Bioinformatic methodologies play a crucial role in the assessment of gut microbiota, offering advanced tools for analyzing complex microbial communities. These methodologies involve high-throughput sequencing technologies, such as 16S rRNA gene sequencing and metagenomics, which generate vast amounts of data on microbial diversity and functional potential, as well as whole-genome sequencing, which, while being more costly, has a more expansive potential. Bioinformatics tools and algorithms process these data to identify microbial taxa and quantify and elucidate their roles within the microbiome. Advanced statistical and computational models further enable the identification of microbiota patterns associated with various diseases and health conditions. Overall, bioinformatic approaches are essential for deciphering the complexities of gut microbiota so that, in the future, we may be able to discover treatments and technologies aimed at restoring or optimizing the microbiome. The goal of this review is to describe the differences in methodology and utilization of 16S versus whole-genome sequencing to address the increased understanding of the role that the gut microbiome plays in human physiology and pathology.

Hepatoblastoma (HB) is a rare but highly malignant tumor that commonly arises in utero. The mainstay treatment is surgical resection, with adjuvant treatment options including chemotherapy, hepatic artery chemoembolization, and liver transplantation. Yttrium-90 (Y90) transarterial radioembolization (TARE Y90) is a developing treatment option that utilizes radioactive beads delivered specifically to blood vessels supplying the tumor. This treatment method has previously been utilized in the treatment of adult tumors but has rarely been utilized in the pediatric population. In this report, we discuss the case of a toddler with an unresectable HB who underwent TARE Y90 as an adjuvant treatment to chemotherapy, ending in a successful liver transplantation. This patient was a 19-month-old female who presented with an abdominal mass and laboratory findings significant for anemia, thrombocytosis, elevated lactate dehydrogenase (LDH), direct hyperbilirubinemia, and alpha-fetoprotein (AFP) elevation. A computed tomography (CT) scan and magnetic resonance imaging (MRI) displayed a large, multilobular mass involving all lobes of the liver without evidence of metastasis, and biopsy results were consistent with HB. Following four rounds of chemotherapy, an MRI of the abdomen revealed a decrease in tumor size. Due to the continued uptrend of AFP raising concern for lack of control of the tumor, treatment with TARE Y90 microspheres radioembolization as a bridging therapy was initiated. Repeat scans showed an interval increase in the HB size, likely secondary to tumor necrosis with edema and hyperemia. Nine months following the diagnosis, the patient underwent an orthotopic liver transplant and a sixth cycle of chemotherapy. This report illustrates the use of TARE Y90 in a pediatric patient diagnosed with HB, thereby inducing a direct cytotoxic effect on tumor cells. Adjunctive therapy Y90 radioembolization worked by controlling tumor size and AFP levels, facilitating the crucial aspect of liver transplantation with tumor resection with negative margins. The patient did not suffer any of the known side effects of TARE Y90 therapy, which include, but are not limited to, post-embolization syndrome, biliary complications, stricture, cholangitis, pulmonary complications, and gastrointestinal ulcers. This therapy, along with chemotherapy, has the potential to be a novel approach as a bridge to resection or orthotopic liver transplant in HB patients. Further case reports and a manuscript compiling the use of Y90 radioembolization therapy in pediatric HB patients would be useful in evaluating the efficacy of the treatment in pediatric patients.

Background: Dysautonomia, including postural orthostatic tachycardia syndrome (POTS) and related orthostatic disorders, is frequently associated with debilitating gastrointestinal (GI) symptoms in adolescents, including chronic nausea, early satiety, postprandial fullness, and functional dysmotility. Despite the significant disease burden, pharmacological options for GI dysmotility in this population remain poorly studied. To our knowledge, no prior case series has described metoclopramide as a targeted prokinetic bridge therapy specifically in adolescents with dysautonomia-associated GI dysmotility symptoms. Case Series Summary: We describe three adolescent females (ages 13, 16, and 16 years) with specialist-confirmed dysautonomia and refractory GI symptoms who were treated with a standardized short-course, low-dose metoclopramide bridge protocol (5 mg three times daily, tapered over approximately 12 weeks). All patients received concurrent multidisciplinary management including dietary modification, neuromodulators, integrative therapies, and behavioral support. All three demonstrated subjective improvement in nausea and GI symptoms, enabling engagement with broader rehabilitative and nutritional interventions. No extrapyramidal symptoms or serious adverse effects were observed. Cumulative metoclopramide doses across all three cases ranged from approximately 770 to 1050 mg—well below the threshold associated with tardive dyskinesia risk in contemporary real-world data. Conclusions: Short-course, low-dose metoclopramide, administered as part of a structured multidisciplinary protocol with explicit safety counseling and planned taper, may serve as a feasible bridge therapy for adolescents with dysautonomia-associated GI dysmotility symptoms. These observations are hypothesis-generating and should be interpreted with caution given the small sample size, concurrent multidisciplinary interventions, and absence of standardized outcome instruments. They support the need for prospective investigation of short-course, weight-dosed metoclopramide use in this specific population.