J Formos Med Assoc
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Tyrosine kinase inhibitors (TKIs) have revolutionized chronic myeloid leukemia (CML) treatment, yet long-term pediatric outcomes and growth effects remain limited. This study describes the long-term efficacy and growth impact of TKIs in children and adolescents with CML. ⋯ This study shows the sustained efficacy of TKIs in achieving MR4.5 in pediatric CML, with second-generation TKIs providing faster responses. Growth retardation remains a concern for TKI treatment. TKI discontinuation in pediatric CML may be feasible and crucial for shortening TKI exposure and optimizing long-term growth outcomes in prepubertal patients.
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Biliary atresia (BA) is a progressive liver disease even after Kasai portoenterostomy (KPE), and the most common cause of liver transplant (LT) in the pediatric population. This study aimed to unveil the risk factors for LT in BA patients post-KPE. ⋯ Higher direct bilirubin 3 months post-KPE (≥1.1 mg/dL) and higher peak annual cholangitis frequency predict LT in BA patients. The first cholangitis occurring 61-120 days post-KPE predicts higher peak annual cholangitis frequency. In patients who achieved JF, peak annual cholangitis episodes with a threshold of ≥3 independently predict LT. Bacteremia and higher serum AST levels at six months post-KPE predict higher peak annual cholangitis frequency.
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Controlling hypertension has become an important issue in the elderly population in whom neurological comorbidities are highly prevalent. Most of the large-scale trials focusing on hypertension management in older populations have excluded patients with comorbid neurological disorders. However, this population requires special considerations, as the benefits of antihypertensive agents are mostly uncertain and there is a higher risk of adverse events. ⋯ For patients with neurodegenerative disorders such as cognitive dysfunction and Parkinson's disease, achieving adequate blood pressure control may be beneficial in reducing cardiovascular risks, although the higher risk of adverse events from antihypertensive treatment may offset some of these benefits. Special considerations for factors such as orthostatic hypotension, risk of falls, polypharmacy, and significant drug-drug interactions are required but frequently neglected in clinical practice. More efforts are warranted to determine the optimal treatment strategy for elderly populations with neurological disorders.