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Objective: We aim to describe the population pharmacokinetics (PPK) of tacrolimus in Chinese pediatric patients under 4 years old after liver transplantation and to develop individualized tacrolimus dosing software. Methods: A total of 663 blood concentrations from 85 patients aged 4.57 months to 3.97 years were collected in this study. PPK analysis was performed using a nonlinear mixed effects modeling approach with the software, Phoenix. Using C#, an individualized tacrolimus dosing software was created. The software was then used to predict the concentrations of another ten pediatric liver transplantation patients to verify the accuracy of said software. The predictive error (PE) and the absolute predictive error (APE) for each predicted time point were computed. Results: A one-compartment model with first-order elimination best fitted the data. The apparent volume of distribution (V/F) and apparent clearance (CL/F) were 198.65 L and 2.41 L/h. Postoperative days (POD), total bilirubin (TBIL), and the use of voriconazole significantly influenced tacrolimus apparent clearance. The incorporation of an increasing number of actual blood drug concentrations into the prediction resulted in a decrease in both PE (72%, 17%, 7%) and APE (87%, 53%, 26%). Conclusions: A qualified PPK model of tacrolimus was developed in Chinese pediatric patients. The individualized tacrolimus dosing software could be used as a suitable tool for the personalization of tacrolimus dosing for pediatric patients after liver transplantation. [ABSTRACT FROM AUTHOR]

Purpose: To comprehensively summarize the incidence and risk factors of drug-induced kidney injury (DIKI) in children. Methods: We systematically searched seven databases from inception to November 2022. Two independent reviewers selected studies, extracted data, and assessed the risk of bias. Meta-analyses were conducted to quantify the incidence and risk factors of DIKI in children. Results: A total of 69 studies comprising 195,894 pediatric patients were included. Overall, the incidence of DIKI in children was 18.2% (95%CI: 16.4%-20.1%). The incidence of DIKI in critically ill children (19.6%, 95%CI: 15.9%-23.3%) was higher than that in non-critically ill children (16.1%, 95%CI: 12.9%-19.4%). Moreover, the risk factors for DIKI in children were intensive care unit (ICU) admission (OR = 1.59, 95% CI: 1.42–1.78, P = 0.000), treatment days (OR = 1.04, 95% CI: 1.03–1.05, P = 0.000), surgical intervention (OR = 1.43, 95% CI: 1.00–2.02, P = 0.048), infection (OR = 2.30, 95% CI: 1.44–3.66, P = 0.000), patent ductus arteriosus (OR = 4.78, 95% CI: 1.82–12.57, P = 0.002), chronic kidney disease (OR = 2.78, 95% CI: 1.92–4.02, P = 0.000), combination with antibacterial agents (OR = 1.98, 95% CI: 1.54–2.55, P = 0.000), diuretics (OR = 1.97, 95% CI: 1.51–2.56, P = 0.000), combination with antiviral agents (OR = 1.50, 95% CI: 1.11–2.04, P = 0.008), combination with non-steroidal anti-inflammatory drugs (OR = 1.79, 95% CI: 1.40–2.28, P = 0.000), and combination with immunosuppressive agents (OR = 2.84, 95% CI: 1.47–5.47, P = 0.002). Conclusion: The incidence of DIKI in children is high, especially in critically ill children. Identifying high-risk groups and determining safer treatments is critical to reducing the incidence of DIKI in children. In clinical practice, clinicians should adjust medication regimens for high-risk pediatric groups, such as ICU admission, some underlying diseases, combination with nephrotoxic drugs, etc., and regularly evaluate kidney function throughout treatment. [ABSTRACT FROM AUTHOR]

Background: Some studies lack detailed analyses of the differences and characteristics of pediatric injury mechanisms between urban and rural areas. Objective: We aim to understand the characteristics, trends, and mortality rates of injury mechanisms in children in urban and rural areas in central China. Results: In a study involving 15,807 pediatric trauma patients, it was observed that boys constituted the majority (65.4%) and those aged ≤ 3 years were the most prevalent (28.62%). Falls (39.8%), burns (23.2%), and traffic accidents (21.1%) were identified as the top three injury mechanisms. The head (29.0%) and limbs (35.7%) were found to be the most susceptible to injury. Additionally, children between the ages of 1–3 years exhibited a higher likelihood of sustaining burn injuries compared to other age groups. The main causes of burn injury were hydrothermal burns (90.3%), flame burns (4.9%), chemical burns (3.5%), and electronic burns (1.3%). In urban areas, the major injury mechanisms were falls (40.9%), traffic accidents (22.4%), burns (20.9%), and poison (7.1%), whereas, in rural areas, they were falls (39.5%), burns (23.8%), traffic accidents (20.8%), and penetration (7.0%). Over the past decade, the overall incidences of pediatric trauma have been decreasing. In the past year, the number of injured children was the highest in July, and the overall mortality rate due to trauma was 0.8%. Conclusion: Our findings revealed that in different age groups, the injury mechanisms are different in urban and rural areas. Burns are the second leading cause of trauma in children. A decrease in pediatric trauma over the past 10 years indicates targeted measures and preventive intervention may effectively prevent pediatric trauma. [ABSTRACT FROM AUTHOR]

Purpose: To identify the profile of a pediatric low-vision population and investigate the differences between low-vision services in urban and rural areas. Methods: A retrospective study was conducted of the records of 286 consecutive children presenting at the Low Vision Clinic of the Eye and ENT Hospital of Fudan University from January 2009 to December 2018. The data retrieved included age, sex, education, family history, rural vs. urban residence, cause of visual impairment, and low-vision aids dispensed. Results: Of the 286 children (65.0% boys and 35.0% girls), over half (178, 62.2%) were from urban areas. The age range of the patients was 3–15 years (mean 9.54 ± 4.11). The four major causes of visual impairment were congenital cataract (70, 24.5%), optic atrophy (37, 12.9%), congenital glaucoma (34, 11.9%), and macular dystrophy (31, 10.8%). Low-vision aids were prescribed for 203 children (71.0%), with binocular telescopes (69, 25.0%) and stand magnifiers (66, 23.9%) being the most common. The urban children enjoyed higher rates of low-vision services than the rural children, with more low-vision aids (192, 94.6%) prescribed for the former. Conclusions: Congenital and hereditary diseases constituted the major causes of low vision in the study population. In contrast to their urban counterparts, the rural children experienced inadequate low-vision rehabilitation. Our findings suggest that policymakers need to better address gender inequalities and urban–rural disparities in low-vision services and that the coverage of low-vision services, especially in rural areas, should be enhanced in China. [ABSTRACT FROM AUTHOR]