COVID-19 infection in children with acute lymphoblastic leukemia in China:Mild clinical course after Omicron infection

To the Editor:Since December 2019,the coronavirus pandemic has been the deadliest disaster with over 6.5 million people confirmed to have died in less than 3 years.[1]The coronavirus disease 2019(COVID-19)has created the biggest global crisis in generations.Children are less likely to develop severe illness than adults,but children with cancer are more likely to develop a serious clinical course and even die after the infection.[2,3]Since early 2022,the Omicron variant has become the main variant of SARS-CoV-2 across the globe.In the first three years of the pandemic when China has taken very strict infection control measures.

Robotic surgery in living liver donors and liver recipients

There have been nearly 60 years since Thomas Starzl’s first liver transplant.During this period,advancements in medical technology have progressively enabled the adoption of new methods for transplantation.Among these innovations,robotic surgery has emerged in recent decades and is gradually being integrated into transplant medicine.Robotic hepatectomy and liver implantation represent significant advancements in the field of transplant surgery.The precision and minimally invasive nature of robotic surgery offer substantial benefits for both living donors and recipients.In living donors,robotic hepatectomy reduces postoperative pain,minimizes scarring,and accelerates recovery.For liver recipients,robotic liver implantation enhances surgical accuracy,leading to better graft positioning and vascular anastomosis.Robotic systems provide more precise and maneuverable control of instruments,allowing surgeons to perform complex procedures with greater accuracy and reduced risk to patients.This review encompasses publications on minimally invasive donor liver surgery,with a specific focus on robotic liver resection in transplantation,and aims to summarize current knowledge and the development status of robotic surgery in liver transplantation,focusing on liver resection in donors and graft implantation in recipients.

Impacts of Nutlin-3a and exercise on murine double minute 2-enriched glioma treatment

Recent research has demonstrated the impact of physical activity on the prognosis of glioma patients,with evidence suggesting exercise may reduce mortality risks and aid neural regeneration.The role of the small ubiquitin-like modifier(SUMO)protein,especially post-exercise,in cancer progression,is gaining attention,as are the potential anti-cancer effects of SUMOylation.We used machine learning to create the exercise and SUMO-related gene signature(ESLRS).This signature shows how physical activity might help improve the outlook for low-grade glioma and other cancers.We demonstrated the prognostic and immunotherapeutic significance of ESLRS markers,specifically highlighting how murine double minute 2(MDM2),a component of the ESLRS,can be targeted by nutlin-3.This underscores the intricate relationship between natural compounds such as nutlin-3 and immune regulation.Using comprehensive CRISPR screening,we validated the effects of specific ESLRS genes on low-grade glioma progression.We also revealed insights into the effectiveness of Nutlin-3a as a potent MDM2 inhibitor through molecular docking and dynamic simulation.Nutlin-3a inhibited glioma cell proliferation and activated the p53 pathway.Its efficacy decreased with MDM2 overexpression,and this was reversed by Nutlin-3a or exercise.Experiments using a low-grade glioma mouse model highlighted the effect of physical activity on oxidative stress and molecular pathway regulation.Notably,both physical exercise and Nutlin-3a administration improved physical function in mice bearing tumors derived from MDM2-overexpressing cells.These results suggest the potential for Nutlin-3a,an MDM2 inhibitor,with physical exercise as a therapeutic approach for glioma management.Our research also supports the use of natural products for therapy and sheds light on the interaction of exercise,natural products,and immune regulation in cancer treatment.

Protective eff ect and mechanism of nanoantimicrobial peptide ND-C14 against Streptococcus pneumoniae infection

BACKGROUND:Streptococcus pneumoniae(S.pneumoniae)is a common pathogen that causes bacterial pneumonia.However,with increasing bacterial resistance,there is an urgent need to develop new drugs to treat S.pneumoniae infections.Nanodefensin with a 14-carbon saturated fatty acid(ND-C14)is a novel nanoantimicrobial peptide designed by modifying myristic acid at the C-terminus of humanα-defensin 5(HD5)via an amide bond.However,it is unclear whether ND-C14 is effective against lung infections caused by S.pneumoniae.METHODS:In vitro,three groups were established,including the control group,and the HD5 and ND-C14 treatment groups.A virtual colony-count assay was used to evaluate the antibacterial activity of HD5 and ND-C14 against S.pneumoniae.The morphological changes of S.pneumoniae treated with HD5 or ND-C14 were observed by scanning electron microscopy.In vivo,mice were divided into sham,vehicle,and ND-C14 treatment groups.Mice in the sham group were treated with 25μL of phosphate-buffered saline(PBS).Mice in the vehicle and ND-C14 treatment groups were treated with intratracheal instillation of 25μL of bacterial suspension with 2×108 CFU/mL(total bacterial count:5×10^(6) CFU),and then the mice were given 25μL PBS or intratracheally injected with 25μL of ND-C14(including 20μg or 50μg),respectively.Survival rates were evaluated in the vehicle and ND-C14 treatment groups.Bacterial burden in the blood and bronchoalveolar lavage fluid were counted.The lung histology of the mice was assessed.A propidium iodide uptake assay was used to clarify the destructive eff ect of ND-C14 against S.pneumoniae.RESULTS:Compared with HD5,ND-C14 had a better bactericidal eff ect against S.pneumoniae because of its stronger ability to destroy the membrane structure of S.pneumoniae in vitro.In vivo,ND-C14 significantly delayed the death time and improved the survival rate of mice infected with S.pneumoniae.ND-C14 reduced bacterial burden and lung tissue injury.Moreover,ND-C14 had a membrane permeation eff ect on S.pneumoniae,and its destructive ability increased with increasing ND-C14 concentration.CONCLUSION:The ND-C14 may improve bactericidal eff ects on S.pneumoniae both in vitro and in vivo.

Association of β-cell function and insulin resistance with pediatric type 2 diabetes among Chinese children

BACKGROUND In addition to insulin resistance,impaired insulin secretion has recently been identified as a crucial factor in the pathogenesis of type 2 diabetes mellitus(T2DM).Scarce clinical data exist for pediatric T2DM.AIM To investigate the association ofβ-cell function and insulin resistance with pediatric T2DM in the first Chinese multicenter study.METHODS This multicenter cross-sectional study included 161 newly diagnosed T2DM children and adolescents between January 2017 and October 2019.Children with normal glycemic levels(n=1935)were included as healthy control subjects.The homeostasis models(HOMAs)were used to assess theβ-cell function(HOMA2-%B)and insulin resistance(HOMA2-IR)levels.The HOMA index was standardized by sex and age.We performed logistic regression analysis to obtain odds ratios(ORs)for T2DM risk using the standardized HOMA index,adjusted for confounding factors including sex,Tanner stage,T2DM family history,body mass index z-score,and lipid profile.RESULTS The male-female ratio of newly diagnosed T2DM patients was 1.37:1(OR=2.20,P=0.011),and the mean ages of onset for boys and girls were 12.5±1.9 years and 12.3±1.7 years,respectively.The prevalence of related comorbidities including obesity,elevated blood pressure,and dyslipidemia was 58.2%,53.2%,and 80.0%,respectively.The T2DM group had lower HOMA2-%B levels(P<0.001)and higher HOMA2-IR levels(P<0.001)than the control group.Both the decrease in HOMA2-%B z-score(OR=8.40,95%CI:6.40-11.02,P<0.001)and the increase in HOMA2-IR z-score(OR=1.79,95%CI:1.60-2.02,P<0.001)were associated with a higher risk of T2DM,and the decrease in HOMA2-%B z-score always had higher ORs than the increase in HOMA2-IR z-score after adjusting for confounding factors.CONCLUSION Besides insulin resistance,β-cell function impairment is also strongly associated with Chinese pediatric T2DM.Gender difference in susceptibility and high comorbidities warrant specific T2DM screening and prevention strategies in Chinese children.

Continuous age-and sex-specific reference ranges of liver enzymes in Chinese children and application in pediatric non-alcoholic fatty liver disease

Background Alanine aminotransferase(ALT)is widely used to screen patients with hepatic diseases.However,the current reference ranges(<50 U/L)were developed by laboratories and have not been validated in populations with a large number of healthy individuals.Methods This study collected venous blood and anthropometric data from a total of 13,287 healthy children aged 3 months to 18 years who underwent routine physical examinations in the Department of Pediatric Healthcare.We applied the least mean square algorithm to establish age-and sex-related reference percentiles of serum levels of transaminases.For validation,we recruited 4276 children and adolescents with obesity/overweight who underwent evaluation and metabolic tests in the hospital.Using receiver operating characteristic curves,we determined age-and sex-specific upper limit percentiles of liver enzymes for fatty liver diseases.Results This study revealed a significant correlation between serum transaminase levels and age and sex(P<0.01).These transaminase levels exhibited age-and sex-specific patterns.Among individuals in the non-alcoholic fatty liver disease(NAFLD)cohort,elevated ALT levels displayed a positive association with clinical markers of disease severity,including homeostatic model assessment of insulin resistance,waist-hip ratio,and serum uric acid levels(P<0.01).According to the receiver operating characteristic curves,ALT levels at the 92.58th percentile for boys and the 92.07th percentile for girls yielded the highest accuracy and specificity.Conclusions This study provides age-and sex-specific reference ranges for ALT,aspartate aminotransferase,andγ-glutamyltransferase in Chinese children and adolescents,making it the largest population study to date.Furthermore,the study establishes a precise upper limit for ALT levels,facilitating their use in NAFLD screening.

Development and validation of a novel non-invasive test for diagnosing nonalcoholic fatty liver disease in Chinese children

With the exploding prevalence of obesity,many children are at risk of developing nonalcoholic fatty liver disease.Using anthropometric and laboratory parameters,our study aimed to develop a model to quantitatively evaluate liver fat content(LFC)in children with obesity.Methods A well-characterized cohort of 181 children between 5 and 16 years of age were recruited to the study in the Endocrinology Department as the derivation cohort.The external validation cohort comprised 77 children.The assessment of liver fat content was performed using proton magnetic resonance spectroscopy.Anthropometry and laboratory metrics were measured in all subjects.B-ultrasound examination was carried out in the external validation cohort.The Kruskal-Wallis test,Spearman bivariate correlation analyses,univariable linear regressions and multivariable linear regression were used to build the optimal predictive model.Results The model was based on indicators including alanine aminotransferase,homeostasis model assessment of insulin resistance,triglycerides,waist circumference and Tanner stage.The adjusted R^(2)of the model was 0.589,which presented high sensitivity and specificity both in internal[sensitivity of 0.824,specificity of 0.900,area under curve(AUC)of 0.900 with a 95%confidence interval:0.783–1.000]and external validation(sensitivity of 0.918 and specificity of 0.821,AUC of 0.901 with a 95%confidence interval:0.818–0.984).Conclusions Our model based on five clinical indicators was simple,non-invasive,and inexpensive;it had high sensitivity and specificity in predicting LFC in children.Thus,it may be useful for identifying children with obesity who are at risk for developing nonalcoholic fatty liver disease.

Higher ambient temperatures may worsen obstructive sleep apnea:A nationwide smartwatch-based analysis of 6.2 million person-days

Obstructive sleep apnea(OSA)is a serious type of sleep disorder that can lead to cardiometabolic and neurocognitive diseases.We utilized smart device-based photoplethysmography technology to collect sleep data from the Chinese population from 2019 to 2022.Distributed lag nonlinear models combined with a generalized nonlinear model or a linear mixed effects model were used to investigate the shortterm associations between daily temperature and indicators of OSA severity.We included a total of 6,232,056 d of sleep monitoring data from 51,842 participants with moderate to severe risk of OSA from 313 Chinese cities.The relationships between ambient temperature and OSA exacerbation,apneahypopnea index(AHI),and minimum oxygen saturation(MinSpO_(2))were almost linear and present only on the same day.Higher temperatures were associated with a greater risk of OSA exacerbation,with an 8.4%(95%confidence interval(CI):7.6%–9.3%)increase per 10℃increase in temperature.A 10℃increase in daily temperature corresponded to an AHI increase of 0.70 events/h(95%CI:0.65–0.76)and a MinSpO_(2)decrease of 0.18%(95%CI:0.16%–0.19%).Exposure to elevated temperatures during the night can also lead to adverse effects.The effects of higher temperatures on OSA severity were stronger among men,participants with a body mass index24 kg/m2,those aged 45 years and older,individuals with a history of hypertension and diabetes,and during the cold season.This large-scale,nationwide,longitudinal study provides robust evidence suggesting that higher ambient temperatures may immediately worsen OSA.

Efficacy of physiological seawater nasal irrigation for the treatment of children with SARS-CoV-2 Omicron BA.2 variant infection:a randomized controlled trial

Background Saline nasal irrigation is an effective therapy for relieving common cold symptoms.This study aimed to investigate and explore the efficacy of physiological seawater nasal irrigation(PSNI)on children with mild and asymptomatic infection with Omicron.Methods This randomized controlled trial was conducted in Shanghai,China,and 403 children with mild and asymptomatic infection with Omicron were included.These children were allocated into the PSNI group and the control group.The primary outcome was the duration of viral shedding(DVS),and the secondary outcome was the change in clinical symptoms.Results The median age of all participants was 5.59(6.26)years old.The DVS was significantly shorter in the PSNI group[2.40(1.13)]than in the control group[3.09(2.14)](P=0.014).The multivariable Cox regression model also showed that patients in the PSNI group had an increased probability of shorter DVS compared with patients in the control group[hazard ratio(HR),1.27;95%confidence interval(CI),1.04–1.55;P=0.017].Subgroup analysis suggested that the DVS of patients without full vaccination was significantly reduced in the PSNI group.The proportions of runny nose and stuffy nose were apparently reduced in the first three days in the PSNI group or the control group,but there was no evidence showing that PSNI contributes to the benefit compared with the control group.Conclusion PSNI can reduce the DVS of patients with mild and asymptomatic infection with SARS-CoV-2 Omicron BA.2 variant.

Thoracoabdominal duplication with hematochezia as an onset symptom in a baby:A case report

BACKGROUND Alimentary tract duplication is a rare congenital disease that may occur in any part of the alimentary tract,whereas thoracoabdominal duplications only account for approximately 2%of all alimentary tract duplication cases.Many symptoms,including abdominal pain,abdominal distension,vomiting,gastrointestinal bleeding,chest discomfort,chest pain,and shortness of breath,may be present in patients with abdominal or thoracic duplication.CASE SUMMARY A 10-mo-old infant,with a free previous medical history,was admitted to our hospital with melena three times in 6 d.Enhanced magnetic resonance imaging of the thoracic vertebrae revealed multiple cervicothoracic vertebral deformities,spina bifida,meningomyelocele towards the posterior mediastinum,and possible concurrent infection.Upper gastroenterography indicated intestinal malrotation.A laparoscopic abdominal examination was performed,and the operation was intraoperatively converted to laparotomy.This case was diagnosed intraoperatively as thoracoabdominal intestinal duplication.The intestinal duplications in the abdomen and large part of the thorax were excised.The results of postoperative pathological examination confirmed that this case was alimentary tract duplication and that part of the duplication contained gastric mucosa.The infant recovered well and was discharged 1 wk after the surgery.A follow-up computed tomography scan 3 mo after operation showed myelomeningocele while the posterior mediastinal cyst was significantly reduced.CONCLUSION Thoracoabdominal duplication should be considered if a child has suspected abdominal intestinal duplication with hematochezia as an onset symptom.

Trends of obesity and overweight among children and adolescentsin China

Background Recent decades have shown a rapid increase in the prevalence of overweight and obesity among Chinese children based on several national surveys.Restrictions due to the coronavirus disease 2019 outbreak have worsened its epidemiol-ogy.This review updates the trends in the prevalence of overweight and obesity among Chinese children and adolescents and analyzes the underlying reasons to provide evidence for better policy making.Methods Studies published in English and Chinese were retrieved from PubMed,Google Scholar,China National Knowl-edge Infrastructure andWanfang.Results The prevalence of overweight and obesity has been increasing for decades and varies with age,sex and geography but is more pronounced in primary school students.The increase in obesity in boys appeared to be slower,whereas that in girls showed a declining trend.The northern areas of China have persistently maintained the highest levels of obesity with a stable trend in recent years.Meanwhile,the prevalence in eastern regions has dramatically increased.Notably,the overall prevalence of obesity in children has shown a stabilizing trend in recent years.However,the occurrence of obesity-related metabolic diseases increased.The effect of migrants floating into east-coast cities should not be neglected.Conclusions The high prevalence of overweight and obesity among Chinese children and adolescents persists but with vary-ing patterns.Obesity-related metabolic diseases occur more frequently despite a stable trend of obesity.Multiple factors are responsible for the changing prevalence.Thus,comprehensive and flexible policies are needed to effectively manage and prevent the burden of obesity and its related complications.

Prevalence and factors associated with pentavalent vaccination:a cross-sectional study in Southern China

Background Immunization is one of the most far-reaching and cost-effective strategies for promoting good health and saving lives.A complex immunization schedule,however,may be burdensome to parents and lead to reduced vaccine compliance and completion.Thus,it is critical to develop combination vaccines to reduce the number of injections and simplify the immunization schedule.This study aimed to investigate the current status of the pentavalent diphtheria-tetanus-acellular pertussis inactivated poliomyelitis andHaemophilus influenzae type B conjugate(DTaP-IPV/Hib)vaccination in Southern China as well as explore the factors in the general population associated with uptake and the differences between urban and rural populations.Methods A cross-sectional study was conducted with recently enrolled kindergarten students in Hainan Province between December 2022 and January 2023.The study employed a stratified multistage cluster random sampling method.Information regarding the demographic characteristics and factors that influence decisions were collected from the caregivers of children via an online questionnaire.Multivariate logistic regression was used to determine the factors associated with the status of DTap-IPV/Hib vaccinations.Results Of the 4818 valid responses,95.3%of children were aged 3-4 years,and 2856(59.3%)held ruralhukou.Coverage rates of the DTaP-IPV/Hib vaccine,from 1 to 4 doses,were 24.4%,20.7%,18.5%,and 16.0%,respectively.Caregivers who are concerned about vaccine efficacy[adjusted odds ratio(aOR)=1.53,95%confidence interval(CI):1.30-1.79],the manufacturer(aOR=2.05,95%CI:1.69-2.49),and a simple immunization schedule(aOR=1.26,95%CI:1.04-1.54)are factors associated with a higher likelihood of vaccinating children against DTaP-IPV/Hib.In addition,caregivers in urban areas showed more concern about the vaccine price(P=0.010)and immunization schedule(P=0.022)in regard to vaccinating children.Conclusions The DTaP-IPV/Hib vaccine coverage rate in Hainan Province remains low.Factors such as lower socioeconomic status,cultural beliefs,concerns about vaccine safety,and cost may hinder caregivers from vaccinating their children.Further measures,such as health education campaigns to raise knowledge and awareness,and encouragement of domestic vaccine innovation,which would reduce out-of-pocket costs,could be implemented to improve the coverage of DTap-IPV/Hib vaccination.

贝叶斯推理和动态神经反馈促进先天性心脏病智能诊断的临床应用

先天性心脏病(CHD)是婴幼儿死亡主要原因。基于人工智能的先天性心脏病诊断网络(CHDNet)是一种基于超声心动图视频的二分类模型,用于判别超声心动图视频是否包含心脏缺陷。现有的CHDNet模型表现出与医学专家相当甚至更好的判别性能,但它们在训练集之外的样本上的不可靠性已成为模型部署的关键瓶颈。而这是当前大多数基于AI诊断方法的共性问题。为了克服这一挑战,本文我们提出了两种基本机制——贝叶斯推理和动态神经反馈——分别用于衡量和提高人工智能诊断的可靠性。贝叶斯推理允许神经网络模型输出CHD判别的可靠性而不仅仅是单一的判别结果,而动态神经反馈是一个计算神经反馈单元,允许神经网络将知识从输出层反馈给浅层,使神经网络有选择地激活相关神经元。为了评估这两种机制的有效性,我们在包含三种常见CHD缺陷的4151个超声心动图视频上训练了CHDNet,并在1037个超声心动图视频的内部测试集和从其他心血管成像设备新收集的692个外部视频集上对其进行了测试。每个超声心动图视频对应于一位患者和一次就诊。我们在多种代表性神经网络架构上展示了贝叶斯推理获得的可靠性如何解释和量化神经网络内部与外部测试集之间的性能显著差异,以及尽管输入被噪声破坏或使用外部测试集时,设计的反馈单元如何帮助神经网络保持高精度和可靠性。

Early recombinant human growth hormone treatment improves mental development and alleviates deterioration of motor function in infants and young children with Prader–Willi syndrome

Background Recombinant human growth hormone(rhGH)therapy has shown to improve height and body composition in children with Prader–Willi syndrome(PWS),the evidence of early rhGH treatment on motor and mental development is still accumulating.This study explored the time effect on psychomotor development,anthropometric indexes,and safety for infants and young children with PWS.Methods A phase 3,single-arm,multicenter,self-controlled study was conducted in six sites.Patients received rhGH at 0.5 mg/m2/day for first four weeks,and 1 mg/m2/day thereafter for up to 52 weeks.Motor development was measured using Peabody Developmental Motor Scales-second edition,mental development using Griffiths Development Scales-Chinese(GDS-C).Height standard deviation score(SDS),body weight SDS,and body mass index(BMI)SDS were also assessed.Results Thirty-five patients were enrolled totally.Significant improvements were observed in height,body weight,and BMI SDS at week 52;GDS-C score showed significant improvement in general quotient(GQ)and sub-quotients.In a linear regression analysis,total motor quotient(TMQ),gross motor quotient(GMQ),and fine motor quotient were negatively correlated with age;however,treatment may attenuate deterioration of TMQ and GMQ.Changes in GQ and locomotor sub-quotient in<9-month group were significantly higher than≥9-month group.Mild to moderate severity adverse drug reactions were reported in six patients.Conclusion Fifty-two-week treatment with rhGH improved growth,BMI,mental development,and lessened the deterioration of motor function in infants and young children with PWS.Improved mental development was more pronounced when instituted in patients<9 months old.

Analysis and prediction of research hotspots and trends in pediatric medicine from 2,580,642 studies published between 1940 and 2021

From 1990 to 2019,there has been a substantial increase in the global population from 5.3 billion to 7.7 billion(about 44.6%)[1,2].Simultaneously,the global death population among people under 20 years of age has increased from 6.22 million to 13.93 million,accounting for an increase of 124%[1,2,3].This means that the mortality rate of children/adolescents is almost three times higher than the growth rate of the global population.

High expression of GPR160 in prostate cancer is unrelated to CARTp-mediated signaling pathways

To the Editor:G protein-coupled receptors(GPCRs)are the largest group of membrane proteins with over 800 members,characteristic of a seven transmembrane domain1.By playing crucial roles in regulation of various physiological processes,GPCRs have been implicated in many diseases including diabetes,obesity,depression and cancer.To initiate different intracellular responses,GPCRs mainly interact with three families of effector proteins upon agonist binding:the heterotrimeric G proteins,G protein-coupled receptor kinases(GRKs)and arrestins1.

The New Era for Respiratory Syncytial Virus Prevention for Infants in China:A Pediatricians’Perspective

This year marks a new era for respiratory syncytial virus(RSV)prevention for infants in China,as it is the first time since the detection of RSV that we have an option,namely,the long-acting monoclonal antibody nirsevimab,to prevent the infection and associated disease burden.We highly support the recent Chinese expert consensus that recommends nirsevimab as a new strategy for preventing RSV infections among infants born before or during their first RSV season,whether or not they have risk conditions putting them at higher risk of severe RSV disease.

Responsible genes in children with primary vesicoureteral reflux: findings from the Chinese Children Genetic Kidney Disease Database

Background Primary vesicoureteral reflux(VUR)is a common congenital anomaly of the kidney and urinary tract(CAKUT)in childhood.The present study identified the possible genetic contributions to primary VUR in children.Methods Patients with primary VUR were enrolled and analysed based on a national multi-center registration network(Chinese Children Genetic Kidney Disease Database,CCGKDD)that covered 23 different provinces/regions in China from 2014 to 2019.Genetic causes were sought using whole-exome sequencing(WES)or targeted-exome sequencing.Results A total of 379 unrelated patients(male:female 219:160)with primary VUR were recruited.Sixty-four(16.9%)children had extrarenal manifestations,and 165(43.5%)patients showed the coexistence of other CAKUT phenotypes.Eighty-eight patient(23.2%)exhibited impaired renal function at their last visit,and 18 of them(20.5%)developed ESRD at the median age of 7.0(IQR 0.9–11.4)years.A monogenic cause was identified in 28 patients(7.39%).These genes included PAX2(n=4),TNXB(n=3),GATA3(n=3),SLIT2(n=3),ROBO2(n=2),TBX18(n=2),and the other 11 genes(one gene for each patient).There was a significant difference in the rate of gene mutations between patients with or without extrarenal complications(14.1%vs.6%,P=0.035).The frequency of genetic abnormality was not statistically significant based on the coexistence of another CAKUT(9.6%vs.5.6%,P=0.139,Chi-square test)and the grade of reflux(9.4%vs.6.7%,P=0.429).Kaplan–Meier survival curve showed that the presence of genetic mutations did affect renal survival(Log-rank test,P=0.01).PAX2 mutation carriers(HR 5.1,95%CI 1.3–20.0;P=0.02)and TNXB mutation carriers(HR 20.3,95%CI 2.4–168.7;P=0.01)were associated with increased risk of progression to ESRD.Conclusions PAX2,TNXB,GATA3 and SLIT2 were the main underlying monogenic causes and accounted for up to 46.4%of monogenic VUR.Extrarenal complications and renal function were significantly related to the findings of genetic factors in children with primary VUR.Like other types of CAKUT,several genes may be responsible for isolated VUR.

Coronavirus disease 2019 vaccine for children in China:when to start?Mandatory or voluntary?

To the Editor:As the coronavirus disease 2019(COVID-19)pandemic continues to expand in many countries,and the more transmissible variants emerged,the second wave could be more severe and result in a greater peak of infection and mortality.There is an urgent need to develop effective vaccines,which remains a critical tool to control the pandemic.Vaccination is equally important in areas where outbreaks persist and in well-controlled countries.

Management of foreign bodies ingestion in children

Foreign bodies(FBs)ingestion in children is one of the common presentations to the emergency department.The majority of FBs ingestion occurs in children younger than 3 years,with males showing a slight predominance[1].Although most FBs pass through the gastrointestinal tract spontaneously,some FBs need urgent medical intervention and even surgical management owing to the complications of obstruction or perforation and a potential risk to children’s health[2].Therefore,timely diagnosis and rational treatment are crucial for reducing FBs complications.However,optimal indications and/or timing of surgery remain controversial.In this study,we discussed the characteristics of FBs ingestion in children and summarized our experience in its management.