CJCP
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2022 Vol.  24 No.  10
Published: 2022-10-15
READER, AUTHOR AND EDITOR
TOPIC OF EPIDEMIC PREVENTION AND CONTROL
STANDARD·PROTOCOL·GUIDELINE
CLINICAL RESEARCH
EXPERIMENTAL RESEARCH
REVIEW
STANDARD·PROTOCOL·GUIDELINE
1069 The Subspecialty Group of Gastroenterology, the Society of Pediatrics, Chinese Medical Association
Expert consensus on clinical application management of enteroscopy in children
Small bowel disease is one of the difficulties in the diagnosis and treatment of digestive system diseases, and limited examination techniques seriously restrict the diagnosis and treatment level of digestive tract diseases in children. With the wide clinical application of enteroscopy in pediatrics and the optimization of enteroscopy equipment and accessories, enteroscopy technique provides a new method for the diagnosis and treatment of pediatric digestive tract diseases, but there are still many issues and challenges in the standardization of clinical operation and endoscopic treatment. In order to standardize the diagnosis and treatment techniques for enteroscopy in children and improve the diagnosis and treatment level of small bowel disease, the Subspecialty Group of Gastroenterology, the Society of Pediatrics, Chinese Medical Association organized experts to fully discuss and formulate the expert consensus on the clinical application management of enteroscopy in children, with reference to the latest advances in the application of enteroscopy in children.
2022 Vol. 24 (10): 1069-1077 [Abstract] ( 1693 ) [HTML 1KB] [PDF 657KB] ( 831 )
TOPIC OF EPIDEMIC PREVENTION AND CONTROL
1078 YAO Kai-Hu
')" href="#"> Interpretation of "Clinical Considerations for Monkeypox in Children and Adolescents" released by the US Centers for Disease Control and Prevention
In order to cope with monkeypox in children and adolescents, the US Centers for Disease Control and Prevention released "Clinical Considerations for Monkeypox in Children and Adolescents", which is specially written for pediatric health workers serving children and adolescents under the age of 18 years to standardize the clinical management of children and adolescents with exposure to monkeypox (human monkeypox or animal monkeypox) or with suspected or confirmed monkeypox. This document highlights the characteristics of children and adolescents and gives some valuable suggestions to the special issues in pediatric clinical practice, and it is worth studying by pediatric health workers who are preparing for a possible epidemic of monkeypox.
2022 Vol. 24 (10): 1078-1084 [Abstract] ( 1323 ) [HTML 1KB] [PDF 729KB] ( 780 )
1085 BIAN Xiang-Li, GUO Zhi, ZHANG Kun, LI Miao-Chen, WU Zhi-Min, JIANG Qin, GUO Miao-Miao, FAN Sai-Nan, CHEN Juan-Juan, HUI Lei, ZHENG Fang, ZHANG Jin-Ping
Clinical features of children and their family members with family clusters of SARS-CoV-2 Omicron variant infection in Shanghai, China: an analysis of 380 cases Hot!
Objective To study the clinical features and prognosis of children and their family members with family clusters of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant infection under the admission mode of parent-child ward. Methods A retrospective analysis was performed on the medical data of 190 children and 190 family members with SARS-CoV-2 Omicron variant infection who were admitted to Shanghai Sixth People's Hospital, the designated hospital for coronavirus disease 2019 (COVID-19), April 8 to May 10, 2022. Results Both the child and adult groups were mainly mild COVID-19, and the proportion of mild cases in the child group was higher than that in the adult group (P<0.05). Respiratory symptoms were the main clinical manifestations in both groups. Compared with the adult group, the child group had higher incidence rates of fever, abdominal pain, diarrhea, and wheezing (P<0.05) and lower incidence rates of nasal obstruction, runny nose, cough, dry throat, throat itching, and throat pain (P<0.05). Compared with the child group, the adult group had higher rates of use of Chinese patent drugs, traditional Chinese medicine decoction, recombinant interferon spray, cough-relieving and phlegm-eliminating drugs, and nirmatrelvir/ritonavir tablets (P<0.05). Compared with the adult group, the child group had a lower vaccination rate of SARS-CoV-2 vaccine (30.5% vs 71.1%, P<0.001) and a shorter duration of positive SARS-CoV-2 nucleic acid (P<0.05). The patients with mild COVID-19 had a shorter duration of positive SARS-CoV-2 nucleic acid than those with common COVID-19 in both groups (P<0.05). The patients with underlying diseases had a longer duration of positive SARS-CoV-2 nucleic acid than those without such diseases in both groups (P<0.05). Conclusions Both children and adults with family clusters of SARS-CoV-2 Omicron variant infection manifest mainly mild COVID-19. Despite lower vaccination rate of SARS-CoV-2 vaccine in children, they have rapid disease recovery, with a shorter duration of positive SARS-CoV-2 nucleic acid than adults, under the admission mode of parent-child ward.
2022 Vol. 24 (10): 1085-1091 [Abstract] ( 1875 ) [HTML 1KB] [PDF 591KB] ( 879 )
1085 BIAN Xiang-Li, GUO Zhi, ZHANG Kun, LI Miao-Chen, WU Zhi-Min, JIANG Qin, GUO Miao-Miao, FAN Sai-Nan, CHEN Juan-Juan, HUI Lei, ZHENG Fang, ZHANG Jin-Ping
Clinical features of children and their family members with family clusters of SARS-CoV-2 Omicron variant infection in Shanghai, China: an analysis of 380 cases Hot!
Objective To study the clinical features and prognosis of children and their family members with family clusters of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant infection under the admission mode of parent-child ward. Methods A retrospective analysis was performed on the medical data of 190 children and 190 family members with SARS-CoV-2 Omicron variant infection who were admitted to Shanghai Sixth People's Hospital, the designated hospital for coronavirus disease 2019 (COVID-19), April 8 to May 10, 2022. Results Both the child and adult groups were mainly mild COVID-19, and the proportion of mild cases in the child group was higher than that in the adult group (P<0.05). Respiratory symptoms were the main clinical manifestations in both groups. Compared with the adult group, the child group had higher incidence rates of fever, abdominal pain, diarrhea, and wheezing (P<0.05) and lower incidence rates of nasal obstruction, runny nose, cough, dry throat, throat itching, and throat pain (P<0.05). Compared with the child group, the adult group had higher rates of use of Chinese patent drugs, traditional Chinese medicine decoction, recombinant interferon spray, cough-relieving and phlegm-eliminating drugs, and nirmatrelvir/ritonavir tablets (P<0.05). Compared with the adult group, the child group had a lower vaccination rate of SARS-CoV-2 vaccine (30.5% vs 71.1%, P<0.001) and a shorter duration of positive SARS-CoV-2 nucleic acid (P<0.05). The patients with mild COVID-19 had a shorter duration of positive SARS-CoV-2 nucleic acid than those with common COVID-19 in both groups (P<0.05). The patients with underlying diseases had a longer duration of positive SARS-CoV-2 nucleic acid than those without such diseases in both groups (P<0.05). Conclusions Both children and adults with family clusters of SARS-CoV-2 Omicron variant infection manifest mainly mild COVID-19. Despite lower vaccination rate of SARS-CoV-2 vaccine in children, they have rapid disease recovery, with a shorter duration of positive SARS-CoV-2 nucleic acid than adults, under the admission mode of parent-child ward.
2022 Vol. 24 (10): 1085-1091 [Abstract] ( 489 ) [HTML 1KB] [PDF 738KB] ( 504 )
1092 QI Zheng-Hong, BEI Ze-Feng, TENG Shu, WANG Hua-Ping, LI Wen, ZHAO Shi-Yong, LIU Shou-Rong
Clinical features of 19 children infected with the Omicron variant of severe acute respiratory syndrome coronavirus 2 in Hangzhou, China
Objective To study the clinical features of children infected with the Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods The medical data of 19 children who were diagnosed with SARS-CoV-2 Omicron variant infection from January 28 to March 3, 2022 in Hangzhou were retrospectively reviewed. Results Among the 19 children, there were 7 boys (37%) and 12 girls (63%), and their age ranged from 6 months to 16 years, with a median age of 2 years and 1 month. Most of these children were infants and young children (aged ≤3 years, accounting for 53%). Among these children, 11 (58%) were unvaccinated with SARS-CoV-2 vaccine and 8 (42%) were vaccinated with SARS-CoV-2 vaccine, and 3 children (16%) had a history of underlying diseases. All 19 children had a clear history of close contact with persons infected with SARS-CoV-2, and 10 children (53%) were involved in the cluster outbreak in a maternal and infant care center. In terms of clinical classification, 13 children (68%) had mild coronavirus disease 2019 (COVID-19) and 6 (32%) had common COVID-19, with no severe cases of COVID-19. The most common clinical symptoms were cough (100%) and fever (63%). The children with a normal peripheral white blood cell count accounted for 84%, and those with a normal lymphocyte count accounted for 68%. There were no significant abnormalities in platelet count, procalcitonin, liver function parameters (alanine aminotransferase and aspartate aminotransferase), and renal function parameters (creatinine and urea). Six children (32%) had obvious signs of pneumonia on chest CT. All 19 children were given symptomatic treatment, and 12 children (63%) were given aerosol inhalation of interferon α. All children were cured and discharged. Conclusions Children infected with Omicron variant strains are more common in infants and young children, with mild symptoms and good prognosis. Most of the children have a history of close contact with persons infected with SARS-CoV-2, and epidemic prevention and control should be strengthened in places with many infants and children, such as maternal and infant care centers.
2022 Vol. 24 (10): 1092-1097 [Abstract] ( 1628 ) [HTML 1KB] [PDF 576KB] ( 781 )
1098 XIN Mei-Yun, WU Jing-Fang, WANG Xiao-Shuang, HAN Lei
Changes in the disease spectrum in the pediatric intensive care units within 2 years before and after the outbreak of coronavirus disease 2019
Objective To investigate the changes in the disease spectrum among hospitalized children in the pediatric intensive care units (PICU) within 2 years before and after the outbreak of coronavirus disease 2019 (COVID-19). Methods The related data on disease diagnosis were collected from all children who were hospitalized in the PICU of Affiliated Hospital of Jining Medical College from January 2018 to December 2019 (pre-COVID-19 group) and from January 2020 to December 2021 (post-COVID-19 group). A statistical analysis was performed for the disease spectrum of the two groups. Results There were 2 368 children in the pre-COVID-19 group and 1 653 children in the post-COVID-19 group. The number of children in the post-COVID-19 group was reduced by 30.19% compared with that in the pre-COVID-19 group. There was a significant difference in age composition between the two groups (P<0.05). The top 10 diseases in the pre-COVID-19 group by number of cases were respiratory diseases, neurological diseases, sepsis, critical illness, circulatory system diseases, severe neurosurgical diseases, digestive system diseases, unintentional injuries, endocrine system diseases, and tumors. The top 10 diseases in the post-COVID-19 group by number of cases were respiratory diseases, neurological diseases, sepsis, circulatory system diseases, unintentional injuries, endocrine system diseases, severe neurosurgical diseases, acute abdomen, trauma surgical diseases, and digestive system diseases. The proportions of respiratory diseases, critical illness and severe neurosurgical diseases in the post-COVID-19 group were lower than those in the pre-COVID-19 group (P<0.05), while the proportions of unintentional injuries, acute abdomen, endocrine system diseases, trauma surgical diseases and sepsis were higher than those in the pre-COVID-19 group (P<0.05). Conclusions COVID-19 epidemic has led to a significant reduction in the number of children admitted to the PICU, and there are significant changes in the disease spectrum within 2 years before and after the outbreak of COVID-19. Relevant prevention and control measures taken during the COVID-19 epidemic can reduce the incidence of respiratory diseases, neurological diseases, and other critical illness in children, but it is necessary to strengthen the prevention of unintentional injuries and chronic disease management during the epidemic.
2022 Vol. 24 (10): 1098-1103 [Abstract] ( 1293 ) [HTML 1KB] [PDF 638KB] ( 563 )
CLINICAL RESEARCH
1104 Jiangsu Province Neonatal Perinatal Cooperation Network
Risk factors for moderate/severe bronchopulmonary dysplasia in preterm infants with a gestational age of <32 weeks: a multicenter retrospective analysis
Objective To investigate the risk factors for moderate/severe bronchopulmonary dysplasia (BPD) in preterm infants with a gestational age of <32 weeks. Methods A retrospective analysis was performed on the medical data of preterm infants with a gestational age of <32 weeks and a length of hospital stay of ≥28 days who were admitted to the neonatal intensive care unit (NICU) of 17 institutions of Jiangsu Neonatal Perinatal Cooperation Network from January 1, 2019 to December 31, 2020 and were diagnosed with BPD. The preterm infants were grouped according to gestational age and severity of BPD. A multivariate logistic regression analysis was used to investigate the risk factors for moderate/severe BPD in various gestational age groups. Results During the two-year period, a total of 2 603 preterm infants with a gestational age of <32 weeks were admitted to the NICU of the 17 institutions, among whom 961 were diagnosed with BPD, and the incidence rates of BPD and moderate/severe BPD were 36.92% (961/2 603) and 8.64% (225/2 603), respectively. The incidence rate of moderate/severe BPD was 56.5% (26/46) in preterm infants with a gestational age of 24+0-25+6 weeks, 31.0% (66/213) in those with a gestational age of 26+0-27+6 weeks, 16.9% (75/445) in those with a gestational age of 28+0-29+6 weeks, and 22.6% (58/257) in those with a gestational age of 30+0-31+6 weeks. The multivariate logistic regression analysis showed that there were different risk factors for moderate/severe BPD in preterm infants with different gestational ages: patent ductus arteriosus requiring treatment as risk factors in preterm infants with a gestational age of 24+0-25+6 weeks; premature rupture of membranes ≥18 hours, positive pressure ventilation for resuscitation, clinical sepsis, and duration of mechanical ventilation ≥14 days as risk factors in preterm infants with a gestational age of 26+0-27+6 weeks; duration of mechanical ventilation ≥14 days, neonatal pneumonia, and patent ductus arteriosus requiring treatment as risk factors in preterm infants with a gestational age of 28+0-29+6 weeks; positive pressure ventilation for resuscitation, neonatal pneumonia, and anemia of prematurity as risk factors in preterm infants with a gestational age of 30+0-31+6 weeks (P<0.05). Conclusions The development of moderate/severe BPD is multifactorial in preterm infants with a gestational age of <32 weeks, and there are different risk factors in different gestational age groups. Targeted preventive measures for preterm infants of different gestational ages may be useful to reduce the severity of BPD.
2022 Vol. 24 (10): 1104-1110 [Abstract] ( 1537 ) [HTML 1KB] [PDF 586KB] ( 601 )
1111 YU Yuan-Qiang, DONG Qing-Yi, HU Jin-Tao, LI Wen, WANG Tao, YANG Yong-Hui, GONG Xiao-Yun, HE Xiao-Ri, CHEN Ping-Yang
A 10-year retrospective study of pathogens and antimicrobial resistance in neonatal sepsis
Objective To investigate the changes in the pathogen spectrum and antimicrobial resistance over time in neonatal sepsis. Methods The medical data were collected from the neonates who were diagnosed with sepsis in the Second Xiangya Hospital of Central South University from January 2010 to December 2019. The incidence rate of sepsis, the pathogen spectrum, and the characteristics of antimicrobial resistance were analyzed. Results The incidence rate of neonatal sepsis was 4.02% (447/11 111). The top four pathogens detected were coagulase-negative staphylococci (CoNS), Klebsiella pneumoniae, Escherichia coli, and Candida. The incidence rate of sepsis and the pathogen spectrum showed no significant changes over time. Klebsiella pneumoniae was the most frequent pathogen in preterm infants, very low birth weight infants, and small-for-gestational-age infants, accounting for 33.9%, 29.5%, and 42.5%, respectively. CoNS, Klebsiella pneumoniae, and Escherichia coli had a high resistance rate to penicillins and third-generation cephalosporins. Conclusions The incidence of neonatal sepsis is high, and the main pathogen is CoNS. The pathogens of neonatal sepsis have a high resistance rate to penicillins and third-generation cephalosporins. It is recommended to enhance the prevention and control of neonatal infection, strengthen the surveillance of pathogens, and further standardize the rational use of antibiotics.
2022 Vol. 24 (10): 1111-1116 [Abstract] ( 1430 ) [HTML 1KB] [PDF 696KB] ( 745 )
1117 CAO Zhao-Lan, PAN Jing-Jing, CHEN Xiao-Qing, WU Yue, LU Ke-Yu, YANG Yang
Pulmonary hemorrhage in very low birth weight infants: risk factors and clinical outcome
Objective To investigate the risk factors for pulmonary hemorrhage and its clinical outcome in very low birth weight infants (VLBWIs). Methods The medical data were collected from all live VLBWIs (gestational age <35 weeks) who were admitted to Jiangsu Women and Children Health Hospital and Children's Hospital of Nanjing Medical University between January 1, 2020 and December 31, 2021. Based on inclusion and exclusion criteria, 574 VLBWIs were included in the study, with 44 VLBWIs in the pulmonary hemorrhage group and 530 VLBWIs in the non-pulmonary hemorrhage group. The clinical data were compared between the two groups. A multivariate logistic regression analysis was used to identify the risk factors for pulmonary hemorrhage. Results There were significant differences between the two groups in maternal age, rate of positive-pressure ventilation for resuscitation, rate of tracheal intubation for resuscitation, and minimum body temperature within 1 hour after birth (P<0.05). The pulmonary hemorrhage group had a higher proportion of VLBWIs with grade Ⅲ-Ⅳ respiratory distress syndrome or early-onset sepsis than the non-pulmonary hemorrhage group (P<0.05). The pulmonary hemorrhage group also had a higher proportion of VLBWIs with a capillary refilling time of >3 seconds within 1 hour after birth and with the maximum positive end-expiratory pressure (PEEP) of <5 cmH2O within 24 hours after birth (P<0.05). The multivariate regression analysis showed that maternal age of 30-<35 years (OR=0.115, P<0.05) was a protective factor against pulmonary hemorrhage, while a lower temperature (<34°C) within 1 hour after birth, the maximum PEEP of <5 cm H2O within 24 hours after birth, and early-onset sepsis were risk factors for pulmonary hemorrhage (OR=11.609, 11.118, and 20.661, respectively; P<0.05). For all VLBWIs, the pulmonary hemorrhage group had a longer duration of invasive ventilation and a higher mortality rate than the non-pulmonary hemorrhage group (P<0.05); for the survival VLBWIs, the pulmonary hemorrhage group had a higher incidence rate of bronchopulmonary dysplasia than the non-pulmonary hemorrhage group (P<0.05). Conclusions Maintaining the stability of temperature, giving appropriate PEEP, and identifying sepsis as early as possible can reduce the incidence rate of pulmonary hemorrhage, thereby helping to reduce the incidence of bronchopulmonary dysplasia and mortality in VLBWIs.
2022 Vol. 24 (10): 1117-1123 [Abstract] ( 1726 ) [HTML 1KB] [PDF 594KB] ( 712 )
1124 LING Qi-Ying, WEI Jiao, WAN Ge, QU Yi, TANG Bin-Zhi
Efficiency of electrocardiogram monitor for positioning the catheter tip in the central catheter placement via lower extremity veins in neonates: a randomized controlled study
Objective To study the efficiency of electrocardiogram (ECG) monitor for positioning the catheter tip in the placement of peripherally inserted central venous catheterization (PICC) via lower extremity veins in neonates. Methods A total of 120 neonates who were admitted to the neonatal intensive care unit from January 2020 to January 2022 and received PICC via lower extremity veins were enrolled and divided into a control group and an observation group using a random number table (n=60 each). The neonates in the control group were given body surface measurement and postoperative chest X-ray localization, and those in the observation group were given body surface measurement, ECG-guided positioning, and postoperative chest X-ray localization. The two groups were compared in terms of general information, one-time success rate of PICC placement, and time spent on PICC placement, and the efficiency of ECG-guided positioning was evaluated. Results Compared with the control group, the observation group had a higher one-time success rate of PICC placement (92% vs 75%; P<0.05) and a shorter time spent on PICC placement [(26.5±3.0) min vs (31.8±2.8) min; P<0.05]. ECG-guided positioning had a sensitivity of 90.9% and a specificity of 100% in the PICC placement via lower extremity veins in neonates. Conclusions ECG monitor helps to determine the position of catheter tip in the PICC placement via lower extremity veins in neonates and can improve the one-time success rate of PICC placement and reduce the time spent on PICC placement, with a good positioning efficiency.
2022 Vol. 24 (10): 1124-1129 [Abstract] ( 1340 ) [HTML 1KB] [PDF 963KB] ( 608 )
1130 DU Chang-Xiu, LI Na
Serum vitamin K2 level and its association with bone metabolism markers in 1 732 children
Objective To study the level of serum vitamin K2 (VitK2) and its association with bone metabolism markers osteocalcin (OC), type I procollagen amino-terminal peptide (PINP), and type I collagen carboxy-terminal peptide (CTX) in children. Methods A prospective analysis was performed on 1 732 children who underwent routine physical examination from October 2020 to October 2021. The serum levels of VitK2 and 25-hydroxy vitamin D [25(OH)D] were measured. According to age, they were divided into four groups: <1 year, 1-3 years group, >3-6 years group, and >6-14 years. A total of 309 children with 25(OH)D≥50 nmol/L were screened out, and serum levels of OC, PINP, and CTX were measured to investigate the correlation of the serum levels of OC, PINP, and CTX with serum VitK2 levels in different age groups. Results The prevalence rate of serum VitK2 deficiency was 52.31% (906/1 732). The VitK2 deficiency group had higher prevalence rates of overweight/obesity and growth pain (≥3 years of age) than the normal VitK2 group (P<0.05). There were differences in the prevalence rate of serum VitK2 deficiency (P<0.0083) and the serum level of VitK2 (P<0.05) between the 1-3 years group and the >6-14 years group. The <1 year group had a higher serum level of CTX and a lower serum level of PINP than the >3-6 years group and the >6-14 years group (P<0.05). The <1 year group had a lower serum level of OC than the >6-14 years group (P<0.05). Serum VitK2 level was positively correlated with OC level (rs=0.347, P<0.01), and CTX level was negatively correlated with PINP level (rs=-0.317, P<0.01). Conclusions Serum VitK2 deficiency may be associated with overweight/obesity. Serum VitK2 may affect the level of OC and even bone health.
2022 Vol. 24 (10): 1130-1135 [Abstract] ( 1399 ) [HTML 1KB] [PDF 574KB] ( 726 )
1136 LIU Jian, CHEN Zhi-Wei, WANG Ying-Jie, MAI Yu-Miao, HU Hui-Hui, REN Bing, WANG Ying-Chao, LIU Yu-Feng
Risk factors for acute kidney injury after hematopoietic stem cell transplantation in children: a retrospective study
Objective To investigate the risk factors for acute kidney injury (AKI) after hematopoietic stem cell transplantation (HSCT) in children. Methods A retrospective analysis was performed on the medical data of 111 children who underwent HSCT from January 2018 to January 2020. A multivariate logistic regression analysis was used to identify the risk factors for AKI. The Kaplan-Meier survival analysis was used to compare the prognosis in children with different grades of AKI. Results Graft-versus-host disease (grade Ⅱ-Ⅳ) (OR=4.406, 95%CI: 1.501-12.933, P=0.007), hepatic veno-occlusive disease (OR=4.190, 95%CI: 1.191-14.740, P=0.026), and thrombotic microangiopathy (OR=10.441, 95%CI: 1.148-94.995, P=0.037) were closely associated with the development of AKI after HSCT. The children with stage Ⅲ AKI had a lower 1-year survival rate than those without AKI or with stage Ⅰ AKI or stage Ⅱ AKI (28.6%±12.1% vs 82.8%±5.2%/81.7%±7.4%/68.8%±11.6%; P<0.05). Conclusions Children with stage Ⅲ AKI after HSCT have a higher mortality rate. Graft-versus-host disease, hepatic veno-occlusive disease, and thrombotic microangiopathy are closely associated with the development of AKI after HSCT.
2022 Vol. 24 (10): 1136-1142 [Abstract] ( 1117 ) [HTML 1KB] [PDF 636KB] ( 761 )
1143 YI Mei-Hui, WAN Yang, CHENG Si-Qi, GONG Xiao-Wen, YIN Zi-Xi, LI Jun, GAO Yang-Yang, WU Chao, ZONG Su-Yu, CHANG Li-Xian, CHEN Yu-Mei, ZHENG Rong-Xiu, ZHU Xiao-Fan
Prevalence and risk factors of obesity in children with Diamond-Blackfan anemia
Objective To investigate the distribution of body mass index (BMI) and risk factors for obesity in children with Diamond-Blackfan Anemia (DBA). Methods The children with DBA who attended National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, from January 2003 to December 2020 were enrolled as subjects. The related clinical data and treatment regimens were recorded. The height and weight data measured within 1 week before or after follow-up time points were collected to calculate BMI. The risk factors for obesity were determined by multivariate regression analysis in children with DBA. Results A total of 129 children with DBA were enrolled, among whom there were 80 boys (62.0%) and 49 girls (38.0%), with a median age of 49 months (range 3-189 months). The prevalence rate of obesity was 14.7% (19/129). The multivariate logistic regression analysis showed that the absence of ribosomal protein gene mutation was closely associated with obesity in children with DBA (adjusted OR=3.63, 95%CI: 1.16-11.38, adjusted P=0.027). In children with glucocorticoid-dependent DBA, obesity was not associated with age of initiation of glucocorticoid therapy, duration of glucocorticoid therapy, and maintenance dose of glucocorticoids (P>0.05). Conclusions There is a high prevalence rate of obesity in children with DBA, and the absence of ribosomal protein gene mutation is closely associated with obesity in children with DBA.
2022 Vol. 24 (10): 1143-1148 [Abstract] ( 1342 ) [HTML 1KB] [PDF 653KB] ( 510 )
1149 CAO Jian-She, HE Jie, ZHANG Xin-Ping, ZHOU Xiong, XIAO Zheng-Hui
Therapeutic plasma exchange in the pediatric intensive care unit: a single-center retrospective study
Objective To study the indication for therapeutic plasma exchange (TPE) and related complications in children admitted to the pediatric intensive care unit. Methods A retrospective analysis was performed on the medical records of the children who received TPE in the Pediatric Intensive Care Unit, Hunan Children's Hospital, from March 2015 to March 2021. The indication for TPE and related complications were analyzed and compared with the American Society for Apheresis (ASFA) indication categories. Results A total of 405 TPE treatment sessions were performed for 196 children, among whom 76 children (38.8%) also received continuous renal replacement therapy and 147 children (75.0%) survived. The children with neurological diseases had the highest survival rate of 93.1% (27/29). The top three indications for TPE were hematologic diseases (61/196, 31.1%), sepsis with multiple organ dysfunction (41/196, 20.9%), and liver diseases (36/196, 18.4%). The children with hematologic diseases received the highest number of 129 TPE treatment sessions. The subjects with ASFA category Ⅲ indications accounted for the highest proportion of 76.5% (150/196), followed by those with ASFA category Ⅰ indications (11.2%, 22/196), ASFA category Ⅱ indications (7.1%, 14/196), and unknown category (5.1%, 10/196), and no ASFA category Ⅳ indications were observed. The incidence rate of TPE complications was 12.3% (50/405), and the most common complications were pipeline coagulation (4.2%, 17/405) and hypotension (3.7%, 15/405). No serious adverse events were observed. Conclusions TPE can be safely used for the treatment of critically ill children with indications in an experienced pediatric intensive care unit.
2022 Vol. 24 (10): 1149-1153 [Abstract] ( 1278 ) [HTML 1KB] [PDF 524KB] ( 587 )
1154 LIANG Ya-Li, MA Jie, ZHANG Yu-Xiao, ZHANG Min, HE Hai-Yan, WANG Shou-Gui, HUANG Yue-E
Sleep patterns of infants and young children and their association with breastfeeding: a study based on K-means clustering
Objective To investigate the sleep patterns and characteristics of infants and young children and the association between sleep patterns and breastfeeding. Methods A general information questionnaire, Brief Infant Sleep Questionnaire (BISQ), and a questionnaire on feeding were used to investigate the sleep quality and feeding patterns of 1 148 infants and young children aged 7-35 months. The K-means clustering method was used to identify sleep patterns and characteristics. A multivariate logistic regression analysis was used to investigate the association between sleep patterns and breastfeeding. Results Three typical sleep patterns were identified for the 1 148 infants and young children aged 7-35 months: early bedtime and long sleep time; short sleep latency and moderate sleep time; late bedtime, prolonged sleep latency, and insufficient sleep time. The third pattern showed sleep disorders. The multivariate logistic regression analysis showed that compared with formula feeding, exclusive breastfeeding within 6 months after birth reduced the risk of sleep disorder patterns by 69% (OR=0.31, 95%CI: 0.11-0.81). The risk of sleep disorder patterns was reduced by 40% (OR=0.60, 95%CI: 0.38-0.96) in the infants receiving breastfeeding for 4-6 months compared with those receiving breastfeeding for 1-3 months. Conclusions There are different sleep patterns in infants and young children, and breastfeeding can reduce the development of sleep disorder patterns.
2022 Vol. 24 (10): 1154-1160 [Abstract] ( 1469 ) [HTML 1KB] [PDF 624KB] ( 547 )
EXPERIMENTAL RESEARCH
1161 SHI Jia, TAO Hui-Xian, GUO Yan, ZOU Yun-Su, WANG Mu-Zi, LU Zhi-Tao, DING Yi-Fang, XU Wei-Dong, ZHOU Xiao-Guang
The role and mechanism of autophagy in lipopolysaccharide-induced inflammatory response of A549 cells
Objective To study the role and mechanism of autophagy in lipopolysaccharide (LPS)-induced inflammatory response of human alveolar epithelial A549 cells. Methods A549 cells were stimulated with LPS to establish a cell model of inflammatory response, and were then grouped (n=3 each) by concentration (0, 1, 5, and 10 μg/mL) and time (0, 4, 8, 12, and 24 hours). The A549 cells were treated with autophagy inhibitor 3-methyladenine (3-MA) to be divided into four groups (n=3 each): control, LPS, 3-MA, and 3-MA+LPS. The A549 cells were treated with autophagy agonist rapamycin (RAPA) to be divided into four groups (n=3 each): control, LPS, RAPA, and RAPA+LPS. The A549 cells were transfected with the Toll-like receptor 4 (TLR4) overexpression plasmid to be divided into four groups (n=3 each): TLR4 overexpression control, TLR4 overexpression, TLR4 overexpression control+LPS, and TLR4 overexpression+LPS. The A549 cells were transfected with TLR4 siRNA to be divided into four groups (n=3 each): TLR4 silencing control,TLR4 silencing, TLR4 silencing control+LPS, and TLR4 silencing+LPS. CCK-8 assay was used to measure cell viability. Western blot was used to measure the protein expression levels of inflammatory indicators (NLRP3, Caspase-1, and ASC), autophagic indicators (LC3B, Beclin-1, and P62), and TLR4. Results After stimulation with 1 μg/mL LPS for 12 hours, the levels of inflammatory indicators (NLRP3, Caspase-1, and ASC), autophagic indicators (LC3B, Beclin-1, and P62), and TLR4 increased and reached the peak (P<0.05). Compared with the LPS group, the 3-MA+LPS group had reduced expression of autophagy-related proteins and increased expression of inflammation-related proteins and TLR4, while the RAPA+LPS group had increased expression of autophagy-related proteins and reduced inflammation-related proteins and TLR4 (P<0.05). The TLR4 overexpression+LPS group had reduced autophagy-related proteins and increased inflammation-related proteins compared with the TLR4 overexpression control+LPS group, and the TLR4 silencing+LPS group had increased autophagy-related proteins and reduced inflammation-related proteins compared with the TLR4 silencing control+LPS group (P<0.05). Conclusions In the LPS-induced inflammatory response of human alveolar epithelial A549 cells, autophagic flux has a certain protective effect on A549 cells. TLR4-mediated autophagic flux negatively regulates the LPS-induced inflammatory response of A549 cells.
2022 Vol. 24 (10): 1161-1170 [Abstract] ( 2265 ) [HTML 1KB] [PDF 1154KB] ( 1066 )
REVIEW
1171 HUANG Fang-Jun, XIONG Tao, TANG Jun
Recent research on pharmacological prevention strategies for invasive fungal infection in preterm infants
There is a relatively high incidence rate of invasive fungal infection (IFI) in preterm infants admitted to the neonatal intensive care unit (NICU), and early diagnosis of IFI is difficult in clinical practice. The patients developing IFI tend to have severe conditions, a long course of treatment, high hospital costs, high mortality, and poor prognosis, and therefore, the prevention of IFI is of particular importance. At present, fluconazole is often used as the first-line drug for the prevention of IFI in preterm infants, but no consensus has been reached on the specific dose and course of treatment, and there are still controversies over the targeted population and prophylactic effect. This article reviews the recent research on the pharmacological prevention strategies for IFI in preterm infants in the NICU, so as to provide a reference for clinicians.
2022 Vol. 24 (10): 1171-1177 [Abstract] ( 1452 ) [HTML 1KB] [PDF 530KB] ( 748 )
READER, AUTHOR AND EDITOR
1178 Mungmunpuntipantip Rujittika, Wiwanitkit Viroj
Letter to editor: human monkeypox and the atypical outbreak
2022 Vol. 24 (10): 1178-1179 [Abstract] ( 1059 ) [HTML 1KB] [PDF 261KB] ( 434 )
1180
')" href="#"> The author's response to "Letter to editor: human monkeypox and the atypical outbreak"
2022 Vol. 24 (10): 1180-1181 [Abstract] ( 915 ) [HTML 1KB] [PDF 321KB] ( 392 )
1182
2022 Vol. 24 (10): 1182-1182 [Abstract] ( 515 ) [HTML 1KB] [PDF 253KB] ( 296 )
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