{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:54:06Z","timestamp":1791262446425,"version":"4.1.0"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Persistent pediatric lower urinary tract dysfunction (LUTD) may be associated with occult sacral neural impairment, a clinically challenging condition characterized by subtle sacral pathway dysfunction without overt spinal dysraphism.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To develop, internally validate, and externally validate a multimodal diagnostic model integrating ultrasound, urodynamics, neuroelectrophysiology, and urinary biomarkers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The development dataset comprised 120 records (45 occult sacral neuropathy-related LUTD, 45 functional non-neurogenic LUTD, and 30 controls). The target-condition label followed a prespecified multidisciplinary composite reference standard based on clinical phenotype, neurological examination, spinal\/pelvic MRI when available, conventional urodynamic interpretation, and longitudinal course; biomarker values and model probabilities were not components of that label. Preanalytical metadata included pre-catheterization collection, centrifugation at 3000 or 5000 x g for 10 minutes, 1.0- 1.5 mL aliquots, storage at -80\u00a0\u00b0C, limited freeze-thaw exposure, and creatinine normalization. We internally validated a six-predictor logistic model with 1,000 bootstrap repetitions. We assessed a separate 90-record, two-site dataset without refitting or threshold optimization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The locked model had an apparent AUC of 0.937 and Brier score of 0.099; optimism-corrected values were 0.920 and 0.116, respectively. The bootstrap mean calibration intercept was -0.065, and the slope was 1.032. In the external transportability analysis, the AUC was 0.928 (95% CI, 0.861-0.977), the Brier score was 0.098, the calibration intercept was -0.400, the calibration slope was 0.887, sensitivity was 80.0%, and specificity was 88.3%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Multimodal neuroimmune profiling demonstrated strong discrimination and acceptable calibration after optimism correction and external validation in an independent two-site cohort. Prospective multicenter validation is required before clinical implementation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1947984","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:26:12Z","timestamp":1791260772000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Multimodal neuroimmune diagnostic profiling for pediatric lower urinary tract dysfunction associated with occult sacral nerve abnormalities"],"prefix":"10.3389","volume":"17","author":[{"given":"Dan","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Pediatric Surgery, Guizhou Provincial People\u2019s Hospital","place":["Guiyang, China"]},{"name":"Department of Pediatric Urology, Shanghai Children\u2019s Medical Center GuiZhou Hospital, Shanghai Jiao Tong University School of Medicine","place":["Guiyang, 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Pediatric Urology, Shanghai Children\u2019s Medical Center GuiZhou Hospital, Shanghai Jiao Tong University School of Medicine","place":["Guiyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuangui","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Guizhou Provincial People\u2019s Hospital","place":["Guiyang, China"]},{"name":"Department of Pediatric Urology, Shanghai Children\u2019s Medical Center GuiZhou Hospital, Shanghai Jiao Tong University School of Medicine","place":["Guiyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Deng","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Guizhou Provincial People\u2019s Hospital","place":["Guiyang, China"]},{"name":"Department of Pediatric Urology, Shanghai Children\u2019s Medical Center GuiZhou Hospital, Shanghai Jiao Tong University School of Medicine","place":["Guiyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nini","family":"An","sequence":"additional","affiliation":[{"name":"Department of Pediatric Urology, Shanghai Children\u2019s Medical Center GuiZhou Hospital, Shanghai Jiao Tong University School of Medicine","place":["Guiyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(06)00305-3","article-title":"The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardization Committee of the International Children\u2019s Continence Society","volume":"176","author":"Nev\u00e9us","year":"2006","journal-title":"J Urol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1002\/nau.22783","article-title":"International Children\u2019s Continence Society standardization report on urodynamic studies of the 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