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To better understand biofilm development and persistence in chronic wounds, Figure 2 illustrates the stages of the biofilm life cycle, including adhesion, microcolony formation, maturation, and dispersion, as well as host immune responses such as neutrophil recruitment, M1/M2 macrophage polarization, and cytokine signaling (e.g., interleukin-1 beta [IL-1], tumor necrosis factor-alpha [TNF-], interleukin-6 [IL-6], interleukin-8 [IL-8], interleukin-12 [IL-12]), which collectively contribute to immune evasion and chronic infection [40-43]

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The comorbid conditions of Fragile X syndrome, tuberous sclerosis, phenylketonuria, or fetal alcohol syndrome were excluded because these children present some autistic behavioral features, but the origin is known

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