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In the early February, 2020, we called up an experts' committee with more than 30 Chinese experts from 11 national medical academic organizations to formulate the first edition of consensus statement on diagnosis, treatment and prevention of coronavirus disease 2019 (COVID-19) in children, which has been published in this journal. With accumulated experiences in the diagnosis and treatment of COVID-19 in children, we have updated the consensus statement and released the second edition recently. The current version in English is a condensed version of the second edition of consensus statement on diagnosis, treatment and prevention of COVID-19 in children. In the current version, diagnosis and treatement criteria have been optimized, and early identification of severe and critical cases is highlighted. The early warning indicators for severe pediatric cases have been summarized which is utmost important for clinical practice. This version of experts consensus will be valuable for better prevention, diagnosis and treatment of COVID-19 in children worldwide. [ABSTRACT FROM AUTHOR]

Summary: Monocytes become susceptible to respiratory syncytial virus (RSV) infection when pretreated with phorbol 12-myristate 13-acetate (PMA). The molecular mechanism underlying this observation is poorly understood, but may be related to inhibition of type I interferon (IFN) signaling by RSV in epithelial cells. Herein, we have investigated the putative role of suppressor of cytokine signaling (SOCS) in the IFN-inducible antiviral response in U937 cells. Upon RSV infection of macrophage-like U937 cells, the expression of SOCS1, SOCS3, and CIS mRNA was rapidly upregulated, and phosphorylation of the IFN-α-inducible signal transducer and activator of transcription (STAT1 and STAT2) was suppressed. These results suggest that RSV can inhibit the phosphorylation of IFN-α-inducible STAT1 and STAT2 by inducing the expression of SOCS proteins in PMA-treated U937 cells. [Copyright &y& Elsevier]

Objective This study is aimed to elucidate age-associated clinical and echocardiography-defined coronary artery (CA) abnormalities features and to identify independent determinants of CA dilatation in pediatric patients with complete Kawasaki disease (cKD) and incomplete KD (iKD) over 15 years in a tertiary hospital in China. Methods This study comprised 241 patients with KD hospitalized in the pediatric department between 2003 and 2018. Patients were divided into three groups according to age at diagnosis: ≤12, 13 to 35, and ≥36 months. Results A total of 167 (69.3%) patients were defined as cKD (aged 24 months, male 60.5%) and 74 (30.7%) patients as iKD (aged 18 months, male 59.5%). The prevalence of cervical lymphadenopathy significantly increased with age in both cKD and iKD patients. In iKD patients, the prevalence of rash significantly decreased with age. CA dilatation most frequently occurred in patients with cKD and iKD aged ≤12 months. The absence of conjunctivitis or oral changes and higher serum creatinine levels were independent determinants of CA dilatation in KD patients aged ≤12 months, regardless of age, sex, and the type of KD. Conclusion Present study underlines the age-stratified disease characteristics, and the factors associated with CA dilatation in cKD and iKD patients. The absence of conjunctivitis or oral changes, higher serum creatinine levels, and mycoplasma, cytomegalovirus, and adenovirus infections might be associated with an increased risk of CA dilatation in KD patients. These findings provide additional hints for pediatricians in the early diagnosis and treatment of KD, especially for individual medical care of cKD and iKD patients in different age groups. [ABSTRACT FROM AUTHOR]

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a rapidly spreading illness, coronavirus disease 2019 (COVID-19), affecting more than seventeen million people around the world. Diagnosis and treatment guidelines for clinicians caring for patients are needed. In the early stage, we have issued "A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version)"; now there are many direct evidences emerged and may change some of previous recommendations and it is ripe for develop an evidence-based guideline. We formed a working group of clinical experts and methodologists. The steering group members proposed 29 questions that are relevant to the management of COVID-19 covering the following areas: chemoprophylaxis, diagnosis, treatments, and discharge management. We searched the literature for direct evidence on the management of COVID-19, and assessed its certainty generated recommendations using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Recommendations were either strong or weak, or in the form of ungraded consensus-based statement. Finally, we issued 34 statements. Among them, 6 were strong recommendations for, 14 were weak recommendations for, 3 were weak recommendations against and 11 were ungraded consensus-based statement. They covered topics of chemoprophylaxis (including agents and Traditional Chinese Medicine (TCM) agents), diagnosis (including clinical manifestations, reverse transcription-polymerase chain reaction (RT-PCR), respiratory tract specimens, IgM and IgG antibody tests, chest computed tomography, chest x-ray, and CT features of asymptomatic infections), treatments (including lopinavir-ritonavir, umifenovir, favipiravir, interferon, remdesivir, combination of antiviral drugs, hydroxychloroquine/chloroquine, interleukin-6 inhibitors, interleukin-1 inhibitors, glucocorticoid, qingfei paidu decoction, lianhua qingwen granules/capsules, convalescent plasma, lung transplantation, invasive or noninvasive ventilation, and extracorporeal membrane oxygenation (ECMO)), and discharge management (including discharge criteria and management plan in patients whose RT-PCR retesting shows SARS-CoV-2 positive after discharge). We also created two figures of these recommendations for the implementation purpose. We hope these recommendations can help support healthcare workers caring for COVID-19 patients.

Objective: To facilitate early recognition of ominous clinical manifestations, to understand pathophysiology and assess treatment effects in patients with severe enterovirus 71 (EV71) associated hand, foot and mouth disease (HFMD)., Method: A retrospective analysis was performed based on the clinical records, laboratory data and treatment effects which were collected from twelve severe EV71 infected cases from nine hospitals in 2008, in Hubei province, China., Result: Of the 12 severe cases, ten (83.3%) were male and two female. The median age was 1.96 yrs (8 m to 7 yrs). The mean hyperthermic duration was 6 days with the peak temperature over 38.5 degrees C, and mean rash duration was 7 days. Fever and rash emerged simultaneously in 4 of 5 cases with cardiopulmonary failure. The severe complications included encephalitis (10 cases), pulmonary edema or hemorrhage (5 cases). Eleven cases were checked with magnetic resonance imaging (MRI) and four cases showed characteristics of encephalitis or meningitis, two with images of naso sinusitis and ethmoid-mastoid inflammation. Chest X-ray examination showed with pulmonary edema on single or both sides (5 cases), bronchitis (4 cases), and normal image (3 cases). There was no specific finding in the cardiac ultrasound and electrocardiogram in any of the patients, as well as the white blood cell count, blood glucose, prothrombin time, partial thromboplastin time and D-dimer. Cerebrospinal fluid showed aseptic meningitis with the increase of cell count in 7 cases. All patients were treated with antibiotics and/or antivirals, such as cephalosporins, ribavirin etc. Eleven patients were treated with intravenous immunoglobulin (total dose 2 - 4.5 g/kg) for 2 - 5 days, and the highest blood concentration of immunoglobulin was detected increasing at 7 g/L. Seven cases were also treated with methylprednisolone 10 - 30 mg/(kg x d), four with dopamine, dobutamine, or digitalis. In addition, by using continuous positive airway pressure by nasal catheter and maintenance of circulation in the cases with cardiopulmonary failure could not relieve the symptoms of dyspnoea, and mechanical ventilation was required to maintain for a mean of 72 hrs (24 - 96 hrs). Except one case died of pulmonary edema in the early stage, others were cured without sequelae., Conclusion: Severe EV71 infection is more common in children younger than 3 years old, in which the profound complications include encephalitis and pulmonary edema. The mechanical ventilation should be critically urged for child with complicating cardiopulmonary failure as soon.