中国当代儿科杂志最新文献

Objectives: To investigate the mechanism by which mycobacterial antigen 85B (Ag85B) inhibits autophagy and promotes apoptosis in Hodgkin lymphoma (HL) cells.

Methods: The clinical data and pathological tissue slides were retrospectively collected from 80 HL children and 30 children with reactive lymphadenopathy (control group) treated at the First Affiliated Hospital of Xinjiang Medical University. Immunohistochemical analysis was performed to assess the expression of microtubule-associated protein 1 light chain 3 (LC3), sequestosome 1 (P62/SQSTM1), and Beclin-1 in the pathological tissues of HL and control groups. Human Hodgkin lymphoma cells (HDLM-2) were divided into the HDLM-2 group and the HDLM-2+Ag85B groups (with Ag85B concentrations of 0.5, 1, 2, and 4 μg/mL). The CCK8 method was used to measure HDLM-2 cell proliferation; qRT-PCR was employed to detect the expression of LC3, P62, Beclin-1, Akt, and mTOR mRNA in cells. An apoptosis kit was used to detect cell apoptosis.

Results: The positive expression of LC3 and Beclin-1 in the HL group were higher than those in the control group (P<0.05), while the positive expression of P62 was lower than that in the control group (P<0.05). In stages III-IV compared to stages I-II, the positive expression of LC3 and Beclin-1 increased, while the positive expression of P62 decreased (P<0.05). Cell experiment results showed that the HDLM-2+Ag85B group had suppressed cell proliferation compared to the HDLM-2 group, with decreased mRNA expression of LC3 and Beclin-1, and increased mRNA expression of P62, PI3K, Akt, and mTOR, leading to increased cell apoptosis. Notably, when Ag85B was at a concentration of 2 μg/mL, it had the strongest effect on HDLM-2 cells after 24 hours (P<0.05).

Conclusions: Autophagy is enhanced in children with HL and increases with disease stage. Ag85B can inhibit the proliferation and autophagy of HL tumor cells and promote apoptosis, possibly related to the activation of the PI3K/Akt/mTOR pathway.

Objectives: To investigate the risk factors for bronchopulmonary dysplasia (BPD) in preterm infants, and to establish a risk prediction model.

Methods: A total of 120 preterm infants who were admitted to the neonatal intensive care unit of Shanghai Children's Hospital from January to December 2022 were included. According to the diagnostic criteria for BPD released by the National Institute of Child Health and Human Development in 2018, they were divided into a non-BPD group (84 infants) and a BPD group (36 infants). The clinical data of the infants and their mothers were compared between the two groups. The univariate analysis and the stepwise multivariate regression analysis were used to identify the risk factors for BPD and establish a risk prediction model.

Results: The results showed that a gestational age of <28 weeks, duration of noninvasive respiratory support, comorbidity with infectious pneumonia, and chorioamnionitis in the mother were independent risk factors for BPD in preterm infants (P<0.05). A nomogram model for predicting the development of BPD was established based on the risk factors, with an area under the receiver operating characteristic curve of 0.93, and the calibration curve of this nomogram had a slope of about 1. The goodness-of-fit test indicated the model fitted well (χ²=8.287, P=0.406).

Conclusions: A gestational age of <28 weeks, duration of noninvasive respiratory support, comorbidity with infectious pneumonia, and chorioamnionitis in the mother are independent risk factors for BPD in preterm infants.

Objectives: To investigate the clinical features and prognosis of childhood acute lymphoblastic leukemia (ALL) with CREBBP gene mutation.

Methods: A retrospective analysis was performed for the clinical data of 14 ALL children with CREBBP gene mutation who were admitted to Children's Hospital of the First Affiliated Hospital of Zhengzhou University from January 2016 to December 2023.

Results: The ALL patients with CREBBP gene mutation accounted for 1.5% (14/963) among all children diagnosed with ALL during the same period of time, among whom there were 4 boys (29%) and 10 girls (71%), with a median age of 4 years and 3.5 months. All children had an immunological type of B-cell ALL and concurrent mutations in other genes including NRAS, KRAS, ETV6, FLT3, PAX5, SH2B3, CDKN2A, and CDKN2B, and 4 children had karyotype abnormality. All 14 children received induction therapy with the VDLP regimen, with a complete remission (CR) rate of 79% (11/14) after the first course of treatment. Three children experienced bone marrow recurrence alone, with a recurrence rate of 21% (3/14), among whom 1 child achieved CR after blinatumomab therapy and 2 received bridging hematopoietic stem cell transplantation after chemotherapy for recurrence. Among the 14 children, 1 died due to treatment discontinuation and 13 achieved disease-free survival. The 5-year overall survival rate was 92%±7%, and the event-free survival rate was 73%±13%.

Conclusions: ALL with CREBBP gene mutation is more common in girls and has a low induction remission rate and a high recurrence rate, and it is often accompanied by other types of gene mutations and abnormal karyotypes. Most children with recurrence can achieve long-term survival after immunotherapy or hematopoietic stem cell transplantation.

Objectives: To detect multidrug resistance gene locus mutations in children with Mycoplasma pneumoniae pneumonia through targeted high-throughput sequencing and to explore its clinical significance.

Methods: A retrospective analysis was conducted on the clinical data of 2 899 children with Mycoplasma pneumoniae pneumonia, who underwent respiratory pathogen-targeted high-throughput sequencing, treated at Hubei Maternal and Child Health Care Hospital between January and December 2023. The patients were divided into a mutation group (n=885) and a non-mutation group (n=2 014) based on whether there was a mutation in the 23SrRNA macrolide-resistant gene of Mycoplasma pneumoniae. Multivariate logistic regression analysis was used to investigate the risk factors for multidrug resistance gene locus mutations in children with Mycoplasma pneumoniae pneumonia.

Results: Among the 2 899 children, 885 cases (30.53%) had mutations in the 23SrRNA resistance gene, including 884 cases with the A2063G mutation and 1 case with the A2064G mutation. In children with 23SrRNA resistance gene mutations, treatment with doxycycline or ofloxacin was more effective than with azithromycin or clarithromycin, and doxycycline was more effective than ofloxacin (P<0.05). The mutation rate of resistance genes in children with Mycoplasma pneumoniae pneumonia increased with age (P<0.001). Multivariate logistic regression analysis showed that increased age, extrapulmonary infection, lung consolidation, prolonged fever, prolonged hospitalization, and elevated CRP levels were risk factors for 23SrRNA gene locus mutations (P<0.05).

Conclusions: Age, extrapulmonary infections, lung consolidation, duration of fever, length of hospitalization, and CRP levels are closely related to 23SrRNA resistance gene locus mutations. Detecting multidrug resistance gene locus mutations in children with Mycoplasma pneumoniae pneumonia can aid in early diagnosis and prediction of treatment efficacy, promoting rational clinical treatment.

Objectives: To investigate the correlation between optimal placement depth (OPD) and physical measurement parameters in preterm infants receiving placement of peripherally inserted central catheter (PICC) through the great saphenous vein (GSV), and to establish a predictive formula for OPD during the placement of PICC through the GSV.

Methods: A retrospective analysis was performed for the preterm infants who received the placement of PICC through the GSV in the Neonatal Intensive Care Unit of the Third Xiangya Hospital of Central South University from December 2022 to February 2024. According to the site of puncture [GSV of the knee joint (KJ) or the ankle joint (AJ)], they were divided into a GSV-KJ placement group (n=38) and a GSV-AJ placement group (n=33). The infants were measured in terms of body weight (BW), body length, the length of the upper and lower parts of the body, head circumference, and abdominal circumference at the time of placement. The Pearson correlation analysis was used to investigate the correlation between the above variables and OPD. A predictive formula was established for OPD in the placement of PICC via the GSV in preterm infants, and the predicted residual between the predicted depth and the ideal OPD was compared between the conventional predictive formula and the new predictive formula.

Results: The Pearson correlation analysis showed that PICC OPD was significantly positively correlated with BW, body length, the length of the upper and lower parts of the body, head circumference, and abdominal circumference in both the GSV-KJ placement group and GSV-AJ placement group (P<0.05), with the highest degree of correlation between OPD and BW. The univariate linear regression analysis showed a linear relationship between PICC OPD and BW in both groups. The predictive formulas for OPD were as follows: GSV-KJ PICC OPD (cm) = 13.1 + 2.7 × BW (kg) and GSV-AJ PICC OPD (cm) = 13.4 + 6.0 × BW (kg), and the new predictive formulas had a significantly lower predicted residual than the conventional predictive formula (P<0.05).

Conclusions: OPD for PICC through the GSV is positively correlated with BW, and the prediction results of the new predictive formula based on BW are closer to the ideal OPD.

Objectives: To study the composition, abundance, and functional profiles of the intestinal microbiota in infants and young children with Kawasaki disease (KD) during the acute phase, and to explore the potential role of intestinal microbiota in the pathogenesis of KD.

Methods: Six children aged 0-3 years with acute KD admitted to the Department of Cardiology, Children's Hospital Affiliated to Capital Institute of Pediatrics from July to October 2021 were prospectively included as the KD group. Six age- and sex-matched healthy children who underwent physical examinations at the hospital during the same period were selected as the healthy control group. Metagenomics sequencing was used to detect and compare the differences in the microflora structure and functional profiles of fecal samples between the two groups.

Results: There were significant differences in the structural composition and diversity of intestinal microbiota between the two groups (P<0.05). Compared with the healthy control group, the abundance of Listeria_monocytogenes (family Listeriaceae and genus Listeria), Bifidobacterium_rousetti, Enterococcus_avium, and Enterococcus_hirae was significantly higher in the intestinal microbiota in the KD group (|LDA|>2.0, P<0.05). The steroid degradation and apoptosis pathways were significantly upregulated in the KD group compared with the healthy control group, while the Bacterial_secretion_system, Sulfur_metabolism, Butanoate_metabolism, Benzoate_degradation, β-alanine metabolism, and α-linolenic acid pathways were significantly downregulated (|LDA|>2, P<0.05).

Conclusions: There are significant differences in the structure and diversity of intestinal microbiota between children aged 0-3 years with acute KD and healthy children, suggesting that disturbances in intestinal microbiota occur during the acute phase of KD. In particular, Listeria_monocytogenes, Enterococcus_avium, and Enterococcus_hirae may be involved in the pathogenesis of KD through steroid degradation and apoptosis pathways.

Objectives: To investigate the clinical features and risk factors of cholestasis in small for gestational age (SGA) preterm infants.

Methods: This study selected SGA preterm infants born at less than 37 weeks of gestation and admitted to the Department of Neonatology, Children's Hospital of Soochow Universitywithin 24 hours after birth. The infants were divided into two groups: a cholestasis group and a non-cholestasis group. Clinical data from July 2017 to June 2022 were collected and retrospectively analyzed.

Results: Among the 553 SGA preterm infants included, 100 infants (18.1%) developed cholestasis. The incidence rates in different gestational age and birth weight groups were as follows: extremely preterm infants 50.0%, very preterm infants 46.6%, moderate preterm infants 32.7%, and late preterm infants 9.8%; birth weight (BW) <1 000 g 60.9%, 1 000 g≤BW<1 500 g 33.9%, and 1 500 g≤BW<2 500 g 10.7%. Multivariate regression analysis showed that low birth weight, intracranial hemorrhage, duration of invasive ventilation, total amino acid accumulation in the second week, total lipid emulsion accumulation in the first week, and total lipid emulsion accumulation in the second week were independent risk factors for cholestasis in SGA preterm infants (P<0.05).

Conclusions: The incidence of cholestasis in SGA preterm infants increases with decreasing gestational age and birth weight. The occurrence of cholestasis in SGA preterm infants is influenced by multiple risk factors, including low birth weight, intracranial hemorrhage, invasive ventilation, and the accumulation of amino acids and lipid emulsions, highlighting the need for comprehensive treatment measures to reduce its occurrence.

Peutz-Jeghers syndrome (PJS) is an autosomal dominant genetic disorder characterized by mucocutaneous pigmentation and multiple hamartomatous polyps, which leads to an increased susceptibility to tumors. The clinical incidence is rare, and the only currently identified pathogenic gene is the serine/threonine kinase 11/liver kinase B1 (STK11/LKB1) located on the short arm of chromosome 19 (19p13.3). This condition can lead to various complications, such as gastrointestinal bleeding, intussusception, intestinal obstruction, and malignancy. In childhood, the greatest risk is associated with intussusception, which increases the risk of surgical intervention and significantly impacts the growth, development, and quality of life of the children. This article provides an overview of the current research status regarding the clinical characteristics, etiology, pathogenesis, diagnosis, and treatment of PJS in children.

Objectives: To explore the effects of antenatal corticosteroids (ACS) on the outcomes of very premature infants (VPIs) and neurodevelopment during infancy.

Methods: A retrospective study was conducted on 190 VPIs admitted to the Department of Pediatrics of the First Affiliated Hospital of Anhui Medical University from January 2020 to December 2022. The infants were categorized into four groups based on ACS usage and dosage: no ACS group (n=18), single-course group (n=88), multi-course group (n=40), and partial-course group (n=44). The clinical outcomes, Neonatal Behavioral and Neurological Assessment (NBNA) scores at 40 weeks of corrected age, and Gesell Developmental Schedule (Gesell) scores at 1 year of corrected age were compared among the four groups. The impact of timing of ACS use on the Gesell scores of infants at 1 year of corrected age in VPIs with specific gestational ages was analyzed.

Results: The incidence rates of neonatal respiratory distress syndrome, bronchopulmonary dysplasia, transient tachypnea of the newborn, and neonatal pneumonia were significantly lower in the partial-course, single-course, and multiple-course groups compared with the no ACS group (P<0.008). However, there was no significant difference among the partial-course, single-course, and multiple-course groups (P>0.008). The NBNA scores (behavioral ability, active muscle tone, primitive reflexes, and general assessment) at 40 weeks of corrected age were significantly higher in the no ACS, partial-course, and single-course groups than in the multiple-course group (P<0.008). The proportion of VPIs with normal neurodevelopment at 1 year of corrected age was significantly higher in the no ACS, partial-course, and single-course groups than in the multiple-course group (P<0.008). The timing of ACS use had no significant effect on neurodevelopment at a corrected age of 1 year in infants with various gestational ages (P>0.05).

Conclusions: ACS is crucial for the development of the respiratory system in VPIs, but multiple courses of ACS may cause neurodevelopmental abnormalities. The impact of ACS use on neurodevelopment is independent of gestational age and the timing of ACS use.

Objectives: To investigate the effects of propranolol on the proliferation, apoptosis, migration, and tube formation ability of human umbilical vein endothelial cells (HUVEC), as well as its impact on the expression of sex-determining region Y-box 18 (SOX18), matrix metalloproteinase-7 (MMP-7), and vascular endothelial growth factor A (VEGFA).

Methods: HUVEC were treated with different concentrations of propranolol, and cell viability was assessed using the CCK-8 method to determine the optimal concentration and treatment duration. The experiment consisted of a control group and groups treated with different concentrations of propranolol (50, 100, 150 μmol/L). Apoptosis, migration, and tube formation of HUVEC were observed using flow cytometry, wound healing assays, and tube formation assays. Western blot and real-time quantitative PCR were used to detect the expression levels of SOX18, MMP-7, and VEGFA proteins and mRNA.

Results: Compared to the control group, the apoptosis rate in the propranolol treatment groups increased significantly (P<0.05), and it rose significantly with increasing drug concentration (P<0.05). The wound healing rate decreased in the propranolol treatment groups, and both the number of tube formation nodes and total tube length were reduced (P<0.05). The expression levels of SOX18, MMP-7, and VEGFA proteins and mRNA were downregulated in the propranolol treatment groups (P<0.05).

Conclusions: Propranolol can inhibit the proliferation, migration, and tube formation ability of HUVEC and promote cell apoptosis, resulting in decreased expression levels of SOX18, MMP-7, and VEGFA.