Irritable bowel syndrome with constipation is a prevalent disorder of gut-brain interaction in children and adolescents, associated with chronic abdominal pain, altered bowel habits, reduced quality of life, and a significant healthcare burden. Despite a wide range of therapeutic approaches, treatment responses remain suboptimal, highlighting the need for effective, evidence-based pharmacological options. This review summarizes current and emerging pharmacological therapies for pediatric irritable bowel syndrome with constipation, with a focus on their mechanisms of action, efficacy, and safety. Traditional treatments such as dietary fiber, probiotics, antispasmodics, laxatives, prokinetics, antidepressants, antibiotics, and antihistamines are reviewed, emphasizing the limited and often inconsistent evidence supporting their use for pain relief and overall symptom improvement. Particular attention is given to newer agents approved for adults with irritable bowel syndrome with constipation, including secretagogues (linaclotide, plecanatide, and lubiprostone) and the retainagogue tenapanor, with a detailed discussion of their pharmacological properties and clinical trial data. Linaclotide is currently the only medication approved by the U.S. Food and Drug Administration for the treatment of irritable bowel syndrome with constipation in children aged 7 years or older. While other novel agents have shown promise in adults, pediatric data remain limited or unavailable. Overall, although pharmacological treatment options for pediatric irritable bowel syndrome with constipation are expanding, high-quality, pediatric specific clinical trials are still needed to guide safe and effective management.

This is a protocol for a Cochrane review (intervention). The objectives are as follows: To assess the efficacy and safety of osmotic and stimulant laxatives for the treatment of functional constipation in children.

Hypercalcaemia is a recognised complication of thyrotoxicosis usually related to increased bone resorption. However, coexistent hyperphosphataemia is uncommon and may create diagnostic uncertainty. It is postulated that serum calcium and phosphate levels rise due to high bone turnover and increased renal reabsorption of phosphate in response to excess thyroxine. Hypercalcaemia may also alter the clinical presentation of thyrotoxicosis, making both diagnosis and management challenging. We report two patients with this unusual biochemical presentation. The first patient was a 69-year-old woman who presented with body aches, lethargy, low mood, constipation, polyuria, and proximal muscle weakness for 2 months. The second was a 56-year-old woman who presented with palpitations, anxiety, tremulousness, dyspnoea, dysphagia, and headache for 4 months. Both had multinodular goitres (MNGs) without eye disease. Their TSH levels were undetectably low with extremely high free T4 levels. Serum calcium and phosphate levels were high in both patients. ALP levels were mildly elevated, vitamin D levels were deficient or insufficient, and parathyroid hormone (PTH) levels were low-normal. DXA scans revealed severe osteoporosis. Both patients improved clinically and biochemically with adequate intravenous hydration, frusemide, carbimazole, propranolol, and bisphosphonates. The second patient underwent a successful left thyroid lobectomy, while the first patient remained well on medical treatment. Unexplained hypercalcaemia and hyperphosphataemia should alert the clinicians to the possibility of underlying thyrotoxicosis. Prompt recognition and management is essential to prevent bone loss, correct metabolic abnormalities, and avoid complications. Clinicians should also consider the possibility of hypercalcaemia associated with thyroid dysfunction in patients presenting with nonspecific symptoms such as fatigue, constipation, proximal weakness, polyuria, or mood changes.

Light-chain proximal tubulopathy (LCPT) is a rare disease, which is classified as crystalline or noncrystalline based on the cytoplasmic inclusions in the proximal tubules. This study aimed to investigate the clinical features of noncrystalline LCPT from a single institute of China. We retrospectively enrolled patients diagnosed with isolated noncrystalline LCPT by kidney biopsy at Peking University First Hospital between 2011 and 2024. We systematically analyzed clinical data, kidney pathological type, treatment and prognosis. Twenty patients were enrolled. The mean age at diagnosis was 58 ± 12 and the sex ratio was 4/16 (female/male). Mean proteinuria was 1.9 ± 2.3g/24 hr and the mean estimated glomerular filtration rate (eGFR) at the point of biopsy 57 ± 30 mL/min/1.73 m2. κ-light chain restriction (70%) was dominant among patients with noncrystalline LCPT. An abnormal serum free light chain ratio was detected in 50% of the patients. Proximal tubulopathy without cytoplasmic inclusions/acute tubular injury (60%) was the most common type, followed by proximal tubulopathy with lysosomal indigestion/constipation (25%) and tubulopathy associated with interstitial inflammation reaction (15%). During follow-up, patients received bortezomib-based or R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone) or a daratumumab-lenalidomide-dexamethasone combination (DRD) chemotherapy vs. supportive treatment only. The mean follow-up time was 24 ± 22 months. All patients showed improved or stable kidney function during the observation period. This represents the first case series detailing noncrystalline LCPT with distinct pathological subtypes in northern China. Chemotherapy targeting aberrant plasma cell clones might favor kidney outcomes in patients with noncrystalline LCPT.

The phenotypic spectrum associated with biallelic RFC1 AAGGG repeat expansion encompasses a range including (1) typical cerebellar ataxia, neuropathy, vestibular areflexia syndrome (CANVAS); (2) cerebellar, sensory, and vestibular impairment; (3) more limited phenotypes involving predominantly or exclusively one of the systems involved in balance control; (4) autonomic dysfunction; and (5) cough. Onset begins after age 35 years. In a retrospective study of 100 affected individuals after ten years of disease duration, two thirds had clinical features of CANVAS; 16 had a complex sensory ataxia with cerebellar or vestibular involvement; and 15 had a sensory neuropathy as the only clinically detectable manifestation.

BackgroundExisting defecation-assistance devices generally lack automated anal localization and image-based screening for conditions that may preclude probe operation.ObjectiveTo develop and evaluate an image-based method for anal localization and abnormal-region detection in an intelligent defecation-assistance system.MethodsThe dataset comprised 1600 human images from 1000 patients and 500 animal images. YOLOv11n and YOLOv11s were trained using transfer learning. A mixed-species technical test set was used for model comparison and ablation analyses, whereas final performance was evaluated on 160 human images. Precision, recall, F1-score, mAP, inference speed, latency, and GPU memory usage were assessed.ResultsOn the mixed-species technical test set, YOLOv11n achieved an F1-score of 97.1%, mAP@0.5 of 99.1%, and 67.1 FPS. On the human-only final evaluation set, it achieved an F1-score of 96.5% and mAP@0.5 of 98.6%. Removing data augmentation and animal images reduced mAP@0.5 by 2.1 and 1.8 percentage points, respectively. Edge-device latency was 14.9 ms per frame, with 2.8 GB GPU memory usage.ConclusionYOLOv11n showed high performance and real-time inference on static images, supporting its technical feasibility for probe localization and abnormality screening. Clinical safety and effectiveness require prospective patient evaluation.