Association of metals with early postnatal gut microbiota among infants admitted to the neonatal intensive care unit.

The gut microbiota is closely related to infant health. However, the impact of environmental factors on the gut microbiota has not been widely investigated, particularly in vulnerable populations such as infants admitted to the neonatal intensive care unit (NICU). This study investigated the association between exposure to 12 metals and the composition of the gut microbiota in infants admitted to the NICU. Metal concentrations were determined in serum samples obtained from 107 infants admitted to the NICU at Hunan Children's hospital, China. Gut microbiota data were derived from 16S rRNA sequencing using stool samples. Generalized linear regression (GLR) models and Bayesian kernel machine regression (BKMR) analyses were used to estimate the associations between metals and both alpha-diversity indices and bacterial taxa. The GLR models showed that tin correlated negatively with the Shannon index (ß = -0.55, 95% conficence interval [CI]: -0.79, -0.30, PFDR< 0.001) and positively with the Simpson index (ß = 0.26, 95% CI: 0.13, 0.39, PFDR< 0.001). The BKMR analysis yielded similar results, showing that tin had the largest posterior inclusion probability for both the Shannon (0.986) and the Simpson (0.796) indices. Tin, cadmium, mercury, lead, and thallium were associated with changes in one or more taxa at the genus level. The BKMR analysis also revealed a negative correlation between metal mixtures and Clostridium_sensu_stricto, and tin contibuted mostly to the negative correlation. Early postnatal exposure to metals were associated with differences in the microbiome among infants admitted to the NICU. However, as the study was cross-sectional, these relationships must be confirmed in further studies.

The association between urinary phthalate metabolites and serum thyroid function in US adolescents.

The aim was to investigate the association between mixed exposure to phthalates and serum thyroid function among US adolescents. The study used 2007-2008 survey data from the National Health and Nutrition Examination Survey (NHANES). Data on urinary phthalates metabolites and serum thyroid function indicators were collected. The weighted multivariable linear regression models and Bayesian kernel machine regression (BKMR) analyses were used to analyze the relationship between phthalates metabolites and thyroid function. A total of 356 adolescents aged 12-19 years were included in the analysis. Linear regression models showed that mono-(carboxyisoctyl) phthalate (MCOP) was positively correlated with total triiodothyronine (TT3) (ß = 0.045, 95% confidence interval [CI] 0.022, 0.068) and thyroid stimulating hormone (TSH) (ß = 0.1461, 95% CI 0.059, 0.232), while mono-(carboxyisononyl) phthalate (MCNP) was negatively correlated with TSH (ß = - 0.119, 95% CI - 0.196, - 0.042). BKMR analyses showed phthalate metabolites mixtures have significantly positive overall effect on TT3. Exposure to phthalate mixtures might be positively correlated with increased TT3 serum level in US adolescents. The study provided evidence for the association between mixed phthalates exposure and thyroid health in adolescent population.

Effect of lead, calcium, iron, zinc, copper and magnesium on anemia in children with BLLs ≥ 100 µg/L.

OBJECTIVE: Adverse effects of lead exposure on children's health have been demonstrated. While studies have examined the relationship between iron status and low-level lead exposure in children with blood lead levels (BLLs) < 100 µg/L, few have investigated the association between blood lead and other trace elements and anemia in children with BLLs ≥ 100 µg/L. This study aimed to assess the levels of lead, iron, copper, zinc, magnesium, and calcium in children aged 0-14 with BLLs≥ 100 µg/L between 2009 and 2021, and to examine the relationship between blood lead, trace elements and anemia. METHODS: A total of 11,541 children with BLLs ≥ 100 µg/L were included in this study. Venous blood samples were collected to measure blood lead levels, hemoglobin levels, and trace element levels. According to the World Health Organization standard, outpatients with hemoglobin levels < 110 g / L were defined as having anemia. RESULTS: The study results found that high BLLs and blood calcium had a negative influence on Hb with odds ratios (95% confidence interval) of 1.411(1.208, 1.649) and 1.219(1.043, 1.424). High blood iron had a positive influence on Hb with odds ratios of 0.421(0.355, 0.499). CONCLUSION: The results suggest that the risk of anemia rose significantly with higher BLLs, blood copper, and blood calcium levels, and decreases considerably with higher blood iron levels.

Association of urine phthalate metabolites levels with kidney function in 1610 US adolescents.

Phthalates are widely used as plasticizer or fragrance ingredients in various consumer products worldwide. However, evidence for the overall effects of mixed exposure to phthalate on kidney function has not been widely investigated. The purpose of this article was to assess the association of urine phthalate metabolite levels and kidney injury parameters in adolescents. We used data from the combined 2007-2016 National Health and Nutrition Examination Survey (NHANES). We fitted weighted linear regressions and Bayesian kernel machine regressions (BKMR) models to explore the association of urinary phthalate metabolites with four parameters of kidney function after adjusting for covariates. Weighted linear regression models showed that MiBP (ß = 8.057; PFDR = 0.016) was significantly positively associated with eGFR and MEP (ß = -0.799; PFDR < 0.001) was significantly negatively correlated with BUN. BKMR analysis showed that the higher the concentration of phthalate metabolite mixture, the higher eGFR in adolescents. Based on the results of these two models, our findings revealed that mixed exposure to phthalates was associated with elevated eGFR in adolescents. However, as the study is cross-sectional, reverse causality is possible, and altered kidney function may impact the concentration of phthalate metabolites in urine.

Association of intestinal microbiota and its metabolite markers with excess weight in Chinese children and adolescents.

OBJECTIVE: The objective of this study was to identify the intestinal microbiota and faecal metabolic biomarkers associated with excess weight in Chinese children and adolescents. METHODS: This cross-sectional study included 163 children aged 6-14 years (including 72 with normal-weight and 91 with overweight/obesity from three Chinese boarding schools). We used 16S rRNA high-throughput sequencing to analyse the diversity and composition of intestinal microbiota. Of these participants, we selected 10 children with normal-weight and 10 with obesity (matched 1:1 for school, sex and age) and measured faecal metabolites using ultra-performance liquid chromatography coupled with tandem mass spectrometry. RESULTS: Alpha diversity was significantly elevated in children with normal-weight compared to overweight/obese. Principle coordinate analysis and permutational multivariate analysis of variance revealed a significant difference in intestinal microbial community structure between the normal-weight and overweight/obese groups. The two groups differed significantly in the relative abundances of Megamonas, Bifidobacterium and Alistipes. In faecal metabolomics analysis, we identified 14 differential metabolites and 2 main differential metabolic pathways associated with obesity. CONCLUSION: This study identified intestinal microbiota and metabolic markers associated with excess weight in Chinese children.

Adverse Childhood Experiences, Inflammation, and Depressive Symptoms in Late Life: A Population-Based Study.

OBJECTIVES: This study investigated the association and dose-response relationship between adverse childhood experiences (ACEs) and depressive symptoms in late life and explored the mediating roles of inflammatory markers in the ACEs-depressive symptom association among Chinese older adults. METHODS: This study was conducted using 2014 life history survey data and 2015 follow-up data from the China Health and Retirement Longitudinal Study. Data on ACEs and depression, inflammatory markers of high-sensitivity C-reactive protein (CRP), and white blood cell were collected. The association between ACEs and depressive symptoms was examined using logistic regression, and the mediation effects of inflammatory markers were evaluated. RESULTS: A total of 6,518 individuals over 60 years were included in the analysis. Compared to no ACE exposure, the adjusted odd ratios ranged from 1.377 (95% confidence interval [CI], 1.133-1.673) when participants had been exposed to 2 ACEs to 1.809 (95% CI, 1.451-2.256) when participants were exposed to 4 or more ACEs. A significant dose-response relationship between cumulative ACE scores and depression was observed. Six of the 12 ACE exposures were related to increased odds of depressive symptoms. CRP appeared to partially mediate the ACE-depressive symptom association, and the proportion of the effect of ACEs on depression was 1.17% (P = 0.008). DISCUSSION: A dose-response association exists between ACEs and the prevalence of depressive symptoms among older Chinese adults. CRP partially mediated the ACE-depressive symptom association in late life. Emphasizing interventions targeting individuals with ACE exposure may minimize the burden of late-life depression in China.

Changes and significance of gut microbiota in children with focal epilepsy before and after treatment.

Objective: To better understand the alterations in gut microbiota and metabolic pathways in children with focal epilepsy, and to further investigate the changes in the related gut microbiota and metabolic pathways in these children before and after treatment. Methods: Ten patients with newly diagnosed focal epilepsy in Hunan Children's Hospital from April, 2020 to October, 2020 were recruited into the case group. The case group was further divided into a pre-treatment subgroup and a post-treatment subgroup. Additionally, 14 healthy children of the same age were recruited into a control group. The microbial communities were analyzed using 16s rDNA sequencing data. Metastas and LEfSe were used to identify different bacteria between and within groups. The Kyoto Encyclopedia of Genes and Genomes database was used to KEGG enrichment analysis. Results: There were significant differences in α diversity among the pre-treatment, post-treatment, and control groups. Besides, the differences in gut microbiota composition in 3 groups were identified by principal co-ordinates analysis (PCoA), which showed a similar composition of the pre-treatment and post-treatment subgroups. At the phyla level, the relative abundance of Actinobacteria in the pre-treatment subgroup was significantly higher than that in the control group, which decreased significantly after 3 months of treatment and showed no significant difference between the control group. In terms of the genus level, Escherichia/Shigella, Streptococcus, Collinsella, and Megamonas were enriched in the pre-treatment subgroup, while Faecalibacterium and Anaerostipes were enriched in the control group. The relative abundance of Escherichia/Shigella, Streptococcus, Collinsella, and Megamonas was reduced significantly after a three-month treatment. Despite some genera remaining significantly different between the post-treatment subgroup and control group, the number of significantly different genera decreased from 9 to 4 through treatment. Notably, we found that the carbohydrate metabolism, especially succinate, was related to focal epilepsy. Conclusion: Children with focal epilepsy compared with healthy controls were associated with the statistically significant differences in the gut microbiota and carbohydrate metabolism. The differences were reduced and the carbohydrate metabolism improved after effective treatment. Our research may provide new directions for understanding the role of gut microbiota in the pathogenesis of focal epilepsy and better alternative treatments.

Association Between Trajectory Patterns of Body Mass Index Change Up to 10 Months and Early Gut Microbiota in Preterm Infants.

Recent research suggests that gut microbiota plays an important role in the occurrence and development of excessive weight and obesity, and the early-life gut microbiota may be correlated with weight gain and later growth. However, the association between neonatal gut microbiota, particularly in preterm infants, and excessive weight and obesity remains unclear. To evaluate the relationship between gut microbiota and body mass index (BMI) growth trajectories in preterm infants, we examined microbial composition by performing 16S rDNA gene sequencing on the fecal samples from 75 preterm infants within 3 months after birth who were hospitalized in the neonatal intensive care unit of Hunan Children's Hospital from August 1, 2018 to October 31, 2019. Then, we collected their physical growth information during 0-10 months. Latent growth mixture models were used to estimate growth trajectories of infantile BMI, and the relationship between the gut microbiota and the BMI growth trajectories was analyzed. The results demonstrated that there were 63,305 and 61 operational taxonomic units in the higher BMI group (n = 18), the lower BMI group (n = 51), and the BMI catch-up group (n = 6), respectively. There were significant differences in the abundance of the gut microbiota, but no significant differences in the diversity of it between the lower and the higher BMI group. The BMI growth trajectories could not be clearly distinguished because principal component analysis showed that gut microbiota composition among these three groups was similar. The three groups were dominated by Firmicutes and Proteobacteria in gut microbiota composition, and the abundance of Lactobacillus in the higher BMI group was significantly different from the lower BMI group. Further intervention experiments and dynamic monitoring are needed to determine the causal relationship between gut microbiota differences and the BMI change.

The concurrence of sexual violence and physical fighting among adolescent suicide ideators and the risk of attempted suicide.

Sexual violence and physical fighting are independent risk factors for suicidal behaviors among adolescents. However, whether the concurrence of these two risk factors increases the risk of suicidal behaviors among ideators, and by how much that risk increases are unknown. This study analyzed data from the 2019 National Youth Risk Behavior Surveys. Students who reported having seriously considered attempting suicide in the past year were included (n = 1755). The associations between physical fighting/sexual violence status and the risk of suicide attempt/plan/attempt requiring medical intervention were estimated. The concurrence of physical fighting and sexual violence substantially increased the relative risk of attempted suicide (adjusted relative risk, adRR = 1.99, 95% CI 1.72, 2.29) and attempted suicide requiring medical intervention (adRR = 4.07, 95% CI 2.84, 5.85; subgroup analyses: among women, adRR = 3.33, 95% CI 2.14, 5.17; among men, adRR = 6.25, 95% CI 3.32, 12.28). Among students who had experienced concurrent physical fighting and sexual violence, more suicide-attempt-associated health-risk behaviors were reported by men (median = 14) than women (median = 12) (p = 0.0023). The concurrence of physical fighting and sexual violence among adolescent suicide ideators was shown to be significantly associated with an increased risk of attempted suicide. A wide variety of health-risk behaviors were shown to cluster with the concurrence of physical fighting and sexual violence. This was especially the case among men, consistent with their higher rate of attempted suicide requiring medical intervention.

Urine Phthalate Levels and Liver Function in US Adolescents: Analyses of NHANES 2007-2016.

Background: Phthalates are non-persistent chemicals with endocrine-disrupting abilities widely used in a variety of consumer products. Evidence for the effects of phthalate exposure on liver function in adolescents is lacking. Methods: Data were analyzed from the combined 2007-2016 National Health and Nutrition Examination Survey (NHANES). Ultimately, a total of 1,650 adolescents aged 12-19 years were selected as the samples. Weighted linear regression was used to investigate the effects of urinary phthalate metabolites on liver function indexes. Results: Weighted Linear regression models showed that MCOP was negatively associated with TBIL (ß = -0.0435, PFDR = 0.007), ΣDEHP (ß = -0.0453, PFDR = 0.003) and MCOP (ß = -0.0379, PFDR = 0.006) were negatively correlated with ALB, while MCPP was positively correlated with ALB (ß = 0.0339, PFDR = 0.024), and MCOP was negatively correlated with TP (ß = -0.0551; PFDR = 0.004). Conclusions: Phthalate metabolites were significantly but weakly associated with changes in liver function indicators among US adolescents. Future work should further examine these relationships.

Consistency between 3 days' dietary records and 24-h urine in estimating salt intake in children and adolescents.

Purpose: This study aimed to evaluate the salt intake in boarding school students and the consistency between salt intake measurements based on 24-h urine and weighed dietary records over 3 consecutive days in this population. Methods: This was a school-based cross-sectional study. Overweight (including obesity) or hypertensive students aged 6-14 years and their normal counterparts were recruited for this study at three boarding schools in China. Three consecutive 24-h urine samples were collected from all participants. During the collection period of 24-h urine, the weighed diet records were collected in children who had all three meals at the school canteens on weekdays. Incomplete 24-h urine or dietary records were excluded from the analysis. Results: The median salt excretion was 6,218 [4,636, 8,290] mg by 24-h urine and 120 (82.2%) consumed excess salt among the participants. The median salt intake was 8,132 [6,348, 9,370] mg by dietary records and 112 (97.4%) participants consumed excess salt than recommended in participants who have all three meals in the school canteens. In children with complete dietary records and 24-h urine, the level of salt intake estimated by 24-h urine accounted for 79.6% of the dietary records. Conclusion: Our study showed that boarding school students consumed excessive salt from school canteens. Thus, policies or strategies targeting school canteens are urgently needed. Weighed dietary records are recommended if feasible.

Diagnostic Time Lag of Pediatric Haemophagocytic Lymphohistiocytosis and Patient Characteristics: A Retrospective Cohort Study.

The difficulties and challenges of applying the HLH-2004 diagnostic criteria to early identification and diagnosis of haemophagocytic lymphohistiocytosis have been fully addressed in previous studies. However, the distribution of the diagnostic time lag of haemophagocytic lymphohistiocytosis and related patient characteristics remain unclear. This study investigated the time lags between symptom onset and diagnosis and between hospital admission and diagnosis among pediatric patients with haemophagocytic lymphohistiocytosis, and identified factors that associated with a shorter or longer diagnostic time lag. The cohort of patients with haemophagocytic lymphohistiocytosis was drawn from a tertiary children's hospital and consisted of 122 pediatric patients. The distributions of symptom-to-diagnosis and admission-to-diagnosis time lags were assessed. Clinical characteristics within 48 h of admission and the fulfillment of HLH-2004 diagnostic criteria were compared among admission-to-diagnosis time lag categories. Logistic regression analyses were conducted to identify factors associated with an admission-to-diagnosis time lag >3 days. The median interval from first symptom onset to HLH diagnosis was 12 days (range 4-71 days) and the median interval from hospital admission to HLH diagnosis was 2 days (range 0-23 days). The following factors were negatively associated with admission-to-diagnosis > 3 days: Epstein-Barr virus infection; admission through pediatric intensive care unit; diagnosis established without NK-cell activity and soluble CD25 tests; the performance of all readily available diagnostic tests for HLH (within 48 and 72 h); concurrent fever, splenomegaly, and cytopenias within 48 h; hemophagocytosis, hypertriglyceridemia and/or hypofibrinogenemia within 48 h; and elevated ferritin, total bilirubin, alanine aminotransferase, and prothrombin time within 48 h. Our findings suggest that performance of adequate diagnostic tests for HLH is essential for early diagnosis of HLH. Once suspected, immediate and adequate diagnostic tests for HLH should be arranged for PICU patients. Improvements in diagnostic procedures and monitoring plans are needed to promote early diagnosis of HLH.

Association between Sleep Duration, Physical Activity, and Mental Health Disorders: A Secondary Analysis of the National Survey of Children's Health 2017-2018.

BACKGROUND: The purpose of this article was to examine the association of sleep duration and physical activity and their interactions on mental health disorders in American children aged 6-17 years. METHODS: Data were analyzed from the combined 2017-2018 National Survey of Children's health. Ultimately, a total of 36370 children aged 6-17 years were selected as the samples. Weighted logistic regression models were used to estimate odds ratios and 95% confidence intervals. RESULTS: Insufficient sleep duration was associated with an increased risk for current anxiety, depression, and behavior/conduct problems (odds ratio = 1.449, 1.991, 1.375; 95% confidence interval: 1.313-1.702, 1.648-2.406, 1.162-1.627). Insufficient physical activity was associated with an increased risk for current anxiety (odds ratio = 1.448; 95% confidence interval: 1.230-1.706) and depression (odds ratio = 1.743; 95% confidence interval: 1.304-2.329). In addition, additive interactions between sleep duration and physical activity were observed on current anxiety and depression. CONCLUSIONS: Insufficient sleep duration and insufficient physical activity in children were associated with mental health disorders. There is a synergistic interaction effect between insufficient sleep duration and insufficient physical activity on current anxiety and current depression.

Changes in the age-specific body mass index distribution among urban children between 2002 and 2018 in Changsha, China.

BACKGROUND: It had been reported that the increase in the prevalence of childhood overweight and obesity in several developed countries over the decade was largely a consequence of changes in the upper end of the body mass index (BMI) distribution. We speculated that the change in BMI distribution among Chinese children is different from that in developed countries. Therefore, we investigated the changes in the BMI distribution among urban children in Changsha, China. METHODS: A secondary data analysis of the 2002 and 2018 Annual Survey on Students' Constitution and Health from Yuhua District, Changsha City, China was performed. The BMI distribution of children aged 6-15 years (n=72,061) was examined by calculating the BMI value at 5th, 50th, 85th, and 95th percentiles. Differences in the BMI value at the 5th, 50th, 85th, and 95th percentiles between 2002 and 2018 according to age and sex were calculated. RESULTS: From 2002 to 2018, the standardized rate of underweight decreased from 6.9% to 3.4%, whereas that of obesity increased from 6.1% to 13.8%. The BMI of the population increased over the 16-year period. The greatest change between the years was seen in the 85th percentile, and moderate changes were seen in the 5th and 50th BMI percentiles. Also, the greatest changes in the BMI percentiles were evident at age 12-14 years. CONCLUSIONS: The whole spectrum of BMI distribution among school-aged children shifted over the 16-year study period, although the increases were more marked in the upper than lower percentiles. Health professionals and health policymakers should develop strategies and interventions aimed at preventing adverse health effects caused by this change.

A decision tree model of cerebral palsy based on risk factors.

OBJECTIVE: A risk prediction model of cerebral palsy (CP) was established by a decision tree model to predict the individual risk of CP. METHODS: A hospital-based case-control study was conducted with 109 cases of CP and 327 controls without CP. The cases and the controls were obtained from Hunan Children's Hospital. A questionnaire was administered to collect the variables relevant to CP by face to face interviews. Chi-square test was used to identify the factors associated with CP, and a decision tree model was used to construct the prediction model. RESULTS: Univariate analysis showed that there were significant differences between cases group and controls group on maternal age, weight gain during pregnancy, medical treatment during pregnancy, preterm birth, low birth weight and birth asphyxia (all p-values <.05). Three factors, including preterm birth, birth asphyxia, and maternal age >35 years old, entered the decision tree model. The area under the receiver operating characteristic curve (AUC) was 0.722 (95%CI: 0.659-0.784, p < .001). CONCLUSION: The decision tree prediction model can be used for predicting the individual risk of CP. Further large-scale, population-based cerebral palsy studies are needed to improve the model.

The prevalence of reduced visual acuity in children from an urban district in China from 2002 to 2018.

BACKGROUND: To investigate trends in the prevalence of reduced visual acuity (VA), a proxy measure for myopia, in an urban district in China. METHODS: Data were extracted from the dataset of the 2002 and 2018 Annual Survey on Students' Constitution and Health from Yuhua District, Changsha City, China. Children aged 6-15 years were included in the study. VA was measured using a LogMAR tumbling E chart. The prevalence of reduced VA was calculated by age and gender. The chi-square test was used to compare the differences between groups. RESULTS: The final VA analysis included 26217 children in 2002 and 45510 children in 2018. The overall prevalence of reduced VA increased from 28.3% in 2002 to 46.5% in 2018 (P < 0.001). The prevalence of reduced VA started to increase markedly from the age of 14 years in 2002, while in 2018 it started to increase markedly from the age of 9 years. The prevalence of severely reduced VA increased in all age groups from 2002 to 2018 and increased with age (all P < 0.001). In 2002, over 50% of children in all age groups had normal VA. By 2018, the prevalence of normal VA decreased from 61.4% in those aged 6 years to 31.9% in those aged 15 years. CONCLUSIONS: The prevalence of reduced VA among children aged 6-15 years in Yuhua District has become more common with age, and there has been a marked increase in the prevalence of reduced VA from 2002 to 2018. The remarkable epidemic of reduced VA started 5 years earlier in 2018 than in 2002. Evidence from the present study suggests that interventions should be launched before the age of 9 years.

Association between Physical Activity and Age among Children with Overweight and Obesity: Evidence from the 2016-2017 National Survey of Children's Health.

Physical activity participation in children declines with age. It is not clear yet whether the age-related trends vary by weight status. This study is aimed at investigating the association between physical activity participation and age among children with healthy weight, overweight, or obesity, using data from the 2016-2017 National Survey of Children's Health (NSCH). Physical activity participation was evaluated by days participated in physical activity for at least 60 minutes out of 7 days. Weight status was categorized from body mass index (BMI) percentiles. Data were analyzed on 33,056 US children age 10-17 years. The percentages of been active 0 day out of 7 days in BMI5th < 85th (healthy weight), 85th < 95th (overweight), and ≥95th percentile (obese) groups were 8.9%, 11.5%, and 18.2%, respectively. Among all groups, been active 0 day out of 7 days was positively associated with age, while the strongest associations were observed in the BMI85th < 95th group (age 17 years vs. age 10 years: OR = 7.48, p < 0.0001). Older age was significantly associated with been active less than 4 days out of 7 days in the BMI5th < 85th and 85th < 95th groups, but those associations were attenuated in the BMI ≥ 95th group. This study found that physical activity participation was inversely associated with age among children with healthy weight, overweight, or obese, and the association was strongest among children with overweight and weakest among children with obesity. Interventions aimed at promoting physical activity among children should take these patterns of association into account.

Clinical profiles and risk factors of 7-day and 30-day mortality among 160 pediatric patients with hemophagocytic lymphohistiocytosis.

BACKGROUND: Hemophagocytic lymphohistiocytosis (HLH) is a relatively rare and life-threatening disorder. Early mortality remains significantly high among patients with HLH. Our aim was to investigate clinical features and risk factors associated with 7-day and 30-day mortality among pediatric HLH patients. We retrospectively collected medical records of patients with discharge diagnosis of HLH between August 2014 and October 2018 from a tertiary children's hospital in China. The main outcome measures were the 7-day and 30-day outcome after hospital admission. The associations between symptoms, concomitant diagnoses, laboratory test results, and the risk of 7-day and 30-day mortality were examined. RESULTS: Among 160 pediatric HLH patients, 18 (11.3%) patients were deceased within 7 days after admission, and 46 (28.8%) patients were deceased within 30 days. The identified strong risk factors (OR > 10 and p < 0.05) for 30-day mortality were myocardial damage, severe pneumonia, respiratory failure, coagulopathy, gastrointestinal disorder, and multiple organ dysfunction syndrome (MODS). Factors strongly associated with 7-day mortality were sepsis, myocardial damage, shock, and respiratory failure. All patients deceased within 7 days developed hepatic dysfunction, coagulopathy, and MODS. CONCLUSIONS: The identified risk factors could help to stratify patients with high risk of early death, and need to be considered in the development of treatment protocols. As early mortality of HLH remains high, studies are needed to investigate how to initiate adequate HLH-directed treatment strategies for patients at higher risk of early death.

A novel three-dimensional printed vacuum bell for pectus excavatum treatment: a preliminary study.

OBJECTIVE: Conservative treatment with a vacuum bell (VB) for pectus excavatum (PE) has now been gradually popularized as an alternative to surgery. We describe our initial experience with a novel three dimensional (3D) printed VB device. METHODS: Prospectively collected data of all patients who started using a 3D printed VB in 2018 at our institution were analyzed. Linear and logistic regressions were used to identify factors associated with effectiveness of device usage. RESULTS: In total, forty-two patients with a median age of 3.6 years were treated with the device. The median follow-up duration was 11.1 months and the mean initial Depth Ratio (DR) was 0.129. There were no permanent sequelae from side effects. Thirty patients with at least one follow-up body scan data showed varying improvement (z = - 4.569, p = 0.0000). Linear regression suggested that longer usage improved outcomes (R2 = 0.235, p = 0.014). By logistic regression there was a trend of younger ages and less initial DR for better improvement though neither was statistically significant (p = 0.086, 0.078, respectively). CONCLUSION: Our initial experience has shown the 3D printed VB may be as effective as other conventional VBs and could be used as an alternative to surgical treatment for selected patients with PE. More experience and studies with this type of VB are needed to demonstrate its superiority with regard to the 3D printing design and optimal timing and indication for use.

[Significance and current development status of pediatric palliative care].

Pediatric palliative care refers to the comprehensive physical, mental, and psychological care provided to the children with life-threatening diseases, as well as support for their families, aiming to provide the best quality of life for children and their families. In the face of the large population of children in China, the increasing demand for palliative care services and the insufficient development of related service resources are existential problems in the field of palliative care for children in China. This article reviews the implementation and current development status of pediatric palliative care in China.