The International Pediatric Multiple Sclerosis Study Group (IPMSSG) put forward the 2007 version of the diagnostic criteria for multiple sclerosis and other immune-mediated demyelinating diseases of the central nervous system in children in 2007 ("2007 version" for short). In 2012, IPMSSG proposed the new diagnostic criteria with reference to the latest research achievements of 150 members ("2012 version" for short). The 2012 version of the consensus statements covers the diagnostic criteria for acute disseminated encephalomyelitis, clinically isolated syndrome, neuromyelitis optica, and multiple sclerosis in children. As the two IPMSSG members in China, the authors give an interpretation of the 2012 version of the consensus statements with reference to related literature and clinical and scientific experience. The authors focus on how the 2012 version comprehensively and thoroughly elaborates on the clinical features, diagnostic criteria, influencing factors, and new ideas of acute demyelinating diseases of the central nervous system in children. These become more operable in clinical diagnosis and treatment of multiple sclerosis and other immune-mediated demyelinating diseases of the central nervous system in children.

Objective To study WT1 gene expression in children with acute myeloid leukemia (AML) and its possible correlations to clinical outcomes. Methods Bone marrow samples were collected from 45 children with AML (excluding acute promyelocytic leukemia, AML-M3) at different time points of AML treatment and follow-up. WT1 gene expression levels in bone marrow mononuclear cells were assayed by real-time fluorescence quantitative PCR. The correlation between WT1 expression and prognosis was retrospectively analyzed. Results The WT1 expression level in AML children with bone marrow blast cell percentage of > 60% was significantly higher than in those with bone marrow blast cell percentage of ≤ 60% (P < 0.05). The lower WT1 expression level was documented in children with AML-M2 compared with in children with other non-M2 subtypes (P < 0.05). WT1 expression level in patients in complete remission was significantly lower than that in patients at diagnosis or relapse (P < 0.01). The 2-year disease-free survival (DFS) in patients with higher WT1 expression was significantly lower than in those with lower WT1 expression at the end of induction chemotherapy (P < 0.05). The 2-year overall survival (OS) and DFS in patients with ≥1 log WT1 reduction range were significantly higher than those with < 1 log reduction of WT1 expression level at the end of induction chemotherapy (P < 0.05). WT1 expression levels tended to rise 2-3 months prior to bone marrow relapse. Conclusions WT1 expression level is closely correlated prognosis in children with AML. Dynamic monitoring of WT1 expression level is of great clinical importance in terms of individualized management, prognosis evaluation and relapse prediction.

Objective To investigate the clinical features and outcomes of neuroblastoma (NB) children aged above 5 years, and to provide a theoretical basis for improving prognosis. Methods A retrospective analysis was performed for the clinical data of 54 previously untreated NB children, and their clinical features and outcome were analyzed. The Kaplan-Meier method was used for survival analysis. Results Among the 54 children, there were 36 boys and 18 girls, and all of them had stage 3 or 4 NB. Of all the children, 41 (41/54, 76%) had retroperitoneal space-occupying lesions, 10 (10/54, 18%) had mediastinal space-occupying lesions, 2 (2/54, 4%) had intraspinal space-occupying lesions, and 1 (1/54, 2%) had pelvic space-occupying lesions. At the end of the follow-up, 30 children (30/54, 56%) survived, among whom 23 (77%) achieved disease-free survival (9 achieved complete remission after chemotherapy for recurrence), 6 (20%) achieved partial remission of tumor (all of them received chemotherapy again due to recurrence), and 1 (3%) experienced progression (with progression after chemotherapy again due to recurrence); 24 children (44%) died, among whom 22 died after chemotherapy again due to recurrence and 2 died of multiple organ failure during the first treatment. According to the Kaplan-Meier survival analysis, the mean survival time was 53.8 months, and the children with stage 3 NB had a significantly higher overall survival rate than those with stage 4 NB (80% vs 53%;P < 0.01). The children with recurrence had a significantly lower mean survival time than those without recurrence (51.68 months vs 62.57 months;P < 0.01). Conclusions Older children often have late-stage NB, but standard treatment can improve their outcomes.

Objective To study the changes and clinical significance of CD4⁺CD25⁺CD127^low regulatory T cells (Treg) and CD3⁺CD16⁺CD56⁺ natural killer T cells (NKT) in peripheral blood of children with Wilms tumor. Methods Twenty-one children with Wilms tumor were enrolled as the case group, and twenty-one healthy children for physical examinations were enrolled as the control group. Flow cytometry was used to detect the levels of CD4⁺CD25⁺CD127^low T cells and CD3⁺CD16⁺CD56⁺ T cells in peripheral blood of two groups. Results The level of Treg cells in peripheral blood of the case group was significantly lower than in the control group (P < 0.05). The level of NKT cells in peripheral blood of the case group was significantly higher than in the control group (P < 0.05). Conclusions Treg cells and NKT cells play important roles in the occurrence and development of Wilms tumor. Treg cells and NKT cells may be useful indexes for evaluating immunological function in children with Wilms tumor.

Objective To study the efficacy of early caffeine treatment in preterm infants with respiratory distress syndrome (RDS). Methods A prospective controlled clinical trial was performed. A total of 59 preterm infants with RDS were enrolled and divided into a caffeine group (30 infants) and a control group (29 infants). Caffeine was administered in the caffeine group and control group at the same dosage at 12-24 hours after birth and before extubation respectively. The respirator parameters and the incidence rates of ventilator-associated pneumonia (VAP) and apnea were compared between the two groups. Results Compared with the control group, the caffeine group had significantly lower peak inspiratory pressure, peak fraction of inspired oxygen, and incidence rate of VAP (P < 0.05), as well as significantly shorter intubation time, NCPAP time, and total duration of oxygen supply (P < 0.05). In addition, the caffeine group had a significantly longer time to first onset of apnea after extubation (P < 0.05) and significantly fewer times of onset of apnea 1-2 days after extubation (P < 0.01), as compared with the control group. Conclusions Early caffeine treatment can reduce the need for assisted ventilation in preterm infants with RDS, help with early extubation and ventilator weaning, reduce the oxygen time in the late stage, reduce the incidence of VAP, and prevent the development of apnea after extubation.

Objective To study the clinical efficacy of porcine pulmonary surfactant (PS) combined with budesonide suspension intratracheal instillation in the treatment of neonatal meconium aspiration syndrome (MAS). Methods Seventy neonates with MAS were enrolled for a prospective study. The neonates were randomly assigned to PS alone treatment group and PS+budesonide treatment group (n=35 each). The PS alone treatment group was given PS (100 mg/kg) by intratracheal instillation. The treatment group was given budesonide suspension (0.25 mg/kg) combined with PS (100 mg/kg). Results The rate of repeated use of PS in the PS+ budesonide group was significantly lower than that in the PS alone group 12 hours after treatment (P < 0.05). The improvement of PaO₂/FiO₂, TcSaO₂, PaO₂, and PaCO₂ in the PS+ budesonide group was significantly greater than that in the PS alone group 6, 12, and 24 hours after treatment (P < 0.05). The chest X-ray examination showed that the pulmonary inflammation absorption in the PS+ budesonide group was significantly better than that in the PS alone group 48 hours after treatment (P < 0.05). The incidence of complications in the PS+budesonide group was significantly lower than that in the PS alone group (P < 0.05), and the average hospitalization duration was significantly shorter than that in the PS alone group (P < 0.01). Conclusions PS combined with budesonide suspension intratracheal instillation for the treatment of neonatal MAS is effective and superior to PS alone treatment.

Objective To investigate the percentage of T lymphocyte subsets and allergen screening results in infants and young children with Mycoplasma pneumoniae (MP) infection complicated by wheezing. Methods Flow cytometry was used to measure the percentage of peripheral blood T cell subsets in 354 infants and young children with MP infection complicated by wheezing (MP wheezing group), 336 infants and young children with MP infection but without wheezing (MP non-wheezing group), and 277 children with recurrent wheezing (recurrent wheezing group). Allergen screening was also performed for these children. Results Both the MP wheezing group and recurrent wheezing group had significantly lower percentages of CD3⁺ and CD3⁺CD8⁺ lymphocytes than the MP non-wheezing group (P < 0.05). The MP groups with or without wheezing had a significantly higher percentage of CD3⁺CD4⁺ lymphocytes than the recurrent wheezing group (P < 0.05). Both the MP wheezing group and recurrent wheezing group had significantly higher percentages of CD3^-CD19⁺ and CD19⁺CD23⁺ lymphocytes than the MP non-wheezing group (P < 0.05), and the recurrent wheezing group had the highest percentages (P < 0.05). The overall positive rate of food allergens was significantly higher than that of inhaled allergens (30.3% vs 14.7%;P < 0.05). The positive rates of food and inhaled allergens in the recurrent wheezing group and MP wheezing group were significantly higher than in the MP non-wheezing group (P < 0.05), and the recurrent wheezing group had the highest rates. Conclusions Imbalance of T lymphocyte subsets and allergic constitution play important roles in the pathogenesis of MP infection complicated by wheezing in infants and young children.

Objective To investigate the features and duration of viral nucleic acid shedding in children with influenza A. Methods The clinical data of 90 children with influenza A with positive influenza A virus nucleic acid in nasopharyngeal swab detected by PCR were collected, and these children were divided into simple influenza A group (n=10), influenza A-pneumonia group (n=61), influenza A-nervous system damage group (n=10), and influenza A-underlying disease group (n=9). A retrospective analysis was performed for clinical features, treatment process, duration of viral nucleic acid shedding, and prognosis. Results The most common symptoms in these children were fever (89/90, 99%), cough (89/90, 99%), running nose (69/90, 77%), shortness of breath (26/90, 29%), and myalgia (23/90, 26%). The mean duration of viral nucleic acid shedding in 90 children was 9.4±2.9 days. The simple influenza A group had a significantly shorter duration of viral nucleic acid shedding than the influenza A-pneumonia, influenza A-nervous system damage, and influenza A-underlying disease groups (P < 0.05), while there were no significant differences between the influenza A-pneumonia, influenza A-nervous system damage, and influenza A-underlying disease groups (P > 0.05). The children who received antiviral therapy within 48 hours after disease onset had significantly shorter duration of viral nucleic acid shedding and time to body temperature recovery than those who received antiviral therapy more than 48 hours after disease onset (P < 0.05). Of all the children with body temperature recovery, 83% still tested positive for viral nucleic acid. Conclusions Complications, underlying diseases, and timing of antiviral therapy are influencing factors for the duration of influenza A virus nucleic acid shedding, and whether body temperature returns to normal cannot be used to decide whether to continue antiviral therapy.

Objective To study the association between the single nucleotide polymorphisms (SNP) of interleukin (IL)-19 and susceptibility to hepatitis B virus (HBV) infection in children. Methods A case-control study was performed, and 136 children with positive HBsAg (case group) and 297 healthy children with negative HBsAg (control group) were enrolled. PCR and DNA sequencing were used for genotyping. Results There were significant differences in the frequencies of genotypes of IL-19 rs1798 between the case and control groups. The case group also had a significantly higher proportion of children with CG genotype than the control group (P < 0.05). There were significant differences in the frequencies of genotypes and alleles of IL-19 rs2243191 between the HBV infection and non-infection groups among children who born to HBV-positive mothers. The infection group had significantly higher proportions of children with TC and CC genotypes and C allele than the non-infection group (P < 0.05). Conclusions The SNP of IL-19 rs1798 may be associated with susceptibility to hepatitis B in children, and the SNP of IL-19 rs2243191 may be associated with susceptibility to breakthrough HBV infection in children at a high risk of HBV infection.

Objective To study the effect of telomerase reverse transcriptase (TERT) on cell apoptosis in neonatal rat brains after hypoxic-ischemic brain injury (HIBD). Methods A total of 72 neonatal rats were divided into sham, vehicle, HIBD and TERT groups. HIBD was induced by Rice method in the later three groups. The neonatal rats in the vehicle and TERT groups were injected with plasmids containing mock or full length TERT by an intracerebroventricular injection 30 minutes after hypoxic-ischemic (HI) injury. Pathological changes of brain tissue were observed by hematoxylin and eosin (HE) staining. Western blot was used to detect the protein expression of TERT, apoptosis-inducing factor (AIF) and cleaved caspase 3 (CC3). Apoptotic cells were detected by TUNEL staining. Results Western blot showed that TERT protein was dramatically increased in the vehicle, HIBD and TERT groups compared with the sham group. Compared with the vehicle and HIBD groups, TERT protein in the TERT group was significantly upregulated. Compared with the sham group, there was a significant increase in apoptotic index and expression of AIF and CC3 proteins in the vehicle and HIBD groups (P < 0.01). The TERT group showed decreased expression of AIF and CC3 proteins and apoptotic index compared with the vehicle and HIBD groups (P < 0.01). Conclusions TERT can inhibit cell apoptosis induced by HI and might have a neuroprotective role in developing brain with HIBD.