Thunderstorm asthma is defined as acute asthma exacerbations occurring during or shortly after thunderstorms, characterized by sudden onset, wide geographic impact, and clustering of cases. Climate change is driving more frequent extreme weather and higher aeroallergen concentrations, making future thunderstorm asthma episodes more frequent and less predictable. In China, the geographic range of pediatric thunderstorm asthma is expanding and its disease burden is underestimated. This paper reviews the literature on thunderstorm asthma in Chinese children, integrates global advances in mechanisms and management, and provides a comprehensive analysis of the epidemiology, pathogenesis, and clinical management of pediatric thunderstorm asthma in China. Regional variation is evident, with historical predominance in northern regions and recent reports from southern cities. Children with seasonal allergic rhinitis constitute a hidden high-risk population; even without an asthma diagnosis, enhanced surveillance and preventive management are warranted. Core components of comprehensive management include graded acute-phase care, pollen concentration monitoring with early warning, and pre-thunderstorm prophylactic medication.
Objective To compare resting-state brain functional connectivity among neonates of different gestational ages using functional near-infrared spectroscopy (fNIRS). Methods Forty hospitalized neonates were enrolled and categorized by gestational age into very preterm (n=10), moderate-to-late preterm (n=10), and full-term (n=20) groups. At a corrected gestational age of (40 ± 4) weeks, resting-state whole-brain oxygenation signals were acquired with fNIRS. The frontal, parietal, and temporal lobes were defined as regions of interest (ROI). Functional connectivity strength was calculated, and between-group comparisons were performed at both the whole-brain and ROI levels. Results At the whole-brain level, the mean functional connectivity strength in preterm infants was significantly lower than that in full-term infants (0.55 ± 0.20 vs 0.68 ± 0.16, P=0.030). Subgroup analysis showed the lowest connectivity strength in the very preterm group (0.46 ± 0.19), significantly lower than in the moderate-to-late preterm group (0.64 ± 0.19, P=0.030) and the full-term group (0.68 ± 0.16, P<0.01). At the ROI level, the very preterm group exhibited significantly reduced connectivity relative to the full-term group across multiple key connections, including left frontal-right frontal, left temporal-right frontal, bilateral frontal-bilateral parietal (both ipsilateral and contralateral), and left parietal-right parietal connections (all P<0.05). Conclusions Preterm birth exerts a gestational age-dependent gradient effect on resting-state brain functional connectivity, with smaller gestational age associated with more pronounced reductions. Very preterm neonates show widespread decreases in connectivity at the whole-brain level and between key cortical regions.
Objective To investigate the longitudinal association between preschool auditory processing and reading-related abilities in early elementary school children (Grades 1-2). Methods A longitudinal design was used. Children (n=107) were randomly sampled from the August 2021 normative study of the Preschool Auditory Processing Assessment Scale (PAPAS) in Nanjing and were re-assessed two years later. Reading-related abilities were evaluated using the Rapid Automatized Naming and Rapid Alternating Stimulus tests (RAN/RAS), the Children's Phonological Awareness Assessment Scale, and the item bank of the Primary School Students' Chinese Character Recognition Test. Cognitive ability and attention were measured with the Wechsler Intelligence Scale for Children and the Integrated Visual and Auditory Continuous Performance Test. Associations between PAPAS and reading-related abilities were examined with correlation analyses and multiple linear regression. Results Eighty-five children completed the follow-up. Children cared for by parents scored higher on the phonological awareness accuracy factor than those cared for by grandparents (P<0.05), and children with music training showed greater literacy than those without (P<0.05). Object naming time on the RAN/RAS was positively correlated with the auditory decoding score (rs=0.223, P<0.05). The accuracy of initial consonant awareness was negatively correlated with the PAPAS total score (rs=-0.313), auditory decoding (rs=-0.262), auditory attention (rs=-0.227), communication (rs=-0.310), and visual attention (rs =-0.367) (all P<0.05). In multiple linear regression adjusting for cognitive ability and attention, auditory decoding was positively associated with object naming time (β=0.264) and negatively associated with the accuracy of final (yunmu) awareness (β=-0.277); hyperactivity/impulsivity was negatively associated with the accuracy of initial consonant awareness (β=-0.311); and visual attention was negatively associated with tone awareness accuracy (β=-0.271) (all P<0.05). In addition, visual attention (β=-0.214) and risk of auditory processing abnormality (β=-0.200) were negatively associated with literacy (P<0.05). Conclusions Preschool auditory processing shows a longitudinal association with reading-related abilities in early elementary school children, and PAPAS has potential clinical value in the early identification of children at high risk of dyslexia.
Objective To evaluate the efficacy and safety of nusinersen in children with spinal muscular atrophy (SMA) types 2 and 3. Methods Prospective data were collected on motor function, compound muscle action potential (CMAP), and spinal Cobb angle from 29 children with SMA type 2 or 3 treated with nusinersen at the Children's Medical Center of Xiangya Hospital, Central South University, from January 2022 to November 2025. Pre- and post-treatment changes were analyzed. Results Of the 29 children, 19 (66%) had a follow-up duration of ≥26 months. Compared with baseline, after 26 months of treatment, clinically meaningful improvement was observed in 53% (10/19) on the Hammersmith Functional Motor Scale-Expanded (HFMSE), 78% (14/18) on the Revised Upper Limb Module (RULM), and 89% (16/18) on the Motor Function Measure 20-item/32-item (MFM-20/32). CMAP amplitudes increased from baseline in the bilateral median, ulnar, and radial nerves (P<0.05). The Cobb angle increased by a median of 6.2 degrees at 26 months of treatment (P<0.05). Compared with the non-rehabilitation group, the rehabilitation group showed greater improvement in MFM-20/32 scores and slower scoliosis progression (P<0.05). Across the 29 children, 309 intrathecal injections were performed; the incidence of procedure-related adverse reactions was 15.2% (47/309), and no serious adverse events were reported. Conclusions Nusinersen is well tolerated and safe in children with SMA types 2 and 3. The proportions achieving clinically meaningful responses on motor-function scales and CMAP improvements increase over time, and rehabilitation training may enhance efficacy.
Objective To explore recent temporal trends in pediatric systemic lupus erythematosus (SLE) in Beijing. Methods Electronic health record data were extracted from the Beijing Hospital Quality Monitoring System and the Beijing Electronic Medical Record Sharing Project (30 pilot hospitals). Changes in epidemiology, clinical characteristics, and treatment patterns were analyzed for the period June 2015 to May 2023. Results A total of 4 197 pediatric SLE patients were included, of whom 874 (20.82%) were male. Among 3 361 children with disease onset after May 31, 2016, the median age at onset was 12 years. From 2016 to 2022, the incidence of SLE among children aged 0-14 years in Beijing increased from 2.91 to 6.02 per 100 000. From 2015 to 2022, the incidence of renal (RR=1.02) and hematologic (RR=1.16) damage in hospitalized children showed a significant upward trend (P<0.05). Over the same period, cyclophosphamide use declined from 59.8% to 29.0% (P<0.05), while the use of hydroxychloroquine (RR=1.09), mycophenolate mofetil (RR=1.11), and tacrolimus (RR=1.29) increased significantly (P<0.05). Conclusions In Beijing, data from 2015-2022 indicate a rising incidence of pediatric SLE, an increasing burden of organ damage among hospitalized patients, and marked shifts in treatment patterns.
Objective To analyze the associations between crescent proportion and renal pathology, laboratory indicators, and prognosis in children with IgA vasculitis with nephritis (IgAVN), and to assess the impact of different treatment strategies on urinary protein and prognosis. Methods A total of 329 children with IgAVN and crescent formation were stratified by crescent proportion into a crescent <25% group and a crescent ≥25% group. Relationships of crescent proportion and treatment strategies with pathological features, laboratory testing results and outcomes were evaluated. Results Compared with the crescent <25% group, the crescent ≥25% group showed higher urine occult blood, urine protein, urinary N-acetyl-β-D-glucosaminidase, and serum urea levels, with decreased renal function and higher acute tubulointerstitial injury scores (P<0.05). Steroids combined with tripterygium glycosides, mycophenolate mofetil or Kunxian capsule all reduced the urine protein/creatinine ratio (P<0.001). The steroid plus Kunxian capsule regimen was associated with the best prognosis (P<0.05). Conclusions A higher crescent proportion is associated with more severe renal injury in pediatric IgAVN. Steroids combined with Kunxian capsule improves prognosis.
Objective To evaluate the early warning value of combined detection of urinary neutrophil gelatinase-associated lipocalin (NGAL), urinary microalbumin and fecal calprotectin for IgA vasculitis with nephritis (IgAVN). Methods A total of 90 children with IgAV and 50 healthy children undergoing physical examination at Yichun People's Hospital from January 2024 to December 2025 were enrolled. Based on urinalysis at admission and at 3-month follow-up, IgAV cases were classified into a simple IgAV group (n=48) and an IgAVN group (n=42; abnormal urinalysis). The IgAVN group was further divided into a mild renal injury subgroup (n=25) and a moderate-to-severe renal injury subgroup (n=17). Pearson correlation analysis, multivariable logistic regression and receiver operating characteristic (ROC) curve analysis were used to assess the diagnostic and early warning value of each marker. Results Levels of urinary NGAL, urinary microalbumin and fecal calprotectin in the IgAVN group were significantly higher than those in the simple IgAV group and the control group (P<0.05). Children with moderate-to-severe renal injury had higher levels of all three markers than those with mild renal injury (P<0.05). Correlation analysis showed that all three markers were significantly positively correlated with the severity of renal injury (P<0.05). ROC analysis indicated that combined detection of the three markers provided significantly better early warning performance than any single marker (P<0.05). Conclusions Combined detection of urinary NGAL, urinary microalbumin and fecal calprotectin improves early warning for IgAVN in children, providing a reliable laboratory basis for early clinical intervention and better prognosis.
Objective To investigate the clinical characteristics and prognosis of pediatric acute myeloid leukemia (AML) with TLS::ERG fusion gene. Methods Clinical data from multiple pediatric hematology centers in South China were retrospectively reviewed for the period September 2015 to October 2025. Cases harboring the TLS::ERG fusion gene were identified and analyzed. Results Among 875 children with AML, 12 (1.4%) were TLS::ERG positive; there were 6 males and 6 females, with a median age of 88 months. The complete remission rate after 2 induction courses was 83% (10/12). Six patients relapsed, yielding a relapse rate of 50% (6/12). Four patients remained disease-free, six died after relapse, and two were lost to follow-up. The 5-year overall survival and event-free survival were 38.4% (95%CI: 16.8%-87.8%) and 30.0% (95%CI: 12.0%-74.7%), respectively. Conclusions Pediatric AML with TLS::ERG fusion is rare, shows a high early induction remission rate, but has a high relapse rate and poor prognosis.
Objective To evaluate the diagnostic value of plasma Epstein-Barr virus (EBV) DNA load and the duration of EBV DNAemia for post-transplant lymphoproliferative disorders (PTLD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in children. Methods Clinical data of children who underwent allo-HSCT at Shenzhen Children's Hospital from January 2016 to December 2023 and had plasma EBV-DNA positivity after transplantation were retrospectively analyzed. According to the occurrence of PTLD, patients were divided into a PTLD group (n=53) and a non-PTLD group (n=376). Results A total of 429 children were included; 53 (12.4%) developed PTLD, with a median time to PTLD diagnosis of 85 days post‑transplant. Peak plasma EBV-DNA load and the duration of EBV DNAemia were both significantly higher in the PTLD group than in the non-PTLD group (both P<0.001). Receiver operating characteristic curve analysis for predicting PTLD showed that using 2 250 copies/mL as the cut-off for plasma EBV-DNA load yielded the highest Youden index (sensitivity 0.811; specificity 0.699), while using 12.5 days as the cut-off for the duration of EBV DNAemia yielded the highest Youden index (sensitivity 0.868; specificity 0.870). Conclusions Dynamic monitoring of plasma EBV-DNA load and the duration of EBV DNAemia helps predict the occurrence of PTLD and facilitates early intervention in children after allo-HSCT.
Objective To investigate the predictive value of mRNA expression of five neuroblastoma (NB) markers—chromogranin A, doublecortin, dopa decarboxylase, paired-like homeobox 2b, and tyrosine hydroxylase (collectively referred to as NB5)—in bone marrow (BM) and peripheral blood (PB) for metastasis and recurrence in pediatric NB, to compare its performance with conventional flow cytometric measurable residual disease (MRD) detection, and to analyze its correlation with progression-free survival (PFS). Methods Clinical data of 47 children with NB admitted to Hunan Provincial People's Hospital from October 2018 to December 2024 were retrospectively collected. Real-time quantitative reverse transcription-polymerase chain reaction was used to detect NB5 expression in BM and PB. Survival was analyzed by the Kaplan-Meier method, and multivariable Cox regression was performed to adjust for confounders. Results A total of 47 children were enrolled, including 44 high-risk (94%) and 3 low-risk (6%) patients. Overall, 99 BM tests were completed. The BM-NB5 positivity rate was 31% (31/99), significantly higher than the MRD positivity rate (19%, 19/99) and the BM morphologic positivity rate (15%, 15/99) (both P<0.001). Among 19 paired BM-PB samples, PB-NB5 was positive in 4 cases and BM-NB5 was positive in 8 cases; the positive concordance rate was 100%, the negative concordance rate was 47%, and the kappa coefficient was 0.321 (weak agreement). Log-rank analysis showed that among MRD-negative patients, the NB5-positive group had significantly shorter PFS than the NB5-negative group (P=0.040). Cox regression indicated a marginal association between NB5 expression and PFS (HR=4.367, 95%CI: 0.896-21.277, P=0.068). Conclusions BM-NB5 detection shows superior sensitivity for MRD identification compared with flow cytometric MRD and BM morphology in high-risk NB patients and can provide early warning of recurrence risk. NB5 expression appears to stratify prognosis in NB, warranting validation in a larger cohort to confirm its independent prognostic value.
Objective To analyze physical development data of preschool children aged 3-6 years in Urumqi, Xinjiang, assess their nutritional status, and provide a reference for improving early childhood growth and development in the city. Methods Health examination records of 15 904 children aged 3-6 years from 14 kindergartens across 7 districts in Urumqi between 2018 and 2024 were selected. Height and weight were measured using standard methods. Physical development and nutritional status were evaluated according to the National Health Commission's Growth Standards for Children Under 7 Years (2022 edition). Data were analyzed using IBM SPSS 26.0 with chi-square tests and chi-square tests for trend. Results Height, weight, and body mass index among children of different sexes and ages in Urumqi showed an upward trend over the years (P<0.05). From 2018 to 2024, the overall detection rate of stunting was 3.31% (526/15 904), underweight 2.00% (318/15 904), thinness 2.63% (418/15 904), overweight 16.74% (2 663/15 904), and obesity 8.78% (1 396/15 904). Boys had higher detection rates of malnutrition (9.12%) and overnutrition (26.48%) than girls (6.57% and 24.42%, respectively; both P<0.05). The detection rate of malnutrition showed a fluctuating downward trend over the years (P<0.001), whereas detection rates of overweight and obesity showed fluctuating upward trends (P<0.001). Conclusions Malnutrition among 3-6-year-old children in Urumqi has improved over time, whereas overweight and obesity rates have shown an upward trend. Weight management for children should be reinforced, with special attention to the monitoring and care of boys' growth and development.
Objective To examine the impact of overweight and obesity on quality of life and body image satisfaction in school-aged children, and to assess mediating pathways linking body mass index (BMI) to academic performance. Methods In this cross-sectional study, 380 students in grades 3-5 from a primary school in Jinan, China, were assessed. Anthropometry was used to calculate BMI; physical fitness test performance and academic grades were recorded. Quality of life and body image satisfaction were measured via questionnaires. Differences across BMI categories were compared, and mediation analyses evaluated indirect effects of BMI on academic performance through physical fitness and quality of life. Results The obese group had a higher proportion of boys than girls (68.7% vs 31.3%, P<0.05). Both the overweight and obese groups had lower quality of life than the normal-weight group (P<0.05). Body image satisfaction was negatively correlated with BMI in both males and females (rs=-0.606, -0.628, respectively; P<0.001). Physical fitness test performance mediated the association between BMI and academic performance (β=-0.098, P<0.001), whereas the mediating effect of quality of life was not significant (P>0.05). Conclusions Overweight and obesity are associated with reduced quality of life in school-aged children, and they are indirectly linked to poorer academic performance through diminished physical fitness.
Objective To investigate the protective effects and mechanisms of gambogic acid (GA) against lipopolysaccharide (LPS)-induced acute lung injury (ALI). Methods An in vivo ALI model was established in ICR mice by LPS administration, and an in vitro model was established in LPS-stimulated BEAS-2B human bronchial epithelial cells. Mice were divided into control, LPS, GA (low, medium, and high doses), and dexamethasone groups. BEAS-2B cells were stimulated with LPS alone or co-treated with GA (low, medium, or high dose) or dexamethasone. Lung histopathology was evaluated by hematoxylin-eosin staining and scored, and the lung index was measured. In vitro, cell viability was assessed by MTS assay, and morphological changes were observed by hematoxylin-eosin staining. Transcriptome sequencing combined with molecular docking was used to predict potential targets and pathways of GA. In cells and mice, Western blotting was used to detect tumor necrosis factor-α, interleukin (IL)-6, IL-1β, the expression of B-cell lymphoma-2 (Bcl-2) and Bcl-2-associated X protein (Bax), and the phosphorylation of mitogen-activated protein kinase (MAPK) pathway proteins [p38, extracellular signal-regulated kinase (ERK), c-Jun N-terminal kinase (JNK)]. Results Compared with the LPS group, the GA medium- and high-dose groups and the dexamethasone group showed reduced lung injury scores and lung index (P<0.05), and alleviated structural damage in BEAS-2B cells. In both models, these groups exhibited decreased expression of TNF-α, IL-6, and IL-1β relative to the LPS group (P<0.05). There was no significant difference in BEAS-2B cell viability among groups (P>0.05). Transcriptomic analysis suggested that GA may attenuate ALI by modulating the MAPK pathway. Molecular docking analysis indicated stable binding of GA to p38, JNK, and ERK. In both models, medium- and high-dose GA inhibited LPS-induced phosphorylation of p38, ERK, and JNK (P<0.05) and suppressed the LPS-induced increase in the Bax/Bcl-2 ratio (P<0.05). Conclusions GA attenuates LPS-induced ALI, possibly by inhibiting the MAPK pathway and exerting anti-inflammatory and anti-apoptotic effects.
Childhood asthma and obesity are rising in prevalence, and obesity-related asthma has emerged as a distinct clinical phenotype. In children, obesity is not only a trigger for asthma but also a key pathophysiological driver of disease progression and a modifier of treatment response. In obesity, shifts in the composition of the gut microbiota and its metabolites can activate pulmonary immunity through the gut-lung axis, while obesity-induced chronic systemic inflammation and metabolic dysregulation are closely linked to pulmonary immune imbalance, airway remodeling, and airway hyperresponsiveness. Together, these processes constitute the microbiota-immune-metabolism axis. This review summarizes potential mechanisms by which obesity influences childhood asthma via this axis and aims to deepen mechanistic understanding and provide research directions and targets for clinical intervention and translation.
The growth plate is the key structure for longitudinal growth of long bones, and its function is coordinated by a complex network of systemic endocrine signals, local paracrine signals, structural support from the extracellular matrix, and intracellular signaling pathways. Dysregulation of this network can lead to short stature (SS). At present, treatment of SS mainly relies on various hormone replacement therapies, but efficacy varies. Emerging approaches, including targeted drugs, molecularly targeted delivery, and gene therapy, have demonstrated potential for clinical application. This review describes the structure and function of the growth plate, summarizes the association between its dysfunction and SS, and outlines related research and therapeutic advances, with the aim of informing studies on the molecular pathogenesis of SS and the exploration of precision treatment strategies.
Individualized white-matter functional networks provide a new paradigm for parsing individual differences and neural mechanisms in attention-deficit/hyperactivity disorder (ADHD) among children and adolescents. This review summarizes construction approaches for such networks, including clustering analysis and independent component analysis, and synthesizes current progress. Group-level studies in children with ADHD have shown increased white-matter functional connectivity in the default mode and sensorimotor networks, but decreased white-matter functional connectivity in attention-related networks; these connectivity abnormalities are associated with core symptoms and impairments in executive function. However, group analyses can obscure inter-individual network heterogeneity and overlook gray-white matter functional coupling, limiting clinical translation. Individualized white-matter functional networks hold promise as potential neuroimaging markers for early screening and precision intervention in ADHD, yet challenges persist, including methodological inconsistency and the difficulty of acquiring pediatric data.
Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy. Although therapeutic advances have markedly improved survival, chemotherapy-related central nervous system (CNS) injury is increasingly recognized as a major determinant of neurofunctional outcomes and quality of life. This review summarizes the clinical manifestations, imaging characteristics, and biomarker-based approaches to diagnosing chemotherapy-related CNS injury in children with ALL; outlines drug-induced neurotoxic mechanisms; and discusses current therapeutic and supportive interventions alongside persistent management challenges. There is no standardized, stage-specific care pathway or integrated intervention program at present. Future strategies should align prevention and management with treatment phase and chemotherapy regimen to achieve more precise CNS protection. This review aims to provide information for clinical healthcare professionals to deepen their understanding of the mechanisms, identification, and long-term management of chemotherapy-related CNS injury in children with ALL.
Necrotizing enterocolitis (NEC) is a life-threatening intestinal disease of preterm infants, with a complex pathogenesis involving inflammation, oxidative stress, and cell death. In recent years, ferroptosis, a novel iron-dependent form of programmed cell death, has attracted increasing attention for its role in NEC. This review systematically summarizes the mechanisms of ferroptosis and its relationship with NEC, elucidates its roles in intestinal barrier injury, inflammatory response, and oxidative stress in NEC, and explores potential intervention strategies, aiming to provide new directions for the early diagnosis and treatment of NEC.
