Manju Ramakrishnan

Pediatric cancers, although less prevalent, remain a significant cause of mortality among children worldwide. Thromboinflammation arises from a complex dysregulation of inflammation and hemostasis, leading to tissue injury and cell death. Angiogenesis, the formation of new blood vessels, is influenced by inflammation. Both processes are closely linked to the progression of various tumors. Emerging evidence increasingly highlights the pivotal role of certain molecular markers in stimulating thromboinflammatory and angiogenic pathways in several types of pediatric cancers, including gliomas, other brain tumors, retinoblastoma, leukemia, lymphoma, and other solid malignancies. Current studies show that noncoding RNAs (ncRNAs), extracellular vesicles (EVs), and epigenetic dysregulation of key biological pathways in specific genes contribute to alterations in the tumor microenvironment. These changes are crucial for tumor initiation, progression, and dissemination through immune-mediated mechanisms that promote thromboinflammation and angiogenesis. The detailed identification and assessment of the expression profiles of these markers hold growing potential to support the diagnosis of various pediatric cancers, provide better prognostic stratification, and guide targeted therapeutic approaches. Therefore, integrating this knowledge into existing strategies for diagnosis, staging, and treatment – especially through liquid biopsy based on EVs and RNA signatures – may enable earlier and more precise interventions. This has the potential to positively impact long-term survival and quality of life.

Objectives: Evidence shows that obstructive sleep apnea (OSA) is associated with the development of stroke. This study investigates the relationship between OSA and post-stroke complications, addressing the limited data on how OSA influences the severity and development of these complications through a systematic review of existing literature. Methods: Data was collected from PubMed, Web of Science, and Scopus databases up to December 2023. Studies meeting the inclusion criteria were selected, and statistical analyses were performed using Review Manager 5.4.1. A random-effects model was used for pooling data with heterogeneity, and findings were presented using standard ratios with 95% confidence intervals. Results: The analysis included nine studies. Stroke patients with OSA did not show a significantly higher risk of post-stroke complications, which include mild cognitive impairment, dementia, insomnia, fatigue, reduced sleep quality, depression, anxiety, recurrent strokes, and death, compared with those without OSA (RR = 1.05, 95% CI 0.97 to 1.13). However, patients with high stroke severity and OSA had a slightly higher risk of post-stroke complications (RR = 1.06, 95% CI 1.01 to 1.12). Conclusions: This systematic review and meta-analysis suggests that OSA confers a higher risk of post-stroke complications in patients with high stroke severity. Further studies are required to explore the impact of OSA on post-stroke complications.