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Objective To investigate the clinical effect of the Early Start Denver Model (ESDM) in children with autism spectrum disorder (ASD). Methods Forty children aged 2-5 years who were diagnosed with ASD from September 2017 to January 2018 were enrolled in the study and were randomly divided into conventional intervention group and ESDM intervention group (n=20 each). Both groups were assessed by the Aberrant Behavior Checklist (ABC), Childhood Autism Rating Scale (CARS), and Clinical Global Impression-Severity (CGI-S) scale before intervention and by the ABC, CARS, CGI-S scale, and Clinical Global Impression-Improvement (CGI-I) scale after 3 months of intervention. Results After 3 months of intervention, the total scores of ABC and CARS were both significantly decreased in the two groups (P < 0.01); the scores on the social withdrawal and hyperactivity subscales of ABC were significantly decreased in the conventional intervention group (P < 0.01), and the scores on the mood swings, social withdrawal, hyperactivity, and stereotyped behavior subscales of ABC were significantly decreased in the ESDM intervention group (P < 0.01). Compared with the conventional intervention group, the ESDM intervention group had significantly greater changes in total score of ABC, scores on three subscales of ABC (mood swings, social withdrawal, and hyperactivity), and total score of CARS after intervention (P < 0.05). After 3 months of intervention, the CGI-I scoring system showed that the disease improvement was significantly better in the ESDM intervention group than in the conventional intervention group (P < 0.05). Conclusions Both conventional intervention and ESDM intervention can improve the social withdrawal and hyperactivity in children with ASD aged 2 to 5 years, but ESDM is more effective in improving the aberrant behavior of children with ASD.

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Objective To investigate the age of diagnosis of autism spectrum disorder (ASD) and the factors influencing the age of diagnosis in children. Methods A retrospective analysis was performed for the clinical data of 1691 children who visited in the Children's Hospital of Chongqing Medical University for the first time and were definitely diagnosed with ASD between February 2011 and July 2017. A multiple linear regression model was used to identify the factors influencing the age of diagnosis of ASD. Results The ASD children had a mean age of 35±17 months (range 9-175 months) at diagnosis. Of all 1691 children, the children who received a diagnosis of ASD at the age of 24-35 months accounted for the highest proportion (46.13%, 780/1691), followed by those at the age of ≥ 36 months (33.41%, 565/1 691). The multiple linear regression analysis showed that the children who had language disorders or lived in the main urban area or whose parents had a high education level had a younger age at diagnosis than other children (P < 0.05). Conclusions Most ASD children have an age of 24-35 months at diagnosis. The age of diagnosis of ASD is associated with children's symptoms, living area, and parents' education level.

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This article reports two cases of childhood-onset nemaline myopathy diagnosed by muscle pathology and genetic diagnosis. The two patients had onset in early childhood, with muscle weakness as the first manifestation, as well as long disease duration and slow progression. Gomori staining and hematoxylin-eosin staining showed redstained rods in the sarcoplasmic cytoplasm and sarcolemma under a light microscope. Electron microscopy showed that the dense nemaline rods were located under the muscle fiber sarcolemma and parallel to the long axis of the muscle fibers, and some muscle fiber myofilaments were dissolved and necrotic. Gene testing found that one of the two patients had heterozygous mutation (c.1013A > C) in the ACTA1 gene, and the other had compound heterozygous mutation (c.18676C > T and c.9812C > A) in the NEB gene. The two mutations were more common in nemaline myopathy. Nemaline myopathy is a recessive or dominant inheritance myopathy, in which the nemaline rod in the cytoplasm of myocytes is a characteristic muscle pathological change. Pathological and genetic diagnosis is the gold standard for diagnosis of nemaline myopathy.

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Objective To investigate the clinical effect of endovascular embolization (EVE) in the treatment of hemoptysis of systemic arterial origin in children. Methods A total of 20 children with hemoptysis of systemic arterial origin who underwent EVE from January 2016 to November 2017 were enrolled. The method for embolization was analyzed and the clinical outcome was evaluated. Results Offending vessels were bronchial artery (BA) in 14 children, non-bronchial systemic artery (NBSA) in 1 child, and BA and NBSA in 5 children. Of all the children, 13 underwent EVE with peripheral embolization agents and 7 underwent EVE with mechanical coils. A total of 41 offending vessels were embolized (34 BAs and 7 NBSAs) and all the children achieved immediate arrest of hemoptysis. Two children experienced recurrence within 6 months after EVE and 2 experienced recurrence with 6-24 months after EVE. The peripheral embolization agent group had a lower overall recurrence rate than the mechanical coil group[8% (1/13) vs 43% (3/7); P=0.10]. One child experienced intracranial ectopic embolism after surgery and had good quality of life during 20 months of follow-up after treatment. No other complications were observed. Conclusions EVE is a safe and effective method for the treatment of hemoptysis of systemic arterial origin in children and thus holds promise for clinical application.

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Objective To investigate deceleration capacity of heart rate (DC), acceleration capacity of heart rate (AC), and heart rate variability (HRV) in children with hyperthyroidism and the correlations of serum thyroid hormone levels with DC, AC, and HRV. Methods A total of 47 children with hyperthyroidism were enrolled as hyperthyroidism group and 50 healthy children were enrolled as control group. The subjects in the two groups underwent 24-hour ambulatory electrocardiography. The two groups were compared in terms of DC, AC, heart rate (HR), HRV parameters[standard deviation of normal-to-normal RR intervals (SDNN), standard deviation of average normal-to-normal RR intervals (SDANN), root mean square of successive differences between adjacent RR intervals (RMSSD), low-frequency power (LF), and high-frequency power (HF)]. The correlations of thyroid hormone indices[free triiodothyronine (FT3) and free thyroxin (FT4)] with DC, AC, and HRV were analyzed. Results Compared with the control group, the hyperthyroidism group had significantly lower DC, SDNN, SDANN, RMSSD, LF, and HF and significantly higher AC and HR (P < 0.05). In the children with hyperthyroidism, serum FT3 and FT4 levels showed significant negative correlation with DC, SDNN, SDANN, RMSSD, LF, and HF and significant positive correlation with AC and HR (P < 0.05). Conclusions Children with hyperthyroidism have cardiac autonomic nerve dysfunction manifested as reduced vagal tone. Vagal tone decreases with the increasing serum thyroid hormone levels, suggesting an increased risk of cardiovascular disease.

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Objective To investigate the value of multiparameter flow cytometry (MFC) and flow cytometric scoring system (FCSS) in the diagnosis and prognostic evaluation of childhood myelodysplastic syndrome (MDS). Methods A retrospective analysis was performed for the clinical data of 42 children who were diagnosed with MDS. MFC was performed to investigate the phenotype and proportion of each lineage of bone marrow cells. The correlations of FCSS score with MDS type, International Prognostic Scoring System (IPSS) score, and revised IPSS (IPSS-R) score were analyzed. Results Of all the 42 children, 20 (48%) had an increase in abnormal marrow blasts, 19 (45%) had a lymphoid/myeloid ratio of > 1, 14 (33%) had abnormal cross-lineage expression of lymphoid antigens in myeloid cells, 8 (19%) had abnormal CD13/CD16 differentiation antigens, 5 (12%) had abnormal expression of CD56, 3 (7%) had reduced or increased side scatter of granulocytes, 3 (7%) had reduced expression of CD36 in nucleated red blood cells, 2 (5%) had reduced expression of CD71 in nucleated red blood cells, 1 (2%) had absent expression of CD33 in myeloid cells, 1 (2%) had reduced or absent expression of CD11b in granulocytes, and 1 (2%) had absent expression of CD56 and CD14 in monocytes. There were significant differences in the median overall survival time and event-free survival time among the low-, medium-, and high-risk FCSS groups (P < 0.05). Among the low-, medium-, and high-risk FCSS groups,the low-risk FCSS group had the highest 2-year overall survival rate, while there was no significant difference between the medium-and high-risk FCSS groups (P > 0.05). The three groups had a 2-year event-free survival rate of 95%, 60%, and 46% respectively (P < 0.05). FCSS score was positively correlated with MDS type, IPSS score, and IPSS-R score (P < 0.05). Conclusions MFC and FCSS help with the diagnosis and prognostic evaluation of childhood MDS.

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Objective To study the changes in C-reactive protein (CRP) and procalcitonin (PCT) levels in neonates with necrotizing enterocolitis (NEC) and their clinical significance. Methods According to the modified Bell's staging criteria, 142 neonates with NEC were divided into stage I group (n=40), stage Ⅱ group (n=72), and stage Ⅲ group (n=30). All the 18 neonates who underwent surgical treatment had stage Ⅲ NEC, and among the 124 neonates who underwent conservative treatment, 12 had stage Ⅲ NEC and the others had stage I or Ⅱ NEC. CRP and PCT were measured before treatment, on the next day after treatment, and during the recovery stage. Results Before treatment, on the next day after treatment, and during the recovery stage, the stage Ⅲ group had a higher level of CRP than the stage I and stage Ⅱ groups (P < 0.05). On the next day after treatment, the stage Ⅱ and stage Ⅲ groups had an increase in CRP (P < 0.05), and the stage Ⅲ group had an increase in PCT (P < 0.05). The stage Ⅱ and stage Ⅲ groups had lower CRP and PCT in the recovery stage than before treatment and on the next day after treatment (P < 0.05). The stage Ⅲ group had higher incidence rate of respiratory failure and rate of mechanical ventilation than the stage I and stage Ⅱ groups (P < 0.05), and the stage Ⅲ group had a higher incidence rate of sepsis than the stage Ⅱ group (P=0.010). Gastrointestinal perforation and intestinal stenosis were observed in 10 and 8 neonates respectively in the stage Ⅲ group. CRP on the next day after treatment had a value in predicting stage Ⅲ NEC (P < 0.05), and CRP before treatment and on the next day after treatment had a value in predicting the need for surgery (P < 0.05). Conclusions Levels of CRP and PCT and their changes can help with the early diagnosis of Bell stage Ⅱ/Ⅲ NEC, and CRP can be used to predict the development of stage Ⅲ NEC and the need for surgery.

Abstract:Objective To study the expression and significance of endothelial microparticles (EMPs) in children with Henoch-Schönlein purpura (HSP). Methods A total of 100 previously untreated children with HSP were classified to Henoch-Schönlein purpura nephritis (HSPN) group (n=40) and non-nephritis group (n=60). Thirty healthy children who underwent physical examination were enrolled as control group. Serum levels of EMPs, T helper 17 cells (Th17), and interleukin-17 (IL-17) were compared between groups. Results The HSPN and non-nephritis groups had significantly higher levels of Th17 and IL-17 than the control group, and the HSPN group had the highest levels (P < 0.05). The HSPN and non-nephritis groups had a significantly higher level of EMPs than the control group, and the HSPN group had the highest level (P < 0.05). In the HSPN group, the levels of Th17 and IL-17 were positively correlated with the level of EMPs (r=0.830 and 0.644 respectively; P < 0.05). Conclusions EMPs play an important role in the pathogenesis of HSP. The increase in EMPs might be one of the reasons for renal involvement in children with HSP.

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Objective To study the applicability of Multi-Test Ⅱ prick device in the skin prick test (SPT) for allergens in children. Methods A total of 87 children with allergic diseases who attended the hospital between March and September, 2017 were enrolled as subjects. The SPT for six inhaled allergens and serum specific IgE (sIgE) measurement were performed for all children. SPT was performed with a single-headed device on the left forearm and Multi-Test Ⅱ prick device on the right forearm. ELISA was used to measure the serum level of sIgE. Visual Analog Scale (VAS) was used to assess the degree of pain during SPT. The three Methods were compared in terms of the detection rates of six allergens, and the sensitivity and specificity of Multi-Test Ⅱ prick device were analyzed. Results There were no significant differences in the detection rates of six allergens among the Multi-Test Ⅱ method, the single-headed method, and ELISA (P > 0.05). Compared with the single-headed method, the Multi-Test Ⅱ method had a sensitivity of 72.7% and a specificity of 78.2%. Compared with ELISA, the Multi-Test Ⅱ method had a sensitivity of 73.4% and a specificity of 77.5%. The Multi-Test Ⅱ method had a significantly lower degree of pain than the single-headed method (P < 0.05). Conclusions The Multi-Test Ⅱ method has high sensitivity and specificity and is easily accepted by children, but the test Results should be combined with children's medical history and serum level of sIgE when necessary.

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Objective To investigate the effects of end time of night feeding on body height, body weight, nutritional status, and prevalence rate of dental caries in children at the age of 30 months. Methods A total of 416 children who were born from January 2014 to September 2015 and had completed a physical examination as required were enrolled. During the physical examination performed at the age of 30 months, the comprehensive child care record and a self-made questionnaire were used. The children who continued to receive night feeding after the age of 6 months were enrolled as study group (n=269), and those for whom night feeding was ended at the age of 6 months were enrolled as control group (n=147). The two groups were compared in terms of body height, body weight, incidence rate of overweight/obesity, and prevalence rate of dental caries at the age of 30 months. Results Compared with the control group, the study group had a significantly lower body height (92.4±3.0 cm vs 93.3±2.8 cm; P < 0.05), a significantly higher incidence rate of overweight/obesity (23.8% vs 12.2%; P < 0.05), and a significantly higher prevalence rate of dental caries (14.9% vs 7.5%; P < 0.05) at the age of 30 months. Conclusions Night feeding continued after the age of 6 months can affect the growth and development of infants/toddlers, cause overnutrition, and increase the prevalence rate of dental caries.

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A boy aged 14 years had abdominal pain as the major manifestation, with elevated serum amylase and lipase. Abdominal ultrasound performed early after onset in another hospital showed enlargement of the pancreas and a reduction in echo. Magnetic resonance cholangiopancreatography (MRCP) showed pancreatic duct dilation and an unclear image of the head of the pancreas. Acute pancreatitis was considered. However, his symptoms were not relieved after fasting, fluid infusion, anti-acid therapy, and somatostatin therapy. Then, abdominal CT scan and MRCP found multiple low-density lesions of the pancreas and enlargement of the hilar and retroperitoneal lymph nodes. Exploratory laparotomy found pancreatic edema and multiple hilar nodules with unclear boundaries, and pathological biopsy showed anaplastic large-cell lymphoma. Since the liver, the spleen, bone marrow, and the central nervous system were not involved, he was diagnosed with stage Ⅲ primary pancreatic lymphoma. After vindesine and dexamethasone were used to reduce tumor load, the patient underwent vindesine-pirarubicin-asparaginase-dexamethasone chemotherapy once and vinorelbine-dexamethasone chemotherapy 8 times. Imaging examination still showed multiple low-density lesions of the pancreas and retroperitoneal lymph node enlargement. His parents discontinued treatment. It is concluded that the rare causes of acute pancreatitis with poor response to conventional treatment should be considered, especially for patients with abdominal lymph node enlargement. Extranodal lymphoma should be considered, and lymph node biopsy should be performed as early as possible to confirm diagnosis. The prognosis of pancreatic lymphoma is associated with clinical stage and pathology.

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Objective To investigate the ideal animal models for attention deficit hyperactivity disorder (ADHD) subtypes and the effect of glucocorticoid receptor (GR) function on the behavior of ADHD rats by comparing behavioral differences between spontaneously hypertensive rats (SHRs), Wistar Kyoto (WKY) rats, and Sprague-Dawley (SD) rats. Methods A total of 24 male SHRs aged 21 days were randomly divided into GR agonist group, GR inhibitor group, and SHR group, with 8 rats in each group. Eight male WKY rats and 8 male SD rats, also aged 21 days, were enrolled as WKY group and SD group respectively. The GR agonist group was treated with intraperitoneal injection of dexamethasone (0.5 mg/kg daily); the GR inhibitor group was treated with intraperitoneal injection of mifepristone (RU486)(54 mg/kg daily); the SHR, WKY, and SD groups were treated with intraperitoneal injection of normal saline (0.5 mL/kg daily). The course of treatment was 14 days for all groups. The open field test and Lat maze test were used to evaluate spontaneous activity and non-selective attention. Results The open field test showed that before drug intervention the SHR group had significantly higher numbers of line crossings and rearings than the WKY and SD groups (P < 0.05); the WKY group had a significantly higher number of line crossings than the SD group (P < 0.05); the SD group had a significantly higher number of groomings than the WKY group (P < 0.05). After drug intervention, the GR agonist group had significantly lower numbers of line crossings and groomings than the SHR group (P < 0.05). The Lat maze test indicated that before drug intervention the SHR group had significantly higher numbers of corner crossings and rearings than the WKY and SD groups (P < 0.05); the WKY group had significantly higher numbers of rearings and leanings than the SD group (P < 0.05). After drug intervention, the GR agonist group had significantly lower numbers of corner crossings and rearings than the SHR group (P < 0.05); the GR inhibitor group had a significantly higher number of rearings than the SHR group (P < 0.05); the WKY group had significantly higher numbers of rearings and leanings than the SD group (P < 0.05). Conclusions SHR is an ideal animal model for mixed subtype ADHD, and further studies are needed to determine whether WKY rats can be used as an animal model for attention-deficit subtype ADHD. GR agonist can effectively improve spontaneous activity and non-selective attention in SHRs.

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Abstract:White matter injury in preterm infants has a complex etiology and can lead to long-term neurocognitive and behavioral deficits, but there are still no specific treatment Methods for this disease at present. More and more studies have shown that mitochondrial dysfunction plays an important role in the pathogenesis of white matter injury in preterm infants and might be a common subcellular mechanism of white matter developmental disorder, which involves oxidative stress, reduced ATP synthesis, and disequilibrium of calcium homeostasis. This article reviews the role of mitochondria in brain development and the mechanism of mitochondrial dysfunction, with a hope to perform early intervention of white matter injury in preterm infants by protecting mitochondrial function, so as to provide a reference for improving the neurodevelopmental outcome of preterm infants who survive.

Abstract:Human cytomegalovirus (HCMV) has a high infection rate worldwide, and 85%-90% of congenital cytomegalovirus (CMV) infections are asymptomatic at birth, with the clinical manifestations of hearing loss, psychomotor retardation, and learning disabilities, while 10%-15% are symptomatic infections. Some preterm infants develop CMV infection after birth, which can cause sepsis-like syndrome, thrombocytopenia, neutropenia, liver injury, and lung injury. However at present, women of childbearing age have a lack of awareness of CMV. CMV education and hygiene precautions for pregnant women can prevent CMV infections in themselves and congenital CMV infections in their infants. No definite Results have been obtained from the studies on the effect of CMV vaccine and high-titer immunoglobulin in preventing congenital CMV infection in fetuses. Recent studies have confirmed that the specificity and sensitivity of urinary or salivary CMV-DNA detection have reached more than 98%, which contributes to the early diagnosis of congenital CMV infection. In addition to short-term treatment with ganciclovir, long-term treatment with oral valganciclovir is safe for symptomatic congenital CMV infection and appears to have a better clinical effect than the short-term treatment. In the future, it is necessary to strengthen the health education for pregnant women, enhance the mother-to-child management of CMV infection, conduct the research on CMV vaccine, and further standardize treatment regimens.

Abstract:Antibiotics are commonly used in the neonatal intensive care unit (NICU), but unnecessary or long-time exposure to antibiotics early after birth can increase the risk of poor prognosis of neonates. Antibiotic treatment in the NICU often begins with empiric therapy, but no uniform standards have been established for the initiation and course of empiric therapy. In neonates with negative bacterial culture Results and stable clinical manifestations, empiric antibiotic therapy should be terminated in a timely manner. There are significant differences in the use of antibiotics in different NICUs. A targeted antimicrobial stewardship program is an effective way for optimizing the use of antibiotics in the NICU.