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Vol 19, No 4
Vol 19, No 4 April 2023 ISSN 1708-8569
Review articles
Original articles
Research letters
Review articles:
Effect of maternal pregestational diabetes mellitus on congenital heart diseases
  Zhi-Yan Chen, Shuang-Fa Mao, Ling-Hong Guo, Jian Qin, Li-Xin Yang, Yin Liu
Background: The increasing population of diabetes mellitus in adolescent girls and women of childbearing age contributes to a large number of pregnancies with maternal pregestational diabetes mellitus. Congenital heart diseases are a common adverse outcome in mothers with pregestational diabetes mellitus. However, there is little systematic information between maternal pregestational diabetes mellitus and congenital heart diseases in the off spring.
Data sources: Literature selection was performed in PubMed. One hundred and seven papers were cited in our review, including 36 clinical studies, 26 experimental studies, 31 reviews, eight meta-analysis articles, and six of other types.
Results: Maternal pregestational diabetes mellitus poses a high risk of congenital heart diseases in the off spring and causes variety of phenotypes of congenital heart diseases. Factors such as persistent maternal hyperglycemia, oxidative stress, polymorphism of uncoupling protein 2, polymorphism of adiponectin gene, Notch 1 pathway, Nkx2.5 disorders, dysregulation of the hypoxia-inducible factor 1, and viral etiologies are associated with the occurrence of congenital heart diseases in the off spring of mothers with pregestational diabetes mellitus. Treatment options including blood sugar-reducing, antioxidative stress drug supplements and exercise can help to prevent maternal pregestational diabetes mellitus from inducing congenital heart diseases.
Conclusions: Our review contributes to a better understanding of the association between maternal pregestational diabetes mellitus and congenital heart diseases in the off spring and to a profound thought of the mechanism, preventive and therapeutic measurements of congenital heart diseases caused by maternal pregestational diabetes mellitus.
  [Abstract] [Full Text] [PDF]  
Psychiatric comorbidities in children and adolescents with chronic urticaria
  George N. Konstantinou, Gerasimos N. Konstantinou
Background: Chronic urticaria (CU) has been shown to impact patients* quality of life negatively and may coexist with psychiatric disorders. We systematically reviewed the published evidence of comorbid psychiatric disorders in children and adolescents with CU.
Methods: A systematic review of studies published until February 2022 in PubMed, Google Scholar, and Scopus was performed. An a priori set of inclusion criteria was predefined for the studies to be included: (1) clear distinction between urticaria and other allergies; (2) precise distinction between acute and CU; (3) participants younger than 18 years old, exclusively; (4) use of appropriate standardized questionnaires, psychometric tools, and standard diagnostic nomenclature for the mental health and behavioral disorders diagnosis; and (5) manuscripts written or published in the English language.
Results: Our search identified 582 potentially relevant papers. Only eight of them satisfied the inclusion criteria. Quantitative meta-analysis was not deemed appropriate, given the lack of relevant randomized control trials, the small number of relevant shortlisted, the small sample size of the patients included in each study, and the remarkable heterogeneity of the studies* protocols.
Conclusions: The included studies suggest an increased incidence of psychopathology among children and adolescents with CU as opposed to healthy age-matched individuals, but the data are scarce. Further research is required to clarify whether psychopathology is just a comorbid entity, the cause, or the consequence of CU. Meanwhile an interdisciplinary collaboration between allergists/dermatologists and psychiatrists is expected to substantially minimize CU burden and improve patients* quality of life.
  [Abstract] [Full Text] [PDF]  
Effectiveness of resilience-promoting interventions in adolescents with diabetes mellitus: a systematic review and meta-analysis
  Yi Wu, Yi-Yun Zhang, Ya-Ting Zhang, Hui-Jing Zhang, Tian-Xue Long, Qi Zhang, Jing Huang, Ming-Zi Li
Background: This study aimed to analyze the efficacy of resilience-promoting interventions among adolescents and youth aged 10每24 years with any type of diabetes.
Methods: A systematic literature search was performed using the PubMed, Web of Science, Embase, Cochrane Library, CINAHL, and PsycINFO databases from inception to May 25, 2022. The Cochrane risk of bias tool (version 2) was used to assess the quality of the included studies. A meta-analysis was performed to calculate the pooled effects of resilience-promoting interventions.
Results: Nineteen articles were included covering an overall sample of 2048 adolescents with diabetes. When analyzing the effectiveness of resilience-promoting interventions, hemoglobin A1c (HbA1c) at six months [mean difference = − 0.47, 95% confidence interval (CI) = − 0.83 to − 0.12, P = 0.009] after the intervention was improved. However, long-term (≡ 12 months) improvement in HbA1c was not significant. In addition, comparing the control group, there were significant differences in the effect size for stress [standardized mean difference (SMD) = − 0.87, 95% CI = − 1.25 to -0.48, P < 0.05], self-efficacy (SMD = 0.50, 95% CI = 0.02每0.98, P = 0.04) and quality of life (SMD = 0.27, 95% CI = 0.03每0.51, P = 0.03).
Conclusions: Resilience-promoting intervention is a promising way for adolescent diabetes management to improve HbA1c, stress, self-efficacy, and quality of life. Incorporating resilience-promoting components into diabetes education and reinforcing these contents every six months are recommended for implementation in clinical practice.
  [Abstract] [Full Text] [PDF]  
Addition of respiratory exercises to conventional rehabilitation for children and adolescents with cerebral palsy: a systematic review and meta-analysis
  Th芍lita Raysa de Lima Crispim, Mansueto Gomes Neto, Tafnes Rayane Lima Crispim, Renivaldo Batista Dias, Maria D谷borah Monteiro de Albuquerque, Micheli Bernardone Saquetto, Paulo Andr谷 Freire Magalhães
Background: Respiratory dysfunctions are an important cause of morbidity and death in cerebral palsy (CP) populations. Respiratory exercises in addition to conventional rehabilitation have been suggested to improve respiratory status in CP patients. The objective of this systematic review and meta-analysis was to verify the effects of the addition of respiratory exercises to conventional rehabilitation on pulmonary function, functional capacity, respiratory muscle strength, gross motor function and quality of life in children and adolescents with CP.
Methods: We searched for randomized controlled clinical trials in PubMed/Medline, Lilacs, SciELO, EMBASE and Physiotheraphy Evidence (PEDro) from their inception until July 2022 without language restrictions. Studies that included respiratory exercises (breathing exercise program; feedback respiratory training; incentive spirometer exercise; inspiratory muscle training; and combination of respiratory exercises + incentive spirometer exercise) in combination with conventional rehabilitation for children and adolescents with CP were evaluated by two independent reviewers. The mean difference (MD) and 95% confidence interval (CI) were estimated by random effect models.
Results: Ten studies met the eligibility criteria, including 324 children aged from 6 to 16 years. The meta-analysis showed an improvement in inspiratory muscle strength of 22.96 cmH2O (18.63每27.27, n = 55) and pulmonary function of 0.60 (0.38每0.82, n = 98) for forced vital capacity (L); 0.22 (0.06每0.39, n = 98) for forced expiratory volume at 1 second (L); and 0.50 (0.05每0.04, n = 98) for peak expiratory flow (L/min). Functional skills in daily living activities improved in the intervention group. Caregivers* assistance of daily living activities, functional capacity, gross motor function and expiratory muscle strength showed a nonsignificant improvement. Social well-being and acceptance and functioning domains improved in only one study.
Conclusions: Emerging data show significant enhancements in inspiratory muscle strength and pulmonary function in CP patients after respiratory training in addition to conventional rehabilitation. There is no consensus on the frequency, type or intensity of respiratory exercises for children with and adolescents with CP.
  [Abstract] [Full Text] [PDF]  
Original articles:
Effects of synbiotic supplementation on anthropometric indices and body composition in overweight or obese children and adolescents: a randomized, double-blind, placebo-controlled clinical trial
  Mohammad Amin Atazadegan, Motahar Heidari-Beni, Mohammad Hassan Entezari, Fariborz Sharifianjazi, Roya Kelishadi
Background: Recently, beneficial effects of probiotics and/or prebiotics on cardio-metabolic risk factors in adults have been shown. However, existing evidence has not been fully established for pediatric age groups. This study aimed to assess the effect of synbiotic on anthropometric indices and body composition in overweight or obese children and adolescents.
Methods: This randomized double-blind, placebo-controlled trial was conducted among 60 participants aged 8每18 years with a body mass index (BMI) equal to or higher than the 85th percentile. Participants were randomly divided into two groups that received either a synbiotic capsule containing 6 ℅ 109 colony forming units (CFU) Lactobacillus coagulans SC-208, 6 ℅ 109 CFU Lactobacillus indicus HU36 and fructooligosaccharide as a prebiotic (n = 30) or a placebo (n = 30) twice a day for eight weeks. Anthropometric indices and body composition were measured at baseline and after the intervention.
Results: The mean (standard deviation, SD) age was 11.07 (2.00) years and 11.23 (2.37) years for the placebo and symbiotic groups, respectively (P = 0.770). The waist-height ratio (WHtR) decreased significantly at the end of the intervention in comparison with baseline in the synbiotic group (0.54 ㊣ 0.05 vs. 0.55 ㊣ 0.05, P = 0.05). No significant changes were demonstrated in other anthropometric indices or body composition between groups.
Conclusions: Synbiotic supplementation might be associated with a reduction in WHtR. There were no significant changes in other anthropometric indices or body composition.
  [Abstract] [Full Text] [PDF]  
Estimated prevalence and trends in smoking among adolescents in South Korea, 2005每2021: a nationwide serial study
  Hyoin Shin, Sangil Park, Hyunju Yon, Chae Yeon Ban, Stephen Turner, Seong Ho Cho, Youn Ho Shin, Jung U. Shin, Ai Koyanagi, Louis Jacob, Lee Smith, Chanyang Min, Young Joo Lee, So Young Kim, Jinseok Lee, Rosie Kwon, Min Ji Koo, Guillaume Fond, Laurent Boyer, Jong Woo Hahn, Namwoo Kim, Sang Youl Rhee, Jae Il Shin, Ho Geol Woo, Hyeowon Park, Hyeon Jin Kim, Yoonsung Lee, Man S. Kim, El谷a Lefkir, Vlasta Hadalin, Jungwoo Choi, Seung Won Lee, Dong Keon Yon, Sunyoung Kim
Background: Although smoking is classifi ed as a risk factor for severe COVID-19 outcomes, there is a scarcity of studies on prevalence of smoking during the COVID-19 pandemic. Thus, this study aims to analyze the trends of prevalence of smoking in adolescents over the COVID-19 pandemic period.
Methods: The present study used data from middle to high school adolescents between 2005 and 2021 who participated in the Korea Youth Risk Behavior Web-based Survey (KYRBS). We evaluated the smoking prevalence (ever or daily) by year groups and estimated the slope in smoking prevalence before and during the pandemic.
Results: A total of 1,137,823 adolescents participated in the study [mean age, 15.04 years [95% confidence interval (CI) 15.03每15.06]; and male, 52.4% (95% CI 51.7每53.1)]. The prevalence of ever smokers was 27.7% (95% CI 27.3每28.1) between 2005 and 2008 but decreased to 9.8% (95% CI 9.3每10.3) in 2021. A consistent trend was found in daily smokers, as the estimates decreased from 5.4% (95% CI 5.2每5.6) between 2005 and 2008 to 2.3% (95% CI 2.1每2.5) in 2021. However, the downward slope in the overall prevalence of ever smokers and daily smokers became less pronounced in the COVID-19 pandemic period than in the pre-pandemic period. In the subgroup with substance use, the decreasing slope in daily smokers was significantly more pronounced during the pandemic than during the pre-pandemic period.
Conclusions: The proportion of ever smokers and daily smokers showed a less pronounced decreasing trend during the pandemic. The findings of our study provide an overall understanding of the pandemic*s impact on smoking prevalence in adolescents.
  [Abstract] [Full Text] [PDF]  
Factors of heavy social media use among 13-year-old adolescents on weekdays and weekends
  Yue-Yue You, Junwen Yang-Huang, Hein Raat, Amy van Grieken
Background: Few studies have investigated which factors were related to adolescents* social media use. This study aimed to evaluate which factors were associated with heavy social media use on weekdays and weekends among 13-year-old adolescents.
Methods: We analyzed data from 3727 children from the Generation R Study, a population-based cohort study in the Netherlands. Associations of demographic factors (child age, sex, ethnic background, and family situation), socioeconomic position (parental educational level, parental employment status, and net household income), screen-based behaviors (computer playing and TV viewing), and the home environment (communication, supervision, and restriction) with adolescents* heavy social media use (≡ 2 hours/day) were assessed separately on weekdays and weekends. Multivariate logistic regression analysis was applied.
Results: The prevalence of heavy social media use was 37.7% on a weekday and 59.6% on a weekend day. Being a girl, living in a one-parent family, and more time spent playing on the computer were associated with heavy social media use on weekdays and weekends (all P < 0.05). Low socioeconomic position adolescents (low parental educational level and low household income) were more likely to show heavy social media use only on weekends (all P < 0.05). Children whose social media use was restricted by parents on weekdays or children whose social media use was supervised by parents on weekends had lower odds of heavy social media use (all P < 0.05).
Conclusions: Being a girl, living in a one-parent family, or having a longer computer playing time were associated with heavy social media use on weekdays and weekends. More studies are needed to understand the factors associated with heavy social media use and the impact of heavy social media use on child health.
  [Abstract] [Full Text] [PDF]  
A predictive model of response to metoprolol in children and adolescents with postural tachycardia syndrome
  Bo-Wen Xu, Qing-You Zhang, Xue-Ying Li, Chao-Shu Tang, Jun-Bao Du, Xue-Qin Liu, Hong-Fang Jin
Background: The present work was designed to explore whether electrocardiogram (ECG) index-based models could predict the effectiveness of metoprolol therapy in pediatric patients with postural tachycardia syndrome (POTS).
Methods: This study consisted of a training set and an external validation set. Children and adolescents with POTS who were given metoprolol treatment were enrolled, and after follow-up, they were grouped into non-responders and responders depending on the efficacy of metoprolol. The difference in pre-treatment baseline ECG indicators was analyzed between the two groups in the training set. Binary logistic regression analysis was further conducted on the association between significantly different baseline variables and therapeutic efficacy. Nomogram models were established to predict therapeutic response to metoprolol. The receiver-operating characteristic curve (ROC), calibration, and internal validation were used to evaluate the prediction model. The predictive ability of the model was validated in the external validation set.
Results: Of the 95 enrolled patients, 65 responded to metoprolol treatment, and 30 failed to respond. In the responders, the maximum value of the P wave after correction (Pcmax), P wave dispersion (Pd), Pd after correction (Pcd), QT interval dispersion (QTd), QTd after correction (QTcd), maximum T-peak-to-T-end interval (Tpemax), and T-peak-to-T-end interval dispersion (Tped) were prolonged (all P < 0.01), and the P wave amplitude was increased (P < 0.05) compared with those of the non-responders. In contrast, the minimum value of the P wave duration after correction (Pcmin), the minimum value of the QT interval after correction (QTcmin), and the minimum T-peak-to-T-end interval (Tpemin) in the responders were shorter (P < 0.01, < 0.01 and < 0.01, respectively) than those in the non-responders. The above indicators were screened based on the clinical signifi cance and multicollinearity analysis to construct a binary logistic regression. As a result, pre-treatment Pcmax, QTcmin, and Tped were identifi ed as signifi cantly associated factors that could be combined to provide an accurate prediction of the therapeutic response to metoprolol among the study subjects, yielding good discrimination [area under curve (AUC) = 0.970, 95% confidence interval (CI) 0.942每0.998] with a predictive sensitivity of 93.8%, specificity of 90.0%, good calibration, and corrected C-index of 0.961. In addition, the calibration curve and standard curve had a good fit. The accuracy of internal validation with bootstrap repeated sampling was 0.902. In contrast, the kappa value was 0.769, indicating satisfactory agreement between the predictive model and the results from the actual observations. In the external validation set, the AUC for the prediction model was 0.895, and the sensitivity and specificity were 90.9% and 95.0%, respectively.
Conclusions: A high-precision predictive model was successfully developed and externally validated. It had an excellent predictive value of the therapeutic effect of metoprolol on POTS among children and adolescents.
  [Abstract] [Full Text] [PDF]  
Research letters:
Food allergy among Mexican infants and preschoolers: prevalence and associated factors
  Mart赤n Bedolla-Barajas, Jaime Morales-Romero, Rafael S芍nchez-Magall車n, Jorge Alejandro Valdez-Soto, Tonatiuh Ramses Bedolla-Pulido, Carlos Meza-L車pez
  [Abstract] [Full Text] [PDF]  
Clinical profile, etiology, and outcome of hemophagocytic lymphohistiocytosis associated with histiocytic necrotizing lymphadenitis
  Kuang-Guo Zhou, Duan-Hao Gong, Dan Peng, Zhi-Qiong Wang, Wei Huang
  [Abstract] [Full Text] [PDF]  
World Journal of Pediatric Surgery
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