Guidelines for the diagnosis and treatment of neurally mediated syncope in children and adolescents (revised 2024).

BACKGROUND: Significant progress has been made in the diagnosis and treatment of pediatric syncope since the publication of the "2018 Chinese Pediatric Cardiology Society (CPCS) guideline for diagnosis and treatment of syncope in children and adolescents" ("2018 Edition Guidelines"). Therefore, we have revised and updated it to assist pediatricians in effectively managing children with syncope. DATA SOURCES: According to the "2018 Edition Guidelines", the expert groups collected clinical evidence, evaluated preliminary recommendations, and then organized open-ended discussions to form the recommendations. This guideline was developed by reviewing the literature and studies in databases including PubMed, Cochrane, EMBASE, China Biomedical Database, and Chinese Journal Full-text Database up to April 2024. Search terms included "syncope", "children", "adolescents", "diagnosis", and "treatment." RESULTS: The guidelines were based on the latest global research progress and were evidence-based. The classification of syncope etiology, diagnostic procedures, postural tests, such as the active standing test, head-up tilt test, and active sitting test, clinical diagnosis, and individualized treatment for neurally mediated syncope in pediatric population were included. CONCLUSIONS: The guidelines were updated based on the latest literature. The concepts of sitting tachycardia syndrome and sitting hypertension were introduced and the comorbidities of neurally mediated syncope were emphasized. Some biomarkers used for individualized treatment were underlined. Specific suggestions were put forward for non-pharmacological therapies as well as the follow-up process. The new guidelines will provide comprehensive guidance and reference for the diagnosis and treatment of neurally mediated syncope in children and adolescents.

Maternal diseases and congenital anomalies of the kidney and urinary tract in offspring: a cohort study.

BACKGROUND: Congenital anomalies of the kidneys and urinary tract (CAKUT) are the most common cause of prenatally diagnosed developmental malformation. This study aimed to assess the relationship between maternal diseases and CAKUT in offspring. METHODS: This retrospective study enrolled all pregnant women registered from January 2020 to December 2022 at one medical center. Medical information on maternal noncommunicable diseases, including obesity, hypertension, diabetes mellitus, kidney disease, hyperthyroidism, hypothyroidism, psychiatric disease, epilepsy, cancer, and autoimmune disease was collected. Based on the records of ultrasound scanning during the third trimester, the diagnosis was classified as isolated urinary tract dilation (UTD) or kidney anomalies. Multivariate logistic regression was performed to establish models to predict antenatal CAKUT. RESULTS: Among the 19,656 pregnant women, perinatal ultrasound detected suspicious CAKUT in 114 (5.8/1000) fetuses, comprising 89 cases with isolated UTD and 25 cases with kidney anomalies. The risk of antenatal CAKUT was increased in the fetuses of mothers who experienced gestational diabetes, thyroid dysfunction, neuropsychiatric disease, anemia, ovarian and uterine disorders. A prediction model for isolated UTD was developed utilizing four confounding factors, namely gestational diabetes, gestational hypertension, maternal thyroid dysfunction, and hepatic disease. Similarly, a separate prediction model for kidney anomalies was established based on four distinct confounding factors, namely maternal thyroid dysfunction, gestational diabetes, disorders of ovarian/uterine, and kidney disease. CONCLUSIONS: Isolated UTD and kidney anomalies were associated with different maternal diseases. The results may inform the clinical management of pregnancy and highlight potential differences in the genesis of various subtypes of CAKUT.

Prevalence of intestinal trichomonads in captive non-human primates in China.

Trichomonads are protozoan symbionts with the capacity to infect vertebrates including humans and non-human primates (NHPs), sometimes with pathogenic effects. However, their diversity and prevalence in NHPs in China are poorly understood. A total of 533 fecal samples were collected from captive NHPs in Yunnan Province, China, of which 461 samples from Macaca fascicularis and 72 from Macaca mulatta. Trichomonadidae species were identified using PCR amplification of the ITS-1/5.8S/ITS-2 sequences. The overall prevalence of trichomonads in NHPs was determined to be 11.4% (61/533), with gender, diarrhea, and region identified as potential risk factors for the infections. Sequence alignment and phylogenetic analysis identified three species of trichomonads, i.e., Trichomitopsis minor (n = 45), Pentatrichomonas hominis (n = 11), and Tetratrichomonas sp. (n = 5). To the best of our knowledge, this is the first study to report Trichomitopsis minor infection in NHPs in China. Of note, Pentatrichomonas hominis is generally recognized as a parasitic organism affecting humans. Collectively, our results suggest that NHPs are potential sources of zoonotic trichomonad infections, highlighting the importance of surveillance and control measures to protect human and animal populations.

Title: Prévalence des Trichomonadidae intestinaux chez les primates non humains captifs en Chine. Abstract: Les Trichomonadidae sont des symbiotes protozoaires capables d'infecter les vertébrés, notamment les humains et les primates non humains (PNH), parfois avec des effets pathogènes. Cependant, leur diversité et leur prévalence chez les PNH en Chine sont mal comprises. Au total, 533 échantillons fécaux ont été collectés sur des PNH captifs dans la province du Yunnan, en Chine, dont 461 échantillons de Macaca fascicularis et 72 de Macaca mulatta. Les espèces de Trichomonadidae ont été identifiées par amplification PCR des séquences ITS-1/5.8S/ITS-2. La prévalence globale des Trichomonadidae dans les PNH a été déterminée à 11,4 % (61 / 533) et le sexe, la diarrhée et la région ont été identifiés comme facteurs de risque potentiels d'infection. L'alignement des séquences et l'analyse phylogénétique ont identifié trois espèces de Trichomonadidae, à savoir Trichomitopsis minor (n = 45), Pentatrichomonas hominis (n = 11) et Tetratrichomonas sp. (n = 5). À notre connaissance, il s'agit de la première étude à signaler une infection par Trichomitopsis minor chez les PNH en Chine. Il convient de noter que Pentatrichomonas hominis est généralement reconnu comme un organisme parasitaire affectant les humains. Collectivement, nos résultats suggèrent que les PNH sont des sources potentielles d'infections zoonotiques à Trichomonadidae, soulignant l'importance des mesures de surveillance et de contrôle pour protéger les populations humaines et animales.