The diagnosis and treatment of pediatric clinical myocarditis in China: a multicenter retrospective study.

This study aims to examine the clinical characteristics and outcomes of clinical myocarditis in pediatric patients in China. This is a multicenter retrospective study. Children diagnosed with clinical myocarditis from 20 hospitals in China and admitted between January 1, 2015, and December 30, 2021, were enrolled. The clinical myocarditis was diagnosed based on the "Diagnostic Recommendation for Myocarditis in Children (Version 2018)". The clinical data were collected from their medical records. A total of 1210 patients were finally enrolled in this study. Among them, 45.6% had a history of respiratory tract infection. An abnormal electrocardiogram was observed in 74.2% of patients. Echocardiography revealed that 32.3% of patients had a left ventricular ejection fraction of less than 50%. Cardiac MRI was performed in 4.9% of children with clinical myocarditis, of which 61% showed localized or diffuse hypersignal on T2-weighted images. Serum levels of cardiac troponin I (cTnI), creatine kinase-MB (CK-MB), and N-terminal B-type natriuretic peptide (NT-proBNP) were higher in patients with fulminant myocarditis than in patients with myocarditis, making them potential risk factors for fulminant myocarditis. Following active treatment, 12.1% of patients were cured, and 79.1% were discharged with improvement. CONCLUSION: Clinical myocarditis in children often presents with symptoms outside the cardiovascular system. CK-MB, cTnI, and NT-proBNP are important indicators for assessing clinical myocarditis. The electrocardiogram and echocardiogram findings in children with clinical myocarditis exhibit significant variability but lack specificity. Cardiac MRI can be a useful tool for screening clinical myocarditis. Most children with clinical myocarditis have a favorable prognosis. WHAT IS KNOWN: • Pediatric myocarditis presents complex clinical manifestations and exhibits varying degrees of severity. Children with mild myocarditis generally have a favorable prognosis, while a small number of children with critically ill myocarditis experience sudden onset, hemodynamic disorders, and fatal arrhythmias. Therefore, early diagnosis and timely treatment of myocarditis are imperative. WHAT IS NEW: • To the best of our knowledge, this multicenter retrospective study is the largest ever reported in China, aiming to reveal the clinical characteristics and outcomes of pediatric clinical myocarditis in China. We provided an extensive analysis of the clinical characteristics, diagnosis, treatment, prognosis, and factors impacting disease severity in pediatric clinical myocarditis in China, which provides insights into the epidemiological characteristics of pediatric clinical myocarditis.

[Expression and significance of Shh and Wnt5a genes in Cornelia de Lange syndrome].

OBJECTIVE: To study the expression of Shh and Wnt5a genes in the limb buds of NIPBL+/- fetal rats and the association of these two genes with Cornelia de Lange syndrome (CdLS). METHODS: A total of 72 NIPBL+/- fetal rats were divided into an experimental group and a control group, with 36 rats in each group. The limb buds were collected from 12 fetal rats each on embryonic days 10, 11 and 12 (E10, E11 and E12) respectively. Real-time PCR and Western blot were used to measure the mRNA and protein expression of Shh and Wnt5a. RESULTS: The mRNA and protein expression of Shh and Wnt5a was detected in the limb buds on E10, E11 and E12, and the experimental group had significantly lower expression than the control group (P<0.01). The mRNA and protein expression of Shh and Wnt5a in limb buds was at a low level on E10, followed by an increase on E11 and a reduction on E12, and the expression on E12 was still lower than that on E10 (P<0.01). CONCLUSIONS: The mRNA and protein expression of Shh and Wnt5a are consistent. The pathogenesis of CdLS may be associated with the low mRNA and protein expression of Shh and Wnt5a inhibited by the low expression of NIPBL gene.

Clinical manifestations of Kawasaki disease in different age groups: retrospective data from Southwest China.

OBJECTIVES: The aim of the present study is to identify the clinical manifestations and laboratory findings of children with Kawasaki disease (KD) in different age groups and to recognize and treat KD in a timely manner. METHODS: A total of 213 children with KD were divided into the following age groups: (1) infants, (2) toddlers, and (3) preschool age. Retrospective analysis of clinical data was performed among the groups. Categorical data were statistically compared by Chi-square analysis, and measurement data were compared using one-way ANOVA analysis. RESULTS: Our study showed that (1) cough (40.5%), diarrhea (16.9%), and vomiting (8.5%) were also very common in KD patients. (2) Patients in the infant group more commonly developed cough and diarrhea, but were less frequently documented with lymphadenopathy and skin rash. (3) Elevation of platelets was more common in the infant group. When urine tests were compared among the three groups, the toddler group had a higher proportion of sterile pyuria, and infants younger than 1 year old had a lower proportion of proteinuria and positive urine ketones. CONCLUSION: Cough, diarrhea, vomiting, and sterile pyuria were very common in infant KD patients less than 1 year old. They should be noted in patients with suspected KD for earlier diagnosis and timely treatments. Key Points • Patients with Kawasaki disease (KD) in different age groups showed different clinical manifestations and laboratory findings. • Cough, diarrhea, vomiting, and sterile pyuria were very common in infant KD patients less than 1 year old. • Paying more attentions to respiratory, gastrointestinal, and urinary manifestations or abnormalities might be helpful for earlier diagnosis of KD, especially incomplete KD, though they were not list in the diagnostic criteria.

[Distribution and composition of organochlorine pesticides in farmland top soils of Anhui Province].

By using ultrasonic method and GC/ECD, this paper analyzed the distribution and composition of 8 kinds of organochlorine pesticides (alpha-HCH, beta-HCH, gamma-HCH, delta-HCH, op'-DDE, pp'-DDD, alpha-endosulfan, and chlorothalonil) in farmland top soils (0-20 cm) in 19 districts of Anhui Province, East China. The total concentration of the pesticides in the top soils ranged from 0 to 23.75 microg x kg(-1), among which, pp'-DDD and gamma-HCH were the major pollutants, with the mean concentration being 13.83 and 13.49 microg x kg(-1), respectively. As compared with the analyses in 1990, the present mean concentration of HCH had an obvious decreasing trend, but was still higher than that in the top soils in other regions of China and in other countries. The mean concentrations of OCPs, HCHs and pp'-DDD in the test top soils were 48.58, 28.64 and 13.83 microg x kg(-1), respectively, not surpassed the first grade level (< 50 microg x kg(-1)) of the China National Soil Environmental Quality Standards (GB 15618-1995), suggesting that the farmland top soils in these districts of Anhui Province were less polluted.