assessing efficacy of novel drug therapies in obstructive hypertrophic cardiomyopathy (oHCM) clinical trials. However, characterizing changes in pVO 2 that patients perceive as beneficial or meaningful (ie, minimal important difference [MID]) has not been determined. METHODS Data from patients with symptomatic oHCM enrolled in SEQUOIA-HCM and MAPLE-HCM were pooled. A total of 282 patients were randomized 1:1 to aficamten (5–20 mg daily) or matching placebo in SEQUOIA-HCM, and 175 patients were randomized 1:1 to aficamten (5-20mg daily) or to metoprolol (50–200 mg) in MAPLE-HCM; follow-up in both trials was 24 weeks. Primary outcome was change from baseline to week 24 (Δ) in pVO 2 using Patient Global Impression of Change with anchor-based analysis to define MID. RESULTS At week 24, ΔpVO 2 (mL/kg/min) that corresponded to no change, one-category improvement, and one-category worsening were –0.05 (95% CI, –0.58 to 0.48), +0.35 (95% CI, –0.22 to 0.91), and –0.61 (95% CI, –1.36 to 0.13), respectively. Similarly, minute ventilation to carbon dioxide production ratio (VE/VCO 2 ) slope that corresponded to no change, one-category improvement, and one-category worsening were 0.16 (95% CI, –0.59 to 0.90), –1.15 (95% CI, – 1.89 to –0.42), and 0.88 (95% CI, –0.42 to 2.19), respectively. In a responder analysis using this new threshold for pVO 2 , 60% of patients receiving aficamten achieved a ΔpVO 2 ≥0.35 versus 31% of patients on placebo or metoprolol (odds ratio, 3.4 [95% CI, 2.3–4.9], P <0.001). Consistent findings were seen with VE/VCO 2 responder analysis. CONCLUSIONS Changes in pVO 2 of +0.35 and –0.61 mL/kg/min were associated with a small but perceptible clinical improvement and worsening, respectively, in patients with oHCM. Applying this newly defined threshold resulted in excellent differentiation of treatment effect in a clinical trial. These novel data provide a measure of clarity to patients and clinicians regarding the interpretation of changes in pVO 2 following therapeutic interventions, with potential impact on HCM management strategies and future clinical trials. Clinical Trial Registration SEQUOIA-HCM ( NCT05186818 ; https://clinicaltrials.gov/study/NCT05186818?term=sequoia-hcm&rank=1 ); MAPLE-HCM ( NCT05767346 ; https://clinicaltrials.gov/study/NCT05767346?term=maple-hcm&rank=1 ) Clinical Perspective What Is New? Using pooled data from over 440 patients with symptomatic obstructive hypertrophic cardiomyopathy enrolled in two phase 3 clinical trials, we define, for the first time, the minimally important difference for peak oxygen uptake (pVO 2 ) and ventilatory efficiency (VE/VCO 2 ) using patient-anchored and distribution-based methodologies. A change in pVO 2 of +0.35 mL/kg/min and a change in VE/VCO 2 of –1.15 represent the minimal thresholds associated with patient-perceived clinical improvement. Responder analyses using these thresholds demonstrated robust differentiation between aficamten and placebo/metoprolol, with an odds ratio exceeding 3 for achieving a meaningful improvement in pVO 2 . What Are the Clinical Implications? These newly defined thresholds bridge the gap between statistically significant changes in cardiopulmonary exercise testing measures and clinically meaningful benefit as perceived by patients with obstructive hypertrophic cardiomyopathy. Clinicians can use these benchmarks to contextualize individual patient responses to medical therapy, informing shared decision-making regarding treatment continuation or modification. These data provide a standardized, patient-centered framework for designing and interpreting primary end points in future hypertrophic cardiomyopathy clinical trials.