Based on the particularity of children and the adjustment of birth policy in recent years, the development of pediatrician team is becoming more and more important. However, most of the current studies on the shortage of pediatricians are qualitative, lacking of quantitative researches.

To establish a multi-perspective demand forecasting model, comprehensively analyze the shortage of pediatricians in Jiangsu, and provide reference for promoting the development of children's health during the "14th Five-Year Plan" period in Jiangsu Province and accelerating the construction of pediatrician team in the new era.

According to the relevant indicators of pediatric medical services in Jiangsu Province in 2018 obtained from "2018 Jiangsu Provincial Health Service Survey and Analysis Report", and the basic data of pediatrics in each city of Jiangsu Province was obtained from "2019 Jiangsu Provincial Statistical Yearbook" and the database of the Jiangsu Provincial Health Statistics Information Center. Using SPSS 24.0 analysis software, a multi-perspective demand forecasting model was developed from the perspectives of supply and demand, and a comprehensive analysis of the number of pediatrician shortage in Jiangsu Province was performed.

The proportion of female physicians in the pediatrician team in Jiangsu is relatively high. The young and middle pediatricians occupy a leading position. The academic backgrounds of the pediatricians are mainly undergraduate. The professional title structure is much reasonable. Most of pediatricians have been working for over 20 years. Combined with the basic situation of the pediatrician team in Jiangsu and the perspective of supply and demand, the shortage number of pediatricians in Jiangsu Province was 18 300 and the average shortage number of physicians in 13 cities was 1 500.

There is an overdemand of resources for pediatric care and a high workload for physicians with an imbalance in the gender and title structure of the workforce; the special practice environment leads to increased practice risk. It is necessary to strengthen the personnel training and introduction policies, consolidate the professional foundation of personnel, and explore a new management model of "Internet + medical consortium".

Food intake disorders are costly to treat, with an increasing prevalence over the years, and a higher risk of mortality compared to other psychiatric disorders. Avoidant/restrictive food intake disorder (ARFID) , as a relatively new type of food intake disorder, is more prevalent in children and adolescents than in other age groups, affecting their normal growth and development, as well as psychosocial functioning. Currently, there are more foreign studies, while domestic studies are still in the initial stage. Therefore, this paper reviews assessment tools, influencing factors and treatment approaches for ARFID in children and adolescents, with the aim of providing a reference for related research in China.

Dilated cardiomyopathy (DCM) is a common cause of sudden cardiac death and heart failure in children, its different etiologies are significantly associated with the prognosis of children with DCM. However, there is a lack of accurate etiologic diagnosis and effective risk stratification programs. Primary DCM has the highest prevalence and relatively poor prognosis, especially in children with genetic factors. Therefore, the analysis of mortality risk factors based on genetic background would be beneficial for the accurate prognosis and risk stratification of children with DCM.

To explore the proportion of genetic etiology, genetic characteristics and factors related to poor prognosis of primary DCM in children.

The clinical data and genetic testing results of 42 children with primary DCM who were hospitalized in Hebei Children's Hospital from July 2018 to December 2022 and completed genetic testing were retrospectively collected, and the included children were regularly followed up in the cardiology outpatient department of Hebei Children's Hospital after discharge. With the time of death or 2022-12-31 as the end point of follow-up, the children were divided into the death group (9 cases) and survival group (33 cases) according to the follow-up outcomes. Survival curves of the children were plotted using the Kaplan-Meier method, and comparisons between groups were performed using the Log-rank test. Multivariate COX proportional risk model was used to analyze the risk factors for death.

The median age of first diagnosis was 12 (7, 96) months, and the median follow-up time was 24 (9, 36) months. The median follow-up time was 8 (0, 11) months in the death group and 30 (12, 39) months in the survival group, the difference was statistically significant (Z=-2.19, P<0.05) . The proportion of male, heart function grade Ⅲ/Ⅳ and gene mutation positive in the death group was higher than that in the survival group, and the left ventricular short axis shortening rate (LVFS) was lower than that in the survival group (P<0.05) . The positive rate of gene mutation was 38.1% (16/42) , of which 25.0% (4/16) were spontaneous mutations and 61.9% (26/42) were negative mutations. All the 9 children in the death group died within 1 year after diagnosis, including 8 patients with positive gene mutation (50.0%, 8/16) and 1 patient with negative gene mutation (3.8%, 1/26) , with statistically significant differences between the two groups (P<0.05) . The heterozygous variation of CSRP3 (c.190C>T) in the dead children with negative gene mutation was classified as unclear clinical significance. The Kaplan-Meier survival curve of the children was plotted, and the Log-rank test results showed that the survival rate of children with negative gene mutation was higher than that of children with positive gene mutation (χ²=18.1, P<0.001) . Multivariate COX proportional risk model analysis showed that gene mutation [HR=23.91, 95%CI= (1.80-317.21) , P=0.016] and cardiac function grade Ⅲ/Ⅳ [HR=11.29, 95%CI (1.13-112.68) , P=0.039] were risk factors for death in children with DCM.

In this study, 38.1% of children with primary DCM were associated with genetic etiology. The first year after diagnosis is the high incidence of death of children with DCM, and the prognosis of children with positive gene mutation is worse. The presence of pathogenic gene mutation and the cardiac function grade of Ⅲ~Ⅳ at the first diagnosis are independent risk factors for death in children.

Regular physical activity is a cornerstone of diabetes management, and more precise guidance on exercise prescriptions is needed in children and adolescents with diabetes due to the complexity of glycemic changes, however, there are relatively few guidelines for this population. As the continuous exploration of experts and scholars in this field, after five years, the International Society for Pediatric and Adolescent Diabetes (ISPAD) updated its guidelines on exercise for children and adolescents with diabetes in 2022. The guidelines target the service population more precisely to the children and adolescents with type 1 diabetes and provide comprehensive guidance from the perspectives of exercise types, exercise timing, blood glucose fluctuations during exercise, insulin adjustment and nutritional supplementation. This article interprets the main contents and key updates of the 2022 ISPAD guidelines, aiming to provide more scientific exercise prescriptions for children and adolescents with diabetes in China.

Aspartate aminotransferase (AST) /alanine aminotransferase (ALT) is a novel indicator to evaluate the prognosis of acute critical illness in recent years. At present, AST/ALT has only been reported to evaluate the prognosis of hemophagocytic lymphohistiocytosis (HLH) in adults, while HLH in children has not been studied.

To explore the relationship between AST/ALT and clinical characteristics and its prognostic significance in children with HLH, so as to provide a theoretical basis for early clinical recognition and diagnosis of HLH in children.

A total of 128 hospitalized children diagnosed with HLH in the Affiliated Hospital of Zunyi Medical University from January 2013 to May 2022 were selected as the research objects, and the baseline data of children were collected through the electronic medical record system. The children were divided into the T1 group (AST/ALT≤1.57, n=43), T2 group (1.57<AST/ALT<3.22, n=42), and T3 group (AST/ALT≥3.22, n=43) according to the AST/ALT quantiles, and followed up by outpatient review and telephone follow-up once every 6 months from the time of discharge to 2022-06-01, with the termination event of death or loss of follow-up. Spearman rank correlation analysis was used to explore the correlation between AST/ALT and laboratory test results. The receiver operating characteristic (ROC) curve of laboratory indicators for predicting death in children with HLHwas plotted, the area under ROC curve (AUC) and optimal cut-off value were calculated. Kaplan-Meier method was used to plot survival curves to analyze the effect of different AST/ALT groupings on overall survival, and Log-rank test was used for comparison. Cox proportional risk model was used to explore the influencing factors of death in children with HLH.

There were statistically significant differences in gender, PICU admission, treatment methods, incidence of respiratory failure and shock among the 3 groups (P<0.05). Lactate dehydrogenase, creatine kinase isoenzyme, serum ferritin and activated partial thromboplastin time in the T3 group were higher than those in the T1 and T2 groups, while the levels of albumin and fibrinogen in the T3 group were lower than those in the T1 and T2 groups (P<0.05). Na⁺ level in the T2 and T3 groups was lower than that in the T1 group, while C-reactive protein level was higher than that in the T1 group (P<0.05). Correlation analysis showed that AST/ALT was positively correlated with absolute neutrophil count (r_s=0.182, P=0.040), C-reactive protein (r_s=0.419, P<0.001), total bilirubin (r_s=0.182, P=0.040), creatine kinase isoenzyme (r_s=0.310, P<0.001), lactate dehydrogenase (r_s=0.474, P<0.001), activated partial thromboplastin time (r_s=0.316, P<0.001), serum ferritin (r_s=0.311, P<0.001), and negatively correlated with albumin (r_s=-0.352, P<0.001), fibrinogen (r_s=-0.179, P=0.043), Ca²⁺ (r_s=-0.259, P=0.003), Na⁺ (r_s=-0.244, P=0.006). ROC curve results showed that the AUCs of C-reactive protein, lactate dehydrogenase, activated partial thromboplastin time, serum ferritin and fibrinogen were 0.560〔95%CI (0.451, 0.669) 〕, 0.666〔95%CI (0.560, 0.772) 〕, 0.605〔95%CI (0.499, 0.710) 〕, 0.724〔95%CI (0.626, 0.822) 〕, 0.648〔95%CI (0.551, 0.745) 〕 and 0.715〔95%CI (0.624, 0.807) 〕, respectively, with the optimal cutoff values of 82.08 mg/L, 40.5 U/L, 927.5 U/L, 53.95 s, 1 897 μg/L, and 1.45 g/L, respectively. The mortality rate in the T1, T2 and T3 groups was 14.0% (6/43), 33.3% (14/42) and 44.2% (19/43), respectively, with statistically significant differences (χ²=9.518, P=0.009). Multivariate Cox proportional hazard regression analysis showed that shock〔HR=4.24, 95%CI (2.09, 8.61), P<0.001〕, activated partial thromboplastin time ≥53.95 s〔HR=2.44, 95%CI (1.24, 4.81), P=0.010〕and serum ferritin ≥1 897 μg/L〔HR=3.05, 95%CI (1.02, 9.09), P=0.046〕were the risk factors for death in children.

HLH patients in children with higher AST/ALT have higher incidence of poor prognosis, shorter overall survival, and worse prognosis.

Myopia is a major risk factor for vision health in children, it is important for the prevention and control of occurrence and development of myopia in children to standardize the screening of myopia and achieve early detection and intervention of myopia. At present, myopia screening, the establishment, management and application of refractive development profile in China are still in the initial stage. In particular, the follow-up measures after refractive development profile establishment still face many problems and challenges. In this paper, the role of primary care in myopia prevention and control behavioral intervention among Children was analyzed in depth according to the current status and characteristics of myopia screening and after refractive development profile establishment, combining with the requirements of hierarchical diagnosis and treatment, in order to provide recommendations on myopia screening, refractive development profile establishment and community behavioral interventions in China, balance medical resources for its development in a regulated, healthy and sustainable manner.

Unintentional injuries are major threats to children's health, but most of them are preventable. Since the incidence and characteristics of distribution of unintentional injuries vary across regions, it is necessary to formulate preventive measures according to local characteristics.

To investigate the clinical characteristics of unintentional injuries in children in Ningbo, providing a theoretical basis for the development of relevant preventive and treatment measures.

This study retrospectively recruited 0-17-year-old children with unintentional injuries (including babies, toddlers, preschoolers, gradeschoolers and teens grouped by age) from Department of Emergency, Ningbo Women and Children's Hospital from August 2020 to July 2021. Clinical data were collected, including age, gender, registered residence, the way of getting to the hospital and pre-hospital emergency care, visit time, injury-to-admission time, places of occurrence of injury, cause of injury, site of injury, outcome of treatment, hospitalization time and hospitalization expenses. ICD-10 was used to classify the unintentional injuries, the children were divided into infancy (n=1 225), early childhood (n=5 116), preschool (n=4 447), school age (n=3 219) and adolescence (n=1 766) according to their age, and compared the types of unintentional injuries across the children by clinical data.

Altogether, 15 773 cases〔including 9 608 males (60.91%) 〕were included, with a mean age of (5.3±3.6) years and a male to female ratio of 1.56∶1. Children with fall/fall injuries, burns and scald, cavity foreign body, poisoning, blunt instrument injury and electric shock injuries are mainly early childhood, road traffic injuries are mainly preschool age, and sharp instrument injuries are mainly school age. Most of the children were from rural areas〔59.15% (9 329/15 773) 〕. Children with rural household registration were mainly affected by falls/fall injuries, road traffic accidents, burns, foreign body aspiration, sharp instrument injuries, electric shocks and drowning. Children who suffered from falls, road traffic accidents and drowning mainly arrived at the hospital by self-driving. Children with fall/fall injuries, road traffic injuries, burns, poisoning, sharp device injuries, electric shock injuries and drowning are mainly treated without pre-hospital emergency rescue. Unintentional injuries occurred more frequently in summer〔27.27% (4 301/15 773) 〕. Road traffic injuries and burns are mainly in summer, blunt instrument injuries and electric injuries are mainly in autumn, and bites are mainly in spring and autumn. Unintentional injuries peaked in July and bottomed in February. Visits due to unintentional injuries peaked at 12:00 at noon and 20:00 in the evening. The injury-to-admission time in children with traffic injuries was shorter than that of those with the other injuries (P<0.05). The majority of injuries〔91.27% (14 396/15 773) 〕occurred at home. The top three causes of unintentional injuries were falls〔78.46% (12 375/15 773) 〕, traffics accidents〔5.29% (12 375/15 773) 〕, and burns〔3.70% (583/15 773) 〕. Most unintentional injuries occurred in the head 〔31.79% (5 015/15 773) 〕. Infant, preschool and school-age children mainly have head injuries, and preschool and adolescent children mainly have both upper limbs. Children with drowning had higher hospitalization rate, longer hospitalization time and higher hospitalization expenses than those with other types of unintentional injuries (P<0.05) .

Among Ningbo's children, unintentional injuries, mainly including falls/fall injuries and traffic injuries, highly occur in toddler age, with rural boys as the major suffering group, summer as the high-incidence season, and head as the major site. Different characteristics of children are associated with the type of unintentional injuries. And the type of unintentional injuries is associated with the way of getting to the hospital, injury-to-admission time, the use of pre-hospital emergency care and outcome of hospitalization. Thus, it is important to strengthen the preventive propaganda of unintentional injuries according to children's features to reduce the incidence of such injuries, and to develop rational clinical treatment strategies according to the types of unintentional injuries in children.

The difficulty of getting pediatric services still exists in China. It is a general trend that community health centers (CHCs) provide pediatric services. There are rare studies on the spectrum of pediatric illnesses in CHCs.

To understand the current status of pediatric diagnosis and treatment in Shenzhen's CHCs by analyzing the spectrum of pediatric illnesses treated in clinics, and to analyze the gap between actual practical status with the training contents based on Spectrum of Diseases for Resident Rotation in Pediatric Medicine (hereinafter referred to as Pediatric Training Rules) specified in General Residency Training Rules in the Standardized Training Contents and Standards for Residents (2022 Edition) .

Through checking the outpatient medical records in CHCs in Shenzhen's 10 districts during April to September 2021, pediatric care expenditure data of children〔including babies (<1 year old), toddlers (1-3 years old), preschoolers (4-6 years old), gradeschoolers (7-12 years old) and teens (13-18 years old) stratified by age〕 contracting family doctor services were collected. The actual spectrum of diseases and diagnosis and treatment behaviors were analyzed, and compared with the Pediatric Training Rules to assess the practical application of the contents required to be mastered in the Pediatric Training Rules.

A total of 961 605 children were included, among whom preschoolers accounted for the highest percentage (38.22%, 367 486/961 605), followed by gradeschoolers (27.57%, 265 151/961 605), toddlers (21.90%, 210 621/961 605), teens (8.49%, 81 594/961 605), and babies (3.82%, 36 753/961 605). The top five diseases in the spectrum and diagnosis and treatment behaviors were respiratory diseases, calcium and vitamin supplements, pediatric physical examination and health care, trauma and postoperative dressing change, and skin diseases, accounting for 67.92% of the total diagnostic and therapeutic workload. Younger age was associated with increased concentrated diagnosis and treatment behaviors. Physical examination and health care (27.60%, 10 142/36 753), calcium and vitamin supplements (25.48%, 9 364/36 753) were the main diagnosis and treatment behaviors in babies. Five diseases in the spectrum and diagnosis and treatment behaviors accounting for ≥80% of the total diagnostic and therapeutic workload in babies, while in teens, 13 diseases in the spectrum and diagnosis and treatment behaviors accounting for ≥80% of the total diagnostic and therapeutic workload. Except for babies, respiratory diseases were the primary reason for seeking treatment in children of other age groups. The proportion of workload of trauma treatment and postoperative dressing change was the highest in teens. Except neonatal asphyxia, neonatal pneumonia, poliomyelitis, infantile tetany and viral myocarditis, the pediatric diseases encountered in these CHCs were covered by the disease spectrum required to be mastered in the Pediatric Training Rules, and the top five healthcare & treatments were respiratory disease treatment〔333 172 (34.65%) 〕, pediatric physical examination and health care〔70 703 (7.35%) 〕, acute infectious diseases treatment〔20 893 (2.17%) 〕, infantile diarrhea〔13 622 (1.42%) 〕, and pediatric abdominal pain〔12 526 (1.30%) 〕. The amount of diagnosis and treatment workload for pediatric anemia, pediatric leukemia, rickets, infantile diabetes, malnutrition, neonatal jaundice, nephritis and nephrotic syndrome, infantile epilepsy, simple obesity, and infantile convulsion accounted for less than 1.00% of the total amount, among which pediatric anemia, pediatric leukemia, neonatal jaundice, nephritis and nephrotic syndrome, infantile epilepsy and simple obesity were mainly transferred for treatment or prescribed a laboratory test.

In general, the CHCs provide a large number of pediatric diagnosis and treatment services, but the services for younger children are still insufficient. Pediatric Training Rules focus on internal diseases, and relevant trainings have some differences with the actual diagnosis and treatment services. The treatments for some diseases in the spectrum in the rules are too specialized, and the diseases are less frequently encountered in community settings, and such patients mainly are transferred for treatment or examined using a laboratory test. Therefore, the pediatric rotation in standardized general residency training should be planned as a whole since the disease spectrum includes many diseases rather than only internal diseases, and actions should be made to expand the training content, improve outpatient teaching, and strengthen the training for physicians to improve their abilities in diagnosis and treatment of young children.

Promoting hierarchical treatment is the key to solve the irrational utilization of pediatric medical resources, but there is a lack of relevant studies on the current status of implementation of hierarchical diagnosis and treatment for children.

To describe the healthcare-seeking behavior of children with upper respiratory tract infection, including number of visits and health-seeking institutions and explore the main influencing factors of first visit of priamry care (community health services) .

Two questionnaires were administered to the parents of children attending the pediatric outpatient department of the Third Affiliated Hospital of Sun Yat-sen University and the Community Health Service Center in Shipai Street, Tianhe District in the same administrative district from March to July in 2019 and from February to July in 2022 using convenience sampling method, respectively. The included subjects were divided into the 2019 group (n=419) and 2022 group (n=307) according to the survey time. The questionnaire on the healthcare-seeking behavior and its influencing factors of children with upper respiratory tract infection using Anderson model as a theoretical guide was involved, univariate and multivariate Logistic regression analyses were used to explore the influencing factors of the first visit of children with upper respiratory tract infection in primary care.

Among the 419 participated children in 2019, 301 (71.84%) visited for the first time, 87 (20.76%) for the second time and 31 (7.40%) for the third time and fourth time, with 47.49%, 27.12% and 16.13% visited the conmmunity health services centers, respectively. Among the 307 participated children in 2022, 219 (71.34%) visited for the first time, 72 (23.45%) for the second time and 16 (5.21%) for the third time or fourth time, with 41.04%, 39.77% and 43.75% visited the conmmunity health services centers, respectively. The results of multivariate Logistic regression analysis showed that the nearest medical institution was not a community health service center〔OR=0.220, 95%CI (0.147, 1.056), P<0.001〕, the education level of parents was high school or below〔OR=0.584, 95%CI (0.365, 0.936), P=0.025〕, parental assessment of disease severity was less severe and general〔OR (95%CI) =0.399 (0.207, 0.768), 0.388 (0.226, 0.665); P=0.006, 0.001〕, children aged under 3 years old〔OR=0.537, 95%CI (0.309, 0.930), P=0.027〕were correlated with less likely to choose community health service center for their first visit compared with the nearest medical institution was a community health service center, the education level of parents was bachelor's degree and above, parental assessment of disease severity was severe and very severe, children aged 7-13 years old. Parents were more awareness〔OR=2.139, 95%CI (1.284, 3.564), P=0.003〕 and in favor of hierarchical medical system〔OR=2.841, 95%CI (1.937, 5.779), P=0.004〕 were more likely to choose a community health service center for their first visit.

Multiple visits are more common in children with upper respiratory tract infection, the proportion of primary care visits is low. The education level of parents, awareness and and attitudes of hierarchical medical system, assessment of disease severity, the age of children and the nearest medical institution are influencing factors for children with upper respiratory tact infection to choose primary care for their first visit. Strengthening the publicity and education of common disease in children and hierarchical medical system, improving the accessibility of community health service centers and pediatric care conditions would be possible approaches to promote primary care for common children diseases.

Bronchial asthma (BA) and obstructive sleep apnea-hypopnea syndrome (OSAHS) are two major chronic diseases affecting the health of children. OSAHS may aggravate BA, adding to the difficulties in BA control, and BA can lead to the occurrence or progression of OSAHS through various mechanisms, such a relationship between them has attracted increasing attention.

To explore the clinical features and influencing factors of children with BA complicated with OSAHS.

One hundred and nine children with BA who were admitted to Children's Asthma Center, Gansu Provincial Maternity and Child Health Care Hospital from September 2021 to August 2022 were selected, including 49 with OSAHS (BA with OSAHS group) and 60 without (simple BA group). The general clinical data, pulmonary function test results, and serum levels of inflammatory cytokines, 25-hydroxyvitamin D 〔25 (OH) D〕 and C-reactive protein (CRP) were collected. The clinical features were analyzed, and factors associated with OSAHS in BA were analyzed by multivariate Logistic regression.

Multivariate Logistic regression analysis showed that obesity〔OR=4.803, 95%CI (1.011, 2.822) 〕, enlarged neck circumference〔OR=1.318, 95%CI (1.003, 1.732) 〕 and gastroesophageal reflux disease (GERD) 〔OR=7.756, 95%CI (1.398, 43.045) 〕 were independent risk factors for OSAHS in BA children (P<0.05), while elevated 25- (OH) D〔OR=0.830, 95%CI (0.757, 0.910) 〕 was a protective factor for OSAHS in BA children (P<0.05) .

The values of pulmonary function indices of children with BA complicated with OSAHS were lower than those of children with simple BA. Obesity, enlarged neck circumference, GERD and 25- (OH) D level were the influencing factors of OSAHS in BA children.

The prevalence of anti-myelin oligodendrocyte glycoprotein (MOG) -IgG associated disorders (MOGAD) is significantly higher in children than that in adults. The characteristics and associations of phenotypes and recurrence risk in children are still unclear.

To examine the phenotypic features and recurrence factors of MOG-IgG positivity in central nervous system inflammatory demyelinating diseases in children.

A follow-up study on 54 children with MOGAD diagnosed in Children's Hospital of Hebei Province from December 2017 to December 2021 was performed. Phenotypic features at each demyelinating attack, laboratory tests, imaging characteristics, MOG-IgG titers in serum/cerebrospinal fluid (CSF), efficacy, and high risk factors for recurrence were analyzed. The MOG-IgG was tested using cell-based immunofluorescence assay. All patients were followed up until March 31, 2022.

In our study, the median age of onset was 6.0 (4.0, 8.0) years and the male to female ratio was 1∶1.07. Serum MOG-IgG titers were 1∶10-1∶320. Acute disseminated encephalomyelitis (ADEM) was the most common phenotype (44.4%, 24/54), followed by optic neuritis (ON) (25.9%, 14/54) and non-ADEM-like meninges /encephalitis (20.4%, 11/54). Ten cases (18.5%) were positive for MOG-IgG in serum and CSF, and 2 (3.7%) were positive for both NMDAR-IgG in CSF and MOG-IgG in serum. Brain MRI showed new lesions during the 76.9% (60/78) of the 78 attacks in total, and the most common locations were cortical white matter (66.7%, 40/60) and optic nerve (35.0%, 21/60). Forty patients (74.1%, 40/54) experienced one episode, the main phenotypes were ADEM (57.5%, 23/40) and non-ADEM-like meninges/encephalitis (25.0%, 10/40). Fourteen patients (25.9%, 14/54) had two or more episodes, and the initial phenotype of them was ADEM with ON (57.1%, 8/14) or ON (21.4%, 3/14). Compared with recrudescent cases, non-recrudescent cases had much lower prevalence of ON or ADEM with ON as the primary phenotype (P<0.05). All the children received first-line immunoregulation therapy at the time of the initial attack. Of the 14 relapsed cases, 2 (14.3%) were improved after mycophenolate mofetil treatment, one (7.1%) was better after rituximab treatment, and the other 11 (78.6%) had improved symptoms and imaging manifestations after being treated with methylprednisone pulse therapy combined with gamma globulin again. MOG-IgG titers were not increased in the recurrent children. After treatment, 28 (51.9%) children were completely improved, while 11 (20.4%) children had various neurological sequelae, among which visual dysfunction〔54.5% (6/11) 〕 was the most common.

The clinical phenotypes of MOGAD in children are diverse, among which the common phenotypes are ADEM, ON and non-ADEM-like meninges/encephalitis. Brain damages detected by MRI are extensive. The initial phenotypes of ADEM with ON and ON are prone to relapse. Most children have a good prognosis, but some may be accompanied by neurological after effects.

The trend of prevalence and severity of the overweight problem in young children, reduces the general quality of the future population to a certain extent, inducing a great risk to the sustainable development of health human capital stock in China.

To scientifically understand the spatio-temporal evolutionary patterns and future development trends of overweight rates among children under 5 in China, in order to provide support for controlling overweight in children, improve the efficiency of local governance and support for the implementation of precise interventions.

In April 2022, the 5 km×5 km gridded dataset in 105 middle-and low-income countries provided by the Institute for Health and Evaluation at the University of Washington (IHME) was used as the data source to extract the gridded data of overweight rates among children under 5 in China (excluding Hong Kong Special Administrative Region, Macao Special Administrative Region and Taiwan District) from 2000 to 2019 in this study. The average overweight rate of children under 5 from 2000 to 2019 was calculated pixel-to-pixel, the Theil-Sen estimator, Mann-Kendall test and Hurst index estimation method was used to characterize the spatio-temporal evolutionary patterns and future development trends among children under 5 pixel-to-pixel.

Overweight among children under 5 is more prevalent in most regions of Shandong Province, Hunan Province and local regions of Fujian Province, Guangdong Province, Hainan Province, Beijing Municipality and Tianjin Municipality during the 20-year period from 2000 to 2019, with the average overweight rate of children under 5 in Hunan Province reaching 29.42%. The area of the regions with significant increase in overweight rates among children under 5 accounts for 60.59% of the total area of the regions in the study (excluding regions with missing data) . The area of the central and eastern regions with a significantly increasing trend in the overweight rates among children under 5 accounts for a higher proportion of the total area of central and eastern regions (excluding regions with missing data) than the proportion accounted by the area of the western regions with a significantly increasing trend in the overweight rates among children under 5 of the total area of western regions (excluding regions with missing data) . The area of the regions with no significant change in the evolution trend of overweight rates accounts for 25.33% of the total area of the regions in the study, which is scattered in patches in parts of provinces, such as cities cluster in the middle reaches of the Yangtze River urban agglomeration. The area of the regions with significant change in the evolution trend of overweight rates accounts for 14.08% of the total area of the regions in the study, concentrated in some regions in the Xinjiang Uygur Autonomous Region, Qinghai Province, Sichuan Province and Yunnan Province in the west of China, and local regions of Hebei Province, Liaoning Province and Shandong Province in the east of China. According to the Hurst index, the area of the regions with persistent or trend-enhancing characteristics of the time series of overweight rates of children under 5 accounts for 84.87% of the total area of the regions in the study.

The spatial heterogeneity of overweight rates among children under 5 in China is obvious. There is a synergistic "U"-shaped association between the overweight rates of children under 5 and the overall level of regional development, the association implies a multi-stage, cascading developmental process of "declining stage of stunting" "stabilization stage" "rising stage of overweight with overnutrition". Focusing on social problems derived from the coupling of multidimensional factors of overweight in young children, the results of the study provide scientific support and policy reference for the government to formulate region-specific policies, build a three-level governance network of "government policy regulation - social concept penetration - family health management", and scientifically and precisely solve the overweight problem among children under 5.

Foreign studies suggest that interactive reading is an exploratory intervention for improving the oral language skill of children with autism in their early years. We summarized and analyzed empirical studies on the effects of interactive reading interventions on oral communication skills of preschool children with autism. The results indicate that the interventions have positive impacts on vocabulary development and spontaneous responses in preschool children with autism, but have discrepant effects on their spontaneous initiations. However, due to the small sample size of these studies, the effects of interactive reading interventions on oral communication in preschoolers with autism need to be further studied. It is expected that future research will explore and verify the effects of interactive reading interventions on both spontaneous responses and initiations in large samples of autism preschoolers, and further investigate whether these effects can be maintained and generalized.

Children with asthma may have deficits in executive functioning, affecting the quality of life and mental health of children. However, there are few studies on the relationship between executive function and pulmonary function.

To investigate whether executive dysfunction is comorbid and its specific manifestations and analyze the relationship between executive function and pulmonary function in children with bronchial asthma.

A total of 35 children diagnosed with bronchial asthma in the pediatric outpatient of the Third Affiliated Hospital of Soochow University (the First People's Hospital of Changzhou) from June 2020 to April 2022 were selected as the children with asthma group, and 35 healthy children were included in the pediatric outpatient of the Third Affiliated Hospital of Soochow University (the First People's Hospital of Changzhou) as the healthy control group. The GO/NOGO experiment was used to collect the executive function indexes and detect the pulmonary function. Pearson correlation analysis and Spearman rank correlation analysis were used to explore the relationship between executive function indexes and pulmonary function test indices.

The number of hits in the children with asthma group was lower than that in the healthy control group, and the response time, response time variability and missed reporting errors were higher than those in healthy control group (P<0.05). The results of Pearson correlation analysis /Spearman rank correlation analysis showed that response time was negatively correlated with maximum vital capacity (VCmax) and forced vital capacity (FVC) in children with asthma, and response time variability was negatively correlated with VCmax, FVC and forced expiratory volume in one second (P<0.05). The number of missed reports was positively correlated with percent predicted forced vital capacity (P<0.05) .

Compared with healthy children, children with asthma perform sustained attentional deficits and reaction rate deficits, and the executive function indexes of children with asthma is correlated with pulmonary function test indices, mainly manifested in sustained attention, reaction speed decreased.

Global developmental delay (GDD) is a common neurodevelopmental disorder in childhood whose clinical manifestations are diverse. Currently, there are few large sample analyses of the gender differences of clinical manifestations in GDD children in China.

To investigate the gender differences of clinical data in GDD children.

Seven hundred and ninety-nine GDD children who received initial inpatient treatment from Department of Child Rehabilitation, Third Affiliated Hospital of Zhengzhou University from January 2020 to February 2022 were recruited. Clinical data including maternal data in pregnancy and the perinatal period, and general data, measurement results of EEG, brain MRI, the Chinese version of Gesell Developmental Scales-Revised of the children and comorbidity rate were retrospectively collected. Gender differences of clinical data of GDD children were analyzed.

The ratio of male children (n=568) to female children (n=231) was 2.46∶1. The age of first visit in male children〔19.0 (8.8, 33.0) 〕 was older than that of female children〔12.7 (6.8, 27.0) 〕 (P<0.05). The chief complaint was motor retardation (51.1%, 118/231) in female children, and language retardation (41.4%, 235/568) in male children. There were significant differences in chief complaint, birth season, gestational age at birth, gestational age at birth in relation to birth weight, birth weight classification and fine motor classification between male and female children (P<0.05). Male children had lower rates of fetal intrauterine distress, EEG abnormalities and microcephaly and higher rate of autism spectrum disorder than female children (P<0.05) .

There are gender differences in some clinical data of children with GDD. Male children have higher prevalence of GDD, and females have more clinical symptoms.

At present, almost all the definitions of hypertension in pediatric hypertension guidelines issued by countries and organizations are based on blood pressure percentile of 95% (P₉₅). However, a large number of research data have shown that high normal blood pressure has a higher risk of progression to hypertension and cause similar target organ damage as hypertension. The review summarized the classification methods of blood pressure of children and adolescents in different countries and organizations, the prevalence of hypertension and high normal blood pressure, the rate of progression from high normal blood pressure to hypertension, and target organ damage caused by high normal blood pressure in children and adolescents, emphasizing that pediatricians should pay greater attention to the definition of high normal blood pressure and hypertension for children and adolescents.

The right to health of children has been a general concern of the society. The rate of systematic health management for children is a core indicator effectively reflecting the monitoring and management of children's physical growth and psycho-behavioral development. Most of the studies on systematic health management for children use an empirical design, mainly focusing on explorations of management models, while few have made in-depth analysis of the national status from temporal and geographical perspectives.

To analyze the temporal changes and regional differences in terms of the rate of systematic health management of children under three years old from 2010 to 2019, providing valuable evidence for the consolidation and improvement of the health management level in this group, and for promoting health level in children.

In November 2021, data about health management of children under three years old in China during 2011—2020 were extracted from 10 volumes of China Health Statistics Yearbook published annually from 2011 to 2020. A descriptive analysis was used to conduct temporal and geographical analysis of the systematic health management for children.

As a whole, the national health management rate for children under three years old showed a continuous upward trend increased from 81.5% in 2010 to 91.9% in 2019, with a 12.8% increase. The annual rate of systematic health management of the children during the period was greater than 90.0% in Beijing, Inner Mongolia Autonomous Region, Liaoning Province, Shanghai, Jiangsu Province, Zhejiang Province, Shandong Province, Guangdong Province and Shaanxi Province, but was relatively low in the Tibet Autonomous Region (71.9% in 2019) , indicating that there was still a certain gap between the local level and policy goals in this region. The analysis from temporal changes and regional differences as well as regional perspective revealed the following findings: the rate of systematic health management for children under three years during 2010—2019 was higher than the national level in 13 (41.9%) out of 31 regions in China, lower than the national level in 7 regions (22.6%) , and moved around the national level in 11 regions (35.5%) . The systematic health management rate of children under 3 years old varied greatly between regions during 2010—2012, but the inter-regional differences gradually narrowed after 2015. The rate of systematic health management for children under 3 years old was the highest in northeast China, followed by eastern China, western China and central China. In 2019, there was still large differences in the rate of systematic health management for these children among regions in western China.

China has achieved remarkable results in systematic health management for children under 3 years old. More attention should be given to the regions in western China, especially the Tibet Autonomous Region during the improvement of the management for these children. To further improve and consolidate the health management level of children, it is suggested to make efforts to improve the equity and accessibility of essential medical services, narrow the inter-regional differences between health resource allocation and public health services, learn and apply relevant good management methods from advanced regions, make full use of big data and internet techniques, and strengthen the construction of community pediatric health management team.

There are less studies on sleep disturbance and limited effective screening and assessment scales for sleep disturbance in Chinese preschoolers.

To assess the reliability and validity of the Chinese version of Sleep Disturbance Scale for Children (SDSC-C) in Chinese preschoolers, providing evidence for expanding the application of SDSC in preschoolers.

By use of convenience sampling, preschool children (3-5 years old) were selected as survey participants for testing the psychometrics of the draft of the SDSC-C from one urban community and one rural community in each of five cities (Fuzhou, Quanzhou, Longyan, Sanming and Nanping) of Fujian Province from June to November 2021 with the assistance of the Fujian Family Planning Association Network, and their parents were selected as their agents to complete the questionnaire survey. Then its items were modified, screened and evaluated by an expert group, after that, the draft was developed into a formal version consisting of six domains and 23 items. The reliability and validity of the scale were assessed by item analysis, reliability analysis, validity analysis, exploratory factor analysis, and confirmatory factor analysis.

The survey obtained a response rate of 92.04% (370/402) . The high-score group〔n=106, ranked the top 27% in terms of total score of SDSC-C (≥49 points) 〕and low-score group〔n=113, ranked the bottom 27% in terms of total score of SDSC-C (≤37 points) 〕divided by critical ratio method had significant differences in the score of each item of the SDSC-C (P<0.05) . The Cronbach's α of the scale was 0.86, with 0.87 of estimating interrater agreement. The I-CVI for each item was >0.78, with kappa values were > 0.74. The S-CVI/UA was 0.87 and S-CVI/Ave was 0.98. For SDSC-C , KMO= 0.85, results of Bartlett's test of sphericity were χ²=3 013.30, P<0.001. By principal component analysis, 7 factors with an engivalue >1 were extracted, explaining 65.125% of the total variance. However, a six-factor solution (i.e. six types of sleep disorder) based on parent-reported sleep disorder symptoms in our study indicated the factor loading of items ranged from 0.34-0.85, which could explain 60.539% of the total variance. The confirmatory factor analysis showed the values of fitting indicator as follows: χ²/DF=2.66, CFI=0.84, TLI=0.81, SRMR=0.08, and RMSEA=0.08.

This study revealed that the SDSC-C is a valid and reliable scale that can provide a comprehensive and detailed assessment of sleep disturbances in Chinese preschool children, which is beneficial to clinicians for early screening and assessment of sleep-related problems in preschool children.

It is hard to make an early and accurate diagnosis of developmental delay (DD) /mental retardation (MR) in children due to complex etiology, diverse and heterogeneous clinical manifestations of the disease. There are few large-sample analyses of the clinical and genetic test data of these children in China.

To perform an analysis of genetic test results of children with DD/MR, providing evidence for genetic diagnosis, treatment plan formulation and prognosis assessment in such children.

Ninety-three children with DD/MR of unknown origin were selected from Department of Rehabilitation, Kunming Children's Hospital from September 2017 to September 2021. Whole-exome sequencing (WES) was performed to explore pathogenic gene mutations associated with clinical manifestations. Copy number variation (CNV) detection was conducted to examine the characteristics of pathogenic CNVs. The detection of gene mutations was analyzed.

The DD/MR in the children was mainly manifested by motor or global DD, or MR, and with a developmental level falling behind normal developmental milestones. Seventy-four cases (79.6%) were detected with genetic variants, and the detection rate was 79.6%, among whom 40 (43.0%) with pathogenic gene mutations, 13 (14.0%) with gene CNVs, and 21 (22.6%) with mutations of uncertain significance. The genetic test results involved more than 50 pathogenic genes in total. The most prevalent disease caused by gene mutation was spinal muscular atrophy caused by mutations in the SMN1 gene (10.0%, 4/40), followed by Bethlem myopathy-1 caused by mutations in the COL6A2 gene (7.5%, 3/40) and Joubert syndrome-21 caused by mutations in CSPP1 (5.0%, 2/40) .

Pathative gene mutations and gene copy number variants may be main causes of DD/MR. SMN1, COL6A2, and CSPP1 are common mutated genes in DD/MR patients. WES combined with CNV detection may greatly contribute to the exploration of the etiology of DD/MR, especially for DD/MR manifested by atypical phenotypes and clinical manifestations.

Pediatricians often receive inconsistent reports from parents and teachers on children's behavior, but there are few available studies on comparing parents and teachers' evaluation of preschool children's behavior problems.

To investigate the prevalence of behavioral problems in preschoolers from Chongqing's main urban areas, and to explore the consistency and discrepancy between parents- and teachers-assessed behavioral problems in these children.

In June 2018, 2 698 preschoolers were sampled by cluster sampling from kindergartens in the main urban area of Chongqing. For understanding the prevalence of behavioral problems in them, their behaviors were rated by their parents using the Conners Parent Symptom Questionnaire (PSQ) , and by their teachers using the Conners Teacher Rating Scale (TRS) . And parents- and teachers-assessed results were compared.

The survey obtained a response rate of 98.59%, involving 2 660 children that were finally included. In accordance with parents' assessment, the prevalence of behavioral problems was 14.47% in preschool children (385/2 660) , and that in boys was higher than in girls〔17.91% (245/1 368) vs 10.84% (140/1 292) , P<0.001〕. According to teachers' assessment, the prevalence of behavioral problems was 4.44% in preschool children (118/2 660) , and that in boys was also higher than in girls〔6.29% (86/1 368) vs 2.48% (32/1 292) , P<0.001〕. Parents' assessment showed that boys had higher prevalence of learning problem, psychosomatic problems, and higher hyperactivity index, while teachers' assessment showed that boys had higher prevalence of conduct problems and higher hyperactivity index. In comparison with girls, boys had higher prevalence of behavior problems in in four factors of PSQ, namely learning problem, conduct problems, impulsivity-hyperactivity and hyperactivity index, and higher prevalence of behavior problems in all four factors of TRS. Spearman correlation analysis indicated that scores rated for boys by teachers in terms of conduct problems, inattention-passivity, and hyperactivity index in TRS were positively correlated with scores rated for them by parents in terms of conduct problems, learning problems, impulse-hyperactivity, and hyperactivity index in PSQ; that scores rated for boys by teachers in terms of hyperactivity problems in TRS were positively correlated with scores rated for them by parents in terms of conduct problems, impulse-hyperactivity, and hyperactivity index in PSQ (r_s ranged from 0.056 to 0.113, P<0.05) ; that scores rated for boys by teachers in terms of hyperactivity problems in TRS were negative correlated with scores rated for them by parents in terms of anxiety problems (r_s=-0.059, P<0.05) . In girls, the scores of each factor in TRS were not correlated with those in PSQ (P>0.05) .

The prevalence of behavior problems in preschoolers assessed by parents was higher than that assessed by teachers. Although there are some differences between the assessment by parents and teachers, there is a good consistency in their assessment of conduct problems and hyperactivity.

Functional constipation (FC) is highly prevalent with complex associated factors in children, posing great health risk to the affected children. So far, the results of studies on the prevalence of FC and its influencing factors vary widely, and those focusing on FC in urban children in China are relatively few.

The purpose was to investigate the prevalence and influencing factors of FC in children in urban communities, so as to provide data support for establishing a database of FC in children in the community and for carrying out standardized, multidisciplinary and continuous management of FC in children in the community.

Children aged 6 to 48 months who were registered as recipients of health services delivered by Yuetan Community Health Center, Beijing were selected from the Beijing Maternal and Child Healthcare Information System (Phase 2) during the period from April to July 2021. A questionnaire designed by our research group was used to survey the primary guardians of the included children, focusing on questions related to defecation habits prepared according to the RomeⅣ criteria for FC in the Childhood Functional Gastrointestinal Disorders: Neonate/Toddler issued in 2016, and factors possibly influencing FC including history of allergies, family history of constipation, mode of delivery, feeding practices, appetite, eating habits, daily water intake, frequency of physical activity, and family parenting practices. In total, 1 458 guardians attended the survey, and children of the 1 264 (86.69%) guardians who handed in responsive questionnaires were finally included for analysis.

The overall prevalence of FC was 9.89% (125/1 264) . Specifically, the prevalence of FC in age groups of 6 to 12, 13 to 36, and 37 to 48 months was 10.39% (16/154) , 8.75% (69/789) , and 12.46% (40/321) , respectively, demonstrating no significant difference in FC prevalence by age group (P>0.05) . The results of multivariate Logistic regression analysis showed that allergy history and feeding practices were influential factors for FC in 6-12-month-old children (P<0.05) , allergy history, feeding practices and parenting style were influential factors for FC in 13-36-month-old children (P<0.05) , and allergy history and parenting style were influential factors for FC in 37-48-month-old children (P<0.05) .

The prevalence of FC in 6-48-month-old children in urban communities is high, which is associated with multiple preventable and controllable factors, suggesting that the prevention of FC in this age group of children should be carried out in accordance with individual factors, family relationship, and social environment.

Helicobacter pylori is difficult to remove naturally in children after being infected with it. Due to differences in sample size and features, design and setting, there is little consistency between studies on epidemiology of Helicobacter pylori infection and its affecting factors in children from China, a country with high prevalence of Helicobacter pylori. Therefore, a comprehensive and objective understanding of the prevalence and risk factors of Helicobacter pylori infection among Chinese children is of great significance for the prevention of Helicobacter pylori infection in this group.

To systematically review the prevalence and risk factors of Helicobacter pylori infection among Chinese children.

In June 2021, We searched for studies on Helicobacter pylori infection and its risk factors among Chinese children in databases of PubMed, EmBase, the Cochrane Library, CNKI, CQVIP and Wanfang Data from inception to June 2021. Two reviewers independently screened the literature, extracted data, and evaluated the quality of included studies. Meta-analysis was performed using R 4.1.0.

Thirty-seven articles were included with a total sample size of 40 786 cases, of whom 11 267 were infected with Helicobacter pylori. Meta-analysis showed that the overall prevalence of Helicobacter pylori infection was 30.31%〔95%CI= (25.72%, 35.10%) 〕. Subgroup analysis showed that the prevalence of Helicobacter pylori infection significantly varied by geographical region of participants, the year of the publication of the article, and Helicobacter pylori detection method (P<0.05) . With the city economic decline, the prevalence of Helicobacter pylori infection in children was on the rise (χ²_trend=465.955, P<0.001) . Univariate meta-regression results showed that the city economic level had a significant impact on the prevalence of Helicobacter pylori infection in children (P<0.05) . Meta-analysis further indicated that poor living conditions〔OR (95%CI) =1.47 (1.09, 2.00) 〕, history of premastication〔OR (95%CI) =2.88 (1.80, 4.60) 〕, children〔OR (95%CI) =1.56 (1.01, 2.43) 〕or family members〔OR (95%CI) =2.23 (1.68, 2.98) 〕with gastrointestinal symptoms, gnawing fingers or toys〔OR (95%CI) =3.64 (2.10, 6.32) 〕, and use of shared bathroom utensils〔OR (95%CI) =2.54 (2.54, 5.73) 〕 were all risk factors for Helicobacter pylori infection in children. In contrast, living in urban areas〔OR (95%CI) =0.63 (0.56, 0.71) 〕and washing hands frequently〔OR (95%CI) =0.36 (0.18, 0.69) 〕were associated with decreased risk of Helicobacter pylori infection. In addition, the prevalence of Helicobacter pylori infection increased with the age of the children (χ²_trend=416.923, P<0.001) .

The overall prevalence of Helicobacter pylori infection among Chinese children is high, which may be higher in children living in rural and economically lagging areas, and with poor hygiene habits of individuals or family members. Strengthening Helicobacter pylori screening in children in rural areas and the education of associated risk factors will help to effectively prevent Helicobacter pylori infection in children.

Functional constipation (FC) is a common health problem in children and a high frequency of consultations among parents of children in outpatient clinics of primary medical and health institutions. Although constipation is not an emergency, it may cause serious complications if not managed properly, which then can affect the quality of life of children and their families.

To understand the capacity of primary-level doctors' diagnosis and treatment in children's FC, and provide a basis for improving primary-level doctors' capacity of diagnosis and management of children's FC.

In July 2020, 130 doctors who had access with children's patients in their daily diagnosis and treatment were selected from primary-level medical and health institutions in Xicheng District, Beijing. A self-designed questionnaire from our research group was administered to the included physicians. The content included awareness of the common symptoms of FC diagnosis for children ≥6 months of age, and the recommended treatment methods, recommended treatment drugs, medication timing and treatment duration for children with FC.

Questionnaires from 108 (83.1%) basic medical doctors were validly returned, including 34 (31.5%) from general practitioners, 30 (27.8%) from pediatricians, 30 (27.8%) from traditional Chinese medicine doctors, and the average monthly outpatient volume with pediatric patients (10.1±4.4) cases was obtained. For the diagnosis of FC in children: when children aged ≥6 months presented with less frequent bowel movements, hard stools, bleeding during defecation, fecal incontinence, difficulty in defecating, and crying symptoms before passing thick stools, 40.7% (44/108) , 39.8% (43/108) , 23.1% (25/108) , 9.3% (14/108) , 39.8% (43/108) , 23.1% (25/108) of the basic medical doctors would consider the diagnosis of FC; 51.9% (56/108) of the physicians considered FC to be diagnosed when two symptoms, including low frequency of defecation and difficulty in defecating, existed simultaneously; according to 25.0% (27/108) of the physicians, FC can be diagnosed when four symptoms including less frequent defecation, hard stools, bleeding during defecation, and difficulty in defecating were present at the same time. For the treatment of FC in children: pharmacotherapy was recommended as the main treatment of choice for FC in children by primary physicians in 37.0% (40/108) ; nonpharmacologic therapy was recommended as the preferred treatment by 63.0% (68/108) of the primary physicians, with 88.2% (60/68) recommending abdominal massage, 85.3% (58/68) recommending a high fiber diet, 82.4% (56/68) recommending toilet training, and 72.1% (49/68) recommending increased fluid intake. Lactulose therapy was recommended by 75.9% (82/108) of the primary physicians; 27.8% (30/108) of the primary physicians recommended combination therapy with microenemas of sodium citrate, sodium dodecylsulfonylacetate, and sorbitol as the rectal treatment, and 64.8% (70/108) of the primary physicians recommended rectal administration when children had particularly difficult bowel movements. According to the basic medical practitioners, the mean time from initiation of treatment to having a positive response was (4.1±2.6) days in children; the mean treatment duration of FC in children by primary physicians was (21.2±4.3) days; 88.9% of doctors believed that the average termination time of constipation treatment was (46.0±9.3) days. When the frequency and/or consistency of bowel movements returned to normal or the patient no longer had discomfort, 88.9% of physicians responded that they would consider discontinuing the treatment.

Although general primary doctors know some methods of diagnosis and treatment of children's constipation, their overall level of awareness still needs to be improved. It is recommended to further enhance the existing primary physicians' awareness and comprehensive management of FC in children, and to develop a comprehensive management model of FC in children in primary health facilities to improve the management level of children's functional constipation, thereby reducing the prevalence and increasing the cure rate.

The association of adverse childhood experiences (ACEs) with chronic disease prevalence among middle-aged and elderly people has become a research hot spot, but the association between ACEs and self-rated health in older people is still unclear, and relevant studies in Chinese population are especially rare.

To explore self-rated health in Chinese elderly people, and its association with ACEs.

The study was conducted in October 2021. Data about ACEs and self-rated health were acquired by applying from the 2014 and 2018 waves of CHARLS conducted by Peking University, involving 7 579 older people (≥ 60 years old) . The ACEs were stratified into three groups by the times of ACEs events (10 kinds in total) : high-risk (4 or more) , low-risk (1-3) , and reference (zero) . The self-rated health was divided into three levels: good, fair and poor. Ordinal logistic regression was used to analyze the correlation of self-rated health with the number and types of ACEs events.

Among the participants, the prevalence of good, fair and poor self-rated health was 22.06% (1 672/7 579) , 59.03% (4 474/7 579) , and 18.91% (1 433/7 579) , respectively, and the prevalence of experiencing ≥4, 1-3 and no ACEs events was 25.36% (1 922/7 579) , 69.71% (5 283/7 579) , and 4.93% (374/7 579) , respectively. The self-rated health differed significantly by age, gender, place of living, and types of ACEs (parental divorce, parental violence, parental depression, parental disability, living in an unsafe neighborhood, childhood loneliness, childhood famishment, bullying) (P<0.05) . The self-rated health also differed significantly across the three groups stratified by the number of ACEs events (P<0.05) . Univariate ordinal logistic regression analysis indicated that the probability of a worse self-rated health increased by a factor of 1.358〔95%CI (1.110, 1.663) 〕in those with 1-3 ACEs events, and increased by a factor of 2.151 in those with 4 or more ACEs events compared with those with no ACEs events (P<0.05) . The ordinal Logistic regression analysis indicated that results showed that parental divorce, parental violence, parental depression, parental disability, living in an unsafe neighborhood, childhood loneliness, childhood famishment, and bullying were associated a worse self-rated health (P<0.05) . The statistical results remained unchanged after adjusting for age, gender and place of living.

The self-rated health status in Chinese older people was generally fair. To improve the self-rated health to promote healthy aging in this population, interventions could be provided for them targeting reducing the negative influence caused by parental divorce, parental violence, parental depression and disability, living in an unsafe neighborhood, childhood loneliness, and childhood famishment.

Myopia is an important cause of visual impairment and has become a public health problem all over the world. In China, myopia has a high incidence rate and age of onset of which is becoming younger. There is no clinical method to reverse myopia in children. Therefore, it is important to standardize the screening for ametropia to realize early detection and intervention of myopia. As a primary care institution, a community health center may accurately understand the prevalence of myopia in teenagers in its service coverage area. So giving full play to the role of community health center has important practical significance for the containment of myopia in children and adolescents.

To explore the feasibility of community-based prevention and control of myopia in school-age children.

A cohort study was conducted. The information about visual acuity and refractive status of students in a primary school in Beijing's Chaoyang District from September 2019 to September 2021 were collected for statistical analysis, among which four groups of data in September 2019, September 2020, March 2021 and September 2021 were finally included according to the inclusion and exclusion criteria, with a total of 5 558 records. Then, based on the data, an electronic students' refractive database was established, with uncorrected visual acuity, corrected visual acuity, refractive status (power of a spherical lens, power of a cylindrical lens, axis) , prevalence of wearing glasses or orthokeratology incorporated. The warning levels of vision screening were set to be 0, 1, 2 and 3 from low to high. The visual change, visual warning level, spherical equivalent (SE) of students were compared by grade. The visual changes and warning level evolution at different times were compared at the individual level. Corresponding interventions were implemented for different warning levels, and the intervention results were analyzed and discussed.

There were statistically significant differences in uncorrected distance visual acuity (UDVA) among students by grade (F=100.413, P<0.05) . The UDVA differed significantly in male or female students (F=47.168, 53.042, P<0.05) . Compared with the lower grade students (grades 1 and 2) , middle and higher grade students (grades 3, 4, 5 and 6) had lower UDVA (P<0.003) . The UDVA decreased with the increase in grade in male and female students, and the decline in female students was faster. The composition of the warning levels of myopia risk assessed based on the UDVA in male and female students in all grades was similar, mainly composed of 0, 1, and 3 levels. With the increase in grade, the number of low warning level (level 0) gradually decreased, while that of high warning level (level 3) gradually increased. The SE in students differed obviously by grade (F=474.728, P<0.05) . The SE also differed much in male or female students (F=121.704, 123.807, P<0.05) . With the increase of grade, SE tended to be negative, and the difference in SE between left and right eyes was statistically significant (t=-4.67, P<0.05) . The negative trend of SE for the right eye was more remarkable, suggesting that the warning level of the right eye was higher, and the right eye was more prone to myopia. The follow-up of three consecutive years for assessing individual visual changes revealed that the results of four UDVA screening differed significantly in all students and female students (F=8.727, 10.221, P<0.05) . The UDVA result screened in March 2021 for all students decreased significantly compared with that screened in September 2019 or September 2020 (P<0.008) , so did the UDVA result screened in September 2021 (P<0.008) . During the evolution of warning level, higher warning level was associated with lower possibility of returning to the low warning level, and the possibility of progressing to a higher warning level increased with the growth of warning level.

The visual acuity and refractive status of students in this primary school in Beijing's Chaoyang District were not optimistic. With the increase in grade, the UDVA decreased and the number of high warning level gradually increased. To actively contain myopia in school-age children, it is suggested to establish a community-based vision screening and warning mechanism, and to promote the containing of myopia by home-school-community collaboration efforts.

The prevalence of health problems in Chinese children and adolescents is high. The mention of myopia, obesity, caries, scoliosis and other health problems in adolescents in the Healthy China 2030 Initiative Indicates that these problems have become the national concerns. The establishment of a long-term, standardized disease screening and management mode by the community health center (CHC) in combination with schools in service coverage areas of the CHC will provide a new idea for strengthening the health management of children and adolescents by the CHC.

To perform posture assessment and vision screening in full-time students receiving the nine-year compulsory education in schools in the service coverage area of Chaohe Community Health Center of Zhengzhou Economic-Technological Development Area using a CHC-school-based approach, to identify problems in disease screening and management for children and adolescents, to analyze the practice and advantages of CHC-school-based disease screening and management, and to develop a CHC-school-based health management model for children and adolescents.

This study was conducted from May to November 2021. Cluster sampling was used to select grades 1-9 full-time students (n=11 318) in 225 classes of 6 primary schools and 3 middle schools in the areas covered with health services delivered by the Chaohe Community Health Center of Zhengzhou Economic-Technological Development Area. All of them received posture assessment and vision screening.

Among the participants, 6 260 were male and 5 058 were female; 7 979 were pupils, and 3 339 were junior high school students. The prevalence of abnormal posture was 41.34% (4 679/11 318) . With the increase of grade, the prevalence of uneven shoulders, thoracic kyphosis, scoliosis, O-shaped legs, and toe valgus increased, while that of knee hyperextension, flat feet and pes valgus decreased (P<0.05) . The prevalence of 1, 2, 3 and 4 or more abnormal postures was 29.13% (3 297/11 318) , 8.60% (973/11 318) , 3.01% (341/11 318) , and 0.60% (68/11 318) , respectively. Male students had higher prevalence of thoracic kyphosis, scoliosis, flat feet and toe valgus, and lower prevalence of knee hyperextension, X-shaped legs, O-shaped legs and foot valgus than female students (P<0.05) . The prevalence of abnormal vision was 74.99% (8 486/11 318) . The prevalence of myopia, hyperopia, and astigmatism was 41.75% (4 725/11 318) , 26.14% (2 959/11 318) , and 7.09% (802/11 318) , respectively. With the increase of grade, the prevalence of myopia increased and that of hyperopia decreased (P<0.05) .

At present, the abnormal posture rate of children and adolescents in Zhengzhou is about 40%, and the myopia rate exceeds 40%. With the increase of grade, the prevalence of uneven shoulders, thoracic kyphosis, scoliosis, O-shaped legs, toe valgus and the prevalence of myopia increased, but there is a lack of effective and normal screening and health management systems. As the hospital-school approach could improve the effectiveness and normalization of the health screening and management for children and adolescents, so this approach is recommended to be used in further improvement of the top-level design and efficacy assessment of health management in children and adolescents. In addition to CHC school-based management, the health management of children and adolescents also involves the efforts of themselves and their families, which is equally important as the former two.

In China, a rational healthcare seeking pattern in children has not yet taken shape amid the active promotion of the implementation of hierarchical medical system, one major cause of which may be inadequate implementation of first contact in primary care settings in children due to poor service capability for children of these institutions. Therefore, it is of great practical significance and application value to analyze the influencing factors of children's intention to seek healthcare in primary healthcare institutions.

To investigate children's intention to seek healthcare in primary healthcare settings and associated determinants, offering insights into the development of a sound and rational healthcare-seeking pattern in children.

Two surveys were conducted during March to July, 2021 using a questionnaire developed based on the Anderson's Behavioral Model of Health Services Use (containing three aspects: demographics of children and their guardians, children's opinions on hospital selection for treatment and associated factors, and intention to seek healthcare in primary care. One survey was offline, with children aged 0-14 years as participants accidental sampled from people in two grade A tertiary general hospitals, three community health centers, and other public places (such as public parks and squares) in Guangzhou's urban areas, and the other one was online, with a purposive sample of age-matched children included in a WeChat group as participants. For collecting information more appropriately, the questionnaire was completed by the children's guardians. Univariate and multivariate ordinal regression were used to identify factors associated with children's intention to seek healthcare in primary care.

Altogether, the results of questionnaires effectively answered by the guardians of 501 children were used for analysis. The prevalence of intending to seek healthcare in primary care in the children was 36.53% (183/501). The prevalence of primarily choosing a primary healthcare setting for initial treatment of common diseases was 26.3% (132/501), which were mainly owing to shorter distance between home and the hospital (83.3%, 110/132), shorter waiting time for treatment (40.9%, 54/132) and having a pediatric or general practice clinic (36.4%, 48/132). Multivariate Logistic regression analysis indicated that the level of intention to seek healthcare in primary care in children was increased if the nearest hospital was a primary hospital instead of a secondary or tertiary hospital〔OR (95%CI) =1.514 (1.060, 2.166) 〕. Visiting a primary hospital at least four times in the last year was associated with a higher level of intention to seek healthcare in primary care in children compared with visiting a primary hospital zero times〔OR (95%CI) =0.248 (0.111, 0.557) 〕. A higher level of intention to seek healthcare in primary care in children was associated with parents' high level of satisfaction with primary care services instead of parents' fair level of satisfaction with primary care services〔OR (95%CI) =0.348 (0.236, 0.515) ] or parents' dissatisfaction with primary care services〔OR (95%CI) =0.086 (0.043, 0.173) 〕.

In general, the children in Guangzhou mainly seek healthcare in nearby hospitals, and the their level of intention to seek healthcare in a primary hospital could be improved greatly. To improve their satisfaction with primary care services and intention to seek healthcare in primary care settings, it is suggested to further deepen the theoretical research and practical exploration regarding hierarchical diagnosis and treatment, strengthen the cooperation between primary and higher level hospitals for balancing the distribution of pediatric medical resources among hospitals, and to improve the pediatric service capabilities of primary hospitals via improving the software and hardware configuration of these hospitals.

In 2019, the National Health Commission issued the Capacity Standards for Community Health Service Center (2018 version), which proposed that the 56 common disease species should be offered diagnosis and treatment services by CHSC, but it did not specify the common disease species of children in the community, which to some extent affects the assessment and construction of CHSC capacity in the community.

To investigate and analyze the common childhood disease species and their characteristics in community health services, in order to provide a reference basis for further community child health service capacity building.

In April 2020, a convenience sampling method was adopted to select community health service agencies in 11 different level cities in China as the sample unit. A self-designed questionnaire was administered to cover the subject's basic condition, the common childhood disease conditions suitable for diagnosis and treatment in the community, and their sequencing. Filled out online voluntarily anonymously by child health service personnel at the sample institution, 3 090 cases were successfully investigated. Respondents ranked the common degree of children's related disorders from low to high, assigning 1 to 5 points to each of the top 5 common childhood disorders, which is, assigning 5 points to ranked 1, 1 point to ranked 5, and 0 points to unselected, calculating a total and sorting by total score.

The top 5 disease categories for children in the community were acute upper respiratory infection, diarrhea, bronchitis, pneumonia, and eczema. Of the top 10 ranked community common childhood disorders, 3 were respiratory, 3 were facial and dermatologic, 2 were infectious, and 1 each was a digestive and growth and development related disorder. The top 5 common childhood diseases ranked by different regions, different levels of cities and different posts were consistent, but the ranking order was different, but there were differences in the 6th-10th disease species and order.

The current coverage of common childhood diseases in community health services is high. There is regional, urban, and post heterogeneity in common childhood disease species in communities. Construction of community child health service capacity should be oriented to improve the capacity of diagnosis and treatment service of common childhood diseases in the community, and fully consider the disease species variability in different regions, cities, and posts.

As the main providers of essential pediatric services, the capabilities of community general practitioners (GPs) in managing pediatric patients may directly reflects the overall status of pediatric care services in primary care settings. In China, there are great regional differences in the supply and demand of pediatric services, and the capabilities of primary care settings are unsatisfactory in providing pediatric services. The current encounters and influencing factors of GPs with pediatric patients in suburban districts are worthy of attention.

To understand the status and associated factors of clinical encounters of GPs with pediatric patients in a suburban district of Beijing, providing a reference for the development of tiered diagnosis and treatment of pediatric diseases.

In June 2021, purposive sampling was used to recruit GPs who participated in a training named "Beijing Miyun District Medical Consortium Construction & General Practitioners' Comprehensive Capability Improvement Project" to attend a semi-structured group interview for understanding the status of clinical encounters of GPs with pediatric patients and related influencing factors. The interview results were recorded, and transcribed, then coded using NVivo 12, and analyzed using thematic analysis.

Nineteen GPs (5 men and 14 women) in the age range of 24-51 years〔average age of (33.2±7.6) years〕, attended the interview, 18 of whom had a bachelor degree; 9 had a title of attending physician; 1 had participated in the standardized general practice residency program; 8 had participated in the "3+2" assistant general practitioners training program; 8 had participated in the standardized training before making a career change into general practice. The average years of them working a GP was 1-18 years〔 (6.3±4.8) years on average〕. Four themes emerged from the analysis: (1) Both the numbers of pediatric patients and illnesses encountered by suburban GPs were less than those encountered by their urban counterparts, and pediatric patients encountered by suburban GPs aged greater than or equal to 3 years. (2) Suburban GPs generally had a low level of self-confidence in treating pediatric patients. (3) The major factors negatively affected suburban GPs encountering pediatric patients include the pediatric patient's parents with a lower level of trust in their GP, inadequate capabilities of GPs in managing pediatric patients, high risk of managing pediatric patients, underperformance of nurses, inadequate available pediatric medicines and equipments for laboratory tests in the community, and lack of a clear referral system. (4) The major facilitators for suburban GPs to encounter pediatric patients include managing pediatric patients in the community by pediatricians, and increasing pediatric medicines and equipments for laboratory tests.

The encounters of suburban GPs with pediatric patients in primary care were unsatisfactory due to many problems and challenges. To improve the situation, it is suggested to improve the capabilities of suburban GPs in managing pediatric patients by trainings, the collaboration between GPs and pediatricians, and the tiered system for the diagnosis and treatment of pediatric diseases.

Birth weight is closely related to individual health. Low birth weight is a high-risk factor for early neonatal death. Macrosomia is associated with higher risk of maternal and infant complications and various chronic diseases in adulthood. Therefore, it is very important to identify the influencing factors of neonatal birth weight.

To investigate the relationship between maternal intestinal flora and neonatal birth weight.

Participants were 516 singleton mothers and their babies〔24 with low birth weight (LW group) , 479 with normal birth weight (NW group) and 13 with macrosomia (OW group) 〕 delivered at term in Guangzhou Women and Children's Medical Center from January to September 2017. Maternal intestinal flora and clinical laboratory test parameters were collected, and the composition and diversity of intestinal flora were analyzed using QIIME. LEfSe analysis was used to compare the relative abundance of intestinal flora at the genus level of the mothers of three groups of babies to identify the flora with significant intergroup differences. MaAslin was used to assess associations of maternal laboratory test parameters and microbial genera. The Boruta was used to build models for predicting three types of neonatal birth weight using maternal laboratory test parameters and intestinal flora OTUs, to assess the association of maternal intestinal floras and neonatal birth weight.

The analysis of maternal intestinal floras showed that the abundance of Firmicutes was the highest at the phylum level, and Faecalibacterium was significantly enriched at the genus level. There were no significant differences in Simpson's Diversity Index and Shannon Diversity Index at the phylum level across the maternal intestinal floras of three groups of babies (P>0.05) . LEfSe analysis found that compared with intestinal flora of mothers of LW group, the intestinal flora of mothers of NW group showed significantly enriched Streptococcus and Roseburia (P<0.05) , and significantly reduced abundance of Bacillaceae, Raphanus, Methanosphaera, Barnesiella and Paraprevotella (P<0.05) , while the intestinal flora of mothers of OW group demonstrated significantly enriched Closrtidiaceae and Alistipes as well as significantly reduced abundance of Barnesiella (P<0.05) . Compared with intestinal flora of mothers of NW group, the intestinal flora of mothers of OW group indicated significantly enriched Megamonas, Coprococcus, Veillonellaceae, cc-115, Closrtidiaceae and Alistipes, and significantly reduced abundance of Blautia and Eggerthella (P<0.05) . The area under ROC curve (AUC value) based on laboratory test parameter OTUs model and intestinal flora OTUs model was 0.62 and 0.77, respectively, in discriminating LW from NW, and was 0.65, and 0.78 respectively, in discriminating OW from NW.

Neonatal birth weight varied by the features of maternal intestinal floras. The OTUs model based on maternal intestinal flora could distinguish the neonatal birth weight. Maternal intestinal flora may be a good predictor of neonatal birth weight.

Helicobacter pylori (H. pylori) infection induced precancerous lesions of gastric mucosa mostly in adulthood. However, it is debatable whether these pathological changes could also occur in children.

To investigate the relationship between H. pylori infection and precancerous lesions of gastric mucosa in children hospitalized due to upper gastrointestinal symptoms in central plain area of China.

A total of 1 015 children under the age of 18 years old were enrolled. These children attended the People's Hospital of Zhengzhou University for upper gastrointestinal symptoms such as abdominal pain, bloating, nausea, vomiting, hiccups, and acid reflux from August 2018 to July 2021. All children underwent gastroscopy, from which gastric mucosal biopsy tissues were taken for rapid urease test and histopathological examination. The clinical and pathological data of the patients were collected retrospectively. The children were divided into infected and uninfected groups according to H. pylori infection status. The age, sex, endoscopic diagnosis, and H. pylori infection rate were compared between children in infected and uninfected groups. The incidence of precancerous lesions of gastric mucosa, inflammatory activity and the degree of inflammatory cell infiltration were compared between infected and uninfected groups, meanwhile these tests were also compared in children of different age groups.

Among the 1 015 children, 854 (84.14%) were infected with H. pylori and 161 (15.86%) were not infected. H. pylori-infected children were significantly older than those of non-infected subjects (P<0.05). Endoscopy examination revealed that the proportion of chronic superficial gastritis in H. pylori- infected group was significantly higher than that in uninfected group, while nodular gastritis was more common in H. pylori-uninfected patients (P<0.05). Among the enrolled children, 54 were 1-4 years old, 199 were 5-8 years old, 435 were 9-12 years old, and 327 were 13-18 years old. H. pylori infection rate in groups of 5-8, 9-12 and 13-18 year-old children was significantly higher than that in group of 1-4 year-old children; and the infection rate in groups of 9-12 and 13-18 year-old children was also significantly higher than that in group of 5-8 year-old children (P<0.05). Among H. pylori-infected patients, 37 out of 854 children had precancerous lesions of gastric mucosa (with incidence rate of 4.33%), of which 17 patients had atrophy, 11 patients had intestinal metaplasia and 9 patients had dysplasia, and only one of the 161 H. pylori-uninfected patients (0.62%) had atrophic gastritis. The incidence of precancerous lesions of gastric mucosa in H. pylori-infected patients were significantly more than those uninfected patients (χ²=5.178, P=0.023). The level of active inflammation and inflammatory cell infiltration of gastric mucosa in H. pylori-infected children were higher than that in non-infected children (P<0.05). In groups of 5-8, 9-12 and 13-18 year-old children, the prevalence of active inflammation and neutrophil granulocyte infiltration in gastric mucosa were significantly higher than that in uninfected patients (P<0.05). In H. pylori-infected patients, children in groups of 9-12 and 13-18 years old showed more severe lymphocyte infiltration over the uninfected patients (P<0.05) .

In children, gastric mucosal precancerous lesions occur in 4.33% of H. pylori-infected patients in central China, this include atrophic gastritis, intestinal metaplasia and dysplasia; the data revealed an obvious critical issue requiring future investigation and intervention for this group of population.

At present, the recurrence rate of children with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is relatively high. But there are relatively few studies and most medical staff are not aware of it.

A comparative study of children with recurrent and non-recurrent anti-NMDAR encephalitis was conducted to improve clinicians' understanding of anti-NMDAR encephalitis and its recurrence-related factors, in order to provide evidence for individualized treatment of children with anti-NMDAR encephalitis and reduce the recurrence rate.

The clinical data of 54 hospitalized children diagnosed with anti-NDMAR encephalitis in the Department of Neurology, Hebei Children's Hospita, Hebei Medical University from January 2016 to December 2021 were retrospectively analyzed. According to the recurrence situation, the children were divided into non-recurrence group and recurrence group. The clinical characteristics of children with anti-NDMAR encephalitis were analyzed, including gender and age distribution, onset time, clinical symptoms and signs, routine examination of cerebrospinal fluid, imaging examination, electroencephalography, immunological examination, treatment and prognosis. The above-mentioned related indicators of the two groups were compared.

The male-to-female ratio of the 54 children was 1.16∶1, and the school-age group (≥7 years old) accounted for 51.8%; The onset time was higher in summer (June-August) (33.3%) . The clinical symptoms were diverse, and the most common clinical symptom was epilepsy, accounting for 61.1%; 38 cases (70.4%) had abnormal cerebrospinal fluid routine examination results, mainly manifested as increased leukocyte and mildly increased protein in cerebrospinal fluid; MRI examination of brain of 25 children (46.3%) showed abnormal signals, the most common abnormal signal was in the frontal lobe, followed by the basal ganglia and thalamus; 6 cases (11.1%) were given immunoglobulin for ≥2 rounds, and 5 cases (9.3%) were given hormone shock ≥ after 2 rounds, 7 cases (13.0%) received second-line immunotherapy, 31 cases (57.4%) received antiepileptic drugs; 26 cases (48.1%) achieved complete remission. There was no significant difference in gender, age distribution, onset time, cerebrospinal fluid routine examination results, abnormal proportion of brain MRI examination results, video EEG examination results, CD₈⁺T lymphocytes, CD₄/CD₈, total B lymphocytes, IgA, IgM, IgG, disease course before treatment, proportion of immunoglobulin ≥ 2 rounds, proportion of hormone shock ≥ 2 rounds, proportion of second-line immunotherapy, proportion of antiepileptic drugs, mRS at discharge, and proportion of complete remission between two groups (P>0.05) . The total T lymphocytes and CD₄⁺ T lymphocytes in the recurrence group were lower than those in the non-recurrence group (P<0.05) .

The clinical symptoms of children with anti-NMDAR encephalitis are diverse, but the early clinical symptoms are severe and the total T cells and CD₄⁺ T cells are significantly reduced after admission, so the children who are not easy to achieve complete remission after standard immunotherapy should be alert to the risk of recurrence.

Mycoplasma pneumoniae pneumonia (MPP) can cause a variety of intrapulmonary and extrapulmonary injuries, including thrombotic diseases, which seriously endanger the health of children. And for assessing the coagulation status, routine coagulation parameters has great limitations, while thromboelastography (TEG) can be comprehensively and rapidly, but there are few data on TEG used in condition evaluation in children with MPP.

To explore the value of TEG in condition assessment of children with MPP.

Two hundred and twelve MPP children were recruited from the Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University from July 2019 to July 2021, including 52 with severe condition and 160 with non-severe condition. Comparisons were made between two groups in terms of demographics, platelet count, routine coagulation parameters, and TEG parameters. The association of TEG parameters with platelet count and routine coagulation parameters was assessed. Multivariate Logistic regression analysis was used to explore influence factors for the condition of MPP. ROC analysis was used for assess the value of those identified risk factors for predicting the condition of MPP.

Both groups had no significant differences in sex ratio and mean age (P>0.05) . Compared with children with non-severe condition, those with severe conditionhad shortened reaction time (R) and kinetic time (K) , and elevated maximum amplitude (MA) , α-angle, clotting index (CI) , fibrinogen (FIB) , prothrombin time (PT) , international normalized ratio (INR) , D-dimer (D-D) (P<0.05) . Correlation analysis showed that MA was moderately positively associated with PLT and FIB (P<0.001) ; R was weakly positively associated with activated partial thromboplastin time (P<0.001) ; K was weakly negatively associated with PLT and FIB (P<0.001) ; α-angle was weakly positively correlated with PLT and FIB (P<0.001) . Multivariate Logistic regression analysis showed that CI〔OR=5.698, 95%CI (3.329, 9.753) , P<0.05〕, and D-D〔OR=5.061, 95%CI (1.724, 14.859) , P<0.05〕were influence associated with MPP, and the prediction algorithm based on them for MPP is CI+D-D: Y=1.777CI+1.624D-D-5.264. ROC analysis indicated that the area under the ROC curve of CI was 0.885〔95%CI (0.830, 0.941) 〕with 0.750 sensitivity and 0.907 specificity when the cut-off value was determined as 2.05, and that of D-D was 0.716〔95%CI (0.632, 0.799) 〕with 0.615 sensitivity and 0.784 specificity when the cut-off value was determined as 0.545, and that of CI in combination with D-D was 0.901〔95%CI (0.850, 0.952) 〕with 0.769 sensitivity and 0.914 specificity when the cut-off value was determined as -0.65.

TEG could partially predict the condition of children with MPP, but could not replace the routine coagulation parameters, and the combined predictive value of the two may be higher.

The burden due to influenza-related hospitalization is heavy in children under 5 years old, a high-risk group of severe influenza, but there is little research on the risk factors for such hospitalizations.

To explore the risk factors for influenza A variant virus-related hospitalization in children under 5 years old.

A retrospective design was used. Children under five years old (n=1 450) with influenza A virus infection were selected from Emergency Department, Beijing Ditan Hospital Capital Medical University during December 2018 to February 2019. Clinical data were collected, including age, sex, baseline chronic disease, time from onset to first contact, time from onset to initiation of antiviral therapy, main clinical features and prevalence of hospitalization. Multivariate Logistic regression analysis was used to identify the risk factors of hospitalization.

The median age for the children was 2.5 (1.1, 3.9) years, and males outnumbered females (56.5% vs 43.5%) . Thirty-eight (2.6%) had baseline chronic diseases, and 155 (10.7%) were hospitalized. Stepwise univariate and multivariate Logistic regression analyses showed that: younger than 6 months〔OR=5.808, 95%CI (2.650, 12.730) , P<0.001〕, male〔OR=1.673, 95%CI (1.098, 2.549) , P<0.05〕, accompanied with baseline chronic diseases〔OR=17.999, 95%CI (7.882, 41.103) , P<0.001〕, time from onset to first visit>48 h〔OR=4.663, 95%CI (1.712, 12.704) , P<0.001〕, the time from onset to initiation of antiviral treatment >48 h〔OR=19.835, 95%CI (9.043, 43.502) , P<0.001〕, prevalence of cough or expectoration symptoms〔OR=7.174, 95%CI (4.222, 12.191) , P<0.001〕and prevalence of disturbance of consciousness / convulsions〔OR=10.044, 95%CI (6.142, 16.425) , P<0.001〕were associated with increased risk of hospitalization.

In children under 5 years old, male, younger than 6 months, and baseline chronic diseases may be risk factors for influenza A variant virus-related hospitalization, cough/expectoration, and disturbance of consciousness/ convulsions may be associated with even higher risk. Early use of antiviral therapy could reduce the risk of hospitalization.

Dyspepsia (namely, the functional dyspepsia) in children, is a common pediatric disease that has a high recurrence rate. Severe dyspepsia will affect the nutritional intake of children, and may further impair their physical development and even mental health.

To systematically review the effectiveness and safety of Changyanning Granules in the treatment of dyspepsia in children.

We searched databases of CNKI, WanFang Data, CQVIP, and SinoMed for randomized controlled trials (RCTs) in Chinese and searched databases of PubMed, The Cochrane Libarary, EMBase, Web of Science for relevant RCTs in English from inception to May 2021. Regarding children with dyspepsia treated by Changyanning Granules or Changyanning Granules in combination with routine western treatment〔Live Combined Bifidobacterium and Lactobacillus Tablets (LCBLT) or Motilium Tablets (MT) 〕 (experimental group) compared with those treated with Xiaoer Xishi Pian (a Chinese patent medicine) or routine western treatment (LCBLT or MT) regardless of dosage, administration route and duration of treatment. We used response rate as the primary outcome indicator, and incidence of adverse reactions and clinical symptoms disappearing time as secondary outcome indicators. We used the Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1) and RevMan 5.3 for conducting the meta-analysis.

Six RCTs were included, involving 1 150 cases (575 in the experimental group and 575 in the control group) . Meta-analysis showed that Changyanning Granules were superior to Xiaoer Xishi Pian in terms of overall response rate〔RR=1.57, 95%CI (1.27, 1.94) , P<0.000 1〕 with lower incidence of adverse reactions〔RR=0.18, 95%CI (0.09, 0.37) , P<0.000 01〕. Compared with LCBLT or MT, Changyanning Granules with LCBLT or MT produced higher overall response rate〔RR=1.60, 95%CI (1.13, 2.26) , P=0.008〕, and shortened the clinical symptom disappearing time (P<0.05) , but showed no significant difference in the incidence of adverse reactions (P>0.05) .

For children with dyspepsia, available evidence has demonstrated that using Changyanning Granules alone, or in combination with LCBLT or MT, could improve the overall response rate, shorten the clinical symptoms disappearing time with relatively low incidence of adverse reactions. However, due to low quality of included RCTs, our conclusion needs to be further verified by RCTs meeting the international standards with a large sample size, and rigorous design.