Relationship between postoperative rehabilitation style, gastrointestinal function, and inflammatory factor levels in children with intussusception

BACKGROUND Intussusception occurs in children and progresses rapidly.If not treated in time,it may lead to secondary complications such as intestinal perforation,which affect the quality of life and health of children.Surgery is the most common clinical treatment and has a good effect.However,the postoperative prognosis of children with intussusception has a correlation with the postoperative rehabilitation method.Therefore,in this study,we explored the relationship between postopera-tive rehabilitation,gastrointestinal function,and the expression of inflammatory factors in children with intussusception.The medical records of 18 children who were admitted to our hospital for intussusception surgery between October 2022 and May 2024 were retrospectively reviewed.The patients were divided into the routine nursing group(n=6)and rehabilitation training group(n=12)according to the postoperative rehabilitation method.The general data,gastrointestinal function,and inflammatory factor levels of the two groups were statistically analyzed.Pearson correlation analysis of gastrointestinal function,inflammatory factors,and postoperative rehabil-itation was performed.RESULTS We found no significant intergroup differences in sex,age,or disease course(P>0.05).The times to first defecation,bowel sound recovery,and anal exhaust were shorter and inflammatory factor levels were lower in the rehabilitation training group than in the routine nursing group(P<0.05).Pearson correlation analysis showed that gastrin and motilin levels were positively correlated with postoperative rehabilitation(P<0.05).Interleukin(IL)-2,IL-4,IL-6,IL-10,high-sensitivity C-reactive protein,and tumor necrosis factor-αlevels were negatively correlated with postoperative rehabilitation(P<0.05).Gastrointestinal function was positively correlated(P<0.05),and levels of inflammatory factors were negatively correlated with postoperative recovery time(P<0.05).CONCLUSION We found a positive correlation between gastrointestinal function and postoperative rehabilitation training,and a negative correlation between inflammatory factor levels and rehabilitation training in children with intussus-ception.

Postoperative intussusception in infants and children:a report of seven cases

Postoperative intussusception is an uncommon but serious condition in infants and children. Here, we report seven cases of postoperative intussusception in infants and children who were seen at our institution over the last 13 y. The patients showed increased nasogastfic drainage, vomiting, lack of stool, and/or growing abdominal dis- tension 2 to 9 d following abdominal surgery. Manual reduction was successful in five cases. In two cases, necro- sis was found and intestinal resection and anastomosis were carded out, No recurrence was observed at six months of follow-up. Postoperative intussusception should be suspected in pediatric surgical patients who showed signs of intestinal obstruction in the early postoperative period.

Risk factors for intussusception in children with Henoch-Schönlein purpura:A case-control study

BACKGROUND The etiology of Henoch-Schönlein purpura(HSP)with intussusception remains undefined.AIM To investigate the risk factors for intussusception in children with HSP and gastrointestinal(GI)involvement.METHODS Sixty children with HSP and concomitant intussusception admitted to the Beijing Children’s Hospital of Capital Medical University between January 2006 and December 2018 were enrolled in this study.One hundred pediatric patients with HSP and GI involvement but without intussusception,admitted to the same hospital during the same period,were randomly selected as a control group.The baseline clinical characteristics of all patients,including sex,age of onset,duration of disease,clinical manifestations,laboratory test results,and treatments provided,were assessed.Univariate and multiple logistic regression analyses were performed to identify possible risk factors.RESULTS The 60 children in the intussusception group comprised 27 girls(45%)and 33 boys(55%)and the 100 children in the non-intussusception group comprised 62 girls(62%)and 38 boys(38%).The median age of all patients were 6 years and 5 mo.Univariate and multiple regression analyses revealed age at onset,not receiving glucocorticoid therapy within 72 h of emergence of GI symptoms,hematochezia,and D-dimer levels as independent risk factors for intussusception in children with HSP(P<0.05).CONCLUSION The four independent risk factors for intussusception in pediatric HSP with GI involvement would be a reference for early prevention and treatment of this potentially fatal disease.

Retrospective Evaluation of Intussusception in Under-Five Children in Nigeria

Background: Assessment of the safety profile of the new rotavirus vaccines in Africa requires base-line epidemiological data on intussusception. Hence, this study was aimed at describing the prevalence and associated factors of intussusception in under-five children in Enugu, Southeast, Nigeria. Methods: This was a retrospective descriptive study involving the sixty reported cases of intussusception in under-five children admitted in a hospital in Enugu between 2007 and 2012. Cases of intussusception were selected using the Brighton collaboration intussusception working group level I diagnostic criteria. Information sought from the patients’ folders included demographic characteristics and clinical manifestations including history of previous rotavirus vaccination, duration of illness prior to presentation, diarrhoea, vomiting, passage of red currant jelly-like stool, abdominal mass and distension, method of diagnosis, treatment option(s) employed and their outcomes. The data was analyzed using SPSS version 17.0. Results: The majority of the cases were aged less than one year (53;88.3%) while the average incidence of intussusception was 0.1 per 1000. None of the cases had received rotavirus vaccinations. The common clinical presentations were vomiting, 55 (17.2%), passage of red currant stool 50 (15.6%), fever 50 (15.6%) and abnormal/absent bowel sound 43 (15.9%). Diagnosis was essentially with the aid of abdominal ultrasonography, 38 (63.3%) while surgery (laparotomy) was the treatment of choice in most cases 48 (80.0%). The case fatality rate was 3 (5.0%). Conclusion: None of the cases studied could be directly linked to rotavirus vaccinations. But seasonal peak incidence coincided with rotavirus diarrhea peak incidence. Efforts should be made to institute post-rotavirus vaccine licensure prospective surveillance study in order to fully determine any relationship between rotavirus vaccination and intussusception in Enugu, South east, Nigeria.

POSTOPERATIVE INTUSSUSCEPTION IN CHILDREN: A REVIEW OF 14 CASES

Objective To search the etiologic factor, clinical diagnosis points and treatment of postoperative intussusception （ PI ）.Methods To retrospectively review the clinical materials of 14 cases with PI including the cause of disease and treatment.Results PI occurred within 10 days （average 4 days） after the primary operation. Bowel obstructive symptoms gradually emerged. One case was diagnosed with intussusception by sonography and received enema reduction of intussusception by hydrostatic pressure. Thirteen cases were performed secondary operation. Small intestine was main site of intussu- sception. Manual reduction of the lesion was performed in 12 cases and bowel resection and anastomosis was done in 1 case with bowel necrosis. Conclusion PI should be suspected if child presents with the symptoms of ileus in early postoperative period. Abdominal sonography may have some value on diagnosis of Pl. Operation is the first choice for the treatment of PI.

Laparoscopic approach for managing intussusception in children:Analysis of 65 cases

BACKGROUND Intussusception can be managed by pneumatic reduction,ultrasound-guided hydrostatic reduction,open or laparoscopic surgery,but laparoscopy in such cases remains controversial.AIM To explore the clinical characteristics,effectiveness,and complications of surgical reduction for intussusception using laparoscopy in children.METHODS This study was a retrospective case series of pediatric patients with intussusception who underwent surgical reduction by laparoscopy from May 2011 to April 2016 at Taizhou Hospital of Zhejiang Province.Clinical characteristics(operation time,intraoperative blood loss,conversion rate of laparotomy,reasons for conversion,postoperative hospital stay,and adverse events)were described.RESULTS The 65 patients included 45 boys and 20 girls.The average age was 2.3 years(27.5±24.5 mo).Of the 65 patients,61 underwent surgical reduction by laparoscopy after a failed enema reduction of intussusception,and four underwent the procedure directly.All patients were treated successfully and 57(87.7%)patients underwent successful laparoscopic surgery,two of which had a spontaneous reduction.Among the remaining cases,one was converted to open surgery via right upper quadrant incision,and seven required enlarged umbilical incisions.Intestinal resection was performed in 5 patients because of abnormal bowel lesions.There were no complications(intestinal perforations,wound infections,or intestinal adhesions)during the follow-up of 3 years to 8 years.Two patients experienced a recurrence of intussusception;one was resolved with pneumatic reduction,and the other underwent a second laparoscopic surgery.CONCLUSION Laparoscopic approach for pediatric intussusception is feasible and safe.Bowel resection if required can be performed by extending umbilical incision without the conventional laparotomy.

Erratum to “Retrospective Evaluation of Intussusception in Under-Five Children in Nigeria” [World Journal of Vaccines Vol.4 No.3 (August 2014) 123-132]

The original online version of this article (Tagbo, B. N., et al. 2014 “Retrospective Evaluation of Intussusception in Under-Five Children in Nigeria”, 2014, 4, 123-132, http://dx.doi.org/10.4236/wjv.2014.43015) was published in August 2014. The author wishes to correct the author’s name and the Table 3 in the text.

Retrospective Surveillance over 11 Years for Intussusception in Children Younger than 14 Years in the State of Qatar

Background: Accurate estimates of the baseline incidence of childhood intussusception could help safety monitoring after introduction of rotavirus vaccines. Therefore, we studied the incidence of intussusception in the state ofQatar. Methods: We retrospectively reviewed cases of intussusception in children younger than 14 years. Children were treated between 2002 and 2012 at a single hospital inQatar. We analyzed information according to age, sex, clinical signs, diagnostic- and treatment-related characteristics, and length of stay. We calculated the national incidence of intussusception using census data. Results: A total of 106 children were diagnosed and treated for intussusception over 11 years. The male to female ratio of intussusception was 1.4:1. The most common symptom was bleeding per rectum (37%). One hundred andfour children with intussusception underwent diagnostic and therapeutic contrast enema, and 31.7% of patients underwent operative management. The length of stay was longer in patients who underwent operative reduction thanthat in those who did not. Conclusions: This is the first study to estimate the incidence of childhood intussusception prior to introduction of rotavirus vaccination in Qatar. A prospective surveillance system using a standardized case definition would be useful for examining the occurrence of intussusception in theArabicGulfarea and developing countries.

Factors determining operative reduction in intussusception in children aged less than fourteen years

Aim: To delineate the factors associated with operative reduction of intussusception, in contrast to enema reduction only without surgical intervention, in children aged less than 14 years. Methods: We retrospectively reviewed the records of all children aged <14 years who experienced intussusception between 2002 and 2012 and were treated at a single hospital in Qatar. Clinical outcomes were correlated with age, sex, clinical symptoms, diagnosticand treatmentrelated characteristics, and length of hospital stay. Results: A total of 141 children were diagnosed and treated for intussusception over 11 years. The male to female ratio of intussusception was 1.4:1. The length of hospital stay was longer in patients who underwent operative reduction than those that did not. Conclusion: Delay in presentation did not decrease the success of radiologic reduction and did not increase the risk of operative intervention and bowel resection.

Colon Adenocarcinoma in a Retrograde Intussusception: A Case Report and Literature Review

Background: Intussusception is defined as a telescoping of a proximal gastrointestinal segment with its mesentery to a distal one, only 5% occur in adults and in colon the probability that it is caused by a malignant disease is up to 65%. Only 1% occurs in a retrograde manner, the rest occur in an anterograde manner. Aim: Describe the clinical presentation of an intussusception in the adult patient as well as its most frequent causes and possible complications that influence decision making for a definitive treatment. Case Presentation: A 66-year-old woman diagnosed with colon adenocarcinoma who underwent elective transverse colectomy and colonic anastomosis with an incidental finding of a transverse colon tumor in a retrograde intussusception was studied. Conclusion: In any adult patient with an intussusception especially in colon a neoplasia should be suspected and the affected segment should be resected without being reduced due to the risk of perforation and tumor dissemination.

Appendiceal intussusception complicated by adenocarcinoma of the cecum:A case report

BACKGROUND Appendiceal intussusception is a pathological condition in which the appendix is inverted into the cecum,which may cause symptoms that resemble those of other gastrointestinal disorders and may induce intestinal obstruction.The rarity of this case presentation is the co-occurrence of appendiceal intussusception and cecal adenocarcinoma,a combination that to our knowledge has not previously been reported in the medical literature.This case provides new insights into the complexities of diagnosing and managing overlapping pathologies.CASE SUMMARY A 25-year-old woman presented with persistent periumbilical pain and bloody stools.An initial biopsy showed cecal cancer;however,subsequent colonoscopy and computed tomography findings raised the suspicion of appendiceal intussus-ception,which was later confirmed postoperatively.This unique case was charac-terized by a combination of intussusception and adenocarcinoma of the cecum.The intervention included a laparoscopic right hemicolectomy,which led to the histopathological diagnosis of mucinous adenocarcinoma with appendiceal intussusception.The patient recovered well postoperatively and was advised to initiate adjuvant chemotherapy.This case highlights not only the importance of considering appendiceal intussusception in the differential diagnosis,but also the possibility of appendicitis and the atypical presentation of neoplastic lesions.CONCLUSIONS Physicians should consider the possibility of appendiceal intussusception in cases of atypical appendicitis,particularly when associated with neoplastic presentation.

Nutrition impacts of non-solid cooking fuel adoption on under-five children in developing countries

This paper examines the nutrition impacts of using non-solid cooking fuel on under-five children in developing countries.We draw on data from more than 1.12 million children in 62 developing countries from the Demographic and Health Surveys(DHS).Results from both fixed effects(FE)and instrumental variable(IV)estimates show that using non-solid cooking fuel significantly improves the nutrition outcomes of under-five children.Compared with their peers from households mainly using solid fuel,children from households mainly using non-solid fuel exhibit a lower probability of experiencing stunting(by 5.9 percentage points)and being underweight(by 1.2 percentage points).Our further investigation provides evidence for several underlying mechanisms,such as improved indoor air quality,induced reduction in children’s respiratory symptoms,benefits on maternal health,and reduction in maternal time spent on fuel collection or cooking.Heterogenous analyses suggest that the nutrition benefits of using non-solid cooking fuel are more prominent among boys,children above three years old,and those from households of lower socioeconomic status,rural areas,and Southeast Asia.

Effect of lens surgery on health-related quality of life in preschool children with congenital ectopia lentis

AIM:To evaluate the effect of lens surgery on health-related quality of life(HRQoL)of preschool children with congenital ectopia lentis(CEL).METHODS:A prospective self-controlled study was conducted in Zhongshan Ophthalmic Center.Children aged from 5 to 7y whom were diagnosed with CEL and underwent phacoemulsification with scleral-fixated posterior chamber intraocular lens implantation and their parents were enrolled in this study.All of them completed the child and proxy(parental)PedsQL™4.0 before and after the surgery.Their preoperative scores were compared to their postoperative ones.Subgroup analyses were performed based on gender and preoperative bilateral presenting visual acuity of the children.RESULTS:Thirty-two children with CEL successfully underwent surgery without any complications,among whom 8 had monocular surgery and 24 had binocular surgery.Preoperative and postoperative questionnaires were completed by 32 child-parent pairs.Surgical intervention could significantly improve the vision of affected children(P<0.001).The medians of physical,psychosocial and total health scores self-reported by the children were 68.75(62.50,81.25),65.00(60.00,80.00)and 67.39(60.87,78.26)preoperatively and were 93.75(87.50,100.00),90.00(83.33,96.67)and 89.13(85.32,95.65)postoperatively.The preoperative scores of the affected children were significantly lower in all scales than age-matched healthy children(P<0.001).All the postoperative scores were significantly higher than the preoperative scores in affected children and their parents(P<0.001).In the physical functioning evaluation,the preoperative score reported by parents of girls was higher than parents of boys(P=0.041),and the postoperative score of girls was higher than that of boys(P=0.036).CONCLUSION:CEL is associated with significantly worse quality of life in preschool children.Surgical intervention can significantly improve the HRQoL in affected children from both personal and family perspective.

Survey and clinical considerations of gender identity in lower primary school children

BACKGROUND Gender consciousness directly affects the development of gender identity,which is a continuous and lifelong process.Meanwhile,hospitalization is a part of many children's lives and has an impact on their gender development.AIM To investigate the current situation of gender identity in lower primary school children by conducting a survey of 202 hospitalized children in the lower grades and to provide a theoretical basis and foundation for the cultivation of gender identity and medical treatment of children based on the results.This study aims to inspire clinical medical staff to scientifically and reasonably arrange hospital wards for lower primary school children and pay attention to gender protection during the medical treatment process and to help children shape a unified and clear gender identity,which will enable them to better integrate into society and promote their personality development.METHODS The gender consciousness scale for elementary and middle school students was RESULTS Gender identity was already present in lower primary school children.The children's gender roles and gender equality consciousness were strong,exceeding the critical value,but their gender characteristics,gender identity,and gender ideal consciousness were weak.Children aged 6 had the weakest gender identity,and girls had significantly stronger gender identity than boys.CONCLUSION Gender identity is already present in lower primary school children,providing a basis and inspiration for the cultivation of gender identity and medical treatment of lower primary school children.Clinical medical staff should be aware of and understand these results and should scientifically and reasonably arrange hospital wards for lower primary school children.

Colo-colonic intussusception as a rare complication of colonoscopy with polypectomy: Two case reports

BACKGROUND Colonoscopy is the most frequently used diagnostic and therapeutic tool for the treatment of colorectal diseases.Although the complication rate is low,it can be potentially serious.Intussusception is a rare and severe complication often associated with polypectomy.Only a handful of post-colonoscopy intussusception cases have been reported,making this study a valuable addition to the medical literature.CASE SUMMARY Case 1:A 61-year-old man underwent colonoscopy with polypectomy for chronic abdominal pain.The patient experienced abdominal pain 11 hours later but was still discharged after pain management.He was readmitted due to recurring pain.Computed tomography(CT)showed colo-colonic intussusception.Initial conservative management and attempts at endoscopic reduction failed;therefore,laparoscopic right hemicolectomy was performed.Histopathological examination revealed tubular adenomas in the polyps and inflammation in the resected specimens.Case 2:A 59-year-old woman underwent colonoscopy with polypectomy for a polyp in the transverse colon.She experienced upper abdominal pain,fever,nausea,and vomiting 9 hours after the procedure.Emergency CT and blood tests revealed a colo-colonic intussusception near the hepatic flexure and an elevated white blood cell count.Initial attempts at endoscopic reduction failed and conservative treatment showed no improvement.She underwent successful laparoscopic reduction and recovered uneventfully.Histopathological examination of the resected polyp revealed hyperplasia.CONCLUSION Post-colonoscopy intussusception in adults is rare,and polypectomy may contribute to its occurrence.Early diagnosis is crucial,with prompt CT examination serving as key.After excluding malignancies,conservative management and reduction of intussusception should be considered before surgical bowel resection.

Adult sigmoid intussusception resembling rectal prolapse:A case report

BACKGROUND Rectal prolapse arises from benign etiology.When symptoms of internal intussusception mirror those of rectal prolapse,a misdiagnosis is possible,especially under limited clinical presentation.It is crucial to recognize and differentiate rectal prolapse from internal intussusception because the two diagnoses have different prognoses.Here,we describe a case of adult sigmoid intussusception presenting as rectal prolapse.CASE SUMMARY A 64-year-old woman with no known medical history visited a gastrointestinal outpatient department due to hard bloody stool defecation for 1 wk followed by constipation for 3 d.Colonoscopy revealed a huge polypoid ulcerated tumor at the sigmoid colon with lumen stenosis.The patient was admitted due to postprocedural dull abdominal pain.Due to failed colonoscopy reduction and stent insertion,the patient underwent sigmoid colon resection with primary end-to-end anastomosis,with the transverse colostomy pathological report showing adenocarcinoma,pT3N0M0.She recovered well from the operation and was discharged with regular outpatient clinic follow-up.CONCLUSION Presentation and manifestation of sigmoid intussusception may resemble that of rectal prolapse,necessitating careful observation due to distinct prognostic implications.

Rare etiology of colonic intussusception involving an adult with emphysematous cystic enteropathy:A case report and review of literature

BACKGROUND Pneumatosis cystoides intestinalis(PCI),characterized by a collection of gas-filled cysts in the intestinal wall,is an uncommon but well-known condition in gastroenterology.Abdominal pain is the most frequent symptom associated with PCI.Intussusception represents a potential cause of recurrent abdominal pain or emergency presentation.However,the occurrence of colonic intussusception secondary to PCI is very unusual in adulthood.CASE SUMMARY A 52-year-old male,known with idiopathic PCI,presented seventeen months after initial diagnosis with a new right upper quadrant pain.A computed tomographyscan demonstrated a colonic intussusception at the hepatic flexure.PCI did not progress compared with initial investigation.The patient underwent an emergency right hemicolectomy.CONCLUSION Resection was recommended in this case because PCI proved to be persisting with no identified curable cause.Surgery allowed to address the underlying pathology,the potential relapse of intussusception,and the likely cause of recurrent abdominal pain,either invagination or PCI itself.

Effect of artificial natural light on the development of myopia among primary school-age children in China:a three-year longitudinal study

AIM:To assess the efficacy of artificial natural light in preventing incident myopia in primary school-age children.METHODS:This is a prospective,randomized control,intervention study.A total of 1840 students from 39 classes in 4 primary schools in Foshan participated in this study.The whole randomization method was adopted to include classes as a group according to 1:1 randomized control.Classrooms in the control group were illuminated by usual light,and classrooms in the intervention group were illuminated by artificial natural light.All students received uncorrected visual acuity and best-corrected visual acuity measurement,non-cycloplegic autorefraction,ocular biometric examination,slit lamp and strabismus examination.Three-year follow-up,the students underwent same procedures.Myopia was defined as spherical equivalent refraction≤-0.50 D and uncorrected visual acuity<20/20.RESULTS:There were 894 students in the control group and 946 students in the intervention group with a mean±SD age of 7.50±0.53y.The three-year cumulative incidence rate of myopia was 26.4%(207 incident cases among 784 eligible participants at baseline)in the control group and 21.2%(164 incident cases among 774 eligible participants at baseline)in the intervention group[difference of 5.2%(95%CI,3.7%to 10.1%);P=0.035].There was also a significant difference in the three-year change in spherical equivalent refraction for the control group(-0.81 D)compared with the intervention group[-0.63 D;difference of 0.18 D(95%CI,0.08 to 0.28 D);P<0.001].Elongation of axial length was significantly different between in the control group(0.77 mm)and the intervention group[0.72 mm;difference of 0.05 mm(95%CI,0.01 to 0.09 mm);P=0.003].CONCLUSION:Artificial natural light in the classroom of primary schools can result in reducing incidence rate of myopia during a period of three years.

Two different autorefractors for vision screening in children and adolescents

AIM:To compare the consistency of two autorefractors(Tianle RM-9000 and Topcon KR-800)for school-age myopia children,and to provide a basis for largescale data analysis and comparison.METHODS:The refractive error in 909 subjects(age 4–18y)were measured using both autorefractors without cycloplegia.The data were analyzed using Fourier decomposition and the correlation coefficients,intraclass correlation coefficients(ICC),and Bland-Altman limits of agreement(LoA)for each parameter were calculated.RESULTS:There was a strong correlation between the spherical equivalent(SE),sphere diopter(DS),and cylinder diopter(DC)readings of the Tianle RM-9000 and those of the Topcon KR-800,with correlation coefficient values of 0.98,0.98 and 0.83 and ICC values of 0.99,0.99 and 0.93,respectively.However,the correlation coefficients and ICC values of J0 and J45 were unreliable(R=-0.004,-0.034;both ICC<0.10).Bland-Altman analysis revealed that SE,DS,and DC measured by the Tianle RM-9000 were significantly biased toward myopia compared with the Topcon KR-800,and the mean differences were-0.072,-0.026,-0.091 D,respectively(all P<0.01).The minimum absolute value of the difference within the 95%LoA for SE,DS,and DC was 0.63 D,0.50 D,0.62 D,respectively;all these values were in the clinically acceptable range.For J0 and J45,the mean differences were close to zero(P=0.43,0.84);however,the 95%LoA were relatively wide(J0 SD:0.53;95%CI:-1.00,1.10;J45 SD:0.52;95%CI:-1.00,1.00).CONCLUSION:The two autorefractors are consistent with each other,as the differences in SE,DS,and DC were within the clinically acceptable range.Readers can compare the data measured by either device in different studies and use the two devices in the same study to generate a dataset that can be analyzed together.However,the J0 and J45 vectors are unreliable and should not be used to assess astigmatism.

Add-on perceptual learning on refractive amblyopia in children

AIM:To evaluate the visual outcomes of standard amblyopic treatment add-on training via perceptual learning in refractive amblyopic children and to identify the risk factors for treatment failure.METHODS:Retrospective charts were reviewed in children with refractive amblyopia who received standard treatment and add-on Cambridge Visual Stimulator(CAM)training.The add-on CAM group that was enrolled had worn full-corrected glasses for at least 2mo before training.A control group received only the standard treatment.Treatment success was defined as best-corrected visual acuity(BCVA)≥20/25.The age,sex,initial BCVA,refractive errors,sessions and duration of training,and final BCVA were recorded.RESULTS:A total of 209 children(129 children in add-on CAM group and 80 children in control group)were enrolled.Seventy-six percent of unilateral and 87%of bilateral amblyopic children achieved treatment success.In children with unilateral or bilateral moderate amblyopia,the duration to reach BCVA≥20/25 was significantly shorter in add-on CAM group than in control group.Poor initial BCVA(P<0.001)and high astigmatism(P=0.007)were risk factors for treatment failure after add-on CAM training.Age,sex,and types of refractive error were not associated with treatment success.CONCLUSION:Add-on CAM training is an effective strategy for visual improvement and can shorten the treatment course when the effect of standard treatment is limited in amblyopic children.