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Abstract Background Earthquakes are potentially traumatic natural disasters due to their destructive nature, and huge impacts, producing scenes of horror, undesirable and uncontrollable results. Children are affected mainly by earthquakes not only physically but also psychologically. We aimed to evaluate the rates of probable PTSD and related factors in children and adolescents after the February 6 Kahramanmaras earthquake. Methods In this cross-sectional study, 246 children and adolescents were included. The research was conducted in Hatay, one of the most affected provinces, between 06/07/2023-06/08/2023. Sociodemographic form, Children’s Depression Inventory, Children’s Posttraumatic Response Reaction Index, Screen for Child Anxiety Related Emotional Disorders, Child and Youth Resilience Measure and Social Support Appraisals Scale for Children were applied by face-to-face survey method. Results The median age of the participants was 12 (8-18). 133 (54%) of the participants were girls. Probable depression rate was 98%, and probable anxiety disorder rate was 63%. Probable mild, moderate, severe and very severe PTSD rates were 18%, 29%, 43% and 8%, respectively. The probable severe PTSD rate was higher in children who were injured in the earthquake (p = 0.032), who received outpatient treatment (p = 0.016), and who saw people trapped under the collapse (p = 0.012). Also, the children whose sleep routines have changed post-earthquake were found to have more probable severe PTSD (p

Abstract Background Oral sensory hypersensitivity has been linked with fussy eating predominantly in non-typically developing children. We hypothesized that child ‘Oral’ (touch, smell and taste in the mouth) and ‘Social-Emotional’ (response to social expectations) sensory processing are associated with child appetitive traits in typically developing preteen children. Additionally, we explored relationships between maternal sensory profiles and their offspring’s sensory profile. Methods This is secondary analysis of 130 mother-child dyads from the 9–11-year-old follow-up of the ROLO longitudinal birth cohort study. The Dunn Sensory Profile (Adolescent/Adult) and the Dunn Child Sensory Profile 2 were used to assess maternal and child sensory profiles, respectively. The Children’s Eating Behaviour Questionnaire was used to assess child appetitive traits. Multiple linear regression examined associations between ‘Oral’ and ‘Social-Emotional’ segments of the child sensory profile and child appetitive traits. Associations between maternal and child sensory profiles were examined using sensory profile quadrants (Dunn’s sensory processing framework). These refer to four distinct patterns of sensory processing that indicate how an individual responds to sensory input. Results In total, 130 mother-child dyads were included. In adjusted analysis child ‘Oral’ sensory processing was associated with higher mean scores in the appetitive traits ‘Desire to Drink’ (B = 0.044, 95% CI = 0.025,0.062) and ‘Food Fussiness’ (B = 0.080, 95% CI = 0.059,0.101) and with lower mean scores in ‘Enjoyment of Food’ (B=-0.038, 95% CI -0.055,-0.022). Child ‘Social-Emotional’ responses were associated with higher mean scores in ‘Desire to Drink’ and ‘Food Fussiness’. Higher scores in the maternal sensory profile quadrants of ‘Sensitivity’, ‘Avoiding’ and ‘Registration’ were positively associated with higher scores in the corresponding child sensory profile quadrants. Conclusion Our findings suggest that in typically developing children presenting with fussy eating, oral sensory hypersensitivity and higher scores in social-emotional responses to sensory processing may be an underlying determinant. The relationship observed between ‘Oral’ and ‘Social-Emotional’ sensory processing segments and ‘Desire to Drink’ requires further research to ascertain the type of drinks being consumed and how this impacts appetite. Further research is also required to explore the influence of maternal sensory profile on their offsprings response to sensory input.

In Kenya, influenza virus circulates year-round, raising questions about optimum strategies for vaccination. Given national interest in introducing influenza vaccination for young children 6–23 months of age, we modeled total influenza-associated illnesses (inclusive of hospitalizations, outpatient illnesses, and non‒medically attended illnesses) averted by multiple potential vaccination strategies: year-round versus seasonal-campaign vaccination, and vaccination starting in April (Southern Hemisphere influenza vaccine availability) versus October (Northern Hemisphere availability). We modeled average vaccine effectiveness of 50% and annual vaccination coverage of 60%. In the introduction year, year-round vaccination averted 6,410 total illnesses when introduced in October and 7,202 illnesses when introduced in April, whereas seasonal-campaign vaccination averted 10,236 (October) to 11,612 (April) illnesses. In the year after introduction, both strategies averted comparable numbers of illnesses (10,831–10,868 for year-round, 10,175–11,282 for campaign). Campaign-style vaccination would likely have a greater effect during initial pediatric influenza vaccine introduction in Kenya; however, either strategy could achieve similar longer-term effects.

Susac syndrome is a rare microangiopathy of unclear etiology, likely autoimmune, characterized by a characteristic clinical triad of encephalopathy, retinopathy, and hypoacusis. The majority of cases reported in the literature involve adult patients, with its occurrence in the pediatric population being extremely rare. Magnetic resonance imaging (MRI) is essential for diagnosis and patient monitoring, revealing nearly pathognomonic features, particularly valuable given the typically incomplete clinical triad and the consistent presence of encephalopathy, often as the initial symptom. We report the case of an 11-year-old child diagnosed with Susac syndrome, highlighting the importance of considering this diagnosis in cases of childhood encephalopathy and initiating treatment as early as possible to prevent irreversible sequelae.

Background With the improvement of economic level and changes in lifestyle of residents, the obesity among children and adolescents has become increasingly severe, threatening the healthy growth of children and adolescents. BMI was used as an evaluation index of obesity in most previous studies, which may underestimate the prevalence of central obesity. Therefore, it is urgent to evaluate the waist circumference (WC) and trend of the prevalence of central obesity among children and adolescents in Putuo District, in order to provide scientific basis for targeted proposed intervention. Objective To analyze WC and the trend in the prevalence of central obesity among children and adolescents aged 7-18 years in Putuo District, Shanghai, from 2018 to 2023. Methods Data on medical examinations of primary and secondary school students in Putuo District in 2018 and 2020 to 2023 were used to analyze the WC, the prevalence of central obesity and the trends. The 90th percentile (P90) age-specific children and adolescents of different genders was used as the cut-off point of high WC, and WC exceeding the P90 value was defined as central obesity. SPSS 22.0 and SAS 13.1 were used for statistical analysis and Excel 2021 was used for graphic plotting. Results A total of 280 648 primary and secondary school students participated in the medical examination in Putuo District, Shanghai, from 2018 to 2023, of which 146 334 (52.1%) were male students and 134 314 (47.9%) were female students, with an median age of 10.5 (8.7, 12.6) years. WC of male and female students from 2018 to 2023 showed fluctuating downward trends with a statistically significant difference (Hmale=209.785, Hfemale=373.076; P

Abstract Background Forearm shaft fractures are common injuries, often caused by falling from a fully-upright position or falling off a bike. They can be treated nonoperatively or surgically with intramedullary nailing or plates. The method of choice for treating pediatric forearm shaft fractures is the application of elastic stable intramedullary nailing (ESIN)|. The aim of the study was to evaluate ESIN in pediatric patients with forearm shaft fractures based on radiological images, and determine the etiology and complication rate associated with the injury. Methods The study included 201 patients, 30.5% female 69.5% male, aged 1 to 17 years (mean 9.1 years; SD = 3.2), all had been diagnosed with a fracture of the forearm shaft and had been treated surgically with ESIN. In addition, all possessed a complete set of X-ray images and had attended a minimum six-month follow-up examination of the forearm. Axial alignment was evaluated retrospectively in the anatomical (AP) and lateral (LAT) positions. In total, 402 radiographs were examined. Of the injuries, 68% occurred during sports activity and 75% involved both the radius and the ulna. Results Union was observed in all cases. Mean axial alignment values in AP and LAT X-ray or both the ulna and radius were satisfactory. Axial alignment values were not influenced significantly by age, type of surgery, type of fracture or etiology. Plaster cast application (9.8% of cases) significantly influenced radius axial alignment. The complication rate was 11.4% (n = 23). Significantly more complications were observed in patients receiving open reduction internal fixation (ORIF) (p = 0.0025). Conclusion The ESIN technique is an effective treatment for forearm diaphyseal fractures in children, with good results regarding reduction and bone healing, indicated by x-ray.

Purpose It is essential to investigate the users’ needs in developing user-centered, family-based applications (apps) for managing childhood obesity. Methods This study conducted focus group interviews with ten parents, ten children, and four app developers to investigate the need to develop a family-based mobile app for childhood obesity. The interview period was from July 17 to August 30, 2023. The data were analyzed using thematic analysis. Results The results highlighted 31 key themes critical to family-based app development, including the need for comprehensive content promoting healthy lifestyle habits, tailored expert support, and motivational factors for app engagement, which were categorized as intrinsic, extrinsic, and social motivations and technological features. Participants also highlighted potential challenges, such as app usability issues and the need for a user-friendly interface. The pivotal role of parents in guiding and supporting their children’s health behaviors was emphasized, particularly in creating a supportive environment that encourages sustained engagement with the app. Conclusion These findings provide a comprehensive understanding of the needs and preferences of parents, children, and app developers in managing childhood obesity. Emphasis on integrating healthy lifestyle content, providing expert support, and incorporating motivational strategies is crucial for the app’s success. Additionally, addressing potential difficulties and recognizing the pivotal role of parents are essential considerations. These insights will inform the design and development of a user-centered mobile app that supports families in managing childhood obesity.

The objective of this research was to examine current telehealth practices in managing children with attention deficit hyperactivity disorder (ADHD) and to map existing implementations using the American Medical Association’s Virtual Care Value Framework. A scoping review was conducted following the Arksey and O’Malley framework. The databases, CINAHL, PsycINFO, and PubMed, were searched with specific keywords related to telehealth and ADHD. The screening process followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. In­clusion criteria were restricted to articles published in English between January 2000 and July 2024, focusing on children with ADHD, their parents, caregivers, family members, teachers, healthcare professionals, and articles implementing telehealth interventions. As a result, out of 389 initially identified articles, 22 met the inclusion criteria. The studies were predominantly conducted in the United States. The most common telehealth meth­ods included videoconferencing and telephone-based communications. Key areas of fo­cus in these studies included clinical outcomes, access to care, patient and family experi­ence, caregiver experience, clinician experience, and financial and operational impact. However, none of the studies addressed health equity. In conclusion, telehealth has shown effectiveness in improving ADHD assessment, treatment adherence, and parental education, leading to positive patient outcomes and experiences. However, the financial impact of telehealth remains uncertain. Further research is needed, particularly outside the United States, to explore emerging telehealth technologies and areas overlooked by the Virtual Care Value Framework, such as health equity.

Abstract Background Multiple cartilaginous exostoses (MCE) are a rare genetic disorder characterized by multiple osteochondromas in the metaphysis of long bones. Case Presentation. We report a 15-year-old male patient, his father, and his brother, all presenting varied severity of the same symptom. The patient exhibited symptoms since infancy, with osteochondromas affecting mobility and causing joint deformities. Whole exome sequencing identified a pathogenic NM_000127.3(EXT1):c.1056 + 2 T > G and a likely pathogenic NM_000127.3(EXT1):c.1047G > T variant in the EXT1 gene, both novel. Conclusions Despite three decades since the discovery of the EXT1 gene, MCE diagnosis may be delayed until adolescence or adulthood. This report contributes to clinical understanding, emphasizing the importance of early diagnosis, genetic analysis, and potential treatment approaches, to mitigate long-term deformities and complications in MCE patients.

Abstract Purpose This study aimed to compare the acceptability of removable acrylic appliances (RA) and Invisalign First (IF) clear aligners (Aligntech, USA) among children undergoing orthodontic treatment during the mixed dentition period, considering the severity of malocclusions. Methods A total of 40 patients, aged 6 to 13 years, were recruited for the study. Malocclusion severity was evaluated using the Index of Orthodontic Treatment Need-Dental Health Component (IOTN-DHC). Patients completed the "Acceptance of Orthodontic Appliance Scale (AOAS)" via a face-to-face Google survey. To assess the reliability of the AOAS, the survey was resent to five patients after three months for a second response, and reliability analysis was conducted. Additionally, inter-rater reliability was evaluated by having all patients independently assessed by a second researcher. Data were analyzed using SPSS Statistics version 26 (IBM Corp., Armonk, NY, USA), with statistical significance set at p < 0.05. Results Although no significant difference was found in IOTN-DHC scores, the IF group demonstrated significantly higher AOAS scores compared to the RA group (p = 0.014). Survey responses revealed noticeable distinctions between groups regarding speaking discomfort, preference for orthodontic appliances, and facial appearance comfort. A negative correlation (r = -0.477, p = 0.034) was observed between malocclusion severity and appliance acceptance. Clinical significance This study underscores the significant superiority and advantage of IF over RA among pediatric orthodontic patients during the mixed dentition period.

Abstract Objectives This study examined the impact of web-based education on enhancing mothers’ awareness of oral health care for children aged 9 and 12 years. It focused on the crucial role of mothers in educating about oral health to prevent dental diseases and reduce long-term healthcare costs. Methods Mothers were divided into three groups: control, intervention with a web system, and intervention with a brochure. Over one month, their knowledge about their children’s oral health was assessed before and after the intervention. Results Data were analyzed using parametric t-tests and non-parametric Mann-Whitney U tests. The findings indicated a significant increase in parental awareness in both intervention groups. Conclusion It is recommended that parent education be done using web-based systems or mobile apps, which are better choices due to greater accessibility and interactivity.

Background: Acute lymphoblastic leukemia (ALL) represents the predominant childhood cancer. High-dose methotrexate is integral to leukemia treatment protocols. This study aimed to explore the efficacy of glutamine in preventing mucositis among leukemia patients undergoing high-dose methotrexate therapy.Method: This randomized clinical trial encompassed 45 patients (22 in the glutamine group and 23 in the placebo group). The intervention group was administered a glutamine mouthwash, while the control group received an identical placebo. Data analysis was performed using SPSS version 23, with a significance threshold set at P < 0.05.Results: No significant difference emerged between the groups concerning the incidence of nausea and vomiting; however, both groups observed a notable reduction in nausea frequency from the first to the fourth days (P = 0.0001 and P = 0.040, respectively). Grades III and IV mucositis were absent in both groups on the third and seventh days post-treatment. Furthermore, no significant difference was detected in mucositis improvement between the groups (P = 0.848).Conclusion: Glutamine mouthwash significantly reduced the incidence of nausea and vomiting, which are common chemotherapy complications. Moreover, up to 95% of patients were free from mucositis by the seventh-day post-chemotherapy.

Abstract Background Community-acquired pneumonia (CAP) is a major global health threat for children, causing numerous hospitalizations and deaths. CAP is a leading cause of mortality in children under five and results in millions of hospital admissions each year. Identifying reliable prognostic markers is crucial. Mean platelet volume (MPV) and red blood cell distribution width coefficient of variation (RDW_CV) are accessible and cost-effective options for prognosis assessment. This study investigates MPV and RDW_CV as prognostic markers in children with CAP. Methods This cross-sectional study included 150 children aged 1–15 years diagnosed with CAP upon initial examination and admitted to the hospital. CAP diagnosis was based on clinical symptoms, physical examination, and/or radiographic findings, with hospitalization criteria set for CAP in children. CAP severity was assessed using the Clinical Respiratory Score, categorizing patients into mild, moderate, and severe groups. MPV and RDW_CV were compared among these groups. Results Among the patients, 71 (47.3%) were girls, and 79 (52.7%) were boys. The average hospitalization duration was 6.24 ± 3.82 days, with a median of 5 days. Disease severity distribution was 58 (38.7%) mild, 54 (36.0%) moderate, and 38 (25.3%) severe. Both RDW_CV and MPV were higher in severe cases and in children hospitalized for more than 10 days (P

Abstract In the past few years, a significant decline in vaccination coverage has been noted, leading to measles outbreaks. Mothers’ adherence or reluctance to undergo childhood immunization is a major contributing factor to a substantial population of children who remain unvaccinated or inadequately vaccinated. This study aimed to investigate adherence to children’s vaccination by investigating mothers’ personal and contextual factors in addition to knowledge and attitudes scores. A cross-sectional analytical design was employed, and data were collected from a sample of 533 mothers in Jordan between May and July 2023. The statistical analysis included descriptive analysis, t-test, ANOVA, and Pearson r correlation. The results demonstrated that adherence to vaccination was associated with several factors, including knowledge score (r = 0.33, p

Abstract Introduction Childhood malnutrition is a complex issue with a range of contributing factors. The consequences of malnutrition are severe, particularly for children. This study aims to identify the factors contributing to inequality gaps in childhood malnutrition. Our study provides insights into modifiable elements to inform interventions targeted at distinct contexts and populations to improve child nutrition. Methods This study utilized data from the Demographic and Health Surveys (DHS) of 27 countries. First, the risk differences (RDs) between the prevalence of childhood malnutrition among the determinant variables, household income, and maternal education categories were calculated. The Blinder‒Oaxaca decomposition was subsequently used to determine the extent to which the difference in childhood malnutrition prevalence between low-income and high-income groups and maternal education levels results from the contributory effects of the explanatory variables: child and maternal individual-level compositional factors. Results We examined data from 138,782 children in 27 countries from 2015 to 2020. The prevalence of childhood malnutrition (10.5%) varied across countries, ranging from 6.5% in Burundi to 29.5% in Timor Leste. On average, the prevalence of childhood malnutrition was 11.0% in low-income households and 10.7% among mothers without education. Some nations had pro-low-income (i.e., malnutrition concentrated among children from poor households) or pro-no-maternal education (i.e., malnutrition concentrated among children from mothers with no formal education) inequality in childhood malnutrition, but most did not. We found a complex interplay of compositional effects, such as the child’s age, maternal education, maternal health behavior, and place of residence, that influence the inequality in childhood malnutrition rates across 10 pro-low-income countries. In addition, we also found that a complex mix of compositional effects, such as the household wealth index, maternal health behavior, and maternal age, contribute to childhood malnutrition inequality between educated and uneducated mothers across the 7 pro-no maternal education countries. Conclusion The prevalence of childhood malnutrition varies among low-income, high-income, and no maternal education-maternal education groups. This study highlights the need for a country-specific approach to addressing childhood malnutrition, with policies and interventions tailored to each country’s specific context.

Idiopathic nephrotic syndrome （INS） is the most common and challenging glomerular disease in childhood and most children respond favorably to glucocorticoid therapy. However， up to half of INS patients present with steroid-dependent or frequently-relapsing nephrotic syndrome so that selecting proper treatment regimens has remained one great clinical challenge. Rituximab （RTX） for nephrotic syndrome is generally efficacious. However， clinical outcomes vary greatly at different centers. This review summarized the effectiveness and risk of different RTX protocols for children with steroid-dependent or frequently-relapsing nephrotic syndrome.

As an endocrine disruptor chemical, pesticide exposure may affect the regulation of growth hormones such as insulin-like growth factor-1 (IGF-1). A few current studies to date have noted that long-term pesticide exposure disrupted IGF-1, a potential risk of stunting in children. This study aims to evaluate studies to date of the effect of pesticide exposure on stunting incidence. This systematic review and meta-analysis adhered to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. The PubMed and EBSCO databases were searched for relevant articles without publication restrictions. This review aimed to include reviews, randomized controlled trials (RCT), and cohort, case-control, and cross-sectional studies, which provide actual exposure types of pesticides with stunting measurement by height-age z score. A screening, extraction, and synthesis were conducted, leading to a consensus for reaching mutual agreement. The analysis was performed using Microsoft Excel 2017 for the screening and extraction, Revman version 5.4 software for the meta-analysis, and OpenMEE software for the meta-regression. Of the 13 studies subjected to the qualitative analysis, 6 were eligible for inclusion in the meta-analysis: 2 reviews, 2 RCTs, 2 cohorts, 2 case-control, and 5 cross-sectional studies. Exposure to organophosphate and pyrethroid pesticides was not associated with stunting (P=0.78; odds ratio [OR], 1.11; 95% confidence interval [CI], 0.65–1.88). Heterogeneity existed for 79% of the meta-analysis (P≤0.000; z=-5.37; 95% CI, -0.034 to -0.016), and the meta-regression identified age as the causative covariate. Pesticide exposure, regardless of type, is not associated with stunting in children.

Abstract The aim of this study was to evaluate the serum level of 25-hydroxyvitamin D (25(OH)D) in children with febrile seizures (FS) in Luzhou, Sichuan Province, China, and in particular its association with gender and age. This should inform possible strategies for supplementation with vitamin D, and hence for prevention of FS in the local pediatric population. The Febrile seizures group consisted of 747 children hospitalized with FS at the Southwest Medical University Affiliated Hospital from January 2020 to January 2024. The healthy control group was comprised of 750 children aged from 0 to 8 years who underwent health checkups during this period. The serum 25(OH)D level was analyzed in relation to gender and age to explore its association with FS. The median serum vitamin D level in the FS group (28.8 ng/mL; IQR 21.64, 33.64) was significantly lower than in the healthy control group (37.51 ng/mL; IQR 31.05, 37.51). The incidence of vitamin D deficiency in the FS group was 10.8%, which was significantly higher than in the healthy control group (P

Abstract Background Common clinical sense would suggest that individuals with milder obsessive-compulsive disorder (OCD) symptoms should be the most suitable for guided internet-delivered cognitive behaviour therapy (CBT), with more intensive forms of treatment reserved for more severe or complex cases. Results In this secondary data analysis of a non-inferiority clinical trial comparing internet-delivered CBT with in-person CBT for young people with OCD (N = 152), we found that higher baseline symptom severity predicted worse treatment outcomes in the in-person group but not the internet-delivered CBT group. Additional analyses showed that among individuals with milder symptoms, internet-delivered CBT was associated with worse outcomes than in-person CBT. Conclusions If replicated, these results would question the axiom that internet-delivered CBT is most suitable for milder cases. Trial registration The original trial was registered at ClinicalTrials.gov ID NCT03263546. Date of registration 2017–08–28.

Purpose : The authors aimed to identify the factors affecting interhospital transfer (“transfer”) of severe pediatric patients who visited to an emergency department (ED). Methods : Using the Korean National ED Information System, we analyzed high-acuity patients aged 18 years or younger who visited EDs of local or regional emergency centers nationwide. The high acuity was defined as a Korean Triage and Acuity Scale 1-2. To investigate the factors associated with transfer, a multilevel modeling was selected, examining independent variables at both individual- and hospital-levels with transfer as a dependent variable. Results : A model consisting of variables at individual- and hospital-levels showed the factors as follows: mode of arrival(self-transport: odds ratio, 0.48 [95% confidence interval, 0.38-0.61]; other ambulances: 0.41 [0.24-0.71]; compared with firehouse ambulance), visit at 18:00-07:59 (0.75 [0.64-0.88]), intentional injury (1.59 [1.03-2.47]; compared with non-injury), decreased level of consciousness (drowsy: 1.94 [1.33-2.84]; stupor: 4.08 [2.99-5.57]; coma: 1.81 [1.26-2.60]; compared with alert), severe illness diagnosis (1.49 [1.12-1.98]), the number of all beds in EDs (1.02 [1.01-1.04]), and acceptance for treatment (0.92 [0.87-0.98]; with increment of 1%). Conclusion : This study confirms that both individual-level and hospital-level factors affect the transfer risk of severe pediatric patients in EDs. The study suggests the needs for direct transportation to specialized pediatric treatment facilities, and concentrated support for the pediatric emergency medical centers and pediatric trauma centers.

Summary: Background and Aims: Unfavourable changes in body composition are frequently reported in children with cancer. An easy and affordable method to measure body composition is bioelectrical impedance analysis (BIA). In this study, we compared the Tanita MC780-MA Body Composition Analyzer (Tanita) versus the Bodystat Quadscan 4000 analyzer (Bodystat) to determine whether the Tanita is a suitable analyzer for pediatric oncology patients. Methods: In this study, 84 childhood cancer patients/survivors were included. Per patient 1, 2 or 3 visits were planned during or after treatment. During each visit, BIA measurements were performed first with the Tanita analyzer followed by the Bodystat analyzer. In total, 131 measurements were included. Spearman correlation and concordance correlation coefficients of Lin (CCC) were calculated for fat percentage (Fat%), fat mass (FM) and fat free mass (FFM). Bland-Altman plots were constructed to assess the agreement between both analyzers. Results: Fat%, FM and FFM values differed statistically significantly when comparing the BIA devices (Wilcoxon signed rank test, P

Abstract Although the role of low-density granulocytes (LDGs), neutrophils in the peripheral blood mononuclear cell (PBMC) fraction, and neutrophil extracellular traps (NETs) in assessing lupus disease severity is acknowledged, data specific to childhood-onset lupus remains scarce. This study analyzed 46 patients with childhood-onset systemic lupus erythematosus (82.6% females, mean age 14.5 ± 0.3 years), including 26 cases with normal complement levels and 20 with low complement levels, along with 20 healthy adult volunteers. Key parameters that distinguished healthy volunteers from lupus patients and differentiated between lupus patients with low and normal complement were serum interferon (IFN)-α, serum citrullinated histone 3 (CitH3), and extracellular traps (ETs) in LDGs. However, NETs (assessed by nuclear staining morphology), LDG abundance, and other parameters (such as endotoxemia, cytokines, and double-stranded (ds) DNA) did not show such differentiation. When lipopolysaccharide (LPS) was administered to LDGs in the PBMC fraction, it induced ETs in both low and normal complement groups, indicating the inducible nature of ETs. In adult healthy volunteers, activation by recombinant IFN-α or dsDNA in isolated neutrophils induced LDGs and NETs (identified using immunofluorescent staining for CitH3, myeloperoxidase, and neutrophil elastase) at 45 min and 3 h post-stimulation, respectively. Additionally, approximately half of the LDGs underwent late apoptosis at 3 h post-stimulation, as determined by flow cytometry analysis. Activation by IFN-α or dsDNA in LDGs also led to a more pronounced expression of CD66b, an adhesion molecule, compared to regular-density neutrophils, suggesting higher activity in LDGs. In conclusion, IFN-α and/or dsDNA in serum may transform regular-density neutrophils into LDGs before progressing to NETosis and apoptosis, potentially exacerbating lupus severity through cell death-induced self-antigens. Therefore, LDGs and ETs in LDGs could provide deeper insights into the pathophysiology of childhood-onset lupus.

Abstract Background The 13-valent pneumococcal conjugate vaccine (PCV-13) was introduced in Malawi in 2011 with an expected impact of reducing pneumococcal pneumonia in children. We aimed to describe clinical characteristics and nasopharyngeal (NP) carriage of pneumococcus by serotype in children hospitalized with primary end-point pneumonia (PEP) between 2013 and 19 after the introduction of PCV-13. Methods We conducted a secondary analysis of children aged under-5-years hospitalized with acute respiratory illness (ARI) in Malawi. Chest radiographs conducted at admission were read by two independent clinicians according to WHO criteria for PEP, and a third reviewer resolved discordant diagnoses. NP swab specimens were processed and Streptococcus pneumoniae growth was serotyped. Multivariable regression analysis was conducted to assess the association between clinical characteristics, NP serotypes, and PEP. Results We had complete radiographic and NP serotype data for 500 children, of which 54 isolates were vaccine-type (VT) (10.8%), 165 were non-VT (NVT; 33.0%), and 281 had no pneumococcal growth (56.2%). Among these, 176 (35.2%) had PEP on chest x-ray. Among those with PEP, pneumococcal carriage was documented in 43.8% of cases, and VT serotypes accounted for 10.8%. For children with PEP, we found no association between clinical characteristics and carrying either VT, NVT, or no pneumococcus. Conclusion Carriage of S. pneumoniae remains high among children hospitalized with ARI in Malawi, but children with VT carriage were no more likely to have PEP than children carrying no pneumococcus or those with NVT carriage. There were no differences in clinical characteristics between those carrying VT, NVT, or no pneumococcus.

Abstract Background Globally, oral diseases remain a major public health problem. However, there is limited information about the oral health status and factors associated with oral disease among children in Uganda. The aim of this study was to examine the oral health status and factors associated with oral health of primary school children in urban and rural areas of the Gulu district of northern Uganda. Methods A comparative cross-sectional study was conducted among 356 school children aged 11–13 years attending six schools located in urban and rural areas. The children received a clinical oral examination and participated in a questionnaire survey that collected information on sociodemographic and oral health knowledge, attitude, and practices. All data were entered and analysed using IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp statistical software. Logistic regression analyses examined factors associated with dental caries and gingival bleeding. Results Of the 356 children (11–13 years) included, the mean age was 12.2 years, 140 (39.3%) were male and 176 (49.4%) were from urban areas. The proportion of school children with dental caries was 33.6% (n = 119), with the mean decayed, missing due to caries, and filled teeth (DMFT) index of 0.81 (25th percentile = 0; 75th percentile = 1.00). There was no significant difference in caries prevalence between rural and urban children (31.6% versus 35.6%, p = 0.33). Of the children involved in the study, 141(39.8%) had gum bleeding. The mean oral knowledge score was 2.85 ± 1.53 (range, 0–7), while the mean attitude, hygiene practice, frequency of sweets consumption, and oral health related impact scores were 4.25 ± 1.23 (range, 1–6), 5.40 ± 1.81 (range, 0–9), 25.66 ± 4.29 (range 9–54) and 2.1 ± 1.65 (range, 0–6), respectively. Using logistic regression analyses, as oral health knowledge score increased the odds of not having dental caries increased (aOR = 1.19, 95% CI 1.02–1.39). Conclusion The prevalence of dental caries and gum bleeding of primary school children in Gulu district is high. Children lacked knowledge on causes of oral disease, and behaviour towards oral disease prevention. In addition, oral health knowledge scores were significantly associated with dental caries. Oral health education programs in schools should emphasise providing skills-based education.

Mature mediastinal teratoma is a rare benign tumor in children. Few cases have been reported in the literature. Moreover, this tumor is often characterized by slow growth, reaching a large volume and frequently causing nonspecific symptoms, making its diagnosis more difficult. It raises the question of differential diagnosis with malignant mediastinal tumors in pediatric patients, requiring histological confirmation by biopsy or excision. The purpose of this article is to report an atypical clinical finding characterized by spinal deformity, and to contribute to medical knowledge concerning this uncommon pediatric tumor.

Background Henoch-Schonlein purpura is a vascular inflammatory illness that develops in childhood and in some children involves the kidneys, clinically known as Henoch-Schonlein purpura nephritis. Different studies have suggested different interventions, and there is a wide variation in the outcome indicators used for the intervention approaches. Objective To investigate and analyze the current status of clinical research outcome indicators for Henoch-Schonlein purpura nephritis in China, so as to provide a reference basis for the establishment of a core set of outcome indicators in this field. Methods CNKI, CBM, VIP, Wanfang Data, PubMed, Cochrane Library, Embase and Web of Science were systematically searched to collect publicly available Henoch-Schonlein purpura nephritis studies from January 2010 to June 2021. The Chinese databases were searched using the search strategy of title or keywords combined with subject terms, and the English databases were searched using subject terms combined with free words. Two investigators independently screened the literature and extracted information according to the inclusion and exclusion criteria, processed and analyzed the data on outcome indicators. Results A total of 148 randomized controlled trials of Henoch-Schonlein purpura nephritis were included, and the outcome indicators of Henoch-Schonlein purpura nephritis studies were mainly physical and chemical indicators, with fewer symptomatic indicators. The highest frequency of outcome indicators were clinical efficacy (121 times, 81.76%), adverse reactions (74 times, 50.00%), 24-hour urine protein (68 times, 45.95%), urinary red blood cells (43 times, 29.05%), and recurrence rate (20 times, 13.51%). The division between primary and secondary outcome indicators was clearly distinguished in only two articles. Conclusion There are several indicators for the research outcomes of Henoch-Schonlein purpura nephritis in China, primarily physical and chemical variables, with significant variation. The research focuses on efficacy measures but ignores adverse reactions. As a result, it is necessary to establish a set of outcome indicators for clinical intervention studies on Henoch-Schonlein purpura nephritis in order to provide a reference basis for selecting outcome indicators and guiding clinical decision-making in future similar studies.

Background Studies have confirmed that executive function in overweight and obese children is closely related to obesity and may have a bidirectional association. Aerobic exercise, as an effective intervention, can effectively promote their brain development and cognitive function, especially executive function, but the quantitative relationship of the improvement effect still needs to be further explored. Objective To systematically evaluate the intervention effect of aerobic exercise on executive function-related indexes in overweight and obese children. Methods Randomized controlled trials of aerobic exercise interventions for executive function in overweight and obese children were searched in CNKI, Wanfang Data, CBM, Cochrane Library, PubMed, Embase, and Web of Science databases, and the timeframe for searching was from the establishment of each database to July 2023. The quality of the included literature was assessed according to the Cochrane Risk of Bias Assessment Tool, and Meta-analysis of outcome indicators was performed using RevMan 5.3 and Stata 15.0 software. Results Nine randomized controlled trials, including 940 overweight and obese children, were finally included. The results of Meta-analysis showed that a single session of aerobic exercise intervention was effective in improving the executive function of overweight and obese children (WMD=-6.98, 95%CI=-11.89 to -2.07, P=0.005). Subgroup analyses showed no significant differences in the improvement of any of the executive function subcomponents in overweight and obese children with a single intervention duration of less than 30 minutes of aerobic exercise (WMD=-0.84, 95%CI=-9.37 to 7.68, P=0.85) ; aerobic exercise with a single intervention duration longer than 30 minutes improved inhibitory function in overweight and obese children (WMD=-10.50, 95%CI=-19.15 to -1.85, P=0.02). When a long-term exercise intervention was carried out (the intervention period was 8 weeks), in contrast to the control group, the aerobic exercise improved interference control in overweight and obese children (WMD=-0.16, 95%CI=-0.18 to -0.14, P

According to the legal system of Iran and Algeria, any marriage before the Marriageable age is subject to the permission of the parents of the child in compliance with the expediency of the child by the court. In Algerian law, such a marriage is possible subject to the child’s status of necessity. In Islamic jurisprudence, the eligibility for marriage is subject to the maturity age of the child (Marriageability age), and Marriage before this age for a child on behalf of the parents, executor, and the judge in the child's interest is allowed. such a marriage is subject only to the parent’s permission. The best interest of the child is a relative concept and must be evaluated according to the child’s gender, age, and mental and physical condition. We have three ways to determine the best interest of a child in such a marriage: consultation with parents, experts, and social research. According to the Algerian family law, permission to marry without a medical certificate is prohibited, and judges also use the criterion of consulting parents. There is a degree of disagreement in opinions regarding the status of child marriage with the permission of the parents and without determining the best interests of the child by the court, and its revocability in Iranian law and validity in Algerian law is preferred.

Aim: The present study employed an analytical, cross-sectional, and pretest-posttest design to assess the impact of parental presence on the anxiety levels of nurses during intravenous interventions in pediatric patients. Materials and Methods: The research was conducted in a public hospital in Istanbul between 01 September and 30 December 2021. The population of the research consisted of nurses working in the pediatric clinic of the hospital (N = 70), and the sample consisted of 50 nurses who met the research criteria and agreed to participate in the research. Data were obtained through an information form and a state-trait anxiety inventory. Participants were first asked to fill out the information form and the trait anxiety inventory. The research was carried out in two phases with the same sample group. In the first phase, nurses were asked to fill out the state anxiety inventory immediately after intravenous interventions were administered to children while their parents were with their children. In the second phase, after a period of 15 days, a state anxiety inventory was applied to the nurses with the same sample group immediately after the intravenous interventions, without the participation of the family. The SPSS 26 package statistical program was used to evaluate the data. Result and Conclusion: It was determined that the mean trait anxiety scores of the participants were at a medium level and that the mean state anxiety scores of the nurses were statistically significantly higher (p

Abstract Pediatric chronic pain places a significant burden on children, their families, and healthcare services. Effective pain measurement is needed for both clinical management and research. Digital pain measurement tools have been developed for adult and adolescent populations however less is known about measurement in younger children. In this systematic review, we aimed to identify, describe, and evaluate (in terms of acceptability) digital tools for the assessment of chronic pain in children (5–11 years). We searched five databases (Cochrane Library, EMBASE, MEDLINE, PsycINFO, and CINAHL), between January 2014 and January 2022. We included empirical studies which included digital tool/s to assess pain in children aged between 5–11 years with chronic pain conditions. We independently double‐screened the papers to determine eligibility. We followed PRISMA guidelines for reporting. A total of five papers, covering four digital tools, were included. The digital tools used ranged from a static online survey to a highly interactive, personalized tablet application. Two studies were cross‐sectional and two collected longitudinal pain data via electronic devices outside the clinical setting. Digital features of the tools included: dynamic testing (n = 2), notifications/prompts (n = 1), data transmission (n = 1), remote monitoring (n = 1), accessibility (n = 1), data visualization/feedback (n = 1), personalization/customization (n = 1), gamification (n = 1) and data labeling (n = 1). Qualitative usability data was only available for one of the tools, which indicated its acceptability and highlighted preferred features/functions by child users (creative and personalizable features, gamification features), and parental users (symptom tracking). This review has highlighted the limited number of digital assessment tools available for children with chronic pain aged 5–11. This review identified some examples of technology enabling the capture of longitudinal, repeated measurement of multiple dimensions of pain (intensity, location, quality). We suggest directions for future research.

A Europe-wide outbreak of invasive pediatric group A streptococcal infections (iGAS) began in fall 2022. Here, we report the evolution of GAS hospitalizations in children and adolescents during the second outbreak year in 2023–2024 at a tertiary center in Switzerland. Using prospective monitoring of all in-patient GAS cases below 16 years of age, including those with iGAS, we compared case frequencies and clinical characteristics in three time periods (2013–2020; 2022–2023; 2023–2024). Annual GAS hospitalizations increased from a median of 25 cases (range 11–28) in 2013–2020 to 89 and 63 cases, respectively, in 2022–2023 and 2023–2024. iGAS cases evolved similarly (2013–2020, 4 cases (3–8); 2022–2023, 32 cases; 2023–2024, 21 cases). The decline in cases from 2022–2023 to 2023–2024 included all types of GAS organ involvement, except suppurative infections in the head area, which remained largely unchanged (48 vs. 45 cases). Pleural empyema declined from 13 to 7 cases, possibly explained by a poor overlap of the GAS and influenza curves, respectively, in 2023–2024 compared to 2022–2023. These data document the prolongation of the GAS outbreak into its second winter season in 2023–2024.

Global developmental delay (GDD) and intellectual disability (ID) are relatively common neurodevelopmental disorders that significantly impact affected children, their families, and society. The etiology of GDD/ID is notably diverse, encompassing both genetic and acquired factors. Although the precise cause of most GDD/ID cases remains unclear, an estimated half of all cases can be attributed to genetic factors. Thus, a detailed medical history and comprehensive physical examination remain pivotal for guiding diagnostic investigations into the underlying causes of GDD/ID. Advancements in genetic testing have supplanted traditional methods such as karyotyping and fluorescence in situ hybridization with chromosomal micro arrays, which are now the primary genetic tests for children with idiopathic GDD/ID. Moreover, the evaluation of Fragile X and Rett syndrome should be an integral component of initial diagnostic assessments. In recent years, whole-exome sequencing and whole-genome sequ-encing have emerged as important diagnostic tools for evaluating children with GDD/ID and have substantially enhanced the diagnostic yield rates. Gene therapy has emerged as a promising avenue and is poised to become a cornerstone in addressing various genetic developmental and epilepsy disorders. Early intervention facilitated by a proficient multidisciplinary team can markedly enhance the prognosis and outcomes of GDD/ID, particularly when parents or caregivers are actively engaged in the interventional process. This review discusses risk factors and common underlying causes, explores recent evidence and recommendations for genetic evaluation, and offers management strategies for children with GDD/ID.

Asthma, the most common chronic disease, is characterized by airway inflammation and airflow obstruction. The World Health Organization estimates that approximately 300 million people worldwide have asthma, 30% of whom are pediatric patients. Asthma is a major cause of morbidity that can lead to hospitalization or death in severe pediatric cases. Therefore, it is necessary to provide children with objective and reliable treatment according to consistent guidelines. Several institutes, such as the Global Institute for Asthma, National Heart, Lung, and Blood Institute, British Thoracic Society, Japanese Society of Pediatric Allergy and Clinical Immunology, and Korean Academy of Asthma, Allergy, and Clinical Immunology have published and revised asthma guidelines. However, since recommendations differ among them, confusion persists regarding drug therapy for pediatric asthma patients. Additionally, some guidelines have changed significantly in recent years. This review investigated the latest changes in each guideline, compared and analyzed the recommendations, and identified the international trends in pediatric asthma drug therapy. The findings of this review may aid determinations of the future direction of the Korean guidelines for childhood asthma.

Background The pathophysiology and susceptibility of children to primary immune thrombocytopenia (ITP) are linked to polymorphisms of the interleukin (IL)-1B and IL-1 receptor (IL-1R) antagonist genes. Purpose To investigate the association between the susceptibility and severity of primary ITP in children and the IL-1B and IL-1R antagonist gene polymorphisms. Methods This comparative case-control studywas conducted at the Menoufia University Hospital Hematology and Oncology Unit, Pediatric Department, between August 2022 and September 2023. The children were divided into patients (28 boys, 22 girls) who received hospital and outpatient clinic care and controls (50 healthy age- and sex-matched children). Results The mutant homozygous GG genotype and mutant G allele of rs16944 of the IL1B gene were considerably greater in patients than in controls (P

Noncystic fibrosis bronchiectasis is a chronic respiratory disease that carries high socioeconomic and medical burdens and is caused by diverse respiratory illnesses. To improve clinical outcomes, early recognition, active treatment of exacerbations, and prevention of further exacerbations are essential. However, evidence for the treatment and prevention of acute exacerbation of noncystic fibrosis bronchiectasis, especially in children, is lacking. Therefore, the evidence- and consensus-based guidelines for medical and nonmedical treatment strategies for noncystic fibrosis bronchiectasis in children and adolescents were developed by the Korean Academy of Pediatric Allergy and Respiratory Disease using the methods recommended by the Grading of Recommendations Assessment, Development, and Evaluation working group with evidence published through July 2, 2020. This guideline encompasses evidence-based treatment recommendations as well as expert opinions, addressing crucial aspects of the treatment and management of non-cystic fibrosis bronchiectasis in children. This includes considerations for antibiotics and airway clearance strategies, particularly in areas where evidence may be limited. Large, well-designed, and controlled studies are required to accumulate further evidence of management strategies for noncystic fibrosis bronchiectasis in children and adolescents.

This study analyzes data from India’s National Family Health Survey to assess the prevalence of anemia among children aged 6–59 months. Over the past decade, the prevalence increased from 59% to 67%, remaining a significant public health concern. Gujarat has highest rates, and Kerala has lowest among major states in India. The Western region tops in prevalence (75.70%), whereas the Northeast has the lowest (56.20%). Factors such as lower maternal education, poverty, religion, rural residence, poor child nutrition, low birth weight, and stunting contribute to higher odds of anemia. Improved socioeconomic conditions and maternal nutrition are recommended for risk reduction.

Objectives The aim of the article is to draw attention to the insufficient protection of a child’s privacy when parents share information, photos or videos with their child on the Internet. Material and methods The work was based on the analysis of literature in the field of sociology and law regarding the phenomenon of sharenting, including its cause and the threats it carries. The work analyzed legal regulation regarding the scope of parental interference in the personal rights of the child. Results The considerations carried out lead to the conclusion that the existing legal regulations do not sufficiently protect the child against violation of personal rights by parents, in particular in the context of parents sharing photos or videos of the child on social networks. Conclusions It was proposed to supplement the regulations of the Family and Guardianship Code with a clear indication that the obligation of the parent or guardian, as part of the exercise of parental authority, is also to protect the privacy and image of the child.

Background: Primary schools fit the criteria for oral health awareness program, and the leading reason is that health behavior developed during early age period has concrete foundation in children’s health practices. Limited amalgamation of dental education in school syllabus is the prime reason, why oral health knowledge in schoolteachers must be optimum. Aim: This study aimed to assess the awareness among primary school teachers toward students’ oral care in Ahmedabad city. Setting and Design: A cross-sectional study enrolling 240 primary school teachers of government and private schools of Ahmedabad city. A total of 16 questions were formulated for the study. Materials and Methods: Schools within a 7 km radius of the institute were considered a sampling frame. Both government and private schools with primary level were included in the study. Cronbach’s alpha value was 0.71 which shows adequate internal consistency and reliability of a given questionnaire. Statistical Analysis Used: The descriptive statistics were expressed in frequency and percentage. The Chi-square test was applied to analyze oral health awareness among government and private primary school teachers. Results: 72.9% of teachers were female. Government school teachers reported significantly higher level (P ≤ 0.05) of knowledge about the number of times one should brush their teeth in a day. 87.4% of government school teachers and 90.5% of private school teachers agreed on attending oral health education program. Conclusion: The present study findings conclude that primary school teachers’ oral health knowledge is good. Their attitude is pragmatic, and practice toward students’ dental care is favorable.

Abstract Background The latent tuberculosis infection (LTBI) burden is still unclear in schoolchildren and adolescents in China. Previous study and daily surveillance data indicate a LTBI detection gap. The research objective was to evaluate the LTBI burden and detection gap among schoolchildren and adolescents in China. Methods A cross-sectional study was conducted among 69,667 schoolchildren and adolescents in Chongqing, China between September 2022 and December 2023 implemented by Chongqing Municipal Institute of Tuberculosis using tuberculin skin test (TST) and creation tuberculin skin test (C-TST). To evaluate the LTBI detection gap, the pulmonary tuberculosis (PTB) screening data implemented by Chongqing Municipal Institute of Tuberculosis have been compared with the data in 2021 implemented by community-level medical and health care institutions. Results The LTBI prevalence rate using TST and C-TST implemented by Chongqing Municipal Institute of Tuberculosis was 12.8% (95%CI, 12.5-13%) and 6.4% (95%CI, 6-6.8%) respectively. The LTBI prevalence rate by Chongqing Municipal Institute of Tuberculosis was 9.6% higher than that by community-level medical and health care institutions (χ 2 = 2931.9, P

Abstract Background Children utilizing invasive home mechanical ventilation (administered via tracheostomy tube) receive intensive care at home without the support of trained staff typically present in an intensive care unit; within the context of worsening home nursing shortages, much of the 24/7 care burden falls to families which are likely under supported. Prior reviews have explored the quality of life of children receiving various forms of mechanical ventilation, without addressing the impact on the family. Additionally, the literature inconsistently differentiates the unique experience of families with children using invasive home mechanical ventilation from non-invasive, which has lower morbidity and mortality and requires less nursing care in the home. Therefore, our study aims to explore and map the existing literature regarding the impact of invasive home mechanical ventilation on the child and family’s quality of life. Identified gaps will inform future research focused on improving the family quality of life of children with invasive home mechanical ventilation. Methods Five databases will be searched using keywords and controlled vocabulary to identify relevant studies: Ovid Medline, Embase, Scopus, and Cochrane Library. English language studies will meet inclusion criteria if they include primary research studies of children or families of children utilizing invasive home mechanical ventilation at home and assess quality of life. Children and young adults aged 0–25 years will be included. We exclude studies of hospitalized children, studies focused solely on healthcare professional experiences or clinical outcomes, and those focused on the period surrounding discharge from admission for tracheostomy placement. Two independent reviewers will screen studies at the title/abstract and full-text levels. Two independent reviewers will extract data from relevant studies. Disagreements will be resolved by an independent third reviewer. A targeted grey literature search will be performed utilizing ProQuest, clinicaltrials.gov, WHO trial registry, Google Scholar, and professional societies. Findings will be presented in tables and figures along with a narrative summary. Discussion This scoping review seeks to map the literature and provide a descriptive report of the health-related quality of life of children using invasive home mechanical ventilation and their families. Registration Open Science Framework https://doi.org/10.17605/OSF.IO/6GB84 Date of Registration: November 29, 2023.

Cystic echinococcosis is a parasitic disease with significant importance for public health in endemic regions. Spinal cystic echinococcosis, however, is a rare form that may lead to severe complications due to its localization. In this manuscript, we presented a 16-year-old male patient who admitted with abdominal and back edema for 2 months, evaluated with preliminary diagnoses of Pott’s abscess and malignant mass, subsequently diagnosed with spinal cystic echinococcosis. It was concluded that cystic echinococcosis should be considered in differential diagnosis of large cystic masses and percutaneous aspiration, injection, reaspiration method might be a safe and effective treatment option particularly for cases of complicated spinal cystic echinococcosis.

Background: Attention-deficit/hyperactivity disorder (ADHD) is associated with increased costs for the family, the health care system and the society. Previous cost-of-illness studies in Germany usually focused on prevalent ADHD. This study addressed the research gap on health care resource utilisation and costs of children and adolescents with incident ADHD diagnosis using nationwide claims data from the statutory health insurance DAK-Gesundheit. Methods: A matched-control design (propensity score matching, 1:3 ratio) was used to examine the health care costs of incident ADHD patients compared with a non-ADHD control group, considering an observation period of four quarters. Besides bivariate statistics, multivariate analyses of total costs were used to consider relevant covariates. Results: Total health care costs for children and adolescents with ADHD in the first year after diagnosis exceeded those of the control group by € 1,505.3. According to the multivariate analysis, the group with incident ADHD had significantly higher (2.86-fold) health care costs when compared with non-ADHD peers. Sensitivity analyses proved these findings. In addition, the analyses identified children’s age and comorbidity index to be significantly associated with increased costs. Conclusions: ADHD in children and adolescents is associated with a significant economic burden. The results emphasise the need for social awareness, prevention, appropriate treatment and research efforts.

Objective To investigate the imaging diagnosis and differential diagnosis methods for common tumors in the posterior fossa of children, and to propose a flow chart for the diagnosis of common tumors in the posterior fossa of children based on the limited diffusion of DWI according to the idea of localization diagnosis followed by qualitative diagnosis. Methods A total of 118 pediatric patients with posterior fossa tumors who underwent surgical resection in Huashan Hospital, Fudan University from January 2021 to January 2024 were enrolled, and all of them underwent head CT and MRI examinations, and preoperative localization diagnosis and qualitative diagnosis were carried out accordingly. Then, based on whether DWI was diffusion limited, a flow chart for the diagnosis of common tumors in the posterior fossa of children was proposed. Results A total of 118 children with posterior fossa tumors were localization and qualitatively diagnosed, including 41 cases of fourth ventricular tumors, including medulloblastoma (27 cases), pilocytic astrocytoma (7 cases), ependymoma (5 cases), choroid plexus papilloma (one case), and rosette-forming glioneuronal tumor (RGNT, one case). There were 38 cases of brainstem tumors, including 24 cases of diffuse midline glioma, H3 K27 - altered, 5 cases of pilocytic astrocytoma, 3 cases of cavernous hemangioma, 2 cases of pediatric-type diffuse high-grade glioma (prone to diffuse midline glioma, H3 wild type), 2 cases of ganglio glioma, one case of atypical teratoid/rhabdoid tumor (AT/RT), and one case of pediatric - type diffuse low - grade glioma. There were 9 cases of cerebellopontine angle (CPA) tumors, including 3 cases of pilocytic astrocytoma, 2 cases of cholesteatoma, one case of medulloblastoma, one case of diffuse midline glioma, H3 K27-altered, one case of pilomyxoid astrocytoma, and one case of Ewing sarcoma. There were 30 cases of cerebellar tumors, including 15 cases of pilocytic astrocytoma, 7 cases of medulloblastoma, 2 cases of cavernous hemangioma, one case of ependymoma, one case of pediatric-type diffuse low-grade glioma, one case of pediatric-type diffuse high- grade glioma (prone to diffuse midline glioma, H3 wild type), one case of dysembryoplastic neuroepithelial tumor (DNT), one case of hamartoma, and one case of extrarenal rhabdomyomatoid tumor cerebellar metastases. Localization diagnosis, the accuracy of preoperative CT was 93.22% (110/118), while the accuracy of preoperative MRI was 100% (118/118). Qualitative diagnosis, 74 cases (62.71%) had accurate qualitative diagnosis, 23 cases (19.49%) had general diagnosis, and 21 cases (17.80%) had wrong diagnosis. The imaging differential diagnosis of posterior fossa tumors in children focuses on medulloblastoma, pilocytic astrocytoma, ependymoma, and diffuse midline glioma, H3 K27-altered. The incidence of limited diffusion of DWI in medulloblastoma, pilocytic astrocytoma and ependymoma outside the brainstem was 100% (35/35), 4% (1/25) and 5/6, and the difference among the three tumors was statistically significant (Z = - 5.601, P = 0.000). The incidence of limited diffusion of DWI in diffuse midline glioma, H3 K27- altered and pilocytic astrocytoma in the brainstem was 79.17% (19/24) and 1/5, and the difference between the two tumors was also statistically significant (Fisher's exact possibility: P = 0.038). Conclusions The early diagnosis of posterior fossa tumors in children is difficult, and DWI is an important basis for differential diagnosis.

Cerebellar mutism syndrome (CMS) is a prevalent postoperative complication in children following posterior fossa tumor surgery, with a significantly variable incidence rate across different pathological types of tumors, being highest in medulloblastoma (24%-30%). The pathogenesis of CMS remains to be elucidated, but it is believed to be associated with damage to the cerebellocerebral circuits, harm to the fastigial nuclei of cerebellum and periaqueductal gray matter of the midbrain, and alterations in brain networks. Predictive models constructed based on the risk factors of CMS have not yet demonstrated the anticipated stability and have not been widely adopted in clinical settings. Pharmacological treatments are primarily based on clinical experience, yet their efficacy requires further validation, hence there is currently a lack of a clearly effective treatment method; non-pharmacological treatments, such as physical therapy, occupational therapy, and speech therapy, have shown some effect on improving the long - term quality of life. This review summarizes the pathogenesis and therapeutic advances of CMS, and future research should be dedicated to exploring the pathophysiological mechanisms of CMS, constructing more accurate predictive models, devising personalized treatment plans, and enhancing the long-term prognosis for children.

Objective To compare the detection rates of epileptogenic foci in drug - refractory epilepsy children using video electroencephalography (VEEG), MRI and PET. Methods The 24 h and 2 h VEEG, MRI and PET/CT or PET/MRI were conducted for 70 children with drug - refractory epilepsy in Children's Hospital of Nanjing Medical University from January 2020 to April 2022, and Raven's Standard Progressive Matrices (SPM) or Developmental Screening Test for Child under six (DST) based on their age (< 5 or ≥ 5 years old) were assessed for intelligence. Results Among 70 children, 44 seizures were detected during 24 h VEEG, while 31 seizures were detected during 2 h VEEG, and there was statistically significant difference between the two methods (χ2 = 5.760, P = 0.015). The consistency of diagnosing single location/ unilateral abnormalities, bilateral abnormalities, or normal results was poor among VEEG, MRI and PET/CT or PET/MRI (κ = 0.194, P = 0.000), and the difference among the three methods was statistically significant (χ2 = 33.068, P = 0.001). The VEEG (χ2 = 25.000, P = 0.000) and PET/CT or PET/MRI (χ2 = 11.764, P = 0.002) had higher diagnostic capabilities than MRI, and PET/CT or PET/MRI had higher diagnostic capability than VEEG (χ2 = 8.048, P = 0.014). There were 41 children (58.57%) showed mental retardation, among them children with onset age ≤ 2 years had a higher rate compared to those with onset age > 2 years (χ2 = 6.193, P = 0.013), and children with abnormal VEEG background had a higher rate compared to those with normal VEEG background (χ2 = 4.868, P = 0.027). Conclusions The detection rate of epileptiform discharges and clinical seizures can be increased by lengthening VEEG time at each time and increasing the number of times of VEEG. PET/CT or PET/MRI and VEEG can provide localization information of epileptic foci of children whose MRI results are negative. The mental retardation rate of children who have onset age ≤ 2 years and of abnormal VEEG background is higher.

Pituitary adenoma is a benign intracranial tumor, commonly found in adults and occasionally in children. Pituitary adenoma is classified into secretory and non-secretory adenoma based on whether there is abnormal hormone secretion. The main manifestations include endocrine system abnormalities, visual disturbance and symptoms of intracranial hypertension. Although the incidence rate of pituitary adenoma in children is low, its physiological and psychological impact on children is obvious, diagnostic and therapeutic process is unique, and it has some characteristics, more complicated differential diagnosis than adults, such as more endocrine symptoms, poor paranasal sinus gasification, the impact of transnasal surgery on developing children, drug therapy and radiotherapy for children and individualization, postoperative endocrine regulation and subsequent development problems, etc.. Therefore, it is necessary to discuss pituitary adenoma in children independently from adults. This article reviews the clinical research progress of pediatric pituitary adenoma in recent years.

Pediatric gliomas are highly heterogeneous and have unique molecular characteristics. They are not smaller versions of adult gliomas. This review emphasizes the basic points of surgery, radiotherapy, and chemotherapy for pediatric gliomas, introduces the similarities and differences with targeted therapy for adult gliomas, describes the important driver gene abnormalities involved in pediatric gliomas and the corresponding targeted therapy strategies, and focuses on the epigenetic treatment strategies for pediatric diffuse high-grade gliomas caused by histone H3 mutations, and looks forward to the future work of diagnosis and treatment of pediatric gliomas.

Pediatric - type low - grade glioma (pLGG) is the most common central nervous system tumor in children, and most pLGG exhibits non -invasive clinical behavior with a good prognosis. Total surgical resection is an important prognostic factor, and patients can achieve long-term survival after total tumor resection. However, tumors in deep location such as brain stem and optic pathway cannot be completely removed by surgery. Chemotherapy is the first choice of adjuvant treatment when the clinical symptoms of pLGG worsen or imaging progress. In recent years, in addition to traditional chemotherapy, the development and application of targeted therapy drugs have also made great progress. This article reviews the research progress and challenges of chemotherapy and targeted therapy of pLGG, in order to provide guidance for clinical practice.

Objective To explore effective treatments and prognostic factors for diffuse intrinsic pontine glioma (DIPG). Methods Clinical and imaging information and survival data of 14 DIPG patients, treated with radiotherapy combined with temozolomide and nitolizumab or radiotherapy combined with ACT001, were retrospectively analysed at Beijing Tiantan Hospital, Capital Medical University from April 2021 to January 2024. The median progression free survival (PFS) and overall survival (OS) were calculated using Kaplan - Meier survival curves, and multifactorial Cox regression analysis was used to investigate the effects of different factors on PFS and OS. Results The objective response rate (ORR) was 10/14, and the median PFS and OS were 7.83 and 8.30 months, respectively. Multfactorial Cox regression analysis identified the absence of enhancement on baseline imaging as a good prognostic variable for both PFS (RR = 0.052, 95%CI: 0.006-0.416; P = 0.005) and OS (RR = 0.046, 95%CI: 0.005-0.413; P = 0.006), while male (RR = 0.085, 95%CI: 0.009-0.764; P = 0.028), older age (RR = 0.631, 95%CI: 0.423-0.942; P = 0.024), and the absence of symptoms of cranial nerve involvement at the onset (RR = 0.116, 95%CI: 0.017- 0.781; P = 0.027) were also good prognostic variables for OS. Conclusions Female, younger age at diagnosis, cranial nerve involvement at the onset, and enhancement on baseline imaging are risk factors for the survival of children with DIPG.