Plasmapheresis for extracorporeal membrane oxygenation (ECMO)-induced hemolysis in infants.

Background: Intravascular hemolysis is a known complication of extracorporeal membrane oxygenation (ECMO). Characterized by elevated plasma-free hemoglobin (PFH), intravascular hemolysis is associated with cytotoxic effects leading to renal replacement therapy (RRT), longer ECMO runs, and mortality. Therapeutic plasma exchange (TPE) in tandem with ECMO was described as a therapy for various pathologic conditions, but there are no Extracorporeal Life Support Organization (ELSO) guidelines for the treatment of ECMO-induced hemolysis.

A national cross-sectional survey of health literacy of caregivers attending Canadian pediatric emergency departments.

Background: Health literacy assessment is key to better meeting family needs and developing informed strategies to promote positive health outcomes for children. The objective of this study was to describe the health literacy of caregivers who use Canadian pediatric emergency departments and relate it to demographic and visit-specific variables.

Methods: This study utilized a descriptive, cross-sectional survey design with medical record review.

Introduction to immunology and immune disorders.

The body has a collection of physical barriers to prevent infection, but once these are overcome, we rely on our immune systems to protect us against a wide variety of infections. The complex mechanisms through which this is achieved are grouped into two lines of defense called the "innate" and "adaptive" immune systems. The innate immune system provides a rapid and tailored response to infection or injury often associated with inflammation.

Primary prevention of food allergy: beyond early introduction.

Food allergy typically begins early in life and persists as a lifelong condition. Delayed introduction of allergenic foods followed by years of hesitancy to introduce these foods early may have contributed to the increase in food allergy prevalence in recent decades. Most infant feeding guidelines focus on the importance of early introduction of allergenic foods in infants at around age 4-6 months.

Eosinophilic esophagitis.

Eosinophilic esophagitis (EoE) is an atopic condition of the esophagus that has become increasingly recognized. Diagnosis of the disorder is dependent on the patient's clinical manifestations and must be confirmed by histologic findings on esophageal mucosal biopsies. The epidemiology, pathophysiology, diagnosis, treatment, and prognosis of EoE are discussed in this review.

Lung Function Recovery from Pulmonary Exacerbations Treated with Oral Antibiotics in Primary Ciliary Dyskinesia.

Rationale: Patients with Primary Ciliary Dyskinesia (PCD) experience acute pulmonary exacerbations (PEx). In Cystic Fibrosis (CF), PEx treated with oral antibiotics (oPEx) were found to be related to short and long-term lung function deficits, however the impact oPEx on lung function in patients with PCD has not yet been assessed.

Objective: To assess the impact of oPEx on lung function recovery in PCD and determine the factors associated with poorer response.

Integrative single-cell RNA-seq and ATAC-seq analysis of the evolutionary trajectory features of adipose-derived stem cells induced into astrocytes.

This study employs single-cell RNA sequencing (scRNA-seq) and assay for transposase-accessible chromatin with high-throughput sequencing technologies (scATAC-seq) to perform joint sequencing on cells at various time points during the induction of adipose-derived stem cells (ADSCs) into astrocytes. We applied bioinformatics approaches to investigate the differentiation trajectories of ADSCs during their induced differentiation into astrocytes. Pseudotemporal analysis was used to infer differentiation trajectories.

MUC17 is an essential small intestinal glycocalyx component that is disrupted in Crohn's disease.

Crohn's disease (CD) is the chronic inflammation of the terminal ileum and colon triggered by a dysregulated immune response to bacteria, but insights into specific molecular perturbations at the critical bacteria-epithelium interface are limited. Here we report that the membrane mucin MUC17 protected small intestinal enterocytes against commensal and pathogenic bacteria. In non-inflamed CD ileum, reduced MUC17 levels and a compromised glycocalyx barrier allowed recurrent bacterial contact with enterocytes.

Molecular and metabolomic characterization of hiPSC-derived cardiac fibroblasts transitioning to myofibroblasts.

Background: Mechanical stress and pathological signaling trigger the activation of fibroblasts to myofibroblasts, which impacts extracellular matrix composition, disrupts normal wound healing, and can generate deleterious fibrosis. Myocardial fibrosis independently promotes cardiac arrhythmias, sudden cardiac arrest, and contributes to the severity of heart failure. Fibrosis can also alter cell-to-cell communication and increase myocardial stiffness which eventually may lead to lusitropic and inotropic cardiac dysfunction.

Definition of sinonasal and otological exacerbation in patients with primary ciliary dyskinesia: an expert consensus.

Background: Recurrent infections of the nose, sinuses and ears are common problems for people with primary ciliary dyskinesia. While pulmonary exacerbations in primary ciliary dyskinesia are defined, there is no definition for ear-nose-throat exacerbations, a potential outcome for research and clinical trials.

Methods: We set up an expert panel of 24 ear-nose-throat specialists, respiratory physicians, other healthcare professionals and patients to develop consensus definitions of sinonasal and otological exacerbations in children and adults with primary ciliary dyskinesia for research settings.

The adoption and compliance to central line-associated bloodstream infection insertion and maintenance bundle programs in intensive care unit settings across Canada.

Evidence-based insertion and maintenance bundles are effective in reducing the incidence of central line-associated bloodstream infections (CLABSI) in intensive care unit (ICU) settings. We studied the adoption and compliance of CLABSI prevention bundle programs and CLABSI rates in ICUs in a large network of acute care hospitals across Canada.

Emergency department management of primary headache disorders in pediatric patients.

Headaches are a common reason for pediatric visits to the emergency department. Emergency clinicians must distinguish between common and dangerous secondary causes of headache and primary headache disorders such as migraine and tension-type headaches. This issue discusses the diagnosis of primary headaches by history and physical examination, the options for first-line treatment of primary headache and for severe or refractory migraines, and procedural interventions that may be considered when other therapies have failed.

Novel models by machine learning to predict the risk of cardiac disease-specific death in young patients with breast cancer.

Background: With the tremendous leap of various adjuvant therapies, breast cancer (BC)-related deaths have decreased significantly. Increasing attention was focused on the effect of cardiac disease on BC survivors, while limited existing population-based studies lay emphasis on the young age population.

Method: Data of BC patients aged less than 50 years was collected from the SEER database.

Increasing Graduate Student Awareness of Cultural Competence Through Bias Exploration Related to Diverse Cultural Families.

Emphasis by the American Nurses Association and the American Association of Colleges of Nursing regarding the importance of cultural competence in nursing education led to the development of a strategy to address personal bias in graduate nursing students. With the updated Essentials and a change to competency-based education, a need to address culturally congruent practices while increasing awareness of professional organization recommendations exists. Since Domain 2 of the Essentials highlights that culturally competent care is essential to person-centered care, a strategy that enhances knowledge by expanding the definition of culture beyond ethnicity and race was developed.

Fluid restriction for treatment of symptomatic patent ductus arteriosus in preterm infants.

Background: The ductus arteriosus is a blood vessel connecting the main pulmonary artery and the proximal descending aorta. After birth, the ductus arteriosus usually closes completely. However, sometimes it remains patent in the neonate, which is called patent ductus arteriosus (PDA).

Re-Imagining Childhood Grief: Children as Active Agents in a Transactional Process.

Bereavement during childhood impacts children's wellbeing and biopsychosocial development. Research examining impacts and outcomes of childhood bereavement and supportive interventions has highlighted a myriad of factors that influence children's unique, complex experiences of grief, necessitating a personalized, child-centred approach. Children's grief support is underpinned by well-established grief theories studied primarily in adult populations, and stage-based developmental theories that characterise child development as "normative" and universal.

Harnessing the biology of regulatory T cells to treat disease.

Regulatory T (T) cells are a suppressive subset of CD4 T cells that maintain immune homeostasis and restrain inflammation. Three decades after their discovery, the promise of strategies to harness T cells for therapy has never been stronger. Multiple clinical trials seeking to enhance endogenous T cells or deliver them as a cell-based therapy have been performed and hint at signs of success, as well as to important limitations and unanswered questions.

External Validation of Brief Resolved Unexplained Events Prediction Rules for Serious Underlying Diagnosis.

Importance: The American Academy of Pediatrics (AAP) higher-risk criteria for brief resolved unexplained events (BRUE) have a low positive predictive value (4.8%) and misclassify most infants as higher risk (>90%). New BRUE prediction rules from a US cohort of 3283 infants showed improved discrimination; however, these rules have not been validated in an external cohort.

Identification of an early subset of cerebellar nuclei neurons in mice.

Cerebellar nuclei (CN) neurons serve as the primary output of the cerebellum and originate from the cerebellar primordium at early stages of cerebellar development. These neurons are diverse, integrating information from the cerebellar cortex and relaying it to various brain regions. Employing various methodologies, we have characterized a specific subset of CN neurons that do not originate from the rhombic lip or ventricular zone of the cerebellar primordium.

The implementation of infant pain practice change resource to improve infant procedural pain practices: a hybrid type 1 effectiveness-implementation study.

Implementation of infant pain practice change (ImPaC) is a multifaceted web-based resource to support pain practice change in neonatal intensive care unit (NICU). We evaluated the (1) intervention effectiveness and (2) implementation effectiveness of ImPaC using a hybrid type 1 effectiveness-implementation study (ie, cluster randomized controlled trial and longitudinal descriptive study). Eligible level 2 and 3 Canadian NICUs were randomized to intervention (INT) or waitlisted to usual care (UC) for 6 months.

How the early life microbiome shapes immune programming in childhood asthma and allergies.

Despite advances in our understanding of their diagnosis and treatment, pediatric allergies impose substantial burdens on affected children, families, and healthcare systems. Further, the prevalence of allergic diseases has dramatically increased over the past half-century, leading to additional concerns and concerted efforts to identify the origins, potential predictors and preventions, and therapies of allergic diseases. Together with the increase in allergic diseases, changes in lifestyle and early-life environmental influences have corresponded with changes in colonization patterns of the infant gut microbiome.