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Background: Sitting height and leg length are the useful indicators for the linear growth evaluation of children and adolescents, but the growth reference standards of the two indicators have not been reported. Objective: To study and formulate the growth reference of sitting height and leg length of Chinese children and adolescents aged 0-18 years. Design: A cross-sectional survey. Methods: Stature and sitting height of 92,494 healthy urban children aged 0-18 years were measured in two national surveys in 2005 in China—The National Survey on the Physical Growth and Development of Children in the Nine Cities of China (NSPGDC) and The Chinese National Survey on Students' Constitution and Health (CNSSCH). Leg length was calculated by height minus sitting height. Growth reference standards of sitting height and leg length were constructed using the LMS method. Main outcome measures: Reference values of sitting height and leg length. Results: The percentile and the Z-scores reference values of sitting height and leg length for Chinese boys and girls aged 0-18 years were shown and their growth charts were drawn. Sitting height increased about 14 cm, 6 cm and 4 cm during the first, second and third year after birth, respectively. After that, the annual increment of sitting height is nearly 2-3 cm. Then the increments became slightly higher at 11-13 years for boys and 9-11 years for girls and gradually became smaller and smaller. Sitting height nearly stopped increasing at the age of 17 years for boys and 15 years for girls. Leg length increased respectively about 11-12 cm and 6.5 cm during the first and second year after birth, then the annual increment was 4-5 cm during 2-5 years, and leg length stopped increasing nearly at 15 years for boys and 13 years for girls. Conclusion: The growth reference standards of sitting height and leg length were formulated, which provide more data and reference for perfecting the growth evaluation system of children and adolescents in China.

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Background：Rehabilitation of children and adolescents with cerebral palsy（CP） needs highquality clinical practice guidelines to provide effective assessment and intervention to improve the health condition of children and adolescents with CP. Objective：To improve and perfect the topic structure of Clinical Practice Guidelines for Children and Adolescents with Cerebral Palsy (CANDLE). Design：A Scoping review Methods：We searched English literature in Google Scholar and Chinese literature in CNKI, WangFang and VIP from January 1, 2010 to May 2, 2022 to get literature about children and adolescents with CP including guidelines, expert consensus, systematic review, and scoping review. Grey literature was searched in Google and BAIDU. According to intelligent sorting of Google scholar, researchers preliminarily screened literature by reading titles and abstracts until consecutive 50 articles of failed to match the inclusion criteria. The included literature was rescreened by reading full texts. References of the included literature after the second screening were compared with the final list of the included studies to find differences. Those unduplicated ones were screened by reading titles and abstracts. Researchers extracted data about questions proposed by the scoping review to a selfmade Excel sheet. The sheet consists of items of the application condition of The International Classification of Functioning, Disability and Health for Children and Youth（ICFCY）, function assessment, development, intervention, and functional influencing factor of children and adolescents with CP. The consistency of extracted data by 6 researchers was requested to be over 80%. Qualitative and quantitative methods were used to analyze data, and the core member of the CANDLE team answered the questions proposed by the scoping review. Main outcome measures：Questions proposed by the scoping review. Results：A total of 372 articles were enrolled in this scoping review. There has been a gradual increase in the number of guidelines, expert consensus, systematic reviews and scoping reviews in the past years. We got 7 English scoping reviews from 2010 to 2018, and 42 from 2018 to 2022. The majority of English literature focuses on intervention techniques, assessment techniques, and function status. Intervention techniques in Chinese literature accounted for 66.7%. There were 37 kinds of intervention techniques in 181 English articles. Four articles adopted ICFCY or ICF concept, and 78 articles partially used ICF concept in their structure. A total of 47 guidelines and expert consensus were enrolled. Among them, 9 expert consensus and 7 guidelines used function as a starting point. In 6 comprehensive guidelines, contents about function related to posture and motor were shown by muscular tension, mobility, hand activity, secondary musculoskeletal, daily living and leisure activities. There were 104 articles (31%) discussing the assessment method separately within 20 articles using COSMIN. Nine articles (3%) independently elaborated the effect of development characteristics on function. A total of 41 articles (12.1%) analyzed the interaction between function and background factors through the methods of correlation and influencing factors. Conclusion：The overall structure of CANDLE was initially formed through this scoping review. Eight domains were established with function as the core, each of which is shown through five elements (ICFCY as the framework, assessment, development, interaction, and intervention). Questions of interest within the scope are built on the elements.

Background：With an increasing number of very preterm infants (VPI, <32 weeks' gestation) treated in China, central vascular catheterization has become a common technique in Chinese neonatal intensive care units (NICUs). Inappropriate use of central vascular catheters(CVCs) may occur in the treatment, but there is still lack of relative data. Objective：To retrospectively analyze the firstyear data from the standardized database of the Chinese Neonatal Network (CHNN) and preform hospitallevel questionnaires, to reveal the current problem of central vascular catheterization among VPIs in Chinese NICUs and to provide baseline data for future quality improvement program. Design：Crosssectional study. Methods：The study described the current situation of central catheterization across gestational age (GA) weeks, including rate, duration and site variation, using the firstyear data of CHNN (from Jan. 1st 2019 to Dec. 31st 2019) from the participating NICUs. Questionnaires were collected on hospital level in terms of the regulation and management of CVC wards, indications of insertion and removal, and related complications of central catheterization. Infants with GA of 24+0~31+6 weeks, admitted into CHNN database from Jan. 1st 2019 to Dec. 31st 2019 within 24 hours after birth were included. Those infants with major congenital anomalies, transferred to other hospitals or discharge against medical advice were excluded. Incomplete and substandard data were also excluded. Subgroup analysis were done for infants with GA at 2428 weeks and 2931 weeks. Research sites were classified into children's specialized hospitals, maternal and children's healthcare centers and general hospitals. Questionnaires were designed to investigate the regulation, management, indications, maintenance and related complications of central catheterization, which were filled by department directors or senior neonatologists authorized by the director. Main outcome measures：The type, rate and duration of central catheterization. Results：A total of 6,532 VPIs from 57 CHNN participating sites were included in the analysis. A total of 69.9% (4,563/6,532) cases received central catheterization. Overall, 38.8% (2,532/6,532), 5.6% (368/6,532), 59.6% (3,895/6,532) and 0.8% (55/6,532)infants received umbilical venous catheters(UVC), umbilical artery catheters(UAC), peripherally inserted central catheters(PICC) and surgical central venous catheters(SCVC). Infants with central catheterization had smaller GA and lower birthweight, and were more likely to be smallforGA, multiple birth, outborn and with 5min Apgar score less than 7, compared to noncatheterized infants (P <0.01). The proportion of pregnancy hypertension, antenatal hormone use, and cesarean section was also higher in the mothers of catheterized infants. The mortality rate did not differ between catheterized and noncatheterized infants but catheterized infants had higher rate of each morbidity and longer hospitalization (P <0.01). Rate of any type of central catheterization generally decreased along with the increasing GA, and the rates were 87.8% and 63.1% for 2428 GA weeks and 2931 GA weeks respectively. Rates of UAC and UVC also decreased along with the increasing GA. Rate of PICC was the highest at 2528 GA weeks, and it was still as high as 52.8% for infants at 2931 GA weeks. The rate of using two or more catheters(UVC/PICC/SCVC) was 29% at 2528 GA weeks, which decreased to 21.8% at 2931 GA weeks. The median duration of UAC, UVC and PICC were 6.0 (IQR: 4.08.0) days, 7.0 (IQR: 4.09.0) days and 22 (IQR: 15.031.0)days, respectively. There were significant variations among NICUs with different hospital types on the catheterization rates and the duration. Response rate of the questionnaire was 91.2% (52/57). Only 50% (26/52) hospitals have hospital guidelines for central vascular catheterization. There were also significant variations on the indications of insertion and removal, and the longest duration as well. A total of 62% (32/52) hospitals had central linerelated leakage and 23% (12/52) had thrombosis within one year. Conclusion：Central vascular catheterization has been commonly used in Chinese NICUs. However, overuse and insufficiency are both existing. Other major problems are the exceeding length of PICC and significant site variation. Guidelines and regulations are on demand. National quality improvement efforts are needed to promote the rationale and standardized use of central catheters for VPIs in NICUs.

Background: Infusion Therapy Standards of Practice published in 2021 did not provide a clear recommendation on how to choose between normal saline and heparin saline as the locking solution for neonates and children, however, Clinical Practice Guideline on Infusion Therapy in Children recommended using heparin solution. Objective: To compare the effects of heparin saline (HS) and 0.9% normal saline (NS) solution as the locking solution of a peripheral intravenous catheter (PIVC) on different pediatric populations. Design: Systematic review and metaanalysis of RCTs. Methods: Hospitalized pediatric patients who need PIVC were divided into the intervention group using HS and the control group using NS. Literature was searched in English databases of Ovid MEDLINE, PubMed, Cochrane Library, and Chinese database of SinoMed from April 1, 2014 to November 23, 2021 for there have been two articles of systematic review and metaanalysis on this topic published in 2005 and 2013. RoB 2 was used to evaluate the risk of bias in the included studies. Main outcome measures: PIVC duration and the related complications. Results: A total of 21 RCTs were included in the analysis. The duration of PIVC in HS group was 8.62 h longer than that in NS group (95%Cl: 2.9814.26, I2=91%, random effects model), and the difference was statistically significant. After removal of four literature about neonates because of greater heterogeneity, the metaanalysis of other eight literature showed that PIVC duration in neonates of HS group was increased by 6.04 h (95%Cl: 4.177.91, I2=56%, random effects model), and the difference was statistically significant. The pooled results of five studies for both neonates and children showed that the PIVC duration of HS group was prolonged by 6.22 h(95%Cl: 2.729.73, I2=20%, random effects model), and the difference was statistically significant. For the population of children, the pooled results of three studies indicated that the PIVC duration was prolonged by 6.94 h(95%Cl: -1.2715.15, I2=27%, fixed effects model ) in HS group, and there was no statistically significant difference. According to the pooled results of 18 studies, the incidence of complications decreased by 17% (RR=0.83, 95%Cl: 0.710.97, I2=19.5%, fixed effects model) in HS group compared with that of NS group, and the difference was statistically significant. The incidence of complications in neonates decreased by 25% in HS group(RR =0.75, 95%Cl: 0.620.91, I2=0%, fixed effects model) according to the pooled analysis of 9 studies, and the difference was statistically significant. There was no significant difference in reducing the incidence of complications between the two groups for children (4 studies) and the population of both newborns and children (5 studies). Conclusion: Locking PIVC by heparin saline is desirable for the neonatal population in terms of duration and complication incidence. Whether it is beneficial to the whole pediatric population still needs to be further explored.

Background: Early screening for autism spectrum disorder (ASD) has become a consensus, but it is unclear whether the children's health physical examination system can be used for screening, and the screening tools and paths need to be explored further. Objective: To explore the path and tools of ASD early screening suitable for children's health physical examination system. Design: Diagnostic accuracy study. Methods: From August 1, 2018 to October 31, 2020,the ASD screening clinical pathway was embedded in the child health physical examination system of Shanghai Changning Maternal and Child Health Hospital for children aged 1836 months. The gold standard was the Autism Diagnostic Observation Scale version 2 (ADOS2) combined with Diagnostic and Statistical Manual of Mental Disorders version 5(DSM5), and the modified checklist for autism in toddlers (MCHATR) + MCHATR/F or two behavioral observations (customized) were the test criteria. After primary MCHATR screening, positive children were rescreened by MCHATR/F, and negative children were rescreened by two rounds of behavior observation. Children with positive rescreening were diagnosed as ASD or not. Children with negative rescreening were inquried in routine physical examination, and after the diagnosis of ASD was confirmed, that would be recorded in the children health physical examination system. Those who were positive in the primary screening but were not rescreened and those who were positive in the rescreening but were not recorded in the children's health examination system were lost to followup and were not included in the analysis. Main outcome measures: The Youden's index of primary screening and secondary screening of ASD. Results: In the primary screening，there were 10,635 children, 5,579 boys with an average age of (22.3±2.9) months and 5,056 girls with an average age of (22.4±2.9) months. A total of 252 cases were positive and 38 cases were lost to followup (loss rate 15.1%). There were 53 cases positive in MCHATR/F rescreening, 13 cases were lost to followup (loss rate 24.5%), and 26 cases were diagnosed as ASD. A total of 161 cases were negative in MCHATR/F rescreening, and 4 cases were inquiny ASD by routine physical examination. Among 10,383 cases negative in the primary screening, there were 8 ASD in the 2018 subgroup, and 3 ASD in the 2019 subgroup by inquiry in the routine physical examination. In rescreening positive patients of the first behavior observation (n= 54),33 cases were positive, 18 cases were lost to followup (loss rate 54.5%), and 13 cases were diagnosed as ASD. There were 54 case of ASD dignosed by the overall screening, 41 boys and 13 girls with an average age of (26.2±5.9) and (23.8±5.3)months, respectively. The Youden's index of MCHATR was 0.539, the specificity was 98.4%, and the sensitivity was 55.6%. On the basis of positive MCHATR primary screening, the rescreening Youden's index of MCHATR/F was 0.78, the specificity was 91.3%, and the sensitivity was 86.7%. On the basis of negative MCHATR primary screening, the rescreening Youden's index of two rounds behavior observation was 0.81, the specificity was 99.96%, and the sensitivity was 81.2%. Eight children in the 2018 subgroup with negative results in MCHATR screening were diagnosed as ASD through inquiry in the following routine physical examination, and the age of diagnosis was (34.8±2.7) months. In 2019 subgroup of negative results in MCHATR screening, 3 cases were diagnosed as ASD during one round of behavior observation, and for negative subjects the age of diagnosis was(32.7±3.8) months. In the second round of behavior observation, 13 cases were diagnosed as ASD, and the age of diagnosis was (24.2±4.0) months. The difference between groups was statistically significant (F=22.809, P＜0.001), and there was also statistically significant difference in further pairwise comparison (P＜0.001, P=0.004). Conclusion: It is feasible for children aged 1836 months to embed ASD screening path in children's health physical examination system, and the screening efficiency is desirable. Behavior observation rescreening in children negative in the MCHATR screening can diagnose ASD 10 months earlier.

Background：Most of systematic review or metaanalysis of neonates with moderatetosevere hypoxic ischemic encephalopathy (HIE) treated with therapeutic hypothermia were published before 2012, and then several RCT studies have been completed. This systematic review and metaanalysis is part of Evidencebased Treatment Guidelines for Hypoxic and Ischemic Encephalopathy in Fullterm Children (2022). Objective：To study the longterm neurological outcomes of hypothermia alone and hypothermia plus agents for moderate to severe HIE. Design：Systematic review and metaanalysis. Methods：English literature was searched in PubMed, Embase, Cochrane and CINAHL from the establishment of databases to November 12, 2021 and Chinese literature was searched in SinoMed from the establishment to December 6, 2021. Literature was selected through preliminary screening by reading titles and abstracts and rescreening by reading full texts. Exclusion criteria for rescreening (meeting one of the following option) included: a. Neonates were with congenital malformations; b. Hypothermia occurred beyond 12 h after birth; c. The core temperature was not between 33℃35.0℃ during the treatment or hypothermia did not last for 72 hours; d. The followup was less than 18 months in the hypothermia group or less than 12 months in the hypothermia plus agents group. e. Hypothermia is not taken as the intervention. GRADE was used to evaluate the evidence system. Metaanalysis was performed using Revman 5.4 and R. Publication bias was analyzed for the evidence body with more than 10 articles. Main outcome measures：The incidence of death and longterm major neurodevelopmental outcome after the 18month followup. Results：Fourteen articles of hypothermia were enrolled in the analysis, including 13 RCTs and 1 NRSI, involving 1 091 neonates in the intervention group (hypothermia) and 1 087 neonates in the control group (supportive care). Selective head cooling (SHC) and whole body cooling (WBC) were in 6 articles and 8 articles respectively. Followup were completed from 18 to 30 months in 13 articles, and 6 to 7 years in 1 article. Hypothermia significantly decreased the incidence of death and / or moderate to severe disability by 27% (RR=0.73，95%CI：0.670.80，I2=0，P＜0.01), including moderate encephalopathy (by 41%), severe encephalopathy (by 19%), SHC (by 30%), WBC (by 25%), cerebral palsy (by 36%), but did not reduce the incidence of hearing and visual impairment. There was no significant difference in the incidence of adverse effects including arrhythmia, severe hypotension, abnormal coagulation, thrombocytopenia, persistent pulmonary hypertension, sepsis, venous thrombosis and skin breakage without deleterious consequences. Ten articles of hypothermia plus agents were enrolled in the analysis, including EPO (4 articles), xenon (2 articles), stem cells (2 articles), melatonin (1 article) and topiramate (1 article). Followup were completed more than 18 months in 3 articles between the hypothermia and the control group (supportive care). There was no significant difference in the incidence of death and disability between hypothermia plus melatonin or topiramate or xenon and hypothermia alone (RR=1.08, 95%CI: 0.591.98, P=0.80). Conclusion：Therapeutic hypothermia reduced the risk of death and neurological disability of neonates with moderate to severe hypoxic ischemic encephalopathy by 27%. Further research of hypothermia combined with agents is needed.

Background: Large Bcell lymphoma in children with interferon regulatory factor 4(IRF4)gene rearrangement is defined as a unique subtype in the 2017 WTO lymphoma classification. Since it is clinically rare with special clinical features, it is necessary to distinguish it from other large Bcell lymphomas. Objective: To investigate the clinical manifestations, pathological features, treatment and prognosis of large Bcell lymphoma with IRF4 gene rearrangement in children. Design: Case series report. Methods: The clinical data of children with large Bcell lymphoma with IRF4 gene rearrangement diagnosed and treated in Beijing Children's Hospital affiliated to Capital Medical University from May 2018 to October 2021 were collected retrospectively. The clinical characteristics were summarized, and PubMed, Wanfang and CNKI were searched for literature review. Main outcome measures: Complete response rate of large Bcell lymphoma in children with IRF4 gene rearrangement. Results: Six cases were included in the analysis, accounting for 2.7% of the invasive mature Bcell lymphoma treated in our hospital in the same period. There were 5 males (83.3%) and 1 female. The age of onset was 7 (4 13) years old. The involved sites were the neck and head in 4 cases, the intestine in 1 case and both of the head and neck and intestine in 1 case. No metastasis was found from the onset to followup. Four cases were in stageⅡ and 2 cases were in stage Ⅲ. Among the 62 cases including 56 from literature review, 61.2% were male, the age of onset was 11.15 (3,18) years old, the main site of tumor was 79% in the head and neck, and 21% in the intestine and groin. Most of them were isolated lesions, and no metastasis was found from the onset to followup. Clinical stage ⅠⅡ accounted for 79%. Under light microscope, 2 of 6 cases showed complete nodular follicular structure featured by nodules of different sizes, lack of "starry sky phenomenon" formed by mantle area and phagocytic nuclear fragments and 4 cases showed completely diffuse like structure with medium or large tumor cells, scattered nuclear chromatin and small basophilic nucleoli. Immunohistochemistry showed the expression of CD20 and PAX5, the strong expression of BCL6 and MUM1, and the positive index of 90% to 95% for Ki67. Three cases were positive for CD10 and BCL2, six cases were positive for IRF4 rearrangement by fluorescence in situ hybridization (FISH), and BCL6, BCL2 and CMYC gene rearrangements were not detected. Sixtytwo cases showed complete diffuse like structure (43.5%), complete nodular follicular like structure (37.1%) and mixed like structure (19.4%) and 88.7% could detect rearrangement with IRF4 . Conclusion: Large Bcell lymphoma with with IRF4 rearrangement is clinically rare. The tumor is mainly involved in the head and neck. The clinical stage is mainly early lesions, which are more isolated and inert, slow progress, weak invasiveness and good prognosis. The pathological morphology showed complete diffuse like, follicular like and mixed like structures. Immunohistochemistry showed the expression of CD20 and PAX5, the strong expression of BCL6 and MUM1, and the high positive index of Ki67. IRF4 rearrangement could be detected by FISH combined with secondgeneration gene sequencing.

Objective: To compare the reliability and validity of the CRIES scale, PIPP scale and N-PASS scale for neonatal postoperative pain assessment and then find the most reliable and valid postoperative pain assessment scale for neonates. Methods: The convenience sampling method was adopted to select 67 newborns who had been operated in a third-grade A children's hospital in Chongqing from August 2019 to January 2020 as the research objects. Data were collected through general information questionnaire and bedside video recording. Three scales were used to evaluate the pain of each patient for a total of 2,412 times at 1, 2, 4, 8, 12 and 24 hours after surgery. The reliability and validity of three scales were evaluated by correlation analysis, reliability analysis, principal component analysis and exploratory factor analysis. Results: The Cronbach's alpha coefficients of CRIES, PIPP, and N-PASS were 0.906, 0.769, and 0.915 respectively. The test-retest reliability was 0.917, 0.753 and 0.919, respectively. Criterion validity was 0.887,0.874 and 0.920, respectively. Exploratory factor analysis extracted 1, 2 and 2 components, and the cumulative variance contribution rate was 72.717%, 71.133% and 87.252%, respectively. Conclusion: The reliability and validity of the N-PASS scale was higher than that of the CRIES scale and PIPP scale, which was more suitable for the assessment of neonatal postoperative pain.

Background：Mild neonatal hypoxic-ischemic encephalopathy (HIE) has been considered to have better long-term outcomes. In recent years, there was evidence that the long-term outcomes of mild HIE were worse than those of normal children. Objective：To explore whether mild neonatal HIE benefits from hypothermia therapy. Design：Systematic review and meta-analysis. Methods：Literature was searched in databases of PubMed, Embase, Cochrane, CINAHL from the establishment to Dec 6,2021, and in database of SinoMed from the establishment to Nov 12, 2021. Retrieved papers were first screened by titles and abstracts. A second phase of screening was subsequently undertaken to screen papers for exclusion criteria as follows either: a. the diagnosis of mild neonatal HIE failing to meet the modified Sarnat standard; b. neonates with congenital malformations; c. failure to extract the outcome data of neonatal mild HIE; d. the follow-up time <12 months. GRADE methodology was used to rate the quality of evidence body. Publication bias analysis was adopted for more than 10 articles in either evidence body, and extracted data were analyzed using Revman 5.4 and R. The I2 test was used for heterogeneity. If I2≤50%, the fixed effect model should be adopted; if I2>50%, the random effect model should be adopted. Main outcome measures：Rate of death and major neurodevelopmental disabilities at more than 12 months. Results：1,839 articles were identified through database searching. A total of 113 full-text articles were assessed for eligibility and 24 articles were included in this review. The review was conducted for 4 RCTs, 7 cohort studies, and 13 case series reports. A total of 21 literature reported nervous system disability by dichotomous variables, and three literature reported nervous system disability by continuous ones. Follow-up time in 16 articles was from 12 months to 3 years, and 9 articles over 3 years (1 article reported neurological disability at 24 months and 7 years old respectively). No deaths were reported in the 24 articles during the observation period. A total of 369 infants with mild neonatal HIE was reported in 21 articles with dichotomous variables and the results showed that the incidence of major neurodevelopmental disabilities in mild HIE survivors was 21% (95%CI: 0.14-0.29), I2=80%, and there was publication bias (Egger test, t=4.68, P<0.01). The incidence of major neurodevelopmental disabilities was 11% (95%CI: 0.00-0.23) on therapeutic hypothermia (6 articles) and 21 percent (95%CI: 0.13-0.29) on non-therapeutic hypothermia (19 articles). There was no difference (OR=0.78, 95%CI: 0.27-2.31, I2=0) in the incidence of major neurodevelopmental disabilities between mild HIE patients treated with therapeutic hypothermia and those not treated with therapeutic hypothermia (4 RCTs), and patients who received non-therapeutic hypothermia compared with normal children (4 cohort studies) had higher incidence of major neurodevelopmental disabilities (OR=19.06, 95%CI: 7.01-51.85, I2=42%). The incidence of neurological disability was 20 percent (95%CI: 11%-29%) in subgroups whose follow-up time was from 12 months to 3 years and 24 percent (95%CI: 11%-36%) in over 3 years. Conclusion：When patients diagnosed with mild HIE was followed up until the age of 3 years old, the potential incidence of major neurodevelopmental disabilities increased to 24%, and benefits of combining with support treatment of therapeutic hypothermia as auxiliary is greater than the disadvantages.

Background: Pediatric antimyelin oligodendrocyte glycoprotein antibody associated disease (MOGAD) has a variety of clinical manifestations, which can be divided into monophasic and polyphasic courses according to the course of disease, of which about 50% children present with a polyphasic course. Recurrent episodes of polyphasic MOGAD lead to varying degrees of neurological impairment. The main prophylactic drugs for relapse of multiphasic MOGAD include mecophenolate mofetil（MMF）, rituximab (RTX), azathioprine (AZA) and intravenous gamma globulin (IVIG) on a monthly basis. However, there is a lack of highquality clinical evidence for the prophylactic treatment. Objective: To investigate the effectiveness of rituximab in the treatment of MOGAD through a systematic review and metaanalysis. Design: Systematic review/metaanalysis. Methods: Literature on rituximab in the treatment of MOGAD was searched in the databases of Pubmed，Embase，Web of Science，Cochrane，Wanfang Data，CKNI and VIP from Jan 1st, 1997 to June 1st, 2021. After two researchers independently screened the literature, extracted the data, and evaluated the risk of bias in the included studies, the metaanalysis was performed using RevMan 5.3. Main outcome measures: Annualized relapse rate and relapsefree rate. Results: Thirteen studies (272 patients) were included. Metaanalysis showed that the relapsefree rate of patients of MOGAD who received rituximab treatment was 32.4%（95%CI:2.9%47.9％，I2=52%，P=0.03）, and the annualized relapse rate changes -1.44（95%CI: -1.67-1.21，I2=71%，P=0.004）. Conclusion: Rituximab reduced the frequency of relapse in some MOGAD patients, but the relapsefree rate was only32.4%. The results of this study need to be verified by more highquality studies.

Background: Offlabel drug use is common in neonates. Appropriate and effective administration of antibiotics for Carbapenemresistant Enterobacteriaceae （CRE） infection in neonates is challenging. Sulfamethoxazole compound (SMZco) can be taken orally with high bioavailability, however, it is not recommended to be used in infants under 2 months. Objective: To summarize the experience and therapeutic effect of oral SMZco for the CRE septicemia in newborns. Design: Case series report. Methods: Through the hospital drug management system, SMZco medical records that meet the following criteria were collected: a. Patients were hospitalized in NICU of Beijing Children's Hospital, Capital Medical University from January 2018 to June 2021; b. The age on admission was ≤ 28 d or the corrected age was ≤ 44 weeks; c. The CRE septicemia was confirmed by positive blood culture results and clinical manifestations. The oral SMZco as a combined use of medications was administered when the pros and cons were thoroughly discussed by neonatal physicians and clinical pharmacists, and formal written consents were signed by parents. The dose of SMZco was referred to that for children above 2 months old. Signs of allergy and manifestations of bilirubin encephalopathy had been closely watched during the treatment. Complete blood counting and renohepatofunction were monitored weekly. The following information was collected: demographic characteristics, history of surgical intervention or long line catheterization, ventilation time, time interval between blood drawing and culture positive, species of the positive culture results together with the drug sensitivity test, age of starting SMZco administration, dosage of SMZco, WBC, PLT and CRP before and after SMZco treatment, adverse reactions and clinical outcomes. Main outcome measures: Discharge after improvement. Results: A total of 9 newborns with CRE septicemia were enrolled, among which 5 were males, 6 received surgery intervention before CRE septicemia was confirmed, and 8 had history of long line catheterization. The average gestational age was (31.0 ± 4.4) weeks, ventilation time was (793±381）h . Specimens for the positive CRE cultures were blood (2 cases), tracheal bronchial secretion (3 cases), tip of PICC (1 case), surgical wound swab (1 case), blood and tracheal bronchial secretion (1 case) and blood+cerebrospinal fluid (1 case). Before the administration of SMZco, all cases were treated with broadspectrum antibiotics for more than 2 weeks. There were 2 cases of CRE meningitis. The medium time of positive CRE culture was 39 (23.5,49) d of hospitalization before or after being transferred to our center. Among the 9 cases, 8 were Klebsiella pneumoniae and 1 was Escherichia coli, all of which produced extendedspectrum βlactamases. Analysis of antimicrobial susceptibility assay revealed resistance to Amikacin (3 cases), Gentamicin (6 cases), Ciprofloxacin (7 cases), and Tetracycline (3 cases). All were sensitive to SMZco and Tegacyclin. SMZco treatment was initiated at 49(38,70.5) days of life for patients, and the dose of SMZ was 4060 mg·kg-1·d-1. There were 6 cases treated with oral SMZco in combination of intravenous carbapenems or thirdgeneration cephalosporins, while 3 cases were with oral SMZco only. Six out of nine patients completed the SMZco course of (24.3 ± 11.6) days, while three out of nine patients did not complete the required SMZco course due to their discharge against medical advice. Among the 6 patients with complete SMZco course, 1 was treated for 10 d (tracheal bronchial secretion positive), and the other 5 were treated for more than 2 weeks. All patients presented improved clinical symptoms and inflammatory markers after the starting of SMZco. All patients had normalization of WBC and PLT, 7 patients had normalization of CRP and other 2 patients had dramatically improved CRP before discharge against medical advice. No allergy was found, nor signs of bilirubin encephalopathy or hemolytic anemia or thrombocytopenia. There were 3 patients (33.3%) with an ALT elevation 2.23.5 times of normal value, which was normalized after symptomatic intervention. All patients had normal renal function during SMZco treatment. Conclusion: For neonates who had culture confirmed CRE septicemia, under the instruction of drug sensitivity results, a combined use of oral SMZco is a choice to treat the CRE infection when the treatment response of strong broad spectrum antibiotics is negative. However, it is necessary to strictly follow the procedures of offlabel drug use, parent consenting, and close monitoring of side effects.

Background: Therapeutic agents of refractory Kawasaki disease（KD） include IVIG, corticosteroids, and infliximab(IFX). However, the evaluation of therapeutic efficacy of those agents is not unified. Objective: To observe the therapeutic effects of IVIG, intravenous methylprednisolone（IMP）, and IFX on patients with refractory KD. Design: Cohort study. Methods: Patients with refractory KD who received retreatment and rescue therapy in Jiangxi Province Children's Hospital were taken as the cohort population. They were required to receive the echocardiographic followup of coronary arteries at the time of 3 months after the onset. IVIG (2 g·kg-1) plus oral aspirin (50 mg/ kg/day) was performed as initial treatment within 10 days of the onset. Retreatment and rescue therapy included IVIG(2 g·kg-1), IMP(30 mg·kg-1, 3 d), and IFX (5 mg·kg-1). Parents of these patients could choose the therapeutic agent according to their own will. Response was defined as patients with refractory KD had normal body temperature within 36 hours after the end of the retreatment therapy or rescue therapy. Main outcome measures: The response rate of total treatment, and coronary artery internal diameters (Zscore) at the time of 3 months after the initial treatment. Results: There were 73 patients with refractory KD from January 2018 to December 2020 in this study, including 30, 25 and 18 cases in IVIG retreatment group, IFX group and IMP group, respectively. There were no significant difference in age, gender, duration of fever before the initial treatment, duration of fever before rescue therapy, and laboratory parameters before the initial treatment (white blood cells, neutrophils, hemoglobin and Creactive protein). The fever duration of IFX group was shorter than that of IVIG group and IMP group (P=0.012, P=0.016, respectively). The difference in fever duration among the three groups was statistically significant(P=0.024). The retreatment response rate of IFX group was higher than that of IVIG group and IMP group (P=0.001, P=0.015, respectively). One patient in IFX group did not respond to the retreatment of IFX and respond to the rescue therapy of IVIG. Thirteen patients in IVIG group did not respond to the retreatment therapy, among which 7 responded to rescue therapy of IMP, and 6 responded to rescue therapy of IFX. Six patients in IMP group did not respond to the retreatment therapy, and 4 of them responded to the rescue therapy of IVIG, 2 of them did not respond until the rescue therapy of IFX. The total response rate of IFX regimen was higher than that of IVIG and IMP(P=0.035, P<0.001, respectively). The fever duration after retreatment in IFX group were shorter than that of IVIG group and IMP group (P=0.001, P=0.026, respectively). The Zscore at the time of 3 months after the initial treatment in IFX group were significantly lower than that of IVIG group and IMP group (P=0.001, P=0.002, respectively). Conclusion: IFX could be used as the first drug for the treatment of patients with refractory KD followed by IMP and IVIG.

Background: Given the poor prognosis of severe hereditary protein C deficiency (PCD), most of the children with severe PCD reported in China gave up treatment and died. Objective: We aimed to explore the longterm therapeutic effect of oral anticoagulants on children with PCD. Design: Case report. Methods: We reported 2 cases with severe hereditary PCD, both having compound heterozygous protein C gene (PROC) mutations. PubMed, CNKI and Wanfang databases were consulted from 1981 to 2021 to find out other cases reported in China. And all the cases were analyzed together on diagnosis, treatment and prognosis. Main outcome measures: Thrombotic or bleeding relief. Results: Case 1 first manifested as fulminant purpura, while case 2 first presented intracranial hemorrhage and pulmonary hemorrhage due to the chronic disseminated intravascular coagulation (DIC). Gene sequencing on both cases showed compound heterozygous mutation on PROC gene. Daily fresh frozen plasma (FFP) infusion and low molecular heparin (LWMH) worked as emergency treatment. Vitamin K antagonist (VKA) warfarin and direct oral anticoagulant (DOAC) rivaroxaban were used sequentially as longterm treatment to prevent thrombotic events, and hemorrhage. Both cases survived through the 36 years of followup without obvious side effects. Conclusion: Severe hereditary PCD can have neonate fulminant purpura, as well as intracranial hemorrhage and pulmonary hemorrhage as the initial manifestations. Doctors and parents should choose active treatment instead of giving up. Warfarin and rivaroxaban could be considered as safe and effective longterm alternatives for patients with severe PCD in infancy which could also improve prognosis.

Background: Kidney injury is one of the risk factors for poor prognosis of HenochSchnlein purpura nephritis(HSPN) , however, there were few researches about the clinical and pathological features of HSPN with acute kidney injury (AKI). Objective: To investigate the pathological features and risk factors for HSPN complicated with AKI in children. Design: Casecontrol study. Methods: Consecutive cases of HSPN diagnosed by kidney biopsy from January 2016 to December 2020 in Guiyang Maternity and Child Care Hospital were included. According to whether AKI was combined or not, the children were divided into the AKI group and the nonAKI group. Demographic data, clinical symptoms, clinical classification, laboratory examination on the day of admission, 24hour blood pressure, pathological grade of kidney biopsy (including classification of ISKDC pathology and Oxford classification) and treatment were extracted from the medical records. Main outcome measures: The risk factors for HSPN with AKI. Results: Among 181 cases diagnosed with HSPN, there were 18 cases(10.0%) complicated with AKI, and 163 cases without AKI. The differences in sex, age of onset, albumin levels and PLT counts between the two groups of children were not statistically significant. The incidence of gross hematuria, the duration of gross hematuria, the level of 24hour urine protein, the level of 24hour creatinine and ambulatory blood pressure in the AKI group were higher than those of children in the nonAKI group, and the differences were statistically significant. The clinical classification difference was statistically significant between the two groups(χ2=8.942,P=0.003).The main clinical classification of AKI group was acute nephritis and nephrotic syndrome, while for nonAKI group it was hematuria and proteinuria type and nephrotic syndrome type. ISKDC classification difference was statistically significant between the two groups(χ2=4.586,P=0.032) that the proportion of type Ⅲ and above was higher in AKI group. According to the Oxford typing score,the proportion of tubular/interstital lesions (T1/T2) and crescent (C1/C2) in AKI group was higher than those in the nonAKI group, and the differences were statistically significant(χ2 was 9.625 and 7.961,P Value was 0.002 and 0.005). Logistic regression showed that acute nephritis in clinical classification, and the tubular stromal lesions in the Oxford classification were two risk factors for AKI in children with HSPN. After treatment, 17 cases in AKI group achieved normal renal function, and one case developed chronic kidney disease. Conclusion: HSPN with AKI is featured by severe clinical and pathologic classifications. Acute nephritis by clinical classification and tubulointerstitial lesions by Oxford typing score were the two risk factors for AKI in children with HSPN.

Background: Juvenile idiopathic arthritis (JIA) associated uveitis is the most common extraarticular manifestation of JIA. Untimely treatment may lead to serious complications and the risk of blindness. Objective: To investigate the clinical features of JIA patients complicated with uveitis. Design: Case series report. Methods: Patients complicated with uveitis admitted to the department of rheumatology and immunology of the Children's Hospital Affiliated to the Capital Institute of Pediatrics from March 2018 to May 2020 were included. Demographic data, laboratory examination, subtype of JIA, ocular manifestations and complications, treatment, and followup were intercepted from the medical records. Main outcome measures: Uveitis and complications, treatment and outcome. Results: Of the 278 cases with JIA, fifteen cases were complicated with uveitis, including 4 males and 11 females. The onset age was within 8 years old. Among the 15 patients, there were 13 cases of oligoarticular type, 1 case of polyarticular type and 1 case of enthesitisrelated arthritis type; there were 2 patients with the onset of visual impairment and the other 13 cases with the onset of arthritis; eye lesions were found in 12 cases at the initial diagnosis, and in 3 patients at the course of 12.5 years. All of the 15 patients were diagnosed with anterior uveitis with 8 cases of bilateral lesions and 7 cases of unilateral lesions. Visual impairment was detected in 7 cases. There were 12 patients treated with biological agents, 13 with methotrexate, 1 with sulfasalazine and mycophenolate mofetil, and 3 with glucocorticoids. For local medication, 13 cases were treated with glucocorticoids, 11 cases with mydriasis drugs, 11 cases with nonsteroidal antiinflammatory drugs, and 3 cases with antibiotics. During the followup (1441 months), the arthritis of all patients was improved after treatment. Eye lesions recovered in 7 cases, improved in 1 case, and delayed and repeated in 2 cases, remained no changes in 5 cases. Conclusion: Uveitis is the main extraarticular manifestation of JIA, which is more common in oligoarticular type, occult onset, and highly disabling. Without treatment in time, serious complications may occur. Regular visual and fundus examination in children with JIA is very important for early detection and treatment of ocular lesions.

Objective: To summarize the clinical data of 2 children with simulated vasculitis like artificial dermatitis (DA) and improve the understanding of the disease. Methods: The outpatient and inpatient medical history data of 2 patients were collected, including treatment process, clinical characteristics, relevant laboratory examination and pathological data, and the literature was reviewed. Results: There were 2 patients, 1 male and 1 female. The onset age was 9 and 10 years old respectively. Two patients underwent frequent and repeated examinations at different hospitals. The shape of skin injury was nonspecific, the boundary with normal skin was clear, and it was distributed in the accessible range of both hands and mouth symmetrically.There was no correlation between skin damage and laboratory examination results.Foreign bodies were found in 1 case by skin biopsypathology, and there was no response to drug treatment. Patients denied that skin damage was selfcaused. Conclusion: Artificial dermatitis is rare in children. Although the manifestations of skin damage are nonspecific, they are clearly separated from normal skin and distributed in the accessible range of hands and mouth. The discovery of foreign bodies by skin biopsy is helpful to the diagnosis of the disease. Attention should be paid to the potential mental and psychological problems of children with DA. Multidisciplinary collaboration contributes to the diagnosis and management

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Background：Chinese Infectious Disease Surveillance of Pediatrics(ISPED)was established in 2015. The data of antibiotics resistance were collected from each hospital and summarized every year to monitor the infectious etiology changes and bacterial drug resistance among Chinese children. Objective：This study is aimed to investigate the bacterial infectious and antimicrobial resistance profiles of pathogens in Chinese children and guide the reasonable use of antibiotics. Design：A crosssectional survey. Methods：Clinical isolates were collected from 13 tertiary children hospitals in China from January 1st to December 31st in 2021. Antimicrobial susceptibility testing was carried out according to a unified protocol using KirbyBauer method or automated systems. Penicillin susceptibility of streptococcus pneumonia was detected by Etest. All of the antimicrobial susceptibility testing results were interpreted according to the criteria of Clinical and Laboratory Standards Institute (CLSI) 2021. All members used the standard methods to perform bacterial culture,identification and antimicrobial susceptibility test and reported the isolated effective strains and bacterial resistance data in a structured format every year for data summary and statistical analysis. Main outcome measures：Detect the distribution of bacteria strains in children and the changes of bacteria drug resistance. Results：A total of 63 508 isolates were collected, of which 39.9% was grampositive organisms and 60.1% was gramnegative organisms. Top ten pathogens were as follows, Escherichia coli (12.7%), Streptococcus pneumonia (12.3%), Straphylococcus aureus (11.6%), Haemophilus influenza (11.4%), Moraxella catarrhalis (6.5%), Klebsiella pneunoniae (5.2%), Pseudomonas aeruginosa (4.0%), Staphylococcus epidermidis (3.7%), Acinetobacter baumannii (2.4%) and Streptococcus pyogenes (2.1%). The distribution of the primary pathogenic bacteria in different age groups was different. Among them, Saureus had the highest isolation rate in neonates (18.7%), and S.pneumoniae was the main pathogenic bacteria in children aged from >28 d to 5 years old, arranging from 13.6% to 20.8%. E.coli was the most common pathogen in children over 5 years old (22.4%). The proportion of penicillininsensitive S.pneumoniae (PNSP) decreased to 9.6%. Multidrugresistant bacteria (MDROs) showed high levels of resistance to a variety of clinical antibiotics, and the ratios of carbapenemresistant Enterobacteriaceae (CRE), K.pneumoniae (CRKP), P.aeruginosa (CRPA), A.baumannii (CRAB) were 4.6%, 14.8%, 6.7% and 30.7%, respectively. The proportions of CRPA and CRAB showed a decreasing trend in the past 6 years. The former had a higher detection rate in the neonatal group, while the latter had a higher detection rate in the nonneonatal group. Moreover, the resistance rates of CRPA and CRAB to multiple antibiotics were significantly higher in the nonneonatal group than in the neonatal group. Methicillinresistant Saureus(MRSA) was relatively stable, with a detection rate of 33.2% in 2021. Conclusion：The detection rate of MDROs in 2021 was lower than previous years, and the resistance ratio of MDROs also decreased in pediatric patients. We must pay attention to the infection and colonization of CRPA in the neonatal population.

Background：Iatrogenic skin injury is a common problem in neonates admitted to NICU. Objective：To investigate the incidence of neonatal iatrogenic skin injury in NICUs in China. Design：Cross-sectional survey. Methods：Children's Hospital of Fudan University took the lead in establishing the NICU clinical data database of neonatal iatrogenic skin injury, which included 22 tertiary hospitals in 15 provinces, autonomous regions and municipalities directly under the central government. The causes of iatrogenic skin injury were related to diapers, viscose, pressure (including medical devices), surgery, vascular access, and physical or chemical factors. The continuous cases reported by NICUs of the cooperative hospitals were sent to the database, and the data were from the electronic medical record system or paper medical document records. The reported data included demographic data, medical devices use, iatrogenic skin injury events, the age, weight and length of hospital stay of the infant at the time of each iatrogenic skin injury, the location, size, type, color, treatment measures and prognosis of skin injury. The leading hospital trained the cooperating hospitals according to the indicators in the database and started data collection after passing the examination. The leading hospital was responsible for reviewing the data. Main outcome measures：Incidence of iatrogenic skin injury in NICU hospitalized neonates. Results：From December 1, 2019 to January 31, 2020, the data of NICU consecutive cases (n=8,126) collected by 22 cooperative hospitals were all qualified and included in this analysis. There were 521 cases of iatrogenic skin injury (6.4%), and the incidence of iatrogenic skin injury in NICU in children's specialized hospitals, general hospitals and maternal and child health hospitals were 7.4%(280/3,783), 6.4% (153/2,387) and 4.5%(88/1,956), respectively. There were 566 times of iatrogenic skin injury in 521 neonates, and 45 cases (8.6%) had two times of iatrogenic skin injury. The median age of neonates with iatrogenic skin injury was 6 (3, 17) days, those within 1 week after birth accounting for 57.4%(n=299). The median corrected gestational age of neonates with iatrogenic skin injury was 37.2% (32.7, 40.0) weeks, those with the corrected gestational age≥40 weeks accounting for 57.4%(n=294). The median weight of neonates with iatrogenic skin injury was 2,800 (1,9123,450) g, those with the weight≥2,500 g accounting for 59.1%(n=308). There were 250 cases of diaperrelated skin injury (48.0%), 81 cases of pressurerelated (including medical devicerelated) (15.5%), 69 cases of viscoserelated (13.2%), 70 cases of various physical and chemical factorsrelated (13.4%), 22 cases of vascular accessrelated (4.2%), 14 cases of surgeryrelated (2.7%), and 15 cases of other types (2.9%). The proportion of all kinds of iatrogenic skin injury in neonates aged 17 days was the highest. Except that pressurerelated skin injury was easy to occur in very low birth weight infants and iatrogenic viscoserelated skin injury was easy to occur in all body recombination, other types of skin injury mostly occurred in neonates weighing≥2,500 g. Pressure-related and viscose-related skin injuries mostly occurred in neonates with the corrected gestational age of 28-32 weeks. Vascular access-related skin injuries accounted for a relatively even proportion in each corrected gestational age group, and other skin injuries were more likely to occur in neonates with the corrected gestational age >32 weeks. Most iatrogenic skin injuries(78.9%) occurred within one-week hospitalization stay of <1 week. The incidence rate decreased week by week. Conclusion：The incidence of iatrogenic skin injury in NICU neonates in China was 6.4%. Diaper-related dermatitis, the application of medical devices, and the use of medical tape were the three main factors of iatrogenic skin injury in neonates. Iatrogenic skin injury was affected by many factors, such as gestational age, birth weight, and the use of various catheters.

Background: Great heterogeneity exists in studies on the relationship between adolescents' mental health and 24-h movement consisting of sleep, sedentary behavior, and physical activity. Therefore, it is difficult to obtain high-quality evidence synthesis sufficient to guide clinical practice. Objective: To summarize and evaluate the current status of research on the relationship between 24-hour movement (sleep, sedentary behavior, and physical activity) and mental health in children and adolescents, as well as the problems in research design, so as to provide a reference for future research. Design: Scoping review. Methods: PubMed, Embase, Web of Science, and CNKI databases were searched from the inception to September 28, 2022, with the keywords of sleep, sedentary behavior, physical activity, 24-h movement, mental health, and adolescents to identify research on the correlation or causal inference between 24-h movement and mental health in healthy children and adolescents. Data extraction forms for movement type, measurement methods, classification of measurement items, and specific item measurement were gradually refined in the process of data extraction and synthesis after reading the text title, abstract, and full text for screening. Main outcome measures: Study types and measurement instruments for the relationship between 24-h movement and mental health in adolescents. Results: A total of 927 articles were retrieved from the English and Chinese databases, and after de-duplication, initial screening and full-text screening, 55 articles were finally included with 45 (82%) cross-sectional studies and 10 prospective cohort studies; 47 (85%) subjective reports and 8 objective monitoring articles. For sleep, 54 described sleep duration and 4 assessed sleep quality, sleep latency, daytime sleepiness, and sleep disruption. For sedentary behavior, there were 50 subjective reports, 5 objective reports, and 46 studies about screen exposure. For physical activity, hours of moderate-to-vigorous physical activity were assessed in 47 subjective reports and 8 objective reports. A total of 32 studies focused on depression, 9 on anxiety, 5 on stress, and 35 on other mental health outcomes (positive mood, behavioral problems, life satisfaction or health-related quality of life, mental illness and symptoms, emotion regulation skills, and cell phone addiction). Forty-four papers explored the correlation between 24-h movement and mental health, 8 papers explored changes in the structure of 24-h movement using isochronous substitution models, and 3 explored mediators of 24-h movement affecting mental health. Conclusions: There are few studies on the association between 24-h movement and mental health in adolescents, and the measurement tools used need to be standardized. In the future, isochronous substitution models or real-world intervention studies are needed to find the recommended 24-h movement packages that can maximize the health effects of the movement and are easy to achieve at the same time.

Background: There has been no report on tracheotomy and home mechanical ventilation therapy for infants with severe bronchopulmonary dysplasia(BPD) in China. Objective: To describe the experience of two cases of severe BPD treated with tracheotomy and home mechanical ventilation therapeutic. Design: Case report. Methods: Clinical characteristics,multidisciplinary evaluation before tracheotomy,and transitional and postdischarge care of two infants with very severe BPD and home mechanical ventilation were reported. Results: Two premature infants were admitted for prolonged dependency of invasive mechanical ventilation (case 1: gestational age of 27+5weeks,7 months and 19 days after birth; case 2:gestational age of 24+6weeks,6 months and 24 days after birth).Evaluations on airway,lung parenchyma,and pulmonary vascular disease were performed,showing severe tracheobronchomalacia and severe heterogeneous lung parenchymal lesions.After multidisciplinary consultation and discussion,tracheotomy and long-term home mechanical ventilation support was indicated as the most suitable management strategy.The indication and risk of tracheotomy and long-term mechanical ventilation were discussed thoroughly with the parents.Tracheotomy was then performed.Both infants were discharged on home ventilators after careful assessment of coordination of postdsicharge care,readiness for home care,training of caregivers,and necessary equipment. Conclusion: Tracheotomy and long-term home mechanical ventilation treatment provided a possible treatment choice for ventilator-dependent severe BPD infants in China,but such treatment required significant efforts from the multidisciplinary medical team and family, and difficulties still remained such as cost, high risk,and postdischarge care.

Background: The diagnosis of allergic diseases lacks definite test criteria and mainly depends on the clinical history. In the absence of allergen stimulation, there are no clinical symptoms, making the diagnosis more difficult. Therefore, it is very important to find auxiliary diagnostic markers for allergic diseases. Objective: Detection of lymphocyte subsets in allergic children is expected to provide a new marker for the diagnosis of allergic diseases. Design: Casecontrol study. Methods: Children with food allergy and respiratory allergy were selected as the allergic disease group, and healthy children matching with gender and age in the same period were selected as the control group. Lymphocyte subsets was analyzed by flow cytometry. Main outcome measures: Lymphocyte subsets. Results: The average age of 30 patients in the allergy group was 3.6 (0.710.6) years, and that of 27 healthy controls was 4.1 (0.811) years. There was no significant difference in age and gender between the two groups (P value was 0.616 and 0.574). For T lymphocyte subsets, the ratio of Th2 cells/effectors helper T cells and Th2/Th1 ratio in the allergic disease group were higher than those in the healthy control group ［(31.34±2.52)% vs (20.02±2.05)%, (6.86±1.51) vs (2.73±0.35)］, and the differences were statistically significant. Percentage and absolute count of mature B cells, absolute count of plasmablasts, percentage of IgE+ plasmablasts, percentage of IgE+ memory B cells in allergic children were higher than those of healthy controls ［(11.53 ± 1.22) % vs (6.02±0.52)%, (1,068±107.3) cells per μL vs (578.74±58.49)cells per μL , (40.71±6.44) cells per μL vs (17.08±2.93)cells per μL , (8.21±1.33) % vs (1.64±0.53)%, (4.48±0.81) % vs (0.47±0.18)%］. Conclusion: The increased percentage of Th2 cells, IgE+ plasmablasts and memory B cells in allergic children may be a marker for the diagnosis of allergy.

Background：Currently, there are differences in the outcomes of risk-stratified treatment in pediatric acute T lymphocytic leukemia (T-ALL). Objective：To explore the association between biological characteristics and clinical features, early treatment responses and longterm outcomes of pediatric T-ALL. Design：Retrospective cohort study. Methods：The immunophenotypic markers and fusion genes at diagnosis and its association with clinical features, early treatment response and long-term outcomes of T-ALL patients treated with CCLG-ALL-2008 protocol in Beijing Children's Hospital affiliated to Capital Medical University from March 2008 to September 2018 were retrospectively analyzed. Main outcome measures：Event free survival (EFS) and overall survival (OS). Results：A total of 101 children with T-ALL were enrolled, including 76 males (75.25%). SIL-TAL1 was the most common fusion gene (21.8%, 22/101) and the proportion of patients classified into high-risk of SIL-TAL1+ was significantly higher than that of SIL-TAL1-. The expression rate of stem cell marker CD34 was 45.5% (46/101). The expression of CD2 was associated with high peripheral white blood cell; the expression of CD34 was associated with poor prednisone response and high minimal residual disease (MRD) at day 15; the expression of CD33 was associated with morphological non-remission and high MRD at the end of induction; while the expression of CD10 was associated with good prednisone response. By K-M analysis, positive SIL-TAL1, poor response to prednisone treatment, non-remission of bone marrow morphology on day 15, high MRD at day 33 and classification of high-risk were associated with adverse EFS and OS (P＜0.05 respectively) . Furthermore, MRD≥1% at day 33 and SIL-TAL1 positive were also validated as independent prognostic factors for EFS and OS. The hazard ratios of MRD ≥1% at day 33 for EFS was 1.96 (95%CI: 1.114-3.452, P=0.020) and for OS was 2.062 (95%CI: 1.138-3.734, P=0.017); SIL-TAL1 ⁺ for EFS was 2.536 (95%CI: 1.053-6.104, P=0.038) and for OS was 2.921 (95%CI: 1.144-7.457, P=0.025). Conclusion：T-ALL is a group of heterogeneous diseases. SIL-TAL1 and early MRD can predict the long-term prognosis on the MRD based treatment protocol.