Abstract Neurofibromatosis Type I (NF1) is an autosomal dominant genetic syndrome that is inherited or sporadic. Neuro-Oncology nurses are experienced in the multidisciplinary care of NF1 patients due to an increased incidence of brain tumors and the treatment of plexiform neurofibromas with Mek inhibitors. However, these children are also at higher risk of rare solid tumors, specifically malignant peripheral nerve sheath tumors (MPNST). Most brain tumors in NF1 have a good prognosis. Conversely, MPNST has an extremely poor prognosis. While patients with MPNST are often cared for by solid tumor care teams, the identification and diagnosis of the tumors occur under the care of the neuro-oncology care team. Complex care coordination for patients with NF1 and cancer is required. Specifically, patients with NF1 are more sensitive to chemotherapy, have a higher incidence of radiation-induced secondary tumors, and need monitoring for NF1 related health impacts. Nurses and nurse practitioners with expertise in neuro-oncology, NF1, and solid tumors must collaborate to provide comprehensive care. Teaching tools and clinical strategies have been developed to maintain patients’ continuity with the primary oncology team while gaining the support of subspecialists. The genetic basis, inheritance pattern, and characteristics of Neurofibromatosis Type I will be discussed as well as rare oncologic diagnoses that are more prevalent in children/young adults with NF1. The multidisciplinary approach to the care of the patient with NF1 and a rare cancer diagnoses at a tertiary care center as well as the optimization of care of patients with NF1 and other underlying syndromes and rare cancers will be reviewed. Increased knowledge of NF1 and the associated health impacts and risk of cancers will improve the care of all patients with NF1.
Abstract Methotrexate (MTX) is an essential component of chemotherapy for childhood acute lymphoblastic leukemia (ALL). Both intravenous (IV) and most commonly intrathecal (IT) routes of MTX have been complicated in acute, subacute, and chronic neurotoxicity syndromes. A 9-year-old girl had been diagnosed with standard risk ALL since 2011 with first chemotherapy protocol was Indonesian protocol standard risk ALL 2006 and remission in 2012. On July 2015, patient was diagnosed as relapse ALL and underwent Indonesian protocol high risk ALL 2013. The last chemotherapy protocol of patient was Indonesian protocol high risk ALL 2013 maintenance phase 89th weeks with total dosage of MTX was 336 mg (IT), 6000 mg/m2 (IV), and 2500 mg/m2 orally. Her presenting symptom was progressive decrease of consciousness since 3 months before hospital admission. First brain computed tomography (CT-Scan) and magnetic resonance imaging (MRI) revealed brain atrophy. One month later she had abnormality in behavior and functional ability with second brain CT-Scan revealed brain atrophy and lacunar infarct in left pons. This case can be in accordance with chronic encephalopathy due to MTX. It is important to recognize early complications taking the form of subclinical or symptomatic CNS damage (e.g. headache, dizziness, tremor, ataxia, aphasia, dysarthria, emotional instabilities, seizures, hemiparesis, encephalopathy) that can occur in the course of chemotherapy especially MTX. Determination of the cause of encephalopathy is associated with considerable difficulty despite the use of various diagnostic methods and also treatment of MTX neurotoxicity is mainly supportive and recovery is usually complete. Keywords: imaging, methotrexate, neurotoxicity, leukemia
ABSTRACT IMPACT: Partnering with academic offices to promote peer-mentoring in a virtual format is feasible, novel, and well-received across a major academic campus. Particularly during a pandemic, the success of this programmatic effort highlights the continued need for peer-to-peer support. OBJECTIVES/GOALS: To identify feasibility and key lessons learned from the planning and implementation of a virtual, interdisciplinary group peer-mentoring series, implemented broadly across an academic medical center in New York City. METHODS/STUDY POPULATION: ASPIRE! (Accountability & Safe-Space to Promote, Inspire, Recharge, & Empower one another!) is a group of seven interdisciplinary mid-career academic women faculty, who began collaborations as CTSA KL2 scholars. Our mission is to support interdisciplinary peer coaching for advancement of gender and racial equity among academic faculty and leaders. We designed and implemented a series of virtual symposia focused on essential struggles for clinicians and investigators at during the COVID-19 pandemic. Partnering with Columbia’s CTSA, Office for Women and Diverse Faculty, and Office for Research, we invited leaders in psychiatry/psychology, early childhood education, organization/team management, and academic advancement as keynote speakers and facilitated peer-mentoring virtual breakouts. RESULTS/ANTICIPATED RESULTS: These efforts resulted in the completion of four separate 1.5-hour symposia, each with keynote speakers, discussions with academic leaders, and 30-minute breakout peer-mentoring sessions. Session topics included Calibrating Expectations, Helping Families Thrive, Managing Remote Teams, and Faces and Phases of Stress. Enrollment ranged from 30 to 70 participants per session. Participants reported: (1) Keynotes focused on actionable solutions stimulated the most productive conversations; (2) Peers from different disciplines and career stages provided a range of actionable recommendations tested within local contexts; (3) The greatest learning came from the peer-to-peer breakout group sessions. DISCUSSION/SIGNIFICANCE OF FINDINGS: Partnering with academic offices to promote interdisciplinary, peer-mentoring in a virtual format is feasible, novel, and can be well-received across a major academic campus during the COVID-19 pandemic. The success of this programmatic effort highlights the continued need for expanded peer-to-peer support in academia.
Background Pollen from birch and other trees in the birch homologous group (e.g., oak) is a common trigger of allergic rhinitis and/or conjunctivitis (AR/C) in Canada. The efficacy and safety of the tree sublingual immunotherapy (SLIT)-tablet in children with AR/C was evaluated post hoc in the Canadian subpopulation of a phase III, double-blind trial (EudraCT2020-004372-17). Methods Children and adolescents aged 5-17 years with moderate-to-severe tree AR/C were randomized to either daily tree SLIT-tablet or placebo for up to 52 weeks. Participants had free access to symptom-relieving medication. The primary endpoint was the average total combined score (TCS; sum of rhinoconjunctivitis daily symptom score [DSS] and daily medication score [DMS]) during birch pollen season (BPS). Average TCS during tree pollen season (TPS, consisting of birch, alder, hazel, and oak pollen seasons), oak pollen season (OPS), and pure OPS (excluding days from birch, alder, or hazel pollen seasons) were also analyzed. Results In the Canadian subpopulation (n = 87), treatment with the tree SLIT-tablet reduced the average TCS by 26.8% versus placebo during BPS (absolute difference [95% CI] = 1.89 [-0.71, 4.49], p = 0.138), 32.0% during TPS (absolute difference = 2.14 [-0.03, 4.32], p = 0.042), 46.6% during OPS (absolute difference = 3.70 [0.98, 6.42], p = 0.004), and 50.6% during pure OPS (absolute difference = 4.20 [1.12, 7.27], p = 0.005). Reductions in DSS and DMS with tree SLIT-tablet versus placebo were also observed. In the total trial population (N = 952), tree SLIT-tablet treatment reduced the average TCS by 19.2% versus placebo during BPS (absolute difference = 1.13 [0.42, 1.84], p = 0.002), 16.8% during TPS (absolute difference = 0.76 [0.26, 1.26], p = 0.003), 23.4% during OPS (absolute difference = 1.32 [0.60, 2.05], p < 0.001), and 19.9% during pure OPS (absolute difference = 1.03 [0.27, 1.80], p = 0.009). The tree SLIT-tablet was well tolerated in the total trial and Canadian subgroup populations. Conclusions The tree SLIT-tablet demonstrated favorable efficacy and was well tolerated in Canadian children and adolescents with AR/C. Clinical trial registration EudraCT 2020-004372-17 and NCT04878354.
Abstract Background Left-behind children（LBC has experienced parent-child separation, which is a special parent-child separation and social isolation model. Adverse events in early development may have important effects on the development of the nervous system, including the influence on sensory and perceptual cognitive processing, thus increasing the susceptibility to mental illness. Meanwhile, there are various neurological and brain root causes behind left-behind children’s learning difficulties, non-socialization and other psychological behavior problems. In addition, left-behind may have sensory, perceptual and cognitive processing abnormalities. This study tries to elaborate and extract the eye movement characteristics of left-behind children, lay a foundation for the discussion of the mechanism of abnormal visual processing, and provide a scientific basis for follow-up of left-behind children and the early identification, prevention and control of mental diseases. Methods The standards for grouping left-behind children are as follows: the children who are separated from both parents 6 months after birth and spend less than 2 months with their parents each month, and the non-left-behind children with matched gender, age and education years, exclusion criteria is: neurological diseases, family history of mental illness, broken family (single parent, bereavement), high myopia (greater than 1000 degrees), eye and eyelash cannot be identified by infrared light. EyeControl portable eye movement tester (built-in infrared, speed: 100Hz, error <0.5°) developed by Qingtech and its software processing system were used. The subjects’ eye movements and various analysis indexes in various tasks were collected. The eye movement indexes of smooth pursuit eye movement, fixation stability and free browsing were collected, so as to investigate the effects of left-behind on static attention retention, visual tracking and face recognition in social scenes. Results Among the 175 children, the smooth tracking mean deviation of LBC is significantly increased (P=0.017). The mean deviation of the O and S-curve tracking of the LBC is significantly increased (P=0.018; P=0.034), and the OS curve mean deviation and hyperactivity correlated (r=-0.273, P=0.011). In terms of the time that peak deviation takes (F=4.329, P=0.014), there is significant interaction between the age groups and the left-behind groups. In the social scenes, the first fixation time of face (P=0.039), the number of eye entry count (P=0.020), and the eye fixation time (P=0.003) of LBC are all significantly reduced, and the number of mouth entry count (P=0.007) and the number of fixation (P=0.023) of LBC are all significantly increased. Under the circumstance of low facial processing, there is a significant difference between LBC and NLBC (P=0.009), and that difference is not significant under the circumstance of high facial processing, and there is a significant difference between low facial processing LBC and high facial processing NLBC (P=0.007). Discussion Left-behind children have obstacles in dynamic visual information processing, insufficient inhibition and control, and poor cognitive flexibility, which may be related to hyperactivity. The attention retention in visual tracking decreased with the increase of age. Left-behind children have difficulties in face recognition in social scenes. In the case of low facial processing, left-behind children aggravated the defects of speech comprehension, while in the case of high facial processing, left-behind children had no significant influence on speech comprehension. Therefore, we should intervene the left-behind children in the early days, and this study provides a scientific basis for the formulation of social policies.
Objective To investigate the safety and short-term efficacy of interventional therapy for congenital portosystemic shunt (CPSS) in children, and to provide single-center small-sample empirical data for clinical practice. Methods A retrospective analysis was conducted on the clinical data of 26 children with CPSS who underwent interventional therapy at Capital Center for Children's Health, Capital Medical University from January 2022 to August 2025. Based on anatomical subtypes, they were categorized into the intrahepatic portal-systemic shunt group (18 cases) and the Abernethy malformation group (8 cases). Techniques such as coil embolization and Amplatzer occluder embolization were employed. Postoperative follow-up was performed for 1-12 months to evaluate technical success rates, complication rates, and improvements in liver function and blood ammonia levels. Results The success rate of interventional therapy in 26 pediatric patients was 73% (19/26). Among them, the technical success rate in the intrahepatic portal-systemic shunt group was 94.4% (17/18), while the Abernethy malformation technique achieved a success rate of 25% (2/8). The incidence of mild complications within 1 month postoperatively was 3.8% (1/26), including 1 case of puncture site hematoma, with no severe complications reported. Among the successfully treated patients, the normalization rate of postoperative liver function parameters [Alanine aminotransferase (ALT), Aspartate aminotransferase (AST)] was 63% (12/19), the improvement rate of bile acids was 73.7% (14/19), and the improvement rate of blood ammonia was 100% (19/19). Conclusion The individualized interventional embolization strategy for children with different anatomical subtypes of CPSS is safe and effective, with definite short-term efficacy, and can be used as the first-line treatment for CPSS children.
It is estimated that, globally, the mean point prevalence of diagnosable mental disorders in children and adolescents is higher than 11%, and around half of cases of major mental disorders have their onset before the age of 18. Mental disorders with onset in childhood or adolescence have an enormous impact on the developing brain, body and personal identity, as well as on the short- and long-term social, educational and functional capacity of individuals. Child and adolescent psychiatry - as a discipline, profession, academic field, and network of clinical services - is still relatively young, with its formal evolution beginning in the 20th century. Therefore, it is not surprising that there are currently many challenges, but also opportunities and expected future developments, in this area. In this paper, we identify and address the core challenges, possible solutions, opportunities, and future directions of child and adolescent psychiatry. In the first part of the paper, challenges and possible solutions are discussed regarding diagnostic issues, stigma, access to care, shortage of mental health professionals, evidence-based treatments, treatment adherence, parental participation/engagement, integration with schools, digital influences and cyberbullying, and war/forced displacement. In the second part, opportunities and developments are addressed that relate to early identification and intervention, resilience, interdisciplinary collaborations, integration with primary care, community-based approaches, use of digital technologies, precision child and adolescent psychiatry, artificial intelligence and related ethical issues, and cultural diversity and competences. Despite the significance and impact of mental disorders in children and adolescents, clinical delivery and research on these conditions remain underfunded and underprioritized, even in high-income countries, with clinical services and prevention/early intervention research receiving minimal investment. Addressing mental health in children and young people requires multi-level strategies beyond individual treatment, including tackling structural and socioeconomic barriers and creating opportunities for strengthening resilience and well-being. A well-trained workforce, adequate policies, and increased public awareness are crucial. Overall, the current gaps demand urgent action and global funding rebalancing to more adequately meet the critical needs of children and young people challenged by mental illness.
Introduction Anorexia Nervosa (AN) and Avoidant/Restrictive Food Intake Disorder (ARFID) are two primary restrictive eating disorders described in DSM-5, characterized both of them by insufficient food intake. This behavior In ARFID is not driven by weight and shape concerns that tipify AN. While there are several studies that highlight the presence of mentalizing difficulties in AN, there are still no data about mentalizing profile in ARFID. Objectives The aim of this study was to better characterize the mentalizing profile of AN and ARFID children and adolescent. Methods Two groups of AN or ARFID outpatients (15+15), aged 6 to 18 years, were assessed by Alexythimia Questionnaire for Children (AQC) and Toronto Alexythimia Scale-20 (TAS-20) to evaluate alexythimia; by Interpersonal Reactivity Index (IRI) and Basic Empathy Scale (BES) to assess empathy; by NEPSY-II social perception subtests to evaluate Theory of Mind and Emotion recognition. Exclusion criteria were the presence of intellectual disability, pervasive developmental disorders and binge eating behavior (eating disorder other than AN or ARFID). Results Preliminary results showed different mentalizing profiles between ARFID and AN patients, with differences in the score for affective empathy, lower in ARFID than in AN patients while the score for alexythimia traits resulted higher in AN population. Conclusions By our results, mentalization impairment appeared trans-diagnostic across several eating disorders. This first result should be further improved to better analyze this construct in order to develop effective clinical intervention to improve the subject’s affective regulation. Disclosure No significant relationships.
Abstract BACKGROUND: The mitogen-activated protein kinase (MAPK) pathway is dysregulated in approximately one third of all malignancies. Agents targeting this pathway are known to cause frequent and significant skin toxicity. METHODS: Patients <21 years of age prescribed any medication targeting the MAPK pathway within the past six months were eligible for this prospective, pilot study. Each participant received a complimentary skin care kit consisting of basic skin and oral care items. At baseline and three months after enrollment, participants completed surveys assessing demographics, skin symptoms, use of the products, and quality of life (QOL; Dermatology Life Quality Index and Child Dermatology Life Quality Index, CDLQI). OBJECTIVES: Primary aims were evaluating utilization of the kit and measuring patient satisfaction of the items included. Secondary aims included determining skin-related QOL and assessing adherence to MAPK targeted therapy. RESULTS: Eleven participants (seven male, four female; median age 13 years, range 4-21 years) have enrolled to date (enrollment goal of 30). Participant therapies included MEK inhibitors (nine), a pan-RAF inhibitor (one), and combination MEK-mTOR inhibition (one). Six have completed the three-month follow-up. Of these six, four rated their satisfaction with the kit as excellent, one each rated very good and fair satisfaction. Five participants rated the kit helpful and thought the kits should be distributed when patients begin therapy. Three started taking their targeted agent before enrolling in the study and their CDLQI changed from 3 to 0.3 (means; improved). Three participants started their targeted agent after enrollment and their CDLQI changed from 1 to 3.3 (means; worsened). CONCLUSIONS: Participants reported that skin care kits were helpful and recommended use by other patients on MAPK-targeted agents. Continued follow-up and enrollment in the study will help further explore the utility of specific products in the kits, as well as changes in patients’ QOL.
Objectives In the context of rising emergency department (ED) visits by children for behavioral health (BH) concerns, our objective was to understand current and desired resources for the care of children presenting to Illinois EDs with BH concerns. Methods We surveyed nurse pediatric emergency care coordinators (PECCs) and nurse managers working in Illinois EDs participating in the Pediatric Facility Recognition Program from March 15 to June 30, 2025. We assessed ED characteristics, pediatric BH care practices, and current and desired BH resources. Results Among 101 eligible EDs, 65 (64%) responded. Respondents included nurse PECCs (77%), nurse managers (17%), and nurses serving in both roles (6%). Most EDs (60%) were in hospitals without a pediatric inpatient unit, 22% were in critical access hospitals, and 67% had <4999 annual pediatric ED visits. On-site mental health professionals and telemental health services were available in 56% and 44% of EDs, respectively. Universal suicide risk screening was reported in 88% of EDs, most frequently using the Columbia-Suicide Severity Rating Scale Screen Version (87%) and starting at age 8 (36%). Among EDs, 56% reported always or often providing all elements of safety planning. Frequently desired resources included activity kits (82%) and a portal to view pediatric psychiatric inpatient bed availability (73%). High priority resources included a mechanism to escalate difficult cases (23%) and increased access to mental health professionals in the ED (23%). Conclusion Survey findings inform opportunities to standardize and improve pediatric BH emergency care through the development and dissemination of desired resources.
