The effect of vitamin D status on the occurrence of Kawasaki Disease: a meta-analysis.

AIM: The relationship between vitamin D status and Kawasaki Disease (KD), as well as coronary artery lesion (CAL), has yet to be established. METHODS: A meta-analysis was conducted to assess the correlation between vitamin D status and KD, as well as the impact of vitamin D status on the progression of KD into CAL. RESULTS: The meta-analysis revealed a consistent and significant association between serum 25(OH)D level and the occurrence KD (studies N = 22; z = -3.51, P < 0.001). Patients with KD had markedly lower levels of vitamin D than healthy controls (SMD: -1.30 ng/mL, 95%CI: -2.05 to -0.55 ng/mL). CONCLUSION: The study provided evidence supporting a significant association between lower serum vitamin D levels and the occurrence of KD, particularly within the Chinese population. However, the findings did not suggest a direct impact of vitamin D on the development of CAL in KD patients.

[Multisystem inflammatory syndrome in children in the context of coronavirus disease 2019 pandemic]. / æ–°åž‹å† çŠ¶ç— æ¯’æ„ŸæŸ“æµè¡ŒèƒŒæ™¯ä¸‹çš„å„¿ç«¥å¤šç³»ç»Ÿç‚Žç—‡ç»¼åˆå¾.

Multisystem inflammatory syndrome in children (MIS-C) is a complex syndrome characterized by multi-organ involvement that has emerged in the context of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak. The clinical presentation of MIS-C is similar to Kawasaki disease but predominantly presents with fever and gastrointestinal symptoms, and severe cases can involve toxic shock and cardiac dysfunction. Epidemiological findings indicate that the majority of MIS-C patients test positive for SARS-CoV-2 antibodies. The pathogenesis and pathophysiology of MIS-C remain unclear, though immune dysregulation following SARS-CoV-2 infection is considered a major contributing factor. Current treatment approaches for MIS-C primarily involve intravenous immunoglobulin therapy and symptomatic supportive care. This review article provides a comprehensive overview of the definition, epidemiology, pathogenesis, clinical presentation, diagnosis, treatment, and prognosis of MIS-C.

[Research advances in genetic polymorphisms in Kawasaki disease]. / å·å´Žç— åŸºå› å¤šæ€æ€§çš„ç ”ç©¶è¿›å±•.

Kawasaki disease (KD) is a systemic inflammatory vascular disorder that predominantly affects children and is the leading cause of acquired heart disease in children. Although the etiology of this disease remains unclear, genome-wide association and genome-wide linkage studies have shown that some susceptible genes and chromosomal regions are associated with the development and progression of KD. With the advancement of high-throughput DNA sequencing techniques, more and more genomic information related to KD is being discovered. Understanding the genes involved in the pathogenesis of KD may provide novel insights into the diagnosis and treatment of KD. By analyzing related articles and summarizing related research advances, this article mainly discusses the T cell activation-enhancing genes that have been confirmed to be closely associated with the development and progression of KD and reveals their association with the pathogenesis of KD and coronary artery lesions.

[Diagnosis and treatment of incomplete Kawasaki disease in children]. / å„¿ç«¥ä¸å®Œå ¨æ€§å·å´Žç— çš„è¯Šæ²».

Kawasaki disease (KD) is a febrile disease mainly observed in children aged <5 years, with medium- and small-vessel vasculitis as the main lesion. Although KD has been reported for more than 50 years and great progress has been made in the etiology and pathology of KD in recent years, there is still a lack of specific indicators for the early diagnosis of KD, especially with more difficulties in the diagnosis of incomplete Kawasaki disease (IKD). At present, there are no clear diagnostic criteria for IKD, which leads to the failure of the timely identification and standardized treatment of IKD in clinical practice and even induce the development of coronary artery lesion. This article reviews the concept, epidemiological features, diagnosis, treatment, and follow-up management of IKD, in order to deepen the understanding of IKD among clinical workers and help to improve the clinical diagnosis and treatment of KD in China.

Pediatric perioperative nutritional assessment and support.

Perioperative nutritional support reduces the healthcare burden of pediatric malnutrition and its risk. Strategic preventive, diagnostic and therapeutic nutritional management guidelines are now available for their optimization. The global needs for pediatric surgery are vast, amounting to millions of children and adolescents, with a corresponding workforce requirement, especially in less socioeconomically developed regions, and where malnutrition is endemic. Acute and elective surgery from neonate to adolescent, for congenital to infective, neoplastic and traumatic conditions, are involved. To identify, highlight and critique current perioperative pediatric nutrition guidelines with regard to availability, utility, affordability and accuracy. Advantages and limitations of nutritional methodologies are taken into account in an algorithmic approach to perioperative decision-making to optimise outcomes. Routine documentation, monitoring and surveillance of pediatric nutritional status as a contributor to surgical risk management should increase its benefits, and reduce costs.

[Strengthening the prevention and treatment of Omicron infection in children]. / åŠ å¼ºå„¿ç«¥å¥¥å¯†å ‹æˆŽæ„ŸæŸ“çš„é˜²æ²».

Omicron is a newly discovered variant virus of coronavirus disease 2019 and has spread rapidly around the world. Omicron has been defined as a variant of concern by the World Health Organization. Its epidemiology, pathogenic characteristics, clinical diagnosis, treatment, and prevention are still being observed and summarized, and in particular, there are few reports on the diagnosis and treatment of children with Omicron infection. This article introduces the influence of Omicron infection in children and its prevention, diagnosis, and treatment.

[Clinical details in the diagnosis of Kawasaki disease]. / å·å´Žç— è¯Šæ–­è¿‡ç¨‹ä¸­éœ€è¦æ³¨æ„çš„ä¸´åºŠç»†èŠ‚.

Kawasaki disease (KD) is one of the leading causes of acquired heart diseases in children aged under 5 years. The clinical manifestations of KD include fever, changes in the extremities, rash or redness at the site of bacille Calmette-Guérin vaccination, bilateral bulbar conjunctival hyperemia, changes in lips and mouth, nonsuppurative cervical lymphadenopathy, and other systemic manifestations. There are difficulties in the diagnosis of KD due to its asynchronous clinical manifestations. With reference to the latest case reports and research advances in KD, this article summarizes the clinical details in the diagnosis of KD, so as to improve the level of clinical diagnosis of KD.

[Clinical experience in the treatment of incomplete Kawasaki disease with no response to intravenous immunoglobulin: a case report]. / é™è„‰æ³¨å°„å ç–«çƒè›‹ç™½æ— åº”ç­”ä¸å®Œå ¨æ€§å·å´Žç— 1例临床经验交流.

This article reports a case of incomplete Kawasaki disease with no response to intravenous immunoglobulin (IVIG). A girl, aged 1 year, had the symptoms of fever, rash, finger desquamation, and coronary artery ectasia. She still had fever at 36 hours after the first dose of IVIG treatment, and her temperature returned to normal after the second dose of IVIG treatment. The follow-up after 1 month showed that the coronary artery diameter returned to normal. This article summarizes the experience in the treatment of incomplete Kawasaki disease with no response to IVIG in order to reduce the incidence of coronary artery damage.

[Interpretation of the JCS/JSCS 2020 guideline on diagnosis and management of cardiovascular sequelae in Kawasaki disease].

Kawasaki disease is the main cause of acquired heart disease in children. The cardiovascular sequelae of Kawasaki disease, such as coronary artery lesion and giant coronary aneurysm, have a great impact on children's physical and mental health. The Japanese Circulatory Society and the Japanese Society of Cardiac Surgery jointly released the JCS/JSCS 2020 guideline on diagnosis and management of cardiovascular sequelae in Kawasaki disease in July, 2020, which systematically introduces the advances in the diagnosis and management of cardiovascular sequelae of Kawasaki disease. The article gives an interpretation in the severity evaluation of Kawasaki disease and diagnosis, treatment and long-term management of cardiovascular sequelae in the guideline.

Comparison of serum eosinophil-derived neurotoxin levels between wheezing and non-wheezing groups in children with respiratory tract infection.

Objective: Eosinophil-derived neurotoxin (EDN) is associated with recurrent wheezing episodes after bronchiolitis, childhood asthma, and allergic rhinitis. We investigated if there is a measurable difference between serum EDN levels in children with wheezing and non-wheezing respiratory infections.Methods: 171 children who visited a university hospital with respiratory infections were enrolled in the study. Subjects were divided into two groups: wheezing (n = 46) and non-wheezing (n = 125). Serum EDN levels were compared.Results: Serum EDN levels in the wheezing group were significantly higher than in the non-wheezing group (P < 0.001). The non-wheezing group was divided into three sub-groups: pneumonia, common cold, and tonsillitis. Serum EDN levels in the wheezing group were significantly higher than in the pneumonia, common cold, or tonsillitis subgroups (P < 0.001). There was no significant difference in serum EDN levels among the pneumonia, common cold, and tonsillitis subgroups.Conclusions: These findings suggest that elevated serum EDN levels could be a distinctive feature of respiratory infections with wheezing. EDN's utility as a biomarker for wheezing-associated disease should be explored through further study.

Lymphocyte Hydrogen Sulfide Production Predicts Coronary Artery Lesions in Children with Kawasaki Disease: A Preliminary, Single-Center Study.

To identify whether lymphocyte hydrogen sulfide production is a potential biomarker for predicting coronary artery lesions (CAL) in children with Kawasaki disease (KD). Eighty-six children with KD, 33 normal children and 43 children with fever from June 2016 to January 2019 in Shaanxi Provincial People's Hospital were enrolled. Of 86 KD patients, 16 patients exhibited CAL. Lymphocyte hydrogen sulfide production was significantly greater in KD patients (13.7 ± 2.7) nmol/min/108 lymphocytes than in the controls (9.26 ± 3.33) nmol/min/108 lymphocytes and the fever group (8.21 ± 2.77) nmol/min/108 lymphocytes. The lymphocyte hydrogen sulfide production was greater in CAL patients than the non-CAL patients [(16.24 ± 1.81) vs. (13.12 ± 2.58), p < 0.001]. Receiver operating characteristic curve indicated when the lymphocyte hydrogen sulfide production was >15.285 nmol/min/108 lymphocytes, the sensitivity and specificity for predicting CAL at convalescence were 87.5% and 82.9%, respectively. Lymphocyte hydrogen sulfide production in the acute period is a potentially useful biomarker for predicting CAL in KD children.

[Kawasaki disease - a new manifestation of COVID-19 in children].

Since the outbreak of coronavirus disease 2019 (COVID-19) in Europe and America, the incidence of Kawasaki disease has significantly increased, which has aroused concern among pediatricians and parents. COVID-19 can cause inflammation reactions of multiple organs, which is similar to the systemic vasculitis of Kawasaki disease, and even COVID-19 can cause skin rash on the extremities of the limbs, which is also similar to Kawasaki disease. The cause of Kawasaki disease is currently unclear, and it cannot be ruled out that COVID-19 is associated with an increased incidence of Kawasaki disease. Therefore, during the epidemic of COVID-19, if children have symptoms similar to Kawasaki disease, intravenous immunoglobulin is recommended as early as possible to reduce the incidence of coronary artery lesions.

[A review on the role of angiotensin-converting enzyme 2 in children with coronavirus disease 2019].

With the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) all over the world, there is an increasing number of children with such infection. Angiotensin-converting enzyme 2 (ACE2), one of the binding sites for SARS-CoV-2 infection in humans, can bind to viral spike proteins, allowing transmembrane serine protease (TMPRSS2) to activate S-protein to trigger infection and induce the production of various inflammatory factors such as interleukin-1, interferon-l, and tumor necrosis factor. Compared with adults, children tend to have lower expression levels of ACE2 and TMPRSS2, which are presumed to be associated with milder symptoms and fewer cases in children. The article summarizes the research advances in the role of ACE2 during SARS-CoV-2 infection, in order to help understand the pathogenic mechanism of SARS-CoV-2 and provide a reference for better development of drugs and vaccines to prevent and treat coronavirus disease 2019 in children.

Salivary Cortisol Levels Predict Therapeutic Response to a Sleep-Promoting Method in Children with Postural Tachycardia Syndrome.

OBJECTIVE: To determine the value of salivary cortisol concentrations in predicting the efficacy of sleep-promoting treatment in children with postural tachycardia syndrome (POTS). STUDY DESIGN: This prospective study involved 40 children with POTS and 20 healthy children (controls). POTS was diagnosed using the head-up or head-up tilt test. Patients with POTS received a sleep-promoting treatment: >8 hours of sleep every night and a midday nap in an appropriate environment; no drinking water or exercising before bedtime; and urination before bedtime. The Pittsburgh Sleep Quality Index was used to evaluate sleep quality, and symptom scores were used to assess POTS severity. Salivary samples were collected upon awakening, 30 minutes after awakening, at 12:00 p.m., 4:00 p.m., and 8:00 p.m., and at bedtime before treatment. Enzyme-linked immunosorbent assay was used to measure salivary cortisol concentrations. RESULTS: Cortisol concentrations were significantly higher in patients with POTS than in the controls at all time points (P < .05 for all). PSQI scores were significantly higher in patients with POTS (7.2 ± 3.0) than in the controls (1.35 ± 1.39; t = -10.370, P <.001). Salivary cortisol concentrations at awakening were significantly higher in responders than in nonresponders (4.83 ± 0.73 vs 4.05 ± 0.79 ng/mL, t = -3.197, P = .003). The area under the receiver operating characteristic curve was 75.8%, (95% CI 59.3%-92%). Cut-off at-awakening salivary cortisol concentrations of >4.1 ng/mL yielded 83.3% sensitivity and 68.7% specificity in predicting therapeutic efficacy. CONCLUSIONS: At-awakening salivary cortisol concentrations may predict the efficacy of sleep-promoting treatment in patients with POTS.

[Efficacy and safety of Choudongning capsule (CDN)in children with Tourette's syndrome of spleen deficiency and phlegm accumulation].

To evaluate the efficacy and safety of Choudongning (CDN)capsule in children with Tourette's syndrome of spleen deficiency and phlegm accumulation through a randomized double-blind three-arm controlled phase Ⅲ study in 588 patients from 8 hospitals. The included patients were randomly divided into test group, positive control group and placebo group at the ratio of 3∶1∶1. Patients in the test group orally took CDN capsules and simulated Tiapridal tablets; the patients in positive control group took Tiapridal tablets and simulated CDN capsules; whereas the patients in placebo group orally took the simulated agents of the above two drugs. The treatment course was 6 weeks for three groups. The global grading rates, YGTSS scores and its factor scores, the degree of social function damage, as well as traditional Chinese medicine syndrome efficacy were evaluated as the outcome measures on efficacy. The AEs/ADRs, vital signs and laboratory testing were observed as outcome measures on safety. The total effective rate of YGTSS was 75.92% in the test group, 72.65% in the positive control group, and 37.29% in the placebo group. Non inferiority test stands between the test group and the positive control group, and they were superior to placebo group in efficacy with statistical difference. Significant difference had also been found among the 3 groups in YGTSS tics score, motor tics score, vocal tics, degree of social function damage and traditional Chinese medicine syndrome efficacy. During the study, there were 5 (1.42%)ADRs in the test group, 10 (8.55%)in the positive control group and 3 (2.54%)in the placebo group. The incidence of ADRs in the test group was lower than that in the positive control group, with statistical difference. It is clear to say that CDN capsule can effectively treat the Tourette's syndrome of spleen deficiency and phlegm accumulation. Its efficacy is not inferior to the commonly used Tiapridal tablets, with even less adverse reactions, so it has clinical application value.

Clinical analysis of 102 cases of Epstein-Barr virus infections in Chinese children.

The purpose of this study is to investigate the clinical manifestations and disease severity, to evaluate the recent trend of clinical manifestations and differences in the clinical and laboratory findings of EBV-associated IM (infectious mononucleosis) according to the age of children. We retrospectively collected cases on hospitalized patients a majority of 7 years old with characteristic symptoms of IM and serologically diagnosed EBV-associated IM at Shaanxi Provincial Peoples University Hospital in Xi'an from Apr, 2012 to Oct, 2013. All their medical records were reviewed and analyzed. For each patient, clinical, laboratory data and outcome were collected retrospectively and compared to previous studies to evaluate the differences between the clinical and laboratory findings of patients of different ages. The clinical manifestations in children with EB virus infection varied. There were 60 (58.8%) cases of children with infectious mononucleosis, 26 (25.49%) cases of Epstein-barr virus infection,16 cases of the atypical EB virus infection, accounting for 15.67%. 78% children were under 7 years of age, 12% were 7 to 14 years of age. There are differences in the symptoms and signs among the different age groups. The clinical manifestations in children with EB virus infection involved multiple systems and produced harm is heavier and should be paid attention to during the treatment. The disease continues to occur mostly in children under 10 years of age. When compared to previous Chinese studies about 15 years ago, the age distribution was similar and the incidence of hepatosplenomegaly was lower in our study.

Relationship between Kawasaki disease and abdominal pain.

This editorial presents an analysis of an article recently published in the World Journal of Clinical Cases. Kawasaki disease (KD) is a well-known pediatric vasculitis characterized by fever, rash, conjunctivitis, oral mucosal changes, and swelling of the extremities. This editorial aims to delve into the intricate relationship between KD and abdominal pain, drawing insights from recent research findings to provide a comprehensive understanding and potential avenues for future investigation.

Subependymal Giant Cell Astrocytomas in Tuberous Sclerosis Complex-Current Views on Their Pathogenesis and Management.

Introduction, Tuberous sclerosis complex (TSC) is an autosomal-dominant disorder caused by mutations inactivating TSC1 or TSC2 genes and characterized by the presence of tumors involving many organs, including the brain, heart, kidneys, and skin. Subependymal giant cell astrocytoma (SEGA) is a slow-growing brain tumor almost exclusively associated with TSC. STATE OF THE ART: Despite the fact that SEGAs are benign, they require well-considered decisions regarding the timing and modality of pharmacological or surgical treatment. In TSC children and adolescents, SEGA is the major cause of mortality and morbidity. CLINICAL IMPLICATIONS: Until recently, surgical resection has been the standard therapy for SEGAs but the discovery of the role of the mTOR pathway and the introduction of mTOR inhibitors to clinical practice changed the therapeutic landscape of these tumors. In the current paper, we discuss the pros and cons of mTOR inhibitors and surgical approaches in SEGA treatment. FUTURE DIRECTIONS: In 2021, the International Tuberous Sclerosis Complex Consensus Group proposed a new integrative strategy for SEGA management. In the following review, we discuss the proposed recommendations and report the results of the literature search for the latest treatment directions.