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Diagnosis, treatment, and prevention of monkeypox in children: an experts' consensus statement
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Rong-Meng Jiang, Yue-Jie Zheng, Lei Zhou, Lu-Zhao Feng, Lin Ma, Bao-Ping Xu, Hong-Mei Xu, Wei Liu, Zheng-De Xie, Ji-Kui Deng, Li-Juan Xiong, Wan-Jun Luo, Zhi-Sheng Liu, Sai-Nan Shu, Jian-She Wang, Yi Jiang, Yun-Xiao Shang, Miao Liu, Li-Wei Gao, Zhuang Wei, Guang-Hua Liu, Gang Liu, Wei Xiang, Yu-Xia Cui, Gen Lu, Min Lu, Xiao-Xia Lu, Run-Ming Jin, Yan Bai, Le-Ping Ye, Dong-Chi Zhao, A-Dong Shen, Xiang Ma, Qing-Hua Lu, Feng-Xia Xue, Jian-Bo Shao, Tian-You Wang, Zheng-Yan Zhao, Xing-Wang Li, Yong-Hong Yang, Kun-Ling Shen |
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Monkeypox is a zoonotic disease. Since the first human monkeypox case was detected in 1970, it has been prevalent in some countries in central and western Africa. Since May 2022, monkeypox cases have been reported in more than 96 non-endemic countries and regions worldwide. As of September 14, 2022, there have been more than 58,200 human monkeypox cases, and there is community transmission. The cessation of smallpox vaccination in 1980, which had some cross-protection with monkeypox, resulted in a general lack of immunity to monkeypox, which caused global concern and vigilance. As of September 14, 2022, there are four monkeypox cases in China, including three in Taiwan province and one in Hong Kong city. Previous foreign studies have shown that children are vulnerable to monkeypox and are also at high risk for severe disease or complications. In order to improve pediatricians* understanding of monkeypox and achieve early detection, early diagnosis, early treatment, and early disposal, we have organized national authoritative experts in pediatric infection, respiratory, dermatology, critical care medicine, infectious diseases, and public health and others to formulate this expert consensus, on the basis of the latest ※Clinical management and infection prevention and control for monkeypox§ released by The World Health Organization, the ※guidelines for diagnosis and treatment of monkeypox (version 2022)§ issued by National Health Commission of the People*s Republic of China and other relevant documents. During the development of this consensus, multidisciplinary experts have repeatedly demonstrated the etiology, epidemiology, transmission, clinical manifestations, laboratory examinations, diagnosis, differential diagnosis, treatment, discharge criteria, prevention, disposal process, and key points of prevention and control of suspected and confirmed cases. |
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[Abstract] [Full Text] [PDF]
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Stressful life events, psychosocial health and general health in preschool children before age 4
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Jie Luo, Amy van Grieken, Shuang Zhou, Yuan Fang, Hein Raat |
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Background: The impact of stressful life events (SLEs) in early childhood is often ignored. We aimed to examine longitudinal associations between SLEs and psychosocial and general health in preschool children.
Methods: Twelve SLEs occurring before the age of 24 months were assessed and categorized by frequency (no events, 1每2 SLEs, and > 2 SLEs) and overall tension (no events, low, and high) (n = 1431). Psychosocial and general health were measured three times at the age of 24, 36 and 45 months. The associations were examined by logistic regression models using generalized estimating equations to handle repeated measurements.
Results: Half (48.4%) of the families experienced SLEs, and 23.8% perceived high-tension SLEs before the children were aged 24 months. Gender differences were observed in the association between SLEs and psychosocial health. Compared to girls without SLEs, girls who experienced > 2 SLEs [OR = 3.31, 95% confidence interval (CI) 2.05每5.35] or high-tension SLEs (OR = 3.01, 95% CI 2.07每4.39) had higher odds of psychosocial problems from 24 to 45 months. The odds ratios in boys were 2.10 (95% CI 1.36每3.24) and 1.47 (95% CI 1.06每2.03), respectively. Moreover, only girls* risk of psychosocial problems increased after experiencing 1每2 SLEs (OR = 2.15, 95% CI 1.54每3.00) or low-tension SLEs (OR = 1.90, 95% CI 1.31每2.74). Regarding general health, children who experienced > 2 SLEs (OR = 1.96, 95% CI 1.21每3.18) and high-tension SLEs (OR = 1.60, 95% CI 1.12每2.28) had higher odds of poor general health from 24 to 45 months. Conclusions: The findings emphasized that young children*s psychosocial and general health can be impacted by experiencing SLEs in early childhood. Attention and adequate support for families experiencing SLEs are needed to minimize the potential negative effect of SLEs on child health, particularly in girls. |
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[Abstract] [Full Text] [PDF]
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Number and distribution of eosinophils and lymphocytes in the Japanese pediatric gastrointestinal tract: in search of a definition for ※abnormally increased eosinophils§
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Mai Iwaya, Shota Kobayashi, Yoshiko Nakayama, Sawako Kato, Shingo Kurasawa, Tomomitsu Sado, Yugo Iwaya, Takeshi Uehara, Hiroyoshi Ota |
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Background: Primary eosinophilic gastrointestinal disorders (EGIDs) constitute chronic allergic inflammation. The number of eosinophils is one of the diagnostic criteria; more than 20 eosinophils per high-power field (HPF) in the gastrointestinal (GI) tract are considered abnormal in Japan. However, the quantity of eosinophils considered normal varies according to anatomical location and geographical region; such values have not been reported in Japanese pediatric patients, nor have the numbers of lymphocytes in the normal pediatric stomach. To establish a reference for defining diagnostic criteria for EGIDs, we evaluated the number of eosinophils in the normal Japanese pediatric GI tract.
Methods: We examined 131 biopsy cases without significant clinical history, endoscopic abnormality, or histological abnormality. Immunohistochemical analysis of CD3 and CD20 was performed.
Results: The mean eosinophil density was highest in the cecum (49.5 ㊣ 22.4 per HPF). Counts of more than 20 eosinophils per HPF were observed in the duodenum [bulb (20.0 ㊣ 9.6) and second portion (30.0 ㊣ 15.8)], terminal ileum (38.3 ㊣ 22.7), cecum (49.5 ㊣ 22.4), ascending colon (42.3 ㊣ 25.3), transverse colon (29.4 ㊣ 17.0), and descending colon (32.2 ㊣ 17.9). Counts of fewer than 10 eosinophils per HPF were observed in the stomach and rectum; a count of fewer than one eosinophil per HPF was observed in the esophagus. More than 100 CD3-positive T cells per HPF were observed in the stomach. Conclusions: The mean numbers of eosinophils in the bowel were greater than 20 per HPF. For Japanese pediatrics, the current threshold eosinophil count should be revised. |
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[Abstract] [Full Text] [PDF]
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Associations of preterm and early-term birth with suspected developmental coordination disorder: a national retrospective cohort study in children aged 3每10 years
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Ming-Xia Liu, Hai-Feng Li, Mei-Qin Wu, Shan-Shan Geng, Li Ke, Bi-Wen Lou, Wenchong Du, Jing Hua |
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Background: This study analyzed the motor development and suspected developmental coordination disorder of very and moderately preterm (< 34 +0 gestational age), late preterm (34 +0 每36 +6 gestational week), and early-term (37 +0 每38 +6 gestational week) children compared to their full-term peers with a national population-based sample in China.
Methods: A total of 1673 children (799 girls, 874 boys) aged 3每10 years old were individually assessed with the Movement Assessment Battery for Children-second edition (MABC-2). The association between gestational age and motor performance of children was analyzed using a multilevel regression model.
Results: The global motor performance [汕 = 每 5.111, 95% confidence interval (CI) = 每 9.200 to 每 1.022; P = 0.015] and balance (汕 = 每 5.182, 95% CI = 每 5.055 to 每 1.158; P = 0.003) for very and moderately preterm children aged 3每6 years old were significantly lower than their full-term peers when adjusting for confounders. Late preterm and early-term children showed no difference. Moreover, very and moderately preterm children aged 3每6 years had a higher risk of suspected developmental coordination disorder (DCD) (≒ 5 percentile of MABC-2 score) when adjusting for potential confounders [odds
ratio (OR) = 2.931, 95% CI = 1.067每8.054; P = 0.038]. Late preterm and early-term children showed no difference in motor performance from their full-term peers (each P > 0.05). Conclusions: Our findings have important implications for understanding motor impairment in children born at different gestational ages. Very and moderately preterm preschoolers have an increased risk of DCD, and long-term follow-up should be provided for early detection and intervention. |
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[Abstract] [Full Text] [PDF]
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T-cell and B-cell repertoire diversity are selectively skewed in children with idiopathic nephrotic syndrome revealed by high-throughput sequencing
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Qing Ye, Dong-Jie Wang, Bing Lan, Jian-Hua Mao |
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Background: Clinical studies suggest that the dysfunction of T cells and B cells may play an essential role in the pathogenesis of idiopathic nephrotic syndrome (INS), but laboratory evidence is lacking. Therefore, this study explored T-cell receptor ( TCR) and B-cell receptor ( BCR) profiling in children with idiopathic nephrotic syndrome.
Methods: High-throughput sequencing technology was used to profile the TCR and BCR repertoires in children with INS. Peripheral blood was collected from ten INS patients, including five vinculin autoantibody-positive patients and five vinculin autoantibody-negative patients, before and after treatment. TCR and BCR libraries were constructed by 5∩-RACE and sequenced by a DNBSEQ-T7 sequencer, and sequence analyses were performed using ReSeqTools, FastP, MiXCR, and VDJtools.
Results: The TRA (T-cell receptor 汐), TRG (T-cell receptor 污), and IGH (immunoglobulin heavy chain) repertoires of the INS group were occupied by highly abundant clonotypes, whereas small clonotypes occupied the healthy group, especially TRA. A significant increase in the Shannon每Weaver index was observed for the TRA and TRG repertoires after treatment in vinculin autoantibody-negative patients, but a significant increase in the IGH repertoire after treatment was observed in vinculin autoantibody-positive patients. The frequency of some V每J pairs was significantly enriched in steroid-sensitive nephrotic syndrome patients. The usage frequency of the V and J genes was skewed in patients, which seemed not related to immunosuppressive therapy. However, after effective treatment, dynamic changes in the size of the individual clonotype were observed. Conclusion: T-cell and B-cell immunity contribute to the pathogenesis of different INSs. |
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[Abstract] [Full Text] [PDF]
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