Growth Failure Research Articles

Diagnostic testing using gene panels for severe childhood growth failure and multiple pituitary hormone deficiency in England

Diagnostic testing using gene panels for severe childhood growth failure and multiple pituitary hormone deficiency in England

Change in the prevalence of extra-uterine growth restriction in very low birthweight infants, following the introduction of a written nutrition protocol, in a tertiary neonatal unit

Background: Advances in neonatal medicine, resulting in improved survival, have brought the concept of extra-uterine growth restriction (EUGR), defined as postnatal growth failure secondary to protein and energy deficits, to the forefront as an important cause of morbidity, particularly in very low birthweight (VLBW) neonates. Objectives: This study’s main objective was to determine the prevalence of EUGR in Steve Biko Academic Hospital in VLBW infants. Methods: This was a pre- (epoch 1) and post- (epoch 2) intervention study. The intervention was the introduction of a written nutritional protocol in the neonatal unit in mid-November 2017. Three definitions were used to identify EUGR, namely: (1) discharge weight < 10th percentile, (2) a change by −1.28 z-score in weight at discharge, and (3) the discharge weight percentile below the nadir percentile. Results: The prevalence of EUGR in epoch 1 was 85.7%, 63.5%, and 88.0% using the above definitions, respectively. The prevalence of EUGR in epoch 2 was 73.9%, 65.8%, and 89.4% using the above definitions, respectively. EUGR using the three definitions combined was present in 95.2% and 92.8% of infants in epochs 1 and 2, respectively. None of the differences in EUGR prevalence between the two epochs were significant. Conclusion: The prevalence of EUGR was not significantly different between the two epochs, although it had been proposed that the introduction of a written nutritional protocol would have decreased the prevalence of EUGR in epoch 2. One of the reasons proposed for this finding was poor adherence to the nutritional protocol during epoch 2.

Short Stature with Type-1 Diabetes: A Clinically Observed Case in Patients Suffering From Mauriac Syndrome

Mauriac syndrome (MS) is an exceptionally rare disorder occurring in poorly controlled Type 1 diabetic patients. The consequences include dwarfism, obesity, hepatomegaly, delayed puberty, growth failure and higher levels of transaminase enzyme. We report a case of an adolescent female with classical features of Mauriac syndrome.

ANALYSIS OF THE INCIDENCE OF STUNTING IN CHILDREN UNDER FIVE

Stunting is a condition of growth failure in toddlers which is characterized by a height-for-age figure of less than -2 (z-score value). The prevalence of stunting in children aged 6-59 months is 41.1%, factors related to stunting are the child's age, food source and children with stunting are more susceptible to disease. This study aims to determine factors related to the incidence of stunting in children under five in the Tanjung Batu Community Health Center UPT Working Area, Ogan Ilir Regency in 2024. The design of this research is quantitative with a cross-sectional approach. The population of this study is the target number of children under five who will be served/weighed at the Tanjung Batu Community Health Center, Ogan Ilir Regency in 2024. The sample in this study was 96 people. The sample collection method used purposive sampling with the inclusion criteria of children under five in the Puskesmas working area and bringing a KIA book. This research was carried out on March 1-30 2024. Data was collected using a questionnaire. Bivariate data analysis used the Chi-Square test and multivariate logistic regression. The results of the research show that there is a relationship between age (p value 0.003), nutritional status (p value 0.020), body weight (p value 0.009) and knowledge (p value 0.018) on the incidence of stunting in children under five in the working area of ​​the UPT Puskesmas Tanjung Batu, Ogan Ilir Regency In 2024. There is no relationship between exclusive breastfeeding (p value 0.11) and comorbidities (p value 0.20) on the incidence of stunting in children under five in the working area of ​​the UPT Puskesmas Tanjung Batu, Ogan Ilir Regency in 2024. The most dominant factor with The incidence of stunting in children under five in the working area of ​​the UPT Puskesmas Tanjung Batu, Ogan Ilir Regency in 2024 is knowledge (p value 0.012) OR (0.318). The community health center can increase public knowledge by providing health education about stunting through classes for mothers of toddlers, social media, leaflets and posters.

Histopathology underlying environmental enteric dysfunction in a cohort study of undernourished children in Bangladesh, Pakistan, and Zambia compared with United States children

BackgroundEnvironmental enteric dysfunction (EED) is an asymptomatic intestinal disorder associated with growth impairment, delayed neurocognitive development, and impaired oral vaccine responses. ObjectivesWe set out to develop and validate a histopathologic scoring system on duodenal biopsies from a cohort study of children with growth failure in Bangladesh, Pakistan, and Zambia (“EED”) with reference to biopsies from United States children with no clinically reported histologic pathology (referred to hereafter as “normal”) or celiac disease. MethodsFive gastrointestinal pathologists evaluated 745 hematoxylin and eosin slide images from 291 children with EED (mean age: 1.6 y) and 66 United States children (mean age: 6.8 y). Histomorphologic features (i.e., villus/crypt architecture, goblet cells, epithelial and lamina propria acute/chronic inflammation, Brunner’s glands, Paneth cells, epithelial detachment, enterocyte injury, and foveolar metaplasia) were used to score each histopathologic slide. Generalized estimating equations were used to determine differences between EED, normal, and celiac disease, and receiver operating characteristic curves were used to assess predictive value. ResultsBiopsies from the duodenal bulb showed higher intramucosal Brunner’s gland scores and lower intraepithelial lymphocyte scores than from the second or third parts of the duodenum (D2/3), so only D2/3 were included in the final analysis. Although 7 parameters differed significantly between EED and normal biopsies in regression models, only 5 (blunted villus architecture, increased intraepithelial lymphocytosis, goblet cell depletion, Paneth cell depletion, and reduced intramucosal Brunner’s glands) were required to create a total score percentage (TSP-5) that correctly identified EED against normal biopsies (AUC: 0.992; 95% CI: 0.983, 0.998). Geographic comparisons showed more severe goblet cell depletion in Bangladesh and more marked intraepithelial lymphocytosis in Pakistan. ConclusionsThis scoring system involving 5 histologic parameters demonstrates very high discrimination between EED and normal biopsies, indicating that this scoring system can be applied with confidence to studies of intestinal biopsies in EED.

Efficacy and safety of growth hormone therapy in children with systemic lupus erythematosus: A systematic review

Introduction Childhood-onset systemic lupus erythematosus (cSLE) is a chronic autoimmune disease with long-term consequences, including growth failure and short stature. Growth hormone (GH) therapy is a potential treatment for short stature in cSLE. Objective The aim of the study was to evaluate the current evidence on the efficacy and safety of GH therapy in cSLE. Methods A systematic review was conducted through PubMed, Cochrane, and Web of Science databases to identify relevant publications from January 1988 to October 2023. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Articles focusing on GH therapy in cSLE were included after an initial screening of their titles and abstracts. The articles were extracted and analyzed by two independent reviewers, with a third reviewer addressing any discrepancies that arose to reach an agreement. Results Among the 6364 screened citations, only two case reports fulfilled the inclusion criteria. Both were for males with cSLE who had short stature due to the disease and corticosteroids. Both case reports demonstrated improved linear growth; however, GH therapy was discounted because of a lupus flare concurrent with GH use, with one case necessitating treatment escalation to control disease activity. Conclusion GH therapy has shown favorable effects on growth in cSLE; however, it may increase the risk of disease flare. Limited evidence precludes a definitive conclusion, highlighting the need for further studies to fill the knowledge gap on the safety and efficacy of GH therapy in cSLE patients.

Factors of Child Growth Failure Based on the Composite Index of Anthropometric Failure in West Sulawesi Province

Background: The composite index of anthropometric failure (CIAF) provides a comprehensive measure of growth failure through various child anthropometric indicators. In regions with a high prevalence of stunting, several factors may contribute to the occurrence of growth failure in children under five years. Objectives: This study aims to analyze the factors influencing the incidence of child growth failure based on the CIAF in a province with high stunting prevalence in Indonesia. Methods: The cross-sectional study used the 2022 Indonesian Nutrition Status Survey (SSGI) data. The sample comprised children aged 0-23 months from West Sulawesi Province, totaling 1,573 children. The number of samples analyzed was 1,327 children, excluding incomplete data and outliers that were values outside a certain range and treated as missing values based on the World Health Organization (WHO). Multivariate analysis was conducted using logistic regression with a complex sample facility. Results: This study found that 24.9% of children experienced growth failure based on the CIAF. Factors associated with the incidence of growth failure based on the CIAF were older age between 12-23 months (OR=4.5; CI=2.36-8.43; p=0.000), birth weight less than 2,500 g (OR=6.85; CI=3.85-12.21; p=0.000), boys (OR=1.56; CI=1.13-2.15; p=0.000), incomplete immunization status (OR=1.8; CI=1.31-2.77; p=0.001), and poor economic status in quintile 1 (OR=2.1; CI=1.08-3.99; p=0.028). Conclusions: The risk factors for child growth failure based on the CIAF included older age, male sex, low birth weight, incomplete immunization status, and low economic status.

Pemantauan Tumbuh Kembang Bayi dan Balita dan Edukasi Gizi dalam Pencegahan Stunting di Posyandu Anggrek di Kelurahan Banyurip Kota Pekalongan

Stunting is a condition of growth failure in children under five due to chronic malnutrition, especially in the first 1,000 days of life (HPK). Stunting affects brain growth and development so that there is a higher risk of suffering from chronic diseases in adulthood. The effort to handle stunting is by maximizing Posyandu. Posyandu can function as a comprehensive early detection, handling and consultation on stunting.) Posyandu cadres must be able to take part in efforts to deal with stunting, at least by being able to carry out early detection of stunting, the existence of posyandu can help monitor the development of nutritional status of toddlers based on recording and reporting taken from data on the results of weighing toddlers. The method used in this community service activity is through counseling activities for parents in the Anggrek Posyandu area, Banyurip Village, Pekalongan City. The results of this activity increased the knowledge of participants, namely good knowledge as much as 92% from the previous counseling only 34%.

An analytical solution of direction evolution of crack growth during progressive failure in brittle rocks

AbstractMicrocrack growth during progressive compressive failure in brittle rocks strongly influences the safety of deep underground engineering. The external shear stress τxy on brittle rocks greatly affects microcrack growth and progressive failure. However, the theoretical mechanism of the growth direction evolution of the newly generated wing crack during progressive failure has rarely been studied. A novel analytical method is proposed to evaluate the shear stress effect on the progressive compressive failure and microcrack growth direction in brittle rocks. This model consists of the wing crack growth model under the principal compressive stresses, the direction correlation of the general stress, the principal stress and the initial microcrack inclination, and the relationship between the wing crack length and strain. The shear stress effect on the relationship between y‐direction stress and wing crack growth and the relationship between y‐direction stress and y‐direction strain are analyzed. The shear stress effect on the wing crack growth direction during the progressive compressive failure is determined. The initial crack angle effect on the y‐direction peak stress and the wing crack growth direction during the progressive compressive failure considering shear stress is also discussed. A crucial conclusion is that the direction of wing crack growth has a U‐shaped variation with the growth of the wing crack. The rationality of the analytical results is verified by an experiment and from numerical results. The study results provide theoretical support for the evaluation of the safety and stability of surrounding rocks in deep underground engineering.

HUBUNGAN ANTARA TINGKAT PENGETAHUAN ORANG TUA DENGAN PERILAKU MAKAN ANAK STUNTING USIA BALITA DI SIDOARJO, JAWA TIMUR

Stunting is a form of growth failure due to malnutrition over a long period. Poor eating behavior is one of the causes of lack of nutrition in children. If there is no good control over the child's eating behavior during the golden period of growth and development, the child may fall into a stunting condition. The phenomenon found in toddlers in Sidoarjo, East Java is eating behavior problems such as picky eaters and feeling full quickly. The purpose of this study was to analyze the relationship between the level of knowledge and the eating behavior of toddler who experienced stunting in Sidoarjo, East Java. The design of this research is a correlation study with a cross sectional approach. The number of samples in this study amounted to 30 respondents, the sampling technique used is total sampling. The variable in this study were the level knowledge of parents and eating behavior of stunting toddler. The instrument in this research the knowledge and the toddler Eating Behavior Questionnaire. The analysis used is Proportional Percentage Descriptive Statistical Analysis. The results showed that 18 (53%) of parents had enough knowledge about eating behavior of stunting toddler. The results showed that 18 (60%) children had a tendency to eat a food approach (like to eat). The relationship between the level of knowledge and eating behavior of stunting toddler of the Spearman Rank correlation test with a value of p = 0.358 and r + 0.174. The results showed there is no relationship level was very low and the direction of the relationship was negative, It is hoped that the head of the Posyandu Kader will be able to increase parental knowledge regarding the need for intake and the importance of providing food according to the child's developmental stage, creativity in serving, quantity and quality of food, as well as factors that affect child growth and development, especially in the incidence of stunting.

Profound T Lymphocyte and DNA Repair Defect Characterizes Schimke Immuno-Osseous Dysplasia

Schimke immuno-osseous dysplasia is a rare multisystemic disorder caused by biallelic loss of function of the SMARCAL1 gene that plays a pivotal role in replication fork stabilization and thus DNA repair. Individuals affected from this disease suffer from disproportionate growth failure, steroid resistant nephrotic syndrome leading to renal failure and primary immunodeficiency mediated by T cell lymphopenia. With infectious complications being the leading cause of death in this disease, researching the nature of the immunodeficiency is crucial, particularly as the state is exacerbated by loss of antibodies due to nephrotic syndrome or immunosuppressive treatment. Building on previous findings that identified the loss of IL-7 receptor expression as a possible cause of the immunodeficiency and increased sensitivity to radiation-induced damage, we have employed spectral cytometry and multiplex RNA-sequencing to assess the phenotype and function of T cells ex-vivo and to study changes induced by in-vitro UV irradiation and reaction of cells to the presence of IL-7. Our findings highlight the mature phenotype of T cells with proinflammatory Th1 skew and signs of exhaustion and lack of response to IL-7. UV light irradiation caused a severe increase in the apoptosis of T cells, however the expression of the genes related to immune response and regulation remained surprisingly similar to healthy cells. Due to the disease’s rarity, more studies will be necessary for complete understanding of this unique immunodeficiency.

Efektivitas Implementasi Program One Day One Egg sebagai Upaya Pencegahan Kasus Stunting melalui Pemenuhan Gizi Ibu Hamil di Desa Grenden

Stunting is a condition in which a child suffers from growth failure that is under the age of five or young that can be caused by chronic malnutrition and/or recurrent infection during the first thousand days of life. According to the Health Department of East Java Province data in 2018, Jember district is one of the districts in East Java that has the highest stunting cases of 39.2%.Stunting is a problem related to malnutrition.Stunting cases can occur from pregnancy to childhood. Stunting is one of the effects that can be caused by nutritional deficien.cies during the first thousand days of a child's life that can cause irreversible physical developmental disorders in a child, resulting in long-term and short-term effects. One solution that can be an attempt to prevent and reduce stunting cases is with a program to provide knowledge and attitude in nutritional fulfillment as well as health in pregnant mothers. The One Day One Egg activity is done by adjusting the posyandu schedule in the village of Grenden, Puger district, Jember. Stunting is caused by chronic malnutrition that occurs in the early stages of development, especially during the first 1,000 days of life, i.e. from pregnancy to the age of 2 years or 23 months.

Pelatihan Pembuatan PMT Nugget dan Sempol Sehat Berbasis Pangan Lokal untuk Mencegah Diare dan Stunting di Desa Mandiro, Kabupaten Bondowoso

Diarrhea can cause disruption of nutrient absorption in the body, which can result in growth failure if not treated immediately. When toddlers experience diarrhea, they will experience a decrease in appetite so that food intake is not optimal. In an effort to prevent diarrhea and stunting in Mandiro Village, the PPK Ormawa Team of HIMA Gizi FKM UNEJ provided training in making PMT based on local food, namely moringa leaf carrot chicken nuggets and cassava leaf chicken sempol to Posyandu Cadres and mothers of toddlers in Mandiro Village. The delivery of training materials is carried out using expository and demonstration methods. Monitoring and evaluation of the activities are conducted using questionnaires in the form of pre-tests and post-tests. The results of the pre-tests and post-tests indicate an increase in respondents' knowledge related to Supplementary Feeding (PMT).

Determining Deviation of the Growth Pattern of Preterm Infants and Its Causes According to the Fenton Growth Chart: A Longitudinal Follow-up Study

Background: Birth weight is a crucial indicator of infant health. In Iran, child growth monitoring for children under six years old is integrated into the healthcare system. However, existing growth charts have limitations in accurately representing preterm infants. Objectives: This study was conducted to determine the frequency of postnatal growth retardation and its causes in preterm infants from hospitalization to six months after birth. Methods: After informing parents, we recruited 255 preterm singleton infants born at the Afzalipour Medical Education and Health Center in Kerman, Iran, over one year. The Fenton growth chart was used to compare the anthropometric characteristics of the infants at birth, and at ages 7, 14, and 28 days, and then monthly up to 6 months. A special questionnaire also recorded the type of feeding, length of hospital stay, use of mechanical ventilation and oxygen, duration of total parenteral nutrition (TPN), and associated causes and complications. Results: The mean Z-score weights at birth, discharge, one month, three months, and six months were -0.34, -1.19, -0.85, -0.94, and -1.79, respectively. The mean Z-score heights at birth, discharge, one month, three months, and six months were 0.74, 0.20, -0.07, -0.79, and -2.5, respectively. Additionally, the mean Z-scores for head circumference at birth, discharge, one month, and three months were 0.41, -0.19, -0.53, and -1.17, respectively. Deviation from the Fenton preterm growth chart was detected in 109 infants (42.7%) at the time of discharge, 79 infants (31%) at one month, 82 infants (32.2%) at three months, and 134 infants (52.5%) at six months of age. Conclusions: The weight at discharge and the length of NPO [due to surgical problems, feeding intolerance, necrotizing enterocolitis (NEC), etc.] were significantly inversely related. Preterm infants grow more slowly in hospitals, so their longitudinal growth data should be interpreted carefully. The incidence of postnatal growth failure can be reduced by improving NICU quality, optimizing nutrition, and increasing enteral feeding rates.

Reciprocal chromosome translocation t(3;4)(q27;q31.2) with deletion of 3q27 and reduced FBXW7 expression in a patient with developmental delay, hypotonia, and seizures.

Reciprocal chromosomal translocation is one of genomic variations. When cytogenetically de novo reciprocal translocations are identified in patients with some clinical manifestations, the genes in the breakpoints are considered to be related to the clinical features. In this study, we encountered a patient with severe developmental delay, intractable epilepsy, growth failure, distinctive features, and skeletal manifestations. Conventional karyotyping revealed a de novo translocation described as 46,XY,t(3;4)(q27;q31.2). Chromosomal microarray testing detected a 1.25-Mb microdeletion at 3q27.3q28. Although the skeletal manifestations may have been affected by this deletion, the neurological features of this patient were severe and could not be fully explained by this deletion. Since no genomic copy number aberration was detected on chromosome 4, long-read whole-genome sequencing analysis was performed and a precise breakpoint was confirmed. A 460-bp deletion was detected between the two breakpoints; however, no gene was disrupted. FBXW7, the gene responsible for developmental delay, hypotonia, and impaired language, is in the 0.5-Mb telomeric region. Most of the patient's clinical features were considered consistent with symptoms of FBXW7-related disorders, but were more severe. FBXW7 expression in the immortalized lymphoblasts of the patient was reduced compared to that in controls. Based on these findings, we suspect that FBXW7 is affected by downstream position effects of chromosomal translocations. The severe neurological features of the patient may have been affected not only by the 3q27-q28 deletion but also by impaired expression of FBXW7 derived from the breakage of chromosome 4.

Diagnostic of Solid-State Lithium Metal Batteries with the Sand Equation: A Symmetric Cell Electrochemical Characterization Method upon Plating

Lithium Metal Anodes (LMAs) have generated significant interest for use in solid-state batteries (SSBs) due to their high theoretical specific capacity. Nonetheless, issues such as dendrite growth (1) and cell failure caused by lithium loss with solid polymer electrolytes (SPEs) (2) of decent ionic conductivities have hindered widespread commercialization. In this work, we report the electrochemical characterization of symmetric Li- SPE– Li cells using thermoplastic vulcanizate (TPV) electrolytes comprised of: PCL:HNBR LiTFSI. Full plating of the lithium metal (LiM) electrode was achieved at 100 μA.cm-2 during constant polarization in pressurized pouch cells. Complete polarization was confirmed through ex-situ analysis by scanning electron microscopy (SEM) with SEM images showing that no dendrites were formed at this current density. Furthermore, cell polarization performed at higher current densities allowed lithium diffusion in the TPV electrolyte to be calculated using the Sand Equation (3, 4). Lithium diffusion was found to be 1.7 x 10-8 cm2.s-1 at 60 °C, which was consistent with other published values (5). The calculated threshold current density (j*) of the corresponding symmetric Li cell was approximately 200 μA.cm-2, confirming the cell failures due to dendrite growth and short circuiting that were observed in the system above this current density. This j* provides valuable information regarding the design of a full cell as the operation current density would be driven by the Li-SPE interface limitation. To this end, 100 cycles were performed in Li-Li symmetric cells with the TPV electrolyte without failure at currents below j* with 0.1 mAh.cm-2 of charge being transferred per cycle, while a charge of 0.5 mAh.cm-2 resulted in rapid cell failure. These findings emphasize the need for current densities and charge references in symmetric Li-Li cells and cells employing solid electrolytes. C. Monroe, J. Newman, The Impact of Elastic Deformation on Deposition Kinetics at Lithium/Polymer Interfaces. Journal of The Electrochemical Society 152, A396 (2005).L. Caradant et al., Effect of Li+ Affinity on Ionic Conductivities in Melt-Blended Nitrile Rubber/Polyether. ACS Applied Polymer Materials 2, 4943-4951 (2020).L. Stolz, G. Homann, M. Winter, J. Kasnatscheew, The Sand equation and its enormous practical relevance for solid-state lithium metal batteries. Materials Today 44, 9-14 (2021).D. Devaux et al., Effect of Electrode and Electrolyte Thicknesses on All-Solid-State Battery Performance Analyzed With the Sand Equation. Frontiers in Energy Research 7, (2020).T. Meyer, T. Gutel, H. Manzanarez, M. Bardet, E. De Vito, Lithium Self-Diffusion in a Polymer Electrolyte for Solid-State Batteries: ToF-SIMS/ssNMR Correlative Characterization and Modeling Based on Lithium Isotopic Labeling. ACS Applied Materials & Interfaces 15, 44268-44279 (2023).

Nocturnal Salivary Cortisol Is an Accurate Non-Invasive Test to Assess Endogenous Hypercortisolism in Children with Obesity and a Clinical Phenotype Suspicious for Cushing's Syndrome.

Cushing's syndrome (CS) constitutes one of the most challenging diagnostic assessments for paediatric endocrinologists. The clinical presentation of some children with exogenous obesity overlaps with those observed in hypercortisolism states. Accurate, non-invasive first-line tests are necessary to avoid false-positive results in the obese. We aimed to evaluate the diagnostic accuracy of salivary cortisol to assess endogenous hypercortisolism in children with obesity and clinical overlapping signs of CS. Case-control study that included children aged 2-18 years, BMI-SDS ≥2.0 and a follow-up &gt;2 years. Patients were assigned to three categories: group A, features strongly indicative of paediatric CS (growth failure combined with increasing weight); group B, features suggestive of CS (e.g., moon face and striae); and group C, less specific features overlapping with CS (e.g., hypertension, hirsutism, insulin resistance). Children in categories A and B formed the control group. Ten patients with confirmed CS were the case group. All children collected saliva samples on the same day in the morning between 7 and 8:00 a.m. (morning salivary cortisol: mSC) and at 11 p.m. (nocturnal salivary cortisol: nSC). The mSC and nSC results were used to calculate the percentage decrease of cortisol at night (%D). Main outcomes by receiver operating characteristic for nSC and the %D were sensitivity, specificity, positive (P) and negative (N) predictive values (PV) and their corresponding 95% CI. Salivary cortisol was measured by electrochemiluminescence assay (lower limit of quantification: 2.0 nmol/L). 75/112 children met the inclusion criteria, whereas 22/75 children were eligible for the control group. Only controls decreased nSC (median and interquartile range: 2.0 [2.0-2.5] nmol/L) compared to mSC (6.9 [4.8-10.4] nmol/L), p &lt; 0.0001. A cut-off for nSC ≥8 nmol/L confirmed CS within a sensitivity: 1.0 (0.69-1.0), specificity: 1.0 (0.85-1.0), PPV: 1.0 (0.69-0.99), and NPV: 1.0(0.85-0.99), achieving a diagnostic efficiency of 100%. The cut-off obtained for %D was 50%. No child with CS had a %D ≥50%, but 6/22 children in the control group had a %D below the cut-off, resulting in a lower overall diagnostic accuracy of 81% compared to nSC. Salivary cortisol at 11 p.m. is an accurate, feasible, and non-invasive first-line test to assess endogenous hypercortisolism in children with obesity and clinical suspicion of CS. The nSC was also useful in showing that the circadian rhythm of cortisol was preserved in children with exogenous obesity. In patients with nSC ≥8.0 nmol/L, other biochemical assessments and imaging studies are needed to further confirm the aetiology.

Do we neglect nutrition in childhood interstitial lung disease?

Growth failure and inadequate weight gain are common problems in childhood interstitial lung diseases (chILD) and these children usually need high calories. It is important to manage both pulmonary functions and nutrition as part of their overall treatment plan and early interventions will help children to improve their quality of life and slow the progression of chronic lung disease. Nutritional evaluation on routine clinical follow-up is important, although there are not any specific guidelines for chILD. Nutritional education, high balanced energy, protein, and fat diet will assist to improve weight gain and maintenance of adequate nutrition status in children with ILD.

Criticality of volumetric defect structure on fatigue properties of stainless steel 316L fabricated by laser powder direct energy deposition

As one of the significant metal additive manufacturing (AM) processes, laser powder direct energy deposition (LP-DED) has established its role in specific applications, including component repair, coatings, and multi-material structure. However, one of the limiting factors for the wide adoption of LP-DED is the formation of volumetric defects during the printing process. These defects are one of the crucial causes of poor and scattered mechanical properties, especially fatigue performance, by accelerating fatigue crack initiation, growth, and final failure. Unraveling defect structure-fatigue correlations can help understand how defects are affecting fatigue properties, how critical they are, and, finally, what solutions can be utilized to diminish their harmful effects. In this research study, novel defect features, including size features, shape descriptors, and location features, were proposed and investigated regarding fatigue properties in LP-DED. Accordingly, stainless steel 316L (SS 316L) blocks were fabricated by LP-DED. After cutting out the dog-bone samples by wire electric discharge machining (EDM), X-ray Computed Tomography (XCT) and subsequent fatigue tests were conducted. The defect features and their statistical descriptors were extracted from XCT data. By statistical analysis of the features, valuable insights regarding their correlations with fatigue life were realized.

Patient, Parental, and Health Professional Perspectives on Growth in Children With CKD

Growth failure is a common problem among children with chronic kidney disease (CKD). Reduced height is associated with psychosocial burden, social stigma, and impaired quality of life. This study aimed to describe the aspects of growth impairment that are most impactful from the perspectives of children with CKD, their parents, and health professionals. Qualitative study. 120 children with CKD (aged 8-21 years), 250 parents, and 445 health professionals from 53 countries participated in 16 focus groups, two consensus workshops, and a Delphi survey. A thematic analysis of all qualitative data concerning growth from the Standardized Outcomes in Nephrology - Children and Adolescents (SONG-Kids) initiative. We identified five themes: diminishing psychological wellbeing (compared to and judged by peers, tired of explaining to others, damaging self-esteem), constrained life participation and enjoyment (deprived of normal school experiences, excluded from sports or competing at a disadvantage, impaired quality of life in adulthood); grappling with impacts of symptoms and treatment (difficulty understanding short stature and accessing help, lack of appetite, uncertainty regarding bone pains, medication side effects, burden of growth hormone treatment); facilitating timely interventions and optimizing outcomes (early indicator of disease, assessing management, maximizing transplant outcomes, minimizing morbidity); and keeping growth and health priorities in perspective (quality of life and survival of utmost priority, achieved adequate height). Only English-speaking participants were included. Impaired growth may diminish psychological wellbeing, self-esteem, and participation in daily activities for children with CKD. Balancing different treatments that can affect growth complicates decision-making. These findings may inform the psychosocial support needed by children with CKD and their caregivers to address concerns about growth.