Ten-year review of trends in children with type 1 diabetes in England and Wales

This review describes the prevalence,incidence,and demographics of children and young people(CYP)with type 1 diabetes in England and Wales using data from the United Kingdom National Paediatric Diabetes Audit(NPDA)and has almost 100%submission from all paediatric diabetes centres annually.It is a powerful benchmarking tool and is an essential part of a long-term quality improvement programme for CYP with diabetes.Clinical characteristics of this population by age,insulin regimen,complication rates,health inequalities,access to diabetes technology,socioeconomic deprivation and glycaemic outcomes over the past decade is described in the review.The NPDA for England and Wales is commissioned by the United Kingdom Healthcare Quality Improvement Partnership as part of the National Clinical Audit for the United Kingdom National Service Framework for Diabetes.The rising incidence of Type 1 diabetes is evidenced in the past decade.Reduction in national median glycated hemoglobin for CYP with diabetes is observed over the last 10 years and the improvement sustained by various initiatives and quality improvement programmes implemented with universal health coverage.

Could sport be part of pediatric obesity prevention and treatment? Expert conclusions from the 28th European Childhood Obesity Group Congress

The prevalence of pediatric obesity continues to increase worldwide,bringing with it various metabolic,functional,social,and psychological complications.1 Both the prevention and treatment of childhood obesity must be based on multidisciplinary approaches combining nutrition,physical activity(PA),and psychological support.2 As an essential element of these multicomponent strategies,regular physical activity has been acknowledged as having beneficial effects on children's and adolescents,body composition,physical fitness,and metabolic profile,as well as on their health-related quality of life,social and psychological health,and academic achievement.3,4 Given that only a relatively small proportion of children and adolescents meet the public health recommendations for PA,5 and given that weight loss exercise-based interventions suffer from a high attrition rate,there is a clear need for appropriate PAs.

The fantasmatic and imaginary child of the pregnant woman

背景:妊娠是一个过渡时期,在这一非常时期孕妇会变得更为脆弱,在不利条件下可能引发母婴心理问题。因此,我们有必要找出对这一时期会产生负面影响的因素。早期干预对保持孕产妇和婴儿的心理健康十分重要。目的:评估产前焦虑和抑郁的危险因素,特别是孕期和产后早期的孕产妇对胎儿和她自己的父母之间的母婴关系。方法:研究采用在孕期进行量化访谈,通过半定式孕期访谈来评估孕妇对胎儿的心理预期和孕妇自己的母婴依附关系归类。孕期访谈可得到有关孕妇与胎儿、孕妇和她生活中重要人物之间关系的有价值的信息。我们对斯德哥尔摩的孕20周的初产妇进行了调查,询问其有关怀孕的经历、以及他们的家庭、伴侣、和未出生的孩子之间的关系。研究的孕妇均属于有较高压力、童年逆境、有否精神疾病家族史的高危人群。这些女性更易罹患围产期焦虑和抑郁。结果:孕期访谈为了解孕产妇的心理构成提供了有价值的信息。她们心理状态和心理反应的量化可以用来衡量预测其母亲养育能力的质量。访谈中出现的反移情和移情有助于更深入地理解孕期女性的压抑、攻击性、悲伤、自恋、防卫等潜在动力学机制。结论:探究评估母孕期的心理构成以及她与未出生孩子之间的关系有助于进行专业的早期干预。早期干预措施应针对特定的高危人群,可有助预防对其孩子可能产生的不良效应。

Mental health impact on Black,Asian and Minority Ethnic populations with preterm birth:A systematic review and meta-analysis

BACKGROUND Preterm birth(PTB)is one of the main causes of neonatal deaths globally,with approximately 15million infants are born preterm.Women from the Black,Asian,and Minority Ethnic(BAME)populations maybe at higher risk of PTB,therefore,the mental health impact on mothers experiencing a PTB is particularly important,within the BAME populations.AIM To determine the prevalence of mental health conditions among BAME women with PTB as well as the methods of mental health assessments used to characterise the mental health outcomes.METHODS A systematic methodology was developed and published as a protocol in PROSPERO(CRD420-20210863).Multiple databases were used to extract relevant data.I2 and Egger's tests were used to detect the heterogeneity and publication bias.A trim and fill method was used to demonstrate the influence of publication bias and the credibility of conclusions.RESULTS Thirty-nine studies met the eligibility criteria from a possible 3526.The prevalence rates of depression among PTB-BAME mothers were significantly higher than full-term mothers with a standardized mean difference of 1.5 and a 95%confidence interval(CI)29%-74%.The subgroup analysis indicated depressive symptoms to be time sensitive.Women within the very PTB category demonstrated a significantly higher prevalence of depression than those categorised as non-very PTB.The prevalence rates of anxiety and stress among PTB-BAME mothers were significantly higher than in full-term mothers(odds ratio of 88%and 60%with a CI of 42%-149%and 24%-106%,respectively).CONCLUSION BAME women with PTB suffer with mental health conditions.Many studies did not report on specific mental health outcomes for BAME populations.Therefore,the impact of PTB is not accurately represented in this population,and thus could negatively influence the quality of maternity services they receive.

Perinatal mental health in China:views of health system professionals in Shanghai

Background:Mental health has recently been receiving a growing amount of attention in China's Mainland,with mental disorders increasingly being recognized as a major public health concern.However,the treatment gap for mental health care is markedly high in China.Previous research and clinical practice have focused on high-risk physical disorders but overlooked psychosocial factors,especially during the perinatal period.Aims:To explore Chinese professionals'perception and attributions of perinatal mental health in China.Method:The study was conducted in Shanghai,China,in 2018,drawing on interviews with 15 key informants including health professionals,government officials,and policymakers recruited through snowball sampling.Content analysis of the semi-structured interviews was performed.Results:The study yielded insights into the perceptions of perinatal mental health among health professionals in Shanghai.Three themes emerged from the informants'reports:(1)mental health influenced by tradition—describing traditions affecting the perception of mental health at both the societal and individual level;(2)societal changed contributing perinatal mental health problems—referring to a rapidly changing cultural and economic backdrop as a source of stress leading to mental health problems;and(3)existing and required resources—demonstrating a lack of professional training,staff shortages,and inadequacy of resources to provide the required mental health care.Conclusion:Our results provide new insights into key health professionals'perceptions of mental health problems in Shanghai.Hesitation to seek care owing to a lack of knowledge,and resource shortages in health care systems are obstacles to improve mental health among women in urban China.

Primary extrapulmonary tuberculosis diagnosis warrants extraprecautious pulmonary tuberculosis exclusion workup

This editorial article takes an opportunity to apprehend the diagnostic challenges of primary gastrointestinal tuberculosis(an uncommon extrapulmonary tuberculosis condition)utilizing the recently published case report of a young male with prolonged gastrointestinal symptoms and weight loss who received intermittent anti-tubercular treatment and underwent operative interventions to relieve gastric outlet obstruction.The diagnosis chiefly relied on high-end examinations,like computed tomography scans and histopathological evaluation of postoperatively resected bowel tissue,which wasn't preceded by an all-inclusive stepwise primary pulmonary tuberculosis exclusion approach that usually begins with a detailed tuberculosis-pertinent history acquisition.Given the geographic locations where the patient had been(and/or treated),pivotal consideration of tuberculosis-associated endemicities in those regions,like human immunodeficiency virus(HIV)infection,might have improved the case description.The obtainment of HIV-relevant histories,like intravenous drug use and sexual practice,are good places to start.The sputum bacteriology also seems imperative to rule out atypical Mycobacterium species infection because of its clinico-radiohistopathological resemblance with pulmonary Mycobacterium tuberculosis.Altogether,this editorial aims to underscore that primary extrapulmonary tuberculosis diagnosis should comprise an elaborative,comprehensive,systematic,and stepwise primary pulmonary Mycobacterium tuberculosis exclusion workup.

Similar causes of various reproductive disorders in early life

During the past few decades, scientific evidence has been accumulated concerning the possible adverse effects of the exposure to environmental chemicals on the well-being of wildlife and human populations. One large and growing group of such compounds of anthropogenic or natural origin is referred to as endocrine-disrupting chemicals （EDCs）, due to their deleterious action on the endocrine system. This concern was first focused on the control of reproductive function particularly in males, but has later been expanded to include all possible endocrine functions. The present review describes the underlying physiology behind the cascade of developmental events that occur during sexual differentiation of males and the specific role of androgen in the masculinization process and proper organogenesis of the external male genitalia. The impact of the genetic background, environmental exposures and lifestyle factors in the etiology of hypospadias, cryptorchidism and testicular cancer are reviewed and the possible role of EDCs in the development of these reproductive disorders is discussed critically. Finally, the possible direct and programming effects of exposures in utero to widely use therapeutic compounds, environmental estrogens and other chemicals on the incidence of reproductive abnormalities and poor semen quality in humans are also highlighted.

Minutes of the 5th Meeting of the International Networ for Young Researchers in Male Fertility

The International Network for Young Researchers in Male Fertility （INYRMF; http：//www.youngresearcher.eu） is committed to establish global networks among young （early stage） scientists in testicular research and to promote collaboration and exchange of methodologies and expertise. We provide a more informal way of commu- nication than many other congresses and meetings and promote online discussions on the homepage and during our annual meetings.

A crowd-sourced genomic project to assess hybrid content in a rare avian vagrant(Azure Tit Cyanistes cyanus(Pallas,1770))

The aim of this study was to correlate plumage variation with the amount of genomic hybrid content in hybrids between Azure Tits Cyanistes cyanus(Pallas,1770)and European Blue Tit Cyanistes caeruleus(Linnaeus,1758),by re-sequencing the genomes of museum specimens of non-hybrids and presumed hybrids with varying plumages.The project was funded by crowdsourcing and initiated when two presumed Azure Tits,observed by hundreds of Swedish birdwatchers,were rejected as hybrids based on minor plumage deviations assumed to indicate hybrid contents from the European Blue Tit.The results confirm that hybrids with intermediate plumages,so called Pleske’s Tits,are first generation hybrids(F1 hybrids).Individuals,whose plumages are similar to Azure Tits,but assessed as hybrids based on minor plumage deviations,are all backcrosses but vary in their degree of hybrid content.However,some individuals morphologically recognized as pure Azure Tits expressed similar degrees of hybrid content.The results indicate that:(1)hybrid content may be widespread in Azure Tits in the western part of its habitat distribution;(2)plumage deviation in backcrosses is not linearly correlated with the genetic degree of hybrid origin;and(3)all Azure Tits observed in Europe outside its natural distribution may have some degree of hybrid origin.We therefore suggest that it is very difficult to phenotypically single out hybrids beyond first generation backcrosses.We argue that decreased sequencing costs and improved analytical tools open the doors for museomic crowd-sourced projects that may not address outstanding biological questions but have a major interest for lay citizens such as birdwatchers.

Effects of Heliotropium indicum L.on Uterine Involution and Its Underlying Mechanisms:An in vivo and in vitro Study

Objective:To investigate the effect of Heliotropium indicum L.(H.indicum L.)on uterine involution and its underlying mechanisms in both in vivo and in vitro study.Methods:For in vivo studies,postpartum rats were randomly divided into 2 groups(n=24 for each):control group and treated group which were orally and daily administered with ethanolic extract of H.indicum L.(250 mg/kg body weight)until day 5 of postpartum.Uteri were collected for analysis of weight,cross-sectional area,collagen cross-sectional area,and collagen content on postpartum day 1,3,and 5(n=8 for each)from both groups.Blood samples were collected for hepatotoxicity and 17?-estradiol(E_(2))measurement.For in vitro studies,the extract effects on uterine contraction at half maximum effective concentration of 2.50 mg/mL were studied in organ bath system for at least 20 min.Results:Uterine parameters were significantly decreased after treated with extract of H.indicum L.(P<0.05).H.indicum L.extract significantly accelerated the reduction of those parameters and significantly decreased E_(2)(P<0.05).The extract facilitated uterine involution with no hepatotoxicity.H.indicum L.extract significantly stimulated uterine contraction(P<0.05)and synergized with oxytocin,prostaglandin and its precursor,linoleic acid.By investigating the different sequencing of the extract with the additional stimulants(added before or after),the two showed antagonistic effects,but still showed potentiated force when compared with control(without the stimulants).Conclusions:The underlying mechanisms by which H.indicum L.facilitated uterine involution might be due to reducing E_(2)which induces collagenase activity,leading to decreases in uterine weight and size and stimulating uterine contraction.Our study provides new findings for future drug development for facilitating uterine involution with H.indicum L.

两种参考值用于诊断妊娠期妇女甲状腺功能的比较研究

目的:比较正常孕妇早中晚孕期甲状腺激素参考值范围(阎氏标准)和普通成人参考值范围(成人标准)在妊娠妇女甲状腺功能诊断中的差异和可靠性。方法:选取不同妊娠期的孕妇共893例,以促甲状腺激素(TSH)和游离甲状腺素(FT4)为实验室诊断指标,分别采用阎氏和成人标准诊断,以符合率和Kappa值为标准评价指标。结果:妊娠早期妇女血清TSH水平低于中、晚期,而FT4高于中、晚期。阎氏标准和成人标准诊断孕妇亚临床甲状腺功能减退(亚甲减)的患病率分别为10.5%和7.5%,差异有统计学意义(P=0.026);诊断单纯低游离甲状腺素血症(低FT4血症)的患病率分别为2.6%和11.0%,差异有统计学意义(P<0.001)。采用2种标准在相邻2个妊娠期对同一孕妇进行诊断,结果表明阎氏标准诊断的一致性高于成人标准。结论:阎氏标准能减少因采用成人标准而造成的亚甲减孕妇的漏诊和低FT4血症的误诊,更符合妊娠期甲状腺激素生理变化规律,有较高的临床应用价值。

Morphological and microcirculatory evaluation of the rat testis after detorsion with or without a capsular release with a tunica vaginalis flap

Testicular torsion may lead to serious ischemia, and the viability depends on the duration of torsion and the effect of ischemia-reperfusion. Testicular decompression and tunica vaginalis flap application technique were introduced in 2008 by Kutikov et al. We aimed to examine the impact of this method on the testicular microcirculation and hemorheological parameters in a rat model. Six adult rats underwent bilateral scrotal exploration. Intravaginal torsion of the testis was created by 720° rotation on both sides for 2 h. After detorsion, the right testes underwent tunica albuginea incision and tunica vaginalis flap application. Testicular microcirculation was monitored and hematological parameters, erythrocyte deformability, and aggregation were determined. Measurements were performed before and after torsion, directly after detorsion, on the 1^st-2^nd and 8^th postoperative day. After the last sampling, testicles were removed to determine their volume for histological examinations. The microcirculatory parameters demonstrated slight differences between testicles. Apical zone of the left （nondecompressed） testicles had elevated compared to the middle zone （P 〈 0.05）. On the 2^nd and 8^th day, the microcirculation of the testes normalized but not equally. The erythrocyte aggregation and deformability decreased by the 8^th day. Both testicles underwent atrophy and epithelial necrosis, but the volume of the decompressed ones was lower （1.07±0.08 vs 1.25 ± 0.31）. Histologically, there was no significant difference in epithelial damage score between decompressed and nondecompressed testes. In conclusion, 2-h ischemia led to alteration in testicular microcirculation, reduction in volume, changes in hemorheological parameters and serious epithelial necrosis both in decompressed and nondecompressed testicles without remarkable differences.

Teenagers’Sexual Behavior in Sweden, Europe

Objective To investigate the development of sexuality from early to late adolescence, and to compare girls and boys of different ages Methods A cross sectional survey in all schools was performed covering all pupils between 13 and 18 years of age that were in school when the survey was conducted. A validated instrument, Q90, created for use in teenagers was distributed in the class- rooms to 3 216 teenagers. Q90 covers 30 questions about body development and sexual behavior. Non-response was insignificant （n=19; 0.6%）. Results Pubertal development was considered “early” or “late” by about 50% of both boys and girls. Eighty percent of the 13 to 15 years old boys and girls had had a romance and 30% had experience of sexual cuddling （petting）, while significantly more girls than boys had sexual intercourse （18% vs 13%; odds ratio 1.5, 95% CI 1.1-1.9）. The difference between girls and boys remained in those being 16-18 years old, where 63% of the girls and 53% of the boys （odds ratio 1.5, 95% CIJ.2-1.9） admitted having intercourse. Mean age at first intercourse was 14.9 and 15 years, respectively. At 16-18 years of age, 23% of the sexually active girls, as compared with 25% of the boys estimated that they had had 6 or more sexual partners. About 30% of the adolescents, irrespective of age and gender, did not use contraceptives at their first and latest intercourse. Eight percent of the older girls had been pregnant, and they had an increased history of sexually transmitted infections, as compared with the boys （6.2% vs 2.7%, odds ratio 2.4, 95% CI 1.2-5.0）. Conclusion Exploring sexuality and experimentation is a normal behavior in adolescence. The results of this study, however, indicate that there are substantial groups of teenagers who practice sexual risk-taking. In addition to general sexual education, programs should also be directed to define sexual risks and its consequences.

周围湿度对极早产儿皮肤屏障成熟度的影响

Objectives:To test the hypothesis that the level of relative humidity (RH) in which preterm infants are nursed might in-fluence their postnatal skin maturation. Study design:In 22 preterm infants (GA 23-27 weeks),transepidermal water loss(TEWL) was determined at postnatal ages (PNA) of 0,3,7,14,and 28 days. At a PNA of 7 days,the infants were randomized to care at either 50%or 75%RH. Results:TEWL decreased at a slower rate in infants nursed at the higher RH. At a PNA of 28 days,TEWL was about twice as high in infants nursed at 75%RH (22 ±2 g/m2 h) than in those nursed at 50%RH(13 ±1 g/m2 h; P < 0.001). Conclusions:The results indicate that the level of RH influences skin barrier development,with more rapid barrier formation in infants nursed at a lower RH.The findings have an impact on strategies for promoting skinbarrier integrity in extremely preterm infants.

扁桃体切除术后儿童行为和注意力的变化

The objective of this study was to quantify behavioral and attention capacity changes in children aged 4-11 y before and 3 mo after adenotonsillectomy (A/T). Overnight cardiorespiratory recordings were performed in 61 “behaviora-lly normal"children 1 wk before A/T. Tests of sustained attention using visual and auditory continuous performance tests (CPT) were completed by children 1 wk before and 3 mo after A/T. Behavioral Assessment Scales for Children (BASC) and a sleep questionnaire were completed by the parent/s at these same times. Results from overnight cardiorespiratory recordings showed that the children had mild sleep-related breathing disorders(SRBD) preoperatively with a mean apnea/hypopnea index of 3.0/h and a movement awakening index of 2.5/h.The majority had parent-perceived sleep and breathing difficulties that significantly improved post-A/T. BASC T scores for externalizing and internalizing behaviors improved post-A/T. e.g.,behavioral symptom index mean pre-A/T was 56.2(95%confidence interval,52.8-59.6) compared with 50.9 (48.5-53.5) post-A/T. Some measures indicative of impulsivity and attentiveness obtained from the visual CPT before surgery,improved post-A/T,but no change was observed in any auditory CPT measures. Our data confirm improvements in subjective measures of sleep problems in children treated for SRBD and strengthen the notion of treating the disorder,not only related to the obvious clinical condition but also to the underlying sleep problems and adverse effects on daytime behavior and attention.

The Survey of Birth Defects Rate Based on Birth Registration System

Background：To investigate the surveillance trend of birth defects,incidence,distribution,occurrence regularity,and their relevant factors in Xi＇an City in the last 10 years for proposing control measures.Methods：The birth defects monitoring data of infants during perinatal period （28 weeks of gestation to 7 days after birth） were collected from obstetrics departments of all hospitals during 2003-2012.Microsoft Excel 2003 was used for data input,and Statistical Package for the Social Sciences version 16.0 （International Business Machines Corporation,New York,NY,USA） was used for descriptive analysis.χ^2 test,Spearman correlation and linear-by-linear association trend test were used for statistical analyses.Results：The birth defect rate declined from 9.18% in 2003 to 7.00% in 2012 （χ^2 =45.001,P 〈 0.01） with a mean value of 7.85%,which is below the Chinese national average level （χ^2 =20.451,P 〈 0.01）.The order of five most common birth defects has changed.The incidence of congenital heart disease （CHD） increased with time,particularly after 2012,it became the most frequent type （rs =0.808,P 〈 0.001）.Till then,the number of neural tube defects （NTDs） declined significantly （χ^2 =76.254,P 〈 0.01）.The average birth defects rate of 8.11% in rural areas was higher than that in urban areas （7.56%,χ^2 =7.919,P 〈 0.01） and much higher in males （8.28%） than that in females （7.18%,χ^2 =32.397,P 〈 0.0 1）.Maternal age older than 35 years （χ^2 =35.298,P 〈 0.01） is the most dangerous age bracket of birth defects than maternal age younger than 20 years （χ^2 =7.128,P 〈 0.0l）.Conclusions：A downward trend of birth defects was observed in Xi＇an City from 2003 to 2012.NTDs significantly decreased after large-scale supplemental folic acid intervention,while the incidence rate of CHD significantly increased.

Childhood obesity in New Zealand

Background Paediatric obesity has reached epidemic proportions globally,resulting in significant adverse effects on health and wellbeing.Early life events,including those that happen before,during,and after pregnancy can predispose children to later obesity.The purpose of this review is to examine the magnitude of obesity among New Zealand children and adolescents,and to determine their underlying risk factors and associated comorbidities.Data sources PubMed,Web of Science,and Google Scholar searches were performed using the key terms 'obesity','overweight','children','adolescents',and 'New Zealand'.Results Obesity is a major public health concern in New Zealand,with more than 33% of children and adolescents aged 2-14 years being overweight or obese.Obesity disproportionately affects Māori (New Zealand's indigenous population) and Pacific children and adolescents,as well as those of lower socioeconomic status.New Zealand's obesity epidemic is associated with numerous health issues,including cardiometabolic,gastrointestinal,and psychological problems,which also disproportionately affect Māori and Pacific children and adolescents.Notably,a number of factors may be useful to identify those at increased risk (such as demographic and anthropometric characteristics) and inform possible interventions.Conclusions The prevalence of overweight and obese children and adolescents in New Zealand is markedly high,with a greater impact on particular ethnicities and those of lower socioeconomic status.Alleviating the current burden of pediatric obesity should be a key priority for New Zealand,for the benefit of both current and subsequent generations.Future strategies should focus on obesity prevention,particularly starting at a young age and targeting those at greatest risk.

Evaluation of Hysteroscopic-guided Removal of Intrauterine Device in Shanghai: A Report of Four Dead Cases

Objective To analyze the possible cause leading to death during the procecture oy IUD removal under hysteroscopy and how it could be prevented. Methods All （11 110） cases of IUD removal under hysteroscopy performed at 87 hospitals in Shanghai from 2001 to 2007 were reviewed. Four dead cases were reported. Results Air embolism was suspected as the cause of death. Associated risk factors included insufficient preoperative preparation, short duration between surgeries, non-standard procedure, careless observation and untimely resuscitation. Conclusion This emphasizes the necessity of early interventions taken such as prevention, early detection and management of the fatal complications.

妊娠期妇女亚甲状腺功能减退症的10年后结局观察

目的探讨和分析妊娠期亚临床甲状腺功能减退症(SCH)的妇女在10年后甲状腺功能的结局。方法对241例妊娠期妇女进行前瞻性随访,随访时间为产后10年,以促甲状腺激素(TSH)、游离甲状腺激素(FT4)和抗甲状腺过氧化物酶抗体(TPOAb)为实验室诊断指标,分别采用阎氏妊娠期特异参考值范围和成人实验室标准诊断。结果妊娠期和10年后随访妇女的SCH患病率分别为18.3%和10.4%(P<0.05)。妊娠期SCH妇女中,10年后有36.4%仍为SCH。妊娠期甲状腺功能正常的妇女中,10年后有4.6%发展为SCH,1.5%发展为甲减,TPOAb阳性占比分别为22.2%和66.7%。对比10年后甲功诊断,阎氏标准的准确度、灵敏度、特异度、假阳性率分别为84.2%、60.0%、87.7%、12.3%。Kappa值为0.38(P<0.05)。10年后随访妇女与妊娠早、中、晚期妇女的TSH和FT4均存在相关性(P<0.05)。结论妊娠期SCH妇女在10年后仍有很大比例存在SCH,TPOAb阳性可能是产后甲功减退的危险因素,采用妊娠期参考值可能会提高诊断的准确度,建议妊娠期SCH妇女产后复查。

Acute infectious osteomyelitis in children: new treatment strategies for an old enemy

Background Acute osteomyelitis still represents a significant clinical challenge,with an increasing incidence in paediatric population.A careful assessment and a rapid diagnosis with proper timing and choice of empirical antimicrobial therapy are necessary to avoid sequelae.The initial treatment should consist of empirical antibiotic therapy,to cover the major responsible pathogens in each age group.Data sources We made a literature search with PubMed and Cochrane database from 2000 to 2019 in English,French,and Spanish languages using the key words"osteomyelitis,children,clinical,diagnosis,and treatment".Results The child's clinical features,age,and the microbiological profile of the geographic area should be evaluated for diagnosis and in the choice of antibiotic treatment.Latest data suggest the administration of intravenous antibiotics for a short period,with subsequent oral therapy,according to the improvement of clinical status and inflammatory markers.For children older than 3 months,the shift to oral medications is already possible after a short course of intravenous therapy,until recovery.The timing for the shift from cefazolin to cephalexin or cefuroxime,intravenous clindamycin to oral clindamycin,and intravenous ceftriaxone+oxacillin to oral equivalents will be decided according to the improvement of clinical status and inflammatory markers.We also present the approach to osteomyelitis due to difficult pathogens,such as Methicillin-resistant Staphylococcus aureus(MRSA)and Panton-Valentine leukocidin(PVL)-positive S.aureus infections.Conclusion In this review,we present the current approach to the clinical diagnosis and management of osteomyelitis in childhood,with an update on recent recommendations,as a useful instrument to understand the rationale of antibiotic therapy.