A systematic review for artificial intelligence-driven assistive technologies to support children with neurodevelopmental disorders

This systematic review examines AI-powered assistive technologies for children with neurodevelopmental dis- orders, with a focus on dyslexia (DYS), attention-deficit hyperactivity disorder (ADHD), and autism spectrum disorder (ASD). Our analysis of 84 studies from 2018 to 2024 provides the first thorough cross-disorder com- parison of AI implementation patterns. According to our data, each condition has different success rates and technological preferences. AI applications are expanding quickly, especially in research on ASD (56 % of studies), followed by ADHD (36 %), and DYS (8 %). In almost half of the reviewed studies, computer-assisted technol- ogies, which have demonstrated encouraging results in terms of treatment support and diagnostic accuracy, became the main mode of intervention. Despite high accuracy in controlled settings, the implementation of these technologies in clinical practice faces significant challenges. While human oversight remains essential in clinical applications, future advancements should prioritize privacy protection and the ability to assess tools longitu- dinally. Notably, multimodal approaches that integrate various data types have improved diagnostic accuracy; recent research has shown that they can detect ASD with up to 99.8 % accuracy and ADHD with up to 97.4 % accuracy. A promising trend is the combination of mobile applications and wearable technology, especially for real-time monitoring and intervention. This review highlights the potential and current limitations of AI-driven tools in supporting children with neurodevelopmental disorders. Future development should focus not on replacing clinical expertise, but on augmenting it. Research efforts should aim at creating tools that enhance professional judgment while preserving the essential human components of assessment and intervention

Rehabilitation versus surgical reconstruction for non-acute anterior cruciate ligament injury (ACL SNNAP): a pragmatic randomised controlled trial

BackgroundAnterior cruciate ligament (ACL) rupture is a common debilitating injury that can cause instability of the knee. We aimed to investigate the best management strategy between reconstructive surgery and non-surgical treatment for patients with a non-acute ACL injury and persistent symptoms of instability.MethodsWe did a pragmatic, multicentre, superiority, randomised controlled trial in 29 secondary care National Health Service orthopaedic units in the UK. Patients with symptomatic knee problems (instability) consistent with an ACL injury were eligible. We excluded patients with meniscal pathology with characteristics that indicate immediate surgery. Patients were randomly assigned (1:1) by computer to either surgery (reconstruction) or rehabilitation (physiotherapy but with subsequent reconstruction permitted if instability persisted after treatment), stratified by site and baseline Knee Injury and Osteoarthritis Outcome Score—4 domain version (KOOS4). This management design represented normal practice. The primary outcome was KOOS4 at 18 months after randomisation. The principal analyses were intention-to-treat based, with KOOS4 results analysed using linear regression. This trial is registered with ISRCTN, ISRCTN10110685, and ClinicalTrials.gov, NCT02980367.FindingsBetween Feb 1, 2017, and April 12, 2020, we recruited 316 patients. 156 (49%) participants were randomly assigned to the surgical reconstruction group and 160 (51%) to the rehabilitation group. Mean KOOS4 at 18 months was 73·0 (SD 18·3) in the surgical group and 64·6 (21·6) in the rehabilitation group. The adjusted mean difference was 7·9 (95% CI 2·5–13·2; p=0·0053) in favour of surgical management. 65 (41%) of 160 patients allocated to rehabilitation underwent subsequent surgery according to protocol within 18 months. 43 (28%) of 156 patients allocated to surgery did not receive their allocated treatment. We found no differences between groups in the proportion of intervention-related complications.InterpretationSurgical reconstruction as a management strategy for patients with non-acute ACL injury with persistent symptoms of instability was clinically superior and more cost-effective in comparison with rehabilitation management

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Unusual presentation of superior mesenteric artery syndrome in a child

Superior mesenteric artery syndrome (SMAS), also known as Wilkie’s syndrome, is a rare cause of upper gastrointestinal tract obstruction. We report a case of a 10-year-old girl with persistent abdominal pain for over 3 months, who on extensive investigations was diagnosed with SMAS. She underwent a surgical procedure to bypass the obstructed portion of the intestine for relief of her symptoms.</jats:p

Sub-glottic cysts causing upper airway obstruction

&lt;p class="abstract"&gt;Wigger and Tang reported the first case of a sub-glottic cyst (SGC) in 1968. SGC are rare but potentially reversible causes of upper airway obstruction, in previously intubated children. These children present with respiratory distress and stridor, and the diagnosis is confirmed by direct laryngoscopy. The management depends on the size of the cysts and the severity of the symptoms. We are presenting two cases of SGCs who were born prematurely and were intubated for a prolonged period. They presented with stridor and were diagnosed to have sub-glottic cysts at bronchoscopy.&lt;/p&gt;</jats:p

Gall bladder duplication with choledochal cyst: A rare entity

A 4-year-old male child presented with complaints of abdominal pain and vomiting along with yellowish discoloration of the eyes. Investigations were suggestive of acute pancreatitis and double gall bladder (GB) with dilated common bile duct (CBD) with intraluminal calculi and Type II choledochal cyst. He underwent surgical resection of double GB with dilated CBD with hepatico-docho-jejunostomy. On follow-up, the patient was asymptomatic. Our case highlights the importance of preoperative diagnosis to deal with increased operative difficulty and complications

Retroperitoneal Teratoma: A Rare Entity in a Young Infant

Background: Primary retroperitoneal teratoma of infancy is rare, comprising only 3.5%–4% of all germ cell tumors. The presentation may range from an asymptomatic mass to an abdominal lump causing symptoms due to mass effect on the neighbouring organs. We present a young infant with an abdominal mass who posed a diagnostic challenge. Clinical Description: A 3monthold female infant with an uneventful antenatal and perinatal history presented with complaints of abdominal distension since 1½ months of age. A lump was palpable involving the entire right side of the abdomen, crossing the midline. Management and Outcome: Despite detailed radiological imaging and trucut biopsy, the diagnosis was unclear. A complete open laparoscopic excision of the mass followed by a biopsy confirmed the diagnosis of grade 2/3 immature teratoma. Serum alphafetoprotein levels and betahuman chorionic gonadotropin levels were normal. Chemotherapy was not administered. The patient has been on followup for the past 2½ years, doing well without any complaints. Conclusion: Early recognition and complete excision of primary retroperitoneal teratoma with mature or partly immature histopathology carries a good prognosis

Livedoid vasculopathy with hyperhomocysteinemia responding to hyperbaric oxygen therapy

A 30-year-old male presented to the dermatology department with complaints of multiple ulcers over both legs of 6 years duration. The ulcers had a waxing and waning course with present exacerbation of lesions since 1 month. Dermatological examination revealed multiple ulcers distributed in a reticular pattern over medial and lateral aspects of both lower legs, extensor aspect of both ankles and dorsum of both feet. Multiple interspersed atrophic porcelain white scars were also present. Investigations revealed raised serum homocysteine levels. A skin biopsy from the ulcers showed features of livedoid vasculopathy. Following recurrence of lesions after oral corticosteroid therapy, the patient was given a course of hyperbaric oxygen therapy for the ulcers to which he responded very well. This case is being presented for the novel option of hyperbaric oxygen therapy in livedoid vasculopathy, which by itself is rarely reported in this part of the world

Type VI choledochal cyst – An emerging rare entity (11th pediatric case of type VI) with a review of literature

Choledochal cysts (CCs) are abnormal dilatations of the biliary system. Usually, CCs are classified into five types. The sixth type (Type VI) is an emerging and rare type, reported the first case in 1991. We report this rare CC, Type VI seen in our experience for the first time. We have also reviewed the literature; only 26 cases of Type VI were found, including adults and children, ever since the first case has been reported in 1991. To the best of our knowledge, this is the 11th pediatric case report of a Type VI choledochal cyst