1.Gestational Age and Neurodevelopmental Outcomes in Preterm Children at Early Preschool Age: A Longitudinal Multidomain Logistic Modeling Study
Ji Na YANG ; Ye Kyeng SEO ; Dong Hyun KIM ; Nam Hun HEO ; Soo A KIM ; Jun Hwan SONG ; Seung Soo KIM
Annals of Child Neurology 2026;34(2):109-119
Purpose:
Preterm birth remains a leading cause of long-term neurodevelopmental impairment, yet early evaluations frequently underestimate subsequent deficits. This study examined longitudinal neurodevelopmental trajectories across gestational age groups and identified predictors of developmental delay.
Methods:
A retrospective cohort of 532 preterm children, stratified by gestational age, was followed from the neonatal period to early preschool age. Neurodevelopment was assessed using the Korean version of the Bayley Scales of Infant and Toddler Development, Third Edition at 8–12 months (n=481), 13–24 months (n=118), and 25–42 months (n=100). Longitudinal trajectories were analyzed using general linear models, and predictors of developmental delay were identified through multivariable logistic regression.
Results:
During the first year, motor scores differed significantly across gestational age groups, with extremely preterm infants showing the lowest values. By the third to fourth years of life, cognitive and language scores diverged markedly, with extremely preterm children exhibiting the steepest decline and additional deficits in motor and adaptive behavior domains. Lower gestational age remained an independent predictor of both cognitive and language delay at early preschool age, while no independent predictors were identified for motor, social-emotional, or adaptive behavior outcomes.
Conclusion
Neurodevelopmental outcomes in preterm children follow dynamic, domain-specific trajectories influenced by gestational age and developmental timing. Motor delays are most evident in infancy, whereas cognitive and language impairments emerge by early preschool age. Gestational age remains a consistent predictor of later delay, emphasizing the need for longitudinal, gestational age–stratified monitoring and early, targeted intervention.
2.Intellectual Disability and Borderline Intellectual Functioning: An Updated Pediatric Neurology Perspective
Youngkyu SHIM ; Dong Hwa YANG ; Baik-Lin EUN ; Jung Hye BYEON
Annals of Child Neurology 2026;34(1):13-24
Intellectual disability (ID) affects 1%–3% of the population, while borderline intellectual functioning (BIF) affects 13%–14% of individuals, together representing a substantial burden in pediatric neurology. This review synthesizes current evidence on diagnostic frameworks, genomic advances, and targeted therapeutics relevant to pediatric practice. We reviewed recent literature focusing on Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) and International Classification of Diseases, 11th Revision (ICD-11) updates, genomic diagnostic innovations, and emerging therapies identified through PubMed and clinical trial registries (2019–2024). Diagnostic frameworks now emphasize adaptive functioning rather than intelligence quotient (IQ)-based classifications, with severity defined by required support levels rather than cognitive scores. Genomic testing has progressed from chromosomal microarray (10%–20% yield) to trio whole-exome sequencing (30%–45% yield), with professional guidelines endorsing genome-first approaches as first-line testing. Common comorbidities require systematic management, including autism spectrum disorder (15%–20%), attention-deficit/hyperactivity disorder (20%), epilepsy (20%–30% in moderate-to-severe cases), and mental health disorders. Traditional management continues to prioritize early intervention, educational support, and comprehensive medical care, while emerging targeted therapies show clinical benefit, including U.S. Food and Drug Administration-approved trofinetide for Rett syndrome and investigational antisense therapies for Angelman syndrome. Contemporary ID management demands genome-first diagnostic strategies, structured comorbidity assessment, and integration of targeted therapeutics. The BIF population requires formal diagnostic recognition and broader service eligibility. Optimal outcomes depend on collaboration among pediatric neurologists, geneticists, and developmental specialists through precision-medicine–based approaches.
3.Cerebral Visual Impairment: Current Concepts, Clinical Assessment, and Management
Jung Hye BYEON ; Youngkyu SHIM ; Han Na JANG ; Baik-Lin EUN ; Donghwa YANG
Annals of Child Neurology 2026;34(1):49-55
Cerebral visual impairment (CVI) is recognized as the most common cause of visual impairment in children in high-income countries. It refers to a heterogeneous group of visual processing deficits of cerebral origin that cannot be explained by ocular pathology alone. Major risk factors include prematurity, perinatal brain injury, and structural abnormalities of the developing brain. The terminology has shifted from cortical to CVI to reflect involvement of the entire visual network, including both primary and associative pathways. The term ‘cerebral visual disorders’ has been proposed to describe a broader range of visuoperceptual dysfunction. Clinically, CVI is characterized by inconsistent visual behaviors, including impaired visual attention, difficulty processing complex visual scenes, and delayed visual responses, often despite relatively preserved visual acuity. Diagnosis is clinical and multidisciplinary, requiring exclusion of ocular causes and assessment of functional vision. Neuroimaging may support etiological classification, but is not definitive for diagnosis. Early identification is important, as timely intervention is associated with improved visual and developmental outcomes. Parent-reported questionnaires serve as useful screening tools in early childhood, and the Korean parental questionnaire for children younger than 72 months provides an age-appropriate example. In this mini-review, management is framed around visual habilitation and environmental modification tailored to the child’s visual profile. Although prognosis varies, early recognition and targeted support can improve functional vision and overall quality of life.
4.Developmental Language Disorder: Current Understanding, Clinical Implications, and Future Directions
Youngkyu SHIM ; Dong Hwa YANG ; Baik-Lin EUN ; Jung Hye BYEON
Annals of Child Neurology 2026;34(1):5-12
Developmental language disorder (DLD) is a common yet under-recognized neurodevelopmental condition characterized by persistent difficulties in acquiring and using language that cannot be explained by hearing loss, intellectual disability, or known neurological injury. Children with DLD exhibit deficits across phonology, morphology, syntax, semantics, and pragmatics, which have downstream effects on literacy and academic attainment. DLD frequently co-occurs with attention-deficit/hyperactivity disorder, dyslexia, and speech sound disorders. Early identification requires attention beyond vocabulary counts to subtler markers such as syntactic comprehension, working memory, and processing speed. Converging genetic and neurobiological evidence suggests a polygenic risk profile and subtle alterations in brain connectivity. Cross-linguistic research is essential for distinguishing universal from language-specific markers and refining culturally appropriate standardized assessments. Because DLD is heterogeneous and multidimensional, it demands early detection, evidence-based intervention, and robust policy support that account for linguistic and cultural diversity to improve long-term outcomes.
5.Diagnostic approaches in distal symmetric polyneuropathy in diabetes mellitus
Annals of Clinical Neurophysiology 2026;28(1):50-56
Distal symmetric polyneuropathy (DSPN) is the most common form of diabetic neuropathy and a major cause of morbidity in patients with diabetes. Despite extensive research, diagnostic advances have been incremental rather than transformative, and accurate diagnoses in clinical practice still rely on careful clinical assessments. This review focuses on diagnostic approaches for DSPN that can be applied in routine neurological practice. We summarize the evolving definition and diagnostic criteria of DSPN, including the graded classification proposed by the Toronto consensus panel. Core diagnostic elements such as detailed history-taking, bedside neurological examinations, and validated clinical scoring systems are reviewed. We also discuss the role and limitations of nerve conduction studies, skin biopsy, corneal confocal microscopy, and tests of small-fiber function. Laboratory evaluations for differential diagnoses and current American Diabetes Association screening recommendations are also discussed.
6.The Potential Role of β-Asarone inCalcium Imbalance and Mitochondrial Dysfunction in Melanoma Cells
Yuze LIU ; Wei TANG ; Biao YU ; Qinghua YANG ; Wenbing LAI
Annals of Dermatology 2026;38(1):75-83
Background:
The treatment landscape for melanoma, a particularly malignant skin cancer, is constrained by notable drug resistance and toxicity. β-Asarone, a natural compound from Acorus tatarinowii, has shown anticancer potential. Disruption of calcium homeostasis and mitochondrial dysfunction are key regulators of tumor cell survival and death.
Objective:
This research was conducted to investigate the impact of β-Asarone on B16F10 melanoma cells, focusing on its potential to induce apoptosis by modulating calcium signaling and mitochondrial function.
Methods:
Cell proliferation and apoptosis were evaluated using CCK-8, colony formation, EdU, and TUNEL assays. Intracellular calcium levels and mitochondrial membrane potential were measured using Fluo-4 AM, Rhod-2 AM, and JC-1 staining. Reactive oxygen species (ROS) generation and adenosine triphosphate (ATP) levels were assessed by fluorescent probes and ATP assay. Western blotting was utilized to detect apoptosis-related proteins, AMP-activated protein kinase (AMPK) pathway activation, and mitochondrial dynamics (OPA1, DRP1, FIS1).
Results:
Treatment with β-Asarone notably inhibited the proliferation of B16F10 cells while simultaneously inducing apoptosis. Fluorescent probe analysis revealed that β-Asarone triggered cytosolic and mitochondrial Ca 2+ overloaded in both the cytosol and mitochondria, accompanied by decreased mitochondrial membrane potential, elevated ROS levels, and reduced ATP production. Western blot analysis showed increased expression of DRP1 and FIS1, decreased OPA1, and enhanced AMPK phosphorylation, indicating that β-Asarone promotes mitochondrial fission through AMPK activation, likely driven by intracellular calcium imbalance.
Conclusion
This study demonstrates that β-Asarone induces apoptosis in B16F10 melanoma cells by triggering Ca 2+ overload and mitochondrial dysfunction.
7.Efficacy and Safety of Novel Botulinum Toxin Type A (Protoxin) in the Treatment of Moderate to Severe Glabellar Lines: A Multicenter, Randomized, Double-Blind, Active-Controlled Phase III Study
Hyung Seok SON ; Min Kyung SHIN ; Jong Hun LEE ; Moon Bum KIM ; Kwang Ho YOO ; Sun Young CHOI ; Hye Sung HAN ; Joon SEOK ; Beom Joon KIM ; Yang Won LEE
Annals of Dermatology 2026;38(1):33-41
Background:
A novel botulinum toxin type A (Protoxin; Protox Inc.) has been developed.
Objective:
To evaluate the efficacy and safety of the newly developed Protoxin compared to the approved drug onabotulinumtoxinA (OBoNT) in moderate to severe glabellar lines.
Methods:
Adults with a glabellar line Facial Wrinkle Scale (FWS) score of 2 (moderate) or 3 (severe) were enrolled in the study. Subjects were randomized in a 1:1 ratio to receive either Protoxin or OBoNT. A total of 20 units of botulinum toxin was injected at five sites in the glabellar region (4 units at each site). FWS scores were assessed at baseline and at weeks 4, 8, 12, and 16 post-injection. The primary endpoint was the proportion of subjects at week 4 who had a reduction of 2 or more points in FWS and a final score of 0 (none) or 1 (mild).
Results:
A total of 274 subjects were randomized, of whom 78.1% were female. At week 4 post-treatment, the improvement rate of glabellar lines was 62.22% in the Protoxin group and 62.96% in the OBoNT group. The lower limit of the two-sided 95% confidence interval (−12.24%) exceeded the −15% margin, confirming the non-inferiority of the new drug. Safety profiles were comparable between the two groups.
Conclusion
Protoxin demonstrated efficacy and safety profiles comparable to those of OBoNT in the treatment of moderate to severe glabellar lines.
8.The SMAD-Pathway Mediates HMGB1-Induced Proliferation and Metastatic Progression in Cutaneous Squamous Cell Carcinoma Cells
De-De LIAN ; Xue Mei LI ; Yu-Xi JIA ; Ming-Wei ZHOU ; Xiang-Ru CHEN ; Yang-Yang TIAN ; Min LI ; Ming-Hui SUN ; Ye ZHAO ; Hong-Jun LI ; Qing-Ling ZHANG
Annals of Dermatology 2026;38(1):51-58
Background:
High-mobility group box protein 1 (HMGB1) is a chromatin-binding protein involved in arthritis, ischemia, sepsis, atherosclerosis, neurodegenerative disorders, meningitis, and cancer. HMGB1 exhibits dual roles in cancer, acting as either a tumor suppressor or oncoprotein depending on context.
Objective:
This research aimed to elucidate HMGB1’s functional significance in cutaneous squamous cell carcinoma (cSCC).
Methods:
We overexpressed HMGB1 in cSCC cell lines using recombinant adenovirus and examined its effects on cell proliferation, colony formation, and cell migration.
Results:
Immunohistochemical analysis revealed elevated HMGB1 expression levels in cSCC tissue relative to normal epidermis. To assess the influence of HMGB1, we employed recombinant adenoviruses expressing HMGB1 to transduce SCC cell lines (SCC12 and SCC13). Enhanced HMGB1 expression significantly promoted cellular proliferation and colony formation capacity.Notably, HMGB1 overexpression elevated the levels of proliferation regulators, including P63, SOX2, CDK4 and CDK6. Furthermore, HMGB1 overexpression substantially enhanced tumor invasiveness, accompanied by upregulation of epithelial-mesenchymal transition (EMT) biomarkers. Mechanistically, overexpression of HMGB1 enhanced transforming growth factor-β signaling by increasing phosphorylation of SMAD2/3, the key mediators of EMT.
Conclusion
These data imply that HMGB1 acts as a tumor-promoting factor in cSCC.
9.Development and Validation of a Lectin-independent Liquid Chromatography–Tandem Mass Spectrometry Method for Serum Glycosylated Alpha-fetoprotein Analysis and Comparison with a Liquid-phase Binding Assay
Hyojin KIM ; Juri PARK ; Hanseul SUH ; Saeyoung LEE ; Yoonha PARK ; Won Suk YANG ; Dohsik MINN ; Soon Sun KIM ; Jae Youn CHEONG ; Je-Hyun BAEK
Annals of Laboratory Medicine 2026;46(1):62-71
Background:
Alpha-fetoprotein (AFP) and its isoform AFP-L3 are well-established serum biomarkers for hepatocellular carcinoma (HCC), a common malignancy and a leading cause of cancer-related mortality worldwide. Current methods for measuring these biomarkers are primarily lectin-based assays including the liquid-phase binding assay (LiBA) and liquid chromatography–tandem mass spectrometry (LC-MS/MS), both of which have limitations in diagnostic sensitivity and clinical utility for samples with low AFP concentrations. We aimed to develop a lectin-independent LC-MS/MS method for quantifying fucosylated AFP proteins (AFP-Fuc%).
Methods:
We conducted analytical validation, including method comparisons, over 2 months. The analytical sensitivity and diagnostic performance of this method were evaluated using 525 human serum samples—235 from HCC patients and 290 from non-HCC individuals—and compared with those of LiBA, which measured AFP-L3 levels.
Results:
The LC-MS/MS method demonstrated acceptable within-laboratory imprecision (CVs < 17.1%) without detectable bias, carryover, or matrix effects. Our method exhibited a broader linear dynamic range (spanning five orders of magnitude) and 10-fold higher analytical sensitivity than LiBA. The diagnostic performance of our method was significantly superior to that of LiBA, particularly in patients with low AFP concentrations ( < 7 ng/mL, P < 0.001), with improved accuracy, sensitivity, and precision at a specificity of 96.2%.
Conclusions
The validated LC-MS/MS method demonstrated robust analytical performance and superior diagnostic accuracy over LiBA for HCC diagnosis while avoiding the inherent limitations of lectin-based assays. Our LC-MS/MS assay shows promise for early HCC detection and may contribute to enhanced patient care.
10.Paradigm Shift in Monoclonal Protein Detection: From Electrophoresis-based to Mass Spectrometry–based Methods
Jikyo LEE ; Sangmi YOO ; Seojin YANG ; Sang Hoon SONG
Annals of Laboratory Medicine 2026;46(1):3-15
Monoclonal protein (M-protein) is a crucial biomarker for diagnosing and monitoring monoclonal gammopathies, including multiple myeloma (MM). Traditionally, electrophoresis (EP)-based methods, such as protein EP and immunofixation EP, have been widely used for M-protein detection. However, these methods can show low sensitivity and inadequate quantification of small amounts of M-protein. To overcome these challenges, EP-based methods are often combined with the quantification of serum free light chains in automated immunoassays. Advances in mass spectrometry (MS) have introduced three main approaches for sample preparation: top-down, middle-down, and bottom-up. Middle-down approaches are commonly used with matrix-assisted laser desorption/ionization time-offlight MS and liquid chromatography–electrospray ionization (LC–ESI) quadrupole time-offlight MS, whereas the bottom-up approach is typically applied with LC–ESI Orbitrap MS. A review of studies, conducted from 2014 to 2024, on plasma cell disorders that utilized MS-based methods demonstrate improvements in the sensitivity and accuracy of M-protein identification and quantification. MM remains the most frequently studied disease, with significant therapeutic advancements leading to improved outcomes. Minimal residual disease has gained attention because of its correlation with better prognoses. Monoclonal gammopathy of undetermined significance and amyloid light-chain amyloidosis are occasionally addressed, while studies on other rare diseases remain limited. This review highlights the clinical applications and advancements in MS-based methods, particularly in assessing M-protein levels for treatment responses, risk factors, and prognostic monitoring. Given their advantages—high sensitivity and specificity, automation, cost-effectiveness, and time efficiency—MS-based methods may eventually replace EP-based methods in clinical laboratories.

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