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Coronavirus disease 2019 (COVID-19) is an emergent infectious pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is highly contagious and pathogenic. COVID-19 has rapidly swept across the world since it was first discovered in December 2019 and has drawn significant attention worldwide. During the early stages of the outbreak in China, traditional Chinese medicines (TCMs) were involved in the whole treatment process. As an indispensable part of TCM, Chinese patent medicines (CPMs) played an irreplaceable role in the prevention and treatment of this epidemic. Their use has achieved remarkable therapeutic efficacy during the period of medical observation and clinical treatment of mild, moderate, severe, and critical cases and during convalescence. In order to better propagate and make full use of the benefits of TCM in the treatment of COVID-19, this review will summarize the potential target of SARS-CoV-2 as well as the theoretical basis and clinical efficacy of recommended 22 CPMs by the National Health Commission and the Administration of TCM and local provinces or cities in the treatment of COVID-19. Additionally, the study will further analyze the drug composition, potential active ingredients, potential targets, regulated signaling pathways, and possible mechanisms for COVID-19 through anti-inflammatory and immunoregulation, antiviral, improve lung injury, antipyretic and organ protection to provide meaningful information about the clinical application of CPMs. [ABSTRACT FROM AUTHOR]

Background: The study aimed to investigate the risk factors of malnutrition in children with congenital heart defect (CHD) in China.Methods: This cohort study was performed at the biggest pediatric heart center in China; 3252 patients with CHD who underwent cardiac surgeries in 2013 were included. Anthropometric measurements included weight for age Z score (WAZ), weight for height Z score (WHZ), and height for age Z score (HAZ). The patients were classified as normal nutritional status and malnutrition, based on a cut-off Z score of <- 2. Factors associated with malnutrition were determined using logistic regression analysis.Results: The prevalence of preoperative WAZ < -2 (underweight), HAZ < -2 (stunting), and WHZ < -2 (wasting) was 23.3, 23.3, and 14.3%, respectively. The multivariable analysis of preoperative malnutrition showed that hospitalization, age at surgery, risk adjustment for congenital heart surgery-1 > 3, mechanical ventilation, pulmonary hypertension, and acyanotic heart disease were associated with underweight. Parents' height, single ventricle, and cyanotic heart disease were associated with stunting. Hospitalization and pulmonary hypertension were associated with wasting. After surgery, the patients presented a significant improvement in growth within the first year in all three parameters and grew to the normal range of WAZ (- 0.3 ± 0.9, P < 0.001), HAZ (0.2 ± 0.8, P = 0.001), and WHZ (0.03 ± 0.6, P < 0.001) at 2 years after surgery. The prevalence of underweight, stunted, and wasting declined to 3.2, 2.7, and 1.9% 3 years after surgery. Malnutrition after surgery was associated with cardiac residual cardiac abnormalities (OR = 35.3, p < 0.0001), high Ross classification of heart function (OR = 27.1, p < 0.0001), and long-term taking oral diuretics (OR = 20.5, P = 0.001).Conclusions: Malnutrition is still a problem in children with CHD in China, especially before the surgery. There is need to strengthen the nutrition support for children with CHD before surgery. Hemodynamic factors were found to be the risk factors associated with malnutrition after operation. [ABSTRACT FROM AUTHOR]

Background: To identify the normal range and distribution in the cephalic index(CI) and horizontal point of maximum width(H-PMW) of Chinese children with normal brain development., Methods: We retrospectively analyzed Chinese Han children who visited our hospitals between June 2015 and June 2020 because of headache or suspected head injuries. 456 children (257 males, 199 females; aged 0-15 years) were enrolled and divided into 7 groups by age. The values of CI and H-PMW were measured using thin-slice brain computed tomography images., Results: The overall mean CI was 86.6 ± 5.2. The mean CI for males was 87.0 ± 5.1, and that for females was 86.0 ± 5.2. The overall mean H-PMW was 53.7 ± 2.4. The mean H-PMW for males was 53.8 ± 2.5, and that for females was 53.5 ± 2.3. The averages CI reached the maximum (89.98) at the age of 4-6 months, then began to decrease, decreased to the minimum (84.31) at the age of 2-3 years, and then gradually increased, and reached 86.17 at the age of 8-15 years. The average H-PMW was the smallest (52.17) at the age of 4-6 months, and reached 54.88 at the age of 8-15 years., Conclusion: The CI and H-PMW values of Chinese normal children reported in this study will provide a valuable reference to diagnose cranial deformities, assess the severity of the disease and the effectiveness of the treatment., (© 2024. The Author(s).)

Aim: To explore the clinical effect and significance of preventive surgery for asymptomatic spinal lipomas in children., Material and Methods: We retrospectively analysed the clinical data of 168 patients with asymptomatic spinal lipoma from April 2001 to June 2019, Shanghai Department of Neurosurgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine. The patients were aged from 1.5 months to 15 years (the average age was 7 months), and there were no neurological symptoms, such as pain, incontinence, and/or bilateral lower limb dysfunction, before surgery. The surgical procedure included completely removing the lipomas in subcutaneous and extramedullary tissues of the spinal cord, subtotal resection of intraspinal fat, and separating the spinal cord, including the medullary conus from the dura sac, to release the tethered cord., Results: For the 168 children with spinal lipomas included in the study, complete resection was undertaken for the dorsal spinal lipomas, and subtotal resection was performed for the transitional lipomas. Subcutaneous effusion caused by cerebrospinal fluid leakage occurred in 5 cases after surgery and was cured after multiple punctures and aspiration. Six patients developed mild incontinence immediately after the operation, 5 of whom completely returned to normal within 1 month, and 1 had no relief of symptoms. A total of 159 of the 168 patients were followed up for 3 to 19 years (the median follow-up time was 76 months). Longterm postoperative symptoms were observed in 13 patients (7.7%), including 12 cases of spinal cord retethering and 1 case of lipoma enlargement., Conclusion: Preventive surgery can reduce the future incidence of neurological dysfunction in children with asymptomatic spinal lipomas.

Objective: We present the clinical features, imaging, and management of 5 cases of visual impairment as the primary manifestation ventriculoperitoneal (V-P) shunt malfunction., Methods: We retrospectively reviewed the medical records of 126 patients of V-P shunt malfunction in Shanghai Children's Medical Center between 2015 and 2020. Medical records including all hospital admissions were reviewed and follow-up data were collected., Results: Five children (3.97%) had visual impairment as the primary manifestation of V-P shunt malfunction, with a mild or no headache. Four broken distal shunt catheters and one proximal catheter blockage were confirmed intraoperatively and cured by surgery. None of the patients had a definite improvement in ophthalmic examinations after 4-52 months of follow-up., Conclusion: Visual impairment as the primary manifestation of V-P shunt malfunction was uncommon and could be easily missed or misdiagnosed as the only problem for lack of typical features of increased intracranial pressure and unchanged ventricular size. Earlier definitive diagnosis and surgical intervention could prevent a further development of the visual loss caused by V-P shunt malfunction., (© 2022 S. Karger AG, Basel.)

Objective: The aim of the study was to evaluate the effectiveness of an audio and animated cartoon questionnaire (AACQ) at improving consent process in child for biospecimen donation., Methods: A multi-center randomized and controlled survey was performed at two pediatric hospitals in China from 2019 to 2020. Children aged from 7 to 18 years in the pediatric surgery wards were invited to investigate the participants' willingness and attitudes for donating biospecimens. A total of 264 children, including 119 in the AACQ group and 145 in the TQ group, and 67 parents of children were analyzed. A separate knowledge test was acquired in the questionnaires., Results: Our findings showed that the response rate of the AACQ group (89.85%) was significantly higher than that of the TQ group (68.44%; p < 0.001). AACQ can improve the child's understanding, increase children's engagement in biospecimen donation, reduced the differences in selected characteristics affecting children understanding, and enhanced their risk awareness of donating biospecimens. We also found that increasing pain and privacy disclosure were the most popular concern among children for the refusal to donate biospecimens., Conclusions: AACQ is an effective and standardized tool of content delivery to children from the surgical wards. Children who fully understood of biospecimen donation are suggested to participate in the consent signing., Impact: Using audio and animated cartoon questionnaire is a more effective and standardized tool of content delivery to children. This study expanded the use of an animated cartoon to a children's survey. Audio and animated cartoon questionnaire (AACQ) can improve the child's understanding, increase children's engagement in biospecimen donation compared to text questionnaire (TQ) group, and enhanced their risk awareness of donating biospecimens. More AACQ should be used with children in the future to effectively deliver content to children and improve children's participation in the survey., (© 2020. International Pediatric Research Foundation, Inc.)

Early weaning can cause intestinal disorders and dysfunction in piglets, and may induce intestinal diseases. Hippophae rhamnoides polysaccharide (HRP) has anti-inflammatory and immune promotion function. However, few studies have explored the change of differentially protein expression by lipopolysaccharide (LPS)-induced porcine intestinal epithelial cell (IPEC-J2) after HRP pre-treatment. In this study, proteomic analysis was used to explore the essential proteins and immune-related pathways that can be regulated by LPS-induced IPEC-J2 cells after HRP pre-treatment. The results indicate that by searching the Sus scrofa database, a total of 18,768 proteins was identified. Among recognized proteins, there are 2052 (1720 up-regulated and 332 down-regulated), 358 (262 up-regulated and 96 down-regulated) and1532 (314 up-regulated and 1218 down-regulated) proteins expressed differently in C vs. L, C vs. H6-L and L vs. H6-L, respectively. The Cluster of Orthologous Groups (COG) analysis divided the identified proteins into 23 categories. Gene Ontology (GO) enrichment analysis revealed that cellular process, cell, cell part, organelle and binding were the most enriched pathways for differentially expressed proteins. KEGG enrichment analysis indicated that the top 20 pathways in the L-vs-H6-L group related to immunity were the Tight junction, MAPK signaling pathway, PI3K-Akt signaling pathway, rap1 signaling pathway, HIF-1 signaling pathway, Ras signaling pathway and Fc gamma R-mediated phagocytosis. Moreover, we also found 42 key proteins related to these immune pathways in this study. Additionally, western blotting analyses confirmed that LPS reduced the levels of claudin2 (CLDN2), insulin-like growth factor 2 (IGF2) and increased phosphorylated mitogen-activated protein kinase 7 (MAPK7), phosphorylated transcription factor p65 (RELA), phosphorylated nuclear factor NF-kappa-B p105 subunit (NF-κB1) and phosphorylated nuclear factor of kappa light polypeptide gene enhancer in B-cells 2 (NF-κB2). Pre-treatment with HRP increased the levels of CLDN2, IGF2 and reduced the levels of the phosphorylated MAPK7, phosphorylated RELA, phosphorylated NF-κB1 and phosphorylated NF-κB2 in cells. These results also showed that HRP alleviated LPS-induced inflammation in IPEC-J2 cells by inhibiting the MAPK/NF-κB signaling pathway and its related differentially expressed proteins., Competing Interests: Declaration of competing interest The authors declare that they have no competing financial interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objective: To examine the factors that may influence Chinese parent's willingness to donate their children's biospecimens for use in pediatric research. Study Design: Parents or caregivers of the patients in the neurosurgery ward, oncological surgery ward, and internal medical wards at Shanghai Children's Medical Center were recruited during the period of March 1, 2016 to July 8, 2018. The questionnaire included the willingness to provide consent for donating their children's clinical biospecimens, their attitudes toward and motivations for donating their children's clinical biospecimens, opinions of contributing specimens, and an ethical consideration for their children's future willingness to donate biospecimens. Participants' demographic data and children's basic information were collected. Results: The majority of the participants agreed to donate the patients' biospecimens for research. Parents with pronounced religious beliefs, less education, who had only one child, child with a more severe disease, and living in an urban district were associated with negative attitudes toward biospecimen donation, but none of other parents' sociodemographic characteristics and some of the children's basic characteristics disclosed significant differences in donation attitudes. In five different types of biospecimens, parents were more reluctant to donate specific blood biospecimens. Physical pain and privacy protection were of most concern to parents when it came to donating their child's biospecimens. It was widely believed in parents that reconsent would be necessary for the 18-year-old adolescent. Conclusions: Our findings explored the factors that were of greatest worry to parents related to parents' willingness to donate their child's biospecimens in China. We recommend greater patient explanation to enhance the participant's engagement in the biospecimen donation, and the adolescent's attitude toward biospecimen donation needs further consideration.

The authors made a profound review on the development and the recent status of craniomaxillofacial surgery in China during past three decades. The emphases were placed on the following aspects: the modifications of the reconstructive procedure and minimal invasive mode, the researches on molecular genetic characteristics of the congenital craniofacial malformations, the clinical applications of three-dimensional digital computer-aided techniques (including three-dimensional printing and prefabricated template for precious osteotomies), the craniomaxillofacial defects reconstructing by using the distraction osteogenesis and osseous integrated titanium implant and prothesis, etc . Finally, the authors outlooked prospectively the future trends of the craniomaxillofacial surgery.